LONDON BOROUGH OF BROMLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 19 7 2 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 INDEX Pages Health Committee 1 Staff of the Health Committee 2 Medical and Dental Staff 2 Nursing and Allied Staffs 3 Public Health Inspector's Staff 4 Chiropody 4 Administrative Staff 4 Introduction 6 GENERAL: Vital and Other Statistics 7 Births 7 Infant Mortality 7,9 Maternal Mortality 8,9 Deaths 8,9 Cancer Death Rates 8 Population 8 Births Registered 8 Birth Notification 9 Tuberculosis 9 Street Accidents 9 Meteorological Observations 9 Causes of Death at Different Periods of Life for 1972 (Table) 10 Accidental Deaths 14 Deaths from Cancer 14 PERSONAL HEALTH SERVICES: Child Health Clinics 15 Vaccination and Immunisation 15 Welfare Foods 16 Hearing Tests 16 Cervical Cytology 16 Family Planning 16 Liaison with Local Hospitals 16 Chiropody 16 Nursing Homes 17 Midwifery 17 Deliveries Attended by Midwives 18 Care of Premature Infants 18 Home Nursing Attachment/Liaison Scheme 18 Ancillary Staff 19 Training 19 Hospital Liaison 19 Marie Curie Memorial Foundation 19 Statistics 19 Health Visiting Establishment 20 Training 20 Home Visits 20 Pages Health Visiting (continued)., Health Education 20 Case Conferences 20 Clinic Sessions 20 School Health 20 Conclusion 20 Medical Arrangements For Long Stay Immigrants 21 National Assistance Act. 1948, Section 47 National Assistance (Amending), Act, 1951 21 Medical Examination of Staff 21 Venereal Disease 22 Health Education and Home Safety Health Education 23 Home Safety London Ambulance Service 25 DENTAL SERVICES: Dental Sessions 26 Dental Services for Expectant and Nursing Mothers and Children under 5 years (as at December, 1972). 27 Attendances and Treatment School Children 28 INFECTIOUS AND OTHER DISEASES: General 30 Food Poisoning (Table) 31 Infective Jaundice 32 Leptospirosis 32 Malaria 32 Measles 32 Meningitis 32 Ophthalmia Neonatorum 32 Poliomyelitis 32 Scarlet Fever 32 Smallpox 32 Tetanus 33 Tuberculosis 33 Typhoid and Paratyphoid Fever 34 Whooping Cough 34 Infectious Diseases (Table) 35 ENVIRONMENTAL HEALTH: Clean Air 36 Housing 36 Places Where People Work 36 Staff and Structure 37 Food Sampling -1972 (Table) 38 Unsound Food 52 Bacteriological Examinations (Milk and Ice-Cream) 53 Meat Inspections 54 Food Complaints 55 Pages Food and Drugs Act, Section 16 56 Slaughter of Poultry Act, 1967 57 Food Hygiene (General) Regulations 1960 58 Milk (Special Designation) Regulations 58 Housing and Slum Clearance 1972 Clearance Areas 59 Closing Orders/Demolition Orders 59 General Improvement Areas 59 Qualification Certificates 59 Housing Repairs 59 Qualifications Certificates 61 Rent Act 1957 62 Housing Inspections 62 Notices 62 Moveable Dwellings 63 Drainage and Sewerage 64 Disinfection 65 Disinfestation 65 Pest Control Rodent Infestation 66 Fox Control 66 Pigeon Control 66 Wasp Nest Destruction 67 Atmospheric Pollution and Table 68, 69 Offices, Shops and Railway Premises Act, 1963 70 Part I-Factories Act, 1961 73 Part VIII- Factories Act, 1961 74 Mortuaries 75 Swimming Baths 76 Diseases of Animals Act, 1951 77 Riding Establishment Acts, 19 & 1970 77 Animal Boarding Establishments Act, 1963 77 Regulation of movement of Swine Order 77 Riding Establishments Acts 1974 and 1970 77 Animal Boarding Establishments Act, 1963 77 Swine Vesicular Disease 77 Animal Keepers 77 Dumping of Dead Animals 77 Riding Establishment Act, 1964 77 Pet Animal Act, 1951 78 Animal Boarding Establishments 78 Summary of Public Health Inspector's Visits General 79 Food Hygiene 79 Factories 79 Clean Air 79 Offices, Shops and Railway Premises Act 80 General Inspections Housing 80 Infectious Diseases 80 Food Inspection 80 Sampling 80 Miscellaneous 80 Complaints 81 Housing Inspections Drainage 81 Sanitary Appliances 81 Dampness 81 Water Supply 81 General Items 81 Notices Served Informal Notices 82 Statutory Notices 82 Pages Water Supply 83 Average Results of the Chemical Examination of Water Supplied To the London Borough of Bromley for 1972 (Table) 84 Bacteriological Results - Yearly Averages 1972 (Table) 85 SCHOOL HEALTH SERVICE School Health Service Index 86 1 HEALTH COMMITTEE (as at 31st December 1972) Chairman : M.B.Kenward, B.D.S., L.D.S., R.C.S. Vice-Chairman Mrs.S.M. Stead The Mayor : Alderman M. Neubert Alderman : Miss B.H. James, O_B.E., J.P. Councillors : M.G.C. Anderson M.I. Blazey Mrs. J. Bryant D.W.J. Eves M.E. Forster C.R. Gaster D.W. Giffin R.J. Kelaway S.J.C. Randall Mrs. O.L. Roberts E.C.H. Smith, M.B.E. 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 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1972) 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. Principal Medical Officer (School Health): P.A. Currie, M.R.C.S., L.R.C.P. Principal Medical Officer (Personal Health): (Mrs.) A.J. Jones, M.B., Ch.B. Medical Officers in Department: (Mrs.) R.H. Flett, M.B., B.Ch., B.A.O. D.(Obst) R.C.O.G. (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: R.G. Cooper, B.D.S., L.D.S., R.C.S.(Eng) (Mrs.) I.T. Creed, L.D.S., R.C.S.(Eng) (Mrs.) M.M. Alford, L.D.S., R.C.S.I. (Mrs.) M.I. Kininmonth, L.D.S. (Mrs.) A.R. Leach, B.D.S. J.M. Farquharson, L.D.S., R.F.P.S. (Glas) 4 Dental Officers (Sessional) 1 Dental Hygienist 10 Dental Surgery Assistants. 2 Physiotherapist: (Mrs.) V. Norman M.C.S.P. (Sessional) Senior Speech Therapist: (Miss) V.M. Connery, L.C.S.T. 1 Speech Therapist 5 Speech Therapists (Sessional) Orthoptist: (Miss) J. Madden D.B.O. (Part.time) Orthopaedic Surgeon: (in conjunction with Regional Hospital Board) K.F. Hulbert, F.R.C.S. Opthalmologists: 4 Sessional Chest Physician: (in conjunction with Regional Hospital Board) E.W. Street, M.R.C.S., L.R.C.P. Psychiatrist: (in conjunction with Regional Hospital Board) 1 (Part.time) NURSING & ALLIED STAFFS: Superintendent Home Nursing Service: Mrs. J.M.W. Teare, S.R.N. Deputy Superintendent Home Nursing Service: Mrs. D.H. Sear S.R.N., Q.N. 40 Home Nurses. 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 Advisor: Miss C.M. Paxton, S.R.N., S.C.M., H.V. Cert. 39 Health Visitors, 7 Part.time Health Visitors 7 Student Health Visitors. Non-Medical Supervisor of Midwives: Miss M.C. Martin, S.R.N., S.C.M. 3 Deputy Supervisor of Midwives: Miss J.S. Brown, S.R.N., S.C.M. 21 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.I., M.R.S.H. Deputy Chief Public Health Inspector: W.T. Weedy, M.A.P.H.I., M.R.S.H. 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. Williams, M.A., P.H.I. 13 Public Health Inspectors 3 Technical Assistants 5 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 7 Rodent Operators 3 Disinfector/Handymen 2 Mortuary Keepers CHIROPODY: Chief Chiropodist : A.S. Jones, S.R.C., M.C.R.S. 2 Senior Chiropodists 7 Chiropodists (Sessional) ADMINISTRATIVE STAFF: Chief Administrative Officer: D.J. Tinson Central Administration: Senior Administrative Officer: W. Hancock 4 Administrative Assistants 1 Secretary 5 Clerical Assistants 2 Clerks 3 Shorthand Typists 4 2 Enquiry Clerks/Receptionists 1 Driver/Storekeeper 23 Clinic Clerks (part.time) Environmental Health Senior Administrative Assistant: B. Adams 2 Administrative Assistants 3 Clerical Assistants 5 Clerks 2 Shorthand Typists Personal Health Senior Administrative Officer: Miss D.W. Gardner 2 Administrative Assistants 5 Clerical Assistants 14 Clerks Health Education & Home Safety Officer : Mrs. M.E. Eves, S.R.N., S.C.M., H.V. cert 5 To: THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF BROMLEY Mr. Mayor, Ladies and Gentlemen: In introducing the Annual Report for the year 1972 on the services administered by the Health Department of the London Borough of Bromley, it can be said at once that the year was one in which significant progress was made in both the personal and the environmental health services of the Borough. One of the principal themes running through the following pages is that of strengthening and improving the links between the Local Authority and hospital services, a logical development that was taking place in advance of the forthcoming changes in the organisation of the National Health Service. Links with local hospitals and their services had been established not only through liaison committees for maternity and cytology, but also through attachments of medical officers, health visitors and district nurses. Extension of the "domino" scheme ensured in addition continuity of midwifery care for the mother before, during and after her confinement. Under this scheme the domiciliary midwives deliver selected patients in hospital subsequently completing the post.natal care in the mother's home. A new development was the adoption during the year of the Family Planning Association scheme whereby patients attending the Association's clinics were able to obtain free advise and supplies if needed on medical grounds. The year also saw another important advance in this field with the inauguration of a domiciliary family planning service as a result of which a doctor and nurse team became available to visit those in need of advice but who were unable to attend a clinic. In the field of child health, increasing emphasis is being placed on the complete developmental assessment of children with the aim of ensuring that the individual's full potential is achieved as a result of the optimum physical, intellectual, emotional and social development. Departures from the normal can be detected at an early stage when there is the best chance of putting matters right. Attendance at appropriate training courses has enabled the Medical Officers to keep up to date with recent knowledge. The beneficial work of health education continues, and holds out hope for the future prevention of avoidable illness and accidental injury, in so far as these can be influenced by the individuals understanding of the factors affecting personal health. The modern techniques of communication using the great variety of audio.visual aids and materials that are now available are fully employed in the work of health education and can be highly effective. Also during the year the Bromley, Beckenham and Orpington Home Safety Committees united to form the London Borough of Bromley Home Safety Committee and the excellent work carried out over many years by the individual committees will be combined in a concerted effort to reduce the toll of home accidents within the Borough. Once again it is pleasing to report that there were no serious outbreaks of infectious disease. This is a continuing tribute to the immunisation procedures resulting from the scientific discoveries that have been so effective in preventing the killing infectious illnesses of the past. In the field of environmental health, the half.way stage was attained in the effort to make the Borough entirely smoke free, in my opinion one of the most beneficial environmental improvements of recent years. The difficult staff situation in the environmental health section had an inhibiting effect on much of the routine visiting work of the department, such as visits to food premises. It is important that this work, which is of such significance to the health of the community, should not be allowed to drift into arrears. For the efficient supervision and performance of the work of the department during the year thanks are due to the heads of sections, in particular to Mr. D.J. Tinson, Chief Administrative Officer, and to the loyal service of the administrative and professional staff during a very busy year. Good wishes also go from the staff to the Medical Officer of Health Dr. L.R.L. Edwards, who has retired at the time this report is being compiled. Finally thanks are due to the members of the Council and especially to the Chairman and members of the Health Committee for their support and encouragement in a year that was to some extent overshadowed by impending change. A.J.I. Kelynack Deputy Medical Officer of Health 6 GENERAL INFANT MORTALITY Peaths of Infants under 1 year of age) Males Females Total Legitimate 38 28 66 Illegitimate 4 3 7 Infant Mortality rate per 1,000 total live births 18 Legitimate infant deaths per 1,000 legitimate live births 18 Illegitimate infant deaths per 1,000 illegitimate live births 23 Infant mortality rate for Greater London per 1,000 live births 17.1 Infant mortality rate for England and Wales "17 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 13 Neonatal mortality rate for Greater London 11.7 Neonatal mortality rate for England and Wales 12 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 12 Early neonatal mortality rate for Greater London 9.8 Early neonatal mortality rate for England and Wales 10 7 VITAL AND OTHER STATISTICS Population (mid year 1972) 306,550 Area (Acres) 37,583 Density of population (persons per acre) 8.15 Rateable value as at 1.4.72 £17,740,000 Product of 1 p Rate £172,300 Rate in pound 1972/1973 (Domestic) 79p BIRTHS Live births 3,971 Males Females Total Legitimate 1869 1801 3670 Illegitimate 155 146 301 Crude birth rate per 1,000 estimated total population 13.0 Adjusted birth rate for comparison with other areas 13.1 (Area comparability factor for births 1.01) Illegitimate live births: 8% of all live births Crude birth rate for Greater London 14.1 Birth rate for England and Wales 14.8 StilIbirths 46 Males Females Total Legitimate 26 16 42 Illegitimate . 4 4 Stillbirth rate for 1,000 live and stillbirths 11.0 Stillbirth rate for Greater London 11.2 Stillbirth rate for England and Wales 12.0 Total births (live arid Still) 4,017 Males Females Total Legitimate 1895 1817 3712 Illegitimate 155 150 305 Total of all live and stillbirths 2050 1 967 4017 Infant Mortality (Contd.) Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live births and stillbirths) 23 Perinatal mortality rate for Greater London 20.9 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) 0.20 DEATHS Males Females Total 1568 1671 3239 Crude death rate per 1,000 estimated total population 10.6 Adjusted rate for comparison with other areas (Area comparability factor for deaths: .98) 10.4 Crude death rate for Greater London per 1,000 population 11.8 Death rate for England and Wales 12.1 CANCER DEATH RATES All forms (per 1,000 population) 2.3 Lung and Bronchus (per 1,000 population) 0.65 Other forms (per 1,000 population) 1.65 POPULATION The Registrar.General's estimate of the population of the Borough, mid.year 1972, was 306,550 This figure gives a density of 8.15 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 732. The figure for 1971 was 1167. BIRTHS REGISTERED There ware 3971 live births allocated to the Borough during 1972 after adjustments for inward and outward transfers, this being a decrease of 311 on the figure for the previous year. Of the 3971 live births, 2024 were males and 1947 were females. The crude birth rate for the Borough was 13.0 per 1,000 population and the adjusted birth rate, for use when comparing one area with another, was 13.1 The birth rate for 1972 was 1.0 lower than that recorded for 1971 and it is below the figures of 14.1 and 14.8 for Greater London and England and Wales respectively. In addition to the live births there were 46 stillbirths, representing a rate of 11 per thousand total births. This rate is comparable with that of 11.2 for Greater London and 12 for the country as a whole. The figure for the Borough for 1971 was 12 per 1,000 total births. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Males 1869 155 2024 26 . 26 Females 1801 146 1947 16 4 20 Totals 3670 301 3971 42 4 46 8 9 BIRTH NOTIFICATION A total of 4049 births were notified as having occurred in the Borough. Of this number 3807 were institutional and 242 domiciliary births. 46 stillbirths actually occurred in the area. 1 of these was at a domiciliary confinement. DEATHS 3239 deaths were registered in 1972, giving a crude death rate of 10.6 per 1,000 population. This rate, when standardised by the comparability factor, gives a figure of 10.4 for comparison purposes. The rates for Greater London and England and Wales were 11.8 and 12.1 respectively. The following table shows cause of death as given in the Registrar.General's statistics. MATERNAL MORTALITY No maternal death occurred in the Borough during the year. The maternal mortality rate for Greater London for 1972 was 0.20 per 1,000 total births. (This figure is based on less than 100 occurrences) TUBERCULOSIS There were 3 deaths attributed to tuberculosis of the respiratory system, one to the late effects of respiratory tuberculosis, and one to non.respiratory tuberculosis, giving a death rate of 0.016 per 1,000 population. INFANT MORTALITY There were 73 deaths of infants under 1 year of age during 1972. 66 of these were legitimate and 7 illegitimate, giving a rate of 18 per 1,000 total births. The rates for Greater London and England and Wales were 17.1 and 17.0 respectively. Of the 73 infant deaths, 52 were under four weeks old, giving a neonatal mortality rate of 13 per 1,000 total live births. The neonatal mortality for Greater London was 11.7 and for England and Wales 12.0. There were 47 deaths of infants under one week of age, giving an early neonatal mortality rate of 12.0 per 1,000 total live births. The rates for Greater London and England and Wales were 9.8 and 10.0. The perinatal mortality rate for the Borough (stillbirths and deaths under one week combined, per 1,000 total live and stillbirths) was 23.0 and those for Greater London and England and Wales were 20.9 and 22.0 respectively. STREET ACCIDENTS 1812 street accidents occurred in the Borough during 1972. 2451 persons were injured and 36 died. These totals include 441 children under 15 years of age who were injured, and 4 who died. METEOROLOGICAL OBSERVATIONS Total Rainfall The average total rainfall taken over the Borough as a whole was 557.9 mm. Temperatures The lowest minimum temperature of 1972 was .10.0 degrees Centigrade which was recorded on 31st January. The highest maximum temperature of 1972 was 27.0 degrees Centigrade which was recorded on 24th August. The mean minimum daily temperature for 1972 was 6.2 degrees Centigrade. The mean maximum daily temperature for 1972 was 13.3 degrees Centigrade. 10 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1972 (Registrar-General's Return) Cause of death Sex All ages Under 4 weeks 4 weeks & 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 1 _ _ 1 _ _ _ _ _ _ _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 2 Tuberculosis of Respiratory System M 2 _ _ _ _ _ _ _ 1 _ _ 1 F 1 _ _ _ _ _ _ _ _ _ _ 1 3 Late effects of respiratory T.B. M _ _ _ _ _ _ _ _ _ _ _ _ F 1 _ _ _ _ _ _ _ _ 1 _ _ 4 Other Tuberculosis M _ _ _ _ _ _ _ _ _ _ _ _ F 1 _ _ _ _ _ _ _ _ _ _ 1 5 Syphilis and its Sequelae M 1 _ _ _ _ _ _ _ _ _ 1 _ F 1 _ _ _ _ _ _ _ _ _ _ 1 6 Other Infective and Parasitic Diseases M 2 1 _ _ _ _ _ _ _ _ 1 _ F 1 1 _ _ _ _ _ _ _ _ _ _ 7 Malignant Neoplasm, Buccal Cavity etc. M 5 _ _ _ _ _ _ _ 1 1 1 2 F 4 _ _ _ _ _ _ _ 1 1 1 1 8 Malignant Neoplasm, Oesophagus M 5 _ _ _ _ _ _ _ _ 2 2 1 F 5 _ _ _ _ _ _ _ 1 _ 1 3 9 Malignant Neoplasm, Stomach M 32 _ _ _ _ _ _ 1 1 12 8 10 F 25 _ _ _ _ _ _ _ 1 6 6 12 10 Malignant Neoplasm, Intestine M 39 _ _ _ _ 1 _ 1 8 2 15 12 F 68 _ _ _ _ _ _ _ 6 14 13 35 11 Malignant Neoplasm, Larynx M 1 _ _ _ _ _ _ _ _ 1 _ _ F 1 _ _ _ _ _ _ _ _ _ _ 1 12 Malignant Neoplasm, Lung, Bronchus M 161 _ _ _ _ _ _ 5 13 51 49 43 F 38 _ _ _ _ _ _ 1 5 9 12 11 13 Malignant Neoplasm, Breast M 1 _ _ _ _ _ _ 1 _ _ _ _ F 94 _ _ _ _ _ _ 5 16 24 23 26 14 Malignant Neoplasm, Uterus F 9 _ _ _ _ _ _ _ _ 1 3 5 15 Malignant Neoplasm, Prostate M 21 _ _ _ _ _ _ _ _ 5 8 8 16 Leukaemia M 9 _ _ 1 _ _ _ _ _ 1 3 4 F 11 _ _ _ 2 1 2 _ _ 3 1 2 11 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1972 (continued) (Registrar-General's Return) Cause of death Sex All ages Under 4 weeks 4 weeks & under year Age in years 1-4 5-14 15-4 25-34 35-44 45-54 55-64 65-74 75 and over 17 Other Malignant Neoplasms M 91 _ _ _ 3 1 3 4 8 23 24 25 F 91 _ _ 1 _ 1 _ 3 16 16 27 27 18 Benign and unspecified Neoplasms M 6 _ _ _ _ _ _ _ _ 3 2 1 F _ _ _ _ _ _ _ _ _ _ _ _ 19 Diabetes Mellitus M 2 _ _ _ _ _ _ _ _ _ 1 1 F 13 _ _ _ _ _ 1 _ _ 1 3 8 20 Avitaminoses, etc. M 1 _ _ 1 _ _ _ _ _ _ _ _ F 1 _ _ _ _ _ _ _ _ 1 _ 21 Other Endocrine etc. Diseases M 5 1 1 _ _ _ _ _ _ 1 2 _ F 4 _ _ _ _ _ _ 1 _ _ 2 1 22 Anaemias M _ _ _ _ _ _ _ _ _ _ _ F 4 _ _ _ _ _ _ _ _ _ 2 2 23 Other Diseases of Blood, etc. M 1 _ 1 _ _ _ _ _ _ _ _ _ F 3 _ _ _ _ _ _ _ _ _ 1 2 24 Mental Disorders M 1 _ _ _ _ _ _ _ _ _ _ 1 F 5 _ _ _ _ _ _ _ _ _ _ 5 25 Meningtitis M 2 _ 1 _ _ _ _ _ _ 1 _ _ F _ _ _ _ _ _ _ _ _ _ _ _ 26 Multiple Sclerosis M 4 _ _ _ _ _ 1 _ 2 1 _ _ F 5 _ _ _ _ _ _ _ 1 2 2 _ 27 Other Diseases of Nervous System M 18 _ _ 2 2 _ 1 _ 3 3 6 1 F 14 _ _ _ _ _ _ _ 2 1 2 9 28 Chronic Rheumatic Heart Disease M 7 _ _ _ _ _ _ _ 1 3 1 2 F 20 _ _ _ _ _ _ 1 2 4 5 8 29 Hypertensive Disease M 15 _ _ _ _ _ _ _ 1 3 6 5 F 21 _ _ _ _ _ _ _ _ 1 5 15 30 Ischaemic Heart Disease M 456 _ _ _ _ _ 1 7 48 116 149 135 F 378 _ _ _ _ _ _ 2 9 30 84 253 31 Other Forms of Heart Disease M 47 _ _ _ _ _ _ _ 1 3 14 29 F 86 _ 1 _ _ 1 _ _ _ 3 10 71 32 Cerebrovascular Disease M 140 _ 1 _ _ 1 _ 1 6 10 35 86 F 274 _ _ _ _ 1 _ 1 4 18 59 191 12 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1972 (continued). (Registrar-General's Return) Cause of death Sex All ages Under 4 weeks 4 weeks & under year Age in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 76 and over 33 Other Diseases of Circulatory System M 63 _ _ _ _ _ - 2 3 15 18 25 F 110 _ _ _ _ _ _ _ 2 5 16 87 34 Influenza M 6 _ _ _ - _ _ - 1 2 _ 3 F 4 _ _ _ _ _ _ _ _ _ 3 3 35 Pneumonia M 145 _ 2 _ _ 1 _ 2 1 7 29 103 F 192 _ 1 _ _ 1 _ 1 3 10 16 160 36 Bronchitis and Emphysema M 102 _ _ 1 _ _ _ 1 4 12 36 48 F 26 _ _ _ _ _ _ _ _ 4 3 19 37 Asthma M 5 _ _ 1 1 _ _ _ _ 1 2 _ F 2 _ _ _ _ _ 1 _ _ 1 _ _ 38 Other Diseases of Respiratory System M 13 _ 3 _ _ _ _ 1 - 1 7 1 F 18 _ 6 2 _ _ _ _ 1 2 2 5 39 Peptic Ulcer M 13 _ _ _ - _ _ - 1 1 5 6 F 9 _ _ _ _ _ _ _ _ _ _ 9 40 Appendicitis M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 41 Intestinal Obstruction and Hernia M 5 _ _ _ 1 _ - - 1 - 2 1 F 12 2 _ _ _ _ _ _ _ 1 2 7 42 Cirrhosis of Liver M 3 - 1 - - 1 - - _ _ 1 _ F 3 _ _ _ _ _ _ _ _ 2 _ 1 43 Other Diseases of Digestive System M 9 - _ _ _ - _ 1 1 3 1 3 F 18 _ _ _ _ _ _ 1 _ 1 6 10 44 Nephritis and Nephrosis M 8 _ _ - - - _ 1 1 3 1 2 F 8 _ _ _ _ 1 _ _ 1 1 1 4 45 Hyperplasia of Prostate M 11 _ _ _ _ _ _ _ _ 1 3 7 46 Other Diseases, Genito-Urinary System M 8 _ - - - - 1 - - 1 4 2 F 11 - _ _ _ _ _ _ _ 1 2 8 47 Diseases of Skin, Subcutaneous Tissue M _ _ _ - _ _ _ _ _ _ _ _ F 1 - _ _ - _ _ _ - 1 - - 13 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1972 (continued). (Registrar-General's Return) Cause of death Sex All ages Under 4 weeks 4 weeks & under year Ages in years 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over 48 Diseases of Musculo-Skeletal system M 6 - - _ _ _ _ _ 1 1 _ 4 F 7 _ _ _ _ _ _ _ 1 1 _ 5 49 Congenital Anomalies M 13 7 2 _ 2 _ _ _ _ 1 _ 1 F 11 6 _ 1 1 1 _ 1 _ _ _ 1 50 Birth Injury, Difficult Labour, ETC. M 13 13 _ _ _ _ _ _ _ _ _ F 7 7 _ _ _ _ _ _ _ _ _ _ 51 Other causes of Perinatal Mortality M 7 7 _ _ _ _ _ _ _ _ _ F 6 6 _ _ _ _ _ _ _ _ _ _ 52 Symptoms and ill Defined Conditions M 2 1 _ _ _ _ _ _ _ _ 1 _ F 6 _ 1 _ _ _ _ _ _ 1 _ 4 53 Motor Vehicle Accidents M 35 _ _ _ 4 4 2 2 1 11 7 4 F 11 _ _ _ _ 1 _ 1 2 1 3 3 54 All other Accidents M 15 _ _ _ 2 3 1 _ 2 1 3 3 F 14 _ _ 1 _ _ _ _ 2 _ 2 9 55 Suicide and Self-inflicted Injuries M 9 _ _ _ _ 1 2 _ 2 3 1 _ F 14 _ _ _ _ _ 1 2 4 3 3 1 56 All Other External Causes M 1 _ _ _ _ _ _ _ _ _ 1 _ F 1 _ _ _ _ _ _ _ 1 _ _ TOTAL ALL CAUSES M 1,568 30 12 7 15 13 12 30 113 306 450 580 F 1,671 22 9 5 3 8 5 20 80 171 320 1,028 14 DEATHS FROM CANCER MALE FEMALE TOTAL 1972 1971 1970 1969 1968 1972 1971 1970 1969 1968 1972 1971 1970 1969 1968 MALIGNANT NEOPLASM STOMACH 32 36 33 35 53 25 31 37 34 39 57 67 70 69 92 MALIGNANT NEOPLASM LUNG, BRONCHUS 161 159 151 168 221 38 42 46 36 54 199 201 197 204 275 MALIGNANT NEOPLASM BREAST 1 _ _ _ 2 94 72 56 83 114 95 72 56 83 116 MALIGNANT NEOPLASM UTERUS _ _ _ _ _ 9 23 22 20 39 9 23 22 20 39 OTHER MALIGNANT & LYMPHATIC NEOPLASMS 177 184 146 220 221 180 186 186 191 256 357 370 332 411 477 TOTALS 371 379 330 423 497 346 354 347 364 502 717 733 677 787 999 Rates per 1,000 population All Forms 2.3 Lung and bronchus 0.65 Other Forms 1.65 ACCIDENTAL DEATHS During the year 75 residents died from accidents of all kinds, including 46 in motor vehicle accidents. PERSONAL HEALTH SERVICES 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., Principal Medical Officer. CARE OF MOTHERS AND YOUNG CHILDREN CHILD HEALTH CLINICS The total number of premises used is still 35, of which 6 are purpose built, 5 adapted and the remainder hired and occupied on a sessional basis. There were an average of 40 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, bacause 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 may lead to mental subnormality. The number of sessions held at these clinics totalled 2,386, an average of approximately 47 per week. The number of children who attended the clinics was 5,385 and the total number of attendances 70,952. These figures represent increases compared with the previous year of 281 and 258 respectively. VACCINATION AND IMMUNISATION Primary courses completed: Year of Birth Others 1972 1971 1970 1969 1965-68 under 16 Total Measles 157 1411 1030 237 187 8 3,030 Diphtheria 142 2278 978 98 68 9 3,573 Whooping Cough 142 2205 928 89 34 7 3,405 Tetanus 142 2279 978 99 72 75 3,648 Poliomyelitis 82 2301 886 80 129 7 3,485 Reinforcing doses: Year of Birth Others 1972 1971 1970 1969 1965-68 under 16 Total Diphtheria 1 150 266 66 3140 148 3,771 Whooping Cough - 127 208 35 791 29 1,190 Tetanus 1 152 268 71 3153 324 3,969 Poliomyelitis 3 78 126 51 2853 217 3,328 Comparative Statistics: Percentage of children born in 1970 and vaccinated by 31.12.72. Whooping Cough Diphtheria Poliomyelitis England and Wales 79 81 80 Bromley 84 87 86 Rubella and B.C.G. were offered routinely, as is mentioned in the Annual Report of the School Health Service. The number of girls vaccinated against Rubella, between their 11th and 14th birthday was 1,792. 15 WELFARE FOODS Sales of these foods were: Number Issued Issued Free National Dried Milk 3,424 345 Cod Liver Oil 14 - Vitamin A & D Tablets 3,596 5 Vitamin A & D plus C Tablets 213 5 Vitamin A D & C Tablets 1,785 13 Orange Juice 28,691 50 Vitamin Drops 14,775 707 HEARING TESTS 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. Older children whose hearing is suspect, or where speech is slow to develop, are also referred. During the year a total of 133 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 12 clinics per month were held, no appointment being necessary. Further publicity was given in the local newspapers in 1972 resulting in an increase in attendances. A national scheme for the recall of patients every five years began in 1972. Details of attendances during the year are as follows: Number of clinics held 144 Total number of tests carried out 2164 Number of positive cases 6 Number of repeat tests 328 Number of cases referred to General 29 Practitioner for other conditions FAMILY PLANNING The Family Planning Association Agency Scheme began in April whereby patients attending any of the F.P.A. clinics had their fees and supplies paid for by the Borough if this was needed on Medical grounds, i.e. where the health would suffer by the increased mental, physical or social burden of a pregancy. The F.P.A. opened three more clinics bringing the total to 12; this resulted in about 30 doctor sessions per week. A domiciliary service also commenced in which a doctor/nurse team visited those who needdd advice but could not attend a clinic. LIAISON WITH LOCAL HOSPITALS Liaison with Local Hospitals continued through 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 car. The midwives continue to assess the suitability of patients' homes for early discharge from hospital after a confinement. The Principal Medical Officers give talks and lectures on aspects of community health to pupils and students when required to do so. CHIROPODY This Authority provided service to 5,884 persons over the age of 65 years, 131 physically handicapped or disabled persons and 2 expectant mothers. The total treatment figures were:- 16 17 7,371 treatments given in Borough Clinics 12,259 patients received treatment in their own home 1,939 treatments were given in the 9 Borough Residential Homes 9,054 treatments were given to Borough patients in private chiropodists' surgeries Grand Total 30,623 treatments If the total number of treatments given during 1972 is compared with the number in the previous year (31,377) it will be seen that there was a decrease of 2.4 per cent. In spite of a chronic shortage of chiropodists the full time staff again numbered three, while 11 sessional and 27 contractual chiropodists were also employed. A clinic was opened within the Bertha James Day Centre but that at Princes Plain was temporarily closed. The Council raised the charge for chiropody treatment from 40p to 50p in 1972 for those not receiving a supplementary benefit. NURSING HOMES 1972 1971 Number of Homes registered at year end 12 14 Homes closed during the year 4 1 Homes registered during the year 2 Number of beds provided at year end 315 349 MIDWIFERY Miss M.C. Martin, S.R.N. S.C.M. Non-Medical Supervisor of Midwives The scheme for domiciliary Midwives to deliver selected patients in hospital and then to complete the post-natal care in the mother's home has extended to the Orpington and Farnborough areas. The 'Domino' Scheme, as it is known, is working well and not only ensures the continuity of Midwifery care for the mother before, during and after her confinement but is also felt to be an important step towards the integration of the hospitals and Local Authority Maternity Services under the National Health Service re-organisation. Regular meetings between Senior Nursing Officers from the hospital and Local Authority Nursing and Health Visiting Services are taking place also with integration in mind. The new single period (one year) Midwifery training commenced in the Bromley Group of Hospitals in July 1972, and the first pupils were seconded for community experience with the domiciliary teaching midwives in November, 1972. The number of teaching midwives in the Local Authority service has been increased to accomodate extra pupils. Besides giving three months domiciliary experience to 38 pupil midwives, arrangements have been made for 59 other students to gain knowledge of this aspect of the community nursing service. Maternity Sisters in hospital who feel they would like community experience are being welcomed by the domiciliary midwives to spend a day with them. This experience is followed up by an insight into the administration of the service at Sherman House. Four midwives went to statutory refresher courses this year and another four attended a family planning conference. The need for more emphasis on Health Education and Parentcraft is recognised and two midwives attended National Childbirth seminars on Preparation for Childbirth and another midwife participated in a series of classes on parentcraft at the Royal College of Midwives. Four more attended a clinical teaching course run by Bromley Group of Hospitals for trained staff and another midwife has been seconded to attend a clinical teaching course at the Royal College of Midwives. One midwife was granted special leave to attend the International Congress of Midwives in Washington in November. She was financed by the local branch of the Royal College of Midwives as a result of many fund raising efforts in the previous twelve months. DELIVERIES ATTENDED BY MIDWIVES The number of domiciliary confinements attended by midwives was 234, the number of hospital confinements conducted by domiciliary midwives 95, and the number of cases delivered in hospitals and other institutions but discharged and attended by midwives 1,151. The total number of visits by midwives during 1972 was 22,885. Relaxation and Mothercraft Classes 485 women attended these classes compared with 354 in 1971. Each attended on average about three classes. CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1972 who were born: 1. At home or in a nursing home 5 2. In hospital 206 (2) The number of those born at home or in a nursing home: who were nursed entirely there 4 who were transferred to hospital on or before the 28th day 1 who died during the first 24 hours 1 who died in 1 and under 7 days who died in 7 and under 28 days 1 who survived at the end of one month 3 (3) The number of those born in hospital: who died during the first 24 hours 18 who died in 1 and under 7 days 7 who died in 7 and under 28 days - who survived at the end of one month 181 (4) The number of premature stillbirths who were born: (a) at home or in a nursing home - (b) in hospital 31 Notifications of Intention to Practice In accordance with the rules of the Central Midwives Board 152 Midwives notified their intention to practice within the Borough during the year 1972. Congenital Malformations 68 notifications were received of which 58 were in respect of live births and 10 of stillbirths. The total number of malformations was 117 and the number of children with multiple malformations was 22. HOME NURSING Mrs. J.W.M. Teare, S.R.N. ATTACHMENT/LIAISON SCHEME The attachment of District Nursing Sisters to general practitioners throughout the Borough has been completed. A total of 26 attachments have been made and the scheme is working smoothly. This has resulted in closer communication between general practitioner and district nurse; and where suitable facilities exist, the district nurse is in attendance at the surgery to give treatment to patients. Additionally, where necessary, the district nurse 18 makes follow-up visits to patients, consequently relieving the general practitioner of a number of visits. The scheme has been favourably accepted and the role of the district nurse has been more clearly defined to general practitioners and the public generally. ANCILLARY STAFF The recruitment of 3 nursing auxiliaries to our establishment has been an essential contribution in relieving district nurses in bathing duties. On appointment a period of in-service training is given to the auxiliaries who work under close supervision by the trained staff, who make periodic visits to the patients being attended. Recently, there has been a noticeable increase in demand for this service by hospitals and general practitioners. TRAINING All newly joined staff are required to take a course conducted by the Kent County Council and obtain the National District Nursing Certificate. During the year, 7 district nurses were successful and awarded the certificate. The Kent County Council Refresher Course for district nurses was attended by most of the staff. Arrangements were also made for staff to attend various day courses and conferences. During the year, 2 senior members of the staff have attended management courses arranged by Thames Polytechnic and Royal College of Nursing. HOSPITAL LIAISON Liaison between hospitals and Local Authority nursing staff has been improved. District nursing sisters are now invited to hospital sisters' study days and this is much appreciated. Sisters from the Bromley Hospital Group have also accompanied district nurses on observation visits. Since the introduction of a revised training syllabus for student nurses, 12 students from Orpington and Farnborough Hospitals have had the community care experience. This has obviously been of great assistance to the student in her understanding of the work carried out in the community and services that are available to patients on discharge from hospital. We were invited to participate in the local Hospitals Careers Week, held at Farnborough. A stand was provided for the Local Authority and manned by our nursing staff. MARIE CURIE MEMORIAL FOUNDATION The night nursing service for terminal carcinoma cases has again proved to be of great benefit. STATISTICS During the year 4,428 persons were nursed. This represented an increase when compared with the previous year of 1,157. The number of visits to patients totalled 84,182 i.e. 5,679 more than in 1971. 19 HEALTH VISITING Miss B N Chandler, SRN, SCM, HV Cert.Dip.Soc.Studies (Lond) Establishment It was agreed that two School/Clinic Nurses should be appointed to assist with routine work, and this has proved a benefit in giving the Health Visitors more visiting time. During the year 6 Health Visitors left, one for a promotion post and 5 for domestic reasons, and were replaced by 6 new appointments, 4 of which were sponsored Student Health Visitors who joined the staff on qualification. At the end of the year there were 45 Health Visitors and 2 School/Clinic Nurses in post. Training 8 Nurses with basic SRN and Midwifery or Obstetric qualifications were sponsored by Bromley to take their Health Visitor training and 10 were given experience with the Fieldwork Instructors in this Borough who were sponsored by other areas. 37 Student Midwives, 50 Student Nurses, 14 Pupil Nurses and 8 Students from other professions were given an insight into the Health Visitors' work. The programming of this undertaking was carried out by the Deputy Superintendent who also gave lectures and conducted discussions before and after the fieldwork placements. The Health Visitors attended the KCC Refresher Course and were grateful to be invited once again, and attended various study days in hospitals and at the London Boroughs Training Committee to keep up to date with current developments. 2 Health Visitors went on a two week Refresher Course, 2 took Fieldwork Instructors' Course, the Deputy Superintendent took a course for Administrators concerned with training and the Superintendent Health Visitor went on a 2 week Middle Management Course. Home Visits The improvement in recruitment has been reflected in the increase in home visits to all age groups, a total of 60,332 effective visits were paid and 11,300 where no reply was obtained. These visits include first visits to 1,973 children between 5 and 16 years, 5,302 to persons aged 17-64 years and 952 to persons aged 65 and over. 629 visits were paid to households where one member suffered from tuberculosis and 493 to persons with other serious chest conditions. 4,621 other visits were paid for various reasons including visits to long stay immigrants and people with psycho-social problems. Health Education 277 sessions were held when the Health Visitor or School Nurse did group teaching and these included talks to school children, expectant parents, groups in other professions and clubs for the elderly and other groups interested in healthy living. Case Conferences 109 formal and informal case conferences were attended where the Health Visitor could usefully contribute. Clinic Sessions 4,134 Maternal and Child Health Clinics (many in General Practitioner Surgeries) and 660 other clinic sessions were conducted by the Health Visitors. School Health The Hygiene and Medical Inspections are reported on in the School Health Section all of which were prepared and/or attended by the Health Visitors or School/Clinic Nurses. Conclusion It is apparent that this year a better service was given to the total population by the Health Visitors. This has given them more job satisfaction in reaching more members of the public and helping towards optimum health by offering their knowledge in the individual situation of the person involved. 20 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 and Social Security. During the year 227 persons were notified to the Department and 169 successfully visited. This not infrequently involved more than one visit. Some persons were not known at the address given and other, 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 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, 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 and Science that teachers taking up their first teaching appointment should be medically examined. 21 The statistical details for this are given below: Total number of Health Declaration forms received 1,386 Number of recommendations without medical examinations 1,185 Number of medical examinations carried out: (a) For admission to Superannuation Scheme 201 (b) Training College candidates 454 (c) Teachers First Appointments 84 (d) Premature retirement in prolonged sick leave 15 (e) For other Authorities 10 (f) For West Kent Main Sewerage Board 27 (g) For Heavy Goods Vehicles Licences 89 880 Candidates examined for this Borough by other Authorities 8 VENEREAL DISEASE Under the National Health 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 1972:- New Cases of Residents treated during 1972: Treatment Centre Syphilis Gonorrhoea Other Genital Infections Other Conditions TOTAL Primary and Secondary Other Croydon General Hospital 1 3 17 146 60 227 Dreadnought Seamen's Hospital, Greenwich - - 10 26 25 65 Greenwich District Hospital - - 9 21 23 53 Middlesex Hospital - - 1 4 6 11 St. Bartholomew's Hospital - - 2 30 9 41 St. Giles's Hospital - - 5 22 16 43 St. John's Hospital - - 25 180 87 292 St. Thomas's Hospital - - 16 41 19 76 Westminster Hospital - - 5 18 6 29 Whitechapel Clinic The London Hospital - - 9 31 13 53 1 3 99 519 264 886 22 HEALTH EDUCATION & HOME SAFETY Health Education It is obvious that to motivate the general public into taking action against illness and disease continual education and correct information must be given to them, as they themselves will not necessarily seek out such information to improve and maintain their health. The promotion of good health as a community ideal has been the prime object of the Health Education Section throughout the past year. The section continued its role as a co-ordinating unit in specific and general health subjects as well as awakening and supporting health education conciousness within the community. Both statutory and voluntary functions were involved and good liaison was established with potential and practising health educators by way of advice, aids, equipment, projects and syllabuses. To widen and stimulate the health patterns of the community, training schemes for adults who are in constant contact with the younger generation proved to be a valuable method. The "in-service" training programme on Health Education for Primary School teachers was held throughout the Spring Term at Stockwell College and the well attended course for Girl Guides at Bromley Town Hall during November and December brought requests for further courses. Health Education was also included as part of the Home Help "in-service" training scheme and, coupled with a general campaign on Hypothermia, the problems concerning the elderly of our community were conveyed to as many as possible. Many talks were given on Health Education. Supporting, for example, the schoolteachers with their health lessons, talks were given to Parents' Associations. It was indeed gratifying to see the interest expressed by the parents. Parents are always anxious to expand their knowledge on health matters and the majority do realise their responsibilities towards their children. Elderly persons clubs. Youth clubs. Young Wives Groups and many Voluntary Societies have requested talks covering a variety of health subjects including drugs, diets, care of feet, teeth, eyes or the new baby, and the health educators have been only too pleased to give the correct information to an interested audience. Great use was made of the section as a resource centre. Over the past year continual assessments of new materials and techniques were made, and support can now be given to the health visitors, midwives and schools with more up-to-date audio visual aids and background materials. It was beneficial to work with the Public Health Inspectors in the production of an exhibition presenting a Clean Food Campaign in July. The Health Education Section has, by working with National Campaigns and with continual surveys and gathering of information, communicated the need to improve the Borough's health. Home Safety The amalgamation of Bromley, Beckenham and Orpington Home Safety Committees to form the London Borough of Bromley Home Safety Committee in September 1972, brought about a more united effort to reduce the number of home accidents within the borough. As the follow-up surveys showed, two local campaigns were well received by the general public. The hospitals within the Bromley Group gave a 'nil' return on firework casualties for November, 1972. This was due partly to the national campaign on the subject on television, the radio and in the press but also to the enthusiastic response on the part of local residents and traders to the request to display the firework poster which we produced. Many associations and groups also adopted the suggestion of arranging organised firework displays. The continual high number of poisonings reported throughout the year resulted in the "Return Unwanted Medicine and Tablets" campaign. With the co-operation of the local dispensing chemists, the campaign produced an overwhelming response but, more important, also succeeded in making householders more conscious of the dangers of misusing medicines and tablets. 23 Despite the efforts of the Home Safety Committee to reduce the home accident figures, it is obvious that more people must be made to realise that it is only by their own efforts of establishing, maintaining and renewing their standards of safety within their own homes that any substantial in-road can be made into the high accidents which occur yearly. Home Accidents 1971 1972 Adults 5236 Adults 5341 Children 3621 Children 3776 Total: 8857 Total: 9117 24 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 nonemergency 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. 25 DENTAL SERVICES DENTAL SERVICES Mrs. C.M. Lindsay L.D.S., R.F.P.S. (Glasgow) Principal Dental Officer The total number of deciduous and permanent fillings is roughly the same as 1971, although there is a considerable increase in the output of crowns and inlays. An increase in conservative treatment was expected, but owing to the illness of one dental officer and the difficulty of replacing another who left the district, there was a loss of working time of approximately six man months. However, the Borough has been fortunate in securing the services of another dental officer. The Borough now has a full complement of dental staff. In this affluent society it is increasingly difficult to curb the amount of sugar and sweetstuffs consumed, in spite of innumerable talks and instructions on oral hygiene and dietary habits. Accordingly the number of extractions continues to increase. The total number of extractions, however, is considerably less by comparison than most of the London Boroughs. The topical application of fluoride is proving very successful, but as has been stated the time expended on this treatment is considerable and cannot be expanded to the detriment of other treatment. However, hygienists and some of the dental officers are doing as much as they possibly can. May I take this opportunity to thank the Head Teachers and Staff who have so readily assisted in the dental health campaign and also the Health Visitors who have always been most co-operative with the dental department. To Dr. Morris and Mr. Miller out thanks are also due for their excellent anaesthetics throughout the year. . The loyalty and co-operation of the dental staff, dental officers, and dental surgery assistants, has been most helpful in the exercising of my duties and has been very much appreciated. SESSIONS Sessions devoted to treatment 3348 Sessions devoted to inspection 223 Sessions devoted to Dental Health Education 76 26 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS (as at December 1972) A. Attendances and Treatment Children Expectant and Number of Visits for Treatment During Year 0-4 (incl.) Nursing Mothers First Visit 600 75 Subsequent Visits 453 52 Total Visits 1053 1 27 Number of Additional Courses of Treatment other than the First Course commenced during year 30 4 Treatment provided during the year - Number of Fillings 1091 92 Teeth Filled 904 52 Teeth Extracted 52 23 General Anaesthetics given 19 5 Emergency Visits by Patients 18 8 Patients X-Rayed 1 14 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 112 61 Teeth Otherwise Conserved 133 Teeth Root Filled - 3 Inlays - 4 Crowns - 2 Number of Courses of Treatment Completed during the year 412 66 B. Prosthetics Children Expectant and 0-4 (incl.) Nursing Mothers Patients Supplied with F.U. or F.L. (First Time) - 2 Patients Supplied with Other Dentures - 2 Number of Dentures Supplied - 4 C. Anaesthetics General Anaesthetics Administered by Dental Officers 30 D. Inspections Children Expectant and 0-4 (incl.) Nursing Mothers Number of Patients given First Inspections During Year 322 18 Number of Patients in A and D above who required Treatment 94 14 Number of Patients in B and E above who were offered treatment 87 13 Number of Patients re-inspected during year - - E . Sessions Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and For Treatment 157.7 Child Health Patients For Health Education 38 27 ATTENDANCES AND TREATMENT - SCHOOL CHILDREN Ages 5 to 9 Ages 10 to 14 Ages 15 & over Total First Visit 3494 1990 372 5856 Subsequent Visits 7026 8564 989 16579 Total Visits 10520 10554 1361 22435 Additional courses of treatment commenced 479 224 32 735 Fillings in permanent teeth 2940 5835 1654 10429 Fillings in deciduous teeth 8768 978 - 9746 Permanent teeth extracted 194 322 52 568 Deciduous teeth extracted 1387 455 - 1842 General anaesthetics 523 259 18 800 Emergencies 293 95 35 423 Number of Pupils X-rayed 254 Prophylaxis 2917 Teeth otherwise conserved 325 Number of teeth root filled 20 Inlays 10 Crowns 47 Courses of treatment completed 6550 ORTHODONTICS New cases commenced during year 241 Cases completed during year 135 Cases discontinued during year 3 Number of removable appliances fitted 306 Number of fixed appliances fitted - Pupils referred to Hospital Consultant 2 PROSTHETICS 5 to 9 10 to 14 15 & over Total Pupils supplied with F.U. or F.L. (first time) - - - Pupils supplied with other dentures (first time) - 14 5 Number of dentures supplied - 2 4 6 ANAESTHETICS General Anaesthetics administered by Dental Officers INSPECTIONS (a) First inspection at school, number of pupils 31921 (b) First inspection at clinic, number of pupiIs 3328 Number of (a) + (b) found to require treatment 14119 Number of (a) + (b) offered treatment 11207 (c) Pupils re-inspected at school or clinic 687 Number of (c) found to require treatment 338 28 SESSIONS Sessions devoted to treatment 3348 Sessions devoted to inspection 223 Sessions devoted to Dental Health Education 76 29 INFECTIOUS AND OTHER DISEASES INFECTIOUS & OTHER DISEASES GENERAL The total number of cases of infectious disease notified to the Department during the year was 1,039. This was a decrease compared with the previous year when 1,658 cases were reported, the difference being mainly accounted for by a smaller number of cases of measles compared with 1971. Although the large epidemics of measles that used to occur in alternate years are a thing of the past as a result of the availability of vaccination against measles, it would nevertheless be beneficial if the proportion of children receiving this protection could be increased and this is highlighted by the fact that the great majority of cases in 1972 affected children under the age of 15 years. There were also reductions in the numbers of cases of scarlet fever, whooping cough, infective jaundice, and food poisoning, also contributing to the improved picture. It is pleasing once again to report the absence from the Borough of any cases of diphtheria or poliomyelitis, a tribute to the programmes of immunisation against these infections which were only recently such a threat to the health of the community. Precautionary surveillance of travellers exposed to possible infection overseas continued, particularly in respect of smallpox and cholera, but no cases of these infections occurred. Statistical details of the various infectious diseases are given below under separate headings and, unless otherwise stated, no deaths from these infections occurred. CHOLERA No case of the infection occurred but the Department was concerned with the surveillance of two returning holiday-makers who were possible contacts of this infection. DIPHTHERIA Once again I am pleased to report that no case of diphtheria was notified in the Borough during the year. DYSENTERY During the year 15 cases of this infection were reported compared with 13 during the preceding year, and were, with one exception, of the mild Sonne type. The single exception was of flexner dysentery infection affecting a resident who had contracted the infection abroad. Once again the illness was mild. FOOD POISONING During the year 10 cases of food poisoning were notified, a decrease compared with the previous year. Details of all the cases notified and of others that came to light as a result of the investigation carried out are shown in the table below. In the majority of instances illnesses were caused by organisms of the salmonella group and were mainly isolated cases, of illness or family infections. There was only one general outbreak affecting 5 persons. There were no deaths during the year resulting from food poisoning infection. 30 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 cols. (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 - - 4 10 7 11 17 2. Other Salmonellae - - - - 14 14 14 3. Cl.welchii - - - - 1 1 1 4. Staph.aureus 1 5 - - - 1 5 5. Other causes - - - - ■ - " 6. Cause unknown - - - 1 1 1 7. TOTAL 1 5 4 10 23 28 38 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of Salmonellae Derby - - - - 1 1 1 Haardt - - - - 1 1 1 Virechow - - - - 1 1 1 Haifa - - - - 1 1 1 Anatum - - r - Newport - - - - 1 1 1 Meleagridis - - - - 1 1 1 Panama - - - - 1 1 1 Enteritidis - - - - 4 4 4 Thompson - - - - 1 1 1 31 INFECTIVE JAUNDICE A total of 31 notifications of infective jaundice were received during the year, a similar figure to the previous year when 35 cases were reported. The general pattern of the infection continued to be of sporadic cases and the illnesses were generally mild in nature, a wide range of age groups being affected. A single death from this cause occurred during the year. LEPTOSPIROSIS No case was notified during the year. MALARIA One case of malaria was reported during the year in the case of a resident who had recently returned from Africa. MEASLES A total of 853 cases were notified during the year compared with 1,390 in 1971. Most of the notifications related to children under the age of 15 years and the following table shows the incidence of the infection in the Borough since 1965. Year No. of cases notified 1965 5119 1966 1236 1967 4299 1968 398 1969 1041 1970 668 1971 1390 1972 853 MENINGITIS There was an increase in the incidence of this infection compared with the previous year, 21 cases being reported during the year compared with 8 during 1971. There were two deaths reported. OPHTHALMIA NEONATORUM One notification was received during the year. POLIOMYELITIS No case of this infection was notified during the year. SCARLET FEVER This infection decreased slightly compared with the previous year. SMALLPOX No case occurred in 1970 but 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. Notification of these contacts was received from the Port Health Authorities. Altogether 42 persons were placed under surveillance in this way during the year. The Department was called upon to authenticate the signature of the Doctor on 2,694 international certificates of vaccination during the year. The corresponding figure for 1971 was 9,637. 32 TETANUS 1 case of tetanus was notified during the year. The patient whose infection derived from an injury to his foot when he stepped on a rusty nail, made a good recovery. TUBERCULOSIS The number of new cases notified showed little change compared with the previous year, 46 cases being reported compared with 42 notifications in 1971. I am once 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 this illness have occurred in schools, or similar communities. In one instance during the year, a pupil residing at a boarding school was found to be suffering from pulmonary tuberculosis and with the co-operation of the Chest Clinic the necessary investigations and preventive measures were taken. The Mass x-Ray Units which operate under the auspices of the South East Metropolitan Hospital Board, continued to pay regular visits to sites in the Borough, these sessions being available to the public without charge. The total number of cases on the register showed a further decline from 2,649 at the beginning of the year to 2,573 at the end of the year. There were 5 deaths attributed to the disease compared with 4 in the preceding year. The following are details of the recordings in the Register for the year ended 31st December, 1972:- Respiratory Other forms Total No. M F M F No. on Register at 1.1.72 1,305 1,030 143 171 2,649 No. of cases notified during 1972 26 14 5 1 46 No. of cases coming to knowledge after death 1 1 - - 2 Restored to Register - 1 - - 1 Inward Transfers 9 6 - - 15 1,341 1,052 148 172 2,713 Deletions - deaths, removals, recoveries etc. 67 64 3 6 140 Number of cases on register at 31.12.72 1,274 988 145 166 2,573 33 1972 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 2 - 1 - - - - - 5-14 years 2 2 - - - - - - 15-24 years 4 1 - - - - - - 25-44 years 5 4 2 - - - - - 45-64 years 5 3 - 1 1 1 - - 65 years and over 8 4 2 - 1 1 - 1 Age unknown - - - - - - - - 26 14 5 1 2 2 - 1 Inward Transfers 9 6 - - TOTALS 35 20 5 1 TYPHOID & PARATYPHOID FEVER 1 case of paratyphoid fever occurred during the year. The patient contracted the infection during travels abroad. Investigations were carried out in connection with 1 suspected case of typhoid fever but the diagnosis was subsequently not confirmed. In a number of other 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, but no case of the illness occurred. WHOOPING COUGH There was a considerable reduction in the number of notifications compared with the previous year, the total in 1972 being 7 as against 77 received during 1971. This is a very pleasing statistic with which to close these comments on infectious disease in the Borough during 1972. 34 35 INFECTIOUS DISEASES 1972 Number of Cases Notified in Age Groups TOTAL All ages Under 1 year 1 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 M F M F M F M F M F M F M F M F M F M F Dysentery - 1 5 3 2 1 - 1 - - - 1 - 1 - - - - 7 8 Food Poisoning - - 1 1 - - 2 - 2 1 - 2 1 - - - - - 6 4 Infective Jaundice - - - - 2 4 6 6 2 2 2 - 4 2 - 1 - - 16 15 Measles 11 15 168 173 251 204 3 2 1 4 - 1 - - - - 9 11 443 410 Meningitis 1 2 2 1 8 3 2 - 2 - - - - - - - - - 15 6 Scarlet Fever - - 8 4 17 15 - 1 - 2 1 - - - - - - 1 26 23 Tuberculosis (Pul.) - - 2 - 2 2 4 1 1 1 4 3 5 3 8 4 - - 26 14 Tuberculosis (Non Pul.) - - 1 - - - - - 2 - - - - 1 2 - - - 5 1 Whooping Cough 2 - - 1 2 2 - - - - - - - - - - - - 4 3 Malaria - - - - - - - - - - - - 1 - - - - - 1 - Ophthalmia Neonatorum 1 - - - - - - - - - - - - - - - - - 1 - Tetanus - - - - - - - - - - - - 1 - - - - - 1 - Encephelitis - - 1 - 2 - - - - - - - - - - - - - 3 - Paratyphoid - - - - - - - 1 - - - - - - - - - - - 1 TOTALS 15 18 188 183 286 231 17 12 10 10 7 7 12 7 10 5 9 12 554 485 ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH CLEAN AIR 1972 has been a year of substantial progress in the field of environmental health. The delay caused by the cut in the clean air programme in 1971 was overcome and indeed overtaken, with the result that six districts were created Smoke Control Areas in place of the usual three. These encompassed 5,505 acres and brought a further 18,534 premises under control, thus substantially passing the half way point in the effort to make the Borough 100% smoke free. The improved condition of the atmosphere is apparent to all. HOUSING In the housing field the Department has played a significant part in launching the new concept of General Improvement Areas, in which an effort to provide essential amenities (bath, internal w.c., hot water supply etc.) to all dwellings in a designated area is co-ordinated with a plan to improve the environmental appearance by tree planting and other visually imaginative features. Several areas in the Borough were considered, and it was decided that a part of Penge should be the first to receive treatment, This became the Penge East General Improvement Area. After inspection of the houses, mostly in multiple occupation, comprising the Palace Square/Palace Road Area of Penge, the Council decided that it was beyond improvement and a decision was taken later to redevelop, involving purchase and demolition of all properties. Additionally, the largest Clearance Area so far identified in the Borough, consisting of old and decrepit cottage-type properties in Waldo Road, Bromley, was surveyed and represented. All families living in these dwellings will be rehoused by the Council and the future use of the land will have to be decided upon. PLACES WHERE PEOPLE WORK The Offices Shops & Railway Premises Act 1963 has opened up a new dimension in the multifarious duties of the Public Health Inspector. There are 2,743 such premises in the Borough, already registered under the Act. The object is to promote and ensure the welfare, health and safety of the very many persons who are employed in retail and wholesale shops, catering establishments, canteens, warehouses, etc. The welfare sections stipulate minimum space required for employees, scale of washing and sanitary accommodation, provision and adequacy of heating, lighting, ventilating, etc. Little is known by the public of the role of the inspector in ensuring the safety of persons working in these premises. This work includes the guarding of office machinery, bacon slicing apparatus and other mechanical aids which are now installed in many establishments. All accidents occurring must be reported by the occupier. Accidents reported followed the usual pattern, falls constituting the largest group reported and the handling of goods the second largest. Strains, cuts and bruises were again the most common injuries sustained. There were no fatal injuries. This concise comment on the 'accident pattern' for the year does nothing to reveal the considerable time spent by the inspectorate in investigating the cause of accidents. Every effort is made to probe all notified accidents, however trivial they seem to be, even where it is obvious from the notification that the cause is due neither to a contravention nor to negligence on the part of the employer. It is felt that a prompt and sympathetic investigation will encourage employers to notify all future accidents when they realise that the primary reason for the investigation is to establish the cause of the accident and not merely to assess blame. Local Authorities are required to make quarterly reports on notified accidents to the Department of Employment, indicating by code numbers the type of premises, the cause of accident, and the type and site of the injury. These reports when collated enable the Department to view the situation nationally and are sometimes of use in indicating the need for remedial legislation. Liaison is obtained through a nominated Deputy Superintending H.M. Factory Inspector. 36 Place Where People Work Continued. At local level, the opportunity sometimes occurs for the Inspector to make recommendations to prevent a recurrence of an accident. In one such case a locking device on a piece of machinery, distributed nationally, was suggested to prevent an arm of the machine falling when not in use. This was adopted and later led to the modification of all the Company's machines. For many years now falls have constituted the largest group of accidents reported and the handling of goods the second. Most falls occur on the same level, usually due to persons slipping on wet or greasy floors or tripping over small objects left lying about. In the second group, over-reaching and lifting fairly heavy articles in an awkward manner accounted for the resultant strains and sprains. Most of these accidents occurred in packing departments and warehouses. On the lighter side, one report read - 'sat on her typing chair which collapsed, one of the legs breaking off'. Nevertheless, a serious investigation was made and the manufacturers of the chair were asked to consider strengthening the joining of the base support arms to the central pivot, either by additional welding or re-design. The Act recognises that prevention is better than cure and deals with matters such as the fencing of exposed parts of machinery, the training and supervision of persons working at dangerous machines and the prohibition of persons under the age of 18 years cleaning machinery if there is a risk of injury by a moving part. Special regulations may also be made by the Minister for protecting persons against the risk of bodily injury arising out of the use of any machinery or equipment. An example of these are the Hoists & Lifts Regulations of 1960. These relate to any premises to which the Act applies, where power driven or manually operated lifts are installed. The Regulations require that such lifts are examined every six months by a competent engineer. A copy of the engineer's report has to be sent to the person responsible for complying with the Regulations (the occupier) and if the report shows that the lift cannot continue to be used with safety a copy of the report has to be sent by the Engineer to the Local Authority which is responsible for ensuring that the defects are remedied. Through this process many lifts in the borough have had repairs carried out although none were found to be in a seriously unsafe condition. Beer hoists in public houses were found to need most attention due to frayed suspension ropes and worn parts. Enclosures were also needed in the cellars to prevent persons coming into contact with the moving parts. Further particulars of the work are included in the body of the report. STAFF AND STRUCTURE Unfortunately, the staff situation in the Environmental Health Section has deteriorated and this has had its inevitable effect on the routine visiting of food premises, slaughterhouses, factories, caravans, pet animal shops and boarding premises, riding stables, and the many other properties which are dealt with under legislation which the Inspectorate has a duty to enforce. Having regard to the coming reorganisation of the National Health Service in 1974, a decision was taken to carry out a review of the staffing and organisation of the Section with a view to correcting the staff deficiency and strengthening the structure. This was in progress when the year ended. 37 FOOD SAMPLING - 1972 ARTICLE NO. EXAMINED NO. ADULTERATED FORMAL INFORMAL FORMAL INFORMAL Baby Foods - 4 - - Beer - 11 - - (a) Biscuits - 2 - 1 Brandy 1 - - - (b) Bread and Bread Rolls - 23 - 15 (c) Butter - 21 - 4 Cakes - 1 — — Cake Decorations - 2 - - Cake Mixes - 2 - - Caramel Dessert - 1 - - (d) Cereal and Cereal Products - 23 - 5 (e) Cheese - 16 - 5 Cheese spread - 4 - - (f) Chocolate and cocoa products - 22 - 4 Cider - 1 - - (g) Coffee beans - 1 - 1 Colouring matters - 5 - - (h) Cream - 6 - 2 Cream desserts - 1 - - Cream of Tartar - 1 - - Diabetic foods - 3 - - Drugs - 25 - - Eggs and egg products - 3 - - (j) Fish and fish products - 13 - 2 Fish spread - 13 - - (k) Flour - 5 - 2 Fruit, dried - 5 - - Fruit, fresh - 4 - - (l) Fruit products (including tinned fruit) - 28 - 6 Gin 2 - - - Ice cream - 32 - - Ice lollie - 1 - - Ice pops - 1 - - Jam and preserves - 1 - - Liqueur chocolates - 3 - - Margarine - 2 - - (m) Meat and meat products (including tinned meat) - 58 - 9 Meat spreads - 16 - - Meat tenderiser - 1 - - (n) Milk and milk bottles - 83 - 19 Milk (dried) - 5 - - (o) Milk (tinned) - 1 - 1 Milk shake mix - 1 - - Mixed drinks - 2 - - (p) Non-brewed condiment - 2 - 1 Oils and fats - 18 - - Pastry - 1 - - (q) Puddings - 2 - 2 Rum 2 - - - Saccharin tablets - 1 - - (r) Salads - 4 - 1 Salad cream and dressing - 7 - - Sauces and pickles - 12 - - (s) Sausages and sausage meat - 38 - 5 (t) Sausage rolls - 2 - 1 Slimming foods - 19 - - (u) Soft drinks - 12 - 2 38 ARTICLE NO. EXAMINED NO. ADULTERATED FORMAL INFORMAL FORMAL INFORMAL Soup - 12 - - (v) Spices and flavourings - 45 - 1 (w) Sugar and sugar products - 2 - 1 (x) Sweets - 23 - 2 Synthetic cream - 1 - - Tea - 14 - - Vegetables (dehydrated) - 1 - - (y) Vegetables (frozen) - 3 - 3 (z) Vegetables (tinned) - 6 - 4 (Aa) Vegetable products - 5 - 1 Vegetarian foods - 7 - - Vinegar - 13 - - Vitamin food - 1 - - Vodka 2 1 - - Whisky 2 - - - TOTALS 9 705 - 100 39 Nature of Unsatisfactory Sample Remarks Serial No. 5146 (m) Canned Chicken Composition: Embedded in the jelly associated with the chicken was a damaged specimen of a house fly, Musca Domestics, which gave a positive reaction for phosphatase enzymes, which indicated it had gained access after the can had been opened. Investigated. Warning letter to importer. Serial No. 5053 Composition: Associated with the steak and kidney pudding was a snail (Kentish, Monacha Cantriana) which probably derived from the peas. It would occur in the vicinity of pea and bean fields and even on these plants. (m) Steak and Kidney Pudding Investigated. Source of foreign matter not confirmed. Serial No. 5095 Composition: Nineteen crystals of common salt, weighing 0.7g,were isolated from the sample. Glass which was thought to be present was not found. (m) Meat Extract Investigated. Attention of manufacturer drawn to complaint, Serial No. 5096 (j) Smoked Haddock with butter Composition: The small dipterous fly embedded in the surface of the butter pat is an Empid Ply of the genus Platypalpus. These are small flies which are generally found out of doors on small plants. Investigated. Warning letter to processors, Serial No. 5046 n) Pasteurised Milk Composition: The internal surface of the bottle was soiled locally by small brown specks due to the presence of iron and mould growths. Investigated. Warning letter to bottlers. Serial No. 5082 (n) Pasteurised Milk Composition: Adherent to the inner surface of the bottle over an area of 2 by ¾ of an inch were fragments of iron and rust. Investigated. Drawn to attention of bottlers. Serial No. 5093 (n) Milk Composition: The material adhering to the inner periphery of the base of the bottle consisted of fragments of a set sand cement mixture. Investigated. Warning letter to bottlers. Serial No. 5121 (n) Pasteurised Milk Composition: The pink and grey residues in the milk were of the nature of distemper or similar paint residue. They contained appreciable amounts of chalk. Investigated. Warning letter to bottler. 40 Nature of Unsatisfactory Sample Remarks Serial No. 5134 (n) Pasteurised Milk Composition: This sample was submitted with a complaint that there was no cream line. The fat content was however normal (3.5 per cent) and the absence of a cream line could be ascribed to homogenisation. The bottle should however have been so marked. Investigated. Attention of bottler drawn to matter. Serial No. 5048 (n) Channel Islands Milk Composition: The internal surface of the bottle was soiled locally by feathery growths of mould and/or algae. These varied in colour from green and pink to brown and it was noticed some were free in the milk. Investigated. Warning letter to bottler. Serial No. 5068 (h) Single Cream Composition: The foreign particles, mainly on the underside of the lid, had probably derived from the filling machine. Investigated. Drawn to attention of bottler. Serial No. 5089 (h) Double Cream Composition: Methylene Blue Test "Unsatisfactory". Repeat samples. Satisfactory. Serial No. 5055 (c) Butter Composition: Affected by small mould growths ( 2 by 1 mm.) limited mainly to the area of the edge of the wrapping paper. Investigated. Warning letter to vendor. Serial No. 5085 (e) Soft Cheese, Medium Pat Composition: The fat figure was 8.2 and the solids 26.3 per cent. This is a low fat soft cheese. For Medium Pat Soft Cheese fat should be between 10 and 20 and solids 30 or more. Trial sample - not offered for sale. Local manufacturer advised of result, amending proportions accordingly. Serial No. 5145 (l) Canned Pruit Composition: The wood louse associated with the canned fruit gave a positive phosphatase reaction, indicating it was not processed with the fruit. Pacts of complaint not verified. Serial No. 5178 (l) Raspberries in Syrup Composition: The insect found in the fruit was a Shield Bug (Palomina prasina) and is known to be a pest of shrubs in most European countries. The absence of phosphatase enzymes indicated that it had been heated. Warning letter to importer. Embassy of exporting country notified. 41 Nature of Unsatisfactory Sample Remarks Serial No. 5110 (l) Blackcurrant Tart Compositions Adherent to the head of the drawing pin associated with the tart was a sugar and flour mixture stained with fruit juice. It was not possible to assess whether a metal object such as this pin had been heated but the adherence of food residues to it indicated it was in the tart during production. Investigated. Warning letter to baker. Serial No. 5047 (Aa) Tomato Juice Composition: The contents of the opened can of tomato juice had attacked the can and acidity had developed so that it was not possible to assess its original quality. Matter investigated. No further action, Serial No. 5083 (z) Six tins of peeled tomatoes Composition: Of the six cans one was slightly 'blown'. Internally five showed slight attack of the can and one showed marked attack. The contents of this can were examined for metals with the following results: Lead 0.8, Copper 3.9, Zinc 7.5, Tin 236 and Iron 63 p.p.m. The iron figure is rather high and could impart a metallic taste. Warning letter to importer. Embassy of exporting country notified. Serial No. 5061 (z) Baked Beans Composition: When examined the greenish areas on the interior of the can showed the presence of iron, the lacquer and tin having been stripped at these points. However, the can had been opened for some time before examination and the condition of the sample could have changed since opening. Matter investigated. Warning letter to canner. Serial No. 5094 (k) Self-Raising Flour and mouse dropping Composition: On sieving the flour two rodent droppings were isolated making a total of three in the sample. Investigated. Source of impurity not confirmed, Serial No. 5045 (b) Bread Composition: Associated with the bread was a piece of string 16" long which could have been used to tie the neck of a sack of flour. It had been baked in the loaf. Matter investigated. Warning letter to baker, Serial No. 5069 (b) Bread Composition: The felt washer, half an inch in diameter, had a number of dough fragments firmly adherent to it and on one side there was evidence of slight charring. These findings are compatible with the washer being adherent to the loaf base during baking. Matter investigated. Warning letter to baker. 42 Nature of Unsatisfactory Sample Remarks Serial No. 5084 (b) Bread Composition: On the basal crust of the white cut loaf was an irregularly shaped black patch measuring 3" by 1" overall, the substance of which had penetrated into some of the slices to a¼". It consisted of charred dough together with iron, mineral oil and some vegetable fibres. Matter investigated. Warning letter to baker. Serial No. 5054 (q) Christmas Pudding Composition: The foreign body from the Christmas Pudding consisted of a rubber ment and was probably part of the apparatus used in manufacture. Matter investigated. Warning letter to manufacturer, Serial No. 5161 (d) Breakfast Cereal Composition: The sample contained a piece of dark material which consisted of slightly charred wheat structures. Matter investigated. No further action. Serial No. 5133 (d) Meatless Sausages Composition: Associated with the sample was part of a Bluebottle Fly. The presence of phosphatase enzymes in its tissues indicated it had not been heated. After investigation warning letter to manufacturer. Serial No. 5051 (w) Soft Brown Sugar Composition: The sugar was in a poor condition in that it contained lentils, rust, wood splinters, tobacco shreds and general debris. In addition, two rodent droppings were found in the sample. Matter investigated. Warning letter to manufacturer. Serial No. 5147 (x) A sweet Composition: Firmly adherent to the sweet was a piece of pink gauze approximately 1" square and on its lower surface was a thin layer of loose fibres consisting of viscose rayon. Legal proceedings. Manufacturer fined £20 with £16 costs. Serial No. 5108 (p) Non-brewed condiment Composition: The acetic acid content, of 3.2 per cent was below the Limit of 4.0 per cent. Correspondence with Manufacturer. Repeat sample satisfactory. Serial No. 5109 (g) Coffee Beans Composition: Associated with the sample was a stone measuring 8 x 6 x 4 mm. and weighing 0.45g. It consisted of quartz (sand). Matter investigated. Warning letters to packers Serial No. 5052 (v) French Mustard Composition: The deterioration of the mustard is due to a small puncture in the lid of the jar. Investigated. Warning letter to manufacturer. 