AC4412(1)BROMLEY BOROUGH OF BROMLEY MEDICAL OFFICER OF HEALTH'S Annual Report HEALTH OF THE BOROUGH 1956 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE on the H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health MUNICIPAL OFFICES, BROMLEY, KENT Telephone : RAVensbourne 4623 BRO 52 BOROUGH OF BROMLEY MEDICAL OFFICER OF HEALTH'S Annual Report on the HEALTH OF THE BOROUGH 1956 INCLUDING ANNUAL REPORT ON THE SCHOOL HEALTH SERVICE H. B. C. CARTER-LOCKE. m.b., b.S., M.R.C.S., L.R.C.P., D.p.H. Medical Officer of Health MUNICIPAL OFFICES, BROMLEY, KENT Telephone : RAVensbourne 4623 3 CONTENTS, Page Members of the Town Council 7 Staff 7 Prefatory Letter 9 Section A. Vital and Other Statistics and Social Conditions of the Area. General Statistics 14 Vital Statistics 14 Births 16 Deaths 16 Medical Examinations 18 Morbidity Statistics 18 Population 15 Unemployment 18 Section B. General Provision of Health Services for the Area. Ambulance Service 29 Disinfection 22 Domiciliary Midwifery 30 Domestic Help Service 30 Health Visiting 30 Home Nursing Service 30 Hospitals 29 Laboratory Service 23 Medical Loan Depots 22 Moral Welfare 23 National Assistance Act, 1948 24 Nursing Homes 24 Old People—Welfare 25 Public Mortuary 25 Women's Welfare Clinic 30 Section C. Sanitary and Environmental Circumstances of the Area Agriculture (Safety, Health and Welfare Provisions) Act, 1956 32 Cesspools 32 Diseases of Animals Acts 32 Drainage and Sewerage 32 Heating Appliances (Fireguards) Act, 1952 33 Pet Animals Act, 1951 33 Petroleum (Regulation) Acts, 1928 and 1936 33 Public Cleansing, Refuse Collection and Disposal 34 Rag Flock and other Filling Materials Act, 1951 34 Registries for Female Domestic Servants 34 Retail Market 34 Rivers, Streams and Lakes 35 Rodent Control 35 Sanitary Inspection of the Area 35 Shops Act, 1950 36 Smoke Abatement 36 Swimming Baths and Pools 36 Verminous Conditions and Uncleanliness 37 Water Supply 37 4 Page Sbction D. Housing. Housing Inspections and Abatements 40 Housing Repairs and Rents Act, 1954 40 Housing Statistics 40 Moveable Dwellings 42 Rehousing 41 Section E. Inspection and Supervision of Foods. Bacteriological Examinations 47 Food and Drugs Act, 1955—Section 16 45 Food Hygiene Regulations, 1955 44 Food Premises 46 Game Act, 1831 49 General Remarks 44 Ice Cream 47 Meat Inspection 48 Merchandise Marks Act, 1926 49 Milk and Dairies Regulations 47 Special Enquiries (Food and Drugs) 45 Unsound Food 46 Section F. Prevalence of, and Control Over, Infectious and Other Diseases. Acute Anterior Poliomyelitis 52 Chest Clinic 57 Diphtheria and Diphtheria Immunisation 53 Dysentery 53 Food Poisoning 53 General Remarks 52 Mass X-Ray 57 Measles 54 Meningococcal Infections 54 Other Infectious Diseases 58 Pneumonia 54 Scarlet Fever 55 Smallpox and Vaccination 55 Tuberculosis 55 Tuberculosis Care Committee 57 Typhoid Fever 58 Whooping Cough 58 APPENDIX—STATISTICAL TABLES. Table I.—Summary of Statistics, 1956 61 „ II.—Vital Statistics of the Borough for past ten years 62 „ III.—Causes of Death 63 „ IV.—Infant Mortality 64 „ V.—Analysis of Causes of Infant Deaths, 1947-56 65 ,, VI.—Notifiable Infectious Diseases—Ward Distribution, Attack and Mortality Rates 66 „ VII.—Notifiable Infectious Diseases—Seasonal Incidence 67 „ VIII.—Meteorological Observations and Open Air Recreational Amenities 68 „ IX.—Local Clinic Services 69 „ X.—Factories Acts, 1937 and 1948 70 XI.—Prevention of Damage by Pests Act, 1949 71 „ XII.—Food and Drugs Act, 1955—Food Sampling 72 „ XIII.—Summary of the work of the Public Health Inspectors, 1956 76 „ XIV.—Nuisances, Defects, Contraventions, etc., Abated or Remedied, 1956 79 5 Page SCHOOL HEALTH SERVICE. 1956. Members of the Committee for Education 84 Officers of the Committee 84 Staff 84 Introductory Letter 85 Audiometry 89 Dental Clinics 93 Ear, Nose and Throat Defects 94 Employment of Young Children 97 Handicapped Children 96 Infectious Diseases in Schools 94 Independent Schools 97 Minor Ailments 89 Ophthalmic Clinic 91 Orthopædic Clinic 92 Other Examinations 97 Periodic Medical Inspections 88 Physical Education 98 School Rolls, Further Education and Clinics 87 School Hygiene and New Schools 96 School Meals and Milk in Schools 96 Special Examinations 88 Speech Clinic 103 Vermin and Uncleanliness 94 STATISTICAL TABLES. Table I.—Medical Inspection of Pupils attending Maintained Primary and Secondary Schools 105 A. Periodic Medical Inspections 105 B. Other Inspections 105 C. Pupils found to reguire treatment 105 D. Classification of the physical condition of the pupils inspected 105 „ II.—Infestation with Vermin 106 „ III.—Return of Defects found by Medical Inspection, 1956 A. Periodic Inspections 106 B. Special Inspections 107 Tonsillectomy 107 „ IV.—Group I. Eye Diseases, Defective Vision and Squint 108 Group II. Diseases and Defects of Ear, Nose and Throat 108 Group III. Orthopedic and Postural Defects 108 Group IV. Diseases of the Skin (Excluding Uncleanliness) 109 Group V. Child Guidance Treatment 109 Group VI. Speech Therapy 109 Group VII. Other Treatment given 109 „ V.—Dental Inspection, Treatment and Orthodontics 110 „ VI.—Orthoptic Clinic 111 „ VII.—Handicapped Pupils 111 „ VIII.—Independent Schools 113 Juvenile Delinquency 114 Boot Club 114 Welfare—Provision of Clothing 114 7 MEMBERS OF THE TOWN COUNCIL (as at 31.12.56) *The Mayor (Alderman L. C. Winterton. J.P.) Aldermen : S. G. W. Baylis *S. L. Best. J.P. (Chairman of Public Health Committee) F. W. Isard Samuel Lane *J. S. Marriott C. L. Smith. J.P. Councillors : R. N. Allen F. G. Austen C. M. Baulf *F. W. Berringer *J. G. Booker G. W. Brown, M.B.E. *G. E. L. Chapman-Hatchett J. C. Clayton *W. K. Curtis A. D. Daysh M. L. Dempster (Mrs.) H. F. Goodway J. L. Hunt *C. E. Latter *F. G. V. Lovell *L. M. Prince (Mrs.) R. H. Roberts R. S. Shillingford *E. F. Waight A. A. J. Wells C. W. Wilmot (*denotes members of the Public Health Committee). STAFF OF THE PUBLIC HEALTH DEPARTMENT. 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 Medical Officer of Health to Chislehurst and Sidcup Urban District Council and Orpington Urban District Council.) Deputy Medical Officer of Health : A. J. I. KELYNACK, m.b., b.s.. d.p.h. (also Deputy Medical Officer of Health to Chislehurst and Sidcup Urban District Council and Orpington Urban District Council.) Assistant Medical Officers : †P. A. CURRIE, m.r.c.s., l.r.c.p. †Mrs. C. MAXWELL, m.a., m.b., b.chir. Chief Public Health Inspector, Inspector under the Diseases of Animals Acts and Petroleum Acts : G. R. WOODS, f.a.p.h.i., A.r.s.h. (.1, 2, 3, 4, 5) District Public Health Inspectors : T. C. TOWERSEY, m.s.i.a. (1, 2, 3). P. R. LIGHT, m.s.i.a., a.r.s.h. (1,2, 6). D. K. EVANS. m.s.i.a, (1, 2, 3, 6). P. DRINKWATER. m.s.i.a. (1, 2). Note.—All Public Health Inspectors are Inspectors under the Food and DrugAct, Shops Act, Rag Flock and Other Filling Materials Act, Pet Animals Act, Heating Appliances (Fireguards) Act, and the Agriculture (Safety, Health and Welfare Provisions) Act. 8 Health Visitors and School Nurses : †Miss E. CHENERY, s.r.n., s.c.m., h.v.cert. †Mrs. A. T. EVANS, s.r.n., s.c.m., h.v.cert. †Mrs. V. GRIEG, s.r.n., s.c.m., h.v.cert. †Miss W. G. HEMMINGS, s.r.n., s.c.m., h.v.cert. †Miss K. OWENS, s.r.n., s.c.m., h.v.cert. †Mrs. N. M. TAYLOR, s.r.n., s.c.m., h.v.cert. †Miss M. E. WOOTTON, s.c.m., s.r.c.n., h.v.cert. "†" denotes officers employed by the Kent County Council. CLERICAL STAFF : Chief Clerk : S. F. JUDD. E. P. J. WYTHE Miss A. BEAUMONT Mrs. D. COX (Appointed 17.9.56) Mrs. W. J. FOOT Miss E.W. EPPER (7) Miss N. M. CROXSON (Retired 14.4.56) (Resigned 22.8.56) Mrs. L. D. JOHNSON Mrs. R. C. TYE Other Appointments : Assistant Rodent Officers : J. L. GOUGH, A.R.S.H. N. W. HAMBLIN (Resigned 4.8.56 R. EDGE (Appointed 5.10.56) Outdoor Staff : Disinfector and Drain Tester : J. W. SEAGER. Market Superintendent : W. THRIFT (Part-time). The figures denote: — 1. Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. 2. Royal Sanitary Institute Certificate for Meat and Other Foods. 3. Royal Sanitary Institute Smoke Certificate. 4. Certificate of Examination Board of the Sanitary Inspectors' Association 5. Diploma of the Institute of Hygiene (London). 6. Royal Sanitary Institute Certificate for Sanitary Science as applied to Public Works and Buildings. 7. Unestablished or Temporary Staff. 9 To the Mayor, Aldermen and Councillors of the Borough of Bromley. Mr. Mayor. Ladies and Gentlemen. During the course of a year's work, one naturally comes into contact with a very large number of people of different types, and I have often been astonished at the unnecessary anxiety some have suffered through ignorance or erroneous knowledge about some simple health problem. It is certainly one of the more satisfying features of my work when I am able to correct some false impression and see a great load of worry lifted from the mind of the person concerned. Perhaps it is rather surprising that in these days when there are so many sources of information, including television, radio and libraries that such circumstances appear to arise frequently, but to my mind it at least shows the need for and importance of, one side of the work of the Public Health Department, and the particular service to which I refer is Health Education which properly employed can be of much value to the layman. That this fact is appreciated by the public appears to be borne out by the increasing number of requests for talks received by the Department during the past year, and with the equipment we now have some informative and, I hope, helpful and entertaining lectures have been given by members of the staff. However, let it not be assumed that the formal lecture or the informal discussion is the only means of disseminating knowledge, for I am firmly of the opinion that the Public Health Inspectors whose work brings them into such close contact with the public, are one of our most valuable assets in this very important task. For the first time ever in an Annual Report, I have written the words " Public Health Inspectors," for it was by an Act of Parliament of 1955, that this title was created in place of the former sanitary inspectors. To my mind, and this is a strictly personal view, not by any means universally acceptable, the change is an improvement giving as it does a much better idea of the many sided activities of these very valuable officers. The text of the report contains full details of the work of the department, but there are one or two outstanding matters to which I should like to refer in this letter. They are all matters affecting every one of us, and what I have in mind are the Food Hygiene Regulations, the commencement of a positive attack on anterior poliomyelitis, and the Clean Air Act. to With regard to the first of these, steady if unspectacular progress has been made, with the full co-operation of the trade, but it will take some time before all establishments can be brought up to the standard required by the regulations. Turning to the attack on anterior poliomyelitis, it is pleasing to be able to record that the County Council's scheme of vaccination against this disease has been commenced in a small way, without untoward incident, and that there are great hopes for the future of this project, the results of which are eagerly awaited. Next, I would like to refer briefly to the Clean Air Act which came into force at the end of the year and made provision amongst other things, for smoke control areas. This latter is a matter which the Council have had under active consideration and with the acquisition of apparatus (which should be in operation next year) to determine the daily atmospheric pollution, hope soon to be in a position to decide their policy for the future. Comment on the vital statistics is made elsewhere in this report, but I am glad to be able to report that the infant mortality rate is once again below that for the country, and that last year's unexpected rise, fortunately, was not maintained. The vital statistics as a whole must be considered satisfactory, but your attention is drawn to the fact that the natural increase in population, that is to say, the excess of births over deaths, has now fallen to 37 from a corresponding figure of 577 in 1947. This excess has been decreasing fairly steadily since that year, and if the present trend is continued, one is faced with the rather unpalatable fact that within a year or so there will be a natural decrease of population. The work of the department has continued smoothly throughout a year in which additional legislation, as has already been indicated, produced a number of new problems to be overcome, and I should like to acknowledge my indebtedness to the staff for their steadfast loyal support. To Mr. Woods, the Chief Public Health Inspector, now entering his fiftieth year in the Public Health service, I must offer my heartiest thanks and congratulations on the quality and length of that service. Mr. Judd, my Chief Clerk, is also deserving of great thanks for his work in general, and in particular of the care and attention he takes in the far from inconsiderable work involved in compiling this report. 11 My thanks are also due to my deputy, Dr. Kelynack, who fits into the department so well and efficiently, and to my professional colleagues, both within and outside the Public Health service, for their continued assistance in all matters of mutual interest. In conclusion I should like to offer a heartfelt word of thanks to the Chairman and Members of the Public Health Committee for their continued interest in the work of the department. I am. Your obedient Servant, H. B. C. CARTER-LOCKE. Medical Officer of Health SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 14 SECTION A. VITAL AND OTHER STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area of the Borough (in acres) 6,519 Area of public open spaces (in acres) 603 Registrar General's estimate of total population (mid-year) 1956 65,100 Rateable Value at 31st March, 1957 £1,329,412 Estimated product of a Penny Rate for year ending 31st March, 1957 £5,372 13s. Od. Number of Valuation Assessments as at 31st March, 1956: — (a) Houses and Flats 19,768 (b) Commercial 1,471 (c) Licensed Premises 41 (d) Entertainment and Recreational 91 (e) Public Utility 20 (f) Educational and Cultural 28 (g) Industrial 60 (h) Miscellaneous 272 Total 21,751 Mileage of Roads as at 31st March, 1956: — County Roads, Class 1 12.26 County Roads, Class 2 6.48 County Roads, Class 3 5.16 District Roads 66.00 Unadopted Roads 14.59 Total 104.49 VITAL STATISTICS Live Births. Males. Females. Total Legitimate 399 364 763 Illegitimate 19 20 39 418 384 802 Crude birth rate per 1,000 estimated total population 12.3 Adjusted birth rate for comparison with other areas 12.5 (The area comparability factor for births is 1.02) Birth rate for England and Wales 15.7 15 Stillbirths. Males. Females. Total Legitimate 5 4 9 Illegitimate — — — 5 4 9 Stillbirth rate per 1,000 estimated total population 0.14 Stillbirth rate per 1,000 live and still births 12.5 Deaths. Males. Females. Total. 381 384 765 Crude death rate per 1,000 estimated total population 11.8 Adjusted death rate for comparison purposes 11.0 (The area comparability factor for deaths is 0.93) Death rate for England and Wales 11.7 Maternal Deaths. Puerperal sepsis Nil Other puerperal causes 1 Maternal mortality rate per 1,000 live and still births 0.81 Infant Mortality. Males. Females. Total. Legitimate 8 4 12 Illegitimate — 1 1 8 5 13 Infant mortality rate per 1,000 live births 16.20 Legitimate infants per 1,000 live legitimate births 15.73 Illegitimate infants per 1.000 live illegitimate births 25.64 Infant mortality rate for England and Wales 23.8 POPULATION The Registrar General's estimate of the total population of the Borough, mid-year, 1956, was 65,100. which is an increase of 320 over the figure for the previous year. This figure gives a density of ten persons to the acre. The natural increase of population, measured by excess of births over deaths, was 37. The small fluctuation in the total population noted in recent years was maintained and there seems no reason to anticipate any dramatic change in this tendency. 16 BIRTHS Eight hundred and two live births were registered during the year, as against eight hundred and twenty-three during 1955. The birth rate for the year is 12.3 per 1,000 total population. The adjusted rate, for comparison with other areas, is 12.5. Of the births registered, 418 were males and 384 females. The rate of 12.3 is slightly lower than that for 1955, and is also well below the rate of 15.7 for England and Wales as a whole. The illegitimate birth rate was 48.09 per 1,000 live and still births. There were 39 illegitimate births registered, 19 being males and 20 females. Nine stillbirths were registered, giving a rate of 0.14 per 1,000 total population, and 12.5 per 1,000 live and still births. Five of the stillbirths were males, and four females. DEATHS There were 765 deaths appertaining to the Borough and registered during 1956, giving a Death Rate of 11.8 per 1,000 total population. The adjusted rate for comparison purposes is 11.0. The rate for England and Wales is 11.7. Of the Bromley deaths registered, 380 were males and 385 females. The following is an analysis of the ages at death :— Male. Female. 13 were under 1 year of age 8 5 5 were 1 and under 5 years of age 2 3 4 were 5 and under 15 years of age 3 1 6 were 15 and under 25 years of age 5 1 20 were 25 and under 45 years of age 12 8 158 were 45 and under 65 years of age 102 56 194 were 65 and under 75 years of age 103 91 365 were 75 years of age and over 146 219 381 384 By comparison with the previous year there is an increase in the adjusted death rate of 1.1 per 1,000 population ; this is worthy of note but is not of course a cause for alarm. 17 Full details of the causes of death will be found in Table III in the appendix, but the following table of comparative rates per 1,000 population for the last seven years of certain causes of death in the Borough may be of interest:— 1950 1951 1952 1953 1954 1955 1956 Cancer (all sites) 1.9 1.98 1.77 2.38 1.99 1.83 2.30 Congenital Causes 0.12 0.09 0.16 0.11 0.08 0.11 0.12 Heart Disease 6.31 5.56 6.31 5.34 5.88 5.94 6.30 Infectious Diseases 0.015 0.062 0.031 0.03 0.03 0.03 0.06 Influenza 0.03 0.11 0.00 0.11 0.01 0.00 0.03 Respiratory Diseases (non-T.B.) 0.68 1.27 1.17 0.91 1.09 1.49 1.12 Tuberculosis 0.26 0.31 0.17 0.14 0.12 0.08 0.01 Last year I remarked that the death rate from tuberculosis could hardly be expected to drop further but, fortunately, I am proved wrong. It is also encouraging to see that the continuous rise in deaths from respiratory diseases other than tuberculosis which had been noted over the past few years has been halted. The cancer death rate for the year was the second highest recorded in the past seven years and included 37 deaths from cancer of the lung, twelve more than in 1955. There was one maternal death but this occurred more than twelve months after birth and was the first to occur following six years with no mortality under this heading. It is very gratifying to be able to report that the infant death rate fell from last year's comparatively high figure of 31.6 to 16.20, which compares very favourably with the figure of 23.8 for England and Wales as a whole. Deaths from violence increased from 18 to 24 and included 7 motor vehicle accidents, 11 suicides and 6 other accidental deaths. The following tabulation gives details of deaths from all forms of cancer for the past ten years :— Year. Males. Females. Total. 1947 60 63 123 1948 58 57 115 1949 66 72 138 1950 50 73 123 1951 62 66 128 1952 56 58 114 1953 70 84 154 1954 66 63 129 1955 53 66 119 1956 83 67 150 18 Deaths from cancer of the lung and bronchus during the past seven years :— Year. Males. Females. Total. 1950 13 4 17 1951 19 3 22 1952 10 4 14 1953 24 5 29 1954 21 7 28 1955 19 6 25 1956 28 9 37 LOCAL SICKNESS The following details have been received from the Ministry of National Insurance during 1956. 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. Number of certificates of incapacity. Four weeks ending First. Intermediate. Final. 24th January 1,394 4,255 994 21st February 1,502 4,450 1,134 20th March 1,484 4,556 1,314 17 th April 852 3,947 839 15th May 743 3,824 644 12th June 651 3,644 622 10th July 662 3,698 564 7th August 622 3,580 502 4th September 549 3,576 451 2nd October 786 3,656 538 30th October 1,010 3,709 777 27th November 1,042 3,791 824 1st January, 1957 (5 weeks) 1,059 4,346 888 MEDICAL EXAMINATIONS Sixty-three members, or potential members of the staff were medically examined during the year. UNEMPLOYMENT I am indebted to the Manager of the Local Employment Exchange for the following information with regard to unemployment in the area during 1956 :— " The following figures indicate the volume of unemployment in the Borough during 1956 :— Men. Women. Total. 16th January 56 51 107 13th February 119 43 162 17th March 69 39 108 16th April 38 37 75 14th May 34 34 68 11th June 27 32 59 16th July 28 53 81 13th August 43 45 88 17th September 42 50 92 15 th October 45 57 102 12th November 58 70 128 10th December 72 61 133 19 It will be seen that unemployment has remained at a comparatively low level throughout the year. During February inclemental weather affected the building industry for about three weeks when approximately 70 local workers were stood off temporarily. The March figures include 23 workers who were affected by a dispute in the printing industry. From March onwards unemployment declined until June when the lowest figure since 1945 was recorded. Since June there has been a slight but steady increase in the numbers registered as unemployed. The increase among men during the latter months of the year was almost entirely due to a number of Painters becoming unemployed as a result of a seasonal decline in the decorating side of the building industry. Apart from these workers, unemployment among men has been generally confined to professional and executive classes, older clerical workers and to disabled persons. Able-bodied skilled and unskilled manual workers have been quickly placed in employment. The increase in the number of women registered as unemployed during the latter half of the year has been in the main due to women returning to the employment field and for whom there were no suitable jobs available. Among women, unemployment has been generally confined to clerical and shop workers in the higher age groups and to women who require work for restricted hours owing to domestic responsibilities. Full use has been made during the year of the facilities available for Industrial Rehabilitation at the Waddon Unit in suitable cases. 12 men and 10 women were recommended for the course and some successful results have been achieved. In one case of a middle aged man who had held a responsible executive position until 1953. when a break-down in health occurred and he had done very little work since then, he was persuaded to undertake the course and on completion was placed in employment where he has reasonable opportunities for the future. In the case of a middle aged women who had done very little work since 1949 as a result of a break-down in health, following a short course at the Unit in March, she has been regularly employed since. Four of the men followed the course by Vocational Training in a skilled trade. 20 The object of the Industrial Rehabilitation Unit at Waddon is to provide men and women who have had a long spell of inactivity following illness, injury or any other cause, the means of restoring them, under expert direction to their full working capacity and giving them professional guidance, where there is need, about the kind of work likely to be most suitable. The Unit is to a considerable extent dependent upon the medical profession and hospital staffs in recommending suitable cases for this course of industrial rehabilitation. The Committee of Enquiry on the Rehabilitation, Training and Resettlement of Disabled Persons under the Chairmanship of Lord Piercy, C.B.E., in their report published in November, commented that there are several important and heavily populated areas without industrial rehabilitation units and recommended that additional units should be supplied as soon as possible." SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 22 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. BRITISH RED CROSS SOCIETYMEDICAL LOAN SERVICE. A medical loan service is provided by the British Red Cross Society at 34a. Market Square, Bromley. A full range of nursing requisites is kept at this depot. A small charge is normally made for the articles hired, but in cases of distress and for most Old Age Pensioners, no charge is made. The depot is open on Monday. Tuesday. Thursday and Friday each week between the hours of 10.30 a.m. - 12.30 p.m.. and 2.30 - 4.0 p.m. DISINFECTION. In appropriate cases disinfection is carried out by the Department after the removal of a person suffering from an infectious complaint from a house, or subsequent to the patient being declared free from infection. Rooms, fixtures and furnishings are sprayed with formalin and in suitable cases bedding and clothing are steam treated in the Council's steam disinfector. Public Library books which have been exposed to infection are rendered safe and returned to the Libraries. Disinfestation. The Department also carries out work to eradicate vermin in premises. Infected rooms are treated with a solution containing a quick acting insecticide, together with D.D.T. Bedding and other articles are steam treated. Advice is given to householders to assist them in dealing with insect infestations. Details of the work of disinfection and disinfestation carried out during the year are as under :— Disinfections : Premises visited 92 Rooms disinfected 67 Articles disinfected 379 Disinfestations : Premises visited 12 Rooms disinfested 27 Articles disinfested 32 23  Articles Treated. Articles Destroyed. feeds 5 5 Mattresses 64 13 Bolsters 5 3 Pillows 131 8 Cushions 11 - Blankets 87 1 Sheets 25 1 Eiderdowns 13 - Bedspreads 6 - Carpets 1 - Garments 28 11 Miscellaneous 14 5 Library Books 21 - 411 47 LABORATORY SERVICE. Food and Drugs samples are sent to the Public Health Laboratory at Maidstone. Swabs and other medical specimens are sent to the laboratory at Bromley Hospital and my thanks are due to Dr. Keall and his staff for the very valuable assistance they have rendered. Details of specimens, etc., sent to these laboratories are as under :— Swabs (for Haemolytic Streptococci) 43 Swabs (for Diphtheria) 2 Swabs from taps 5 Faeces 98 Food Samples, etc 502 Urine 1 Vomit 3 Water Samples 36 Water (Swimming Baths) 43 Miscellaneous 19 752 MORAL WELFARE. The Church Army Home, Wells Road. Bickley. The Sister in charge has kindly furnished the following report : "The accommodation in this Hostel is 15 mothers and 15 babies. There were 13 mothers and 13 babies resident in the Hostel on the 1st January. 1956. Altogether 24 mothers and babies were in the Hostel during the year 1956. Of these, seven, when the child reached the age of eighteen months to two years, went into satisfactory lodgings with the child, and three returned to relatives. Fourteen mothers and babies were in the Hostel on the 1st January. 1957. As will be seen from the above figures, the Hostel does answer a very real need for the unmarried mother who wishes to keep her child." 24 Rochester Diocesan Association for Moral Welfare Home, Blyth Road. The following report has been furnished by the Superintendent: " During the year 85 girls and 57 babies were admitted. Of this number, 46 were maternity cases. Forty-nine cases were admitted to various hospitals during the year. Of those admitted to hospital. 13 returned home with baby. 19 returned home and babies were placed with the Children's Society for adoption. 5 returned home and babies were placed with Foster Mothers, 1 returned to friends and baby was placed with a Foster Mother. 1 returned to a Training Hostel and baby went to a Foster Mother, 1 returned to a mother and baby hostel, 3 returned home and babies were placed in residential nurseries. 2 did not return after confinement. Shelter cases—During the year 24 cases were admitted for varying periods of time." Report of Sister Papps, Outdoor Worker : " One hundred and eighty-one new cases have been referred and dealt with during the year and at the close there were 69 cases outstanding. Of these cases, 65 were maternity. 85 preventive, 18 matrimonial. 2 rescue, and 11 miscellaneous. Fifty of the maternity cases concerned single girls between 16 and 18 years of age. During the year 861 home visits were made. 1.447 interviews given. 33 meetings addressed, and 1.770 letters written." NATIONAL ASSISTANCE ACT, 1948. Section 47 It was not necessary for the local authority to take any action during the year for the compulsory removal to hospital of any person, although several possible cases were investigated. Section 50 No burials were arranged during the year. NURSING HOMES. There are 6 Nursing Homes on the register at the present time, with provision for a total of 99 beds for medical and surgical cases. No maternity beds are provided in these homes. 25 Frequent inspection of these homes was carried out during the year and at no time were any contraventions found which called for action on the part of the Local Authority. These Nursing Homes are fulfilling a very useful purpose in that they are providing accommodation for a type of case which in many instances it is extremely difficult to get into hospital. Details of the Homes registered are :— Address No. of Beds Surgical Number of new patients received during 1956 Medical and Chronic 18, Blyth Road 26 — 44 42, Cambridge Road 8 — 14 17, Edward Road 12 — 29 24. Elmfield Road 10 — 6 47, Park Avenue 22 — 56 " St. Cecilia's" Sundridge Avenue 21 — 25 PUBLIC MORTUARY. The public mortuary is situate at the rear of the Fire Station in South Street, Bromley. During the year 29 bodies were received at the mortuary, 17 of which were received from hospitals. Inquests were held in 11 cases. WELFARE OF OLD PEOPLE. The following reports have been received on the various homes run by voluntary associations and public authorities :— " Greenhill," Oaklands Road, Bromley. This Home is run by the Brook Lane Medical Mission, and General Secretary reports " There are 22 beds available in the Home. We are hoping soon to go forward with the building of an extension, which will give us more ground floor accommodation. During 1956, we have lost 2 residents by death, and 3 residents have been moved to other Homes owing to their increasing infirmity. 5 new patients have been admitted to Greenhill. The new balcony, mentioned in our last report, was finished in time for the summer months, and gave great pleasure to the residents. A new sun blind was also fitted and new chairs supplied. Nearly all the residents were able to go away for a change during the summer—some to relatives or friends, and others to Convalescent Homes at Brighton and Bognor run by the Bermondsey Medical Mission." 26 " Armstrong House," 1, Southlands Grove, Bickley. The following report has been received from the General Secretary of the S.O.S. Society :— " ACCOMMODATION— Capacity 28 (Since reduced to 26) Weekly average 27.5 Admitted during the year 6 Present residents :— Women 10 Men 16 Average Age 84 All the usual facilities of a residential Home for old people are provided, namely, full board and lodging, general care and supervision of the residents, nursing during periods of sickness and various forms of entertainment. With an average age of 84. it is not surprising that minor illnesses were fairly frequent, but, fortunately, no sustained periods of illnesses were experienced. The local doctors, with whom the residents are registered, are always most helpful and the Matron knows that their advice is available at any time. The difficulty of obtaining hospital beds for chronically sick residents has not eased but hospital almoners are considerate and helpful and, if possible, will arrange for a sick resident from the Home to be exchanged for a patient who has recovered sufficiently to be discharged from hospital. The Home continues to receive the very active support of the Bromley Ladies Circle, whose members visit the Home regularly and who organised a party for the residents during the summer. Members of the Bromley Baptist Church organised musical evenings at the Home and film shows have been arranged during the year by Dr. Barnardo's Homes. Religious services continue to be held in the Home. During the Society's financial year ended 22nd September. 1956, the total cost of maintaining the Home amounted to £4,793. which was roughly £300 in excess of income." " Merevale," Bickley Park Road, Bickley. The Secretary of the North West Kent Housing Society. Ltd., has kindly furnished the following information : " Merevale has continued to accommodate 36 old people, but during the year had the largest turn over in its history, due mainly to the increasing age of the residents. Actually there were 10 changes due to deaths and other causes. At the close of 1956 all beds were occupied and the average age was 82." 11 "Southwood Residential Club for Elderly People," Oldfield Road, Bickley. This Home is run by the W.V.S. and the following report has been received : " The past year has been marked by few changes. The health of the residents has been good, and considering the average age is 83 with a total of 42 residents, a great deal of credit can be given to the Staff for this. The increasing frailty of the residents as they get older becomes a problem as staffing is difficult. Thanks to a small bequest the Committee were able to make two very welcome improvements to the house which have given a great deal of pleasure to the residents. The residents have had some very nice outings during the year, and they continue to do handicrafts for themselves and also to help the various appeals on the town." " Town Court " and " The Vane," Bickley. The undermentioned report has been received from the Chief Officer of the Welfare Department, London County Council " Town Court " " The Vane " Tolal number of beds 32 51 Residents on 31st December, 1955 31 22 Admissions during 1956 13 60 Discharges during 1956 13 31 Residents on 31st December, 1956 31 51 On completion in January, 1956, of necessary adaptation works, the house, No. 10, Denbridge Road, Bickley, was combined with the existing home " The Vane," 12, Denbridge Road, and the two premises are administered as one home known as " The Vane," thus increasing the accommodation from 29 to 51. " Elmwood " and " Homefield," Southborough Road, Bickley. These Homes are run by the Bermondsey Medical Mission. " Homefield " is for patients no longer needing hospital treatment but still in need of nursing and medical care. " Elmwood " is for residents officially described as being in need of care and attention. The average age of the residents during the year was about 78 years, and, considering their frailness their health was good. 7 residents who became ill were transferred to hospitals and 8 new residents were accepted during the year. A number of the old ladies had two weeks' holiday at the Mission's new convalescent home at Bognor Regis, and during their absence the beds were used for 28 other old people needing care whilst their families were on holiday. Local organisations and friends arranged shopping expeditions and trips into the country, and also ran a weekly " shop " and arranged jumble sales for the old people. The British Red Cross Society also arranged a weekly library service. WOMEN'S VOLUNTARY SERVICES Over 60's Clubs. These Clubs meet once a week on various days in different parts of Bromley, and there are 10 functioning at the present time in the Borough. The old people have the opportunity of meeting and making friends, playing games and doing handicrafts together, and enjoy the chat and ever pleasant cup of tea. Sick visiting is done by members of the Clubs and the W.V.S. helpers. The members are very busy working for a County Handicraft Exhibition in 1958. This gives them an aim for serious work. Club Leaders arrange outings to the sea in the summer, and half day outings during the spring and autumn. This is a regular feature of the Clubs. Several Clubs have their own Concert Party. The Church service arranged for the combined clubs is now an annual feature of Club life and is looked forward to and well attended. Meals on Wheels and Luncheon Club. An average of 70/80 meals are cooked by voluntary workers 4 days a week (Tuesday, Wednesday, Thursday and Friday) at the Meals Kitchen, St. Mary's Church House, College Road, Bromley. Sixty meals are taken out in insulated containers in two W.V.S. vans, and old people who are mobile can take advantage of a luncheon club which is run in conjunction with the kitchen at St. Mary's Church House. On September 30th. W.V.S. finished the fourth year of cooking meals on wheels service, and in the last week in October. 1956. delivered the 55.000th meal cooked by the teams at the kitchen. 14.475 meals were cooked during 1956. Over the four years, much has been done to improve this service, and during 1956. 5 new Hotlock insulated containers were added to the equipment, improving considerably the delivery of the meal. These containers are heated with charcoal which ensures that the last meal remains as hot as the first one to be delivered. In spite of the increased cost of food and the high cost of potatoes and vegetables earlier in the year, the cost of the meal over the year has been l,/6d.. which includes food, heating and cleaning. The old people pay from 1/- to l/6d. according to their means. 29 A gift from Alexandra Rose Day and the Sunday Cinema Fund helped to subsidise those who could not afford the full cost of the meals. During the year there have been visitors from all parts of the country to see this Meals on Wheels Service in action. Welfare Work and Trolley Shops. W.V.S. members visit the two London County Council Homes, and " Dunoran." " Homefield," " St. Cecilia's," Lennard Hospital and Hayes Grove Nursing Home, and a trolley shop service is given where needed. Wheel chairs are kept at the Centre and loaned to those in need. These are appreciated and much used during the summer months. W.V.S. members visit the housebound and lonely. HOSPITAL SERVICES. The following hospitals are within the area and are controlled by the Bromley Group Hospital Management Committee, whose offices are at Farnborough Hospital. Farnborough. Kent. (a) Bromley Hospital, Cromwell Avenue. General hospital with 133 beds. Bromley Hospital Maternity Units : 20. Masons Hill. Bromley. Provision for 33 beds. 118, Widmore Road, Bromley. Provision for 21 beds. (b) Lennard Hospitals. Lennard Road. Provision for 56 beds for use by infectious disease cases. This number can be more than doubled in an emergency. Fifty beds for geriatric cases. (c) Chest Clinic, Tiger Lane, Bromley. Venereal Diseases. Patients requiring treatment for these diseases are referred to the hospitals with the necessary specialist clinics. COUNTY COUNCIL SERVICES. Ambulance Service. This area is served by ambulances and sitting-case cars based at the main depot which is situate at 12. Hayes Lane. Bromley. The majority of the vehicles are radio controlled, and at the present time there are 29 ambulances and 20 sitting-case cars available for use. 30 Domestic Help Service. Applications for this service should be made to the District Organiser, Municipal Offices. Bromley. Family Help Service. This service was brought into operation towards the end of the year, and is provided to deal with the care of children in their own homes when they are temporarily deprived of the care of their mother or a female guardian. Night Attendant Service. The Night Attendant Service is for old people in their own homes, and arrangements include evening service and preparation for sleep, preparation of meals, attention to fires and night service. Domiciliary Midwifery. There are four full-time domiciliary midwives employed in the area. The services of a midwife may be obtained by the patient on direct application, or through the patient's private doctor. Health Visiting. Seven Health Visitors are employed in this area. Their time is equally divided between Health Visiting and work in connection with the School Health Services. In addition to their school work. Health Visitors are responsible for the Maternity and Child Welfare Clinics, Immunisation and Vaccination Clinics. Home Visiting. After Care, etc., and give advice on the care of young children, and advice to expectant and nursing mothers. All Health Visitors now undertake Mental Health work. Home Nursing Service. There are 10 home nurses engaged in the area (9 female and 1 male). The services of a Home Nurse are obtained on medical certification. A day service only is provided at present. Women's Welfare Clinic. Patients from this area are referred to the Chislehurst Clinic. During the year 1956 demands for the service continued to be heavy and the following cases received assistance :— Maternity (expectant mothers) 95 Tuberculosis 20 Aged 377 Others 225 Total 717 SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. 