ERI 22 BOROUGH OF ERITH. ANNUAL REPORT of the Medical Officer of Health AND School Medical Officer FOR THE YEAR ENDED 1942 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 1942 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 13 4. Unemployment Figures and Comments 13 B Maternity and Child Welfare Services. 1. Maternity and Child Welfare Scheme 14 2. Notification of Births Table 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 18 (c) Abnormal Cases 19 6. Infant Life Protection 19 7. Midwives 19 8. Dental Clinic 19 9. Home Help 20 C Prevalence of and Control over Notifiable Infectious Diseases. 1. Infectious Diseases' Hospital 20 2. Tables 20 (a) Notifications 21 (b) Scabies 21 (c) Age Distribution 22 I Page Section C (continued). 3. Diphtheria Immunisation 23 . 4. Smallpox 23 5. Disinfection of Premises 23 6. Laboratory Facilities 24 7. Tuberculosis 24 (a) Treatment and Hospital Accommodation 24 (b) Tables (i) Particulars of New Cases and Deaths 24 (ii) Quarterly Statements 25 8. Ear, Nose and Throat 26 D Hospital and Ambulance Facilities. 1. General 26 2. V.D. 26 3. Children 26 4. Ambulance Facilities 26 E Sanitary Circumstances of the Area. 1. Refuse Collection and Disposal 26 (a) Costs 27 (b) Details of Refuse Vehicles and Staff 27 (c) Details of Tonnage 27 2. Trade Refuse 28 3. Salvage 28 4. Water Supply 29 5. Closet Accommodation and Cesspools 29 6. Shops Act 1912-1938 30 (a) Offices 30 7. Camping Sites 30 8. Hop Pickers 30 9. Rag Flock Act 30 10. Sanitary Inspection of the Area 30 (a) Routine Visiting 31 (b) Summary of Nuisances and Defects Remedied during the year 31 (c) Smoke Abatement 31 (d) Health Education 32 (e) Eradication of Bed Bugs 32 (f) Cleansing of Verminous Persons 32 (g) Swimming Baths and Pools 32 II Page Section E (continued). (h) Mortuary 33 (i) Schools 33 (j) Mosquito Control 33 11. Housing 33 (a) Inspection of Dwellinghouses during the year 33 (b) Remedy of Defects during the year without service of formal notices 34 (c) Housing Act 1936—Overcrowding 35 (d) Rent and Mortgage Interest strictions) Act, 1939 35 12. Factories 36 (a) Inspections 36 (b) Defects Found 36 F Inspection and Supervision of Food Supply 1. Cowsheds, Dairies and Milk Stores 36 2. Bacteriological Examination of Milk 37 3. Designated Milk 37 4. Sampling of Milk for Tubercle Bacilli 37 5. Meat and Food Inspection 37 6. Food and Drugs Act Sees. 3 and 68, Routine Sampling 38 7. 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, Aldermpn and Councillors of the Borough of Erith. Mr. Mayor, Ladies and Gentlemen, This report is again curtailed as in the previous three • years for purposes of national economy and consists, therefore, mainly of statistics. The fall in the birth rate has for a generation or more, now ceased to be merely an interesting occurrence in statistics and has become a matter of vital importance in the life of the nation. About the physiology and pathology of human reproduction at the moment we know, in fact, very little, but as reproduction is dominated by emotion far more than any other physiological function, it is reasonable to expect an increase in the birth rate at the present time. That this is so is illustrated by the fact that the births in the district have this year increased by roughly a third as compared with those in the preceding year, and it has again been necessary to increase the accommodation at the municipal maternity home in this instance to 12 beds. This is exactly double the capacity of the home in 1940 and it is no secret that plans and estimates are in hand to further increase the number of beds. The total number of births during this year exceeds those in any other year since 1920. > The death rate of 11.1 shows a reduction on the previous year's figure, and is below the standardised rate for the rest of the country (England and Wales). The maternal mortality rate of 2.6 is, unfortunately, higher than in the previous year, and at this figure exactly equals the average material mortality rate of the town during the last twenty-two years. 3 In noting the further satisfactory reduction in the infantile mortality rate of 35.4 it is interesting to observe that the present rate in the borough is just half of the rate of 71.1 recorded ten years ago in 1933, and that there has been a reduction of one-third in the rate of 53.(32 recorded five years ago in 1938. It compares favourably with the present general rate of 49 for England and Wales and with the rate of 60 for the administrative county of London, and may be held as an indication of your child welfare and health services and social services in the area generally. It may be worth while remembering when the question of the future of public health services is under consideration. It is gratifying to record the continued expansion of the borough's maternity and child welfare services which this year include three child welfare and one ante-natal additional weekly clinic session, together with one additional monthly specialist ante-natal session. A new scabies scheme has been inaugurated for the treatment of notified cases and examination and subsequent treatment of contacts. This disease is, unfortunately, increasing and one of the defects of the Scabies Order is that the medical officer of health has no control over cases which are under treatment by a panel or private doctor. This naturally may lead to the spread of the disease for there is no restriction on the patient's movements or activities whilst undergoing such treatment. This year the department has received considerable assistance from civil defence personnel. Nursing auxiliaries have helped in staffing the municipal maternity home occasionally the isolation hospital, and in attending the various child welfare sessions, while since June of this year the ambulance personnel have taken over from the fire service the public health ambulance service of the town. I cannot conclude without commenting on the remarkable number of proposals that have been published during this year for changing or reforming present medical practice in this country. Having studied most of the schemes put forward and knowing something of the personnel involved, I feel sure that practically all would to some extent at least be successful, although there appears to be some confusion with regard to the difference between health and medical services. 4 Finally, I would like to thank those councillors who have so often helped the department in our particular endeavours, and also the staff who have been so loyal through such a dfficult time and without whose help so much could not have been accomplished. 1 am, Mr. Mayor, Ladies and Gentlemen. Your obedient Servant, REGINALD LEADER, Medical Officer of Health. December, 1943. 5 H (2). MEMBERS OF COMMITTEES. Health Committee. Chairman—Councillor Alford. Alderman Christian. Councillor Farquhar ,, Bates. Alderman Ewens. Councillor Dunkley. Councillor Morling. 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 S. G. A. Mantle. Deputy Mayor, Councillor G. H. Luck. 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— F. Schenk, M.D. M. R. Blair, M.R.C.S., L.R.C.P., L.D.S. 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. Sanitary Inspectors— C. S. T. Dancer, Cert. S.I.E.B., Meat Inspector's Certificate. W. E. Moses, Cert. S.I.E.B., Meat Inspector's Certificate, C.A.G.S. Sanitary Foreman & Disinfecting Officer— H. W. Cooper. Health Visitors— Miss I. P. Burt, S.R.N., S.C.M., R.F.N., H.V. Cert. Miss T. M. Torpie, S.R.N., S.C.M., H.V. Cert. Miss M. A. G. Williams, S.R.N., S.C.M., H.V. Cert. Matron, Infectious Diseases Hospital— Miss P. Jay, S.R.N., R.F.N. Sister-in-Charge, Maternity Home— Miss L. M. Barclay, S.R.N., S.C.M. Matron War-time Nursery, Bedwell RoadMiss V. A. Higgs, S.R.N. (Appointed 1/5/42.) 7 Clerks— Chief Clerk and Senior Staff Officer (C.D.)—H. M. Coles, L.A.G.C. (Discharged H.M. Forces 6/10/1942.) Acting Chief Clerk—W. Hillier. (Resigned March, 1942.) Acting Chief Clerk and Senior School Clinic Clerk (from March, 1942) and Deputy Chief Clerk and Senior School Clinic Clerk (from October, 1942)—Miss M. Smith. General Clerks— Maternity and Child Welfare—Miss O. R. Reeves. Accounts Clerk—Mrs. G. P. MacPherson. Public Health—R. Durey, M.R.I.P.H.H., L.A.G.C. (to H.M. Forces 2/1/1941). War-time Nurseries—Mrs. M. Morrison. Shorthand Typist—Miss B. L. Kell (Mrs. R. Durey, 12/9/42) Junior Clerks Public Heath—P. R. Cooper. School Medical Service—Miss J. Redgrave, Miss E. Bartlett, Miss D. Beacroft. (Appointed 30/3/42.) Maternity and Child Welfare—Miss E. Varnham, Miss G. Roberts, Miss E. Godwin, Miss B. Cattermole. Civil Defence— Staff Officer—Mr. D. Featherstone (appointed May, 1942). Clerk—Mrs. V. E. Hockley (resigned March, 1942). P. MacPharlane (appointed March, 1942) (resigned 22/12/42). E. N. Wellington, A.R.P.S. (appointed 23/12/1942). 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.). Details of members of the staff of the School Medical Service are embodied in the report to the Education Committee. 8 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Annual Report, 1942. A(1). SUMMARY OF STATISTICS. A (1 ) a. General. Area.—4,607 acres. Population.—41,870 (Estimated 1939), 37,340 (Estimated 1942). Density of population, i.e. number of persons per acre.—8.1. Number of inhabited houses.—11,009. Rateable value, 1942—£316,646. Sum produced by a penny rate, 1942—£1256. A (1 ) b. Births. TOTAL. Male. Female. Live Births. Legitimate 707 356 851 Illegitimate 27 16 11 734 Live birth rate per 1,000 of population (1942 estimated)— 19.6. Corresponding rate for 1941—16.8. TOTAL. Male. Female. Stu.l Births. Legitimate 28 15 13 Illegitimate — — — 28 vStill birth rate per 1,000 births—38.00. A(l)c. Deaths. Males—229. Females—186. Total—4 IS. Death rate per 1,000 of population (estimate 1942)— 11.1. Corresponding rate for 1941—17.00. Number of women dying in, or in consequence of, childbirth—2. Maternal Mortality per 1,000 total registered births—2.6. Comparative figure for England and Wales—2.01. 9 Illegitimate Legitimate A(l)d. Infantile Mortality. Deaths of infants under one year of age. 25 — 25 TOTAL. — 12 Male. — 12 Female. lJiarrhoea (under 1 years) Whooping Cough (all ages) T"\ . l y -i * Measles (all ages) Death rate of infants under one year of age per 1,000 live births—35.4. Total number of deaths from : 1 5 — 1941 2 2 — 1942 A(1)e. Vital Statistics of Whole District during 1942 and previous years. Year Population estimated to middle of each year Births Total Deaths registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected Number Nett of 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 1933 35,950 514 492 14.07 262 6.95 '7 I42 35 71.1 387 1100 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 I0 158 21 40.0 360 10.06 1936 36,380 580 510 14.18 243 6.67 17 186 3° 58.82 412 11.32. 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 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 37.95 473 17.00 1942 37,340 775 734 19.6 259 6.93 20 126 26 35.4 415 11.1 10 A(l)f. Table showing Summary of Causes of Death during the year ended 31st December, 1942. Cause of Death Males Females Total 1 Typhoid Fever, &c. - - - 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — — — 4 Whooping Cough — 2 2 5 Diphtheria 1 — 1 6 Tuberculosis of resp. system 9 6 15 7 Other forms of Tuberculosis 2 7 9 8 Syphilitic diseases — 1 1 9 Influenza 4 — 4 10 Measles — - 11 Ac. polio-myel. & polioenceph — — — 12 Ac. inf. enceph 1 — 1 18 Cancer of b. cav. & oesoph 7 5 12 14 Cancer of stomach and duodenum 13 6 19 15 Cancer of breast - 4 4 16 Cancer of all other sites 30 19 49 17 Diabetes 3 2 5 18 Intra-cran. vase, lesions 21 20 41 19 Heart disease 48 59 107 20 Other diseases of circ. system 10 S 18 21 Bronchitis 17 4 21 22 Pneumonia 12 7 19 23 Other resp. disease 3 1 4 24 Ulcer of stomach or duodenum 3 . 3 25 Diarrhoea under 2 years 2 2 26 Appendicitis 1 1 27 Other digve. dis. 5 7 12 28 Nephritis 6 2 8 29 Puer. & post-abort, sepsis — — — 80 Other maternal causes _ 2 2 81 Premature birth 4 3 7 82 Con. mal. birth inj. infant dis. 5 8 / 13 83 Suicide 5 2 7 84 Road traffic accident 1 1 2 35 Other violent causes 3 4 7 36 All other causes 13 6 19 Total all causes 229 186 415 11 A(1)g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1942. Provisional figures. The mortality rates for England and Wales refer to the whole population, but lor London and the towns to civilians only Kate per 1,000 total population Annual Death-rate per 1,000 population Kate 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 126 County Boroughs and Great Towns, including 15.8 0.54 11.6 0.00 0.00 0.01 0.00 0.02 0.05 0.09 5.2 49 London 17.3 0.66 13.3 0.00 0.00 0.02 0.00 0.03 0.06 0.00 7.5 59 148 smaller towns resident population 25,000 50,000 at 1931 census 18.4 0.62 12.1 0.00 0.00 0.01 0.00 0.02 0.04 0.10 4.8 46 London Adm. County .14 0.48 13.9 0.01 0.00 0.01 0.00 0.04 0.02 0.07 8.6 60 Erith (Estimated population 37,340 19.6 0.63 11.1 0.00 0.00 0.01 0.00 0.05 0.026 0.107 2.7 35.4 12 A (2). Since 1920 there have been 13,138 births with 35 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 1942 2 762 775 Total 35 13138 12619 13 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. A (3). Infantile Mortality. 25 infants died before reaching one year of age, giving an infantile mortality of 35.4. The comparable figure for the whole country is 49. Analysis of the cause of death of this age group reveals the following figures:— Deaths from Prematurity and Debility 7 Bronchitis and Pneumonia 4 Whooping Cough 1 Gastro Enteritis 2 Marasmus and General Debility 2 Other causes 8 T.B. Meningitis 1 Total 25 I have included a table showing the Infantile Mortality at 5 year intervals for the past 25 years and for 1942. Erith England and Wales 1910 70.91 130 1915 73.17 91 1920 61.5 83 1925 56.48 75 1930 61.05 66 1935 40.0 59 1940 37.17 55 1942 35.4 49 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. 14 Year ending Adults Young Persons Men Women Men Women Total 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 December, 1942 38 39 1 5 83 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 again important alterations under sections (a) and (f). I have pleasure in recording that the Infant Welfare Centre at Picardy held fortnightly during 1941 has been fully justified, and since April of this year has been doubled. It is now a weekly clinic session every Wednesday and appears to be developing satisfactorily. Owing to increased attendances a new weekly clinic session was opened in August at the Bedonwell Welfare Centre and for the same reason an additional weekly clinic commenced at the "Hainault" Welfare Centre in the same month. Following the increase in the numbers attending the Child Welfare Clinics in the Borough, more use has been made of the Specialists services available. the Specialists services available. One of the Specialists services concerned is the Orthopaedic clinic, and this, since August of this year, has been doubled and is now functioning on two days each month. 