67744 C 4413(1) KINGSTON KINI Borough of Kingston-upon-Thames. Annual Reports. for 1923 of the MEDICAL OFFICER OF HEALTH and SCHOOL MEDICAL OFFICER together with the Annual Report of the SANITARY INSPECTOR. Borough of Kingston-upon-Thames. Annual Reports FOR 19 2 3 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report OF THE SANITARY INSPECTOR. 2 Staff of the Public Health Department. Medical Officer of Health: E. W. MATTHEWS, M.B., B.S.Lond., M.R.C.S., L.R.C.P., D.P.H. Maternity and Child Welfare: WINIFRED WARNER, M.B., B.S.Lond., D.P.H. Sanitary Inspector: H. T. PERRY, A.R. S.I., Cert.R.S.I., as Sanitary Inspector and Meat and Foods Inspector. Assistant Sanitary Inspector: F. D. HARVEY, A.R.S.I., Cert.R.S.I., as Sanitary 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, M.R.C.V.S., Veterinary Inspector of Dairy Cows. Report of the Medical Officer of Health. Municipal Offices, Kingston-upon-Thames, March, 1924. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to present my Annual Report for the Year 1923. The general health of the Borough has been satisfactory and the death-rate was very low. There was no undue prevalence of Infectious Disease, and the remarkable fall in the number of cases of Diphtheria is noteworthy. I thank Mr. H. T. Perry, your Chief Sanitary Inspector, and the Staff of the Public Health Department for their loyal support during the year. I am, Gentlemen, Your obedient Servant, E. W. MATTHEWS, Medical Officer of Health. 4 General Statistics. Area 1,133 acres. Population, 1923 (Registrar-General) 40,320 Number of inhabited houses, 1923 8,802 Rateable Value— To Poor Rate £261,137 Assessable Value to District Rate £256,526 Sum represented by a Penny Rate— Poor Rate £1,064 District Rate £1,051 Extracts from Vital Statistics of the Year, Births— Total. Male. Female. Legitimate 675 342 333 Birth Rate (R.G.) 17.5 per 1,000 population. Illegitimate 31 14 17 706 356 350 Deaths — 416 219 197 Death Rate (R.G.) 10.3 per 1,000 population. Number of women dying in, or in consequence of child-birth— From Sepsis 0 From other causes 1 Deaths of Infants under one year— Total. Male. Female. Legitimate 46 25 21 Illegitimate 6 3 3 52 28 24 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 68 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 193 Total Deaths of Infants under one year of age per 1,000 births 73 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under two years of age) 6 5  Birth Rate Death Rate. Rate per . Diarrhoea under2 years 1000 Births. Total Deaths under 1 year England and Wales 19.7 11.6 7.7 69 157 Smaller Towns 19.8 10.6 6.4 69 London 20.2 11.2 10.2 60 Kingston-upon-Thames 17.5 10.3 8.5 73 Causes of Death. (Civilians only.) Causes of Death. Male. Female. All Causes 219 197 1. Enteric Fever — — 2. Smallpox — — 3. Measles 2 — 4. Scarlet Fever 2 — 5. Whooping Cough — 2 6. Diphtheria — — 7.' Influenza 3 2 8. Encephalitis Lethargica — 1 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 13 7 11. Other Tuberculous Diseases 2 1 12. Cancer, Malignant Disease 27 27 13. Rheumatic Fever — 1 14. Diabetes — 1 15. Cerebral Hasmorrhage, etc. 14 17 16. Heart Disease 28 30 17. Arterio-Sclerosis 11 5 18. Bronchitis 13 7 19. Pneumonia (all forms) 18 9 20. Other Respiratory Diseases — 3 21. Ulcer of Stomach or Duodenum 3 5 22. Diarrhoea, etc. (under two years) 3 3 23. Appendicitis and Typhlitis 2 3 24. Cirrhosis of Liver 3 1 25. Acute and Chronic Nephritis 6 7 26. Puerperal Sepsis — — 27. Other Accidents and Diseases of Pregnancy and Parturition - 1 28. Congenital Debility and Malformation, Premature Birth 10 1? 29. Suicide 4 2 30. Other Deaths from Violence 7 — 31. Other defined Diseases 48 48 32. Causes ill-defined or unknown — — 6 Notifiable Diseases during the Year. Cases, Deaths. Under I 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 Diphtheria — — I 2 2 3 4 1 4 — — — 17 15 — — — — — — — - — - - - — Scarlet Fever 1 — 5 5 7 40 36 12 11 — 1 — 118 80 - - - - - - - - - - - - 2 Enteric Fever including Paratyphoid - - - - - - - - - - - - 1 - - - - - - - - - - - - - - Puerperal Fever — — — — — — — — 2 — — — 2 — - - - - - - - - - - - - - Pneumonia — — — — — — — — 3 — 1 1 5 — - - - - - - - - - - - - 1 Erysipelas 1 1 — — — 2 1 — 2 5 5 5 22 2 - - - - - - - - - - - 1 1 Encephalitis Lelhargica 1 — — — — 1 — — 1 — — — 3 — — — — — — 1 — - — - - - 1 New Cases. Deaths. Under 1 year. 1—5 5—io 10—15 15—20 20—25 25-35 35—45 45-55 55—65 65 & over. Total. Under 1 year. 1—5 5—10 10-15 15—20 20—25 25—35 35—45 45—55 55—65 65 & over. Total. Tuberculosis (41) Pulmonary M. - - 3 4 6 5 6 7 2 1 34 _ _ 1 2 3 2 5 - - 13 F. - - - 1 2 6 3 2 3 — - 17 — — — — 2 3 1 1 - - 7 Total - - - 4 6 12 8 8 10 2 1 51 - - - 1 2 2 6 3 6 20 |6) Non-Pulmonary M. - - 1 3 — 1 - - - 5 2 - - - - - - - - - 2 F. - 2 2 1 - - - - - 5 - - - - - - - - - - - 1 Total - — 1 5 2 1 — 1 — — — 10 — 2 1 - - - - - - - - 3 CASES. Ophthalmia Treated. Vision Vision Total Neonatorum. Notified. At Home. In Hospital. Unimpaired. Impaired. Blindness. Deaths. 7 Causes of Sickness. Scarlet Fever and Diphtheria. The decline in the number of Scarlet Fever cases notified is satisfactory. The remarkable fall in the number of Diphtheria cases is not easily explained, only 17 being notified during the year. There were three periods of 10 weeks each, during which no case of diphtheria was notified. Investigations failed to establish any connection between cases occurring before these intervals with those arising to terminate them, so the 10 weeks elapsing in each instance appears to be a coincidence. The following table gives the number of cases notified during the last five years:— Year. Scarlet Fever. Diphtheria. Total. 1919 98 142 240 1920 139 82 221 1921 302 79 381 1922 238 74 312 1923 118 17 135 Measles. Apart from a small outbreak of Measles at Richmond Road Infants' School in June, the Schools have enjoyed a year of comparative freedom from infectious disease and there was no School closure. Influenza. Influenza made its appearance just before the close of the year. The doctors report that it is of the three days' fever type with sudden onset, and the chief symptoms are headache, myalgic pains, nausea, and cough. Intense depression and weakness seem to be the common results of an attack and fortunately pneumonic complications appear to be rare. 8 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 Diarrhoea, 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 seven 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 " Elmfield," Consultation & Treatment of Minor Ailments. Refractions School Clinic The Education Committee London Koad Day Nuisery Canbury Park Rd. 9 Babies & 16 Infants Vol. Committee Surrey .C. British Red Cross Society Tuberculosis Dispensary Grove Crescent - Red Cross Curative Post Coombe Road Out Patients. Massage, Electrical. & Orthopaedic Treatment Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. Maternity. The Kingston Nursing Association, 33, Birkenhead Avenue, have six beds for Maternity cases. The charge made is £3 3s. a week, and arrangements are made whereby the Council pay half the fees in deserving cases. 9 The Kingston and District Hospital (Board of Guardians) have Maternity Wards. Children. The Kingston and District Hospital (Board of Guardians). 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. Smallpox. The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. No case of Smallpox has occurred in the Borough during the year. 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, Illegitimate 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. 10 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. Maternity and Child Welfare. 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 supplied at cost price. During the year there were the following number ot attendances at the Centres:— Meetings. Attendances. New Cases. Total. Eden Street 50 164 2588 Washington Road 49 68 1161 The two Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers 59 71 Infants under one year 570 1679 Children, one to five years — 2186 Incidental and Infectious — 200 Baby Week was held in July, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. A Garden Party and Tea was given at St. Peter's Parish Hall, and a Lantern Lecture entitled "Our Mothers and Babies" was delivered by Lady Nott Bowers at the Public Library. A Scheme for the re-organisation of the Nursing Staff was approved by the Ministry of Health, and is set out in my Annual Report as School Medical Officer on page 33. 11 Notification of Births. Owing to the large number of unnotified Births during 1921, a letter, embodying an Extract of the Act, and asking for an explanation of failure to notify the birth, has been sent to the father of the child in every instance since May, 1922. Year. Births. Notified within 36 hours. 1921 799 646 = 80.8% 1922 698 618 = 88.5% 1923 706 653 = 92.4% 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, is available at all times, and is stocked only in phials which contain 3,000 units for treatment and 500 units for prophylaxis, as suggested by the Ministry of Health. List of Adoptive Acts and Bye-Laws in Force in the Borough. Adoptive Acts. L )ate 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 ... Public Health Acts Amendment Act, 1907... Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Sect. 94). 27th Nov., 1922 Bye-Laws relating to the following matters are in force within the Bprough :— 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 12 Sanitary Administration. The Veterinary Surgeon, Mr. Edwards, inspected the Cowsheds with me at intervals, and on the whole we found the conditions satisfactory. The Sale of Food and Drugs Acts are administered bv the Surrey County Council, and the following table shows action taken in the Borough during the year Articles. Formal Analysed. Adulterated or Deteriorated. Tots Prosecutions il Convictions Informal Total Formal Informal Milk 137 l 138 5 l 6 3 2 Cream (preserved) 1 — 1 - - - - - Flour 4 — 4 - - - - - Cocoa 11 2 13 1 — 1 — — Confectionery and Jam - 4 4 - 1 1 - - Spirits 3 5 8 — 2 2 — — Other Articles 1 27 28 — 4 4 — — Totals 157 39 196 6 8 14 3 2 Housing. Details of Housing Inspection are to be found in the Annual Report of the Sanitary Inspector, and I am in agreement with his conclusions. I am of opinion that one of the many causes conducive to overcrowding of artisan and working class dwellings, is the fact that young girls, who ordinarily should reside away from home in domestic service, now prefer to sleep at home. It is difficult to understand this preference, but the resulting unhealthy and overcrowded conditions are lost sight of by both parents and daughters. I feel sure that in a residential district such as Kingston, there are many spare bedrooms to-day which were originally occupied by maids. To prevent duplication, other action taken under the Public Health Acts or Bye-Laws, the condition of Slaughterhouses, Disinfection, Housing, etc., are included in the Annual Report of the Sanitary Inspector. 13 METEOROLOGY. 1923. Temperature of Air. Rainfall Highest Lowest Mean Max. Mean Mm. Inches January 57 26 48 34 1.265 February 57 28 49 39 3.035 March 69 30 53 39 2.26 April 63 32 57 41 1.61 May 81 33 63 45 2.39 June 80 38 69 49 0.325 July 92 48 80 57 3.675 August 88 42 75 53 1.81 September 77 39 67 48 1.51 October 65 32 58 44 5.935 November 59 22 44 32 1.595 December 50 23 45 33 2.36 Total 27.77 inches DEFECTS IN FACTORIES, WORKSHOPS & WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Fublic Health Acts: Want of Cleanliness 8 5 — — Want of Ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 8 7 — — Sanitary accommodation insufficient I — — unsuitable or defective 4 2 - - not separate nor sexes 1 1 - - Offences under the Factory and Workshop Acts Illegal occupation of underground bakehouses - - - - Breach of special sanitary requirements for bakehouses 3 3 - - Other offences 1 1 — — Total 27 20 Nil Nil 14 REGISTERED WORKSHOPS. Workshops & Workplaces on Register at the end of the Year. Number Bakers 25 Boat Builders 5 Bootmakers and Repairers 43 Brewery, Winery or Distillery 3 Builders 13 Carpet Beating Companies 3 Chocolate Manufacturers 1 Coach & Body Builders & Wheelwrights 6 Concrete Block Makers 3 Copper Smiths & Sheet Metal Workers 4 Dressmakers, Milliners & Costumiers 42 Dyers and Cleaners 2 Farriers 6 Jam Manufacturers 1 Laundries 18 Mineral Water Manufacturers 4 Motor Electrical or Cycle Engineers 42 Motor Upholsterer 1 Plating and Lacquering Works 4 Printers and Bookbinders 12 Rag, Metal & Bottle Merchants & Marine Store Dealers 5 Saddlers 4 Saw Mills 2 Stonemasons 5 Tailors 17 Tannery 1 Upholsterers 6 Watch Makers and Repairers 9 Miscellaneous 8 OTHER MATTERS. Matters notified to H.M. Inspector of Factories: Failure to affix Abstract of the Factory and Workshops Acts 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts. Notified by H ,M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 1 Other Action — Under gronnd Bakehouses in use at the end of the year — 15 Report of the Sanitary Inspector. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to present to you my fifth Annual Report on the work carried out by your Sanitary Inspectors during the Year 1923 in connection with the various Statutes and Bye-Laws relating to public health in force within the Borough. The report is in brief form. The total number of Inspections made was 6,675, as compared with 5,316 during 1922; 1,241 premises were inspected during the year. On 965 premises, sanitary defects to the number of 4,066 were discovered. In connection with these defects, 806 "preliminary" and 120 "verbal" notices were issued. In 70 instances "statutory" notices were served. Of the 365 premises in respect of which notices were outstanding on December 31st, 1922, 308 were complied with by December 31st, 1923. Of the 965 premises added to the Registers during 1923, only 190 remained outstanding at the end of the year. Of these 190 a considerable proportion were in hand. It will be seen that a considerably larger number of houses were inspected during 1923 as compared with 1922, the numbers being 1,241 and 864 respectively. The number of Sanitary defects discovered during 1923 is nearly double the number found during the year 1922. It is satisfactory to note that whilst the number of "Informal" notices served is proportionately higher, the number of "statutory" notices served is lower than during the previous year. "Statutory" notices are usually only served when all informal efforts have proved unsuccessful. By closely following up and frequently re-inspecting, 16 the total number of premises in respect of which notices were outstanding on December 31st, 1923, was reduced to 247. Inspections The following is the total number of Inspections made in regard to each section of the work, together with a Summary of Sanitary Improvements executed:— Rent Restrictions Act Inspections 16 Re-inspections after Order or Notice 2,505 Visits to Works in Progress 1,198 Factories and Workshops 100 Cowsheds, Dairies and Milkshops (excluding inspections by Medical Officer of Health and Veterinary Inspector) 34 Ice Cream Premises 18 Foodshops and Food Preparaing Rooms 391 Infectious Disease Inquiries 257 Markets 86 Special Inspections (Complaints, etc.) 1,196 Slaughter-houses 111 Offensive Trades 36 Sanitary Conveniences 22 Common Lodging-Houses 22 Canal Boats 6 Theatres, Cinemas, etc. 6 House-to-House 67 Bakehouses 27 Smoke Observations 3 Stables and Yards 105 Caravans 4 Miscellaneous Visits 465 Total number of Inspections 6,675 Drainage Number of old Drains examined, tested, exposed, etc. 40 Number of Houses and Premises re-drained ... 23 Number of Drains repaired or amended 4 Drains or Gullies unstopped or cleansed 71 Manholes provided 43 Manholes altered or repaired ... 4 17 Intercepting Traps fixed 16 Fresh-air Inlet Shafts repaired or renewed 26 New Gulley Traps fixed 59 New Soil Pipes or Ventilating Shafts 27 Soil Pipes or Ventilating Shafts repaired 5 Smoke Tests applied 24 Water Tests applied 55 Cesspools abolished, repaired, or cleansed 1 Water Closets and Sanitary Fittings W.C. Flush Pipe repaired 14 W.C. Apartments cleansed and limewashed 51 New W.C. Basins fixed 80 W.C.s unstopped, cleansed or repaired 20 W.C. Flushing Tanks repaired or renewed 30 Water supplied to W.C.s 4 New W.C. Apartment provided 4 W.C. Apartments lighted, repaired and ventilated 24 New Impervious Sinks provided 36 New Waste Pipes fixed 31 Existing Waste Pipes trapped 11 New Lavatory basins 2 Urinals cleansed or repaired 9 Urinals renewed 7 Miscellaneous 8 Miscellaneous Roofs repaired 90 Eaves Gutters renewed or repaired 59 Stack Pipes renewed or repaired 40 Stack Pipes disconnected from Drains 54 Damp Walls remedied 82 Ventilation provided beneath floors 27 Yards paved 73 Yard Paving repaired 17 Yards cleansed 17 Floors of Rooms repaired 71 Floors of Rooms renewed or repaved 9 Rooms repaired, cleansed and distempered 527 New ceilings 5 Windows repaired, renewed or made to open 171 Doors rehung or repaired 22 Cisterns repaired, cleansed, covered or removed 21 18 Movable Ashbins provided 610 Nuisance from overcrowding abated 11 Nuisance from animals abated 23 Accumulation of Manure or Refuse removed 40 Water Supplied to Houses 10 Water Supply direct from Main 5 Well Water Supply discontinued 1 Premises Limewashed (Workshops, etc.) 10 Firegrates repaired or renewed 53 Pumps for Water Supply repaired or renewed 1 Stables and Pigstyes abolished 5 Milk Stores provided 1 Sheds removed 5 Defective Coppers repaired 19 Brickwork of Walls repaired 26 Handrails provided to Staircases 20 Manure or Offal Receptacles provided or repaired 22 Insanitary Living Accommodation discontinued 2 Milk Premises cleansed, repaired, etc. 5 Food Preparing Premises repaired or cleansed 2 Nuisance from Fish Frying abated 1 Nuisance from Smoke abated 3 Offensive Trade discontinued 2 Miscellaneous 35 Meat and Food Inspection. The work of Meat and Foods Inspection again received considerable attention, and every care was taken to ensure that no diseased, unsound or unwholesome foodstuffs were deposited or exposed for sale. During the year 640 visits were paid to premises where food is prepared or exposed for sale. Included in this number are 111 visits to slaughter-houses. As far as possible, the time of visiting slaughter-houses was arranged to coincide with the time of slaughtering. It is not possible at the present time to require butchers to give notice of slaughter to the Local Authority. As a result it is frequently found that organs have been removed from the slaughter-house before the carcase has been inspected. The absence of the organs materially affects the value of inspection of the carcase and, in addition, there is always the possibility that the missing organs themselves may be diseased. It is a matter for regret that the butchers 19 do not voluntarily give notice of intention to slaughter. If such notice were given a considerable amount of time now spent in making fruitless visits to these premises could be saved. The hours of slaughtering also should be restricted. It should not be possible to kill animals late at night and to remove the carcases from the slaughter-house early the next morning before inspection. If, however, night slaughtering is permitted there should be a requirement that the carcases and offal should remain on the premises for a reasonable time to allow a proper examination to be made. The adoption of some such requirements as those suggested above would prove of benefit to the community and would give greater security to the meat trade. In connection with slaughter-houses and foodshops, a considerable number of visits and inspections were made in the evenings, after office hours. The undermentioned articles of food were condemned durintr the vear. . In the majority of the cases the foodstuffs were ''surrendered" for destruction, but in several instances the articles were " seized," in accordance with the powers conferred by the Public Health Acts:— Article of Food Condition Action taken. BEEF 3 Carcases & offal Generalised Tuberculosis 1 " seized " 2 surrendered 1,802 lbs. Bone Taint or Putrefaction Surrendered Ox Tails 11 lbs. ,, ,, ,, ,, Livers 83 lbs. ,, ,, ,, ,, Tripe 2 boxes ,, ,, ,, ,, Kidneys 36 lbs. ,, ,, ,, ,, Corned Beef 108 lbs. ,, ,, ,, ,, Calf's Pluck, one Tuberculosis ,, MUTTON. 