ERI 21 BOROUGH OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1941 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 1941 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 8 (a) General 8 (b) Births 8 (c) Deaths 8 (d) Infantile Mortality 9 (e) Vital Statistics of District 9 (f) Causes of Death 10 (g) Birth-rate, Death-rate and Analysis of Mortality 11 2. Maternal Mortality 12 3. Infantile Mortality 12 4. Unemployment Figures and Comments 13 B Maternity and Child Welfare Services 14 1. Maternity and Child Welfare Scheme 14 2. Notification of Births 15 3. Infant Welfare Centres 16 4. Home Visits by Health Visitors 17 5. Maternity Services 17 (a) Maternity Home—Hainault 17 (b) Ante-natal 17 (c) Abnormal Cases 18 6. Infant Life Protection 19 7. Midwives 19 8. Dental Clinic 19 9. Home Help 19 C Prevalence of and Control over Notifiable Infectious Diseases 20 1. Infectious Diseases' Hospital 20 2. Tables 20 (a) Notifications 20 (b) Age Distribution 21 3. Diphtheria Immunisation 22 4. Smallpox 22 5. Disinfection of Premises 22 6. Laboratory Facilities 22 i Section C (continued). Page 7. Tuberculosis 23 (a) Treatment and Hospital Accommodation 23 (b) Tables (i) Particulars of New Cases and Deaths 23 (ii) Quarterly Statements 24 8. Ear, Nose and Throat 25 D Hospital and Ambulance Facilities 25 E Sanitary Circumstances of the Area 25 1. Refuse Collection and Disposal 25 (a) Costs 25 (b) Details of Refuse Vehicles and Staff 26 (c) Details of Tonnage 26 2. Trade Refuse 26 3. Salvage 27 4. Water Supply 28 5. Closet Accommodation and Cesspools 28 6. Shops Act 1912—1938 29 (a) Offices 29 7. Camping Sites 29 8. Hop Pickers 29 9. Rag Flock Act 29 10. Smoke Abatement 29 11. Sanitary Inspection of the Area 30 (a) Routine Visiting 30 (b) Summary of Nuisances and Defects Remedied during the year 30 (c) Health Education 31 (d) Eradication of Bed Bugs 31 (e) Cleansing of Verminous Persons 32 (f) Swimming Baths and Pools 32 (g) Mortuary 32 (h) Schools 32 12. Housing 32 (a) Inspection of Dwellinghouses during the year 32 (b) Remedy of Defects during the year without service of formal notices 33 (c) Individual Houses. Section 11 34 (d) Housing Act 1936—Overcrowding 34 (e) Rent and Mortgage Interest tions) Act, 1939 34 ii Section E (contnued). Page 13. Factories 35 (a) Inspections 35 (b) Defects Found 35 F Inspection and Supervision of Food Supply 36 1. Cowsheds, Dairies and Milk Stores 36 2. Bacteriological Examination of Milk 36 3. Sampling of Milk for Tubercle Bacilli 36 4. Milk Supply 36 5. Slauglhter of Animals Act 1933 36 6. Meat and Food Inspection 37 7. Food and Drugs Act Sees. 3 and 68, Routine sampling 38 8. Offensive Trades 39 H General. 1. Letter by Medical Officer of Health 2 2. Members of Committees 5 3. Staff of Public Health Department 6 4. Legislation in Force 39 iii 2 H (1 ). Public Health Department, Council Offices, Erith. To:— The Mayor, Aldermen and Councillors of the Borough of Erith. Mr. Mayor, Ladies and Gentlemen, This report is again curtailed as in the previous two years for purposes of national economy and consists therefore mainly of statistics. Speculation is essential to progress, but when submitted as nothing more than a possibility and refutation is invited, it cannot fail to fulfil a useful purpose. Premature attempts at simplification, or over-simplification of many detailed observations are manifestly dangerous and may result in crudely expressed or even false conclusions. It is encouraging to note that as far as can be ascertained no children under the age of 5 years who had the complete course of immunisation against whooping-cough developed the disease in the subsequent epidemic that took place in tJhe town during this year. It must be stated, however, that the number actually immunised was relatively small and that the question of exposure to risk has not been completely investigated. The .number of children immunised against this serious disease is not likely to be very spectacular while three to four injections of the protecting material at monthly intervals have to be given, with the frequent difficulties of "missed appointments." It has to be recorded that during 1941 scabies showed a disturbing increase in prevalence over the previous year. 102 cases came to the notice of the Department compared with the 32 cases in 1940, and the incidence towards the end of the year appears to be rising. Pre-school children and school cases are generally accessible, but the infested adults in the family concerned are a different problem. The Scabies Order of the 28th October, 1941, should help to remedy this, and a scheme 3 is in hand for the borough population involving the use of a small cleansing unit in the grounds of the Isolation Hospital. In May of this year tihe Authority's new high pressure steam disinfector was installed at the Isolation Hospital, and the provision of this magnificent up to date machine fills a long-felt want and will enable verminous conditions to be dealt with completely and effectively. I bring to your notice the satisfactory state of the register recording the number of persons suffering from tuberculosis in this Borough. The total number on the register is now 301, a reduction of some 274 persons as compared with the previous year, this big reduction in the total figures being a direct result of a large scale enquiry which was made into all cases of tuberculosis recorded as residing within the town. In accordance with the requirements of the Ministry to provide accommodation for children of mothers who wish to take up work of national importance a Nursery School was opened in August at the Bedonwell Hill School. That the nursery school is a popular venture is revealed by the attendance figures which during 1941 showed an average monthly enrolment of 52 children. It is perhaps not inappropriate for me to mention in this letter the municipal piggery housing some fifty pigs which has been established in the grounds of the Isolation Hospital. As an essential part of the Council's salvage of waste food service, and apart from sundry small difficulties such as obtaining the necessary meal rations, etc., the scheme on the whole has been successful. During this year the clerical branch of the Department has suffered severely, for both the permanent male members of the staff including the Chief Clerk have been called to H.M. Forces. That clerical work can be efficiently performed by temporary female replacement is undoubtedly true, but administrative ability is surely another matter particularly in view of the increasing duties assigned to Public Health Services. In calling attention to the slightly increased infantile mortality figure of 37.95, as compared with the figure of 59 for the country as a whole, mention may be made of the Maternity and Child Welfare services in the town. The 4 accommodation at the Borough Maternity Home has been increased by the addition of two beds to 9 beds. In two areas of the town, the weekly Child Welfare Centres have been doubled and in a third area the Centre has been increased from two sessions each month to a fortnightly clinic. A new weekly Ante-natal Clinic has been opened in the Picardy area, and the Ante-natal Clinic in the Erith area has been changed to an evening Centre so that there is now a morning, afternoon and evening Ante-natal Clinic functioning weekly within the Borough. These new ventures have increased the medical duties of the Department, and I am pleased to record the appointment of a second full-time Assistant Medical Officer in August of this year. Increased conditions at all the Centres have rendered these expansions necessary. Whether this is due entirely to the method of distribution of the National Milk Scheme through the Centres, or to the applications for the extra clothing coupons to expectant mothers being dealt with by the same personnel, is doubtful, but it should be remembered that these two schemes give the Health Department of the town an unrivalled opportunity for propaganda with this section of the community, and incidently also provide unofficial notifications of pregnancy occurring in the District. In conclusion I must record my gratitude for the wholehearted co-operation and help of all members of the staff during a difficult period. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, REGINALD LEADER, Medical Officer of Health. December, 1942. 5 H (2). MEMBERS OF COMMITTEES. Health Committee. Chairman—Councillor Alford. Alderman Christian. Alderman Ewens. ,, Bates. Councillor Morling. Councillor Dunkley. ,, Ellis. ,, Farquhar. Maternity and Child Welfare Committee. Chairman—Alderman Ewens. Alderman Christian. Councillor Alford. Councillor Nichols. ,, Dunkley. ,, Burgess. ,, Farquhar. ,, Tyrer. Co-opted Members : Mesdames Hyde, Smith and West. Ex-officio Members of both Committees : His Worship the Mayor, Councillor G. H. Luck. Deputy Mayor, Councillor C. F. Morling. Chairman of Finance and General Purposes Committee, Councillor T. C. Pannell. 6 H (3). STAFF. 1. Whole-time. Medical Officer of Health, School Medical Officer, Medical Officer in Charge of Sanatorium for Infectious Diseases and Maternity and Child Welfare, Milk Officer, Borough Salvage Officer— Reginald A. Leader, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers of Health and Assistant School Medical Officers— C. H. D. Asher, B.Sc., M.D., B.S., M.R.C.P., D.C.H. (Resigned 15/4/41.) F. Schenk, M.D. (Appointed 9/9/41.) M. R. Blair, M.R.C.S., L.R.C.P., L.D.S. (Appointed May, 1941.) 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 Inspectors— 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. Sanitary Foreman & Disinfecting Officer— H. W. Cooper. Health Visitors— 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., and S.C.M. (1) (Resigned 22/5/41.) Miss I. P. Burt, S.R.N., New H.V. Cert., S.C.M., and R.F.N. (Appointed 23/6/41.) Miss P. M. Lindsay, S.R.N., New H. V. Cert.; S.C.M., T.A. (Resigned June, 1941.) Miss M. A. G. Williams, S.R.N., S.C.M., H.V. Cert. (Appointed 21/5/41.) 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. 7 Clerks— Chief Clerk—H. M. Coles, L.A.G.C. (To H.M. Forces, 1/9/1941.) Acting Chief Clerk—W. Hillier. (Appointed 20/8/1941.) Accounts Clerk—Mrs. M. R. Bartlett. (Resigned 18/10/41.) Mrs. G. P. MacPherson. (Appointed 20/10/1941.) General Clerks—R. Durey, M.R.I.P.H.H., L.A.G.C. (to H.M. Forces 2/1/1941). Maternity and Child Welfare—Miss O. R. Reeves. School Medical Service—Miss M. Smith. A.R.P.—Mrs. V. E. Hockley. War-time Nurseries—Mrs. M. Morrison. Shorthand Typist—Miss B. L. Kell. Junior Clerks— Public Health—A. R. Jones. (Resigned September, 1941.) P. R. Cooper. (Appointed 8/10/1941.) School Medical Service—Miss J. Redgrave, Miss E. Bartlett. Milk Scheme—Miss E. Varnham, Miss J. Ellis, (Resigned 30/11/1941), Miss G. Roberts, Miss E. Godwin (appointed 1/12/1941), Miss B. Cattermole (appointed 1/12/1941). 2. Part-time. Consulting Surgeon for Aural Diseases— T. P. Gill, F.R.C.S. Ante-natal Consultant— J. V. O'Sullivan, M.D., 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— . E. A. Lloyd, L.D.S. (Resigned.) Miss Thompson-Smith, L.D.S. (Appointed 13/9/1941.) Details of members of the staff of the School Medical Service are embodied in the report to the Education Committee. (1) — Exchequer Grants. 8 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Annual Report, 1941. Ad). SUMMARY OF STATISTICS. A(l)a. General. Area.—4,607 acres. Population.—41,870 (Estimated 1939), 36,520 (Estimated 1941). Density of population, i.e., number of persons per acre.—7.92. Number of inhabited houses.—10,875. Rateable value, 1941.—£313,964. Sum produced by a penny rate, 1941.—£1,255. A (1 )b. Births. TOTAL. Male. Female. Live Births. Legitimate 591 301 290 Illegitimate 15 7 8 606 Live birth rate per 1,000 of population (1941 estimated)— 16.8. Corresponding rate for 1940—17.8. TOTAL. Male. Female. Still Births. Legitimate 21 10 11 Illegitimate 2 11 23 Still birth rate per 1,000 births—37.95. A (1) c. Deaths. Males—276. Females—197. Total—473. Death rate per 1,000 of population (estimate 1941).— 17.00. Corresponding rate for 1940.—12.08. Number of women dying in, or in consequence of, childbirth.—1. Maternal Mortality per 1,000 total registered births—1.65. Comparative figure for England and Wales.—2.23. 9 Illegitimate Legitimate A(l)d. Infantile Mortality. Deaths of infants under one year of age. 23 1 22 TOTAL. - 13 Male. 1 9 Female. Death rate of infants under one year of age per 1,000 live births.—37.95. Total number of deaths from : Diarrhoea (under 2 years) Whooping Cough (all ages) Measles (all ages) ... ... ... — — — 1940 1 5 — 1941 A(l)e. Vital Statistics of Whole District during 1941 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-residents registered in the District of residents not registered in the District Under 1 year 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 1932 34,250 486 475 138 236 689 13 137 30 63.1 360 10.51 1933 35,950 514 492 14.07 262 6-95 17 142 35 71.1 387 11.00 1934 35,020 531 481 13 7 230 656 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 6.67 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 5362 390 9799 1939 41,870 716 745 17.79 253 6.14 21 220 31 44.28 452 10.984 1940 40,210 656 721 17.8 273 6.78 22 235 24 37.17 486 12.08 1941 36,520 554 606 16.6 293 8.02 32 212 23 3795 473 17.00 10 A(l)f. Table showing Summary of Causes of Death during the year ended 31st December, 1941. Cause of Death Males Females Total 1 Typhoid Fever, &c. 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — - — 4 Whooping Cough 3 2 5 5 Diphtheria — — - 6 Tuberculosis of resp. system 10 12 22 7 Other forms of Tuberculosis 2 2 4 8 Syphilitic diseases 1 — 1 9 Influenza 2 2 4 10 Measles — — - 11 Ac. polio-myel. & polioenceph — — — 12 Ac. inf. enceph I — 1 13 Cancer of b. cav. & oesoph 5 4 9 14 Cancer of stomach and duodenum 8 1 9 15 Cancer of breast — 2 2 16 Cancer of all other sites 21 19 40 17 Diabetes — - - 18 Intra-cran. vase, lesions 19 19 38 19 Heart disease 67 49 116 20 Other diseases of circ. system 13 3 16 21 Bronchitis 14 11 25 22 Pneumonia 14 12 26 23 Other resp. disease 4 2 6 24 Ulcer of stomach or duodenum 7 1 8 25 Diarrhoea under 2 years 1 - 1 26 Appendicitis — - - 27 Other digve. dis. 5 3 8 28 Nephritis 8 4 12 29 Puer. & post-abort, sepsis — - — 30 Other maternal causes - 1 1 31 Premature birth 6 3 9 32 Con. mal. birth inj. infant dis. 1 4 5 33 Suicide 3 - 1 4 34 Road traffic accident 8 1 9 35 Other violent causes 28 24 52 36 All other causes 26 15 41 Total all causes 276 197 473 11 A(l)g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1941. Provisional figures. The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians 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 14.2 O.51 12.9 O.OO O.OO 0.03 O.OO 0.06 0.07 0.19 5.1 59 126 County Boroughs and Great Towns, including London 14.7 058 I4.9 O.OO O.OO 0.03 O.OO 0.07 0.08 0.17 7.5 71 148 smaller towns resident population 25,000 50,000 at 1931 census 16 4 060 13.0 0.00 0.00 0.03 O.OI 0.06 0.06 O.20 4.6 56 London Adm. County 8.9 033 16.3 O.OI 0.00 O 02 O.OO 0.04 0.03 0.15 6.8 68 Erith (Estimated population 36,520) 16.6 0 63 17.O O OO 0.00 O.OO O.OO 0.14 0.00 0.11 1.65 37.95 12 A (2). Since 1920 there have been 12,376 births with 33 maternal deaths, as shown below, giving a Maternal Mortality rate of 2.6. 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 1 558 547 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 1937 1 671 656 1938 3 656 634 1939 3 745 721 1940 1 743 656 1941 1 629 564 Total 1 33 12376 11844 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. 13 A (3). Infantile Mortality. 23 infants died before reaching one year of age, giving an infantile mortality of 37.95. The comparable figure for tihe whole country is 59. Analysis of the causes of death of this age group reveals the following figures:— Deaths from Prematurity and Debility 7 Bronchitis 2 Whooping Cough 1 Gastro Enteritis 1 Bronchial pneumonia 4 Other causes 8 Total 23 I have included a table showing the Infantile Mortality at 5 year intervals for the past 25 years and for 1940. 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 1940 37.17 55 A (4). 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 a marked decrease in unemployment figures largely owing to continued demands for labour due to the war. 14 Year ending Adults Young Persons Men Women Men Women Total December, 1934 926 223 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 934 169 40 16 1159 December, 1939 373 299 31 48 751 December, 1940 75 255 3 37 370 December, 1941 39 44 17 17 117 SECTION B.—MATERNITY AND CHILD WELFARE SERVICES. B(1). Maternity and Child Welfare Scheme. The details of the Maternity and Child Welfare Scheme are fully described on page 14 of my report for 1940, with important alterations under sections (a) and (f). Two of the four weekly Infant Welfare Centres have this year been doubled, and of the remaining two one which formerly functioned twice a month has been altered to a fortnightly clinic. This is an increase from approximately fourteen sessions per month to at least twenty-two sessions monthly and marks a real advance in this important service. The methods of propaganda now available to the Department and the latest figures of attendances suggest even with this recorded development that further extension is mainly a matter of sufficient staff and adequate accommodation having due regard to the geographical disposition of the "under-five" population of the District. 15 Month Births Sex Legitimacy Notified by B (2). Live S'born M F Leg. Meg. Midwives Hosp. etc. Doctors M F M F January 38 — 1 25 14 39 — — 16 23 — February 38 — 1 18 21 39 — — 17 21 1 March 37 1 2 25 15 38 1 1 12 26 2 April 40 — — 17 23 40 — — 15 22 3 May 39 — 1 23 17 40 — — 15 22 3 June 33 — 1 17 17 33 — 1 17 16 1 July 44 — 1 30 15 45 — — 10 35 —■ August 46 2 2 23 27 47 1 2 19 30 1 September 54 — — 31 23 54 — — 22 29 3 October 53 — — 24 29 49 3 1 16 37 — November 44 1 1 23 23 45 1 — 11 34 1 December 69 2 3 27 47 73 — 1 20 54 — Total 535 v 6 13 283 271 542 6 6 190 349 15 554 554 554 554 16 Infant Welfare Centres. B (3). Month Belvedere Erith Picardy Bedonwell Infants weighed Consultations Infants weighed Consultations Infants weighed Consultations Infants weighed Consultations Under 1 year 1 to 5 yea re Under 1 year 1 to 5 years Under 1 year 1 to 5 years Under 1 year 1 to 5 years January 99 46 39 146 37 44 28 10 f 12 201 77 74 j February 150 89 58 184 58 45 37 23 24 209 119 56 March 191 135 62 317 73 89 48 36 26 182 132 74 April 178 116 55 197 56 25 36 23 14 166 102 54 May 182 164 60 223 66 38 30 26 10 282 155 76 Tune 174 117 41 230 176 50 32 29 13 276 173 62 July 224 153 67 265 103 44 32 31 18 260 120 64 August 216 112 66 194 59 48 43 35 24 293 160 74 September 298 213 66 316 144 58 50 48 25 217 124 59 October 204 130 60 255 110 52 47 38 12 308 181 82 November 302 105 66 263 101 82 51 26 18 265 175 92 December 224 118 79 271 106 91 80 57 36 327 186 107 Totals 2442 1498 719 2861 1089 666 514 387 232 2986 1704 874 3940 3950 901 4690 17 B(4). Home Visits by Health Visitors. 1941 Children Special Visits Expectant Mothers Infant Life Protection Total Visits 1st Visits ReVisits StillBirths Others January 41 450 — 27 11 2 531 February 29 606 1 47 15 1 699 March 44 694 — 27 16 2 783 April 37 626 3 21 13 2 702 May 42 730 — 13 15 1 801 June 28 644 1 10 21 6 710 July 55 1035 1 22 23 5 1141 August 53 790 2 11 20 6 882 September 43 1092 1 29 45 6 1216 October 62 1114 — 27 19 7 1229 November 51 877 — 23 61 8 1020 December 50 964 3 35 50 8 1110 Total Visits 535 9622 12 292 309 54 10824 B (5). MATERNITY SERVICES. B(5)a. Maternity Home—Hainault. The Council provides a maternity home the accommodation of which this year has been increased by the addition of a two-bedded ward to a total of 9 beds, including one isolation bed. The staff consists of a Sister-in-Charge, a Junior Sister, a Staff nurse midwife and two midwives. Institutional treatment for normal cases is provided, and during the period under review 143 maternity cases were admitted. Of tlhese 100 cases were delivered by midwives and 43 by doctors. The average duration of stay of these cases in the home was 13 days. The following table illustrates the admissions during the last five years to the Hainault Maternity Home. Year Admissions 1937 134 1938 116 1939 118 1940 118 1941 143 B(5)b. Ante-natal. The ante-natal sessions held on one half-day each week at the Bedonwell Clinic continue to function satisfactorily. With regard to ante-natal clinics generally, it was felt that during the present urgent industrial activity some facilities should be given for the attendance of expectant mothers while 18 they are working. Accordingly a weekly pre-natal evening session has been established at the Hainault Maternity Home, and reporting after a full years work at this centre it can certainly be described as a very useful clinic and to have fully justified itself. It serves the whole borough, and all the Welfare Centres can therefore send their expectant mothers to attend while they are working and unable to come to the ordinary day-time sessions. It is run by a Medical Officer and the staff of the Borough Maternity Home, and a further advantage is that appointments can be made when necessary (and it is sometimes very necessary) to see the patients' husbands. Later in the year a third ante-natal clinic was opened in the Picardy area, and the attendances here are most promising. Ante-natal patienta seen by Doctor Erith 1941 Jan. Feb. Mr. Apr. Mar June July Aug Sep. Oct. Nov Dec. Total 81 59 46 74 76 58 80 68 98 98 63 44 845 1784 Bedonwell 37 82 72 75 84 66 64 98 92 88 68 59 880 Picardy Clinic opened 17th November 28 31 59 B(5)c. Abnormal Cases. Accommodation for abnormal maternity cases, in need of hospital treatment is provided by an arrangement between this Council and London Hospitals. Twenty cases were admitted under this arrangement during the year. The conditions for which they were admitted were as follows: Condition No. Disproportion 12 Toxaemia 1 Epilepsy 1 Eclampsia 3 Pre-eclampsia 2 Abnormal Presentation 1 Total 20 19 B(6). Infant Life Protection. Number of foster mothers on register at end of year 19 Number of children on register at 31st December, 1941 23 B(7). Midwives. The administration of the Midwives Acts is carried out by the Kent County Council whidh is the Local Supervising Authority. Under the new Midwives Act the County Council employ and supervise midwives working in this area. B (8). 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 tlhe year, attendances being as follows:— Hainault 178 Bedonwell 64 B(9). Home Help. The 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 19 No. of cases attended by : Home Help No. 1 9 Home Help No. 2 7 16 No. of cases booked and subsequently cancelled 3 — 19 No. of days on which Home Help was employed Home Help No. 1 137 Home Help No. 2 88 225 20 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 may be 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 1941:— Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Scarlet Fever 15 9 Diphtheria 18 13 - Pneumonia 41 1 26 Erysipelas 6 - - Puerperal Pyrexia 1 1 - Paratyphoid 3 3 - Typhoid 4 4 - Cerebro-Spinal Meningitis 2 1 - Pneumococcal Meningitis 1 1 - Ophthalmia Neonatorum 1 1 -- Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Measles 343 9 - Whooping Cough 178 22 5 21 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 Scarlet Fever — — — , 3 2 6 1 3 — — — — — 15 Diphtheria — — — 1 — 7 3 4 3 — — — — 18 Pneumonia 2 2 4 6 1 2 1 2 6 2 8 2 3 41 Pneumococcal M. — - — — — — 1 — — — — — — — 1 Cerebro-Spinal M. — — — — — — — — —— — — — — 2 Erysipelas — — — — — — — — 1 — 2 2 1 6 Puerperal Pyrexia — — — — — — — — — — — — — 1 Ophthalmia N. 1 — — — — — — — — — — —— 1 Para-Typhoid — —— — — — 1 — 1 1 — — — — a Typhoid — — — 1 — 1 — 1 — — 1 — — 4 Totals 3 2 4 11 3 18 5 11 14 2 11 4 4 92 22 C(3). Diphtheria Immunisation. The Scheme for the immunisation of children against Diphtheria was continued throughout the year, and the following table will indicate the number of cases dealt with : No. of applications received during the year 1,688 No. of first injections given 1,688 No. of second injections given 1,505 No. of third injections given 120 A comparison of these figures with those for 1940 reveals the results of the efforts of this Department in this connection. C(4). Smallpox. An arrangement exists between the London County Council and the Erith Borough Council for accommodation for cases occurring within the district. C (5). Disinfection of Premises after Infectious Disease. Following the removal of cases of infectious disease, tuberculosis, etc., 93 premises were disinfected, whilst enquiries to obtain particulars regarding 63 cases of tuberculosis were undertaken. 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(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 1941, 224 specimens were sent, as shown below:— Nature of Specimen sent Result Total Positive Negative Swabs for Diphtheria 7 41 48 Sputum for suspected Tuberculosis 44 88 13 2 Various 2 42 44 Total 53 171 224 23 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 Eritih residents. A dispensary is held 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 1941 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, 1941. C(7)b. Table i. Particulars of New Cases and Deaths. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. . M. F. Under I year — — — — 1 — — — 1 1 — — — — — — — 5 — 1 — — — 1 — — 10 —— — — — — — — — 15 3 2 — — — 2 — 1 20 8 7 — — 3 6 — — 25 9 5 — 2 1 1 — — 35 7 3 I — 3 1 — — 45 2 3 — — 1 1 — — 55 3 3 — — 1 2 — — 65 & upwards 2 1 — — — 1 — — Totals 35 25 1 2 10 15 — 1 24 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 176 153 329 178 153 331 115 101 216 118 100 218 New notifications during year 8 7 15 7 8 15 8 4 12 10 6 16 Cases removed, which have been restored - 2 2 - - - - - - - - - Cases added to register other than by notification 1 1 2 4 2 6 3 1 4 - 1 1 Cases removed from register 7 10 17 74 62 136 8 6 14 5 7 12 Cases remaining on register 178 153 331 115 101 216 118 100 218 123 100 223 Non-Pulmonary T.B. Number on register 58 56 114 58 56 114 39 35 74 39 37 76 New notifications during year — — — 2 — 2 — 1 1 1 1 2 Cases removed, which have been restored - - - - - - - - - 1 - 1 Cases added to register other than by notification - - - - 1 1 - 1 1 - - - Cases removed from register - — — 21 22 43 - - - - 1 1 Cases remaining on register 58 56 114 39 35 74 39 37 76 41 37 78 25 C(8). Ear, Nose and Throat. Operative treatment for cases of Tonsils and Adenoids in school children is being carried out at Erith Hospital. 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. SECTION D.—HOSPITAL AND AMBULANCE FACILITIES. The details of this Section of the Report may be found on reference to page 25 of my Annual Report for 1940. SECTION E.—SANITARY CIRCUMSTANCES OF THE AREA. E (1 ). 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. E (1 ) a Costs. The cost per ton of collecting refuse is lis. 7d. (previous year was lis. Od.) The cost per ton of disposing refuse 4s. 9d. Net cost per 1,000 of population £157. 26 The following tables show : 1. Details of the refuse collection vehicles and staff. 2. Details of the tonnage dealt with during the year. E (1 ) b. Table 1. Vehicle Capacity 1 Dennis Lorry 12 cubic yards 2 Easyloaders 4 „ „ 4 S.D. Freighters 7 „ „ 1 Fordson 10 „ „ These are operated by— 1 Foreman, 8 Drivers and 11 Loaders. E (1) c. Table 2. Month Tonnage Tons Cwt January, 1941 704 10 February 607 9 March 631 5 April 647 6 May 639 3 June 546 5 July 522 3 August 473 19 September 486 16 October 488 14 November 489 3 December 602 2 Total 6838 14 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 approximately 116 tons were disposed of while in 1941 the amount reached approximately 306 tons. 27 E(3). Salvage. The following details regarding Salvage collection and disposal are given. A perusal of the figures will reveal the fact that this service produced satisfactory results as will be seen in the following table. Tons Cwts. Qrs. Lbs. Newsprint 19 15 — — Periodicals 37 18 — — Strawboard 96 2 3 — Mixed Waste 89 8 2 — Kraft Blue Bags 2 19 3 — Other Paper 2 2 2 — Selected Waste 7 8 — — Iron 172 0 1 — Cast Aluminium 9 1 24 Aluminium 17 3 19 Lead 1 13 0 24 Copper 17 0 23 Brass 3 8 0 23 Zinc 5 2 7 Other metals 14 0 3 Tins 155 0 0 0 Textiles 18 1 3 16 Marble 2 15 0 0 Bottles 47 11 0 0 „ 97 gross 1-9/12 doz. Rubber 59 6 0 0 Cullett 10 19 2 0 Bones 9 5 2 22 Dry Batteries 28 8 2 0 Foil 15 1 19 Cartons Drums Pianos (2) Cars (2) Waste Food 142 7 1 0 This gives a total tonnage of 910 tons, 10 cwts. 2 qrs. 12 lbs. salvaged and sold producing a sum of approximately £2,826. 28 E(4). Water Supply. The water supply in this district is almost exclusively provided 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 few premises only. Routine examinations of such supplies have been undertaken throughout the year with completely satisfactory results, and arrangements are in existence with Kent County Laboratory for the examination of two samples monthly which are submitted by Sanitary Inspectors from various sources within the district. The following are typical reports on samples:— REPORT ON THE BACTERIOLOGICAL EXAMINATION OF ERITH WATER. Taken from tap over sink at 115 West Street 3/12/41. No. of organisms per cc. capable of growth on Agar at 37 deg. C 0 No. of organisms per cc. capable of growth on Agar at 22 deg. C. 5 Remarks. B. Coli absent in 100 ccs. Good water. (Signed) E. R. JONES, Pathologist. E (5). Closet Accommodation and Cesspools. The whole of the closet accommodation both in the older parts of the town and the comparatively newly built up areas is on the main drainage system, there being only 23 known premises which are drained into cesspools. During the year, two cesspools have been abolished, and the drainage connected to sewers. Cesspools are emptied once a month free of charge by machines belonging to the Council 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, necessitates covering considerable distances both for pumping out and conveying to the point of disposal. 29 During the year 1941, 44 cesspools were emptied by the Council's plant. The total number of visits of all kinds made by the Sanitary Inspectors during the year was 6,469. Notices served:— Statutory 14; Informal 499. Number of houses and other premises disinfected 45. E (6).Shops Act 1912-1938. Regarding hours of closing, it was necessary to issue 7 warnings to shopkeepers upon tlheir non-compliance with the Statute. No Police Court proceedings were instituted during the year. Infringements of Section 10 of the Shops Act 1934 relating to health and comfort of shop assistants were located in the following instances and Notices were subsequently served to effect the necessary improvement: Notices served. Lack of heating facilities 3 Lack of facilities for taking meals 1 Such Notices had all been complied with by the end of the year. E(6)a. Offices. In one instance it was found that no sanitary accommodation existed for the use of females at an office as provided for by Section 46 Public Health Act 1936. Notice was subsequently served and complied with. E(7).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 licences have been granted by the Authority during the year under Sec. 269 Public Health Act 1936. E (8).Hop Pickers. There are no hop fields within the District. E(9).Rag Flock Act. No premises exist in which rag flock is manufactured, used, or sold within the District. E (10).Smoke Abatement. No smoke Nuisances have come to the Notice of the Sanitary Inspectors during the year. 30 E (11).Sanitary Inspection of the Area. In the following tables, the work of the Sanitary Inspectors during the year is summarised:— E (11) a.Routine Visiting. Premises visited and recorded results of such visits: Premises No. in District No. of visits 1941 No. of defects found No. of defects remedied Bakehouses 10 59 3 3 Cowsheds 3 19 1 1 Dairies 11 48 4 4 Butchers Shops 33 347 10 10 Fish friers 10 62 1 1 Restaurants 39 84 11 11 Ice Cream Manufacturers 18 46 5 5 Food Factories 3 13 1 1 Slaughter Houses 4 — — — Factories 119 128 18 i3 Outworkers 14 14 — — E (11)b.Summary of Nuisances and Defects Remedied during the year. Other than those enumerated in the above tabulations: Drains cleared 138 Drains repaired 43 W.C. pans renewed 19 W.C.'s repaired 24 Cisterns renewed 26 Roofs repaired 55 Eaves gutters repaired 73 Damp walls made dry 36 Plasters renewed 15 Floors repaired 7 New sinks fixed 6 New firegrates 16 Yard pavings repaired 5 New W.C.'s constructed 7 New cooking stoves 11 Coppers repaired 11 Windows made to open 1 Houses cleansed 18 Vermin eradicated 22 Dustbins provided 30 Accumulations removed 21 Drains : Water tested 0; Smoked tested 9. 31 E (11 ) c. Health Education. With a view to maintaining a good standard in sanitary circumstances, the following leaflets prepared by the Senior Sanitary Inspector are available to members of the public: 1. Cleanliness in food preparing premises. 2. How to get rid of bugs, lice, fleas, etc. 3. Precautions against rats. 4. Sanitary obligations regarding infectious diseases. Many of the leaflets have been utilised by the public, and there is every reason to believe that the information has been most helpful. Control measures regarding rats have been vigorously applied by the Sanitary Inspectors during the year, and the private ratcatcher in the district has visited and operated at many premises. Literature is available at the office, and supplies of vermicide are available on payment of a small fee. Back yard poultry still appear to be one of the many sources of infestation, and every effort is made to impress occupiers on the need of maintaining such structures in a satisfactory condition. E(11) d.Eradication of Bed Bugs. During 1941, dwellinghouses were found to be infested with vermin, and subsequently disinfested as under:— Private houses 22 Council houses 10 Presence of vermin in private houses is usually located by Inspectors whilst investigating complaints and viewing home circumstances. On every occasion removal of wallpaper, picture rails, etc., is insisted upon, any measures falling short of this proving more than useless. The use of a blow lamp or efficient insecticides has been found to be effective, and re-visits are made to see that the improvement is being maintained. The cleansing of Council houses is carried out by the Surveyor's staff. All prospective and selected applicants for Council houses are visited by Sanitary Inspectors who report their findings direct to the Housing Clerk. When the effects are found to be verminous, furniture and other articles are subjected to cyanide fumigation by Contractors employed by the Council, but who work under the supervision of an Inspector. This method of re-housing has proved to be successful. 32 E(11) e. Cleansing of Verminous Persons. The Scabies Order 1941 necessitates the provision of a cleansing station wherein verminous persons may be cleansed promptly and thoroughly. With this end in view, a structure is to be erected at the Borough Infectious Disease Hospital. Clothing is dealt with at the Disinfector. Prior to the provision of the above cleansing station, persons requiring treatment could obtain it by agreement with the Dartford Hospital. E(11) f. 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. Water in the open air pool is warmed to a temperature of 70 deg. F. by low pressure steam heating and is sterilised by the Chloramine process, i.e. addition of ammonia in conjunction with cthlorine. E (11 ) g. Mortuary. The Borough Mortuary is situated at the rear of the Erith Parish Church in West Street, and consists of a receiving room and viewing room. There is accommodation for 4 bodies. During 1941, 42 bodies were placed in the building. E (11) h. Schools. Schools within the district were regularly visited by the Sanitary Inspectors, and defects if any, are referred to the Education Committee. All the premises are served by the Metropolitan Water Board's supply. Further details with regard to schools are to be found in the Report of the School Medical Officer. E (12). HOUSING. E(12)a. Inspection of Dwellinghouses during the year. 1. (a) Total number of dwellinghouses inspected for housing defects (under Public Health Act or Housing Acts) 880 (b) Number of inspections made for the purpose 2631 2. (a) Number of houses (included under sub-head (1) above) which were inspected and recorded under Consolidated Housing Regulations 1925 and 1932 8 (b) Number of inspections made for the purpose 35 33 3. Number of houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 4. Number of houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 868 E(12)b. Remedy of Defects during the year without service of formal notices. Number of defective dwellinghouses rendered fit in consequence of informal action by Local Authority 856 Action under Statutory Powers during the year. (a) Proceedings under Sections 9 and 10, Housing Act, 1936: (1) No. of houses in respect of which Notices were served requiring repairs 0 (2) No. of dwellinghouses which were rendered fit after service of formal Notices:— (a) By owner 0 (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 14 (2) Number of dwellinghouses in which defects were remedied after service of formal notice:— (a) By owner 14 (b) By Local Authority 0 (c) Proceedings under Section 11 and 13 of the Housing Act, 1936: (1) No. of dwellinghouses in respect of which demolition orders were made 0 (2) No. of houses demolished in pursuance of demolition orders 0 (d) Proceedings under Section 12 of the Housing Act, 1936: (1) No. of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) No. of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 0 34 E(12)c. Individual Houses. Section 11. In anticipation of formal action, the following houses were demolished, and the sites cleared, viz.:— 225, 227, 229, 231, 233 and 235 Lower Road. 4 and 5 Oxford Terrace. E(12)d. Housing Act 1936.—Overcrowding. (a) (1) No. of dwellings overcrowded at end of year 23 (2) No. of families dwelling therein 24 (3) No. of persons dwelling therein 171 (b) Number of new cases of overcrowding reported and relieved during the year 0 (c) (1) No. of cases of overcrowding relieved during the year 2 (2) No. of persons concerned in such cases ... 104 (d) Number of dwellinghouses which again became overcrowded after the Local Authority had taken action for the abatement of overcrowding Nil E(12)e. Rent and Mortgage Interest (Restrictions) Act 1939. The provisions of this Act which came into force in September, 1939, are administered by the Senior Sanitary Inspector. The maximum permissible rent of houses brought under control by the Act is the rent payable at 2nd September, 1939, subject to certain permitted increases which are provided for by the Act. There is however no provision allowing for decontrol on vacant possession. During the year many cases have been dealt with by the Senior Sanitary Inspector, improvements being effected as follows:— (a) Rent reduced from 18/- to 17/- (b) Rent reduced from 12/6 to 10/- (c) Rent reduced from 16/- to 15/3 and surcharge of £4 0s. 6d. to tenant. (d) Rent reduced from £1 1s. Od. to 18/- and surcharge of £ll 8s. Od. to tenant. (e) Rent reduced from 16/6 to 10/10 and surcharge of 17/- to tenant. 35 E (13). FACTORIES. E (13) a. Inspections for the purpose of provisions as to health including inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 64 7 _ Factories without mechanical power 52 3 _ Other premises under the Act (including works of building and engineering construction but not including outworkers premises) 12 _ _ Total 128 10 _ (13)b.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 3 3 _ _ Overcrowding _ _ — — Unreasonable Temperature - - - - Inadequate Ventilation — — — — Ineffective drainage of Floors - - — — Sanitary Conveniences: Insufficient 7 7 - — Unsuitable or defective 3 3 — — Not separate for sexes — — — — Other offences 5 5 - - Total 18 18 — — 36 SECTION F.—INSPECTION AND SUPERVISION OF FOOD SUPPLY. F(l).Cowsheds, Dairies and Milk Stores. The current register of cowsheds, dairies and milk stores records the following registration figures : No. of registered farms and cowsheds 8 No. of dairies 11 Shops selling milk in sealed receptacles 40 No. of registered purveyors outside Borough 19 F(2).Bacteriological examination of milk. Seven samples of Pasteurised milk were obtained and submitted to the County Bacteriologist for examination, and all were reported upon as being satisfactory. F(3). Sampling of milk for Tubercle Bacilli. Routine sampling of bulk milk resulted in the Tubercle Bacilli being isolated in one instance in consequence of which 3 cows were rejected, slaughtered and disposed of as provided for by the Tuberculosis Order 1938. F(4).Milk Supply. The following table indicates the number of licences issued by the Local Authority under the Milk (Special Designations) Order, 1936 : No. Pasteurisers licence 1 Pasteurisers dealers licence 7 Tuberculin Tested dealers licence 5 Pasteurised dealers supplementary 2 Tuberculin tested supplementary 2 Total 17 F(5).Slaughter of Animals Act 1933. The above Act makes the use of mechanically operated instruments a statutory obligation. By resolution of the Council dated 23rd May, 1938, the provisions of Section I of the Act apply to sheep which are slaughtered in this district. 37 During the year, no persons applied for renewal of licences to slaughter or stun animals in compliance with the Act. No. of licensed slaughtermen on register at 31st December, 1940 9 No. of licensed slaughtermen on register at 31st December, 1941 9 F(6).Meat and Food Inspection. The usual time and attention has been devoted to the inspection of meat and other foods in shops and stores, and the following articles were confiscated as being unfit for human consumption: Beef 371 lbs. Ox liver 1 Ox heads 9 Pigs heads 2 Sheeps livers 1 Mutton 13 lbs. Lambs 2 Rabbits 74 Bacon 63 lbs. Beef 3 tins Tripe 18 lbs. Eggs 2189 Vegetables 1 tin Brawns 6 Milk 1 pint Milk 9 tins Fish 490 lbs. Tomatoes 183 lbs. Mushrooms 10 lbs. Butter 30 lbs. Marmalade 3 lbs. Cheese 1 lb. Apples 40 lbs. Onions 336 lbs. 38 F(7).Food and Drugs Act Sees. 3 and 68, Routine sampling. The following samples were procured by the Sanitary Inspectors during the year and submitted to the Public Analyst for analysis : Nature of Sample . Adulterated Genuine Informal Formal Total Coffee 4 4 - 4 Custard Powder — 2 2 - 2 Jam — 1 1 - 1 Cocoa — 3 2 1 3 Jellies — 1 1 - 1 Milk — 59 38 21 59 Egg substitute — 2 2 - 2 Rice — 2 2 - 2 Semolina — 1 1 - 1 Pearl Barley — 1 1 - 1 Sago — 1 1 - 1 Rolled oats - 1 1 - 1 Vinegar — 2 1 1 2 Fish — 2 2 - 2 Lemonade - 5 3 2 5 Sugaro — 2 2 - 2 1 Sausage — 1 1 Onion flavour - 1 1 - 1 Stuffing -— 1 1 - 1 Beechams powder — 1 1 - 1 Syrup of figs — 1 1 - 1 Cheese powder - 2 - 2 Flour - 4 - 4 Curry powder — 1 1 - 1 Soup — 1 1 - 1 Health salts — 1 1 - 1 Castor oil - 2 - 2 Margarine — 1 1 - 1 Tincture of iodine — 1 1 - 1 Chix cubes - 1 1 - 1 Vantas - 1 1 - 1 Butter - 1 1 - 1 Meat pies — 1 1 - 1 Fish paste — 2 - 2 Mixed vegetables - 1 1 - 1 Sauce _ 1 1 - 1 Fluid beef — 1 1 - 1 — 116 90 26 116 As will be seen from the above table, all the samples so procured were reported by the Analyst as being genuine, and of good quality. 39 F(8).Offensive Trades. In addition to the statutory Offensive Trades which are specified in the Public Health Act, 1936, Section 107, fish frying was declared to be an offensive trade on 17th March, 1939, and Bye-laws were made accordingly. Within the Borough, there are no offensive trades other than fish frying premises of which there are 10 in operation. H(4). Legislation in Force. List of Bye-laws etc. in force in this district with date of adoption: Tents, Vans and Sheds 28th Feb., 1928 Houses let in lodgings 27th Jan., 1930 Slaughterhouses 29th Jan., 1932 School attendance 17th Feb., 1932 Libraries and Museums 15th June, 1934 Nursing Homes 20th July, 1934 Pleasure grounds 4th Feb., 1936 Emplovment 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 Erith Cemetery 25th Oct., 1939 Public Baths 26th Oct., 1939 Prevention of Nuisances, etc 23rd April, 1940 BOROUGH OF ERITH. ANNUAL REPORT OF THE School Medical Officer for the year 1941. rflossfl jauvivia 3HT 'iO 733iftO IfioibsM loorb8 im AA3Y 3 FIT flOH 3 EDUCATION COMMITTEE. Chairman:—Councillor Farquhar. Vice-Chairman:—Councillor Mantle. Alderman Mrs. Ewens. Alderman Mrs. Lenney. Councillor Bates. „ Ebben. „ Powrie. Councillor Mrs. Nichols. „ Pannell. „ Wilkinson. Co-opted Members: A. W. Lawrence, Esq. Dr. H. A. Maunder. Mrs. E. A. Munns. Miss K. Murphy. F. H. Hunt, Esq. Ex-officio Members: His Worship the Mayor—Councillor G. W. H. Luck. Deputy Mayor—Councillor C. F. Morling. SCHOOL MEDICAL STAFF. School Medical Officer: Reginald A. Leader, m.r.c.s., l.r.c.p., d.p.h. Assistant School Medical Officers: C. H. D. AsHER, b.sc., m.d., b.s., m.r.c.p., d.c.h. (Resigned 15/4/41.) F. Schenk, m.d. (Appointed 9/9/41.) M. R. Blair, m.r.c.s., l.r.c.p., l.d.s. (Appointed May, 1941.) Orthopaedic Surgeon : E. A. Lindsay, f.r.c.s. Ophthalmic Surgeon : F. O. Walker, m.r.c.s., l.r.c.p., d.p.m., d.o. Dental Surgeon : E. A. Lloyd, l.d.s. (Resigned 30/4/41.) Miss Thomson-Smith, l.d.s. (Appointed 13/9/41.) School Nurses : Mrs. Lange, s.r.n., c.m.b., Miss Briggs, s.r.n. Clerks : Miss M. Smith, Miss J. Redgrave, Miss E. Bartlett. 4 Report of the School Medical Officer, As suggested by the Board of Education, the Annual Report of the School Medical Services for purposes of war economy is again shortened and curtailed. Under the authority of the Erith Education Committee there are 10 provided schools with 18 departments including one Nursery School, and one non-provided school with one department. At the end of 1941 there were 3,943 children on the roll of the elementary schools, distributed as follows: — Nursery School 54 Infants Schools 929 Junior Mixed and Infants Schools 278 Junior Schools 1356 Senior Schools 1326 In addition there were in Special Schools (outside the District) 5 The Belvedere Infants School badly damaged by enemy action, is to be re-built as a full-time War Nursery for children of 0—5 years of age. Further to help in the problem of the custody of children under 5 years of age (3—5 year olds) whose mothers wish to undertake work in factories or otherwise participate in the war effort, a nursery school has been opened in one wing of the Bedonwell Hill School building. This portion of the building was vacant owing to the reduction in numbers of children in the school through evacuation and after various alterations including the provision of a paddling pool and sand pit, has provided a nursery school with 50 places. All entrants have been medically examined, and efforts are being made to protect them against diphtheria and also, if possible, against whooping-cough. 5 THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. No. of children on School Roll 3943 No. of individual children \viho attended medical clinics 2759 No. of individual children medically examined at schools 1181 No. of medical examinations at the clinics 9728 (1) Hainault 8789 (2) Bedonwell 939 No. of inspections for uncleanliness and verminous conditions (school nurses) 10330 No. of attendances for treatment at the Dental Clinic 2317 No. of treatments at the Eye Clinic 139 No. of spectacles prescribed 70 No. of operations for Tonsils and Adenoids 56 No. of attendances at the Orthopaedic Clinic 760 (1) For consultations 138 (2) For treatments, massage, etc. 622 No. of attendances at Ultra Violet Ray Clinics 233 Medical Inspection. A more comprehensive system of medical inspection has been adopted this year, whereby all schools are visited in rotation by the Assistant Medical Officers who examine every child in the school, irrespective of the routine age groups. This more thorough inspection with its obvious advantages, was made possible by the quiet conditions in the borough during the later half of the year, and has two main aims:— 1. The detection of incipient disease and defects as soon as possible so that they may be brought under medical surveillance at the school clinics, and 2. The arranging of medical care and supervision for all cases of malnutrition, and immediate defects of a major or minor character. The following table gives the number of routine medical examinations made during the last five years:— No. of school children on register. No. of Routine Medical Exams during the year. 1941 3943 1181 1940 3086 413 1939 5131 785 1938 5125 1689 1937 4982 1581 6 Malnutrition. Provision of Meals and Malt and Oil. 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 18.2 per cent. in A (excellent), an increase of 5.7 per cent.; 64.5 per cent. were in B (normal), a decrease of 6.7 per cent.; 17.2 per cent. in C (slightly sub-normal), an increase of 2.2 per cent.; and there were none in D (bad), a decrease of 1.2 per cent. In the second age group, 8 year olds, there were 14.9 per cent. in A, an increase of 1.7 per cent.; 69.2 per cent. in B, a decrease of 6.8 per cent.; 14.9 per cent. in C, an increase of 4.2 per cent.; and 0.9 per cent. in D, an increase of 0.9 per cent. In other routine inspections, there were 21.8 per cent. in A; 63.4 per cent. in B; 13.5 per cent. in C; and 0.93 per cent. in D. Comparing totals of children examined with last year's figures, there is this year an actual increase of 185.9 per cent. in the number of children examined. It will be appreciated that roughly one-third of the school population has been examined, but even so it would appear that the school children in this borough, as regards nutrition compare quite favourably with those recorded during the last three years. If this conclusion is correct it is an astonishing one, and reflects credit on the various services health and otherwise responsible, and above all it should not be forgotten that in our school canteens we now have a very practical means of "immunisation" against malnutrition in which all school dhildren should participate. At the moment in this town, all school children classed in the D and C groups, irrespective of family income, can have free school dinners. Malt and Oil. Total amount issued during the year 1185 lbs. Amount issued free 764 lbs. No. of children who received free issues 109 Amount sold at cost price 421 lbs. At the end of the year a total of 143 children were receiving free milk at school. 7 Ear, Nose and Throat Defects. Individual defects are shown in Table III (Group III), others being included in Table III (Group 1). The arrangements with the Erith District Hospital for the operative treatment of tonsils and adenoids are still in force. Visual Defects and External Eye Disease. Table III (Group II) gives the extent of the ophthalmic work carried out by Mr. Oliver Walker, L.R.C.P., M.R.C.S.. D.P.H., D.O., who further reports:— „ Of the total of 1.39 children seen, 64 were boys and 75 girls including 21 from the child welfare clinics. Glasses were ordered for 70 children and 5 children were admitted to hospital for operative treatment. These were: Strabismus 1 Strabismus with Ptosis 1 Meibomian Cyst 2 Lachrymal Obstruction 1 The cases of strabismus are all doing uniformly well. Two patients requiring special treatments, one for chronic seborrhoeic blepharitis, and one with a disfiguring injury due to burns were admitted to hospitals, and three cases of strabismus and one of ptosis are awaiting admission. One girl (G.P.) very much disfigured by a marked ptosis of the right upper eyelid and alternating external strabismus has had three operations in hospital during the year, and the ultimate result is highly satisfactory. Her parents are delighted and the girl is considerably improved in appearance. The above details illustrate in some measure the type of work at present being undertaken through this authority's School Medical Services. Dental Defects. In my opinion the care of the teeth of children, even in the present difficult times, is well worth persevering with and is likely to pay good dividends towards the general health of the school population in the future. It is pleasing to record, therefore, that despite the smaller number inspected this year, actually more children have required and have had treatments. There are still, however, too many "refusals" of dental treatment. 8 TABLE IV. Dental Inspection and Treatment. (1) Number of children inspected by the Dentist. (i) Routine Age Groups Total Age 5 6 7 8 9 10 11 12 13 14 Number 76 77 121 172 227 227 305 191 225 160 1781 (b) Specials 457 (c) TOTAL (Routine and Specials) 2238 (2) Number found to require treatment 1971 (3) Number actually treated 1051 (4) Attendances made by children for treatment 2317 (5) Half-days devoted to: Inspection 23 Treatment 464 4.87 (6) Fillings:— Permanent Teeth 1276 Temporary Teeth 133 1409 (7) Extractions:— Permanent Teeth 592 Temporary Teeth 2505 3097 (8) Administrations of general anaesthetics for extractions 930 (9) Other operations:— Permanent Teeth 235 Temporary Teeth 16 Total 251 9 ORTHOPAEDIC AND POSTURAL DEFECTS. Mr. Lindsay writes:—66 The work of the School Orthopaedic Clinic is not spectacular, but consists of correction of the many slight defects found to be so prevalent among children of school age, e.g. flat foot, knock knee, scoliosis, etc., with occasionally more severe disability such as spastic paralysis and infantile paralysis. It is essential that all these ailments be treated as early as possible to obtain the best results. There has been a fresh element during the past year, viz. the number of children with pains in the legs apparently due to rheumatism, and which it was suspected originated in the inflamed tonsils. This is probably due to the fact tlhat during the recent disturbed conditions these children escaped their usual medical inspection. On the whole I have noticed a steady improvement with treatment in all the patients who have attended regularly." I find Mr. Lindsay's observations concerning inflamed tonsils extremely interesting, for it is a fact that nearly double the number of children have had the operation for Tonsils and Adenoids this year as compared with the last. Despite many difficulties medical examinations however, have not been overlooked in this service during the past two years. Reference to this report for instance, illustrates that 1181 school children had the complete routine medical examination this year, as compared with 413 during last year, and that during May of last year it will be remembered that for purposes of evacuation (Plan iv) a complete survey of the total school population was made. This survey included an examination of the nasopharanx, and any abnormalities were noted in the usual way, and action taken accordingly. I think that probably the conditions within the borough during the early half of this year may have been a definite contributive cause of this rheumatism. The following is a list of cases which have attended the clinic:— Infant School Welfare. Children. Talipes Equinus 1 — Genu Valgum 10 6 Calcaneo Valgum 1 — Hallux Valgus — 3 Pes Valgus — 1 10 Infant School Welfare. Children. Pes Cavus — 1 Equinus Varus — 1 Hallux Varus — Genu Varum 2 8 Hallux Rigidus — 1 Valgus Ankles — 8 Kyphosis — 1 Scoliosis — 6 Postural Curvature — 8 Round Hollow Back — 2 Stoop — 8 Round Shoulders — 1 L. Dorsal Curve — 1 Sp. Paralysis arm and leg — 1 Congenital Deformities — 1 Schlatters Disease — 1 Inco-ordination 1 — Flat Feet 12 25 Cerebral Diplegia — 1 Torticollis 2 Outward Curved Tibiae 2 — Intoeing 2 — Synovitis — 1 E.T.A — 1 O.C.T 2 A.P.M. — 2 Mallet Toes — 1 Cyst Knee — 1 Ganglion — 1 Cyst Finger — 1 Semi-membranous bursa — 2 Wart Foot — 1 Foot Strain — 2 Pain Hip — 1 „ Knees — 4 „ Groin — 1 „ Metat. Joint — 1 „ Ankle — 2 11 Orthopaedic Clinic. No. Sessions for Remedial Exercises, etc. No. of Attendances January —— — February — — March — — April 7 89 May 8 47 J une 2 8 July 6 53 August 4 30 September 3 19 October 6 54 November 8 109 December 7 110 51 519 No sessions held from August, 1940, to the end of March, 1941. Infectious Disease. This year there have been epidemics of both measles and whooping¬cough. During the year there were 343 cases of measles notified to the Department, the first cases occurring in the second week of January and the last case during the third week of September. Most of these were mild attacks, but nine cases with complications were admitted to the authority's isolation hospital. The following table gives the reasons for admission. Number of cases of measles. Complication necessitating admission to hospital. 1 (+ 1 contact) Unsatisfactory home conditions. 4 Pneumonia. 3 Whooping Cough. 1 Whooping Cough and Pneumonia. An interesting investigation was carried out during the early part of the year from January to April, 1941. The first 63 cases of measles, as notified to the Department were visited in their homes by the Medical Officer of Health, who examined all members of the household and other contacts of the sick child, and gave convalescent serum intramuscularly to selected contacts of the patient. 12 Table 2 explains this:— No. of cases investigated No. of cases with no child contacts No. of cases with child contacts Actual number of contacts found and investigated 63 23 40 87 In this series of 63 cases, 23 children were found to have no child contacts, and of the remaining 40 cases the number of actual contacts was found to be 87 children. These were all examined, and their medical histories carefully investigated, and it was demonstrated that 30 of the 87 children had previously had measles and were therefore protected from further attack. Number of child contacts investigated Number of these contacts who had previously had measles Number of susceptible children 87 30 57 In these 30 cases, therefore, serum was withheld, while being offered to the 57 other susceptible children. Altogether 38 cases had this prophylactic treatment, and of this number 4 children subsequently developed measles. Of the remaining 19 unprotected children contacts (16 in one class of a junior school) who did not have the injection, three children subsequently developed measles. No. of susceptible contacts of measles cases Number of these given serum No. of susceptibles not given serum Number of susceptibles refusing serum 57 38 19 16 Number of children given serum subsequently developing measles 4 Number of unprotected children not having serum developing measles 3 It should be stated that except in one or two instances, small doses of serum were given (10 ccs.), and the 4 cases noted after the administration of serum were mild attacks of the disease. One of the primary objects of the investigation was to try and control the epidemic, and in this it obviously failed, possibly owing to the geographical situation of the borough in the outer London ring of towns. It is to be noted, however, that only 63 of the 343 notified cases occurred in the first four months of a nine months epidemic. A second aim to try to induce 13 in the susceptible children a milder form of the disease may have been more successful, as no complicated case of measles was admitted to the isolation hospital until the month of May when the administration of serum had been discontinued. In the outbreak of whooping-cough, there were 178 notifications, distributed throughout the town, and on investigation it was found that 5 of these had had injections for immunisation against pertussis. Further investigation however, demonstrated that not one of these five children had had the complete course of injections before contracting the disease, and these children therefore, had not in actual fact had the opportunity of developing an immunity against this distressing disease. In one of these 5 cases, two injections of the vaccine were given after the child had contracted whooping cough, and it did not appear that this treatment in any way influenced the course of the attack. In contrast to the outbreak of measles, this epidemic of whooping cough produced a number of severe cases, and 22 children were admitted during the year to the Borough's Isolation hospital as complicated cases of whooping-cough. The following table illustrates the various cases:— Number of cases admitted Complication 7 Severe type of whooping-cough. 2 Measles, and whooping-cough with severe bronchitis. 1 Measles and whooping-cough. 1 Whooping-cough and generalised impetigo. 1 Measles, and whooping-cough with pneumonia. 8 Whooping-cough with pneumonia. 1 Whooping-cough with pneumonia and convulsions. 1 Whooping-cough and burns. Two of these patients died, one from a pneumonia and convulsions, and the second from a severe pneumonia complicating the whooping-cough. A further three cases under the care of private practitioners in the town also died, the cause of death in each case being a broncho-pneumonia. 14 It is satisfactory to record that none of the 111 children who had the complete course of immunisation subsequently contracted pertussis, and the fact that the five recorded deaths were ail of children under two years of age suggests the best time to have the child protected, namely as soon as possible after the age of 9 months. The authority's present scheme allows for the simultaneous immunisation against both whooping-cough and diphtheria in the same injection, but it must be emphasized that at least three injections, preferably at monthly intervals, are necessary to develop an adequate protection. It should be stated, however, that as far as is known at the moment this protection does not operate in 100 per cent. of cases. Immunisation against Diphtheria. During the year 3,313 injections for immunisation against diphtheria and diphtheria and whooping cough were given, 1,710 children having the complete course of protection. This gratifying response reflects credit on the work done by the various staffs responsible for carrying out the scheme and the percentage of school children immunised in the borough now stands at 53.7 per cent. The records of the department illustrate that prior to 1st January, 1941, only 1,340 children in the borough had had the complete course of immunisation and that 331 of this number were children under the age of 5 years. It is very necessary that efforts to increase this number of protected children should be maintained, for the problem is an urgent one and demands the continued co-operation of the teaching staff, medical officers and school nurses, and in fact anyone who has direct access to the parents concerned. Laboratory Facilities. Examination of pathological specimens and other laboratory work for the district is undertaken by the Kent County Laboratory, Maidstone. As mentioned last year, we still have the additional assistance of the Ministry of Health's Emergency Laboratory Service, Buckston Browne Farm, Downe. Mentally Defective Children. During the year one child has taken advantage of the Home Teaching Scheme under which lessons are given weekly in the home. This Scheme is in operation under the supervision of the Kent Voluntary Association for Mental Welfare. 15 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, and I have much pleasure in including these in my Annual Report for the year 1941. 1. INTRODUCTION. With the return of more normal conditions for school work and attendance, it has been possible during the past year to restore the subject of Physical Education to a position much nearer its pre-war level. Improvement has been due partly to the increased regularity of the physical training and games lessons, and partly to general raising of the standard of teaching among those members of school staffs who, since the outbreak of war, have been required to fill the gaps left by their younger colleagues who had been called to the Services. Offsetting this improvement, increasing difficulties have been experienced in obtaining replacements of physical training and games materials, and with the recent rationing of clothing and footwear, the problem of ensuring the satisfactory personal equipment of children for their P.T. lessons has already given cause for concern. 2. ORGANISED GAMES. Owing to the increasing difficulties of arranging for the transport of children to and from the Committee's Playing Fields, it has been impossible to cater adequately for this subject in all schools in the Borough. Only those schools which are fortunate in being situated within easy reach of grass pitches have been able to show any real progress in this subject, and unless' more attention is given to the upkeep and maintenance of school grounds, the general standard of games even in these schools is likely to decline. 3. TRAINING OF TEACHERS. Previous local arrangements for the further training of teachers specialising in Physical Education had enabled the organisers to conduct teacher's classes during school hours. Owing to the general depletion of the regular school staffs and the shortage of supply teachers of a type suitable for training in this subject, it has been judged impracticable to continue such arrangements during the past year. The question of evening or Saturday classes has been considered as a possible alternative but found equally impracticable owing to the many extraneous duties in which teachers as a whole were occupied in their out-of-school hours. 16 TABLE I. Medical Inspections of Children Attending Public Elementary Schools. A.—Routine Medical Inspection. Entrants 93 Second Age Group 241 Third Age Group — No. of other routine inspections 847 Total 1181 B.—Other Inspections. Number of Special Inspections and Re¬Inspections 7461 TABLE II. Age-Groups Number of Children Inspected A B C D Excellent Normal Slightly subnormal Bad No. % No. % No % No. % Entrants 93 17 18.2 60 64.5 16 17.2 — — Second AgeGroup 241 36 14 9 167 69 2 36 14.9 2 .9 Third AgeGroup - - - - - - - - - Other Routine Inspections 847 185 21.8 537 63 4 115 13.5 9 1.06 Total 1181 238 20.1 764 646 167 14.1 11 .93 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 — — — — — Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 1 — — — 1 17 Mentally Defective Children. FEEBLE-MINDED CHILDREN. At Certified Schools for Mentally Defective Children At Public Elementary Schools At other Institutions At no School or Institution Total — 4 — 5 9 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1941. TREATMENT TABLE. GROUP I.—MINOR AILMENTS. (excluding Uncleanliness, for which see Group V). 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 1 - 1 (i) X-Ray Treatment. If none, indicate by dash. - - - (ii) Other Treatment - Ringworm—Body 1 _ 1 Scabies 102 7 109 Impetigo 61 2 63 Other skin disease 60 10 70 Minor Eye Defects. (External and other, but excluding cases falling in Group II). 39 42 Minor Ear Defects 36 3 39 Miscellaneous (e.g., minor injuries, bruises, •ores, chilblains, etc.). 257 16 273 Total 557 41 598 18 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) 139 5 144 Other Defect or Disease of the Eyes (excluding those recorded in Group 1) 15 1 16 Total 154 6 160 No. of children for whom spectacles were prescribed: (i) Under the Authority's Scheme 70 (ii) Otherwise 5 No. of children for whom spectacles were obtained : (i) Under the Authority's Scheme 58 (ii) Otherwise 5 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Total Received other forms of Treatment Total number treated 1 2 3 4 5 56 13 69 — 69 19 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme (I) Otherwise (2) Total number treated 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 orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number of children treated 1 — 123 — — 3 127 TABLE V. Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 6.2 (2) Total number of examinations of children in the Schools by School Nurses 10330 (3) Number of individual children found unclean 143 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 4 (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —