ERI 24 BOROUGH OF ERITH. ANNUAL REPORT of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1944 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 1944 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 16 4. Unemployment Figures and Comments 16 B Maternity and Child Welfare Services. 1. Maternity and Child Welfare Scheme 17 2. Notification of Births Table 18 3. Infant Welfare Centres 19 4. Home Visits by Health Visitors 20 5. Maternity Services 20 (a) Maternity Home—Hainault 21 (b) Ante-natal 21 (c) Abnormal Cases 22 6. Infant Life Protection 22 7. Midwives 23 8. Dental Clinic 23 9. Home Help 23 C Prevalence of and Control over Notifiable Infectious Diseases. 1. Infectious Diseases' Hospital 23 2. Tables 24 (a) Notifications 24 (b) Scarlet Fever 24 (c) Measles 24 (d) Pertussis 25 Age Distribution 26 (e) Scabies 27-28 i Section C (continued). Page 3. Diphtheria Immunisation 29 4. Smallpox 30 5. Disinfection of Premises 30 6. Laboratory Facilities 31 7. Tuberculosis 31 (a) Treatment and Hospital Accommodation 31 (b) Tables (i) Particulars of New Cases and Deaths 31 (ii) Quarterly Statement 32 8. Ear, Nose and Throat 33 D Hospital and Ambulance Facilities. 1. General 33 2. V.D 34 3. Children 34 4. Ambulance Facilities 34 5. Mortuary 34 E Water Supply—Milk and Food and Drugs. 1. Water Supply 35 2. Cowsheds, Dairies and Milk Stores 35 3. Bacteriological Examination of Milk 35 4. Examination of Milk for Tubercle Bacilli 36 5. (a) Designated Milk 36 (b) Phosphatase 36 6. Food and Drug Act 1938, Section 3 and 68 37 7. Meat and Food Inspection 38 8. Slaughter of Animals Act, 1933 38 F Sanitary Circumstances of the Area. 1. Sanitary Inspection of Area 39 (a) Visits by Sanitary Inspectors 39 (b) Premises visited and results of such visits 39 (c) Summary of Nuisances and Defects Remedied during the year 39 (d) Offensive Trades 40 (e) Closet Accommodation and Cesspools 40 (f) Smoke Abatement 40 (g) Swimming Baths and Pools 40 ii Section F (continued). Page (h) Schools 41 (i) Camping Sites 41 (j) Hop Pickers 41 (k) Rag Flock Act 41 (I) Eradication of Bed Bugs 41 (m) Mosquito Control 42 Housing. 2. (a) Inspection of Dwelling Houses during year 42 (b) Remedy of Defects during the year without service of Formal Notices 42 Proceedings under Public Health Act 43 (c) Proceedings under Section 11 and 13 of the Housing Act, 1936 43 (d) Proceedings under Section 12 of the Housing Act, 1936 43 (e) Rent and Mortgage Interest tions) Act, 1939 43 (3) (a) Shops Act 1912-1938 44 (b) Offices 44 (c) Factories 45 4 (a) Health Education—Films 45 (b) Health Education—(Five Year Plan) 46 5. Legislation in Force 46 G 1. (a) Refuse Collection and Disposal 46 (b) Costs 47 (c) Details of the Refuse Collection Vehicles and Staff 47 (d) Details of the Tonnage dealt with during the year 47 (e) Trade Refuse 48 (f) Salvage 48 H General. 1. Letter by Medical Officer of Health 2 2. Members of Committees 5 3. Staff of Public Health Department 6 iii Pafee The Five Year Plan 49 House Refuse 1. Collection 50 2. Disposal 51 Physical Training and Recreation 52 Open Air School 53 Homes for Aged Persons 53 Clearing Houses for Council House Applicants 54 Provisions with respect to Blindness 54 Mortuary 55 Laboratory 55 Crematoria 55 Borough Markets 56 Public Slaughterhouse 56 Amenities in Streets 57 Public Health Centres 57 Maternity Hospital 59 Infectious Diseases Hospital 60 Belvedere Marshes Development 61 2 H (1). Public Health Department. Council Offices, Erith. To The Mayor, Alderman and Councillors of the Borough of Erith. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Report for the year 1944 and as the need for security fortunately is now over, I have introduced some additional features omitted in recent years. The present emergency has shown how necessary it is to maintain a constant and unremitting vigilance over environment, including nutrition, if the health of the people is to he secured. In the school report therefore, I have made some short comments on the public feeding in the borough. Despite great advances in the environmental field of health, large tracts have hardly as yet been touched:—atmospheric pollution, milk supply, factory hygiene and even housing are only a few of those which readily come to mind as presenting problems for solution—and in my special report on a proposed five-year plan for public health in the town, included in this report as a supplement, the conclusion is accepted that despite other claims, housing of necessity must occupy a 100 per cent. priority in any immediate health plan for the district. In examining the statistics in the Report the low estimate of the population, given by the Registrar General as 36,780, must be borne in mind the lowest recorded with the exception of 1941, since 1936. The death rate is 12.5 compared with 15.7 for the administrative County of London and with 11.6 for England and Wales, and it is to be noted that among the causes of death—''other violent causes"—stands third (nearly second) in the list. Infants, though they have the highest potential for survival, are the citizens most vulnerable to unfavourable environmental conditions. The infantile mortality rate of 49.16 is the highest recorded in the borough during the past five years but I believe it reflects the war social conditions of the area. Of the neo-natal deaths, 42.3 per cent. were in premature 8 infants, which indicates either that premature infants are prone to die, or that infants likely to die are prone to be premature. A fuller analysis of this is included in the body of the Report, but it is appropriate to mention that special equipment and some accommodation at the Municipal Maternity Home are to be provided in the near future. 93 per cent, of school-children and 79 per cent. of children under the age of five years are now immunised against diphtheria, and it is pleasing to record that only four cases of diphtheria occurred during the year, and again, as in 1943, there has been no death from diphtheria. It is also gratifying to note that there has been no death from Whooping Cough during 1944, in view of our efforts to give infants protection by immunisation against this distressing disease. There were 895 births credited to the town, and this is a record during the last 37 years so that it is no surprise to find that the birth-rate of 24.3 is the highest recorded for the town since 1920 and before that in 1908 when the Erith birthrate was 25.87, and the total number of births 750 with an estimated population of 28,986 persons. This situation was to a certain extent anticipated and again as during each of the last five years the accommodation of the Municipal Maternity Home has been increased. The capacity of the present buildings has been utilised to the utmost and practically all the staff have in consequence been made non-resident, billets being provided in the immediate neighbourhood of the home. The demand in Erith for institutional assistance during childbirth in my opinion is definitely rising, but further expansion to meet this need will be seriously handicapped, or may even be impossible, as more accommodation can now only be provided by acquiring additional premises or by building an annex in the grounds of the institution. It is a matter for congratulation that despite many difficulties the collection of house refuse in the borough has been maintained on a weekly basis, and two new Scammel vehicles, each with a capacity of six cubic yards, have been purchased this year for the service. These are in actual fact the first implementation in the re-organisation suggested in the five-year plan, and are specially designed with narrow bodies in order to negotiate the many ill-paved and badly surfaced backalleyways in the town. 4 The Salvage Service has continued as efficiently as ever and a gross sum of £4,444 17s. 4½d. has resulted from the sale bf the various materials. Of this amount it is satisfactory to note that £1,165 3s. 6¾d. comes from the Waste food scheme which includes the Municipal Piggery in the grounds of the Sanatorium. Whether this is now the best site for this thriving municipal enterprise is rather questionable for the scheme allows of much development and also makes a fine contribution to the national larder. In concluding I have to thank many Councillors for their continued interest in the department, and again the staff, both professional and clerical, who have carried on so magnificently and made it possible for the department to continue to give the public its health services at the pre-war level. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, REGINALD LEADER, Medical Officer of Health. Hainault Maternity Home. 5 H (2). MEMBERS OF COMMITTEES. Health Committee. Chairman—Councillor Alfori). Alderman Christian. Alderman Christian. Councillor Farquhar. ,, Bates. Alderman Ewens. Councillor Dunklev. Councillor Morlikg. ,, Ellis. ,, Burgess ,, Luck. Res. 1-2-44. ,, Pannell. Maternity and Child Welfare Committee. (1hairman—Alderman Ewens. Alderman Christian. Councillor Mantle. Councillor Alford. ,, Woodcock. ,, Dunklev. ,, Tyrer. ,, Firmin. Co-opted Members: Mesdames Hyde, Smith and West. E,v-officio Members of both Committees: His Worship the Mayor. Councillor Farquhar. Iieputy Mayor, Councillor Burgess. 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 W elfare, Medical Superintendent Municipal Maternity Home, 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. H. G. Williams, M.R.C.S., L.R.C.P. 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, C^rt. S.I.E.B., Meat Inspector's Certificate. (Res. Aug., 1944.) W. E. Moses, Cert. S.I.E.B., Meat Inspector's Certificate, C.A.G.S. Sanitary Foreman Sf Disinfecting Officer— H. W. Cooper. Health Visitors— Miss I. P. Burt, S.R.N., S.C.M., R.F.N., H.V. Cert. Miss D. Hellett, S.R.N., S.C.M., H.V. Cert. Miss T. M. Torpie, S.R.N., S.C.M., H.V. Cert. Miss C. E. Vesey, 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. Matrons War-time Nursery, Bedwell Road—Mrs. W. Hill, S.R.N., R.P.N. (Appointed 24-1-44.) Franks Park—Miss O. Williams, S.R.N. Lessness Abbey—Mrs. L. R. Mallard, S.R.N. (Res. 4-3-44.) Miss J. Grayson, R.S.C.N. (App. 26-5-44.) lUversite—Mrs. C. Budd, S.R.N. 7 Clerks— Chief Clerk—H. M. Coles. Res. 7/10/44. P. D. Bunyan. App. 20/11/44. Deputy Chief Clerk and Senior School Clinic Clerk— Miss M. Smith. General Clerks— Maternity and Child Welfare— Miss O. R. Reeves. Res. 29/7/44. Mrs. E. M. Towse. App. 15/8/44. Accounts—Mrs. G. P. MacPhearson. Public Health R. Durey, M.R.I.P.H.H., L.A.G.C. (H.M.F. 2/1/41.) War-time Nurseries—Mrs. G. Randall. Shorthand-Typist—Mrs. M. Bond. Junior Cleric Public Health—H. Penreath. Res. 15/4/44. School Medical Service—Miss E. Bartlett. Res. 12/2/44. Miss 1). Beacroft. Res. 21/3/44. Mrs. Fenner. App. 13/3/44. Mrs. Tucker. App. 10/2/44. 2. Part-time. Consulting Surgeon for Aural Diseases— A. B. Alexander. M.D. T. P. Gill, F.R.C.S. Ante-natal Consultant— I. 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 1944. A(l). SUMMARY OF STATISTICS. A(l)a. General. Area.—4,607 acres. Population.—41,870 (estimated 1939), 37,890, (estimated 1943) 36,780. Density of population, i.e. number of persons per acre.—8.3. No. of inhabited houses.—11,365. Rateable value.—£318,906. Sum produced by penny rate.—j£ 13*28. A (1 ) b. Births. Live Births. TOTAL. Male. Female. Legitimate 863 439 421 Illegitimate 32 17 15 895 Live birth rate per 1,000 of population (R.G. figures).— 24.3. Corresponding rate for 1943—21.6. Still Births. TOTAL. Male. Female. Legitimate 18 11 7 Illegitimate — — - 18 Still birth rate per 1,000 births—20.1. A (1 ) c. Deaths. Males—258. Females—205. Total—463. Death rate per 1,000 of population (1944)—12.5. Corresponding rate for 1943—11.58. Number of women dying in, or in consequence of, childbirth—2. Maternal Mortality per 1,000 total registered births—2 2 Comparative figure for England and Wales—1.93. 44 Death rate of infants under one year of age per 1,000 live births—49.16. Total number of deaths from: 1943 1944 Measles (all ages) — Whooping Cough (all ages) 1 — Diarrhoea (under 2 years) 3 3 A(l)e. Vital Statistics of Whole District during 1944 and previous years. Year Population sstiinated to middle of each year Births Total Deaths registered in the District Transferable Deaths Nett Deaths belonging t» the District Uncorrected Number Nett ol Nun-i emdents registered in the District ot residents not registered in the District Under i 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 1935 35,760 572 525 14.6 2 12 5-93 IO 158 21 40.0 360 10.06 1936 36,380 580 510 14.18 243 6.67 17 186 30 58.82 412 11.324 1937 38,240 656 605 15.82 262 6.85 27 180 28 46.28 415 10.852 1938 39,800 668 656 16.48 273 6.83 17 134 34 5362 390 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 5.93 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 1944 36,780 882 895 243 315 8.20 22 I70 44 49.16 463 12.5 10 A (1 ) f. Table showing Summary of Causes of Death during the year ended 31st December, 1944. Cause of Death Males Females Total 1 Typhoid Fever, &c. - - - 2 Cerebro-spinal Fever — — — 3 Scarlet Fever — — — 4 Whooping Cough - — — 5 Diphtheria — — — 6 Tuberculosis of resp. system 15 13 28 7 Other forms of Tuberculosis 4 1 5 8 Syphilitic diseases 5 1 6 9 Influenza 3 — 3 10 Measles — — - 11 Ac. polio-myel. & polioenceph — — — 12 Ac. inf. enceph — — — 13 Cancer of b. cav. & oesoph 3 6 9 14 Cancer of stomach and duodenum 4 6 10 15 Cancer of breast - 7 7 16 Cancer of all other sites 27 15 42 17 Diabetes 2 1 3 18 Tntra-cran. vase, lesions 26 19 45 19 Heart disease 47 69 116 20 Other diseases of circ. system 5 2 7 21 Bronchitis 22 9 # 31 22 Pneumonia 12 4 16 23 Other resp. disease 1 2 3 24 Ulcer of stomach or duodenum 3 _ 3 2.3 Diarrhoea under 2 years 2 1 3 26 Appendicitis 3 —- 3 27 Other digve. dis. 2 5 7 28 Nephritis 3 6 9 29 Puer. & post-abort, sepsis - 2 2 30 Other maternal causes .. 