AC4412(1) BROMLEY BRO 47 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1951 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES Printed by Kentish Times Limited, 22, North Street, Bromley. Kent BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1951 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES 3 CONTENTS. PACE Members of the Health Committee 7 Staff 8 Prefatory Letter 9 Section A. Vital and other Statistics and Social Conditions of the Area. Vital Statistics 12 Population 13 Births 15 Illegitimate Births 15 Stillbirths 15 Deaths 16 Maternal Mortality 17 Infantile Mortality 17 Unemployment 18 Open Air Recreational Amenities 18 Meteorological Conditions 19 Section B. General Provision of Health Services for the Area. Nursing Homes 22 Hospitals 22 Ambulance Service 22 Home Nursing Service 22 Health Visiting 23 Domiciliary Midwifery 23 Day Nurseries 23 Domestic Help Service 23 Venereal Diseases 24 Laboratory Service 24 Public Mortuary 25 Medical Loan Depots 25 Clinics, Child Welfare Centres, etc. 25 National Assistance Act, 1948 26 Old People's Homes 27 Section C. Sanitary and Environmental Circumstances. Water Supply 32 Drainage and Sewerage 33 Cesspools 33 Rivers, Streams and Lakes 34 Swimming Baths and Pools 34 Public Cleansing, Refuse Collection and Disposal 34 Factories Acts, 1937 and 1948 34 Sanitary Inspection of the Area 35 Smoke Abatement 35 Shops Act, 1950 35 Petroleum Acts 36 Verminous Conditions and Uncleanliness 36 Rodent Control 36 Diseases of Animals Acts 37 Registries for Female Domestic Servants 37 Retail Market 37 4 Section D. Housing. page Rehousing 40 Housing Inspections and Abatements 41 Section E. Inspection and Supervision of Foods. Food and Drugs Act, 1938—Food Sampling 44 Bacteriological Examinations 46 Ice Cream 46 Special Enquiries 47 Unsound Food 47 Inspection of Food Premises 49 Milk Licences 49 Meat Inspection 49 Section F. Prevalence of, and Control over Infectious and other Diseases. Smallpox 52 Vaccination 52 Anterior Poliomyelitis 52 Scarlet Fever 53 Diphtheria 53 Diphtheria Immunisation 53 Typhoid Fever 54 Puerperal Pyrexia 54 Ophthalmia Neonatorum 54 Pemphigus Neonatorum 54 Measles 54 Whooping Cough 54 Tuberculosis 55 Mass X-Ray Survey 55 Food Poisoning 56 Other Infectious Diseases 56 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 59 „ II.—Causes of Death 60 „ III.—Infant Mortality 61 ,, IV.—Analysis of Causes of Infant Deaths 62 „ V.—Notifiable Infectious Diseases—Sex and Age Distribution 63 „ VI.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 64 ,, VII.—Notifiable Infectious Diseases—Seasonable incidence 65 ,, VIII.—Tuberculosis—New Cases and Mortality 66 „ IX.—Housing Statistics 67 X.—Summary of the Work of the Sanitary Inspectors 68 „ XI.—Factories Acts. 1937 and 1948 71 „ XII.—Nuisances, Defects and Contraventions Abated 73 5 SCHOOL HEALTH SERVICE, 1951. PAGE Members of Welfare Committee 78 Officers of the Committee 78 Staff 78 Introduction 79 General Information 84 School Hygiene 85 Medical Inspections at Schools 85 Special Examinations 86 Dental Service 86 Ophthalmic Clinic 87 Orthoptic Clinic 87 Ear, Nose and Throat Defects 87 Orthopaedic Clinic 88 Speech Clinic 89 Vermin and Uncleanliness Inspection 91 Exceptional and Handicapped Children 91 Child Guidance 92 Milk in Schools 92 Schools Meals Service 92 Nursery Schools 93 Employment of Children and Young Persons 93 Juvenile Delinquency 93 Bromley Schools' Boot Club 93 Necessitous Cases 93 Infectious Diseases in Schools 93 Physical Education 94 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 100 A. Periodic Medical Inspections 100 B. Other Inspections 100 C. Pupils found to require treatment 100 „ II.—A. Return of Defects found by Medical Inspection in the year 1951 101 B. Classification of the general condition of pupils inspected during the year, in age groups 101 ,, III.—Group I. Diseases of the Skin 102 Group II. Eye Diseases, Defective Vision and Squint 102 Group III. Diseases and Defects of Ear, Nose and Throat 102 Group IV. Orthopædic and Postural Defects 103 Group V. Minor Ailments 103 ,, IV.—Dental Inspection, Treatment and Orthodontics 103 ,, V.—Infestation with Vermin 104 ,, VI.—Orthoptic Clinic 104 ,, VII.—Handicapped Pupils 105 ,, VIII.—Independent Schools 106 7 MEMBERS OF THE HEALTH COMMITTEE Alderman M. Stafford Smith, B.A. (Miss) (Chairman). Alderman J. S. Marriott (Vice-Chairman). Councillors: J. C. Clayton. S. Lane. M. L. Dempster (Mrs.) G. H. Russell. L. L. Irwin, M.A., LL.B., J.P. A. A. J. Wells. STAFF OF THE PUBLIC HEALTH DEPARTMENT as at 31st December, 1951. "*" 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 (l, 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. HEM MINGS (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). Mrs. B. B. LAMPARD. Mrs. D. COX. Miss M. N. CROXSON. Mrs. M. J. COX. Mrs. W. J. FOOT. Miss E. W. LEPPER (11). Mrs. R, C, TYE. 8 Other Appointments: Assistant Rodent Officers: J. L. GOUGH and A. G. HODDER. 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' Association. 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. Madam Mayor. Ladies and Gentlemen, I have the duty, for the twenty-seventh consecutive year, to report to you on the work of the Department and on the health of the Borough during the year 1951. So far as the facts are before me, Bromley continues to show a state of good health, there having been no serious outbreaks of illness or infectious disease. The death rates continue to show improvement on those of England and Wales, while the birth rate is only one per 1,000 less. These facts are to be expected in a good residential area which is comparatively free from industries and where there is only a very small proportion of the adult population classified by the Registrar General in the lowest Social Grades IV and V. The infantile mortality rate made a sudden drop and reached the very low figure of 12 per 1,000 births. One awaits with interest the full returns of the Census taken in the early part of the year, when we shall be able to give the age distribution of the population. The fact is that the population of England and Wales is not only increasing in numbers and leading to housing problems and all the problems of health that overcrowding brings with it, but the population is also becoming top-heavy in the older age groups. It is therefore all the more important that we keep the Public Health Services at their maximum efficiency and maximum provision, and make prevention of disease a priority over the treatment of disease, which to-day is becoming an ever-increasing financial burden to the country. The time is overdue when attention should be given to the type of service that should be given, e.g., the Health Services to the mother and child, formulated some thirty years ago, are still operating to that pattern. It may be that part of the energy and time given to these services may well be transferred to the aged, and to the prevention and control of those illnesses that make for an unhappy old age. The progressive improvement in the handling and distribution of foodstuffs is the result of intensive action by the department over recent years. The trader in food is giving us full co-operation, without which the task would be doubly difficult. I am sure that, when the public themselves exercise care and protection of all foodstuffs in the home and in the cafes and foodshops, the danger of food poisoning will be largely eliminated. In spite of intensive activity of the housing authority, there still remain 3,400 homes with more than one family. Young married 10 couples are compelled to share a home, which does not make for social happiness and social health. High rents and high travelling costs, where the place of employment is not local, are other barriers to the development of Public Health. We can at least aim at Utopia. We continue to suffer the handicap that there is no truly local government in Health Services. As I reported in last year's Annual Report: "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." I thank the Committee for their continued support and their encouragement. I would also like to place on record the help I have received from Mr. Woods throughout his twenty-five years as Chief Sanitary Inspector. The staff have worked with enthusiasm and I am indebted to them for lightening my burden, and to Mr. Judd, the Chief Clerk, who has done so much in the compilation of this report. I am, Your obedient Servant, K. E. TAPPER, Medical Officer of Health. June, 1952. SECTION A VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA 12 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The area of the Borough is 6,519 acres. Registrar General's estimate of total population (mid-year), 1951 64,550 Figures as given in Preliminary Report of Registrar General on 1951 Census:— Population 64,178 Censal Increase, 1931/ 1951 16,480 Number of valuation assessments as at 31st March, 1951:— (a) Houses and Flats:— Not exceeding £10 Rateable Value 326 £11 to £13 Rateable Value 551 £14 to £20 Rateable Value 4,845 £21 to £30 Rateable Value 6,791 £31 to £40 Rateable Value 2,557 £41 to £50 Rateable Value 1,389 £51 to £75 Rateable Value 1,251 £76 to £100 Rateable Value 397 Exceeding £100 Rateable Value 338 18,445 (b) Commercial 1,369 (c) Licensed Premises 40 (d) Entertainment and Recreational 88 (e) Public Utility 27 (f) Educational and Cultural 27 (g) Industrial 54 (h) Miscellaneous 199 Total 20,249 Rateable Value at 31st March, 1951 £750,089 Estimated Rateable Value at 31st March ,1952 £769,910 Estimated Product of a Penny Rate for the year ending 31st March, 1952, is £3,070 Vital Statistics. Live Births. Total. Male. Female. Legitimate 895 444 451 Birth Rate 14.2 per 1.000 total population. Illegitimate 21 13 8 916 457 459 Stillbirths. Total. Male. Female. Legitimate 14 9 5 Stillbirth Rate 0.23 per 1,000 total population and 16.1 per 1,000 (live and still births). Illegitimate 1 1 15 10 5 Deaths. Total. Male. Female. 735 362 373 Death Rate 11.4 per 1.000 total population. 13 Deaths from Puerperal Causes. Puerperal Sepsis Nil Other Puerperal Causes Nil Deaths of Infants under I year of age. Total. Male. Female. Legitimate 11 7 4 Infant Mortality Rate 12.0 per 1,000 live births. Illegitimate — — — 11 7 4 Death Rates of Infants under 1 year of age. All Infants per 1,000 live births 12.0 Legitimate Infants per 1,000 live legitimate births 12.0 Illegitimate Infants per 1,000 live illegitimate births - Comparative statistics for the year 1951. Birth rate (per 1,000 population). Death Rate. (per 1,000 population) Infant mortality rate (per 1,000 live births). Live Births. Still Births. Bromley 14.2 0.23 11.4 12.0 England and Wales 15.5 0.36 12.5 29.6 (a) London Administrative County 17.8 0.37 13.1 26.4 (a) Per 1,000 related live births. POPULATION. The Registrar General's estimate of the total population (Civilian and Non-Civilian) of the Borough, mid-year 1951, is 64,550. This population figure gives a density of 9.9 persons to the acre. Natural Increase of Population. This is measured by the excess of births over deaths. The following table gives details of the annual increase for the past twenty years:— Year. Estimated Population. Natural Increase of Population. 1932 46,800 125 1933 48,270 126 1934 53,890 202 1935 56,200 225 1936 57,850 239 1937 58,700 188 1938 59,470 229 1939 60,000 281 1940 56,580 63 War years— evacuation period. 1941 50,430 Deaths exceeded births by 72 1942 50,480 317 1943 51,300 319 1944 49,730 179 1945 52,310 230 1946 60,540 553 1947 62,640 611 1948 63,360 435 1949 64,140 354 1950 64,610 174 1951 64,550 196 14 1951 Census—Preliminary Report. The preliminary report of the Registrar General on the Census of 1951 has now been published and shows the population of Bromley at mid-night on the 8th April, 1951, to be 64,178—an increase over the previous census in 1931 of 16,480, that is, 34.6%. Compared with the neighbouring authorities, the percentage increase shows 208.7% for Chislehurst and Sidcup (the fourth highest percentage), 145% for Orpington, 48.4% for Beckenham, and 171.9% for Bexley. This increase in North West Kent's population is largely due to the flow of population from London, especially from those areas which were badly blitzed during the second World War. The percentage increase in the various local authorities' areas is also affected by certain changes of boundaries which have occurred since the census in 1931. It is to be noted that the figures stated in the census are exclusive of those persons absent in the armed forces, mercantile marine and others outside the country on the night of Sunday, 8th April, 1951. The population of England and Wales is shown to be 43,744,924 persons, which gives the number of persons per square mile as 750— a density which is higher than any other country in the world. The population of England and Wales has increased by 3,792,547 —a percentage increase of 9.5 over the previous census. This increase is largely due to the excess of births over deaths since 1931 and accounts for 3,288,000. Females continue to exceed males by 1} million. In Bromley there are 29,076 males compared with 35,102 females, but age distribution and other statistical figures will be made available when the final census figures are published. The following information, which is based on a 1 per cent. sample, has also been extracted from the report:— Housing Conditions. Bromley Chislehurst & Sidcup. Orpington. Total households 20,500 24,100 18,500 Households sharing accommodation 3,400 2,000 1,300 Persons living more than 2 persons per room - 1.12% 1.33% Average number of persons per household 3.09 3.34 3.25 Average number of persons per room .66 .75 .70 Households living density— 1½—2 persons per room 700 700 300 1-1½ persons per room 2,000 2,700 1,400 Less than 1 17,800 20,600 16,700 Households without exclusive use of— water closet 2,100 1,700 1,000 fixed bath 5,100 3,600 2,700 stove and sink 1,700 1,300 900 15 Age Distribution. 1. Persons of over 65 years of age: Bromley 12% Chislehursl & Sidcup 9% Orpington 11% 2. Child population (0-15 years): Bromley 20% Chislehurst & Sidcup 23% Orpington 25% 3. Excess females over males (all ages): Bromley 6,000 Chislehurst & Sidcup 4,200 Orpington 4,500 4. Single females (all ages): Bromley 13,800 Chislehurst & Sidcup 19,100 Orpington 14,600 BIRTHS. The Birth Rate for 1951 is 14.2 per 1,000 total population, which compares favourably with the rate of 15.5 for England and Wales and 17.3 for the 126 large towns, including London. There were 916 live births registered during the year, of which 457 were males and 459 females. Comparative rates during the past ten years are as follow:— Year. Bromley. England and Wales. 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 1951 14.2 15.5 The average yearly Birth Rate during the past ten years was Bromley 16.9, England and Wales 17.2. Illegitimate Births. The illegitimate birth rate (per 1,000 live and still births) for 1951, is 23.6. Stillbirths. The total number of stillbirths allocated to the Borough during the year was 15, which gives a stillbirth rate of 16.1 per 1,000 live and stillbirths and a rate of 0.23 per 1,000 total population. 16 The following table 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 Bromley. 1,000 population. England and Wales 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 1951 15 16.1 0.23 0.36 DEATHS. The Death Rate for the year 1951, is 11.4 per 1,000 total population. Of the 735 deaths occurring, 362 were males and 373 females. Comparative death rates for the past ten years are given below:— Year. Bromley Rate England and Wales Rate 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 1951 11.4 12.5 An analysis of the ages at death show that 484 were 65 years and over. The main causes of death in Bromley, together with comparative rates per 1,000 population for the last five years are given below:— 1947 1948 1949 1950 1951 Cancer 1.9 1.8 2.2 1.9 1.98 Congenital Causes 0.2 0.2 0.1 0.12 0.09 Heart Disease 3.5 2.7 3.2 6.31 5.56 Infectious Diseases 0.03 0.01 0.05 0.015 0.062 Influenza 0.03 — 0.08 0.03 0.11 Respiratory Diseases (non-T.B.) 1.0 0.9 1.3 0.68 1.27 Tuberculosis 0.4 0.3 0.3 0.26 0.31 The following details relate to deaths from Cancer during the past ten years:— l7 Year. Number of Deaths. Rate per 1,000 population. Percentage of Total Deaths recorded for the year. 1942 113 2.2 19.5 1943 93 1.8 15.4 1944 122 2.4 18.5 1945 106 2.0 16.1 1946 109 1.8 16.6 1947 119 1.9 16.3 1948 114 1.8 18.1 1949 141 2.2 20.2 1950 122 1.9 16.5 1951 128 1.98 17.4 During the year 1951, there were 29 deaths from violence, including 6 suicides, 7 motor vehicle accidents, 15 other accidents, and 1 homicide. Maternal Mortality. There were no maternal deaths in the Borough during 1951. The causes and rates of maternal mortality for Bromley are shown in 5-yearly periods since 1911 in the following table:— 5-yearly period. 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 1951 — — — Infantile Mortality. Eleven infants died during 1951 before reaching their first birthday, giving an Infant Mortality Rate for the year of 12.0 per 1,000 live births. Eight died in first four weeks of life, seven of which were within the first week. The average Rate for the past ten years is 22.9. The Infant Mortality Rate for 1951 is the lowest ever recorded for the area. The Rate for England and Wales was 29.6 per 1,000 related live births, and 26.4 per 1,000 live births for London Administrative County. 18 UNEMPLOYMENT. The Manager of the Employment Exchange has kindly supplied the following information with regard to unemployment during 1951: "Employment prospects during the year were always good, and the Festival of Britain provided additional openings, with the result that during the summer our Unemployed Register reached its lowest figure for several years. The Building Industry in the area has been busy until the last weeks of the year, when the labour demands showed signs of falling off. Placings in this industry were greatly in excess of any other local industry. The Unemployed Register consists mainly of men of 50 years of age and upwards, disabled persons, and women who are registered for part-time work, for which there is very little local demand." OPEN-AIR RECREATIONAL AMENITIES. Commons, Public Recreation Grounds and Gardens. 603 acres of land have been secured or reserved for public recreational purposes within the Borough, representing 9.2 per cent. of the total acreage of the Borough. Acres. Roods. Poles Bromley Public Golf Course 56 1 8 Church House Grounds 12 3 20 Elmstead Wood 61 1 36 Golf Course Playing Fields 41 1 5 Hayes Common (including Pickhurst Green) 213 1 32 Hollydale Open Space 6 1 0 Husseywell Open Space 2 1 30 Keston Common 55 1 24 Kings Meadow Recreation Ground 9 1 0 Library Garden 1 2 0 Martins Hill Recreation Ground 12 0 29 Oakley Road Recreation Ground 2 0 0 Pickhurst Green Recreation Ground 12 2 14 Queens Garden Recreation Ground 2 1 4 Queens Mead Recreation Ground 10 3 15 Southborough Open Space 6 0 0 The Knoll Open Space 4 1 39 Turpington Open Space .. 1 3 10 Whitehall Recreation Ground 17 1 6 Widmore Open Space 3 1 28 Reserved:— 25 0 Hayes (Old) Rectory Grounds 2 0 Hillcrest Open Space 0 2 New Street Hill Open Space 11 2 8 0 Norman Park 56 0 603 1 13 19 METEOROLOGICAL OBSERVATIONS. 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 during 1951 34.19 inches Mean maximum daily temperature 57.2°F. Mean Minimum daily temperature 43.5°F. Highest maximum temperature 82.0°F. (on 28th July) Lowest minimum temperature 20.0°F. (on 30th January) Lowest Grass temperature recorded 23.0°F. (on 4th and 29th January) 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, 1951, there were five nursing homes registered with the Authority in accordance with Sections 187—194 of the Public Health Act, 1936. This is an increase of one over the previous year. Fourteen visits of inspection were made during the year, and there were no infringements of the Local Byelaws. Details of these homes are as under:— Address. No. of Beds. No. of new patients received during Nursing Staff. Qualified. Other. 1951. Surgical. Medical. S.R.N. S.E.A.N. R.M.P.A. 18, Blyth Road 23 — 28 4 2 — 3 17, Edward Road 12 — 29 2 1 1 2 24, Elmfield Road 10 — 1 1 2 — 1 67, Hayes Road 3 — 3 1 — — 1 47 and 51, Park Avenue 32 — 54 1 4 — 2 The majority of these beds continue to be occupied by the aged sick or aged infirm. Hospital Services. (a) Bromley Hospital, Cromwell Avenue. Provides a general hospital service with 159 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 Hospitals, Lennard Road (212 possible) beds, of which 98 are staffed and available for the isolation and treatment of infectious diseases. (c) Chest Clinic. Situate at the rear of the main hospital buildings and entrance obtained from Tiger Lane. All the above are under the control of the Bromley Group Hospital Management Committee, whose offices are at Farnborough Hospital, Farnborough, Kent. Ambulance Service. The Ambulance Depot is at Masons Hill, Bromley. There are, at the present time, seven ambulances and three sitting case cars available at this depot. Home Nursing Service. There are eight full-time Home Nurses operating in the Borough, plus one relief nurse. 23 Home Nursing is provided on medical certification only, and is free. A day service only is provided. Health Visiting. Seven Health Visitors are engaged on this work in the area. The appointment is a combined one of Health Visitor and School Nurse, fifty per cent. of their time being allocated to each service. In addition to their school work, they are responsible for the Maternity and Child Welfare Centres, Clinics in connection with Vaccination, Diphtheria Immunisation, etc., and carry out home visiting in connection with Child Life Protection, After Care, etc. Details of Welfare Centres, Clinics, etc., will be found later in this report. Midwifery (Domiciliary). The County Council is the supervising Authority under the National Health Service Act, 1946. There are four midwives engaged in domiciliary midwifery in the area. Their services are engaged direct by the patient, or through the patient's private doctor, and they act either as midwives or maternity nurses. Ante-natal clinics are held on every Monday and the 1st, 3rd and 5th Thursday afternoons in the month at the North Clinic, Station Road, Women's Welfare Clinic. This clinic is held on the second and fourth Thursday afternoon of each month, at the North Clinic, Station Road. Patients attending this clinic are referred on medical grounds and are seen by appointment only. Day Nurseries. At the end of the year there were two Day Nurseries provided by the County Council. Draycott Nursery has, however, been closed by the County Council as from the end of February, 1952. Elmfield Nursery has provision for forty children, and applications for admission of children to this nursery are made direct to the Matron. Domestic Help Servicc. Demands for this service continue to increase, especially for cases of illness in the home and for old people. Applications for this service should be made to the Area Supervisor at the Municipal Offices, Bromley. 24 The following is a summary of the cases assisted in Bromley area during the year 1951:— Types of Cases. Total Lying-in 96 Expectant Mothers:— Ambulant 9 Bedridden 3 Aged:— Ambulant 75 Bedridden 37 Tuberculosis:— Ambulant 10 Bedridden 3 Other Cases:— Ambulant 226 Bedridden 77 Total 536 Average number of Part-time Domestic Helpers 47 per week. Number of Full-time Domestic Helpers 3 per week. Venereal Diseases. No centre is provided within the Borough for the treatment of these diseases. Patients are referred either to one of the London Hospitals or one of the established centres in the County. Laboratory Service. There has been no change in this service during the past year. Routine medical and Food and Drugs samples are forwarded to the County Laboratory at Maidstone. In cases of an urgent nature specimens, etc., have been sent to the Laboratory at Bromley Hospital, and 1 would once again 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 161 Diphtheria 4 Faeces .. 13 Food Samples, etc 515 Water Samples 39 Miscellaneous 2 734 25 Public Mortuary. The premises are situate in South Street, at the rear of the Fire Station. The number of bodies taken to the mortuary during the year was 25, of which 24 were received from hospitals. Twelve post mortem examinations were made and inquests were held in 5 cases. Month. Bodies received from hospitals. Others. Post Mortem examinations Inquests. January 3 1 2 1 February 3 — 1 — March 2 — 2 — April 2 — — 2 May 1 — — 1 June 4 — 2 1 July 3 — 3 — August 2 — 1 — September 2 — — — October 1 — 1 — November — — — — December 1 — — — Totals 24 1 12 5 Medical Loan Depots. The British Red Cross Society have continued with their Medical Loan Depots during the year. A full range of nursing requisites is available at these depots. Application for loan of such equipment for Bromley residents should be made to either of the following depots: — 34a, Market Square, Bromley. 4, East Street. Bromley. LOCAL CLINIC SERVICES. Ante-Natal Clinics. North Clinic, Station Road Monday, and first, third and fifth Thursday in month., p.m. (New cases should attend Thursdays). Hayes School Clinic, George Lane Wednesday p.m. Women's Welfare Clinic North Clinic, Station Road Second and fourth Thursday 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 Monday and Thursday p.m. First Aid Post, Southlands Road Wednesday and Friday p.m. Village Hall, Hayes Tuesday . p.m. Village Hall, Keston . First and third Thursday in every month . p.m. St. Andrews Hall, Burnt Ash Lane Wednesday p.m, 26 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 Monday, Wednesday and Friday a.m. Medical Room, Burnt Ash School Monday to Thursday 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 and 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 Saturday (by appointment —once a month) a.m. Specialist Clinics. North Clinic, Station Road Monday, a.m. Ophthalmic. Wednesday, a.m. . . Ophthalmic. Friday, p.m. Ophthalmic. Friday, p.m., Orthopaedic. (Four sessions a month). Monday, p.m. Orthoptic. Tuesday, a.m & p.m. Orthoptic. Thursday, a.m. & p.m. Orthoptic. Friday, a.m. Orthoptic. South Ciinic, Princes Plain Monday, p.m. Speech Defects. Saturday, a.m. . . Lip Reading. Wednesday, p.m. Lip Reading. NATIONAL ASSISTANCE ACT, 1948. Section 47. This Section of the Act gives powers to the local authority to apply to a court of summary jurisdiction for an order for the compulsory removal of any person suffering from chronic disease, or who is aged, infirm or physically incapacitated, and who is living in insanitary conditions and unable to devote to himself and not receiving from other persons proper care and attention, to a suitable hospital or other place in, or within convenient distance of, the area of the local authority, and for his detention and maintenance therein. Before such application is made, however, the medical officer of health must be satisfied. 27 after thorough inquiry, that in the interests of any such person or for preventing injury to the health of, or serious nuisance to, other persons it is necessary to remove that person. Several possible cases were investigated during the year but in no instance was it necessary to apply to the court for an order for compulsory removal. Section 50. This section of the Act places a duty on the local authority to arrange for the burial or cremation of the body of any person who has died or been found dead in their area if it appears that no suitable arrangements for the disposal of the body have or are being made. Expenses incurred by the local authority may be recovered from the estate of the deceased person or from any person liable to maintain the deceased person immediately prior to his death. During the year the Council accepted responsibility for the burial of one person (Coroner's Order) at a net cost of £7 7s. Od. 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: — "Southwood Residential Club for elderly people has had a happy and successful year since the last report was submitted. The forty residents average age 77 plus, have kept remarkably well, considering all things, largely due to the comfort and warmth of the house and the excellent food. We are very fortunate in being able to grow such a large proportion of our vegetables, salads and fruits on our 5½ acres of garden, and this gives outdoor activity to those residents who feel so inclined. The home-grown fruit and vegetables assist us with the menus. During the year three residents were admitted to hospital, one to a nursing home and one to a W.V.S. Nursing Home, and were not fit enough to return. One was admitted to hospital for an operation and died there after complications had set in, and one resident died at the Club after a heart attack. In June the W.V.S. opened another Club at Sharnbrook, Bedford, where those residents who became too frail for ordinary life in residential clubs can go and receive more care and attention, a larger staff being employed. Three of our residents were transferred there. We were, therefore, able to accept two married couples, four men and three women for residence. 28 One or two have been away to a W.V.S. Nursing Home for short periods and returned. A new venture during the year has been the development of a handicrafts party, and residents are getting a great amount of pleasure from making soft toys, knitted and crocheted articles, cushions, etc., and a large rug was made for the lounge by a number of the residents. Really excellent results are being achieved, which is giving them all quite a thrill. The full-size billiards table is a source of much enjoyment, as is also the television set presented by a prominent Rotarian. A great number of friends have given their time and services in entertaining the old folk. The rising cost of living is a source of some concern to the Management Committee." "Merevale," Bickley Park Road. This Home is run by the North West Kent Housing Society, Ltd., and the Secretary reports, as follows:— "Merevale had another successful year, finishing, as it began, with 35 residents of an average age of 80 years, and made up of 26 ladies and 9 men, including one married couple. During the year two were transferred to other homes and four died, but all were replaced by applicants from our waiting list, which continues to be a long one. Of the residents, 16 were partly paid for by the Kent County Council, and two by the London County Council, the remainder being able to pay all our charges themselves. After maintaining our charges at £2 12s. 6d. per week since our opening in 1947, we were reluctantly forced to raise our charges in November to £3 0s. 0d. being the charge considered suitable by the Kent County Council." "Armstrong House," 1, Southlands Grove, Bromley. This Home is run by The Save Our Souls Society, and the following report for the year ended 31st December, 1951, has been received from the Assistant Secretary:— Capacity of Home 28 Weekly average numbers. 28 Admissions during 1951 10 Departures during 195111 Present residents: — Men . 16 Women 11 Average age of residents 77 years. General and Health. In our reports for the years 1949 and 1950 reference was made to the difficulty experienced in arranging for the admission of sick residents to hospital, and during 1951 this was again our most serious 29 problem. Undoubtedly the Medical Officer of Health for the Borough of Bromley is fully aware of the administrative gulf which exists between a Local Authority responsible for the welfare of old people and a Regional Hospital Board concerned with health. Old people still living in their own homes and those resident in communal Homes who become chronically sick may find themselves in an administrative "no man's land " between the two with neither side being able to fully cater for their needs. A partial solution from the Society's point of view appeared to be in the exchange of hospital patients, who had responded to treatment, with chronically sick from old people's Homes, but, unfortunately, more often than not those admitted from hospital have proved most unsuitable. In most cases no alternative choice was offered by the hospital, neither was it possible for the matron to interview the prospective resident before admission. Another difficulty is that a hospital sometimes expects the Home to re-admit the resident after a stay in hospital, in spite of the fact that the bed has been occupied by the ex-hospital patient. The Matron of Armstrong House has asked me to say that, without the co-operation and constant help of local doctors, the staff would not have been able to carry on during the winter months when at one time eight residents in the Home were seriously ill. As well as regular visits from doctors, arrangements were made for the residents to receive Out Patients Specialist treatment, X-Ray examinations and eye and dental treatment. Source of Supply. The majority of new residents have come as the result of exchanges with hospitals, but close liaison is maintained with the Welfare Officer of the Kent County Council, who is given first call on all vacancies arising. It is more and more difficult to find reasonably fit old people as opposed to those who need a fair amount of care and nursing attention. The overall demand for accommodation is still greatly in excess of the facilities available. Recreation, Entertainments and Welfare. With the residents becoming less and less mobile, home entertainments assume greater importance. Concerts and film shows are frequently given by local organisations and friends. Voluntary helpers visit the Home regularly to chat with and take an interest in the old people. A weekly allowance is given to every person with which to buy sweets, cigarettes or tobacco. Periodicals and magazines are provided in the Home. Religious Worship. Short informal services are held in the Home every Sunday evening. 