AC 4412(1) BROMLEY BRO 46 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1950 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES Printed by Bromley Office Supplies & Printing Co., Ltd., 3g & 46 East Street, Bromley BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1950 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 of the Area. Vital Statistics 14 Population 15 Births 15 Illegitimate Births 15 Stillbirths 16 Deaths 16 Maternal Mortality 17 Infantile Mortality 17 Unemployment 17 Meteorological Conditions 18 Open Air Recreational Amenities 18 Section B. General Provision of Health Services for the Area. Nursing Homes 22 Hospitals 22 Home Nursing Service 22 Health Visiting 23 Domiciliary Midwifery 23 Womens' Welfare Clinic 23 Day Nurseries 23 Domestic Help Service 24 Ambulance Facilities 24 Venereal Diseases 24 Laboratory Services 24 Medical Loan Depots 24 Clinics, Child Welfare Centres, etc. 25 Care of the Aged 26 Old People's Homes 30 Section C. Sanitary and Environmental Circumstances. Water Supply 36 Drainage and Sewerage 37 Cesspools 37 Rivers, Streams and Lakes 37 Swimming Baths and Pools 38 Public Cleansing and Refuse Collection 38 Factories Acts, 1937 and 1948 38 Sanitary Inspection of the Area 39 Smoke Abatement 39 Shops Act, 1950 40 Petroleum Acts 40 Verminous Conditions and Uncleanliness 40 Rodent Control 41 Diseases of Animals Acts 42 Registries for Female Domestic Servants 42 Retail Market 43 Section D, Housing. Rehousing 46 Housing Inspections and Abatements 47 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 69 „ II.—Causes of Death 70 „ III.—Infant Mortality. Causes and Age Groups 71 IV.—Analysis of Causes of Infant Deaths, 1946-1950 72 V.—Notifiable Infectious Diseases. Sex and age Distribution 73 VI.—Notifiable Diseases, Ward Distribution, Attack and Mortality Rates 74 „ VII.—Tuberculosis. New Cases and Mortality 75 „ VIII.—Housing Statistics 76 IX.—Summary of Work of Sanitary Inspectors 77 „ X.—Factories Acts, 1937 and 1948 30 XI —Nuisances, Defects and Contraventions Abated 81 4 Section E. Inspection and Supervision of Foods. Food Sampling 50 Bacteriological Examinations 52 Ice Cream 53 Special Enquiries 54 Food Preparing Places 56 Slaughterhouses 56 Inspection of Food Premises 56 Milk Licences 56 Meat Inspection 57 Unsound Meat and Other Foods 57 Section F. Prevalence of, and Control Over, Infectious and Other Diseases. Smallpox 60 Vaccination 61 Anterior Poliomyelitis 61 Scarlet Fever 62 Diphtheria 63 Diphtheria Immunisation 63 Typhoid Fever 63 Puerperal Pyrexia 63 Ophthalmia Neonatorum 63 Pemphigus Neonatorum 63 Measles 63 Whooping Cough 64 Tuberculosis 64 Food Poisoning 65 Other Infectious Diseases 65 5 SCHOOL HEALTH SERVICE, 1950. Members of Welfare Committee 86 Officers of Committee 86 Staff 86 Introduction 87 General Information 90 School Hygiene 90 Medical Inspections at Schools 91 Special Examinations 92 Dental Service 92 Vermin and Uncleanliness Inspection 92 Treatment Clinics 93 Orthopaedic Clinic 93 Ophthalmic Clinic 94 Orthoptic Clinic 94 Ear, Nose and Throat Defects 95 Speech Clinic 95 Exceptional and Handicapped Children 96 Child Guidance 97 Milk in Schools 97 School Meals Service 97 Nursery Schools 97 Employment of Children and Young Persons 98 Juvenile Delinquency 98 Bromley Schools' Boot Club 98 Necessitous Cases 98 Infectious Diseases in Schools 98 Physical Training 99 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 104 II.—Return of Defects found by Medical Inspection during 1950 105 III.—Group I. Diseases of the Skin 106 Group II. Eye Diseases. Defective Vision and Squint 106 Group III. Diseases and Defects of Ear, Nose and Throat 106 Group IV. Orthopaedic and Postural Defects 107 Group V. Minor Ailments 107 IV.—Dental Inspection, Treatment, and Orthodontics 107 "V.—Infestation with Vermin 108 " VI.—Orthoptic Clinic 108 " VII.—Handicapped Children 109 " VIII.—Independent Schools 110 7 MEMBERS OF THE HEALTH COMMITTEE Alderman M. Stafford Smith, M.B.E., B.A. (Miss) (Chairman). Alderman H. M. V. Green (Mrs.) (Vice-Chairman). Councillors : M. L. Dempster (Mrs.). E. H. Hurst. L. L. Irwin, M.A., LL.B., J.P. P. M. James (Mrs.). S. Lane. G. H. Russell. C. W. Wilmot. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1950. " * " denotes Officers employed by the Kent County Council. 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 : * P. A. CURRIE, m.r.c.s., l.r.c.p. * A. ORGLER. m.d. (Berlin). * Miss G. H. STINSON, m.r.c.s., l.r.c.p. Chief Sanitary Inspector, Chief Sampling Officer, Inspector under the Petroleum Acts, Diseases of Animals Acts, and the Shops Act: G. R. WOODS (1, 2, 3, 4, 5). District Sanitary Inspectors and Sampling Officers : T. C. TOWERSEY (1,2,3). P. R. LIGHT (1, 2, 3). D. K. EVANS (1, 2, 3, 6). H. COOPER (1, 2, 11). Health Visitors and School Nurses : * Mrs. N. M. TAYLOR <7, 8, 9). * Miss W. G. HEMMINGS (7, 8, 9) * Miss H. M. HOGGER (7, 8, 9). * Miss E. CHENERY (7, 8, 9) * Miss K. OWENS (7, 8, 9) * Mrs. V. GREIG (7, 8, 9). * Miss M E. WOOTTON (8, 9. 10) CLERICAL STAFF : Chief Clerk : S. F. JUDD. E. P. J. WYTHE (Senior Clerk). Miss B. B. BURROWS. Mrs. D. COX. Miss M. N. CROXSON. Mrs. M. J COX. Mrs. W. J. FOOT. Miss E. W. LEPPER (11). Miss D. I. PAYNE 8 Other Appointments: Assistant Rodent Officer : J. L. GOUGH. Outdoor Staff: Disinfector and Drain Tester: J. W. SEAGER. Rodent Operative : R. H. MITCHELL. Market Superintendent: W. THRIFT (Part-time). The figures denote: — 1. Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. 2. Royal Sanitary Institute Certificate for Meat and Other Foods 3. Royal Sanitary Institute Smoke Certificate. 4. Certificate of Examination Board of the Sanitary Inspectors' tion. 5. Diploma of Institute of Hygiene (London). 6. Royal Sanitary Institute Certificate for Sanitary Science as applied to Public Works and Buildings. 7. State Registered Nurse. 8. State Certified Midwife. 9. Health Visitors' Certificate of the Royal Sanitary Institute 10. State Registered Children's Nurse. 11. Unestablished or Temporary Staff. 9 To the Mayor, Aldermen and Councillors of the Borough of Bromley. Mr. Mayor, Ladies and Gentlemen, This is my twenty-sixth Annual Report and covers the year 1950. Because it is the half century it is, perhaps, opportune to refresh our memories on some of the milestones of progress in public health over the past hundred years. In the eighteen forties cholera and other acute intestinal infections were endemic, not only in Bromley, but in the country as a whole. It was these recurrent epidemics that caused Sir Edwin Chadwick, a pioneer in Public Health, to be instructed by Parliament to set in motion measures for the control and prevention of disease. Because he based his administration on centralisation, his efforts were only partially successful, but they did lead to the first Public Health Act of 1848 whereby Local Boards of Health were empowered to be set up and to replace the inadequate administration by the Parish Vestries. It was not, however, until 1867 that the Bromley Local Board of Health was formed. One of their first resolutions was to form a Sanitary Committee of four of their elected members, two of whom were general medical practitioners. Their first action was to report upon insanitary cottages at Masons Hill and upon cesspool pollution of the Ravensbourne and to deal with "streets which were defiled by pools of foul water and heaps of decomposing refuse indiscriminately scattered abroad." In the same year they found it necessary to appoint the first Surveyor and Inspector of Nuisances—Mr. Arthur Jacob, at a salary of £150 per year. The next milestone of national and local importance was the passing into Law of the Public Health Act of 1875, extending the powers and functions of Local Boards of Health and providing for the formation of Local Authorities. As a result of this Act, Dr. C. O. Bayliss was appointed part-time Medical Officer of Health and Mr. Hugh S. Gregeen as the first wholetime Inspector of Nuisances in 1876. Two years later, in 1878, was formed the West Kent Main Sewerage Board, to make order out of the chaos of drainage in the area. It was not until 1895, twenty years after the passing of the 1875 Act, that Bromley Local Board of Health was replaced bv the formation of the Urban District of Bromley. Three years 10 later, Dr. Codd was appointed Medical Officer of Health on a part-time basis. Dr. Codd held this post until 1915 and his Annual Reports are available as a record of his valuable service to the district. Throughout all these years, 1848 to 1907, the public health actions of the Local Authority were concerned mainly with environment, the abatement of nuisances and the prevention of nuisances, but took no action in the personal health services, except in the control of infectious diseases. With the coming into force of the Education Act of 1907, Bromley was empowered to form a School Medical Inspection Service in 1909 and later established, through the excellent help of the Voluntary Children's Care Committee, a Minor Ailment Treatment Service. Following the Notification of Births Act of 1907, there was formed the Bromley Health Society, a voluntary body of farsighted women, advised by Dr. Codd, who undertook through welfare centres and day nurseries the care and after-care of necessitous mothers and children under five years. It was not until the passing of the Maternity and Child Welfare Act of 1918 that the Local Authority undertook the responsibility for their work. The result of these extensions of medical services called for the appointment of the first full-time Medical Officer of Health —Dr. Stewart Stalker, in 1921—but, shortly after his appointment, he had to relinquish the post owing to illness. In 1925, the school medical service and the Maternity and Child Welfare and environmental services were amalgamated as one service both at Departmental and Committee member level and continued as such until July 1948, when, having come full circle in the hundred years, the services which were locally controlled and operated were passed over to "centralisation under the Kent County Council at Maidstone. To-day the Town Council have the power to spend only one quarter of the money raised by local rates, and, except for control of Infectious Diseases and the School Health Service, have no part to play in the personal health services. In 1850, Bromley was an area of communities centred round each of the parish churches, with a population (including Hayes and Keston) of 5,323 persons living in 1,092 houses, with an environment inadequately sewered, no safe water supply, inadequately lighted and of "darkness visible," a death rate of 11 twenty-three and an infant death rate of one hundred and fiftyeight. It was, in spite of this, described in Mr. Charles Freeman's "History of Bromley — "No Parish, perhaps, considering its short distances from the Metropolis and that coaches pass through it almost every hour of the day, could afford a more desirable retreat from the hurry and bustle of Town." Even in those days Bromley was noted for the excellence of its private schools. It boasted of a" workhouse on the western side of the street in the entrance from London" as it boasted in the 17th century of an Infectious Disease Hospital or "Pest House" on almost the same location. This tradition of being in the forefront has been carried on to the present day when Bromley is recognised as a well administered model Municipal Borough with a population of 64,610 persons living in 18,101 houses and flats. Bromley may have lost much of its romance, its picturesqueness, its rural "old world" beauty, but it has certainly gained in Public Health. Some 40 years ago. 40% of school-children showed evidence of vermin, 30% extreme dental caries and 10% serious visual defects. The infant death rate has been progressively reduced from 131 to 21.3 in 1950. This is the economic triumph of prevention over treatment. It may be, however, that we are to-day, through no fault of our own, being over-administered at costs which are crippling to the very people we are wishful to help. There is too, apparent to those who care to seek, an increasing tendency to depend upon a benevolent state, upon the efforts of others and a lessening of that necessity to all vital States—"self-help," but these are I am sure only temporary troubles. The day must come when local incentive and local interest will require truly local government. With development of new estates, shops, houses and transport, the boundaries of Local Authorities are no longer defined, and amalgamation of authorities is a natural sequence—large enough to be financially sound and small enough so that the administrator, the elected representative, and the electorate, are members of a team and can exercise their functions without reference to forms and form filling. The vital statistics of the year show progressive improvement. A death rate of 11.4, a birth rate of 13.8 and an infantile mortality rate of 21.3 all show the result of improved environmental and social conditions of the people which began with the 1875 Act and was especially marked with the development of the local services since 1918. 12 There was little change in the incidence of notifiable infectious diseases as compared with recent years except for a large increase in measles and whooping cough, both of a mild nature. I am indebted as always to Mr. Judd, the Chief Clerk and to all the staff of the Department for their loyal support throughout the year. Mr. Woods, at the time of writing this report, has completed twenty-five years as your Chief Sanitary Inspector. His great help to me during these years of development of the Health Department is an example of good and true relationship between a medical officer of health and chief sanitary inspector, without which no health department can operate successfully. I am, Your obedient Servant, K. E. TAPPER. June, 1951. Medical Officer of Health. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 14 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The area of the Borough is 6,519 acres. Registrar General's estimate of total population (mid-year) 1950 64.610 Number of valuation assessments as at 31st March, 1950: — (a) Houses and Flats 18.101 (b) Commercial 1.356 (c) Licensed Premises 39 (d) Entertainment and Recreational 88 (e) Public Utility 29 (f) Educational and Cultural 26 (g) Industrial 56 (h) Miscellaneous 198 19,893 Estimated rateable value at 31st March. 1951. is £754.065 Estimated Product of a Penny Rate for the year ending 31st March. 1952. is £3,070 Vital Statistics. Live Births. Total Male Female Birth Rate 13.8 per 1,000 total population. Legitimate 849 424 425 Illegitimate 43 23 20 892 447 445 Stillbirths. Total Male Female Stillbirth Rate 23.0 per 1.000 (live and still) births. Legitimate 21 14 7 Illegitimate — — — 21 14 7 Deaths. Total Male Female Death Rate 11.4 per 1.000 total population. 739 347 392 Deaths from Puerperal Causes. Puerperal Sepsis Nil Other Puerperal Causes Nil Deaths of Infants under 1 year of age. Total Male Female Legitimate 19 10 9 Infant Mortality Rate 21.15 per 1,000 live births. Illegitimate — — — 19 10 9 15 Death Rates of Infants under 1 year of age. All Infants per 1,000 live births 21 3 Legitimate Infants per 1,000 live legitimate births 21.3 Illegitimate Infants per 1,000 live illegitimate births - POPULATION. The Registrar General's estimate of the total population (Civilian and Non-Civilian) of the Borough, mid-year 1950, is 64,610 which shows an increase of 470 on the corresponding figure for 1949. This population figure gives a density of 9.9 persons to the acre. The following figures show the estimated population of the Borough during the past ten years:— Year Estimated Population 1941 50,430 (War years—evacuation period) 1942 50,480 1943 51,300 1944 49,730 1945 52,310 1946 60,540 1947 62,640 1948 63,360 1949 64,140 1950 64,610 The next census is due to be taken in April, 1951, and when the results are published it will be possible to make a survey of the changes which have taken place during the last twenty years. BIRTHS. The Birth Rate for 1950 is 13.8 per 1000 total population. Comparative rates during the past ten years are as follows:— Year Bromley England & Wales 1941 13.3 14.2 1942 17.2 15.8 1943 17.5 16.5 1944 16.5 17.6 1945 16.6 16.1 1946 19.4 19.1 1947 20.9 20.5 1948 16.4 17.9 1949 16.1 16.7 1950 13.8 15.8 The average yearly Birth Rate during the past ten years was Bromley 16.8, England and Wales 17.0. The Registrar General's returns for the year showed the following registered births, after transferable adjustments had been made:— Live Births 892, Stillbirths 21, Total 913. All rate calculations are based on these official figures. Illegitimate Births. The illegitimate birth rate (per 1,000 live and stillbirths) for 1950, is 47.1. 