The Royal Borough of Ringston- upon- Thames. Annual Reports . . for 19 2 8 , . of THE , . MEDICAL OFFICER OF HEALTH . . AND , . SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report or THE SANITARY INSPECTOR The Royal Borough of Ringston-upon- Dhames. Annual Reports . . FOR . . 19 2 8 . . 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), 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 of the Central Midwives Board. †New Health Visitors' Certificate †General Hospital Training Report of the Medical Officer of Health. Municipal Offices, Kingston-upon-Thames, March, 1929. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1928. Circular 939 (Ministry of Health) directs that the Annual Report for 1928 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. A Special Report on an outbreak of Smallpox which occurred in May is embodied in this Annual Report. Diphtheria was prevalent in the Borough this year. Health Education has been continued by weekly " talks " at the Infant Welfare Centres. A full programme of Lectures was given at the Library Hall during Baby Week, and a Public Lecture on Tuberculosis was delivered by Dr. S. G. Peill, from the National Association for the Prevention of Tuberculosis. We are proud that, for the second year in succession, the Baby Week Campaign was awarded a Certificate of Merit in connection with the Astor Challenge Shield Competition. Meat Inspection still occupies much of the Sanitary Inspectors' time, and necessitates a considerable amount of evening work. I thank Mr. H. T. Perry, your Chief Sanitary Inspector, and all members of the Staff of the Public Health Department for their untiring support throughout a strenuous year. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 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 £294,990 Assessable Value to District Rate £290,460 Sum represented by a Penny Rate— Poor Rate £1,194 District Rate £1,178 Amount of Poor Law Relief (1927) £3,383 4 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total Male. Female. Legitimate 529 259 270 Birth Rate (R.G.) per 1,000 population. 14.2 Illegitimate 31 15 16 Deaths— 560 274 286 Death Rate (R.G.) Per 1,000 population. 12.1 47E 233 242 Number of women dying in, or in consequence of child-birth— From Sepsis 0 From other causes 4 Deaths of Infants under one year— Legitimate Total. Male. Female. 34 21 13 Illegitimate 5 4 1 39 25 14 5 Deaths of Legitimate Infants under one;year per 1,000 Legitimate births 64 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 161 Total Deaths of Infants under one year of age per 1,000 69 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under two years of age) 3 Birth Death Rate Rate Rate per 1ooo Births Diarrhoea Total Deaths under 2 years. Under 1 year England and Wales 16.7 11.7 7.0 65 156 Smaller Towns 16.6 10.6 4.8 60 London 15.9 11.6 10.2 67 Kingston-upon-Thames 14.2 12.1 5.3 69 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 233 242 1. Enteric Fever — — 2. Smallpox — — 3. Measles 3 1 4. Scarlet Fever — — 5. Whooping Cough 2 1 6. Diphtheria 3 4 7. Influenza 1 4 8. Encephalitis Lethargica 1 — 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 14 13 11. Other Tuberculous Diseases 3 3 12. Cancer, Malignant Disease 18 45 13. Rheumatic Fever — 1 14. Diabetes 5 5 15. Cerebral Haemorrhage, etc. 12 20 16. Heart Disease 35 49 17. Arterio-Sclerosis 6 7 18. Bronchitis 11 5 19. Pneumonia (all forms) 26 15 20. Other Respiratory Diseases — 2 21. Ulcer of Stomach or Duodenum 5 — 22. Diarrhoea, etc. (under two years) 2 1 23. Appendicitis and Typhlitis 4 1 6 24. Cirrhosis of Liver 3 2 25. Acute and Chronic Nephritis 7 2 26. Puerperal Sepsis - — 27. Other Accidents and Diseases of Pregnancy and Parturition - 4 28. Congenital Debility and Malformation, Premature Birth 10 7 29. Suicide 1 2 30. Other Deaths from Violence 16 8 31. Other defined Diseases 45 40 32. Causes ill-defined or unknown - — METEOROLOGY. 1928. Temperature of Air Rainfall Highest Lowest Mean Max. Mean Min. Inches January 55 24 46 33 3.45 February 59 28 50 34 1.57 March 67 25 54 41 1.64 April 77 29 57 36 1.36 May 82 31 70 45 2.59 June 79 39 73 46 2.58 July 92 48 81 55 2.47 August 82 44 76 51 2.41 September 78 37 68 46 0.87 October 69 31 62 43 3.63 November 62 28 53 40 1.56 December 59 22 44 32 2.17 Total 26.30 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 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 Eden Street Consultation The Corporation Child Welfare Maternity and Washington Consultation The Corporation Child Wellare Road Ante-natal "Elmfield," Consultation The Corporation Clinic London Road School Clinic "Elmfield," Consultation & The Education London Road Treatment of Committee Minor Ailments, Refractions, Dental Treatment Day Nursery Canbury Park 9 Babies and Vol. Committee Road 16 Infants Red Cross Coombe Road Out-Patients, British Red Curative Post Massage, Cross Society Electrical, Light and Orthopaedic Treatment Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. The Tuberculosis Dispensary was moved from Grove Crescent, Kingston, to the new Clinic at Surbiton. Maternity. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. 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. Mrs. Evans died in September and her Maternity Home was Closed. The Kingston and District Hospital (Board of Guardians) has 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. Seven cases of Smallpox 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 197 accident cases and 56 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, 1892-1901 Baths and Washhouses Acts 28th July, 1896 Public Health Acts Amendment Act, 1890 1st July, 1891 Private Street Works Act, 1892 19th Jan., 1897 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 Sect. 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 Sanitary Conveniences „ 11th May, 1899 Houses Let in Lodgings „ 31st 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 Offensive Trades „ 5th March, 1928 Slaughter-houses „ 14th November, 1928 Common Lodging Houses „ 27th December, 1928 SANITARY CIRCUMSTANCES OF THE AREA. WATER. The Water Supply of the town is furnished by the Metropolitan Water Board, 10 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. The use of well water was discontinued at nine houses during the year. 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. 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 1928 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 Milk 52 3 Cream 5 — Butter 3 — Sugar 1 1 Spirits 5 — Drugs 2 — Other Articles 22 1 Totals 90 5 No prosecutions were made under these Acts in the Borough during the year. Notifiable Diseases during the Year. Cases. Deaths. Under year. I—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Notified Cases admitted to Hospital Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45-65 65 & over Total Deaths Small-pox - - - - - — — - - - 4 3 7 7 - - - - - - - - - - - - - Scarlet Fever 1 2 4 8 16 63 21 7 10 3 - - 135 111 - - - - - - - - - - - - - Diphtheria 1 2 5 4 6 72 43 9 8 1 - 1 152 142 — — — - 1 6 - - - - - - 7 Enteric Fever including Paratyphoid - - - - - - - 1 2 - 2 1 7 3 - - - - - - - - - - - - - Pneumonia 1 — 1 1 3 5 1 3 1 4 10 3 33 4 - - - - - - - 1 - - 4 2 7 Erysipelas — — 1 — - - 1 - 2 4 9 4 21 4 - - - - - - - - - - - - - Encephalitis Lethargies - — - — — — 2 - — 1 1 - 4 - - - - - - - - - - - - 1 Poliomyelitis - - - - - - - - - - - - 1 - - - - - - - - - - - - - Puerperal Fever - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - Puerperal Pyrexia — — — — — - - - 7 1 - - 8 7 - - - - - - - - - - - - 3 Ophthalmia Neonatorum 4 - - - - - - - - - - - 4 2 - - - - - - - - - - - - - New Cases. Deaths. Under 1 year 1-5 5—1o 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 I5—20 20—25 25—35 35—45 45—55 55-65 65 & over Total. Tuberculosis (a) Pulmonary M. - - - 1 3 3 13 3 4 3 - 30 - - - - 1 1 4 2 3 1 1 13 F. — - - 1 2 4 4 4 2 2 - 19 — - - 1 2 2 4 1 1 — 1 12 Total — — — 2 5 7 17 7 6 5- - 49 - - - 1 3 3 8 3 4 1 2 25 (6) Non-Pulmonary M 1 1 1 1 1 1 - - 1 - - 7 - 1 - - - - - - - - - 1 F. — - 2 — 1 — 1 - - - - 4 - - 1 - 1 — - - — — — 2 Total 1 1 3 1 2 1 1 — 1 - - 11 - 1 1 - 1 - - - - - - 3 11 13 INFECTIOUS DISEASE. SMALLPOX. The following Special Report on an outbreak of Smallpox was submitted to the Public Health Committee. Copies were sent to the Ministry of Health and to the Surrey County Council. Report on an outbreak of Smallpox, May, 1928. I submit the following; report on an outbreak of Smallpox that occurred in the Borough of Kingston-uponThames during the week ended May 19th, 1928. Seven cases were notified, and in addition I was informed of one suspected case. All the patients were removed to the Surrey Smallpox Hospital, East Clandon. A tabulated list of the patients in the order of notification, together with the essential particulars relating to each case, is detailed below. Notified Cases of Smallpox. Case Sex Age Notification Date of Onset Rash Date of rem. to Hosp. Vacc. condition at time of infection No. 1 M 77 yrs. 16-5-28 12-5-28 13-5-28 16-5-28 Vacc. in Inf 2 M 6o yrs. 17-5-28 20-4-28 22-4-28 17-5-28 —do— 3 M 58 yrs. 17-5-28 17-5-28 17-5-28 17-5 28 Doubtful 4 M 57 yrs- 17-5-28 17-5-28 17-5-28 17-5-28 —do— 5 M 85 yrs. 17-5-28 17-5-28 17-5-28 17-5-28 Vacc. in Inf 6 M 83 yrs. 18-5-28 18-5-28 18-5-28 18-5-28 —do— 7 M 64 yrs. 19-5-28 17-5-28 19-5-28 19-5-28 —do— Suspected Case of Smallpox. No. i F 15 yrs. 19-5-28 - 17-5-28 19-5-28 (for observ) Unvac- cinated. Cases Nos. 1, 3, 4, 5, 6 & 7. All these cases were notified to me from "H" Ward, Kingston and District Hospital, where they had been inpatients for varying periods, 13 Case No. 1 was first brought to my notice on May 16th, 1928, when I visited the Hospital during the afternoon of that day, in response to a request from the Medical Superintendent. I examined the patient and diagnosed the case as one of Smallpox of moderate severity, this being confirmed later by the Acting County Medical Officer of Health for Surrey, who saw the patient, with me, between 5 and 6 p.m. on the same day. As will be seen in the tabulated statement of cases, this man fell ill on May 12th, and the rash appeared on the following day. He had been admitted to the Kingston and District Hospital from Teddington on April 6th, 1928, suffering from retention of the urine and enlarged prostate. "H" Ward was visited on the following days, and Cases Xos. 3, 4, 5, 6 and 7, all of whom had not complained of illness, but were each found to have a very mild rash on the face, forearms and legs, were diagnosed as cases of Smallpox on May 17th, 18th and 19th. Cases Nos. 6 and 7 were admitted to the Kingston and District Hospital on May 4th, 1928, and May 14th, 1928. respectively, but Cases Nos. 3, 4 and 5 had been in-patients for very considerable periods. Case No. 2. This case arose in connection with a visit to contacts recently discharged from "H" Ward of the Kingston and District Hospital. The man was admitted to the Hospital on April 20th, 1928, and on his discharge on May 12th he returned to a Common Lodging House in Kingston, where he resided for about a month prior to his admission to the Hospital. I visited the Common Lodging House on the morning of May 17th and found clinical evidence that the man had had a mild attack of Smallpox. Inquiries elicited the fact that he felt ill on April 20th, was admitted to the Kingston and District Hospital the same day, and had a rash on April 22nd. It appears that the rash was noticed but thought to be due to Iodide which was contained in the medicine he was taking. Suspected Case No. 1. On May 19th I was called to see an unvaccinated girl aged 15 years at the surgery of a local medical practitioner. The girl had a rash on her face, and after consulting with the Acting County Medical Officer of Health, who saw the 14 case with me, we decided, in the circumstances, to send her to the Surrey Smallpox Hospital for observation. She was vaccinated before removal by the local practitioner. The vaccination took well, and after a period of observation it was considered not to be a case of Smallpox. The girl has now returned home. General Procedure. Upon first becoming aware of Smallpox in the district I notified the Ministry of Health by telephone, and subsequently in writing. The Acting County Medical Officer of Health for Surrey was informed immediately. Letters were sent to all the medical practitioners in the district on May 17th and 18th, 1928, informing them of the presence of Smallpox in the Borough, and circular letters were also sent to the neighbouring local authorities. Also I informed the Clerk to the Kingston Board of Guardians and the Vaccination Officer for the Kingston Union. Compulsory Notification of Chickenpox. When the suspected case of Smallpox occurred in the girl it was considered advisable to recommend that cases of Chickenpox be made compulsorily notifiable. For this purpose a special meeting of the Public Health Committee was held on May 22nd, 1928, and a recommendation made at this meeting was submitted to, and approved by, a special meeting of the Town Council, held on May 25th, 1928. The recommendation was made under Section 7 (6) of the Infectious Diseases (Notifications) Act, 1889, and came into operation on June 2nd, 1928, for a period of one month from that date. As far as possible, all notified cases of Chickenpox have been visited. Contacts and Vaccination. Lists of contacts were prepared after each case, and particulars were circulated promptly to Medical Officers of Health in whose districts any of the contacts resided. Copies of the lists were sent to the Acting County Medical Officer of Health, and to the Vaccination Officer, who, I understand, communicated with each person and drew attention to the urgent need for vaccination. I visited all the contacts who resided in the borough and advised with regard to 15 tion. All the patients, attendants, and orderlies in "H" Ward, together with the ward cleaner, porters, laundry hands, etc., engaged at the Hospital were vaccinated or re-vaccinated. None of the contacts developed Smallpox. Particular attention was paid to the Common Lodging House at which Case No. 2 was found, and I visited the premises at night on May 17th, 1928, in company with the Public Vaccinator. I examined the lodgers (45) and vaccination was offered in each case. Only nine -of the contacts agreed to be vaccinated, and the remaining 36 refused. Of this latter number, 17 had been vaccinated in infancy, but the remainder had been vaccinated several times, either during the late war or more recently. The inmates of this lodging house and the lodgers in the one other Common Lodging House in the borough have been kept under daily observation. No one has been admitted to the premises at which Case No. 2 resided, and it is satisfactory to record that only three men have left since the cases were notified. The bedding used by Case No. 2 was destroyed. No further cases arose at the lodging house, and it is probable that the man (Case No. 2) was admitted to the hospital before the infectious period occurred and, similarly, was not infectious when discharged. With regard to the suspected case a list of contacts was prepared immediately, and notifications sent to the Medical Officers of Health concerned. The girl in question was employed in a laundry and I communicated with the proprietor on the morning of the girl's removal to hospital. I informed him of the case and suggested, as a matter of precaution, that the girl's fellow employees should be advised to be vaccinated or re-vaccinated. Sixty-one girls were found to have been in contact with the suspected case, and of this number forty-four were vaccinated or revaccinated. The remainder had been vaccinated in infancy or later, but were not re-vaccinated. The total number of contacts in connection with the outbreak amounted to 212. Approximately 700 vaccinations and re-vaccinations have been carried out by the Public Vaccinator in the Borough between May 15th and June 13th, and 133 by the Medical Superintendent of the Kingston & District Hospital. Remarks. The six cases at the Kingston & District Hospital were confined to "H'' Ward and, as no further cases have been notified from the Hospital, it would appear that the outbreak 16 from this particular source is at an end. This Ward is used ordinarily for certain chronic male cases, and is staffed by male orderlies and attendants. It is situated in a separate block, and is, in consequence, isolated from the main hospital building and Central Relief Institution. It is, no doubt, for this reason the outbreak was more easily controlled. The Ward consists of two rooms, separated by a lobby, and I was able to arrange for the disinfection of each half to be carried out separately. The Ward was visited by me daily for twenty days. There is little doubt that the hospital cases arose from Case No. 2, but with regard to the latter, despite exhaustive inquiries, the source of infection was not definitely traced. It is interesting to record, however, that on Thursday, April 26th, 1928, I was informed by the London County Council that a man, R.B., who had been residing in Kingston up to and including Friday, April 20th, 1928, and who afterwards went to Fulham, had been admitted to Hospital on April 24th, 1928, suffering from Smallpox. In view of the date of appearance of the rash, it is probable that he contracted the disease at the same time as Case No. 2 but, unfortunately, even after a house-to-house visitation had been undertaken and the Common Lodging Houses visited, no evidence was forthcoming that R.B. had ever stayed at the Common Lodging House at which Case No. 2 resided, though it appears likely that he (R.B.) had stayed at the other Common Lodging House under a different name during the Easter week-end. CHICKENPOX. Thirteen cases were notified in accordance with the requirements of the temporarily compulsory notification order. It was not found necessary to continue the regulations in force for more than one month, as the suspected case of Smallpox resident in the Borough was not confirmed and the outbreak of Smallpox was limited to one ward at the Hospital. SCARLET FEVER. The type of case has been mild, and no deaths have been attributed to this disease during the year. 17 The following table gives a comparative statement of notifications received during the last ten years:— Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid) 1919 98 142 1 1920 139 82 2 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 1928 135 152 7 DIPHTHERIA. There were 152 cases notified during the year, and reference to the above table shows that for the first 5 years there was a steady decline in the incidence, whereas for the last 5 years there has been a corresponding increase. It is hoped that the maximum incidence has been reached this year, and that we may have the good fortune to experience a decline during the next few years. This year, therefore, must be looked upon as a "Diphtheria Year," the type having varied from mild bacteriological cases to those of extreme virulence. Seven deaths have occurred among the latter class. It is a regrettable fact that medical aid is not sought at the earliest opportunity, and there is little doubt that several of the deaths might have been averted had the parents called in a doctor earlier. A letter was sent to all medical practitioners early in the year with regard to the issue of Diphtheria Antitoxin, which can be obtained from two chemists, and is available at all times. It is stocked in phials containing 8,000 units for treatment and 500 units for prophylaxis, as suggested by the Ministry of Health. Later in the year, a further letter was sent to all doctors urging that antitoxin should be administered at the earliest possible moment to all doubtful and suspected cases. As regards the Public Elementary Schools, Diphtheria was prevalent in the early part of the year at Bonner Hill School, and in the autumn at St. John's School. A brief account of these two outbreaks will be found in paragraph "Infectious Diseases," page 51, in the Report of the School Medical Officer. In November, cases occurred among boys attending Tiffin's School. They were limited to one class, which was swabbed, with the result that one carrier was 18 isolated, and the outbreak definitely ceased after the action taken. In general, the procedure consisted of the examination and swabbing of contacts. In certain instances, such as the outbreak at Tiffin Boys' School, this action apparently met with success, but in other instances the disease was not so successfully controlled. Immunisation against Diphtheria and Schick testing is not, at present, offered in the Borough, and it appears doubtful at the present time whether parents would take advantage of such offer for the protection of their children. Further, it should be noted that additional medical staff would be necessary to carry out this work. ENTERIC FEVER (Including Paratyphoid). Seven cases were notified during the year. Of these, 5 were notified as Typhoid and 2 as Paratyphoid B. Very careful inquiries were made into each case, but the sources of infection were not definitely traced. ACUTE POLIOMYELITIS. One case occurred during the year in a female child, aged 5 years, who was notified on January 7th. Paralysis of the left leg resulted from the attack. The child has been seen by the Orthopaedic Specialist at the Red Cross Curative Post, and is having massage treatment three times a week. ENCEPHALITIS LETHARGICA. Four cases were notified during the year. Of this number, 3 died, but according to the Registrar-General, however, only 1 death was attributed to Encephalitis Lethargica as a primary cause. It is of interest that 2 of the cases (a boy of 14 years and a girl of 12 years) occurred within a fortnight of primary vaccination, at a time when a great number of vaccinations were being carried out owing to the presence of Smallpox in the Borough. Very careful investigations were made into these cases, in collaboration with a Medical Officer of the Ministry of Health, but there was no positive proof of any direct connection between the Encephalitis and vaccination, 19 PUERPERAL FEVER, PUERPERAL PYREXIA AND OPHTHALMIA NEONATORUM. Comment on these diseases will be found in the Maternity and Child Welfare Section of this report, on page 22. 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 CASES OF INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. There were small outbreaks of Chickenpox at Richmond Road and St. Peter's Infants' Schools during the early months of the year. Measles was prevalent in the Borough from February until June, affecting many infants' departments of the elementary schools, and 4 deaths were attributed to this disease during the year. As regards Influenza, there was nothing in the nature of an epidemic, and only 5 deaths were attributed to this disease. 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. 20 During the year there were the following number of attendances at the Centres:— Attendances. Meetings. New Cases. Total. Eden Street 51 149 2,747 Washington Road 49 60 960 The Health Visitors paid the following number of home visits:— First Visits.. Total Visits. Expectant Mothers 54 74 Infants under one year 558 1,810 Children, one to five years — 2,212 Incidental and Infectious — 545 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 41 mothers have purchased 150 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 1st to 7th, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. This was preceded by a Shop Window Display during the week commencing June 18th, and a film entitled "Empire Builders "exhibited at the Picture Theatre, Richmond Road, on June 20th. The following programme was carried out at the Library Hall in the evenings during Baby Week:— July 2nd.—Lantern Lecture: "Flies," by Dr. E. W. Matthews, Medical Officer of Health. July 3rd.—Social Evening, including Health Plays by School Children and entertainment by Parents. July 5th.—Film and Lecture: "A Brush with the Enemy,"by Mr. F. S. Steadman. July 6th.—Lantern Lecture: "Milk, from Cow to Consumer," by Mr. Harold T. Perry, Chief Sanitary Inspector. 21 In corresponding order, Councillors G. S. Crawford, W. H. Bowskin, G. D. Densham and L. Frazer Nash kindly presided at the above lectures. July 4th.—The Annual Garden Party for members of both Centres was held at St. Peter's Vicarage, when Mrs. Penny very kindly presented the prizes. For the second year in succession, the Baby Week Campaign was awarded a Certificate of Merit by the Committee of the "National Baby Week Council" in connection with the Astor Challenge Shield Competition. The Centres also competed in the National Welfare and Baby Week Mothercraft Competition, attaining fourth place, which must be regarded as a highly successful effort. Certificates were awarded to six parents, four obtaining honours. The Annual Winter Tea and Entertainment was held at each Centre in January. In the autumn a "Mothers' Committee" was formed. This Committee is comprised of mothers of children no longer in arms, and is doing very useful work in welcoming and assisting new members and arranging short, bright entertainments from time to time. Short "talks" to the mothers have been given throughout the year. STAFF. There has been no change in the Nursing Staff during the year. 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. During the year 97 expectant mothers attended, making 190 visits to the clinic, which is an average attendance of nearly 1G per session, which compares with 8 last year and 22 4 in 1926. This is very satisfactory, but a fall of about 40 per cent, in attendance must be anticipated, since an Ante-Natal Clinic was established at the end of the year by the Guardians for those expectant mothers who have booked their confinements at the Kingston & District Hospital. Hitherto, many of these expectant mothers have attended your Ante-Natal Clinic. Support from midwives engaged in private practice is still disappointing, but the midwives from the Kingston Nursing Association continue to bring expectant mothers. 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 & District Hospital or other Maternity Home, returning after the puerperium with the infant to the "Shelter" tor 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 8 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. The consultant, Dr. Andrew McAllister, was not summoned during the year. 23 Five cases were mild and due to a variety of causes, such as breast abscess, femora! thrombosis, etc., but 3 died, and the following is a brief record of these fatal cases:— Case 1.—Age 26. Confined at her home on February 16th, 1928. Attended by a midwife. Got up on February 26th, 1928, but fell ill the following day, when she sent for the midwife, who summoned a doctor. Notified as Puerperal Pyrexia on February 28th, 1928, and admitted to the Kingston & District Hospital on March 2nd, 1928; She died on March 3rd, 1928, and an inquest was held, the medical evidence as to the cause of death being "Syncope from double lobar pneumonia." Case 2.—Age 34. Confined in the Kingston and District Hospital on March 23rd, 1928. Notified as Puerperal Pyrexia on April 2nd, 1928, and died on April 8th, 1928. Cause of death — "Broncho-pneumonia" — Parturition, placenta praevia with severe ante-partum haemorrhage. Case 3.—Age 26. Confined in the Kingston & District Hospital on April 5th, 1928. Notified as Puerperal Pyrexia on April 18th, 1928, and died on the same day. Cause of death—Syncope and shock from torsion of left (Cystic) ovary following labour. PUERPERAL FEVER. A case was notified on June 19th, 1928, by a doctor who was called in by a midwife to a woman aged 38, who had been confined on June 9th, 1928, at her home. She was admitted to the Kingston & District Hospital, and recovered. OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1928:— Treated Vision Vision Total Notified. At Home. In Hospital, unimpaired impaired Blindness Deaths 4 2 2 4 — — — Arrangements have been made with the Metropolitan Asylums Board for the reception and treatment of cases of Ophthalmia Neonatorum from the Borough at St. Margaret's Hospital, Kentish Town, N.W.5. 24 Application for the admission of cases will be made by the Medical Officer of Health of the Borough, who will arrange for the conveyance of patients to and from the Hospital. The charge is to be at the rate of 10s. per patient per day. ORTHOPAEDIC 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 6 infants received out-patient treatment, making 243 attendances. The cost of out-patient treatment was £24 15s., and the contributions paid by parents towards this expenditure amounted to £13 3s. Two infants were treated as in-patients at St. Vincent's Orthopaedic Hospital at a total cost of £79 5s. 3d., the parents in both cases being unable to contribute anything towards this charge. I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Inspections Number of Written Notices. Occupiers prosecuted Factories—(including Factory Laundries) 13 2 Nil Workshops—(including Work shop Laundries) Workplaces—(other than Outworkers' premises) Total 13 2 Nil 25 II—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H M. Inspector. Nuisances under the Public Health Acts''— Want of Cleanliness 2 I - - Want of Ventilation I — - - Overcrowding — — — — Want of drainage of floors — — — - Other nuisances 2 3 - - Sanitary Accommodation Insufficient Unsuitable or Defective Not separate for sexes - - - - 2 1 — - - - - - Oftences 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 10 8 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Work shop 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 Tenth Annual Report on the work carried out by your Sanitary Inspectors during the year 1928 in connection with the various Statutes and Bye-laws relating to Public Health in force within the Borough. The total number of inspections during 1928 was 8,020 as compared with 6,986 during 1927. On 432 premises sanitary defects to the number 3,314 were discovered. In connection with these defects 370 "preliminary" and 67 "verbal" notices were issued. In 25 instances it was found necessary to serve "statutory" notices. During the year 1928 particulars relating to the inspection of 432 premises were added to the records, whilst 373 entries were struck off the registers following the completion of necessary works. On December 31st, 1928, 348 premises remained on the registers, compared with 287 at the end of 1927. Once again I have to report an increase (nearly 15 per cent.) in the total number of inspections and visits. This increase was due partly to the work of food inspection and to inspections of premises after service of notices, etc., but was also due to a special inquiry into well-water supplies, assistance rendered to the Housing Committee, and to investigations caused by the large number of cases of Infectious Disease. It must be clear that this extensive amount of work could not be carried out during the ordinary official hours and, although it has been done willingly in the cause of the public health, it is only right to point out that it is a great strain to work throughout the greater part of the year at such high pressure. I invite your Council to compare the amount of work carried out in this Borough with that of other similar districts, and it will be found that your staff is not adequate to maintain the standard which has been reached. This fact was demonstrated more than once during the past year when, by reason of the increase of infectious disease and other unlooked-for occurrences, the work of the 27 Sanitary Department was entirely disorganised. Not only is the machine being worked at high speed continuously, but there is no spare power available in case of emergency. I do not wish to labour this point unduly, but the effects of the existing conditions are far-reaching. Apart from the lack of leisure time—a fair meed of which might.be expected —it is difficult to keep au fait with matters appertaining to the many and varied duties, and the work cannot be kept up-to-date. The policy of affording property-owners facilities to discuss with your Sanitary Inspector difficulties and differences which may arise as the result of inspections and subsequent service of notices, has been continued. These interviews lead to a better understanding between the parties concerned, and if only for that purpose are well worth the time and endeavour. In a brief report it is unnecessary to comment specially upon such work as preparation of records, clerical routine and other administrative duties. Inspections and Visits. The following is the total number of Inspections made in regard to each section of the work, together with a Summary of Sanitary Improvements executed:— Rent Restrictions Act Inspections 5 Re-inspections after Order or Notice 1,720 Visits to Works in Progress 1,119 Factories and Workshops 13 Cowsheds, Dairies and Milkshops 30 Ice Cream Premises 9 Foodshops and Food Preparing Rooms 452 Infectious Disease Inquiries 664 Markets 93 Special Inspections (Complaints, etc.) 920 Slaughter-houses 1,990 Offensive Trades 17 Sanitary Conveniences 53 Common Lodging-Houses 158 Canal Boats 2 Theatres, Cinemas, etc. 11 House-to-House 19 28 Bakehouses 14 Smoke Observations 20 Stables and Yards 19 Enquiries re Housing Applicants 115 Schools 10 Well Water Enquiries 312 Fair Ground 4 Miscellaneous Visits 245 Total 8,020 Drainage. Number of Houses and Premises re-drained 49 Number of Drains repaired or amended 2 Drains or Gullies unstopped or cleansed 12 Manholes provided 63 Manholes altered or repaired 3 Intercepting Traps fixed 23 Fresh-air Inlet Shafts repaired or renewed 25 New Gully Traps fixed 140 Gully Curbs renewed or repaired 7 New Soil Pipes or Ventilating Shafts 53 Soil Pipes or Ventilating Shafts repaired 1 Smoke Tests applied 74 Water Tests applied 136 New Rain water Soakaways 6 Soil Pipe Ventilated 2 Miscellaneous 2 Water Closets and Sanitary Fittings, W.C. Apartments cleansed and limewashed 41 New W.C. Basins fixed 85 W.C.s unstopped, cleansed or repaired 7 W.C. Flushing Tanks repaired or renewed 71 Water supplied to W.C.s 2 W.C. Apartments lighted, repaired and ventilated 61 New Impervious Sinks provided 46 New Waste Pipes fixed 46 Existing Waste Pipes trapped or repaired 13 Urinals cleansed or repaired 9 New W.C apartments provided 11 Miscellaneous 1 29 Miscellaneous. Roofs repaired 55 Eaves Gutters renewed or repaired 53 Stack Pipes renewed or repaired 35 Stack Pipes disconnected from Drains 73 Damp Walls remedied 67 New dry Areas provided 5 Ventilation provided beneath floors 16 Additional ventilation provided to rooms 18 Larders provided and repaired 5 Staircases lighted 7 Site of house concreted 3 Yards and passages paved 102 Yard Paving repaired 10 Yards cleansed 8 Floors of Rooms repaired 48 Floors of Rooms renewed or repaved 25 New Sculleries 3 Rooms repaired, cleansed and distempered 348 Verminous rooms cleansed 2 New ceilings 13 Windows repaired, renewed or made to open 112 Doors re-newed or repaired 23 Cisterns repaired, cleansed, covered or removed 20 Door and window sills renewed or repaired 71 Stairs repaired or renewed 12 Portable ashbins provided 134 Accumulations of manure and refuse removed 7 Nuisance from overcrowding abated 6 Nuisance from animals abated 3 Water supplied direct from main 45 Water supply reinstated 6 Premises connected to M.W.B. mains and use of well water discontinued— 9 Fire grates repaired or renewed 36 New Coppers provided 3 Defective coppers repaired 20 Walls repaired, repointed or rebuilt 60 Foundations of walls strengthened 2 Chimney Stacks repointed or repaired 17 Handrails, provided to staircases, or repaired 36 Covers provided to manure receptacles 2 Nuisance from smoke abated 4 Premises repainted 12 30 New fences 10 Premises limewashed 12 Improper sleeping place discontinued 1 W.C. adjoining food premises ventilated into open air 2 Common Lodging House cleansed 1 Shed demolished 1 Insanitary food premises discontinued 5 Miscellaneous 9 Smoke Abatement. The number of complaints received during 1928 in respect of alleged nuisance from smoke was 7, this figure being the same as for the previous year. Twenty-six observations were made, and in several instances excessive amounts of smoke were recorded. 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 1928 158 inspections were made of the registered premises. This huge increase in the number of visits was due chiefly to the outbreak of Smallpox in the early part of the year. Daily visits, in addition to visits at night, were necessary in order to maintain the closest possible supervision over the movements of the lodgers and the places visited by any newcomers. Nocturnal visits were also made together with the Medical Officer of Health and the Public Vaccinator. Offensive Trades The following offensive trades are carried on in the Borough:— Leather Tanning and Fellmongering. Rag and Bone Dealers. Fish Frying. 31 The Rag and Bone Yards are situated in unsuitable positions in the Borough, and require frequent visits of inspection. During 1928 the Corporation adopted new Bye-laws to control all offensive trades. The additional powers have proved very useful in dealing with Rag and Bone Yards and Fried Fish premises. Seventeen visits were made to premises in connection with offensive trades, in addition to reinspections after notices or warnings. One fried fish shop was closed during the past year. This particular shop was the source of continual complaint owing to the old-fashioned apparatus used and the consequent emission of odours. A notice was served under the Bye-laws, requiring the apparatus to be remodelled, but no further action was necessary after the business closed down. No new fried fish shop or other offensive trade premises were licensed during the year. Complaints One hundred and eighty-five complaints were received during the year as follows:— Drains and Sanitary Arrangements 23 Overcrowding 2 Insanitary Condition of Premises 80 Absence of Ashbins 1 Water Supply 3 Accumulation of Manure and Non-collection of House Refuse 11 Dampness 3 Keeping of Animals and Fowls 10 Smoke Nuisance from Chimneys 7 Defective Stoves 6 Defective Roofs and Gutters 14 Stagnant Water or Flooding 3 Premises Infested with Vermin 2 Premises infested with Flies 3 Dirty Condition of Yards, etc. 3 Water Flowing over Footpaths 2 Overhanging Trees Obstructing Light and Air 2 Miscellaneous 2 185 32 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 1927 was 172. 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 98 (b) With State assistance under the Housing Acts— (1) By the Local Authority 60 (2) By other bodies or persons Nil 1. Inspection of Dwelling-houses During the Year. (1) Total number of dwelling-houses inspected for housing defects (under Public Health) or Housing Acts) 687 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 16 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 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 377 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 314 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 33 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 22 (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 Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil It is to be regretted that the time available will not permit of house-to-house inspection, under the Housing Acts, of working-class property—although this branch of the work is needed very badly in the Borough. It is incontrovertible that labour devoted to this form of inspection, and the consequent prevention of slums, is far more economical in the long run than expenditure incurred in clearing insanitary areas and the building of new estates for the slum-dwellers. It is not difficult to cite roads in 34 the Borough, the property in which is deteriorating year by year. These houses will eventually become slums unless the downward trend is checked. Unfortunately, it is difficult to awaken the conscience of some landlords to the needs of their property without some action by the local authority. Equally so, it is hard to understand why some tenants consistently keep their houses in such a deplorable state. It is really unnecessary to say that these classes of people, both owners and tenants, resent the local authority carrying out its duty, and they do not attempt to conceal their opinions. In a brief report of this kind, however, one cannot discuss the housing problem of to-day fully. I have mentioned one particular class of owner but, fortunately, there is the more usual type who welcomes the assistance of the local authority. As an example, I should like to refer to some property in what is regarded as a mean street in Norbiton The houses referred to have improved year by year, and the owner is co-operating with your Council in the endeavour to reduce the overcrowding, which has existed for years. During 1928 these houses have been redecorated throughout, the roofs have been stripped and re-slated where necessary and several of the chimney stacks have been renewed. Floors have been renewed, and woodwork painted throughout. The total cost of the work amounted to some hundreds of pounds, and it has been carried out without the need for any formal action by the Corporation. Many of the houses were sublet room by room, but gradually this condition is being changed, and the owner has given instructions that as and when rooms are vacated, they shall not be re-let separately. This particular class of property needs frequent inspection if the efforts of the owners are to bear good results. Owing to the inadequate staff, however, it is not possible to devote the requisite attention to the area. In these houses one can find the kind of tenant I have referred to above, yet, despite this fact and the lack of domestic convenience in the houses, some of the occupants display a remarkable determination to have clean homes, and they succeed. There is hope that the spirit shown by the landlord to whom I have referred may result in a general uplift amongst the less desirable tenants of the houses. The term "slum area" is used very frequently these days, and it may not be out of place to mention it here. In my opinion the word "slum" is used much too freely and without regard to what a real slum is. I venture to say 35 that in this Borough there are no "slums" as the word is known and used to describe the narrow courts and alleys which exist in some of the industrial areas throughout the country. At the same time, there is a very considerable amount of property in the district which is far below par, and which will eventually be past redemption unless action on the lines I have suggested is taken. The women in these houses, who might otherwise be good housewives, frequently lose pride in their homes and become slovenly and careless; only those who are in touch with these matters know how difficult it is to raise the standard of cleanliness when once it has dropped. ASH RECEPTACLES AND COLLECTION. The practice of periodically reviewing the ashbin accommodation throughout the Borough was continued during the past year and 134 new ashbins were provided as the result of action taken. A decided improvement has been effected by the partial adoption of the recommendation I have made from time to time, namely, that it should not be a requirement for certain householders to place their ashbins on the footpaths in readiness for the collectors. Your Council has rescinded this requirement in Shortlands Road, and a similar change is under consideration for other parts of the town, together with questions of improved transport. OVERCROWDING. There were fifteen cases of overcrowding known to exist in the Borough at the end of 1928, but undoubtedly there were others which had escaped notice. This number is much lower than in previous years, and there can be no doubt that the new houses erected by your Corporation have relieved the serious condition which existed a few years ago. In my view much could be done to prevent overcrowding, if it was a necessary precedent to subletting of rooms that the permission of the Local Authority should be obtained. Many houses, which were not designed to accommodate more than one family, have been sublet, and no attempt has been made to make necessary alterations or to provide additional sanitary accommodation or domestic facilities. This subletting may not be serious where no overcrowding is caused, but occasionally it is found that tenants have sublet the upper rooms and kept the kitchen 36 and one other room only for their own use. These cases must be regarded as serious, especially when each room in the house is used as a bedroom. During 1928, 6 cases of overcrowding were abated as the result of informal action. HOUSE DRAINAGE. Forty-nine houses were re-drained during the year, as compared with 15 during 1927. 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 premises re-drained during the year:— Albany Park Road 1 Acre Road 6 Canbury Park Road 4 Cambridge Road 1 Clarence Street 1 Elm Crescent 6 Elm Road 6 Fairfield South 1 Hudson Road 1 Kings Road 3 Lowther Road 2 Mill Place 2 Park Road 12 Queens Road 2 Richmond Park Road 1 For some years a plan of each house re-drained was prepared and filed for future reference. Unfortunately, this extremely useful form of record is not possible now and with other records, equally desirable, but not definitely required by Statute or Regulation, has been suspended. Increase of Rent and Mortgage Interest Acts. Five applications were received during the year from tenants for certificates under Section 2, Sub-Section 2, of the above Act, as compared with 8 during 1927. 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. 37 In one instance, necessary repairs were not carried out by the owner, and a certificate was granted to the tenant. Applications for these certificates are becoming- less frequent each year. Inspection and Supervision of Food. (a) Milk Supply. During 1928 6 persons were removed from the register owing to business changes. One dairyman was added to the register, making a total of 38 on December 31st, 1928, compared with 43 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:— Dealer's Licence to bottle and sell Grade A (Tuberculin Tested) Milk 1 Supplementary Licence to sell Certified Milk 2 Supplementary Licence to sell Grade A Milk 1 Supplementary Licence to sell Grade A (Tuberculin Tested) Milk 1 Supplementary Licence to sell Pasteurised Milk 1 Licence to sell Pasteurised Milk 3 (b) Meat and Other Foods. This branch of the work appears to have no bounds so far as expansion is concerned. I believe it is a fact that during each of the ten years I have had the honour to make an annual report, the statistics show increased amount of work in this direction. The year 1928 proved no exception. Previous to 1925, when the Meat Regulations came into force, there was no obligation for butchers to notify their intention to slaughter animals. Carcases were only examined when a chance call at the slaughterhouse coincided with the time of slaughter, and as the greater part of the killing is done during the late afternoons and evenings, a large proportion of the meat was not inspected. The Meat Regulations changed this state of affairs, and now, as will be seen by the table on page 39, only a fraction of 1 per cent, of the animals are not seen. At the time the new Regulations were about to come into force I submitted a report to your Public Health Committee and in that report I estimated the number of animals slaughtered in the Borough as 2,000 per annum. The Meat 38 Regulations, however, enabled accurate records to be kept, and it was found that the actual number for 1925 was nearly four times the estimate. Since 1925 the amount of slaughtering in the Borough has increased by 40.3 per cent. The following figures show the increase year by year:— 1924 2,000 (Estimate number before mencement of Meat Regulations.) 1925 7,672 1926 7,636 1927 8,350 1928 11,093 With the exception of a few sheep and goats, 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. The total visits to premises having relation to the food supply during 1928 was 2,588. This large increase may be attributed to various causes. One neighbouring authority has no slaughterhouse at all, and in other nearby districts, the amount of slaughtering is comparatively small. Again, the removal of the cattle market to the present position has resulted in a larger number of animals being sent in for sale. Frequently it is more convenient for butchers from other districts to have the animals slaughtered in Kingston than to convey them to their premises alive. For this reason, and also owing to the fact that there are several dealers in the town, a large proportion of the meat inspected at the slaughterhouses is not consumed in the Borough, but is sent to other localities. Records are kept of all notices received, the number of animals slaughtered, the time of inspection and the result of the inspection. The following table is a summary of all notices for the year 1928 and reflects the very considerable amount of time devoted to this work. 39 MEAT REGULATIONS, 1924. Summary for Year ended December 31st, 1928. Number of Notices Received. Number of Animals Slaughtered. Carcases not Examined. Percentage of Total Animals not Examined. Beasts Pigs. Calves Sheep, Goats. Total. Sheep Goats. 1111 92 5870 2861 2117 153 11093 — — 15 3 1 • Inspections during Office Hours. Percentage of Total. Inspections made after Office Hours. Percentage of Total. 423 338 828 662 4o The following- tabulated list shows the various amounts of foodstuffs condemned during the year. Where the action taken is stated to be "inspected and condemned" the inspection was made at the slaughterhouse at the time of slaughter. In the other cases a request for inspection was made by the owner. Artides of Food. Reason for Condemnation. Action taken. PORK— 32 Carcases and offal Tuberculosis Inspected & Condemned 2 Carcases and offal Pneumonia ,, ,, ,, 1 Carcase and offal Haematuria ,, ,, ,, 119 Heads and Necks Tuberculosis ,, ,, ,, 1 Head and Neck Abscess ,, ,, ,, 5 Plairs Lungs Tuberculosis ,, ,, ,, 10 pairs Lungs Congestion ,, ,, ,, 1 Pair Lungs Pneumonia ,, ,, ,, 32 Plucks (Complete) Tuberculosis ,, ,, ,, 1 Pluck Inflammation ,, ,, ,, 5 Livers Tuberculosis ,, ,, ,, 5 Livers Cirrhosis ,, ,, ,, 1 Liver Parasitic disease ,, ,, ,, 6 Livers Fatty Infiltration ,, ,, ,, 26 Mesenteries Tuberculosis ,, ,, ,, 1 Kidney Tuberculosis ,, ,, ,, 10 Spleens Tuberculosis ,, ,, ,, 2 Miscellaneous offal Tuberculosis ,, ,, ,, 266 Ibs. Pork Tuberculosis ,, ,, ,, 8 Ibs. Pork Bruised ,, ,, ,, BEEF— 6 Ox Heads & Tongues Tuberculosis ,, ,, ,, 2 Livers Tuberculosis ,, ,, ,, 10 pairs Lungs Tuberculosis ,, ,, ,, 83 ½lbs. Liver Putrefaction Voluntarily surrendered 65 ½lbs. Kidneys Putrefaction ,, ,, ,, 390 ½lbs. Beef Putrefaction ,, ,, ,, VEAL— 3 Carcases and offal Tuberculosis Inspected & Condemned 1 Head Tuberculosis ,, ,, ,, 1 Liver Fatty Infiltration ,, ,, ,, 4 Livers Tuberculosis ,, ,, ,, 4 Pairs Lungs Tuberculosis ,, ,, ,, 24 Kidneys (10 lbs.) Putrefaction Voluntarily surrendered 1 Spleen Bruised Inspected & Condemned TRIPE— 2 lbs of Tripe Putrefaction Seized and Condemned 41 MUTTON — 56 Livers Distomatosis I Inspected & Condemned 10 pairs Lungs Strongylus Rufescens ,, ,, ,, 1 Forequarters Inflammation ,, ,, ,, 20 lbs.Lamb Putrefaction ,, ,, ,, FISH— 1 Box Dog Fish Putrefaction Voluntarily surrendered 1 Box Coal Fish Putrefaction ,, ,, 1 Box Mixed Fish Putrefaction ,, ,, 2 Boxes Smoked Haddocks Putrefaction ,, ,, 91 lbs Plaice Putrefaction ,, ,, 70 Soles Putrefaction ,, ,, Well Water Supplies A special enquiry was made in the early part of 1928 with regard to the use of well-waters. Visits were made to all houses where records showed that well-water had been used for domestic purposes. The result of the enquiry, which was the first general review since 1919, proved satisfactory, and only 76 premises were found to be utilising water from wells, compared with 271 in 1919. Seven samples of well-waters were taken during the year and were submitted to the Corporation Analyst, Mr. P. G. Lloyd. Two other samples were submitted to the Clinical Research Association for Chemical and Bacteriological Examination respectively. The results of the chemical analyses were similar in each case and showed that the waters were usable for drinking purposes, but there were indications of previous pollution. The bacteriological examination did not reveal the presence of excremental organisms. The use of well-water was discontinued in the case of 9 houses during the year 1928 as follows:— Bearfield Road 3 houses Elm Road 1 house High Street 1 house Kings Road 1 house Mill Street 1 house Richmond Road 2 houses Private Slaughterhouses There are six private slaughterhouses in the Borough, and the following Table is set out in accordance with the 42 request of the Ministry of Health :— In December, 1928. Registered 3 Licensed 3 Total 6 All the premises have been in use during 1928. The buildings, with one exception, are old. One slaughterhouse has been very much improved by the removal of an old loft overhead and the provision of added light and ventilation. A new pen has also been constructed at these premises. One thousand nine hundred and ninety visits were paid to these premises during the year as compared with 1,701 during 1927. New Bye-laws were adopted by the Corporation during the year, including the requirement that all animals shall be stunned by a mechanically operated instrument previous to slaughter. The Bye-laws came into force in November, but it is too early yet to report on the result. Disinfection The increase in the number of notified cases of infectious disease was responsible for the larger number of houses disinfected during 1928, compared with 1927. There were 397 rooms in 353 houses sprayed and fumigated with formalin; 2,326 articles were passed through the steam disinfector. This figure is not high when one considers the increase in the number of houses disinfected. Disinfection of premises is not only carried out after notifiable infectious diseases, but also at the request of the public. In such cases a charge, sufficient to cover the cost of the work, is made. The Infectious Motor Ambulance is constructed for the dual purpose of removing patients to Hospital and for the conveying of bedding to and from the disinfecting station. Factories, Workshops and Workplaces Thirteen visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in the tables on pages 24 and 25. 43 There are twelve "Outworkers" resident in the Borough, and the premises so used were inspected periodically. This branch of the work requires much more time devoted to it. No review of the records of Workshop premises has been possible for some years, and this work is now overdue. Stables and Yards There is no change to report 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. Eleven formal inspections were made of the above premises during the year under review. The sanitary conveniences are usually maintained in good order, and the ventilation apparatus was in good working order when the visits were made. 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 1928 two 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. The conveniences attached to licensed houses in this Borough compare very favourably with similar places in all 44 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. Rag Flock Acts, 1911 and 1928. There are at least two, and probably several more, premises on which Rag Flock is used in the making of upholstery, cushions and bedding, but no samples were taken for analysis during 1928. It is anticipated that some action may be taken during the current year. Legal Proceedings Legal proceedings were instituted in one instance only during 1928. Nature of offence Result 1. Failure to observe due clean liness in connection with a room used for the preparation of food. Fined £10 and £5 5s. costs 2. The exposure for sale of meat which was unwholesome and unfit for the food of man. Summons dismissed on payment of £2 2s. costs by the defendants. 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, 1929. 45 Report of the School Medical Officer. March, 1929. To the Chairman and Members of the Education Committee of the Royal Borough of Kingston-upon- Thames. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1928. The average number of children on the school register for the year was 4,552. Medical Inspection was carried out on the same lines as before, and no objection to medical examination of a child was received from any parent. Three half-days a week were devoted to Dental work until the end of February, when an additional session per week was sanctioned. The gradual extension of Dental Supervision and Treatment to the whole of the School population will necessitate periodically an increase in the number of sessions per week. The scheme for orthopædic treatment of Crippled Children worked satisfactorily, but the contributions received from parents towards the cost of this treatment showed a comparative decrease. The Eye Clinic was held on Wednesday afternoons during the School terms, 20 meetings in all being necessary during the year. The Scheme for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital worked satisfactorily, 35 children receiving treatment under this Scheme. 46 The work at the Inspection and Minor Ailments Clinic continues to increase, there having been 6,999 attendances during the year, or 527 more than in 1927. There was no School Closure on account of Infectious Disease. Diphtheria has been prevalent this year. Immunisation against diphtheria is not offered at present, but must be a subject for careful consideration in the near future. I thank the Staff of the School Medical Service for their co-operation and willing assistance at all times. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 47 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. COORDINATION. The School Medical Officer is also Medical Officer of Health. The School Nurses are also Health Visitors, and each carries out both Maternity, Child Welfare and School Work in her own particular area. Close touch is kept between the School Attendance Officers and the School Medical Department. Constant difficulties and waste of time arise from the fact that the Office and Clinic of the School Medical Service are at a considerable distance from the Public Health Department, so I take this opportunity of emphasising the following paragraph from my Annual Report for 1925: "In a compact Borough such as Kingston-upon-Thames, I consider centralisation of Offices, Clinics, Welfare Centres, etc., an ideal to be aimed at for efficient health administration," 48 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 is set out each year. During 1928 the following repairs have been carried out:— Bonner Hill Road School. The whole of the external woodwork and ironwork of the Boys', Girls' and Infants' Departments, including the Caretaker's Cottage, have been painted, also the Lavatories of all Departments have been redecorated. Richmond Road School. The whole of the external woodwork and ironwork of the Boys', Girls' and Infants' Departments have been painted. The Bungalow Classroom has been redecorated both internally and externally. The Lavatories of all Departments have been redecorated. Non-Provided Schools. St. Peter's School.—Minor redecorations. St. Paul's School.—Redecorations on reorganisation St. Agatha's School.—Minor redecorations. All Saints' School.—Walls and ceilings of Girls' Department redecorated. Stoves repaired in Infants' Department. 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. 49 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 326 263 81 Girls 279 236 85 Intermediates, Boys 348 230 66 Girls 345 228 67 Leavers, Boys 227 92 41 Girls 229 131 57 FINDINGS OF MEDICAL INSPECTION. (a) Cleanliness. 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 vear by year. It must be borne in mind that a child exhibiting only a few nits is classified as unclean and the following table clearly shows the satisfactory progress made during the last four years :— Year. Inspections Unclean. Prosecutions. 1925 17,946 936 16 1926 17,585 944 8 1927 19,012 874 4 1928 18,638 652 5 Of the 652 children found unclean, 144 were discovered at Routine Medical Inspections, while the remaining 508 were noted by the School Nurses at their special Cleanliness Surveys. (b) Tonsils and Adenoids. There were 89 children suffering from enlarged tonsils and adenoids referred for treatment during the year. (c) Tuberculosis. Any children suspectcd 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. 50 (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 only 19 cases of ringworm of the scalp referred for treatment during the year. (e) Vision. During the year 83 children were found requiring treatment for defective vision. (f) Dental Defects. At his inspection the School Dentist found 1,377 children needing treatment. MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily at the Clinic during School Terms, 6,999 attendances being registered during the year. (b) Tonsils and Adenoids. The Scheme for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital has worked satisfactorily. Thirty-five cases were treated under this Scheme 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 98 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 14 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. 51 (/) Dental Defects. Of the 1,377 children requiring treatment found by the School Dentist, 501 were actually treated, 359 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) Cripping Defects and Ortlwpcedics. During the year 25 individual children received electrical, massage and other forms of treatment at the Red Cross Curative Post, Norbiton, making 1,276 total attendances. The cost of the above out-patient treatment amounted to £127 15s., towards which the parents contributed £41. Two children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment at a total cost of £134, the parents only being able to contribute £18 5s. towards this expenditure. Parents' contributions show a decrease, for whereas last year £68 was collected against a total expenditure of £234, this year only £59 was received towards £262 spent on Orthopaedic treatment. INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. Chicken-pox was somewhat prevalent at Richmond Road and St. Peter's Infants' School during the first four months of the year. Outbreaks of measles occurred at Richmond Road Infants in February, All Saints' Infants in February and March, Bonner Hill Road, St. John's and St. Peter's Infants' Departments during April, May and June. Though there were many cases, it was not regarded desirable to close any of the Infants' Departments affected by the measles outbreaks. The prevalence of Diphtheria at Bonner Hill Road Schools reported in last year's Annual Report continued during January and early February. The Schools had been thoroughly disinfected during the Christmas Holidays of 1927. From mid-September for four weeks, thirteen cases of diphtheria were notified among children attending St. John's 52 Schools. Strict supervision and swabbing of contacts was carried out, and inspection and swabbing in classes was undertaken, 'l'wo healthy carriers were isolated, and no further cases were reported for nearly three weeks, when a fresh crop occurred without apparent cause. Similar action was taken and one carrier isolated. During the Christmas Holidays St. John's Schools were disinfected, and all scholars were medically examined on the reopening of the Schools on January 7th, 1929, the result being that two positive children were isolated, and no cases of Diphtheria have occurred during January and February, 1929. The virulence of the infection has varied greatly, a large number of cases being extremely mild, while, on the other hand, some were very severe. During the year six deaths were caused by Diphtheria among children attending the Public Elementary Schools. 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 the Annual Report for 1925, and the following table specifies some of the work carried out by them during 1928. Number of children prepared for Routine Medical Inspection 1,842 Number examined at Schools for uncleanliness 18,638 Number of following-up home visits 589 Total number of visits to the Schools 736 Total number of Clinic Sessions 376 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. 53 The National Society for Prevention of Cruelty to Children has aided in following up obstinate cases when notified by the School Medical Officer. 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 entrants infants showing vaccination marks was 71. This is much higher than last year's figure, 54, and is partly accounted for by a number of primary vaccinations having been done at the time of the outbreak of Smallpox at the Kingston and District Hospital. SPECIAL SCHOOLS. The Special School for Physically Defective Children is situated at " Elmfield," London Road. There are .'11 Physically Defective Children on the register, three of whom come from outside the Borough. The School Medical Olficer 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 were carried out at this School during the year. It has become necessary to vacate " Elmfield " at the end of the vear, since the premises are required in connection with the new Tiffin Boys' School now in course of erection, so arrangements have been made to move the School for Physically Defective Children to the ground floor of the new building in Bonner Hill Road, which is being erected as a Domestic Subjects Centre. This is a temporary arrangement. SCHOOL CLINIC. The Clinic is situated at " Elmfield," London Road, and has been described in past Annual Reports, 54 Owing to the building of the new Tiffin Boys' School, it has become essential to vacate " Elmfield " at the end of the year, and arrangements have been made to move the Clinic to the first floor of the new building in Bonner Hill Road, which is being erected as a Domestic Subjects Centre. This will be a temporary occupation until permanent accommodation can be provided for the Clinic and Offices of the School Medical Service. (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 302 attendances at the 20 sessions held during the year, 153 being new cases and 149 re-inspections. Refractions numbered 101, and spectacles were prescribed in 98 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. 55 Children for whom spectacles are prescribed are reinspected by the School Medical Officer when he visits the Schools each term. The Head Teachers are periodically sent lists of those children who should have their glasses in constant wear. (d) Dental Clinic. During the year four sessions per School Week were devoted to Dental Inspection and Treatment. In all, 27 half-days were given to Inspection and 141 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 234 gas cases during the year. Mr. H. A. L. Morris, the School Dentist, reports as follows :— " During the year the time given to inspection and treatment until February 28th was three sessions of 2½ hours per School Week, and from that date four Sessions per week, directed to children aged 5, 6, 7, 8, 9 and 10, also all the children at the Physically Defective School and " Specials," i.e., children not eligible for Routine Treatment referred by School Medical Officer, etc. " All the children in the Routine Groups were inspected during the year; absentees at the first visit to the School were inspected later in the year, during my re-visit. This, in conjunction with the arrears of cases brought forward from 1927, has given me a considerable waiting list of approximately 450 children. " There was an increase all round in the work for the year, due to the extra session per week. The number of " Specials " treated remains fairly constant. The rise in the number of gas administrations enabled me to practically clear off the arrears of waiting gas cases. " To carry out the progressive programme as in previous years—that is, to inspect and treat where necessary all children born in 1918 and subsequently, " Specials " and Physically Defective children—means that another large group is automatically added each year. This will necessitate an increase in the number of sessions for treatment, and also further gas sessions." 56 EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 56 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. SCHOOL BATHS During the summer months 708 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 lid. 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 Tudor Road. St. John's Boys' School at the School. Physically Defective School at " Elmfield." At present, All Saints', 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 57 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. Certain of these children would do better if they could attend the Occupation Centre of the Surrey County Voluntary Association, and it is hoped that arrangements will be made in the near future for some of the lower grade feeble-minded children to go there for instruction. 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. 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 22nd, all the girls were examined by the School Medical Officer. The party consisted of 30 girls, 20 of whom were taken for the holiday entirely free, 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. STATISTICAL TABLES. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 605 Intermediates 693 Leavers 456 Total 1,754 Number of other Routine Inspections 88 B.—Other Inspections. Number of Special Inspections 1,736 Number of Re-Inspections 6,490 Total 8,226 TABLE II. A RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DEC., 1928. 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. 144 — 508 — Skin Ringworm, Scalp — — 19 — Body — — 29 — Scabies — — 5 — Impetigo 6 — 317 — Other diseases (non Tb) 10 I 201 — Eye Blepharitis — — I — Conjunctivitis — — 7 — Keratitis — — — — Corneal Opacities 1 1 — — Defect, vision exc Squint 24 11 59 — Squint 14 10 12 — Other Conditions 2 2 14 — Ear Defective Hearing 2 — 7 — Otitis Media 2 I 1 — Other Ear Diseases 2 2 31 — Nose and Throat Enlarged Tonsils only 42 12 *3 — Adenoids only Enlarged Tonsils 3 2 2 — and Adenoids 10 1 9 — Other Conditions 4 — 55 — Enlarged Cervical Glands (nou Tb) 7 8 *9 1 Defective Speech 2 — Teeth—Dental Diseases — — 2 — (see Table IV., Group IV.) Heart and Circulation Heart Disease—Organic Functional Anaemia 4 3 6 2 3 — Lungs Bronchitis 2 2 4 — Other non Tb. Diseases I 1 7 1 Tuberculosis Pulmonary—Definite — — 1 — Suspected — 1 — — Non-Pulmonary-Glands — — 2 — Spine — — — — Hip — — — 1 Other Bones & Joints — — — Skin .. — — Other Forms — Nervous System Epilepsy Chorea Other Conditions — 1 3 — — 2 1 4 1 1 Deformities Rickets 4 1 2 Spinal Curvature 1 — 1 Other Forms 6 15 Other Defccts and Diseases 24 22 366 3 TABLE II.— continued. B. NUMBER OF Individual Children FOUND AT Routine MEDICAL INSPECTION TO REQUIRE TREATMENT EXCLUDING UNCLE AN LI NESS AND DENTAL DISEASES. GROUP. Number of Children. Percentage Inspected. Found to Require Treatment. found to require Treatment. Code Groups—Entrants 605 69 11 Intermediates 693 56 8 Leavers 456 29 6 Total Code Groups 1754 154 9 Other Routine Inspections 88 14 16 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 — 1 1 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 2 2 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 — 1 1 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 Cei tified Schools or Classes for the Deaf Attending Public Elementary Schools 1 — 1 At other Institutions — — — At no School or Institution Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children — — 1 Attending Public Elementary Schools 23 11 34 At other Institutions — — — At no School or Institution — — Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles 1 — I Idiots — I I 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 3 i 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 — — — 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 2 4 At other Institutions — — — At no School or Institution — I I Delicate children (e.g pre or latent tuberculosis, malnutrition, debility, anaemia, etc). At Certified Residential Open Air Schools — — At Certified Day Open Air Schools — — At Public Elementary Schools 22 18 40 At other Institutions — — — At 110 School or Institution — 1 1 Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At 110 School or Institution — — — 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 16 13 29 At Public Elemental'} Schools 7 4 II At other Institutions 1 — 1 At no School or Institution — — — 61 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 14 5 '9 Ringworm, Body 13 8 21 Scabies 5 1 6 Impetigo 292 8 300 Other Skin Disease 81 12 93 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 3 2 5 Minor Ear Defects... 14 4 18 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 60 7 67 Total 482 47 529 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 eluding Squint) 101 — — I I I Other Defect or Disease of the Eyes (excluding those recorded in Group 4 — II Total 108 — 122 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 98 (b) Otherwise 9 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 90 (b) Otherwise 9 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBFR, 1928. Group III.— Treatment of Defects of Nose and Throat, Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital — 35 By Private Practitioner or Hospital apart from the Authority's scheme. 26 Total 61 Received other forms of treatment 12 Total number treated 73 Group IV. Dental Defects. (I) Number of Children who were :— (a) Inspected by the Dentist : Ages 5 6 7 8 9 10 11 12 13 14 114 48 6 457 454 334 114 — — — — Total 1959 Specials 61 Grand 'Total .'020 (b) Found to require treatment ... 1377 (c) Actually treated 501 (2) (d) Re-treated during the year as the result of periodical examination 182 Half-days devoted to:— Inspection 27 Treatment 141 Total 168 (3) Attendances made by children for treatment 1685 (4) Fillings :— Permanent teeth 781 Temporary teeth 106 Total 887 (5) Extractions : — Permanent teeth 104 Temporary teeth 13S5 Total 1489 (6) Administrations of general anæstheticsfor extraction s284 (7) Other operations:Permanent teeth 202 Temporary teeth 168 Total 370 63 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 18,688 (iii.) Number of individual children found unclean 652 (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 5 Farrinoton Bros. 12a, Fife Road, Kingston-on-Thames.