30 Staff. Mrs. Grunberg is still in charge of the Home, assisted by Mrs. Van Hemelryck, Assistant Matron, and one other non-resident assistant and domestic staff. Finance. Total expenditure incurred in running the Home during the Society's financial year ended 29th September, 1951, amounted to £3,378 The weekly all-in cost for the year amounted to 53s. 1d. per head. There was a deficit on the year's working of £385. "Greenhill," 5, Oaklands Road, Bromley. This Home is run by the Brook Lane Medical Mission, and the Secretary reports:— "The number of residents is twenty-two. During the year, three residents have died, and one was transferred to another Home owing to increased infirmity. Four new cases have been admitted during 1951. During the summer months, when the residents were visiting relatives, it was possible to give brief holidays to fifteen old ladies who otherwise would not have been able to have any change. The Home is served by three regular staff, assisted by daily help." '"The Vane," Denbridge Road, and "Town Court" Wells Road, Bickley. 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, 1950 29 29 Admissions during 1951 30 14 Discharges during 1951 30 12 Residents on 31st December, 1951 29 31 "Dunoran," Park Farm Road. Bickley. This Home is run by the Bermondsey and Southwark Group Hospital Management Committee, and 1 am indebted to the Medical Superintendent of the Home for the following information. "The work of the Dunoran Home has continued much as usual during the past year. There are now 38 beds, 107 patients were admitted during the year, 58 discharged and 45 died. In addition to the permanent admissions, a number of patients on the chronic waiting list were admitted for periods of two or three weeks, giving relations a much needed rest and the patients a welcome change of environment. The Hospital Management Committee have built a verandah and balcony, thus enabling patients on both floors to be wheeled into the open on fine days." SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES 32 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 1951:— "No new source of public water supply has been instituted in the Council's area during 1951, and there have been no extensions of trunk mains, but short lengths of service mains have been laid within the Borough. The supply generally has been satisfactory as regards quantity. The higher level of the area is supplied from Shortlands well and by Thames-derived filtered water from Walton works; the lower level is supplied from West Wickham and Orpington wells with additional Thames-derived water during the summer months. All the Thames-derived water is chlorinated 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 analyses 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 the 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 results of analyses are not up to standard. A Table giving the average results of the chemical and bacteriological analyses of the various supplies to the area for 1951 is attached. 33 Average Results of Chemical and Bacteriological examination of the water supply to Bromley during the year 1951. Chemical. (Parts per million unless otherwise stated). Shortlands Well. West Wickham Well. Orpington Well. River Thames water filtered at Walton works. Number of samples 6 5 2 249 Ammoniacal Nitrogen 0.005 0.010 0.000 0.021 Albuminoid Nitrogen 0.022 0.022 0.016 0.088 Oxidised Nitrogen—Nitrate 5.1 6.1 8.5 4.5 Chlorides as Cl. 16.3 15.0 16.0 23.0 Oxygen abs. from Permanganate 3 hrs. at 80°F. 0.05 0.22 0.09 1.35 Turbidity in terms of Silica — — — 0.2 Colour m.m. brown 2ft. Tube Burgess's Tintometer 0 0 0 16 Hardness (Total) 295 268 292 258 Hardness (Non-carbonate) 77 32 52 63 pH Value 7.3 7.3 7.3 7.8 Phosphate as P.O. 111/4 — — — 0.33 Silic as Si. O2 Conductivity 17 450 15 425 13 475 13 450 Bacteriological Results. No. of samples. Plate count. (Av. per millilitre) Colonies counted on Agar. Bact. Percentage of samples coli. test. Average number Bact coli per 100 ml. 22°C (3 days) 37°C (20-24 hrs.). negative in 100 ml. Shortlands Well 256 7.8 0.1 100.0 Nil. West Wickham Well 246 — — 100.0 Nil. Orpington Well 249 108.7 9.7 99.6 .008 River Thames water filtered at Walton Works 255 - 22.7 99.6 .004 Drainage and Sewerage. Approximately half a mile of the South Eastern Main Intercepting sewer was reconstructed and enlarged during the year. 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 twenty-three individual cesspools were emptied by the Department. 34 Rivers, Streams and Lakes. There were no works of improvement carried out during the year. Thirty-six visits of inspection were made by the Sanitary Inspectors. Swimming Baths and Pools. The Corporation Open-air Swimming Bath was completely redecorated. Modifications were carried out to the filtration plant circulation mains and to the water storage facilities. An improved hot water supply was made available for the Refreshment Buffet. The Sanitary Inspectors made a total of 83 visits of inspection to Swimming Baths and Pools in the Borough and thirty-five samples of water were taken for examination. The results of these examinations were as follow:— Three samples taken from Corporation Swimming Bath—all satisfactory. Thirty-two samples taken from privately owned swimming baths and pools—twenty-four were found to be satisfactory and eight unsatisfactory. 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 content and pH value is checked by means of a Lovibond Comparator. Public Cleansing, Refuse Collection and Disposal. The Borough Engineer reports that an electrically operated paper baling press was installed to replace a hand operated press, and the presses transferred to a new building in closer proximity to the Destructor. Factories Acts, 1937 and 1948. A total of 348 inspections and re-inspections were made during the year and 41 nuisances and defects were found. There were 87 nuisances and defects remedied during 1951—this figure includes those which were outstanding from the previous year. In addition to the above, 33 inspections were made of out-workers premises, all of which were found to be satisfactory and no nuisances or defects were found. Tables X, XI and XII in the Appendix give statistical details of the inspections made by the Sanitary Inspectors, and nuisances, defects and contraventions found and abated. 35 Sanitary Inspection of the Area. Tables X, XI and XII give details of the 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 5,438 1,590 Infectious Diseases 180 — Food Premises 2,976 149 Factories, Outworkers, etc. 381 41 Sampling Visits 382 — Trade Premises (Various) 319 62 Rodent Control 9,395 873 Miscellaneous 971 64 Total 20,042 2,779 In addition to the above, there were 1,381 interviews with owners, agents, etc., on site and at the office, in connection with the above work. Notices issued : Preliminary: — Housing 721 Food Premises 91 Factories, etc. 47 Trade Premises 14 Rodent Control 567 Miscellaneous 83 1,523 Statutory: — Nil Total 1,523 Food Condemnation Certificates issued 1,713 SMOKE ABATEMENT. Seven inspections and re-inspections were made by the Inspectors. Two nuisances were found and at the end of the year two had been remedied. SHOPS ACT, 1950. One hundred and thirty-one visits were made and fifty-five defects and contraventions were found; forty-nine of these were remedied by the end of the year. 36 A talk was given to a Trading Association, by Mr. G. R. Woods, who dealt principally with the relevant sections of the Shops Act, 1950, with regard to Sunday Trading. In no case was statutory action necessary. PETROLEUM ACTS. Mr. G. R. Woods is the Inspector appointed under the above Acts. Ninety-three licences were issued to store Petroleum Spirit, Petroleum Mixtures and one for Carbide of Calcium. The total storage capacity licensed during the year was:— Bulk Storage 116,860 gallons. Can Storage 1,939 gallons. Carbide of Calcium 300 lbs. Can storage includes Petroleum Mixtures and Thinners. One hundred and seventy-three visits of inspection were made in connection with this work. Only three minor contraventions were found and these were remedied immediately. A number of the new flame-proof electrically operated pumps have been installed in lieu of the old pattern and the electrical wiring carried out in accordance with the Home Office Regulations. VERMINOUS CONDITIONS AND UNCLEANLINESS. Sixty-six visits to premises by Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. Fifteen nuisances were found during the year and 22 were abated (including those carried over from the previous year). RODENT CONTROL. The Rodent staff continued to do excellent work, which greatly encourages the co-operation between occupiers of private property and business premises. The sewers have received the necessary maintenance treatments in accordance with the requirements of the Ministry of Agriculture and Fisheries. A considerable amount of rat-proofing methods were suggested to and carried out by the persons concerned, especially those who were poultry keepers. 37 PREVENTION OF DAMAGE BY PESTS ACT, 1949. Type of Property. Local Authority. Dwelling Houses. Agricultural. All other (including Business and Industrial). Total 1. Total number of properties in Local Authority's District 27 18,617 29 1,775 20,448 2. Number of properties inspected by the Local Authority during 1951 as a result (a) of notification or (b) otherwise (a) 4 551 1 123 679 (b) 2 1,370 — 391 1,763 3. Number of properties (under 2) found to be infested by rats Major — — — 1 1 Minor 3 380 1 76 460 4. Number of properties (under 2) found to be seriously infested by mice 1 84 34 119 5. Number of infested properties (under 3 & 4) treated by the Local Authority 4 464 1 111 580 6. Number of notices served under Section 4: — (i) Treatment - - - (ii) Structural Works (i.e.) Proofing) — - - - — TOTALS 14 2,849 3 736 3,602 7. Number of cases in which default action was taken by Local Authority following issue of notice under Section 4 8. Legal Proceedings — — — — — 9. Number of "block" control schemes carried cut 76 Private Premises. 23 Business Premises. DISEASES OF ANIMALS ACTS. Mr. G. R. Woods, Chief Sanitary Inspector, is the authorised officer under these Acts for the Borough of Bromley. Forty-six inspections were made and one hundred and ten 38 views granted concerning the issue and countersigning of Licences. Sixty-two information letters were sent to animal keepers. From the 19th November, 1951, Bromley was included in a Foot and Mouth Disease (Controlled Areas) Special Order, and continued to be so at the end of the year. The disease was very prevalent on the Continent of Europe, and the Ministry thought it probable that infection was brought to Great Britain from that area. The control of movement of animals in regard to the many orders received during this period is naturally very exacting, and the excellent co-operation received from the Ministry concerned is much appreciated. Restrictions with regard to Poultry, etc., continued throughout the year and many orders and letters were received. Four reports of suspected Fowl Pest were received, and in one instance the disease was confirmed. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. It would appear that there is little work for Registry Offices within the area. Observation has been kept on shops displaying advertising boards. Unless these shops are registered with the Local Authority, the exhibition of advertisements for female domestic servants contravenes the Byelaws. RETAIL MARKET. 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 1951, amounted to £283 11s. 9d., which is an increase of £93 6s. 9d. on the corresponding figure for 1950, SECTION D HOUSING 40 SECTION D.—HOUSING. Rehousing. The problem of housing still remains acute, and at the 31st December, 1951, there were some 1,892 families on the waiting list of the Local Authority. The following statement shows the Council's post-war housing programme as at 1st January, 1952: — PERMANENT HOUSING: Completed and Occupied: — Units. Princes Plain Estate 50 Coppice Estate 532 London Road Flats 54 Bourne Way Flats 66 Tylney Road Flats (part) 30 Purchased Properties 32 Hayes Place Estate (part) 8 Under Construction:— London Road1 Flats (Extension) 12 Tylney Road Flats (Contract No. 2.) 24 Longfield Site 18 Hayes Place Estate (part) 148 Scheme prepared—Tenders to be invited in 1952:— Hayes Place Estate (part) 186 Schemes being prepared:— Blackbrook Lane 90 Hayes Place (Old People's dwellings) 29 Schemes to be prepared: — London Road (Park End/Highland Road) 50 (Estimated) Blyth Road 76 (Estimated) Nichol Lane 6 (Estimated) TEMPORARY HOUSING: Properties. Units. Occupied. Prefabricated Bungalows 325 325 325 Requisitioned Properties available for occupation 375 762 762 Halfway Houses and Hayes Camp 9 135 135 709 1,222 1,222 I am indebted to the Property Manager for the following details which relate to the year 1951 only:— 1. (a) No. of permanent houses occupied' during 1951:— Re-let 42 New Properties 94 236 (b) No. of families accommodated in permanent houses during 1951 236 (c) No, of persons accommodated in permanent houses during 1951 903 41 2. (a) No. of premises requisitioned during 1951 Nil (b) No. of premises de-requisitioned during 1951 . 8 3. No. of families on waiting list as at 31st December, 1951:— For permanent accommodation: Medical Category 14 General Category 1,719 O.A.P. 159 1,892 In addition to the above, 29 houses were erected by private enterprise during the year. Housing Inspections and Abatements. Statistical details of the work carried out by the Sanitary Inspectors during the year will be found in Tables X and XII in the appendix. The following extract summarises the work relating to housing: — Inspections. Reason for Inspection. On Complaint. Routine. Re- inspections. Total Inspections. Nuisances found For Nuisances 1,027 75 3,861 4,963 1,529 Overcrowding 107 81 12 200 6 Verminous Conditions 20 2 34 56 11 Dirty Conditions 9 3 13 25 4 Water Supply 8 3 12 23 5 Disinfestation 5 1 4 10 4 Noxious Accumulations 14 2 12 28 7 Other Accumulations 29 27 38 94 9 Miscellaneous 4 28 7 39 15 1,223 222 3,993 5,438 1,590 Nuisances and Defects Abated:— Drainage 392 Dampness 694 Water Supply 65 General Items 1,828 2,979 This figure includes defects outstanding from previous year and abated during 1951. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 44 SECTION E. INSPECTION AND SUPERVISION OF FOODS. During the year, this service continued to receive the special attention of the Department and is one of its main functions. The co-operation of the shopkeepers, restaurant owners, etc., and the personnel engaged in the preparation and handling of food has been all that could be desired. It was not necessary for the Council to take any formal action under the Byelaws adopted under Section 15 of the Food and Drugs Act, 1938. FOOD AND DRUGS ACT, 1938—FOOD SAMPLING. Article. Samples taken. Result. Remarks. Formal. Informal. Genuine. Adulterated. Apples — 1 — 1 See (a) Baking Powder — 1 1 — Batter Flour — 1 1 — Biscuit Batter Flour — 1 1 — Blanc Mange Powder — 1 1 — Bone & Vegetable Broth — l 1 — Bread Crumbs — 1 1 — Breakfast Fry (Sausage) — 1 1 — Cake — 1 1 — Cake (Fruit) — 1 — 1 See (b) Caraway Seeds — 1 1 — Cordial — 2 2 — Corn Flour — 1 1 — Cream (Synthetic) — 2 2 — Culinary Oil — 1 2 — Custard Powder — 2 2 — Double Cream — 1 2 — Dressed Crab — 1 1 — Dripping — 2 2 — Dutch White Fondant — 1 1 — Farinoca — 1 1 - Farola — 1 1 — Fish Cakes — 1 1 — Frescof — 1 1 — Gelatine — 1 1 — Glace Cherries — 1 1 — Ground Rice 1 — 1 — Honey — 1 1 — Horseradish with Vitacream — 1 l — Ice Cream (Loose ) — 16 16 — Ice Cream (Pre-packed) — 43 43 — Ice Cream (Choc. Pre-packed) — 8 8 — Ice Lolly — 1 1 — Icing Sugar 1 — 1 — Jelly — 2 2 — Lemon Juice — 1 1 — Lemonade Crystals — 1 1 — Liquid Fruit Pectin — 1 1 - Milk (Pasteurised) 1 12 13 — 45 Article. Samples taken Result Remarks. Formal. Informal. Genuine. Adulleraled. Milk. (Sterilised) 2 2 Milk (Tuberculin Tested) — 1 1 — Milk Whipping Compound.. — 1 1 — Milk Chocolate Beads (Cake Decoration) 1 1 Mincemeat 1 2 2 1 Sec (c) Olive Oil — 1 1 - Pea Flour — . 