16 Stillbirths. The number of stillbirths registered for the area during 1950 is 21. The stillbirth rate per 1,000 (live and still) births for the year is 23 and the rate per 1,000 total population 0.32. The following tabulation gives the number of stillbirths, rates per 1,000 births, and comparative rates per 1.000 population with England and Wales, for the past ten years:— Year No. of Stillbirths Rate per 1,000 births Rate per 1,000 population Bromley England & Wales 1941 20 28.1 0.39 0.51 1942 26 28.9 0.51 0 54 1943 22 23.8 0.42 0.52 1944 20 23.8 0.40 0.50 1945 15 16.9 0.28 0.46 1946 33 27.2 0.54 0.53 1947 34 25 3 0.54 0.50 1948 24 22.5 0.38 0.42 1949 23 21.8 0.36 0.39 1950 21 23.0 0.32 0.37 DEATHS. The Death Rate for the year 1950 is 11.4 per 1,000 total population. Of the 739 deaths occurring, 347 were males and 392 females. Comparative death rates for the past ten years are given below:— Year Bromley Rates (Crude) England and Wales Rate 1941 15.1 12.9 1942 11.4 11 6 1943 11.7 12.1 1944 13.3 11.6 1945 12.5 11.4 1946 10.8 11.5 1947 11.7 12.0 1948 9.9 10.8 1949 10.8 11 7 1950 11.4 11.6 The ages at death show that 449 were 65 years and over. The main causes of death in Bromley, together with comparative rates per 1,000 population are given below:— 1946 1947 1948 1949 1950 Cancer 1.8 1.9 1.8 2.2 1.9 Congenital Causes 0.5 0.2 0.2 0.1 0.12 Heart Disease 2.9 3.5 2.7 3.2 6 31 Infectious Diseases 001 0.03 0.01 0.05 0.015 Influenza 0.1 0.03 — 0.08 0.03 Respiratory Diseases (not. T.B) 1.1 1.0 0.9 1.3 0.68 0.26 Tuberculosis 0.3 0.4 0.3 0.3 During 1950 there were twenty deaths from violence, including seven suicides, three motor vehicle accidents and ten other accidents. 17 The Death Rate for the year is .5 per 1,000 population greater than the rate for 1949. Maternal Mortality. There were no maternal deaths in the Borough during 1950. The causes and rates of maternal mortality in the Borough are shown in 5-yearly periods since 1911 in the following table:— 5-yearly periods Puerperal Sepsis Other Puerperal causes Rate per 1,000 births 1911-1915 4 5 2 1916-1920 9 9 6 1921-1925 6 7 4 1926-1930 4 6 3 1931-1935 6 9 4 1936-1940 4 9 3 1941-1945 2 3 1 1946-1950 1 3 0.7 Infantile Mortality. The Infant Mortality rate for the year is 21.3 per 1,000 live births. 19 infants died during 1950 before reaching their first birthday, and the following relate to these cases :— Died in first four weeks of life 9 Died within first week and twelfth month10 19 The Infantile Mortality Rate for 1950 compares unfavourably with the abnormally low rate for 1949, viz., 15.5 per 1,000 live births. The average rate for the past five years is 20. UNEMPLOYMENT. The Manager of the Employment Exchange has kindly supplied the following information with regard to unemployment during 1950:— "During 1950 the local employment position has been good, and in consequence the register of unemployed persons reached a low level during the summer months. Apart from seasonal fluctuations, e.g., building trade workers stopped on account of inclement weather, the Unemployed Register has remained fairly steady. The majority of the unemployed are over 50 years of age and some of them are also registered as disabled persons. There is no difficulty in placing young and able-bodied persons in local work. The number of unfilled vacancies has, generally, been in excess of the number of available workers. Placings in the Building Industry outnumbered those of any other local industry." 18 METEOROLOGICAL CONDITIONS. I am indebted to the Borough Engineer for the following information, which has been extracted from the records at the Climatological Station at Church House Grounds:— Total rainfall 2517 inches Mean maximum daily temperature 57.9'F. Mean minimum daily temperature 43.9°F. Highest maximum temperature 86.0"F. (on 6th June) Lowest minimum temperature 32.0 F. (on 15th December) Lowest Grass temperature recorded 21.0°F. (on 6th December) OPEN AIR RECREATION AMENITIES. Bromley is very fortunate in the number of its open air recreational facilities, for there are few things more refreshing both for the body and mind than the ability to be able to get away, even if only for an hour or so, from the turmoil and stress of modern city life. The Council, by its wise provision of these amenities, has given everybody a chance of enjoying the peace and quiet of the open spaces and thereby made a great, if unspectacular, contribution to the health of the populace. There is, however, the extraordinary anomaly that on fine Saturday mornings one sees children queueing for admission to cinemas. 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 19 Public Gardens and Grounds. Church House Grounds 12 3 20 Hayes (Old) Rectory Grounds 2 0 25 Husseywell Crescent 2 1 30 Library Garden 1 2 0 Queens Garden 2 1 4 The Knoll 4 1 39 25 2 38 492 2 26 Golf Course (Bromley and Bickley) 103 1 0 Total 595 3 26 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 22 SECTION B. SUMMARY OF HEALTH SERVICES FOR THE AREA. Nursing Homes. At 31st December, 1950, there were four nursing homes which had been registered with the Authority in accordance with Section 187 of the Public Health Act, 1936. Thirteen visits of inspection were made during the year, and there were no infringements of the Local Byelaws. Details of these homes are, as under :— No. Patients received Nursing Staff Address of during 1950 Qualified S.R.A.N. Other Beds Surgical Medical S.R.N. S.E.A N. 18, Blyth Road 23 — 24 3 2 2 24, ELmfield Road 10 - 6 1 2 1 67, Hayes Road.3 - 1 1 -1 47 and 51, Park Avenue 32 -50 3 4 2 The majority of these beds are now occupied by the aged sick or aged infirm and are likely to continue to be so used until adequate accommodation is provided by the County Council or by the Hospital Board. Hospital Services. (a) Bromley Hospital, Cromwell Avenue. Provides a general hospital service with 155 beds. There are two Maternity Units attached to this hospital, one at 118, Widmore Road (22 beds), and the other at 20, Masons Hill (38 beds). (b) Lennard Hospital, Lennard Road. 212 (possible) beds, of which 62 are for the isolation and treatment of infectious diseases. (c) Chest Clinic. The new prefabricated building in Tiger Lane, at the rear of the main hospital, was officially opened in August, 1950. The provision of this new Clinic building is a most welcome addition to the hospital service provided for the area, especially as it has meant the giving up of the premises previously occupied for this purpose, and which were the subject of adverse reports for many years. Home Nursing Service. There are six Home Nurses operating in the Borough. Home Nursing is provided on medical certification only, and is free. A day service is provided. There is need for extension of this service especially while there are long waiting periods for admission to hospital. The average gross annual cost per Home Nurse is £553. 23 Health Visiting. Seven Health Visitors are engaged on this work in the Borough. In addition to their duties in connection with the School Health Service, they attend all Maternity and Child Welfare Centres, Clinics in connection with Immunisation, Vaccination, etc., and carry out home visiting in respect of Child Life Protection, After Care, etc. Full details of all Welfares, Clinics, etc., are given in the tables appearing later in this report. The estimated gross annual cost per Health Visitor is £523. Midwifery (Domiciliary). Four midwives are engaged in domiciliary midwifery in the area. The services of the midwives are engaged direct by the patient, or through the patient's private doctor, and the midwives act either as midwives or maternity nurses. Ante-natal clinics are held on Monday and Thursday afternoon at the North Clinic, Station Road. The County Council is the supervising Authority under the National Health Service Act, 1946. The estimated gross annual cost per midwife is £634. Womens' Welfare Clinic. This clinic is held on the second and fourth Tuesday afternoon of each month, at North Clinic, Station Road, and is for cases referred on medical grounds. Day Nurseries. Two Day Nurseries are provided by the County Council. Elmfield Nursery provides for forty children, and " Draycott " now has thirty places which is a reduction of thirty on the number previously provided. Admission to Day Nurseries is now restricted to the children of women who are unmarried, widowed, separated, having to work because of a dependent husband or who are, by reason of illness or confinement, unable to look after their families, and children from families who are living in conditions inimical to the proper care of young children and. exceptionally, children from a family where the father himself is endeavouring to bring up a family but is unable to obtain any suitable person to look after a child under five years of age during his normal working hours. The estimated gross cost per year, per place, is £141. 24 Domestic Help Service. Application for this service is made to the Area Supervisor at the Municipal Offices, Bromley. Demands for assistance continue to increase, especially for cases of illness in the home, and for old people. Provision is also made for domestic help during a home confinement. The estimated gross cost per annum, per whole time Domestic Help is £253. Ambulance Facilities. The Ambulance Depot is at Masons Hill, Bromley, and provision is made for the removal of case to the appropriate hospitals. Sitting case cars are provided for out-patients on medical certification. The estimated gross cost per mile for the ambulances, etc., is 1s. 9d. Venereal Diseases. Patients are referred either to the London Hospitals or one of the established centres in the County. No centre is provided within the Borough for the treatment of these diseases. Laboratory Services. There has been no change in the past year. The Kent County Council provide a Laboratory service for the whole of the County through their Laboratory at Maidstone. In cases of an urgent nature specimens, etc., have been sent to the Laboratory at Bromley Hospital, and I would record my appreciation of the assistance given in this respect by Dr. Keall and his staff. The following details are given of the swabs, specimens, etc., sent for examination and report during the year:- Haemolytic Streptococci 360 Diphtheria 6 Faeces 59 Food Samples, etc. 632 Water Samples 11 Miscellaneous 5 1,073 Medical Loan Depot. The British Red Cross Society have continued with their Medical Loan Depots during the past year. A full range of nursing requisites is available at these depots. Application for loans of such equipment for Bromley residents should be made to either of the following depots:34a, Market Square, Bromley. 4, East Street, Bromley. 25 LOCAL CLINIC SERVICES. Ante-Natal Clinics. North Clinic, Station Road Mon. and Thursday.. p.m. (New cases should attend Thurs.) Womens' Welfare Clinic. North Clinic, Station Road Second & fourth Tues. in every month p.m. 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 First & third Thurs. in every month p.m. St. Andrews Hall, Burnt Ash Lane Wednesday 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 (Closed for the time being owing to lack of Dental Officers.) Immunisation. North Clinic, Station Road Monday 11 a.m. Thursday 11 a.m. South Clinic, Princes Plain Wednesday 11 a.m Medical Room, Hayes School Wednesday 11 a.m. Medical Room, Burnt Ash School Thursday 11 a.m. Vaccination. North Clinic, Station Road Tuesday 11 a.m. South Clinic, Princes Plain Last Wednesday in every month 11 a.m. Medical Room, Hayes School Wednesday 11 a.m. Medical Room, Burnt Ash School Sat. (by appointment -once a month) a.m. Specialist Clinics. North Clinic, Station Road Mon., a.m Ophthalmic. Wed., a.m Ophthalmic. Friday, p.m Ophthalmic. Friday, p.m Orthopaedic. (Four sessions a month.) South Clinic, Princes Plain Mon., p.m Speech Defects. 26 NATIONAL ASSISTANCE ACT, 1948. (Section 47). One Court Order was applied for, and obtained, in respect of the removal to suitable premises of a person in need of care and attention. CAKE OF THE AGED. Aproximately 14% of the population comes into the category of persons of pensionable age-a figure which will be verified when the census figures are available. It is, however, not practicable to give an accurate estimate of the number of these persons who require additional aid, nor the number in each of the four categories mentioned later. It is increasingly obvious that the care of the aged is an urgent social problem. With the coming of the Welfare State, it would seem that there is a certain lack of charity creeping into the attitude of some families, and that it is a more or less accepted principle that every problem of welfare is one for the State and not for the individual or the family. It is only fair to say, however, that this is very much tied up with the economic problems of the day and there are many families who cannot afford either the time or the money to care for an elderly relative. The real factor that makes the problem of the care of the aged so acute is the inadequacy of the institutional provisions to replace those at one time provided by the Board of Guardians and later transferred to the County Council under the Act of 1929. Authorities that are now concerned with the statutory care of the aged, excluding such services as National Assistance and National Insurance, are as follows:- 1. Regional Hospital Board. Provision of hospital beds for those aged persons requiring hospital treatment. 2. Kent County Council. (a) Provision of residential homes for the aged infirm unable to be cared for at home. (b) Home Helps. (c) Home Nurses. 3. Local District Authority. (a) Provision of houses for the aged who are able to look after themselves. (b) Certain sections of the National Assistance Act, 1948. especially with regard to Burial and to removal, by Courts Order, from insanitary conditions. 27 Any inadequacy of any one of the above services tends to make the social problem more grave, e.g., the lack of hospital beds places an additional strain upon the domiciliary service for the aged sick left at home. At all times there must be an inter-relationship between all those concerned, whether it be voluntary service or statutory provision, if this care of the aged is to be reasonably complete. When considering this problem it is perhaps more simple to classify the aged into groups and then deal with the provisions for each group separately-bearing in mind that there is constant interflow between each group. Broadly speaking, the classifications are as follows:- 1. Old people who are fit and well and are not dependent upon outside assistance. 2. Those who are in reasonably good health but who require help of some nature if they are to remain at home. 3. Those who, through advanced age, are too feeble, either physically or mentally, to cope with the battle for existence. 4. Those who are chronically sick and need expert medical treatment in hospital or nursing home. Group 1. Though the first group is, perhaps, the easiest to deal with, it must be remembered that they too will inevitably feel the toll of years and will come to swell the ranks of the other groups. Old People's Clubs are doing much to dispel the boredom and loneliness which might otherwise hasten the deterioration of the mental and physical health of the people in this category. In Bromley, there are eight of these Clubs which are well run and well attended. The total membership is over a thousand, which figure is indicative of the popularity of this venture. They have proved their value in giving old people opportunities to meet their own contemporaries at a place where they can be sure of a warm welcome and friendship and it may well be that, in the case of a good many elderly people, the days of the Club's meeting are red letter days in what is otherwise a monotonous and lonely life. Recently, a holiday scheme was inaugurated by his Worship the Mayor, whereby, during the " off holiday season " an aged fit person can receive a holiday at Margate at half the usual weekly cost. It is expected that this scheme will operate during May and October and arrangements will be made with the help of the Women's Voluntary Services, through the Old People's Clubs. 28 The Local Authority is providing housing accommodation, in ground-floor flats, for thirty old age pensioners, under their housing allocation system. Applicants are restricted to people who have remained resident in Bromley since September, 1939. Group 2. There are many organisations, both voluntary and statutory, to assist the elderly people in the second group-the domestic help service provided by the Kent County Council under the National Health Service Act, and the meals on wheels service provided by the Women's Voluntary Services, being the two in greatest demand. The domestic help service helps to lighten the burden of housework and has been a great boon to many old peoplenearly a hundred households consisting of one or more old people were assisted during the year-but it is a "housework" service and so has to be restricted within permissible bounds of essential work, which, in most cases where old people are living in one or two rooms, can be covered in a few hours each week. This, necessarily, leaves days when they must carry on themselves and it is of great help to them when meals are delivered by the W.V.S. During 1950 approximately seventy meals were cooked each week at the Municipal Offices Canteen and delivered by the Women's Voluntary Services, the majority of them to old people. This service is increasing. Group 3. What is being done for those in the second group can equally well apply to the third group with the addition of the services of the home nurse from time to time, and the provision of residential accommodation. Unfortunately there are not enough home nurses in the area to cover the full need. The plight of the aged sick person who is compelled to remain at home, even though there may be adequate grounds for removal to hospital, is a sad one. The provision of residential homes has been the responsibility of the County Council since 1948. The provision of sixty-six "Part III" beds at Orpington Hospital is inadequate to meet the requirements of North West Kent. The County Council, however, are actively proceeding with accommodation at "Kokine" in Orpington (approximately thirty-five beds), and "Elmbank" in Bromley (approximately thirty-five beds), but it may be some time before these homes are in operation. 