ERI 12 Urban District of Erith. annual report of the Medical Officer of Health and School Medical Officer, For the Year 1921, by A. E. JERMAN, M.B., D.P.H. Health and Buildings Committee, 1921. Chairman—Councillor Mrs. Grubb. Councillor Fletcher. Councillor Salmon. „ Palmer. „ Watson. „ Mrs. Robinson. „ Wilson. Maternity and Child Welfare Committee, 1921. Chairman—Councillor Mrs Robinson. Councillor E. S. Clark. Councillor Kell. „ Downer. „ Robertshaw. „ Mrs. Grub. „ Stebbing. „ Hampton. Co-opted Members. Mrs. Cross. Mrs. Keller. Mrs. Humphries. Mrs. Pooler. Education Committee, 1921. Chairman—Councillor Higgins. Councillor E. S. Clark. Councillor Kell. „ F. Clark. „ Mrs. Robinson. „ Downer. „ Stebbing. „ Gough. „ Wilkinson. Co-opted Members. Mr. Bates. Mr. Meadows. „ Chubb. „ Pilcher. „ Martin. Mrs. Todd. STAFF. Medical Officer of Health, School Medical Officer, and Medical Officer in charge of Sanatorium for Infectious Diseases— A. E. Jerman, M.B., D.P.H. Assistant School Medical Officer— J. Hardie, M.B., C M. Lady Medical Officer of Infant Welfare Centres and Antenatal Clinic— Dr. J. Lorimer Hawthorne. Senior Sanitary Inspector— D. B. Davies, C.R. San. Inst. Sanitary Inspector— T. Vaughan, C.R. San. Inst. Health Visitors— Nurse Crouch. „ Anstis. School Nurses— Nurse Lange. „ Clarke. Clerks— Health Dept.—Mr. E. J. Castree. Maternity and Child Welfare Dept. Miss C. Vaughan. Miss W. Meadows. School Medical Service—Miss Smith. Dental Surgeon—R A. Presslie, L.D.S. Ophthalmic Surgeon—A. E. Reynolds, M R.C.S. Etc. Council Offices, Erith, May 8th, 1922. To the Chairman and Members of the Urban District Council of Erith. Ladies and Gentlemen, I have the honour to submit herewith my Annual Report for the year 1921, in accordance with the Regulations of the Ministry of Health. The Report is much shorter than in former years, in accordance with a memorandum issued by the Ministry of Health, which requires that Reports of a full and detailed character need only be made normally at intervals of not more than five years, those made in the intermediate period being shorter and simpler. This Report also includes the Report on the School Medical Work for the year, which has been prepared by the Assistant School Medical Officer. I am, Your obedient Servant, A. E. Jerman. Annual Report for 1921. (I) General Statistics. The population of the district at the Census of 1911 was 27,750, viz.:—14,143 males and 13,607 females. On the 19/20th June, 1921, another Census was taken, and the population was found to be 31,568, viz.:— 16,149 males and 15,419 females. This is an increase in the 10 years of 2,006 males, and 1,812 females, a total of 3,818. As, however, the Registrar-General had some reason to think that the commencement of the holiday season had some effect on the figures, he has furnished an estimate of the population at the middle of the year, which differs somewhat from the Census result, and it is this figure, 32,060, which has been utilised for the calculation of the birth and death rates, etc. The number of inhabited houses and the number of separate occupiers has not yet been published, but the number of inhabited houses at the end of the year was approximately 5,850. The Rateable Value of the District was £202,399, and the product of a penny rate £805. The area of the District is 3,859 acres. (II) Vital Statistics. Births. 717 births were registered in the District, viz.:— 378 males and 339 females. The net number of births belonging to the District was, Legitimate—males 378, females 342, a total of 720; Illegitimate, males 10, females 5, a total of 15, making a total altogether of 735. 6 The number of stillbirths notified during 1921 was 11, viz.:—8 males and 3 females. The birth rate for 1921 was 22.92, as compared with 25.6 for the previous year, and with a rate of 22.4 for England and Wales. Deaths. The number of deaths registered in the District was 233. The total number of deaths belonging to the District was 337, viz.:—183 males and 154 females, giving a net death rate of 10.51, as compared with 9.64 last year, and with a rate of 12.1 for England and Wales. The number of women dying from puerperal sepsis was 2, and from other diseases or accidents of pregnancy and parturition 1. Infantile Mortality. The number of deaths under 1 year of age was 51, of which 3 were illegitimate. The infantile mortality rate was 69.38, as compared with 61.5 last year, and 83 for England and Wales. The number of deaths at all ages from whooping cough was 1, but the number of deaths from diarrhoea at ages under two years was 19. There were no deaths at all from measles. The Table shows the nett deaths from stated causes at various ages under 1 year of age. 7 Infantile Mortality in 1921. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks, 4 wks. & under 3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Scarlet Fever 1 i Diphtheria & Croup Diarrhœa 4 6 3 4 17 Enteritis 2 1 3 Abdominal Tuberculosis 1 1 Congenital Malforma- tion 1 1 2 2 Premature birth 11 11 11 Marasmus, &c. 1 1 1 2 4 Congenital Syphilis 1 1 Convulsions 1 1 1 2 Bronchitis 1 1 Pneumonia (all forms) 2 1 3 Injury at Birth 1 1 1 Other causes 1 1 1 1 1 4 Totals 14 2 1 17 11 11 6 6 51 The chief causes of death during the year were:— Heart Diseases 42 Cancer 38 Pulmonary Tuberculosis 32 Pneumonia 26 Bronchitis 23 Diarrhoea (under 2 years) 19 Table showing ages at which deaths have occurred: Year. Under 1 year 1—2 years. 2-5 years. 5—15 years. 15—25 years, 25-45 years. 45—65 years. 65 yrs. & over. Total all ages. 1920 50 11 7 16 19 37 80 86 306 1921 51 12 13 14 23 44 80 100 337 (III) Notifiable Diseases. There were 369 cases of infectious disease notified in the District during 1921, viz. :—Scarlet Fever 194, Diphtheria 73, Enteric Fever 2, Erysipelas 14, Pneumonia 24, Encephalitis Lethargica 4, Ophthalmia neonatorum 1, Puerperal Fever 1, Pulmonary Tuberculosis 45, other forms of Tuberculosis 11. 8 Number of Cases Notified. Disease. Under 1 year 1—5 years 5—15 years 15—25 years 25—45 years 45—65 years 65 yrs, & over Total at all ages Cases admitted to Hospital. Total number of Deaths Scarlet Fever 2 35 122 22 13 194 181 4 Diphtheria 19 41 9 4 73 67 4 Enteric Fever 1 1 2 2 1 Puerperal Fever 1 1 2 Pneumonia 3 3 3 8 5 2 24 25 Erysipelas 1 1 2 6 4 14 2 Encephalitis Lethargica 2 2 4 1 * Pulmonary Tuberculosis M. 8 5 8 21 13 14 F. 3 8 8 4 1 24 7 17 Total 3 16 13 12 1 45 20 31 *Other forms of Tuberculosis M. 1 1 2 4 7 F 3 3 1 7 Total 1 4 2 3 1 11 7 * The total number of notifications of all forms of Tuberculosis was 103, but many of these were duplicates, and the total number of fresh cases notified was 45 pulmonary tuberculosis and 11 other forms as shown in the table. Twenty of these 103 notifications were on Form C and 19 on Form D. Table showing ages at death from the notifiable diseases:— Disease. Under 1 year old 1 -5 years 5—15 years 15—25 years 25—45 years J 45—65 years 65 yrs. & over J Total Scarlet Fever 1 1 1 1 4 Diphtheria 2 1 1 4 Enteric Fever 1 1 Puerperal Fever 2 2 Pneumonia 3 4 1 3 8 6 25 Erysipelas 1 1 2 Encephalitis Lethargica 1 1 Pulmonary Tuberculosis M. 6 5 3 14 F. 2 5 3 5 2 17 Other forms of Tuberculosis M. 1 4 1 1 7 F. 9 Only one case of Ophthalmia neonatorum was notified, this was treated at home, and recovered without any permanent damage to the eyes. Six deaths of persons suffering from Pulmonary Tuberculosis and 3 of those suffering from Non-pulmonary Tuberculosis occurred in patients who had not been notified, and making a total of 9 out of 38 deaths, or just under 24 per cent. Two out of these 9 cases occurred in persons who died suddenly, without having had medical attendance, and the condition was discovered at the postmortem examination. Letters are written to the Medical Practitioners certifying the cause of death in these cases, drawing their attention to the fact that notification had been omitted. (4) Causes of Sickness. There has been no very specially noteworthy cause of sickness in the District during the year. The large amount of unemployment has caused a certain amount of undernutrition and unsuitable feeding in young children, and this, with the hot prolonged summer was responsible for a very much larger amount of Summer diarrhoea than we have had for some years. The supply of free milk by the Council did something to mitigate this. (5) Nursing Arrangements, Hospitals and Other Institutions available for the District. (a) Professional Nursing in the Home—General. The Erith and Belvedere Provident Nursing Association and the Ranyard Nurses maintain 3 District Nurses in the District, and their services are largely made use of by the residents. These are not subsidised by the Local Authority nor by the County Council, but a small weekly subscription is collected from the members by voluntary workers. 10 (b) Midwives. There are 6 Midwives practising locally in the District, none of whom are subsidised. There are in addition three Midwives employed by the Council in their Maternity Home, but who do not do work outside the Home. (c) Clinics and Treatment Centres. School Clinics. There is a School Clinic maintained in connection with the School Medical Service, where treatment for minor ailments, dental and visual defects and enlarged tonsils and adenoids is carried out. A full account of the work done in these will be found in the Report of the School Medical Officer at the end of this Report. Maternity and Child Welfare Centres. The Local Authority maintain an Ante-natal Clinic for mothers, and two Welfare Centres for infants. The Ante-natal Clinic is conducted on Tuesday morning in each week by a lady doctor (Dr. J. Lorimer Hawthorne) with considerable experience in such work. It is held at "Hainault," the Council's Maternity Home, and has proved very successful, and very useful to the local mothers. During 1921, 1T8 expectant mothers made 377 attendances, the Clinic being open on 47 occasions, giving an average attendance of 8 per session. The Infant Welfare Centres are also conducted by Dr. Hawthorne, one for the Erith and Northumberland Heath Districts on Monday afternoons at "Hainault," and one for Belvedere and Abbey Wood Districts on Tuesday afternoons at the Belvedere Public Hall. Each of these was open on 47 occasions during the year, anil 2,348 attendances were made at the Erith Centre, and 2,035 at Belvedere, giving averages of 50 and 43.3 attendances respectively. The Health Visitors assist at each of these Clinics, and in addition paid 5,332 visits to homes during the year. 11 The Council also provide a Dental Clinic in connection with their Maternity and Child Welfare work, which is held every alternate Wednesday afternoon; 154 attendances were made, and assistance was granted in five cases in the provision of dentures for nursing or expectant mothers. The Council also have a scheme for the supply of milk in necessitous cases to children under 3 years of age, and to expectant or nursing mothers. This scheme has been approved by the Ministry of Health, and is based on an economic scale. During the year 1921, under this scheme 62,408 pints of fresh milk, and 3,414 packets of dried milk were supplied to applicants either free or at a reduced price. The lowest number of applicants supplied was in April, when 71 received 2,749 pints, and the highest in December, when 294 applicants received 7,750 pints. In addition, three varieties of dried milk are kept, together with Lactagol, Cod Liver Oil and Malt, and Virol, and retailed at the Welfare Centres. The amount received by the sale of these foods during 1921 was £T,008 10s. 11d. Tuberculosis Dispensary. A Tuberculosis Dispensary, provided by the Kent County Council, is established in Pier Road, Erith, and is largely made use of by those in the district suffering from any form of this disease. It is open twice a week. No Day Nursery or Venereal Disease Clinic is established in the District, but the V.D. Clinic established by the Kent County Council at Dartford is available for this area. (d) Hospitals Provided by the Local Authority. Maternity A small Maternity Hospital, with 5 beds and an isolation or observation ward (1 bed), is provided by the Council at "Hainault," Erith. It is staffed by 3 midwives, with the necessary domestic staff, and during the 12 past year 82 patients have been admitted for their confinement There were no maternal deaths, but two premature infants died, and there were two still births. Medical assistance was required in 21 cases, in 5 during labour, 9 after labour, and in 7 cases for the child. No case of puerperal sepsis occurred. In addition two children suffering from malnutrition were admitted, one recovered and was discharged well, the other died at the age of five months. Fewer. The Sanatorium at Little Heath, Erith, is provided for Infectious Diseases. There are 52 beds available for Scarlet Fever, Diphtheria and Enteric Fever. There art1 28 beds for Scarlet Fever, 16 for Diphtheria, and a small block with 2 wards (4 beds in each) available for other diseases, or for observation purposes. The Staff consists of Matron, a Charge Nurse, 4 Assistant Nurses, and 2 Probationers, with the necessary domestic Staff, Laundress, Porter, and Ambulance Driver. Table showing admissions and discharges during 1921:— Scarlet Fever. Diphtheria. Enteric Fever. Total. In Hospital, January 1st, 1921 16 9 25 Admitted during 1921 181 67 1 249 Discharged during 1921 176 62 1 239 Died during 1921 2 4 6 Remaining in Hospital, Dec. 31st, 1921 19 10 29 During the year 245 swabs from throats and noses of patients suffering from Diphtheria were sent to The Kent County Laboratory at Maidstone. Of these 174 proved negative, 53 positive, and 18 were doubtful. In addition one patient's blood was sent for examination as to Enteric Fever, and proved to be positive. The average stay of Scarlet Fever cases in the Hospital was 42 days, and of Diphtheria cases 32 days. 13 Small Pox. No hospital accommodation is provided for such cases, but the Local Authority has an arrangement with the Metropolitan Asylums Board for their reception. Tuberculosis. No hospital accommodation is provided by the Local Authority, but the County Sanatorium at Lenham, and various Sanatoria and Hospitals in the Country are available for these patients under County Council arrangements. Other Hospitals. There is a local Cottage Hospital available for accident and other cases, with 12 beds. In addition many local residents avail themselves of the facilities afforded by the many London General and Special Hospitals. There is no local institutional provision for unmarried mothers, illegitimate infants and homeless children. Ambulance Facilities. (a) For Infectious Cases. A motor