1 1 - Pepper — 4 4 - Pepper Flavoured Compound — 1 1 - Popcorns — 1 1 - Pudding (Xmas) — 1 1 - Ratafia Flavouring — 1 1 - Readicake 1(d) 1(e) - 2 See (d) & (C) Salad Cream — 1 1 — Salmcm Spread — 1 1 — Sardines in Edible Oil — 1 1 — Sausage Meat 1 9 9 1 See (f) Sausages 2 6 7 1 See (g) Scotch Shortbread Mixture — 1 1 — Silds in Tomato Sauce — 1 1 — Soup (Baby—Meat & Veg.) — 1 1 — Soup (Chicken Noodle) — 1 1 — Suet — 1 1 — Thirst Quenchers — 1 1 — Vegetable Salad — 1 1 — Vinegar (Malt) — 1 1 — Vitacream 2 2 1 3 See (h) Wheaticrunch — 1 1 — Totals 10 164 164 10 (a) Arsenic content slightly above the accepted limit of 1/100 grain per lb., viz.: 1/70 grain ner lb. (b) Currants, Sultanas, Sugar and Fat. Fat rather rancid: Oleic acid 4.6% on fat. Inferior. (c) Not mincemeat or a substitute for it but only dried fruit (Currants, Sultanas and Sugar). (d) Of ingredients mentioned, Arrowroot and Dried Egg not detected. Milk Powder and Baking Powder present in small amounts, if any. (e) Arrowroot not detected. Carbon dioxide only 0.05%, Fat 10.2°/,, Sugar 29.6%, Labelling generally unsatisfactory. (f) Meat 56%, sulphite 38 p.p.m. Deficient 13.8% minimum amount of meat. (g) Meat 47%. (h) (i) Fat 38.4%. Total solids 43.05%. Does not contain egg yolk, (ii) Fat 30.3%. Sugar (as Sucrose), 1.6%. Other non-fatty solids including sodium alginate 1.9%. The sample contained no detectable amount of egg yolk (or of egg white), and the label describing the ingredients as edible fat, egg yolk sodium alginate and sugar is therefore false. (iii) Fat 32.5%. Total solids 34.7%. Sugar 1.5%. Egg yolk none. 46 BACTERIOLOGICAL EXAMINATIONS. Milk. No. of Samples taken. Description. Satisfactory. Unsatisfactory. 139x Designated Milk 129 9 6 Ordinary Milk 6 — 3 Undesignated Milk 2 1 7 Sterilised Milk 7 — 1 Washed Bottle 1 — 156 145 10 x.—One bottle broken in transit. ICE CREAM. The Ice Cream (Heat Treatment) Regulations came into operation on 1st May, 1947. There are 151 premises registered to sell ice cream and 5 of these premises are registered to manufacture ice cream in this district. There was a very marked improvement in the bacteriological quality of ice cream sold in this district during 1951. It would appear that the ice cream manufacturers are complying in a very marked degree with the Regulations and are thereby producing a safe article of food. The undermentioned figures indicate the real improvement in the quality of ice cream sold last year, as compared with the year 1947. Grade. No. of Samples. 1947. % No. of Samples. 1951. % I 13 17.8 110 84.0 11 18 24.6 11 8.4 III 17 23.3 8 6.1 IV 25 34.3 2 1.5 73 100.0 131 100.0 Fifty-seven samples were submitted for chemical examination, the lowest fat content was 6.5 per cent. and the highest 19.5 per cent. In addition, seven Chocolate Ice Cream samples were submitted for examination, the lowest fat content being 10.8 per cent. and the highest 23.7 per cent. 47 SPECIAL ENQURIES (a) Bacteriological investigation into complaints. Forty-three samples were taken of the following foodstuffs:— Apples Ham Baking Powder Icing Sugar Blackberries Jelly Blanc Mange Luncheon Loaf Bone & Vegetable Broth. Luncheon Meat Cake Meat Pie Chocolate Milk Coconut Ice Pork Currants Raspberries Duck Salmon Spread Flour Sherry Galantine Sweetened Fat Gelatine Tomato Paste Ground Rice Whacon of these 13 were inferior or unsatisfactory, 23 were genuine or satisfactory, 7 were adulterated. (b) Bacteriological investigations inade on routine inspections. Fifteen samples were taken of the following foodstuffs:— Ham Dripping Pigs Foot Flour Beef Sausages Meat Water Sherry Bread Vitacream of these 13 were genuine, two gave some evidence of bacteriological contamination. UNSOUND FOOD. The amount of unsound food condemned during the year again showed an increase. One thousand seven hundred and thirteen Food Condemnation certificates were issued, affecting in quantity 21 tons 2 cwt. 2 qtrs. 9 lbs. of varied articles of food, which was utilised either for manufacturing purposes, animal food, or where this was impracticable, destroyed. Ihe corresponding figures for the year 1950 were 1,393 certificates, and 20 tons, 2 cwts. 4 qtrs. 1 lb. of food Article of Food. Approximate Weight (lbs.) Animal Food 2346 Biscuits 238½ Blanc Mange Powder 42 Butter and Margarine 11½ Cake and Cake Mixtures 54¾ Cereals I15¼ Cheese 24¼ 48 Article of Food. Approximate Weight (lbs.). Coffee 3½ Cooking Fals 55 Cordials 22 Custard Powder 14 Cocoa ½ Eggs (Dried) 4 Fish (Fresh) 957 Fish (Canned) 169¾ Fish and Meat Pastes 16 Flour and Flour Mixtures 60½ Fruit (Canned) 2,091½ Fruit (Crystalised) 1½ Fruit (Dried) 269½ Fruit (Fresh) 54 Fruit Juice 44 Jams and Syrups 607¼ Meat (Fresh) and Bacon 17,262 Meat (Canned) 11,923¾ Meat (Cooked) 2,0741¼ Meat Pies 591 Milk (Canned) 1,223 Milk (Powder) 62 Milk Whipping Compound 11¼ Mincemeat 1 Pickles and Sauces 49½ Poultry (Fresh) 1,061 Poultry (Tinned) 26 Puddings and Pudding Mixtures 124 Rabbits 3,907 Rabbits (Canned) 18 Salad Dressings 3 Soups 145¼ Sugar 308 Sweets 214½ Tea 116½ Vegetables 919 Vinegar 10 Miscellaneous 76¼ 47,329 TINNED HAM. A great deal of belated publicity was given to the question of Imported Canned Hams, many of which were found unfit for consumption. The contents of the cans were found decomposed, mainly due to faulty canning and damaged containers due to bad packing and handling in course of transit and storage. If the large amount rejected by the Department during the year is representative throughout the country, there has been a colossal waste of animal feeding stuffs and carcases in the countries of origin, a waste of transport, and, more important, risk of food upsets if the ham had been consumed. It would be of interest to know the total tonnage and monetary value involved by taking the country as a whole. 49 In Bromley, 621 cans, representing 6,288 lbs. of ham, were condemned during the year 1951. FOOD PREPARING PLACES. There are approximately 258 premises within the area issued with a catering licence by the Ministry of Food, this figure includes school and industrial canteens, hospitals, nursing homes, nurseries and institutions, hotels and public restaurants, etc. INSPECTION OF FOOD PREMISES. Two thousand nine hundred and seventy-six visits of inspection were made to Food Premises during the year and 149 defects were noted. Two hundred and twenty defects were abated during 1951 ; this figure includes those noted in 1950 which were remedied in 1951. FOOD AND DRUGS ACTS, 1938 AND 1944. Milk and Dairies Regulations, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The following licences were issued by the Local Authority under the above Regulations: — Dealers' (Pasteurisers') Licence 1 Dealers' Licences: — "Pasteurised" Milk 15 "Sterilised" Milk 15 "Tuberculin Tested" Milk 15 Supplementary Licences: — "Pasteurised" Milk 18 "Sterilised" Milk .. 15 "Tuberculin Tested" Milk 13 MEAT INSPECTION. Slaughterhouses. There are five slaughterhouses still in existence within 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 five slaughtermen under the provisions of the Slaughter of Animals Act, 1933. The following table gives details of the ante- and post-mortem inspection of animals made during 1951: — 50 Carcases Inspected and Condemned. Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed — — - - 10 Number Inspected — — — — 10 All diseases except tuberculosis: Whole carcases condemned - - - - - Carcases of which some part or organ was condemned -- - - - 2 Percentage of the number inspected affected with disease other than tuberculosis - - - - 20% Tuberculosis only : Whole carcases condemned - - - - - Carcases of which some part or organ was condemned - - - - - Percentage of the number inspected affected with tuberculosis — — - — — SECTION F. I PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 52 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Statistical details of notifiable infectious diseases are shown in Tables V, VI and VII in the Appendix. There were no epidemics of a serious nature during the year 1951. Two thousand and eighty-seven cases of infectious diseases were notified. SMALLPOX No cases occurred in the area during 1951. Thirty-five visits were made to people living in the area who had recently returned from other countries and who were possible contacts. These contacts are visited daily foe a period of amk days from date of contact. Owing to rapidity of modern travel facilities, smallpox will remain a potential danger. It has therefore been the policy to have in readiness an operative scheme for the dealing with any outbreak, and to keep the staff in a state of protection by vaccination every year. VACCINATION. The County Medical Officer has furnished the following figures showing the number of persons who were vaccinated against smallpox during the year 1951. Age at 31st December, 1951. Under 1. 1 to 4. 5 to 14. 15 or over. Total. Number vaccinated 366 293 77 98 834 Number Rc-vaccinated — 13 75 364 452 ACUTE ANTERIOR POLIOMYELITIS. Three notifications of this disease were received during the year 1951. The cases were all removed to hospital. All were non-paralytic. Months during which the cases were notified: — July .. 1 September 1 October 1 There were no deaths. 53 SCARLET FEVER. Forty-seven cases of Scarlet Fever were notified during the year, giving an attack rate of 0.76 per 1,000 population. Twenty-five of these cases were home nursed, and twenty-two cases were removed to hospital. The infection continued to be mild in character, and the figure for the year 1951 showed a considerable decrease compared with the previous year's figure of one hundred and fifteen. There was one " return " case. There were no deaths from this disease recorded in the area. DIPHTHERIA. There were no cases of this disease notified during the year. The following tabulation, covering sixty years in five-yearly periods, gives for comparison the number of cases, deaths and mortality percentage: — Years. No. of Cases. No. of Deaths. Mortality Percentage 1891-1895 94 39 41.5% 1896-1900 139 21 15.1% 1901-1905 170 21 12.4% 1906-1910 262 20 7.6% 1911-1915 347 21 6.0% 1916-1920 354 21 5.9% 1921-1925 149 4 2.7% 1926-1930 249 9 3.6% 1931-1935 190 10 5.3% 1936-1940 116 6 5.1% 1941-1945 67 4 6.0% 1946-1950 18 1 5.5% A brief study of these figures shows clearly the rapid decrease in incidence of this disease since 1940. I have reported in previous annual reports the reason for the trend of this, at one time, very serious disease of childhood. DIPHTHERIA IMMUNISATION. During the year 1951, a total of 956 children received Primary Inoculations and 1,076 Reinforcing Inoculations. (Figures for 1950 were 544 Primary and 499 Reinforcing Inoculations). A total of 9,893 children under the age of fifteen years on 31st December, 1951, had completed a course of immunisation (i.e., at any lime since 1st January, 1937), 54 TYPHOID FEVER. One case was notified, and was home nursed. This was an isolated case and no secondary cases occurred. PUERPERAL PYREXIA. Fifty-one cases, all of which were institutionally treated, were notified during 1951. This represents an attack rate of 54.8 per 1,000 total births. There was no mortality from this disease. OPHTHALMIA NEONATORUM. No cases were notified during the year 1951. PEMPHIGUS NEONATORUM. No cases were notified during the year 1951. MEASLES. One thousand three hundred and eighty-one cases were notified in the Borough during 1951, as against three hundred and sixty-eight for 1950, giving an attack rate of 21.4 per 1,000 population. Twelve of these cases were admitted to hospital and the remainder were home nursed. The majority of these cases were notified during the first six months of the year, with February (490) and March (504) being the peak periods. The distribution of the cases occurring was fairly even throughout the area. Although there was one death from this disease, the type of disease remains mild in character. The tendency for the disease is to fluctuate in two-yearly or five-yearly periods, both in severity and in prevalence. It may become advisable to attach an infectious disease nurse to the Department, to give home advice on nursing of acute cases kept at home should the disease show evidence of acuteness. WHOOPING COUGH. Four hundred and forty-four cases were notified during 1951, as against one hundred and thirteen cases for 1950, giving an attack rate of 6.9 per 1,000 population. Thirteen of these cases were removed to hospital and the remainder were home nursed, 55 TUBERCULOSIS. Recordings in the Register for the year ended 31st December, 1951, are as under: — Respiratory. Other Forms. Total No. of Cases. M. F. M. F. On Register at 1.1.51 357 299 51 57 764 New cases notified during 1951 32 31 3 1 67 Number of cases coming to knowledge after death 2 2 4 Restored to Register 1 — — — 1 Inward Transfers 11 9 1 1 22 403 341 55 59 858 Deletions—deaths, removals, recoveries etc. 30 22 5 2 59 No. of cases on Register at 31.12.51 373 319 50 57 799 Full details of the new cases and mortality during the year are shown in Table VIII of the Appendix. The number of new cases notified during the year showed a decrease of one over the corresponding figure for 1950. There were fifty-nine deletions from the Register as against thirty-two for the year 1950. MASS X-RAY SURVEY. A South East London Mass X-Ray Unit visited the Borough from 4th luly to 30th July, 1951, when a total of 6,970 people attended the unit. Two hundred and eighteen people were recalled for large films, of whom 185 showed abnormality. The following is an analysis of 174 of these cases: — Probably significant new cases of Pulmonary Tuberculosis 46 Probably significant Non-Tuberculosis 8 Previously known Tuberculosis cases 13 Cardiac vascular disease 30 Abnormalities requiring no action .. 77 The age groups affected in the 46 cases are as under: — 14/16 5 17/24 5 25/34 14 35/44 11 45/59 9 6o and over. 2 56 If this sample of population, approximately ten per cent, of the total population, is a true picture of the whole, it may well be said that there are at present in the population some 428 persons with undiagnosed tuberculosis in various stages of development. It is known that the average yearly number of new cases notified is 78. As this statistical conclusion may give rise to some alarm, it should not be overlooked that there exists in the population a natural immunity to tuberculosis which prevents the infection developing into a crippling disease or reaching a state needing notification. All the General Practitioners in the area were notified of this possible reservoir of infection. The work of the Mass X-Ray is, in truth, a preventive service, as it enables early diagnosis, and early treatment and protection to be inaugurated, and so preventing the disease becoming a crippling illness. It is economical in that occupation of hospital beds is limited, and the patient, with successful treatment in the early stages, is able to become a productive unit. More frequent surveys are desirable and will be welcomed. FOOD POISONING. One case of Food Poisoning was notified during the second quarter of the year 1951. This was an isolated case and the agent was not identified. OTHER INFECTIOUS DISEASES. In addition to the infectious diseases enumerated above, notifications were received as under: — Dysentery 6 Erysipelas. 7 Pneumonia (all forms) . 52 APPENDIX. STATISTICAL TABLES. 58 STATISTICAL TABLES, 1951. 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.—Notifiable Infectious Diseases—Seasonable incidence. TABLE VIII.—Tuberculosis—New Cases and Mortality. TABLE IX.—Housing Statistics. TABLE X.—Summary of the work of the Sanitary Inspectors. TABLE XL—Factories Acts, 1937 and 1948. TABLE XII.—Nuisances, Defects and Contraventions Abated. 