, Ac4412(1)Bromley Bro.44 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1948 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES Printed by Bromley Office Supplies & Printing Co. Ltd. 46 East Street, Bromley, Kent 68006 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1948 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES 3 CONTENTS. Page Members of the Health Committee 7 Staff 7 Prefatory Letter 9 Section A. Vital and Other Statistics and Social Conditions. Vital Statistics 14 Population 15 Births 15 Premature Births 16 Stillbirths 16 Infantile Mortality 17 Maternal Mortality 17 Deaths 17 Unemployment 18 Meteorological Conditions 19 Open Air Recreational Amenities 19 Section B. General Provision of Health Services for the Area. Ambulance Service 22 Laboratory Services 22 Supply of Insulin 22 Nursing in the Home 22 Old People's Homes 23 Clinics and Welfare Centres 26 Domestic Help Scheme 30 Hospitals 30 Nursing Homes 31 Section C. Maternity and Child Welfare. Municipal Midwifery Scheme 34 Ante-Natal Clinic 34 Administration of Midwives Acts, 1902-1936 35 Home Helps Scheme 35 Dental Treatment (Expectant and Nursing Mothers) 35 Care of Premature Infants 36 Puerperal Pyrexia 36 Ophthalmia Neonatorum 36 Pemphigus Neonatorum 36 Welfare Centres 36 Clinic Treatment of Children under 5 years 37 Home Visiting by Health Visitors 37 Child Life Protection 37 Adoption of Children 38 Care of Illegitimate Children 38 Day Nurseries 38 4 Section D. Sanitary Circumstances of the Area. Page Water 40 Drainage and Sewerage 41 Cesspools 41 Rivers, Streams and Lakes 41 Swimming Baths and Pools 41 Public Cleansing and Refuse Collection . 42 Sanitary Inspection of the Area 42 Factories Act, 1937 43 Shops Acts, 1912-1936 43 Smoke Abatement . 43 Verminous Conditions and Uncleanliness 43 Rodent Control . 44 Section E. Housing. Housing Inspections 46 Rehousing 46 Section F. Inspection and Supervision of Foods. Food Sampling. Food and Drugs Act. 1938 . 50 Bacteriological Examinations 51 Special Enquiries 53 Slaughterhouses . 53 Inspection of Food Premises 54 Milk (Special Designations) Regulations, 1936-46 . 54 Unsound Meat and Other Foods 34 Section G Prevalence of, and Control Over, Infectious and Other Diseases. Scarlet Fever 58 Diphtheria 58 Diphtheria Immunisation 58 Poliomyelitis and Polioencephalitis 58 Typhoid Fever 58 Puerperal Pyrexia 60 Ophthalmia Neonatorum 60 Pemphigus Neonatorum 60 Measles 60 Whooping Cough 60 Tuberculosis 60 Public Health (Prevention of Tuberculosis) Regulations, 1925 61 Public Health Act. 1936. Section 172 61 Food Poisoning 61 Other Infectious Diseases 61 Section H Other Services Supervised by the Health Department. Diseases of Animals Acts 64 Registries for Female Domestic Servants 64 Petroleum Acts 64 Retail Market 64 5 APPENDIX—STATISTICAL TABLES. Vital and General Statistics. Page Table I.—Summary of Statistics 67 „ II.—Causes of Death 68 ” III.—Infant Mortality—Causes and Age Groups 69 ” IV.—Infant Mortality—Analyses of Causes, 1944-1948 70 Maternity and Child Welfare. Table V.—Health Visiting 71 Housing and Sanitary Inspection. Table VI.—Housing Statistics 72 „ VII.—Summary of the Work of the Sanitary Inspectors 73 „ VIII.—Nuisances, Defects and Contraventions Abated 76 „ IX.—Factories Act, 1937 79 Notifiable Diseases. Table X.—Ward Distribution, Attack and Mortality Rates 80 XI.—Age and Sex Grouping 81 „ XII.—Tuberculosis—New Cases and Mortality 82 SCHOOL HEALTH SERVICE, 1948 Members of the Welfare Committee 84 Officers of the Committee 84 Staff 85 Introduction 35 General Information 87 School Hygiene 87 Medical Inspection at Schools 88 Special Inspections 88 Dental Inspection 89 Vermin and Uncleanliness Inspection 89 Treatment 90 Orthopaedic Clinic 90 Ophthalmic Clinic 91 Orthoptic Clinic 92 Ear, Nose and Throat Clinic 92 Speech Clinic 93 Exceptional and Handicapped Children 93 Child Guidance 93 Milk in Schools 93 School Meals Service 94 Nursery Schools 94 Employment of Children and Young Persons 94 Juvenile Delinquency 94 Physical Training 95 Boot Club 103 Infectious Diseases in Schools 103 Acknowledgements 104 6 STATISTICAL TABLES. Page Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 106 ” II.—Return of Defects found by Medical Inspection 107 „ III.—Group I. Minor Ailments 108 Group II. Defective Vision and Squint 108 Group III. Treatment of Defects of Nose and Throat 108 Group IV. Orthopaedic and Postural Defects 109 Group V. Child Guidance and Speech Therapy 109 „ IV.—A. Dental Inspection and Treatment 109 B. Orthodontic Clinic 110 „ V. —Infestation with Vermin 110 „ VI.—Orthoptic Clinic 110 „ VII.—Speech Clinic 110 „ VIII.—Handicapped Children 111 7 MEMBERS OF THE HEALTH COMMITTEE. Councillor J. S. Marriott (Chairman), Alderman M. Stafford Smith M.B.E., B.A. (Vice-Chairman), The Worshipful the Mayor (Alderman F. W. Isard, J.P.), Alderman W. F. Skilton, Councillor H. M. V. Green, Councillor A. L. Hill, Councillor L. L. Irwin, M.A., LL.B., Councillor S. Lane, Councillor Major-General C. W. Norman, C.B.E., B.A. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1948. Medical Officers. Medical Officer of Health K. E. Tapper, o.b.e., g.m., m.b., ch.b., d.p.h. Assistant Medical Officers of Health j Miss G. H. Stinson, m.r.c.s., and School Medical Officers L.r.c.p. j P. A. currze, m.r.c.s., l.r.c.p. jk A. Orgler, m.d. jk Miss N. C. Elphinstone, m.r.c.s., l.r.c.p., d.c.h. Specialists (Part-time): Orthopaedic Surgeon j K. F. Hulbert, f.r.c.s. Eye Specialist j Eric Lyle, m.a., m.d., ch.b., d.o.m.s. Dental Surgeons: j P. Mayo, l.d.s. j B. S. Birkhahn, l.d.s., r.c.s. (part-time). j Fairman J. Ordish, l.d.s., r.c.s. (part-time). Sanitary Inspectors: Chief Sanitary Inspector, Chief abcde G. R. Woods, m.s.i.a., Sampling Officer, and Inspector a.r.san.i. under the Petroleum Acts, the Diseases of Animals Acts and the Shops Acts District Sanitary Inspectors and abc T. C. Towersey, m.s.i.a. Sampling Officers abi H. Archer, m.s.i.a., m.r.san.i. abe P. R. Light, m.s.i.a., a.r.san.i. ak H. Cooper, a.r.san.i. Health Visitors and School Nurses: fghj Miss E. B. Crowe, s.r.n. fghj Miss F. L. Gray, s.r.n. fghj Mrs. N. M. Taylor, s.r.n. fghj Miss W. G. Hemmings, s.r.n. fghj Miss H. M. Hogger, s.r.n. fghj Mrs. M. L. Hocking, s.r.n. 6 Clerical Staff. Chief Clerk S. F. Judd. Senior Clerk E. P. J. Wythe. Grade I Clerks Miss R. Brock. Mrs. D. Cox. Grade II Clerks Miss B. B. Burrows. Miss M. N. Croxson. Miss M. J. Kelly. k Miss E. W. Lepper. Miss S. Potterton. Dental Clinic Assistants j Mrs. W. Carrie. j Miss F. E. Rolfe. j Miss M. Ellen (part-time). Other Appointments: Physiotherapist j Mrs. P. A. Urwin, m.c.s.p. (part-time). Orthoptist j Miss P. A. Cope, d.b.o. time). Assistant Rodent Officers ek J. C. Dunn. J. L. Gough. Outdoor Staff: Disinfector and Drain Tester J. W. Seager. Market Superintendent F. J. Ephgrave (part-time). Rodent Operative R. H. Mitchell. The letters denote:— a Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. b Royal Sanitary Institute Certificate for Meat and Other Foods. c Royal Sanitary Institute Smoke Certificate. d Certificate of Examination Board of the Sanitary Inspectors' Association. e Diploma of Institute of Hygiene (London). f State Registered Nurse. g State Certified Midwife. h Health Visitor's Certificate of the Royal Sanitary Institute. i Certificate in Combustion Engineering, L.C.C. School of Engineering. j County Officers. K.C.C. Staff. k Unestablished or Temporary Staff. 9 To the Mayor, Aldermen and Councillors of the Borough of Bromley Mr. Mayor, Ladies and Gentlemen, In submitting to you my 24th Annual Report covering the year 1948, I have met with the difficulty that in the mid-year services ably carried out and developed by you over the years, were transferred, under the National Health Service Act, en bloc to the County Council. The administration of the Part III Services under the National Health Service Act as from July 5th, 1948, became centralised at Maidstone with the establishment of an Area Sub-Committee covering Penge, Beckenham, Bromley, Chislehurst and Sidcup and Orpington, a population of approximately 300,000. As from that date I was appointed Area Medical Officer under the Kent County Council, and from August 1st, my services as Medical Officer of Health for Bromley were shared with Orpington and Chislehurst and Sidcup. Under this rearrangement of duties there results an administrative liaison between the environmental services of the Local Authorities, excepting Beckenham and Penge, and the various services scheduled under Part III of the National Health Act. In June, 1948, I submitted to Bromley Maternity and Child Welfare Committee a report on their services during the years 1908-1947, a report which indicates the progress made by the Local Authority in the care and welfare of the Mother and Child. I have thought it of interest to incorporate this report as a matter of record. “To the Chairman and Members of the Maternity and Child Welfare Committee:— The Maternity and Child Welfare Committee will cease to exist as a Committee on July 5th. and I have thought it wise to give a short history of Bromley's work on the care of Mother and Child, and to place on record the results of this work during the years, results which, in my humble view, must bring satisfaction to the Committee for work well done. There is no doubt that these services have not only received the approbation and support of the ratepayers, but have been the keystone of Public Health in Bromley. It is with feelings of deep regret that I am losing the administrative and clinical control of these services, which for so many years have been my earnest endeavour. However, there is some consolation in knowing that we are passing to the County Authority a successful service and one that can be described in more senses than one as a ' going concern.' Bromley was not only in the forefront in the commencement of Maternity and Child Welfare work in 1908, but has to-day a service which is, I believe, equal to any in the country. The movement began in Bromley in 1908 by the formation of a voluntary agency known as the Bromley Health Society, where Mothers of the working classes were instructed how 10 to feed and manage their babies. Later the Society became known as the Bromley and District Health Society, and by 1910 were holding weekly sessions at three centres, one in the town, one at Bromley Common, and one at Plaistow. Babies were weighed and Mothers instructed on infant feeding. Expectant Mothers were advised on their own health, and. where necessary, proper clothing and miik were provided on recommendation. Convalescence at the seaside was also arranged for special cases, and there is record of women placed on hire to keep the home clean during illness of the Mother.' The founders of this Health Society were Mrs. Harrison, Mrs. Yolland and Mrs. Haslegrave. Miss Vera Vincent (present co-opted member of the Maternity and Child Welfare Committee) began work with this voluntary society in 1912, and is, I believe, the only active member still remaining in the work. A voluntary Health Visitor was appointed by the Society in 1910. and by 1911 there were 165 Mothers on the books, making an annual attendance of 1,179 The voluntary Health Visitor made 238 visits to the homes of special cases. This society worked with the Medical Officer of Health at the time (Dr. Codd), and with the Bromley Charity Society, the Queens Nurses, and the Society for the Prevention of Cruelty to Children. It was in 1911 that the Medical Officer of Health advised the Local Authority to pay the salary of the Health Visitor in order that application for the adoption of the Notification of Births Act, 1907, could be proceeded with. A Mrs. Kelf, who had acted as voluntary Health Visitor, was appointed whole-time Health Visitor in 1912, but it would appear that it was not until January, 1914. that the Local Authority adopted the Notification of Births Act, 1907. Apparently about this time Mrs. Kelf was replaced by a Miss Evans, who commenced duties in February, 1914. Her duties were laid down as follows:— (1) To visit mothers after confinement. (2) To note the feeding and clothing of the younger children, and to advise on medical assistance where necessary. (3) To visit tuberculosis cases, measles, whooping cough. (4) To visit workshops where females were employed. (5) To act as inspector under the Shops Acts. (6) Any other duty as might be required by the Medical Officer of Health. In 1914 Schools for Mothers and Babies' were held at St. Mary's Hall (85 Mothers. 1,136 attendances), St. Mark's Room (72 Mothers, 843 attendances), and St. Luke's Institute (60 Mothers, 992 attendances). It is perhaps of some interest to note that a grant of £64 7s. 9d. was given by the Board of Education to the Society. In the same year a small Day Nursery was established at No. 1. Homesdale Road with accommodation for 30 children under a resident Matron assisted by a young girl. The Health Visitor submitted her first Annual Report for the year, giving details of her work, and recorded 2,740 visits. In 1918 The Milk (Mothers and Children) Order gave rise to the constitution of a Milk Sub-Committee of the Health Committee, where cases were considered for a supply of milk at reduced cost. There is a note in the Annual Report of the Medical Officer of Health (Dr. Codd):On the whole very few complaints were heard of. except as to the scarcity of milk, which was dealt with by the Food Control Office. “ In 1919, after the passing of the Maternity and Child Welfare Act of 1918, the Local Authority established three Infant Welfare Centres—St. Luke's Institute, St. Mary's, Plaistow, and the Wesleyan Hall, Widmore, 11 holding weekly sessions. A second Health Visitor was appointed. The Day Nursery was moved from Homesdale Road to larger premises at 87, Masons Hill, and a grant of £50 per annum was made. This nursery was closed in 1920, owing to dwindling attendances. In 1925 the Maternity and Child Welfare services were incorporated into the Health and School Medical Services so that the care of mother and child became one continued service and not separately administered. In 1930 Bromley was made the Supervising Authority under the Midwives Acts, and by the Midwives Act, 1936, became responsible for providing a Municipal Midwifery Service. With that service the Council inaugurated the Scheme for Home Helps in maternity cases. The first ad hoc clinic building was completed in 1928, and the second completed in 1936. Diphtheria immunisation began in 1928. As an indication of the value of these services, I am submitting statistical comparisons:— 1908 1924 1947 Birth Rate (per 1,000 population) 21.1 15.1 20.9 Infant Mortality Rate (per 1,000 live births) 72.8 58.0 19.11 Maternal Mortality Rate (per 1,000 live and still births) Not available 4.9 0.74 Number of visits by Health visitors nil 3,926 8,800 Ante-Natal Clinic (attendances) nil 51 404 Welfare Centre attendances * 6,767 24,654 Treatments— Dental—Mothers nil nil 613 Children under five nil nil 192 Eye Clinic nil nil 159 Ultra-Violet Rays nil nil 469 Orthopaedic nil nil 352 Minor Ailments nil 15 147 Day Nurseries—Number of Children on register at 31st December nil nil 97 Domestic Help—Cases assisted nil nil 170 Home Help—Cases assisted nil nil 100 Diphtheria Immunisation nil nil 711 * No Welfare Centre facilities were afforded by the Local Authority, but a voluntary organisation (the Bromley Health Society) instructed working mothers on the proper feeding and management of their infants. No figures are available. These statistics speak for themselves, and must indicate the success of the work carried out during the period of years. I am sure that the Committee would wish to acknowledge the active services of the voluntary workers, numbering 60 at present, and to extend to them the hope that the change of control will not cause them to curtail, in any way, the time, energy and help that they have given to the benefit of the services as a whole. They are doing, and have done, valuable work in the care of Mother and Child, and without these services I am convinced that we could not have reached our present standard." The year has been without unusual incidents, but it is worthy to note the changes occurring in infectious diseases. Diphtheria has become rare in incidence—whether this fact is due to intensive immunisation or not must be left to the future before coming to a definite conclusion. Two of the three cases of Diphtheria which did occur were of a virulent type but close contacts in the family and elsewhere were not infected and both 12 recovered after treatment in hospital. Scarlet Fever has been widespread but unusually mild in symptoms and complications. Coincident with the fall in severity of Scarlet Fever and Diphtheria there has been a like fall in severity of Measles and Whooping Cough. There were four cases of Poliomyelitis and two deaths—the tail end of the epidemic of 1947. The report on the Typhoid case which occurs in the body of the report is worthy of notice. The death rate of infants remained low at 20.15. There was also a low death rate of 9.9 and a falling birth rate of 16.4 compared with the immediately preceding years. The fact that nearly 12 per cent, of your population are ot pensionable age brings with it the problems of the care of the aged, problems which will become more acute as the years pass. On this matter, one must record a word of praise to the excellent work of the W.V.S. and other voluntary agencies in the establishment of homes for aged in Bromley. Included in this report, is the report on the School Health Service, Bromley being an excepted area under the Education Act. It is in this age group that you have the only direct administrative contact with the family health, excepting of course, the environmental service which applies to the population as a whole. The details of these latter services occupy the main body of the report. This branch of work of the Health Department is fundamental in the development of social medicine. There is thus a wide horizon in the field of work of a Medical Officer of Health and his staff provided he is given the means and facilities to carry out survey of all factors affecting the health and well being of the population at all ages. The services that are now left to you may not be spectacular, but they permit of more time being given to the real work of Preventive Medicine. Again I would wish to record my appreciation to each member of the Health Department, and especially to Mr. Woods, the Sanitary Inspectors, and to Mr. Judd, the Chief Clerk, for their help in compiling this report and for their diligent application to the work of Public Health throughout the year. I am, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 14 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6.519 Registrar General's estimate of population (mid-year), 1948 63.360 No. of inhabited houses and flats, according to the rate books at the close of the year 17,574 No. of valuation assessments of habitable premises at the close of the year 17,624 (a) Bromley (b) Hayes and (Old Borough area) Keston Total Houses 12,969 2,917 15,886 Flats 1,605 84 1,689 Farmhouses 12 1 13 Public Houses 31 5 36 14,617 3,007 17,624 Rateable Value (31st March, 1949) £712,638 Product of a Penny Rate for the year ending 31st March, 1950 £2,940 Vital Statistics. Live Births Total Male Female Legitimate 990 493 497 Birth Rate 16.4 per 1,000 population. Illegitimate 52 29 23 1,042 522 520 Deaths. Total Male Female 631 310 321 Beath Rate 9.9 per 1,000 poputation Deaths from Puerperal Causes. Puerperal Sepsis 1 Maternal Mortality Rate 0.94 per 1.000 Other Puerperal Causes —(live and still) births. - 1 Stillbirths. Total Male Female Stillbirth Rate 22.5 per 1.000 (live and still) births. Legitimate ... 