29 Fortunately, and with much credit to the W.V.S., the home provided by them at "Southwood," for forty persons, is fulfilling a great need. Residential Part III accommodation requirements are complicated in that there are certain restrictions applicable to an aged person which make them ineligible for admission, and there are borderline cases which cannot be classified either as hospital cases or as fit for residential home accommodation. It is, perhaps, these borderline cases which place such stress upon the voluntary and statutory social services for the care of these patients left unattended in their homes. Group 4. This brings us to the provision made for the fourth group. At present there are seventy-four beds allocated to the elderly chronic sick in the Bromley Group Hospitals, which cover a much wider area than Bromley alone. The future programme of this Group provides for a total of one hundred and thirty-two beds, and, as at the present time there are ninety aged sick persons on the waiting list for hospital admission, it would appear that this accommodation, when provided, will be inadequate for the needs of this large population, even allowing for vacancies caused by deaths and partial recoveries. In addition to the hospital provision, there are beds at many of the private nursing homes which accommodate the aged sick at private cost. There are four such nursing homes in Bromley with a total of sixty-eight beds-these beds, of course, are not exclusively devoted to the chronic aged sick and few families can afford the cost. In addition, there are certain nursing homes run by voluntary associations which provide for residential care of the aged sick and infirm, e.g., Brook Lane Medical Mission which provides and manages the nursing home at " Greenhill" (twenty-two beds), and " Dunoran" (thirty-three beds), also North-West Kent Housing Society, Ltd., which provides residential accommodation for thirty-four persons at " Merevale," many of whom are of the " hospital " category. The lack of cohesion in the various schemes for the welfare of the aged infirm cannot be remedied by the setting up of new committees, rather is it a case, not of divided control but of unified control, passing all institutional care to one authority, leaving the domiciliary care, whether it be voluntary or state, to another. 30 OLD PEOPLE'S HOMES. The following reports on the Homes run by Voluntary Associations and Public Authorities have been received:- "Southwood," Residential Club, Oldfield Road. Bickley. This Club is run by the Women's Voluntary Services and the Centre Organiser states:- "We have twenty-eight single and six double bed-sitting rooms at the Club. There were twenty-five women, eight men and three married couples living in the Club on 31st December, 1950, the average age being seventy-seven and a half years. Except for a few weeks we were full right up for the whole year, with a long waiting list. We have stopped taking names for the waiting list, because we feel it to be unfair on the applicants, who, when their names are accepted, live in a state of suspended hope indefinitely-vacancies so rarely occur. Most of the residents have been with us since the early days of the Club, and a number are becoming increasingly frail. Two residents died during the year, one at the Club after a heart illness, the other at a W.V.S. Nursing Home. Four residents were admitted to W.V.S. Nursing Homes for short periods of convalescence and returned to the Club very much better. One resident entered hospital for observation, and another for removal of cataract. Two women and one man have been accepted for residence during the year. Two of our women residents, both over seventy, who had been at Southwood, one for three and a half years and the other fourteen months, felt so fit and able that they decided they could undertake some work, and so took up posts as companion helps. A grand piano was presented to the Club during the year, also a television set. The full size billiard table is a source of great joy to the men. Entertainments are frequent-film shows, musical evenings, whist drives and concert parties." Merevale," Bickley Park Road. This Home is run by the North West Kent Housing Society, Ltd., and the Secretary reports, as follows:- "A further increase of one was made in the available accommodation at ' Merevale' early in 1950, and, but for short periods, all beds were occupied throughout the year. On 31st December, 1950, the residents consisted of twenty-six females and nine males, of an average age of 81.8 years. This included one married couple. There were five deaths, two of which took place in the Home and three in hospitals. 31 The position as regards the admission of our residents to hospital when sick eased recently, and, if this trend continues, should result in voluntary homes of this kind accepting less robust types than they have been able to consider hitherto, which would operate to the advantage of a particularly necessitous type of aged person. The standard charge at ' Merevale' remains at the original charge which applied when the Home opened in 1947, namely, £2 12s. 6d. per week.'' " Armstrong House," 1, Southlands Grove, Bickley. The following report has been received from the Save Our Souls Society, 24, Ashburn Place, London, S.W.7, the Society responsible for this Home:- " Accommodation: Capacity 28 Weekly average numbers 28 Admissions during 1950 7 Departures during 1950 7 Present Residents : Men 16 Women 10 Average age 78 General and Health. In the report covering 1949, reference was made to the difficulty experienced in arranging for the admission of sick residents to hospital and any report for the year under review cannot fail to have as a backcloth a scene depicting the serious effects on Armstrong House of the acute shortage of hospital beds for chronically sick old people. The introduction of the National Assistance Act, 1948, and the National Health Service has created many unexpected problems quite unknown two to three years ago ; the most serious from the point of view of an Old People's Home being the complete gulf which exists between the local authorities responsible for the welfare of old people and Regional Hospital Boards. On the one hand old people seriously in need of hospital treatment find it impossible to obtain admission to hospital; on the other, hospitals complain that although many of their patients are well enough to leave, they cannot be discharged owing to lack of outside accommodation. Local authorities although responsible for the old people are themselves powerless to act and a state of deadlock exists. Exchanges have been arranged but generallv speaking we find that hospitals 32 are unwilling to consider any old person who suffers only from senility and not from some organic complaint or disease. The additional strain thus imposed on the staff of an Old People's Home who are called upon to care for the bedridden and chronically sick, is severe and some change in the character and function of the Home, not of our making, is the inevitable result. In fairness to the medical profession, however, mention must be made of the selfless service by the doctors, in the face of many difficulties, attending the old people in our care at Armstrong House, and of their strenuous efforts to gain admission to hospital for those who have become chronically sick. In addition, arrangements are made for out-patients specialist treatment, x-ray examinations, oculist examinations and dental treatment where necessary. A Chiropodist visits the Home regularly. Source of Supply. Very close liaison exists between the Matron and the Welfare Officer of the County Council, who is given first call on all vacancies which occur. With a turn-over of only seven, however, the demand greatly exceeds the need for accommodation and a great many applicants have to be refused. Recreation, Entertainments and Welfare. With the general health of the inhabitants of the Home deteriorating, fewer old people are able to journey into Bromley or Beckenham for their entertainment, but concerts and film shows have been given in the Home by local organisations and friends. A weekly allowance is given to every old person with which to buy sweets, cigarettes or tobacco. Periodicals and magazines are provided in the Home. Finance. Total expenditure of £3,170 0s. Od. incurred in running the Home during the financial year ended 30th September, 1950, exceeded income by £465. The weekly all-in cost for the year amounted to £2 7s. 3d. per resident, per week, to which must be added a proportion of Central Office administrative expenses bringing the true cost up to £2 13s. 9d. per week." 33 "Greenhill," Oaklands Road. This Home is run by the Brook Lane Medical Mission, and the Secretary reports:- "There are twenty-two residents at present, and throughout the year the Home has been full. Two of the old ladies left Greenhill during 1950. and one died in hospital. Six new cases have been admitted. There are three resident staff, supplemented by daily help. We have been able again this year to take in other old ladies for short rest periods, while the residents were taking holidays with relatives." "The Vane," Denbridge Road, and " Town Court," Wells Road, Bickley. "Dunoran," Park Farm Road, Bickley. This Home is run by the Bermondsey and Southwark Group Hospital Management Committee and I am indebted to the Medical Superintendent of the Home for the following report:- "During 1950 Dunoran Home continued to admit chronic sick and dying patients. The patients came mainly from the Bermondsey and Southwark area and included some who came for a short stay whilst their relatives were having a much needed rest. Plans were passed during the year for the adaptation of three rooms in the garage annexe for carcinoma cases, and for the addition of a balcony and verandah which should improve amenities of place. There are now thirty-three beds available and sixty-seven patients were admitted during the year." These Homes are run by the Welfare Department of the London County Council, and the following details are given:- The Vane Town Court Residents on 31st December, 1949 29 18 Admissions during 1950 13 25 Discharges during 1950 13 14 Residents on 31st December, 1950 29 29 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 36 SECTION C. SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. Water. I am indebted to 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 1950:- "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 area during 1950. There have been no extensions of trunk mains, but short lengths of service mains have been laid within the Borough, and the supply generally has been satisfactory as regards quantity. The high level of the area is supplied from Shortlands well and by Thames-derived water during the summer months. All the Thames-derived water is chlorinated before it leaves the works. The well water is also chlorinated, but any residual chlorine is completely removed before the water leaves the works. Bacteriological analysis of all supplies are made at least 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 to establish that the quality of water is up to the standard normally supplied. None of the supplies is plumbo-solvent. The closest watch is kept for any evidence of deterioration in quality whether physical, chemical, bacteriological or biological and immediate action is taken if the result of analyses are not up to standard. Appended are the average results of the chemical and bacteriological analyses of the various supplies for 1950." 37 Chemical. (Parts per million unless otherwise stated ) Shortlands Well West Wickham Well 1 Orpington Well hames-derived filtered water (Walton) Number of samples 4 4 3 241 Ammoniacal Nitrogen 0.004 0.001 0.007 0.018 Albuminoid Nitrogen 0.025 0.021 0.023 0.097 Oxidised Nitrogen-Nitrate 4.3 4.3 5.9 5.1 Chlorides as Cl 18.6 14.3 15.0 27.6 Oxygen abs. from Permanganate 3 hrs. at 80' F 0.13 0.05 0.09 1.32 Turbidity in terms of Silica - - - 0.3 Colour, m.m. brown 2 ft. tube, Burgess's Tintometer 0 0 0 17 Hardness (Total) 298 272 276 260 Hardness (Permanent) 90 50 42 81 pH Value 7.2 7 3 7.4 7.8 Phosphate as P.O. 111/4 - - - 0.39 Silica - - - 11.0 Conductivity 475 425 475 450 Bacteriological Results. No. of microbes per ml. Colonies counted on agar after 20-24 hours at 37' C - - - 15.3 Bact. coli test: Percentage of samples negative to Bact. coli in 100 ml 100.0 100.0 99.6 100.0 Bact. coli per 100 ml Nil. Nil. 0.004 Nil. Drainage and Sewerage. No new drainage schemes were undertaken during 1950, except the provision of drains and sewers on the Housing Estates being developed by the Corporation. Cesspools. No new premises were 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. During the year thirty individual cesspools were emptied by the Department. Rivers, Streams and Lakes. There were no works of improvement carried out during the year. Fourteen visits of inspection were made by the Sanitary Inspectors. 38 Swimming Baths and Fools. A Break-point chlorination plant was installed and brought into use at the Corporation Open-Air Bath during the early part of the year. The Sanitary Inspectors made a total of seventy-eight visits of inspection of swimming baths and pools in the Borough, and forty-five samples of water were taken for examination. The results of these examinations were as follows:- Eight samples taken from the Corporation Swimming Pool -all satisfactory. Thirty-three samples taken from privatelyowned swimming baths and pools-thirty were found to be satisfactory and three were unsatisfactory. These unsatisfactory samples were found to have a high bacterial count due to inefficient treatment of the water. Four samples were broken in transit. In addition to the above examinations, the Sanitary Inspectors also take routine colometric tests for checking the efficiency of purification plants at swimming pools. The chlorine contents and pH value is checked by means of a Lovibond Comparator. Public Cleansing and Refuse Collection. The Borough Engineer reports that one improved type dustless loading vehicle was put into service during the year. A new Heenan & Froude Hydraulic Power Tin Baling Press was installed. Factories Acts, 1937 and 1948. Tables IX, X and XI in the Appendix give statistical details of the inspections made by the Sanitary Inspectors, and nuisances, defects and contraventions found and abated. A total of two hundred and three inspections and reinspections were made during the year and one hundred and six nuisances and defects were found. There were one hundred and twenty-eight nuisances and defects remedied during 1950-this figure includes those which were outstanding from the previous year. In addition to the above, forty-two inspections were made of out-workers' premises, all of which were found to be satisfactory and no nuisances or defects were found. 39 Sanitary Inspection of the Area. Tables IX, X and XI show the very varied duties involved in sanitary inspection of the area as carried out by the Sanitary Inspectors. The following are the aggregate totals under the respective headings:- Total No. of Inspections and Visits Total No. of Defects and Nuisances found Housing 6,074 1,923 Infectious Diseases 288 - Food Premises 2,681 206 Factories, Outworkers, etc. 371 110 Sampling Visits 476 - Trade Premises (Various). 387 197 Rodent Control 9,099 779 Miscellaneous 967 136 Total 20,343 3,351 In addition to the above, there were 1,284 interviews with owners, agents, etc., on site and at the office, in connection with the above work. Notices Issued: Preliminary :- Housing 769 Food Premises 82 Factories, etc 69 Trade Premises 37 Rodent Control 696 Miscellaneous 53 1,706 Statutory :- Nil Total 1,706 Food Condemnation Certificates issued 1,393 SMOKE ABATEMENT. Forty-six inspections and re-inspections were made by the Inspectors. Four nuisances were found and at the end of the year two had been remedied. Complaints were received regarding the emission of grit from the Works of the South Eastern Gas Board. Grit arrestors have now been installed by the Board and the nuisance appears to have been abated. 40 SHOPS ACT, 1950. This Act came into operation on 1st October, 1950. It consolidated all previous Acts relating to Shops Acts and therefore contained no amendments. It has not been possible to carry out extensive routine inspections of all shops in the district. As in the past, the principal contraventions concerned the absence of forms which should be exhibited. There were two complaints concerning Sunday Trading and in both cases the shops were newly occupied by traders who were not acquainted with the conditions laid down for trading on Sundays-these contraventions were immediately remedied. One hundred and sixty-three inspections were carried out, one hundred and thirty-seven defects and contraventions were found and one hundred and four were remedied by the end of the year. In no case was statutory action necessary. PETROLEUM ACTS. Ninety-five licences were issued to store Petroleum Spirit and one for Carbide of Calcium. The total storage capacity licensed during the year was:- Bulk Storage 119,560 gallons. Can Storage 8,549 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. Eighty-seven visits were made in connection with this work. VERMINOUS CONDITIONS AND UNCLEANLINESS. One hundred and forty-nine visits to premises by Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. Fifty-two nuisances were found. During the year thirty-two nuisances were abated (including those carried over from 1949). The very few cases of vermin infestation found in connection with the Council's Housing Estates were successfully dealt with. The continued low incidence of verminous conditions and uncleanliness is a source of gratification, particularly taking into consideration the housing shortage and the consequent overcrowded conditions in which so many families are living. It is surely a measure of our success in educating the public in the 41 principles of cleanliness, that conditions fostered by dirt have declined to such an extent as to be almost negligible. It would probably be true to say that in the majority of cases of uncleanliness, the condition has arisen as a result of old age or illness and not to neglect of the elementary principles of hygiene in healthy, able-bodied people. Having attained such an excellent general standard of cleanliness, it is now our duty to see that it is maintained, and with modern methods and ideas, there seems to be no adequate reason why this should not be done. RODENT CONTROL. The Rodent staff did excellent work during the year and obtained a large measure of co-operation from the traders and the public in this matter. There was an increased number of complaints receivednearly one-third of which concerned the presence of mice. The sewers have received the necessary maintenance treatments in accordance with the requirements of the Ministry of Agriculture and Fisheries. In no instance was it necessary for statutory action. PREVENTION OF DAMAGE BY PESTS ACT, 1949. PREVALENCE OF RATS AND MICE. Type of Property (1) (2) (3) (4) (5) (6) (7) Number of properties in Local Authority's Area Analysis of Column 4 Total in which infestation was recorded No. infested by Notified by Occupier Otherwise discovered Total of (2) & (3) Rats Mice only Major Minor Local Authority's Property 27 6 1 7 - 7 - Dwelling Houses 18.419 520 47 507 - 445 122 Business Premises 1,775 103 17 120 1 89 30 Agricultural Property 29 6 - 6 - 6 - total 20,250 035 05 700 1 547 152 42 MEASURES OF CONTROL BY LOCAL AUTHORITY. Type of Property No. of properties inspected No. of inspections made Number of notices served under Section 4 Number of treatments carried out Block treatments of properties in different occupancies under Sect. 0 (1) or by informal arrangement By arrangement with occupier Under .Section 5 (1) Treatments Works Ratst Mice only Ratst Mice only No. of blocks Surface Associated Sewers No. of separate occupancies Number of manholes treated Local Authority's Property 7 71 - - 7 - - - - - 551 Dwelling Houses 2,072 0,538 - - 445 122 - - 88 560 - Business Premises 265 1,334 - - 90 30 - - 8 49 - Agricultural Property 9 48 - - 6 - - - - - - Total 2,353 7,991 - - 548 152 - - 96 609 551 † Includes premises infested with both rats and mice. DISEASES OF ANIMALS ACTS. Mr. G. R. Woods, Chief Sanitary Inspector, is the authorised inspector under these Acts for the Borough of Bromley. Fifty-two inspections and interviews were made in connection with this work. Many Orders were received from the Ministry of Agriculture and Fisheries concerning Fowl Pest, Foot and Mouth Disease and the Regulations of Movement of Swine Order, 1950. Under the latter regulations twenty licences were received authorising the movement of two hundred and fifteen pigs. Fowl Pest was confirmed to exist on one premise within the Borough. 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. 43 RETAIL MARKET. The Corporation owns the Retail Market under a Charter of Market Rights (granted 20th July, 1447). The Market is held on Thursday of each week at the Car Park, Station Road. The administrative supervision is under the Health Committee and the Market is controlled by the Market Superintendent. The Market Tolls collected during 1950 amounted to £190 5s. 0d., which is a decrease of £3 18s. 6d. on the corresponding figure for 1949. SECTION D. HOUSING. 46 SECTION D-HOUSING. Rehousing. The problem of housing remains acute, and at the 31st December, 1950, there were still some 2,162 families on the waiting list of the Local Authority. The following statement shows the Council's post-war housing programme as at 1st January, 1951 PERMANENT HOUSING: Completed and occupied :- Units. Princes Plain Estate 50 Coppice Estate (part) 458 London Road Flats 54 Bourne Way Flats 66 Tylney Road Flats (part) 24 Purchased Properties 27 Under construction:- Coppice Estate (Contract No. 2) 2 Coppice Estate (Contract No. 5) 72 Tylney Road Flats (Contract No. 1) 6 London Road Flats (Extension) 12 Tenders approved :- Blyth Road Flats 76 Hayes Place Estate (Contract No. 1) 86 Schemes being prepared-Tenders to be invited in 1951:- Tylney Road Flats (Contract No. 2) 24 Hayes Place Estate (Contract No. 2) 161 London Road (Longfield) Flats 18 Schemes being prepared, awaiting Ministry oj Health consent to invite tenders:- Hayes Place Estate (Remaining ment) 150 Schemes to be prepared:- Rodway Road Site 4 Blackbrook Lane 200 (Estimated) 1,490 TEMPORARY HOUSING: Properties. Units. Occupied. Prefabricated Bungalows 325 325 325 Requisitioned Properties available for occupation 382 769 769 Halfway Houses and Hayes Camp 10 143 143 717 1,237 1,237 47 I am indebted to the Property Manager for the following details which relate to the year 1950 only:- 1. (a) No. of permanent houses occupied during 1950: - Re-let 104 New properties 333 437 (b) No. of families accommodated in permanent during 1950 houses 437 (c) No. of persons accommodated in permanent houses during 1950 1,750 2. (a) No. of premises requisitioned during 1950 Nil (b) No. of premises de-requisitioned during 1950 9 3. No of families on waiting list as at 31st December, 1950:- Medical Category 3 General „ 1,283 O. A. P. 183 Outside Categories 693 2,162 In addition to the above, 28 new houses were erected by private enterprise during the year. Housing: Inspections and Abatements. Tables IX and XI in the appendix give details of the work carried out by the Sanitary Inspectors during the year. The following extract summarises the statistics relating to housing. Inspections. Reason for Inspection On Complaint Routine ReInspections Total Inspections Nuisance found For Nuisances 1,071 66 4,045 5,182 1,678 Overcrowding 129 65 25 219 14 Verminous Conditions 40 - 50 90 27 Dirty Conditions 17 17 14 48 20 Water Supply 7 - 13 20 7 Disinfestation 9 1 1 11 5 Noxious Accumulations 20 1 12 33 8 Other Accumulations 22 4 30 56 14 Miscellaneous 55 69 291 415 150 1,370 223 4,481 6.074 1,923 Nuisances and Defects Abated:- Drainage 427 Dampness 1,106 Water Supply 97 General Items 4,409 This figure includes defects 6,039 outstanding from previous year and abated during 1950. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 50 SECTION E. INSPECTION AND SUPERVISION OF FOODS. This service has been maintained at high pressure throughout the year, during which time the Council adopted the model byelaws with regard to the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air. The day to day task of stressing the importance of clean food handling was supplemented, during November, by a highly successful film show for food handlers. At the two performances, given at the Public Library, there was an audience of some 350 people. The meetings were under the Chairmanship of the Chairman of the Public Health Committee, the inaugural address being given on both occasions by His Worship the Mayor. Both the Mayor's address, and the films shown by the Central Office of Information, were much appreciated by the audiences, and the effort would appear to have been well worth while and should bear fruit in the future. Although this was the only large scale educational and propaganda effort during the year, it might well be described as the culmination of the constant work of the department on a much more individual basis. I am particularly grateful to the Mayor for his attendance and interest, without which the meetings could hardly have been such a great success as they undoubtedly were. We have again been fortunate in avoiding any serious outbreak of food poisoning because accidents will happen, however good the technique in food handling may be, and when one considers the number of people who must daily be exposed to the potential risk of food poisoning, it is indeed a matter for thankfulness that so few have been affected. It is also a warning that the slightest relaxation in the watchfulness either of the department or the traders could have serious repercussions on the public health, and gives some small indication of the magnitude of the task continually confronting us. FOOD SAMPLING. In addition to the samples taken for analysis under the provisions of the Food and Drugs Acts. 1938 and 1950. samples were also taken for bacteriological examination, and full details are given in the following tables. 51 FOOD AND DRUGS ACT, 1938. Article Samples taken Result Remarks Formal In formal Genuine Adulterated Aspirin Tablets - 2 2 - Baking Powder - 1 1 - Bicarbonate of Soda - 1 1 - Butter 2 - 2 - Cereal Filler - 1 1 - Chocolate Couverture - 1 1 - Cocoa - 1 1 - Coffee Extract - 1 1 - Confectionery - 1 1 - Cooking Fat 1 - 1 - Cough Mixture - 2 2 - Cream of Tartar - 1 1 - Custard Powder - 1 1 - Dessert Powder (Sweetened) - 1 1 - Epsom Salts - 1 1 - Fish Paste - 1 1 - Flavouring & Colouring Tablets - 1 1 - Flavouring & Colouring Powder - 5 - Frofrute - 1 1 - Gelatine - 5 5 - Glace Cherries - 1 1 - Glycerine, Lemon & Orange Balsam - 1 1 - Horseradish Sauce - 1 1 - Ice Cream (Loose) - 28 28 - Ice Cream (Mix) - 2 2 - Ice Cream (Pre-packed) - 57 57 - Ice Cream (Choc. Pre-packed) - 17 17 - Ice Cream Powder - 1 - 1 See (a) Ice Lolly - 6 6 - Kola - 1 1 - Lemonade Powder - 1 1 - Lime Water - 1 1 - Liquorice - 1 1 - Liver Salts - 1 1 - Margarine 1 - 1 - Milk (Ordinary) 1 - 1 - Milk (Pasteurised) 2 3 5 - Milk (TT. Pasteurised) 2 1 3 - Milk (T.T Farm Bottled) - 2 1 1 See (b) Milk (T.T.) 1 - 1 - Milk (Condensed Sweetened) - 1 - 1 See (c) Milk (Dried) - 1 1 - Mincemeat - 1 1 - Mixed Spice - 1 1 - Pastry Mix - 1 1 - Pepper Flavoured Compound - 1 1 - Pickled Pork - 1 - 1 See (d) Pickles - 2 2 - Quenchers - 1 1 - Saccharin - 2 2 - Salad Oil - 1 1 - Sausage Meat - 10 3 2 See (e), (i) & (ii) 52 Sausages 3 7 9 1 See (f) Sausage Rusk 1 3 4 — Stomach Powder — 1 1 — Sugar Substitute — 1 1 — Sugar Wheat Puffies — 1 1 — Sweephat — 2 1 1 See (g) Table Jelly Crystals — 1 1 — Tartaric Acid Powder — 1 1 — Throat Lozenges — 1 1 — Tincture of Iodine — 1 1 — Tomato Ketchup — 1 1 — Toothache Tincture — 1 1 — Vanilla Essence — 1 1 — Vantes Sparkling Drink — 1 — 1 See (h) Yellow Basilican Ointment — 1 1 — Zinc Ointment — 2 2 — Totals 14 202 207 9 (a) Heavily infested with mites. (b) Deficient 7.5% min. amount of fat. (4%). (c) Sample had a " Cheesy " taste and fat was rancid. (d) Partly sour, partly putrid, evidence of incipient purification. (e) (i) One sample: Meat 45%, Filler 30%, Water 25%. (ii) One sample: Meat 58%. Sulphite none. (f) Meat 47%, Filler 22%. (g) Excessively rancid. (h) Sugar 0.24%, Saccharin 0.015%. Total solids 0.3%. Compared with Standard of Soft Drinks Order, contains only 22% minimum amount of sugar. BACTERIOLOGICAL EXAMINATIONS MILK. No. of samples taken Description Satisfactory Unsatisfactory 136* Designated Milk 128 4 2 Ordinary Milk 2 — 2 Undesignated Milk 2 — 1 Ungraded Milk 1 — 141 133 4 * Four bottles broken in transit. 53 ICE CREAM. The Ice Cream (Heat Treatment) Regulations came into operation on 1st May, 1947. There are one hundred and thirty-five premises registered to sell Ice Cream and seven premises to manufacture Ice Cream in this Borough. There was a very slight deterioration in the bacteriological results compared with 1949. Seventy-seven samples were submitted for chemical examination the lowest fat content was 2.65% and the highest 20.75%. In addition, seventeen Chocolate Ice Cream samples were submitted for chemical examination, the lowest fat content being 4.0%, and the highest 25.6%. Week-end samples were obtained from itinerant dealers selling in the district. The Department has no prior knowledge of their visits or sites from which sales take place. It is, however, significant that pathogenic organisms have not been cultivated in any sample examined since the inception of the tests in 1947. Bacteriological Examinations. No. of samples taken Description Satis. Unsatis. Methylene Blue Group I. II. III. IV. 54 Ice Cream (Loose) 54 22 16 12 4 4 Ice Cream (Mix) 4 — 2 1 — 1 91 Ice Cream (Pre-Packed) 91 — 48 22 14 7 31 Ice Cream (Choc.) 31 — 14 1 13 3 9 Ice Lollies, etc. 9 — 8 1 — — 3 Ingredients 3 — 3 — — — 192 192 — 97 41 39 15 Tabulation of 584 samples examined from 1st May, 1947, to 31st December, 1950. Grade 1947 (part) 1948 1949 1950 No. Samples % No. Samples % No. Samples % No. Samples % I. 13 17.8 46 40.0 108 53.0 97 50.5 II. 18 24.6 24 20.9 52 25.5 41 21.4 III. 17 23.3 19 16.5 28 13.7 39 20.3 IV. 25 34.3 26 22.6 16 7.8 15 7.8 73 100.0 115 100.0 204 100.0 192 100.0 54 SPECIAL ENQUIRIES. The following are details of foods, etc., which were submitted for bacteriological examination after investigation into complaints made to this Department:— No. of samples subumte Description Result Remarks 1 Biscuits (Rich Tea Finger) Adulterated Black deposit had microscopic appearance of chaff or straw and consisted of dirt. 1 Bread Adulterated Contained fragments of rodent exrement. 1 Chocolate Couverture Genuine — 1 Flour (Self Raising) Genuine — 2 Meat (Stewed) Genuine — 2 Milk (Dried) Genuine — 1 Milk (Dried) Genuine — 1 (after sifting) Milk (Dried) (siftings) Inferior Particles appeared to be caramelized dried milk. No foreign matter detected. 1 Milk (Dried) Inferior Solubility slightly low. Slight deterioration had occurred. 1 Milk (Dried) Inferior Moisture 4.6%. Solubility 91.2%. Acidity 1.35% lactic acid. Borderline quality. 1 Milk (Dried) Adulterated The sample had a definite tallowy odour and unpleasant taste. 1 Milk (Full Cream Condensed) Inferior fit for use. Of poor but not bad quality. Acidity 0.5% (borderline). 1 Milk (Full Cream Condensed) Inferior Slightly bitter taste, probably due to bacterial decomposition of protein which in its turn was probably due to slight failure in sterilisation prior to condensation. 1 Potatoes (Cooked) Inferior Copper 9 p.pm. 1 Pudding (Christmas) Genuine — 1 Pudding (Date) Genuine — 1 Pudding (Rice) Genuine — 1 Salad Cream Genuine — 2 Sausage Meat (Pork) Unfit for Food Oxidative rancidity had developed to a degree rendering the article unfit for food and was responsible for the tallowy taste reported. 1 Sweephat Genuine — 55 Samples of the following were submitted for bacteriological examination as a result of routine inspections:— Description Result Beef (British Hind Quarter and Rump) Unsound bacteriologically. Chopped Pork in Natural Juices Sound. Leg of Lamb Sound. Pickled Pork Unsound bacteriologically. Turkey Unsound bacteriologically. Water (Drinking) (6 sample) No organisms of the food poisoning group or toxin producers isolated. Water (Cistern) Sound. Samples of the following were submitted for examination after investigation into alleged food upsets reported to this Department:— Description Result Cauliflower and Greens No pathogenic organisms isolated. Chopped Pork in Natural Juices Unsound. Cooked Meat (Steak) No pathogenic organisms isolated. ,, ,, (Lamb Chops) Unsound ,, ,, (Lamb Chops) No pathogenic organisms isolated. ,, ,, (Mutton) No pathogenic organisms isolated. Dried Egg Sound Dripping (Mutton) Sound Gravy No pathogenic organisms isolated. Humanized Trufood No pathogenic organisms isolated. Milk (Dried) Sound Potatoes (Cooked) No pathogenic organisms isolated. Pudding (Macaroni) No pathogenic organisms isolated. Pudding (Cooked) No pathogenic organisms isolated. Pudding (Rice) No pathogenic organisms isolated. Pudding (Roll) No pathogenic organisms isolated. Sausages (Beef) No pathogenic organisms isolated. Sausages (Pork) No pathogenic organisms isolated. Sausage Rusk No pathogenic organisms isolated. Vanilla Cream Slice No pathogenic organisms isolated. 56 Food Preparing Places. There are approximately one hundred and seventy premises within the area issued with a catering licence by the Ministry of Food, and these include thirty-three school canteens, seventeen hospitals, Nursing Homes, Nurseries and Institutions, sixty-seven Hotels and Public Restaurants, etc., twelve Clubs and forty-one Staff Canteens. This figure shews a considerable decrease over that for 1949, and is mainly due to a number of Clubs, Licensed premises, etc., having given up catering. Slaughterhouses. There are five slaughterhouses still in existence in the Borough. Two only of these are used at the present time, slaughtering being carried out on behalf of local pig-keeping clubs, etc. 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. INSPECTION OF FOOD PREMISES. Two thousand six hundred and eighty-one visits of inspection were made to Food Premises during the year and two hundred and six defects were noted. Two hundred and eight defects were abated during 1950; this figure includes those noted in 1949 which were remedied during 1950. FOOD AND DRUGS ACTS, 1938 AND 1944. Milk ani 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 15 " Sterilised " Milk 17 "Tuberculin Tested" Milk 14 Supplementary Licences: — "Pasteurised" Milk 15 " Sterilised " Milk 14 " Tuberculin Tested " Milk 11 57 MEAT INSPECTION. The following table gives details of the ante- and post-mortem inspection of animals made during 1950:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 22 Number inspected — — — — 22 All Diseases except Tuberculosis. Whole carcases condemned - - - - - Carcasses of which some part or organ was condemned - - - - 6 Percentage of the number inspected affected with disease other than Tuberculosis — — — — 27.3% Tuberculosis only. Whole carcasses condemned - - - - - Carcasses of which some part or organ was condemned - - - - 1 Percentage of the number inspected affected with Tuberculosis - - - - 4.5% UNSOUND FOOD. 1,393 Food Condemnation Certificates were issued during the year affecting in quantity 20 tons 2 cwts. 3 qtrs. 1 lb. of varied articles of food, which was utilised either for manufacturing purposes, animal food, or, where this was impracticable. destroyed. The corresponding figure for 1949 was 15 tons 12 cwts. 20$ lbs. Article of Food Approximate Weight (lbs.) Bicarbonate of Soda 3 Biscuits 57 Cereals 74¾ Cheese 26¼ Coffee 1 Cooking Fats 28 Cordials 9 Cream 1 Eggs 68½ Fish (Fresh) 1,632 Fish (Tinned, etc.) 212 Fish and Meat Pastes 71¾ Flavouring Essence ¾ Flour and Cake Mixtures 929¾ Fruit (Canned, etc.) 2,891¾ Fruit (Dried) 430 Fruit (Fresh) 45 58 Article of Food Approximate Weight (lbs.) Fruit Juice 340 Ginger Wine 3 Jams and Marmalade 6284 Meat (Tinned, etc ) 2,530½ Meat (Fresh) and Bacon 17,321 ¼ Meat Pies (Pork) 22½ Milk (Tinned and Powdered, etc.) 8.929 Mincemeat 403¾ Pickles and Sauces 105 ¾ Poultry 3,904¼ Puddings and Pudding Mixtures 276 Rabbits 2,807¼ Salad Cream 28½ Salt 4 Soup (Tinned and Packets) 139¼ Sugar 2 Sweets 138½ Vegetables (Fresh and Canned) 1.390½ Vinegar 2½ Miscellaneous 14 45,109 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 60 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Statistical details of notifiable diseases are shown in Tables V and VI in the Appendix. There were no serious epidemics during the year. INFECTIOUS DISEASES. The control of infectious diseases necessitates prompt exchange of information between the authorities concerned and it is a matter for gratitude that during the course of the year the liaison between the Medical Officer of Health and the Hospitals has been built up and strengthened. By virtue of arrangements made during the course of the year, the Hospitals keep me informed of any case of infectious or suspected infectious disease which may occur in institutions under their control. For our part we keep the Hospital authorities apprised of all important developments on the Infectious Disease front, thereby enabling them to be on the look out for the particular infectious diseases which may be rampant at any particular time. These arrangements would be especially valuable should an outbreak of a serious Infectious Disease, for example, smallpox or enteric fever occur. SMALLPOX. This disease is no longer endemic in the British Isles but owing to the modern speed of travel there is always a risk of it being imported into this country. It is perfectly possible for a person to be a contact of smallpox, for example in India, to fly to this country and to develop the first signs of illness after being here for several days. If such a sequence of events happened and the patient had been partially immune to smallpox, he might well be insufficiently ill to consult a doctor. In such circumstances, the disease could be spread to a large number of persons before its presence had been suspected, particularly if the population as a whole were not immune. In view of this it will be clear that constant vigilance is necessary on the part of all concerned, if the importation of smallpox on a big scale is to be avoided, every day's delay in the control of movement of a case increases the danger of an epidemic. As the Council are aware, there were two or three instances of smallpox being brought into this country during the past year, but they must all be considered to have been very well controlled. 61 In view of the ever present potential risk it is the practice of the department to urge the necessity for frequent vaccination of all those members of the staff who would be especially exposed to the risk of contracting smallpox, should an outbreak occur in this district. Owing to the difficulty of differentiating smallpox from chickenpox and other diseases, any weakening of the link between the Medical Officers of Health, General Practitioners and Hospitals, would increase the risk of the spread of smallpox. I am happy to say this link is locally a strong one. All contacts of smallpox who were residents in the Borough were kept under surveillance for the necessary period, and no cases developed. 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, 1950:— Age at 31st December. 1950 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated 286 250 33 35 604 Number Re-Vaccinated 6 24 191 221 ACUTE ANTERIOR POLIOMYELITIS. Fourteen notifications of this disease were received during the year, seven of which proved to be paralytic and seven nonparalytic. Five cases were removed to hospital and nine were home nursed. There were no deaths from this disease recorded in the area. Months during which cases were notified:— June 2 August 6 October 2 July 1 September 2 November 1 In view of the large and widespread epidemic of infantile paralysis which occurred in the country in the latter part of the year, we were indeed fortunate to have only 14 cases, of which half were paralytic. Last year's outbreak was distinctive in that many widely separated districts had a large number of cases leaving extensive intervening areas relatively unaffected. Critical analysis of this peculiar distribution would rather lead to the conclusion that, spread out over the country, there are at certain times of the year, quite virulent foci of infection. If we take as an example two neighbouring towns A and B of similar type and of more or less equal population and find that in A, there are a large number of cases, while in B only two cases occur, the reasonable inference appears to be that a large number of people in town A have come into contact with the focus of infection in that town, whereas in town B only those 62 who visited A have exposed themselves to the risk of infection. This theory would do a lot to explain the fact that case to case infection appears to be very rare, for example the unusualness of more than one case in a household and the fact that hospital staffs are not particularly prone to the disease. Unfortunately we are still floundering in the dark as to possible foci of infection and although many ingenious theories have been advanced, I still adhere, in the present state of our knowledge, to the view that human carriers are the most likely source of infection. Before leaving the subject, a word should be added about immunity, at present we have no test to determine whether or not an individual is susceptible to infantile paralysis. It may well be that the majority of people have a natural immunity to the disease, which could explain why only one person in a household is usually affected, but if this is so, the increased number of cases in the community of recent years can only be explained by the fact that there are more foci of infection now than there were formerly. This might well be the case, with the increased intercontinental travel of modern days, by means of which healthy carriers could import the disease into this country from other countries where it is endemic. From the above remarks it will be clear that although the problem of anterior poliomyelitis is as yet unsolved, there are lines of approach which it is hoped will bring forth fruit in the not too distant future. SCARLET FEVER. One hundred and fifteen cases were notified (139 during 1949), fifty-two of which were treated in hospital and sixty-three were home nursed. There were three " return " cases. The infection continued to be mild in character and no deaths from this disease were recorded. The continued lack of seriousness in the symptoms of this disease in the majority of cases, gives just cause for gratification, but whether this is a temporary or permanent feature will only be able to be judged with the passage of time. If one studies the incidence and life history of scarlet fever over the years, it is a striking fact that both have been subject to periodical waves of alternating seriousness and mildness and it may well be that we are now in the trough of the wave with the crest to be found at some future date. Whether this present attenuation is due to a building up in the resistance of the population or to a weakening in virulence of the infecting organism is not clear. but whatever the cause. the possible course of this disease will need constant vigilance. 63 DIPHTHERIA. One case—in an adult—was notified during the year and removed to hospital. The source of infection in this instance did not originate in this area. DIPHTHERIA IMMUNISATION. During the year 1950, a total of 544 children received Primary Inoculations and 499 Reinforcing Inoculations. (Figures for 1949 were 1,103 Primary and 1,427 Reinforcing Inoculations.) A total of 9,609 children under the age of 15 years had completed a course of immunisation (since 1st January, 1936), at the 31st December, 1950. This is equivalent to approximately 76'/? of the population under 15 years of age. TYPHOID FEVER. One case was notified, and was home nursed. This was an isolated case and no secondary cases occurred. PUERPERAL PYREXIA. Twenty-one cases, all of which were institutionally treated, were notified during 1950. This represents an attack rate of 23 per 1,000 total births. There was no mortality from this disease. OPHTHALMIA NEONATORUM. Two cases of this disease were notified during the year. Both of these were institutionally treated and made full recovery. PEMPHIGUS NEONATORUM. No cases were notified during 1950. MEASLES. Three hundred and sixty-eight cases occurred in the Borough during 1950, as against three hundred and fifty-eight cases for 1949, giving an attack rate of 5.7 per 1,000 population. Five of these cases were admitted to hospital and the remainder were home nursed. The distribution of the cases occurring was fairly even throughout the area. The incidence of this disease almost invariably follows a predictable course, for being so very infectious, the great majority of those not immunised by a previous attack, develop it in a time of epidemic. Thus, after a large outbreak we expect to be relatively free until the next lot of susceptible children become exposed to the risk of infection when they also will contract measles, thus providing the next epidemic. The inter-epidemic cases are made up from the susceptibles who somehow missed 64 being attacked during the epidemic and from those who contract the disease more than once—an uncommon occurrence in the case of measles. The vast majority of cases occurring during 1950 were mild in character and it does seem that, providing there is good home hygiene and that very young children are not infected, most of the terrors of this illness have been overcome. WHOOPING COUGH. One hundred and thirteen cases were notified during 1950, as against one hundred and ninety-nine for 1949, giving an attack rate of 1.75 per 1,000 population. Two of these cases were admitted to hospital, and there were no deaths. There was a fall in the incidence of this disease compared with the previous year, but it would be incorrect to draw any conclusions from the number of notifications of an illness which has always shown inconsistent variations. It is, however, pleasant to be able to record that like measles and scarlet fever, this disease appears to be of a mild type, generally speaking, at the present time, and what has been said about measles with reference to hygiene and avoidance of the disease in very early life, applies very much in this case also. Immunisation against Whooping Cough is still unfortunately in the experimental stage, and there is no statistical evidence to prove its efficacy, but one is constantly coming across individuals who are of the opinion that it saved their own children either from having the disease at all or at very least modified the attack considerably. Such " evidence " is of course inadmissible and as yet immunisation against whooping cough on large scale cannot be advocated. TUBERCULOSIS. Recordings in the Register for the year ended 31st December, 1950. are as under:— Respiratory Other Forms Total No. of Cases M. F. M. F. On Register at 1.1.50 321 282 51 54 708 New cases notified during 1950 43 23 — 2 68 No. of cases coming to knowledge after death 2 1 3 Restored to Register 1 1 — — 2 Inward Transfers 7 7 — 1 15 374 314 51 57 796 Deletions—deaths, removals recoveries, etc. 17 15 — — 32 No. of cases on Register at 31.12.50 357 299 51 57 764 65 Full details of the new cases and mortality during the year are shown in Table VII of the Appendix. Sixty-eight cases were added to the Register, three cases were noted after death, and there were fifteen Inward Transfers to the area. Thirty-two cases were deleted from the Register on account of deaths, removals, recoveries, etc., leaving a net figure on the Register of seven hundred and sixty-four, an increase of fifty-six over the total for 1949. The number of new cases notified showed a decrease of eighteen over the corresponding figure for 1949. There were only thirty-two deletions from the Register during the year as against a total of one hundred for the year 1949. FOOD POISONING. Two cases of Food Poisoning were notified by medical practitioners during 1950, both of which were isolated cases. The agent identified in each instance was Salmonella Typhi Murium. OTHER INFECTIOUS DISEASES. In addition to the infectious diseases enumerated above, notifications were received as under:— Pneumonia 53 Dysentery 3 Erysipelas 8 Meningococcal Infection 3 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. 68 STATISTICAL TABLES, 1950. TABLE I.—Summary of Statistics. TABLE II.—Causes of Death. TABLE III.—Infant Mortality. TABLE IV.—Analysis of Causes of Infant Deaths. TABLE V.—Notifiable Infectious Diseases — Sex and Age Distribution. TABLE VI.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates. TABLE VII.—Tuberculosis—New Cases and Mortality. TABLE VIII.—Housing Statistics. TABLE IX.—Summary of the work of the Sanitary Inspectors. TABLE X.—Factories Acts, 1937 and 1948. TABLE XI.—Nuisances, Defects and Contraventions Abated. 69 TABLE I. Summary of Statistics 1950. Population (mid-year 1950, per Registrar General) 64,610 Birth Rate 13.8 Death Rate 11 .4 Maternal Mortality Rate - Infant Mortality Rate 21.3 Number of Births (live) 892 Number of Stillbirths 21 Number of Deaths 739 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 19 Death Rate of Respiratory Diseases 0.68 „ „ Tuberculosis 0.26 „ „ „ Cancer 1.9 „ „ „ Zymotic Diseases 0.015 Notifications of Infectious Diseases: Scarlet Fever 115 Diphtheria 1 Poliomyelitis 14 Typhoid Fever 1 Puerperal Pyrexia 21 Pneumonia 53 Tuberculosis (New Cases) 88 Number of Deaths from Infectious Diseases 1 „ „ „ Diarrhoea (under 2 years) Nil „ „ „ Child Birth Nil Number of visits by Sanitary Inspectors 20,359 70 TABLE II. Causes of Death, 1950. Male Female Total 1. Tuberculosis—Respiratory 11 5 16 2. „ other 1 — 1 3. Syphilitic diseases 4 2 6 4. Diphtheria — — — 5. Whooping Cough — — - 6. Meningococcal Infection — — — 7. Acute Poliomyelitis — — — 8. Measles — — — 9. Other infective and parasitic diseases — 1 1 10. Malignant neoplasm, stomach 7 11 18 11. Malignant neoplasm, lung bronchus 13 4 17 12. Malignant neoplasm, breast 1 18 19 13. Malignant neoplasm, uterus — 11 11 14. Other malignant and lymphatic neoplasms 29 29 58 15. Leukaemia, aleukaemia 1 1 2 16. Diabetes 4 3 7 17. Vascular lesions of nervous system 38 63 101 18. Coronary disease, angina 58 35 93 19. Hypertension with heart disease 18 17 35 20. Other heart disease 52 98 150 21. Other circulatory disease 7 22 29 22. Influenza — 2 2 23. Pneumonia 12 8 20 24. Bronchitis 16 4 20 25. Other diseases of the respiratory system 2 2 4 26. Ulcer of stomach or duodenum 8 2 10 27. Gastritis, enteritis and diarrhoea — 3 3 28. Nephritis and nephrosis 5 3 8 29. Hyperplasia of prostate 11 — 11 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformation 4 4 8 32. Other defined and ill-defined diseases 33 36 69 33. Motor vehicle accidents 2 1 3 34. All other accidents 6 4 10 35. Suicide 4 3 7 36. Homicide and operations of war — — — All causes 347 392 739 71 TABLE III. INFANT MORTALITY, 1950. (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 Broncho-Pneumonia - - - - - 2 1 1 - 4 Atelectasis 1 - — — 1 — — — — 1 Prematurity 5 — — — 5 — — — — 5 Congenital Heart Disease — — 1 — 1 1 — 2 — 4 Other Causes 1 — 1 — 2 — . 1 1 1 5 Totals 7 - 2 - 9 3 2 4 1 19 72 TABLE IV. Analysis of Causes of Infant Deaths 1946 - 1950. 1046 1947 1048 1049 1050 Total No. of Births (live) 1,170 1,304 1,042 1,030 802 5,444 Infant Mortality Rate 26 19 21 16 19 101 Malformation 3 13 — — — 16 Prematurity 14 5 6 3 5 33 Respiratory Diseases 4 5 2 1 4 16 Marasmus and General Debility — - — — — - Infectious Diseases 1 — — 3 — 4 Gastro Enteritis — - 1 1 - 2 Convulsions — — — — — - Atelectasis - - - 1 1 2 Congenital Heart Disease - - - 3 4 7 Other Causes 9 2 12 4 5 32 Totals 31 25 21 16 19 112 73 TABLE V. Notifiable Infectious Diseases, 1950. Sex and Age Distribution Disease Totals Under 1 1-2 3-4 5-9 10-14 15-24 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 50 65 3 4 15 12 27 41 3 7 2 1 Whooping Cough 40 64 1 4 9 12 20 21 16 23 1 2 — — 2 1 1 Poliomyelitis (Paralytic) 2 5 — — — — — 1 — 2 — 1 1 1 1 — — (Non Paralytic) 1 6 — — — — — 1 — 1 — 2 1 1 — 1 Measles 167 201 3 5 28 41 49 45 84 104 1 3 1 2 — 1 1 Diphtheria — — — — - — — — — — — — - 1 — - - — 269 342 4 9 40 57 84 80 127 171 5 15 5 5 3 4 1 1 Under 5 5-14 15-44 45-64 65 and over Age Unknown Acute Pneumonia 27 26 3 3 3 4 10 6 6 5 4 5 1 3 Dysentery 2 1 1 — 1 — — 1 — — — - - - Erysipelas 1 7 - - - - - 3 1 3 — 1 Cerebro-Spinal Fever 3 — 3 — — — — — — — Puerperal Pyrexia — 21 - - - - - 21 - - - - - - Typhoid & typhoid fevers 1 — 1 - - - - - - - - - - Food Poisoning 1 1 - - - - - 1 1 - - - - - Ophthalmia Neonatorum 1 1 1 1 - - - - - - - - - - Tuberculosis— Pulmonary 53 32 1 1 2 2 28 27 15 2 7 Non-Pulmonary — 3 — — — 1 — 1 — — — 1 — — 89 92 10 5 6 7 38 60 23 10 11 7 1 3 358 434 TABLE VI. Notifiable Diseases, 1950. Ward Distribution, Attack and Mortality Rates. Disease Total WARDS Cases removed to Hospital Attack Rate per 1,000 population No. of Deaths Death Rate per 1,000 population Plaistow Martins Hill Town Sundridge Bickley Bromley Common Keston and Hayes Scarlet Fever 115 8 12 10 14 15 36 20 52 1.78 - - Whooping Cough 113 13 6 14 15 11 41 13 2 1.75 - - Acute Poliomyelitis (Paralytic) 7 1 - 1 1 2 1 1 4 0.11 - - „ „ (Non-Paralytic) 7 - 1 - 1 3 - 2 1 0.11 - - Measles 368 23 26 24 35 59 173 28 5 5.7 - - Diphtheria 1 1 - - - - - - 1 0.01 - - Acute Pneumonia 53 3 8 2 10 11 15 4 14 0.82 20‡ 0.31 Dysentery 3 1 - 1 1 - - - 1 0.04 - - Erysipelas 8 5 - 1 - 1 1 - 1 0.12 - - Cerebro-Spinal Fever 3 - - - 1 - 2 - 3 004 - - Puerperal Pyrexia 21 - - 21 - - - - 21 0.33§ - - Typhoid & Paratyphoid Fever 1 - - - 1 - - - - 0.01 - - Tuberculosis: Pulmonary 85 21 11 5 7 8 19 14 - 1.32 18 0.28 Non-Pulmonary 3 - - - - 3 - - - 0.04 1 0.01 Food Poisoning 2 - - 2 - - - - 1† 0.03 - - Ophthalmia Neonatorum 2 - - 1 - - 1 - 2 0.03 - - Totals 792 76 64 82 86 113 289 82 108 12.26 39 0.6 †This case occurred in hospital. ‡ Includes Pneumonia (all forms). § Based on attack rate per 1,000 (live and still births), and not population. 74 75 TABLE VII. TUBERCULOSIS New Cases and Mortality during the Year 1950. 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 5 1 1 - - - - - - 5—14 2 2 - 1 - - - - 15—44 21 21 - 1 4 7 - - 45-64 15 1 - - 6 1 - - 65 and over 7 - - - 4 1 - - 46 25 - 2 14 9 - - *Inward Transfers 7 7 - 1 Totals 53 32 - 3 76 TABLE VIII. Housing Statistics for the Year 1950. Total number of inhabited houses and flats at 31st March, 1950 18,101 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) 682 (b) No. of inspections made for the purpose 5,182 (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 2 (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 543 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1.197 77 TABLE IX. Summary of the Work of the Sanitary Inspectors for the Year 1950. TYPE OF INSPECTION. On Complaint Routine ReInspec tion Total Visits Nuisances Found Housing— 1. Inspection of District Regulations 53 69 291 413 150 2. For Nuisances 1,071 66 4,045 5,182 1,678 3. Overcrowding 129 65 25 219 14 4. Verminous Conditions 40 - 50 90 27 5. Dirty Conditions 17 17 14 48 20 6. Water Supply 7 - 13 20 7 7. Cesspools 2 - - 2 - 8. Eartn Closets - - - - - 9. Privy Pails - - - - - 10. Houses Let in Lodgings - - - - - 11. Disinfestation 9 1 1 11 5 12. Noxious Accumulations 20 1 12 33 8 13. Other Accumulations 22 4 30 56 14 Totals 1,370 223 4,481 6,074 1,923 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded in above table) 98 84 26 208 - 2. Disinfection Purposes 19 8 - 27 - 3. Smallpox Inquiries - 38 - 38 - 4. Public Health (Aircraft Regulations) - - - - - ft. Suspected Food Poisoning 15 - - 15 - Totals 132 130 26 288 - Meat, Milk and Other Food Shops— 1. Butchers 28 654 53 735 40 2. Confectionery 1 62 19 82 6 3. Dairies and Cowsheds (excl. Past Plants) 1 83 4 88 5 4. Pasteurising Plants - 58 - 58 - 5. Fish 4 258 5 267 8 6. Fried Fish 2 48 23 73 17 7. Food Hawkers 1 27 1 29 1 8. Fruit, Greengrocery 2 62 17 81 15 9. Grocery 48 467 43 558 50 10. Ice Cream Shops 13 215 19 247 10 11. Meat Regulations(Special Visits) 1 - - 1 - 12. Milk Examined on Highway - 11 - 11 - 13. Retail Market 3 63 - 66 - 14. Slaughterhouses - 24 - 24 - 15. Horseflesh Shops - 4 - 4 - 16. Restaurants 3 100 37 140 13 17. School Canteens 10 45 30 85 13 18. Public Houses 4 22 26 52 26 19. Factory Canteens - - 2 2 - 20. Special visits re Clean Food Byelaw 4 59 - 63 2 21. Food Salvage Depot - 10 - 10 - 22. Wholesale Food Store - 1 - 1 - 23. Mobile ice Cream Vans - 2 - 2 - 24. Hotels, etc. - 2 - 2 - Totals 125 2,277 279 2,681 206 Factorial, Outworkers, etc. 1. (i) Factories in which Sects. 1, 2, 3, 4 and 0 of the Factories Act 1937 are to be enforced by the Local Authority 5 19 20 44 21 (ii) Factories not included in (i) to which Section 7 applies 12 59 50 127 61 (a) Subject to Local Authority (transfer of Enforcement) Order, 1938 - - - - - (d) Others 1 3 3 7 4 Carried Forword 18 81 79 178 86 78 TABLE IX. (Continued) Type of Inspection On Complaint Routine Re Inspection Total Visits Nuisances Found Brought Forward— 18 81 79 178 86 Factories, Outworkers, etc. Contd. 2. Other Premises under the Act (excl. outworkers' premises, hotels, Restaurants, etc. 10 7 8 25 14 3. Bakehouses (a) Mech. power 4 40 23 67 24 (b) Non-mech. power - 10 3 13 10 4. Outworkers' premises 2 39 1 42 - 5. Smoke Abatement ... 6 6 34 46 4 Totals 40 183 148 371 138 Sampling of Food and Drugs - 1. Milk : T.T. Certified - 11 2 13 - T.T. Farm Bottled 2 - - 2 - T.T. Pasteurised 1 15 - 16 - Pasteurised - 28 - 28 - Sterilised - 3 - 3 - Ordinary - 4 - 4 - 2. Schools Milk (Pasteurised) - 16 - 16 - 3. Pasteuring Plant: T.T. Milk 1 14 - 15 - Pasturised - 18 - 18 - 4.Tined Milk 1 1 - 2 - Dried Milk 5 2 - 7 - Condensed Milk 1 - 1 2 - 5. Ice Cream - 120 8 128 - Ice Cream Mix. - 4 - 4 - Ice Cream Ingredients - 2 - 2 - 6. Other Foods 10 67 5 82 - 7. Food Poisoning 11 89 13 113 - 8. Drinking Water 6 1 2 9 - 9. Food containing foreign bodies 1 - - 1 - 10. Sale of Milk—Licences - 11 - 11 - Totals 39 406 31 476 - Trade PremisesVarious 1. Under Shops Act 13 86 64 163 53 2. Under Petroleum Acts 1 66 20 87 1 3. Registry Offices 1 26 - 27 3 4. Offices (P.H. 1936 Act, Secs. 46 and 91) 2 5 4 11 4 5. Diseases of Animals Acts: Movement Licences - 1 - 1 - Foot and Mouth Disease - 3 - 3 - Swine Fever 1 5 - 6 Fowl Pest - 1 - 1 1 Other 1 - - 1 - Interviews 40 - - 40 - 6. Piggeries,Cleansing - 2 - 2 - Sanitary Conditions 1 12 11 24 4 7. Stables: Cleansing - 11 - 11 - Sanitary Conditions - 3 1 4 1 8. Animals, Keeping of 11 - 11 22 3 Totals 71 221 111 403 70 Rodent Control— 1. Trade Premises 143 157 1,169 1,469 136 2 Private Premises 732 1,402 4,480 6,614 575 3. Sewers 259 - 684 943 121 4. Corporation Property 8 1 64 73 7 Totals 1,142 1,560 6,397 9,099 839 79 TABLE IX. (Continued) TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Miscellaneous— 1. Schools 14 8 23 45 13 2. Drain Tests: Smoke 24 4 1 29 12 Water 24 42 30 90 25 Colour 4 6 - 10 2 3. Swimming Baths: Visited 3 50 19 78 2 Samples taken - 46 4 50 - Chlorine & Ph. Test - 112 20 132 - 4. Tents, Vans and Sheds 9 28 18 55 11 5. Accumulations (other than dwellings) 11 8 20 39 13 6. Streams - 11 3 14 1 7. Tips 2 3 1 6 - 3. Special Visits 43 213 10 206 39 9. Public Houses—Urinals 3 115 25 143 14 10. Cinemas 1 2 - 3 4 11. Exhumations - 1 - 1 - Totals 138 655 174 967 136 Grand Totals 3,057 5,655 11,647 20,359 3,312 80 TABLE X. 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 72 44 3 - (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 225 127 2 - (c) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 1 7 4 - Totals 298 178 9 - 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 Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (Sect. 1) 18 40 - 5 - Overcrowding (Sect. 2) 2 2 - - - Unreasonable temperature(Sect. 3) 2 - - - - Inadequate ventilation (Sect. 4) 4 4 - - - Ineffective drainage of floors (Sect. 6) - - - - - Sanitary Conveniences (Sect. 7)— (a) Insufficient 8 9 - 4 - (b) Unsuitable or defective 44 39 - 2 - (c) Not separate for sexes 13 8 - 2 - Other offences against the Act (excluding Outwork) 15 26 - - - Totals 100 128 - 13 - Outwork : Nil. TABLE XI. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1950. HOUSING Drainage - Premises re-drained and connected to sewer 1 Cesspools emptied ... 1 Drains relaid or repaired 106 Drains unstopped 113 Inspection chambers provided 9 W.Cs. provided (additional or separate) 9 „ buildings reconstructed 3 „ „ repaired 16 ,, pans renewed 57 „ „ cleansed 6 „ box seats removed 2 Soil/vent pipes renewed or repaired 25 Sink/bath waste pipes renewed or repaired 51 Sinks renewed 10 Lavatory basins renewed or repaired 15 Baths ,, „ 1 Inspection chamber covers renewed 1 Gully surround repaired 1 427 Dampness— Roofs repaired or renewed 382 R.w.p.'s, guttering, repaired or renewed 244 Vertical Plinth provided 14 Walls rendered 70 Horizontal damp-course provided 12 Solutioning 8 Earth removed from walls 12 Walls repainted 79 Weather-board walls repaired, etc. 1 Sub-floor ventilation provided or improved 63 Dry areas constructed 3 Brickwork repaired 154 Miscellaneous 64 1,106 Water Supply— Drinking water service supplied direct from main 11 Fittings, etc. renewed 27 Separate or additional water supply provided 3 Supply reinstated 7 Flushing cisterns renewed or or repaired 3 Storage tanks „ „ „ 7 Boilers „ „ „ 1 97 81 82 TABLE XI. (Continued) General Items— Rooms cleansed 973 W.C. walls cleansed 86 Entrance hall and staircase cleansed 112 Bathroom cleansed 61 Light and ventilation improved 21 Plastering repaired or renewed 1,795 Floors repaired or renewed 223 Windows, frames, etc. repaired or renewed 425 Sashcords repaired or renewed 85 Putty pointing repaired or renewed 47 Doors repaired or renewed 102 Stoves and grates repaired or renewed 94 Coppers repaired or renewed 8 Handrails repaired or renewed 3 Stairtreads repaired or renewed 16 Dustbins provided 77 Dirty conditions remedied 9 Overcrowding abated 1 Chimneys repaired 99 External woodwork repainted 83 Food stores provided - Food stores ventilated 1 Yard paving, etc. renewed 23 Houses disinfested 23 Accumulations removed 36 Walls rebuilt 3 Miscellaneous 3 4,409 Total 6,039 MEAT, MILK AND OTHER FOOD PREMISES- Yards, floors, etc repaired 13 Cleansed, lime-washed shops, rooms 39 Lighting/Ventilation improved 10 Drainage improved 10 Manure or refuse removed 2 Refuse bins provided 15 Cold store or refrigerator improved 8 Water supply improved 13 Sinks provided 6 Washing facilities improved 30 Sanitary conveniences improved 18 Miscellaneous 44 Total 208 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 40 Overcrowding (Sect. 2) 2 Inadequate ventilation (Sect. 4) 4 Sanitary conveniences (Sect. 7): (a) Insufficient 9 (b) Unsuitable or defective 39 (c) Not separate for sexes 8 Other offences 26 Outworkers' premises - Smoke nuisances 2 Total 130 83 TABLE XI. (Continued) TRADE PREMISES— Shops Act : Ventilation improved 2 Temperature improved 2 Sanitary conveniences improved 6 Absence of statutory forms 71 Unsatisfactory Washing facilities remedied 4 Seats for female workers provided 1 Other offences or defects remedied 18 Petroleum Acts contraventions - Registry Office contraventions 3 Offices (P.H. Act, 1936, Sect. 46) contraventions 4 Total 111 RODENT CONTROL— Trade premises 147 Private premises 563 Sewers (manholes) 121 Corporation property 7 Total 838 MISCELLANEOUS — Diseases of Animals Act: Piggeries—Sanitary Conditions 2 Stables—Cleansing 1 Stables—Sanitary Conditions 3 Animals, Keeping of 2 Schools 14 Drain tests: Smoke 6 Water 21 Colour 1 Swimming Baths—visited 2 Tents, Vans and Sheds 4 Accumulations (other than dwellings) 17 Public Houses—Urinals 4 Cinemas 4 Total 81 Grand Total 7,407 NOTICES ISSUED— Preliminary : Housing 769 Food Premises 82 Factories, etc. 69 Trade Premises 37 Rodent Control 696 Miscellaneous 53 1.706 Statutory: Nil 1,706 BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1950 K. E. TAPPER, O.B.E., G.M.a M.B., Ch.B., D.P.H. Medical Officer of Health 86 Members of the Welfare Committee. Alderman M. Stafford Smith, B.A. (Chairman). Alderman H. M. V. Green (Vice-Chairman). Alderman F. W. Isard, J.P. Councillor F. G. Austin. Councillor G. H. Russell. Councillor L. C. Winterton, J.P. 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. Education Welfare Officers: S. J. Mann and L. Saysell. Staff. Proportion of time Medical Officers. allocated to School Health Whole-time : Service Medical Officer of Health Dr. K. E. Tapper 25% Deputy Medical Officer of Health Dr. H. B. C. Carter-Locke 50% * Assistant Medical Officers Dr. P. A. Currie 64% Dr. A. Orgler 50% Dr. G. H. Stinson 75% Part-time: Ophthalmic Surgeon Dr. Eric Lyle 3 sessions a week Orthopaedic Surgeon Dr. K. F. Hulberi 4 sessions a week Dental Officers. Mr. A. F. King Whole-time Mr. Russell Edey 3 sessions a week Clinic Assistants Mrs. W. Carrie Whole-time Mrs. E. Brookes Whole-time Nursing Staff. Mrs. N. M. Taylor 50% Miss W. G. Hemmings 50% Miss H. Hogger 50% Miss E. Chenery 50% Miss K. Owens 50% Mrs. V. Greig 50% Miss M E. Wootton 50% 87 Part-time. Physiotherapist Mr. W. A. Taylor 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 Clerk (Clerical Division) Mrs. D. Cox ¾ Clerks (General Division) Mrs. W. Foot ¾ Miss D. I. Payne ¾ * Includes duties in connection with Independent Schools. Introduction. To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen, The functioning of the School Medical Service has continued without great change from the scheme approved by the Education Committee 25 years ago. The administration of certain specialised services has, within the last three years, been centralised, but even in these the day to day administrative work is being carried out by the local medical and nursing staff under the direction of the Local School Welfare Committee. This delegation of the School Health Services to the excepted area of Bromley is. unlike that of Part III services under the Health Act, a reasonably true delegation of day to day administration. This effects a sustained incentive, an economy of action, and a close public partnership of Committee, public and officers, a partnership necessary and desirable in all local government. The statistics that appear in the appendix are those required of us by the Ministry of Education and will in due course be incorporated into the statistics of the Kent County as a whole. One should not judge the service by mass statistics but rather by the character and efficiency of the professional work carried out during the year. During 1949, half of Dr. Carter-Locke's service was transferred to School Health Service and to the routine periodic medical examinations of pupils attending Private Schools in Bromley. This new extension of the service to the independent private school began with the Summer Term. Six independent schools signified their desire to be included in the scheme and by the end of the year some 543 of their pupils had been examined. The innovation appears to have been well received both by the schools and parents. The burden on the shoulders of the School Nurses was considerably lightened by use where possible, of such persons as school matrons, who undertook the work normally performed by the school nurse. 88 A few figures have been worked out which seem to show that this service is greatly needed and is indeed long overdue. Admittedly the figures are not yet great but they would appear to be large enough to be significant. Defects Needing Treatment. Independent schools. Maintained schools. Vision 9.58% 3.75% Nose and Throat 5.89% 1.19% From the above table it would appear to be fairly clear that children who have had the advantage, over the years, of regular medical inspection at school shew a much smaller incidence of two of the most common defects. This does not by any means imply either criticism of, or lack of interest by the parents of children attending other than maintained schools, but it does imply that without routine periodic medical examination many minor defects would remain undiscovered and untreated. Such defects if detected early can be corrected easily, but if allowed to continue unchecked, may eventually give rise to major disabilities. The following comparative figures indicate that the general physical state of the children attending private schools is of a higher standard than those attending maintained schools. These figures do not allow for the varying idea of the professional examiners as to the correct category of borderline cases, but the figures can be taken as substantially correct. Independent schools. Maintained schools. Category A 84.9% 68.35% Category B 15.1% 30.17% Category C — 1.48% It would appear that the time and effort put into this newventure have been more than justified and I hope by next year sufficient data will have been collected to prove beyond any shadow of doubt, that this work is supplying an efficient and very necessary service. During 1950, Mr. Mayo, Dental Officer, who had given us admirable service, left the service for the more remunerative private practice, so leaving Mr. King assisted by Mr. Edey at three sessions a week, to carry the task of a dental service for some 7,000 school children and for those nursing and expectant mothers requiring urgent dental treatment. As a result of a visit of inspection and the advice of Dr. A. T. Wynne, Dental Officer to the Ministry of Education, the system of dealing mainly with emergency treatments was changed at this year's end, and routine inspection extended at the schools 89 The practice of emergency treatments has therefore ceased as from January, 1951. Mr. King has submitted a detailed report in the body of the report and I would commend your attention to his valuable and enthusiastic services. There has been some falling off in the attendances at the school clinics as compared with previous years and it may well be that greater use is being made of the general practitioner service or of the out-patient services of the hospitals. There is evidence this year of a decline in the need for treatment of minor ailments of the children. Generally speaking and excluding the incidence of the minor infectious diseases during the year, the health and the physique of the Bromley child continues good as one would expect it to be in a good residential area. Ill health is an insidious thing, difficult to detect in its early stages. I have been unable to discover any signs or evidence of any retrogression. Improving housing conditions, however slow, will give improved home conditions and it is this factor of a happy home that plays such an important part in the physical and mental health of the child. We see, however, an increase in delinquency, an indication of lack of parental control and parental training. It seems to me a terrible admission of failure when parents to-day take their own children to court because they are out of their control and ask the court to deal with them. Perhaps this is just another of those tendencies of recent years for the individual to pass responsibility to the next person. One also notices a too ready resource to psychology as the panacea for all the ills of the difficult child. It may well be asked why the greatly increased practice of psychology during the past few years has not made for reduction in the number of delinquent and maladjusted children and whether we would not get a better and lasting result if we transferred these energies to improving the house and home care and providing one house to one family. We tend to give too much attention to the individual and not enough attention to the family forced to live with other families in houses built with facilities for one family only. We suffer too from the administrative fault of too many "home visitors" —Health Visitor, School Nurse, Social Worker, Psychiatric Worker, Welfare Officer, District Officer, National Assistance Visitor, Midwife, District Nurse, Domestic Help Organiser, Sanitary Inspector, Hospital Almoner, etc., and in some cases, the Probation Officer, all with specialised functions for purposes of good. But as most of these officers work for different authorities and different committees, some local, some distant, the right hand does not know what the left hand is doing, and until there is local combined effort under local direction and amalgamation of duties there will continue to be misdirected 90 effort. It may well be that this multiplicity of visitation is one of the causes of the growing tendency "to pass the buck," undermining the responsibility which is the heritage of the parents and which is the rock upon which all child care must rest, and upon which this country and commonwealth has been built. I would wish to record my acknowledgment to the Committee for their interest in the work and for their help to me over the many years of my endeavour to make, with the loyal assistance of my colleagues, school nurses and clerical staff under Mr. Judd, an efficient School Health Service. K. E. TAPPER, Medical Officer of Health. GENERAL INFORMATION. School Roll 1949 1950 Primary Schools 4,028 4,198 Secondary Schools 1,906 1,933 Grammar and Technical Schools 1,754 1,711 Total 7,688 7,842 Further Education. School of Arts and Crafts, Tweedy Road. Building Department, Wharton Road. Technical Institutes. Bromley Technical Institute (County Grammar School for Boys). Raglan Road Evening Institute. Burnt Ash Evening Institute. SCHOOL HYGIENE. The standard of cleanliness and hygiene of the Bromley Schools has been well maintained during the past year. It is unfortunate, however, that due to shortage of labour and materials, the Ministry of Education has found it necessary to curtail works of capital expenditure, thus further delaying the necessary hygienic improvements in outmoded schools. Burnt Ash County Primary School. Additional sanitary and cloakroom accommodation has been provided consequent upon the re-organisation at Burnt Ash. Seven new W.C.'s and 14 wash basins (with hot water supply) have been installed for the Junior Department, and there have been certain minor improvements in the Infants' Department. 91 Hayes County Primary School—Gadsden Extension. Arrangements are in hand for certain minor improvements in the lavatory system in the Boys' Department. Parish C.E. Primary School. At long last work has started on a major scheme i'or the complete renewal of the sanitary accommodation and water supply at this school. This has been a matter which has been subject to my adverse reports since 1926. Valley County Primary School. Infants' Department. Lavatory and cloakroom accommodation has now been provided for the staff. Junior Department. Arrangements are in hand for certain improvements in the lavatory system—Boys section. Frequent inspections have been made of the various school canteens. The high standard of cleanliness of the canteens has been maintained throughout the year due to the enthusiasm of the canteen staff who have also seen that the production of school meals is up to clean food requirements. MEDICAL INSPECTIONS AT SCHOOLS. 257 medical inspection sessions were held at the schools and clinics during 1950, when 3,523 children were examined, as against 3,269 for the previous year. The average attendance at. each session was 13.7 as compared with 13.3 for 1949. 324 individual pupils were found to require treatment (excluding Dental Diseases and Infestation with Vermin), giving a percentage of 9.2. This figure is the lowest recorded since the war, the figures for the last five years being:— 1950 1949 1948 1947 1946 9.2% 16.36% 15.9/ 30.0% 17.7% It will be seen from Table II—B, of the statistical tables that the general condition of the pupils inspected in the various age groups reached a much higher standard. Comparative rates for the past three years are shown below:— 1950 1949 1948 Group A 68.35% 54.60% 49.25% Group B 30.17% 43.65% 46.72% Group C 1.487% 1.74% 4.02% 92 The examinations have shown a satisfactory standard of both health and general physique. The attendance of parents at routine medical inspections was good, especially in the case of entrants. It is most pleasing to see the interest that continues to be taken in the School Health Services. SPECIAL EXAMINATIONS. During the past year 2,499 cases have come under medical supervision, necessitating 4,739 medical examinations. (5,707 examinations in 1949 and 3,159 cases.) 74 cases requiring special investigation or certification were referred for examination at the Municipal Offices. 147 cases were referred to either Farnborough or Bromley Hospitals for Paediatricians' and other specialists' advice and treatment. The close link with the hospitals has been one of the features during the year and I would wish to bring to the notice of the Committee, and to the Hospital Board, how helpful to the School Medical Service is this practical co-operation. DENTAL SERVICE. Mr. King reports:— "It was my fervent hope during 1950 that school inspections on a large scale would have been resumed. Owing to the loss of the very valuable services of one whole-time Dental Surgeon (Mr. P. D. B. Mayo), who resigned in February last, this has not been possible. I have, however, inspected some children at school and expect during 1951 to greatly extend this service. Every expectant and nursing mother presenting herself at the Clinic has received all treatment necessary to restore dental fitness. The Child Welfare Service has been fully maintained. A limited Orthodontic Service is functioning. Oniy cases where the full co-operation of both parent and child is forthcoming are undertaken. Until such time as we are again fully staffed, it will not be possible to give the full comprehensive service desired, to the very large number of school children in this area. At the moment priority is being given to the younger age groups as it is felt more lasting benefit will result." VERMIN AND UNCLEANLINESS INSPECTION. 18,535 routine inspections were carried out by the School Nurses during the year, as against 15,573 in 1949. Eleven children were found to be infested, and, in addition, 93 174 children showed minor evidence of uncleanliness. In nearly all cases, the condition was cleared up by the parents who were assisted, where necessary, by the School Nurses. The infestation rate is remarkably low and speaks well for the parental care of the school child in the Borough. TREATMENT CLINICS. These clinics are held at North Clinic, South Clinic. Hayes Clinic, Burnt Ash Clinic, and Aylesbury Road and Quernmore. 12,229 attendances for minor ailment treatment at the clinics were made during 1950, a falling off compared with previous years. The types of ailments treated were, as under:— 1949 1950 Ringworm, (Body) 13 7 Scabies 16 9 Impetigo 45 36 Other Skin Diseases 646 397 Eye Disease (external and other, but excluding errors of refraction squint and cases admitted to hospital) 705 544 Ear Defects (excluding serious diseases of the ear. e.g., operative treatment in hospital 508 222 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 2.926 2,413 ORTHOPÆDIC CLINIC. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on the Orthopaedic Clinic:— "The Orthopaedic Clinic has been carried on at the North Clinic, Station Road, throughout the past year. The clinics are now held four times a month, on Friday afternoons, and the waiting list has thereby been reduced to a minimum. Patients requiring in-patient treatment are still taken into the Southern Hospital, Dartford. because there are no beds available in the Bromley area, and this is a matter that should receive attention because it is really not quite satisfactory. There has been no marked difference in the type of case sent up, postural defects of the feet and spine still largely predominate. There have, however, been several instances in which parents have complained about the cost of shoes, and it appears that the quality of shoes is now deteriorating, because parents cannot afford the higher prices, and there is the regrettable tendency for children to wear shoes for too long a time until they become too small for the feet. Mr. Taylor, the Physiotherapist in charge, has done his work faithfully and well, and I would like to pay a tribute to his skill and enthusiasm." 94 OPHTHALMIC CLINIC. Dr. Eric Lyle reports, as follows:— "1950 has been a year of steady progress in the work of the School Eye Clinic. Pupils from certain private schools are now being admitted to the Clinic in addition to the children from the maintained schools. Due to an ever increasing number of children at the schools, and the fact that the waiting list of patients for re-inspection a year ago was larger than it should have been, it has been found necessary to increase the hours of the regular clinics. These extra hours have been well worth while because, not only are all new cases able to be dealt with without any delay at all, but also the delay with cases for re-inspection is slowly but surely being reduced. That is a very satisfactory state of affairs. The total number of cases who attended in 1950 was 1.481 as against 1,186 in 1949, an increase of 295. Attendance throughout the whole year has been very good indeed. Co-operation on the part of the parents has been excellent. The question of delay in the provision of spectacles for children who need them as the result of their examination has been considerably reduced, though it is still not as good as one would desire. Further progress there must be made. Once again many cases of squint have been dealt with, both surgically at the Bromley Hospital, and also in co-operation with the Orthoptic Clinic. In conclusion, I should like to record my sincere thanks to the Health Visitors and to the clerical staff. They give wonderful help over all matters appertaining to the smooth running of thp Department." ORTHOPTIC CLINIC. 1,630 treatments have been given at this Clinic during 1950, as compared with 1,123 for 1949. The clinic is extremely busy and many more cases have been postponed where sufficient treatment had been given. The latter cases are taught exercises to do at home and a great deal of time is saved. The number of new cases is only five more than in the previous year. Owing to the care with which the squints are diagnosed no time is wasted in the clinic by seeing cases where orthoptic treatment is not worth a trial. It is very difficult to give the number of cures as the cases which have responded well to treatment. are postponed for increasing lengths of time so that any deterioration may be noted. Cases are therefore coming up for check-up only, for some years probably before being finally discharged. 95 EAR, NOSE AND THROAT DEFECTS. During the year 139 children were referred to the various hospitals for treatment No child was found to require treatment for serious diseases of the ear during 1950. I think it wise that I should restate the procedure adopted before a child is referred to the E.N.T. specialist. A child found with enlarged tonsils and adenoids without complications is merely kept under yearly observation. Those with additional evidence of complications are referred for special examinations at the school clinic, and if those complications persist in spite of treatment, they are referred to hospital for the advice of the specialist and the matter left entirely in his hands. Such a child will only be seen by us at the next periodic medical inspection. SPEECH CLINC. This Service is operated by the County Council and the following report on the working of the Bromley Clinic has been received from the Chief Speech Therapist, Miss J. Pollitt:— "The Clinic has been open for one session each week throughout the year. An analysis of the work carried out is shown below:— A. Number of cases in contact with the Clinic during the year: Cases closed 9 Cases carried forward to 1951 10 — 19 B. Number of cases on the Waiting List and carried forward to 1951 47 66 Reasons for closing the nine cases mentioned above:— (i) Improved so that no abnormality existed or condition became such that little residual defect remained 5 (ii) Treatment incomplete owing to patient leaving district — greatly improved — steps were taken to arrange for treatment to continue under the L.C.C. 1 *(iii) Nature of defect found to be such that other educational training or treatment was required 2 (iv) Left district following investigatory interviews, but prior to the commencement of treatment, which would otherwise have been arranged. 1 9 * One of these cases was admitted to a School for the Deaf. The other was passed on to a Child Guidance Clinic because the Therapist was of the opinion that she personally was unable to help the psychological problem involved. 96 Diagnosis relating to the nine closed cases mentioned above Stammer 1 Dyslalia—ranging from comparatively slight articulation defects to unintelligible speech 7 Dyslalia plus Dysphonia 1 9 During 1950 facilities have been given to the Therapist to help in assessing the intelligence of children. Such testing can be of inestimable value as a child's innate intellectual ability cannot be dissociated from his articulatory and linguistic ability at any given age. Work with young children is handicapped at the Bromley Clinic owing to the fact that the room used for Speech Therapy is unsuitable for some forms of treatment. For example, it has been found that where the defect in young children is related to psychological causes, treatment through play may produce results where direct work on speech proves of little value. The room used at the Bromley Clinic is ideal for work with adolescents and interviews with parents but unfortunately there is not enough floor space to make the introduction of sufficient play material for young children possible. If such an approach is to be used in treatment, it is desirable to have a room in which the child has scope to express himself freely without being constrained by the Therapist to avoid touching medical equipment belonging to other clinics. The Waiting List at Bromley constitutes a very serious problem. This problem cannot be relieved to any extent until more premises suitable for Speech Therapy are available, and more Speech Therapists are appointed. These two factors link together, as the introduction of one without the other would be useless." 26 new cases were referred during the year. EXCEPTIONAL AND HANDICAPPED CHILDREN. 74 attendances were made at the special clinic held at the Municipal Offices for exceptional and handicapped children. Details of handicapped children are shown in the Appendix. Each one of these examinations demands much patience and time of the medical officer and although the numbers appear small, the time necessary is great. This table does not include those cases reported for residential care as this return will be included in that for the County as a whole. 97 CHILD GUIDANCE. All cases requiring treatment at the Child Guidance Clinic are referred to the County School Medical Officer at Maidstone, as this service is the responsibility of the County Council and appointments to attend the Clinic at Chislehurst are made bv them direct . Twenty-seven cases were referred for treatment at this Clinic during 1950. Twenty-one including some of those referred in 1949 actually received treatment. MILK IN SCHOOLS. There is no change to report in the arrangements for the provision of milk during the year 1950. 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 88.22% SCHOOL MEALS SERVICE. The canteen buildings referred to in last year's report as being under construction were completed and taken into use in January. The new kitchen at Raglan Road Secondary and Primary Schools serves approximately 750 meals a day, and the new kitchen at Hayes Primary School caters for approximately 500 meals a day. Several schools are in urgent need of new kitchens and dining accommodation but, in view of the continued building restrictions, the only new provision that is likely to be made in the near future is the kitchen and dining room for 750 meals daily at Southborough Primary School, which is to be erected as part of the new school premises. At the close of the year work was in hand to improve the washing-up facilities in some of the old kitchens by the installation of sterilising sinks. The average number of meals being served each day has dropped and towards the end of the year was approximately 6,250. This reduction may be due to the fact that the charge for meals to children in Primary Schools was increased to 6d. a meal at the beginning of the year and the slight reduction given for weekly payments was abolished. A return sent to the Ministry of Education showed that on a single day in October 76.79% of the pupils in attendance at school received a mid-day meal. NURSERY SCHOOLS. There are no important changes to report during 1950. 98 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. 144 boys and 49 girls were examined by the School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in all but three cases. JUVENILE DELINQUENCY. During the year 64 children appeared before the Local Court The types of offences were as follows:— Larceny 40 Beyond control 2 Breach of supervision 2 Assault 2 Wilful damage 1 Driving vehicle under age and no Insurance 1 Being in moral danger 2 Road Traffic Act 14 Insulting words and behaviour 2 Offences under Bromley Bye-laws 6 Non-payment of Fine 1 73 BROMLEY SCHOOLS' BOOT CLUB. The work of the Bromley Schools' Boot Club progressed satisfactorily without any particular incident during the year ended 31st December. 1950. Number of members at end of year—820. £ s. d. Amount deposited 386 11 7 Purchases of footwear (Gross) 494 7 7 Purchases of footwear (Nett) 449 19 3 Discounts received 44 8 4 NECESSITOUS CASES. The number of children of school age supplied with clothing under Section 5 of the Education Act, 1948, was 56, involving a total cost of £179 4s. 1d. INFECTIOUS DISEASES IN SCHOOL. 78 cases of scarlet fever in school children were notified during the year, as against 23 for the previous year. Of this number 42 were home nursed cases and 36 were admitted to hospital. The infection continues to be of a mild type, and it is mainly due to this fact that the control of he infection is made more difficult as this tends to "missed" cases, which spread the infection. 99 There were no cases of diphtheria in children of school age notified during the year. Of the six cases of poliomyelitis notified, three were paralytic and three non-paralytic. 192 cases of measles were notified during 1950, which is high in comparision with the figure of 92 for the previous year. There were 42 cases of whooping cough in children of school age during the year, and eight cases of pneumonia were also notified. The year has been free of many notifiable infectious diseases proved to be due to attendance at school. It must however, be assumed that diseases such as chickenpox, mumps, measles and whooping cough are always liable to spread where there is any congregating of young children and the more there is overcrowding in classrooms, the more likely the danger of spread. PHYSICAL TRAINING. Report of the Physical Training Organisers:— "The first post-war period of new ideas for the broadening and freshening of schemes of work is coming to an end and teachers, applying the lessons of their recent experiments, have begun to establish a firmer programme of physical education, particularly in primary schools, in which physical education theories have been most critically examined in the past few years. Refresher Courses for Teachers.—The following statistics show that the teachers have been keen to keep abreast of the new ideas. Their good response to these courses, organised by the Physical Education Advisers, is indicative of their interest :— (a) One Day Course Primary Work.—Well attended by a group of head teachers, teachers, student-teachers and advisers. (b) Gymnastics for Secondary Girls.—Average attendance 15 specialist teachers. (c) Swimming ,all teachers. Elementary—average attendance 13 Advanced „ „ 22 Life Saving „ „ 19 (d) Tennis, Secondary School Teachers.—Average dance, 34 specialist teachers. (e) Modern Dance, all teachers.—Average attendance 28. 100 School Swimming. (a) Provision made:— For Secondary Schools — 47 classes a week. For Primary Schools — 27 classes a week. (b) Attendance:— In Secondary Classes — 1.410 per week. In Primary Classes — 810 per week. (c) Instruction:—Teaching of swimming was carried out by the members of school staffs and by four qualified instructors, two men and two women. (d) Transport:—The use of coaches was greatly appreciated by schools distant from the baths, since they reduced to a minimum the children's absence from the school building. Clothing for Physical Education.—It is pleasing to note that more children were sensibly "dressed for the job." The efforts of the parents to provide the proper clothing for the performance of gymnastics, games and dancing, together with the provision made by the Committee for Education, have enabled the majority of the children to work with increased efficiency and pride. Difficulty in provision by parents is often encountered where two to four children or more in one family are in attendance at various schools in the Borough. It is still necessary, however, to reiterate that the vigorous nature of modern work demands special clothing, for the sake of the child's hygiene, freedom of movement and safety. Climbing and Agility Apparatus in Primary Schools.—Children at five junior mixed and infant schools in the Borough demonstrated the use of climbing and agility apparatus to lecturers and students from Training Colleges, as well as to six H.M. Inspectors, and a large number of County Organisers and Teachers. The visitors were unanimous in agreeing that such apparatus should eventually be supplied to all schools. In 1950, the proposal to equip all primary schools in the Borough with the apparatus was restricted by the general reduction in expenditure. It is hoped that the scheme may be completed as soon as financial provision can be made. 101 Schools' Sports Association. (a) Athletics.—The Bromley Schools' Athletic Association has been suspended and its members have joined with Beckenham and Penge to form the West Kent Athletic Association. (b) Games.—The schools maintained the Leagues for Secondary Cricket, Secondary Soccer, Junior Cricket and Junior Soccer. Inter-school hockey matches were played on a freindly basis. It is hoped that swimming and tennis will soon provide further inter-school competition. Recreative Evening Classes and Outdoor Activities in connection with Youth Work have been a feature of the programme for the Your Service. Priority is given to all registered Youth Clubs in connection with the letting of Football Pitches, Tennis Courts, Netball Courts, and the use of facilities for indoor Physical Recreation. Conclusion.—A full education must include the deliberate training of the child's mental, emotional and physical abilities. It is pleasing to note that considerable progress is being made, and that a wide physical education programme, consisting of gymnastics, athletics, dancing, games and swimming now provides the child with many opportunities to develop a well co-ordinated, versatile and healthy body. We would like to acknowledge indebtedness to the Borough Education Officer and his staff for continued support, and to the Head and Assistant Teachers for their loyal co-operation." F. M. BENTLEY. J. LOUGHRAN. Advisers for Physical Education. ACKNOWLEDGMENT. I would, once again, express my appreciation of the cooperation which has been afforded by the Borough Education Officer and members of his staff. 103 SCHOOL HEALTH SERVICE. STATISTICAL TABLES. 1950. 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 during 1950. B. Classification of the General Condition of Pupils Inspected during the Year, in the Age Groups. TABLE III.—Group I. Diseases of the Skin. II. Eye Diseases, Defective Vision and Squint. III. Diseases and Defects of Ear, Nose and Throat. IV. Orthopædic and Postural Defects. V. Minor Ailments. TABLE IV.—Dental Inspection, Treatment and Orthodontics. TABLE V.—Infestation with Vermin. TABLE VI.—Orthoptic Clinic. TABLE VII.—Handicapped Children. TABLE VIII.—Independent Schools. 104 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. Number of Inspections in the Prescribed Groups: Entrants 851 Second Age Group 787 Third Age Group 854 Total 2,492 Number of Other Periodic Inspections 1,031* Grand Total 3,523 *Children aged 8 years. Children in their 13th year, at County Grammar and Technical Schools. B. Other Inspections. Number of Special Inspections 2,499 Number of Re-inspections 2,240 Total 4,739 C. Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspections to require treatment (excluding Dental Diseases and Infestation with Vermin):— Group For defective vision excluding squint) For any of the other conditions recorded in Table II.A. Total individual pupils Entrants 19 58 77 Second Age Group 24 40 64 Third Age Group 41 40 81 Total (prescribed groups) 84 138 222 Other Periodic Inspections 48 54 102 Grand Total 132 192 324 105 TABLE II. A. Return of Delects Found by Medical Inspection. Defect Code No. Defect or Disease Periodic Inspections. No. of Defects. Special Inspections. No of Defects. Requiring treatment Requiring to be kept under observation but not requiring treatment Requiring treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 4 12 197 10 5 Eyes- (a) Vision 132 135 118 33 (b) Squint 14 20 7 5 (c) Other 2 16 97 11 6 Ears— (a) Hearing 2 17 4 5 (b) Otitis Media 1 3 32 2 (c) Other 2 10 92 6 7 Nose or Throat 42 144 289 133 8 Speech 8 10 13 5 9 Cervical Glands 1 9 7 8 10 Heart and Circulation 1 31 22 26 11 Lungs 1 15 27 15 12 Developmental— (a) Hernia 3 1 5 3 (b) Other 17 90 51 16 13 Orthopaedic— 15 (a) Posture 26 70 29 (b) Flat Foot 48 248 62 41 (c) Other 25 64 189 35 14 Nervous System— 2 (a) Epilepsy — 1 — (b) Other 1 12 30 16 15 Psychological— 18 26 (a) Development 1 4 (b) Stability 1 5 15 3 16 Other 11 59 445 147 Totals 343 976 1,749 563 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 851 580 68.16 264 31.02 7 .82 Second Age Group 787 545 69.25 229 29.09 13 1.65 Third Age Group 854 591 69.20 257 30.09 6 .70 Other periodic inspections 1,031 692 67.12 313 30.36 26 2.52 Total 3,523 2,408 68.35 1,063 30.17 52 1.48 106 TABLE III. TREATMENT TABLES. Group I.—Diseases of the Skin. Number of cases treated or under treatment during the year:— By the Authority Otherwise. Ringworm (i) Scalp 4 No Information available. (ii) Body 7 No information available. Scabies 9 No information available. Other skin diseases 397 11 Impetigo 36 No information available. Total 453 11 Group II.—Eye Diseases, Defective Vision and Squint. Number of cases dealt with:— By the Authority Otherwise. External and other, excluding errors of refraction and squint 643 No information available. Errors of refraction (including squint 914* No information available. 1,557 Number of pupils for whom spectacles were:— (a) Prescribed 590* No information available. (b) Obtained 423* No information available. Total 1,013 *Including cases dealt with under arrangements with the Supplementary Ophthalmic Services. Group III.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated:— By the Authority. Otherwise. Received operative treatment: (a) for diseases of the ear — 1 (b) for adenoids and chronic tonsilitis - 146 (c) for other nose and throat conditions - 1 Received other forms of treatment 222 36 Total 222 184 107 Group IV.—Orthopædic and Postural Delects. (a) Number treated as in-patients in hospital No information available. By the Authority. Otherwise. (b) Number treated otherwise, e.g., in clinics or outpatient department 284 (new 683 (re-ins.) No information available. Group V.—Minor Ailments. Number of cases treated:— By the Authority. Otherwise. Miscellaneous minor ailments 2413 No information available. TABLE IV. Dental Inspection and Orthodontics. Treatment. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic Age Groups 172 2,468 (b) Specials 2,296 (2) Number found to require treatment 2,412 (3) Number referred for treatment — (4) Number actually treated 1,878 (5) Attendances made by pupils for treatment 5,114 (6) Half-days devoted to: Inspection 1 Treatment 624 (7) Fillings: Permanent Teeth 862 Temporary Teeth 422 (8) Number of teeth filled: Permanent Teeth 855 Temporary Teeth 422 (9) Extractions: Permanent Teeth 464 Temporary Teeth 2,491 (10) Administration of general anæsthetics for extraction 1,327 (11) Other Work:— Referred N20. Consultation 2,040 Anæsthetics (General) given by Dental Surgeons Orthodontics. Number of children referred for Orthodontics 72 Number of Orthodontic appliances ordered 76 Number of Orthodontic appliances fitted 61 Attendances for Orthodontic treatment 416 Scaling and Polishing 56 Dressings. Permanent Teeth 478 Temporary Teeth 706 Number of pupils referred for X-ray 46 108 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 18,535 (ii) Total number of individual pupils found to be infested 11 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) - *In addition 174 children showed minor evidence of uncleanliness. TABLE VI. Orthoptic Clinic. Number of cases under treatment during the year 170 Number of new cases 85 Number of treatments given 1630 Number of cases on occlusion during the year 5 Number of cases awaiting or undergoing operation at the end of the year 35 Number of cases found unsuitable 13 Number of cases failed to attend 17 Number of cures (with and without operation) 10 109 TABLE VII. Handicapped Pupils Requiring Education at Special Schools or Boarding in Boarding Homes. 1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 0. Physically Handicapped 7. Educationally Sub-normal 8 Maladjusted 9. Epileptic T O T AL 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) In the calendar year ending 31st Dec., 1950: A. Handicapped Pupils newly placed in Day Special Schools or Homes - - - 2 - - 5 - - 7 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or Boarding in Homes - 1 - 4 6 - - 3 - 14 Number of children reported during the year:— (a) under Section 57 (3) (excluding any returned under (b)) 3 (b) under Section 57 (3) relying on Section 57 (4) Nil. (c) under Section 57 (5) 3 of the Education Act, 1944. 1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Subnormal 8. Maladjusted 9. Epileptic T O T A L 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) On or about December 1st: C. Number of Handicapped Pupils from the area: (i) Attending Special Schools as: (a) Day Pupils — — — 2 - — 8 — — 10 (b) Boarding Pupils - - - - - - - - - - (ii) Boarding in Homes — — - — - — - — — — (iii) Attending Independent Schools under arrangements made by the Authority - - - - - - - - - - Total (C). - — — 2 - - 8 - - 10 110 TABLE VIII. Independent Schools. Total number of pupils examined (various age groups) 543 Nutrition Table: Classification "A" (good) 461 pupils or 84.9% Classification "B" (fair) 82 pupils or 15.1% Table of Defects found by Medical Inspection: Defect or Disease. Number of Requiring treatment. defects:— Requiring observation. Skin 5 — Eyes—Vision 52 3 —Squint 6 — —Other 4 1 Ears—Hearing 2 — —Otitis Media - 1 —Other 1 — Nose and Throat 32 32 Speech 2 4 Cervical Glands — 6 Heart and Circulation 2 4 Lungs 17 1 Developmental—Hernia — 1 —Other 2 — Orthopaedic—Posture 9 3 —Flat Feet 43 16 —Other 6 5 Nervous System—Epilepsy — 1 Psychological Development — 1 Other 2 — Totals 185 79 Number of pupils referred to Dentist 74