LIBRARY ER 123 BOROUGH of ERITH. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the year ended. 31st December 1943. by REGINALD A. LEADER. M.R.C.S L.H.C.P., D.P.H. AURRNGEMENT OF REPORT, Section Page. A STATISTICS AND SOCIAL CONDITIONS OF THE ARSA. 1. General Summary of Statistics 9 (a) General 9 (b) Births 9 (c) Deaths 9 (d) Infantile Mortality 9 (e) Vital Statistics of District 10 (f) Causes of Death 11 (g) Birth-rate, Death-rate nd Analysis of Mortality 12 2. Maternal Mortality 13 3. Unemployment figures and comments 13 4. Infantile Mortality 14 B. MATERNITY AND CHIID WELFARE SERVICES. 1. Maternity and Child Welfare Scheme 14 2. Home Visits by Health Visitors 15 3. Notification of Births 16 4. Infant Welfare Centres 17 5. Maternity Services (a) Maternity Home - Hainault 18 (b) Ante-natal 18 (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. 1. Infectious Diseases' Hospital 20 2. Tables (a) Notifications 20 (b) Age Distribution 21 3. Diphtheria Immunisation 22 4. Smallpox 22 5. Disinfection of Premises 22 6. Laboratory Facilities 22 7. Tuberculosis 22 (a) Treatment & Hospital Accommodation 22 (b) Tables: (i)Quarterly Statements 23 (ii) Particulars of New cases and deaths 24 8. Scabies 14 9. Scabies table 25 10. Ear, Nose and Throat 26 D. HOSPITAL AMBULANCE AND MORTUARY FACILITIES. 1. General 26 2. Venereal Diseases 26 3. Children 26 4. Ambulance Service 26 5. Mortuary S17 E. INSPECTION AND SUPERVISION OF FOOD SUPPLY. 1. Water Supply 27 2. Cowsheds, Dairies and Milk shops 27 3. Bacteriological Examination of milk 27 /4 -3- ARRANGEMENT OF REPORT. (continued) Section Page E 4. Sampling of MILK for Tubercle Bacilli 27 5. Designated Milk 28 6. Pood and Drugs Act Secs. 3 and 68 Routine Sampling 28 7. Inspection of Meat and Other Foods 28 8. Slaughter of Animals Act, 1933. 29 F SANITARY CIRCUMSTANCES OF THE AREA. 1. Sunitary Inspection of the .Area (a) Visits by Inspectors, etc. 29 (b) Premises visited 29 (c) Summary of Nuisances 30 (d) orrensive Trades 30 (e) Closet Accommodation and Cesspools 30 (f) Smoke Abatement 30 (g) Swimming Baths and Pools 30 (h) Schools 31 (i) Camping Sites 31 (j) Hop Pickers 31 (k) Rag Flock Act 31 (l) Eradication of Bed Bugs 31 (m) Mosquitos 3l (n) Roden Control 32 2. Housing. (a) Inspection of dwellinghouses during the year 32 (b) Remedy of defects found - 32 (c) Rent Restrictions Acts 33 3.Shops, Offices and Factories (a) Shops Acts 33 (b) Offices 34 (c) Factories 34 (i) Inspections 34 (ii) Defects 34 4.General (a) Health Education 34 " " 35 (b) Legislation in Force 36 G REFUSE COLLECTION AND DISPOSAL. 1. General 36 2 Costs 36 3. Vehicles and Staff Table 1 36 4. Tonnage collected Table II 37 5. Trade Refuse 37 6. Salvage 38 H. General. 1. Letter by Medical Officer of Health 4 2. Members of Committees 6 3. Staff of Public Health Department 7 -4- H (1) Public Health Department, Council Offices, E???th. To:-, The Mayor, A1dermon, and Councillors of the Borough of Erith. Mr• Mayor, Ladies and Gentlemen, I have the honour to present to you the annual report on the work of your Public Health D pertment for the year 1943, and again it should be noted that it is an interim report and'confined mainly to a statement of statistics. That prevention is better than curo is an old adage but perhaps the greatest handicap to the practice of preventive medicine today is not that we do not know how to prevent many diseases - which is still unfortunately true - but that the public does not take full advantage of the knowledge we already have. The age long function of the physician is to cure end relieve the sick but with the air full of new ideas end new trends there is one that must be kept constantly in front of us - to prevent disc.: so and point the way to positive health, and cultivate the tendency to make people or doctors health-minded rather than disease..minded. During the last two years extensive efforts have been m... de with regard to protecting against diphtheria all children of 9 months of age to the present school leaving ago of 14 years. Or the 31st December,1943, 85.81 percentage of the children under the age of 5 years and 78.53 percent-go of school children have had the course of injections for this purpose. In. which way this tremendous experiment will eventually alter this deadly disease is not quite clear at the moment,but it is interesting to note that of thirteen cases notified as diphtheria and admitted to the borough's isolation hospital during 1943, only one case in fact as actually diphtheria and he, probably s result of being immunised during the preceding year was clinically of a mild type. In all, sixteen notifications wore referred to the department and while it was not necessary to notify five cases only two of the remaining eleven notifications were officially cancelled. The town is, therefore, credited with nine cases of diphtheria during this twelve months although in. fact only two c ses were actally suffering from the disease. Fortunately there is now a more practical method by which notifies tiers can be chocked at more frequent intervals. During 1942 and 1943 four day nurseries were asked. for in Erith by the Ministry of Labour and four have been provided. To some reformers the ideal unit is the family, while others, probably a much larger number would provide whole-time nurseries for all children under 2 end nursery schools for all children from 2 to 5 years of age. Social structure in the p.st has been largely built around the family with its parental responsibility, but the happiness of family life is not necessarily Joopardised if the mother is freed from the cure of the children for _ few hours each day. The benefit derived by the average child during those few daily hours in the nursery may be surprising ranging from obvious improved physique in a neglected child to the education of the parents concerning cleanliness and such matters as the desirability of washing before each meal or the use of the tooth brush. None.of the day nurseries has a full complement of children or as yet is working to c capacity. /Again -5- Again this year real progress has been made in the maternity and child welfare services, with an additional ante-natal and four additional infant welfare weekly clinics to record together with the increase in the accommodation of the municipal maternity home to a total of twenty-two beds. In the school medical service a new specialist ear nose and throat clinic has commenced in conjunction with the new operative scheme - and this will I think be much appreciated in the area. One other feature of 1943 should be mentioned and that is the programme of health education undertaken during the year. The cinema film shows, mainly of sound films, have been quite popular and justified the time required for their organisation, and the health discussions thus engendered particularly within the Youth Organisations have been encouraging. The printing of this report is a new departure for the department, and it has often been difficult to decide just what to leave out. In this venture I have been ably assisted by my clerical staff who have all given of their spare time to its compilation. In particular I would mention the chief clerk, Mr. H.M. Coles, who has constantly aided a d