ambulance was provided in April, 1921, for removal of Infectious cases, at a cost of £480. It is kept at the Sanatorium for Infectious Diseases, and can be called by telephone for the immediate removal of cases. (b) For Non-infectious and Accident Cases. A Ford ambulance has been in use for some years now, and last year the Council provided a second ambulance of the very latest type on an "Albion" Chassis. They have both been extensively used during the year, a total of 728 journeys having been made. Of these 496 were made conveying patients from Erith to one of the London General or Special Hospitals, and 232 from and to addresses in the District, including 57 to the Cottage 14 Hospital. The ambulance service is carried out by the members of the Erith Fire Brigade, and the men employed are all thoroughly competent to render first aid in any case of accident. (6) Laboratory Work. The Kent County Council has established at Maidstone a County Laboratory to which various pathological and bacteriological specimens may be sent by the medical men practising in the District. Each medical man is supplied with outfits for taking the necessary specimens which are forwarded to Maidstone for examination, and the result of this is sent both to the Medical Practitioners, and to me, as Medical Officer of Health. A fresh outfit is at the same time sent to the medical man. Table showing number and nature of specimens sent by medical men, with the result:— Nature of Specimen sent. Positive. Negative Doubtful. Total. Sputum for Suspected Tuberculosis 10 64 74 Swabs for Diphtheria (Acute) 13 54 1 68 Swabs for Diphtheria (Contacts) 11 62 2 75 Blood for Enteric Fever 1 1 The 11 positive swabs in the case of Diphtheria Contacts came from 8 children, one of whom was positive on 3 occasions, and another on two occasions, none of them were showing any symptoms at the time, but one developed an attack of Diphtheria a few days later. Swabs are also sent from the Sanatorium for Infectious Diseases in connection with the cases of Diphtheria admitted there, and the number of these is given in the section relating to that Hospital. Antidiphtheritic Serum is kept at the office of the Medical Officer of Health, and can be obtained by any Medical Practitioner on application. A small quantity of Antitetanic Serum is also kept, but has not hitherto been required. 15 An Anti-influenzal Vaccine supplied by the Ministry of Health is also kept, but there has been no demand for ibis during the past year. List of Bye-laws, Regulations and adoptive Acts in force in the District, with date of adoption:— Prevention of Nuisances Sept. 1887. Keeping of Animals Sept. 1887. Removal of Offensive Matter Sept. 1887. Public Mortuaries Sept. 1888. Dairies, Cowsheds and Milk Shops Order June, 1891. Slaughterhouses May, 1897. Pleasure Grounds June, 1897 Sewerage Regulations July, 1898. Cleansing and Removal of Refuse Oct., 1898. Tents, Vans and Sheds, &c June, 1900. New Streets and Buildings May, 1900. Public Baths and Washhouses Sept., 1907. Filth and Rubbish May, 1912. Offensive Trades Dec., 1912. Employment of Children Dec., 1920. Erith Tramways and Improvement Act, 1903. Erith Improvement Act, 1920. Infectious Diseases Prevention Act. P.H. Acts Amendment Act, 1890. P.H. Acts Amendment Act, 1907, Sections 19, 21, 22, 23, 25, 31, 33, and 51. (7) Sanitary Administration. Drainage and Sewerage. Towards the end of 1921 work was commenced on a new sewer, which, when completed, will take the sewage from 106 houses near the Belvedere Railway Station. These houses have hitherto been drained into cesspools, and have for years been a source of recurrent nuisance owing to the cesspools filling up with marsh water as soon as they were emptied, and so causing an overflow of sewage within a very short period after emptying. 16 A full description of the Sewerage and Sewage Outfall Works has been given in previous reports. There are no privy middens, but eight houses have earth closets only, these, however, cannot be drained into the sewers. The following tables give a summary of the Inspections made during the year, with the results of notices served as a consequence of the inspection:— Inspections made during the year. [louses visited for the detection of Nuisances 905 Houses inspected under Housing and Town Planning Act 898 Slaughterhouses 110 Cowsheds, dairies and milkshops 64 Workshops 50 Outworkers' premises 6 Bakehouses 42 Offensive Trades 31 Vans, tents and sheds 64 Complaints enquired into 450 2,626 Result of the above inspections. Nuisances detected 1154 Preliminary Notices served to abate nuisances 455 Statutory notices served to abate nuisances 164 Nuisances abated 932 Notices issued under the Factory and Workshops Act 1 Notices complied with 1 Notices issued to provide proper sanitary dustbins 361 Notices complied with 338 Notices issued under the Cowsheds, Dairies and Milkshops Order 1 Notices complied with 1 Notices issued to properly pave and drain yards, Sec. 25 P.H.A.A. Act, 1907 15 Notices complied with 6 Notices issued in respect of vans, tents and sheds 16 Notices complied with 9 17 Nuisances. Showing the number and nature of the nuisances dealt with during the year:— Defective and choked drains 548 Damp and dilapidated dwellings 327 Defective rain-water guttering and down pipes 92 Insanitary water storage cisterns 15 Defective flushing cisterns to w.c.'s 78 Defective scullery sinks 36 Foul accumulations 35 Dirty premises 12 Overcrowding 7 Animals kept so as to be a nuisance 4 1,154 Cleansing. Number of cesspools emptied 392 Number of loads of house refuse removed 6674 I nfectious Disease. Number of cases enquired into 331 Number of cases removed to Hospital 249 Number of bouses disinfected 275 Food Inspection. The following articles of food were surrendered to me as unfit for human consumption:— Meat. Fish. Other Articles. 127 lbs. of Salt Beef 24 lbs. of Roe 18 lbs. of Butter 109 lbs. of Beef 2 cwt. of Winkles 44 lbs. of Cheese 22 lbs. of Pork 1 box of Plaice 3 cwt. of Brussel Sprouts 3 cases of Rabbits 2 Poxes of Sprats 1 barrel of Apples 23½ lbs. of Bacon 1 box of Maggs 30 tins of Tomatoes 7 tins of Corned Beef 1 barrel of Lobsters 804 Eggs 147 tins of Salmon 59 tins of Condensed Milk 2 tins of Lobster 24 tins of Peaches. 4 jars of Fish Paste 3 tins of Pineapple. 2 tins of Pears. 18 (8) Public Health Staff. (a) Whole Time. A. E. Jerman, Medical Officer of Health, School Medical Officer and Medical Officer-in-Charge of Infectious Hospital and Maternity Home. D. B. Davies, Sanitary Inspector holding certificates from the Royal Sanitary Institute as Inspector of Nuisances, and for the Inspection of meat and other foods. T. Vaughan, Assistant Sanitary Inspector (with same certificates). Nurse Crouch, Health Visitor. Nurse Anstis, Health Visitor. Mr. E. J. Castree, Clerk in P.H. Department. Miss C. Vaughan, Clerk in Maternity and Child Welfare Department. Miss W. Meadows, Clerk. (b) Part Time. Dr. J. Lorimore Hawthorne, Lady Medical Practitioner, conducting Ante-natal and Infant Welfare Clinics. (9) Housing. Number of new houses erected during 1920:— (a) Total 61 (b) As part of a municipal housing scheme 50 (1) Unfit dwelling-houses:— Inspection. (i) Total number of houses inspected for housing defects (under Public Health or Housing Acts) 1423 (ii) Number of dwelling-houses inspected and recorded under the Housing (Inspection of District) Regulations 898 (iii) Number of houses found to be unfit for human habitation 4 (iv) Number of houses (exclusive of those ferred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 821 19 (2) Remedy of defects without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 211 (3) Action under Statutory Powers:— (a) Proceedings under Section 28 of the Bousing and Town Planning Act, 1919 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs 47 (2) Number of dwelling-houses rendered fit: (a) by Owners 13 (b) by Local Authority in default of owners 0 (3) Number of houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close 2 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 619 (2) Number of houses in which defects were remedied (a) by owners 478 (b) by Local Authority in default of owners 0 (c) Proceedings under Section 17 and 18 of the Housing and Town Planning Act, 1919 : (1) Number of representations made with a view to the making of closing orders 4 (2) Number of houses in respect of which closing orders were made - (3) Number of houses in respect of which closing orders were determined - (4) Number of houses in respect of which demolition orders were made - (5) Number of houses demolished in ance of demolition orders 20 Vital Statistics of Whole District during 1921 and previous years. Year. Population estimated to middle of each year. Births. Ttl. Deaths registrd. in the Distrit Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. ! of Non-residents registered in the District. of Resid'ts not registered in the District. Under 1 year of age. At all Agar Number Rate. No. Rate per 1000 nett Births. No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1916 (a) 38,093 807 827 21.71 307 8.48 21 95 48 58.04 381 10.88 (b) 35,011 1917 ((a) 36,929 695 734 19.87 256 7.72 10 102 59 80.38 348 10.50 (b) 33,129 1918 (a) 36,701 620 660 17.98 334 10.19 6 104 50 75.75 432 13.18 (b) 32,755 1919 (a) 31,798 597 670 21.07 249 8.12 8 86 38 56.71 327 10.71 (b) 30,525 1920 31,741 795 813 25.61 226 7.1 5 85 50 61.5 306 9.64 1921 32,060 717 735 22.92 233 7.26 5 109 51 69.38 337 10.51 (a) Population including non-civilian population belonging to the District used for calculating Birth rate). (b) Civilian population only (for all rates except the Birth rate). Area of District in Acres 3859.513 Total Population at all Ages 31,568 At Census of 1921. Erith Urban District Council. Annual Report OF THE School Medical Officer FOR THE YEAR 1921. STAFF. School Medical Officer: A E JERMAN, M.B„ d.p.h. Assistant School Medical Office: J. HARDIE, M.B.c.m. Ophthalmic Surgion A E. REYNOLDS, m.r.c.s., &c. Dental Surgeon: R. PRESSLIE, L.D.S, EDIN. Throat and Nose Specialist: C. WATNEY ROE, m.r.c.s &c School Nurses: Mrs. LANGE and Miss CLARKE. Records Glerk: Miss SMITH. Report of School Medical Officer. School Medical Service in Relation to Public Elementary Schools. Under the Authority of the Erith Education Committee there are nine provided schools, with nineteen departments, and two non-provided schools, with three departments. The accommodation of these schools provides for 6,818 scholars. The number on the roll is 5,627, with an average attendance of 5,200. These schools are mostly of modern type, and are well situated as regards their open-air spaces and playgrounds. Their sanitary conveniences and lavatories are efficient and in good order, many improvements having been made during the past year. The heating and lighting of the schools is of varied character, and has also been much improved during the past year. One school has been entirely fitted with electric lighting. The Assistant School Medical Officer has visited each department of the schools during the year, for the purpose of enquiring into the general hygienics and sanitary conditions of these schools, and reports of any defects found have been submitted to you. Medical Inspection. The general Routine Medical Inspection has been carried out as in former years, and according to the Board of Education's full schedule for the Medical Inspection of School Children. The record card which is used is that suggested by the Board. These routine inspections are carried out during the afternoons by the Assistant School Medical Officer. 4 Very little disturbance of the school work is caused by these examinations of the children, because the Head Teacher of the schools concerned has been notified a few days beforehand, and is able to provide a suitable room for that purpose. At this examination the Head Teacher and the parent, if present, are both in attendance. Four groups of children were medically examined during the year. The absentees on those occasions were visited later, so that no child escaped medical inspection. They were selected thus:— I.—Entrants, 5—6 years. II.—8 years. III.—11 years. IV.—13 years or leavers. Table I, at the end, shows the number of children inspected. Findings of Medical Inspection. A review of the facts disclosed by the inspection of the children is here given in a short form. Table II at the end of the report gives fuller details. Uncleanliness. On the occasion of these Routine Inspections of the children, only 20 were found to be affected with vermin, chiefly in the hair. The smallness of this number, I believe to be accounted for by the unremitting efforts of the teachers and nurses in endeavouring to make your children clean and free from this pest. I shall have something further to say, under my remarks with reference to the nurses' duties. Tonsils and Adenoids. 15 per cent. of the children examined were found to be affected with enlarged tonsils and adenoids. This includes only slight cases which do not call for 5 tion. It was noted that many children had had these growths removed, with great benefit to themselves. Tuberculosis. No cases were met with this year, but 7 children were kept under observation as suspects for several months, with nothing definite to be discovered. They are still attending school. Skin Diseases. Few cases are to be met with at the time of inspection, because a child, when found to be suffering from any skin trouble, is sent direct to the School Clinic, either by the teachers or by the nurses. External Eye Diseases. The same remarks apply to these, only 6 cases being recorded for the year, although it will be noted that we have treated many cases at the Clinic. Vision. 10 per cent. of the children examined were found to be suffering from defective vision to some degree. From a total of 209, 169 children were referred to the Specialist. Children already supplied with suitable spectacles are not included in this number. Ear Diseases. Only 8 cases of discharge from the middle ear were met with during the inspections, although many more have been treated at the Clinic. Dental Defects. 50 per cent. of the children examined were suffering from carious teeth, from one tooth upwards. This high percentage is greatly due to the high number of younger children who enter the school, already affected with decayed teeth. 