1 1 31 Premature birth 7 3 10 32 Con. mal. birth inj. infant dis. 10 8 18 83 Suicide 1 - 1 84 Road traffic accident 3 3 3.3 Other violent causes 33 11 . 44 36 All other causes 15 13 38 Total all causes 258 205 463 11 A(1 )g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1944. Provisional figures. The mortality rates for England and Wales refer to the whole population, hut for London and the towns to civilians only Rate per 1,000 total population Annual Death-rate per 1,000 population Kate per 1,000 Live Births Live Births Still Bii ths All Causes Typhoid and Paratyphoid Small-pox Measles Sea 1 let Fever Whooping Cough Diphthet ia Influenza Diarrhoea & Enteritis (under Two years) Total Deaths under one year England and Wales 17.6 0.50 11.6 0.00 0.00 0.01 0.00 0.03 0.02 0.12 4.8 46 126 County Boroughs and Great Towns, including London 20.3 064 13.7 0.00 0.00 0.01 0.00 0.00 0.03 0.10 7.3 52 H-8 smaller towns resident population 2.5,000 .50.000 at 1931 census 20.9 0.61 12.4 0.00 0.00 0.01 0.00 0.02 0.03 0.11 4.4 44 London Adm. County 15.0 0.42 15.7 0.00 0.00 0 00 0.00 0.04 0.01 0.08 10.1 61 Erith (Estimated population 36,780 24.03 0.48 12.5 0.00 0.00 0.00 0.00 0.00 0.00 0.09 3.3 49 12 A (2). Since 1920 there have been 14,894 births with 40 materna deaths, as shown beiow, giving a Maternal Mortality rate o: 2.6. Year Maternal Deaths Totai Births (including still births) Registered Live Births 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 1943 3 843 868 1944 2 913 895 Total 40 14894 14312 13 Maternal deaths are investigated by the Medical Officer of Health in collaboration with the medical practitioner and midwife concerned. A (3). Infantile Mortality. 44 infants died before reaching one year of age, giving an infantile mortality of 49.16. The comparable figure for the whole country is 46. This is a higher number of deaths in infants under one year of age than has obtained for a number of years, and compares unfavourably with that of 35.4 in the borough in 1942. Graph No. 1 shows the incidence throughout the year, and illustrates that the deaths are not related to any particular period or season during the year. Graph No. 2 confirms this with regard to the neo-natal deaths, and of those infants dying within the first week of life. An analysis of the causes of deaths of this age group reveals the following figures:— 14 TABLE I. Deaths from : Prematurity and Debility 11 Developmental conditions, including injury at birth 17 Bronchitis and Pneumonia 8 Gastro Enteritis 3 Miliary Tuberculosis 2 Other causes: Acute Nephritis 1 Cellulitis 1 Asphyxia 1 Total 44 If the returns are examined more closely as to the period of the first year in which mortality occurs, it will be found that no less than 26 of the deaths took place within the first month of life, i.e. within the neo-natal period. TABLE II. Deaths from: Prematurity and Debility 11 Developmental conditions 13 Bronchitis and Pneumonia 1 Cellulitis 1 Total 26 This is 59 per cent. of the total deaths recorded, as against the figure of approximately 40 per cent. exhibited in the national returns. Moreover 20 of these 26 deaths occurred within the first week of life; and in 12 instances within the first day of life, while in 8 cases the age of the child is recorded in hours. 15 An analysis of the remaining 18 deaths is as follows:— TABLE III. Deaths from : Prematurity and Debility 0 Developmental conditions 4 Bronchitis and Pneumonia 7 Gastro Enteritis 3 Tuberculosis-Miliary 2 Acute Nephritis 1 Asphyxia 1 Total 18 Table IV illustrates that no fewer that 33 of these 44 children were admitted to hospitals or institutions, and that their urgent condition was therefore well recognised and dealt with by the respective services concerned. TABLE IV. Children admitted to hospitals or institutions were as follows:— Outside Borough. Within Borough. Total Number. 21 12 33 Children admitted to institutions within the borough:— Municipal Institutions. Other Institutions. Total Number 2 10 12 In all 23 of the children died outside the borough. I think the answer to this problem lies first in the large percentage (59 per cent.) of neo-natal deaths, and can be elucidated from Tables II and III. The figures for Premature births and Developmental conditions in Table II are high as compared with previous years, and these are causes which are "less amenable to those influences which have led to so marked a reduction in the infant death rate as a whole." The year 1944 was notable in this district for a considerable degree of enemy activity spread throughout the twelve months. There is a record of some 494 siren warnings alone. I venture to submit that while these may or may not have had an influence on the high number of developmental conditions recorded— and it must be remembered that birth injuries are included under the heading of developmental conditions—the large number of infantile deaths in the neo-natal period associated with premature births must have been influenced by this set of conditions. 16 I would further point out that Table III illustrates that the chief killer in the last eleven months of the first year of life, is Pneumonia, and that this admits of hope, for the special treatment necessary lies within our compass. I have included a table showing the Infantile Mortality at 5 year intervals for the past 25 years and for 1944. 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 1944 49.16 46 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. Year ending Adults Young Persons Men Women Men Women Total December, 1937 501 94 20 8 623 December, 1938 934 160 40 16 1159 December, 1939 373 299 31 48 751 December, 19 40 75 255 3 37 370 December, 1941 39 44 17 17 117 December, 1942 38 39 1 5 83 December, 1943 27 6 1 5 39 December, 1944 31 6 — 3 40 17 SECTION B.—MATERNITY AND CHILD WELFARE SERVICES. B (1 ). Maternity and Child Welfare Scheme. This has been a rather disappointing year with regard to the child welfare centres. The total attendances have diminished by nearly four thousand (3,741), at the Erith, Bedonwell and Belvedere Centres, the Picardy Centre however holding its own and actually increasing by eighteen attendances with an increase of sixty-two medical consultations during the year. There was also an additional 199 medical consultations held at the Erith Clinic. This is the first time during the past five years that I am unable to report any new or additional clinics in this service : two proposals were actually formulated, one in the Abbey Wood area, which is undoubtedly the worst served district of the town in this respect, and the other in the Northumberland Heath area. Both were rejected however as it was held that the available accommodation was unsuitable for the purpose. All other aspects of the child welfare services functioned normally, including the specialist clinics. Following a communication from the Ministry of Health, a scheme for the care of illegitimate children was adopted by this welfare authority. It provides for continued support of the Rochester Diocesan Society for Moral Welfare, and the payment of a sum of money to the Society for each Erith case admitted to the Oakhurst Hostel for unmarried mothers which now includes a residential nursery for 9 children under five years of age. A conference of autonomous welfare authorities was held at Maidstone with representatives of the County Council, and a more comprehensive scheme drafted, which is being submitted for official approval. 18 B (2). N.B. This table compiled ion figures of births actually notified in district. Month Births Sex Legitimacy Notified by Live Suborn M Leg. Meg. Midwives Hosp. etc. Doctors M F M F January 73 1 1 27 46 71 — 2 19 55 1 February 79 2 2 39 40 76 — 3 25 58 — March 73 1 — 33 40 67 3 3 24 50 — April 92 — — 54 38 91 1 — 22 70 — May 87 — — 41 46 84 2 1 23 63 1 June 94 1 — 50 44 88 1 5 23 70 2 July 85 1 — 44 41 84 1 — 22 62 2 August 63 1 1 33 30 59 3 1 13 51 1 September 39 1 1 24 15 37 2 — 11 30 — October G6 1 — 36 30 62 2 2 22 45 — November 69 — — 32 37 60 3 6 15 54 — December 47 — 1 18 29 44 2 1 7 41 — Total 867 9 6 431 436 823 20 24 226 649 7 B (3). Infant Welfare Centres. Month Erith Belvedere Picardy Bedonwell Infants weighed Consultations Infants weighed Consultations Infants weighed Consultations 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 year 1 to 5 years January 401 126 99 121 73 25 289 97 42 708 328 147 February 330 110 101 181 97 54 304 84 49 688 229 144 March 474 124 122 147 73 39 404 129 77 806 333 198 April 442 114 96 152 72 39 333 105 52 687 298 102 May 473 139 112 204 95 44 408 116 54 794 309 118 June 479 119 118 160 67 43 321 75 63 700 286 106 July 319 81 88 165 60 47 326 70 51 457 181 73 August 262 52 63 144 54 17 217 57 27 393 152 50 September 335 84 81 145 43 41 279 61 60 428 210 86 October 438 135 105 190 66 42 308 58 51 502 217 102 November 534 143 122 155 79 35 319 90 61 542 248 96 December 382 106 91 134 56 26 179 62 35 344 168 63 Totals 4869 1333 1198 1898 835 452 3687 1004 622 7049 2959 1285 6202 2733 4691 10008 19 20 B(4). Home Visits by Health Visitors. 1942 Children Special Visits Expectant Mothers Infant Life Protection Total Yrisits 1st Visits ReVisits StillBirths Others January 66 824 — 45 51 3 989 February 77 1080 4 40 54 7 1262 March 73 1017 2 78 55 3 1228 April 72 622 — 32 38 6 770 May 86 919 — 39 45 4 1093 June 78 842 3 28 62 7 1020 July 83 830 3 19 62 5 1002 August 66 758 1 22 58 6 910 September 55 623 1 43 44 6 772 October 62 501 3 18 29 3 616 November 62 675 — 35 44 7 823 December 49 485 1 43 40 4 .622 Total Visits S28 9176 18 442 582 61 11107 B (5). MATERNITY SERVICES. B(5)a. Maternity Home—Hainault. For the fourth year in succession it is my pleasure to record an increase in accommodation at the borough maternity home where an additional six beds has brought the total up to 22 beds. As the six ante natal beds in the annex at Ormonde House are still available this increases the maternity accommodation for the town up to a total of 28 beds. One ante natal bed is required for every three maternity beds, and one premature cot for every ten maternity beds, so that while the ante natal provision is correct for the size of the institution, there is at present no accommodation for premature infants. The staff consists of one matron, one sister, one staff nurse midwife, two midwives and five assistant nurses. During the year 330 cases were admitted, 212 cases being delivered by midwives and 118 cases by doctors. The average duration of stay of these cases in the home was 13 days. 21 As will be seen from the figures given the number of beds and the number of admissions into this institution has gradually increased during the last five years. I think the home is now of such a size as to demand the full-time services of a resident assistant medical officer who will also participate in the ante natal scheme. It must be recorded that the municipal maternity home was damaged by a fly-bomb in June of this year. The blast walls saved the structure on the ground floor, but two wards in particular on the first floor, together with all windows, most ceilings and doors, and the roof suffered considerable damage. As the home was busy and several booked cases were expected for admission the decision was taken not to evacuate, and in fact within a few hours it was possible to carry on almost as usual. • Thanks for this are due to the staff from all our institutions who rallied so spontaneously, to the squads of the N.F.S. who tirelessly cleared away the internal debris, and also to the first-aid repair men who by the same evening had the building reasonably weatherproof. The only casualty was one baby in the nursery with a small cut on the forehead although everybody in the home was rather shaken. The following table illustrates the admissions during the last eight years to the Hainault Maternity Home. Year Admisrious No. of Beds 1937 134 7 1938 116 7 1939 118 7 1940 118 7 1941 143 9 1942 215 12 1943 293 22 1944 330 28 B(5)b. Ante-natal. With a birthrate of 24.3 and an 8 per cent. increase in the total births in the town, there has been an increase of 10 per cent. in the attendances at the Ante natal clinics. Five weekly sessions were continued throughout the year together with two specialist clinics each month. For the first time the Erith clinic has recorded more attendances than the Bedonwell ante-natal clinic, both centres holding two sessions a week. 22 Ante-natal patients seen by Doctor Erith 1914 4336 Jan. Feb Mr. Apr. May June July Aug Sep. Oct. Nov Dec. Total 158 204 216 166 202 179 104 109 110 155 135 85 1823 Bedonwell 162 138 163 155 139 132 119 139 130 138 172 34 721 Picardy 75 58 70 66 67 75 78 49 54 98 58 44 792 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. 30 cases were admitted under this arrangement during the year. The conditions for which they were admitted were as follows : Reason No. Pre-Eclampsia _ Post Maturity Breech Presentation 2 Induction 1 Toxaemia 13 Placenta Praevia 1 Disproportion 5 Anencephalic Csesarian 3 Premature Labour – Abnormal Presentation 3 Breast Abscess ] Mitral Stenosis 1 Total 30 Also during the year 40 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 12 Number of children on register at 31st December 22 23 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 weekly, for Dental treatment for mothers and pre-school children, was well attended during the year, attendances being 205. 6(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:— No. of cases attended by : Home Help No. 1 8 Home Help No. 2 8 Home Help No. 3 11 27 No. of days on which Home Help was employed : Home Help No. 1 113 Home Help No. 2 138½ Home Help No. 2 141½ 393 SECTION C.—PREVALENCE OF AND CONTROL OVER NOTIFIABLE INFECTIOUS DISEASES. C(l). 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, for medical complications and for domicilary reasons. 24 C (2). TABLES. C(2)a. Notifications. The following table shows the total notifications received during the year 1944:— Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Scarlet Fever 89 57 – Diphtheria 4 4 — Cerebro-Spinal Meningitis 1 1 – Paratyphoid – — — Enteritis – — — Dysentery 4 1 — Ophthalmia Neonatorum ... 4 2 – Puerperal Pyrexia 5 2 2 Erysipelas 17 1 — Poliomyelitis 1 — — Pneumonia 29 — 16 Tubercular Meningitis – – – Measles 44 — — Whooping Cough 99 — — C(2)b. Scarlet Fever. Although 89 cases of scarlet fever were notified during the year, no epidemic occurred, the notifications being distributed throughout the year. As recorded 57 of these patients were admitted to the isolation hospital and made uneventful recoveries, with only two children developing ear complications which healed well with no resultant disability. No deaths occurred. , All cases and contacts were investigated and followed up, and kept under the supervision of the department and in this connection I would like to thank the private medical practitioners who were so helpful. C(2)c. Measles. In contrast to the last two years, as noted in the report of the school medical officer for 1943, there were practically no cases of measles during the year. Only 44 cases were notified, no serious complications developed, and no deaths recorded. 25 C(2)d. Pertussis. An outbreak of whooping cough occurred this year in the town, 99 cases being notified to the department. The epidemic was of a mild type, mainly limited to the first five months of the year, 81 of the cases being recorded in the period January to May inclusive. No serious complications were noted in any of the cases so that none received treatment in hospital, and no deaths occurred. None of the 99 children had received the treatment for immunisation against the disease. In my opinion this disease is so distressing in most of its aspects that it is to be hoped that in the future hospitalisation will be the rule not the exception for these patients. 26 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 1 1 3 7 6 7 47 8 7 2 – – – 89 Tubercular Meningitis – – – – – – – – – – – – – Poliomyelitis — — — — — 1 — — — — — — — 1 Acute Primary Pneumonia 2 1 1 1 2 1 2 2 n b 2 29 Erysipelas — — — – — — — 2 3 2 6 — 4 17 Diphtheria — — — 1 — 1 — — 2 — — — — 4 Cerebral Spinal Meningitis – – – – – – – – _ _ 1 – – 1 Measles 5 5 6 6 5 8 1 2 6 — — – — 44 Para-Typhoid — — — — — — — — — — — — — — Dysentery 2 — — 1 — — — — — — — 1 4 Enteritis —- – – – – – – – – – – – — — Ophthalmia Neonatorum 4 – – – – – – – – – – – – 4 Puerperal Pyrexia — — — — – — — — 3 2 — — — 5 Whooping Cough 6 12 15 9 18 36 2 1 – – – – – 99 Totals 20 19 25 24 30 55 52 15 22 13 15 — 7 297 27 C(2)e. Scabies. In accordance with the requirements of the Scabies Order 1942, the Council continued the scheme for the treatment of notified cases of Scabies and the examination and subsequent treatment if found necessary of contacts. This is fully described in the Annual Report for 1943. Cases and contacts are treated at the disinfestation station provided in the cleansing section of the Erith First Aid Post. The following table shows details of cases treated, following notification:— 28 Table showing Details of Cases Treated etc. following Notification under the Scabies Order. Month Cases showing symptona and treated Contacts not showing symptons but treated Total Contacts examined not showing symptons and 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 January 42 33 75 15 23 26 613 26 58 84 February 103 33 136 5 116 32 23 33 56 March 85 38 73 4 86 27 1264 22 60 82 April 41 45 86 2 91 28 28 56 84 May 25 30 55 4 61 19 530 15 43 58 June 23 37 60 — 56 9 6 44 50 July 23 6 29 — 37 10 638 7 29 36 August 30 12 42 — 33 13 6 30 36 September 36 15 51 1 29 15 Disinfestation discontinued owing to spoiling of materials 11 8 19 October 33 49 82 1 24 23 22 8 30 November 29 30 59 — 71 14 13 3 16 December 38 24 62 -— 53 19 6 62 68 TOTALS 458 352 810 32 680 235 3045 185 434 619 29 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 antigen. Immunisation facilities are available at all sessions of the various clinics held in the town, without previous appointment. I am often asked questions regarding the efficacy or otherwise of immunisation against diphtheria, and this year made a special report to the Public Health Committee on the subject. Immunisation is a highly technical matter, but the contention is that it renders inert the poisons (toxins) produced by any germs that succeed in getting into the child, and so tides over the immediate danger and gives the body time to manufacture (anti-bacterial) neutralising substances also. The following statistics may therefore be of interest. From 1920 to 1941 the deaths from diphtheria in England and Wales were never below 2,000 in any one year, but in 1942 they had dropped to 1,827, in 1943 to 1,370, and in 1944 to under 1,000. It might be suggested of course, that this reduction was not influenced by immunisation, but that the disease is becoming less virulent in this country, and that this drop in the number of deaths just happens to coincide with the increased number of children who have been immunised in the years 1942, 1943 and 1944 throughout the country. it is pertinent therefore to investigate further and ascertain what proportion of the deaths occurred in immunised and in non-immunised persons. In the first half of 1944 there were 16 deaths in immunised children, and in the same period 368 deaths in non-immunised children. As approximately half the child population in the country has been immunised it follows that an immunised child is 23 times less liable to die from diphtheria than a child who has not been immunised. Another point of considerable significance was illustrated in the last annual report of the Ministry of Health, that while during 1943 the mortality from diphtheria at all ages from 1—15 years—the age group in which immunisation has been most complete—declined to the lowest level yet recorded, at all other ages the mortality increased. 30 It is not claimed that immunisation will entirely prevent one from getting diphtheria. What is claimed is that the organism will be kept in check and prevented from producing the dangerous consequences, heart lesions, paralysis and death itself, which make the disease such a dreadful menace to children. The following table will indicate the number of cases dealt with:— Diphtheria Diphtheria and Whooping Cough Injections 1st Injection. 2nd Injection. 1. 2. 3. 4. January 48 45 1 — — — February 52 55 3 1 5 — March 42 37 5 1 — — April 35 38 2 1 1 2 May 46 25 2 3 3 1 June 52 36 1 1 — — July 33 33 August 21 15 September 46 33 October 3 9 44 November 32 33 December 11 26 — 3 — — Total s 457 420 14 10 9 3 Grand Totals—1st Injections 471 2nd ,, 430 3rd ,, 9 4th ,, 3 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., 117 premises were disinfected, whilst enquiries to obtain particulars regarding 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. 31 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. 480 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, and 90 beds at the Kettle well Hospital are now available for cases from this and neighbouring towns. A portable X-ray apparatus is in use each Friday at the Erith dispensary so that X-ray examinations are now carried out in the borough. In the tables which follow, particulars of new cases of Tuberculosis, and of all deaths from the disease in the area, during 1944 are shown in table 1, whilst table 2 shows the quarterly statements of cases on the register, together with the position at the 31st December, 1944. C(7)b. Table i. Particulars of New Cases and Deaths. Age Periods New Cases Deaths Puiroonary Non-Pulm'n'rj' Pulmonary Non-Pulmonary Under 1 year 1 – – – 1 2 — – — 5 — — — — 10 1 —- — — 15 11 I — — 20 13 I 2 — 25 7 — 4 — 35 7 2 2 — 45 7 I 6 — 55 4 — 3 — 65& upwards 2 — 8 — Totals 55 5 25 — 32 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 150 116 266 149 118 267 152 124 276 148 121 269 New notifications during year 4 5 9 9 10 19 2 5 7 6 9 15 Cases removed, which have been restored – – – – – – – – – – 1 1 Cases added to register other than by notification – 1 1 – – – 1 – 1 – 5 5 Cases removed from register 5 4 9 6 4 10 7 8 15 5 5 10 C ases remaining on register 149 118 267 152 124 276 148 121 269 149 131 280 Non-Pulmonary T.B. Number on register 45 39 84 46 41 87 49 41 90 50 40 90 New notifications during year 2 3 5 3 – 3 1 1 2 – – – Cases removed, which have been restored – – – – – – – – – – – – Cases added to register other than by notification 1 – 1 1 – – – – – – – – Cases removed from register 2 1 3 1 — 1 – 2 2 – 1 1 Cases remaining on register 46 41 87 49 41 90 50 40 90 50 39 89 33 C(8). Ear, Nose and Throat. The arrangements made last year with the Southern Hospital, Dartford, for the operation treatment of tonsils and adenoids, was continued this year up to June, when war circumstances prevented the further operation of the scheme. It was possible to continue the aural clinic throughout the whole year and in view of the waiting lists of children, it was decided to increase this to two monthly sessions as from August. Mr. A. Alexander again acted as your consulting aural surgeon, and the following shows the number of cases dealt with:— Cases operated on at the Southern Hospital 37 Cases operated on at other hospitals 3 Total 40 The following records the cases seen at the aural clinic at Bedonwell during the year:— New Cases. Re-examinations. Total No. Attendances. Ear Conditions 28 8 36 Nose Conditions 26 6 32 Throat Conditions 104 42 146 Other Associated Conditions 2 2 4 160 58 218 Mr. T. P. Gill again acted as your Consulting Aural Surgeon for the Sanatorium. His services are available for opinion and for operations on patients in the hospital as required, and this appointment is renewable annually, a retaining fee being paid. 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. 34 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. Three ambulances are run for non-infectious or accident cases and one for the removal of infectious disease. During 1944 the service was utilised as shown in the following table:— Cases. Mileage January 480 4215 February March 534 5434 April May 646 5921 J une July 468 4790 August September 400 4346 October November 390 4544 December D(5). 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, and during 1942 23 bodies were placed within the building. As mentioned in my special report to the Council on a Five year plan for Public Health in the Borough, I am of the opinion that these premises are inadequate. 1 suggest that a new building incorporating proper and sufficient facilities for post mortem examinations is now necessary for a town of this size. 35 SECTION E.—WATER SUPPLY—MILK AND FOOD AND DRUGS. Ed ). Water Supply. The water supply in the district is almost exclusively provided by the Metropolitan W ater Board. The water, though possessing a considerable degree of hardness is of good quality, and is palatable. The supply in nearly all cases is fed into the houses; standpipes exist on a few premises only- Routine examinations of such supplies have been undertaken throughout the year with complete satisfactory results, and arrangements are in existence with Kent County Laboratory for the examination of two samples monthly. E(2). Cowsheds, Dairies and Milk Stores. The current register of cowsheds, dairies and milk stores, records the following registration figures:— No. of registered farms and dairies 4 No. of dairies 12 Shops selling milk in sealed receptacles 42 No. of registered purveyors outside Borough 19 E(3). Bacteriological Examination of Milk. The following samples of milk retailed within the Borough were obtained and forwarded for examination:— (a) Pasteurised—Satisfactory. (b) Pasteurised—Satisfactory. (c) Pasteurised—Satisfactory. (d) Pasteurised—Satisfactory. (e) Pasteurised—Unsatisfactory. (f) Pasteurised—Unsatisfactory. (g) Pasteurised—U nsat isf actory. (h) Pasteurised—Satisfactory. (i) Pasteurised—Satisfactory. (j) Pasteurised—Satisfactory, (k) Pasteurised—Satisfactory. (1) Repeat sample on E.F.G.—Satisfactory. 36 E(4). Examination of Milk for Tubercle Bacilli. The following samples of bulk milk supply were obtained during the year at cowshed premises within the Borough. Herd. Number of Cows. Result of Biological Test. A 24. No evidence of Tubercle. B 4 No evidence of Tubercle. C 22 Report not yet to hand. E(5)a. Designated Milk. The following table indicates the number of licences issued by the Local Authority in 1944, under the Milk (Special Designations) Order 1936. Dealers. Tuberculin Tested 5 Pasteurised 6 Supplementary. Tuberculin Tested 3 Pasteurised 3 Total 17 E(5)b. Phosphatase Test. Of 11 samples of Pasteurised milk submitted to the Public Analyst for the above test, 2 samples produced a negative result. On submitting repeat samples of the latter two sources, the results were satisfactory and indicated that the milk was efficiently heat-treated. 37 E(6). Food and Drugs Act 1938, Sections 3 and 68. 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 — 2 2 Epsom salts — 2 2 Hun Flour — 1 1 Aniseed — 1 1 Svrup of figs — 1 1 Milk — 22 22 Pepper — 2 2 Sauce — 1 1 Sedlitz Powder — 1 I Lemon Flavour — 2 2 Bicarbonate of Soda — 2 2 Bloater Paste — 1 1 Bronchial Mixture — 1 1 Soup — 2 2 Influenza Cure — 1 1 Licorice Powder — 1 1 Custard powder — 1 1 Malted Milk — 1 1 Baking powder 1 1 Horseradish Cream — 1 1 Vinegar — 1 1 Gravy Powder — 2 2 Cocoa — 2 2 Desert Mould — 1 1 Pudding mixture — 1 1 Air Raid Tonic — 1 1 Health Salts — 1 1 Glaubers Salt — 1 1 Pea Flour — 1 1 Glycerine — 1 1 Curry powder — 1 1 Total — 60 60 38 E(7). Meat and Food Inspection. The usual time and attention has 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:— Milk 349 tins. Vegetables 482 lbs. ,, 140 tins. Fish 560 lbs. ,, 386 tins. Shellfish 336 lbs. Meat 382½ lbs. ,, 145 lbs. Cheese 83 lbs. Fruit 356 lbs. ,, 107 tins. Cocoa 4½ lbs. Cereals 533 lbs. ,, 31 packets. Shell eggs 1,348 Dried eggs 30½ lbs. Tea 2½ lbs. Sauce 8 bottles. Oranges 50 Jam 230 lbs. ,, 4 tins. Salt 6 packets. Soup 25 packets. Pickles 41 jars. Confectionery 298 lbs. Sugar 3½ lbs. Margarine 15 lbs. Coffee 4 lbs. Total weight 2 tons, 1 cwt., 2 qrs., lbs. E(8). Slaughter of Animals Act 1933. The above Act makes the use of mechanically operated instruments a statutory obligation. By resolution of the Council dated 23rd May, 1938, the provisions of Section I of the Act apply to sheep which are slaughtered in the district. 39 SECTION F.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Sanitary Inspection of Area. F(l)a. Visits by Sanitary Inspectors. The total number of visits of all kinds was 7349 Notices served:— Statutory 50. Informal 758. Number of dwellings and other premises disinfected 117 Complaints received and investigated 1343 F(1)b. Premises visited and results of such visits. Premises No. in District No. of visits »944 No. of defects found No. of defects remedied Bakehouses 10 62 1 1 Cowsheds 4 23 1 1 Dairies 12 65 5 5 Butchers Shops 32 359 8 8 Fish friers 10 51 2 2 Food Factories 2 24 1 1 Slaughter Houses 4 — — — Factories 128 104 14 14 Outworkers 22 22 — — F(l)c. Summary of Nuisances and Defects Remedied during the year. Other than those enumerated in the above Tabulations: Drains cleared 134 Drains repaired 23 W.C. pans renewed 12 Cisterns, repaired 26 New sinks 2 New W.C.s provided 3 Roofs repaired 131 Damp walls remedied 69 Houses cleansed 13 Floors repaired 21 Eaves gutters repaired 31 Cooking stoves repaired 10 40 Plasters renewed 11 Windows made to open 6 Dustbins provided 185 Accumulations removed 12 . Cesspools abolished 2 Yard pavings repaired 2 Water supply provided 4 Coppers repaired 1 Drains tested:— Smoke 12 Water Nil F(l)d. Offensive Trades. In addition to the statutory Offensive Trades which are specified in Section 107 of the Public Health Act 1936, fish frying was declared to be an offensive trade on 17th March, 1939, and bye-laws were made accordingly. Within the Borough, there are no offensive trades other than fish-frying premises, of which there are 10 in operation. F (1 )e. Closet Accommodation and Cesspools. The whole of the closet accommodation both in the older parts of the town and the immediately pre-war areas is on the main drainage system, there being only 30 known premises which are drained into cesspools- During the year two cesspools have been abolished, and the drainage connected to sewers. Cesspools are emptied once a month free of charge by machines belonging to the Borough Council, the contents of cesspools being discharged into the Council's sewers. The cesspools which now require the service are scattered throughout the district and, in the majority of cases, necessitate covering considerable distances both for pumping out and conveying to the point of discharge. Duiing the year 1944, cesspools were emptied on 47 occasions by the Council's plant. F (1 ) f. Smoke Abatement. No smoke nuisances have come to the notice of the Department during the year. F(1)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. 41 F (1 ) h. Schools. Schools within the district are visited regularly, 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. F (1 ) i. Camping Sites. There are no summer camping sites within the district. There are however, 4 sites which have been occupicd by van dwellings for a number of years. Frequent inspections have been made by Sanitary Inspectors with a view to the maintenance of circumstances which are in compliance with Bye-laws- No licences have been granted by the Authority during the year under Section 269 Public Health Act 1936. F (1 ) j. Hop Pickers. There are no hop fields within the district. F(l)k. Rag Flock Act. No premises exist within the Borough in which rag flock is manufactured or sold. F. (1)1. Eradication of Bed Bugs. During the year 1944, dwellinghouses were found to be infested with vermin and subsequently disinfested as under : — Privately owned houses 22 Council houses 8 Presence of vermin in private houses is usually located by the Department's Sanitary Inspectors whilst investigating complaints or viewing home circumstances. On every occasion removal of wallpaper, picture rails, etc. is insisted upon, any measures falling short of this being useless. The use of a blow lamp and approved insecticides is effective, and re-visits are made to see that the improvement is being maintained. Every assistance is given to occupiers who are encouraged to report infestations so that their premises may be efficiently treated. The services of the Public Health Department outdoor assistant may be obtained upon application, an appropriate charge being made for the carrying out of the necessary work of vermin destruction. Owners and occupiers are encouraged to report vermin infestations. The cleansing and destruction of vermin within Council houses is carried out by the Borough Surveyor's staff. 42 All prospective and selected applicants for Council houses are visited and a report on the findings is made direct to the housing clerk. When the effects are found to be verminous, furniture and other articles are subjected to cyanide fumigation by Contractors employed by the Council. This method of rehousing has proved to be successful. F(1)m. Mosquito Control. Specimens Numbers 40 and 41 were submitted to the Malaria Officer of the Ministry of Health, and identified as insects belonging to the Genera Ryphus Group, this result therefore being negative. HOUSING. F(2)a. Inspection of Dwelling Houses during year. 1. (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 1022 (b) Number of inspections made for the purpose 2964 2. (a) Number of houses (included under sub-head (1) above) which were inspected and recorded under the Consolidated Housing Regulations 1925 and 1932 0 (b) Number of inspections made for the purpose 0 3. Number of houses found to be in a state so dangerous or injurious to health 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 all respects reasonably fit for human habitation 771 F(2)b. Remedy of Defects during the year without service of Formal Notices. Number of defective dwellinghouses rendered fit in consequence of informal action by Local Authority 698 Action under Statutory Powers during the year: (a) Proceedings under Section 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 43 F(2)b. Proceedings under Public Health Act. (1) No. of dwelling-houses in which respect notices were served requiring defects to be remedied 50 (2) No. of dwellinghouses in which defects were remedied after service of formal notices: (a) By Owner 44 (b) By Local Authority 0 F(2)c. Proceedings under Sections 11 and 13 of the Housing Act 1936. (1) No. of dwellinghouses in respect of which demolition orders were made 0 (2) No. of houses demolished in persuance of demolition orders 0 F(2)d. Proceedings under Section 12 of the Housing Act 1936. (1) No. of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) No. of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 0 F(2)e. Rent and Mortgage Interest (Restrictions) Act 1939. The provisions regarding extortionate rents are administered by the department and during the year 1944, 240 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 Act. 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 27/6 to 20/- and £2/13/6 returned to tenant. (b) Rent reduced from 27/6 to 25/7-J- and £3/15/- returned to tenant. (c) Rent reduced from 16/6 to 13/9^ and <£5/16/5 returned to tenant. (d) Rent reduced from 20/- to 10/5. (e) In this instance, the applicant (as sub-tenant) appealed to the County Court, when the Registrar determined the standard rent at 11/- having regard to the number of rooms occupied. 44 (f) In this case, the owner instituted proceedings in the County Court for the recovery of a flat, and which resulted in a possession order being granted. On an appeal for stay of execution by the defendant, new facts were presented, subsequent to which the Order to vacate was rescinded by the Court. (g) On this occasion, the sub-tenant applied to the County Court for the establishment of standard rent in respect of certain rooms sub-let. The action resulted in the rent being reduced from 8/- to 6/- per week. F (3)a. Shops Act 1912-1938. With regard to statutory hours of closing, it was necessary to issue 11 warnings to shopkeepers 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 and comfort of shop assistants were located in the following instances, the necessary improvement being subsequently effected:— Notices served. Lack of heating facilities 3 In accoddance with Defence Regulation 60AB, the following hours of closing were substituted for the closing hours prescribed by Section 1 of the Shops (Hours of Closing) Act 1928 during the period 5th November, 1044 to 3rd March, 1945. General Shops. Monday, Tuesday and Wednesday 5.30 p.m. Friday 6.30 p.m. Saturday 5.30 p.m. Hairdressers and Barbers. Monday, Tuesday and Wednesday 7 p.m. Friday 7 p.m. Saturday 8 p.m. No order was made revoking closing hours during Christmas week, 1944. F (3) b. Offices. In no instance was it found necessary to take action 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 accommodation exist at such business premises. 45 F(3)c. Factories. (i) Inspections for the purpose of provisions as to health are detailed below:— Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 46 3 — Factories without mechanical power 52 1 — Other premises under the Act (including building works and engineering construction but not including outworkers premises) 6 — — Total 4 4 — (ii) DEFECTS FOUND. Particulars Number of Defects Number of defects in respect of which prosecutions were instituted Found Remedied Referred to H M Inspector Want of Cleanliness 1 1 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate Ventilation — — — — Inadequate lighting — — — — Ineffective drainage of Floors 1 1 — — Sanitary Conveniences Unsuitable or defective 11 11 — — Not separate for sexes — — — — Other offences 1 l — — Total 14 14 — — F(4)a. Health Education—Films. It was endeavoured, in view of the successful campaign of the previous year, to repeat this type of programme during 1944. During April, a lecture on public health was given by the Medical Officer of Health to a Youth organisation at which three silent films dealing with immunisation against diphtheria, 46 the importance of vitamins and the unceasing fight by scientists and medical services to prevent disease were shown. These lectures accompanied by films appear to be popular with the young people of the borough, and the attendance was good. Later in the year, a further lecture and film show on public health was held for the benefit of local Government Officers, the two films depicting the danger of the common cold and the new methods of rehabilitation for men injured in industry or in the forces. It is evident that interest in this type of programme is increasing and it is hoped that in the future, when a feeling of greater security prevails, subsequent programmes will be arranged, when possibly even larger attendances may be expected. F(4)b. Health Education—(Five Year Plan). A plan was submitted to a joint meeting of the Public Health and M. & C.W. Committees, in October, 1944, which is published as a supplement to this report. The plan is a review of suggested ventures to be undertaken by these two committees on a five year schedule. It is further suggested that publicity might be given to some, or all the proposed improvements in Local Public Health Services, with a review to getting- the general public "Health Minded." F(5). Legislation in Force. List of Bye-Laws etc. in force in this district with date of adoption. Tents, Vans and Sheds 28th Feb., 1928 Houses let in lodgings 27th Jan., 1930 Slaughterhouses 29th Jan., 1932 School Attendance 17th Feb., 1932 Libraries and Museums 15th June, 1934 Nursing Homes 20th July, 1934 Pleasure Grounds 4th Feb., 1936 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 23rd April, 1940 Good Rule and Government 1st Jan., 1941 G(1)a. Refuse Collection and Disposal. 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 con- 47 eerned, 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. During the year two new Scammell lorries were purchased at a cost of £1,113 lis. 0d., and have subsequently' been put into service. Thus part of the suggestions outlined in the five year plan, under this heading which is issued as a supplement to this report, has been implemented. These vehicles are fitted with special bodies which enable them to have easier access to the narrow approaches which are peculiar to a large number of the rear portions of the houses in this district. G(l)b. Costs. Cost per ton of collecting refuse 12s. 9d. Cost per ton of disposing refuse 6s. Od. Net cost per 1,000 population per annum £154 0s. Od. G(l)c. Details of the Refuse Collection Vehicles and Staff. Vehicle. Capacity. 1 Dennis Lorry 12 cubic yards 1 Easyloader 5 ,, ,, 5 S.D. Freighters 7 ,, ,, 1 Fordson Lorry — 1 Austin 10 Utility Van. These are operated by— 1 Foreman. 9 Driver Loaders. 6 Loaders (5 men, 1 lad). 2 Salvage Sorters (Female). G(l)d. Details of the Tonnage dealt with during the year. Month Tons Cwt. January, 1944 635 19 February ,, 596 12 March ,, 665 18 April ,, 499 15 May ,, 462 10 June ,, 409 2 July ,, 387 16 August ,, 359 5 September ,, 391 8 October ,, 530 10 November ,, 578 17 December ,, 503 16 Total 6021 8 48 G(l)e. Trade Refuse. Trade Refuse is collected from the shops by arrangement with the shopkeepers, an agreed charge being made. The growth of this section of the refuse services continues. In 1944, the amount reached approximately 400 loads producing a revenue of £300 12s. 4d. C (1) f. Salvage. The following table gives details regarding the collection and disposal of salvage during the year:— Items. Tonnage Collected. £ s. d. T. C. Q. lbs. Income. Paper: Newsprint 5 18 0 0 63 18 6 Periodicals 12 15 1 0 118 1 2 Strawboard and Mixed Waste 217 16 0 0 1388 9 11 Selected Waste 4 19 3 0 34 18 3 Kraft Blue Bags 3 6 1 0 22 7 11 Textiles 31 1 1 15 590 4 7 Bottles, Wt. 25 7 0 0 74 1 2 Bottles, Gr. 313 gross, 4 doz. 141 3 3½ Metals: Iron 72 8 0 0 123 15 9 Brass 14 0 15 15 8 6 Copper 3 0 11 6 8 4 Aluminium 10 3 8 11 0 8 Lead 14 2 26 13 16 0 Zinc, etc. 1 1 2 26 14 2 9 Tins 128 2 2 0 96 2 2¼ Rubber 9 15 0 0 24 7 6 Bones 5 16 0 1 27 13 0¾ Sundries: Cullett Batteries Foil Rabbit Skins Manure 17 16 1 5 66 12 10 Waste Food Scheme: Waste Food 423 11 1 14 635 7 0¾ Sale of pigs 529 16 6 General: Subsidy on Iron 267 9 7 Cartage Allowances 179 6 1¾ 961 17 1 9 £4444 14 7½ This gives a total tonnage of 961 tons 17 cwts. 1 qr. 9 lbs. (plus 313 gross 4 doz. bottles) salvaged and sold producing a sum of £4444 14s. 7½d. 49 The Chairmen, Public Health and Maternity and Child Welfare Committees. Dear Mr. Chairman, THE FIVE YEAR PLAN. The incongruity of the world to-day in which all the discoveries of modern science that can and have increased the scope of each individual's life are now organised to terrify and destroy the individual, will produce a profound change in the outlook of those who survive the present dangers. Some by concentrating on unworldly things may achieve the peace of mind for which they yearn, but the majority will unconsciously seek to allay their bewilderment by identifying themselves with some plan for curing the evils which surround them, thereby finding for their mental energies an outlet much more satisfying than a state of hesitant inaction. It is in regard to the latter reaction that I present to you my impressions of what may constitute the 44 Five Year Plan in Public Health " in this borough. In your terms of reference you ask me to indicate in some degree the priority that could be assigned to the various ventures. May I say therefore straight away, that with 233 families in t he district to be re-housed, and 475 houses demolished as a result of enemy action, I could not conscientiously advise the Authority to undertake any of these works until the 500 new homes have been supplied. In this connection, it would appear that during the next five years the choice will not be between the Portal sub-standard house and the good municipal type house, which we all hope to see built in the near future, but between the Portal or some pre-fabricated house on the one hand, and on the other no house at all, or cramped rooms. It is admitted that the Portal house is not a first-class home, and I look forward to the time when I shall personally be agitating for its complete abolition, but it can be a temporary home, and a better temporary home than can be provided by other means than are at our disposal. The people in urban areas are much more verminous than is generally supposed and recent investigations have probably surprised many medical officers. After making every allowance for the damage that can be done by a small group of chronic offenders, it is obvious that a substantial proportion of the population lack the essentials for the maintenance of personal cleanliness—namely, soap, hot water, and the desire to be clean. Through no fault of their own, many of them lack easily 50 available hot water. The Housing Act informs us that sanitary defects " include, among other things, absence of adequate and readily accessible water supply or sanitary accommodation, or of other conveniences, and it is difficult with regard to the latter term to question the fitness of a house mainly on the grounds that it lacks a bath room or a proper supply of hot water. I believe that if the morbidity rate for respiratory disease and the various problems of personal cleanliness are to be adequately solved in the future, the proper supply of hot water to, or better still the whole heating of the house will have to be tackled municipally. Much of the report is of necessity discoursive, but I would suggest that priorities lie in the scheme for collection and disposal of house refuse, the maternity home, and the central public health centre. I am, Your obedient Servant, REGINALD LEADER, Medical Officer of Health. October, 1944. HOUSE REFUSE. 1. Collection : The type of transport to be used for Refuse Collection in the Borough should only be selected after a costed try-out, to suit the local conditions and all they may mean in terms of set-back of properties, location of receptacles, peculiarities in the nature of narrow lanes, storage on or access to premises, length of man travel, stof losses of vehicles, gradients, lengths of haul, and the need for silent operation. Length of haul or the average distance to be traversed between the collection area and the disposal-point, is a fundamental consideration and its effect may rule out one form of transport or maximise the merits of another. Having regard to the inaccessibility by refuse vehicles to traverse the many uneven and sunken back passages in the borough, it is imperative that an improvement be effected by surfacing and levelling the passages in question. I would recommend that due regard be had to this important aspect in refuse collection which has become considerably aggravated during the past few years. 51 With regard to the type of transport vehicle design, if a mechanical horse system were to be used, this would need the provision of at least two mechanical horses of the Scammell type and the acquisition of at least three rear loading pantechnicons of 18 cu. yard capacity presumably horse hauled. This system may be more efficient than the present one, it will certainly be more expensive and will mean augmentation of the staff to at least 25 men and a foreman. The approximate cost of the new vehicles would be :— 2 Mechanical Horses (Scammell) at <£450 = £900 0 0 .3 Rear-loading Pantechnicon type (18 cu. yds.) at £600 £1800 0 0 Hire 3 horses and 3 men at daily rate of £3 15 0 2. Disposal. The collection of refuse is a comparatively straight-forward matter as compared with its disposal and in the past an out-ofsight out-of-mind policy sufficed in too many cases. Each community has to find its cheapest and most satisfactory means of final disposal. For this borough I would recommend that consideration be given to the following : — (a) Barging by contract. This is probably the cheapest and most economical in the long run and has already worked satisfactorily for a number of years in the town. (b) Land Reclamation—Controlled tipping. Here all objections sentimental and real must be envisaged and full regard paid to the immediate surroundings. Suitable sites within the borough on the marshes and elsewhere are at the moment under consideration as an emergency measure. At least four additional staff would be required for any such scheme together with the necessary equipment and the rental or purchase of the site, and these costs would have to be set against the improved value of the land over a number of years and the cultural satisfaction of well-drained municipal playing fields or pleasure gardens on a former derelict marshy terrain. Industrial interests are of course always capable of reclaiming derelict land where the economic situation warrants any such outlay. (c) Incineration. Most large cities appear to favour this method either as complete incineration or as incineration with power production. The question of dust and smell nuisance must be borne in mind and call for careful decision in the localisation of the incinerator. During the past few years the advantages of incineration have been fully acknowledged and at the destructor a system of salvage of at least metal and tins could be instigated. Heat and steam generated in the plant is useful for heating in public baths and other places the clinker residue being of value for ballast for roads. In this connection it might be worth while ascertaining whether any neighbouring authorities would be interested in using an incinerator in this town and so reduce the rather heavy initial outay. The Garchey Syttein. In recent years the Garchey system of water-borne disposal of solid refuse from the house has been tried in this country but it results in extra cost, it adds a further use of water in considerable quantities and it is doubtful how far the system is applicable to housing in this country. A trial plant adapted for a housing estate at Leeds embraces 940 flats. The Garchey plant embodies a large sink in each flat down which solid refuse contained in paper wrappings is swilled with water and passes down large diameter pipes into an underground sump. This sump is a collecting receptacle for a large number of the dwellings and from these the refuse is drawn by suction into an incinerator, de-watered and burnt, the heat generated being used to supply hot water and steam for a communal laundry. It would appear that combined with a comprehensive scheme of high density flat buildings it has certain advantages. It seems more difficult to apply to varied types of buildings in an ordinary urban development. Disposal of refuse by straight emptying of bins and the method of central incineration cannot be considered ideal. It has many serious drawbacks, dust and dirt, high cost and a considerable amount of rather objectionable labour are amongst them. An ideal system would be some form of decomposition on the site and eventual disposal via the drains, but the nature of commercial and domestic solid refuse is such that it would probably be a complicated chemical process. The use of household incinerators is quite feasible although this still leaves the problem of disposal of ashes and involves a certain amount of additional domestic labour. Physical Training and Recreation. This important Public Health adjunct is provided for by the Physical Training and Recreation Act 1937, Section 4 of which empowers a Local Authority to acquire, lay out, provide with suitable buildings and otherwise equip and maintain lands for the purpose of gymnasiums, playing fields, camps, and societies or organisations having athletic, social or educational objects. The Authority may also provide, and where necessary arrange for the training of wardens, teachers, and leaders as may be deemed requisite. Section 3 of the Act enacts that the 53 Board of Education may, in accordance with recommendations made by the Committee appointed for the purposes of the Act by the Prime Minister and in accordance with arrangements approved by the Treasury, make grants towards expenses of a Local Authority in aiding the provision of facilities for physical training and recreation, and also towards the training and the supply of teachers and leaders. Local Authorities interpreted by Section 9, include County Councils, County Boroughs, Metropolitan Boroughs, County Districts and Parishes. Having regard to the public health advantages which would materialise from physical training, recreation, and the provision of bathing places in the various Recreation grounds situated within the Erith Borough Boundary, I would recomment that the provisions of this Act should be exploited to the full which generally prescribe for the development of facilities for, and the encouragement of physical training and recreation and to facilitate the establishment of centres for social activities. For this purpose, I would recommend swimming pools and bathing places in all recreation grounds, and adequately equipped playing centres for children. Open Air School. The Borough Council may consider the question for the provision of an open air school for child sufferers, and whose education may be continued. Such an establishment would be a Public Health asset, and it may be that adjoining Local Authorities would contribute to a joint scheme. Homes for Aged Persons. In most administrative authorities homes for the aged may be considered a public health necessity, for no amplification on my part would describe the distress which is often apparent in cases where aged persons occupy one room within a selfcontained family dwelling. My experience would indicate that aged persons have much loyalty to those districts in which they have lived and worked during the greatest part of their lifetime and it is with a certain tenacity that they desire to retain their environment. Having considered this question most carefully I am of the opinion that elaborate housing accommodation is not necessary on the part of a local authority, neither is it desired by the aged person. Re-housing of aged persons into salubrious areas may in certain cases appear to have beneficial results, but there are as always exceptions to the rule. As a departure from the orthodox approach to this subject I would recommend the purchase by the local authority of a row, or rows of the older type of dwelling, and from which the structure of bedroom accommodation on the first floor 54 should be removed. In effect, the dwelling would be reduced to a structure of the bungalow principle. Adequately roofed such accommodation would be suitable for aged persons for living and sleeping, and the necessary water supply, cooking, heating and other fitments would be situated on the ground floor. These dwellings being vested in the local authority would be under the direct supervision of the health department which I have every reason to believe would enhance the existence for those persons who would occupy such dwellings. That the older type of house could be reconditioned as described above I have no doubt whatever. Indeed such reconditioned bungalows suitably rough-casted, or cement rendered could present a pleasant appearance. Clearing Houses for Council House Applicants. Departure from and lapse in standard of cleanliness within houses owned by the local authority, would indicate that a certain amount of health education is necessary for a number of prospective applicants of Council houses. My contribution to the solution of this problem would be to recommend that say six houses should be constructed wherein applicants known to be of the careless type could reside during a probationary period, and during which period the householder could be visited by an appropriate officer of the department, and supervised in maters regarding cleanliness and public health generally. That such a system would work out satisfactorily I have no doubt, inasmuch that I believe that dubious applicants could be transformed into really suitable occupants of council houses. Provisions with respect to Blindness. Under Section 176, Public Health Act 1936, a Local Authority may make such arrangements as they think desirable for assisting in the prevention of blindness, and in particular for the treatment of persons ordinarily resident in their area who are suffering from any disease of, or injury to, the eyes. The Blind Persons Act 1928 defines a blind person as "so blind as to be unable to perform any work for which eyesight is essential." When the acuity of vision is below 3/60 Snellen the person may usually be regarded as blind. (Ministry of Health Circular 1353.) The principal Act of 1920 provides blind persons with Old Age pensions when 50 years of age, since which time, the Blind Persons Act of 1938, has reduced the age at which Old Age pensions may be received from 50 to 40 years. Under the Public Health Act 1936, the Local Authority may arrange for welfare schemes and provide employment, hostels, or homes. 55 Though the actual work under the aforementioned schemes is in fact usually delegated in whole or part to voluntary associations, it would appear very necessary, having regard to Post War Planning for the Local Authority to make local provision for defective vision and the local treatment and management thereof. A local welfare scheme would include the provisions of a hostel, and home teaching for those so afflicted. Mortuary. The Mortuary situated in the ground at the Erith Parish Church must be regarded as obsolete having every regard to the modern aspect of Public Health. The accommodation consists of a receiving room and a viewing and the maximum capacity is for 4 bodies. It is estimated on an average that 45 bodies are received therein each year. For some long time past, these premises have been totally inadequate for a Borough with some 40,000 population, and the attendant and medical practitioners are unable lo do their work to the best advantage. With respect to Post War planning I would recommend the consideration of a new Mortuary, statute for which is provided by Section 198 Public Health 1936, and this project might well be considered with the next item in the lay-out of a Public Health Centre. Laboratory. Under Section 195 Public Health Act 1936 a Local Authority may provide a laboratory for purposes connected with the diagnosis and treatment of diseases, and for the making of such bacteriological, chemical, and other examinations as may assist them in the performance of functions under this Act. Crematoria. Under Section 4 of the Cremation Act 1902, the powers of a burial authority to provide and maintain burial grounds or cemeteries, or anything essential, ancillary, or incidental thereto shall be deemed to extend to and include the provision, and maintenance of Crematoria. Sites for Crematoria must be approved by the Ministry of Health. Under Section 7 of the Act the Secretary of State has made Regulations as to the maintenance and inspection of Crematoria. Having regard to the modern aspect concerning disposal of the dead, I would submit that the Borough Council should examine all the possibilities regarding the provision of such a system facilities for which are enacted by the aforementioned Act. 56 Borough Markets. Establishment or acquisition of market by a Local Authority is provided for by Section 44, Food and Drugs Act 1938, and with the consent of the Minister of Health such a market can be instituted together with convenient approaches thereto and buildings convenient for the holding of a market. Without the consent of the person concerned, no market shall be established in pursuance of the section so as to interfere with any rights, powers, or privileges enjoyed within the district in respect of a market by any person. Under Section 46, a market authority may, with the approval of the Minister, appoint the days on which and the hours during which markets may be held. Section 47 provides for the fixing of stallages, tolls and other charges. Having regard to lack of central shopping facilities within the Borough there is no doubt that the provision of a well equipped market, together with adequate approaches, and well established system of administration is an asset long overdue, and I would submit that provision of such a market is . a necessity having regard to Post War Planning. Public Slaughterhouse. A Local Authority may provide a Public Slaughterhouse under Section 60 Food and Drugs Act 1938. The experience of most Councils is that a slaughterhouse, vested in the Local Authority is a most useful acquisition. In Erith there are four privately owned and licenced slaughterhouses ; two situated in Lower Belvedere, one in Upper Belvedere, and one in the Town Ward. For the elimination of private slaughterhouse following upon the provision of a Public slaughtering establishment by a Local Authority, Section 61 of the Act enacts that a Local Authority may acquire by agreement any premises within their district which are used as slaughterhouses, and discontinue the use of the premises for that purpose. Sub-section (6) of Section 61 provides for the payment of compensation by the Local Authority to dispossessed Slaughterers for any loss sustained by them by reason of it being no longer lawful to use the premises as slaughterhouses. The provision of a Public Slaughterhouse in Erith would be a worthy Public Health improvement, and I would recommend its consideration with regard to Post War Planning. Requirements o£ a good Public Slaughterhouse are (1) The premises should be in proximity to a railway (2) Not too far from retail shops (3) Be capable of extension (4) There should be copious water supply and adequate means for sewage disposal. 57 Amenities in Streets. In my opinion, more street shelters for bus passengers should be provided which allow for protection during adverse weather. The need is almost a Public Health necessity. With a view to reduction of street accidents, I would suggest the provision of 4 4 roundabouts " at the various street junctions. It is noted that in townships where 44 roundabouts are operating, accidents are infrequent at these points. I would suggest that the appearance of 44 roundabouts " be enhanced by surfacing with flowers, thus introducing some colour into otherwise drab streets. Public Health Centres. One of the greatest difficulties in popularising preventive medicine is its lack of dramatic interest. The doctor who rescues his patient from some grave emergency, even if he has helped (inadvertently) him into this parlous position, wins the admiration of the public in a way with which the doctor, whose patient remains in good health, cannot hope to compete. The Minister has, however, made it clear that II.M. Government will introduce a National Health Service and it would now appear that three main principles will govern this service. Firstly, the central administration will be by the department of the Ministry of Health ; secondly, that local administration must be under the local authorities, that is, by direct representatives of the people and that any grouping of authorities envisaged does not effect this principle, and lastly that the scheme will be national, that is, available to all and paid for by all. Within this frame-work all else is open to discussion and in my opinion whatever the Act which brings in the national medical service may command, it will be many years before all its provisions can come into force. I therefore hold that the fundamental considerations with regard to our present services will still obtain for a considerable period of time. Even then, whatever new names or groupings are introduced the present public health services are basic and can surely not be reduced in scope ; and whoever signs the last letter in future correspondence, it can be assumed that your medical officers will be required to carry out their present functions. The clinic needs of the borough divide themselves into three basic geographical areas, namely—Bedonwell, Abbey Wood and the Old Town areas. I suggest that the two former must be served by public health centres of a type similar in character to that at present at Hainault, but with much 58 extended facilities and accommodation. They should have consulting rooms for a medical officer who should be available for all school medicai work, and child welfare and maternity clinics of their area and should have properly equipped facilities for dental treatment and such other treatments as, for example, ultra violet light. With the increased development of the area the clinic built in 1938 at the Bedonwell School is now far too small, and due to the lack of a third clinic in the town several sessions are badly overcrowded. In the Old Town Ward, that is in Erith proper, I suggest that a Public Health Centre of a larger type with greater increased facilities should be available at, or adjacent to the borough's new town hall which, being at the transport centre of the town and contiguous to other developing areas should cater for the specialist requirements of the services. It should house the orthopaedic and ophthalmic clinics, the ear nose and throat specialist, the diabetic clinic, the main foot clinic of the borough, the specialist ante-natal clinic, and if possible, the chest clinic of the town. It should also have facilities for a child welfare clinic and school clinic for this area. In the building should be a pathological laboratory where bacteriological investigations could be made and I see no reason why the building should not incorporate, or have adjacent to it, a modern mortuary where post mortem examinations could be properly held, and also an ambulance centre. It should have a large hall with a platform which could be used for public health lectures and demonstrations, and it may well hold a dispensary where any medical prescription may be ordered, and in conjunction with the chest clinic an X-ray room which need not be on elaborate lines or hold too expensive equipment. A light treatment room would be an additional advantage and the dental rooms could well be housed on the first floor. The garages of the Public Health Ambulance Service should be adjacent and the relief ambulance driver could well be the resident caretaker of the Centre. The technician of the pathological laboratory would be the assistant for the post mortem examinations. One wing of the ground floor or the first floor of the building would house the present public health department and extra committee rooms might well be provided for the use of various sub-committees and for interviews. Finally I would postulate here that architects versed in hospital and clinic buildings should submit designs for the lay-out, and that the design should be such that it is capable of easy extension and 59 additions, and for this purpose copies of the Model Health Clinic demonstrated at the Glasgow Empire Exhibition in 1938, and of the Central Health Clinic of the Southampton Planning Committee of 1942 are enclosed. It will be noted that the former only deals with the lay-out of clinic rooms. Maternity Hospital. History tells us that the most promiscuous of men have not fathered many children, that many of the Don Juans of the past appear in fact to have been incapable of producing children, so that the contemporary gibe that, if Louis XV was not the father of all his people, he was of a great many of them, is rather an inaccurate witticism. Certainly human reproduction appears to be dominated by emotion more than by any other physiological function, but how far this may account for recent tendencies in the birthrate is difficult to assess. It would appear, however, that there is likely to be an increase in the number of births, at least during the next few years. The present plans of the Authority it will be remembered, are for a new maternity home of twenty-two beds which but for the present emergency would probably now be in being. Lying-in accommodation can, of course, be provided either in a separate hospital or in a maternity department of a general hospital. As most cases in a maternity hospital are normal with complications relatively rare and emergencies mainly obstetrical in character, I would urge that a maternity home or hospital is the more favourable project for an industrial borough. It is my opinion that confinements of expectant mothers either in a maternity hospital or a maternity home in an industrial area will find favour in the future with an increasing number of women. Admission to hospital for confinements should be arranged through the ante-natal clinics with the co-operation of the private practitioner, and the consultant obstetrician and the institutional facilities of the area should be firmly linked with the domiciliary, particularly with regard to staff. During 1943 there were a total of 822 births in Erith and I believe in the future that the greater proportion of these will occur in the borough's municipal institution. I would therefore suggest that the new maternity home should contain at least sixty maternity beds; ten of these would be for ante-natal patients, two to four beds for potential septic cases, ten beds and cots would be reserved to meet the needs of premature children in accordance with the recent Ministry of Health Circular 20/44. I would suggest that there should 60 be at least six single bedded wards of appropriate size (floor space) and that no ward with the exception of the ante-natal section should contain more than four beds. A nursery of appropriate size (floor space) should be provided to take all the babies at night and there should be four first stage rooms, four delivery rooms together with a sterilising room and a.sluice room. One of the delivery rooms may well be made larger and fitted up as an operating theatre. Adjoining the reception centre should be the ante-natal clinic with a separate entrance, waiting rooms and preparation rooms, etc. There should also be a small hand laundry for the infants napkins and garments. Finally I would suggest that the siting of the institution is important. It should not be in a noisy neighbourhood, it must not be too far from the main transport facilities, it should be planned so as to be capable of additional expansion which I think suggests a semi-permanent type of construction as well as an adequate acreage. If it is also possible to give a pleasant view and surroundings I believe that the mothers would appreciate it. Infectious Diseases Hospital. The Fever Hospital Medical Service Group of the Society of Medical Officers of Health printed in 1948 recommendations with regard to planning the fever hospital service. There has been much discussion on the possibility of combining general and fever hospitals, and this has arisen partly from the desire to eliminate small fever hospitals, and partly from the experience of some hospitals which, admitting only fever cases in pre-war days, are now functioning as combined general and fever hospitals under the emergency medical service. If the requirements of an area justify a fever hospital of economic size, the weight of opinion is distinctly in favour of such a hospital continuing to discharge its pre-war function, or largely so. In many respects the function of the fever hospitals is too limited in its scope. Acute infectious diseases, not uniformly admissible at present, such as for example measles, whooping cough, enteritis of childhood, streptococcal sore throat and acute primary pneumonia, should be made so. It is recommended that the minimum size of an effective fever hospital appears to lie at, or about, 200 beds, but as far as existing hospitals are concerned it would probably be justifiable to preserve those maintaining an average ;daily 61 occupation of 100 beds, or which had reasonable prospects of reaching such a figure by combining areas, anticipating rapid increases of population, etc. At the moment only two hospitals of Kent authorities have accommodation over 100 beds; the Bow Arrow Isolation Hospital at Dartford has 135 beds and the West Kent Joint Isolation Hospital, Bromley Common with 118 beds and cots, and neither of these institutions preserves an average daily occupation of 100 beds. The Erith authority has always, I believe in the past, exhibited the principle of providing its own services and since the year 1893 has maintained an isolation hospital for the benefit of the area. If this policy is to be continued it will be necessary to add additional ward accommodation to the present Sanatorium. I would suggest that this should be in the form of cubicle wards with a total capacity of 28-30 beds, preferably of the 66 T " Block or cruciform type including an operating theatre. m Additional accommodation for staff is also necessary, and the refitting of the present staff rooms and bedrooms with modern fitments is a matter of some urgency. Belvedere Marshes Development. I would again make reference to the Physical Training and Recreation Act 1937, Section 4 of which enacts that a Local Authority may acquire, lay out, provide with suitable buildings, and otherwise equip and maintain lands for the purpose of gymnasiums, playing fields, holiday camps, or camping sites, or for the purpose of centres for use of clubs, societies, or organisations having athletic, social, or educational objects. Having regard to the aforementioned Statute, I would submit to the Council for its consideration the possibilities of providing a holiday camp situated on the Belvedere Marshes. Within the purview of the scheme, I envisage suitable chalets for accommodation, tennis courts, swimming pools, puttinggreens, bowling green, community hall complete with cinema and or other entertainment and dance floor, together with children's playground including sand pits, etc. The proximity of Abbey Wood Station and the regular train service is an asset 62 to the scheme when it is realised that some 1,024,000 persons are resident within some 10 municipal authorities which are served direct by this branch of the Southern Railway. An analysis of the quotation on population is as follows : — City of Westminster 130,000 South war k 145,000 Bermondsey 99,000 Deptford 70,000 Greenwich 100,000 Lewisham 229,000 Woolwich 146,000 Erith 40,000 Crayford 25,000 Dartford 40,000 1,024,000 Should a portion of the Belvedere Marshes be suitably adapted on the lines which I have indicated, it may well be that one of London's playgrounds would eventually be situated within Erith's Administrative Boundary. REGINALD LEADER, Medical Officer of Health. BOROUGH OF ERITH. ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR 1944. EDUCATION COMMITTEE. Chairman :—Alderman Pannell. Vice-Chair man :—Councillor Farquhar . Alderman Bates. Alderman Ewens. Councillors: Burgess (resigned 1/2/44), Ebben, Ellis, Mantle, Firmin and Powrie. Mrs. F. West (nominated on March 22nd, 1944). Co-opted Id embers : G. M. Green, Esq., A. W. Laurence, Esq., Dr. J. B. Lobo, Dr. II. A. Maunder and Mrs. E. A. Munns. SCHOOL MEDICAL STAFF. School Medical Officer: Reginald A. Leader, m.r.c.s., l.r.c.p., d.p.h. Assistant School Medical Officers : Fritz Schenk, m.d. H. G. Williams, m.r.c.s., l.r.c.p. Orthopaedic Surgeon : E. A. Lindsay, f.r.c.s. Opthalmic Surgeon : F. (). Walker, m.r.c.s., l.r.c.p., d.p.m., d.o. A ural Suzgeon : A. B. Alexander, m.d. Dental Surgeon : T. A. Hall, l.d.s. School Nurses : Mrs. H. M. Lange, s.r.n., c.m.b., Miss A. Briggs. s.r.n. Clerks : Senior Clerk: Miss M. C. A. Smith. Miss D. Beacroft (resigned 21/3/44), Miss M. Johnson, Mrs. M. Fenner (appointed 13/3/44). Dental Clerk: Miss E. Bartlett (resigned 12/2/44). .. ' Mrs. Tucker (appointed 10/2/44) 4 Report of the School Medical Officer, 1944. Between the end of 1944 and the issue of this report, the Erith Education Committee has ceased to exist and the Kent County Council has become the Local Education Authority. My fifth report as School Medical Officer for Erith is also the last report of a school medical officer of this town after the school medical service has been in existence for 37 years. I can only speak personally of the last five years and in retrospect this has been as difficult a period of time as it is possible to imagine, complicated by every kind of known aerial attack with consequent oscillations and variations of the school population between each fresh evacuation. And yet they have been years of definite progress each marked by some new development of the school medical service which I think should be recorded. The recruitment of a full time dental officer in 1940, the new separate dental clinic in 1941 adjacent to the minor ailment clinic, the new weekly skin clinics for scabies and the doubling of the specialist orthopaedic sessions in 1942, the erection of the new Hainault School clinic and the inauguration of a new monthly specialist aural clinic in 1943, the doubling of the ear, nose and throat clinic, and the increase in the percentage of school population examined at the routine medical inspections from 13 per cent, in 1940 to 79 per cent, of the school children in 1944, are all extensions and developments worthy of mention, to be compared with the next five years. I have been privileged during the last few months to participate in a good deal of work done on behalf of the noncounty boroughs in efforts made to obtain some practical recognition of their past successes in the field of School Medicine, and in this I have met County Medical Officers and Medical Officers of the Ministry. It is agreed, I think, that the future practice of the School Medical Service will be founded on a genuine partnership between the County Authority and those who are to work in the Divisional Executive, and this has led to the appointment of Divisional School Medical Officers and the delegation of much local administration to these Officers. The local Medical Officer of Health has been given the right in manjr cases to include in his annual Public Health report an account of his work done as Divisional School Medical Officer 5 and this is gratifying for the school medical service is after all an integral part of the environmental hygiene, and it would surely be a retrograde step to try and isolate it from the other health services of the town or district. While the last two sentences may apply to the greater part of England and Wales, the position at the moment in this county is a little obscure as no meetings between county district medical officers of health and the county medical staff has been held this year to discuss the implementation of the Education Act, 1944, and no divisional school medical officers so far, have been appointed in Kent. 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 1944, there were 3,882 children on the roll of the elementarv schools, distributed as follows: — Nursery Classes 83 Infants Schools 845 Junior Mixed and Infants Schools 286 Junior Schools 1422 Senior Schools 1196 THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. No. of children on School Roll 3832 No. of individual children who attended medical clinics 2917 No. of individual children medically examined at schools 3028 No. of medical examinations at the clinics 8300 (i) Hainault 7584 (ii) Bedonwell 716 No. of inspections for uncleanliness and verminous conditions (school nurses) 10325 No. of attendances for treatment at the Dental Clinic 2588 No. of treatments at the Eye Clinic 350 No. of spectacles prescribed 199 No. of operations for Tonsils and Adenoids 37 No. of attendances at the Orthopaedic Clinic 488 (i) For consultation 321 (ii) For treatment, massage, etc. 167 No. of attendances at Ultra Violet Rav Clinics 139 Medical Inspection. The comprehensive system of medical inspection commenced in 1941 has been continued throughout the present year. The incidence of the flying bombs, from the 15th June until the second week in September, resulted in a decrease in 6 attendances at both schools and clinics. In the subsequent evacuation of mothers and children, the number of medical examinations carried out, prior to their removal were as follows: — Unaccompanied Children Expectant Mothers and mothers with 288 children under 5. Mothers Children—5 yrs. and over. 290 600 The following table gives the number of routine medical examinations made during the last eight years : — Year No. of School Children on Register No. of Routine Medical Exams. Percentage of Children examined (R.M.I.) 1944 3832 3028 79.01 1943 4723 2175 46.05 1912 4742 3212 67.77 1941 3943 1181 29.95 1940 3086 413 13.38 1989 5131 785 15.29 1938 5125 1689 32.95 1937 4982 1581 31.73 Malnutrition. Provision of Meals and Malt and Oil. On referring to Table 44 B,,? and comparing these figures with those for last year, the following facts emerge : — In the first age group entrants, there were 12.17 per cent, in 4 A ' (excellent), an increase of 5.87 per cent. ; 57.39 per cent, were in 4 B * (normal), an increase of .79 per cent. ; 27.82 per cent, in 4 C ' (slightly sub-normal), a decrease of C.28 per cent. ; and there were 2.6 in 4 1) ' (bad), a decrease of .2 per cent. In the second age group, 8 year olds, there were 14.81 per cent, in 4 A,' an increase of 8.31 per cent. ; 57.93 per cent, in 'B,' an increase of .13 per cent.; 31.21 per cent, in 'C,' a decrease of 2.99 per cent., and 2.91 per cent, in 'D," an increase of 1.61 per cent. In other routine inspections, there were 20.02 per cent, in 'A,' 55.08 per cent, in ; 'B' 22.24 per cent, in 'C,' and 2.63 per cent, in 'D.' School Meals. The School Meal Service has been functioning now for over 2 years, and much progress has been made. As I have never previously reported on this, perhaps it is worth while since I may not have the opportunity at a later date, to describe briefly the arrangements and premises at the various schools, as there are slight differences in the six canteens. 7 The two Central Schools, at Picardy and at Northumberland Heath, have canteens in the school grounds, although in the case of the Northumberland Heath Schools the canteen is adjacent to the British Restaurant in Belmont Road. In the case of each of the four other groups of schools, premises continuous with school grounds have been acquired for the combined feeding of both the school population and the general public. In two instances, at Bedonwell and at the Corinthian British Restaurant which serves the West Street School, new buildings have been erected—in the case of Bedonwell a central kitchen serving the school meals to the one side and the public restaurant to the other side. The Fourseas British Restaurant is an adapted premises on the same plan as Bedonwell, the school canteen serving the St. Augustine's Road School on the one side, and the public restaurant on the other side. At the Manor Road British Restaurant the old school buildings have been adapted and rebuilt to serve the general public and the Crescent Road School. It will be noted that in all but the one instance of the Picardy Central Schools the school canteening is combined with the public feeding of the district, and it should be mentioned that the same premises are utilised for the town's emergency feeding following enemy action. The fact that the catering Manager of these three municipal services is also the Borough Electrical Engineer, is well reflected in the modern lay-out and heating apparatus in the various kitchens, and this amalgamation of the three services with its decentralisation into six main groupings ensures that adequate kitchen space is always available, and obviates the need for packing and transporting meals in containers. The meals are served hot over the counter which conserves the vitamin C content of the cooked vegetables usually lost in meals cooked centrally and transported in containers. A weekly copy of the proposed menus for the school meals is sent to the School Medical Officer in advance and dietetically it would be easy to criticize them. In the early days they certainly lacked variety but they have much improved in this respect. Many voluntary workers together with the teachers have given most generously of their time and rendered yeoman service. I consider this service contributes in no small measure to the maintenance of the good physical condition of the school children in the town. The following table illustrates the number of attendances at the school canteens, including holiday periods, during the year : —  North Heath Bedonwell Picardy St. Augustines West St. & St. Fidelis Crescent Road Bedonwell Nursery Crescent Rd. Nursery January 8353 8449 4831 5295 4574 1477 1601 310 February 7721 7558 4388 4633 4293 1481 1501 260 March 11126 10091 6119 6417 6185 2116 1805 333 April 5627 5225 2991 3409 3369 1094 1018 165 May 9053 8683 4439 5124 4984 1610 1834 238 June 5634 5168 2963 2962 3291 1147 1159 179 July 3258 2750 1626 1144 1718 571 694 165 August 2022 1301 1128 844 739 457 273 51 September 5378 3955 2852 2133 1832 747 905 151 October 5078 4441 2490 2456 2310 750 1042 121 November 8462 7110 4157 4205 . 4918 1072 1866 211 December 4848 3955 2449 2474 1931 738 942 128 76560 68686 40433 41096 40144 13260 14640 2312 9 Malt and Oil. Total amount issued during the year 2878 lbs. Amount issued free 2057 lbs. No. of children who received free issues 162 Amount sold at cost price 821 lbs. At the end of the year a total of 238 children were receiving free milk at school. Ear, Nose and Throat Defects. Individual defects are shown in Table III (Group III), others being included in Table III (Group I). Mr. A. B. Alexander continues to act as your laryngologist and aural surgeon. The Ear, Nose and Throat Clinic, opened in October, 1943, continued until August, 1944, when, in view of the waiting lists, the sessions were increased from one to two per month. The cases examined at these clinics were as follows:— Re- Re-exam. Recommended New Cases Post TOTAL examination Operation operation 160 33 25 218 86 Unfortunately, as a result of the resumption of enemy activity, the Southern Hospital, with whom we have arrangement for operative treatment, were unable to admit patients after June, 1944, with the exception of one or two special cases. In all, 37 children received operative treatment. Visual Defects and External Eye Disease. Table IV (Group II) gives the extent of the ophthalmic work of the Eye Clinic. There was an increase in the number of children treated for errors of refraction and it was necessary to continue the weekly sessions of the Specialist Ophthalmic clinic throughout the year. A total of ten children were recommended to hospital for operative treatment, three suffering from Strabismus, two with Chalazion and five cases suffering from Lachrymal Obstruction. Two young children were submitted for admission to Sunshine Homes, one being certified under the Blind Persons' Act. In addition to these cases, the following defects were treated:— Styes 7 Seborrhoeic blepharitis 4 Hordeoleum 1 Conjunctival hyperaemia 7 Phlyctenules 1 Trauma 2 F.B. in eye 2 Post operative Ptosis 1 10 Dermoid 1 Meibomian Cyst 3 Exophoria 1 Dental Defects. Considering the disturbances in the town during the year, I think the statistics as illustrated in the following table can be regarded as satisfactory. The actual number of dental inspections is approximately double that of the previous year and the dental condition of the school children continues to improve. It is hoped that ultimately every child will be inspected at least once during the year, and if this can be achieved it should reduce the number of extractions required and also minimise the extent of conservative treatment. It is gratifying to note that the total number of attendances for treatment shows an increase over the previous year. Dental Inspection and Treatment. (1) Number of children inspected by the Dentist. (a) Routine Age Groups Total Age 5 6 7 8 9 10 11 12 13 14 Number — 42 227 185 179 168 388 341 574 20 2124 (b) Specials 462 (c) TOTAL (Routine and Specials) 2586 (2) Number found to require treatment 870 (3) Number actually treated 439 (4) Attendances made by children for treatment 2588 (5) Half-days devoted to: Inspection 120 Treatment 480 600 (6) Fillings:— Permanent Teeth 1214 Temporary Teeth 175 1389 (7) Extractions:— Permanent Teeth 218 Temporary Teeth 1151 1369 (8) Administrations of general anaesthetics for extractions 691 (9) Other operations:- Permanent Teeth 73 Temporary Teeth 12 TOTAL 85 11 Orthopaedic and Postural Defects. Mr. E. A. Lindsay, F.R.C.S., continues to act as your consultant Orthopaedic surgeon in the continued absence on war duty of Mr. W. Eldon Tucker. Although the majority of cases attending the Orthopaedic Clinic are suffering from flat feet and knock knees, a number of more serious cases continually appear. Recently there have been four cases of congenital dislocation of the hip, two of these children having both hips affected and requiring treatment in special plaster splints. There are also six cases of paralysis due to infantile paralysis and congenital spasticity, and a few of the cases of surgical tuberculosis are being treated quite successfully as out-patients at the Clinic. Accidents such as fractures and injured limbs appear at times but these have to be treated in conjunction with the local hospitals, usually the Erith District Hospital. 'The lack of a masseuse to treat these cases as well as those suffering from such spinal deformities as scoliosis and bad posture has been a serious drawback. We have to depend on the patients doing their own exercises when shown, and also on adjustments to shoes. 'The more serious of such cases have therefore to be sent to the hospitals for treatment, but this may take much valuable school time as well as tending to overload busy massage departments. I feel sure the general welfare of these children would benefit materially if a masseuse could do this work at the borough's orthopaedic clinic. The following is a list of cases which have attended the clinic:— School Children. Infant Welfare. Flat Feet 87 44 Flat Feet and G.V. 10 26 Flat Feet and Hallux Valgus 1 — Flat Feet and Bow Legs — 1 Flat Feet and Stoop 4 — Flat Feet and Deformed sturnum 1 — R. Equino Varus 1 — Turns foot in—out 1 3 Intoeing — 1 Foot Strain 8 4 12 Deformed Toes 3 3 Deformed Feet 1 — Hammer Toe 1 — High arches and G.V. 1 — G.V 4 — Pollux Valgus 1 9 Metasalgia 1 — Metatarsal Varus — 3 Valgus ankles 3 1 Lump on ankle 1 — Wears heels — 1 Bow Legs — 13 Hallux Rigidus 2 — Enlarged Right Leg 1 — Smaller Left Leg — 1 K.K. — 1 Pains Scapular 1 — ,, Thigh 1 — ,, Dorsal — 1 ,, Feet 1 1 ,, Ankle 1 — A.P.M. 5 2 O.C.T — 3 Limp — 1 R. Arm and Leg — 1 Swelling Knee 1 — Torticollis 2 3 Dislocated Hip — 1 Subluxation R. Hip — 1 Cerebral Diplegia — 1 Weak Legs 1 2 Congenital deformities 2 — Congenital broken R. femur 1 — Short R. Leg—L. Leg 2 — Scoliosis 1 — R. Dorsal Scoliosis 1 — Scoliosis and stoop 2 — Stoop 11 — Hollow back 1 — Spinal curvature 2 — Kypho - lordosis 1 — Slack back 1 — Spastic Paresis 1 — C.E.V. & R 1 — Osteomyelitis L. femur 1 — Asthma 1 — 13 Scaphoids promin. 1 — Fibrositis 1 — Bulge R. Leg — 1 Adenoids — 1 Epiphysitis 1 — Hamstrings very tight 1 — General Health 1 3 188 133 INFECTIOUS DISEASES Scarlet Fever. Cases of Scarlet Fever were notified throughout the year and 55 of these were school children. Of this number 34 children were admitted to the borough's isolation hospital, the remainder being nursed at home under the supervision of their private practitioners. Practically all were mild cases and only two of those admitted to the isolation hospital developed complications, in both instances this being due to Otorrhoea which healed satisfactorily. Two other cases admitted to the hospital were found to be also suffering from Scabies. Measles. Only 44 cases of measles were notified during the year and of these 9 were school children, no serious illness being recorded. Whooping Cough. As noted in the medical officer of health's report, there was an outbreak of whooping cough in the first half of the year. 38 school children were notified but no severe cases occurred. Only one of these children had had the protective treatment, nearly three years previously in 1941, for immunisation against whooping cough. Diphtheria. Only two children were notified as suffering from diphtheria in 1944 and both made excellent recoveries. This is a splendid tribute to the immunisation campaign and the figure for school children immunised against diphtheria is now 93.31 per cent, of the school population. Arrangements are still in force under which any school children can obtain this preventative treatment free of cost on any weekday at the school clinic, without previous appointment. The following table illustrates the number of school children immunised:— 14 Month DIPHTHERIA A.P.T. and TERTUSSIS Under 5 years 5—15 years Under 5 vears 1st 2nd Comp'd 1st 2nd Comp'd 1st 2nd 3rd Jan. 41 28 28 7 13 13 1 — — Feb. 42 45 45 9 9 9 — — — March 39 37 37 6 15 15 3 1 5 April 40 34 34 5 15 15 2 1 1 May 42 25 25 4 5 5 3 — 1 June 48 34 34 3 7 7 1 2 1 July 32 36 36 2 — — — 2 — August 4 16 16 1 2 2 — — — Sept. 46 20 20 — — — — — — Oct. 33 23 23 — 2 2 — — — Nov. 59 44 44 4 2 2 — — — Dec. 14 36 36 4 3 3 — 2 3 Totals 440 378 378 45 73 73 10 8 11 15 TABLE I. Medical Inspections of Children Attending Public Elementary Schools. A.—Routine Medical Inspection. Entrants 115 Second Age Group 378 Third Age Group 373 No. of other routine inspections 2162 Total 3028 B.—Other Inspections. Number of Special Inspections and Re-Inspections 5768 TABLE II. Age-G roups Number of Children inspected A Excellent B Normal C Slightly subnormal D Bad Entrants 115 No. % 14 12 17 No. % 66 57.39 No % 32 27.32 No. % 3 2.6 Second AgeGroup 378 56 14 81 193 57 93 118 31.21 11 2 91 Third AgeGroup 378 82 21.98 222 59.51 66 17.69 3 80 Other Routine Inspections 2102 433 20. 02 1191 55 08 481 22.24 57 2.63 Total 3028 585 19.31 1672 55 21 697 23.01 74 2.44 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 — — — — — 16 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 7 5 — — 12 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1944. TREATMENT TABLE. GROUP I.— MINOR AILMENTS. (excluding Uncleanliness, for which see Group V). Disease or Defect 1 Nuirber of Delects treated, or under treatment during the year Under the Authority's Scheme 2 Otherwise 3 Total 4 Skin— Ringworm—Scalp 2 1 3 (i) X-Ray Treatment. If none, indicate by dash. — — — (ii) Other Treatment — — — Ringworm—Body — 1 1 Scabies 92 3 95 Impetigo 57 1 58 Other skin disease 391 5 196 Minor Eye Defects (External and other, but excluding cases falling in Group II). 35 3 38 Minor Ear Defects 91 13 104 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 669 16 685 Total 1137 43 .1180 17 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) 343 5 348 Other Defect or Disease of the Eye (excluding those recorded in Group I) 7 — 7 Total 350 5 355 No. of children for whom spectacles were prescribed: (i) Under the Authority's Scheme 199 (ii) Otherwise 4 No. of children for whom spectacles were obtained: (i) Under the Authority's Scheme 166 (ii) Otherwise 4 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 5 37 8 45 28 73 18 GROUP IV.— ORTHOPAEDIC AND POSTURAL DEFECTS. Under the Authority's Scheme (1) Otherwise (2) Total number treated Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedicclinic Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — 321 — — 4 325 TABLE V. Uncleanliness and Verminous Conditions. (e) Average number of visits per school made during the year by the School Nurses 5 (2) Total number of examinations of children in the Schools by School Nurses 10,325 (3) Number of individual children found unclean 213 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 73 (5) Number of cases in which, legal proceedings wore taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —