BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1954 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES BOROUGH OF BROMLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH on the HEALTH OF THE BOROUGH OF BROMLEY 1954 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICES Printed, by Bromley Office Supplies & Printing Co., Ltd. 39 & 46 East Street, Bromley, Kent 3 CONTENTS. Page Members of the Health Committee7 Staff 7 Prefatory Letter 9 Section A. Vital and Other Statistics and Social Conditions of the Area Vital Statistics 12 Population 13 Births 14 Illegitimate Births 14 Stillbirths 14 Deaths 14 Causation of Deaths 15 Maternal Mortality 16 Infantile Mortality 16 Unemployment 16 Morbidity Statistics 18 Meteorological Observations 18 Open Air Recreational Amenities 18 Section B. General Provision of Health Services for the Area. Nursing Homes 22 Public Mortuary 22 National Assistance Act, 1948 22 Laboratory Service 22 Disinfection 23 Medical Loan Depots 24 Old People's Homes 24 Old People—Welfare 27 Moral Welfare 28 Hospitals 30 Venereal Diseases 30 Health Visiting 30 Domiciliary Midwifery 30 Women's Welfare Clinic 31 Ambulance Service 31 Domestic Help Service 31 Home Nursing Service 31 Local Clinic Services 31 Section C. Sanitary and Environmental Circumstances. Factories Acts, 1937 and 1948 34 Sanitary Inspection of the Area 35 Smoke Abatement 35 Heating Appliances (Fireguards) Act, 1952 36 Shops Act, 1950 36 Water Supply 36 Drainage and Sewerage 38 Cesspools 38 Rivers, Streams and Lakes 38 Public Cleansing, Refuse Collection and Disposal 39 Swimming Baths and Pools 39 Verminous Conditions and Uncleanliness 39 Moveable Dwellings 39 Rag Flock and other Filling Materials Act, 1951 39 Pet Animals Act, 1951 40 Prevention of Damage by Pests Act, 1949 40 Diseases of Animals Acts 41 Petroleum (Regulation) Acts, 1928 and 1936 42 Registries for Female Domestic Servants 42 Retail Market 42 4 Page Section D. Housing. Housing Repairs and Rents Act, 1954 44 Housing Inspections and Abatements 44 Rehousing 45 Section E. Inspection and Supervision of Foods. Food and Drugs Act, 1938—Food Sampling 48 Special Enquiries 51 Food and Drugs Act, 1938—Section 14 52 Food Premises 52 Unsound Food 53 Milk and Dairies Regulations, 1949 53 Bacteriological Examinations 54 Meat Inspection 54 Merchandise Marks Act, 1926 55 Game Act, 1831 55 Section F. Prevalence of, and Control Over, Infectious and Other Diseases. Smallpox 58 Vaccination 58 Acute Anterior Poliomyelitis 59 Diphtheria 59 Diphtheria Immunisation 59 Typhoid Fever 60 Scarlet Fever 60 Puerperal Pyrexia 61 Ophthalmia Neonatorum 61 Pemphigus Neonatorum 61 Measles 61 Whooping Cough 61 Food Poisoning 61 Dysentery 62 Pneumonia 62 Tuberculosis 63 Chest Clinic 64 T.B. Care Committee 64 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics 67 „ II.—Causes of Death 68 „ III.—Infant Mortality 69 „ IV.—Analysis of Causes of Infant Deaths 70 „ V.—Notifiable Infectious Diseases — Sex and Age Distribution 71 „ VI.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 72 „ VII.—Notifiable Infectious Diseases—Seasonal Incidence 73 ,, VIII.—Summary of the work of the Sanitary Inspectors 74 „ IX.—Nuisances, Defects and Contraventions Abated 77 5 Page SCHOOL HEALTH SERVICE, 1954. Members of the Welfare Committee 82 Officers of the Committee 82 Staff 82 Introduction 83 General Information 84 Clinics 84 Minor Ailments 85 School Hygiene 85 Periodic Medical Inspections 85 Special Examinations 86 Independent Schools 86 Other Examinations 87 Dental Service 87 Ophthalmic Clinic 88 Orthoptic Clinic 89 Ear, Nose and Throat Defects 89 Orthopedic Clinic 89 Physiotherapy Clinic 90 Speech Clinic 90 Vermin and Uncleanliness 91 Handicapped Pupils 91 Child Guidance 92 Milk in Schools 92 School Meals Service 92 Employment of Children and Young Persons 92 Bromley Schools' Boot Club 92 Welfare—Provision of Clothing 92 Infectious Diseases in Schools 92 Juvenile Delinquency 93 Physical Education 94 STATISTICAL TABLES. Table 1.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 99 A. Periodic Medical Inspections 99 B. Other Inspections 99 C. Pupils found to reguire treatment 99 „ II.—A. Return of Defects found by Medical Inspection in the Year 1954 100 B. Classification of the General Condition of Pupils Inspected during the Year, in age groups 100 „ III.—Group I. Diseases of the Skin 101 Group II. Eye Diseases, Defective Vision and Squint 101 Group III. Diseases and Defects of Ear, Nose and Throat 101 Group IV. Orthopedic and Postural Defects 101 Group V. Minor Ailments 101 ,, IV.—Dental Inspection, Treatment and Orthodontics 102 ,, V.—Infestation with Vermin 103 ,, VI.—Orthoptic Clinic 103 ,, VII.—Handicapped Pupils 103 „ VIII.—Independent Schools 105 7 MEMBERS OF THE HEALTH COMMITTEE. Alderman J. S. Marriott (Chairman). Alderman Marion Green, J.P. (Mrs.) (Vice-Chairman). The Worshipful the Mayor (Councillor S. G. W. Baylis, J.P.). Councillors : F. W. Berringer. A. D. Daysh. S. L. Best, J.P. L. M. Prince (Mrs.). J. G. Clayton. G. H. Russell. F. G. Coates. 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.) (Retired 12th January, 1955.) 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.) (Appointed Medical Officer of Health 13th January, 1955.) Assistant Medical Officers : * P. A. CURRIE, m.r.c.s., l.r.c.p. * Mrs. C. MAXWELL, m.b., b.ch., m.r.c.s., l.r.c.p., d.c.h. 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, m.s.i.a., a.r.san.i. (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, m.s.i.a. (1, 2, 3). D. K. EVANS, m.s.i.a., m.r.san.i. (1, 2, 3, 6). P. R. LIGHT, m.s.i.a., a.r.san.i. (1, 2, 6). P. DRINKWATER, m.s.i.a., a.r.san.i. (1, 2). Health Visitors and School Nurses : * Miss E. CHENERY (7, 8, 9). * Mrs. V. GREIG (7, 8, 9). * Miss E. HATCH (7, 8, 9). * Miss W. G. HEMMINGS (7, 8, 9). * Miss K. OWENS (7, 8, 9). * Mrs. N. M. TAYLOR (7, 8, 9). * Miss M. E. WOOTTON (8, 9, 10). 8 CLERICAL STAFF : Chief Clerk : S. F. JUDD. E. P. J. WYTHE. Mrs. R. BAKER. Mrs. D. COX. (Appointed 25.10.54) Mrs. W. J. FOOT. Mrs. R. McGlBNEY. Miss E. W. LEPPER (11) M „ (Resigned Sept. 1954) Mrs. R.C. TYE. Miss M. N. CROXSON. Other Appointments : Assistant Rodent Officer : J. L. GOUGH. Outdoor Staff : Disinfector and Drain Tester : J. W. SEAGER. Rodent Operative : N. HAMBL1N. 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 Scicnce as applied to Public Works and Buildings. 7. State Registered Nurse. 8. State Certified Midwife. 9. Health Visitors' Certificate of the Royal Sanitary Institute. 10. State Registered Children's Nurse. 11. Unestablished or Temporary Staff. 9 To the Mayor, Aldermen and Councillors of the Borough of Bromley. Mr. Mayor, Ladies and Gentlemen, My first prefatory letter will perforce be short as it refers to a period prior to my becoming your Medical Officer of Health. As, of course, is well known, Dr. Tapper retired early in 1955 after long years of meritorious service, and many eulogistic references have been made to him by others capable of far finer phraseology than anything to which 1 could hope to aspire. Nevertheless, 1 should like to pay my small tribute to the tremendous energy, drive and enthusiasm with which he always undertook his work, and to the inspiration which was the mainspring of many of the Public Health services of which the local authority can be justly proud. I shall now endeavour to survey briefly some of the more outstanding features of the year. Firstly, 1 would refer to the abolition of food rationing which had for so long become a part of our daily lives that a generation was beginning to grow up which had never experienced what life was like without a ration book. This relief was. I believe, very welcome to the vast majority, but it does raise an educational problem in that the public must now be kept informed of the best way of spending the money that is available to them for purchasing food. In the days of rationing, a balanced diet was assured to all who took up their rations to the full, even if at times that diet may have appeared somewhat dull. This leads me naturally to the subject of health education in general, and here the department has not been lax, for in addition to the routine day by day work of the sanitary inspectors in encouraging personal cleanliness and clean food handling, a number of talks have been given to various organisations in the town on matters of public health interest and on these occasions the opportunity for putting over our ideas on cleanliness of food and person, has not been lost. A great field of work undoubtedly lies before us in this direction, and one hopes that we shall be given the opportunity of extending this service in the future. Another activity of the local authority to which I should like to refer is the anti-litter campaign which, although it is not being conducted by the Health Committee, is indirectly of considerable importance to its general duty of promoting the health and welfare of the population. If only the desire for general cleanliness and tidiness can be inculcated into all of us in our use of the highway. 10 we shall have learned a lesson which will be carried into the home, the food shop, the canteen, etc., with beneficial results to all. Particularly is this so in the case of the children who are of the right age to form new habits which they will carry on throughout their lives and pass on to succeeding generations. It is usual in reports such as these to give lengthy and incredibly dull dissertations on vital statistics, but 1 am proposing to be unusual and merely say that they are in all respects eminently satisfactory. Any other matters which may be of interest have been annotated in the body of this report which can be referred to by those seeking for more detailed information. There only remains for me the very pleasant task of thanking the Committee for their indulgence and help in the past and of expressing my gratitude to the staff of the department for their unfailing loyalty and devotion to duty. Perhaps I may be forgiven for mentioning by name two particular stalwarts—Mr. Woods, who always gives of his time and energy so unstintingly. and Mr. Judd who. in addition to his many other duties, year after year does many hours of devoted work in the compilation of this report, but to all a very sincere and heartfelt " thank you " for a good year's work well done. I am, Your obedient Servant, H. B. C. CARTER-LOCKE, May, 1955. Medical Officer of Health SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 12 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,519 Registrar General's estimate of total population (mid-year), 1954 64.800 Rateable Value at 31st March, 1954 £793,840 Rateable Value at 31st March, 1955 £800,501 Estimated product of a Penny Rate for year ending 31st March. 1955 £3.195 Number of Valuation assessments as at 31st March, 1954: — (a) Houses and Flats: — Not exceeding £10 Rateable Value 348 £11 to £13 Rateable Value 553 £14 to £20 Rateable Value 4,933 £21 to £30 Rateable Value 7,124 £31 to £40 Rateable Value 2,688 £41 to £50 Rateable Value 1,470 £51 to £75 Rateable Value 1,322 £76 to £100 Rateable Value 407 Exceeding £100 Rateable Value 332 19,177 (b) Commercial 1,407 (c) Licensed Premises 40 (d) Entertainment and Recreational 87 (e) Public Utility 19 (f) Educational and Cultural 28 (g) Industrial 53 (h) Miscellaneous 235 Total 21,046 Mileage of Roads as at 31st March, 1954: — County Roads, Class 1 12.26 County Roads, Class 2 6.48 County Roads, Class 3 5.16 District Roads 63.51 Unadopted Roads 15.85 Total 103.26 Vital Statistics. Live Births. Total. Male. Female. Legitimate 784 399 385 Birth Rate 12.7 (crude) per 1,000 total population. (Adjusted rate for comparison with other areas 12.9.) Illegitimate 40 20 20 824 419 405 The area comparability factor calculated by the Registrar General for the purpose of determining rates for comparison with other areas is 1.02. 13 Stillbirths. Total. Male. Female. Legitimate 11 8 3 Stillbirth Rate 0.18 per 1,000 total population and 14.3 per 1,000 (live and still births). Illegitimate 1 1 - 12 9 3 Deaths. Total. Male. Female. 727 356 371 Death Rale 11.2 (crude) per 1,000 total population. (Adjusted rate for comparison with other areas 9.7.) The area comparaoiiity tactor calculated by the registrar General for comparison of death rates, is 0.87. Deaths from Puerperal Causes. Puerperal Sepsis Nil Maternal Mortality Rate Nil Other Puerperal Causes Nil per 1,000 (live and still births.) ueatns ot intants under i year of age. Total. Male. Female. Infant Mortality Rate 20.6 per 1,000 live births. Legitimate 16 9 7 Illegitimate 1 1 - 17 10 7 Death Rates of Infants under 1 year of age. All Infants per 1,000 live births 20.6 Legitimate Infants per 1,000 live legitimate births 20.4 Illegitimate Infants per 1,000 live illegitimate births 25.0 Comparative statistics for the past five years: — Year Birth rate (per 1,000 total population) Death Rate (per 1,000 total population) Infant mortality rate (per 1,000 live births) 1950 13.8 11.4 21.3 1951 14.2 11.4 12.0 1952 14.1 11.2 22.0 1953 13.6 10.7 14.8 1954 12.7 11.2 20.6 England and Wales (1954) 15.2 11.3 25.5 POPULATION The total mid-year 1954 population (civilian and non-civilian) estimated by the Registrar General is 64.800 which is an increase of 210 over the figure for the previous year. The figure of 64,800 gives a density of 9.94 persons to the acre. The natural increase of population, measured by excess of births of deaths, for the year was 97. 14 BIRTHS 824 live births were registered during the year, of which 419 were males, and 405 females, giving a birth rate of 12.7 per 1,000 total population. (Adjusted rate for comparison purposes 12.9). This rate is a decrease on that for the previous year, and is below that of 15.2 for England and Wales. The rate for Bromley during the past five years is :— Year. Rate. 1950 13.8 1951 14.2 1952 14.1 1953 13.6 1954 12.7 Average rate for the five years was 13.6. Illegitimate Births. There were 40 illegitimate births registered, of which 20 were males, and 20 females. The illegitimate birth rate, per 1,000 live and still births, for the year 1954. is 47.8. Stillbirths. The stillbirth rate for the Borough during 1954. is 0.18 per 1,000 live and stillbirths, and 14.3 per 1,000 total population. There were 12 stillbirths registered during the year, of which 9 were males and 3 females. DEATHS The Death Rate for the year 1954. is 11.2 per 1.000 total population. (Adjusted rate 9.7.) There were 727 deaths appertaining to the Borough and registered during the year, of which 356 were males, and 371 females. The rate for England and Wales is 11.3. Death rates for Bromley for the past five years are as under Year. Rate (crude). 1950 11.4 1951 11.4 1952 11.2 1953 10.7 1954 11.2 15 An analysis of the ages at death shows that of the deaths registered :— Male. Female. 17 were under 1 year of age 10 7 2 were 1 and under 5 years of age 2 — 4 were 5 and under 15 years of age 1 3 5 were 15 and under 25 years of age 4 1 25 were 25 and under 45 years of age 14 11 150 were 45 and under 65 years of age 83 67 187 were 65 and under 75 years of age 103 84 337 were 75 years of age and over 139 198 356 371 CAUSATION OF DEATHS. Main causes of death in the Borough during the year 1954. together with comparative rates per 1.000 population for the last five years were :— 1950 1951 1952 1953 1954 Cancer 1.9 1.98 1.77 2.38 1.99 Congenital Causes 0.12 0.09 0.16 0.11 0.08 Heart Disease 6.31 5.56 6.31 5.34 5.88 Infectious Diseases 0.015 0.062 0.031 0.03 0.03 Influenza 0.03 0.11 — 0.11 0.01 Respiratory Diseases (non-T.B.) 0.68 1.27 1.17 0.91 1.09 Tuberculosis 0.26 0.31 0.17 0.14 0.12 Other Causes of Death. There were 19 deaths from violence, including 7 suicides. 5 motor vehicle accidents and 7 other accidents. Cancer of the Lung. Although the figures of deaths from cancer of the lung have shown a tendency to rise in the Borough during the past five years, the numbers are not sufficiently large to be significant statistically. On the other hand, we must not fall into the trap of minimising the seriousness of a problem which is really a national rather than a local one. That there is a large increase in diagnosed cancer of the lung cannot be denied, but with the ever increasing efficiency and availability of diagnostic methods, the actual increase in incidence may not be so great as a superficial perusal of the figures might suggest. Another factor which must be taken into account is the fact that with the always increasing expectation of life there must inevitably be an increase in these diseases which are more prone to attack their victims in the later decades. The part which smoking and atmospheric pollution play in the cause of this disease are as yet undetermined, and it would be unwise at this stage to dogmatize about matters which are still very much under investigation. In conclusion, I should say that although this is a very 16 serious problem, it may well be that taking all the factors concerned into consideration, the increased incidence of this disease must be interpreted with caution. DEATHS FROM TUBERCULOSIS. Year. Deaths. Notifications 1950 17 68 1951 20 67 1952 11 78 1953 9 65 1954 6 46 The above table shows that there is a very satisfactory tendency for deaths from pulmonary tuberculosis to be falling, but that a similar fall in the number of fresh notifications is not evident to anything like the same extent. Some would blame the preventive health services for this discrepancy, and would say that they are lagging behind the curative side of medicine in this respect, but it is well to remember present facilities for early diagnosis cause more cases to be unearthed, and therefore diagnosed early enough for the best results to be obtained from curative measures. This underlines the value and importance of the work of the Mass X-ray units which in so many instances discover cases of pulmonary tuberculosis before they become a danger either to themselves or anyone else. MATERNAL MORTALITY. For the fifth year in succession, it is pleasing to be able to report that there were no maternal deaths in the Borough. INFANTILE MORTALITY. The Infant Mortality Rate for the year is 20.6 per 1,000 live births. Seventeen infants died during 1954 before reaching their first birthday. Of this number 16 were legitimate and one illegitimate. Twelve neonatal deaths occurred (under one month of age). UNEMPLOYMENT. I am indebted to the Manager of the Bromley Employment Exchange for the following information with regard to unemployment durine 1954 :— " The following figures illustrate the rise and fall of unemployment in the area of Bromley Employment Exchange during 1954 as compared with the corresponding periods in 1953. 