ERI 25 BOROUGH OF ERITH. ANNUAL REPORT OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1945 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 1945 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 7 (a) General 7 (b) Births 7 (c) Deaths 7 (d) Infantile Mortality 8 (e) Vital Statistics of District 8 (f) Causes of Death 9 (g) Birth-rate, Death-rate and Analysis of Mortality 10 2. Maternal Mortality 11 3. Infantile Mortality 12 4. Unemployment Figures and Comments 12 B Maternity and Child Welfare Services. 1. Maternity and Child Welfare Scheme 13 2. Notification of Births Table 14 3. Infant Welfare Centres 15 4. Home Visits by Health Visitors 16 5. Maternity Services 16 (a) Maternity Home—Hainault 16 (b) Ante-natal 17 (c) Abnormal Cases 17 6. Infant Life Protection 17 7. Midwives 18 8. Dental Clinic 18 9. Home Help 18 C Prevalence of and Control over Notifiable Infectious Diseases. 1. Infectious Diseases' Hospital 19 2. Tables 20 (a) Notifications 20 (b) Scarlet Fever 20 (c) Diphtheria 21 (d) Measles and Whooping Cough 21 (e) Age Distribution 22 (f) Scabies 23-24 i Section C (continued). Page 3. Diphtheria Immunisation 24 4. Smallpox 24 5. Disinfection of Premises 24 6. Laboratory Facilities 25 7. Tuberculosis 25 (a) Treatment and Hospital Accommodation 25 (b) Tables (i) Particulars of New Cases and Deaths 25 (ii) Quarterly Statement 26 8. Ear, Nose and Throat 27 D Hospital and Ambulance Facilities. 1. General . 27 2. V.D. 27 3. Children 27 4. Ambulance Facilities 27 5. Mortuary 28 E Water Supply—Milk and Food and Drugs. 1. Water Supply 28 2. Cowsheds, Dairies and Milk Stores 29 3. Bacteriological Examination of Milk 29 4. Examination of Milk for Tubercle Bacilli 29 5. (a) Designated Milk 29 (b) Phosphatase 30 6. Food and Drug . Act 1938, Section 3 and 68 30 7. Meat and Food Inspection 31 8. Slaughter of Animals Act, 1933 31 F Sanitary Circumstances of the Area. 1. Sanitary Inspection of Area 31 (a) Visits by Sanitary Inspectors 31 (b) Premises visited and results of such visits 32 (c) Summary of Nuisances and Defects Remedied during the year 32 (d) Offensive Trades 33 (e) Closet Accommodation and Cesspools 33 (f) Smoke Abatement 33 (g) Swimming Baths and Pools 33 ii Section F (continued). Page (h) Schools ... ... ... ... 33 (i) Camping Sites ... ••• ... 33 (j) Hop Pickers ... ... ... 34 (k) Rag Flock Act ... ... ... 34 (1) Eradication of Bed Bugs ... ... 34 (m) Cleansing of Verminous Persons ... 34 (n) Mosquito Control ... ... ... 34 (o) Rodent Control ... ... ... 35 Housing. 2. (a) Inspection of Dwelling Houses during year ••• ... ... ... 35 (b) Remedy of Defects during the year without service of Formal Notices 35 (c) Rent and Mortgage Interest tions) Act, 1939 ... ... 36 3. (a) Shops Act 1912-1938 37 (b) Offices ... ... ... ... 37 (c) Factories ... ... ... ... 38 4. (a) Health Education—Civic Week ... 38 5. Legislation in Force ... ... ... 40 G 1. (a) Refuse Collection and Disposal ■ ■ • 40 (b) Costs ... ... ... ... 40 (c) Details of the Refuse Collection Vehicles and Staff ... ... 40 (d) Details of the Tonnage dealt with during the year ... ... 41 (e) Trade Refuse ... ... ... 41 (f) Salvage ... ... ... ... 41 H General. 1. Letter by Medical Officer of Health ... 2 2. Members of Committees ... ... 4 3. Staff of Public Health Department ... 5 iii 2 To the Mayor, Aldermen and Councillors of the Borough of Erith. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my sixth Annual Report oil the Health Services of the Borough for the year 1945, the year of Victory. Social medicine of which we have heard so much of late, is another name fbr work which medical officers of health have been doing ever since they came into existence nearly 100 years ago. Exploring social conditions and their influence on health is the everyday task of the health department, and the annual reports of medical officers of health therefore are the main source of knowledge of social medicine. Moreover public health is dependent more on environment and education than on medicine and the formation of healthy habits, the development of the right outlook on health, social hygiene, educational facilities, and opportunities to make the best use of leisure are the fundamental principles on which to base the people's health. The statistics for 1945 are generally satisfactory. The general death-rate, 11.78 per 1,000 of population, is again slightly above the rate of 11.4 for the county, comparing favourably with 13.8 for the Administrative County of London, and with 13.5 for the larger towns. The birth rate of 19.13 is less than that fbr 1944 but higher than in the 15 pre-war years, and the infant death rate of 39.61 compares well with the rate of 45 per 1,000 births for whole of England and Wales. For some decades now the production of children has been increasingly a rational act, and the biological revolution in which sex has been separated from child bearing can hardly have been wiped out since 1941 when the increase in the birth rate became so noticeable. The wave of marriages experienced since the outbreak of war may supply a reason and a shortage of contraceptives might account for a small proportion of the additional births. 3 The magnitude of the problems of war and lack of security may have increased the individual's sense of isolation in the community, making marriage the shock-absorber and children once again the main source of pleasure and interest. One may hope that this will emphasize the importance of the home and all it stands for in the social sense. In 1909 your Medical Officer of Health estimates the population of the town as 31,235 persons inhabiting 5,700 houses, and records the fact that 17 new houses were built during that year. In 1945 with a population of 38,270 there are 11,205 houses—a decrease of 100 houses on the previous year although new dwellings have been completed during the twelve months under review. Despite intense activities by the local authority the need for new houses is already an urgent one, for a family without a house is a family without a home. Perhaps the most remarkable feature of the (vital) statistics is the entire absence of maternal deaths during the year. It may reasonably be claimed that this surprising absence of maternal mortality reflects the well developed maternal health service which you have always so heartily encouraged. The number of cases of infectious disease is again low, with only five notified cases of diphtheria to record and again no deaths. 67 per cent, of school children and 81.4 per cent, of children from the age of one to five years have now completed the course of immunisation against this disease. With the cessation of hostilities and the dispersal of the Civil Defence Services the ambulance service has come within the province of the Public Health Department, and two new vehicles of the latest type and fitted with the most modern items of equipment have been added to this valuable service. In April, 1945, the School Health Service came under the general control of the Kent County Council, and the records of medical inspection and treatment are included in the report. The staff have continued to give efficient and loyal service, and it is to them that I am indebted for any success obtained, " I have only made a nosegay of culled flowers and have brought you nothing of my own, but the thread that ties them together." I have the honour to be, Your obedient servant, REGINALD LEADER, Medical Officer of Health. November, 1946. 4 H (2). MEMBERS OF COMMITTEES. Health Committee. Councillor Alford Councillor LeFebvre. ,, Baker. ,, Stevens. ,, Ellis. ,, Watkins. ,, Handy. ,, Wright. Maternity and Child Welfare Committee. Councillor West. Councillor LeFebvre. ,, AlFORD. ,, PoWRIE. ,, Baker. Alderman Christian. ,, Handy. ,, Ewens. Co-opted Members. Mrs. S. A. Hyde, Mrs. H. A. Jerome, Miss Johnson. Ex-officio Members of Both Committees. His Worship the Mayor. Deputy Mayor. Alderman Luck. 5 H (3). STAFF. 1. Whole-time. Medical Officer of Health, School Medical Officer, Medical Officer in Charge of Sanatorium for Infectious Diseases and Maternity and Child Welfare, Milk Officer, Borough Salvage Officer— Reginald A. Leader, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers of Health and Assistant School Medical Officers— F Schenk, M.D. (Deceased 25-11-45). H. G. Williams, M.R.C.S., L.R.C.P., D.P.M. Senior Sanitary Inspector—L. E. King, M.R. San. I., Certificate R.S.I., Certificate S.I.E.B. Meat Inspectors Certificate, Certificate of Advanced Knowledge in Duties of Sanitary Inspector, Certificate in General Hygiene & Sanitation, Certificate R.I.P.H. & H. Sanitary Inspectors— W. E. Moses, Certificate S.I.E.B. Meat Inspectors Certificate, B.A.G.S. O. B. Dodds, Certificate S.I.E.B. (Appointed 3-9-45). Sanitary Foreman Sf Disinfecting Officer— H. Wr. Cooper. Health Visitors—• Miss I. P. Burt, S.R.N., S.C.M., R.F.N., H.V. Certificates. Miss D. Hellett, S.R.N., S.C.M., H.V. Certificates. Miss T. M. Torpie, S.R.N., S.C.M., H.V. Certificates. Miss C. E. Vesey, S.R.N., H.V. Certificate. Miss M. A. Williams, S.R.N., S.C.M., H.V. Certificates. Matron Infectious Disease Hospital— Miss P. Jay, S.R.N., R.F.N. (Res. 30-4-45—Ememy Action— Sanatorium closed). Sister in Charge of Maternity Home— Miss L. M. Barclay, S.R.N., S.C.M. Matron War Time Nursery, Bedwell Road— Mrs. W. Hill, S.R.N., R.F.N. (Transferred to Riversite 30-9-45—Bedwell closed). 6 Matron, Franks Park Nursery— Miss O. Williams, S.R.N. Matron, Lessness Abbey Nursery— Miss J. Grayson, R.S.C.N. (Resigned 30-5-45—Lessness Abbey Closed). Matron, Riversite Nursery— Mrs. A. Coombes, S.R.N. (Resigned 30-9-45). Miss W. Hill, S.R.N., R.F.N. (Transferred from Bedwell Road, 30-9-45). Clerks. Chief Clerk— T. H. Prestage (Commenced 25-6-45). Deputy Chief Clerk and Senior School Clinic ClerkMiss M. Smith. General Clerks. Maternity and Child Welfare— Mrs. G. P. McPherson. Accounts and Infectious Disease— Miss G. M. Newton. Public Health— R. Durey, M.R.I.P.H.H. (H.M. Forces 2-1-41). Home and Domestic Helps—Miss W. Lill. War Time Nurseries—Mrs. E. L. Hewitt. Shorthand Typist—Miss J. Beaumont. Junior Clerk, Public Health—M. Butler. School Medical Service—Mrs. Fenner (Resigned 30-11-45). Mrs. Tucker. Miss Johnson. 2. Part-time. Consulting Surgeon for Aural Diseases— T. P. Gill, F.R.C.S. Ante-Natal Consultant— J. V. O'Sullivan, M.D., B.Ch., F.R.C.S., M.R.C.P., M.A.O., M.C.O.G. Consulting Obstetrician— A Galletly, M.C., M.B., F.R.C.S.(Ed.) Details of members of the staff of the School Medical Service are embodied in the report to the Education Committee. 7 SECTION A—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Annual Report 1945. A(l). SUMMARY OF STATISTICS. A(1)a. General. Area :—4,607 acres. • Population :—38,270. Density of population, i.e. number of persons per acre : — 8.3. Number of inhabited houses:—11,265. Rateable value 1945 :—£324,521. Sum produced by a penny rate 1945 :—Estimated £1,300. A(1)b. Births. TOTAL. Male. Female. Live Births. Legitimate 698 346 352 Illegitimate 34 17 17 Total 732 Live Birth rate per 1,000 of population (Registrar General's figures):—19.13. Corresponding rate for 1944 : — TOTAL. Male. Female. Stili.-Births. Legitimate 17 9 8 Illegitimate — — — _ 17 Still birth rate per 1,000 births:—22.70. A (1) c. Deaths. Males—237. Females—214. Total—451. Death rate per 1,000 of population:—11.78. Corresponding rate for 1944 :—12.3. Number of women dying in or in consequence of childbirth :—Nil. Maternal Mortality per 1,000 total registered births :—Nil. Comparative figure for England and Wales:—1.69. 8 Diarrhoea (under 2 years) Whooping Cough (all ages) Measles (all ages) live births:—39.61. Total number of deaths from : — Death rate of infants under one year of age per 1,000 Illegitimate Legitimate A(l)d. Infantile Mortality. Deaths of Infants under 1 year of age : 29 3 26 TOTAL. 3 — — 1944 3 9 Male. — 1 — 1945 — 17 Female. A(1 )e. Vital Statistics of Whole District during 1945 and previous years. Year Population estimated to middle of each year Births Total Deaths registered in the District Transferable Deaths Nett Deaths belonging t« the District Uncorrected Number Nett ot Non-residents 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 Rirths No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1936 36,380 580 510 14.18 243 6.67 17 186 30 58.82 412 u.324 1937 38,240 656 605 15.82 262 6.85 27 180 28 46.28 415 10.852 1938 39.800 668 656 1648 273 6.83 17 134 34 53-62 39° 9799 1939 41,870 716 745 17.79 253 6.14 21 220 3i 44.28 452 10.984 1940 40,210 656 721 17.8 273 6.78 22 235 24 3717 486 12.08 I94I 36,520 554 606 16.6 293 8.02 32 212 23 3795 473 17.00 I942 37.340 775 734 19 6 259 5-93 20 126 26 35-4 415 II.1 1943 37.890 868 822 21.6 286 7-54 30 183 35 42.57 439 II.58 I944 36,780 882 895 243 315 8.20 22 170 44 49.16 463 12-3 1945 38,270 826 732 I9-I3 295 7-71 23 156 29 39.61 451 II 78 9 A (1) f. Table showing summary of Causes of Death during the year ended 31st December, 1945. Cause of Death Males Females Total 1 Typhoid Fever, &c. 2 Cerebro-spinal Fever — — 3 Scarlet Fever — — 4 Whooping Cough — 1 1 5 Diphtheria — — 6 Tuberculosis of resp. system 11 13 24 7 Other forms of Tuberculosis 2 I 3 8 Syphilitic diseases 3 2 5 9 Influenza 2 3 5 10 Measles — 11 Ac. polio-myel. & polioenceph — — — 12 Ac. inf. enceph 2 — 2 13 Cancer of b. cav. & oesopli 4 2 6 14 Cancer of stomach and duodenum 2 4 6 15 Cancer of breast - 3 3 IS Cancer of all other sites 30 26 56 17 Diabetes - 1 2 18 Intra-cran. vase, lesions 23 27 50 19 Heart disease 75 54 129 20 Other diseases of circ. system 6 3 9 21 Bronchitis 16 4 20 22 Pneumonia 6 8 14 23 Other resp. disease 5 3 8 24 Ulcer of stomach or duodenum . 6 6 25 Diarrhoea under 2 yea - - — 26 Appendicitis 1 — 1 27 Other digve. dis. 5 5 10 28 Nephritis 2 6 8 29 Puer. & post-abort, sepsis — — — 30 Other maternal causes — — — 31 Premature birth 2 7 9 32 Con. mal. birth inj. infant dis. 3 8 11 33 Suicide 1 4 6 34 Road traffic accident 2 — 2 35 Other violent causes 9 13 22 36 All other causes 17 16 33 Total all causes 237 214 451 10 A(1 )g. Table showing Birth-rate, Death-rate, and Analysis of Mortality during the year 1945. Provisional figures. The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only Rate per 1,000 total population Annual Death-rate per 1,000 population Rate per 1,000 Live Births Live Births Still Births All Causes Typhoid and Paratyphoid Small-pox Measles Whooping Cough Diphtheria Influenza Diarrhoea & Enteritis (under Two years) Total Deaths under one year England and Wales 126 County Boroughs and Great Towns, including 16.1 0.46 11.4 0.00 0.00 0.02 0.02 0.02 0.08 5.6 46 London 148 smaller towns resident population 25,000 19.1 0.58 13.5 0.00 0.00 0.02 0.02 0.02 0.07 7.8 54 50,000 at 1931 census 19.2 0.53 12.3 0.00 0.00 0.02 0.01 0.02 0.07 4.5 43 London Adm. County Erith (Estimated 15.7 0.40 13.8 0.00 0.00 0.01 0.02 0.01 0.07 7.6 53 tion 38,270 19.13 0.44 11.78 0.00 0.00 0.00 0.03 0.00 0.13 0.0 29 11 A (2) Since 1920 there have been 15,720 births with 40 maternal deaths as shown below, giving a Maternal Mortality rate of 2.55. Year M iternal Deaths Total Births (including still births) Registered Live Births 1921-23 7 2002 1933 1924 1 558 526 1926 — 602 548 1926 8 546 497 1927 — 532 532 1928 3 513 513 1929 1 558 547 1930 2 505 488 1931 — 501 492 1992 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 a 762 775 1943 1 843 868 1944 2 913 895 1945 — 826 819 Total 40 15720 15194 12 Maternal Deaths are investigated by the Medical Officer of Health, in collaboration with the medical practitioner and midwife concerned. A (3). Infantile Mortality. 29 infants died before reaching one year of age, giving an infantile mortality of 39.61. This figure is a valuable index of the social and child welfare services of the borough. The comparable figure for the whole country is 46 and 53 for the administrative County of London. Analysis of the cause of death at this age group reveals the following figures : — Deaths from :— Prematurity and Debility 9 Bronchitis and Pneumonia 6 Whooping Cough 1 Gastro Enteritis 1 Marasmus and General Debility — T. B. Meningitis 1 Other Causes:— Atelectasis 3 Respiratory failure 1 Melaena Neonatorum 1 Intestinal Obstruction 1 Syncope 3 Haematemesis 1 Spina Bifida 1 Total 11 Grand Total 29 I have included a table showing the Infantile Mortality at 5 year intervals for the past 25 years and for 1945. Erith England and Wales 1915 73.17 91 1920 61.5 83 1925 56.48 75 1930 61.05 66 935 40.0 39 1940 37.7 55 1944 40.16 46 1945 39.61 46 13 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. 1938 934 169 40 16 i>59 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 Dece nber, 1945 91 133 1 1 226 SECTION B.—MATERNITY AND CHILD WELFARE SERVICES. B(l). Maternity and Child Welfare Scheme. With the cessation of hostilities the child welfare services . were able to function more normally, as did the specialist clinics. The total attendances iscreased by over two thousand (2059) an increase of 8.7 per cent, as compared with the previous year, although the actual numbers attending the Belvedere Centre shows a small reduction. The number of medical consultations held was nearly 3 per cent (102) less than in the preceding twelve months, this being due to illness and consequent changes of staff. Hunu i.t Xkw Pbkmatirk Ward. N.B. This table compiled on figures of births actually notified in district. Month Births Sex Legitimacy Notified by B (2). Live S'born M F Leg. Meg. Midwives Hosp. etc. Doctors M K M F January 86 — 1 43 44 83 4 — 19 68 — February 69 — ' — 38 31 63 5 1 22 45 2 March 71 — — 38 33 66 1 4 11 60 April ... 53 — 1 23 31 50 3 1 9 45 — May 61 — — 24 37 57 1 3 15 45 1 June 73 — 1 42 32 70 3 1 12 62 — July 70 1 — 33 38 65 3 3 11 59 1 August 65 1 — 35 32 61 3 3 16 51 — September 61 — 1 37 25 57 2 3 14 48 October 76 4 1 47 34 79 2 — 17 64 — November 61 1 1 33 30 59 3 1 10 50 3 December 65 — 1 33 33 62 1 3 11 55 — Total 812 7 7 426 400 772 31 23 167 652 7 15 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 376 75 88 159 52 45 297 60 60 477 219 105 February 436 97 103 174 74 46 292 80 76 485 256 99 March 484 121 89 153 79 39 302 67 66 522 271 108 April 482 112 103 167 64 53 245 53 41 539 290 80 May 544 110 94 192 57 27 338 77 66 638 333 88 June 524 141 106 186 93 54 374 69 80 654 352 128 July 584 133 124 226 120 76 355 95 78 691 359 147 August 502 118 56 156 75 18 425 93 52 650 364 86 September 487 111 51 147 71 12 371 109 74 578 315 97 October 591 130 68 169 81 29 414 152 84 697 408 89 November 550 136 102 130 64 9 362 123 75 618 321 116 December 351 74 52 92 37 16 229 70 30 405 212 70 Totals 5911 1358 1036 1951 767 424 4004 1048 782 6954 3700 1213 7269 2718 5052 10654 B (3). 16 B (4). Home Visits by Health Visitors. 1945 Children Special Visits Expectant Mothers Infant Life Protection Total Visits 1st Visits Re- Visits Still- Births Others January 78 785 1 41 59 6 971 February 73 642 — 39 43 17 817 March 50 899 — 70 63 9 1097 April 62 641 1 76 25 6 813 May 70 703 — 51 27 4 855 June 58 644 1 34 45 9 792 July 62 547 1 31 40 9 691 August 63 621 1 35 46 — 767 September 57 646 1 12 36 12 765 October 48 827 5 34 34 6 954 November 65 971 3 23 55 7 1131 December 63 608 — 21 35 2 732 Total Visits 749 8534 14 467 508 87 10385 B (5). MATERNITY SERVICES. B(5)a. Maternity Home—Hainault. The Council provides a maternity home of 22 beds ,including one isolation bed. The staff consists of a Sister-in-Charge, a Junior Sister, a Staff Nurse midwife, two midwives and two assistant nurses. Institutional treatment for normal cases is Provided. Of these 267 cases were delivered by midwives and 118 by doctors with 16 cases transferred to hospital owing to complications. The average duration of stay of these cases in the home was 13 days. The six ante-natal beds in the annex at Ormonde House have not been available this year, the premises being required for other purposes. Under the circumstances therefore the increase in the number of institutional cases is a meritorious performance, particularly in view of the shortage of trained staff throughout the year. The following table illustrates the admissions during the last nine years to the Hainault Maternity Home. Year Admissions No. of Beds 1937 134 7 1938 116 7 1939 118 7 1940 118 7 1941 143 9 1942 215 12 1943 293 2S 1944 330 28 1945 401 22 17 B(5)b. Ante-natal. Five weekly sessions are held at the Ante-natal clinics, with two specialist clinics each month. Arrangements ensure that every expectant mother attending the centre has an examination hv the obstetrical consultant. Ante-Natal Patients seen by Doctor. Ante-natal patients seen by Doctor 1945 4160 Jan. Keb Mr. Apr. May |une July Aug Sep. Oct. Nov Dec. Total Erith 105 75 84 102 114 127 132 — 160 149 229 175 1452 Bedonwell 148 121 122 139 139 97 87 122 169 147 178 144 1613' Picardy 74 60 71 65 62 66 86 68 48 86 116 72 874 Hainault 20 36 61 34 19 15 18 9 7 2 — — 221 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. 36 cases were admitted under this arrangement during the year. The conditions for which they were admitted were as follows : — R eason No. A.P.H 6 Post Maturity 1 Breech Presentation 2 Toxaemia 14 Disproportion 4 Hydramnios 1 Cardiac 1 Version 1 Transverse Lie 2 Investigation 1 Eclampsia 2 Pyrexia 1 Totai 36 Also during the year 19 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 13 Number of children on register at 31st December, 1945 22 18 B(7). Midwives. The administration of the Midwives Acts is carried out by Kent County Council which is the Local Supervising Authority. Under the 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 mother and pre-school children, was well attended during year, attendances being 181 mothers, babies 98, total 279. B (9). Home Help. Following the receipt of Circular 179/41 from the Ministry of Health it was decided to incorporate the Council's Home Helps in the new Domestic Help Scheme which was inaugurated in January. The aim of this additional service is to provide whole-time or part-time domestic help for persons who are sick or infirm who are unable to obtain the domestic help of which under present conditions 'they are in need. Typical examples to whom help is given are : — Where the housewife falls sick or must have an operation. Where the wife is suddenly called away to see her husband in hospital and arrangements have to be made to look after the children ; With elderly people who are infirm or one of whom suddenly falls ill; Where several members of a household are ill at the same time, e.g. during an influenza epidemic. Under the scheme it will be necessary to appoint and maintain a register of domestic helpers available for work at any time and to arrange for their payment, to determine which are the most urgent of the applicants for help, and to assess what part of the cost of the help provided should be recovered from each household and to receive its payment. The expenses incurred including the expense of additional clerical assistance will rank for reinbursement. As part of the need is to provide help for the sick and i infirm who cannot afford to pay the prevailing rates for such [help, the department is employing its own helpers and allocating them to households where the help is most needed. The i whole or part of the cost is recovered from the household insofar as the resources of the household permit and this has been done according to a scale laid down by the Council, and recovered in advance when possible. 19 The rates of pay are those which are prevailing in the district for such work and in any case is not less than that stated in the Hetherington scale. The following figures illustrate the position up to the end of the year : Number of Cases booked during 1915. Number of days on which Home Helps were employed. Number of cases booked but subsequently cancelled. 32 355 4 Number of Cases attended by Domestic Helps during 1945. Number of days Domestic Helps were employed. Number of days employed at Hainault Maternity Home. Full-time 54 845£ 136 Part-time 25 410i 79 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. On Thursday, 8th February, the Isolation Hospital was severely damaged by a long range rocket which although falling some short distance away in Langdale Crescent blasted all the windows, roofs and most of the doors. Fortunaely no casualties occurred in either staff or patients, it was decided not to evacuate the hospital as two wards were usable and repair gangs were drafted on to the emergency work. 20 Unfortunately at 4.30 on Tuesday, 13th February, another long range rocket landed in the grounds of the institution some few yards from the home buildings. The blast walls again saved both patients and staff from serious injury although certain members of the staff were severely shocked but widespread damage was caused in every building of the hospital. The patients were evacuated to the Bow Arrow and West Kent Joint Board Hospitals and the staff to the Ormonde House Half Way Rest Centre. It was eventually decided in view of the shortage of materials and man power and the prevailing conditions in the district to admit further infectious disease patients to the two hospitals mentioned and these arrangements have been continued throughout the year. C (2). TABLES. C(2)a. Notifications. The following table shows the total notifications received during the year 1945. Disease Total cases notified Cases admitted to infectious diseases hospital Total Deaths Scarlet Fever 29 20 - Diphtheria 5 5 - Enteritis 1 1 - Dysentery 1 - - Puerperal Pyrexia 2 2 - Erysipelas 11 3 - Cerebro-Spinal Fever 3 2 - Poliomyelitis 3 3 Pneumonia 23 6 12 Malaria 1 Ophthalmia - - Neonatorum 2 1 - Measles 232 3 - Whooping Cough 117 1 - C(2)b. Scarlet Fever. Only 29 cases were notified during the year and of these 20 were admitted to hospital. Practically all were mild cases and no deaths occurred. 21 C(2)c. Diphtheria. Five cases of diphtheria were notified throughout the year all receiving hospital treatment. It is gratifying to record that again there were no deaths from this disease and the borough is now reaping the benefit from the immunisation campaigns continued throughout the last four years. C(2)d. Measles and Whooping Cough. The epidemic of measles and whooping cough were both notable for their mildness and freedom from complications. This was particularly fortunate in view of the loss of the isolation hospital which occurred early in the year. Only 3 patients out of the 232 notified cases of measles and one of the 117 notified cases of whooping cough had to seek hospital treatment. The latter, a premature baby, aged 1 month, died in the Sevenoaks Isolation Hospital from Broncho-pneumonia and exhaustion complicating its whoping cough and emphasizes the deadly nature of this disease in children under the age of two years. Age Distribution. C(2)e. This second table shows in details the age distribution of the notified diseases mentioned previously:— 22 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 3 3 3 12 3 2 1 1 — — — 29 Diphtheria — — — — — 4 — — — 1 — — — 5 Enteritis 1 — — — — — — — — — — — — 1 Dysentery — — — 1 — — — — — — — — — 1 Puerperal Pyrexia — — — — — — — — 2 — — — — 2 Erysipelas — — — — — — — — — 3 3 — 5 11 Cerebral Spinal Meningitis 1 — 1 — — 1 — — — — — — — 3 Poliomyelitis — 1 — — — — — — 1 — — — 1 Age Unknown 3 Pneumonia 2 2 1 1 2 1 1 2 1 3 2 — 5 23 Malaria — — — — — — — — — — 1 — — 1 Ophthalmia Neonatorum 2 — — — — — — — — — — — — 2 Measles 12 29 27 35 42 72 14 1 — — — — — 232 Whooping Cough 12 18 22 9 12 40 — — 4 — — — — 117 Totals 30 51 54 49 59 130 18 5 9 8 6 — 11 430 Table showing Details of Cases Treated etc., following Notification under the Scabies Order. 1945. Month Cases showing symptoms and treated Contacts not showing symptoms but treated Total Contacts examined not showing symptoms 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 16 12 28 4 21 10 — 2 36 38 February 17 21 38 — 32 12 — 6 9 15 March 22 20 42 — 51 14 — 13 22 35 April 30 21 51 — 28 14 — 12 14 26 May 14 8 22 — 30 7 — 7 27 34 June 23 25 48 — 38 17 — 23 12 35 July 48 17 65 — 35 13 — 13 13 August 30 40 70 — 67 7 — 15 8 23 September 18 4 24 1 19 4 — 5 — 5 October 55 38 93 — 44 33 2 16 — 16 November 55 27 82 — 78 19 — 19 6 25 December 12 8 20 — 14 6 — 7 — 7 TOTAI.S 340 241 583 5 457 156 2 138 134 272 23 24 C(2)f. 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. Adults, children and contacts are treated in the cleansing section of the Erith First Aid Post. C(3). Diphtheria Immunisation. The Scheme for the immunisation of children against Diphtheria was continued throughout the year as was also the immunisation of children against Diphtheria and Whooping Cough with a combined vaccine. Immunisation facilities are available at all sessions of the various clinics held in the town. The following table will indicate the number of cases dealt with:— Diphtheria Diphtheria and Whooping Cough 1st 2nd Injection. Injection. 1. 2. 3. 4. January 20 18 13 3 — — February 16 8 30 5 1 — March 28 13 40 16 1 — April 34 19 29 20 — — May 79 20 41 21 5 — June 73 50 48 35 1 — July 52 57 62 39 12 — August 20 38 41 53 40 5 September 43 18 54 28 25 5 October 11 19 92 47 18 1 November 11 12 52 80 43 4 December 10 5 17 29 38 — Totals 397 277 519 376 184 15 Grand TotalS. 1st Injections 916 2nd ,, 653 3rd ,, 184 4th ,, 15 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., 52 premises were disinfected, whilst enquiries to 25 obtain particulars regarding 81 cases of tuberculosis were undertaken. The Council have a modern steam disinfector at the Isolation Hospital, in which clothing, bedding, etc., are disinfected, in addition to the disinfections carried out for the hospital itself. C(6). Laboratory Facilities. Examination of pathological specimens, and other laboratory work, for the district, are undertaken by the Kent County Laboratory, Sessions House, Maidstone. C (7). TUBERCULOSIS. C(7)a. Treatment and Hospital Accommodation. The Kent County Council are responsible for cases of Tuberculosis occurring within the district, and also for Sanatorium treatment and hospital accommodation for Erith residents. A dispensary is held weekly at 65 Bexley Road, Erith, by a whole-time Tuberculosis Officer. In the tables which follow, particulars of new cases of Tuberculosis and of all deaths from the disease in the area, during 1945 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, 1945. C (7 ) b. Table i. Particulars of New Cases and Deaths. Age Periods New Cases Deaths Pulmonary Non-Pulm'n'ry Pulmonary Non-Pulm'n'ry Under year — — 1 — 1 — 1 — 1 5 — 2 — — 10 — 2 — — 15 6 — 2 — 20 12 2 6 — 25 13 2 3 — 35 6 1 4 — 45 13 1 5 — 55 3 — 1 — 65 & upwards 4 1 5 1 Totals 57 12 27 2 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 149 131 280 157 130 287 156 135 291 161 140 301 New notifications during vear 12 5 17 8 5 13 13 6 19 4 4 8 Cases removed, which have been restored — — — — — — — — — — — — Cases added to register other than by notification 1 1 2 1 3 4 — 1 1 — — — Cases removed from register 5 7 12 10 3 13 8 2 10 1 5 6 Cases remaining on register 157 130 287 156 135 291 161 140 301 164 139 303 Non-Pulmonary T.B. Numl>er on register 49 40 89 51 41 92 53 42 95 54 42 96 New notifications during vear 3 2 5 2 1 3 — 1 1 1 2 3 Cases removed, which have been restored — — — — — — — — — — — — Cases added to register other than bynotification — — — 1 2 3 1 — 1 — 1 1 Cases removed from register 1 1 2 1 2 3 — 1 1 1 1 Cases remaining on register 51 41 92 53 42 95 54 42 96 54 45 99 26 27 C(8). Ear, Nose and Throat. Operative treatment for cases of Tonsils and Adenoids, in school children is being carried out at Erith Hospital. Mr. T. P. Gill is Consulting Aural Surgeon, this appointment is renewable annually and a retaining fee is paid. Mr. A. Alexander conducted the monthly Aural Clinic at the Bedonwell Clinic throughout the year. section d.—hospital and ambulance facilities. D (1 ). General. Situated in the area is a hospital of 43 beds, which is maintained by voluntary efforts. The building is well equipped and has a visiting staff of local medical practitioners. The special departments are attended by a special consultant staff. The services of the large General and Special Hospitals in London are readily accessible to residents in this area. D(2). Venereal Diseases. A Venereal Diseases clinic for this area is held at Dartford and is provided by the Kent County Council. D (3 ). Children. A ward of ten beds is provided at the Erith and District Hospital, whilst special hospitals in Woolwich and other parts of London are easily accessible. D(4). Ambulance Service. During the year under review the Ambulance Service has carried 2,854 patients covering a distance of 28,948½ miles. The efficiency of the service has been greatly advanced by the addition of two new Austin-Lomas Ambulance vehicles, carrying every modern device to ensure the comfort of patients. These vehicles are fitted with Clayton Heaters and Lomas stretchers with patent head movements and special locking devices. The comfort of the occupants has been very carefully considered in the design and the reports from patients from time to time has shown that this is fully appreciated by the general public. Each vehicle is also fitted with Novox resuscitation apparatus, carrying sheets, specially fitted flood lights for rear loading portable first aid kits, drinking bottle and containers for splints and accessories. Owing to Ministry regulations still in force, the exterior design is not of the stream line type, but is very serviceable, and the vehicles have quite a pleasing exterior finish of grey bearing the Maltese Cross on the sides and the Erith Corporation Coat of Arms on the doors. 28 Specially fitted glass to the windows enables the patient to see out but seals the interior from the outside world when travelling. Provision in the form or two special chair-seats is also made for the comfort of relatives or attendants travelling with the patient. Cases Mileage Months 466 5,679 January / February 494 4,267 March/April 537 5,323 May/June 454 4,525½ July/August 466 5,254 September / October 437 3,841 November / December Totals 2854 28,948½ D(5). Mortuary. The Borough Mortuary is situated at the rear of the Erith Parish Church in West Street and consists of a reception room and a viewing room. There is accommodation for 4 bodies, the structure sustained considerable damage during air raid incidents, and considerable repairs have been effected. During the year 1945, 4 bodies were placed therein. section e.—water supply—milk and food and drugs. E(1 ). Water Supply. The water in this district is almost exclusively supplied by the Metropolitan Water Board. The water though possessing a considerable degree of hardness, is of good quality and is Palatable. The supply is led direct into the dwellings served, no standpipes being known to exist. Routine examinations of such supplies have been undertaken throughout the year with completely satisfactory results, and arrangements exist with the Kent County Council for 2 samples of this supply to be submitted to the Laboratory Monthly for bacteriological examination. Report on the Chemical Examination of Sample submitted:— Total solid residue 45.0 Chlorine 2.7 Free Ammonia 0.0 Albuminoid Ammonia 0.0 Nitrogen as Nitrates 0.4 Oxygen absorbed ¼ hr. at 80 deg. F. 0.009 29 Oxygen absorbed 4 hrs. at 80 deg. F. 0.018 Nitrites Absent Total Hardness 27.6 Permanent Hardness 6.6 Temporary Hardness 21.0 Remarks : This water is of excellent organic quality. 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 cowsheds and dairies 4 No. of dairies 12 Shops selling milk in sealed receptacles 42 No. of registered purveyors outside the Borough 19 E(3). Bacteriological Examination of Milk. The following samples of milk retailed within the Borough were obtained and forwarded to the County Laboratory for examination:— (a) Pasteurised. (b) Ordinary. (c) Pasteurised. (d) Pasteurised. (e) Pasteurised. (f) Pasteurised. (g) Ordinary. (h) Ordinary. (i) Pasteurised. (j) Pasteurised. All were reported upon satisfactorily. E(4). Milk Supply—Biological Testing. Samples were taken from a bulk supply from 22 cows and submitted for Biological testing when Tubercle Bacilli was located. As a result, the herd was inspected by the Veterinary Officer and 2 animals re-acted to the Tuberculin test, and were consequently slaughtered under the Tuberculosis Order. E(5)a. Designated Milk. The following table indicates the number of licences issued by the Local Authority in 1945 under the Milk (Special Designations) Order 1936:— Dealers. Tuberculin tested 5 Pasteurised 6 Supplementary. Tuberculin tested 4 Pasteurised 4 Total 19 Internal View of New Borough Council Ambulance. 30 E(5)b. The Phosphatase Test. Five sample of Pasteurised milk were submitted to the Public Analyst, and were reported to be efficiently heattreated. E(6). The 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 Cake flour — 1 1 Ground nutmeg — 1 1 Horseradish Cream — 2 2 Currant flavouring — 1 1 Lemonade crystals — 2 2 Milk — 15 15 Non-brewed vinegar — 1 1 Cocoa — 2 2 Cascara sagrada — 1 1 Pork sausage meat — 1 1 Castor oil — 2 2 Fish paste — 1 I Coffee with chicory — 1 1 Lemon Flavour — 1 1 Baking powder — 4 4 Cough mixture — 1 1 Orange colouring — 1 1 Junket rennet — 1 1 Chocolate spread — 1 1 Celery soup — 4 4 Vita gravy — 1 1 Steam pudding mixture — 2 2 Egg substitute — 2 2 Almond flavouring — 2 2 Bismuth mixture — 1 1 Balsam of aniseed — 1 1 Concentrated lemonade — 1 1 Bloater Paste — 1 1 Gravo thick — 4 1 Cloves — 2 2 Desert Mould — 1 1 Mustard — 1 1 Kidney soup — 1 1 Rum flavour essence — 1 1 Soda Bicarbonate — 1 1 Curry powder — 2 2 Ground ginger — 1 1 Gravy browning — 1 1 Total — 67 67 31 The milk samples averaged a content of 3.83 per cent. fat, and 8.94 per cent. of solids other than fat. E(7). Meat and Food Inspection. Considerable time and attention has been devoted to the inspection of meat and other foods in shops and stores, and the following were confiscated as being unfit for human consumption:— Meat 278 tins. ,, 58½ lbs. Fish 426 tins. ,, 145½ stones. Milk 1,095 tins. Vegetables 291 tins. „ 87 lbs. Fruit 7 tins. „ 282½ lbs. Eggs 100 Cereals 20l½ lbs. Confectionery 336½ lbs. Tea 14 lbs. Cheese 81½ lbs. Lard 3 lbs. Jam 134 lbs. Coffee 2½ lbs. Cocoa 20 lbs. Dried egg 18 lbs. Butter 12¼ lbs. Margarine 43½ lbs. Sugar 112 lbs. Fowls 4 lbs. Potatoes 448 lbs. Total weight 2 tons, 14 cwts., 1 qr., ¾lb. 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 1 of the Act apply to sheep which are slaughtered in the district. section f.—sanitary circumstances of the area. 1. Sanitary Inspection of Area. F (1) a- Visits by Sanitary Inspectors. The total number of visits of all kinds was ... 6832 Notices served:—1,005. Formal 29. Informal 976. Number of dwellings and other premises disinfected 52 Complaints received and investigated 1646 32 F(l)b. Premises visited and results of such visits. Premises No. in District No. of visits 1945 No. of defects found No. of defects remedied Bakehouses 10 59 — — Cowsheds 4 18 1 1 Dairies 12 49 4 4 Butchers Shops 32 262 5 5 Fish friers 10 58 3 3 Food Factories 2 25 1 1 Slaughter Houses 4 — — — Factories 129 111 26 26 Outworkers 22 2 — — F(l)c. Summary of Nuisances and Defects Remedied during the year. Other than those enumerated in the above Tabulation: Drains repaired 27 Drains cleared 30 W.C. pans renewed 19 Cisterns repaired 27 New sinks 14 New W.C.s provided 11 Roofs repaired 76 Damp walls remedied 48 Houses cleansed 21 Floors repaired 37 Eaves gutters repaired 34 Cooking stoves repaired 18 Plasters renewed 56 Windows made to open 3 Dustbins provided 224 Accumulations removed 6 Yard pavings repaired 1 Water supply provided 15 Coppers repaired 5 Many requests were received from owners and occupiers in respect of clearing of drains, destruction of wasps and ants nests and eradication of vermin, etc. In each case the necessary service was provided with much beneficial result to the applicant. The charges made in connection with the above services amounted to £33 9s. 0d. 33 F(l)d. Offensive Trades. In addition to the statutory offensive trades which are specified in Section 107 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 one cesspool has been abolished, and the drainage connected to the sewer. Cesspools are emptied once a month free of charge by machines belonging to the Borough Council, and the contents thereof are discharged into the nearest Council sewer. The cesspools which require the service are scattered throughout the district, and, in the majority of cases necessitate the covering of considerable distances both for pumping out and conveying to the point of discharge. During the year 1945, cesspools were emptied on 35 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 some 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 degrees F. by low pressure steam heating and is sterilised by the Chloramine process, i.e. addition of ammonia in conjunction with chlorine. F(l)h. Schools. Schools within the district are visited regularly, and defects if any are referred to the Education Authority. All the premises are served by Metropolitan Water Board water supply. F (1) i. Camping Sites. There are no summer camping sites within the Borough. There are, however, 4 sites which have been occupied by vans for a number of years. 34 Frequent inspections have been made with a view to the application of Bye-law requirements. No licences have been granted by the Local 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 (1 ) k. Rag Flock Act. No premises exist within the Borough in which rag flock is manufactured or sold. F(l)I. Eradication of Bed Bugs. During the year 1945, dwelling-houses were found to be infested with vermin and subsequently disinfested as under:— Privately owned houses 24 Council houses 8 Presence of vermin in private houses is usually located by the department's sanitary inspectors during their duties. On every occasion removal of wallpaper, picture rails etc. is insisted upon and measures falling short of this has been found to be useless. The use of the blow-lamp and approved insecticides is advocated and revisits are made with a view to effecting the maintenance of the improvement. Owners and occupiers are encouraged to report vermin infestations in which case, the services of the out-door assistant may be obtained. For an appropriate charge the assistant carries out the necessary disinfestation. The cleansing and disinfestation of council houses is carried out by the staff of the Borough Engineer and Surveyor. All prospective and selected tenants for Council houses are visited and a report on the findings is made direct to the housing clerk. When household effects of such applicants are found to be verminous, such material is subjected to cyanide fumigation by Contractors employed by the Council. This method of re-housing has proved to be most successful. F(1 ) m. Cleansing of Verminous Persons. The cleansing station at the first aid post operates in connection with the above and all persons suffering from scabies are directed to this site. F(l)n. Mosquito Control. Specimens Numbered 42 and 43 were submitted to the Malaria Officer of the Ministry of Health, number 42 being identified as Culex Pipiens whilst 43 was Ryphus Fenestralis, a non-biting insect similar to a mosquito. 35 F(l)o. Rodent Control. infestation Order 1943. SRO 680. In accordance with Direction of the Ministry of Food a first and second treatment for sewer rats operated, commencing in October. In all, some 42 manholes were dealt with, the treatment consisting of depositing pre-bait on benchings from Monday to Thursday when on Friday a 5 per cent. Zinc Phosphide poisoning ensued. HOUSING. F (2) a. Inspection of Dwelling Houses during the year. 1. (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1672 (b) Number of inspections made for the purpose 3241 2. (a) Number of houses (included under sub-head (1) above) which were recorded and inspected under the Consolidated Housing Regulations 1925 and 1932 13 (b) Number of inspections made for the purpose 41 3. Number of houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 13 4. Number of houses (exclusive of these referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 812 F(2)b. Remedy of Defects during the year without service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the local authority 786 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 houses which were rendered fit after service of formal notices:— (a) By owner 0 (b) By local authority 0 (b) Proceedings under the Public Health Act. (1) No. of dwelling houses in which respect notices were served requiring defects to be remedied 29 36 (2) No. of dwelling houses in which defects were remedied after service of formal notices: (a) By owner 29 (b) By local authority 0 (c) Proceedings under Section 11 and 13 of the Housing Act 1936. (1) No. of dwelling houses in respect of which demolition orders were made 13 (2) Number of houses demolished in pursuance of demolition orders 0 (d) Proceedings under Section 12 of the Housing Act 1936. (1) Number of separate tenements or underground rooms in respect of which closing orders were made 0 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been made fit 0 The Demolition orders referred to in (c) (1) above were made in respect to:— 8 Victoria Street, Belvedere. 1, 2, 3, 3a, 4, 5, 6, 7, 8, 9 Orient Cottages, Belvedere. 74 and 76 Nuxley Road, Belvedere. Housing, informal action, Sec. 12, Housing Act 1936. In the case of 2 basements, the owners thereof submitted undertakings not to re-let these premises as and when such premises became vacant. F(2)c. Rent and Mortgage Interest (Restriction) Act 1939. The provisions regarding extortionate rents are administered by the department and during the year 1945 278 applicants who have sought advice and assistance have been dealt with. The maximum 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. 37 Appended below is a summary of the improvements effected:— (a) Rent reduced from 20/6 per week to 19/- and £7/16/- returned to tenant. (b) Rent reduced from 25/- to 10/- (c) Rent reduced from 27/6 to 25/- (d) Rent reduced from 13/6 to 5/- (e) Rent reduced from 16/- to 12/- and £14/8/- returned to tenant. F (3)a. Shops Act 1912-1938. With regard to the statutory hours of closing, it was necessary to issue 9 warnings to shopkeepers upon the noncompliance with the statute. No police court proceedings were instituted during the year. Infringements of Section 10 of the Shops Act 1934 relating to health and comfort of shop assistants were located in the following instances, and the necessary improvement being subsequently effected:— Shops cleansed and re-decorated 3 Floors renewed 3 W.C.s cleansed 1 Staff rooms cleansed 1 In accordance with Defence Regulations, the following hours of closing were substituted for the closing hours enacted by Section 1 of the Shops (Hours of Closing) Act 1928 during the period 4th November, 1945 to 2nd March, 1946: General Shops: Monday, Tuesday & Wednesday 5.30 p.m. Friday 6.30 p.m. Saturday 5.30 p.m. Hairdressers and Barbers: Monday, Tuesday & Wednesday 7 p.m. Friday 7 p.m. Saturday 8 p.m. No Order was made revoking closing hours during Christmas week 1945. F (3) b. Offices. In no instance was it necessary to take action under Section 46 Public Health Act 1936, in respect to sanitary accommodation at offices, and in no case has it been found that insufficient accommodation exist. 38 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 35 — — Factories without mechanical power 68 4 — Other premises under the Act (including building works and engineering construction but not including outworkers premises) 8 — — Total 111 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 1 1 — — Inadequate Ventilation — — __ — Ineffective drainage of — — — — Sanitary Conveniences: Unsuitable or defective 3 3 — — Not separate for sexes 11 1 1 — — Other offences 10 10 — — Total 26 14 — — F(4)a. Health Education—Civic Week. During the week 13th and 20th October, 1945, the Council organised a Civic Week in which the Public Health department played its part. A stand was organised by the department and manned voluntarily until 9 o'clock each evening by members of the clerical and nursing staff. During the course of the week the .39 Sanitary Inspector's section gave talks and lectures to visiting parties of school children during the mornings describing the disinfestation section and the bacteriological display which was kindly included in the department's stand by courtesy of the Metropolitan Water Board. Other contributors of exhibits were as follows:— The Borough Refuse Collection Service. Messrs. Lomas, supplying stretcher equipment as used in the Council Ambulances. Messrs. Harland Engineering Co., Ltd., supplying a bore hole pump model. Central Council of Health Education, provided gramophone records and pictorial displays. Messrs. Siebe Gorman, Novox apparatus. Photographs were also exhibited showing various phases of the Council's Health services including the public health ambulance ; day nurseries, the maternity home and the borough refuse collection service. A public foot clinic was in daily session and members of the public by application at the stand were able to make appointments to see the chiropodist. This experiment proved exceedingly interesting, and as was shown by the increase in numbers of attendance at the end of the week the general public gradually overcame an initial shyness and began to take a practical interest by booking appointments. The section of the stand which also created a great deal of interest was that in connection with the disinfestation service. A number of household pests were on view in glass containers, also stuffed specimens of rodents together with photographic exhibits, the latter being supplied by the Ministry of Food. The stand itself was tastefully decorated, the floral displays provided by members of the staff, and the voice of the Radio Doctor (on a gramophone record) booming out from a hidden recess attracted a great deal of public attention. Pamphlets dealing with almost every phase of the Public Health Service were handed out to the public and also specially selected booklets were given to the visiting Head Teachers for the use of their pupils. 40 F(5). Legislation in Force. lents, Vans and Sheds 28th Feb., 192S Houses let in lodgings 27th Jan., 1930 sS AH°T 29th Feb" 1932 ■ chool Attendance 17th Feb., 1932 Libraues and Museums ]5th June, 1934 Nursing Homes 20th July> 1934 easure Grounds 4th Feb-> lg36 Lmployment of Children 25th Mar., 1936 Jogs fouling footpaths 22nd Feb 1939 o£Frym$ , 9th May, 1939 ?SS1VeRlrafeS 9th May," 1939 Holt"! ^e"Iaws 10th Aug., 1939 '-■HI. Cemetery S X S CrZ lT ,N"isances 23rd April, 1940 ood Rule and Government 1st Jan., 1941 G (1 ) a. Refuse Collection and Disposal. r , "le method of storage is by means of sanitary dust-bins, are emptied weekly. The dust-bins are <»• ,e ,an< ma'ntained by tJie owners of the properties connet , ie Council securing this by a local act—the Erith ipiovement Act, 1920. Disposal is effected by barging under factoril ' ^'lese ai'l'angements are still working very satis- C (1) b. Costs. The following tables show : £ s. d. Cost per ton of Collecting Refuse 14 6 (v°st Per ton of Disposing Refuse 6 lOf • et cost per 1,000 population per annum 165 0 0 •' )c. Details of the Refuse Collection Vehicles and Staff. Vehicle. Capacity. 1 Dennis Lorry 12 cubic yards 1 Easyloader 5 » „ 4 S.D. Freighters 7 » 2 Scammell Lorries 5 " ,, 1 Fordson Lorry 1 Austin 10 Utility Van 41 These are operated by: 1 Foreman. 9 Driver Loaders. 6 Loaders. 1 Salvage Sorter (female) part-time. 1 Salvage Sorter (male) full-time. During the month of June, 1945, two new 5 cubic yard Scammell vehicles were purchased, these vehicles being a special design for negotiating rear alleyways. G (1 ) d. Details of the Tonnage dealt with during the year. Month Tonnage Tons Cwt. January, 1945 642 10 February ,, 630 19 March ,, 569 8 April ,, 499 0 May ,, 502 10 June ,, 621 13 July „ 717 2 August ,, 395 8 September ,, 383 1 October ,, 511 12 November ,, 613 13 December ,, 576 8 Total 6363 4 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, and in 1945 the amount reached approximately 300 loads producing a revenue of £225. C (1 ) f. Salvage. Tonnage collected. Income. T. C. Q- Lbs. £ s. d. 782 17 3 4 3,473 16 2s- 2¾ Public Health Department's Stand—Civic Week. BOROUGH OF ERITH. ANNUAL REPORT of the School Medical Officer FOR THE YEAR 1945 • 3 SCHOOL HEALTH SERVICE. ERITH EDUCATION COMMITTEE. Chairman:—Councillor Farquhar. Vice-Chairman:—Alderman Pannell. Alderman Bates. ,, EwenS. Councillor Ebuen. ,, Ellis. Councillor Firmin ,, Mantle. ,, powrie. ,, West. Co-opted Members : A. W. Lawrence, Esq. Dr. H. A. Maunder. Dr. J. B. Lobo. Mrs. E. A. Munns. G. M. Green, Esq. KENT EDUCATION COMMITTEE. North West Kent Divisional Executive. (As from 1st April, 1945.) (a) County District Council Members— (i) Appointed by Dartford Borough Council. †Mr. W. A. Ward. Mr. H. G. Hicks. *Mr. L. Fuller. Mr. J. F. Snell. Mr. C. Bareham. Mr. P. R. Steele. (ii) Appointed by Erith Borough Council. Mrs. F. M. Ewens. Mr. F. T. Ellis. Mr. G. R. N. Farquhar. Mr. J. N. Powrie. Mr. T. C. Pannell. Mrs. F. West. *Mr. H. J. Gooding. (iii) Appointed by Cray ford Urban District Council. †Mr. E. B. Clark. Mrs. M. M. Hetherington †Mr. H. ,T. Earl. Mr. G. V. Sayer. †Mr. J. W. Taylor. (iv) Appointed by Dartford Rural District Council. †Mrs. K. Wood. Mr. A. E. Rogers. Mr. H. W. Lee. †Mr. E. W. G. Simpson. *Mr. A. E. Symonds. 4 (b) County Members— *Mr. E. R. Blackman. †Mr. W. J. Ebben. †Mr. S. A. Lyle. †Mr. C. F. Morling. Rev. Canon Elliott. Mitchell. Mr. W. L. Parry. (c) Members representing Religious Denominations. Rev. H. Hebden Hurwood Mr. A. E. Diment. Rev. W. H. Richards. (d) Other Members. Mr. B. T. Ellis. Miss E. M. Fryer. Mr. J. A. Halsall. † No longer a member of the Divisional Executive. * Deceased. 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. (died 25/11/45). H. G. Williams, m.r.c.s., l.r.c.p., d.p.h. F. O. Walker, m.r.c.s., l.r.c.p., d.p.m., d.o. (appointment terminated 27/4/45) (Returned from Services—re-instated 4/5/45). Aural Surgeon: 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: Orthopaedic Surgeon: E. A. Lindsay, f.r.c.s. Ophthalmic Surgeon : N. Howard Allen Senior Cleric: Miss M. C. A. Smith. Miss M. Johnson. Mrs. M. Fenner. Dental Clerk: Mrs. E. Tucker, 5 Report of the School Medical Officer. The School Health Service functioned as in previous years except with the necessary modifications of procedure brought about with the coming into operation of the Education Act 1944, on the 1st April. Dental work was continued by the Dental Surgeon, and diphtheria immunisation proceeded on the lines previously described. At the present time the School Medical Service remains linked with the Maternity and Child Welfare and general Public Health Services of the Borough and it is hoped that this policy can be maintained. At the end of 1945 there were 4,828 children on the roll of the elementary schools, distributed as follows: Nursery Class 89 Infants Schools 996 Primary and Infants Schools 368 Primary Schools 1909 County Modern Schools 1466 THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. No. of children on the school roll 4828 No. of individual children who attended medical clinics 2086 No. of individual children medically examined at schools 2625 No. of medical examinations at the clinics 6953 (i) Hainault 6268 (ii) Bedonwell 685 No. of inspections for uncleanliness and verminous conditions (school nurses) 11866 No. of attendances for treatment at the Dental Clinic 2681 No. of treatments at the Eye Clinic 389 No. of spectacles prescribed 145 No. of attendances at the Orthopaedic Clinic 498 (i) For consultation 305 (ii) For treatment, massage, etc. 193 No. of attendances at Ultra Violet Ray Clinics 161 MEDICAL INSPECTION. Routine medical inspections have not been confined only to the usual prescribed age groups, and every endeavour has been made to give as many school children as possible the benefit of this examination. 6 Children referred by Head-Teachers, School Nurses, and School Enquiry officers have been included where possible in the medical inspections, and the annual examination of physically handicapped children has been carried out mainly in the school clinics. The following table gives the number of routine medical examinations made during the last nine years:— Year No. of School Children on Register No. of Routine Medical Exams. Percentage of Children examined (R.M.I.) 1945 4828 2625 54.37 1944 3832 3028 79.01 1943 4723 2175 46.05 1942 4742 3212 67.77 1941 3943 1181 29.95 1940 3086 413 13.38 1939 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 "B," and comparing these figures with those for the last year, the following facts emerge: — In the first age group entrants, there were 14.56 per cent. in "A" (excellent), an increase of 2.39 per cent.; 58.04 per cent. were in "B" (normal), an increase of .65 per cent.; 26.06 per cent. in "C" (slightly subnormal), a decrease of 1.76 per cent.; and there were 1.31 per cent. in "D" (bad), a decrease of 1.29 per cent. In the second age group, 8 and 9 year olds, there were 14.03 per cent. in "A," a decrease of .78 per cent.; 55.73 per cent. in "B," a decrease of 2.20 per cent.; 28.45 per cent. in "C," a decrease of 2.76 per cent., and 1.77 per cent. in " D," a decrease of 1.14 per cent. In the third age group there were 19.44 per cent, in " A," 47.22 per cent. in "B," 27.77 per cent. in "C," and 5.55 per cent. in " D." In other routine inspections, there were 22.56 per cent. in "A," an increase of 2.54 per cent., 52.64 per cent. in "B," a decrease of 2.44 per cent., 22.73 per cent. in "C," an increase of .49 per cent., and 2.05 per cent. in "D," a decrease of .49 per cent. Malt and Oil. Total amount issued during the year 3127 lbs. Amount issued free 2656 lbs. No. of children who received free issues 407 Amount sold at cost price 471 lbs. 7 At the end of the year a total of 367 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 clinics being maintained on a monthly basis. The cases examined at these clinics were as follows: — New Cases. Re-examination. Re-exam. TOTAL. Recommended Post Operation operation 124 61 2 187 69 Visual Defects and External Eye Disease. Table IV (Group II) gives the extent of the ophthalmic work of the Eye clinic. The increase in the number of children treated for errors of refraction continues and it was therefore necessary to continue the weekly sessions of the ophthalmic clinic throughout the year. A total of eleven children were recommended for hospital treatment during the year for the following defects: — Conjunctivitis 1 Tear duct infection 2 Strabismus 5 Entropiom 1 Bilateral Epiphora 1 Seborrhoeic blepharitis 1 One child with myopia was recommended for admission to a special school. In addition to these cases the following defects were treated: Tear Duct infection 3 Conjunct Photophobia 1 Epliphora 3 Conjunctivitis 1 Discharging Eye 4 Seborrhoeic blepharitis 1 Meibomian Cysts 1 Persistent Pupillary Membrane 1 Blepharitis 1 Phlycten. Conjunctivitis 1 17 8 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 3 38 73 191 166 147 154 291 281 181 1525 (b) Specials 471 (c) TOTAL (Routine and Specials 1996 (2) Number found to require treatment 1049 (3) Number actually treated 2442 (4) Attendances made by children for treatment 2681 (5) Half-days devoted to: Inspection 16 Treatment 401 417 (6) Fillings: Permanent Teeth 1519 Temporary Teeth 203 1722 (7) Extractions :— Permanent Teeth 226 Temporary Teeth 796 1022 (8) Administration of general anaesthetics for extractions 523 (9) Other operations:— Permanent Teeth 34 Temporary Teeth 4 Total 38 ORTHOPAEDIC AND POSTURAL DEFECTS. Mr.E.A.Lindsay, F.R.C.S., acts as your consultant orthopaedic surgeon, and the following is a list of cases attending the clinic during 1945. School Children. Infant Welfare. Flat Feet 66 42 ,, ,, and Bow Legs — 1 „ „ G.V 20 22 ,, ,, Valgus Ankles 1 — ,, ,, depressed sternum 1 1 ,, ,, stoop 3 — ,, ,, spasticity — 1 Footstrain 14 — 9 Valgus Ankles 4 2 G.V. 12 10 Hallux Valgus 2 — Stoop 11 2 A.P.M. 3 1 Scoliosis 5 — Kyphosis 1 1 Inco-ordination 1 — Schlatters Disease 1 — Mallet Fingers 1 — Pes Cavus 5 — Congen. Flexion deform. 1 — Old Erb's Palsy 1 — C.D.H. 1 — Deformed Toe 2 2 Periosteal 1 — Pain L. Parella, R. Thumb 2 — Fibrositis 1 — Old S.P.M 1 — Osteomyelitis L. femur 1 — Injuries Toe, Heel, Ankle, Foot, Elbow 5 1 Prom. Lower Sternum 1 — Tight Hamstrings 1 — Spastic Paresis 1 1 Hallux Rigidus 1 — Chilblain 1 — R. dorsal scoliosis 1 — L. lumber ,, 1 — Metatarsal Varus — 2 Metarsolgia 1 — T.B. L. Foot 1 — Pes. Plane Valgus 1 — R. equine varus 1 — Deformed foot, leg, toes 1 2 Intoeing — 7 Clicking hip — 2 Talipes valgus, varus. 2 3 Tightness R. Sterno mastoid — 1 Enlarged R. leg — 1 Cerebral diplegia — 1 Pes Varum — 7 Torticollis — 1 Limps R. leg — 1 Wears heels inner side — 1 Trigger Thumb — 1 O.C.T. — 1 Hydrocephalus — 1 Trendelouberg — 1 Contractive little fingers 1 — 10 Medical Inspections of Children Attending Public Elementary Schools. A.—Routine Medical Inspection. Entrants 913 Second Age Group 506 Third Age Group 36 No. of other routine inspections 1170 2625 B.—Other Inspections. Number of Special Inspections and Re-inspections 6561 TABLE II. Age-Groups Number of Children Inspected A B C D Excellent Normal Slightly subnormal Bad No. % No. % No % No. % Entrants 913 133 14.56 530 58.04 238 26.06 12 1.31 Second AgeGroup 505 71 14.03 282 55.73 114 28.45 9 1.77 Third AgeGroup 36 7 19.44 17 47.22 10 27.77 2 5.55 Other Routine Inspections... 1170 264 22.56 616 52.64 266 22.73 24 2.05 Total 2625 475 18.09 1445 55.04 658 25.06 47 1.79 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 — — — — — 11 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 7 — — 14 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1945. TREATMENT TABLE. GROUP I.—MINOR AILMENTS. (excluding Uncleanliness, for which see Group V). Disease or Defect Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Total 1 2 3 4 Skin— Ringworm—Scalp 1 1 (i) X-Ray Treatment. If none, indicate by dash. — — — (ii) Other Treatment — — — Ringworm—Body 10 2 12 Scabies 87 2 89 Impetigo 356 3 359 Other skin disease 105 1 106 Minor Eye Defects (External and other, but excluding cases falling in Group II). 131 1 132 Minor Ear Defects 86 4 90 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 1532 7 1539 Total 2308 20 2328 12 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease Number of Deftcts dealt with Under the Authority's Scheme otherwise Total 1 2 3 4 Errors of Refraction (including Squint) 386 3 389 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 3 — 3 Total 389 3 392 No. of children for whom spectacles were prescribed: (i) Under the Authority's Scheme 145 (ii) Otherwise 3 No. of children for whom spectacles w ere obtained: (i) Under the Authority's Scheme 126 (ii) Otherwise 3 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 — 12 12 55 . 67 13 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 Non Residential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education NonResidential treatment at an orthopaedic clinic (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — 305 — — 3 308 TABLE V. Uncleanliness and Verminous Conditions. (1) Average number of visits per school made during the year by the School Nurses 6 (2) Total number of examinations of children in the Schools by School Nurses 11866 (3) Number of individual children found unclean 156 (4) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 (5) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws — NUTRITIONAL SURVEY. The Ministry of Health has been conducting systematic nutritional surveys of certain sections of the population throughout the country during the past three years and following a discussion with Dr. Magee of the Ministry of Health in which it was intimated that to continue these examinations a similar survey was desirable in this industrial borough, arrangements were made for a conference with Dr. Adcock (of the Ministry of Health). At this conference it was proposed to use the clinical estimation of malnutrition states introduced by Dr. Sydenstricker from America into this country, and it was decided as far as possible to obtain a cross section of all grades of the population of the town. 14 The method employed involves the use of a special slitlamp for examination of the vascular supply of the cornea, and the rest of the examination involves the mouth, mucous membranes, the condition of the skin and certain groups of muscles. The whole examination of the individual takes some four to five minutes and does not involve therefore any pain or discomfort to the examinee and very little dislocation of the work in the institution or factory in which the investigation is taking place. Several factories were contacted either by telephone or letter but it was found that while some of these firms were working at top pressure and were reluctant to agree to anything that might disorganise their production departments, eight works were eventually able to co-operate. It had been originally intended for Dr. Adcock to begin the survey on Monday, 29th January, with the examination of children over 8 years of age at West Street Junior Boys' and Girls' but on arrival at the school it was found that the pipes had burst owing to the frost and the children on the point of returning home. Examinations were eventually carried out at Crescent Road Junior School with the co-operation of the Head Teacher. On the second day, children from St. Augustine's Road Junior Boys' and Girls' attended Hainault school clinic, and were conveyed to and from the school by car in batches of eight. It was feared at first that the thick snow and the condition of the roads would have an effect on attendance but by the end of the morning a total of twentyseven children had been seen and examined. On two occasions, Wednesday 31st January and Monday 5th February, it was uncertain as to whether the factories would have sufficient volunteers to keep Dr. Adcock employed for the whole of the day, the examination being purely voluntary on the part of the employee and actually in both instances it was found that by the end of the morning no further volunteers were forthcoming. It was therefore necessary to attend a school without previous notice but the head teachers at both the schools concerned co-operated in everyway possible, and as a result about fifty children were seen on each occasion. 15 The programme was carried out according to plan and I give below in detail the factories and schools visited and the number of persons examined at each: Jan. 29th Crescent Road School (Juniors) 14 boys 13 girls 30th St. Augustine School (Juniors) 9 boys 18 girls 30th Hainault Ante-natal Clinic 14 females 31st Heron Engineering Co., Ltd. 26 males 31 females 31st Pieardy Central School (Senior) 30 boys) 20 girls Feb. 2nd West Street School (Juniors) 20 boys 20 girls 2nd Admiralty Machinery Depot 3 males 6 females 5th Salford Engineering Co., Ltd. 2 males 62 females 5th North. Heath Central School 26 boys 23 girls 6th Fraser & Chalmers Ltd. 70 males 7th Burndept Ltd. 15 males 114 females 8th Viokers-Armstrongs Ltd. 32 males 5 females (West Street) ,, ,, (Main) 32 males 3 females 9th Sovex Ltd. 28 males 9 females 9th Callender & Co. (Cable Construction) Ltd. 36 males 21 females In all 702 persons were examined, 343 males and 359 females. The clinical findings are set out in the table attached and the percentages for all persons of corresponding group examined elsewhere up to the end of 1944 are noted for comparison. Comment. A. School Children. Ninety-nine boys and ninety-four girls in all were examined from the junior sections of three and the senior "sections of two elementary schools. Ages ranged from 8—14 years. A midday meal and milk are provided at all these schools. The nutritional status of the boys was satisfactory on the whole but more than usual were found to be below normal 87.9 per cent. were assessed good, 10.1 per cent. fair and 2 per cent. poor as compared with 90 per cent. good, 9.6 per cent. fair and 0.4 per cent. poor of boys examined elsewhere. There was no evidence of deficiency disease, nor of any vitamin deficiency, and those graded below par appeared to be suffering from a suboptimal intake or utilisation of body building foodstuffs in that their general physical development was below average for their age. 16 The incidence of folliculosis (12.1 per cent. against 29.3 per cent.) and gingivitis (7.1 per cent. against 14.3 per cent.) was only half the average elsewhere. The nutritional status of the girls was good and of a higher standard than that of girls examined elsewhere. 92.5 per cent. were assessed good, 7.5 per cent. fair and none poor in comparison with 88 per cent., 9.6 per cent. and 2.4 per cent respectively elsewhere. The incidence of folliculosis and gingivitis was much less than the average elsewhere. No case of cheilosis, angular stomatitis or corneal vascularization was observed in boys or girls. B. Expectant Mothers. Only 14 expectant mothers were examined; a number too small for analysis or comparison. The nutritional status of all those seen was very satisfactory. C. Factory Workers. Adolescents. 90 males and 106 females were examined and their general nutritional status was good. That of the females was somewhat below and that of the males above the average examined elsewhere. A large proportion of the females assessed "fair" came from one factory and it may be that the lighter type of work there attracted less robust individuals. The impression obtained was that the status of the adolescents of both sexes was quite satisfactory. Adults. The same remark applies to the nutritional status of the 154 adult males and 145 adult females examined. One male case of vascularization of the cornea was seen but this was his only sign of possible deficiency. In both adults and adoescents the incidence of folliculosis and gingivitis was well below the average found elsewhere. The following table illustrate the clinical findings:— Table of Clinical Findings. Good Fair Poor Pityriasis Acne Folliculosis Cheilosis Angular Stomatitis Enlarged Tongue Papillae Dentures Gingivitis Pyorrhiea Blepharitis Corneal tion Loss of Vibratory Sense SCHOOL CHILDREN, BOYS Crescent Road (Juniors) 13 1 0 1 0 1 0 0 1 — 0 0 0 0 0 St. Augustine's (Junior) 8 1 0 0 0 1 0 0 0 — 1 0 1 0 0 Picardy Central 25 3 2 1 1 3 0 0 1 — 4 2 0 0 0 West Street (Junior) 17 3 0 0 0 1 0 0 2 — 2 0 10 0 0 Northumberland Heath (Central) 24 2 0 0 0 6 0 0 0 — 0 0 0 0 0 Total examined 99 87 10 2 2 1 12 0 0 4 — 7 2 1 0 0 Percentage 87.9 10.1 2 2 1 12.1 — — 4 — 7.1 2 1 — — % 1940 boys examined to end 1911 90 9.6 0.4 15.1 — 29.3 1.8 1.7 39.6 — 14.3 2.8 — 0.9 — GIRLS Crescent Road 13 0 0 1 0 5 0 0 1 — 1 0 0 0 0 St. Augustine's 15 3 0 1 0 5 0 0 2 — 1 0 0 0 0 Picardy Central 19 1 0 0 0 2 0 0 1 — 0 0 0 0 0 West Street 18 2 0 3 0 5 0 0 1 — 0 0 1 0 0 Northumberland Heath 22 1 0 0 0 3 0 0 3 — 1 0 0 0 0 Total examined 94 87 1 0 5 0 20 0 0 8 — 3 0 1 0 0 Percentage 92.5 7.5 — 5.3 — 21.3 — — 8.5 — 3.2 — 1.1 — — % 1450 girls examined to end 1911 88 9.6 2.4 10 — 41.6 — — 51.4 — 13.9 2.3 — 1.6 — EXPECTANT MOTHERS Hainault Clinic 14 0 0 0 0 2 0 0 1 0 1 0 0 0 0 FACTORY WORKERS Adolescent males (90) 89 1 0 0 2 8 0 0 6 0 6 0 0 0 0 Percentage 98.9 1.1 — — 2.2 8.8 — — 6.6 — 6.6 — — — — % in 415 examined to end 1944 94.8 5 0.2 5.2 — 15 1 1.2 44.6 — 19.3 12.4 — 3.3 — Adolescent females (106) 98 8 0 1 1 14 0 0 10 1 5 0 0 0 0 Percentage 92.4 7.6 — 0.9 0.9 13.2 — — 9.4 0.9 4.7 — — — — % in 393 examined to end 1944 99.2 0.8 — 6.1 — 24.2 0.8 2 43.3 — 12.5 4.5 — 4.1 — Adult males (154) 149 5 0 1 1 7 0 0 3 35 15 8 0 1 0 Percentage 96.7 3.3 — 0.65 0.65 4.5 — — 1.9 22.5 9.6 5.2 — 0.65 — % 1322 examined to end 1944 97.6 2.3 0.1 1.3 — 7.2 0.4 1.3 11.5 — 22.8 20.9 — 2.1 — Adult females (145) 141 4 0 0 0 9 0 0 4 21 4 0 0 0 0 Percentage 97.2 2.8 0 0 0 6.2 0 0 2.8 14.5 2.8 0 0 0 0 % 1429 examined to end 1944 97.8 1.8 0.4 2.8 — 15.3 0.8 1.1 27.4 — 20.3 10 — 2.8 — 17