Ac 4413 (1) Borough of Kingston-upon-Thames. Annual Reports FOR 1924 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 1924 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 R. BARTTER (Senior), 2/5 time. *† Miss E. ARTHL'R, 4/5 time. * Miss C, J. DUNCAN, 4/5 time. 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. † Certificate for Health Visitors (Royal Sanitary Institute). * Certificate of the Central Midwives Board. Report of the Medical Officer of Health. Municipal Offices, Kingston-upon-Thames, March, 1925. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to present my Annual Report for the Year 1924. The Report which is an Ordinary Report (Ministry of Health Circular 269) has been kept as short as possible, in view of the fact that a Survey Report will be required for the year 1925. A Health Exhibition was held in October. The success attained fully justified our effort and called for further activities of this nature in the future. The Birth Rate was 15.9 per 1,000 population, the lowest since the War, and compares unfavourably with the figure 18.8 for England and Wales. The Death Rate was 12.5 per 1,000 population, which is slightly in excess of 12.2 for the whole country. Mr. W. C. Cockell, Clerk to the Public Health Department, obtained the post of Assistant Sanitary Inspector to Southall-Norwood in November, and Mr. W. J. Fell was appointed to replace him. I again thank Mr. H. T. Perry, your Chief Sanitary Inspector, and the Staff of the Public Health Department for their loyal support. I am, Gentlemen, Your obedient Servant, E. W. MATTHEWS. Medical Officer of Health. 4 General Statistics. Area 1,133 acres. Population, 1924 (Registrar-General) 40,430 Number of inhabited houses, 1924 8,889 Rateable Value— To Poor Rate ,£268,050 Assessable Value to District Rate £263,402 Sum represented by a Penny Rate— Poor Rate £1,077 District Rate £1,064 Extracts from Vital Statistics of the Year. Births— Total. Male. Female. Legitimate 622 Illegitimate 20 333 12 289 8 Birth Rate (R.G.) 15.9 per 1,000 population. 642 345 297 Deaths— 502 249 253 Death Rate (R.G.) 12.5 per 1,000 population. Number of women dying in, or in consequence of child-birth— From Sepsis 1 From other causes 1 Deaths of Infants under one year— Total. Male. Female. Legitimate 43 23 20 Illegitimate 6 3 3 49 26 23 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 69 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 300 Total Deaths of Infants under one year of age per 1,000 births 76 Deaths from Measles (all ages) 8 Deaths from Whooping Cough (all ages) 7 Deaths from Diarrhoea (under two years of age) 4 5 Birth Death Rate Rate Rate per 1000 Births. Diarrhœa Total Deaths under 2 years under 1 year England and Wales 18.8 12.2 7.3 75 157 Smaller Towns 18.9 11.2 6.2 71 London 18.7 12.1 8.4 69 Kingston-upon-Thames 15.9 12.5 6.2 76 Causes of Death. (Civilians only.) Causes of Death. Male. Female. All Causes 249 253 1. Enteric Fever 1 — 2. Smallpox — — 3. Measles 4 4 4. Scarlet Fever — — 5. Whooping Cough 1 6 6. Diphtheria — — 7. Influenza 3 9 8. Encephalitis Lethargica — 2 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 13 13 11. Other Tuberculous Diseases 8 5 12. Cancer, Malignant Disease 37 38 13. Rheumatic Fever — — 14. Diabetes 1 1 15. Cerebral Haemorrhage, etc. 12 18 16. Heart Disease 48 46 17. Arterio-Sclerosis 8 4 18. Bronchitis 14 18 19. Pneumonia (all forms) 18 11 20. Other Respiratory Diseases 2 1 21. Ulcer of Stomach or Duodenum 3 1 22. Diarrhoea, etc. (under two years) 3 1 23. Appendicitis and Typhlitis 2 2 24. Cirrhosis of Liver — 1 25. Acute and Chronic Nephritis 7 3 26. Puerperal Sepsis — 1 27. Other Accidents and Diseases of Pregnancy and Parturition — 1 28. Congenital Debility and tion, Premature Birth 6 4 29. Suicide 2 1 30. Other Deaths from Violence 11 6 31. Other defined Diseases 45 56 32. Causes ill-defined or unknown — — 6 Notifiable Diseases during the Year. Cases, Deaths. Under I year. 1—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. Ttal Deaths Scarlet Fever 1 1 3 9 10 59 43 9 3 5 – – 143 109 – – – – – – – – – – – – – Diphtheria – – 2 1 2 8 3 1 3 – – – 20 18 – – – – – – – – – – – – – Enteric Fever including Paratyphoid – – – – – – – 1 2 – 3 – 6 1 – – – – – – – – – – 1 – 1 Pneumonia 2 – 1 – 1 1 2 3 4 1 4 3 22 1 – – – – – – – – 1 – – 2 3 Erysipelas 2 – 1 – – 1 3 2 1 2 10 5 27 5 – – – – – – – 1 – – – – 1 Encephalitis Lethargica – – – – – – 1 – 1 1 1 – 4 2 – – – – – – 1 – – – 1 – 2 Poliomyelitis – – – – – 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 (a) Pulmonary M. – – – – 3 5 14 – 6 3 2 33 – – – – – 4 4 – – 4 1 13 F. – 1 2 – 3 9 9 7 2 2 1 36 – – – – 2 4 3 – 2 2 – 13 Total – 1 2 – 6 14 23 7 8 5 3 60 – – – – 2 8 7 – 2 6 1 26 (b) Non-Pulmonary M. 2 1 3 – 2 1 1 1 – 1 – 12 2 1 1 – 3 – 1 – – – – 8 F. 1 1 1 1 – 2 2 – – – – 8 1 – – 1 – – 1 1 – – – 4 Total 3 2 4 1 2 3 3 1 – 1 – 20 3 1 1 1 3 – 2 1 – – – 12 Cases. Ophthalmia Neonatorum. Notified. At Home. Treated. In Hospital. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. 7 Causes of Sickness. Scarlet Fever and Diphtheria. The following table gives the number of cases notified during the last six 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 1924 143 20 163 There were no deaths during 1924 from either Scarlet Fever or Diphtheria. Measles. During the first four months of the year Measles was prevalent, affecting Bonner Hill Road, Richmond Road, and St. Paul's Infants' Schools. The outbreak did not assume proportions necessitating school closure. Eight deaths were attributed to this disease. Influenza. The outbreak of Influenza at the end of 1923 was continued into the first three months of 1924. The doctors report that the great majority of cases were mild, with sudden onset, headache, myalgic pains, and nausea. Intense weakness and depression were common results of an attack. Pneumonia was not a common complication. Twelve deaths were recorded. Enteric Fever (including Paratyphoid). During the year six cases were notified, one proving fatal. The following very brief notes on the cases are interesting:— (1) R.W., female, age 17, was admitted on December 11th, 1923, to the Workhouse, where she remained until her transfer to the Kingston and District Hospital, adjoining, on January 23rd, 1924, presumably suffering from Influenza. It was not until five days later that she exhibited symptoms suggestive of Typhoid Fever. 8 Samples of her blood and faeces were sent to Dr. Roster at Charing Cross Hospital. The Widal Reaction was masked by the presence of B. Gaertner, but by making cultures he definitely isolated B. Typhosus. A further sample of blood showed agglutination in high dilutions. Dr. Roster regards the case as a type which is far more common than is generally realised. The difficulty is to determine how or when she was infected. No other inmate of the Workhouse contracted the disease and no carrier was discovered. (2) G.F.N., male, age 64, became ill on June 25th and died on July 12th. He stayed at a Farm near Dover from May 23rd to 27th. There was an outbreak of Typhoid in Dover at the time, and though no direct evidence was obtained, it appears highly probable that he was infected during his stay there. (3) L.W., female, age 50, was notified on July 28th, suffering from Paratyphoid. Very little history could be obtained beyond the fact that she dined at a cafe in London on July 5th and went on to a Garden Party. At neither of these places did she partake of anything likely to infect her, and investigations failed to prove anything. (4), (5), and (6) E.L., female, age 20, M.G., female, age 50, and G.G., male, age 23, all residing in the same house. E.L. and M.G. were notified on December 8th, and G.G. on December 13th. No local source of infection could be traced. The patients visited London together on November 19th and dined at a Club. No direct evidence of infection at this Club was forthcoming, but it is a noteworthy fact that only these three inmates of the house contracted the disease, while other members of the family, who did not make the excursion to London, escaped. 9 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 eight residing in the Borough at the end of the year. Clinics and Treatment Centres. Centre. Situation. Accommodation. Provided by Maternity and Eden Street Consultation The Corporation Child Welfare Maternity and Washington Consultation The Corporation Child Welfare Road School Clinic " Elmfield," Consultation & The Education London Road Treatment of Committee Minor Ailments, Refractions, Dental Treatment Day Nursery Canbury Park 9 Babies and 16 Vol. Committee Road Infants Tuberculosis Grove Crescent Consultation Surrey C.C. Dispensary Red Cross Coombe Road Out-Patients, British Red Curative Post Massage, . Cross Society Electrical and Orthopaedic Treatment 10 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. 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). 11 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 in your own Motor Ambulance. (b) For non-infectious and accident cases : A Motor Ambulance for non-infectious and accident cases was provided by the Corporation in October. 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 of attendances at the Centres:— Attendances. Meetings. New Cases. T otal. Eden Street 50 151 2129 Washington Road 50 72 1195 The Health Visitors paid the following number of home visits :— First Visits. Total Visits. Expectant Mothers 60 91 Infants under one year 689 2114 Children, one to five years – 2561 Incidental and Infectious – 240 Baby Week was held in July, when the Infant Welfare Centres and Day Nursery where open to visitors on certain days. 12 A Garden Party, at which the Mayoress very kindly presented the prizes to Mothers winning Competitions, took place in the grounds of St. Peter's Vicarage. Girls from St. John's School assisted by giving an admirable display of "Country Dances." The Annual Winter Tea and Entertainment was held at each Centre in January. The Centres maintain their popularity, and the work for the year must be regarded as satisfactory. Notification of Births. Owing to the large number of unnotified Births during 1921, a letter, embodying an Extract of the Act, asking for an explanation of failure to notify the birth, has been sent to the father of the child in everv instance since May, 1922. The percentage of births notified within 36 hours has risen from 80 per cent. in 1921 to 94 per cent. this year. 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 8,000 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. 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 Public Health Acts Amendment Act, 1907 27th Nov., 1922 Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Section 94). 13 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 Tents, Vans, Sheds, and Similar Structures ,, 28th November, 1924 Sanitary Administration. 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 Detcriorated. Prosecutions Convictions Formal In forma Total Formal Informal Total Milk 111 – 111 3 – 3 1 1 Cream (preserved) 4 – 4 – – – – – Butter – 8 8 – – – – – Margarine – 9 2 – – – – – Lard – 1 1 – – – – – Spirits 4 – 4 1 – 1 – – Other articles – 8 8 – 3 3 – – Totals 119 19 138 4 3 7 1 1 In order to prevent duplication, action taken under the Public Health Acts or Bye-Laws, Condition of Slaughterhouses, Disinfection, Housing, etc., are included in the Annual Report of the Sanitary Inspector. METEOROLOGY. 1924. Temperature of Air Rainfall Highest Lowest Mean Max. Mean Min. Inches. January 52 27 45 36 2.575 February 50 21 43 32 0.525 March 60 25 49 32 0.84 April 74 29 53 37 3.83 May 80 35 68 46 3.515 June 82 44 73 52 3.00 July 88 44 76 53 3.435 August 79 45 72 53 2.52 September 72 42 66 53 3.42 October 70 43 59 47 3.65 November 67 27 53 40 2.705 December 60 30 50 38 3.07 Total 33.085 14 DEFECTS IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Fund Remedied Referred to H M. Inspector Nuisances under the Public Health Acts : Want of Cleanliness 5 5 – – Want of Ventilation – – – – Overcrowding – – – Want of drainage of floors – – – Other nuisances 10 8 – – Sanitary accommodation 'insufficient – — – – unsuitable or defective 5 5 – – not separate for sexes – – – Offences under the Factory and Workshop Arts – Illegal occupation of underground bakehouse – – – – Breach of special sanitary requirements for bakehouses 5 5 – Other offences – – – – Total 25 23 Nil Nil REGISTERED WORKSHOPS. Bakers 25 Boat Builders 5 Bootmakers and Repairers 43 Brewery, Winery or Distillery 3 Builders 12 Carpet Beating Companies 3 Coach and Body Builders and Wheelwrights 6 Concrete Block Makers 3 Copper Smiths and Sheet Metal Workers 4 Dressmakers, Milliners and Costumiers 42 Dyers and Cleaners 6 Farriers 6 Jam Manufacturers 1 Laundries 18 Mineral Water Manufacturers 4 Motor, Electrical or Cycle Engineers 42 Motor Upholsterers 1 Plating and Lacquering Works 3 15 Printers and Bookbinders 12 Rag, Metal & Bottle Merchants & Marine Store Dealers 5 Saddlers 4 Saw Mills 2 Stonemasons 6 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 to the Factory and Workshops Acts 3 Action taken in matters referred Notified by H.M. by H.M.Inspector as remediable Inspector 3 under the Public Health Acts, Reports (of action but not under the Factory and taken) sent to Workshop Acts. H.M. Inspector 2 Other Action nil Underground Bakehouses in use at the end of the year nil Health Exhibition. A Health Exhibition was held at the Baths Hall, Wood Street, on October 20th, 21st, and 22nd. This was the first time a venture of this nature had been attempted in the Borough. No charge was made for admission, and it is estimated that between four and five hundred persons visited the Exhibition on each day, which must be regarded as highly satisfactory. A charge for floor space was made to stall holders of trade exhibits. The large Central Stand showed the activities of the Public Health Department in all its branches, and was most popular. A working model of Sewage Disposal as carried out at Kingston by the A.B.C. process was very kindly constructed and exhibited by Mr. P. G. Lloyd, the Sewage Works Manager. 16 The National Council for Combating Venereal Disease assisted by showing Films, accompanied by Lectures, and also contributed to the cost of the Exhibition. The following programme was successfully carried through:— Monday, October 20th. 3 p.m. Opening by the Worshipful the Mayor, Alderman W. E. St. L. Finny, M.D. Address, "The Health Services in Kingston," by Dr. E .W. Matthews, Medical Officer of Health, Kingston-upon-Thames. 6 p.m. Film, "The Gift of Life." Speaker: Col. R. J. Blackham, C.B., C.M.G., D.S.O., M.D. 7 p.m. Address, " Hygiene in the Home," by Dr. A. Gilmour, Medical Officer of Health, Wimbledon. 8 p.m. Films : (1) "The Public Health Twins." (2) "The Shadow." Speaker: Col. R. J. Blackham, C.B., C.M.G., D.S.O., M.D. Tuesday, October 21st. 3.30 p.m. Address, " Mother and Baby," by Dr. Winifred Warner. 6 p.m. Films: (1) "The Public Health Twins." (2) "Memories." Speaker : Dr. Elizabeth Sloan Chesser. 7 p.m. Address, "The Fly Menace," by Dr. J. Cates, County Medical Officer of Health, Surrey. 8 p.m. Film, "The Gift of Life." Speaker: Dr. Elizabeth Sloan Chesser. Wednesday, October 22nd. 3 p.m. Address, "The Care of the Teeth," by H. A. L. Morris, Esq., L.D.S. 17 G p.m. Films : (1) "The Public Health Twins." (2) "The Flaw." Speaker: Dr. J. Feldman, Lecturer in Physiology at the London Hospital. 7 p.m. Address, "The Health of a School Child," by Dr. C. S. Brebner, Medical Officer of Health, Richmond. Address, "Consumption," by Dr. F. J. H. Coutts. 8 p.m. Film, "The End of the Road." Speaker: Dr. J. Feldman. 19 Report of the Sanitary Inspector. To the Corporation of Kingston-upon-Thames. Gentlemen, I have the honour to present to you my sixth Annual Report on the work carried out by your Sanitary Inspectors during the year 1924 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 5,956, as compared with 6,675 during 1923. On 566 premises, sanitary defects to the number of 2,747 were discovered. In connection with these defects, 482 "preliminary" and 100 "verbal" notices were issued. In 60 instances " statutory " notices were served. Of the 291 premises in respect of which notices were outstanding on December 31st, 1923, 106 were complied with by the end of the year 1924. Of the 566 premises added to the registers during 1924, 333 remained outstanding on December 31st last. Of these 333 a considerable proportion were in hand. The actual number of inspections during 1924 is less than for the previous year, but this is probably due to the greater amount of time devoted to important duties, such as Slaughter House Inspection, Visits to Sanitary Works in Progress, Infectious Disease Enquiries, etc. In each of these branches of the work increased time was allotted during 1924 compared with 1923. There is a reduction in the number of sanitary defects discovered and a proportionate decrease in the number of notices served. 20 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 5 Re-inspections after Order or Notice 1,686 Visits to Works in Progress 1,491 Factories and Workshops 66 Cowsheds, Dairies and Ivlilkshops (excluding inspections by Medical Officer of Health and Veterinary Inspector) 31 Ice Cream Premises 31 Foodshops and Food Preparing Rooms 354 Infectious Disease Inquiries 367 Markets 106 Special Inspections (Complaints, etc.) 1,128 Slaughter-houses 220 Offensive Trades 7 Sanitary Conveniences 73 Common Lodging-Houses 30 Canal Boats 17 Theatres, Cinemas, etc, 8 House-to-House 37 Bakehouses 27 Smoke Observations 8 Stables and Yards 10 Miscellaneous Visits 254 Total number of Inspections 5,956 Drainage. Number of old Drains examined, tested, exposed, etc. 52 Number of Houses and Premises re-drained 32 Number of Drains repaired or amended 3 Drains or Gullies unstopped or cleansed 53 Manholes provided 45 Manholes altered or repaired 4 Intercepting Traps fixed 18 21 Fresh-air Inlet Shafts repaired or renewed 21 New Gulley Traps fixed 79 New Soil Pipes or Ventilating Shafts 29 Soil Pipes or Ventilating Shafts repaired 2 Smoke Tests applied 23 Water Tests applied 66 Cesspools abolished, repaired, or cleansed 1 Drainage to dry areas 3 Water Closets and Sanitary Fittings, W.C. Apartments cleansed and limewashed 45 New W.C. Basins fixed 66 W.C.s unstopped, cleansed or repaired 12 W.C. Flushing Tanks repaired or renewed 57 Water supplied to W.C.s 2 New W.C: Apartments provided 5 W.C. Apartments lighted, repaired and ventilated 81 New Impervious Sinks provided 47 New Waste Pipes fixed 40 Existing Waste Pipes trapped 9 Urinals cleansed or repaired 11 Urinals renewed 4 Miscellaneous 4 Miscellaneous. Roofs repaired 36 Eaves Gutters renewed or repaired 48 Stack Pipes renewed or repaired 61 Stack Pipes disconnected from Drains 43 Damp Walls remedied 51 Ventilation provided beneath floors 41 Yards paved 63 Yard Paving repaired 43 Yards cleansed 3 Floors of Rooms repaired 69 Floors of Rooms renewed or repaved 8 Rooms repaired, cleansed and distempered 380 New ceilings 8 Windows repaired, renewed or made to open 146 22 Doors rehung or repaired 3 Cisterns repaired, cleansed, covered or removed 8 Window Sills renewed or repaired 34 Staircases lighted and ventilated 11 Stair Treads renewed 7 Unsafe Staircase removed 1 Ditch cleansed 1 Common Lodging-House cleansed and bedding renewed 1 New Scullery Apartment 1 Movable Ashbins provided 130 Nuisance from overcrowding abated 28 Nuisance from animals abated 7 Accumulation of Manure'e or Refuse removed 4 Water Supply direct from Main 28 Premises Limewashed (Workshops, etc.) 5 Firegrates repaired or renewed 47 Pumps for Water Supply repaired or renewed 1 Stables abolished 2 Milk Stores provided 1 Sheds removed 1 Defective Coppers repaired 32 Brickwork of Walls repaired 40 Handrails provided to Staircases 33 Manure or Offal Receptacles provided or repaired 3 Food Preparing Premises repaired or cleansed 2 Nuisance from Smoke abated 1 Offensive Trade discontinued 1 Miscellaneous 48 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, 769 visits were paid to premises where food is prepared or exposed for sale. Included in this number are 220 visits to slaughter-houses. As far as possible, the time of visiting slaughter-houses was arranged to coincide with the time of slaughtering. Practically double the number of visits were made to slaughter-houses during 1924 compared with 1923, The 23 time absorbed by a visit may vary from a few minutes to as many hours, but there is little doubt that the results accruing from such work more than justify the time and labour expended. In the absence of compulsory notice of slaughter, many visits to the slaughter-houses proved fruitless. Notice of intended slaughter is now provided for by the Meat Regulations, 1924. These new Regulations will also prevent the removal of carcases slaughtered in the evenings until an opportunity has been given for inspection. This is a great advance, although the inspection will need to be made before 7 a.m. A considerable number of animals are slaughtered in this Borough after the ordinary office hours and the carcases are often removed to the London Markets. The new Regulations meet the suggestions made in previous Annual Reports, and are very welcome. It is to be hoped that the Regulations will prove a sound basis for further improvement in the handling and preparation of our food supplies, and that the experience gained by working the Regulations will enable the provisions to be extended in due course. Two common causes of food contamination are overlooked frequently. I refer to the practice of some shopkeepers who permit domestic animals to roam at will amongst the foodstuffs, and secondly to the still common use of old newspapers for wrapping purposes. The high cost of greaseproof paper is no doubt the reason for the continued use of newspaper, but it is not a sufficient reason. Where greaseproof paper is used as a first covering it is seldom of sufficient size, and the newspaper is allowed close contact with the fish or meat as the case may be. There is no need to detail the means by which newspapers may' become soiled or infected. From the time the newspaper is deposited on the doorstep until it appears in the food shop the sheets are open to contamination, and the only safe course to pursue is to avoid the use of old newspaper and to use only new greaseproof and wrapping papers. Perhaps Food Regulations will be extended at some future date to cover matters such as these. The following is a list of articles of food which were condemned during the year. In the majority of cases the foodstuffs were "surrendered," but in several instances the articles were "seized" in accordance with the powers conferred by the Public Health Acts. Legal proceedings were taken against one vendor—see Page 32. 24 Articles of Food. Condition Action taken BEEF— 756 lbs. Bone taint or putrefaction Surrendered 237 lbs. Bruised „ 94 lbs. Degeneration of tissue ,, 2 Forequarters Tuberculosis Seized 1 Brisket Inflammation ,, 2 Ox heads and tongues Tuberculosis 1 Seized and 1 Surrendered 1 Pair ox lungs Tuberculosis Surrendered I Liver Tuberculosis Seized Livers—142½ lbs. Putrefaction Surrendered Kidneys—48½ lbs. Putrefaction „ Ox tails—196 lbs. Putrefaction ,, 1 Skirt Tuberculosis ,, Skirts (48 lbs.) Putrefaction and mould „ Complete offal of two beef Tuberculosis Seized carcases Corned beef Putrefaction and mould Surrendered MUTTON— 70 lbs. Putrefaction and mould Surrendered Sheep's hearts (240) Putrefaction ,, Sheep's tongues (30 lbs.) Putrefaction ,, PORK— 17 Pig's heads and necks Tuberculosis Surrendered 5 Plucks Tuberculosis ,, 1 Carcase Tuberculosis „ 2 Forequarters Tuberculosis „ Complete offal for two Tuberculosis „ carcases Kidneys (78 lbs.) Putrefaction „ FISH— Haddocks (1 box) Putrefaction „ Herring- (3 boxes) Putrefaction ,, Plaice (3 stone) Putrefaction ,, Skate wings (63 stone) Putrefaction „ Dog Fish (5 stone) Putrefaction ,, Fish roes (2 stone) Putrefaction ,, Winkles (2 bags) Putrefaction ,, Whelks (1 bag) Putrefaction ,, MISCELLANEOUS— Dates (I box) Putrefaction and fermentation Seized 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. 25 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. Two hundred and twenty visits were paid to these premises during the year, as compared with 111 during 1923. Dairies, Cowsheds, and Milkshops Orders, During 1924, 4 persons were removed from the Register. In each instance the removal was due to changes in ownership of the businesses. During the same period, 7 persons were added to the Register, making a total of 39 on December 31st. Of these 39, only one was registered as a cowkeeper. The cowsheds in use were inspected periodically and were found to be kept in good condition. One application for registration as a Purveyor of Milk was refused as the shop was not suitable for the purpose. There was one application for a supplementary licence to sell certified milk, and a licencc was issued. Disinfection. Two hundred and fifty-three rooms have been disinfected in 227 houses during 1924, as compared with 207 rooms in 179 houses during 1923. 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 26 May, 1921, and during the year 1924, 1,567 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. Thirty-six patients were removed in this ambulance last year, compared with 27 during 1923. House Drainage. Thirty-two houses were redrained during the year, as compared with 23 during 1923 The examination of the old combined drain at the rear of Washington Road was completed during the year, and with the exception of two premises, the drains of all the houses which were found to be connected to this old drain were disconnected. New drainage systems were reconstructed and connected to the public sewer in the roadway. The two exceptions were cases of special difficulty, but they will be completed during 1925. As the result of the action taken in connection with this old drain, a great improvement has been effected, and the flooding of several of the gardens has been prevented. The pollution of the ground from the very defective drains is now impossible. A further investigation was commenced during the year into the condition of an old drain at the rear of Elm Crescent. This investigation involved the drainage of about 50 houses and was not completed at the end of the year. The following shows the number and situation of premises redrained during 1924 :— Burton Road 1 Bonner Hill Road 1 Cambridge Grove Road 9 Canbury Park Road 4 Canbury Passage 1 Elm Road 1 Glenville Road 1 Grove Crescent 1 Hawks Road 5 Park Road 2 Richmond Road 2 27 Villiers Road 1 Washington Road 1 Wood Street 2 Total 32 Complaints One hundred and fifty-one complaints were made during the year as follows :— Drains and Sanitary Arrangements 35 Water Supply 4 Accumulation of Manure and non-removal of House Refuse 6 Absence of Ashbins 2 Dampness 8 Insanitary Condition of Premises 57 Defective Roofs 4 Nuisance from Keeping Animals 6 Overcrowding 10 Smoke Nuisance from Chimneys 1 Refuse Destructor and Tip 1 Miscellaneous 17 Total 151 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 1923 was 198. 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. Seven visits were made to premises in connection with offensive trades during the year, in addition to re-inspections after notices or warnings. 28 Factories, Workshops and Workplaces. Sixty-six visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in Tables on Pages 14 and 15, There are 15 " Outworkers " resident in the Borough, and the premises so used were inspected periodically. Increase of Rent & Mortgage Interests Acts. Six applications were received during the year from tenants for certificates under Section 2, Sub-Section 2, of the above Act, as compared with 16 during 1923. 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 four instances necessary repairs were not carried out by the owners, and certificates were granted to the tenants. Sanitary Condition of Music Halls, Cinemas, &c. Eight 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 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 1924, 17 visits and inspections were made in connection with the Canal Boats Acts. There do not appear to be many boats subject to inspection in this part of the river. The working stages are short and the crews live ashore instead of on board. 29 Housing. Thirty-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 58 (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 dwelling houses inspected for housing defects (under Public Health or Housing Acts estimated 701 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 37 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 470 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 284 3. Action under Statutory Powers. A.— Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919— 30 (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 (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 12 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 7 (b) by Local Authority in default of owners nil C.— Proceedings under Section 17 and 18 of the Housing, Town Planning, etc., Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (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 31 House-to-house inspection of the Borough was continued. The road selected was Acre Road, and the inspection was not completed by the end of the year. Upon completion of the inspection of each house a communication was addressed to the owner and an interview was arranged for the purpose of discussing the necessary works of repair, if any. This method is not always practicable, and in such cases an informal notice is issued. Such a notice usually forms the subject of a future interview. Special mention should be made of a row of nine cottages in Acre Road. As the result of interviews the owners agreed to demolish the existing dilapidated scullery apartments and to erect new sculleries in lieu thereof. This decision involved considerable expenditure, but the improvement in the sanitary condition of the property will be immense. The whole of the drainage system and the W.C. apartments have been reconstructed, and the remainder of the works will be completed during 1925. The time available for housing inspections is not great, and the inspection of a large number of houses with a view to statistics only has been purposely avoided. An effort is made to have all sanitary defects remedied as the inspections are made, and re-inspections during the progress of the work are frequent. SMOKE ABATEMENT. Only one complaint was received during the year in respect of alleged nuisance from smoke. Eight observations were made of chimneys, and in one instance a nuisance was proved to exist. A consultation with the owner of the premises and a subsequent interview with the stoker proved successful, and the nuisance was abated. COMMON LODGING HOUSES Thirty visits were made to the two Common Lodging Houses in the Borough. In one case the whole of the bedding was found to be in bad condition and the premises required cleansing. The owner was interviewed, and he immediately gave the necessary instructions for the replacement of all bedding and the rooms were thoroughly cleansed. The bedsteads were all taken down, cleansed, and reinstated. This necessitated closing part of the Lodging House for a short period. 32 Information was received of a case of Smallpox in Epsom during October, and under the direction of the Medical Officer of Health, special attention was paid to the Lodging Houses with a view to the detection of any contacts with the case who might arrive at the premises. LEGAL PROCEEDINGS. Proceedings were instituted against a butcher for exposing for sale certain meat which was diseased (Tuberculosis) and unfit for the food of man. The defendant was convicted and fined £10 with an additional £5 5s. costs. 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, 1925. 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 1924. The average number of children on the school register for the year was 4,642. The schools have enjoyed a year of comparative freedom from infectious disease, apart from outbreaks of measles at Bonner Hill Road, Richmond Road, and St. Paul's Infants' Schools during the first four months of the year. Mr. H. A. L. Morris was appointed School Dental Surgeon and he commenced Dental Inspection and Treatment of Entrant Infants in September. The Dental Clinic was established at "Elmfield," London Road, two sessions a week being held, but it is probable that three sessions a week will become necessaryafter twelve months' work, in order that re-inspection and treatment of those infants seen this year may be undertaken. Owing to the re-organisation of the Nursing Services, it was possible to open the Clinic daily for the treatment of Minor Ailments. This year must be looked upon as a progressive one and should be regarded with satisfaction by all concerned. I have to express my hearty thanks to Miss R. Bartter, your Senior School Nurse, whose untiring efforts have been a large factor in the success of the School Medical Service. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 34 Staff of the School Medical Service, School Medical Officer: E. W. MATTHEWS, m.b., b.s.(lond.), m.r.c.s., l.r.c.p., d.p.h, Ophthalmic Surgeon: WINIFRED WARNER, m.b., b.s.(lond.), d.p.h. Dental Surgeon : H. A. L. MORRIS, l.d. s., r.c.s. (eng.). School Nurses : Miss R. BARTTER (Senior) 3/5 time. Miss E. ARTHUR 1/5 time. Miss C. J. DUNCAN 1/5 time. Clerk : Miss F. FRANCIS. CO-ORDINATION. On January 1st, 1924, the duties of the School Nurse and the two Maternity and Child Welfare Health Visitors were combined, their time being allocated as follows :— 35 School Medical Service. Maternity Child Welfare. 1. Senior Nurse 3/5 2/5 2. Nurse 1/5 4/5 3. Nurse 1/5 4/5 Total 1 2 Though no actual increase of Staff resulted from this amalgamation, the time of only one Nurse remaining for the School Medical Service, it however rendered it possible to open the School Clinic daily for the treatment of minor ailments, and also to inaugurate the Dental Clinic, which could not have been done had the School Nurse been one individual, since she would have been required in two places at one time. The duties are so arranged that each Nurse gains experience in all branches of both the School Medical Service and Maternity and Child Welfare Work. 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 1924 the following repairs and improvements have been carried out :— Bonner Hill Road Schools. External painting has been carried out in all Departments. Additional heating has been installed by a new circuit from the boiler to new radiators in five class rooms and three existing radiators have been re-arranged so as to procure more efficient heating. Richmond Road Schools. External painting has been carried out in all Departments. The Central Hall, corridors, and cloakroom in the Boys' Department and eight classrooms, corridors and 36 cloakrooms in the Girls' Department have been re-decorated internally. The walls of the lavatories in the Boys', Girls', and Infants' Departments have been distempered. A shelter in the playground of the Infants' Department has been converted into an additional classroom, one side and part of the front of which can be folded back, in order that it may be used as an open-air classroom in fine weather. 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 following table is instructive :— No. of Children Examined. No. of Parents present Percentage Entrants, Boys 235 195 83% Girls 217 167 77% Intermediates, Boys 271 142 52% Girls 234 148 63% Leavers, Boys 264 70 26% Girls 288 144 50% FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. At Routine Medical Inspections 159 children were found unclean, as compared with 403, 366, and 126 during the years 1921, 1922 and 1923 respectively. The School Nurses at their Cleanliness Surveys found during the year 547 children unclean. It remains a fact that many children return to school after the holidays with unclean heads, so it is now a routine procedure for the School Nurses to visit all schools within the first fortnight of each term for the purpose of carrying out Cleanliness Surveys. 37 Legal proceedings taken under the School Attendance Bye-Laws :— Prosecutions were made in the cases of 24 children. (b) Tonsils and Adenoids. There were 53 children suffering from enlarged tonsils and adenoids referred for treatment compared with 75, 49, and 42, in 1921, 1922 and 1923. (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. Only 3 cases of scabies were seen, and this disease must now, I think, be regarded as a comparatively rare one in the Borough. The 44 cases occurring during 1920 were a direct result of demobilisation of the Army. The 31 cases of ringworm affecting the scalp were about an average number, but the 68 cases of ringworm of the body and the 145 cases of impetigo both show a considerable increase, which is more apparent than real, being no doubt due to the greater facilities afforded by a daily Clinic, many cases being now brought under our notice and care, which previously would have escaped inclusion in our records. (e) Vision. During the year 104 children were found requiring treatment for defective vision, this number being somewhat higher than the average for the last few years. (f) Dental Defects. Dental Inspection was commenced in September by Mr. H. A. L. Morris, the School Dentist, who states that out of 287 entrant infants examined, 240, or 84%, were found to require attention. This large percentage he attributes to the fact that the great majority had not received any previous dental treatment. 38 (g) Thyroid Enlargement. Out of 278 girls of 12 years of age, 6 were discovered exhibiting definite enlargement of the thyroid gland; but no boys of the same age showed this defect out of 254 examined. MEDICAL TREATMENT. (a) Minor Ailments. Under the Combined Nursing Scheme, it was possible to undertake the treatment of minor ailments daily during school terms, 1,888 attendances for treatment being registered during the year. (b) Tonsils and Adenoids. Operative treatment for tonsils and adenoids has been carried out in the cases of 56 children at the Kingston and District, Kingston Victotia, and other hospitals. (c) Skin Disease. The treatment of impetigo, ringworm, and other skin diseases has been undertaken at the Minor Ailments Clinic. (d) Vision. Cases of defective vision are referred by the School Medical Officer to Dr. Winifred Warner, who has prescribed spectacles for 91 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 26 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (f) Dental Defects. Parents were urged to seek advice for children found suffering from dental defects by the School Medical Officer, and 70 received treatment from private dentists or at hospitals. Of the 240 Entrant infants found by the School Dentist requiring treatment, 86 were rendered dentally fit by him at the Clinic before the end of the year, 39 (g) Crippling Defects and Orthopædics. 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 Orthopædic 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. On the whole the Schools have enjoyed a comparatively good year, the absence of diphtheria being highly satisfactory. There were outbreaks of measles at Bonner Hill Road, Richmond Road, and St. Paul's Infants' Schools during the months of January, February, March and April. There was very little scarlet fever for the first six months, but during the last half of the year a mild form has been in evidence, though not reaching epidemic proportions. 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. The work of the School Nurses may be briefly summarised as follows :— They prepare beforehand for Routine Medical Inspections at the Schools, by weighing, measuring, and applying rough vision tests. A Nurse is present to assist the School Medical Officer at Routine Medical Inspections and re-inspections. 40 Cleanliness Surveys are carried out at the Schools and the following table specifies the work done in 1924:— Number of children prepared for Routine Medical Inspection 1,509 Number of Routine Medical Inspections 1,509 Number of Medical Re-inspections 3,381 Number of Cleanliness Surveys 16,768 Number of following-up home visits 315 In addition they attend the School Medical Officer and the Ophthalmic Surgeon during their sessions at the Clinic, and carry out the treatment of minor ailments under their direction, and also apply atropine ointment to children warned to attend the Clinic for refractions. Also a Nurse assists the Dental Surgeon at his Inspections at the Schools and his sessions at the Clinic. A Nurse is in attendance daily at the Clinic at 9.15 a.m. to undertake the treatment of minor ailments. The work of the clerk and the keeping of all records and cards are supervised by the Senior School Nurse under the direction of the School Medical Officer. It should be noted that the total time amounting to that of one School Nurse only, is allotted to the School Medical Service, and that during the year it has been necessary for the Senior Nurse to put in constant long hours of overtime. It becomes self-evident that no further extension in the activities of Medical or Dental work can be entertained under these conditions. 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 235 128 54% Girls 217 129 59% Intermediates, Boys 271 156 57% Girls 234 133 56% Leavers, Boys 264 169 64% Girls 288 183 63% SPECIAL SCHOOLS. The school for Physically Defective Children at " Elmfield," London Road, was described in the Annual Report for 1922. 41 There were 36 children on the books during 1924, compared with 28 the previous year. The physically defective children are periodically examined by the School Medical Officer, and the Clinic, being on the same premises, is always at hand should the Head Teacher desire to consult the School Medical Officer or Nurses about any of the children. SCHOOL BATHS. During the summer months 713 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. SCHOOL CLINIC. The Clinic and School Medical Officer are situated at " Elmfield," London Road. It is a great advantage having the office at the Clinic, records and correspondence being always immediately available, and the Clerk being on the premises to deal with enquiries by parents and others when the Clinic is closed. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days when the School Nurses carry out the treatment of minor ailments under the direction of the School Medical Officer. No charge is made, but a box is provided for voluntary contributions. 42 (c) Ophthalmic Clinic. Dr. Winifred Warner attends fortnightly on Wednesday afternoons during school terms, to deal 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 atropine ointment applied by the School Nurse. There were 331 attendances at the 21 sessions held during the year, 126 being new cases and 205 re-inspections. Refractions numbered 104 and spectacles were prescribed in 94 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. During the year approximately 88% of the cost of spectacles was paid by the parents, which must be regarded as highly satisfactory. (d) Dental Clinic. On his appointment in September as School Dentist, Mr. H. A. L. Morris proceeded to inspect 287 Entrant Infants at Richmond Road and Bonner Hill Road Schools, and found 240 required treatment. The first 5 sessions were occupied by this work. The Dental Clinic was then opened, meetings being held on Monday and Thursday mornings. At the 20 sessions held at the Clinic before the end of the year, 202 attendances were registered and 86 Infants were marked off as rendered dentally fit. From time to time a session is devoted entirely to those cases requiring a general anaesthetic and the School Medical Officer attends to administer the nitrous oxide gas. Mr. Morris writes: "The mode of treatment is conducted on conservative lines as far as possible, but the health of the child is the primary factor and therefore teeth detrimental to health are extracted. Every endeavour is made to render the child dentally fit, thereby avoiding absence from school through dental disease. Instruction is given at the Clinic in Oral Hygiene. The enthusiasm and co-operation of the parents and all concerned greatly facilitates the work and administration." 43 A flat rate of 1s., payable in advance for each child, is charged for dental treatment, irrespective of the number of teeth requiring attention, i.e., fillings, or extractions with gas or otherwise. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 70 school children and 1 young person 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 girls to Broadstairs for a week. In all, 45 girls, 10 of whom paid all, and 5 part of, their own expenses, proceeded to the St. Mary's Convalescent Home, Broadstairs, on June 20th, but unfortunately had to return on June 26th owing to one of the children contracting scarlet fever. This necessitated the exclusion of all the contacts from attending school for 14 days after their return. Fortunately, no case of scarlet fever developed among the contacts. 44 STATISTICAL TABLES. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.— Routine Medical Inspections. Number of Code Group Inspections— Entrants 412 Intermediates 454 Leavers 532 Total 1,398 Number of other Routine Inspections 111 B.— Other Inspections. Number of Special Inspections 1,197 Number of Re-Inspections 3,381 Total 4,578 TABLE II. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1924. Defect or Disease. Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — — — Uncleanliness— (See Table IV.GroupV.) 159 — 547 — Skin 'Ringworm, Scalp — — I Body — — 68 4 Scabies — — 3 — Impetigo 4 — 145 2 Other diseases (non Tb) 10 — 121 14 Eye Blepharitis 2 — 18 — Conjunctivitis — — 4 — Keratitis — — 2 — Corneal Opacities 2 — 7 — Defect. vision exc.Squint 86 — 18 2 Squint 14 4 5 3 Other Conditions 7 1 31 3 Ear Defective Hearing 1 1 7 — Otitis Media 2 — — — Other Ear Diseases 5 1 24 — Nose and Throat Enlarged Tonsils only 23 3 18 — Adenoids only 1 — 2 2 Enlarged Tonsils and Adenoids 5 — 4 — Other Conditions 1 — 20 2 Enlarged Cervical Glands (non Tb) 1 1 9 1 Defective Speech — 8 — 2 Teeth—Dental Diseases (see Table IV., Group IV.) 54 1 6 — Heart and Circulation Heart Disease—Organic 2 14 4 — Functional — — — — Anæmia — 1 1 — Lungs Bronchitis 2 — 2 1 1 Other non Tb. Diseases 3 2 14 5 Tuberculosis Pulmonary—Definite — — 1 — Suspected — — 6 — Non-Pulmonary-Glands — — 2 — Spine — — — — Hip — — 2 — Other Bones & Joints — — 2 — Skin — — 1 — Other Forms — — — — Nervous System Epilepsy — 2 1 1 Chorea — — 1 — Other Conditions — 2 2 1 Deformities Rickets 1 14 — — Spinal Curvature 5 — 1 — [Other Forms 4 1 5 1 Other Defects and Diseases 8 9 32 11 TABLE II.—continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEAN LI NESS AND DENTAL DISEASES). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups—Entrants 412 36 8 Intermediates 454 68 15 Leavers 532 60 11 Total (Code Groups) ... 1398 164 11 Other Routine Inspections 111 25 22 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 1 — 1 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 2 — 2 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 2 — 2 Attending Public Elementary Schools 17 10 27 At other Institutions — — — At no School or Institution 2 4 6 Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles I 1 2 Idiots — — — 47 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 — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 2 2 4 At no School or Institution — — — Infectious pulmonary and glandular tubercuk sis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Non-infectious but 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 — — — At other Institutions — 1 1 At no School or Institution — — — Physically Defective Delicate children (e.g. pre or latent tuberculosis, malnutrition.debility. anæmia, etc). At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 5 7 12 At other Institutions — — — At no School or Institution — 3 3 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 i i 2 At no School or Institution — — — 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 14 11 25 At Public Elementary Schools 2 2 4 At other Institutions — — — At no School or Institution 1 — 1 48 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1924. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V). Disease or Defect. Number of Defects treated or under treatment during the year Under the Authority's Scheme. Otherwise. Total Skin—Ringworm, Scalp 19 12 31 Ringworm, Body 63 5 68 Scabies 2 1 3 Impetigo 142 5 147 Other Skin Disease 59 16 75 Minor Eye Defects —(External and other, but excluding cases falling in Group II.) 33 2 35 Minor Ear Defects 26 8 34 Miscellaneous— e.g., minor injuries, bruises, sores, chilblains, etc. 47 6 53 Total 391 55 446 Group II.— Defective Vision and Squint (excluding minor Eye 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. Errors of refraction (including Squint) 104 11 — 115 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.)22 2 1 25 Total 126 13 1 140 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 94 (b) Otherwise 11 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 82 (b) Otherwise 10 49 Group III.— Treatment of Defects of Nose and Throat Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital — By Private Practitioner or Hospital apart from the Authority's scheme. 56 Total 56 Received other forms of treatment 4 Total number treated 60 Group IV. Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist : Ages 1 5 6 7 8 9 10 11 12 13 14 249 38 — — — — — — — — Total 287 Specials 28 Grand Total 310 (b) Found to require treatment 240 (c) Actually treated 86 (d) Re-treated during the year as the result of periodical examination Nil (2) Half-days devoted to : — Inspection 5 Treatment 20 Total 25 (8) Attendances made by children for treatment 202 (4) Fillings :— Permanent teeth 13 Temporary teeth 127 Total 140 (5) Extractions :— Permanent teeth 11 Temporary teeth 125 Total 136 (6) Administrations of general anæstheticsfor extractions 19 (7) Other operations:— Permanent teeth 10 Temporary teeth 94 Total 104 50 Group V.— Uncleanuness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurse 70 (ii.) Total number of examinations of children in the schools by School Nurse 167,08 (iii.) Number of individual children found unclean 706 (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 School Attendance Bye-laws 42 Farrington Bros,, Printers, 12a, Fife Road, Kingston - upon - Thames.