1954 Men. Women. Total. 1953 Men. Women. Total. Uth Jan. 159 70 229 12th Jan. 234 84 318 12th Apr. 82 51 133 13th Apr. 106 89 193 12th July 66 58 124 13th July 54 63 117 11th Oct. 77 77 154 12th Oct. 99 95 194 6th Dec. 71 44 115 7th Dec. 118 64 182 17 With the exception of the first month of the year, when building trade workers were temporarily affected as result of inclement weather, unemployment throughout the year has been exceptionally low and from the Spring onwards has remained almost continuously at its lowest level since December. 1945. The customary rise in unemployment expected during the last quarter of the year has failed to materialise at the time of preparation of this report. The problem of winter unemployment among Painters has been less acute this winter to date, as the following figures illustrate. 1954 1953 8 th October Nil 7th October 11 20th October 9 21st October 12 3rd November 10 4th November 27 17th November 3 18th November 35 1st December 8 2nd December 32 Unemployment among men. has been, in the main, confined to the older black coated worker or to those affected by some degree of disability. Of the 71 registered as unemployed on 6th December, 61 were over 40 years of age and 49 were over 50. In this connection attention is directed to the recommendations of the National Advisory Committee on the Employment of Older Men and Women, which very briefly summarised are :— (a) On Engagement—The test for engagement should be capacity and not age. (b) On Retirement—That men and women who can give effective service should be given the opportunity, without regard to age, to continue at work if they wish. Unemployment among women is mainly comprised of clerical and shop workers for whom there is difficulty in placing on account of age restrictions, and of women who require work for a limited number of hours owing to domestic responsibilities, many of whom only register for short periods when the urge or necessity to take a job arises. The rise in the number of women registered as unemployed in October was mainly due to married women registering for employment following the return of children to school and not to any other cause. Of the 44 registered as unemployed on 6th December. 22 were over 40 and 22 under that age. Also 20 of the women registered were married. There have been no important changes in local industry during the year excepting that at Bromley Gas Works where production of gas ceased on 31st March. All displaced workers were either transferred to other depots of the S.E. Gas Board or were placed in other employment by this office. 18 Although unemployment has remained so low throughout the year, this office has placed 3,143 men and women in the twelve months ending 17th November as compared with 3,300 during the twelve months ending 18th November, 1953. The majority of these people have been placed on the first day of attendance at the office and consequently would rarely be included in the number of persons registered as unemployed." MORBIDITY STATISTICS. The following details have been received from the Ministry of National Insurance during 1954. and give some indication of the seasonal trend of illness in the area :— Four weeks ending. Total number of Certificates received. Weekly average. 26th January 1,175 294 23rd February 1,162 291 23rd March 922 231 20th April 719 180 18th May 779 195 15th June 651 163 13th July 703 176 10th August 579 145 7th September 588 147 5th October 730 183 2nd November 871 218 30th November 977 244 28th December 853 213 It will be noted that these figures follow the expected trend, namely that the highest incidence of illness normally occurs during January and February, and declines to its lowest level in August, after which it tends to rise again. METEOROLOGICAL OBSERVATIONS. The following details, which have been extracted from the records at the Climatological Station at Church House Gardens, have been furnished by the Borough Engineer :— Total rainfall: 27.44 inches. Mean maximum daily temperature: 56.83°. Mean minimum daily temperature: 43.42°. Highest maximum temperature recorded: 84° (1st September). Lowest minimum temperature recorded: 15° (6th February). Lowest grass temperature recorded: 14° (7th February). OPEN AIR RECREATIONAL AMENITIES. The value of Bromley's open spaces cannot be over estimated, for they provide rest and relaxation for the older members of the population and facilities for recreational activities for the younger generation, thus making a notable contribution to the general well being of the community. 19 Commons, Public Recreation Grounds and Gardens. Six hundred and three 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 Southborough Open Space 6 0 0 The Knoll Open Space 4 1 39 Turpington Open Space 1 3 10 Whitehall Recreation Ground 17 1 6 Widmore Open Space 3 1 28 Reserved 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. 22 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. NURSING HOMES. (Public Health Act, 1936. Sections 187/195.) Six Nursing Homes are on the register at the present time, with provision for a total of 106 beds for medical and surgical cases. There are no private nursing homes in the area with provision for maternity cases. The aged sick or aged infirm patients occupy the majority of these beds. The 106 beds provided by nursing homes in the Borough are fulfilling a very useful purpose in that they are providing accommodation for a type of case which in many instances it is difficult to get into hospital. Frequent inspections of these Homes were carried out during the year, and at no time were any contraventions found which called for action on the part of the Local Authority. Details of the Homes are :— Address No. of Beds Number of new patients received during 1954 Surgical Medical and Chronic 18, Blyth Road 25 — 30 42, Cambridge Road 8 — 5 17, Edward Road 12 — 26 24, Elmfield Road 10 — 5 47/51, Park Avenue 32 — 79 "St. Cecilia's" Sundridge Avenue 19 — 19 PUBLIC MORTUARY. The Mortuary is situate in South Street, at the rear of the Fire Station. Thirty-two bodies were taken to the mortuary during the year, and of this number 17 were received from hospitals. Inquests were held in 13 cases. NATIONAL ASSISTANCE ACT, 1948. Sections 47 and 50. It was not necessary to take any action during the year 1954. LABORATORY SERVICE. Food and Drugs samples and routine medical specimens, etc., are normally sent to the County Laboratory at Maidstone. In cases of an urgent nature, specimens are sent to the Laboratory 23 at Bromley Hospital, and the help and assistance rendered by Dr. Keall and his staff are greatly appreciated. The following details of swabs, specimens, etc., sent to these laboratories are given :— Swabs—Haemolytic Streptococci 139 Swabs—Diphtheria 2 Vomit 2 Faeces 19 Blood Samples — Food Samples, etc 470 Rag Flock 7 Water Samples 57 Miscellaneous 11 707 DISINFECTION. The disinfecting station is situate at Waldo Road Depot. Details of the work carried out during 1954 are as follow :— Disinfections : Premises visited 123 Rooms disinfected 80 Articles disinfected 486 Disinfestations: Premises visited 35 Rooms disinfested 54 Articles disinfested 47 Articles Treated. Articles Destroyed. Beds 13 3 Mattresses 101 15 Bolsters 15 2 Pillows 160 6 Cushions 2 4 Blankets 92 — Sheets 24 — Eiderdowns 6 2 Bedspreads 3 — Carpets — — Garments 92 — Miscellaneous 25 — 533 32 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. 24 MEDICAL LOAN DEPOTS. The British Red Cross Society have continued their medical loan depot at 34a. Market Square, where they keep a full range of nursing requisites which are available to Bromley residents upon request. Where the circumstances of the applicant permit, a small charge is made for the loan of such articles. OLD PEOPLE'S HOMES. Reports received on the various homes run by voluntary associations and public authorities are as follow :— "Greenhill," Oaklands Road, Bromley. This Home is run by the Brook Lane Medical Mission. The Home has been full throughout the year. It has twenty-two beds, occupied by frail and infirm elderly ladies, who are in need of some care and attention. During 1954. two of the residents died, and two were transferred to Dunoran Home, owing to their increasing illness. Four new residents were admitted in their places. One resident, if spared, will reach the age of one hundred years in September. 1955. During the year friends again kindly invited the old people to their homes and gardens, and several coach outings were arranged for the old ladies. "Dunoran," Park Farm Road, Bickley. This Home is run by the Bermondsey and Southwark Group Hospital Management Committee, and I am indebted to the Medical Superintendent for the following report:— " During the year 1954. 78 patients were admitted to " Dunoran," 52 discharged and 26 died. The Home continues to admit dying and chronic patients and where possible priority is given to those under 40. but owing to the proximity of our Homes in Bromley we have of necessity had to admit some of their patients when they were too ill to be removed to Bermondsey. Great help has been given by voluntary organisations ; the Red Cross supply a library, and the W.V.S. an excellent shop. Some friends are hoping to raise enough money to buy a car to be used for this and other Homes so that the patients may be able to be taken out for a change." " Homefield " and " Elmwood," Southborough Road, Bickley. These Homes are run by the Bermondsey Medical Mission, and the Matron and Warden have kindly furnished the reports:— " Elmwood." The new wing was opened in December. 1953, and the Home now takes 24 inmates. Of these, most are very elderly, but there are a few younger chronic cases. Outings are 25 arranged whenever possible for those who aire fit to go, and kind friends arrange entertainments as often as possible. "Homefield." Admissions to "Homefield" during the year totalled 103, and 55 patients were discharged during this time to their own homes. There were four deaths during the early winter months. The poultry continue to yield good results and the eggs are a great boon. Two outings were made during the year—one in the Spring to see the flowering trees, and one during Christmas week to see the lighted trees at St. Pauls and Trafalgar Square, and decorations in the West End. Improvements in the Home include an additional sitting room on the first floor, seating 16 patients. Southwood Residential Club. The W.V.S. Residential Club is always full and our waiting list continues to lengthen. We have had forty residents at Southwood since the opening seven years ago. Our oldest resident is now 92, but still quite active. The health of the residents in the last year has been good, and the weekly handicraft class has given them an interest and kept them happy and busy. An exhibition of Old People's Handicrafts in Bromley in April and another for the County in September gave them something to work for. They have also made toys for the children of Farnborough Hospital this Christmas. We have had one death during the year, and three residents who have been with us for many years have been transferred to the W.V.S. Nursing Home. Patcham Grange, near Brighton, as they were now in need of more nursing care than we could give them at Southwood. Two residents have been transferred to Sharnbrook. the W.V.S. half-way house, as they too, were in need of more care and attention, and two residents were transferred to another W.V.S. Club. The rooms thus left vacant were quickly filled from our long waiting list. It has again been possible, by careful management, to maintain the fees at last year's level of £2 14s. Od. per week. Some residents are subsidised by the Local Authority. We are most fortunate in our Warden who has been with us since the Club opened. The care and attention she gives the residents are very much appreciated, and adds very much to their 26 well-being. 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. Kind friends have provided entertainments for the residents during the long winter evenings, and everyone enjoyed a Garden Party on one of the few fine days of the summer when Southwood were hosts to parties of old people from East London. A Library Service is run with the help of the Borough Library. "Merevale," Bickley Park Road, Bickley. The Secretary of the North West Kent Housing Society, Limited, who run this Home, has kindly furnished the following information :— "Merevale" had a successful year, during the course of which steps were taken to completely re-organise the kitchen. On the 31st December, 1954, the average age of the thirty-six residents was 82.8 years, and five were over ninety. Four residents died during the year, and three left for various reasons." "The Vane" and "Town Court," Bickley. These Homes are run by the Welfare Department of the London County Council, and the following details have been furnished by the Chief Officer of that Department:— "Town Court." "The Vane." Total number of beds 32 29 Residents on 31st December, 1953 30 29 Admissions during 1954 13 17 Discharges during 1954 13 17 Residents on 31st December, 1954 30 29 "Armstrong House," Southlands Grove, Bickley. This report has been furnished by the Save Our Souls Society :— Accommodation . Capacity 28 Weekly average numbers 27.5 Admitted during 1954 9 Present residents: Women 11 Men 17 Average age 81 Vacancies. During the year only nine vacancies arose and these were all filled through the Welfare Officer. Kent County Council. Maidstone, General Health. With an average age of 81 it is not surprising that the general health of the residents can be described as only fair. 27 Medical Attention. Two local doctors make routine weekly calls and emergency visits when necessary. Several residents are under the constant medical supervision of their doctors. Residents are referred to hospital for specialist and occulist examinations, surgical treatment and x-ray. A chiropodist visits the home each month. Recreation. The residents enjoyed many concerts, film shows and special lea parties which were given by local organisations and friends. Several residents are members of the 0ver-60 Club and many invitations were received for special parties, the cinema, theatre and coach trips at reduced costs. The Ladies Circle, Bromley, arranged a coach outing to Hildenborough Barn, Kent, and a special tea, which all residents greatly enjoyed. Religious Worship. Short informal Services were held each Sunday evening and Holy Communion once a month for those wishing to take part. Staff. The Staff consisted of the Matron and one resident Assistant Matron, also non-resident domestic staff, a part-time cook and handyman/gardener. Owing to illness and the increasing infirmity of several residents, a night attendant has been engaged. This reduces the strain on the Matron and her Assistant. Finance. During the Society's financial year ended 25th September. 1954. the total cost of maintaining the Home amounted to £3,900 and exceeded income by approximately £400. WELFARE OF OLD PEOPLE. 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. 28 Clubs are held as under :— Bromley Common Over 60's Club, The Village Hall, Bromley Common Keston Over 60's Club, The Village Hall, Keston St. Mary's Over 60's Club, St. Mary's Church House, College Road Tylney Over 60's Club, St. George's Hall, Nightingale Lane St. Augustine's Over 60's Club, St. Augustine's Hall, Southborough Lane Hayes Over 60's Club, Hayes Village Hall, Hayes Freelands Road Over 60's Club, Presbyterian Church Hall, Freelands Road Shortlands Over 60's Club, Congregational Mission Hall, Martins Road Burnt Ash Over 60's Club, St. Andrew's Church Hall, Burnt Ash Lane St. Mark's Over 60's Club, St. Mark's Church Hall, Bromley South Monday, 2.30 p.m. Monday, 2.30 p.m. Wednesday, 2.30 p.m. Wednesday, 2.30 p.m. Thursday, 2.15 p.m. Thursday, 2.30 p.m. Friday, 2.30 p.m. Friday, 2.0 p.m. Friday, 2.0 p.m. Thursday, 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, Lennard Hospital, and Hayes Grove Nurses Home. Wheel chairs are lent to those in need, and a list of capable partially trained women willing to do night and day nursing is kept at the W.V.S. Centre for the information of relatives in need. MORAL WELFARE. Church Army Home, Wells Road, Bickley. The Sister-in-charge has kindly furnished the following report:— " At the beginning of 1954. Denbridge House, which was opened by the Church Army as a Mother and Baby Hostel, had twelve mothers in residence, with their babies. Nine of these have since left, some to the mother's own home, others to resident posts, and one mother married the father of her child. 