32 SECTION C SANITARY AND ENVIRONMENTAL CIRCUMSTANCES OF THE AREA. AGRICULTURE (SAFETY, HEALTH AND WELFARE PROVISIONS) ACT, 1956. This Act came into operation on the 5th July, 1956, its main object being to make provision for securing the safety, health and welfare of farm workers and avoiding accidents to children arising out of the use of agricultural equipment. 13 visits of inspection were made by the Inspectors and 9 contraventions found. DISEASES OF ANIMALS ACTS. Mr. G. R. Woods is the Inspector under the above Acts. Seventy-eight Statutory Instruments were received during the year concerning outbreaks of Foot and Mouth Disease in the country. Fortunately, Bromley was not included in an infected area. From the 1st October to the 31st December, the holding of markets, fairs or sales of store poultry will be prohibited in England and Wales. The order is made with a view to reducing further incidence of Fowl Pest. The new order does not apply to licensed sales of poultry intended for immediate slaughter. DRAINAGE AND SEWERAGE The reconstruction of a further length of 300 yards of main soil sewer through the Public Golf Course, between the length dealt with last year and Princes Plain, was completed. A relief surface water sewer was laid along Elmstead Lane between Sundridge Avenue and Walden Road, so as to make provision for building development taking place near the Borough boundary. Cesspools. No new houses were erected with cesspool drainage during 1956. Eighteen individual cesspools were emptied by the Borough Engineer's Department upon the request of the householders. 33 HEATING APPLIANCES (FIREGUARDS) ACT, 1952. 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. During the year under review 15 visits of inspection were made by the Public Health Inspectors. One contravention was observed and remedied. PET ANIMALS ACT, 1951. This Act is designed to regulate the sale of pet animals, and during the year 6 premises were licensed. In the main, the sale of pets at these premises consists of cage birds and tropical and other fish. Thirty-one visits of inspection were made by the Inspectors, and 2 nuisances and defects found, both of which were remedied by the end of the year. In no case has it been found necessary to attach any special conditions (other than the general conditions) to any licence which has been issued. PETROLEUM (REGULATION) ACTS, 1928 AND 1936. Mr. G. R. Woods is the Inspector appointed under the above Acts. During the year 94 licences were issued to store Petroleum Spirit and Petroleum Spirit Mixtures, and one for Carbide of Calcium. The total storage capacity licensed during the year ending 31st March, 1957, was :— Bulk Storage 115,720 gallons. Can storage 1.389 gallons. Carbide of Calcium 300 lbs. In several instances improvements have been made to Filling Stations and new flame proof electrically operated pumps were installed to replace old pattern pumps, and the electrical wiring was carried out in accordance with the Home Office Regulations. 77 visits of inspection were made during the year and the very few minor contraventions found were immediately remedied. 34 PUBLIC CLEANSING, REFUSE COLLECTION AND DISPOSAL. The Borough Engineer has kindly furnished the following information :— The refuse collection rounds had to be rearranged shortly before the end of the year, so as to deal with the increasing number of properties in the Borough, and during this reorganisation the number of rounds was increased by 1 to 12. The construction of the new chimney shaft and water seal dustcatcher for Unit No. 2 of the Refuse Destructor was carried out during the summer months and brought into trial operation. Modification to Unit No. 1 will proceed during the coming summer. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. This Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined, or for purposes connected therewith. 8 informal samples were taken during the year and all conformed to the standard of cleanliness laid down in the regulations. REGISTRIES FOR FEMALE DOMESTIC SERVANTS. Only two premises are registered in connection with the existing legislation. General observations are made with a view to ascertaining whether premises displaying notices advertising for vacancies are complying with the law. During the year, 35 inspections were made, 8 contraventions were found and remedied. RETAIL MARKET. Mr. G. R. Woods continues to control the market which has shewn marked progress since January, 1956. It is hoped that when the suggested improvements are finally carried out, it will be to the financial advantage of the Borough. It is noticeable that the public are attracted to the Market on Thursdays and it is evident that many people are coming to it from outside areas. 35 RIVERS, STREAMS AND LAKES. The culverting of the river Ravensbourne behind houses in Newbury Road and across the allotments as far as Glassmill Lane was completed just before Christmas. As mentioned in the report last year, this scheme included the construction of a lake to store approximately 1,800,000 gallons of water at the peak of any storm, so as to ameliorate conditions where flooding might otherwise have occurred at points downstream. During the course of the work the invert of the existing culvert under the railway line was lowered to the new level by the British Transport Commission on behalf of the Council. A length of the stream at Princes Plain, in the vicinity of the Public Golf Course was piped during the year. RODENT CONTROL. The two assistant Rodent Officers have carried out excellent work with their usual efficiency and with great tact in dealing with the public. A tabulation of their work, in addition to which are the six monthly maintenance treatments of the sewers in the area, will be found in Table XI in the appendix. SANITARY INSPECTION OF THE AREA. Full details of the work carried out by the Inspectors will be found in Tables XIII and XIV 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 4,474 1,128 Infectious Diseases 300 — Food Premises 4.723 569 Factories, Outworkers, etc 468 91 Sampling Visits 455 — Trade Premises (Various) 501 102 Rodent Control 252 42 Miscellaneous 986 38 Total 12,159 1,970 In addition to the above, there were 1,223 interviews with owners, agents, etc., on site and at the office, in connection with the above work. 36 Notices issued :— Preliminary: — Housing 610 Food Premises 192 Factories, etc 36 Trade Premises 57 Rodent Control 775 Miscellaneous 83 1,753 Statutory: — Housing Nil Total 1,753 Food Condemnation Certificates issued . 761. SHOPS ACT, 1950 One hundred and seventy-two visits of inspection were made by the Public Health Inspectors. Sixty-four contraventions were found and 39 remedied. The infringements were of a minor character—principally the omission of exhibiting the statutory forms. No prosecutions were instituted during the year. It is noticeable that the statutory hours of employment of young persons in the shops were not in any instances exceeded. The revised legislation has not yet been implemented. Clean Air Act, 1956. This Act forms part of the Public Health Code and the functions of Local Authorities were extended when certain sections of the Act became operative on the 20th December. 1956. It is anticipated that during the next twelve months public opinion will be awakened to appreciate the reason for establishing smoke control areas in which only smokeless fuels will be burnt. The use of raw coal for heating purposes will, ultimately, be abolished. One hundred and eight visits of inspection to Swimming Baths and Pools in the area were made by the Inspectors. Forty-three samples of water were taken for examination. Of these samples. 10 were from the Corporation Open Air Pool and all were satisfactory. Two of the samples from privately owned swimming baths were unsatisfactory, having a high bacterial count due to inefficient treatment of the water. ATMOSPHERIC POLLUTION SWIMMING BATHS AND POOLS 37 In addition to the above, 162 routine colometric tests for checking the efficiency of purification plants were also made by the Inspectors. The chlorine content and pH value are checked by means of a Lovibond Comparator. VERMINOUS CONDITIONS AND UNCLEANLINESS One hundred and thirty-nine visits to premises by the Inspectors related to eradication of bugs, dirty conditions and disinfestations. Twenty-eight nuisances were found and 35 remedied during the year. (This latter figure includes those found in 1955 and abated in 1956). WATER SUPPLY. Twelve samples of drinking water were taken during the year, to ascertain the toxic metal content (zinc). In no sample was zinc detected. The supply of water to the Borough is provided by the Metropolitan Water Board, and I am indebted to the Director of Water Examination, to that authority, for the following information on the supply during the year 1956 :— The supply to the Borough of Bromley is from four of the Board's Kent Wells, namely, North Orpington, Orpington, Shortlands and West Wickham. together with Thames-derived filtered water. All the water is chlorinated before it leaves the works. Contact tanks are 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 on the works and in the distribution system. The following table gives the average results of the chemical and bacteriological analyses of the various supplies to ihe area for 1956 38 Average results of the Chemical and Bacteriological examination of the water supplied to Bromley during the year 1956. Milligrammes per litre (unless otherwise stated). Shortlands Well No. 1 Shortlands Well No. 2 West Wickham Well Orpington Well North Orpington New Bore Hole North Orpington Well No. 1 Thames-derived filtered water Chemical No. of samples 4 4 5 3 3 3 1598 Ammonia Nitrogen 0.001 0.005 0.003 0.003 0.007 0.002 0.0036 Albuminoid Nitrogen 0.024 0.025 0.022 0.018 0.020 4.7 0.086 Oxidised Nitrogen—Nitrate 4.8 5.1 5.4 6.2 5.3 4.7 4.3 Chlorides as Cl. 16 16 13 15 16 12 30 Oxygen abs. from ganate 4 hours at 27°C. 0.08 0.06 0.04 0.10 0.06 0.06 0.3 Turbidity in terms of Silica Nil Mil Nil Nil – Nil 13 Colour m.m. brown 2ft. Tube Burgess's Tintometer 282 282 260 278 258 262 258 Hardness (Total) 74 72 34 48 36 42 72 Hardness (non-carbonate) 7.2 7.2 7.1 7.1 7.3 7.1 7.7 Phosphate as P.O4 – – – – – – 0.90 Silicate as SiO2 — – – – – — 10 Sulphates as SO4 — – 4 16 8 8 58 Conductivity 40 475 40 500 400 475 425 450 500 Bacteriological Results Shortlands Wells West Wickham Well Orpington Well North Orpington Wells Thames-derived filtered water Before Chlorination No. of samples 499 232 251 146 7086 Plate count (Average per millilitre) Colonies counted on Agar : 37°C. (20-24 hours) 0.01 0.01 0.3 4.7 – Bact. coli test: Percentage samples negative in 100 ml. 100.0 100.0 99.6 13.7 61.2 Average number per 100 ml. – – 0.02 17.86 4.43 After Chlorination (Water passing into Supply). No. of Samples 255 236 256 149 3736 Plate count (Average per millilltre) Colonies counted on Agar: 37°C (20-24 hours) – – — – – 100 ml. 100.0 99.6 100.0 100.0 99.9 Average number per 100 ml. – 0.013 – – 0.002 SECTION D. HOUSING. 40 SECTION D. HOUSING. HOUSING REPAIRS AND RENTS ACT, 1954. There was a continued lack of use of this Act by tenants in applying for certificates of disrepair and it may well be that working-class property in this area is in a good state of repair. Owners have taken advantage of the relevant sections of the Act by applying for and receiving grants to enable their properties to be improved and so comply with modern conditions. During the year approval was given to grants totalling £6.819 involving improvement or conversion of thirty properties. Housing Statistics for the year 1956. Total number of valuation assessments, houses and flats, at 31st March, 1956 19,768 I. Inspection of dwelling-houses during the year: — 1. (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) ... 516 (b) Number of inspections made for the purpose 4,095 2. (a) Number of dwelling-houses (included under sub-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 7 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 344 II. 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 627 Number of dwelling-houses demolished during the year: — CLEARANCE AREAS—(Housing Act, 1936, and Housing Repairs and Rents Act, 1954)— Number of dwelling-houses demolished during the year Nil HOUSES NOT INCLUDED IN CLEARANCE AREAS— Housing Act, 1936: — (a) Houses demolished as a result of formal or informal procedure (Section II) (b) Parts of building closed (Section 12) 41 Rehousing. 1 am indebted to the Property Manager for the following information which gives the position as at 1st January. 1957 :— 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.) 48 Blackbrook Estate 64 Blackbrook Estate (O.A.P.) 10 Nichol Lane 6 Purchased Properties 89 Havelock Road (O.A.P.) 18 Blyth Road Flats 66 Bromley Park (O.A.P.) 78 1,513 Under construction :— Springfield Site (O.A.P.) 28 Marlins Road (Re-development) 60 Weston Road and Weston Grove (Re-development) 30 Schemes being prepared :— Palace Road (Re-development) 6 Wharton Road (Re-development) 21 Nichol Lane (Re-development) 15 Clarence Road 18 TEMPORARY HOUSING: Properties. Units. Occupied. Prefabricated Bungalows 296 296 296 Requisitioned Properties 154 320 320 Half-way Houses 2 18 18 452 634 634 42 Lettings during 1956. 1. (a) No. of permanent houses occupied during 1956: — Re-let 168 New Properties 144 312 (b) No. of families accommodated in permanent houses during 1956 312 (c) No. of persons accommodated in permanent houses during 1956 773 2. No. of premises de-requisitioned during 1956 (251 units) 78 3. No. of families on waiting list at 31st December, 1956: — Medical category 14 General category 554 O.A.P 172 Total on waiting list 740 During the year 144 houses and fiats were erected by the Council, and 279 by private enterprise. Moveable Dwellings. One licence, embracing a total of 24 caravans was granted by the Council during 1956. SECTION E. INSPECTION AND SUPERVISION OF FOODS. 44 SECTION E. INSPECTION AND SUPERVISION OF FOODS. The Food and Drugs Act. 1955. came into operation on the 1st January, 1956. This Act is a consolidation measure, as besides repealing the 1954 Act. it consolidates it with the Food and Drugs Act. 1938. the Food and Drugs (Milk. Dairies and Artificial Cream) Act, 1950. and other legislation, while amending Part V of the 1938 Act in connection with Slaughterhouses and Knackers Yards. The Food Hygiene Regulations. 1955. made under Section 13 of the Food and Drugs Act. 1955. were promoted for securing the observance of sanitary and cleanly conditions and practices in connection with the sale of food for human consumption, and came into operation during 1956. The Regulations provide for the more hygienic handling of food, cleanliness of food premises, etc.. and equipment. Generally, the standard of food preparing places and retail food shops is fairly high. The department is appreciative of the cooperation of the traders who, in the main, have welcomed the advice offered by the Inspectorate staff. Some difficulty has been experienced when applying the " No Smoking " rule, but it may be said that this apparently unpopular regulation has now been resolved and without recourse to legal action. Considerable help has been given by some traders in making their open-fronted shops into closed and more hygienically constructed shops. The owners of several fish and fruiterers and greengrocery shops have made suitable alterations. In some cases roller-shuttered doors have been replaced with open-and-shut doors which is an improvement to prevent dust, dirt. etc.. from contaminating the foodstuffs during inclement weather and which add much to the comfort of the customers and assistants during the periods of cold weather. It would be helpful if all open food, whether or not in a forecourt, was placed at least eighteen inches above ground level in all shops. There is. however, a regulation that may be applied to remedy this matter but this means in obstinate cases, recourse to legal action. There are a few self-service food stores in the Borough and it is anticipated that more are on the way. The provision of refrigerated counters, bins. etc.. will eventually have to be made to prevent spoilation of food. 45 The exposure of open food behind the glass windows of the shops is often not satisfactory ; in many cases, refrigerated treatment is most essential. During the year, in addition to the 455 visits in connection with food sampling, the Inspectors made a total of 4,723 inspections and re-inspections of food premises, and the attention of all shopkeepers, restaurant owners, etc.. was drawn to the requirements of the new regulations and advice was given where necessary. Five hundred and sixty-nine defects were noted and 331 remedied during the year. Talks on clean food practices with suitable illustrations were also given to various associations and organisations, and to personnel engaged in the handling of food. SPECIAL INVESTIGATIONS. The public have drawn the attention of the department to complaints and investigations have been carried out. In consequence. samples have been submitted for both bacteriological and chemical examination and in every instance the Committee have considered the reports. It is much appreciated that the public report such matters to the Local Authority. During the year. 91 samples of various foodstuffs, etc., were submitted for examination. Fifty-six of the samples were satisfactory and 35 unsatisfactory. Food and Drugs Act, 1955. Section 16. Two hundred and forty-four shops and food premises have been registered under the above Act, as follow :— Manufacture, sale or storage of Ice Cream Preparation and manufacture of Pres'vd Foods etc. Bakers and Caterers 6 — Butchers' Shops — 35 Cinemas 1 — Clubs 1 Confectioners, Tobacconists, etc. 89 Dairies/Grocers 6 — Fish Shops (Wet) 3 — Fish Shops (Fried) — 7 Fruiterers and Greengrocers 13 — General Stores 6 — Grocery and Provisions 33 21 Ice Cream Stores 1 — Public Houses 1 Restaurants, Cafes. Snack Bars. etc. 21 — 181 63 One hundred and seventy-nine premises are registered for the sale of ice cream, one for storage and distribution, and one for manufacture. 46 Sixty-three premises are registered for the preparation or manufacture of Preserved Foods, etc. Food Premises. There are some 627 food premises in the area, as under :— 54 Butchers. 40 Bakers and Confectioners. 94 Confectioners. 15 Dairies/Grocers. 25 Fishmongers (Wet, Dried and Fried). 53 Greengrocers. 112 Grocers. 54 Restaurants, Cafes, etc. 35 School Canteens. 33 Industrial Canteens. 21 Hospitals, Nursing Homes and Old People's Homes. 33 Public Houses. 13 Off Licences. 20 Chemists. 25 Clubs and Hotels. 627 UNSOUND FOOD. Seven hundred and sixty-one food condemnation certificates were issued during the year, affecting in quantity 3 tons 19 cwts. 1 qtr. 13 lbs. of varied articles of food, which was utilised either for manufacturing purposes, animal food, or where this was impracticable, destroyed. The corresponding figures for the year 1955 were 1,160 certificates and 6 tons 4 cwts. 2 qtrs. 26 lbs. of food. Details of the main items condemned are as under :— Cake and Cake Mixture 226 lbs. Fish (Fresh) 571 lbs. Flour 126 lbs. Fruit (Canned) 833 lbs. Fruit (Dried) 130 lbs. Fruit Juice 88 lbs. Jellies, Jelly Crystals and Blanc Mange Powder 141 lbs. Meat (Canned) 762 lbs. Meat (Raw) and Bacon 4,064 lbs. Milk (Canned) 245 lbs. Pickles and Sauces 87 lbs. Poultry 50 lbs. Soups 137 lbs. Sugar 164 lbs. Vegetables (Canned) 670 lbs. It was not necessary to make any special examination of a stock or of a consignment of food during the year. 47 MILK AND DAIRIES REGULATIONS. Fifteen dairies are registered under the above Regulations and details of the licences issued for the year 1956 are as under :— Dealers' (Pasteurisers') Licences 2 Dealers' Licences: — " Pasteurised " Milk 14 " Sterilised " Milk 28 " Tuberculin Tested " Milk 15 Supplementary Licences: — " Pasteurised " Milk 14 " Sterilised " Milk 17 " Tuberculin Tested " Milk 14 BACTERIOLOGICAL EXAMINATIONS. Milk. No. of Samples taken. Description. Result Satisfactory. Unsatisfactory 117 Designated Milk 117 — 15 Washed Bottles 15 — — — — 132 132 — — — — Ice Cream. No. of Samples Taken Description Satis. Unsatis. Methylene Blue Group I. II. III. IV 6 Ice Cream (Loose) 6 — 6 — — — 1 Ice Cream (Mix) 1 — — — 1 — 22 Ice Cream (Pre-packed) 22 — 13 9 — — 1 Ice Cream Choc.) 1 — — 1 — — 2 Ice Lollies — — — — — — — — — — — — — 32 30 — 19 10 1 — * Two samples unsuitable for test. More acid than pH4. Three samples were submitted for chemical examination, the lowest fat content being 10.95% and the highest 13.6%. The standard of ice cream remains at a high level, and in no instances have pathogenic organisms been cultivated in any sample examined since the inception of the tests in 1947. 48 The following tabulation shows the results obtained in respect of the 1,027 samples examined from 1st May, 1947 to 31st December, 1956 :— Year Grade I No. of Samples % Grade 11 No. of Samples % Grade III No. of Samples % Grade IV No. of Samples % Total No. of Samples 1947 13 17.8 18 24.6 17 23.3 25 34.3 73 1948 46 40.0 24 20.9 19 16.5 26 22.6 115 1949 108 53.0 52 25.5 28 13.7 16 7.8 204 1950 97 50.5 41 21.4 39 20.3 15 7.8 192 1951 no 84.0 11 8.4 8 6.1 2 1.5 131 1952 79 77.5 14 13.7 6 5.9 3 2.9 102 1953 72 74.2 15 15.5 10 10.3 — ' — 97 1954 36 94.7 2 5.3 — — — — 38 1955 45 90.0 3 6.0 1 2.0 1 2.0 50 1956 19 63.3 10 33.3 1 3.3 — — 30 MEAT INSPECTION. Annual licences were granted to 5 slaughtermen during 1956, and the licence of 1 privately owned slaughterhouse was also renewed during the year. The following table gives details of the ante and post-mortem inspection of animals made during 1956 :— Carcases Inspected and Condemned. e Cattle •xcluding Cows Cows Calves Sheep and Lambs Pigs Number killed 54 It 40 509 135 Number inspected 54 11 40 509 135 All diseases except tuberculosis: Whole carcases condemned Carcases of which some part or organ was condemned 20 5 26 10 Percentage of the number inspected affected with disease other than tuberculosis 37.04 45.45 – 5.11 7.41 Tuberculosis only: Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 1 – — Percentage of ihe number inspected affected with tuberculosis – 9.09 – 49 MERCHANDISE MARKS ACT, 1926. Two hundred and forty-seven visits were made to premises by the Public Health Inspectors and 17 contraventions were observed and remedied. No statutory action was taken during the year. The main object of the Act is to ensure that certain imported foodstuffs offered or exposed for sale bears an indication of origin in accordance with the requirements of the Order made thereunder. The contraventions mentioned above refer to the exposure for sale of imported tomatoes not suitably marked. GAME ACT, 1831. Fifteen licences were issued by the Local Authority during the year for dealers in Game to use premises in the district. SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 52 SECTION F. PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. GENERAL. A year in which only 355 notifications of infectious disease, excluding tuberculosis, were received must be considered a very light one. This figure compares with one of 1,033 during the previous year, and the main reason for the difference was the big drop in the prevalence of measles. Other variations which have occurred during the year include a reduction in the number of cases of acute anterior poliomyelitis and scarlet fever, and a small increase in whooping cough and a larger rise in notifications of dysentery. The overall picture is one of a continued decline in what might almost be called the traditional infectious diseases and this decline is shewn not only in lessened numbers but what is even more important, in decreased virulence. The latter point is underlined when it is considered that only 40 cases in all. of the notified illnesses, were treated in hospitals (including 22 cases of Puerperal Pyrexia). One of the outstanding features of the year was the introduction, on a small scale, of the County Council's scheme for vaccination against acute anterior poliomyelitis. It is much too early to attempt to judge the efficacy of this new preventive measure but high hopes are held out for the future and research is continuing in methods of preventing a disease which quite naturally produces so much public anxiety. ACUTE ANTERIOR POLIOMYELITIS. During the past year 7 cases in all were notified, as against 25 during the previous year. Whether this reduction was due to the exceptionally inclement weather experienced in the Summer of 1956 or not is uncertain, but it has been noticeable that some of the worst epidemics have tended to coincide with the end of a long dry and warm spell. The County Medical Officer informs me that 409 Bromley children completed a course of 2 injections against this disease during the year and that a further 45 received 1 injection, but these numbers are of course too small to have had any significant influence on the incidence of this illness. Further analysis of the 7 notified cases reveals that 3 were paralytic, 1 was non-paralytic.and the remaining 3 eventually proved to be other illnesses. Of the 4 confirmed cases 2 were treated in hospital and 2 home nursed. No deaths were attributable to this condition. 53 DIPHTHERIA AND IMMUNISATION. Once again, and for the sixth consecutive year, 1 am thankful to be able to report a complete absence of this disease from our community. The immunisation campaign against this illness appears to have been wonderfully successful in the past, but with the development of immunisation procedures against other diseases, and the publicity given them, it is sincerely to be hoped that no one will forget to have their children immunised against a disease which has not yet been stamped out of the country entirely and could still give rise to a serious epidemic if proper precautions are not taken. The present position with regard to immunisation against this disease is summarised in the following figures which have been furnished by the County Medical Officer. Of the children resident in the area who were born since 1942, a total of 789 received primary inoculations and 871 received reinforcing inoculations during 1956. A total of 10,816 children under the age of 15 years have completed a course of immunisation at some time prior to 31st December, 1956. DYSENTERY. This is a condition which is causing a good deal more trouble than formerly. 70 cases were notified during the year as against 14 last year, but only 2 were sufficiently severe to need hospital treatment. Generally speaking, the illness is of a mild character and a great number must inevitably never receive any medical attention, this combined with the fact that in an outbreak there always appear to be a large number of symptomless carriers makes control by ordinary public health measures extremely difficult as there must always be so many unsuspected sources of infection. An exhortation to hand cleanliness is probably the best single piece of advice that can be given in our efforts to eradicate this very annoying complaint. FOOD POISONING. Only 12 cases were notified to the department during the course of the year, and, of these, 3 were sufficiently severe to necessitate hospital admission. In a town of this size it is difficult to believe that this condition was limited to such small numbers and one would like to think that such was indeed the case, but it would only be self deception not to acknowledge that there must in reality have been many more cases. In point of fact, many probable cases have such short lived symptoms that they never come to the notice of the medical profession despite the fact that for a few hours the symptoms can be most distressing. 54 In half the cases notified the causative organism was indentified and in each case Salmonella Typhi-murium was incriminated. The following is a copy of the annual return rendered to the Ministry of Health. Notifications (Corrected):— 1st Quarter. Nil 2nd Quarter. 2 3rd Quarter. 5 4th Quarter. 5 Total. 12 Outbreaks due to identified agents:— Total outbreaks: Nil. Total cases: Nil. Outbreaks of undiscovered cause:— Total outbreaks: Nil. Total cases: Nil. Single cases:— Agent identified. 6 Unknown cause. 6 Total. 12 (Salmonella Typhi-murium) MEASLES. Following a year of heavy incidence the expected drop in notifications duly occurred, there being only 103 cases brought to our notice as against 760 during the previous year. The fact that not a solitary case had to be admitted to hospital indicates how the severity of this condition has declined with the passing of the years. No deaths from this disease were recorded in the area. MENINGOCOCCAL INFECTIONS Three cases came to our attention during the year, all affecting young children, 2 of whom unhappily died of particularly virulent infections. One of the patients concerned was a young child visiting this country, on holiday. One of these cases was diagnosed in a hospital outside the area. PNEUMONIA. Eighteen cases were notified during 1956, as against 23 in the previous year. There were 33 deaths from pneumonia. This figure includes people who died in other areas but who are normally resident in the Borough. 55 SCARLET FEVER. Notifications reached the very low level of 14 during the year and this despite the fact that it is no longer the practice to exclude child contacts from school. One case was admitted to hospital but the general run of cases is now so mild and uncomplicated that normally very little anxiety is occasioned by this illness. In addition, some cases are so mild and atypical that extreme difficulty may be experienced in arriving at a definite diagnosis and it may well be that cases are occurring which do not receive medical attention, having been considered merely as a slight throat infection. There were no "return cases," and no deaths occurred in the area from this disease during 1956. SMALLPOX. Another year has passed without any cases of this disease but it is still an ever present potential menace against which our defences must always be kept deployed. The policy of offering re-vaccination annually to all members of the staff of the Public Health Department has been maintained. It is interesting to note that during the year as many as 576 International Certificates of Vaccination have passed through the hands of the department for purposes of authenticating doctors' signatures. I am indebted to the County Medical Officer for the following figures shewing the current position with regard to vaccination in Bromley. A total of 663 residents received primary vaccination and 88 re-vaccination during 1956. TUBERCULOSIS. The total of new notifications received during the year was 44. a drop of 4 compared with the previous year. The fact that 15 of these 44 cases occurred in the age group 45-64 indicates how this disease appears to be affecting to a greater and greater extent those of middle age rather than the young adult who formerly bore the brunt of this infection. There was only one death from this disease in the area during 1956. 56 The following are details of the recordings in the register for the year ended 31st December, 1956. Respiratory. Other forms. Total number of cases. M. F. M. F. On Register at 1.1.56 454 384 46 58 942 New cases notified during 1956 30 12 — 2 44 Number of cases coming to knowledge after death — 1 — — 1 Restored to Register — 1 — — 1 Inward Transfers 7 6 — — 13 491 404 46 60 1,001 Deletions, deaths, removals, recoveries, etc. 16 19 — — 35 Number of cases on Register at 31st December, 1956 475 385 46 60 966 New cases and Mortality, 1956:— Age groups New cases notified or otherwise revealed. (Not including Inward Transfers.)* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 5 — 1 — — — — — — 5—14 2 1 — — — — — — 15—24 6 4 — — — — — — 26—44 7 5 — 1 — — — — 45—64 13 2 — — — — — — 65 and over 2 1 — 1 — — — — *Inward Transfers 30 14 — 2 — — — — 7 6 — — Totals 37 20 — 2 57 MASS X-RAY. The Mass X-Ray Unit of the South Eastern Regional Hospital Board did not visit this area during 1956. The Unit hopes to pay a visit to Bromley early in 1957. CHEST CLINIC. Dr. D. G. Madigan, Physician in charge, has kindly furnished the following details:— New cases attending the Chest Clinic for the first time during 1956:— Adults. Children. M. F. M. F. Pulmonary Tuberculosis 28 20 — — Non-Pulmonary Tuberculosis — 1 — — Non-Tuberculous 36 44 6 5 New Contacts examined durine 1956:— Negative. Positive. M. F. M. F. 77 100 2 2 (These contact figures are not included in the first table.) B.C.G. Vaccination of Contacts: 82 Number of patients who completed a course of sanatoria or hospital treatment during 1956: 51 BROMLEY TUBERCULOSIS CARE COMMITTEE 1 am indebted to the Honorary Secretary of the above Committee for the following report:— "Throughout the year 1956 the Care Committee's Liaison Officer has visited many patients suffering from tuberculosis. Visits have also been made to the homes of these patients, as it is felt that provision should not only be made for the patient's requirements, but regard paid to the needs of the family exposed to the risk of tuberculosis. As in previous years assistance has been given in the provision of fares for relatives to visit patients in Sanatoria, extra nourishment, payment of coal bills, and the supply of clothing. In brief, it is the Care Committee's earnest desire not only to provide where possible for the physical needs of the patients, but also to relieve their minds of any anxieties associated with their homes and families." 58 TYPHOID FEVER. A single case was notified during the year. This was imported from overseas by a traveller who happened to come to Bromley and developed the disease soon after arrival. After a spell in hospital the patient made a good recovery. WHOOPING COUGH. One hundred notifications were received, which was a reduction of 24 compared with the previous year. Only 3 of these cases were admitted to hospital and once again we are facing a problem of apparently declining virulence. There were no deaths from this disease recorded in the area. OTHER INFECTIOUS DISEASES In addition to those previously mentioned, notifications were received as under:— Erysipelas 9 cases (1 removed to hospital). Puerperal Pyrexia 22 cases (all of these occurred in hospitals). APPENDIX STATISTICAL TABLES. 60 STATISTICAL TABLES, 1956. TABLE I. Summary of Statistics. 1956. TABLE II.—Vital Statistics of Borough for past ten years. TABLE 111.—Causes of Death. TABLE IV.—Infant Mortality. TABLE V.—Analysis of Causes of Infant Deaths. 1947-56. TABLE VI.—Notifiable Infectious Diseases—Ward Distribution. Attack and Mortality Rates. TABLE VII.—Notifiable Infectious Diseases- Seasonal Incidence. TABLE VIII.—Meteorological Observations and Open Air Recreational Amenities. TABLE IX.—Local Clinic Services. TABLE X.—Factories Acts. 1937 and 1948. TABLE XI—Prevention of Damage by Pests Act. 1949. TABLE XII. Food and Drugs Act. 1955—Food Sampling. TABLE XIII.—Summary of the Work of the Public Health Inspectors. 1956. TABLE XIV.—Nuisances, Defects, Contraventions, etc.. Abated or Remedied. 1956. 61 TABLE I. Summary of Statistics, 1956. Population (mid-year 1956, per Registrar General) 65,100 Birth Rate (crude) 12.3 Death Rate (crude) 11.8 Maternal Mortality Rate 0.81 Infant Mortality Rate 16.20 Number of Births (live) 802 Number of Stillbirths 9 Number of Deaths 765 Number of Maternal Deaths 1 Number of Infant Deaths (under 1 year) 13 Number of Deaths from Infectious Diseases 4 Death Rates:—Respiratory Diseases 1.12 Tuberculosis 0.01 Cancer (all forms) 2.30 Cancer of the Lung 0.57 Infectious Diseases 0.06 Notifications of Infectious Diseases: Diphtheria Nil Dysentery 70 Erysipelas 9 Food Poisoning 12 Measles 103 Pneumonia (all forms) 18 Poliomyelitis (paralytic) 3 Poliomyelitis (non-paralytic) 4 Puerperal Pyrexia 22 Scarlet Fever 14 Tuberculosis (new cases and including inward transfers) 57 Typhoid and Para-Typhoid Fever 1 Whooping Cough 100 Number of visits made by Public Health Inspectors 12,159 62 TABLE II. Vital Statistics of the Borough for the Past Ten Years. Year Population No. of Births (live) No. of Deaths No. of Infant Deaths No. of Maternal Deaths Birth Rate (per 1,000 population) Death Rate (per 1,000 population) Infant Mortality (per 1,000 live births) Maternal Mortality (per 1,000 live and still births 1947 62,640 1308 731 25 1 20.9 11.7 19.11 0.74 1948 63,360 1042 631 21 1 16.4 9.9 20.15 0.94 1949 64,140 1030 699 16 1 16.1 10.9 15.5 0.95 1950 64,610 892 739 19 Nil 13.8 11.4 21.3 Nil 1951 64,550 916 735 11 Nil 14.2 11.4 12.0 Nil 1952 64,350 908 720 20 Nil 14.1 11.2 22.0 Nil 1953 64,590 880 692 13 Nil 13.6 10.7 14.8 Nil 1954 64,800 824 727 17 Nil 12.7 11.2 20.6 Nil 1955 64,780 823 741 26 Nil 12.7 11.4 31.6 Nil 1956 65,100 802 765 13 1 12.3 11.8 16.20 0.81 63 TABLE III. Causes of Death. 1952 1953 19G4 1956 Male 1966 Female Total 1. Tuberculosis—Respiratory 11 8 7 5 — 1 1 2. „ Other — 1 1 — — — — 3. Syphilitic diseases 3 1 4 1 2 1 3 4. Diphtheria — — — — — — 5. Whooping Cough — — — — — — 6. Meningococcal Infections — 1 — — 1 1 2 7. Acute Poliomyelitis 1 — — 1 — — 8. Measles — — — — — — 9. Other infective and parasitic diseases 1 1 2 1 1 1 2 10. Malignant neoplasm, stomach 24 21 12 16 9 11 20 11. Malignant neoplasm, lung bronchus 14 29 28 25 28 9 37 12. Malignant neoplasm, breast 11 20 18 13 — 14 14 13. Malignant neoplasm, uterus 3 6 6 4 — 2 2 14. Other malignant and lymphatic neoplasms 62 78 65 61 46 31 77 15. Leukaemia, Aleukaemia 4 3 9 6 4 4 8 16. Diabetes 3 7 4 5 3 1 4 17. Vascular lesions of nervous system 102 86 94 113 30 70 101 18. Coronary disease, angina 104 116 125 112 92 59 151 19. Hypertension with heart disease 13 16 18 12 10 12 22 20. Other heart disease 143 102 103 107 27 62 89 21. Other circulatory diseases 44 25 41 41 20 27 47 22. Influenza — 7 1 — — 2 2 23. Pneumonia 30 22 34 44 16 17 33 24. Bronchitis 39 30 28 39 26 6 32 25. Other diseases of respiratory system 6 7 9 6 4 4 8 26. Ulcer of stomach and duodenum 9 4 11 8 5 3 8 27. Gastritis, enteritis & diarrhœa 1 4 3 4 2 5 7 28. Nephritis and nephrosis 5 7 4 5 — 4 4 29. Hyperplasia of prostate 11 3 11 7 7 — 7 30. Pregnancy, childbirth, abortion — — — — — 1 1 31. Congenital malformations 10 7 8 7 6 2 8 32. Other defined and ill-defined diseases 47 62 65 80 25 26 51 33. Motor vehicle accidents 5 5 5 4 4 3 7 34. All other accidents 8 8 7 7 5 1 6 35. Suicide 6 5 7 7 8 3 11 36. Homicide and operations of war — — — — — — — 720 692 727 741 381 384 765 64 TABLE IV. Infant Mortality, 1956. (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 Atelectasis 1 — — — 1 — — — — 1 Broncho-Pneumonia — — — — — — — — — — Gastroenteritis — — — — — 1 — — — 1 Malformation — — — — — — — — — — Prematurity 4 — — — 4 — — — — 4 Other Causes 2 — — — 2 1 2 — 1 6 Totals 7 — — — 7 2 2 1 1 13 63 TABLE V. Analysis of Causes of Infant Deaths. 