AC4412 (1) BROMLEY Pc. AZK. 3.1.54 BRO 49 BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1953 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES K. E. TAPPER, O.B.E., G.M., M.B., Ch.B., D.P.H. Medical Officer of Health. BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1953 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES K. E. TAPPER. O.B.E., G.M.. M.B., Ch.B.. D.P.H. Medical Officer of Health. Printed by Bromley Office Supplies & Printing Co., Ltd. 39 & 46 East Street, Bromley, Kent 3 CONTENTS. Page Members of the Health Committee 7 Staff 7 Prefatory Letter 9 Section A. Vital and Other Statistics and Social Conditions of the Area. Vital Statistics 14 Population 15 Births 15 Illegitimate Births 16 Stillbirths 16 Deaths 17 Causation of Deaths 17 Maternal Mortality 18 Infantile Mortality 18 Unemployment 18 Local Sickness 19 Meteorological Conditions 19 Open Air Recreational Amenities 20 Section B. General Provision of Health Services for the Area. Disinfection 24 Public Mortuary 24 Laboratory Service 25 National Assistance Act, 1948 25 Nursing Homes 25 Medical Loan Depots 26 Old People's Homes 26 Old People—Welfare 30 Homes for Unmarried Mothers 31 Hospitals 32 Venereal Diseases 32 Home Nursing Service 32 Domestic Help Service 33 Ambulance Service 33 Health Visiting 33 Domiciliary Midwifery 33 Women's Welfare Clinic 33 Local Clinic Services 33 Section C. Sanitary and Environmental Circumstances. Water Supply 36 Drainage and Sewerage 37 Cesspools 38 Rivers, Streams and Lakes 38 Swimming Baths and Pools 38 Public Cleansing, Refuse Collection and Disposal 38 Factories Acts, 1937 and 1948 38 Sanitary Inspection of the Area 39 Smoke Abatement 40 Shops Act, 1950 40 Petroleum (Regulation) Acts, 1928 and 1936 41 Verminous Conditions and Uncleanliness 41 Rodent Control 41 Diseases of Animals Acts 43 Registries for Female Domestic Servants 43 Rag Flock and other Filling Materials Act, 1951 43 Pet Animals Act, 1951 43 Retail Market 43 Moveable Dwellings 44 4 Page Section D. Housing. Housing Inspections and Abatements 46 Rehousing 46 Section E. Inspection and Supervision of Foods. Food Premises 50 Food Premises (Food & Drugs Act, 1938, Section 14) 50 Milk Licences 51 Inspections 51 Food and Drugs Act, 1938—Food Sampling 51 Bacteriological Examinations—Milk 54 Ice Cream 54 Special Enquiries 54 Unsound Food 55 Meat Inspection 56 Section F. Prevalence of, and Control Over. Infectious and Other Diseases. Infectious Diseases—General 58 Smallpox 59 Vaccination 59 Acute Anterior Poliomyelitis 60 Scarlet Fever 60 Diphtheria 60 Diphtheria Immunisation 61 Typhoid Fever 61 Puerperal Pyrexia 64 Ophthalmia Neonatorum 64 Pemphigus Neonatorum 64 Measles 64 Whooping Cough 64 Tuberculosis 64 Mass Radiography 66 Food Poisoning 66 Other Infectious Diseases 66 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 69 „ II.—Causes of Death 70 „ III.—Infant Mortality 71 „ IV.—Analysis of Causes of Infant Deaths 72 „ V.—Notifiable Infectious Diseases—Sex and Age Distribution 73 „ VI.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 74 „ VII.—Notifiable Infectious Diseases—Seasonal Incidence 75 „ VIII.—Housing Statistics 76 „ IX.—Summary of the work of the Sanitary Inspectors 77 „ X.—Nuisances. Defects and Contraventions Abated 80 5 Page SCHOOL HEALTH SERVICE. 1953. Members of the Welfare Committee 84 Officers of the Committee 84 Staff 84 Introduction 85 General Information 86 School Hygiene 87 Periodic Medical Inspections 88 Special Examinations 88 Dental Service 89 Ophthalmic Clinic 90 Orthoptic Clinic 91 Ear, Nose and Throat Defects 91 Orthopaedic Clinic 91 Physiotherapy Clinic 92 Speech Clinic 92 Vermin and Uncleanliness Inspection 93 Handicapped Children 93 Child Guidance 93 Milk in Schools 93 School Meals Service 94 Employment of Children and Young Persons 94 Bromley Schools' Boot Club 94 Provision of Clothing 95 Infectious Diseases in Schools 95 Juvenile Delinquency 95 Physical Education 96 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 102 A. Periodic Medical Inspections 102 B. Other Inspections 102 C. Pupils found to require treatment 102 „ II.—A. Return of Defects found by Medical Inspection in the Year 1953 103 B. Classification of the General Condition of Pupils Inspected during the Year, in age groups 103 „ III.—Group I. Diseases of the Skin 104 Group II. Eye Diseases, Defective Vision and Squint 104 Group III. Diseases and Defects of Ear, Nose and Throat 104 Group IV. Orthopaedic and Postural Defects 104 Group V. Minor Ailments 104 „ V.—Dental Inspection, Treatment and Orthodontics 105 „ V.—Infestation with Vermin 105 „ VI.—Orthoptic Clinic 106 „ VII.—Handicapped Pupils 106 „ VIII.—Independent Schools 108 7 MEMBERS OF THE HEALTH COMMITTEE. Alderman Marion Green. J.P. (Mrs.) (Chairman). Alderman J. S. Marriott (Vice-Chairman). The Worshipful the Mayor (Councillor Leighton L. Irwin. M.A.. LL.B.. J.P.). Alderman M. Stafford Smith. M.B.E.. B.A. (Miss) (Retired 5.12.53). Councillors: J. C. Clayton. S. Lane. F. G. Coates. L. M. Prince (Mrs.). J. L. Hunt. G. H. Russell. STAFF OF THE PUBLIC HEALTH DEPARTMENT. " * " 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. (also Medical Officer of Health for Orpington Urban District Council and Chislehurst and Sidcup Urban District Council.) 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. (also Deputy Medical Officer of Health for Orpington Urban District Council and Chislehurst and Sidcup Urban District Council.) Assistant Medical Officers: * P. A. CURR1E, M.R.C.S., L.R.C.P. * Mrs. S. A. LAING, M.R.C..S, L.R.C.P., D.C.H. (Resigned 10.10.53.) * Mrs. C. MAXWELL, M.B., B.CH., M.R.C.S., L.R.C,P., D.C.H. (Appointed 12.10.53) Chief Sanitary Inspector. Chief Food and Drugs Act Inspector. Inspector under the Petroleum Acts, Diseases of Animals Acts, Shops Act, Rag Flock and Other Filling Materials Act. Pet Animals Act. and Heating Appliances (Fireguards) Act: G. R. WOODS (1, 2, 3, 4, 5). District Sanitary Inspectors. Food and Drugs Act Inspectors, and Inspectors under the Rag Flock and Other Filling Materials Act, Pet Animals Act, and Heating Appliances (Fireguards) Act: T. C. TOWERSEY (1, 2, 3). H. COOPER (1. II). D. K. EVANS (1, 2. 3. 6). (Retired 20.9.53) P. R. LIGHT (1, 2, 6). P. DRINKWATER (1, 2). (Appointed 13.11.53) Health Visitors and School Nurses: * Mrs. N. M. TAYLOR (7, 8. 9). * Miss W. G. HEMMINGS (7, 8, 9). *Miss K. OWENS (7, 8. 9). * Miss E. CHENERY (7, 8, 9). *Miss E. HATCH (7. 8, 9). * Mrs. V. GREIG (7, 8, 9). (Appointed 5.1.53) * Miss M. E. WOOTTON (8, 9, 10). 8 CLERICAL STAFF: Chief Clerk: S. F. JUDD. E. P. J. WYTHE. Mrs. R. C. TYE. Mrs. D. COX. Miss M. N. CROXSON. Mrs. W. J. FOOT. Miss E. W. LEPPER (11) Mrs. M. J. COX. Mrs. R. McGIBNEY. (Resigned 6.10.53) (Appointed 4.5.53) Mrs. B. B. LAMPARD. (Resigned 31.3.53) Other Appointments: Assistant Rodent Officer: J. L. GOUGH. Outdoor Staff: Disinfector and Drain Tester: J. W. SEAGER. Rodent Operative: N. HAMBLIN. 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 the 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. Slate Registered Children's Nurse. 11. Unestablished or Temporary Staff. 9 To the Mayor, Aldermen and Councillors of the Borough of Bromley. Mr. Mayor. Ladies and Gentlemen, This is my 29th Annual Report on the Health of Bromley and it covers the year 1953. Except for the historical fact that 1953 was the 50th Anniversary of Bromley's Incorporation, the Public Health year has been uneventful. The body of the report is largely statistical and indicates the work of the Health Department during the twelve months. The Vital Statistics show little change compared with previous years and continue to compare favourably with those of like Authorities. A digest of the 1951 Census figures gives a useful form of comparison with other neighbouring Authorities, Chislehurst and Sidcup. and Orpington, for which 1 also act as Medical Officer of Health. It is upon such figures as these, that one can interpret the need towards which social and other Health Services should be directed. From these extracted figures one notes that Bromley has 8.2% of her population under 5 years of age, compared with 9.9% in Chislehurst and Sidcup, and 6% in Orpington, and at the other end of the age group Bromley has 12.6% over 65 years of age, compared with 8.1% in Chislehurst and Sidcup, and 10.4% in Orpington. Taking Bromley figures alone, 5.266 were under 5 years of age. while there were 8.093 from 65 years and over. It will be interesting to see how these figures will compare with the next Census, especially as the population figure for Bromley seems to be rather static. In the Census of 1931 7% of Bromley's population were under 5 years of age, whereas 7.7% were over 65. The Registrar General has a method of classifying the population over 18 years of age into five social classes according to their occupation, and the following table is of interest and self explanatory. Bromley Chislehurst & Sidcup Orpington Number over 18 years of age 21,234 27,918 21,153 Social Class I (Professional) 87 55 92 Social Class 11 (Intermediate) 234 171 240 Social Class III (Skilled) 515 556 494 Social Class IV (Partly Skilled) 89 96 94 Social Class V (Unskilled) 75 122 80 These figures are per 1.000 employed persons. 10 Overcrowding, i.e., persons living more than two persons per room, shows Bromley .93%, Chislehurst and Sidcup 1.65%, and Orpington .86%. There are 3,472 Bromley households sharing dwelling accommodation, which is twice that of Chislehurst and Sidcup, and nearly 3½ times that of Orpington. There are 3,560 households which have no fixed bath, while 2.466 households share a fixed bath with other households. These figures must be taken with some reserve, as they are liable to householders' misinterpretation in the completing of the Census papers. In my twenty-nine years service with you. there have been some remarkable Public Health changes, perhaps the outstanding one has been the reduction in the Maternal deaths and deaths of Infants. I believe this reduction in the Infant Mortality rate has been largely due to the teaching in the homes of the mothers, by trained and experienced Health Visitors. A reduction from 60 deaths per 1.000 births, to under 20 per 1,000 births is a remarkable achievement, but there is still a hard-core of neonatal infant deaths and still births which show little or no evidence of decline. We know that certain illnesses in the mother in the early stages of pregnancy have serious affects upon the embryo, but there is much that remains hidden. Here lies a source of work for those Authorities who are now responsible for the services to the Mother and Child. It cannot be too often repeated that we tend to work too long on a pattern laid down so many years ago. The second great change has been the development of a public consciousness of the importance of health. No longer do we tolerate dust producing dust carts, nor public notices "Do not spit." We now see food handled and produced in a hygienic state far advanced from the days when the milkman came round with a dip-can and dressed in a butcher's apron. The producers of food-stuffs provide for the public, factory wrapped food whenever this is practicable. The Italian ice-cream man and his monkey have gone from the streets. The producer of food has found that it pays to produce clean food in order to meet the public demand. For mere interest I am extracting a page from my report for the year 1926, which I think is a fair comment on the progress made in the past 28 years. "Clean handling and protection of food from fly and dust contamination should be the principle of all buying and selling. The public are still prepared to accept unprotected meat, unwrapped bread, unbottled milk and to buy dust and fly contaminated sweets, fruit and vegetables. Food stalls, especially fish, should be abolished from the open-air market." 11 "Admittedly there are some shopkeepers in Bromley who make food protection a principle of their trade—many of their principles could be well copied by other traders in food stuffs. Not all butchers in Bromley have the closed shop windows; not all take sufficient action against fly contamination, but there is improvement and the public are beginning to demand the principles governing purity in their food supply. This is typically demonstrated by the increased demand for graded milks. The antiquated and unhygienic method of delivery by can is discouraged—a polished urn does not always indicate clean milk inside." The third change that I would record is the improvement in the stature of the school child who no longer comes to school dirty and verminous. No longer do you see ringworm of the scalp at the school clinics, nor rickets, nor gross malnutrition, nor grossly neglected dental hygiene. And finally, the change in Infectious Diseases. Diphtheria has disappeared from our returns. Scarlet Fever is not now a killing disease. Typhoid Fever is rare, and the common infectious diseases such as Measles and Whooping Cough show definite signs of decreasing virulence. Tuberculosis is well on the way to be conquered ; the incidence is falling in Bromley in spite of increased facilities in diagnosis, and its death rate reduced by 77%. It is indeed pleasing to have served the Health Committees through this period of years when the Public Health Service proved its worth, but it is still true that when one problem is solved another arises in its place; when the problems associated with the young mother and baby have been practically conquered, the problem of the care of the aged arises. What has been done in the Child Welfare Service can be done for the care of the aged and a field of work is wide open for prevention or for easing of incapacity of the aged. Our streets have been cleaned but we still have our dog nuisances and our atmosphere polluted. We have our clean food, but there are instances of carelessness in handling. We have not yet reached the stage of one house one family. The stress and strains of urbanisation have brought with them the stress diseases, cardio-vascular diseases, duodenal ulcers and other so called psycho-somatic diseases. Until we learn the way to live with these stresses, such diseases will continue to swell the death and sickness returns. We spend too much time in treatment by the way of the psychological approach, and not enough time in treating the cause and the building up of a family unity and discipline. There has been the great reduction in the Tuberculosis death rate, but we get an increase in deaths from Cancer of the Lungs. The air we breathe must be cleared of all carcinogenic factors. We must learn afresh that prevention of disease is a practical 12 undertaking and that treatment of disease cannot be the "end all" in a Welfare State. The Hospital Services should always have before them the part that they themselves can play in the prevention of the cause of disease for which the patient is being treated—cooperation alone is not enough. It is more than ever important that the General Practitioner should operate in the sphere of Preventive Medicine and Public Health service. I would end this introductory letter with a personal acknowledgment of the debt I owe to the members of my own staff, past and present, and to my fellow officers. I would record my indebtedness to the many Health Committees who have been so patient with my endeavours to advise as their Medical Officer of Health, and I would wish for nothing more than that my successor shall be treated as kindly. I am. Your obedient Servant. K. E. TAPPER. May, 1954. Medical Officer of Health. SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 14 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. The area of the Borough is 6,519 acres. Registrar General's estimate of total population (mid-year), 1953 64.590 Population at time of Census, 1951 64,178 Censal Increase, 1931/1951 16,480 Number of Valuation assessments as at 31st March, 1953: — (a) Houses and Flats:— Not exceeding £10 Rateable Value 344 £11 to £13 Rateable Value 553 £14 to £20 Rateable Value 4,881 £21 to £30 Rateable Value 6,989 £31 to £40 Rateable Value 2,622 £41 to £50 Rateable Value 1,452 £51 to £75 Rateable Value 1,293 £76 to £100 Rateable Value 408 Exceeding £100 Rateable Value 337 18,879 (b) Commercial 1,401 (c) Licensed Premises 40 (d) Entertainment and Recreational 87 (e) Public Utility 28 (f) Educational and Cultural 28 (g) Industrial 54 (h) Miscellaneous 218 Total 20,735 Rateable Value at 31st March, 1953 £778,033 Rateable Value at 31st March, 1954 £793,840 Estimated Product of a Penny Rate for the year ending 31st March, 1955, is £3,195 Vital Statistics. Live Births. Total. Male. Female. Legitimate 858 421 437 Birth Rate 13.6 (crude) per 1,000 total population. (Adjusted rate for comparison with other areas 13.9.) Illegitimate 22 10 12 880 431 449 Stillbirths. Total. Male. Female. Legitimate 16 6 10 Stillbirth Rate 0.25 per 1,000 total population and 17.9 per 1,000 (live and still births). Illegitimate — — — 16 6 10 Deaths. Total. Male. Female. 692 325 367 Death Rate 10.7 per 1,000 total population. (Adjusted rate for comparison with other areas 9.3.) 15 Deaths from Puerperal Causes. Puerperal Sepsis Nil Other Puerperal Causes Nil Deaths of Infants under 1 year of age. Total. Male. Female. Legitimate . 12 10 2 Illegitimate 1 — 1 Infant Mortality Rate 14.8 per 1.000 live births. 13 10 3 Death Rates of Infants under 1 year of age. All infants per 1,000 live births 14.8 Legitimate Infants per 1,000 live legitimate births 14.0 Illegitimate Infants per 1,000 live illegitimate births 45.45 Comparative statistics for the year 1953:— Birth rate (per 1,000 total population) Death Rate (per 1,000 total population) Infant mortality rate (per 1,000 live births) Live Births still Births Bromley 13.9 0.26 9.3 14.8 (adjusted) (adjusted) Chislehurst and Sidcup 14.6 0.34 10.5 24.0 Orpington 14.8 0.26 9.8 17.2 England and Wales 15.5 0.35 11.4 26.8* London Administrative County 17.5 0.38 12.5 24.8 * 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 1953. is 64.590. an increase of 240 over the year 1952. This population figure gives a density of 9.9 persons to the acre. The natural increase of population (measured by excess of births over deaths) for the year was 188. The population of Bromley has become almost static as records for the past eight years will indicate:— 1946 60,540 1947 62,640 1948 63,360 1949 64,140 1950 64,610 1951 64.550 1952 64,350 1953 64,590 BIRTHS The birth rate for 1953 is 13.6 per 1.000 total population (corrected rate for comparison purposes is 13.9) which is a decrease °n that of the previous year, and is below the rate of 15.5 for 16 England and Wales and 17.0 for the 160 County Boroughs and large towns, including London. 880 live births were registered during the year, there being 431 males and 449 females. 28 births less than in 1952. Rate for Bromley during the past ten years is:— Year. Bromley. 