59 TABLE 1. Summary of Statistics, 1951. Population (mid-year 1951, per Registrar General) 64,550 Birth Rate 14.2 Death Rate 11.4 Maternal Mortality Rate Nil Infant Mortality Rate 12.0 Number of Births (live) 916 Number of Stillbirths 15 Number of Deaths 735 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 11 Death Rate of Respiratory Diseases 1.27 „ „ „ Tuberculosis 0.31 „ „ „ Cancer 1.98 „ „ „ Zymotic Diseases 0.062 Notifications of Infectious Diseases: Scarlet Fever 47 Diphtheria Nil Poliomyelitis 3 Typhoid Fever 1 Puerperal Pyrexia 51 Pneumonia (all forms) 52 Tuberculosis (new cases) 84 Number of Deaths from Infectious Diseases 4 „ „ „ „ Diarrhoea (under 2 years) Nil „ Child Birth Nil Number of Visits by Sanitary Inspectors ,, ,, ,, 20,273 60 TABLE II. Causes of Death, 1951. Male. Female Total 1. Tuberculosis, respiratory 13 5 18 2. Tuberculosis, other 2 — 2 3. Syphilitic Disease 6 — 6 4. Diphtheria — — — 5. Whooping Cough — — — 6. Meningococcal infections — - — 7. Acute Poliomyelitis — 8. Measles — 1 1 9. Other infective and parasitic disease- 3 — 3 10. Malignant neoplasm, stomach 11 10 21 11. Malignant neoplasm, lung, bronchus . 19 3 22 12. Malignant neoplasm, breast — 12 12 13. Malignant neoplasm, uterus — 8 8 14. Other malignant and lymphatic neoplasms 32 33 65 15. Leuksemia, aleukaemia 1 1 2 16. Diabetes 3 3 6 17. Vascular lesions of nervous system 30 54 84 18. Coronary disease, angina 47 33 80 19. Hypertension with heart disease 17 21 38 20. Other heart disease 47 86 133 21. Other circulatory disease 11 13 24 22. Influenza 5 2 7 23. Pneumonia 16 15 31 24. Bronchitis 27 13 40 25. Other diseases of respiratory system 8 3 11 26. Ulcer of stomach and duodenum 8 5 13 27. Gastritis, enteritis and diarrhoea 1 1 2 28. Nephritis and nephrosis 2 2 4 29. Hyperplasia of prostate 8 — 8 30. Pregnancy, childbirth, abortion — — — 31. Congenital malformations 3 3 6 32. Other defined and ill-defined diseases 26 33 59 33. Motor vehicle accidents 4 3 7 34. All other accidents 7 8 15 35. Suicide 4 2 6 36. Homicide and operations of war 1 — 1 All causes 362 373 735 61 TABLE III. INFANT MORTALITY, 1951. (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. Atelectasis 1 .. .. .. 1 .. .. .. .. 1 Malformation 1 .. .. .. 1 .. .. .. .. 1 Prematurity 3 .. .. .. 3 .. .. .. .. 3 Broncho-pneumonia 1 .. .. .. 1 .. 1 .. .. 2 Other Causes 1 .. 1 .. 2 .. 1 .. .. 4 Totals 7 .. 1 .. 8 .. 2 .. .. 11 62 TABLE IV. Analysis of Causes of Infant Deaths, 1946—1951. 1946 1947 1948 1949 1950 1951 Total No. of Births (live) .. 1,176 1,304 1,042 1,030 892 916 6,360 Infant Mortality Rate (per 1,000 live births) 26.3 19.11 20.15 15.5 21.3 12.0 19.3 Malformation 3 13 — — — 1 17 Prematurity 14 5 6 3 5 3 36 Respiratory Diseases 4 5 2 1 4 2 18 Marasmus and General Debility — — — — — — — Infectious Diseases 1 — 3 — 1 5 Gastro Enteritis — — 1 1 — — 2 Convulsions - - - - - - - Atelectasis — — — 1 1 1 3 Congenital Heart Disease — — — 3 4 — 7 Other Causes 9 2 12 4 5 3 35 Totals 31 25 21 16 19 11 123 63 TABLE V. NOTIFIABLE INFECTIOUS DISEASES, 1951. 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 24 23 — — 1 1 3 2 17 17 — — 2 1 1 2 - - Whooping Cough 185 259 17 6 39 61 50 97 77 79 — — — 3 — 11 2 2 Poliomyelitis - - - - - - - - - - - - - - - - - - Poliomyelitis (Non-Paralytic 2 1 - - - - - - 1 - - - - 1 1 - - - Measles 665 716 13 14 109 113 180 204 331 345 6 17 12 4 5 10 9 9 Diphtheria — - — — — — — — — — — — - - — — — — 876 999 30 20 149 175 233 303 426 441 6 17 14 9 7 23 11 11 Under 5 5—14 15—44 45—64 65 and over. Age unknown M. M. F. M F M. F. M. F. M F. 24 28 4 2 3 3 5 7 7 3 5 - - . Dysentery 3 3 - 3 2 - 1 - - - - - - - Erysipelas 1 6 - - - - - - - 4 1 2 - - Cerebro Spinal Feve - - - - - - - - - - - - - - Puerperal Pyrexia — 51 - - - - - 51 - - - - - - Typhoid and ParaTyphoid Fever 1 - - - - - - - - - - - - Food Poisoning 1 - - - - - - - 1 - - - - - Ophthalmia Neonatorun - - - - - - - - - -- - - - - Tuberculosis (Pulm.) 46 42 1 - 4 4 29 30 10 7 2 1 - - Tuberculosis (NonPulmonary) 4 2 - - - - 3 2 1 - - - - - 80 132 5 5 9 7 39 90 19 14 8 15 — 1 956 1131 64 TABLE VI. NOTIFIABLE DISEASES, 1951. 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 1000 population Plaistow Martin's Hill Town Sund ridge Bickley Bromley Common Keston and Hayes Scarlet Fever 47 3 3 5 10 5 10 11 22 0.76 - - Whooping Cough 444 38 64 17 43 47 127 108 13 6.9 - - Acute Poliomyelitis (Paralytic) — - - — - - - — - - - - ,. ,, (Non-Paralytic) 3 1 1 - — - - 1 3 0.05 - - Measles 1381 153 129 93 115 158 458 275 12 21.4 1 0.015 Diphtheria — - - - - - - - - - - - Acute Pneumonia 52 5 7 6 6 7 12 10 17 0.81 *31 0.48 Dysentery 6 I — 1 — 1 2 1 2 0.09 — - Erysipelas 7 3 — 1 — — 3 — 3 0.18 - - Cerebral Spinal Fever — — — — - — — - - — - - Puerperal Pyrexia 51 - — 51 - - - - 51 54.8 t - - Typhoid and Paratyphoid Fever 1 1 — - - - - - - 0.015 - - Tulierculosis (Pulmonary) 88 18 8 9 9 14 23 7 22 1.36 18 0.28 Tuberculosis (Non-Pulmonary) 6 — - 1 1 2 1 1 1 0.09 2 0.03 Food Poisoning 1 — — - - — 1 - — - - - Ophthalmia Neonatorum . — - - - — — — — — — — — Totals 2087 223 212 183 184 234 •537 414 146 86.455 52 0.805 •Includes Pneumonia (all forms). tBased on attack rate per 1,000 total births, and not population 65 TABLE VII. NOTIFIABLE INFECTIOUS DISEASES, 1951. Seasonable Incidence. Disease. Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total. Scarlet Fever 4 7 8 2 3 3 5 1 3 i 4 6 47 Diphtheria — — — - — — - — - — - — Measles 196 490 504 90 50 29 13 2 7 — - — 1381 Whooping Cough 69 124 101 34 18 16 16 19 26 6 3 12 444 Dysentery - - 2 2 - - 1 — - - - 1 6 Erysipelas 1 - 1 — 1 - - 1 - 1 1 - 7 Cerebro Spinal Fever - - - - - - — - - — — - — Pneumonia (all forms) 15 8 7 4 5 2 1 4 1 - 1 4 52 Typhoid & Paratyphoid Fever — — - - - — 1 - — — — - Acute Anterior Poliomyelitis - - - - - - 1 - i 1 - - - Food Poisoning - — - - 1 - - - - — — - 1 Puerperal Pyrexia 4 2 1 3 - 1 1 12 10 9 5 3 51 TOTALS 289 631 624 135 78 52 38 40 48 18 14 26 1993 66 TUBERCULOSIS. New Cases and Mortality during the year 1951. Age Groups New cases notified or otherwise revealed. (Not inclu- j ding Inward Transfers.)* I Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M F. M F M F M F Under 5 1 .. .. .. .. .. .. .. 5—14 4 3 .. .. .. .. .. 15—44 21 23 2 1 6 4 1 .. 45-64 7 6 1 .. 4 1 .. 1 65 and over 2 1 .. .. 5 .. .. .. 35 33 3 1 15 5 1 1 •Inward Transfers 11 9 1 1 Totals 46 42 4 2 67 TABLE IX. Housing Statistics for the year 1951. Total number of valuation assessments, houses and flats, at 31st March, 1951 18,445 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) 626 (b) No. of inspections made for the purpose 4,963 (2) (a) No. of dwelling-houses (including under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 (b) No. of inspections made for the purpose — (3) No. of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4) No. of dwelling-houses (exclusive of those referred to under preceding sub-head) found not to be in all respects reasonably fit for human habitation 721 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 . 859 68 TABLE X. Summary of the Work of the Sanitary Inspectors for the year 1951. TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits ances Found Housing— 1. Inspection of District Regulations 1 27 2 30 12 2. For Nuisances 1027 75 3861 4963 1529 3. Overcrowding 107 81 12 200 6 4. Verminous Conditions 20 2 34 56 11 5. Dirty Conditions 9 3 13 25 4 6. Water Supply 8 3 12 23 5 7. Cesspools 3 1 5 9 3 8. Earth Closets — — — — — 9. Privy Pails — — — — — 10. Houses Let in Lodgings — — — — — 11 Disinfestation 5 1 4 10 4 12. Noxious Accumulations 14 2 12 28 7 13. Other Accumulations 29 27 38 94 9 Totals 1223 222 3993 5438 1590 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded in above Table) 29 54 14 97 — 2. Disinfection Purposes 12 30 3 45 - 3. Smallpox Enquiries 2 25 8 35 - 4. Public Health (Aircraft) Regulations 1 - 2 3 - Totals 44 109 27 180 - Meat, Milk siad Other Food Shops, etc.— 1. Butchers (incl. 2 Wholesale Depots) 2 914 25 941 7 2. Confectionery 2 64 6 72 3 3. Dairies, Cowsheds (excl. Past. Plants).. — 86 1 87 6 4. Pasteurising Plants — 69 — 69 - 5. Fish 1 215 59 275 7 A 6. Fried Fish — 37 4 41 4 7. Food Hawkers — 21 2 23 I 10 8. Fruit, Greengrocery 6 115 29 150 \y 9. Grocery 6 550 74 630 45 10. Ice Cream Shops — 156 27 183 6 11. Meat Regulations (Special Visits) 1 — 2 3 - 12. Milk Examined on Highway 1 14 — 15 2 13. Retail Market — 70 — 70 - 14. Slaughterhouses — 29 — 29 - 15. Horseflesh Shops i 99 5 105 6 16. Restaurants 2 111 33 146 20 17. School Canteens 10 34 5 49 10 18. Public Houses — 24 37 61 12 19. Hotels — 1 — 1 - 20. Food Wholesalers — 18 — 18 - 21. Chemists — 1 — - 22. Clean Food Byelaws — 7 - 7 - Totals 32 2635 309 2976 149 Factories, Outworkers, etc.— 1. (i) Factories in which Sects. 1, 2, 3, 4 and 6 of the Factories Act, 1937, are to be enforced by the Local Authority 7 52 40 99 25 (ii) Factories not included in (i) ta which Sec. 7 applies (a) Subect to the L.A. (Transfer of Enforcement) Order, 1938 9 69 69 147 45 (b) Others 1 2 7 10 L Carried forward 17 123 116 256 72 69 TABLE X—0Continued). TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Brought forward 17 123 116 256 72 Factories, Outworkers, etc.—(continued). 2. Other premises under the Act (excl. outworkers' premises, hotels, restaurants, etc. 6 9 7 22 7 3. Bakehouses (a) Mech. power 2 43 17 62 13 (b) Non-mech. power 7 1 8 2 4. Outworkers' premises — 31 2 33 — 5. Smoke Abatement 5 1 1 7 2 Totals 30 214 144 388 % Sampling of Food and Drugs— 1. Milk: T.T. Certified — 6 — 6 — T.T. Pasteurised — 23 — 23 — Pasteurised — 52 — 52 — Sterilised — 9 — 9 — Ordinary — 3 — 3 — 2. Schools Milk (Pasteurised) —- 12 — 12 — 3. Pasteurising Plant: T.T. Milk 1 22 — 23 — Pasteurised 2 25 2 29 — Washed Bottle — 1 — 1 — 4. Ice Cream — 111 — 111 — Ice Cream Mix — 1 — 1 — 5. Other Foods 11 75 13 99 — 6. Drinking Water 1 3 1 5 — 7. Food Poisoning 1 4 2 7 — 8. Labelling of Food — — 1 1 — Totals 16 347 19 382 — Trade Premises—Various— 1. Under Shops Act — 58 59 117 27 2. Under Petroleum Acts 1 69 103 173 3 3. Registry Offices — 9 — 9 — 4. Offices (P.H. Act 1936,, Sees. 46 and 91) — 3 1 4 4 5. Rag Flock Act . . — 2 - 2 — 6. Diseases of Animals Acts: - Movement Licences — 1 1 2 — Foot and Mouth Disease — 16 — 16 — Swine Fever 2 1 11 14 - Fowl Pest — 8 — 8 - Other — 6 — 6 - Interviews — 110 — 110 - 7. Piggeries : Cleansing 1 24 4 29 4 Sanitary Conditions I 6 7 14 1 8. Stables: Cleansing 1 4 — 5 — Sanitary Conditions — — 2 2 — 9. Animals, Keeping of 11 12 9 32 5 Totals 17 329 197 543 44 Rodent Control— 1- Trade Premises 124 391 544 1059 112 2. Private Premises 551 1370 3767 5688 464 3. Corporation Property 4 2 25 31 4 4. Sewers 913 — 1704 2617 293 Totals 1592 1763 6040 9395 873 70 TABLE X—(Continued). TYPE OF INSPECTION On Complaint Routine Re- Inspection Total Visits Nuisances Found Miscellaneous— 1. Schools 15 3 19 37 4 2. Drain Tests : Smoke 33 26 8 67 14 Water 19 89 24 132 3 Colour 9 6 1 16 1 7 Chemical — 1 - - Mirror 1 1 2 - 3. Swimming Baths: Visited — 59 24 83 6 Samples taken — 35 — 35 - Chlorine and Ph. Test — 104 - 104 - 4. Tents, Vans and Sheds 2 31 9 42 - 5. Accumulations (other than dwellings) . 6 16 84 106 13 6. Streams 4 10 22 36 - 7. Tips 1 3 - 4 4 8. Special Visits 14 158 26 198 - 9. Public Houses—Urinals — 88 14 102 10 10. Cinemas 1 2 3 6 3 Totals 104 632 235 971 64 Grand Totals 3058 6251 10964 20273 2816 71 TABLE XI. Factories Acts, 1937 and 1948. 1. 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 Local Authorities 67 99 5 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 218 147 2 — (c) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 8 10 1 — Totals 293 256 8 — 72 2. Cases in which defects were found. Particulars. Number of cases in which defects were: — Number of cases in which prosecutions were instituted. Found. Remedied. Referred To H.M. Inspector. By H.M. Inspector. Want of cleanliness (S.l) 11 15 — 2 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — 1 — — Inadequate ventilation (S.4) — 2 — — — Ineffective drainage of floors (S.6) — 2 - — — Sanitary Conveniences (S.7): (a) insufficient 6 9 (b) unsuitable or defective 20 42 - 13 (c) not separate for sexes 2 3 — — — Other offences against the Act (not including offences relating to out-work) 2 13 — — — Total .. 41 87 — 15 — Outwork : Nil. 73 TABLE XII. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1951. HOUSING Drainage— Premises re-drained and connected to sewer 2 Cesspools abolished 1 Earth closets abolished — Cesspools emptied 2 Privy pails, etc., abolished — Drains relaid or repaired 114 Drains unstopped 142 Inspection chambers provided 30 Inspection chambers repaired 2 W.C.'s provided (add. or sep.) 3 buildings reconstructed 2 buildings repaired 7 pans renewed 33 pans cleansed 2 box seats removed 2 Soil vent pipes renewed or repaired 15 Sink/Bath waste pipes renewed or repaired 23 Sinks renewed 6 Lavatory basins renewed or repaired 3 Baths renewed or repaired 3 392 Dampness— Roofs repaired or renewed 274 R.w.p.'s, guttering, repaired or renewed 144 Vertical plinth provided 9 Walls rendered 48 Horizontal damp-course provided 3 Solutioning 3 Earth removed from walls 4 Walls repointed 51 Weather-board walls repaired 1 Sub-floor ventilation provided or improved 38 Dry areas constructed Brickwork repaired 76 Miscellaneous 39 694 Water Supply— Drinking water service supplied direct from main 9 Fittings renewed, etc. 19 Separate or additional water supply provided 2 Supply reinstated 1 Flushing cisterns renewed or repaired 30 Storage tanks renewed or repaired 3 Boilers renewed or repaired 65 74 TABLE XII. (Continued). General Items— Rooms cleansed 328 W.C. walls cleansed 38 Entrance hall and staircase cleansed 34 Bathroom cleansed 17 Light and ventilation improved 31 Plastering repaired or renewed 702 Floors repaired or renewed 144 Windows, frames, etc., repaired or renewed 176 Sashcords repaired or renewed 59 Putty pointing repaired or renewed 10 Doors repaired or renewed 40 Stoves, grates repaired or renewed 54 Coppers repaired or renewed 5 Handrails repaired or renewed 2 Stairtreads repaired or renewed 3 Dustbins provided, repaired or renewed 75 Dirty conditions remedied 2 Overcrowding abated - Chimneys repaired 29 External woodwork repainted 20 Food stores provided - Food Stores ventilated 2 Yard paving renewed, etc. 8 Houses Disinfested 20 Accumulations removed 19 Fencing 2 Houses closed. Unfit 2 Houses demolished. Unfit 2 Miscellaneous 4 1828 Total 2979 MEAT, MILK AND OTHER FOOD PREMISES— Yard floors repaired, etc. 15 Cleansed, lime-washed shops, rooms 41 Lighting/Ventilation improved 10 Drains improved 20 Manure or refuse removed 13 Refuse bins provided 20 Cold store or refrigerator improved 3 Water supply improved 1 Sinks provided 5 Washing facilities improved 25 Sanitary conveniences improved 26 Miscellaneous 41 220 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 15 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) 1 Inadequate ventilation (Sect. 4) 2 Ineffective drainage of floors (Sect. 6) 2 Sanitary conveniences (Sect. 7)— (a) Insufficient 9 (b) Unsuitable or defective 42 (c) Not separate for sexes 3 Other offences 13 Outworkers' premises — Smoke nuisances 87 75 TABLE XII. (Continued). TRADE PREMISES Shops Act:— Ventilation improved — Temperature improved — Sanitary conveniences improved 4 Absence of statutory forms 23 Unsatisfactory washing facilities remedied 1 Other offences or defects remedied 4 Petroleum Acts contraventions 3 Registry Office contraventions — Offices (P.H. Act, 1936, Sec. 46 and 91) contraventions 13 Rag Flock Act — 48 RODENT CONTROL— Trade Premises 110 Private Premises 456 Sewers (manholes) 293 Corporation property 3 862 MISCELLANEOUS— Diseases of Animals Acts:— Piggeries—Sanitary Conditions 5 Piggeries—Cleansing 2 Stables—Cleansing 1 Animals, Keeping of 2 Schools 3 Drain tests :— Smoke 5 Water 14 Colour 2 Swimming baths—visited 4 Tents, Vans and Sheds 2 Accumulations (other than dwellings) 21 Public houses—urinals 5 66 Grand Total . 4262 - NOTICES ISSUED— Preliminary: Housing 721 Food premises 91 Factories, etc. 47 Trade premises 14 Rodent Control 567 Miscellaneous 83 1523 Statutory Nil 1523 BOROUGH OF BROMLEY. COMMITTEE FOR EDUCATION. ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1951. February, 1952. K. E. TAPPER, O.B.E., G.M.. M.B., ch.B., D.P.H. Medical Officer of Health. 78 Members of the Welfare Committee. Alderman M. Stafford Smith, B.A. (Chairman). The Mayor (Alderman H. M. V. Green, J.P.) (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 Whole-time. School Health Servicc. Medical Officer of Health Dr. K. E. Tapper. 25% Deputy Medical Officer of Health Dr. H. B. C. Carter-Locke. 50% Assistant Medical Dr. P. A. Currie. 64% Officers Dr. A. Orgler. 50% Dr. G. H. Stinson. 75% Part-time. Ophthalmic Surgeon Dr. Eric Lyle. 3 sessions per week. Orthopaedic Surgeon.. Mr. K. F. Hulbert. 4 sessions per month. Dental Officers. Mr. A. F. King. Whole-time. Mr. Russell-Edky. 3 sessions per week. Clinic Assistants .. Mrs. W. Carrie. Whole-time. Mrs. E. Brooks. Whole-time. Nursing Staff. Mrs. N. M. Taylor. Miss W. G. Hemmings. Miss H. Hogger. Miss E. Chenery. 50% Miss K. Owens. Mrs. V. Grieg. Miss M. E. Wootton. 79 Purl-lime. Physiotherapist Mr. W. A. Taylor. 6 sessions per week. Orthoptist Miss M. A. Jones. 6 sessions per 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 Clerk (General Division) Mrs. W. J. Foot. ¾ Clerk (General Division) Mrs. R. C. Tye. ¾ "x" Includes duties in connection with Independent Schools. To the Chairman and Members of the Welfare Committee. School Health Service. It can be safely claimed that the School Health Service has fulfilled the aims set so many years ago. That the health of the school child in Bromley has improved over these years is demonstrable. To claim that this improvement is entirely due to the School Health Service would be fallacious, for the progressive social uplift of the people during the past forty years and all that follows full employment are perhaps greater factors. Nevertheless. the time is due to give attention to the administrative pattern of the service which has remained practically unaltered, although extended, during the past twenty-five years, and to consider, without prejudice, whether this routine is applicable to present day needs of the school child and whether the service should not be still more closely associated with the Hospital Services or the general practitioner service. If consideration is to be given to change, it is fundamental that the administration of Health Service to the school child should not only be unified with the Health Services of the family, but unified to a local authority in close contact with the people for whom the services are provided, and should operate without a multiplication of forms and reports. A service based on statistical returns is valueless if it operates without personal consultation with the individual concerned. In this direction, too, economy of effort and economy in costs will result. Three hundred and twenty sessions of periodic medical examinations were held at the schools, 71 of which were held at private schools. Of the 3,367 children examined, 9.6% showed defects requiring treatment, and 21.3% for further examination and observation. The reexaminations of these children are carried out at the various clinics by special appointment, each clinic being situate close to the schools and the homes. For details of the defects found, defects treated, and for reports on the specialised clinics, ophthalmic, orthopaedic, speech, etc., reference should be made to the body of the report and statistical tables. 80 The following tabulation indicates the extent of defects discovered at periodic medical inspections at schools in Bromley compared with the extent of defects in the county as a whole. Requiring Treatment. Incidence per 1,000 Insp. Requiring Observation. Incidence per 1,000 Insp. Skin 4.16 (10.7) 7.42 ( 4.1) Eyes—Vision 38.61 (73.1) 39.50 (43.2) Eyes—Squint 2.67 (10.5) 3.56 ( 4.7) Ears—Hearing 1.19 ( 2.5) 0.59 ( 2.5) Ears—Otitis Media — ( 2.9) 0.3 ( 1.8) Nose and Throat 4.46 (45.8) 25.25 (63.6) Speech 2.08 ( 2.4) 2.08 ( 3.6) Epilepsy — ( 0.3) — ( 0.6) Other Nervous Conditions. 0.3 ( 1.5) 2.67 ( 2.7) Note.—The figures in brackets are comparable figures for the whole country covering the year 1947, the latest figures available to me at the time of writing. With regard to the private schools, a difficulty arises from the fact that there is a good deal of movement of pupils and ages of entry are not fixed. It has therefore been found difficult to examine the children at definite age groups without missing out a large number altogether. In view of this, all the schools have been worked through systematically, and the intention is to repeat the examinations at three-year intervals, and by this method it is hoped that very few whose parents wish them to be examined will escape the net. Last year a table was, printed in the Annual Report comparing the nutritional state of children attending independent schools with that of children at maintained schools, and it is interesting and instructive to see how little variation there is in the figures. Independent Schools. Maintained Schools. 1950. 1951. 1950. 1951. Category A 84.9% 85.2% 68.3% 64.4% Category B 15.1% 14.6% 30.2% 34.7% Category C — 0.2% 1.5% 0.9% These figures tend to confirm the impression, gained as a result of last year's experience, that pupils attending independent schools have, on the average, a higher nutritional standard than those attending maintained schools. Turning for a moment to the question of some of the defects needing treatment, a marked change has come over the picture, as will be seen from the following table:— 81 Independent Schools. Maintained Schools. 1950. 1951. 1950. 1951. Vision 9.6% 4.7% 3.7% 3.8% Nose and Throat 5.9% 2.6% 1.2% 0.4% In view of the above finding, further comment would appear to be desirable. The first point which stands out is that the number of visual defects discovered at the independent schools is slightly less than half the number for the previous year. This can probably be explained by the fact that the children examined this year were, on the average, a good deal older than those seen in 1950, and that, with the passage of time, a visual defect is eventually suspected either by the parents, the teacher, or the child and appropriate remedial action taken. With regular medical supervision this time lag between development of the defect and obtaining treatment should be cut considerably with obvious corresponding advantages to the child. It is also interesting to note that defects of the nose and throat at the independent schools are less than half of what they were for the previous year, and the same explanation probably applies in this case also. The reason for the sudden big decline in the incidence of nose and throat defects found at the maintained schools is not easy to explain, and it would almost certainly be wiser to refrain from comment until the future trend has become apparent. Some interesting facts and figures have come to light as a result of a closer analysis of the finding in the cases of children specially examined during the year for a disability of the mind (see Table VII). Of the eight children recommended during the year for admission to special schools, for educationally sub-normal pupils, only three have so far gone. Of the three mal-adjusted children recommended for admission to residential schools, only one has gone, and of the three ineducable children recommended for institutional care, accommodation has so far only been obtained for one. The lack of suitable provision for the educationally sub-normal child in Kent is thus a great problem, for with large classes in ordinary schools, it is well nigh impossible to give these unfortunate children any special attention, and should the attempt be made, it can only be to the detriment of the rest of the class. But, until a greatly increased number of places can be found for E.S.N. pupils (and this is a national as well as a County problem), these children have to drag on receiving education which is unsuitable to their intellectual capacity. In the case of mal-adjusted children requiring residential schools, we are up against the same difficulties, and the child's chance of ultimate recovery is, needless to say, not improved by the delay in obtaining the most suitable form of treatment. With regard to the cases of the ineducable children, the problem is rather different, but the 82 ties are just the same. In these cases the child is, of course, not losing suitable schooling, but is kept at home in the care of parents or guardians—in some cases much to their distress—although the latter naturally depends largely on how bad the child is. There seems no immediate prospect of these conditions being alleviated, but 1 feel justified in drawing your attention to them. This year I have thought it wise to bring a fresh mind into this Annual Report, and I have asked Dr. Currie his views of the School Health Service in Bromley. Dr. Currie has been Assistant Medical Officer in Bromley since 1946, and he reports as follows: — " No observations upon the present state of health of the children would be complete without some reference to past reports and statistics. For this reason I have been studying the Annual Reports since 1909. To have attempted to compile graphs or columns of comparative figures for these forty odd years would have been a very ambitious undertaking requiring consideiable skill if a true picture was to be obtained. During the period of the last war, for example, considerable evacuation of the child population occurred, making accurate records and therefore conclusions impossible. In view of this and as most of us do not appreciate long columns of figures by themselves, I propose just to note down a few of the more interesting—even startlingfacts which caught my particular attention. 1909. The average time (for treatment) of some of the cases of ringworm was 9 months, and in many cases over one year. 15% of the children examined had defective vision—six cases of opacities and five of cataracts were observed. Seventy children had defective hearing. 81% (of 1,076) children confessed to never cleaning their teeth. 1913. 5% of 1,328 children had rickets. 1917. 31 cases of ringworm were seen. 3% of children were infested with "pediculi," and, 1923. 3.4% were found to be unclean. 70% of children at routine inspection actually required dental treatment—which corresponds to the figure indicated by the Chief Medical Officer of the Board of Education. So much for the first twenty-five years—the next period reveals a steady all-round improvement. This can also be shown by a study of the number of children found requiring treatment at routine medical inspections. These have shown a variation from 12% (1923) to 9% (1951), but have not fallen regularly and uniformly, but 1 feel sure the general trend is to lower figures still; so much so that the question has been raised as to the necessity of these examinations. A very good case can be made out for their discontinuance; as I admit that it comes as quite a surprise to discover an abnormality nowadays—quite the converse of my colleagues' experience half a century ago. Further, 83 the vision of children could be tested by a nurse, a hearing defect revealed by an audiogram, while mass X-rays would show early lung changes that are imperceptible on stethescopic examination. Unfortunately there are still many complaints (some very minor admittedly) which pass unnoticed by the lay eye. In fact, 1 had almost reached the conclusion that 1 was wasting a lot of time in these examinations, when I found a very anaemic boy actually at school. (In 1910-14 the yearly average was 23%). This child was accepted by all as being quite well, but his real state of " good health " was only evident on his return from hospital. Of course, if his condition had deteriorated, he would have eventually been taken to his own general practitioner, but I was happy that this loss of time had been avoided. These early and often borderline cases are the particular province of the school medical officer; not only physical, but conditions founded on mental instability or emotional upset, can and should be found, but only if the inspection ceases to be formally routine and becomes, as anticipated by the Medical Officer of Health in one of his earlier reports, an opportunity to discuss with the parents any particular problems. Often these are the very ones which cause so much anxiety, but for which no advice is sought because of the overcrowded surgeries of to-day. I am aware that it is fashionable nowadays to consult a psychiatrist on the least provocation, but it is perhaps because of the great amelioration in the physical condition of the child that more attention is being paid to psychological effects. The general state of health is, without doubt, good, but this can only be maintained by vigilance, education and the closest co-operation of all concerned, and the National Health Service Act has, I think, brought the general practitioner and the school medical officer closer together in their mutual tasks and aims." 1 have again included a report by Miss Bentley on physical education, and this will be found at the end of the Report. Mr. King, the dental officer, has continued to work with his usual enthusiasm and efficiency in spite of dental staff shortage, and his report will be found in the text of the Report. The reports of Dr. Lyle, Ophthalmic Surgeon, and Mr. Hulbert, Orthopaedic Surgeon, are also embodied in this Report. I could not end this introductory letter without expressing appreciation of the help I have always received from the members of the Welfare Committee and from the Borough Education Officer, Mr. Smith, nor could I carry out my duties without the tireless efforts of the professional staff and of Mr. Judd, the Chief Clerk and the clerical staff who work under him. K. E. TAPPER, Medical Officer of Health. 84 GENERAL INFORMATION. Numbers on School Roll 1950. 1951. 12 County Primary Schools 4198 4501 5 County Secondary Schools 1933 1884 3 County Grammar and Technical Schools 1711 1737 Total 7842 8122 Further Education. Bromley College of Arts, Tweedy Road. Department of Building, Wharton Road. Technical Institute Bromley Technical Institute, " Springhill," College Road. Clinics. Minor Ailments. North Clinic, Station Road. Monday to Friday. a.m. (Doctor in attendance Monday, Tuesday and Thursday). South Clinic, Princes Plain. Monday to Friday. a.m. (Doctor in attendance Monday, Wednesday and Friday). Medical Room, Hayes School. Monday to Friday. a.m. (Doctor in attendance Monday, and Wednesday). Mcdical Room, Quernmore School. Monday, Wednesday and Friday. a.m. (Doctor in attendance, Friday). Medical Room, Burnt Ash School. Monday, Tuesday and Thursday. a.m. (Doctor in attendance, Tuesday and Thursday). Medical Room, Aylesbury Road School. Monday to Friday. a.m. Dental. North Clinic, Station Road. Monday to Friday. a.m. and p.m. (By appointment only). South Clinic, Princes Plain. (Closed for time being owing to lack of Dental Officers). Sunlight Clinics. North Clinic, Station Road. Tuesday (p.m.), Friday (a.m.). South Clinic, Princes Plain. Monday and Wednesday (p.m.). Specialist Clinics. Ophthalmic. North Clinic, Station Monday and Wednesday. a.m. Road. Friday. p.m. (Appointments only). Orthopaedic. North Clinic, Station Road. Ftiday. P.m. (Appointments only). Speech. South Clinic, Princes Plain. Monday. p.m. (Appointments only). During the year 11,779 attendances for minor ailment treatment at the clinics were made, as against 12,229 during 1950. 85 The main types of ailments treated were, as under: — 1950. 1951. Ringworm. Body 7 25 Scabies 9 — Impetigo 36 28 Other Skin Diseases 397 457 Ear Defects (excluding serious diseases of the ear, e.g., operative treatment in hospital) 222 240 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 2413 2277 Many, in fact most of the ailments are such that the attendance of the Doctor at the clinics is not necessary, and cases can well be left to the School Nurse. However, use is made of the Doctor's attendance to call up those cases for special examination referred from the school inspections and to carry out immunisation and vaccination at the same session. The functioning of these minor clinics is a safety valve against overcrowding of Doctors' Surgeries and Hospital Outpatient Departments. SCHOOL HYGIENE. The high standard of cleanliness and hygiene of the Bromley Schools was maintained during the past year. Parish C.E. Primary School .. During the year the work of providing a new lavatory block to replace the former " sanitary accommodation " was completed. Valley County Primary Infants' Improvements to the boys' lava- School tories have been carried out. During the year the Sanitary Inspectors made frequent visits of inspection to the various school canteens, and in every instance the standard of cleanliness was most satisfactory. MEDICAL INSPECTIONS AT SCHOOLS. During the year 3,367 children were examined at schools and clinics, necessitating the holding of 259 medical inspection sessions. The average attendance at each session was thirteen compared with 13.7 for 1950. Three hundred and twenty-two individual pupils were found to require treatment (excluding Dental Diseases and Infestation with Vermin), giving a percentage of 9.6 as against 9.2 for the year 1950. Table 1IB, of the statistical tables gives information on the general condition of the pupils inspected in the various age groups. Comparative rates for the past four years are shown below:— 86 1951. 1950. 1949. 1948. Category A. 64.42% 68.35% 54.60% 49.25% Category B. 34.63% 30.17% 43.65% 46.72% Category C. 0.95% 1.48% 1.74% 4.02% The examinations continue to show a satisfactory standard of health and general physique, and the attendance of parents at routine medical inspections is still high. SPECIAL EXAMINATIONS. Two thousand, four hundred and thirty-eight cases have come under medical supervision during the year, necessitating 4,567 medical examinations (2,499 cases and 4,739 medical examinations during 1950). Seventy-five cases requiring special investigation or certification were referred for examination at the Municipal Offices. One hundred and forty-five cases were referred to Hospital for Paediatricians' and other specialists' advice and treatment. The close liaison with the hospitals has continued throughout the year, and I am indeed grateful to them for the assistance given. DENTAL SERVICE. Mr. King reports: — " Owing to the acute shortage of Dental Surgeons in the School Health Service, it has not been possible to provide full comprehensive dental inspection and treatment for the 8,000 school children in the Borough. At least one more full-time Dental Officer is urgently required. Private practitioners are very reluctant to undertake the treatment of children, consequently, practically every child between one year and fifteen years of age has to rely on the one understaffed clinic available. Inspection at the schools continued throughout the year, and as a result considerable preventive work has been possible. In May last we lost the services of Mr. R. B. Whalley, who attended for seven sessions weekly. This was a very unfortunate setback to the programme of extensive school inspections. The child welfare service has functioned to the fullest extent, and all expectant and nursing mothers who have presented themselves have received all necessary treatment, including the supply and fitting of dentures. Some five hundred pre-school age children, together with pre and post natal mothers, received treatment during the year. Every child referred from the Day Nurseries and Special Schools has been restored to dental fitness. 87 Orthodontic treatment has been carried out in a considerable number of cases. As preference is given to the alleviation of pain and the restoration of teeth, only a limited amount of time can be spared for this important branch of dentistry. It is hoped that in the very near future we shall again be fully staffed and able to provide the full service so desirable and necessary. I would wish to record my grateful thanks to the Radiologists and Radiographers at Bromley Hospital for their very willing and valuable assistance." OPHTHALMIC CLINIC. I am indebted to Dr. Eric Lyle for this report:— " It is with pleasure that I am able to report further progress in the work of the School Eye Clinic during the year 1951. The total number of attendances has been 1,581 as against 1,481 in 1950. This has been made possible by once again increasing the hours of work at the Clinic. New cases can therefore be examined without any delay at all. Re-inspection cases are still somewhat behind-hand, but the delay in this direction is happily becoming less and less, and parents are appreciative of this piece of progress. Co-operation at all times is forthcoming from all the School Medical Clerical staff, and it is by their continued hard work and interest that the efficiency of the Department is able to be increased. I should like to place on record my sincere thanks to all of them." ORTHOPTIC CLINIC. During the year 1951, there were 1,586 treatments given at this clinic. After the resignation of Miss Ford from orthoptic duties, there was a period of six weeks before Miss Jones commenced, and this caused a slight waiting list for treatment, but it has now been overcome and patients are seen regularly for observation purposes or given treatment as the case may be. EAR, NOSE AND THROAT DEFECTS. During the year 280 children received operative treatment in hospitals for tonsils and adenoids, one for other nose and throat conditions, and one for the disease of the ear (double mastoid). In addition. 52 children received other forms of treatment as Outpatients, etc. 88 ORTHOPAEDIC CLINIC. I am indebted to Mr. K. F. Hulbert, F.R.C.S., for the following report on this clinic:— "The Orthopaedic Clinics have been continued throughout the past year on every Friday afternoon. There has been no slackening in the number of cases and there has been no marked change in the variety. Three problems, however, have been paramount this year: — (1) The treatment of spastic paraplegia. The treatment of infants and children suffering from this condition is not satisfactorily carried out in an Out-Patient Clinic, and the need for institutional treatment for these children in your area is great, and any effort that can be made towards improving the situation will be appreciated by the parents, and eventually by the children suffering from this crippling disability. (2) The general posture and physical development of the children would be improved by providing, at the schools, daily remedial exercises, done under the supervision of someone trained in the subject. Children with poor muscular development are often only frightened and tired out by the usual gymnastics, whereas a quarter-of-an-hour daily would do them all much more good. (3) There is still dissatisfaction amongst parents because when their children require hospital treatment, they have to come all the way to the Southern Hospital, Dartford, instead of having access to hospitals in their own area. 1 would also like to pay tribute to the work of the Physiotherapist Mr. Taylor, who has gained a place in the esteem and affection of" the patients, by his skill and conscientious treatment, and by his p'easant and friendly approach." PHYSIOTHERAPY AND SUNLIGHT CLINIC. Mr. Taylor reports, as follows:— "The work of this clinic during 1951 has been varied and interesting. The remedial exercises classes have been well attended, a total of 1,985 attendances being made. A large percentage of children attend for postural and foot defects. It is noticeable that a marked improvement in a comparatively short period is obtained by those attending the postural classes. Those attending the foot classes take a much longer period to show improvement, 89 The spastic and anterior poliomyelitis cases continue to show improvement, and the Walking Machine which was recently purchased has proved a most valuable asset in the treatment of these children. The Sunlight clinic has not been quite so busy as in the previous year, a total of 395 treatments being given to school children." SPEECH CLINIC. A Speech Therapy clinic is held at the South Clinic. The one session a week is inadequate to deal with the local demand. 1 am able this year to submit a full report by the Chief Speech Therapist for the County, who clearly indicates the position in her report. "Miss Snellgrove, who has been spending one session per week at Bromley, resigned her appointment in August, 1951, in order to take up her duties as Senior Therapist at the Moor House Residential School for Speech Defective Children. Miss Edsor was appointed in her place and has been in charge of the Bromley Clinic since November, 1951. Unfortunately Miss Snellgrove's resignation resulted in a break of over two months in the work which was going on in this clinic. An arrangement made during the year between the County Health Department and the South-East Metropolitan Regional Hospital Board now makes it possible for appointments to be made for adults at the speech therapy clinics. In Kent, not only are the clinics open to children attending schools, but appointments can also be given to children of under school age as well as adults. The Ministry of Education and the Ministry of Health estimate that a school population of 10,000 warrants the appointment of a full time therapist. As the work of the Bromley clinic is administered by the Speech Therapy Department under the County Health Department and as any expansion, under the present arrangement, would have to be considered in the light of the needs of the County as a whole, I feel it is not out of place to explain that the waiting lists throughout the County constitute a serious problem. At present five therapists (excluding myself) is the establishment approved by the County. The waiting lists in the County, including that of Bromley, are such that an establishment of at least fourteen therapists could be employed by the County; any expansion of the service in the future cannot be considered solely in regard to the establishment of clinics and therapists, but consideration must also be given to the work which is going through the County Speech Therapy Department office; increased accommodation and staffing are needed there if the ever increasing 90 amount of work going through the office is to be dealt with satisfactorily. A Therapist employed full-time in a clinic can carry approximately 50 open cases. The tables, which follow, show that nine patients were in touch with the clinic at the end of 1951 and need to continue attendance in 1952, and, also, that at the end of 1951 a further 51 patients were on the waiting list; thus it is known that 1952 opens with 60 patients requiring appointments at Bromley. Such a case load warrants the appointment of a full-time therapist. It is impossible for a Therapist to investigate and treat all aspects of any case unless each patient is considered individually. Where children are concerned, interviews with parents can be as important as interviews with their children. Whether or not a Therapist does any group work within the course of treatment, depends upon the individual therapist; one therapist may arrange group work for some specific purpose with some patients for a period during the course of treatment, whereas another therapist may obtain better results by working individually throughout. Group work may enable larger numbers to be shown in regard to " patients seen " in any one year, but the number of patients who have benefited from treatment during that year will not necessarily be increased. Figures showing the number of patients who have benefited, are of greater importance than figures relating to the number of patients seen. Analysis of work carried out:— A. Total number of patients 21 Cases closed during 1951 12 Patients attending clinic at end of 1951, and therefore, carried forward into 1952 9 21 B. Number of patients awaiting appointments at the end of 1951 and, therefore, carried forward into 1952 51 72 Discharges during the year: — (a) Improved so that no abnormality existed or condition became such that little residual defect remained .. 5 (b) Treatment incomplete owing to parent and patient being satisfied with the condition or owing to parent and patient being unwilling to continue further, or owing to patient leaving district, etc. 2 (c) Delayed speech development associated with severe mental retardation 1 91 (d) Reported by Medical Officer,, parent and/or school to have improved and, therefore, investigatory appointments at Speech Therapy Clinic cancelled 1 (e) Appointments offered, but not kept as parents or patients unwilling to attend, or attendance impossible owing to other commitments, hospitalisation, etc. 1 (f) Started work or left district prior to appointment being made 2 Patients, whose cases were closed during the year, suffered from stammer, dyslalia and retarded speech development associated with severe mental retardation. VERMIN AND UNCLEANLINESS INSPECTION. The number of children infested with vermin continued to be extremely low, and from a total of 18,681 routine inspections carried out by the School Nurses, only sixteen children were found to be infested, with a further 111 children showing minor evidence of uncleanliness. The sixteen children infested are the "regulars," and if these could be eliminated from the returns, the routine cleanliness inspections could be considerably reduced and so save much of a skilled nurse's time. Parents are advised on the advance in the treatment of infestation by modern insecticides. EXCEPTIONAL AND HANDICAPPED CHILDREN. Thirty-four attendances were made at the special clinic held at the Municipal Offices for exceptional and handicapped children. There are, at the present time, sixty known educationally subnormal and physically handicapped children in the area. Details of these children are:— Not in School. In residential schools for E.S.N. children 4 Attending day schools for E.S.N. children 10 5 In residential schools for blind and partially sighted children 4 In residential schools for deaf and partially deaf children 3 Attending day schools for deaf and partially deaf children 4 In residential premises for physically handicapped children 5 7 In residential premises for delicate children 6 3 In residential premises for epileptic children 1 In residential premises for mal-adjusted children 6 2 There are twenty-five known ineducable children in the area, thirteen of this number being in Institutions and twelve at home. 92 CHILD GUIDANCE. All cases requiring treatment at the Child Guidance Clinic are referred to the local hospital Psychiatric Departments. Nineteen cases were referred for treatment during 1951. MILK IN SCHOOLS. There is no change to report in the arrangements for the provision of milk during 1951. A return to the Ministry of Education showed that on a single day in October, the percentage of pupils receiving milk, based on the number in attendance at Primary and Secondary Schools, was 84.97%. SCHOOL MEALS SERVICE. Due to the increasing necessity for economy in all services, it has only been possible during the year to carry out minor improvements in the School Meals Service. The majority of canteens have now been fitted with sterilizing sinks, and much needed storage accommodation has been provided at the Grammar School for Girls and Burnt Ash School Canteens. The kitchen to serve 750 meals daily being built at Southborough County Primary School in conjunction with the new Junior Department, is in course of construction, but it is unlikely that it will be available for use until the latter part of 1952. Plans have been approved for a kitchen to serve 600 meals daily, and a dining room to accommodate 324 infants in two sittings at the proposed new school at Pickhurst Lane, and it is hoped that construction will start during 1952. In September, an additional dining centre was opened at the Technical Institute, " Springhill," College Road, where approximately 90 full-time students are now receiving a mid-day meal. The meals are supplied by container servicc from Princes Plain School Canteen. The Ministry of Education found it necessary, from 1st April, 1951. to increase from 6d. to 7d. the charge for meals to all pupils, except those in Nursery Classes. This increase led to a slight falling off in numbers, but, due, presumably, to the increased cost of living, numbers rose again and towards the end of the year an average of 6,477 meals daily was being served. A return to the Ministry of Education showed that on a single day in October, 75.48% of the pupils in attendance at Primary and Secondary Schools received a mid-day meal, 93 NURSERY SCHOOLS. As an economy measure the Nursery Classes at Burnt Ash and Valley County Primary Schools were closed on the 31st December, 1951. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. One hundred and sixty boys and 29 girls were examined by the Assistant School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in all but one case. JUVENILE DELINQUENCY. During the year 41 children appeared before the Local Court. The types of offences were as follows: — Larceny 21 Insulting words and behaviour 8 Road Traffic Act 5 Beyond Control 2 Wilful Damage 2 Indecent Assault 2 Offences under Bromley Byelaws 1 BROMLEY SCHOOLS' BOOT CLUB. The work of the Bromley Schools' Boot Club progressed satisfactorily during the year 1951. Number of members at the end of the year 708 £ s. d. Amounts deposited 563 4 3 Purchases of Footwear (Gross) 571 3 0 Purchases of Footwear (Net) 520 1 8 Discounts received 51 1 4 NECESSITOUS CASES. The number of children of school age supplied with clothing under Section 5 of the Education Act, 1948, was 24, involving a total cost of £112 11s. 2½d. INFECTIOUS DISEASES IN SCHOOLS. Thirty-four cases of scarlet fever in school children were notified during the year, as against 78 for the previous year. Of this number, 19 were home nursed and 15 admitted to hospital. As in previous years, the infection continued to be mild in character. 