23 11 12 Illegitimate 1 1 — 24 12 12 15 Deaths of Infants under 1 year of age. Total Male Female Legitimate 20 10 10 Infant Mortality Rate 20.15 per 1.000 live births. Illegitimate 1 1 — 21 11 10 Death Rates of Infants under 1 year of age. All infants per 1,000 live births 20.15 Legitimate infants per 1,000 legitimate live births 20.20 Illegitimate infants per 1.000 illegitimate live births 19.23 POPULATION. The Registrar General's estimate of the population (mid1948) is 63.360, which is an increase of 720 on the corresponding figure for 1947, equivalent to a density of 9.7 persons per acre. The following figures show the increase in the population of the area over a long period of time:— Year Population Year Population 1831 4,002 1942 50,480* 1901 27,354 1943 51,300* 1911 33,646 1944 49,730* 1921 35,052 1945 52,310* 1931 45,374 1946 60,540 1939 60,000 1947 62,640 1940 56,580* 1948 63,360 1941 50,430* * War years—evacuation period. It is now 18 years since the last Census and a change in the character of the population, age grouping, employment and distribution has occurred, and without these statistical details it is not possible to report on any actions necessary to safeguard the health of the population nor on services necessary for their wellbeing. A case in point, it is known that during these recent years, there has been a proportionate increase in the higher age groups, calling for services for the care and protection of the aged and infirm. BIRTHS. The birth rate for 1948, is 16.4 per 1,000 population. The comparative rates between Bromley and England and Wales during the past ten years, are as follows:— Year Bromley England & Wales 1939 13.9 15.0 1940 13.2 14.6 1941 13.3 14.2 1942 17.2 15.8 1943 17.5 16.5 1944 16.5 17.6 1945 16.6 16.1 1946 19.4 19.1 1947 20.9 20.5 1948 16.4 17.9 16 The Registrar General's returns for the year showed the following registered births, after transferable adjustments had been made:— Live Births Stillbirths Total 1,042 24 1.066 All rate calculations are based on these official figures. The total number of births notified under Section 203 of the Public Health Act, 1936, occurring in the Borough, between 1st January, 1948, and 5th July, 1948, when the National Health Service Act, 1946, came into operation, were as follows:— Live Births Stillbirths Total 802 6 808 The number of maternity cases in the Borough during the same period, which were attended by Municipal Midwives. is as follows:— Domiciliary Confinements. Municipal Midwives attended: — (a) As Midwives 230 (b) As Maternity Nurses (with a Doctor) 53 283 PREMATURE BIRTHS. Details of premature births (birth weight of 5½ lbs. or less), which occurred in Bromley during the first half of the year are as follows:— (a) Domiciliary Births 5 (b) Institutional Births 18 23 Number of non-residents whose particulars were transferred to other authorities 10 Number of premature babies born out of the area whose mothers normally reside in the Borough — Total number of premature babies notified during the first half of the year whose mothers normally reside in the Borough 13 23 STILLBIRTHS. The Registrar General's returns for the year show that the number of stillbirths registered for the area was 24 (after adjustment for inward and outward transfers), which represents a stillbirth rate of 22.5 per 1,000 (live and still) births, and 0.38 per 1,000 population, 17 The number of stillbirths, rates per 1.000 births, and rates per 1,000 population for the past ten years, with comparative rates per 1,000 population for England and Wales, are shown in the following table:— Year No. of Stillbirths Bromley Rate per 1,000 births England & Wales Rate per 1,000 population 1939 39 44.8 0.61 0.59 1940 26 32.2 0.45 0.55 1941 20 28.1 0.39 0.51 1942 26 28.9 0.51 0.54 1943 22 23.8 0.42 0.52 1944 20 23.8 0.40 0.50 1945 15 16.9 0.28 0.46 1946 33 27.2 0.54 0.53 1947 34 25.3 0.54 0.50 1948 24 22.5 0.38 0.42 INFANTILE MORTALITY. The Infant Mortality Rate for the year is 20.15 per 1.000 live births. 21 infants (including 7 outward transfers) died during 1948 before reaching their first birthday. MATERNAL MORTALITY. There was one maternal death in the Borough during 1948. giving a mortality rate of 0.93 per 1,000 total births. The following table shows the causes and rates of maternal mortality over the past ten years:— Year Other Puerperal puerperal Rate per Sepsis causes 1.000 births 1939 — 3 3.45 1940 1 — 1.28 1941 2 1 4.68 1942 1 1 2.23 1943 — — — 1944 — — — 1945 — — — 1946 — 1 0.8 1947 — 1 0.74 1948 1 — 0.93 DEATHS. The Death Rate for 1948 is 9.9 per 1,000 population. The total number of deaths recorded was 631, of which 310 were males and 321 females, 18 The following table gives the death rates for Bromley in comparison with the death rates for England and Wales during the past ten years:— Year Bromley Rate (crude) England and Wales 1939 10.0 12.1 1940 12.9 14.3 1941 15.1 12.9 1942 11.4 11.6 1943 11.7 12.1 1944 13.3 11.6 1945 12.5 11.4 1946 10.8 11.5 1947 11.7 12.0 1948 9.9 10.8 The main causes of death in Bromley, with comparative rates per 1,000 population for the past five years, are shown in the following table:— Rates per 1,000 population 1948 1947 1946 1945 1944 Heart Disease 2.7 3.5 2.9 3.4 3.6 Cancer 1.8 1.9 1.8 2.0 2.4 Respiratory disease (non-T.B.) 0.9 1.0 1.1 1.2 1.2 Tuberculosis 0.3 0.4 0.3 0.7 0.4 Congenital causes 0.2 0.2 0.5 0.5 0.6 Infectious disease 0.01 0.03 0.01 0.04 0.04 Influenza — 0.03 0.1 0.06 0.06 UNEMPLOYMENT. The Manager of the Employment Exchange, Bromley, has kindly supplied the following details with regard to unemployment during 1948:— “ Recorded unemployment at the end of December, 1948:— (a) Men 156 (b) Women 55 These included 73 disabled men, suffering from major and minor disabilities, and one disabled woman. All the disabled persons were fit for some sort of employment. The majority of the men are in the later age group of 50 to 70. The majority of the women registered desire part-time employment only, for which there is practically no demand. The peak figures for unemployment in 1948, were recorded in September, viz:— Men 160 Women 87 A large number of the workpeople who register for employment are submitted to employers and placed in employment within a few days. There is a continual turnover of the workpeople who register for employment. Women are still reluctant to take domestic work, especially employment as resident maids. 19 METEOROLOGICAL CONDITIONS. Climate conditions were generally good throughout the year, and fortunately, the past winter was less severe than the previous one. The Borough Engineer has kindly supplied the following details for 1948 from records kept by his Department at the Climatological Station at Church House Grounds:— Total rainfall: 24.48 inches. Mean maximum daily temperature: 59.3°. Mean minimum daily temperature: 43.5°. Highest maximum temperature recorded: 92° (on 28th July, 1948). Lowest grass temperature recorded—no records available, due to the thermometer having been stolen and a replacement instrument not being available. OPEN AIR RECREATIONAL AMENITIES. Commons and Open Spaces. Acres Roods Poles Acres Roods Poles Elmstead Woods 61 1 36 Keston Common 55 1 24 Hayes Common (incl. Pickhurst Green) 213 1 32 Hollydale 6 1 0 New Street Hill 11 2 8 Southborough 1 0 0 Turpington 1 3 10 355 3 30 Public Recreation Grounds. Kings Meadow 9 1 0 Martins Hill 12 0 29 Oakley Road 2 0 0 Queens Mead 10 3 15 Widmore 3 1 28 Whitehall 17 1 6 Norman Park (reserved) 56 0 0 110 3 38 Public Gardens and Grounds. Church House Grounds 12 3 20 Hayes (Old) Rectory Grounds 2 0 25 Husseywell Crescent 2 1 30 Library Garden 1 2 0 Queens Garden 2 1 4 The Knoll 4 1 39 25 2 38 492 2 26 Golf Course (Bromley and Bickley) 103 1 0 Total 595 3 26 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 22 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. AMBULANCE SERVICE. The Ambulance Depot is at Masons Hill, Bromley, and the service is operated by the County Council as part of the combined scheme for the whole of the County. During the past year the ambulances at this Depot covered 48,100 miles and conveyed 7,917 patients. LABORATORY SERVICES. There has been no change in this service during the year. The Kent County Council provide a Laboratory service for the whole of the County through their Laboratory at Maidstone. Considerable assistance has also been rendered by Dr. Griffiths and the staff of the Laboratory at Farnborough Hospital in the examination of and reporting upon specimens of an urgent nature which it was not possible to send to Maidstone for examination. The examination of emergency diphtheria swabs is carried out, as previously, at the West Kent Isolation Hospital, and the liaison here is most satisfactory. The following swabs, specimens, etc., were sent for tion and report during the year:— Hsemolytic Streptococci 495 Diphtheria 43 Specimens of blood (for Rhesus factor, Wassermann. Widal, Kahn and Haemoglobin Tests) 452 Food Samples, Water Samples, etc. 569 Miscellaneous 16 SUPPLY OF INSULIN. During the first half of the year, financial assistance was given to seven necessitous diabetic patients, by the free or part-cost provision of insulin. This service is now incorporated in the State Health Scheme. NURSING IN THE HOME. The Bromley and District Nursing Association, and the Hayes and West Wickham Nursing Association, both of whom for many years gave yeoman service in the provision of nursing facilities for the sick in the home, ceased to function on 5th July, 1948. The Home Nursing Service is now incorporated in the Health Service of the County Council. 23 OLD PEOPLE'S HOMES. There are five homes within the area which are run by Voluntary Associations and Public Authorities for the care of old people. "Armstrong House," 1, Southlands Grove, Bickley. This home is run by the Save Our Souls Society, of 24, Ashburn Place, London, S.W.7, and I am indebted to the Secretary of that Society for the following report on the Home during 1948:— "The average number accommodated during 1948, was 28 (17 men and 11 women). Three residents left during the year, three new applicants were admitted and there were two deaths. Although the general health of the residents was on the whole good, many of them are noticeably more feeble. Doctors visit the Home once a week or more often if necessary, and a Chiropodist attends once a month. Various friends of the Home arrange concerts and film shows for the old people at least twice a month. Gifts of food, books and clothing were received during 1948, and at Christmas, the Mayor of Bromley made a gift of 12s. 6d. to eighteen of the residents who had no income other than their old age pension. During 1948, "Armstrong House" was registered with, and recognised by the Kent County Council, and the general scheme of co-operation with the County Council is working very satisfactorily. It is hoped to increase the facilities of the Home by building an additional lounge and quiet room on the site of the old conservatory, which was damaged by blast during the war." "Southwood,'' Residential Club, Oldfield Road, Bickley. This Club is run by the Women's Voluntary Services, and the Organiser has kindly furnished the following report:— "The Club was officially opened on 2nd January, 1948, by the Lord Mayor of London. Numbers of residents steadily increased during the year and the full complement of forty was reached on 23rd October, 1948. The Club has double and single bed-sitting rooms with hot and cold water, with use of communal dining room and lounge, billiard room and stands in 5½ acres of ground. Residents may furnish their own rooms if they wish, with the exception of bed and bedding, which is provided by the Club; furniture is also provided by the Club if desired. 24 Residents, who must be over 65 years of age, are drawn from the Old Age Pensioners group, and accommodation is available to persons with an income up to £200 per annum, net. All residents must be able bodied with a clean bill of health." "Merevale," Bickley Park Road, Bickley. This Home is run by the North West Kent Housing Society Ltd., and has accommodation for 29 old people. At the end of 1948, there were 7 male and 22 female residents, of whom 3 were registered as blind persons and there was one married couple. The average age at 31st December, 1948, was 79 years." "The Vane," Denbridge Road, Bickley. The London County Council is the responsible authority for this Home, which has accommodation for 29 residents (4 for men and 25 for women). There were 27 residents at 31st December, 1947, 20 admissions during 1948, and 18 discharges during the year. All residents draw old age pensions, or, if necessary, an allowance from the National Assistance Board of 26s. per week, and pay 21s. for their maintenance and keep 5s. for themselves. Any who have private means, however, are asked to pay for their accommodation, according to their income, up to a maximum of £3 8s. 3d. per week. "Dunoran," Park Farm Road, Bickley. I am indebted to the Administrative Officer of the Bermondsey and Southwark Group Hospital Management Committee for the following report:— "In 1948 the number of beds available at Dunoran Home was increased to thirty and during the year there were 59 admissions. Thirty-one of these were dying patients; the remaining twenty-eight were permanent chronic cases or patients admitted for a short time for a necessary change of scene or to give relatives a rest. "In July the Home was taken over by the State and came under the administration of the Bermondsey and Southwark Hospital Management Committee. Since that time only chronic and dying patients have been admitted and arrangements have been made for the transfer of the elderly non-medical residents. Most of these have now been transferred to Greenhill, Oaklands Road, Bromley, a new Home for elderly women recently opened by the Brook Lane Medical Mission." 25 MEDICAL LOAN DEPOT. Arrangements have been made with the British Red Cross Society for the continuation of the Medical Loan Depots. The full range of nursing requisites is available at these depots, which are additional to the loan cupboards kept by the Home Nurses. Applications for loans of such equipment for Bromley inhabitants should be made to either of the following depots:— 34a, Market Square, Bromley. 4, East Street, Bromley. CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL HEALTH AUTHORITY UNDER PART III. OF THE NATIONAL HEALTH SERVICE ACT. 1946. WITH BRIEF DETAILS OF THE SERVICES AVAILABLE Description Situation No. of Sessions Per Week Professional Attendants Services Available Ante-Natal Clinic North Clinic, Station Road, Bromley. 3 (Mon. 2) (Thurs. 1) Monday Afternoon 1 Doctor 2 Midwives Monday Evening 2 Midwives Thursday Afternoon 1 Doctor 2 Midwives Medical Examinations. Blood Tests Rh. Ante-Natal Care. Chemical Foods, Drugs, etc. Masons Hill Welfare Centre William Morris Hall, Masons Hill, Bromley. 2 Monday and Thursday Afternoon Doctor and Health Visitor Medical Examinations. Mothercraft. Weighing of Babies Chemical Foods, Drugs, Cod Liver Oil, etc. Whitehall Welfare Centre Whitehall F.A. Post, Recreation Ground, Southlands Road, Bromley. 2 Wednesday and Friday Afternoon Doctor and Health Visitor Do. Bromley Common Welfare Centre South Clinic, Princes Plain, Bromley Common. 1 Tuesday Afternoon Doctor and Health Visitor Do. Hayes Welfare Centre Hayes Village Hall, Hayes Street, Hayes. 1 Tuesday Afternoon Doctor and Health Visitor Do. Koston Welfare Centre Village Hall, Keston 1 Thursday Afternoon Doctor and Health Visitor Do. Immunisation Vaccination Clinic. 26 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL HEALTH AUTHORITY UNDER PART III. OF THE NATIONAL HEALTH SERVICE ACT. 1946. WITH BRIEF DETAILS OF THE SERVICES AVAILABLE—(Continued) Description Situation No. of Sessions Per Week Professional Attendants Services Available Plaistow Welfare Centre North Clinic, Station Road, Bromley. 1 Wednesday Afternoon Doctor and Health Visitor Medical Examinations. Mothercraft. Weighing of Babies. Chemical Foods, Drugs, Cod Liver Oil, etc. Burnt Ash Welfare Centre Burnt Ash Lane Branch Library, Bromley. 1 Wednesday Afternoon Doctor and Health Visitor Do. Immunisation Clinic. North School Clinic North Clinic, Station Road, Bromley. 4 Doctor and Nurse Minor Ailment Treatment Clinic. 1 Nurse ,, ,, 2 Doctor and Nurse Immunisation Clinic. 1 Doctor and Nurse Vaccination Clinic 1 Doctor and Nurse Infectious disease examinations 2 Physiotherapist Ultra Violet Ray Treatment. 