AC . 4412(1) BROMLEY BRO 45 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1949 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES Printed by Bromley Office Supplies & Printing Co., Ltd. 39 & 46 East Street, Bromley, Kent BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1949 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 12 Population 13 Births 13 Illegitimate Births 13 Stillbirths 13 Deaths 13 Maternal Mortality 14 Infantile Mortality 14 Unemployment 14 Meteorological Conditions 15 Open Air Recreational Amenities 15 Section B. General Provision or Health Services for the Area. Sanitary and Environmental Services 18 Nursing Homes 18 Hospitals 18 Health Visiting 19 Domiciliary Midwifery 19 Home Nursing Service 19 Domestic Help Service 19 Venereal Diseases 19 Laboratory Service 19 Child Welfare Centres 20 Clinics 20 Day Nurseries 21 Ambulance Service 21 Medical Loan Depôts 21 Old People's Homes 21 Section C. Sanitary and Environmental Circumstances. Water Supply 26 Drainage and Sewerage 27 Rivers, Streams and Lakes 27 Swimming Baths and Pools 28 Public Cleansing and Refuse Collection 28 Factories Acts, 1937 and 1948 28 Sanitary Inspection of the Area 28 Shops Acts 29 Petroleum Acts 30 Smoke Abatement 30 Verminous Conditions and Uncleanliness 30 Rodent Control 30 Diseases of Animals Acts 31 Registries for Female Domestic Servants 31 Retail Market 31 Section D. Housing. Housing Inspections 34 Rehousing 34 4 Section E. Inspection and Supervision of Foods. Food Sampling 33 Bacteriological Examinations 40 Ice Cream 40 Special Enquiries 41 Food Preparing Places 43 Slaughterhouses 43 Inspection of Food Premises 44 Milk Licences 44 Meat Inspection 44 Unsound Meat and Other Foods 45 Section F. Prevalence of, and Control Over, Infectious and Other Diseases. Smallpox 48 Vaccination 48 Anterior Poliomyelitis 48 Scarlet Fever 49 Diphtheria 49 Diphtheria Immunisation 50 Typhoid Fever 50 Puerperal Pyrexia 50 Ophthalmia Neonatorum 50 Pemphigus Neonatorum 50 Measles 51 Whooping Cough 51 Tuberculosis 51 Public Health (Prevention of Tuberculosis) Regulations, 1925 52 Food Poisoning 52 Other Infectious Diseases 53 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 56 „ II.—Causes of Death 58 „ III.—Infant Mortality. Causes and Age Groups 59 „ IV.—Analysis of Causes of Infant Deaths, 1945-49 60 „ V.—Housing Statistics 61 „ VI.—Summary of Work of Sanitary Inspectors 62 „ VII.—Nuisances, Defects and Contraventions Abated 65 „ VIII.—Factories Acts, 1937 and 1948 68 „ IX.—Notifiable Diseases, Ward Distribution, Attack and Mortality Rates 69 „ X.—Age and Sex Grouping 70 „ XI.—Tuberculosis. New Cases and Mortality 71 5 SCHOOL HEALTH SERVICE, 1949. Members of Welfare Committee 74 Officers of Committee 74 Staff 74 Introduction 75 General Information 76 School Hygiene 77 Medical Inspection at Schools 77 Special Inspections 78 Dental Inspection 78 Vermin and Uncleanliness Inspection 78 Treatment 79 Orthopaedic Clinic 79 Ophthalmic Clinic 80 Orthoptic Clinic 81 Ear, Nose and Throat Clinic 81 Speech Clinic 82 Exceptional and Handicapped Children 82 Child Guidance 82 Milk in Schools 82 School Meals Service 82 Nursery Schools 83 Employment of Children and Young Persons 83 Juvenile Delinquency 83 Boot Club 83 Necessitous Cases 84 Infectious Diseases in Schools 84 Physical Training 85 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 90 „ II.—Return of Defects found by Medical Inspection 91 „ III.—Group I. Minor Ailments 92 Group II. Defective Vision and Squint 92 Group III. Treatment of Defects of Nose and Throat 92 Group IV. Orthopaedic and Postural Defects 93 Group V. Child Guidance and Speech Therapy 93 „ IV.—A. Dental Inspection and Treatment 93 B. Orthodontic Clinic 93 „ V.—Infestation with Vermin 94 „ VI.—Orthoptic Clinic 94 „ VII.—Speech Clinic 94 „ VIII.—Handicapped Children 95 7 MEMBERS OF THE HEALTH COMMITTEE. Alderman J. S. Marriott (Chairman), Alderman M. Stafford Smith M.B.E., B.A. (Vice-Chairman), The Worshipful the Mayor (Alderman B. J. Finnie, M.C., J.P.), Alderman 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., Councillor C. W. Wilmot, Councillor M. L. Dempster. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1949. Medical Officers. Medical Officer of Health K. E. Tapper, o.b.e., g.m., m.b., ch.b., d.p.h. Deputy Medical Officer of Health H. B. C. Carter-Locke, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Assistant Medical Officers of Health and School Medical Officers j Miss g. H. Stinson, m.r.c.s., l.r.c.p. j P. A. currie, m.r.c.s., l.r.c.p. jk A. E. Orgler, m.d. Specialists (Part-time): Orthopaedic Surgeon j K. F. Hulbert, f.r.c.s. Ophthalmic Surgeon j Eric Lyle, m.a., m.d., ch.b. d.o.m.s. Dental Surgeons j P. D. B. Mayo, l.d.s. j A. F. King, l.d.s. j Russell Edey, l.d.s. (parttime). Sanitary Inspectors: Chief Sanitary Inspector, Chief abcde G. R. Woods, m.s.i.a., a.r.san.i. Sampling Officer, and Inspector under the Petroleum Acts, the Diseases of Animals Acts and the Shops Acts District Sanitary Inspectors and Sampling Officers abc T. C. Towersey, m.s.i.a. abc P. R. Light, m.s.i.a., a.r.san.i. ab H. Cooper, a.r.san.i. Health Visitors and School Nurses: 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 Miss E. Chenery, s.r.n. fghj Miss K. Owens, s.r.n. fghj Mrs. V. Greig, s.r.n. 8 Clerical Staff: Chief Clerk S. F. Judd. Senior Clerk E. P. J. Wythe. Grade I Clerks Mrs. D. Cox. Miss M. J. Kelly. Grade II Clerks Miss B. B. Burrows. Mrs. W. J. Foot. Miss N. M. Croxson. Miss D. I. Payne. k Miss E. W. Lepper. Dental Clinic Assistants: j Mrs. W. Carrie. j Mrs. E. Brookes. j Miss M. Ellen (part-time). Other Appointments: Physiotherapist j Mrs. P. A. Urwin, m.c.s.p. (part-time). Orthoptist j Miss M. Ford, d.b.o. (Part- time). Assistant Rodent Officers J. L. Gough. ek J. C. Dunn. 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. 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, I have the honour to submit to you the Annual Report on the Public Health of the Borough for the year 1949, which is my twenty-fifth Annual Report to you. Because of its residential character, Bromley can be expected to have a good standard of health, and the vital statistics of 1949 continue to show a satisfactory state. In spite of the fact that a large percentage of the wage earners resident in Bromley must travel in overcrowded carriages to and from their work in London during times of stress and hurry, and in spite of the fact that a large number of young families have no home of their own, but must share accommodation, and in spite of the high rentage and high taxation, all of which have an indirect effect upon the health of the people, the vital statistics, as shown by death rates, show an improvement year by year. The health of babies and of young children continues to indicate that all is well; yet, as one looks deep into the matter, one knows that the doctors' surgeries are crowded, the hospitals have difficulty in meeting the demand for beds, and there appears, to the careful observer, a tiredness and anxiety in the adult population. With the change of executive administration from truly "local" government to "central" government, which has now been operative since July, 1948, one notices the increase of forms and form filling and the requirement to enter into correspondence on even matters of minor detail. Every district has its own special problems, and, while it is desirable to deal with such problems as a part of a whole, the solving of the problem is often better understood locally than centrally. My thirty years' experience in Public Health has shown me the importance of two facts—the interdependence of the personal health service and environmental services, and that effective Health Administration is dependent upon the facilities of approach of the ratepayer to the executive Medical Officer. The first is now broken, and the second difficult, because the administrative centre is some 30 miles from the field of work. During the 25 years prior to July, 1948, the Health Services in Bromley grew from scattered units into a well-functioning whole, satisfying to the people of Bromley and applicable to their needs. My earnest hope is that the next 25 years will see an uplift of services throughout the County. 10 The care of the aged continues to be an ever-increasing problem, and were it not for the work of voluntary agencies, especially that of the W.V.S., this problem would be much more serious. The provision for the aged sick, which is the responsibility of the Hospital Boards, falls far short of the demand for beds. The institutional care of aged infirm requiring care and attention, a responsibility of the County Council, is not yet met in North-West Kent. The Local Authorities, such as Bromley, have little power to act except in the provision of homes and removal of aged under Section 47 of the National Assistance Act. The vital statistics of 1949 show a death rate of 10.9, a birth rate of 16.1, and an infant mortality rate of 15.5, all below the average of the country as a whole and of the non-County Boroughs in particular. The Infectious Diseases statistics show a repetition of the infantile paralysis epidemic of 1947, but milder in extent and character. There were seven cases notified, no deaths, and only three cases showing paralysis. Diphtheria continues to remain in the trough of its wave of incidence, and this continues to give hope that immunisation is a controlling factor. Scarlet Fever was extensive, but mild in form; 51.1% of the cases notified were home nursed. I have again included in this Annual Report a report on the work of the School Health Services. The appointment of Dr. Carter-Locke, in January, 1949, as my Deputy, has been invaluable to me, and as he is an experienced officer I have benefited greatly by his help and advice. The Sanitary Inspectors have been short staffed throughout the main part of the year, but, in spite of this, Mr. Woods has been able to maintain an efficient service. He has been Chief Sanitary Inspector for some twenty-four years, and his knowledge of the district and of the work of the Health Department are invaluable to the public and to the Local Authority. I hold him in very high esteem as a colleague in the Public Health Service. To Mr. Judd and the clerical staff I am again indebted for the compilation of these statistics and for a year of enthusiastic work. I would, finally, like to express my indebtedness to the members of the Council for the confidence placed in me and for the support they have given me at all times. I am, Your obedient Servant, K. E. TAPPER, Medical Officer of Health SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 12 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres 6,519 Registrar General's estimate of total population (mid-year), 1949 64,140 No. of inhabited houses and flats, according to the rate book, at the close of the year 17,819 No. of valuation assessments of habitable premises at the close of the year 17,918 (a) Bromley (Old Borough area) (b) Keston and Hayes Total Houses 13,102 2,952 16,054 Flats 1,724 91 1.815 Farmhouses 12 1 13 Public Houses 31 5 36 14,869 3,049 17,918 Rateable Value (31st March, 1950) £742,901 Product of a Penny Rate for year ending 31st March, 1950 £3,070 Vital Statistics. Live Births. Total Male Female Legitimate 987 508 479 Birth Rate 16.1 per 1,000 population. Illegitimate 43 24 19 1,030 532 498 Stillbirths. Total Male Female Illegitimate - — — Stillbirth Rate 21.8 per 1,000 (live and still) births. Legitimate 23 11 12 23 11 12 Deaths. Total Male Female Death Rate 10.9 per 1,000 population. 699 321 378 Deaths from Puerperal Causes. Puerperal Sepsis — Maternal Mortality Rate 0.95 per 1,000 (live and still) births. Other Puerperal Causes 1 Deaths of Infants under 1 year of age. Total Male Female Legitimate 16 12 4 Infant Mortality Rate 15.5 per 1,000 live births. Illegitimate — — — 16 12 4 13 Death Rates of Infants under 1 year of age. All Infants per 1,000 live births 15.5 Legitimate Infants per 1,000 legitimate live births 15.5 Illegitimate Infants per 1,000 illegitimate live births — POPULATION. The Registrar General's estimate of the population of the Borough (Civilian and Non-civilian), mid-year, 1949, is 64,140, which is an increase of 780 on the corresponding figure for 1948, and is equivalent to a density of 9.8 persons per acre. BIRTHS. The Birth Rate for 1949 is 16.1 per 1,000 population. Comparative rates between Bromley and England and Wales during the past five years are as follows:— Year Bromley England & Wales 1945 16.6 16.1 1946 19.4 19.1 1947 20.9 20.5 1948 16.4 17.9 1949 16.1 16.7 Illegitimate Births. The illegitimate birth rate (per 1,000 live and stillbirths) for 1949 is 40.8. This rate varies from year to year. The average rate over the last fifteen years was 53.5 per 1,000 births. Stillbirths. The Registrar General's returns for the year show that the number of stillbirths registered for the area was 23 (after adjustment for inward and outward transfers), which represents a stillbirth rate of 21.8 per 1,000 (live and still) births, and 0.36 per 1,000 population. The following table gives details of stillbirths for the past five years:— Year No. of Stillbirths Bromley Rate per 1,000 births England & Wales Rate per 1,000 population 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 1949 23 21.8 0.36 0.39 DEATHS. 699 deaths were recorded during the year, giving a Death Rate of 10.9 per 1,000 population. Of this figure, 321 were males and 378 females. The following table shows the main causes of death in Bromley, with comparative rates per 1,000 population, for the past five years. 14 The ages at death show that 70.24% were 65 years and over. Rates per 1,000 population 1949 1948 1947 1946 1945 Heart Disease 3.2 2.7 3.5 2.9 3.4 Cancer 2.2 1.8 1.9 1.8 2.0 Respiratory Diseases (non-T.B.) 1.3 0.9 1.0 1.1 1.2 Tuberculosis 0.3 0.3 0.4 0.3 0.7 Congenital Causes 0.1 0.2 0.2 0.5 0.5 Infectious Diseases 0.05 0.01 0.03 0.01 0.04 Influenza 0.08 — 0.03 0.1 0.06 The following table gives the death rates for Bromley in comparison with the death rate for England and Wales during the past five years:— Year Bromley Rate (crude) England and Wales 1945 12.5 11.4 1946 10.8 11.5 1947 11.7 12.0 1948 9.9 10.8 1949 10.9 11.7 Maternal Mortality. There was one maternal death in the Borough during 1949, giving a mortality rate of 0.95 per 1,000 total births. Infantile Mortality. The Infant Mortality Rate for the year is 15.5 per 1,000 live births. 16 infants died during 1949 before reaching their first birthday. UNEMPLOYMENT. The Manager of the Employment Exchange has kindly supplied the following details with regard to unemployment during 1949:— Recorded unemployment at the end of December, 1949:— (a) Men 116 (b) Women 55 These figures included 63 men and 3 women registered as Disabled Persons, and fit for some form of employment. The Men's Register was largely comprised of older age group men, from 55 to 65 years of age. Many of the women desire only part-time work, for which there is very little demand locally, and there is a general antipathy towards domestic employment, particularly residential posts. During the year there has been a constant turnover of labour, the majority of these workpeople being placed in employment immediately. The peak of unemployment during the year was in February, when the figures were 147 men and 57 women. 15 METEOROLOGICAL CONDITIONS. The Borough Engineer has kindly supplied the following details for 1949, from records kept by his Department at the Climatological Station at Church House Grounds:— Total rainfall: 18.29 inches (24.48 inches during 1948). Mean maximum daily temperature: 61.1°. Mean minimum daily temperature: 44.4°. Highest maximum temperature: 88.0° (on 27th June, 1949). Lowest minimum temperature: 19.0° (on 4th February, 1949). Lowest grass temperature: Not available, as replacement instrument only received in May, 1949. 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. 18 SECTION B. SUMMARY OF HEALTH SERVICES FOR THE AREA. Health Services Rendered by the Council. Sanitary and Environmental Services. These services, which are the major services of the Health Department, are reported upon fully under Sections C, D, E and F. A summary of the year's work is given in the appendices. Inspection of Nursing Homes. There are four registered Nursing Homes within the Borough, and fifteen visits of inspection were made during the year. There were no infringements of the Local Byelaws. Details of these homes, at 31st December, 1949, are given below:— Address No. of Beds Patients received during 1949 Nursing Staff Other Qualified S.R.A.N. S.E.A.N. Surgical Medical 18, Blyth Road 22 — 17 3 4 1 24, Elmfield Road 10 — 23 1 2 1 67, Hayes Road 3 — 3 1 — 1 47 and 51, Park Avenue 26 — 48 1 5 1 The Nursing Homes are not utilised to their full extent, partly due to the National Health Act, and also to the fact that people are no longer able to pay the fees of Private Nursing Homes. There is still a large number of aged sick who are awaiting admission to hospital, and for whom the Nursing Homes could provide the necessary attention pending such admission, but as most of these cases come within the low income group, there are no means for meeting the cost. Services Rendered by the Hospital Board. (a) Bromley Hospital, providing a general hospital service with 155 beds. This Hospital also has two Maternity Units, at 118, Widmore Road (22 beds), and 20, Masons Hill (38 beds). (b) Lennard Hospital, Lennard Road, with 212 (possible) beds, of which 62 are for the isolation and treatment of infectious diseases. (c) Bromley Chest Clinic, 2, Park Road. New pre-fabricated premises are at present under construction at Masons Hill, Bromley, and, when, completed, will provide long overdue and up-to-date premises for this branch of the Health Service. 19 Services Rendered by the County Council. The following services are provided by the County Council, and supervised through the Area Sub-Committee. Health Visiting. There are seven Health Visitors carrying out their duties in the Bromley area. In addition to their duties in connection with the School Health Service, they give advice on the care of young children, and to expectant and nursing mothers, and carry out work in connection with immunisation, vaccination and other Maternity and Child Welfare services. Midwifery (Domiciliary). There are four Midwives engaged full-time in domiciliary midwifery in the area. Their services are engaged direct by the patient, or through the patient's private doctor, and they act either as midwives or maternity nurses. Home Nursing Service. This service, which, under the National Health Service Act, became free on 5th July, 1948, provides trained nurses for patients who require nursing in their own homes. The service is provided on medical certification only, and, at present, there is no night service available. There are six Home Nurses in the Bromley area. Domestic Help Service. Applications for this service are made to the Area Supervisor at the Municipal Offices, Bromley. Assistance is given in cases of illness, and provision is also made for a domestic help during a home confinement. Venereal Diseases. No centre is provided within the Borough for treatment of Venereal Diseases; patients are referred either to the London Hospitals or one of the established centres in the County. Laboratory Services. The Kent County Council provides 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, and by Dr. Keall and the staff of the Laboratory at Bromley Hospital, in the examination of and reporting upon specimens of an urgent nature which it was not possible to send to Maidstone for examination. 20 The following swabs, specimens, etc., were sent for examination and report during the year:— Hæmolytic Streptococci 327 Diphtheria 12 Food Samples, Water Samples, etc. 744 Miscellaneous 54 Child Welfare Centres. North Clinic, Station Road Wednesday p.m. South Clinic, Princes Plain Tuesday p.m. William Morris Hall, Masons Hill Mon. and Thursday p.m. First Aid Post, Southlands Road Wed. and Friday p.m. Village Hall, Hayes Tuesday p.m. Village Hall, Keston Thursday p.m. Burnt Ash Library, Burnt Ash Lane Wednesday p.m. Ante-Natal Clinics. North Clinic, Station Road Mon. and Thursday p.m. Minor Ailment Clinics (Schools). North Clinic, Station Road Monday to Friday a.m. South Clinic, Princes Plain Monday to Friday a.m. Medical Room, Hayes School Monday to Friday a.m. Medical Room, Quernmore School Mon., Wed. and Frid. a.m. Medical Room, Burnt Ash School Monday to Thurs a.m. Medical Room, Aylesbury Rd. School Monday to Friday a.m. Dental Clinics. North Clinic, Station Road Monday to Friday a.m. & p.m. South Clinic, Princes Plain (Temporarily closed owing to lack of Dental Officers.) Immunisation and Vaccination. Immunisation Vaccination North Clinic, Station Road Mon., 11 a.m. Tuesday, 11 a.m. Thur., 11 a.m. South Clinic, Princes Plain Wed., 11 a.m. Last Wednesday in every month, 11 a.m. Medical Room, Hayes School Wed., 11 a.m. Wed., 11 a.m. Medical Room, Burnt Ash School Thur., 11 a.m. Saturday, a.m. by appointment. (Once a month.) Specialist Clinics. North Clinic, Station Road Mon., a.m. Ophthalmic. Wed., a.m. Ophthalmic. Friday, p.m. Ophthalmic. North Clinic, Station Road Four sessions Orthopædic. a month. (Frid., p.m.) South Clinic, Princes Plain Mon., p.m. Speech Defects. 21 Day Nurseries. "Draycott," Southborough Lane. Accommodation for 60 children. Elmfield Day Nursery, Elmfield Road. Accommodation for 40 children. Ambulance Depôt. The Ambulance Depot is situate 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. Medical Loan Depôt. Arrangements have been made with the British Red Cross Society for the continuation of the Medical Loan Depots. A full range of nursing requisites is available at these depôts. Applications for loan of equipment for Bromley inhabitants should be made to either of the following depôts:— 34a, Market Square, Bromley. 4, East Street, Bromley. OLD PEOPLE'S HOMES. There are seven homes within the area, which are run by Voluntary Associations and Public Authorities, for the care of old people. "Southwood," Residential Club, Oldfield Road, Bickley. This Club is run by the Women's Voluntary Services, and the Centre Organiser has kindly furnished the following report:— "The Club has 28 single and 6 double bed-sitting rooms with hot and cold water, with use of communal dining room and lounge, and billiard room. A full-size billiard table was presented to the Club by Rotary. "Residents may furnish their own rooms if they wish, with the exception of bed and bedding, which is provided by the Club, but furniture is provided if necessary. "Residents must be over the age of 65, able-bodied, and with an income of not more than £200 per annum, net. Payment ranges from 33s. to £2 12s. 6d. per week. "During the year we have had an average of 39 residents, and, at 31st December, 1949, there were 40 residents—9 men, 25 women and 6 married couples. The average age at that date was 78 years. 22 "Four residents died during the year, three at the Club, and one at Southend whilst visiting his brother-in-law. Three residents went away for periods of convalescence, and then returned to the Club. One resident who was removed to hospital was not fit enough to return, and one left to go into a Nursing Home. "We have a long waiting list, and have been able to accept nine persons for residence—three men, one married couple, and five women." "The Vane," Denbridge Road. 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 29 residents on 31st December, 1948, 14 admissions during 1949, and 14 discharges. This Home is run by the Welfare Department of the London County Council, and is used as a home for aged Londoners needing care and attention not otherwise available to them. "Town Court," Wells Road, Bickley. This Home has recently been purchased by the London County Council for use as a home for the aged. It was opened on 23rd June, 1949, with accommodation for 18 persons (7 men and 11 women), but when adaptation works are completed the ultimate accommodation will be for 31 persons, including married couples. Up to 31st December, 1949, 18 persons had been admitted and none discharged. "Greenhill," Oaklands Road, Bromley. This Home, which is run by the Brook Lane Medical Mission, was opened in April, 1949, and the first nine patients were admitted on the 11th of that month. There are 20 beds for patients, all of which have been filled throughout the year. During the summer months some of the old people were able to go away for holidays, either to relatives or to the Mission Rest House at Brighton, which enabled the Mission to take in other old people in need for short periods. "Merevale," Bickley Park Road, Bickley. The following report has been received from the Secretary of the North-West Kent Housing Society, Ltd., who are responsible for this Home:— "The year 1949 was a successful year for 'Merevale.' We commenced the year with 29 residents, but rearranged the accommodation early in the year to accommodate 34 persons. 23 "Actually, owing to two deaths late in the year, we had 32 in residence at the end of the year, made up of 7 men and 25 women, including one married couple. Three were registered blind persons. "We have had three deaths actually in the Home, and two deaths of residents in Nursing Homes during 1949. Our difficulties are much increased by the total inability of the hospitals to accept old people. "All residents were taken to the seaside for a day, and two Christmas parties were arranged for them. Throughout the year entertainments were arranged, and averaged about two per month. "The standard charge is £2 12s. 6d. per week, but our expenses have greatly increased as regards food and staff." "Dunoran," Park Farm Road, Bickley. The following report has been received from Dr. B. S. Morton, Medical Superintendent to the Dunoran Home:— "During 1949 Dunoran Home has continued to admit chronic sick and dying patients, chiefly from the Bermondsey and Southwark Hospital Group. There were 66 patients admitted during the year. "The Committee of the Brook Lane Medical Mission, Downham, has bought and rented to the Bermondsey and Southwark Hospital Management Committee a house in Sundridge Avenue for use as a Nurses' Home. It is hoped that this will mean an addition of at least five to the number of beds available at Dunoran Home. "The waiting list is long, and it is hoped that the opening of a 'half-way house' at Bickley by the Bermondsey Medical Mission, made possible by the help of King Edward's Hospital Fund, may relieve the pressure on beds a little. "During the year it has been possible to start occupational therapy for the patients, and this has proved extremely helpful, providing an interest as well as remedial activity. A microphone connected with all the wards, enabling all to share in concerts, services, etc., has contributed greatly towards the happiness of the patients." "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 for the following report on the Home during 1949:— "The average number accommodated during 1949 was 28 (17 men and 11 women). Eight residents left during the year, and there were eight new admissions. All vacancies arising 24 during the year were offered to and filled by the Welfare Officer, Kent County Council. With less than one vacancy per month arising, and due to our obligations to the Kent County Council, it has been necessary to refuse many applications from individuals and other organisations. "The difficulty of arranging admission of sick residents to hospital has had the effect of lowering the general standard of health of residents. This tendency will continue until more hospital accommodation is provided for the chronically sick. "At present, although the general standard can be described as 'fair,' some of the old people are becoming noticeably more feeble and helpless, and two old ladies are quite unable to look after themselves. These two require continual nursing and care night and day, and to a degree which, in fairness to the old people themselves and to the staff, cannot be provided in the Home of any voluntary organisation. "Two doctors make routine weekly calls and emergency visits whenever necessary. Residents are referred to hospital for surgical or medical specialists' treatment, etc. A chiropodist visits the Home regularly. "The residents enjoyed many concerts and film shows given in the Home by local organisations and friends. Invitations to attend parties held by the Over 60 Club and Old Age Pensioners were accepted, and a number of the residents visit friends in the vicinity and also the cinema. Home entertainments are, however, the most popular with the majority. "During the summer the Mayor of Bromley presided at a very successful fete held in the garden. This proved to be an event of some importance in the lives of the residents, and the standard of work on their handicraft stall did them no little credit. "Each resident is given a weekly allowance with which to buy sweets, cigarettes or tobacco. Periodicals are provided daily. "Gifts of clothing, food parcels and books have been gratefully received throughout the year. "Total expenditure during the financial year ending 1.10.49 was just under £3,000, and exceeded income by £330. This gave an all-in cost of £2 3s. lid. per resident per week, which is increased to £2 9s. 9d. after taking into account Central Office administrative expenses." SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 26 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. Water. I am indebted to both the Clerk and 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 1949:— "No standpipe supplies were provided, and houses throughout the Borough received their supplies direct from the public water mains. "No new source of public water supply has been instituted in the Council's area during the year, and there have been no extensions of trunk mains. "Considerable lengths of service mains have been laid on the Coppice Estate, and short lengths in the Hayes and Keston districts. "The supply to the Bromley district 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 of all supplies are made five times a week, and 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 1949." 27 Chemical. (Parts per million unless otherwise stated.) Short tar ds Well West Wickham Well Orpington Well Thames-derived filtered water (Walton) Number of samples 5 6 4 247 Ammoniacal Nitrogen .001 .007 .000 .017 Albuminoid Nitrogen .038 .022 .025 .093 Oxidised Nitrogen—Nitrate 4.7 4.6 7.5 4.6 Chlorides as C1 22.3 13.2 16.1 28.8 Oxygen abs. from Permanganate 3 hrs. at 80° F .40 .15 .05 1.26 Turbidity in terms of Silica — — — .3 Colour, m.m. brown, 2 ft. tube, Burgess's Tintometer 5 0 0 16 Hardness (Total) 261 260 283 238 Hardness (Permanent) 95 55 83 69 pH Value 7.3 7.1 7.1 7.6 Phosphate as P.O. 111/4 — — — .36 Silica — — — 12.5 Conductivity 450 400 450 450 Bacteriological Results. Number of samples 255 240 254 255 No. of microbes per ml. Colonies counted on agar after 20-24 hours at 37° C 20.8 Bact. coli test: Percentage of samples negative to Bact. Coli in 100 ml 99.2 100.0 100.0 100.0 Bact. Coli per 100 ml .016 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. Cesspool emptying is undertaken by the Borough Engineer's Department upon the request of the householders, a charge being made of 17s. 6d. for the removal of the first 500 gallons and 12s. 6d. for subsequent or part loads. Rivers, Streams and Lakes. No further works of culverting rivers or streams within the area have been undertaken during the year. 25 inspections and re-inspections were made by Sanitary Inspectors during the year. 28 Swimming Baths and Pools. A total of 35 inspections were made by Sanitary Inspectors during 1949, and 38 samples of water were taken for examination. The results of these examinations were as follows:— Of the 12 samples taken from the Corporation Swimming Pool, 10 were satisfactory and 2 unsatisfactory. 26 samples were taken from privately owned Swimming Baths and Pools, and of this number 15 were satisfactory and 11 unsatisfactory. The unsatisfactory samples were mainly due to inefficient treatment, which was remedied after advice had been given. Public Cleansing and Refuse Collection. The Borough Engineer reports that the reconstruction of Cell Unit No. 1 at the Refuse Destructor was completed during the year. A new Hydraulic Tin Baling Press has been placed on order, and delivery is expected shortly. Factories Acts, 1937 and 1948. Statistical details are given in Tables VII., VIII. and IX. 128 visits of inspection were paid to Factories during the year; 86 nuisances and defects were found, of which 93 (including those outstanding from 1948) had been remedied by the end of the year. In addition to the above, 53 inspections were made of Outworkers' premises, all of which were found to be satisfactory and no nuisances or defects were found. There is great need for liaison between the Local Authority and the Factory Authority when dealing with welfare of the employees. At present this liaison is weak, as the service is directly under the Home Office. To me there appears to be a new scope of work for the Medical Officer of Health in the medical supervision both at the factory and in the homes of those so employed. SANITARY INSPECTION OF THE AREA. Statistical details of the work carried out by the Sanitary Inspectors will be found in Table VI. of the Appendix. The following are the aggregate totals under the respective headings:— 29  Total No. of Inspections and Visits Total No. of Defects and Nuisances found Housing 6,937 5,326 Infectious Diseases 288 — Food Premises 2,274 278 Factories, Outworkers, etc 262 90 Sampling Visits 385 — Trade Premises (Various) 253 137 Rodent Control 14,247 761 Miscellaneous 696 74 Total 25,342 6,666 In addition, there were 1,214 interviews with owners, agents, etc., on site and at the office, in connection with the above work. Notices Issued: Preliminary:— Housing 1,105 Food Premises 70 Factories, etc 33 Trade Premises 60 Rodent Control 615 Miscellaneous 60 1,911 Statutory :— Housing 3 Total 1,914 Food Condemnation Certificates issued 1,439 SHOPS ACTS. Mr. G. R. Woods, the Inspector under the Shops Acts, reports:— "The expected consolidation of the Shops Acts and the many relevant Regulations has not yet been enacted. "It has not been possible to carry out an extensive routine inspection of all shops in the district. The conditions of employment in shops in this area are good and employers generally are willing to co-operate with the Department. "The principal contraventions found were the absence of various forms which should be exhibited. On inspection it was found that certain re-decorative work had been carried out, thus necessitating the removal of the forms, and they had not been replaced. "There were 103 inspections made and 119 defects or contraventions observed; by the end of the year 48 had been remedied. "In no case was statutory action necessary." 30 PETROLEUM ACTS. 95 licences were issued to store Petroleum Spirit and one for Carbide of Calcium. The total storage capacity licensed during the year was :— Bulk Storage 178,760 gallons. Can Storage 12,689 gallons. Carbide of Calcium 300 lbs. As will be seen from the above figures, a large majority of the Petroleum Spirit is stored in underground containers. Can storage includes Petroleum Mixtures and Thinners. 42 visits were made in connection with this work. SMOKE ABATEMENT. 12 inspections and re-inspections were made by the Inspectors. One complaint was received regarding the emission of grit from a Milk Processing Plant. The firm provided and installed two grit arrestors, and, from further observations, the nuisance appears to have been abated. VERMINOUS CONDITIONS AND UNCLEANLINESS. 89 visits to premises by Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. 26 nuisances were found, and there were 41 nuisances abated during the year (including those carried over from 1948). Only four cases of vermin infestation were found in connection with the Council's Housing Estates, and these were successfully dealt with. The very low incidence of verminous infestation and uncleanliness is most pleasing, especially when one considers the overcrowded and unsatisfactory conditions under which so many people are still living. RODENT CONTROL. The Rodent Staff consisted of 2 Assistant Rodent Officers and 1 Rodent Operator, and they did excellent work during the year. The public and traders are co-operating and requesting the services of the staff. Unless this work is efficiently carried out the build-up of rodents will again become a nuisance. The sewers have received the necessary maintenance treatments in accordance with the recommendations of the Ministry of Agriculture and Fisheries. 31 A new Act, known as "The Prevention of Damage by Pests Act, 1949," comes into operation on the 1st April, 1950, which will add additional responsibilities on local authorities. Number of inspections made :— (a) Trade Premises 2,074 (,b) Private Premises 9,022 (c) Sewers 2,914 (d) Corporation Property 12 14,022 Number of infested premises :— Found. Cleared. (a) Trade premises 110 Trade premises 105 (b) Private premises 537 Private premises 521 (c) Sewers 97 Sewers 97 (d) Corporation property .... 3 Corporation property 1 747 724 DISEASES OF ANIMALS ACTS. Mr. G. R. Woods, Chief Sanitary Inspector, is the authorised inspector under these Acts for the Borough of Bromley. 48 inspections and interviews were made in connection with this work. Many orders were received from the Ministry of Agriculture and Fisheries concerning Fowl Pest. Of six cases of suspected Fowl Pest, two cases were confirmed and four not confirmed. No case of Swine Fever occurred in any pigs within the area during the year. For a short period Bromley was in a Foot and Mouth Control Area, which necessitated the issue of Movement Licences. In this connection it is interesting to note that a performing Llama in a visiting Circus came under a Movement Licence. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. It would appear that there is little work for Registry Offices within the area. Observation has been kept on shops displaying advertising boards. Unless these shops are registered with the Local Authority, the exhibition of advertisements for female domestic servants contravenes the Byelaws. RETAIL MARKET. A total of £194 3s. 6d. in Market Tolls was collected during 1949. This figure shows a decrease of £6 13s. 6d. on the corresponding figure for 1948. SECTION D. HOUSING. 34 SECTION D.—HOUSING. Full statistical details of the work carried out by the Sanitary Inspectors will be found in the Tables shown in the Appendix. 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 1,441 172 4,772 6,385 5,250 Overcrowding 194 93 9 296 10 Verminous Conditions 15 3 16 34 15 Dirty Conditions 8 6 30 44 5 Water Supply 11 2 23 36 11 Disinfestation 3 4 4 11 6 Noxious Accumulations 10 — 12 22 8 Other Accumulations 20 8 25 53 19 Miscellaneous — 12 44 56 2 1,702 300 4,935 6,937 5,326 Nuisances and Defects Abated :— Drainage 834 Dampness 2,219 Water Supply 352 General Items 8,536 11,941 One application was made to the Ministry of Health during the year for a clearance order, and confirmation of the order has now been received. Rehousing. I am indebted to the Property Manager for the following information on this subject:— 1. (a) Number of permanent houses occupied during 1949: — New Premises 86 Premises re-let 27 Total 113 (b) No. of families accommodated in permanent houses during 1949 (c) No. of persons accommodated in permanent houses during 1949 436 35 2. (a) No. of pre-fabricated dwellings occupied during 1949 (re-let) 13 (b) Total No. of occupied pre-fabricated houses at 31.12.49 325 (c) Total No. of families " permanently " housed in fabricated dwellings as at 31.12.49 325 (d) Total No. of persons " permanently " housed in fabricated dwellings as at 31.12.49 1,093 3. (a) No. of premises requisitioned during 1949 7 (b) No. of premises de-requisitioned during 1949 4 (c) Total No. of families accommodated in requisitioned premises as at 31.12.49 906 (d) Total No. of persons accommodated in requisitioned premises as at 31.12.49 3,230 4. No. of families on waiting list as at 31.12.49 : — (a) Medical 6 (b) Category I 61 (c) Category II 28 (d) Category III 1,010 (e) O.A.P. 141 (f) Category IV 361 Total 1,607 The above figures show that considerable progress has been made during the past year, and, since the recent review of the housing applications, the number of applicants on the waiting list has been materially reduced. In addition to the above, 39 new houses erected by private enterprise were occupied during the year. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 38 SECTION E. INSPECTION AND SUPERVISION OF FOODS. FOOD SAMPLING. During the past year the Sanitary Inspectors continued to give particular attention to this most important work of safeguarding the food supply of the Borough. The success or failure of this service depends enormously on the assistance and cooperation given us by the traders and retailers, and their unfailing helpfulness has been greatly appreciated. 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 Formal Informal Genuine Adulterated Inf. Remarks Baking Powder 6 6 — — Bicarbonate of Soda — 1 1 — — Bread — 4 4 — — Bronchial Cough Mixture — 1 1 — — Celery Salt — 1 1 — — Cheese (Processed) — 1 1 — — Chinchards in Oil — 2 2 — — Cod Liver Oil and Malt. — 1 1 — — Coffee — 5 5 — — Compound Cooking Fat — 1 1 — — Compound Fat — 1 1 — — Cream of Tartar — 1 1 — — Culinary Essence — 1 1 — — Curry Powder — 3 3 — — Custard Powder — 2 2 — — Dessert Powder — 1 1 — — Dutch Fat (Sweetened) — 1 1 — — Egg, Dried — 1 1 — — Emulsion (Tin Greasing) — 4 4 — — Emulsion (Fat Extender) — 3 3 — — Fat Extender — 1 1 — — Fish Cakes — 2 2 — — Fish Paste — 2 2 — — Flour — 5 5 — — Forcemeat — 1 1 — — Fro-Frute — 1 1 — — Fruit Syrup — 4 — 4 — See (a) Gin — 5 5 — — Ginger Pudding and Cake Mixture - 1 1 - — Ginger Wine - 1 1 — — Ginger Wine Flavouring - 1 1 — — Golden Raising Powder - 2 2 — — 39 Ground Ginger — 1 1 — — Horseradish Sauce — 1 1 — — Ice Cream (Loose) 3 94 95 — 2 See (b) Ice Cream (Mix) — 15 15 — — Ice Cream (Pre-Packed) — 35 35 — — Ice Cream (Chocolate— Pre-Packed) — 27 27 — — Ice Lolly — 6 5 — — See (c) Jellied Rabbit — 1 — 1 — See (d) Lemonade Crystals — 1 1 — — Liquid Paraffin — 1 1 — — Malted Milk Tablets — 1 1 — — Maralyn — 1 1 — — Margarine (Kosher and Vegetarian) - 1 1 — — Meat Paste — 1 1 — — Milk (T.T. Pasteurised) — 7 7 — — Milk (Pasteurised) 3 23 26 — — Milk (Machine Skimmed) — 1 — 1 — See (e) Milk (Yoghourt) — 1 1 — — Olive Oil — - 3 — — Pepper — - 3 — — Peppermint Flav. Essence — 1 1 — — Pork Pie — 1 1 — — Potato Crisps — 3 — — Pudding Mixture — 1 1 — — Quinine (Ammoniated Tincture of) - 1 1 — — Rice Cake Flour Mixture — 1 1 — — Salad Cream — 3 1 1 See (f) Sausages 5 7 1 11 — See (g) Sausage Meat 3 4 3 — See (h) Sausage Rusk 5 1 6 — — Sausage Seasoning — 1 1 — — Semolina — 1 1 — — Soft Oil (for Greasing) — 1 1 — — Soup (Meat) — 1 1 — — Tomato Sauce — 1 1 — — Vinegar (Malt) — 1 1 — — See (i) Whiskey 1 2 2 1 — Zinc and Castor Oil Cream — 1 1 - - 20 325 319 22 3 (a) Contained no material quantity of fruit. (b) Fats 2.4%, total solids 21.4% and 26.4% respectively. (c) One bottle broken in transit. (d) Putrid. Unfit for food. (e) Cane sugar crystallised. (f) Adulterated—mouldy. Inferior—oil 29.2%, egg yolk solids 1%. (g) Deficient in meat content. (h) Deficient in meat content. (i) 4.5% excess water. 40 BACTERIOLOGICAL EXAMINATIONS. Milk. No. of samples taken Description Satisfactory Unsatisfactory 117 Designated Milk 108 9 5 Ordinary Milk 5 2 Washed Milk Bottles 2 — 124 115 9 ICE CREAM. The Ice Cream (Heat Treatment, etc.) Regulations came into operation on 1st May, 1947. There are 87 premises registered to sell ice cream and 10 premises to manufacture ice cream in ihis Borough. A method of grading ice cream was initiated in 1947 ; it was not considered a legal standard with which statutory compliance should be demanded. The tests are a simple and practicable method for grading ice cream according to the degree of bacterial cleanliness. On experience the tests have proved to be reliable and give a reasonably fair indication of bacteriological contamination. When unsatisfactory samples, manufactured outside Bromley, are obtained, there is complete co-operation with the Health Departments concerned who are notified immediately, and, in consequence, there has been a noticeable improvement. It is significant that pathogenic organisms have not been cultivated in any sample since the inception of the tests in 1947. Week-end samples have been taken from itinerant dealers. Some of these dealers only sell in this district on Sundays, and the Department has no prior knowledge of their visits or sites from which sales take place. It will be observed from the tabulations of samples and results that there is a marked improvement in the bacteriological quality of ice cream sold in Bromley since 1947—in Grades I. and II. from 42.4% to 78.5%, and there being a reduction in Grade III. from 23.3% to 13.7%, and Grade IV. from 34.3% to 7.8%. There is no legal chemical standard, and, in consequence, ice cream sold has a varying food value. It is hoped that eventually there will be a prescribed standard for a minimum content for fat and solids not fat. 96 samples of ice cream were submitted; the lowest fat content was 2.4% and the highest 15.35%. 27 Chocolate Ice Cream samples showed lowest fat content 4.7% and highest 36.4%. The reason for high fat content is that the chocolate coating contains fat. 41 Table " A." Ice Cream—Bacteriological Examination. No. of samples taken Description Satis. Unsatis. Methylene Blue Group I. II. III. IV. 94 Ice Cream (Loose) 94 46 24 16 8 28 Ice Cream (Mix.) 28 — 17 6 1 4 44 Ice Cream (Pre-Packed) 44 — 25 12 6 1 25 Ice Cream (Choc.) 25 7 10 5 3 10 Ice Lollies, etc 10 10 - - - 3 Ingredients 3 — 3 — — — 204 204 — 108 52 28 16 Table " B." Tabulation of 392 samples examined from 1st May, 1947, to 31st December, 1949. Grade 1947 (part) 1948 1949 No. Samples % No. Samples % No. Samples % I. 13 17.8 46 40.0 108 53.0 II. 18 24.6 24 20.9 52 25.5 III. 17 23.3 19 16.5 28 . 13.7 IV. 25 34.3 26 22.6 16. 7.8 Total 73 100.0 115 100.0 204 100.0 SPECIAL ENQUIRIES. The following tables give details of foods, etc., which were submitted for bacteriological examination after investigation into complaints made to this Department:— NO. of samples subnutte Description d Result Remarks 2 Almond Essence Genuine — 1 Biscuits (Wafer) Genuine — 1 Bread Adulterated Microscopic — wheat bran, a little wood, several typical rodent hairs. 2 Butter Genuine — 1 Cheese Genuine — 1 Cheese (Camembert) Genuine — 2 Cheese (Processed — American) Genuine - 1 Cornflour Genuine - 1 Jellied Rabbit Genuine - 2 Margarine (Kosher and Vegetarian Genuine - 3 Milk Powder Inferior Acidity rather high. 1 Milk (Machine Skim'd —Sweetened) Genuine — 42 No. of sample submits s Description ed Result Remarks 1 Milk (Pasteurise) Adulterated Foreign body in milk consisted of cotton wool with small adhering amount of vegetable debris. 1 Soup (Meat) Genuine — 1 Tapioca Inferior Sample had stale and musty odour, and appeared to be old stock. 1 Turkey Genuine — 1 Water (River) Blue colouration due to organic dye. Samples of the following foodstuffs were submitted for bacteriological examination as a result of routine food inspections :— Description Result Argentine Beef. Shin Bone Unsound bacteriologically. Steak Unsound bacteriologically. Silverside Unsound bacteriologically. Aitch Bone Meat Unsound bacteriologically. Bone Taint confirmed. Thick Flank Meat Unsound bacteriologically. Bone Taint confirmed. Bones Unsound bacteriologically. Bone Taint confirmed. Chitterlings (Imported) Unsound bacteriologically. Fish—Halibut Diseased. Flake Egg Yolk Unsound bacteriologically. Pigs' Rinds Unsound bacteriologically. Sausages Unsatisfactory. Sheeps' Livers (Icelandic) Unsound bacteriologically. Samples of the following were submitted for examination after investigation into food upsets reported to this Department :— Description Result Beef Sausages No pathogenic organisms isolated. Beetroot No food poisoning organisms isolated. Carrots (Tinned) Paracolon Bacilli. CI. Welchii. Custard (prepared and cooked) No food poisoning organisms isolated. Custard CI. Welchii. Cheese No pathogens isolated. Chocolate Semolina No food poisoning organisms found. Cooked Mutton No pathogens isolated. Dates No pathogens isolated. Dripping No food poisoning organisms found. Dripping (from Mutton) No food poisoning organisms found. Dripping (Lamb) No food poisoning organisms found. Dripping (used in the cooking of Mutton) No food poisoning organisms found. Fruit Buns No food poisoning organisms found. Milk Powder No food poisoning organisms found. 43 Meringue Powder No pathogens isolated. Meat (uncooked) No food poisoning organisms isolated. Mustard and Cress No pathogens isolated. Salad Cream No food poisoning organisms isolated. Sausage (uncooked) Paracolon Bacilli. Coliform organisms. Heavy growth of CI. Welchii. Sausage Rolls No pathogens isolated. Veal and Ham Pies No pathogens isolated. Water (Tap) No organisms of the food poisoning group or toxin producers isolated. Food Preparing Places. The special survey was continued by the Sanitary Inspectors. There are some 285 premises issued with a catering licence, and these include 33 school canteens, 14 hospitals, Nursing Homes and Institutions, 121 Hotel? and Public Restaurants, etc., 25 Industrial undertakings, 70 Clubs and 15 Staff Canteens. There is no doubt that as a result of this survey and the co-operation given by the proprietors, that improvement in the handling and preparation of food has resulted in spite of the many physical difficulties associated with many of the premises. Many of the kitchens are not well planned and are too small for the number of meals served, so that the proprietors are forced to cook in cramped conditions which do not lead to hygienic practice. It is desirable that when new plans are submitted for kitchens the advice of the Health Department should be sought. The prevention of food poisoning outbreaks depends mainly on the personal hygiene of the employees, and if this is practised as a routine the difficulties of the lack of equipment and of suitable premises can be overcome. One would like to see the reporting to the Medical Officer of Health of all sickness occurring among food handlers, for herein lies hope of good preventive work against food poisoning. MEAT AND OTHER FOODS. Slaughterhouses. There are six slaughterhouses 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 pig-keeping clubs. As centralised slaughtering is still in operation, no other slaughtering of animals is carried out in the area. Annual licences were granted to seven slaughtermen under the provisions of the Slaughter of Animals Act, 1933. 44 INSPECTION OF FOOD PREMISES. 2,274 visits of inspection were made to Food Premises during the year, and 278 defects were noted. 250 defects were abated during 1949 ; this figure includes those noted in 1948 which were abated in 1949. FOOD AND DRUGS ACTS, 1938 AND 1944. Milk and Dairies Regulations, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The following licences were issued by the Local Authority under the above Regulations:— Dealers' Pasteurisers' Licences 1 Dealers' Licences: — " Pasteurised " Milk 14 " Sterilised " Milk 14 " Tuberculin Tested" Milk 14 Supplementary Licences: — " Pasteurised " Milk 15 " Sterilised" Milk 13 " Tuberculin Tested" Milk 11 MEAT. The following table gives details of the ante- and postmortem inspection of animals made during 1949 :— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed — — — — 35 Number inspected — — — — 35 All Diseases except Tuberculosis. Whole carcasses condemned — — — — — Carcasses of which some part or organ was condemned — — — — 9 Percentage of the number inspected affected with disease other than Tuberculosis — — — — 25.71 Tuberculosis Only. Whole carcasses condemned — — — — Carcasses of which some part or organ was condemned — — — — 3 Percentage of the number inspected affected with Tuberculosis — — — — 8.57 45 UNSOUND FOOD. During 1949, 1,439 Food Condemnation Certificates were issued, affecting in quantity 15 tons 12 cwts. 20£ lbs. of varied articles of food, which was utilised either for animal food or, where this was impracticable. destroyed. Details of the food condemned are as under:— Article of Food Approximate Weight (lbs.) Bread, Cake, Biscuits, etc 13¼ Butter 4 Cereals 283¾ Cheese 123 Coffee 4 Eggs (Fresh) 29¼ Eggs (Dried) 20 Fat 17 Fish (Fresh) 3,255 Fish (Canned) 309 Flour and Flour Mixtures 85 Fruit (Fresh) 72 Fruit (Canned) 1.532½ Fruit Juice (Tinned, etc.) 329½ Jams and Syrups 748¼ Meat (Fresh) and Bacon 10,079 Meat (Canned) 708¾ Meat (Cooked) 791½ Milk (Tinned and Powdered) 2,292 Peanuts 116 Pickles and Sauces 370¾ Poultry 3,116 Rabbits 6,424 Soup (Tinned) 187½ Sugar 227 Sweets 117 Tea 1½ Vegetables (Fresh) 1,792 Vegetables (Canned and Dried) 1,202½ Miscellaneous 713½ Total 34,964½ The corresponding figure for the previous year (1948) was 13 tons 2 cwts. 1 quarter 24J lbs. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 48 SECTION F. SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Statistical details regarding notifiable diseases are shown in Tables IX. and X. in the Appendix. There were no serious epidemics during the year. SMALLPOX. Contacts of Smallpox imported into the country were kept under surveillance for the necessary period, and no cases developed. It was not found necessary to undertake mass vaccination, but, as a precaution, all those members of the Public Health Staff who were unprotected were re-vaccinated. As the Council will be aware, compulsory vaccination passed out of being on the National Health Act being put into operation in July, 1948, and with probably not more than 40% of the population now vaccinated, one cannot help wondering what may be in store for us should this country have the misfortune to be visited by a virulent form of smallpox on anything like a large scale; the medical resources of the country would be stretched to the limit to undertake the inevitable demand for vaccination which would arise. Vaccination has become unpopular owing to the publicity which has been given to the occasional unfortunate incidents which have followed it. These complications very rarely arise when a baby is vaccinated before the age of six months, hence the great need for propaganda to get vaccination done in infancy and not wait until the child is older, when it may become a matter of urgency and at the same time might, in rare instances, not be such an innocuous operation. VACCINATION. The following figures, which have been furnished by the County Medical Officer, show the number of persons who were vaccinated against smallpox during the year 1949 :— Age at 31st December, 1949 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated . 258 182 15 17 472 Number Re-Vaccinated — 2 27 115 144 ANTERIOR POLIOMYELITIS. In common with the rest of the country, we had a minor outbreak of infantile paralysis in the summer and autumn of 1949. 12 suspected cases were admitted to the Lennard Hospital, six of which were confirmed and notified, and six were not con- 49 firmed. One case was also admitted to the Park Hospital. Of these cases, three were non-paralytic and three paralytic. On such occasions as this, theories as to the spread of the disease are many and varied, but there are none which stand the test of rational argument better than the old-fashioned one, that the complaint is spread by healthy carriers in crowded communities. This would seem to be the only explanation of the fact that more than one case in a family is the exception rather than the rule. In this feature it differs entirely from, e.g. Measles, which if picked up by one child in a family, usually affects all the rest of the household who have not been immunised by a previous attack. It is known that the virus which causes the disease can be found in the Naso-pharynx and in the stools of infected persons. Hence the importance of hygiene in the handling of food. In view of our comparative ignorance of the spread of this malady, preventive means are naturally difficult, but I did think it worth while drawing up a short letter, which was handed to all known contacts, advising them of the reasonable precautions open to them. The local doctors were also circularised, and a film showing the most recent advances in the diagnosis and treatment of the disease was shown at Beckenham and all the local general practitioners were invited to its showing. An interesting point which has arisen recently is the discovery of a new virus disease which has been designated "lymphocytic Chorio-meningitis." This condition is not fatal, but is similar in its symptomatology to abortive anterior poliomyelitis and may have accounted for some of the pre-paralytic cases of anterior poliomyelitis which were notified. SCARLET FEVER. 139 cases were notified, 71 of which were home nursed and 68 treated in hospital. The infection continued to be mild in type, and it does appear that this disease is no longer the acute disease of a few decades ago. The mildness of the infection, however, tends to " missed " cases, and consequently leads to spread of infection. DIPHTHERIA. Only one case—in an adult—of this disease was notified during the year. The continued low incidence, in fact the rarity of the disease, requires some explanation other than that it is solely due to immunisation. It has been known that in Bromley, diphtheria had a peak wave every seven years between the years 1890 and 1919. Following 1919 the incidence fell rapidly and remained 50 below 1 per 1,000 for five years, although immunisation did not begin until 1928. During the four years between 1928-32 the incidence exceeded 1 per 1,000, and since 1932 the incidence has remained below 1. It is apparent that the nature of the disease has changed— prior to 1900 the case death rate was anything up to 40%. For the past 5 years there has been 1 death in 24 cases. DIPHTHERIA IMMUNISATION. This service is now the responsibility of the County Council. Immunisation is carried out at the various School Clinics within the area by the Assistant School Medical Officers. Prior to the taking over of this service by the County Council some 80% of the children within the Borough had received protective immunisation at one time or another, and it is pleasing to note that this high standard is still being maintained. During the year 1949 a total of 1,079 children received Primary Inoculations and 1,426 Reinforcing Inoculations. A total of 8,942 children under the age of 15 years had completed a course of immunisation (since 1st January, 1935) at the 31st December, 1949. This is equivalent to 71% of the population under 15 years of age. TYPHOID FEVER. Two cases were notified during the year. These were isolated cases and had no relation to one another. No secondary cases occurred. Both cases began immediately on return from seaside holidays, one in August and the other in November. Both seaside resorts were informed, and necessary " follow up " action taken. PUERPERAL PYREXIA. 25 cases of Puerperal Pyrexia, representing an attack rate of 23.7 per 1,000 total births, were notified. All of these cases were institutionally treated, and there was no mortality. OPHTHALMIA NEONATORUM. There were no cases of this disease notified during 1949. PEMPHIGUS NEONATORUM. No cases were notified during the year. 51 MEASLES. 559 cases of measles occurred in the Borough during 1949, as against 358 cases for "1948, giving an attack rate of 8.7 per 1,000 population. The distribution of the cases occurring was fairly even throughout the area. Of these cages, ten were admitted to hospital. As this disease is largely a disease of the young child, an attack of Measles can have a far-reaching debilitating effect. The control of the disease is not an easy matter, but careful nursing and isolation are not only necessary for the sake of the patient, but necessary for preventing the spread to others. The use of immune sera is not universally practised. WHOOPING COUGH. 199 cases were notified, giving an attack rate of 3.1 per 1,000 population. Six of these cases were admitted to hospital, and there was one death. Whooping Cough again was of a mild type, and it is principally the pulmonary complications of this disease that give rise to trouble, especially in very young children. Investigations are still proceeding into the efficacy of various prophylactic vaccines, but as yet nothing very definite has been discovered. On the other hand, one does not want to appear pessimistic, and it can only be a question of time before the control of Whooping Cough becomes as effective as that of Diphtheria. TUBERCULOSIS. Recordings in the Register for the year ended 31st December, 1949, are as under :— Respiratory Other Forms Total No. of Cases M F M F On Register at 1.1.49 .... » 313 274 53 56 696 New cases notified during 1949 .... 47 33 4 2 86 No. of cases coming to knowledge after death 4 4 Restored to Register — — Inwards Transfers 6 15 1 — 22 370 322 58 58 808 Deletions—deaths, removals, recovery, etc. 49 40 7 4 100 No. of cases on register 31.12.49 321 282 51 54 708 Full details of the new cases and mortality during the year are shown in Table XI. of the Appendix. 52 86 new cases were added to the register, 4 cases were noted after death, and there were 22 inward transfers to the area. 100 cases were deleted from the register on account of death, removals, recoveries, etc., leaving a net figure on the register of 708, a decrease of 12 over the total for 1948. The number of new cases notified showed an increase of 13 over the previous year. The Ministry of Health has now decided to try out B.C.G. vaccination on selected groups of volunteers, and we must hope the results will justify the expectations placed in this form of prophylaxis. The groups selected are nurses and medical students, and, in addition, appropriate specialists will be allowed to use the vaccine at their own discretion such as in suitable cases of home contacts of a case of open tuberculosis. The reason, of course, for choosing such groups as nurses and medical students is that they are particularly exposed to the risk of infection from tuberculosis, and in the majority of cases are of an age which is peculiarly liable to this infection. Continental workers have been using this form of prophylaxis over a number of years and are enthusiastic about its efficiency, but one must not think that because a person is vaccinated against tuberculosis and does not develop the disease, he or she would necessarily have had it in any case. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. PUBLIC HEALTH ACT, 1936 (SECTION 172). It was not found necessary to take any action under these Regulations and Section of the Public Health Act during the year. FOOD POISONING. There were twelve cases of Food Poisoning notified by medical practitioners during the year. Of these, five were isolated cases and it was not possible for various reasons to carry out investigations into the cause of the illness. One case notified was that of a person residing in the area who had attended a dinner in London, after which many cases had been brought to the attention of the Authority concerned and they had made the necessary investigations. Five persons in one family were reported to be suffering from Food Poisoning, and, after full investigation and analysis of various specimens, etc., had been made, the source of the original infection was traced to Duck Eggs which had been eaten by the persons concerned. 53 There was an outbreak of Food Poisoning at one of the schools within the area, and, although only one case was notified as being under the care of a doctor, some ninety-four cases were ascertained as having occurred. After full investigation both at the school and at the homes of the persons concerned, and many specimens of foodstuffs, faeces, etc., had been submitted to the laboratory for examination, the cause of the infection was traced to the presence of Clostridium Welchii in Sausage Meat. OTHER INFECTIOUS DISEASES. In adition to the other infectious diseases already enumerated there were 30 cases of Pneumonia, 8 of Erysipelas, 2 of Cerebro Spinal Fever and 2 of Dysentery notified during the year. GENERAL. A total of 288 visits were made by the Sanitary Inspectors during the year in connection with investigation and control of Infectious Diseases. APPENDIX. STATISTICAL TABLES. 56 STATISTICAL TABLES, 1949. TABLE I.—Summary of Statistics. TABLE II.—Causes of Death. TABLE III.—Infant Mortality. TABLE IV.—Analysis of Causes of Infant Deaths 1945-9. TABLE V.—Housing Statistics. TABLE VI.—Summary of the Work of the Sanitary Inspectors. TABLE VII.—Nuisances, Defects and Contraventions Abated. TABLE VIII.—Factories Act, 1937. TABLE IX.—Infectious Diseases—Ward Distribution, Attack and Mortality Rates. TABLE X.—Sex and Age Distribution. TABLE XI.—Tuberculosis—New Cases and Mortality. 57 TABLE I. Summary of Statistics 1949. Population (raid-year 1949, per Registrar General) 64,140 Birth Rate 16.1 Death Rate 10.9 Maternal Mortality Rate 0.95 Infant Mortality Rate 15.5 Number of Births (live) 1,030 Number of Stillbirths 23 Number of Deaths 699 Number of Maternal Deaths 1 Number of Infant Deaths (under 1 year) 16 Death Rate of Respiratory Diseases 1.3 „ „ „ Tuberculosis 0.3 „ „ „ Cancer 2.2 „ „ Zymotic Diseases 0.05 Notifications of Scarlet Fever 139 „ „ Diphtheria 1 ,. „ Poliomyelitis 7 ,, Typhoid Fever 2 „ Puerperal Pyrexia 25 ,, „ Pneumonia 30 .. „ Tuberculosis (New Cases) 86 Number of Deaths from Infectious Diseases 28 „ „ „ Diarrhoea (under 2 years) 1 „ „ „ Child Birth 1 Number of visits by Sanitary Inspectors 25,256 58 TABLE II.Causes of Death, 1949. Male Female Total 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-Spinal Fever — 1 1 3. Scarlet Fever — — — 4. Whooping Cough — 1 1 5. Diphtheria — — — 6. Tuberculosis—Respiratory 13 7 20 7. „ Other forms — — — 8. Syphilitic diseases — — — 9. Influenza 3 2 5 10. Measles — — — 11. Acute Poliomyelitis, etc. — — — 12. Acute Infectious Encephalitis — 1 1 13. Cancer—Buccal Cavity etc. (M), Uterus (F) 3 4 7 14. „ Stomach, Duodenum 10 10 20 15. „ Breast — 12 12 16. „ Other sites 53 46 99 17. Diabetes 2 3 5 18. Intra-Cranial Vascular Lesions 32 36 68 19. Heart Diseases 78 126 204 20. Other Diseases Circulatory System 21 20 41 21. Bronchitis 15 21 36 22. Pneumonia 15 23 38 23. Other Respiratory Diseases 6 5 11 24. Ulcer of Stomach or Duodenum 6 — 6 25. Diarrhoea (under 2 years) 1 — 1 26. Appendicitis — — — 27. Other Digestive Diseases 6 14 20 28. Nephritis 7 2 9 29. Puerperal and post-abortion Sepsis — — — 30. Other Maternal causes — 1 1 31. Premature Birth 3 — 3 32. Congenital Malformation, etc. 4 5 9 33. Suicide 4 6 10 34. Road Traffic Accidents 2 1 3 35. Other Violent causes 4 7 11 36. All other causes 33 24 57 Totals 321 378 699 59 TABLE III. INFANT MORTALITY, 1949. (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 Meningitis - - - - - - - 1 - 1 Measles — — — — — — - — — - Whooping Cough — — — — — — — — — — Tuberculosis — — — — — — — — — - Convulsions — — — — — — — — — - Bronchitis — — — — — — 1 — — 1 Pneumonia - — — — — 1 1 — — 2 Diarrhoea — — — — — — — — — — Gastro-Enteritis — — — — — 1 — — — 1 Injury at Birth — — — — — — — — — — Atelectasis 1 — — — 1 — — — — 1 Malformation — — — — — — — — — Premature Birth 3 — — — 3 — — — — 3 Marasmus, etc. — — — — — — — — — — Other Causes 2 — — — 2 — 2 — — 4 Syphilis — — — — — — — — — — Congenital Heart Disease 1 - - - 1 1 1 - - 3 Totals 7 - - - 7 3 5 1 - 16 60 TABLE IV. Analysis of Causes of Infant Deaths 1945—1949. 1945 1946 1947 1948 1949 No. of Births (live) 872 1,176 1,304 1,042 1,030 Total Infant Mortality Rate 28 26 19 21 16 Malformation 4 3 13 — — 20 Premature Births 9 14 5 6 3 37 Respiratory Diseases 3 4 5 2 1 15 Marasmus and General Debility 1 — — — — 1 Infectious Diseases — 1 — — 3 4 Gastro Enteritis 2 — — 1 1 4 Convulsions — — — — — — Atelectasis — — — — 1 1 Congenital Heart Disease — — — — 3 3 Other Causes 6 9 2 12 4 33 Totals 25 81 25 21 16 118 61 TABLE V. Housing Statistics for the Year 1949. Total number of inhabited houses, 1949 17,819 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) 1,957 (b) No. of inspections made for the purpose 6,385 (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 12 (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 1,739 '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 2,020 62 TABLE VI. Summary of the Work of the Sanitary Inspectors for the Year 1949. TYPE OF INSPECTION. On Complaint Routine ReInspec tion Total Visits Nuisances Found Housing — 1. Inspection of District Regulations — 12 42 54 - 2. For Nuisances 1,441 172 4,772 6,385 5,250 3. Overcrowding 194 93 9 296 10 4. Verminous Conditions 15 3 16 34 15 5. Dirty Conditions 8 6 30 44 5 6. Water Supply 11 2 23 36 11 7. Cesspools — — — — - 8. Earth Closets — — - - - 9. Privy Pails — — 2 2 2 10. Houses Let in Lodgings — — - - - 11. Disinfestation 3 4 4 11 6 12. Noxious Accumulations 10 12 22 8 13. Other Accumulations 20 8 25 53 19 Totals 1,702 300 4,935 6,937 5,326 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded in above table) 57 123 14 194 - 2. Disinfection Purposes 10 13 7 30 - 3. Smallpox Inquiries 21 24 - 45 — 4. Public Health (Aircraft Regulations) — — - — — 5. Polio Contacts — 14 14 6. Typhoid Contacts — 5 — 5 - Totals 88 179 21 288 Meat, Milk and Other Food Shops— 1. Butchers 16 579 44 639 41 2. Confectionery 1 21 4 26 2 3. Dairies and Cowsheds (excl. Past Plants) 1 38 14 53 7 4. Pasteurising Plants — 39 - 39 — 5. Fish . 7 293 6 306 16 6. Fried Fish — 44 6 50 2 7. Food Hawkers — 8 8 — 8. Fruit, Greengrocery — 39 — 39 1 9. Grocery 45 406 35 486 72 10. Ice Cream 1 227 7 235 18 11. Meat Regulations (Special Visits) 2 3 - 5 — 12. Meat Examined on Highway — 9 - 9 — 13. Retail Market — 77 - 77 — 14. Slaughterhouses — 29 - 29 — 15. Horseflesh Shops — 1 - 1 — 16. Restaurants 5 126 58 189 97 17. School Canteens 7 14 3 24 8 18. Public Houses 2 30 16 48 7 19. Cinemas & Theatre 1 1 2 4 5 20. Hotels 1 2 3 1 21. Circus — 1 3 4 1 Totals 89 1,985 200 2,274 278 Factories, Outworkers, etc. 1. (i) Factories in which Sects. 1, 2, 3, 4 and 6 of the Factories Act 1937 are to be enforced by the Local Authority 13 18 12 43 36 (ii) Factories not included in 1 in which Sect. 7 is enforced by the Local Authority (a) Subject to Local Authority (transfer of Enforcement) Order, 1938 5 13 64 82 22 (b) Others 2 — 1 3 2 Carried Forward . 20 31 77 128 60 63 TABLE VI. (Continued) Type of Inspection On Complaint Routine ReInspec tion Total Visits Nuisances Found Brought Forward — 20 31 77 128 60 Factories, Outworkers, etc. Contd. 2. Other Premises under the Act (excl. workers' premises hotels, Restaurants, etc. 3 — 1 4 4 3. Bakehouses (a) Mech. power 3 38 18 59 21 (b) Non-mech. power 1 4 1 6 3 4. Outworkers' premises — 51 2 53 — 5. Smoke Abatement 4 6 2 12 2 Totals 31 130 101 262 90 Sampling of Food and Drugs— 1. Milk : T.T. Certified — 5 — 5 — T.T. Pasteurised — 17 — 17 — Pasteurised 1 29 — 30 — Accredited — — — — — Sterilised — 4 — 4 — Yoghourt — 1 — i — Ordinary — 3 — 3 — 2. Schools Milk (Pasteurised) - - - - - 3. Pasteurising Plant: 22 — 22 — T.T. Milk — 14 — 14 — Pasteurised — 10 — 10 — Washed Bottle — 1 — 1 — 4. Tinned Milk — — — — — Dried Milk 2 — — 2 — Condensed Milk 2 — — 2 — 5. IceCream — 136 — 136 — Ice Cream Mix. — 16 — 16 — Ice Cream Ingredients — 1 — 1 — 6. Other Foods 7 60 — 67 — 7. Food Poisoning 11 31 7 49 — 8. Drinking Water 4 1 5 — Totals 27 351 7 385 — Trade Premises— Various 1. Under Shops Acts 10 44 49 103 119 2. Under Petroleum Acts — 23 19 42 — 3. Registry Offices — — 5 5 — 4. Offices (P.H. Act, Sees. 46 and 91) 1 4 — 5 9 5. Diseases of Animals Acts: Movement Licences — 5 — 5 — Sheep Dipping — — — — — Foot and Mouth Disease — 3 — 3 — Swine Fever 1 — 2 3 — Fowl Pest 2 2 — 4 — Other — — — — — Interviews 10 23 — 33 — Piggeries,Cleansing 2 3 2 7 — Sanitary Conditions 2 6 9 17 5 7. Stables, Cleansing — 1 3 4 1 Sanitary Conditions 1 4 7 12 1 8. Animals, Keeping of 7 — 3 10 2 Totals 36 118 99 253 137 Rodent Control— 1. Trade Premises 86 60 1,982 2,128 119 2. Private Premises 580 2.4C6 6,145 9,191 542 3. Sewers 441 4S2 1,993 2,916 97 4. Corporation Property 3 9 12 3 Totals 1,110 3,008 10,129 14,247 761 64 TABLE VI. (Continued) TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Miscellaneous— 1. Schools 5 9 14 28 14 2. Drain Tests: Smoke 21 5 3 29 25 Water 31 93 2 126 3 Colour 4 3 7 1 Chemical - - - - Mirror - - - - - 3. Swimming Baths: Visited - 33 2 35 4 Samples taken Chlorine — 33 — 33 3 Ph. test - 59 - 59 — 4. Tents, Vans and Sheds - 4 1 5 1 5. Accumulations (other than dwellings) 4 16 15 35 7 6. Streams 12 5 8 25 4 7. Tips 3 6 4 13 3 3. Special Visits 59 140 4 203 1 9. Public Houses—Urinals — 81 10 91 3 10. Cinemas 1 - 6 7 5 Totals . 140 487 69 696 74 Grand Totals 3,223 6,558 15,561 25,342 6,666 65 TABLE VII. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1949. 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 136 Drains unstopped 112 Inspection chambers provided 31 W.Cs. provided 8 „ buildings reconstructed 13 „ „ repaired 52 ,, pans renewed 221 „ „ cleansed — „ box seats removed 20 Soil/vent pipes renewed or repaired 20 Sink/bath waste pipes renewed or repaired 90 Sinks renewed 48 Lavatory basins renewed or repaired 75 Baths ,, ,, 6 834 Dampness- Roofs repaired or renewed 766 R.w.p.'s, guttering, repaired or renewed 420 Vertical plinths provided 70 Walls rendered 132 Horizontal damp-course provided 15 Solutioning 3 Earth removed from walls 19 Walls repointed 128 Weather-board walls repaired, etc. 2 Sub-floor ventilation provided or improved 113 Dry areas constructed 126 Brickwork repaired 253 Miscellaneous 166 Site Concrete 4 Walls rebuilt 2 2,219 Water Supply- Drinking water service supplied direct from main 12 Fittings, etc. renewed 135 Separate or additional water supply provided 7 Supply reinstated 3 Flushing cisterns renewed or repaired 95 Storage tanks „ „ „ 69 Boilers „ „ 31 352 66 TABLE VII. (Continued) General Items- Rooms cleansed 2,357 W.C. walls cleansed 214 Entrance hall and staircase cleansed 351 Bathroom cleansed 173 Light and ventilation improved 10 Plastering repaired or renewed 3,013 Floors repaired or renewed 279 Windows, frames, etc. repaired or renewed 759 Sashcords repaired or renewed 222 Putty pointing repaired or renewed 68 231 Doors repaired or renewed Stoves and grates repaired or renewed 201 Coppers repaired or renewed 20 Handrails repaired or renewed 5 Stairtreads repaired or renewed 17 Dustbins provided . 123 Dirty conditions remedied 16 Overcrowding abated — Chimneys repaired 145 External woodwork repainted 225 Food stores provided 5 Food stores ventilated 4 Yard paving renewed, etc. 37 Houses disinfected 25 Accumulations removed 34 Miscellaneous 2 8,536 Total 11,941 MEAT, MILK AND OTHER FOOD PREMISES— Yards, floors, etc repaired 13 Cleansed, lime-washed shops, rooms 78 Lighting/Ventilation improved 7 Drainage improved 7 Manure or refuse removed 2 Refuse bins provided 8 Cold store or refrigerator improved 10 Water supply improved 11 Sinks provided 10 Washing facilities improved. 15 Sanitary conveniences improved 22 Miscellaneous 67 Total 250 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 11 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) — Inadequate ventilation (Sect. 4) 4 Ineffective drainage of floors (Sect. 6) — Sanitary conveniences (Sect. 7): (a) Insufficient 1 (b) Unsuitable or defective 44 (c) Not separate for sexes — Other offences 33 Outworkers' premises: (a) Want of cleanliness — (b) Workstopped re: Infectious disease 1 (c) Other nuisances — Smoke nuisances — Total 94 67 TABLE VII. (Continued) rRADE PREMISES— Shops Acts : Ventilation improved — Temperature improved — Sanitary conveniences improved 1 Absence of statutory forms 26 Unsatisfactory Washing facilities remedied — Meals rest interval contraventions remedied — Seats for female workers provided - Other offences or defects remedied 20 Petroleum Acts contraventions — Registry Office contraventions — Offices (P.H. Act, 1936, Sect. 46) contraventions 1 Total 48 RODENT CONTROI Trade premises 105 Private premises 521 Sewers (manholes) 97 Corporation property 1 Total 724 MISCELLANEOUS— Schools Drain tests : Smoke 23 Water 2 Colour - Chemical - Mirror - Swimming Baths : - Visited 4 Samples taken 3 Chlorine & Ph. test — Tents, Vans and Sheds - Accumulations (other than dwellings) 27 Streams 1 Tips - Special Visits - Public Houses—Urinals 1 Cinemas - Total 51 Grand Total 13,108 NOTICES ISSUED— Preliminary : Housing 1,105 Food Premises 70 Factories, etc. 33 Trade Premises 28 Rodent Control 015 Miscellaneous 00 1.911 Statutory: Housing 3 1,914 68 TABLE VIII. Factories Acts, 1937 and 1948. 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 Authorities 61 43 5 - (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 209 82 13 - (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 1 3 — — Totals 271 128 18 — 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) 22 11 - 6 — Overcrowding (Sect. 2) — — — — — Unreasonable temperature (Sect. 3) — — — — — Inadequate ventilation (Sect. 4) — 4 — — — - - — — — Sanitary Conveniences (Sect. 7)— (a) Insufficient 3 1 — 2 (b) Unsuitable or defective 33 44 — 7 — (c) Not separate for sexes 1 — — — — Other offences against the Act (excluding Outwork) 27 33 — 4 - Totals 86 93 — 19 — Outwork Nature of Work No. of Outworkers Number of Inspections Nuisances Notices Served Wearing Apparel 22 53 - - Curtains and Furniture Hangings 2 Christmas Crackers 1 Totals 25 53 — — 69 TABLE IX. Notifiable Diseases, 1948 (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 139 26 20 8 24 12 29 20 68 2.17 — - Whooping Cough 199 26 14 11 7 61 59 21 6 3.10 1 0.01 Acute Poliomyelitis 7 3 1 — 1 — — 2 5 0.11 — — Acute Polioencephalitis - — - — — - — — — — - — Measles 559 94 54 50 109 61 86 105 10 8.71 — — Diphtheria 1 - - — — — 1 — 1 0.01 - — Acute Pneumonia 30 5 2 3 6 7 4 3 6 0.47 38t 0.59 Dysentery 2 - - 1 1 — — — 2 0.03 - — Erysipelas 8 1 — — 1 2 4 — 1 0.12 - — Cerebrospinal Fever 1 1 - — - — — - 1 0.01 0.01 Puerperal Pyrexia 25 - - 25 — — — - 25 23.74§ - — Typhoid & Paratyphoid Fever 2 - — 2 - — — — 2 0. 03 - — Tuberculosis : Pulmonary 105 30 7 4 12 11 19 22 2 1.64 20 0.31 Non-Pulmonary 7 2 1 2 - 2 — 0.11 Food Poisoning 12 1 1 — — 6 — 4 — 0.19 - — Totals 1,097 189 100 106 161 162 202 177 129 17 .10 60 0.93 t 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. 70 TABLE X. Notifiable Diseases, 1949 (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 60 79 4 9 15 10 35 48 2 5 1 1 3 6 - - Whooping Cough 95 104 4 8 20 37 29 28 41 25 — 1 — 1 1 4 — — Acute Poliomyelitis 4 3 - - - - - - 2 - 1 1 - 1 1 1 - - Measles 279 280 5 7 65 55 69 61 129 141 5 6 2 5 4 4 — 1 Diphtheria — — — — — — — — — — — — — — — — — — 438 467 9 15 89 101 113 99 207 214 8 13 3 8 9 16 - 1 0- 5- 15- 45- 65 and over Age Unknown Acute Pneumonia 18 12 1 1 2 2 4 3 6 3 5 3 Dysentery 1 1 — — — — 1 1 — — — — — — Erysipelas 3 5 1 3 4 — — — — Cerebro-Spinal Fever 1 - 1 - - - - - - - - - - - Puerperal Pyrexia — 25 — — — — — 25 — —. — — — — Typhoid & Paratyphoid fever; 2 - - - 1 - - - 1 - - - - - Food Poisoning 6 6 2 — — 1 2 3 — 1 9 1 — — Tuberculosis— Pulmonary 57 48 2 1 4 2 30 41 18 3 3 1 — — N on-Pulmonary 5 2 3 1 - - 1 1 1 - - - - - 93 99 9 3 7 5 38 75 29 11 10 5 531 566 71 TABLE XI. TUBERCULOSIS New Cases and Mortality during the Year 1949 Age groups New cases notified or otherwise revealed. (Not including Inward Transfers.)* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 2 1 - - 1— 5 2 — — — — — — — 5—15 4 2 — — — — — — 15—25 13 9 1 1 1 — — — 25-35 6 13 — — 2 2 — — 35—45 5 5 — — 1 1 — — 45—55 11 2 1 — 2 1 — — 55—65 7 1 — — 6 2 — — 65 and over 3 1 — — 1 1 — - 51 33 4 2 13 7 - - *Inward Transfers 6 15 1 - Totals 57 48 5 2 BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1949 K. E. TAPPER, O.B.E., G.M.j M.B., Ch.B., D.P.H. Medical Officer of Health 74 Members of the Welfare Committee. Alderman M. Stafford Smith, M.B.E., B.A. (Chairman). Alderman H. M. V. Green (Vice-Chairman). Alderman F. W. Isard, J.P. Councillor A. L. Hill. Councillor G. H. Russell. Councillor L. C. Winterton. Rev. F. W. Armstrong, M.A. Mrs. E. R. Baylis. Officers of the Committee. Borough Education Officer: H. T. Smith, M.A. Assistant Education Officer: A. C. Cleveland. School Enquiry Officers: L. Saysell and S. J. Mann. Welfare Officer: Mrs. G. White. Staff. Proportion of time Medical Officers. allocated to School Health Whole-time: Service Medical Officer of Health Dr. K. E. Tapper ¼ Deputy Medical Officer of Health Dr. H. B. Carter-Locke — Assistant Medical Officers Dr. G. H. Stinson* ¾ Dr. P. A. Currie* ¾ Dr. A. E. Orgler* ½ Part-time: Ophthalmic Surgeon Dr. Eric Lyle * 3 sessions a week Orthopaedic Surgeon Dr. K. F. Hulbert * 2 sessions a month Dental Officers. Whole-time Mr. P. Mayo * Whole-time Mr. A. F. King * 7/10 Mr. Russell Edey * 3 sessions a week Clinic Assistants Mrs. w. Carrie * Whole-time Mrs. E. Brookes * 7/10 Part-time Miss M. Ellen * 4 sessions a week Nursing Staff. Whole-time Miss F. L. Gray * ½ Mrs. N. M. Taylor * ½ Miss W. G. Hemmings * ½ Miss H. Hogger * ½ Miss E. Chenery * ½ Miss K. Owens * ½ Mrs. V. Greig * ½ 75 Part-time. Masseuse Mrs. P. A. Urwin *6 sessions a week Orthoptist Miss M. Ford *6 sessions a week 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 ¾ Grade II. Clerks Mrs. W. Foot ¾ Miss D. I. Payne ¾ *County Officers. (Kent County Council Staff.) Introduction. To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen, Except for the Dental Service we have been able to maintain a full School Health Service during 1949. The periodic medical inspections at schools have continued throughout the four age groups: entrants, eight years, eleven years, and fourteen years, involving 3,269 children. The confidence of the parents in these examinations has been built up over the years by making these examinations in the nature of a consultation between the Medical Officer, the Parents, School Nurse and Head Teacher. Some 16% of the children showed evidence of defect requiring treatment. The usual routine is to refer such children to their own doctors or to the school clinics, either the special clinics or the minor ailment clinics. There have been certain changes in the services of minor ailment clinics, and sessions are now held at: Hayes School, where a shelter has been converted into a clinic; at Burnt Ash, Quernmore and Aylesbury Road Schools. The premises at Station Road are, in addition to minor ailments, used for the Special Clinics, i.e., Dental, Maternity and Child Welfare, Immunisation, Vaccination, Orthopaedic, Ophthalmic and Orthoptic. The premises at Princes Plain are used for Dental, Child Welfare, Speech, Minor Ailments, Immunisation, Vaccination and Ultra-Violet Rays. The area is thus adequately covered so as to avoid long absence from school, the clinics being within easy access of the homes of the children. The establishment of the Health Service Act has made little difference to the functioning of the clinics, no less than 15,061 attendances being made during the year. The close co-operation of the Hospital Staffs, and their sending copies of their reports on school children attending the hospital has been indeed helpful. The skilled advice we receive has added much to the efficiency of the Health Service. I should like to record how 76 grateful we are to them all, for it has added much work to their already arduous duties. The Dental Services, owing to the shortage of Dental Officers, have not been able to function fully throughout the year. We have not been able to overcome the heavy arrears of the past few years, and as yet are not able to carry out the routine inspections so necessary to a complete service. The main burden has fallen upon Mr. Mayo, for whose services no praise is too high, and it is with regret we learn that he will be leaving us in the near future. The change in school nursing staff, who are also Health Visitors, through retirement and through changes in County Services has in a small way interfered with the smooth flow of the work. Too frequent changes of staff are to be avoided if possible, for it takes time to develop that confidence of the parent which is so necessary to a successful service. In the body of the report, which is mainly statistical, will be found reports on the various services and on the School Meals Service and Physical Training, two ancillary services which are doing so much for the well-being of the school child in Bromley. I would not end this introduction without recording the excellent work of all the school medical staff, the School Nurses, and the clerical staff, who have all carried out their duties throughout the year with untiring zeal, and of Mr. Judd, who has been responsible for the compilation of the statistical tables K. E. TAPPER, Medical Officer of Health GENERAL INFORMATION. School Roll 1948 1949 Primary Schools 4,311 4,028 Secondary Schools 1,314 1,906 Grammar and Technical Schools 1,738 1,754 Total 7,363 7,688 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. 77 SCHOOL HYGIENE. The standard of cleanliness and hygiene of the Bromley schools has been maintained during the past year. Bickley and Widmore C.E. School. New lavatories have been provided, the playground re-surfaced, and the school internally redecorated. These works have made a considerable improvement to these temporary school buildings. The premises are, however, totally inadequate for the purpose of modern education, and the only solution is the building of the new school. Valley County Primary School. The obsolete type of trough closets have been removed during the year and a new w.c. system installed. Parish C.E. School, College Road. Plans for a complete new system of lavatories and water supply at this school are under consideration by the Kent Education Committee, and it is hoped that the work, so long delayed, will be commenced very shortly. School canteens have been frequently inspected during the year, and the standard of cleanliness and personal hygiene of the workers has been encouraged and maintained. MEDICAL INSPECTIONS AT SCHOOL. (See Tables I A and I C, and Table II A, cols. 2 and 3.) 246 medical inspection sessions were held at the schools and clinics during the year ,when 3,269 children were examined, as against 3,035 for the previous year. The average attendance at each session was 13.3. 535 individual pupils were found to require treatment (excluding Dental Diseases and Infestation with Vermin), giving a percentage of 16.36 as against 15.9 for the previous year. Parents continue to attend at the schools and clinics when their children are being examined, and it is a source of satisfaction to see the interest being taken in the School Health Services. Every opportunity is taken to obtain the consent of parents to their children being immunised against diphtheria, but as this service is now the responsibility of the County Council and the records kept at Maidstone, I am unable to furnish detailed figures. The examinations have shown a satisfactory standard both of health and general physique. 78 SPECIAL INSPECTIONS. (See Tables I B, II A, cols. 4 and 5, III, Group I and Table VIII.) During the past year 3,159 cases have come under medical supervision, necessitating 5,707 medical examinations. 87 cases requiring special investigation or certification were referred for examination at the Municipal Offices. 186 cases were referred to Farnborough Hospital for Pediatricians' and other specialists' advice and treatment, and I would again express my appreciation of the help given by the Pediatric Unit at this Hospital, especially by Dr. Hackwood, Dr. Leys, Dr. Gilcrist and Mr. Lipscombe, the ear, nose and throat consultant. DENTAL INSPECTION. Mr. P. D. B. Mayo reports as follows:— "This has been a very difficult year for the Dental Department. "It has not been possible to do any school inspections; all treatment has had to be on an emergency basis to cover the enormous numbers dependent on the service. Despite the many handicaps, it has been possible to continue an Orthodontic Service for essential cases and to maintain the Ante-natal and Child Welfare Service. "Special mention must be made of the resignation of Mr. Ordish in July last. He had served the Clinic for thirty years, and his departure is a great loss. "In October we welcomed Mr. King (whole-time) and Mr. Russell Edey (part-time). "It is a melancholy thought, after last year's encouraging report, that under the existing conditions it is certain that there will be no school inspections for a considerable time and that any preventive work will have to be confined to specific age groups." VERMIN AND UNCLEANLINESS INSPECTION. (See Table V.) 15,573 routine inspections were carried out by the School Nurses during the year. 35 children, or .224%, were found to be infested (.184% for 1948). In addition, 240 children showed minor evidence of uncleanliness. Instructions and advice are given to the parents at the Minor Ailments Clinic. What at one time, not so many years ago, was a major problem at school is now, as indicated above, a minor matter. There have been no cases for legal action. 79 TREATMENT. 15,061 attendances for minor ailment treatment at the Clinics were made during 1949. The types of ailments treated are as under:— 1948 1949 Ringworm (Body) 10 13 Scabies 34 16 Impetigo 66 45 Other skin diseases 538 646 Eye diseases (excluding Squint and errors of refraction) 493 705 Ear Defects 336 508 Miscellaneous (minor injuries, bruises, sores, chilblains, etc.) 2,648 2,926 Children requiring special treatment, e.g., Orthopædic, Ophthalmic, Dental and Speech, are referred to the special clinics. Cases requiring hospital treatment are referred to either Farnborough Hospital or Bromley Hospital, and those requiring domiciliary treatment are referred to their own doctor. The Child Guidance Clinic is held at Chislehurst, and children in need of this treatment are referred to the County Council for appointments at this clinic. Tuberculous children are referred to the Chest Clinic at Park Road, Bromley. ORTHOPÆDIC CLINIC. (See Table III, Group IV.) I am indebted to Mr. K. F. Hulbert, the Orthopaedic Surgeon, for the following report:— "The Orthopaedic Clinic has continued throughout the year with increasing numbers. Clinks have been held on the second and fourth Friday afternoons of every month, and several extra sessions have been included to keep up with the numbers. "There has been no marked change in the type of case attending, and feet and backs still predominate over everything else. There is a tendency to regard flat feet as an anatomical rather than a physiological problem, and the child with flat feet who comes in first in all the school sports is regarded with disfavour, rather than the child with apparently normal feet who comes in last. The feet should be regarded from the point of view of function alone, and a flat foot that fulfils its normal functions is a normal foot. If this point is always emphasised, it will clear up misunderstandings in the minds of parents and teachers when children are discharged from the clinic with flat feet still apparent. 80 "There are still a great number of children coming up with lazy posture who can stand perfectly straight when addressed in the stentorian tone of the Army Sergeant Major, and these cases should be regarded as the responsibility of the school rather than the Orthopaedic Surgeon. The cause of this defect of posture is an attitude of mind, not an organic deformity, and is much better treated at school than in the atmosphere of a clinic. "There has been a considerable amount of absenteeism during the year, sometimes amounting to as much as 30% of the attendances, mainly due to the non-attendance of extra district children. This is quite a serious state of affairs, because it shows a considerable lack of parental responsibility, quite apart from the fact that it upsets organisation of clinics and the smooth function of the appointment system. It is not easy to see what can be done about this sort of thing, but some attempt at propaganda in this respect should be made in the coming year. "Children requiring in-patient treatment are now taken into the Southern Hospital, Dartford, and there is quite a short waiting list. There have been several complaints about the distance that has to be travelled, but it should be remembered that this is the only Orthopaedic Hospital in the area, until further reorganisation occurs. "The general impression of the year's work is that a considerable number of children in Bromley who were crooked are now straight, and have been fitted out for a useful and happy life as the result of the efforts of the Orthopaedic Service, especially of the excellent work of Mrs. Urwin, the Physiotherapist." OPHTHALMIC CLINIC. (See Table III, Group II.) Dr. Eric Lyle reports as follows:— "During the past year one very useful stride in the efficiency of the Eye Clinic has been made; that is, that the Waiting List for new cases has been completely abolished. Cases referred from the School Medical examinations and from the Welfare Services, etc., can now be dealt with as soon as requests are received. This has been made possible by holding three Clinics per week, and is a very real step in the right direction. "The cases for re-inspection and review are not in quite so happy a position, but the delay has been considerably reduced. Every effort is being made to reduce it still further, and one hopes that in the future it may be possible to bring the delay down to the same state as the conditions now prevailing for new cases. 81 "Grave concern continues to be experienced about the delay in the supply of spectacles for the children. One can only continue to hope that things will improve soon. At the moment it is a very real 'weak link' and a cause of much worry and anxiety both to the parents and to myself, especially in cases of Squint and Myopia. "I have been able to treat many cases of Squint by operation and with the help of Orthoptics. This work is of importance, in that the cure of Squint at an early age has a very good psychological effect on those who suffer from the defect. "Other than for the delay in the dispensing of spectacles, the Clinic has run smoothly and satisfactorily despite an increase in the amount of clerical work entailed, owing to the everincreasing number of forms to be filled in for each patient. I have been accorded wonderful co-operation and help over this from the Clerical Staff. For this I am sincerely grateful, and I should like to record my appreciation of their excellent work." ORTHOPTIC CLINIC. (See Table VI.) 1,123 treatments have been given at this Clinic during 1949. There is no longer a waiting list for new cases, but some patients who have had a considerable number of treatments have been postponed for a few months, where no ill effects are likely to result. The new Synoptophore has now arrived and will be a great asset. Owing to the increasing number of paralytic squints now being sent through for investigation, a Hess screen would be very useful for accurate diagnostic purposes. The delay in obtaining glasses for priority cases has not only hindered treatment, but in some cases has actually made any improvement in their condition impossible. EAR, NOSE AND THROAT CLINIC. (See Table III, Group III.) During the year 115 children received operative treatment at Farnborough Hospital for tonsil and adenoids, which is practically double the number (60) receiving treatment in 1948. This number would have been greater had it not been for the fact that in the latter part of the year these operations were suspended due to the prevalence of Poliomyelitis. At 31st December, 1949, there were 161 children awaiting operative treatment. No child was found to require treatment for serious diseases of the ear during 1949. 82 SPEECH CLINIC. (See Table III, Group V, and Table VII.) This service is operated through the Health Department at Maidstone, and the clinics are held at the South Clinic, Princes Plain, under the control of Dr. Stableforth. 10 new cases were referred during 1949. 43 sessions were held during the year; there were 247 attendances and 18 cases treated. Lip reading classes for children who are "hard of hearing" are also held at the South Clinic, under the supervision of Miss Snelgrove. EXCEPTIONAL AND HANDICAPPED CHILDREN. The special clinic held at the Municipal Offices on Saturday mornings continued throughout the year. The total of attendances during 1949 was 87. Details of handicapped children are shown in Table VIII. CHILD GUIDANCE. All cases requiring Child Guidance are referred to the County Council for treatment at the Clinic at Chislehurst. Six teen cases were so referred during the year. MILK IN SCHOOLS. There is no change to report in the arrangements for the provision of pasteurised 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 showed that on a day in October the percentage of pupils receiving milk, based on the number in attendance, was 89.66%. SCHOOL MEALS SERVICE. During 1949 the expansion of the School Meals Service in the Borough was continued as far as the priority restrictions would permit. By the end of the year no less than four new Kitchens and Dining Rooms were completed. A Kitchen for 500 meals and a Dining Room to accommodate 375 at Aylesbury Secondary School for Girls and a Kitchen and Dining Room for 350 meals at Quernmore Secondary School for Boys were taken into use in September A new Kitchen and Dining Room for 750 meals daily at Raglan Road Secondary and Primary Schools and a new Kitchen and Dining Room for 500 meals daily at Hayes Primary School are nearing completion and will be taken into use very shortly. 83 Unfortunately, in view of the new economy restrictions announced towards the end of the year, the remaining undermentioned School Meals Service projects have had to be abandoned for the time being:— Girls' Grammar School, Kitchen and Dining Room 600 meals. Technical School „ „ „ 500 „ Valley School „ „ „ 375 Burnt Ash School „ „ „ 750 „ The daily average number of meals being served continues to increase, and towards the end of the year reached 6,500. A return sent to the Ministry of Education showed that on a single day in October 80.30% of the pupils in attendance at school received a mid-day meal. NURSERY SCHOOLS AND CLASSES. There have been no important changes, extensions or curtailments to Nursery Schools and Classes during the past year. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. 106 boys and 71 girls were examined by the Assistant School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in all cases. JUVENILE DELINQUENCY. During the year 78 children appeared before the Court, an increase of four over the year 1948. The types of offences were as follows:— Larceny and storebreaking 25 Beyond parental control 7 Cycle stealing 10 Traffic offences 10 Motor car stealing 8 Sacrilege 5 Wilful damage 6 Breach of Probation Order 4 Care and protection 1 Attempted suicide 1 Causing grievous bodily harm 1 Total 78 BROMLEY SCHOOLS' BOOT CLUB. The Chairman reports as follows:— "The work of the Bromley Schools' Boot Club progressed satisfactorily without any particular incident during the year ended 31st December. 1949." £. s. d. Amount deposited 505 17 0 Purchases of Footwear (Gross) 451 19 8 Purchases of Footwear (Nett) 418 13 10 Discounts received 33 5 10 Number of contributors: 791. 84 NECESSITOUS CASES. The School Welfare Officer reports that during the year there were 56 applications for clothing in respect of 90 children of school age. The total cost involved was £230 8s. 6½d. INFECTIOUS DISEASES IN SCHOOL. During the latter half of the year there was a minor outbreak of Scarlet Fever (Scarlatina) at Burnt Ash Primary School. Fumigation of the school rooms and sterilisation of toys, plasticine, etc., are of little use in controlling an outbreak of this disease, which is usually spread by direct contact with a case, i.e., a child suffering from the illness; from a case which, although recovered, still harbours the germs, for example, in the throat, nose, or in a discharging ear; or, finally, from a carrier —a healthy person who has for some as yet unknown reason picked up the germs without developing the disease. With these facts in mind. Dr. Currie examined all children who had been away from school during the previous month suffering from fever or malaise. Forty-six children were seen, and two were found to have "peeling hands." These are sometimes called "missed cases," and occur most frequently when the illness takes a very mild form. The two children were immediately excluded, and one gave positive results when swabs of the nose and throat were subsequently examined. Of the remainder of the children, swabs were taken from thirteen, and a further three positive results obtained; these children were also excluded. There has been only one further case in the school—one week after this examination. This would indicate that the source of the original spread of the disease had been detected and excluded in time. No cases of Diphtheria in children of school age were notified during the year, and only two cases of Infantile Paralysis in children occurred. One case of Typhoid Fever was notified during 1949. Measles showed a sharp rise over the previous year, 282 cases being notified as against 92 for 1948. In the non-notifiable infectious diseases there was a corresponding decrease in the number of cases. There were 35 cases of Mumps and 26 of Chickenpox, as against 249 and 117 respectively for the previous year. 85 NON-NOTIFIABLE INFECTIOUS DISEASES. Extracted from returns made by Head Teachers:— 1948 1949 Mumps 249 35 Chickenpox 117 26 PHYSICAL TRAINING. A full and detailed report by Miss Bentley and Mr. Loughran, Area Advisers on Physical Training, has been submitted to the Committee, a report which is worthy of close study. I feel conscious of my limitations when I have taken the liberty of extracting, for the purposes of the report on the health of the School Child, some statments from their report. General.—During the year under review the broader conception of Physical Education mentioned in my last report has found wider acceptance and has now brought about a fuller realisation of the aims and objects of Physical Education throughout the area. Considerable progress has been made in most branches of the subject, but particularly in the Infant and Junior Schools. We have discovered that younger children especially will adjust themselves in their own way and in their own time. Taken as individuals and not as a class unit, the Infant School children now seem much more skilful, active and venturesome than formerly. We have travelled far from the day when the whole school as a unit took part in a daily period of set military exercises. Primary Junior Schools.—Physical Education in the Junior School has of late received considerable stimulus from the welcome introduction into so many of our schools of outdoor agility apparatus of various kinds. Secondary Modern Schools.—The work in the gymnasium, both for older boys and girls, provides a wide contribution to the education of the individual, particularly in respect of a sense of discipline, concentration, quick response, health and cleanliness. NOTIFIABLE DISEASES. Disease Cases Contacts. 1948 1949 1948 1949 Typhoid Fever — 1 — — Scarlet Fever 23 73 39 48 Diphtheria 3 — 4 — Poliomyelitis 1 2 2 1 Polioencephalitis — — 1 — Measles 92 282 Contacts are not excluded. Whooping Cough 50 68 86 The tendency nowadays is for less formal or stereotyped gymnastics and the increased use of more basic movements, connected with sports activities and athletics for the boys, and similar basic movements connected in some way with dance, games or swimming for the girls. Organised Games.—The arrangements for organised games continue to give satisfaction. All Secondary Schools and the top classes of Primary Schools are fortunate in being able to use well marked and maintained playing fields. The standard of winter games generally is still such that many of the older children do not learn to play the major game sufficiently well to be able to enjoy it. Summer games offer great attraction, and the standard of play has improved considerably. A start was made on two of our playing fields with Tennis as a class subject for Secondary School girls. This introduction augurs well for the future and has met a real need in these schools. Playground and Playing Fields.—Playground surfaces on the whole are being well maintained. This year we have acquired a new playing field at Quernmore, where concrete practice cricket pitches are to be introduced. Swimming.—Owing to the wonderful weather enjoyed during 1949 summer, attendances at the open-air pool were overwhelming. The younger children from the Primary Schools who started swimming instruction this year for the first time showed great keenness, and on the whole we had very good results. Training Courses for Teachers.—The further training of teachers is a most essential factor in the effective introduction of new ideas and the development of Physical Education. Youth Activities.—There seems to be little sign of a decline in interest in physical activities on the part of Youth Clubs in the area. The attractive surroundings of our own countryside seem to be the main attraction during the summer months, and if the bookings for winter games pitches is any criterion of the interest in winter games, we can feel assured that there is no lessening of enthusiasm. Progress must be shown if we are to supply any alternative to passive and uncreative interests, and we must have more coaches to inspire and to teach. The National Sports Bodies have now introduced coaching schemes in conjunction with the Ministry of Education, and these should help to provide a greater number of efficient leaders and coaches. 87 Conclusion.—The continued progress of, and increasing interest in, physical education during the past year is most encouraging. The well-being of the individual through effective physical education is closely connected with the development of his pride in achievement and knowledge of his powers. The importance of this factor now seems to be more fully understood, and the standard of achievement of the individual should rise accordingly. In September, 1949, Mr. J. Loughran was appointed by the Kent Education Committee as Area Adviser of Physical Education, and his duties will include this area. 89 SCHOOL MEDICAL SERVICE. STATISTICAL TABLES. 1949. 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. TABLE 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. 90 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspection. Number of Inspections in the Prescribed Groups: — Entrants 734 Second Age Group 802 Third Age Group 571 Total 2,107 Number of Other Periodic Inspections 1,162* Grand Total 3,269 *Children aged 8 years. Children' in their 13th year at County Grammar and Technical Schools. B. Other Inspections. Number of Special Inspections 3,159 Number of Re-inspections 2,548 Total 5,707 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 11.A. Total individual pupils Entrants 19 80 99 Second Age Group 40 107 147 Third Age Group 33 79 112 Total (prescribed groups) 92 266 358 Other Periodic Inspections 56 121 177 Grand Total 148 387 535 91 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 19 11 476 32 5 Eyes— (a) Vision 148 113 118 30 (b) Squint 10 11 23 9 (c) Other 40 16 265 19 6 Ears— (a) Hearing 4 4 23 10 (b) Otitis Media 4 1 70 3 (c) Other — — 215 12 7 Nose or Throat 69 138 322 109 8 Speech 6 8 15 3 9 Cervical Glands 3 5 14 10 10 Heart and Circulation 18 45 42 48 11 Lungs 3 12 53 14 12 Developmental— (a) Hernia 7 7 6 4 (b) Other 1 11 16 16 13 Orthopaedic— (a) Posture 53 50 19 19 (b) Flat Foot 42 100 50 21 (c) Other 42 29 196 23 14 Nervous System— (a) Epilepsy — — 1 — (b) Other 4 10 23 17 15 Psychological— (a) Development 1 1 14 22 (b) Stability 1 3 6 1 16 Other 60 76 730 133 Totals 535 651 2,697 555 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 734 416 56.68 307 41.83 11 1.50 Second Age Group 802 382 47.63 402 50.12 18 2.24 Third Age Group 571 298 52.19 259 45.36 14 2.45 Other periodic inspections 1,162 689 59.29 459 39.50 14 1.20 Total 3,269 1,785 54.60 1,427 43.65 57 1.74 92 TABLE III. TREATMENT TABLES. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V). (a) Number of Defects Treated or under Treatment during the year Skin. Ringworm—Scalp: — (i) X-Ray Treatment 1 (ii) Other Treatment — Ringworm—Body 13 Scabies 16 Impetigo 45 Other Skin Diseases 646 Eye Disease (external and other, but excluding errors of refraction, squint and cases admitted to hospital) 705 Ear Defects (excluding serious diseases of the ear, e.g. operative treatment in hospital) 508 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 2,926 Total 4,860 (b) Total number of attendances at the Minor Ailments Clinic, 15,061. 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) 643 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 88 731 Number of Pupils for whom spectacles were (a) Prescribed 585 (b) Obtained 401 Group III.—Treatment of Defects of Nose and Throat. Total number Treated Received Operative Treatment: — (a) For Adenoids and Chronic Tonsilitis 115 (b) For other Nose and Throat Conditions 5 Received other forms of treatment 60 Total 180 93 Group IV.—Orthopædic and Postural Defects. (a) Number referred for treatment as in-patients in hospital or hospital schools 1 (b) Number treated otherwise, e.g. in clinics or patients' department (New) 191 (Reins.) 693 Number of attendances for massage and exercises 2,803 Number of attendances for ultra violet rays 1,654 Group V.—Child Guidance and Speech Therapy. Number of pupils referred: — (a) Under Child Guidance arrangements 16 (b) Under Speech Therapy arrangements 10 TABLE IV. A. Dental Inspection and Treatment. Number of pupils inspected by the Authority's Dental Officers: — (a) Periodic Age Groups 590 (b) Specials 1,500 Total (Periodic and Special) 2,090 Number found to require treatment 1,852 Number actually treated 1,977 Attendances made by pupils for treatment 5,307 Half-days devoted to (a) Inspection 2 (b) Treatment 623 1/10 Total 625 1/10 Fillings— (a) Permanent Teeth 1,761 (b) Temporary Teeth 1,635 Total 3,396 Extractions— (a) Permanent Teeth 479 (b) Temporary Teeth 1,970 Total 2,449 Administrations of general anaesthetics for extraction 924 Other Operations— (a) Permanent Teeth 1,196 (b) Temporary Teeth 342 Total 1,538 Number of scalings and polishings 61 Number of dressings— (a) Permanent Teeth 46 (b) Temporary Teeth 94 Total 140 B. Orthodontic Clinic. Number of children referred for orthodontic treatment 65 Number of orthodontic appliances (a) ordered 121 (b) fitted 121 Attendances for orthodontic treatment 794 94 TABLE V. Infestation with Vermin. Individual Pupils Total number of examinations in the schools by School Nurses or other authorised persons 15,573 Total number of individual pupils found to be infested 35* Number of individual pupils in respect of whom cleansing notices were issued (Sect. 54 (2) Education Act, 1944) - Number of individual pupils in respect of whom cleansing orders were issued (Sect. 54 (3) Education Act, 1944) - TABLE VI. Orthoptic Clinic. Number of cases under treatment during the year 131 Number of new cases 90 Number of treatments given 1,123 Number of cases on occlusion during the year 15 Number of cases awaiting or undergoing operation at the end of the year 32 Number of cases found unsuitable 15 Number of cases failed to attend 12 Number of cures (with and without operation) 14 TABLE VII. Speech Clinic. Total number of sessions held 43 Total number of attendances for treatment 247 Total number of cases treated 18 Classification:— (a) Sigmatism — (b) Simple Dyslalia 2 (c) General Dyslalia 1 (d) Multiple Dyslalia 6 (e) Alalia — (f) Aphasia - (g) Dysphonia (i) Cleft Palate 1 (ii) Other causes 1 (h) Dysartria — (i) Stammer 7 *In addition, 240 children showed minor evidence of uncleanliness. 95 TABLE VIII. Handicapped Pupils Requiring Education at Special Schools or Boarding in Boarding Homes. (1) Blind. (2) Partially sighted. (3) Deaf. (4) Partially deaf. (5) Delicate. (6) Physically handicapped. (7) Educationally Sub-normal. (8) Maladjusted. (9) Epileptic. (1) (2) (3) (4) (5) (6) (7) (8) (9) 1949. In the calendar year: A. Handicapped Pupils newly placed in Special Schools or Homes - - 3 - 8 1 2 - - B. Handicapped Pupils newly ascertained as requiring education at Special Schools or Boarding in Homes - 1 3 - 10 3 8 1 - On 31st December: C. Number of Handicapped pupils from the area: (i) Attending Special Schools, Day - - 1 - - - 7 - - Boarding 1 — 4 — 3 2 1 - 2 (ii) Boarded in Homes - - - - - - - - - (iii) Attending assisted schools (under approved arrangements) - - - - 1 - - 2 - D. Number of Handicapped pupils from the area requiring places in special schools or homes, but remaining unplaced - 1 - - 2 1 6 2 - E. Number of Handicapped pupils receiving home tuition (including those shown in "D") - - - - - 1 - - - F. Number of Handicapped pupils from the area on 31st December, 1949, attending Special Schools or boarded in Homes on account of: — (i) Defect of Speech Nil. (ii) Diabetes Nil.