LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1971 L. R. L. EDWARDS. M.D. (Lond.). M.B.. B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health and Principal School Medical Officer SHERMAN HOUSE, SHERMAN ROAD, BROMLEY, BR1 3TF Telephone: 01-464 3333 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1971 L. R. L. EDWARDS, M.D. (Lond.). M.B.. B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health and Principal School Medical Officer SHERMAN HOUSE, SHERMAN ROAD, BROMLEY, BR1 3TF Telephone: 01-464 3333 3 INDEX See Page 120 for Index to School Health Service Report Page A Accidents—Street 23 Ambulance Service 47 Animal Boarding Establishments 110,111 Animal Keepers 110 Animals—Miscellaneous 110 Animals—Pets 111 Atmospheric Pollution 100 B Bacteriological Examinations 88, 89 Births 17,19 C Cancer—Deaths from 22 Census—1971 24 Cervical Cytology 34 Chiropody 35 Cholera 57 Clean Air Act—see under Atmospheric Pollution Cytology—see under Cervical Cytology D Deaf Children 34 Deaths 18-20 Dental Services 51 Diphtheria 57 Diseases of Animals 109 Disinfections 100 Disinfestation 100 Drainage and Sewerage 99 Dysentery 58 Page E Environmental Health Services 67 F Factories Act 107 Family Planning 35 Food and Drugs Act 70, 92 Food and Drugs Act— Sampling 70 Food Complaints 91 Food Poisoning 58 Food Hygiene Regulations 93 Fox Control 103 H Health Committee 7 Health Education 44 Health Visiting 36 Home Nursing 38 Home Safety 44 Housing and Slum Clearance 94 Housing Inspections 97 Housing—Public Health Acts 95 I Ice Cream Sampling 88 Immigrants— Medical Arrangements 42 Infant Mortality 18,22 Infectious and Other Diseases 57 Infective Jaundice 59 Introduction 11 L Leptospirosis 59 5 INDEX—(continued) Page M Malaria 59 Maternal and Child Health 22 Measles 59 Meat Inspection 90 Meningitis 60 Meteorological Observations 30 Midwifery 39 Milk Sampling 88 Milk (Special Designation) Regulations 93 Mortuaries 108 Moveable Dwellings 98 N National Assistance Acts 42 Nursing Homes 34 O Offices, Shops and Railway Premises Act 104 Outwork 108 P Paratyphoid Fever 62 Personal Health Services 33 Pigeon Destruction 104 Poliomyelitis 60 Population 17 Public Health Inspectors' Visits —Summary of 111 R Rabies 60,109 Rag Flock 94 Page Rehousing 95 Rent Act 1957 97 Riding Establishments 110,111 Rodent Control 103 S Scarlet Fever 60 Slaughter of Poultry Act 1967 92 Smallpox 60 Smoke Control—see under Atmospheric Pollution Staff of Health Department 8 Staff—Medical Examinations 43 Statutory Notices 114 Swimming Baths 109 Swine—movement of 109 T Tetanus 61 Tuberculosis 61 Typhoid 62 U Unsound Food 87 V Vaccination and Immunisation 36 Venereal Diseases 44 Vital Statistics 17 w Wasp Nest Destruction 100 Water Supply 114 Welfare Foods 34 Whooping Cough 62 7 HEALTH COMMITTEE (as at 31st December, 1971) Chairman: M. B. Kenward, B.D.S., L.D.S., R.C.S. Vice-Chairman'. Mrs. S. M. Stead The Mayor: Alderman A. T. Johnson, J.P. Councillors: M. G. C. Anderson M. I. Blazey Mrs. J. Bryant D. W. J. Eves M. E. Forster D. W. Giffin R. J. Kelaway Mrs. D. Partridge S. J. C. Randall Mrs. O. L. Roberts E. C. H. Smith W. H. Stevenson A. M. Wilkinson Mrs. M. L. Wilson Co-opted Members: Mrs. P. Drew H. J. Lester, O.B.E., J.P., F.C.A. G. D. Stilwell, M.R.C.S., L.R.C.P. Mrs. M. E. Thomas 8 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1971) MEDICAL AND DENTAL STAFF: Medical Officer of Health and Principal School Medical Officer: L. R. L. EDWARDS, m.d.(Lond.), m b. b.s., m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health and Deputy Principal School Medical Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer (School Health): P. A. Currie, m.r.c.s., L.r.c.p. Senior Medical Officer (Maternal & Child Health): (Mrs.) A. J. Jones, m.b.. ch.b. Medical Officers in Department: (Mrs.) G. L. Hobbs, m.r.c.s., l.r.c.p. E. Gaynor Lewis, m.b., b.ch., d.t.m. & h. (Miss) M. E. Lyttle, m.b., b.ch., b.a.o. (Mrs.) B. R. Luscombe, m.r.c.s., l.r.c.p. (Mrs.) V. N. Menon, m.b., B.S., D.C.h. (Mrs.) I. F. Maclean, m.b., ch.B. D. J. Thornton, m.b., ch.B. (Mrs.) J. C. Van Essen, m.b., ch.b. 10 General Practitioners attend clinics on a sessional basis. Principal Dental Officer : (Mrs.) C. M. Lindsay, l.d.s., r.f.p.s. (Glasgow) Dental Officers: (Mrs.) M. M. Alford, l.d.s., r.c.s.i. R. G. Cooper, b.d.s., l.d.s., r.c.s. (Eng.) (Mrs.) I. T. Creed, l.d.s., r.c.s. (Eng.) J. M. Farquharson, l.d.s., r.f.p.s. (Glas.) (Mrs.) M. I. Kininmonth, l.d.s. (Mrs.) A. R. Leach, b.d.s. 5 Dental Officers (Sessional), 1 Dental Hygienist, 10 Dental Surgery Assistants. Orthopaedic Surgeon: (in conjunction with Regional Hospital Board): K. F. Hulbert, f.r.c.s. Physiotherapist: (Mrs.) V. Norman, m.c.s.p. (Sessional) Senior Speech Therapist: (Miss) V. M. Connery, l.C.S.t. 3 Speech Therapists (One part-time) Orthoptist: (Miss) L. P. A. Brownlow, d.b.o. (part-time) Ophthalmologists: 4 Sessional. 9 Chest Physician: (in conjunction with Regional Hospital Board) E. W. Street, m.r.c.s., l.r.c.p. Psychiatrist: 1 (in conjunction with Regional Hospital Board) (Parttime) NURSING AND ALLIED STAFFS: Superintendent Home Nursing Service: Mrs. M. O. Tierney, s.r.n., q.n. Deputy Superintendent Home Nursing Service: Mrs J. W. M. Teare, s.r.n. 41 Home Nurses Superintendent Health Visitor: Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., dip.s0c.studies(L0nd.) Deputy Superintendent Health Visitor: Mrs. L. A. Hamilton, s.r.n., c.m.b. Part 1., h.v. Cert. Group Adviser : Miss. C. M. Paxton, s.r.n., s.c.m., h.v.cert. 42 Health Visitors, 3 Part-time Health Visitors, 4 Student Health Visitors. Non-Medical Supervisor of Midwives: Miss M. C. Martin, s.r.n., s.c.m. Deputy Supervisor of Midwives: Miss J. S. Brown, s.r.n., s.c.m. 23 District Midwives, 1 Part-time midwife. 1 Cytology Nurse (Sessional) PUBLIC HEALTH INSPECTORS' STAFF: Chief Public Health Inspector: J. C. Kermode, m.a.p.h.1., m.r.s.h. Deputy Chief Public Health Inspector: W. T. Weedy, m.a.p.h.i., m.r.s.n. Divisional Public Health Inspectors: D. K. Evans, m.a.p.h.i. P. R. Light, m.a.p.h.i., a.r.s.h. E. V. Willams, m.a.p.h.i. 17 Public Health Inspectors, 3 Technical Assistants, 5 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 8 Rodent Operators, 3 Disinfector/Handymen, 2 Mortuary Keepers. 10 CHIROPODY Chief Chiropodist: A. S. Jones, s.R.c., M.ch.s. 2 Senior Chiropodists 9 Chiropodists (Sessional) ADMINISTRATIVE STAFF: Chief Administrative Officer: D. J. Tinson Central Administration: Senior Administrative Assistant: W. Hancock. 1 Administrative Assistant, 1 Secretary, 2 Clerical Assistants, 3 Clerks, 3 Shorthand Typists, 2 Enquiry Clerks/Receptionists, 1 Driver/ Storekeeper. ENVIRONMENTAL HEALTH Senior Administrative Assistant: B. Adams. 2 Administrative Assistants, 3 Clerical Assistants, 3 Clerks, 2 Shorthand Typists. MATERNAL AND CHILD HEALTH Administrative Assistant: J. F. McCarthy. 1 Administrative Assistant, 6 Clerks, 1 Typist. SCHOOL HEALTH Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant, 2 Clerical Assistants, 9 Clerks. HEALTH EDUCATION AND HOME SAFETY OFFICER : J. Bretton. 11 To: THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF BROMLEY Mr. Mayor, Ladies and Gentlemen: I have the honour to present a Report for the year 1971 on the services administered by the Health Department of the London Borough of Bromley. The separation of Health and Social Services Departments on the 1st April 1971 was accomplished with the minimum of disturbance and the maximum of goodwill between the Departments particularly on the allocation of accommodation. The fact that much the same accommodation in Sherman House could still be used was a major factor in maintaining ease of communication and co-ordination of services. The services of the Management Service Unit of the Authority were enlisted in a restructuring and streamlining of the Health Department coupled with a reorganisation of the Nursing Section on lines indicated by the Mayston Report. It was decided to proceed with the study of the Medical, Nursing and Administrative Sections first of all in view of approaching National Health Service Reorganisation in 1974 and the need to give to staff who would take part in the Reorganisation the greatest possible length of experience in a new administrative structure resembling that with which assimilation would be achieved. At the same time, as previous annual reports have shown, the practical work of the medical and nursing staff has been increasingly integrated with the work of hospitals and general medical practice in those particular directions where there is a close affinity of purpose; and all but complete integration has been achieved. The final phase of restructuring of the Environmental Health Section can be dealt with in the light of better knowledge of the type of structure needed for the Authority in the future; and one best adapted for liaison with the personal health services transferred to the new Health Authorities. In the final detailed shaping of services the knowledge derived from local statistics will undoubtedly play an important part, and so this part of the annual report receives first commentary. Statistics The fall in births continued and the total births (live and stillbirths) was 92 fewer than last year. As the birth rates for Greater London and for England and Wales remain the same the fall in births is that more significant. Though the stillbirth rate 12 remains the same there were 6 less of these deaths than in the previous year. On the debit side there were 67 fewer total deaths. Other death rates except all forms of cancer showed a decrease. The death rate from cancer of the lung and bronchus remained the same. Statistics derived from the 1971 Census and commented upon in an introductory factual statement are of great interest and in particular the proportionate growth and population percentage contains some surprises. Included for the first time in this year's report are tables showing monthly road accidents in the Borough for the years 1969, 1970 and 1971 and annual totals for the years 1965 to 1971. The total accidents in the age range 16-50 years show a continuing improvement from 1965 to 1971 whereas the accidents to children 15 years or under show no improvement at all. The monthly road accident figure shows the highest number in September to December and the least accidents in April over the 3 years. Maternal and Child Health Early in 1971, the scheme started last year of attaching by mutual agreement midwives of this local authority to group practices or groups of practices was satisfactorily completed. The scheme whereby the local authority midwife attends the mother in hospital was extended and either a full or modified scheme is now almost complete for the whole Borough. Miss Martin, non-medical Supervisor of Midwives describes this scheme later in the Report, and it merits special attention. Also of interest is the extension of Training, Observation and Community experience and the progress towards integration. It is clear from the figures that there is a considerable amount of domiciliary work to be provided for though it is difficult to forecast where it will finally level out. Though confinements in the home attended by Authority Midwives fell by 55 and the number of mothers delivered in hospital and attended postnatally fell by 558, the number of all visits of Authority Midwives increased by 430 over the figure for last year. The report on Home Nursing shows that a start has been made by a gradual change over from allocation to Home Nurses of geographical areas of work to allocation by attachments or liaison to six groups of medical practice. This scheme like the midwife attachment was delayed originally by the need to carry 13 out pilot studies; but now its successful implementation throughout the Borough is anticipated. Dr. Jones indicates in her report the extent of the transfer of certain responsibilities to the new Social Services Department, and the transfer from that Department for responsibility for the Chiropody Section. The inevitable expansion of that Section is shown by the increase in number of patients and treatments by 591 and 5,196 respectively. Clearly such a service can only be restricted at the expense of increased waiting lists and intervals between treatments. The National shortage of entrants to this occupation in both private and local Authority sectors continues. The shortages in the private sector from retirements throws greater pressures on the local Authority sector. Above all the need for a contractual service between local Authority and private sector increases costs. Though smallpox vaccination ceased as a routine procedure— Rubella and BCG vaccination are offered as a routine in the schools, and tables show the protection that is offered against measles, diphtheria, whooping cough, tetanus and poliomyelitis. Miss Chandler comments on the shortage of staff in the Health Visiting Service and the pressure of work, some of which is linked to these important immunisation schemes, resulted in a decrease in number of home visits—a vital function of the Health Visitor. However, more mothers were visited antenatally and first visits to elderly increased. Infectious and other Diseases This report by Dr. Kelynack stresses at various points the substantial necessary surveillance of travellers returning from abroad as contacts or as possible incubating cases of infectious diseases not endemic to this country. In 1971 cholera contacts provided a new alarm to add to the yearly total of typhoid fever and smallpox suspects. A general outbreak of food poisoning is reported, and reminds one of this ever present risk greatly increased by communal feeding and sophisticated methods of food production. Liaison between Medical Officers and Public Health Inspectors is vital, and when these services are separated by National Health Service Reorganisation speed in communications and action must be preserved. Environmental Health The report by Mr. Kermode indicates that work in connection with some aspect of housing occupies one third of the Public Health Inspector's time. Clearly it is difficult in a working day neatly to parcel out time between housing and health, and from time to time new pressures arise. In 1971 increased 14 tance has been given to improvement of environment by the setting up of general improvement areas and resulting in this Authority in the establishment this year of its first General Improvement Area under the new Act. Food Hygiene still requires continuing vigilance especially now that more imported food is increasingly sampled for the first time nearer to its point of sale to the public. Other parts of this Report show the wide range of duties that concern the Public Health Inspector; and increase the development of his advisory function year by year in new developments while maintaining his vigilance of old problems in new guises. Finally that section of the environmental health staff concerned primarily with either containing or reducing where possible rodent infestation and nuisances caused in other ways continue this extremely valuable work. Feral pigeons, wasps and urban foxes causing nuisance vary with the weather and availability of food. While rats show a decrease in number there is now generally an increase in mouse infestation. Variations are inevitable but nonetheless the need for a specially skilled staff is always necessary. In conclusion I wish to thank the Heads of Sections and my staff for their continued support. Especially would I thank Mr. D. J. Tinson, Chief Administrative Officer, who came to the Department in September and has so quickly taken up the reins from my former Chief Administrative Officer, Mr. N. Collins, now Assistant Director in the Social Services Department, who helped me so efficiently and cheerfully over the past five years. Mr. S. F. Judd, Senior Administrative Officer and former Chief Clerk to the former Bromley Authority retired early in the year and I acknowledge his many years of service. Dr. Sara Syrop left Bromley for a senior appointment with Bexley, and I would wish to thank her for her wonderful work in developing the Mental Health Services. Liaison with the Hospital and Medical Practitioner Services has continued throughout the year and the Medical and Nursing staff in particular have received the most valuable help from the various voluntary organisations in the Borough with whom they have worked in harmony and unison for so many years. Finally I would thank for their unfailing support the Members of the Council and especially the Chairman and Members of the Health Committee. I am sure that they will continue to find whatever changes the future holds, the same unswerving loyalty and service from all in the Health Department. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 17 VITAL AND OTHER STATISTICS Population (mid-year 1971) 306,680 Area (acres) 37,583 Density of population (persons per acre) 8.16 Rateable value as at 1.4.71 £17,443,482 Product of lp Rate £169,320 Rate in pound 1971/1972 (Domestic) 70p Births: Males Females Total Live ... ... ... 4,282 Legitimate 2,058 1,935 3,993 Illegitimate 148 141 289 Crude birth rate per 1,000 estimated total population 14.0 Adjusted birth rate for comparison with other areas 14.1 (Area comparability factor for births = 1.01) Illegitimate live births = 7% of all live births Crude birth rate for Greater London 15.2 Birth rate for England and Wales 16.0 Stillbirths Stillbirths Males Females Total 47 Legitimate 21 22 43 Illegitimate 2 2 4 Stillbirth rate for 1,000 live and stillbirths 11.0 Stillbirth rate for Greater London 11.7 Stillbirth rate for England and Wales 12.0 Total births (live and still) 4,329 Males Females Total Legitimate 2,079 1,957 4,036 Illegitimate 150 143 293 Total 2,229 2,100 4,329 18 Infant Mortality: Deaths of infants under 1 year of age Males Females Total Legitimate 23 15 38 Illegitimate 2 3 5 Infant mortality rate per 1,000 total live births 10 Legitimate infant deaths per 1,000 legitimate live births 10 Illegitimate infant deaths per 1,000 illegitimate live births 17 Infant mortality rate for Greater London per 1,000 live births 17.4 Infant mortality rate for England and Wales 18 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 7 Neonatal mortality rate for Greater London 11.6 Neonatal mortality rate for England and Wales 12 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 6 Early neonatal mortality rate for Greater London 9.7 Early neonatal mortality rate for England and Wales 10 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live births and stillbirths) 17 Perinatal mortality rate for Greater London 21.3 Perinatal mortality rate for England and Wales 22 Maternal Mortality: Maternal deaths (including abortions) Nil Maternal mortality rate for Greater London per 1,000 live and stillbirths (excluding deaths due to abortion) 0.12 Deaths: Males Females T otal 1,484 1,631 3,115 Crude death rate per 1,000 estimated total population 10.2 Adjusted rate for comparison with other areas (Area comparability factor for deaths = .97) 9.9 19 Crude death rate for Greater London per 1,000 population 11.5 Death rate for England and Wales 11.6 Cancer Death Rates: All forms (per 1,000 population) 2.4 Lung and Bronchus (per 1,000 population) 0.65 Other forms (per 1,000 population) 1.75 Population: The Registrar-General's estimate of the population of the Borough, mid-year 1971, was 306,680. This figure gives a density of 8.16 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 1,167. The figure for 1970 was 1,186. Births Registered: There were 4,282 live births allocated to the Borough during 1971, after adjustments for inward and outward transfers, this being a decrease of 86 on the figure for the previous year. Of the 4,282 live births, 2,206 were males and 2,076 were females. The crude birth rate for the Borough was 14.0 per 1,000 population and the adjusted birth rate, for use when comparing one area with another, was 14.1. The birth rate for 1971 was 0.5 lower than that recorded for 1970 and it is below the figures of 15.2 and 16.0 for Greater London and England and Wales respectively. In addition to the live births there were 47 stillbirths, representing a rate of 12 per thousand total births. This rate is comparable with that of 11.7 for Greater London and 13 for the country as a whole. country as a whole. The figure for the Borough for 1970 was also 12 per 1,000 total births. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Males 2,058 148 2,206 21 2 23 Females 1,935 141 2,076 22 2 24 Totals 3,993 289 4,282 43 4 47 Deaths: 3,115 deaths were registered in 1971, giving a crude death rate of 10.2 per 1,000 population. This rate, when standardised by the comparability factor, gives a figure of 9.9 for comparison purposes. The rates for Greater London and England and Wales were 11.5 and 11.6 respectively. The following table shows cause of death as given in the Registrar-General's statistics. 20 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1971 (Registrar-General's Return) Cause of Death Sex Total all ages Under four weeks Four weeks and under 1 year Age in Years 1 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74 75 and over 1. Enteritis and other Diarrhoeal Diseases M _ _ _ _ _ _ _ _ _ _ _ _ F 1 — — 1 — — — — — — — — 2. Tuberculosis of Respiratory System M 3 _ 1 1 1 F — — — — — — — — — — — — 3. Other Tuberculosis M 1 — — 1 F — — — — — — — — — — 4. Meningococcal Infection M 1 1 — — — — — — — — — F — — — — — — — — — — — 5. Other Infective and Parasitic Diseases M 2 — — — — 1 — — — — — 1 F — — — — — — — — — — — — 6. Malignant Neoplasm, Buccal Cavity Etc. M — — — — — — — — — 1 2 1 F 3 — — — — — — — — 1 — 2 7. Malignant Neoplasm Oesophagus M 19 _ 1 8 7 3 F 8 — — — — — — — — 3 — 5 8. Malignant Neoplasm, Stomach M 36 — — — — — — — — — 9 13 F 31 — — — — — — — 1 3 8 19 9. Malignant Neoplasm, Intestine M — — — — — — — — — — — 10 F 56 — — — — — 1 1 3 7 12 32 10. Malignant Neoplasm, Larynx M 3 _ _ _ _ _ _ _ — 2 1 F — — — — — — — — — — — — 11. Malignant Neoplasm, Lung, Bronchus M 159 1 8 49 64 37 F 42 — — — — — — — 4 9 20 9 12. Malignant Neoplasm, Breast M F 72 — — — — — — 2 10 27 15 18 13. Malignant Neoplasm, Uterus F 23 — — — — — — — 4 4 4 11 14. Malignant Neoplasm, Prostate M 26 — — — — — — — — 1 12 13 15. Leukaemia M 11 — — — — — 1 — 1 4 3 2 F 12 — — — 1 — — — 1 1 5 4 16. Other Malignant Neoplasms M 77 — — — 3 — — 5 10 22 20 17 F 100 — — — — — 4 2 10 29 29 26 17. Benign and Unspecified Neoplasms M 5 — — — 1 — 1 — 1 1 1 — F 7 — — — — — — — 2 1 1 3 18. Diabetes Mellitus M 11 — — — — — 1 — 3 2 2 3 F 15 — — — — — — — 1 5 2 7 19. Avitaminoses, etc. M 2 — 1 1 F — — — — — — — — — — — 20. Other Endocrine etc. Diseases M — — — — — — — — — — — F 2 — — — 1 — — — — — — 1 21. Anaemias M 2 1 1 _ F 7 — — — — — — 1 — — 1 5 22. Mental Disorders M 4 — — — — — — — 1 1 — 2 F 6 — — — — — — — — — — 6 23. Meningitis M — — — — — — — — — — — F 1 — — — — — — — — — 1 — 24. Multiple Sclerose M 2 — — — — — — — — — — — F 5 — — — — — — 1 2 1 1 — 25. Other Diseases of Nervous System M 14 — — — 1 — — 1 1 8 1 2 F 16 — — — — 1 — — 2 1 1 11 21 Cause of Death Sex Total all ages Under four weeks Four weeks and under 1 year Age in Years 1 4 5 14 15 24 25 34 35 44 45 54 55 64 65 74 75 and over 26. Chronic Rheumatic Heart Disease M 16 1 4 3 6 2 F 24 — — — — — — — 1 4 11 8 27. Hypertensive Disease M 23 _ _ _ — — 7 2 12 F 33 — — — — — — — 1 3 10 19 28. Ischaemic Heart Disease M 412 _ _ _ _ _ 2 7 33 104 134 132 F 335 — — — — 1 — / 31 80 216 29. Other Forms of Heart Disease M 48 2 — 1 8 9 28 F 90 — 1 — — — — 1 — 6 6 76 30. Cerebrovascular Disease M 122 — — — 1 7 15 40 59 F 256 — — — — — — 1 4 18 56 177 31. Other Diseases of Circulatory System M 59 1 1 11 15 31 F 76 — — — — — 2 - 3 7 64 32. Pneumonia M 105 2 1 2 5 18 77 F 197 — — 1 — 1 3 8 20 164 33. Bronchitis and Emphysema M 117 1 2 17 49 48 F 41 — — 1 — ~ — 6 34 34. Asthma M 3 — — — — — — — — — — — F 4 — — — — — 1 — 2 1 — 35. Other Diseases of Respiratory System M 17 4 1 1 1 1 3 6 F 11 — — 1 — 1 — — — 1 — 8 36. Peptic Ulcer M 14 — — 1 — 1 6 6 F 15 — — — — — — — 1 3 11 37. Appendicitis M 3 1 _ _ _ 1 1 F 1 — — — — — — — — — — 1 38. Intestinal Obstruction and Hernia M 4 1 — — — — — — — 1 1 1 F 8 — 1 — — — — — — — — 7 39. Cirrhosis of Liver M 3 _ _ _ — — _ _ 1 1 1 F 4 — — — — — — — 1 1 1 1 40. Other Diseases of Digestive System M 17 _ — 3 4 5 5 F 22 — — — — — — — — 3 7 12 41. Nephritis and Nephrosis M 4 1 — 1 1 1 F 8 — — — — — — 1 — 2 4 1 42. Hyperplasia of Prostate M 4 — — — — — — — ~ 1 — 3 43. Other Diseases, Genito-Urinary System M 6 _ _ _ _ _ 1 _ 5 F 11 — — — — — — — — 3 4 4 44. Diseases of Musculo-Skeletal System M 3 — — — — — — — — — 1 1 F 11 — — — — — — — — 1 4 5 45. Congenital Anomalies M 16 7 1 4 1 1 — — — — — — F 10 1 2 4 — — — — — 1 — 2 46. Birth Injury, Difficult Labour, etc. M 6 6 _ — — — — — — — — — F 8 8 — — — — — — — — — — 47. Other Causes of Perinatal Mortality M 4 4 — — — — — — — — — — F 4 4 — — — — — — — — — — 48. Symptoms and III defined Conditions M 2 — — — — — — — — — — 2 F 6 — 1 — — — — — — — — 5 49. Motor Vehicle Accidents M 22 — — _ 2 4 5 1 — 3 4 3 F 15 — — — — 1 — — — 1 8 5 50. All Other Accidents M 15 2 2 3 _ 1 2 1 2 2 F 21 — — — — — 1 1 2 2 2 13 51. Suicide and Selfinflicted Injuries M 15 _ 1 4 1 2 4 2 1 F 13 — — — — — 2 1 2 2 4 2 52. All Other External Causes M 3 — — — — 1 — — — 1 1 _ F — — — — — — — — — — — — TOTAL ALL CAUSES M 1,484 18 7 9 11 15 18 ?7 100 312 433 534 f 1,631 13 5 7 2 5 11 14 62 184 334 994 22 Accidental Deaths During the year 73 residents died from accidents of all kinds, including 37 in motor vehicle accidents. DEATHS FROM CANCER Male Female Total 1971 1970 1969 1968 1967 1971 1970 1969 1968 1967 1971 1970 1969 1968 1967 Malignant neoplasm, stomach 36 33 35 53 28 31 37 34 39 33 67 70 69 92 61 Malignant neoplasm, lung, bronchus 159 151 168 221 148 42 46 36 54 41 201 197 204 275 189 Malignant neoplasm, breast — — — 2 — 72 56 83 114 76 72 56 83 116 76 Malignant neoplasm, uterus — — — — — 23 22 20 39 18 23 22 20 39 18 Other malignant and lymphatic neoplasms 184 146 220 221 191 186 186 191 256 161 370 332 411 477 352 Totals 379 330 423 497 367 354 347 364 502 329 733 677 787 999 696 Rates per 1,000 population All forms 2.4 Lung and bronchus 0.65 Other forms 1.75 Maternal Mortality No maternal deaths occurred in the Borough during the year. The maternal mortality rate for Greater London for 1971 was 0.12 per 1,000 total births. T uberculosis There were 3 deaths attributed to pulmonary tuberculosis and 1 to non-respiratory tuberculosis, giving a death rate of 0.01 per 1,000 population. Infant Mortality There were 43 deaths of infants under 1 year of age during 1971. 38 of these were legitimate and 5 illegitimate, giving a rate of 10 per 1,000 total births. The rates for Greater London and England and Wales were 17.4 and 18.0 respectively. Of the 43 infant deaths, 31 were under four weeks old, giving a neonatal mortality rate of 7 per 1,000 total live births. The neonatal mortality rate for Greater London was 11.6 and for England and Wales 12.0. There were 26 deaths of infants under one week of age, giving an early neonatal mortality rate of 6.0 per 1,000 total live births. The rates for Greater London and England and Wales were 9.7 and 10. The perinatal mortality rate for the Borough (stillbirths and deaths under one week combined, per 1,000 total live and stillbirths) was 17 and those for Greater London and England and Wales were 21.3 and 22 respectively. 23 Street Accidents 1,592 street accidents occurred in the Borough during 1971. 2,213 persons were injured and 22 died. These totals include 395 children under 15 years of age who were injured, and 2 who died. LONDON BOROUGH OF BROMLEY ROAD ACCIDENT STATISTICS FOR 1969, 1970 and 1971 ACCIDENTS CASUALTIES FATAL SERIOUS SLIGHT 15 YRS. & UNDER 16 TO 50 YRS. OVER 50 YRS. JANUARY 1969 151 204 3 51 150 40 138 26 1970 138 189 4 34 151 37 107 45 1971 142 201 3 51 147 25 139 37 FEBRUARY 1969 113 163 — 31 132 22 122 19 1970 132 189 1 36 152 22 126 41 1971 127 186 1 31 154 34 134 18 MARCH 1969 145 190 2 34 154 36 128 26 1970 130 178 2 29 147 41 107 30 1971 133 184 — 29 154 27 114 43 APRIL 1969 105 152 1 27 124 33 102 17 1970 118 200 4 33 163 29 140 31 1971 123 175 5 25 145 27 124 24 MAY 1969 161 213 — 29 184 43 142 28 1970 140 187 2 37 148 39 122 26 1971 105 135 2 20 113 21 91 23 JUNE 1969 134 173 2 41 130 34 111 28 1970 132 168 1 39 128 43 106 19 1971 133 204 2 31 171 66 104 34 JULY 1969 149 206 — 35 171 40 143 23 1970 119 172 1 32 139 28 118 26 1971 120 153 2 26 125 30 96 27 AUGUST 1969 135 196 3 34 159 26 130 40 1970 125 175 8 38 129 30 117 28 1971 95 124 2 15 107 24 82 18 SEPTEMBER 1969 145 189 2 35 152 33 131 25 1970 153 216 1 32 183 43 134 39 1971 132 203 — 33 170 29 145 29 OCTOBER 1969 168 226 9 47 170 41 146 39 1970 142 197 — 31 166 38 131 28 1971 161 208 2 27 179 44 125 39 NOVEMBER 1969 166 212 2 43 167 27 140 45 1970 160 230 6 46 178 27 163 40 1971 162 216 — 19 197 34 145 37 DECEMBER 1969 147 193 6 59 128 22 133 38 1970 194 248 3 62 183 41 160 47 1971 159 224 2 30 192 34 152 38 TOTALS FOR YEARS 1965 TO 1971 1965 1878 2619 26 458 2135 391 1919 309 1966 1831 2577 27 423 2127 409 1838 330 1967 1656 2317 33 411 1873 395 1566 356 1968 1633 2227 26 360 1841 402 1487 338 1969 1719 2317 30 466 1821 397 1566 354 1970 1683 2349 33 449 1867 418 1531 400 1971 1592 2213 22 337 1854 395* 1451 367 •includes 24 children injured in one coach accident. 24 1971 CENSUS Parts I, II and III of the Greater London County Report on the 1971 Census contain data on population, households and dwellings for individual London boroughs. The following information has been extracted and includes preliminary analysis of the census data relevant to the London Borough of Bromley. Population (Tables 1 and 3) The total population of Greater London at the 1971 census was 7.45 millions, a decline of over half a million persons during the preceding ten year inter-censal period. This is a 6.8% decrease compared with a 6% increase in England and Wales as a whole. Whilst boroughs in Central London showed marked declines of population, mainly because of immigration, in outer boroughs natural increases more than offset such losses. The fastest proportionate growth (4.1%) and addition to population (11,983) occurred in Bromley. The population percentages show that compared with both Greater London and England and Wales Bromley has a higher proportion of persons in the age range 35 to 64 and a lower proportion of persons aged 65 and over. Whereas there has been an increase of 21% in the number of persons of pensionable age in Bromley during the period 1961/71, there has been no change in the number of children aged under 16. Birth Place (Tables 1 and 4) 86% of the Greater London population were persons born in the U.K. The corresponding figure for Bromley was 93%. Of persons in Bromley born outside the U.K. 1.9% were from the new Commonwealth (6.4% in Greater London) 1.3% from the Irish Republic (3.2% in Greater London) and 2.3% from European and other foreign countries (4.2% in Greater London). Housing (Tables 2 and 5) 40% of households in the London area were in owneroccupied accommodation and the corresponding figure in Bromley was 63%. Whilst 75% of all households in Greater London had exclusive use of a hot water supply, fixed bath and inside flush toilet, nearly 90% of Bromley households were similarly provided. The lack of exclusive use of these amenities was most marked in inner London and in households in rented unfurnished accommodation. The occupancy rate in Bromley of 0.56 persons per room was one of the lowest in Greater London. In fact more than 65% of Bromley households were living at occupancy rates of less than 0.75 persons per room. 25 GREATER LONDON AND LOCAL AUTHORITY AREAS Population, showing change in inter-censal period, percentages of certain age groups and of persons born in U.K. TABLE 1 Area Population at 1971 Census % change since 1961 Census % under age 25 Persons of pensionable age: % living alone Percentage of population born in U.K. GREATER LONDON 7,452,346 -6.8 36.4 25.6 84.1 City of London 4,245 -11 29.7 15.2 80.6 London Boroughs: Barking 160,800 -9.2 37.1 22.7 95.3 Barnet 306,560 -3.7 35.2 21 81.9 Bexley 217,076 3.4 37 20.6 95.5 Brent 280,657 -5.2 37.3 23.3 70.5 Bromley 305,377 4.1 36.5 21.2 93.3 Camden 206,737 -15.9 33.4 35 69.1 Croydon 333,870 3.1 38 22.5 88.4 Ealing 301,108 -0.2 36.6 22.2 78 Enfield 268,004 -2.1 34.9 22.5 90.6 Greenwich 217,664 -5.3 38.2 25.6 91.9 Hackney 220,279 -14.5 38.6 30.5 78.8 Hammersmith 187,195 -15.7 35.9 32.2 75 Haringey 240,073 -7.4 38 27.3 75.2 Harrow 203,215 -2.8 34.8 19.1 88.3 Havering 247,696 0.9 39.2 20.5 96.1 Hillingdon 234,888 2.9 37.6 19.1 91.8 Hounslow 206,956 -0.9 36.6 22.6 85.7 Islington 201,874 -22.7 36.8 33.5 75.1 Kensington and Chelsea 188,227 -13.9 36.1 35.9 62.9 Kingston upon Thames 140,525 -3.8 34.3 22.2 90.9 Lambeth 307,516 -10 38.7 30.6 78.5 Lewisham 268,474 -7.6 37.9 26.3 88.3 Merton 177,324 -6.2 34 23.5 88.4 Newham 237,390 -10.5 38.9 27.1 87.5 Redbridge 239,889 -4.1 35.1 21.4 91.7 Richmond upon Thames 174,628 -3.5 32.7 24.7 88.8 Southwark 262,138 -16.4 37.5 31.5 87.4 Sutton 169,494 0.2 34.8 21.2 92.9 Tower Hamlets 165,776 -19.4 37.1 31.2 86.8 Waltham Forest 234,680 -5.6 35.3 24.7 89.9 Wandsworth 302,258 -9.9 36.5 27.9 81 Westminster 239,748 -11.8 29.6 34.8 62.3 26 GREATER LONDON AND LOCAL AUTHORITY AREAS Households—accommodation and amenities TABLE 2 Area Percentage of households owner occupied Percentage of households with: Exclusive use of hot water supply fixed bath and inside flush toilet No hot water supply No fixed bath or shower No flush toilet Outside flush toilet GREATER LONDON 40.4 75.1 7.7 9.1 0.2 8.1 City of London 1.3 89.4 2.1 5.9 0.8 London Boroughs: Barking 24.9 91.2 3.8 2.3 0.1 4.5 Barnet 56.1 87.3 2.6 2.4 0.1 2.8 Bexley 70.0 90.5 3.3 3.9 0.1 6.1 Brent 48.2 73.0 6.7 6.1 0.1 3.5 Bromley 62.9 89.5 3.5 4.0 0.2 3.9 Camden 14.2 63.8 9.2 10.4 0.2 3.9 Croydon 57.1 84.8 4.5 5.6 0.1 6.1 Ealing 49.7 77.0 5.2 5.9 0.1 5.8 Enfield 61.4 84.0 4.2 5.5 0.1 9.0 Greenwich 36.6 80.0 7.1 9.7 0.2 13.0 Hackney 11.6 60.7 16.3 20.1 0.2 11.2 Hammersmith 17.9 54.8 15.4 17.8 0.2 11.2 Haringey 35.1 61.0 10.5 10.5 0.2 10.3 Harrow 70.2 92.9 1.4 1.4 0.0 1.9 Havering 66.2 94.2 2.0 2.1 0.2 3.0 Hillingdon 58.6 94.7 1.2 1.2 0.2 2.2 Hounslow 49.3 82.0 4.6 5.5 0.2 6.6 Islington 13.4 51.1 19.0 20.9 0.2 8.8 Kensington & Chelsea 15.9 63.4 5.6 5.8 0.3 2.7 Kingston upon Thames 61.6 86.4 3.1 4.1 0.2 4.7 Lambeth 19.8 65.5 11.5 11.9 0.2 7.8 Lewis ham 32.4 75.4 8.1 9.0 0.1 9.5 Merton 54.7 84.0 4.7 5.9 0.1 6.0 Newham 32.7 54.7 17.5 24.8 0.2 34.3 Redbridge 64.2 84.3 3.1 3.1 0.1 6.6 Richmond upon Thames 51.8 80.8 5.0 6.2 0.3 7.4 Southwark 12.6 65.8 16.1 21.6 0.2 14.3 Sutton 63.0 90.5 2.3 2.6 0.1 3.7 Tower Hamlets 2.4 70.5 18.3 23.9 0.2 15.6 Waltham Forest 46.0 69.5 10.4 15.4 0.2 19.2 Wandsworth 25.6 66.0 10.5 12.2 0.1 11.2 Westminster 10.0 68.2 8.8 10.2 0.2 3.2 27 LONDON BOROUGH OF BROMLEY (A) Population by age, marital state and sex The figures given in this table include all households in the Borough and refer to the population present on the night of the census. TABLE 3 Age Males Females TOTAL Married Single Widowed Divorced Total Married Single Widowed Divorced Total 0— 4 - 11,508 11,508 - 10,856 10,856 22,364 5— 9 - 12,652 12,652 - 11,770 11,770 24,422 10—14 - 11,149 11,149 - 10,696 10,696 21,845 15—19 111 9,709 9,820 597 9,547 10,144 19,964 20—24 3,578 7,711 11,289 6,058 5,649 11,707 22,996 25—29 6,697 2,847 9,544 7,952 1,658 9,610 19,154 30—34 7,208 1,161 8,369 7,802 1,018 8,820 17,189 35—39 7,817 905 8,722 8,223 952 9,175 17,897 40—44 8,717 904 9,621 9,281 1,259 10,540 20,161 45—49 9,485 858 10,343 9,640 1,579 11,219 21,562 50—54 9,200 787 9,987 8,729 1,838 10,567 20,554 55—59 8,725 879 9,604 7,781 2,516 10,297 19,901 60—64 7,830 932 8,762 6,549 3,234 9,783 18,545 65—69 5,222 930 6,152 4,229 3,784 8,013 14,165 70—74 2,888 839 3,727 2,334 3,922 6,256 9,983 75+ 2,571 1,800 4,371 1,814 8,486 10,300 14,671 TOTAL 80,049 65,571 145,620 80,989 78,764 159,754 305,373 (B) Percentage comparisons of population AGE RANGE BROMLEY G.L.C. ENGLAND & WALES 0—14 22.5 21.1 24.1 15—34 26.0 28.5 26.9 35—49 19.5 18.1 18.1 50—64 19.3 19.2 17.7 65+ 12.7 13.1 13.2 28 LONDON BOROUGH OF BROMLEY Population by place of birth and sex This table is restricted to those persons who were enumerated at their address of usual residence TABLE 4 Place of Birth Number of Persons Males Females Total England 129,292 139,014 268,306 Wales 1,835 2,360 4,195 Scotland 2,662 2,894 5,556 N.Ireland 617 803 1,420 Irish Republic 1,685 2,238 3,923 Old Commonwealth 764 860 1,624 New Commonwealth: Africa 459 429 888 America 622 758 1,380 Ceylon 93 104 197 India 983 982 1,965 Pakistan 128 92 220 Far East 272 322 594 Other 290 234 524 Other European 1,582 2,812 4,394 Other Foreign 1,632 2,050 3,682 TOTAL 142,916 155,952 298,868 29 LONDON BOROUGH OF BROMLEY HOUSEHOLDS BY TENURE, OCCUPANCY AND USE OF AMENITIES TABLE 5 Household Tenure Number of Households Occupancy Households with use of three amenities (hot water, fixed bath and inside toilet) Number of persons Number of rooms Number of persons per room Exclusive use One or more shared Number Percentage of total households Number Percentage of total households Owner Occupied 65,669 193,351 370,166 0.52 63,512 96.7 702 1.1 Owned by Local Authority 19,087 59,996 82,010 0.73 18,009 94.3 321 1.7 Rented Unfurnished 14,756 35,068 63,196 0.55 9,631 65.3 1,256 8.5 Rented Furnished 4,712 9,721 13,996 0.69 2,242 47.6 2,080 44.1 Not Stated 222 556 975 0.57 182 82.0 12 5.4 TOTAL: 104,446 298,692 530,343 0.56 93,576 89.6 4,371 4.2 30 METEOROLOGICAL OBSERVATIONS Rainfall The average total rainfall taken over the Borough as a whole was 26.30 inches. Temperatures The lowest minimum temperature of 1971 was 26 degrees Fahrenheit, which was recorded on 5th January and 5th March. The highest maximum temperature of 1971 was 83 degrees Fahrenheit, which was recorded on 11th July. The mean minimum daily temperature for 1971 was 45.59 degrees Fahrenheit. The mean maximum daily temperature for 1971 was 51.37 degrees Fahrenheit. PERSONAL HEALTH SERVICES 33 PERSONAL HEALTH SERVICES These services are provided under Part III of the National Health Service Act of 1946. MATERNAL AND CHILD HEALTH Audrey Jones, m.b., ch.b., Senior Medical Officer CARE OF MOTHERS AND YOUNG CHILDREN From 1st April, 1971, the following responsibilities of the Health Department were gradually relinquished to the new Social Service Department:— 1. Care of Unmarried Mother and Child. 2. Day Nurseries and Child Minders. 3. Recuperative Care. Moreover, responsibility for the Chiropody Service was transferred to the Personal Health Services from the Welfare Department. Child Health Clinics The total number of premises used is still 36, of which 6 are purpose built, 3 adapted and the remainder hired and occupied on a sessional basis. There were an average of 41 doctor sessions per week. Local Authority Medical Officers are becoming increasingly orientated towards the developmental assessment of children. Physical, intellectual, emotional and social growth are all necessary for a child to reach his best potential. Risk and observation registers are kept to follow up those who are at risk of developing a handicap, because of an adverse genetic or perinatal history or later factors influencing progress, so that the most appropriate help can be instigated if it is required. There is close liaison here with the Maternity and Paediatric Departments of the local hospitals. All babies have a test by the midwife about 8-10 days after birth to detect the presence of phenylketonuria which if untreated leads to mental subnormality. There was one case detected, which is now being successfully treated. The number of sessions held at these clinics totalled 2,421, an average of approximately 48 per week. The number of attendances by children was 70,694, a decrease of 10,621 compared with the figure for the previous year. Of this total 59 per cent were children under one year of age, 21 per cent children of one to two years of age, and 20 per cent children from 2 to 5 years of age. The number of children who attended the clinics was 5,104. 34 Welfare Foods Sales of these foods were: No. Issued Issued free National Dried Milk 4,606 387 Cod Liver Oil 1,400 83 Vitamin A. & D. Tablets 3,848 77 Orange Juice 121,745 2,627 Vitamin Drops 8,442 456 Overall these figures represent a decrease of 7 per cent on 1970. The number of commodities issued free of charge was 3,630 which represented 2.5 per cent of the total issued. The total cash value of sales was £10,293.20. Nursing Homes 1970 1971 Number of Homes at year end 15 14 Homes closed 2 1 Homes registered 2 - Number of beds provided at year end 353 349 Deaf Children All mothers are invited to have their babies tested routinely for hearing at 6-9 months of age. Where there is difficulty in obtaining a response the child is either referred to his family doctor or to the Local Authority Audiology Clinic for further testing. Sometimes older children whose hearing is suspect, or where speech is slow to develop, are also referred. During the year a total of 64 children were seen at this Clinic. Cervical Cytology Regular Clinics were held at 8 centres and extra ones held where the demand warranted. An average of 15 clinics per month were held, no appointment being necessary. Further publicity is planned in the local newspapers in 1972. There is close liaison with the Pathology Departments. A National scheme for the recall of patients over every 5 years is planned for early 1972. Details of attendances during the year are as follows:— Number of Clinics held 179 Total number of tests carried out 1,748 Number of Positive cases 4 Number of doubtful cases requiring repeat tests 56 Number of cases referred to General Practitioners for other conditions 54 35 Family Planning The scheme continued whereby patients attending any of the 9 local F.P.A. Clinics had their fees and supplies paid for by the Borough if this was needed on medical grounds, i.e. where health would suffer by the increased mental, physical or social burden of a pregnancy. All 428 patients referred were helped in this way. Liaison with Local Hospitals continues with Maternity and Cytology Liaison Committees. One Medical Officer regularly attends the Phoenix Centre at Farnborough Hospital. There is a Health Visitor attending the Paediatric Outpatients Department at Sydenham and Farnborough, and another is attached to the Lennard Hospital Geriatric Day Unit. The District Nursing Sisters visit the Lennard Hospital and surgical wards to see patients prior to discharge home and into their care. The Midwives continue to assess the suitability of patients' homes for early discharge from hospital after a confinement. The Senior Medical Officers give talks and lectures on aspects of community health to pupils and students when requested to do so. Chiropody This Authority provided service to 5,382 persons over the age of 60 years, 137 physically handicapped or disabled persons and 4 expectant mothers. The total treatment figures consist of:— 7,150 treatments given in Borough Clinics 12,125 patients received treatment in their own home 2,178 treatments were given in the 9 Borough residential homes 9,924 treatments were given to Borough patients in private chiropodists' surgeries Grand Total 31,377 treatments If the total number of treatments given during 1971 is compared with 1970, it will be seen that there has been an increase of 21 per cent in the number of treatments. In spite of a chronic national shortage of chiropodists, an additional Senior Chiropodist was engaged bringing the total full time staff number to 3. 9 sessional and 25 contractual chiropodists were also employed. A 6th Chiropody clinic was opened at the Hawes Down School Clinic in West Wickham and plans were made for a new clinic within the Bertha James Day Centre. A start was made during 1971 in providing some selected 36 patients with appliances instead of adhesive dressings and this is proving to be very successful. The Council raised the charge for chiropody treatment from 37p to 40p as from the 1st April, 1971, for those not receiving a supplementary benefit. Vaccination and Immunisation Smallpox ceased to be recommended as a routine procedure. Rubella and B.C.G. were offered routinely—as is mentioned in the Annual Report of the School Health Service. Primary Courses completed: Year of Birth Others Under 16 Total 1971 1970 1969 1968 1964-7 Measles — 1,098 1,252 410 359 46 3,165 Diphtheria 187 2,600 590 101 86 33 3,597 Whooping Cough 186 2,528 555 87 44 10 3,410 Tetanus 187 2,601 589 102 86 119 3,684 Poliomyelitis 133 2,680 976 114 101 27 4,031 Reinforcing doses: Diphtheria — 159 307 160 3,797 501 4,924 Whooping Cough — 137 252 112 1,029 107 1,637 Tetanus — 159 308 166 3,827 713 5,173 Poliomyelitis — 72 143 88 3,537 480 4,320 Comparative Statistics: Percentage of children born in 1969 and vaccinated by 31.12.71. Whooping Cough Diphtheria Poliomyelitis England and Wales 78 80 80 Bromley 81 82 89 HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert. Dip.Soc.Studies (Lond.) (1) Staff Although the establishment was 47 in January, 1971, there were only 40 Health Visitors in post of whom two were half time and three worked a 4 day week. There were five sponsored Students who qualified in September and joined the staff. There were three retirements. Two Qualified Health Visitors were appointed on a full time basis and two on a part time basis and 37 one temporary School Nurse appointment was made against a Health Visitor Vacancy, so that in December, 1971, there were 44 Health Visitors in post of whom three were half time and four part time. One Health Visitor had 6 months of sick leave. The shortage of staff therefore made 1971 a very busy year and until August the Health Visitors also paid 1393 Daily Minders visits, this work being handed over to the Social Services Department in August following the implementation of the Social Services Act in April, 1971. The standard of work remained high but the numbers of home visits dropped in consequence of pressure of work due to relief duties in fixed clinic and school medical sessions. The number of first visits to the elderly increased, and due to better communications with the Maternity Hospitals more mothers were visited ante-natally. Miscellaneous visits also increased showing the increasing use of the Health Visitors skills by all age groups in the community. (2) Training 7 Student Health Visitors sponsored by other Local Authorities were placed for their Fieldwork Instruction and 6 obtained their qualification—51 Student Nurses, and 7 Nurses taking their obstetric course from Bromley Hospital Group, 4 Student Nurses from Orpington Hospital Group, 34 Student Midwives and one N.S.P.C.C. Officer, 2 Social Work Students and one Student Nurse from Great Ormond Street Hospital were all given training in the form of visits, lectures and discussions on the Health Visitors work. The Kent County Council again invited the staff to their week's Refresher Course and all the Health Visitors were able to attend these valuable lectures on the afternoons when they had no clinic session. One Health Visitor trained as a Field Work Instructor, and 2 Health Visitors attended a two week Refresher Course. 6 Staff Meetings were held and among other matters discussed were the giving of Rubella Vaccination to vulnerable schoolgirls, the importance of keeping the Cervical Cytology screening service in the public mind and discussion of the content of work on Health Education in Secondary schools now adopted as Borough policy with which the Health Visitors are well qualified to advise and participate, many of them being keen to do so in the schools where they carry out their paramedical duties. The proposed Mayston Structure was discussed particularly in the light of the restructuring of the Health Service, and it was agreed that a career structure similar to that enjoyed by hospital colleagues was a necessary step in ensuring recruitment to the Health Visiting Service. This stimulus was clearly demonstrated in 1971 throughout the Country when some Health Visitors were 38 attracted to better paid posts in Social Service Departments and many would-be recruits to Health Visiting decided to stay in the Hospital Service. (3) Prophylaxis Figures are shown elsewhere and all were above the National Average, but vaccination against Smallpox showed a lower figure than usual, due to the change of policy by the Department of Health and Social Security. HOME NURSING Mrs. M. O. Tierney, s.r.n., q.n. The Home Nursing Service is now well known to the Family Doctor, Hospitals and the General Public. Although a Night Service is not yet provided, The Marie Curie Cancer Service is utilised where necessary. Late evening visits are covered by staff "on call." The Establishment of Home Nursing Sisters on the staff remained at 45 and there has been no difficulty in staff recruitment. Training All newly appointed Staff are required to take the National District Nursing Certificate. During the year six Sisters and one State Enrolled Nurse were successful in obtaining their certificate. Attachment/Liaison with General Practitioner The gradual abandonment of geographical areas of work in favour of Attachment/Liaison of District Nurses to Family Doctors is now being successfully implemented and six schemes were started during the year. The potentialities of District Nursing are now being fully realised and where facilities are available, staff attend patients at the surgery. Liaison with Hospitals Arrangements have now been made for District Nurses to visit some patients prior to discharge from the Lennard Geriatric Unit of Farnborough Hospital. Sisters from Orpington Hospital have accompanied District Nursing Sisters on observation visits. Pupil Midwives, Student and Pupil Nurses also continue to have visits arranged during their training. During the year, discussions were held with the Hospital Teaching Staff regarding the G.N.C.'s revised syllabus for Student 39 Nurses on Community Care Option and the best methods of implementing the new syllabus. Lectures and Talks Numerous talks were given in Hospitals and to the General Public by members of the staff on the work of the District Nurse. Statistics During the year 3271 persons were nursed. This represented an increase over the previous year of 444. The number of visits to patients totalled 78,503. MIDWIFERY Miss M. C. Martin, s.r.n., s.c.m. Non-Medical Supervisor of Midwives Group Practice Attachment of Domiciliary Midwives Following the successful pilot scheme completed in August, 1970, in which a Domiciliary Midwife was attached to a group of General Practitioner Obstetricians, the scheme was extended to a further three groups of doctors and finally, early in 1971 throughout the Borough. In some practices full attachment has taken place, in others Midwives cover the maternity case load of a number of doctors rather than a geographical area. In many cases G.P.'s have realised the value of a Midwife working in their team and what started as a liaison has become full attachment with the Midwife attending the surgery clinics. Modified "Domino" Scheme (Hospital Confinement and Early Discharge by Domiciliary Midwife) Arrangements were made for domiciliary Midwives to deliver a limited number of mothers in hospital, taking them home early in the puerperium. These mothers were selected from practices where Midwives and G.P.'s were involved in "shared care" with local Maternity Hospitals. Many Midwives are eager for G.P. involvement at the confinement as this ensures consecutive and comprehensive care of the mothers by a smaller team. Domiciliary Midwives are now taking mothers into Beckenham Maternity Hospital, Masons Hill and Widmore Road Maternity Units and Queen Mary's Maternity Unit, Sidcup (Full Domino). Arrangements for a "Domino" Scheme involving Farnborough Hospital are almost complete. 40 Training New Single Period Training for Pupil Midwives Central Midwives Board approval for Bromley Hospital Management proposals for starting the new training was somewhat delayed, but arrangements for providing domiciliary experience for 12 pupils every three months were completed. Discussions concerning the new syllabus is taking place between the Hospital Tutors and the Supervisor of Midwives. Present Training Our existing programme of Community Care Experience is adequate, but improvements are constantly being considered and implemented where desirable. Thirty-five pupil midwives were each placed with Teaching Midwives for three months domiciliary experience. These pupils are drawn from Beckenham Maternity Hospital, Masons Hill and Widmore Maternity Units, Farnborough Hospital Maternity Unit and Queen Mary's Maternity Unit, Sidcup. Observation and community experience were also given to:— 1. Fourteen Student Nurses. 2. Twenty Obstetric Nurses. 3. Two Midwife-Teachers Diploma Students from the Royal College of Midwives. 4. Two Overseas Midwives. Peri-Natal Survey The Farnborough Hospital Peri-Natal survey is continuing; interesting data are being produced making the tedious formfilling by the Midwives worthwhile. Courses Two Midwives went to a National Childbirth Trust Seminar of Psycho-Prophylactic preparation for childbirth. In this Borough considerable emphasis is laid on the preparation of the mother for labour and delivery and Midwives are given every encouragement to hold the necessary classes. Two Midwives went to Statutory Refresher Courses which are compulsory each five years for practising midwives. The Supervisor of Midwives and her Deputy both went on Management Courses. Accommodation In the past pupil midwives have been placed with landladies when working on the district. It has become increasingly difficult 41 to find suitable accommodation and the Supervisor of Midwives is grateful for co-operation of Hospital Authorities in providing accommodation from time to time. Integration of Maternity Services Under Area Boards Liaison between Maternity Hospitals in the area and the Domiciliary Service is increasing rapidly, e.g. Domino and Early Discharge Schemes. Moreover Domiciliary Midwives are invited to Study Days in the hospital and appreciate social contacts made with their colleagues in hospital. It is to be hoped that as the Maternity Service has progressed further along the path to integration the final change-over into Area Health Boards should be reasonably smooth. Some of us in the Maternity Service feel that complete integration could take place before 1974 with some advantage. Deliveries attended by Midwives The number of domiciliary confinements attended by midwives was 404, and the number of cases delivered in hospitals and other institutions but discharged and attended by midwives before the tenth day 618. The total number of visits by midwives during 1971 was 26,460, 433 more than in the previous year. Relaxation and Mothercraft classes 354 women attended these classes compared with 414 in 1970. Each attended an average of beween three and four classes. Care of Premature Infants (1) Number of live premature babies notified during 1971 who were born: 1. at home or in a Nursing Home 1 2. in hospital 232 (2) The number of those born at home or in a Nursing Home: who were nursed entirely there 1 who were transferred to hospital on or before the 28th day — who died during the first 24 hours — who died in 1 and under 7 days — who died in 7 and under 28 days — who survived at the end of one month 1 42 (3) The number of those born in hospital: who died during the first 24 hours 6 who died in 1 and under 7 days 4 who died in 7 and under 28 days 3 who survived at the end of one month 219 (4) The number of premature stillbirths who were born: (a) at home or in a Nursing Home 1 (b) in hospital 23 Notifications of Intention to Practise In accordance with the rules of the Central Midwives Board, 174 Midwives notified their intention to practise within the Borough during the year 1971. Congenital Malformations 51 notifications were received of which 46 were in respect of live births and 5 of stillbirths. The total number of malformations was 61 and the number of children with multiple malformations was 7. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS Arrangements to cover the special problems which arise in connection with the health and treatment of long-stay immigrants to this country have been laid down by the Department of Health & Social Security. During the year 141 persons were notified to the Department and 90 successfully visited. This not infrequently involved more than one visit. Some persons were not known at the addresses given, and others, despite repeated visits, had not been contacted by the end of the year. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 Under this section of the Act as amended by the National Assistance (Amendment) Act, 1951, powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to 43 devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year it was not found necessary in any instance to apply for a removal order as, with the assistance of other interested bodies, it was possible to effect improvement in the conditions found to exist. MEDICAL EXAMINATION OF STAFF Staff who are eligible for admission to the Council's Superannuation Scheme are required to complete a medical questionnaire. From the information given it is decided whether the candidate can be regarded as fit, or if necessary for a medical examination to be carried out before a decision is made. Other examinations are arranged following prolonged sick leave and in cases of retirement on health grounds; candidates may also be examined at the request of the Chief Officer to assess their fitness for employment. In addition to these examinations of the Council's staff a similar procedure is carried out for the West Kent Sewerage Board and for the Stockwell Teachers' Training College. A considerable number of medical examinations take place as a result of applications by residents in the Borough for admission to Teacher Training Colleges, and also from the requirements of the Department of Education & Science that teachers taking up their first teaching appointment should be medically examined. The statistical details for this are given below: Total number of Health Declaration forms received 1,311 Number of recommendations without medical examinations 1,079 Number of medical examinations carried out: (a) In admission to Superannuation Scheme 210 (b) Training College candidates 477 (c) Teachers' First Appointments 104 (d) Premature retirement in prolonged sick leave 13 (e) In other Authorities 13 (f) In West Kent Main Sewerage Board 8 825 Candidates examined for this Borough by other Authorities 8 44 VENEREAL DISEASE Under the National Health Service Act of 1946 diagnosis and treatment of venereal diseases became a responsibility of the Regional Hospital Boards and the functions of the local health authorities were limited to those of prevention. This involves the tracing of contacts wherever possible, and health education. There are no treatment centres for these diseases within the Borough. I am indebted to the physicians at the undermentioned treatment centres for the following statistics for 1971: New Cases of Residents Treated During 1971 Treatment Centre Syphilis Gonorrhoea Other Genital Infections Other Conditions Total Primary and Secondary Other Croydon 1 — 27 122 26 176 Dreadnought Seamen's Hospital, Greenwich — — 6 31 36 73 Greenwich District Hospital — — 8 17 7 32 St. Bartholomew's Hospital — 1 3 45 16 65 St. Giles's Hospital — — 4 29 29 62 St. John's Hospital — 5 27 117 52 201 St. Thomas's Hospital — — 10 71 11 92 The Middlesex Hospital — — 6 3 4 13 Westminster Hospital — — 1 10 6 17 1 6 92 445 187 731 HEALTH EDUCATION & HOME SAFETY Trends in Health Education in Schools In 1948 a group of lecturers in training colleges sent a memorandum to the Health Education Panel of the Inspectorate complaining of the low regard in which the subject was held in schools despite their efforts to send out teachers eager to encourage the development and practice of healthy living in the children. They concluded by asserting that this is a matter which affects the life and habits of the children and is thus a 45 sibility of every teacher, but "everybody's business becomes nobody's business and little or nothing is achieved." Great changes have taken place in schools of all kinds since 1948. The curriculum has widened and, in secondary schools, pre-occupation with external examinations has grown. Although there is less time for the inclusion of yet another subject, especially one that is rarely examined, such as health education, there has been a widening within many subjects so that matters which nowadays may be regarded as part of health education may be discussed by many teachers—not only biologists, home economists and physical education specialists, but by many teachers of the humanities, chemists, mathematicians, physicists (in relation to various aspects of safety and to the effects of radiation) and in growing numbers, experts in personal relationships. It is realised that dogmatic teaching about health is as impractical as dogmatic teaching about history or art. With the above quoted information in mind, a Working Party, consisting of representatives from Schools, Education & Health Departments, put forward a suggested scheme for Health and Social Education in Secondary Schools, which was subsequently approved by the Chief Education Officer and the Education Committee. In the Preamble of this scheme, it is emphasised that all teachers are concerned with the total work of educating and training, that is, with the development of the whole human being. Health Education is often taken to be concerned with the more physical aspects of growth and development, but it should extend far beyond anatomy and physiology and include a consideration of the relationships of the individual with family, peers, members of the opposite sex, the community and society as a whole. It is to be appreciated by all concerned that many elements in the subject-matter of health education necessarily involve value judgments and are therefore the focus of conflicting views and ideas. For many, the fundamentals of the Christian faith— which have hitherto in such large measure shaped the general outlook and ethical standards of our community in Britain— remain the determinants of their social attitudes and conduct and of their training of their children. Others have come to feel that greater reliance should in the future be placed on the development of an enlarged individual sense of responsibility and moral sensitivity to match the greater social freedom. It will in any case be important to ensure that what is offered by way of formal health education in our schools: (a) Discharges faithfully the responsibility of the adult world to assist the rising generation individually to come to the acceptance of a set of values which will lead them to personal health and happiness in society. 46 and (b) offends neither the consciences of our pupils' parents nor the sensibilities of the pupils themselves at their varying stages of maturation. This last point is particularly important at the present time if the sympathy and support of parents for this most necessary element in the totality of our educational work is not to be forfeited. The present scheme has been compiled to aid teachers in this work of helping our pupils to prepare themselves for entering into our present complex society where personal relationships are so important and where social health is of such paramount concern to us all. That our young people should cherish standards which conduce to the building of our general well-being, that they should conduct themselves with an appropriate measure of responsibility which they have grown in and for themselves, as well as with due tolerance and understanding for the views and actions of others, is the very essence of this whole matter. This scheme of work illustrates the individual, relational and environmental influences which have a considerable bearing on a person's health. It provides opportunities for the study of factual knowledge as well as for the examination of human behaviour, problems and attitudes in present-day society. Home Safety From January to December, 1971, a total of 8,857 home accident cases were treated at the hospitals of Beckenham, Farnborough, Orpington and Bromley. Of these 5,236 were adults and 3,621 children. In the previous year (1970) the overall totals from these hospitals was 8,820, and of these 5,093 were adults and 3,727 children. It will be seen that these figures show an overall increase of 37 cases, compared with the previous year. Once again the most prominent cause of these accidents, with serious complications, according to the statistics supplied by the hospital authorities were given as follows:— FALLS Being the chief danger to old people. (Every year more people die from falls than from all other accidents in the home—as many as 60% of the fatalities in 1969 resulted from falls). BURNS/SCALDS POISONING Affect both the young and the old people. Is a danger to adults, especially in relation to gas and medical substances, through overdoses, mistakes, etc. 47 SUFFOCATION Is chiefly the tragedy of small children and babies. (Choking over food resulted in more than half the fatalities in 1969, among the under-fives). Why Safety is your Best Bargain No one deliberately sets out to shop for danger. Yet how many people, in every other way responsible and careful in conducting their affairs, stop to consider safety before they buy? Every year around 8,500 people in Great Britain die as a result of accidents in the home and it is estimated that for every death, there are probably at least 200 non-fatal injuries of varying degrees of severity. Accidents don't just happen. They are caused, by human carelessness or ignorance, by a fault in one of the host of mechanical devices which surround us, or by a combination of both of these factors. . A good many of the burns and scalds, falls, cuts and bruises which contribute to the appalling home accident casualty figures can be traced to some ordinary household article of everyday use —a kettle without a heat resistant handle, a badly balanced stepladder, a rug without non-slip backing to prevent it slithering on a highly polished floor, a tin opener that leaves jagged edges on tins, an electric blanket with a faulty fitting. A good deal of pain and suffering could have been avoided if someone had only said "But is it safe," before buying. LONDON AMBULANCE SERVICE The Ambulance Service for the whole of Greater London is provided by the G.L.C. Ambulance stations within the Borough are sited in Crown Lane, Bromley, and Croydon Road, Penge, but service is provided in addition from other stations sited outside of the Borough. There is a main Control in Bromley which covers the whole of South-East London for non-emergency work. All emergency calls are routed directly to a Central Ambulance Control at Ambulance Headquarters which directs ambulances by radio and by direct telephone lines to ambulance stations. DENTAL SERVICES 51 DENTAL SERVICES Mrs. C. M. Lindsay l.d.s., r.f.p.s. (Glasgow) Principal Dental Officer It was reported in 1970 that is was expected that all sections of the Dental Department would produce increased output in 1971. This expectation has been fully realised as over 2,000 more permanent and over 1,500 more deciduous fillings have been inserted with virtually the same complement of five full time, six part time dental officers, one hygienist, eight full time, two part time dental surgery assistants. During the past year practically all schools in the Borough have received a dental inspection. The few remaining have been scheduled for inspection in January and February. A number of patients have been treated with a topical application of sodium fluoride which, in the majority of cases, has resulted in the improvement in the incidence of caries. However, it has been found that such treatment must be accompanied with good oral hygiene and a controlled intake of sugar if such improvement is to be maintained. Despite the time consuming nature of this experiment, parents will be pleased to note that we hope to continue this treatment to the limit of our capacity until more definite results can be established. In July a Dental Surgeon from the Department of Education and Science inspected the Dental Services and his report contained inter alia the following: "The Authority is commended on its efficient Dental Service, the staff are working well and an exceptionally good pattern of treatment is provided." The ready co-operation and efficient anaesthetics given by Dr. Morris and Dr. Miller has enabled my colleagues to perform their duties satisfactorily. Sessions Sessions devoted to treatment 3142 Sessions devoted to inspection 327 Session devoted to Dental Health Education 71 52 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS (as at December 1971) A. Attendances and Treatment: Number of Visits for Treatment During Year: Children 0-4 (incl.) Expectant & Nursing Mothers First Visit 448 60 Subsequent Visits 408 79 Total Visits 856 139 Number of Additional Courses of Treatment other than the First Course commenced during year 36 5 Treatment provided during the year: Number of Fillings 725 58 Teeth Filled 671 37 Teeth Extracted 64 11 General Anaesthetics given 38 3 Emergency Visits by Patients 13 2 Patients X-Rayed 3 2 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 93 36 Teeth Otherwise Conserved 57 — Teeth Root Filled — — Inlays — 4 Crowns — — Number of Courses of Treatment completed during the year 284 5 B. Prosthetics: Patients supplied with F.U. or F.L. (First Time) 2 Patients supplied with Other Dentures 5 Number of Dentures supplied 7 C. Anaesthetics: General Anaesthetics Administered by Dental Officers — D. Inspections: Children 0-4 (incl.) Expectant & Nursing Mothers Number of Patients given First Inspections during year A. 169 D. 7 Number of Patients in A and D above who required Treatment B. 80 E. 7 Number of Patients in B and E above who were offered Treatment C. 76 F. 7 E. Sessions: Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment G. 107.6 For Health Education H. 20 53 ATTENDANCES AND TREATMENT—SCHOOL CHILDREN Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First Visit 3532 2663 360 6555 Subsequent Visits 7004 8540 1080 16624 Total Visits 10536 11203 1440 23179 Additional courses of treatment commenced 405 251 64 720 Fillings in permanent teeth 3330 6810 1721 11861 Fillings in deciduous teeth 9647 1594 — 11241 Permanent teeth extracted 91 289 43 423 Deciduous teeth extracted 1284 312 — 1596 General anaesthetics 432 176 12 620 Emergencies 219 77 30 326 Number of Pupils X-rayed 161 Prophylaxis 2,942 Teeth otherwise conserved 566 Number of teeth root filled 14 Inlays — Crowns 2 Courses of treatment completed 6,400 ORTHODONTICS New cases commenced during year 242 Cases completed during year 158 Cases discontinued during year 4 Number of removal appliances fitted 276 Number of fixed appliances fitted — Pupils referred to Hospital Consultant 1 PROSTHETICS 5 to 9 10 to 14 15 and over Total Pupils supplied with F.U. or F.L (first time) — — — — Pupils supplied with other dentures (first time) — 2 1 3 Number of dentures supplied 3 1 3 7 ANAESTHETICS General Anaesthetics administer by Dental Officers — INSPECTIONS (a) First inspection at school, number of pupils 36,863 (b) First inspection at clinic, number of pupils 3,855 Number of (a) + (b) found to require treatment 16,490 Number of (a) + (b) offered treatment 12,559 (c) Pupils re-inspected at school or clinic 665 Number of (c) found to require treatment 265 SESSIONS Sessions devoted to treatment 3,142 Sessions devoted to inspection 327 Sessions devoted to Dental Health Education 71 INFECTIOUS AND OTHER DISEASES 57 INFECTIOUS AND OTHER DISEASES General The total number of cases of infectious disease notified to the department was 1,658, an increase compared with the previous year when 1,002 cases were reported. The difference was accounted for by an increased number of cases of measles compared with 1970. This infection continues to fluctuate in numbers from year to year, though to a much less extent than was the case before the availability of immunisation, and the large epidemics of measles that occured bi-annually in the winter months until quite recently, are now a thing of the past. Other infections remained at a low level and there is nothing to report upon specially in this respect, except to note again with pleasure the absence of cases of Poliomyelitis and Diphtheria. I would like to draw attention to the very considerable amount of precautionary surveillance that is undertaken every year by the staff of the Department and which, although constituting an important measure in the prevention of infection, is relatively unspectacular and may not achieve the deserved degree of recognition. For example, in the year under consideration, preventive work of this kind was necessary on a substantial scale when cases of Cholera were reported on the Continent, and similar steps were necessary in instances where residents had been in contact with cases of Typhoid and Para Typhoid Fever. Surveillance of unvaccinated travellers who have arrived from areas of endemic or epidemic smallpox is also an accepted part of the normal day-to-day work of the Department. Statistical details of the various infectious diseases are given below under separate headings and, unless otherwise stated, no deaths from these infections occurred. Cholera During the year the Department was concerned with the surveillance of returning holiday makers who were possible contacts of this infection, cases of which had been reported to have occurred on the continent. Surveillance was necessary for 348 residents involved in this way. No case of the infection occurred. Diphtheria Once again I am pleased to report that no case of Diphtheria was notified in the Borough during the year. Investigations were carried out in one suspected case of the infection and it was 58 confirmed that the patient was not suffering from the disease. This does, however, serve as a reminder that a high level of protection by immunisation in the child population is as important as ever in preserving our present freedom from this infection. Dysentery Only 13 cases of this infection were reported during the year, a figure that can be considered as small compared with the total population. The cases reported were of the mild sonne type with the exception of two instances where the patients had recently returned from Tunisia, the infection in these cases being of the Flexner type. Food Poisoning During the year 19 cases of food poisoning were notified, a decrease compared with the previous year when 30 cases were reported. Details of all cases notified or otherwise ascertained are shown in the table below. In the majority of instances the illnesses were caused by organisms of the Salmonella group. Most were confined to individual cases of illness or family infections, and there was only one general outbreak of food poisoning. The origin of the infection in this instance proved to be food consumed at a restaurant and appropriate preventive measures were taken to eliminate further risk of infection from this source. FOOD POISONING—Incidents and Cases Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases cols. (1+3+5) TOTAL No. of cases columns (2+4+5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S. typhimurium — — 3 7 9 12 16 2. Other Salmonellae (a) 1 9 4 10 12 17 31 3. Cl. welchii — — — — — — — 4. Staph, aureus — — 1 3 1 2 4 5. Other causes (b) — — — — — — — 6. Cause unknown — — — — 1 1 1 7. TOTAL 1 9 8 20 23 32 52 59 DETAILS OF FOOD POISONING DUE TO SALMONELLAE Type of Salmonellae OTHER THAN S. TYPHIMURIUM Indiana — — — — 1 1 1 Oranienburg — — — — 2 2 2 Infantis 1 9 1 2 1 3 12 Enteritidis — — 1 2 2 3 4 Bredeney — — — — 1 1 1 Agona — — 1 3 1 2 4 Panama — — — — 1 1 1 Dublin — — — — 1 1 1 Stanleyville — — 1 3 1 2 4 Muenchen — — — — 1 1 1 Infective Jaundice A total of 35 notifications of this infection were received during the year compared with 44 in 1970. The general pattern of the infection continues to be of sporadic cases and the illnesses were generally mild in character, a wide range of age groups being affected. Leptospirosis No case of Leptospirosis was notified during the year. Malaria 5 cases of Malaria were notified during the year. In each case the infection had been contracted overseas. Measles A total of 1,390 cases of Measles were notified during the year, approximately twice as many as were reported during 1970. The great majority of the notifications continue to relate to children under the age of 15 years and the illness occurs throughout the year, the former concentration in the winter months being now much less in evidence. The following table shows the incidence of the infection in the Borough since 1965 and it would seem from this that the traditional bi-annual occurrence of an increased incidence of the infection continues to occur, although much reduced by measles vaccination which has brought to an 60 end the big winter epidemics of the illness that were characteristic of the recent past. Year Number of Cases Notified 1965 5,119 1966 1,236 1967 4,299 1968 398 1969 1,041 1970 668 1971 1,390 Meningitis 8 cases of Meningitis were notified during the year compared with 7 in the preceding year. There was one death reported from Meningococcal infection. Poliomyelitis I am once again pleased to report that no case of this disease was notified during the year. Rabies One suspected animal case of Rabies was reported during the year, and arrangements were made as a precaution for a member of the household to receive prophylactic vaccination. The animal was subsequently shown to have been free from the infection. Scarlet Fever This infection continued to occur in a mild form and no deaths were recorded. 69 cases were notified compared with 56 during the previous year. Smallpox No cases of the infection occurred during 1971. In accordance with the usual arrangements it was necessary for a number of travellers from overseas who had been possible contacts of the infection to be kept under surveillance—information concerning these contacts being received from the Port Health Authorities. Altogether 19 persons were placed under surveillance in this way during the year. The Department was called upon to authenticate the signature of the Doctor on 9,637 International Certificates of Vaccination during the year; the corresponding figure for 1970 was 7,342. 61 The advice of the Consultant was obtained in several cases during the year, in each instance the patient proving not to be suffering from the complaint. Tetanus There was no case of Tetanus notified during the year. T uberculosis The number of new cases notified maintained the good record of recent years, a total of 42 notifications being received compared with 44 during the previous year. I am again particularly indebted to the Consultant Chest Physician, Dr. E. W. Street, and his colleagues for their expert advice in connection with preventive measures when cases of the illness have occurred in schools or similar communities. The mass X-ray units which operate under the auspices of the South East Metropolitan Regional Hospital Board continued to pay regular visits to sites in the Borough, these sessions being open to the public free of charge. The total number of cases on the register showed a further decline from 2,728 at the beginning of the year to 2,649 at the end of the year. There were four deaths attributed to the disease compared with 9 in the preceding year. TUBERCULOSIS The following are details of the recordings in the Register for the year ended 31st December, 1971:— Respiratory Other forms Total No. of Cases M F M F No. on Register at 1.1.71 1,350 1,064 147 167 2,728 No. of cases notified during 1971 25 13 1 3 42 No. of cases coming to knowledge after death 2 — 1 — 3 Restored to Register — — — — — Inward Transfers 9 12 1 3 25 1,386 1,089 150 173 2,798 Deletions - deaths, removals recoveries, etc., 81 59 7 2 149 Number of cases on Register at 31.12.71. 1,305 1,030 143 171 2,649 62 1971 New cases and mortality:— Age Groups New cases notified or otherwise revealed. (Not including Inward Transfers). Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 5 1 1 — 1 — — — — 5-14 years — 1 — — — — — — 15-24 years — 2 — 1 — — — — 25-44 years 6 6 1 1 1 — — — 45-64 years 14 2 — — 1 — 1 — 65 years and over 4 1 — — 1 — — — Age Unknown — — — — — — — — 25 13 1 3 3 — 1 — Inward Transfers 9 12 1 3 Totals 34 25 2 6 Typhoid and Paratyphoid Fevers There were no cases of either infection during the year, but in a number of instances investigations were undertaken in the case of residents who had been in contact with confirmed cases of the infection, or had been otherwise at risk of contracting the illness. Whooping Cough 77 notifications were received during 1971 compared with 138 in the preceding year. The infection was generally mild in character. 63 INFECTIOUS DISEASES 1971 Notifiable Disease Number of Cases Notified in Age Groups Under 1 year and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 65 65 and Upwards Age unknown Total All ages M F M F M F M F M F M F M F M F M F M F Dysentery — 1 — 1 3 3 1 — 1 1 — — 1 1 — — — — 6 7 Food Poisoning — — 1 3 2 — 2 1 1 2 1 — 1 4 1 — — — 9 10 Infective Jaundice — — 2 3 3 2 2 5 4 4 2 2 5 1 — — 18 17 Malaria — — — — 1 — 1 — — 3 — — — — — — — — 2 3 Measles 11 19 337 310 358 303 5 5 4 2 — — — — — — 16 20 731 659 Meningitis — — — 1 2 — 1 3 — — — — 1 — — — — — 4 4 Scarlet Fever — 1 7 7 27 24 — 1 — 1 — — — — — — — 1 34 35 Tuberculosis (Pul.) — — 1 1 — 1 — 2 1 2 5 4 14 2 4 1 — — 25 13 Tuberculosis (N.Pul.) — — — 1 — — — 1 — — 1 1 — — — — — 1 3 Whooping Cough 4 3 14 16 18 19 — 1 — — — 1 — — — — — 1 36 41 Totals 15 24 362 343 414 352 12 19 11 15 9 8 22 8 5 1 16 22 866 792 ENVIRONMENTAL HEALTH 67 ENVIRONMENTAL HEALTH The professional staffing situation in the Environmental Health Department improved temporarily in 1971 enabling some back log of work to be cleared and a greater degree of attention to be paid to the important routine inspection of food shops, offices and the like. A systematic programme of inspection of houses used in multiple occupation was commenced. The Inspectorate are very concerned at the squalid conditions which exist in some parts of the area due to the occupation by several families of properties originally designed to accommodate only one family. Often they are used with only the minimum of adaptation and there may be considerable fire risk. The Council has adopted standards for these houses and the aim must be to require all landlords to carry out alterations to enable the properties to comply. Unfortunately, the staff situation did not allow the programme to continue but urgent cases continued to be dealt with. It is not only in the field of housing that great demands are being made on the Inspectors' time. We are living in an age when the populace generally is becoming aware of the "environment" in which they live and its importance to their health, habits, comfort and, perhaps, their very existence. This can do no harm. There are, and always will be, a multitude of ways in which the environment can be improved. The prophets of doom, who have so suddenly made themselves heard must have been singularly obtuse not to have realised it long ago. Their instant forecasts may turn out to be as inaccurate as the tardiness which characterised their realisation of the problems. In 1840 a select committee was formed "to enquire into the circumstances affecting the health of the inhabitants of large towns with a view to improved sanitary arrangements for their benefit." It needed several years of agitating by Edwin Chadwick, a civil servant, and others to translate the Committee's findings into action which resulted in the first of many public health acts. The first Medical Officer of Health was employed by Liverpool in 1847 and this was followed by the appoinlment of "Inspectors of Nuisances." Eventually, every local authority in the land had officers capable of caring for the environment. These men changed their names to "Sanitary Inspectors" and later to "Public Health Inspectors." The nature of their duty did not alter. Legal powers were granted sparingly and grudgingly but in the years which have elapsed more and more weapons have been added to the Inspector's armoury. Firstly, the water supply was cleaned up in the country and water-borne cholera became a scourge of the past. The grosser 68 nuisances, including the universal "privy middens" were abolished. The nation's food supply was virtually freed from wilful adulteration. Food and its handlers were subjected to stringent hygiene controls. Medical techniques and environmental improvements conquered many of the infectious diseases which have afflicted the populace until recent years. The squalid "back to back" houses of the "working classes" resulting from the Industrial Revolution were cleared and well-planned estates took their place. In the course of a decade London's air was dramatically cleared. Problems recently "re-discovered" have, in fact, never been lost from sight. Much of the work of the local authority is directed towards nullifying the effects of pollution, in all its aspects, and in this the public health inspectors play a leading part. Their section of the Health Department was renamed "Environmental Health Section" in 1965, which aptly describes the work done. This report cannot catalogue all steps taken to protect and improve the health and well being of the inhabitants of the borough in 1971. Over 1,200 samples of all types have been taken. A few of these were for the purpose of detecting the possible presence of harmful insecticidal residues in food stuffs. Others were taken to monitor water supplies; to ensure the purity and freshness of milk; to discover whether certain foods were contaminated by bacteria, and to check whether rag flock, used in the manufacture of furniture, was within the prescribed standard for cleanliness. Drugs were sampled to ensure their efficacy and harmlessness. Pollution gauges are constantly in operation to confirm the continuing diminution of soot and sulphur dioxide in the atmosphere as the smoke control programme proceeds. In 1971 almost 9,000 more premises were brought under control. In a sense, these examinations are routine measures but they are frequently adapted to keep abreast of modern developments. New manifestations of pollution require new techniques in monitoring. The above reference to cholera is of topical interest in that in 1971 the disease broke out on the continent of Europe for the first time for very many years. Each person returning from parts of Spain and other affected countries was immediately visited and adequate surveillance exercised until danger of infection had passed. Some hundreds of returning travellers were placed under surveillance for this disease or for smallpox. No actual cases were reported. Environmental catastrophes will not be prevented by sensationalism. Indeed it can do more harm than good. Disasters will 69 be circumvented and existing conditions improved by vigilance and wise direction exercised by sound training and unremitting team work. Housing: The Housing Act 1969 resulted in important changes in relation to the Department's work in connection with housing which occupies one-third of the Inspectors' time and the policy of dealing with areas of dwellings in need of improvement was changed. In spite of the cumbersome procedures laid down for the compulsory improvement of tenanted houses in suitable districts under the Housing Act 1964 the area established on Bromley Common had been a marked success. The system was replaced by the conception of "General Improvement Areas." Here, again, areas of older houses of sound structure but lacking in modern amenities are selected. Every effort is made, through co-operation with tenant and landlord, to encourage improvement with the aid of suitable grants. In addition the Council would be responsible for giving the environment around the houses a face lift. This principle of Compulsory Improvement Areas was dropped although compulsion still applies to individual buildings both inside and outside General Improvement Areas where the tenant makes the necessary request. Late in 1970 Housing Act items which had previously been dealt with by the Health Committee were transferred to the Housing Committee and it was fitting that a report was submitted to this Committee early in 1971 on General Improvement Areas. Three such areas in Penge were considered and one was discarded as being unsuitable after survey by the Inspectorate, South Penge Park was eventually adjudged to be better dealt with by redevelopment and in the third area, adjacent to Penge East Station, it was later decided to set up the Authority's first General Improvement Area. 70 FOOD AND DRUGS ACT, 1955 FOOD SAMPLING—1971 Letters in parenthesis are referred to on page 72. Article No. Examined No. Unsatisfactory Formal Informal Forma Informal (w) Baby Foods — 5 — 2 (u) Beer — 4 — 2 (q) Biscuits — 4 — 1 Blancmange Powder — 1 — — Brandy 1 1 — — (k) Bread and Bread Rolls — 17 — 13 Butter — 7 — — Buttered Rolls — 2 — — (z) Buttermilk — 1 — 1 (1) Cakes — 10 — 3 Cake Decorations — 2 — — Cake Mixes — 2 — — (r) Cereal and Cereal Products — 17 — 4 (aa) Cheese — 22 — 2 Cheese spread — 8 — — (n) Chocolate and cocoa products — 3 — 1 Cider — 1 — — (ee) Coffee products — 3 — 1 Colouring matters — 4 — — (f) Cream — 30 — 11 Cream Cakes — 13 — — Cream Desserts — 2 — — Dessert powders — 5 — — Diabetic foods — 7 — — (x) Drugs — 39 — 2 Eggs and egg products — 8 — — (c) Fish and fish products — 32 — 4 (j) Flour — 13 — 5 Frog Fore Legs — 1 — — (g) Fruit and fruit products (including tinned fruit) — 19 — 4 Fruit, dried — 2 — — (v) Gin 2 1 — 1 Herbal drink — 1 — — Tee Cream — 11 — — Ice cream mix — 1 — — (t) Ice lolly — 7 — 1 (cc) Jam and preserves — 8 — 1 Jelly — 2 — — Liqueur chocolates — 1 — — Macaroni cheese — 1 — — Margarine — 3 — — Marzipan — 1 — — (a) Meat and meat products (including tinned meat) — 96 — 15 Meat tenderiser — 1 — — 71 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal (d) Milk and Milk bottles 1 95 — 29 Milk (dried) — 2 — — Milk dessert — 1 — — Milk drink — 1 — — (e) Milk (tinned) — 3 — 1 Mousse — 1 — — Nuts — 4 — — Oils and fats — 6 — — Pastes — 16 — — (bb) Pastries — 6 — 1 (o) Peanut butter — 1 — 1 Peppermint tea — 1 — — (y) Poultry and poultry products — 3 — 1 Puddings — 3 — — Raising agent — 1 — — Rum 1 — — — Salads — 1 — — Salad cream and dressing — 5 — — (i) Sauces and pickles — 19 — 1 (b) Sausages and sausage meat 2 42 — 5 Sausage rolls — 6 — — Savoury filling — 1 — — Sherry trifle — 1 — — Slimming foods — 21 — — Soft drinks — 22 — — Soup (canned) — 3 — — (p) Spaghetti Bolognese — 1 — 1 (m) Spices and flavourings — 32 — 5 (s) Sugar and sugar products — 9 — 1 Sweets — 16 — — Synthetic cream — 1 — — Tea — 18 — — Vegetables (dehydrated) — 2 — — (h) Vegetables (tinned) — 16 — 3 (dd) Vegetable products — 18 — 1 Vegetarian foods — 3 — — Vending machines:— Bovril — 1 — — Chocolate — 1 — — Coffee — 2 — — Tea — 2 — — Vinegar — 15 — — Vodka 1 — — — Whisky 3 — — — Wine — 4 — — Yeast — 2 — — Yoghurt — 3 — — For Pesticide Residues:— Fats — 3 — — Fresh fruit — 5 — — Fresh Vegetables — 4 — — Meat — 3 — — TOTALS 11 845 — 124 72 Nature of Unsatisfactory Sample Remarks Serial No. 4358 (a) Meat Ball Composition: Contained a pig's tooth and the presence of flour and meat fibres adhering to its surface indicated that it had been processed in the meat ball. Matter investigated. Advice given to producer. Serial No. 4294 (a) Ham Composition: Associated with the ham was a used cotton bandage, 2 inches wide and 31 inches long. Warning letter to importers. Embassy of country of origin notified. Serial No. 4392 (b) Pork Sausages Composition: The discolouration on the outer surface of the sausages was due to the presence of iron particles. Warning letter to manufacturer. Serial No. 4293 (c) Cod Fish Cake Composition: Thought to have contained a match stick but part of the stem of a plant was found and this appeared to have been processed in the fish cake. Matter investigated and attention of manufacturer drawn to occurrence. Serial No. 4309 (d) Milk Composition: The unopened pint bottle of milk contained a spiral of rubber approximately 1 mm. in diameter. Serial No. 4360 Matter investigated. Warning letter to bottler. (d) Milk Composition: Soiling of the inner surface of the glass of the bottle was due to sand and grit particles. Serial No. 4362 Matter investigated. Warning letter to bottler. (d) Milk Composition: On the inner surface of the glass of the bottle base was a skin of denatured milk in which mould had grown. Matter investigated. Warning letter to bottler. Serial No. 4393 (e) Full Cream Evaporated Milk Composition: The contents of the unopened can were dark in colour and this may be attributable to overheating or prolonged storage. Matter drawn to attention of manufacturer. 73 Nature of Unsatisfactory Sample Remarks Serial No. 4312 (f) Cream Composition: Contained a female house fly of the species Musca Domestica which had been heated. Matter investigated. Warning letter to manufacturer. Serial No. 4245 (g) Apricot Fruit Filling Composition: The lacquer of the can had deteriorated over small areas and at one point this had allowed the fruit acids to penetrate the can, allowing access of mould spores and hence dense mould skin found by the complainant. Matter investigated. Warning letter to canner. Serial No. 4342 (h) Canned Peas Composition: Contained the pupa of a butterfly which had been heated. Matter investigated. Warning letter to canners. Serial No. 4327 (j) Flour Composition: The foreign object associated with the flour was a fish's anal fins adherent to which were fragments of flour. Matter investigated. Source of foreign matter not precisely ascertained. Serial No. 4286 (j) Jowan Flour Composition: This description would not be generally understood and it not an "appropriate designation" and therefore not in accordance with the Labelling of Food Order. It had the microscopical appearance of a mixture of farinaceous substances and, if prepacked, would need a declared list of ingredients. Investigation in progress. Serial No. 4310 (k) Bread Composition: Associated with the bread was a cigarette end but difficulty was encountered in establishing its original location in the loaf. Matter investigated. Source of foreign material not precisely ascertained. Serial No. 4361 (k) Bread Composition: Contained 15 small fragments of soda glass which could have originated from an electric light bulb. Matter investigated. Source of foreign material not precisely ascertained. 74 Nature of Unsatisfactory Sample Remarks (k) Serial No. 4343 Bread Composition: Embedded in a depression in the crust was a cockroach which had been baked in the loaf. Legal proceedings. Baker fined £40 with £10 costs and £4.70 analyst's fee. (l) Serial No. 4214 Slab Cake Composition: Contained a pin adherent to which were fragments of iron-stained dough. There were similar stains in the cake dough, surrounding the pin, suggesting the pin was baked in the cake. Matter investigated. Warning letter to baker. (r) Serial No. 4321 Poppadums Composition: The ingredients were not listed in the correct order in that salt (4.0%) should have been third in the list of six ingredients and not last. Also "Jiva" was listed and this does not indicate to the purchaser the nature of that ingredient. Article withdrawn from sale for re-labelling to conform with Labelling Regulations. (i) Serial No. 4182 Pickle Composition: Associated with the pickle was a bent nail about 40 mm. long with a point at either end. Matter investigated. Strong warning letter to manufacturer. (m) Serial No. 4284 Haldi Powder Composition: The sample consisted of tumeric powder and would be more appropriately labelled as such. Now re-labelled as tumeric. Satisfactory. (b) Serial No. 4501 Pork Sausages Composition: Meat 61 per cent as opposed to the required 65 per cent. Repeat formal sample— satisfactory. Correspondence with vendor. (b) Serial No. 4508 Pork Sausages Composition: Meat 63 per cent as opposed to the required 65 per cent. Repeat formal sample— satisfactory. Correspondence with vendor. (b) Serial No. 4533 Beef Sausages Composition: Associated with the sausages was a 3/8 in. 4BA roundheaded brass machine screw which showed signs of damage and adherent to the thread were fragments of wheat flour and meat, compatible with its having been in a sausage. Matter investigated. Source of screw not positively ascertained. 75 Nature of Unsatisfactory Sample Remarks (a) Serial No. 4442 Meat Pasty Composition: In the portions of meat pasty submitted a 2i in. wire nail was partly but firmly embedded in the meat. Investigated. Warning letter to manufacturer. (c) Serial No. 4547 Fish Hors d' Oeuvre Composition: In addition to the declared ingredients the sample contained 23 per cent onions, 12 per cent kidney beans and 4 per cent carrots. Correspondence with importers — new label produced, listing all ingredients. (c) Serial No. 4513 Dressed Crab Composition: The crab content at 88 per cent was below the minimum of 93 per cent laid down in the Fish and Meat Spreadable Products Regulations. Correspondence in progress with importers. (d) Serial No. 4394 Milk, Pasteurised Composition: Free in the milk were three small fragments of mould growths. Investigated. Warning letter to dairy. (o) Serial No. 4441 Peanut Butter Composition: Associated with the peanut butter were 24 fragments of glass which varied in size from 50 x 20 mm. overall to minute splinters. The glass was similar to that of the containing jar. Legal proceedings. Manufacturer fined £30 with £15 costs. (h) Serial No. 4561 Sliced Beans Composition: Associated with the empty tin of sliced beans were two fragments of glass having the characteristics of common bottle glass. Matter investigated. Importer and authorities of exporting country notified. (h) Serial No. 4509 Baked Beans in Tomato Sauce Composition: The foreign object found in the can was a plant shoot 20 mm. long. Investigated and attention of canners drawn to matter. (k) Serial No. 4475 Bread Composition: A fruit fly (Drosophila) was partly embedded in the crust of the loaf. It was possible that the fly had become embedded in the relatively soft crust after baking. Matter investigated. Warning letter to baker. 76 Nature of Unsatisfactory Sample Remarks (k) Serial No. 4492 Bread Composition: Each of three slices showed whole wheat grains or cut fragments thereof in the crumb. Matter investigated and drawn to attention of baker. (1) Serial No. 4525 Hot Cross Bun Composition: The glass fragment associated with the bun measured 12 x 4 mm. overall and a small amount of wheat starch was adherent to it. It had the characteristics of hard or resistance glass. Matter investigated. Source of foreign matter not positively ascertained. (m) Serial No. 4522 Coffee Colouring and Flavouring Composition: A complaint had been made that the liquid caused green discolouration in calces. An experimental cake showed satisfactory crumb colour but there was a hint of greenish discolouration on the base. Correspondence with manufacturer — satisfactory. (a) Serial No. 4595 Corned Beef Composition: The tin plating on the inner surface of the can had broken down in places and the iron had become exposed and to some degree stained the surface of the meat. Matter investigated and drawn to the attention of importer. (a) Serial No. 4648 Stewed Steak with gravy Composition: Meat 71 per cent. Meat with gravy should contain not less than 75 per cent meat. Correspondence with manufacturer. New filling method adopted. Product bearing this code withdrawn. (a) Serial No. 4649 Braised Steak with rich gravy Composition: Meat 73 per cent as against the minimum of 75 per cent required. Correspondence with manufacturer. Repeat samples satisfactory. (a) Serial No. 4650 Minced Steak in rich gravy Composition: Meat 73 per cent (low). Serial No. 4653 Correspondence with manufacturer. Repeat samples satisfactory. (a) Stewed Steak with gravy Composition: Meat 68 per cent (low). Correspondence with manufacturer in progress. 77 Nature of Unsatisfactory Sample Remarks (a) Serial No. 4656 Stewed Steak with gravy Composition: Meat 69 per cent (low). Correspondence with manufacturer. Repeat samples satisfactory. (a) Serial No. 4831 Beefburgers Composition: Meat 78 per cent. The standard requires not less than 80 per cent. Correspondence with manufacturer. Repeat sample in progress. (a) Serial No. 4728 Pork Loaf Composition: Contained a piece of ferrous metal 9 thousandths of an inch thick and ½ by 3/8in. overall. It was plated in parts with zinc and adhering to its surface were fragments of meat and starch. A minute fragment of iron (less than 1 mm. in diameter) was found in the remaining parts of the loaf. Warning letter to importer. Danish Embassy notified. (b) Serial No. 4571 Pork Sausages Composition: Contained 160 p.p.m. sulphite as preservative without declaration required by the Preservatives Regulations. Correspondence with vendors in progress. (a) Serial No. 4660 Veal and Ham Pie Composition: A bluebottle in a fragmentary state was found on the meat filling. The absence of phosphatase enzymes in its tissues indicated that it had been heated. Matter investigated. Strong warning letter to manufacturer. (p) Serial No. 4837 Spaghetti Bolognese Composition: Contained a small fragment of bovine skin with hair. Matter investigated and drawn to the attention of canner. (c) Serial No. 4592 Fish Cakes Composition: The nail alleged to have been found in the fish cake had fragments of fish cake firmly attached to it and therefore the complaint was considered justified. Warning letter to importer. Norwegian Embassy notified. (d) Serial No. 4673 Untreated Farm Bottle Milk Composition: Butter fat 2.9 per cent and therefore deficient 3.3 per cent of the minimum amount of fat. Repeat formal sample satisfactory. Producer notified. 78 Nature of Unsatisfactory Sample Remarks (d) Serial No. 4745 Pasteurised Milk Composition: In each of the bottles there were 50 to 100 small black particles having the characteristics of rubber. The largest was approximately 1.5 mm. in diameter. Legal proceedings. Bottler fined £50 with £14.70 costs. (d) Serial No. 4746 Pasteurised Milk (3 pints) (d) Serial No. 4747 Pasteurised Milk (2 pints) (d) Serial No. 4748 Pasteurised Milk (Channel Islands) (d) Serial No. 4800 Pasteurised Milk Composition: A fly and an empty pupal case were present. Matter investigated. Warning letter to bottler. (d) Serial No. 4744 Pasteurised School Milk Composition: The third of a pint bottle of milk contained a brass ring 13/8 in. in diameter with unjoined ends. Matter investigated. Warning letter to bottler. (d) Serial No. 4708 Pasteurised Milk Composition: Contained rust particles. They weighed in aggregate 15 mg. and were of less than 1 mm. in diameter. Matter investigated. Warning letter to dairy. (d) Serial No. 4707 Pasteurised Milk Composition: The bottle was badly stained internally down one side by fragments of denatured milk, in which mould had grown. Matter investigated. Warning letter to dairy. (d) Serial No. 4709 Three bottles of Pasteurised Milk Composition: All three samples contained rust particles. The total weights of rust particles in the three individually were 25, 40 and 42 mg. Matter investigated. Warning letter to dairy. (d) Serial No. 4706 Pasteurised Milk Composition: Contained four small dark coloured fragments of adventitious soiling material. Matter investigated. Warning letter to bottlers. 79 Nature of Unsatisfactory Sample Remarks (d) Serial No. 4659 Channel Islands Pasteurised Milk Composition: The small particles adherent to the inner surface of the bottle consisted of a sand and cement mixture. Matter investigated. Warning letter to dairy. (d) Serial No. 4686 Pasteurised Milk Composition: The small particles adherent to the inner surface of the bottle consisted of a sand and cement mixture. Matter investigated. Warning letter to dairy. (d) Serial No. 4693 Empty Milk Bottle Composition: The small particles adherent to the inner surface of the bottle consisted of a sand and cement mixture. Matter investigated. Warning letter to dairy. (d) Serial No. 4676 Pasteurised Milk Composition: Adherent to the inner surface of the bottle was a denatured milk film, 3 mm. by 2 mm., in which mould hyphae were present. Matter investigated. Warning letter to bottler. (d) Serial No. 4765 Pasteurised Milk Composition: Small brown particles adherent to the inner surface of the bottle consisted of spores and hyphae of an unidentified mould. Matter investigated. Warning letter to bottler. (d) Serial No. 4766 Pasteurised Milk Composition: The grey stain covering about two-thirds of the interior of the bottle appeared to have been caused by a water paint. Matter investigated. Warning letter to dairy. (f) Serial No. 4811 Single Cream (fresh) Composition: lene Blue unsatisfactory. Methy- Investigation in Test— progress with manufacturers and vendors. (f) Serial No. 4812 Fresh Whipping Cream (f) Serial No. 4813 Fresh Double Cream (f) Serial No. 4814 Fresh Single Cream (f) Serial No. 4818 Fresh Dairy Cream 80 Nature of Unsatisfactory Sample Remarks (k) Serial No. 4610 Bread Composition: Embedded in the crust of the loaf were fragments of a bluebottle fly. The phosphatase test indicated that it had been baked in the loaf. Matter investigated. Warning letter to baker. (k) Serial No. 4743 Bread Composition: Three slices were badly soiled by iron and mineral oil. Legal proceedings. Baker fined £20 with £15.50 costs. (k) Serial No. 4764 Bread Composition: The foreign matter embedded in two slices consisted of charred dough. Matter investigated. Warning letter to baker. (k) Serial No. 4783 Bread Composition: A small moth and fragments of a dipterous fly were present in the loaf. Matter investigated. Warning letter to baker. (k) Serial No. 4803 Bread Composition: Part of a smoked cigarette, approximately 1 in. long, was flattened against one of the two slices of bread and the other slice had an indentation approximately l¼ in. long by i in. deep, and when the two slices were fitted together the indentation superimposed the cigarette end. Legal proceedings. Baker fined £20 with £14.70 costs. (k) Serial No. 4821 Bread Composition: A piece of wood ½ in. x 4½ in. x 1/10th in. was embedded in the bread. About ¼ in. of the wood protruded from the loaf. The end embedded in the loaf had dough firmly adherent to it. Matter investigated. Warning letter to baker. (1) Serial No. 4611 Cake Composition: Associated with the cake was a flat strip of iron 2 mm. wide and 48 mm. long. Firmly adherent to it were fragments of cake crumb similar to that of the sample, indicating that it had been baked in the cake. Matter investigated. Warning letter to manufacturer. 81 Nature of Unsatisfactory Sample Remarks (q) Serial No. 4753 Biscuit Composition: The sample contained fat other than butter fat which was the only fat declared in the list of ingredients. Correspondence with manufacturers. Product re-labelled—satisfactory. (r) Serial No. 4687 Breakfast Cereal Composition: The cigarette filter tip associated with the sample had a strong odour of smoked tobacco but no tobacco was present in it. In a depression in the side of the filter tip there was farinaceous matter similar to that of the cereal in the packet, suggesting that it could have been in the cereal during manufacture. Matter investigated. Strong warning letter to manufacturer. (s) Serial No. 4820 Caster Sugar Composition: The foreign matter in the sugar was not rodent droppings as suspected but pellets consisting of sugar with mineral oil and other adventitious debris. Matter investigated. Warning letter to refiners. (t) Serial No. 4594 Ice Lollie Composition: The foreign matter removed from the inside corner of the packet consisted of a gelatinous mass, 12 by 25 mm. overall; it contained numerous fungal hyphae. Matter investigated. Warning letter to manufacturer. (u) Serial No. 4710 Light Ale Composition: When received the beer was sour and vinegary and contained a deposit of gram positive bacilli. The oily flavour complained of was not confirmed. Matter investigated. Warning letter to vendor. (v) Serial No. 4822 Gin Composition: The alcohol content was 14 per cent proof and sugars (dextrose and sucrose) 2.4 per cent. Repeat formal sample. Satisfactory. (m) Serial No. 4642 Mixed Stuffing Composition: Two broken portions of a cigarette were present in the mixed stuffing. They were 25 mm. and 18 mm. long respectively and the short portion showed slight charring of one end of the paper. A few loose strands of tobacco were also noted. Matter investigated. Warning letter to manufacturer. 82 Nature of Unsatisfactory Sample Remarks (w) Serial No. 4784 Baby Food (Beef and Vegetable) Composition: The piece of glass received with the sample was approximately l½ in. x ½ in. x 1/12th in. It had the same physical properties as the glass of the sample jar. Legal proceedings. Manufacturer fined £40 with £16 costs. (x) Serial No. 4789 Cough Mixture Composition: 12.5 per cent v/v alcohol and 0.50 per cent v/v chloroform were claimed but only 7.5 per cent and 0.05 per cent respectively were found. Correspondence with manufacturers. Product withdrawn from sale. (x) Serial No. 4801 Rubbing Oil (Snig Oil) Composition: The volatile oil content was 2.1 per cent v/v as against 5.5 per cent v/v declared. Correspondence with manufacturers in progress. (y) Serial No. 4956 Chicken Casserole Composition: This was an uncooked chicken only, for casseroling, and should be described as a casserole chicken. Correspondence with manufacturers. Withdrawn from sale. Satisfactory. (a) Serial No. 4850 Stewed Steak with rich gravy Composition: Meat 65 per cent. This type of product should contain not less than 75 per cent meat. All affected stock withdrawn from sale. Satisfactory. (a) Serial No. 4844 Chopped Braised Pork Kidneys in gravy Composition: Meat 55 per cent. The meat content should be not less than 75 per cent. Correspondence with manufacturers. Repeat samples satisfactory. (a) Serial No. 4967 Minced Beef Composition: Associated with the sample were two pieces of ferrous metal each measuring approximately 0.2 in. by 0.1 in. overall. Matter investigated. Source of metal not positively identified. (d) Serial No. 4853 Pasteurised Milk Composition: The unopened bottle of milk contained a small dark body about the size of a pin head. When examined microscopically it showed no organised structure and appeared to consist of dust particles. Matter investigated. Warning letter to bottlers. 83 Nature of Unsatisfactory Sample Remarks (d) Serial No. 4938 Pasteurised Milk Composition: A brown film adherent to the inner surface of the bottle was due to mould growths. Matter investigated. Warning letter to bottler. (d) Serial No. 4855 Pasteurised Milk Composition: Associated with the milk was a plastic bottle cap. Matter investigated. Warning letter to bottlers. (d) Serial No. 4972 Pasteurised Milk Composition: The foreign matter consisted of a film of denatured milk in which mould had grown. Smaller areas up to i in. in diameter were noted adherent to the bottle surface as well as free in the milk. Matter investigated. Warning letter to bottlers. (d) Serial No. 5001 Milk Bottle Composition: A deposit around the periphery of the internal surface of the base of the bottle was a set sand cement mixture. Normal washing processes would not remove it. Matter investigated. Warning letter to bottlers. (d) Serial No. 4968 Separated Milk Composition: In the sealed bottle were three films of denatured milk in which mould had grown. Similar mould growths were also noted around the periphery of the base. Matter investigated. Warning letters to manufacturer and vendor. (z) Serial No. 4894 Buttermilk, fat free Composition: The sample was not butter milk, which is a by-product of cream or butter manufacture, but a cultured product prepared from skimmed milk. It would be more aptly be described as Cultured Buttermilk. Correspondence with manufacturers. Product relabelled—satisfactory. (d) Serial No. 4920 Milk, Channel Island Pasteurised Composition: Over an area of 4 in. by 2 in. the inner surface of the bottle was soiled by adherent denatured milk in which mould had grown. Five small fragments were also free in the milk. Legal proceedings. Bottler fined £30 with £21 costs. 84 Nature of Unsatisfactory Sample Remarks (d) Serial No. 4937 Empty Milk Bottle Composition: There were areas of soiling inside the rim of the neck and around the outer rim of the inner surface of the base of the bottle. The deposits contained plant debris and mould growths. Matter investigated. Warning letter to vendor. (f) Serial No. 4899 Single Cream (in carton) Composition : Methylene Blue Test unsatisfactory. Investigation with vendors and manufacturers. Repeat samples satisfactory. (f) Serial No. 4901 Single Cream (in carton) (f) Serial No. 4999 Single Cream (in carton) (f) Serial No. 4897 Double Cream (in carton) Composition: Fat 46 per cent. The standard is not less than 48 per cent butter fat. Correspondence with vendors. Repeat sample satisfactory. (f) Serial No. 4900 Double Cream Composition: Methylene Blue Test unsatisfactory. Investigation with vendor and manufacturer. Repeat sample satisfactory. (aa) Serial No. 4867 Camembert Cheese Composition: The composition was satisfactory but to accord with the Cheese Regulations should be labelled "Full Fat Soft Cheese". Vendor advised. Now satisfactorily labelled. (aa) Serial No. 4963 Tartare Fromage frais aux fines herbes Composition: The composition was satisfactory but to accord with the Cheese Regulations should be labelled "Full Fat Soft Cheese". Vendor advised. Now satisfactorily labelled. (bb) Serial No. 4989 Danish Pastry Composition: Embedded in the fruit filling was a larva of the Bacon or Larder Beetle. Matter investigated. Warning letter to vendor. 85 Nature of Unsatisfactory Sample Remarks (g) Serial No. 4854 Strawberries in Syrup Composition: An iron staple associated with the sample measured 12 mm. by 7 mm. overall and the wire was 1.1 mm. thick. It showed evidence of surface attack by the fruit and small fragments of fruit were adherent. Matter investigated. Warning letter to canner. (g) Serial No. 4903 Apricot Halves in Syrup Composition: The insect associated with the sample was a female earwig. Phosphatase enzymes were present, indicating that the insect had not be processed with the fruit. Matter investigated. No further action. (g) Serial No. 4990 Peaches in Syrup Composition: The glass fragment associated with the sample had the character of common glass and could be part of a bottle. Investigated. Warning letter to importer. Embassy of exporting country notified. (cc) Serial No. 4969 Jam Composition: The lepidopterous larva in the apricot jam was that of the Codling Moth. It had been heated. Investigated. Warning letter to exporting country notified. (dd) Serial No. 5029 Mixed Vegetable Soup (Frozen) Composition: The entire label, including the instructions for use, was in Italian and therefore not in accordance with the Labelling of Food Regulations. Correspondence with vendors. Special label now provided — satisfactory. (j) Serial No. 4971 Flour Composition: The larva associated with the flour was that of the Mediterranean Flour Moth, Ephestia. Matter investigated. Warning letter to miller. (j) Serial No. 4988 Flour Composition: Contained a single small beetle, 2 mm. long. It was identified as a member of the genus Cryptolestes. Investigated. Not an insect associated with flour. No further action. (j) Serial No. 5027 Plain Flour Composition: The flour contained a proportion of bran particles. Investigated. Matter drawn to attention of miller. 86 Nature of Unsatisfactory Sample ks (k) Serial No. 4939 Bread Composition: Embedded in a slice of the bread was a portion of a plastic sheet measuring 1 in. by 0.3 in. overall. It had the character of nylon and had dough and iron particles adherent. Investigated. Warning letter to baker. (k) Serial No. 5017 Bread Composition: It was confirmed that eight pellets of rodent droppings were present. Examination of a hole in the loaf showed it to be due to rodent attack, one rodent hair being isolated from the top inside edge of the hole. Matter investigated. Case legally unsuited to prosecution. Warning letter to vendor. (r) Serial No. 4921 Cornflakes Composition: A metallic fragment associated with the sample weighed 0.2 g. and measured 0.5 in. by 0.3 in. overall. It consisted of stainless steel and fragments of cornflakes were firmly adherent to its surface. Investigated. Warning letter to manufacturer. (r) Serial No. 5025 Rice Composition: The object, which resembled a rodent dropping, was a discoloured rice grain. Drawn to attention of packers. (u) Serial No. 4904 Beer Composition: Half of the circumference of the inner rim of the neck of the bottle was found to be slightly chipped and in the beer were twelve small fragments of glass. The largest was 2 mm. by 0.5 mm. and they were found to have similar characteristics to the glass of the bottle. Matter investigated. Warning letter to brewer/ vendor. (ee) Serial No. 4982 Pure Coffee Composition: The coffee had been satisfactorily decaffeinated but it should be described as "decaffeinated coffee extract". Correspondence in progress. (n) Serial No. 4889 Chocolate Sauce Composition: The composition was glucose syrup 41 per cent, invert sugar 19 per cent, cocoa 8 per cent. Sugar should have preceded cocoa in the list of ingredients. Correspondence with manufacturers. Label revised — satisfactory. 87 Nature of Unsatisfactory Sample Remarks (m) Serial No. 4970 Bay Leaves Composition: Contained a living earwig which had eaten to some degree 15 of the leaves in the packet. Investigated. Source of infestation not positively identified. Packers notified. (m) Serial No. 4928 Curry Sauce Composition: The ingredients were not listed in order of the amounts present in the article as is required by the Labelling of Food Order 1953 or the Labelling of Food Regulations 1970. Correspondence with manufacturer in progress. (w) Serial No. 4922 Baby Food (Strained Pineapple and Rice) Composition: Contained a wasp which was complete except for one leg and part of an antenna. Investigated. Source of insect not identified. No further action. Unsound Food A total of 12 tons 19 cwts. of food unfit for human consumption was surrendered to Public Health Inspectors during the year. Details of the various items are given below: — Tons Cwts. lbs. Meat and Offal at Slaughterhouse — 5 85 Meat and Offal at Wholesale and Retail Premises 1 10 — Tinned Meat and Meat Products — 6 70 Tinned Fruit 1 — 65 Tinned Vegetables — 3 28 Fresh Fruit and Vegetables — 13 56 Frozen Foods 6 10 5 Preserves — 1 37 Fish (Fresh and Canned) — 18 — Other Foods 1 10 — The large quantity of frozen food dealt with arose mainly from the breakdown or malfunction of refrigerated display cabinets and cold stores in shop premises. Once thawing has occurred, frozen foods should not be re-frozen, and unless it can be used immediately (which is seldom practical), it must be regarded as unsaleable. Manufacturers and distributors of frozen foods are very aware of the advisability of immediately withdrawing "thawed out" food from sale. They advise retailers accordingly and offer replacement, upon the production of the Health Inspector's surrender certificates. 88 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken and submitted for examination with the following results: — Satisfied Failed Phosphatase Test 140 — Methylene Blue Test 163 8 Ring Test 67 — The tests shown in the above table were applied for the following purposes: — Phosphatase Tests—Applied to "Pasteurised" Milk to determine that the milk was satisfactorily pasteurised. Methylene Blue Tests—Applied to "Untreated" and "Pasteurised" milks to indicate that the bacterial content was within the prescribed standard. Ring Test—Applied to untreated milk to determine the presence of "Brucellus abortus." Where samples failed to satisfy the prescribed tests investigations were undertaken and further samples obtained, the tests of which proved to be satisfactory. BACTERIOLOGICAL SAMPLES OF ICE CREAM Samples taken during the year give the following results: — Grade I — 66—Satisfactory Grade II — 8—Satisfactory Grade III — Nil—Unsatisfactory Grade IV — 1—Unsatisfactory Follow-up samples were obtained from the supplier whose product had given a Grade IV result. These further samples were satisfactory. 89 OTHER SAMPLES AND SPECIMENS SUBMITTED TO PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION Samples of foodstuffs, as under, were examined in connection with Food Poisoning enquiries and were found to be free of pathogenic organisms: — Chicken Pie Herrings Scotch Beef Mince Kipper Milk Veal & Ham Pie Salad Slices of Chopped Ham & Pork Frankfurters Prawns Pork Beef Chicken Noodles Rice The culture from samples of Prawns and Chicken showed a heamolytic strain of Clostridium Welchii. 498 specimens of faeces were examined from persons suspected to be suffering from infectious disease or food poisoning, or who were contacts of persons so suffering. The results were: — Faeces Specimens Positive Negative Suspected Dysentery 141 29 112 Suspected Food Poisoning 337 82 255 Suspected Typhoid, Para-typhoid,etc. 20 — 20 90 MEAT INSPECTION Annual licences were granted to two slaughtermen and the licence for one private slaughterhouse was also renewed during the year. The carcases of all animals slaughtered within the Borough were inspected and regular routine visits and inspections were made to distributing depots and retail butchers' shops. CARCASES INSPECTED AND CONDEMNED Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 47 9 10 511 111 — Number not inspected NIL NIL NIL NIL NIL NIL All diseases except Tuberculosis and Cysticerci Whole carcases condemned — 1 — — — — Carcases of which some part or organ was condemned 5 — — 26 19 — Tuberculosis only Whole carcases condemned Carcases of which — — — — — — some part or organ was condemned — — — — — — Cysticerci Carcases of which some part or organ was condemned — — — — — — Carcases submitted to refrigeration — — Generalised and totally condemned — — — — — — Approved charges totalling £27.12 were made for the inspection by Public Health Inspectors of the carcases shown in the above table. Amount of Meat Condemned—5cwt 85 lbs. 91 FOOD COMPLAINTS There was again an increase in the number of complaints received regarding alleged unsatisfactory items of food. The 161 complaints were 31 in excess of last year's total, the largest increase being in respect of milk contained in bottles which, although subjected to mechanical washing and sterilization, still had traces of staining on the inside or contained adherent or loose foreign matter. All complaints were fully investigated and whilst 17% were unjustified, the remainder were dealt with by the issue of written warnings, or by prosecution. The complaints came within the following categories: — Alleged condition Foreign Bodies, Dirty, etc. Mouldy Other Conditions Bread and flour confectionery 27 13 1 Tinned foodstuffs 11 — 5 Perishable articles (pies, sausages, etc.) 7 13 1 Milk, cream and milk bottles 37 — 2 Chocolate and sugar confectionery — — 1 Cereals 2 — — Preserves 1 — — Miscellaneous 19 2 14 Butter 1 1 — Cheese — 3 — Foreign bodies identified in the specimens were: — Bread and flour confectionery: Pieces of rubber, glass, wire, string, paper, bakehouse char, slivers of wood. Tinned Foodstuffs: Pieces of plastic strip, metal, animal hide and hair, insects and finger bandage. Pies, Sausages, etc: Part of an animal tooth, piece of fur, insects and a metal nail. Milk and Milk Bottles: Cement, insects, piece of wire, stains on internal surfaces of bottles. Cereals: Small pieces of metal in breakfast food. Preserves: Maggot in jam. 92 Miscellaneous: Insects in baby foods, a nail in fish cakes, maggots in pork chops, bacon and in flour, small pieces of metal in minced beef. Not all complaints were justified, there were some instances where the smell, taste or appearance of articles complained of proved to be natural to the foodstuffs in question. During 1971 it was found necessary to issue one hundred and fifteen warning letters and to institute proceedings as shown below: — Prosecutions Fined Costs FC 578 Foreign matter in milk Dairyman £25 £12 FC 593 & 594 Sour milk from vending machine Retailer £35 £10 FC 530 & 606 Insects in bread Manufacturer £40 £10 FC 619 Glass in peanut butter Manufacturer £30 £15 FC 657 Mould in sausages Retailer £25 £10 FC 663 Dirty dough in loaf Baker £20 £15.50 FC 685 Mouldy bread Baker £25 £10 FC 682 & 686 Mouldy bread Baker £25 £ 5 FOOD AND DRUGS ACT, SECTION 1 Number of Food Premises registered under the above-mentioned Act for: — (a) Sale or manufacture for purposes of sale of icecream or the storage of ice-cream intended for sale 573 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 202 SLAUGHTER OF POULTRY ACT 1967 There is one registered premises in the Borough at which the slaughter of poultry is carried out. The premises consist of a turkey farm on which 4-5,000 turkeys are raised annually. These birds are all slaughtered at the Christmas period, the main bulk between 12th to 20th December. Slaughter is carried out at two specially equipped units within the curtilage of the premises, both units are equipped with 85-volt stunning devices. The birds are dry plucked after slaughter and placed in chilled storage. No evisceration is carried out on the premises. In 1971 approximately 4,500 birds were slaughtered, the premises were visited on 14 occasions. No birds were rejected as unfit for human consumption. The 93 standard of hygiene maintained during the rearing and subsequent slaughter of the birds is very satisfactory, and the flock was carefully 'culled' during the rearing period to ensure that only healthy birds in good condition were kept for eventual slaughter. FOOD HYGIENE (GENERAL) REGULATIONS 1960 4,848 visits were made to premises where the provisions of these regulations apply. The table headed "Summary of Inspectors' Visits" gives a breakdown of the number of visits paid to various types of premises. Some contraventions were found and 106 informal notices were served. Two stallholders and the proprietors of a restaurant were successfully prosecuted, and a total of £170 fines and £47 costs were levied. The following premises in the Borough are subject to the requirements of the above-mentioned Regulations: — Bakers and Bakehouses 105 Butchers 166 Confectioners 227 Milk Dealers 170 Clubs and Hotels 135 Chemists 73 Fishmongers (wet, dried and fried) 63 Greengrocers 141 Grocers 273 Hospitals, Nursing Homes and Old People's Homes 76 Canteens 105 Public Houses161 School Canteens and Services 116 Cafes and Restaurants 178 MILK (SPECIAL DESIGNATION) REGULATIONS Licences to deal in specially designated milks were currently held as under: — Dealers (Pasteurisers) 1 Pasteurised 138 Sterilised 101 Ultra Heat Treated 116 Untreated 35 Licences authorising milk dealers to use special designations are issued for a period of 5 years. On 1st January 1971 it was 94 sary for all licence holders to make application for a renewal of their licences for a further period of five years, and a number took this opportunity of applying for approval to sell a wider variety of designated milks. RAG FLOCK AND OTHER FILLING MATERIALS ACT 1951 Samples of unused cotton waste, cotton millpuff, kapok and cotton felt were taken from stock in use at upholsterers' premises. All were found to be of a satisfactory standard. HOUSING AND SLUM CLEARANCE At the end of 1969 the Minister of Housing and Local Government requested Local Authorities to submit a four year programme of clearance of unfit houses. The first year programme (1970) was completed and during 1971 detailed surveys of the properties on the listed programme were carried out. Clearance Area Representations were made in respect of properties in Croydon Road, Beckenham; Lullington Road, Anerley; and three areas in Crampton Road, Penge; as detailed below. In addition, properties in Hamlet Road, Penge and Station Road, Penge, although not scheduled in the Slum Clearance Programme, were also dealt with as Clearance Areas. Clearance Areas 48, 50, 52, 54, 56 and 58 Croydon Road, Beckenham. 6, 8 and 10 Lullington Road, Anerley. 53, 55 and 57 Crampton Road, Penge (No. 1) 71 and 73 Crampton Road, Penge. (No. 2) 83, 85 87 and 89 Crampton Road, Penge. (No. 3) 34 and 36 Hamlet Road, Penge. 3, 5 and 7 Station Road, Penge. In 1971—9 Closing Orders were Represented and 2 Demolition Orders were made. General Improvement Area During the year officers of the Health Department cooperated with various other Departments in the establishment of the Penge East General Improvement Area. This involved carrying out House Condition Surveys, attendance at Public Meetings, and meetings with owners, tenants and other interested bodies, concerning the general improvement of the area. 95 Redevelopment Area Housing Surveys were also conducted in the South Penge Park area, which has subsequently been declared a Redevelopment Area. Housing Repairs, etc. Repair—Housing and Public Health Acts. Number of houses rendered fit by owners after service of Informal Notices—450, Formal Notices 107. Beyond Repair—Housing Act, 1957 Undertakings accepted (Sec. 16) Nil Closing Orders made (Sec. 17) 3 Demolition Orders made (Sec. 17) 3 Closing Orders made (Sec. 18) 6 Closing Orders determined (Sec. 27) 2 Closing Orders revoked and Demolition Orders substituted (Sec. 28) Nil Houses demolished following demolition orders Nil Clearance Areas Represented during year 7 Houses unfit for human habitation 23 Houses included by reason of bad arrangement, etc. Nil Houses on land acquired under Sec. 43 (2) Nil People to be displaced (a) Individuals 62 (b) Families 22 Houses demolished by Local Authority or owners (a) Unfit 90 (b) Others 63 Persons displaced from houses to be demolished or closed (a) Individuals 510 (b) Families 176 Compulsory Improvement of Dwellings Preliminary Notices served 3 Immediate Improvement Notices served Nil Formal undertakings given by owners to execute improvement work 2 Houses where works of improvement were completed during the year 7 Re-housing The following information has been supplied by the Housing Manager in respect of 1971: — New houses built 400 Families housed from waiting list 594 On waiting list at 31st December, 1971 4,294 96 Qualification Certificates The provisions of the Housing Act 1969 in respect of the issue of Qualification Certificates, and the relevant action required, and taken, by the Department were very fully described in last year's report and it is perhaps sufficient to record that work on similar lines has continued throughout 1971. During the year 378 applications were made, 352 certificates were issued, and 103 applications were refused, thus bringing the overall totals since 1969 to—1,171 Applications received, 674 Certificates issued and 245 Certificates refused. In 167 instances owners were required to carry out items of repair before the issue of Certificates could be approved, the variety and extent of the items being as follows:— Baths 9 Brickwork and Pointing 12 Ceilings 13 Doors 42 Electric Wiring 10 Fireplaces and Boilers 22 Fences and Gates 28 Gutters and Downpipes 41 Manhole Covers 3 Floors, damp and defective 18 Paintwork, External 53 Plaster-Walls 16 Skirting Board 10 Paving 14 Roofs 15 Rendering 6 Sink Wastes 11 Sinks 2 Stairs, defective 8 Steps 10 Tiling 16 Windows, frames 93 putties 61 cills 13 ill fitting 64 glazing 33 sashcords 26 reveal 4 Walls, damp and defective 39 97 Water heaters 5 Water taps 25 Water tanks 4 Washbasins 16 W.C.s, pans 13 cisterns 3 At the end of the year 252 applications were in abeyance, pending the completion of repairs required before the issue of certificates could be approved. RENT ACT 1957 No applications were made for Certificates of Disrepair during 1971. HOUSING INSPECTION Defects Remedied, Nuisances Abated by Informal Action. Drainage Drains: Constructed or Reconstructed 137 Repaired 226 Cleansed 1,210 Cesspools: Provided 3 Overflowing 22 Leaking— Abolished— Sanitary Appliances: Sinks, etc., provided 36 Sinks, etc., repaired 15 W.C.s provided 20 W.C.s repaired 63 Dampness: Roofs and rainwater fittings 379 Walls and stacks 313 Damp-proof courses and floors 93 98 Water Supply: Provided — Installations repaired 52 General Items: Wallplaster 411 Ceiling Plaster 192 Floors 148 Rooms cleansed or redecorated 95 Windows and doors 353 Ventilation 27 Staircases 26 Fireplaces, etc. (ex. Clean Air) 13 Yard paving and drainage 15 Dustbins 72 Food storage and preparation 85 Nuisances from animals abated 19 Accumulations removed 197 Premises disinfested 105 Premises disinfected 23 NOTICES Infringements found, either as a result of routine inspections, or following the investigations of complaints, are dealt with by informally requesting the owners or agents to apply a suitable remedy. If these requests are not acceded to after an appropriate interval Statutory Notices are served. 719 Informal Notices were issued of which 438 had been complied with by the end of the year. 131 Statutory Notices were served. During the year 107 Statutory Notices were fully complied with. MOVEABLE DWELLINGS The Caravan Sites and Control of Development Act 1960 prohibits the use of land as a caravan site without a site licence. Licences are issued by Local Authorities who may attach conditions to them to enforce a satisfactory standard of environment for the caravan dwellers. 99 At the end of the year there were six licences in force in the borough. Particulars of the licensed sites are as follows:— Location of Licensed Sites No. of Vans permitted The Paddock, Downe Road, Keston 12 Lower Hockenden Farm, Hockenden, Swanley 1 Crittenden Caravan Park, Pond Lane, High Street, West Wickham 35 Chalk Pit Caravan Site, St. Paul's Cray 25 11, Heathfield Road, Keston 23 Restavon, Berry's Green Road, Cudham, Nr. Biggin Hill 60 The Council has provided a site for twelve gipsy families at Star Lane, St. Mary Cray, which is managed by the Housing Department. Accommodation for an additional three families at this site was being considered at the end of the year. Under the Act, cases are cited where a caravan licence is not required. One of these is where the Minister may grant a certificate of exemption to any organisation as to which he is satisfied that its objects include the encouragement or promotion of recreational activities. The Caravan Club of Great Britain holds such a certificate in respect of a site at Crystal Palace which is capable of accommodating 80-100 vans. The period of stay is limited to 14 days and because of its proximity to London is much used by foreign visitors. DRAINAGE AND SEWERAGE Control of the trunk soil sewerage system is vested in the West Kent Main Sewerage Board and the Greater London Council. Certain types of public sewers and private drains, when found to be obstructed, are cleared by employees of the Health Department. 1,801 such clearances were effected, 1,005 being private drains, for which approved clearance charges were made. The Borough Engineer states that the following sewerage was provided during 1971:— Foul sewers 14,665 yards Surface water sewers 12,147 yards 1 Pumping Station including 139 yards of rising main. 100 DISINFECTION Articles of clothing, bedding etc. were dealt with at the steam disinfecting plant at Crofton Road Depot to which they were transported in specially constructed vehicles. Articles unsuitable for treatment by steam disinfection were disinfected by chemical methods. The disinfection of premises was undertaken by spraying with liquid disinfectants or by the use of chemical fumigants. Disinfection following notifiable infectious disease was carried out free of charge, a few requests were received for the use of the disinfecting service when notifiable disease was not involved and in such cases an approved nominal charge was made. DISINFEST ATION One hundred and nineteen requests were received for the treatment of premises and articles infested by vermin and insects and were dealt with by the use of insecticides in either liquid or powder form. This type of work was undertaken on payment of approved charges. WASP NEST DESTRUCTION Wasps were very prevalent during 1971, the number of nests destroyed, namely seven hundred and fifty one, being double the average for the last five years. The majority of complaints were received during July, August and September and at the peak period operators had to continue work into evenings and weekends to avoid a backlog. ATMOSPHERIC POLLUTION Smoke Control Orders Nos. 10 (Part Plaistow and Sundridge Ward, Part Bickley Ward), 11 (Part Farnborough Ward) and 12 (Copers Cope Ward) which had been previously confirmed by the Minister of Housing and Local Government came into operation and brought a further 8,970 premises and 2,634 acres of the borough under smoke control. There are now some 25 Smoke Control Orders in operation within the borough and these cover approximately 26% of the total area and approximately 43% of the premises. Confirmation of three further Orders designated London Borough of Bromley Nos. 13 (Part Bickley Ward), 14 (Part Farnborough Ward and Part Keston and Hayes Ward) and 15 101 (Part Manor House Ward) was received from the Department of the Environment during the year and the Orders will become operative on 1st July, 1972. The work in connection with installing smokeless forms of heating is at present in progress and grants are being made. The areas affected embrace approximately 2,276 acres and 9,597 premises. A survey of three areas in Chislehurst Ward, St. Paul's Cray Ward and Eden Park Ward, which it is hoped will be brought under smoke control at the end of 1972 was well under way by the end of 1971 and sufficient information has been obtained to enable a report to be prepared and submitted to the Health Committee early in the New Year. As the objectives of a General Improvement Area are the improvement of the houses and the environment, it was agreed as a matter of policy that all future General Improvement Areas should be brought under smoke control at the outset in order to keep air pollution to a minimum. Consequently that part of the Penge East General Improvement Area not already under smoke control comprising 203 premises, was surveyed and an Order made so that it could be established concurrently. Very few complaints of nuisance from the emission of industrial smoke and fumes were received during the year, but smoke from garden bonfires and the burning of waste material and felled trees on sites that were being cleared for re-development was a source of annoyance to residents. Because of the transient nature of the nuisance it is ordinarily possible only to take informal action in these cases. Strict control is exercised over the installation of new industrial plants and large central heating boilers to ensure that only plant is installed which is capable of being operated without emitting smoke. All new chimneys constructed to serve boilers etc. are now required to be of sufficient height to ensure effective dispersal of the effluent gases. Special investigations were carried out during the year in connection with complaints concerning grit and dust caused by the mechanical handling of gravel and ballast at a railway goods yard and solid fuel at two coal depots. Although some improvements have been effected problems of this nature are not easily resolved. The premises in question are being kept under observation. Routine measurement of air pollution has continued at four stations within the borough, but one does not have to produce figures to show that there has been a marked reduction in pollution levels over the years, because the benefits, i.e. improved winter visibility, increased winter sunshine and absence of smog, have been apparent to all. 102 Smoke Control Order No. Wards Operative Date Acres Premises Borough of Bromley No. 1 Bromley Common (part) 1.10.60 11 284 Borough of Bromley No. 2 Hayes & Keston (part) 1.10.60 70 443 Borough of Bromley No. 3 Hayes & Keston (part) 1.12.61 175 1,118 Borough of Bromley No. 4 Hayes & Keston (part) 1.12.62 130 896 Borough of Bromley No. 5 Hayes & Keston (part) 1.12.63 411 1,161 Borough of Bromley No. 6 Hayes, Keston (part), Martins Hill and Town (part) 1. 7.65 654 1,175 Chislehurst & Sidcup U.D.C. No. 1 Mottingham South 1. 7.64 225 2,417 Chislehurst & Sidcup U.D.C. No. 2 Mottingham North 1. 7.65 425 1,731 Borough of Beckenham No. 1 Manor House Ward (part), Eden Park Ward (part) West Wickham South (part) 1.11.61 307 2,667 Borough of Beckenham No. 2 West Wickham South (part) 1.10.63 534 2,870 Borough of Beckenham No. 3 West Wickham North 1.11.65 1,016 2,260 Penge U.D.C. No. 1 Penge (part) 1. 9.62 67 691 Penge U.D.C. No. 2 Penge (part) 1.10.63 48 738 London Borough of Bromley No. 1 Penge (part) 1.11.66 68 1,193 London Borough of Bromley No. 2 West Wickham North (part) 1.11.66 359 2,003 London Borough of Bromley No. 3 Martins Hill and Town Ward (part) 1.11.66 278 1.954 London Borough of Bromley No. 4 Petts Wood (part) 1.12.67 685 3,423 London Borough of Bromley No. 5 Martins Hill, Town Ward (part), Plaistow and Sundridge (part) 1.12.67 268 3,164 London Borough of Bromley No. 6 Anerley 1.12.67 346 2,436 London Borough of Bromley No. 7 Plaistow and Sundridge (part) 1.12.68 620 3,247 London Borough of Bromley No. 8 Petts Wood (part) 1.12.68 420 1,936 London Borough of Bromley No. 9 Petts Wood (part) 1.12.68 210 950 London Borough of Bromley No. 10 Plaistow, Sundridge, Bickley (parts) 1. 7.71 923 2,361 London Borough of Bromley No. 11 Famborough (part) 1. 7.71 921 3,176 London Borough of Bromley No. 12 Copers Cope (part) 1. 7.71 790 3,433 London Borough of Bromley No. 13 Bickley (part) 1. 7.72 674 4,464 London Borough of Bromley No. 14 Farnborough (part) 1. 7.72 1,261 2,649 London Borough of Bromley No. 15 Manor House 1. 7.72 341 2,484 103 RODENT INFESTATION The number of complaints relating to rats showed a substantial decrease (32% compared with 1970). This is thought to be due to a combination of the weather conditions obtaining during the breeding season and to one of the cyclic changes which occur in the rat population. The respite enabled the staff to concentrate more on long standing centres of infestation, such as tips, roadside banks, verges, streams, banks etc. where disinfestation is likely to show lasting results. For mice, however, the number of treatments were practically the same, showing that the increase of 38% reported last year has been maintained. Sewers: Rat infestation continues at a low level and there was evidence during the year of a further considerable reduction. Properties other than sewers Type of Property NonAgricultural Agricultural 1. Number of properties in district 122,388 323 2. (a) Total number of properties (including nearby premises) inspected following notification 4,474 5 (b) Number infested by (i) Rats 1,394 3 (ii) Mice 359 — 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 541 (b) Number infested by (i) Rats 117 3 (ii) Mice 9 1 FOX CONTROL 1971 was the second year during which the Department operated a fox control service. In the period immediately before the operation was taken over from the Ministry of Agriculture, Fisheries & Food, control had lapsed, resulting in an increase in the urban fox population. The number of complaints received during the year at 751 shows an increase of 133 over the previous 104 year, although the number of animals killed at 302 is a decrease of 44. The work of the Fox Control Officer has attracted much publicity, both in the national media and locally. The task of deciding where control has to be exercised requires considerable judgement and the comparative figures given above speak for themselves. PIGEON DESTRUCTION The feral pigeon is another creature which has substantially increased in past years. Like the fox it appears to be preferring an urban habitat and its numbers have become so excessive as to need control. The bird is a prolific breeder, nesting amongst other places under railway bridges, where its droppings give rise to nuisance, and in roof spaces, where considerable damage and fouling is caused. Trapping and shooting of the pigeons in public places is a particularly difficult operation, but one which has to be performed if the environment is not to be spoiled. As part of the system of control, periodic visits are made to known roosting sites, although, where possible, owners are asked to carry out proofing works to prevent ingress by the birds. In 1971 3,836 pigeons were accounted for, compared with 4,149 in the previous year. OFFICES, SHOPS & RAILWAY PREMISES ACT 1963 The following tables give details of the premises registered under this Act, the visits and inspections made, contraventions found, and accidents reported and investigated. None of the 65 accidents reported were of a serious nature, nor were they due to any negligence on the part of employers. Two-thirds of this number, in fairly even proportions, were due to the falls of persons, usually on the same level or on a fixed staircase, and also to the handling of goods. Advice was given in those cases where it was thought that certain measures could be applied to assist in preventing a recurrence. The Regulations controlling the safety of hoists and lifts in premises covered by the Act have now been in force for two years. Under the system of examination by "approved persons," usually insurance engineers, and reporting to Local Authorities, much of the more antiquated equipment has been replaced and considerable improvements achieved in suspension ropes, gates, guards and interlock mechanisms. No accidents involving hoists and lifts were reported. 105 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 (A) Registrations and General Inspections Class of premises No. of premises registered during the year No. of registered premises at end of year No. of registered premises receiving a General Inspection Offices 38 817 334 Retail shops 56 1,668 1,167 Wholesale shops, warehouses 5 63 37 Catering establishments open to the public, canteens 4 182 182 Fuel storage depots 1 13 13 Totals 104 2,743 1,733 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 2627 This total is slightly up on that of 1970, which reflects the easier staff position. (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 18 15 Eating facilities 2 5 Overcrowding — 16 Floors, passage and stairs 32 6 Temperature 22 17 Fencing exposed machinery 8 7 Ventilation 15 8 Lighting 3 18 Protection of young persons from dangerous machinery — 9 Sanitary Conveniences 15 10 Washing facilities 25 19 Training young persons working at dangerous machinery — 11 Supply of drinking water 4 12 Clothing accommodation 6 23 Prohibition of heavy work — 13 Sitting facilities — 24 First Aid—General Provisions 14 14 Seats (Sedentary Workers) — 50 Exhibition of abstract of Act 15 TOTAL 179 106 (C) Exemptions Nos. of applications received NIL (D) Prosecutions Number instituted NIL Number of complaints (or Summary applications made under Section 22) NIL Number of interim orders granted NIL (E) Reported Accidents: Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advice Offices 4 2 — — — 4 Retail Shops 50 41 — — 6 44 Wholesale Shops, Warehouses 7 6 — — 7 Catering Establishments open to the public 4 1 4 Canteens — — — — — — Fuel Storage Depots - - - - - - TOTALS 65 50 — — 6 | 59 Analysis of Reported Accidents: Offices Retail Shops Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery 1 — 1 — — Transport 1 3 1 — — Falls of persons 3 20 — 1 — Stepping on or striking against object or person — I — — — Handling goods — 13 5 3 — Struck by falling object — 3 — — — Fires and Explosions — — — — — Electricity — — — — — Use of hand tools — 5 — — — Not otherwise specified — 4 — — — 107 Prescribed Particulars on the Administration of the Factories Act, 1961 PART I OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 54 83 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 726 235 7 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 45 176 — - Total 825 494 7 — 2. Cases in which DEFECTS were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 3 3 — — - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 4 4 — — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) — — — 9 — (a) Insufficient — — — — — (b) Unsuitable or defective 4 4 — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 1 1 — — — Total 12 12 — 9 — 108 PART VIII OF THE ACT OUTWORK (Sections 133 and 134) No. of out-workers in August list required by Section 133(1)(c) Wearing Apparel—making, etc. 73 Lace, lace curtains and nets 1 Upholstery 4 Making of paper bags 1 Making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 Making of Christmas Crackers 1 Manufacture of lampshades 2 Total 86 Section 133: There were no cases of default in sending lists or prosecutions for failure to supply lists. Section 134: There were no instances of work in unwholesome premises. MORTUARIES The Council maintains two mortuaries at which proper facilities are provided for the Pathologist to carry out post mortem examinations. There were six hundred and fifty-five such examinations during 1971. The mortuary at Beckenham continues to receive full usage but that at Beaverwood, Chislehurst, is less used, most of the bodies originating from Queen Mary's Hospital, Sidcup. When the new hospital now being constructed on the site is completed, it is expected that it will provide public mortuary facilities for the whole of the London Borough of Bexley. Consideration will then be given to the closing of Beaverwood. 109 SWIMMING BATHS 62 samples of water were taken from swimming baths and pools available for public use, and were subjected to bacterial and chemical examination. All were of satisfactory standard with the exception of four instances where, chlorination of the water being found to be inadequate, the required adjustments were requested. There are the following baths and pools in the Borough:— Clubs, Hotels etc 6 Municipally owned 4 Council Schools 14 Private Schools 8 Greater London Council 3 The Greater London Council's Scientific Branch control the three pools at the Crystal Palace Sports Centre, and reports on samples taken by that Branch were submitted monthly. Swimming baths and pools owned by the London Borough of Bromley are controlled by the Baths' Manager and Engineer, who also provides practical assistance and advice in the management of Council School Baths. THE DISEASES OF ANIMALS ACT 1951 The City of London's Veterinary Department has continued to operate a service to undertake certain duties under this Act for the London Borough of Bromley and I am indebted to the Veterinary Officer, Mr. G. S. Wiggins, m.r.c.v.s., for the cooperation of his Department. REGULATION OF MOVEMENT OF SWINE ORDER Under the terms of this Order, one hundred and fifty-eight movement licences were received and verified. The restrictions and terms of these licences were properly complied with by the pigkeepers concerned. RABIES ORDER 1938 In February an animal was suspected to be suffering from rabies: fortunately tests undertaken at the Ministry's Laboratory proved negative, but pending this result precautionary measures were taken and a police van which had been used to convey the animal was satisfactorily disinfected. 110 ANIMAL (WASTE FOODS) ORDER 1957 Contrary to the terms of the above-mentioned Order, two poultry keepers were found to be feeding unboiled food scraps to poultry. They were requested to forthwith cease this practice, and have subsequently complied by boiling such food before feeding it to poultry. RIDING ESTABLISHMENTS ACTS 1964 AND 1970 The existing Riding Establishments in the Borough received annual inspections and were recommended for re-licensing. In addition a new riding establishment was inspected and recommended for the issue of a licence. These inspections are very comprehensive and concern the suitability of buildings, fire risks, general hygiene and also a veterinary inspection of the animals kept for hire. ANIMAL BOARDING ESTABLISHMENTS Inspections were made of the fourteen premises already licenced and the renewal of the licences were recommended. One new establishment was inspected and recommended for the issue of a licence. MISCELLANEOUS On two separate occasions, pig carcases were found dumped on waste ground. They were examined for the presence of infection but were found to have died from non-infectious conditions. The carcases were subsequently buried in lime. ANIMAL KEEPERS ETC. The undermentioned premises where animals are kept are situated in the Borough and were from time to time inspected. No irregularities were found:— No. of Premises Inspections Stock Keepers 29 65 Farms 39 112 Pig Keepers 43 294 Poultry Keepers 25 59 Horses 4 8 Slaughterhouse 1 80 Laboratory—Research 1 2 Riding Establishments 14 25 Animal Boarding Establishments 15 23 Ill RIDING ESTABLISHMENTS ACT, 1964 Fourteen applications were received for the grant of licences to keep Riding Establishments. The premises were inspected and were referred to, and reported upon, by a Veterinary Surgeon and a Fire Prevention Officer. All animals available to be hired from the premises were also examined by Veterinary Surgeons. Conditions were satisfactory and the licences were issued. During the year eighty seven routine inspections were made and on twenty three occasions minor infringements were found and were remedied by informal action. PET ANIMALS ACT 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to twenty eight applicants. The majority of the businesses were on a small scale, selling fish, tortoises, birds and small animals. A total of fifty five visits were made to the premises, nineteen contraventions of the terms of the licences being found and remedied. ANIMAL BOARDING ESTABLISHMENTS Fifteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at these premises for boarding 379 dogs and 281 cats. Seventy-seven visits were made to these premises during the year—seven contraventions of a minor nature being remedied by informal action. SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS General Sanitation Agricultural Welfare 5 Animal Boarding Establishments 77 Caravans 261 Cesspools 685 Common Lodging Houses — Drainage 2,314 Filthy Premises 72 Fouling of Footpaths 6 Hairdressers 184 Keeping of Animals 91 Noxious Accumulations 606 112 Piggeries 33 Public Conveniences 106 Rivers, etc 108 Schools 96 Swimming Baths—Public 24 Swimming Baths—Private 39 Theatres, etc 17 Verminous Premises 167 Housing Housing Acts (Clearance) 447 Housing Acts (Improvement) 779 Overcrowding 51 Public Health Acts 6,680 Houses in Multiple Occupation 496 Rent Act 1,187 Factories, etc. Factories with power 235 Factories without power 83 Building Sites 176 Outworkers 14 Offices, Shops and Railway Premises General Inspections—Offices 388 Retail Shops 954 Wholesale Shops and Warehouses 42 Catering Establishments and Canteens 242 Fuel Storage Depots 30 Visits of all kinds (including above) 2,276 Food Premises—Food Hygiene Regulations Bakers' Shops 416 Bakehouses 253 Butchers 722 Dairies 152 Fishmongers 335 Greengrocers 612 113 Grocers 1,122 Ice Cream 186 Merchandise Marks 96 Restaurants 683 Slaughterhouses 62 Stalls 209 Food Complaints 160 Inspection of Foodstuffs Meat—Slaughterhouses 69 Meat—Wholesale Depots 71 Meat—Retail Shops 190 Other Foods 604 Rodent Control Agricultural premises 34 Non-agricultural premises 346 Water Supply 139 Noise Abatement 461 Pharmacy and Medicines 7 Rag Flock and Other Fillings Act 15 Riding Establishments Act 87 Pet Animals Act 55 Clean Air Act Nuisances 308 Industrial premises 170 Smoke Control Areas 11,292 Pigeons Infestations 87 Infectious Diseases General 503 Food Poisoning 185 Disinfection supervision 15 Surveillance of Infectious Diseases Contacts etc. 500 114 Nursing Homes and Child Minders 126 Sampling Egg Products 5 Food and Drugs 856 Ice Cream (Bacteriological) 100 Milk (Bacteriological) 339 Water—Drinking 26 Rivers, etc 5 Swimming Baths 58 Rag Flock Act 1 NOTICES SERVED Informal Notices: Public Health and Housing 719 Others 216 Complied with at the end of year: Public Health and Housing 438 Others 141 Statutory Notices: Public Health Act 123 Housing Act 8 Clean Air Act 2 Complied with at the end of year: Public Health Act 99 Housing Act 8 Clean Air Act 2 WATER SUPPLY The main water supply in the borough is provided by the Metropolitan Water Board, and I am indebted to the Director of Water Examination of that Authority for the following information: 1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the 115 pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1971, was 304,178. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations: — River Thames—derived water from The Thames Valley Group. Well water from Eynsford, Horton Kirby, Lullingstone, North Orpington, Orpington, Shortlands, Sundridge and West Wickham Pumping Stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also lead. 116 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY, 1971 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. B.O.D. 5 days at 20°C. Hardness (total) CaCO 3 Hardness (non-carbonate) CaCOa Magnesium as Mg Sodium as Na Potassium as K Chloride as CI Phosphate as PO4 Silicate as SiO2 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (ID (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames derived 364 0.029 0.084 6.1 1.04 281 90 5 23.5 5.1 34 2.3 10 64 0.15 0.02 0.1 13 7.8 580 Eynsford 8 0.009 0.016 4.9 0.06 266 52 19 0.10 0.0 1 7.3 500 Horton Kirby 9 0.004 0.014 5.8 0.07 268 59 19 0.10 0.0 0 7.3 480 Lullingstone 9 0.004 0.014 5.0 0.06 257 41 15 0.10 0.0 1 7.3 470 North Orpington 8 0.007 0.015 5.5 0.06 265 31 15 0.10 0.0 2 7.2 510 Orpington 4 0.009 0.016 7.0 0.08 295 59 18 0.10 0.0 1 7.1 550 Shortlands 11 0.007 0.022 5.6 0.08 294 83 25 0.10 0.0 0 7.3 540 Sundridge 17 0.006 0.013 4.3 0.04 222 57 20 0.10 0.0 2 7.5 420 West Wick ham 2 0.014 0.033 5.8 0.10 282 52 20 0.10 0.1 0 7.5 530 BACTERIOLOGICAL RESULTS—YEARLY AVERAGES, 1971 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply Number of samples BEFORE TREATMENT Escherichia coli count Number of samples AFTER TREATMENT Agar plate count per ml. Coliform count Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37°C. 3 days at 22°C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. River Thames-Derived 8,154 53.9 40.37 12.2 54.91 5.1 3,901 8.4 99.51 99.97 Eynsford Well 161 0.0 10 98.14 — 98.14 — 255 0.1 13 100.0 100.0 Eynsford Borehole 197 0.0 3 99.49 0.1 99.49 0.1 Horton Kirby No. 1 Horton Kirby No. 2 134 169 0.0 0.0 29 5 88.81 98.22 0.3 95.52 98.82 0.1 251 0.1 3 100.0 100.0 Lullingstone No. 1 108 0.2 104 100.0 — 100.0 — 250 0.0 35 99.60 100.0 Lullingstone No. 2 158 0.0 9 98.73 — 98.73 — 218 4.5 85 12.84 18.3 31.65 5.3 254 1.1 23 99.61 99.61 169 4.8 79 17.16 22.8 39.64 6.3 Orpington 251 0.2 5 98.41 99.60 — 254 0.1 3 100.0 100.0 Shortlands No. 1 153 0.2 44 98.69 — 99.35 — 254 0.0 3 100.0 100.0 Shortlands No. 2 123 0.2 30 96.75 0.1 100.0 — 223 0.2 63 100.0 — 100.0 — Sundridge No. 1 157 4.5 60 99.36 — 99.36 — Sundridge No. 2 187 0.5 335 99.47 — 100.0 — 255 0.2 230 100.0 100.0 Sundridge No. 3 199 0.1 513 100.0 — 100.0 — Sundridge No. 4 184 1.3 382 100.0 — 100.0 — West Wickham 114 1.4 132 96.49 0.1 100.0 116 0.0 47 100.0 100.0 117 SCHOOL HEALTH SERVICE SCHOOL HEALTH SERVICE INDEX Page Page Members of Education Audiology Service 145 Committee 121 B.C.G. Vaccination 135 Minor Ailments 133 Otieyne Hospital 150 Ophthalmic Clinics 133 Child Guidance 140 Orthopaedic Clinic 135 Cleanliness Inspections 129 Orthoptic Clinic 133 Clinics 164 Other Inspections 128 Defects—Periodic and Special ther Medical Examinations 158 Medical Examinations 130 Periodic Medical Inspections 128 Diseases of Ear, Nose and Throat 134 phoenix Centre 149 Diseases of Skin 135 Physiotherapy Clinic 135 Employment of Young Prefatory Letter 123 Children 158 Rubella 136 Follow-up Examinations 129 School Health Service 126 Handicapped Pupils 148 School Meals and Milk Service 158 Health Education and Home School Psychological Service 142 Safety 160 Speech Therapy 137 Health Visiting 159 Special Inspections 129 Independent Schools 131 Special Schools 154 Infectious Diseases 137 Staff 122 120 121 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December, 1971) *Councillor F. J. Packer, F.C.I.S. (Chairman) *Councillor J. F. David (Vice-Chairman) Alderman A. T. Johnson, J.P. (Mayor) Alderman Mrs. A. L. Gunn, J.P. Alderman Miss B. H. James, J.P. Alderman C. H. E. Pratt *Alderman R. A. Sanderson, J.P. Councillor Mrs. J. Bryant *Councillor Mrs. N. V. Carter *Councillor R. D. Foister *Councillor D. W. Giffin Councillor Mrs. M. A. Goffe *Councillor Mrs. M. I. F. Harvey Councillor R. W. Huzzard Councillor R. J. Inniss *Councillor R. A. Knox-Johnston Councillor M. G. Law *Councillor Mrs. M. C. McClure, B.Sc. Councillor M. J. Mason Councillor H. J. Palmer Councillor K. A. Pawsey *Councillor Mrs. J. Tatham Councillor W. F. D. Walker Councillor St. J. E. F. Ward *Councillor O. K. Williams *Councillor Mrs. J. K. Wykes Co-opted Members: Mr. J. Atkins, J.P. Mr. N. K. H. Bailey, B.A., B.Sc. Mr. J. Davies Miss M. C. Grobel, M.A. The Rev. Canon S. H. Hoffman, M.A. *Mr. N. L. Hevey Miss E. M. Huxstep, C.B.E., B.A. *Mr. J. W. Watts Mrs. K. G. Wheeler Mr. C. E. Wiltshire, J.P. *Denotes Members of Primary Education and Welfare SubCommittee. (one vacancy) CHIEF EDUCATION OFFICER—D. R. Barraclough, M.A., Dip.Ed. 122 STAFF OF THE SCHOOL HEALTH SECTION (as at 31st December, 1971) Principal School Medical Officer: L. R. L. Edwards, m.D.(Lond-), m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Deputy Principal School Medical Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer: P. A. Currie, m.r.c.s., l.r.c.p. *9 Medical Officers in Department. Principal Dental Officer: Mrs. C. M. Lindsay, l.d.s., R.F.P.s.(Glasgow). *6 Dental Officers. *1 Dental Officer. *4 Sessional Dental Officers. *9 Dental Surgery Assistants. *1 Dental Hygienist. *2 Anaesthetists (sessional). Senior Speech Therapist: *Miss V. M. Connery, l.c.s.t. *1 Speech Therapist (full time). *2 Speech Therapists. 4 Ophthalmologists. †1 Orthoptist. †l Physiotherapist. †l Orthopaedic Surgeon. †l Consultant Psychiatrist. Superintendent Health Visitor: *Miss B. N. Chandler, s.r.n., s.c.m., h.v.Cert., Dip.Soc.Studies(Lond.). Deputy Superintendent Health Visitor: * Mrs. L. A. Hamilton, s.r.n., c.m.b. Part 1, h.v.Cert. Group Adviser: *Miss C. M. Paxton, s.r.n., s.c.m., h.v.Cert. *40 Health Visitors. Chief Administrative Officer: D. J. Tinson, Inter., d.m.a. Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant. 10 Clerical Assistants. 1 Clinic Clerk (full time). †2 Clinic Clerks. †l Shorthand Typist. * Also employed in the Maternal and Child Health Service. † Part time. 123 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the seventh annual report of the School Health Service of the London Borough of Bromley. The health of the schoolchildren has continued satisfactorily as revealed in the medical examinations at maintained and independent schools by a one per cent decrease in the number of pupils referred for treatment. Though the backlog in medical inspections will be reduced, there was a decrease of 2,075 medical examinations which will need to be completed as soon as possible. Immunisation Service The only schemes carried out as part of the school medical service are B.C.G. vaccination of children in the 13-14 age group and Rubella vaccination for girls between their 11th and 14th birthdays; 3,252 pupils received B.C.G. vaccination and 4,216 pupils received Rubella vaccination. The acceptance of Rubella vaccination has quickly reached 73.3% and indicates the ready acceptance by the public of measures designed to reduce the incidence of congenital handicaps. In B.C.G. vaccination against tuberculosis the number of children who gave a positive reaction because of previous vaccination increased by 44 and the number of children referred to the Chest Clinic for further examination to exclude tuberculosis decreased by 22. Though these figures are small they represent a trend whereby in the foreseeable future the epidemiological need for routine B.C.G. vaccination will need to be reassessed. Audiology and Speech Therapy The shortage of qualified speech therapists is part of a national shortage of therapists which is noted in other fields of therapy such as psychotherapy and physiotherapy. Against this background the efforts of the various services have been directed towards greater integration with the Hospital Service and priority to diagnostic assessment. In speech therapy while there has been some delay in treatment and unfortunately lack of provision at Goddington Special 124 School the general waiting list for diagnostic assessment has been reduced. At the same time there has been an increase in preschool group therapy for language handicapped children. This is a most important group of deprived children who can be helped by the therapist in preparation for the increased language opportunity that formal school will provide. The Report also shows the valuable attendance of students from a number of schools of speech therapy and schools of Speech and Drama. In audiology this has been a year of consolidation and reassessment of aims and objectives. The four main objectives are set out later in this Report, and the multidisciplinary team basis of integration with the medical practitioner and Hospital services, now and in future, are clearly delineated. The sound base that has been laid in educational treatment for hearing impaired children in the past two years at the Darrick Wood Unit supplemented by the valuable peripatetic service provided by Teachers of the Deaf can be built on by the provision of a secondary unit in the new Darrick Wood School. The absence of Dr. Gaynor Lewis from full duty from January to September 1971 was a severe handicap but this popular officer has now returned to the service. Handicapped Pupils and School Psychological Service The integration with the Hospital service that already exists is shown in the Reports from Farnborough Hospital concerning special services at Cheyne Hospital, West Wickham and the Phoenix Centre, Farnborough Hospital. This is further emphasised in the Report on Child Guidance. In the latter Report it is alarming to read of the increase in numbers referred for school phobia and truancy and for drug abuse. Previous Reports have referred to the pressures on the Child Guidance Clinic because of lack of a psychotherapist. Part of this difficulty is that only on one day are facilities available, a difficulty which is inherent in the multipurpose use of the building for so many different purposes. Continued collaboration internationally with teams from the United States and France through the Institute of Psychiatry, University of London on a pilot study relating to childhood psychiatry is a tribute to Dr. Rodriguez and a valuable contribution of this Clinic to research. Members will note in the section of the Report the important 125 changes brought about by the Education (Handicapped Children) Act 1970. An important consequence of the Act locally is that Woodbrook Training Centre for mentally handicapped now becomes a Special School. The activities of our five Special Schools, Woodbrook, Goddington, Grovelands, St. Nicholas and Cheyne are reported in detail later. Future Trends It is now clear that important legislation in the next few years will provide a framework in which total integration of health including school health, medical practitioner and Hospital service is possible. It is important that in the intervening period there should be no interruption of forward plans for the School Health Service and that there should be no loss of morale among staff; but the present lack of skilled staff in every field of medical, dental, nursing and technical services must dictate for many years ahead the speed of change. In conclusion, I wish to thank the Chairman and Members of the Education Committee for their support and understanding of the changes that new advances in medical care and in legislation have brought to the School Health Service. The practical application of these changes in Bromley have in no small measure owed their success to the co-operation of the Principal School Medical Officer and staff with the Chief Education Officer, Mr. Barraclough, his staff, in particular, Mr. Chamberlain, and with the Heads of Schools throughout the Borough. Dr. P. A. Currie, Senior Medical Officer, supported by Miss D. Gardner, has been responsible for the day to day medical administration of the Service and has given me valuable advice and help throughout the year. The Principal Dental Officer, Mrs. C. M. Lindsay, has managed her service with her customary tact and efficiency. To these Section Heads and to the supporting professional, clerical and technical staff I offer my most sincere thanks and hopes for the future. L. R. L. EDWARDS, Principal School Medical Officer. 126 SCHOOL HEALTH SERVICE The Borough has a duty to provide for the medical inspection at appropriate intervals and to make arrangements for securing the provision of free medical and dental treatment to pupils in attendance at Maintained Schools. The School Health Service, under the direction of the Principal School Medical Officer, administers these services on behalf of the Borough. It is the aim of the School Health Service, in collaboration with the Education Department, to be satisfied, by means of these medical examinations, that every child is able to receive the type of education best suited to his age, aptitude and ability. There are 34 Secondary Schools (including 2 Direct Grant) and 90 Primary Schools in the Borough; also 4 special day schools for educationally subnormal children, and one hospital school. In January there were 48,119 pupils (an increase of 1,253) on the registers of the Maintained Primary, Secondary, Special and Nursery Schools. It is the aim to give statutory routine medical inspections to all pupils entering the infants' school and to repeat these when they reach the age of 10 years and 14 years. In addition at 8 years of age pupils are given routine tests of vision and hearing alone; a full medical examination is undertaken at this age only if, for any reason, it appears necessary. Further, when at any time during a child's school career the head teacher, parent or doctor is concerned about the health of a particular child in relation to school education or activity, arrangements are made for special examinations to be carried out. Private schools may participate in the School Health Service at request. The total number of children attending both Maintained and Independent Schools who were examined in the routine age groups was 12,293. The physical condition of all the pupils inspected was satisfactory and 1,632 pupils (13.3%) were found to require treatment. A further 2,729 children were given routine tests of vision and hearing, as a result of which 103 pupils (3.8%) were referred 127 for treatment because of visual defects and 36 pupils (1.3%) were referred for treatment because of hearing defects. Follow-up examinations, referrals to General Practitioners, specialist clinics and to Hospital Consultants were arranged as and when necessary. Further details of these examinations will be found later in the report. It will be appreciated that Medical Officers devote about half of their time to the School Health Service. The arrangement of identification of an area based around the Child Health Clinics has worked very satisfactorily, as it enabled a continuity of service to be given to the family. As was noted in the Report for the year 1970, a number of medical examinations had to be postponed until the following year due to the shortage of Medical Officers. However, owing to an even greater shortage of Medical Officers during 1971, the year ended with yet another backlog of work. The appointment of a Audiometrician, who commenced her duties in September, will relieve the Medical Officers of the duty to carry out Hearing and Vision tests of the eight-year-old children, and this will certainly ease the situation. One continues to hope that the outstanding vacancies for Medical Officers will be filled and as a result the annual programme of medical examinations completed. An intensive programme was carried out of Rubella vaccinations which has resulted in the completion of a programme to offer this protection to girls in the three age groups who were born in 1957, 1958 and 1959. The result of this is that following the Ministry's recommendation that this protection should be provided for girls between their 11th and 14th birthday, the youngest age group possible can now be offered this protection annually. Details are given later in this report. It is opportune at this point to recognise the great cooperation and goodwill which is extended to the School Health Service by the Head Teachers and staff of schools within the Borough, when medical examinations are carried out. This enabled the maximum number of children to be seen, which is especially to be remembered where real difficulties of accommodation exist. In conclusion, the most significant change which has occurred this year has been the amendment of the Education Act; further details regarding this are reported under Handicapped Pupils. 128 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND SPECIAL SCHOOLS) TABLE A—PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of Pupils who have received a full medical examination Physical of Pupils Condition Inspected No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory No. Unsatisfactory No. (1) (2) (3) (4) (5) (6) (7) (8) 1967 and later 47 47 — — — 4 4 1966 1,914 1,914 — — 79 205 270 1965 3,169 3,169 — — 132 286 401 1964 193 193 — — 3 25 27 1963 47 47 — 2,719* 3 5 7 1962 25 25 — — — 1 1 1961 963 963 — — 51 76 126 1960 1,838 1,838 — — 126 189 299 1959 20 20 — — 1 4 5 1958 11 11 — — — 2 2 1957 3,181 3,181 — — 175 187 351 1956 and earlier 124 124 — — 1 4 5 TOTAL 11,532 11,532 — 2,719* 571 988 1,498 The physical condition of all the children inspected was satisfactory. Tests of Vision and Hearing only at age of eight years. 102 Pupils referred for treatment because of Visual Defect. 36 Pupils referred for treatment because of Hearing Defect. Other Inspections Number of Special Inspections 1,801 Number of Re-inspections 2,465 4,266 129 Special Inspections Special inspections are carried out at any time during a child's school career if the head teacher, family doctor, parent or health visitor is concerned about the health of a particular child. A total of 1,801 special inspections was carried out during the year. Re-Inspections A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. A total of 2,465 re-inspections was carried out during the year. Follow-up Examinations Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. Cleanliness Inspections These inspections are carried out by the Health Visitors. Children in the Infants Departments are inspected during the first six weeks of each term. Inspections in the Junior and Secondary schools are also carried out each term unless clear inspections are reported for three consecutive terms. In addition to the above, inspections are carried out at any time if and when necessary. (a) Total number of individual examinations of pupils in schools by Health Visitors 39,032 (b) Total number of individual pupils found to be infested 317 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 38 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 5 130 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS—MAINTAINED SCHOOLS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total 4 Skin T O 77 64 97 238 3 46 9 37 92 2 5 Eyes—a. Vision T O 211 176 184 571 194 502 242 354 1,098 398 b. Squint T O 34 2 2 38 3 30 2 3 35 1 c. Other T O 10 — 12 22 — 8 6 9 23 2 6 Ears—a. Hearing T O 44 9 16 69 76 304 61 85 450 268 b. Otitis T Media O 32 2 4 38 1 23 — 6 29 1 c. Other T O 1 1 5 7 — 14 1 7 22 — 7 Nose and Throat T O 77 22 19 118 3 202 15 64 281 15 8 Speech T O 30 4 6 40 11 67 3 23 93 13 9 Lymphatic Glands T O 6 — 4 10 — 38 1 4 43 2 10 Heart T O 4 1 1 6 — 29 8 11 48 4 11 Lungs T O 52 14 19 85 2 74 24 40 138 4 12 Developmental— T a. Hernia O 9 5 15 29 — 25 — 4 29 — b. Other T O 11 1 12 24 8 66 10 21 97 30 13 Orthopaedic— T a. Posture O 3 12 6 21 1 16 31 42 89 8 b. Feet T O 42 14 21 77 10 54 26 76 156 5 c. Other T O 15 13 7 35 3 29 24 28 81 5 14 Nervous System— T a. Epilepsy O 4 4 4 12 1 13 — 4 17 3 b. Other T O 4 2 2 8 — 69 7 7 83 2 15 Psychological— T a. Development O 8 2 11 21 11 61 6 8 75 14 b. Stability T O 5 4 8 17 12 112 32 83 227 26 16 Abdomen T O 20 6 12 38 — 61 8 6 75 4 17 Other T O 7 9 6 22 4 25 24 36 85 22 T = TREATMENT O = OBSERVATION 131 INDEPENDENT SCHOOLS Independent Schools, which so desire, have continued to participate in the School Health Service. At present 16 such schools take advantage of the facilities provided by the Service. Subject to their parents' consent pupils attending these schools receive routine medical inspections (at the same ages as children attending maintained schools), and also have the advantage of access, where necessary, to the specialist clinics. Arrangements are also made as and when necessary for the special examination of any child. During the year 761 children were medically inspected and a further 10 children received tests of vision and hearing only. In addition, a total of 11 special inspections and 19 re-inspections was carried out. Further details, with a summary of the various defects found at these examinations are as follows: — PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of Pupils who have received a full medical examination Physical Condition of Pupils Inspected No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory Unsatisfactory (1) (2) (3) (4) (5) (6) (7) (8) 1967 and later 9 9 — — — 3 3 1966 62 62 — — — 5 5 1965 70 70 — — 1 12 13 1964 25 25 — — 3 4 7 1963 27 27 — 10* 2 1 3 1962 6 6 — — 2 — 2 1961 61 61 — — 7 10 17 1960 119 119 — — 5 8 13 1959 35 35 — — 1 1 2 1958 30 30 — — — — — 1957 255 255 — — 33 34 67 1956 and earlier 62 62 — — — 2 2 TOTAL 761 761 — 10* 54 80 134 The physical condition of all the children inspected was satisfactory. *Tests of vision and hearing only at age of eight years. 1 pupil referred for treatment because of visual defects. - pupil referred for treatment because of hearing defects. OTHER INSPECTIONS: Number of Special Inspections 11 Number of Re-inspections 19 30 132 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS—INDEPENDENT SCHOOLS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total 4 Skin T O 3 12 6 21 — 3 4 2 9 — 5 Eyes—a. Vision T O 1 33 20 54 2 27 22 26 75 3 b. Squint T O 1 3 — 4 — 1 1 1 3 — c. Other T O — 2 — 2 — 1 — 1 2 — 6 Ears—a. Hearing T O 2 1 1 4 1 13 2 9 24 — b. Otitis T Media O — 1 1 2 — 1 1 — 2 — c. Other T O — — — — — — — 1 1 — 7 Nose and Throat T O 4 1 3 8 — 10 2 3 15 — 8 Speech T O 2 — 1 3 — 2 — 1 3 — 9 Lymphatic Glands T O — — — — — — — 1 1 — 10 Heart T O — — — — — — 1 1 2 — 11 Lungs T O 2 3 2 7 — 1 3 3 7 — 12 Developmental— T a. Hernia O 2 — — 2 — 2 — — 2 — b. Other T O — 3 3 6 — 1 1 3 5 — 13 Orthopaedic— T a. Posture O — 1 — 1 — — — — — — b. Feet T O 2 4 — 6 — 4 7 3 14 — c. Other T O — 3 — 3 — 2 4 3 9 — 14 Nervous System— T a. Epilepsy O — — — — — — — — — — b. Other T O — — 1 1 — 1 — 1 2 — IS Psychological— T a. Development O — — — — — — 1 — 1 — b. Stability T O — — 2 2 1 — — 2 2 — 16 Abdomen T O 2 1 1 4 — 2 7 — 9 — 17 Other T O — 1 3 4 — 1 4 1 6 — T—TREATMENT O—OBSERVATION 133 Minor Ailments Minor ailments are treated by the Health Visitors at the Clinics, or at school if requested by the Head Teacher. These arrangements are found to avoid loss of school time which would otherwise be inevitable. During the year a total of 295 pupils was treated. Treatment of Pupils EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with: — External and other, excluding errors of refraction and squint 9 Errors of refraction (including squint) 3,444 Total 3,453 Number of pupils for whom spectacles were prescribed 1,638 Ophthalmic Clinics These Clinics are situated at Beckenham, Bromley, Chislehurst, Orpington, Penge and St. Paul's Cray. A total of 9 weekly sessions is held at these centres. In addition, a session is held every other week at Bromley. A total of 558 new cases and 2,895 re-examinations was seen at the Clinics. It would seem unnecessary to stress how vital it is that children's vision should be checked. It is not universally appreciated how defects of vision are often accepted by a child, and the parents are, therefore, not alerted to their existence. In spite of this it is surprising the wastage that occurs from appointments not being kept. Regrettably, in some cases no message is received either, which leads to difficulties in making up full appointment lists. Orthoptic Clinic Patients seen at this Clinic are always referred by an Ophthalmologist. Two weekly sessions are held at the Bromley North Clinic, and one session per week at The Willows Clinic, Chisle- 134 hurst. Patients not living in the areas served by these two clinics are seen at the nearest local Hospital. The following types of cases are referred: — (a) Cases of obvious strabismus or squint. (b) Patients suspected of having a strabismus. (c) Amblyopic patients. (d) Patients with any ocular muscle imbalance. (e) Patients who are complaining of ocular symptoms, the cause of which is not obvious to the Ophthalmologist. Details of treatments and attendances are as follows: — Number of new cases 60 Number on treatment 71 Number on occlusion 116 Number of treatments given 111 Number of cures with operation 4 Number of cures without operation 22 Cases discharged—cured: (a) Functional for binocular single vision 20 (b) Cosmetic 7 Total number of attendances 628 Transferred or left the district Nil Number of sessions 139 Number on waiting list at 31.12.71 5 Diseases and Defects of Ear, Nose and Throat Number of cases known to have been dealt with: — Received operative treatment: — (a) for diseases of the ear — (b) for adenoids and chronic tonsilitis 482 (c) for other nose and throat conditions 270 Total 752 Total number of pupils in schools who are known to have been provided with hearing aids: — (a) during 1971 16 (b) in previous years 85 135 Orthopaedic and Postural Defects Number known to have been treated: — (a) Pupils treated at clinics or out-patients 132 (b) Pupils treated at school for postural defects — 132 Orthopaedic Clinic The Clinic is situated at Bromley North and caters for the surrounding population. Other parts of the area are covered by various Hospital Out-patient Departments. The attendances continued to be good and the Clinic is held according to need, which is approximately once a month. Physiotherapy Clinic Cases are treated at the Bromley North and Beckenham Town Hall Clinics and at Hospital Out-patient Departments. The majority of cases attending for treatment were referred direct from the Orthopaedic Consultant. Cases of general debility were referred to the Clinics for a course of sunlight. A total of 949 attendances was made at the two Clinics and of these 765 were for remedial exercises, etc., and 184 for sunlight. Diseases of the Skin (excluding uncle online ss) Number of pupils known to have been treated: — Ringworm—(a) Scalp 1 (b) Body 2 Scabies 24 Impetigo 2 Other skin diseases 117 146 B.C.G. Vaccination In the effort to eradicate tuberculosis, B.C.G. vaccination was again undertaken, with parental consent, on children in the 13-14 year age group, who are found to need this form of protection following upon a skin test. In addition, those who are shown by the skin test to need further investigation are referred, with the approval of the family doctor, to the appropriate Chest Clinic. During the year 3,629 children received a skin test and the 136 3,252 negative reactors received B.C.G. vaccination. Of the 206 children who were found to have a positive reaction to the skin test, 30 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 176 children who gave a positive reaction because of previous B.C.G. vaccination. Rubella As has already been mentioned at the beginning of this Report an intensive programme of Rubella vaccination was undertaken this year because the Department of Health and Social Security had recommended that vaccination against Rubella (German Measles) should be offered to all girls between their 11th and 14th birthdays, with initial priority being given to the older girls in this group. This is to ensure that as many girls as possible are offered protection against Rubella by vaccination, before reaching child-bearing age. Although the disease itself is mild, there are well-established associations between an attack of Rubella during pregnancy and the occurrence of serious abnormalities in the unborn child. Certain difficulties were experienced in phasing this with the B.C.G. programme due to the necessity of an interval of at least four weeks between these vaccinations, but with the experience gained this year and also the fact that the age group has been lowered in the case of the Rubella vaccinations, such difficulties have now been resolved. During the year the following programme of Rubella vaccinations was carried out: — Age Group Term No. of Vaccs. carried out. 1957* Spring 977 1958 Summer 1,616 1959 Autumn 1,623 Total number of vaccinations carried out during the year: 4,216 *Balance of age group (part carried out Autumn term 1970). It is gratifying to record that the average acceptance rate for the vaccination was 73.3% 137 Infectious Diseases 774 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as below: — Disease Total No. of Cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Dysentery 6 — 4 2 — *Food Poisoning 3 — 1 1 1 Inf. Jaundice 7 2 3 2 — †Measles 666 320 248 86 12 Meningitis 2 — 1 — 1 Scarlet Fever 51 12 19 6 14 Tuberculosis (Pul.) 1 — — 1 — Whooping Cough 37 21 8 8 Malaria 1 1 — — — Totals 774 356 284 106 28 Speech Therapy This year has once more seen some changes of staff. We filled one full-time post in February and one part-time post in May. But, with the resignation of a full-time Therapist in November, we are still left with two full-time posts vacant. We have attempted to keep the clinics in all areas open but with staff shortages some children have unfortunately to wait some time for treatment after the initial diagnostic interview. The Pre-School Group Therapy for language handicapped children is however gradually being expanded and continues to be well worthwhile. Once again this year we had three students from The Central School of Speech Therapy and two students from the OldreyFleming School of Speech Therapy, attending the Bromley Clinic; we also had two students from the Kingdon-Ward School of Speech Therapy for a month of practical training during their summer vacation. As in previous years we have had visits from the Rose Bruford College of Speech and Drama for observation study and from several girls who are contemplating Speech Therapy as a career. 138 The figures for 1971 are as follows: — Number of children referred by: — 1. Medical Officers in Department 97 2. Head Teachers 34 3. Hospital Consultants 4 4. General Practitioners 7 5. Parents 31 6. Health Visitors 28 7. Educational Psychologist 3 8. Teachers of the Deaf 2 9. Other Districts 3 Total 209 Number of Children seen in Clinic 524 Number of Children seen in Special Schools (Including Cheyne Hospital) 89 613 Number of attendances: — 1. Clinics 4,583 2. Special Schools (Including Special Opportunity Classes) 1,195 The numbers for Special Schools do not include Goddington, as no Speech Therapist was available to work there. Number of Home Visits 137 Number of School Visits 38 Number of Initial Interviews 160 139 Distribution of Cases: — Stammer 42 Dyslalia 180 Retarded Speech and Language Development 191 Interdental Speech 60 Lateral Speech 18 Deaf 15 Dysphonia 3 Dysphasia 3 Dysarthria 10 Nasal Speech 9 Hyponasality 2 Cleft Palate—Repaired 17 General Retardation 42 Dyspraxia 1 Total 593 Twenty cases seen in the Clinic have not been classified as therapy was either not indicated, or being received elsewhere. Cases closed: — Improved 75 Removed 11 Refused Appointments 10 Non-attendance after First Interview 15 Failed Interview Appointment 3 Therapy not indicated 10 Having Therapy elsewhere 4 Left School 4 Total 132 At the end of the year the waiting list was 63, including 21 priorities. 140 Child Guidance Through various sources, cases of psychological disturbance come to light and are referred, if necessary to the appropriate Child Guidance Clinic. These Clinics, which are spaced throughout the district, are held in Hospital premises except at "The Willows," Red Hill, Chislehurst, which is the Council's own premises. The remaining Child Guidance Clinic sessions are held at Farnborough Hospital, "Stepping Stones," Bromley Hospital and at Sydenham Hospital, which serves the Borough of Bromley although it is outside the geographical limits. One Consultant Psychiatrist is now responsible for the Child Guidance work at local hospitals and at our own Clinic at Chislehurst. I am grateful to Dr. Rodriguez, Consultant Psychiatrist, for the following report in respect of the Chislehurst Child Guidance Clinic, where he attends for four sessions per week. During 1971 there has been some increase in the demands made on the Clinic: this is reflected in the slight increase in the number of referrals, of diagnostic assessments, and of interviews done by the Psychiatrist and the Social Worker. In spite of this increased volume of work, it has again been possible to reduce the median length of the waiting list to just over nine weeks (1968—24 weeks; 1969—16 weeks; 1970—13 weeks). More than half the cases had their diagnostic interview within two months of being referred; many urgent cases were seen within one or two weeks. Without any increase in staff, it will be extremely difficult to improve on these figures, and the long waiting list will continue to cause frustration amongst parents and referring agencies. Because of the lack of adequate treatment facilities, the Clinic is still falling short of the goal of early diagnosis and effective treatment for all the children referred. It is a matter for concern that, due to so many other commitments, the School Psychological Service has had to reduce the amount of work undertaken at this Clinic. There has been an increase in the number of children and young adolescents referred because of poor school attendance (school phobia and truancy) and of drug abuse. The staff of the Clinic has continued to co-operate with other care-giving professions through informal meetings, case conferences and discussions. The Clinic is still collaborating with the Institute of Psychiatry of the University of London in a pilot study, sponsored by the World Health Organisation, on standardization of the classification of childhood psychiatric disorders, to be incorporated in the next edition of the International Classification of Diseases. Teams in the United Kingdom, France and the United States of America are collaborating in this project. Some new furniture and toys were provided during the year. 141 The proposed re-organisation of the National Health Service and the Psychiatric Services in Area 7 will highlight even further the limitations of the present building. Seventy-eight children from the borough were investigated and taken on for treatment (1970-71). There has been no great change in the proportion of children referred by different agencies. Medical Officers in Department and General Practitioners continue to refer more than half the children seen at this Clinic. Close co-operation was maintained with the other disciplines in the field of education and child care. Efforts will continue to be made to improve communications with Medical Officers in Department, Head Teachers, Education Welfare Officers, Department of Social Services, Probation Officers and Health Visitors. Some inter-disciplinary Case Conferences were held at the Clinic. The staff also continued to have quarterly meetings with the Tutorial Teachers at St. Paul's Wood Hill Unit. Eight Students attended the Clinic: — 2 Mental Health Students 1 Probation Student 1 Post Graduate Medical Student 2 Education Students 2 Health Visitor Students Details of referrals and attendances during the year are as follows: — Waiting List: (a) Awaiting first interview 34 (b) Interviews and awaiting treatment Nil In attendance: — (a) Active 100 (b) Periodic Review (holiday cases) 16 Number of cases closed 100 Number of applications withdrawn: — (Failed repeatedly to attend for diagnostic interview) 15 Source of referral: — Probation Officers 3 Court 3 Head Teachers 10 Medical Officers in Department 22 General Practitioners 27 Parents 3 Social Services Department 7 Hospital (Paediatricians and Psychiatrists) 14 Chief Education Officer 5 School Psychological Service 8 Others 6 Total 108 142 Number of new patients taken on for treatment during each month: — January 6; February 9; March 9; April 3; May 7; June 9; July 8; August 3; September 8; October 7; November 6; December 3. Number of Psychiatric Interviews: Quarter to 31st March, 1971 178 Quarter to 30th June, 1971 166 Quarter to 30th September, 1971 158 Quarter to 31st December, 1971 178 680 Number of Social Workers Interviews: Quarter to 31st March, 1971 227 Quarter to 30th June, 1971 214 Quarter to 30th September, 1971 166 Quarter to 31st December, 1971 221 828 Number of Home Visits by Psychiatric Social Worker 55 Number of School Visits: Psychiatric Social Worker 8 Educational Psychologists No figures available The Social Workers made 21 visits to different outside agencies. School Psychological Service I am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following report on the School Psychological Service: — Looking back, this has been a challenging year, marked in the summer term by a historical event—the transfer of responsibility to Education for the severely handicapped. Statistically, their number form a very small group. Educationally, they form a somewhat unknown quantity. They seem to require abundant resources and need to be more precisely understood. They have been made welcome; but for the transfer of responsibility to be meaningful, education would have to go beyond merely incorporating the severely handicapped within its own framework. It 143 would need to acquire such knowledge of skills and techniques as are necessary to reach this group in a practical and effective manner. To the Educational Psychologists, this transfer of responsibility represents a major task of on-going observations, careful studies and constant dialogues with the teaching staff and the parents. The full impact of this transfer should be felt increasingly in the forthcoming academic year. As usual the basic work of the Service can best be described under the three main categories of individual investigations, group investigations and general advisory activities. For the first time too, this year, the Service has been manned by three Educational Psychologists. All officers are full time. At present 1/5th of each officer's working time is spent at Hospital/ L.E.A. clinics and up to another 1/5th is spent in special schools/ classes/units. There remains at best 3/5ths of the full working time to, (1) carry out basic duties within the ordinary sectors of the local education authority and other institutions and departments within the Borough; (2) conduct work with groups; and (3) engage in advisory duties. As there is a limit to the size of the individual case load any officer can effectively and continuously deal with, it has been felt desirable, when the establishment was increased, to develop preventive work. The best approach seemed to be to expand both the work with groups and the advisory activities in schools. This policy explains the apparent lack of growth in the total number of children recorded in the School Psychological Service this year. The gain, although not yet obvious, is reflected in an equal lack of growth in the waiting list. Despite the transfer of the severely subnormal and the increase in the population, the size of the overall waiting list has been kept constant. Group Investigation This year special educational provisions were increased. There exists at present in the Borough four special infant units for the handicapped in the 3-7 year group, at Alexandra Infants' School, Crofton Infants' School and two at St. Paul's Wood Primary School. There is one all-age school—Woodbrook—formerly the day training centre. There are also five Infant Opportunity Classes—at Churchfields Primary, Leesons Infants', Midfield Primary, Raglan Infants' and St. Paul's Wood Primary schools— three day ESN schools—Grovelands, Goddington and St. Nicholas—the Cheyne Hospital School for physically and severely handicapped children (primary age range), the Phoenix Cerebral Palsy Centre at Farnborough Hospital, and the Hearing Impaired Unit at Darrick Wood. There are also three voluntary and private play groups for the handicapped in the Borough—the British Red Cross Society at Beckenham, Willett Way in Petts Wood and St. 144 Mary's in Hayes—which have received the attention of the Service. The Educational Psychologists have carried out group investigations in all units for the handicapped—including the play groups—the Special Opportunity Classes, as well as at the Cheyne Hospital School and at Woodbrook School. Rating scales have been drawn up and tried out. The evaluation continues. Some 200 children were thus studied in the handicap group alone. An experimental questionnaire was drafted in collaboration with the peripatetic Teachers of the Deaf and Medical Officers concerned. This questionnaire is to be used by the Teachers of the Deaf to help the Ascertainment Team. The annual screening of slow learners at top infant level continues. No group work was carried out this year in the secondary sector. However, Mr. A. Bennett undertook to study the educational provisions for the slow learners in both the primary and secondary levels. He thus set out to review the various surveys carried out nationally, aiming at evaluating the information available and its implications for the Borough's school population. Mr. Bennett had indeed embarked on a task of considerable magnitude. The results of his researching should be ready in the coming year and no doubt may be helpful in formulating the necessary educational provisions required. General Advisory Activities within Education This year, this little known role of the Service has developed more vigorously. There have been more teaching seminars and talks taking place between the Educational Psychologists and various groups of teachers. Of these, the series on Perceptual Development was more in the nature of an in-service training course for remedial teachers and the teachers of special classes and schools. It demanded considerable preparation of special material and absorbed a good deal of time. An in-service training course for teachers in special education was organised in collaboration with Mr. Gale, Warden at Stockwell Teachers' Centre, and the Educational Advisers, for the forthcoming year. In the summer term, the Service arranged a one-day conference on subnormality to help inform generally all Education sectors regarding the severely handicapped with the hope of effecting a desirable set or attitude towards them. It was well attended and well received. In the spring term, the staff of the Infant Special Opportunity Classes and special units enjoyed two educational visits to (1), the Link School in the Borough of Sutton and (2), Cold Harbour Training Centre in the Borough of Croydon. Liaison with Mrs. Powell and the Remedial Service remains 145 free and easy and regular case discussion meetings with the teachers, the Education Psychologists and Dr. Rodriguez took place at St. Paul's Wood Hill and at the Bromley Hospital Psychiatry Department. The Ascertainment Team for the hearing impaired has met regularly at St. Paul's Wood Hill. The Educational Psychologists, the Medical Officers and Teachers of the Deaf have worked very harmoniously together. Generally, it is pleasant to report that good working relationships were maintained within the Service and with colleagues and officers both in the Education and in the Health Departments. Looking back over 1970/71, I am able to state with confidence that the School Psychological Service has met the challenge of special education with good spirit and has endeavoured to provide a balanced service for the Borough. Results this year have confirmed that group work and training schemes for teachers are proving worthwhile preventive measures and this aspect of the Service would need to be developed and refined. Audiology Service Two Medical Officers have particular responsibilities in this field and I am happy to submit this report: — It has been a year of consolidation in this field marking a further step towards the realisation of our aims and objectives. These can be defined as follows: — 1. To identify any infant, child or adolescent who fails to respond to the age-appropriate screening test of hearing. 2. To identify any child with delayed or disordered language development which could signify an underlying hearing loss. 3. To refer screening failures to the Audiology Clinic or to hospital, with the concurrence of the child's General Practitioner, for diagnostic investigations which will either confirm the existence of a loss or, alternatively, reveal another cause than deafness. If a hearing loss is confirmed the extent is then measured, the nature of the loss investigated and the aetiology determined. Referral for suitable treatment follows. 4. To refer language disordered children, concerning whom we have a very good working relationship with the Speech Therapy service. These children as outlined above, are primarily investigated for any hearing difficulties, and secondarily examined in their general development with particular reference to the areas of receptive and expressive language. 146 Details of attendances at the Audiology Clinic are as follows: — Number of sessions held 36 No. of children seen No. of attendances Over 2 years of age 74 79 Under 2 years of age 64 74 138 153 We continue with our regular Ascertainment Team meetings (arranged on an interdisciplinary basis) which afford such a splendid opportunity for making joint recommendations on hearing-impaired children. We have already made reference to the Speech Therapy Service, and it is a pleasure also to record the equally close co-operation which exists between Medical Officers, teachers of the deaf, and educational psychologists. We feel that our combined efforts give meaning and practical application to the holistic approach to the deaf child and we look forward with enthusiasm to another year of team work in this field. Also under the heading "Audiology Service" I am grateful to Mr. D. R. Barraclough, Chief Education Officer, for the following report on the service for the hearing impaired child: — The Darrick Wood Unit for Deaf Children This Unit for hearing impaired children has now been operating at Darrick Wood for just over two years and has established itself as the educational provision for deaf children in this Borough. The numbers attending as at December 31st, 1971, are as follows: — Nursery-Infant groups 13 (including 2 from Bexley) Junior Class 9 (including 3 from Bexley) Total 22 Previously the children under five years of age attended for mornings only. All of them now stay for the full day, although this can be rather long for three-year-olds. An initial settling-in period of morning attendance only is recommended for these. The children are integrated to varying degrees within the normal hearing classes, thanks to the interest and support of the staff of the Infant and Junior Schools. There is a wide range of hearing losses within the Unit and flexible arrangements are 147 necessary for those children whose profund deafness might once have indicated residential placement, to benefit both linguistically and socially from controlled contacts with normally hearing children. Ideally, an expansion in staff could eventually lead to more flexible provision for partially hearing children who cannot adequately cope in a normal Primary School, although the present size of the premises does not make too great an increase in numbers advisable. With the eldest children now ten years of age, plans are being promulgated for the inclusion of a Secondary Unit for Deaf Children in the new Darrick Wood Comprehensive School. The progress at present being initiated at the Primary stage can then be continued within the Borough. The major item of expenditure was the acquisition of a mobile group hearing aid for use with the nursery-infant children. The Peripatetic Service At the end of December, 1971, the two Peripatetic Teachers of the Deaf were generally responsible for: — Pre-school deaf children 4 Children in residential schools 19 Children in day placement outside the Borough 12 Children in normal schools receiving regular help from a teacher of the deaf 17 Total 52 In addition there are 41 other children attending Borough schools who have hearing aids but who only receive occasional visits. Excluded this time from the above numbers is a large and everchanging group of children with minor, often temporary, hearing losses. There is no uniform system at present by which these are brought to our notice and many only require a single school visit from a teacher of the deaf. As the December, 1971, official figure for this group—80—is not regarded as including all school children in the Borough with minor hearing losses, it seems unrealistic to include them in any statistical analysis. However, information on them and others is retained and they can and are visited if and when necessary. The numbers attending residential schools should decline with the extension of our own day provision, but boarding school places are still provided, especially in cases where there are family problems and at the Secondary level. Weekly clinics with Medical Officers have continued and 148 I thank them for their energetic help in following up hearingimpaired children with the appropriate otologist or other specialist or department. Expenditure has been mainly on the purchase and maintenance of powerful hearing aids and controlled trials indicate that severely deaf children benefit from our being able to obtain these. Continued thanks go to all who help, support or take an interest in the work with deaf children in Bromley. Handicapped Pupils It is the duty of the local authority to ascertain those children in its area who, having attained the age of two years, may require special educational treatment. These children usually come to the attention of the School Health Service through the Health Visitors, the Chief Education Officer, Parents and Hospitals. The officially recognised types of handicaps are: —Blind, Partially Sighted, Deaf, Partially Hearing, Physically Handicapped, Delicate, Maladjusted, Educationally Sub-Normal, Epileptic and Speech Defects. Once a child has been ascertained as handicapped surveillance is maintained and recommendations for special educational treatment are forwarded to the Chief Education Officer for his consideration and action. Special appointments are arranged for the Medical Officer to see these children, either at a Clinic or at the child's home, depending usually on the degree or type of handicap. Before a recommendation is made the advice of the various appropriate Hospital Consultants, with whom there is a very close liaison, is sought. During the year 59 boys and 36 girls were assessed as needing special educational treatment at special schools. Details of the various handicaps are included in the following table. The Borough is fortunate in possessing four day special schools for educationally sub-normal pupils, and a report on each of these schools will be found later in this Report. It is anticipated that work will start on the School for Physically Handicapped children at Coopers, Chislehurst, early in 1972, as final siting has been decided. This will be between the two main blocks of the present school, with direct access for the special vehicles required for the handicapped children. Obtaining the best possible arrangements for the education of the handicapped child requires time and patience, but the effort involved is fully justified by the results obtained. It should be stressed that the assessment of a handicapped child does not consist merely in appraising the defects. The assets—what the child can do, the total environment etc., must not be forgotten. 149 Further, there is a new approach to this often purely clinical examination, namely an attempt to see the child in the home and school environment because a handicap or defect can have a different meaning to a Doctor, a Parent or a Child. Education (Handicapped Children) Act 1970 Chapter 52— Amendment It was long ago recognised that the exclusion of children from formal education (Education Act 1944) was too final an action and could be, to all practical purposes, irrevocable. Subsequent legislation made for a more liberal interpretation and enabled all who were concerned in the education of a child to make a recommendation for exclusion from the school system under the term of "unsuitable for education," with much less apprehension for the child's future in the knowledge that a subsequent assessment could reverse the decision. During these years more and more evidence has accumulated which high-lighted two points (1) that all children could be educated—of course to varying extent, and (2) that such education could not be given too soon. The second of these statements was easily understandable and, in fact, taken for granted in the case of the blind child and, later, also in the case of the deaf child. 1971, however, will be especially remembered in any caring community for, on April 1st, the amendment came into force in which educational provision must be made for all children. Some of them, tragically, are severely handicapped and the best ways of teaching them are still unknown—much work, time and money must be given to them so that the many problems they present to parents and teachers may be resolved as speedily as possible. As is mentioned in the report of the Education Psychological Service simple absorption is not enough—in fact the danger of their number, being small, becoming lost and unidentified in the total school population, must ever be borne in mind. The majority of these children will continue to attend Woodbrook which now becomes recognised as a day special school; the remainder attend special classes at ordinary schools but receive additional and more frequent medical supervision, so that constant assessment of their needs and progress may be made. The Phoenix Centre for Children with Cerebral Palsy I am grateful to Dr. C. H. Upjohn, Consultant Paediatrician, Farnborough Hospital, for the following report: — The work in the Phoenix Centre has continued the same as in the previous year with only a slight variation in the number of children attending, now 31, and there has been no change in 150 the hospital or educational staff and both have been fully occupied with the care of the children during the year. Four children have been transferred to other schools, one has moved away, one died and three have been discharged. There have been eight new admissions in various age groups. The new Centre which is being built by the Spastics Society should be completed during 1972. Cheyne Hospital, West Wickham I am grateful to Dr. R. J. Harris, Senior Paediatric Registrar, Farnborough Hospital, for the following report:— The school at Cheyne has continued to give the children as full and interesting experience as possible. Young children have been admitted to the nursery class as day pupils. I think this could continue to be an increasingly valuable asset. The number of admissions during 1971 were 24, with 16 discharges. Six of the admissions were children who had been discharged and came back for holidays. Five of the children stayed for a few weeks only to benefit from the intensive physiotherapy offered. Six children arrived from Leybourne Grange and have been fully integrated into the hospital. 151 RETURN OF HANDICAPPED CHILDREN PART I New assessments and placements During the calendar year ended 31st December, 1971:— Blind (1) P.S. (2) Deaf (3) Pt.Hg. (4) P.H. (5) Del. (6) Mal. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) A How many handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? boys 1 1 — 1 2 6 6 41 1 — 59 girls — — — 1 3 4 1 26 1 — 36 B How many children were newly placed in special schools (other than hospital special schools) or boarding homes? (i) of those included at A above boys 1 1 — — 1 3 5 21 — — 32 girls — — — — 1 3 1 16 1 — 22 (ii) of those assessed prior to January, 1971 boys _ _ _ 1 _ 7 10 1 19 girls — — — — — — — — — — 4 (iii) TOTAL newly placed—B (i) and (ii) boys 1 1 — — 2 3 12 31 1 — 51 girls — — — — 1 3 1 20 1 — 26 C How many children from the Authority's area, previously regarded as unsuitable for education at school, became the Authority's responsibility on 1st April, 1971? boys 92 girls 56 Total 148 152 PART II Handicapped pupils awaiting places in special schools or receiving education in special schools : independent schools: in special classes and units: under Section 56 of The Education Act, 1944; and boarded in homes. As at 21st January, 1972:— Blind (1) PS. (2) Deaf (3) Pt. Hg. (4) P.H. (5) Del. (6) Mal. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) A How many children from the Authority's area were awaiting places in special schools other than hospital special schools? (1) Under 5 years of age (i) waiting before 1st January, 1971:— (a) day places boys — — — — — — — — — — — girls — — — — — — — — — — — (b) boarding places boys — — — — — — — — — — — girls — — — — — — — — — — — (ii) newly assessed since 1st January, 1971:— (a) day places boys — — — — — — — — — — — girls — — — — — — — — — — — (b) boarding places boys — — — — — — — — — — — girls — — — — — — — — — — — (2) Aged 5 years and over (i) waiting before 1st January, 1971:— (a) whose parents had refused consent to their admission to a special school (a) day places boys — — — — — — — — — — — girls — — — — — — — 1 — — 1 (b) boarding places boys — — — — — — — — — — — girls — — — — — — — — — — — (b) others (a) day places boys — — — — — — — 11 — — 11 girls — — — — — — — — — — 5 (b) boarding places boys — — — — — — — — — — — girls — — — — — — — 1 — — 1 (ii) newly assessed since 1st January, 1971:— (a) whose parents had refused consent to their admission to a special school (a) day places boys — — — — — — — — — — — girls — — — — — — — — — — — (b) boarding places boys — — — — — — — — — — — girls — — — — — 1 — — — — 1 (b) others (a) day places boys — — — 1 — 2 — 6 — — 9 girls — — — — — — — 1 — — 1 (b) boarding places boys — — — 1 — 1 1 2 1 — 6 girls — — — — — — — 1 — — 1 (3) Total number of children awaiting admission to special schools other than hospital special schools—total of (1) and (2) above (a) day places boys — — — 1 — 2 — 17 — — 20 girls — — — — — — — — — — 7 (b) boarding places boys — — — — 1 1 1 2 1 — 6 girls — — — — — 1 — 2 — — 3 153 Handicapped pupils awaiting places in special schools or receiving education in special schools : independent schools: in special classes and units: under Section 56 of The Education Act, 1944; and boarded in homes. As at 21st January, 1972:— Blind (1) P.S. (2) Def (3) Pt. Hg. (4) P.H. (5) Del. (6) Mal. (7) E.S.N. (8) Epil. (9) Sp. Def. (10) TOT. (11) B How many pupils from the Authority's area were on the registers of:— (i) Maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) regardless by what authority they are maintained day boys — 4 4 3 13 7 — 285 — — 316 girls — 1 1 1 6 3 — 183 — — 195 boarding boys 1 — 1 1 4 5 2 9 — — 23 girls — — 1 — 4 3 — 1 — — 9 (ii) Non-maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) wherever situated day boys — — — — 4 — — — — — 4 girls — — — — 2 — — — — — 2 boarding boys 1 2 8 — 2 5 7 8 2 — 35 girls 2 1 1 1 2 4 2 2 4 — 19 (iii) Independent schools under arrangements made by the authority day boys — — — — — — 1 — — — 1 girls — — 1 — 2 — — — — — 3 boarding boys — — 3 — 3 1 29 16 — — 52 girls — — 2 — 2 — 3 7 — — 14 (iv) Special classes and units not forming part of a special school. boys X — X 7 — — — X X X 7 girls — 14 — — — 10 C How many children from the Authority's area were boarded in homes and not already included in B above. boys — — — — — — 1 — — — 1 girls — — — — — — — — — — — D How many handicapped pupils (irrespective of the area to which they belong) were being educated under arrangements made by the authority in accordance with Section 56 of the Education Act, 1944. (i) in hospitals boys — — — — — — — — — — — girls — — — — — — — — — — — (ii) in other groups, e.g. units for spastics, etc. boys — — — — 12 — — — — — 12 girls — — — — 8 — — — — — 8 (iii) at home boys — — — — 2 — — — — — 2 girls — — — — 2 1 — — — — 3 E Total number of handicapped children requiring places in special schools; receiving education in special schools; independent schools; special classes and units; under Section 56 of the Education Act 1944; and boarded in Homes. Totals of A(3); B(i) to (iv); C and D(i) to (iii) boys 2 6 16 12 41 21 41 337 3 — 479 girls 2 2 6 12 28 12 5 202 4 — 273 154 SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington The year 1971 has seen more emphasis in physical education and this has, in turn, produced a livelier approach to all school work in the classroom and out of it. A trampoline purchased by the friends of Goddington has helped in the explanation of movement. All the classes use this under the direction of Mrs. Oliver. The learner pool, though it still remains unroofed, has been a tremendous asset. 96% of the school children can now swim. It is hoped that the pool will soon be roofed. During the winter the children visit the Swanley Bath once every week. The better swimmers are practising to take the Swimming Teachers' Association awards. In November two demonstration lessons were given to Bromley in-service teachers on the teaching of slow learning pupils. One of these was a gymnastics lesson with junior mixed group, and the second was a dance lesson with senior girls. The children enjoyed both the lessons. On the 6th December two boys were presented with the Duke of Edinburgh Bronze Award at Ramsden School for Boys. The Senior girls have an extensive Social Service Scheme and soon hope to participate in the Duke of Edinburgh Awards. The school hit the news when for the first time the school flat was used for an overnight stay with two senior girls and their teacher, Mrs. Perkins, and her baby. The girls enjoyed themselves and did their own planning, shopping, costing, cooking and laundry, and looked after two year old Carl Perkins as well. Mr. Hurd, the peripatetic teacher of the deaf, visits the school once a week. There have been eleven school leavers in 1971. Of these ten have gone into employment successfully. One girl with severe eye defect has not been able to cope with employment. Special defects in the school cur Physically handicapped Partially hearing Poor sight Maladjusted Speech defect Epileptic ntly are as follows: 10 4 19 19 4 15 155 St. Nicholas School, West Wickham Number on roll Boys 58 Girls 44 Every child in the school was medically examined during the year and referred to Specialist, Clinic or G.P. for treatment when necessary. Rubella vaccine was given to six senior girls and BCG vaccine to eleven boys and girls. Classification of disabilities (Many children have multiple defects) Arrested hydrocephalus 2 Asthma 4 Autistic 2 Brain damage 4 Colour blind 2 Delicate 2 Epilepsy or petit mal 6 Heart defect 2 Mongol 4 Muscular disease or weakness 2 Obesity 2 Ophthalmic disease 5 Partially hearing 1 Physical deformities 7 Problem families, deprived, or broken homes 13 Psychological, emotional and behaviour problems 14 Speech defects (major) 9 Number of children wearing or recommended glasses 32 There are two sets of twins in the school, four children from one family and three children from each of two families. There are nineteen children, not all true E.S.N., who are educationally or culturally deprived and may be able to return to normal school in two or three years. All the children in the school are slow learners, and have experienced failure in the larger classes of their local schools. The aim of the school is to provide success and happiness in a slower moving educational environment with an eventual target of satisfactory employment within each child's capacity. There were thirteen school leavers, and there is close 156 operation with the special officer of the Youth Employment Service. Several activities in and out of school have given the children social and learning experience. Inter-school and internal sports, visits to St. Paul's, Greenwich, the Docks, a Wood yard and Foal farm. The swimming pool is a great asset and so is the new adventure play area. The year ended with a most successful Christmas social and fayre with stalls and side-shows and concert items by the children. Grovelands School, St. Pauls Cray There were 123 pupils on the school roll, twenty-one were admitted, mostly transfers from other areas or local authority special opportunity classes. Nineteen pupils left. Eight of these went to work, which included fencing and training in clerical work, four transferred to a training centre, one transferred to residential school, six transferred to other E.S.N, schools. One member of staff has left and so far the vacancy is still unfilled. Routine medicals, vision, hearing and dental inspections have continued as usual as have B.C.G. and Rubella vaccinations. Unfortunately due to shortage of speech therapists the sixteen pupils who had been having regular treatment have had very little during the past year. However, the School Psychological Service have been able to give more time. Part of the Senior girls practical room has been converted into a kitchen where 400 mid-day meals were provided and enjoyed by members of staff and the girls concerned. They cooked a Christmas dinner for themselves and some guests and also Christmas cakes to take home and for the Senior citizens they help with shopping and domestic chores. The Senior boys help with gardening and the heavier shopping. The P.T.A. continued its activities and helped to provide more books for the library, materials for cookery and woodwork and the petrol for the mini-van. Places of historical interest both in London and locally have been visited in addition to the usual places to give ideas for future employment. There has been a very keen football team who much to their joy managed to beat Goddington. Visiting speakers have included a member of the Fire Brigade, and an R.S.P.C.A. official; a brass quintet and a theatre 157 group gave an audience-participating performance, all of which gave much pleasure and contributed to their education. The whole staff continued to work hard in order to give these children the greatest possible help towards fitting into the general community. Woodbrook School Headteacher: Mrs. S. I. Walton Deputy Headteacher: Mrs. V. A. Harvey 9 Teachers 2 Welfare Assistants 1 Physiotherapist—part-time In April, 1971 the responsibility of Woodbrook School was transferred from the Mental Health Section to the Education Department. The recognition of the educability of the handicapped pupils attending this school will give renewed enthusiasm to work for their needs. During the year Woodbrook lost the valuable services of Dr. Syrop who is missed by both staff and pupils who often ask after her. The pressure on places was a continued difficulty. There were 110 children on the register in January, 1971. During the year five children were transferred to special classes in infants schools, two children went to Astley Adult Training Centre and three children were sent to residential schools. There were five new entrants in September, 1971. The Special Care Unit continued to function as previously with aggressive and hyperactive children in one room, and the totally helpless in the other. Routine annual medical inspections were carried out during the year. These were arranged with an opportunity system which provided useful contact with the parents and the time to discuss problems and give advice. Speech therapy is provided but it has not been possible to fill the established post due to a national dearth of Speech Therapists. The physiotherapist continues to carry out her essential and difficult job with enthusiasm. It is obvious from meeting the children how competently the staff are helping each individual child to develop to his or her utmost potential. 158 Employment of Young Children 205 children were examined by the Medical Officers in Department during the year. Certificates were issued in 204 cases, and in only one case was the certificate not issued. Boys Girls Delivery of newspapers 98 18 Delivery of milk 7 — Delivery of Bread 1 — Shop Assistant 11 20 Shelf filler 8 2 Waitress — 1 Hairdresser's Assistant — 8 Library Assistant 1 2 Entertainment 3 4 Domestic 1 5 Clerk — 1 Errand Boy/Girl 13 1 Totals 143 62 Other Medical Examinations The following examinations were carried out by Medical Officers during the year:— Training College candidates 477 Teachers 104 Total 581 School Meals and Milk Services The average daily number of meals served during 1971 was 31,500. The corresponding figure for 1970 was 35,400 representing a drop of 11%. A return submitted by schools for a day in October showed that the number of pupils taking 1/3-pint of milk was 10,139 (maintained) and 1,220 (non-maintained) compared with 24.172 (maintained) and 2,105 (non-maintained) in 1970, a drop of 58%. 159 The withdrawal of free milk to pupils of Junior schools was of course a major factor in the percentage drop. The School Meals Service provided approximately 40 meals daily between Stembridge Hall and Beckenham Works Centre, 75 meals daily to Clarks College and a further five or six daily to Coney Hall School. Canteens which came into full-time use during 1971 were (1) Hawes Down Infants, and (2) Scotts Park Junior School, where the number of meals served daily are 260 and 170 respectively. The experiment with convenience foods at Kentwood (extended to include Alexandra Infants School, in November 1970) has continued to date. The Health Visitor in the School Health Service There have been no new developments this year and the routine work has been carried out on the usual lines, the Health Visitors preparing and/or assisting at the full medical examination of 12,293 School children, and testing visions of 2,729 eight-yearold children in which they have been assisted during the latter part of the year by the appointment of a full-time School Nurse. Children have been inspected at Hygiene Sessions and where infestation has been found home visits have been paid and the parents advised on treatment. 160 HEALTH EDUCATION AND HOME SAFETY HEALTH EDUCATION First and foremost, all teachers are concerned with the total work of educating and training, that is with the development of the whole human being. Health education is often taken to be concerned with the more physical aspects of growth and development, but it should extend far beyond anatomy and physiology and include a consideration of the relationships of the individual with family, peers, members of the opposite sex, the community and society as a whole. It is to be appreciated by all concerned that many elements in the subject-matter of health education necessarily involve value judgments and are therefore the focus of conflicting views and ideas. For many, the fundamentals of the Christian faith— which have hitherto in such large measure shaped the general outlook and ethical standards of our community in Britainremain the determinants of their social attitudes and conduct and of their training of their children. Others have come to feel that greater reliance should in the future be placed on the development of an enlarged individual sense of responsibility and moral sensitivity to match the greater social freedom. It will in any case be important to ensure that what is offered by way of formal health education in our schools: — (a) Discharges faithfully the responsibility of the adult world to assist the rising generation individually to come to the acceptance of a set of values which will lead them to personal health and happiness in society. and (b) Offends neither the consciences of our pupils' parents nor the sensibilities of the pupils themselves at their varying stages of maturation. This last point is particularly important at the present time if the sympathy and support of parents for this most necessary element in the totality of our educating work is not to be forfeited. Parents are, at the least, partners with the schools in the moral education of their children. It is very difficult to estimate the extent or the success of health education in schools. Much of the teaching at all ages is incidental and properly so. The private answer to an individual child's question may be at least as valuable to him as the most carefully presented lesson. Teachers influence their pupils 161 pective of whether what they are teaching is recognised as health education. Perhaps the most encouraging recent development in secondary schools is the work of teachers trained in what is sometimes referred to as education in personal relationships. Such men and women are trained to listen, not to preach. It is slowly being realised that someone in every school should accept responsibility for co-ordinating health education, and should be encouraged to identify the needs of each age group, to see how these can be met within the framework of the curriculum, to initiate discussions with colleagues and parents to form an effective link with school medical officers and health education officers. This is very different from inserting yet another "subject" into the curriculum. It offers a demanding job but the time is now ripe for more teachers to undertake it. A beginning has been made and both an awakening of public interest and a growth of in-service training are clearly discernible. The Education Division of the Health Education Council is now established. The Schools Council has a working party to assess the need for, and feasibility of, curriculum development work in health education. Many local authorities have set up study groups of teachers, school medical officers, and health education officers to devise programmes of health education for schools. Several have recently published many interesting suggestions and schemes, including the London Borough of Bromley. This scheme has been compiled to aid teachers in the work of helping pupils to prepare themselves for entering into our present complex society where personal relationships are so important and where social health is of such paramount concern to us all. That our young people should cherish standards which conduce to the building of our general well-being, that they should conduct themselves with an appropriate measure of responsibility which they have grown in and for themselves, as well as with due tolerance and understanding for the views and actions of others, is the very essence of this whole matter. This scheme of work illustrates the individual, relational and environmental influences which have a considerable bearing on the person's health. It provides opportunities for the study of factual knowledge as well as for the examination of human behaviour, problems and attitudes in present-day society. Physical Education Mr. D. R. Barraclough, Chief Education Officer, has submitted the following report:— In the more orthodox education field there has been much 162 progress, especially in preparing courses which may provide an effective structure for those pupils who will now stay on for an extra year when the Act comes into force in 1972/73. It has been shown that physical education can provide the motivating force to enable a less able pupil to produce work of excellence. Allied to this, is work out of doors called "Learning from Life." This combines ecology, problem solving, orienteering, map reading, adventure and exercise in adaptability which have something significant to contribute to education in a rapidly changing society. It is true to say that more and more is being packed into the curriculum so that one school can say that in physical education alone it practises twenty-six activities and another that it has carried out three hundred and forty fixtures during the past year. The enlargement of secondary schools in the Borough means that better facilities are now possible. Already three fine games halls have been built and three more are at the planning stage. These buildings will serve the community as well as the school and should bring nearer the hope that before very long everyone will be able to take part in the sporting activity of his choice within easy distance of home. The English Schools' Athletic Championship The past year has seen the culmination of a tremendous joint effort in which the London Borough of Bromley played a major role in organising and presenting the English Schools' Athletic Championships at the Crystal Palace National Sports Centre. The detailed planning of this event was under the chairmanship of a Bromley physical education teacher; the billetting of two thousand four hundred competitors and three hundred officials was organised by another Bromley teacher; and sale of tickets and seating, the organisation and distribution of meals, the organisation and stewarding of the track and field events were all the responsibility of Bromley staff. No praise can be too great for the efficiency and high quality of the organisation exhibited during two days of superb athletics. Few meetings have ever presented each event more efficiently, so that everyone knew what was happening at each part of the arena. No meeting in Europe had as many athletes taking part in a single meeting. The detailed planning was finally written up in a seventy-two page booklet, a copy of which has been sent on a request to UNESCO. The occasion has been greatly praised by the counties which 163 took part and this praise has been matched by the great financial success of the championships. Our own School Meals Service performed magnificently in feeding nearly three thousand people, and the quality of food produced was the subject of many compliments. Medical supervision was provided by the London Borough of Bromley School Health Service. The teamwork of all the teachers from Bromley, Bexley and Kent was more than equal to this enormous task and its unqualified success is indicative of the standard achieved. Finally, a packed stadium of fifteen thousand young people watched athletics with rapt attention for two days. Not a performance escaped their careful gaze, nothing of merit was allowed to pass uncheered, and yet not a Sunday paper could mention that fifteen thousand youngsters could sit through two intense days of sport without causing the slightest disturbance. Perhaps this meeting gives the lie to adult criticism of young people and reveals more surely their true calibre. 164 DETAILS OF CLINICS CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) OPHTHALMIC: School Clinic, The Willows, Red Hill, Chislehurst. Monday—a.m. School House, 55 Chislehurst Road, Orpington. Monday—All day Mickleham Road Clinic, St. Paul's Cray. Monday—a.m. North Clinic, Station Road, Bromley. Monday—a.m. Wednesday—a.m. Friday—p.m. Saturday—a.m. (Alternate) School Clinic, Town Hall, Beckenham. Wednesday—a.m. School Clinic, Oakfield Road, Penge. Friday—a.m. ORTHOPTIC: North Clinic, Station Road, Bromley. Tuesday—All day School Clinic, The Willows, Red Hill, Chislehurst. Thursday—a.m. *ORTHOPAEDIC North Clinic, Station Road, Bromley. Friday—p.m. (monthly) *PHYSIOTHERAPY: School Clinic, Town Hall, Beckenham. Monday—p.m. Thursday—a.m. North Clinic, Station Road, Bromley. Tuesday—a.m. Friday—a.m. *Children living in Beckenham and Bromley are referred to these Clinics. Children living in the remainder of the borough are referred to: Orpington Hospital; Farnborough Hospital; Queen Mary's Hospital, Sidcup; or to the Children's Hospital, Sydenham. 165 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) SPEECH: Assemblies of God Church Rooms, Masons Hill, Bromley. Monday—All day Wednesday „ „ Thursday „ „ Friday Tuesday—p.m. School Clinic, Town Hall, Beckenham. Monday—All day Wednesday „ Friday Tuesday—a.m. The Clinic, Kimmeridge Road, Mottingham, S.E.9. Tuesday—All day Thursday—a.m. Hawes Down School Clinic, Hawes Lane, West Wickham. Tuesday—p.m. Wednesday „ School Clinic, The Willows, Chislehurst. Monday—All day Wednesday—a.m. *CHILD GUIDANCE: The Willows, Red Hill, Chislehurst. Tuesday—All day Friday *Cases are also referred to the Child Guidance Clinics at Bromley Hospital, and the Children's Hospital, Sydenham. Cases may also be seen at the Child Guidance Clinic at Farnborough Hospital, having been referred via the Paediatricians. DENTAL: School Clinic, The Willows, Red Hill, Chislehurst Monday—All day Wednesday „ „ School House, 55 Chislehurst Road, Orpington Monday—All day Tuesday Wednesday „ „ Thursday „ „ Friday Mickleham Road, St. Paul's Cray. Monday—All day Tuesday „ Wednesday „ Thursday „ „ Friday Kimmeridge Road, Mottingham. Tuesday—All day Thursday „ Friday 166 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) North Clinic, Station Road, Bromley. Monday—All day Tuesday Wednesday „ Thursday „ Friday South Clinic, Princes Plain, Bromley. Monday—All day Tuesday „ „ Wednesday „ Thursday „ „ The Pavilion, Recreation Ground, Church Road, Biggin Hill. Friday—All day School Clinic, Town Hall, Beckenham. Monday—All day Thursday „ „ Tuesday—a.m. only Wednesday „ Friday Hawes Down Clinic. Monday—a.m. only Tuesday—All day Wednesday „ Thursday „ „ Friday—a.m. only School Clinic, Oakfield Road, Penge Tuesday—All day Thursday „ „ Monday—a.m. only Wednesday „ Friday *SPECIAL EXAMINATION CLINICS: School Clinic, Oakfield Road, Penge 2nd and 4th Thursday in month 9.30 — 12 noon. The Willows, Red Hill, Chislehurst. 2nd and 4th Thursday in month 4.15 —5.00 p.m. Mickleham Road Clinic, St. Paul's Cray. 2nd and 4th Thursday in month 4.15 —5.00 p.m. School House, 55 Chislehurst Road, Orpington. 2nd Friday in month, 9.30 — 12 noon. *In addition to these fixed times, appointments are arranged as and when necessary at other clinics for the purpose of carrying out special examinations, etc. Printed by BOSP & Co.Ltd., 22 North Street, Bromley, Kent, BR1 1QZ