94 There were no cases of diphtheria in children of school age notified during 1951. One case of poliomyelitis (non-paralytic) was notified and the child admitted to hospital. Five cases of pneumonia were notified, two children being admitted to hospital. During the first four months of 1951 there was an epidemic of measles and 699 cases were notified. Eleven were admitted to hospital. PHYSICAL EDUCATION, 1951. The following is the report of the Area Advisers of Physical Education:— "General. Throughout the post war years physical education in both Primary and Secondary Schools has undergone a continuous process of investigation and experiment with a consequent widening in scope and effectiveness. During the past year satisfactory progress has been maintained and a wider conception of physical education has now been accepted in most schools. Recent experiments in Primary Schools have been consolidated and many useful and efficient schemes of work have been produced. Developments in Secondary Schools give greater prominence to Basket Ball and Athletics for boys and to Basic Movement for older girls. Training Courses for Teachers. The following Training Courses for Teachers have been organised by the Advisers of Physical Education. The courses proved to be very popular and in every case were well attended. Physical Education in Secondary Schools. Gymnastics for Secondary Boys - Men Teachcrs. Gymnastics for Secondary Girls - Women Tcachcrs. Tennis for Secondary Boys & Girls - Men and Women Teachcrs. Hockey for Secondary Girls - Women Teachers. Dance—Short Course—Secondary Girls Women Teachers. Basket Ball—Short Course—Sec. Boys Men Teachers. Physical Education in Primary Schools. Games Course - - - - - Women Teachers. Physical Training - - - - Men and Women Teachers. Music and Movement - - - Women Teachers. 95 Swimming. In some respects swimming instruction during the past year has not proved to be quite as successful as in previous years. Building alterations and the necessity for the installation of new plant led to the closure of Crown Lane Swimming Bath until early in June, and this curtailed the programme. The weather, too, proved very unfavourable and was not the kind of weather to encourage open-air swimming. Owing to reductions in expenditure it was not possible to complete winter swimming arrangements. Winter swimming is generally at a very low ebb chiefly owing to the lack of an Indoor Swimming Bath within th,e immediate Bromley area. Swimming Arrangements. Provision was made for a ten weeks' session for most schools. Secondary Schools. Number of classes per week 41 Number of pupils per week 1230 (approx.). Primary Schools. Number of classes per week 34 Number of pupils per week 1020 (approx.). Total weekly attendance 2250 A slight increase was possible for Primary Schools, six additional classes being catered for. Swimming Instruction. Swimming instruction is given by members of school staff wherever qualified teachers are available. Two men and two women part-time instructors assisted school staffs at the various swimming baths. A limited coach service was available for those schools situated at a distance from a Swimming Bath. Bromley Schools Swimming Association was formed during the past year. Through the good offices of this Association, Bromley schools became affiliated to the Kent and Surrey Division of the National Schools Swimming Association. At the National Championships held at Blackpool, two Bromley schoolboys gained places in individual events, and two Bromley boys were in the Divisional team of the National Medley Relay. The Kent and Surrey Divisional Team, which included Bromley schoolboys, held the English Schools Divisional Championship during 1951. One of Bromley schoolgirl swimmers was awarded the Royal Humane Society's Certificate for saving life while on holiday. 96 Climbing and Agility Apparatus. Secondary Schools. Fixed gymnastic apparatus has been installed in the Hall at Burnt Ash Secondary Girls' School and, to compensate for the lack of a gymnasium, a limited amount of outdoor heaving apparatus has been ordered for Quernmore County Secondary Boys' School. Primary Schools. Where suitable facilities are available, climbing apparatus has been installed. This provision has been made over a two or three-year period and some Primary Schools now have sufficient agility apparatus to meet their needs. The value of the apparatus is obvious in the increased effort made by the children and in the beneficial effects on their physique. This being Festival Year, it was not surprising to find that we had a remarkable number of foreign visitors. In addition there were many visitors from neighbouring counties and Training Colleges. Their interest was chiefly in modern gymnastics and modern dance in Secondary Schools and in the outdoor lesson for Primary Schools using both large and small apparatus. Clothing and Shoes. The suggestion that provision of physical training shoes and clothing should be made by parents has received a gratifying response, but there are still some children who will need to be assisted by the authority. If we are to obtain the maximum benefit from the excellent facilities that are provided, children must be suitably clothed for their activities whether in the playground, hall, gymnasium or playing field. School Sports Association. West Kent School Sports Association. (Bromley Schools are contributing members). Athletics. (Boys). (a) Most of the Honours at the West Kent School Sports were won by a Bromley Secondary Boys' School. (b) Bromley schoolboys, as representatives for the West Kent area, took part in the Kent County Sports, winning the final of the 100 yards (senior) and several Standards. (c) Many trophies from the Beckenham Festival Sports came to Bromley. Athletics. (Girls). Girls from Bromley Schools did remarkably well at the West Kent Sports. Four Bromley girls represented the West Kent area at 97 the County Sports, winning the Intermediate Hurdle Race and the Intermediate High Jump. Many trophies at the Beckenham Festival Sports were won by Bromley Girls' Schools. West Kent Schools—Football. Two Bromley Secondary Schools took part in the West Kent League, and some Bromley boys were in the County Football XI. A number of Primary Schools entered the Junior League, and others played a series of friendly matches as soon as the staff of the schools felt that the boys were ready to play competitive football. Cricket. Two Secondary Boys' Schools entered the West Kent Cricket League and had a good season. Primary Schools generally preferred friendly matches with neighbouring schools. Games in Secondary Girls' Schools. Tennis, Hockey, Netball and Swimming. In these activities Secondary Girls' Schools give preference to friendly matches which have been played throughout the year. It is hoped to see an extension of this arrangement in all branches during the coming year. YOUTH ACTIVITIES. The recreative classes arranged in the interests of youth in previous years have been reduced by four-fifths as an economy measure. It was possible to arrange only one class in physical recreation for boys and men at Raglan Road School gymnasium and a similar class for women and girls at Aylesbury School gymnasium. English Folk Dance Classes are now run under the auspices of the English Folk Dance Society., and our strong contingent of Scottish Dancers has transferred its classes to a neighbouring area where financial assistance is available. The letting of football pitches has not been quite so heavy this year possibly owing to increased charges. Tennis courts have been fully booked throughout the season, and there is an obvious need for increased facilities for tennis. Cricket facilities have been enlarged and were fully booked for the season, 98 CONCLUSION. During a "Festival Education Week" in Bromley, the staffs of the Primary and Secondary Schools gave excellent demonstrations of various branches of Physical Education. Secondary Boys' and Girls' Schools provided programmes at the County Grammar School for Boys, and the Primary Schools produced many interesting demonstrations of work, under normal conditions, on their own premises. These combined programmes were of a high standard and illustrated many aspects of modern physical education. They demonstrated the value of the systematic physical education which is undertaken in the schools. The continued progress and the increasing interest in Physical Education in the Borough is, on the whole, most encouraging, although disappointment is felt at the reduction in the winter programmes of youth and adult activities. In conclusion we wish to express our thanks to the Borough Education Officer and his staff for their valuable support and our appreciation of the good work done by the Head and Assistant Teachers in the schools." F. M. BENTLEY, J. LOUGHRAN, Area Advisers of Physical Education. 99 SCHOOL HEALTH SERVICE. STATISTICAL TABLES, 1951. TABLE 1.—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 in the year 1951. B. Classification of the General Condition of Pupils inspected during the year, in 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. Orthopaedic 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 Pupils. TABLE VIII.—Independent Schools. 100 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 299 Second Age Group .. 1043 Third Age Group .. 612 Total 1959 Number of other Periodic Inspections 1408* Grand Total 3367 *Children aged 8 years. Children in their 13th year, at County Grammar and Technical Schools. B. Other Inspections. Number of Special Inspections .. 2438 Number of Re-Inspections .. 2129 Total 4567 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 4 31 35 Second Age Group 31 57 88 Third Age Group 29 36 65 Total (prescribed groups) 64 124 188 Other Periodic Inspections 66 68 134 Grand Total 130 192 322 101 TABLE II. Return of Defects Found by Medical Inspection. Periodic Inspections. No. of defects. Special Inspections. No. of defects. Defect Code No. Defect or Disease. 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 14 25 255 9 5 Eyes— (a) Vision 130 133 120 17 (b) Squint 9 12 4 2 (c) Other 6 9 95 5 6 Ears— (a) Hearing 4 2 8 5 (b) Otitis media — 1 26 — (c) Other 1 6 102 2 7 Nose and Throat 15 85 195 84 8 Speech 7 7 6 14 9 Cervical Gland* — 6 9 2 10 Heart and Circulation.. 1 30 6 27 11 Lungs 5 12 30 13 12 Developmental:— (a) Hernia 2 12 2 2 (b) Other 16 61 17 26 13 Orthopædic:— (a) Posture 45 67 16 16 (b) Flat Foot 27 119 41 48 (c) Other 18 42 173 21 14 Nervous System:— (a) Epilepsy — — 3 3 (b) Other 1 9 6 17 15 Psychological:— (a) Development 1 1 20 28 (b) Stability 1 4 4 1 16 Other 23 75 515 193 Totals 326 718 1653 535 B. Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups. Number of Pupils Inspected A (Good). % of B (Fair). % of C (Poor). % of No. Col. 2 No. Col. 2 No. Col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 299 132 44.15 163 54.51 4 1.34 Second Age Group 1048 656 62.60 382 36.45 10 0.95 Third Age Group 612 445 72.71 163 26.63 4 0.65 Other Periodic Inspections 1408 936 66.48 458 32.53 14 0.99 Total 3367 2169 64.42 1166 34.63 32 0.95 102 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 — — (ii) Body 25 — Scabies — — Impetigo 28 — Other Skin Diseases 457 15 Total 510 15 Group II.—Eye Diseases, Defective Vision and Squint. Number of cases dealt with. By the Authority. Otherwise. No information available. External and other, excluding errors of refraction and squint 548 Errors of Refraction (including Squint) 1223* - Total 1771 — Number of pupils for whom spectacles were: (a) Prescribed 658* No information available. (b) Obtained 522* Total 1180 — *Including cases dealt with under arrangements with the Supplementary Ophthalmic Services. Group 111.—Diseases and Defects of Ear. Nose and Throat. Number of cases By the Authority. treated. Otherwise. Received operative treatment: (a) for diseases of the ear — 1 (b) for adenoids and chronic tonsilitis 280 (c) for other nose and throat conditions — 1 Received other forms of treatment 240 52 Total 240 334 103 Croup IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in in hospitals 11 By the Authority. Otherwise. (b) Number treated otherwise, e.g., in 272 (New) No information clinics or out-patient depart- 670 (Re-Ins.) available. ments Croup V.—Minor Ailments. Number of cases treated. By the Authority. Otherwise. Miscellaneous minor ailments 2277 No information available. TABLE IV. Dental Inspection, Treatment and Orthodontics. (1) Number of pupils inspected by the Authority's Dental Officers: — (a) Periodic age groups 1238 (b) Specials 1855 Total (1) 3093 (2) Number found to require treatment 2696 (3) Number referred for treatment 2696 (4) Number actually treated 2543 (5) Attendances made by pupils for treatment 5239 (6) Half-days devoted to: Inspection 11 Treatment 5941 Total (6) 605i (7) Fillings: Permanent Teeth 1005 Temporary Teeth 189 Total (7) 1194 (8) Number of Teeth filled: Permanent Teeth 956 Temporary Teeth 187 Total (8) 1143 104 (9) Extractions: Permanent Teeth 521 Temporary Teeth 2474 Total (9) 2995 (10) Administration of general anaesthetics for extraction 1571 (11) Other operations: Permanent Teeth 740 Work not headed 1547 Temporary Teeth 491 Total (11) 2778 Dentures fitted 33 Number of children referred for Orthodontics 104 Number of Orthodontic appliances ordered 20 Number of Orthodontic appliances fitted 20 Attendances for Orthodontic treatment 283 Scaling and Polishing 228 Referred for X-ray 42 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 18,681 (ii) Total number of individual pupils examined 6,385 (iii) Total number of individual pupils found to be infested 16* (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 19441 - (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) — *In addition, 111 children showed minor evidence of uncleanliness. TABLE VI. Orthoptic Clinic. Total number of treatments given 1586 Number of new cases 60 Number of cases on occlusion alone 6 Number of cases found unsuitable 9 Number of cases failed to attend 5 Number of cases awaiting or undergoing operation at the end of the year 21 Number of cures, with operation 1 without operation ,, ,, ,, „ „ 3 105 TABLE VII. Handicapped Pupils Requiring Education at Special School or Boarding in Boarding Homes. 1. Blind 2. Partially Sighted 3. Deaf 4. Partiallv Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Sub-normal 8. Maladjusted 9. Epileptic T O T A L 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) In the calendar year ended 31st December, 1951: A. Handicapped Pupils newly placed in Special Schools or Homes - - 2 - - - 4 - - 6 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or boarding in Homes - - 1 - 8 - 8 3 - 20 Number of chidren reported during the year: — (a) under Section 57 (3) (excluding those returned under (b)) 3 (b) „ „ 57 (3) relying on Section 57 (4) Nil (c) „ ., 57 (5) 1 of the Education Act. 1944. 1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Sub-normal 8. Maladjusted 9. Epileptic T O T A L 1—9 On or about December 31st, 1951: (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) C. Number of Handicapped Pupils from the area—(i) attending Special Schools as Day Pupils - - 2 2 - - 10 - - 14 D. Number of Handicapped Pupils being educated under arrangements made under Section 56 of the Education Act, 1944— (i) in hospitals — - — — - 3 — - - 3 (ii) elsewhere (home) - - - - - 1 - - - 1 E. Number of Handicapped Pupils from the area requiring places in Special Schools (including any such unplaced children who are temporarily receiving home tuition) - - 2 - - - 5 2 - 9 Amount spent on arrangements under Section 56 of the Education Act, 1944. for the education of handicapped pupih in the financial year ended 31st March, 1951 £199 3s. 8d. 106 TABLE VIII. Independent Schools. Number of Schools visited 7 Number of Medical Inspection Sessions .. 71 Number of children examined (various age groups) 810 Number of Re-Inspections from 1950 28 Nutrition Table. Classification "A " (Good). 690 pupils or 85.2% „ "B" (Fair). 118 pupils or 14.6% „ "C" (Poor). 2 pupils or 0.2% Table of Defects found by Medical Inspection. Number of Defects: — Defect or Disease. requiring treatment. requiring observation. Skin 6 1 Eyes, Vision 38 27 Eyes, Squint — 1 Ears, Hearing 1 — Ears, Otitis Media 1 — Ears, Other 5 3 Nose and Throat 21 11 Cervical Glands — 2 Heart and Circulation 4 7 Lungs 10 1 Developmental, Other 1 - Total 87 53