1947-1956. 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Total No. of Births (live) 1,308 1,042 1,030 892 916 908 880 824 823 1,229 9,852 Infant Mortality Rate (per 1,000 Live Births) 19.11 20.15 15.5 21.3 12.0 22.0 14.8 20.6 31.6 10.58 18.39 Malformation 13 — — — 1 — — — — — 14 Prematurity 5 6 3 5 3 3 5 8 8 4 50 Respiratory Diseases 5 2 1 4 2 7 2 4 5 1 33 Infectious Diseases — — 3 — 1 — — — — 2 6 Gastro Enteritis — 1 1 — — — 3 — — 1 6 Atelectasis — — 1 1 1 1 — 1 5 1 11 Congenital Heart Disease — — 3 4 — 5 1 3 — 16 Other Causes 2 12 4 5 3 4 2 4 5 4 45 Totals 25 21 16 19 11 20 13 17 26 13 181 66 TABLE VI, Notifiable Infectious Diseases, 1956—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 14 3 3 — — — 1 7 — 0.22 — — Whooping Cough 100 50 8 9 19 1 10 3 3 1.54 — — Acute Poliomyelitis (paralytic) 3 — — — 1 1 — 1 1 0.05 — „ „ (Non-Paralytic) 1 — — 1 — — — — 1 0.01 — — Measles 103 2 1 3 8 5 9 75 — 1.58 — — Diphtheria — — — — — — — — — — — — Acute Pneumonia 18 1 2 3 — 4 3 5 4 0.28‡ 33 0.51 Dysentery 70 2 2 4 3 21 37 1 2 1.08 — — Erysipelas 9 — — 1 3 2 3 — 1 0.14 — — Cerebro Spinal Fever — — — — — — — — — — — — Puerperal Pyrexia 22 — — 22 — — — — 22 27.13§ — — Typhoid & Paratyphoid Fever 1 — 1 — — — — — 1 0.01 — — Tuberculosis (Pulmonary) 42 8 4 3 6 1 14 6 13 0.65 1 0.01 „ (Non-Pulmonary) 2 1 1 — — — — — 1 0.03 — — Food Poisoning 12 — 4 — 2 — 2 4 3 0.18 — — Ophthalmia Neonatorum — — — — — — — — — — — — Meningococcal Infections 2 — — — 1 — — 1 2 0.03 2 0.03 Totals 399 67 26 46 43 35 79 103 54 6.13 36 0.55 ‡Includes Pneumonia (all forms). §Based on attack rate per 1,000 total births, and not population. 67 TABLE VII. Notifiable Infectious Diseases, 1956—Seasonal Incidence. Disease Jan. Feb. Mch. Apl. May June July Aug. Sept. Oct. Nov. Dec. Total Scarlet Fever 2 5 1 1 2 — — 1 1 1 — — 14 Diphtheria — — — — — — — — — — — — — Measles 1 — 2 3 1 6 69 15 — 1 — 5 103 Whooping Cough 1 — 4 3 8 26 25 18 12 3 — — 100 Dysentery 2 — 2 — 3 1 2 — 1 9 7 43 70 Erysipelas 2 — 2 1 — — 1 — — 1 — 2 9 Cerebro-Spinal Fever — — — — — — — — — _ — — — Pneumonia (all forms) 1 3 4 1 2 2 — 1 — 1 1 2 18 Typhoid & Paratyphoid Fever — — — — — — — — — 1 — — 1 Acute Anterior Poliomyelitis — — — — — — — — — 1 1 2 4 Food Poisoning — — — 2 — — — 2 3 1 4 — 12 Puerperal Pyrexia 4 3 1 — 3 — 2 4 — — 2 3 22 Meningococcal Iniections — 1 — — — — — — 1 — — — 2 Totals 13 12 16 11 19 35 99 41 18 19 15 57 355 68 TABLE VIII. METEOROLOGICAL OBSERVATIONS. The Borough Engineer has kindly furnished the following information from the records at the Climatological Station, Church House Gardens:— Total Rainfall 23.41 inches. Mean maximum daily temperature 56.0° Mean minimum daily temperature 42.0° Highest maximum temperature 83° (26th July) Lowest minimum temperature recorded 15° (4th February) Lowest grass temperature recorded 13° (4th February) OPEN AIR RECREATIONAL AMENITIES. The value of Bromley's open spaces cannot be over estimated, for they provided 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. 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 69 TABLE IX. LOCAL CLINIC SERVICES. Ante-Natal Clinics. North Clinic, Station Road Thursday p.m. South Clinic, Princes Plain Monday p.m. Hayes School Clinic, George Lane Wednesday p.m. Child Welfare Centres. North Clinic, Station Road Wednesday p.m. South Clinic, Princes Plain Tuesday p.m. William Morris Hall, Masons Hill Monday & Thursday p.m. First Aid Post, Southlands Road Wednesday & Friday p.m. Village Hall. Hayes Tuesday p.m. Village Hall, Keston First and third Thurs. in every month p.m. St. Andrew's Hall, Burnt Ash Lane Wednesday p.m. Minor Ailment Clinics (Schools). North Clinic, Station Road Mon. to Fri. 9-10 a.m. South Clinic, Princes Plain Mon. to Fri. 9-10 a.m. Medical Room, Hayes School. George Lane Mon. to Fri. 9-10 a.m. Medical Room, Burnt Ash School Mon. to Thurs. 9-10 a.m. Medical Room, Southborough School Mon., Wed. & Fri. 9-10 a.m. Medical Room, Aylesbury Rd. School Mon., Wed. & Fri. 9-10 a.m. Dental Clinics. North Clinic, Station Road Monday to Friday . a.m. & p.m. South Clinic, Princes Plain Saturday (by Appointment) a.m. Specialist Clinics. North Clinic, Station Road Ophthalmic (Appointments only)— Monday & Wednesday a.m. Friday p.m. Alternate Saturdays a.m. Orthop/Edic (Appointments only)— Alternate Fridays p.m. Orthoptic (Appointments only)— Monday p.m. Tuesday a.m. & p.m. Thursday a.m. & p.m. Friday a.m. Physiotherapy (Appointments only)— Tuesday a.m. & p.m. Thursday a.m. Friday a.m. South Clinic, Princes Plain Speech (Appointments only)— Thursday p.m. Lip Reading (Appointments only)— Wednesday 5-6 p.m. Saturday 10 a.m. -12 noon Immunisation and Vaccination. Carried out at Child Welfare Centres (By Appointment). 70 FACTORIES ACTS, 1937 AND 1948. The following is a copy of the return supplied to the Ministry of Labour and National Service in respect of the year 1956:— I. Inspections for purposes of provisions as to health. Premises Number on Register Number of Occupiers Prosecuted Inspections Written Notices (a) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by the Local Authorities 66 78 5 — (b) Factories not included in (a) in which Section 7 is enforced by the Local Authority 214 139 13 — (c) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) *148 70 4 — Total 428 287 22 — II. Cases in which Defects were found. No. of cases in which defects were: Referred Number of cases in which prosecutions were instituted. Found. Remedied. To H.M. Inspector. By H.M. I nspector. Want of cleanliness (S.I) 3 8 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — — — Inadequate ventilation (S.4) 2 — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7)— (a) Insufficient 8 12 — — — (b) Unsuitable or defective 52 18 — 1 — (c) Not separate for sexes 1 4 — — — Other offences against the Act (not including offences relating to Outwork) 4 5 1 — — Total 71 48 1 1 — 3 Engineering works (Road works, etc.). *1 Electrical Station (Sect. 103). 120 Private house sites. 24 Building sites where more than one house erected (including three Corporation sites). OUTWORK: Nil. 71 TABLE XI. PREVENTION OF DAMAGE BY PESTS ACT, 1949. TYPE OF PROPERTY Local Authority Non-Agricultural Agricultural Dwelling Houses (including Council Houses) Allother (including business premises) Total of Cols. (1) (2) & (3) (1) (2) (3) (4) (5) I. Number of properties in Local Authority's District 27 20,010 2,317 22,354 29 II. Number of properties inspected as a result of: (a) Notification (a) 2 633 86 721 4 (b) Survey under the Act (b) — 3,252 117 3,369 13 (c) Otherwise, (e.g., when visited for some other purpose) (c) — 53 171 224 12 III. Total inspections carried out—(including reinspections) 7 7,644 607 8,258 39 IV. Number of properties inspected (in Sect. II) which were found to be infested by: (a) Rats Major — — — — — Minor 2 698 56 756 4 (b) Mice Major — — — — — Minor — 58 29 87 — V. Number of infested properties (in Sect. IV.) treated by Local Authority 2 756 85 843 4 VI. Total treatments carried out—including retreatments 2 812 98 912 4 VII. Number of "Block Control" Schemes carried out — 348 23 371 — 72 TABLE XII. FOOD AND DRUGS ACT, 1955. Food Sampling. Article Samples taken. Result. Adulterated Remarks Formal. Informal. Genuine. Inferior Almond Marzipan — 2 2 — — Ammoniated Tincture of Quinine — 1 1 — — Amphoteric Gel — 1 1 — — Aniseed Balls — 1 1 — — Apples — 2 2 — — Apple Pectin — 1 1 — — Apple Vinegar — 1 1 — — Baby Cream (Brytema) — 1 1 — — Baked Beans with Pork Sausages — 1 1 — — Banbury — 1 1 — — Beans with Tomato Sauce & Pork — 1 — 1 — See (a) Beans in Tomato Sauce — 1 1 — — Beechams Powders — 1 1 — — Benerva, vitamin B. — 1 1 — — Biscuits — 4 4 — — Butter — 3 3 — — Butter Macaroons — 1 1 — — Butter Mints (Scotch) — 1 1 — — Butterscotch — 2 2 — — Buttered Assortment — 1 1 — — Buttered Caramel Popcorns — 1 1 — — Butterkist Cereal — 1 1 — — Cake Marzipan — 1 1 — — Cake Mix — 1 1 — — Caramel Mallow — 1 1 — — Cheese (Gruyere) — 1 1 — — Cheese Spread — 3 3 — — Cheesetts — 1 1 — — Chewing Gum — 2 2 — — Chicken (Minced) — 1 1 — — Chicken Pasties — 1 1 — — Chickletts — 1 1 — — Choc Bar Wafer — 1 1 — — Chocolate (Fruit & Nut) — 2 2 — — Chocolate (Milk, Full Cream) — 1 1 — — Chocolate Coins 1 — — 1 — See (b) Chocolate Eggs — 2 2 — — Coffee (Standard Blend) — 1 1 — — Coffee & Chicory Mix — 1 1 — — Compound Glycerine of Thymol — 1 1 — — Cooking Fat — 1 1 — — Cream (Fresh Jersey) — 1 1 — — Cream (Double) — 3 3 — — Cream (Pure) — 1 1 — — Cream Powder (Synthetic) — 1 1 — — Cream (Sterilized) — 1 1 — — Creamed Rice — 1 1 — — Creamy Mints — 1 — 1 — See (c) Creamy Titbits — 1 1 — — 73 Article Samples taken. Result. Adultcrated Remarks Formal. Informal. Genuine. Inferior. Crysialised Peppermints — 1 1 — — Currants — 1 1 — — Curry Powder — 1 1 — — Dales (Stoned) — 2 2 — — Del (Disinfectant & Antiseptic) — 1 1 — — Diuromil — 1 1 — — Dolly Babies — 1 1 — — Dutch Sweet Figures — 1 1 — — Figs (Layer) — 1 1 — — Fish Cakes — 1 1 — — Fish (Canned) — 1 1 — — Flavouring (Ratafia) — 1 1 — — Flour (Self Raising) — 1 1 — — Foam Crystals — 1 1 — — Frankfurters — 1 1 — — Fruit Flavoured Sulphur Tablets — 1 1 — — Fruit Pack — 1 1 — — Fudge (Clotted Cream) — 1 1 — — Glacc Cherries — 2 2 — — Glace Pineapple — 1 1 — — Glauber Salts — 1 1 — — Gravy Salt — 1 1 — — Ground Ginger — 1 1 — — Halibut Liver Oil Capsules — 1 1 — — Ham Sandwiches (Buttered) — 1 1 — — Hazel Nut Toffee — 1 1 — — Heatherdown Spread — 1 1 — — Ice Cream (Pre-packed) — 3 3 — — Ice Lolly — 1 1 — — Icing Sugar — 1 1 — — Jam (Gooseberry) — 1 — 1 — See (d) Jam (Raspberry) — 2 2 — — Jam (Red Plum) — 1 1 — — Jelly — 2 1 1 — See (e) Lard — 2 2 — — Lemon Barley Water — 1 1 — — Lemon Juice (Real) — 1 1 — — Lemons — 1 1 — — Likbits — 1 1 — — Liquorice Sandwich — 1 1 — — Liver Sausage — 1 1 — — Margarine — 3 2 1 — See (f) Mayonnaise (Continental) — 1 1 — — Meat Paste (Liver & Bacon) — 2 2 — — Meat Pie — 1 1 — — Milk (Pasteurised) — 14 14 — — Milk (C.I. Pasteurised) — 3 3 — — Milk (C.I., T.T. Pasteurised) — 5 5 — — Milk (T.T.) — 6 6 — — Milk (T.T. Pasteurised) — 10 10 — — Milk (T.T. Farm Bottled) — 4 4 — — Milk (C.L. T.T.) — 1 1 — — Milk (Raw) — 2 2 — — Milk (Ray T.T.) — 2 2 — — Milk (Sterilized) — 3 3 — — Milk (Yoghourt) — 3 3 — — 74 Article Samples taken. Result. Adulterated Remarks Formal. Informal. Genuine. Inferior. Milk (Goats) - 1 1 - - Milk Chocolate Chews — 1 1 — — Milk Chocolate Cream Wafer Fingers - 1 - 1 - See (g) Milk Chocolate Flake — 1 1 — — Milk Chocolate Strawberry Cream - 1 1 - - Mincemeat — 2 — — Mint Chocs — 1 1 — — Mints (Extra Strong) — 1 1 — — Muscatel Cluster Raisins — 1 1 — — Mushrooms — 2 1 1 — See (h) Mustard — 2 2 — — Nougats — 1 1 — — Nut Rings — 1 1 — — Orange Squash — 1 1 — — Orangeade (Concentrated) — 1 1 — — Oranges — 2 2 — — Pale Ale — 1 1 — — Paprika — 1 1 — — Peaches — 1 1 — — Peeled Shrimps in Aspic Jelly — 1 1 — — Pickled Beetroot — 1 1 — — Pickled Onions — 1 1 — — Pie Filling (Meringue) — 1 1 — — Pork Pies — 2 2 — — Pork Roll (Stuffed) — 1 1 — — Prawns (Peeled) Frozen — 1 1 — — Raisins (Stoned) — 2 2 — — Rose Hip Syrup — 1 1 — — Rum Butter — 2 2 — — Rum Chocolate — 1 1 — — Rum ft Butter Toffee — 1 1 — — Salad Cream — 2 2 — — Sausage Meat (Beef) — 4 4 — — Sausage Rolls — 2 2 — — Sausages (Beef) — 11 11 — — Sausages (Beef Chipolata) — 4 3 1 — See (i) Sausages (Pork) — 16 14 2 — See (j) Sausages (Pork Chipolata) — 5 5 — — Saveloys — 1 — 1 — See (k) Savoury Ducks — 1 1 — — Soup (Chicken) — 1 1 — — Soup (Cream of Chicken) — 1 1 — — Soup (Cream of Mushroom) — 1 1 — — Soup (Cream of Pea) — 1 — 1 — See (1) Soup (Cream of Tomato) — 1 1 — — Steak & Kidney Pie — 1 1 — — Sugar — 1 1 — — Sultanas — 3 3 — — Sweet Tobacco — 1 1 — — Table Creams — 1 1 — — Tomato Ketchup — 1 1 — — Tomato Paste — 1 1 — — Tomato Puree — 1 1 — — Tomatoes (Peeled) — 1 1 — — 75 Article Samples taken. Result. Adulterated. Remarks Formal. Informal. Genuine. Inferior. Tuck Shop Sweets - 1 1 - Turkish Delight (Milk) — 1 1 - — Tyrozets (Throat Lozenges) — 1 1 — — Vegetables — 1 1 — — Walnuts (Shelled) — 1 1 — — Welsh Rarebit — 1 1 — — Xmas Pudding — 1 1 — — Zinc & Castor Oil Cream — 1 1 — — Zinc Ointment — 1 1 — — Totals 1 280 268 13 — REMARKS: — (a) Inferior—Total solids 27.2%. Tomato solids 0.8%. Pork 1.7%— very little Pork. (b) Inferior—In sample marked " 10 Chocs "—fat rancid. Oleic acid 1.5%. (c) Inferior—Fat 3.4%. No butter fat—not entitled to be called "creamy (d) Inferior—Sol. solids 62.0%; Fruit 55%. Low in sol. solids. Sulphite none. (e) Inferior—The jelly (as it comes to the table) will contain not more than 0.2% fruit juice. Insufficient to justify claim. Lead 0.2 ; Copper 6 ; Zinc 10 p.p.m. (f) Inferior—Moisture 15.4%; Butter 7.9%. Vitamin A satisfactory. Low in butter. (g) Inferior—Fat 34.0% (chiefly palm kernel oil; no butter). Skimmed Milk Chocolate. (h) Inferior—Claim to be equivalent to 230 gms. Mushrooms—not justified—170 gms. only. (i) Inferior—Fat 37%, Lean 31%. Total meat 68%. Fat excessive (exceeds lean). (j) Inferior—(1) Fat 21%, Lean 39%. Total meat 60%. Sulphite none. Meat content of pork sausages should be not less than 65%. (2) Fat 27%, Lean 36%. Total meat 63%. Sulphite none. (k) Inferior—Fat 21 %, Lean 40%. Total meat 61 %. Sulphite 150 ppm. (1) Inferior—Fat 3.1%. Protein 3.2%. In absence of butter fat total fat should be not less than 3.5%. 76 TABLE XIII. Summary of the work of the Public Health Inspectors for the year 1956. TYPE OF INSPECTION. On Complaint Routine Re Inspection Total Visits Nuisances Found Housing 1. Inspection of District Regulations — 11 12 23 11 2. For Nuisances 683 179 3,233 4,095 1,053 3. Overcrowding 10 35 22 67 6 4. Verminous Conditions 17 7 22 46 8 5. Dirty Conditions 16 15 24 55 14 6. Water Supply 8 11 11 30 2 7. Cesspools 1 1 1 3 - 8. Earth Closets — - - - - 9. Privy Pails - - 1 1 - 10. Houses Let in Lodgings 1 - - 1 - 11. Disinfestations 8 12 18 38 6 12. Noxious Accumulations 12 9 12 33 6 13. Other Accumulations 11 9 36 56 11 14. Housing Repairs & Rents Act 2 2 20 24 11 15. Old People's Homes — 2 — 2 - Totals 769 293 3,412 4,474 1,128 Infectious Diseases - 1. Inquiry Visits (Nuisances found recorded - in above table) — 112 66 178 - 2. Disinfection Purposes — 22 9 31 - 3. Smallpox Inquiries — - - - - 4. Public Health (Aircraft) Regulations — - - - - 5. Food Poisoning 1 53 37 91 — Totals 1 187 112 300 — Meat, Milk and Other Foods etc.— 1. Butchers and Wholesale Depots 6 1,157 21 1,184 86 2. Confectionery 4 122 36 162 30 3. Dairies and Cowsheds (excl. Past. Plants) — 46 3 49 4 4. Pasteurising Plants ... — 49 1 50 - 5. Fish 1 182 8 191 10 6. Fried Fish — 48 1 49 5 7. Food Hawkers - 64 4 68 10 8. Fruit Greengrocery 1 205 30 236 52 9. Grocery 11 371 64 446 129 10. Ice Cream Shops 1 85 6 i)2 4 11. Meat Regulations (Special Visits) — 6 4 10 - 12. Milk Examined on Highway - 4 2 6 - 13. Retail Market 1 98 185 284 7 14. Slaughterhouses - 131 - 131 - 15. Horseflesh Shops 1 56 5 62 3 16. Restaurants, Hotels, Clubs, etc 3 113 52 168 82 17. School Canteens & Others 3 60 19 82 19 18. Public Houses 2 19 11 32 7 19. Food Wholesaler 2 277 1 280 9 20. Food Hygiene Regulations - 749 7 756 28 21. Industrial, Institutional & Hospital Kitchens - 25 7 32 38 22. Merchandise Marks Act - 234 13 247 17 23. Food Preserving Premises - 29 1 30 - 24. Bakehouses (other than Factory Act) 3 58 13 74 29 25. Meat Carriers - 2 - - Totals 39 4,190 494 4,723 569 Factories, Outworkers, etc.— 1. (t) Factories in which Sects. 1, 2, 3, 4 and 6 of the Factories Act 1937 are to be enforced by the Local Authority - 26 52 78 14 (i») Factories not included in (») in which Section 7 is enforced by the Local Authority — 96 43 139 55 Carried Forward — 122 95 217 69 77 TABLE XIII. (Continued) Type of Inspection On Complaint Routine ReInspec tion Total Visits Nuisances Found Brought Forward — 122 95 217 69 Factories, Outworkers, etc. Contd.— (Hi) Other Premises in which Section 7 is enforced by the Local Authority (Excluding Out-Workers' Premises) - 48 22 70 15 2. Bakehouses (a) Mech. power — 18 13 31 2 (b) Non-mech. power — — 3 3 - 3. Outworkers' premises — 58 18 76 1 4. Smoke Abatement 10 37 24 71 4 Totals 10 283 175 468 91 Sampling of Food and Drugs, etc.— 1. Milk : Ordinary — 1 — 1 - T.T. Pasteurised — 25 - 25 - Pasteurised — 32 - 32 - T.T. Farm Bottled — 5 - 5 - Sterilised — 10 - 10 - Channel Islands T.T. — 3 - 3 - Farm Bottled - 2 - 2 - T.T - 4 - 4 - Goats - 1 - 1 - 2. Schools Milk (Pasteurised) — 17 - 17 - 3. Pasteurising Plant: - - T.T. Milk — 11 - 11 - Pasteurised — 18 - 18 - Washed Bottle — 3 - 3 - 4. Tinned Milk - - - - Condensed Milk - - - - 5. Dried Milk - 2 - 2 - 6. Ice Cream - 35 - 35 - Ice Cream Mix. - 1 - 1 - 7. Cream - 4 - 4 - 8. Other Foods 16 171 6 193 - 9. Food Poisoning 7 43 7 57 - 10. Drinking Water 6 17 1 24 - 11. Drugs — 1 1 - 12. Water (Stream and Paddling Pool) — - - - 13. Rag Flock - 6 - 6 - 14. Court Cases — — - - Totals 29 412 14 455 — Trade Premises Various— 1. Under Shops Act 4 126 42 172 64 2. Under Petroleum Acts — 47 30 77 - 3. Registry Offices — 25 10 35 8 4. Offices (P.H. Act 1936, Sees. 46 and 91) 1 1 - 2 1 5. Pet Animals Act - 18 13 31 2 6 Rag Flock and Other Filling Materials Act — 4 1 5 - 7. Merchandise Marks Act - 58 4 62 3 8. Diseases of Animals Acts: - Movement Licences - - - - - Foot and Mouth Disease - - - - - Swine Fever - - - - - Fowl Pest - - - - - Anthrax - - - - - Other - - - - - Interviews - 28 - 28 - 9. Piggeries,Cleansing 1 17 5 23 - Sanitary Conditions - 8 2 10 5 10. Stables: Cleansing 1 8 2 11 - Sanitary Conditions 2 8 2 12 1 Carried Forward 9 348 111 468 84 78 TABLE XIII. (Continued) TYPE OF INSPECTION On Complaint Routine ReInspec tion Total Visits Nuisances Found Brought Forward 9 348 111 468 84 11. Animals Keeping of 9 3 8 20 9 12 Poultry Farms — — — — — 13. Agriculture (Safety, Health & Welfare Provisions) Act, 1956 - 12 1 13 9 Totals 18 363 120 501 102 Rodent Control 1. Trade Premises 14 131 34 179 28 2 Private Premises 25 28 16 69 14 3. Agricultural Premises — — — — — 4. Sewers — 4 — 4 — Totals Miscellaneous 39 163 50 252 42 1. Schools 5 65 16 5 2. Drain Tests: Smoke - 15 - 15 7 Water 4 56 7 67 6 Colour 4 2 2 8 1 Chemical 1 1 - 8 - Mirror - - - 2 - 3. Swimming Baths: Visited 1 64 - - 1 Samples taken - 43 - 65 1 Chlorine & Ph. Test - 162 - 43 - 4. Tents, Vans, Sheds, Caravans and Fairgrounds 2 96 35 162 5 5. Accumulations (other than dwellings) 3 10 98 133 2 6. Streams, Ponds and Watercourses 4 36 9 111 - 7. Tips - 7 - 49 2 8. Special Visits 36 120 23 7 - 9. Public Houses—Urinals - 26 11 179 2 10. Exhumations - - - 37 - 11. Cinemas, Theatres etc. - 4 3 - 5 12. Heating appliances (Fireguards) Act, 1652 - 13 2 7 15 1 Totals 60 720 206 986 38 Grand Totals 965 6,611 4,583 12,159 1,970 79 TABLE XIV. Nuisances, Defects, Contraventions, etc., Abated or Remedied in 1956. HOUSING Drainage- Piemises re-drained and connected to sewer — Cesspools abolished — Earth closets abolished 1 Cesspools emptied 2 Privy pails, etc., abolished — Drains relaid or repaired 92 Drains unstopped 187 New Covers to Inspection Chambers — Inspection chambers provided 7 Stopper provided to Interceptor — W.C's. provided (additional or separate) 6 ,, buildings reconstructed 1 „ „ repaired 6 ,, pans renewed or repaired 26 „ „ cleansed 1 „ box seats removed 2 „ seats repaired — Soil vent pipes renewed or repaired 19 Sink/bath waste pipes renewed or repaired 23 Sinks renewed 5 Lavatory basins renewed or repaired 16 Baths renewed or repaired 4 Gulley renewed or repaired 1 Miscellaneous 21 - 420 Dampness— Roofs repaired or renewed 111 R.w.p.'s, guttering, repaired or renewed 58 Vertical Plinth provided 11 Walls rendered 25 Horizontal damp-course provided 4 Solutioning 8 Earth removed from walls 10 Walls repointed 32 Weather-board walls repaired — Sub-floor ventilation provided or improved 14 Dry areas constructed — Brickwork repaired 21 Miscellaneous 30 - 324 Water Supply- Drinking water service supplied direct from main 2 Fittings, etc. renewed 14 Separate or additional water supply provided — Supply reinstated 12 Flushing cisterns renewed or repaired 32 Storage tanks 8 Boilers „ „ „ — Water service pipe repaired 3 Miscellaneous 3 - 74 80 TABLE XIV. (Continued) General Items- Rooms cleansed 42 W.C. walls cleansed 7 Entrance hall and staircase cleansed 3 Bathroom cleansed 3 Light and ventilation improved 2 Plastering repaired or renewed 112 Floors repaired or renewed 47 Windows, frames, etc. repaired or renewed 34 Sashcords repaired or renewed 30 Putty pointing repaired or renewed 4 Doors repaired or renewed 16 Stoves and grates repaired or renewed 16 Coppers repaired or renewed — Draining Board renewed — I ron Staircase renewed — Handrails repaired or renewed 1 Stairtreads repaired or renewed 3 Dustbins provided 81 Dirty conditions remedied 14 Overcrowding abated 1 Chimneys repaired 7 External woodwork repainted 6 Food stores provided 1 Food stores ventilated - Yard paving renewed, etc. 19 Houses disinfested 21 Accumulations removed 37 Fencing — Houses demolished 3 Houses closed 2 Miscellaneous 27 - 539 MEAT, MILK AND OTHER FOOD PREMISES- Yard floors, repaired, etc. 12 Cleansed, lime-washed, shops, rooms 60 Lighting/Ventilation improved 4 Drains improved 9 Manure or refuse removed 18 Refuse bins provided 32 Cold store or refrigerator improved 2 Water supply improved 6 Sinks provided 9 Washing facilities improved 25 Sanitary conveniences improved 15 Meat vehicles improved 3 Meat handlers washable clothing 1 Miscellaneous 135 - 331 FACTORIES, OUTWORKERS, Etc.— Want of Cleanliness (Sect. 1) 8 Overcrowding (Sect. 2) — Unreasonable temperature (Sect. 3) 1 Inadequate ventilation (Sect. 4) — Ineffective drainage of floors (Sect. 6) — Sanitary conveniences (Sect. 7): (a) Insufficient 12 (b) Unsuitable or defective 18 (c) Not separate for sexes 4 Other offences 5 Outworkers'premises — Smoke nuisances 1 - 49 81 TABLE XIV. (Continued) TRADE PREMISES- Shops Act : Ventilation improved — Temperature improved 2 Sanitary conveniences improved 1 Absence of statutory forms 29 Unsatisfactory Washing facilities remedied 1 Meals rest interval contraventions remedied — Seats for female workers provided 2 Other offences or defects remedied 4 Petroleum Acts contraventions — Registry Office contraventions 3 Offices (P.H. Act, 1936, Sects. 46 and 91) contraventions 1 Pet Animals Act — Merchandise Marks Act 22 - 65 RUDENT CONTROL— Trade premises 92 Private premises 715 Sewers (manholes) 363 Corporation property 3 - 1,173 MISCELLANEOUS— Diseases of Animals Acts: Piggeries—Cleansing 2 Piggeries—Sanitary Conditions 3 Stables—Cleansing — Stables—Sanitary Conditions — Animals, Keeping of 4 Poultry Farms — Schools 5 Drain tests: Smoke 1 Water 3 Colour — Swimming Baths—visited — Tents, Vans, Sheds, Caravans and Fairgrounds 4 Accumulations (other than dwellings) 5 Streams, Ponds and Watercourses 3 Tips — Public Houses—Urinals 4 Cinemas, Theatres etc. 3 Fireguards Act 1 - 38 Grand Total 3,013 NOTICES ISSUED- Preliminary : Housing 610 Food Premises 192 Factories 36 Trade Premises 57 Rodent Control 775 Miscellaneous 83 1,753 Statutory—Housing 0 1753 BOROUGH OF BROMLEY COMMITTEE FOR EDUCATION ANNUAL REPORT on the SCHOOL HEALTH SERVICES of 1956 H. B. C. CARTER-LOCKE, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health January, 1957 84 EXCEPTED DISTRICT OF BROMLEY. Members of the Committee for Education. Alderman Samuel Lane (Chairman) *Councillor J. L. Hunt (Chairman *Councillor F. G. Austin of the Welfare Sub-Committee) (Vice-Chairman) *Councillor L. M. Prince (Mrs.) Alderman S. L. Best, J.P. *Councillor C. W. Wilmot Alderman F. W. Isard *Mrs. S. G. W. Baylis (Vice-Chairman Alderman J. S. Marriott of the Welfare Sub-Committee) Councillor G. W. Brown, M.B.E. Mrs. A. J. Howe, J.P. *Councillor J. C. Clayton Mr. Leighton L. Irwin, Councillor W. K. Curtis M.A., LL.B., J.P. *Councillor A. D. Daysh Miss O. M. Lambert, M.A. *Councillor M. L. Dempster (Mrs.) Mr. J. Davies Councillor H. F. Goodway Mr. G. J. Gully, C.B.E., J.P. (* L)(notes members of Welfare Sub-Committee) Officers of the Committee. Borougti Education Officer: H. T. Smith, M.A. Assistant Borough Education Officer: A. C. Cleveland. Education Welfare Officer: L. Saysell School Health Service. Medical Officers. Part-time. Medical Officer of Health H. B. C. Carter-Locke, m.b.. b.s.. m.r.c.s., l.r.c.P.. d.p.h. Deputy Medical Officer of Health A. J. I. Kelynack, m.b., b.s., d.p.h. Assistant Medical Officers P. A. Currie, m.r.c.s.. l.r.c.p. Mrs. C. Maxwell, m.a.. m.b.. b.chir. Ophthalmic Surgeons E. H. Lyi.e, m.d., d.o.m.s. Miss I. Gregory, f.r.c.s.. d.o.m.s. Orthopaedic Surgeon K. F. Hulbert, f.r.c.s. Dental Officers. Part-time. Mr. A. F. King, l.d.s.. r.c.s. Mrs. C. McKenzie Lindsay, Health Visitors and School Nurses. l.d.s., r.f.p.s. (Glasgow). Part-time. Miss E. Chenery, s.r.n., s.c.m., h.v.cert. Mrs. A. T. Evans, s.r.n.. s.c.m., h.v.cert. Mrs. V. Greig, s.r.n.. s.c.m.. h.v.cert. Miss W. G. Hemmings, s.r.n.. s.c.m., h.v.cert. Miss K. Owens, s.r.n., s.c.m., h.v.cert. Mrs. N. M. Taylor, s.r.n., s.c.m., h.v.cert. Miss M. E. Wootton, s.c.m., s.r.c.n.. h.v.cert. Physiotherapist. Mrs. V. Norman Part-time. Orthoptist. Miss E. Simpson, d.b.o. Part-time. Dental Attendants. Mrs. E. Brooks, s.r.n. Mrs. D. Harris Clerical Staff. Chief Clerk Mr. S. F. Judd (part time) Clerks Mr. E. P. J. Wythf (part time) Mrs. D. Cox (whole time) Mrs. W. J. Foot (part time) Mrs. R. C. Tye (whole time) 85 To the Chairman and Members of the Education Welfare SubCommittee. Mr. Chairman, Ladies and Gentlemen, This year my letter will commence with an appeal, which at least has the merit that unlike most appeals it will not touch the reader's pocket! All 1 ask is that having started reading this letter, you will continue to read it to the end. Surveying the School Health Service broadly, the first point that strikes me as being worthy of special mention is the fact that an all time record for the number of school children examined at periodic medical inspections in any one year in Bromley, was set up in 1956. It is encouraging to note that of the large number thus examined, slightly less than three per cent were considered to come within the category of unsatisfactory, and this is surely a tribute to the combined efforts of parents, teachers and school health service staff, all of whom in their own individual ways have made their contribution to this happy state of affairs. It will be noted that I have mentioned parents first and this has been done intentionally, as they are the most important factor in the development of their offspring. It may well be that there are those who will say that this is a statement of the obvious, but at a time when the state tends to obtrude more and more upon the individual's responsibilities, it would not appear to me to be out of place to stress this point. Having given the parents their just and due pat on the back, my thoughts naturally wander off to consider how their already excellent record can be further improved. One matter that has given me cause for some concern during the past twelve months is the fact that from time to time members of the staff of the School Health Service have drawn my attention to the fact that some of the children they have seen at school, have appeared very tired, and I feel that 1 must stress here the importance of adequate sleep especially for the growing child. 1 am not personally one of those who could draw up a rigid inflexible scheme of so many hours sleep for different age groups, as there is undoubtedly a variation in the need for sleep in different individuals, and there are occasions when the normal rules will be waived with every justification, but I would advise that the " occasions " should not be too frequent. In no other age, 1 suppose, has the temptation to keep the young people up late been more insistent than it is to-day, with the constant and ever growing appeal of the television screen, but it is a demand that must be resisted if it is eventually going to have a deleterious effect on the health of the next generation. 86 Having written a fairly lengthy preamble last year, it is not my intention to prolong the agony unnecessarily and 1 propose to stick to broad principles as details of the individual services which make up the School Health Service as a whole are dealt with at some length in the body of this report. The measure of the success of any service such as this is, that less and less treatment should be required as a result of more and more examinations, and looking back over past reports, one cannot help but notice the great decline in the number of children requiring treatment with the passing of the years. This of course has enabled more preventive work to be undertaken and I am glad to be able to report that nearly half the children attending school in Bromley have now had hearing tests completed using the pure tone audiometer which was only acquired during 1955. Critics of the service may say that the numbers of children found with defects are comparatively small, but there are distinct advantages in having the assurance that your own child's hearing is normal, and when a defect has been detected, it is to the advantage of all concerned, that the facts of the case should be brought to light. At this stage my conscience begins to prick me about that promise not to be too long winded, but I cannot conclude without a word of praise for the really united efforts of the staff, both professional and lay, on behalf of the health of the school children of Bromley. 1 should also like to thank the Borough Education Officer and the Head Teachers and their staffs for their continued good will and co-operation which make such a material contribution towards the smooth running of the service. Finally, but by no means least, I have to thank the Chairman and Members of the Education Welfare Sub-Committee for their never failing interest, sympathy and kindly understanding which are of such importance in assisting to resolve the many human problems which are inevitably encountered during a year's work. H. B. C. CARTER-LOCKE. Medical Officer of Health 87 SCHOOL ROLLS, FURTHER EDUCATION AND CLINICS Numbers on School Roll. 1953 1954 1955 1956 County Primary Schools 5,073 5,162 5,196 5,261 County Secondarv Schools 1,987 2,044 2,196 2,314 County Grammar & Technical Schools 1,837 1,833 1,892 1,881 Independent Schools 2,216 2,265 2,521 2,271 11,113 11,304 11,805 11,727 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 Mon., Wed. & Fri. a.m. (Doctor in attendance) Alternate Wednesdays a.m. Medical Room, Burnt Ash School Monday to Thursday a.m. (Doctor in attendance) Thursday a.m. Medical Room. Southborough School Mon., Wed. & Fri. a.m. Medical Room. Aylesbury Road School Mon., Wed. & Fri. a.m. Medical Room. Pickhurst School Tuesdays & Thursdays a.m. (Doctor in attendance) Alternate Wednesdays a.m. Dental. North Clinic, Station Road Monday to Friday a.m. & p.m. South Clinic, Princes Plain Saturday a.m. (By appointment only.) Specialist Clinics. Ophthalmic. North Clinic, Station Road Mondays & Wednesdays a.m. Friday p.m. 2nd & 4th Saturday in every month a.m. (By appointment only.) Orthoptic. North Clinic, Station Road Monday p.m. Tuesday a.m. & p.m. Thursday a.m. & p.m. Friday a.m. (By appointment only.) Orthopcedic. North Clinic, Station Road 1st & 3rd Friday in everv month p.m (By appointment only.) 88 Physiotherapy. North Clinic, Station Road Tues., Thurs. & Fri. (By appointment only.) a.m. Speech. South Clinic, Princes Plain Thursday (By appointment only.) p.m. Lip Reading. South Clinic, Princes Plain Wednesday 5-6 p.m. Saturday 10 a.m. - 12 noon (By appointment only.) PERIODIC MEDICAL INSPECTIONS. The medical examination of the school child at regular intervals during his or her school career is still the mainstay of the School Health Service. Although other aspects of this work are gradually, and deservedly, assuming greater importance, there can be no immediate prospect that the periodic medical inspection will be displaced from this position. That this is so is largely due to one unique feature of these examinations, namely, that they are a means of bringing together parent, teacher, school doctor and school nurse in one place, at one time and with one object— the welfare of the child. During 1956, 4,232 children were examined in this way—the largest total seen in the Borough in any year so far. 323 sessions were devoted to the work, so that the average number of children seen on each occasion was 13.1. Comparative figures for the previous year were 269 sessions. 3.830 children examined, and 14.2 average attendance. Three hundred and fifteen individual pupils were found to require treatment, excluding dental diseases and infestation with vermin. Although the number examined during 1956 was 402 more than in 1955. the number of pupils requiring treatment shewed a reduction of 30. It is not possible to give comparative rates with previous years on the general condition of the pupils examined as the categories have this year been altered to "Satisfactory" and "Unsatisfactory" in place of those used previously, i.e. "A" (Good), "B" (Fair) and "C" (Poor). The percentages for 1956 are 97.02% Satisfactory, and 2.98% Unsatisfactory. SPECIAL EXAMINATIONS. In addition to the periodic medical inspections, a further 1,968 special examinations and re-examinations were carried out during 1956, as compared with 1,944 in 1955. Sixty-eight cases requiring special investigation were examined at the Municipal Offices, and of these 33 had their intelligence quotients investigated. 89 Two hundred and forty cases were referred to the various hospitals for Specialists' advice and treatment, 175 of this number being Ear, Nose and Throat cases. A striking feature of these figures is an increase, compared with the previous year, in the number of children referred for an Ear. Nose and Throat Specialist's opinion, the total being, in fact, the largest since 1953. A proportion of this increase can be attributed to cases discovered as a result of the Audiometer tests in schools, and a further proportion to the normal year to year fluctuation of any statistical figure. It is also possible that some of these cases represent an aftermath of the exceptional measles epidemic of 1955. Also worthy of comment is the number of children examined in connection with their Intelligence Quotients. This work is exacting and time consuming, and consists of far more than the simple administration of an intelligence scale. Largely concerned with the handicapped pupil, it is of inestimable value in ensuring that these children derive full benefit from the various resources available for their special education and welfare. MINOR AILMENTS. A total of 2,962 attendances were made at the various clinics for the treatment of minor ailments by the School Nurses. Attendances at these clinics have shewn a rise during the year when compared with 1955, and this can only be attributed to the increase in the number of miscellaneous ailments treated. Any child attending the clinic and requiring medical advice is either referred to his own private doctor or to the clinic doctors at their visits. Although these clinics are concerned with the treatment of such simple conditions as minor cuts and abrasions, verrucas and other common skin diseases, it is true to say that their underlying purpose is preventive. Some of these minor conditions may not remain trivial if neglected, and in other cases, early and effective treatment may prevent cross-infection. AUDIOMETRY. Reference was made in my report for 1955 to the hearing tests which were being carried out in Bromley schools, and further progress has been made this year, when a total of 3,349 children (including 341 children attending independent schools) were examined with the pure tone audiometer. Nearly threequarters of this total were children in the age group 7-11 years, and indeed the great majority of pupils of this age attending Bromley schools 90 have now been examined. Two hundred and nine children failed the initial test, and these are being recalled for further examination, as a result of which, a number have already been referred for a specialist's opinion. The test used is easily understood by young children and, in fact, little difficulty was experienced in gaining their co-operation ; older children often seemed to view the test as a rather intriguing novelty. The tests can be carried out in any quiet room, and only in one school, situated on a busy main road, was the noise of the traffic sufficient to interfere seriously with the examinations at certain times of the day. Middle ear disease has again accounted for the majority of the cases of deafness found, followed by wax and foreign bodies in the meatus. No case of deafness severe enough to require special school tuition has so far been discovered, which suggests that the ascertainment of these more serious cases by other means has been satisfactory. Of the children so far referred to Consultants, treatment has been prescribed in many instances, but in some cases, the prospect of any marked improvement in the hearing is held to be slight. Although this is disappointing, these cases will, never the less, benefit from the fact that their disability is known, so that the appropriate adjustments can be made in the classroom. It is now well recognised that an inattentive or backward child may prove to be suffering, in reality, from a defect of hearing rather than of ability. The converse, however, is not necessarily true, and the children with slightly or moderately impaired hearing who are exceptionally gifted, who have by good fortune been favourably placed in the classroom, or who have received some individual tuition, may be able to overcome their disability to such an extent, as to give no clue in their work to the handicap under which they are labouring. In other words, in circumstances which would make the average child appear to be dull, the brilliant pupil will be reduced to an appearance of average ability—an equally serious matter and, moreover, one which is far more likely to be overlooked. This underlines the importance of examining the hearing of all children, not only of selected groups such as those known to be backward, just as all children, for example, are given periodic tests of vision. Since the audiometer tests were commenced in the Autumn of 1955 a grand total of 5,348 children have been examined, and of these, 317 failed the initial test. 91 OPHTHALMIC CLINIC. The position with regard to new cases is still satisfactory, it being possible for appointments to be given within 2-3 weeks after the case is referred. There is. however, still a considerable delay in the call up of cases for re-inspection, but as we have been fortunate enough to obtain the services of Dr. I. D. Gregory for two sessions a month, in addition to the three sessions worked by Dr. Lyle. it is anticipated that some improvement will soon be apparent. Dr. Lyle reports :— " During 1956 the School Eye Clinic has continued to deal with a large number of cases. Though the work has been heavy, it has been made worthwhile by the co-operation of the parents. Attendances have been particularly good this year and the clinic has run smoothly, thanks to the efforts of the Health Visitors and of the Clerical Department. The number of new cases seen during the year has increased and is 361. and the number of old patients seen was 1.357. giving a grand total of 1.718. as against 1.551 for the previous year. This increase has been made possible by the addition of two extra sessions per month. It has been a great pleasure to have Dr. Gregory doing these two extra sessions. Her co-operation is greatly appreciated. A large number of cases of Strabismus have been treated and 1 have carried out surgical treatment on a considerable proportion of these at the Bromley Hospital. In conclusion. I wish to thank the two Health Visitors who work untiringly at the North Clinic and the Clerk who arranges the appointments and deals with the administrative work so admirably." ORTHOPTICS. Miss Simpson reports :— "Once again there was a change of Orthoptist in the summer, when Miss Langmead left to take up another appointment, but fortunately the clinic was not closed at all. The patients and their parents have co-operated well and most of them have progressed very satisfactorily, several reaching the standard for discharge. The attendances of patients have remained fairly good, but there are still too many children who fail to attend without good reason. The numbers seem very much the same as those of 1955. but 1 am glad to see that the number of patients who fail to attend has been reduced. 1 hope the reduction will continue." 91 ORTHOPAEDIC CLINIC. This clinic continued to function well throughout the year under the able control of Mr. K. F. Hulbert and the following report has been received from him :— " The Orthopaedic Clinic has continued on Friday afternoons as previously, and there has been no marked change in either the number or type of case seen. During the year we have lost the services of Miss Pakes in the Physiotherapy Department and Mrs. Norman has been appointed in her place, and we are very much indebted to both these Physiotherapists for their skill and help. There have been two developments in the year which promise to be helpful. The first was the proposed scheme for a spastic unit at Farnborough. and the second is the scheme for providing long-stay children's orthopaedic beds at West Wickham Heart Hospital. Both of these schemes which are now being planned, will offer very material benefits to the children attending this clinic. We have had some very gratifying co-operation from the physical education departments of some schools and this is something which should be encouraged in every way. We have had a great deal of help from the Health Department, and wish to thank all those concerned for their co-operation which has made things very much easier." Details of the work of this clinic will be found in the appendix to this report. PHYSIOTHERAPY AND SUNLIGHT. Mrs. Norman reports :— "Both these clinics have had plenty of variety this year, and sonic good results have been obtained. Good co-operation is still given by the schools, both for attendance at the clinic, and in continuance of special exercises for certain postural cases by the P.T. staff of the schools. This is much appreciated. The remedial classes have been well attended by boys and girls, although the number of attendances has fallen compared with last year. The Sunlight clinic has had a busy year, the number of treatments being slightly up compared with last year. Most of these treatments were given between the months of October and May. In this way they act as a preventive from the winter ailments. In September Miss Pakes left to take up similar clinic work nearer her home." 93 DENTAL CLINICS. North Clinic. Mr. King reports :— " Owing to illhealth no inspections were carried out at the schools for a period of two months, but I am pleased to report an increase in the number of children examined during the year. The inspection of periodic age groups has resulted in an improvement of the dental health of the children. A part-time dental surgeon was appointed in April for four sessions a week. but. unfortunately, she resigned in November. The Assistant Medical Officers have shewn an even greater interest in the dentition of the children and. as well as referring cases to the clinic, often come to see me to discuss difficult cases. Regulation of the permanent teeth is in ever increasing demand ana considerable time has been devoted to this very desirable branch of dentistry. Unfortunately Mr. N. K. Thorne. the County Orthodontist resigned in February and has not been replaced. Maternity and Child Welfare cases showed a slight increase during the year. My grateful thanks are offered to the Staff of the Bromley Hospital, particularly the Radiological Department, for their very helpful and willing co-operation during the year." South Clinic, Princes Plain. Mrs. Lindsay reports :— " There has been a marked increase in the conservative work in the past year. 4.036 permanent and temporary teeth filled in comparison with some 3.000 the previous year. The orthodontic work has been progressing very satisfactorily and a number of cases have been completed successfully this year. This is very gratifying both to patient and operator. The other branches of the service have been maintained at their previous level. There have been a number of new patients applying for treatment who have not previously attended the clinic. Of those offered treatment over 75% accepted and were actually treated. 1 would like to take this opportunity to express my thanks to the anxsthetists. Dr. Morris and Dr. France, for their co-operation throughout the year." 94 EAR, NOSE AND THROAT DEFECTS. Two hundred and thirty-four children received operative treatment in hospitals for adenoids and chronic tonsillitis during 1956. This figure is nearly double that for the previous year and the increase is undoubtedly due to the fact that it was not necessary to hold these operations in abeyance due to the prevalence of poliomyelitis. One child received operative treatment for mastoid, and seven for sinus trouble, etc. In addition to the above, thirty-two children received other forms of treatment at the school clinics and as out-patients at hospitals. VERMIN AND UNCLEANLINESS. Seventeen thousand five hundred and fifty-eight inspections were carried out by the School Nurses at Primary and Secondary Schools. No inspections were made at the Grammar and Technical Schools. A total of forty-three children were found to be infested or shewed minor signs of infestation. These figures continue to shew a very high standard of cleanliness. INFECTIOUS DISEASES IN SCHOOLS. Notifications of infectious diseases in children of school age have been remarkably low during 1956. only 149 being notified as against 535 during the previous year. Six cases of Scarlet Fever were notified as against thirty-eight during 1955. These were all mild cases and none were admitted to hospital. Whooping Cough shewed a slight rise, fifty-eight cases being notified as against forty-nine for the previous year. Three of these cases were admitted to hospital. The main decrease in notifications occurred in the number of cases of measles, only forty-five being notified as against four hundred and thirty-three in 1955. One case of poliomyelitis (paralytic) was notified in October. This was in respect of a six-year-old child attending an independent school in the area. The patient had only mild paralysis and has since made a good recovery. Thirty-seven cases of Dysentery were notified, as against three during the previous year. The majority of these cases occurred during the latter part of the year, and affected children attending one primary school in the borough. Although this illness, in the form now prevalent, is generally very mild in character (only one of the cases reported above required hospital treatment), there is no doubt that it is becoming more of a problem. This is because of the ease with which the 95 infection can be transmitted from person to person, particularly where young children are concerned, and also because many of those infected do not develop symptoms, and are consequently unaware that they are liable to spread the disease. The problem is by no means a local one, for the prevalence of the illness in England and Wales as a whole has increased markedly during the past ten years, reaching a new maximum during 1956. It is believed that the infection is spread mainly by personal contact, and this perhaps explains why the younger child is at greater risk. The only effective way of controlling the disease is by raising standards of personal hygiene, and particular importance is attached to the proper cleansing of the hands after use of the toilet. This is by no means easy to achieve in the case of the young child, but my advice to parents would be to try to see that their children acquire these habits as early in life as possible. In addition to the above, notifications were received of one case of Pneumonia and one of Food Poisoning. Four cases of Pulmonary Tuberculosis in school children were notified during 1956. Three of these occurred in children in the same family. The parent or parents in the two families concerned were previously known tuberculous patients. Mention must also be made of one disease that did not occur during the year. In fact, no case of diphtheria has been notified in the borough since 1950. and there is no reason why this happy state of affairs should not continue, if parents will continue to ensure that their children receive the necessary protection. In the case of school children who have been immunised in infancy, a re-inforcing or " booster " dose of the vaccine is recommended at the ages of 5 and 10 years. If for any reason the child has not already been immunised, it is still not too late to have this done, and parents who are in doubt about this are strongly advised to ask the advice of their family or school doctor. The following table gives details of the incidence and number of cases of the various diseases notified :— Disease Total No. of cases No. admitted to Hospital Seasonal incidence Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Scarlet Fever 6 - 2 - - 1 1 - - - 1 1 - - Measles 45 - 1 — 1 1 ■— 3 37 1 — — 1 Whooping Cough 58 3 — — 3 3 5 20 16 9 2 — — - Poliomyelitis (Paralytic) 1 - - - - - - - - - - 1 - - Dysentery 37 1 — — — — 2 1 2 — — 5 5 22 Pneumonia 1 1 — 1 - - - - - - - - - - Food Poisoning 1 - - - - - - - - 1 - - - - Totals 149 5 3 1 4 5 8 24 55 11 3 7 5 23 96 HANDICAPPED CHILDREN. During the year. 68 special cases were examined at the clinics held at the Municipal Offices on Saturday mornings. Of this number. 20 have been certified as handicapped and not suitable for education in ordinary schools. At the present time, there are 75 known educationally sub-normal and physically handicapped children in the area. Details of these children are given below :— Waiting Admission. In Residential Schools for E.S.N, children 2 — Attending Day School for E.S.N, children 18 4 In Residential Schools for Blind and Partially Sighted children 2 1 In Day Schools for Blind and Partially Sighted children 2 — In Residential Schools for Deaf and Partially Deaf children 2 — Attending Day Schools for Deaf and Partially Deaf children 4 1 In Ordinary Schools (Physically Handicapped children) 7 — In Residential premises for Physically Handicapped children 8 — In Day Schools for Physically Handicapped children 8 — In Residential premises for Epileptic children 1 — In Residential premises for Delicate children 2 — Attending Day Schools for Delicate children 1 In Residential premises for Mal-adjusted children 7 4 Receiving Home Tuition 1 As will be seen from the foregoing table, there are now ten handicapped children awaiting admission to special schools, and of these, four are educationally sub-normal. There are 36 known ineducable children whose homes are in the area, 12 of these children are in institutions, and 24 at home. SCHOOL HYGIENE AND NEW SCHOOLS. The only improvements worthy of note carried out during 1956 were :— Burnt Ash County Primary Junior School: Provision of hot water supply to six wash basins in Girls' Cloakroom. Burnt Ash County Primary Infants' School: Provision of hot water supply to six wash basins in Boys' Cloakroom. Provision of New School Buildings. Primary Education. The Pickhurst Junior School was completed during the year and taken into use. SCHOOL MEALS AND MILK IN SCHOOLS. Meals. There is little to report in the way of development during the year. The kitchen at the new Technical School for Boys is still under construction and it is hoped will be ready for use in 1957. The erection of the new Hayes Secondary Mixed School had not begun by the close of the year. 97 At the beginning of the Autumn term the daily average number of meals being served amounted to 6,793, a slight reduction on the number for the corresponding period last year. This reduction may be due to the fact that from 1st September the Ministry increased the cost of the mid-day meal from 9d. to lOd. A return to the Ministry of Education shewed that on a day in September/October 66.88% of the pupils in attendance at Primary and Secondary Schools received the mid-day meal. The school canteens are under regular supervision by the Public Health Inspectors, and a very high standard of hygiene has been maintained throughout the year. Milk in Schools. A return to the Ministry of Education shewed that on a single day in September/October 89.22% of the pupils in attendance at Primary and Secondary Schools received milk. EMPLOYMENT OF YOUNG CHILDREN. The number of children examined by the School Doctors in respect of fitness for employment out of school hours was less than for the previous year. One hundred and sixty-one examinations were carried out and in every instance fit certificates were issued. Two hundred and two examinations were made during 1955 and fit certificates issued in every case but one. OTHER EXAMINATIONS. In addition to the examination of school children, fifty-five students, teachers and other employees of the Committee were medically examined during 1956. INDEPENDENT SCHOOLS. Medical inspections were carried out at nine independent schools during the year, when 565 children in various age groups were examined in the 54 sessions held. Statistical details of these examinations will be found in Table VIII at the end of this report. In addition to the periodic medical examinations, sessions for audiometer tests were held at 5 schools, when 341 children were examined. Of the 14 children who were confirmed to have hearing defects, on re-examination, 5 were referred for treatment to the Ear, Nose and Throat Consultant, or to their family doctors, while a further two were already receiving treatment. Five other children were placed under observation and. in the remaining two cases, the defects were so slight that no action was considered necessary. Special examinations have included intelligence testing of retarded children and the investigation of maladjustment. 98 At one school, the Physical Training mistress has arranged exercises for children found to be suffering from postural and foot defects, and it is no small tribute to her enthusiasm and to the keenness of her pupils, that the results have been outstandingly successful. It is pleasing to be able to record that both parents and schools have continued to give their support to this voluntary scheme, and my thanks are due to the school authorities and staff concerned for their generous assistance in providing facilities for the examinations. PHYSICAL EDUCATION. 1. General. The year 1956 has been one of expansion rather than of exploration and experiment, with the result that physical education in the schools of the borough has made steady if unspectacular progress. The quality of work has been maintained and some schools have produced work of an exceptionally high standard. More teachers are using their greater freedom to good advantage and more have acquired a clear understanding of the ideas and ideals behind the changed routine. Primary Schools. In some primary schools there is still need to examine the value of some of the activities in the " daily " lesson performed with small apparatus. Too often such apparatus tends to hinder rather than to help movement and prevents children from obtaining the desired effects or a full range of movement. Progression in the work and standard of performance depend to a great extent on the new material and ideas introduced to the class by the individual teacher. A more complete assessment of the varying abilities and aptitudes within the class, as well as of the influence of growth and development, are necessary if teachers are to give their children every oppoitunity to reach their full physical capacity. Secondary Schools for Boys. "Blocked" schemes of work in Secondary Schools for Boys were mentioned in our last report and observations made during the year under review suggest that concentration on one particular aspect of physical education (e.g. basketball) for a number of consecutive periods during the academic year may have serious drawbacks among the younger classes. Boys in the age group 11-13 years are at a formative age physically, and may need developmental gymnastic work of wider scope than can be obtained under the "block" system when half a term or more of gymnastic work may be missed. 99 On the boys' side also it is considered that teachers should give more attention in the gymnastic lesson to "personal" work which caters for the physical needs of the different individuals in a class, rather than spend so much time on the preconstructed exercises of the pre-war syllabus, which were designed to suit the hypothetical average child and were selected for their effects on specific joints and muscles. Secondary Schools for Girls. In the Secondary Schools for Girls interest in educational dance strongly influences the type and presentation of indoor work, since it has a direct appeal to most adolescent girls. In gymnastics we endeavour to educate the individual child, and the pupils are allowed to feel that they all have a contribution to make, a contribution which will vary according to their innate ability, confidence and creativeness. They should be encouraged to give of their best and to work to their limit, though not beyond it. So often less than a child's best is accepted, with a resultant lack of challenge and lowering of individual standard. In addition to the provision of opportunities for experiment and for developing their own activities, the question of challenge is now taking on greater importance. It is hoped that girls will be encouraged to go "all out" in an effort to discover previously unknown capabilities entailing the maximum effort. 2. Games and Athletics. The programme of outdoor activities has followed the pattern of previous years. In some cases there still remains a tendency in games periods to emphasise match play before the necessary degree of skill has been acquired, with the result that many of the less able performers obtain little enjoyment or physical benefit. If every pupil is to have an equal chance of obtaining knowledge of, and developing skill in athletics and the major games, a better balance will need to be struck in games periods between playing and practice. Inter-house, inter-school and inter-district matches have again formed a considerable part of out-of-school activities and the element of competition has added zest and stimulated endeavour in an exhilarating and helpful manner. Twenty-four boys and girls from the Borough were included in the District Athletics Team at the County Sports held at Dover. A Bromley girl was successful in one event (high jump) and a number of "County Standards" were achieved, but general performances were considered to be below those required for competition in the English Schools' Championships. Schools in the Borough have been well represented in the various District and County Teams. Six boys secured places in 100 the District Football XI, two girls were selected for the County Cricket XI, and one girl each for the County Junior Tennis VI and the County Junior Netball VII. It is encouraging to find that schemes of work in Secondary Schools have been broadened to allow a choice of major games during winter and summer and to cater for the different interests and aptitudes within the school. In addition to the normal activities in athletics, cricket, football and swimming, one school in the area has also provided opportunities in rugby football, cross-country running and boxing. A Hockey Coaching Course for selected senior girls was arranged on several evenings towards the end of the Winter Term. Schools were invited to send older girls with an interest in games to meet secretaries of local Kent Women's Hockey Clubs, in order to provide a contact with club hockey before leaving school. Special coaching sessions for the girls were held on each evening. The lecture-demonstration on Outdoor Pursuits, so successful in 1955, was repeated on two occasions during the year. On both occasions school leavers from all the Secondary Schools for Girls in the area were given information on the various outdoor pursuits which promote physical well-being and on the facilities available to them on leaving school and in adult life. It is hoped that a permanent interest has been aroused in this type of outdoor activity, especially among school leavers who have no special interest in, or aptitude for, team games. Lists of contacts for the various youth and adult activities were provided for all schools. Invitations were issued to all Junior Schools to participate in two large Folk Dance gatherings during the year. Both occasions were sponsored by the English Folk Dance and Song Society, and indoor and outdoor facilities were used. 3. Swimming. Rather less than one quarter of the total school population in the Borough attended swimming baths during the year and swimming instruction was enjoyed mainly in a ten-week summer season by an average of 970 junior pupils and 1,319 Secondary pupils at the following swimming baths:— 1. Bromley Open Air Swimming Bath. 2. Bromley Crown Lane Swimming Bath. 3. Downham Swimming Bath. Information received from the schools indicates that no fewer than 433 non-swimmers were taught to swim during the year and. with two exceptions, it has been possible to fit into the swimming ioi timetables groups of pupils from all junior and secondary schools in the Borough. If the two schools for which no provision has been possible up to the present time are to receive swimming instruction, it will be necessary to make arrangements for them during the Autumn or Winter Terms and to use facilities outside the Borough. Three Secondary Schools are to be congratulated on progressing to the standards of the Medallist Awards of the A.S.S.A. and the E.S.S.A. Thirty-seven achievement awards of this category have been gained this year. Competitive Swimming (i) Bromley Schools' Galas. A larger number of schools entered for the Annual Gala at Downham Baths and to avoid a protracted programme it was necessary to arrange the Primary and the Secondary events on two separate evenings. In all ten Secondary and ten Junior Schools took part and some excellent swimming and diving were witnessed on both occasions. (ii) Kent County Gala. Bromley was once again well represented at the County Schools Swimming Championships ; sixteen boys and sixteen girls took part, gaining four first places for girls and one first place for boys. These pupils represented Kent at Division II Trials of E.S.S.A., but only one girl secured a place as a reserve in the Division Eleven (Kent and Surrey) Team for the English Schools National Swimming Championships. 4. Further Training of Teachers. Renewed efforts were made during the year to consolidate the progress already made rather than to break fresh ground, with the result that fewer Refresher and Training Courses than usual were arranged. Nevertheless, opportunities to attend the following courses have been available to all teachers 1. Modern Dancc Course for women teachers in Primary Schools, held at Bexleyheath on one Saturday during the Summer Term. 2. Athletics (Pole Vaulting) Course for men teachers in Secondary Schools for Boys held at St. Paul's Cray on one Sunday during the Summer Term. 3. Athletics Course for women teachers in Secondary Schools for Girls at Maidstone on one Saturday during the Summer Term. 102 4. Modern Dance Practice Group for women teachers, held in Bromley for eight consecutive weeks during the Summer Term. 5. "Medau" Recreative and Development Work in Physical Education for women teachers in Secondary Schools held in Chatham on two Saturdays during the Autumn Term. 6. Association Football Course for men teachers in Secondary Schools for Boys held at Kingsgate, Broadstairs. for one week-end during the Autumn Term. Youth Activities and Adult Classes. For at least three years recreative classes in physical activities have been severely restricted for reasons of economy. This year there has been some relaxation in the financial restrictions and it has been possible to duplicate classes within the Borough for both men and women. Requests from Youth Clubs for facilities for cricket, football, netball and tennis have remained at a high level and have always received sympathetic consideration. In an area which offers such excellent facilities for cycling, walking and Youth Hostelling it is natural that the popularity of these activities should form the major part of the Summer programme, catering particularly for individuals and smaller groups. 6. Conclusion. In the review of Physical Education during the year 1954 the hope was expressed that the excellent basic training developed in the Schools of the Borough would be carried forward by school leavers into youth and adult life. Renewed efforts have been made during 1956 to ensure that all school leavers are made aware of the opportunities for the various games, sports and outdoor activities available to them. In this way it is hoped that interest will be developed during the period immediately after leaving school and that increased membership will accrue to local clubs and associations in consequence. To this end the continued generous co-operation of the various County Associations of the National Bodies of Sport and of the Central Council of Physical Recreation has been most gratifying and helpful. In conclusion we wish to express our thanks to the Borough Education Officer and his Staff for their valuable support and our appreciation of the good work done by the Head and Assistant Teachers in the Schools. F. M. BENTLEY. J. M. PELL. Area Advisers of Physical Education. 103 SPEECH THERAPY CLINIC. The following report has been received from the County Senior Speech Therapist:— "Mrs. Swan's resignation from her full-time appointment in the County took effect at the end of March. 1956. Family commitments made it impossible for her to continue full-time work. She has been re-appointed to the County in a part-time capacity. She was not able to resume her duties at the Bromley Clinic until the beginning of July. Owing to the enforced break, due to Mrs. Swan's home commitments, the clinic had to be closed during the months of April. May and June. There is urgent need for a full-time Speech Therapist to work in Bromley. Steps have been taken during the year to increase the establishment of Speech Therapists on the County's staff so that a full-time appointment at Bromley may be made. The appointment, however, cannot proceed until full-time premises are available. Considerable work has been done in an effort to obtain such premises and it is hoped that 1957 may see the opening of a fulltime clinic. In the meantime. Mrs. Swan continues to attend for one session a week at the Princes Plain Clinic. Fourteen cases have been closed during 1956. Of these, nine were dealt with at the Bromley Clinic and five at the Beckenham Speech Therapy Clinic. The reason for closing these fourteen cases was as follows :— Satisfactory result following treatment 7 Reported improved by Medical Officer or Head Teacher prior to appointments being offered 4 Investigation incomplete, parents not prepared to agree to full investigation of the case 1 Treatment arranged elsewhere prior to appointments being offered 1 Treatment incomplete; co-operation with the Child Guidance Clinic was attempted but appointments were not kept 1 Seventeen Bromley children and their parents were in contact with Speech Therapy Clinics at the end of 1956. and will continue to attend at the clinics into 1957. Nine are attending at the Bromley clinic and eight are attending at the Beckenham clinic. At the end of 1956. 113 cases were on the waiting list." 104 SCHOOL HEALTH SERVICE. STATISTICAL TABLES, 1956. 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. D. Classification of the Physical Condition of the Pupils Inspected. TABLE II.—Infestation with Vermin. TABLE III.—Return of Defects Found by Medical Inspection. 1956. A. Periodic Inspections. B. Special Inspections. TABLE IV.—Group 1. Eye Diseases. Defective Vision and Squint. Group II. Diseases and Defects of Ear. Nose and Throat. Group III. Orthopaedic and Postural Defects. Group IV. Diseases of the Skin. (Excluding Uncleanliness.) Group V. Child Guidance Treatment. Group VI. Speech Therapy. Group VII. Other Treatment Given. TABLE V.—Dental Inspection. Treatment and Orthodontics. TABLE VI.—Orthoptic Clinic. TABLE VII.—Handicapped Pupils. TABLE VIII.—Independent Schools. Juvenile Delinquency. Boot Club. Welfare—Provision of Clothing. 105 TABLE I. Medical Inspection of Pupils Attending Maintained Primary and Secondary Schools. A. Periodic Medical Inspections. Age Groups inspected and number of pupils examined: — Entrants 764 Second Age Group 1,787 Third Age Group 485 Total 3,036 Number of additional Periodic Inspection's 1,196 Grand Total 4,232 B. Other Inspections. Number of Special Inspections 1,387 Number of Re-inspections 581 Total 1,968 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). Age Group For defective vision (excluding squint) For any of the other conditions recorded in Table III.A. Total individual pupils Entrants 18 54 72 Second Age Group 55 87 142 Third Age Group 9 13 22 Total (prescribed groups) 82 154 236 Other Periodic Inspections 46 33 79 Grand Total 128 187 315 D. Classification of the Physical Condition of Pupils Inspected. Age Groups Number of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (5) (6) Entrants 764 723 94.63 41 5.37 Second Age Group 1,787 1,728 96.70 59 3.30 Third Age Group 485 471 97.11 14 2.89 Other periodic inspections 1,196 1,184 99.00 12 1.00 Total 4,232 4,106 97.02 126 2.98 106 TABLE II. Infestation with Vermin. (i) Total number of individual examinations of pupils in schools by the nurses or other authorised persons 17,558 (ii) Total number of individual pupils found to be infested 43 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act. 1944) Nil. (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil. TABLE III. Return of Defects Found by Medical Inspection in the year 1956. A. Periodic Inspections. Defect Code No. Defect or Disease Periodic Inspections Total (including all other age groups inspected) Entrants Leavers Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation (1) (2) (3) (4) (5) (6) (7) (8) 4 Skin 3 1 4 5 Eyes—(a) Vision 18 185 9 17 128 415 (b) Squint 2 1 — — 6 3 (c) Other 2 1 — 3 12 12 6 Ears—(a) Hearing 2 6 — 1 4 13 (b) Otitis Media 2 — — — 2 — (c) Other — 1 — — — 1 7 Nose and Throat 19 49 — 2 26 77 8 Speech 5 5 1 — 11 8 9 Lymphatic Glands — — — — — — 10 Heart 1 — — — 1 4 11 Lungs — 7 — 1 1 15 12 Developmental— (a) Hernia 2 7 1 — 6 9 (b) Other 9 27 2 11 25 118 13 Orthopaedic— (a) Posture 3 6 5 25 33 157 (b) Feet 7 32 5 7 56 108 (c) Other 1 3 — 2 9 14 14 Nervous System— (a) Epilepsy — 1 — — — 2 (b) Other — 1 — 1 — 3 15 Psychological— (a) Development — 1 — — — 1 (b) Stability 1 1 — — 3 3 16 Abdomen 1 — — — 1 — 17 Other 0 15 17 13 131 107 TABLE III. (Continued) B. Spccial Inspections. Defect Code No. Defect or Disease Special Inspections Requiring Treatment Requiring Observation (1) (2) (3) (4) 4 Skin 44 2 5 Eyes— (a) Vision 82 65 (b) Squint 3 — (c) Other 32 3 6 Ears— (a) Hearing 23 26 (b) Otitis Media 1 — (c) Other 23 1 7 Nose and Throat 58 27 8 Speech 11 6 9 Lymphatic Glands — — 10 Heart 2 2 11 Lungs 9 15 12 Developmental— (a) Hernia 2 2 (b) Other 24 37 13 Orthopaedic— (a) Posture 11 24 (b) Feet 16 36 (c) Other 35 7 14 Nervous System— (a) Epilepsy 1 1 (b) Other — 1 15 Psychological— (a) Development 5 10 (b) Stability 11 7 16 Abdomen 1 2 17 Other 143 47 Totals 537 321 Tonsillectomy. Children attending maintained schools who have at some time or other undergone tonsillectomy: — Number Age Groups. Boys. Girls. Entrants 33 20 Second 251 228 Third 81 53 Others 115 308 480 609 108 TABLE IV. Group I.—Eye Diseases, Defective Vision and Squint. Number of cases known to have been dealt with: By the Authority. Otherwise. External and other, excluding errors of refraction and squint 398 No information Errors of refraction (including squint) 1,558 available. Total 1,956 — Number of pupils for whom spectacles were prescribed 856 Group II.—Diseases and Defects of Ear, Nose and Throat. Number of cases known to have been treated: By the Authority. Otherwise. Received operative treatment: (a) for diseases of the ear — 1 (b) for adenoids and chronic tonsillitis 234 (c) for other nose and throat conditions – Received other forms of treatment. 32 7 Total 32 242 Total number of pupils in schools who are known to have been provided with hearing aids: (a) in 1956 — — (b) in previous years — 6 Group III.—Orthopaedic and Postural Defects. By the Authority. Otherwise. Number of pupils known to have been treated at clinics or out-patient New 108 departments Re-insp. 258 8 operations 109 Group IV.—Diseases of the Skin (excluding uncleanliness for which see Table II). Number of cases treated or under treatment during the year by the Authority. Ringworm—(i) Scalp 1 (ii) Body 3 Scabies — Impetigo 12 Other Skin Diseases 186 Total 202 Group V.—Child Guidance Treatment. Number of pupils treated at Child Guidance Clinics under arrangements made by the Authority: 15 (referred) Group VI.—Speech Therapy. Number of pupils treated by Speech Therapists under arrangements made by the Authority: 25 (referred) Group VII.—Other Treatment Given. (a) Number of cases of miscellaneous minor ailments treated by the Authority: 934 (b) Pupils who received convalescent treatment under School Health Service arrangements: 3 (c) Pupils who received B.C.G. vaccination : 14 110 TABLE V. Dental Inspection and Treatment Carried Out by the Authority. (1) Number of pupils inspected: — (a) at Periodic Inspections 3,826 (b) as Specials 2,535 Total (1) 6,361 (2) Number found to require treatment 4,698 (3) Number offered treatment 4,361 (4) Number actually treated 2,639 (5) Number of attendances made by pupils for treatment including those recorded at beading 11(h) below 9,397 (6) Half days devoted to: Periodic (School) Inspection 26 Treatment 967 Total (6) 993 (7) Fillings: Permanent Teeth 4,671 Temporary Teeth 1,378 Total (7) 6,049 (8) Number of teeth filled : Permanent Teeth 4,534 Temporary Teeth 1,363 Total (8) 5,897 (9) Extractions: Permanent Teeth 541 Temporary Teeth 2,579 Total (9) 3,120 (10) Administration of general ana:sthetics for extraction 1,436 (11) Orthodontics: (a) Cases commenced during the year 122 (b) Cases carried forward from previous year 171 (c) Cases completed during the year 140 <d) Cases discontinued during the year 15 (e) Pupils treated with appliances 159 (f) Removable appliances fitted 159 (g) Fixed appliances fitted — (h) Total attendances 1,620 (12) Number of pupils supplied with artificial dentures 17 (13) Other operations: Permanent Teeth 2,570 Temporary Teeth 2,108 Total (13) 4.678 111 TABLE VI. Orthoptic Clinic. Total number of treatments given 962 Number of new cases 69 Number of cases on occlusion alone 78 Number of cases found unsuitable 7 Number of cases postponed 445 Number of cases failed to attend 33 Number of cases put down for operation 32 Number of cures—with operation 10 „ „ without operation 8 Number of sessions held during 1956 284 Number of attendances 1,270 Number of patients discharged (various reasons) 27 TABLE VII. Handicapped Pupils Requiring Education at Special Schools Approved Under Section 9(5) of the Education Act, 1944 or Hoarding 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 (i) (2) (3) (4) (5) (6) (7) (8) (9) (10) During ilie calendar year ended 31.vr Dec., 1956: A. Were newly placed in Special Schools or Boarding Homes – – – 2 1 1 3 – 1 8 B. Were newly assessed as needing special educational treatment at Special Schools or in Boarding Homes – – – 3 4 1 3 4 1 16 112  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) On or about January 31st. 1957. C. (i) Were on the registers of Special Schools as: (a) Day Pupils — 2 — 3 1 8 18 — — 32 (b) Boarding Pupils (ii) Were on the registers of independent schools under arrangements made by the Authority 1 1 (iii) Were boarded in homes and not already included under (i) or (ii) Total C — 2 1 3 1 8 18 — – 35 D. Were being educated under arrangements made under Section 56 of the Education Act, 1944: (i) in hospitals – – – – – – – – – — (ii) in other groups (e.g., units for spastics, convalescent homes) (iii) at home — — — — — 1 — — — 1 E. Were requiring places in special schools: (i) Total (a) day — — 1 — — — 4 — — 5 (b) boarding – – – – – – – – – – Number of pupils included in the totals above— (ii) Who had not reached the age of 5: (a) Awaiting day places – – 1 – – – – – – 1 F. Were on the registers of hospital special schools — G. During the calendar year ended 31st December, 1956, number of children who were reported to the local health authority: — (a) under Section 57 (3) (excluding any returned under (b)) 4 (b) under Section 57 (3) relying on Section 57 (4) Nil. (c) under Section 57 (5) of the Education Act, 1944. 2 H. During the financial year ended 31st March. 1956. Amount spent on arrangements under SECTION 56 of the Education Act, 1944. for the education of handicapped pupils otherwise than at school £148 0s. 10d 113 Nutrition Table. Classification—" Satisfactory " .... 560 pupils or 99.12% „ —" Unsatisfactory " .... 5 pupils or 0.88% TABLE VIII. Independent Schools. Number of schools visited 9 Number of Medical Inspection Sessions held 54 Number of children examined (various age groups) 565 Number of Re-inspections 109 Table of Defects found by Medical Inspection. Defect or Disease. Number of Defects:— Requiring treatment. Requiring observation Skin 4 1 Eyes, Vision 17 36 Eyes, Squint 1 3 Eyes, Other 2 — Ears, Hearing 4 5 Ears, Otitis Media — — Ears, Other I — Nose and Throat 5 13 Speech — — Lymphatic Glands — 1 Heart 1 2 Lungs 3 6 Developmental, Hernia — 1 Developmental, Other 1 5 Orthopaedic, Posture 11 4 Orthopedic, Feet 28 5 Orthopædic, Other 6 9 Nervous System, Epilepsy — — Nervous System, Other 1 — Psychological, Development 1 2 Psychological, Stability — 3 Abdomen — — Other 3 2 89 98 114 JUVENILE DELINQUENCY. During the year 55 children and young persons appeared before the Local Court. The types of offences were:— Being beyond parental control 3 Breach of Probation 1 Committing damage to a lamp 1 In need of care and protection 1 Indecent exposure 1 Larceny 20 Riding cycle without lights 7 Riding Cycle on footpath 1 Road Traffic Act 3 Wilfully obstructing passage of the footway 2 Wilfully killing a wild bird 1 BOOT CLUB. The transactions of the Boot Club during 1956 shew a marked reduction on those for previous years, mainly due to the lower rate of bonus now being offered. There were 157 members on the 31st December. 1956, and trading during the year can be summarised as follows :— Deposits from members £170 Number of vouchers issued 205 Value of vouchers issued £230 WELFARE—PROVISION OF CLOTHING. As a result of applications received, thirty-two children were provided with clothing during the year, at a total cost of £144 7s. 5d.