3 Physiotherapist Remedial Exercises. Electrical Treatment. 6 Orthoptist Massage. 3 Eye Specialist Eye Defect Treatment. Refractions and Other Eye Treatments. 2 Per Month 22 Orthopaedic Surgeon 3 Dental Surgeons Consultative Service and Treatment. Primary Scholars— 1-5 yrs. to 11 yrs. Age Groups— Routine Annual Inspection and Treatment. 2-11 yrs. to 14 yrs. Age Groups— Half-year Routine Inspection and Treatment. Secondary Scholars- Half-yearly Routine Inspection and Treatment. 27 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL HEALTH AUTHORITY UNDER PART III. OF THE NATIONAL HEALTH SERVICE ACT, 1946. WITH BRIEF DETAILS OF THE SERVICES AVAILABLE—(Continued) Description Situation No. of Sessions Per Week Professional Attendants Services Available Ancillary Service for all Children. 1. Orthodontics including consultant Service. 2. X-Rays. 3. Prosthetics (Crowns, etc.) Maternity and Child Welfare. 1. Inspection and Treatment of Day Nurseries and Welfare Children. 2. Inspection and Treatment of all Ante-Natal Mothers. 3. Treatment of Welfare Mothers. 4. Denture Service for all Mothers. South School Clinic South School Clinic, Princes Plain, Bromley. 5 Doctor and Nurse Minor Ailment Treatment Clinic. 1 Doctor and Nurse Immunisation and Vaccination Clinic. 1 Doctor and Nurse Infectious Disease examinations. 2 Nurse Ultra Violet Ray Treatment. 4 Dental Surgeon Service as shown under North School Clinic. 1 Speech Therapist Speech Clinic. Burnt Ash Clinic (auxiliary) Burnt Ash School, Rangefield Road, Downham. 3 Doctor and Nurse Minor Ailment Treatment Clinic. 2 Nurse ,, ,, 1 Doctor and Nurse Immunisation Clinic. 1 Doctor and Nurse Vaccination Clinic. Hayes Clinic (auxiliary) Hayes School, George Lane, Hayes. 2 Doctor and nurse Minor ailment treatment clinic 3 Nurse ,, ,, 1 Doctor and Nurse Immunisation and Vaccination Clinic. 28 CLINICS AND WELFARE CENTRES PROVIDED BY THE LOCAL HEALTH AUTHORITY UNDER PART III. OF THE NATIONAL HEALTH SERVICE ACT, 1946. WITH BRIEF DETAILS OF THE SERVICES AVAILABLE— (Continued) Description Situation No. of Sessions Per Week Professional Attendants Services Available All Schools 5 Doctor and Nurse Routine Medical Inspection of various age group 2 Dental Surgeon Routine Dental Inspection of Various Age Groups. Municipal Offices 1 Doctor and Nurse Special Examinations of Handicapped Children by Appointment. Description Situation Accommodation Open On Services Available Elmfield Day Nursery Elmfield Road, Bromley. 40 Children under 5 yrs. Each day 8 a.m. to 6.30 p.m. (excluding Sundays) Routine Medical Inspections. Baby Care and Mothercraft. Education Work. Student Training. Meals Provided. Cod Liver Oil, Orange Juice and Vitamins Daily. Draycott Day Nursery Southborough Lane, Bickley. 60 Children under 5 yrs. Do. Do. 29 30 DOMESTIC HELP SCHEME. During the first six months of the year there was a continued and steady demand for this service. The slight increase in the assistance afforded by the Ministry of Labour to patients requiring domestic help over a long and continuous period enabled us to meet all applications for assistance in needy cases and those in an emergency. The following table gives details of assistance given under the Domestic Help Scheme whilst operated by this Department:— Average number of helpers employed continuously: — (a) Whole-time 4 (b) Part-time 10 Total number of cases assisted: — (a) Maternity 30 (b) Sickness 49 The Domestic Help Service is now operated by the County Council through their Area Supervisor, and there has been a great increase in the demand for the supply of domestic workers. HOSPITALS. All hospitals within the area are now State controlled, and are administered by the Bromley Group Hospital Management Committee on behalf of the South East Metropolitan Regional Board. (a) Bromley Hospital, Cromwell Avenue. Provides a general hospital service with general in-patient and out-patient departments. This hospital, which serves a wider area than the Borough, also has two Maternity Units, at 118, Widmore Road and 20. Masons Hill, Bromley. (b) West Kent Isolation Hospital. Provision for the isolation and treatment of infectious disease is made by the hospital in Lennard Road. (c) Bromley Chest Clinic. This Clinic is situate at 2 Park Road, Bromley, in premises most inadequate for such purpose, and is now under the control of the Regional Board. The continued co-operation and liaison received from both the medical and administrative staff of this Clinic is much appreciated, 31 NURSING HOMES. There are five registered Nursing Homes within the Borough, which come under periodic inspection from the Health Department. Details of these Homes at 31st December, 1948, are as follows:— Address No. of Beds Patients Received during 1948 Nursing Staff Surgical Medical Qualified S.E.A.N. Other 42, Cambridge Road 13 — 13 2 — 6 47 and 51, Park Avenue 26 — 64 1 1 6 18, Blyth Road 22 — 19 2 — 7 67, Hayes Road 3 — 3 1 — 1 24, Elmfield Road 10 — 4 1 2 1 Venereal Diseases. No centre is provided within the Borough for the treatment of Veneral Diseases, patients are referred either to the London Hospitals or one of the established centres in the County. SECTION C. MATERNITY AND CHILD WELFARE. 34 SECTION C. MATERNITY AND CHILD WELFARE. The whole of the maternity and child welfare services previously operated by this authority were, on 5th July, 1948, taken over by the Kent County Council. Statistics given therefore are in respect of the period 1st January, 1948, to 5th July, 1948, unless specifically stated. MUNICIPAL MIDWIFERY SERVICE. The six municipal midwives employed by the Council carried out the whole of the domiciliary midwifery practice of the Borough. No notices were received in respect of independent midwives practising within the area during the year. Routine work of the municipal midwives is shown in the following figures:— Total number of bookings 102 Confinements attended 112 Hospital cases (ante-natally and post-natally supervised by the midwives) 110 Visits— Ante-natal 1,373 Post-natal 1,922 Owing to the very acute housing shortage and overcrowded conditions under which so many families are living at the present time, the number of domiciliary confinements is below that of pre-war years. ANTE-NATAL CLINIC. The Ante-Natal Clinic is held at the North Clinic, Station Road, with sessions, as follow:— Mondays, at 2 p.m. with Doctor and two Midwives in attendance. Mondays, at 4.30 p.m., with two Midwives in attendance. Thursdays, at 2 p.m., with Doctor and two Midwives in attendance. Specimens of blood are taken at the Thursday afternoon session for Wassermann, Kahn and Haemoglobin tests. An investigation into the Rhesus factor is also made in an endeavour to combat and reduce the prevalence of infant mortality in babies under one week old. The activities of the Ante-Natal Clinic are shown in the following figures:— Number of sessions by Doctor and Midwife 51 Number of sessions by Midwives 24 New cases examined by Doctor 222 Total of all medical examinations 443 Total of all Midwives' examinations 177 Number of specimens of blood taken 438 35 ADMINISTRATION OF THE MIDWIVES ACTS, 1902-1936. Inspection of midwives, their records and equipment, was carried out by Dr. G. H. Stinson, Assistant Medical Officer of Health, the Inspector of Midwives appointed for the area. Thirty-six Midwives gave notice of their intention to practice within the area during the half year, six of whom were Municipal Midwives and thirty Institutional. The number of confinements attended by Municipal Midwives was 112, made up, as under:— As Midwives (without medical assistance) 91 As Maternity Nurses (with a Doctor) 21 Medical aid in an emergency was sought by Midwives on 21 occasions in respect of domiciliary confinements. HOME HELPS SCHEME. This scheme continued to operate successfully and assistance was arranged for every applicant. In addition to the four whole-time Home Helps, part-time helpers were employed as required, and during the first half of the year assistance was given to 36 cases. DENTAL TREATMENT. (EXPECTANT AND NURSING MOTHERS) The acute shortage of Dental Officers threw a great strain on this service, but the Maternity and Child Welfare Service was maintained and all cases referred to the clinics received treatment. The following figures, for the half year, show the extent of the work carried out:— Mothers. Total number of attendances 346 Total number discharged 77 Number of dentures fitted 35 Number of fillings 134 Number of extractions 115 Number of gas administrations 25 Children (under five years of age) Total number of attendances 121 Number discharged 77 Number of extractions 61 Number of fillings 82 Number of gas administrations 36 36 CARE OF PREMATURE INFANTS. The Health Visitors and Municipal Midwives continued to give particular care and attention to premature infants. The births of 23 premature babies in the Borough were notified during the first half of the year, of which 5 occurred at home and 18 took place in institutions. Of the home birth cases:— (a) 4 were nursed entirely at home. (b) 1 was removed to hospital. (c) 1 died during the first 24 hours of life. (d) 2 died during the first week of life. (e) 2 survived at the end of one month. Of the premature infants born in institutions:— (a) 1 died during the first 24 hours of life. (b) 2 died during the first week of life. (c) 15 survived at the end of one month. PUERPERAL PYREXIA. Twenty cases of Puerperal Pyrexia were notified during the year, of which one was in respect of domiciliary and nineteen were in respect of institutional confinements. OPHTHALMIA NEONATORUM. No cases were notified during the year. PEMPHIGUS NEONATORUM. A minor outbreak of Pemphigus Neonatorum occurred at the Widmore Road Maternity Unit of Bromley Hospital in April, 1948. Eight cases were notified; the disease, however, was of a mild type and all cases made a good recovery. POST NATAL SERVICES. WELFARE CENTRES. The following table gives details of attendances, etc., at Welfare Centres during the first half of the year:— Number of new enrolments during the period: — (a) Under 1 year 470 (b) Over 1 year 137 607 Total number of Welfare Sessions held 230 Total attendances of infants under 5 years of age 14,376 Total number of medical sessions held 205 Total number of medical consultations 1,859 37 CLINIC TREATMENT OF CHILDREN UNDER 5 YEARS. The following table gives details of the treatments received by children, under 5 years of age, at the various remedial school clinics, and it is most encouraging to note the use of these clinics by the under 5 years. Eye Clinic 175* Sunlight Clinic 713 Orthopaedic Clinic 295* „ „ 165† Minor Ailments Clinic 65 * Attendances for surgeon. † Attendances for massage. In addition to the above nine children were referred to hospital for tonsil and/or adenoid treatment. HEALTH VISITORS. HOME VISITING. 530 primary visits to infants under one year were paid by the Health Visitors up to 5th July, 1948. 1146 visits were made before these children attained one year of age. 2396 visits were made to children between one year and five years, giving a total of 4072 welfare and babycraft visits to children under five years of age. Details of all home visiting during the period is as follows:— Primary visits under 1 year 530 Re-visits under 1 year 1,146 Re-visits 1 to 5 years 2,396 Expectant mothers— special visits 38 School children 145 Stillbirths— special enquiries 5 Infant deaths— special enquiries 6 Miscellaneous 120 4,386 "Ineffectual" visits 840 Total 5,226 Visits classified in above figures: — Diphtheria Immunisation 67 Boarded-out children 20 Adopted children 36 CHILD LIFE PROTECTION. The supervision of foster mothers is carried out by the Health Visitors. At 5th July, 1948, fourteen children under nine years of age were in the care of thirteen foster mothers, five children having been received during the six months. It was not necessary to institute legal proceedings during this period. 38 ADOPTION OF CHILDREN. Ten persons gave notice under Section 7 (3) of the Adoption of Children (Regulation) Act, 1939, in respect of 10 children. At 5th July, 1948, there were two children in respect of whom adoption proceedings had not been completed, and who were still under the supervision of the Local Authority. CARE OF ILLEGITIMATE CHILDREN. Valuable work is carried out in this sphere by the Rochester Diocesan Association for Moral Welfare, with whom this Department works in the closest co-operation. Expectant mothers are admitted to the Ravensbourne Home prior to confinement, and arrangements are made by the Sister in charge for post natal care and advice, transfer to hospital, rehabilitation of mothers and arrangements with foster parents, etc. The care and attention given to these cases, both by the Health Visitors and the Association, is reflected in the low illegitimate infant mortality rate of 19.23 per 1,000 births (1 death only) for the Borough as a whole. DAY NURSERIES. The two Day Nurseries in Bromley continued in full activity and, apart from occasional fluctuation in attendance due to the . incidence of measles and whooping cough, etc., attendances were at a high level. Periodic medical inspection of the children was carried out by Dr. P. A. Currie, Assistant Medical Officer. The accommodation provided at the two Day Nurseries is as under:— Number of approved places: — (a) For children 0 to 2 years 39 (b) For children 2 to 5 years 61 100 The Nurseries remain open from 8 a.m. to 6 p.m. daily, except Sundays, a charge of 2s. 6d. per day for each child being made prior to July 5th. Children of parents in straightened circumstances are admitted free or at a reduced charge. The demand for Day Nurseries continued at a high rate, and at 5th July, 1948, when this service was taken over by the County Council, there was a waiting list in respect of each Nursery. SECTION D. SANITARY CIRCUMSTANCES OF THE AREA. 40 SECTION D. SANITARY CIRCUMSTANCES OF THE AREA. WATER. I am indebted to the Director of Water Examination of the Metropolitan Water Board for the following information on the supply of water to the Borough during the year:— "No standpipe supplies were provided and houses throughout the Borough received their supplies direct from the public water mains. "During the year approximately 2,000 yards of 18 in. trunk main were laid in Masons Hill and Bromley Common. "No new sources of public water supply were instituted in the Borough and there were no cnanges in the general scheme of supply. The supply to the Bromley district during 1948 has been adequate at all times. The higher level is supplied from Shortlands Well and by the Thames derived filtered water; the lower level is supplied from West Wickham and Orpington Wells with additional Thames derived water during the summer months. "All the Thames derived water is chlorinated as it leaves the works. The well-water is also chlorinated but any residual chlorine is completely removed before the water leaves the works. "Bacteriological analyses are made five times a week of all supplies and 100 per cent, first-class results have been obtained. In the case of the river-derived supply the water is tested bacteriologically at all stages of purification. All new and repaired mains are disinfected with chlorine before being restored to use and samples of water from them are tested bacteriologically. "None of the supplies is plumbo-solvent. "The closest watch is kept for any form of contamination and immediate action is taken if the results of analyses are not up to standard. "Appended are the average results of the chemical and bacteriological analyses of the various supplies for 1948." 41 Chemical. (Parts per million unless otherwise stated.) Shoirtlar.ds West Wickham Orpington Thames-derived filtered water (Walton) Number of samples 3 5 3 250 Ammoniacal Nitrogen 0.000 0.000 0.010 0.043 Albuminoid Nitrogen 0.024 0.019 0.017 0.097 Oxidised Nitrogen 4.5 4.0 5.2 4.4 Chlorides as CI 19.0 13.5 16.0 28.7 Oxygen abs. from Permanganate 3 hrs. at 80o F 0.15 0.08 0.16 1.18 Turbidity in terms of Silica — — — 0.4 Colour, m.m. brown, 2 ft. tube, liurgess's Tintometer 0 0 0 18 Hardness (Total) 315 303 324 237 Hardness (Permanent) 129 81 81 72 pH Value 7.2 7.2 7.1 7.6 Conductivity 475 425 475 450 Bacteriological. Number of samples 255 252 255 258 Colony count on Agar at 370 C. — — — 14.8 B. Coli Test : — % of samples negative 100 ml. 100.0 100.0 100.0 100.0 B. Coli per 100 ml. Nil Nil Nil Nil DRAINAGE AND SEWERAGE. There have been no works of major importance carried out during the year. CESSPOOLS. No new premises have been erected with cesspool drainage and no alterations to the drainage system of any other properties on cesspool drainage have been carried out. RIVERS. STREAMS AND LAKES. No further works of culverting rivers or streams within the area have been undertaken during the year. Seven inspections and re-inspections were made by Sanitary Inspectors during the year. Two samples of water were taken from the pond in Church House Gardens, with the following results:— Sample A.—B. Coli (presumptive) present in 1 c.c., absent in 1/10 c.cs. Further tests showed that these were not typical B. Coli. Sample B.—B. Coli (presumptive) present in 1/10 c.cs., absent in 1/100 c.cs. Further tests showed that these were not typical B. Coli. There was no evidence of recent faecal contamination. SWIMMING BATHS AND POOLS. 39 inspections of swimming baths and pools in the Borough were made by the Sanitary Inspectors, and 38 samples of water were taken for examination. The results of these examinations are, as follows:— 42 8 samples taken from Corporation's Swimming Pool—6 were satisfactory and 2 unsatisfactory. 