1944 16.5 1945 16.6 1946 19.4 1947 20.9 1948 16.4 1949 16.1 1950 13.8 1951 14.2 1952 14.1 1953 13.6 The average yearly birth rate for Bromley during the past ten years was 16.2. Illegitimate Births. The illegitimate birth rate, per 1.000 live and still births, for the year 1953, is 24.6. There were 22 illegitimate births (10 males and 12 females). Stillbirths. The total number of still births occurring in the Borough during the year was 16. This represents a still birth rate, per 1,000 live and still births, of 17.9 and a rate of 0.25 per 1.000 total population. The following tabulation gives the number of stillbirths and rates per 1.000 (live and still) births and comparative rates per 1.000 population with England and Wales for the past ten years:— Year No. of Stillbirths Rate per 1,000 births Rate per 1,000 population Bromley England & Wales 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 1952 18 19.4 0.28 0.35 1953 16 17.9 0.25 0.35 If one is interested in local statistics. I would refer to previous Annual Reports, especially 1944 and 1946, where I have discussed the problem of the continued high stillbirth rate in spite of the marked reduction of infantile mortality that has taken place since 1928. 17 DEATHS The total number of deaths appertaining to the Borough and registered during the year was 692. Of this number, 325 were males and 367 females. The Crude Death Rate for the year 1953 is 10.7 per 1.000 total population. (Corrected rate for comparison purposes. 9.3.) The rate for England and Wales is 11.4 and 12.5 for the Administrative County of London. Death Rates for Bromley for the past ten years are as under:— Year. Bromley, (crude) 1944 13.3 1945 12.5 1946 10.8 1947 11.7 1948 9.9 1949 10.9 1950 11.4 1951 11.4 1952 11.2 1953 10.7 An analysis of the ages at death shows that of the deaths registered:— Male. Female. 13 were under 1 year of age 10 3 1 was 1 and under 5 years of age — 1 3 were 5 and under 15 years of age — 3 2 were 15 and under 25 years of age 1 1 28 were 25 and under 45 years of age 13 15 156 were 45 and under 65 years of age 89 67 189 were 65 and under 75 years of age 103 86 300 were 75 years of age and over 109 191 325 367 CAUSATION OF DEATHS. Main causes of death in Bromley during the year 1953. together with comparative rates per 1.000 population for the last six years were:— 1948 1949 1950 1951 1952 1953 Cancer 1.8 2.2 1.9 1.98 1.77 2.38 Congenital Causes 0.2 0.1 0.12 0.09 0.16 0.11 Heart Disease 2.7 3.2 6.31 5.56 6.31 5.34 Infectious Diseases 0.01 0.05 0.015 0.062 0.031 0.03 Influenza — 0.08 0.03 0.11 — 0.11 Resp. Diseases (non-T.B.) 0.9 1.3 0.68 1.27 1.17 0.91 Tuberculosis 0.3 0.3 0.26 0.31 0.17 0.14 Once again the deaths from Tuberculosis are remarkably low. whilst the deaths from Cancer show an increase. 18 Other Causes of Death. There were 18 deaths from violence, including 5 suicides. 5 motor vehicle accidents and 8 other accidents which occurred in the Borough during the year 1953. Cancer of the Lung. During the years 1950/53. eighty-two persons have died of cancer of the lung. This cause of death has increased in recent years. In 1950 it was seventeen, and in 1953. twenty-nine. This increase may be due to better diagnosis, but the general opinion is that it is an actual increase of the disease throughout the country. No other form of cancer shows a like increase. Investigations as to the reason for this increase are actively proceeding under the direction of the Medical Research Council, and it is too early yet to say whether it is due to excessive smoking or to carcinogenic factors in the atmosphere. However, a field for prevention lies open. MATERNAL MORTALITY For the fourth year in succession, there were no maternal deaths in the Borough. Causes and rates of maternal mortality in the Borough, in five-yearly periods since 1911. are given below:— Five-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 — — — 1952 — — — 1953 — — — INFANTILE MORTALITY. The Infant Mortality Rate for the year is 14.8 per 1.000 live births. 13 infants died during 1953 before reaching their first birthday. Of this number. 12 were legitimate and 1 illegitimate. There were 6 neonatal deaths (under one month of age). In my previous Annual Reports for 1944 and 1946 I discussed Infantile Mortality and its analyses. What was said then applies now. UNEMPLOYMENT. I am indebted to the Manager of the Bromley Employment Exchange for the following information with regard to unemployment during 1953:— 19 "The following figures illustrate the rise and fall of unemployment in the area of Bromley Employment Exchange during 1953. as compared with the corresponding period in 1952:— 1953. Men. Women. 1952. Men. Women. 12th January 234 84 14th January 156 87 13th April 106 89 21st April 106 82 13th July 54 63 14th July 87 78 12th October 99 95 13th October 132 115 7th December 118 64 8th December 158 80 With the exception of the period at the commencement of the year when unemployment among Painters was high, unemployment has remained at a low level throughout the year and the customary rise in the last quarter of the year has been to a less marked degree than previously. Unemployment has not been so heavy during the last quarter among Painters, which may be due to either the exceptional mild weather during November and December or to the campaign to encourage employers and the public to spread decorating work more evenly throughout the year or possibly to a combination of both factors. Although one of Bromley's few factories (Viscose Development Company) transferred production to its Swansea establishment during the year, displacing about 60 workers, all these workers—excepting two—were absorbed into other industries with a minimum of unemployment. The percentage of unemployment in the area has remained well below the national figure of 1.4 throughout the year. Unemployment among men is. in the main, confined to the older or physically handicapped worker. Of the number registered on 7th December. 93 were over 40 years of age and 57 of these were 55 and over, whilst 43 of the men registered were disabled persons. Unemployment among women has remained at a low level with a customary rise during October mainly from women with domestic responsibilities who return to the employment field for a short period, or others on completion of seasonal employment at holiday resorts. Of the number registered as unemployed on 7th December. 20 were over 40 years of age, 13 of these being 50 and over. Nine of the women registered are disabled persons. Bromley is mainly a residential area with very little industry apart from the distributive trades and the unemployment position is therefore, to a considerable extent, dependent upon the industrial position in other areas. During the 12 months ending 18th November, 1953, 1.729 men and 1.571 women have been placed by this office into employment, a total of 3,300 which indicates an appreciable turnover of labour as compared with the amount of unemployment in the area." 20 LOCAL SICKNESS. A weekly return is received from the Regional Office of the Ministry of National Insurance, indicating for the area the first certificates of sickness benefit received at the Local Office. These figures give some indication of the major trend of sickness in the area, but must not be taken as being exact as the area for the Ministry statistics is mainly that of Bromley Postal district and not that covered by the Borough boundaries. The following information is given in respect of the year 1953 Four weeks ending. Total number of certificates received. Weekly Average. 27th January 1,895 474 24th February 2,752 688 24th March 1,214 304 21st April 805 201 19th May 732 183 16th June 592 148 14th July 608 152 11th August 533 133 8th September 511 128 6th October 699 175 3rd November 971 243 1st December 854 214 29th December 609 152 METEOROLOGICAL OBSERVATIONS The following information, which has been extracted from the records at the Climatological Station at Church House Gardens, has been furnished by the Borough Engineer:— Total rainfall during 1953: 22.52 inches. Mean maximum daily temperature: 58.04°F. Mean minimum daily temperature: 44.05°F. Highest maximum temperature: 89°F. (12th August). Lowest minimum temperature: 21 °F. (7th February). Lowest grass temperature recorded: 14°F. (7th and 8th February). OPEN AIR RECREATIONAL AMENITIES. A study of the vital statistics of Bromley will indicate that it is a healthy town. One of the contributory factors to this is undoubtedly the vision and foresight shown by the Local Authority in the provision of open spaces for the enjoyment of games and leisure. Further benefits are likely to accrue from the opening up of Norman Park as a pleasure ground and sports centre. If the vision of Norman Park as a sports arena comes to full fruition. 21 there will be provided facilities not only for watching and enjoying all types of sport of the highest standard, but more important still, first class opportunities for taking part in those sports with what should be very beneficial results not only to the bodies but also to the minds of the younger generation. Commons, Public Recreation Grounds and Gardens. 603 acres of land have been secured or reserved for public recreational purposes, representing 9.2 per cent. of the total acreage of the Borough. Acres. Roods. Poles. Bromley Public Golf Course 56 1 8 Church House Gardens 12 3 20 Elmstead Woods 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 2 1 4 Queens Mead Recreation Ground 10 3 15 South borough 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: Hayes (Old) Rectory Grounds 2 0 25 Hillcrest Open Space 0 2 0 New Street Hill Open Space 11 2 8 Norman Park 56 0 0 603 1 13 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 24 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. DISINFECTION. The disinfecting station is situate at Waldo Road Depot. Details of the work carried out during 1953 are as follow:— Disinfections: Premises visited 99 Rooms disinfected 102 Articles disinfected 493 Disinfestations: Premises visited 7 Rooms disinfested 21 Articles disinfested 28 Articles Treated. Articles Destroyed. Beds 5 4 Mattresses 89 11 Bolsters 16 — Pillows 213 5 Cushions 10 2 Blankets 116 — Sheets 19 — Eiderdowns 9 — Bedspreads 18 — Carpets 1 2 Chairs — 2 Miscellaneous 25 10 Total articles 521 36 In the case of disinfections, rooms and furniture are sprayed with Formalin, and Formalin candles are also burned. Articles are steam treated with a pressure of 5 lbs. per square inch. Bedding is steam treated with a pressure of 10 lbs. per square inch. Disinfestation of Premises. Rooms and furniture are sprayed with Zaldecide solution. Bedding and articles are steam treated. PUBLIC MORTUARY. The Mortuary is situate in South Street, at the rear of the Fire Station. During the year 1953. 42 bodies were taken to the Mortuary, of which 29 were received from hospitals. Inquests were held in 13 cases. 25 LABORATORY SERVICE. Routine medical and Food and Drugs samples are sent to the Laboratory at Maidstone. In cases of an urgent nature, specimens are sent to the Laboratory at Bromley Hospital, and I would once again record my sincere appreciation of the assistance given this Department by Dr. Keall and his Staff. Details of the swabs, specimens, etc.. sent to the Laboratories for examination and report during 1953, are as under:— Haemolytic Streptococci 253 Urine 3 Faeces 22 Food Samples, etc. 499 Water Samples 51 Miscellaneous 10 838 NATIONAL ASSISTANCE ACT, 1948. Section 47. It was not necessary to take any action under this section of the Act during 1953. Section 50. One case an unidentified baby—was dealt with under this Section. NURSING HOMES. (Public Health Act, 1936. Sections 187/195.) Five Nursing Homes are on the register at the present time. These Homes provide a total of eighty-seven beds for medical and surgical cases. The majority of the beds are occupied by aged sick or aged infirm patients. No maternity beds are provided. The Nursing Homes are inspected at frequent intervals, and during the past year there have been no matters which have called for action on the part of the Local Authority. Details of the Homes are as under:— Address No. of Beds No. of new patients received during 1953 Surgical Medical and Chronic 18, Blyth Road 25 — 42 42, Cambridge Road 8 — 7 17, Edward Road 12 — 22 24, Elmfield Road 10 — 8 47/51, Park Avenue 32 — 98 26 MEDICAL LOAN DEPOTS. The British Red Cross Society keep a full range of nursing requisites at their depot at 34a. Market Square, and these are available to Bromley residents upon request. A small charge is made for the loan of these articles. OLD PEOPLE'S HOMES. The following reports on the Homes run by Voluntary Associations and Public Authorities have been received:— "Dunoran," Park Farm Road, Bickley. I am indebted to the Medical Superintendent of the Home, which is run by the Bermondsey and Southwark Group Hospital Management Committee, for this report. "1953 has been little different from previous years, the Home has continued to cater for the young incurables, and eight beds have been reserved for the dying. Some of the younger patients were able to go to nursing homes by the sea for a fortnight's change, through the kindness of the Management Committee who gave a grant from the Amenity Fund. Several chronic invalids were admitted for a short period to allow relatives to have a much needed rest. We have been very grateful to the W.V.S. who have organised a weekly 'shop' for patients and given help to the staff in various ways. Voluntary helpers living near have also been in to visit lonely patients and help with letters and shopping. We should be grateful for more of this kind of help if Bickley residents could spare time" Bed complement of Home 38 Daily number occupied 37.8 Total number admitted during 1953 84 Number died 24 Number discharged 59 "The Vane," Denbridge Road, Bickley, and "Town Court," Wells Road, Bickley. These Homes are run by the Welfare Department of the London County Council, and the following details have been supplied by the Chief Officer of that Department:— "Town Court." "The Vane." Total number of beds 31 Residents on 31st December, 1952 30 Admissions during 1953 14 21 Discharges during 1953 14 19 Residents on 31st December, 1953 30 29 "Southwood," Residential Club, Oldfield Road, Bickley. The following report has been furnished by the Centre Organiser:— 27 "The W.V.S. Residential Club remains full and there is a long waiting list. A vacancy occurred during the year by one resident being removed permanently to a nursing home; this was filled by a man. We have had forty residents there since the opening six years ago. The ages vary from 67 to 91. Whilst they are still ablebodied and take a pride in the various jobs they do. i.e.. gardening, woodwork, odd jobs, sewing, knitting, handicrafts, etc., they are that much older. We attribute their well-being to the excellent care given them by the Warden, the good food and warmth of the house, their feeling of having a home of their own (their bed-sitting room) within the larger unit of the Club, and to keeping them occupied so that they feel they still have a contribution to make to the common good. The garden produce helps to keep a good supply of fresh fruit and vegetables and eggs, which we again feel to be a tremendous asset. It has been possible, by careful management, to maintain the fees at last year's level, i.e., £2 14s. 0d. The major proportion pay their own fees, some are subsidised by the Local Authority. A Library Service is run with the help of the Borough Library. Books are brought in and exchanged every fortnight. Billiards and entertainments of all sorts help to provide recreation." "Homefield" and "Elmwood," Southborough Road, Bickley. The Bermondsey Medical Mission run the above Homes, and I am indebted to the matron for the following information:— "'Homefield,' which functions as a half-way house between Hospital and Home, admitted 108 elderly women during the past year, the greater number being able to return to their own homes after varying lengths of stay. The year has been one of quiet consolidation. During the summer the main event was of course the Coronation, enjoyed with Television and a special tea. Kind friends also took small parties for short car rides into the country. Much valuable help has been given by members of the W.V.S. Their weekly visit with the 'shop' and serving of teas is a pleasure much looked forward to. 'Elmwood' was opened as an Old Ladies Home (Part III Accommodation), in December. 1952, and permission was given to accommodate fifteen persons until such time as an addition to the house was completed. The addition consisted of two four-bedded rooms on the ground floor and further washing and lavatory accommodation. This work is now nearly completed and it is hoped to increase the numbers to twenty-four in the near future. 28 The house is run in conjunction with 'Homefield.' so that any patients there who recover sufficiently, but are not able to return home, can be transferred to 'Elmwood' for permanent residence." "Greenhill," 5. Oaklands Road. This Home is run by the Brook Lane Medical Mission, and the General Secretary reports:— "The Home has been full throughout the year. There are twenty-two beds available, and during 1953. three new cases have been admitted. The old ladies have enjoyed several outings during the year. On Coronation Day they were invited to the home of a kind friend so that they could view the proceedings on Television, and later in the day a Coronation Tea was provided for them at 'Greenhill.' A coach outing was arranged a little later so that they could see the decorations, and during this trip, they had the good fortune to see the Queen. On another occasion the old ladies were taken to South Bank (Waterloo) by coach, and much enjoyed having tea by the river. Nearly all the residents have been away for holidays during the year, either to their relatives and friends, or to a Convalescent Home connected with the Mission." "Merevale," Bickley Park Road. This Home is run by the North West Kent Housing Society. Limited. Of the 35 residents, five are over 90 years of age. ten are between the ages of 85 and 90. and the average age over all is 84.4 years, which leads to the thought that attention will probably have to be given to recruiting younger entrants. Several of the residents have been in the Home since it first opened in 1947. "Armstrong House," 1, Southlands Grove, Bromley. This Home is run by the Save Our Souls Society, and the following report for the year 1953 has been received:— "Accommodation. Capacity 28 Weekly average numbers 27 Admitted during 1953 12 Present residents: Women 10 Men 17 Average Age 76 Source of Supply. During the year there was a total of only twelve vacancies and of these six were caused by the transfer of residents to hospital or other Homes on the understanding that ex-hospital patients or 29 similar nominees were offered a vacancy in the Home. Six vacancies during the year were filled by new admissions through the Welfare Officer. Kent County Council. There was no sign of the demand for accommodation lessening and many old people were refused admission every month. General Health. With an average age of 76 it is not surprising that the general health of the residents can only be described as fair. The fogs in 1953 caused considerable distress to the old people and although the mild weather at the end of the year proved beneficial, ailments common to old people frequently occurred. The nursing of chronically sick residents unable to obtain admission to hospital placed severe strain on the staff, and it is significant that of the twelve vacancies which arose six were the result of deaths in the Home. Medical Attention. In spite of many calls on their time, local Doctors with whom the old people are registered could not have been more helpful. Some residents are in constant need of medical attention and. as well as emergency visits whenever necessary. Doctors make routine weekly calls. Residents are referred to hospital for specialist examination ; a chiropodist visits the Home regularly and one resident has been supplied with a hearing aid. Recreation. Entertainment and Welfare. Local people and organisations take an increasing interest in the Home and the residents were invited to attend many concerts and parties during the year. Film shows and concerts were also given in the Home. Many of the residents were able to watch the Coronation ceremony on television and special Coronation gifts from the Bromley Borough Council and a donation to provide a special tea were greatly appreciated. The Bromley Ladies Circle hired a coach and took many of the old people to London to see the Coronation route. Another outstanding event was the gift of a television set at Christmas by the Members of the Bromley Ladies Circle. Religious Worship. Short informal services are held in the Home every Sunday evening by members of the Bromley Baptist Church. The Rev. Appleton holds communion service every month. Staff. Mrs. Grunberg and Mrs. Van Hemelryck continue as Matron and Assistant Matron. They are assisted by one non-resident Assistant, a resident cook, whose husband is handyman-gardener, and non-resident domestic staff. 