117 lbs. Brine stained ,, Lamb Livers 188 lbs. Putrefaction ,, Kidneys 2 boxes and 8 dozen ,, ,, PORK. 1 Carcase & offal Generalised Tuberculosis ,, Lungs 1 pair ,, ,, ,, Kidneys 21 lbs. and 3½ cases Putrefaction ,, 20 FISH. Skate 119 lbs. Putrefaction surrendered Plaice 14 lbs. ,, ,, Hake 84 lbs. ,, ,, Haddocks 1 box )» ,, Scollops 240 ,, ,,; MISCELLANEOUS. Rabbits 12 ,, ,, Fish in Oil 1,056 tins ,, ,, Coffee approx. 20 lbs. Dirty ,, 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 despatch 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 six private slaughter-houses in the Borough, all of which have been in use during the year. The addresses are:— No. 36, Cambridge Road Registered. No. 90, Acre Road Licensed. Bath Passage Registered. No. 45, Cambridge Grove Road Registered. No. 120, London Road Licensed. Cowleaze Road Licensed. 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. One hundred and eleven visits were paid to these premises during the year. Dairies, Cowsheds, and Milkshops Orders. During 1923, 7 persons were removed from the Register. In 6 instances the removal was due to changes in the businesses. In the remaining case the premises were not suitable for the purpose of milk production and the Corporation decided to determine the registration. The dairymen concerned ceased to sell milk in the Borough. 21 Ten persons were added to the Register during- the year. On December 31st there were 36 persons registered in the Borough under the above Orders. Of these 36 only 2 were registered as cowkeepers. There were no applications during the year for liccnces to sell graded milk. Disinfection. Two hundred and seven rooms have been disinfected in 179 houses during 1923, as compared with 383 rooms in 336 houses during 1922. This reduction is due to the fewer cases of infectious disease notified during the year. The Council possesses 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 during the year 1923, 1,185 articles were passed through the apparatus. In addition, all infected rooms and furniture, etc., were sprayed and fumigated with Formalin. The Council also possesses a motor ambulance, which is constructed for the dual purpose of removing patients to Hospital and for the conveying of infected bedding, etc., to and from the disinfecting station. Twenty-seven patients were removed in this ambulance last year. House Drainage. Twenty-three houses were redrained during the year. An investigation into the condition of an old drain situated at the rear of the odd numbered premises in Washington Road, was made during the year. In connection with this examination it was necessary to examine the drains, etc., of 23 houses under the powers conferred upon the Corporation by Section 41 of the P.H.A., 1875, and the amending Acts. The examination disclosed the fact that this old drain was composed of 12-inch unglazed channel pipes without sockets or joints. At the time of examination the sewage from 10 houses and premises in the immediate 22 hood discharged into this drain. Originally the drain was probably intended for subsoil drainage of the site only, but as houses were built the drains were connected to this very defective conduit. Immediate action was taken and notices were served requiring each of the premises affected to be redrained and connected to the public sewer in the roadway. This work was not completed at the end of the year. was not completed at the end of the year. The following premises were redrained during the year :— Acre Road 2 premises. Beaufort Road 8 ,, Canbury Passage 1 ,, Cowleaze Road 3 ,, Elm Road 1 ,, Gibbon Road 1 ,, Kingston Hill 1 ,, New Road 2 ,, Portland Road 4 ,, Total 23 ,, Complaints. One hundred and ninety-eight complaints were made during the year, as follow :— Drains and Sanitary Arrangements 54 Water Supply 4 Accumulation of Manure and non-removal of House Refuse 15 Absence of Ashbins 11 Flooding of Cellars 3 Dampness (Bursting Pipes, etc.) 7 Insanitary Condition of Premises 56 Defective Roofs 5 Nuisance from keeping of Animals 7 Overcrowding ... 8 Smoke Nuisance from Chimneys 4 Nuisance from Vermin 1 Miscellaneous 23 Total 198 23 The complaints were investigated promptly, and where the Corporation possessed powers to interfere, immediate steps were taken to remove the cause of the complaint. The number of complaints during 1922 was 146. 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. Thirty-six visits were made to premises in connection with offensive trades during the year. Factories, Workshops and Workplaces. One hundred visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in Tables on pages 13 and 14. There are 15 " Outworkers " resident in the Borough, and the premises so used were inspected periodically. Increase of Rent & Mortgage Interests Acts. Sixteen applications were received during the year from tenants for certificates under Section 2, Sub-Section 2, of the above Act, as compared with an equal number during 1922. 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. In five instances necessary repairs were not carried out by the owners, and certificates were granted to the tenants. Sanitary Condition of Music Halls. Cinemas, &c. Six inspections were made of the above premises during the year, in accordance with the suggestion contained in the Circular Letter from the Ministry of Health. Visits 24 were made to the Cinemas during performances in connection with the ventilation of the premises. The premises generally are satisfactory. Suggestions made to the Managers with respect to the sanitary condition of the premises are invariably well received and acted upon. Canal Boats Acts, 1877 to 1884. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to report as follows :— During the year 1923, six visits were made to Canal Boats alongside the Wharves. During the year the Canal Boats Order, 1922, came into force. This Order provides that certain vessels which were registered under the Merchant Shipping Acts, 1894 to 1921, and which were not subject to inspection under the Canal Boats Acts, are now brought within the scope of the latter Acts and are subject to inspection. The Order will cause a considerable increase in this branch of the work. housing. Sixty-seven house-to-house inspections were made during the year. 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 47 (b) With State assistance under the Housing Acts, 1919 or 1923. (1) By the Local Authority nil (2) By other bodies or persons nil 1. Unfit Dwelling-houses. Inspection : (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 1,157 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 67 25 (3) Number of dwelling-houses found to be in a state so 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 subheading) found not to be in all respects reasonably fit for human habitation 887 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 1,027 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 rendered fit— (a) by owners nil (h) 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 70 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 55 (b) by Local Authority in default of owners nil 26 C.—Proceedings upnder Section 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 dwelling-houses 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 pursuance of Demolition Orders nil House-to-house inspection in the Borough was recom menced during the year. No systematic inspection had been made for some years previously. The time available for this important work is not great, and the inspection of a large number of houses with a view to statistics only was purposely avoided. Under present conditions it is impossible to deal with high numbers of poor condition houses each year if, in addition to the inspection, supervision is maintained to ensure that necessary works are not only carried out but that the works are satisfactory. In order to deal with greatly-increased numbers of houses it would be essential to limit the time given to owners in which to carry out works voluntarily, otherwise the number of houses under review at one time would be overwhelming. Asylum Road presented considerable difficulty. The houses are mostly let in lodgings. The Byelaws relating' to these houses were not enforced during' and after the war and at the time of inspection nearly every house was overcrowded. This overcrowding had not been reduced substantially at the end of the year. The following analysis of the results of the inspection are interesting:— 27 HOUSES LET IN LODGINGS. Number of houses, 19. Average rent per house, £1 3s. lOd. per week. Number of rooms used for living and sleeping purposes, 77. Number of occupants of such rooms, 146 adults and 74 children. Average number of persons per house, 11.6. Average number of persons per room, 2.86. HOUSES NOT LET IN LODGINGS. Number of houses, 13. Average rent, lis. lOJd. per week. Number of rooms used for sleeping purposes only, 40. Average number of persons per sleeping room, 2.75. Total number of occupants, 82 adults and 28 children. Average number of occupants per house, 6.3 adults and 2.16 children. The other road inspected was Excelsior Road. Whilst the houses in this road showed signs of neglect in the fabric the internal conditions were very dissimilar when compared with Asylum Road. The rooms were generally clean and sweet and there was practically no overcrowding. The following figures relate to Excelsior Road :— Total houses, 35. Average rent per week, 10s. 6½d. Total occupants, 128 adults, 42 children. Average persons per house, 4.85. Average persons per room, 1.05. Average persons per bedroom, 2.15. Constant re-inspections have been made whilst works have proceeded in both the above roads and whilst the houses in Excelsior Road are now much improved, both internally and externally, some of the houses let in lodgings in Asylum Road returned to their usual grimy condition soon after the rooms had been thoroughly cleansed and distempered. Other houses in the same road are maintained in a perfectly clean condition by the tenants and lodgers. One can only recommend the rigid application of the Byelaws for Houses let in Lodgings. 28 Overcrowding. At the end of the year 57 cases of overcrowding were known to exist. There are undoubtedly many others which have not been brought to notice. During the year only 11 c. ises of overcrowding were abated. In the majority of ci'ses the total number of persons in the house was not rtduced but the distribution of the occupants in the rooms was varied. Demolition of Unfit Houses. Owing to the housing shortage it was not possible to put into force closing orders on three houses which were represented as unfit for human occupation during the year 1922. Immediately the houses are vacated the buildings will be demolished. Well Waters, Four samples of water were submitted to your Council's Chemist, Mr. P. G. Lloyd, during the year, and the results of the analyses are shown as follows 1. Fountain Court.—Organically a usuable drinking water. 2. Bearfield Road.—Ditto. 3. Windsor Road.—Ditto. *4. Richmond Road.—An extremely bad sample and totally unfit for drinking purposes—obviously highly polluted. * There was no complaint made with regard to this water. The sample was taken in the ordinary course of inspection, and despite the gross pollution, the tenant stated that the water was "most palatable and pleasant." Immediate steps were taken to prevent the continued use of the water, and a new supply was obtained from the Metropolitan Water Board. An examination of the drainage system was made, and as a result, serious defects were discovered. The well also was traced and found to be within a few feet of the house. The defective drain passed within 1 foot of the well. The drains were reconstructed and the well abolished. 29 Stables and Yards. One hundred and five visits were made to stables and yards during the year, with a view to the provision and maintenance of proper manure receptacles. This work is important as there can be no doubt that a relationship exists between the breeding of flies and the improper storage of manure. The time occupied by this work proved fruitful and no less than 22 new receptacles were constructed. Smoke Abatement Four complaints were received during the year in respect of alleged nuisance from smoke. In three instances a nuisance was proved to exist. In each case the nuisance was abated after consultation with the owners. Conclusion. I again desire to thank the Chairman and the members of the Public Health 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.', Chief Sanitary Inspector. Municipal Offices, Kingston-upon-Thames. March, 1924. 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 present my Annual Report for the year 1923. The average number of children on the school register for the year was 5,081. The Schools enjoyed a year of comparative freedom . from infectious disease, apart from one small outbreak of measles. During the year Dr. Winifred Warner was appointed Ophthalmic Surgeon, and the Eye Clinic was established in October, Six sessions being held before Christmas. A scheme for the reorganisation of the Nursing Services was approved, which will come into operation on January 1st, 1924. I wish again to thank Miss R. Bartter, your School Nurse, for her willing and efficient assistance at all times. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 32 Staff of the School Medical Service. School Medical Officer: E. W. MATTHEWS, m.b., b.s.(loni.), m.r.c.s., l.r.c.p., d.p.h. Ophthalmic Surgeon: WINIFRED WARNER, m.b., b.s.(l'ond.), d.p.h. School Nurse: Miss R. BARTTER, Cert, c.m.b., Cert, r.s.i. as H.V. and S.N. Clerk : Miss F. FRANCIS. CO-ORDINATION. Infant and Child Welfare. As a step towards further co-ordination and unification of the Medical Service, for its better and more efficient working, both as regards School and Child Welfare work, also to present overlapping and secure that the same staff look after infants both before and after they reach school age, a scheme was presented suggesting that the School Nurse and the two Health Visitors should in future work both sections, their time being allocated as follows:— 33 School Medical Service. Maternity & Child JVelfare. 1. Senior Nurse 3/5 2/5 2. Nurse 1/5 4/5 3. Nurse 1/5 4/5 Total 1 2 The scheme was approved by the Ministry of Health and the Board of Education, and came into operation on January 1st, 1924. . SCHOOL HYGIENE, A general review of the Public Elementary Schools was given in the Report for 1920, giving in detail their hygienic conditions with particular reference to their surroundings, ventilation, lighting, warming, and sanitation. The artificial lighting in those Schools using incandescent gas burners is in most instances unsatisfactory. During the year 1923 the following repairs and improvements have been carried out :— Bonner Hill Road Schools. Boys', Girls', and Infants' Departments. All classrooms, central halls, corridors, lavatories, teachers' rooms, etc., re-decorated throughout. Two huts at the rear of the school re-decorated externally, and the ceiling whitened internally. Five screens for dividing off the Boys' Assembly Hall. Installation of 2 new " Ideal " boilers for heating the school in place of 3 worn-out boilers. Richmond Road Schools. Boys' Department—8 classrooms, 2 cloakrooms, Teachers' Common Room and passage re-decorated. Girls' Department—Central hall and corridors redecorated. Infants' Department—5 classrooms, all woodwork painted. Cloakrooms and entrance to classrooms re-decorated. 2 screens for Infants' School. The lavatories in all departments re-decorated throughout. 34 St. Agatha's School. All classrooms, staircases, passages and cloakrooms have been re-decorated. St. John's School. All classrooms, cloakrooms, corridors and lavatories in all departments have been re-decorated. Elm field—Physically Defective School. Warm-air independent stove for classroom. School Clinic. Ceilings and walls of the Clinic and waiting-room have been distempered. MEDICAL INSPECTION. All departments of every school are visited by the School Medical Officer each term, when Routine Medical Inspections of the three age groups, re-inspections and examination of special cases are carried out. The procedure of the above examinations was set out in detail in my Annual Report for 1920. Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and the followintr table is instructive :— No. of Children Examined. No. of Parents present Percentage Entrants, Boys 186 145 78% Girls 218 160 74% Intermediates, Boys 359 203 56% Girls 326 202 62% Leavers, Boys 298 88 30% Girls 277 150 54% FINDINGS OF MEDICAL INSPECTION, (a) Uncleanliness. At Routine Medical Inspections 12G children were found unclean, as compared with .'JOG during the year 1922. The School Nurse at her Cleanliness Surveys found during the year 802 children unclean. The general standard of cleanliness has greatly improved during the last few years, but it is a noteworthy fact that 35 many children return to school after the holidays with unclean heads. Owing to this, the School Nurse visits all schools within the first fortnight of each term, for the purpose of carrying out Cleanliness Surveys. The following procedure is adopted :— On discovery that a child has an unclean head, the School Nurse issues a notice to the parent calling attention to the fact, and giving instructions as to the means ot cleansing the head. She re-inspects the child a fortnight later, and if still unclean, she issues a second notice urging the parent to cleanse the head, and pointing out that unless the condition is remedied, the child will be excluded from school, when the parent becomes liable to prosecution for not sending the child to school in a fit state. She again re-inspects after another fortnight, ahd if still unclean, the child is brought before the School Medical Officer, who excludes her from school if he thinks necessary. This action usually causes the parent to act and clean the child's head within a week. If the child still remains in an unclean state, the parent is warned by the School Attendance Officer to appear before the School Attendance Sub-Committee, who either obtain a promise from the parent to properly cleanse the child's head, or decide to prosecute in obstinate cases. Therefore, at least three to four months elapse before the comparatively few parents appear before the Justices, and then only after all the preceding measures have failed to secure adequate cleansing. Legal proceedings taken under the School Attendance Bye-Laws :— Prosecutions were made in the cases of 23 children, resulting in fines varying from 2/6 to 15/-. In one case a parent was fined four times, in another three times, and in two cases parents were fined twice during the year. (b) Tonsils and. Adenoids. There were 42 children suffering from enlarged tonsils and adenoids referred for treatment during the year, as compared with 19 in 1922, and 75 in 1921. 36 The diminution in numbers is due to the success that has been achieved in helping the parents to obtain, for the infants particularly, operative treatment in hospitals. (c) Tuberculosis. All cases of suspected tuberculosis have been referred to the Surrey County Council Tuberculosis Officer, Dr. Cameron Renwick, who has given great assistance in his advice, supervision, and recommendation as to the disposal and treatment of these children. (d) Skin Disease. There has been a marked diminution in the number of children found suffering from scabies, as during the year only 4 cases were seen, compared with 9 last year, 19 during 1921, and 44 during 1920. The prevalence of scabies following the war was undoubtedly due to demobilised soldiers, suffering from the disease, returning to their homes and infecting the occupants. (e) Vision. During the year 9(5 children were found requiring treatment for defective vision. Refraction work was undertaken in October, and all outstanding cases of visual defect, who had not yet received treatment at hospital or otherwise, were placed on a waiting list for attendance at the Ophthalmic Clinic. MEDICAL TREATMENT (a) Minor Ailments. Although only two sessions a week were possible at the Clinic, the treatment of many minor ailments was undertaken with success, and under the new scheme, the Clinic will be open for daily treatment when the schools re-open in January, 1924. (b) Tonsils and. Adenoids. During the year 54 children suffering from enlarged tonsils and adenoids received operative treatment at the 37 Kingston and District, Kingston Victoria, and other hospitals. (c) Skin Disease. The treatment of impetigo, ringworm, and other skin diseases has been undertaken as far as possible at the Minor Ailments Clinic. (d) Vision. The majority of children suffering from defective vision were treated at the Royal Eye Hospital, London, S.E., and Richmond Hospital, and during the year 72 were submitted to refraction and obtained glasses in this way. 1 In October the Ophthalmic Clinic was established al " Elmfield," London Road, by installing the necessary apparatus in the same room as the inspection and minor ailments clinic is held. Dr. Winifred Warner was appointed Ophthalmic Surgeon. One session is held every fortnight on Wednesday afternoons, when Dr. Warner deals with cases referred to her by the School Medical Officer. Those children, who have errors of refraction, attend the Clinic three times a day on the Monday and Tuesday preceding the meeting, and also on the same morning for the purpose of having drops applied by the School Nurse. There were 07 attendances at the six sessions held dur ing the last term of the year, 27 children were submitted to refraction, and glasses were prescribed in 21 instances. Parents are charged the cost price of spectacles, except in really necessitous cases, when the Committee is prepared to pay part or the whole cost of the same. The ophthalmic work is proceeding smoothly and very successfully, and is already proving a great asset to the Medical Service. (e) Ear Disease and Hearing. Minor ear defects in the cases of 28 children have been treated at the Clinic. Other ear diseases and deafness were referred to private practitioners and hospitals. 38 (f) Dental Defects. Parents were urged to seek advice for children suffering from dental defects, and 83 received treatment from private dentists or at hospitals. It is proposed to undertake the treatment of dental defects at an early date and to establish a Dental Clinic at " Elmfield," London Road. (g) Crippling Defects and Orthopccdics. Advice has been given to parents whose children have crippling defects, and several are receiving electrical, massage, and other forms of treatment at the Red Cross Curative Post, under the direction of the Visiting Orthopaedic Specialist. 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. INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. Except for a small outbreak of measles in the Infants' Department of Richmond Road School in June, the schools have enjoyed a comparatively good year. The absence of diphtheria during the year is noteworthy, only 17 cases having been reported among the entire population of the Borough. 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 method of procedure was set out in my Annual Report for 1921. 39 The work of the School Nurse may be briefly summarised as follows :— The School Nurse prepares beforehand for Routine Medical Inspections at the schools, by weighing, measuring and applying rough vision tests. She attends again to assist the School Medical Officer at Routine Medical Inspections and re-inspections. Cleanliness surveys are carried out by her at the schools, and the following table specifies the work done in 1923 :— Number of children prepared for Routine Medical Inspection 1,661 Number of Routine Medical Inspections 1,664 Number of Medical Re-inspections 3,667 Number of Cleanliness Surveys 15,179 Number of following-up home visits 400 In addition the School Nurse attends the School Medical Officer and the Ophthalmic Surgeon during their sessions at the Clinic, and carries out the treatment of minor ailments under their direction, and also she applies the atropine ointment to children warned to attend the Clinic for refractions. The work of the clerk and the keeping of all records and cards is supervised by her under the direction of the School Medical Officer. VACCINATION. The following table is compiled from the Routine Medical Inspections for the year, and gives the number and percentage of children showing vaccination marks :— No. of Children Examined. No. Showing Vaccination Marks Percentage Entrants, Boys 186 106 57% Girls 218 135 62% Intermediates, Boys 359 214 60% Girls 326 194 59% Leavers, Boys 298 198 66% Girls 277 196 71% SPECIAL SCHOOLS. The school for Physically Defective Children at " Elmfield," London Road, was described in last year's Annual Report. 40 There are 28 children in attendance, but the classrooms are large enough to accommodate at least 40, so it was suggested that physically defective children might attend from outside the Borough, with the result that two children from the neighbourhood have been admitted for the Surrey County Council. SCHOOL BATHS. During the summer months 661 children, from the Boys' and Girls' Departments, of all the schools, attended the Corporation Baths during school hours for instruction in swimming. In addition a number of pupils from Richmond Road Boys' School attended the baths on Wednesdays, after school hours, at their own expense. The importance of instruction in swimming cannot be over-estimated, particularly in a river-side town. SCHOOL CLINIC. Meetings were held on Tuesday and Friday mornings at " Elmfield," London Road, when the School Medical Officer held his Inspection Clinic, and the treatment of minor ailments was undertaken. During the last term Dr. Warner attended fortnightly on Wednesday afternoons to undertake ophthalmic work. As we have one School Nurse only for all the duties connected with the School Medical Service, the above activities at the Clinic were deemed to be the limit of her capabilities. Owing to the improved conditions of working which will be brought about by re-organising and amalgamating the duties of the Health Visitors and School Nurse in January, 1924, it is proposed to open the Minor Ailments Clinic daily for treatment, and this will be possible even though only the time of one Nurse is still allocated to the School Medical Service. During the year the Clinic has become very popular among teachers, attendance officers, and parents, who took advantage of the facilities for obtaining medical examination and advice with regard to school children. 41 EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During- the year 77 school children and 5 young persons were issued with certificates under the Bye-laws. GARDENING CENTRES. There are Gardening 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. All Saints' Boys' School. "Elmfield " Special School. SCHOOL JOURNEY. St. Peter's Girls' School. Again the Head Teacher, Miss A. Thompson, and her assistants were able by their work to raise sufficient funds to take a party of 30 girls to Broadstairs for a week. In all 35 girls, five of whom paid their own expenses, proceeded to the St. Mary's Convalescent Home, Broadstairs, on June 22nd, and returned on the 29th, after a most enjoyable holiday. The benefit to the poorer children by this invaluable work cannot be over-estimated, and I understand that the Head Teacher hopes to be able to take even a larger party next summer. STATISTICAL TABLES. TABLE I. RETURN OF MEDICAL INSPECTIONS FOR THE YEAR 1923. A. Routine Medical Inspections. Number of Code Group Inspections— Entrants 384 Intermediates 540 Leavers 575 Total 1,499 Number of other Routine Inspections 165 B. Other Inspections. Number of Special Inspections 669 Number of Re-inspections 3,667 Total 4,336 TABLE II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1923. Defect or Disease. routine inspec. special inspec. No. of Defects. No. of Defects. Requiring Treatment. Requii ing to be Uept under obs 1 vation, but not requiring treatment. Requiring Treatment. Requi: ing lo be kept under observation but not requiring Treatment. Malnutrition — — — — Uncleanliness— (See Table IV.GroupV.) 1 26 — 80 — Skin Ringworm, Scalp — — 24 3 Body — — 34 — Scabies — — 4 — Impetigo — — 105 5 Other diseases (non Tb) 2 — 67 10 Eye Blepharitis 2 — 19 — Conjunctivitis 2 — 10 — Keratitis — — 1 — Corneal Opacities — — — — Defect.vision exc.Squint 89 4 7 9 Squint 7 1 1 1 .Other Conditions — — 7 — Ear Defective Hearing 5 1 9 3 Otitis Media 3 1 18 1 Other Ear Diseases — — 4 1 Nose and Tliroat Enlarged Tonsils only 18 2 7 — Adenoids only 5 1 5 3 Enlarged Tonsils and Adenoids 5 — 2 — Other Conditions 1 — 13 6 Enlarged Cervical Glands (11011 Tb) 6 — 15 — Defective Speech — 1 — 1 Teeth—Dental Diseases 121 — 11 1 Heart and Circulation Heart Disease—Organic 4 12 1 1 Functional — — — 1 Anaemia 1 — 2 — Lungs Bronchitis 2 2 4 2 Other non Tb. Diseases — — 0 5 Tuberculosis Pulmonary—Definite — — 2 — Suspected 1 — 1 — Non- Pulmonary-Glands 1 — 3 — Spine — — — — Hip — — 1 — Other Bones & Joints 1 — 2 — Skin — — 1 — Other Forms — — — — Nervous System Epilepsy 1 — 2 — Chorea — — 4 — Other Conditions — 2 1 3 Deformities Rickets 1 1 — — Spinal Curvature 1 — — — Other Forms 6 5 4 — Other Defects and Diseases 7 3 31 14 Minor Injuries — — 18 3 TABLE II.— continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UN CLE AN LI NESS AND DENTAL DISEASES). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups—Entrants 384 Intermediates 540 — — Leavers 575 — — Total (Code Groups) 1499 136 8.1 Other Routine Inspections 165 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA — — — Boys. Girls. Total. Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind Attending Certified Schools or Classes for the Blind — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind Attending Certified Schools or Classes for the Blind — — — Attending Public Elementary Schools — — At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf — 4 4 Attending Public Elementary Schools — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Con. trol Authority). Attending Certified Schools for Mentally Defective Children 1 1 Attending Public Elementary Schools At other Institutions 1 — 1 At no School or Institution 1 1 2 Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles — 3 3 Idiots — — — TABLE: III.—Continued. — — — Boys Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics — — — In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — At no School or Institution 1 1 2 Suffering from epilepsy which is not severe. Attending Public Elementary Schools 1 1 2 At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tubercuk sis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At 110 School or Institution 1 — 1 Non-infectious hut active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — At Certified Day Open Air Schools — — — At Public Elementary Schools — 1 1 At other Institutions — — At no School or Institution — — — Delicate children (e.g. pre or latent tuberculosis, malnutrition.debility. an;emia, etc). At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — At Public Elementary Schools — — — At other Institutions — — — At 110 School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At 110 School or Institution — 1 1 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools — — — At Certified Residential Cripple Schools — At Certified Day Cripple Schools 17 11 28 At Public Elementary Schools i 1 2 At other Institutions — — — At 110 School or Institution — — — 45 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED :51ST DECEMBER, 1923. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Delect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise Total. Skin - Ringworm, Scalp 14 10 24 Ringworm, Body 23 10 33 Scabies 4 — 4 Impetigo 98 7 105 Other Skin Disease 39 20 59 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 35 7 42 Minor Far Defects 28 12 40 Miscellaneous—eg. minor injuries, bruises, sores, chilblains, etc. 14 3 17 Total 255 69 324 Group II.—Defective Vision and Squint (excluding Minor Eve Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. Frrors of refraction (including Squint) 27 72 1 100 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — — Total 27 72 1 100 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 24 Otherwise 72 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 13 (b) Otherwise 72 46 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received operative treatment Under the Authority's scheme,1n Clinic or Hospital — By Private Practitioner or Hospital apart from the Authority's scheme 54 Total 54 Received other forms of treatment 18 Total number treated 72 Group IV.—Dental Defects. The treatment of Dental Defects was not undertaken by the local authority, but it is proposed to establish a Dental Clinic at an early date. During the year the School Medical Officer referred 132 children for dental defects and 83 received treatment from private dentists or at hospital. Group V.—Uncleanlinf.ss and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurse 53 (ii.) Total number of examinations of children in the schools by School Nurse 15,179 (iii.) Number of individual children found unclean 928 (iv.) Number of children cleansed under arrangements made by the local Education Authority Nil (v). Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 (b) Under School Attendance Bye-laws 23