ER 120 LIBRARY BOROUGH OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1939 BY REGINALD A. LEADER, M.R.C.S., L.R.C.P., D.P.H. BOROUGH OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1939 BY REGINALD A. LEADER, 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 7 (d) Infantile Mortality 7 (e) Vital Statistics of District 8 (f) Causes of Death 9 (g) Birth-rate, Death-rate and Analysis of Mortality 10 2. Population 11 3. Births 11 4. Deaths 11 5. Maternal Mortality 11 6. Infant Mortality 12 7. Unemployment Figures and Comments 13 B Maternity and Child Welfare Services. 1. Maternity and Child Welfare Scheme 14 2. Notification of Births 15 3. Child Welfare Centres 16 4. Home Visits by Health Visitors 18 5. Maternity Services. (a) Maternity Home—Hainault 18 (b) Ante-Natal Clinic 18 (c) Abnormal Cases 19 6. Infant Life Protection 19 7. Midwives 20 8. Maternity and Nursing Homes 20 9. Dental Clinic 20 10. Nursing in the Home 20 (a) General 20 (b) Infectious Disease 20 (c) Home Help 20 11. National Society for the Prevention of Cruelty to Children 21 C Prevalence of and Control over Notifiable Infectious Diseases. 1. Infectious Diseases’ Hospital 21 2. Tables 21 (a) Notifications 21 (b) Age Distribution 22 3. School Incidence of Infectious Disease 23 i Section C (continued). Page 4. Diphtheria Immunisation 24 5. Comments on: (a) Diphtheria 24 (b) Scarlet Fever 24 (c) Enteric Fever 24 (d) Puerperal Pyrexia 24 (e) Ophthalmia Neonatorum 24 (f) Smallpox 25 6. Disinfection of Premises after Infectious Disease 25 7. Laboratory Facilities 25 8. Tuberculosis 25 (a) Treatment and Hospital Accommodation 25 (b) Table (i) Particulars of New Cases and Deaths 26 (ii) Quarterly Statements 27 9. Ear, Nose and Throat 28 10. Clinics and Treatment Centres 29 D Hospital Facilities. 1. General 31 2. Venereal Diseases 31 3. Children 31 4. Ambulance Facilities 31 E Sanitary Circumstances of the Area. 1. Refuse Collection and Disposal 31 (a) Details of Refuse Vehicles and Staff 32 (b) Details of Tonnage 32 2. Trade Refuse 32 3. Water Supply 33 4. Drainage and Sewerage 34 5. Closet Accommodation and Cesspools 34 6. Sanitary Inspection of the Area 34 (a) Routine Visiting 34 (b) Summary of Nuisances and Defects Remedied during the Year 35 (c) Number of New Houses erected during the year 35 (d) Shops Acts, 1912-1938 35 (e) Offices 36 (f) Camping Sites 37 (g) Hop Pickers 37 (h) Rag Flock Act 37 (i) Smoke Abatement 37 ii Section E (continued). Page (j) Health Education 37 (k) Eradication of Bed Bugs 37 (1) Cleansing of Verminous Persons 38 (m) Swimming Baths and Pools 38 (n) Mortuary 38 (o) Schools 38 7.Housing 39 (a) Inspection of Dwellinghouses during the year 39 (b) Remedy of Defects during the Year without Service of Formal Notices 39 (c) Action under Statutory Powers during the Year 39 (d) Housing Act 1936—Part IV, crowding 40 (e) Fitness of Houses 40 (f) Clearance Areas 40 (g) Individual Houses, Section II 40 8. Factories 41 F Inspection and Supervision of Food. 1. Milk Supply 42 2. Slaughter of Animals Act, 1933 42 3. Inspection and Supervision of Meat and Other Foods 43 4. Other Foods 43 5. Food and Drugs Act 44 6. Offensive Trades 44 H General. 1. Letter by Medical Officer of Health 2 2. Members of Committees 4 3. Staff of Public Health Department 5 4. Legislation in Force 45 iii 2 H(1 ). Public Health Department, Council Offices, Erith. The Mayor, Aldermen and Councillors of the Borough of Erith. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the work carried out by the Health and School Medical Services of the Council for the year 1939. In apologising for the late appearance of this Report, I would state that besides the war effort interfering with the work of the Department to such a degree as to render its earlier publication impracticable, the figures of the Registrar General were received much later than usual. As it has been the aim in this town to make the Annual Reports each year, volumes of reference as well as an annual review of the work of the department, despite considerable difficulty, the Report has again been completed in much the same form as previous years. Although I am presenting the Report, I must state that the work it reviews was carried out under the direction of my predecessor, Dr. A. Wallace Johns who left Erith in March, 1940, to take up an appointment with the Merton and Morden Lrban District Council, and I should like to express my sincere thanks for the willing assistance and guidance he afforded me when I assumed the position of Medical Officer of Health to Erith. The sections of the Report reveal the fact that, despite the declaration of War and the consequent diverting of the efforts of practically the whole of the staff of the department to the completion and organisation of the Casualty Services, an active policy in public health was pursued. With regard to Air Raid Precautions, I wish to report that the Casualty Services were organised and completed in accordance with the directions given in the various Circulars 3 and Memoranda from the Government Departments, the London Civil Defence Region and the Scheme-making Authority, and it is pleasing to record that practically without exception every member of the staff of the Public Health Department has some voluntary position with one or other Section of the Casualty Services Organisation. Taking over a position as Medical Officer of Health during normal times usually proves an arduous task for a considerable period of time, but in war-time the extra work occasioned by the war effort, and the continually multiplying duties of the Public Health Department, have greatly increased the responsibility. I have had to depend, therefore, on the staff of the department with their intimate knowledge of local details and conditions, in 110 small degree, and I wish to record my appreciation of the assistance they have given. In conclusion, I cannot do better than reiterate the last paragraph of the Medical Officer’s letter to the Annual Report for 1938. “It is to their credit that a Public Health outlook has been maintained in the atmosphere of the past year, and it is to them that what success the department has achieved is due.” I am, Your obedient Servant, REGINALD LEADER, Medical Officer of Health. November, 1940. 4 H (2). MEMBERS OF COMMITTEES. Health Committee. Chairman—Councillor Alford. Alderman Christian. Alderman Ewens Councillor Bates. Councillor Powrie. ” Dunkley. ,, Selfe. ,, Farquar. Maternity and Child Welfare Committee. Chairman—Alderman Ewens. Alderman Christian. Councillor Alford. Councillor Nichols. ,, Dunkley. ,, Powrie. ,, Farquhar. ,, Tyrer. Co-opted Members : Mesdames Hyde, Smith and West. Ex-officio Members of both Committees. His Worship the Mayor, Councillor J. W. Wilkinson. Deputy Mayor, Councillor C. F. Morling. Chairman of Finance & General Purposes Committee, Councillor T. C. Pannell. 5 (H3). 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— H. M. Evans, M.R.C.S., L.R.C.P., D.P.H. (Resigned Oct., 1939.) C. H. D. Asher, B.Sc., M.D., M.B., B.S., M.R.C.P., D.C.H. (Appointed Nov., 1939.) Senior Sanitary Inspector— L. E. King, Cert. R.S.I., Cert. S.I.E.B., Meat Inspector's Certificate, Cert. R.I.P.H. & H. (1) Sanitary Inspector— W. E. Moses, Cert. S.I.E.B., Meat Inspector's Certificate, C.A.G.S. (1) C. S. T. Dancer, Cert. S.I.E.B., Meat Inspector's Certificate. (1) 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) Miss E. W. L. Woods, S.R.N., New H.V. Cert. R.S.I., S.R.F.N. & C.M.B. (1) Matron, Infectious Diseases Hospital— Miss P. Jay, S.R.N. Sister-in-Charge, Maternity Home— Miss L. M. Barclay, S.R.N., S.C.M. Clerks— Chief Clerk—H. M. Coles, L.A.G.C. General Clerks— Public Health—R. Durey, M.R.I.P.H.H., L.A.G.C. Maternity and Child Welfare—Miss O. R. Reeves. School Medical Service—Miss M. Smith. Shorthand Typist—Miss B. L. Kell. Junior Clerks— Public Health—G. S. A. Hallett. School Medical Service—Miss J. Redgrave. 6 2. Part-time. Consulting Surgeon for Aural Diseases— T. P. Gill, F.R.C.S. Ante-natal Consultant— J. V. O'Sullivan, M.D., M.B., B.Ch.F.R.C.S., M.R.C.P., M.A.O., M.C.O.G. Consulting Obstetrician— 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. SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Annual Report, 1939. Ad). SUMMARY OF STATISTICS, A(1)a. General. Area.—4,607 acres. Population.—41,870 (Estimated 1939). Density of population, i.e., number of persons per acre.—9.088. Number of inhabited houses.—11,317 (as per Rate Book). Rateable value, 1939.—£318,228. Sum produced by a penny rate, 1939.—£1,196. A(l)b. Births. TOTAL. Male. Female. Live Births. Legitimate 704 369 335 Illegitimate 17 9 8 721 378 343 Live birth rate per 1,000 of population (1939 estimated). —17.219. Corresponding rate for 1938.—15.87. TOTAL. Male. e. Still Births. Legitimate 23 15 8 Illegitimate 1 0 1 24 15 9 Still Birth rate per 1,000 total births.—33.28. A (1 ) c. Deaths. Males 256. Females 196. Total 452. Death rate per 1,000 of population (estimated 1939).— 10.984. Corresponding rate for 1938.—9.799. Number of women dying in, or in consequence of, childbirth—3. Maternal Mortality per 1,000 total registered births—4.28. A(l)d. Infantile Mortality. Deaths of infants under one year of age. TOTAL. Male. Female. Legitimate 30 17 13 Illegitimate 1 — 1 31 17 14 Death rate of infants under one year of age per 1,000 live births.—44.28. Total number of deaths from : 1938 1939 Measles (all ages) — — Whooping Cough (all ages — 2 Diarrhoea (under 2 years) — 2 4 8 A(1)e. Vital Statistics of Whole District during 1939 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 ot Non-i esidents registered in the District of residents not registered in the District Under 1 year of age At all Ages Number Rate Number Rate No. Kate per 1000 nett Births No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1930 33,420 456 488 14.60 209 6.25 6 145 32 65.5 348 10.4 1931 32,920 432 492 14.94 258 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 14.07 262 6.95 17 142 35 71.1 387 1 1.00 1934 35,020 531 481 13.7 230 6.56 18 140 21 43.6 347 9.9 1935 35,760 572 525 14.6 212 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 1937 38,240 656 605 15.82 262 6.85 27 180 28 46.28 415 10.852 1938 39,800 668 656 16.48 273 6.83 17 134 34 53.62 390 9.799 1939 41,870 716 745 17.79 253 6.14 21 220 31 44.28 452 10.984 9 A(l)f. Table showing Summary of Causes of Death during the year ended 31st December, 1939. Cause of Death Males Females Total 1 Typhoid Fever, etc. — — — 2 Measles — — 3 Scarlet Fever — — 4 Whooping Cough 1 1 2 5 Diphtheria 1 — 1 6 Influenza 3 4 7 7 Encephalitis Lethargica - - - 8 Ccrebro-spinal fever — — — 9 Respiratory Tuberculosis 11 11 22 10 Other Tuberculosis — 2 2 11 Syphilis 2 — 2 12 General paralysis of insane, etc. 1 1 2 13 Cancer 30 25 55 14 Diabetes 1 3 4 15 Cerebral haemorrhage 14 11 25 16 Heart disease 85 59 144 17 Aneurysm 4 - 4 18 Other circulatory diseases 16 22 38 19 Bronchitis 2 1 3 20 Pneumonia 14 5 19 21 Other respiratory diseases 1 - 1 22 Peptic ulcer 6 2 8 23 Diarrhoea, etc. (under 2 years) 2 - 2 24 Appendicitis — — 25 Cirrhosis of liver — 1 1 26 Other liver diseases 1 1 27 Other digestive diseases 4 3 7 28 Nephritis 6 9 15 29 Puerperal sepsis — 1 1 30 Other puerperal causes — 2 2 31 Congenital causes, etc. 13 9 22 32 Senility 1 1 2 33 Suicide 3 1 4 34 Other violence 11 6 17 35 Other defined causes 24 13 37 36 Ill-defined causes - - - 37 Diarrhoea (2 yrs. and over) — 2 2 Total All Causes 256 196 452 10 A(l)g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1939. Provisional figures. The mortality rates for England and Wales refer to the whole population, hut for London and the towns to civi ians only Rate per 1,000 total population Annual Death-rate per 1,000 population Rate per 1,000 Live Births Live Births Still Births All Causes Typhoid and Paratyphoid Small-pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea & Enteritis (under Two years) Total Deaths under one year England and Wales 15.0 0.59 12.1 0.00 0.00 0.01 0.01 0.03 0.05 0 21 4.6 50 125 County Boroughs and Great Towns, including London 14.8 0 59 I2.0 0.00 0.00 0.01 0.00 0.03 0.05 0.21 6.3 53 148 smaller towns (1931) adjusted populations 25,000—50,000 15.6 0.57 11.2 0.00 0.00 0.01 0.00 0.02 0.04 0.20 3.0 40 London 123 0.44 11.9 0.00 0.00 0.00 0.00 0.03 0.02 0.18 8.2 48 Erith (Estimated population 41,870) 17.219 0.575 10.984 000 0.00 0.00 0.00 0.047 0.023 0.167 2.856 44.28 11 A (2). Population. The Registrar General's estimate of 41,870 as the population for the year ending mid-year, 1939, is an increase of 2,070 over last year's figure. A (3). Births. During 1939, the number of births under the Notification of Births Act, was 716, approximately 7 per cent, more than those for the preceding year. Twenty-four stillbirths were also registered, giving a stillbirth rate of 26.53 per 1,000 live births. A (4). Deaths. The total number of deaths was 452, 256 being males and 196 females. This is after allowing for inward and outward transfers. The death rate for 1939 is 10.984. Compared with 1938 the number of deaths shows an increase of 62. A (5). Maternal Mortality. Three deaths were recorded during 1939 under this heading. 12 Since 1020 there have been 10,024 births with 31 maternal deaths, as shown below, giving a Maternal Mortality rate of 2.84. Year Maternal 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 1 658 547 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 1937 1 671 656 1938 3 656 634 1939 3 745 721 Tota 1 31 11004 10624 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. A (6). Infant Mortality. 31 infants died before reaching one year of age, giving an infant mortality of 44.28. The comparable figure for the whole country is 50. 13 Analysis of the causes of death of this age group reveals the following figures : — Deaths from 1938 1939 Pneumonia 6 1 Whooping Cough — 1 Bronchitis 2 — Neo-Natal 9 24 Other causes 13 3 Gastro-Enteritis 4 2 34 31 I have included a table showing the Infant Mortality at 5 year intervals for the past 25 years and for 1939. 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 1939 44.28 50 A (7). Unemployment Figures and Comments. With the courteous co-operation of the Manager of the Erith Employment Exchange, it once again is possible to give definite figures on the state of unemployment in the District, as shown in the following table. A perusal of this table shows that an increase in unemployment has occurred in the female groups but that it generally has decreased by 408. 14 Year ending Adults Young Persons Total Men Women Men Women December, 1934 926 113 62 33 1134 December, 1935 784 128 27 37 976 December, 1936 514 101 19 14 648 December, 1937 501 94 20 8 623 December, 1938 934 160 40 16 1159 December, 1239 373 299 31 48 751 SECTION B.—MATERNITY AND CHILD WELFARE SERVICES. B(l). Maternity and Child Welfare Scheme. The Maternity and Child Welfare Scheme provides the following services : 1. Ante-natal clinic—one session per week at Hainault. one session per week at Bedonwell. 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. The facilities for the provision of Free Milk for expectant, and nursing mothers. 5. Provision for dental treatment of children under school age and nursing and pregnant women at a session held fortnightly at the School Dental Clinic. 6. Four Infant Welfare Centres holding fourteen sessions per month. 7. Provision for Orthopaedic treatment for children under school age. The School Medical Service facilities are available to children under five years of age. Infants and toddlers with eye defects are seen by the School Ophthalmic Surgeon; with orthopaedic defects are seen by the Orthopaedic Surgeon, and certain cases with minor ailments in need of regular treatment secure this at the School Minor Ailment Clinic. 15 Month Births Sex Legitimacy Notified by B(2). Notification of Births. During 1939, 697 live births and 19 stillbirths, giving a total of 716 were notified to me, as shown in the following table : Live S'born M F Leg. Meg. Mid wives Hosp. etc. Doctors M F M F January 50 2 1 27 26 53 — — 29 24 — February 42 — — 20 22 42 — — 19 21 2 March 70 1 1 44 28 72 — — 31 38 3 April 44 — — 21 23 43 —- 1 20 22 2 May 63 1 2 30 36 66 —- — 24 40 2 June 60 1 1 30 32 62 — — 26 35 1 July 71 2 1 41 33 74 — — 30 42 2 August 69 1 — 32 38 68 1 1 31 37 2 September 48 — 1 26 23 49 — — 18 30 1 October 59 1 — 35 25 60 — — 26 32 2 November 61 1 2 26 38 64 — — 34 29 1 December 60 — — 34 26 60 — — 25 33 2 Total 697 10 9 366 350 713 1 2 313 383 20 16 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 five years are investigated by the Health Visitors. B(3). Child Welfare Centres. The basis of child welfare facilities in the Erith Borough is a system of 3 clinics held on one half-day a week, and one clinic held on one half day a fortnight, in various parts of the town. Each Infant Welfare Clinic is attended by a Medical Officer, three 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 shown in the Table on page 17. The work of the infant welfare centre is for the most part educational and advisory, and any ailments of a serious nature are referred to the private medical practitioner, or to a hospital, for treatment. Dried milks and other auxiliary foods, i.e., Cod Liver Oil and Malt, Glucose, Farex, &c., 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. 17 Infant Welfare Centres. Month Belvedere Erith Picardy Bedonwell nfants weighed Consultations Infants weighed Consultations Infants weighed Consultations Infants Weighed Consultations Under 1 year 1 to 5 years Under 1 year I to 5 years Under I Year 1 to 5 years Under 1 Year 1 to 5 years January 224 66 28 264 189 70 41 23 16 275 110 57 February 254 104 57 198 148 61 50 44 15 296 131 64 March 360 109 32 218 140 49 53 51 16 294 122 44 April 209 76 43 178 107 51 39 34 18 247 69 55 May 241 81 41 243 154 55 47 31 10 306 102 59 June 290 93 41 246 172 73 50 51 22 343 121 54 July 196 65 35 245 178 53 42 45 17 406 134 65 August 218 55 31 258 160 61 34 37 9 244 104 44 September 95 34 8 47 30 15 — — — 17 13 4 October 124 37 28 294 128 44 — — — 268 83 48 November 161 47 28 249 133 43 — — — 277 77 51 December 104 36 32 150 80 50 — — — 282 52 72 Totals 2476 803 404 2590 1619 625 356 316 123 3255 1118 617 3279 4209 672 4373 Grand Total—Infants Weighed 12,533 Consultations 1,769 Under 1 year 8,677 1—5 years 3,856 18 B(4). Home Visits by Health Visitors. 1938 Children Special Visits Expectant Mothers Infant Life Proteclion Total Visits 1st Visits ReVisits StillBirths Others January 48 390 3 11 10 3 465 February 42 768 1 24 18 4 857 March 61 763 4 19 20 12 879 April 50 468 — 18 12 4 552 May 56 613 2 14 23 7 715 June 64 632 1 17 15 12 741 July 63 628 3 11 13 4 722 August 73 433 1 9 9 2 527 September 32 513 — 5 8 5 563 October 57 545 — 2 8 20 632 November 55 620 1 17 8 3 704 December 27 293 1 20 5 — 346 Total Yisils 628 6666 17 167 149 76 7703 B (5). MATERNITY SERVICES. B(5)a. Maternity Home—Hainault. 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 118 maternity cases were admitted Of these 88 cases were delivered by midwives and 30 by doctors. The average duration of stay of these cases in the home was 13 days. Although the Maternity Home was classified as a 1 B Hospital under the Emergency Hospitals' Scheme, the Home was not evacuated and the Hospital Officer for Sector 10 advised us soon after the outbreak of hostilities that Hainault would be allowed to continue with its normal peace-time functions. B(5)b. Ante-natal. The ante-natal sessions which are held on one half-day each week at the Hainault and Bedonwell Clinics, continue to function and as will be seen from the following table, the attendance figures are most gratifying. 19 Ante-natal patients seen by Doctor 1939 175£ Jail. Feb. Mr. Apr. Mas June July Aug Sep. Oct. Nov Dec. T otal 69 101 89 98 113 100 84 98 44 35 59 65 955] Erith Bedonvvell 99 86 51 79 84 96 55 65 23 38 66 58 800 J B(5)c. Abnormal Cases. Accommodation for abnormal maternity cases, in need of hospital treatment is provided for by an arrangement between this Council and the City of London Maternity Hospital. Seven cases were admitted under this arrangement during the year. I he conditions for which they were admitted were as follows : Condition No. Toxaemia 3 Trial Labour 2 Extended Breeeh 1 Ante partum haemorrhage 1 Total 7 B(6). Infant Life Protection. The Health Visitors are responsible for the execution of Infant Life Protection work. 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 16 Number of children on register at 31st December, 1939 20 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. 20 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 employ and supervise midwives working in this area. B(8). Maternity and Nursing Homes. At present there is one registered Nursing Home in the district. No applications for registration were received during the year. B (9). Dental Clinic. The Maternity and Child Welfare Dental Clinic which is held fortnightly for Dental Treatment for mothers and preschool children, was well attended during the year, attendances being as follows : — Hainault 132 Bedonwell 151 B (10). NURSING IN THE HOME. B (10)a. General. Three voluntary Nursing Associations provide nurses for work in the district. These are not directly subsidised by the Local Authority, but are supported b}' weekly contributions by Members of the Associations, and subscriptions from others. The services of these nurses are also available to nonmembers of the Associations for a small fee per visit. B(10)b. Infectious Disease. 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) c. Home Help. 1 lie Council s Home Help Scheme continued to function throughout the year, and the following figures will show the extent to which it was used : Total No. of cases booked 28 No. of cases attended by : Home Help No. 1 16 Home Help No. 2 7 23 No. of cases booked and subsequently cancelled 2 No. of cases booked and subsequently evacuated 3 28 No. of days on which the Home Help was employed : Home Help No. 1 149 Home Help No. 2 45½ 1944½ 21 A full-time Home Help is employed by the Council and she will attend daily at the homes of patients for a period of two weeks, as directed by the Medical Officer of Health, or to suit the convenience of the patient, A scale of charges is in operation and is based on incomes and sizes of families. B (11 ). 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(1). Infectious Diseases' Hospital. The Erith Borough Council provides its own Isolation Hospital. A large portion of admissions are cases of Scarlet Fever and Diphtheria, but any notifiable infectious disease maybe admitted with the exception of smallpox and puerperal infections, special arrangements for which are described elsewhere in this report. Cases of Measles and Whooping Cough are admitted during epidemic times. C(2). TABLES. C(2)a. Notifications. The following table shows the total notifications received during the year 1939 : — Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Diphtheria 14 14 1 Scarlel Fever 231 184 — Erysipelas 6 — — Pneumonia 32 — 19 Puerperal P 6 — 3 Oph. Neon. 1 — — Dysentery 1 — — Paratyphoid 'B' 2 1 — Pcliomyelitis Acute 1 — — 22 C (2) b. Age Distribution. This second table shows, in detail, the age distribution of the notified infectious diseases mentioned above Disease Groups Totals under 1 1 2 3 4 5 10 15 20 35 45 65 over 65 Diphtheria — 1 1 1 — 3 1 4 2 — — 1 — 14 Scarlet Fever — 2 7 13 16 28 95 45 10 10 3 2 — 231 Erysipelas — — — — — — — — — 1 1 3 1 6 Pneumonia 2 — 4 — — 1 1 1 1 4 7 8 3 32 Puerperal P — — — — — — — — 3 3 — — — 6 Oph. Neon. 1 — — — — — — — — — — — — 1 Poliomye'is Acute — 1 — — — — — — — — — — — 1 Paratyphoid 'B ' 1 — — — — — — — — 1 — — — 2 Dysentery — — — — 1 — — — — — — — — 1 Totals 4 4 12 14 17 32 97 50 1G 19 11 14 4 294 23 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 Scarle Fever Typhoid Total Central Boys. North. Heath 560 3 3 Picardy 480 — 10 — 10 Central Girls. North. Heath 560 — — — — Picardy 480 2 8 10 Junior Boys. North Heath 200 — 3 — 3 St. Augustine's Road 350 — 12 12 West Street 300 — 7 — 7 Junior Girls. North. Heath 200 — 10 10 St. Augustine's Road 350 — 11 11 West Street 300 1 13 — 14 Junior Mixed. Bedonwell Hil 490 — 29 — 29 Juniors Mixed anc Infants. Crescent Road 530 1 5 — 6 Crossness 150 — — — — Mixed and Infants Infants. St Fidelis R.C 150 — — — Bedonwell Hill 240 — 12 — 12 Belvedere 150 — 3 — 3 North. Heath 340 1 8 — 9 St. Augustines Road 350 1 9 — 10 West Street 350 — 15 — 15 Totals 6530 6 158 0 164 Private and other Schools. Males — 1 — 1 Females 1 4 — 5 Schools out of Town Males — — — — Females — 2 — 2 Under School Age Males 2 16 1 19 Females 1 20 — 21 Over School Age Males 1 10 1 12 Females 3 20 — 23 Totals 8 73 2 83 Grand Totals 14 231 2 247 24 C (4). DIPHTHERIA IMMUNISATION. The Scheme for the Immunisation of children against Diphtheria was continued with throughout the year, and the following table will indicate the number of cases dealt with : o No. of applications received during the year 127 No. of First Injections given 483 No. of Second Injections given 477 No. of Third Injections given 468 A full description of the scheme is contained on page 26 of my Report for the year 1938. C(5). Comments on :— (a) Diphtheria. Anti-toxin is always available as provided by the Antitoxin Order, 1915, and the Council's Medical Officers are always willing to give a second opinion on doubtful cases. There was no special incidence in any school. (b) Scarlet Fever. There were 231 cases of Scarlet Fever, as compared with 150 for the previous year, notified during the year. The incidence of these cases was fairly uniformly spread throughout the year; the weekly totals maintaining a fairly constant level which was higher than the previous year but not a greatly increased number over a short period. Of the 231 cases notified 184 were admitted to hospital for treatment. (c) Enteric Fever. There were two cases under this heading during the year notified as Paratyphoid B. (d) Puerperal Pyrexia. Six cases of Puerperal Pyrexia 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 Pyrexia) Regulations 1939, a Consulting Obstetrician, Mr. A. Galletly, is available for assistance to Medical Practitioners within the area. (e) Ophthalmia Neonatorum. One case of Ophthalmia Neonatorum was notified, and was treated at Hospital. There was no impairment of vision as a sequel. 25 (f) Smallpox. An arrangement exists between the London County Council and the Erith Borough Council for accommodation for cases of smallpox occurring within the District. C (6). Disinfection of Premises after Infectious Disease. The Sanitary Foreman acts also as Infectious Disease Enquiry Officer and Disinfecting Officer. Following the removal of cases of infectious disease, tuberculosis, etc., 311 premises were disinfected, whilst enquiries to obtain particulars regarding 46 cases of tuberculosis were undertaken. In the instances where patients are isolated at home, disinfection is carried out at the request of the Medical Practitioner, who, for the purpose, is supplied with a card stating that the patient has recovered and the room requires disinfection. The Council have a 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(7). Laboratory Facilities. Examination of pathological specimens, and other laboratory work for the District, are undertaken by the Kent County Laboratory, Sessions House, Maidstone. During 1939, 298 specimens were sent, as shown below : — Nature of Specimen sent Result Total Positive Negative Swabs for Diphtheria 4 87 91 Sputum for suspected Tuberculosis 56 135 191 Various 7 9 16 Total 67 231 298 C (8). TUBERCULOSIS. C(8)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. 26 A dispensary is held twice weekly at 65 Bexley Road, Erith, by a whole-time Tuberculosis Officer. In the tables which follow, particulars of new cases of Tuberculosis and of all deaths from the disease in the area, during 1939 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, 1939. C(8)b. Table (i). Particulars of New Cases and Deaths. Age Periods New Cases Deaths Pulmonary Non-Pulm'n'ry Pulmonary Non-Pultn'n'ry M. F. M. F. M. F. M. F. Under I year — — — — __ — 1 — — — I — — 5 2 1 4 1 — — — — 10 — 1 1 2 — — — 15 2 3 — 2 — 2 — 1 20 4 4 3 1 3 4 — — 25 5 4 1 2 2 2 — — 35 6 3 — T 3 3 — — 45 4 1 — — 3 — — — 55 — 2 65 & upwards — — — 1 — 1 — — Totals 23 19 9 1 1 11 12 — 1 27 Table (ii). Quarterly Statements. ist Quarter 2nd Quarter 3rd Quarter 4th Quarter M F T M F T M K T M K T Pulmonary T.B. Number on register 194 191 385 200 187 387 202 187 389 202 193 395 New notifications during year 7 4 11 3 3 6 4 3 7 3 4 7 Cases removed, which have been restored — 1 1 — 1 1 — — — — — — Cases added to register other than by notification ... 4 — 4 3 2 5 1 3 4 — 1 1 Cases removed from register 5 9 14 4 6 10 5 1 6 3 6 9 Cases remaining on register 200 187 387 202 187 389 202 192 394 202 192 394 Non-Pulmonary T.B. Number on register 85 69 154 87 73 160 86 74 160 86 76 162 New notifications during year 3 4 7 — 1 1 — 3 3 3 1 4. Cases removed, which have been restored — — — — — — 1 — 1 — — — Cases added to register other than by notification 1 1 2 — — — — — — — — — Casei removed from register 2 1 3 1 —— 1 1 1 — 1 1 Cases remaining on register 97 73 160 86 74 160 86 77 163 89 76 165 Total Pulmonary and Non-Pulmonary cases on Register at end of year 559 28 C(9). Ear, Nose arcd 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. Mr. T. P. Gill is Consulting Aural Surgeon, this appointment is renewable annually and a retaining fee is paid. His services are available for opinion, and for operations on patients in the Sanatorium, as required. 20 C(10). Clinics and Treatment Centres. Clinics and Treatment Centres. Address. Attended by. Day and Time. Ante Natal Clinics Provided by the Erith Borough Council. Thursdays, 2—4 Thursday 9.30—12 J. Hainault, Lesney Park Road 2. Bedonwell Clinic Assistant M.O.H. Assistant M.O.H. Infant Welfare Centres 1. Hainault, Lesney Park Road 2. Belvedere Public Hall 3. Primitive Methodist Church, Belvedere 4. Bedonwell Clinic Assistant M.O.H. Assistant M.O.H. M.O.H. Assistant M.O.H. Fridays 2—4 Tuesdays 2—4 1st and 3rd Wednesday 2—4 Mondays 2—4 Maternity and Child Welfare Dental Clinic 1. Hainault, Lesney Park Road 2. Bedonwell Clinic M.O.H. and Mr. R. A. Presslie, L.D.S. 4th Wednesday 2.0 2nd Wednesday 2.0 School Clinics (Minor Ailment) 1. Hainault, Lesney Park Road 2. Bedonwell Clinic A.S.M.O. and School Nurse Daily at 9.15 Tuesdays 9.30 Ophthalmic Clinic Hainault, Lesney Park Road Dr. N. Howard Allen, M.R.C.S., L.R.C.P. Alternate Wednesdays 9.30 (by appointment) School Dental Clinic (Conservation) Hainault, Lesney Park Road Bedonwell Clinic Mr. Presslie Mr. Stone-Wigg ,, ,, ,, ,, ,, Tuesdays 2.0 Fridays 9.30 Wednesdays 9.30 1st & 3rd Wednesdays 2.0 1st, 2nd and 4th Thursdays 2.0 Fridavs 2.0 30 (Extractions) ( ,, and Fillings) (I)ental Inspections) Hainault, Lesney Park Road Bedonwell Clinic Schools Mr. Presslie Mr. Stone-Wigg ,, Thursdays 9.30 Tuesdays 9.30 3rd Thursdays 2.0 Orthopaedic Clinic: (Consultation) (Treatment) (Remedial Exercises) Bedonwell Clinic Erith Hospital Bedonwell Clinic W. Eldon Tucker, Esq., F.R.C.S. Orthopaedic Sister Orthopaedic Sister 3rd Thursdays 2.0 By arrangement Monday and Friday 10.0 Foot Clinic Bedonwell Clinic Miss N. Heddle, M.I.S.Ch. Tuesdays. Alternating 2—4 and 7—9. Diphtheria Immunisation Clinic Bedonwell Clinic Hainault, Lesney Park Road Assistant M.O.H. Assistant M.O.H. Alternate Saturday mornings at 10.0 (by appointment) Tuberculosis Dispensary Provided by the Kent County Council. Mondays 5—6. Thursdays 10.30—12.30 65 Bexley Road, Erith Dr. S. Roy C. Price Venereal Diseases Clinic County Hospital, West Hill, Dart ford. Drs. Renton and Ockwell Men. Mondays 4.30—6.30 Wednesdays 5—6. W omen. Mondays, Tuesdays, Thursdays and Fridays 2—4 31 SECTION D.—HOSPITAL FACILITIES. D (1 ). General. Situated within the area is a hospital of 43 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 Chief Officer 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. Ed). Refuse Collection and Disposal. The arrangements at present existing in connection with the collection and disposal of house refuse continue to work satisfactorily. The method of storage is by means of sanitary dust-bins, and some 12,000 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. Costs. The gost per ton of collecting refuse is 8s. 4d. (previous year was 7s. 4d.). The cost per ton of disposing refuse 4s. Net cost per 1,000 of population £147. The following tables show : 1. Details of the refuse collection vehicles and staff. 2. Details of the tonnage dealt with during the year. 32 E (1 ) a. Table 1. Vehicle Capacity I Dennis Lorry 12 cubic yards 2 Easyloaders 4 ,, ,, 2 S. D. Freighters 7 ,, ,, These are operated by— 1 Foreman, 5 Drivers and 9 Loaders. E (1) b. Table 2. Month Tonnage Tons Cwt January, 1939 912 17 February 811 8 March 926 7 April 821 — May 887 11 June 809 13 July 727 16 August 813 19 September 751 10 October 772 10 November 791 3 December 739 1 Total 9764 15 The total tonnage dealt with during the year, as shown above was 9,764 tons 15 cwts., this is an increase of 602 tons 17 cwt. over that of last year. 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. The growth of this section of the refuse disposal services has been rapid, when it is remembered that 8 years ago appr'ox. 116 tons were disposed of while in 1939 the amount reached approx. 383 tons. 33 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. Routine examinations of such supplies have been undertaken throughout the year with completely satisfactory results, and arrangements are in existence with the Kent County Laboratory for 2 samples of this supply to be taken monthly for bacteriological examination from various points in the district. The following are typical reports on samples : — REPORTS ON THE BACTERIOLOGICAL EXAMINATION OF SAMPLES OF ERITH WATER. Taken from tap at 13 Methuen Road, Belvedere, on 16th May, 1939. No. of organisms per c.c. capable of growth on Agar at 37 deg. C. 2 No. of organisms per c.c. capable of growth on Agar at 22 deg. C. 15 REMARKS. B. Coli absent in 100 ccs. Good water. (Signed) E. R. Jones, Pathologist, Sessions House, Maidstone. Taken from tap at 23 Appold Street, Erith, on 14th March, 1939. No. of organisms per c.c. capable of growth on Agar at 37 deg. C. 0 No. of organisms per c.c. capable of growth on Agar at 22 deg. C. 6 REMARKS. B. Coli absent in 100 c.cs. Good water. (Signed) Louis L. Griffiths, Pathologist, Sessions House, Maidstone. Extensive sampling of water from the abyssinian wells on the Belvedere marshes has resulted in warning letters regarding the unsuitabilitv for drinking purposes of water from certain wells being issued to owners and occupiers of the sites. Statutory action under Section 140 Public Health Act, 1936, was taken in the case of one well, water from which was reported as unsatisfactory. Police Court proceedings resulted in a magistrate's order to dismantle the pump and fittings, together with 11/- costs against defendant. 34 Resulting from informal action by Sanitary Inspectors, two other wells were abandoned, and all fittings removed. E(4). Drainage and Sewerage. Extensions to the existing drainage systems were made during the year by the completion of 6,500 yards of new sewer and approximately 2,500 yards of drains to estates being developed in the District, and, in addition, there have been many extensions of house drains and connections. E(5). Closet Accommodation and Cesspools. The whole of the closet accommodation in both the older parts of the town and the newly built up areas is on the main drainage system, there being only 21 known premises which are drained into cesspools. Cesspools are emptied once a month by mechanical plant belonging to the Council free of charge, or more frequently as required, when a fee is charged to cover the cost of labour. The contents of these cesspools are discharged into the Council's sewers. The cesspools which now require the service are scattered throughout the District, and, in the majority of cases, necessitate travelling considerable distances both for pumping out and conveying to the point of disposal. During the year 1939, cesspools were emptied on 73 occasions. E(6). Sanitary Inspection of the Area. In the following tables, the work of the Sanitary Inspectors during the year is summarised:— E(6)a. Routine Visiting. Premises visited and recorded results of such visits:— Premises No. in District No. of visits in 1938 No. of faults and defects found No. of Faults and defects remedied Bakehouses 12 S5 9 9 Cowsheds 3 19 3 3 Dairies 10 59 2 2 Butchers Shops 33 183 11 11 Fishfriers 12 68 8 8 Restaurants 32 84 11 11 Ice Cream Manufacturers 6 28 3 3 Food Factories 3 21 2 2 Slaughter Houses 4 463 4 4 Factories 115 193 28 28 Outworkers 11 11 — — 35 E(6)b. Summary of Nuisances and Defects remedied during the year. Other than those enumerated in the above tabulation: Drains cleared 55 Drains repaired 38 W.C. pans renewed 24 W.C.'s repaired 12 Cisterns renewed 22 Roofs repaired 115 Eaves gutters repaired 98 Damp walls remedied 85 Plasters renewed 112 Floors repaired 66 New sinks fixed 24 New firegrates 20 Yard pavings repaired 9 New W.C.'s constructed 16 New cooking stoves 9 Coppers repaired 8 Windows made to open 46 Houses cleansed 37 Accumulations removed 19 Vermin eradicated 21 Dustbins provided 115 Drains: Water tested 19 Smoke tested 7 The total number of visits of all kinds made by the Sanitary Inspectors during the year was 5,360. Notices served:—Statutory 14; Informal 585. Number of houses and other premises disinfected 316 Batches of bedding, etc.. disinfected 200 E(6)c. Number of New Houses erected during the year. (1) By the Local Authority 0 (2) By other Authorities 0 (3) By other bodies or persons 644 E(6)d. Shops Acts 1912-1938. The Shops Act, 1912, provides for the closing of shops to customers not later than one o'clock in the afternoon on one week day in every week. The Erith Weekly Half-Holiday Order dated 17th February, 1913, and made under Section 4 of the Act prescribes Thursday as the general Weekly HalfHoliday. 36 The Shops Act of 1934 which came into operation on 31st December, 1934, regulates the number of hours which young persons under the age of 18 years may be employed, and provides generally for the health and comfort of the workers. The Shops Act, 1936, brings lending libraries, with certain exceptions within the purview of the Shops Acts. The Retail Meat Dealers (Sunday Closing) Act, 1936, requires that butchers' shops shall be closcd on Sundays, with certain exceptions with regard to the selling of kosher meat. The Shops (Sunday Trading Restrictions) Act, 1936, requires that butchers' shops shall be closed on Sundays, with certain exceptions with regard to the selling of kosher meat. The Shops (Sunday Trading Restrictions) Act, 1936, restricts the opening of shops and trading on Sunday. The Act contains provisions for granting exemption orders and special provisions regarding the Jewish Sabbath. Where assistants are employed on Sundays, the Act provides for holidays on week-days in lieu thereof. The Young Persons Act, 1938, substantially limited the number of working hours for young persons as from 1st January, 1940, to 48 hours a week if they are between the ages of 16 and 18, and to 44 hours a week if they are under 16. No young person under the age of 16, may in any circumstances be employed overtime. A total of 29 shops were inspected by the Sanitary Inspectors during the year, the results of such inspections being duly recorded on inspection cards. Regarding hours of closing, it was necessary to issue 24 warnings to shop-keeners. Non-compliance with Section 10 of the Shops Act, 1934, relating to health and comfort was located in the following instances, and Notices were consequently served to effect the necessary improvement:— Notices served. Insufficient closet accommodation 4 Absence of washing facilities 5 Lack of heating facilities 1 Lack of messroom 1 Such Notices had all been complied with by the end of the year. E(6)e. Offices No action has been taken during the year under Section 46 Public Health Act, 1936, in respect to sanitary accommodation at offices within the Borough. In on case has it been located that insufficient sanitary conveniences exist at such premises. 37 E(6)f. Camping Sites. There are no summer camping sites within the district. There are, however, 4 sites which have been occupied by van dwellings for a number of years. Frequent inspections have been made by the Sanitary Inspectors with a view to the maintenance of circumstances which are in compliance with Bye-law standards. No licenses have been granted by the Authority during the year under Section 290 of the Public Health Act, 1936. E (6)g. Hop Pickers. There are no hop fields within the district. E(6)h. Rag Flock Act. No premises exist in which rag flock is manufactured, used, or sold. E(6)i. Smoke Abatement. Twenty-three smoke observations were made at various factory chimneys, but no statutory action was taken regarding the abatement of nuisances from smoke. Informal action in respect to the taking of smoke observations resulted in the installation of a new induced draught fan at one factory. E(6)j. Health Education. Rat week activity was identical with that of other years. Large posters were displayed, and the public were invited to co-operate with the Sanitary Inspectors in destroying rats and mice. Literature as prescribed by the Ministry of Agriculture on the subject was available at the Sanitary Inspectors' Office. Routine visits were made to factories, food preparing premises, slaughterhouses, etc., hunting by dog at one factory producing 21 dead rats. In addition to advice available at the Office, free issue of vermicide was also obtainable. E(6)k. Eradication of Bed Bugs. During 1939, 34 dwellinghouses were found to be infested with vermin and subsequently disinfested as under:— Private dwellinghouses 19 Council houses 15 The infestation of the private houses was located by the Sanitary Inspectors whilst carrying out housing and other visits. In each instance, the owner was requested to remove wallpaper, picture rails, etc., and proceed with disinfestation by means of spraying, fumigation, or use of a blow lamp, the work being supervised by a Sanitary Inspector. 38 With a view to the maintenance of the improvement effected, the Inspectors re-visit the premises in question. The disinfestation of Council houses is carried out by the Surveyor's Department, the methods utilised being spraying with Solution 'B,' or alternatively fumigation with Cimex Blocks. All prospective and selected tenants for Council houses are visited by the Sanitary Inspectors who subsequently report to the Housing Committee upon the condition of the applicant's household contents. When the effects are found to be infested, furniture and other articles are subjected to Cyanide Fumigation by Contractors, who work under the direction of the Inspector. This method of rehousing has proved to be successful. E(6) I. Cleansing of Verminous Persons. No cleansing station is provided by this Authority, but cases requiring treatment can obtain it by arrangement with Dartford Hospital. E(6)m. Swimming Baths and Pools. The Council's open air swimming bath is situated in Walnut Tree Road, and comprises one swimming pool of 70,000 gallons capacity. There is a slipper establishment with accommodation for 16 males, and 4 females. The open air bath is warmed to a temperature of 70 deg. F. by low pressure steam heating and is sterilized by Chloramine process, i.e., the use of ammonia in conjunction with chlorine. The average yearly attendance is 50,000. During 1939, 8 samples were taken for bacteriological examination, all of which proved to be satisfactory. E(6)n. Mortuary. The Borough Mortuary is situated in the grounds of the Erith Parish Church and consists of a receiving room and viewing room. There is accommodation for 4 bodies. During the year 1939, 44 bodies were placed in the building. E(6)o. Schools. Schools within the district are visited regularly by the Sanitary Inspectors, and defects if any, are referred to the Education Committee. All such buildings are supplied with the Metropolitan Water Board's service. Further details with regard to schools are to be found in the Report of the School Medical Officer. 39 E(7). HOUSING. E(7)a. 1. Inspection of Dwellinghouses during the year. 1. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 884 (b) Number of inspections made for the purpose 2275 2. (a) Number of dwellinghouses (included under subhead (1) above) which were inspected and recorded under Consolidated Housing Regulations 1925 and 1932 199 (b) No. of inspections made for the purpose 458 3. No. of dwellinghouses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 15 4. Number of dwellinghouses (exclusive of those referred to under the proceding sub-head) found not to be in all respects reasonably fit for human habitation 330 E(7)b. 2. Remedy of Defects during the year without service of formal notices. Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their Officers 373 E(7)c. 3. Action under Statutory Powers during the year. (a) Proceedings under Section 9, 10 and 16 of the Housing Act, 1936: (1) No. of dwellinghouses in respect of which Notices were served requiring repairs 13 (2) Number of dwellinghouses which were rendered fit after service of formal Notices:— (a) By owner 13 (b) By Local Authority 0 (b) Proceedings under Public Health Act: (1) No. of dwellinghouses in respect of which Notices were served requiring defects to be remedied 1 (2) Number of dwellinghouses in which defects were remedied after service of formal Notices:— (a) By owner 1 (b) By Local Authority 0 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936: (1) Number of dwellinghouses in respect of which Demolition Orders were made 9 40 (2) Number of houses demolished in pursuance of Demolition Orders 1 (d) Proceedings under Section 12 of Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 0 E(7)d. Housing Act, 1936. Part IV—Overcrowding. (a) (1) No. of dwellings overcrowded at end of year 22 (2) No. of families dwelling therein 23 (3) No. of persons dwelling therein 165½ (b) Number of new cases of overcrowding reported and relieved during year 1 (c) (1) No. of cases of overcrowding relieved during year 7 (2) No. of persons concerned in such cases 48½ (d) Number of dwellinghouses which again became overcrowded after the Local Authority had taken action for abatement of overcrowding Nil E(7)e. Fitness of Houses. During the year, in connection with the inspection of existing houses under the Housing Consolidated Regulations, 1932, 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, 199 records were made of houses necessitating 458 inspections. In addition to these, 330 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(7)f. Clearance areas. Section 25. No action has been taken during the year under the provisions of Part III of the Housing Act, 1936 relating to Clearance areas. E(7)g. Individual Houses. Section 11. Demolition Orders were made in respect to the following houses: 1, 2, 3, 4, 5, 6, 7, 8, 9, Salters Terrace. 41 In anticipation of formal action, the following houses have been demolished: Higham's farmhouse, Brook Street. 1 The Walnuts, Bedonwell Hill. 2 The Walnuts, Bedonwell Hill. 38, 40, 42, Albert Road, Belvedere. E(8). Factories. 1. INSPECTIONS for the purposes of provisions as to health including inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 134 9 — Factories without mechanical power 36 7 — Other premises under the Act (including works of building and engineering construction bat not including outworkers premises) 23 — — Total 193 16 — 2. DEFECTS FOUND. Particulars Number of Defects Number of defects in respect of which prosecutions were instituted Found Remedied Referred to H M Inspector Want of Cleanliness 6 6 — — Overcrowding — — — — Unreasonable Temperature — — — — Inadequate Ventilation — — — — Ineffective drainage of Floors 2 2 — — Sanitary Conveniences: Insufficient 5 5 — — Unsuitable or Defective 6 6 — — Not separate for sexes — — — — Other offences 9 9 — — Total 28 28 — — 42 SECTION F.—INSPECTION AND SUPERVISION OF FOOD SUPPLY. F(1). Milk Supply. The current register of cowsheds, dairies, and milk stores, records the following figures of registration : No. of registered farms and cowsheds in the Borough 3 No. of registered dairies 10 No. of milkshops selling milk in sealed receptacles only 34 No. of registered purveyors outside the district 17 31 samples of milk from various sources were obtained and submitted to the County Bacteriologist for bacteriological examination as follows:— Ordinary milk 16 Graded 15 Of the above, two samples of graded milk and one of ordinary milk were found to be unsatisfactory, and as a result of action by the Sanitary Inspectors, repeat samples of the supplies Proved to be satisfactory. The following table indicates the number of licences issued by the Authority under the Milk (Special Designations) Order, 1*936:— Designation No. Pasteuriser's licence C 1 Pasteurised Dealers licence B 2 Tuberculin Tested Dealers licence B 1 Supplementary licences Pasteurised D 7 Tuberculin Tested D 2 Tuberculin Tested (Pasteurised) D 4 13 F(2). Slaughter of Animals Act, 1933. The Slaughter of Animals Act, 1933, made the use of a mechanically operated instrument in certain instances a statutory obligation. During the year 8 persons made application for renewal of their licences to slaughter or stun animals in compliance with the requirements of the above Act. No. of licensed slaughtermen on register at 31st December, 1938 10 No. of licensed slaughtermen on register at 31st December, 1939 8 43 F(3). Inspection and Supervision of Meat and Other Foods. There are 4 licensed slaughterhouses, and 33 butchers' shops within the Borough, inspections at such premises resulting in the confiscating of 15 cwts. 1 qr. 24 lbs. of meat, as unfit for human consumption. SUMMARY OF CARCASES INSPECTED AND CONFISCATED. Cattle excluding Cows Cows Calves Sheep & Lambs Pigs Number killed 16 — 36 434 1564 Number inspected 16 — 36 434 1564 All diseases except Tuberculosis Whole Carcases condemned — — — — 3 Carcases of which some part or organ was condemned 2 — — — 15 Percentage of the number inspected affected with disease other than tuberculosis 12.5% — — — 1.15% Tuberculosis only Whole' Carcases condemned — — — — 6 Carcases of which some part or organ was condemned — — — — 37 Percentage of the number inspected affected with tuberculosis — — — — 2.74% F(4). Other Foods. In addition to the meat inspected in the slaughterhouses and butchers' shops and stores, the Sanitary Inspectors dealt with the following foodstuffs which upon examination was found to be unfit for human consumption and which was duly surrendered and destroyed:— Milk 16 pints Cucumbers 12 lbs. Tomatoes 216 lbs. Lemons 60 lbs. Coconuts 28 lbs. Fish 224 lbs. Potatoes 5600 lbs. 44 F(5). Food and Drugs Act, 1938. On 26th August, 1939, the Minister of Health, having regard to the application made to him under Section 64 (proviso b), issued an Instrument giving direction that the Erith Borough Council should as from 1st October and until the population of the Borough according to the last published census ceased to amount to 20,000, be the Food and Drugs Authority for the Borough. As from 1st October, 1939, the Sanitary Inspectors have administered accordingly, and the following samples were submitted to the Borough Analyst for examination:— Nature of sample Adulterated Genuine Informal Formal Total Milk — 9 1 8 9 Cocoa — 1 1 — 1 Flour — 1 1 — 1 Vinegar — 2 2 — 2 Sauce — 1 1 — 1 Atora Suet — 1 1 — 1 Butter — 1 1 — 1 Cheese — 1 — 1 1 Plum Pudding — 1 1 — 1 Welsh Rarebit — 1 1 — 1 Pepper — 1 — 1 1 Custard Powder — 1 1 — 1 Mustard — 1 1 — 1 Table Jelly — 1 — 1 1 Ground Rice — 1 — 1 1 Trex Fat — 1 1 — 1 Sardines — 1 1 — 1 Mincemeat — 1 1 — 1 Coffee and Chicory — 1 1 — 1 Raisins — 1 1 — 1 Green Peas — 1 — 1 1 Margarine — 1 1 — 1 31 18 13 31 As will be seen from the above table, all the samples procured were reported upon by the Public Analyst as being genuine, and of good quality. F(6). Offensive Trades. In addition to the statutory Offensive Trades specified under Section 107 Public Health Act, 1936, fish frying was on 17th March, 1939, declared to be an offensive trade within the Borough, and Bye-laws were made accordingly. There are no offensive trades, other than fish frying premises of which there are 12 within the Borough. 45 H(4). Legislation in Force. List of Bye-laws, etc., in force in this district with date of adoption:— Tents, Vans, Sheds and similar structures 28th Feb., 1928. Houses let in lodgings 27th Jan., 1930. Slaughterhouses 29th Jan., 1932. School Attendance 17th Feb., 1932. Libraries and Museum 15th June, 1934. Nursing Homes .20th July, 1934. Pleasure grounds 4th Feb., 1936. Employment of children 25th Mar., 1936. Dogs fouling footpaths 22nd Feb., 1939. Fish frying 9th May, 1939. Offensive trades 9th May, 1939. Building Bye-laws 10th Aug., 1939. House refuse 17th Oct., 1939. Frith Cemetery 25th Oct., 1939. Public baths 26th Oct., 1939. Prevention of nuisance and keeping of animals 23rd Apr., 1940. BOROUGH OF ERITH. ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1939. EDUCATION COMMITTEE. 3 School Medical Officer: Chairman:—Councillor Farquahar. Vice-Chairman:—Councillor Mantle. Alderman Mrs. Lenney. Councillor Bates. Councillor Mrs. Nichols. ,, Ebben. ,, Pannell. ,, Fletcher. ,, Powrie. Co-opted Members: A. Affleck, Esq. Miss K. Murphy. Dr. P. H. Macdonald. Mrs. Pannell. F. H. Hunt, Esq. SCHOOL MEDICAL STAFF. A. Wallace Johns, m.r.c.s., l.r.c.p., d.p.h. Assistant School Medical Officer: Helen M. Evans, m.r.c.s., l.r.c.p., d.p.h. Orthopaedic Surgeon: W. Eldon Tucker, f.r.c.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., c.m.b., Miss Briggs, s.r.n. Clerks: Miss M. Smith. Miss J. Redgrave. 4 Report of the School Medical Officer. As a request has been included in Form 6M of the Medical Branch of the Board of Education, which is the Annual Official Instruction as to the method of presentation of these reports, to keep the report as brief as possible owing to the urgent need for economy, observations will be restricted to what may be regarded as essential. Items which have been recorded in detail in previous years will only be included for the purpose of retaining the reference value of the report, and no further detail will be given to them other than appears to be necessary to secure that object. The Borough of Erith was entirely included in the evacuation areas, and evacuation of the school children was carried out on 5th September, 1939. The School Population of the Borough according to the register at 1st September, 1939, was 5131 The number of children evacuated was 1592 Number of children remaining in the reception area at 1st December, 1939, was 632 As a result of a strong desire of the Committee to maintain contact with these evacuated children, arrangements were made with the generous co-operation of the County Medical Officer, for visits to be paid to the schools and billets in the reception area, and reports on the welfare of the children to be made to the Erith Education Committee. These reports invariably showed that the Erith children were being well looked after, were happy and were enjoying increasing good health and physical condition, and revealed no instances where necessary services were unavailable. 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 18 departments, and one nonprovided school with one department. 5 Prior to the Evacuation of School Children in September, 1939, there were 5,131 children on the roll of the elementary schools, distributed as follows: Infants Schools 1,552 Junior Mixed and Infant Schools 393 Junior Mixed Schools 533 Junior Schools 1,256 Senior Schools 1,397 Medical Inspection. Up to the outbreak of war, Routine Medical Inspection was carried out as required by the Board of Education, namely entrants, 8 year olds and leavers. I repeat my observations on Routine Medical Inspection made in last year's report, as it appears to me that the Medical Inspection carried out for Evacuees, where it is carried out as in districts like this, showed how a method of selection of children needing further medical investigation could be provided, so that the whole school population could be brought under review each year so that every child could pass through a medical examination every year instead of three times only in its school life. Malnutrition. On referring to table B, and comparing these figures with last year's, the following facts emerge. In the first age group, Entrants, there were 13.9 per cent. in A (excellent), an increase of 4.9 per cent.; 53.9 per cent. were in B (normal), a decrease of 13.1 per cent.; 30.7 per cent. in C (slightly sub-normal), an increase of 8.7 per cent.; and there were 1.3 per cent. in D (bad), an increase of .8 per cent. In the second age group, 8 year olds, there were 24.4 per cent. in A, an increase of 7.4 per cent.; 43.1 per cent. in B, a decrease of 16.9 per cent.; 29.3 per cent. in C, an increase of 7.3 per cent.; and 3.1 per cent. in D, an increase of 2.8 per cent. In the third age group, leavers, 19.3 per cent. were A, an increase of 4.3 per cent.; 60 per cent. were B, an increase of 2 per cent.; 20.1 per cent. were C, a decrease of 4.9 per cent.; and 0.3 per cent. were in D, a decrease of 0.1 per cent. Comparing totals of children examined with last year's figures, there are 147 children in A Group, an actual decrease in number of 102. There are 415 in B Group, a decrease of 618. There are 211 in the C Group, a decrease of 189, and there are 12 in the D Group, an increase of 5. 6 Provision of Meals, Milk and Malt and Oil. Milk has been issued on the School Medical Officer's certificate to 107 children during the year, the issue being two-third pint bottles per day. In the case of children suffering from a greater degree of mainourishment, meals have also been provided. Below is set out a table showing the quantities of Malt and Oil distributed:— Total amount issued during the year: Erith 1239 lbs. Bedonwell 137 lbs. 1376 lbs. Amount issued free: Erith 1161 lbs. Bedonwell 128 lbs. 1289 lbs. No. of children receiving free issues: Erith 148 Bedonwell 11 159 Amount sold at cost price: Erith Bedonwell 78 lbs. 9 lbs. 87 lbs. At the end of the year a total of 329 children were receiving free milk at school. Twenty-two recommendations were made for free meals during the year, bringing the total number of children receiving free meals to 29. Uncleanliness. During 1939, 152 children were found to be verminous at inspections made in the schools by the School Nurses. This figure shows an increase in number of 12 over that of last year, but, in fairness to the large proportion of parents whose children are invariably clean, I must again repeat that the persistence of this figure is due to a small group of chronic offenders. Many words and much ink have been expended probably on this problem of the School Medical Service, and I am convinced that vigorous action by the Local Authority is necessary. 7 Nose and Throat Defects. Reference to Table II will show individual defects under this heading. Since the war the Royal Waterloo Hospital, who have provided us with these facilities for many years, and with whom our relations have invariably been eminently satisfactory, have been under the control of the Emergency Medical Service and unable to take our cases. Arrangements are therefore being made for this work to be done at the Erith Hospital. Ear Diseases and Defective Hearing. Reference to Table IV will show that 139 defects were treated during the year. Dental Defects. Up to the outbreak of war the Dental Scheme was operating at 8 sessions per week. After the evacuation of the School Children and the closure of the Schools it was found impossible to secure sufficient clinical material to sustain this number of operating sessions and they were reduced to 4 for school children. At the time of writing there is the promise of reopening of the schools within a very short time and then the full number of sessions can be resumed. I must add again, in such circumstances, that the need for increasing these sessions to the extent of not less than a full time equivalent. On the contrary if the schools do not re-open but if evacuation takes place, it will be necessary to consider the need of Dental Treatment of our children in the reception areas. Visual Defects and External Eye Disease. The table under Group II shows the extent of the ophthalmic work carried out by the Ophthalmic Surgeon. In past years a brief description of the scope of this work has been supplied by the Ophthalmic Surgeon, Mr. N. Howard Allen, M.R.C.S., L.R.C.P., but Mr. Allen is at the moment in the Army, and Mr. Oliver Walker, L.R.C.P., M.R.C.S., D.P.M., D.O., is carrying on this work. Orthopaedic and Postural Defects. Full details of the operation of this service will be found in previous reports, a particularly full account having been given last year. W. Eldon Tucker, Esq., F.R.C.S., has been called to the Army and his work is now being carried on by E. A. Lindsay, Esq., F.R.C.S. 8 The following is a list of cases which have attended the clinic: Defects. Infant Welfare. School Children. Spastic Varus 1 Talipes Equino Valgus 1 „ Varus 5 2 „ Valgus 1 2 Metatarsal Varus 3 Genu Valgum 7 2 „ Varus 2 „ Varum 3 1 „ Recurvation 1 Hallux Valgus 3 Flat Feet 3 17 Hammer Toe and Overlapping Toes 5 Prominent Bone Foot 1 Aching Ankles and Feet 2 Deformity Feet 1 Toes bent 4 Difficulty in walking 2 Mild P.P.U. 1 Legs hoop 1 Shortening of leg 1 Amputation leg 1 Rickets 2 1 Outward Curved Tibia 1 Sternomastoid Tumour 1 Congen. Torticollis 1 Rectus Femosis tight 1 Crooked Back 2 Kyphosis and Scoliosis 27 Dropped Shoulders 1 Spastic Paraplegior 6 Osteomyclitis 1 Poliomyclitis 2 Infantile Paralysis 1 Chondritis R. hip 1 Rheumatism legs 1 Protusion 4th rib 1 Asthma 3 Fibrositis neck 1 Fibrositi adhesion 1 9 The restrictions placed on removal of patients from one group to another by the Emergency Medical Service in the early part of the war, gave rise to difficulties with regard to institutional treatment, as under our scheme the Royal National Orthopaedic Hospital, and its branch at Stanmore, provided us with this accommodation ; but these cases have been dealt with under the institutional arrangements of the Kent Education Committee's Orthopaedic Scheme with the generous co-operation of the County Medical Officer of Health. Tuberculosis. The responsibility for the Tuberculosis Scheme for this area, rests with the County Council and under their Tuberculosis Scheme they provide a Dispensary at Erith where a Tuberculosis Officer attends twice weekly. Following up and Summary Work by the School Nurses. Following up work by the School Nurses is summarised in the following table:— Visits paid to the schools 511 Children examined 10813 Children found with vermin 152 Visits to homes 1233 Attendances at Ophthalmic Clinic 20 ,, ,, Orthopaedic ,, 8 Attendances at Dental Clinic: Bedonwell Hill •2i> Erith 35 Since the war attendances at the Minor Ailment Clinic have fallen considerably, and this absence of large numbers of minor casualties occupying the doctor's time, enables a higher proportion of special cases to be given appointments for Medical Consultation, which is, after all, an important function of the School Medical Service. I have always felt that too much of the doctor's time is taken by these out-patient department cases at the Clinic, but in the absence of an out-patient department of a hospital available, there does not seem to be any solution other than restricting access to the doctor to particular days or by appointment, or by arranging for extra medical assistance on a sessional basis for part of or all of these Minor Ailment Sessions. 10 Set out below is a table giving the number of childrer examined, together with the total attendances, at the various clinics:— 1939 1938 Children Attendances Children Attendances Minor Ailments Clinic 1570 7060 1885 9567 Dental Clinic 1263 2222 1278 2196 Ophthalmic Clinic 192 561 256 696 Special Examinations 2S85 4528 3307 5495 Operations for Tonsils and Adenoids 63 – 83 – Orthopaedic Clinic 128 223 92 254 Total 6101 14594 6901 18208 Infectious Disease. Cases of the more common infectious diseases, measles, chickenpox, whooping cough, scarlet fever, &c., occurred throughout the year in the various Departments and Schools in small concentration and were not in greater numbers than would warrant them being described as sporadic. There was no unusual grouping in any particular school. Immunisation against Diphtheria. At the first attempt to restart after the dislocation caused by the outbreak of war, the response to endeavours to secure attendances for immunisation was particularly disappointing. Out of 117 appointments given at one session, only 8 turned up. It is probable however that better results will be secured now that the attitude and outlook of the population has returned to normal. Laboratory Facilities. Examination of pathological specimens, and other laboratory work for the District, are undertaken by the Kent County Laboratory, Sessions House, Maidstone. During 1939, 21 swabs as will be seen from Table III a number of delicate children attend certified day schools and residential open air schools maintained by other Education Authorities, this Authority being responsible for the fees and in most cases the parents contribute towardwere examined for Diphtheria, 20 of which proved to be negative; and 4 swabs for Haemolytic Streptococci, 2 of which were positive. Open Air Schools. There is no open-air school provided by this Authority, buts the cost. 11 The number of children for whom special school, convalescent or hospital school treatment was provided during the year for periods of varying length was 42. Physical Training. Miss F. W. Bentley and Mr. G. H. Atkinson, the Organisers of Physical Education for Erith have kindly submitted the following notes on their work during the year. I have much pleasure in including these in my Annual Report of the School Medical Service for the year 1939. "One of the immediate consequences of modern warfare is its disturbing effect on the minds and emotions of the young. The daily contact of children with parents harassed by anxieties of family disunion, and by the general repercussions and horrors of war, creates a problem which calls for immediate consideration on the part of all teachers. The influence of a happy school environment is invaluable to the child, and of all the means to this end at the teacher's command, none can be so effective than a well-planned scheme of joyous and disciplined physical activities. It is, therefore, unfortunate that, with the abrupt dislocation of the educational services at the outbreak of war, the excellent progress in Physical Education maintained during previous years has been seriously interrupted. Compared with most other subjects of the school curriculum, Physical Education has proved particularly vulnerable: the provision of new facilities, such as gymnasia and playing fields, which in many areas was approaching adequacy, has been suspended; playground and playing field space has been restricted by the siting of Air Raid Shelters, and specialist teachers, whom their schools could ill afford to lose, have been diverted into military service. In spite of these difficulties, however, we are confident that with the restoration of more normal conditions for work in the schools, the subject will be afforded every possible opportunity to play its new and vital role in the service of the community. In the light of present circumstances, the following report of the subject's progress is limited to that period preceding the war when the normal work of schools was possible, i.e., January—July, 1939. 12 Physical Exercises. (a) Senior Schools. The advanced schemes of physical exercises adopted in all the Committee's Senior Schools, required but one more year of normal progress for their full potentialities to be realised and their true values ascertained. The accumulative results of the previous two years could be readily observed amongst the boys, in their increased prowess in gymnastic work, and amongst girls, in their improved posture and general refinement of movement. In the hands of specially-trained teachers of both sexes, the teaching has been vigorous and purposeful, and as their pupils have gained in skill, previous difficulties of rhythm and "finish" have largely disappeared. It is extremely unfortunate that at the age of 14, when the majority of children leave school, they are unable, through lack of facilities, to continue those practices which have contributed so much to their physical development and prowess. In the Borough of Erith there is not a single gymnasium suitably equipped for the task of carrying on where the elementary school leaves off. (b) Junior Schools. Recent efforts to introduce a higher degree of definition and precision in the Physical Training lesson for Juniors have been well repaid. In a 20 minute lesson it has always been a difficult task for the teacher to obtain maximum correctness of detail, whilst, at the same time, preserving the recreational and joyous character of the work. In order to overcome this difficulty, the majority of Head Teachers have increased the lesson-period to 30 minutes; they are generally agreed that results have more than justified the change. (c) Infant Schools. In both Primary and Secondary Lessons a really satisfactory improvement has been observed. It is in the Infant Schools that the basis for all future work is laid, and in which the results of successful teaching are so valuable and lasting. Of the chief aims which have been sought, good posture, a well-trained and immediate response to signals, and a happy and energetic reaction to teaching, were particularly noticeable. Care in the preparation of lessons 13 and pride in their execution were clearly evident amongst teachers, and the increased use of apparatus has given added joy and interest to the children. With regard to the less formal Secondary Lesson, success largely depends upon the musical ability of the teacher; for unless she possesses the necessary musical technique, the pleasure and value of movement to music, the main objectives of this lesson are completely absent. In most Infant Schools, however, the problem, where it had been present, has been satisfactorily solved by teachers specialising in this work. Although excellent progress has already been made in this Secondary Work, there is still a need for the adoption of comprehensive and progressive schemes throughout each Infant School, with the object of securing unbroken continuity of work and the proper accumulation of results. Shoes and Clothing. Arrangements for the provision and storage of physical training shoes and clothing have been continued, and up to the outbreak of war, a steady increase was observed in the number of schools in which the practice of changing footwear for physical training had become general. A number of Junior Schools are still without locker accommodation, in consequence of which, children, unable with safety to leave their shoes at school, frequently forget to bring them from home when required. Organised Games and Athletics. It cannot be too frequently emphasised that the highest values of Organised Games can only be secured when training is planned and carried out on progressive and scientific lines. In the Committee's Senior Schools continued facilities for regular weekly instruction in Organised Games have been available and the standard of coaching in the major team games has improved. In one Senior Boys' School the introduction of field athletics has proved highly successful; useful standards having been achieved in Throwing the Javelin and Discus. In Junior Schools the development of minor team games has shown improvement, and the planning of markings in playgrounds has given evidence of the variety and scope of the activities employed. 14 Swimming. New arrangements for organised instruction in swimming have been adopted and proved highly successful. Under a scheme providing for ten weekly lessons for all Senior and a limited number of Junior School children, classes were conveyed to and from the Bath by special motor coach, and by arrangement with the Baths' Committee, the valuable services of the Bath Superintendent and his wife were again made available. Both are experienced and expert swimming teachers, and their whole-hearted and untiring efforts are deserving of the highest appreciation and esteem. In order to ensure that no child should be compelled to forego swimming instruction for want of costume or towel, an adequate supply of these articles were provided by the Committee and kept available at the Bath. Further Training of Teachers. Owing to the unsettled conditions resulting from the succession of crises preceding the war, and the subsequent closure and evacuation of schools, it has been found impracticable fully to carry out our intended programme for the further training of teachers. The following courses, however, were completed:— (1) A Course of Physical Training for Women Teachers in Junior Schools of Erith and Gravesend held at Northumberland Heath Central School on Saturday mornings throughout the period October 8th—February 25th inclusive. Attendance 36. (2) A short intensive Course of Physical Training for Teachers in Infant Schools of Beckenham, Bromley, Erith, Gravesend and Penge, held in Bromley each afternoon during the period, February 21st—March 3rd. Attendance 30. (3) A three weeks' Intensive Course for Men Teachers in the Junior Schools of Beckenham, Bromley, Erith, Gravesend and Penge, held at Bromley during afternoons. Attendance 14. Physical Training for A.R.P. Services. Actuated by a desire to assist in the general National effort at the beginning of the war, and in the belief that our specialised training and experience might be of benefit to the 15 Civil Defence Services, we were pleased to have obtained the Committee's permission to organise and conduct a short course of training for intending instructors of Physical Training in the Erith A.R.P. Services. Our offer to do this work was much appreciated by the local A.R.P. Officer, who has since informed us that as the result of our voluntary efforts, regular instruction in Physical Training is now being given to many of the local A.R.P. personnel. Conclusion. In the difficult times which lie ahead, the educational ideal of a "sound body and a sound mind" will have a new and important significance. Education must adapt itself to the principle that its prime function in time of war is to protect the child from an environment which tends to undermine his spirit and confuse his emotions. A well-trained body under the control of a strong, courageous will, now becomes a far more important educational objective than ever before, and we would invite those who, in the past may have regarded Physical Education as a subject outside the true educational conception, to reconsider its values in this new light. We would acknowledge, with gratitude, our thanks and appreciation of the continued support of the Education Committee and its Officers and for the friendliness and co-operation of the teaching staff. The fact that, harassed as all have been by the events of the past year, we have always received a ready welcome in all the Committee's schools, has helped us considerably in our work." Blind, Deaf and Epileptic Children. One child comes within the blind children group this year. This child lost her sight following cerebro spinal meningitis. There are no deaf children in our area. No epileptic children came under our notice during 1939. Nursery Schools. There are no nursery schools provided by the Erith Education Authority but as has previously been noted, Nursery Classrooms are provided in four of the Infant Schools. Mentally Defective Children. The following is taken from the Annual Report of the Local Organiser of the Kent Voluntary Association for Mental Welfare . 16 "Changes due to the War. Since the outbreak of war many defectives have moved with their families from their own homes and have had to be traced. Patients placed under the Kent Guardianship Scheme with guardians living in danger zones have been evacuated to reception areas. The majority have been admitted to Leybourne Grange for the duration of hostilities. Occupation Centres. The War has necessitated the closing down of all Occupation Centres. In the event of air-raids, protection was inadequate and it was felt that too great a responsibility would rest upon the Supervisors. It was evident that a strenuous effort must be made to keep in close touch with the children and young people in training at the Centres, if years of patient work were not to be thrown away. Official approval was obtained for the organisation of a Home Teaching Scheme. This is being carried out by the Supervisors of the Centres, who have succeeded in providing each child with at least two lessons a week. This effort is greatly appreciated by parents and guardians, and is proving helpful in keeping the children out of mischief. The services of Cooks and Guides at the Centres had unfortunately to be dispensed with for the time being; they have always given valuable help." TABLE I. Medical Inspections of Children Attending Public Elementary Schools. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 302 Second Age Group 225 Third Age Group 258 Total 785 Number of other Routine Inspections Grand Total 785 B.—Other Inspections. Number of Special Inspections and Re-Inspections 4528 17 TABLE II. B—Classification of the Nutrition of Children Inspected during the year in the Routine Age Croups up to 31st August, 1939. (See Administrative Memorandum No. 124, dated 31st December, 1934.) Age-Groups Number of Children Inspcted A B C D Excellent Normal Slightly subnormal Bad No. % No. % No % No. % Entrants 302 42 13.9 163 53.9 93 30.7 4 1.3 Second AgeGroup 225 55 24.4 97 43.1 66 29.3 7 3.1 Third AgeGroup 258 50 19.3 155 60.0 52 20.1 1 0.3 Other Routine Inspections... – – – – – – – – – Total 785 147 18.7 415 52.8 211 26.8 12 15 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 — — — 1 1 Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total — — — — — 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 — — — 3 3 18 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1939. 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 3 – 3 Scabies 29 3 32 Impetigo 08 – 68 Other skin disease 84 13 97 Minor Eye Defects (External and other, but excluding cases falling in Group II). 72 – 72 Minor Ear Defects 130 9 139 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 801 18 819 Total 1187 43 1230 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 Authority's Scheme Otherwise Total 1 2 3 4 Errors of Refraction (including Squint) 192 18 210 Other Defect or Disease of the Eyes (excluding those recorded in Group I) – – – Total 192 18 210 19 No. of Children for whom spectacles were prescribed: (i) Under the Authority's Scheme 128 (ii) Otherwise 15 143 No. of children for whom spectacles were obtained: (i) Under the Authority's Scheme 100 (ii) Otherwise 15 115 GROUP III.—TREATMENT OF DEFECTS OF NOSE. AND THROAT. Number of Defects. Received Operative Treatment Received other forms of Treatment Total 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. 14 — 49 — 4 — 6 — 18 — 55 — — 73 (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 (i) (2) Residential treatment with education Residential treatment without education N onResidential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number of children treated 1 – 82 — — 5 84 TABLE V. Dental Inspection and Treatment. Routine Age Groups Total Specials Grand Total 5 6 7 8 9 10 11 12 13 14 (?) Inspected by Dentist 67 90 37 89 93 97 192 126 62 31 884 964 1848 20 (2) Number found to require treatment 1505 (3) Number actually treated 1263 (4) Attendances made by children for treatment 2222 (5) Half-days devoted to:— Inspection 7 Treatment 231 238 (6) Fillings:— Permanent Teeth 1111 Temporary Teeth 2 1113 (7) Extractions:— Permanent Teeth 279 Temporary Teeth 1277 1556 (8) Administrations of general anaesthetics for extractions 824. (9) Other Operations:— Permanent Teeth 238 Temporary Teeth — 238 TABLE VI. Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 3.8 (2) Total number of examinations of children in the Schools by School Nurses 10813 (3) Number of individual children found unclean 152 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 – (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 – (b) Under School Attendance Byelaws –