30 Finance. During the Society's financial year ended 26th September. 1953. the total cost of maintaining the Home amounted to £3.300. against income of only £2.900. In addition £997 was spent on erecting an external fire escape and certain internal modifications. This work brought the loss on the Home for the year up to £1,400. Old People—Welfare. The Women's Voluntary Service do a tremendous amount of good work in this welfare service and the following details have been furnished by the Centre Organiser. Over 60's Clubs. These Clubs meet once a week and old people have the opportunity of meeting others, making friends, playing games, doing handicrafts, reading, etc.. and having a cup of tea together. Sick visitors take tea to those unable to attend. Clubs are held as under:— Bromley Common Over 60's Club, The Village Hall, Bromley Common. Monday, 2.30 p.m. Keston Over 60's Club, The Village Hall, Keston Monday, 2.30 p.m. St. Mary's Over 60's Club, St. Mary's Church House, College Road Wednesday, 2.30 p.m. Tylney Road Over 60's Club, Methodist Hall, Tylney Road Wednesday, 2.30 p.m. St. Augustine's Over 60's Club, St. Augustine's Hall, Southborough Lane. Thursday, 2.15 p.m. Hayes Over 60's Club, Hayes Village Hall, Hayes Thursday, 2.30 p.m. Freelands Road Over 60's Club, Presbyterian Church Hall, Freelands Road. Friday, 2.30 p.m. Shortlands Over 60's Club. Congregational Church. Martins Road. Friday, 2.0 p.m. Burnt Ash Over 60's Club, St. Andrew's Church Hall, Burnt Ash Lane. Friday, 2.0 p.m. Toc H Over 60's Club, Toc H, Hawkesworth Road. Bromley. Friday, 2.30 p.m. Meals on Wheels Service. An average of sixty meals daily are cooked by voluntary workers and taken out in insulated containers in W.V.S. vans to the sick and aged in the town, on recommendation of Almoners. Doctors. Health Visitors, etc. A Luncheon Club is run at the Meals Kitchen at St. Mary's Church House, College Road. Bromley, for mobile old people. These two services operate on Tuesdays. Wednesdays. Thursdays and Fridays. Welfare Work and Trolley Shops. These services are undertaken at the two London County Council Homes, and Dunoran, Homefield. and Lennard Hospital. 31 Wheel chairs are lent to those in need, and a list of capable partially trained women willing to do night nursing is kept at the W.V.S. Centre for the information of relatives in need. Church Army Home, Wells Road. Bickley. The following report has been received from the Sistcr-inCharge:— "The Church Army opened this Home in October. 1953. as a Hostel for unmarried mothers, where they could stay until their babies reached the age of two years. The Hostel staff look after the babies during the daytime, whilst the mothers are at work. It was felt that at the end of two years, if not before, the mothers would be able to make arrangements according to circumstances. either to return to their own homes with their children, or to marry, or to find posts or suitable lodgings where they could have the children with them. Since the opening of the Hostel, nineteen mothers have been accommodated, and of these, three have returned home, one has married, and two have moved to other areas. The mothers now in the Hostel were able to get suitable work reasonably quickly and satisfactorily, in some cases through the Bromley Employment Exchange. It is of course, a busy life for both the mothers and the staff, but it does mean that the mothers can be with their babies and look after them in the evenings and at week-ends, and also feel quite happy about their welfare during the day. Also, it is felt that the babies do get a good start in life, with a regular routine day by day. and their mothers' love, and it is this that makes the task of running the Hostel, although not always an easy one. both interesting and worthwhile." Rochester Diocesan Association for Moral Welfare Home, Blyth Road. The following report has been furnished by the Hon. Secretary:— "During the year 185 girls, women and children have been helped by the Association. 117 men and women came for advice and help upon different matters. 49 girls and 34 babies have been admitted and passed through the Refuge. Of this number. 40 were maternity cases, of whom :— 32 were admitted to Farnborough Hospital. 1 was admitted to Bromley Hospital. 3 were admitted post-natally. 4 were admitted to Diocesan Homes. 26 were Kent cases, 6 Sussex. 4 Lincoln, I each from Surrey, Notts, Bedford and Yorkshire. 32 Of those admitted to Hospital:— 12 returned home with their babies. 13 returned home and their babies placed for adoption with the C. of E. Children's Society. 2 entered the C.A. Mother and Baby Hostel at Bickley with their infants. 1 girl returned home and her baby placed in a residential nursery. 1 girl entered a L.A. Institution with her baby. 2 went into lodgings with their babies. 1 entered a domestic post with her baby. SHELTER CASES— 2 admitted for Probation Officers. 3 admitted for the Police. 4 applied for shelter. 5 girls were resident at the close of the year. 400 home visits have been paid. 1,105 interviews given. In addition to the above. 140 outdoor cases were dealt with. 1953. like its predecessor, has not been an easy year, the work inside and out being hampered by the lack of. and changes, in staff, which meant we were unable to do the work at full strength." HOSPITAL SERVICES. (a) Bromley Hospital, Cromwell Avenue. Provides a general hospital service with 133 beds. Bromley Hospital Maternity Units : 20. Masons Hill. Bromley. Has provision for 34 beds. Widmore Road. Bromley. Has provision for 20 beds. Chest Clinic. Situate at the rear of the main Bromley Hospital buildings, with entrance from Tiger Lane. (b) Leonard Hospitals, Leonard Road, Bromley. 56 beds are provided for infectious disease cases. The number of beds can be doubled in an emergency. Provision is also made for 24 beds for geriatric cases. All the above are under the control of the Bromley Group Hospital Management Committee, whose offices are at Farnborough Hospital. Farnborough. Kent. Veneral Diseases. Patients are referred to the various hospitals with special clinics for dealing with these diseases. COUNTY COUNCIL SERVICES. Home Nursing Service. There are 10 full-time Home Nurses operating in the Borough (1 male and 9 female). Home Nursing is provided on medical certification only, and is free. A day service only is given at the present time. 33 Domestic Help Service. Demands for this service are still high, especially for cases of illness in the home and for old people. The following is a summary of the cases in the Bromley area who received assistance during 1953:— Maternity (expectant mothers) 75 Tuberculosis 20 Aged 189 Others 319 Ambulance Service. The main ambulance depot is at 12. Hayes Lane. Bromley. At the present time there are 12 Radio-controlled Ambulances and 12 Sitting-case Cars available at this depot. Health Visiting. There are seven Health Visitors carrying out their duties in the Bromley area. These Health Visitors give fifty per cent, of their time to the School Health Service. In addition to their duties in connection with the School Health Service, they give advice on the care of young children, and to expectant and nursing mothers, and are responsible for the Maternity and Child Welfare Centres. Vaccination and Immunisation Clinics. Home Visiting. After Care. etc. Domiciliary Midwifery. Four Midwives are engaged full-time in domiciliary midwifery in the area. The services of the midwives are engaged direct by the patient, or through the patient's private doctor, and they act either as midwives or maternity nurses. Women's Welfare Clinic. This clinic is held on the second Thursday afternoon in each month, at North Clinic. Station Road. Bromley. Patients attending this clinic must be referred on medical grounds, and are seen by appointment. Facilities are restricted to nursing mothers. LOCAL CLINIC SERVICES. Ante-Natal Clinics. North Clinic, Station Road Every Monday & first, third & fifth Thurs. in month p.m. (New cases should attend Thurs.) Hayes School Clinic, George Lane Wednesdays p.m. Women's Welfare Clinic. North Clinic, Station Road Second Thursday in every month p.m. 34 Child Welfare Centres. North Clinic, Station Road Wednesday p.m. South Clinic, Princes Plain Tuesday p.m. William Morris Hall. Masons Hill Monday & Thursday p.m. First Aid Post, Southlands Road Wednesday & Friday p.m. Village Hall, Hayes Tuesday p.m. Village Hall, Keston First and third Thurs. in every month p.m. St. Andrew's Hall. Burnt Ash Lane Wednesday p.m. Minor Ailment Clinics (Schools). North Clinic, Station Road Monday to Friday a.m. South Clinic, Princes Plain Monday to Friday a.m. Medical Room, Hayes School Monday, Wednesday (except 1st in month) & Friday a.m. Medical Room. Pickhurst School First Wednesday in month & every Tuesday & Thursday a.m. Medical Room, Quernmore School Wednesday & Friday 11 a.m. Medical Room, Burnt Ash School Monday to Thursday a.m. Medical Room, Southborough School Monday to Friday a.m. Medical Room. Aylesbury Rd. School Monday to Friday a.m. Dental Clinics. North Clinic, Station Road Monday to Friday a.m. & p.m. South Clinic, Princes Plain Saturday a.m. (Emergency treatments & appointments only.) Specialist Clinics. North Clinic, Station Road Ophthalmic (Appointments only)— Monday & Wednesday a.m. Friday p.m. Orthopædic (Appointments only)— First & third Friday in every month p.m. South Clinic, Princes Plain Speech (Appointments only)— Monday p.m. Lip Reading (Appointments only) Wednesday 5-6 p.m. Saturday 10 a.m. - 12 noon Immunisation. North Clinic, Station Road 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 Thursday 11 a.m. South Clinic, Princes Plain Wednesday 11 a.m. Medical Room, Hayes School Wednesday 11 a.m. St. Andrew's Hall, Burnt Ash Lane Wednesday 3 p.m. SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 36 SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. WATER. I am indebted to the Clerk, and the Director of Water Examination of the Metropolitan Water Board, for the following information on the supply of water to the Borough during the year 1953:— "No new source of public water supply has been instituted in the Council's area during 1953, and there have been no extensions of trunk mains, but 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. Tables giving the average results of the chemical and bacteriological analyses of the various supplies to the area for 1953 are attached." 37 Results of the Chemical and Bacteriological Examination of the Water supplied to Bromley during the year 1953. (Parts per million unless otherwise stated.) Shortlands Well West Wickham Well Orpington Well Thames-derived filtered water (Walton) Chemical. No. of samples 8 3 4 1766 Ammoniacal Nitrogen 0.003 0.012 Nil 0.012 Albuminoid Nitrogen 0.022 0.023 0.025 0.081 Oxidised Nitrogen—Nitrate 4.7 5.5 6.7 3.3 Chlorides as Cl 15.5 14.3 15.4 26.8 Oxygen abs. from Permanganate 4 hrs. at 27°C 0.12 0.13 0.09 1.02 Turbidity in terms of Silica Nil Nil Nil 0.2 Colour m.m. brown 2 ft. Tube Burgess's Tintometer Nil Nil Nil 12 Hardness (Total) 283 251 281 259 Non-carbonate Hardness 68 32 47 64 pH Value 7.2 7.2 7.2 7.9 Magnesium Mg 3.9 2.7 3.1 4.0 Silica Si02 16 15 15 10 Sulphates S 04 41 9 15 49 Oxygen Saturation % — — — — B.O.D. 5 days at 65°F. — — — — Conductivity 500 450 500 500 Bactcriological Results. Before Chlorination (Raw Water). No. of samples 493 — 249 7930 Plate count (Average per millilitre). Colonies counted on Agar: 22°C. (3 days) 1.9 — 1825.6 - 37°C. (20-24 hrs.)0.1 — 34.4 Bact. coli test: Percentage samples negative in 100 ml. 99.8 — 99.6 68.8 Average number per 100 ml. 0.004 — 0.008 2.10 After Chlorination (Water passing into Supply). No. of samples 253 213 255 3488 Plate count (Average per millilitre). Colonies counted on Agar: 22°C. (3 days) — — — — 37°C. (20-24 hrs.) — — — 13.5 Bact. coli test: Percentage samples negative in 100 ml. 100.0 100.0 100.0 99.9 Average number per 100 ml. Nil Nil Nil 0.001 DRAINAGE AND SEWERAGE A contract was commenced, at the end of the year, for the relaying of a length of the main soil sewer in the vicinity of Westmoreland Road. No other works of major importance have been carried out during 1953. 38 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. During the year twenty-three individual cesspools were emptied by the Borough Engineer's Department upon the request of the householders. RIVERS, STREAMS AND LAKES. No work of major improvement was carried out during the year. The Sanitary Inspectors made 28 visits of inspection during 1953. Four nuisances were found, of which three had been abated at the end of the year. SWIMMING BATHS AND POOLS. The Sanitary Inspectors made a total of 70 visits of inspection to Swimming Baths and Pools in the Borough, and 44 samples of water were taken for examination. Results of examination of these samples are given below:— Eight samples taken from Corporation Swimming Bath. Seven were satisfactory and one unsatisfactory. 36 samples taken from privately-owned Swimming Baths and Pools. 31 were satisfactory and five unsatisfactory. 99 routine colometric tests for checking the efficiency of purification plants were also made. The Chlorine content and pH value are checked by means of a Lovibond Comparator. No improvements or alterations were made to the Corporation Open Air Swimming Bath during 1953. PUBLIC CLEANSING, REFUSE COLLECTION AND DISPOSAL. There is no change to report under this heading. FACTORIES ACTS, 1937 AND 1948. A total of 323 inspections and re-inspections were made during the year and 74 nuisances and defects were found. There were 97 nuisances and defects remedied during 1953 (this figure includes those which were outstanding from the previous year). In addition to the above. 81 inspections were made of outworkers' premises, all of which were found to be satisfactory and no nuisances or defects were found. When visiting factories which provide canteens, opportunity is taken of discussing with the canteen staff the various requirements needed to maintain a good standard in food hygiene. The following is a copy of the return relating to the year 1953. which has been supplied to the Minister of Labour and National Service. 39 I. Inspections for purposes of provisions as to health. Premises Number on Register Number of Occupiers Prosecuted Inspections Written Notices (a) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by the Local Authorities 70 64 1 - (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 224 201 37 - (c) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) *86 58 4 - Total 380 323 42 — II. Cases in which Defects were found. Number of cases in which prosecutions were instituted. No of cases in which defects were: Referred Found. Remedied. To H.M. By H.M. Inspector. Inspector. Want of cleanliness (S.l) 16 21 — 5 — Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7)— (a) Insufficient 9 21 — 1 — (b) Unsuitable or defective 41 37 — 21 — (c) Not separate for sexes 3 2 — — — Other offences against the Act (not including offences relating to Outwork) 5 16 - - - Total 74 97 — 27 — * 1 Electrical Station (Sec. 103). 0 Institutions. 8 Building sites where more than one house erected (including four Corporation sites). 2 Sites of Engineering works for Corporation. 75 Sites—single private houses. OUTWORK: Nil. SANITARY INSPECTION OF THE AREA. Tables IX and X in the Appendix give full details of the work carried out by the Sanitary Inspectors during 1953. The following are the aggregate totals under the respective headings:— 40 Total No. of Inspections and Visits. Total No. of Defects and Nuisances found. Housing 4,447 1,148 Infectious Diseases 294 — Food Premises 3,241 223 Factories, Outworkers, etc. 581 89 Sampling Visits 353 — Trade Premises (Various) 653 77 Rodent Control 363 32 Miscellaneous 866 24 Total 10,798 1,593 In addition to the above, there were 1,286 interviews with owners, agents, etc.. on site and at the office, in connection with the above work. Notices issued:— Preliminary:— Housing 600 Food Premises 111 Factories, etc. 38 Trade Premises 20 Rodent Control 473 Miscellaneous 51 1,293 Statutory:— Housing 2 Total 1,295 Total number of Food Condemnation Certificates issued: 1414. SMOKE ABATEMENT. 67 inspections and re-inspections were made by the Inspectors. Four nuisances were found, and at the end of the year six had been remedied. (This includes those carried over from the previous year.) SHOPS ACT, 1950. 249 visits were made by the Inspectors. 61 defects and contraventions were found. 54 were remedied by the end of the year (including those carried over from 1952). As in the past, the principal contraventions concerned the absence of forms which should be exhibited. In no case was statutory action necessary. During the year, the Home Secretary considered recommendations from relevant associations with a view to extending the legislation by special regulations in respect of those places of employment considered in the Report of the Gowers Committee on Health. Welfare and Safety in Non-Industrial employment which fall to be dealt with by his Department. 41 PETROLEUM (REGULATION) ACTS, 1928 AND 1936. Mr. G. R. Woods is the Inspector appointed under the above Acts. Ninety-five licences were issued to store Petroleum Spirits and Petroleum Mixtures, and one for Carbide of Calcium. The total storage capacity licensed during the year ending 31st March, 1954, was:— Bulk Storage 117,980 gallons. Can Storage 2,109 gallons. Carbide of Calcium 300 lbs. 93 visits of inspection were made in connection with this work. Two contraventions were found and these were remedied immediately. A number of the new flame-proof electrically operated pumps were installed in lieu of the old pattern and the electrical wiring carried out in accordance with the Home Office Regulations. No accident has been reported during the year occasioned by the storage of Petroleum Spirit. VERMINOUS CONDITIONS AND UNCLEANLINESS. 24 visits to premises by Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. Six nuisances were found. During the year ten nuisances were abated (including those carried over from 1952). The very few cases of vermin infestation found in connection with the Council's Housing Estates were successfully dealt with. The continued low incidence of verminous conditions and unclcanliness is a source of gratification, especially when one considers the housing conditions under which many people arc living. PREVENTION OF DAMAGE BY PESTS ACT, 1949. Excellent work is being carried out by the two Rodent start who deal tactfully with the public. The following is a tabulation of their work:— 42 PREVENTION OF DAMAGE BY PESTS ACT, 1949. TYPE OF PROPERTY Local Authority Dwelling Houses Agricultural All other (including busi- Tout (1) (2) (3) (4) (5) 1. Total number of properties in Local Authority's District 8 19,177 29 1,861 21,075 11. Number of properties inspected by the Local Authority during the 15 months ended 31st March, 1954, as a result of (a) notification, (b) survey under the Prevention of Damage by Pests Act, 1949, (c) otherwise, e.g., when visited primarily for some other purpose (a) 4 652 8 138 802 (b) 1 2,121 12 172 2,306 (c) 2 113 9 74 198 111. Number of properties inspected (see Section II) which were found to be infested by rats Major — — 1 1 2 Minor 5 553 11 129 698 IV. Number of properties inspected (see Section II) which were found to be seriously infested by mice - 94 - 48 142 V. Number of infested properties (see Sections III and IV) treated by the Local Authority 5 647 12 178 842 VI. Number of notices served under Section 4: (1) Treatment - - - - - (2) Structural Works (i.e., Proofing) — — - — — VII. Number of cases in which default action was taken by the Local Authority following the issue of a notice under Section 4 - - - - - VIII. Legal Proceedings — — — — — IX. Number of "block'' control schemes carried out Business Premises 54 Private Dwellings 127 43 DISEASES OF ANIMALS ACTS. Mr. G. R. Woods. Animals Acts Inspector, reports:— There was a confirmed case of Anthrax in a Milch Cow in a Dairy Farm. The source of infection was not found. The carcase was disposed of by burning on the site and all other precautions were taken as laid down by the Anthrax Order. 1938. Anthrax is transmissible to humans. 54 Statutory Orders were received during the year, and 23 licences issued. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. 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 Bye-laws. RAG, FLOCK AND OTHER FILLING MATERIALS ACT, 1951. The importance of clean fillings in relation to Public Health is acknowledged by this enactment and the introduction by the British Standards Institution of Standards of Cleanliness which are now enforceable. Four informal samples were procured, three conformed to the standards laid down. One sample of cotton felt showed the True Trash Contents as 8.4% in lieu of 7.5%, but the Analyser Trash Content. Moisture Content. Oil Content and dust index met the requirements of British Standard 1425—1951. Information of the result of this sample was given to the Health Department in whose district the cotton felt originated. PET ANIMALS ACT, 1951. During the year nine premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and other fish. 53 visits of inspection were made by the Inspectors and three nuisances and defects found, of which two were remedied by the end of the year. In no case has it been found necessary to attach any special conditions (other than the general conditions) to any licence which has been issued. RETAIL MARKET. The Corporation owns the Retail Market under a Charter of Market Rights (granted 20th July, 1477). The Market is held on Thursday of each week at the Car Park, Station Road. The 44 administrative supervision is under the Health Committee and the Market is controlled by the Market Superintendent. The Market Tolls collected during 1953 amounted to £523 19s. 9d.. which is an increase of £64 9s. 3d. on the corresponding figure for 1952. MOVEABLE DWELLINGS. During the year four licences were granted, embracing a total of twenty-three caravans. Frequent visits of inspection to the four sites were made by the Sanitary Inspectors, and no nuisances were found. SECTION D. HOUSING. 46 SECTION D. HOUSING. HOUSING INSPECTIONS AND ABATEMENTS. Statistical details of the work carried out by the Sanitary Inspectors during the year 1953. will be found in Tables IX and X in the Appendix. The following is a summary of the work relating to housing:— Inspections. Reason for Inspection On Complaint Routine ReInspections Total Inspections Nuisances found For Nuisances 803 147 3,141 4,091 1,110 Overcrowding 43 104 14 161 3 Verminous Conditions 7 7 10 24 6 Dirty Conditions 6 5 6 17 4 Water Supply 7 — 5 12 3 Disinfestation 11 6 11 28 5 Noxious Accumulations 8 4 2 14 6 Other Accumulations 11 13 26 50 11 Miscellaneous 3 41 6 50 — 899 327 3,221 4,447 1,148 Nuisances and Defects Abated. Drainage 318 Dampness 324 Water Supply 53 General Items 523 This figure includes defects 1218 outstanding from 1952 and abated during 1953. Rehousing. The following information, which has been furnished by the Property Manager, shows the position as at 1st January. 1954. PERMANENT HOUSING: Completed and occupied:— Units. Princes Plain 50 Coppice Estate 532 London Road Flats 78 Longfield Flats 18 Bourne Way Flats 66 Tylney Road Flats Hayes Place Estate 335 Purchased Properties 36 Under construction:— Units. Hayes Place Estate (Houses) 4 Hayes Place (Old Peoples) 48 Longfield Extension (Old Peoples) 9 Nichol Lane (Houses) 6 Blackbrook Estate (Houses) 74 47 Schemes prepared— Tenders awaiting Ministry approval:— Havelock Road (Old Peoples) 18 Bromley Park (Flats) 78 Blyth Road (Flats) 66 TEMPORARY HOUSING: Properties Units Occupied Prefabricated bungalows 325 325 325 Requisitioned properties available for occupation 336 669 669 Half-way houses and camps 8 125 119 669 1,119 1,113 Lettings during 1953. 1. (a) No. of permanent houses occupied during 1953:— Re-let 89 New properties 218 307 (b) No. of families accommodated in permanent houses during 1953 307 (c) No. of persons accommodated in permanent houses during 1953 1,157 2. (a) No. of premises requisitioned during 1953 Nil (b) No. of premises de-requisitioned during 1953 21 3. No. of families on waiting list as at 31st December, 1953:— Medical Category 12 General Category 1,454 O.A.P. 171 1,637 In addition to the above. 102 houses were erected by private enterprise during the year 1953. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 50 SECTION E. INSPECTION AND SUPERVISION OF FOODS. There are some 627 food premises in the area, made up as under:— 49 Butchers 35 Bakers and Confections 104 Confections 15 Dairies 37 Fishmongers, Wet Dried and Fried 53 Green Grocers 114 Grocers 52 Restaurants 25 School Canteens 30 Industrial Canteens 20 Hospitals and Nursing Homes (including Old People's Homes) 36 Public Houses 13 Off Licences 20 Chemists 24 Clubs and Hotels 627 Approximately 165 premises within the area have been issued with a catering licence by the Ministry of Food. Food and Drugs Act, 1938. Section 14. 237 shops and food premises have been registered in accordance with this Section of the Act. as under:— Manufacture, Sale or Storage of Ice Cream. Preparation and Manufacture of Preserved Foods, etc. Bakers and Caterers 5 — Butchers' Shops — 42 Cinemas 1 — Clubs 2 — Confectioners, Tobacconists, etc. 90 — Dairies/Grocers 8 — Fish Shops (Wet) 2 — Fish Shops (Fried) — 8 Fruiterers and Greengrocers 10 — General Stores 6 — Grocery and Provisions 27 13 Ice Cream Stores 2 — Public Houses 1 — Restaurants, Cafes, Snack Bars 20 — 174 63 2 premises are registered for storage and distribution, 1 for the manufacture and 171 for the sale of ice cream. 63 premises are registered for the preparation or manufacture of Preserved Food, etc. 51 Milk and Dairies Regulations, 1949. 15 Dairies have been registered under the above Regulations. The following licences were issued by the Local Authority during 1953:— Dealers (Pasteurisers') Licence 1 Dealers' Licences: — "Pasteurised" Milk 15 "Sterilised" Milk 32 "Tuberculin Tested" Milk 15 Supplementary Licences:— "Pasteurised" Milk 14 "Sterilised" Milk 16 "Tuberculin Tested" Milk 14 Inspections. During the year the Sanitary Inspectors made a total of 3241 inspections and re-inspections of Food Premises. 223 defects were noted. A total of 239 defects were remedied during 1953—this figure includes those noted in 1952 which were remedied in 1953. The Inspectors took every opportunity during their visits to give advice on food hygiene to all those engaged in the preparation and handling of food. Talks were also given during the year to various Associations and Organisations on clean food practices. No formal action was taken by the Council during 1953. under the Byelaws adopted under Section 15 of the Food and Druss Act. 1938. 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. FOOD SAMPLING—FOOD AND DRUGS ACT, 1938 Article Samples taken. Result. Remarks Formal. Informal. Genuine. Adulterated. Barley Crystals — 1 1 — Batter Flour — 1 1 — Bev. (Coffee and Chicory) — 1 1 — Bloater Spread — 1 1 — Bread — 1 - 1 See (a) Brisling (Norwegian) - 1 1 - Bronchial Mixture — 1 1 - Browning for Gravies - 1 1 — Celery Cheese Spread — 1 1 - Certo Crystals - 1 1 - Cheese Spread - 2 1 1 See (b) Chicken Puffs - 1 1 Chocolate Mousse - 1 1 - Chop Sauce - 2 - - - Cocktail Onions - 1 1 - Cocoanut Marshmallows - 1 1 - Cocoanut Marzipan — 1 1 — Coffee and Chicory Essence — 1 1 - Coffee Spread — 1 1 — 52 Article Samples taken. Result. Formal. Informal. Genuine. Adulterated. Remarks Crab Paste — 1 — 1 See (c) Cream of Tomato Soup — 1 1 — Dessicated Soup — 1 1 — Devon Cream (Pure) — 1 1 — Digestive Peppermint — 1 1 — Double Cream — 2 2 — Fish Cakes — 1 1 — Fish Paste — 4 4 — Flour (Self-Raising) — 1 1 — Fresh Cream (Double) — 1 1 — Fruit Sauce — 1 1 — Full Cream — 1 1 — Glace Cherries — 2 2 — Grated Parmesan Cheese — 1 1 — Ham and Veal Rissoles — l 1 — Horseradish Sauce — l 1 — Ice Cream (Loose) — 1 1 — Ice Cream (Pre-packed) — 48 47 1 See (d) Ice Cream (Choc. Pre-packed) — 2 2 — Ice Lolly — 3 3 — Jam (Blackcurrant) — 1 1 - Jam (Damson) — 1 1 - Jelly Creams — 1 1 - Junket Essence — 1 1 - Kiddicalm Travel Sickness Tablets — 1 1 - Lemonade Cubes — 1 1 - Lucozade — 1 1 - Lung Tonic Pastilles — 1 1 - Malt Extract with C. L. Oil — 1 1 - Marmalade — 1 1 - Meat Paste — 3 3 - Metholated Bronchial Throat Tablet — 1 1 - Milk (Pasteurised) — 12 12 - Milk (Pasteurised Homogenised — 1 1 - Milk (Channel Island Pasteurise — 5 5 Milk (Channel Island T.T.) — 1 1 - Milk (South Devon Pasteurised) — 3 3 - Milk (T.T. Pasteurised) — 10 10 - Milk (T.T. Jersey) — 2 2 - Milk (Sterilised) — 9 9 - Milk (Yoghourt) — 2 2 - Milk (Condensed Full Cream) — 4 4 - Milk (Condensed Machine Skimmed) — 1 1 - Minced Meat Loaf — 1 1 - Mincemeat — 1 1 - Mixed Fruit Jellies — 1 1 - Molasses — 1 1 - Mustard Sauce — 1 1 - Nipits (Throat Pastilles) — 1 1 - Olive Oil — 3 3 - Opas Stomach Digestive Tablets — 1 1 — Orange Curd — 2 2 - Orange Squash — 1 1 - Pastry Mixture — 1 1 - Peach Puree (Strained) — 1 1 - Peanut Butter — 1 1 - 53 Samples taken. Result. Article Formal. Informal. Genuine. Adulterated. Remarks Peas (Strained and Homogenised) — 1 1 — Peel (Cut Mixed) — 2 2 — Pepper (White) — 4 4 — Quinine and Cinnamon Tablets — 1 1 — Rosehip Syrup — 1 1 - Rosena Rose Hip and Orange — 1 1 — Sage and Onion Stuffing — 1 1 — Salad Cream — 3 3 — Sandwich Spread — 1 1 — Sardines in Edible Oil — 2 2 — Sausages 1 2 3 — Sherry (British) — 1 1 — Soft Herring Rocs with Salt — 1 1 — Soups — 2 2 — Soya Flour — 1 1 — Spirit Vinegar — 1 1 — Sponge Mixture — 1 1 — Steamed Pudding Mixture — 1 1 — Sterilized Cream — 1 1 — Sugar (Demerara) — 1 1 — Sugar Pieces — 1 1 — Sugar (Raw Barbados) — 1 1 — Sugared Cocoanut — 1 1 — Swiss Roll — 1 1 — Synthetic Cream — 3 3 — Synthetic Cream Powder — 2 2 — Table Delight — 1 1 — Table Jelly — 1 1 — Tincture of Iodine — 1 1 — Tomato Juice Cocktail — 1 1 — Tomato Ketchup — 2 2 — Tomato Sauce — 2 2 — Vinegar (Malt) — 2 2 — Vinegar — 1 1 — Vitacream (Synthetic) — l 1 — Vita Glucose Tablets — 1 1 — Wine Gums — 2 — 2 See (e) Xmas Pudding — 2 2 — Zinc and Castor Oil Ointment — 1 1 — Totals 1 232 227 6 (a) Sample mouldy when received. Microscopical examination revealed the presence of numerous Fungal hyphæ and sponangia. (b) Fat 18.05. Moisture 58.3%. (c) Probable composition:—Crab 70. Water 18, Milk Fat 4. Starch Filler 7, Salt and Spice 1%. Starch Filler not declared. (d) Fat 10%. Total solids 31.6%. Sugar (Sucrose) 9.5%. Milk Powder 3.6%. (e) (i) Sweets contained small amounts of gritty matter of nature of sand and small amounts of unidentifiable vegetable matter. Inferior. (ii) Contained 0.054% insoluble sand and vegetable debris. Inferior. 54 BACTERIOLOGICAL EXAMINATIONS. Milk. No. of Samples taken. Description. Satisfactory. Unsatisfactory. 132 Designated Milk 132 — 8 Washed Bottles 8 — 140 140 - Icc Cream. Six of our small ice cream manufacturers have discontinued making and they now buy ice cream from reliable firms for resale. Another manufacturer has also discontinued but buys ice cream mix which is subjected to the freezing process on his premises. 97 samples of ice cream were submitted for examination, and the results indicate a very good standard obtained during the year. Pathogenic organisms have not been cultivated in any sample examined since the inception of the tests in 1947. No. of samples taken Description Satis. Unsatis. Methylene Blue Group I. II. III. IV. 4 Ice Cream (Loose) 4 — — 3 1 — 81 „ „ (Pre-packed) 81 — 65 8 8 — 6 „ „ („ Choc.) 6 — 2 3 1 — 6 Ice Lollies 6 — 5 1 — — 97 97 - 72 15 10 - Fifty-four samples were submitted for chemical examination, the lowest fat content being 4.5% and the highest 14.4%. Tabulation of 914 samples examined from 1st May. 1947. to 31st December, 1953:— Grade I. Grade II. Grade III. Grade IV. Total No. samples Total % No. samples % No. samples % No. samples % No. samples % 1947 (part) 13 17.8 18 24.6 17 23.3 25 34.3 73 100.0 1948 46 40.0 24 20.9 19 16.5 26 22.6 115 100.0 1949 108 53.0 52 25.5 28 13.7 16 7.8 204 100.0 1950 97 50.5 41 21.4 39 20.3 15 7.8 192 100.0 1951 110 84.0 11 8.4 8 6.1 2 1.5 131 100.0 1952 79 77.5 14 13.7 6 5.9 3 2.9 102 100.0 1953 72 74.2 15 15.5 10 10.3 — — 97 100.0 SPECIAL ENQUIRIES. Bacteriological investigation into complaints. Twenty samples of the undermentioned foodstuffs were submitted for examination:— Blanc Mange Powder Milk (T.T. Pasteurised) Bread Milk (Condensed Full Cream) Custard Powder Milk (Dried) Fruit Juice (Orange) Orange Juice (Concentrated) Groats Rock Lobster (South African) Honey and Lemon Squash Sausage Meat Jellied Veal Sugar (Raw) Muscavado Lemon Squash Wine Gums of these. 15 were satisfactory. 5 inferior or unsatisfactory. 55 22 samples of the undermentioned were submitted for bacteriologieal examination in connection with investigations associated with infectious diseases and reported food upsets:— Blanc Mange Orange Juice Cabbage Pork Sausage Meat in Pastry Coffee Cream Potato Gravy Shepherds Pie Icing Sugar Synthetic Cream Jam Unicream Mincemeat (Cooked) Water Milk Powder (Dried) Nineteen of these were satisfactory and three unsatisfactory. UNSOUND FOOD. One thousand four hundred and fourteen Food Condemnation Certificates were issued during the year, affecting in quantity 15 tons. 4 cwts.. 1 qtr., 11 lbs. of varied articles of food, which was returned through the Trade, utilised for manufacturing purposes or animal food, or where this was impracticable, destroyed. The corresponding figures for the year 1952 were 1.687 certificates and 30 tons. 17 cwts. 1 qtr., 24 lbs. of foodstuffs. Article of Food. Approximate weight (lbs.) Baby Food 20 Cakes and Cake Mixtures 945½ Cereal 150¼ Cheese 16¼ Eggs 18 Eggs (Dried) 18¼ Fats 44 Fish (Fresh) 947 3/4 Fish (Tinned) 98½ Fish and Meat Pastes 20 3/4 Flour 462 3/4 Fruit (Dried) 48 Fruit Juice 151 3/4 Fruit (Tinned) 9,630 3/4 Jams and Marmalades 333 Jelly 29 Meat (Raw and Bacon) 9,617½ Meat (Tinned) 2,660 Milk (Tinned) 518 3/4 Mincemeat 38½ Pickles and Sauces 6,589 Poultry 177½ Puddings and Pudding Mixtures 37¼ Rabbits 471 Soft Icing 95 Soups (Tinned) 67½ Sweets 216¼ Vegetables 629¼ Miscellaneous Items 21 34,073 56 MEAT INSPECTION. Only two of the five existing slaughterhouses in the Borough are used at the present time. Slaughtering is carried out on behalf of local pig-keeping clubs, etc. No other slaughtering of animals is carried out in the area, regionalised slaughtering still being in operation. 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 1953:— Carcascs 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 - — - — 1 Carcases of which some part or organ was condemned - - - - 1 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. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 58 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. One thousand five hundred and ninety-two eases of infectious diseases (exeluding tuberculosis) were notified during 1953. as against seven hundred and eighty-three during 1952. The increase was mainly due to a sharp rise in notifications of Measles and Whooping Cough. If we survey the last few decades, we are bound to be struck by the fact that such illnesses as Measles. Scarlet Fever. Whooping Cough. Diphtheria. Smallpox and Typhoid Fever, have either almost lost their terrors or have become so infrequent as to cause our security measures to appear rather superfluous and unnecessary. From the Public Health point of view, this is not so. While we may perhaps claim some of the credit for the cliangc. there are always other infectious disease problems cropping up which continue to baffle us. Foremost in the public mind during recent years, is the question of Infantile Paralysis which up to now has not revealed to us the mystery of its actual method of spread. This being so. we are unable to apply any specific counter measures, but only those applicable, in a general way. to any infectious diseases. It is. however, desirable to point out to the anxious lay mind that the total number of cases notified in Bromley during the year 1953 was only 8. giving an attack rate of 0.12 per thousand population, and that there were no deaths from this disease. I have quoted these figures in order that this disease should be seen in its right perspective, but would not offer them as an excuse for any attitude of laissez-faire on our part. I am submitting a detailed report on a case of Typhoid which showed some interesting epidemiological facts. There was no extension of this infection but it caused considerable anxiety at the time. Diphtheria has again not been reported and this may be one of the reasons why there has been a falling off in the number of children immunised. The falling incidence of Tuberculosis and of deaths from Tuberculosis is indicative that control over this dread disease is at last being exercised. The earlier diagnosis and the more effective treatment have played their part in the falling rates. It might be appropriate to consider in this general survey another infectious illness which this time is not notifiable—that is the common cold. On the whole I suppose there are few. if any. illnesses which receive less attention from the General Public, but few things cause more loss of man hours per year in business and industry at large. Until such time as an entirely satisfactory preventive agent has been discovered, a great deal remains to be done 59 by way of educating the public in the absolute necessity of keeping their colds to themselves. A deal of trouble could undoubtedly be avoided if only everybody were taught from the earliest possible moment to cough and sneeze direct into their handkerchiefs, and to keep separate from common use. eating and drinking utensils. These simple and elementary precautions would probably eventually lead to a reduction in all the infectious diseases. This appears as a trifling piece of advice, but if put into operation one hundred per cent, throughout the land, would probably produce surprisingly beneficial results to both the health and earnings of the country. With the changes that have occured in the incidence and severity of infectious diseases. I would again stress the need to revise the list of notifiable diseases by making appropriate deletions and additions; for instance, the value of notifying measles seems very doubtful under present conditions. The scope of true prevention does not lie with infectious diseases alone, but could well be directed. and I believe with like success, to other diseases which at present are common causes of invalidity and death. Statistical details of the notifiable infectious diseases are shown in Tables V. VI and VII in the Appendix. SMALLPOX. No cases were notified in 1953. Many contacts, or suspected contacts of cases came under supervision during the year, none of whom showed any evidence of illness. VACCINATION. The following figures have been furnished by the County Medical Officer, and show the number of persons from this area who were vaccinated against smallpox during 1953. Year of Birth Primary Vaccination Re-vaccination 1953 356 - 1952 252 - 1951 11 - 1950 6 1 1949 2 3 1948 4 4 1947 1 7 1946 1 4 1945 1 2 1944 2 3 1943 1 3 1942 — 4 1941 — 3 1940 1 2 1939 1 1 Before 1939 34 118 Total 673 155 60 ACUTE ANTERIOR POLIOMYELITIS. Eight notifications of this disease were received during the year. Six of these cases were removed to hospital. Seven were paralytic and one non-paralytic. There were no deaths from this disease in Bromley. Months during which the cases were notified:— May—2. June—2. July—3. December—1. It was apparent that there were many other cases during the year who had the prodromal symptoms without reaching a diagnostic stage. Present state of the seven paralytic cases:— 1. Family moved from area—no information. 2. J.M. Had facial paralysis, which although not quite gone, is almost imperceptible. Is still under Doctor but is having no treatment. Otherwise no other ill effects or handicaps. 3. C.W. Still in Hospital. Likely to remain there for another year. Both legs affected. Up now for ½ hour each day. Has boots and will have caliper for right leg soon. 4. J.B. Child well and healthy. Right leg muscles affected. Attending Hospital twice weekly for treatment—wearing right leg walking caliper satisfactorily. Good home care. 5. L.M. In Hospital 6/52 and has recovered fully without any complications. 6. R.K In Hospital 6/52. Attended Hospital for remedial exercises twice weekly for 3/12 and has now fully recovered. 7. K.J. Was in Hospital 6/52 and had no complications from polio. SCARLET FEVER. This disease continues to be mild in character. One hundred and twenty cases were notified, giving an attack rate of 1.86 per 1.000 population. Twenty-seven of these cases were removed to hospital, the remainder being home nursed. There were 3 "return" cases. There were no deaths from this disease recorded in the Borough during 1953. The widely spread presence of Haemolytic Streptococci "A"—the causal organism of Scarlet Fever—makes notification of Scarlet Fever of little use in the control of infection. DIPHTHERIA. For the third year in succession, no cases were notified in the Borough. 61 DIPHTHERIA IMMUNISATION. The following figures have been furnished by the County Medical Officer, and show the number of children resident in the area who were immunised against Diphtheria during 1953:— Year of Birth Primary Inoculations Re inforcing inoculations 1953 56 - 1952 532 - 1951 53 - 1950 12 - 1949 12 21 1948 11 190 1947 48 261 1946 6 28 1945 3 46 1944 5 21 1943 — 128 1942 10 24 1941 1 2 1940 1 2 1939 — 1 Total 750 724 The following is a return of the number of children under the age of 15 years on 31st December. 1953. who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January. 1939). Year of Birth Last complete course of injections (whether primary or booster) 1049-1953 1948 or earlier 1939 356 278 1940 238 296 1941 309 270 1942 479 231 1943 555 69 1944 603 93 1945 564 192 1946 764 64 1947 798 93 1948 809 — 1949 609 — 1950 739 — 1951 723 — 1952 586 — 1953 56 — Total 8,188 1,586 The figure of 8.188 is equivalent to approximately 62% of the total population under 15 years of age. TYPHOID FEVER One case was notified and removed to hospital. An epidemiological episode of great interest occurred in connection with this case. The incident proved the value of Phage Typing in tracing the source of infection and also reinforced the 62 necessity for awareness of statements given on enquiry and for not coming to a too early conclusion as to the source of infection. The history is as follows:— The patient was 48 years of age and dangerously ill. Illness began on 28th January. 1953. A Consultant was called in on 8th February and diagnosed Typhoid, which he later confirmed by blood culture and stool on 9th February. Detailed Public Health enquiries began on the 9th February. These proved that the patient had been resident in the premises since 1938. Except for a weekend in Oxfordshire in 1940. she had not left the district at any time, nor had she taken meals or food otherwise than that provided on the premises. There had been no illness in the premises, either among the eighteen residents or among the four resident and seven non-resident staff. There had been no changes in staff or in the residents during the previous six months. The water supply was that of the Metropolitan Water Board; the premises were on main drainage except for the lodge which was on cesspool drainage. There had been no case of Typhoid in the district for the past five years, nor any case of Typhoid recorded as related to the premises. All residents and staff declared that they had never suffered from an enteric fever. The kitchen hygiene was good, but there was no provision for handwashing immediately available to the kitchen staff. No vegetables had recently been supplied from the garden of the premises which took some of the effluent from cesspool. It was apparent from the information and investigations that the infection was within the premises. We therefore first concentrated on the food handlers. Stool outfits were left for all staff and all residents, and it is of special interest to record that it was later found that the proprietor and his wife were the only ones who were unable to submit specimens. At these early stages of investigations, the water supply was examined. Moore's sewer swabs were laid in the effluent from the lodge cesspool—all of which proved negative to Typhoid. One of the first results of the pathological specimens to be returned on 12th February was a positive stool from a part-time dishwasher, who attended for two hours each evening. Her blood reaction indicated a carrier state, the Vi-agglutination being positive in 1/10 and her Widal negative. The conclusion reached was that here was the source of infection. The history of this young married woman was that she had been perfectly well during the past six months and had had no illness except about two and a half years ago when she had an attack of Dysentery. She had been employed in her job on a part-time basis for a few hours each evening since October. 1952. Her husband had served in the Middle East before her marriage two and a half years ago. Repeated stools and bloods taken from him and the child all proved negative. His blood reaction was as follows:— 63 Salm. Typhi H to a titre of 1 /40. Salm. Paratyphi A H to a titre of 1/160. Salm. Paratyphi B H to a titre of 1/160. It did not agglutinate: Salm. Typhi O. Salm. Paratyphi A O. Salm. Paratyphi B O. Brucella Abortus (Bang). Vi-agglutination test: Negative. At this stage the fact was accepted that this dishwasher was a carrier of infection, and that her attack of Dysentery was probably an attack of Typhoid. Except for the fact that no other case of Typhoid had occurred either in her present or previous employments. it seemed reasonable to conclude that the source of Infection in this instance was due to her. As was ultimately proved, these conclusions were wrong and premature. Cultures from this carrier and from the patient were sent to Colindale for Phage Typing—both proved on 24th February to be a Type "K." so that there was relationship between the two cases. An interesting and important fact was reported by Colindale—it was that their records showed no other recorded case of Type "K" in this country, except for one at Wincanton in 1942. Enquiries made in 1947 by Colindale. showed that this patient had been a transient visitor at the premises in Bromley for two nights prior to her attack of Typhoid in 1942. There were no cases of Typhoid in Bromley at that time. It was obvious from this Colindale Report that the conclusions arrived at with regard to the "dishwasher carrier "were to be negatived, and that within the premises there must be a long time resident carrier of Type "K" Typhoid. There were four persons still resident who were there in 1942. The Proprietor and his wife, the cook, and one other occupant. On this information, further stools, urine and bloods were taken. Those from the proprietress proved positive to Typhoid and her blood showed:— Widals Typhi H plus 1/160. Typhi O plus 1/20. Vi-agglutination positive 1/10. On close enquiries, the proprietress admitted that she had had Typhoid when resident in India in 1935. but that she had forgotten the incident until recently reminded of it by her daughter. Typing of her culture at Colindale showed that she was Type "K." Stool samples were not enforced from her in the first instance owing to Ihe early discovery of the "dishwasher carrier." It is surprising that a chronic carrier of Type "K" Typhoid since 1935 who had been a proprietress of residential premises since 1938 had not infected anyone except one person in 1942 who was a transient visitor for two nights, and a patient in 1953, who had been in actual residence since the beginning of 1938. 64 The "dishwasher carrier" was placed under restriction and treated with Chloromycetin and her blood continues to show negative Widals but Vi-agglutination remains at 1/10 - 1/20. Her stools have now been cleared of Typhoid Bacillus and she has been freed from restriction under the Infectious Disease Regulations. PUERPERAL PYREXIA. Fifty-four cases were notified, all of which were institutionally treated. This represents an attack rate of 60.3 per 1.000 total births. OPHTHALMIA NEONATORUM. No cases were notified. PEMPHIGUS NEONATORUM. No cases were notified. MEASLES. There was a sharp rise in the incidence of this disease, mainly during the first four months of the year. A total of nine hundred and sixty-eight cases being notified, as against three hundred and eighty-five cases for the previous year. This represents an attack rate of 15.0 per 1.000 total population. The majority of cases were in children under ten years of age. The distribution of the cases was fairly even throughout the Borough. Seven cases were removed to hospital, the remainder being home nursed. There were no deaths from this disease in the area. No effective epidemiological action can be taken by the Department because the unhappy practice has grown up among the General Practitioners that notification of measles is of no importance and therefore can wait his or her pleasure before notifying. No Home Visiting of measles cases is carried out. WHOOPING COUGH. Notifications of this disease also showed a rise as compared with the previous year, a total of three hundred and eighty-two cases being notified, as against one hundred and sixty cases for 1952. This represents an attack rate of 5.9 per 1.000 total population. Seven cases were removed to hospital and the remainder home nursed. There were no deaths from this disease recorded in the area. TUBERCULOSIS. Recordings in the Register for the year ended 31st December. 1953. are as under:— 65  Respiratory. Other forms. Total number of cases. M. F. M. F. On Register at 1/1/53 414 349 54 58 875 New cases notified during 1953 33 27 — 5 65 Number of cases coming to knowledge after death 1 1 - 1 3 Restored to Register — 1 — — 1 Inward Transfers 23 16 1 1 41 471 394 55 65 985 Deletions, deaths, removals, recoveries, etc. 23 13 — 1 37 Number of cases on Register at 31st December, 1953 448 381 55 64 948 The number of new cases notified during the year showed a decrease of 14 over the corresponding figure for 1952. There were 37 deletions from the Register as against 38 for the previous year. New Cases and Mortality, 1953:— Age groups New cases notified or otherwise revealed. (Not including Inward Transfers.)* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 5 2 - - — — - - - 5—14 3 1 - 1 - - - - 15—44 16 24 - 3 1 1 - - 45—64 10 2 - 2 1 3 - 1 65 and over 4 1 - - 1 1 - - 35 28 - 6 3 5 - 1 *Inward Transfers 23 16 1 1 Totals 58 44 1 7 66 MASS RADIOGRAPHY. A Unit attended for public sessions at the Congregational Church Hall. Widmore Road, from 29th June to 28th July. 1953. when 5.577 people were radiographed. Of this total, 24 were probably significant new cases of tuberculosis for investigation, which is equivalent to a rate of 4.3 per 1,000 X-rayed. This is a reduced rate when compared with the previous survey in July. 1951. when 6.970 persons attended and 46 were discovered to be probably significant new cases of pulmonary tuberculosis for further investigation ; a rate of 6.6 per 1,000 X-rayed. This is a pleasing result and corresponds with similar reductions in other areas. FOOD POISONING. Three cases of Food Poisoning were notified during the year. These were all isolated cases and it was not possible to identify the agent responsible. OTHER INFECTIOUS DISEASES. In addition to the infectious diseases enumerated above, notifications were received as under:— Dysentery 10 Erysipelas 5 Pneumonia (all forms) 41 The Dysentery cases were all Sonnes dysentery and represent only a small number of those which occurred in this and other Local Authorities' areas. APPENDIX STATISTICAL TABLES. 68 STATISTICAL TABLES, 1953. 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—Seasonal Incidence. TABLE VIII.—Housing Statistics. TABLE IX.—Summary of the work of the Sanitary Inspectors. TABLE X.—Nuisances. Defects and Contraventions Abated. 69 TABLE I. Summary of Statistics, 1953. Population (mid-year 1953, per Registrar General) 64,590 Birth Rate 13.6 Death Rate 10.7 Maternal Mortality Rate Nil Infant Mortality Rate 14.8 Number of Births (Live) 880 Number of Stillbirths 16 Number of Deaths 692 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 13 Death Rate of Respiratory Diseases 0.91 „ „ „ Tuberculosis 0.14 „ „ „ Cancer 2.38 „ „ „ Zymotic Diseases 0.03 Notifications of Infectious Diseases: Scarlet Fever 120 Diphtheria Nil Poliomyelitis 8 Typhoid Fever 1 Puerperal Pyrexia 54 Pneumonia (all forms) 41 Tuberculosis (new cases) 110 Number of Deaths from Infectious Diseases 2 „ ,, „ „ Diarrhœa (under 2 years) 3 Number of visits by Sanitary Inspectors 10,798 70 TABLE II. Causes of Death. 1951 1952 1953 Total Male Female 1. Tuberculosis—Respiratory 18 11 3 5 8 2. „ Other 2 — — 1 1 3. Syphilitic diseases 6 3 — 1 1 4. Diphtheria - - - - - 5. Whooping Cough - - - - - 6. Meningococcal Infections — — — 1 1 7. Acute Poliomyelitis — 1 — — — 8. Measles 1 — — — — 9. Other infective and parasitic diseases 3 1 1 — 1 10. Malignant neoplasm, stomach 21 24 10 11 21 11. Malignant neoplasm, lung bronchus 22 14 24 5 29 12. Malignant neoplasm, breast 12 11 1 19 20 13. Malignant neoplasm, uterus 8 3 — 6 6 14. Other malignant and lymphatic neoplasms 65 62 35 43 78 15. Leukaemia, Aleukaemia 2 4 1 2 3 16. Diabetes 6 3 3 4 7 17. Vascular lesions of nervous system 84 102 31 55 86 18. Coronary disease, angina 80 104 71 45 116 19. Hypertension with heart disease 38 13 7 9 16 20. Other heart disease 133 143 46 56 102 21. Other circulatory disease 24 44 11 14 25 22. Influenza 7 — 3 4 7 23. Pneumonia 31 30 10 12 22 24. Bronchitis 40 39 15 15 30 25. Other diseases of the respiratory system 11 6 3 4 7 26. Ulcer of the stomach and duodenum 13 9 2 2 4 27. Gastritis, enteritis and diarrhœa 2 1 2 2 4 28. Nephritis and nephrosis 4 5 5 2 7 29. Hyperplasia of prostate 8 11 3 — 3 30. Pregnancy, childbirth, abortion — - — — — 31. Congenital malformations 6 10 5 2 7 32. Other defined and ill-defined diseases 59 47 22 40 62 33. Motor vehicle accidents 7 5 3 2 5 34. All other accidents 15 8 6 2 8 35. Suicide 6 6 2 3 5 36. Homicide and operations of war 1 — — — - All causes 735 720 325 367 692 71 TABLE III. Infantile Mortality, 1953. (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 Acute Bronchitis — - - - - — - — 1 1 Broncho-Pneumonia. — — — — — — 1 — — 1 Gastro-enteritis — — — — — — — 2 1 3 Malformation — — — — — 1 — — 1 2 Prematurity 5 — — — 5 — — - - 5 Other Causes 1 — — — 1 — — - - 1 Totals 6 - - - 6 1 1 2 3 13 72 TABLE IV. Analysis of Causes of Infant Deaths. 1946 -1953. 1946 1947 1948 1949 1950 1951 1952 1953 Total No. of Births (live) 1,170 1,304 1,042 1,030 892 916 908 880 8,148 Infant Mortality Rate (per 1,000 Live Births) 20.3 19.11 20.15 15.5 21.3 12.0 22.0 14.8 19.1 Malformation 3 13 — — — 1 — — 17 Prematurity 14 5 6 3 5 3 3 5 44 Respiratory Diseases 4 5 2 1 4 2 7 2 27 Marasmus& General Debility - - - - - - - - - Infectious Diseases 1 — — 3 — 1 - - 5 Gastro Enteritis — — 1 1 - - — 3 5 Convulsions - - - - - - - - - Atelectasis - - - 1 1 1 1 - 4 Congenital Heart Disease - - - 3 4 - 5 1 13 Other Causes 9 2 12 4 5 3 4 2 41 Totals 31 25 21 16 19 11 20 13 156 73 TABLE V. Notifiable Infectious Diseases, 1953. 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 59 61 - - 1 7 11 4 43 44 1 3 3 1 - 2 - - Whooping Cough 172 210 12 8 36 44 55 46 64 90 3 6 - 2 2 11 - 3 Poliomyelitis (Paralytic) 5 2 — — 1 1 — — 4 1 - - - - — - - - (Non Paralytic) — 1 — — — — — — — 1 — - - — - - - - Measles 472 496 8 9 87 104 145 119 225 255 — 1 4 4 1 3 2 1 Diphtheria — — — — — — — — — — — — - - - - - - 708 770 20 17 125 156 211 169 336 391 4 10 7 7 3 16 2 4 Under 5 5-14 15-44 45-64 65 and over Age Unknown Acute Pneumonia 20 21 3 1 2 3 4 5 1 5 9 7 1 - Dysentery 4 6 3 2 1 1 — 3 - - - - - - Erysipelas 2 3 — 1 - - 1 — - 2 1 - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - Puerperal Pvrexia — 54 - - - - - - - - - - - - Typhoid & Paratyphoid fevers - 1 - - - - - - - - - - - - Food Poisoning 1 2 - - - - - 2 1 - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - Tuberculosis— Pulmonary 58 44 2 — 4 3 35 37 13 2 4 2 - - Non-Pulmonary 1 7 — — 1 1 — 4 — 2 - - - - Malaria — — — — - — — - — - - - — — 86 138 8 4 8 8 40 106 15 11 14 9 1 - 794 908 74 TABLE VI. Notifiable Infectious Diseases, 1953. Ward Distribution, Attack and Mortality Rates. Disease Total WARDS Cases removed to Hospital Attack Rate per 1,000 population No. of Deaths Death Rate per 1,000 population Plaistow Martins Hill Town Sundridge Bickley Bromley Common Keston and Hayes Scarlet Fever 120 13 18 10 12 20 26 21 27 1.86 - - Whooping Cough 382 31 26 21 18 49 178 59 7 5.9 - - Acute Poliomyelitis (Paralytic) 7 - - 1 - 1 3 2 5 0.11 - - „ „ (Non-Paralytic) 1 - - - - - 1 - 1 0.02 - - Measles 968 108 66 45 66 155 316 212 7 15.0 - - Diphtheria - - - - - - - - - - - - Acute Pneumonia 41 7 8 3 2 9 9 3 13 0.63‡ 22 0.34 Dysentery 10 - - - 2 2 6 - 1 0.15 - - Erysipelas 5 - 1 - 1 1 2 - 2 0.08 - - Cerebro-Spinal Fever - - - - - - - - - - - - Puerperal Pyrexia 54 - - 93 - - - 1 54 60.27§ - - Typhoid & Paratyphoid Fever 1 - - - - 1 - - 1 00.2 - - Tuberculosis (Pulmonary) 102 14 10 11 15 15 19 13 22 1.58 8 0.12 „ (Non-Pulmonary) 8 2 - 1 2 1 1 1 5 0.12 1 0.02 Food Poisoning 3 1 - - - 1 1 - - 0.05 - - Ophthalmia Neonatorum - - - - - - - - - - - - Malaria - - - - - - - - - - - - Totals 1702 176 129 145 118 255 562 317 145 26.35 31 0.48 ‡ Includes Pneumonia (all forms). § Based on attack rate per 1,000 total births, and not population. 75 TABLE VII. Notifiable Infectious Diseases, 1953. Seasonal Incidence. Disease Jan. Feb. Mch. Apl. May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 11 5 19 14 8 7 16 5 5 9 11 10 120 Diphtheria - - - - - - - - - - - - - Measles 401 321 174 59 6 5 1 1 - - - - 968 Whooping Cough 52 51 86 60 31 23 29 26 8 5 9 3 382 Dysentery - - 1 - 1 2 1 - - 1 3 1 10 Erysipelas - - - - 1 1 1 - - - 2 - 5 Cerebro Spinal Fever - - - - - - - - - - - - - Pneumonia (all forms) 8 21 5 3 2 - - - - 1 1 - 41 Typhoid & Paratyphoid Fever - 1 - - - - - - - - - - 1 Acute Anterior Poliomyelitis - - - - 2 2 3 - - - - 1 8 Food Poisoning - - - - - - 1 - 1 1 - - 3 Puerperal Pyrexia 4 5 6 3 4 3 5 5 2 2 5 10 54 Malaria - - - - - - - - - - - - - Totals 476 404 291 139 55 43 57 36 16 19 31 25 1592 76 TABLE VIII. Housing Statistics for the year 1953. Total number of valuation assessments, houses and flats at 31st March, 1953 18,879 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) 552 (b) Number of inspections made for the purpose 4,091 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 - (b) Number of inspections made for the purpose - (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 333 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 594 Number of dwelling-houses demolished during the year Nil 77 TABLE IX. Summary of the Work of the Sanitary Inspectors for the year 1953. TYPE OF INSPECTION. On Complaint Routine ReInspec tion Total Visits Nuisances Found Housing— 1. Inspection of District Regulations — 38 — 38 — 2. For Nuisances 803 147 3,141 4,091 1,110 3. Overcrowding 43 104 14 161 3 4. Verminous Conditions 7 7 10 24 6 5. Dirty Conditions 6 5 6 17 4 6. Water Supply 7 — 5 12 3 7. Cesspools 2 3 2 7 — 8. Earth Closets 1 — 1 2 — 9. Privy Pails — — 3 3 — 10. Houses Let in Lodgings — — — — — 11. Disinfestation 11 6 11 28 5 12. Noxious Accumulations 8 4 2 14 6 13. Other Accumulations 11 13 26 50 11 Totals 899 327 3,221 4,447 1,148 Infectious Diseases- 1. Inquiry Visits (Nuisances found recorded in above table) 42 106 68 216 — 2. Disinfection Purposes 18 35 5 58 — 3. Smallpox Inquiries — 18 - 20 - 4. Public Health (Aircraft) Regulations - - - - - Totals 60 159 75 294 - Meat, Milk and Other Food Shops, etc.— 1. Butchers 8 849 13 870 20 2. Confectionery 5 93 22 120 15 3. Dairies and Cowsheds (excl. Past. Plants) — 62 5 67 3 4. Pasteurising Plants — 47 — 47 — 5. Fish 4 223 4 231 2 6. Fried Fish 3 82 19 104 16 7. Food Hawkers — 51 — 51 1 8. Fruit, Greengrocery 3 136 15 154 17 9. Grocery 13 542 51 606 30 10. Ice Cream Shops 2 174 38 214 8 11. Meat Regulations (Special Visits) — — — — — 12. Milk Examined on Highway — 7 — - — 13. Retail Market 1 61 4 66 — 14. Slaughterhouses — 16 — 16 — 15. Horseflesh Shops — 93 6 99 — 16. Restaurants 2 127 46 175 38 17. School Canteens 12 54 21 87 22 18. Public Houses — 16 12 28 3 19. Food Wholesaler — 11 1 12 — 20. Hotels — — — — — 21. Clean Food Byelaws — 172 6 178 25 22. Hospital Food Store and Kitchen — 2 — 2 — 23. Merchandise Marks Act — 101 1 102 23 24. Food Preserving Premises — 5 — 5 — 25. Cinemas - — — — — Totals 53 2,924 264 3,241 223 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 5 36 23 64 16 (ii) Factories not included in (i) to which Section 7 applies 16 88 97 201 41 (a) Subject to Local Authority (transfer of Enforcement) Order, 1938 - - - - - (b) Others 1 4 1 6 — Carried Forward 22 128 121 271 57 78 TABLE IX. (Continued) Type of Inspection On plaint Routine Re- Inspection Total Visits Nuisances Found Brought Forward 22 128 121 271 57 Factories, Outworkers, etc. Contd. 2. Other Premises under the Act (excl. outworkers' premises, hotels, Restaurants, etc. - 38 20 58 17 3. Bakehouses (a) Mech. power 3 50 32 85 10 (b) Non-mech. power - 12 6 18 1 4. Outworkers' premises 6 62 13 81 - 5. Smoke Abatement 12 16 39 67 4 6. Fireguards Act - 1 - 1 - Totals 43 307 231 581 89 Sampling of Food and Drugs- 1. Milk: T.T. Certified - 5 1 6 - T.T. Pasteurised 1 22 - 23 - Pasteurised - 43 - 43 - Sterilised - 13 - 13 - 2. Schools Milk (Pasteurised) - 13 - 13 - 3. Pasteurising Plant: T.T. Milk - 19 - 19 - Pasteurised - 23 - 23 - Cream - 5 - 5 - Washed Bottle - 6 - 6 - 4. Dried Milk 1 - - 1 - 5. Condensed Milk 1 5 - 6 - 6. Ice Cream - 67 - 67 - Ice Cream Mix. - - - - - 7. Other Foods 9 76 5 90 - 8. Food Poisoning 6 8 17 31 - 9. Drinking Water 1 2 - 3 - 10. Rag Flock - 4 - 4 - 11. Court Cases - - - - - Totals 19 311 23 353 - Trade Premises—Various— 1. Under Shops Act 4 193 52 249 61 2. Under Petroleum Acts 1 50 42 93 2 3. Registry Offices 2 50 7 59 5 4. Offices (P.H. Act 1936, Sec. 46 and 91) - 1 1 2 - 5. Pet Animals Act - 38 15 53 3 6 Rag Flock and Other Filling Materials Act - 14 2 16 1 7. Diseases of Animals Acts: Movement Licences - 2 - 2 - Foot and Mouth Disease - - - - - Swine Fever - 3 3 6 - Fowl Pest - - - - - Anthrax - 10 14 24 - Other - 1 - 1 - Interviews - 53 - 53 - 8. Piggeries, Cleansing 1 35 - 36 2 Sanitary Conditions - 14 - 14 - 9. Stables: Cleansing 1 10 7 18 1 Sanitary Conditions - 6 5 11 1 10. Animals, Keeping of 6 4 6 16 1 11. Poultry Farms - - - - - Totals 15 484 154 653 77 79 TABLE IX. (Continued) TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Rodent Control- 1. Trade Premises 4 60 126 190 13 2 Private Premises 43 54 63 160 19 3. Agricultural Premises - 6 2 8 - 4. Sewers - 3 2 5 - Totals 47 123 193 363 32 Miscellaneous- 1. Schools 1 4 2 7 1 2. Drain Tests: Smoke 5 22 1 28 3 Water 8 93 22 123 - Colour 2 5 - 7 - Chemical - - - - - Mirror - - - - - 3. Swimming Baths: Visited - 67 3 70 1 Samples taken - 44 - 44 2 Chlorine & Ph. Test - 99 - 99 - 4. Tents, Vans and Sheds 2 151 6 159 - 5. Accumulations (other than dwellings) 9 11 21 41 9 6. Streams and Ponds 6 15 7 28 4 7. Tips 2 6 1 9 - 8. Special Visits 42 127 7 176 2 9. Public Houses—Urinals - 62 2 64 2 10. Exhumations - - - - - 11. Fireguards Act - 11 - 11 - 12. Cinemas - - - - - Totals 77 717 72 866 24 Grand Totals 1,213 5,352 4,233 10,798 1,593 80 TABLE X. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1953. HOUSING Drainage- Premises re-drained and connected to sewer 5 Cesspools abolished 2 Earth closets abolished - Cesspools emptied 1 Privy pails, etc., abolished 1 Drains relaid or repaired 91 Drains unstopped 149 Inspection chambers provided 13 W.C's. provided (additional or separate) 3 „ buildings reconstructed — „ „ repaired — ,, pans renewed 23 „ „ cleansed — „ box seats removed — Soil vent pipes renewed or repaired 5 Sink/bath waste pipes renewed or repaired 10 Sinks renewed 2 Lavatory basins renewed or repaired 7 Baths 5 Baths Provided 1 318 Dampness- Roofs repaired or renewed 140 R.w.p.'s, guttering, repaired or renewed 72 Vertical Plinth provided 3 Walls rendered 21 Horizontal damp-course provided 4 Solutioning 3 Earth removed from walls — Walls repointed 25 Weather-board walls repaired — Sub-floor ventilation provided or improved 10 Dry areas constructed — Brickwork repaired 15 Miscellaneous 31 324 Water Supply- Drinking water service supplied direct from main — Fittings, etc. renewed 19 Separate or additional water supply provided - Supply reinstated 8 Flushing cisterns renewed or repaired 19 Storage tanks 6 Boilers 1 53 81 TABLE X. (Continued) General Items- Rooms cleansed 61 W.C. walls cleansed 2 Entrance hall and staircase cleansed 4 Bathroom cleansed 3 Light and ventilation improved 2 Plastering repaired or renewed 146 Floors repaired or renewed 37 Windows, frames, etc. repaired or renewed 40 Sashcords repaired or renewed 14 Putty pointing repaired or renewed 5 Doors repaired or renewed 14 Stoves and grates repaired or renewed 19 Coppers repaired or renewed 3 Handrails repaired or renewed 1 Stairtreads repaired or renewed 1 Dustbins provided 126 Dirty conditions remedied 1 Overcrowding abated - Chimneys repaired 9 External woodwork repainted 2 Food stores provided - Food stores ventilated - Yard paving renewed, etc. 2 Houses disinfested 9 Accumulations removed 20 Fencing 2 Miscellaneous - 523 MEAT, MILK AND OTHER FOOD PREMISES- Yard floors, repaired, etc. 7 Cleansed, lime-washed shops, rooms 79 Lighting/Ventilation improved 7 Drains improved 12 Manure or refuse removed 11 Refuse bins provided 6 Cold store or refrigerator improved 2 Water supply improved 4 Sinks provided 6 Washing facilities improved 22 Sanitary conveniences improved 24 Clean Food Byelaws 1 Miscellaneous 58 239 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 21 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) — Inadequate ventilation (Sect. 4) - Ineffective drainage of floors (Sect. 6) — Sanitary conveniences (Sect. 7): (a) Insufficient 21 (b) Unsuitable or defective 37 (c) Not separate for sexes 2 Other offences 16 Outworkers' premises - Smoke nuisances 6 103 82 TABLE X. (Continued) TRADE PREMISES— Shops Act: Ventilation improved — Temperature improved — Sanitary conveniences improved 2 Absence of statutory forms 43 Unsatisfactory Washing facilities remedied 1 Meals rest interval contraventions remedied — Seats for female workers provided 1 Other offences or defects remedied 7 Petroleum Acts contraventions 2 Registry Office contraventions 5 Offices (P.H. Act, 1936, Sects. 46 and 91) contraventions... 2 Pet Animals Act 2 Rag Flock and other Filling Materials Act 1 66 RODENT CONTROL— Trade premises 94 Private premises 389 Sewers (manholes) 205 Corporation property — 688 MISCELLANEOUS— Diseases of Animals Acts: Piggeries—Cleansing — Piggeries—Sanitary Conditions 1 Stables—Cleansing 1 Stables—Sanitary Conditions 1 Animals, Keeping of 3 Poultry Farms — Schools — Drain tests: Smoke — Water — Colour — Swimming Baths—visited 1 Tents, Vans and Sheds — Accumulations (other than dwellings) 13 Streams and Ponds 3 Tips — Public Houses—Urinals 1 Cinemas — 24 Grand Total 2338 NOTICES ISSUED— Preliminary: Housing 600 Food Premises 111 Factories 33 Trade Premises 20 Rodent Control 473 Miscellaneous 51 1,293 Statutory—Housing 2 1,295 BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1953 January, 1954 K. E. TAPPER O.B.E., G.M., M B., Ch.B., D.P.H. Medical Officer of Health 84 Members of the Welfare Committee. Alderman M. Stafford Smith. M.B.E.. B.A. (Chairman). Alderman Marion Green. J.P. (Vice-Chairman). Councillor F. G. Coates. Councillor F. G. Austin. Councillor J. L. Hunt. Councillor G. H. Russell. 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-lime. School Health Service. Medical Officer of Health Dr. K. E. Tapper 25% Deputy Medical Officer of Health Dr. H. B. C. Carter-Locke 50%* Assistant Medical Officers Dr. P. A. Currie 70% Dr. C. Maxwell 44% Part-time. Ophthalmic Surgeon Dr. Eric Lyle 3 sessions per week. Orthopædic Surgeon Mr. K. F. Hulbert 2 sessions per month. Dental Officers. Mr. A. F. King Whole-time. Mrs. C. McKenzie Lindsay Whole-time. Part-time. Mr. A. B. G. Smith 4 sessions per week. Clinic Assistants Whole-time. Mrs. E. Brooks Whole-time. Mrs. D. Harris Whole-time. Part-time. Mrs. M. Bloomfield 4 sessions per week. Health Visitors and School Nurses. Mrs. N. M. Taylor Miss W. G. Hemmings Miss E. Chenery Miss K. Owens 50% Mrs. V. Greig Miss M. E. Wootton Miss E. Hatch Part-time Officers. 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 ⅜ Mr. E. P. J. Wythe ⅜ Mrs. D. Cox ¾ Mrs. W. J. Foot ¾ Mrs. R. C. Tye ¾ * Includes duties in connection with Independent Schools. 85 To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen. School Health Service. The School Health Service has functioned normally throughout 1953 with no additional service added, and no service abandoned. It tends to run on routine, which may be taken as a bad sign, for static services are apt to deteriorate. I can. however, see no signs of deterioration, rather is there an increased effort of professional and non-professional staff to cope with the ever increasing number of children to be dealt with. The school population in 1953 was over 11,000, of whom 2,216 were in independent schools. There has been no additional staff to deal with these increases. This, my twenty-ninth Annual Report, gives the details of each branch of the School Health Service and there are special reports from each of the specialised officers. Included in the report is a full report of the Advisers of Physical Education. The School Health Service is now the only medical service for which the Local Authority (as an Excepted District) is responsible. This day to day administrative contact with the child and its parent is the basic reason why the service is so successful and so helpful in Bromley. It expresses in practice what is meant by a Delegated function, a principle which could well apply to other Health Services in Bromley to the advantage of the ratepayers. It is perhaps opportune that I should remind you of some of the successes of the School Health Service during the past 29 years. I do not claim that these successes are due to my efforts, for I have been merely the head of a loyal and efficient staff, professional and clerical, who have so ably carried out the instructions and wishes of the Committee members. Some of these Committee members are with us still, but some, like Mrs. Mann and Mrs. Lindsey Bell, have died during my years of office. There is a tendency to forget their good work. The School Health Service was founded on the principle that if you improved the health of the school child, you would not only improve its physique, but you would give protection against infectious disease, and would control the killing diseases of childhood. In 29 years, the Committee has seen these things happen. The child has increased in average weight and height. Diphtheria has disappeared from the yearly returns. Scarlet Fever is no longer a serious disease, and the common infectious diseases have lost their virulence and, except in some of the virus diseases such as Poliomyelitis, have almost ceased to cause anxiety. In the early 1920's no less than 14% of all deaths occurred under 15 years of age—to-day the percentage has fallen to less than 3%. These are merely the major successes—there are so many others, not the least of which is the greater attendance at school. It would, however, 86 be a little unfair to place the whole credit on the School Medical Service which between 1925 and 1948 was a service in administrative unity with that of the Maternity. Child Welfare, and environmental services. If credit is to be given, then the major part must be given to the Fathers and Mothers with whom I have worked so closely during these many years. It is they who must be the final judges of what is best for their children. At all costs the family must be the unit around which the services work, especially if we are to combat the diseases that come with the stress and strain of urban life. We must at the same time combat the tendency for bureaucracy to creep into the medical and social services. It is an insidious and infectious disease from which I hope I have managed to escape throughout these years of service. I am. Your obedient Servant. K. E. TAPPER. Medical Officer of Health. GENERAL INFORMATION. Numbers on School Roll. 1952. 1953. County Primary Schools 4,897 5,073 County Secondary Schools 1,897 1,987 County Grammar and Technical Schools 1,764 1,837 Total 8,558 8897 In addition there are 2.216 children on the Roll of Independent Schools. 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) Thursday a.m. South Clinic, Princes Plain Monday to Friday a.m. (Doctor in attendance) Wednesday a.m. Medical Room, Hayes School Monday. Wednesday (except 1st in month) and Friday a.m. (Doctor in attendance) 2nd, 3rd. 4th & 5th Wed. a.m. Medical Room, Pickhurst School 1st Wed. in month and every Tues. and Thurs. a.m. (Doctor in attendance) 1st Wednesday in month a.m. Medical Room. Quernmore School Wednesday & Friday 11.0 a.m. Medical Room, Burnt Ash School Monday to Thursday a.m. (Doctor in attendance) Thursday a-01- Medical Room. Southborough School Monday to Friday a.m. Medical Room, Aylesbury Road School Monday to Friday a.m. 87 Dental. North Clinic, Station Road Monday to Friday a.m. & p.m. South Clinic, Princes Plain Saturday a.m. (By appointment only.) Specialist Clinics. Ophthalmic. North Clinic, Station Road Monday & Wednesday a.m. Friday p.m. (By appointment only.) Orlhopædic. North Clinic, Station Road 1st & 3rd Friday in every month p.m. (By appointment only.) Speech. South Clinic, Princes Plain Monday p.m. (By appointment only.) Lip Reading. South Clinic, Princes Plain Wednesday 5-6 p.m. Saturday 10 a.m.-12 noon (By appointment only.) Attendances at the minor ailment treatment clinics again showed a decrease during the year 1953. a total of 5.159 being made. The main type of ailment treated, together with comparative figures for the four previous years, is shown below:— 1949 1950 1951 1952 1953 Ringworm, Body 13 7 25 6 5 Scabies 16 9 — — 3 Impetigo 45 36 26 8 21 Other Skin Diseases 646 397 457 372 276 Minor Ear Defects 508 222 240 197 105 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 2,926 2,413 2,277 1,973 1,268 A doctor attends one session a week at each of three clinics, and periodically each month at two others. Treatments are carried out by the School Nurses as need arises. Cases attending minor ailment clinics and requiring medical advice, are referred to the General Practitioner or to the clinic doctors at their visits. There is very close contact between the teaching and the medical staff. SCHOOL HYGIENE. During the year the new Infants School at Pickhurst was opened, provision being made for 360 pupils. A commencement has also been made on the re-building of the St. George's Bickley Infants and Junior School, and it is anticipated that this will be available for use towards the end of 1954. provision being made for 240 pupils. A modern school in this area will prove a most valuable asset in safeguarding the health of the school children, and will enable the use of the present highly unsatisfactory premises to be discontinued. 88 The provision of an additional classroom and lavatory accommodation at St. Joseph's School was completed during 1953. thus bringing these premises up to the required standard. There have been no other noteworthy improvements carried out during the year under review. School canteens have frequently been inspected during 1953. and the standard of cleanliness and personal hygiene of the workers has been encouraged and maintained. PERIODIC MEDICAL INSPECTIONS. Three thousand nine hundred and eighty-three children were examined at schools and clinics during the year, necessitating the holding of 298 medical inspection sessions. (1952 figures were 3.738 children and 286 sessions.) The average attendance at each session was 13.4 compared with 13.7 for 1952. and 13 during 1951. Three hundred and seven individual pupils were found to require treatment (excluding Dental Diseases and Infestation with Vermin), giving a percentage of 7.71 compared with 6.8 for 1952 and 9.6 during 1951. Information on the general condition of the pupils inspected in the various age groups will be found in Table II. B. at the end of this report. Comparative rates for the past five years are given below:— 1953. 