30 samples taken from privately owned Swimming Baths and Pools— 25 were satisfactory, 3 unsatisfactory and 2 were found to have a high bacterial count which were reduced by efficient treatment. PUBLIC CLEANSING AND REFUSE COLLECTION. The Borough Engineer reports that the reconstruction of cell unit No. 2 at the Refuse Destructor was completed during the year and that of unit No. 1 commenced. Separate containers to receive salvage wastepaper were fitted to all side loading refuse collection vehicles during 1948. SANITARY INSPECTION OF THE AREA. Table VIII in the appendix of statistical tables gives full details of the work carried out by the Sanitary Inspectors during the year, and the following are the aggregate totals under the respective headings:— Total No. of Inspections and Visits Total No. of Defects and Nuisances Found Housing 11,767 12,946 Infectious Diseases 290 — Food Premises 2,871 329 Factories 580 309 Sampling Visits 304 — Trade Premises (various) 435 56 Rodent Control 12,565 1,693 Miscellaneous 530 41 Total 29,342 15,374 In addition, there were 1,343 interviews with owners, agents, etc., on site and at the office in connection with the above work. Notices issued:— Preliminary :— Housing 2,227 Food Premises 139 Factories, etc. 64 Trade Premises 29 Rodent Control 470 Miscellaneous 73 3,002 Statutory :— Housing 4 3,006 Food Condemnation Certificates issued 1,287 43 FACTORIES ACT, 1937. Tables VII, VIII and IX give statistical details of the inspections made by Sanitary Inspectors, and nuisances, defects and contraventions found and abated. A total of 518 inspections and re-inspections were made during the year and 309 nuisances and defects were found, of which 258 had been remedied by the end of the year. In addition to the above, 38 inspections were made of outworkers' premises, all of which were found to be satisfactory and no nuisances or defects were found. SHOPS ACTS, 1912-1936. Mr. G. R. Woods, the Inspector under the Shops Acts, reports:—Owing to the pressure of work it has not been possible to carry out systematic routine inspections of shop premises. Investigations were made into the employment of young persons. Contraventions were found. Two firms were warned for contravening the hours of employment and not keeping the necessary records for young persons. In one case it concerned van boys and in the other, a waitress. In consequence there was an improvement in the employment of these persons. During the year 130 visits of inspection were made under the provisions of the Shops Acts, at which 71 nuisances or contraventions were noted. 72 nuisances (including those outstanding from 1947) were remedied. The expected consolidation of the Shops Acts and the many relevant Regulations has not yet been enacted. SMOKE ABATEMENT. Twenty-four inspections and re-inspections were made by the Sanitary Inspectors. There were no instances of smoke nuisance. VERMINOUS CONDITIONS AND UNCLEANLINESS. 134 visits to premises by the Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. Thirtythree nuisances were abated. Only two cases of vermin infestation were found in connection with the Council's Housing Estates and these were successfully dealt with. Having regard to the adverse and unsatisfactory housing conditions under which so many families are living at the present time, the very low incidence of verminous infestation and uncleanliness is most pleasing. 44 RODENT CONTROL. The Chief Sanitary Inspector is a member of the London Regional Planning and Advisory Committee of the Ministry of Agriculture and Fisheries, and also Chairman of No. 9 London Workable Area Committee. The Rodent Staff of two Assistant Rodent Officers and one Rodent Operative have carried out excellent remedial work in this connection. The sewers have received the necessary treatment in accordance with a statutory obligation. The treatments are carried out at six monthly intervals. New legislation is anticipated which will do much to remedy the defects in the present Acts and Orders in force. The following figures give an indication of the volume of work carried out and include inspectorial and supervisory action by the Sanitary Inspectors. Number of inspections made of (a) Refuse Tips 14 (b) Trade Premises 2,056 (c) Private Premises 6,974 9,044 Number of infested premises : (i) Found: (ii) Cleared : (a) Trade Premises 201 (a) Trade Premises 201 (b) Private Premises 1,397 (b) Private Premises 1.391 1,598 1.592 In addition, 3,480 sewer manholes were inspected under the maintenance schemes and 915 were baited: there were 105 "takes." SECTION E. HOUSING. 46 SECTION E.— HOUSING. Table VI in the appendix gives details of the work carried out by the Sanitary Inspectors and relates exclusively to the structural and other defects of the fabric of dwelling houses. Tables VII and VIII give details of inspections and abatements of environmental housing defects. The following extract from these tables summarises the statistics relating to housing. Housing Inspections and Nuisances and Defects Abated. Inspections. Reason for Inspection On Complaint Routine ReInspections Total Inspections Nuisances found For Nuisances 2,457 529 8,133 11,119 12,843 Overcrowding 280 41 37 358 - Verminous Conditions 29 - 31 60 19 Dirty Conditions 13 13 17 43 12 Water Supply 21 — 32 53 18 Cesspools 1 - 2 3 1 Disinfestation 15 3 13 31 2 Noxious Accumulations 2 4 11 17 5 Other Accumulations 30 7 32 69 25 Special Visits — 101 — 101 — 2,848 698 8,308 11,854 12,925 Nuisances and Defects Abated:— Drainage 1,303 Dampness 2,083 Water Supply 711 General Items 7,034 11,131 Rehousing. The acute problem of housing continues to cause considerable anxiety, and I am indebted to the Property Manager for the following information on this subject. 1. (a) Number of permanent houses occupied during 1948: — Coppice Estate 181 Princes Plain 50 Old Estate (Re-let) 37 Purchased Properties 4 Total 272 47 (b) Number of families accommodated in permanent houses during 1948 276 (c) Number of persons accommodated in permanent houses during 1948 1,326 2. (a) Number of pre-fabricated dwellings occupied during 1948 28* (b) Total number of occupied pre-fabricated houses at 31.12.48 325 (c) Number of families "permanently" housed in prefabricated dwellings during 1948 28* (d) Number of persons ditto 37* (e) Total number of families "permanently" housed in pre-fabricated dwellings as at 31.12.48 325 (f) Total number of persons ditto 1,075 3. (a) Number of premises requisitioned during 1948 8 (b) Number of premises de-requisitioned during 1948 22 (c) Total number of premises requisitioned as at 31.12.48 398 (d) Number of families accommodated in requisitioned premises during 1948 331 (e) Number of persons accommodated in requisitioned premises during 1948 1,123 (f) Total number of families accommodated in requisitioned premises as at 31.12.48 868 (g) Total number of persons accommodated in requisitioned premises as at 31.12.48 3,118 * Re-let. 4. Number of families on waiting list as at 31.12.48: — (a) Medical 6 (b) Category I 83 (c) Category II 37 (d) Category IIIA and IIIB 2,779 (e) Category IIIC 1,802 (f) Category IV 885 Total 5,592 The above figures give same indication of the very considerable efforts made in the endeavour to remedy the unsatisfactory conditions under which so many families in the Borough are living, but it will be many years before this distressing problem is satisfactorily overcome. In addition to the above, 36 new houses erected by private enterprise were occupied during the year. SECTION F. INSPECTION AND SUPERVISION OF FOODS, 50 SECTION F. INSPECTION AND SUPERVISION OF FOODS. FOOD SAMPLING. The vigilance exercised by the Sanitary Inspectors, in the important work of safeguarding the food supply of the Borough was maintained at the highest possible level during the year, and the co-operation between Inspector and Trader has also been all that could be desired. Deliberate adulteration of food and drugs is found on rare occasions, unsatisfactory samples generally being due to defective packing, lack of care in preparation, improper storage, etc. In addition to the samples taken for analysis under the provisions of the Food and Drugs Act, 1938, samples were also taken for bacteriological examination and full details are given in the following tables. FOOD AND DRUGS ACT, 1938. Article Samples taken Result Genuine Adulterated Inf. Remarks Formal Informal Almond Paste - 1 1 - - Baking Powder — 2 2 — — Black Pudding — 1 1 — — Bun Flour — 1 1 — — Butter 1 — 1 — — Cake — 1 1 — — Cake Flour — 3 3 — — Cake Mixture — 1 1 — — Castor Oil — 1 1 — — Chutney — 1 1 — — Coffee — 2 2 — — Coffee and Chicory Essence - 1 1 — — Cooking Fat 1 7 7 1 — See (a) Cough Tablets — 1 1 — — Custard Powder — 1 1 — — Fat — 1 1 — — Fat Emulsion — 2 — 2 — See (a) Fish Cakes — 4 1 — 3 See (b) Fish Paste — 1 1 — - Flour — 1 1 — — Fynnon Salts — 1 1 — — Gelatine — 1 1 — — Ginger Wine — 1 1 — — Ground Ginger — 2 2 — — Hydrol — 1 1 — — Ice Cream — 67 67 — — Iced Lollies — 1 1 — — Lemonade Crystals — 1 1 — — Lemonade Powder — 2 2 — — 51 Luncheon Sausage - 4 3 - 1 See (c) Liver Sausage - 4 4 - - Macaroni - 1 1 - - Malt Vinegar - 3 3 - - Margarine 1 13 14 - - Milk 7 18 25 - - Milk (Condensed) - 3 2 1 - See (d) Milk (Dried) - 5 4 1 - See (e) Milk of Magnesia — 1 1 - - Mineral Spring Salts - 2 2 - - Mustard - 1 1 - - New Malsene - 1 1 - - Olive Oil - 1 1 - - Onion Powder — 1 1 - - Paraffin (Medicinal) - 1 1 - - Pickle - 1 1 - - Piping Jelly - 1 1 - - Pudding Mixture 1 - 4 - 1 See (f) Quinine — 1 1 - - Salad Oil - 1 1 - - Salt (Table) - 1 1 - - Sauce - 2 2 - - Sausages - 4 4 - - Sausage Meat 1 13 14 - - Savoury Filling - 1 1 - - Seidlitz Powder - 1 1 - - Semolina - 1 1 - - Soup Powder 1 1 1 - 1 See (g) Sponge Mixture — 1 1 - - Steamed Golden Pudding — 1 - 1 - See (h) Stewed Fruit - 1 1 - - Sweet Almond Oil - 1 1 - - Syrup of Figs - 3 3 - - Zinc Ointment — 1 1 — — 13 209 210 6 6 (a) Rancid and unfit for food. (b) Fish approx. 33% slightly deficient. (c) Meat content approx. 27% slightly deficient. (d) Acidity as lactic acid 1.17% (excessive). (e) Moisture 5.4%, Solubility 97%, Acidity as lactic acid 2.2%. (f) Mite infested. (g) Old Stock. Mite infested. (h) Infested with live mites. BACTERIOLOGICAL EXAMINATIONS. Milk. No. of samples taken Description Satisfactory Unsatistactory 107 Designated Milk 107 - 4 Ordinary Milk 4 - 12 Washed Milk Bottles 12 — 123 123 — 52 Ice Cream. No. of samples taken Description Bacteriological Examination Methylene I Blue II. Group Satis. Unsatis. III. IV. 109 Ice Cream 109 - 40 24 19 26 3 Ice Cream Mix. 3 - 1 1 1 - 2 Ice Lollies 2 - 2 — — — 1 Ice Pop. 1 — 1 — — — 115 115 115 samples of ice cream were procured, and results shown as under: — Grade I 46 = 40.0% Grade II 24 = 20.9% Grade III 19 = 16.5% Grade IV 26 = 22.6% 11 samples in Grade IV were from ice cream stored in this area, but not sold in it. Tabulation of Ice Cream Sampling since inception of Grading in 1947. Manufactured elsewhere Manufactured in Bromley 1947 % 1948 % 1947 % 1948 % Grade I 17.2 38.4 22.2 54.6 Grade II 27.1 21.2 11.2 18.2 Grade III 18.7 15.4 55.5 27.2 Grade IV 37.0 25.0 11.1 00.0 Number of samples taken 64 104 9 11 There was an improvement in the bacteriological quality of ice cream sold in Bromley during 1948 as compared with 1947. Pathogenic organisms were not found in any sample, e.g., 73 in 1947, 115 in 1948. It is significant that ice cream made in our area showed a marked improvement. When unsatisfactory samples manufactured outside Bromley are obtained, it is the practice to notify the Health Departments concerned; in consequence there has been an improvement in the quality. There was also a noticeable decrease in the number of itinerant dealers selling in Bromley during the weekends. 53 SPECIAL SURVEY. The special survey on public feeding places was continued during the year, special attention being given to the personal hygiene of all those dealing in food. The standard is a high one and it is pleasing to note the interest and the co-operation received. SPECIAL ENQUIRIES. The following table gives details of foods which were submitted for bacteriological examination after investigation into complaints made to this Department. No. of samples submitted Description Satisfactory Unsatisfactory 1 Apples 1 — 1 Apricots 1 — 1 Apricot Conserve 1 — 1 Butter — 1 2 Custard Powder 2 — 2 Cooking Fat 1 1 2 Dried Egg 2 — 3 Hors d'oeuvre 3 — 1 Jam Tart 1 — 2 Macaroni Pudding — 2 1 Margarine 1 — 1 Minced Meat 1 — 2 Meat Pie 2 — 2 Meat (Tinned) 2 — 1 Milk (Tinned) 1 — 17 Milk (Dried) 11 6 1 Milk Pudding 1 — 2 Pork Pie 2 — 1 Prunes 1 — 1 Potatoes 1 — 2 Rabbit Pie 1 1 4 Sago — 4 2 Salmon 2 — 1 Semolina — 1 3 Soya Flour 3 — 2 Water (Drinking) 2 — 2 Water (Rinse) 2 — 61 45 16 MEAT AND OTHER FOODS. Slaughterhouses. Six slaughterhouses are recorded on the register of the Local Authority. Two only of these premises are used at the present time, slaughtering being carried out on behalf of local pigkeeping clubs. No other slaughtering of animals is carried out in the area, centralised slaughtering still being in operation. Annual licences were granted to seven slaughtermen under the provisions of the Slaughter of Animals Act, 1933. 54 INSPECTION OF FOOD PREMISES. 2,871 visits of inspection were made to Food Premises during the ye?r, and 329 defects were noted. 251 defects were abated during 1948; this figure includes those noted in 1947 which were abated in 1948. MILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936 1946. The following licences were issued by the Local Authority under the above Regulations, in respect of designated milk:— Pasteurisers' Licences 2 Dealers' Licences: — "Pasteurised" Milk 9 "Tuberculin Tested" Milk 10 Supplementary Licences: — "Pasteurised" Milk 6 "Tuberculin Tested" Milk 6 MEAT The following table gives details of the ante- and postmortem inspection of animals made during 1948:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed — — — 29 Number inspected — — — 29 All Diseases except Tuberculosis. Whole carcasses condemned - - - 1 Carcasses of which some part or organ was condemned — — — 8 Percentage of the number inspected affected with disease other than Tuberculosis - - - 31,03 Tuberculosis Only. Whole carcasses condemned - - - 2 Carcasses of which some part or organ was condemned — — — 2 Percentage of the number inspected affected with Tuberculosis — — — — 13.79 UNSOUND FOOD. A total of 13 tons 2 cwts. 1 quarter 24¼ lbs. of foodstuffs was surrendered during the year as unfit for human consumption, as against 25 tons during 1947. 55 1287 Food Condemnation Certificates were issued during the year in respect of the quantities of foodstuffs shown in the following table:— Article of Food Quantity Containers Approximate Weight (lbs.) Bread, Cake, Biscuits, etc. - 478½ Cereals 45 392¼ Coffee 8 4½ Eggs (Fresh) 358 44¾ Eggs (Dried) 18 6¼ Fats 13 257¾ Fish (Fresh) — 6,061 Fish (Canned) 526 290 Flour and Flour Mixtures 2,028 3,088 Fruit (Fresh) — 230 Fruit (Canned, Bottled, etc.) 680 1,145½ Ice Cream — 122½ Jams and Syrups 426 887 Meat (Canned) 676 1,495 Meat (Fresh) and Bacon — 3,111½ Meat (Cooked) — 414 Milk (Tinned and Powdered) 960 6,525½ Pickles and Sauces 51 24 Poultry — 1,007¾ Rabbits — 1,626 Soup (Tinned) 144 129 Soup (Packets) 91 9 Sugar — 8 Sweets 5 72¾ Tea — 68 Vegetables 826 1,315½ Miscellaneous 414 582¼ 29,396¼ SECTION G PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES 58 SECTION G. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Statistical details regarding notifiable diseases are shown in Tables X, XI and XII in the Appendix. SCARLET FEVER 124 cases were notified during the year, giving an attack rate of 1.96 per 1,000 population. The cases were widespread in time and area, and there was no mortality. Seventy-nine of the cases were isolated in hospital, which is 63.7 per cent, of all notifications. There were six "return" cases. The type of infection continues to be mild and there were no serious complications in any of the cases. DIPHTHERIA. Three cases were notified during the year, all of which occurred in children of school age. In the case of two of these children, who had not been immunised, the attack was severe and of gravis type bacilli. The third child had been immunised against the disease and this was a mild attack. Diphtheria Immunisation is the only known means protecting childhood against the menace of diphtheria and every effort is made to induce parents to have their children immunised. DIPHTHERIA IMMUNISATION. The responsibility for this service has now passed from the Local Authority to the County Council. Immunisation is carried out at the various school clinics in the area by the Assistant School Medical Officers. POLIOMYELITIS AND POLIOENCEPHALITIS. Three cases of Poliomyelitis and one case of Polioencephalitis were notified during the year, as against the figures of 30 and 2 cases respectively for 1947. There was one adult death from Poliomyelitis, in addition to the adult fatal case of Polioencephalitis. TYPHOID FEVER. A Bromley case of Typhoid (a boy of 14 years) occurred in Farnborough Hospital and died on 28th November, 1948. The illness began about 23rd September, 1948; he was admitted to hospital for observation on October 29th, and was not diagnosed until November 11th, confirmed on November 16th and officially notified to me on November 17th. 59 Circumstances existed in this incident that would allow of widespread infection, and I believe that had we not discovered the carrier of the infection, a serious epidemic might have arisen. The circumstances that gave rise to this danger were: (1) The long period before diagnosis could be established— September 23rd to November 11th. (2) The large number of persons, both at home and at the school exposed to the infection for a lengthy period and not limited to Bromley residents. (3) The virulence of the infection which led to the boy's death. (4) The fact that the carrier, a resident maid, was for a period of three weeks employed in the preparation of food for family and guests. From the period September 23rd to October 23rd, the case attended school, except for seven days spread over that period. His brother, aged 17 years, had a minor illness for four days at the end of September, and has been proved, following bacteriological investigation, to have had an abortive attack. The carrier was of Public Health interest. She gave no history of illness since she had German Measles nine years ago. For a year prior to coming as a resident maid on September 13th, she had been a Naafi Superintendent and had a week's holiday in Northumberland before coming to Bromley. In neither place was there any Typhoid. Blood and stools which were taken from this girl on November 17th showed her to have Typhoid bacilli of the same type and character as the bacilli of the case that died. She was therefore either an active case of typhoid without symptoms, or a carrier. There was presumptive evidence that she was a carrier and the cause of the infection. It is significant that she went to the home on September 13th and within three weeks one acute typhoid and one abortive case arose in the family. Further tests taken from her confirmed her as a carrier and not a patient. On discovering the typhoid bacilli in her stools she was admitted to the Isolation Hospital where she now is and remains an active carrier. It is the responsiblity of the local authority to inform her officially that she is a carrier and while she remains so, must not be employed in the handling or preparation of food. Should she take her discharge from hospital and become employed in food handling, her employers must be so informed that she is a carrier. So far as I understand the law, there is nothing to stop her taking her discharge and seeking employment elsewhere in the country and it may be difficult to control her movements should she act in defiance of the advice rendered to her. As she is an unmarried mother, I have advised Sister Papps, who has an interest in the girl, that she should not be 60 so employed as to give rise to Public Health danger. The girl herself is an intelligent girl, is co-operative and fully understands the position. All the many contacts of the case were followed up and bacteriological investigations carried out. Four persons came under suspicion, but further tests proved negative. PUERPERAL PYREXIA. Twenty cases of Puerperal Pyrexia, representing an attack rate of 18.76 per 1,000 total births were notified, with happily no mortality. Nineteen of these cases were institutionally treated and one case occurred at home. OPT1IALMIA NEONATORUM. There were no cases of this disease notified during 1948. PEMPHIGUS NEONATORUM. Eight cases were notified during the year, all of which were institutionally treated and there was no mortality. MEASLES. 