KIN 065 Borough of Kingston-upon-Thames. Annual Reports FOR 192 1 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report OF THE SANITARY INSPECTOR. kingston-upon-thames ; Farrington Bros., Printers, 12a, Fife Road. Report of the Medical Officer of Health. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to submit the Annual Report for the year 1921. I took over the duties of Medical Officer of Health from Dr. Sam Browne on September 1st, 1921. Circular 269, as to the contents and arrangements of the Annual Reports of Medical Officers of Health, was received from the Ministry of Health, and I quote the following extract for your information:— "Annual Reports of a full and detailed character (referred to in this circular as Survey Reports) will normally be required at intervals of not more than five years. "In other years Medical Officers of Health should be asked to prepare an Annual Report of a more simple character (referred to in this circular as an Ordinary Report), including, as a minimum requirement, the particulars indicated in paragraph 5 of, and the appendix to, this circular. "The Annual Reports of 1919 and 1920 will be treated as constituting the first of the series of Survey Reports The Annual Report for 1921 will accordingly be an Ordinary Report” I have to express my hearty thanks to Mr. Perry, your Sanitary Inspector, and to the Staff of the Health Department, for their wholehearted support during my initial period' of office. I am, Mr. Chairman and Gentlemen, Your obedient Servant, E. W. MATTHEWS, Medical Officer of Health. 4 Staff of the Public Health Department. Medical Officer of Health. E, W. MATTHEWS, m.b., B.s.(Lond.), m.r.c.s., i..r.c.p., d.p.h. also duties (half-time) as School Medical Officer. Maternity and Child Welfare. WINIFRED WARNER, m.b., b s.(Lond.), b.p.h. Sanitary Inspector. H. T. PERRY, a.r.san.i., Cert. R.San. Inst, as San. Inspector and Meat and Foods Inspector. Health Visitors. Miss E. ARTHUR, Cert. c.m.B., Cert, r.s.i. as H.V. and S.N. Miss. C. J. DUNCAN, Cert, c.m.b. Clerk. W. C. COCKELL. Disinfector and Ambulance Driver. C. BENSON. Special Officer. H. J. EDWARDS, mr.c.v.s., Veterinary Inspector of Dairy Cows. 5 GENERAL STATISTICS. Area 1,133 acres. Population (1921) (Registrar-General) 39,520 Number of inhabited houses (1921) 8,694 Rateable Value— To Poor Rate £251,554 Assessable value to District Rate £247,040 Sum represented by a penny rate— Poor Rate £1,036 District Rate £1,016 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births Total. Male. Female. Legitimate 763 401 362 Birth Rate (R.G.) 20.2 per 1000 population. Illegitimate 30 13 23 799 414 385 Deaths 457 232 225 Death Rate (R.G.) 11.5 per 1000 population. Number of women dying in, or in consequence of, childhood— From Sepsis — From other causes 1 Deaths of infants under one year— Total. Male. Female. Legitimate 43 28 15 Illegitimate 5 2 3 48 30 18 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 56 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 139 Total Deaths of Infants under one year of age per 1,000 births 60 Death from Measles (all ages) 1 Death from Whooping Cough (all ages) 2 Death from Diarrhoea (under 2 years of age) 18 6 Birth Rate. Death Rate. Rate per 1oooBirtlis. Diarrhœa under 2 years. Total Deaths under 1 year England and Wales 22.4 12.1 15.5 83 148 Smaller Towns 22.7 11.3 15.6 84 (1911 Pop. 20,000-50,000) London 22.3 12.4 21.3 80 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All causes 232 225 1. Enteric Fever — — 2. Smallpox — — 3. Measles — 1 4. Scarlet Fever 2 — 5. Whooping Cough 2 — 6. Diphtheria 2 3 7. Influenza 5 1 8. Encephalitis lethargica 1 — 9. Meningococcal Meningitis — — 10. Tuberculosis of respiratory system 6 19 11. Other Tuberculous Diseases 5 3 12. Cancer, Malignant Disease 35 38 13. Rheumatic Fever — — 14. Diabetes 3 2 15. Cerebral Hæmorrhage, etc. 21 15 16. Heart Disease 29 31 17. Arterio-Sclerosis 3 2 18. Bronchitis 8 13 19. Pneumonia (all forms) 12 15 20. Other Respiratory Diseases 6 2 21. Ulcer of Stomach or Duodenum 2 1 22. Diarrhœa, etc. (under 2 years) 10 8 23. Appendicitis and Typhlitis 4 2 24. Cirrhosis of Liver — 2 25. Acute and Chronic Nephritis 5 — 3 26. Puerperal Sepsis — — 27. Other Accidents and Diseases of Pregnancy and Parturition - 1 28. Congenital Debility and Malformation, Premature Birth 2 6 29. Suicide 4 2 30. Other Deaths from Violence 6 6 31. Other defined Diseases 49 49 12. Causes ill-defined or unknown - - According- to figures furnished by the Registrar-General, 7 Figures which call for comment are those of 73 deaths from Cancer, malignant disease, during the year, compared with 56 during 1920. Also the 18 deaths from Diarrhœa, etc. (under 2 years) against 8 during 1920, were probably due to the hot, dry summer. The Infant Mortality rate of 60 compares favourably with those of England and Wales, 83; smaller towns, 84, and London, 80. Notifiable Diseases during the Year. Cases. Deaths. Under 1 year. I—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35-45 45—65 65 & over. Total Cases Notified. Cases admitted to Hospital. Under 1 year. 1—2 2—3 3—4 4—5 5-10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Deaths Diptheria 1 1 — 9 7 40 10 6 3 2 — — 79 60 — — — 1 — 4 — — — — — — 5 Scarlet Fever 3 13 8 10 23 145 61 18 1 7 2 — 302 221 — — — 1 — 1 — — — — — — 2 Enteric Fever including Paratyphoic — — — — — 1 — 1 2 — — — 4 1 — — — — — — — — — — — — — Puerperal Fever — — — — — — — — — — — — 1 1 — — — — — — — — — — — — — Pneumonia — — — — — — — — — — — — 1 — — — — — — — — — 1 — — — 1 Malaria — — — — — — — — 1 — — — 1 — — — — — — — — — — — — — — Acute Polio-myelitis — — — 1 — — — — — — — — 1 — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — 2 — 2 1 — — — — — — — — — — 1 — 1 Erysipelas — 1 — — — — 4 — 3 4 5 11 28 15 — — — — — — — — — — — — — Tuberculosis (a) Pulmonary M. — — — — — 2 — 4 7 2 11 1 27 18 1 — 1 — I — — — 1 1 1 — 6 F. — — — — — 3 — 4 12 3 2 2 26 12 — — — — — — 1 4 3 4 5 2 19 Total — — — — — 5 — 8 19 5 13 3 53 30 — 1 — 1 — 1 1 4 4 5 6 2 25 (b) Non Pulmonary M — — — — — 2 — — 1 1 — — 4 2 — 1 — — — 2 1 — — — 1 — 5 F. — — — — — 3 — — 1 — — — 4 2 — — — — — 1 1 — 1 — — — 3 Total — — — — — 5 — — 2 1 — — 8 4 — 1 — — — 3 2 — 1 — 1 — 8 Opthalmia Neonatorium. CASES. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 6 4 2 4 — — 2 8 9 CAUSES OF SICKNESS. Scarlet Fever. This disease was prevalent especially during the last quarter of the year, 302 cases being notified against 139 during 1920. The type was mild, and there were only two deaths. There is little doubt that the spread of infection was brought about by "missed" cases and those not recognised until late in the disease. Children have been found peeling at school, and many cases have not been notified until desquamating, no medical practitioner having been summoned until this stage is reached, the parents regarding the original sickness, etc., as a "bilious attack." The number of notifications received each month shows the top of the curve in November. Jan. Feb. Mar. Apl. May. June. July. Aug. 11. 16. 16. 21. 11. 16. 28. 7 Sept. Oct. Nov. Dec. 25. 50. 58. 43. Diphtheria. Seventy-nine cases were notified compared with 82 during 1920. In September 10 cases occurred at St. Paul's Girls' School, where a carrier was discovered, isolated, and treated, resulting in the temination of the outbreak. Influenza. At the end of the year a mild form of Influenza occurred, affecting all classes alike. The general practitioners report that the onset was sudden, with myalgic pains and gastric symptoms. Pneumonic complications appear to have been very rare, only one case of influenzal pneumonia being notified before the end of the year. Influenza vaccine was at the disposal of the medical practitioners. 10 SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (b) Infectious Diseases.—In Measles, Whooping Cough, and Epidemic Diarrhœa, the Health Visitors are under instructions to visit the cases and give practical advice as to the best methods of nursing them. Cases of Ophthalmia Neonatorum are visited and treatment carried out by Nurses from the Kingston Nursing Association, the fees being paid by the Council. Midwives. The Midwives are under the administrative control of the Surrey County Council. There were ten practising in the Borough at the end of the year. Clinics and Treatment Centres. Centre. Situation, Accommodation, Provided By. Maternity & Child Welfare Eden Street Consultation & Treatment The Corporation Maternity & Child Welfare Washington Road Consultation & Treatment ,. Day Nursery Canbury Park Rd. 9 Babies & 16 Infants Vol. Committee School Clinic " Devoncroft." Consultation & Treatment The Education Fairfield South of Minor Ailments Committee Tuberculosis Dispensary Grove Crescent - Surrey C.C. Red Cross Curative Post Coombe Road Out Patients, Massage & British Red Electrical Treatment Cross Society Maternity and Child Welfare Centres. The two Centres, one at the Y.M.C.A. Hall, Eden Street, and the other at St. Peter's Hall, Washington Road, are maintained by the Town Council. Dr. Winifred Warner attends each Centre once a week, and much valuable help is given by many voluntary lady workers. In necessitous cases babies and nursing mothers are provided with free milk on the advice of Dr. Warner, and dried milk. etc.. is sunnlied at cost orice. During the year there were the following number of attendances at the Centres :— Meetings. Attendances. New Cases. Total. Eden Street 50 232 2,392 Washington Road 48 62 935 11 1. Tuberculosis.—None. Cases in the area are admitted to Sanatoria through the Surrey County Council. 2. Maternity. The Kingston Nursing Association, 33, Birkenhead Avenue, have six beds for Maternity cases. The charge made is three guineas a week, and arrangements are made whereby the Council pay half the fees in deserving cases. The Kingston and District Hospital (Board of Guardians) have Maternity Wards. 3. Children..—None. 4.—Fever. Arrangements are made whereby Wimbledon, Molesey, and Hampton Isolation Hospitals accept cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. 5. Smallpox. The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. 6. Other. Other Hospitals situated in the Borough available for the district are:— (a) The Kingston and District Hospital (Board of Guardians. (b) The Kingston Victoria Hospital, supported by voluntary contributions. Institutional provision for the unmarried mothers, illegetimate infants, and homeless children. Within the district provision is made at the Union Infirmary (Kingston and District Hospital). There is a Hostel at Epsom to which cases from the Borough can be admitted on payment. Ambulance Facilities. (a) For infectious cases. Those cases removed to Wimbledon Isolation Hospital are transported by the Wimbledon Ambulance. Those removed to Molesey or Hampton Isolation Hospitals are taken by your own motor ambulance. (b) For non-infectious and accident cases there is no provision made by the Corporation. 12 LABORATORY WORK. Arrangements are made whereby general practitioners send material for pathological and bacteriological examinations to the Clinical Research Association, and the cost is met by the Council. The issue of Diphtheria antitoxin is made through two chemists, and is available at all times. Anti-Influenza vaccine is issued to the local doctors through the Public Health Department. LIST OF ADOPTIVE ACTS & BYE-LAWS IN FORCE IN THE BOROUGH. Adoptive Acts. Date of Adoption. Public Libraries Acts 1st March, 1881 Baths and Washhouses Acts 28th July, 1896 Public Health Acts Amendment Act, 1890 1st July, 1891 Private Street Works Act, 1892 Bye-Laws relating to the following matters are in force within the Borough:— Nuisances allowed 28th November, 1881 Slaughter-houses ,, 28th November, 1881 Common Lodging Houses ,, 28th 'November, 1881 Sanitary Convenience ,, 11th May, 1899 Houses let in Lodgings ,, 31st October, 1911 SANITARY ADMINISTRATION. The Veterinary Surgeon, Mr. Edwards, inspected the dairies and cowsheds with me at intervals, and on the whole we found the conditions satisfactory. The Sale of Food and Drugs Acts are administered by the Surrey County Council, and the following table shows action taken in the Borough during the year:— Articles. Analysed. Adulterated or Deteriorated. Prosecutions. Convictions Formal Informal Total. Formal Informal Total. Milk 97 ... 97 5 ... 5 2 1 Butter 7 14 21 ... 2 2 ... ... Lard 2 1 3 ... ... ... ... ... Sugar ... 1 1 ... ... ... ... ... Other Articles 10 21 31 7 8 15 6 3 Totals 116 37 153 12 10 22 8 4 In order to prevent duplication, action taken under the Public Health Acts or Bye-laws, Condition of Slaughterhouses, Disinfection, Housing, etc., are included under the Annual Report of the Sanitary Inspector. 13 Report of the Sanitary Inspector. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to present to you my third Annual Report on the work carried out by your Sanitary Inspector during the year 1921 in connection with the various Statutes and Bye-laws relating to public health in force within the borough. In accordance with Circular 269, the Report is rendered extremely brief. The total number of inspections made was 2,786, as compared with 2,644 during 1920. On 455 premises inspected, sanitary defects to the number of 2,310 were discovered. In connection with these defects, 265 preliminary and 78 verbal notices were issued. It was only found necessary to issue 33 "Statutory" notices during the year. At the end of the year notices were outstanding in respect of 399 premises. INSPECTIONS. The following is the total number of inspections made in regard to each section of the work, together with a summary of sanitarv improvements executed:— Rent Restrictions Act Inspections 49 Re-inspections after Order or Notice 494 Visits to Works in progress 658 Factories and Workshops (including Bakehouses) 53 Cowsheds, Dairies and Milkshops (excluding inspections by Medical Officer of Health and Veterinary Inspector) 44 Ice Cream premises 5 Foodshops 213 Infectious Disease enquiries 91 14 Markets 45 Special Inspections (complaints, etc.) 806 Slaughterhouses 39 Offensive trades 15 Sanitary Conveniences 50 Common Lodging Houses 6 Canal Boats 1 Theatres, Cinemas, etc. 4 Miscellaneous visits 213 Total number of Inspections 2,786 DRAINAGE. Number of old drains examined, tested, exposed, etc. 31 Number of houses and premises re-drained 30 Number of drains repaired or amended 8 Drains or gullies unstopped or cleansed 32 Manholes provided 71 Manholes altered or repaired 4 Intercepting traps fixed 23 Fresh-air inlet shafts repaired or renewed 28 New gully traps fixed 117 New soil pipes and ventilating shafts 45 Ventilating shafts repaired 4 Smoke tests applied 52 Water Tests applied 98 New cesspools (where no sewer available) 1 WATER CLOSETS & SANITARY FITTINGS. New W.C. basins fixed 74 W.C.'s unstopped, cleansed or repaired 2 W.C. flushing tanks repaired or renewed 28 Water supplied to W.C.'s 4 New W.C. apartments provided 4 W.C. apartments lighted, repaired and ventilated 33 New impervious sinks provided 19 New waste pipes fixed 20 Existing waste pipes trapped 10 SANITARY CONVENIENCES. New urinals constructed 11 Urinal abolished 1 15 MISCELLANEOUS. Roofs repaired 29 Eaves gutters renewed or repaired 14 Stack pipes renewed or repaired 13 Stack pipes disconnected from drains 24 Damp walls remedied 26 Ventilation provided beneath floors 11 Yards paved 27 Yard paving repaired 2 Yards cleansed 5 Floors of rooms repaired 15 Floors of rooms renewed or repaved 2 Rooms repaired, cleansed and distempered 177 Windows repaired, renewed or made to open 53 Cisterns repaired, cleansed, covered or removed 12 Movable ashbins provided 139 Nuisance from overcrowding abated 4 Nuisance from animals abated 16 Accumulation of manure or refuse removed 13 Water supplied to houses 1 Premises limewashed (workshops, etc.) 39 Firegrates repaired or renewed 9 New pumps for water supply 1 Pigstyes abolished 3 New milkstone provided 1 Nuisance from smoke abated 1 Sheds removed 4 Miscellaneous 32 MEAT & FOODS INSPECTION. This branch of the work has received considerable attention during the year. Every care has been taken to detect any diseased, unsound or unwholesome food. During the year 346 visits have been paid to premises where food is prepared or exposed for sale. Probably the most important part of this work is that of examination of carcases of meat at the time of slaughter, when all the organs may be examined. A ccnsderable number of visits and inspections have been made in connection with food inspection in the evenings after office hours. The result of inspections is reflected in the following list of foodstuffs condemned during the year:— 16 Articles. Cause of Condemnation. Beef, 1,199 lbs. Small part tuberculosis, remainder putrefaction. Beef Offal, 1,348 lbs. Ditto. Mutton & Lamb, 1,024 lbs. Putrefaction, "black spot." Corned Beef, 38 lbs. Putrefaction. Rabbits, 53 lbs. Ditto, and mould. Pork, 4 carcases Generalised Oedema. Shrimps, 1 basket Putrefaction. Cod, 84 lbs. Ditto. Haddocks, 28 lbs. Ditto. Herrings, 1 box Ditto. Lemon Soles, 32 lbs. Ditto. Tomatoes, 44 boxes Ditto. Potatoes, 112 lbs Ditto. Black currants. 2 crates Ditto. There are several wholesale meat depots in the borough, and a large quantity of meat is distributed from this town to the surrounding districts. A great deal of this meat is inspected in the London markets before dispatch to Kingston, but inspection here is necessary when the consignment comes direct from the boats, or when some days have elapsed since it left the London markets. SLAUGHTER HOUSES. There are now 6 private slaughterhouses in the borough, all of which have been in use during the year. The addresses are:— No. 36, Cambridge Road. No. 90, Acre Road. Bath Passage. No. 45, Cambridge Grove Road No. 120, London Road. Cowleaze Road. The buildings, with one exception, are old. They are, however, kept in a fairly satisfactory condition, and the occupiers show willingness to comply with your Council's requirements. Thirty-nine visits were paid to these premises during the year. These visits were made at the time of slaughtering so far as possible, but as no notice of slaughtering is given to the Sanitary Inspector, and the times of slaughtering are not regular, it is obvious that only a proportion of the animals killed could be examined. 17 DISINFECTION. Three hundred and seventy-two rooms have been disinfected in 326 houses during. 1921, as compared with 296 rooms in 253 houses during 1920. The Council possess a "Velox" high-pressure steam disinfecting apparatus, which is contained in a convenient building adjacent to the Electricity Works. Steam for use in connection with the apparatus is obtained from the Electricity Works, and is available at all times. The erection of the premises and machine was completed in May, 1921, and since the end of June no less than 2,329 articles have been passed through the apparatus. In addition, all infected rooms and furniture, etc., are sprayed and fumigated with formalin. HOUSE DRAINAGE. Thirty houses were re-drained during the year. In order to ascertain correctly the condition of drains in 16 cases it was necessary for the Corporation to avail themselves of the powers conferred upon them by Section 41 of the Public Health Act, 1875, to authorise your Sanitary Inspector to enter the premises, open up the ground and examine the drains, etc. In other cases, however, the owners had the necessary excavations carried out themselves, and have afforded all reasonable facilities to your Sanitary Inspector to apply tests to the drains. The following premises were re-drained during the year:— Caversham Road 3 houses. Cambridge Road 1 house. Fife Road 4 houses. Mill Street 2 houses. London Road 1 house. St. Albans Road 1 house. Clarence Street 4 houses. Beaufort Road 1 house. Knights Park 3 houses. Shortlands Road 1 house. Lower Ham Road 1 house. Fairfield West 1 house. Canbury Place 2 houses. Springfield Road 3 houses. Park Road 1 house. Surhiton Road 1 house. Total 30 houses. 18 COMPLAINTS. Two hundred and fifty-four complaints were made during the year as follows:- Drains and Sanitary arrangements 40 Water Supply 5 Accumulation of manure and non-removal of house refuse 18 Absence of ashbins 6 Flooding of cellars 1 Dampness (bursting pipes, etc.) 4 Insanitary condition of premises 125 Defective roofs 5 Nuisance from keeping of animals IS Overcrowding 10 Smoke nuisance from chimneys 2 Nuisance from flies 3 Miscellaneous 19 Total 254 The complaints were investigated promptly, and where the Corporation possessed powers to interfere immediate steps were taken to remove the cause of the complaint. HOUSING. No house-to-house inspections were made during the year. The Corporation has recently decided to appoint an Assistant Sanitary Inspector, and it is confidently anticipated that during the year 1922 inspections under the Housing (Inspection of District) Regulations, 1910, will be recommenced. The following statistics are set out in accordance with the requirements of the Ministry of Health :— Number of new houses erected during the year :— (a) Total 16 (b) As part of municipal housing scheme 12 1. Unfit dwelling-houses. Inspection: (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 448 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 nil. 19 (3) Number of dwelling-houses found to be in a state 50 dangerous or injurious to health as to be unfit for human habitation nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 379 2. Remedy of defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 285 3. Action under Statutory Powers. A.—Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil. (2) Number of dwelling-houses which were dered fit:— (a) by owners nil. (b) by Local Authority in default of owners nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 12 (b) by Local Authority in default of owners nil. C.—Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders nil. (2) Number of dwelling-houses in respect of which Closing Orders were made nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made nil. (5) Number of dwelling-houses demolished in suance of Demolition Orders nil. 20 INCREASE OF RENTS & MORTGAGE INTERESTS ACTS. Fifty applications were received during the year from tenants for certificates under section 2, sub-section 2, of the above Act. The premises were subjected in each case to a careful inspection, and the owners of the houses respectively were invited to carry out any necessary items of repair. With the exception of 7 cases, all the owners agreed to carry out the repairs, and, therefore, only 7 certificates were granted during the year. OFFENSIVE TRADES. The following offensive trades are carried on in the town:— Leather Tanning. Rag and Bone Dealers. The premises are inspected at irregular intervals and without notice to the occupiers. The tannery is maintained in a satisfactory condition, and no complaints in respect thereof have been received during the year. CONCLUSION. I again desire ±0 thank the Chairman and the members of the Sanitary and Drainage Committee and the Corporation generally for their kindly consideration and support during the year. I am, Gentlemen, Your obedient Servant, HAROLD T. PERRY, A.R.San.I., Sanitary Inspector. 21 Report of the School Medical Officer. To the Chairman and Members of the Education Committee of the Borough of Kingston-upon-Thames. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1921. During the year I was appointed Medical Officer of Health to the Borough of Kingston-upon-Thames, and took up the duties of that office on September 1st, 1921, my time being Apportioned equally as Medical Officer of Health and School Medical Officer. The teachers have again been most helpful at Routine Inspections, and have availed themselves of my visits to the schools by bringing special cases before me. In only one instance was I notified in writing that a parent objected to his two children being examined medically, and still refused after having the advisability of allowing it explained to him. As a compromise he was allowed to have the Medical Inspection Record Cards completed by his own doctor. The general nutrition of the children, on the whole, is very good, but meals were provided in necessitous cases selected by the head teachers, the cost being defrayed by voluntary funds. Arrangements are made whereby children from all the schools use the Corporation swimming baths at specified times. There was no school closure during the year on account of infectious disease. The average number of children in the school register for the year was 5,468. A lady clerk was appointed in January, with the object of relieving the School Nurse of office work, and thereby permit her to carry out her proper duties, which has resulted in a great advance in the most important work of following-up. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer, 22 Staff of the School Medical Service. School Medical Officer. IS. VV. MATTHEWS, m.b., B.s.(Lond,), d.p.h. School Nurse. Miss R. BARTTER, Cert. C.m.b., Cert, R.s.i. as H.V. and S.N. Clerk. • Miss FLAVELL. SUMMER TIME ACT. In answer to Circular 1215 of the Board of Education, the followng reply was made on September 28th, 1921, by the School Medical Officer:— Reliable information from parents on the effects of this Act on the health of children attending public elementary schools is most difficult to obtain, and that received from teachers is very contradictory. One head teacher of a large infants' school writes: "I have found no ill-effects on the health, attendance, or ability to work of the children attending this department owing to the putting on of the clock during the summer months," whereas another teacher of a similar infants' school says: "In many cases the children are kept up later, and therefore do not have sufficient sleep. In consequence, when they come to school in the morning, they are sleepy, often yawning and lacking in energy and vitality. They seem unable to concentrate." Other reports from teachers vary between these two extremes. 22 Now, as one who has engaged in private practice until recently, and it is the private practitioner who is so intimate with the home-life of the people, I have found that the better class mothers of the working population put their children to bed at the same time by the clock during the summer time and darken the room, thus making every effort to get the child to acquire the habit of going to sleep an hour earlier, and generally, after a very short period, this is successful. Also, these mothers allow their children to lie longer in the morning, if possible; but on the whole, there is probably a slight loss of sleep in these better-cared-for children. Now, in the poorer districts the children go to bed when their parents do, and also get up at the same time in the morning. With the earlier closing of public-houses, most of these go to bed earlier now than formerly, and owing to the shortened hours of labour a later start is made in the morning; so I consider the number of hours of sleep obtained by the children of the poorer class has in no way been curtailed by the Summer Time Act. Also, it is the children of this latter class who play during the daylight until late in the streets and parks, and it appears possible that their health has actually benefited by the extra hours out of doors instead of inside, poor, overcrowded homes, where they would not retire to bed until the same time as their parents. On the whole there appears to be no evidence that the Act has had any injurious effect on the children attending public elementary schools in this Borough, and the suggestion made by some teachers that a late start should be made at the schools in the morning would avail nothing, as it would not affect home conditions, and the matter is one entirely of parental care. The only legislation I should like to see would be that children of school age be prohibited from attending indoor places of amusement, such as theatres, picture houses, etc., after a certain hour in the evening; but I would not suggest the closing of parks and recreation grounds for the reasons stated above. CO-ORDINATION. Infant and Child Welfare. The Medical Record Cards of those children who have attended the Maternity and Child Welfare Centres are now transferred to the School Medical Service when these children attain the age of five. 24 Public Health Department. Co-ordination between the School Medical Service and the Public Health Department is now complete since my appointment as Medical Officer of Health. Nursery Schools. There are no Nursery Schools in the Borough, and the Nursery Class at All Saints' Infants' School was discontinued for reasons of economy in April. ELEMENTARY SCHOOLS. 1. School Hygiene. A general review of the Public Elementary Schools was given in last year's Report, giving in detail their hygiene conditions with particular reference to their surroundings, ventilation, lighting, warming and sanitation. During the year 1921 the following repairs and improvements have been carried out:— Bonner Hill Road Schools. Painting the outside of the boys' and girls' school, and also the infants' school. A hut has been erected to be used as a Training Centre for cookery and laundry. All Saints' School. Boys', girls' and infants' schools have been decorated internally throughout. St. Luke's School. Boys' department, 5 new lavatory basins. Girls' department, 2 new lavatory basins. Elm Road Council (Infants') School. Glass partition dividing class-rooms has been taken down and re-erected in another class-room. St. Paul's School. Boys', girls' and infants' schools have been decorated internally throughout, and all wood and iron work painted externally. Defective chimney stacks were taken down and rebuilt. St. Peter's School. Boys', girls' and infants' schools have had walls and dados painted. 25 MEDICAL INSPECTION. All departments of every school are visited by the School Medical Officer each term for the purpose of carrying out:— 1. Routine inspections of— (a) Entrants, as soon as possible after entry. (b) Intermediates, age 8. (c) Leavers, age 12 and over. 2. Re-inspections of those children referred for defects at previous routine inspections. 3. Examination of special cases brought forward by the teachers. The procedure of the above examinations set out in detail in the Annual Report, 1920, has been continued, and the Board of Education schedule followed. Early ascertainment of crippling defects is secured by urging the teachers to bring children so affected forward as special cases at these inspections, and they are also seen at the Clinic when sent by the Education secretary, teachers, and attendance officers. It is found that by visiting the schools each term instead of annually for routine inspections, the disturbance of school arrangements is reduced to a minimum, and a closer touch is kept with the teachers in respect of special cases, and fewer children are missed as absentees. In the more modern schools a quiet room is always provided for the School Medical Officer, but in the older schools the inspections have to be carried out in a class-room, and it is more convenient and creates less disturbance to empty this for two or three days each term rather than for six to nine successive days each year, and the former system is much preferred by the teachers. UNCLEANLINESS. At Routine Medical Inspections, 252 children were found with unclean heads and 181 with unclean bodies, which compares favourably with 370 and 300 respectively during the year 1920. It is also very evident that the degree of uncleanliness has markedly improved, and the number of children exhibiting flea bites has greatly diminished. The use of "Derbac" soap has been tried, and where the directions have been carried out by the parents the result appears very satisfactory. 26 The average number of visits per annum made by the School Nurse to each school was 59. The total number of individual children found unclean: Head, 998; body, 183. Legal Proceedings taken under the Children Act, 1908, or School Attendance Bye-laws:— Prosecutions were made in cases of 19 children, resulting in 15 convictions, with fines amounting to £5 5s. in all. The School Attendance Officer reports: "Some of the cases have been adjourned three or four times with a view of getting the children clean and improving their attendance, but the cases are never withdrawn until the children are certified fit and clean and very regular in attendance, and the habit of so attending is established." INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. Measles.—In May there was an outbreak of 28 cases of Measles at St. Agatha's Infants' School, but on investigation it was found that no good would have resulted on school closure. Measles also occurred at Richmond Road Infants' School during the summer months. Mumps.—There was an outbreak of Mumps at St. John's Infants' School during November. Diphtheria.—An outbreak of Diphtheria occurred at St. Paul's Girls' and Infants' School, there being 10 cases reported between September 13th and 20th. Swabs were taken from 24 girls in Standard II., with the result that one carrier and one very suspicious swab were found. The carrier, suspicious case, and four contacts were excluded from school until two negative swabs had been taken from each. One further case occurred on September 22nd, who had probably contracted the disease before September 20th. This terminated the outbreak. Scarlet Fever.—During March eight cases of Scarlet Fever occurred at St. Agatha's School, and it was deemed advisable to have the class-room disinfected. 27 During the last three months of the year the incidence of a mild type of Scarlet Fever was high, and on account of its mildness the spread is probably due to "missed" cases, this view being strengthened by the fact that several cases have been notified by the doctors as being in the peeling stage, medical attendance not having been summoned until that stage is reached. Also, I found at the School Clinic a desquamating child who had been previously at home for a few days with a "cold," and then was sent back to school by the parents when apparently better, no doctor having been called. FOLLOWING-UP. The following-up of children suffering from defects is carried out by the School Medical Officer and School Nurse, aided in some instances by the teachers and attendance officers. The School Medical Officer completes a following-up card for each child found defective, and he re-examines the child on re-visiting the school each term until satisfactory treatment has been obtained. When no treatment has been obtained after a second notice, the School Nurse visits the home and interviews the parents in order to point out the necessity of treatment and to advise and help them in the right way of getting this carried out. The work of the School Nurse may be briefly summarised as follows:— 1. To prepare beforehand for routine medical inspections by weighing, measuring, etc. 2. To assist at routine medical inspections and reinspections. 3. To follow up by paying home visits. 4. To carry out cleanliness surveys at the schools. 5. To re-examine those children found unclean after a short interval. 6. To bring obstinate cases of uncleanliness before the School Medical Officer. 7. To attend the Clinic. 8. To supervise the work of the clerk. A short comparative table is here appended, and the marked improvement in the number of children treated is chiefly due to the energies of the School Nurse, who has been able during 1921 to carry out home visiting more fully. 28  1920. 1921. Children referred for treatment 951 568 Children satisfactorily treated 344 512 Home visits made by School Nurse 281 550 Cleanliness surveys 14,046 16,617 MEDICAL TREATMENT. Medical treatment has been obtained on the advice of the School Medical Officer from Hospitals or private practitioners. Minor ailments and skin diseases have been treated by the issue of ointments, etc., at the Clinic. Sixty-seven cases of enlarged tonsils and adenoids have received treatment, chiefly at the Kingston and District, Kingston Victoria, and Richmond Hospitals. All cases of suspected Tuberculosis have been referred to the Surrey County Council Tuberculosis Officer, Dr. Cameron Renwick, who has given very great assistance in his advice, supervision, and recommendation as to the disposal of these children. Sixty-six children suffering from defective vision were submitted to refraction and obtained glasses, mainly at the Royal Eye Hospital, London, S.E., and Richmond Hospital. Ear disease and deafness were referred to private practitioners and Hospitals. One hundred and seventeen children suffering from dental defects received treatment during the year from the local dentists chiefly. Advice has been given to parents whose children have crippling defects, and now several receive electrical and massage treatment at the Red Cross Curative Post at Norbiton. The Central Aid Society has been most helpful in assisting the School Medical Service in obtaining letters for Hospitals, fares to London, payments for massage, etc., in cases where the parents cannot afford to pay. When notified by the School Medical Officer, the National Society for Prevention of Cruelty to Children has aided in following up and in urging parents to obtain essential treatment, with satisfactory results. 29 VACCINATION. At routine inspections a record is made of children showing evidence of having been vaccinated or not, and again it is evident that the number of unvaccinated children in the Public Elementary Schools is increasing. The following table is of interest:— Examined ??? Parents Present Entrants, Boys 296 170 57% 211 71% Girls 249 136 54% 193 77% Intermediate, Boys 377 226 60% 184 50% Girls 348 191 55% 214 61% Leavers, Boys 35° 275 81% 92 26% Girls 342 250 73% 172 50% Parents are always warned as to the hour their children are to be examined. SPECIAL SCHOOLS. The Special School for Physically Defective Children at "Devoncroft," Fairfield South, was reviewed in detail last year, and it is proposed to move ths school to "Elmfield," London Road, as soon as the necessary alterations are complete. Dinners are served and payments up to fourpence a meal are made by parents, and any deficit is defrayed by voluntary contributions. The teaching specialises in manual training—needle-work, jam-making, and laundry for girls; gardening and basket work for boys. The Clinic has been held upstairs, and this will also be removed to "Elmfield" as soon as the rooms are ready. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants, and issues certificates as to the physical fitness, and these certificates are taken to and endorsed by his employer. The child is issued with an Employment Card by the Local Education Authority. During the year, 87 school children and five young persons have been issued with certificates by the School Medical Officer under the Bye-laws made under the Employment of Children Act, 1903, as amended by Section 13 of the Education Act, 1918. 30 GARDENING CENTRES. There are Gardenings Centres in connection with the following' schools:— Bonner Hill Road Boys' School. Richmond Road Boys' School. St. John's Boys' School. St. Paul's Boys' School. St. Peter's Boys' School. Devoncroft Special School. TABLE I. NUMBER OF CHILDREN INSPECTED 1st January, 1921—31st December, 1921. A. Routine Medical Inspection. Entrants. Boys Girls Age 3 4 5 6 Other ages. Total. — 1 211 62 22 296 — 2 154 75 18 249 Totals — 3 365 137 40 545 Intermediate Group. Leavers. Other ages. Total. Grand Total. Boys Girls Age 8 12 13 14 224 265 74 11 153 727 1024 196 254 78 10 151 689 938 Totals 420 519 152 21 304 1416 1962 B, Special Inspections. Special Cases. Re-Examination (i.e. No. of children Re-Examined). Boys Girls 188 467 403 490 Totals 591 957 C. Total Number of Individual Children inspected by the Medical Officer, whether as Routine or Special cases (no child being counted more than once in one year)— 2553. TABLE II. RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION IN 1921. Defect or Disease. Routine Inspections. Specials. No referred for treatment. No. kept under observation not referred for treatment. No. referred for treatment. No. requiring to be kept under observation not referred for treatment. Malnutrition — — 2 1 Uncleanliness- Head 252 — 746 — Body 151 — 32 — Skin Ringworm, Head — — 40 5 1 Body 1 — 15 — Scabies — — 19 — Impetigo 1 — 6l 11 Other diseases (non Tb) — — 13 5 Eye Blepharitis 2 — 2 1 Conjunctivitis 2 — — — Keratitis — — 2 — Corneal Ulcer 1 — — — Corneal Opacities 1 — 1 — Defective Vision 69 — 6 5 Squint 7 1 3 — Other conditions — — 2 — Ear Defective hearing 8 — — — Otitis Media 9 1 8 — Other ear diseases — — — 1 Nose and Throat Enlarged Tonsils 59 — 6 2 Adenoids 4 1 1 — Enlarged Tonsils and Adenoids 5 — — — Other conditions 2 — 3 5 Enlarged Cervical Glands (Non Tb) — — — — Defective Speech — — 1 — Teeth—Dental Diseases 135 — 7 2 Heart and Circulation Heart disease, Organic 1 9 1 1 Functional — — — — Anæmia — — 3 — Lungs Bronchitis 1 2 3 — Other (non Tb) — 1 4 2 Tuberculosis Pulmonary, Definite — — — — Suspected 1 1 2 2 Non-pulmonary, Glands 3 — 10 2 Spine — — — — Hip — — 1 2 Other bones and joints — — — 1 Nervous System Epilepsy — — — — Chorea — 1 — 1 Other conditions — — — 2 Deformities Rickets 1 — — — Spinal curvature — 2 — — Other Forms 2 5 7 2 Other defects and diseases 5 — 27 29 Number of Individual Children having defects which require treatment, or to be kept under observation ,,, ,,, 648 32 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1921. Blind. (Including partially Blind). Boys. Girls. Total. Attending Public Elementary School 2 ... 2 Attending Certified Schools for the Blind 2 ... 2 Not at School ... ... ... Deaf and Dumb. (Including Partially Deaf). Attending Public Elementary School 2 ... 2 Attending Certified School for the Deaf 1 3 4 Not at School ... ... ... Mentally Deficient. Feeble-minded. Attending Public Elementary School ... 1 1 Attending Cert. School for M.D. Children ... ... ... Notified to the Local Control Authority by Local Education Authority during the year ... ... ... Not at School ... ... ... Imbeciles. Notified to the Local Control Authority 1 ... 1 At School ... ... ... Not at School ... ... ... Idiots. Notified to the Local Control Authority ... ... ... Epileptics. Attending Public Elementary School 1 ... 1 Attending Certified School for Epileptics ... ... ... In Institutions other than Certified Schools ... ... ... Not at School ... ... 33 TABLE III. (Continued), Physically Defective. Pulmonary Tuberculosis. Attending Public Elementary School ... ... ... Attending Cert. Schools for P.D. Children ... ... ... In Institutions other than Certified Schools ... ... ... Not at School ... ... ... Crippling due to Tuberculosis. Attending Public Elementary School ... ... ... Attending Cert. Schools for P.D. Children 10 3 13 In Institutions other than Certified Schools ... ... ... Not at School ... ... ... Crippling due to causes other than Tuberculosis i.e, Paralysis, Rickets, Traumatism. Attending Public Elementary School ... ... ... Attending Cert. Schools for P.D. Children 5 4 9 In Institutions other than Certified Schools ... ... ... Not at School ... ... ... Other Physical Defectives e.g. delicate and other children suitable for admission to open-air schools—children suffering from severe heart disease. Attending Public Elementary School ... ... ... Attending open-air Schools ... ... ... Attending Certified Schools for P.D. Children other than open-air Schools 1 ... 1 Not at School ... ... ... Dull or Backward. Retarded two years 4 5 9 Retarded three years 5 2 7 34 TABLE IV. TREATMENT OF DEFECTS OF CHILDREN DURING 1921. A. Treatment of Minor Ailments. Disease or Defect. Referred for Treatment. Number of Children. Total. Treated. Under Local Education Authority's Scheme. Otherwise. Skin, Ringworm, Head 40 ... 45* 45 „ Body 16 11 ... 11 Scabies 19 ... 23* 23 Impetigo 62 62 ... 62 Minor Injuries ... ... ... ... Other Skin Diseases 13 ... 11 11 Ear Diseases, External 25 ... 41* 41 „ Other ... ... ... ... Eye, omit D.V, and Squint 13 ... 11 11 Miscellaneous 32 ... 30 30 (other defects and diseases). The apparent discrepancy in figures is due to the inclusion of cases outstanding from 1920, receiving treatment during 1921. B. Treatment of Visual Defect. No. of Children Referred for Refraction 85 Submitted to Refraction. Under Local Education Authority Scheme Clinic or Hospital By Private Practioner or Hospital 49 Otherwise 17 Total 66 For whom Glasses were prescribed ... For whom Glasses were provided ... Received for treatment other than by glasses ... Received other forms of treatment ... For whom no treatment was considered necessary ... C. Treatment of Defects of Nose and Throat. No. of Children Referred for Treatment 80 Received Operative Treatment. Under Local Education Authority Scheme Clinic or Hospital By Private Practioner or Hospital 67 Total 67 Received other forms of Treatment ... D. Treatment of Dental, Defects. Dental defects 142. Treated 117 35 TABLE V. SUMMARY OF TREATMENT OF DEFECTS AS SHOWN IN TABLE IV. (A,B,C,D,F, but excluding E). Disease or Defect. NUMBER OF CHILDREN. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 220 73 161 234* Visual Defects 85 ... 66 66 Defects of Nose & Throat 80 ... 67 67 Dental Defects 142 ... 117 117 Other Defects 41 ... 28 28 Total 568 73 439 512 * The apparent discrepancy in figures is due to the inclusion of cases outstanding from 1920, receiving treatment during 1921. 36 1. Total number of children medically inspected at the routine inspections 1,962 2. The number of children in (1) suffering from Malnutrition — Skin Disease 2 Defective Vision (including squint) 77 Eye Disease 6 Defective Hearing 8 Ear Disease 10 Nose and Throat Disease 71 Enlarged Cervical Glands — Defective Speech — Dental Disease 135 Heart Disease (Functional) — (Organic) 10 Anæmia — Lung Disease (Non-tubercular) 4 Tuberculosis (Definite) — Pulmonary (Suspected) 2 Non-pulmonary 3 Disease of the Nervous System 1 Deformities 10 Other defects and diseases 5 3. The number of children in (1) suffering from fects (other than uncleanliness or defective clothing or foot-gear) who require to be kept under observation (but not referred for treatment) 24 4. The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 320 5. The number of children in (4) who received ment for one or more defects (excluding uncleanliness, defective clothing, etc.) 87