abetted, and to whom the production of the graph contrasting the two, measles epidemics is wholly due. In conclusion I wish to thank the many friends the department has in the Council for their help and guidance, and particularly the staff of the department who have been so loyal during our strenuous endeavours. i. am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical officer of Health. July 1944. -6— MEMBERS OF COMMITTEES . PUBLIC HEALTH COMMITTEE Chairman - Councillor Alford. Vice-Chairman - Alderman Christian. Alderman Bates Councillor Farquhar " Ewens " Luck Councillor Dunkley " Morling MATERNITY AND CHILD WELFARE COMMITEE . Chairman - Alderman Ewens Vice-chairman - Alderman Christian Councillor Alford Councillor Nichols " Dunkley " Tyrer " Farquhar " Woodcock Co-opted 1 Members:- Mesdames Hyde, Smith and West. Ex-officio Members of both Committees: His Worship the Mayor, Councillor J. E. Burgess. Deputy Mayor, Councillor S.G.A.Mantle. Chairman, Finance and General Purposes Committee , Councillor f.C. Pannell. -7- 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, 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 - FRITZ SCHENK, M.D. M. R. BLAIR, M.R.C.S.,L.R.CP.,L.D.S.L.P.H (Reaigned 3.1.43) LUCY M. SUTCLIFFE, M.R.C.S., L.R.C.P., D.C.O.G.,D.P.H. (Appointed 18.1.43 - Resigned 30.6.43.) H. G. WILLIAMS, M.R.C.S. , L.R.C.P. (Appointed 27.6.43) Senior Sanitary Inspector - L. E. KING, Cert, R.S.I., Cert, S.I.E.B., Meat Inspector's Cert. Cert. R.I.P.H & H. Sanitary Inspectors W. E. MOSES, Cert. S.I.E.B., Meat Inspector's Cert, C.A.G.S. C.S.T.DANCER, Cert. S.I.E.B., Meat Inspector's Cert. Sanitary Foreman and Disinfecting Officer H. W. COOPER, Health Visitors, Miss. I. P. PURT, S.R.N., S.C.M., R.F.N., H.V.Cert. Miss. D. E, HELLETT, S.R.N.. S.C.M., H.V.Cert., (Appointed 15.2.43) 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. A. JAY, S.R.N.,R.F.N. Matron, Council's M-.ternity Home, Miss. L. M. PARCLaY, S.R.N. ,S.C.M. Matrons , War Time Nurseries. (4) , Bedwell Road. - Miss. V. A. HIGGS, S.R.N. (Resigned 18.10.43) Franks Park - Miss. M. WILLIAMS, S.R.N. (Appointed 4.1.43) Lessness Abbey - Mrs. L.R.MALLARD,, S.R.N. (Appointed 10.5.43) Riversite - Mrs. C. BUDD, S.R.N. (Appointed 28.7.43) Clerical Staff Chief Clerk and Senior Staff Officer (C.D.) H. M. COLES L.A.G.C. Deputy Clerk Clerk and Senior School Clinic Clerk - Miss-M-SMITH. General Clerks: Maternity ana Child Welfare - Miss. 0. R. REEVES. Accounts Clerk - Mrs. G. P. McPHERSON, Public Health - R. DUREY, M.R.I.P.H.H., L.A.G.C., (H.M.Forces). War Time Nurseries - Mrs. M. MORRISON (Res: 7.8.43) Mrs. G. KING (App:9.8.43 Res: 30.10.43) Mrs. G. RANDALL (App: 1.11.43) Shorthand Typist - Mrs. B. L, DUREY (Res: 30.4.43.) Mrs. M. BOND (Appointed 3.5.43) -8- Clerical Staff (CTD). Junior Clerks: Public Health - P. R. COOPER (Res: 27,11.43) E. PENTREATH (App: 26.11.43) School Medical Service - Miss. J. REDGRAVE (H.M.F. 28.7.43) Miss. D. BEACROFT Miss. M. JOHNSON (App: 12.4.43) Miss. E. Bartlett (Dental) Maternity and Child Welfare - Miss. E. VARHHAM (Res: 17.4.43) Miss. G. ROBERTS (Res: 25.3.43.) Miss. E. GODWIN Miss. B. CATTERMOLE (Res: 17.4.43) Miss. D. DAVIS (App: 1.11.43) Miss. A. CORNISH (App: 19.4.43 Res: 18.9.43) Civil Defence: Staff Officer - D. FEATHBERSTONE. Clerk - E. N. WELLINGTON, A.R.P.S. 2. Part Time. Consulting Surgeon for Aural Diseases T. P. GILL, F.R.C.S. Ante Natal Consultant J. v. 0'SULLIVAN, M.D., B.Ch., F.R.C.S., M.R.C.P., M.A.O. M.C.O.G. Consulting Obstetrician GALLETLY, M.C., M.B. , F.R.C.S.(Ed) Orthopaedic Consultant E. A. LINDSAY, F.R.C.S. Ophthalmic Specialist F.o. . WALKER , F.R.C .S. Consulting Ear, Nose and Throat ,Surgeon. Alfred B. Alexander, L.R.C.P.,L.R.C.S.M.D.L.R.F.P.S. ( Details of Members of the staff of the School Medical Service are embodied in the report of the School Medical Officer) -9- Section 'A'- Statistics and Social Conditions of the Area. .A.1. Summary of statostoes. A.1.a. General. Area - 4607 acres. Population - 41,870 (estimated 1939), 37890 (estimated 1943). Density of population, i.e. number of persons per acre - 8.42. Number of inhabited houses - 11,042. Rateable Value, 1943 - £318,801. Sum produced by a penny rate - £1,246:7:4. A.l.b. Births. Live Births. Total. Male . Female . Legitimate 794 382 412 Illegitimate 28 11 17 822 Live Birth Rate per 1,000 of population (1943 Estimated) 21.6. Corresponding Rate for 1942 - 19.6 Still Births. Total. Male. Female. Legitimate 21 12 9 Illegitimate - - - - - 21 Still birth rate per 1,000 births - 25.54 A.1.c . Deaths. Males - 232 Females 207 T0TAL - 439. Death rate per thousand of population (estimated 1943) 11.58. Corresponding rate for 1942 - 11.1 Number of women dying in, or in consequence of, childbirth 3. Maternal Mortality per 1,000 total registered births - 3.65. Comparative figure for England and Wales - 2.29. A.1.a .Infantile Mortality. Death rate of infants under one year of ago per 1,000 live births - 42.57. Total number of death from 1942 \ 1943 Measles (all ages) - - Whooping Cough (all ages) 5 1 Diarrhoea (under 2 years) 1 3 Deaths of infants under one year of ago. TOTAl. Male Female. Legitimate 32 20 12 Illegitimate 3 2 1 35 - -10- A.1.e. VITAL STATISTICS OF WHOLS DISTRICT DURING L(@ 1945 and previous years. Year. Population estimated to middle of year. Births Total deaths registered in the District Transferable Deaths. Nett Deaths belonging to the District, Uncorrected number. Net 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 1,000 nett births. No. Rate. i 1. 2. 3. 4. 5 6. 7. 8. 9. 10. 11. 12. 13. 1932 34,250 486 475 13.8 236 6.89 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 6.56 18 140 21 43.6 347 9.9 1935 35,760 572 525 14.6 212 5.93 10 158 21 40.0 360 10.06 1936 36,380 580 510 14.18 243 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 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 1943 37,890 868 822 21.6 286 7.54 30 183 35 42.57 439 11.58 -11 A.l.f. TABLE SHOWING SUMMARY OF CAUSES OF DEATH DURING THE YEAR ENDED 31st DECEMBER 1943. No. Cause of Death. Male. Female. TOTAL. 1. Typhoid Fever &c., - - - 2. Cerebro-spinal Fever - - - 3. Scarlet Fever - - - 4. Whooping Cough 1 - 1 5. Diphtheria - - - 6. Tuberculosis of resp: system 9 14 23 7. Other forms of Tuberculosis - 1 1 8. Syphilitic Diseases 3 - 3 9. Influenza 8 7 15 10. Measles - - - 11. Acute Polio-mel: and polio-enceph: - - - 12. Acute inf: enceph: - - - 13. Cancer of buc: cav: & œ soph: (m) ) uterus (f) ) 5 4 9 14. Cancer of stomach and duodenum 13 6 19 15. Cancer of breast - 10 10 16. Cancer of all other sites 26 23 49 17. Diabetes 1 4 5 18. Intra-cranial vascular lesions . 18 24 42 19. Heart Disease 44 47 91 20. Other diseases of circ: system 7 1 8 21. Bronchitis 20 9 29 22. Pneumonia 13 10 23 23. Other respiratory diseases 7 2 9 24. Ulcer of stomach and duodenum 7 - 7 25. Diarrhoea under two years 3 - 3 26. Appendicitis 1 1 2 27. Other digestive diseases 3 2 5 28. Nephritis 6 5 11 29. Puerperal and post-abort: sepsis - 1 1 30. Other maternal causes - 2 2 31. Premature birth 5 5 10 32. Con: Mai: birth inj: infant dis: 5 7 12 33. Suicide 1 2 3 34. Road Traffic accidents 1 1 2 35. Other violent causes 5 3 8 36. All other causes 22 16 38 TOTAL ALL CAUSES. 