1952. 1951. 1950. 1949. Category "A" (Good) 32.11% 50.08% 64.42% 68.35% 54.60% Category "B" (Fair) 66.28% 48.90% 34.63% 30.17% 43.65% Category "C" (Poor) 1.61% 1.02% 0.95% 1.48% 1.74% The above figures are given for information only and the interpretation of this classification of A. B. C. should not be taken too critically—they are based on an overall opinion on the child. Categories A and B are closely associated in type, and to make a comparison with previous years would be unreliable. The examinations have continued to show a satisfactory standard of health and general physique in the Bromley child, and the attendance of parents at routine medical inspections continues to be high. SPECIAL EXAMINATIONS. One thousand six hundred and thirty cases came under medical supervision during 1953. necessitating 2.070 medical examinations. (1.897 cases and 2.781 medical examinations during 1952.) Forty-eight cases requiring special investigation were examined at the Municipal Offices. Three hundred and two cases were referred to the various hospitals for Specialists' advice and treatment. 201 of which were Ear, Nose and Throat cases. 89 Once again I should like to express my appreciation and thanks for the assistance given by the hospitals and the General Practitioners. The close liaison which exists between them and this Department has done much in the build-up of the school health service. DENTAL SERVICE. The modernisation and re-equiping of the Dental Clinic at Princes Plain was completed and the clinic re-opened on 4th June. 1953. The services of a part-time Dental Surgeon were obtained during August, 1953. thus bringing up to full strength the dental establishment. North Clinic. Mr. King reports:— "The improved and more comprehensive dental service visualised a year ago has materialised. Outstanding progress has been made during 1953, this being the result of more frequent routine dental inspections at the schools. A considerably smaller number of serious defects is now encountered. Every child in the maintained schools allocated to the clinic has been inspected and, where parental consent has been given, treatment carried out during the past fourteen months. In future it is hoped that all children will be examined and treated at least once every year. Orthodontic treatment is being undertaken on a much larger scale and parents realise to a greater extent the importance of this branch of dentistry. Co-operation of both parent and child is being much more readily obtained. Considerable demand is made upon the Maternity and Child Welfare facilities provided, and all who presented themselves for treatment were restored to dental fitness. In August. Mr. A. B. Grantley Smith was appointed part-time Dental Surgeon and is rendering valuable help, especially in the treatment of the Grammar School children. He attends four sessions weekly. We extend our grateful thanks to the Radiologists and staff of Bromley Hospital for their willing co-operation and help during 1953. Statistical details of inspections and treatments will be found in the Tables at the end of the main report." South Clinic, Princes Plain. Mrs. Lindsay reports:— "The re-opening on 4th June, 1953, of the dental clinic at Princes Plain has added materially towards the aim of providing 90 a more fully comprehensive dental service for the school children of the Borough. The daily average attendance at this clinic has been remarkably good. As there was urgent need of conservative and orthodontic treatment owing to previous shortage of dental staff, this has been undertaken on a comparatively large scale. It has been difficult during this period to carry out full dental inspections owing to the amount of work involved in making children, under treatment, dentally fit. Maternity and Child Welfare dental clinics have also been well attended. In total 450 children under school age. nursing and expectant mothers, have been attended to. the latter receiving full dental treatment, including provision of dentures. The Head Teachers in the area have been most co-operative and have facilitated the work. Details of inspections and treatment appear in the Statistical Tables at the end of the main report." OPHTHALMIC CLINIC. I am indebted to Dr. Eric Lyle for this report:— "The Eye Clinic has continued to be held regularly on three half days per week throughout the year. The total number of new cases examined was 300. and the total number of cases re-inspected was 986. These figures are not quite up to last year's standard because of illness during the early part of the year which necessitated a certain number of sessions being cancelled. They are not far behind when one considers that there were 48 more new cases examined this year than last year. The drop occurred in cases for re-inspection, there were 129 less than last year. The total drop is therefore only 81. The work has consisted mainly of Squint management cases and Refraction cases, though patients with various other eye defects and diseases have been diagnosed and treated satisfactorily. Parents have co-operated well in all ways except one. This exception is the appalling unpunctuality of the cases in the early part of Friday afternoons. This causes undue waiting for the patients with appointments later in the afternoon. This matter is my only criticism, otherwise the Clinic runs smoothly. It is only by the efforts of the parents and children that the unpunctuality can be cured. I should like to express my sincere thanks to the Clerical staff for the wonderful help and support that I always get from them. Co-operation is obviously their watchword and no words of praise and thanks could be enough for them. Without their efficient administration the work could be very difficult, as it is the Clinic goes along in the happiest possible atmosphere." 91 At the present time there is a waiting list of approximately one month for new cases and nine months for re-inspections, except for those marked as urgent and to be seen within a specified time. The work of the Eye Clinic has increased tremendously in recent years, especially as so many out of district children attend Bromley schools and have to be seen at this Clinic. ORTHOPTIC CLINIC. During the past year 1.396 treatments have been given and 249 sessions held. These figures are lower than for the year 1952. and this is unfortunately due to prolonged absence due to illness of the Orthoptist and the difficulty experienced in obtaining the services of a locum. At the present time there is a small waiting list for both new cases and treatments. EAR, NOSE AND THROAT DEFECTS. Two hundred and fifty children received operative treatment in hospitals for adenoids and chronic tonsillitis. One child received operative treatment for mastoid. In addition to the above. 150 children received other forms of treatment at the school clinics and as outpatients at the hospitals. ORTHOPÆDIC CLINIC. I am indebted to Mr. K. F. Hulbert. F.R.C.S.. for the following report on this Clinic:— "The Orthopaedic clinics have continued at Bromley on the first and third Friday afternoon of every month. Attendances are about the same, but we have felt during the last year that considerable assistance could be given us from the physical training departments at schools. The treatment of poor posture is a question of re-education and this means daily treatment. As eight per cent. of the cases referred are from girls in the secondary schools, it is obvious that if there has to be any concentration of effort it should be in these schools. For a girl with poor posture to spend one lesson a week in the gymnasium doing routine exercises in the wrong posture is not only a waste of time, but is undoing whatever good may be done at the Physiotherapy clinic. It is therefore suggested that these children should receive more than their usual quota of attention, and what they really should have is daily supervision at school, in the art of standing and walking correctly. There has been no material change in the type of cases seen this year. Once again I wish to thank my physiotherapist. Mr. Taylor, for all his careful treatment and also for his enthusiasm." 92 PHYSIOTHERAPY CLINIC. Mr. Taylor reports:— "Another extremely busy and interesting years' work can be reported for 1953. Statistics show that a total of 2.507 children attended the clinic for remedial exercises, an increase of 241 on the previous year. The greater proportion attend for faulty posture, which appears rather prevalent in young children. However, a few weeks training in correct posture seems to benefit the children greatly. Every co-operation is obtained from the schools, both in attendance at the Clinic and in continuance of special exercises for certain conditions (chiefly posture) by the Physical Training staff of the schools. This is much appreciated. The Spastic children continue to make progress, this is. of course, very slow, but real improvement can be observed over a period of time. Two of these children are now able to attend a Special School at Catford and appear to be settling down very well —they still attend the clinic for treatment. The Sunlight Clinic has also had a very busy year, a total of 1.043 treatments being given, an increase of 260 over the previous year." SPEECH CLINIC. The Speech Therapy Clinic is held on Monday of each week at South Clinic, Princes Plain. At the end of the year there were 65 cases on the waiting list. Thirteen cases were closed during 1953. Of these, two were closed in view of the improvement made following contact with the clinic. In a third case there was considerable improvement in a stammer, but the stammer recurred at times; the mother found it too difficult to attend the clinic herself, and after a considerable time, during which an attempt was made to help the boy further without the full co-operation of the home, it was finally decided that, as no further progress was being made, the case would be closed. In two of the thirteen cases, appointments offered were not kept. In a further two. it was reported that treatment had been arranged elsewhere prior to appointments being offered, and in six cases it was reported by an Assistant County Medical Officer, or by the school or parent, that the condition had improved prior to appointments being offered. Eight cases were in contact with the clinic at the end of 1953, and will continue to attend the clinic in 1954. 93 VERMIN AND UNCLEANLINESS INSPECTION. A total of 17.478 inspections were carried out by the School Nurses, as under:— Primary and Secondary Schools 16,724 Grammar and Technical Schools 653 Occupation Centre 101 17,478 Five pupils were found to be infested, with a further 87 showing minor evidence of uncleanliness. HANDICAPPED CHILDREN. A special clinic is held at the Municipal Offices on Saturday mornings, and on other occasions as circumstances demand, to which handicapped and other children needing special examination are referred. During 1953, 48 special cases were examined, of whom 17 have been certified as handicapped and not suitable for education in ordinary schools. There are, at the present time. 61 known educationally subnormal and physically handicapped children in the area. Details of these children are:— Waiting admission. In residential schools for E.S.N. children 4 2 Attending day schools for E.S.N. children 19 1 In residential schools for Blind and Partially Sighted children 5 — In residential schools for Deaf and Partially Deaf children 2 1 Attending day schools for Deaf and Partially Deaf children 2 — In ordinary schools (Physically Handicapped Pupils) 2 — In residential premises for Physically Handicapped children 3 3 In day schools for Physically Handicapped children 4 1 In residential premises for Epileptic children — 1 In residential premises for Delicate children 3 — Attending day schools for Delicate children 1 — In residential premises for Mal-adjusted children 5 2 There are 23 known ineducable children in the area, nine of this number being in Institutions and 14 at home. CHILD GUIDANCE. Cases requiring treatment at the Child Guidance Clinics are referred to the local hospital Psychiatric Department. Eighteen cases were referred for treatment during 1953. MILK IN SCHOOLS. A return to the Ministry of Education showed that on a single day in October, 1953. 88.26% of the pupils in attendance at Primary and Secondary Schools received milk. 94 SCHOOL MEALS SERVICE. Further progress was made during the year with new Canteen provision and in April, the Kitchen and Dining Room for 375 meals daily at Valley Primary School was completed and taken into use. In September, an extension of the container service of meals to St. George's School. Bickley. was arranged to supply the temporary Junior Department opened at the former Day Nursery in Holwood Road. By the end of the year arrangements were complete for opening of the Canteen at Pickhurst School at the beginning of 1954. Until the new Junior Department is built the canteen will be equipped to serve 250 meals daily. It is becoming increasingly necessary to provide alternative Canteen Accommodation at Burnt Ash School and negotiations have been undertaken with the London County Council for the acquisition of land required for the purpose. It is hoped that the Ministry will give early approval to the erection of the new buildings so that the existing kitchen can be released for classroom purposes The provision of new Canteen accommodation at the Girls' Technical School, mentioned last year, is provisionally included in the 1955/56 Building Programme. Plans are also being prepared for a Kitchen for 500 meals daily at the proposed new Technical School for Boys, which is included in the Building Programme for 1954/55. Early in the year, the Ministry of Education decided for economy reasons that the cost of the mid-day meal should be increased to 9d. with effect from 1st March. 1953. This increase may be partially responsible for the drop in the number of children taking the mid-day meal but an additional factor may well be the relaxation of certain food controls during the year. Towards the end of the year the daily average number of meals dropped to 6.530. a reduction of approximately 500 a day compared with the corresponding period last year. A return to the Ministry of Education showed that on a single day in October. 68.12% of the pupils in attendance at Primary and Secondary Schools received a mid-day meal. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. One hundred and forty-seven children were examined by the School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in all but two cases. BROMLEY SCHOOLS' BOOT CLUB. The work of the Club progressed satisfactorily during the year 1953. Contributions received from members £536 Cost of purchases made during year £595 Number of purchases made during year 575 Total number of members at 31st December, 1953 595 95 PROVISION OF CLOTHING. During the year twenty-one applications were received, as a result of which thirty children of necessitous families were provided with clothing at a total cost of £65 18s. 3d. INFECTIOUS DISEASES IN SCHOOLS. There were no serious epidemics notified during the year 1953. The incidence of Measles and Whooping Cough showed an increase over that of the previous year. i.e.. 481 and 163 cases for 1953. as against 238 and 76 during 1952. Ninety-one cases of Scarlet Fever in school children were notified, as against 92 for the previous year. The infection was mild in character and the distribution of cases fairly even throughout the area. No cases of Diphtheria were notified during 1953. The following table gives details of incidence and number of cases of the various diseases notified which were admitted to hospital. Disease Total No. of cases No. admitted to Hospital Seasonal incidence Jan. Feb. Mar . A pl. May. june July Aug. Sept. Oct. Nov. Dec. Scarlet Fever 91 19 9 5 15 7 6 6 14 2 3 8 8 8 Measles 481 10 200 162 91 25 2 1 — — - — — — Whooping Cough 163 8 24 21 - 23 10 9 12 10 4 2 2 — Poliomyelitis (Paralytic) 5 5 - - - - 2 1 2 - - - - - Poliomyelitis (Non Paralytic) 1 1 - - - - - 1 - - - - - - Dysentery 2 - - - - - - - - - - - 1 1 Pneumonia 5 - - 2 - 1 1 - - - - - 1 - Totals 748 43 233 190 152 56 21 18 28 12 7 10 12 9 No child of school age was notified as having died of an infectious disease during the year 1953. Nine children of school age were notified as suffering from Tuberculosis, seven being pulmonary and two non-pulmonary. Of this number four cases were inward transfers from other districts. JUVENILE DELINQUENCY. During the year 62 children and young persons appeared before the Local Court. The types of offences were:— Larceny and attempted larceny 32 Wilful damage 2 Breaking and entering 6 Road Traffic Act 10 Wilful obstruction of footway 1 Causing unnecessary suffering to dog 1 Insulting behaviour 1 Beyond control 2 In need of care and protection 3 Breach of Probation and/or variations of Probation Order 6 96 PHYSICAL EDUCATION, 1953. The following is the report of the Area Advisors of Physical Education:— 1. General. In the review of Physical Education in the Schools of the Borough for the years 1948 and 1949 special mention was made of the wider conception of physical activities, exemplified in childcentred work and the individual approach and in informal methods of coaching and guidance by the teacher. These features have now been recognised as desirable by most schools throughout the country and are more in line with present teaching methods observed in other subjects of the curriculum. Whilst more generally accepted by the teaching profession, there is a tendency for the conservative lay-mind to regard the lessening of formal work, with its rigid formations and imposed discipline, as detrimental to the educational development of the individual and to the maintenance of standards. The recent editions of Physical Education in the Primary School. Parts I and II. published by the Ministry of Education, advocate the newer approach which develops a stronger and more lasting self-discipline and encourages self-reliance. Self-discipline properly achieved should provide the teacher with a well occupied group of interested children working quietly and steadily. In addition the good teacher unobtrusively and skilfully guides and controls the individual work of the children, who consequently very often attain higher standards than were previously possible. The present policy in Physical Education is thus found to promote more effectively the physical development of the child. Primary.—During 1953. physical activities in the Primary Schools have received considerable stimulus from the welcome introduction of "Planning the Programme." Part II of the Ministry of Education publication referred to above. The first book for Primary Schools. "Moving and Growing." dealt mainly with general principles of physical growth and development, while the second book gives more practical guidance for the teacher in framing his lesson. The additional climbing apparatus installed during the year has brought greater opportunity and increased the scope of the work of the daily lesson. When the apparatus is used regularly the beneficial effect of the strengthening work, particularly on the shoulder girdle and back muscles, is illustrated by the improved poise observed in the children. It will be understood that these effects are more obvious when surplus garments are discarded. If also shoes are changed for the lesson, complete freedom of movement is possible and a sense of adventure on the apparatus is cultivated. A very limited supply of plimsolls was made available by the Kent Education Committee during the year. Children not provided with suitable footwear owing to lack of 97 support from their parents were handicapped in their efforts in all branches of the subject and it is hoped that in the coming year more adequate provision will be possible to alleviate this difficulty. Secondary.—The strong work now so evident in the Primary Schools is desirable and should be continuous at the Secondary level. Many of the old established principles and much of the material previously accepted in gymnasia has now been replaced by less formal gymnastic work conducted on an individual rather than class approach. As. however, the training in the gymnasium forms the groundwork for all other branches of Physical Education, there will still be a paramount need for fully equipped gymnasia to be provided. In this connection the hygiene of the lesson should become a more positive part of the programme. It is pleasing to note that, where available, the regular use of shower baths has been conducive to much higher standards of cleanliness and self-respect. 2. Further Training of Teachers. The further training of teachers is an essential factor in the introduction of new ideas and methods of teaching. During the year, opportunity has been provided for attendance at the following courses — (1) A further Refresher Course in Modern Dance for men and women teachers. (2) Modern Dance Course for women teachers (mainly in Primary Schools) without previous experience of this branch of the work. (The movement training experienced in the above Courses should provide the groundwork for movement in most branches of physical education. The training of boys however seems to need the more objective training of techniques.) (3) Athletics for Secondary Girls. Week-end Course for women teachers. (4) Basket Ball Course for men teachers in Secondary Schools. In addition, dinner-hour talks have been given in many schools to introduce the new ideas and material advocated in the new Syllabus. In most cases the whole of the staffs are available at this time and common difficulties and plans can be readily discussed. At a later date, supplementary demonstrations showing different types of class work of good standard will be held at intervals. 3. Swimming. The continued co-operation of the Baths Department is greatly appreciated. Requests for accommodation are met whenever possible and facilities are used to their fullest extent. Any increase in the demand from the schools during the past few years has necessarily depended on the generosity of private owners or on public facilities outside the Borough. 98 Swimming Arrangements.—Provision was made for a session of ten weeks, using all facilities at present available. Schools. Attendances (each week). No. of Children. Secondary 49 classes of 25-30 children. 1,230 (approx.) per week. Primary 35 classes of 25 - 30 children. 1,050 (approx.) per week. Total 2,280 per week. A wider development of swimming in the Autumn Term has been possible and one class from each of six Secondary Schools attends throughout the term though it has not been financially possible to include all schools who would wish to benefit from the arrangements. Whenever qualified teachers are available, swimming instruction is taken by members of the school staffs. Two part-time men and three part-time women undertake limited periods of teaching service in the various swimming baths. It will be obvious that, although swimming progresses favourably, future extension must depend upon additional facilities which at present do not exist. A possibility for the future might be a swimming bath below the floor of the gymnasium in a Secondary School available throughout the Summer Term. An arrangement of this kind would probably result in a substantial reduction in expenditure since the building, changing rooms, hot and cold water and drainage are already provided for the initial building. Lack of facilities particularly for the Secondary Schools now limits full instruction. It is pleasing to note that a generous concession has been granted by the Downham Baths Committee. Bromley school children who normally receive instruction at the Bath will now be charged only half price when attending Downham Baths out of school hours. Individual School Galas.—The number of individual school Galas has increased in both Primary and Secondary Schools during the year, with a consequent quickening of interest in swimming within the schools concerned and a noticeable improvement in the standard of achievement. Bromley Schools Swimming Association.—Out of a total of 20 Secondary and Primary Junior Schools in the Borough. 16 have affiliated to the Bromley Schools Swimming Association and have taken part in a very successful Gala held in July. Two Bromley Teachers recently qualified for inclusion on the Kent A.S.A. panel of officials as judges, starters and time keepers. Competitive Swimming. (1) Kent County Schools Gala. Eight girls and five boys from Bromley were selected to compete at the Divisional Trials held at Kingston-on-Thames. (2) English Schools Championships. Three girls took part in this Gala and two did well to gain places, the third acting as a reserve. 99 4. Organised Games. Instructional periods for the teaching of organised games during school time are well catered for in most schools and facilities are well used. It might be possible, however, to encourage more free practices and dinner-hour matches which would produce a corresponding improvement in the general standard of play. The lack of suitable footwear for games has once again proved a handicap. Boys and girls must be suitably shod if they are to play major games during the winter season and to take full advantage of the excellent outdoor facilities and equipment provided. In spite of the continued efforts of heads of schools, supplies of foot gear have not been forthcoming for hockey and football and this acts as a serious deterrent to regular practice and progress. Cricket.— The installation of a small number of concrete practice cricket ends has proved popular and most successful and has given added incentive to the boys to the regular practice of correct stroke play without fear of injury or the handicap of poor and often unplayable conditions. It is a fallacy to suggest that practices on artificial surfaces do not promote effective standards of good batting and bowling techniques. Schools still prefer to play friendly matches and not to form a league. Basket Ball.— Basket Ball has now been accepted in secondary Schools for Boys as an active and vigorous team game holding the interest of the boys and it is showing steady progress. 5. Schools Sports Associations. Athletics.— Many schools organise their own sports meetings in addition to entering:— (a) The North West Kent Sports for Secondary Boys. (b) The North West Kent Sports for Secondary Girls. (c) The Kent County Sports. (d) Triangular competitions with neighbouring areas. Though many records have been broken at district level this year, we have not been so successful in the more challenging competitions of the Kent County Sports or in representative spheres generally. Coronation festivities probably interfered in some degree with the continuity of training in the schools. Athletic practices have now been accepted as part of the normal programme of work in the gymnasium throughout the year and we hope that these will result in improved techniques and in a raising of athletic standards. Football.— Two Secondary Boys' Schools and ten Primary Junior Schools are affiliated to the West Kent Schools Football Association and Bromley gained the Senior and Intermediate 100 Championships of the Association. The standard of football in the Primary Schools Section is commendable and most promising for the future. Primary Schools generally show a great interest and take a full part in out-of-school games and activities. Football, cricket, netball. rounders, shinty and swimming have been well organised and supported throughout the year. 6. Youth Activities. The necessity for reduced expenditure on recreative work of all kinds has limited the choice of physical activities previously enjoyed by many clubs. Only one class of gymnastics for boys and a more recreative class for girls are permitted within the Borough. A great deal of activity, however, is still in progress out of doors and pitches for football, cricket, netball and tennis are in steady demand. The period of National Service has apparently adversely affected attendances at many of the clubs. Cycling. Walking and Youth Hostelling provide the greater part of the summer programme and the excellent opportunities within the area encourage clubs to arrange their own expeditions. 7. Adult Classes. Classes in English Folk Dancing are held weekly in the Autumn and Spring terms and it is with regret that we find the very active local Scottish Folk Dance classes transferred to an area where more financial assistance is possible. 8. Conclusion. Good progress is being maintained generally in Physical Education, though the lack of suitable footgear is proving a limiting factor in outdoor work. The support of parents in the provision of Physical Education clothing and shoes has on the whole been praiseworthy, but there are still the few cases where assistance in kind is essential. The many " Open Days." sports days, galas, and parents' afternoons give ample opportunity for parents to see their children in action and to gain their sympathy and support. Numerous visitors from local authorities, training colleges, and from overseas, who are interested in Physical Education, have visited the schools during the year. The Advisers wish to record their appreciation of the support of the Borough Education Officer and his staff and of the cooperation of the Head Teachers and Assistant Teachers in the schools. F. M. BENTLEY, J. M. PELL. Area Advisers of Physical Education. 101 SCHOOL HEALTH SERVICE. STATISTICAL TABLES, 1953. 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 1953. B. Classification of the General Condition of Pupils Inspected During the Year, in Age Groups. TABLE 11I.— Group I. Diseases of the Skin. Group II. Eye Diseases. Defective Vision and Squint. Group 111. Diseases and Defects of Ear. Nose and Throat. Group IV. Orthopaedic and Postural Defects. Group 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. 102 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. * Periodic Medical Inspections. Number of Inspections in the Prescribed Groups:— Entrants 946 Second Age Group 749 Third Age Group 604 Total 2,299 Number of other Periodic Inspections 1,684* Grand Total 3,983 Children aged 8 years. Children in their 13th year, at County Grammar and Technical Schools. B. Other Inspections. Number of Special Inspections 1,630 Number of Re-inspections 440 Total 2,070 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 21 93 114 Second Age Group 23 78 101 Third Age Group 23 31 54 Total (prescribed groups) 67 202 269 Other Periodic Inspections 74 105 179 Grand Total 141 307 448 103 TABLE II. A. Return of Defects Found by Medical Inspection. Defect Code No. Defect or Disease Periodic Inspections. No. of Defects. Special Inspections. No of Defects. Requiring treatment Requiring to be kept under observation but not requiring treatment Requiring treatment Requiring to be kept under observation but not requiring treatment (1) (2) (3) (4) (5) 4 Skin 6 5 61 8 5 Eyes— (a) Vision 141 208 79 42 (b) Squint 11 6 13 — (c) Other 11 10 55 7 6 Ears— (a) Hearing 4 13 3 3 (b) Otitis Media — 1 8 1 (c) Other 6 8 51 3 7 Nose and Throat 45 98 112 52 8 Speech 5 10 4 2 9 Cervical Glands 1 8 1 1 10 Heart and Circulation 3 7 3 5 11 Lungs 8 33 18 21 12 Developmental— (a) Hernia 1 4 1 - (b) Other 15 83 15 39 13 Orthopaedic— (a) Posture 52 89 32 21 (b) Flat Foot 56 103 18 27 (c) Other 43 33 72 21 14 Nervous System— (a) Epilepsy 1 - - 1 (b) Other 3 23 5 11 15 Psychological— (a) Development 1 3 7 12 (b) Stability 1 6 8 6 16 Other 55 106 177 102 Totals 469 857 743 385 B. Classification of the General Condition of Pupils Inspected During the Year in the Age Groups. Age Groups (1) Number of Pupils Inspected (2) A—Good B—Fair C—Poor No. (3) % of Col. 2 (4) No. (5) % of Col. 2 (6) No. (7) % of Col. 2 (8) Entrants 946 235 24.84 691 73.05 20 2.11 Second Age Group 749 266 35.51 475 63.42 8 1.07 Third Age Group 004 228 37.75 369 61.09 7 1.16 Other periodic inspections 1,684 550 32 66 1,105 65.62 29 1.72 Total 3,983 1,279 32.11 2,640 66.28 64 1 .61 104 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 2 — (ii) Body 5 — Scabies 3 — Impetigo 21 — Other Skin Diseases 276 11 Total 307 11 Group II.— Eye Diseases, Defective Vision and Squint. Number of cases dealt with: By the Authority. Otherwise. External and other excluding errors of refraction and squint 489 No information available. Errors of refraction (including squint) 1,225 Total 1,714 0 Number of pupils for whom spectacles were: (a) Prescribed 663 No information available. (b) Obtained 646 Total 1,309 0 Group 1IL- Diseases and Defects of Ear, Nose and Throat. Received operative treatment: Number of cases treated: By the Authority. Otherwise. (a) for diseases of the ear — 1 (b) for adenoids and chronic tonsillitis - 250 (c) for other nose and throat conditions - - Received other forms of treatment 105 45 Total 105 296 Group IV.— Orthopædic and Postural Defects. (a) Number treated as in-patients in hospitals No information available. By the Authority. Otherwise. (b) Number treated otherwise, e.g., in clinics or out-patient departments 191 (new cases) - 356 (Re-inspections) - Group V. Minor Ailments. [ Number of cases treated: By the Authority. Otherwise Miscellaneous minor ailments 1,268 No information available. 105 TABLE IV. Dental Inspection, Treatment and Orthodontics. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 4,169 (b) Specials 2,224 Total (1) 6,393 (2) Number found to require treatment 3,090 (3) Number referred for treatment 2,028 (4) Number actually treated 2,751* (5) Attendances made by pupils for treatment 8,531* (6) Half-days devoted to: Inspection 31 Treatment 1,014 Total (6) 1,045 (7) Fillings: Permanent Teeth 3,234 Temporary Teeth 655 Total (7) 3,889 (8) Number of teeth filled: Permanent Teeth 3,150 Temporary Teeth 646 Total (8) 3,796 (9) Extractions: Permanent Teeth 847 Temporary Teeth 3,010 Total (9) 3,857 (10) Administration of general anaesthetics for extraction 1,819 (11) Other operations: Permanent Teeth 1,878* Temporary Teeth 926 Total (11) 2,804 * These figures include orthodontic work. TABLE V. Infestation with Vermin. Primary and Secondary Schools. (i) Total number of examinations in the schools by the school nurses or other authorised persons 16.724 (ii) Total number of pupils on roll of schools visited 6,409 (iii) Total number of individual pupils found to be infested * In addition 87 pupils showed minor evidence of infestation. 5* (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) Nil. (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) Nil. 106 Grammar and Technical Schools. (i) Total number of examinations in the schools by the school nurses or other authorised persons 653 (ii) Total number of pupils on roll of schools visited 697 (iii) Total number of individual pupils found to be infested Nil. (iv) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) Nil. (v) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) Nil. Occupation Centre. (i) Total Number of examinations by school nurse 101 (ii) Total number of pupils on roll 62 (iii) Total number of pupils found to be infested Nil TABLE VI. Orthoptic Clinic Total number of treatments given 1,396 Number of new cases 71 Number of cases on occlusion alone 2 Number of cases found unsuitable 5 Number of cases postponed 262 Number of cases failed to attend 16 Number of cases put down for operation 37 Number of cures, with operation 8 without operation 9 Number of sessions, 1953 249 Number of sessions, 1952 293 TABLE VII. Year 1953. Handicapped Pupils Requiring Education at Special Schools (other than Hospital Schools) or Boarding in Boarding Homes. 1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Sub-normal 8. Maladjusted 9. Epileptic T 0 T A L 1-9 (I) (2) (3) (4) (5) (6) (7) (8) (9) (10) In the calendar year ended 31st Dec 1953: A. Handicapped Pupils newly placed in Special Schools or Boarding Homes 1 4 6 11 B. Handicapped Pupils newly ascertained as requiring education at Special Schools or Boarding in Homes 2 - - - 3 6 3 1 1 16 Number of children reported during the year: — (a) under Section 57 (3) (excluding any returned under (b) ) 5 (b) under Section 57 (3) relying on Section 57 (4) 1st Nil. (c) under Section 57 (5) of the Education Act, 1944. 6 107  1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Subnormal 8. Maladjusted 9. Epileptic T O T A L 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) On or about December 147, 1953: C. Number of Handicapped Pupils from the area: (i) Attending Special Schools as: (a) Day Pupils - - 3 - - - 19 - - 22 (b) Boarding Pupils - - - - - - - - - - (ii) Attending Independent Schools under arrangements made by the Authority - - - - - - - - - - (iii) Boarded in Homes and not already included under (i) or (ii) - - - - - - - - - - Total (C) — — 3 — — — 19 — — 22 D. Number of Handicapped Pupils being educated under arrangements made under Section 56 of the Education Act, 1944: (i) in hospitals - - - - - - - - - - (ii) elsewhere - - 1 - - - - - - 1 E. Number of Handicapped Pupils from the area requiring places in Special Schools (incl. any such unplaced children who are temporarily receiving home tuition) - - - - - 1 1 - - - Amount spent on arrangements under SECTION 56 of the Education Act. 1944, for the education of handicapped pupils otherwise than at school, in the financial year ended 31st March, 1953 £294 13s. 11d. 108 TABLE VIII. Independent Schools. Number of Schools visited (including Occupation Centre) 7 Number of Medical Inspection Sessions 44 Number of children examined (various age groups) 488 Number of Re-inspections 27 Nutrition Table. Classification "A" (Good) 122 pupils or 25.0% „ "B" (Fair) 359 pupils or 73.57% „ "C" (Poor) 7 pupils or 1.43% Table of Defects found by Medical Inspection. Defect or Disease. Number of Defects:— Requiring treatment. Requiring observation Skin 2 — Eyes, Vision 23 21 Eyes, Squint 7 — Eyes, Other 1 — Nose and Throat 27 5 Heart and Circulation — 1 Lungs 5 — Developmental, Hernia 1 — Developmental, Other 3 — Orthopaedic, Posture 16 — Flat Feet 50 — Other 11 3 Nervous System, Epilepsy 1 — Other 11 4 Total 158 34