43 Nature of Unsatisfactory Sample Remarks (n) Serial No. 5270 Pasteurised Milk Composition: The base of the bottle was soiled internally with a sooty deposit. Matter investigated. Warning letter to bottler. Serial No. 5225 (n) Channel Islands Pasteurised Milk Composition: The blue material adherent in small patches to the interior of the glass of the bottle consisted of a blue iron pigment, probably Prussian Blue. Two small pieces were found free in the milk. Matter investigated. Warning letter to bottler. Serial No. FC.786 (c) Unsalted butter Control Sample (c) Unsalted butter Composition: The butter was affected by mould growths. Legal proceedings. Vendor fined £20 with £16 costs. Serial No. 5226 (1) Raspberries in Syrup Composition: The three Coleopterous larvae found in the can of raspberries gave a negative phosphatase test, indicating that the larvae had been heated. Warning letter to importers, Embassy of producing country notified. Serial No. 5285 y) Frozen Peas Composition: Two greenish-brown lumps of material associated with the peas consisted entirely of vegetable structures: the larger measured approximately 9 mm. in diameter and the smaller 3 mm. Matter investigated. Warning letter to processors, Serial No. 5187 (u) Flavoured Drink Composition: A complaint as to the flavour and colour of a proprietary soft drink was considered and while no variation in flavour was noted it was accepted that the colour was abnormal. After investigation, matter draw to attention of manufacturer. Serial No. 5195 u) Ginger Wine, Non-alcoholic Composition: This article, not being a fermented product, cannot be described as a wine. It was suggested that the cription Ginger Cordial was appropriate. Article not offered for sale to general public. Trial sample only. Manufacturer advised accordingly. Serial No. 5227 (f) Chocolate Drops Composition: The chocolate drops were rather sticky and had a rancid odour indicating old stock or unsatisfactory storage conditions. In addition, some of the chocolate drops had small patches of the mould Aspergillus on them. Matter investigated. No other action on account of doubt as to identification of vendor. Serial No. 5314 (m) Pork Meat - Canned Composition: The sample contained a brass strip, 14 mm. long and 2 ram. wide, with perforations 1 mm. in diameter down its length. It was probably a fragment of a sieve. Matter investigated. Warning letter to processor, 44 Nature of Unsatisfactory Sample Remarks Serial No. 5554 (m) Corned Beef Composition: The dark coloured 'bodies' in the corned beef were connective tissue which had acquired a dark colour in processing. Matter investigated, Condition brought to attention of manufacturer. Serial No. 5381 (m) Pork Shoulder and Ham-Canned Composition: Associated with the sample was a ferrous metal fragment 4 mm. long and 2 mm. wide at the base, and about 1 mm. thick, which could have been part of a staple used for tagging carcasses. Matter investigated. Warning letter to processor. Serial No. 5454 (m) Pork Shoulder and Ham - Canned Composition: The discolouration of the meat was due to the presence of iron and/or rust particles admixed with the meat fibres. Legal proceedings. Manufacturer fined £25 plus £17 costs. Serial No. 5439 (m) Bacon Composition: The soiling of the fat was due to iron or rust particles which could have derived from the cutter. Matter investigated. Warning letter to vendor. Serial No. 5411 (s) Pork Sausages Composition: The sample contained 250 parts per million sulphite preservative which should have been declared. Vendor warned. Preservative notice now displayed. Satisfactory. Serial No. 5316 (m) Meat Pie Composition: An half-inch tin-tack, associated with the sample; showed residues of meat and flour firmly adherent to its surface, but there was no indication of the possible site of the tack in the pie itself. Matter investigated. Warning letter to manufacturer, Serial No. 5469 (t) Sausage Roll Composition: Embedded in the meat portion of the sausage roll was a lesser house fly. The absence of phosphatase enzymes in its tissues, and its close association with the roll indicated that it was baked with it. Matter investigated. Warning letter to vendor. Serial No. 5347 (n) Pasteurised Milk (two one-pint bottles) Composition: Sample (a) contained three wool fibres 5 mm. in length, end eight small specks of plant matter less than 0.1 mm. in diameter. Sample (b) contained a few wool fibres of similar length to those in (a), two fragments of plant matter less than 0.1 in diameter and three specks of dirt. Matter investigated. Warning letter to bottler. 45 Nature of Unsatisfactory Sample Remarks Serial No. 5365 (n) Pasteurised Milk Composition: Adherent to the inner surface of the base of the bottle were a number of fragments of a set sand cement mixture. Two small fragments were also noted free in the milk. Matter investigated, Warning letter to bottler, Serial No. 5467 (n) Milk Composition: The bottle was soiled internally by a band about 5 mm. wide passing round the circumference. The deposit contained chalk and denatured milk and was not completely removed with warm (l60°F) caustic soda for ten minutes. It is possible that the incrustation was present before the last filling. Matter investigated. Warning letter to bottler. Serial No. 5507 (n) Pasteurised Milk Composition: Three brown patches, about l/lO" diameter, of milk solids and mould hyphæ, were adherent to the inside of the bottle near the bottom rim, indicating that the bottle had not been cleaned properly. Matter investigated. Warning letter to bottler, Serial No. 5424 (e) Cheddar Cheese Composition: The dark specks on the surface consisted of iron rust and, in one case, a fragment of mould growth. All the contamination was at, or near, the surface and may, therefore, have occurred at the cutting stage. Matter investigated, Warning letter to vendor, Serial No. 5335 (e) Pull Pat Cheese Composition: The article was full fat soft cheese and should have been so described. The composition was factory for such a cheese. Correspondence with retailer. Cheese now properly labelled. Serial No. 5336 (e) Full Fat Creamery Cheese Composition: The article was full fat soft cheese and should have been so described. The composition was factory for such a cheese. Correspondence with retailer. Cheese now properly labelled. Serial No. 5492 (q) Creamed Rice Milk Pudding Composition: On the surface of the opened tin of rice pudding adjacent to the side seam was a patch of mould approximately 12 mm. by 6 mm. There was a small hole in. the can at the point where the mould had grown. Matter investigated. Warning letter to canner. 46 Nature of Unsatisfactory Sample Remarks Serial No. 5346 (1) Plums - Canned Composition: A male Oriental Cockroach (Blatta Orientalis) about 25 mm. in body length was associated with the canned plums. The absence of phosphatase enzymes in its tissues indicated it had been heated. Matter investigated. Warning letter to importer and attention of Embassy of exporting country notified, Serial No. 5440 (l) Apricot Pie Composition: The two small pellets embedded in the pastry consisted of vegetable matter with similar structures to those of apricots and they could have derived from the filling material. Matter investigated and drawn to attention of baker, Serial No. 5350 (z) Tomatoes - Canned Composition: The two globules of metal removed from the can, and the smaller globules removed from the seam, consisted of tin/lead solder. Matter investigated. Warning letter to importers. Embassy of exporting country notified, Serial No. 5348 (z) Butter Beans Composition: Associated with the butter beans was an irregularly shaped piece of rusted iron about 0.5 mm. thick and 30 by 45 mm. overall. It was noted that one of the beans showed a discolouration due to contact with iron, which suggests possible contact with the foreign body. Matter investigated. Warning letter to canner. Serial No. 5410 (b) Bread Composition: The bristle associated with the bread was of plant origin. It was 25 mm. in length and had breadcrumbs firmly adherent to its surface. Matter investigated. Warning letter to baker, Serial No. 5468 (b) Bread Rolls Composition: The nine bread rolls were all very dirty at the base. A wooden splinter, approximately 18 mm. long, was partially embedded in one of the rolls and had probably penetrated the roll after baking. A piece of plastic film was embedded in the base of a second roll. It was 10 mm. in diameter and the presence of zinc oxide indicated it was part of a surgical dressing. A third roll had a currant embedded in the side of it. Matter investigated. Strong warning letter to baker. Serial No. 5470 (b) Bread Composition: Embedded in the loaf were parts of a buff and green flour sack label. The label was in four pieces which fitted together to form a rectangle approximately 3 by 5 cm. The label had been baked in the bread. Legal proceedings. Baker fined £50 with £10 costs. 47 Nature of Unsatisfactory Sample Remarks Serial No. 5480 (b) Bread Rolls Composition: Three pieces of P.V.C. type plastic were embedded 12 mm. inside one of the rolls, the largest piece being 25 by 6 mm. In addition, five more pieces were embedded in the bottom of the roll, the largest piece being 10 by 5 mm. Similar pieces of plastic were found in the other roll. Matter investigated. Warning letter to baker. Serial No. 5493 (b) Bread Composition: Embedded in each of the slices of bread was a piece of chewing gum approximately 50 by 5 mm. The adjacent bread was closely adhering to the chewing gum, which appeared to have been baked in the loaf. Legal proceedings. Baker fined £75 with £16 costs. Serial No. 5509 (b) Bread Composition: The bread contained pieces of a rubber band which had been baked with it. Matter investigated, Warning letter to baker, Serial No. 5481 (a) Stone removed from biscuits Composition: The dark red 'stone' was about 5 mm. by 4 mm. in size and had a flat surface, suggesting it may have been part of a tile. Small starchy fragments were present on its rougher surfaces, compatible with its having originated in the biscuit. Matter investigated. Warning letter to manufacturer. Serial No. 5441 (d) Breakfast Cereal Composition: A Dipterous fly was embedded in the inner wrapper of the cereal. No foreign matter was present in the cereal itself. Matter investigated and drawn to the attention of firms concerned. Serial No. 5397 (x) Sweets Composition: Embedded in the boiled sweets were two lengths of springy iron wire 13 mm. and 7 mm. long, and 0.2 mm. in diameter. One end of the longer piece was rounded as if forming the tip of a wire brush and when a piece was withdrawn from the partly consumed sweet, the cavity left in the sweet was found to be discoloured. Matter investigated. Warning letter to manufacturer. Serial No. 5361 (f) Chocolate covered Coconut Ice Bar Composition: A voluntary list of ingredients for the coconut ice was present but the chocolate coating should have been included. Correspondence with manufacturers. Label amended. Now satisfactory, 48 Nature of Unsatisfactory Sample Remarks Serial No. 5380 (f) Chocolate Composition: The chocolate was infested by larvae and adults of the saw-toothed grain beetle which was thought to have gained access via the dried vine 'fruit in the chocolate. Matter investigated, Warning letter to vendor, Serial No. 5688 (s) Pork Sausages Composition: The samples contained sulphite without the necessary declaration. Correspondence with vendors, Appropriate notice now exhibited. Satisfactory. Serial No. 5679 (s) Pork Sausages Composition: The sample contained 60% meat whereas pork sausages should contain not less than 65% meat. The sample also contained sulphite without the necessary declaration. Repeat formal sample in progress. Serial No. 5693 (s) Wire in Pork Sausage Composition: The wire, which was scored as if it had passed through the mixer, had meat and cereal adherent to it. Matter investigated. Warning letter to manufacturer. Serial No. 5689 (s) Beef Sausages Composition: The sausages contained sulphite without the necessary declaration. Correspondence with vendors, Appropriate notice now exhibited. Satisfactory. Serial No. 5600 (j) Pish Cake Composition: Associated with the sample were pupae of a Bluebottle fly. Investigated. Warning letter to manufacturer. Serial No. 5572 (n) Milk Composition: The interior surface of the glass of the bottle was soiled by an adherent film of denatured milk in which dirt particles were embedded. Legal proceedings. Bottlers fined £30 plus £25 costs. Serial No. 5690 (n) Milk Composition: The interior of the bottle was soiled by a band of discoloured denatured milk about 50 mm. wide. Investigated. Warning letter to bottlers. Serial No. 5615 (n) Milk Composition: Material adhering to the inside surface of the base of the bottle consisted of a set sand cement mixture. Investigated. Warning Serial No. 5691 (n) Milk Composition: Fragments of cement, dis- coloured by iron, were adherent to the side and base of the bottle. One fragment was free in the milk. Investigated. Warning letter to bottlers. 49 Nature of Unsatisfactory Sample Remarks Serial No. 5585 (n) Milk Bottle Composition: The interior surface of the bottle showed numerous small dark coloured mould growths. Investigated. Warning letter to bottlers. Serial No. 5601 (n) Milk Composition: The internal surface of the bottle was soiled by an adherent film in which mould and algae had grown. Two small fragments were loose in the milk. Investigated. Warning letter to bottlers. Serial No. 5599 (n) Milk Composition: Three pupae of a phorid fly were attached to the inner surface of the glass of the bottle. Investigated. Warning letter to bottlers. Serial No. 5677 (o) Evaporated Milk F.C. Composition: The milk had deteriorated due to a small hole in the can. Investigated. Warning letter to vendors. Serial No. 5724 (c) Butter Composition: One of three half pound blocks of butter, showed signs of incipient rancidity. Investigated. Warning letter to vendors. Serial No. 5630 (e) Cheese Composition: A house-fly was found to be embedded in the cheese. of exporting country notified. Investigated. Warning letter to vendors. Embassy Serial No. 5647 (y) Peas Composition: The slug associated with the peas was 26 mm. long, and of the species Agriulnax Reticulatus which is a widely distributed species and known to feed on a variety of plants. Investigated. Warning letter to processors. Serial No. 5740 (y) Peas Composition: The snail associated with the peas was 9 mm. in diameter and 6 mm. in thickness, and could have been graded as a pea. Investigated. Warning letter to processors, Serial No. 5586 (r) Mixed Salad Composition: The salad contained four glass fragments, the largest being 3 by 3 mm. Investigated. Warning letter to importer. Embassy of exporting country notified. Serial No. 5598 (k) Flour Composition: The flour contained a larva of the Codling Moth and a human hair. Investigated, No further action. 50 Nature of Unsatisfactory Sample Remarks Serial No. 5587 (b) Bread Composition: A rusty staple associated with the sliced white loaf, had fragments of crumb adherent to it and there were areas of rust staining on the crumb of two slices of the bread. Investigated. Warning letter to bakers. Serial No. 5645 (b) Bread Composition: Firmly embedded in the crumb of the bread was a piece of black foam rubber 10 by 3 by 1.5 mm. Investigated. Warning letter to bakers. Serial No. 5653 (b) Bread Composition: There were areas of dis- colouration in the crust and crumb due to the presence of soiled dough containing iron and mineral oil. Investigated. Warning letter to bakers. Serial No. 5692 (b) Bread Composition: Dark coloured material from a cavity in the crumb of the loaf consisted of bakehouse char. Investigated. Matter drawn to attention of bakers, Serial No. 5646 (b) Bread Composition: The cut surface of the loaf had four areas of discolouration. ation showed mould growths in each case. Investigated. Warning letter to bakers. Serial No. 5708 (d) Cereal Composition: The triangular fragment of metal associated with the cereal was an aluminium iron alloy at one corner of which a fragment of cereal was adherent. Investigated. Warning letter to manufacturer. Serial No. 5723 (b) Bread Roll Composition: A lump of soiled and discoloured dough was embedded in the crumb of the roll. It contained rust, mineral oil and a few small fragments of tea leaves. The close association with the crumb of the roll indicates it was baked in the roll. Investigated. Warning letter to bakers. Serial No. 5570 (d) Short Grain Rice Composition: The rice contained two dead and one live larva of the food infesting moth, Plodia Interpunctella. Also present were small piece of stone and general. debris, as well as webbing and excreta from the larvae. Investigated. Warning letters to importers, manufacturer and vendor, Serial No. 5707 (f) Loose Chocolates Composition: The chocolates showed evidence of infestation by the larvae of the moth, Plodia Interpunctella. Investigated. Warning letters to importers and vendor. 51 UNSOUND FOOD A total of 32 tons 3 cwts. of food unfit for human consumption was surrendered to Public Health Inspectors during the year, as shown below Tons Cwts. Meat and Offal at Slaughterhouse - 2 Meat and Offal at Wholesale and Retail Premises 2 - Cooked Meat and Meat Products - 1 Canned Meats - 14 Other Canned Foods 2 6 Fish (Fresh) - 9 Fruit and Vegetables (Fresh) 1 6 Frozen Foods 16 5 Other Foods 9 - Total 32 3 All surrendered foodstuffs are collected and destroyed under the Health Inspectors' supervision Breakdowns of refrigerated cabinets and cold stores accounted for the large quantity of frozen foods surrendered. Manufacturers and distributors are aware of the danger of refreezing thawed out foodstuffs and both they and the inspectorate advise retailers accordingly. Surrendered thawed out stocks are readily replaced by manufacturers upon production of Health Inspectors surrender certificates. 52 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken and submitted for examination with the following results Satisfied Failed Phosphatase Test 120 - Methylene Blue Test 151 6 Ring Test 54 - 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 satisfactory. BACTERIOLOGICAL SAMPLES OF ICE CREAM Samples taken during the year give the following results Grade I 29 - Satisfactory Grade II 5 - 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. 53 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. 33 3 7 500 113 - Number NOT inspected - - - - - - All diseases except Tuberculosis and Cysticerci. Whole carcases condemned. - - - - - - Carcases of which some part or organ was condemned. 7 - - 23 12 - Tuberculosis only. Whole carcases condemned. - - - - - - Carcases of which some part or organ was condemned. - - - - 1 - Cysticerci. Carcases of which some part or organ was condemned. - - - - 1 - Carcases submitted to refrigeration. - - - - - - Generalised and totally condemned. - - - - - - Approved charges totalling £24.81 were made for the inspection, by Public Health Inspectors, of the carcases shown in the above table. Amount of Meat Condemned 2cwt. 54 FOOD COMPLAINTS The 128 complaints received regarding alleged unsatisfactory items of food was 33 less than those received in the prevous year. This decrease was mainly in respect of bread and flour confectionery, and the conditions of milk and milk bottles. A full investigation was made of every complaint and for various reasons 12% were found to be unjustified. Amongst the remainder some were considered to be sufficiently serious to warrant prosecutions, whilst the balance were dealt with by the issue of written warnings. The complaints came within the following categories:- Alleged Condition Foreign Bodies, Dirty etc. Mouldy Other Conditions Bread and flour confectionery 22 5 1 Tinned foodstuffs 17 3 2 Perishable articles (Pies, Sausages etc.) 3 8 1 Milk, Cream and milk bottles 20 - 3 Chocolate and sugar confectionery 4 - 1 Cereals 1 - - Miscellaneous 14 4 14 Butter - 1 1 Cheese 2 - 1 Foreign bodies and conditions identified in the specimens were - Bread and flour confectionery : Wood splinters, mould, chewing gum, rubber band, small piece of metal, bakehouse char, small metal bolt, pieces of plastic, drawing pin. Tinned foodstuffs : Insects, solder, small pieces of metal, fish hook (in Salmon), mould, discolouration of insides of tins, pieces of glass. Pies, Sausages etc : Mould, a tin tack, piece of wire, insects. Milk and milk bottles : Pieces of plastic, paint, bottle top, stains on inside of bottles, cement. Cereals I Larvae, mould, metal. Chocolate and sugar confectionery: Sticking plaster, discolouration, insects, piece of wire, larvae. Miscellaneous : Insects in cooked chicken, dirt on oven ready chicken, mould and dirty marks on bacon, mould on potatoes, tainted bacon, larvae in fish cakes, sour evaporated milk, insects in frozen peas, mould in bottled beer, mould in yogurt, cider femented cloudy. Butter: Rancid condition, mould. Cheese: Insects, staleness 55 Food Complaints (Contd.) Complaints were also made that wrapped gammon, baby food and vitamin tablets were on sale after the expiry date marked on the packets. There were other complaints regarding the appearance and taste of foods which on investigation proved unfounded. During 1972, 99 warning letters were issued and legal proceedings were also taken, as shown below :- Prosecutions : Fined Costs FC 768 Sticking plaster in sweet Manufacturers £20 £16 FC 786 Mouldy butter :- Vendor £26 £16 FC 787 Mouldy Pork Pie :- Vendor £30 £10 FC 816 Foreign matter in Spam :- Manufacturer £25 £17 FC 829 Foreign matter and mould on loaf :- Baker £50 £16 FC 832 Chewing gum in bread :- Baker £75 £16 FC 842 Dirty milk bottle Dairyman £50 £25 FOOD AND DRUGS ACT, SECTION 16 Number of Food Premises registered under the above-mentioned Act for :- (a) Sale or manufacture for purposes of sale of ice-cream or the storage of ice-cream intended for sale 541 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 159 56 SLAUGHTER OF POULTRY ACT 1967 There is only one establishment in the Borough to which this Act applies. This is a turkey farm where all the birds are raised in hygienic conditions and are slaughtered during December for the Christmas trade. The slaughtering is carried out on the premises in specially equipped units provided with electrical stunning devices. After slaughter the birds are dry-plucked and put into chilled storage. Approximately 4500 birds were slaughtered and all were found to be fit for human consumption. 