29 During the course of the year sixteen more mothers and their babies have been admitted, eleven still being in the Home, so that fourteen are resident at the present time. Considering that the mothers all go out to work daily, but see their babies early morning and night, and at weekends, it is fortunate that there has been very little illness in the Home " Rochester Diocesan Association for Moral Welfare Home, Blyth Road. The following report has been furnished by the Hon. Secretary :— " During the year 110 girls, women and children were admitted to the Home. Of the 66 girls admitted, 55 were maternity cases, of which :— 23 were admitted to Farnborough Hospital. 1 was admitted to Bromley Hospital. 1 was admitted to The London Hospital. 1 was admitted to The Thomas Coram Foundation Mother and Baby Home. 1 returned home. 1 returned to lodgings. 39 were Kent cases, 4 Gloucester, 7 Surrey, 2 London, and 1 each from Sussex, Lincoln and Middlesex. Of those admitted to hospital:— 8 returned home with baby. 9 returned home and babies placed with Children's Society for adoption. 2 returned home and babies placed with Southwark Rescue Society for adoption. 2 returned home and babies placed with National Adoption Society. 2 returned home and babies went to a residential nursery. 1 returned home and baby went to The Chichester Diocesan Adoption Society. 1 returned home and baby went to The Lincoln Diocesan Adoption Society. 1 went to a domestic post with baby. 1 went to Foster Mother with baby. 2 went to Residential Nursery and Mother to residential post. SHELTER CASES— 2 were admitted for Probation Officers. 2 were admitted for Sister Papps. 2 were admitted for the Children's Officers. 3 were admitted for the Police. 1 was admitted for the Almoner of Lewisham Hospital. 1 was admitted for the Woolwich Moral Welfare Worker." Report of Sister Papps, Outdoor Worker:— "159 cases have been referred and dealt with, of which 61 were maternity, 51 preventive cases concerning young people and children, 24 matrimonial and 23 miscellaneous. Of these cases, 72 were from Bromley and district. 30 110 men and women visited the Office for advice and help on different matters. 581 home visits were made and 1.611 interviews given during the year. Our thanks are due to the many friends who have sent gifts of clothes and baby clothing and the Churches for their gifts of toys, etc. HOSPITAL SERVICES. (a) Bromley Hospital, Cromwell Avenue. General hospital with 133 beds. Bromley Hospital Maternity Units : 20, Masons Hill. Provision for 34 beds. Widmore Road. Provision for 20 beds. Chest Clinic. Situate at the rear of the main Bromley Hospital buildings, with entrance from Tiger Lane. (b) Lennard Hospitals, Lennard Road. At the present time there are 41 beds available for use by infectious disease cases. This number can be doubled in an emergency. 39 beds are also provided at these hospitals for geriatric cases. The above hospitals all come within the area of the Bromley Group Hospital Management Committee, whose offices are at Farnborough Hospital. Farnborough, Kent. Venereal Diseases. Patients are referred to the various hospitals with special clinics for dealing with such diseases. COUNTY COUNCIL SERVICES. Health Visiting. Seven Health Visitors are responsible for this work in the Bromley area. These Health Visitors are also School Nurses and their time is equally divided between the two services. In addition to their work in connection with the School Health Service, they are responsible for Maternity and Child Welfare Centres. Vaccination and Immunisation Clinics, Home Visiting, After Care, and give advice on the care of young children, and advice to expectant and nursing mothers, etc. Domiciliary Midwifery. There are four full-time domiciliary midwives working in the area. The services of the midwives may be obtained through the patient's private doctor or by the patient direct, and they act either as midwives or maternity nurses. 31 Women's Welfare Clinic. This clinic was closed in October, 1954, and patients are now referred to the Chislehurst clinic. Ambulance Service. The main depot for this area is at 12, Hayes Lane, Bromley, and at the present time there are 29 ambulances and 20 sitting-case cars based there, the majority of which are radio-controlled. Domestic Help Service. This service is still in great demand, especially for old people and cases of illness in the home. During the year 1954. the following cases received assistance :— Maternity (expectant mothers) 97 Tuberculosis 13 Aged 314 Others 245 Home Nursing Service. At the present time a day service only is given, and is obtainable on medical certification. There are eight nurses (seven female and one male) working in the area. LOCAL CLINIC SERVICES. Ante-Natal Clinics. North Clinic, Station Road South Clinic, Princes Plain Hayes School Clinic, George Lane Child Welfare Centres. North Clinic, Station Road South Clinic, Princes Plain William Morris Hall, Masons Hill First Aid Post, Southlands Road Village Hall, Hayes Village Hall, Keston St. Andrew's Hall, Burnt Ash Lane Minor Ailment Clinics (Schools). North Clinic, Station Road South Clinic, Princes Plain Medical Room, Hayes School, George Lane Medical Room, Pickhurst School, Pickhurst Lane Thursday p.m. Monday p.m. Wednesday p.m. Wednesday p.m. Tuesday p.m. Monday & Thursday p.m. Wednesday & Friday p.m. Tuesday p.m. First and third Thurs. in every month p.m. Wednesday p.m. Monday to Friday a.m. Monday to Friday a.m. Monday & Wednesday (except 1st & 3rd in month) & Friday a.m. First & third Wednesday in month & every Tuesday & Thursday a.m. 32 Medical Room. Burnt Ash School Medical Room, Southborough School Medical Room, Aylesbury Rd. School Dental Clinics. North Clinic, Station Road South Clinic, Princes Plain Specialist Clinics. North Clinic, Station Road South Clinic, Princes Plain Immunisation and Vaccination. North Clinic, Station Road South Clinic, Princes Plain Medical Room, Hayes School (Immunisation only) Medical Room, Burnt Ash School (Vaccination only) St. Andrew's Hall, Burnt Ash Lane Monday to Thursday a.m. Monday to Friday a.m. Monday to Friday a.m. Monday to Friday a.m. & p.m. Saturday a.m. (by appointment.) Ophthalmic (Appointments only)— Monday & Wednesday a.m. Friday p.m. Orthopedic (Appointments only)— First & third Friday in every month p.m. Speech (Appointments only)— Wednesday p.m. Lip Reading (Appointments only)— Wednesday 5-6 p.m. Saturday 10 a.m. - 12 noon Thursday 11 a.m. Wednesday 11 a.m. Wednesday 11 a.m. Thursday 11 a.m. Wednesday 3 p.m. SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES. 34 SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. FACTORIES ACTS, 1937 AND 1948. The following is a copy of the return in respect of the year 1954, which has been supplied to the Minister of Labour and National Service :— I. Inspections for purposes of provisions as to health. Premises Number of Number on Register Inspections Written Notices Occupiers Prosecuted (a) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by the Local Authorities 61 70 3 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 224 196 8 — (c) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) *132 96 6 — Total 417 362 17 — 11. Cases in which Defects were found. No. of cases in which defects were : Number of cases in which prosecutions were instituted. Found. Remedied Referred To H.M. Inspector. By H.M Inspector Want of cleanliness (S.l) 2 9 — 2 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — 1 — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (a) Insufficient 21 30 — 2 — (b) Unsuitable or defective 44 48 — 14 — (c) Not separate for sexes — 1 — 1 — Other offences against the Act (not including offences relating to Outwork) 5 7 — — — Total 72 96 — 19 — * 1 Electrical Station (Sect. 103). 0 Institutions. 29 Building sites where more than one house erected (including six Corporation sites). 102 Private house sites. OUTWORK: Nil. 35 SANITARY INSPECTION OF THE AREA. Statistical details of the work of the Sanitary Inspectors will be found in Tables VIII and IX in the Appendix. The following are the aggregate totals under the respective headings :— Total No. of Inspections and Visits. Total No. of Defects and Nuisances found. Housing 4,259 1,125 Infectious Diseases 208 — Food Premises 4,399 316 Factories, Outworkers, etc 663 121 Sampling Visits 351 — Trade Premises (Various) 756 143 Rodent Control 258 29 Miscellaneous 802 29 Total 11,696 1,763 In addition to the above, there were 1,434 interviews with owners, agents, etc., on site and at the office, in connection with the above work. Notices issued :— Preliminary: — Housing 580 Food Premises 159 Factories, etc 71 Trade Premises 48 Rodent Control 447 Miscellaneous 73 1,378 Statutory: — Nil Total 1,378 Food Condemnation Certificates issued 1,062 SMOKE ABATEMENT. 78 inspections and re-inspections were made by the Sanitary Inspectors during the year. Three nuisances were found and 4 remedied in 1954. (This includes those found in 1953 and remedied in 1954.) This Local Authority is co-operating with the Department of Scientific and Industrial Research in the investigation of atmospheric pollution, by making observations and communicating the results of the estimation of sulphur by lead peroxide method. The Council has two representatives on the Standing Conference of Co-operating Bodies which discusses research into remedial measures for dealing with atmospheric pollution and the administrative action to be taken by Local Authorities in the exercise of their statutory powers and responsibilities. 36 The Committee on air pollution, under the Chairmanship of Sir Hugh Beaver, M.Inst.C.E., M.I.Chem.E., issued their very comprehensive report with a summary of recommendations, which aim at the reduction of the pollution of the atmosphere by smoke, dust, grit and gases. It may well be that these suggestions will be embodied in future legislation. HEATING APPLIANCES (FIREGUARDS) ACT, 1952. 40 visits of inspection were made during the year and no contraventions found. This Act is designed to require fireguards to be fitted to gas fires, electric fires and oil heaters of types so designed that they are suitable for domestic use and so constructed that, without a guard, there is likelihood of injury by burning or of ignition of clothing by reason of contact with or proximity to the heating element or flame. The standards of construction and fitting of guards and the tests to be employed in ascertaining whether guards comply with prescribed standards are controlled by regulations. SHOPS ACT, 1950. 256 visits of inspection were made by the Inspectors. 130 defects and contraventions were found, of which 61 had been remedied by the end of the year. The provisions of the Shops Act are designed to minimise, as far as practicable, any conditions which would affect the health of the shop assistants, and, as far as Bromley is concerned, the infringements encountered have been of a minor character, principally the omission of exhibiting the statutory forms. WATER. Six samples of drinking water were taken, to ascertain the toxic metal content (zinc). In five samples zinc was not detected, and in the sixth sample 0.08% was found. 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 1954 :— " No new source of public water supply has been instituted in the Council's area during 1954, 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 37 works; the lower level is supplied from West Wickham and Orpington Wells with additional Thames-derived water during the summer months. All the water is chlorinated before it leaves the works. Contact tanks are now in operation at all these works to give opportunity for the chlorine to exert its full effect before the water is pumped into supply. Any residual chlorine in the well waters 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. The following tables give the average results of the chemical and bacteriological analyses of the various supplies to the area for 1954." Average results of the Chemical and Bacteriological examination of the water supplied to the Borough of Bromley during the year 1954. (Parts per million unless otherwise stated.) Shortlands Well West Wickham Well Orpington Well Thames-derived filtered water (Walton) Chemical. No. of samples 4 5 4 1585 Ammoniacal Nitrogen 0.004 0.007 0.003 0.021 Albuminoid Nitrogen 0.024 0.026 0.020 0.092 Oxidised Nitrogen—Nitrate 5.4 5.1 6.1 3.9 Chlorides as C1. 18.5 13.0 15.4 26.7 Oxygen abs. from Permanganate 4 hours at 27°C 0.14 0.10 0.10 1.20 Turbidity in terms of Silica Nil Nil Nil 0.3 Colour m.m. brown 2 ft. Tube Burgess's Tintometer Nil Nil Nil 12 Hardness (Total) 287 264 276 269 Hardness (non-carb) 74 32 48 70 pH Value 7.2 7.2 7.1 7.9 Phosphate as P.O.4 0.07 0.06 0.08 0.65 Silica as Si02 18 15 14 11 Magnesium as Mg 3.9 2.5 2.5 5.0 Sulphates S 04 43 4 14 50 Conductivity 425 425 400 450 38  Shortlands Well West Wickham Well Orpington Well Thames-derived filtered water (Walton) Bacteriological Results. Before Chlorination (Raw Water). No. of samples 504 * 246 7222 Plate count (Average per millilitre). Colonies counted on Agar: 22 °C. (3 days) 2.1 * 1478.7 37°C. (20-24 hours) 0.2 * 101.0 — Bact. coli test: Percentage samples negative in 100 ml 100.0 * 100.0 62.2 Average number per 100 ml Nil * Nil 3.45 After Chlorination (Water passing into Supply). No. of samples 257 248 257 3604 Plate count (Average per millilitre). Colonies counted on Agar: 22°C. (3 days) — — — — 37°C. (20-24 hours) — — 0.1 8.8 Bact. coli test: Percentage samples negative in 100 ml 100.0 100.0 100.0 99.8 Average number per 100 ml. Nil Nil Nil 0.004 * On account of the engineering layout at these works it is not yet possible to obtain regular samples before treatment. DRAINAGE AND SEWERAGE The reconstruction of a length of the main soil sewer in the vicinity of Westmoreland Road was completed. CESSPOOLS. No new houses were erected with cesspool drainage. One house was converted from cesspool to main drainage during the year. 24 individual cesspools were emptied by the Borough Engineer's Department upon the request of the householders. RIVERS, STREAMS AND LAKES. A contract was let for the culverting of approximately 185 yards of the River Ravensbourne immediately north of Hayes Lane, and substantial progress made with the work. The Sanitary Inspectors made 29 visits of inspection during 1954. No nuisances were found. 39 PUBLIC CLEANSING, REFUSE COLLECTION AND DISPOSAL. The number of collection rounds was increased by one, and an additional vehicle was purchased for this purpose. A Heenan One Fill Power Baling Press was installed at the Refuse Disposal Works to replace the hand operated paper baling presses. SWIMMING BATHS AND POOLS. No improvements or alterations were made to the Corporation Open Air Swimming Bath during 1954. The Sanitary Inspectors made a total of 76 visits of inspection to Swimming Baths and Pools in the Borough, and forty-four samples of water were taken for examination. Eight samples from the Corporation Bath were all satisfactory. Of thirty-six samples taken from privately-owned swimming baths and pools, thirty-two were satisfactory and four unsatisfactory. 116 routine colometric tests for checking the efficiency of purification plants were also made by the Inspectors. VERMINOUS CONDITIONS AND UNCLEANLINESS 105 visits to premises by Sanitary Inspectors related to eradication of bugs, dirty conditions and disinfestations. 31 nuisances were found during the year and 15 were abated. (This figure includes those found in 1953 and abated during 1954.) MOVEABLE DWELLINGS. During the year five licences were granted embracing a total of twenty-three caravans. The Sanitary Inspectors made frequent visits of inspection to the four sites and no nuisances were found. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. Seven informal samples were taken, all of which were satisfactory. One registration has been granted under this Act. The enforcement of the statutory requirements for cleanliness of all fillings and stuffings for bedding, upholstery, toys and other domestic articles, is essential for public health measures, as this prevents unclean filling materials reaching the public. 40 PET ANIMALS ACT, 1951. During the year seven 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. 39 visits of inspection were made during the year and only one nuisance or defect found. It has not been found necessary to attach any special conditions (other than the general conditions) to any licence which has been issued. PREVENTION OF DAMAGE BY PESTS ACT, 1949. Excellent work, which requires vigilant and energetic action, was carried out by the two Rodent staff who deal tactfully with the public. The following is a tabulation of their work, in addition to which are the six monthly maintenance treatments of the sewers in the area :— TYPE OF PROPERTY Local Authority Non-Agricultural Agricultural Dwelling Houses (including Council Houses) All other (including business premises) Total of Cols. (1) (2) & (3) (1) (2) (3) (4) (5) I. Number of properties in Local Authority's District 8 19,544 1,881 21,433 29 II. Number of properties inspected as a result of: (a) Notification, (b) Survey under the Act, (c) Otherwise, (e.g., when visited primarily for some other purpose) (a) 6 497 113 616 5 (b) - 3,514 401 3,915 17 (c) 4 64 136 204 9 III. Total inspections carried out—including reinspections. (To be completed only if figures are readily available.) 34 7,374 1,122 8,530 160 41  TYPE OF PROPERTY Local Authority Non-Agricultural Agricultural Dwelling Houses (including Council Houses) All other (including business premises) Total of Cols. (1) (2) & (3) (1) (2) (3) (4) (5) IV. Number of proper- lies inspected (in Sect. II) which were found to be infested by: (a) Rats Major — — — — — Minor 5 323 70 398 6 (b) Mice Major — — — — — Minor 1 88 38 127 — V. Number of infested properties (in Sect. IV.) treated by the L.A. (Figures should NOT exceed those given at Sect. IV.) 6 385 108 499 6 VI. Total treatments carried out—including retreatments 7 431 118 556 8 VII. Number of notices served under Section 4 of the Act: (a) Treatment (b) Structural Work (i.e., Proofing.) - - - - - — — — — — VIII. Number of cases in which default action was taken following the issue of a notice under Sect. 4 of the Act - - - - - IX. Legal Proceedings — — — — — X. Number of "Block" control schemes carried out - 295 119 414 - DISEASES OF ANIMALS ACTS. During the year 118 visits of inspection were made by Mr. G. R. Woods the Animals Acts Inspector. 49 Statutory Orders were received during 1954, and 11 licences issued. A suspected case of swine fever on a farm in the area was confirmed. The source of infection was traced by the Ministry to 42 pigs bought at a Cattle Market. The pig dealer lost the whole of the fourteen store pigs he had purchased from the Market. All the necessary inspections and subsequent action were carried out in accordance with the Swine Fever Order, 1928. PETROLEUM (REGULATION) ACTS, 1928 AND 1936. Mr. G. R. Woods is the Inspector appointed under the above Acts. Ninety-six 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, 1955. was :— Bulk Storage 121,480 gallons. Can Storage 2,074 gallons. Carbide of Calcium 300 lbs. 177 visits of inspection were made in connection with this work, and no contraventions or nuisances found. A number of the new flame-proof electrically-operated pumps were installed in lieu of the old pattern and the electrical wiring was carried out in accordance with the Home Office Regulations. No accident has been reported during the year occasioned by the storage of Petroleum Spirit and Mixtures. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. Three premises are registered in connection with the above. RETAIL MARKET. The Retail Market is held on Thursday of each week at the Car Park. Station Road, Bromley. The Market Tolls collected during 1954 amounted to £586 17s. 6d., which is an increase of £62 17s. 9d. on the figure for 1953. SECTION D. HOUSING. 44 SECTION D. HOUSING. HOUSING REPAIRS AND RENTS ACT, 1954. During 1954. sixteen applications were received for certificates of disrepair under the above Act. Five certificates were granted, three refused, and eight were under investigation at the end of the year. It is not certain whether this part of the Act. referring to the application by tenants for a certificate of disrepair will be used to the extent originally anticipated. It is hoped that owners of property will take advantage of the Improvement Grants envisaged in the Act. HOUSING INSPECTIONS AND ABATEMENTS. Statistical details of this work will be found in Tables VIII and IX 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 814 188 2,752 3,754 1,058 Overcrowding 29 108 16 153 10 Verminous Conditions 13 3 8 24 9 Dirty Conditions 11 6 11 28 12 Water Supply 5 6 13 24 5 Disinfestation 23 6 24 53 10 Noxious Accumulations 7 3 13 23 5 Other Accumulations 21 17 27 65 8 Housing Repairs and Rents Act 9 12 58 79 4 Miscellaneous 3 42 11 56 4 935 391 2,933 4,259 1,125 Nuisances and Defects Abated. Drainage 374 Dampness 343 Water Supply 38 General Items 620 1,375 This figure includes defects outstanding from 1953 and abated during 1954. 45 Housing Statistics for the year 1954. Total number of valuation assessments, houses and flats at 31st March, 1954 19,177 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) 518 (b) Number of inspections made for the purpose 3,754 (2) (a) Number of dwelling-houses included under head (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 - (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 325 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 581 Number of dwelling-houses demolished during the year Nil CLEARANCE AREAS—Housing Act, 1936— Number of dwelling-houses demolished during the year Nil HOUSES NOT INCLUDED IN CLEARANCE AREAS— Demolition and Closing Orders—Housing Act, 1936— Houses closed in pursuance of an undertaking given by the owners under Section II, and still in force 3 Parts of buildings closed (Section 12) 2 Rehousing. The following information, which has been furnished by the Property Manager, shows the position as at 1st January. 1955 :— PERMANENT HOUSING: Completed and occupied ;— Units. Princes Plain 50 Coppice Estate 532 London Road Flats 66 Longfield Flats 27 Tylney Road Flats 54 Bourne Way Flats 66 Hayes Place Estate 339 Hayes Place Estate (O.A.P.) 28 Blackbrook Estate 64 Blackbrook Estate (O.A.P.) 10 Nichol Lane 6 Purchased Properties 55 1,297 46 Under construction :— Hayes Place (O.A.P.) 20 Havelock Road (O.A.P.) 18 Bromley Park (O.A.P.) 78 Schemes prepared—Tenders awaiting Ministry approval :— Blyth Road Flats 66 TEMPORARY HOUSING: Properties. Units. Occupied Prefabricated bungalows 321 321 321 Requisitioned properties available for occupation 276 574 574 Half-way houses and camps 6 73 73 603 968 968 Lettings during 1954. 1. (a) No. of permanent houses occupied during 1954: — Re-let 79 New Properties 140 219 (b) No. of families accommodated in permanent houses during 1954 219 (c) No. of persons accommodated in permanent houses during 1954 403 2. (a) No. of premises requisitioned during 1954 Nil (b) No. of premises de-requisitioned during 1954 62 3. No. of families on waiting list as at 31st December, 1954: — Medical category 13 General category 1,328 O.A.P 199 1,540 In addition to the above, 150 housing units were erected by private enterprise during the year 1954. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 48 SECTION E. INSPECTION AND SUPERVISION OF FOODS. During the year, this service continued to receive the special attention of the Department. The Sanitary Inspectors made a total of 4,399 inspections and re-inspections of Food Premises. 316 defects were noted and a total of 340 defects remedied during 1954 this includes those noted in 1953 and remedied during 1954. Every opportunity was taken by the staff of the Department of giving advice on food hygiene to all those engaged in the preparation and handling of food, and the co-operation of the shopkeepers, restaurant owners, and personnel engaged in this work has been all that could be desired. Talks were also given during the year to various Organisations and Associations on clean food practices. No formal action was taken by the Council during 1954. under the Byelaws adopted under Section 15 of the Food and Drugs Act. 1938. FOOD SAMPLING—FOOD AND DRUGS ACT, 1938 Article Samples taken. Genuine. Result. Inferior. Adult- era ted. Remarks Formal. Informal. Beans in Tomato Sauce 1 1 - — Bismuth, Indigestion Tablets — 1 1 — — Bonamint (Laxative Chewing Gum) - 1 1 - - Butter — 7 7 — — Butter Brazils — 2 — 2 — See (a) Butter Drops — 3 3 — — Butter Mints — 1 1 — — Butterscotch — 3 3 — — Buttermint Lumps — 1 1 — — Cheese Cake Mixture — 1 1 — — Chewing Gum — 1 1 — — Chocolate Cream Novelties — 1 1 — — Coffee — 2 2 — — Codeine, Compound Tablets — 1 1 — — Cooking Fat — 2 2 — — Corned Beef with Cereal — 1 1 — — Cough Balsam — 1 1 — — Cream (Double) — 3 3 — — Cream (Pure Fresh) — 1 1 — — Cream (Pure Thick) — 1 — 1 — See (b) Cream (Sterilized) — 3 3 — — Cream of Tartar — 1 1 — — Currants — — — Curry Powder — 1 1 — — Custard Powder — 3 3 — — Daisy Powders — 1 1 — — Dressed Crab — 1 1 — — 49 Article Samples taken. Result. Adulterated. Remarks formal. Informal. Genuine. Inferior. Epsom Salts — 2 2 — — Essence of Beef — 1 I — — Essence of Rennett — 1 i — — Fish Cakes — 1 i — — Fish Paste — 1 i — — Flour (Self Raising) — 1 i — — Frizets — 1 i — — Fruit Cake — 1 i — — Glace Cherries — — — Glauber Salts — — — Gob Stoppers — T i — — Golden Raising Powder — i i — — Grape Fruit (Soft Drink) — i i — — Ground Almonds — i i — — Ground Cinnamon — — — Ground Mixed Spice — i i — — Ground Nutmeg — I i — — Hog Fat — I i — — Honey — — — Honey and Glycerine — i i — — Honeycombe Mould — i i — — Ice Cream (Loose) — I i • — — Ice Cream (Mix) — i i — — Ice Cream (Choc. Pre-packed) — 3 — — Ice Cream (Pre-packed) — 16 16 — — Ice Lolly — 11 11 — — Icing (Festive) — 1 1 — — Icing Sugar — 1 1 — — Jam (Blackcurrant) — 1 1 — — Jam (Raspberry) — 1 1 — — Jam Roly Poly — 1 1 — — Lard — 1 1 — — l emonade (Soft Drink) — I 1 — — 1 emon Squash — 1 1 — — Liquid Paraffin — 1 — 1 — See (cl Lucky Dip Kiddies Fountain .... — 1 1 — — Margarine — — — Marzipan — 3 — — Marzipan Bars — 1 1 — — Men Paste (Beef) — 1 1 — — Milk (Pasteurised) — 16 16 — — Milk (T.T. Pasteurised) — II II — — Milk (South Devon Pasteurised) — 1 1 — — Milk (Channel Island T.T. Past.) — — — Milk (Sterilized) — — — Milk (Yoghourt) — 1 ii — — Milk (Condensed Full Cream).. — 1 1 — — Milk (Condensed Machine Skimmed) — 1 1 — — Milk (Evaporated) — 1 1 — — Mincemeat — — — Mixed Herbs — 1 1 — — Mixed Thyme, Parsley and Marjoram — 1 1 — — Mussels (Danish Pickled) — 1 1 — — Ointment (Yellow Basilican) .... — 1 1 — — Ointment (Zinc) — 1 I — 50 Article Samples taken. Result. Adulterated Remarks Formal. Informal. Genuine. Inferior. Ointment of Sulphur — 2 2 — — Olive Oil — 1 1 — — Oranges — 4 2 — 2 See (d) Orange Drink (Fresh) — 2 1 — 1 See (e) Orange Squash — 1 1 — — Parsley Sauce — 1 1 — — Peanut Butter — 1 1 — — Peel (Cut, Mixed) — 2 2 — — Pepper (White) — 2 2 — — Pie Filling (Lemon Flavour) — 1 1 — — Pimento — 1 1 — — Pork Roll (Stuffed) — 1 1 — — Prunes — 1 1 — — Ribena (Blackcurrant Juice) — 1 1 — — Rose Hip Syrup — 1 1 — — Salad Cream — 1 1 — — Salmon Spread — 1 1 — — Sandwich Spread — 1 1 — — Sauce (Daddies Favourite) — 1 1 — — Sausage Meat (Pork) 1 1 1 1 — See (f) Sausage Rusk — 3 3 — — Sausages (Beef) — 6 6 — — Sausages (Cocktail) — 1 1 — — Sausages (Pork) 1 5 4 2 — See (g) Seedless Raisins — 1 1 — — Seidlitz Powder — 2 2 — — Sherbert (Lemon Flavour) — 1 1 —: — Soups — 12 11 1 — See (h) Soupmix — 2 2 — — Soup Powders — 3 3 — — Sponge Mixture — 3 3 — — Suet (Shredded Beef) — 2 2 — — Sugar (Tinted Crystals) — 1 1 — — Sultanas — 2 2 — — Sweets (Fruit Salad) 1 — 1 — — Tea — 4 4 — — Vanilla Flavouring — 1 1 — — Vegetable Salad — 1 1 — — Vinegar (Malt) — 2 2 — — Welsh Rarebit — 1 1 — — Wow Bublow Gum — 1 1 — — Xmas Pudding — 1 1 — — Zinc and Castor Oil Cream — 2 2 — — Totals 3 257 249 8 3 (a) Sample No. 365. Coating contained only 1.0% butterfat. Sample No. 367. Coating contained only 2.7% butterfat. (b) Fat 24.9%. Fat content agrees with label. Word " Thick " not justified unless 48%. (c) Did not pass B.P. test for carbonisable substances. (d) Sample No. 380. Thiourea in Juice 40 p.p.m. Sample No. 394. Thiourea in Juice 5 p.p.m. 51 (e) Comminuted whole orange not more than 3.5%. (Should be not less than 5.5%.) Vitamin C not detected ; therefore not fresh. (f) Meat % Fat 21, Lean 39, total 60%. Sulphite absent. (g) Sample No. 505. Meat 58% Sulphite absent. Sample No. 524. Total meat 53%. Cereal Filler 21%. Pork Sausages contain not less than 65% meat. There is therefore a deficiency of 12% of meat below the minimum amount. The deficiency represents 18.5% of the minimum. (h) Fat 3.3% (butter fat 0.15%). Very slightly deficient in fat. SPECIAL ENQUIRIES. (a) Bacteriological investigation into complaints made to this Department. Twenty-nine samples of the following were submitted for examination during the year :— Apples. Meat. Bread. Milk (Condensed). Breadcrumbs. Milk (Dried). Cheese. Oranges. Corned Beef. Plums (Canned). Dried Egg. Sausage Meat (Pork). Herrings in Tomato Sauce. Sausages (Beef Chipolatas). Icing Sugar. Sweets. Marzipan. Water. Twelve of these were satisfactory and seventeen unsatisfactory. (b) Bacteriological investigations made on routine inspections. Ten samples were taken of the following foodstuffs :— Marzipan. Sweets (Dolly Mixtures). Water (Drinking). Sweets (Liquorice Allsorts). Of these, nine were satisfactory and one unsatisfactory. (c) Bacteriological examinations in connection with investigation into Infectious Diseases and reported food upsets. Thirty samples were submitted for examination, as under :— Apricots (Cooked). Dripping. Apple Pudding. Gravy. Beans in Tomato. Milk (Pasteurised). Beef (Cooked). Sweets (Dolly Mixtures). Butter. Sweets (Tom Thumb Mixtures). Coconut Sponge Pudding. Pastry. Custard. Potatoes (Cooked). Drinking Straws. Water (Drinking). Drinking Water Beaker. Of these, fourteen were satisfactory and sixteen unsatisfactory. 52 Food and Drugs Act, 1938. Section 14. 254 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. 93 — Dairies/Grocers 10 — Fish Shops (Wet) 2 — Fish Shops (Fried) — 9 Fruiterers and Greengrocers 10 — General Stores 6 — Grocery and Provisions 32 16 Ice Cream Stores 2 — Public Houses 1 — Restaurants, Cafes, Snack Bars, etc. 23 — 187 67 Two premises are registered for storage and distribution, one for the manufacture and 184 for the sale of ice cream. 67 premises are registered for the preparation or manufacture of Preserved Foods, etc. Food Premises. There are some 615 food premises in the area, as under :— 54 Butchers. 36 Bakers and Confectioners. 98 Confectioners. 15 Dairies. 22 Fishmongers, Wet, Dried and Fried. 51 Green Grocers. 112 Grocers. 52 Restaurants, Cafes, etc. 34 School Canteens. 30 Industrial Canteens. 21 Hospitals, Nursing Homes and Old People's Homes. 33 Public Houses. 12 Off Licences. 21 Chemists. 24 Clubs and Hotels. 615 53 UNSOUND FOOD. During the year a total of 11 tons 19 lbs. of varied articles of food were condemned, and 1,062 Food Condemnation Certificates issued. The main items were :— Cheese 107 lbs. Chicken Livers 838 lbs. Fish (Fresh) 1,037 lbs. Fish (Canned) 105 lbs. Fruit (Canned) 1,267 lbs. Jams and Marmalade 319 lbs. Meat (Raw) and Bacon 15,415 lbs. Meat (Canned) 2,542 lbs. Milk (Canned) 361 lbs. Milk Powder 133 lbs. Poultry 743 lbs. Rabbits 356 lbs. Sweets 287 lbs. Vegetables (Canned) 426 lbs. The corresponding figures for the year 1953 were, 15 tons. 4 cwts., 1 qtr.. 11 lbs., and 1.414 certificates. There was no consignment of food especially examined during the year. Unsound food is normally returned through the Trade, utilised for manufacturing purposes or animal food. or. where this is impracticable, destroyed. MILK AND DAIRIES REGULATIONS, 1949. Ten Dairies have been registered under the above Regulations, and licences for the year 1954 were issued, as under Dealers' (Pasteurisers') Licence 1 Dealers' Licences: — " Pasteurised " Milk 15 " Sterilised " Milk 34 " Tuberculin Tested " Milk 15 Supplementary Licences: — " Pasteurised " Milk 14 " Sterilised " Milk 16 " Tuberculin Tested " Milk 14 54 BACTERIOLOGICAL EXAMINATIONS. Milk. No. of Samples taken. Description. Satisfactory. Unsatisfactory 112 Designated Milk 112 — 8 Washed Bottles 8 — 120 120 — Ice Cream. No. of Samples Taken Description Methylene Blue Group Satis. Unsatis. I. II. III. IV. 1 Ice Cream (Loose) 1 — 1 — — — 1 Ice Cream (Mix) 1 — 1 — — — 24 Ice Cream (Pre-packed) 24 — 23 1 — — 4 Ice Cream (Choc.) 4 — 3 1 — — 8 Ice Lollies 8 — 8 — — — 38 38 — 36 2 — — Thirty-two samples were submitted for chemical examination, the lowest fat content being 6.05% and the highest 12.7%. The following tabulation shows the results obtained in respect of the 952 samples examined from 1st May, 1947, to 31st December, 1954 :— Year Grade I No. of Samples % Grade II No. of Samples 0/ /o Grade III No. of Samples % Grade IV No. of Samples % Total No. of Samples Total % 1947 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 1954 36 94.7 2 5.3 — — — — 38 100.0 As will be seen from the above, the results of samples taken show the standard of ice cream remains at a high level. It is pleasing to note that in no instance have pathogenic organisms been cultivated in any sample examined since the inception of the tests in 1947. MEAT INSPECTION. Annual licences were granted to five slaughtermen during 1954. and one private slaughterhouse was also licensed during the year. The following table gives details of the ante- and post-mortem inspection of animals made during 1954 :— 55 Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 6 4 8 43 65 Number inspected 6 4 8 43 65 All diseases except tuberculosis: Whole carcases condemned - - - - 2 Carcases of which some part or organ was condemned 3 1 - - 7 Percentage of the number inspected affected with disease other than tuberculosis .... 50% 25% - - 13.8% Tuberculosis only: Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 1 3 - - 2 Percentage of the number inspected affected with tuberculosis i 16.66% 75% - - 3.07% Meat rationing ended on the 5th July. 1954. and the two wholesale meat depots were free to buy and trade without control from the Ministry of Food. Carcases of Beef. Mutton, Lamb, Veal and Pork both English and Imported became free to buy by the butchers. For the first two weeks business was brisk and rather hectic—prices rose but eventually found their normal level. It was noticeable that the quality of the meat was excellent, but the vigilance of the Sanitary Inspectors who carry out the inspection of meat at Depots, Butcher's shops and Slaughterhouses became of paramount importance. MERCHANDISE MARKS ACT. The attention of retail traders has been called to Orders in Council made under the Merchandise Marks Act, 1926, relating to the marking of Imported produce. On exposure for sale by retail, goods are required to be marked with a show ticket clearly visible to intending purchasers, bearing an indication of the origin, in letters not less than half an inch in height. The principal contraventions found during this year were the absence of marking fresh apples and tomatoes. The tradesmen in each instance immediately complied with the Act. 196 visits of inspection were made during the year, and thirtyone contraventions found. GAME ACT, 1831. Nineteen licences were issued during the year for dealers in Game to use premises in the district. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 58 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECIOUS AND OTHER DISEASES. Statistical details of notifiable intectious diseases are shown in Tables V, VI and VII in the Appendix. There were no epidemics of a serious nature during 1954. A total of six hundred and twenty-four cases of infectious diseases (excluding tuberculosis) were notified, as against 1,592 for the previous year. SMALLPOX. Although we had another year free from this disease, it is still an ever present potential danger which may arise at any moment— the danger perhaps being greater with the ever increasing speed with which it is possible to travel from one part of the globe to another. Four people living in the area who had recently returned from abroad and who were possible contacts, were kept under surveillance for the requisite period. VACCINATION. The following figures, which have been furnished by the County Medical Officer, show the number of persons who were vaccinated against smallpox during 1954 :— Year of Birth Primary Vaccination Re-vaccination 1954 320 — 1953 231 — 1952 26 1 1951 9 1 1950 3 2 1949 6 4 1948 1 1 1947 6 3 1946 2 3 1945 2 2 1944 — 2 1943 1 8 1942 1 1 1941 — 2 1940 — 2 Before 1940 28 80 636 112 59 ACUTE ANTERIOR POLIOMYELITIS. In common with the country as a whole, there was a reduction in the incidence of this disease compared with the previous year. There was in no sense an epidemic for the three cases notified were all at different times and as far as could be determined, entirely unrelated. All three cases were paralytic ; two were home nursed and one admitted to hospital. Two of the patients have fully recovered and the third is making good progress towards recovery. All cases were in children of school age. DIPHTHERIA. For the fourth year in succession no cases occurred in the Borough, and this very satisfactory state of affairs must be maintained at all costs, and if the public response to immunisation continues to be satisfactory, there seems no real reason why this should not be so. DIPHTHERIA IMMUNISATION. The following figures, which have been furnished by the County Medical Officer, show the number of children resident in the area who were immunised against diphtheria during 1954:— Year of Birth Primary Inoculations Re-inforcing Inoculations 1954 63 — 1953 640 — 1952 88 — 1951 18 — 1950 12 20 1949 18 278 1948 29 232 1947 8 54 1946 6 91 1945 3 45 1944 2 107 1943 3 69 1942 — 4 1941 — — 1940 — 2 Total 890 902 The following is a return of the number of children under the age of 15 years on 31st December. 1954, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1940). 60 Year of Birth Last Complete course of injections (whether primary or booster) 1950-1964 1949 or earlier 1940 78 362 1941 103 306 1942 272 211 1943 343 283 1944 405 290 1945 565 134 1946 811 38 1947 764 113 1948 576 186 1949 703 40 1950 757 — 1951 741 — 1952 674 — 1953 696 — 1954 63 — Total 7,551 1,963 TYPHOID FEVER. This is another of those diseases whose complete absence during the year under review, is a cause for congratulation, but the organism causing the disease still survives in this country and any failure on our part to maintain the highest possible standard of hygiene could originate an outbreak of the disease at any time. In fact the disease has not been stamped out but is being kept at bay by our defensive measures, which can at no time be relaxed if our present immunity is to be maintained. SCARLET FEVER. Sixty cases were notified as against one hundred and twenty for the previous year. This figure represents an attack rate of 0.93 per 1,000 population. Sixteen of these cases were removed to hospital, and the remainder home nursed. There were no "return" cases. No deaths were registered. As will be seen from the above figures, the incidence of scarlet fever was only half of what it had been in the previous year and in nearly all cases the infection was of a reasonably mild kind. This change in the character of the disease in recent years has been commented upon previously, and at the moment there seems no indication that a change for the worse is in any way likely in the near future. In my own mind I find it difficult to decide whether the organism causing the disease has lost a great deal of its virulence, or whether the generally improved standard of living has built up such a strong generation that the human body is now able to cope with the invader very much more effectively. It may well be, of course, that a combination of these circumstances is responsible, but whatever the cause, the results can only be counted as eminently satisfactory. 61 PUERPERAL PYREXIA. Forty-one cases were notified, representing an attack rate of 49.0 per 1,000 total births. All of these cases occurred in hospitals. No deaths were registered. OPHTHALMIA NEONATORUM. One case was notified. This occurred in hospital and the child made a full recovery. PEMPHIGUS NEONATORUM. No notifications of this disease were received during 1954. MEASLES. There was a sharp drop in the number of cases occurring in 1954. Two hundred and nine notifications were received, as against nine hundred and sixty-eight for the previous year. This figure represents an attack rate of 3.23 per 1,000 total population. No deaths were registered. What has been said of scarlet fever with regard to its severity might well be repeated in the case of measles, but there the similarity ends. In the case of measles we still get large outbreaks occurring usually in alternate years, that is to say when a large number of non-immune children are congregated at school. In other words, in the year following an epidemic, there are normally too few susceptibles left in the schools to allow of an outbreak, in view of the fact that one attack of measles usually confers a life long immunity. WHOOPING COUGH. Notifications of this disease also showed a reduction during 1954. Two hundred and fifty-one cases occurred, as against three hundred and eighty-two for 1953, giving an attack rate of 3.87 per 1.000 total population. No deaths were registered. In this case also, we seem to be facing a problem of diminishing severity although it may well be that improved methods of treatment are largely responsible, but here again the improved stamina of the children may be a likely factor in the severity of the disease. The value of immunisation against this illness is still a controversial point and although many doctors and parents are convinced of its efficacy at least in mitigating the effects of the disease, it has not yet received universal approval. FOOD POISONING. Under Section 17 of the Food and Drugs Act, 1938, medical practitioners are required to notify the Medical Officer of Health of any patient he is attending, if he becomes aware, or suspects, that such person is suffering from food poisoning. 62 During the year ten single cases of food poisoning were notified and in two cases only was it possible to isolate the agent responsible —i.e., Salmonella Typhi-murium. In all cases of food poisoning, or suspected food poisoning, full enquiries are made to ascertain the source of infection. If any suspected food is available samples are submitted for bacteriological examination. No deaths were registered. A great deal of publicity is being given to-day to the ravages of food poisoning and there is little doubt that most sections of the community are very much alive to its dangers. Unfortunately, it is one of those conditions where the human element enters into a great extent and some minor deviation from the best practice of food hygiene can have disastrous consequences to a large number of people. It is on account of this fact that our efforts to teach food handlers, and they represent almost the whole population, to handle food cleanly must be unending for it is only by constant reminders that we can hope to maintain or improve the standard. As far as this town is concerned, with only two cases confirmed during the whole of 1954, we cannot complain, but it is as well to remember that there were, in all probability, a much larger number which never came to light. Efforts to build up our defences against this illness are constantly being made by all possible means, but ultimately we are in the hands of those whose task it is to prepare and handle our food, and if we can impress upon them all the importance of their work, we shall have made a great contribution to eradicating another of those diseases which are all too prevalent to-day. DYSENTERY, This disease, which now appears to have become endemic, is normally of a very mild type and gives rise to more inconvenience than serious ill-health. It is a very fair assumption that the disease is more prevalent than the notified figures would indicate, as owing to its extreme mildness, many sufferers probably never come for medical attention. On the other hand, this very point tends to the spread of the disease and makes its proper control a matter of great difficulty. Only by the exercise of extreme care in personal hygiene can this condition be mastered and it therefore resolves itself into a problem of health education especially once again of those responsible for our food. PNEUMONIA. The number of notifications of this illness were low. as is usual in a year in which influenza was not prevalent. 63 TUBERCULOSIS. The following details of the recordings in the Register for the year ended 31st December, 1954. are given:— Respiratory. Other forms. Total number of cases. M. F. M. F. On Register at 1/1/54 448 381 55 64 948 New cases notified during 1954 27 14 — 5 46 Number of cases coming to knowledge after death 1 - - 1 2 Restored to Register — — — — — Inward Transfers 15 20 1 — 36 491 415 56 70 1,032 Deletions, deaths, removals, recoveries, etc 56 56 10 12 134 Number of cases on Register at 31st December, 1954 435 359 46 58 898 New Cases and Mortality, 1954:— 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 — — — — — — — - 5—14 2 1 — - - - - - 15—44 15 10 - 3 - - - - 45—64 6 3 - 2 1 1 - - 65 and over 5 - - 1 1 - - - 28 14 - 6 2 1 - - *Inward Transfers 15 20 1 - Totals 43 34 1 6 64 CHEST CLINIC. I am indebted to Dr. D. G. Madigan. Physician in charge, for the following information:— New cases attending Chest Clinic for the first time during 1954:— Adults. Children. M. F. M. F. Pulmonary Tuberculosis 28 25 — 1 Non-Pulmonary Tuberculosis — 2 — — Non-Tuberculous 57 53 11 7 Totals 85 80 11 8 New Contacts examined during 1954. Negative. Positive. M. F. M. F. 95 110 1 1 These contact figures are not included in the above table. B.C.G. vaccination of contacts : 68. Number of patients who completed a course of hospital or Sanatorium treatment during 1954 : 57. T.B. CARE COMMITTEE. The Honorary Secretary of the County Tuberculosis Care Committee has kindly supplied the following information in respect of the year 1954:— "Throughout 1954 our Liaison Officer has visited many patients and their families with a view to solving the special problems of the tuberculous household. Help has been given in the provision of extra nourishment, clothing, bed and bedding, payment of coal bills, fares to enable relatives to visit patients in Sanatoria, holidays, and in general to assist not only the patient but also the health of the family which is exposed to the possible risk of tuberculosis." APPENDIX STATISTICAL TABLES. 66 STATISTICAL TABLES, 1954. 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.—Summary of the work of the Sanitary Inspectors. TABLE IX.—Nuisances, Defects and Contraventions Abated. 67 TABLE I. Summary of Statistics, 1954. Population (mid-year 1954, per Registrar General) 64,800 Birth Rate (crude) 12.7 Death Rate (crude) 11-2 Maternal Mortality Rate Nil Infant Mortality Rate 2036 Number of births (Live) 824 Number of Stillbirths 12 Number of Deaths 727 Number of Maternal Deaths Nil Number of Infant Deaths (under 1 year) 17 Death Rate of Respiratory Diseases 1.09 „ „ „ Tuberculosis 0.12 „ „ „ Cancer (all forms) 1-99 „ „ „ Cancer of Lung 0.43 „ ,, „ Zymotic Diseases 0.03 Notifications of Infectious Diseases: Scarlet Fever 60 Diphtheria Nil Poliomyelitis (paralytic) 3 Typhoid Fever Nil Puerperal Pyrexia 41 Pneumonia (all forms) 31 Tuberculosis (new cases) *84 Number of Deaths from Infectious Diseases 2 „ „ „ Diarrhoea (under 2 years) Nil Number of visits by Sanitary Inspectors 11,696 * Including Inward Transfers. 68 TABLE II. Causes of Death. 1951 1952 1953 Male 1954 Female Total 1. Tuberculosis—Respiratory 18 11 8 4 3 7 2. „ Other 2 — 1 — 1 1 3. Syphilitic diseases 6 3 1 1 3 4 4. Diphtheria - - - - - - 5. Whooping Cough - - - - - - 6. Meningococcal Infections — — 1 — — — 7. Acute Poliomyelitis — 1 — — — — 8. Measles 1 - - - - 9. Other infective and parasitic diseases 3 1 1 1 1 2 10. Malignant neoplasm, stomach 21 24 21 8 4 12 11. Malignant neoplasm, lung bronchus 22 14 29 21 7 28 12. Malignant neoplasm, breast 12 11 20 1 17 18 13. Malignant neoplasm, uterus 8 3 6 — 6 6 14. Other malignant and lymphatic neoplasms 65 62 78 36 29 65 15. Leukaemia, Aleukaemia 2 4 3 5 4 9 16. Diabetes 6 3 7 3 1 4 17. Vascular lesions of nervous system 84 102 86 36 58 94 18. Coronary disease, angina 80 104 116 68 57 125 19. Hypertension with heart disease 38 13 16 10 8 18 20. Other heart disease 133 143 102 40 63 103 21. Other circulatory disease 24 44 25 16 25 41 22. Influenza 7 — 7 — 1 1 23. Pneumonia 31 30 22 19 15 34 24. Bronchitis 40 39 30 18 10 28 25. Other diseases of the respiratory system 11 6 7 7 2 9 26. Ulcer of stomach and duodenum 13 9 4 7 4 11 27. Gastritis, enteritis & diarrhoea .. 2 1 4 2 1 3 28. Nephritis and nephrosis 4 5 7 4 — 4 29. Hyperplasia of prostate 8 11 3 11 — 11 30. Pregnancy, childbirth, abortion — — — — — — 31. Congenital malformations 6 10 7 3 2 5 32. Other defined and ill-defined diseases 59 47 62 24 41 65 33. Motor vehicle accidents 7 5 5 5 — 5 34. All other accidents 15 8 8 3 4 7 35. Suicide 6 6 5 3 4 7 36. Homicide and operations of war 1 — — — — — All causes 735 720 692 356 371 727 TABLE III. Infantile Mortality, 1954. (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 1 — 3 Gastroenteritis — — — — — — — — — — Malformation — — — — — — — — — — Prematurity 8 - - — 8 — — — — 8 Other Causes 3 1 — — 4 1 — - - 5 Totals 11 1 - - 12 2 2 1 - 17 69 70 TABLE IV. Analysis of Causes of Infant Deaths. 1946 - 1954. 1946 1947 1948 1949 1950 1951 1952 1953 1954 Total No. of Births (live) 1,176 1,308 1,042 1,030 892 916 908 880 824 8,976 Infant Mortality Rate (per 1,000 Live Births) 26.3 19.11 20.15 15.5 21.3 12.0 22.0 14.8 20.6 19.27 Malformation 3 13 — - — 1 — — - 17 Prematurity 14 5 6 3 5 3 3 5 8 52 Respiratory Diseases 4 5 2 1 4 2 7 2 4 31 Marasmus & General Debility - - - - - - - - - - Infectious Diseases 1 - - 3 - 1 - — - 5 Gastro Enteritis — — 1 1 — — — 3 — 5 Convulsions - - - - - - - - - - Atelectasis — - — 1 1 1 1 - 1 5 Congenital Heart Disease — — — 3 4 — 5 1 - 13 Other Causes 9 2 12 4 5 3 4 2 4 45 Totals 31 25 21 16 19 11 20 13 17 173 TABLE V. Notifiable Infectious Diseases, 1954. 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 34 26 - - 2 - 4 6 24 15 4 3 - 1 - 1 - - Whooping Cough Poliomyelitis 120 131 5 9 20 30 32 27 60 54 2 2 — — 1 8 — 1 (Paralytic) 3 - - - - - - - - - - - - - - - - - (Non-Paralytic) — — — — — — — — — — — — — — - - - - Measles 116 93 6 1 17 16 23 22 70 53 — — — — - 1 - - Diphtheria - - - - - - - - - - - - - - - - - - 273 250 11 10 3) 46 59 55 156 122 6 5 1 1 1 10 - 1 Under 5 5-14 15-44 45-64 65 and over Age Unknown Acute Pneumonia 16 15 - 1 1 4 3 4 6 2 6 4 - - Dysentery 7 4 2 1 1 3 3 — — — 1 - - - Erysipelas 1 6 1 — — — — — — 4 - 2 - - Cerebrospinal Fever - - - - _ - - - - - - - - - Puerperal Pyrexia — 41 - - - - 41 - - - - - - Typhoid & typhoid fevers - - - - - - - - - - - - - - Food Poisoning 4 6 — - — 1 2 3 1 1 1 1 - - Ophthalmia Neonatorum - 1 — 1 — — - — - - - - - - Tuberculosis— - - Pulmonary 27 14 1 - 1 1 15 10 5 3 5 - — - Non-Pulmonary - 5 — — — — — 2 - 2 - 1 — — Malaria — — — — — — — — — — — - — — 55 92 4 3 3 9 23 60 12 12 13 8 - - 32S 342 71 TABLE VI. Notifiable Infectious Diseases, 1954. 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 60 9 4 5 5 9 17 11 16 0.93 — — Whooping Cough 251 7 5 15 11 54 135 24 5 3.87 - — Acute Poliomyelitis (paralytic) 3 - - - — — 2 1 1 0.05 - - „ „ (Non-Paralytic) — — — — — — — — — — — — Measles 209 4 6 4 20 42 128 5 1 3.23 — — Diphtheria — - — — - — — — - - - — Acute Pneumonia 31 4 3 1 2 3 18 — 3 0.48‡ 34 0.52 Dysentery 11 2 1 1 — 4 1 2 - 0.17 - - Erysipelas 7 1 — 1 - - 4 1 2 0.11 - - Cerebro Spinal Fever — - — — — — — — — — — — Puerperal Pyrexia 41 - — 41 - — - — 41 49.0 $ — - Typhoid & Paratyphoid Fever - - — - - — - — - - - - Tuberculosis (Pulmonary) 77 15 8 9 9 8 23 5 15 1.19 7 0.11 ,, (Non- Pulmonary) 7 2 — 1 2 1 — 1 5 0.11 1 0.01 Food Poisoning 10 — 1 - 1 1 5 2 2 0.15 - - Ophthalmia Neonatorum 1 — — 1 — — — - 1 0.01 - - Malaria - — — — - - - - — - - - Totals 708 44 28 79 50 122 333 52 92 10.92 42 0.65 ‡ Includes Pneumonia (all forms). $ Based on attack rate per 1,000 total births, and not population. TABLE VII. Notifiable Infectious Diseases, 1954. Seasonal Incidence. Disease Jan. Feb. Mch. Apl. May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 1 8 4 2 5 9 11 7 3 3 3 4 60 Diphtheria — — — - - — — — — - — — — Measles — — 1 2 1 — — - 2 2 61 140 209 Whooping Cough 2 3 4 19 7 12 24 38 18 10 70 44 251 Dysentery — — — 1 1 3 3 1 1 1 — — 11 Erysipelas - — 1 - 1 — 1 1 — 2 1 — 7 Cerebro Spinal Fever — — — — — — - — — — - — — Pneumonia (all forms) 3 6 6 — 1 — 2 - 1 3 3 6 31 Typhoid & Paratyphoid Fever - - - - - - - - - - - - - Acute Anterior Poliomyelitis 1 1 - — — 1 — — — — — — 3 Food Poisoning — 1 — - - 3 - — 1 4 — - 10 Puerperal Pyrexia 1 1 5 - 5 — 3 3 11 3 4 5 41 Ophthalmia Neonatorum — — — — — — — — 1 - — — 1 Totals 8 20 21 25 21 28 44 50 38 28 142 199 624 74 TABLE VIII. Summary of the Work of the Sanitary Inspectors for the year 1954. TYPE OF INSPECTION. On Complaint Routine Re- Inspection Total Visits Nuisances Found Housing— 1. Inspection of District Regulations 3 23 10 36 4 2. For Nuisances 814 188 2,752 3,754 1,058 3. Overcrowding 29 108 16 153 10 4. Verminous Conditions 13 3 8 24 9 5. Dirty Conditions 11 6 11 28 12 6. Water Supply 5 6 13 24 5 7. Cesspools — 16 1 17 — 8. Earth Closets — 2 — 2 — 9. Caravans — — — — — 10. Privy Pails — 1 — 1 — 11. Houses Let in Lodgings — — — — — 12. Disinfestations 23 6 24 53 10 13. Noxious Accumulations 7 3 13 23 5 14. Other Accumulations 21 17 27 65 8 15. Housing Repairs & Rents Act 9 12 58 79 4 Totals 935 391 2,933 4,259 1,125 Infectious Diseases— 1. Inquiry Visits (Nuisances found recorded in above table) 2 88 13 103 — 2. Disinfection Purposes 3 23 3 29 — 3. Smallpox Inquiries 1 8 2 11 — 4. Public Health (Aircraft) Regulations — - — — - 5. Food Poisoning 5 44 16 65 - Totals 11 163 34 208 - Meat, Milk and Other Food Shops, etc.— 1. Butchers and Wholesale Depots 3 1,008 39 1,050 34 2. Confectionery 1 177 18 196 20 3. Dairies and Cowsheds (excl. Past. Plants) — 78 15 93 2 4. Pasteurising Plants — 52 — 52 — 5. Fish — 279 30 309 4 6. Fried Fish 1 76 9 86 5 7. Food Hawkers — 45 1 46 3 8. Fruit, Greengrocery 2 207 21 230 16 9. Grocery 18 508 85 611 50 10. Ice Cream Shops 1 165 4 170 4 11. Meat Regulations (Special Visits) — 10 2 12 — 12. Milk Examined on Highway — 2 — 2 — 13. Retail Market — 56 — 56 2 14. Slaughterhouses — 51 — 51 — 15. Horseflesh Shops — 87 2 89 — 16. Restaurants 4 119 40 163 56 17. School Canteens 3 52 17 72 16 18. Public Houses 1 36 38 75 15 19. Food Wholesaler — 109 9 118 1 20. Hotels - — - — — 21. Clean Food Byelaws 5 599 62 666 27 22. Hospital Food Store and Kitchen — 18 — 18 — 23. Merchandise Marks Act — 170 13 183 29 24. Food Preserving Premises — 11 6 17 — 25. Bakehouses (other than Factory Act) — 21 13 34 32 Totals 39 3,936 424 4,399 316 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 - 41 29 70 9 (ii) Factories not included in (i) to which Section 7 applies 15 84 97 196 52 Carried Forward 15 125 126 266 61 75 TABLE VIII. (Continued) Type of Inspection On Complaint Routine Re Inspection Total Visits Nuisances Found Brought Forward 15 125 126 266 61 Factories, Outworkers, etc. Contd. (a) Subject to Local Authority (transfer of Enforcement) Order, 1938 - - - - (b) Others — 24 16 40 11 2. Other Premises under the Act (excl. outworkers' premises, hotels, Restaurants, etc. - 51 45 96 24 3. Bakehouses (a) Mech. power 2 31 11 44 19 (b) Non-mech. power — 6 5 11 2 4. Outworkers' premises — 85 4 89 1 5. Smoke Abatement 9 43 26 78 3 6. Fireguards Act — 38 39 - Totals 26 403 234 663 121 Sampling of Food and Drugs, etc.— 1. Milk : T.T. Certified — 3 - 3 - T.T. Pasteurised — 23 - 23 - Pasteurised — 43 - 43 - Channel Islands Pasteurised — 1 — 1 - Sterilised — 9 — 9 - Channel Islands T.T. Pasteurised — 2 - 2 - 2. Schools Milk (Pasteurised) — 11 — 11 — 3. Pasteurising Plant: T.T. Milk — 15 — 15 - Pasteurised — 19 — 19 - Washed Bottle 1 4 — 5 - 4. Tinned Milk 1 - - 1 - Condensed Milk — 2 - 2 - 5. Ice Cream — 39 - 39 - Ice Cream Mix. — 1 - 1 - 6. Cream - 4 - 4 - 7. Other Foods 21 101 3 125 - 8. Food Poisoning 1 20 9 30 - 9. Drinking Water 1 10 1 12 - 10. Rag Flock — 6 - 6 - 11. Court Cases — — — - - Totals 25 313 13 351 — Trade Premises- Various— 1. Under Shops Act 2 203 51 256 130 2. Under Petroleum Acts — 65 112 177 - 3. Registry Offices — 20 2 22 2 4. Offices (P.H. Act 1936, Sees. 40 and 91) 1 5 7 13 3 5. Pet Animals Act — 22 17 39 3 1 6 Rag Flock and Other Filling Materials Act — 1 2 - 7. Merchandise Marks Act — 10 3 13 2 8. Diseases of Animals Acts: Movement Licences — 1 - 1 - Foot and Mouth Disease 10 - - 10 - Swine Fever - 47 2 49 - Fowl Pest - 1 - I - Anthrax - - - - - Other - - - - - Interviews - 109 - 109 - 9. Piggeries, Cleansing — 25 4 2 2 Sanitary Conditions — 11 1 12 - 10. Stables: Cleansing — 3 6 9 - Sanitary Conditions — 3 - 3 - 11. Animals, Keeping of 3 4 3 10 3 12. Poultry Farms — — - - - Totals 16 530 210 756 143 76 TABLE VIII. (Continued) TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Rodent Control- 1. Trade Premises 9 127 33 169 18 2 Private Premises 32 22 23 77 11 3. Agricultural Premises — 2 — 2 — 4. Sewers 2 5 3 10 — Totals 43 156 59 258 29 Miscellaneous- 1. Schools 4 18 11 33 4 2. Drain Tests: Smoke — 8 3 11 1 Water 9 72 2 83 1 Colour 5 6 — 11 - Chemical - — - - - Mirror — — - - - 3. Swimming Baths: Visited — 73 3 76 6 Samples taken — 44 — 44 — Chlorine & Ph. Test — 116 — 116 — 4. Tents, Vans, Sheds, Caravans and Fairgrounds - 89 - 89 1 5. Accumulations (other than dwellings) 6 9 30 45 4 6. Streams and Ponds 1 26 2 29 — 7. Tips 8 2 10 1 8. Special Visits 2 152 31 185 2 9. Public Houses—Urinals — 30 31 61 5 10. Exhumations — - - - - 11. Fireguards Act — 1 — 1 — 12. Cinemas 1 3 4 8 4 Totals 28 655 119 802 29 Grand Totals ... 1,123 6,547 4,026 11,696 1,763 77 TABLE IX. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1954. HOUSING Drainage— Premises re-drained and connected to sewer — Cesspools abolished 1 Earth closets abolished — Cesspools emptied — Privy pails, etc., abolished — Drains relaid or repaired 82 Drains unstopped 143 New Covers to Inspection Chambers 8 Inspection chambers provided 25 Stopper provided to Intercepter 1 W.C's. provided (additional or separate) 7 „ buildings reconstructed 2 „ ,, repaired 8 ,, pans renewed 25 „ „ cleansed 4 „ box seats removed 5 „ seats repaired 1 Soil vent pipes renewed or repaired 14 Sink/bath waste pipes renewed or repaired 27 Sinks renewed 3 Lavatory basins renewed or repaired 6 Baths renewed or repaired 1 Miscellaneous 11 874 Dampness— Roofs repaired or renewed 105 R.w.p.'s, guttering, repaired or renewed 90 Vertical Plinth provided 8 Walls rendered 40 Horizontal damp-course provided 7 Solutioning 3 Earth removed from walls 8 Walls repointed 22 Weather-board walls repaired — Sub-floor ventilation provided or improved 24 Dry areas constructed 1 Brickwork repaired 18 Miscellaneous 17 343 Water Supply— Drinking water service supplied direct from main 4 Fittings, etc. renewed 3 Separate or additional water supply provided — Supply reinstated 4 Flushing cisterns renewed or repaired 20 Storage tanks „ „ „ 4 Boilers „ „ „ 3 88 78 TABLE IX. (Continued) General Items— Rooms cleansed 51 W.C. walls cleansed 11 Entrance hall and staircase cleansed 3 Bathroom cleansed 3 Light and ventilation improved 2 Plastering repaired or renewed 164 Floors repaired or renewed 47 Windows, frames, etc. repaired or renewed 56 Sashcords repaired or renewed 27 Putty pointing repaired or renewed 7 Doors repaired or renewed 16 Stoves and grates repaired or renewed 32 Coppers repaired or renewed 1 Draining Board renewed 1 Iron Staircase renewed 2 Handrails repaired or renewed — Stairtreads repaired or renewed 5 Dustbins provided 117 Dirty conditions remedied 6 Overcrowding abated — Chimneys repaired 20 External woodwork repainted 4 Food stores provided — Food stores ventilated 2 Yard paving renewed, etc. 0 Houses disinfested 9 Accumulations removed 25 Fencing — Miscellaneous 3 620 MEAT, MILK AND OTHER FOOD PREMISES- Yard floors, repaired, etc. 25 Cleansed, lime-washed shops, rooms 102 Lighting/Ventilation improved 6 Drains improved 13 Manure or refuse removed 25 Refuse bins provided 21 Cold store or refrigerator improved 9 Water supply improved 8 Sinks provided 14 Washing facilities improved 19 Sanitary conveniences improved 23 Miscellaneous 75 340 FACTORIES, OUTWORKERS, Etc.- Want of Cleanliness (Sect. 1) 9 Overcrowding (Sect. 2) - Unreasonable temperature (Sect. 3) - Inadequate ventilation (Sect. 4) 1 Ineffective drainage of floors (Sect. 6) - Sanitary conveniences (Sect. 7): - (a) Insufficient 30 (b) Unsuitable or defective 48 (c) Not separate for sexes 1 Other offences 7 Outworkers' premises - Smoke nuisances 4 100 79 TABLE IX. (Continued) trade premises— Shops Act : Ventilation improved — Temperature improved 2 Sanitary conveniences improved 1 Absence of statutory forms 49 Unsatisfactory Washing facilities remedied 4 Meals rest interval contraventions remedied — Seats for female workers provided 2 Other offences or defects remedied 3 Petroleum Acts contraventions — Registry Office contraventions 1 Offices (P.H. Act, 1936, Sects. 46 and 91) contraventions... 1 Pet Animals Act — Merchandise Marks Act 10 Other 1 — 74 rodent control— Trade premises 89 Private premises 335 Sewers (manholes) 225 Corporation property 5 — 654 miscellaneous — Diseases of Animals Acts: Piggeries—Cleansing 1 Piggeries—Sanitary Conditions. 1 Stables—Cleansing — Stables—Sanitary Conditions — Animals, Keeping of 5 Poultry Farms — Schools 1 Drain tests: Smoke — Water — Colour — Swimming Baths—visited 4 Tents, Vans and Sheds — Accumulations (other than dwellings) 6 Streams and Ponds — Tips — Public Houses—Urinals 0 Cinemas 2 Fireguards Act 1 — 26 Grand Total 2,569 notices issued— Preliminary : Housing 580 Food Premises 159 Factories 71 Trade Premises 48 Rodent Control 447 Miscellaneous 73 1,378 Statutory—Housing 0 1,378 BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES for 1954 January, 1955 82 Members of the Welfare Committee. Councillor F. G. Austin (Chairman). Councillor F. G. Coates (Vice-Chairman). Councillor J. G. Clayton. Councillor M. L. Dempster (Mrs.) 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 Borough Education Officer : A. C. Cleveland. Education Welfare Officers : S. J. Mann and L. Saysell. Staff. (as at 31st December, 1954.) Medical Officers. Dr. K. E. Tapper Proportion of time allocated to School Health Service 25% Whole-time. Medical Officer of Health 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. Orthopaedic 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. Vacant 4 sessions per week. Clinic Assistants Mrs. E. Brooks Whole-time. Mrs. D. Harris Whole-time. Health Visitors and School Nurses. Miss W. G. Hemmings . 50% Miss E. Chenery Miss K. Owens Miss E. Hatch y Miss M. E. Wootton Mrs. V. Greig j Mrs. N. M. Taylor Part-time Officers. Physiotherapist Mr. W. A. Taylor 6 sessions per week Orthoptist Mrs. J. Fitzsimmons 6 sessions per week. Clerical Staff. Chief Clerk Mr. S. F. Judd ⅜ Mr. E. P. J. Wythe ⅜ Mrs. D. Cox ⅞ Mrs. W. J. Foot ⅜ Mrs. R. C. Tye Whole * Includes duties in connection with Independent Schools. 83 To the Chairman and Members of the Welfare Committee. Ladies and Gentlemen. This, my first introductory letter to you. will, under the circumstances be brief, for it covers a period when I was not your Medical Officer of Health. Indeed, it was not until the early days of 1955 that Dr. Tapper handed over to me the fruits of many years of labour in the interests of the school children of Bromley. I count myself fortunate and privileged to be heir to such a " going concern " and although with the passage of time some changes and. what I hope, will be improvements in the service, are inevitable, nothing will detract from the merit of the sure and firm foundation from which the School Health Service was built up so ably by my predecessor and the Committees he advised so well. It is my earnest hope that the same Committee support will be extended to me. and that together we shall see the service proceed from strength to strength. This brings me to the future, for nothing can prosper by being static, and I feel that the time is fast approaching, if indeed it is not already here, when we shall have to deal more and more with the individual problems of the children and their parents, and less with the purely routine physical examination of children who, in the great majority of cases are in a sound physical state. This, of course, will involve devoting an immense amount of time to rather lengthy interviews, but if that is the service required, it is up to us to give it. This is just one thought that crosses my mind after a very brief period of office, but after further deliberation, I hope to be in a position to advance further ideas for the future. As I draw to my conclusion, may I express my gratitude to the Committee who have always treated me with such courtesy during my period as Deputy Medical Officer of Health, to the Borough Education Officer and his staff, and the staff of my department, for their always ready and willing co-operation. Finally, a very special word of thanks to my Chief Clerk, Mr. •lucid, who has devoted many hours to the preparation of this report. H. B. C. CARTER-LOCKE, Medical Officer of Health. 84 GENERAL INFORMATION. Numbers on School Roll 1953. 1954. County Primary Schools 5,073 5,162 County Secondary Schools 1,987 2,044 County Grammar and Technical Schools 1,837 1,833 Independent Schools 2,216 2,265 Total 11,113 11,304 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 & 3rd in month) and Friday a.m. (Doctor in attendance) 2nd, 4th & 5th Wednesday a.m. Medical Room, Pickhurst School 1st & 3rd Wednesday in month and every Tuesday and Thursday a.m. (Doctor in attendance) 1st & 3rd Wednesday in month a.m. Medical Room, Burnt Ash School .... Monday to Thursday a.m. (Doctor in attendance) Thursday a.m. Medical Room, Southborough School Monday to Friday a.m. Medical Room, Aylesbury Road School Monday to Friday a.m. Dental. North Clinic, Station Road South Clinic, Princes Plain Monday to Friday a.m. & p.m. Saturday a.m. (By appointment only.) Specialist Clinics. Ophthalmic. North Clinic, Station Road Monday & Wednesday a.m. Friday p.m. (By appointment only.) Orthopcedic. North Clinic, Station Road 1st & 3rd Friday in every month pm. (By appointment only.) Speech. South Clinic, Princes Plain Wednesday 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.) 85 MINOR AILMENTS. Minor ailments treated at the various school clinics again showed a decrease during the year 1954. 4,079 attendances were made for treatment. The main type of ailment treated, together with comparative figures for the previous five years are shown below :— 1949 1950 1951 1952 1953 1964 Ringworm, Body 13 7 25 6 5 7 Scabies 16 9 — — 3 2 Impetigo 45 36 26 8 21 8 Other Skin Diseases 646 397 457 372 276 271 Minor Ear Defects 508 222 240 197 105 51 Miscellaneous (e.g.. minor injuries, bruises, sores, chilblains, etc.) 2,926 2,413 2,277 1,973 1,268 1,079 Treatments are carried out by the School Nurses as need arises, and any cases attending minor ailment clinics and requiring medical advice, are referred to the General Practicitioner or to the clinic doctors at their visits. The very close contact between the teaching and medical staff was maintained throughout the year. The decline in the number of cases treated at the minor ailment clinics continues, but does not necessarily mean that minor ailments themselves are any less. There is an undoubted tendency to make greater use of the services of the family doctor whenever a question of curative treatment arises, but the clinics are still fulfilling a useful prophylactic purpose in that by dealing with these small defects and injuries as they arise, they are helping to prevent the development of greater disabilities with the consequent loss of valuable time to both doctor and patient. SCHOOL HYGIENE. There have been no noteworthy improvements carried out during the year under review. School canteens have frequently been inspected during 1954, and the high standard of cleanliness and personal hygiene of the workers encouraged and maintained. We are very fortunate in the high standard attained by the school canteens, for it helps clearly to produce the urge for cleanliness in the children at a most impressionable period of their life. This lesson once learned is unlikely ever to be forgotten, and should help to build up a generation practising food hygiene automatically. PERIODIC MEDICAL INSPECTIONS. Three hundred and eighteen medical inspection sessions were held during 1954. when 3.998 children were medically examined (1953 figures were 286 sessions and 3.983 examinations), the average attendance at each session being 12.6 compared with 13.4 for 1953. 86 Excluding dental diseases and infestation with vermin. 287 individual pupils were found to require treatment. This gives a percentage of 7.2 compared with 7.7 for 1953. Table II B, at the end of this report, gives information on the general condition of the pupils inspected, in the various age groups. The examinations continue to show a very satisfactory standard of health and general physique, and the attendance of parents at such inspections is high. Comparative rates of the general condition of the pupils inspected during the past five years are given below :— 1954 1953 1962 1951 1950 Category "A" (Good) 33.74% 32.11% 50.08% 64.42% 68.35% Category "B" (Fair) 64.91% 66.28% 48.90% 34.63% 30.17% Category "C" (Poor) 1.35% 1.61% 1.02% 0.95% 1.48% Categories A and B can be considered satisfactory, but all children in category C are normally kept under supervision and special advice is given re. such matters as special diet, adequate sleep, etc. SPECIAL EXAMINATIONS. In addition to the periodic medical inspections, a further 1.414 cases came under medical supervision during 1954, necessitating 1,932 medical examinations. (Figures for 1953 were 1.630 cases and 2.070 examinations.) Sixty-one cases requiring special investigation were examined at the Municipal Offices. One hundred and fifty-nine cases were referred to the various hospitals for Specialists' advice and treatment, of which 89 were Ear, Nose and Throat cases. The past year has seen a continuance of the close liaison which exists between the hospitals, general practitioners, and this department. and I should like to express my appreciation and thanks for the assistance so willingly given. The continued valued co-operation of the Head Teachers of the schools is another factor in any success that may come the way of the school health service, and to them I should like to express a special word of thanks. INDEPENDENT SCHOOLS. During the year eight schools including the Occupation Centre were visited, and a total of 551 children in various age groups were examined, necessitating the holding of 54 medical inspection sessions. Statistical details of these examinations will be found in Table VIII at the end of this report. 87 OTHER EXAMINATIONS. In addition to the examination of school children, the Medical Officers examined 37 students and teachers. Nineteen other employees of the Committee were also examined for Superannuation purposes, etc. DENTAL SERVICE. North Clinic. Mr. King reports:— " The school dental service has functioned satisfactorily throughout 1954. Owing to illness, the Clinic was staffed by only two temporary part-time Dental Surgeons between February and June. During Ihis period one school inspection was made. Much of this unavoidable lapse has now been made up and periodic inspections are proceeding normally. Considerable difficulty is being experienced in obtaining the services of another part-time Dental Surgeon to bring the establishment up to strength. Three part-time Dental Officers have resigned during 1954. There is a considerable improvement in the dentition of the school children, but much has yet to be done. Continuity of professional staff would be a valuable asset. There is a growing demand for orthodontic treatment which points to the far greater interest shown by parents in the condition of the teeth of their children. I am greatly indebted to Mr. N. K. Thorne. the County Orthodontist, for his advice in difficult cases. The Maternity and Child Welfare service continues to serve a valuable purpose. Some 350 treatments were given during the past year. Private Practitioners appear to be very reluctant to accept for treatment children between two and five years of age, thus causing an increasing demand on the facilities provided. Our thanks are due to the staff of the Radiological Department of Bromley Hospital for their great help during the year." South Clinic. Mrs. Lindsay reports :— " There has been an improvement even in the large attendances reported last year. Orthodontic cases have progressed in the same ratio and attendances for adjustments, impressions and plates have trebled those of the previous year. There has been an increase of over twenty-five per cent, in the Maternity and Child Welfare section, bringing the total annual cases to approximately six hundred. 88 These achievements have not resulted in any reduction in the conservative treatment as the number of cases in the latter category have been well maintained. It has still not been possible to cover every school in the annual inspection owing to the amount of work required to make the children dentally fit in those schools inspected." General. The second dental surgery at the North Clinic is now being reconstructed and re-equipped and it is anticipated this work will be completed in the course of a few weeks. The difficulty of obtaining a part-time Dental Officer for four sessions a week at the North Clinic is a problem not easily overcome, and it would appear that the only solution, once the second Surgery is completed, would be for an additional full-time Officer to be appointed. The services of this Officer could then be utilised by Bromley for the required four sessions each week, the remainder of the time being taken over by the County for the treatment of out-district children. Despite the above mentioned difficulty at the North Clinic, taking the year as a whole, the dental service has had a very satisfactory one, and due tribute must be paid to Mr. King and Mrs. Lindsay for their untiring efforts. OPHTHALMIC CLINIC. Dr. Eric Lyle reports :— " During the past year the Eye Clinic has continued to function three half days each week regularly. Though there is no delay at all over the new patients, there is still some degree of delay over the cases for re-examination. Many cases of squint have been treated during the year. Both operative and orthoptic treatment have played their part in these particular cases. Attendance has been good on the whole, although unpunctuality on the part of some of the cases continues. The total number of new cases examined was 258 and the total number of cases re-inspected 1.063." Dr. Lyle expresses his thanks to the staff for their help and co-operation in all matters dealing with the Eye Clinic. General. Whilst there is no waiting period before new cases are seen at this Clinic, I am rather perturbed at the delay which has arisen in the call-up of cases for re-inspection owing to the large number of children in this category. It may well be that in the near future 89 consideration will have to be given to additional sessions being held in order to make up some of this leeway. At the moment we arc giving priority to the urgent cases for re-inspection, but this, of course, tends to cause still further delay in the re-call of the non-urgent cases. ORTHOPTIC CLINIC. During the year a record number of 101 new cases have attended this clinic. The number of treatments given, 1.096. may seem slightly lower than previously. This is due to the greater number of patients, particularly those coming from any great distance, on the postponed list. These children attend, on an average, once a month and are given a variety of exercises to do at home under parental supervision. Also patients are being referred to the orthoptic clinic at a slightly earlier age and so require a smaller number of treatments. There has been a change of orthoptists during the year. but. as no sessions were lost owing to the changeover, there is no waiting list for treatment. The number of sessions held during the year was 285. EAR, NOSE AND THROAT DEFECTS. Two hundred and sixty children received operative treatment in hospitals for adenoids and chronic tonsillitis. Two children received operative treatment for intranasal antrostomy and polypoidectomy and insertion of polythene tubes. In addition to the above. 68 children received other forms of treatment at the school clinics and as out-patients at the hospitals. ORTHOPAEDIC CLINIC. Mr. K. F. Hulbert reports :— " The Orthopaedic Clinics have been carried on at Bromley North Clinic on the first and third Friday afternoon in each month during the past year. There has been no appreciable change either in the number or the character of cases coming up. but some of the old problems still remain. First and foremost comes the spastic child for whom educational and training facilities are still sadly lacking, except for the favoured few who are accepted for special institutions. The treatment of postural defects still looms very large, but one of the promising features of this problem has been an increased interest from the physical training instructors in certain schools, and increased co-operation. Mr. Taylor has continued as physiotherapist and his keenness, enthusiasm and all round capability has been much appreciated by all concerned." 90 PHYSIOTHERAPY CLINIC. Mr. Taylor reports:— " Another extremely busy and interesting year's work. The remedial classes have been well attended with the older boys age group (11-15 years) being in the majority, particularly in the posture class. A total of 2,635 attendances have been made which shows a slight increase on the previous year. It is noticeable that in the posture classes the older age group show a greater improvement than the younger age group (5-11 years), whereas in the foot classes the position is the reverse. No doubt this is partly explained by " personal appearance " and the fact that greater co-operation is obtained from the older children. In the foot classes the younger children appear to find more enthusiasm than the older children. The spastics continued to make steady progress. One is on the waiting list for a special school, but owing to the length of time waiting for a vacancy, he has been admitted to Cheney Hospital, Sevenoaks. as an interim measure, where he will get daily treatment which is very essential to his future. Two pairs of aluminium walking sticks have been obtained for use of the spastics and are very beneficial in maintaining balance for these cases. The Sunlight Clinic has not been so busy as in previous years, a total of 768 treatments having been given as against 1,043 for the previous year." SPEECH CLINIC. This is a County service, and the following report has been furnished by the County Medical Officer :— Mrs. Swan continues to attend at the Bromley Speech Therapy Clinic for one session per week. Nine cases were closed during the year. Of these, three were closed in view of the improvement made following treatment. A fourth case improved to the extent to which the nature of the condition might be expected to allow. The family of one child moved out of the district prior to completion of treatment, considerable progress having been made. A sixth child, who had been on the waiting list for some time, was found to have no speech abnormality when Mrs. Swan was eventually able to see him at the clinic. One case was found to have left school and another was found to have left the district prior to initial appointments at the clinic being offered. In the ninth case, treatment was arranged elsewhere prior to appointments being offered at the clinic. Nine cases were in contact with the clinic at the end of 1954, and will continue to attend at the clinic into 1955. There were 96 cases on the waiting list at the end of 1954. The number of new cases referred during 1954 has been larger 91 than ever. By " new case " is meant a case not already on the waiting list at the end of the previous year. Year. Number of new cases referred. (i.e., cases not already on the waiting list at the end of the previous year.) 1951 14 1952 20 1953 13 1954 37 The waiting list situation is not likely to be relieved until it is possible to make a full-time appointment in the Bromley district. VERMIN AND UNCLEANLINESS. A total of 18,253 inspections were carried out by the School Nurses at Primary and Secondary Schools, and 151 at the Occupation Centre. Six pupils were found to be infested, with a further eighty-two showing minor evidence of uncleanliness. Parents are advised by the School Nurses in the treatment of infestation by modern insecticides. That only six cases of infestation were found in over eighteen thousand inspections, is a truly remarkable reflection of the modern urge for cleanliness and is a great tribute to all concerned. HANDICAPPED CHILDREN. Handicapped and other children needing special examination, are referred to the special clinic which is held at the Municipal Offices on Saturday mornings and on other occasions as circumstances demand. During the year. 56 special cases were examined, of whom 28 have been certified as handicapped and not suitable for education in ordinary schools. There are, at the present time, 54 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 5 — Attending Day Schools for E.S.N, children 18 2 In Residential Schools for Blind and Partially Sighted children 3 — In Residential Schools for Deaf and Partially Deaf children 2 — Attending Day Schools for Deaf and Partially Deaf children 4 — In Ordinary Schools (Physically Handicapped children) 2 — In Residential premises for Physically Handicapped children 5 — In Day Schools for Physically Handicapped children 7 — In Residential premises for Epileptic children — 1 In Residential premises for Delicate children 4 — Attending Day Schools for Delicate children — — In Residential premises for Mal-adiusted children 4 There are 30 known ineducable children in the area. 9 of these being in Institutions, and 21 at home. 92 CHILD GUIDANCE. Twelve cases were referred for examination and treatment at the Psychiatric Department of the local hospital. MILK IN SCHOOLS. A return to the Ministry of Education showed that on a single day in October, 1954, 88.95% of the pupils in attendance at Primary and Secondary Schools received milk. SCHOOL MEALS SERVICE. The total number of meals served during 1954 was 1.184,430. A return to the Ministry of Education showed that on a single day in October. 66.64% of the pupils in attendance at Primary and Secondary Schools received a mid-day meal. Further progress was made during the year with new Canteen provision. At the new St. George's Bickley C.E. Primary School, a kitchen for 150 meals daily has been completed and will be taken into use at the beginning of the Spring Term. 1955. Plans for the enlargement of the kitchen at Pickhurst County Primary School, to cater for 500 meals a day, have been submitted to and approved by the Committee. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS One hundred and forty-six children were examined by the School Medical Officers in respect of fitness for employment out of school hours. Fit certificates were issued in every instance. BROMLEY SCHOOLS' BOOT CLUB. There were no outstanding occurrences in connection with this Club during the year 1954. Total contributions from members £471 Cost of purchases made during year £501 Number of purchases 465 WELFARE—PROVISION OF CLOTHING. During the year 17 applications were received, as a result of which 21 children of necessitous families were provided with clothing at a total cost of £180 Is. 7½d. INFECTIOUS DISEASES IN SCHOOLS. The number of cases of notifiable infectious diseases in children of school age showed a substantial decrease during 1954, compared with the figures for the previous year. 93 No serious epidemics were notified during 1954. Forty-six cases of Scarlet Fever were notified as against 91 during the year 1953. The infection continued to be mild in character. There were 123 cases of Measles and 118 of Whooping Cough notified, as against 481 and 163 during 1953. Three cases of Poliomyelitis (paralytic) occurred in children of school age. Two patients have fully recovered and the third is making good progress but is still under treatment. In addition to the above. 4 cases of Dysentery and 5 of Pneumonia were notified. No case of diphtheria was notified. Three children of school age were notified as suffering from pulmonary tuberculosis, of this number one case was an inward transfer from another district. No school child was notified as having died of an infectious disease during 1954. The following table gives details of incidence and number of cases of the various diseases notified :— Disease Total No. of cases No. admitted to Hospital Jan. Feb. Mar. Apl. Seasonal incidence May June, July Aug. Sept. Oct. Nov. Dec. Scarlet Fever 46 16 — 5 3 5 7 9 5 2 3 3 4 Measles 123 I — — — 1 — 2 1 43 76 Whooping Cough 118 5 1 1 2 8 3 5 8 17 3 5 43 22 Poliomyelitis (Paralytic) 3 1 1 1 — — — 1 — — — — — — Poliomyelitis (Non Paralytic) — — — — — — — — — — — — — — Dysentery 4 — — — — 1 — 2 1 — — — — — Pneumonia 5 1 — — — — — — — — — — 2 3 Totals 299 24 2 7 5 10 8 15 18 22 7 9 91 105 JUVENILE DELINQUENCY. During the year 60 children and young persons appeared before the Local Court. The types of offences were :— Larceny and attempted larceny 40 Wilful damage 1 Breaking and entering 7 Road Traffic Act 6 Beyond Control 1 Receiving 3 Having parents not exercising care, etc 2 60 94 PHYSICAL EDUCATION, 1954. The following is the report of the Area Advisors of Physical Education :— 1. General. Physical Education during the year 1954 has shown steady progress and has seen the consolidation of many useful schemes of work. A feeling of life and vitality at present infuses all branches of the work and this is a stimulus to all concerned with the physical welfare of the school children in the area. The generally accepted aim of " a healthy mind in a healthy body " is now understood to include a combination of a well balanced physique with the optimum development of mind and personality as well as the health and cleanliness of the child —a very full and ambitious objective ! Present policy demands greater effort in every way from the teacher in the skilful planning and presentation of the lesson and encourages purposeful work of good standard, courage, selfreliance and self-discipline in the child. Suitable facilities in most schools and an adequate supply of equipment provided by the Education Committee have done much to stimulate effort generally and to assist in the promotion of our objects. Unfortunately, during the year under review, adverse weather conditions have seriously interfered with many outdoor activities and the temporary use of hall space as classrooms in some schools, owing to the increased school population, has deprived some schools of essential alternative indoor accommodation. The Primary School general training with its emphasis on freedom of effort, activity and exploration, provides an ideal groundwork for the development of specific technique in all branches of Physical Education at the Secondary level. In some cases it is anticipated that in the future the need for a more complete assessment of Primary School activities will be appreciated by staffs, so that training can be continuous and progressive for a pupil entering a Secondary School. For several years the provision of special clothing and footwear for Physical Education has been a serious problem, but it is pleasing to note that the praiseworthy support of parents in general has been further maintained. Parents with large families of school age often find great difficulty in providing four or five pairs of plimsolls and outfits of physical training clothing at prevailing prices and their needs merit further consideration. A slight but valuable increase in the supply of plimsolls was made by the Kent Education Committee during the year. It is hoped that more adequate provision will be possible in the near future in order that opportunities for field activities may be afforded more regularly and allow of active participation by greater numbers of children. 95 2. Games and Athletics. The normal games programme has been carried out despite the inclement weather conditions, but this year the exceptionally sodden state of the grounds used for hockey, together with the unsuitable footgear often worn by many girls, has appreciably limited the scope of training. A very successful Hockey Tournament staged in Bromley for approximately 17 schools from the North West Kent area, was arranged by the Kent Women's Hockey Association towards the end of the Spring Term. During dinner hour periods in the summer months schools with adjacent outdoor facilities took advantage of them to accommodate inter-form, interhouse, inter-age group matches and athletic training practices. It is pleasing to note the introduction of Rugby Football as a new venture in Secondary Modern Schools. Football.—Bromley Schools have again been well represented in the West Kent Schools XI. and several boys were selected for County trials, but were unfortunate in that they failed to achieve places in the County Team. Cricket.—Friendly matches are still favoured in both Primary and Secondary schools in the Borough. Two Secondary Modern schoolboys have distinguished themselves by being chosen for the County Schools Cricket XI. One of these boys played in all matches throughout the season. Athletics.—A one-day course for Athletics for Girls was held at Elgood Playing Field. Beckenham, at the beginning of the Easter Term. It was attended by a great many girls from the Upper forms of various schools who have a special interest in athletics. Bromley schools gave a very good performance at a special invitation competition involving nine schools from the Borough and neighbouring areas. Individual School Sports.—Sports Meetings were arranged early in the Summer Term, so that choice of entry for the NorthWest Kent Sports could be determined. North-West Kent Sports.—These Sports were held with success on the playing field of a Bromley Secondary School. Twenty-two boys and girls gained places in various events and six boys and three girls went forward to the Kent County Sports. Kent County Sports.—In two events (100 yards and 440 yards) Bromley boys were successful and were selected for the All England Championship, one boy being placed. 3. Swimming Instruction. The continued co-operation of the Baths Department is greatly appreciated. Facilities are now used to their fullest extent and requests for accommodation have been granted whenever possible. 96 In order to provide for greater numbers, arrangements were made in one instance to duplicate classes for older pupils attending the large Open Air Swimming Bath. Provision was made for a session of ten weeks duration, but inclement weather reduced rather seriously the teaching value of some of the swimming periods in the open air. Schools. Attendances (each week). No. of children. Secondary 53 classes of 25-30 children. 1,590 (approx.) per week. Primary 35 classes of 25-30 children. 1,050 (approx.) per week. Total 2,640 per week. Owing to financial restrictions winter swimming was not possible at the beginning of 1954. but arrangements were made for seven Secondary schools and one Primary school to send single classes during the Autumn Term. This extension of the swimming season enabled indoor facilities to be experienced by schools whose normal programme has previously relied solely on the variable conditions experienced with an open air swimming bath. Competitive Swimming. Individual School Galas.—Most schools arrange a small Gala as an item in the programme for the Summer Term. Bromley Schools Gala.—A most successful and well organised Gala was held at Downham Baths in July when eight Secondary and six Primary schools provided a most interesting evening with excellent swimming and diving. Kent County Gala.—Bromley was well represented at the Kent County Schools Swimming Association Gala by 14 boys and 13 girls from Secondary Schools but results were not as good as was hoped. All England Schools Gala.—Two girls represented Bromley at the All England Schools Gala in breast stroke and diving, and the girl in the latter event finished seventh. 4. Further Training of Teachers. The further training of teachers has continued steadily throughout the year, providing a wide choice of subjects to cover the many aspects of modern Physical Education. Opportunities to attend the following courses have been available to all teachers. The majority of these courses attracted encouraging support and attendances were good throughout:— (1) Modern Dance Course for teachers in Secondary Girls Schools, held on six Saturday mornings during the Spring Term. (2) Modern Dance Course for beginners, held on eight evenings during the Summer Term. (3) Basket Ball Course for men teachers, held on six evenings during the Autumn Term. 97 (4) Athletic Course for teachers in Secondary Boys' Schools, held on five evenings during the Autumn Term. (5) Remedial Course for men and women, held at Kingsgate, Broadstairs, for one week-end during the Summer Term. (6) Athletics Course for women teachers held at Maidstone for one Saturday during the Summer Term. (7) Outdoor Pursuits for men teachers, held at Wittersham during the Summer vacation. (8) Games Course (Cricket, Football, Rugby).—A subsidiary course for men teachers in connection with the Kent Summer School. 5. Youth Activities. The programme of activities connected with Youth Service has of necessity followed the pattern of the previous year, owing to the limited financial provision available for recreative purposes. The demand for facilities for football, cricket, netball and tennis for those clubs interested in developing team games has been consistent. Alternatively, individuals and small groups have a wealth of choice of outdoor activities both within the Borough and in its environs. Walking, cycling, camping and Youth Hostelling retain their popularity. 6. Adult Classes. Classes in Folk Dancing and Keep Fit activities have been arranged and held successfully throughout the year. 7. Conclusion. The past year has been one of growing appreciation of the value of most aspects of Physical Education. It is hoped that this good feeling and interest will be carried forward by school leavers into youth and adult life, so that the excellent groundwork in the schools will be the basis of a sound development later. It should be possible for every boy and girl leaving school to have discovered some appropriate aspect of physical activity in which he or she has special interest or aptitude. Many visitors from local authorities, training colleges and from overseas, 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. 98 SCHOOL HEALTH SERVICE. STATISTICAL TABLES, 1954. TABLE I.—Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. B. Other Inspections. C. Pupils Found to Require Treatment. TABLE II.—A. Return of Defects Found by Medical Inspection in the Year 1954. B. Classification of the General Condition of Pupils Inspected During the Year, in Age Groups. TABLE III.—Group I. Diseases of the Skin. Group II. Eye Diseases, Defective Vision and Squint. Group III. 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. 99 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. Number of Inspections in the Prescribed Groups:— Entrants 665 Second Age Group 1,775 Third Age Group 388 Total 2,828 Number of other Periodic Inspections 1,170* Grand Total 3,998 * Children aged 8 years. Children in their 13th year, at County Grammar and Technical Schools. B. Other Inspections. Number of Special Inspections 1,414 Number of Re-inspections 518 Total 1,932 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 14 55 69 Second Age Group 39 84 123 Third Age Group 11 16 27 Total (prescribed groups) 64 155 219 Other Periodic Inspections 35 33 68 Grand Total 99 188 287 100 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 3 6 67 2 5 Eyes— (a) Vision 99 218 61 35 (b) Squint 10 2 5 1 (c) Other 13 7 45 4 6 Ears— (a) Hearing 1 4 4 4 (b) Otitis Media — 1 — 1 (c) Other 2 4 19 2 7 Nose or Throat 17 67 80 28 8 Speech 15 13 5 9 9 Cervical Glands — 2 1 1 10 Heart and Circulation — 4 2 2 11 Lungs 2 16 10 19 12 Developmental— (a) Hernia 6 6 1 2 (b) Other 6 98 17 41 13 Orthopaedic— (a) Posture 44 159 15 17 (b) Flat Foot 15 71 25 23 (c) Other 29 46 117 37 14 Nervous System— (a) Epilepsy — 1 1 — (b) Other 3 11 3 9 15 Psychological— (a) Development — 2 10 13 (b) Stability — 5 9 6 16 Other 38 121 202 53 Totals 303 864 699 309 B. Classification of the General Condition of Pupils Inspected During the Year in the Age Groups. Age Groups Number of Pupils Inspected A—Good B—Fair C—Poor No. % of Col. 2 No. % of Col. 2 No. %of Col. 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 665 199 29.92 455 68.42 11 1.66 Second Age Group 1775 534 30.09 1216 68.50 25 1.41 Third Age Group 388 146 37.63 238 61.34 4 1.03 Other periodic inspections 1,170 470 40.18 686 58.63 14 1.19 Total 3,998 1,349 33.74 2,595 64.91 54 1.35 101 TABLE III. TREATMENT TABLES. Group I.—Diseases of the Skin. Number of cases treated or under treatment during the year:- By the Authority. Otherwise Ringworm—(i) Scalp — — (ii) Body 7 — Scabies 2 — Impetigo 8 — Other Skin Diseases 271 — Total 288 — 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 658 No information available. Errors of refraction (including squint) 1,312 Total 1,970 — Number of pupils for whom spectacles were: (a) Prescribed 742 No information available. (b) Obtained 659* * Including spectacles prescribed in 1953 and obtained in 1954. Group III.—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 — 2 (b) for adenoids and chronic tonsillitis — 260 (c) for other nose and throat conditions — — Received other forms of treatment 51 17 Total 51 279 Group IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals 16 By the Authority. Otherwise. (b) Number treated otherwise, e.g., in clinics or out-patient departments 150 (new cases) No information available. 337 (re-inspections) Group V.—Minor Ailments. Number of cases treated : By the Authority. Otherwise. Miscellaneous minor ailments 1,079 No information available. 102 TABLE IV. Dental Inspection, Treatment and Orthodontics. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 3,098 (b) Specials 1,606 Total (1) 4,704 (2) Number found to require treatment 3,377 (3) Number referred for treatment 2,816 (4) Number actually treated 2,140* (5) Attendances made by pupils for treatment 8,633* (6) Half-days devoted to: Inspection 22 Treatment 1,003 Total (6) 1,025 (7) Fillings: Permanent Teeth 3,224 Temporary Teeth 1,173 Total (7) 4,397 (8) Number of teeth filled: Permanent Teeth 3,088 Temporary Teeth 1,155 Total (8) 4,243 (9) Extractions: Permanent Teeth 517 Temporary Teeth 2,624 Total (9) 3,141 (10) Administration of general anaesthetics for extraction 1,379 (11) Other operations: Permanent Teeth 1,504* Temporary Teeth 1,080 Total (11) 2,584 * These figures include orthodontic work. Orthodontics. Number of children referred for Orthodontics 255 Number of Orthodontic appliances ordered 154 Number of Orthodontic appliances fitted 126 Attendances for Orthodontic treatment 1,183 Scaling and Polishing 548 X-Ray 165 103 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 18,253 (ii) Total number of pupils on roll of schools visited 7,206 (iii) Total number of individual pupils found to be infested * In addition, 82 pupils showed minor evidence of infestation. 6* (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. Grammar and Technical Schools. No examinations were found necessary at these schools. Occupation Centre. (i) Total number of examinations by school nurse 151 (ii) Total number of pupils on roll 65 (iii) Total number of pupils found to be infested Nil. TABLE VI. Orthoptic Clinic. Total number of treatments given 1,096 Number of new cases 101 Number of cases on occlusion alone 6 Number of cases found unsuitable 12 Number of cases postponed 356 Number of cases failed to attend 52 Number of cases put down for operation 25 Number of cures—with operation 12 without operation 7 Number of sessions, 1954 285 TABLE VII. Year 1954. 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 O T A L 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) In the calendar year ended 31s; Dec., 1954: A. Handicapped Pupils newly placed in Special Schools or Boarding Homes — — 1 1 — 3 4 — — — B. Handicapped Pupils newly ascertained as requiring education at Special Schools or Boarding in Homes — — 1 1 5 5 6 1 — — 104 Number of children reported during the year:— (a) under Section 57 (3) (excluding any returned under (b)) 7 (b) under Section 57 (3) relying on Section 57 (4) Nil. (c) under Section 57 (5) Nil. of the Education Act, 1944. 1. Blind 2. Partially Sighted 3. Deaf 4. Partially Deaf 5. Delicate 6. Physically Handicapped 7. Educationally Subnormal 8. Maladjusted 9. Epileptic T O T A L 1—9 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) On or about December 1st, 1954: C. Number of Handicapped Pupils from the area: (i) Attending Special Schools as: (a) Day Pupils — — 2 2 — 7 18 — — — (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 — — 2 2 — 7 18 — — — D. Number of Handicapped Pupils being educated under arrangements made under Section 56 of the Education Act, 1944: (i) in hospitals — — — — — 1 — — — — (ii) elsewhere — — — — — — — — — — (iii) at home — — — — — — — — — — E. Number of Handicapped Pupils from the area requiring places in Special Schools (incl. any such unplaced children who are temporarily receiving home tuition) — — — — — — 2 — — — 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, 1954 £207 7s. 0d. 105 TABLE VIII. Independent Schools. Number of schools visited (including Occupation Centre) 8 Number of Medical Inspection Sessions 54 Number of children examined (various age groups) 551 Number of Re-inspections 19 Nutrition Table. Classification " A " (Good) 163 pupils or 29.58% " B " (Fair) 386 pupils or 70.06% " C " (Poor) 2 pupils or 0.36% Table of Defects found by Medical Inspection. Defect or Disease Number of Defects:— Requiring treatment. Requiring observation Skin 5 — Eyes, Vision 22 24 Eyes, Squint 2 1 Eyes, Other 1 — Ears, Hearing 1 1 Ears, Other 1 2 Nose and Throat 16 11 Speech 3 1 Cervical Glands — 1 Heart and Circulation — 3 Lungs 4 — Developmental, Hernia — — Developmental, Other 2 — Orthopaedic, Posture 12 — Flat Feet 16 1 Other 11 1 Nervous System, Epilepsy 1 — Psychological Development 2 — Other 10 1 Total 109 47