358 cases of measles occurred in the Borough, as against 533 for 1947, giving an attack rate of 5.65 per 1,000 population. There was no mortality and the distribution of cases occurring was fairly even throughout the area. WHOOPING COUGH. 196 cases were notified (3.09 per 1,000 population). Here again the cases were fairly evenly distributed throughout the Borough. TUBERCULOSIS. Details of new cases and mortality during the year are shown in Table XII of the Appendix. Recordings in the Register 1948:— Respiratory Other Forms Total No. M F M F of Cases On Register at 1.1.48 280 257 50 56 643 New cases notified during 1948 40 26 4 3 73 Number of cases coming to ledge after death 2 1 1 — 4 Restored to Register 1 1 — — 2 Inward Transfer 11 6 — — 17 334 291 55 59 739 Deletions—deaths, removals, recovery, etc. 21 17 2 3 43 No. of cases on register 31.12.48 313 274 53 56 696 61 Seventy-three new cases were added to the register, 4 cases were noted after death, 2 old cases were restored to register and there were 17 inward transfers to the area. 43 cases were deleted from the register on account of death, removals, recoveries, etc., leaving a net figure on the register of 696, an increase of 53 over the total for 1947. There were 23 deaths from all forms of tuberculosis during the year. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. No action was necessary in respect of these Regulations during 1948. PUBLIC HEALTH ACT, 1936 (SECTION 172). This Section relates to compulsory removal to hospital of persons suffering from tuberculosis. No case arose during the year. FOOD POISONING. There were no outbreaks of food poisoning within the area during 1948. OTHER INFECTIOUS DISEASES. In addition to the infectious diseases already enumerated, there were 31 cases of Pneumonia, 8 of Erysipelas, 2 of Cerebro spinal fever and 1 of Malaria, notified during the year. SECTION H. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. 64 SECTION H. OTHER SERVICES SUPERVISED BY THE HEALTH DEPARTMENT. DISEASES OF ANIMALS ACTS. Mr. G. R. Woods, Chief Sanitary Inspector, is the authorised inspector under these Acts for the Borough of Bromley. 74 inspections were made in connection with the administration of these Acts, of which 17 were in respect of suspected Fowl Pest. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. There are no special comments to make. PETROLEUM ACTS. The Chief Sanitary Inspector undertakes the duties of Inspector under the Petroleum Acts for the Borough. 98 licences for the storage of petroleum and one for the storage of carbide of calcium were issued in 1948. 107 visits of inspection were made by the Chief Sanitary Inspector and no contraventions were discovered. RETAIL MARKET. The Market Tolls collected during 1948 amounted to £200 17s. showing an increase of £62 2s. 6d. on the corresponding figure for 1947, and is the highest since 1940. APPENDIX. STATISTICAL TABLES. 66 STATISTICAL TABLES, 1948. Vital and General Statistics. TABLE I.— Summary of Statistics. TABLE II.— Causes of Deaths. TABLE III.— Infant Mortality—Causes and Age Groups. TABLE IV.— Infant Mortality—Analysis of Causes. Maternity and Child Welfare. TABLE V.— Health Visiting. Housing and Sanitary Inspection. TABLE VI.— Housing Statistics. TABLE VTI.— Summary of the Work of the Sanitary Inspectors. TABLE VIII.— Nuisances. Defects and Contraventions Abated. TABLE IX.— Factories Act, 1937. Notifiable Diseases. TABLE X.— Wards Distributions, Attack and Mortality Rates. TABLE XI.— Age and Sex Grouping. TABLE XII.— Tuberculosis—New Cases and Mortality. 67 TABLE I. Summary of Statistics 1948. Population (mid-year 1948, per Registrar General) 63,360 Birth Rate 16.4 Death Rate 9.9 Infant Mortality Rate 20.15 Number of Births (live) 1,042 Number of Stillbirths 24 Number of Deaths 631 Number of Infant Deaths (under 1 year) 21 Death Rate of Respiratory Diseases 0.9 „ „ „ Tuberculosis 0.3 „ „ „ Cancer 1.8 „ „ „ Zymotic Diseases 0.01 Notifications of Scarlet Fever 124 „ „ Diphtheria 3 „ „ Pneumonia 31 „ „ Tuberculosis 96 Number of Deaths from Scarlet Fever — „ „ ,, Diarrhoea (under 2 years) — „ „ „ Child Birth 2 Number of visits by Sanitary Inspectors 29,342 „ „ „ „ Health Visitors (to 5th July, 1948) 5,226 68 TABLE II. Causes of Death, 1948. Male Female Total 1. Typhoid and Paratyphoid Fevers 1 - 1 2. Cerebro-Spinal Fever 1 1 2 3. Scarlet Fever — — — 4. Whooping Cough — 1 1 5. Diphtheria — — - 6. Tuberculosis—Respiratory 12 6 18 7. „ Other forms 2 - 2 8. Syphilitic diseases — — — 9. Influenza — — — 10. Measles — — — 11. Acute Poliomyelitis, etc. 1 — 1 12. Acute Infectious Encephalitis — 1 1 13. Cancer—Buccal Cavity etc. (M), Uterus (F) 3 5 8 14. „ Stomach, Duodenum 5 5 10 15. ,, Breast — 17 17 16. „ Other sites 50 30 80 17. Diabetes 1 2 3 18. Intra-C.ranial Vascular Lesions 35 48 83 19. Heart Diseases 80 91 171 20. Other Diseases Circulatory System 17 16 33 21. Bronchitis 19 10 29 22. Pneumonia 11 10 21 23. Other Respiratory Diseases 6 4 10 24. Ulcer of Stomach or Duodenum 10 1 11 25. Diarrhoea (under 2 years) 2 - 2 26. Appendicitis — 1 1 27. Other Digestive Diseases 6 5 11 28. Nephritis 6 4 10 29. Puerperal Sepsis — 1 1 30. Other Maternal causes — — — 31. Premature Birth — 5 5 32. Congenital Malformation, etc. 9 6 15 33. Suicide 7 5 13 34. Road Traffic Accidents 3 — 3 35. Other Violent causes 1 9 10 36. All other causes 22 37 59 Totals 310 321 631 TABLE III. INFANT MORTALITY, 1948 (Compiled locally from Registrar's Death Returns) CAUSES OF DEATH Under 1 Week 1 and under 2 Weeks 2 and under 3 Weeks 3 and under 4 Weeks Total under 4 Weeks 1 month and under 3 Months 3 months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under 1 year Measles - - - - - - - - - - Whooping Cough - - - - - - - - - - Tuberculosis - - - - - - - - - - Convulsions - - - - - - - - - - Bronchitis - - - - - - - - - - Pneumonia — 2 — — 2 — — — — 2 Diarrhoea — — — — — — — 1 — 1 Gastro-Enteritis - - - - - - - 1 - 1 Injury at Birth 1 - - - 1 — - - - 1 Atelectasis 6 6 — - - - 6 Malformation — — — — — — — — — — Premature Birth 6 - - - 6 — — — — 6 Marasmus, etc. - - - - - - - - - - Other Causes 1 - - 1 2 - 1 - - 3 Syphilis - - - - - - - - - - Congenital Heart Disease 1 - - - 1 - - - - 1 Totals 15 2 - 1 18 - 1 2 - 21 69 70 TABLE IV. Analysis of Causes of Infant Deaths 1944-1948 1944 1945 1946 1947 1948 No. of Births (live) 820 872 1,176 1304 1042 Total Infant Mortality Rate 39 28 26 19 21 Malformation 7 4 3 13 27 Premature Births 4 9 14 5 6 38 Respiratory Diseases 3 3 4 5 2 17 Marasmus and General Debility 1 1 — — — 2 Infectious Diseases — — 1 — — 1 Gastro Enteritis 3 2 — — 1 6 Convulsions — — — — — — Other Causes 14 6 9 2 12 43 Totals 32 25 31 25 21 134 71 TABLE V. Health Visiting, 1948 (1st January to 5th July) Classification of Visits. Totals AREAS. 1 2 3 4 5 6 Primary Visits—Under 1 year 530 63 75 198 38 75 81 Re-Visits—Under 1 year 1,146 275 150 287 101 187 146 Re-Visits—1 to 5 years 2,396 398 302 756 246 413 281 Expectant Mothers 38 6 — 7 8 15 2 School Children 145 24 41 15 29 5 31 Special Enquiries—Stillbirths 5 2 3 — —- — — „ „ Infant Deaths 6 2 1 — — 2 1 Miscellaneous 120 8 28 3 67 6 8 Net Total of all Visits 4,386 778 600 1,266 489 703 550 "Ineffectual" Visits 840 161 183 282 24 82 108 Aggregate Total of all Visits 5,226 939 783 1,548 513 785 658 OTHER VISITS (Classified and Included in the above Tabulation) Diphtheria Immunisation 67 — — — — — 67 Boarded-out Children 20 3 3 4 — 5 5 Adopted Children 36 2 2 2 — 2 28 Totals 123 5 5 6 — 7 100 12 TABLE VI. Housing Statistics for the Year 1948 Total number of inhabited houses, 1948 17,574 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,901 (b) No. of inspections made for the purpose 11,119 (2) (a) No. of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) No. of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) No. of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,817 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,998 73 TABLE VII. Summary of the Work of the Sanitary Inspectors for the Year 1948 TYPE OF INSPECTION. On Complaint Routine Re Inspection Total Visits Nuisances Found Housing— 1. Inspection of District Regulations — — — — — 2. For Nuisances 2,457 529 8,133 11,119 12,843 3. Overcrowding 280 41 37 358 — 4. Verminous Conditions 29 — 31 60 19 5. Dirty Conditions 13 13 17 43 12 6. Water Supply 21 — 32 53 18 7. Cesspools 1 — 2 3 1 8. Earth Closets — — — — 9. Privy Pails 1 2 — 3 3 10. Houses Let in Lodgings 6 3 2 11 18 11. Disinfestation 15 3 13 31 2 12. Noxious Accumulations 2 4 11 17 5 13. Other Accumulations 30 7 32 69 25 Totals 2,855 602 8,310 11,767 12,946 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded in above table) — 187 16 203 — 2. Disinfection Purposes 24 32 3 59 — 3. Smallpox Inquiries — 27 1 28 — 4. Public Health (Aircraft Regulations) — — — — — Totals 24 246 20 290 — Meat, Milk and Other Food Shops— 1. Butchers 27 755 76 858 78 2. Confectionery — 50 36 86 20 3. Dairies and Cowsheds 4 167 25 196 22 26 4. Fish 8 385 33 426 5. Fried Fish 1 64 5 70 7 6. Food Hawkers — 8 — 8 — 7. Greengrocers, Fruiterers — 60 6 66 7 8. Grocery 42 543 122 707 163 9. Ice Cream — 192 31 223 3 10. Meat Regulations (Special Visits) 5 44 — 49 — 11. Milk Examined on Highway — 20 — 20 — 12. Retail Market — 74 — 74 3 13. Slaughterhouses — 35 — 35 — 14. Horseflesh Shops — 53 — 53 — Totals 87 2,450 334 2,871 329 Factories, Outworkers, etc. 1. Factories in which Sects. 1, 2, 3, 4 and 6 of the Factories Act 1937 are to be enforced by the Local Authority 1 28 53 82 29 2. Factories not included in 1 in which Sect. 3 is enforced by the Local Authority 27 52 55 134 114 3. Other Premises in which Sect. 7 is enforced by the Local Authority (excluding outworkers' premises) — — — — — 4. Bakehouses (a) Mech. power 2 60 33 95 41 (b) Non-mech. power — 6 — 6 1 5. Outworkers' premises — 33 5 38 — 6. School Canteens 10 56 12 78 19 7. Smoke Abatement 1 10 13 24 — 8. Restaurants, Hotels, Etc 4 85 34 123 105 Total 45 330 205 580 309 74 TABLE VII. (Continued) Type of Inspection On Complaint Routine ReInspec tion Total Visits Nuisances Found Sampling of Food and Drugs- 1. Milk: T.T. Certified — 5 — 5 — T.T. Pasteurised — 15 — 15 — Pasteurised — 37 — 37 — Accredited — — — — — Sterilised — — — — — Ordinary — 4 — 4 — Tinned 1 3 2 6 — Dried 2 4 4 10 — 2. Other Foods 8 95 13 116 — 3. IceCream — 50 — 50 — Ice Cream Ingredients 1 41 — 42 — 4. Food Poisoning 5. Samples from: Milk past, plants — 14 — 14 — Samples of bottles — 5 — 5 — Totals 12 273 19 304 — Trade PremisesVarious 1. Under Shops Acts. 3 58 69 130 71 2. Under Petroleum Acts — 51 56 107 — 3. Registry Offices 2 — 2 4 — 4. Offices (P.H. Act, Sees. 46 and 91) 4 1 9 14 12 5. Diseases of Animals Acts: — 3 — 3 — Movement Licences — — — — — Sheep Dipping — — — — — Foot and Mouth Disease — — — — — Fowl Pest 4 13 — 17 — Swine Fever — — — — — Other — 32 — 32 — 6. Piggeries 1 13 — 14 1 7. Stables 1 6 — 7 3 8. Public Houses—Urinals 1 95 11 107 3 Totals 16 272 147 435 90 Rodent Control— 1. Refuse Tips — 14 — 14 — 2. Trade Premises 484 588 4,500 5,572 299 3. Private Premises 680 926 5,389 6,993 1,394 4. Sewers — 3,480 — 3,480 915 Totals 1,164 5,008 9,887 16,059 2,608 Miscellaneous— 1. Keeping of Animals 16 2 17 35 6 2. Schools 9 25 13 47 24 3. Drain Tests: Smoke 3 10 — 13 1 Water 28 145 — 171 5 Colour 2 2 — 4 1 Chemical — — — — — Mirror — — — — — 4. Tents, Vans and Sheds — 1 — i — 5. Billets and Camps 1 — — 1 — 6. Swimming Baths — 46 — 46 4 7. Accumulations (other than dwellings) 25 5 47 77 24 8. Streams 2 2 3 7 —- 9. Unclassified — 101 — 101 Totals 86 337 80 503 65 4,289 9,518 19,002 32,809 16,347 Interviews (in addition to above) 1,343 75 TABLE VII. (Continued) Food and Drugs Samples Taken ARTICLE No. of Samples taken TYPE OF EXAMINATION Bact. or M.B. T.B. Phos. Chem 1. Milk: T.T. Certified 8 8 — 6 — T.T. Pasteurised 10 10 — 10 — Pasteurised 44 44 — 44 18 Accredited — — — — — Sterilised 1 1 — — — Ordinary 4 4 2 — 7 Tinned 4 1 — — 5 Dried 22 17 — — 17 School Milks (Pasteurised) 16 15 — 15 1 2. Other Foods 171 28 — — 143 3. Ice Cream 183 115 — — 68 Ice Cream Ingredients. 2 2 — — — 4. Food Poisoning 16 14 — — 2 5. (a) Samples from milk pasteurising plant 28 28 — 28 28 (b) Samples of milk bottles 12 12 — — — 6. Water (drinking) 2 2 — — — Totals 523 76 TABLE VIII. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1948 HOUSING Drainage- Premises re-drained and connected to sewer — Cesspools abolished — Earth Closets abolished — Cesspools emptied 2 Privy pails, etc. abolished — Drains relaid or repaired 164 Drains unstopped 168 Inspection chambers provided 41 W.Cs. provided (additional or separate) 9 „ buildings reconstructed 4 ,, „ repaired 114 ,, pans renewed 494 „ ,, cleansed 3 ,, box seats removed 20 Soil/vent pipes renewed or repaired 33 Sink/bath waste pipes renewed or repaired 96 Sinks renewed 136 Lavatory basins provided 19 — 1,303 Dampness- Roofs repaired or renewed 742 R.w.p.'s, guttering, repaired or renewed 457 Vertical plinths provided 42 Walls rendered 183 Horizontal damp-course provided 12 Solutioning 3 Earth removed from walls 17 Walls repointed 135 Weather-board walls repaired, etc. 19 Sub-floor ventilation provided or improved 102 Dry areas constructed 120 Brickwork repaired 80 Site Concrete provided — Miscellaneous 171 — 2,083 Water Supply- Drinking water service supplied direct from main 20 Fittings, etc. renewed 452 Separate or additional water supply provided 6 Supply reinstated 36 Flushing cisterns renewed or repaired 197 — 711 77 TABLE VIII. (Continued) General Items- Rooms cleansed 1,808 W.C. walls cleansed 173 Entrance hall and staircase cleansed 197 Bathroom cleansed 109 Light and ventilation improved 32 Plastering repaired or renewed 2,220 Floors repaired or renewed 255 Windows, frames, etc. repaired or renewed 615 Sashcords repaired or renewed 175 Putty pointing repaired or renewed 208 Doors repaired or renewed 175 Stoves and grates repaired or renewed 230 Coppers repaired or renewed 16 Handrails repaired or renewed 6 Stairtreads repaired or renewed 26 Dustbins provided 134 Dirty conditions remedied 25 Overcrowding abated 14 Chimneys repaired 185 External woodwork repainted 297 Food stores provided 7 Food stores ventilated 3 Yard paving renewed, etc. 29 Houses disinfected 41 Accumulations removed 54 7,034 Total 11,131 MEAT, MILK AND OTHER FOOD PREMISES— Yards, floors, etc repaired 31 Shops, rooms, etc. cleansed/limewashed 61 Lighting/Ventilation improved 29 Drainage improved 11 Manure or refuse removed 10 Refuse bins provided 10 Floors, etc. cleansed 7 Cold storage improved 8 Water supply improved 16 Sinks provided 4 Miscellaneous 64 Total 251 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 52 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) 3 Inadequate ventilation (Sect. 4) 4 Ineffective drainage of floors (Sect. 6) 4 Sanitary conveniences (Sect. 7): (a) Insufficient 7 (b) Unsuitable or defective 37 (c) Not separate for sexes 4 Other offences 79 Outworkers' premises — Smoke nuisances — Restaurants, Hotels, etc. (nuisances remedied) 68 Total 258 78 TABLE VIII. (Continued) TRADE PREMISES— Shops Acts: Ventilation improved 1 Temperature improved — Sanitary conveniences improved 18 Absence of statutory forms remedied 3 Unsatisfactory Washing facilities remedied 9 Meals rest interval contraventions remedied — Seats for female workers provided 17 Other offences remedied 24 Petroleum Acts contraventions — Registry Office contraventions 2 Offices (P.H. Act, 1936, Sect. 46) contraventions 16 Diseases of Animals Acts contraventions — Piggeries, cleansing, etc. — Stables, cleansing, etc. — Total 90 RODENT CONTROL— Trade premises 201 Private premises 2,391 Sewers (manholes) 105 Total 1,697 MISCELLANEOUS— Animal nuisances 9 Tents, Vans and Sheds — Billets and Camps — Accumulations (other than dwellings) 24 Stream pollutions 1 Schools 6 Total 40 Grand Total 13,467 NOTICES ISSUED— Preliminary: Housing 2,227 Food Premises 139 Factories, etc. 64 Trade Premises 29 Rodent Control 470 Miscellaneous 73 3,002 Statutory: Housing 4 3,006 79 TABLE IX. Factories Act, 1937 I. Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by the Local Authority 58 82 6 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 200 134 68 — (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 1 1 — — Totals 259 217 74 — II. Cases in which defects were found. Particulars No. of cases in which defects were No. of cases in which prosecutions were instituted Found Remedied Refe rred To H.M. Inspector By H.M. Inspector Want of cleanliness (Sect. 1) 37 52 — — — Overcrowding (Sect. 2) — — — — — Unreasonable tempe'rature (Sect. 3) 1 3 — — — Inadequate ventilation (Sect. 4) 1 4 — — — 2 4 — — — Sanitary Conveniences (Sect. 7)— (a) Insufficient 5 7 — 1 — (b) Unsuitable or defective 80 37 — 21 — (c) Not separate for sexes 2 4 — 1 — Other offences against the Act (excluding Outwork) 77 79 — — — Totals 205 190 — 23 — Outwork Nature of Work No. of Outworkers Number of Inspections Nuisances Notices Served Wearing Apparel 19 20 — — Making of Paper Boxes 3 3 — — Christmas Crackers 1 1 — — Totals 23 24 — — 80 TABLE X. Notifiable Diseases (Civilian) Ward Distribution, Attack and Mortality Rates Disease Total WARDS Cases removed to Hospital Attack Rate per 1,000 population No. of Deaths Death Rate Plaistow Martin's Hill Town Sundridge Bickley Bromley Common Keston and Hayes Scarlet Fever 124 11 23 12 20 12 31 15 77 1.96 — — Whooping Cough 196 38 7 18 37 34 48 14 2 3.09 1 0.01 Acute Poliomyelitis 3 — — — — 1 1 1 2 0.05 1 0.01 Acute Polioencephalitis 1 — — — — 1 — — 1 0.01 1 0.01 Measles 358 105 28 9 54 23 37 102 2 5.65 — — Diphtheria 3 — — — — 1 2 — 3 0.05 — — Acute Pneumonia 31 7 1 — 6 6 9 2 14 0.49 21† 0.33 Dysentery — — — — — — — — — — — — Erysipelas 8 2 1 2 — 2 — 1 — 0.13 — — Cerebrospinal Fever 2 1 — — — — — — 2 0.03 2 0.03 Puerperal Pyrexia 20 — — 17 2 1 — — 19 18.76§ — — Typhoid & Paratyphoid Fever 1 — — — — — — 1 1 0.01 1 0.01 Malaria (contracted abroad) 1 1 — — — — — — — 0 .01 — — Tuberculosis: Pulmonary 88 18 12 12 2 13 17 14 — 1.39 18 0.28 Non-Pulmonary 8 1 2 1 1 2 1 — 0.13 2 0.03 Totals 844 184 74 70 122 95 147 151 123 13.3 47 0.74 †Includes Pneumonia (all forms). Notifiable types include only acute primary pneumonia and acute influenzal pneumonia. §Based on attack rate per 1,000 (live and still) births, and not population. 81 TABLE XI. Notifiable Diseases, 1948 (Civilian) Sex and Age Distribution Disease Totals 0- 1- 3- 5- 10- 15- 25 and over Age Unknown M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 56 68 — — 3 3 10 14 37 38 4 8 1 2 1 3 — — Whooping Cough 85 111 8 17 23 30 25 34 28 28 — — — 1 1 1 — — Acute Poliomyelitis 3 — — — — — — — — — 1 — — — 2 — — — Acute Polioencephalitis — 1 — — — — — — — — — — — — — — — — Measles 192 166 — — 28 37 45 36 108 83 7 5 4 2 — 2 — 1 Diphtheria 2 1 — — — — — — 1 1 — — — — — — — — 338 347 8 17 54 70 80 84 174 150 13 13 5 5 4 7 — 1 0- 5- 15- 45- 65 and over Age Unknown Acute Pneumonia 16 15 2 — — 1 7 6 4 4 3 4 — — Dysentery — — — — — — — — — — — — — Erysipelas 2 6 — — — — 2 6 — — — — — — Cerebro-Spinal Fever ... — 1 — 1 — — — — — — — — — — Puerperal Pyrexia — 20 — — — — — 20 — — — — — — Typhoid & Paratyphoid fevers. 1 — — — — — — — — — — — — — Malaria (contr'ct'd abroad) 1 — — — — — 1 — — — — — — — Tuberculosis— Pulmonary 55 33 2 — 2 1 34 28 15 2 2 2 — — Non-Pulmonary 5 3 — — 2 1 3 2 — — — — — — 80 78 4 1 5 3 47 62 19 6 5 6 — — 418 425 82 TABLE XII. TUBERCULOSIS New Cases and Mortality during the Year 1948 Age groups New rases notified or otherwise revealed. (Not including Inward Transfers.)* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 — — — — — — — — 1— 5 1 1 — — — — — — 5—15 2 1 2 1 — — 1 — 15—25 11 13 1 2 2 4 — — 25—35 8 6 — — 1 1 — — 35—45 7 3 2 — 2 1 — — 45—55 5 — — — 3 2 — — 55—65 7 — — — 3 — — — 65 and over 2 2 — — 1 2 — — 43 26 5 3 12 10 1 — *Inward Transfers 11 6 — — Totals 54 32 5 3 In addition one male and one female (pulmonary) patients who had previously removed from this Borough, returned, and their names were, accordingly, restored to the Register, BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1948 K. E. TAPPER, O.B.E., G.M., MB, Ch.B., D.P.H. Medical Officer of Health 84 Members of the Welfare Committee. Alderman M. Stafford Smith, M.B.E., B.A. (Chairman). Councillor H. M. V. Green (Vice-Chairman). Councillor H. Dorrett. Councillor A. L. Hill. Councillor G. H. Russell. Mrs. E. J. Munn. Rev. F. W. Armstrong. M.A. Officers of the Committee. Acting Borough Education Officer: A. C. Cleveland. Chief School Enquiry Officer : (Vacant). Staff. The services of the Public Health, Maternity and Child Welfare, and School Welfare are joint services, and officers perform multiple duties. The members of the staff, as at 31st December, 1948, whose duties are concerned with the School Health Service are as follows:— Proportion of time Medical Officers. allocated to School Health Whole-time: Service Medical Officer of Health Dr. K. E. Tapper ½ Assistant Medical Officers Dr. G. H. Stinson * 5/8 Dr. A. E. Orgler * 3/4 Dr. P. A. Currie * 3/4 Dr. N. C. Elphinstone.* (Temporary) 3/14 Part-time: Orthopaedic Surgeon Dr. K. F. Hulbert * 2 sessions a month Ophthalmic Surgeon Dr. Eric Lyle * 3 sessions a week Dental Officers. Whole-time Mr. P. Mayo * 7/10 Part-time: Mr. B. S. Birkhahn * 4 sessions a week Mr. Fairman J. Ordish * 4 sessions a week Clinic Assistants Mrs. W. Carrie * Whole-time Miss F. E. Rolfe * 7/10 Miss M. Ellen * 1/6 (part-time) Nursing Staff. Whole-time Miss E. B. Crowe * ½ Miss F. L. Gray * ½ Mrs. N. M. Taylor * ½ Miss W. G. Hemmings * ½ Miss H. M. Hogger * ½ Part-time. Mrs. M. K. Feilden 5 sessions a week Masseuse Mrs. P. A. Urwin * 6 sessions a week Orthoptist Miss P. a. Cope * 6 sessions a week 85 Clerical Staff. Chief Clerk Mr. S. F. Judd 3/8 Senior Clerk Mr. E. P. J. Wythe 3/8 Grade I. Clerk Mrs. D. Cox 3/4 Grade II. Clerks Miss S. Potterton 3/4 Miss M. Kelly 3/4 *County Officers. (Kent County Council Staff.) Introduction. To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen, The School Health Services in the "excepted District" of Bromley have continued to function well throughout the year and have complied with the County Scheme for the Health of the School Child. All the age groups, viz.: five, eight, eleven and thirteen years old, were medically examined at school, necessitating 245 sessions for the examination of 3,035 children. There are, however, some schools where the facilities for a proper medical examination at school are impracticable and it was necessary to carry out these examinations at special sessions at the School Clinic. These periodic medical inspections, because they are complete examinations, bring to light certain defects in the child which are causing, or might cause, serious interference with the child's receiving the full benefit of the education provided. It is again pleasing to note that the parents attend and welcome these medical examinations and, in the case of the primary schools, the attendance of parents is almost 100 per cent. The following up of children found to have defects is carried out at the school medical clinics of which there are four in the Borough. The clinics are available to parents and teachers seeking advice on the children and is perhaps the main field of work in the School Health Services. In association with the medical clinics are the minor ailment treatment clinics; no less than 6,656 medical examinations were carried out and 16,030 attendances were made at these clinics by children, during the year. The co-operation with the Hospital services is a close one and complete, and I am indeed indebted to the staff at the hospitals for the help they render us and the children. The figures are indicative of the confidence the parents place in the School Health Service and this link between the 86 medical officers and the family is of great value in encouraging any advice which leads to healthier living and prevention of disease. In addition to these medical examinations there are the special clinics : orthopaedic, eye, orthoptic, dental, etc., which are reported on fully within the report. We were handicapped during the year by the serious illness of Dr. Orgler, and I am unable, this year, to continue the investigations into height and weight comparisons of the Bromley school child. In the retirement of Miss Briggs, School Nurse in Bromley for 25 years, we have lost a loyal worker whose knowledge of the families was invaluable to the service as a whole and who was untiring in her efforts to make this service what it is to-day The importance of this work by School Nurses and Health Visitors cannot be overstressed, for without their knowledge of the home life and circumstances of the family the work of the medical staff would be frustrated. One cannot exclude from this short introduction a comment on the threatened breakdown of the School Dental Service, which has been built up over the years into a complete and efficient service. This breakdown is due to the shortage of Dental Officers —a shortage due to the financial attraction in other fifclds of dental work. It is a sincere hope of all interested in the welfare of the school child that this service will soon recover, otherwise irreparable damage may result. There is one other service which is a prime factor in the improvement in the physique of the school child : the school meal service. This service has been well advanced in Bromley, and no less than 79% of Bromley children are receiving this mid-day meal at school and 92% are receiving the school milk. A fact which must not be overlooked is that the larger the number of persons receiving a meal the greater the calamity would be in the event of food poisoning unless the strictest rules of hygiene in the handling and preparation of food are applied. I am pleased to report that the staff dealing with school meals are fully aware of this, and are, to the best of their ability with facilities available applying these principles. All the staff have worked with enthusiasm and efficiency, and to Mr. Judd, who has been responsible for the collation of statistics in this report, I am indebted. K. E. TAPPER; Medical Officer of Health. 87 General Information. School Roll 18 Primary Schools 4,311 4 Modern Schools 1,314 2 Grammar Schools 1,357 Technical School for Girls 381 7,363 Further Education. School of Arts and Crafts, Tweedy Road. Building Department, Wharton Road. Technical Institutes. Bromley Technical Institute (County Grammar School for Boys). Raglan Road Evening Institute. Burnt Ash Evening Institute. SCHOOL HYGIENE. The rebuilding of the bomb damaged Princes Plain County Modern School was completed during the year, and the school reopened in the autumn term, 1948. 282 pupils are now attending this school, the reopening of which has to some extent alleviated the overcrowded condition of other schools within the area. With the exception of the temporary school premises of Bickley and Widmore Church of England Primary School, and the Parish Church of England Primary School, College Road, which are far below standard, the cleanliness and hygiene of Bromley schools has been maintained. Long delayed plans are under consideration for a complete new system of lavatories at the Bromley Parish C.E. School to replace the present system, and it is hoped that this work will be undertaken during 1949. Replacement of the obsolete type of water closets at the Valley County Primary School has been carried out, and it is hoped that the remainder of the lavatory accommodation at that school will be modernised during the course of 1949. School canteens have been frequently inspected during the year, and, whilst some of the buildings are not of the required standard, conditions generally are satisfactory. The programme of the Ministry of Education provides for new or modernised canteen buildings to be provided during the next three years. 38 MEDICAL INSPECTIONS AT SCHOOL. (See Tables I A and I C, and Table II A, cols. 2 and 3.) During the year 3,035 children were examined, necessitating the holding of 245 medical inspection sessions at the schools, the average attendance being 12.4 per session. 483 individual pupils were found to require treatment (excluding Dental Diseases and Infestation with Vermin), giving a percentage of 15.9, as against 30 per cent. for the previous year. The Assistant School Medical Officers, commenting on their inspections during 1948, state that although skin cases occur from time to time, instances of scabies, etc., are few and far between There have been a few cases of multiple boils, but these have cleared up with local treatment together with general and sunlight treatment. Cases of flat foot are numerous, although many children with this condition do not seem to suffer any pain or inconvenience The inferior footwear of war-time years may have still accounted for many of these cases. The interest taken by parents in the health of the child is a source of satisfaction, and many mothers attend at the clinics when their children are being examined. Opportunity is taken at these times to obtain consent of the parents for the "booster" doses of anti-diphtheria serum, at 5 and 9 years of age. Every effort is being made to achieve a 100% protection figure, no forgetting those who have not already been primarily immunised The examinations themselves show a satisfactory standarc both of health and general physique. SPECIAL INSPECTIONS. (See Tables I B, II A, cols 4 and 5, III, Group I, and Table VIII.) 4,149 cases have come under medical supervision during the year, necessitating 6,656 medical examinations. 131 cases requiring special investigation or certification were referred for examination at the Municipal Offices. The great importance of the School Clinic is demonstrated by the very low incidence of skin infections, impetigo, scabies, etc., and although only minor complaints can be treated, disease can be often readily detected at the onset, and an early start of treatment made. This has been found to be particularly important with regard to ears; previously, many cases of acute otitis proceeded to perforation, with a recurrent discharge and frequent impairment of hearing; now it is possible to initiate Penicillin treatment with quite dramatic results. 212 cases were referred to Farnborough Hospital for Pediatricians' and other specialists' advice and treatment, and I would 89 6nce again express my appreciation of the help given by the Pediatric Unit at this hospital, especially by Dr. Hackwood, Dr. Leys and Mr. Lipscombe, the ear, nose and throat consultant. DENTAL INSPECTION. (See Table IV.) Mr. P. D. B. Mayo reports as follows: The year commenced with a depleted staff of one full-time and two part-time Surgeons. Efforts were made to overcome the special and emergency treatments, and to commence routine inspections again. Mr. Ross (part-time) resigned in April, and was replaced by Mr. Mayo (full-time). With the extra sessions thus made available, it was possible to maintain school inspections and treatment and to recommence the orthodontic scheme. It was hoped that a complete programme of inspection and treatment would be achieved during the year, but owing to the fact that Mr. Birkhahn reverted to part-time service during October, this was not possible. However, only four schools remained uninspected and treated at the end of the year. In May the Orthodontic clinic became available to all serious cases, and we are indebted to Mr. G. C. Dickson, the County Orthodontic Officer, for his advice and hard work in maintaining the service. "The Maternity and Child Welfare service has been maintained, and all cases referred to the clinics have received treatment. This service came under the County administration on 5th July, 1948. "It may be seen from the year's statistics that a great deal of extremely useful preventative work was done. This is fortunate, as the service faces 1949 with only one full-time and one part-time Surgeon. It is to be hoped that, when so much has been achieved, the service will not be allowed to lapse into its emergency state again.'' VERMIN AND UNCLEANLINESS INSPECTION. (See Table V.) 14102 routine inspections were carried out by the School Nurses during the year. 26 children were found to be infested, with a further 317 children showing minor evidence of uncleanliness. This is a satisfactory reduction on last year's figures of infestation, but, obviously, there is still room for improvement. 90 TREATMENT. Attendances for minor ailment treatment at the clinics again show an increase over the previous year, 16,030 attendances being made during 1948, as against 15,795 during 1947. Some inconvenience is being caused to a few parents whose children attending the clinic require treatment by prescriptions, as the child must be referred to its family doctor in order that the prescription may be obtained free under the National Health Service Act. With the coming into operation of this Act the Minister has ruled that no prescriptions should be issued by Medical Officers at these clinics. Special clinics continue to be provided covering orthopaedic, ophthalmic, dental and speech defects. Cases requiring hospital treatment are referred to either Farnborough Hospital or Bromley Hospital, and those requiring domiciliary treatment are referred to their own doctor. Children in need of Child Guidance treatment are referred to the County Council for appointments at the Child Guidance Clinic. Since the introduction of the National Health Service Act the responsibility for the treatment of tubercular children has passed to the South Eastern Regional Hospital Board, and children in need of treatment are referred to the Chest Clinic at Park Road, Bromley. ORTHOPÆDIC CLINIC. (See Table III, Group IV.) This service is operated by the Kent County Council, who provide their own Orthopaedic Surgeon and Physiotherapist. In-patient treatment is provided at Pembury Hospital or Southern Hospital, Dartford. I am indebted to Mr. K. F. Hulbert, the Orthopaedic Surgeon, for the following report : "During the past year 33 Surgeon's sessions have been held and 934 patients have attended for consultation. The numbers of patients attending is increasing considerably, and several extra sessions have had to be held in order to keep the waiting list down to a reasonable time. The number of attendances for massage and exercises was 4,684, and 1,482 attended for ultra-violet ray treatment. The cases seen have not differed appreciably from former years, and disorders of the feet and back, of course, predominate. "The problem of the spastic child still gives cause for some concern, because so often these children are not fit for an ordinary school, and accommodation at special schools is very difficult at the present time. The result is that several of these 91 children are not getting adequate education, which in these cases is often the only compensation for the physical deformity. "The renovations in the Clinic room have been very much appreciated. "During the past year some orthopaedic beds have been made available at the Southern Hospital, Dartford, and as a result of this facility the In-Patients' waiting list has been considerably reduced." OPHTHALMIC CLINIC. (See Table III, Group II.) Dr. Eric Lyle reports as follows: "There has been a steady increase in the work at the Bromley School Eye Clinic this year; 1,213 cases have been examined, of which 570 were new cases and 643 re-inspections. This has necessitated an increase in the nuinber of sessions held each week. Instead of two sessions each week, there are now three, and it is hoped that the waiting list of patients for examination will soon decrease in consequence. "The average attendance at each clinic has been very high, more especially so since the inception of the State Service on July 5th. This increase of attendance rate is, of course, a good thing in that children who need treatment are getting it and seem to be rightly encouraged by their parents to obtain the necessary treatment. This fact is to be regarded as a very satisfactory outcome of the State Health Service and its implications. "Unfortunately, there are a few matters which have arisen as disadvantages since the School Ophthalmic Service has come under the control of the National Health Service : "(1) The delay in obtaining lenses for school children is quite phenomenal and extremely disquieting. Whereas before July 5th spectacles could be dispensed within 10-14 days, now it is more like 10-14 weeks. This is a very unsatisfactory feature and one which should be remedied. "(2) The increase in form-filling is irksome and timeconsuming. It adds at least twenty minutes on to the total time expended per session. It is hoped that the present form, O.S.C.2, will be dispensed with when the Hospital Service takes over the School Eye Clinics. "(3) Whereas before July 5th such things as SALVOC lenses and Occluders were able to be prescribed at the Clinic, now. when these articles have to be prescribed, these cases have to be referred to my own Hospital Out-Patients' Department. Then, 92 and then only, am I able to prescribe these things. This is a cumbersome arrangement, and wastes the time of the patient, the parent and myself. "However, if the children can be given the necessary treatment, and if the State Service is such that it is taken full advantage of (as it would seem to be at the present time), then I feel that all these petty annoyances and difficulties must be worth while and must be tolerated. "As in 1947, so in 1948 a very considerable number of cases of Squint have been successfully treated, mainly by the combined method of correction of refraction error, Orthoptics and Operation. Miss Cope, the Orthoptist, has co-operated whole-heartedly in all the work. I am much indebted to her and wish to record my appreciation of her work. "I should like to conclude this report by thanking those who have helped to make the running of the Department both happy and efficient, and in particular the Health Visitors and School Nurses and Administrative Staff of the Health Department." ORTHOPTIC CLINIC. (See Table VI.) 76 sessions have been held, and attendances at the Orthoptic Clinic during the year have been good, showing a slight increase over 1947. Some new cases have been referred by Dr. Lyle from the Chislehurst Clinic as well as from the Bromley and Orpington Clinics. 29 cases have been discharged as cured during the year, and 13 of these have been discharged with binocular single vision. The delay experienced in dispensing lenses and frames for the patients attending this Clinic has proved a great disadvantage to treatment. EAR, NOSE AND THROAT CLINIC. (See Table III, Group III.) 60 children received operative treatment at Farnborough Hospital for tonsils and adenoids during the year, which is a slight increase over the number receiving treatment in 1947. At the 31st December, 1948. there were 99 children awaiting operative treatment. No child was found to require treatment for serious diseases of the ear during 1948. 93 SPEECH CLINIC. (See Table III, Group V, and Table VII.) This service is operated through the Health Department at Maidstone. One session of 2½ hours per week is held at the South Clinic, Princes Plain, under the control of Dr. Stableforth. 43 sessions were held during the year. Lip reading classes for children who are "hard of hearing" are also operated through the County Health Department, and, commencing from 16th October, 1948, classes have been held on Saturday mornings at the South Clinic, Princes Plain, under the supervision of Miss E. C. Duke. EXCEPTIONAL AND HANDICAPPED CHILDREN. The total of attendances at the special clinic held at the Municipal Offices on Saturday mornings for exceptional and handicapped children during 1948 was 131. Details of all handicapped children are shown in Table VIII. CHILD GUIDANCE. (See Table Illj Group V.) Responsibility for this service rests with the County School Medical Officer, to whom all cases are referred for treatment at the Child Guidance Clinic at Chislehurst. 28 cases were so referred during the year, after reports had been received from the head teacher of the child's school and an environmental report had been received from the School Nurse. Owing to the long waiting list, there is considerable delay in receiving appointments, and further sessions are required. MILK IN SCHOOLS. There is no change to report in the arrangements for the provision of milk during the year. The permitted quantity of milk per child per day has throughout the year remained at one-third of a pint. A return to the Ministry of Education shows that, on a day in October, the percentage of pupils receiving milk, based on the number in attendance, was 92%. 94 SCHOOL MEALS SERVICE. The progress in the provision of new Kitchen and Dining Huts for schools has, unfortunately, not been as rapid as expected, due to the fact that a priority list for the County as a whole was introduced by the Ministry early in the year, which meant that the majority of the prospects for Bromley had to give way to more urgent requirements elsewhere in the County. Certain work has, however, been carried out during the year. In May the Ministry of Works commenced the erection of a Kitchen and Dining Hut at Aylesbury Secondary School for Girls, to provide 500 meals a day; a new Kitchen and two Dining Huts at Princes Plain Secondary and Primary Schools, to serve 600 meals daily, were completed and taken into use in September; a much needed extension to the Kitchen at the College of Art was carried out during the summer vacation, and a start was made in October on a Kitchen and Dining Hut for the new Secondary School at " Quernmore.'' The daily average number of meals being served towards the end of the year was 6,100, and a return sent to the Ministry of Education showed that on a single day in October 79% of the pupils in attendance at school received a mid-day meal. NURSERY SCHOOLS. There are no important changes to report during 1948. Proposals are under consideration for extending the accommodation at the Valley County Primary School to meet the new regulations of the Ministry of Education. The Nursery Classes at this school and the Burnt Ash County Primary School have been accorded official recognition by the Ministry of Education, and it is anticipated that the recognition will be confirmed when additional works have been carried out. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. 82 boys and 31 girls were examined by the School Medical Officers in respect of fitness for employment out of school hours Fit certificates were issued in all cases. JUVENILE DELINQUENCY. 74 children appeared before the Court during the year, a decrease of 10 over 1947. The types of offences were as follows: Larceny 38 Shop and store breaking 15 Breach of recognizance 8 Beyond parental control 5 Shoplifting 6 Traffic offences 2 74 95 PHYSICAL TRAINING. Report of the Physical Training Organiser. General.—As stated in my report for 1947, we are still in process of witnessing a remarkable advancement in methods of teaching physical education in our schools. The whole conception of the teaching of physical education is steadily changing and broadening. The Physical Training, games and dancing lessons are no longer separated, but are so unified that the physical education of the child may now be interpreted as the development of his or her body and personality in ways that are enjoyable. Growth in children goes on whether we do anything about it or not, and in order to make this natural growth easier plenty of opportunity for movement is essential. Also, it is true that by scientifically planned exercises the development of the body is affected for good. The child should be taught by informal methods and incidental coaching in order to get the strong, free movement of an agile, mobile body. In addition, boys and girls should also achieve the confidence and skill of foot, hand and eye, which is the basis of all games technique and which equips them to take part intelligently in the more advanced games they will play in later years. This type of activity demands great skill and knowledge on the part of the teacher, who should, by suggestion and encouragement, present the next stage of progression in training skills and practices for any one of her pupils. Thus a very sound knowledge of the subject is called for, and it is to be regretted that on the male staff side little help and assistance has been possible in order to supplement the very meagre period of initial training given to many men teachers after leaving the Services. Primary Schools.—Development in physical education in Primary Schools has been most marked during the year. Small apparatus of all kinds, such as hoops, ropes, balls, etc., has been increasingly used in all schools for training practices. This factor has widened the scope of the work considerably and stressed the value of games and activities of a varied nature, and, in addition, by increasing the enjoyment, interest and activity, has helped to achieve greater informality of method. Activities suggested in modern physical education tend to produce skill in the use of the body, agility, good jumping ability, balance and fundamental games skills. Soon we hope to have in our schools large Fixed Apparatus, chiefly for out-of-doors, which will permit children of the Primary School age to exercise in a natural manner through 96 climbing, hanging and swinging, etc., using their natural strength of arms and abdominal muscles to stronger effect than previously possible. It has been considered advisable to introduce differing types of fixed apparatus to coincide more closely with the needs of the individual school, particularly in regard to siting, to the material to be used and to construction. The following types are now in use in various parts of the area covered by the Organiser, and it is hoped to have two of these types erected in Bromley schools in the very near future. Outdoor Agility Apparatus. Junior Age Group. (1) Rural Type.—Designed for installation where rural or garden surroundings are possible—particularly where a spinney of trees is available. The apparatus consists of larch poles and stout ropes, which are fitted between and from trees of a suitable nature. This type is only suitable for the smaller sized school. (2) Climbing Frame.—This type is specially suited to schools where playground space is restricted and no playing field is available. A "block" frame taking roughly 8 ft. of ground space only, but allowing all the activities previously mentioned, is constructed of galvanised iron and timber. Other smaller pieces of apparatus needing little space carbe added. (3) Galvanised Metal Structures, suitable for large playgrounds or playing fields where there is space available and where numbers are large and the apparatus must be more durable. Individual structures to provide the following may be built up gradually. (1) Frame to hold four climbing ropes. (2) Frame to hold somersault bars of varying heights. (3) Frame to hold one travelling bar. (4) Balancing bars of varying heights. Infant Age Group. (1) Climbing or Scrambling Nets to be fixed over larch pole goalpost erection in playgrounds and playing fields. (2) Essex Agility Apparatus may be used both indoors and in the open air. This type consists of stools, poles, planks, and a small frame for climbing and swinging. 97 Plans have been made for two of these types to be erected in the very near future, and it is hoped that an appreciable number of Primary Departments will be supplied in the new financial year. Future development should provide climbing apparatus for all Primary Departments in order to give opportunities for the sense of adventure, confidence and well-being gained in the use of this kind of apparatus. Organised Games.—Organised games facilities on playing fields or recreation grounds are now the privilege of all Primary Junior Departments. Arrangements have now been made for four of our smaller schools, with only limited playground space, to be conveyed by coach to Hayes School playing field for an hourly games period each week. This widening of the scope for games in Junior Schools is greatly appreciated. Developments in Swimming have at long last included a small number of Junior Classes. Results of the experiment were extremely satisfactory, and, provided the same special facilities can be extended, it is hoped to include the top classes of most of our Junior Departments. Owing to the vagaries of our English climate, the question of changing of clothing for physical education is a cause for concern. When dealing with physical education taken in the open air a great deal of discretion is required, for though we must continue to encourage getting air to the skin and greater freedom of movement, we must remember the more delicate child, who needs a little latitude, or the child who has been absent through illness. The changing of clothing for physical education in the Junior School has become a more general practice, but it is still not a tradition in many of our schools. A stimulating Conference of Ministry of Education Inspectors, Primary School Head and Assistants, and Training College lecturers was arranged at Hayes School during the autumn term. Physical education had an appreciable share in the programme, the subject being dealt with in a stimulating way which presented a much wider scope for future development. Secondary Modern Departments. The change from very formal methods of class instruction to those of a freer character, aiming at developing the individual's pride in achievement and the knowledge of his (or her) own bodily powers, is still in process of experiment. We now find in the gymnasium that the boy (or girl) is given still further opportunity of measuring and improving his own best performance, rather than of indulging solely in competition against 98 another child or team. More freedom of choice is evident, and still more can be exercised with benefit to the children, so that they can begin to form their personal interests and likings in the different branches of physical education before they leave school. In this way we would avoid the effect of a sudden release from a subject they have always been made to do, which is often experienced in relation to post-school activities. The difficulties of obtaining fully qualified staffs for gymnastic teaching are still rather unsurmountable, and the revival of short Ministry of Education refresher courses of three months' duration for experienced women teachers would be of great assistance. Training Courses for specialist teachers in Secondary Schools for both men and women have been held during the year, and were appreciated. Extended accommodation this year has provided an opportunity for senior boys at an all-boys' Primary Department to be given regular instruction with portable gymnastic apparatus, which was previously denied to them owing to lack of space. Clothing and Plimsolls.—An encouraging feature in all Secondary Modern Departments has been the increased provision of clothing and plimsolls for all boys and girls. In some cases, particularly in girls' departments, parents have been encouraged to provide these articles for their children, and are to be congratulated on an excellent response. Arrangements for the storage of clothing and shoes still present a major problem, but until controls are somewhat relaxed the ingenuity of Head Teachers will be severely tested. We hope soon to see all classes suitably clothed, whether they are in the gymnasium, hall, playground or playing field. Playgrounds and Playing Fields.—On the whole playing field accommodation in the area is good, though we have now reached the stage for the first time when it has not been possible to accede to all demands for pitches from the various Youth Clubs and Associations. The high standard of maintenance has been sustained, and the groundsmen have been most helpful and considerate. Summer games do not fare quite so well as winter games, for we are still particularly short of facilities for Tennis for Secondary Modern Departments. However, it is hoped that a solution of this difficulty may be found during the new financial year by utilising some of the existing playing field space. The revival of the Secondary Schools Football League and a similar league for Primary Schools is a matter for congratulation. The standard of play is to be commended, but it is timely to remember that the tendency to "train the few at the expense 99 of the many" must always be guarded against. In order to improve the standard of play it has been decided to take advantage of the Football Association Coaching Scheme. Interested Head Teachers were asked to make formal application for a coach to visit the school, and the response has been excellent. Arrangements .are now being made for coaching visits to be fulfilled towards the end of fhe Easter term. In the same way we hope to take full advantage of the national coaching schemes for Hockey, Tennis and Cricket when conditions allow. Playground surfaces are, on the whole, recovering their prewar standard. Head Teachers are grateful for the help and assistance of planned markings. Swimming.—As an exercise, swimming claims advantages over all others; unequalled as a method of attaining physical development, its practice inculcates a love of cleanliness, develops self-reliance and control, and induces a brighter mental outlook. Such qualities are of sufficient importance to justify the inclusion of swimming in any school curriculum. This being so, it would appear necessary for sufficient provision to be made to allow the maximum number of children to receive tuition. As an area we enjoy comparatively good facilities for physical education. However, surveying the needs of the schools in connection with possible demands for swimming instruction, we are faced with the problem of a serious shortage of accommodation. Only a small section of Secondary School children are able to receive instruction, and an almost negligible number of Primary School children are able to benefit. The kindly co-operation of the Bath's Department is acknowledged and fully appreciated. Requests for accommodation are met whenever possible, and facilities are used to their fullest extent. However, until we have a closed swimming bath in the town, with possibly arrangements for a teaching bath in addition to the normal public swimming bath, the standard of swimming is bound to be much below what one could hope it to be given better opportunity. This year we experienced a first successful season of winter swimming for older children. Junior schools had an introduction to class swimming in that two classes of girls and two classes of boys were able to be instructed at a privately owned bath in the area. Successful results were forthcoming, and it is hoped to extend this privilege during the coming year to the top classes of several Primary Departments. 100 Arrangements for classes were as follows:— Bromley Open Air Pool. 8 classes of senior boys. 11 classes of senior girls. Downham Baths (L.C.C.). 8 classes of senior boys. ( 6 classes of senior girls. Two Privately Owned Baths (by arrangement). 4 classes from Primary Departments. 3 classes Youth Service. The provision of Distance Certificates by the K.E.C. should do a great deal to stimulate interest and improve individual standards of endurance. Education Week.—Opportunity to review the scope of Physical Education generally in the area was provided durin the Summer Term when an Education Week was arranged in which most of the schools took an active part. Classes of all ages and both sexes demonstrated the varied range of activities to be found in physical education from the Infant School stage to that of the adult student at the Evening Institute. The teachers taking part in the many programmes are to be congratulated on their interest, co-operation and high standard of work. Arrangements were made for two demonstrations of differing character to take place during each afternoon, and a similar programme for older students was presented each evening. The following branches of physical education were demonstrated:— Gymnastics.—Secondary Grammar School (Boys). Grammar School (Girls). Modern School (Boys). Physical Exercises.—Seven classes of Primary School physical exercises, using small apparatus. Dancing. Modern Dance.—Secondary Modern School. Senior Primary Schools. Junior Primary Schools. Infant Primary School. Country Dancing.— 2 Primary Schools. May Pole.—1 Primary School. 1 Adult Class. Scottish Dancing.—1 Adult Class. Sword Dances, etc.—Secondary Modern Boys. Sports.—All age Primary Boys' School. Recreative. P.T. and Boxing.—1 Adult Class. Unfortunately, it was not possible to extend the work to swimming and field games, but parents were invited to visit the schools during the following week to see these activities in progress under normal conditions of the school curriculum. 101 Training Courses for Teachers. The following training courses for teachers have been held during the year, and the attendance of Bromley teachers has been satisfactory. (1) Modern Dance.—Two advanced courses of instruction in Modern Dance were held during the Autumn and the Christmas terms. We regret the loss of the valuable services of Miss Bruce, who has been a source of great inspiration and enthusiasm in this branch of the subject. As a remit of the interest aroused by this class, the Kent County Modern Dance Group was inaugurated, and terminal meetings have been arranged in various parts of the County during the year. (2) Swimming.—A ten session course of swimming instruction was held at Beckenham Baths for teachers assisting with swimming instruction in the schools. (3) Dartford College Course.—At the end of the term (Summer) a ten days' residential course was arranged by the County Authority at the above College for teachers in both Primary and Secondary Schools. Response in Bromley was not quite as good as was hoped for, and it is anticipated that an improvement will be shown on future occasions. «) Refresher Course.—A refresher course for men teachers in Secondary Schools was held by Mr. John Barry. Chief Adviser for Physical Education to K.E.C., during the Christmas Term. Recreative Evening Classes.—These classes, arranged to promote the mental and physical health of the adult community through physical recreation, have, on the whole, been most successful. On the women's side dancing still holds priority of preference. Classes were arranged in the following branches of Physical Education:— 1. Recreative Physical Training for Women and Girls. 2. Recreative Physical Training for Men and Boys. 3. Advanced Gymnastics for Men. 4. Advanced Gymnastics for Women (short course). 5. Ballroom Dancing. 6. Scottish Dancing. 7. English Country Dancing. 8. Boxing and Physical Training. 9. Swimming. Outdoor Activities for Youth Associations. Facilities have been provided upon application for the following outdoor activities and these have been fully used throughout both the summer and winter months. Football.—All available bookings for pitches at Gadsden, Oakley Road Playing Field and Hayes Playing Field taken for all Saturdays and Sundays throughout the season. It was found impossible to accept further bookings. 102 Cricket.—Pitches at Gadsden, St. Hugh's, Oakley Road and Hayes Playing Fields fully booked except for an occasional date at Hayes. Tennis.—Two hard courts and five grass courts at Gadsden, fully booked throughout the summer for evenings and week-end play. In addition, through the kindness of the Mother Superior, two courts were available for Youth Clubs at the Convent ground. Camping.—No official arrangements were made for camping, since many of the clubs in the area prefer to arrange their own personal camps. Cycling, Walking and Youth Hostelling offer wonderful opportunities in this area. Organised runs and outings are part of the programmes of most of our clubs during the summer months. Conclusion. The progress of the development of all branches of physical education in the Borough during the past twelve months has been most satisfactory and augurs well for the future. A new vigour seems to have infected the subject and it is possible to look ahead and plan for the health and wellbeing of individuals to enable them to face the stresses and strains of everyday life after years of austerity and anxiety. This is largely due to the keenness and interest of the teaching staff generally and to their increasing appreciation of the value and importance of their work in Physical Education. I should like to acknowledge my indebtedness to the Borough Education Officer and his staff for their continued support and to the Head and Assistant Teachers upon whose loyal cooperation the value of the work must ultimately depend. F. M. BENTLEY. Organiser of Physical Education. 103 BROMLEY SCHOOLS BOOT CLUB. The Chairman reports as follows:— The Bromley Schools' Boot Club has continued to operate successfully during the year ended 31st December, 1948. Contributions received from members amounted to £437 and purchases of footwear amounted to £441 17s. 3d. net. At the end of the year there were 680 members and 629 purchases were made during 1948. NECESSITOUS CASES. The School Welfare Officer reports that during the year there were twenty-four applications for clothing in respect of forty-five children of school age. The total cost involved was £62 13s. 9½d. INFECTIOUS DISEASES IN SCHOOL. In addition to the usual infectious diseases, i.e., measles, whooping cough, etc., three cases of Diphtheria in children of school age were notified during the year. Two of these cases were of a severe type and in both instances the child had not been immunised against the disease. The third case was mild in type and the child had been immunised. Several cases of scarlet fever have been notified during the year, but these have been mostly of a mild type and no drastic action has been called for. It is pleasing to note that only one case of infantile paralysis occurred in a child of school age during the year. The figures of absentees during 1948. affecting Primary and Modern School attendance owing to infectious disease are as follows:— NOTIFIABLE DISEASES. Cases. Contacts. Scarlet Fever 23 . 39 Diphtheria 3 . 4 Poliomyelitis 1 . 2 Polioencephalitis — . 1 Measles 92 Contacts are not excluded. Whooping Cough 50 „ NON-NOTIFIABLE INFECTIOUS DISEASE. Extracted from returns made by Head Teachers:— Mumps 249 Chickenpox 117 104 ACKNOWLEDGEMENTS. The co-operation which has been afforded by the Borough Education Officer and members of his staff is very much appreciated, and I would also once again pay tribute to the help and assistance given by Miss M. A. Isard, the Honorary Secretary of the Bromley Children's Care Committee, particularly with regard to the arrangement of Convalescent Home treatment for children in need. 165 SCHOOL MEDICAL SERVICE. STATISTICAL TABLES.—1948. TABLE I.— Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils found to require Treatment. TABLE II.- A. Return of Defects found by Medical Inspection. B. Classification of the General Condition of Pupils Inspected during the Year, in the Age Groups. TAELE III.- Group I. Minor Ailments. II. Defective Vision and Squint. III. Treatment of Defects of Nose and Throat. IV. Orthopaedic and Postural Defects. V. Child Guidance and Speech Therapy. TABLE IV- A. Dental Inspection and Treatment. B. Orthodontic Clinic. TABLE V.- -Infestation with Vermin. TABLE VI- Orthoptic Clinic. TABLE VII.— Speech Clinic. TABLE VIII.— Handicapped Children. 106 TABLE I. Medical Inspections of Pupils Attending Maintained Primary and Secondary Schools A. Periodic Medical Inspections Number of Inspections in the Prescribed Groups: Entrants 877 Second Age Group 609 Third Age Group 594 Total 2,080 Number of Other Periodic Inspections 955* Grand Total 3,035 'Children aged 8 years. Children in their 13th year at County Grammar and Technical Schools. B. Other Inspections Number of Special Inspections 4,149 Number of Re-inspections 2,507 Total 6.656 C. Pupils Found to Require Treatment Number of Individual Pupils found at Periodic Medical Inspections to require treatment (excluding Dental Diseases and Infestation with Vermin): Group For defective vision (excluding squint) For any of the other conditions recorded in Table II.A. Total individual pupils Entrants 22 97 119 Second Age Group 31 84 115 Third Age Group 43 72 115 Total (prescribed groups) 96 253 349 Other periodic inspections 38 96 134 Grand Total 134 349 483 107 TABLE II. A. Return of Defects Found by Medical Inspections Defect Code No. Defect or Disease Periodic Inspections. No. of Defects. Special Inspections. No of Defects. Requiring treatment Requiring to be kept under observation but not requiring treatment Requiring treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 4 4 501 67 5 Eyes— (a) Vision 134 125 107 18 (b) Squint 22 6 16 6 (c) Other — 6 221 11 0 Ears— (a) Hearing 3 2 5 2 (b) Otitis Media — — 94 1 (c) Other 5 1 168 12 7 Nose or Throat 63 172 573 176 8 Speech 5 4 7 — 9 Cervical Glands — 28 31 12 10 Heart and Circulation t) 61 39 31 11 Lungs 3 27 105 17 12 Developmental— (a) Hernia 1 9 5 3 (b) Other 3 9 39 13 13 Orthopaedic— (a) Posture 58 55 43 25 (b) Flat Foot 73 35 41 18 (c) Other 70 63 202 30 14 Nervous Svstem— (a) Epilepsy — — 3 — (b) Other 4 9 81 20 15 Psychological— (a) Development 1 3 11 4 (b) Stability — — 12 5 16 Other 55 76 1,194 123 Totals 513 695 3,498 594 B. Classification of the General Condition of Pupils Inspected During the Year in the Age Groups Age Groups Number of Pupils Inspected A—Good B—Fair C—Poor No. % of Col. 2 No. % of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 877 430 49 03 404 46-06 43 4-9 Second Age Group 609 422 69-29 179 29-39 8 1 31 Third Age Group 594 380 63-97 205 34 51 9 1 51 Other periodic inspections 955 263 27-53 630 65-96 62 6-49 Total 3,035 1,495 49-25 1,418 46-72 122 4-02 108 TABLE III. TREATMENT TABLES Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V.) (a) Number ot Defects Treated, or under Treatment during the year Skin. Ringworm—Scalp:— i. X-Ray Treatment — ii. Other Treatment — Ringworm—Body 10 Scabies 34 Impetigo 66 Other Skin Diseases 538 Eye Disease (external and other, but excluding errors of refraction, squint and cases admitted to hospital) 493 Ear Defects (excluding serious diseases of the ear, e.g. operative treatment in hospital) 336 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 2,648 Total 4,125 (b) Total number of attendances at the Minor Ailments Clinics, 16,030. Group II.—Defective Vision and Squint (excluding Eye Diseases treated as Minor Ailments—Group I.) Number of defects dealt with Errors of Refraction (including squint) 518 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 52 570 Number of Pupils for whom spectacles were (a) Prescribed 433 (b) Obtained 241* Number of Clinics held 100 Number of Re-Inspections 643 * Up to and including 5th July, 1948. Group III.—Treatment of Defects of Nose and Throat Total nnmber Treated Received Operative Treatment: (a) For Adenoids and Chronic Tonsilitis 60 (b) For other Nose and Throat conditions 4 Received other forms of treatment 52 Total 116 109 Group IV.—Orthopaedic and Postural Defects (a) Number referred for treatment as in-patients in hospital or hospital schools 9 (b) Number treated otherwise, e.g. in clinics or out-patients' department 446 Number of Clinics held 33 Number of attendances for'consultation with Surgeon 934 Number of attendances for massage and exercises 4.684 Number of attendances for ultra violet rays 1,482 Group V.—Child Guidance and Speech Therapy Number of pupils referred: (a) Under Child Guidance arrangements 28 (b) Under Speech Therapy arrangements 17 TABLE IV. A. Dental Inspection and Treatment Number of pupils inspected by the Authority's Dental Officers: (a) Periodic Age Groups 4,117 (b) Specials 974 Total (Periodic and Special) 5,091 Number found to require treatment 3.277 Number actually treated 2.936 Attendances made by pupils for treatment 6.641 Half-days devoted to (a) Inspection 21 (b) Treatment 838 1/24 Total 859 1/24 Fillings—(a) Permanent Teeth 2,147 (b) Temporary Teeth 1,777 Total 3.924 Extractions—(a) Permanent Teeth 512 (b) Temporary Teeth 2,413 Total 2,925 Administrations of general anaesthetics for extraction 1.316 Other Operations—(a) Permanent Teeth 2,383 (b) Temporary Teeth 323 Total 2,706* * Including— Number of scalings and polishing 143 Number of dressings—(a) Permanent Teeth 153 (b) Temporary Teeth 301 Total 454 110 B. Orthodontic Clinic Number of children referred for orthodontic treatment 98 Number of orthodontic appliances (a) ordered 122 (b) fitted 92 Attendances for orthodontic treatment 843 TABLE V. Infestation with Vermin Individual Pupils Total number of examinations in the schools by School Nurses or other authorised persons 14.102 Total number of individual pupils found to be infested 26* Number of individual pupils in respect of whom cleansing notices were issued (Sec. 54 (2) Education Act, 1944) - Number of individual pupils in respect of whom cleansing orders were issued (Sec. 54 (3) Education Act. 1944) - * In addition, 317 children showed minor evidence of uncleanliness. TABLE VI. Orthoptic Clinic Number of cases under treatment during the year 71 Number of new cases 46 Number of treatments given 1,268 Number of cases on occlusion during the year 3 Number of cases awaiting or undergoing operation at the end of the year 7 Number of cases found unsuitable 1 Number of cases failed to attend 5 Number of cures 29 With operation, 12. Without operation, 17. TABLE VII. Speech Clinic Total number of cases treated 11 Classification— (a) Sigmatism - (b) Simple Dyslalia — (c) General Dyslalia 2 (d) Multiple Dyslalia 3 (e) Dysarthria (f) Stammer 1 5 Number of cases receiving treatment at end of year 9 111 TABLE VIII. Handicapped Children In pecial schools In maintained prim, and sec. schools In independent schools Not in school Total Blind 2 — — - 2 Partially sighted — — — — — Deaf 3 3 — — 6 Partially Deaf — 7 - 1 8 Delicate — 21 — — 21 Diabetic — — — — — Educationally Subnormal 9 20 2 4 35 Epileptic 2 — — — 2 Maladjusted 3 71 1 — 75 Physically Handicaoped 2 13 3 2 20 Speech Defects — 36 — — 36 Multiple Disabilities — 3 — 3 6 Total 21 174 6 10 211 In addition to the above. 26 children have been certified as ineducable.