57 FOOD HYGIENE (GENERAL) REGULATIONS 1960 5091 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 77 informal notices were served. Two stall holders were prosecuted for offences under the regulations and were fined £10 and £25 respectively. The following premises in the Borough are subject to the requirements of the above-mentioned Regulations Bakers & Bakehouses 101 Butchers 157 Confectioners 186 Milk Dealers 172 Clubs and Hotels 95 Chemists 63 Fishmongers (wet, dried & fried) 58 Greengrocers 135 Grocers 274 Hospitals, Nursing Homes and Old Peoples Homes 76 Canteens 100 Public Houses 145 School Canteens & Services 115 Cafes & Restaurants 132 MILK (SPECIAL DESIGNATION) REGULATIONS Licences to deal in specially designated milks were currently held as under Dealers (Pasteurisers) 1 Pasteurised 140 Sterilised 102 Ultra Heat Treated 120 Untreated 34 58 HOUSING AND SLUM CLEARANCE 1972 Continuing the progress made in previous years in dealing with the most urgent housing problems, detailed surveys of properties on the listed slum clearance programme were made. Several of the dwellings listed were found not to be unfit but capable of rehabilitation. However, Clearance Area representations were made in respect of properties in Maple Road, Penge and Waldo Road, Bromley. House condition surveys were also found necessary to establish the condition of property in Lullington Road, Anerley and in Palace Road/Palace Square, South Norwood. These were subsequently declared Redevelopment Areas. During the course of the year several basements, parts of houses and individual houses were found to be unfit and Closing Order or Demolition Order procedures were adopted. Clearance Areas 31, 33, 35, 37, 39 & 41 Maple Road, Penge 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 14, 16, 18, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42 Waldo Road, Bromley Closing Orders/Demolition Orders In 1972 13 Closing Orders relating to basements and parts of houses and 2 Demolition Orders were made. During the year one property subject to a Demolition Order was rehabilitated and the Demolition Order was revoked. Three Undertakings from owners not to use unfit properties for human habitation were accepted. General Improvement Areas A considerable amount of work devolved on to the Department as a result of the Declaration of the Penge East General Improvement Area. Staff were in attendance at the Show House which was open in the area for several months, and meetings with tenants, owners and other interested bodies to further the improvement of their dwellings continued. Qualification Certificates Although the numberof inspections and visits required as a result of the receipt of applications for Qualification Certificates fell during the year, a great deal of work was involved. The Regulation of Rents under the Housing Finance Act 1972 will eventually obviate the Qualification Certificate procedure. Detailed figures of Applications, inspections made, etc. appear on Page of this report. Housing Repairs, etc. Details of action taken under the Housing and Public Health Acts during the year are appended Repair - Housing and Public Health Acts Number of houses rendered fit by owners after service of Informal Notices - 384 Formal Notices - 77 Beyond Repair - Housing Act 1957 Undertakings accepted (Sec.16) 3 Closing Orders made (Sec.17) 1 Demolition Orders made (Sec.17) 2 Closing Orders made (Sec.18) 12 Closing Orders determined (Sec.27) Closing Orders revoked and Demolition Orders substituted (Sec.28) Revocation of Demolition Order 1 Houses demolished following demolition orders 1 59 Housing and Slum Clearance (Contd.) Housing Repairs,etc. (Contd.) Clearance Areas Represented during year 2 Houses unfit for human habitation 37 Houses included by reason of bad arrangement, etc. Houses on land acquired under Sec.43(2) People to be displaced (a) Individuals 102 (b) Families 36 Houses demolished by Local Authority or owners (a) Unfit 2 (b) Others 31 Persons displaced from houses to be demolished or closed (a) Individuals 161 (b) Families 61 Compulsory Improvement of Dwellings Preliminary Notices served 2 Immediate Improvement Notices served 1 Formal undertakings given by owners to execute improvement work 7 Houses where works of improvement were completed during the year 2 Re-housing The following information has been supplied by the Housing Manager in respect of 1972:- New houses built 316 Families housed from waiting list 505 On waiting list at 31st December 1972 5340 60 QUALIFICATION CERTIFICATES During the year, 153 applications were made, 174 certificates were issued, and 63 applications were refused, thus bringing the overall totals since 1969 to 1324 Applications received, 848 Certificates issued and 308 Certificates refused. In 185 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 At the end of the year 33 applications were in abeyance, pending the completion of repairs required before the issue of certificate could be approved. Baths 3 Brickwork and Pointing 28 Ceilings 25 Doors 32 Electric Wiring 13 Fireplaces and Boilers 4 Fences and Gates 25 Gutters and Downpipes 26 Gullies 9 Manhole Covers 2 Floors, damp and defective 10 Paintwork, External 50 Plaster - Walls 51 Skirting Board 12 Paving 25 Roofs 32 Rendering 19 Sink Wastes 6 Sinks 3 Stairs, defective 7 Steps 7 Tiling 9 Windows, frames 51 putties 27 cills 19 ill fitting 90 glazing 22 sashcords 15 revea I 4 Walls, damp and defective 54 Water heaters 12 Water taps 13 Water tanks 2 Washbasins 11 W.C's, pans 9 cisterns 5 61 RENT ACT 1957 No applications were made for Certificates of Disrepair during 1972. HOUSING INSPECTIONS Defects Remedies, Nuisances Abated by Informal Action. Drainage Drains: Constructed or Reconstructed 102 Repa i red 234 Cleansed 1,248 Cesspools: Provided Overflowing 11 Leaking 12 Abolished 5 Sanitary Appliances Sinks, etc., provided 4g Sinks, etc., repaired 27 W.C's provided 19 W.C's repaired 71 Dampness Roofs and rainwater fittings 426 Walls and stacks 420 Damp-proof courses and floors 182 Water Supply Provided 4 Installations repaired 122 General Items Wallplaster 414 Ceiling Plaster 208 Floors 231 Rooms cleansed or redecorated 116 Windows and doors 454 Lighting 22 Ventilation 21 Staircases 43 Fireplaces, etc. (ex.Clean Air) 6 Yard paving and drainage 157 Dustbins 76 Food storage and preparation 90 Nuisances from animals abated 27 Accumulation removed 268 Premises disinfested 147 Premises disinfected 13 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. 427 Informal Notices were issued of which 283 had been complied with by the end of the year. 126 Statutory Notices were served. During the year 148 Statutory Notices were fully complied with, of which 41 had been served prior to 1972. 62 MOVEABLE DWELLINGS The Caravan Sites and Control of Development Act 1960 prohibits the use of land as a caravan site without a licence. Site licences are issued by Local Authorities who may attach conditions to them to enforce a satisfactory standard of environment for the caravan dwellers. 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 Hockendon Farm, Hockendon, Swanley 1 Crittendon Caravan Park, Pond Lane, High Street, West Wickham 35 Chalk Pit Caravan Site, St. Paul's Cray 25 11 Heathfiled Road, Keston 23 Restavon, Berry's Green Road, Cudham, Nr. Biggin Hill 60 In addition to the above, the Caravan Club of Great Britain has a site for 80-100 vans at Crystal Palace which is very popular for short stays particularly with foreign visitors. 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 is being considered. 63 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. There were 2240 calls made on this service of which 998 related to private drains for which approved clearance charges were made. The Borough Engineer states that the following sewerage was provided during 1972 - Foul Sewers 6,282 yards Surface water sewers 8,312 yards 64 DISINFECTION A steam disinfection plant and sufficient appropriate equipment is maintained to provide for the disinfection of bedding, clothing and premises, should an outbreak of infectious disease occur. This service is provided free of charge in respect of notifiable infectious diseases. Fortunately the demands upon this service were minimal during 1972. Some requests were received for disinfection when notifiable diseases were not involved. These were mainly in respect of clothing and bedding and in such cases an approved charge was made. DISINFESTATION One hundred and forty-four requests were received for the treatment of premises and articles infested by vermin and insects; these were dealt with by the use of insecticides in either liquid or powder form. This service was undertaken on payment of approved charges. 65 PEST CONTROL Rodent Infestation The number of complaints received rose by 11% compared with last year. The number of rat infestations dealt with rose by 9% and mouse infestation rose by 32%. This considerable upward trend in the number of mouse infestations was apparently experienced in most of the other London Boroughs and lead to the Ministry of Agriculture and Fisheries organizing a survey in the Greater London area. This was undertaken in October/ November and 500 premises were visited in Bromley by the Inspectorate. The Public Health Committee adjourned consideration of a free service for mouse complaints pending the result of the survey. SEWERS: Rat infestation in the sewers is still controlled at a very low level. Treatments are carried out in the Spring and Autumn with the assistance of the Borough Engineer's department in the lifting of sewer manhole covers. Type of Property Non Agricultural Agricultural Properties other than Sewers 1. Number of properties in district 124,980 313 2. (a) Total number of properties (including nearby premises) inspected following notification. 4,990 47 (b) Number infested by (i) Rats (ii) Mice 1,518 474 223 11 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification. 962 24 (b) Number infested by (i) Rats (ii) Mice 203 21 555 1 Fox Control During 1972 there were 649 complaints regarding foxes, this was a decrease of 101 in relation to complaints received the previous year. The number of foxes killed was 279 this being 23 less than in the previous year. The task of deciding where control has to be exercised requires considerable judgement and the comparative figures given above speak for themselves. The policy of the Council to deal only with those foxes which are the subject of complaint was re-affirmed by the Health Committee following the receipt of a petition from a local group of conservationists. Many of the foxes destroyed were found to be suffering from Mange and were in poor physical condition. Pigeon Control The control of feral pigeons has been actively pursued in order to reduce the size of flocks roosting on public and private buildings and thereby causing a nuisance. Railway bridges are favourites as a nesting place and these are visited at night time on a routine basis During the year 4,237 pigeons were destroyed. 66 PEST CONTROL (continued) Wasp Nest Destruction The cool Summer weather of 1972 was not conducive to wasp colony development. Only three hundred and forty-nine applications were received for the destruction of wasp nests, as compared with seven hundred and fifty in 1971. These nests were destroyed on payment of approved charges. 67 ATMOSPHERIC POLLUTION Considerable progress was made during the year towards the target of bringing the whole of the Borough under smoke control by 1977. Smoke Control Orders in respect of three areas situated respectively in Bickley Ward, Farnborough Ward with an adjacent part of Keston and Hayes Ward, and Manor House Ward came into operation on 1st July 1972. and three Orders covering Chislehurst Ward, St. Paul's Cray Ward (part) and Eden Park Ward on 1st December 1972. The six areas embraced approximately 5505 acres of the Borough and 18,534 premises. As a result of these Orders becoming operative, approximately 42% of the total acreage of the Borough, and 60% of its premises, are now under smoke control. A Smoke Control Order in respect of approximately 203 houses in the Penge East General Improvement Area was confirmed by the Department of the Environment in April. A survey of three areas in Bromley Common Ward, St. Paul's Cray Ward and Shortlands Ward was carried out during the year, with a view to Smoke Control Orders being made by the Council in 1973. The Table on page No. shows the parts of the Borough covered by Smoke Control Orders. Complaints were received during the latter part of the year concerning dark smoke caused by the burning of scrap cable in order to remove the polyvinylchloride insultation. The recovery process was being carried out by itinerant dealers on farmland in the St. Mary Cray area. As this process is registrable under the Alkali etc. 68 under the Alkali etc. Act and Orders, the matter was referred to the Alkali Inspectorate and as a result of the joint action which was taken with the Health Department, the process was discontinued. 69 Smoke Control Order No.1 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 Farnborough (part) 1. 7.71 921 3,176 London Borough of Bromley No.12 Copsrs .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 London Borough of Bromley No.16 Chislehurst Ward 1.12.72 1,812 3,896 London Borough of Bromley No.17 St. Paul's Cray (part) 1.12.72 963 2,688 London Borough of Bromley No.18 Eden Park Ward 1.12.72 454 2,353 OFFICES, SHOPS 8. 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 23 820 458 Retail Shops 35 1,662 1,044 Wholesale Shops, Warehouses 2 65 52 Catering establishments open to the public, canteens. 4 183 183 Fuel Storage Depots. - 13 13 Totals 64 2,743 1,750 Total number of Visits of all kinds by Inspectors to registered premises under the Act:- 2,309 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 10 15 Eating facilities 2 5 Overcrowding 3 16 Floors, passages and stairs 24 6 Temperature 13 17 Fencing exposed machinery 7 7 Ventilation 13 18 Protection of young persons from danger ous machinery 8 Lighting 5 19 Training young persons working at dangerous machinery 9 Sanitary conveniences 12 23 Prohibition of heavy work - 10 Washing facilities 11 24 First Aid-General Provisions 18 11 Supply of drinking water 17 50 Exhibition of abstract of Act Continued/. 22 70 Section No. of Contraventions found Section No. of Contraventions found 12 Clothing accommodation 4 -7 Lifts and Hoists defects 18 13 Sitting facilities 2 14 Seats (Sedentary Workers) TOTAL 170 (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 No. Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advise Offices 7 7 - - 2 5 Retail Shops 52 52 - - 11 41 Wholesale Shops, Warehouses 8 8 _ . 2 6 Catering Establishments open to public 3 3 - - - 3 Canteens - - - - - - Fuel Storage Depots - - ' - - - - TOTALS 70 70 - - 15 55 ANALYSIS OF REPORTED ACCIDENTS: Offices Retail Shops Wholesale Warehouses Catering Establishments open to public, canteens Fuel Storage Depots Machinery - 4 - - - Transport 1 2 1 - - Falls of Persons 6 14 2 1 Continued/ 71  Offices Retail Shops Wholesale Warehouses Catering Establishments open to public, canteens Fuel Storage Depots Stepping on or striking against object or person - 4 . - . Handling goods - 11 4 1 - Struck by falling object - 8 1 2 - Fires and explosions - - - - - Electricity - - r - Use of hand tools - 7 - - - Not otherwise specified - 1 - - - 72 Prescribed Particulars on the Administration of the Factories Act, 1961 PART 1 OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors.) Premises (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers prosecuted (5) (1) Factories in which Sections 1, 2,3, 4 and 6 are to be enforced by the Local Authorities 55 63 (11) Factories not included in (1) in which Section 7 is enforced by the Local Authority 764 328 4 (111) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers'Premises) 43 177 _ _ Total 862 568 4 - 2. Cases in which DEFECTS were found Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.1) _ _ _ _ _ Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) 3 3 - - - •Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) - - - 3 - (a) Insufficient - - - - - (b) Unsuitable or defective 3 3 - - - (c) Not separate for sexes - - - - - Other offences against the Act (not) including offences relating to Outwork) - - - - - Total 6 6 - - 73 PART VIII OF THE ACT OUTWORK (Sections 133 and 134) No. of outworkers in August list required by Section 133 (1) (c) Making etc. of wearing apparel 86 Making up etc. of household linen 2 Making etc. of lace 1 Making of boxes, or other receptacles made wholly or partially of paper 6 74 MORTUARIES The Council maintains two mortuaries at which suitable facilities are provided for the Pathologist to carry out post mortem examinations. There were seven hundred and forty-four such examinations during 1972. Mention was made in last years report of the likelihood of the Mortuary at Beaverwood, Chislehurst, being closed down. It is now evident that this closure will be affected in 1973. 75 SWIMMING BATHS 64 Samples of water were taken from swimming baths and pools available for public use, and were subjected to bacterial and chemical exaimination. In one instance the water was not entirely satisfactory and this situation was remedied by the cleansing of filters. The remainder of the samples were of satisfactory standard. 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 controls 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. 76 DISEASES OF ANIMALS ACT, 1951 RIDING ESTABLISHMENT ACTS 1964 & 1970 ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 Certain duties under these Acts are undertaken on behalf of the London Borough of Bromley by the City of London's Veterinary Department to the co-operation of whose Officers I am indebted. Regulation of Movement of Swine Order Under the terms of this order one hundred and fifty four movement licences were received and the movements of the animals concerned were verified. RIDING ESTABLISHMENTS ACTS 1964 & 1970 ANIMAL BOARDING ESTABLISHMENTS ACT 1963 Licences to keep premises coming within the provisions of these Acts are issued annually. All such premises were inspected and recommendations for the renewal of licences were made. One new licence was issued in respect of an Animal Boarding Establishment. Swine Vesicular Disease The first outbreak of this disease occurred on the 11th December 1972 in Staffordshire and by the end of the year there had been 34 outbreaks. All of England south of Lancashire and Yorkshire became a 'controlled area' which meant that pigs could only be moved under controlled area licences. The cause of the original outbreak was thought to be infected swill and as a precautionary measure all owners of swill boiling plants in the Borough were notified in writina of the extreme Drecautions which must be taken. Animal Keepers etc. Within the Borough animals are kept at the under-mentioned premises which were visited and inspected - no irregularities were found. No. of premises Inspections Stock Keeper 28 72 Farms 38 95 Pig Keepers 43 128 Poultry Keepers 24 62 Horses 3 9 Slaughterhouse 1 12 Laboratory- Research 1 1 Riding Establishments 14 14 Animal Boarding Establishments 14 16 DUMPING OF DEAD ANIMALS When dead animals, or parts of animals, are found dumped on waste land or farms etc. it is a matter of immediate concern to discover if death was caused by any infectious condition. There were three separate occasions when such dumpings were discovered, namely 3rd May 3 calves, 6th July - a pig, and 28th July - 3 calves' stomachs and intestines. Post mortem examinations were carried out, and it was found that the deaths had not been caused by any infectious condition. The carcases were suitably disposed of by burial in lime, the stomachs etc. of the calves being burned. RIDING ESTABLISHMENT ACT 1964 Fourteen applicants 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-one routine inspections were made and on twenty-three occasions minor infringements were found and were remedied by informal action. 77 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. Seventy-eight visits were made to the premises, no contraventions of the terms of the licences were found. ANIMAL BOARDING ESTABLISHMENTS Fourteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at these premises for boarding 435 dogs and 346 cats. Seventy-seven visits were made to these premises during the year. No contraventions of the the terms of the licences were found. 78 SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS GENERAL Accumulations 595 Agriculture Welfare 12 Animal Boarding 77 Caravans 354 Cesspools 1,005 Drainage 2,267 Filthy premises 52 Hairdressers 156 Keeping of Animals 53 Merchandise Marks 8 Noise Abatement 416 Nursing Homes and Child Minders 219 Pet Animals 78 Pharmacy and Medicine 20 Piggeries 28 Pigeons 71 Public Conveniences 143 Rag Flock 8 Riding Establishments 81 Rivers, etc. 91 Rodent Control (Agricultural) 18 Rodent Control (Non-Agricutlural) 893 Schools 83 Swimming Baths - Public 10 Swimming Baths - Private 23 Theatres etc. 16 Verminous premises 258 Water supply 156 FOOD HYGIENE Bakehouses 247 Bakers' shops 411 Butchers 755 Confectioners 379 Dairies 294 Fishmongers 91 Food Factories 41 Greengrocers 526 Grocers 1,039 Public Houses 263 Premises registered under Section 16 - Food and Drugs Act 161 Restaurants, etc. 661 Slaughterhouses 44 Stalls, etc. 131 Wholesale premises 48 FACTORIES Power 328 Non-power 63 Sites 177 Outworkers 21 CLEAN AIR Nuisances 326 Industrial 347 Smoke Control Areas 987 79 OFFICES, SHOPS AND RAILWAY PREMISES ACT GENERAL INSPECTIONS Offices 458 retail Shops 1,046 Wholesale shops and warehouses 53 Catering Est. & Canteens 387 Fuel Storage Depots 36 Visits of all kinds (incl. above) 2,553 HOUSING Public Health Acts 6,358 Housing Acts (Clearance) 514 Housing Acts (Improvement) 1,933 Houses in Multiple Occupation 428 Overcrowding 112 Rent Act 406 INFECTIOUS DISEASES General 692 Food Poisoning 127 Disinfection 5 Surveillance 265 FOOD INSPECTION Slaughterhouses 149 Wholesale (Meat) 61 Shops etc. (Meat) 259 Poultry 101 Other Foods 696 SAMPLING Egg Products etc. Fertilisers Food and Drugs 533 Ice Cream 68 Milk 185 Water (Drinking) 30 Water (Rivers etc.) 10 Water (Swimming Baths) 39 Rag Flock etc. MISCELLANEOUS Demolition Sites 74 80 COMPLAINTS RECEIVED Accumulations 450 Drainage 1,291 General Sanitary Defects 996 Keeping of Animals 65 Insects 331 Noise 202 Smoke 290 Verminous premises 192 Dry Cleaning Plant - Ventilation 1 Industrial Fumes 4 Land Pollution 1 Water supply 12 Food 86 HOUSING INSPECTIONS DRAINAGE Drains constructed or reconstructed 102 Drains repaired 234 Drains cleansed 1,248 Cesspools provided Cesspools overflowing 11 Cesspools leaking 12 Cesspools abolished 5 SANITARY APPLIANCES Sinks etc. provided 49 Sinks etc. repaired 27 W.C's provided 19 W.C's repaired 71 DAMPNESS Roofs and rainwater fittings 426 Walls and stacks 420 D.P.C's and floors 182 WATER SUPPLY Provided 4 Installations repaired 122 GENERAL ITEMS Wall plaster 414 Ceiling Plaster 208 Floors 231 Rooms cleansed or decorated 116 Windows and doors 454 Lighting 22 Ventilation 21 Staircase 43 Fireplaces etc. (ex Clean Air) 6 Yard Paving and drainage 157 Dustbins 76 Food storage and preparation 90 Nuisance from animals abated 27 Accumulations removed 268 Premises disinfested 147 Premises disinfected 13 Rodent Survey 32 81 NOTICES SERVED Informal Notices: Public Health and Housing 427 Others 164 Complied with at the end of the year: Public Health and Housing 283 Others 82 Statutory Notices: Public Health Act 125 Housing Act Clean Air Act 6 Greater London Council General Powers Act 4 Complied with at the end of the year: Public Health Act 159 Housing Act Clean Air Act 3 Greater London Council General Powers Act 4 82 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 1972. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed and refilled; samples of water are then collected from these treated mains; and the mains are returned to service 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, 1972, was 306,370. (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 of works. Well water from Eynsford, Horton Kirby, Lullingstone, Merton, 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 to lead. 83 SCHOOL HEALTH SERVICE AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY FOR 1972 Milligrammes per litre (unless otherwise stated) Description of the Sample Numbera of Samples Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMAO 4 hrs at 27° C. B.O.D 5 days at 20° C Hardness (total) CaCOj Hardness / non- \ V carbonate' CaCOa Magnesium as Mg Sodium as Na Potass ium as K Chloride as CI Phosphate as PO Silicate as SiO2 Sulphate as SO4 Natural Fluoride as F Surfaceactive material as Manoxol OT CO2 Turbidity units Colour (Burgess units) pH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thamesderived 364 0.031 0.069 6.9 1.06 — 274 82 5.0 24.5 5.5 35 2.8 10 58 0.15 0.02 0.1 13 7.9 570 Eynsford 8 0.002 0.010 5.5 0.07 280 40 2.5 17 0.10 30 0.1 0 7.3 490 Horton Kirby 8 0.003 0.014 5.6 0.10 270 55 2.6 20 0.11 29 0.1 1 7.3 490 Lulling stone 7 0.005 0.014 5.1 0.10 262 34 2.3 16 0.09 21 0.1 1 7.3 460 Merton 1 0.070 0.016 0.5 0.04 244 24 13.0 23 0.40 - 1.3 22 7.3 450 Nth. Orpington 8 0.006 0.013 6..1 0.07 273 30 2.5 15 0.08 36 0.1 £1 7.2 560 Orpington 4 0.002 0.015 8.5 0.08 296 52 2.5 19 0.08 40 0.1 1 7.2 550 Shortiands 12 0.003 0.011 6.7 0.12 290 72 4.0 26 0.10 31 0.1 1 7.1 550 Sundridge 16 0.006 0.013 43 0.08 224 58 3.0 20 0.09 20 0.1 1 7.5 420 West Wickham 4 0.002 0.011 6.6 0.11 267 35 2.5 15 0.09 35 0.1 1 7.2 1490 84 BACTERIOLOGICAL RESULTS—YEARLY AVERAGES, 197? . FOR WATER SUPPLIED TO THE LOUDON BOROUGH OP BROMLEY Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples 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 lf>0 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 8 087 42.3 — 41.94 10.2 56.76 4.0 3 891 10.0 99.85 99.97 Eynsford Well 182 0.0 10 100.0 - 100.0 - Evnsford Borehole 214 0.1 3 100.0 — 100.0 - 244 0.2 14 100.0 100.0 Horton Kirby No.l 115 0.0 62 87.83 0.3 0.1 Horton Kirby No.2 163 0.0 2 98.77 - 99.39 - 248 0.1 11 100.0 100.0 Lulling stone No.l 107 0.1 67 99.1 - 99.1 - Lullingstcne No.2 182 0.1 3 100.0 - 100.0 - 251 0.1 31 100.0 100.0 Merton Abbey 1 - - 100.0 - 100.0 - 1 5.7 - 100.0 100.0 North Orpington No.l 198 3.7 36 18.69 13.7 38.89 3.0 253 0.6 60 99.60 99.60 North Orpington No.2 189 1.0 89 22.75 10.5 49.21 2.2 Orpington 248 0.1 87 98.79 - 100.0 - 252 0.0 5 100.0 100.0 Shortlands No.l 160 0.0 10 98.75 0.1 99.38 - Shortlands No.2 150 0.0 11 100.0 - 100.0 - 253 0.1 3 100.0 100.0 Shortlands No.3 213 0.1 22 100.0 - 100.0 - - Sundridge No.l 139 0.0 13 100.0 - 100.0 - Sundridge No.2 153 0.1 6 100.0 - 100.0 - 193 0.1 63 100.0 _ 100.0 - 249 0.3 55 100.0 100.0 Sundridge No.4 184 0.1 29 100.0 - 100.0 - West Wickham 182 0.1 172 97.80 - 100.0 - 181 0.2 108 100.0 100.0 SCHOOL HEALTH SERVICE INDEX Page Members of Education Committee 87 Staff of the School Health Section 88 Prefatory letter 89 School Health Service 92 Medical Inspections 94 Special Inspections 94 Re-Inspections 94 Follow-up Examinations 94 Cleanliness Inspections 95 Defects - Periodic and Special Medical Examinations 96 Minor Ailments 99 Treatment of Ailments 99 Ophthalmic Clinics 99 Orthoptic Clinic 99 Diseases and Defects of Ear, Nose and Throat 100 Orthopaedic Clinic 100 Physiotherapy Clinic 100 Diseases of the Skin 100 B.C.G. Vaccination 101 Ruebella 101 Infectious Diseases 102 Speech Therapy 103 Child Guidance 104 School Psychological Service 106 Audio logy Service Handicapped Pupils 114 Cheyne Hospital 118 Phoenix Centre 118 Special Schools 118 Employment of Young Children 122 Other Medical Examinations 122 School Meals and Milk Service 123 Health Visiting 123 Health Education and Home Safety 124 Physical Education 124 Clinics 127 86 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December 1972) * Councillor F. J. Packer, F.C.I.S. (Chairman) * Councillor J. F. David (Vice-Chairman) Alderman M. J. Neubert (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. I. F. Harvey * Councillor R. W. Huzzard Councillor R. J. Inniss * Councillor R. A. Knox-Johnston * Councillor Mrs. M. C. McClure, B.Sc. Councillor M. J. Mason Councillor H. J. Palmer Councillor K. A. Pawsey Councillor Miss B. Pedley, B.A. Councillor C. G. Priest * 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. * Mr. N. L. Hevey The Rev. Canon S. H. Hoffman, M.A. Miss E. M. Huxstep, C.B.E., B.A. * Mr. J. W. Watts Mrs. K. G. Wheeler Mr. S. E. Willingham, M.A., J.P. * Denotes Members of Primary Education and Welfare Sub-Committee, (one vacancy) CHIEF EDUCATION OFFICER - D. R. Barraclough, M.A., Dip.Ed. 87 LONDON BOROUGH OF BROMLEY STAFF OF THE SCHOOL HEALTH SECTION (as at 31st December, 1972) 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. Principal 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 * 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) *+ 5 Speech Therapists + 4 Ophthalmologists + 1 Orthoptist + 1 Physiotherapist + 1 Orthopaedic Surgeon + 1 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. * 38 Health Visitors + 7 Health Visitors 2 School/Clinic Nurses Chief Administrative Officer D. J. Tinson, Inter., D.M.A. Senior Administrative Officer Miss D. W. Gardner 1 Administrative Assistant 10 Clerical Assistants 2 Clinic Clerks (Full time) + 2 Clinic Clerks * Also employed in the Maternal and Child Health Service + Part time 88 TO: THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Ladies and Gentlemen, I have the honour to present the eighth annual report of the School Health Service of the London Borough of Bromley. There was no special outbreak of infectious disease, and in general the health of schoolchildren is satisfactory. The pattern of measles incidence follows that of previous years. A Table indicating defects found on periodic and special medical inspections though not required in future by the Department of Education and Science, has been included as the information was available and enable a final local comparison with previous tables to be recorded. There was an increase of 2,353 routine medical inspections which was an improvement on previous years. A contributory factor has been the employment of a school nurse for vision testing and an audiometrician for hearing tests thus freeing more time of the Medical Officers in Department for these examinations. DENTAL HEALTH Even though comparing favourably with most London Boroughs indications are that dental good health if expressed by a diminishing tooth extraction rate, still leaves much to be desired. The Principal School Dental Officer refers to the harmful effects of consuming sugar and sweetstuffs, and comments favourably on a small trial of topical application of fluoride, and on the co-operation of Head Teachers and Staff in a Dental Health Campaign. IMMUNISATION SERVICE The acceptance rate for Rubella (German Measles) vaccination reached a record 79.9%, and this vaccination has now been offered to all eligible groups. The acceptance rate for B.C.G. vaccination for the prevention of tuberclosis was 91.5%. SPEECH THERAPY Changes and shortages of staff have continued in this section. Consequently, while the number of children referred to clinics increased from 209 to 221, the number of attendances fell from 4,583 to 3,579. However, the service is being spread in as rational a manner as possible and while there was a decrease in the number of home and school visists, there was an increase in the number of initial interviews and of attendances at Special Schools (excluding Goddington) and at special opportunity classes. SCHOOL PSYCHOLOGICAL SERVICE A most precise and comprehensive report summarises the provisions for children within the scope of the School Psychological Service; and also indicates the extent of commitment of this service beyond its original brief as the result of new legislative requirements arising in the past 3 years. Of particular interest is the anticipated additional work arising from four capital educational projects planned for handicapped children during 1973/74/75 of a school for Physically Handicapped, a Day School for Maladjusted, a Day School for Severly Sub-Normal, and a Secondary Partially Hearing Unit. Most important has been the extension of the risk age range from the narrower limits of 5 to 15 years to one starting at 2 years or even before and extending to 16 years and even beyond both for private provisions and under the National Health Service. 89 In view of National Health Service Reorganisation it is especially relevant to note the supporting services now given to National Health Service Hospitals and Centres and to the Local Authority Social Services Department, and the need for any new authority to maintain these services to the present high standard of provision. Anomalies of referral procedures to Child Guidance Clinics should be rectified after 1974. The analysis of referrals indicates various associations where further research could prove fruitful, and high in priority should be research as to why boys-form 72% of the total of referrals for learning and behaviour problems. AUDIOLOGY In this report a very valid point is made that time spent in excluding deafness is as justifiable as time spent in identifying and diagnosing deafness. It is, therefore, reassuring to note that 4,866 children (8 years) out of a total 5,095 passed the necessary audiometric examination. The further educational provision for hearing impaired children is set out in the Report, and especial praise is due to the staff of the Peripatetic Service of Teachers of the Deaf and to the Head Teachers and staff concerned with the Unit at Darrick Wood. Members will be aware of the need for secondary provision within the Borough for children with impaired hearing, and the progress towards this end that has already been achieved. The co-operation of two Medical Officers interested in this speciality of School Health with the Peripatetic Teachers of the Deaf, the development of aids in ordinary classrooms, the supervision at the Hearing Clinic, and counselling services to parents and teachers, has helped to retain as many partially hearing children as possible in their neighbourhood schools. HANDICAPPED PUPILS The handicapped pupil attends an ordinary school for preference both for social and educational reasons, and in Bromley the splendid co-operation of Head Teachers, the School Health Section and the Social Services Department, assures that such children are correctly identified and placed, and that their parents receive informed counsel in their care both at home and at school. A report from the Department of Education and Science on a National Survey of the welfare of physically handicapped children attending neighbourhood schools indicates the criteria by which certain children should be selected for special schools and suggests that studies should continue on the welfare needs of children who attend neighbourhood schools. The building of a Special School for handicapped children adjacent to Coopers School, Chislehurst, has commenced, and also during the year a new Phoenix Centre at Farnborough Hospital, presented to the Hospital by the Spastic Society was opened by Sir Keith Joseph, Bt. M.P., Secretary of State for Social Services. The Centre has impressed all by its spaciousness and comprehensive planning for the needs of a wide range of spastic children who now attend. Cheyne Hospital School, West Wickham, also provides for physically handicapped children and during the year the hospital admitted six children transferred from Leybourne Grange Hospital. The activities at the five Special Day Schools, are dealt with in detail towards the end of the Report and the special defects of children attending these schools are noted. 90 HEALTH EDUCATION AND HOME SAFETY This is an aspect of preventive medicine that has interested me intensely throughout my career in the School Health Service. In this Borough the service has benefited from the splendid efforts of Mr. J. Bretton who retired in 1972. His reports were most factual and comprehensive, and contained much practical common sense advice. He was a popular figure in all the schools. Mrs. Eves, who succeeded him, brought a valuable approach of experience in health visiting, midwifery and nursing, coupled with a flair for organisation. Both Officers were concerned with the scheme now developed in the Secondary Schools of education for health and personal relationships. Both Officers developed the seasonal campaigns on Health Hazards and Home Accidents which are a continuing feature in schools. Health Education must be regarded as complementary to Physical Education and the valuable activities of that section of the Education Department are set out clearly in the final pages of this Annual Report. In conclusion, I wish to thank the Chairman and Members of the Education Committee for their support and advice in the past year. This Report may well be the last under present arrangements and therefore an occasion to express the hope that the service given to the Education Authority may continue to be efficient, humane, and with local understanding of problems. The Principal Dental Officer, Mrs. C. M. Lindsay, will be retiring in 1973, and I would pay tribute to the manner in which she has managed the dental service with tact and efficiency throughout our association in the London Borough of Bromley from 1965. Dr. P. A. Currie, Principal Medical Officer, supported by Miss D. Gardner, has been responsible for the day to day medical administration of the service, and it is a tribute to them that problems have been so few, and that this Report, like its predecessors, has been so precisely compiled. The co-operation of Mr. Barraclough, Chief Education Officer, of Mr. Chamberlain, and other members of the Education Staff has been invaluable in giving great support to the School Health Service throughout the year. Finally, I would offer my most sincere thanks and good wishes for the future to the medical, nursing, administrative and clerical staff of the School Health Section. L.R.L. Edwards, Principal School Medical Officer. 91 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 48,174 pupils (an increase of 55) 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 14,646. The physical condition of all the pupils inspected was satisfactory and 1,819 pupils (12.4%) were found to require treatment. A further 5,199 children were given routine tests of vision and hearing, as a result of which 215 pupils (4.1%) were referred for treatment because of visual defects and 47 pupils (0.9%) 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. It will have been noted in the figures reported above that an increased number of children have been routinely tested for vision and hearing. Whereas in previous years sweep testing in the 8 year old children was carried out by Medical Officers at special vision and hearing sessions, this service has now been taken over by the Audiometrician and School Nurse — the first to be appointed to the School Health Service. The former received training at the Audiology Clinic and during this year has completed audiometric testing of all 8 year old children within the Borough, details of which are enumerated later in this Report. Particulars of the numbers of children issued with free milk certificates under the Education (Milk) Act 1971 since it became operative in the latter part of that year are shown under School Meals and Milk Service. It was possible during the year to release several Medical Officers for attendance at formal Courses, in addition to which some were able to attend either one day or half day Conferences. There has been continued difficulty in filling the post for a part-time Psychotherapist as only 2 applicants were interviewed and both subsequently withdrew from the appointment. 92 In March of this year a report was received from the Department of Education and Science of a survey made on physically handicapped children in normal schools. A considerable amount of detail and figures are contained in this report, but the conclusion which is quoted is worthy of note: CONCLUSION It is the wish of many parents that their child should attend an ordinary school, both for social and educational reasons. In Circular 276, issued on 25 June, 1954 by the Department of Education and Science it states that "no handicapped pupil should be sent to a special school who can be satisfactorily educated in an ordinary school". Where a special school is necessary, a day school is preferable if it offers a satisfactory and practical solution. It has been shown that 10,200 physically handicapped children are, in fact attending ordinary schools. For some this may be the right placement but for others the more sheltered environment of the special school with smaller classes, intensive medical and nursing care and a full range of therapies available may be more suitable. Those in the special schools tend to be the most severely physically handicapped; many having multiple defects. This survey by its very nature and the inclusion of multiple observers and many variables can only produce a value judgement which cannot be standardised. It may, however, be considered to be an indication that further study of the needs of physically handicapped children in ordinary schools might be appropriate." As no Borough was identified local figures are not available for publication. Two years have now elapsed since the separation of the Health and Welfare Departments, but liaison has been maintained with what is now known as Social Services on a very happy and reciprocal basis, particularly with a free exchange of information on handicapped pupils. The report would be incomplete without an appreciative reference to the great co-operation 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 enables the maximum number of children to be seen, which is especially to be remembered where real difficulties of accommodation exist. 93 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 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) Satisfactory Unsatisfactory for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils No. No. (1) (2) (3) (4) (5) (6) (7) (8) 1968 and later 13 13 - 1 2 4 1967 841 841 - 40 51 90 1966 2,489 2,489 - 117 289 391 1965 195 195 - 13 15 28 1964 68 68 - 3,396* 10 14 23 1963 102 102 - 1,683* 10 16 26 1962 3,596 3,596 - 145 191 331 1961 2,622 2,622 — 156 268 410 1960 104 104 - 6 3 9 1959 70 70 - 4 11 15 1958 3,482 3,482 - 260 233 469 1957 and earlier 154 154 - 11 12 23 TOTAL 13,736 13,736 - 5,079* 773 1,105 1,819 The physical condition of all the children inspected was satisfactory. * Tests of Vision and Hearing only at age of eight years. 215 Pupils referred for treatment because of Visual Defect. 47 Pupils referred for treatment because of Hearing Defect. OTHER INSPECTIONS Number of Special Inspections 2,245 Number of Re-inspections 3,129 5,374 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 2,245 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 3,129 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. 94 \ 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 45,670 (b) Total number of individual pupils found to be infested 328 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 75 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) 2 95 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS MAINTAINED SCHOOLS Defects Code No Defect or Disease PERIODIC INSPECTIONS SPECIAL INSPECTION ENTRANTS LEAVERS OTHERS TOTAL (1) (2) 4 Skin T 12 78 185 275 11 O 8 26 58 92 9 5 Eyes — a. Vision T 41 271 461 773 279 O 118 298 1133 1549 944 b. Squint T 5 8 27 40 2 O 3 6 43 52 5 c. Other T 1 14 28 43 -- O 1 3 22 26 1 6 Ears — a. Hearing T 12 15 66 93 112 O 169 70 717 956 536 b. Otitis Media T 3 - 13 16 1 O 8 1 43 52 1 c. Other T -- 2 5 7 1 O 1 2 5 8 — 7 Nose and Throat T 5 31 85 121 2 O 29 19 203 251 25 8 T 4 2 31 37 24 O 22 1 84 107 19 9 Lymphatic Glands T - - 3 3 - O 1 3 21 25 10 T - 4 6 10 1 O 4 20 60 84 5 11 T - 18 45 63 4 O 9 19 86 114 10 12 Developmental — a. Hernia T 1 5 7 13 5 O 6 6 26 38 11 b. Other T 2 7 39 48 15 O 10 18 139 167 40 13 Orthopaedic — a. Posture T 1 8 5 14 7 O 1 26 79 106 8 b. Feet T 2 13 57 72 14 O 2 18 112 132 8 c. Other T 1 15 28 44 5 O 4 17 55 76 10 14 Nervous System — a. Epilepsy T 9 18 27 — O 2 1 17 20 3 b. Other T — — 7 7 2 O 8 12 61 81 15 15 Psychological — a. Development T 3 3 8 14 6 O 7 19 119 145 21 b. Stability T - 5 21 26 22 O 18 50 292 360 55 16 Abdomen T 1 3 20 24 14 O 6 8 86 100 16 17 T - 6 4 10 20 O 8 68 243 319 11 T = TREATMENT O= OBSERVATION 96 INDEPENDENT SCHOOLS Independent Schools, which so desire, have continued to participate in the School Health Service. At present 14 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 910 children were medically inspected and a further 120 children received tests of vision and hearing only. 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) Satisfactory No. Unsatisfactory No. for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils (1) (2) (3) (4) (5) (6) (7) (8) 1968 and later 4 4 - - - - 1967 97 97 - 3 16 19 1966 72 72 - 1 4 5 1965 22 22 - - 4 4 1964 14 14 - - - — 1963 12 12 - 120* - - - 1962 179 179 - 16 24 38 1961 139 139 - 5 15 20 1960 17 17 - 3 2 5 1959 4 4 - - - — 1958 315 315 - 13 28 39 19 57 and earlier 35 35 - 3 10 13 TOTAL 910 910 120* 44 103 143 The physical condition of all the children inspected was satisfactory * Tests of Vision and Hearing only at age of eight years Pupils referred for treatment because of Visual Defects = 2 Pupils referred for treatment because of Hearing Defects = Nil OTHER INSPECTIONS Number of Special Inspections 110 Number of Re-inspections 90 200 97 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 7 10 20 37 1 O 1 3 8 12 2 5 Eyes— a. Vision T 3 17 23 43 17 O 19 30 66 115 46 b. Squint T 2 2 — 4 O - - 1 1 - c. Other T 1 1 2 — O - 1 2 3 — 6 Ears — a. Hearing T -- 1 - 1 — O 22 7 30 59 16 b. Otitis Media T - - - — O 7 — 1 8 — c. Other T - - 2 2 - O - - 1 1 — 7 Nose and Throat T 2 2 3 7 — O 6 2 14 22 5 8 Speech T 1 - 2 3 - O 2 - 1 3 - 9 Lymphatic Glands T - - - - - O - 1 3 4 — 10 Heart T - - 2 2 — O 2 — — 2 — 11 Lungs T 1 - 1 2 1 O 2 10 12 — 12 Developmental — a. Hernia T - - - - - O 3 — 1 4 — b. Other T 1 6 - 7 - O 2 1 2 5 3 13 Orthopaedic — a. Posture. T - 1 2 3 1 O 1 6 10 17 2 b. Feet T 1 - 5 6 1 O 2 4 10 16 2 c. Other T - 2 1 3 O 3 6 3 12 1 14 Nervous System a. Epilepsy T - - - - - O — — 1 1 _ b. Other T - 1 - 1 — O — 1 1 2 _ 15 Psychological — a. Development T 1 - - 1 O 3 1 1 5 2 b. Stability T - - 2 2 — O 2 5 21 28 — 16 Abdomen T - 1 1 2 O 3 2 4 9 2 17 Other T - 5 - 5 - O 1 15 12 28 12 T = TREATMENT O = OBSERVATION 98 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 252 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 11 Errors of refraction (including squint) 3,984 Total 3,995 Number of pupils for whom spectacles were prescribed 1,734 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 837 new cases and 3,147 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 net 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, Chislehurst. 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 77 Number on treatment 19 Number on occlusion 52 Number under observation 149 Number of treatments given 44 Number of cures with operation 13 Number of cures without operation 50 Cases discharged — cured a) Functional for binocular single vision 36 b) Cosmetic 27 99 Total number of attendances 586 Transferred or left the district 21 Number of sessions 141 Number on waiting list at 31.12.72 Nil 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 452 (c) for other nose and throat conditions 321 Total 773 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) during 1972 21 (b) in previous years 85 ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated (a) Pupils treated at clinics or out-patients 112 (b) Pupils treated at school for postural defects - 112 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 899 attendances was made at the two Clinics and of these 753 were for remedial exercises, etc., and 146 for sunlight. DISEASES OF THE SKIN (excluding uncleanliness) Number of pupils known to have been treated Ringworm — (a) Scalp — (b) Body — Scabies 12 Impetigo — Other skin diseases 181 193 100 B.C.C. 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 3,309 children received a skin test and the 2,806 negative reactors received B.C.G. vaccination. Of the 297 children who were found to have a positive reaction to the skin test, 81 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 216 children who gave a positive reaction because of previous B.C.G. vaccination. RUBELLA Rubella vaccination was initially introduced into the School Health Service Immunisation Programme in September, 1970. At that time the Department of Health and Social Security 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 to ensure that as many girls as possible were offered protection against Rubella by vaccination, before reaching child-bearing age. Although the disease itself is mild, there are wellestablished associations between an attack of Rubella during pregnancy and the occurrence of serious abnormalities in the unborn child. Due to an intensive programme in 1971, vaccination of the lowest possible age group within the category laid down, has now been achieved. During the year the following programme of Rubella vaccinations was carried out:- Age Group Term No. of Vaccs. carried out 1960 Autumn 1,677 It is gratifying to record that the average acceptance rate for the vaccination was 79.9% 101 INFECTIOUS DISEASES 524 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as below SEASE TOTAL NO. OF CASES 1st QUARTER 2nd QUARTER 3rd QUARTER 4th QUARTER Dysentery 3 1 2 - - Food Poisoning 1 - - 1 - Infective Jaundice 7 2 4 - 1 Measles 456 147 116 164 29 Meningitis 13 3 - 4 6 Scarlet Fever 32 13 7 5 7 Tuberculosis (Pulmonary) 6 2 2 2 - Whooping Cough 4 2 - 1 1 Encephalitis 2 - - 1 1 TOTALS: 524 170 131 178 45 102 SPEECH THERAPY Once again there have been changes in staff. Early in the year we lost one full time and one part-time therapist, but we were fortunate in gaining the services of three part-time therapists in September. Nevertheless, as the waiting list indicates, the Speech Therapy services are seriously understaffed and in some areas children are having to wait for more than a year before they can receive treatment. Again we have not had a Speech Therapist available to work at Goddington School. As a part of their practical training students from The Central School of Speech Therapy and The OldreyFleming School of Speech Therapy have been attending the Bromley Clinic and students from The Kingdon-Ward School of Speech Therapy have been attending the sessions held in the Special Opportunity Classes at St. Paul's Wood School, Leesons School and Midfield School. Conferences and Courses attended during the year included a 4-day Conference of the College of Speech Therapists which the Senior Speech Therapist attended; a weekend Course of the National Society for Autistic Children was attended by one of the Therapists, who also attended a one-day Symposium sponsored by the I.L.E.A. The figures for 1972 are as follows:- Number of children referred by:- 1. Medical Officers in Department 111 2. Head Teachers 47 3. Hospital Consultants 8 4. General Practitioners 9 5. Parents 14 6. Health Visitors 26 7. Educational Psychologists 2 8. Other Districts 4 Total: 221 Number of children seen in Clinic 553 Number of children seen in Special Schools (including Cheyne Hospital and Special Opportunity Classes) 81 634 Number of Attendances:- 1. Clinics 3,579 2. Special Schools (including Cheyne Hospital and Special Opportunity Classes) 1,321 The numbers for Special Schools do not include Goddington, as no Speech Therapist was available to work there. Number of Home Visits 76 Number of School Visits 50 Number of initial interviews 176 Distribution of Cases:- Retarded Speech & Language Development 227 Dyslalia 162 Interdental Sigmatism 59 Lateral Sigmatism 16 Stammer 44 Cleft Palate (repaired) 15 103 Deaf 11 Dysphasia - Language Difficulties 14 Hypenasality 8 Hyponasality 0 Dysphonia 3 Dysarthria 5 Mentally Retarded 48 612 Twenty two cases seen in the Clinic have not been classified as therapy was either not indicated, or being received elsewhere. Cases closed:— Improved 41 Removed 12 Refused Appointments 9 Non-attendance after first interview 11 Failed Initial Appointment 5 Therapy not indicated 7 Therapy elsewhere 4 Left School 3 92 At the close of the year the numbers on the Waiting List were almost treble those of 1971. The figures are as follows: — Assessed and Awaiting Treatment 82 Awaiting Assessment 104 Total (including 18 children considered j to be priority cases) 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, the Consultant Psychiatrist for the following report in respect of the Chislehurst Child Guidance Clinic. During 1972 the demands made on the Clinic have remained fairly constant as regards the number of new referrals and new cases taken on for treatment, but there has been a marked increase in the number of interviews carried out by the Psychiatrist and Social Worker. The median length of the waiting list was about 10 weeks — more than half the cases had their diagnostic interview within 2 months of being referred. Some urgent cases were seen within 48 hours. The waiting list is still long and continues to be a source of frustration to parents and referring agencies. Treatment facilities are still insufficient, and it is not possible to offer adequate treatment for all the children still referred while the post of Child Psychotherapist remains unfilled. The appointment of a fourth Psychologist to the School Psychological Service was most welcome, as for some time, because of so many other commitments, the School Psychological Service had reduced drastically the amount of work undertaken at this Clinic. 104 The staff of the Clinic, as in previous years, has co-operated with other care-giving agencies through informal meetings, case conferences and discussions. With the reorganisation of the National Health Service in 1974, some uncertainty exists about the future of psychiatric services for children in the London Borough of Bromley. Staff: Medical Staff: Dr. R. Rodriguez MD., MRCP., DPM., MRC. Psych, has continued to act as Consultant Psychiatrist and Medical Director (4 sessions per week). Educational Psychologists: Miss A. Griffiths and Mr. T. Russell, who recently joined the School Psychological Service have visited the Clinic to carry out psychological assessments and also for weekly case discussions. Their efforts in increasing communication with schools has been greatly appreciated. Social Worker: Mrs. Walton was appointed full time Social Worker in September 1972. This is most welcome, as this for the first time, has meant there has been full time professional coverage at the Clinic. Child Psychotherapist: This post is still vacant. Clerical Staff: Mrs Gun has given valuable service as Clinic Secretary, assisted by Mrs. Lane (one morning per week). Building and Equipment: Some much needed decorations were carried out during the year. The shortcomings of the present building were partly highlighted by the failure to appoint a Psychotherapist, as the sessions can only be held on a Thursday. It is not possible to have a full team (Psychiatrist, Psychologist, Social Worker and Psychotherapist) to work simultaneously at this Clinic, as there are not enough rooms available. Referral and Treatment: 68 children from the Borough were investigated and taken on for treatment (1971 = 78). Approximately another 180/200 children were seen by Dr. Rodriguez in the hospitals of the Bromley Group. School Medical Officers and General Practitioners continue to refer nearly 50% of the children seen at this Clinic. Co-operation with outside agencies: As in previous years, close co-operation was maintained with other disciplines in the field of education and child care, and there were discussions with School Medical Officers, Head Teachers, Education Welfare Officers, Social Service Department Workers, Probation Officers and Health Visitors. Inter-disciplinary case conferences were held at this Clinic. Dr. Rodriguez attended the quarterly meetings with other Child Psychiatrists working for the South-East Regional Metropolitan Hospital Board. Six students attended the Clinic: — 1— Social Services Student 5— Health Visitor Students Details of referrals and attendances during the year are as follows:Waiting List: (a) Awaiting first interview 31 (b) Interviews and awaiting treatment Nil In attendance: (a) Active 87 (b) Periodic Review (holiday cases) 25 Number of cases closed: 74 105 Number of applications withdrawn (Failed repeatedly to attend for diagnostic interview) 15 Source of referral: Probation Officers 3 Court 2 Head Teachers 8 Medical Officers in Department 18 General Practitioners 32 Parents 19 Social Services Department 5 Hospital (Paediatricians and Psychiatrists) 2 Chief Education Officer 1 School Psychological Service 6 Others 8 Total 104 Number of new patients taken on for treatment during each month: January 6 May 6 September 7 February 7 June 6 October 10 March 8 July 5 November 6 April — August 2 December 5 Number of Psychiatric Interviews: Number of Social Workers Interviews: Quarter to 31st March, 1972 275 263 Quarter to 30th June, 1972 226 178 Quarter to 30th September, 1972 211 190 Quarter to 31st December, 1972 263 274 975 905 Number of Home Visits by Psychiatric Social Worker: 61 Number of School Visits: Psychiatric Social Worker 12 Educational Psychologists No figures available The Social Workers made 21 visits to different outside agencies, and attended Court on 2 occasions. SCHOOL PSYCHOLOGICAL SERVICE I am grateful to Mr. D. R. Banaclough, Chief Education Officer, for the following report on the School Psychological Service:- The School Psychological Service is intimately concerned with both the education and the welfare of children. Not surprisingly, the new Acts*, together with other educational changes such as the raising of the school leaving age and the effects of a vigorous population growth within the Borough, have imposed new demands resulting in subtle but continuous changes in the working of the Service. It seems desirable to look at the extent to which the service has thus found itself committed beyond its original brief within the Borough. (A) Summary of Provisions for Children relating to the work of S.P.S. The Service is concerned with all children resident or at school (L.E.A., direct grant or private) in the Borough. The provisions for children can be classified broadly within three categories, as follows: 1. Within the Educational framework la L.E.A. **Provisions (i) Total population 49,399 (summer term) 106 (ii) Total number of schools *** 122, thus: 22 Junior 68 Infant and Primary 32 Secondary (iii) Total number of special establishments 28 **** thus: 4 Special Day Schools 5 Infant Opportunity Classes 4 Special Infant Units 3 Voluntary Play Groups (S.S.N.) 2 Partially Hearing Units (Nursery & Primary) 9 Tutorial: Remedial and Maladjusted 1 Child Guidance Clinic *Children and Young Persons Act 1969 Social Services Act 1970 Education (Handicapped) Act 1971 **And Direct Grant Schools ***Excluding Special Schools dealt with under (iii) ****This number is to increase to possibly 32 units by 1975 as follows: 1 P.H. School, all ages, at Coopers (?1973) 1 Day S.S.N. School in the Crays (?1974) 1 Secondary Partially Hearing Unit, Darrick Wood (?1973/74) 1 Day Maladjusted School shared with Bexley (?1975) 1b Private Provisions (i) Total population not known (ii) Total number of private schools 24 (Infant, Junior & Secondary) (iii) Boarding and other day schools outside the Borough which Borough children attend, variable number. Now all the children are the responsibility of the Education Authority throughout their educational careers. For some this responsibility may start as early as 2 years of age and for some it may extend well beyond the age of 16 into same form of further education and training. This Service now finds itself required to cover a considerably extended age range. Its original commitment was to children between the ages of 5 and 15 years. 2. Within the National Health Service (under re-organisation by 1974) Total number of provisions 7*, thus: Bromley Hospital Child Guidance Clinic Farnborough Hospital Paediatric Department Farnborough Hospital Psychiatric Clinic Phoenix Centre for Spastic Primary Classes and Nursery Group Cheyne Hospital Primary School Nursery Group S.S.N. Group Now all children, whether normal or handicapped and whatever the nature, degree and number of handicaps, are the responsibility of the Education Authority. This Service now finds itself required to apply its resources to an increasingly varied and complex range of problems attending the handicapped. This has considerably widened the scope of the Service. Its original brief excluded the handicapped, who were then the responsibility of the Health Authority. 3. Within the Social Services Department Total number of special establishments 2**, thus: Reception/Assessment Hostel (all ages), Reynolds House Adult Training Centre 107 Children who are made subjects of Care Orders should now have their personal needs assessed by a multidisciplinary team which includes a psychologist. The Children's Department has become incorporated in the new Social Services Department, with wider involvement in community care, and inevitably would request the psychologist's advice about children in a wider variety of instances than just those in which a formal Care Order has been made. The School Psychological Service now faces increasing demands from an entirely new Department. Over half the special provisions for children have been established during the past three years to meet the requirements of the new Acts. It is expected that they should continue to grow in the next few years as the full extent of the educational needs of the handicapped becomes more clearly understood. *This number is to increase to 8 by 1975 with the proposed S.S.N. Unit at Cheyne Hospital. **This number is to increase to 4 by 1975 with the proposed S.S.N. Hostel in Bromley for children up to 16 years (?1973) and another Reception/Assessment Hostel. (B) Analysis of work carried out in the 1971-72 Academic Year Whatever the growth in diversity and complexity of duties, the work of the Service is still best presented under the three main categories of individual psychological investigations, group studies and general education advisory activities. Individual Psychological Investigations The psychological investigation of an individual child includes the necessary interviews and dialogues with parents, teachers and any other professional concerned in the case. During the course of the year, many children are put forward by their schools as presenting some problems. Some of these can be resolved through discussion with the teachers on the spot. Such cases are not included in the number of individual investigations, because they would not have been reported on; these numbers do not figure in the statistics of the Annual Report but come under the umbrella term of advisory activity. » This year, 623 children were investigated and reported on by the three Educational Psychologists who manned the Service. Table I below sets out details of the referral agencies and the incidence of boys and girls referred. TABLE I REFERRALS Total number of children seen and reported on individually during the academic year 1.9.71-31.8.72. SOURCE BOYS GIRLS TOTAL NO. OF CHILDREN (a) Schools 293 110 403 (307)** (b) Hospitals 98 44 142 (169)** L.E.A. Clinics - - - (c) Miscellaneous: 54 24 78 S.M.O. (5) (2) (7) C.E.O. (40) (19) (59) Parent (4) (1) (5) G.P. (1) (-) (1) Probation Officer (-) (1) (1) Child Care Officer (4) (1) (5) TOTALS 445 178 623(556)** **These figures refer to the 1970/71 referrals; the first year when the Service had had three full-time Educational psychologists on establishment. 108 There is an increase in the total number of children seen as usual, the heaviest demand by far comes from the schools. Over the past years this demand has grown*. Some transient working difficulties in connection with the Local Education Authority Child Guidance Clinic at The Willows may explain the apparent slight drop in the number of children seen in the hospital clinics. Their demands, on the whole, remain fairly constant. *There is still a large waiting list of children referred but not investigated. It is some relief to note that the waiting list has decreased to 160 children this year. It is interesting to note the relatively high number of boys seen. They form 72% of the total. A closer examination of the returns shown in the appendices, which carry more detailed statistics indicates that the majority of problems are related to, or reveal, learning difficulties. This appears more obviously within the younger age groups. The discrepancy between the sexes is consistently large enough to warrant closer investigation as to possible contributing causes. Unfortunately, the present staffing ratio of the Service does not permit a research project of this nature to be undertaken as part of the general work. It remains, however, an aspect of work which needs to be considered for future development. Children are referred to the Service for a variety of reasons by a variety of agencies; mostly, it would seem, their problems prove to be of an educational nature. Just over half of all children referred fall into three categories:- behaviour problems, learning difficulties and general retardation. It would seem that learning problems attend mostly the children of average and below average intelligence. Behaviour problems — whether within the home or in the schools—seem to occur more among children of average and above average intelligence. There are few cases referred for queried developmental retardation. This category concerns young, pre-school infants. It would seem that young infants may wrongly present a clinical picture of retardation, as most prove to be slow rather than subnormal. A total of 196 children (S.S.N., E.S.N., and Dull) were identified as slow children in practice. One fifth would have clearly fallen in the field of special educational provision; the remaining four-fifths would have been retained within framework of the ordinary schools. For a few of them, boarding school placement would have been required. The recommendations made by the Educational Psychologists when investigating individual cases, seem to fall mainly into eight categories. Some of these are mutually exclusive but most are not; in fact, frequently multiple recommendations occur. Table II below lists the eight main categories and the number of children involved with each of them. TABLE II Distribution of main categories of recommendation made by the Educational Psychologists during the academic year 1.9.71 - 31.8.72. RECOMMENDATION BOYS GIRLS TOTAL 1. Advice to Parents 59 32 91 2. Advice to Teachers 248 94 342 3. Remedial Teaching Provision 43 9 52* 4. Remedial Maladjusted Provision 9 4 13** 5. E.S.N. Placement 36 17 53*** 6. S.S.N. Placement 8 2 10 7. Special Opportunity Class (Inf.) Placement 11 6 17 8. Referred to Child Guidance Clinic 14 8 22 TOTALS 428 172 600 *Only 3 of there were implemented during the year. **Only 1 of these was implemented during the year. ***The total number implemented is not known precisely. 109 AUDIOLOGY SERVICE Two Medical Officers have particular responsibilities in this field and I am happy to submit this report:— All the Medical Officers continue to carry out sweep frequency tests during medical examinations at their schools and give particular emphasis to these at the entrant routine medical examinations. Whereas in previous years sweep testing in the eight year old children was also done by the Medical Officers at special Sessions, this service is now undertaken by the newly appointed Audiometrician. Following a period of training at the Audiology Clinic, these children were then tested with the following results. Passed Failed Absent Total pupils tested First Test 4733 + 362 (165) 5095 Passed Failed second test To own G.P. Failed appointment carried forward Second test of failures (362) + above 133 69 * 15 55 90 * Referred to Medical Officer in Department. Total number of sessions 165 Average number of pupils per session 31 We have maintained weekly diagnostic sessions at the Audiology Clinic at Beckenham where we see referrals from Child Health Clinics, Schools, School Psychological Service, Speech Therapists and General Practitioners. In our work there we regard the exclusion of deafness in a child to be quite as justified of the time allotted to us as is the time spent in identifying and diagnosing a hearing loss. Details of attendances at the Audiology Clinic are as follows:- Number of sessions held 41 No. of children No. of seen attendances Over 2 years of age 76 84 Under 2 years of age 57 66 133 150 The Ascertainment Team meetings are now well established. They are held about twice a term when every effort is made to plan educational provision to suit the individual needs of the child, and to make specific recommendations to the Chief Education Officer. The total number of sessions held this year was 7 and the number of children discussed was 47. We hope the truth is not obscured by the cliche to say that the interest of the child is our only consideration at these meetings and that there exists a stimulating and agreeable relationship between the members in trying to fulfil this aim. 111 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 total number of hearing impaired children in Bromley, as of July 31st 1972, who come under the regular supervision of a teacher of the deaf is 122, 116 of which have hearing aids. 5 of this total live in Bexley but attend the Darrick Wood Unit, and 31 are educated outside the Borough. Of the remaining 86, 17 are at Darrick Wood and 69 are covered by the Peripatetic Service. i.e. Children attending the Darrick Wood Unit:- Nursery- Infant groups 13 (including 2 from Bexley) Junior Class 9 (including 3 from Bexley) Total 22 (including 5 from Bexley) Peripatetic Service: The following receive regular help from a teacher of the deaf: Pre-school children with hearing aids 6 Children with hearing aids attending normal schools within the Borough 17 Hearing impaired children without hearing aids 6 Total 29 In addition, the Peripatetic Service has some responsibility for the following: Children with hearing aids educated outside the Borough: (a) in residential placement- 18 (including 1 placed because of maladjustment) (b) in day placement- 13 (including 3 in normal I.L.E. A. schools) 31 Other children with hearing aids attending normal schools within the Borough— 40 Total for Peripatetic Service=100. Full total=122 The Darrick Wood Unit In addition to the 22 children attending full-time, 1 pre-school deaf child in the Autumn term and 2 in the Summer term each spend three or four trial-sessions a week at the Unit as a preparation for full-time admission when older. This has been found most helpful both for adjusting the children to the Unit routine, and for assessing their suitability for permanent admission. The mothers of the children provided the transport and have generally felt that the benefits of this arrangement have outweighed the personal inconvenience. Varying amounts of integration, as appropriate to the individual hearing impaired child, has continued with the hearing Infant and Junior children; this has included participation in school outings and functions — although the Unit children have also gone on visits within their own groups. Even the profoundly deaf children can gain in verbal communication skills and social ease from controlled contacts with their hearing contemporaries and the practice of integration has the support of Mrs Jordan and Mr. Langiey the Headteachers of the Infant and Junior Schools respectively; extension of it was also urged by Dr. D. C. Wollman, H.M.I., of the Department of Education and Science when he visited the Unit in January 1972. 112 Discussions on secondary provision within the Borough for children with impaired hearing has been continuing, the interest in and helpful advice on the project having been obtained of Mr! J. E. J. John of the Department of Audiology and Education of the Deaf at Manchester University. The Peripatetic Service 29 pre-school and school age children have been receiving regular help from the Peripatetic Teachers of the Deaf at home, in school or at the Beckenham Audiology Clinic. This help varies in intervals from twice a week to once a fortnight and takes the form of speech improvement, auditory training, parent guidance, language development, remedial reading, number work etc. About two thirds of the teachers' time is devoted to these regular cases; one session a week is spent at the Audiology Clinic with Medical Officers of the Health Department and most of the remaining time at schools assessing new cases and checking on children with hearing aids etc. In our endeavour to retain as many partially hearing children as possible in their neighbourhood schools we have been helped not only by their parents but also by many busy teachers who involve themselves actively in the childrens progress. Apart from the weekly clinics with either Dr. Lewis or Dr. Luscombe both of whom take a keen interest in our work and give us unfailing assistance, there have been in the course of the year several meetings of the ascertainment team, consisting of these two School Medical Officers, The Educational Psychologists and the Teachers of the Deaf. These assess the progress of our hearing impaired children and consider any who may be causing concern. Two meetings have been held at Darrick Wood and the remainder at the School Psychological Service centre at St. Paul's Wood Hill. These meetings have been productive of useful advice and more so this year as a result of our jointly devising a comprehensive report form for completion by the teachers of the children. Not included in our statistical analysis are the increasing number of children with minor hearing defects being brought to our notice not only by the Principal School Medical Officer but also by the Heads of schools. Many of these appreciate our function of helping to avoid any educational retardation due to a loss of hearing by ascertaining and advising on its existence as early as possible. We depend on their interest for this and are grateful for it. Some of our children have participated in research conducted by Miss Alison Barclay of the Institute of Education at London University into ways in which children with severely impaired hearing can be helped to keep up in ordinary schools. This has involved them in tests and experimental studies and their parents and teachers in the completion of questionaires; they have all co-operated very willingly. Although the findings are not yet complete we hope they will suggest further ways of adapting deaf and partially hearing children to their neighbourhood environment. Expenditure has been mainly on consolidating the provision of hearing aids and other amplifying equipment—e.g. individual inductance loops in ordinary classrooms. Although this may suggest disproportionate expenditure on one child, this system has great advantages for that child. Throughout the year the interest and helpfulness of parents, teachers and others whose work brings them into the field of deaf education has been marked. We much appreciate this, and would also like to thank the administrative staff concerned with us, whose knowledge of our work and whose efforts on our behalf it is easy to expect. 113 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, Speech Defects, Dyslectic, Autistic and Blind-Deaf; no return is made at present for the last 3 categories to the Department of Education and Science. 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 64 boys and 26 girls were assessed as needing special educational treatment at special schools. Details of the various handicaps are included in Table Part I (New assessments and placements) 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. In addition classes for severely sub-normal pupils have been provided in 4 schools-details of which are available in the report of the School Psychological Service. As anticipated building was started on the special school for handicapped children which is sited between the two main blocks of Coopers School Chislehurst. Obtaining the best possible arrangements for the education of the handicapped child require 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. 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. 114 RETURN OF HANDICAPPED CHILDREN PART I New assessments and placements During the calendar year ended 31st December, 1972 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) TOTAL (11) A How many handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? Boys - - 1 - 4 5 13 41 - - 64 Girls - 1 1 - 2 4 2 19 1 - 30 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 4 10 35 - - 50 Girls - 1 - - - 4 1 13 1 - 20 (ii) of those assessed prior to January 1972 Boys - - - - 1 2 1 9 1 - 14 Girls - - - - 1 - - 5 - - 6 (iii) TOTAL newly placedB(i) and (ii) Boys - - - - 2 6 11 44 1 - 64 Girls - 1 - - 1 4 1 18 1 - 26 115 PART II HANDICAPPED PUPILS AWAITING PLACEMENT AND RECEIVING SPECIAL EDUCATIONAL TREATMENT (6- 12) Children from the authority's area as at 25 January 1973 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) Total (11 ) Awaiting places in special schools. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Under 5 years of age 1. waiting before 1 January 1972 (a) day places (b) boarding places 2. newly assessed since 1 January (a) day places 1 2 3 1972 (b) boarding places Aged 5 years and over 3. Waiting before 1 January 1972 (a) day places 7 3 7 3 (b) boarding places 1 1 4. Newly assessed since 1 January 1972 (a) day places 1 1 (b) boarding places 1 2 1 4 5. Total number of children awaiting admission to special schools. 1 to 4 above. (a) day places 1 10 3 11 3 (b) boarding places 1 2 1 1 4 1 6. Maintained Special Schools including attached units and hospital Special Schools. (a) day 4 2 5 1 13 9 8 2 256 161 286 175 (b) boarding 1 1 1 1 1 6 9 5 3 1 29 13 44 27 7. Non-maintained Special Schools including attached units and hospital Special Schools. (a) day 3 3 3 3 (b) boarding 1 3 2 7 1 1 4 2 4 5 7 1 10 4 4 1 40 17 8. Independent schools under arrangements made by the Authority. (a) day 1 2 1 1 2 3 (b) boarding 2 2 2 2 37 4 21 8 62 16 9. Special classes in ordinary schools (assume all day) 7 7 5 6 1 4 2 29 23 1 4 1 51 39 10. Total on registers-6 to 9 above (a) day 4 2 12 9 5 6 17 14 8 2 5 2 286 184 1 4 1 342 220 (b) boarding 2 3 2 10 4 1 2 12 13 9 8 45 5 60 21 4 4 1 146 60 11. Boarded in homes and not already included above. 2 2 2 2 12. Educated under arrangements made by the Authority in accordance with Section 56 of the Education Act 1944. (a) in hospitals (b) in other groups eg units for spastics 7 6 7 6 (c) at home 1 2 1 1 3 13. Total number of handicapped children awaiting 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 5, 10, 11 and 12. 2 3 6 2 22 13 6 8 38 35 18 11 54 10 35 7 20 8 5 4 5 1 513 295 116 117 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 full and interesting treatment. Young children have continued to be admitted to the Nursery class of day pupils, and to take advantage of the comprehensive physiotherapeutic services offered. The children concerned have benefited from this arrangement. The number of admissions during 1972 were 7, with 6 discharged and 1 death. In addition 9 children spent varying periods of time at the hospital during the holidays. The 6 children from Leybourne Grange have shown some improvement in the past year; their future is as yet undecided. 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 new Centre presented by the Spastics Society was opened by Sir Keith Joseph, Bt., M.P. Secretary of State for Social Services on 26th September, 1972. The ceremony was attended by a large gathering of people representing various departments of the Hospital and Local Authority, and also many groups and individuals who had contributed generously towards the £60,000 required for the new building and equipment. The children and staff are now happily settled in the new Centre and are benefiting greatly from all the facilities and increased space in the specially designed building. The number of children attending is now 39, 22 attend daily and 17 attend selective afternoon groups at regular intervals. There have been 13 new patients admitted to the Centre since January, 1972, and 6 patients have left, 5 to go to other schools, and 1 moved away from the district. Mrs. N. Dawson, Senior Physiotherapist and also in charge of the day to day administration of the Unit, retired in December after eight years work in the Phoenix Centre. All her valuable work was much appreciated and she was given a leaving present by the Parents Group, and a Hospital party was also held for her in the Phoenix Centre. Miss M. Sage has been appointed as Senior Physiotherapist to succeed Mrs. Dawson. Mrs. A. Waterhouse continues as Senior Teacher, and is assisted by Mrs. Bray, who teaches the senior group, and Miss B. Cook who has replaced Mrs. J. Williams as Teacher for the Nursery Group. Other members of the therapy staff continue their appointments, including Mrs. S. Walster as Senior Occupational Therapist, assisted by Mrs. R. Rosier wno has been appointed as an additional part-time Occupational Therapist, Miss P. Park as Physiotherapist and Mrs. E. Clarke and Mrs. R. MacKenzie as Speech Therapists, Mrs. Woodbridge, Nursery Warden, and her staff, with numerous voluntary helpers, too many to mention by name. Mrs. A. Dalton was also appointed as Receptionist, who took up her duties in September. This is a new appointment and has greatly contributed to the day to day organisation of the Unit. SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington Number on roll: — Boys 80, Girls 48 During the year routine medical inspections were carried out, and as a result three children were referred to the Ophthalmic clinic, one hearing defect has been referred and one child with tortcollis was referred and has since been operated on. Rubella vaccination was carried out on four girls. There have been twelve school leavers and of these, three girls were transferred to a training centre, two to ESN/Maladjusted School—Swaylands (residential) and one to a residential epileptic hospital school. Special defects in the school are currently as follows: Hearing defect- 3 Hearing—under investigation- 2 Defects of vision- 15 Epileptics- 9 Sturge Weber syndrome with epilepsy- 2 Arrested hydrocephalus with petit mal- 1 Congenital heart lesion- 1 (operated) Mongols- 118 The Bromley & Bexley Special Schools Sports Association was formed and Mrs Rackham, the Head Teacher, Goddington School, was elected Secretary, since when there have been 2 swimming galas and two sports days, a crosscountry run and football matches. The swimming pool is now covered and swimming takes place during all the months except November to February. The senior boys and girls of Goddington School worked on a six months educational programme on the dimensions and role of housecraft based on the organisation and preparation needed for a wedding. It involved work in budgeting, needlework, cake making, planning the music for the wedding, the lay-out of the invitation card etc. Work was also done on the health aspects of marriage and family and a visit to the Family Planning Clinic was arranged, and subsequently a mock wedding took place at the local Baptist Church Hall, when the following talk was given:- "At this point in the service I usually address the bride and groom, but as this is not a real wedding, I felt this would be a good time to explain why we are here. The Senior Boys & Girls of Goddington have been working for the past six months on an educational and social developmental project based on the organisation and preparation needed for a wedding. The bride's dress was a present from a parent and the veil lent by the sister of one of the Senior Girls. But the bridesmaids' dresses and head-dresses were made by the girls themselves as were also the table decorations for the reception. The food was prepared by the Senior Boys, who also made the cake. The groom decorated the cake himself, helped by a Class 7 boy who made the fondant flowers. The children have taken photgraphs of these processes which they will develop themselves. I have visited the school twice to talk about the religious meaning of a wedding. The girls have visited at my home for coffee and also came along twice to church. In Handicraft home maintenance and interior decoration and renovation has been thoroughly explored. Health education has included visits to local clinics and has included much time spent discussing the morals and responsibilities of marriage. In English lessons the invitations were planned, letters asking friends to be bridesmaids, forms were filled in from the local Housing Office, "thank-you" letters were written for presents and the home-movie film sequence planned. Mathematics lessons were very busy costing all the activities, hire of cars, halls, cost of church, choir, flowers, food, wine, the honeymoon etc. Also the cost of furnishing and running a small flat. The hymns and music were chosen by the children, and the school choir is very thrilled to be actually singing in the choir stalls of the church. As you can see, the involvement of the children in this event has been very full, and will continue after today with follow-up work at the school. Perhaps the greatest value is in the poise and confidence which has obviously developed in the children through this experience of taking the learning situation out of schools". The seniors have felt a continued interest in the project after the wedding and have done drawings and a film of the entire work of the school. 119 St. Nicholas School, West Wickham Number on roll: Boys 62 Girls 43 A medical examination was carried out on new entrants during their first term and all the other children had their annual medical inspection during the other terms with appointments for their parents to attend. Every child in the school is a slow learner, many have disabilities and defects causing this and several have multiple handicaps under the following classifications: Asthma and respiratory disease 9 Autistic 2 Brain damage 9 Colour blind 1 Delicate 8 Epilepsy or petit mal 5 Hearing defect 4 Heart defect 3 Hydrocephalus (arrested) 2 Mongolism 3 Muscular disease or weakness 4 Ophthalmic disease 4 Obesity 3 Physically handicapped 4 Psychological, emotional and behaviour problems 18 Problems of deprivation 27 Speech defects 12 Language, as distinct from speech difficulties. 17 Forty-one children wear glasses or were referred to the Eye Clinic for vision defects. The services of the Speech Therapist are absolutely necessary, and a third of the total number are receiving regular speech and language development therapy in school. B.C.G. vaccinations were carried out on 6 boys and girls, and Rubella vaccination was given to 6 senior girls. There were 12 school leavers who obtained a variety of different jobs, mostly of a routine nature and under supervision. All the activities of the school are geared to help independence to stimulate and to create interest, to allow the pupils to gain confidence and ability so that when they leave school they will be able to gain useful employment within their capabilities. Sporting activities have included canoeing on the lake at Stockwell College and a camping trip. Outings to London and Educational visits took place to Southwark Cathedral, London Bridge, Covent Garden (old and new), Gatwick Airport, Horniman's Museum, Knole Park, Windsor Safari, Whittington Church, St. Leonards-on-Sea and Crystal Palace Football Ground. Many of these outings have been made possible by the presentation of a Mini-Coach to the school. The heated swimming pool is in use all the year round and each one who is physically capable is taught to swim which is an important asset. The pool is in the process of having new chlorination and filtration equipment, part of which is being carried out as an engineering project by the senior boys. The year concluded with a Christmas Fayre with entertainment from a school choir and a country dance team giving a real sense of achievement. 120 Grovelands School, St. Pauls Cray Number on roll: Boys 73 Girls 47 During the year 19 pupils were admitted and 20 left; two attend normal schools part-time. Of the leavers 13 are fully employed, 4 were transferred to other schools and 3 moved out of the Borough. Routine medicals, with referrals as necessary; B.C.G. and Rubella vaccinations were carried out as usual. The school now has regular visits both from a Speech Therapist and an Educational Psychologist which have proved to be of great value to pupils and staff. The Peripatetic Teacher of the Deaf also visits. There were two staff changes during the year. School activities have been increased by the introduction of badminton and many boys have become interested in billiards and snooker. Community work now includes the invitation of old age pensioners to lunches prepared and cooked by senior girls. Outside visits and activities continue with wide variety and are much enjoyed by all age groups as are the traditional annual events. All members of the staff work very hard to produce self-confidence and happiness in all the pupils and encourage them to integrate successfully both into employment and the outside community. Special defects in the school currently are as follows:- Defective Vision 32 Partially Hearing 2 Delicate or Physically Defective 8 Maladjusted 19 Epileptic 10 Severe Speech Defects 9 Woodbrook School, Beckenham. Number on roll: Boys 67 Girls 34 During the Spring and Summer terms thirteen children left Woodbrook School. Of this number five were school leavers and now attend Astley Adult Training Centre. Another two children left during the Autumn term. There were ten new entrants during the year. Every child was medically examined during the year and B.C.G. and Rubella vaccinations were carried out. Many of the children have multiple handicaps. The following is a classification of the conditions associated s with severe mental retardation. In many, the cause of the mental retardation is unknown. Down's Syndrome 30 Epilepsy 12 Cerebral Palsy 10 Birth Trauma 8 Arrested Hydrocephalus 4 Post-encephalitis Encephalopathy 3 Autism and secondary autistic features 3 Rubenstein Taylor Syndrome 1 Hypercalcaemia 1 121 Associated with the above are other defects — cardiac conditions, eye defects, epilepsy, spasticity, speech defects, hyperactivity, bronchitis, skin disorders, partially hearing and diabetes. There were three families with two children from each family attending the school. At the beginning of the year there was a shortage of speech therapists but the situation improved, which resulted in more regular therapy since the Autumn term. There were fifteen children having regular treatment and four others periodically. The addition of another classroom has provided further facilities and a slight decrease in class numbers. The appointment of a teacher for manual instructions has given the more senior boys opportunities which they enjoy very much. The introduction of swimming and horse riding to the curriculum has been greeted with great enthusiasm. Football and outside activities are much appreciated by the pupils. For the first time the pupils took part in the Special Schools Sports Day at Goddington. This is hoped to be held at Woodbrook in the future. The supply of a hoist to the special care unit is a very useful addition. The staff have continued to work hard to give each child as much help as possible. The co-operation and help of the head teacher, Mrs Walton and the physiotherapist, Mrs MacLachlan with the medical inspections has been greatly appreciated. EMPLOYMENT OF YOUNG CHILDREN 258 children were examined by the Medical Officers in Department during the year. Certificates were issued in all cases. Boys Girls Delivery of milk 7 - Delivery of newspapers 120 36 Delivery of meat 1 - Delivery of groceries 1 - Light framework 1 - Car cleaning 1 - Shop Assistant 6 30 Shelf filler 3 4 Hairdresser's Assistant - 5 Library Assistant 1 3 Entertainment 3 15 Waitress/Waiter 1 2 Domestic 1 2 Bath Attendant - 1 General Help - 7 Table clearing 4 3 150 108 OTHER MEDICAL EXAMINATIONS The following examinations were carried out by Medical Officers during the year:- Training College candidates 454 Teachers 84 Total 538 122 SCHOOL MEALS AND MILK SERVICES The average daily number of meals served during 1972 was 34,100. The corresponding average for 1971 was 31,500, an increase of 8%. A return submitted by schools for a day in the Autumn Term 1972 showed that the number of children taking a 1/3 pint of milk was 11,133 and a further 16 children of primary school age were receiving free milk for reasons of health. A similar return in respect of meals was also completed, showing that 33,084 meals were taken, including 2,531 which were free meals. The return also disclosed that 1,669 primary and 3,434 secondary school children were bringing a sandwich meal each day. EDUCATION (MILK) ACT 1971 Under the above Act, free school milk is no longer provided after the age of 7 years (except to children attending special schools) unless there are health indications that it should be continued. YEAR NO. REFERRED CERTIFICATE ISSUED CERTIFICATE NOT ISSUED PARENTS REFUSED MEDICAL EXAMINATION *971 150 14 123 13 1972 26 5 21 — *These figures were not quoted in the 1971 Report as the Act was not implemented until the latter part of that year, 1972 being the first full year. THE HEALTH VISITOR IN THE SCHOOL HEALTH SERVICE The routine work of the Health Visitor in the School Health Service has been assisted since the Autumn of 1972 by the employment of two full time School/Clinic Nurses. 4,094 School Medical Sessions were attended by Health Visitors or School Nurses. 45,670 Children were examined at Hygiene Inspections which is 6,638 more children than last year, resulting in 328 home visits to parents to give advice and instruction for treatment of head infestation. This shows a decrease in the percentage of cases since last year. An additional 1,973 home visits were made to the parents of children between ages of 5 years and 16 years of age to give advice and discuss their various problems. 252 Children attended minor ailments clinics by request of their parents for treatment of various conditions, necessitating 1,084 follow-up visits, and for employment certificate examinations. A total of 19 Health Education Sessions was given by Health Visitors in Junior and Secondary Schools. The work of the Health Visitor and School Nurse reflects the continuity of care provided for the child linking his home care with the school medical services. 123 HEALTH EDUCATION AND HOME SAFETY Every good wish is offered to Mr. J. Bretton, who retired in April 1972, and who has been responsible, since the formation of the London Borough of Bromley, for Health Education and Home Safety. His pleasant and enthusiastic disposition, coupled with his untiring energy, will be greatly missed by children and adults alike. Mrs. M.E. Eves, S.R.N., S.C.M., H.V. Cert, was appointed Health Education Officer/Home Safety Officer, in July, 1972. With an extensive and varied career in nursing, midwifery and the public health field, including considerable experience with assisting health education in schools, the forward looking approach to health education will be continued and expanded. The adoption of the 'Health and Social Education Working Parties' suggested scheme of education for health and personal relationships in Secondary Schools, has established a closer link between health and education departments, resulting in the better promotion of united health education for the London Borough of Bromley. Many teachers have sought the advice of the Health Education Officer in compiling their programmes. Talks by Public Health Inspectors, Health Visitors and the Health Education Officer have been given in the schools and the loan of visual aids from the Health Department have proved very popular with teachers. At the one-day conference on Health Education for Primary Schools in October, 1972, it was the unanimous wish of those attending that a policy similar to that adopted by the Secondary Schools should apply and, accordingly, an in-service training course on Health Education will be arranged for the Spring Term 1973. Home Safety is also promoted under the umbrella of Health Education. The Schools and the Health Education Section by following the National Home Safety Campaigns suggested by R.O.S.P.A., are showing a more united publicity of the dangers within the home. The gratifying result of no reported firework accidents produced by the intensive Campaign organised within the Borough by the Health Education Officer and supported by the Schools, proves that a combined effort from all levels will encourage the desired effects of reducing home accidents. Mr. D. R. Barraclough, Chief Education Officer, has submitted the following report: PHYSICAL EDUCATION In a year which has seen many signs of change in Bromley on the broad educational front there is little in Physical Education that is new to report. However, if there is not much breaking of new ground there is certainly an intensive cultivation of the tried and approved that gives much pleasure especially in that part of the planned programme which is bringing into existence many more games halls in the new larger secondary schools. These large structures enable the staff to carry out a more elastic programme and at the same time provide a welcome antidote to the problem of games coaching which so often suffers from the vagaries of the English climate. Major sports continue to flourish in schools and it is fair comment to say that more Hockey, more Cricket, more Rugby, more Soccer, more Basketball, more Netball and more Volleyball are being played by the young people of Bromley in schools than ever before. This contradicts the often repeated statement that the major games are no longer popular and that the young are more attracted by the individual pursuits. In support of this claim about the major games it should be noted that in one secondary school last year the various school teams played three-hundred and forty games and in another they had played over a hundred by just half term this present season. This intensive use of school grounds makes it impossible to provide any further use for the general public of any school grass area. One school possesses an all-weather porous pitch and others are planned. If they possessed simple floodlighting, it would be possible to use the facility until ten o'clock at night without detriment to the surface. One major development is that of larger sports halls in place of or, sometimes, in addition to the traditional gymnasia. These new structures are the largest spaces yet built in the service of education and much time and thought has gone into their planning so that they can be used for a very wide range of activities. These Games Halls can be used if necessary for any major school gathering and the sacrosanct nature of a fine wooden gymnasium floor has given way to a multi-purpose surface which is capable of withstanding even the ravages of stiletto heels. Before very 124 long the Borough will possess nine of these very important adjuncts to the social and physical life of the schools. If the campaign of 'Sport for All' is to become a reality all major schools should have a sports complex as a selfcontained unit consisting of a Games Hall, a floodlit hard porous area and a pool so that in any of the neighbourhoods there will exist play and leisure areas which people can reach without travelling great distances. This might encourage adults once again to walk to their fun! Physical Education has much to give the less able and the handicapped child. This year great efforts have been made to develop the work suitable for this section of the schools' community and the results have been very rewarding. At adult level, the swimming pool at St. Olave's School has been a great boon for a group of seriously physically handicapped people who each week come together for swimming recreation and social enjoyment. They have raised considerable funds to help themselves and are now competing with similar people at places such as Stoke Mandeville and even gaining gold and silver medals for their efforts. For every handicapped swimmer whether limbless, blind or spastic, there is a voluntary helper who, apart from looking after the safety of the swimmer, also becomes a friend and a companion in the very highest sense. They give without thought of reward and find justification enough in the new-found happiness of their charges. Swimming, Archery, Table Tennis are available for the disabled. Ways will be found of extending the range of activities - Billiards and Athletics will shortly become available — so that for every sport there will be found the 'wheelchair' equivalent. Opportunities are being found to raise the physical ability of seriously mentally-handicapped youngsters through play and games, who as a result become more self-reliant and less in need of help from those in whose care they are placed. In Mrs. Rye, the Borough is singularly fortunate in processing an Adviser with special ability in this kind of work. Under her leadership rapid progress is being made with the integration of these pupils into the normal school system. She has now been with us for five terms and has strengthened the Advisory team with her great experience and understanding of the pupils who attend schools for handicapped children. In the realm of her specialism she has conducted, in infants' schools secondary schools and special schools in Bromley, courses in movement education, courses in games skills and courses in National Dance and in Modern Educational Dance. In outdoor pursuits, much work has been done in the Borough, especially in the training of teachers in Mountain Leadership, Camping and Orienteering and, on the pupils' side, in work connected with The Duke of Edinburgh Award and courses concerned with adventure and initiative. The latter courses have taken place at the camp site at Leigh where the existence of river, rook, forest, scrub and grassland provides a wider range of activities involving orienteering, ecology, improvisation, adventure, endurance, camping, cooking and map-reading. All this work and much more is monitored by a very fine band of dedicated P.E. teachers. Between them they encourage the growth of forty-three sports in the Borough. It is a pleasure to record the gratitude and appreciation of the Authority for all their fine efforts. 125 CLINIC ADDRESS WEEKLY SESSIONS Held as follows: (By appointment only) OPHTHALMIC: School Clinic, The Willows, Monday-a.m. Red Hill, Chislehurst. School House, 55 Chislehurst Road Monday-all day Orpington. Mickleham Road Clinic, Monday-a.m. St. Paul's Cray North Clinic Monday-a.m. Station Road, Wednesday-a.m. Bromley. Friday-p.m. Saturday- a.m. Saturday-a.m. (Alternate) School Clinic, Wednesday-a.m. Town Hall, Beckenham. School Clinic, Friday-a.m. Oakfield Road, Penge. ORTHOPTIC: North Clinic, Tuesday-all day Station Road, Bromley. School Clinic, The Willows, Thursday-a.m. Red Hill, Chislehurst. *ORTHOPAEDIC North Clinic, Friday-p.m. Station Road, Bromley (monthly) *PHYSIOTHERAPY: School Clinic, Monday-p.m. Town Hall, Beckenham Thursday-a.m. North Clinic, Tuesday-a.m. Station Road, Bromley 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. SPEECH: Assemblies of God Church Rooms, Tuesday Masons Hill, Bromley. Wednesday) All Thursday) Day Monday-a.m. School Clinic, Monday) All Town Hall, Beckenham. Tuesday) Day Friday) Thursday—p.m. The Clinic Tuesday) Kimmeridge Road, Wednesday) a.m. Mottingham, S.E.9.) Hawes Down School Clinic Tuesday ) Hawes Lane, West Wickham. Wednesday) p.m. School Clinic, Monday-p.m. The Willows, Friday-a.m. Redhill, Chislehurst. 126 CLINIC ADDRESS WEEKLY SESSIONS *CHILD GUIDANCE: The Willows, Tuesday) Red Hill, Chislehurst. Friday) a11 day *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. School Clinic, DENTAL The Willows, Monday ) all day Redhill, Chislehurst. Wednesday) School House, Monday) 55 Chislehurst Road, Tuesday) Orpington. Wednesday) all day Thursday) Friday) Mickleham Road, Monday) St. Paul's Cray Tuesday) Wednesday) all day Thursday) Friday) Kimmeridge Road, Tuesday) Mottingham Thursday) all day Friday) North Clinic, Monday) Station Road, Tuesday) Bromley. Wednesday) all day Thursday) Friday) South Clinic, Monday) Princes Plain Tuesday) Bromley. Wednesday) all day Thursday ) The Pavilion, Recreation Ground, Friday—a.m. only Church Road, Biggin Hill. School Clinic, Monday) Town Hall, Tuesday) Beckenham. Wednesday) a.m. only Thursday) Friday) Hawes Down Clinic, Monday) Hawes Lane, Tuesday) West Wickham. Wednesday) a.m. only Thursday) Friday) School Clinic, Monday) Oakfield Road, Tuesday) Penge. Wednesday) all day Thursday) Friday) 127 CLINIC ADDRESS WEEKLY SESSIONS Held as follows: (By appointment only) *SPECIAL EXAMINATION CLINICS School Clinic, 2nd and 4th Thursday in month Oakfield Road, Penge. 9.30-12 noon. The Willows, 2nd and 4th Thursday in month Red Hill, Chislehurst. 4.15—5.0 p.m. Mickleham Road Clinic, 2nd and 4th Thursday in month St. Paul's Cray. 4.15—5.0 p.m. School House, 2nd Friday in month, 55 Chislehurst Road, 9.30—12 noon. Orpington. *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. MINOR AILMENT FACILITIES-See page 128