232 207 439 -12- A.l.g. TABLE SHOWING BIRTH RaTE, DEATH RATE, aND ANaLYSIS OF MORTALITY DURING 1943. 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. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria . Influenza. Diarrhoea and Enteritis under two yrs. Total deaths under 1 year of ago. England and Wales 16.5 0.5 12.1 0.00 0.00 0.02 0.00 0.03 0.03 0.37 5.3 49 126 County Boroughs & ) Great Towns, including( London. ) 18.6 0.63 14.2 0.00 0.00 0.02 0.00 0.03 0.04 0.36 7.9 58 148 smaller towns res indent population 25,000( 50,000 (1931 census. ) 19.4 0.61 12.7 0.00 0.00 0.02 0.00 0.03 0.04 0.37 4.4 46 London Admin: County 15.8 0.45 15.0 0.00 0.00 0.02 0.00 0.03 0.02 0.27 10.4 58 Erith (estimated pop-) lation 37,890.) ) 21.6 0.55 11.58 0.00 0.00 0.00 0.00 0.02 0.00 0.39 3.64 42.57 -13- A. 2. Since 1920 there have been 13,981 births with 38 maternal deaths, as shown below, giving a Maternal Mortality Rate of 2.8. 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 47 5 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 1 629 554 1942 2 762 775 1943 3 843 868 TOTAL 38 13,981 13,487 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. A. 3. 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 the table shows a further decrease in the figures for 1943. Year Ending. Adults Young Persons TOTAL. Men Women Mon Women. December 1934 926 223 62 33 1134 " 1935 784 128 27 37 976 " 1936 514 101 19 14 648 " 1937 501 94 20 8 623 " 1938 934 169 40 16 1159 " 1939 373 299 31 48 751 " 1940 75 255 3 37 370 " 1941 39 44 17 17 117 " 1942 38 39 1 5 83 " 1943 27 6 1 3 39 -14- Infantile Mortality. A.4. 35 infants died before reaching one year of age, giving an infantile mortality rate of 42.57. The conparable figure for the whole country is 49. Analysis of the causes of death of this age group reveals the following figures Deaths from No. Prematurity and Debility 17 Bronchitis 1 Broncho Pneumonia 5 T.B. meningitis 1 Gastro Enteritis 3 Other Causes 8 35 I have included a table showing the infantile Mortality at 5 year intervals for the past 30 years and for 1943. Year Srith England and Wales 1910 70.91 130 1915 7 3.17 91 1920 61.5 83 1925 56.48 75 1930 61.05 66 1935 40.0 59 1940 37.17 55 1943 42.57 49 Section B. . Maternity and Child. Welfare Services. B. 1. It is pleasing to record that during 1943 four additional child weekly clinic sessions wore inaugurated in the borough's child welfare scheme. All districts of the.town participated two of the sessions being adaed to the Bedonwell Clinic, the first in January and the second in May, one session to the Picardy clinic in February, and one session to the H???inault clinic in May. The attendances at these new clinics have been most encouraing, demonstrating that when these services are available the public are not slow under certain conditions in taking advantage of such facilities, Following the receipt of circul. r 2713 from the Minister of Health and in conjunction with the drive to immunise against diphtheria as many children under 5 years of age as possible, an additional health visitor was appointed in February of this year. Another health visitor is to be appointed when available to implement the instructions!in the Ministry's circular No. 2831 with regard to the cleanliness of children under five years of age. These two health visitors will also act as school nurses, infant life protection visitors, will visit when necessary the Council's four /day -15- four day nurseries and are very necessary under "the authority's progressively expanding clinic programme. The following table illustrates this expansion during the last four years:- 1940 1945. Infant Welfare Centres attendances. 3 weekly, 1 twice monthly (i.e. 180 sessions per annum) 12,127 12 weekly clinics (i.e.624 sessions per annum) 27,357 Ante-Natal Centres. Attendances. 1 Specialist monthly 2 weakly centres 1,369 2 specialist monthly clinics 5 weekly clinics 3,928 Municipal Maternity Home. 6 beds 16 beds (Since July, 6 antenatal beds) No. of Patients 117. 293 Health Visitors Number of 3 5 Home Helps 1 full-time 2 full-time 3 part-time Nursery Schools 0 1 with 120 places Nursery Glasses 0 1.with 25 places Day Nurseries 0 4 with 170 places B. (S.) Homo Visits by Health Visitors.. Children Special Visits Infant Lifa Protection Total Visits 1943 1st Visits ReVisits StillBirths Others Expectant Mothers January 93 765 1 45 40 7 951 February 60 734 4 33 44 6 881 March 70 1169 1 54 50 11 1355 April 55 1023 4 38 57 11 1188 May 71 991 3 55 35 11 1166 June 75 724 2 60 27 6 894 July 69 717 - 39 49 10 894 August 79 643 - 33 42 4 801 September 61 710 2 27 46 10 856 October 63 842 2 39 47 9 1002 November 68 785 - 50 43 9 955 December 68 734 1 52 43 7 905 Total Visits 832 9847 20 525 523 101 11,848 -16- B (5) Notification of Births. Births Sex Legitimacy Notified by Month Live Stillborn M. F. Leg. Illeg. Midwives Hosp.eto. Doctors. F. M. M F January 78 2 - 40 F 40 73 3 4 22 58 February 58 — - 32 26 54 2 2 12 45 1 March 74 1 2 39 38 71 2 4 16 60 1 April 65 4 1 40 30 60 5 5 17 53 - May 66 — 1 28 39 62 2 3 15 52 - June 73 — l 36 38 68 4 2 21 52 1 July 77 1 _ 35 43 69 4 5 19 59 - AUgUSt 72 1 — 35 38 70 1 2 16 55 2 September 70 - - 34 36 62 2 6 19 51 - October 81 1 1 36 47 721 7 4 15 68 - November 74 — — 37 37 70 2 2 23 51 - December 80 — l 43 38 78 2 1 22 59 — Total 868 10 7 435 450 809 36 40 217 663 5 885 885 885 885 -17- Infant Welfare Centres B (4) month Belvedere Erith Consultations Picardy Bedonwell Infants weighed Consultstions. Infants weighed infants weighed Oonsultations. Infants weighed Consultations \ Under 1 year 1 to 5 years Under 1 year 1 to 5 years. » Under 1 year 1 to 5 years Under 1 yeas 1 to 5 years January l00 100 51 313 114 56 192 63 36 600 280 153 February 168 95 45 402 170 96 228 81 43 588 272 149 March 222 133 72 371 163 76 290 94 42 697 317 136 Aprl 177 94 50 422 146 68 262 76 36 625 329 167 May 200 111 41 446 214 101 291 109 41 686 348 170 Jure 235 149 81 389 198 91 361 94 62 706 306 153 July 193 114 61 478 227 121 278 67 39 774 338 201 August 218 124 45 433 165 72 329 80 54 783 280 150 September 161 84 51 438 185 95 367 109 63 897 278 206 October 180 109 51 477 177 76 327 95 47 841 293 192 November 204 113 70 418 141 73 319 106 45 798 235 132 December 187 68 7 345 88 74 347 108 52 667 221 73 Totals 2311 1294 625 4932 1988 999 3591 1082 560 8662 3497 1882 3605 6920 I : ... .... 4673 12159 Children Immunised during year. 198 430 216 777 -18- B.5. MATERNITY SERVICES B.5 (A) Hainault. Confinement of the expectant mother either in hospital or Maternity Hone has found favour with an increasing number of women. It is Gratifying to again record for the third year in succession an increase in the accommodation at the Borough Maternity Hone. It now contains lb beds, and with the annex since July six additional ante-natal beds and the number of 293 confinements is naturally a record increase. The staff consists of one Matron, one sister, two staff nurse midwives, and three midwives. Institutional treatment for normal cases is provided, and during the period under review 293 cases were admitted. Of these 196 cases were delivered by midwives and 95 by doctors. The average duration of stay of these cases was 13 days. In my view admission to hospital for confinement should be arranged through the Ante-Natal clinic, with the co-operation of the private practitioners, and the consultant obstetrician would thus be freely available to both domiciliary and institutional cases. The following table shows.the admission for the past seven years:- Year Admissioins No: of beds. 1937 134 7 1938 116 7 1939 118 7 1940 118 7 1941 143 9 1942 215 12 1943 293 22 B. (5) b. Ante-natal The four ante-natal sessions which are held each week at the Hainault, Bedonwell end Picardy clinics continue to function satisfactorily. Last year it will be remembered it was necessary to institute a second weekly clinic in the Badonwell area, and this year it has boon nocessary to add an additional weakly session to the Hainault centre. This only commenced in September but the attendance figures s illustrated in the following table are most encouraging Ante-natal patients seen by Doctor. Jan. Feb. Mar. Apr. May June July Aug. Sept. oct. Nov. Dec. Total Erith 65 83 91 82 62 76 98 77 183 165 172 142 1296 Bedonwell 158 132 145 168 182 166 198 119 188 173 124 159 1912 Picardy 51 59 66 56 56 58 67 52 71 59 | 85 40 720 Total 3928 B.5 (c ) Abnormal Cases. Accormmodation for abnormal maternity cases in need of hospital treatment is provided by arrangements between this Council and London /Hospitals -19- B.5c Abnormal cases (cout'd) Hospitals. Thirty-three cases were admitted under the arrangements during the year. The conditions for which they were admitted were as follows:- Condition No. Disproportion 3 Toxaemia 12 Ante Pirtun Haemorrhago 1 Trial labour 1 Transverse Lie 1 Past maturity 6 High Blood Pressure 6 Caesarian Section 1 Abnormal Presentation 2 33 During the year eighteen abnormal cases were treated by the Medical superintendent in the Hainault Maternity Home. B.6. Infant Life Protection. Number of foster mothers on register at end of year 14 Number of children on register at 31st December 1943 18 B.7. Midwives. The administration of the Midwives Acts is carried out by the Kant Country Council which is the local supervising authority. Under the new Midwives Act the County Council employ and supervise midwives working in the area. B.8 Dental Clinic • The Maternity and Clid Welfare dental Clinic which is hold regularly for dental treatment for mothers and pre-school children, was well attended during the year, attendance being as follows:- Bodonwell 213 B.9. Home. Help The council's home Help Scheme continued to function throughout the year nd proved a most popular service, several applications having to be refused, owing to lack of staff. To Meet this situation an additiona1 fill-time home help was appointed and the services of part-tine hone helps utilised. There is no doubt that it the moment this service is in great demand and could be expanded provided sufficient staff are available. -20- B.9 Home Help (continued) The following figures will show the extent to which the service was used:- Number of cases booked during 1945 No. of cases attended by Home Help No. 1 19 32 No. 2 9 No. 3 A. No. 4 1 33 N . of cases booked c.nd subsequently cancelled - No. of days on which the Home Help was eployed Home Help No.l 214 No.2 99 No. 3 47 No.4 12 372 Section C. Prevalence of and control over notifiable infectious diseases. C.1 Infectious Diseases Hospital. The Erith 3orough Council provides its own Isolation Hospital A large portion of admissions are cases of Scarlet Fever and Diphtheria but any notifiable infectious diseases may be admitted with the exception of smallpox and puerperal infections, special arrangements for which are described elsewhere in this report. C of Measles and Whoooping cough are admitted during epidemic times. C. 2.Tables C.2 ( ) Notifiections. The following table shows the total notification received during the year 1943:- Disease Total cases notified. Cases admitted to Infectious Diseases Hospital Total deaths. Scarlet Fever 101 76 — Erysipelas 12 - — Diphtheria 9 9 - Pneumonia 44 23 Typhoid Fever 1 - — — Enteritis and Bronchitis 2 — — Infantile Paralysis 1 — — C.S.F. 1 - — G???stro Enteritis 1 — — Ophthalmia Neonatorum 6 3 — Puerperal Pyrexia 3 - — Dysentery 9 — — whooping Cough 43 5 1 Measles 239 9 — -21- C. 2. b. AGS DISTRIBUTION. This second table shows, in detail, the age distribution of the notified infectious diseases mentioned:- Disease. Age Groups. under 1 1 2 3 4 5 10 15 20 35 45 65 Over 65 Total. Scarlet Fever - 1 5 10 13 9 45 8 — 9 1 — — 101 Erysipelas - - - - - - - - - 1 1 5 6 12 Diphtheria 1 1 - - - - 3 3 - 1 - - - 9 Typhoid Fever - - - - - - - - - - - 1 - 1 Pneumonia 1 2 2 1 1 - 3 4 - 3 8 14 5 44 Enteritis & Bronchitis 1 1 - - - - - - — - - - - 2 Infan: Paralysis - - - l - - - - - - - - - 1 Cerebro Spinal Men: - - - - - - - - - - 1 - - 1 Gastro Enteritis - - - 1 - - - - - - - - - 1 Ophthalmia Neonatorum 6 - - - - - - - - - - - - 6 Puerperal Pyrexia - - - - - - - - - 3 - - - 3 Dysentery - 2 2 1 1 1 1 - - 1 — - - 9 Whooping Cough 7 4 6 6 5 8 7 - - - - - - 43 Measles 10 17 19 26 37 67 53 10 - - - - - 239 TOTALS 26 28 34 46 57 85 112 25 - 18 11 19 11 472 -22- C.3. Diphtheria immunisation. The scheme for the immunisation of children against Diphtheria continued throughout the year, and the following table will indicate the number of cases dealt with:- In unised against Di jiit aria APT & ??? Under 5 years 567 70 5-15 gears 439 1 Total 1106 71 Full details are shown in School medical ???. C.4. Smallpox. All arrangement exists between the London County Council and the Erith Borough, Council for ??? for cases occurring within the Borough. C.5. Disinfection. Followin, the removal of cases of infectious disease tuberculosis, etc. 141 premises were disinfected, whilst enquiries to obtain particulars regarding 80 cases of tuberculosis were undertaken. The Council have??? disinfactor at the isolation hospital at which clothing, bedding, etc. are disinfected in addition to disinfections carried out for the hospital. C.6. Laboratory. Examinations one of pathological specimens and other laboratory work for the department are undertaken by the Kent County Laboratory, Sessions House, Maidsbone. C.7. Tuberculosis. C. 7...Treatment_ and Hospital Accammodation. 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 and since June 1941, 90 beds at the Kettlewell Hospital, Swanley, have been made available for the treatment of Tuberculosis patients. Arrangements are in hand (end practically completed)for a portable X-ray apparatus to be in use ??? Friday morning at the Erith dispensary so that X-ray examinations may be carried out in the borough. This will be a creat help_ to patients as previously nearly all these examinations involved journeys outside the town. In the tables which follow, particulars of new cases of tuberculosis and of all deaths from the disease in the area, during 1943 are shown in Table II whilst Table I shows the quarterly statements of cases on the register, together with the position at the 31st December, 1943. -23- Table (L) QUARTERLY STATEMENTS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals M F T M F T M F T M F T PULMONARY T. B. Number on Register 130 102 232 132 105 237 137 109 246 149 114 263 - New notifications during year 6 7 13 7 7 14 11 6 17 7 2 9 53 Cases removed which have been restored 1 - 1 - - - 1 - 1 — - - 2 