URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1936 BY A. WALLACE 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 1936 BY A. WALLACE JOHNS, M.R.C.S., L.R.C.P., D.P.H. Arrangement of Report. Section Page A Statistics and Social Conditions of the Area. 1. General Summary of Statistics. (a) General 6 (b) Births 6 (c) Deaths 6 (d) Infant Mortality7 (e) Vital Statistics of District 8 (f) Causes of Death 9 (g) Birth Rates, Death Rates and Analysis of Mortality 10 2. Population 11 3. Births 11 4. Deaths 11 5. Maternal Mortality 11 6. Infant Mortality 12 7.Natural and Social Conditions of the Area 13 8. Unemployment figures and comments 14 9. Riverside Gardens 14 B Maternity and Child Welfare Services. 1. The Maternity and Child Welfare Scheme 15 2. Notification of Births 15 3. Child Welfare Centres 15 4. Home visits by Health Visitors 17 5. Maternity Services 17 (a) Maternity Home—Hainault 17 (b) Ante-natal Clinic 17 (c) Abnormal Cases 17 6. Infant Life Protection 18 7. Midwives 18 8. Maternity and Nursing Homes 18 9. Nursing in the Home 18 (a) General 18 (b) Infectious 19 10. National Society for the Prevention of Cruelty to Children 19 C Prevalence of and Control over Notifiable Infectious Diseases. 1. Infectious Diseases Hospital 19 2. Tables (a) Notifications 19 (b) Age Distribution 20 i Section C (Continued). Page 3. School Incidence of Infectious Disease 21 4. Comments on : (a) Diphtheria 22 (b) Scarlet Fever 22 (c) Enteric Fever 22 (d) Measles 22 (e) Puerperal Fever and Puerperal Pyrexia 22 (f) Ophthalmia Neonatorum 22 (g) Smallpox 23 5. Disinfection of premises after Infectious Disease 23 6. Laboratory Facilities 23 7. Tuberculosis. (a) Treatment and Hospital tion 23 (b) Table (i) Particulars of new cases and deaths 24 (ii) Quarterly Statements 25 8. Consultations with local Medical titioners 26 9. Arrangements for operations for Ear, Nose and Throat conditions 26 10. Clinics and Treatment centres 27 D Hospital Facilities. 1. General 28 2. Venereal Diseases 28 3. Children 28 4. Ambulance Facilities 28 E Sanitary Circumstances of the Area. 1. Collection and Disposal of House Refuse 28 2. Trade Refuse 29 3. Water Supply 29 4. Drainage and Sewerage 29 5. Closet Accommodation 30 6. Swimming Baths 30 7. Hop Pickers 30 8. Inspection of Schools 30 9. Rag Flock Act 30 10. Smoke Abatement 30 11. Health Education—Rat Week 30 12. Cleansing of Verminous Persons 30 ii Section E (continued). Page 13. Housing: (a) Fitness of Houses 31 (b) Unhealthy Areas 31 (c) Overcrowding & General Observations 31 F Inspection and Supervision of Food. 1. Meat Inspection 32 2. Slaughter of Animals Act, 1933 33 3. Milk 33 4. Other Foods 34 5. Offensive Trades 34 G Sanitary Inspection of the Area. 1. Routine Visiting 35 2. Nuisances and defects remedied during year 35 3. Housing Inspections. (a) Number of new houses erected 36 (b) Inspection of dwelling houses 36 (c) Remedy of Defects 36 (d) Action under Statutory Powers 36 4. Factories, Workshops and Workplaces 38 H General. 1. Letter by Medical Officer of Health 2 2. Members of Committee 4 3. Staff of Public Health Department 5 4. Legislation 39 iii 2 H(l). 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 31st December, 1936. The Registrar General's Statistical Figures, a summary of which will be found on page 6, show that our population has now reached 36,380, and from the number of houses still being erected this increase is likely to be maintained. These statistics confirm other evidence we have of the steady expansion of the District, and the consequent necessity for expansion of services. During the year it was necessary to augment the refuse collection service by the purchase of a new 12 yard refuse vehicle. The need for extended School Medical and Maternity and Child Welfare Services found expression in the construction of a new Clinic at Bedonwell Hill, which at the time of writing is nearing completion. Extensions of arrangements in the several branches of my Department were effected. New legislation recently introduced by Parliament, particularly the Housing Act, 1936, has thrown additional duties and responsibilities on this Department. Details of the Housing situation in the District will be found in the body of the report. With regard to the apparent satisfactoriness of the position regarding overcrowding, in the District, it is well to remember that the standard of overcrowding laid down in the Act was a very low one, for the reason we are told, that it was thought that a higher standard might not have been workable. It may be that, as overcrowding is abated and conditions improve, a higher standard will be introduced. 3 Comment has been made on various statistical figures in the appropriate paragraphs, it is sufficient here to mention that the death rate is lower than that for the Country as a whole, and slightly lower than that for towns of similar size, and that during the year under review the population has maintained a good standard of health. I again offer my thanks to the Members of the Council for their interest and help in the work of my Department, and I wish to record my appreciation for the loyal help and co-operation of all the Members of my Staff. I am, Your obedient Servant, A. WALLACE JOHNS, Medical Officer of Health. May, 1937. 4 H(2). Health and Buildings Committee. Chairman—Late Councillor Watson. Acting Chairman—Councillor Grant. Councillor Bates. Councillor Selfe. ,, Ebben. ,, Wilson, J.P. ,, Munns. ,, Wilkinson. Maternity and Child Welfare Committee. Chairman—Councillor Emes. Councillor Bates. Councillor Grant. ,, Crimes. ,, Mrs. Nichols. „ Dunkley. ,, Woodcock. Co-opted Members. Mesdames Grant, Munns and Reeves. 5 H(3). STAFF. 1. Whole-time. Medical Officer of Healthy 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., D.P.H. (1) Senior Sanitary Inspector— D. A. Pearson, Certificate of Royal Sanitary Institute. (1) Sanitary Inspector— S. C. Smith, Certificate of Royal Sanitary Institute. (1) Meat Inspector's Certificate. (Resigned November, 1936.) W. E. Moses, Certificate of Royal Sanitary Institute. (1) Meat Inspector's Certificate. (Appointed December, 1936.) Sanitary Foreman and Disinfecting Officer— H. W. Cooper. 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 P. Jay, S.R.N. Sister-in-Charge, Maternity Home— Miss M. Gambrill, S.R.N., S.C.M. Clerks— Chief Clerk—A. W. Razzell (Resigned November, 1936). H. M. Coles (Appointed November, 1936). Miss O. Reeves. (1) R. C. Durey. 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—Maternitv 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. 6 SECTION A.—STATISTICS AND SOCIAL CONDITION OF THE AREA. Annual Report, 1936. A(l). SUMMARY OF STATISTICS. A(l)a. General. Area.—4,607 acres. Population.—36,380. (Estimated 1936.) Density of population, i.e., number of persons per acre.—7.89. Number of inhabited houses.—9,444 (as per Rate Book)* Rateable value, 1936.—£265,711. Sum produced by a penny rate. 1936.—£1,040. A(l)b. Births. TOTAL. Male. Female. Live Births. Legitimate 488 258 230 Illegitimate 22 9 13 510 267 243 Live birth rate per 1,000 of population (1936 estimated). —14.18. Corresponding rate for 1935—14.6. TOTAL. Male. Female. Still Births. Legitimate 18 12 6 Illegitimate — — — 18 12 6 Still Birth rate per 1,000 total births.—35,294. A(l)c. Deaths. Males 255. Females 157. Total 412. Death rate per 1,000 of population (estimated 1936).— 11.324. Corresponding rate for 1935.—10.06. Number of women dying in, or in consequence of, childbirth—1. Maternal Mortality per 1,000 total registered births—1.96. 7 A(l)d. Infantile Mortality. Deaths of infants under one year of age. TOTAL. Male. Female. Legitimate 29 21 8 Illegitimate 1 — 1 30 21 9 Death rate of infants under one year of age per 1,000 live births.—58.82. Total number of deaths from : 1935 1936 Measles (all ages) — 6 Whooping Cough (all ages) — 2 Diarrhoea (under 2 years) 5 — 5 8 8 A(l)e. Vital Statistics of Whole District during 1936 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 District Uncorrected Number Nett of Nun-residents registered in the District of residents not registered in the District Under 1year of 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 l6l 45 82.44 419 12.53 1930 33.420 456 488 14.60 209 6.25 6 145 32 65.5 348 10.4 1931 32,920 432 492 14.94 253 7.67 10 119 37 75.2 362 10.99 1932 34,250 486 475 13.8 236 6.89 13 137 30 63.1 360 10.51 1933 34,950 514 492 I4.07 262 6.95 17 142 35 71.1 387 11.00 1934 35,020 531 481 13.7 230 6.56 18 140 21 43.6 347 9.9 1935 35,760 572 525 I4.6 212 5.93 10 158 21 40.0 360 10. 06 1936 36,380 580 510 14.18 243 0.67 17 186 30 58.82 412 11.324 9 A(l)f. Table showing Summary of Causes of Death during the year ended 31st December, 1936. Cause of Death Males Females Total 1 Typhoid Fever, etc. — — — 2 Measles 4 2 6 3 Scarlet Fever — — — 4 Whooping Cough 1 1 2 5 Diphtheria 1 — 1 6 Influenza — 1 1 7 Encephalitis Lethargica — — — 8 Cerebro-spinal fever 1 — 1 9 Respiratory Tuberculosis 18 17 35 10 Other Tuberculosis 2 3 5 11 Syphilis — — — 12 General paralysis of insane, etc. 1 — 1 13 Cancer 23 27 5o 14 Diabetes 4 2 6 15 Cerebral haemorrhage 9 7 16 16 Heart disease 61 43 104 17 Aneurysm 2 1 3 18 Other circulatory diseases 21 13 34 19 Bronchitis 5 4 9 20 Pneumonia 24 6 30 21 Other respiratory diseases 2 1 3 22 Peptic ulcer 7 1 8 23 Diarrhoea, etc. (under 2 years) — — — 24 Appendicitis 1 _ 1 25 Cirrhosis of liver — 2 2 26 Other liver diseases 2 1 3 27 Other digestive diseases 10 2 12 28 Nephritis 8 3 11 29 Puerperal sepsis — — — 30 Other puerperal causes — 1 1 31 Congenital causes, etc. 11 3 14 32 Senility 4 1 5 33 Suicide 3 — 3 34 Other violence 14 3 17 35 Other defined causes 16 11 / 27 36 Ill-defined causes — 1 1 Total All Causes 255 157 412 10 A(l)g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1936. Provisional figures. The mortality rates for England and W ales reftr to the whole population, but for London and the towns to civilians only Rate per 1,000 total population Annual Death-rate per 1.ooo population Rate per 1000 live Births Live Births Still Births All Causes Enteric Fever Small-pox Measles Scarlet Fever Whooping Cough Diphtheria Violence Influenza Dianhcea & 1 mentis (under Two years) Total Deaths under one year England and Wales I48 0.6l 12.1 0.01 0.00 0.07 O.01 0.05 0.07 0 52 0.14 5.9 59 122 County Boroughs and Great Towns, including London I4.9 0. 67 12.3 0.01 0.00 0.09 0.01 0.06 0.08 0.45 0.14 8.2 63 143 smaller towns (1931) adjusted populations 25,000—50,000 150 O.64 11.5 0.00 0.00 0.04 O.01 O.O4 0.05 0.39 0.15 3.4 55 London 136 0.53 12.5 0.01 0.00 0.14 O.OI 0.06 0.05 0.52 0.14 14.4 66 Erith (Estimated population 35,760) 14.18 0.49 11.324 0.0 0 00 0I65 0.00 0.054 0.027 0.548 0.027 0.00 58 11 A(2). Population. It will be seen from the summary of statistics that the Registrar General's estimate of the population of the District for the middle of 1936, was 36,380, an increase of 620 over the figure for the previous year. 755 houses were erected during the year, so that building activity does not yet show signs of exhaustion. A(3). Births. The birth rate has maintained approximately the same level as last year. While the total number of births—510 as compared to 525 last year—is approximately the same, the total illegitimate births is 18, actually the same figure as last year. A(4). Deaths. The total number of deaths was 412, 255 being males and 157 females. This is after allowing for inward and outward transfers. The Death Rate for 1936 is 11.324. This again shows a slight increase over last year, and the increase in total deaths producing this rate will be seen to be 52. The largest number of deaths attributed to one cause was due to Heart Disease, accounting for 104. The next most common cause was Cancer accounting for 50. These figures closely follow figures recorded in previous years and they present no unusual features. A(5) Maternal Mortality. The Maternal Mortality rate for England and Wales as a whole, remains steady at about four per thousand births. One death was recorded in Erith during 1936, giving a maternal mortality rate of 1.773. 12 Since 1920 there have been 8,813 births with 24 maternal deaths, as shown below, giving a Maternal Mortality rate of 2.723. Year M iternal Deaths Total Births (including still births) Registered Live Births 1921 3 735 717 1922 3 644 621 1923 1 623 595 1924 1 558 526 1925 — 602 548 1926 3 546 497 1927 — 532 532 1928 3 513 513 1929 1 558 547 1930 2 505 488 1931 — 501 492 1932 2 491 475 1933 1 502 492 1934 1 498 481 1935 2 544 525 1936 1 580 564 Total 24 8932 8813 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. A(6). Infant Mortality. 30 infants died before reaching one year of age, giving an infant mortality of 58.82. The comparable figure for the whole country is 59. The fact that this figure would be high, was forecast in the early part of the year, when we were experiencing an excessive prevalence of infectious disease. 18 Analysis of the causes of death of this age group reveals the following figures : — Deaths from 1936 1935 Pneumonia 7 3 Whooping Cough 2 — Bronchitis 1 — Neo-Natal 14 16 Other causes 6 4 30 23 The figures bring out the large share that neo-natal deaths (deaths of infants under one month) play in contributing to the infant mortality rate. It is this group that will have to be reduced before any further serious reduction in our infant mortality rates can be achieved. The effect on this figure, of the new midwifery service under the Midwives Act, 1936, will be an interesting speculation, when this service has reached maturity. I have included a table showing the Infant Mortality at 5 year intervals for the past 25 years and for 1936. Erith England and Wales 1910 7091 130 1915 73.17 91 1920 61.5 83 1925 56.48 75 1930 61.05 66 1935 40.0 59 1936 58.8 59 A(7) Natural and Social Conditions of the Area. Erith is situated south of the river Thames, adjoining the County of London on the West and the Urban Districts of Crayford on the East, and Bexley on the South. A large number of the population are employed in the several large factories, situate in the neighbourhood. The principal industries being Cable Making, Oil Refining, and the manufacture of Mining and Electrical Machinery, Asbestos and Cement Slabs. 14 The District has a frontage to the river of about 6 miles. The northern part lying alongside the river, is mostly below the level of high tide in the river, and is marshy. The southern portion rises fairly rapidly to about 200 feet above sea level. In parts of the Area, new estates of the residential suburban type, have been growing up in the past few years, with a socalled "dormitory population." A(8). Unemployment Figures and Comments. A further most gratifying reduction has again occurred in the unemployment figures for 1936. The increase in employment has again occurred mainly in the adult male group, there being very little alteration in the adult female group, and the December 1936 figure for the adult male group is nearly half the figure of two years before. It is hoped that this reduction will continue during 1937. It has been pointed out before that it is the reduction in unemployment of male adults that is most desirable. It has happened, that new industrial undertakings come into a District, and take on a large number of young persons between the ages of 16 to 18 years, thus reducing the total unemployment figures, but not affecting the adult males, which from the social point of view is the important group. Furthermore to employ the young person until the age of 18 and then to expose him to long periods of idleness, sometimes almost permanent, is of no benefit to the person or the community. The following table shows, in figures, this reduction as against the figures for 1934 and 1935 :— Adults Young Persons Men Women Men Women Total December, 1934 926 113 62 33 1134 December, 1935 784 128 27 37 976 December, 1936 514 101 19 14 648 A(9). Riverside Gardens. During the year a scheme was conceived to secure some of Erith's river frontage for pleasure grounds and it was proposed to purchase the piece about 200 feet in length which included Cannon & Gaze's flour mill and extends from The Causeway to opposite Walnut Tree Road. 15 SECTION B.—MATERNITY AND CHILD WELFARE SERVICES. B(l). The Maternity and Child Welfare Scheme is comparatively a complete one, and provides the following services : — 1. Ante-natal clinic—one session per week (shortly to be increased to two per week when the new clinic at Bedonwell is opened). 2. Provision of an Obstetric consultant for difficulties and emergencies arising during pregnancy and labour. 3. Hospital provision for cases of Puerperal Pyrexia and Ophthalmia Neonatorum. 4. Provision of Free Milk for necessitous expectant, and nursing mothers. 5. Provision of sterilised maternity outfits at cost price, or free to necessitous cases. 6. Provision for dental treatment of children under school age and nursing and pregnant women at a clinic held fortnightly at the School Dental Clinic. 7. Three Infant Welfare Centres holding 10 sessions per month. (Shortly to be increased by 4 per month when the new Clinic at Bedonwell is opened). Provision for Orthopaedic treatment for children under school age, is provided for in a scheme now under consideration by the Council. B(2). Notification of Births. During 1936, 564 live births and 16 stillbirths, giving a total of 580, were notified to me. Of these, 458 were notified by midwives and 122 by doctors and other persons. In every case where a birth is registered and has not been notified, the responsible person is requested to furnish an explanation. All still births and deaths of children under the age of 5 years are investigated by the Health Visitors. B(3). Child Welfare. The basis of child welfare facilities in the Erith Urban District is a system of, two clinics held on one half-day a week, and one clinic held on one half-day a fortnight, in various parts of the town. It is proposed to establish two more weekly clinics, an ante-natal and an infant welfare, at the new clinic now in process of erection at Bedonwell Hill. Each infant welfare clinic is attended by a Medical Officer, two Health Visitors, and one clerk. The Health Visitors weigh each child who attends, advise mothers in certain cases and refer others to the Medical Officer for consultation, as 16 shown in Table set out below. The work of the infant welfare centre is for the most part advisory, and any ailments of serious nature are referred to the private medical practitioner or to a hospital for treatment. Dried milks are supplied to the mothers, on the advice of the Medical Officer, as a rule at cost price, but where the family income falls below a stated figure, milk may be provided either at half cost or free. Infant Welfare Centres. Month Belvedere Erith Picardy Infants weighed Consultations Infants weighed Consultations Infants weighed Consultations Under I year 1 to 5 years Under i year I to 5 years Under I Year I to 5 years January 189 80 42 195 56 47 26 19 11 February 216 105 49 175 58 46 31 32 15 March 304 168 71 232 101 76 33 33 19 April 212 103 60 165 57 46 44 24 22 May 292 145 61 201 98 37 41 38 18 June 258 145 62 206 102 60 69 14 24 July 249 130 80 215 95 55 38 34 23 August 189 94 43 197 80 33 52 30 21 September 321 182 89 185 79 51 43 30 23 October 236 138 64 180 65 50 42 27 11 November 223 124 70 234 163 64 29 20 11 December 191 94 58 107 37 27 40 29 21 Totals 2880 1508 749 2292 991 592 486 330 219 4388 3283 816 Grand Total—Infants Weighed 8,478. Consultations 1,560. Under 1 year 5,658. 1—5 years 2,829. 17 B(4). Home Visits by Health Visitors. Children Special Visits Infant Life Protection Total Visits 1936 1st Visits ReVisits StillBirths Others Expectant Mothers January 45 900 3 4 34 7 993 February 46 693 2 20 20 1 782 March 31 812 3 8 15 8 877 April 48 742 — 8 12 6 816 May 35 873 3 5 20 11 947 Tune 38 752 1 6 24 5 826 July 88 1152 3 7 50 8 1308 August September 43 817 1 — 37 6 904 October 48 801 2 - 16 5 872 November 49 715 — — 24 3 791 December 49 593 1 3 22 8 676 Total Visits 520 8850 19 61 274 68 9792 B(5). Maternity Services. B(5)a. Maternity Home. The Council provides a maternity home of 7 beds, including one isolation bed. The staff consists of a Sister-in-Charge, a Junior Sister, and two midwives. Institutional treatment for normal cases is provided, and during the period under review, 125 maternity cases were admitted. B(5)b. Ante Natal Clinic. lhe work in the existing Ante-natal clinic has again increased during the year the total number of attendances being 1,250 as shown below. Ante-natal patients seen by Dcctor 1936 Jan. Feb. Mr. Apr. May June July Au^ Sep. Oct. Nov Dec. Total 120 110 95 115 97 98 108 75 75 130 103 124 1250 B(5)c. Abnormal Cases. Accommodation for abnormal maternity cases, in need of hospital treatment, is now provided at the City of London Maternity Hospital, and nine cases were admitted under this arrangement during the year. 18 The conditions for which they were admitted were as follows:— Ante partum hæmorrhage 4 Trial Labour 3 Extended Breech 1 Cardiac Insufficiency 1 Total 9 B(6). Infant Life Protection. The Health Visitors are responsible for the general execution of Infant Life Protection work, under Part I of the Children Act, 1908, as amended by Part V of the Children & Young Persons Act, 1932. As a general rule they undertake routine visiting in their own districts. Cases in which medical examinations are required, or when doubt arises, are submitted to the Medical Officer of Health. Information with regard to foster children is obtained from the following sources :— 1. By Health Visitors in the course of Routine Visits. 2. By scrutiny of advertisements in the local newspapers, etc., and explanatory leaflets are available for the guidance of foster mothers upon application to the Public Health Department. Number of foster mothers on register at end of year 18 Number of children on register at 31st December, 1936 22 During the year frequent visits were paid to foster children, and in no case was it found necessary to take legal action against any foster parent. B(7). Midwives. 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 the County Council will employ and supervise midwives working in this area. B(8). Maternity and Nursing Homes. At present there are two registered Nursing Homes in the district. No applications for registration were received during the year. B(9). Nursing in the Home. B(9)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 19 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(9)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. B(10). National Society for the Prevention of Cruelty to Children. An account of the Welfare Work of the Department would be incomplete without a mention of the splendid work of and, the valuable assistance given by, the National Society for the Prevention of Cruelty to Children. Cases coming to the notice of the Medical Officer of Health are referred to the local inspectors. SECTION C.—PREVALENCE OF AND CONTROL OVER NOTIFIABLE INFECTIOUS DISEASES. C(l). Infectious Diseases' Hospital. The Erith Urban District Council provides its own Isolation Hospital. A large portion of admissions are cases of Scarlet Fever and Diphtheria, but any notifiable infectious disease is admitted, with the exception of smallpox and puerperal infections, special arrangement for which are described elsewhere in this report. Cases of measles are admitted during epidemic times. C(2). Tables. C(2)a. Notifications. The following table shows the total notifications received during the year 1936 : — Disease Total cases notified Cases admitted to infectious diseases hospital TotaJ Deaths Diphtheria 40 38 1 Scarlet F. 49 46 — Erysipelas 10 — — Pneumonia 47 3 30 Puerperal P. 8 — — Puerperal F. 2 — 1 Oph. Neon. 1 — — Enteric 4 2 — Meningitis 1 - 1 20 C(2)b. Age Distribution. This second table shows, in detail, the age distribution of the notified infectious diseases mentioned above Disease Age Groups Totals under 1 1 2 3 4 5 10 15 20 35 45 65 over 65 Diphtheria — — — - 2 4 15 10 2 7 — 40 Scarlet F. — 2 1 5 5 4 19 2 5 5 1 - — 49 Erysipelas — — — — — — — — 2 1 — 7 — 10 Pneumonia 2 3 5 4 — 5 5 2 2 2 — 13 4 47 Puerperal P. — — — — — — — 1 6 1 — — — 8 Puerperal F. — — — — — — — — 2 — — — 2 Oph. Neon. 1 — — — — — — — — — — — — 1 Enteric — 1 — — — — 1 1 1 — — — — 4 Meningitis - - - - - - - - - - - - - 1 Totals 3 6 6 9 7 13 41 16 20 16 1 20 4 162 21 C(3). School Incidence of Infectious Disease. The following Table gives in detail the prevalence of certain notifiable Infectious Diseases in each of the Schools in the District, along with the number of cases above and below School age (5 years). School Accommoda tion Diphtheria Scarlet Fever Typhoid Total Senior Boys. North. Heath 560 1 — — 1 Picardy 480 1 — — 1 Senior Girls. North. Heath 560 2 1 — 3 Picardy 480 1 1 - 2 Junior Boys. Manor Road 238 1 1 - 2 North Heath 200 3 - - 3 St. Augustine's Road 350 1 - - 1 Junior Girls. West Street 300 4 - - 4 Crescent Road 238 2 2 — 2 North. Heath 200 — — — 2 St. Augustine's Road 350 3 1 - 4 West Street 300 2 - — 2 Junior Mixed. Bedonwell Hill 290 - 2 1 3 All Saints C. of E. 130 - 7 - 7 Junior Mixed and Infants. Crossness 150 1 1 - 2 Mixed and Infants Infants. St. Fidelis R.C 193 1 — — 1 Bedonwell Hill 240 — — — — Belvedere 150 - — - — Crescent Road 200 — — — — North. Heath 406 2 — — 2 St. Augustines Road 350 - - - - West Street 350 — 2 — 2 Totals 6715 25 18 1 44 Private and other Schools. Males — 4 — 4 Females — 1 — 1 Schools out of Town Males — — — — Females — — 1 1 Under School Age Males 2 6 - 8 Females 1 8 1 10 Over School Age Males 6 7 1 14 Females 6 5 — 11 Totals 15 1 3 49 Grand Totals 40 49 4 93 22 C(4). Comments on:— C(4)a. Diphtheria. The incidence of Diphtheria has been considerably below that for 1935, and there has been no grouping of cases. The type of Diphtheria was not unduly severe and there was no special incidence in any school. C(4)b. Scarlet Fever. Although the number of cases of Scarlet Fever was slightly above those occurring during 1935, there was no epidemic. Cases of Scarlet Fever occurred sporadically throughout the year, and never in such concentration that it was possible to trace severe cases to a common source of infection. Of the 49 cases notified 46 were admitted to hospital for treatment. C(4)c. Enteric Fever. Four patients were notified to be suffering from Typhoid Fever, of this number two were admitted to the Sanatorium for treatment. C(4)d. Measles. This condition is not notifiable in this district. From school attendance records it is observed that, in common with other parts of the Metropolitan district, Erith suffered from an epidemic of Measles during January, February, March and part of April, 1936. Hospitalisation was called for in a number of cases, and during the year this complaint accounted for six deaths. C(4)e. Puerperal Fever and Pyrexia. Eight cases of Puerperal Pyrexia and two cases of Puerperal Fever were notified during the year. Arrangements have been made to secure admission of these patients either to Queen Charlotte's Annexe or to the North Western Hospital, which is controlled by the London County Council, except when the patient's own practitioner arranges for treatment elsewhere. Under the Public Health (Puerperal Fever) Regulations, a Consulting Obstetrician, Mr. A. Galletly, is available for assistance to Medical Practitioners within the area. His services were requested on one occasion during the year. C(4)f. Ophthalmia Neonatorum. One case was notified, during the year, which was treated as an Out-patient at the Royal Eye Hospital, vision was not impaired in this instance. 23 C(4)g. Smallpox. An arrangement exists between the London County Council and the Erith Urban District Council for accommodation for cases of smallpox occurring within the District. C(5). Disinfection. The Sanitary Foreman also acts as Infectious Disease Enquiry Officer and Disinfecting Officer. Following the removal of cases of infectious disease, tuberculosis, etc., 203 premises were disinfected, whilst enquiries to obtain particulars regarding 51 cases of tuberculosis were undertaken. The Council have a high pressure steam disinfector at the Isolation Hospital, at which clothing, bedding, etc., are disinfected, in addition to the disinfections carried out for the hospital itself. C(6). Laboratory Facilities. Examination of pathological specimens, and other laboratory work for the District, are undertaken by the Kent County Laboratory, Sessions House, Maidstone. During 1936, 222 specimens were sent, as shown below:— Nature of Specimen sent Result Total Positive Negative Swabs for Diphtheria 10 91 101 Sputum for suspected Tuberculosis 35 74 109 Various 3 9 12 48 174 222 C(7). Tuberculosis. C(7)a. Treatment and Hospital Accommodation. The Kent County Council are responsible for cases of Tuberculosis occurring within the district, and also for Sanatorium treatment and hospital accommodation for Erith residents. A dispensary is held twice weekly at 65 Bexley Road, Erith, by a whole-time Tuberculosis Officer. 24 In the tables which follow, particulars of new cases of Tuberculosis and of all deaths from the disease in the area, during 1936, are shown in Table 1, whilst Table 2 shows the quarterly statements of cases on the register, together with the position at the 31st December, 1936. It will be seen that there is an increase in the number of deaths from Tuberculosis. Reference to Table 1, page 24, shows that among the Females the age periods 25 to 35 inclusive, show the highest mortality. This is a fact which has already been noted in statistics for the whole country and one which is receiving the attention of all engaged in Tuberculosis work. The heaviest mortality among the Males is in the age periods 45 to 55. C(7)b. Table (i). Particulars of new cases and deaths. 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 — — — — — — — — 5 — — 2 — — — — — 10 1 — — — — 1 — 15 4 2 1 — 1 1 — 1 20 5 4 1 — 1 3 — — 25 3 11 1 1 2 3 — 1 35 5 — — — 3 3 1 1 45 6 3 — — 6 2 1 — 55 * — — — 4 3 — — 65 & upwards 1 — — — 1 1 — — Totals 28 20 5 1 18 17 2 3 25 Table (ii). Quarterly Statements. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter M F T M F T M F T M F T Pulmonary T.B. Number on register 173 163 336 179 167 346 181 168 349 185 170 355 New notifications during year 7 4 11 8 5 13 9 6 15 4 5 9 Cases removed, which have been restored — 1 1 — — — — — — — — — Cases added to register other than by notification 2 2 4 — 3 3 — — — — 1 1 Cases removed from register 3 3 6 6 7 13 5 4 9 11 5 16 Cases remaining on register 179 169 346 181 168 349 185 170 355 178 171 349 Non-Pulmonary T.B. Number on register 81 67 148 84 67 151 85 66 151 85 64 149 New notifications during year 3 — 3 1 1 2 1 — 1 — — — Cases removed, which have been restored — — — — — — — — — — — — Cases added to register other than by notification — — — — — — 1 2 3 — — — Cases removed from register — — — — 2 2 2 4 6 — — — Cases remaining on register 84 67 151 85 66 151 85 64 149 85 64 149 Total Pulmonary and Non-Pulmonary cases on Register at end of year 498 26 C(8). Consultations with local Medical Practitioners. It is pleasing to record that the relationship between officers of the Health Department and private practitioners is characterised by mutual trust and respect. Practitioners invite the opinion of the Medical Officer of Health in connection with the diagnosis of Infectious Diseases, and by such action greatly facilitate the work of the department. It has been the policy of the department to encourage such a course in every way. As the Medical Officer of Health is also the School Medical Officer complete co-ordination with the Education Department is assured, while after-supervision either by the family doctor or the School Medical Officer is encouraged in every way. C (9). 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. 27 C(10). Clinics and Treatment Centres. Clinics and Treatment Centres. Address. Medical Officer in Attendance. Day and Time. Accommodation. Provided by Ante Natal Clinic Hainault, Lesney Park Road M.O.H. Thursdays 2—4 Two rooms Erith U.D.C. Infant Welfare Centres (1) Hainault, Lesney Park Road. Assistant M.O.H. Mondays 2—4 Four rooms „ „ (2) Belvedere Public Hall. (3) Primitive Methodist Church, Belvedere Assistant M.O.H. M.O.H. Tuesdays 2—4 1st and 3rd Wed. 2—4 Three rooms „ „ 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. Daily at 9.15 Two rooms „ „ (2) All Saints' Schools. School Nurse Tuesdays 9.30 One room „ „ Ophthalmic Clinic Hainault, Lesney Park Road Mr. N. Howard Allen, M.R.C.S., L.R.C.P. 1st and 3rd Wed 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 and Ockwell. Men. Mondays 4.30 to 6.30 Wed'sdays 5—6 Women. Tuesdays 4—6 „ „ 28 SECTION D.—HOSPITAL FACILITIES. D(1). General. Situated within the area is a hospital of 41 beds which is maintained by voluntary efforts, the building is well equipped and has a visiting staff of local medical practitioners. The special departments are attended by a specialist consultant staff. The services of the large General and Special Hospitals in London are readily accessible to residents in this area. D(2). Venereal Diseases. A Venereal Diseases clinic for this area is held at Dartford and is provided by the Kent County Council. D(3). Children. A ward of 10 beds is provided at the Erith and District Hospital, whilst special hospitals in Woolwich and other parts of London are easily accessible. D(4). Ambulance Facilities. The Ambulance service is under the control of the Captain of the Fire Brigade, and is carried out by a full-time staff. Four ambulances are kept for non-infectious or accident cases and one for the removal of Infectious cases. SECTION E.—SANITARY CIRCUMSTANCES OF THE AREA. E(l). Collection and Disposal of House Refuse. During the year, the Council purchased a new Dennis refuse collecting vehicle, with a capacity of 12 cubic yards. This new addition to the existing fleet of vehicles has increased the efficiency of the service. A weekly collection of house refuse is carried out by the Council who now have a fleet of house refuse collection vehicles as follows:— Vehicle Capacity 1 Dennis Lorry 12 cubic yards 2 Easyloaders 4 „ „ 2 S.D. Freighters 7 „ „ These are operated by— 1 Foreman, 5 Drivers and 9 Loaders. 29 The method of storage is by means of sanitary dust-bins, and some 9,000 are emptied weekly. The dust-bins are provided and maintained by the owners of the properties concerned, the Council securing this by a local act—The Erith Improvement Act, 1920. Disposal is effected by barging under contract, and these arrangements are still working very satisfactorily. The following table shows the weight of refuse collected during the year:— Month Tonnage Tons Cwts. January 711 14 February 613 6 March 652 ll½ April 647 2 May 618 4 June 575 11½ July 637 7½ August 549 11 September 644 2½ October 705 1 November 682 5 December 748 11 Total 7585 7 The total tonnage dealt with, as shown above, was 7,585 tons 7 cwts. E(2). Trade Refuse. Trade Refuse is collected from the shops by arrangement with the shopkeepers, an agreed charge being made, or it is brought to the wharf by the traders themselves. E(3). Water Supply. 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 few 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. E(4). Drainage and Sewerage. Extensions to the existing drainage system were made, during the year, as follows:— 1,815 yards of new sewers. 4,350 yards of new drains. 30 Cesspools are emptied once a month by the Council free of charge, or more frequently as required, when a fee is charged to cover the cost of labour. E(5). Closet Accommodation. Approximately 9,325 water closets are connected with the main drainage system and 61 with cesspools. 57 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. E(6). Swimming Baths. An open air swimming bath is provided by the Council. The water is mechanically filtered and regularly sampled. During 1936, 2 samples were taken for examination and proved satisfactory. E(7). Hop Pickers. There are no hop fields within the district. E(8). 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. E(9). Rag Flock Act. There are no premises in the district in which rag flock is manufactured, used or sold. E(10). Smoke Abatement. There are no bye-laws in force in this district for dealing with smoke nuisances. During the year 9 investigations were made by the Inspectors. E(ll). Health Education. Rat Week was observed in Erith during the week commencing November 2nd. 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. E(12). Cleansing of Verminous Persons. No cleansing station is provided by this Authority. Cases requiring treatment can obtain it by arrangement with the Dartford Hospital. 81 E(13). Mousing. E(13)a. 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, 59 records were made of houses necessitating 562 inspections. In addition to these, 546 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. E(13)b. Unhealthy Areas. No action has been taken during the year under the provisions of the Housing Act, 1930, relating to Clearance Areas. E(13)c. Overcrowding and General Observations. The Overcrowding Survey, required by the Housing Act, 1935, was carried out under the direction of the Medical Officer of Health with temporary staff, employed by the Council. The Preliminary Survey revealed that 9,691 families were living in 8,200 houses and, that 116 cases of definite overcrowding had been found to exist within the district, giving a percentage of overcrowding for the area of 1.19. Out of the 116 overcrowded families, 53 were overcrowded by ½ a person only, a further 24 families by one person only, the remaining 39 being overcrowded by more than one person, as shown below:— Overcrowded by No. of Dwellings. ½ person 53 1 „ 24 1½ „ 14 2 „ 12 2½ „ 7 3 „ 3 3½ „ 1 4 „ 1 6 „ 1 116 32 At the time of carrying out the Survey there were 182 unoccupied premises in the district. General Observations. For the past 5 years, an average of 400 to 450 houses have been built every year by private enterprise. The amount of overcrowding in this district cannot be described as extensive and at the 31st December, 1936, 57 of the 116 cases of overcrowding referred to above had been abated, as shown in the following table, leaving 59 cases still to be dealt with. Overcrowding abated by No. of Cases Removal of sub-tenants or lodgers 17 Reduction in number of members of family 12 Allocation of Council Houses 4 Removal of tenants to other and adequate premises, etc. 13 Marriage or death of an occupant 9 Premises demolished 2 57 As far as the Housing (Overcrowding) Survey was concerned, at the 31st December, 1936, there remained the matter of issuing Permitted Numbers, recording and tabulating cases for review, i.e., cases where premises will become overcrowded during the course of time, or by reason of a child attaining either the age of one or ten years; checking up and obtaining particulars regarding newly-erected properties; and surveying properties which are owned by the occupiers. The Council are retaining the services of a Temporary Clerk for the execution of these duties. SECTION F.—INSPECTION AND SUPERVISION OF FOOD. Once again I have to report that the staff of the Public Health Department continue to take keen interest in this important branch of their work. F(l). Meat. Owing to the widespread situation of the slaughterhouses in the district, and irregular times of slaughter the present system of meat inspection leaves much to be desired. Supervision by the inspectors, however, has been carried out extensively during the year when 2 tons 4 cwts. 1 qr. 20 lbs. of food was condemned as unfit for human consumption. No legal action was taken by this Authority with regard to unsound meat during the year. 33 F(2). Slaughter of Animals Act, 1933. The Slaughter of Animals Act, 1933, makes the use of a mechanically operated instrument for stunning compulsory. Previous to the passing of the Act, the use of such an instrument was required and governed by the Council's Byelaws. During the year one person made application for a licence to slaughter or stun animals in compliance with the terms of the above Act, and was duly licensed. No. of licensed slaughtermen on register at 31st December, 1935 10 No. of slaughtermen licensed during 1936 1 No. of licences not renewed during 1936 1 Total number of licensed slaughtermen on register at 31st December, 1936 10 F(3). Milk. On the 1st June, 1936, a new order, the Milk (Special Designations) Order 1936 came into operation, which revoked the Milk (Special Designation) Orders of 1923 and 1934, and prescribed the following new special designations for milk. Tuberculin Tested. Milk from cows that have passed the tuberculin test for freedom from Tuberculosis. Tuberculin Tested (Certified). Tuberculin tested milk which is bottled on the farm. Tuberculin Tested (Pasteurised). Tuberculin tested milk which is also pasteurised. Accredited. Milk from cows that have passed a veterinary inspection but not a test for Tuberculosis and which may be bottled on the farm or elsewhere. Pasteurised. Milk that has been heated to 145 deg. Fah. and kept at this temperature for 30 minutes. The following tables show the number of licences issued by this authority, (a) Under the Milk (Special Designations) Orders 1923 and 1934 and (b) under the new Order of 1936. A Designation Number Certified Milk—Supplementaly licences 2 Grade A Tuberculin tested—do. 2 Grade A Milk — do 1 Grade A Pasteurised— do. 4 Pasteurised — do. 7 84 B Designation Number[/$$$] Tuberculin Tested B (Dealers) licence 1 Pasteurised B (Dealers) licence 1 Routine Inspection, of the fourteen Dairy and Cowshed premises within the district, has been carried out throughout the year, 119 visits having been paid for this purpose. Two Cowshed and Dairy premises were vacated and demolished during the same period. Samples of milk subjected to bacteriological examination show a high standard of cleanliness. F(4). Other Foods. Routine sampling under the Food and Drugs Acts is undertaken by the Kent County Council. The Inspector who takes samples under these Acts is also Inspector of Weights and Measures. Samples of any suspected foods taken by the Sanitary Inspector are submitted to the County Analyst for examination. F(5). Offensive Trades. In addition to the statutory Offensive Trades under the Public Health Act of 1875, Fish Frying, Extracting of Melting Fat and dealing in Rags and Bones were in 1912 declared by Order to be Offensive Trades within the District, and Byelaws have been made under this head. The only Offensive Trade carried out in the District is Fish Frying: there are 15 Fish Fryers carrying on business, and visits are frequently paid in order to ensure that the standard of cleanliness is maintained. Within the area of the Council's Town Planning Scheme, Offensive Trades may be carried on only in certain prescribed zones, and subject to obtaining the consent of the Council. SECTION G.—SANITARY INSPECTION OF THE AREA. The following tables summarize the work of the Sanitary Inspectors during the year. 35 C(l). Routine Visiting. Premises visited with the results of such visits:— No. in District No. of visits in 1935 No. of faults and defects found No. of Faults and defects remedied Bakehouses 10 16 2 2 Dairies 14 119 33 22* Slaughter Houses (licensed) 4 519 9 9 Other Food preparing places which are, as such, subject to inspection 24 67 4 4 Factories 15 16 25 25 Workshops II 9 Workplaces (other than Outworker's homes) 12 8 * 2 demolished C(2). Nuisances and Defects Remedied during the year (other than those enumerated in the above tabulation). Re Overcrowding 2 Re Keeping of Animals 3 Re Sanitary Accommodation Insufficiency — Other 97 Re Drainage Reconstruction 57 Do. Cleansing 135 Do. Other 73 Re Dustbins, &c. 242 Re Tents, Vans, Sheds, &c. 6 Re Smoke Abatement 9 Cesspools Abolished 57 ,, Repaired — Offensive Accumulations 19 Yard Paving 26 Dampness 91 Roofs and Rainwater Pipes 205 Floors 45 Walls and Ceilings 315 Windows and Ventilation 125 Baths, Lavatory Basins and Sinks 49 Water Supplies 9 Others 248 36 The total number of visits of all kinds paid by Inspectors during the year was 3,956. Notices served—Statutory, 15 ; Informal 468. Number of houses and other premises disinfected 203. Batches of clothing disinfected 14. C(3). Housing Inspections. C(3)a. Number of New Houses erected during the year. (1) By the Local Authority 22 (2) By other Local Authorities - (3) By other bodies or persons 733 C(3)b. Inspection of Dwelling Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 546 Number of Inspections made 2104 (2) Number of dwelling-houses (included under the preceding heading) which were inspected and recorded under the Housing Consolidated Regulations 1925 59 Number of Inspections made 562 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 546 G(3)c. 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 515 G(3)d. 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 7 37 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 6 (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 8 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 8 (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) Number of dwelling-houses demolished in pursuance of Demolition Orders 24 (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 — 38 G(4). Factories, Workshops and Workplaces. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises 1 Number of Inspections 2 Written Notices 3 Occupiers Prosecuted 4 Factories (including Factor} Laundries) 10 6 - Workshops (including Workshop Laundries) 9 2 - Workplaces (other than Oatworkers' premises) 8 I — Total 33 9 — . 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES Particulars Number of Defects Number of Prosecutions Found Remedied Refered to H M Inspector 1 2 3 4 5 Nuisances under the lic Health Acts:— Want of Cleanliness 4 4 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 3 2 — — Sanitary accomodation: Insufficient 11 11 — — Unsuitable or Defective 8 8 — — Not separate for sexes — — — — Offences under the Factory and Workshop Acts:— Illegal Occupation of underground bakehouse — — — — Other offences — — — — Total 25 25 — —— 39 H(4). 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. Pleasure Grounds Jan., 1936. 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, 31, 33 and 51 1912. Section 95 1928. Public Health Act, 1925, Sections 14—19, 21—28, 30—35, 38—44, 48—55 1927. URBAN DISTRICT OF ERITH. ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1936. 3 EDUCATION COMMITTEE. Chairman:—Councillor Bates. Vice-Chairman:—Councillor Ebben. Councillor Brierley. Councillor Wilkinson. ,, Dunkley. ,, Whinnerah. ,, Graham. ,, Woodcock. Councillor Mrs. Nichols. Co-opted Members: T. W. Fudger, Esq. F. J. Millard, Esq. Rev. W. R. Hartwright. Mrs. Norris. J. L. Miles, Esq. V. W. Tobin, Esq. SCHOOL MEDICAL STAFF. School Medical Officer: A. 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. 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. School Nurses: Mrs. Lange, s.r.n., Miss Briggs, s.r.n. Clerk : Miss M. Smith. 4 Report of the School Medical Officer. In accordance with the suggestions contained in Form 6M issued by the Board of Education, much of the subject matter of this Report, having been included in previous reports, is not repeated ; 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, infectious diseases discovered through absences from school and which are not notifiable are transmitted to the Health Department for following up, thereby ensuring that such outbreaks are controlled. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. Under the Authority of the Erith Education Committee there are 9 provided schools with 20 departments and one nonprovided school with one department. At the end of 1936 there were 4,876 children on the roll of the elementary schools, distributed as follows : Infant Schools 1353 Junior Mixed and Infant Schools 460 Junior Schools 1365 Senior Schools 1698 Special Schools 18 Some change has taken place, since my last report, in the dispensation of the schools and departments at Belvedere. The All Saints' School has been partly closed, and during the Autumn term of 1930, a new school was opened at Bedonwell Hill comprising a Junior Mixed and an Infants' Department. Accommodation has thus been found for scholars from the school which has been closed, and, for the children who have migrated into the district and who are living in the new estates which have sprung up in this particular part of the district. 5 Medical Inspection. The general routine medical inspection work has been carried out as in former years. These routine inspections are carried out during the afternoons, and, where possible, in the presence of the Head-teacher and the parent. The practice of examining three routine age groups has again been followed. FINDINGS AT MEDICAL INSPECTION. Malnutrition. Reference to Table IIb, in accordance with a memorandum issued by the Board of Education, will show that nutrition has been classified into four groups. It is gratifying to note that the standard of nutrition according to this table has considerably improved. The most marked change has occurred in the groups B (normal) and D (bad). While there has been a decrease percentage in number of children falling into the excellent class and no change in the slightly subnormal class, there has been a marked increase in percentage of children falling into the normal class, and a marked decrease in percentage of children falling into the bad class. Last year there were 109 children examined who fell into the D (bad) group. The figure for this year being only 16. Arrangements for supplying children with milk, both during school term and the holidays, continue to work satisfactorily. The value of adding milk to the child's diet in this way has been pointed out on previous occasions. Last year mention was made of the fact that parents are frequently afraid that the issue of this milk late in the morning will deprive the child of its appetite for the mid-day meal ; but the increased numbers of children taking the milk and the benefit the children derive should dispel this illusion. In some quarters the opinion has been expressed that the coldness of the milk renders it unpalatable to many children. Arrangements have therefore been made by means of a wire cradle fixed on the radiators in the schools to take the chill off before consumption. Below is set out a table showing the quantities of Malt and Oil distributed : Total amount issued 1168 lbs. Amount issued free 1129 lbs. No. of children receiving free issues 109 Amount sold at cost price 39 lbs. In addition to the above, 100 children were recommended for a supply of free milk at school, making a total of 169 children who are now participating in the Milk in Schools Scheme. 6 Provision of Meals. Mention has been made, earlier in this report, of the issues of free milk at the schools. In addition, foods, such as Cod Liver Oil and Malt, are provided free in necessitous cases. During the period under review, the scheme for the provision of free meals has received full consideration, and in cases where this assistance was thought desirable, the child concerned was referred to the Medical Officer at the School Clinic for examination and recommendation—14 children were supplied with meals, free of charge, for certain periods during the year. Uncleanliness. During 1936, 235 children were found to be verminous at inspections made in the schools by the School Nurses. While this figure again shows a slight improvement over the previous year's figure it is none the less a fact that it could be reduced, and that a small group of chronic offenders is largely responsible for its persistence. The figures are given in Table IV Group VI. Nose and Throat Defects. The number of individual defects are set out in Table II. As pointed out last year, 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. It will be observed from the following table, which shows the comparison year by year of the number of operations for the removal of Tonsils and Adenoids, that once again the numbers have decreased. Operations were performed on 61 children, 57 being under the Authority's scehme, whilst 4 done by private practitioners, were on the advice given at School Medical Inspection. Year Operation in Hospital under Authority's Scheme By Private Practitioners Total 1932 131 30 161 1933 132 17 149 1934 87 14 IOI 1935 . 63 12 80 1936 57 4 61 I am pleased once more to record the happy relations existing between the staff of the Royal Waterloo Hospital for Children and Women, and ourselves, with regard to operative treatment. 7 Ear Diseases and Defective Hearing. There was once again little variation in the numbers of children suffering from diseases of the ear. Reference to Table IV will show that 43 defects were treated during the year. Dental Defects. The extended dental scheme has been in operation since September, 1935, thus allowing a review, over a 12 month neriod, of the existing scheme. It will be noted upon reference to Table IV, Group V, that conservation work has received the fullest attention possible from the Schools Dentist, and, as predicted in my last report, the extraction conservation ratio, which was hitherto far too high, has now assumed a more reasonable proportion. Year. No. of fillings. 1931 215 1932 195 1933 178 1934 226 1935 (extended service in operation during last quarter of year) 394 1936 (first full year of extended service) 791 I have included the number of fillings done in previous years to show the result of the extended dental service which came into operation in September, 1935. The number of sessions devoted to school dental work was increased from 8 to 18 per month. It will be seen that about four times as much conservation work has been done under the new arrangement. As I have pointed out many times this conservation work must be regarded as the main function of the school dental service and extractions must not be allowed to reach such proportions as to interfere with this aim. 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 and Minor Ailment Departments have been carried on in conjunction. The children seen in the Ophthalmic Dept. being either 44 old cases " attending for periodic inspection, or new cases referred to the Ophthalmic Clinic on account of defective vision or Diseases of the Eye. At each Session appointments are made so that at each successive clinic 10 children attend for Refraction after having had the pupils of the eye dilated with a suitable mydriatic—these children are drawn from both old and new cases. 8 In addition to prescribing glasses, the children are treated for such diseases affecting the eye as Blepharitis, Corneal Ulceration, etc. Further, an important treatment which is carried out, is the correction of Squints and re-education of amblyopic or lazy eyes. Such cases as require operative treatment for squint have to be dealt with elsewhere. I have submitted forms which can be given to parents advising them regarding the method to be adopted in re-educating lazy eyes, also the best regime to follow in caring for the eyes in cases of Myopia. I am at present reviewing Myopics of such degree that special arrangements will be needed for their education. Orthopaedic and Postural Defects. Children found to be suffering from these conditions are referred for treatment usually to one of the London General Hospitals. A scheme has, however, been prepared during the year, by which arrangements for the treatment of these cases will be the direct responsibility of the Education Committee. At the time of writing this report the scheme has yet to be submitted to the Board of Education for their approval. Heart Disease and Rheumatism. Table II showsi that 17 cases of organic heart disease were observed, whilst the number of cases of functional heart disease was 142. Tuberculosis. The Kent County Council is responsible for the Tuberculosis Scheme, and a Dispensary is maintained at 65, Bexley Road, where Dr. Martin, the Tuberculosis Officer, attends twice weekly. Sanatorium treatment is also provided by that Council. It will be seen by reference to Table III, Subsections 1 and 2, that 5 cases of Pulmonary Tuberculosis and 7 cases, of Non-Pulmonary Tuberculosis are included in the records for this district. The closest co-operation is maintained between the Dispensary Staff and the Staff of the School Medical Service and as your School Medical Officer is a member of the Tuberculosis Care Committee, which is a voluntary committee organised by the Kent Council for Social Service, the opportunities for mutual help in this work are thereby extended. 9 Following up and Summary Work by School Nurses. Following up work by the school nurses is summarised in the following table: Visits paid to the schools 1014 Children examined 16424 Children found with vermin 235 Visits to homes 864 Attendances at Ophthalmic Clinic 43 It will be noticed that although the number of visits paid to schools, and the number of children examined, has greatly increased over last year's work, the number of children found verminous was less. The various duties of the school nurses include their attendance at the Minor Ailments Clinic, and the Dental and Ophthalmic Sessions, at their respective times. Minor Ailments are treated at the school clinic, but in all cases where practicable children suffering from defects, other than Minor Ailments, are referred to general medical practitioners or to Hospitals. Apart from the use of the clinic as a treatment centre, it performs the function of re-examining certain children who were discovered at previous inspections to require observation ; also children are presented for examination 011 the advice of teachers or parents. Set out below is a table giving the number of children examined, together with the total attendances, at the various clinics:— 1935 1936 Children Attendances Children Attendances Minor Ailments Clinic 1340 7913 1392 9086 Dental Clinic 1332 1554 1331 1867 Ophthalmic Clinic 400 1070 463 1156 Special Examinations 2491 4646 2792 5321 Operations for Tonsils and Adenoids 68 57 5631 15183 6035 17430 Infectious Diseases. As mentioned last year, 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. During 1936, 29 swabs were examined for Diphtheria, 2 of these proving positive. 10 Open Air Schools. There is 110 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. 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 teachers to attend courses of instruction in physical training. The appointments of Mr. G. H. Atkinson and Miss I. C. Maclennan as physical training organisers will undoubtedly result in co-ordination of our physical training arrangements. These appointments are the outcome of a proposal made by the Erith Education Committee to the Education Committees of Beckenham, Bromley, Gravesend and Penge that they should combine to secure the services of a full time man and woman for the five areas. The suggestion was accepted and a joint committee formed of representatives from the five authorities with Bromley as the parent authority. The allocation of service and expenses to Erith has been made in the proportion of 4/20. Their duties consist of demonstrating and organising the physical education in the school time-tables which indicate when and where physical training is taken. They are also advising on the provision of physical training apparatus in the schools and also arranging classes for teachers one of which, for men, was held in Bromley, during the mornings, for three weeks in March, 1937, the other for women being proposed similarly for April, 1937. It is hoped that the influence of the organisers upon the physical training, games and swimming in the schools will be valuable, as both the organisers are well qualified and experienced. I ndoubtedly physical training facilities already in existence, such as gym clubs in the schools and evening courses for juveniles will receive fresh stimulation when the new arrangements have had time to produce their effect, and the physical training given by teachers in the schools will be improved in quality and of more value to the children. 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 College. 11 Co-operation of Parents, Teachers, &c. I have mentioned previously that parents continue to show keen interest in the medical examination of their children. At Routine Medical Inspections the parents attended in 91 per cent. of inspections in the case of infants, 84 per cent. in the case of intermediates and 65 per cent. in the case of leavers. 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. It will again 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 3 children who are partially deaf attend elementary schools. Every possible care is taken in classifying those concerned when Routine Medical Inspection has been completed. No epileptic children came under our notice during 1936. 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. Mentally Defective Children. I append the Annual Report of the Local Organiser of the Kent Voluntary Association for Mental Welfare. I may add 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 1936. Enquiries have been made in the case of 7 children and young people remaining under supervision at the end of last year. No new names have been received from the Committee. 12 The two remaining School cases have now left—a boy leaving the Day Special School at Easter and a girl being due to leave the Senior School at Christinas, have reached the age of 16 years. The former is already under supervision on behalf of the County Mental Deficiency Committee to whom reports are rendered. As there may be need for some action in the future, it is recommended that the other cases be reported informally for Friendly Supervision. After Care Cases. Two boys and three girls remain 011 the After Care list. One lad is in regular work and believed to be getting along well but the other case is less satisfactory partly 011 account of home circumstances. One girl has been in domestic service but, in December, was looking for other employment. Two are helping at home ; it is doubtful if either of these is capable of becoming self-supporting. An additional case (an epileptic girl) is visited by the Association as the parents need help and advice in regard to training and employment. The Association appreciates the co-operation of the Education Committee in forwarding names of cases notified to the Mental Deficiency Authority 011 leaving S]>ecial Schools. Two names have been received this year. The Association has to thank the Head Teacher of the Senior School for kind co-operation in reporting progress of school cases. TABLE I. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 611 Second Age Group 273 Third Age Group 478 Total 1362 B.—Other Inspections. Number of Special Inspections 2792 Number of Re-Inspections 2529 Total 5321 C.—Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). 13 GROUP Number of Children Inspected Found to require Treatment 1 2 3 Prescribed Groups:— Entrants 611 83 Second Age Group 273 53 Third Age Group 478 63 Total (Prescribed Groups) 1362 199 TABLE II. A—Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. Defect or Disease Routine Inspections Special Inspections No. ot Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring treatment Requiring Treatment Requiring to be kept under observation but not requiring treatment 1 2 3 4 5 Skin:— Ringworm: Scalp — — — — Body 1 — 4 — Scabies — — 23 1 Impetigo 6 — 109 1 Other Diseases (Non-Tuberculous) 19 17 103 24 Eye :— Blepharitis 1 — 20 1 Conjunctivitis ... — — 20 — Keratitis — — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 60 92 10 — Squint 11 10 3 — Other Conditions 5 1 35 4 Ear:— Defective Hearing 1 19 2 13 Otitis Media 11 8 21 4 Other Ear Diseases 3 4 52 20 14 TABLE II—Continued. 1 2 3 4 5 Nose and Throat:— Chronic Tonsillitis only 5 223 30 17 Adenoids only 4 36 8 4 Chronic Tonsillitis and Adenoids 16 27 33 6 Other Conditions 13 32 199 84 Enlarged Cervical Glands (Non-Tuberculous) — 384 44 24 Defective Speech — 1 — 2 Heart and Circulation:— Heart Disease: Organic 1 25 4 6 Functional — 127 1 14 Anaemia — 1 8 4 Lungs:— Bronchitis 7 5 14 9 Other Non-Tuberculous Diseases 4 52 44 42 Tuberculosis s— Pulmonary: Definite — — — — Suspected — 1 — — Non-Pulmonary: Glands — 1 — 1 Bones and Joints — — — — Skin — — — — Other Forms — — 1 — Nervous System:— Epilepsy — — — 1 Chorea — 4 4 1 Other Conditions 2 6 8 8 Deformities:— Rickets — 15 1 Spinal Curvature 2 7 1 6 Other Forms 12 32 15 3 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 22 44 728 220 Total 206 1174 1545 570 15 B.—Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups. (See Administrative Memorandum No. 124, dated 31st December, 1934.) Age-Groups A umber of Children Inspected A Excellent B Normal C Slightly subnormal D Bad No. % No. % No % No. % Entrants 611 70 11 404 66* 132 21 5 .81 Second AgeGroup 273 23 8.4 182 66 CO 21 8 3 Third AgeGroup 478 60 12 319 66 96 20 3 .62 Other Routine Inspections — — — — — — — — — Total 1362 153 11 905 66 288 21 16 1 TABLE III. Return of all Exceptional Children in the Area. Blind Children. At Certified Schools for the Blind. At PublicElementary 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 — — 3 — — 3 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 1 11 — 3 15 Epileptic Children. CHILDREN SUFFERING FROM SEVERE EPILEPSY. At Certified Special Schools At PublicElementary Schools At other Institutions At no School or Institution Total — — — — — 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 PublicElementary Schools At other Institutions At no School or Institution Total 2 5 — — 7 B. DELICATE CHILDREN. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 3 74 1 — 78 C. CRIPPLED CHILDREN. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 8 16 — 1 25 D. CHILDREN WITH HEART DISEASE. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 6 — — — 6 18 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1936. TREATMENT TABLE. GROUP I.—MINOR AILMENTS. (excluding Uncleanliness, for which see Group VI). Disease or Defect Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Total 1 2 3 4 Skin— Ringworm—Scalp - - - (i) X-Ray Treatment. If none, indicate by dash. (ii) Other Treatment - - - Ringworm—Body 4 1 5 Scabies 23 3 26 Impetigo 108 3 111 Other skin disease 91 5 96 Minor Eye Defects (External and other, but excluding cases falling in Group II). 61 3 64 Minor Ear Defects 35 8 43 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 683 47 730 Total 1005 70 1075 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defec ts treated as Minor Ailments—Group I). Defect or Disease Number of Defects dealt with Under the Authority's Scheme Otherwise Total 1 2 3 4 Errors of Refraction (including Squint) 463 28 491 Other Defect or Disease of the Eyes (excluding those recorded in Group I) - - - Total 463 28 491 19 No. of children for whom spectacles were prescribed: (i) Under the Authority's Scheme 200 (ii) Otherwise 26 226 No. of children for whom spectacles were obtained: (i) Under the Authority's Scheme 175 (ii) Othenvise 26 201 GROUP III.—TREATMENT OF DEFECTS OF NOSE. AND THROAT. Number of Defects. Received Operative Treatment Received other forms of Treatment Total number treated Unaer 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. 1 62 23 7 27 — , 1 — 3 — 24 7 30 — (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 Otherwise Total number treated (1) (2) Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education NonResidential treatment at an oi thopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — — — — 16 16 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 (i) Inspected by Dentist 19 73 131 223 137 146 356 478 467 138 2168 993 3161 20 (ii) Found to require treatment 2399 (iii) Actually treated ??? (2) Half-days devoted to:— Inspection 14 Treatment 178 192 (3) Attendances made by children for treatment 1867 (4) Fillings:— Permanent teeth 791 Temporary teeth — 791 (5) Extractions:— Permanent teeth 293 Temporary teeth 1533 1826 (6) Administrations of general anaesthetics for extractions 910 (7) Other operations:— Permanent teeth 113 Temporary teeth — 113 GROUP VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (1) Average number of visits per school made during the year by the School Nurses 6 (2) Total number of examinations of children in the Schools by School Nurses 16,424 (3) Number of individual children found unclean 235 (4) Number of children cleansed under arrangements made by the Local Education Authority 0 (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 0 (b) Under School Attendance Byelaws 0