AC 4413(1) KIN 7 The Royal Borough of Kingston-upon-Thames. Annual Reports FOR 1929 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER TOGETHER WITH THE Annual Report OF THE SANITARY INSPECTOR The Royal Borough of Kingston-upon-Thames. Annual Reports FOR 19 2 9 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. on 31st December, 1929. 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: OLIVE G. AUBREY, B.A., M.D., B.Ch. Ante-natal: RUTH C. TOWNSHEND, M.B., B.S. Lond., M.R.C.S., L.R.C.P., D.P.H. Sanitary Inspector: H. T. PERRY, M.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 A. GILL, 1/2 time. *||†Miss C. A. HOOKWAY. 1/2 time. *||Miss L. G. SALWAY, 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 3 Report of the Medical Officer of Health. Municipal Offices, Kingston-upon-Thames, March, 1930. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1929. Circular 1048 (Ministry of Health) directs that the Annual Report for 1929 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. The severe winter caused a high mortality rate among elderly people. The incidence of Infectious Diseases generally was low apart from an outbreak of Diphtheria in the autumn. Further progress was made in Maternity and Child Welfare work by an additional Ante-natal Session per month being commenced in December. In September, the sudden death of Dr. Winifred Warner deprived us of a most valued colleague and friend. Dr. Warner had presided at the Infant Welfare Centres for over eleven years and had become a universal favourite. Her loss is deeply mourned. by all. Dr. Olive Aubrey was appointed to succeed her at the Centres, and Dr. Ruth Townshend as Special Medical Officer for Ante-Natal work. The work of the Public Health Department continues to steadily increase and is becoming extremely difficult to handle efficiently, largely due to the fact that the Public Health Office and the School Medical Department are situated nearly a mile apart, 4 To ensure co-ordination, I am Medical Officer of Health and School Medical Officer, and the Nurses are both Health Visitors and School Nurses, yet the offices are widely separated, which involves much waste of time in journeys, liability to error, delay in dealing with subjects of inquiry or furnishing immediate information, since records and correspondence may not be to hand. The position calls urgently for centralization of the Health Services of the Borough, and it is earnestly hoped that the proposed building for that purpose will be proceeded with as soon as possible. I thank Mr. H. T. Perry, your Chief Sanitary Inspector, and the Staff of the Public Health Department for their willing assistance at all times. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. s GENERAL STATISTICS. Area 1,133 acres. Population, 1929 (Registrar-General) : For birth-rate 38,760 For death-rate 38,500 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 £293,740 Assessable Value to District Rate £289,218 Sum represented by a Penny Rate— Poor Rate £1,184 District Rate £1,168 Amount of Poor Law Relief £3,523 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. Male. Female. Legitimate 529 265 264 Birth Rate (R.G.) Illegitimate 27 17 10 per 1,000 population 14.3 556 282 274 Still Births— Total. Male. Female. Legitimate 12 6 6 Illegitimate 1 — 1 13 6 7 Deaths— 517 244 273 Death Rate (R.G.) per 1,000 population 13.4 Number of women dying in, or in consequence of, child-birth— From Sepsis 0 From other causes 1 6 Deaths of Infants under one year— Total. Male. Female. Legitimate 28 15 13 Illegitimate 3 3 — 31 18 13 Deaths of Legitimate Infants under one year per 1 ,000 Legitimate births 53 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 111 Total Deaths of Infants under one year of age per 1,000 births 56 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under two years of age) 2 Birth Rate Death Rate Rate Per 1000 Births Diarrhoea Total Deaths under 2 years. Under 1 year England and Wales 157 Smaller Towns London Kingston-upon-Thames 16.3 16.0 15.7 14.3 13.4 12.3 13.8 13.4 8.1 5.0 10.7 3.6 74 69 70 56 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 244 273 1. Enteric Fever — — 2. Smallpox — — 3. Measles — — 4. Scarlet Fever — 1 5. Whooping Cough — 1 6. Diphtheria 2 1 7. Influenza 14 12 8. Encephalitis Lethargica — — 9. Meningococcal Meningitis 1 — 10. Tuberculosis of Respiratory System 16 10 11. Other Tuberculous Diseases 2 4 12. Cancer, Malignant Disease 28 38 13. Rheumatic Fever — 2 14. Diabetes 2 2 15. Cerebral Haemorrhage, etc. 11 21 16. Heart Disease 52 53 17. Arterio-Sclerosis 9 7 1 18. Bronchitis 16 16 19. Pneumonia (all forms) 21 22 20. Other Respiratory Diseases 1 3 21. Ulcer of Stomach or Duodenum — 1 22. Diarrhoea, etc. (under two years) 1 1 23. Appendicitis and Typhlitis 2 1 24. Cirrhosis of Liver — — 25. Acute and Chronic Nephritis 4 4 26. Puerperal Sepsis — — 27. Other Accidents and Diseases of Pregnancy and Parturition - 1 28. Congenital Debility and Malformation, Premature Birth 8 7 29. Suicide 7 — 30. Other Deaths from Violence 10 8 31. Other Defined Diseases 37 57 32. Causes ill-defined or unknown — — METEOROLOGY, 1929. Temperature of Air Rainfall Highest Lowest Mean Max, Mean Min. Inches January 52 21 39 30 0.91 February 55 11 40 27 0.24 March 69 18 54 32 — April 73 26 60 36 0.83 May 86 29 68 44 1.29 June 83 41 75 49 0.96 July 93 43 81 54 1.33 August 83 46 77 53 2.27 September 90 40 76 53 0.15 October 72 28 64 42 2.56 November 60 25 51 38 5.46 December 58 27 48 36 4.60 Total 20.60 GENERAL PROVISION OF HEALTH SERVICES. Professional Nursing in Ike Home. (a) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (b) Infectious Diseases.—In Measles, Whooping Cough, and Epidemic Diarrhœa, the Health Visitors are under instructions to visit the cases and give practical advice as to the best methods of nursing them. 8 Midwives. The Midwives are under the administrative control of the Surrey County Council. There were eight registered as practising in the Borough at the end of the year. Clinics and Treatment Centres. Centre. Situation. Accommodation. Provided by Maternity and Child Welfare Eden Street Consultation The Corporation Maternity and Child Welfare Washington Road Consultation The Corporation Ante-natal Clinic Bonner Hill Consultation The Corporation School Clinic Road Consultation & Treatment of Minor Ailments, Refractions, Dental Treatment The Education Committee Day Nursery Canbury Park Road 9 Babies and 16 Infants Vol. Committee Red Cross Curative Post Coombe Road Out- Patients, Massage, Electrical, Light and Orthopaedic Treatment British Red Cross Society Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. Maternity. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. Three 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. 9 The Kingston and District Hospital (Board of Guardians) has Maternity Wards. Children. The Kingston and District Hospital (Board of Guardians). Fever. Arrangements are made whereby Wimbledon, Molesey and Hampton Isolation Hospitals accept cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. Smallpox. The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. No case of Smallpox has occurred in the Borough during the year. Other. Other Hospitals situated in the Borough available for the District are:— (a) The Kingston and District Hospital (Board of Guardians). (b) The Kingston Victoria Hospital, supported by voluntary contributions. Institutional Provision for 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 Southward 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. 10 (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 224 accident cases and 53 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 Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Sect. 94). 27th Nov., 1922 Public Health Act, 1925, Parts II. to V. 26th Jan., 1926 Bye-laws relating to the following matters are in force within the Borough:— Nuisances allowed 28th November, 1881 Sanitary Conveniences 11th May, 1899 Houses Let in Lodgings ,, 31st October, 1911 Tents, Vans, Sheds and Similar Structures ,, 28th November, 1921 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. There are still some shallow wells, and the policy is to advise owners to have their property connected to the Main Supply of the Metropolitan Water Board, 11 The use of well water was discontinued at twelve 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 1929 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 49 1 Cream 2 — Butter 2 — Lemon Cheese I — Cheese 2 — Confectionery and Jam 1 — Wine 1 — Spirits 7 1 Other Articles 11 1 Totals 76 3 Two prosecutions were made under these Acts in the Borough during the year, and there was one conviction. 