(1) KINGSTON UPON THAMES KIN 4 Borough of Kingston-upon-Thames. Annual Reports . . FOR . . 1926 . . 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 . . 1926 . . OF THE . . MEDICAL OFFICER OF HEALTH . . AND . . SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report OF THE SANITARY INSPECTOR. 2 Staff of the Public Health Department. Medical Officer of Health: E. W. MATTHEWS, M.B., B.S.Lond., M.R.C.S., L.R.C.P., D.P.H. Maternity and Child Welfare : WINIFRED WARNER, M.B., B.S.Lond., D.P.H. Sanitary Inspector: H. T. PERRY, A.R.S.I., Cert.R.S.I., as Sanitary Inspector and Meat and Foods Inspector. Assistant Sanitary Inspector: F. D. HARVEY, A.R.S.I., Cert.R.S.I., as Sanitary Inspector, and Meat and Foods Inspector. Health Visitors : *†Miss R. BARTTER (Senior), 2/5 time. * Miss E. RILEY, 4/5 time. * Miss A. GILL, 4/5 time. Junior Clerks: Miss T. P. DILLIWAY, G.H. COCKELL. Disinfector and Ambulance Driver: C. BENSON. †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. 1927. To the Corporation of Kingston-upon-Thamf.s. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1926. Circular 743 (Ministry of Health) directs that the Annual Report for 1926 will be an Ordinary Report, that is, a report of a more simple character than the full Survey Repprt which the Medical Officer of Health was asked to prepare last year. The chief features of the year have been the low incidence of Scarlet Fever and Diphtheria, the undertaking of Orthopædic treatment for Crippled Infants under school age, a small outbreak of Enteric Fever, and the regrettable occurrence of a series of cases of Puerperal Fever. Special reports on these two latter subjects were prepared and are embodied in this Annual Report. The duties of Meat Inspection continue to be very heavy and occupy a great part of the time of the Sanitary Inspector. I thank Mr. H. T. Perry, your Chief Sanitary Inspector, and the staff of the Public Health Department for their willing assistance at all times. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 4 GENERAL STATISTICS. Area 1,133 acres. Population, 1926 (Registrar-General): For birth-rate 39.840 For death-rate 39,680 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 £279,010 Assessable Value to District Rate £274,521 Sum represented by a Penny Rate— Poor Rate £a,083 District Rate £1,073 Amount of Poor Law Relief (1925) £3,048 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Male. Female. Birth Rate (R.G.) 15.5 per 1,000 population. Legitimate 577 289 288 Illegitimate 42 19 23 619 308 311 Deaths— 466 236 230 Death Rate (R.G.) 11.7 per 1,000 population. Number of women dying in, or in consequence of child-birth— From Sepsis 4 From other causes 0 Deaths of Infants under one year— Total. Male. Female. Legitimate 42 27 15 Illegitimate 4 4 — 46 31 15 5 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 95 Total Deaths of Infants under one year of age per 1,000 births 74 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhœa (under two years of age) 4 Birth Rate Death Rate Rate per Diarrhœa under 2 years 1000 Births Total Deaths . Under 1 year England and Wales 17.8 11.6 8.7 70 158 Smaller Towns 17.6 10.6 6.6 67 London 17.1 11.7 11.8 64 Kingston upon Thames 15.5 11.7 6.4 74 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 236 230 1. Enteric Fever 1 — 2. Smallpox — — 3. Measles 1 1 4. Scarlet Fever — — 5. Whooping Cough 1 — 6. Diphtheria — 2 7. Influenza 1 4 8. Encephalitis Lethargica — 1 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 19 9 11. Other Tuberculous Diseases 2 2 12. Cancer, Malignant Disease 34 37 13. Rheumatic Fever 1 1 14. Diabetes 2 1 15. Cerebral Haemorrhage, etc. 12 15 16. Heart Disease 24 31 17. Arterio-Sclerosis 9 13 18. Bronchitis 13 12 19. Pneumonia (all forms) 24 10 20. Other Respiratory Diseases 2 3 21. Ulcer of Stomach or Duodenum 3 2 22. Diarrhoea, etc. (under two years) — 4 23. Appendicitis and Typhlitis 1 2 6 24. Cirrhosis of Liver 4 2 25. Acute and Chronic Nephritis 11 8 26. Puerperal Sepsis — 4 27. Other Accidents and Diseases of Pregnancy and Parturition 28. Congenital Debility and Malformation, Premature Birth 11 5 29. Suicide 4 3 30. Other Deaths from Violence 10 5 31. Other defined Diseases 46 53 32. Causes ill-defined or unknown — — METEOROLOGY. 1926 Temperature of Air. Rainfall. Highest. Lowest. Mean Max. Mean Min. Inches. January 54 18 45 34 2.64 February 61 27 52 41 2.28 March 63 29 53 38 0.22 April 75 34 61 41 3.32 May 89 34 66 44 1.53 June 82 37 75 46 2.64 July 93 42 80 50 2.23 August 87 40 75 46 0.78 September 83 37 66 48 1.20 October 67 22 52 36 2.36 November 56 20 45 35 6.55 December 50 20 36 29 0.23 Total 25.98 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. Midwives. The Midwives are under the administrative control of the Surrey County Council. There were live registered as practising in the Borough at the end of the year. 7 Clinics and Treatment Centres. Centre. Situation. Maternity and Child Welfaie Maternity and Child Welfare Ante-natal Clinic School Clinic Eden Street Washington Road "Elmfield," London Road "Elmfield," London Road Day Nursery Tuberculosis Dispensary Red Cross Curative Post Canbury Park Road Grove Crescent Coombe Road Accommodation. Provided by Consultation The Corporation Consultation The Corporation Consultation The Corporation Consultation & The Education Tieatment of Committee Minor Ailments, Refractions, Dental Treatment 9 Babies and 16 Infants Consultation Out- Patients, Massage, Electrical, Light and Orthopaedic Treatment Vol. Committee Surrey C.C. British Red Cross Society Tuberculosis. Cases of Tuberculosis in administrative control of the the Borough come under the Surrey County Council. Maternity. The Kingston Nursing Association, 33, Avenue, had six beds for Maternity cases. Birkenhead This Home was closed in May owing to Puerperal Fever, and had not been re-opened by the end of the year. Four private Maternity Homes were registered by the Surrey County Council at the following addresses in the Borough:— Mrs. Burns : 9/11, Minerva Road. 8 beds Mrs. Burrows : 35, Balmoral Road. 1 bed. Miss Duckett : 31, Queen's Road. 5 beds. Mrs. Evans : 22, Fairfield South, 2 beds. The Kingston and District Hospital (Board of Guardians) have Maternity Wards. 8 Children. The Kingston and District Hospital (Board of Guardians). Fever. Arrangements are made whereby Wimbledon, Molesey and Hamilton Isolation Hospitals accept cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. Smallpox. The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. No case of Smallpox has occurred in the Borough during the year. Other. Other Hospitals situated in the Borough available for the District are:— (a) The Kingston and District Hospital (Board of Guardians). (b) The Kingston Victoria Hospital, supported by voluntary contributions. Institutional Provision for 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. The local branch Shelter of the Kingston, Surbiton, and District Voluntary Society, which is affiliated to the Southwark Diocesan Association for Rescue and Preventive Work, is situated at No. 45, Fairfield South. Ambulance Facilities. (a) For infectious cases : Those cases removed to Wimbledon. or Molesey Isolation Hospitals are transported by the Motor Ambulances attached to these Hospitals. Cases to Hampton Isolation Hospital are removed by your own Motor Ambulance for infectious diseases. 9 (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 127 accident cases and 27 private cases were removed by this ambulance. LIST OF ADOPTIVE ACTS AND BYE-LAWS IN FORCE IN THE BOROUGH. Adoptive Acts. Date of Adoption. Public Libraries Acts 1st March, 1881 Baths and Washhouses Acts 28th July 1896 Public Health Acts Amendment Act, 1890 1st July, 1891 Private Street Works Act, 1892 Public Health Acts Amendment Act, 1907 27th Nov., 1922 Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Section 94). Public Health Act, 1925, Parts II. to V. 26th Jan., 1926 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 several shallow wells, and the policy is to advise owners to have their property connected to the Main Supply of the Metropolitan Water Board. 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. 10 SCHOOLS. A general review of the sanitary condition of the Public Elementary Schools was given last year. The repairs and improvements carried out during 1926 will be found in the Annual Report of the School Medical Officer. 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 Council, 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 87 87 2 — 2 Cream 2 1 3 — — — Butter — 1 1 — — — Margarine — 1 1 — — — Other Articles 2 13 15 I 6 7 Totals 91 l6 107 3 6 9 No prosecutions were made under these Acts in the Borough during the year. Notifiable Diseases during the Year. Cases. Deaths. under 1year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Notified Cases admitted to Hospital under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Total Deaths scarlet fever — 1 2 4 7 38 14 4 8 4 — — 82 54 - - - - - - - - - - - - - diphtheria — 2 4 1 1 10 3 3 2 -— 1 - 27 24 - - 1 - - 1 - - - - - - 2 enteric fever including paratyphoid — - 2 1 2 1 — — 1 7 6 - - - - - - - - - - 1 - 1 pneumonia 2 2 4 1 3 6 3 — 4 3 8 4 40 8 — 1 — — — — 2 — 1 — 1 2 7 erysipelas — — — — — 2 — — 7 3 3 2 17 7 - - - - - - - - - - - - — encephalitis lethargica - - - - - - - - 1 - - - 1 1 - - - - - - - - 1 - - - 1 poliomyelitis — — — — — — — 1 1 — — — 2 — - - - - - - - - - - - - — puerperal fever — — — — — — — — 4 — — — 4 4 — — — — — — — — 3 — — — 3 ophthalmia neonatorum 2 - - - - - - - - - - - 2 — - - - - - - - - - - - - - New Cases. under 1year. 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. 1 1 — 2 2 1 7 8 — - 22 F. — 1 — — 3 4 5 — 2 1 1 17 total — 2 1 — 5 6 6 7 10 1 1 39 (b) non-pulmonary m. — 1 - - - - - - - - - 1 F. — — 1 — 2 1 — 1 — — - 5 total — 1 1 — 2 1 — 1 — — - 6 Deaths. under 1 year. 1-5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55-65 65 & over. total - - - - - 1 6 4 3 3 2 19 - - - - - 1 3 2 1 1 — 8 - - - - - 2 9 6 4 4 2 27 - - - - - - - - - 1 — 1 - - - - 2 - - - - - - 2 - - - - 2 - - - - 1 — 3 It 12 INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. There has been no epidemic during the year, and the number of notifications has been small, owing chiefly to the low incidence of Scarlet Fever. There was a localized outbreak of Enteric Fever, which was traced to a "carrier." The Special Report appears under the paragraph on Enteric Fever. The following table gives a comparative statement of notifications received during the last six years:— Year Scarlet Fever. Diphtheria Enteric Fever (including Paratyphiod) 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 1926 82 27 7 SCARLET FEVER. The type of case has been mild, and no death has been attributed to this disease during the year. Only 82 cases were notified, which is the lowest number for many years. DIPHTHERIA. There were 27 cases notified, and 2 deaths were attributed to this disease. The cases were scattered, but a small outbreak consisting of four cases occurred between September 26th and October 1st. Two children were notified, and removed to hospital on September 26th, and as the result of enquiries, suspicion fell upon a child who had recently returned from Broadstairs, where she had contracted Diphtheria, and had been treated in the Isolation Hospital there. This child and her sister were at once swabbed, and kept at home pending the result. The child proved to be a positive carrier, and was removed to the Molesey Isolation Hospital, and the home disinfected. The next day the sister and baby brother were removed to Hospital suffering from Diphtheria, which they no doubt had contracted from the carrier. No further cases occurred. 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. 13 ENTERIC FEVER (including Paratyphoid). Seven cases were notified during the year. One of these was an isolated case in a nine-year-old boy, who was notified on June 19th, and admitted to the Wimbledon Isolation Hospital on the same day. In spite of careful investigation no source of infection could be traced. The remaining six cases notified during the year form the subject of a Special Report, as set out below, which was completed on March 1st, and forwarded to the Ministry of Health. Report on Six Cases of Enteric Fever Notified Between 20.1.26 and 4.2.26. No. 1. A. S., male, 28 years. Notified 20.1.26. Paratyphoid " A." Date of onset—about 25.12.25. Enquiries. Enquiries were made on the day of notification, and resulted in the information that this man had been employed as a wireless operator on board the S.S. " Scalaria," and that he had landed at Thames Haven (after having been away from England for a considerable period), on the 13th January, 1926. It was ascertained that the last port of call before arrival in England was Suez, where the patient had been ashore, but the ship put in to Southampton to land the Second Steward (J. W.) who was ill. Upon receipt of this information the owners of the ship were communicated with by telephone. They were informed of the case, and were asked if they were aware of any other illnesses amongst the officers or crew, etc. They were also asked to supply the names and addresses of the ship's engineers, and any other officers who had been in intimate contact with the patient. This request was made, as it was understood from the patient that he had shared quarters with the ship's engineers, and that upon arrival at Thames Haven several of them signed off, and proceeded to their homes. A letter was sent to the owners the same day (20.1.26) in confirmation of the above. . In response to this enquiry I received a letter on the following day (21.1.26), giving the required information, and in addition the owners stated that the Second Steward (J. W.) had been admitted to a hospital at Southampton suffering from " Typhoid Fever " and that he had died on the 14th January, 1926. 14 The Medical Officers of Health of the Districts to which the contacts had gone were communicated with, letters being sent on the 21.1.26. A telephone message was also sent on the day of notification (20.1.26) to the Medical Officer of Health, Port Sanitary Authority, London, detailing the facts stated above, and confirmed by a letter the same day. A similar communication was also sent to the Medical Officer, Port Sanitary Authority, Southampton. The Widal reaction in this case showed agglutinations in all the dilutions employed. The patient is under the care of a private practitioner, and is being nursed at home. Conclusions. The above enquiries point to the disease having been contracted abroad, either directly, or by contact with the Steward (J. W.) who waited at the Officers' Mess, of which the patient was a member. There is no connection between this case and the following cases No. 2. R. M., male 67 years. Notified 31.1.26. Paratyphoid " B." This patient was notified originally on 26.1.26 as suffering from Pneumonia, but on 31.1.26 he had an attack of Melaena, and showed rose-pink spots on the abdomen. He was diagnosed as suffering from Enteric Fever, and removed, on my instructions, to the Molesey Isolation Hospital on the same day. Enquiries. Enquiries were made on 1.2.26, and it was found that this man had been employed on road work in Richmond Park. I communicated with the Park authorities, and was informed that there were no other cases of illness amongst his fellow employees. Exhaustive enquiries were made with regard to the food supplies (including milk), water, shellfish, and other possible sources of infection, with negative results. The house occupied by the patient is of average cottage type, and the occupants consist of the patient and his wife. They have received no visitors recently, and in turn have not visited elsewhere. Conclusions. The origin of this case is still obscure. No. 3. The following four cases may, I think, be grouped together as they all originated in the same house, and probably from the same source. 15 The house is a working-class dwelling, and at the time of the first notification was occupied by Mr. S. and his wife, their five children and step-children, and two elderly persons (the mother and father, respectively, of Mr. and Mrs. S.). (a) Bernard B., 13 years. Was first taken ill on the 11th January, 1926. He went to school on that date, and did not complain of feeling ill until the evening. He was not taken to his doctor until the 15th January, 1926. His legs ached, he had a slight headache, and was shivering, but had no diarrhoea. He was sent to bed on the 15th January, and remained there until the 19th January, when he was allowed up. He then gradually got better. This boy was supposed to have had an attack of Influenza. (b) Frederick S., 5 years. Was first taken ill about the same time as the boy mentioned above. He did not go to bed but was seen by his doctor. Later he became worse, and was sent to the Kingston and District Hospital on 1.2.26, as a possible case of Typhoid Fever. (c) Barbara B., 15 years. Was first taken ill on the 27th January, 1926. She was sick on that evening before going to bed, and complained of a headache and aching limbs. She was also shivering. On the 2nd February she was diagnosed as suffering from " Typhoid Fever," and was admitted to the Molesey Isolation Hospital. (d) Victor B., 16 years. Was first taken ill on the 28th January, 1926. Complained of a headache and pains in the limbs and was shivering. He was also diagnosed as suffering from " Typhoid Fever " on the 2nd February, 1926, and admitted into the Molesey Isolation Hospital. General Remarks. As the result of the diagnosis of " C " and " D," Widal tests were made in the cases of " A " and " B," both of which proved positive. Investigations. Very complete enquiries were made, and particular attention paid to food, water supply, shellfish, etc. These enquiries produced negative results, but from the sequence of the cases there appeared to be little doubt that the source of infection was at the house, and a carrier was suspected. Widal tests were therefore done on all the other inmates, with the result that Mr. S. and Mrs. D. (mother of Mr. S.) gave positive reactions. Mr. S. left the Navy two years ago, and on enquiries being made from the Admiralty, it was found that he had been inoculated with anti-typhoid vaccine (triple) in July, 1915 (two inoculations), and August-September, 1916 (two inoculations). Mrs. D. stated that she had suffered from " Typhoid Fever " about 16 thirty years ago. It was therefore thought necessary for the faeces and urine of all the inmates of the house to be examined, and negative results were obtained in each case with the exception of Mrs. D. This woman is also suffering from carcinoma of the cervix uteri, and as soon as the positive result was known, arrangements were made for her to be admitted to the Kingston and District Hospital, and to be kept under proper supervision. I attach here a tabulated form showing the results of the tests carried out. PARTICULARS OF INMATES OF HOUSE. (See Section Three of Report.) (Divided into two groups for the convenience of investigation) Group 1.—Inmates who are apparently well, and who have had no recent illness. Designation Age Result of Tests Remarks Widal Faeces Urine Mr. S. 32 + - - Ex-Navy, two years ago, was inoculated (see special report). Mrs. S. 33 - - - — Mr. H. 60 ? - — — Mrs. D. 56 + + - Stated to have had typhoid fever thirty years ago. Is also suffering from carcinoma of Cervix Uteri. Royston S. 2½ - - - Has not been well, but has had no definite illness. Group 2.—The Inmates who have been notified as suffering from Enteric Fever. Designation Age Onset of Illness Result of Widal Test Remarks Bernard B. 13 11.1.26 + Was not diagnosed until recovered. Thought to be Influenza. Only in bed for a few days —examination of faeces and urine made 15.2.26. Negative result. Fred S. 5 about 11.1.26 + Is an inpatient in the Kingston and District Hospital. Barbara B 15 27.1.26 + Is an inpatient in the Molesey Isolation Hospital. Victor B. 16 28 1.26 ditto. 17 Conclusion. From the investigations it is concluded that Mrs. D. is the carrier responsible for the outbreak in this house. It has been ascertained that she assisted in the serving of food, washing up, etc., and she has also been in direct contact with all the other members of the family. It would appear strange that she had not infected them previously, as she has been living at the house for the last four years, and it is worth considering whether the carcinoma of the cervix uteri from which she is suffering has so lowered her vitality that she has become an infective carrier recently. She can give me no history of any persons suffering from typhoid, or any suspicious illness, at her places of residence during the last thirty years, since she had typhoid fever herself. Of course, strict disinfection was carried out at these premises. ANTERIOR POLIOMYELITIS. Two cases were notified during the year, the first in a girl, aged 19 years on November 18th. The doctor reports that he first saw this girl in August, when she complained of a limp and twitching of the right leg. He found that there was some wasting of the right thigh. Her general condition was good, and there was no history of any febrile disturbance or other illness. He sent her up to St. Bartholomew's Hospital, where his diagnosis was confirmed. He thinks it probable that the attack dated from about July. He reported subsequently that the girl made a rapid recovery, though some wasting of the thigh persisted. The second case was in a man, aged 35 years, who was notified on December 16th. The symptoms and signs were slight, and the probable date of onset of the disease is given as October. This man was sent to a Specialist in London, who gives the diagnosis as probably Polio-Encephalitis. 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. No cases have arisen during the year in which any action became necessary under either the Public Health (Prevention 18 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. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. There was an epidemic of Mumps from February to June, and as regards the Public Elementary Schools, the exclusion of cases only was ordered, contacts being allowed to continue attending school. During the same period there were outbreaks of Measles, but no school closure became necessary. Whooping Cough was prevalent at Richmond Road Infants' School in June and July. INFLUENZA. The number of deaths attributed to this disease was 5, which is low. There was a certain prevalence of a mild type during the early months of the year, and again in December there were signs of a return of a similar type. 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. Owing to structural alterations at the Y.M.C.A. Hall, Eden Street, it was necessary to find other accommodation for this Centre. Arrangements were made to occupy the Wesleyan Hall, Fairfield Road, on August 6th, and the work was carried out there every Friday until the end of the year. These premises were not satisfactory for our work, but the best that could be obtained as a temporary measure, pending completion of the alterations to the Y.M.C.A. Hall which is expected early in the New Year. 19 During the year there were the following number of attendances at the Centres:— Meetings. Attendances. New Cases. Total. Eden Street 52 127 2,273 Washington Road 51 79 1,024 The Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers 51 80 Infants under one year 697 1,403 Children, one to five years — 2,535 Incidental and Infectious — 318 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. At the Eden Street Centre there is an excellent Clothing Stall where 40 mothers have purchased 125 garments during the year. This stall is of considerable educational value, since use is made of it to illustrate the correct garments, and methods of making them. Baby Week was held from June 28th to July 3rd, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. On June 30th, the Annual Garden Party for both Centres was held at St. Peter's Vicarage, when the Mayoress very kindly presented the prizes to mothers winning the various competitions. The Annual Winter Tea and Entertainment was held at each Centre in January. STAFF. Miss G. H. Saunders relinquished her post as 4/5th time Health Visitor on February 20th, having obtained the position of Ward Sister at the Northern Hospital, Winchmore Hill. Miss A. Gill was appointed to fill the vacancy, and took up her duties on March 3rd. The work of the Health Visitors has been most ably carried out under the direction of Miss R. Bartter. 20 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 result of this procedure is most gratifying, since unnotified births have become exceedingly rare. Ante-Natal Clinic. The Ante-Natal Clinic was established in December, 1925, 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. Dr. Winifred Warner was approved as presiding Medical Officer, under the direction of the Medical Officer of Health,, and seeing that she also carries out the work at the Maternity and Child Welfare Centres, continuity of observation is maintained. The Clinic was held on the first Tuesday in each month at 10 a.m., and during the year 29 expectant mothers attended, 10 of them making more than one visit to the Clinic. This attendance must be considered as quite satisfactory for the first year. Support from the midwives practising in the Borough has been disappointing, but I feel sure that in time they will realize the advantage and benefit of recommending their patients to attend the Clinic. 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 21 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. Puerperal Fever. Four cases were notified during the year, all between May 20th and June 10th, and occurred in connection with the maternity work of the Kingston Nursing Association. Three of these cases died, and also two infants who were infected. The Nursing Home of the Kingston Nursing Association was closed and maternity work discontinued. It was felt that the District Nurses (other than maternity) employed by the Kingston Nursing Association for nursing the poor were essential, and that continuity of this service must be maintained. A meeting of the doctors of Kingston was called, and due to their efforts funds were raised to ensure that the district nursing might continue during the formation of a new Committee of the Association and necessary reorganisation. This was eminently successful, and the district nursing has been carried on, but no further maternity work had been undertaken by the Association by the end of the year. A Special Report, as set below, was completed on July 1st, and forwarded to the Ministry of Health. Four Cases Notified Between May 20th and June 10th, 1926. Case 1. Confined at her own home on May 13th, and delivered by a midwife from the Kingston Nursing Association, the doctor engaged not being present at the birth. She was notified as suffering from Puerperal Fever on May 22nd, and admitted to the Kingston and District Hospital. She died on June 2nd. An inquest was held on June 4th, and adjourned until June 8th for the attendance of the doctor engaged and the Matron of the Nursing Home. The Coroner found the cause of death to be Puerperal Septicaemia. Case 2. Confined at her own home on Mav 18th. being delivered 22 by the same midwife from the Kingston Nursing Association. She was notified as suffering from Puerperal Fever on May 20th, and admitted to the Kingston and District Hospital on May 21st. She died on May 26th. An inquest was held on May 28th. Death from Puerperal Septicaemia, in accordance with medical evidence. This patient's baby was admitted to the Kingston and District Hospital on May 2.3rd, suffering from pyaemia and died on May 30th. An inquest was held. The post-mortem examination revealed general Septicaemia, the infection apparently having been conveyed from the umbilicus. Case 3. This patient was sent into the Kingston Nursing Association Home by a doctor on May 23rd, in a state of collapse, suffering from ante-partum hemorrhage. She remained in the Home until May 30th, when she was transferred to the Kingston and District Hospital. The midwife concerned in Cases 1 and 2 did not attend this patient in any way, and no examination was done by any midwife, the doctor being in attendance. At the Kingston and District Hospital, she was found to be a case of placenta praevia, and she was delivered of a macerated dead infant. She was notified as suffering from puerperal fever on June 4th, and died on June 22nd. An inquest was held on June 26th, when the cause of death was syncope following thrombosis of the inferior vena cava, and puerperal septicaemia. Case 4. Confined at her own home on May 19th, being delivered by the same midwife from the Kingston Nursing Association as attended Cases 1 and 2. The midwife was withdrawn from this patient on May 22nd, owing to the condition of Case 2, and another midwife was substituted for her. This patient had some rise in temperature for three days during the puerperium, but was left on the 10th day. On the 15th day she was not well, and her husband called in a doctor, who reported to me that he thought she was suffering from parametritis on June 5th. On June 7th the doctor stated that she was improving. She was sent into the Kingston and District Hospital on June 10th, and notified as a case of puerperal fever. 23 To-day, July 1st, the Medical Superintendent reports : " The acute symptoms which she had on admission have abated; fortunately the infection appears to be fairly well localized in the pelvis. She still runs a temperature varying from 99 to 101. The prognosis is doubtful, and however favourably she progresses, her recovery is likely to be very protracted. Her general condition remains fairly good." This patient's baby was sent into the Kingston and District Hospital on June 8th, and died the following morning. An inquest was held and the Coroner gave a verdict in accordance with the medical evidence—syncope from general peritonitis, the umbilical cord having become infected from an outside source. It will be noted that Cases 1, 2 and 4, were all delivered at their homes by the same midwife, and that the babies of Cases 2 and 4 both died from pyaemia originating from umbilical sepsis. The Surrey County Council are responsible for the administration of the Midwives Acts, but on May 26th I wrote a confidential letter to the County Medical Officer of Health, calling his particular attention to the fact that the two cases which had been notified up to that time were attended by the same midwife. I also reminded him that a case of hers occurred in the Nursing Home just prior to last Christmas, and informed him that I had made personal investigations at that time into her cases in the past, but was unable to produce evidence that she was the cause of infection. Though Cases 1 and 2 had occurred on the District, and circumstances did not point to the infection being at the Nursing Home itself, it was thought advisable to issue instructions that no further patients should be admitted, and an inspection of the Home was made, when some temperature cases were discovered. It was then decided to clear the Home as soon as practicable, and to carry out complete disinfection of the building and contents, and close the Home for at least one month after the departure of the last patient. The inquiries into the temperature cases in the Home revealed the following facts:— Case A. Confined on March 11th, attended by a midwife— adherent placenta removed by a doctor. White leg on March 24 25th, and second white leg on April 4th. Temperature normal by April 26th. Case B. Confined on May 13th (the midwife who attended Cases 1, 2 and 4 examined). Curetted May 29th—retained products found. Dr. J. Bright Banister, obstetric surgeon, saw this case and diagnosed parametritis. She was removed to Chelsea Hospital under his care. Case C. Forceps delivery on May 21st—complete tear involving the bowel—stitched. Seen by Dr. J. Bright Banister on June 3rd—hæmatoma diagnosed which discharged the following day—temperature fell. With regard to these temperature cases, I do not think that there is any evidence that Cases A and C are connected with the series of puerperal fever cases. Case B was examined by the midwife concerned in the puerperal fever cases, and it appears very probable that she was the cause of infection in this case. In answer to my letter, Dr. Banister reports on June 25th, that he saw this woman at Kingston Nursing Association Home about three weeks ago. "She then had a temperature of 103 and a pulse of 110, but in general appeared quite well. The history that I got was that she had a normal labour, but had developed fever soon afterwards. When this fever had persisted for some days, she was examined under an anaesthetic, and a piece of placenta was removed. The uterus was then curetted, following which there was a marked exacerbation of fever. On my examination she appeared to have a large parametric effusion principally on the left side. As I thought this was likely to require surgical intervention, I admitted her to the Chelsea Hospital for Women next day. Three days after her admission there, she passed another piece of what appeared to be placenta. The fever has continued, and the parametric effusion has got firmer. I have not yet operated, as I am waiting for some sign of pointing." Now returning to the notified cases of puerperal fever, I think that it is very doubtful that Case 3 was infected while in the Nursing Home, and in my opinion there is no definite proof that infection was introduced while she was there. With regard to Cases 1, 2 and 4, the two babies, and 25 temperature Case B, it will be seen that they were all attended by the same midwife. This midwife is stated to have contracted a septic finger from the baby of Case 2. It appears that formerly she suffered at times from an ear discharge, though not lately. Swabs were taken from her throat, and the laboratory report states: "The cultivation of this throat swabbing gives considerable growths of streptococci with small numbers of a non-pathogenic staphylococcus albus, and of a chromogenic micrococcus catarrhalis. "The streptococci occur iawn three strains, two of which are haemolytic and one non-hæmolytic. "The hæmolytic strains belong to Brown's beta type, and according to Holman's grouping, one of the strains is a true streptococcus pyogenes longus, and the other a streptococcus angiosus. The third strain is of Brown's gama type (non-pathogenic streptococci)." A later report on the virulence of these two hæmolytic strains reads:— "Each of these streptococcal strains has been injected subcutaneously and intra-peritoneally into white mice. None of the animals died within a week of infection. Post-mortem examination showed circumscribed local lesions at the site of injection only." CONCLUSIONS. In my opinion the midwife, who attended Cases 1, 2 and 4, the two babies, and temperature Case B, was the infective agent. It is my view that infections of this nature are conveyed by individuals, and that the source is not as a rule traceable to the room or ward of an institution. Though the midwife's septic finger is stated to have been contracted from the baby of Case 2, I do not think the possibility that it was previously infected can be ruled out completely. I do not propose to review the methods of administration adopted by the staff of the Kingston Nursing Association, as an inquiry has been made by a medical officer from the Ministry of Health. The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into operation on October 1st, 1926. Puerperal Fever was previously notifiable, and still 26 mains so under these Regulations, which in addition require every medical practitioner to notify the Medical Officer of Health of the Local Sanitary Authority of the occurrence cf a temperature of 100.4 degs. Fahrenheit sustained during a period of twenty-four hours, or recurring during that period in a woman within twenty-one days after childbirth or miscarriage. Also it is provided that the Medical Officer of Health of the Local Sanitary Authority must, within twenty-four hours of the receipt of a notification under these Regulations, forward a copy to the County Medical Officer of Health. Under these Regulations, Andrew McAllister, M. B., B.S.(Lond.), F.R.C.S.(Eng.), was appointed Consultant. No notifications were received before the end of the year. Ophthalmia Neonatorum. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during- 1926:— Notified. Treated Vision unimpaired Vision impaired. Total Blindness Deaths At Home. In Hospital. 2 2 – 2 – – – The Public Health (Ophthalmia Neonatorum) Regulations, 1926, came into operation on October 1st, 1926. Under these Regulations the duty of notifying Ophthalmia Neonatorum is placed solely on the medical practitioner attending the case. Also the Medical Officer of Health of a Local Sanitary Authority must forward a copy of the notification to the County Medical Officer of Health within twenty-four hours of its receipt. Orthopœdic Treatment. A scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton, and District Red Cross Curative Post, Norbiton, was approved by the Ministry, and put into operation on October 1st, 1926. The following arrangements were made:— 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. 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. 27 3. Surgical boots, surgical appliances which have to 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 Medical Officer of Health will visit the Centre from time to time. 6. All cases for whom the Authority accepts responsibility must be recommended for treatment by the Medical Officer of Health, 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 Medical Officer of Health 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 Medical Officer of Health. During the last quarter of the year, 8 infants received out-patient treatment, making 66 total attendances at the Red Cross Curative Post. The total cost for this period was £7 3s. 0d., and the contributions paid by the parents towards this expenditure amounted to £1 15s. 8d. I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections Written Notices. Occupiers prosecuted. Factories—(including Factory Laundries) 36 — Nil Workshops—(includingWorkshop Laundries) Workplaces—(other than Outworkers' premises) Total 36 – Nil 28 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 5 4 – – Want of Ventilation — — — – Overcrowding — — – — Want of drainage of floors — — — – Other nuisances 4 4 — – Sanitary Accommodation Insufficient — – – – Unsuitable or Defective – – – – 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 3 3 – – Total 12 11 – – *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 Report of the Sanitary Inspector. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present to you my Eighth Annual Report on the work carried out by your Sanitary Inspectors during the year 1926 in connection with the various Statutes and Bye-laws relating tp Public Health in force within the Borough. The total number of inspections during 1926 was 6,540 as compared with 6,533 during 1925. On 690 premises sanitary defects to the number of 2,500 were discovered. In connection with these defects 497 "preliminary" and 69 "verbal" notices were issued. In 92 instances it was found necessary to serve "statutory" notices. During the year 1926 particulars relating to the inspection of 690 premises were added tp the records, whilst 899 entries were struck off the registers following the completion of necessary works. On December 31st, 1926, 246 premises remained on the registers, compared with 389 at the end of 1925. This substantial reduction shows that the arrears of work is being overcome successfully despite the greater number of fresh premises dealt with during 1926. The number of inspections during 1926 is approximately the same as for the previous year. The number of visits to slaughter-houses and food premises has increased, whilst a corresponding reduction is shown under Works in Progress and other headings. Each of the Schools in the Borough was inspected during the year and details of sanitary improvements carried out are contained in the Report of the School Medical Officer. Assistance was rendered to the Housing Committee in various ways during the year. 30 A considerable amount of time is taken up with clerical routine, interviews with owners of property and other administrative work which does not call for detailed comment in a brief report. 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 1,973 Visits to Works in Progress 886 Factories and Workshops 36 Cowsheds, Dairies and Milkshops (excluding inspections by Medical Officer of Health and Veterinary Inspector) 55 Ice Cream Premises 16 Foodshops and Food Preparing Rooms 452 Infectious Disease Inquiries 258 Markets 59 Special Inspections (Complaints, etc.) 1,307 Slaughter-houses 987 Offensive Trades 12 Sanitary Conveniences 86 Common Lodging-Houses 23 Canal Boats 4 Theatres, Cinemas, etc. 20 House-to-House 16 Bakehouses 13 Smoke Observations 20 Stables and Yards 61 Miscellaneous Visits 246 Total number of Inspections 6540 Drainage. Number of Houses and Premises re-drained 31 Number of Drains repaired or amended 7 Drains or Gullies unstopped or cleansed 44 Manholes provided 65 31 Manholes altered or repaired 2 Intercepting Traps fixed 26 Fresh-air Inlet Shafts repaired or renewed 33 New Gully Traps fixed 157 Gully Curbs renewed or repaired 9 New Soil Pipes or Ventilating Shafts 42 Soil Pipes or Ventilating Shafts repaired 3 Smoke Tests applied 42 Water Tests applied 80 Subsoil drainage provided 4 Gratings provided to gully traps 3 Rain Water Pipe disconnected from Soil Pipe 1 Miscellaneous 1 Water Closets and Sanitary Fittings, W.C. Apartments cleansed and limewashed 44 New W.C. Basins fixed 78 W.C.s unstopped, cleansed or repaired 10 W.C. Flushing Tanks repaired or renewed 54 Water supplied to W.C.s 2 New W.C. Apartments provided 5 W.C. Apartments lighted, repaired and ventilated 46 New Impervious Sinks provided 40 New Waste Pipes fixed 40 Existing Waste Pipes trapped or repaired 4 Urinals cleansed or repaired 14 Urinals reconstructed 2 Miscellaneous. New roofs 3 Roofs repaired 51 Eaves Gutters renewed or repaired 48 Stack Pipes renewed or repaired 37 Stack Pipes disconnected from Drains 93 Damp Walls remedied 69 Ventilation provided beneath floors 42 Yards and passages paved 85 Yard Paving repaired 8 Yards cleansed 11 Floors of Rooms repaired 44 Floors of Rooms renewed or repaved 15 Rooms repaired, cleansed and distempered 387 Additional light and ventilation to sculleries 4 Verminous rooms cleansed 8 32 New ceilings 6 Windows repaired, renewed or made to open 128 Doors re-hung or repaired 8 Cisterns repaired, cleansed, covered or removed 24 Door and window sills renewed or repaired 37 Stairs repaired or renewed 3 Portable ashbins provided 378 Accumulations of manure and refuse removed 18 Nuisance from overcrowding abated 14 Nuisance from animals abated 3 Water supplied direct from main 30 Water supply reinstated 9 Wells abolished and M.W.B. water laid on 2 Premises limewashed (Workshops, food preparing rooms, etc.) 9 Fire grates repaired or renewed 26 Sheds removed 4 Defective coppers repaired 23 Walls repaired, repointed or rebuilt 30 Handrails, provided to staircases, or repaired 26 Manure or offal receptacles provided or repaired 13 Nuisance from smoke abated 2 Closing Orders made 1 House demolished 1 Miscellaneous 22 Common Lodging Houses. Verminous bedding cleansed 2 Common room cleansed 1 Schools. Wash-house cleansed 1 Urinal Flush repaired 1 W.C. Pan cleansed 1 Glazed Slab Urinals provided 2 New Basin provided 1 Sanitary Apartment cleansed 1 Ashpit abolished 1 Ashbins provided 2 Smoke Abatement. A decrease in the number of complaints in respect of alleged nuisance from smoke occurred during 1926, the 33 ber being 2 compared with 8 during 1925. Twenty smoke 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. 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 approach 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 I would again point out that it is very 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 1926, 23 inspections were made of the registered premises. At both 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. Fish Frying. 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. 34 The trade of fish-frying was declared an offensive trade in the Borough by the Corporation during 1926. 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. In other premises modern ranges, constructed sp as to effectually prevent the escape of any objectionable odours, have been installed. The adoption of Bye-laws dealing with Offensive Trades was under consideration by the Council at the close of the year. Twelve visits were made to premises in connection with offensive trades in addition to re-inspections after notices or warnings. Complaints. One hundred and thirty-nine complaints were received during the year as follows:— Drains and Sanitary Arrangements 16 Overcrowding 7 Insanitary Condition of Premises 59 Absence of Ashbin 2 Water Supply 4 Accumulation of Manure and Non-collection of House Refuse 10 Dampness 7 Keeping of Animals and Fowls 3 Smoke Nuisance from Chimneys 2 Defective Stoves 3 Defective Roofs and Gutters 7 Rag and Bone Yards 2 Odours from Trade Waste 7 Stagnant Water 1 Condition of Undeveloped Land 2 Miscellaneous 7 139 The complaints were investigated promptly, and where the Corporation possessed powers to intervene immediate steps were taken to remove the cause of the complaint. The number of complaints during 1925 was 176. 35 House Drainage. Thirty-one houses were redrained during the year as compared with 53 during 1925. 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:— Brunswick Road 1 Cambridge Grove Road 1 Canbury Park Road 2 Cowleaze Road 7 Durlston Road 1 Elm Crescent 13 Elm Road 1 Liverpool Road 1 St. James' Road 1 Uxbridge Road 1 Water Lane 2 Increase of Rent & Mortgage Interest Acts. Twelve applications were received during the year from tenants for certificates under Section 2, Sub-Section 2, pf the above Act, as compared with 12 during 1925. 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 four instances necessary repairs were not carried out by the owners, and certificates were granted to the tenants. 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 150 36 (ft) With State assistance under the Housing Acts. (1) By the Local Authority 58 (2) By other bodies or persons Nil 1. Unfit Dwelling-houses. Inspections: (1) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 75 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925. 6 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably tit for human habitation 552 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 634 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 37 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close nil B.—Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 87 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 94 (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 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit nil (4) Number of dwelling-houses in respect of which Demolition Orders were made 1 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 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 30, 31 and 32 where details are given of the works carried out during 1926. Generally speaking, there was a large increase in the amount of sanitary works executed as the result of action by the Department. 38 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 31 houses were entirely redrained during 1926. A house-to-house inspection of ashbin accommodation was continued during the year, with good result. Very considerable works have been carried out to houses in Acre Road following Housing Inspections. 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. During the year efforts were concentrated upon a reduction in the number of premises under review, and as a result, the number outstanding at the end of 1926 was less than two-thirds the number outstanding at the end of 1925. This action caused a large increase in the number of reinspections and is also reflected in the details of sanitary works completed. The number of statutory notices served during the year shows an increase but only 18 of the notices related to serious sanitary defects whilst the remainder required the provision of ashbins. Included in the statutory notices complied with are no less than 21 notices served in the Elm Crescent area during 1925 requiring premises to be redrained. Of the remainder, 62 referred to ashbins and 11 to sanitary defects in dwelling houses. Inspection and Supervision of Food. (a) Milk Supply. During 1926, three persons were removed from the Registers. Five purveyors of milk were added to the Register, making a total of 41 on December 31st, 1926, compared with 33 at the end of the year 1922, when the 39 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. No licences have been issued to producers in the Borough in respect of graded milk, but two licences have been granted to dairymen to sell certified milk. In addition, one licence has been granted to bottle and sell "Grade A" Tuberculin Tested Milk. No request has been made by the Ministry of Health for samples to be taken for bacteriological examination. 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. (b) Meat and other Foods. The work of meat and foods inspection is now generally regarded as one of the most important of the duties of Sanitary Inspectors and in this Borough every effort has been made to ensure that the inspection shall be both regular and efficient. The Meat Regulations require notice of intention to slaughter to be given and it is, therefore, possible to arrange for inspection of the carcases with a reasonable degree of certainty. The past year has seen very greatly increased activity in this branch of the work in the Borough. 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 Meat 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. During last year permanent notices of slaughter were given in respect of two slaughter houses, which covered each 40 day of the week except Friday, Saturday and Sunday. Casual notices were received in respect of all the slaughter houses in addition to the permanent notices. The casual notices referred to slaughtering carried out at irregular times on each day of the week including Saturdays and Sundays. Over 99 per cent. of the animals slaughtered in the town during 1926 were inspected. The work of meat and foods inspection is not confined to the examination of carcases slaughtered in the Borough. Visits are made to all kinds of food premises, such as restaurants, sausage making rooms, ice cream makers, bakehouses, grocers, etc., etc. The total of such visits made during the year was 1,523. The wholesale meat stores, and the vehicles used, have been kept under observation during the year. 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 year 1926:— 41 MEAT REGULATIONS, 1924. Summary for Period Year ended December 31st, 1926. Number of Notices Received. Number of Animals Slaughtered. Carcases not Examined. Percentage of Total Animals not Examined. Beasts Pigs. Calved Sheep, Goats, Total. Pigs. Calves Sheep Goats. 827 42 3413 2512 1382 287 7636 3 4 27 12 .6 Inspections during Office Hours. Percentage of Total. Inspections made after Office Hours. Percentage of Total. 216 21.6 784 784 42 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— 3592 lbs. and I forequarter Bone taint or putrefaction Surrendered 148 lbs. Bruised ,, Ox Kidneys and Kidney Fat 164 lbs. Putrefaction ,, Liver—28 lbs. ,, ,, 1 Liver Tuberculosis ,, 6 pairs of Ox Lungs ,, ,, 4 Mesenteries ,, ,, 1 Heart ,, seized 5 Ox Heads and Tongues ,, surrendered 2 Hindquarters Tuberculosis seized 1 Carcase and Offal ,, surrendered MUTTON- 765 lbs. Putrefaction Surrendered 17 lbs. Lambs Tongues ,, ,, 15 dozen Hearts ,, ,, 1 Pluck Parasitic disease ,, 1 Sheeps Head ,, ,, 4 Livers Flukts ,, PORK— 6 Carcases and Offal Tuberculosis 4 surrendered and 2 seized 1 Carcase and Offal Oedema surrendered 4 Forequarters Tuberculosis ,, 86 Heads and Necks ,, 84 surrendered and 2 seized 26 Plucks ,, surrendered 5 pairs Lungs ,, ,, 25 Mesenteries „ ,, 7 Spleens ,, 6 surrendered and 1 seized 2 Udders Actinomycosis surrendered 28 lbs. Kidneys Putrefaction ,, 70 lbs. ,, ,, GOAT— I Liver Parasitic Disease ,, VEAL— 4 Carcases and Offal Tuberculosis 2 surrendered and 2 seized surrendered 2 Calves' Plucks 11 1 Calf's Liver ,, ,, 82 lbs. Putrefaction ,, 43 FISH— 3 stone Herrings Putrefaction Surrendered 3½ stone Skate Wings ,, ,, 4 stone Haddocks ,, ,, 4 stone Dog Fish ,, ,, FRUIT— 507 Pears Arsenica! Contamination ,, There appears to be a reduction in the incidence of Tuberculosis in pigs over the whole year. This may be accounted for by the gradual reduction in the number of diseased cows following upon the re-introduction of the Tuberculosis Order. There should be a corresponding reduction in the amount of infected milk but statistics are not available for this district. Special mention should be made of the last item on the list of condemned foodstuffs. Samples of pears upon which the familiar greyish fruit wash could be seen clearly were sent to the public Analyst for examination. The result of the analysis showed that arsenic was present in appreciable quantities and the pears were condemned and destroyed. 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. Water Supply. The water supply of two houses which was investigated at the end of 1925 and found to be derived from unsatisfactory shallow wells, was dealt with during 1926. The use of the well water was discontinued and the premises were provided with services from the Metropolitan Water Board's mains. 44 I am of opinion that owners of property would be more willing to close doubtful wells if the cost of providing an alternative supply could be reduced. A substantial reduction in cost could be effected by the omission of large storage tanks, especially in the case of small cottages. The provision of tanks, where no hot water system is installed, and where a constant supply is maintained, seems quite unnecessary, and I have noticed no inconvenience result from the removal of tanks in such circumstances. 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 Dec., 1926. Registered 3 Licensed 3 Total 6 All the premises have been in use during 1926. 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. Nine hundred and eighty-seven visits were paid to these premises during the year, as compared with 742 during 1925. Disinfection. During 1926, 1,304 articles were passed through the steam disinfecting apparatus, compared with 2,275 during 1925. In addition to the steam disinfection, 204 rooms and contents in 175 houses were sprayed and fumigated with formalin. In addition to disinfection after notifiable infectious diseases, articles are also collected for steam disinfection and 45 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. Seven patients were conveyed in this ambulance last year. Factories, Workshops and Workplaces. Thirty-six visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in Tables on pages 27 and 28. 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 1926. 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. Sanitary Condition of Music Halls, Cinemas, &c. Twenty 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. 46 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 1926, four visits and inspections were made in connection with the Canal Boats Acts. • There do not appear to be many boats subject to inspection in this part of the river. The working stages are short and the crews live ashore instead of on board. Sanitary Conveniences. Attention was again given to the conveniences attached to Refreshment Places during the year. Two urinals were entirely reconstructed and the structural and sanitary condition of these places compares very favourably with similar premises in other towns. Legal Proceedings. Legal proceedings were instituted in two instances during 1926. In the first c;ise application was made to the Court for possession of a house in respect of which a Closing Order had been made. The Court made an Order for possession and the tenant vacated the property, which was then demolished. The second case was that of a Meat Dealer who was summoned for (1) failing to give notice of disease in a carcase and (2) removing carcases between the hours of 7 p.m. and 7 a.m. without sanction and before the carcases had been examined, in contravention of the Meat Regulations, 1924. The Defendant pleaded guilty and was fined £3 on each summons and ordered to pay £2 2s. Od. costs. Conclusion. I again desire to thank the Chairman and the members of the Public Health Committee and the Corporation generally for their kindly consideration and support during the year. I am, Ladies and Gentlemen, Your obedient Servant, HAROLD T. PERRY, A.R.San.I., Chief Sanitary Inspector. Municipal Offices, Kingston-upon-T hames. 47 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 1926. The average number of children on the school register for the year was 4,636. There was no School closure on account of Infectious Disease. Medical Inspection was carried out on the same lines as before, and though a very occasional objection to Medical Examination of a child has been received, in each instance the objection has been withdrawn after a visit to the parent by the School Nurse. The improvement observed in the condition of the mouths of children of the Intermediate Group examined at Routine Medical Inspections, due to the fact that most of these had received dental treatment, was most gratifying. The School Dentist devoted three half-days a week to the work, but as the Scheme for Dental Treatment extends to include further age groups, more time will be required for this branch of the Service. The appointment of an additional School Nurse, who commenced duty on May 31st, enabled arrears in the work to be cleared off, and placed the Nursing Service on a satisfactory footing. 48 The scheme for Orthopaedic treatment of Crippled children worked smoothly, and in most cases parents paid towards the cost of out-patient treatment according to their means. As regards children admitted to Hospitals under the scheme, the parents' contributions were very small in spite of the fact that while a child is in Hospital, a parent is actually saving the cost of the child's maintenance. The Eye Clinic was held on alternate Wednesdays during school terms, eighteen meetings in all being necessary during the year. The popularity of the Inspection and Minor Ailments Clinic was well maintained. The year may be regarded as a very satisfactory one, in which steady progress has been made, and the efficiency of the Service increased. I thank the Nursing Staff, under the able direction of Miss R. Bartter, for their willing and loyal support at all times. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 49 Staff of the School Medical Service. School Medical Officer: E. W. MATTHEWS, m.b., b.s.(lond.), m.r.c.s., l.r.c.p., d.p.h, Ophthalmic Surgeon: WINIFRED WARNER, m.b., b.s.(loNd.), d.p.h Dental Surgeon : H. A. L. MORRIS, l.d.s., r.c.s. (eng.). School Nurses : Miss R. BARTTER (Senior) 3/5 time. Miss E. RILEY 1/5 time. Miss A GILL 1/5 time. Miss C. A. HOOKWAY whole time. Clerk: Miss O. ROWLES. Miss G. H. Saunders relinquished her post as 1/5 time School Nurse on February 20th, having obtained the position of Ward Sister at the Northern Hospital, Winchmore Hill. Miss A. Gill was appointed to fill the vacancy, and took up her duties on March 3rd. In order that the work of the School Medical and Dental Services might be efficiently carried on, the appointment of a second School Nurse was sanctioned by the Board of Education. Miss C. A. Hookway was appointed to the post, and took up her duties on May 31st. 5° Miss F. Francis who had been typist since 1921, resigned and left at the end of January. Miss Stacey succeeded her temporarily, and Miss O. Rowles, a pupil from the Technical Schools was appointed typist on May 26th. CO-ORDINATION. The School Medical Officer is also Medical Officer of Health. It is hoped in the near future that the working time of each individual Nurse will be equally divided between School Nursing and Health Visiting', as by this means, I think, there is little doubt that the efficiency and flexibility of both Services would be enhanced, and also the allocation of duties would be simplified. The Nursing Staff would welcome this equal division of duties. 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. SCHOOL HYGIENE. A general review of the Public Elementary Schools was set out in last year's Annual Report, giving in detail their hygienic conditions with particular reference to their surroundings, ventilation, lighting, warming, and sanitation. During 1926 the following repairs and improvements have been carried out :— Bonner Hill Road School. Sundry distemper work has been done to the staircases, Teachers' Room, Masters' Room, etc. The walls and woodwork in the Boys' lavatory were distempered and painted where required. Richmond Road School. The walls and ceilings of all classrooms, cloakrooms, and passages in the Infants' School have been distempered, and the woodwork washed down. The walls of the Infants' lavatory have been distempered. 51 St. Luke's School. In the Boys' Department, the two cracked w.c.'s have been repaired, and the urinal cleansed, but not reconstructed. In the Girls' Department the two cracked basins have been repaired. St. Paul's School. The ceilings and walls of all departments have been distempered. The Boys' urinal has been cleaned and improved. The urinal for infant boys has been cleansed and the paving relaid, but not reconstructed. St. Peter's School. The ceilings and walls of all departments have been distempered, and sundry repairs have been carried out to the roof and chimneys. The cement urinal has been cleaned and the walls distempered. The surface water drains have been cleared. St. John's School. In order to obtain better heating, the stoves have been brought forward into the classrooms, and the steps under the doors renewed. The paving of the boys' urinal has been repaired and the walls distempered. In the Girls' Department the movable cover over a drainage inspection chamber in the passage has been sealed, and a new manhole constructed in the playground. The asphalt paving forming the approach to the Infants' Department has been repaired. St. Agatha's School. The boys' w.c.'s have been repainted. The urinal has been cleansed, but has not yet been provided with any flushing apparatus. All Saints' School. The boys' urinal has been relined with glazed slabbing. The defective w.c. in the Girls' Department has been repaired. 52 The old dust pit has been demolished and replaced by a sanitary dustbin. In the Infants' Department new basins have been provided in the outside wash-house. The w.c.'s are now flushed four times a day, and the urinal for infant boys has been relined with glazed slabbing and the walls distempered. MEDICAL INSPECTION. All Departments of every School are visited by the School Medical Officer each term for the purpose of carrying out Routine, Special, and Re-inspections. A full description of the methods employed at these inspections was set out in last year's Annual Report. Parents are warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows :— No. of Children Examined. No. of Parents present. Percentage. Entrants, Boys 281 231 82% Girls 243 197 81% Intermediates, Boys 177 94 53% Girls 187 125 67% Leavers, Boys 245 83 34% Girls 257 138 54% The above percentages equal those of last year, which were the highest yet attained. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. Efforts are still being made to shorten the period which elapses between the issue of an exclusion certificate by the School Medical Officer, and the appearance of the parent before the School Attendance Sub-Committee, and later before the Justices. I am glad to be able to note that during the year there has been a speeding up in this direction, and that only in eight instances has it been necessary to take legal proceedings. At Routine Medical Inspections, 87 children were found unclean, and the School Nurses at their cleanliness surveys discovered 857 individual children requiring treatment for uncleanliness. 53 (b) Tonsils and Adenoids. There were 49 children suffering from enlarged tonsils and adenoids referred for treatment during the year. (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 was particularly prevalent during the Autumn, and 193 cases for the whole year is the highest figure yet recorded. The 34 cases of ringworm of the scalp, and 42 of body constitute about an average number. Only 8 cases of scabies were discovered during the year. (e) Vision. During the year 62 children were found requiring treatment for defective vision, this number being below the average. In my opinion, now that the Eye Clinic has been established since October, 1925, we must expect to find somewhat fewer children needing treatment, as many of those inspected in the Leaver Group have already been treated as Intermediates, which" was, oT course, not so when the Clinic was instituted. (/) Dental Defects. At his inspection the School Dentist found 760 children requiring treatment. MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily at the Clinic during School Terms, 5,128 attendances being registered during the year. (b) Tonsils and Adenoids. Operative treatment for tonsils and adenoids has been carried out in the cases of 44 children at the Kingston and District, Kingston Victoria, and other hospitals. 54 (c) Skin Disease. The treatment of impetigo, ringworm, and other skin diseases have 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 78 children during the yeat. (e) Ear Disease and Hearing. Minor ear defects in the cases of 4 children have been treated at the Clinic; other ear diseases and deafness were referred private practitioners and hospitals. (/) Dental Defects. Of the 760 children requiring treatment found by the School Dentist, 433 were actually treated, 279 being rendered dentally fit before the end of the year. Remarks by the School Dentist are given under the paragraph on the Dental Clinic. (g) Crippling Defects and Orthopædics. The Scheme for Orthopaedic Treatment was set out in detail in last year's Annual Report, and 18 individual children have received electrical massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 1,363 total attendances for the year. Those requiring operative or in-patient treatment are sent to St. Vincent's Orthopædic Hospital, Eastcote, and during the year 4 children were treated there. One child was admitted to the Royal National Orthopaedic Hospital. During the year the cost amounted to £115 4s. Od. for out-patient, and £207 12s. Od. for in-patient treatment. Parents' contributions amounted to £31 18s. Od. towards out-patient, and £5 1s. Od. towards in-patient treatment. Parents are expected to contribute towards treatment according to their means, but I am sorry to say that in many instances there appears to be great reluctance on their part to agree to pay anything towards the expenses. The sense of parental responsibility, which might be shown by even the smallest donations, appears to be totally lacking in too many instances. The Central Aid Society has been most helpful in assisting the School Medical Service in obtaining letters for 55 tals, 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. INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. There was an epidemic of Mumps from February to June, affecting Bonner Hill Road, Richmond Road, St. Peter's, All Saints', and St. Paul's Schools. Exclusion of cases only was ordered, contacts being allowed to continue attending School. There were outbreaks of Measles during the same period at Bonner Hill Road Infants', Richmond Road Infants', St. Paul's Infants', St. John's Infants', and St. Agatha's Infants' Schools. An outbreak of Whooping Cough occurred at Richmond Road Infants' School in June and July. The incidence of both Scarlet Fever and Diphtheria was remarkably low, only isolated cases occurring. FOLLOWING-UP. The following-up of children suffering from defects is carried out by the School Medical Officer and School Nurses, 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. The various duties of the School Nurses were set out in detail in last year's Annual Report, and the following table specifies some of the work carried out by them during 1926. 56 Number of children prepared for Routine Medical Inspection 1,565 Number examined at Schools for uncleanliness 17,585 Number of following-up home visits 439 Total number of visits to the Schools 642 Total number of Clinic Sessions 343 VACCINATION. At Routine Medical Inspections an entry is made on the Medical Record Card of every child not exhibiting evidence of previous vaccination. Entrant Infants showing vaccination marks remains at 55 per cent. SPECIAL SCHOOLS. The Special School for Physically Defective Children is situated at " Elmfield," London Road. There are 35 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. Children needing Orthopaedic treatment attend the Red Cross Curative Post, Norbiton, when necessary. SCHOOL CLINIC. The Clinic is situated at " Elmfield," London Road. 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. 57 (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days when the School Nurses carry out the treatment of minor ailments under the direction of the School Medical Officer. No charge is made, but a box is provided for voluntary contributions. (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 310 attendances at the 18 sessions held during the year, 124 being new cases and 116 re-inspections. Refractions numbered 98 and spectacles were prescribed in 78 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. Children for whom spectacles are prescribed are reinspected by the School Medical Officer when he visits the Schools each term. In too many instances children are found at School without their glasses. The excuses offered by the children are either that the glasses are broken, lost, or that the parent says that they are unnecessary. This last excuse, I think, is unpardonable, but is one that has been given on more than one occasion. The following-up of children who have had spectacles prescribed, causes far more work than it should, and in 58 obstinate cases the Teachers are asked to assist by requiring these children to wear their glasses when at School. (d) Dental Clinic. During the year three sessions per School Week were devoted to Dental Inspection and Treatment. In all, 18 half days were given to Inspection,and 111 to Treatment. When necessary, a session is devoted entirely to those requiring a general anaesthetic, when the School Medical Officer attends to administer the nitrous-oxide gas. There were 139 gas cases during the year. Mr. H. A. L. Morris, the School Dentist reports as follows :— The arrears of treatment, carried over from 1925, were cleared off. During the year all the children of the new group were inspected, and the remainder re-inspected. Every effort was made to inspect children absent through illness, etc., later. The younger groups were large, and consequently the number of children found to require treatment is still high, but I am glad to report that the condition of the mouths of the older children who have previously been rendered dentally fit, is good, and comparatively few required further treatment. Unfortunately there are a number of children, whose parents refused the treatment when first offered, but the number of refusals is getting less. The condition of the teeth of these children is getting progressively worse, and if and when they eventually present themselves for treatment, more time has to be spent in rendering them dentally fit, the permanent teeth requiring large and extensive fillings, and the temporary teeth being unsavable. The root of the trouble is that an extraordinary number of people mistake the first permanent molars for teeth of the deciduous set, and are quite happy to let them decay, on the false presumption that they will be replaced. When their mistake is pointed out, and they are finally convinced, they are usually anxious for treatment. It is also explained that the deciduous teeth are given to children for a function, and should remain in the mouth until due to be lost naturally, between the ages of seven and eleven, and because they will be replaced is no reason why they should be allowed to decay unchecked, and so be lost prematurely before their function is carried out. 59 EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 92 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 676 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 lid. 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. The Teachers are invited to bring any children they consider defective before the School Medical Officer. If suffering from a physical defect, they are admitted to the Special Day School for Physically Defective Children at " Elmfield," London Road. 6o There is no Special Day School for Mentally Defective children, and difficulty is experienced in the disposal of feeble-minded children who are considered suitable for admission to such a School. Investigations are proceeding into the possibility of forming, staffing, and housing a school of this kind. SCHOOL CAMP St. Peter's Girls' School. The Head Teacher, Miss A. Thompson, and her assistants again were able to raise funds to take a party of girls to Dovercourt for a week. In all, 30 girls, 6 of whom paid all, and 6 part of their expenses, proceeded to Dovercourt on June 18th and returned on June 25th. Prior to departure, the girls were examined by the School Medical Officer. During the Coal Strike, no reduced fares by rail were available, and the possibility of carrying out the excursion was threatened. The Mayor, Councillor G. D. Densham, very kindly raised enough money to defray the expenses of the return journey by charabanc, and so these children from a poor part of the town were able to benefit by a change of air as arranged. Similar excursions were made in 1922, 1923, and 1924 to Broadstairs, and in 1925 to New Romney, and I hope Miss Thompson will continue to carry on this splendid work every year. STATISTICAL TABLES. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 524 Intermediates 364 Leavers 502 Total 1,390 Number of other Routine Inspections 175 B.—Other Inspections. Number of Special Inspections 1.521 Number of Re-Inspections 6,335 Total 7,856 TABLE II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1926. Defect or Disease. Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring lo be kept under observation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — — – Uncleanliness— (See Table IV.GroupV.) 87 — 857 — Skin Ringworm, Scalp — — 24 1 Body — — 46 - Scabies — - 8 - Impetigo — — 193 — Other diseases (non Tb) 3 2 263 2 Eye Blepharitis 3 — 11 — Conjunctivitis 1 - 10 1 Keratitis — - — — Corneal Opacities — 1 — — Defect.vision exc.Squint 32 1 30 2 Squint 15 1 5 1 Other Conditions 1 — 9 — Ear Defective Hearing 3 2 1 — Otitis Media 6 1 4 — Other Ear Diseases — 2 22 — Nose and Throat Enlarged Tonsils only 25 3 13 1 Adenoids only 1 — 4 - Enlarged Tonsils and Adenoids 2 - 4 2 Other Conditions 1 — 39 6 Enlarged Cervical Glands (non Tb) 10 14 21 3 Defective Speech — 2 - — Teeth—Dental Diseases 8 — 5 — (see Table IV., Group IV.) Heart and Circulation Heart Disease—Organic 1 4 2 1 Functional 1 2 2 - AnEemia 1 — 1 — Lungs Bronchitis 1 1 2 1 Other non Tb. Diseases 2 2 5 2 Tuberculosis Pulmonary—Definite — — — — Suspected 1 1 — — Non-Pulmonary-Glands 2 — — — Spine 1 — — — Hip - 1 — — Other Bones & Joints — — — — Skin — — — — Other Forms - — — — Nervous System Epilepsy — — — 4 Chorea 2 - 7 1 Other Conditions - 2 3 1 Deformities Rickets 1 - - - Spinal Curvature 5 — — — Other Forms 4 2 12 — Other Defects and Diseases 11 5 151 31 TABLE 11.—continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT EXCLUDING UNCLEANLINESS AND DENTAL DISEASES. GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups—Entrants 524 54 10 Intermediates 364 26 7 Leavers 502 41 8 Total Code Groups 1390 121 9 Other Routine Inspections 175 22 12 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. — — — Boys. Girls. Total. Blind (including partially blind] (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind – – – Attending Public Elementary Schools – – – At other Institutions – — — At no School or Institution – — — Deaf (including deaf and dumb and partially deaf) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf – 4 4 Attending Public Elementary Schools – – – At other Institutions – — — At no School or Institution – — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf – – – Attending Public Elementary Schools 1 1 At other Institutions – – – At no School or Institution – — — Mentally Defective Feebleminded (cases not notifiable to the Local Con. trol Authority). Attending Certified Schools for Mentally Defective Children 2 – 2 Attending Public Elementary Schools 32 16 48 At other Institutions — 1 1 At no School or Institution 1 1 2 Notified to the Local Control Authority during the year. Feebleminded 1 — 1 Imbeciles 1 — 1 Idiots — — — TABLE III.—Continued. — — — Boys. Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics – – – In Institutions other than Certified Special Schools . – – – Attending Public Elementary Schools – – – At no School or Institution — — — 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 tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board – – – At other Institutions – — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board – – – At Certified Residential Open Air Schools – – At Certified Day Open Air Schools – – – At Public Elementary Schools 1 1 2 At other Institutions – — — At no School or Institution — — — Delicate children (e.g pre or latent tuberculosis, malnutrition.debility, anæmia, etc). At Certified Residential Open Air Schools – – – At Certified Day Open Air Schools – – – At Public Elementary Schools 5 6 11 At other Institutions – — — 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 2 3 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 1 1 2 At Certified Residential Cripple Schools At Certified Day Cripple Schools 17 15 32 At Public Elementary Schools 2 3 5 At other Institutions — — — At no School or Institution – – – 64 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1926. 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 12 11 23 Ringworm, Body 29 5 34 Scabies 7 — 7 Impetigo 108 2 110 Other Skin Disease 65 11 76 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 14 9 23 Minor Ear Defects 4 1 5 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 38 6 44 Total 277 45 322 Group II.—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). Dcfect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. , Errors of refraction (including Squint) 98 19 117 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) .) 6 — 2 8 Total 104 19 2 125 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 78 (b) Otherwise 11 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 65 (b) Otherwise 11 65 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. 44 Total 44 Received other forms of treatment 23 Total number treated 67 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 14 329 851 292 196 2 — — – — — Total 1080 Specials 65 Grand Total 1145 (b) Found to require treatment 760 (c) Actually treated 433 (d) Re-treated during the year as the result of periodical examination 71 (2) Half-days devoted to:— Inspection 18 Treatment 111 Total 129 (S) Attendances made by children for treatment 1341 (4) Fillings :— Permanent teeth 473 Temporary teeth 145 Tota 618 (5) Extractions :— Permanent teeth 53 Temporary teeth 906 Total 959 (6) Administrations of general anasstheticsfor extractions l39 (7) Other operations :— Permanent teeth 80 Temporary teeth 232 Total 312 66 Group V.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurse 74 (ii.) Total number of examinations of children in the schools by School Nurse 17,585 (iii.) Number of individual children found unclean 944 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws 8