AC 4413 (1) KINGSTON ??? ??? KIN 5 The Royal Borough of Kingston-upon-Thames. Annual Reports FOR 1927 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report OF THE SANITARY INSPECTOR. The Royal Borough of Kingston-upon-Thames. Annual Reports FOR 1927 OF THE MEDICAL OFFICER OF HEALTH . . ANI) . . 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), 1/2 time. * Miss E. RILEY, 1/2 time. * Miss A. GILL, 1/2 time. * Miss C. A. HOOKWAY. 1/2 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, March, 1928. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1927. Circular 834 (Ministry of Health) directs that the Annual Report for 1927 will be an Ordinary Report, that is, a report of a more simple character than the full Survey Report which the Medical Officer of Health was asked to prepare for 1925. There was an outbreak of Diphtheria in the autumn, otherwise the Borough has enjoyed a year of comparative freedom from infectious diseases. The duties of Meat Inspection continue to be very heavy, and have been conscientiously carried out, occupying a great part of the time of the Sanitary Inspector. Housing conditions show definite improvement, and overcrowding is far less acute than it was some years ago. The steady increase in the attendance at the Ante-natal Clinic is most gratifying, and has fully justified its establishment. The Birth Rate was 13.1 per 1,000 population, the lowest on record for the Borough, and compares unfavourably with 16.7 for England and Wales. The Death Rate was 12.4 per 1,000 population, which slightly exceeds that of the whole country. I thank Mr. H. T. Perry your Chief Sanitary Inspector, and the Staff of the Public Health Department for their loyal support at all times. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health, 4 GENERAL STATISTICS. Area 1,133 acres. Population, 1927 (Registrar-General) For birth-rate 39,330 For death-rate 39,080 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 £291,042 Assessable Value to District Rate £286,510 Sum represented by a Penny Rate— Poor Rate £1,179 District Rate £1,162 Amount of Poor Law Relief (1926) £3,033 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. Male. Female. Legitimate 493 269 224 Birth Rate (R.G.) 13.1 per 1,000 population. Illegitimate 24 11 13 517 280 237 Deaths— 486 241 245 Death Rate (R.G.) 12.4 per 1,000 population. Number of women dying in, or in consequence of child-birth— From Sepsis 1 From other causes 2 Deaths of Infants under one year— Total. Male, Female. Legitimate 16 8 8 Illegitimate 3 2 1 19 10 9 5 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 32 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 125 Total Deaths of Infants under one year of age per 1,000 births 37 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under two years of age) 1 Birth Rate Death Rate Rate per 1000 Births Diarrhœa under 2 years. Total Deaths Under 1 year England and Wales 16.7 12.3 6.3 69 155 Smaller Towns 16.4 11.3 5.0 68 London 16.1 11.9 7.5 59 Kingston-upon-Thames 13.1 12.4 1.9 37 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 241 245 1. Enteric Fever — — 2. Smallpox — — 3. Measles — — 4. Scarlet Fever 1 — 5. Whooping Cough — 1 6. Diphtheria — 1 7. Influenza 11 12 8. Encephalitis Lethargica 1 2 9. Meningococcal Meningitis — 1 10. Tuberculosis of Respiratory System 26 11 11. Other Tuberculous Diseases — 6 12. Cancer, Malignant Disease 29 39 13. Rheumatic Fever 1 — 14. Diabetes 1 4 15. Cerebral Hæmorrhage, etc. 5 7 16. Heart Disease 36 37 17. Arterio-Sclerosis 8 9 18. Bronchitis 19 12 19. Pneumonia (all forms) 27 19 20. Other Respiratory Diseases 1 3 21. Ulcer of Stomach or Duodenum 3 1 22. Diarrhœa, etc. (under two years) 1 — 23. Appendicitis and Typhlitis 2 1 6 24. Cirrhosis of Liver 1 2 25. Acute and Chronic Nephritis 4 6 26. Puerperal Sepsis — 1 27. Other Accidents and Diseases of Pregnancy and Parturition - 2 28. Congenital Debility and Malformation, Premature Birth 4 2 29. Suicide 2 2 30. Other Deaths from Violence 12 9 31. Other defined Diseases 46 55 32. Causes ill-defined or unknown — — METEOROLOGY. 1927. Temperature of Air. Rainfall. Highest. Lowest. Mean Max. Mean Min. Inches. January 48 18 42 25 1.95 February 56 18 43 29 4.01 March 66 24 51 34 3.05 April 69 25 57 35 1.63 Mav 80 25 66 41 1.58 June 79 37 67 47 3.41 July 79 47 71 51 2.95 August 82 43 73 54 4.43 September 79 35 68 51 4.69 October 68 33 59 44 1.17 November 60 26 57 37 3.83 December 59 18 41 34 3.39 Total - 36.09 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. M id wives. The Midwives are under the administrative control of the Surrey County Council. There were nine registered as practising in the Borough at the end of the year. 7 Clinics and Treatment Centres. Centre. Situation. Accommodation. Provided by Maternity and Child Welfare Eden Street Consultation The Corporation Maternity and Child Welfare Washington Road Consultation The Corporation Ante-natal Clinic "Elmfield," London Road Consultation 'The Corporation School Clinic "Elmfield," London Road Consultation & Treatment of Minor Ailments, Refractions, Dental Treatment The Education Committee Day Nursery Canbury Park Road 9 Babies and 16 Infants Vol. Committee Tuberculosis Dispensary Grove Crescent Consultation Surrey C.C. Red Cross Curative Post Coombe Road Out-Patients, Massage, Electrical, Light and Orthopaedic Treatment British Red Cross Society Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. Maternity. The Kingston Nursing Association, 33, Birkenhead Avenue, re-commenced District Midwifery work in the autumn, but decided not to re-open the Maternity Home. Four private Maternity Homes are 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 Hampton Isolation Hospitals accept cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. Smallpox. The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. No case of Smallpox has occurred in the Borough during the year. Other. Other Hospitals situated in the Borough available for the District are:— (a) The Kingston and District Hospital (Board of Guardians). (b) The Kingston Victoria Hospital, supported by voluntary contributions. Institutional Provision for 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. 18, Richmond Park Road. 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 168 accident cases and 33 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 Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Sect. 94). 27th Nov., 1922 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 „ 3lst October, 1911 Tents, Vans, Sheds, and Similar structures „ 28th November, 1924 New Streets and Buildings „ 15th January, 1927 Underground Rooms. „ 26th July, 1927 Fouling of Footpaths „ 9th September, 1927 Smoke Abatement „ 6th October, 1927 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. Eleven wells were abolished during the year. 10 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. The following leaflet was issued to householders:— BOROUGH OF KINGSTON-UPON-THAMES. The Corporation earnestly ask for the hearty and sympathetic co-operation of householders in general, and housewives in particular, in order to render the removal and disposal of house refuse as efficient and economical as possible. Waste Paper should be made into a bundle and placed on the top of the dustbin. Cover the Dustbin with a properly fitting lid. Leaving the bin uncovered allows wet to enter, involving danger to public health. You can Reduce the quantity of refuse to be removed by obeying the following simple rules: Don't put any liquid into the bin—it is not fair to the dustman and tends to destroy your bin. Don't put unriddled ashes into the bin—reduce your coal bill and the rates. Don't put garden refuse into the bin. Bury it in your garden, or, better still, burn it; the ashes are a valuable manure. In either case your garden will benefit. Don't put vegetable refuse into the bin. It is a valuable food for pigs and poultry. If not used thus, it should be buried in your garden or burnt on the kitchen fire. CLOSET ACCOMMODATION. All Closets in the Borough are on the Water Carriage System. SCHOOLS. A general review of the sanitary condition of the Public Elementary Schools was given in 1925. The repairs and improvements carried out during 1927 will be found in the Annual Report of the School Medical Officer, 11 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. MOSQUITO CONTROL. In April the following circular was issued to householders, distributed through the Schools, Clinics, Welfare Centres, etc.:— BOROUGH OF KINGSTON-UPON-THAMES. MOSQUITO CONTROL. A Mosquito is a two-winged insect easily recognised by its long "beak" or "proboscis," which the female (but not the male) employs for blood-sucking purposes. The mosquitoes which settle on our skin or clothing are invariably females. A Mosquito lays 100 to 200 eggs at a time, either on water such as water-butts, puddles, holes in trees, gully traps, and even! rubbish which will hold water, e.g., tin cans, broken china, etc. Hence the importance of Keeping Gardens and Yards Free from Such Accumulations. The mosquito eggs may hatch in as short a period as five hours, when Larvaæ ppear. These larva (often called "wrigglers") hang head downwards in stagnant water with their tail-like breathing tubes just penetrating the surface. In order to exterminate mosquitoes from any locality, we must Attack Them during the Larval Stage. When we have located a "breeding place" (i.e., a collection of stagnant water infected with mosquito larvae) we can either A. Abolish the Breeding Place 1. By filling it in. 2. By draining it dry. 3. By restoring the proper flow of water. Or B. Kill the Larvæ, 4. By paraffining the surface of the water. 5. By mixing some chemical substance cide) with the water. 6. By stocking the water with suitable fish which will devour the mosquito. 12 1f possible, employ methods of Group A., as they effect a Permanent Cure. As regards Group B., No. 4, the film of oil on the surface of the water enters the breathing tubes of the larvae and suffocates them. Should No. 5 be employed, a form of Jeyes' Fluid known as White Cross Disinfectant will kill the larvae if added to infested water in as small a proportion as one part in 30,000 Water thus treated is quite harmless if drunk by human beings or animals. Method No. G is very useful in the case of ornamental lakes, etc. Get Rid of Mosquitoes by Abolishing their Breeding Places or by Killing the Larvæ in Early Spring. E. W. MATTHEWS, Medical Officer of Health. 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 DETER1ORATED. Formal. 1nformal. Total. Formal. 1nformal Total. Milk 62 1 63 3 - 3 Cream 1 - 1 - - - Preserved Cream 1 - 1 - - - Butter - 1 1 - - - Spirits 8 - 8 1 - 1 Other Articles 12 4 16 - - - Totals 84 6 90 4 - 4 No prosecutions were made under these Acts in the Borough during the year. 13 Notifiable Diseases during the Year. Cases. Deaths. 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 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 — 9 6 5o 12 3 4 2 — — 87 62 — — — — — 1 — — — — — — 1 Diphtheria — — 1 2 2 40 12 5 2 1 — — 65 59 — — — — — 1 — — — — — — 1 Enteric Fever including Paratyphoid — — — — — — — 1 2 — — — 3 1 — — — — — — — — — — — — — Pneumonia — 3 4 2 — 3 2 — 6 3 10 7 40 8 — — — — — — — — — — 2 2 4 Erysipelas — — 1 — — 5 8 — 2 7 11 1 35 9 — — — — — 1 — — — — — — 1 Encephalitis Lethargica — — — — — — — — — — 2 — 2 2 — — — — — — — — — — 2 — 2 Poliomyelitis — 1 — — — — — — — — — — I — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 1 7 1 — — 9 4 — — — — — — — — — — — — — Ophthalmia Neonatorum 3 — — — — — — — — — — — 3 1 — — — — — — — — — — — — — Cerebro-Spinal Fever — — — 1 — — — — — — — — 1 1 — — — — — — — — — — — — — New Cases. 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. Under 1 year. 1—5 5—10 10—15 15—20 20—23 25—35 35—45 45—55 55-65 65 & over. Total. Tuberculosis (a) Pulmonary M. — — — — 5 5 5 3 2 2 3 25 — — — — 2 3 7 2 3 5 4 26 F. — — — — 5 7 4 3 2 — 1 22 — — — 1 2 3 3 1 — — 1 11 Total — — — — 10 12 9 6 4 2 4 47 — — — 1 4 6 10 3 3 5 5 37 (6) Non-Pulmonary M — — 5 2 — 1 — — — — 8 — — — — 1 — — 1 — — — 2 F. — 1 3 I — 2 2 — 1 — — 10 — 1 — 1 1 — — — 1 — — 4 Total — 1 8 3 — 3 2 — 1 — — 18 — 1 — 1 2 — — 1 1 — — 6 14 INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. There was a seasonal rise in the incidence of Scarlet Fever during the autumn. After four years of comparative freedom from Diphtheria, a number of cases were notified during; October November and December. It is difficult to account" for this increase, the primary cause of which, I think, must be due to some general influence giving rise to a number of healthy "carriers" and very mild "missed" cases, which become the source of infection. The following table gives a comparative statement of notifications received during the last seven years:— Year Scarlet Fever Diphtheria Enteric Fever (including Paratyhiod) 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 1926 82 27 7 1927 87 65 3 SCARLET FEVER. The type of case has been mild, but one death was attributed to this disease. DIPHTHERIA. There were 65 cases notified, but only one death was attributed to this disease. During the first nine months of the year only isolated cases occurred, but in October cases were notified among children attending Bonner Hill Road Infants' and Girls' Schools. In all, nine cases in the Infants' and six cases in the Girls' Departments were notified during the last three months of the year. Supervision and swabbing of contacts was undertaken, and also inspection and swabbing in classes in which the cases occurred. As a result, six healthy carriers were isolated. The same procedure was undertaken with cases and contacts not of school age, and I thank the General Practitioners for their co-operation and help in this work. 15 Most of the cases were extremely mild, many suffering from nasal discharge, only proved to be diphtheria by bacteriological examination. That "missed" cases may be a source of infection is supported by the fact that a child was seen at the School Clinic suffering from definite diphtheritic palatal paralysis, the mother having brought the child to the Clinic because of the "peculiar sound of his voice." It is difficult to estimate how many very mild cases occur, which exhibit no symptoms or complications to attract the attention of the parents. 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. ENTERIC FEVER (including Para-typhoid). Three cases were notified during the year. The following is a brief summary of the cases:— W. J. T., male, 22 years. Notified 20/5/27. Is stated to have been "not well" for some time, but was definitely taken ill on 1/5/27 with vomiting and shivering. On 3/5/27 he sent for the doctor, and on 12/5/27 he was admitted to the Kingston Victoria Hospital as a case of Pneumonia. A Widal test on 18/5/27 proved positive for para-typhoid B. V. T., female, 19 years. Notified 20/5/27. Sister of above case. Is stated to have been "not well" for some time, but was definitely taken ill on 11/5/27 and was seen by the doctor on the following day. She was nursed at home. Most careful investigation failed to discover the source of infection in both cases. E. M., male, 21 years. Notified 11/6/27. On 30/5/27 he complained of severe headache and pains in his limbs, but continued his occupation until 2/6/27, when he went to bed, but did not call his doctor until 6/6/27. A Widal test was positive for para-typhoid B on 15/6/27. His stepfather had had Typhoid in 1900, but bacteriological examination of his fæces and urine proved negative. In spite of exhaustive inquiries, no source of infection was traced in this case. 16 ANTERIOR POLIOMYELITIS. One case only occurred during the year in an infant of eighteen months, notified on December 29th. Some paralysis of the right arm and leg resulted from the attack. Subsequently this condition showed signs of improvement, and the infant was referred to the Orthopaedic Specialist at the Red Cross Curative Post. 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 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. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. Except for small outbreaks of Mumps and Whooping Cough at Richmond Road Infants' and Bonner Hill Road Infants' Schools respectively, the Schools enjoyed a remarkable freedom from non-notifiable infectious diseases. INFLUENZA. The number of deaths attributed to this disease was 23, which is higher than of recent years. The prevalence which commenced in December, 1926, was continued throughout the early months of the year, and took its toll chiefly among elderly patients. The majority of cases were of a mild gastric tvpe, pneumonia was not a common complication, and there was no return to the severe type of the pandemic of 1918. 17 MATERNITY AND CHILD WELFARE. Two centres, one at the Y.M.C.A. Hall, Eden Street, and the other at St. Peter's Hall, Washing-ton Road, are maintained by the Town Council. During the year there were the following number of attendances at the Centres:— Attendances. Meetings. New Cases. Total. Eden Street 50 178 2,801 Washington Road 49 91 1,089 The Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers ... 64 103 Infants under one year 594 1,876 Children, one to five years — 2,616 Incidental and Infectious — 409 Dr. Winifred Warner attended 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 50 mothers have purchased 227 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 July 10th to 15th, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. The Baby Week Campaign was awarded a Certificate of Merit by the Executive Committee of the "National Baby Week Council" in connection with the Astor Challenge Shield Competition. The Welfare Exhibition of the Central Council for Infant and Child Welfare was held at the Y.M.C.A. Hall on July 14th and 15th, and was open on both days from 11 a.m. until 8.30 p.m. The Exhibition was well patronised, and organised visits were made by Elementary School Children and their Teachers in the mornings. 18 A Special Stand was entirely supplied by the Kingston mothers, and two health plays were given by the Elementary School Children. On July 21st the Annual Garden Party for both Centres was held at St. Peter's Vicarage, when Mrs. Lang very kindly presented the prizes to mothers winning the various competitions. The Annual Winter Tea and Entertainment was held at each centre in January. A special feature has been made of short "talks" to the mothers at every meeting, and their increasing interest in competitions in Homecraft, Essays, etc., is very gratifying. Miss R. Bartter (Senior Health Visitor) attended the Fifth English Speaking Conference on Maternity and Child Welfare held in London from July 5th to 8th. During the last quarter of the year Dr. Olive Aubrey attended the Centres owing to Dr. Warner's absence on sick leave. STAFF. There has been no change in the Nursing Staff during the year. In January the working time of each Nurse was apportioned equally between Health Visiting and School Nursing. This arrangement has proved to be far more satisfactory than the former unequal division of duties, each Nurse being now responsible for her particular area in which she carries out both Maternity and Child Welfare and School Work. The work of the Health Visitors has been most ably carried out under the direction of Miss R. Bartter. NOTIFICATION OF BIRTHS. There are now very few unnotified births. A letter, embodying an extract of the Act, asking for an explanation of failure to notify the birth is sent to the father of the child in every instance of an unnotified birth. ANTE-NATAL CLINIC. The Ante-Natal Clinic was held on the first Tuesday in each month at the School Clinic, "Elmfield," London Road, the Dental waiting room and operating room being used temporarily. 19 During the year 52 expectant mothers attended, making 100 visits to the clinic, which is an average attendance of just over 8 per session. This is very satisfactory, and compares with 29 expectant mothers and an average attendance of 4 per session in 1926. The popularity is likely to increase still more since the Kingston Nursing Association recommenced District Midwifery in the Autumn, and already are supporting the Clinic by urging and bringing expectant mothers on their books. Support from midwives engaged in private practice on their own in the Borough is disappointing. Dr. Winifred Warner is the presiding Medical Officer, under the direction of the Medical Officer of Health. 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. 18, Richmond Park Road. Unmarried expectant mothers are admitted to the home about two or three months before full term, or later if desired. If possible they contribute towards their own support, and assist by doing domestic work while in the home. They are transferred for confinement to the Kingston and District Hospital or other Maternity Home, returning after the puerperium with the infant to the "Shelter" for a further period of residence until the infant is three months old. The infant is then placed with a foster mother, and the parent is found a suitable situation in domestic service PUERPERAL PYREXIA. During the year nine cases were notified as Puerperal Pyrexia under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Immediate investigation was made into the circumstances of each case, and a copy of the notification sent to the County Medical Officer of Health. Eight cases were mild and due to a variety of causes, but one proved fatal, and the following is a brief history of this case. 20 Primipara. Age 38. Confined at her home on 29.10.27. The midwife who was engaged beforehand summoned a doctor, who was present at the birth—instrumental delivery of a 101b. baby. The temperature of the mother rose to 103.4° F. on the third day, when she was notified as a case of Puerperal Pyrexia and admitted to the Kingston and District Hospital on 31.10.27. She died on 9.11.27, and an inquest was held, the medical evidence as to the cause of death being "Syncopegeneral peritonitis from extensive laceration of the vagina during childbirth." The consultant, Dr. Andrew McAllister, was not summoned during 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 1927:— Treated Vision Vision Total Notified. At Home. In Hospital. unimpaired. impaired. Blindness Deaths. 3 2 I 2 I — — The one serious case was sent by the doctor in attendance to the Richmond Royal Hospital and then transferred to St. Margaret's Hospital, N.W.5, an Institution specially provided by the Metropolitan Asylums Board for the treatment of Ophthalmia Neonatorum. ORTOHÆDIC TREATMENT. The scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, worked satisfactorily, and during the year 10 infants received out-patient treatment, making 315 attendances. The total cost was £32 3s. 0d., and the contributions paid by the parents towards this expenditure amounted to £14 6s. 4d. One infant was admitted to St. Vincent's Orthopædic Hospital on October 31st, 1927, and was still in the Hospital at the end of the year. The charge for in-patient treatment is at the rate of £90 per annum, and in this particular case the parents were only able to contribute 2s. per week, as they are in very poor circumstances. I. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Number of Premises. Inspections Written Notices. Occupiers prosecuted Factories—(including Factory Laundries) Workshops—(including Work- shop Laundries) 15 — Nil Workplaces—(other than Out- workers' premises) Total 15 — Nil 21 11 —DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Particulars. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 4 2 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 2 — — — 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 5 4 — — Total 11 6 — — *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 Chief Sanitary Inspector. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present to you my Ninth Annual Report on the work carried out by your Sanitary Inspectors during the year 1927 in connection with the various Statutes and Bye-laws relating to Public Health in force within the Borough. The total number of inspections during 1927 was 6,986 as compared with 6,540 during 1926. On 505 premises sanitary defects to the number 2,721 were discovered. In connection with these defects 402 "preliminary" and 57 "verbal" notices were issued. In 29 instances it was found necessary to serve "statutory" notices. During the year 1927 particulars relating to the inspection of 505 premises were added to the records, whilst 493 entries were struck off the registers following the completion of necessary works. On December 31st, 1927, 287 premises remained on the registers, compared with 246 at the end of 1926. The total number of inspections made during 1927 is considerably higher than the corresponding figure for 1926. The chief increase was in respect of slaughterhouses and food premises. In these instances, the visits for 1927 are practically double those for the previous year. Supervision of Works in Progress necessitated an increased number of visits over 1926 by nearly 50 per cent. In order to carry out these important duties, the time devoted to re-inspections of property after completion of works was very much reduced, and the preparation of records in the office, such as plans of all redrainage schemes, and other work equally desirable, but not definitely required by Statutes or Regulations, was suspended. Assistance was rendered to the Housing Committee in various ways during the year. 23 There is a welcome inclination on the part of owners of property to take advantage of the opportunities afforded them to discuss with your Sanitary Inspector difficulties and differences in connection with their properties which may arise as the result of inspections and subsequent service of notices. These interviews take place either at the office or at the premises under review, and although they absorb a very great deal of time, the results which accrue more than compensate for the trouble and time involved. These interviews, together with preparation of records, clerical routine, and other administrative work, do not call for further 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 1,197 Visits to Works in Progress 1,221 Factories and Workshops 15 Cowsheds, Dairies and Milkshops 54 Ice Cream Premises 18 Foodshops and Food Preparing Rooms 487 Infectious Disease Inquiries 396 Markets 73 Special Inspections (Complaints, etc.) 1,386 Slaughter-houses 1,701 Offensive Trades 7 Sanitary Conveniences 71 Common Lodging-Houses 26 Canal Boats 3 Theatres, Cinemas, etc. 2 House-to-House 34 Bakehouses 23 Smoke Observations 13 Stables and Yards 13 Miscellaneous Visits 236 Total number of Inspections 6986 24 Drainage. Number of Houses and Premises re-drained 15 Number of Drains repaired or amended 8 Drains or Gullies unstopped or cleansed 21 Manholes provided 28 Manholes altered or repaired 1 Intercepting Traps fixed 10 Fresh-air Inlet Shafts repaired or renewed 11 New Gully Traps fixed 66 Gully Curbs renewed or repaired 8 New Soil Pipes or Ventilating Shafts 32 Soil Pipes or Ventilating Shafts repaired 3 Smoke Tests applied 21 Water Tests applied 58 Subsoil drainage provided 1 Gratings provided to gully traps 4 Rain Water Pipe disconnected from Soil Pipe 1 Miscellaneous 1 Soil Pipe Ventilated 1 Water Closets and Sanitary Fittings. W.C. Apartments cleansed and limewashed 46 New W.C. Basins fixed 40 W.C.s unstopped, cleansed or repaired 5 W.C. Flushing Tanks repaired or renewed 22 Water supplied to W.C.s 2 W.C. Apartments lighted, repaired and ventilated 45 New Impervious Sinks provided 46 New Waste Pipes fixed 43 Existing Waste Pipes trapped or repaired 10 Urinals cleansed or repaired 5 Urinals reconstructed 1 Miscellaneous. Roofs repaired 39 Eaves Gutters renewed or repaired 27 Stack Pipes renewed or repaired 36 Stack Pipes disconnected from Drains 44 Damp Walls remedied 66 25 Ventilation provided beneath floors 28 Site of house concreted 1 Yards and passages paved 74 Yard Paving repaired 12 Yards cleansed 6 Floors of Rooms repaired 34 Floors of Rooms renewed or repaved 13 Rooms repaired, cleansed and distempered 261 Verminous rooms cleansed 6 New ceilings 8 Windows repaired, renewed or made to open 86 Doors re-newed or repaired 6 Cisterns repaired, cleansed, covered or removed 11 Door and window sills renewed or repaired 44 Stairs repaired or renewed 5 Portable ashbins provided 182 Accumulations of manure and refuse removed 8 Nuisance from overcrowding abated 23 Nuisance from animals abated 6 Water supplied direct from main 19 Water supply reinstated 5 Premises connected to M.W. B. mains and use of well water discontinued— 32 Premises limewashed (Workshops, food preparing rooms, etc) 6 Fire grates repaired or renewed 31 Sheds Removed 2 Defective coppers repaired 22 Walls repaired, repointed or rebuilt 37 Handrails, provided to staircases, or repaired 12 Manure or offal receptacles provided or repaired 2 Nuisance from smoke abated 3 House demolished 3 Basement dwelling vacated 1 Miscellaneous 6 Smoke Abatement. The number of complaints in respect of alleged nuisance from smoke received during 1927 was seven, as compared with two received during 1926. Thirteen smoke observations were made, and in several instances excessive amounts of smoke were recorded. 26 No structural alterations were made to boilers or shafts with a view to remedying smoke nuisances during 1927. Interviews with owners and their stoking staffs, however, resulted in considerable improvement being effected by more regular and frequent stoking, and by the use of more suitable fuel. During the year the Corporation adopted a Bye-law fixing a standard with regard to the emission of black smoke. The new Bye-law provides that the emission of black smoke in excess of a period of two minutes in any consecutive thirty minutes shall be regarded as a nuisance. A model bye-law dealing with smoke which is other than black is not yet available. 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. During 1927 26 inspections were made of the registered premises. There was a decided improvement in the sanitary condition of the registered Lodging Houses during 1927. Offensive Trades. The following offensive trades are carried on in the Borough:— Leather Tanning and Fellmongering. Rag and Bone Dealers. Fish Frying. The Rag and Bone Yards are situated in unsuitable positions in the Borough, and despite frequent visits of inspection, their condition is usually far from satisfactory. During 1927 the Corporation considered the framing of Bye-laws to control all offensive trades. The new Byelaws were not approved finally at the end of the year, but are now in force in the Borough. The additional powers should prove very useful in dealing with Rag and Bone Yards and Fried Fish premises. Seven visits were made to premises in connection with offensive trades, in addition to reinspections after notices or warnings. 27 Complaints One hundred and seventy-two complaints were received during the year as follows:— Drains and Sanitary Arrangements 22 Overcrowding 5 Insanitary Condition of Premises 80 Absence of Ashbins 6 Water Supply 4 Accumulation of Manure and Non-collection of House Refuse 10 Dampness 6 Keeping of Animals and Fowls 3 Smoke Nuisance from Chimneys 7 Defective Stoves 3 Defective Roofs and Gutters 4 Odours from Trade Waste 5 Stagnant Water or Flooding 2 Premises Infested with Vermin 3 Premises Infested with Flies 2 Condition of Undeveloped Land 1 Miscellaneous 9 172 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 1926 was 139. house Drainage. Fifteen houses were redrained during the year, as compared with 31 during 1926. 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 Beaufort Road 1 Crescent Road 2 Clifton Road 1 Gibbon Road 1 Kingston Hill 1 Liverpool Road 3 Richmond Road 1 Shortlands Road 2 Washington Road 2 28 Increase of Rent & Mortgage Interest Acts. Eight applications were received during the year from tenants for certificates under Section 2, Sub-Section 2 of the above Act, as compared with 12 during 1926. 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 two 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 193 (b) With State assistance under the Housing Acts— (1) By the Local Authority 108 (2) By other bodies or persons Nil 1. Inspection of Dwelling-houses During the Fear. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 689 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 31 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 452 2. Remedy of Defects During the Year Without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 355 29 3. Action under Statutory Powers During the Year. 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 (6) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 22 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 24 (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 Nil (2) Number of dwelling-houses in respect of which Closing Orders were made 1* (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 *This Closing Order relates to a house in respect of which a previous order had been made but had not been enforced. The house has now been demolished. 30 It will be seen that there was an increase in the number of houses inspected under the Housing Regulations, but the number inspected is still much below that which should be recorded. The time available for systematic house-tohouse inspection in the Borough is small. With the present staff it is difficult to keep the ordinary routine work in hand, and it is not possible to carry out the important duty of systematic inspection of district as required by the Housing Acts. The houses inspected during the year 1927 were situated in Acre Road, and marked improvement in the condition of the properties has resulted from the action taken. Unless additional assistance is given, however, or other work left, it appears to be unlikely that the inspection of Acre Road will be completed during 1928. There are other large areas awaiting house-to-house inspection when opportunity presents itself. The general condition of ashbin accommodation in the Borough is much improved. The concentrated efforts of the past two or three years are showing good results. It is the exception now to find more than a few houses unprovided with suitable receptacles, whereas a few years ago certain roads, seen on refuse-collecting days, presented a most appalling spectacle of miscellaneous receptacles in various stages of decrepitness. Although most of the old boxes and baths have been replaced by galvanised iron receptacles, it is regrettable that the requirement that ashbins should be placed at the front of the houses on collecting days should still be enforced in certain roads. Tenants appear to be afraid of losing the lids, and consequently the ashbins are left uncovered, much to the annoyance of pedestrians, especially after stray dogs have spilled the contents of the receptacles over the footpaths in search of food. The number of statutory notices served during the year shows a considerable decrease compared with 1926. The reduction was chiefly in respect of notices requiring the provision of ashbins. Overcrowding. In no less than 23 instances overcrowding was abated as the result of action taken following inspection of the rooms. This is a considerable improvement on previous years, and one is tempted to interpret the result as a sign that the housing shortage is steadily being overcome. In 10 of the cases the occupiers of the overcrowded rooms were allotted houses on the Corporation Housing Estate. 31 Inspection and Supervision of Food. (a) Milk Supply. During 1927 five persons were removed from the register, due to removal from the town. Seven dairymen were added to the register, making a total of 43 on December 31st, 1927, compared with 41 for the corresponding date in the previous year. There is only one cowkeeper in the Borough. No licences have been issued to producers in the Borough in respect of graded milk, but the following licences have been issued to dairymen:— To sell Certified Milk 1 To sell Pasteurised Milk 1 To bottle and sell "Grade A" (Tuberculin Tested) Milk 1 Supplementary licence to sell Certified Milk 1 (b) Meat and Other Foods. Once again I have to report increased activity in this important duty of your Sanitary Inspector. The amount of slaughtering in the Borough shows no sign of lessening; in fact, although the actual number of animals is not available, there was a definite increase during 1927 compared with 1926, the total being estimated at 8,350. The increase was specially noticeable in the number of beasts slaughtered, and it may be due to the fact that one neighbouring authority now has no slaughter-house at all, the last one being closed early in 1927. Animals which would, in the ordinary way, have been sent to that district are now killed in Kingston. In addition, butchers from other districts near by send their animals into Kingston, or buy them at Kingston and arrange for them to be collected and slaughtered at one or other of the private slaughter-houses. A further cause for the increase was the frequent restrictions placed upon the movement of live animals owing to foot and mouth disease. Animals could only be sent to the market if they were intended for immediate slaughter, but no live animals could be sent out of the area. All the animals, therefore, had to be killed in Kingston, and then the owners could remove the carcases to any destination in or out of the restricted area. 32 With the exception of about six sheep, every animal slaughtered in the Borough was examined, despite the fact that a considerable portion of the killing was carried out during late afternoons and evenings and on Saturday afternoons and Sundays. The work of inspection is not confined to the examination of animals slaughtered in the Borough. All and every kind of food premises, such as restaurants, sausage making rooms, ice cream premises, etc., etc., are visited from time to time. The total visits to premises having relation to the food supply during 1927 was 2,356. The following tabulated list shows the various amounts of foodstuffs condemned during the year. Generally speaking, where the reason for condemnation is stated to be putrefaction or bone-taint, a request for inspection was made by the owner. In other cases, the condemnation followed examination of the meat in slaughter-houses:— Articles of Food. Reason for Condemnation. Action taken. BEEF- 2 Carcases & complete Offal Tuberculosis Surrendered 1 Forequarter „ 4.479½ lbs. Bone taint or putrefaction Surrendered 9 pairs of Ox Lungs Tuberculosis 8 surrendered and r seized. 7 Mesenteries „ 6 surrendered and 1 seized. 4 Ox Heads and Tongues „ 3 surrendered and 1 seized. I Stomach Surrendered 60½ lbs. Livers Putrefaction „ 2 Livers Distomatosis „ 1 Liver Hydatid Cysts „ 1 Liver Tuberculosis „ 25 lbs. Kidneys Putrefaction „ VEAL— 4 Carcases and Offal Tuberculosis Surrendered 20 Plucks ,, 18 surrendered and 2 seized. MUTTON- 2 Carcases and Offal Emaciation and Oedema Surrendered 1 Carcases and Offal In moribund state at time of slaughter „ 131 lbs. Putrefaction Surrendered 43 Livers Distomatosis ' 3 Livers Strongylus Rufescens ' 32 pairs Lungs „ „ „ Hearts—rolbs. Putrefaction „ 33 PORK— 11 Carcases and Offal Tuberculosis Surrendered 1 Carcase and Offal In moribund state at time of slaughter ,, 3 Forequarters Tuberculosis ,, 2 Hindquarters ,, ,, 102 Heads and Necks ,, 27 Plucks ,, ,, 7 pairs Lungs .. ,, 2 pairs Lungs Congestion ,, 19 Mesenteries Tuberculosis ,, 5 Livers Cirrhosis ,, 4 Livers Fatty Infilitration ,, 2 Spleens Tuberculosis ,, 3 Udders Mastitis ,, GOAT— 2 Carcases and Offal Emaciation Surrendered FISH— 4 stone Cat Fish Putrefaction Surrendered 1 bag Whelks ,, ,, FRUIT— 40 Apples (14 lbs) Putrefaction Surrendered The amount of meat condemned in the slaughter-houses during 1927 is greater than the amount condemned during the previous year. There is no reason to attribute this increase to a higher incidence of disease amongst animals. On the contrary, I believe that there is now less serious disease amongst animals used for human food. The increase is undoubtedly a proportionate one to the increased number of animals examined. Condemned foodstuffs are usually sent to the Dust Destructor for cremation. The exception to this rule is that of carcases of beef. In these cases, if circumstances permit, authority is given for the carcases to be moved to a knacker's yard, where they are boned and treated so as to prevent their use for human consumption. The removal and treatment of the carcases is supervised by your Meat Inspector. The condemned carcases of beef have a monetary value which, although not large, reduces the loss sustained by the butcher. Pork and other fat meat is not accepted by the knackerman, and it is therefore cremated. Water Supply. Active measures were taken during the year to reduce the number of premises supplied with water from wells. 34 Twelve samples of water were taken and were submitted to the Corporation Analyst, Mr. P. G. Lloyd. In the case of 11 of the premises, the use of well water was discontinued, and supplies were laid on from the Metropolitan Water Board's mains. In addition to these 11 houses, the use of well water for drinking purposes was discontinued at 21 other premises as the result of informal action taken since the records were last revised. Thus the total number of premises removed during 1927 from the list of those supplied with well water was 32. This progress is being steadily maintained, but until some tenants are satisfied that it is worth a little extra rent in order to have a reliable water supply, a few of the existing wells will remain. In these few cases the analyses have shown that the water is usable, and the wells cannot be closed. 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., 1927. Registered 3 Licensed 3 Total 6 All the premises have been in use during 1927. The buildings, with one exception, are old. They are, however, kept in a fairly satisfactory condition, and the occupiers show willingness to comply with your Council's requirements. One thousand seven hundred and one visits were paid to these premises during the year, as compared with 987 during 1926. In one slaughter-house the "Cash Captive Bolt" humane killer has been in general use for stunning pigs and sows. The pistol has proved quite satisfactory, and much more expeditious than the previous method of stunning. 35 Disinfection. Owing to the increase in the number of notified cases of infectious disease, there was nearly double the number of articles passed through the steam disinfector during 1927 compared with 1926, the figures being 2,545 and 1,304 respectively. No less than 270 rooms in 226 houses were sprayed and fumigated with formalin. In addition to disinfection after notifiable infectious diseases, articles are also collected for steam disinfection, and rooms are disinfected on request. A charge is made in such cases sufficient to cover the cost of the work. This arrangement is much appreciated by the public. The Council also possess a motor ambulance, which is constructed for the dual purpose of removing patients to hospital and for the conveying of bedding, etc., to and from the disinfecting station. Eleven patients were conveyed in this ambulance last year. Factories, Workshops and Workplaces. Fifteen visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in Tables on pages 20 and 21. There are nine "Outworkers" resident in the Borough, and the premises so used were inspected periodically. Stables and Yards. An improvement generally may be reported in the condition of stables and yards in the town. For the past few years a campaign has been directed against unsuitable stables and the absence of, or defective condition of, manure receptacles. This work is more important than it may appear to be at first glance, as there is a very definite relation between the breeding of flies and the storage of manure. The reduction in the number of horses in towns has had a decided effect in reducing the number of flies. Sanitary Conditions of Music Halls, Cinemas, &c. Only three formal inspections were made of the above premises during the year under review. The sanitary conveniences are usually maintained in good order, but no visits were made during the performances in connection with the ventilation of the premises. 36 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 1927, three 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 given to the conveniences attached to refreshment places during the year. One urinal was entirely reconstructed and one was modified in accordance with requirements. The conveniences attached to licensed houses in this Borough compare very favourably with similar places in all other towns I have visited. Practically all the premises now have glazed stalls or slabs, and the minimum of labour is required to keep the conveniences in clean condition. Comparatively few of the licensees have failed to keep the premises in order. Legal Proceedings. Legal proceedings were instituted in three instances during 1927. No. Nature of Offence. Result. 1. Failing to comply with a notice to abate a nuisance arising from overcrowding. Order made to abate nuisance within 21 days. 2. (a) Impeding the Meat Inspector in the execution of his duties by removing a part of a carcase (a diseased lymphatic gland) and withholding such gland from inspection. Fined £16 and £5 5s. costs. (b) Failing to give notice of disease in a carcase to the Meat Inspector. 37 3. (a) Failing to keep clean the inside and covering of meat van. (b) Failing to observe due cleanliness of a room used as a meat store, and of apparatus and utensils. Total fines amounting to £15 and £5 5s. costs. (c) Failing to afford the Meat Inspector all reasonable information required for the purposes of the Meat Regulations. Conclusion I again desire to thank you, Mr. Chairman, and the Members of the Public Health Committee and Corporation generally, for your consideration and support during the year, and the Officers of other departments who are always very willing to afford me assistance and information. I am, Ladies and Gentlemen, Your obedient servant, HAROLD T. PERRY, Chief Sanitary Inspector. Municipal Offices, Kingston-upon-Thames. March, 1928. 38 Report of the School Medical Officer. To the Chairman and Members of the Education Committee of the Royal Borough of Kingston-uponThames. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1927. The average number of children on the school register for the year was 4,639. There was no School closure on account of Infectious Disease. Medical Inspection was carried out as before, and the high percentage of parents present speaks well for its growing popularity. No objection to medical examination of any child was received. The School Dentist devoted three half-days a week to dental inspection and treatment, but the time prosed insufficient to cope with the work, and therefore will be extended to four sessions per School week in the coming year. The scheme for Orthopædic Treatment of crippled children worked satisfactorily, both as regards in-patients and out-patients. The Eye Clinic was held on Wednesdays during the School terms, 19 meetings in all being necessary during the year. Further progress was made by an arrangement for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital, which was commenced in October. 39 The equal division of work between the School Nurses, which was commenced in January, increased the efficiency of the Service. The year has been a satisfactory one for the School Medical Service, progress having been made in many directions, particularly the added facility for operative treatment of tonsils and adenoids. In future, further extension of dental work will become necessary in order to include additional age groups, and ultimately embrace the whole School population. There remains the question of X-ray treatment for ringworm, and possibly the treatment of delicate children by artificial sunlight. Again the disposal of feeble-minded children is a matter which must be investigated later. I thank the Nursing Staff, under the direction of Miss R. Bartter, for their excellent work throughout the year. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. VV. MATTHEWS, School Medical Officer. 40 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) 1/2 time. Miss E. RILEY 1/2 time. Miss A. GILL 1/2 time. Miss C. A. HOOKWAY 1/2 time. Clerk: Miss O. ROWLES. CO-ORDINATION. The School Medical Officer is also Medical Officer of Health. In, January the working time of each Nurse was apportioned equally between School Nursing and Health Visiting. This arrangement has proved to be far more satisfactory than the former unequal division of duties. Each Nurse is now allotted her particular area, in which she carries out both Maternity and Child Welfare and School Work. Close touch is kept with the School Attendance Officers, whose office is now situated at the Lodge at " Elmfield." 41 SCHOOL HYGIENE. A general review of the Public Elementary Schools was given in the Annual Report for 1925, and a list of repairs and improvements was set out in last year's Annual Report. During 1927 the following repairs have been carried out :— Homier Hill Road School. The tar-paved playgrounds have been repaired, tarred and gritted. A Teachers' Room, and the lavatories in the Boys', Girls', and Infants' Departments have been distempered and painted where required. Richmond Road School. The whole of the playgrounds of the Boys', Girls' and Infants' Departments have been repaired, tarred and gritted. The Head Teachers' Rooms have been redecorated. The Bungalow Classroom in the playground of the Infants' Department has been painted externally. The lavatories in the Boys', Girls', and Infants' Departments have been distempered and the woodwork painted. 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 the Annual Report for 1925. 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 252 200 79% Girls 255 212 83% Intermediates, Boys 227 141 62% Girls 202 152 75% Leavers, Boys 224 66 29% Girls 241 131 54% 42 FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. The School Nurses visit all Schools within the first fortnight of each term for the purpose of carrying out cleanliness surveys, since a number of children return to School after the holidays in an unsatisfactory condition. Still, there is no doubt that the general cleanliness of the children shows a gradual and steady improvement year by year. It has only been necessary to take legal proceedings in respect of four children under the School Attendance Byelaws, which compares with 23, 16 and 8 during 1923, 124 and 1925 respectively. At Routine Medical Inspections, 130 children were found unclean, and the School Nurses at their cleanliness surveys discovered 744 individual children requiring treatment for uncleanliness. (b) Tonsils and Adenoids. There were 69 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 and ringworm of the body and scalp are the skin diseases chiefly met with among the children. Exclusions from School for impetigo and ringworm of the body are usually short, but in ringworm of the scalp the period of exclusion is three or four months as a rule. There were 29 cases of ringworm of the scalp referred for treatment during the year. (e) Vision. During the year 75 children were found requiring treatment for defective vision. (/) Dental Defects. At his inspection the School Dentist found 779 children needing treatment. Dental Inspection was concentrated on children aged 6 and 7. 43 MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily at the Clinic during School Terms, 6,472 attendances beingregistered during the year. (b) Tonsils and Adenoids. A scheme for the operative treatment of tonsils and adenoids was sanctioned and put into operation in October. Under this scheme cases recommended by the School Medical Officer are admitted to the Kingston Victoria Hospital. Parents are expected to contribute towards the cost according to their means. Twenty-five cases were treated under this scheme during the last quarter of the year. A special effort was made to clear off outstanding cases, with the result that in all 65 children (including the 25 under the scheme) received operative treatment during the year. (c) Skin Disease. The treatment of impetigo, ringworm, and other skin diseases has been undertaken at the Minor Ailments Clinic. (d) Vision. Cases of defective vision are referred by the School Medical Officer to Dr. Winifred Warner, who has prescribed spectacles for 97 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 8 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (f) Dental Defects. Of the 779 children requiring treatment found by the School Dentist, 422 were actually treated, 241 being rendered dentally fit before the end of the year. Remarks by the School Dentist are given under the paragraph on the Dental Clinic. 44 (g) Crippling Defects and Orthopaœdics. During the year 23 individual children received electrical, massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 1,071 total attendances. The cost of the above out-patient treatment amounted to £112 16s., towards which the parents contributed £43 3s. Four children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment, at a total cost of £121 5s. 3d., the parents contributing £25 10s. The Central Aid Society has helped in obtaining letters for hospitals, etc., in cases where the parents cannot afford to pay, and also in sending children away for convalescence to the seaside. . The National Society for Prevention of Cruelty to Children has aided in following up obstinate cases when notified by the School Medical Officer. INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. Except for very small outbreaks of mumps and whooping cough at Richmond Road Infants' and Bonner Hill Road Infants' Schools respectively, the Schools enjoyed a remarkable freedom from infectious diseases for the first nine months of the year. In October, however, cases of diphtheria were notified among children attending Bonner Hill Road Infants' and Girls' Schools. In all, nine cases in the Infants' and six cases in the Girls' Departments were notified during the last three months of the year. Supervision and swabbing of contacts was undertaken, and also inspection and swabbing in classes in which the cases occurred. As a result, six healthy carriers were isolated. On the whole the cases were mild, many suffering only from nasal discharge proved to be diphtheria bacteriologically, but one death occurred in a very virulent case. The Schools were disinfected during the Christmas vacation. FOLLOWING UP. The following-up of children suffering from defects is 15 c'arried 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 the Annual Report for 1925, and the following table specifies some of the work carried out bv them during 1927. Number of children prepared for Routine Medical Inspection 1,567 Number examined at Schools for uncleanliness 19,012 Number of following-up home visits 584 Total number of visits to the Schools 590 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. The percentage of entrant infants showing vaccination marks was 54. SPECIAL SCHOOLS. The Special School for Physically Defective Children is situated at " Elmfield," London Road. There are 35 Physically Defective Children on the register, four 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, under the supervision of the Orthopaedic Specialist. Dental inspection and treatment was carried out at this School during the year. 46 SCHOOL CLINIC. The Clinic is situated at " Elmfield," London Road. The Medical Inspection Room is used also as the Minor Ailments and Eye Clinics. Artificial lighting is by incandescent gas, and there is a supply of hot and cold water. The heating is by a closed stove, and although the air temperature of the room is raised, the effect of the stone floor, though covered by matting, is very unpleasant in winter. The Dental Clinic is situated on the first floor of the main building, and consists of a Waiting Room and Operating Room, communicating by an internal door, which obviates the necessity for a child to return to the Waiting Room after treatment. This is a great advantage, especially on days devoted to extractions under a general anaesthetic. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic 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. During the Christmas term Dr. Estcourt-Oswald attended five sessions owing to Dr. Warner's absence on sick leave. 47 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 382 attendances at the 19 sessions held during the year, 155 being. new cases and 127 re-inspections. Refractions numbered 100, and spectacles were prescribed in 97 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. The number of children found at School without their glasses is undoubtedly gradually diminishing, due to the vigilance of the School Nurses, the termly re-inspection by the School Medical Officer, and the co-operation of the Teachers. The Head Teachers are periodically sent lists of those children who should have their glasses m constant wear. (d) Dental Clinic. During the year three sessions per School Week were devoted to Dental Inspection and Treatment. In all, 17 half-days were given to Inspection and 110 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 177 gas cases during the year. Owing to the long list of children awaiting treatment, it was considered advisable to continue working on those aged 5, 6, and 7 rather than to re-inspect the children aged 8 and 9. An additional session has become essential, and so it is hoped to commence next year with four sessions per School Week. Mr. H. A. L. Morris, the School Dentist, reports as follows :— " During the year the time given to Inspections and Treatment was three sessions of 2½ hours per School Week, directed to children aged 5, 6, 7 and specials (i.e., children not in the Routine Groups, referred by the School Medical 48 Officer, etc.). Also all the children in the Physically Defective School. The inclusion of the latter children for Routine Treatment has, and will take up a fair amount of time for treatment, considering the cases individually, as most of these children have received no previous dental treatment. There is a steadily increasing number of ' consents ' and requests for treatment by parents, who now appreciate the benefit of the Scheme, and very few refuse treatment when it is offered at the School Inspection. " This, in addition to the arrears of cases brought forward from 1926, gave me a waiting list of approximately 400 children throughout the year, and it was thought inadvisable to re-inspect the groups aged 8 and 9. The parents of children who have been previously treated at the Clinic usually bring the child for re-treatment if the necessity is obvious, irrespective of the child being re-inspected, so these children will not suffer in consequence. " Children requiring treatment, including ' Specials,' show a reduction of approximately 11 per cent. as compared with 1925, and 1 have no doubt this figure would have been increased had all the age groups been re-inspected, and tends to show that the Routine Treatment is beginning to have the desired effect. " There was an increase of 38 in the administration of general anaesthetics as compared with 1926. " At the inspections of smaller Schools where the number to be inspected did not occupy the whole of the session, the balance of the time was spent at the Clinic with treatment. " The programme for 1928 is to inspect and treat children born 1918 and subsequently." EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 66 schoolchildren over 12 years of age were issued with certificates under the Bye-laws permitting their employment on milk and paper rounds, and five over school age as street traders. 49 SCHOOL BATHS. During the summer months 733 children from the Boys' and Girls' Departments of all the Schools attended the Corporation Baths during School hours for instruction in swimming. In addition, a number of pupils from Richmond Road Boys' School attended the baths on Wednesdays, after School hours, at their own expense at the reduced price of l½d. per visit. On request, special tickets are issued to children attending the Public Elementary Schools entitling them to admission to the Baths at l½d. during ordinary hours. 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, if considered unsuitable to attend an ordinary Public Elementary School. 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. 5° There are four epileptic children attending the Public Elementary Schools, but as they are mild cases there appears to be no reason why they should not continue to do so at present. There are two children at Certified Schools for the Blina, and two partially blind children, one attending the Public Elementary Schools, and another at no School at present, as he is under Hospital treatment, on the result of which depends his ultimate disposal. 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. Prior to departure on June 17th, all the girls were examined by the School Medical Officer. The part)' consisted of 40 girls, 27 of whom were taken for the holiday entirely free, while three contributed towards their maintenance, and 10 paid in full. Similar excursions have been made every year since 1922, and I think Miss Thompson is to be congratulated upon her success. The benefit of a seaside holiday to these children, who are specially selected from the poorer part of the Borough which this School serves, cannot be overestimated, and it is hoped that this annual effort may be repeated for many years to come. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 507 Intermediates 429 Leavers 465 Total 1,401 Number of other Routine Inspections 166 B.—Other Inspections. Number of Special Inspections 1,669 Number of Re-Inspections 5,969 Total 7,638 TABLE 11. A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1927. Defect or Disease. Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — — — Uncleanliness— (See Table IV.GroupV. I30 - 714 — Skin Ringworm, Scalp — 1 29 — Body I — 46 — Scabies I - 6 I Impetigo 3 - 257 — Other diseases (non Tb) 11 - 161 — Eye Blepharitis — - 5 — Conjunctivitis — - 6 — Keratitis — - — - Corneal Opacities — - 2 — Defect.vision exc.Squint 36 I 39 — Squint 20 2 8 — Other Conditions 1 — 24 — Ear Defective Hearing 3 — 8 - Otitis Media — — 4 - Other Ear Diseases 6 I 46 - Nose and Throat Enlarged Tonsils only 26 I 13 1 Adenoids only 3 — 10 - Enlarged Tonsils and Adenoids 12 5 Other Conditions 2 1 68 1 Enlarged Cervical Glands (non Tb) 4 — 20 — Defective Speech 1 1 1 — Teeth—Dental Diseases — — 10 - (see Table IV., Group IV.) Heart and Circulation Heart Disease—Organic 1 5 4 — Functional — 2 — - Anaemia 3 1 3 — Lungs Bronchitis 3 — 3 — Other non Tb. Diseases 1 — 4 - Tuberculosis Pulmonary—Definite — — — - Suspected — — 2 — Non-Pulmonary-Glands 2 — — — Spine — — — — Hip 1 — 2 — Other Bones & Joints - — — — Skin — 1 — Other Forms — — - Nervous System Epilepsy 3 — 1 — Chorea 2 — 4 — other Conditions - 2 Deformities Rickets 5 — — — Spinal Curvature 4 — 1 — (Other Forms 5 5 14 1 Other Defects and Diseases 18 345 7 TABLE II.— continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT EXCLUDING UNCLEANLINESS AND DENTAL DISEASES. GROUP. Number of Chii.drek. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups—Entrants 507 69 14 Intermediates 429 43 10 Leavers 465 43 9 Total Code Groups I4O1 155 11 Other Routine Inspections 166 23 14 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THF 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 1 1 2 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind Attending Public Elementary Schools - 1 1 At other Institutions - — — At no School or Institution 1 — 1 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 Puhlic Elementary Schools — At other Institutions -- — - At no School or Institution - — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 2 - 2 Attending Public Elementary Schools 7 17 24 At other Institutions — — At no School or Institution — — — Notified to the Local Control Authority during the year. Feebleminded — Imbeciles — I 1 Idiots I — 1 TABLE III.—Continued. — — — Boys. Girls. Total. Epileptics Suffering from severe epilepsy Suffering from epilepsy which is not severe. Attending Certified Special Schools for Epileptics - - - In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution — — — Attending Public Elementary Schools 3 1 4 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 1 — 1 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 2 I 3 At other Institutions 1 — I 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 13 10 23 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 2 1 3 At no School or Institution I — 1 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools 4 3 7 At Certified Residential Cripple Schools At Certified Day Cripple Schools 17 16 33 At Public Elementary Schools 4 5 9 At other Institutions — — — At no School or Institution - - - TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1927. 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 13 13 26 Ringworm, Body 26 10 36 Scabies 4 1 5 Impetigo 215 10 225 Other Skin Disease... 68 13 81 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 17 2 19 Minor Ear Defects 8 6 14 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 45 8 53 Total 396 63 459 54 Group II.—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practitioner or at hospital. apart from the Authority's Scheme. Otherwise. Total Errors of refraction (in cluding Squint) 100 6 106 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 14 2 - l6 Total 114 8 - 122 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 97 (b) Otherwise 5 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 95 (b) Otherwise 2 55 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital 25 By Private Practitioner or Hospital apart from the Authority's scheme 40 Total 65 Received other forms of treatment 28 Total number treated 93 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 70 463 482 1 1 — — — — — Total 1017 Specials 60 Grand Total 1077 (b) Found to require treatment 779 (c) Actually treated 422 (d) Re-treated during the year as the result of periodical examination 95 ( 2 Half-days devoted to:— Inspection 17 Treatment 110 Total 127 (3) Attendances made by children for treatment 1314 (4) Fillings : — Permanent teeth 438 Temporary teeth 134 Total 572 (5) Extractions : — Permanent teeth 69 Temporary teeth 1042 Total 1111 (6) Administrations of general anaesthetics for extractions 177 (7) Other operations :— Permanent teeth 179 Temporary teeth 157 Total 336 56 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 19,012 (iii ) Number of individual children found unclean 874 (iv.) Number of children cleansed under arrangements made by the Local Education Authority — (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws 4