12 Notifiable Diseases during the Year. Cases. Cases admitted, to Hospital Deaths. Under 1 year. 1—2 2—3 3—4 4—s 5—10 10—15 15—20 20—35 35—45 45-65 65 & over. Total Cases Notified Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Total Deaths Scarlet Fever — 2 3 4 2 31 13 6 6 5 2 - 74 59 - - - - - 1 - - - - - - 1 Diphtheria 2 — 4 2 s 63 21 10 3 3 — - 113 109 - - - - - 2 1 - — — — - 3 Enteric Fever including Paratyphoid - - - - - - - - - - - 1 1 - - - - - - - - - - - - - - Pneumonia — 2 1 2 3 7 1 2 7 9 11 12 57 14 - - - - - - - - - 2 3 5 10 Erysipelas — — — — — 5 1 — 4 6 8 6 30 6 - - - - - - - - - - - - - Cerebro Spinal Fever - - - - - 2 - - - - - - 2 2 - - - - - 2 - - - - - - 2 Puerperal Pyrexia - - - - - - - 1 2 2 — — 5 4 - - - - - - - - - 2 - - 2 Ophthalmia Neonatorum 3 - - - - - - - - - - - - - - - - - - - - - - - - - - New Cases. Deaths. Under I year. 1-5 5—10 10—15 15—20 20—25 25-35 35—45 45-55 55—65 65 & over. Total Under 1 year. 1-5 5—10 IO—I5 15—20 20—25 25—35 35—45 45—55 55-65 65 & over. Total. Tuberculosis (a) Pulmonary M. - - - - 2 4 4 5 I 2 1 19 - - - - - 3 7 - 3 2 1 16 F. — - - 1 2 5 8 3 2 - - 21 - - 1 - 1 - 3 1 1 - 1 8 Total — - - 1 4 9 12 8 3 2 1 40 — — 1 — 1 3 10 1 4 2 2 24 (b) Non-Pulmonary M - - 2 - - 1 - - - 2 - 5 - 1 - - 1 - - - - - - - 2 F. - 1 - 2 - 2 2 - 1 - - 8 - 1 - - - - - - - - - - 1 Total — 1 2 2 — 3 2 - 1 2 - 13 - 2 - - 1 - - - - - - - 3 13 INFECTIOUS DISEASE. SCARLET FEVER. The type of case has been mild, and one death was attributed to this disease during the year. The following table gives a comparative statement of notifications received during the last eleven years :— Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid) 1919 98 142 l 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 1929 74 113 1 DIPHTHERIA. There were 113 cases notified during the year, and the hope expressed that last year, 1928, was the summit of the curve appears likely to prove correct. Again cases have varied widely in virulence from mild bacteriological cases to those of a severe character, and three deaths were attributed to the disease. Though the doctors were circularized urging them to give antitoxin at the earliest possible moment in all doubtful and suspected cases, I fear that many still await the bacteriological results of swabs taken by them. A brief account of an outbreak at Richmond Road Infants' School at the end of July will be found on page 51 in the Report of the School Medical Officer. ENTERIC FEVER (including Paratyphoid). Only one case of Paratyphoid B. was notified during the year. This occurred in an old man, who recovered from the attack. No information was obtained as to the likely source of infection. CEREBRO-SPINAL FEVER. Two cases of Cerebro-spinal Fever were notified, both proving fatal. The first, a male child, aged 5, was notified on 1/5/29, the date of onset being given as 2/5/29. This child was admitted to St. Thomas's Hospital, but died on 6/5/29. *4 The second, a male child, aged 5, was notified on 8/5/29, and was removed to Wimbledon Isolation Hospital on the same day, and died on 23/5/29. 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 18 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 has been little non-notifiable infectious disease this year, due to the absence of any outbreak of Measles. Outbreaks of Mumps and Whooping Cough occurred at Richmond Road School, and Mumps at All Saints' Infants' School, but apart from these, the Schools enjoyed a year of remarkable freedom from non-notifiable infectious diseases. Twenty-six deaths were certified as being caused by Influenza. This higher fatality than of recent years may be attributed to the severity of the winter weather experienced during February and early March. GENERAL PROCEDURE. It should be mentioned that in cases of notifiable infectious disease, Laundries, Libraries and Sunday Schools are notified when concerned. I regard this procedure as important in addition to isolation of patients, exclusion of school contacts, and routine disinfection of premises, etc., so careful inquiries are made in every case with regard to washing, books, and Sunday Schools. 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. During the year there were the following number of attendances at the Centres :— Meetings. Attendances New Cases. Total. Eden Street 51 167 3,015 Washington Road 52 91 1,039 The Health Visitors paid the following number of home visits:— First Visits. Total-Visits. Expectant Mothers 63 99 Infants under one year 552 1,331 Children, one to five years — 2,347 Incidental and Infectious — 437 The above figures show an increase in work, despite the fact that for a month we were short of one nurse. In necessitous cases, babies and nursing mothers are provided with free milk on the recommendation of the presiding medical officer. Careful investigation is made into the circumstances of each case to ascertain whether it falls within the approved scale, and when recommended it is endorsed by the Medical Officer of Health and approved by the Committee. Dried milk is supplied at cost price. At the Eden Street Centre there is an excellent Clothing Stall, where 37 mothers have purchased 114 garments during the year. This stall is of considerable educational value, and it is hoped it may be possible to inaugurate one at the Washington Road Centre. Baby Week was held from July 7th to 12th, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. The following programme was carried out :— Sunday, July 7th.—Special reference in local churches and Sunday Schools. 16 Tuesday, July 9th.—Entertainment by Welfare Centre mothers. Chairman, Councillor Turk. Wednesday, July 10th.—Garden Party for Infant Welfare mothers only. Prize distribution by Councillor Frazer Nash. Thursday, July 11th.—Lecture, " Maternity and Child Welfare: What it Means to the Town," by Miss Dorothy Dodd. Chairman, His Worship the Mayor (Councillor W. E. Blake Carn). The Centres again competed in the National Welfare and Baby Week Mothercraft Competition, gaining 6th place, which is extremely creditable. Certificates were awarded to five parents, two obtaining honours. The Annual Winter Tea and Entertainment was held at each Centre early in the year. The " Mothers' Committee," which is composed of mothers of children no longer in arms, continued to function, and concentrated upon increasing the social services at the Centres. Short " talks " to the mothers have been given regularly throughout the year. STAFF. It was my sorrowful duty to report the sudden death, on September 8th, of Dr. Winifred Warner, who had presided at the Infant Welfare Centres ever since they were taken over by the Corporation in 1918. Dr. Olive Aubrey was appointed to fill the vacancy, and in December Dr. Ruth Townshend was appointed special Medical Officer for Ante-Natal work only. Miss E. Riley terminated her appointment as half-time Health Visitor on October 18th, having obtained the post of Tuberculosis Health Visitor to Bermondsey. Miss L. G. Salway was appointed to fill the vacancy, and took up her duties on November 19th. Miss R. Bartter tendered her resignation, to take effect at the end of the year, and obtained the post of Health Visitor to Buckhurst Hill. 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. 17 ANTE-NATAL CLINIC. The Ante-Natal Clinic was held on the first Tuesday in each month at the School Clinic, which was moved from " Elmfield " to temporary accommodation at the new building at Bonner Hill Road in January. It was considered advisable to hold an additional session per month, and approval having been obtained, this was commenced in December on the third Tuesday morning. During the year, 81 expectant mothers attended, making 159 visits to the Clinic, which is an average attendance of over 12 per session. It was thought that there would be a large fall in attendance owing to the establishment of an Ante-Natal Clinic at the Kingston and District Hospital for those expectant mothers who had booked to enter there for confinements, but though the figures are not quite so high as last year, there were indications during the latter months that the popularity of the Ante-Natal Clinic is on the increase. The Kingston Nursing Association continue to support the Clinic by sending their cases, but private midwives seldom urge their patients to attend. Dr. Winifred Warner was presiding Medical Officer up to the time of her death in September. Dr. Ruth Townshend was appointed to fill the vacancy and took up her duties in December. THE UNMARRIED MOTHER. The care of unmarried mothers and their illegitimate children is undertaken by the Kingston, Surbiton and District Voluntary Society, which is affiliated to the Southwark Diocesan Association for Rescue and Preventive Work. The Local Branch Shelter is at No. 18, Richmond Park Road. Unmarried expectant mothers are admitted to the home about two or three months before full term, or later if desired. If possible they contribute towards their own support, and assist by doing domestic work while in the home. They are transferred for confinement to the Kingston and District Hospital or other Maternity Home, returning after the puerperium with the infant to the " Shelter " for a further period of residence until the infant is three months old. 18 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 5 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. Of the five cases notified, two died, and the following is a brief record of the fatal cases :— Case 1. Age 40. Admitted on April 19th to the Kingston and District Hospital for prolonged labour. She was delivered of a stillborn male infant in hospital the same day. Notified as Puerperal Pyrexia on April 24th and died on April 26th. Cause of death, " Broncho-pneumonia— parturition premature, stillborn male child, placenta praevia." Case 2. Age 39. Admitted to Kingston and District Hospital on October 2nd. A diagnosis of partial placenta prævia was made, and she had marked varicose veins in both legs which were thrombosed. Delivery under a general anaesthetic was performed on October 4th. Apart from the condition of thrombosed veins, she progressed favourably until October 8th, when her left ankle showed signs of inflammation. By October 13th the ankle commenced to suppurate, and on October 16th she died suddenly. The cause of death was certified as " Pulmonary embolism, femoral thrombosis, placenta praevia, parturition stillborn child." OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1929 :— Treated Vision Vision Total Notffied. At Home In Hospital. unimpaired impaired. Blindness. Deaths. 