ERI 16 URBAN DISTRICT OF ERITH. —— ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1935 BY ARTHUR W. JOHNS, M.R.C.S., L.R.C.P., D.P.H. URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1935 BY ARTHUR W. JOHNS, M.R.C.S., L.R.C.P., D.P.H. 2 Health and Buildings Committee. Chairman—Councillor J. Watson. Councillor Ebben. Councillor Selfe. ,, Grant. ,, Vinson. ,, Munns. ,, Wilson, J.P. Maternity and Child Welfare Committee. Chairman Councillor Emes. Councillor Bates. Councillor Grant. ,, Crimes. ,, Munns. ,, Dunkley. ,, Mrs. Nichols. Co-opted Members. Mesdames Grant, Munns and Reeves. 3 STAFF. 1. Whole-time. Medical Officer of Health, School Medical Officer, Medical Officer in charge of Sanatorium for Infectious Diseases and Maternity and Child Welfare— A. W. Johns, M.R.C.S., L.R.C.P., D.P.H. (1). Deputy Medical Officer of Health and Assistant School Medical Officer (part-time)— D. S. Clark, M.B., B.S. (Appointed 1st Sept., 1935.) (1) Senior Sanitary Inspector— D. A. Pearson, Certificate of Royal Sanitary Institute. (1) Sanitary Inspector— T. Williams, Certificate of Royal Sanitary Institute. (1) Meat Inspector's Certificate. (Resigned August, 1935.) T. L. Cox, Certificate of Royal Sanitary Institute. (1) (Appointed October, 1935.) (Resigned December, 1935.) S. C. Smith, Certificate of Royal Sanitary Institute. (1) Meat Inspector's Certificate. (Appointed December, 1935). Health Visitors— Miss M. Jones, H.V. Cert. R.S.I., and S.C.M. (1) Miss T. M. Torpie, S.R.N., New H.V. Cert. R.S.I., and S.C.M. (1) Matron, Infectious Diseases Hospital. Miss I. Moscarella, S.R.N., S.C.M. (Resigned, January, 1935.) Miss P. Jay, S.R.N. (Appointed, March, 1935.) Sister-in-charge, Maternity Home. Miss M. Gambrill, S.R.N., S.C.M. Clerks— Chief Clerk—C. Masterman (Resigned, October, 1935). A. W. Razzell (Appointed December, 1935). Miss O. Reeves. (1) D. H. Godwin (Resigned, June, 1935). R. C. Durey (Appointed, July, 1935). 2. Part-time. Consulting Surgeon for Aural Diseases— F. C. W. Capps, F.R.C.S. (Eng.) Consulting Obstetrician (Maternity Home and Puerperal Fever Regulations)— A. Galletly, M.C., M.B., F.R.C.S. (Ed.). (1) Dental Surgeon—Maternity and Child Welfare— R. A. Presslie, L.D.S.(Ed.). (1) Details of members of the staff of the School Medical Service are embodied in the report to the Education Committee. (1) = Exchequer grants. 4 Public Health Department, Council Offices, Erith. To the Chairman and Members of the Erith Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit to you the Annual Report on the health of Erith for the year ended December 31st, 1935. It will be noted that the population estimated by the Registrar General for the middle of the year concerned is 35,760. This is the highest yet attained by this district and there is evidence that the increase will continue for the next few years. These facts, together with expansion of services and increased duties as a result of new legislation must be borne in mind in regard to the necessity for the expansion of the department. The vital statistics compare favourably with those districts of similar size and character. I take this opportunity of offering my thanks to the Chairman of the Health Committee, Mr. Councillor .T. Watson, to the other members of the Committee, and to the members of the Council, for their interest and support during the past year. I would also like to mention my appreciation of the continued loyal co-operation and assistance of the members of the ^tnff of the Health Department. I am, Your obedient Servant. A. W. JOHNS. Medical Officer of Health. June, 1936. 5 Annual Report, 1935. SUMMARY OF STATISTICS. 1. General. Area.—3,859 acres. Population.—35,760. (Estimated Mid-year, 1935.) Density of population, i.e., number of persons per acre.—9.26. Number of inhabited houses.—8,745. Rateable value, 1935.—£255,264 Sum produced by a penny rate, 1935.—£1,002. 2. Vital. Births. TOTAL. Male. Female. Live Births. Legitimate 507 263 244 Illegitimate 18 6 12 525 269 256 Live birth rate per 1,000 of population (1935 estimated). —14.6. Corresponding rate for 1934.—13.73. TOTAL. Male. Female. Still Births. Legitimate 16 6 10 Illegitimate 2 2 — 18 8 10 Still Birth rate per 1,000 total births.—34.3. Deaths. Males 194. Females 166. Total 360. Death rate per 1,000 of population (estimated 1935).— 10.06. Corresponding rate for 1934.—9.9. Number of women dying in, or in consequence of, childbirth—2. Maternal Mortality per 1,000 total registered births—3.8. 6 Infantile Mortality. Deaths of infants under one year of age. TOTAL. Male. Female. Legitimate 19 13 6 Illegitimate 2 1 1 21 14 7 Death rate of infants under one year of age per 1,000 live births.—40.0. Legitimate, 34,28. Illegitimate, 111. Total number of deaths from: 1934 1935 Measles (all ages) 3 — Whooping Cough (all ages) 2 — Diarrhoea (under 2 years) 5 5 10 5 7 Table showing Summary of Causes of Death during the year ended 31st December, 1935. Cause of Death Males Females Total 1 Typhoid Fever, etc. - - - 2 Measles — - — 3 Scarlet Fever — 1 1 4 Whooping Cough — — — 5 Diphtheria — 1 1 6 Influenza 2 — 2 7 Encephalitis Lethargica 1 — 1 8 Cerebro-spinal fever — — — 9 Respiratory Tuberculosis 15 14 29 10 Other Tuberculosis 1 2 3 11 Syphilis 4 — 4 i2 General paralysis of insane, etc. 2 — 2 13 Cancer 26 31 57 14 Diabetes 3 2 5 15 Cerebral haemorrhage 8 4 12 16 Heart diseast 49 56 105 17 Aneurysm - - - 18 Other circulatory diseases 11 11 22 19 Bronchitis 3 5 8 20 Pneumonia 6 7 13 21 Other respiratory diseases 2 2 4 22 Peptic ulcer 2 2 4 23 Diarrhoea, etc. (under 2 years) 3 2 5 24 Appendicitis 2 — 2 25 Cirrhosis of liver 1 - 1 26 Other liver diseases - 1 1 27 Other digestive diseases 7 3 10 28 Nephritis 6 1 7 29 Puerperal sepsis - - - 30 Other puerperal causes - 2 2 31 Congenital causes, etc. 7 3 10 32 Senility 1 - 1 33 Suicide 1 1 2 34 Other violence 8 5 13 35 Other defined causes 23 10 33 36 Ill-defined causes - - - Total All Causes 194 166 360 8 Table showing Birth.rate, Death.rate, and Analysis of Mortality during the year 1935. Provisional figures. The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only Kate per 1,000 total population Annual Death.rate per 1,000 population Rate per 1,000 Live Births Live Births Still Births All Causes Enteric Fever Small.pox Measles Scarlet Fever Whooping Cough Diphtheria Violence Influenza Diarrhoea & Enteritis (under Two years) Total Deaths under one year England and Wales 14.7 0.62 11.7 0.00 0.00 0.03 0.01 0.04 0.08 0.52 0.18 57 57 121 County Boroughs and Great Towns, including London 14.8 068 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.47 0.12 7.9 62 135 smaller towns (1931) adjusted populations 25,000—50,000 14 8 0.64 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.41 0 17 3.8 55 London 133 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.06 0.51 0.1 I 11.2 58 Erith (Estimated population 35,760) 14.6 0.5 10.06 0.0 0.00 0.00 0.02 0.00 0.02 0 42 0.05 9.5 40 9 Vital Statistics of Whole District during 1935 and previous years. Year Population estimated to middle of each year Births Total Deaths registered in the District Transferable Deaths Nett Deaths belonging to the Disti ict Uncorrected Number Nett ol Ni»n-i esidents registered in the District ot residents not registered in the District Under i year ol' age At all Ages Number Rate Number Rate No. Rate per 1000 nett Births No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1929 33,420 463 547 16.36 274 8.19 16 161 45 82 44 419 12.53 1930 33,420 456 488 14.60 209 6.25 6 145 32 65.5 348 104 1931 32,920 432 492 14.94 253 7.67 10 119 37 75.2 362 1099 1932 34.250 486 475 13.8 236 689 13 137 30 63.1 360 IO.5I 1933 34,950 514 492 14.07 262 6-95 17 I42 35 71.1 387 1 1.00 1934 35,020 531 481 137 230 6.56 18 I40 21 43.6 347 9.9 1935 35,76O 572 525 14.6 212 5.93 10 158 21 40.0 360 10.06 10 Social Conditions. A gratifying reduction in the unemployment figures has occurred in the past year. New industrial undertakings do not always increase employment to the extent we hope at their commencement. Often moreover, it is found that the great proportion of the workers engaged are drawn from young persons and the services of these are dispensed with upon their attaining the adult scale of pay. The increase of employment during the past year, however, has occurred mainly in tlhe adult male group. It is to be hoped that absorption will continue and be permanent. The following table gives some idea of the drop in the unemployed figures for the district during the year:— Adults Young Persons Men Women Men Women Total December, 1934 926 113 62 33 1134 December, 1935 811 165 57 37 1040 The work of the Fellowship Centre lhas increased in value and amount each year since its inception in July, 1933. Owing to the increased demand for instruction in the crafts of bootmaking and woodwork provision for more classes has been necessary. The social value of this work has been alluded to before and amply justifies mention here. Our tram services have been superseded by trolley buses during the year and while scientific and medical opinion does not appear to regard noise as being of very great importance in its effect upon health, those of us who work day by day close to the route are nevertheless grateful for its diminution. Population. The estimate of the Registrar General of the population for Midyear, 1935, was 35,760, an increase of 740 over that of the corresponding date for 1934. This is the highest population yet recorded for the district. It appears that this increase is largely due to the influx into the district of a residential type of population, and from the continued activity of building in the area this increase does not yet seem to have reached its limit. Births. The Birth Rate has increased from 13.73 last year—the lowest recorded—to 14.4 this year, while the total number of births has increased from 469 to 525. The total illegitimate births numbered 18. 11 Deaths. The total number of deaths was 360, 194 being males and 166 females. This is after allowing for inward and outward transfers. The Death Rate for 1935 is 10.8. This shows a slight increase over last year, but the increase in total deaths producing this rate will be seen to be only 13. The largest number of deaths attributed to one cause was due to Heart Disease, accounting for 105. The next most common cause was Cancer accounting for 57. These figures closely follow figures recorded in previous years and they present no unusual features. Infantile Mortality. The Infantile Mortality Rate—the number of infants who died under one year of age per 1,000 live births is 4(i. This figure again is an improvement over last year, and is the lowest recorded since 1928. As I have pointed out before this figure is one of those which is regarded as a criterion for the healthiness of an area, and this reduction in infantile mortality in the past decade is a tribute to the work done bv the Public Health Service, I have included a table showing the Infant Mortality at 5 year intervals for the past 25 years. Erith England and Wales 1910 70.91 130 1915 73.17 91 1920 61.5 83 1925 56.48 75 1930 61.05 66 1935 40.0 59 Maternal Mortality. Two women who died during the year as a consequence of childbirth give a maternal mortality rate of 3.8 per 1,000. It will be seen therefore that one death more from this cause than last year raises our maternal mortality rate from 2.07 to 3.8. This is of course owing to the relatively low number of total births. Cases of this nature which occur in the district are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife in attendance. 12 HOSPITAL PROVISION. 1. General. The services of large general and special hospitals are readily accessible to residents in our area. Since writing my last report the local Erith and District Hospital has opened a Children's Ward of 10 beds. 2. Fever. The Kent County Council have recently undertaken a review of isolation hospital accommodation throughout the County in accordance with their responsibilities under the Local Government Act, 1929. The Sanatorium at Little Heath has been deemed adequate for the needs of the area. 3. Smallpox. An arrangement between the London County Council and the Erith Council has been in operation for some years. Negotiations to confirm and perpetuate this arrangement are being carried on at the time of writing this report. 4. Tuberculosis. The provision of institutional treatment for this disease is the responsibility of the Kent County Council. Close co-operation is maintained between the Tuberculosis Officer for the district and your Medical Officer and the latter is a member of the Tuberculosis After-Care Committee. 5. Maternity. There has been no change in the provision of Maternity beds by the Council during the year. The number of applications for admission reached its maximum during the year under review. An arrangement was entered into during the year to secure accommodation for maternity cases in need of hospital treatment. This is now provided at the City of London Maternity Hospital. Three cases were admitted under this arrangement during the year. The conditions for which they were admitted are as follows : No. 1. Albumenuria. No. 2. Albumenuria. No. 3. Albumenuria, early pregnancy, toxaemia of pregnancy. 6. Children. There is no special hospital in the district for treating the diseases of children but the hospitals in Woolwich and other 13 parts of London are easily accessible. As mentioned elsewhere, a children's Ward of ten beds has now been completed at the Erith and District Hospital. 7. Orthopaedic. The Special Hospitals and Special departments of General Hospitals in the Metropolis are available for treatment of conditions falling under this heading. In addition there is a Clinic at Dartford, and another at the Erith and District Hospital, for exercises, massage and light treatment. 8. Ear, Nose and Throat. The arrangement made in 1930 by the Education Committee with the Royal Waterloo Hospital to undertake the operative treatment of Tonsils and Adenoids in the school children continues to function satisfactorily. The Health Committee re-appointed Mr. F. C. W. Capps, F.R.C.S., of St. Bartholomews Hospital, as Consulting Aural Surgeon. This appointment is renewable annually and a retaining fee is paid. The services of Mr. Capps are available for his opinion and for operations on patients in the Sanatorium as required. 9. Puerperal Fever and Pyrexia. Patients suffering from either of these conditions are admitted to the North Western Hospital, which is controlled by the London County Council, except where the patient's own practitioner arranges for her treatment elsewhere. A Consulting Obstetrician, appointed under the Public Health Puerperal Fever Regulations, Mr. A. Galletly, M.C., M.B., F.R.C.S., is available for assistance to medical practitioners in the area. 10. Maternity and Nursing Homes. At present there are two registered Nursing Homes in the district. No applications for registration were received during the year. 11. Ambulance Facilities. (a) For Infectious Cases. An ambulance for removal of such cases is maintained, and is available at any time by telephone. (b) Three ambulances are kept for use of non-infectious and accident cases. All the ambulances are motor vehicles and the service is carried out by members of the Fire Brigade. 14 Public Health Officers of the Local Authority. These are enumerated in tabular form at the commencement of the Report. Nursing in the Home. (a) General. 'Three voluntary Nursing Associations provide five nurses for work in the district. These are not subsidized by the Local Authority, but are supported by weekly contributions by Members of the Associations and subscriptions from others. The services of these nurses are also available to non-members of the Associations for a small fee per visit. (b) Infectious. No nursing in the homes is carried out by the Staff of the Health Department. It has not been found necessary during the year to make use of the legislation which enables this Authority to compel removal of infectious patients to hospital. Midwives. Arrangements were made during the year, in accordance with conditions suggested by the Ministry of Health, to compensate midwives for patients removed to hospital on the advice of the Medical Officer of Health. The administration of the Midwives Acts is carried out by the Kent County Council which is the Local Supervising Authority. Under the new Midwives Act now in Committee stage at the time of writing this report, it will be the County Council who will employ and supervise midwives working in this area. It has been pointed out before that the supervision of midwives might be done by your Staff with advantage to the efficiency of the practice of midwifery. The provision of a municipal midwifery service serves to emphasise this point. 15 Clinics and Treatment Centres. Clinics and Treatment Centres. Address. Medical Ofiicer in Attendance. Day and Time. Accommodation. Provided by Ante Natal Clinic Infant Welfare Centres Hainault, Lesney Park Road M.O.H. Assistant M.O.H. Tuesdays 2—4 Two rooms Rrith U.D.C. (1) Hainault Lesney Park Road. Mondays 2-4 Four rooms ” ” Three rooms ” ” (2) Belvedere Public Hall. Assistant M.O.H. Tuesdays 2—4 (3) Primitive Methodist Church, Belvedere M.O.H. 1st and 3rd Wed. 2—4 Two rooms ” ” Maternity and Child Welfare Dental Clinic Hainault, Lesney Park Road M.O.H. and Mr. R. A. Presslie. L.D.S. 2nd and 4th Wed. 2.30 'Three rooms ” ” School Clinics (1) Hainault, Lesney Park Road. Assistant S.M.O. School Nurse Daily at 9.1.5 Tuesdays 9.30 'Two rooms ” ” One room ” ” Ophthalmic Clinic (2) All Saints' Schools. Hainault, Lesney Park Road Mr. N. Howard Allen, M.R.C.S., L.R.C.P. Wed nesdays 9.30 'Three rooms ” ” School Dental Clinic (Extractions) Hainault, Lesney Park Road Mr. R. A. Presslie, L.D.S. Thursdays 9.30 Three rooms ” ” \ / School Dental Clinic (Conservation) Hainault, Lesney Park Road Mr. R. A. Presslie, L.D.S. Tuesdays Thursdays 2.0 Fridays 'Three rooms ” ” Tuberculosis Dispensary 65 Bexley Road, Erith. Dr. W. B. Martin Mondays 5—6 Thursdays 2—4 Kent C.C. Venereal Diseases Clinic 37 West Hill, Dartford. Drs. Renton nnd Ockwell. Men. Mondays 4.30 to 6.30 Wed'sdays 5—6 Women. Tuesdays 4—6 ” ” 16 Laboratory Facilities. Examinations of pathological specimens and other laboratory work is carried out for us at the Kent County Laboratory. At various times in past years when an immediate opinion was necessary advantage has been taken of the day and night service of the Clinical Research Association, Adelphi, London. It has not been necessary to avail ourselves of this service during the year. Legislation in Force. List of Bye-Laws, Adoptive Acts, and Regulations in force in this 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. Pleasure Grounds June, 1897. Sewerage Regulations July, 1898. Cleansing and Removal of Refuse Oct., 1898. Public Baths and Wash-houses Sept., 1907. Filth and Rubbish May, 1912. Offensive Trades Dec., 1912. Employment of Children Dec., 1912. New Streets and Buildings Oct., 1927. Tents, Vans and Sheds Feb., 1928. Houses Let in Lodgings Jan., 1930. Slaughter-houses Jan., 1932. Nursing Homes July, 1934. New Streets and Buildings Oct., 1935. Erith Tramways and Improvement Act, 1903. Erith Improvement Act, 1920. Infectious Disease (Prevention) Act, 1890 1891. Public Health Acts Amendment Act, 1890 1891. Public Health Acts Amendment Act, 1907, Sections 19, 21, 22, 23, 25, 81, 33 and 51 1912. Section 95 1928. Public Health Act, 1925, Sections 14—19, 21—28, 30—35, 38—44, 48—55 1927. 17 SANITARY CIRCUMSTANCES OF THE AREA. Water. The water in this district is almost exclusively supplied by the Metropolitan Water Board. The water, though possessing a considerable degree of hardness is of good quality and is palatable. The supply in nearly all cases is led into the houses ; standpipes exist on a few7 premises only. The encampment on Belvedere Marshes derives its water supply chiefly from bore-holes, the water is analysed from time to time to enable a check to be kept on its purity. Drainage and Sewerage. During the year, extensions to the existing sewerage system were made as follows:— The Drive 50 yards Kingswood Avenue 50 yards Cartmel Road 100 yards Parsonage Farm Estate 5450 yards 5650 yards The total length of drains in the district is 4,500 yards. Closet Accommodation. Approximately 8,627 water closets are connected with the main drainage system and 118 with Cesspools. 4 W.C.'s previously connected with cesspools now discharge into the sewer. With the exception of the encampment on Belvedere Marshes it may be said that the district is almost entirely on the water carriage system. Scavenging. Sanitary dust bins are exclusively used throughout the district. House Refuse. Collection as in the past few years has been effected by four low loading vehicles, twro of which are of a size suitable for back street and secondary access work. The growth of the new estates has thrown so much extra work on the collection service that four vehicles are insufficient. The Council have decided therefore to obtain an extra vehicle which it is hoped will soon be in operation. During the year the method of disposal carried on for a number of years past has been discontinued and the refuse has been disposed of by barging under contract. The arrangements have worked very satisfactorily since their commencement in August of this year. 18 Trade Refuse. This is either collected by the Council upon application for removal being made by the traders and a sum charged which covers the cost of the removal, or it is brought to the wharf by the traders themselves. A scale of charges is in operation which is based on the Contractors' rate. Cesspools. Cesspools are emptied by the Council's staff once per month where necessary. Sanitary Inspection of the Area. The following tables summarize the work of the Sanitary Inspectors during: the year. Premises visited with the results ot such visits:— No. in District No. of visits in 1935 No. of faults and defects found No. of Faults and defects remedied Bakehouses 10 22 4 4 Dairies 17 6l 25 20 Slaughter Houses (licensed) 4 234 20 18 Other Food preparing places which are, as such, subject to inspection 24 50 10 9 Factories 15 19 4 4 Workshops 11 5 - - Workplaces (other than Outworker's homes) 12 10 - — Nuisances and Defects Remedied during the year (other than those enumerated in the above tabulation). Re Overcrowding 7 Re Keeping of Animals — Re Sanitary Accommodation Insufficiency — Other 105 Re Drainage Reconstruction 1 Do. Cleansing 180 Do. Other 81 Re Dustbins, &c. 242 Re Tents, Vans, Sheds, &c. 258 Re Smoke Abatement 12 Cesspools Abolished 2 ,, Repaired 0 Offensive Accumulations 14 Yard Paving 45 19 Dampness 87 Roofs and Rainwater Pipes 215 Floors 49 Walls and Ceilings 356 Windows and Ventilation 147 Baths, Lavatory Basins and Sinks 56 Water Supplies 14 Others 238 The total number of visits of all kinds paid by Inspectors during the year was 4,730. Notices served—Statutory, 21 ; Informal 594. Number of houses and other premises disinfected 184. Batches of clothing disinfected 5. Meat and Food Inspection. During the year 1 ton 12 cwt. 3 qrs. 15 lbs. of food was condemned as unfit for human consumption. Cleansing. Number of Cesspools emptied 208 House refuse removed (tons) 7097 Trade refuse ,, ,, 281 Infectious Diseases, Number of cases enquired into 232 Number of cases removed to hospital 80 Smoke Abatement. There are no bye-laws in force in this district for dealing with smoke nuisances. During the year 12 investigations were made and in each case the nuisance was abated without recourse to Statutory notices. Swimming Baths. Open air swimming baths belong to the Council and the water is passed through mechanical filters and appears to be clean and satisfactory. One sample of water was submitted for bacteriological examination and reported to be satisfactory. Hop Pickers. There are no hop fields within the district. Schools. All schools in the district are visited at least twice during the year by a member of my Staff and any defects found are reported to the Education Committee. Further details with regard to the schools are given in my report as School Medical Officer. 20 Health Education. Rat Week was observed in Erith during the week commencing November 4th. Large posters were displayed on the Council's advertising boards, affixed to various Council vehicles and announcements were made in the local press inviting the public to co-operate with the Local Authority in destroying rats and mice. In addition to the help and advice always available from this Department in the destruction of these vermin, free issues of vermicide were available at this time. A Health Week was organised in the Schools and took place in October. Reference to this is made on Page 10 of my report to the Education Committee. In addition to organised campaigns such as these,.dissemination of health propaganda is continually being carried on by the Health Visitors, School Nurses, and by your Medical Officers. Rag Flock Act. There are no premises in the district in which rag flock is manufactured, used or sold. HOUSING. Number of New Houses erected during the year. (1) By the Local Authority— (2) By other Local Authorities — (3) By other bodies or persons 593 1. Inspection of Dwelling Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 614 Number of Inspections made 2450 (2) Number of dwelling-houses (included under the preceding heading) which were inspected and recorded under the Housing Consolidated Regulations 1925 141 Number of Inspections made 782 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 594 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 554 21 3. Action under Statutory Powers. (a) Proceedings under Section 17, 18, and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 11 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 11 (b) By Local Authority in default of owners— (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 10 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 9 (b) By Local Authority in default of owners— (c) Proceedings under sections 19 and 21 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which Demolition Orders were made 2 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders— (d) Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made— (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit- HOUSING CONDITIONS. General Observations as to Housing Conditions. During the year under review 593 houses were erected by private enterprise. There is thus as yet no substantial reduction in the number of new houses provided in this way. Arrangements to build 20 houses to rehouse persons displaced from houses scheduled for demolition were completed during the year. 22 Overcrowding. The preliminary survey required by the Housing Act, 1935, was completed before the end of the year. This showed for the district as a whole, that there were 9,691 families living in 8,800 dwellings. 116 of these families were overcrowded either by insufficient accommodation or inability to segregate the sexes. As a percentage the overcrowding in the district gives a figure of 1.19. Fitness of Houses. During the year in connection with the inspection of existing houses under the Housing Consolidated Regulations, 1925, which make it the duty of a Local Authority to cause systematic inspection of the district to be made, the findings recorded, and any defects discovered to be remedied, 141 records were made of houses necessitating 782 inspections. In addition to these 594 dwelling houses were found on inspection to be not in all respects reasonably fit for human habitation and in all cases steps were taken to render them so fit. Unhealthy Areas. No action has been taken during the year under the provisions of the Housing Act, 1930, relating to Clearance Areas. INSPECTION AND SUPERVISION OF FOOD. The Staff of the Health Department continue to take a keen interest in this most important branch of their work. Milk. The number of licences under the Milk (Special Designations) Order, issued by this Department is as follows: — "Certified" Milk 2 Grade "A" Tuberculin Tested 2 Grade "A" 1 Grade "A" Pasteurised 4 Pasteurised 11 Sampling has been carried out from cowsheds, roundsmen, and at the Schools. Sampling at the schools has been done on delivery as vendors complain that milk is warmed for the children, and that as a consequence the bacterial count is raised. 23 The results of bacteriological examination show that too much emphasis cannot be laid on the importance of careful and cleanly methods being employed in the production and distribution of milk. Every effort is made to elicit the co-operation of persons engaged in the trade, and advice in technique is continually being given by the 'Staff of the Health Department. Meat. Supervision by the Inspectors over Slaughterhouses has been carried out extensively during the year. This work could be done more easily and more effectively if the hours of slaughtering could be arranged more conveniently. A summary of the work of the Inspectors is shown in the tables. No legal action has been taken by this Authority with regard to unsound meat. One successful action was taken by this Authority for exposing food for sale which was unfit for human consumption. Other Foods. The routine sampling of foods under the Food and Drugs Act is undertaken by an Inspector who is appointed by the Kent County Council. Samples of suspected foods are submitted to the County Laboratory at Maidstone for examination. A case of suspected food poisoning, alleged to be due to iced cake, was brought to our notice during the year. Thorough investigation was carried out, and samples of the cake and icing submitted for analysis. The result of the analysis showed that the cause of the alleged poisoning could be attributed to neither the cake nor the icing. INFECTIOUS DISEASE. Reference to the table on page 25 will show that a considerable reduction in the total incidence of infectious disease has taken place compared with last year's figure which was 240. There was a considerable drop in the number of cases of Scarlet Fever notified—35; and a slight increase in the number of cases of Diphtheria—57. Of the 35 cases of Scarlet Fever, 30 were admitted to the Sanatorium, whilst all the 57 cases of Diphtheria underwent treatment in Hospital. Diphtheria was responsible for one death in the Sanatorium. 24 There were, in addition to the above, 26 cases of Pneumonia notified. This disease, during the year accounted for 13 deaths, but as it is notifiable only when it occurs as a primary disease or is of influenzal origin, it will be appreciated that the 13 deaths did not occur only among the 26 cases notified. Five cases of Erysipelas were notified during the year, one case of Enteric Fever, and one case of Malaria. None of these proved fatal. One case of Scarlet Fever proved fatal during the year, as did one case of Encephalitis Lethargica. Diphtheria anti-toxin is available for the use of general practitioners on application to the Health Department or to the Sanatorium outside office hours. No case of Smallpox occurred during the period under review. No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Cleansing of Verminous Persons. No cleansing station is provided by this Authority. Cases requiring treatment can obtain it by arrangement with the Dartford Hospital. Tuberculosis. 29 deaths from pulmonary and 3 deaths from non-pulmonary tuberculosis were registered. Of these, one death was certified as being due to tuberculosis in a patient who had not been notified under the Public Health (Tuberculosis) Regulations, 1930. The practitioner concerned was communicated with and a satisfactory explanation received. Table showing Number of Cases of Infectious Disease notified during 1935. Disease Under 1 year 1—2 years 3 years 3—4 years 4-5 years 5—10 years 10 15 years 15 20 years 20 35 years 35—45 years 45 65 years 65 years and over Total at all ages Cases admitted to Hospital Total Number of Deaths Scarlet Fever 2 4 2 14 2 3 7 1 35 3C Diphtheria 3 1 3 5 29 8 2 3 3 57 57 1 Enteric Fever 1 1 Puerperal Fever Puerperal Pyrexia 2 4 1 7 Erysipelas 2 1 I I 5 Pneumonia 1 4 3 2 1 2 4 2 2 5 26 13 Ophthalmia Neonatorum 3 3 3 Acute Poliomyelitis 1 1 1 Small Pox Cerebro Spinal Meningitis Malaria 1 1 Grand Total 4 9 4 7 7 46 12 11 18 8 4 6 136 91 14 26 The following table shows the number of specimens sent to the County Laboratory for examination : — Nature of Specimen sent Result Total Positive Negative Swabs for Diphtheria 23 154 177 Sputum for suspected Tuberculosis 41 81 122 Various 2 10 12 66 245 311 Public Health (Prevention of Tuberculosis) Regulations 1923, and Public Health Act, 1925, Section 2. No cases arose during the year requiring action under the above Regulations and Act. Tuberculosis. New Cases and Mortality during 1935. Particulars of New Cases of Tuberculosis and of all deaths from the disease in the area during 1935. Age Periods New Cases Deaths Pulmonary Non-Pulm'n'ry Pulmonary Non-Pulm'n'ry M. F. M. F. M. F. M. F. Under 1 year 1 1 5 2 1 1 10 1 1 1 15 5 2 2 1 20 5 4 1 1 4 3 25 3 5 1 1 35 4 2 1 3 45 4 2 2 2 55 3 1 3 1 1 65 & upwards 1 1 Totals 27 18 3 3 13 12 1 27 MATERNITY AND CHILD WELFARE. As is mentioned elsewhere in this report, minor extensions in the scope of the Maternity and Child Welfare Scheme have been effected during the year. Provision of beds for maternity emergencies, compensation for midwives whose patients are admitted to hospital, and an added dental session. During the year the provision of clinics under the Maternity and Child Welfare Scheme for the newly developed area at Bedonwell in connection with the new junior school has reached the stage of inclusion in the plans of the school and their acceptance by the Board of Education and the Ministry of Health. The work of the Health Visitors and the clinics continues to be successful and the attendances clearly indicate the value the patients place on the services available. The numbers attending the ante-natal clinic continue to mount, an increase of over 200 attendances being shown over last year, and again it is gratifying to note that midwives are making freer use of the clinic. I would again emphasise that the ante-natal clinic is not restricted to patients who are booked to enter Hainault. Institutional treatment for normal cases is provided at Hainault. During the year 129 patients were admitted for confinement. A stock of sterile maternity outfits is kept at the Council offices and retailed at cost price, viz., 3/6 each or free in necessitous cases. Ophthalmia Neonatorum. Three cases of this disease occurred during the year. All of the patients were removed to hospital. In two cases vision was unimpaired and in the third case the patient removed from the district. Infant Life Protection. Administration of Part 1 of the Children Act, 1908 reenacted in the Children and Young Persons Act, 1932, is undertaken by this Authority, the Health Visitors being appointed as Infant Protection Visitors. Reports on the homes of Foster Mothers are submitted by the Health Visitors and when doubt arises they are visited by your Medical Officer. In cases in which conditions are not considered satisfactory the Maternity and Child Welfare Committee make representation to a Court of Petty Sessions who have the power to order the removal of foster children to a place of safety. 28 During the year under review frequent visits were paid to foster children, and in no case was it found necessary to take legal action against any foster parent. Notification of Births. During 1935, 556 live births and 16 stillbirths, giving a total of 572, were notified to me. Of these, 451 were notified by midwives and 121 by doctors and/or parents. The total number of births registered was 525. In every case where a birth is registered and has not been notified, the responsible person is requested to furnish an explanation. All stillbirths and deaths of children under the age of 5 years are investigated by the Health Visitors. Supply of Milk. In certain circumstances milk is supplied to nursing and expectant mothers free or at half-cost. A scale of income approved by the Ministry of Health has been adopted for this purpose. The amount so distributed during the year was 34,012 pints and 1,017 lbs. of dried milk. Infant Welfare Figures for 1934 and 1935. No. of visits by Health Visitors to1934 1935 expectant mothers 238 309 infants under 1 year 3434 3511 children 1—5 years 4891 4172 No. of visits of Health Visitors for special enquiries 99 89 ,, ,, ,, under the Children and Young Persons Act, 1932 136 106 No. of attendances of children and infants at: Erith Welfare Centre 3335 3549 Belvedere ,, 4392 4447 Picardy ,, 1025 803 ,, ,, ,, at the Ante-Natal Clinic 1021 1287 ,, ,, ,, at the Dental Clinic 181 180 29 Factories, Workshops and Workplaces. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Number of Inspections Written Notices Occupiers Prosecuted 1 2 3 4 Factories (including Factory Laundries) 19 4 - Workshops (including Workshop Laundries) 5 - - Workplaces (other than Oatworkers' premises) 10 — — Total 34 4 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H M. Inspector 1 2 3 4 5 Nuisances under the Public Health Acts :— Want of Cleanliness Want of Ventilation Overcrowding Want of drainage of floors Other Nuisances Sanitary accomodation: Insufficient 1 1 Unsuitable or Defective 3 3 Not separate for sexes Offences under the Factory a?id Workshop Acts :— Illegal Occupation of underground bakehouse Other offences Total 4 4 URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1935. '2 EDUCATION COMMITTEE Chairman :—Councillor Whinnerah. Vice-Chairman :—Councillor Ebben. Councillor Bates. Councillor Graham. ,, Brierley. ,, Stebbing. ,, Dunkley. ,, Tobin. Councillor Mrs. Nichols. Co-opted Members: T. W. Fudger, Esq. F. J, Millard, Esq. Rev. W. R. Hartwright. Mrs. Norris. J. L. Miles, Esq. Mrs. Pyne. SCHOOL MEDICAL STAFF. School Medical Officer : Arthur Wallace Johns, m.r.c.s., l.r.c.p., d.p.h. Assistant School Medical Officer (part-time) : David S. Clark, m.b., b.s. (Appointed—1st Sept., 1935.) Ophthalmic Surgeon : N. Howard Allen, m.r.c.s., etc. Dental Surgeon : R. A. PreSSlie, l.d.s., Edin. Dental Attendant: Miss M. L. Buckley. (Appointed—1st September, 1935.) School Nurses: Mrs. Lange, s.r.n., Miss Briggs, s.r.n. Clerk : Miss Smith. 3 Report of the School Medical Officer. In accordance with the suggestions contained in Form 6M. Schedule issued by the Board of Education, much of the subject matter of this Report having been included in previous reports it is not repeated but reference is made to items which have in previous years received full consideration. Co-ordination. As your Medical Officer of Health is also School Medical Officer it is ensured that there is no overlapping between the two departments. All information as to the incidence of infectious diseases is immediately available for the use of the Assistant School Medical Officer and the school nurses and vice versa, unnotifiable infectious diseases discovered through absences from school are transmitted to the Health Department and followed up, thereby in many cases enabling such outbreaks to be controlled. Attention has been drawn to the advantages of combining the duties of Health Visitors and School Nurses in previous reports. It is to be hoped that at some future date it will be possible to secure this arrangement, which will undoubtedly make for economy and an all round increase in the efficiency of the service. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. There are 8 provided sdhools with 18 departments and 2 non-provided schools with one department each under the authority of the Erith Education Committee. The schools are visited by a Medical Officer at least twice in the year and any defects found are brought to the attention of the Committee. Since the publication of my last report one of our nonprovided schools—All Saints, has been partly closed owing to structural defects which rendered parts of the building dangerous. In November, 1935, it was handed over to the Local Education Authority and will be a provided school pending the opening of the new Bedonwell School in September, 1936. 4 Various improvements such as a new heating system, new hard wood floors and cleansing by vacuum cleaners, in West Street School, and the re-construction of a large playground at the Picardy Central School, have been effected, enabling them to compare favourably with our more modern and consequently better equipped and planned buildings. The scheme for a school at Bedonwell put forward during last year is nearing completion and in view of the proposed abandonment of the premises of All Saints' School the provision of an additional department at Bedonwell is being submitted to the Board of Education. As before, the scheme includes provision for Medical Inspections and facilities for clinical work under the Maternity and Child Welfare scheme. Medical Inspection. The practice of examining three routine age groups has been followed and particular attention to following up defects has been continued. FINDINGS AT MEDICAL INSPECTIONS. Malnutrition. As will be seen by reference to Table IIB. in accordance with a memorandum issued by the Board, Nutrition has been classified into four groups. The recorded number of cases corresponding to what was previously labelled malnutrition shows an increase over last year. Arrangements for supplying children with milk both during school term and in the holidays continue to work satisfactorily, and for this our thanks are due to the teachers and staff. The value of adding milk to the child's diet in this way has been pointed out on previous occasions; what is not so clear is whether the time chosen for the issue of this milk is the best possible. Parents are frequently afraid that the issue of this milk so late in the morning will deprive the child of its appetite for the mid-day meal. Below is set out a table showing the quantities of Oil and Malt distributed:— Total amount issued 1251 lbs. Amount issued free 1113 lbs. No. of children receiving free issues 105 Amount sold at cost price 138 lbs. In addition to the above 60 children were recommended for a supply of free milk at school, making a total now of 96 children who are in receipt of free milk at school. 5 Uncleanliness. In my last report I drew attention to the regrettable increase in the number of children found to be verminous in the inspections at the schools, and gave the total loss of attendances as a consequence for their exclusion for this reason. The figures for the year under review show some improvement in this respect, but this improvement does not by any means justify complacency in this matter. Reference to Table IV reveals that 243 children were found to be suffering from this condition as compared with 306 last year. Minor Ailments and Diseases of the Skin. Below is set out a table giving the number of children examined and the total attendances at the various clinics:— 1934 1935 Children Attendances Children Attendances Minor Ailments Clinic 1613 7805 1340 7913 Dental Clinic 1113 1393 1332 1554 Ophthalmic Clinic 380 974 400 1070 Special Examinations 2812 4322 2491 4646 Operations for Tonsils and Adenoids 86 68 6004 14494 5631 15183 There is a slight increase in the incidence of infective skin diseases. Visual Defects and External Eye Disease. The following Notes have been supplied by the Ophthalmic Surgeon (Dr. N. Howard Allen). During the last year the Ophthalmic department has been carried on, with the addition of children seen for Minor Ailments since last September—the combined clinic working quite satisfactorily. The majority of children are old cases attending for routine inspection; the new cases being those referred on account of defective vision or diseases of the eye by the School Medical Officers. At each session about 10 Refractions are performed, these cases being composed of old cases requiring fresh examination and new cases requiring Retinoscopy. The number of cases seen on account of such complaints as Blepharitis, Corneal Ulceration, Squint, etc., number about 15 per cent. 6 Cases of Squint are treated with glasses and covering of the good eye, with a view to re-educating the Amblyopic or 'lazy' eye. In one case in which I thought operative treatment desirable, I performed the necessary operation last Autumn with definite benefit. There are other cases having treatment who may be found to require operative treatment at a later date, this being decided as they come up for review at stated intervals. The difficulty of dealing with children suffering from High Myopia still persists owing to the fact that there is no special school in the vicinity. Nose and Throat Defects. The number of individual defects found are set out in Table II. As has previously been pointed out a growing section of medical opinion is leaning to the view that if tonsils are not giving rise to secondary conditions they do not call for removal. Moreover the part that enlarged adenoids alone plays in producing the conditions attributed jointly to enlarged tonsils and adenoids has not been assessed precisely. These facts will explain the diminution in the number of operations for the removal of tonsils and adenoids, and the relative increase in the number of operations for removal of adenoids alone. Comparison of the number of operations for removal of tonsils and adenoids. Year Operation in Hospital under Authority's Scheme By Private Practitioners Total 1932 131 30 161 1933 132 17 149 1934 87 14 101 1935 68 12 80 The arrangement for the removal of tonsils and adenoids at the Royal Waterloo Hospital for Children and Women has been continued and I am pleased to say that the parents and ourselves are still very pleased with the treatment obtained. Reference was made to this in the report of 1932. Ear Diseases and Defective Hearing. There is little variation in the numbers of children suffering from diseases of the ear. 7 Dental Defects. Since September 1st, 1935, an extended dental scheme has been in operation giving 18 sessions per month for dental treatment of school children as compared with 8 per month previously. It was realised that it would not be possible, even with these extra sessions, to undertake the conservation work for all the school children so that it was decided to inspect all age groups, recommend treatment where necessary and provide treatment for the younger children first, extending our services to the older children subsequently if possible. The figures in the Table Group V show the results of three months' working of the scheme, and reveal a gratifying increase in the conservation work done, and in inspections carried out. Later figures, now available but not of course included, further emphasise these points and the extraction conservation ratio, which was hitherto far too high, begins to assume a more reasonable proportion. It is perhaps not entirely out of place here to mention that the number of Maternity and Child Welfare dental sessions have also been increased. Orthopaedic and Postural Defects. Children found to be suffering from these conditions are referred for treatment usually to one of the London general hospitals as there is no provision made for them in Erith. Heart Disease and Rheumatism. Table II shows that 17 cases of organic heart disease were observed, the number of cases of functional heart disease was 49. Tuberculosis. Two cases of suspected pulmonary tuberculosis are still under observation by the Tuberculosis Officer. In addition two cases of suspected pulmonary tuberculosis were sent to the Tuberculosis Officer who notified them as cases, together with three others discovered by him. As you are aware the actual treatment of tuberculosis is carried out by the Tuberculosis Officer who is on the staff of the County Medical Officer. Following up, and Summary of Work by School Nurses. The meaning of this term and the details of its operation have been given in former reports. A brief summary, however, may be given of the amount of work carried out during the year, and the various duties of the two school nurses. They are in attendance at the Clinic for Minor Ailments, Dental and Ophthalmic work at their respective times. 8 SUMMARY. Visits paid to the schools 664 Children examined 14,214 Children found with vermin 243 Visits to homes 882 Attendances at Dental Clinic 72 Attendances at Ophthalmic Clinic 37 Arrangements for Treatment. In all cases where practicable children are referred for treatment to their private doctors, certain cases however receive treatment for minor ailments at the school clinic, and others are treated at the general and special hospitals in London. As in the past, facilities for light treatment are provided at the clinic at King Edward Hospital, Dartford. As previously stated throat defects are treated at the Royal Waterloo Hospital for Children and Women. Infectious Diseases. The scheme adopted for detecting outbreaks of infectious diseases is fully described on page 11 of the report to the Committee for the year 1932. No occasion arose for taking action under the Code-Grant Regulations No. 8. During the year swabs were examined for Diphtheria from 28 children—7 of these proved to be positive. Open Air Schools. There is no open-air school provided by this Authority but as will be seen from Table III a number of delicate children attend certified day schools maintained by other Education Authorities, this Authority being responsible for the fees and in most cases the parents contribute towards the cost. The establishment of an open-air school is still under consideration and would undoubtedly benefit certain types of cases of whidh we have records. Physical Training. On the recommendation of the School Medical Officer children are given physical training in the schools by teachers who have been trained in this subject. Facilities are given to teadhers to attend courses of instruction in physical training. Facilities for physical training have been fully utilised and Gymnastic Clubs formed in the schools have continued to use the Gymnasium and halls in the Central Schools after school hours. Juveniles who have left school during the last few 9 years have also been able to benefit by evening courses of physical training. As in previous years Students from the Bergman Osterberg Physical Training College, Dartford Heath, have attended some of our central schools for teaching practice under the supervision of the Head Teachers and tutors of the C ollege. A scheme further to meet the needs of physical education in this area has been initiated by this Authority in approaching four other part III Local Education Authorities:— Beckenham, Bromley, Gravesend and Penge, to secure the appointments of a male and female physical training organiser. If present negotiations come to fruition, this will be of inestimable benefit and it is to be hoped that it may be possible to extend this service to include the pre-school age-groups. It is not necessary to point out, for example, that a postural defect corrected by remedial exercises in a child of 5 to 6 years of age, or older, could with more advantage and more easily have been corrected at the age of 3 to 4, not to mention the fact that the first mentioned might then never occur. Provision of Meals. The provision of milk in the schools continues to be in operation and those who are discovered to be malnourished and whose parents cannot pay the cost of this milk receive a free supply by arrangement with the Education Committee or the Public Assistance Committee. In addition foods such as cod liver oil and malt are provided free in necessitous cases. Three children were supplied with meals free of charge during the year. Co-operation of Parents, Teachers, &c. Parents continue to show keen interest in the Medical examination of their children. At Routine Medical Inspections the parents attended in 90 per cent. in the case of infants, 81 per cent, in the case of intermediates and 55 per cent, in the case of leavers. The value of these routine examinations has recently been questioned and the substitution of a more rapid review by teachers or nurses and the reference of a percentage of the children to the Medical Officer for fuller investigation lhas been advocated on the grounds of economy of time and labour. There is undoubtedly a good deal to be said for such an arrangement, but it must be remembered that it is important to maintain the close co-operation already existing between parents and the school medical personnel, and it is difficult to see how any considerable economy of time can be effected where a high proportion of parents seek an opportunity to discuss the health of the child with the Medical Officer. 10 Blind, Deaf and Epileptic Children. An analysis of children falling under this head is given in Table III, in which is fully set out the type of education and treatment received. The condition of affairs shown is that existing at approximately the last day of the year. Every possible care is taken in classifying those ooncerned when routine medical inspection has been completed. It will be appreciated that under the new arrangement some diminution in the time available has occurred. Every endeavour has, however, been made by most careful scrutiny of the cases to ensure that re-examination is carried out where necessary. The sources from which information is obtained are chiefly as follows:—Routine Medical Inspections, information received from the Maternity and Child Welfare Section regarding those about to enter schools, special inspections at the school clinics, and children brought to our notice by parents and teachers. It will be noticed that we have no blind children but 9 who are partially blind are attending public elementary schools. There are no deaf children in our area but 5 children who are partially deaf are attending elementary schools. The problems of the deaf child are being investigated by a Committee set up by the Board of Education. The lack of precision in estimating the degree of minor deafness renders the decision as to the need for special treatment in these cases extremely difficult. Large scale investigations have been made with a special instrument which measures the disability and records it in standard terms, and it is claimed that deafness can be measured with accuracy. The instrument is, however, cumbersome and costly and has not yet come into general use. Nursery Schools. There are no nursery schools provided by this Authority. Parents’ Payments. A scale of charges is in operation for the recovery of the cost of treatment at the minor ailments clinic from those who are able to contribute. There is also a scale of charges for those in receipt of treatment at the dental and ophthalmic clinics. A fee has been fixed also for Secondary School Children who attend our Dental and Ophthalmic Clinics, for which the Higher Education Authority is responsible. Health Education. A combined Health and Safety Week for the schools was held on October 7th to 12th. In addition, as usual, the attention of Head Teachers has been drawn to official publications 11 and suggestions in respect of health education and soirr attention has been given to matters of hygiene through the Domestic Subjects and Science lessons in the Central Schools. The development in the use of films in the Central Schools for purposes of education will clearly make possible more intensive work in Health Education. The publications and posters of the Health and Cleanliness Council have been brought to the notice of the schools and are extensively used. Mentally Defective Children. I append the Annual Report of the Local Organiser of the Kent Voluntary Association for Mental Welfare. I may say that the work of this Association is very highly valued by the School Medical Department. Report of the Work of the Kent Voluntary Association for Mental Welfare for the Erith Education Committee for 1935. There have been 9 cases under supervision this year. No new cases have been received. One case was reported to the Committee for medical examination and the Association is still in touch with the girl who is subject to epileptic fits. Summary of Cases: Remaining on list last year 9 Reached age 19 years 2 7 Leaving 7 cases under supervision. Of the two young people whose names have been removed from the list on reaching age 19 years, one is under Friendly Supervision for the County Mental Deficiency Committee and in the other case supervision appears unnecessary though occasional enquiries may be continued. Both are working and shew signs of becoming self-supporting. School Cases. Two children are attending School, one boy an L.C.C. Day Special School and one girl the Northumberland Heath Central School. The girl's health is poor and she is very retarded. After Care Cases. One girl left the Central School since the last report was rendered, she is now engaged in part time domestic work. Two young people reached age 16 years during 1935. One girl is helping at home and the boy is understood to be doing odd jobs 12 only. Both remain under voluntary supervision of the Association. One girl 18 years is under Friendly Supervision on behalf of the County Mental Deficiency Committee to whom reports are rendered. One boy is in regular work and it is understood that he is in the same employment as last year. Visits and Reports. 11 visits 'have been paid by the staff of the Association in addition to school enquiries and interviews. Reports have been rendered in all cases not under supervision for the County Mental Deficiency Committee. The Association appreciates the courtesy of the Committee in informing them of cases notified to the Mental Deficiency Committee on being withdrawn from Special School. Three cases were reported to the Association last year, one being already known and on the list of cases under supervision. TABLE 1. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 517 Second Age Group 486 Third Age Group 519 Total 1522 B.—Other Inspections. Number of Special Inspections 2491 Number of Re-Inspections 2155 Total 4646 C.—Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Number of Children GROUP 1 Inspected 2 Found to require Treatment 3 Prescribed Groups:— Entrants 517 157 Second Age Group 486 201 Third Age Group 519 140 Total (Prescribed Groups) 1522 498 13 TABLE II. A—Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. Defect or Disease 1 Routine Inspections Special Inspections No. ol Defects No. of Defects to Requiring Treatment Requiring to be kept za under observation, but not requiring treatment Requiring Treatment Requiring to be kept m under observation but not requiring treatment Skin:— Ringworm: Scalp 4 Body 4 8 Scabies 1 28 Impetigo 6 80 1 Other Diseases (Non-Tuberculous) 20 10 88 20 Eye:— Blepharitis 1 10 Conjunctivitis 1 1 12 Keratitis Corneal Opacities Defective Vision (excluding Squint) 132 81 29 1 Squint 13 6 3 1 Other Conditions 2 2 49 7 Ear:— Defective Hearing 1 35 3 2 Otitis Media 5 7 32 Other Ear Diseases 29 28 32 6 14 TABLE II—Continued. 1 2 3 4 5 Nose and Throat:— Chronic Tonsillitis only 27 279 28 16 Adenoids only 5 13 4 5 Chronic Tonsillitis and Adenoids 11 13 21 1 Other Conditions 6 25 150 57 Enlarged Cervical Glands (Non- Tuberculous) 128 29 33 Defective Speech 4 4 1 Heart and Circulation:— Heart Disease: Organic 2 5 5 5 Functional 2 29 2 16 Anaemia 9 7 4 2 Lungs:— Bronchitis 22 48 102 13 Other Non-Tuberculous Diseases 2 5 14 12 Tuberculosis:— Pulmonary: Definite Suspected 2 4 Non-Pulmonary: Glands 1 1 Bones and Joints 1 Skin 1 Other Forms Nervous System:— Epilepsy 3 Chorea 2 8 5 4 Other Conditions 5 1 3 Deformities:— Rickets 1 15 1 Spinal Curvature 3 5 3 Other Forms 20 22 10 1 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 25 35 731 197 Total 357 816 1495 409 15 B.—Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. (See Administrative Memorandum Xo. 124, dated 31st December, 1934.) Age-Groups Number of Children Inspected A Excellent B Normal C Slightly subnormal D Bad No. % No. % No % No. % Entrants 517 88 17 306 59 97 18 26 5 Second AgeGroup 486 76 15 261 53 111 22 38 7 Third AgeGroup 519 88 16 267 51 119 22 45 8 Other Routine Inspections — — — — — — — — — Total 1522 252 16 834 54 327 21 109 7 TABLE III. Return of all Exceptional Children in the Area. Blind Children. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions At no School or Institution Total — — — — — Partially Sighted Children. At Certified Schools for the Blind At Certified Schools for the Partially Sighted At Public Elementary Schools At other Institutions At no School or Institution Total — — 9 — — 9 16 TABLE III—Continued. Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total. — — — — — Partially Deaf Children. At Certified Schools for the Deaf At Certified Schools for the Partially Deaf At Public Elementary Schools At other Institutions At no School or Institution Total — — 5 — — 5 Mentally Defective Children. FEEBLE-MINDED CHILDREN. At Certified Schools for Mentally Defective Children At Public Elementary Schools At other Institutions At no School or Institution Total 4 19 — 3 26 Epileptic Children. CHILDREN SUFFERING FROM SEVERE EPILEPSY. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 1 2 — — 3 17 Physically Defective Children. A. TUBERCULOUS CHILDREN. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total — 5 — — 5 II.—Children Suffering from Non-Pulmonary Tuberculosis. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total — 8 — — 8 B. DELICATE CHILDREN. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 6 60 — — 66 C. CRIPPLED CHILDREN. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 7 16 — — 23 D. CHILDREN WITH HEART DISEASE. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 7 2 — — 9 18 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1935. TREATMENT TABLE. GROUP I.—MINOR AILMENTS. (excluding Uncleanliness, for which see Group VI). Disease or Defect 1 Number of Defects treated, or under treatment during the year Under the Authority's S, heme 2 Otherwise 3 Total 4 Skin— Ringworm—Scalp (i) X-Ray Treatment. If none, indicate by dash. – – – (ii) Other Treatment 2 2 Ringworm—Body 6 1 7 Scabies 22 2 24 Impetigo 79 4 83 Other skin disease 60 4 64 Minor Eye Defects (External and other, but excluding cases falling in Group II). 54 4 58 Minor Ear Defects 37 7 44 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 516 35 551 Total 774 59 833 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease Number of Defects dealt with Under the Authoritx's Scheme Otherwise Total 1 2 3 4 Errors of Refraction (including Squint) 399 22 421 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 1 1 Total 400 22 422 19 No. of children for whom spectacles were prescribed: (i) Under the Authority's Scheme 226 (ii) Otherwise 18 No. of children for whom spectacles were obtained: (i) Under the Authority's Scheme 196 (ii) Otherwise 18 GROUP III.—TREATMENT OF DEFECTS OF NOSE. AND THROAT. Number of Defects. Received Operative Treatment Received other forms of Treatment Tctal number treated Under the Authority's Scheme, in Clinic or Hospital (See Note B) By Private Practitioner or Hospital, apart from the Authority's Scheme Total 1 2 3 4 5 i. ii iii. iv. i. ii iii. iv. i. ii. iii. IV. 28 3 37 — 6 2 3 1 34 5 40 1 1 81 (i)Tonsils only, (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme (1) Otherwise (2) Total number treated Residential treatment with education k esidential treatment without education NonResidential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (i i) Number of children treated — • — — — — 11 11 GROUP V.—DENTAL DEFECTS. (1) Number of Children who were:— Routine Age Groups Total Specials Grand Total 5 6 7 8 9 10 11 12 13 14 (z) Inspected by Dentist 310 362 318 318 344 243 13 12 13 4 1937 1216 3153 20 (ii) Found to require treatment 2742 (iii) Actually treated 1332 (2) Half-days devoted to:— Inspection 14 Treatment 115 — 129 18) Attendances made by children for treatment 1554 (4) Fillings:— Permanent teeth 394 Temporary teeth – — 394 (5) Extractions:— Permanent teeth 411 Temporary teeth 1658 — 2069 (6) Administrations of general anaesthetics for extractions 1072 (7) Other operations:— Permanent teeth 43 Temporary teeth — — 43 GROUP VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (1) Aerage number of visits per school made during the year by the School Nurses, 7. (2) Total number of examinations of children in the Schools by School Nurses, 14, 214. (3) Number of individual children found unclean, 243. (4) Number of children cleansed under arrangements made by the Local Education Authority, none. (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921, none. (b) Under School Attendance Byelaws, none. ???