6 If you exclude the children who are suffering from one carious tooth only of a very slight nature, then The percentage is considerably lowered to 26 per cent. of the children examined. In this way 576 were referred for treatment. There is no doubt that the elder children have benefitted considerably from the treatment in past years. There are very few cases of carious teeth amongst them. Infectious Disease—Review of the Action taken to Detect and Prevent the Spread of Infectious Disease. The Medical Officer of Health when notified of the occurrence of any infectious disease in the district, sends a list of all the children so affected to the Assistant School Medical Officer, with the name of the School at which the child attends. Enquiries are at once made by him at that particular school, as to the possible source of its origin there, and for the detection of "missed" cases. Classes are examined, contacts kept under observation, and in the case of diphtheria and suspicious sore throats, swabs are taken for bacteriological examination. 28 swabs were taken from suspicious cases during the year, and 3 children in whom the result was positive, were excluded from school. At times, suspicious cases of sore throats or rash are sent direct from school by the teachers, to the Clinic, and in this way we have been able to detect and segregate 2 cases of diphtheria and 11 cases of scarlet fever. In all, 138 visits were paid by the Assistant School Medical Officer to the various departments of the schools, in connection with his investigations into cases of infectious disease, and the contacts during the year. 7 Following-up.—A Review of the arrangements for the Following-up of Children suffering from Physical Defects, including a Summary of Work undertaken by the School Nurses. The discovery alone of physical defects in the school child is not the sole purpose of the School Medical Service. If the child is to receive any benefit from such examination it follows that the recommendations given at the time should be carried out, and the defective condition, if at all possible, remedied. The parents are therefore notified of the presence of any defect found in their child, and are recommended at once to give it their attention, either through their own private Doctor, 01 through the School Clinic. Those children having defects are put upon record, and are not allowed to slip past without some effort being made to remedy their condition. Some of the parents are very ready indeed to accept our advice or our aid, but others, unfortunately, do not. They do not see the necessity for it, or are indifferent to the possible ill results to the child from their want of attention. These latter are the cases which require to be "followed-up" time after time, with patience and tact. It is here that the qualities of your nurses are tried. They visit the homes of the children to impress upon the parents the necessity for dealing with these defects, in order that their child may be fitted for the battle of life. Their persuasive powers are on many occasions successful, so that we at the School Clinic are able to give relief by the Dentist, the Ophthalmic Surgeon, the Operating Surgeon for tonsils, etc., and where necessary, the examination of children who want a little advice or guidance in health. If one visit by the nurse does not succeed we hope to succeed by another. If promises are made by the parents, the nurse calls in a few weeks' time to ascertain if these have been kept, and the defect remedied. 8 I may be permitted here to give an outline of the word done by the school nurses. We have two trained nurses at work. Each morning they are in attendance at the School Clinic, engaged in either the Minor Ailments Department or the Dental Department, as the occasion may be. At the Minor Ailments they dress and attend to skin conditions and sores upon the children, wash and apply remedies to eye conditions, and syringe discharging ears, and treat other minor ailments, under the direct supervision of the Assistant School Medical Officer. On the morning and afternoon of the Dentist's visits, one is present with the child in the Dentist's room, whilst the other is looking after the general welfare and comfort of the little patient after extraction. They are similarly occupied in rendering services to the children and the Ophthalmic Surgeon on the occasion of his visit once a fortnight. During the afternoons not engaged at the Clinic on these duties they visit the schools for the purpose of examining the children for cleanliness. Each nurse has her own set of schools to attend to, and they have visited each department at least four times in the school year, making 336 visits in all, and examining every child for cleanliness of person and clothing. By this constant attention we have succeeded in reducing the number of verminous cases to a considerable extent. 105 children were excluded during the year, and after cleansing, returned to school in an average of 5 days. The great majority of these cases are what we term "old offenders," appearing time after time with unblushing regularity. No sooner are they clean, than through sheer neglect, they return to the same old condition of uncleanliness. The nurses examined 9,684 girls, and 7,407 boys, making a total of 17,091 children for the year. Every child under treatment, and excluded from school for some minor ailment, is told to return to the Clinic for further treatment, upon a certain day, until he or she has recovered, and is fit to return to school. 9 Many of the elder children seize this opportunity to stay away from school and Clinic, and so the nurse visits their homes to secure the proper attendance of the child for treatment. 440 visits to the homes of the children for this and other reasons, were made during the year by the nurses. Medical Treatment.—Review of the Methods employed or available for the Treatment of Defects, and the results attained. As many of the members of this Committee are new, perhaps I may be permitted to offer again the remarks which I made last year upon the Clinic. Some of you are aware a small Clinic had been carried on in the Old Council Offices, High Street, Erith, for some two or three years in a successful manner, as far as the limited space would permit. It was deemed necessary, for its proper and full working, that it should have larger premises. About the middle of April, 1920, the School Clinic was removed to "Hainault," Lesney Park Road, where it occupies several rooms on the ground floor of the building. Here there are large and well-appointed waiting rooms for the children who are in attendance, with ample accommodation for their parents also, if they desire to come with them. The inspection room is also of good size, and is fitted upon one side with four large washing basins, with hot and cold water. The basins are used for cleansing purposes, and for the disinfection and cleansing of children with scabies on their hands and arms. On the afternoon of the Dentist's visit they are put in use by the children who have had teeth extracted, for the washing out of their mouths. In another corner of this room, there is a large cupboard and table with all the necessaries and dressings for minor ailments and skin affections. A desk and small table occupied by the Medical Officer and clerk takes up the centre of the 10 room, and here it is that children are examined and advice given, and if necessary passed over to the nurses for attention. A second large room is given over entirely to the Dentist and the Eye Specialist on their visiting days. It is fitted up with a dentist's chair and spittoon, a cupboard for all the instruments required in his professional duties, and with the appliances for the administration of gas to the patients. A small portion of this room has been partitioned off to make a dark-room for the Eye Specialist to examine the children's eyes under the proper conditions with his retinoscope. The length of the room also proves suitable to the required distance for the fitting of the proper lenses. There is also a small room suitably furnished in which a child may, if not sufficiently recovered after an extraction of teeth, lie down for a short period of rest. This is called the rest room. Apart from the main building a coach-house and stable have been completely altered and re-fitted to form an operating-room for the removal of tonsils and adenoids, and a rest-room for recovery. This recovery-room has 6 beds, with complete fittings, so that a child can be made quite comfortable for the two hours necessary for its supervision, and recovery after the operation, before it is taken home again. This building is lighted by electricity, and heated by hot-water pipes and radiators, and makes a miniature hospital of which the Committee may be proud. The School Clinic is open for Minor Ailments every morning from 9.15 until all the children have been seen and attended to, usually about 11 or 11.30 o'clock. The Dentist's visits are on Tuesday afternoon at 2 o'clock, and on Thursday morning at 10 o'clock—each session lasting approximately 2 hours. The Ophthalmic Surgeon visits the School Clinic every alternate Thursday at 2.30, and sees the cases referred to him by the School Medical Officer for opinion 11 and recommendation. The Committee have made arrangements with a firm of Opticians to supply glasses at a comparatively low figure, and in cases where the parents are unable to pay even this amount, they assist them by part payment, and in a few cases, spectacles are supplied gratis. The operations on the throat are undertaken as occasion requires, and arrangements are made with the Operating Surgeon. The advantages of the Clinic are becoming more and more appreciated every year. Many parents bring their children willingly and gladly. The children in the schools themselves are becoming cleaner and freer from minor ailments. 545 children attended the Clinic and were treated for some minor ailment or injury. 2,077 children attended the Clinic simply for inspection and examination as to their fitness to attend school. Many of these had either suffered from or been in contact with infectious disease, and it was necessary to declare them free, before allowing them to return to school. A considerable number were sent by their teachers or brought by their parents, who were anxious regarding the health or general welfare of the child. Several of these were again seen regularly at a few weeks' interval. Minor Ailments. Table IV shows the classification and number of children we have treated during the year. Under the heading of Miscellaneous and Minor Injuries are included children suffering from sore throats, bronchial attacks, inflamed glands, and other passing ailments, in which a little advice and direction for treatment are often of service to parents, and benefit to the child. 12 Skin Diseases. Wo are particularly free in this district from that obstinate affection of the scalp—ringworm. 8 cases have been noted during the year. These cases entail a long exclusion from school, and arrangements were made by the Committee for their treatment at Guy's Hospital, London, by X Rays, about the end of the year. Two such cases have been treated with marked success, the period of their exclusion from school being lessened to a considerable degree. The number of cases of scabies (40) is less than that of last year. We are still treating them in the same way, that is by lysol scrubbings every day, under the nurses, and ointments at home. Impetigo, 190 cases, is the most frequent of our skin affections, and it takes up the attention of our nurses every morning, more than anything else. Ear Disease. There are 29 children attending the Clinic for this distressing malady. They are not excluded from school as long as they attend the Clinic regularly to have treatment by the school nurses. Many of these cases are very chronic. External Eye Disease. 75 children suffering from diseases consisting of ophthalmia, conjunctivitis and corneal ulcer were sent to us from the schools. A great number suffered from conjunctivitis, and were treated by the school nurses every morning. Any severe cases were referred to the Ophthalmic Surgeon. Tuberculosis. We are in close co-operation with the Tuberculosis Dispensary in this district, and cases either pulmonary or glandular, are at once referred there for special advice and treatment. A register of cases is kept at the Clinic, 13 and the children visited from time to time by the school nurses. This year we have very few upon the register, and only 23 visits were made by our nurses. Vision. Many of the children suffering from defective vision arc now provided with suitable glasses, so that the numbers requiring treatment under this heading become less each year. Out of a total of 1,695 children examined for sight, it was found that 193 required some correction by the aid of spectacles. There is still some objection to be overcome in the parents' mind against the use of spectacles by the children, so that only 1G8 of these obtained them after prescription by the Specialist. Dental Defects. 1,282 children received treatment by the Dentist during the year. He confined his attention chiefly to the younger children, 6—8 years of age. He conducted two series of examinations twice in the year, one in spring, and one in autumn, amongst these children, and this accounts for the great number of temporary teeth which were extracted, as can be seen in Table IV—"D." Many children are sent direct to the Clinic on the dental days, by their teachers or their parents, with some temporary tooth trouble. These amounted to 747, and are included in the above total. I am glad to say we have now overtaken our back work, and the way is now open for us to give more attention to the preservation of teeth. Tonsils and Adenoids. Your staff, with the assistance of Dr. Watney Roe as operator, undertake these cases at the small hospital annexe. Consent is obtained from the parents in every case, and a certain number of children are operated upon every fortnight, during spring, summer and autumn. 14 The little patients are detained in bed for at least two hours, under the care of the nurses, and are then sent home in the Council's motor ambulance, under supervision of a nurse. 74 cases were undertaken during the year. Summary of Work done at the Clinic. 545 children treated for Minor Ailments 7822 attendances. 1282 ,, ,, by Dentist 1500 ,, 281 ,, ,, by Oculist 1134 ,, 2077 ,, for Special Examination 2077 ,, 74 ,, operated on for Tonsils 74 ,, 4259 children. 12607 attendances. Summary of Work by School Nurses. Visits paid to the Schools 336 Children examined 17091 Children excluded for vermin 105 Visits to homes 440 Open-air Education. There are no open-air class rooms, but the Committee have under consideration the erection of an openair School at "Hainault" to hold 40 or 50 children of poor condition of health. The character of the district, with its scattered houses and its schools with abundant open-air space, does not demand the same attention with respect to fresh air, as more crowded districts. A boys' school and a girls' school, with 25 and 35 scholars respectively, paid a fortnight's visit to Eastbourne (boys) and Broadstairs. The girls spent a delightful open-air educational holiday. They visited Canterbury Cathedral, the North Foreland Lighthouse, and other places of interest. They took several short walking tours to the surrounding district of Broadstairs, returning to their quarters by car. They enjoyed seabathing in a private cove, and on Saturdays their drillmistress visited them and took physical drill and games with them on the sands. It is needless to say how much they benefited in their health by the open air. 15 25 boys spent 14 days at a farmhouse at Jevington, near Eastbourne. Whilst there, they had daily instruction upon the geographical and geological features of that part of the coast. Practical lessons were given them on the survey of the land. They made several walking tours in the surrounding district, its historical associations being explained to them. On certain afternoons they were given physical drill and exercises, and special instructions and supervision were given to the boys on the subject of Hygiene and the forming of clean and healthy habits of a personal nature. The benefit of this open-air life to the boys, has been very great. Letters from parents of these have been received, expressing their great pleasure at the improved condition of health, the holiday had brought about in their boys. Seven of these boys had never seen the sea. Physical Training. Two special instructors, one man and one woman, both of whom have been specially trained on the latest lines, visit the schools in rotation for this purpose. M any of the teachers on the staff have received a course of lessons in this subject, and are engaged in training the children. Provision of Meals. This year, there has been a much greater demand for the provision of meals to the children, the number reaching its highest point at 550. The Municipal Restaurant has been utilised for the great majority of the children. The Assistant School Medical Officer has visited the Restaurant during the children's dinner, and was satisfied with the quality and quantity of the food provided for them. 16 School Baths. There are no school baths, but swimming is taught to nearly all the senior children at the Public Baths with considerable success. Co-operation of Parents, Teachers, Etc. The greatest sympathy with the whole Medical service exists in the minds of the teachers in the various schools, and their co-operation is of the very greatest value to the Medical Officer. They are always present at the Routine Inspections of the children under their charge, and at times give great assistance in making known any facts regarding the family or personal history of the child. They have always been found ready to offer any help in carrying out the work of the School Medical Service, and they often are a means of communication between the doctor and the parent if the latter be not present at the* child's examination. The parents are always welcomed, and indeed, are invited to attend at the examination of their child, a notice being sent, intimating to them the time and date when it is to take place. It gives the Medical Officer an opportunity to explain any defects found, and where and how they can be treated, either by their own attention, or by the facilities of the School Clinic. It is very gratifying to us that many of the parents, especially of the younger children, that is entrants, avail themselves of this opportunity of advice and intercourse. 80 per cent. of the parents of these entrants and 25 per cent. of the parents of the older children, a total of 806 parents, attended these examinations. Blind, Deaf, Defective and Epileptic Children. A glance at Table III at the end of the report, will show how many of these are in the district. We have no special schools under the Erith Authority, but when a case becomes known it is dealt with as far as we can at present, by Institutional treatment. 17 Dr. Hardie writes:— I should like, if the Committee will permit me, to offer my personal opinion upon the results of the work I have been engaged upon during the last seven years. We cannot expect to see the immediate effect of Medical Inspection appear at once upon children examined. It must take many years before the full effect becomes apparent, but contrasting the general condition of children now, with what it was ten years ago, I am certain that the improvement is very marked indeed. In the elder children of 13 years, as they come up for their final inspection before leaving school, very few cases of defects are to be found. Many of them at this period owe their improved condition to the advice offered them, and to the treatment meted out to them at the Clinic in previous years, so that they are now free from the defects noted before, and have had time to recover after remedial measures had been taken. Especially does this apply to children suffering from slight chest affections, in which care, attention and precautions have been taken, and thus have been prevented from developing into Tuberculous Disease. Fewer cases of this plague are met with in the children of our schools to-day, than formerly, and I believe, as our knowledge and our Service become more perfect, fewer will in the years to come. Another factor in the well-being of the child, is the possession of sound teeth, for the proper mastication of its food, and a mouth free from the septic matter, consequent upon the presence of carious teeth. The detriment to the child's condition of health by the absorption of such poisonous matter into its blood needs no explanation. The great improvement which has arisen in the condition of the teeth of the children who come before me to-day adds considerably to my feeling of well-doing. 18 So also, in the case of children affected with enlarged tonsils and adenoids, whose parents had taken my advice, and had these growths removed, either at your School Clinic or one of the London Hospitals, there is much benefit to the child's health. It is no unusual thing for the parents to express their satisfaction and pleasure that the advice had been followed, saying that their child was like a different child altogether, after the operation. The child was no longer so subject to colds or sore throats, its general health had improved, and its appetite was such that it was now ready and eager for food. These main points I have brought to your notice, but there are many others, small, but significant, that crop up daily in a School Clinic, of great importance to the child's preservation in health. The detection of disease in its early stages in these young people is of great importance, and to be able to avert its ravages in their young lives, must be of great value to the nation as well as to themselves. A constant stream of child life passes before one in the schools, and who can tell or estimate the real value obtained by this Medical Service? Only the future can do that, but I look forward with confidence to it, that the present efforts you are making, will result in a stronger and healthier manhood and womanhood of the rising reneration. In the meantime the children are being taught by their regular attendance at the Clinic, to pay attention to personal cleanliness, and learn those habits which are necessary for the maintenance of health. They no longer fear the dentist's chair, and are quite alive to the importance of keeping their teeth clean. Thus their steps being guided into the way of health in their young days, it is to be hoped they will not forsake that way as they grow older. 19 TABLE I. Number of Children Inspected 1st January, 1921 to 31st December, 1921. a—routine medical inspection. Age Entrants. 3 4 5 6 Other Ages. Total. Boys 329 329 Girls 282 282 Totals 611 611 age Intermediate Group Leavers. Other Ages. Total Grand Tl. 8 12 13 14 11 Boys 273 221 62 234 790 1119 Girls 346 234 26 299 905 1187 Totals 619 455 88 533 1695 2306 B—Special inspections. Special Cases. Re-examination (i.e., No. of Children Re-examined.) Boys 2229 125 Girls g—Total number of individual children inspected by The Medical Officer, Whether as Routine or Special Cases (no Child being counted more than once in one year). Number of Individual Children inspected 1535 20 TABLE II. Return of Defects found in the course of Medical Inspection in 1921. Defect or Disease. Routine Inspections. Specials. Number referred for Treatment. Number requiring to be kept under observation, but not referred for Treatment. Number referred for Treatment. Number requiring to be kept under observation, but not referred for Treatment. 1 2 3 4 5 Malnutrition Uncleanliness: Head 20 105 65 Body Skin:—Ringworm: Head 8 Body 13 Scabies 40 Impetigo 3 190 Other Diseases (non-Tubercular) 21 Eye:—Blepharitis 5 13 Conjunctivitis 51 Keratitis 1 Corneal Ulcer 1 10 Corneal Opacities 1 Defective Vision 169 40 Squint 6 Other Conditions Ear:—Defective Hearing 3 Otitis Media 8 29 Other Ear Diseases Nose and Throat: Enlarged Tonsils Adenoids 9 Enlarged Tonsils and Adenoids 174 182 Other Conditions 34 Enlarged Cervical Glands (Non-Tubercular)... 67 7 Defective Speech 1 Teeth:—Dental Diseases 576 429 Heart and Circulation :— Heart Disease: Organic Functional Anaemia 4 1 Lungs:—Bronchitis 23 2 Other Non-Tubercular Diseases 21 table II—Continued. l 2 3 4 5 Tuberculosis:— Pulmonary: Definite Suspected 7 4 Non-Pulmonary: Glands Spine Hip Other Bones and Joints Skin 1 Other Forms Nervous System:— Epilepsy 1 Chorea 2 1 Other Conditions Deformities:— Rickets 4 Spinal Curvature 2 4 Other Forms Other Defects and Diseases 7 118 Number of Individual Children having Defects which required Treatment or to be kept under observation 1466 TABLE III. Numerical Return of all Exceptional Children in the Area in 1921. Boys. Girls. Total. Blind (including partially blind)— Attending Public Elementary Schools 2 2 Attending Certified Schools for the Blind 1 3 4 Not at School Deaf and Dumb (including partially deaf)— Attending Public Elementary Schools Attending Certified Schools for the Deaf 1 2 3 Not at School Mentally Deficient— Feeble Minded— Attending Public Elementary Schools 2 3 5 Attending Certified Schools for Mentally Defective Children 3 3 Notified to the Local Control Authority by Local Education Authority during the year Not at School 22 TABLE III—Continued. Boys. Girls. Total. Mentally Deficient—continued. Imbeciles— At School Not at School Idiots— Epileptics— Attending Public Elementary Schools 1 1 2 Attending Certified Schools for Epileptics In Institutions other than Certified Schools Not at School 1 1 Physically Defective— Pulmonary Tuberculosis— Attending Public Elementary Schools 1 4 5 Attending Certified Schools for Physically Defective Children In Institutions other than Certified Schools Not at School 2 3 5 Crippling due to Tuberculosis— Attending Public Elementary Schools 2 1 3 Attending Certified Schools for Physically Defective Children In Institutions other than Certified Schools Not at School 1 1 Crippling due to causes other than Tuberculosis, i.e., Paralysis Rickets, Traumatism— Attending Public Elementary Schools 3 3 Attending Certified Schools for Physically Defective Children In Institutions other than Certified Schools Not at School Dull or Backward— Retarded 2 years 10 6 16 Retarded 3 years 6 4 10 23 table IV. Treatment of Defects of Children during 1921. a—treatment of minor ailments. Disease or Defect. Number of Children referred for Treatment. Treated under Local Education Authority's Scheme. Skin—Ringworm—Head 8 8 Body 13 13 Scabies 40 40 Impetigo 190 190 Minor Injuries 69 69 Other Skin Disease 21 21 Ear Disease 29 29 Eye Disease (external and other) 75 75 Miscellaneous 100 100 Total 545 545 b—Treatment of visual defect. Number of Children submitted to refraction under Local Education Authority's Scheme, Clinic or Hospital 281 Number of Children for whom glasses were prescibed 193 Number of Children for whom glasses were provided 166 Recommended for treatment other than by glasses — Number of Children for whom no treatment was considered necessary (including re-examinations) 88 c—Treatment of defects of nose and throat. Number of Children referred for Treatment 174 Received operative treatment, under Local Education Authority's Scheme, Clinic or Hospital 74 By Private Practitioner or Hospital — d—treatment of dental defects. 1—Number of Children dealt with. Age Groups. Specials. Total. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 2773 74 2847 (b) Referred for treatment 576 365 941 (c) Actually treated 535 747 1282 (d) Re-treated * (result of periodical examination) 89 — * It is understood that cases under this head are also included under (c) above. 24 2. Particulars of Time given and of Operations undertaken. 1 Number of half-days devoted to inspection 9 2 Number of half days devoted to treatment 70 3 Total number of attendances made by the children at the Clinic 1478 4 Number of permanent teeth extracted 322 5 Number of permanent teeth filled 199 6 Number of temporary teeth extracted 2295 7 Number of temporary teeth tilled 2 8 Total number of fillings 201 9 Number of Administrations of General Anæsthetics included in (4) and (6) 1033 10 Number of other operations Permanent Teeth 77 TABLE V. Summary of Treatment of Defects as shown in Table IV. (A, B, C, and D ) Number of Children treated under Local Education Authority's Scheme. Disease or Defect— Minor Ailments 545 Visual Defects 281 Defects of Nose and Throat 74 Dental Defects 1282 Total • 2182 TABLE VI. Summary relating to Children Medically Inspected at the Routine Inspections during the Year 1921. 1 The total number of children medically inspected at the routine inspections 2306 2 The number of children in (1) suffering from— Malnutrition — Skin Disease 3 Defective Vision (including Squint) 217 Eye Disease 7 Defective Hearing 3 Ear Disease 8 Nose and Throat Disease 365 Enlarged Cervical Glands (non-tubercular) 67 Defective Speech 1 Dental Disease 1005 Heart Disease—Organic 39 Functional — Anaemia 4 Lung Disease (non-tubercular) 23 25 TABLE VI — Continued. Tuberculosis—Pulmonary—Definite — Suspected 7 Non-pulmonary — Disease of the Nervous System 2 Deformities 6 Other defects and diseases 7 3 The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 570 4 The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 850 5 The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 890* * Includes a number of children from 1920 list.