15 Month Births Sex Legitimacy Notified by Live S'born M F Leg. Illeg. Midwives Hosp. etc. Doctors M F M F January 33 1 — 24 10 33 1 — 17 17 — February 37 2 — 32 7 39 — — 16 22 1 March 64 1 — 35 30 64 1 — 22 42 1 April 62 2 2 32 34 65 1 — 22 44 — May 63 1 — 40 24 62 — 2 22 41 1 June 68 1 2 34 27 60 1 — 21 40 — July 73 1 — 43 31 66 7 1 26 47 1 August 68 — — 28 40 65 — 3 16 51 1 September 87 — 1 45 43 84 2 2 26 61 1 October 71 1 1 32 41 67 1 5 17 55 1 November 66 — 1 41 26 65 2 — 19 48 — December 73 2 1 36 40 70 4 2 18 57 1 Total 755 12 8 422 353 740 20 15 242 525 8 775 775 775 775 B (2). 16 B (3). Infant Welfare Centres. Month Erith Belvedere Picardy Bedonwell Infants Under 1 year weighed 1 to 5 years Consultations Infants Under 1 year weighed 1 to 5 years Consultationa Infants Under 1 year weighed 1 to 5 years Consultations Infants Under 1 year •weighed 1 to 5 years Consultations  Tannary 270 ' 100 89 154 45 45 59 40 20 380 236 132 February 237 103 76 155 99 33 88 55 31 391 226 114 March 336 154 116 290 152 70 71 67 23 381 234 120 April 348 119 112 218 92 45 118 57 25 456 208 120 May 300 90 86 234 72 47 122 53 38 471 187 106 June 422 114 85 314 104 64 137 54 37 481 177 103 July 404 111 83 267 104 59 151 59 26 564 237 147 August 392 118 89 235 87 55 156 55 27 523 225 116 September 364 111 94 274 122 122 217 72 63 629 270 191 October 349 187 99 225 121 104 159 68 75 587 236 209 November 367 105 76 193 99 83 169 70 99 567 221 173 December 324 92 72 206 115 71 214 71 90 536 172 157 Totals 4113 1404 1077 2765 1212 798 1661 721 554 5966 2629 1688 5517 3977 2382 8595 17 B(4). Home Visits by Health Visitors. 1942 Children Special Visits Expectant Mothers Infant Life Protection Total Visits 1st Visits ReVisits StillBirths Others January 58 1029 3 34 71 11 1206 February 42 929 2 38 49 6 1066 March 44 992 1 43 46 2 1128 April 61 893 3 23 43 17 1040 May 65 882 3 45 42 11 1038 June 69 1025 3 30 61 14 1202 July 57 559 1 90 18 8 733 August 73 435 1 66 20 11 606 September 85 892 1 42 39 9 1060 October 72 957 2 39 43 9 1122 November 66 987 2 60 49 1 1165 December 58 818 2 37 57 15 987 Total Visits 740 10398 24 547 538 114 12361 B (5). MATERNITY SERVICES. B(5)a. Maternity Home—Hainault. The Council provides a maternity home the accommodation of which this year has been again increased by the addition of a three-bedded ward to a total of 12 beds, including one isolation bed. The staff consists of a Sister-in-Charge, a Junior Sister, a Staff nurse midwife, two midwives, and two assistant nurses. Institutional treatment for normal cases is provided. During the period under review 215 maternity cases were admitted. Of these 129 cases were delivered by midwives and 86 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 six years to the Hainault Maternity Home. Year Admissions 1937 134 1938 116 1939 118 1940 118 1941 143 1942 215 18 B(5)b. Ante-natal. With the increase in the total number of births in the Borough, and the fine opportunity for ante-natal education provided by distribution of the extra clothing coupons for expectant mothers through the Health Department, considerable progress has been made during the year. It should be noted that the issue of these clothing coupons in this manner provides an unofficial notification of the pregnancies within the district and in my opinion, is one of the most valuable measures that has happened to the Maternity Section of the department during the last few years. It enables every expectant mother of the town to be informed in a friendly unofficial manner of her nearest ante-natal clinic, to meet before the confinement the Health Visitor in her district who will eventually guide her through most of her subsequent difficulties, and it enables advice and arrangements for the actual confinement to be discussed and completed in good time before the happy event. The ante-natal sessions held weekly at the Bedonwell and Picardy clinics have both continued to function satisfactorily and the evening pre-natal clinic at the "Hainault" centre established in 1940 has proved very popular and served a most useful purpose. The attendance at the Bedonwell Centre has continued to increase throughout the year and a second weekly clinic at this Centre was therefore opened in August. With the additional ante-natal attendances it was found necessary to double the specialist clinics attended by the ante-natal consultant from one each month to two monthly. Ante-natal patients seen by Doctor 1942 Jan. Feb Mr. Apr. May June July Aug Sep. Oct. Nov Dec. Total Erith 70 76 50 64 57 50 93 94 81 103 93 98 929 2863 Bedonwell 89 91 104 136 100 99 123 82 126 138 142 162 1392 Picardy 40 46 48 48 30 55 49 50 43 43 59 31 5427 19 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. 21 cases were admitted under this arrangement during the year. The conditions for which they were admitted were as follows: Reason No. Pre-Eclampsia 4 Post Maturity 1 Breech Presentation 2 Induction 2 Toxaemia 5 Placenta Praevia 1 Disproportion 3 Anencephalic 1 Caesarian 1 Premature Labour 1 21 B(6). Infant Life Protection. Number of foster mothers on register at end of year 11 Number of children on register at 31st December, 1942 14 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 domiciliary 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 the year, attendances being 209. 20 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 42 No. of cases attended by: Home Help No. 1 21 Home Help No. 2 14 Home Help No. 3 5 40 No. of cases booked and subsequently cancelled 2 42 No. of days on which Home Help was employed: Home Help No. 1 294 Home Help No. 2 138 Home Help No. 3 33½ 4 465½ 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. 21 C (2) a. Notifications. The following table shows the total notifications received during the year 1942:— Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Scarlet Fever 68 37 – Diphtheria 7 11 1 Cerebro-Spinal Meningitis 2 1 – Paratyphoid 1 2 – Enteritis 4 – – Dysentery 5 1 – Ophthalmia Neonatorum 1 – – Puerperal Pyrexia 1 – – Erysipelas 11 1 – Poliomyelitis 3 1 – Pneumonia 47 2 19 Tubercular Meningitis 1 – – Measles 348 4 – Whooping Cough 52 4 2 G(2)b. Scabies. In accordance with the requirements of the Scabies Order 1942, the Council inaugurated a scheme for the treatment of notified cases of Scabies and the examination and subsequent treatment if found necessary of contacts. Male cases and contacts were treated at a disinfestation station provided at the Isolation Hospital which was opened during September 1942 and females and children were treated in the cleansing section of the Erith First Aid Post. The Council own a high pressure steam disinfector at the Erith Isolation Hospital and bedding and clothing as necessary is treated there. 10,027 items were actually dealt with during 1942 in connection with 286 cases of Scabies treated. 22 C(2)c. 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 – 2 3 6 9 38 7 – 2 – 1 – – 68 Tubercular Meningitis – – – – – – – 1 – – – – – 1 Poliomyelitis – – – – – 3 – – – – – – – 3 Acute Primary Pneumonia 2 – 3 2 2 5 4 – 5 7 13 – 4 47 Erysipelas – – – – – – – 1 – 5 1 – 4 11 Diphtheria – 1 1 1 – 1 1 1 1 – – – – 7 Cerebral Spinal Meningitis 1 1 – – – – – – – – – – 2 Measles 11 28 45 61 66 129 5 1 – 1 1 – – 348 Para-Typhoid – – – – – 1 – – – – – – – 1 Enteritis 1 1 – – – – – – 2 – – – – 4 Dysentery – – – – – – 1 – – – 3 – 1 5 Ophthalmia Neonatorum 1 – – – – – – – – – – – – 1 Puerperal Pyrexia – – – – – – – – 1 – – – – 1 Whooping Cough 5 4 6 5 12 14 – – 1 1 4 – – 52 Totals 21 37 58 75 89 191 18 4 12 14 23 – 9 551 23 C (3 ). Diphtheria Immunisation. The Scheme for the immunisation of children against Diphtheria was continued throughout the year as was also the immunisation of children against Diphtheria and Whooping Cough with a combined vaccine. Immunisation facilities are available at all sessions of the various clinics held in the town. The following table will indicate the number of cases dealt with:— Diphtheria Diphtheria and Whooping Cough 1st 2nd Injections Injection. Injection. 1. 2. 3. 4. January 113 99 9 21 51 20 February 123 101 4 3 7 5 March 70 106 3 7 4 2 April 36 71 4 4 2 2 May 103 59 3 1 4 5 June 62 53 5 18 14 1 J uly 146 68 13 4 8 11 August 223 160 4 8 11 11 September 227 212 2 2 3 5 October 234 228 4 5 1 1 November 294 211 12 10 4 3 December 89 225 4 3 7 2 Totals 1720 1593 67 96 116 68 Grand lotals—1st Injections 1/87 2nd ,, 1689 3rd ,, 116 4th ,, 68 A comparison of these figures with those for 1941 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., 186 premises were disinfected, whilst enquiries to obtain particulars regarding 69 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. 24 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. 475 specimens were dealt with during the year. C (7). TUBERCULOSIS. C(7)a. Treatment and Hospital Accommodation. The Kent County Council are responsible for cases of Tuberculosis occurring within the district, and also for Sanatorium treatment and hospital accommodation for Erith residents. A dispensary is held 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 1942 are showTn in table 1, whilst table 2 shows the quarterly statements of cases on the register, together with the position at the 31st December, 1942. C(7)b. Table i. Particulars of New Cases and Deaths. Age Periods New Cases Deaths Pulmonary Non-Pulm'n'rj Pulmonary Non-Puim'a'ry M. F. M. F. M. F. M. F. Under 1 year – – – – – – – – 1 1 – – – – 1 – – 5 1 1 1 1 – – – – 10 – – – – – – – – 15 2 6 2 – 1 – – – 20 6 7 – 3 1 4 – – 25 9 5 1 2 1 4 1 – 35 6 4 – – 2 3 – – 45 5 2 – – 2 1 1 – 55 3 – – – 4 – – 1 65& upwards 1 – – – 1 – – – Totals 34 25 4 6 12 13 2 1 25 Table (ii). Quarterly Statements. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter M F T M F T M F T M F T Pulmonary T.B. Number on register 128 100 223 117 84 201 124 95 219 131 97 228 New notification's during year 6 1 7 6 12 18 12 6 18 8 8 16 Cases removed, which have been restored – – – 2 – 2 1 – 1 – – – Cases added to register other than by notification – 2 2 4 3 7 1 – 1 – 1 – Cases removed from register 12 19 31 5 4 9 7 4 11 9 4 13 Cases remaining on register 117 84 201 124 95 219 131 97 228 130 102 232 Non-Pulmonary T.B. Number on register 41 37 78 41 33 74 43 33 76 43 34 77 New notifications during year – – – 2 – 2 1 2 3 – 1 1 Cases removed, which have been restored – – – – – – – – – – – – Cases added to register other than by notification 1 – 1 – – – – – – – – – Cases removed from register 1 4 5 – – – 1 1 2 3 1 4 Cases remaining on register 41 33 74 43 33 76 43 34 77 40 34 74 26 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. 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 special 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 ten 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 which was under the control of the Chief Officer of the Fire Brigade was transferred to the Public Health Department in June, 1942, when the Auxiliary Fire Service was nationalised. Since that time the Public Health Ambulance Service has been run by Civil Defence personnel stationed at the Central Ambulance Depot under the supervision of the Casualty Staff Officer. Three ambulances are run for non-infectious or accident cases and one for the removal of infectious disease. 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. 27 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(l)a. Costs. The cost per ton of collecting refuse is 13s. 2d. (previous year lis. 7d.). The cost per ton of disposing refuse 4s. lOd. Net cost per 1,000 of population £129. 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. Table1. Vehicle Capacity 1 Dennis Lorry 12 cubic yards 2 Easy loaders 4 „ „ 4 S.D. Freighters 7 „ „ 1 Fordson 10 „ „ 1 Austin 10 Utility Van These are operated by— 1 Foreman, 9 Drivers and 11 Loaders (6 men, 4 lads). 2 Salvage Sorters (female). E(l)c. Table 2. Month Tonnage Tons Cwt January, 1942 602 2 February 524 10 March 562 4 April 453 4 May 386 13 June 360 17 July 296 1 August 248 13 September 254 3 October 355 17 November 426 2 December 444 1 Total 4904 7 28 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 9 years ago approximately 116 tons were disposed of while in 1942 the amount reached approximately 400 tons producing a revenue of £317 10s. Od. E(3). Salvage. Item Tonnage Collected Income T. c. q. lbs. £ s. d. Food: Waste Food 370 4 0 0 500 12 10 Sale of Pigs – – – – 328 0 4 Paper: Newsprint 14 5 0 0 139 2 6 Periodicals 43 15 3 0 336 10 0½ Strawboard and Mixed Waste 350 17 3 0 1971 19 6 Selected Waste 21 17 1 0 122 5 6 Kraft Blue Bags 4 9 2 0 34 17 9 Textiles 40 4 3 6 649 9 7 Bottles W.T. 37 18 2 0 116 10 3 Bottles Gr. 323 gross 6 doz. 120 4 8 Metals: Iron 176 11 3 0 258 13 7 Brass 1 2 3 22 23 13 7 Copper 5 2 1 10 17 8 Aluminium 15 3 21 . 26 0 7 Lead 1 6 1 1 26 1 4 Zinc, etc. 2 18 5 3 54 2 8 Tins 282 13 0 0 212 6 6 Rubber 21 8 3 20 53 6 1½ Bones 10 14 3 20 40 4 7 Sundries: Dry Batteries Cardboard Cartons Tyres, Tin Foil Rabbit skins, Records 17 4 1 9 51 15 5 General: Subsidy on Iron 277 15 1 Cartage Allowances 342 9 11½ 29 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 complete satisfactory results, and arrangements are in existence with the Kent County Laboratory for the examination of two monthly samples which are submitted from various sites within the district. The following is a typical report on samples : — REPORT ON BACTERIOLOGICAL EXAMINATION OF ERITH WATER. Taken from tap over sink at 5 Colebrook Vale 3/11/42. 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. 8 Remarks. B. Coli absent in 100 c.cs. Good water. (Signed) E. R. JONES, Pathologist. E(5). Closet Accommodation and Cesspools. The whole of the closet accommodation in both the older parts and the comparatively newly built up areas is on the main drainage system, there being only 24 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 by mechanical plant belonging to the Council free of charge. 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 and conveying to the point of disposal. During the year 53 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 8,423. Notices served—Statutory 7; Informal 746. Number of houses and other premises disinfected 186. Complaints received and investigated during year 1309. 30 E(6). Shops Act 1912-1938. Regarding hours of closing, it was necessary to issue 3 warnings to shop-keepers upon their 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 arid 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 5 All such Notices had been complied by the end of the year. E (6) a. Offices. No action has been taken during the year under Section 46 Public Health Act 1936 in respect to sanitary accommodation at offices and in no case has it been found that insufficient sanitary conveniences exist at such business premises. 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 with a view to the maintenance of standards in accordance with the Borough Byelaws. No licences have been granted by the Authority during the year under Section 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). SANITARY INSPECTION OF THE AREA. In the following tables, the work of the Sanitary Inspectors during the year is summarised:— 31 E(10)a. Routine Visiting. Premises visited and recorded results of such visits: Premises No. in District No. of visits 1942 No. of defects found No. of defects remedied Bakehouses 10 65 1 1 Cowsheds 4 21 2 2 Dairies 12 63 2 2 Butchers Shops 33 352 1 1 Fish friers 10 71 – – Ice Cream Manufacturers 18 38 – – Food Factories 3 16 – – Slaughter Houses 4 18 – – Factories 124 89 11 11 Outworkers 18 11 – – E (10) b. Summary of Nuisances and Defects remedied during the year. Other than those enumerated in the above tabulations: Drains cleared 105 Drains repaired 44 Roofs repaired 120 Damp walls remedied 79 Floors repaired 19 Accumulations removed 13 W.C. cisterns repaired 42 Water supply provided 21 W.C. pans renewed 20 New Dustbins provided 133 Plasters renewed 47 Windows made to open 27 New sinks installed 8 New firegrates provided 14 Yard pavings repaired 3 New W.C.s provided 10 Animal nuisances abated 3 Cesspools abolished 2 Clothing disinfected : — E (10) c. Smoke Abatement. No action has been taken during the current year in respect of smoke abatement. 32 E (10) d. Health Education. With a view to preventing lapses in sanitary circumstances, leaflets have been prepared on subjects relating to cleanliness in food preparing premises, precautions against burst water pipes, destruction of rats, and sanitary obligations in respect to infectious diseases. Many of the leaflets have been circulated amongst the public, and have proved extremely useful. E(10)e. Eradication of Bed Bugs. During 1942, 38 dwellinghouses were found to be infested with vermin and subsequently disinfested as under: — Private houses 32 Council houses 6 In respect to private houses, the owner is requested to remove wallpapers, picture rails prior to disinfestation. The usual re-visits are jnade by Inspectors. The cleansing of Council houses is carried out by the Surveyors staffy the methods utilised being spraying, or alternatively fumigation by Cimex blocks. All prospective tenants including those selected are visited and a report upon the conditions found is made to the Housing Committee. When the effects are found to be verminous, the articles are subjected to Cyanide Fumigation by Contractors employed by the Council, who work under supervision of the Department. This method of re-housing has proved to be successful. Four dwellings and one factory premises were fumigated with Hydro cyanic Acid Gas for which subsequent clearance certificates were received. E(10)f. Cleansing of Verminous Persons. Cleansing stations are operating at the C.D. First Aid Post, and the Borough Infectious Disease Hospital, and all persons suffering from Scabies are directed to these sites for cleansing. Bedding and personal effects are subsequently stoved in the Council's Steam Disinfector. With a view to the prevention of Scabies amongst employees of industrial undertakings, the service of stoving bedding, etc. has been offered to the managements of the local factories. The response has on occasions, been overwhelming, but the system has worked completely satisfactory. E(10)g. 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 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 chlorine. 33 E(10)h. Mortuary. The Borough Mortuary is situated at the rear of the Erith Parish Church in West Street, and consists of a receiving room and a viewing room. There is accommodation for 4 bodies. During 1942, 36 bodies were placed within the building. E(10)i. Schools. Schools within the District are regularly visited and defects if any, are referred to the Education Committee. All the premises are served by Metropolitan Water Board water supply. Further details with regard to Schools are to be found in the Report of the School Medical Officer. E (10) j. Mosquito Control. Considerable time and attention has been devoted during the year to the above, and meetings of the Sub-Committee representing the administrative Authorities of Barking, Dagenham, Woolwich and Erith have been attended by the Senior Sanitary Inspector. A survey of watercourses and marsh land was vigorously conducted and a total of 38 specimens were submitted to the Ministry of Health's Malarial Officer for identification. Of the specimens so submitted, Culex Pipiens was chiefly the tjpe. It is said that this specie has increased enormously all over the country, but, fortunately they do not attack man, but because they pass most of their adult lives in dwellings where they are numerous, they are a pest because of buzzing around at night and so keep people awake. Close attention has been paid to the ten 5,000 gallon capacity N.F.S. dams in the district, and the necessary precautions against breeding taken. Resulting from the joint survey and deliberations of the Area sub-committee, the Ministry of Health was negotiated with, when in September, 1942, the Clerk to the Committee reported that the Ministry could not agree to the use of labour on an extensive land drainage scheme. E (11 ). HOUSING. E (11 ) a. Inspection of Dwellinghouses during the year. 1. (a) Total number of dwellinghouses inspected for housing defects (under Public Health Act or Housing Acts) 992 (b) No. of inspections made for the purpose 2976 2. (a) No. of houses (included under sub-head (1) above which were inspected and recorded under the Consolidated Housing Regs. 1925 and 1932 0 (b) No. of inspections made for the purpose 0 34 3. No. of houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 4. No. of houses (exclusive of those referred to . under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 721 E (11 ) b. Remedy of Defects during the year without service of formal notices. 