Cases added to Register other than by notification 2 - 2 1 4 5 2 - 2 - — - 9 Cases removed from Register 7 4 11 3 7 10 2 1 3 6 - 6 30 Cases remaining on Register 132 105 237 137 109 246 149 114 263 150 116 266 266 NON-PULMONARY T. B. Number on Register 40 34 74 40 35 75 43 36 79 45 39 84 — New notifications during year - 2 2 3 2 5 3 4 7 4 - 4 18 Cases removed which have be-on restored - - - - - - - - - - - - - Cases added to Register other than by notification — — — - — — - - — — — — - Cases removed from Regsiter - 1 1 - 1 1 1 1 2 4 - 4 8 Cases remaining on Register 40 35 75 43 36 79 45 39 84 45 39 84 84 -24- Table II Tuberculosis 1943. Age periods New cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. M. F. M. F. M. F. Under 1 year - - - - - - - - 1 year - - 1 1 - - - - 5 years 2 1 1 - - - - - 10 ,, - 3 1 1 - 1 - - 15 ,, 3 5 2 2 - 1 1 - 20 ,, 6 4 1 1 1 1 - - 25 ,, 7 5 - 2 2 5 - - 35 ,, 6 3 2 - 2 2 - - 45 ,, 2 - - - 4 1 - - 55 ,, 5 1 - 1 1 1 - - 65 years and upwards 1 1 - - - - - - 32 23 8 8 10 12 1 - SCABIES. C.8. The scheme for th treatment of Scabies was continued throughout the year 1943. and combined this year with facilities to combat infestation by head-lice. The scheme is a flexible one dependent upon primary notifications from individual private practitioners, the school clinic and the other clinics held in the Borough. Scabies is not notifiable in Erith so that the following figures reveal the extent of the cooperation which the department has received. The procedure in Erith has been considerably simplified in that upon notification of - definite Cases a Nurse Visitor visits the premises arranges for the treatment of the patient, requests the attendance of all contacts at the next skin clinic for the purpose of examination and treatment if necesary, and advises generally. With a view to the prevention of Scabies etc. amongst industrial employees, th_ service of disinfecting bedding etc. has been offered to the managements of the local factories. The response continues to become overwhelming on occasions, but the system has worked satisfactorily. In very few instances during 1943 was it necessary to apply any pressure at all to secure the attendance of contacts as described. At the begining of 1943 females were treated at the First Aid Post Cleansing Station, and males at the Sanatorium Cleansing station but in the early weeks of 1943 the splitting of the staff caused some difficulties and with additional equipment the treatment was concentrated at the First Aid Peat Cleansing Station. . It should be mentioned that apart from the Assistant Medical Officer the treatment of these cases is undertaken entirely by Civil Defence personnel attached to the First Aid Post in accordance with London Region Circular 660 and the following figures reveal the extent to which their services have been utilised in this connection. -25- C.9. Table showing details of cases treated etc., following notifications under the Scabies Order. Month. Cases showing symptoms & treated Contacts not showing symp tons but treated. Total. Contacts examined not showing symptoms & not treated. No: of second treatments given. No: of families involved. No: of items disinfested. Visits by Nurse Visitor. Preliminary visits. Follow up visits. Total. Jan: 125 6 131 4 94 44 3786 24 49 73 Feb: 120 2 122 3 113 33 22 48 70 March 69 14 83 1 99 37 2963 34 48 82 April 58 10 68 1 96 25 23 45 68 may 110 15 125 13 103 34 1017 30 51 81 June 49 11 60 - 87 19 13 32 45 July 77 19 96 14 96 34 894 35 76 111 August 53 13 66 4 49 13 16 54 70 Sept: 63 23 86 9 74 27 561 23 48 71 Oct: 82 48 130 10 132 37 35 78 113 Nov: 77 28 105 4 112 29 504 27 61 88 Dec: 22 24 46 5 59 19 16 73 89 Totals 905 213 1118 68 1114 351 9725 395 566 961 -26- C 10 5,.r. Nose and Throat. Owing to shortage of staff and beds the arrangements exits with the Erith hospital for the operative treatment of tonsils and adenoids have had to be revised. With the help of the London County Council and Dr. Honderson, the Medical Superintendent, in June arrangements were made to admit children to the Southern Hospital, Dartford, for this operation, while in October of this year in conjunction with this scheme monthly specialist clinic was opened at the Bedonwell clinic. This attended by Mr. Alexander, the consulting aural surgeon of the Southern. Hospital and provides fox examination of the children before and after admission to hospital, aid for proper observation subsequently. At the end of the year there were no children awaiting this operative procedure. The following shows the number of cases dealt with:- Cases operated on at the Erith Hospital - 25 ,, ,, ,, ,, ,, Southern Hospital - 136 Total 161 SECTION D. - HOSPITAL AMBULANCE AND MORTUARY 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 and has a visitings staff of local medical practitioners. The special departments are attended by a special consultant staff-. Tha services of the large General and Social Hospital in London are redically accessiable to residents an this area. D (2) VENERAL DISTRICTS. A Veneral Diseases for 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 Wellwich and other parts of London are easily accessible. D (4) AMBULANCE SERVICE. As indicated in my Report for 1948 the Public Health Ambulance service consisting of three ambulances for non infectious or accident cases and one for the removal of infectious cases, is run entirely by Civil Defence personnel at the Central Ambulance Debot. During 1943 the service increased considerably and was utilised as shown in the following table: Cases ??? January & February 422 3773 March & April 459 3900 May & June 449 4202 July & August 14 5028 /september -27- D (4) AMBULAMNCE SERVICE (continued) Cases ??? September & October 505 41???1 November & December 539 4344 D. 5. MORTUARY. The Borough morsuary is situated, at the rear of the Erith Parish C. arch in "Test Street, nd consists of a receiving room and a viewing room. There is accommodation for 4 bodies. During the year 1943, 34 bodies were placed therein. Section E. Inspection and Sup3rvision of Food. E.1• WATER SUPPLY. The water supply in the district is almost exclusively provided by the metropolit in Water Board. The water, though possessing a considerable degree of hardness is of good quality, and is palatable The supply in nearly a11 cases as fed into the houses; standpipes exist on few premises only Routine examinations of each supplies have been undertaken throughout the year with complete satisfactory results, and arrangements are in existence with Kent County ??? of two samples monthly. ??? E.2 cowsheads, Dairies and milk Stores The current, register of cowshed, dairies, and milk stores records the following registration figures:- No. of registered for ??? dairies 4 No. of dairies 12 Shops selling milk in sealed receptacles 43 No. of registered purveyors outside Borough 19 E3. Bacteriological examination of milk. The following samples of milk retailed within the Borough were obtained and forwarded for examination:- (a) Pasteurised (b) Pasteurised (c) Pasteurised (d) Pasteurised (e) Pasteurised (f) Pasteurised All were subsequently reported as being satisfactory. e.4. Exanination of milk for Tuberele Bacilli. The following samples of bulk milk suppler were obtained during the year at cowshed premises within the Borough. Herd Number of cows Result of Biological Test A 20 In all three staples B 27 there was no evidence C 25 of Tuberculosis. /Designated -28- E.-D. Designated Milk. The following table indicates the number of licences issued by the Local Authority in 1943 under the Milk (Special Designations) Order 1936. Pasteurisers licence 1 Tuberculin tested dealers 5 Pasteuriser dealers 6 Tuberculin tested supplementary 2 Pasteurised supplementary 2 16 E.6. FOOD &_DRUGS_ ACT 1938 Sections 3 and 8. The following samples were procured during the year, and submitted to the Public Analyst for analysis: Nature of samp1e Adulterated. Genuine No .of samples. Milk 20 20 Liquid paraffin - 1 1 Lune syrup - 4 4 Pudding mixture — 12 12 Egg powder - 4 4 Cinnamon - 1 1 Bicarbonate of soda - 1 1 Soup cubes - 4 4 Glycerine - 1 1 L??? powder - 1 1 Orange squash - 5 6 Glauber salts 1 1 2 Influenza powders - 1 1 Eucalyptus oil Chocolate powder — 1 1 1 1 Koray pain killer - 1 1 Epsom salts - 2 2 Soda mint tablets - 1 1 Mustard - 2 2 Vinegar - 3 3 Balsam of aniseed - 2 2 Sauce - 3 3 Essence of almonds - 1 1 Cochineal — 1 1 Mushroom ketchup - 1 1 Cocoa — 1 1 Ostermilk - 1 1 Pea flour — 1 1 Cust ???rd powder — 2 2 Spread — 1 1 1 82 83 The sample of Glaubers salt enumerated l.s adulterated above was Reported by the Public Analyst :'to contain the equivalent of 223*8^, sodium sulphate whereas Glauber' salt should lot contain more than the equivalent of 102^ The o . pie consisted of dried sodium sulphate whereas Glauber'■ salt should consist of orystalline sodium sulphate'1. Resultant action arising from the above was a warning letter addressed to both retailer and wholesaler, and the subsequent removal of the article from the market. E • 7 • lI&iT & FOOD INSPECTION. The ueu..l tirno nd attention hus been devoted to the inspection of meat and other foods in stores and shops, and the following articles were confiscated as being unfit for human consumption:- A- t -29- MEAT AND FOOD INSPECTION (continued) Meat ... ... ... 132 lbs. ... ... ... 331 tins Bacon ... ... ... 161 lbs. Fish ... ... ... 71 stones ... ... ... 123 tins Milk ... ... ... 293 tins Fruit ... ... ... 108 tins Vegetables ... ... ... 264 tins Eggs ... ... ... 2.115 Dried egg 10 lbs. Cheese ... ... ... 96 lbs . ... ... ... 6,014 portions Onions ... ... ... 332 lbs . Oranges ... ... ... 40 Figs ... ... ... 9 lbs . Jan ... ... ... 66 lbs. Soup ... ... ... 114 tins Sugar ... ... ... 66 lbs. Cereal ... ... ... 183 lbs. Pickles ... ... ... 19 tins Chocolate ... ... ... 3 lbs. Cocoa ... ... ... 7 lbs. E.8. SLu-JJGHEBR OF I-I,13. CJT IS35 The above Act makes the use of mechanically opereated 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 the district. Section F. Sanitary _circumstances of the Area. 1. Sanitary Inspection of Area. 1 (a) VISITS BY SANITARY INSPECTORS. The total number of visits of all kinds was 8,908 Notices served:- Statutory 20: Informal 1 813: Number of dwellings and other premises disinfected 141 Complaints received and investigated 1,592 1 (b) Premises visited and results of such visits. Premises No. in district. No. of visits 1943. No. of defects found . No. of defects remedied. Bakehouses 10 71 1 1 Cowsheds 4 26 2 2 Dairies 12 57 3 3 Butchers shops 33 368 6 6 Fish friers 10 74 1 1 Food factories 3 28 1 1 Slaughterhouses 4 - - - Outworkers 20 20 - - Factories 126 83 21 21 /SUMMARY 1 (c) -30 SUMMARY OF NUISANCES AND DEFFECTS REMEDIED DURING THE YEAR Other than those- enumerated in the above Tabulations: Drains cleared 150 Drains repaired 25 W. C. pans r enewed 16 Cisterns repaired 31 New sinks 7 New W.C.s provided 3 Roofs repaired 145 Damp walls remedied 86 Houses cleansed 18 floors repaired 2 Stoves repaired 18 Plasters renewed 68 Windows mc.de to open 19 Washing facilities provided 7 Dustbins provided 41 Accumul. tions removed 16 Cesspools abolished 1 Yard pavings repaired 5 Water supply provided 9 1(d) OFFENSIVE TR-.D3S. In addition to the statutory Offensive Trades which _>re specified in Section 107 of the Public He 1th Act 1936, fish frying was declared to be an offensive trade on 17th i„..rch 1939, aid byelaws were made accordingly. Within the Borough, there are ...o offensive trades other than fish frying premises, of which there c.re 10 in operation. 1(e) CLOSET -.CC01I 0D,,TIQK and CESSP00IS. The whole of the closet accomaiodation both in the older parts of the town and the comparatively newly built up areas is on the main drainage system, there being only 24 known premises which ..re drained into cesspools. During the year ona cesspool h.,s been abolished, and the drainage connected to sewers. Cesspools are emptied once .,. month free of "charge by m chinos belonging to the Borough Council, the contents of cesspools being discharged into the Council's sowa-rs. The cesspools which now require the service are scattered throughout the district and, in the majority of cases, necessitate covering considerable distances both for pumping out and conveying to the point of discharge. During the year 1943 cesspools wore emptied on 49 occasions by the Council's plant. 1(f) SMOKE itB»TEMENT. No smoke nuisances have come to the notice of the Department during the year. KeL S-ZBa:ING B^THS -HP -POOLS. The Council's Open Air swimming bath is situated in W Inut Tree Road, nd comprises one swim ling pool of 70,000 gallons capacity. There is a slipper establishment with accommodation for 16 males and 4 females. Water in the pool is war ed to a temperature of 70 deg. 1 by low pressure steam heating Mid is sterilised by the ChloraaJLne process i.e. addition of amoni . in conjunction with chlorine . /SCHOOLS. ' . -31- 1 (h) SCHOOLS. Schools within the district aro visited regularly. -hd d-jfoots if any uro roferrod to the Hduc tion Officer. ^.11 the. premis-Us ;re served by Metropolitan Y;..;tor Board water supply. (xr) X Further details with re* ;.rd to Schools --.re to be found in the Report of the School Medic..1 Officer. , . 4 CL.LIPING SITES. (*) —— — There are no sum ier ca. ping sites with:.:. the district. There -re, however, 4 sites which have been occupied by-van •dwellings for a number of ye ..rs. ■ Frequent inspections have been n .do by Sanitary Inspectors' with - view to the maintenance of circumstances which ...ro in ' J" compliance with Bye-laws. & No licences have been granted by the authority during the year under Section 269 Public Health ^ct 1936. (JO HOP PICKERS. There -.re no hoe fields within the district. (k) R..G FLOCK ,,CT. No premises exist within the Borough in which rag flock is manufactured or sold. (1) gR..DIC_.TION OF JI1D 8UGS. During 1943 dwellinghousos were found to bo infested with vermin ..nd subsequently di'sinfested s under:- Privately owned.houses 35. Council houses 5 Presence of vermin in private houses is usually located by the Department's Sanit .ry Inspectors whilst investigating complaints or viewing home circumstances. On every occasion removal of wellpaper, picture rails, etc. Is insistea upon, any measures falling short of this proving more tie a useless. The use of a blow lamp or efficient insecticides h.s been found to be effective, nd revisits . re made to see that the improvement is being maintained. Every assistance is .iven to occupiers who re encouraged to report infestations so that their premises may be efficiently treated. The cleansing ..nd destruction oi vermim within Council houses is carried cut by the Borough Surveyor's staff. mil prospective nd selected applicants for Council houses are visited arid a report on the findings is a., de direct to the .housing cleric, YVhe'n thu effects ;ro found to bo verminous, furniture and other articles ...ro subjected to cyanide. fumigation by Contractors employed by the Council This method of re-housing has proved to be successful. (m) MPS QUIT o/cCBftRQL . On 13th September 1943 specimen specie Ho.39 was obtained within the district - nd submitted to the Institute of microbiology Such specimen was subsequently identified by Professor ... Moore Hogarth as .anopheles maculii/ennis• Go..orally speaking this specie existing in England is zoophilic i.e. it prefers the blood of animals; to that of man, ...nd it seldom or never attacks In the open air. Breeding grounds constitute stagnant lakes, ponds, etc. but the specie is never found to exist naturally in highly polluted water. ..nopheles maculipoimis is the most important carrier of the m-laria parasite in Stir ope and North hfrica. /Having - 32— Having regard to the above, pi ecautionarjr measures wore inaedlately put into operation which included the spraying of N.F.S. water dans, and subsequently oilin th: surface of water bulk with orude oil. Simil. i _pj_ o' c c - u u n. ens w r 0 u0, Iran at Factories and at many privc. te dwellings o l(n) RODENT CCI-iTR L. The rodent compile „x com .encod on October 1st, and was introduced by the Ministry .f Food which authority inserted publicity notices in the local press '.nd provided posters for display at various sites within the Boroug . Tee scheme included the forwarding of newspaper coupons by the general public to the Rodent officers of the Local Authority, but this latter err rigenent cannot be regarded as successful. The local effort, apart frori that of the Ministry of Food included co-operation with the local chemists for tlm sale of appropriate poisons, and the participation, in window displays. Earlier in the year, survey hud been conducted and a nap forwarded to the Ministry of Food indicating reservoir nd major primary types of infestations. Having ascertained the are-.s infested, by r ts, every effort has been nade to a. feet systems tic destruction. Many rats.- have been destroyed at factories, .nd the Local authority's own premises including South Road tip, Hospital grounds, baths area can be regarded as clear. During the year the increase in bl-.ck rat population was clearly demonstrated, and co-operation with factories on the riverside was effected. Many food shops ..nd stores have been treated for rats, and the operations continue. II ving regard to the laying of poison baits at private dwellinghouses, it would appear that much success is achieved when many baits ..re laid simultaneously by occupiers in co-operative effort. For the . .ost part, haphaz rd baiting is futile, hence the endeavour of Rodent officers to regard in some instances a whole row of houses an _.rea of . otential infestation and to effect a propriate treatment ..s such. S. a .HOUSING. Inspection of dwellinghouses during year. 1. (a) Total number of dwellinghouses inspected for housing dcfects (under Public Health or Housing ..cts) 944 (b) Number of inspections made for tie purpose 2,893 2. (a) Number of houses (included under sub-head (I) above which were inspected and recorded under the Consolidated Housing Regulations 1925 and 1932 0 (b) Number of inspections m_.de for the purpose 0 3. Number of houses found to be in a state so dangerous or injurious to dealth as to be unfit for human habitation 0 4. Number of houses (exclusive of those referred to under the preceding sub-head) found not to be in ail respects reasonably fit for hunan habitation 754 2(b) REMEDY OF DEFECTS hdPIPG TK5 .PE. .R MITa XT .SERVICE OF FORMAL NOTICES. Number of defective dwellingshouses rendered fit in consequence of informal action by Loc.i Authority 674 Action under Statutory Powers during the- year: (a) Proceedings under Section 9 & 10 H-aaing Act 1936 (1) No. of houses in respect of which Notices were served requiring repairs 0 (2) No. of dwellinghouses a .ich wore rendered fit after service of formal notices;- (a) By owner 0 /.it) r -33- (b) Local Authority ... ... 0 (b) Proceedings under Public K.alth Act (1) No. cf dwelli.ghouses in wifich respect notices were served requiring defects to be remedied 20 (2) No. of dwellinghouses in which defects were remedied after service of formal notices:- (c.) By Owner 20 ■ (b) By Local Authority 0 (c) Proceedings under Sections 11 and 13 of the mousing Act 1 36 (1) No. of dwellinghouses in respect of which de. olition orders were made 0 (2) No. of houses demolished in persuanco of demolition orders 0 (d) Proceedings under Section 12 of the Housing Pet 1936. (1),No. of separate te. ... .ante or underground rooms in respect of which Closing Orders were made 0 (2) No. of oop^ rate te;. e,.n .ts or underground rooms in respect of which Closing Orders v/ere determined, the tenement or room having been made fit. 0 2. (c) RUNT & I.:QrtTG,,GE INTEREST ipST- JCTI 0NS|_ ACT. .1939. The provisions regarding, extortionate rents are administered by the department and during the year 1943 118 applications for advice and assistance have been dealt with. 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 ^ct. There .is, however, no provision allowing for decontrol on vacant possession by the landlord. Appended below is a summary of the improvements effected (a) Rent reduced from 11/- to 10/- (b) Rent reduced from 35/- to 27/6d and £4.2.6, returned to tenant (c) Rent reduced from 20/- to 16/7d sad £4.14.6.returned to tenant (d) Rent reduced from 12/6 to 10/bd (e) Rent reduced from 15/4 to li/8 • . ■ .d £10.0.0.returned to tenant (f) Rent reduced from 25/- to 20/- ..ad £13.0.0.returned to tenant (g) Rent reduced from 23/u to 19/- nd £5.17 0.returned to tenant (h) Rent reduced from 20/- to 15/3. (i) SHOPS ,,CT 1912-1938. YJith regard to statutory hours of closing, it was necessary to issue 16 warnings to shopkeepers u on their non-compliance with the Statute. No Police Court proceedings were instituted during the year. Infringements of Section 10 of the Shops „»ct 1934 relating to health and comfort cf shop assistants were located in the following instance, the necessary improvement being subsequently effected Notices served. Lack of heatin , facilities 1™ In accordance with Defence Regulation 60AB, the following hours of closing Were substituted for the closing hours prescribed by Sec.l of the Shops (Hours of Closing) net 1928 during the period 7th November 1943 to 4th March 1944: General Hairdressers and Barbers Mon. Tues. and Wed. 5.30 p.m. Mon. Tues. and Wed. 7 p.m. Friday 6.30 p.m. Friday 7 p.m. Saturday 5.30 p.m. Saturday 8 p.m. No order was made revoking, closing hours during Christmas week 1943. -34- 3. (b) OFFICES I:: .) - inst-nco it v„s found th t no sanitary . ccoranodation existed x or the use of enployoes .s provided for by S .ction 4b Public Health ^ct 1S36. In the c©ursc- of the your the Statute w s complied with. 3. (c) FACTORIES. (i) Inspections for the purpose of provisions as to health are detailed below:- Premises Inspections by Sanitary Inspectors. grit ton Notices Served. Occupiers Prosecuted Factories with mechanical power 38 3 - Factories without mechanical power 41 3 - Other premises under the Act (including building works and engineering construction but not including outworkers premises) 4 - - 83 6 - 3. (c) (ii) DEFECTS FOUND. Number of defects Number of defects in respect prosecutions were instituted Particulars Found Remedied Referred to H.M. Inspector. Want of cleanliness 5 5 - - Overcrowding - - - — Unreasonable taaperature - — - - Inadequate ventilation - - - - Inadequate 1ighting 1 1 - - Ineffective drainage of floors 1 1 . - Sanitary conveniences: Insufficient Unsuitable or defective 14 14 - - Not separate for sexes — — — — Other offences — — — — 21 21 - — 4. S&>LTK EDUCATION. Leaflets on varied sub jeets- available to the general public and additional ones in respect of the following letters were prepared durin the year. 1* Cleanliness in food premises 2» How to get rid of bugs, lice, fle .s, etc. 3. Destruction of rats. 4, Sanitary obligations regarding infectious diseases. / LSGI3L_»TI ON 35. ~ @.(a) . Health Education - Films. During 1943, Indication was received from the Ministry of Health that a film - 'Scabies' - diagnosis and treatment - was available to be shown to audiences restricted to professional people and others who had special interest in the subject. As a result, on the 80th June this film was shown at Electricity House, Erith, to audiences comprising doctors, nurses and others vitally 'interested, not only from Erith but from neighbouring boroughs comprising the Dartford Division of the British Medical Association. The attendance was excellent and the reaction to this instructive method of dealing with a subject of current interest was clearly evidenced. 0 the 14th July 1943, a series of films were shown on four occasions (lunch time, tea time and two evening performances) when ' the attendances, especially from the Youth Organisations in the Borough were again excellent. -he films shown on this occasion were:- 1. Defeat Diphtheria. 2. -Blood 3. Subject for Discussion. 4. A. B. C. D. of Health. 5. 'Oh! Whiskers'. On the 9th September 1943, an experiments was made in producing a balanced programme. There were four performances as before and between each film were slides giving details of (a) one Diphtheria Immunisation Campaign, (b) details and cimes of various clinics, (c) details of school canteens a d (d) details of war time nurseries.- The films shown on this occasion were:- 1. The Empty Bed. 2. Dinner at School. 3. A Child Went Fcrt.,. 4. Defeat Diphtheria. During October a further effort was made in this direction, having due regard to the interest evidenced in the previous films, and on the 27th October the following films were shown on three occasions during the afternoon and evening. 1. Unwanted Guests. 2. Rut Destruction. 3. The Nose Has It. 4. Dangers in the Dark. 5. The Soviet School Child. At each performance the Medical 0. ficer of Health was available to introduce the programme and to answer any questions afterwards. It would appear that there is a definite call for health education of this type providing that an effort is made to balance the programme. The attendance by the Youth Organisations was encouraging as also were their questions. 1 consider that it is essential to group a series of films so as to make a programme of from 60 to 90 minutes duration and that a doctor should be present at each performance to answer questions as they arise. -36- LAGISLATION IN FORCE. List of Bye-lAws etc. in force in this district with date of adoption Totals, v s and sheds 28th February 1928 Houses let in lodgings 27th January 1930 SI ughterhousesi 29th January 1952 School attendance 17th February 1932 Libraries & Museuns 15 th June 1934 ??? 20th Jv.ly 1934 Pleasure grounds 4th February 1936 Employment of children 25th f.-r ch 1936 Dogs fouling footpaths 22nd February 1939 Fish frying 9th Hay 1939 Offensive trades 9th ???1939 Building bye-laws 10th August 1939 ouse refuse 17th October 1939 Frith Cemetery 25th October 1939 Public baths 2oth October 1939 Prevention of Nrisances 23rd April 1940 G" ; rule cc government 1st J nuary 1941 Section G. Refuse Cjll .cti.on Dispos--.!, t nc 3rfLva£G» G.l. General. 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 dustbins and some 12,000 re emptied weekly. The dustbins ->re provided and maintained by the owners of the properties concerned ad the Council secure this by a local Act - The Frith Improvement Act 1920. Owing to the difficulty in obtaining the regulation dust-bins at the present time, a considerable number of house refuse receptacles consist of old baths, boxes, etc. The difficulty in handling these odd receptacles tends to slow collection. Disposal is effected by barging under Contract, and these arrangements are still worlcin, very satisfactorily, G.2, Costs. The cost per ton of collecting refuse was 15/lld. per ton. The cost per ton of disposing of refuse was 4/l0d. per ton. N.et cost per 1,000 of population £158. Tile following tables show: 1. Details of the refuse collection vehicles and staff. 2. Deta. Is of the tonnage dealt with during the year. G.3. Table 1. Vehicles and Staff. Vehicle Capacity 1 Dennis 12 cubic yards 1 Easyloader 5 ,, ,, 4 S.D. Freighters 7 ,, ,, I Fordson 10 ,, ,, 1 Austin van Utility van 37. These are operated by - One Foreman Nine Drivers One Assistant Foreman Seven Loaders Two female salvage sorters. Table 2. Tonnage Collected. The following table shows the tonnage of refuse collected during the year:- 1943 Month. Tonnage. Tons Cwts. January 536 16 February 473 16 March 534 9 April 417 5 May 396 6 June 304 10 July 284 0 August 262 13 September 284 17 October 388 7 November 498 15 December 577 11 Total. 4,959 5 C. 5. 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 reifuse disposal service has been rapid, when it is re embored that 10 years ago approximately 116 loads were disposed of, while in 1943 the amount reached approximately 431 loads producing £322: 2: lOd. C. 6. Salvage. The following table gives details regarding the collection and disposal of salvage during the year. -38- Items. Tonnage collected. Income. T C Q lbs £ s d . Paper. Newsprint 9 3 — — 96 15 9 Periodicals 15 7 1 — 157 15 — Strawboard and Mixed Waste 260 — — - 1657 10 10 Selected Waste 5 18 1 - 41 - 9 Kraft Blue Bags 4 4 3 - 28 11 9 Textiles 44 12 — 3 660 19 3 Bottles Wt. 33 18 — — 101 14 — Bottles Gr. 351 gross 1 12 dOZ 168 16 9½ Metals. Iron 85 18 3 — 145 — 4 Brass 1 4 — 4 28 - 7 Copper - 5 2 18 11 19 8 Aluminium — 14 — 15 15 13 11 Lead 1 1 2 19 23 17 2 Zinc etc 1 11 2 1 26 8 4 Tins 282 12 - - 211 19 - Rubber 12 13 - - 31 12 6 Bones 9 - - - 42 14 6 Sundries. Cullett Batteries Foil 35 1 1 2 99 14 - Rabbit Skins Manure Waste Food Scheme. Waste Food 418 16 — — 621 — 5 Sale of Pigs 528 14 5 General Subsidy on Iron 254 5 10 Cartage allowances 244 13 4½ 1221 4 1 6 5178 18 1¾ This gives a . total tonn age of 1,221 tons 4 cwts 1 qr 6-11: (plus 351 gross 111/12 doz bottlus) saav .god aid sold oroduciiig sura of £5178: 18: l¾d.