3 3 - 3 - - - 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. 19 Application for the admission of cases to 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. ORTHOPÆDIC 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 8 infants received out-patient treatment, making 308 attendances. The cost of out-patient treatment was £30 16s., and the contributions paid by parents towards this expenditure amounted to £9 2s. 2d. One infant was treated as an in-patient at St. Vincent's Orthopaedic Hospital at a cost of £.1 3s. 11d., but the parent was unable to contribute anything towards this charge. I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections Written Notices. Occupiers prosecuted Factories—(including Factory Laundries) Workshops — (includingWorkshop Laundries) 20 - Nil Workplaces—(other than Outwotkers' premises) Total 20 - Nil 20 II— DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect to which Prosecutions were instituted. found. Remedied. Refered to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 3 4 — — Want of Ventilation — — — — Overcrowding — — — - Want of drainage of floors — — — — Other nuisances 1 1 — — Sanitary Accommo- elation Insufficient — — — — Unsuitable or Defective - - - - Not separate for sexes — — — — Offences under Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s. 101) - - - - Other Offences—(Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers)Order, 1921 7 7 - - Total 11 12 - - *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. 21 Report of the Chief Sanitary Inspector. To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I have the honour to present to you my eleventh Annual Report on the work carried out by your Sanitary Inspectors during; the year 1929 in connection with the various Statutes and Bye-laws relating to Public Health in force within the Borough. The total number of inspections made during the year was 7,879, as compared with 8,020 during the year 1928. On 498 premises sanitary defects to the number of 2,539 were discovered. Arising; out of these defects, it was found necessary to serve 394 " preliminary " and 78 " verbal " notices. In 65 instances the informal action did not have the desired effect, and it was necessary to serve " statutory " notices. During the year under review no less than 529 fresh entries were added to the Register of Sanitary Defects, whilst in 606 cases entries were cancelled following completion of necessary works. On December 31st, 1929, 310 separate entries remained under review compared with 387 at the end of 1928. Despite the increase of 97 in the number of entries in the register during 1929 over and above the total number for the previous year, it is worthy of note that at the end of the year the number of records outstanding was very much lower than the corresponding figure for the previous year. A special effort to achieve this object was made during the year. The high standard in the work of sanitary inspection which has been set in this Borough, has been maintained despite the difficulties encountered. This result could not have been accomplished without the loyal assistance given to me by the staff, and I would like also to record my thanks to your Public Health Committee for their help by affording me the use of the motor car for transport purposes. Apart from the question of ordinary saving of time, the car has enabled important work to be carried out without interruption 22 when other available means of locomotion could not have been used. The additional inspectorial assistance which your Public Health Committee were considering at the end of the year gives promise of relief in the pressure of work, and I gratefully acknowledge the sympathetic consideration given to the question by the Committee. A large number of interviews with property owners or their architects, agents, or builders, took place either at the office or the premises under review. It is safe to assert that in the great majority of cases these interviews proved the means of clearing away any difficulties or misunderstanding which may have existed, and certainly avoided the need for legal proceedings in some cases. Legal Proceedings to enforce compliance with notices served were necessary in one case only during 1929. In the case in question the owner was summoned for failing to abate a nuisance within the meaning of Section 91, Public Health Act, 1875. An Order was made for the necessary remedial works to be carried out forthwith. The Order was complied with. During the year under review 321 enquiries under the Land Charges Act, 1925, were received from the Town Clerk's Department and replied to. For convenience of reference the number of inspections and visits is set out in the following tabular form. Inspections and Visits. The following list shows the number of Inspections made in regard to each section of the work, and the total of all inspections. Rent Restrictions Act Inspections 6 Re-inspections after Order or Notice 1,720 Visits to Works in Progress 1,244 Factories and Workshops 20 Cowsheds, Dairies and Milkshops 28 Ice Cream Premises 12 Foodshops and Food Preparing Rooms 438 Infectious Disease Enquiries 418 Special Small Pox Enquiries 167 Markets 94 Special Inspections (Complaints, etc.) 1,058 Slaughter-houses 1,891 Offensive Trades 17 23 Sanitary Conveniences 106 Common Lodging-Houses 15 Canal Boats 5 Theatres, Cinemas, etc. 7 House-to-House 9 Bakehouses 15 Smoke Observations 26 Stables and Yards 17 Enquiries re Housing Applicants 328 Schools 25 Well Water Enquiries 14 Miscellaneous Visits 199 Total 7,879 Summary of Sanitary Improvements. Under the various headings shown, the details of sanitary and other works carried out as the result of notices served will be found in the following tabulated lists. Drainage. Number of Houses and Premises re-drained 38 Number of Drains repaired or amended 9 Drains or Gullies unstopped or cleansed 27 New Manholes provided 73 Existing Manholes altered or repaired 3 Intercepting Traps fixed 22 Fresh-air Inlet Shafts repaired or renewed 24 New Gully Traps fixed 145 Gully Curbs renewed or repaired 8 New gratings provided to gullies New Soil Pipes or Ventilating Shafts 36 New Ventilating Shafts 15 Smoke Tests applied 42 Water Tests applied 74 Water Closets and Sanitary Fittings, New W.C. Basins fixed 83 W.C.s unstopped, cleansed or repaired 3 W.C. Flushing Tanks repaired or renewed 61 24 New W.C apartments provided 5 W.C. Apartments lighted, repaired or ventilated 34 W.C. Apartments cleansed and limewashed 64 New Impervious Sinks provided 41 New Trapped Waste Pipes fixed 57 Existing Waste Pipes trapped or repaired 3 Urinals cleansed or repaired 6 New Public House Urinal constructed 1 New Lavatory Basins fixed 26 Trough closets abolished 3 New Seat provided to W.C. 2 Miscellaneous 6 Miscellaneous. Roofs entirely renewed 3 Roofs repaired 53 Eaves Gutters renewed or repaired 45 Stack Pipes renewed or repaired 41 Stack Pipes disconnected from Drains 59 Dampness abated 71 Defective walls repaired, repointed or rebuilt 79 Ventilation provided beneath floors 25 Ventilation provided to rooms 12 Staircases lighted 2 Sites of houses concreted 3 Yards paved 74 Yard Paving repaired 17 Yards cleansed 8 Paved pathways constructed 18 Dairy premises paved 2 Floors of Rooms repaired 58 New floors of Rooms 18 New Scullery provided 1 Rooms repaired, cleansed and distempered 378 Larders cleansed 2 Verminous bed and bedding cleansed 2 New ceilings 11 Ceilings repaired 3 Windows repaired, renewed or made to open 115 Doors re newed or repaired 7 Door and window sills renewed or repaired 47 Stairs repaired or renewed 3 25 Handrails and Banisters provided to staircases, or repaired 16 Portable aslibins provided 211 Accumulations of manure and refuse removed 4 Stables limewashed 2 Manure receptacle provided 1 Nuisance from overcrowding abated 13 Water supply provided direct from rising main 30 Water supply reinstated 8 Cisterns repaired, cleansed or covered 3 Disused cisterns removed 7 Water pipes or taps provided or repaired 6 Premises connected to M.W.B. mains and use of well water discontinued 12 Stoves and firegrates repaired or renewed 46 Coppers repaired or renewed 25 Chimney flue repaired 2 Chimney Stacks repointed or repaired 12 Dilapidated buildings demolished 16 Sheds removed or repaired 2 Nuisance from smoke abated 5 Illegal use of basement rooms discontinued 2 Odours from trade premises abated Miscellaneous 7 SMOKE ABATEMENT. The number of complaints received during 1929 in respect of alleged nuisance from smoke was five. Twentysix observations were made, and in several instances excessive amounts of smoke were recorded. In three industrial premises new boilers and furnaces were installed. In each case smoke eliminators were fixed and there has been considerable reduction in the amount of black smoke emitted from their chimneys as a result. COMMON LODGING HOUSES. There are only two common lodging houses registered in the Borough, but there is also another building in which lodgers are taken for short periods, but it does not come within the scope of the Bye-laws owing to the fact that lodgers are not received for one night only. 26 A similar building at the rear of the old "Two Brewers" Public House was demolished during the past year. Many of the lodgers in the two registered Houses are regular lodgers and some have resided in one or the other for several years. During 1929, 15 inspections were made of the registered premises. OFFENSIVE TRADES. The following offensive trades are carried on in the Borough:— Leather Tanning and Fellmongering. Rag and Bone Yards. Fish Frying. The Rag and Bone Yards are situated in unsuitable positions in the Borough, and require frequent visits of inspection. Seventeen visits were made to premises in connection with offensive trades, in addition to reinspections after notices or warnings. A more frequent inspection is anticipated and should be possible when the additional Sanitary Inspector has commenced duty. One new fried fish shop was licensed during the year. Two applications for licences were refused, chiefly on the ground that adequate provision for the supply of this popular commodity already existed in the districts where the proposed new premises were situated. COMPLAINTS. Two hundred and twenty-nine complaints ware received during the year as follows:— Drains and Sanitary arrangements 41 Sanitary Conveniences in Theatres 2 Overcrowding 4 Insanitary Condition of Premises 60 Absence of ashbins 4 Water supply 35 Accumulation of manure and non-collection of house refuse 3 27 Dampness and defective roofs, gutters, etc. 26 Keeping of animals and fowls 10 Smoke nuisance from chimneys 5 Defective stoves and coppers 8 Defective gas appliances 3 Unpaved yards and passages 2 Nuisance from flies 2 Offensive odours 6 Underground rooms used as sleeping place 1 Miscellaneous 17 229 The complaints were investigated promptly, anc! where the Corporation possessed powers to intervene, immediate steps were taken to remove the cause of the complaint. The number of complaints during- 1928 was 185. The increase of 44 in the number received during 1929 was due to the contaminated water supply in August and to the unusually severe weather conditions towards the end of the year and which resulted in so many houses suffering from damp walls. 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 28 (b) With State assistance under the Housing Acts— (1) By the Local Authority Nil (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) 622 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 13 28 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 443 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 467 3. Action under Statutory Powers During the Year. A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (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 65 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 55 (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 6 29 (2) Number of dwelling-houses in respect of which Closing Orders were made 6 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (i) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 5* * These houses were demolished before demolition Orders became operative. It will be seen that the number of recorded house-tohouse inspections under the Housing Acts has been few. Nevertheless, by means of action under the Public Health Acts a very considerable amount of work in the direction of sanitary repairs and improvements has been carried out in connection with working class property in the Borough. These details are shown in the tables on pages 23, 24, 25. The six houses referred to in the preceding Housing Statistics as being closed were situated in Pratts Passage and formed a row of six cottages. As the Officer appointed under the Housing Acts, I inspected these cottages and reported to the Public Health Committee that they were in my opinion in such a state as to be dangerous and unfit for human habitation. The Medical Officer of Health concurred in this opinion, and formal representations were made accordingly. Four of the cottages were demolished by the end of the year, but the two referred to above were not vacated until after 31st December, 1929. During the past year several other dilapidated old houses have been demolished voluntarily by the owners. The premises referred to are as follows:— Nos. 25 and 27, Cowleaze Road (one of which was subject to an old Closing Order). Nos. 9 to 23 (odd), Fairfield North. Row Barge Public House—cottage at rear of. Cottage in St. Luke's Passage (off Elm Road). In no instances were new dwelling-houses erected in place of the old ones. In the Norbiton Ward there is an estate of over 100 cottages situated in three roads. This estate had been neglected for some years, but towards the end of 1929 I had several interviews with the owners and extensive works Were commenced. The weather conditions were so severe in the last three months of the year that little progress was made, but it is anticipated that during 1930, the works will be completed. ASH RECEPTACLES AND COLLECTION. In order to keep in touch with ashbin accommodation in the Borough, an arrangement has been made whereby the collectors record particulars of houses where the ashbins are in bad condition or where insufficient receptacles are provided. These particulars are handed in to the Borough Surveyor, who passes them on to your Sanitary Inspector from time to time. The arrangement works quite well and during the past year no less than 211 new ash receptacles were provided as the result of notices served. OVERCROWDING. There were eight cases of overcrowding known to exist in the Borough at the end of 1929. There is no statutory definition of overcrowding in the Public Health Acts, but for the purpose of calculating the air space required per person, the standard adopted for common lodging houses is adopted, viz., 300 cubic feet for each adult person and 150 cubic feet for each child under 12 years of age. This is admittedly a low standard to adopt and it does not necessarily take into consideration that a house may be so sub-let, room by room, that it would be very difficult to keep the house wholesome and clean, and yet it might not be overcrowded according to the cubic capacity standard. In order to deal more adequately with such cases, your Council has under consideration the adoption of revised bye-laws for Houses Let in Lodgings or occupied by more than one family. There can be little doubt that the housing situation is somewhat easier. This is probably due to the relief afforded by the Corporation Housing Scheme, and the Census which is due to take place next year should provide definite evidence of this improvement. 31 Daring 1929 overcrowding in 13 instances was abated as the result of action taken, and this in itself is an indication that the position has eased, and may be regarded as very satisfactory. Of these 13, the overcrowding was abated in 7 instances by the provision of Corporation houses. In 3 cases the overcrowding was caused by families moving into the Borough from outside districts and in o cases it arose owing to the marriage of sons or daughters who remained in their old homes because other accommodation could not be found at rents which they could afford to pay. This arrangement is quite common in these days of high rents and few vacant houses. The reduction in the number of cases of overcrowding may be thought to be a transient one, but there is reason to believe that this is not so. Only seven years ago nearly GO cases were known to exist, and despite the additional instances which have come to light from time to time since then, only 8 remained on the records as unabated on December 31st, 1929. HOUSE DRAINAGE. Thirty-eight houses were re-drained during the year, as compared with 49 during 1928. There can be no doubt whatever that the elimination of these seriously defective drains will have a beneficial effect on the Borough and the large amount of time absorbed by this branch of the work is well spent. The following list shows the situation and number of premises re-drained during the year:— Canbury Park Road 2 Canbury Passage 5 Crescent Road 1 Deacon Road 1 Elm Road 3 Fairfield South 6 Gibbon Road 1 High Street 3 Kings Road 6 Mill Street 1 Orchard Road 2 Park Road 2 12 Portland Road 1 Queens Road 1 Richmond Park Road 1 Richmond Road 2 For some years a plan or 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. In practically all cases an examination of the drainage system was made under the powers conferred on your Council by Sec. 41, P.H.A., 1875, and a specification of necessary works was then prepared and forwarded to the respective owners of the premises. INCREASE OF RENT AND MORTGAGE INTEREST ACTS. Seven applications were received during the year from tenants for certificates under Section 2, Sub-section 2, of the above Act, as compared with 5 during 1928. The premises were subjected to a careful inspection and a specification of any necessary repairs was prepared in each case and forwarded to the owner, together with a suitable covering letter. This informal action usually had a satisfactory result, but in 1 case it was necessary to issue a certificate giving details of the works which should be carried out to put the dwelling house in a reasonable state of repair within the meaning of the Act. INSPECTION AND SUPERVISION OF FOOD. (a)—MILK SUPPLY. During 1929 3 persons were removed from the register of Dairies owing to business changes. Five dairymen were added to the register making a total of 40 on December 31st, 1929, compared with 38 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:— 33 Dealer's Licence to bottle and sell Grade A (Tuberculin Tested) Milk 1 Dealer's Licence to sell Grade A (Tuberculin Tested) Milk 2 Dealer's Licence to sell Certified 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 An application for registration as a dairy in respect of a general shop was withdrawn after an inspection of the premises concerned. Generally speaking, all milk delivered in the Borough early in the morning is contained in bottles. In a few instances the old type handcan is still used during the second round, but the more progressive milk retailers have entirely discarded this unsatisfactory method, and no milk is delivered by them except in bottles which are filled and sealed in properly constructed hygienic dairies. It is an offence under the Milk and Dairies Order, 1926, for any person to interfere with the disc or cap of the milk bottle after it has left the dairy and before delivery to the consumer. Likewise it is an offence to fill milk bottles in the street. In order to ascertain that the provisions of the Order are observed it is necessary for observations to be made early in the morning. During the past year, warnings were given in two instances where it was suspected that bottles had been filled in the street. The attention of householders has been directed from time to time to the obvious dangers which may accrue from the practice of placing empty milk bottles on the public footpath ready for collection. It may be said that all the bottles are cleansed and washed before refilling, but that is not a good reason, or even an excuse, for placing the bottles where they may be fouled in no uncertain manner. The time has not yet arrived when every dairy, small and large, is provided with a plentiful supply of steam for sterilisation purposes, and merely washing a bottle is not a sufficient safeguard against bacterial contamination. Warnings have 34 also been given to roundsmen who have left crates containing full bottles on the pavement outside houses. It is satisfactory to be able to record a steady but continued growth in the demand for Tuberculin Tested milk, one of the designated Grades of milk. This class of milk deserves a much greater demand, for it is of high grade and is sold in the Borough at very little above the price of ungraded milk. Legal proceedings were taken against a purveyor of milk for exposing for sale milk which was unsound and unfit for the food of man. As this offence is uncommon, the facts are recorded briefly as follows:—On two separate days, bottles of milk containing visible dirt were examined on, and in course of delivery, respectively. The dirt was so obvious in all the bottles that no less than 32 were "seized" and condemned. A Bacteriological examination was made, and a count of over 27,000,000 bacteria per c.c. was recorded, whilst the deposit was described as being "considerable in amount and consisting mainly of vegetable debris." The dairyman, whose premises were not situated in the Borough, was fined £10 and ordered to pay £5 5s. costs, whilst a charge of aiding and abetting on the part of the roundsman was dismissed on payment of 4s. costs. The past year has not produced any unusual features so far as this particular branch of the work is concerned. It would appear that the peak has been reached in the number of animals slaughtered in the Borough, the increase last year above the total of 1928 beinc- only 611. (b) MEAT AND OTHER FOODS. last year above the total of 1928 being only 611. The following figures show the total number of animals killed in the town during each of the past five years:— 1925 7,672 1926 7,636 1927 8,350 1928 11,093 1929 11,704 Only a proportion of these animals are killed for consumption in Kingston. By far the greater number are purchased by dealers in various cattle markets situated in the home counties, or even further afield, and brought to 35 Kingston for slaughter. The carcases are afterwrds distributed to neighbouring districts or are sent to Smithfield Market for sale on commission. It may be, of course, that some of these latter carcases are purchased by local retailers and are brought back again from Smithfield to Kingston, but the number so dealt with would probably be quite small. It can be shown therefore that Kingston acts as a centre for slaughtering activities and this is one of the reasons why no effort is spared to ensure that all carcases are examined before removal from the slaughterhouses. If all the carcases were destined for local shops they could be inspected at more convenient times than is possible in the present circumstances when visits have to be made late in the evenings and before 7 a.m. in the morning. The lateness in the commencement of slaughter is due in some measure to the time of arrival of some of the animals in the town from outside markets. It used to be the custom to rest animals for a reasonable period before slaughter but this very desirable practice is the exception to-day, and animals which have had a fatiguing journey are slaughtered the same day, even if they arrive during the week-end. 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 1929 was 2,478. The table on the following page shows the number of notices of slaughter received, the various animals killed, percentage examined, etc., and gives some idea of the amount of time devoted to this work. 36 MEAT REGULATIONS, 1924. Summary for year ended December 31st, 1929. Number of Notices Received. Number of Animals Slaughtered. Carcases not Examined. Percentage of Total Animals not Examined. Beasts Figs. Calves Sheep, Goats. Total. Pigs Sheep 1049 81 6332 2726 2555 10 11704 2 28 3 Inspections during Office Hours. Percentage of Total. Inspections made after Office Hours. Percentage of Total. 318 27.6 834 72.4 37 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. slaughter. In the other cases a request for inspection was made by the owner. Articles of Food. Reason for Condemnation Action taken PORK— 19 Carcases and offal Tuberculosis Inspected & Condemned 8 Carcases and offal Emaciation „ „ ,, 1 Carcase and offal Pleurisy and Pneumonia „ „ ,, 1 Carcase and offal Fevered „ „ ,, 2 Carcases and offal Jaundice „ „ ,, 3 Carcases and offal Swine Erysipelas „ „ ,, 135 Heads and Necks Tuberculosis „ „ ,, Heads and Necks Abscess „ „ ,, 19 pairs Lungs Tuberculosis „ „ ,, 1 pair Lungs Congestion „ „ ,, 12 pairs Lungs Pneumonia and Inflammation „ „ ,, 1 pair of Lungs Fatty Infiltration „ „ ,, 26 Plucks Tuberculosis „ „ ,, 3 Livers ,, ,, „ „ ,, 9 Livers Fatty Infiltration „ „ ,, 4 I.ivers Necrosis „ „ ,, 3 Livers Cirrhosis „ „ ,, 31 Mesenteries Tuberculosis „ „ ,, 9 Spleens „ „ „ „ ,, 1 Kidney „ „ „ „ ,, 2 Hind Quarters „ „ „ „ ,, 2 Udders Mastitis „ „ ,, 2 Loins Tuberculosis „ „ ,, 1 Heart „ „ „ „ ,, 1 Leg „ „ „ „ ,, BEEF— 3 Carcases and offal Tuberculosis „ „ ,, 5 Heads & Tongues „ ,, „ „ ,, 1 Head and Tongue Actinomycosis „ „ ,, 14 pairs Lungs Tuberculosis „ „ ,, 6 Livers Tuberculosis „ „ ,, 5 Livers Distomatosis „ „ ,, 1 Liver Neoplasm „ „ ,, 2 Livers Echinococcus Veterinoruin „ „ ,, 3 Mesenteries Tuberculosis „ „ ,, 2 Skirts „ ,, „ „ ,, 1086½ lbs. Beef Putrefaction Voluntarily surrendered 21½ lbs. Liver „ ,, „ ,, 24 lbs. Kidneys „ ,, „ ,, 10 Fat Trimmings „ „ ,, 38 VEAL— 2 Carcases and offal Tuberculosis Inspected & Condemned 1 Carcase and offal Immaturity „ „ „ 1 Carcase and offal Improperly bled „ „ „ 1 Carcase and offal Jaundice „ „ „ 1 Liver Tuberculosis „ „ „ 5 Plucks „ „ „ „ „ GOAT— I Carcase and offal Emaciation „ „ „ MUTTON— 3 Carcases and offal Emaciation „ „ „ i Carcase and offal Fevered „ „ „ 4 Livers Parasitic Disease „ „ „ i Liver Strongylus Rufescens „ „ „ 3 Livers Distomatosis „ „ „ 3 pairs Lungs „ „ „ „ „ 344 lbs. Mutton Putrefaction Voluntarily Surrendered FISH — I Hox Sprats Putrefaction „ „ „ I Box Herrings „ „ „ „ „ I Box Skate Wings „ „ „ „ „ FRUIT— 70 Boxes Pears Putrefaction „ „ „ 105 Melons „ „ „ „ „ MILK— 5 Gallons Contaminated with dirt Inspected & Condemned (Seized) PRIVATE SLAUGHTERHOUSES. There are six private slaughterhouses in the Borough, and the following table is set out in accordance with the request of the Ministry of Health:— In December, 1929 Registered 3 Licensed 3 Total 6 All the premises have been in use during 1929. 39 The buildings, generally speaking, are old, but they are all in better condition than they were several years ago. Where the walls are not constructed with impervious material it is more difficult to keep the premises in a satisfactory condition, but the Bye-laws are very useful in this direction and provide for frequent cleansing. During the year under review difficulties arose owing to the non-collection of the hides as often as required by the Bye-laws. The Company who purchase the hides was approached and an extra collection per week was arranged. The frequent collection of offal and other waste from these premises is also difficult to provide for in an urban area such as this, where there is no available agricultural land, and some further arrangement will have to be made shortly. One thousand eight hundred and ninety-one visits were paid to these premises during the year as compared with 1990 during 1928. During the year it was necessary to issue a warning to one butcher who contravened the Bye-laws by failing to effectually stun several animals by a mechanical instrument before slaughtering them. No further contraventions have been noted since then. WELL WATER SUPPLIES. There are still a few shallow wells situated in the Borough, and which supply water for domestic purposes. The effort to reduce the number proceeds steadily and is attended by satisfactory results. Eight samples of well-waters were taken during the year and were submitted to the Corporation Analyst, Mr. P. G. Lloyd. The results of the chemical analyses were similar in each case and showed that the waters were usable for drinking purposes, but there were indictions of previous pollution. The use of well-water was discontinued in the case of 12 houses during the year 1929 as follows:— Acre Road 3 houses Bearfield Road 7 houses Kings Road 2 houses 40 DISINFECTION AND INFECTIOUS DISEASE. The decrease in the number of notified cases of infectious disease was responsible for the reduced number of houses disinfected during 1929 compared with 1928, There were 295 rooms in 233 houses sprayed and fumigated with formalin; 1,612 articles were passed through the steam disinfector. Disinfection of premises is not only carried out after notifiable infectious disease, 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. Each house where infectious disease occurred was visited and enquiries were made into the history of the case. The results of the investigations were passed on to the Medical Officer of Health. FACTORIES, WORKSHOPS AND WORKPLACES. Twenty visits were made to Factories and Workshops, etc. Other details with respect to these premises are contained in the tables on pages 19 and 20. There are twelve "Outworkers" resident in the Borough, and the premises so used are 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, but this work is now in hand and should be completed during 1930. 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 relationship between the breeding of flies and the storage of manure. 41 The reduction in the number of horses in towns has had a decided effect in reducing the number of flies. SANITARY CONDITION OF MUSIC HALLS, CINEMAS, ETC. Seven formal inspections were made of the above premises during the year under review. In several instances matters requiring attention were drawn to the notice of the Management and towards the end of the year special inspections were made to ascertain whether the premises conformed to the requirements of the new Regulations adopted by the Surrey County Council. CANAL BOATS ACTS, 1877 TO 1884. In accordance with Section 3 of the Canal Boats Act, 1884, 1 beg to report as follows:— During the year 1929 five visits 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 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. One sanitary convenience was reconstructed during the year. 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 42 upholstery, cushions and bedding, but no opportunity occurred during 1929 for the taking of samples. I his is a branch of the work which will require more attention when the additional assistance is available. PUBLIC ELEMENTARY SCHOOLS. ST. JOHN'S SCHOOLS. Following the outbreak of Diphtheria at St. John's Schools in 1928 and the reorganization of the Church Schools, a special inspection was made at St. John's Schools in the early part of the year. As the result of this inspection it was found that the whole of the drainage system was defective and that reconstruction of the system was imperative. This work was carried out during the year and in connection therewith all the sanitary conveniences were remodelled and modernised and additional conveniences were provided. In addition to this, extensive works were carried out, details of which are mentioned in the report of the School Medical Officer. ST. PETER'S SCHOOLS. At this school also the sanitary conveniences were remodelled and additional ones provided. The drainage system, as a whole, was not examined and was not involved in the alterations which were made. 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, F.S.I.A., M.R.S.I. Chief Sanitary Inspector. Municipal Offices, Kingston-upon-Thames. April, 1930. 43 Report of the School Medical Officer. March, 1930. 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 1929. The average number of children on the school register for the year was 4,389. Medical Inspection was carried out on the same lines as beiore, and no objection to medical examination of a child was received from any parent. The removal of the Clinic from " Elmfield " to temporary accommodation in the new building in Bonner Hill Road was effected in January. The building was scarcely completed at the time, with the result that some delay was experienced before Eye and Dental work could be recommenced. For these services special fittings and fixtures were necessary, which could not be fixed until various electrical and gas points had been provided. The first floor of these premises was adapted for the work, and though far from ideal, the accommodation has allowed all branches of the Service to be carried on efficiently. The Physically Defective School was transferred from "Elmfield" to the ground floor of the same building. Four half-days a week were devoted to Dental work, affording treatment of children up to the age of eleven. The Scheme for Orthopædic treatment of crippled children was carried on as before, out-patients receiving treatment at the Red Cross Post, Norbiton, and in-patients at St. Vincent's Orthopaedic Hospital, Pinner. 44 The Eye Clinic met on Wednesday afternoons, but only 14 meetings were held during the year owing to the late start due to delay in adapting the new building, and again to the break caused by the sad death of Dr. Warner in September. Dr. Winifred Warner was appointed School Oculist when the Eye Clinic was established in 1923. She was a friend of all with whom she came into contact, whether members of the Staff, parents, or children, and her death was deeply mourned by all. Dr. Ivor Aubrey was appointed Oculist in October. Operative treatment of tonsils and adenoids was performed at the Kingston Victoria Hospital, 59 children receiving treatment under the Authority's Scheme. There was no school closure on account of infectious disease. Apart from an outbreak of diphtheria at Richmond Road School, the Schools enjoyed a remarkable freedom from infectious diseases this year. The year as a whole has been a satisfactory one, progress in many directions having been made, but satisfactory and permanent housing for the Clinics and Offices is urgently necessary, together with centralisation of the Health Services. To complete the School Medical Service, additional Dental Sessions are required up to a total of eight half days a week before the whole School population would come under dental inspection and treatment, and some arrangement for the X-ray treatment of ringworm. I thank all members of the Staff of the School Medical Service for their willing co-operation and help throughout the year. I am, Mr. Chairman, Ladies and Gentlemen, Your Obedient Servant, E. W. MATTHEWS, School Medical Officer. 45 Staff of the School Medical Service on 31st DECEMBER, 1929. School Medical Officer: E. W. MATTHEWS, M.B., B.S.(LOND.), m.r.c.s., l.r.c.p., d.p.h. Oculist: IVOR AUBREY, M.C., M.R.C.S., L.R.C.P. Dental Surgeon : H. A. L. MORRIS, M C., L.D.S. R.C.S., (eng,) School Nurses: Miss R. BARTTER (Senior) 1/2 time. Miss A. GILL 1/2 time. Miss C. A. HOOKWAY 1/2 time. Miss L. G. SALWAY 1/2 time. Clerk: Miss P. M. INGILLSON. It was my sorrowful duty to report the sucklen death on September 8th, of Dr. Winifred Warner, who had presided at the Eye Clinic since its inception in 1923. Dr. Ivor Aubrey was appointed School Oculist to fill the vacancy. Miss E. Riley terminated her appointment as half-time School Nurse on October 18th, having been successful in obtaining the post of Tuberculosis Health Visitor to Bermondsey. Miss L. G. Salway was appointed to fill the vacancy, and took up her duties on November 19th. 46 Miss R. Bartter tendered her resignation to take effect at the end of the year, and obtained the post of Health Visitor to Buckhurst Hill. Miss O. Rowles, clerk and typist, left the Service on June 29th, having obtained a post under the Surrey County Council. Miss P. M. Ingillson was appointed to take her place. CO-ORDINATION. 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. The difficulties and waste of time caused by the fact that the office and Clinics of the School Medical Service are nearly a mile from the Public Health Department, have been accentuated by the steady growth of Public Health, School, and Maternity and Child Welfare work. Since further duties are to be undertaken in the very near future, it is an urgent matter that all branches of the Health Services should be centralized under one roof, where the various activities could be carried out, and all records and correspondence would be immediately available, otherwise both administrative and executive work will continue to be most difficult, and the efficiency of the Services must suffer in consequence to a further extent. I drew attention to the position in my Annual Report for 1925, and again emphasised the need for contralization in my Annual Report for last year. 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. 47 During 1929 the following repairs have been carried out:— Bonner Hill Road School. Richmond Road School. All Saints' Infant School. At the above schools only small decorations to certain rooms were carried out, and the lavatories thoroughly cleansed and redecorated. St John's School The roof was stripped, retiled and the guttering overhauled. The old steeple was removed. The whole School was re-drained; pedestal W.C. pans were fixed throughout. New heating stoves were fixed, and a Teachers' Room was provided, with separate sanitary accommodation. The old lavatory basins inside the building were abolished. A new verandah was erected at the rear of the School, and several board and glass partitions were fixed. St. Peter's School A small entrance lobby, and a new doorway were made. Six new W.C. pans for children, and a lavatory and W.C. adjoining the Teachers' Room. Personal Hygiene—Rubber Boots. Quite a number of School children nowadays wear Wellington rubber boots to School. The practice, no doubt, has an advantage in that it prevents the children getting their feet wet on their way to School, but it should be remembered that these rubber boots do not allow proper ventilation, with the result that moisture condenses inside, rendering their feet damp and very cold when tne children are in class Again, so many of these children wear rubber boots when the weather is fine and dry, which is very inadvisable. In my opinion these boots are very bad for constant wear, and I recommend that all children should have a pair of leather slippers or shoes at School into which they should change on arrival. I hope that teachers will aid by advising parents to provide a change of shoes for their children, 48 and in cases where this is clone, I trust they will also see that the children cultivate the habit of putting on the dry shoes immediately they arrive at School. MEDICAL INSPECTION. All Departments of every School are visited by the School Medical Officcr 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. FINDINGS OF MEDICAL INSPECTION. (a) Uncleanliness. The School Nurses visit all Schools within the first fortnight of each term for the purpose of carrying out cleanliness surveys, since a number of children return to School after the holidays in an unsatisfactory condition. 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 five 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 1929 16,325 648 2 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:— Entrants Boys 215 174 81% Girls 199 159 79% Intermediates, Boys 256 175 68% Girls 216 153 71% Leavers Boys 166 71 43% Girls 176 93 53% 49 It was noted towards the end of the year that a number of girls, whose hair had been previously shingled, were now allowing it to grow long. It is hoped that parents will keep their girls' hair short while at School as there is no doubt that this fashion has contributed towards the general improvement in the standard of cleanliness. (b) Tonsils and Adenoids. There were 67 children suffering from enlarged tonsils and adenoids referred for treatment during the year. (c) Tuberculosis. Any children suspected by the School Medical Officer are referred to the Surrey County Council Tuberculosis Officer, Dr. Cameron Renwick, for his opinion, observation and treatment, if necessary. (d) Skin Disease. Impetigo and ringworm of the body and scalp are the skin diseases chiefly met with among the children. Exclusions from School for impetigo and ringworm of the body are usually short, but in ringworm of the scalp the period of exclusion is three months or more. There were 27 cases of ringworm of the scalp referred for treatment during the year. (e) Vision. During the year 65 children were found requiring treatment for defective vision, and 21 for squint. (f) Dental Defects. At his inspection the School Dentist found 1,196 children needing treatment. MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily 50 at the Clinic during School Terms, 6,678 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. Fifty-nine cases were treated under this Scheme during the year. (c) Skin Diseases. 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 the Oculist, who has prescribed spectacles for 67 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. (f) Dental Defects. Of the 1,196 children requiring treatment found by the School Dentist, 618 were actually treated, 455 being rendered dentally fit before the end of the year. Remarks by the School Dentist are given under the paragraph on the Dental Clinic. (g) Crippling Defects and Orthopœdics. During the year 26 individual children received electrical, massage and other forms of treatment at the Red Cross Curative Post, Norbiton, making 1,859 total attendances. The cost of the above out-patient treatment amounted to £185 19s., towards which the parents contributed £22 9s. Three children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment at a total 51 cost of £178 12s., the parents only being able to contribute £21 8s. towards this expenditure. INFECTIOUS DISEASE. There was no school closure during the year for infectious disease. The number of absentees on account of infectious diseases has been remarkably low, chiefly, no doubt, due to the fact that no outbreak of Measles occurred in any of the Schools. In May Mumps and Whooping Cough were somewhat prevalent among the Infants of Richmond Road School. An outbreak of Mumps occurred at All Saints' Infants' School in June and July. An outbreak of Diphtheria occurred at the end of July affecting the Infants' Department of Richmond Road School. Three cases were notified during the week ended July 13th, and then no further cases occurred for ten days, when six cases were notified in the week ended July 27th. The children were kept under daily supervision, and such necessary precautions were taken as is usual in outbreaks of this nature, both with regard to notified cases and contacts. On the Schools closing for the Summer Vacation on July 31st the outbreak did not cease, but continued during the first three weeks of August, when it terminated somewhat abruptly, seventeen cases in all having been notified among the Infants of Richmond Road School. The Department was disinfected. 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. 52 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 1929. Number of children prepared for Routine Medical Inspection 1,368 Number examined at Schools for uncleanliness 16,325 Number of following-up home visits 468 Total number of visits to the Schools 613 Total Number of Clinic Sessions 388 The Central Aid Society has helped in obtaining letters for hospitals, etc., in cases where the parents cannot afford to pay, and also in sending children away for convalescence to the seaside. The National Society for Prevention of Cruelty to Children has aided in following up obstinate cases when notified by the School Medical Officer. VACCINATION. At Routine Medical Inspections an entry is made on the Medical Record Card of every child not exhibiting evidence of previous vaccination. The percentage of entrant infants showing vaccination marks was 69.8. SPECIAL SCHOOL. The Special School for Physically Defective Children is now temporarily accommodated in the ground floor of the new building in Bonner Hill Road, which has been erected as a Domestic Subjects Centre. 53 It became necessary to vacate " Elmfield " at the end of 1928, as the premises were required in connection with the new Tiffin Boys' School. The new building could not be occupied at once as it was too damp, so the physically defective children were accommodated at All Saints' School while the process of drying out the premises was undertaken. They were admitted there on March 11th, occupying two large rooms on the ground floor, with cloak rooms, kitchen, and dining room. There is an entirely separate entrance on the opposite side of the building from the Clinic, and a fence was erected to prevent any encroachment by clinic children. The playground is small. There are 27 physically defective children on the register 4 of whom come from outside the Borough. The School Medical Officer periodically examines the children, and the Clinic, being on the same premises, is always at hand should the Head Teacher desire to consult him or the School Nurse about any child. Children needing orthopaedic treatment attend the Red Cross Post, Norbiton, under the visiting Orthopaedic Specialist. Dental inspection and treatment was carried out during the year. SCHOOL CLINIC. Owing to the building of the new Tiffin Boys' School at " Elmfield," the Clinic was moved on January 7th to a new building which had been erected as a Domestic Subjects Centre in Bonner Hill Road. This is a temporary move pending the provision of permanent accommodation for the Clinic and Offices of the School Medical Service. The Clinic occupies the first floor, which consists of two large and four very small rooms. One large room is used is a general waiting room, the School Medical Officer holding his Inspection sessions in an adjacent small room. 54 The second small room contains a gas boiler, etc., for washing towels used in the Clinic. The other large room is used for the treatment of minor ailments, and a portion containing a sink is screened off to form a dental recovery room. The two small rooms adjoining are used as Dental and Eye Clinics. Heating is by hot water and gas radiators, and lighting by electric light. There is a hot and cold water supply throughout. The upper floor of the teachers' quarters, leading from a half landing, is used as the office and for the accommodation of the Staff. The Clinic is approached by a separate gateway from Bonner Hill Road, a path leading to the Main Entrance, and thence by a stone stairway to the first floor. There is no communication between the lobby of this entrance and the ground floor except by one door, which is kept locked. The building when first occupied was hardly finished and very damp, but considering the difficulties and also the fact that it was not erected to accommodate Clinics, the work was undertaken immediately, and the process of settling down took far less time than was anticipated. (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. 55 (c) Ophthalmic Clinic. 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 244 attendances at the 14 sessions held during the year, 123 being new cases and 121 re-inspections. Refractions numbered 102, and spectacles were prescribed in 67 instances. Parents are charged the cost price of spectacles, except in really necessitous cases, when the Committee is prepared to pay part or the whole cost of the same. Children for whom spectacles are prescribed are reinspected by the School Medical Officer when he visits the Schools each term. The 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, 19 half-days were given to Inspection and 151 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 219 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 was four sessions of 2½ hours per school week, directed to children aged 5, 6, 7, 8, 9, 10 and 11, also the children in the Physically Defective School, and " Specials " (i.e., children not eligible for Routine treatment—referred by School Medical Officer, etc.) The programme of work for the year carried out the progressive policy as in previous years, by the addition of an age group. The work presented rather a formidable aspect 56 with a waiting list of about 450 children at the termination of the previous year, and an additional age group added, together with an increasing number of consents for treatment. However, the decrease in the number of " Specials " and the increase in number of re-treated cases, for whom less treatment is required, left more time available for the new cases, and enabled more children to be treated, but has not reduced the waiting list. Re-treated cases are children who, having previously been rendered dentally fit, are referred as a result of periodical inspection, consequently a small amount of time is taken up rendering them dentally fit again, whereas new cases are usually visiting a dentist for the first time and, speaking generally, require much more treatment, according to the age of the child. The extra time available from the proposed additional session during 1930, together with the exclusion of children from the routine groups whose parents or guardians have definitely and consistently refused to permit treatment, will allow for an additional age group to be added, and also will assist in clearing off arrears of waiting cases. The programme for 1930 is to inspcct and treat children born 1918 and onwards, and all children in the Physically Defective School." EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 48 schoolchildren over 12 years of age were issued with certificates under the Bye-laws permitting their employment on milk and paper rounds, and one over school age as a street trader. SCHOOL BATHS. During the summer months 675 children from the Boys' and Girls' Departments of all the Schools attended the Corporation Baths during School hours for instruction in swimming. 57 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 1½d. per visit. On request, special tickets are issued to children attending the Public Elementary Schools entitling them to admission to the Baths at 1½d. 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. Luke's Boys' School at the rear of St. John's School. Physically Defective School at the School. At present, St. John's, St. Peter's and St. Agatha's Schools are without Gardening Centres. DEFECTIVE CHILDREN. Exceptional children are brought to the notice of the School Medical Officer by the School Nurses, Health Visitors and Attendance Officers. The Teachers are invited to bring any children they consider defective before the School Medical Officer. If suffering from a physical defect, they are admitted to the Special Day School for Physically Defective Children 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. There are two 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. 58 SCHOOL CAMP. St. Peter's Girls' School. The Head Teacher, Miss A. Thompson, and the assistants again were able to raise funds to take a party of girls to Dovercourt for a week. Prior to departure on June 21st all the girls were examined by the School Medical Officer. The party consisted of 31 girls, 19 of whom were taken for the holiday entirely free, 10 paid in full, and 2 in part. 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 414 Intermediates 472 Leavers 342 Total 1,228 Number of other Routine Inspections 140 B.—Other Inspections. Number of Special Inspections 1,767 Number of Re-Inspections 5,983 Total 7,750 TABLE II. A. Return of Defects found by Medical Inspection IN the Year ended 31st December, 1929 Defect or Disease Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under servation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — — — Uncleanliness— (See Table IV.GroupV.) 101 — 547 — Skin Ringworm, Scalp — — 27 — Body 2 — 48 — Scabies 1 — 8 — Impetigo 7 I 244 — Other diseases (non Tb) 12 14 199 — Eye Blepharitis 3 — 13 — Conjunctivitis 1 — 16 — Keratitis — — — — Corneal Opacities — — — — Defect.vision exc.Squint 23 7 42 — Squint 11 3 10 — Other Conditions — 2 31 — Ear Defective Hearing 4 1 10 — Otitis Media — — 9 — Other Ear Diseases 3 — 27 — Nose and Throat Enlarged Tonsils only 24 7 29 — Adenoids only — 1 2 — Enlarged Tonsils and Adenoids 8 — 4 — Other Conditions 4 — 68 — Enlarged Cervical Glands (non Tb) 5 5 27 — Defective Speech 2 3 2 — Teeth—Dental Diseases 5 — 3 — (see Table IV., Group IV.) Heart and Circulation Heart Disease—Organic 2 4 3 — Functional 1 2 — — Anaemia 3 — — — Lungs Bronchitis l 3 3 — Other non Tb. Diseases 3 3 17 — — Tuberculosis Pulmonary—Definite — — — Suspected — — 1 — Non-Pulmonary-Glands — 3 — Spine — — — — Hip — — 1 — Other Bones & Joints — — — — Skin — — — — Other Forms — — — — Nervous System 'Epilepsy — — — — Chorea 2 1 4 — Other Conditions 2 4 4 — Deformities Rickets 1 4 — — Spinal Curvature 5 — — — Other Forms 10 3 8 — Other Defects and Diseases 25 29 304 2 TABLE II.—continued. B- Number of Individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases) Group. Number of Children. Percentage of Children found to require Treatment. Inspected. Found to Require Treatment. Code Groups —Entrants 414 48 12 Intermediates 472 51 i i Leavers 342 32 9 Total Code Groups 1228 131 11 Other Routine Inspections 140 16 11 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 — — — 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 — — — Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools 1 — 1 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). Attending Certified Schools for Mentally Defective Children 1 — 1 Attending Public Elementary Schools 20 11 31 At other Institutions — — — At no School or Institution — — — Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles 2 — 2 Idiots — — — TABLE III -Continued. — — — Boys. Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special — — — 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 1 — 2 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 — — — At other Institutions — 1 1 At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 3 2 5 At other Institutions — — — At no School or Institution — — — Delicate children (e.g pre or latent tuberculosis, malnutrition,debility, anaemia, etc). At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 17 18 35 At other Institutions — — — At no School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease. At Certified Hospital Schools 1 1 2 At Certified Residential Cripple Schools — — — At Certified Day Cripple Schools 12 10 22 At Public Elementary Schools 7 8 15 At other Institutions — — — At no School or Institution — — — TABLE IV. Return of Defects Treated during the Year ended 31st December, 1929. 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. Other wise. Total Skin—Ringworm, Scalp 18 13 31 Ringworm, Body 43 2 45 Scabies 6 2 8 Impetigo 256 — 256 Other Skin Disease 168 19 187 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 44 9 53 Minor Ear Defects 14 2 16 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 181 11 192 Total 730 58 788 Group II. — Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). No. of Defects dealt with. Defect or Disease. Under the Authority's Scheme, Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total Errors of refraction (ineluding Squint) 102 14 — 1 l6 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 2 — 7 9 Total 104 14 7 125 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 67 (b) Otherwise 12 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 64 (b) Otherwise 12 Group III.—Treatment of Defects of Nose and Throat, Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital 69 By Private Practitioner or Hospital apart from the Authority's scheme. 22 Total 81 Received other forms of treatment 14 Total number treated 95 Group IV. Dental Defects (1) Number of Children who were :— (a) Inspected by the Dentist : Ages 5 6 7 8 9 10 11 12 13 14 141 334 322 314 374 228 98 — — — Total 1811 Specials 16 Grand Total 1827 (b) Found to require treatment 1196 (c) Actually treated 618 (d) Re-treated during the year as the result of periodical examination 193 (2) Half-days devoted to:— Inspection 19 Treatment 151 Total 170 (3) Attendances made by children for treatment 1760 (4) Fillings : — Permanent teeth 815 Temporary teeth 74 Total 889 (5) Extractions: — Permanent teeth 110 Temporary teeth 1664 Total 1774 (6) Administrations of general anæstheticsfor extractions 219 (7) Other operations : — Permanent teeth 171 Temporary teeth 147 Total 318 64 Group V. —Uncleanliness and Verminous Conditions (i.) Average number of visits per school made during the year by the School Nurses 68 (ii) Total number of examinations of children in the schools by School Nurses 16325 (iii.) Number of individual children found unclean 648 (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 2