1 Number of defective dwellinghouses rendered fit in consequence of informal action by. Local Authority 662 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, 1936: (1) No. of dwellinghouses in respect of which Notices were served requiring defects to be remedied 7 (2) No. of dwellinghouses in which defects were remedied after service of formal notice: (a) By Owner 7 (b) By Local Authority 0 (c) Proceedings under Section 11 and 13 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 Sec. 12 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 35 E (11 ) c. Housing Act 1936—Overcrowding. (a) (1) No. of dwellings overcrowded at end of year 15 (2) No. of families dwelling therein 15 (3) No. of persons dwelling therein lll½ (b) Number of new cases of overcrowding reported and relieved during the year 1 (c) (1) No. of cases of overcrowding relieved during the year 10 (2) No. of persons concerned in such cases 8½ (d) Number of dwellinghouses which again became overcrowded after the Local Authority had taken action for the abatement of overcrowding 0 E (11 ) d. Rent and Mortgage Interest (Restrictions) Act, 1939. The provisions regarding extortionate rents are administered by the Senior Sanitary Inspector. The maximum permissible rent of houses brought under control by this 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 by the Landlord. During the year 1942, many cases have been dealt with and improvements effected as follows:— (a) Rent reduced from 14/- to 8/9 per week. (b) Rent reduced from 15/8 to 14/9 and surcharge of £3 0s. 6d. to tenant. (c) Rent reduced from 27/- to 26/- per week. (d) Rent reduced from £l 1s. 0d. to £l 0s. 6d. per week. (e) Rent reduced from 13/- to 10/10 per week. (f) Rent reduced from £l 5s. 0d. to £l 1s. 0d. and surcharge of £2 to tenant. 36 E (12). FACTORIES. E (12) a. Inspections for the purposes of provisions as to health. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 75 9 – Factories without mechanical power 1 2 2 – Other premises under the Act (including works on building and engineering construction but not including outworkers premises) 2 – – Total 89 11 – E (12) b. Defects found. Particulars Number of Defects Number of defects in respect of whicn prosecutions were instituted Found R emedied Referred to H.M. Inspector Want of Cleanliness Overcrowding 2 2 – – Ineffective drainage of Floors – – – – Inadequate Ventilation 1 1 1 – Sanitary Conveniences: Insufficient 2 2 – – Unsuitable or defective 4 4 – – Not separate for sexes – – – – Other offences 2 2 – – Total 11 11 1 – SECTION F.—INSPECTION AND SUPERVISION OF THE FOOD SUPPLY. F(1). 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 4 No. of dairies 12 Shops selling milk in sealed receptacles 40 No. of registered purveyors outside Borough 19 37 F(2). Bacteriological Examination of Milk. The following samples of milk retailed within the Borough werS obtained and forwarded for examination:— Pasteurised 10 Ordinary 1 All were subsequently reported as being satisfactory. F(3). Designated Milk. The following table indicates the number of licences issued by the Local Authority under the Milk (Special Designations) Order, 1936:— No. issued. Pasteurisers licence 1 Pasteurised dealer 6 Tuberculin tested dealer 5 Pasteurised dealer (Supplementary) 1 Tuberculin tested dealer (Supplementary) 2 Total 15 F(4). Examination of Milk for Tubercle Bacilli. The sampling of a bulk milk supply from 18 cows resulted in failure to locate the Tubercle Bacilli. F(5). 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:— Meat 405 lbs. ,, 185 tins Fish 112 lbs. ,, 67 tins Milk 905 tins Fruit 65 tins Vegetables 207 lbs. ,, 255 tins Eggs 790 Cheese 120 lbs. Oranges 453 Coffee 10 lbs. Cereals 15 lbs. Jam 3 jars The weight of the above articles of food was 1 ton, 5 cwts., 2 qrs. and 4 lbs. 38 F(6). Food and Drugs Act. Sections 3 and 68. Routine Sampling. The following samples were procured during the year and submitted to the Public Analyst for analysis:— Nature of Sample Adulterated Genuine No. of Samples Egg substitute – 6 6 Baking powder – 1 1 Gravylets – 2 2 Fish paste – 2 2 Beef extract – 3 3 Epsom salts – 1 1 Syrup of figs – 1 1 Milk – 32 32 Ground Cinnamon – 1 1 Ground Ginger – 1 1 Fish Cakes – 1 1 Ham paste – 2 2 Chocolate cup – 1 1 Pork pie – 1 1 Kidney soup – 1 1 Kipper creme – 1 1 Gravy salt – 1 1 Vinegar – 2 2 Honey, Glycerine & Lemon – 1 1 Butter – 1 1 Margarine – 1 1 Custard powder – 1 1 Coffee – 3 3 Stuffing – 1 1 Mint – 1 1 Lemon essence – 3 3 Salad dressing – 1 1 Lard – 1 1 Edible oil – 1 1 Sausage meat – 1 1 Curry powder – 2 2 Lemonade powder – 1 1 Pudding mixture – 1 1 Banana spread – 1 1 Orangestead – 1 1 Friars Balsam – 1 1 Castor oil – 1 Betox – 1 1 Whiskey – 1 1 Gin – 1 1 Port – 1 1 Ale – 1 1 Ginger beer – 1 1 – 90 90 As will be seen from the above table, all samples were reported as being genuine and of good quality. 39 F(7). 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 Byelaws 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 operation:— 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 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 Erith Cemetery 25th Oct., 1939 Public Baths 26th Oct., 1939 Prevention of Nuisances, etc 23rd April, 1940 BOROUGH OF ERITH. ANNUAL REPORT y OF THE School Medical Officer FOR THE YEAR ENDED 1942 * , 3 EDUCATION COMMITTEE. Chairman:—Councillor Farquhar. Vice-Chairman:—Councillor Pannell. Alderman Mrs. Ewens. Councillor Bates. ,, Burgess. ,, Ebben. Councillor Powrie. ,, Mrs. Nichols. ,, Mantle. Co-opted Members: A. W. Lawrence, Esq. Dr. J. B. Lobo. Dr. H. A. Maunder. Mrs. E. A. Munns. F. H. Hunt, Esq. Ex-officio Members: His Worship the Mayor—Councillor S. G. A. Mantle. Deputy Mayor—Councillor G. W. H. Luck. SCHOOL MEDICAL STAFF. School Medical Officer: Reginald A. Leader, m.r.c.s., l.r.c.p., d.p.h. Assistant School Medical Officers: F. Schenk, m.d. (Appointed 9/9/41.) M. R. Blair, m.r.c.s., l.r.c.p., l.d.s. 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: Miss Thomson-Smith, l.d.s. 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. Miss D. Beacroft. 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 1942 there were 4,742 children on the roll of the elementary schools, distributed as follows:— Nursery School 109 Infants Schools 1085 Junior Mixed and Infants Schools 342 Junior Schools 1659 Senior Schools 1537 In addition there were in Special Schools (outside the District) – THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. No. of children on School Roll 4742 No. of individual children who attended medical clinics 3637 No. of individual children medically examined at schools 3212 No. of medical examinations at the clinics 12476 (1) Hainault 10540 (2) Bedonwell 1936 No. of inspections for uiicleanliness and verminous conditions (school nurses) 11429 No. of attendances for treatment at the Dental Clinic 2687 No. of treatments at the Eye Clinic 205 No. of spectacles prescribed 124 No. of operations for Tonsils and Adenoids 60 No. of attendances at the Orthopaedic Clinic 1936 (1) For consultations 194 (2) For treatments, massage, etc. 1742 No. of attendances at Ultra Violet Ray Clinics 351 5 Medical Inspection. During the year inspections have been carried out at each school in the borough. The number of Routine Medical Inspections show an increase of 2031 over and above that of 1941. Similarly the Special Inspection figure shows an increase of 1024 children re-inspected, over the number in the previous year. previous year. This increase in inspection is the largesl recorded in the borough school medical service, and I must add, is in no small measure due to the hard work and enthusiasm of one of my colleagues, Dr. Maurice Blair, your Assistant School Medical Officer. No. of school children on register. No. of Routine Medical Exams, during the year. 1942 4742 3212 1941 3943 1181 1940 3086 413 1939 5131 785 1938 5125 1689 1937 4982 1581 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 9.29 per cent, in A (excellent), a decrease of 8.91 per cent.; 70.78 per cent, were in B (normal), an increase of 5.78 per cent. ; 19.36 per cent, in C (slightly sub-normal), an increase of 2.16 per cent. ; and there were 0.54 in D (bad). In the second age group, 8 year olds, there were 9.09 per cent, in A, a decrease of 5.81 per cent.; 60.96 per cent, in B, a decrease of 8.24 per cent.; 28.87 per cent, in C, an increase of 13.97 per cent.; and 1.06 per cent, in D, an increase of .16 per cent. In other routine inspections, there were 12.24 per cent, in A; 64.28 per cent, in B; 22.44 per cent, in C; and 1.02 per cent, in D. Malt and Oil. Total amount issued during the year ... ... 1663 lbs. Amount issued free ... ... ... ... 952 lbs. No. of children who received free issues ... 118 Amount sold at cost price ... ... . ... 711 lbs. At the end of the year a total of 178 children were receiving free milk at school. 6 Ear, Nose and Throat Defects. Individual defects are shown in Table III (Group III), others being included in Table III (Group I). Arrangements with Erith District Hospital for operative treatment of tonsils and adenoids are still in force but are handicapped by the small number of beds available and the general shortage of staff. There is some evidence of need of more regular specialised supervision for this type of case. Visual Defects and External Eye Disease. The ophthalmic service during 1942 has been entirely carried out at the Hainault Clinic, and Mr. Oliver Walker has again acted as your Consultant Specialist. This work in the borough is increasing and Table III (Group II) gives the usual s statistics. Dental Defects. It is pleasing to record, that despite the smaller number inspected this year, actually more children have had treatments. There are still, however, too many 44 refusals " of dental treatment. M iss H. Thomson-Smith, your dental officer, further reports:— In spite of difficulties created by war conditions the work of the dental clinic has proceeded and the service provided has been comparable with that of a normal peace-time year. It should be noted with gratification that the average number of fillings per session of conservative treatment has risen from 3.4 to 3.6 per session. Further the number of tooth extractions has dropped from 55.3 to 36.3 per gas extraction session. The above comparisons are made with the appropriate figures of the previous year. Twelve root fillings were completed during the year. In view of the delicate and tedious nature of this work and therefore the necessity for the exercise of great patience on the part of operator and patient this type of treatment is usually considered too difficult for clinic practice. With regard to prosthetic treatment, that is to saj^, the construction and fitting of dental appliances, the number fitted during the year has increased threefold. Most of these, of course, were supplied under the Maternity and Child Welfare Scheme. Orthodontic cases have been divided into two groups. The more straightforward cases have been treated in the clinic, whereas the more difficult cases have been referred to the appropriate departments of the London Hospitals, in order that the benefits of specialised opinion might be secured. A point of particular interest is that the acceptance rate has increased from 52 per cent, to 75 per cent.—a most encouraging sign. TABLE IV. Dental Inspection and Treatment. (1) Number of children inspected by the Dentist. (a) Routine Age Groups Age 5 6 7 8 9 10 11 12 13 14 Total Number 290 361 177 77 94 96 134 74 71 4 1378 (b) Specials 917 (c) TOTAL (Routine and Specials) 2295 (2) Number found to require treatment 1727 (3) Number actually treated 1069 (4) Attendances made by children for treatment 2687 (5) Half-days devoted to : Inspection 9 Treatment 454 463 (6) Fillings : — Permanent Teeth 1130 Temporary Teeth 174 1304 (7) Extractions :— Permanent Teeth 360 Temporary Teeth 2801 3161 (8) Administrations of general anaesthetics for extractions 1185 (9) Other operations : — Permanent Teeth 181 Temporary Teeth 64 Total 245 ORTHOPAEDIC AND POSTURAL DEFECTS. Mr. E. A. Lindsay continued to be your Consultant Orthopaedic Surgeon during 1942, and the work in this department was carried out normally, your Masseuse undertaking considerable treatment such as massage and exercises 8 at the Bedonwell clinic, the artificial sunlight and electrical treatment being referred to the various hospitals, in particular the Erith and District Hospital. By the middle of the summer it was apparent that the monthly specialist consulting clinic was becoming badly overcrowded, and from the month of August this was accordingly increased by an additional monthly session. Ihe following is a list of cases which have attended the clinic : — ORTHOPAEDIC, 1942. School Children. Infant Welfare. Genu Varum — 9 ,, Valgum 12 10 Curved Tibiae — 4 Rounded R. Tibia 1 — Pollux Valgus — 1 Stoop 18 — Dorsal Kyphosis 1 — Torticollis 1 — Scoliosis 6 — Kypho-scoliosis 1 — Lumbar Scoliosis 1 — SI. Spinal Curvature 1 — Round Hollow Back 1 — Prominent Scaphoids 1 — ,, Abdomen 1 — Flat Chest 1 — Flat Feet 52 21 Talipes Equino Varus 1 2 Hallux Valgus 4 — ,, Rigidus 1 — Valgus Ankles 5 — Weak Ankles 2 — Overlapping Toes 1 1 Deformed L. Foot 1 — ,, Toes 1 — Intoeing — 1 Hammer Toe 1 — Calcaneo Valgus — 1 Prominent Heel 1 — Plantav Fasia — 1 Foot Strain 4 — Congenital Deformities 1 — 9 Tightening R.S. Mastoid — 1 Inco-ordination — 1 A.P.M. 3 1 Cerebral Diplegia — 1 Asymetry of Head — 1 Cannot Walk — 1 Calcium Deficiency — 1 Pain Tubercle R. Scaphoid 1 — Pains Foot, Shoulder, ankle, knees 6 — Schlatters Disease 1 — Semimembranosus Bursa 1 — Epiphysitis 1 — Wasting Thigh 1 — Asthma 1 — 136 58 Orthopaedic Clinic. No. Sessions for Remedial Exercises, etc. No. of Attendances January 9 97 February 8 82 March 8 104 April 5 83 May 7 135 June 9 178 July 8 139 August 5 89 September 9 193 October 5 118 November 8 191 December 6 152 87 1561 INFECTIOUS DISEASES. A. Scarlet Fever. During the year forty-five school children were notified as suffering from Scarlet Fever. Apart from the first quarter of the year all these were generally distributed throughout the remaining nine months. No school, therefore, had to be closed for this or any other infectious disease throughout the year. Twenty-three of these school children were admitted to the Borough Isolation Hospital, and of this number four children had complications. These were as follows : — 10 COMPLICATIONS. Otorrhoea 1 Nephritis 1 Abscess 1 Cellulitis 1 With the exception of these four cases the others were of a mild type, although the boy with Nephritis was very ill indeed for a considerable period. B. Diphtheria. Three cases were notified during the year. One of these children, aged 7 years, unfortunately succumbed two days after admission to hospital following an emergency operation for tracheotomy. It is reasonable to assume that in the future with more intensive immunisation such disasters will be conspicuous by their absence. None of these three school children had had the protective course of injections for immunisation against diphtheria. C. Measles. With the exception of the month of January, cases of this disease were notified throughout the year, 195 being school children. The highest incidence of this disease occurred during the months of May and June, and practically all cases were of a mild type, only one child with the complication of pneumonia needing hospitalisation. D. Whooping Cough. Thirteen cases of whooping cough in school children were notified during the year. None of these children had been immunised against whooping cough although one child had had injections during the same month as it acquired the disease, the time interval here being too short for protection to develop. No case was severe enough as to require admission to hospital. E. Scabies. The incidence of Scabies again showed an increase on the preceding year and extensive arrangements were made to deal with this troublesome complaint. Two weekly medical sessions were allocated to the skin clinic which for school children was transferred to the Erith First Aid Post. Up to the 31st December 153 school children received treatment. 11 Immunisation against Diphtheria. Following the receipt of Circular 2627 of the 21st April, 1942, in which the Minister of Health urged the need of energetic action to secure the immunisation against Diphtheria of at least 3 out of every 4 children between the ages of 1 and 15, a Campaign was launched in this Borough supported by a national appeal by the Ministry during the period commencing the 10th August, 1942. Six stereos obtained from the Ministry of Health were shown in the local press weekly editions during August, at fortnightly intervals, during which time posters were displayed on notice boards, shop windows, in the Clinics and on the Authority's vehicles. Simultaneously, cinema slides worded as below were shown at the two local cinemas giving details of the Clinics where immunisation could be obtained, which the following illustrates : — ERITH BOROUGH COUNCIL Immunisation against Diphtheria can be done at the following centres : — WELFARE CENTRE SESSIONS Bedonwell Centre Infant Welfare. Belvedere Centre Infant Welfare. Erith Centre Infant Welfare. Picardy Centre Infant Welfare. The Clinic, Bedonwell Hill School, Bedonwell Road. Mons., Weds. & Frids., 1.45 to 4 p.m. Public Hall, Belvedere. Tues., 1.45 to 4 p.m. Hainault, Lesney Park Road, Erith. Mons. & Thurs., 1.45 to 4 p.m. Methodist School-rooms, Picardy Hill, Belvedere. Weds., 1.45 to 4 p.m. SCHOOL CLINIC SESSIONS The Clinic, Hainault, Lesney Park Road, Erith. Sessions are held each week-day 9 a.m. to 12 a.m. The co-operation of the Headteachers was sought and readily given for the distribution of pamphlets to those children not j-et immunised, the Health Visitors approaching those not yet of school age. At the end of June, 1942, the percentage of the child population in this district recorded as immunised was, under 5 years—35.1 per cent, 5 years to 15 years—53.2 per cent. As a result of the Campaign, the figures at the 31st December, 1942, were as follows :—Under 5 years—65 per cent.—5 years to 15 years—66 per cent. 12 I give below, a table showing the number of children immunised during the period 1st January and 31st December, 1942 : — Diphtheria Diphtheria & Pertussis Under 5 5—15 Under 5 5—15 January 42 57 36 9 February 43 58 11 — March 106 4 — April 29 42 — 1 May 24 35 5 — June 25 28 3 — July 30 38 12 — August- 93 67 11 — September 162 50 5 — October 137 91 3 — November 141 70 3 — December 103 122 3 2 829 658 96 13 106 Total 1593 Total 109 Thus, during the year 3,648 injections for immunisation against Diphtheria and Diphtheria and Whooping Cough were given, 1,702 children having the complete course of protection. In all, a total of 4,732 children in the Borough have now had this protective treatment. It is still very necessary that efforts to increase this number of protected children should be maintained, and the problem demands the continuous co-operation of the teaching staff, medical officers and school nurses. 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. Physical Training. With the approval of the Board of Education the arrangement between the five Part III Authorities in North-West Kent for the employment of two organisers of Physical Education 13 terminated on the 31st January, 1942. The Board suggested that arrfangements should be made with the Kent Education Committee for the part-time employment in the Borough of one of the County Physical Training Advisers. The Kent Education Committee were able to arrange for a weekly visit by the Physical Education Adviser attached to their Bexley Day Technical School for Girls, from the beginning of the Autumn Term, 1942. This arrangement has proved of great help to Girls' and Junior Mixed Schools, but it is unlikely that the services of an adviser for boys' schools will be available until after the war. TABLE I. Medical Inspections of Children Attending Public Elementary Schools. A.—Routine Medical Inspection. Entrants 914 Second Age Group 187 Third Age Group 392 No. of other routine inspections 1719 Total 3212 B.—Other Inspections. Number of Special Inspections and Re-Inspections 8485 TABLE II. Age-Groups N umber of Children Inspected A Excellent B Normal C Slightly subnormal D Bad No. % No. % No % No. % Entrants 914 85 9.29 647 70.78 177 19.36 5 0.54 Second AgeGroup 187 17 9.49 114 60 96 54 28.87 2 1.06 Third AgeGroup 392 48 12.24 252 64.28 88 22.44 4 102 Other Routine Inspections 1719 284 16.62 L069 62 18 345 20.06 21 1.22 Total 3212 434 13.51 2082 64 81 664 20 67 32 .99 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 — — — — — 14 . Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 1 — — — 1 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 — 8 — 4 12 TABLE IV. Return of Defects Treated during the Year endec 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 (i) X-Ray Treatment. If – – none, indicate by dash. – (ii) Other Treatment – Ringworm—Body 2 3 5 Scabies 198 12 210 Impetigo 113 7 120 Other skin disease 175 8 183 Minor Eye Defects (External and other, but excluding cases falling in Group II). 26 2 28 Minor Ear Defects 60 9 69 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 434 19 453 Total 1008 60 1068 15 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) 191 16 207 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 14 2 16 Total 205 18 223 No. of children for whom spectacles were prescribed : (i) Under the Authority's Scheme 124 (ii) Otherwise 15 No. of children for whom spectacles were obtained : (i) Under the Authority's Scheme Ill (ii) Otherwise 15 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 By Private Practitioner or Hospital, apart from the Authority's Scheme Total 1 2 3 4 ] 60 10 70 — 70 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme (i) Otherwise (2) Total number treated Residential treatment with education R esidential treatment without education N •inResidential treatment at an orthopaedic clinic Residential treatment with education Residential treatment wilhout education NonResidential treatment at an orthopaedic clinic (i) (ii) (lii) (i) (ii) (iii) Number of children treated 1 194 — — 2 197 TABLE V. Uneleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 4.7 (2) Total number of examinations of children in the Schools by School Nurses 11,429 (3) Number of individual children found unclean 158 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 2 (5) Number of cases in which legal proceedings were taken : — (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —