A-C 4413(1) KINS Ton [???] TA AM[???] KIN 3 Borough of Kingston-upon-Thames. Annual Reports FOR 1925 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 1925 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 Floods 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 G. H. SAUNDERS, 4/5 time. * Miss E. RILEY, 4/5 time. Junior Clerks : Miss T. P. DILLIWAY, G. H. 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, April, 1926. To the Corporation of Kingston-upon-Thamf.s. Gentlemen, I have the honour to present my Annual Report for the year 1925. Circular 269 (Ministry of Health) directs that Annual Reports of a full and detailed character (referred to in this Circular as Survey Reports) will normally be required at intervals of not more than five years. The Annual Reports of 1919 and 1920 will be treated as constituting the first of the series of Survey Reports. Circular 540 of the 18th December, 1924, intimated that the Annual Report of the Medical Officer of Health for 1925 should be a Survey Report. For reasons of economy the Report has been kept as short as possible, and no doubt there are many omissions, but an effort has been made to refer to the main activities. The period 1921-25 has been one of steady progress, and when looked back upon must be regarded with satisfaction. Just prior to this period the Public Health Department had moved from the Municipal Offices to Clattern Lodg-e, which is adjacent. In November, 1923, the Sanitary and Drainage Committee was reconstructed, and renamed the Public Health Committee, and the Maternity and Child Welfare Committee became a sub-committee of the Public Health Committee. 4 In 1922, owing to the ever-increasing work of the Department, it was found necessary to appoint an Assistant Sanitary Inspector. Mr. F. D. Harvey was selected to fill the post from a large number of applicants, and he took up his duties on June 26th, 1922. Mr. W. C. Cockell, who had been clerk to the Public Health Department for five years, qualified as a Sanitary Inspector, and resigned in November, 1924, having obtained a post as Assistant Sanitary Inspector. Mr. W. J. Fell was appointed to replace him, but resigned in May, 1925, having obtained a post on the Southern Railway. Miss T. P. Dilliway, a pupil from the Technical Institute, was then appointed as a shorthand-typist, and Mr. G. H. Cockell as a boy clerk. Owing to these rapid changes and the inexperience of the Clerical Staff, much time has and is still devoted to training these junior members in their clerical duties, time which should be devoted to outside sanitary work. The Public Health (Meat) Regulations, 1924, came into force on April 1st, 1925, and the additional duties imposed by these Regulations were immediately felt. It was found that far more slaughtering was taking place in the latter part of the day and evening than was anticipated, and it is a matter for careful consideration as to the best means of regulating this, if possible, since there are no less than six private slaughter-houses. The duties of Meat Inspection have been conscientiously carried out, so that a great part of the time of the Sanitary Inspector has been occupied in this branch of his duties. Details of Housing are set out in the Report of the Sanitary Inspector, and I am in agreement with his observations. During the past five years 290 houses have been erected in the Borough, 82 of these by the Corporation. Overcrowding exists in certain areas, in spite of the fact that the Census of 1921 shows the number of rooms in the Borough per person to be 1.15. It is the uneven distribution of the population that accounts for the congestion in certain quarters, and I am even more convinced now than when I wrote in my Report for 1923, that this overcrowding is increased by the fact that young girls, who ordinarily should reside away from home in domestic service, now prefer to sleep at home. 5 In a residential district such as Kingston, there are a great many spare bedrooms to-day which were formerly occupied by maids, and it seems a great pity that these girls will now only seek daily places, and return at night to sleep in overcrowded houses, when so many airy and hygienic bedrooms are awaiting them. This contributory cause of overcrowding is by no means a small one in this district, and could so easily be mitigated by the girls entering resident domestic service voluntarily. Again, it is becoming a practice for young people to marry and continue to reside in the home of one of the parents, a further family being added to the home in this way. Sub-letting one room to married couples is a common procedure, and one to be deprecated. Also the influx of people from other districts is by no means inconsiderable. Attention to such points as those mentioned by the people themselves would assist in the prevention of overcrowding, and render easier the problem of housing. The removal of the Cattle Market from the Market Place to a site on the Fairfield, in April, 1925, was a step conducive to public health. The first Health Exhibition was held at the Baths Hall in October, 1924, and proved a great success. It was hoped that this venture might be repeated, but under the increased stress of work thrown on to the Public Health Department of late, it is feared that this hope is not likely to be realised. Another feature of progress was the addition of Humus Tanks to the Sewage Works in 1925. The motor traffic in the town has increased enormously during the past five years, and in December, 1924, a Public Motor Park was opened at the rear of the Municipal Offices. The urgent need of warning notices at certain dangerous junctions and cross roads appears still very necessary. A light motor ambulance for accident cases was installed at the Fire Station by the Corporation in October, 1924. Maternity and Child Welfare Work has become far more efficient since the reorganisation of the Nursing Services in January, 1924, 6 An Ante-Natal Clinic was established in December, 1925. I thank Mr. H. T. Perry, your Chief Sanitary Inspector, and the Staff of the Public Health Department, for their loyal support at all times. I am, Gentlemen, Your obedient Servant, E. W. MATTHEWS. Medical Officer of Health. NATURAL AND SOCIAL CONDITIONS Kingston-upon-Thames is situated on the Surrey bank of the Thames, about 12 miles by road from Charing Cross, and the same distance by railway from Waterloo Station. The greater part of the Borough is on flat ground, rising to the East to the top of Kingston Hill, a height of about 140 feet. Surbiton adjoins on the Southl the village of Ham is to the North, and the West of the Borough is bounded by the River Thames, across which it is connected to Hampton Wick on the Middlesex bank by a wide stone bridge. The town is surrounded by a magnificent and healthy belt of open country', formed by Ham Common, Richmond Park, Wimbledon Common, Hampton Court and Bushy Parks. The Canbury Gardens and the Queen's Promenade form delightful and picturesque stretches along the banks of the Thames. A large open space known as the Fairfield is situated near the centre of the Borough, and is maintained as a Recreation Ground. The Market Place and Town Hall are situated near the bridge at the West end of the Borough. A Produce Market is held on Tuesdays, Wednesdays, Thursdays and Fridays. On Saturdays there is a General Market, when the covered portioh under the Town Hall is used as a Meat Market. 7 The Cattle Market, which was formerly held in the Market Place, was moved to a specially prepared site on the Fairfield in April, 1925, where it is held on Mondays. This move constitutes an achievement in the interests of public health among many other advantages. In addition to being a market town, Kingston-uponThames is a very large shopping centre, and thus affords employment to many of its inhabitants. The Borough is also a dormitory of the Metropolis, many persons travelling daily to London to follow their occupations in offices and business houses. The greater part of the remaining working population is engaged in the engineering and building trades, and as transport workers. GENERAL STATISTICS. Area 1,133 acres. Population, 1925 (Registrar-General): For birth-rate 40,220 For death-rate 40,040 Census (1921) 39,479 Number of inhabited houses (1921) 7,859 Number of families or separate occupiers (1921) 9,210 Number of families per dwelling (1921) 1.18 Number of rooms per person (1921) 1.15 Rateable Value— To Poor Rate £271,645 Assessable Value to District Rate £267,233 Sum represented by a Penny Rate— Poor Rate £1,083 District Rate £1,073 Amount of Poor Law Relief (1925) £3,024 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Male. Female. Legitimate 562 297 265 Birth Rate (R.G.) 14.9 per 1,000 population. Illegitimate 37 25 12 509 322 277 Deaths— 454 234 220 Death Rate (R G.) 11.1 per 1,000 population. 8 Number of women dying in, or in consequence of child-birth— From Sepsis 1 From other causes 0 Deaths of Infants under one year— Total. Male. Female. Legitimate 41 28 13 Illegitimate 3 3 — 44 31 13 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 72 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 81 Total Deaths of Infants under one year of age per 1,000 births 73 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under two years of age) 5 Birth Rate Death Rate Rale per Diarrhoea 1000 Births Total Deaths under 2 years. Under 1 year England and Wales 18.3 12.2 8.4 75 157 Smaller Towns 18.3 11.2 7.6 74 London 18.0 11.7 10.6 67 Kingston upon-Thames 14.9 11.1 8.3 73 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 234 220 1. Enteric Fever 2 — 2. Smallpox — — 3. Measles — — 4. Scarlet Fever — — 5. Whooping Cough — 4 6. Diphtheria — 1 7. Influenza 5 5 8. Encephalitis Lethargica — 1 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 17 13 11. Other Tuberculous Diseases 3 3 12. Cancer, Malignant Disease 29 29 13. Rheumatic Fever — — 9 14. Diabetes 2 2 15. Cerebral Haemorrhage, etc. 6 13 16. Heart Disease 30 24 17. Arterio-Sclerosis 3 10 18. Bronchitis 10 18 19. Pneumonia (all forms) 21 21 20. Other Respiratory Diseases 10 2 21. Ulcer of Stomach or Duodenum 4 — 22. Diarrhoea, etc. (under two years) 3 2 23. Appendicitis and Typhlitis 1 1 24. Cirrhosis of Liver 2 — 25. Acute and Chronic Nephritis 12 3 26. Puerperal Sepsis — 1 27. Other Accidents and Diseases of Pregnancy and Parturition - 28. Congenital Debility and Malformation, Premature Birth 13 6 29. Suicide — 3 30. Other Deaths from Violence 6 6 31. Other defined Diseases 55 52 32. Causes ill-defined or unknown — — Cancer, Heart and Respiratory Diseases account for the majority of deaths, and the following table gives the number of deaths caused by these diseases during the last five years:— Year. Cancer. Heart Disease. Bronchitis Respiratory , Pneu- T monia. Diseases, uberculosis. Total. Total Deaths from All Causes. 1921 73 60 21 27 25 206 457 1922 69 78 38 43 36 264 515 1923 54 58 20 27 20 179 416 1924 75 94 32 29 26 256 502 1925 58 54 32 42 30 216 454 When requested, the Public Health Department carried out disinfection after deaths from cancer. Notified cases of pneumonia have been followed up, in order to ensure that they are being nursed under satisfactory conditions. Disinfection is carried out in pulmonary tuberculosis whenever premises are vacated by cases, either on account of their removal, admission to hospital or sanatorium, or death. 10 METEOROLOGY. 1925. Temperature of Air. Rainfall. Inches. highest. Lowest. M. an Max Mean Mill. January 62 27 53 37 1.81 February 62 27 54 36 3.96 March 62 22 54 34 .47 April 71 29 62 38 2.16 May 81 32 69 47 1.91 June 86 43 75 51 .07 July 90 47 79 55 4.11 August 80 46 74 54 2.40 September 73 38 65 45 2.51 October 72 33 61 45 2.71 November 62 22 47 33 1.94 December 59 20 45 33 2.39 Total 26.44 The average annual rainfall (Greenwich) for (he hundred years, 1821—1920, was 24.39 inches. The following table gives the annual rainfall, as recorded at the Kingston Sewage Works, for the last five years:— 1921 13.05 inches. 1922 25.40 „ 1923 27.77 ,, 1924 33.08 ,, 1925 26.44 „ GENERAL PROVISION OF HEALTH SERVICES. 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 nine residing in the Borough at the end of the year. IX Clinics and Treatment Centres. Centre. Situation. Accommodation. Provided by Maternity and Child Welfare Eden Street Consultation The Corporation Maternity and Child Welfarc Washington Road Consultation The Corporation Ante-natal Clinic "Elmfield," London Road Consultation The Corporation School Clinic "Elmfield," London Road Consultation & Ti eatment of The Education Com mittee Minor Ailments, Refractions, Dental Treatment Day Nursery Canbury Park Road 9 Babies and 16 Infants Vol. Committee Tuberculosis Dispensary Grove Cresent Consultation Surrey C.C. Red Cross Curative Post Coombe Road Out-Patients, Massage, Electrical and Orthopaedic Treatment British Red Cross Society 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. 12 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 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. During the year a motor ambulance has been provided by the Molesey Urban District Council for their Isolation Hospital, and they now remove cases recommended for admission to this hospital. Cases to the Hampton Isolation Hospital are removed in your own motor ambulance. (b) For non-infectious and accident cases. A motor ambulance for non-infectious and accident cases is provided by the Corporation. Accident cases are removed free, but a charge is made for its use in private cases. During the year 106 accident cases and 49 private cases were removed by this ambulance. *3 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 Private Street Works Act, 1892 1st July, 1891 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 Section 94). 27th Nov., 1922 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 CIRCUMSTANCES OF THE AREA. WATER. The Water Supply of the town is furnished by the Metropolitan Water Board. There are still a few shallow wells, and the policy is to advise owners to have their property connected to the Main Supply of the Metropolitan Water Board. Sixteen wells have been abolished during the past five years. RIVERS AND STREAMS. The bank of the River Thames is formed mainly by the Queen's Promenade, Canbury Gardens, Hotel Gardens, Wharves and Boat-houses, and cannot be regarded as liable to serious pollution. The Hogg's Mill River enters the Thames near the Market Place, after having traversed the Borough. It receives the effluent of the Maiden Sewage Works just beyond the Borough boundary. 14 Behind houses in Fairfield Place, Mill Street, and the adjacent land, persons are in the habit of throwing debris into the stream. The difficulty is to identify the actual culprits, who deserve severe punishment. It is found necessary to periodically clear out the stream at this spot. The open ditch coming from the old mill into the water splash has been piped in and made up, which is a great improvement, since formerly it often became stagnant and offensive. It is the practice for youths to bathe in this river near its entry to the Borough, but in my opinion this pastime is to be strongly deprecated. CLOSET ACCOMMODATION. All Closets in the Borough are on the Water Carriage System. SEWAGE DISPOSAL. The Sewage Disposal Works are situated just behind the Canbury Gardens. « These works have been in operation since 1888, the process adopted being known as the A. B. C. system of chemical precipitation, and this method is still in use, the only essential difference being that, whereas originally the tank effluent was discharged direct to the River Thames, it is now subjected to further treatment through percolating filters and humus tanks. The works deal with a population of approximately 44,000 from Kingston and Hampton Wick, the average daily flow being about two million gallons. The sludge deposited in the tanks is pressed, and subsequently dried and ground into a fine powder, and sold to farmers, market gardeners, fruit growers, etc., as a fertilizer. This product has been marketed by the Native Guano Company, under the name " Native Guano " for the past thirty-eight years, but on the termination of the contract in November, 1925, the Corporation have undertaken the sale direct at a considerably reduced price. During the past five years the whole of the filters have been cleaned. Three 50-feet percolating filters have been added, together with humus tanks of a capacity equal to two hours' dry weather flow. 15 It is the intention of the Corporation to increase the filter area, and allowance is made in the annual estimates for the work to be carried out by direct labour. SCAVENGING. The removal and disposal of house refuse is undertaken by the Borough Surveyor's Department. Refuse is partly tipped, and the remainder is burnt in the Dust Destructor. SCHOOLS. The sanitary condition of the Public Elementary Schools is set out in the Annual Report of the School Medical Officer on pages 59 to 65. OTHER SANITARY CIRCUMSTANCES. In order to prevent duplication, the Sanitary Inspection of the Area, Ashbins, Smoke Abatement, Housing, Inspection and Supervision of Food, etc., are entirely included in the Annual Report of the Sanitary Inspector. SALE OF FOOD AND DRUGS ACTS. These Acts are administered by the Surrey County Coupcil, and the following table shows action taken in the Borough during the year :—- Articles. ANALYSED. ADULTERATED OR DETERIORATED. formal. Informal. Total. Formal. Informal Total. Milk 74 6 80 5 — 5 Cream 2 — 2 1 — 1 Hutter — 7 7 — — Cheese — 1 1 — - — Lard — 1 r — — — Tea — 2 2 — — — Cocoa — 5 5 — — — Sugar — 1 1 — — — Mustard — 1 i — — — Confectionery and Jain — 2 2 — — Drugs — 3 3 - — — Other Articles — 7 7 - 3 3 Totals 76 36 112 6 3 9 No prosecutions were made under these Acts in the Borough during the year. id Notifiable Diseases during the Year. Cases, Under i year. 1—2 2—3 3—4 4—5 5—io IO—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Notified Scarlet Fever 1 — 6 11 19 91 38 18 22 5 2 - 213 Diphtheria — I 3 4 2 9 3 1 2 — - 25 Enteric Fever including Paratyphoid - - - 1 - 1 1 2 - - 2 - 7 Pneumonia 3 6 3 2 1 13 3 3 8 6 9 9 66 Erysipelas - - - 1 — 1 1 2 3 4 7 2 21 Encephalitis Lethargica - - - - - - - - - - 1 — 1 Poliomyelitis — — — — 1 1 1 - - - - - 3 Puerperal Fever — — — — — — — — 3 1 — — 4 Deaths. Cases admitted to Hospita U nder 1 year. I—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Totar Deaths 177 — — — — — — — — — — — — — 20 - - - - - 1 - - - - - - 1 7 - - - - - - 1 - - - 1 - 2 14 1 - - - - - - 1 - - 3 1 6 9 - - - - - - - - - - - - - — - - - - - - - - - - 1 — 1 3 - - - - - - 1 - - - - - 1 3 - - - - - - - - 1 - - - 1 New Cases. 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 3 1 8 10 3 2 3 33 F — — 1 — 4 4 8 2 1 2 2 24 Total 1 — — 1 3 7 5 16 12 4 4 5 57 (b) Non-Pulmonary M — — 2 — — — 1 1 - 1 — 5 F. - 1 — — 2 — — — — — — 3 Total 1 — 1 2 — 2 — 1 1 — 1 — 8 Deaths. Under I year. 1-5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 & over. Total — — — 1 1 — 3 6 4 4 - 19 — — — — 2 1 6 2 1 r 1 14 — — — 1 3 1 9 8 5 5 1 33 - - 1 - - - 1 - - - - 2 — 1 — — — 1 1 — — — - 3 — 1 1 — — 1 2 — — — — 5 17 INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. During the period since 1920 there has been no epidemic except that of Scarlet Fever during the year 1921, which affected a large area of this part of the country, when 302 cases were reported in the Borough, the height of the outbreak being reached during the months of October and November of that year. The type was mild, only two deaths being attributed to the disease. There was a rapid fall in the incidence during the two following years, 1922 and 1923, but since then there has again been an increase in its prevalence. Special reference is made to Scarlet Fever, Diphtheria and Enteric Fever in subsequent paragraphs. Immediately upon receipt of notification of an infectious disease, the home is visited under the direction of the Medical Officer of Health, and details of the case are entered upon an enquiry form. This form is set out to obtain information as to the disease, removal to hospital, school or place of work, Sunday School, milk supply, water supply, laundry, library books, residence previous to illness, any trade carried on in the house, number of living and sleeping rooms, number of inmates, etc. Also there is a section for information with regard to contacts, requiring their names, ages, schools, or places of work, etc., and a large space for any further remarks and details as to the sanitary condition of the premises. The prompt investigation and completion of this form is a most important factor in the control of infectious disease. During office hours cases are removed to Isolation Hospital through the Public Health Department. This procedure, in my opinion, is the most satisfactory one, since the control and disposal of cases is thereby retained. During week-ends and general holidays the doctors are informed that they may remove urgent cases themselves by communicating by telephone directly with the Isolation Hospital, and notifying the Medical Officer of Health. Wimbledon, Molesey, and Hampton Isolation Hospitals admit cases from the Borough, and this arrangement has proved satisfactory. 18 Ten cases of Encephalitis Lethargica have occurred during the last five years, seven being adults, and three children, resulting in the deaths of three adults and two children. The one case this year was a woman of fifty, who died from the disease. There has been no connection between any of the cases, and investigations have failed to elicit any source or cause. There has been a very large increase in the number of cases of Pneumonia notified during the last two years under the Regulations of the 7th January, 1919. In my opinion this increase is very much more apparent than real, and is due primarily to the fact that the obligation to notify cases of Acute Primary and Influenzal Pneumonia has only recently been fully realised by some general practitioners. I feel sure also that this accounts for the very divergent figures appearing from other districts. No primary vaccinations or revaccinations have been performed by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. No cases of Anthrax or Rabies have occurred during the last five years. Puerperal Fever and Ophthalmia Neonatorum are referred to under the Maternity and Child Welfare Section of the Report. NOTIFICATIONS DURING THE LAST FIVE YEARS. Year. Scarlet Fever. Diphtheria. Enteric Fever (including Paratyphoid ) 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 SCARLET FEVER. The type of case met with during the epidemic of 1921 still persists. It is of a mild nature and no deaths have been attributed to this disease for the past two years. This year, 1925, there were two brisk rises in its incidence, the first occurring in the middle of October and the second at the beginning of December. 19 It is most difficult to attribute the spread of Scarlet Fever to any main source, and evidence seems to point to the infectivity varying considerably in different instances. It would appear probable that the disease is most infectious during the early period of sore throat, rash and fever; yet in spite of this a child was found in the late peeling stage, possessing a very definite history of an attack of Scarlet Fever, living in rooms, with six young brothers and sisters, none of whom contracted the disease. These children had never previously suffered from the •disease, and they had all been quite well during, and some time before the patient was attacked. Again, in 1924, a child contracted Scarlet Fever whilst one of a party of 45 girls of St. Peter's School, who were together at Broadstairs. This child was not diagnosed as Scarlet Fever until the third day of the disease, and had been in close contact with the others, yet no further case occurred. Further similar instances might be quoted, but I am of opinion that the disease is usually most infectious during the period of sore throat and fever. One is also led to suspect that the disease is spread by " missed " cases, and those not recognised until late in the disease. From time to time children are discovered in the peeling stage at school or at the Clinic, and many cases are not notified until desquamating, no medical practitioner having been summoned until this stage is reached, the parents regarding the original vomiting, etc.t as a bilious attack. " In spite of this failure to recognise the disease or late diagnosis, these cases have not formed a nucleus of any outbreak, and therefore it is very doubtful whether "missed " cases aid in its spread to any marked extent. Over the period under review, no definite evidence has been forthcoming that healthy carriers are the cause of the spread of the disease. Occasionally, the source has been suspected in a class at school; and during 1925 three cases occurred in one class at St. Paul's Infants' School. All the children were medically examined, and three infants were excluded, as they had sore throats and had vomited. These infants were kept under observation, but none of them developed a rash or showed any signs of desquamation subsequently. 2 0 There is no doubt whatever that children suffering from nasal or ear discharge after Scarlet Fever are a very definite danger, and during 1925 there have been six " return " cases after discharge from Isolation Hospital. Therefore, I think it must be assumed that all the above modes of spread are contributory to the almost constant occurrence of cases of Scarlet Fever. The majority of the cases occur among the poorer classes, and are admitted to the Isolation Hospital; but when cases can be satisfactorily isolated, they are nursed at home. Those kept at home seldom give rise to secondary cases, and as a rule do very well. All bedding, etc., is subjected to steam disinfection in a Velox Disinfector on removal of cases to hospital or after recovery at home. The rooms are disinfected by means of a formalin spray and formaldehyde vapour. School contacts are excluded for a fortnight, and places of work notified in respect of patients and contacts. Special care is taken to exclude contacts from Sunday Schools, and laundries are informed of the occurrence of a case of infectious disease at the house of a customer. The Dick Test has not been used, or any artificial method of immunization employed. DIPHTHERIA. There has been a somewhat remarkable diminution in the incidence of Diphtheria during the past three years, which is difficult to explain, and it is much too early to prophesy that this low figure is likely to be permanent. It will be remembered that the last epidemic of Diphtheria occurred in the year 1919, during which 142 cases were reported, and this was followed by 80 cases in 1920. There was an outbreak of Diphtheria at St. Paul's Girls' and Infants' School in 1921, ten cases being notified between September 13th and 20th. Swabs were taken from 24 girls in Standard II, with the result that one positive and one very suspicious swab were found. The carrier, suspicious case, and four contacts were excluded from School until two negative swabs had been taken from each. 21 One further case occurred on September 22nd, who had probably been infected before September 20th. This terminated the outbreak. In all 79 cases were notified during 1921, and 74 in 1922, after which the sudden drop in the number of cases notified occurred. Only one death was attributed to this disease in 1925, and there were no deaths caused by it in 1923 and 1924. The issue of Diphtheria Anti-toxin 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. This arrangement works very satisfactorily. Routine swabbing of all contacts is not undertaken unless there are indications that this procedure is advisable. The same procedure as regards disinfection is carried out as in cases of Scarlet Fever. The Schick Test has not been employed. The only case of particular interest during 1925 was that of a boy, who was treated at home. He had a comparatively mild attack, but positive swabs were obtained from his throat for a prolonged period after his recovery. He was kept isolated until a negative virulence test was obtained, when he was allowed to go free, and his parents were strongly advised to have his tonsils removed. ENTERIC FEVER (including Paratyphoid). Last year, 1924, the occurrence of six cases of Enteric Fever was considered worthy of special note, and an outline of each case was given in the Annual Report for that year. Very briefly, it will be remembered that three of these occurred in one family, affecting only the three who visited London together on a particular day between two and three weeks before their illness. Another case had stayed near Dover, while there was an outbreak of Typhoid in that town. Another case had been an inmate of the Workhouse for some six weeks before her illness, and how or when she was infected was not ascertained. 22 The other case had dined at a cafe in London, and visited a garden party three weeks before her illness, but investigations failed to prove anything. With regard to the seven cases notified during 192 6 the first was in a lad in a comfortable home, and no source could be traced. The next two cases occurred in young children, one seven and another three years of age, in which there appeared to be some doubt as to the diagnosis. The fourth case was a man of sixty, who was admitted to the Kingston and District Hospital. This man had been working at Angmering-on-Sea from July 20th. He first felt queer on August 6th, and returned to Kingston on August 11th, when he came under medical supervision, and was definitely notified as suffering from paratyphoid B on August 26th. He stated that at Angmering the drinkingwater at the cottage where he was living was drawn from a pump which was very dirty. In answer to enquiries, no positive evidence was forthcoming, and no other cases were reported at Angmering. The next two cases occurred in two brothers, and it was ascertained that they were in the habit of bathing in the Hogg's Mill River at a spot where the effluent of the Maiden Sewage Works enters the stream. There had been no cases of Enteric Fever at Maiden. The last case notified was a man of fifty-five, who had been ill for six months and gave a negative Widal Reaction. He died, and from tactful investigation it would appear probable that the diagnosis in this case was very doubtful. Disinfection was carried out in these cases. TUBERCULOSIS. Cases of Tuberculosis notified in the Borough come under the administrative control of the Surrey County Council. Every effort is made to assist the County Medical Officer and Tuberculosis Officer in their activities in the area. A special campaign was undertaken in 1924 in order to check the whereabouts of all tuberculosis patients whose names still appeared in the Register. 23 This necessitated a vast amount of work, correspondence, and home visiting, which was ably undertaken by the Assistant Sanitary Inspector, School Nurses and Health Visitors, with the result that early in 1925 we were able to confidently state that all records for the Borough were absolutely accurate. The returns made to the Surrey County Council under the Public Health (Tuberculosis) Regulations, 1924, for the quarter ending March 31st, 1925, were thereby rendered reliable, and we were able from the results of our investigations to give the County Medical Officer of Health much valuable information. The efficiency of notification of tuberculosis in the area is good, and there have been no cases of wilful neglect or refusal to notify. There was only one tuberculosis death not notified during lifetime out of a total of 38 deaths during the year. In 1924 there were none, and in 1923 only one out of 23 deaths. No cases have arisen during the year in which any action became necessary under either the Public Health (Prevention of Tuberculosis) Regulations, 1925, or the Public Health Act, 1925, Section 62. Disinfection of premises is carried out in all cases of death, or when patients are admitted to hospital or sanatorium. It is unfortunate that frequently information regarding the movements of patients is not received until several days after their departure, thereby causing unnecessary delay in disinfection. In my opinion, this delay might well be remedied, when Tuberculosis Schemes are next under consideration. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. There have been outbreaks of Measles, Mumps, Whooping Cough and Chickenpox from time to time during the last five years, but on no occasion has it been deemed necessary to resort to School Closure. One outbreak of Measles in 1922 began and spread during the school holidays, a fact which tends to confirm the view that School 24 Closure for this disease is of little value in closely-populated areas, and is a procedure which renders it even more difficult to keep an outbreak under observation. During the first half of the year 1922, Mumps was extremely prevalent, and in view of its long incubation period and the absence of danger to life, it was decided to exclude patients only, and permit contacts to attend school. During this year Whooping Cough was prevalent from March to July at Richmond Road, Bonner Hill Road, and St. Paul's Infants' Schools. An outbreak of German Measles occurred at Richmond Road Infants' School in July. Towards the end of the year, Chickenpox affected Bonner Hill Road and Richmond Road Infants' Schools. Small outbreaks of Measles occurred at Bonner Hill Road Infants' and Richmond Road Girls' Schools in December. A Memorandum on Closure of and Exclusion from School was issued jointly by the Ministry of Health and the Board of Education in January, 1925, and forms a most useful guide in these matters. Influenza. Influenza was prevalent in December, 1921, and was continued into the early months of 1922. It again visited the Borough just before the close of 1923, and remained through the first three months of 1924. During the autumn of this year the doctors report that there are many cases. The deaths attributed to this disease numbered 6 in 1921, 15 in 1922, 5 in 1923, 12 in 1924, and 10 in 1925. During the outbreak 1921-22, influenza vaccine was placed at the disposal of the medical practitioners. They were also invited to report on the disease, and from information received, it appeared that the type, as a rule, was mild and was accompanied by myalgic pains and gastric symptoms. Again, in the outbreak in 1923-24, the doctors were asked for information, and they reported that the majority of cases were mild, with sudden onset, headache, myalgic pains, and nausea. Intense weakness and depression were common results of an attack. 25 In both these outbreaks, pneumonia was not a common complication, and there was no resemblance to the type of the pandemic of 1918, in which the results of haemolysis played such a prominent part. This year the disease appears to be giving rise to various neuralgic symptoms, often affecting the neck, scalp and ear. 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: — Meetings. Attendances. New Cases. Total. Eden Street 50 109 2223 Washington Road 49 67 897 The Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers 31 50 Infants under one year 555 1489 Children, one to five years — 1803 Incidental and Infectious — 753 Baby Week was held in July, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. An Exhibition of Needlecraft, Homecraft, Cookery, etc., was held, and the events of the week terminated in a garden party, at which the Mayoress very kindly presented the prizes to mothers winning competitions. Girls from St. John's School assisted by giving a picturesque display of "Country Dances." The Annual Winter Tea and Entertainment was held at each Centre in January. 26 The Centres maintain their popularity, and the work for the year must be regarded as satisfactory. Staff. Miss G. H. Saunders and Miss M. E. Skinner were appointed 4/5th-time Health Visitors on April 6th, owing to the resignations of Miss E. Arthur and Miss C. J. Duncan. Unfortunately, Miss M. E. Skinner was taken ill soon after her appointment, and was absent for a considerable period, eventually resigning her post owing to ill-health. Miss E. Riley was appointed on October 19th to fill this vacancy. In spite of these frequent changes, which temporarily tend to hamper continuity of effort, the work has been carried on successfully by the Health Visitors under the able leadership of Miss R. Bartter. 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 every 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. Ante-Natal Clinic. The Ante-Natal Clinic was established in December at the School Clinic, "Elmfield," London Road, which is situated in the geographical centre of the Borough. The Dental Waiting-room and Operating-room, which are large and suitable, will be used for the purpose temporarily. Hot and cold water is already installed, and screens are provided. To equip the Clinic certain apparatus were purchased, including a couch, urine-testing apparatus, drugs, dressings, bowls, speculae, probe, calipers, etc. Dr. Winifred Warner was approved as presiding Medical Officer, under the direction of the Medical Officer of Health, and seeing that she has carried out the work at the Maternity and Child Welfare Centres since 1921, continuity of observation will be maintained. 27 The Kingston Nursing Association have expressed a willingness to support the Clinic, and the midwives practising in the Borough have been approached, and on the whole they favour the scheme. The Kingston and District Hospital (Poor Law) have maternity wards, and take paying cases at £3 3s. per week. Kingston-upon-Thames only being half an hour's journey from London, it is possible to send cases to hospital for specialist opinion if necessary. It is proposed to hold the meetings on the first Tuesday in each month at 10 a.m. The Clinic was opened on Tuesday, December 1st, 1925, but unfortunately the three expectant mothers who proposed attending did not arrive owing to the extremely bad weather. Any report, therefore, on the working of the Clinic must be reserved till next year. The Unmarried Mother. The care of unmarried mothers and their illegitimate children is undertaken by the Kingston, Surbiton and District Voluntary Society, which is affiliated to the Southwark Diocesan Association for Rescue and Preventive Work. The Local Branch Shelter is at No. 45, Fairfield South. Unmarried expectant mothers are admitted to the home about two or three months before full term, or later if desired. If possible they contribute towards their own support, and assist by doing domestic work while in the home. They are transferred for confinement to the Kingston and District Hospital or other Maternity Home, returning after the puerperium with the infant to the "Shelter" for a further period of residence until the infant is three months old. The infant is then placed with a foster mother, and the parent is found a suitable situation in domestic service. The Sister-in-Charge of the Shelter continues to supervise the welfare of the infant, and the mother is always welcomed to the home. It is noteworthy that an average of 120 visits per month are being made by the mothers to the home. 28 The valuable work carried out by this Society is fully appreciated, and expectant mothers at the Shelter are invited to attend the Ante-Natal Clinic for advice. Children Deprived of their Own Home. When children are found temporarily or permanently deprived of a home with their own parents, the cases are considered, and referred to various organisations for their assistance in bringing about satisfactory arrangements. Among the bodies to which such matters are referred are the Central Aid Society, National Society for Prevention of Cruelty to Children, and the Board of Guardians, all of whom are always most willing to co-operate. Puerperal Fever. The number of cases notified in each year from 19211925 were 1, 1, 2, 0 and 4 respectively. During the years 1921-1924 there were no deaths from Puerperal Sepsis, the only one recorded in the figures furnished by the Registrar-General in 1924 being an "inward transfer." Unfortunately, this year four cases have been notified in the area. The first case was notified from the Kingston and District Hospital on January 31st, 1925. It appears that the woman was confined on December 26th, 1921, when she was attended by a midwife. A doctor was called in on January 19th, 1925, and she was admitted to the Kingston and District Hospital on January 22nd, 1925. The Medical Superintendent of the Hospital reports the case as "Septicaemia following confinement at home. Patient was admitted here with retained products of conception." The patient died on February 1st, 1925, and an inquest was held on February 4th.—" Death from natural causes." It is also of interest that a child residing in the patient's home was removed on January 9th to Isolation Hospital, suffering from Scarlet Fever. The next case was notified on December 3rd, was of a mild nature, and recovered. 29 The two further cases both occurred in a Nursing Home. The first was confined on December 12th, being delivered by a midwife. A doctor was called in on December 16th, and later the patient was also seen by a gynaecologist from London. The patient died on December 27th, and the post-mortem examination showed old pelvic peritonitis with many adhesions, and an acute peritonitis super added. The uterus was absolutely empty. The second case was confined on December 24th, being delivered by another midwife. A doctor was called in on December 25th, when one stitch was necessary for a slightly ruptured perineum—this healed quite normally. The case was treated by the administration of iodine douches, and had antistreptococcic serum; she suffered from joint pains and septic rash. She appeared better on the morning of January 1st, 1926, but collapsed and became moribund in the afternoon, dying at 5 p.m. Both these cases occurred in one wing of the home, and though very full investigations were made, and the Matron gave all the help in her power to ensure an exhaustive inquiry into the circumstances, no definite source of the infection could be traced, and no blame could be attached to anyone in attendance upon these women. It must be regarded, I think, as one of those most unfortunate incidents which occur at times in almost all institutions in spite of the utmost care. The rooms were thoroughly disinfected and completely redecorated to our entire satisfaction. A report on each case is furnished to the Surrey County Council, who administer the Midwives' Acts. Ophthalmia Neonatorum. The number of cases notified in each year from 19211925 were 5, 6, 5, 4 and 5 respectively. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case, and a copy of the report is furnished to the Surrey County Council. 30 Cases notified during 1925:— Notified. Treated. Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 5 5 — 5 — — — Orthopædic Treatment. A scheme for the Orthopaedic Treatment of children under five years of age is under consideration, and it is hoped that this treatment may be undertaken in the near future. FACTORIES. WORKSHOPS AND WORKPLACES. The following tables are set out in accordance with the request of the Secretary of State, Home Office. There are very few outworkers in the Borough, but such premises as do exist are inspected from time to time. The figures in column 3 in Table No. 2 are higher than those in column 2 in several instances. This is due to the fact that in column 3 defects, which were discovered previous to January 1st, 1925, but which were remedied during the year 1925, have been included:— I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections Written Notices. Occupiers prosecuted. Factories —(including Factory Laundries) 32 1 Nil Workshops—(includingWorkshop Laundries) Workplaces—(other than Outworkers' premises) Total 32 1 Nil 31 II.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 2 6 — — Want of Ventilation — — — — Overcrowding 1 1 1 — Want of drainage of floors — — — — Other nuisances 3 4 — — Sanitary Accommodation Insufficient 1 2 — — Unsuitable or Defective — 2 — — Not separate for sexes — — — — Offences under Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s. 101) — — — — Other Offences—(Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers)Order, 1921 1 3 — — Total 8 18 1 — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. III.—OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. No action was found to be necessary in connection with the above. 33 Report of the Sanitary Inspector. To the Corporation of Kingston upon-Thames. Gentlemen, I have the honour to present to you my seventh Annual Report on the work carried out by your Sanitary Inspectors during the year 1925 in connection with the various Statutes and Bye-laws relating to Public Health in force within the Borough. In submitting this Report I do so with a feeling of satisfaction at the amount of work accomplished during 1925 and the improvement which has taken place in the sanitary condition of the Borough during the last five years. The total number of inspections during 1925 was 6,533 as compared with 5,956 during 1924. On 672 premises sanitary defects to the number of 2,431 were discovered. In connection with these defects 534 "preliminary" and 68 "verbal" notices were issued. In only 28 instances was it found necessary to serve "statutory" notices. During the year 1925 particulars relating to the inspection of 672 premises were added to the records, whilst 668 entries were struck off the registers following upon the completion of necessary works. On December 31st, 1925, 389 premises remained on the registers. In a number of these cases, however, works were actually in progress and instructions had been given for tEe execution of the works in many other instances. The number of inspections during 1925 is higher than for the previous year. This increase is 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 1925 compared with 1924, 34 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 10 Re-inspections after Order or Notice 1,341 Visits to Works in Progress 1,514 Factories and Workshops 32 Cowsheds, Dairies and Milkshops (excluding inspections by Medical Officer of Health and Veterinary Inspector) 40 Ice Cream Premises 22 Foodshops and Food Preparing Rooms 409 Infectious Disease Inquiries 464 Markets 59 Special Inspections (Complaints, etc.) 1,356 Slaughter-houses 827 Offensive Trades 14 Sanitary Conveniences 18 Common Lodging-Houses 26 Canal Boats 8 Theatres, Cinemas, etc. 7 House-to-House 16 Bakehouses 13 Smoke Observations 15 Stables and Yards 24 Miscellaneous Visits 318 Total number of Inspections 6,533 Drainage. Number of old Drains examined, tested, exposed, etc. 56 Number of Houses and Premises re-drained 53 Number of Drains repaired or amended 4 Drains or Gullies unstopped or cleansed 48 Manholes provided 66 Manholes altered or repaired 5 Intercepting Traps fixed 31 Fresh-air Inlet Shafts repaired or renewed 34 New Gulley Traps fixed 133 New Soil Pipes or Ventilating Shafts 46 Soil Pipes or Ventilating Shafts repaired 2 35 Smoke Tests applied 45 Water Tests applied 177 Cesspools abolished, repaired, or cleansed 1 Subsoil drainage provided 1 Gratings provided to gully traps 3 Water Closets and Sanitary Fittings, W.C. Apartments cleansed and limewashed 46 New W.C. Basins fixed 88 VV.C.s unstopped, cleansed or repaired 5 W.C. Flushing Tanks repaired or renewed 22 Water supplied to W.C.s 1 New W.C. Apartments provided. 19 W.C. Apartments lighted, repaired and ventilated 26 New Impervious Sinks provided 90 New Waste Pipes fixed 58 Existing Waste Pipes trapped or repaired 6 Urinals cleansed or repaired 2 Urinals renewed 3 Additional and eparate sanitary accommodation (or both sexes provided 1 Sanitary accomodation provided 1 Miscellaneous 4 Miscellaneous. Roofs repaired 44 Eaves Gutters renewed or repaired 35 Stack Pipes renewed or repaired 34 Stack Pipes disconnected from Drains 67 Damp Walls remedied 71 Ventilation provided beneath floors 32 Yards paved 87 Yard Paving repaired 17 Yards cleansed 7 Floors of Rooms repaired 32 Floors of Rooms renewed or repaved 7 Rooms repaired, cleansed and distempered 418 Additional light and ventilation to sculleries 8 Verminous rooms cleansed 9 Bedding cleansed 3 New ceilings 5 Windows repaired, renewed or made to open 88 36 Doors re-hung or repaired 1 Cisterns repaired, cleansed, covered or removed 19 Door and window sills renewed or repaired 34 Staircases lighted and ventilated 2 Stairs repaired or renewed 4 New scullery apartments 9 Portable ashbins provided 851 Brick ashpits abolished 2 Accumulations of manure and refuse removed 21 Nuisance from overcrowding abated 13 Nuisance from animals abated 10 Water supplied direct from main 20 Wells abolished and M.W.B. water laid on 9 Premises limewashed (Workshops, food preparing rooms, etc) 16 Rag and bone yards cleansed, etc. 4 Fire grates repaired or renewed 25 Stables abolished 1 Sheds Removed 10 Defective coppers repaired 27 New coppers provided 9 Walls repaired, repointed or rebuilt 39 Handrails, provided to staircases, or repaired 20 Manure or offal receptacles provided or repaired 13 Nuisance from smoke abated 3 New porches constructed 9 Chimney stacks rebuilt or repaired 7 Unsuitable work premises discontinued 4 Basement discontinued as separate dwelling 2 Closing Orders made 3 House demolished 1 Miscellaneous 39 Smoke Abatement. An increase in the number of complaints in respect of alleged nuisance from smoke occurred during 1925, the number being 8 compared with 1 during 1924. As a result, more frequent observations were made and in several instances excessive amounts of smoke were recorded. In all cases, consultations with the owners and subsequent interviews with the stokers, together with a change of fuel, proved successful, and emissions of smoke were reduced to reasonable proportions. 37 Common Lodging Houses. There are two registered Common Lodging Houses in the Borough and at least two other premises where lodgers are received for short periods in conditions which approximate very closely to Common Lodging houses, but the premises are not subject to the same control simply because the lodgers are not received for one night only. In this respect it would appear highly desirable for a clear definition of a Common Lodging House to be included in future Public Health legislation. Premises where lodgers are received for periods up to at least one week should be included, provided that dormitories and living-rooms are used in common as in the present recognised Lodging Houses. During 1925, 26 inspections were made of the registered premises. At one of the registered Lodging Houses several insanitary conditions were detected during the year, including verminous condition of bedding. Immediate action was taken and the premises were cleansed throughout. Offensive Trades. The following offensive trades are carried on in the Borough:— Leather Tanning. Rag and Bone Dealers. The former business also includes Fellmongering. The premises are maintained in a satisfactory condition and no complaints in respect of the tannery have been received during the year. The Rag and Bone Yards require frequent attention, and, generally speaking, the situation and condition of these premises leaves much to be desired. Fourteen visits were made to premises in connection with offensive trades in addition to re-inspections after notices or warnings. Fish-frying is not included as an offensive trade in the Borough at present, but the Corporation has decided to 38 Seek power to declare the trade as offensive. There are still several fish-shops in the Borough where furnaces and pans of old design are in use. In these cases objectionable odours pour from the shops and pervade the immediate neighbourhood. Complaints. One hundred and seventy-six complaints were received during the year as follows:— Drains and Sanitary Arrangements 37 Overcrowding 11 Insanitary Condition of Premises 49 Absence of Ashbin 7 Water Supply 10 Accumulation of Manure and Non-collection of House Refuse 11 Dampness 8 Keeping of Animals and Fowls 7 Smoke Nuisance from Chimneys 8 Defective Stoves 3 Defective Roof 4 R'ag and Bone Yards 4 Smells from Ashbins in Street 1 Odours from Trade Waste 4 Stagnant Water 1 Miscellaneous 11 176 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 1924 was 151. Housing, 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 (including numbers given separately under (b) 155 (b) With State assistance under the Housing Acts. (1) By the Local Authority 70 (2) By other bodies or persons nil 39 1. Unfit Dwelling-houses. Inspection: (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 920 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 16 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 644 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 595 3. Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (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 40 B.—Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 23 (2) Number of dwelling-houses in which defects were remedied after Service of formal notices:— (a) by owners 4 (b) by Local Authority in default of owners nil C.—Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 3 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (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 1 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (1) General Housing Conditions and Overcrowding. There is still a distinct shortage of houses for the Working Classes, but the position appears to be less acute than it was five years ago. It is difficult to show improvement by figures, but one notices that a change for the better is gradually taking place. 41 In my Report for the year 1923 I recorded that 57 cases of overcrowding were known to exist at the end of that year. On December 31st, 1925, only 26 houses were known to be overcrowded. There are other cases, without doubt, which have not been brought tp notice, but these would not aftect the comparison, as there would be unknown cases at the end of 1923 also. Thirteen cases of overcrowding were abated during 1925. During the last five years 290 houses have been erected in the Borough, 82 of which have been erected by the Corporation under the Housing Acts. In several instances overcrowding has been abated by the granting of new houses to the overcrowded tenants. Every endeavour has been made in such cases to prevent re-letting of the rooms so as to cause further overcrowding. The causes of overcrowding in the Borough are many. In some cases women gave up houses during the war when their husbands were away on service and moved into one or two rooms. At that time, with no children or perhaps one only, the rooms they went to would not be overcrowded. With the passing of time additional children have arrived and overcrowding of the rooms has resulted. There is also an increase in the industrial population to account for some of the overcrowding. Several fairly large works were erected in the neighbourhood during the war and larger numbers of persons are employed in local works now than there were ten years ago. Many houses which were intended for the occupation of one family only are sub-let to two or more families. Six cases of overcrowding were added to the records during 1925. Of these six, two were granted Council houses, one moved out of Kingston, one abated the overcrowding by varying the distribution of the occupants in the rooms, and two remained overcrowded at the end of the year. In the latter cases, Statutory Notices requiring the overcrowding to be abated were issued. (2) Fitness of Houses. The general standard of housing in the Borough is good, but there are a few small areas where, owing to various 42 reasons, the property is below the usual standard of fitness. These areas are four in number as follows:— 1. Area bounded by part of Hawks Road, Cambridge Road, Hampden Road, Bonnerhill Road, Franklin Road, Washington Road and Excelsior Road. 2. The Mill Street and Mill Place area. 3. Hudson Road, Elm Crescent and Cowleaze Road. 4. Area bounded by part of Richmond Road, the Railway and Kingston Gas Works. Only a few houses have been subjected to systematic house-to-house inspection, but a large number of premises were inspected under the Public Health Acts during the year. The character of the defects found to exist may be judged by a perusal of pages 34, 35 & 36, where details are given of the works carried out during 1925. Generally speaking, there was a large increase in the amount of sanitary works executed as the result of action by the Department. Before taking action in respect of property, the tenant is usually asked if the owner has been acquainted with the conditions. This avoids unnecessary friction, as in the event of a negative reply, the tenant is referred to the owner direct before further action is taken. The drainage systems of old houses in the Borough are seldom found to be in good order, and no less than 53 houses were entirely redrained during 1925. A house-to-house inspection of ashbin accommodation was continued during the year, with good result. Where ashbins were found "to be defective, the owner was requested to provide a new receptacle, and the Council adopted the following as a minimum requirement: The ashbin to be of galvanised iron, not less than 16 inches by 20 inches in size, and of a quality known as 22 B.W.G. before galvanising. The insertion of this specification in the communication to owners resulted in less complaints of damaged bins being received, and the old unwieldy type of bin is seldom seen. The abolition of ashpits also was continued during the year. Owners have discovered that it is cheaper to demolish the remains of such receptacles and to provide 43 portable bins rather than to incur expenditure in bringing the ashpits up to reasonable requirements. Very considerable works have been carried out to houses in Acre Road following Housing Inspections. The new sculleries and w.c. apartments at the rear of nine cottages were completed during the year, and the re-drainage scheme also was finished. This work has provided increased light and air to the cottages and constitutes a great improvement. The time available for systematic house-to-house inspection is not great, and, as in past years, the inspection of a large number of houses with a view to producing statistics only has been avoided. The view has been taken that it is better to deal completely with a few houses and to see that these houses are brought up to a reasonable standard, than to inspect many houses and only record the defects found without obtaining necessary improvements. Some difficulty is found in dealing with underground rooms which are let off as flats. Several large houses which were originally intended for the occupation of one family only have been converted into two or more separate dwellings, and the basement portion, previously used as servants' rooms and kitchens, is frequently let as a separate dwelling. These premises could more readily be dealt with if Regulations under Section 18 (1) of the Housing Act, 1925, were adopted. Despite their attractive decorative appearance, these basement flats form the subject of frequent complaints when tenants have discovered such defects as damp walls and lack of proper ventilation. In the case of four houses, an extensive subsoil drainage system was found to be necessary in order to abate the nuisance caused by flooding of the basement rooms. The works appear to have abated the nuisance. House Drainage. Fifty-three houses were redrained during the year as compared with 32 during 1924, and a total of 170 during the last five years. The examination of the old combined drainage system at the rear of Elm Crescent was completed during the year and a full report was submitted to the Council. The drains on or belonging to about 50 houses were exposed and examined, and, as a result, it was found that 33 houses 44 were connected to this old system. Twenty-five different ownerships were involved. Statutory notices were served requiring the reconstruction of all defective drains. The new drains of four houses in this area were completed by the end of the year and the works in other premises were well advanced. This investigation was the second one of large dimensions undertaken during the last five years, the other being in connection with an old drain at the rear of Washington Road. There can be no doubt whatever that the elimination of these seriously defective drains will have a beneficial effect on the Borough, and the large amount of time absorbed by this branch of the work is well spent. The following list shows the situation and number of premises redrained during the year:— Acre Road 14 Bishops Hall 3 Cambridge Road 4 Cambridge Grove Road 2 Canbury Park Road 11 Cowleaze Road 2 Elm Crescent 1 Fairfield West 2 Franklin Road 4 Hawks Road 1 High Street 1 Richmond Park Road 4 Shortlands Road 2 Washington Road 2 Increase of Rent & Mortgage Interest Acts. Twelve applications were received during the year from tenants for certificates under Section 2, Sub-Section 2, of the above Act, as compared with six during 1924. The premises were subjected in each case to a careful inspection, and the owners of the houses were invited to carry out any necessary items of repair. In three instances necessary repairs were not carried out by the owners, and certificates were granted to the tenants. Well Water. The water supply of nine houses which was found to 45 be derived from shallow wells and to be unsatisfactory, was dealt with during: 1925. In each case a supply was laid on from the Metropolitan Water Board system. I am of opinion that owners of property would be more ready to cease the use of water from doubtful wells if the cost of providing a supply from the Metropolitan Water Board mains could be reduced. At the present time, even in the case of small cottages, it is a requirement of the Board's Officers that a sixty-gallon tank should be provided for each house. This requirement appears to be unnecessary where a constant supply of water is provided, as no inconvenience appears to have accrued where tanks have been removed. There is quite a large number of houses in the Borough where the water is derived from shallow wells. During the last five years sixteen wells have been abolished. Inspection and Supervision of Food. (a) Milk Supply. During 1925 no persons were removed from the Registers. Two purveyors of milk were added to the Register, making a total of 41 on December 31st, 1925, compared with 33 at the end of the year 1922, when the Registers were reviewed. There is only one cowkeeper in the Borough, and the cowhouses on his premises have been improved very considerably during the last few years. The insanitary lofts over the byres have been removed, providing more air space, light, and head room, and facilitating the cleansing of walls and roofs. In the large shed iron barrel has replaced wood in the stalls wherever possible and clean drinking water is provided by a constant supply to each trough. The lighting has been improved. No licenses have been issued to producers in the Borough in respect of graded milk, but two supplementary licenses have been granted to dairymen to sell certified "Grade A" milk. No request has been made by the Ministry of Health for samples to be taken for bacteriological examination. There is a growing tendency on the part of the dairymen to abolish the use of hand cans and churns for delivery of milk. There can be little doubt that the frequent opening of such receptacles in the course of detivery allows dust 46 and dirt to gain access to the milk, and the consumer who receives the last portion would consequently receive most of the extraneous matter. The modern method of delivery of milk in glass bottles has several advantages. The milk is handled less as the bottles are filled and closed in the dairy. There is less opportunity for the milk to be tampered with on the round, as most employers prohibit the opening of any bottles by the roundsmen. Dirt and dust cannot gain access to the milk after bottling before delivery to the consumer. There are disadvantages in the use of bottles, but I consider that they are outweighed by the advantages. During the last few years efforts have been made to prevent the storage and sale of milk in general shops, where, by reason of the nature of other commodities in the shop, milk is likely to be contaminated. In one instance during 1925, an unregistered person was required to cease selling milk in such a shop. (b) Meat. The past year has seen very greatly increased activity in Meat and Foods Inspection in the Borough. Since the year 1918, when systematic inspection commenced, this branch of the work has received ever-increasing attention. On April 1st, 1925, the new Meat Regulations came into force, and, as a result, more adequate supervision over food premises has been rendered possible. Before the advent of these Regulations it was possible for animals to be slaughtered and the carcases to be removed without any inspection whatever. There was no provision for notice of slaughter to be given to the Council, and your Sanitary Officers had to visit the slaughter-houses at irregular times on the chance that killing might be in progress. The Regulations have made a welcome change in this direction. Notices of intended slaughter now have to be sent to the Meat Inspector, and carcases must be retained for inspection except in certain circumstances. The need for these Regulations has been felt for many 47 years, and although the provisions of the Regulations might be extended with advantage, they form a very useful basis for further legislation. A very considerable proportion of the slaughtering in the Borough is carried out during late afternoons and evenings, and the carcases are removed early the following mornings. Many of these carcases are intended for London Markets and other destinations outside the Borough. In such cases requests are frequently made for permission to remove the carcases very early in the morning before the time limit fixed by the Regulations, namely, 7 a.m. In order to meet the convenience of the trade, and wherever it has been possible to do so, the carcases have been inspected overnight. On other occasions the carcases have been inspected early in the morning in order to allow removal by 7 a.m. Records are kept of all notices received, the number of animals slaughtered and the time of inspection, and the following table is a summary for the period from April 1st to December 31st, 1925:— 48 MEAT REGULATIONS, 1924. Summary for Period April 1st, 1925, to December 31st, 1925. Number of Notices Received. Number of Animals Slaughtered. Number of Animals per annum. Carcases not Examined. Percentage of Total Animals not Examined. Beasts Pigs. Calves Sheep, Goats. Total. Pigs. Calves Sheep Goats. 747 73 2738 2064 525 354 5754 7672 46 5 26 25 1.7 Inspections during Office Hours. Percentage of Total. Inspections made after Office Hours. Percentage of Total. 157 27.4 572 72.6 49 It will be seen that only 27.4 per cent. of the animals were inspected during office hours, but despite this fact only 1.7 per cent. of the total number of animals were not examined. This percentage would be still further reduced had not a notice relating to 40 pigs gone astray. In the first three months of the year 88 visits were made to the slaughter-houses. During the remaining nine months 157 visits were made in ordinary office hours, making a total of 245, compared with 220 for the year 1924, and an annual average of 112 for the five years 1920-24 inclusive. These figures not only show the increase, but they also demonstrate that the additional work imposed by the Meat Regulations has only increased the amount of meat inspection work during official hours to a small extent. The 572 visits made outside official hours represent the additional work and have absorbed time which is usually devoted to recreation. It is obvious that your Meat Inspector could not be present during the whole of the slaughtering process, but in most cases the butchers have co-operated to avoid, as far as possible, the difficulties which arise as the result of this absence. The object of being present at the time of slaughter is, inter alia, to enable the Meat Inspector to see the organs of the carcase in situ and to identify the organs with the corresponding carcase. It is only possible to witness the process of dressing in a small proportion of the total number of carcases. The second object, however, has been overcome to a great extent by the use of numbered hooks to receive the organs, with corresponding numbers for the carcases. This arrangement has answered well, but one has to rely very much on the help of the slaughtermen. There is no system of meat marking in force in the Borough. I have said that the Regulations could.be extended with advantage, and I suggest the following directions : (1) In order to obtain more complete supervision, local authorities should be given power to regulate the hours of slaughtering in private slaughter-houses in their district; (2) There should be definite power to retain a carcase for 24 hours where deferred examination is considered desirable. These suggested extensions would tend to reduce the work of the local authority, and I feel sure that np serious 50 interference with the trade need occur. There are many other amendments which one would wish to see adopted, but these could only be achieved very gradually and as the need for them is proved by the administration of the Regulations. The following tabulated list shows the various amounts of foodstuffs condemned during the year. Generally speaking, where the reason for condemnation is stated as putrefaction or bonetaint, a request for inspection was made. The remaining amounts have been detected as the result of inspections. Articles of Food. Reason for Condemnation Action taken. BEEF— 711 lbs. Bone taint or putrefaction Surrendered 65 lbs. Bruised ,, Ox Tails—62 lbs. Putrefaction ,, Ox Kidneys—116½ lbs. ,, ,, Livers—67 lbs. ,, ,, 1 Liver Parasitic disease 5 Ox Heads and Tongues Tuberculosis ,, 1 Ox Head and Tongue Actinomycosis ,, 2 Carcases and Offal Tuberculosis I surrendered and I seized MUTTON - 136 lbs. Putrefaction Surrendered 16 lbs. Bruised ,, PORK— 19 Carcases and Offal Tuberculosis 15 surrendered and 4 seized 1 Carcase and Offal Swine Fever Surrendered 49 Pigs' Heads and Necks Tuberculosis ,, 20 Pigs' Plucks ,, ,, 23 Pigs' Fats „ ,, 3 pairs of Pigs' Lungs ,, ,, 70 lbs. ,, ,, 2 Udders Mastitis ,, GOAT— 1 Carcase and Pluck Emaciation ,, VEAL— 3 Carcases and Offal Tuberculosis I surrendered and 2 seized 1 Calf's Pluck Surrendered 44 lbs. Putrefaction ,, FISH— 40 lbs. Cod Putrefaction ,, 21 lbs. Witches ,, ,, 6 stone Dog Fish ,, ,, 2 boxes kippers ,, ,, 5 large Cod ,, ,, MISCELLANEOUS— 2 boxes Black Currants Putrefaction ,, 51 With the exception of one carcase of beef, the condemned foodstuffs were sent to the Corporation Dust Destructor and cremated. Permission was given for the excepted carcase of beef to be moved to a knackers yard, where it was boned and treated so as to prevent its use for human consumption. This action was taken in order to reduce the monetary loss incurred by the butcher, who had purchased the beast at a good price in the open market. The removal and treatment of the carcase was supervised by your Meat Inspector. Pork and other fat meat is not accepted by the knackerman, and it is therefore cremated. Stalls, Shops Stores and Vehicles. Before the Meat Regulations came into force, the Market Committee considered the question of the food Stalls. There was not sufficient room in the Market Hall to accommodate all the stalls, but it was decided to move the outside meat stalls into the Market Hall. There are no meat stalls in the open Market Place now. Waterproof covers and screens are provided to stalls on which bacon, fish, sweets and other foodstuffs are exposed. Early in 1925, the local branch of the Butchers' Federation called a meeting and invited your Meat Inspector to meet the butchers and to explain the provisions of the Regulations. This meeting proved very successful, both as regards the numbers attending and the results which followed. The way was smoothed to obtain improvements in the meat shops, and, I am glad to say, that at the present time all butchers' shops in the Borough are provided with windows, although in all cases the windows are not fixed ones. Meat Regulations alone appear to be insufficient to ensure a clean food supply. Public opinion, too, is necessary. When the public will refuse to purchase food from open stalls and improperly protected shops, then, and then only, I believe, will the perfect foodshop be produced. As in the case of the slaughtering clauses of the Regulations, amendment would appear to be very desirable in connection with foodshops. The definition of meat is not sufficiently broad. At the present time, rabbits, poultry and other such foods are not included in the Regulations, and may be exposed outside shops. Regulations to deal with groceries and fish would also appear to be desirable. The wholesale meat stores, and the vehicles used, have been kept under observation during the year. 52 Private Slaughter Houses. There are now six private slaughter-houses in the Borough, and the following table is set out in accordance with the request of the Ministry of Health :— In 1920. In Jan., 1925. In Dec., 1925. Registered 3. 3 3 Licensed 3 3 3 Total 6 6 6 All the premises have been in use during 1925. 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. Seven hundred and forty-two visits were paid to these premises during the year, as compared with 220 during 1924. Disinfection. Previous to May, 1921, the only disinfection process employed by the Council was that of fumigation of rooms and contents by means of sulphur dioxide. In certain cases bedding was sent to a private firm at Putney to be steam disinfected. This latter method entailed delay and considerable inconvenience to those persons who had no spare bedding, as it was not possible to remove, disinfect, and return the bedding in one day. In 1920 the Council decided to erect a disinfection station and to purchase a "Velox" High-pressure Disinfector. The building is situated at the rear of the Electric Light Works, and was completed in May, 1921. Steam for use in the apparatus is obtained from the works, and is available at all times. The steam pressure is reduced to about 40 lbs. per square inch before entering the machine through a water-chamber, wherein it is converted into "saturated steam." The pressure inside the machine is regulated by means of safety valves so as not to exceed 15 lbs. to the square inch. This pressure of steam gives a corresponding temperature of 250 deg. F. in the chamber. 53 During 1925, 2,275 articles were passed through the apparatus, compared with 1,567 during 1924. Since May, 1921, and up to December 31st, 1925, no less than 7,857 articles have been passed through the machine. In addition to the steam disinfection, 343 rooms and contents in 307 houses were sprayed and fumigated with formalin. This number is above the average, the totals for the last five years being 1,511 rooms in 1,321 houses. In addition to disinfection after notifiable infectious diseases, articles are also collected for steam disinfection and rooms are disinfected on request. A. charge is made in such cases sufficient to cover the cost of the work. This arrangement is much appreciated by the public. The Council also possess a motor ambulance, which is constructed for the dual purpose of removing patients to hospital and for the conveying of bedding, etc., to and from the disinfection station. Fifty-nine patients were conveyed in this ambulance last year, compared with 36 in 1924. Factories, Workshops and Workplaces. Thirty-twp visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in Tables on pages 30 and 31. There are 15 "Outworkers" resident in the Borough, and the premises so used were inspected periodically. Stables and Yards. The campaign against the absence or defective condition of manure receptacles in stables and yards was maintained during 1925. This work is important, as there can be no doubt that a very definite relationship exists between the breeding of flies and improper storage of manure. During the last five years considerable time has been devoted to this work, and 45 new receptacles have been provided or repaired. 54 Sanitary Condition of Music Hails, Cinemas, &c. Seven 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 1925, 8 visits and inspections were made in connecticn 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. Legal Proceedings. I am glad to report that it was not found necessary to take any legal proceedings during 1925. 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. May, 1926. 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 1925. The average number of children on the school register for the year was 4,575. There was no School closure on account of Infectious Disease. Medical Inspection was carried out on the same lines as before, and no objection to medical examination of a child was received from any parent. Two half-days a week were devoted to Dental Inspection and treatment until December, when an increase to three sessions a week became necessary in order to maintain the progress of the Dental Scheme. The steady progress of the School Medical Service may be better realised, if it be remembered that up to the end of the year 1919 the School Medical Officer visited each School for as many sessions as were necessary to make his inspections, only oncc a year, and the School Nurse's time was chiefly occupied in copying his notes into a register and making cleanliness surveys. No systematic following-up was done at this time. The whole system was then re-organised to be in working order by January, 1921, a junior lady clerk being appointed, the card system introduced, systematic followingup, and the School Medical Officer visiting every department of all Schools each term for the purpose of making Medical Inspections and re-inspections. Up to the end of 1921, the Inspection Clinic was held at "Devoncroft" once a week, but on removal to " Elmfield " in February, 1922, the meetings were increased to twice a week, and the treatment of a few minor ailments was undertaken. 56 It might be observed that the attendance at the Inspection Clinic has risen from about 15—20 once a week in 1921, to about 50 twice a week in 1925, and has on occasions reached between 70 and 80 per session. The Eye Clinic was started in October, 1923, and is held once a fortnight during School terms. Owing to the amalgamation of the Nursing Services it became possible to undertake the treatment of minor ailments daily in January, 1924, and in September, 1924, Dental Inspection and Treatment was commenced twice a week and increased to three times a week in December, 1925. A scheme for the Orthopaedic treatment of crippled children was put into operation in November, 1925. All these large advances in Inspection and Clinic work have proportionately increased the amount of clerical, cardindexing, record-keeping, correspondence, and nurses' duties, and I think great credit is due to the Staff, equivalent to one Nurse and one junior clerk, which is the same strength as in January, 1921. The steady advance made during the last five years must be looked upon with satisfaction by all, and it is hoped that the same progress may continue. In the future, the gradual extension of Dental Supervision and Treatment to the whole of the School population will necessitate periodically an increase in the number of sessions per week devoted to this work, and an efficient scheme for educating feeble-minded children in a special class or school is yet a difficult problem for solution. I thank Miss R. Bartter, your School Nurse, for her keen and untiring work over the whole period which I have briefly reviewed. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 57 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 G. H. SAUNDERS 1/5 time. Miss E. RILEY 1/5 time. Clerk: Miss F. FRANCIS. Miss G. H. Saunders and Miss M. E. Skinner were appointed l.5th time School Nurses on April 6th, owing to the resignations of Miss E. Arthur and Miss C. J. Duncan. Unfortunately, Miss M. E. Skinner was taken ill soon after her appointment, and was absent for a considerable period, eventually resigning her post owing to ill-health. Miss E. Riley was appointed on October 19th to fill the vacancy. At present the time of one School Nurse is allocated to the School Medical Service, and in my opinion the appointment of an additional Nurse is a matter for serious 58 sideration, in order that the full time of two Nurses be available for maintaining the present activities and progress of the work. A brief summary of the work of the School Nurse is set out under the heading " Following Up " on page 71. From my Annual Report for 1924, I quote the following:— 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." During this year the strain has become more acute in spite of constant overtime and " home work." It must be remembered that in December an additional Dental Session was commenced, and an Orthopaedic Scheme inaugurated, which will throw further work on the Staff. I fear that unless additional assistance is forthcoming it will be impossible to efficiently carry on the duties or make further progress towards a complete School Medical and Dental Service. CO-ORDINATION. The School Medical Officer being also Medical Officer of Health, and the Nurses' duties being arranged so that each Nurse gains experience in all branches of both School and Maternity and Child Welfare Work, secures that the same Staff looks after infants both before and after they reach school age, and makes for efficient working between the various ramifications of the Public Health Services. Medical Record Cards of those infants who have attended the Maternity and Child Welfare Centres are transferred to the School Medical Service as soon as these infants attain the age of five. Close touch is kept between the School Attendance Officers and the School Medical Department. The Office is situated at the Clinic, "Elnifieid," London Road, and during the year has been put into direct telephonic communication with the Public Health Department. In a compact Borough such as Kingston-upon-Thames, I consider centralisation of Offices, Clinics, Welfare Centres, etc., an ideal to be aimed at for efficient health administration. 59 Nursery Schools'. There are no Nursery Schools in the Borough. The Nursery Class at All Saints' Infants' School was discontinued for reasons of economy in April, 1921. SCHOOL HYGIENE. During the year only small repairs have been carricd out in the Public Elementary Schools. The water supply of all school is derived from the Metropolitan Water Board, and the drains are connected with the sewers of the town. The general cleanliness of the class-rooms and cloakrooms is good, but a fault common to nearly all the Schools is the practice of hanging numerous articles, such as maps, drawings, etc., on the walls for prolonged periods, so collecting dust. The following is a brief review of the Public Elementary Schools, the figures in brackets denoting the number of pupils on the register in each department. Bonner Hill Road School. This School stands in an open situation in an area of about three acres,adjoining the cemetery. The main building is of the central hall type, the Boys' Department being on the ground floor, and the Girls' School above. The Infants' Department is a separate building on the ground level. The floors are of the block type, and the walls of glazed brick up to about four feet and distempered above. Heating is maintained by hot water radiators, ventilation is natural, and all rooms are fitted with electric light. Dual desks are used throughout. The playground is tar-paved, and the surface is good. The Boys' Department (432), consists of a central hall, eight classrooms, Head Teacher's room, and two cloakrooms, each with four basins, and heated. There is a large drill shed in the playground and a lavatory, consisting of six wash-down w.c.s and a urinal. There are two drinking fountains, which are not in use. The Girls' Department (416) consists of a central hall, eight classrooms, Head Teacher's room, Teachers' room, and two cloakrooms, each fitted with four basins and heated. 60 There is a large drill shed in the playground and a lavatory consisting of 13 wash-down w.c.s. There is a Teachers' Lavatory in the main building. The Infants' Department (332) consists of a central hall, eight classrooms, Head Teacher's room, Teachers' room, and two cloakrooms, each fitted with four basins and heated. There is a large drill shed in the playground and a lavatory consisting of nine wash-down w.c.s and two urinals. Richmond Road School. The main building is of the central hall type and similar to Bonner Hill Road School, but the surroundings are not so favourable. In front is the Richmond Road of good width, and at the back are the Kingston Gasworks, where a new and very large gasometer is at present in course of erection. The floors are of the block type, and the walls of glazed brick below and distempered above. Heating is maintained by hot-water pipes and radiators, ventilation is natural, and all rooms are fitted with electric light- Dual desks are used throughout, and in Standard VII. they have lockers. The playground is of tar paving. The Boys' Department (392) consists of a central hall, eight classrooms, Head Teacher's room, Teachers' room, and two cloakrooms, with six basins and sink, and heated by radiators. There is a drill shed in the playground and a lavatory consisting of six wash-down w.c.s and a urinal, which is furred. There are two drinking fountains in the playground. The Girls' Department (391) consists of a central hall, eight classrooms, Teachers' room, two cloakrooms with six basins and sink, and heated by radiators. There is a drill shed in the playground and a lavatory consisting of 13 wash-down w.c.s and one Teachers' w.c. The paving is worn somewhat and does not drain properly. There is also a Teachers' lavatory in the main building. The Infants' Department (325) is a separate building on the ground level and was built in 1900 with the exception of one room, all that remains of the old Public School built in 1826. The new part consists of five classrooms, divided by glass partitions, the walls of glazed brick below and distempered above, and a wood-block floor. 61 The old part consists of one classroom, the walls of varnished matchboarding below and distempered above, and a hollow plank floor. Heating is maintained by open fires and artificial lighting by incandescent gas. An additional classroom, one side and part of the front of which can be folded back, is situated in the playground. This is heated by means of a stove and is fitted with electric light. There are two cloakrooms with no heating, and four wash-basins in a shed across the playground, and apparently no main drinking water. Lavatory accommodation consists of a urinal and four w.c.s for boys, and six w.c.s for girls—automatic flush. St. Luke's School. This School is situated in the Elm Road in a fairly open position, the Boys' Department being on the ground floor, and the Girls' School above. The inner walls are of washable plaster below and distempered above and need re-decorating. Artificial lighting is by incandescent gas and is unsatisfactory. Heating is maintained by hot-water pipes and radiators, the pipes running in sunken channels covered by gratings, in the Boys' Department. There are fireplaces, but no grates. The playground is asphalt. The Boys' Department (284) consists of a large room divided into three classrooms by glass screens, and four other classrooms, two cloakrooms with a sink and 10 basins. The cloakrooms are heated by radiators. There is no Teachers' room. The lavatory accommodation consists of five w.c.s, two of which are cracked, with wooden seats, and one Teachers' w.c. all on one trough. These are unsatisfactory. The urinal is foul and the cement-rendered surface should be replaced by modern glazed slabbing. The Girls' Department (278) has classrooms as in the Boys' Department, dual desks throughout, and two cloakrooms open to the stairs, heated by radiators, and containing a sink and seven basins, two of which are cracked. There is no Teachers' room. The lavatory accommodation consists of seven w.c.s on a trough, which is unsatisfactory. 63 St. Paul's School. This School is situated in the Borough Road, and is surrounded by small property. All departments are heated by open fires. Artificial lighting by incandescent gas, which is inadequate.* The windows are small and the window frames very thick, excluding much light. The walls are distempered. There are no Teachers' rooms. The playground is asphalt and is shared by all departments. There is a drill shed and a drinking fountain, which is out of order and should be removed, as it draws its supply from a tank. In all departments the majority of the desks are of the old long type, having no backs. The Boys' Department (148) consists of two classrooms separated from each other by a glass screen, and a third large classroom, in which there is a gas stove for additional heating. The cloakroom is a small lobby—no heating. There are two basins in a small shed outside. The lavatory accommodation consists of five w.c.s—trough, automatic flush, enclosed wooden seats. An old and unsatisfactory system. The urinal is foul and requires reconstruction. The Girls' Department (130) consists of two classrooms, one being very large. The cloakroom is narrow, dark, and badly ventilated, and contains two basins and a sink—no heating. The lavatory accommodation consists of seven w.c.s, with enclosed wooden seats—trough, automatic flush. An unsatisfactory system. There is a urinal for infant boys, which is foul, dark, and wet. This needs reconstruction. The Infants' Department (182) consists of three classrooms, the largest having a gas radiator in addition to an open fire, but even so it appears difficult to keep this room warm in cold weather. The cloakroom is merely a passage between the Infants' and Girls' Schools and is used by both. St. Peter's School. This is an old School, situated in Cambridge Road. All departments are heated by open fires, and artificial lighting is by incandescent gas. The natural lighting is not good, the windows having 63 very thick frames. The walls are distempered and the floors hollow. The playground is asphalt and contains trees, which afford shade in the summer for open-air classes. There are no Teachers' rooms or lavatories. Most of the desks are of the old long type. The Boys' Department (173) consists of five classrooms and an unheated cloakroom. No washing basins. There are five w.c.s—trough, automatic flush—which are as clean as possible, but the system in unsatisfactory. The cement urinal is somewhat furred, and is unsatisfactory. The Girls' Department (141) consists of three classrooms and an unheated cloakroom, low, but of fair size, containing a sink and two enamelled iron basins. There are seven w.c.s—trough, automatic flush, as in the Boys' School. The Infants' Department (62) consists of a large room, divided by glass partitions, and a smaller classroom. There is an unheated cloakroom containing sink and enamelled bowls. There are six w.c.s—trough, automatic flush—and two urinals for infant boys. St. John's School. This School is situated in the Portland Road, and behind has the Hogg's Mill Stream with the land adjoining, giving an open position. The natural lighting is indifferent, much of the light being shut out by the very thick window frames. Artificial lighting is by incandescent gas, and is poor. The floors are hollow and the walls distempered. The desks in all departments are of the old long type, except a few in the Infants' School. There are no Teachers' rooms or lavatories. The playground is small, gravel, and very dusty or muddy, and contains a large tree, which gives shade to an open-air class in summer. The heating is by open fires and coal stoves. In the large rooms it appears difficult to maintain a reasonable temperature in cold weather. The Boys' Department (111) consists of two classrooms, the larger one being partially divided by a glass screen. There is an unheated cloakroom with two basins. There are three w.c.s—wash-down—and a urinal, the floor of which needs repair. 64 The Girls' Department (138) consists of two classrooms, the larger one being- partially divided by a glass screen. Unheated lobby and passage used as cloakroom with four basins—unsatisfactory. In this passage there is a drainage inspection chamber with a loose movable cover. There are three w.c.s, wooden-cased—trough, automatic flush—an old unsatisfactory system. The Infants' Department (108) consists of one large classroom divided by glass partitions, and an unheated cloakroom containing three basins. There are five w.c.s— wash-down—and a cement urinal. St. Agatha's School. The School consists of two departments only—Mixed and Infants'—the latter being on the ground floor. Natural lighting is good and artificial lighting by incandescent gas. Heating is maintained by coal stoves. The inner walls are distempered. The playground for Girls' and Infants' has been recently tar-paved, and is good, but the playground for boys is gravel and badly worn. The Mixed Department (114), on the upper floor, consists of two classrooms, and there are two unheated cloakrooms with three basins in each. The Infants' Department (86) consists of two classrooms behind a glass partition, and a large room used for play. There is an unheated cloakroom with three basins. There are seven w.c.s for infants and girls, and four w.c.s for boys—fixed seats, trough, automatic flush. The boys' w.c.s are dirty and require repainting. The urinal is foul, has no flush, and needs reconstruction. All Saints' School. The Boys' and Girls' Departments are in one building and the Infants' Department in a separate building on" the opposite side of Wood Street. The main building is in a cramped position, adjacent to high buildings, which exclude light, particularly in the Girls' Department, which is on the ground floor. Heating is maintained by open fires, and artificial lighting by incandescent gas. The small playground is asphalt, and is used alternately for boys and girls. 65 The Boys' Department (143) is upstairs and consists of a large room divided by glass screens into four classrooms. There is a separate classroom adjoining and a small room in the roof, which is not used. Two classes are provided with dual desks, and three classes with the old long type. The cloakroom is on a half-landing. It contains six basins and a sink, and is unheated. The lavatory is in the playground and consists of four w.c.s and one Teachers' w.c.—automatic flush—a urinal rendered in cement, which is unsatisfactory. The Girls' Department (90) on the ground floor consists of a large room divided by glass screens into four classrooms, the natural lighting of which is poor owing to the adjoining buildings and the heavy framework of the windows. There is a small additional classroom, but no Teachers' room. Dual desks are provided in two classes, the remainder being of the old long type. The lavatory accommodation consists of five w.c.s, one defective, automatic flush, and one Teachers' w.c.— wash-down. There is a dust pit in a dilapidated condition, which should be replaced by a sanitary dustbin. The Infants' Department (92) is situated on the opposite side of Wood Street and consists of four classrooms with block floors and the back rows raised. The walls are of glazed brick below and distempered above. There is an unheated cloakroom, and outside a wash-house containing three basins. The playground is asphalt, and there is a covered drill shed. Dual desks are provided, and for the youngest children chairs and tables. There are four w.c.s for girls and two for boys, pans badly furred, automatic flush regulated to operate too slowly, and a wash-down w.c. for the Teachers. The urinal is rendered in cement, furred and foul, and requires reconstruction. SCHOOL INSPECTION. All Departments of every School are visited by the School Medical Officer each term for the purpose of carrying out:— 1. Routine Inspections of (a) Entrants, as soon as possible after entry. (b) Intermediates, age 8. (c) Leavers, age 12 and over. 66 A Medical Card is made out for all Entrants, and any children in the other age groups not already possessing one, and on these cards the results of Medical Inspection are entered. In addition to the Medical Card, a "Following-up" Card is made out for each child found to be suffering from any defect, and a letter is handed or sent to the parents advising them to consult their own doctor with regard to the defect. In cases of visual defect, an Ophthalmic Card is completed, and the parent is informed that the child will be warned as soon as possible to attend the Clinic for the purpose of being examined by the Oculist. In cases requiring to be kept under observation, but in need of no immediate active treatment, a "Followingup "Card is also made out. The Health Report on the Juvenile Employment Card is filled in by the School Medical Officer for each child of the Leaver Group. 2. Re-inspections. Systematic re-inspections are made each term at the Schools by the School Medical Officer of all children for whom "Following-up" Cards have been made out at previous Routine or other Inspections, and the results of treatment are ascertained and entered on the card. When it is found that no advice has been sought or treatment obtained, a second notice is issued to the parents again calling their attention to the defect, and recommending them to seek advice forthwith. Further failure in procuring treatment is dealt with by home visits by the School Nurse. 3. Special Inspections. Children are brought before the School Medical Officer at the Schools by the Teachers for his opinion and advice. These are entered on a General Card, and when necessary a "Following-up" Card is completed in addition. In keeping Medical Records the dossier system is employed, in which all cards relating to an individual child are filed in one covering envelope. Parents are always warned beforehand as to the hour 67 their children are to be medically examined at Routine Inspections, and during the year attended as follows :— No. of Child Examined No. of Parents present. Percentage. Entrants, Boys 305 255 83% Girls 283 230 81% Intermediates Boys 220 138 63% Girls 196 131 67% Leavers, Boys 299 96 32% Girls 273 151 55% The above percentages of parents attending were the highest yet attained, and, I think, speak well for the still growing popularity of School Medical Inspection. In no instance did any parent object to Medical Examination of a child. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. At Routine Medical Inspections 204 children were found unclean, and the School Nurses at their cleanliness surveys discovered 732 individual children requiring treatment for uncleanliness. It still remains a fact that many children return to school after the holidays with unclean heads, so it is 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. Prosecutions were made in the cases of 16 children under the School Attendance Bye-Laws, resulting in fines varying from 2/6 to 15/-. Details of the procedure adopted before the comparatively few parents appear before the Justices were set out in my Annual Report for 1923. It must be remembered that no parent appears in Court until three or four months have elapsed since the child was found to have an unclean head, and during this period every persuasion has been exercised by the Nurses, School Medical Officer, and School Attendance Subcommittee to induce the parent !o act and cleanse the child's head without result. (b) Tonsils and Adenoids. There were 65 children suffering from enlarged tonsils and adenoids referred for treatment during the year. 68 (c) Tuberculosis. Any children suspected by the School Medical Officer are referred to the Surrey County Council Tuberculosis Officer, Dr. Cameron Renwick, for his opinion, observation and treatment if necessary (d) Skin Disease. Impetigo and ringworm of the body and scalp are the skin diseases chiefly met with among the children. The apparent increase in the number of cases of impetigo latterly is 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. Scabies is now rare. Conditions such as urticaria, psoriasis, warts, acne, rashes, etc., account for the large number included under the heading " Other Skin Diseases." (e) Vision. During the year 68 children were found requiring treatment for defective vision, this number- being rather low. (/) Dental Defects. The very large percentage of Entrant Infants requiring attention the School Dentist attributes to the fact that the great majority have never received any previous dental treatment. The following table gives a comparative statement of certain defects found during the last five years. [ ]Year. Tonsils and Adenoids. Defective Vision. Skin Disease. Scabies. Ringworm. Scalp. Bodv Impetigo. 1921 75 75 40 15 62 19 1922 49 80 21 23 81 9 1923 42 96 24 34 105 4 1924 53 104 31 68 149 3 1925 65 68 31 42 138 5 MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily 69 at the Clinic during School Terms, 5,248 attendances being registered during the year. (b) Tonsils and Adenoids. Operative treatment for tonsils and adenoids has been carried out in the cases of 43 children at the Kingston and District, Kingston Victoria, 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 101 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 20 children have been treated at the Clinic ; other ear diseases and deafness were referred to private practitioners and hospitals. (f) Dental Defects. Of the 514 children requiring treatment found by the School Dentist, 357 were actually treated, 208 being rendered dentally fit before the end of the year. (g) Crippling Defects and Orthæpadics. Advice has been given to parents whose children have crippling defects, and several received electrical, massage and other forms of treatment at the Red Cross Curative Post, under the direction of the Visiting Orthopaedic Specialist. In November the final approval of the Board of Education was given to the Scheme for Orthopaedic Treatment of schoolchildren at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, which is a fully-equipped centre. 1. A charge of 2/- per visit for cases requiring massage and exercises, or electrical treatment and exercises. This includes examination by the Surgeon, and prints for flat feet. 70 2. A charge of 3/- per visit for cases requiring any treatment in addition to those specified in paragraph 1, such as X-rays, photographs, plasters, splinting, etc., etc. 3. Surgical boots, surgical appliances which have tp be made and obtained outside the Clinic, plaster beds and night shoes, have to be paid for by the parents at cost prices on a weekly repayment basis direct to the Red Cross Post. 4. Cases requiring long in-patient treatment will be sent to the St. Vincent's Orthopaedic Hospital, Eastcote, and to the Shropshire Orthopaedic Hospital, Oswestry. 5. The School Medical Officer will visit the centre from time to time. 6. All cases for whom the Authority accepts responsibility must be recommended for treatment by the School Medical Officer, and must be provided by the Authority with an authorisation for attendance at the Centre. Claims in respect of any other cases cannot be entertained. 7. Records of attendances of all children under treatment must be submitted to the School Medical Officer monthly. 8. A monthly report on each case must be submitted to the Authority. 9. When treatment of a child is terminated or ceases from any cause, the Authority must be promptly notified. 10. Notices of admission or discharge of a child as an in-patient at a hospital must be immediately notified to the Authority. 11. Parents will be expected to pay for treatment according to their means, their contributions being paid through the School Medical Officer. Fourteen children attended the Centre during the last quarter of the year for treatment. The Central Aid Society has been most helpful in assisting the School Medical Service in obtaining letters for hospitals, fares to London, 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. 71 INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. Whooping Cough was prevalent at Richmond Road Infants' School from March to July, and a few cases were recorded in April at Bonner Hill Road Infants' School, and in June at St. Paul's Infants' School. An outbreak of German Measles occurred at Richmond Road Infants' School in July. Chicken-pox affected Bonner Hill Infants' School during October and November, and Richmond Road Infants' School in November only. Small outbreaks of Measles occurred at Bonner Hill Infants' and Richmond Road Girls' Schools in December. The incidence of Scarlet Fever was higher than during the two preceding years, two maximum periods being reached, one in the middle of October and a second in the first week of December. The type was mild. In October suspicion fell upon a classroom of St. Paul's Infants' School, which was disinfected, and certain infants were excluded by the School Medical Officer. For the third year in succession there has been very little Diphtheria. FOLLOWING-UP. The following-up of children suffering from defccts is carried out by the School Medical Officer and School Nurse, aided in some instances by the Teachers and Attendance Officers. The School Medical Officer completes a Following-up Card for each child found defective, and he re-examines the child on re-visiting the School each term until satisfactory treatment has been obtained. In more urgent cases the child is seen at the Clinic at more frequent intervals. When no treatment has been obtained after a second notice, the School Nurse visits the home and interviews the parents in order to point out the necessity of treatment and to advise and help them in the right way of getting this carried out. The work of the School Nurse may he briefly summarised as follows :— 1. To attend the Clinic daily at 9.15 a.m. to 72 take the treatment of Minor Ailments. 2. To prepare beforehand for Routine Medical Inspections at the Schools by weighing, measuring and applying rough vision tests. 3. To assist the School Medical Officer at Routine Medical Inspections and Re-inspections. 4. To assist the Dental Surgeon at his Inspections at the Schools and at his sessions at the Clinic. 5. To apply atropine ointment to children warned to attend the Clinic for refractions. 6. To assist the Ophthalmic Surgeon at the Clinic. 7. To follow-up by paying home visits. 8. To carry out cleanliness surveys at the Schools. 9. To re-examine those children found unclean after a short interval. 10. To bring obstinate cases of uncleanliness before the School Medical Officer. 11. To supervise the work of the Clerk, and the keeping of all records and cards under the direction of the School Medical Officer. The following table specifies some of the work done in 1925 :— Number of children prepared for Routine Medical Inspection 1,750 Number examined at Schools for uncleanliness 17,946 Number of following-up home visits 583 Total number of visits to the Schools 642 Total number of Clinic Sessions 353 VACCINATION. At Routine Medical Inspections a record is made of children showing evidence of having been vaccinated or not, and in 1921 it was evident that the number of unvaccinated children attending the Public Elementary Schools was increasing, since the percentage of vaccinated children of the Leaver group was 77 per cent., whilst that of the Entrants was only 55 per cent. During the last four years since then the percentage of vaccinated Entrant Infants has remained stable between 50 and 60 per cent., causing a halt in the previous steady decline. SPECIAL SCHOOLS. The Special School for Physically Defective Children is situated at "Elmfield," London Road, 73 The School consists of two large classrooms on the ground floor. A third large room on the same floor is used as the dining room, with a serving hatch leading from the kitchen. Dinners are served, and payments up to 4d. a meal are made by parents, the deficit being defrayed by voluntary contributions. The large garden provides ample playground space and soil for instruction in gardening. The teaching specialises in Manual Training, Needlework, Jam Making and Laundry for girls, Gardening and Basket Work for boys. The School is situated in almost the exact geographical centre of the Borough, and is on the main tram route. Arrangements have been made for the admission of crippled children from the adjacent neighbourhood outside the Borough for whom the Surrey County Council are responsible. There are 33 Physically Defective Children on the register, three of whom come from outside the Borough. The School Medical Officer periodically examines the children, and the Clinic, being on the same premises, is always at hand should the Head Teacher desire to consult him or the School Nurse about any child. SCHOOL CLINIC. The Clinic is situated at "Elmfield," London Road. In January, 1922, alterations were made to a wash-house and lean-to, converting them into a Medical Inspection Room and Waiting Room respectively. The Medical Inspection Room is used also as the Minor Ailments and Eye Clinics. Heating is maintained by closed stoves, artificial lighting by incandescent gas, and there is a supply of hot and cold water. The Dental Clinic is situated on the first floor of the main building, and consists of a Waiting Room and Operating Room, communicating by an internal door, which obviates the necessity for a child to return to the Waiting Room after treatment. This is a great advantage, especially on days devoted to extractions under a general anaesthetic. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic 74 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. (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 350 attendances at the 26 sessions held during the year, 146 being new cases and 204 re-inspections. Refractions numbered 118 and spectacles were prescribed in 101 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 89% of the total cost of spectacles was paid by the parents, which must he regarded as highly satisfactory. (d) Dental Clinic. During the year two sessions per school week were devoted to Dental Inspection and Treatment, and this was increased to three sessions per week in December. In all, seven half-days were given to Inspection and 83 to Treatment. When necessary, a session is devoted entirely to those cases requiring a general anaesthetic, when the School Medical Officer attends to administer the nitrous-oxide gas. 75 Mr. H. A. L. Morris, the School Dentist, reports as follows:— "Inspection and Treatment were directed to all children aged 5, 6 and 7, and to Specials. Specials are children outside the routine age groups requiring urgent treatment or those referred by the School Medical Officer. "The necessity of treatment is conveyed to parents and guardians at the Inspection, and is realised and appreciated by the majority, consequently the number of children who presented themselves for treatment is, I think, very satisfactory, and the attendances were also good. "The programme for 1926 is to inspect the new age groups—5 years, re-inspect those aged 6, 7 and 8, and to carry out treatment where necessary. I anticipate more conservative work (fillings) during 1926 with the first permanent molars in children whose parents did not consent to treatment in 1925. "Instruction was given at the Clinic in Oral Hygiene." A flat rate of 1/-, 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 or without gas. The total sum collected during the year amounted to £16 15s. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 63 schoolchildren over 12 years of age were issued with certificates under the Bye-Laws permitting their employment on milk and paper rounds. SCHOOL BATHS. During the summer months 711 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 at the reduced price of l½d. per visit. GARDENING CENTRES. There are Gardening Centres in connection with the following- Schools :— Bonner Hill Road Boys' School at the School. Richmond Road Boys' School at "Elmfield." St. John's Boys' School at the School. St. Paul's Boys' School at Tudor Road. All Saints' Boys' School at "Elmfield." Physically Defective School at "Elmfield." At present, St. Luke's, St. Peter's and St. Agatha's Schools are without Gardening Centres. DEFECTIVE CHILDREN. Exceptional children are brought to the notice of the School Medical Officer by the School Nurses, Health Visitors and Attendance Officers. As regards Mentally Defective Children, the School Medical Officer invites the Teachers to bring before him any children they consider to be very backward, feebleminded or mentally defective whenever he visits the Schools for the purpose of carrying out re-inspections. He then makes out a Following-up Card for each child and re-inspects every term those not in special schools, thus keeping them under supervision. There is no Special Day School for Mentally Defective Children, but at Bonner Hill Infants' School there is a special class in which the infants are instructed on lines based upon the Montessori System, and there are special classes for backward children in the Boys' and Girls' Departments at the same School. SCHOOL CAMP. St. Peter's Girls' School. The Head Teacher, Miss A. Thompson, and her Assistants were a61e by their work to raise sufficient funds to take a party of girls to New Romney, Kent, for a week. In all, 30 girls, three of whom paid all, and 14 part of their own expenses, proceeded to the Aerodrome Camp, New Romney, on June 19th and returned on June 26th. 76 77 Prior to departure all the girls were examined by the School Medical Officer. It may be recalled that similar excursions were taken in 1922, 1923 and 1924 to Broadstairs. This School draws its pupils from a poor district, and the girls selected by the Teachers are those whom they consider would benefit most by a change of air. This invaluable work cannot be over-estimated, and I think, should be more tha n appreciated by all. STATISTICAL TABLES. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 588 Intermediates 416 Leavers 572 Total 1,576 Number of other Routine Inspections 174 B.—Other Inspections. Number of Special Inspections 1,724 Number of Re-Inspections 4,237 Total 5,961 table ii. a RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1925. Defect or Disease. Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requit ing to be kept under observation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition 1 — — — Uncleanliness— (See Table IV.GroupV.) 204 — 732 — Skin 'Ringworm, Scalp — — 31 2 Body 1 — 41 I Scabies 1 — 4 I Impetigo 3 — 135 I Other diseases (non Tb) 3 11 174 14 Eye Blepharitis 4 2 8 — Conjunctivitis — — 7 — Keratitis — — — — Corneal Opacities 1 — 1 — Defect,vision exc.Squint 51 4 — Squint 14 7 6 — Other Conditions 3 2 15 1 Ear Defective Hearing 5 — 11 — Otitis Media 1 — 2 — Other Ear Diseases 3 I 18 3 Nose and Throat Enlarged Tonsils only 33 9 18 — Adenoids only 3 — 5 — Enlarged Tonsils and Adenoids 3 1 3 1 Other Conditions 3 — 35 6 Enlarged Cervical Glands (non Tb) 8 8 26 8 Defective Speech 2 3 1 — Teeth—Dental Diseases (see Table IV., Group IV.) 12 — 25 — Heart and Circulation Heart Disease—Organic 2 6 1 5 Functional — 5 — — Anaemia 3 5 — 1 Lungs Bronchitis 11 7 3 Other non Tb. Diseases — — 9 13 Tuberculosis Pulmonary—Definite 1 — — — Suspected — 1 1 — Non-Pulmonary-Glands — — 1 Spine — — — — Hip — — — — Other Bones & Joints — — — — Skin — — — — Other Forms — — — — Nervous System Epilepsy 2 1 2 — Chorea — — 4 — Other Conditions 2 7 3 3 Deformities Rickets 2 21 1 Spinal Curvature 5 3 — — Other Forms 3 4 8 6 Other Defects and Diseases 10 32 73 134 TABLE 11.— continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UN CLEAN LIN ESS AND DENTAL DISEASES). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups—Entrants 588 53 9.0 Intermediates 416 49 11.7 Leavers 572 49 8.5 Total (Code Groups) 1576 151 9.5 Other Routine Inspections 174 22 12.6 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA — — — Boys. Girls. Total. Blind(incluHing 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 110 School or Institution — — — (it.) 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 — — — (i'i.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools 1 — 1 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 22 12 34 At other Institutions — 1 1 At no School or Institution 1 2 3 Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles — — — Idiots — — — 8o 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 4 3 7 At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tuberculcsis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions 1 — 1 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 — — — At no School or Institution — — — Delicate children (e.g pre or latent tuberculosis, malnutrition.debility, anaemia, etc). At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 6 4 10 At other Institutions — 2 2 At no 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 — 1 1 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 2 — 2 At Certified Residential Cripple Schools — — — At Certified Day Cripple Schools 17 13 30 At Public Elementary Schools 2 3 4 At other Institutions — — At no School or Institution — 2 2 8i TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31ST DECEMBER, 1925 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 15 16 31 Ringworm, Body 42 8 50 Scabies 5 1 6 Impetigo 134 4 138 Other Skin Disease 145 16 161 Minor Eye Defects - (External and other, but excluding cases falling in Group II.) 43 4 47 Minor Ear Defects 20 3 23 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 112 10 122 Total 516 62 578 Group II.—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. Xo. 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(ineluding Squint) 118 14 132 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 16 — 6 22 Total 134 14 6 154 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 101 (b) Otherwise 10 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 75 (b) Otherwise 10 82 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. 43 Total 43 Received other forms of treatment 22 Total number treated 65 Group IV. Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Ages 5 6 7 8 9 10 11 12 13 14 124 249 136 2 – – – – – – Total 511 Specials 102 Grand Total 613 (b) Found to require treatment 514 (c) Actually treated 357 (d) Re-treated during the year as the result of periodical examination 15 (2) Half-days devoted to : — Inspection 7 Treatment 83 Total 90 (8) Attendances made by children for treatment 967 (4) Fillings:— Permanent teeth 222 Temporary teeth 249 Total 471 (5) Extractions : — Permanent teeth 74 Temporary teeth 830 Total 904 (6) Administrations of general anaestheticsfor extractions 97 (7) Other operations:— Permanent teeth 68 Temporary teeth 403 Total 471 83 Group V.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurse 71 (ii.) Total number of examinations of children in the schools by School Nurse 17,946 (vi.) Number of individual children found unclean 936 {iiv,) Number of children cleansed under arrangements made by the Local Education Authority Nil (i.) Number of cases in which legal proceedings were taken:— (a) Under School Attendance Bye-laws 16 Kingston-on-Thames , Farrington Bros., Printers, 12a, Fife Road.