KIN 8 The Royal Borongh of Kingston-upon-Thames. Annual Reports FOR 1 9 3 0 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 193O 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, 1930. 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. Additional Sanitary Inspectors: F. D. HARVEY, A.R.S.I., Cert.R.S.I., as Sanitary Inspector, and Meat and Foods Inspector. G. H. COCKELL, A.R.S.I., Cert.R.S.I., and S.I.E.J.B., as Sanitary Inspector. Health Visitors: *||†Miss A. GILL, (Senior), 1/2 time. *||†Miss C. A. HOOKWAY, 1/2 time. *||Miss L. G. SALWAY, 1/2 time. *||Miss A. GUMBLETON, 1/2 time. Junior Clerks : Miss T. P. DILLIWAY, R. H. FELGATE. 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, 1931. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1930. Circular 1119 (Ministry of Health) directs that although the Annual Report for 1930 will be a Report of a more simple character than the full Survey Report which the Medical Officer of Health was asked to prepare for 1925, it should, for the following reasons, contain information on certain matters in more detail than has been given in the Reports for the last four years, viz.:— (a) The transfer of the Poor Law functions in pursuance of the Local Government Act, 1929. (b) The proposals of the Government in relation to Housing. In July, Mr. G. H. Cockell, Clerk to the Public Health Department, qualified as a Sanitary Inspector, and on October 1st he was appointed as an additional Sanitary Inspector. On 24th November, R. H. Felgate was appointed junior clerk to fill the vacancy in the office. On April 1st the administration and duties under the Children Act, 1908, were taken over from the Poor Law Authority, and the Health Visitors were designated Infant Life Protection Visitors for the purposes of the Act. No additional staff has been engaged for this extra work. 4 The incidence of Infectious Diseases generally was low, apart from an outbreak of Diphtheria at the Kingston and District Hospital in the Spring. One case of Smallpox occurred in a man who was under observation as a contact, so prompt removal to the Smallpox Hospital and vaccination of contacts prevented any spread of the disease. Meat Inspection occupies much of the Sanitary Inspectors' time, and necessitates a considerable amount of evening work. Housing conditions show definite improvement, and over-crowding is far less acute now than it was a few years ago. The provisional proposals of the Corporation with regard to Housing submitted to the Minister of Health are set out in the body of the Report. Maternity and Child Welfare work continues to grow steadily, and the Health Visitors are to be congratulated upon obtaining a first-class Certificate for Records in the National Welfare and Baby Week Competitions. The Birth Rate was 14.3 and the Death Rate 11.0 per 1,000 population, compared with 16.3 and 11.4 respectively for England and Wales. I thank Mr. H. T. Perry, Senior Sanitary Inspector, and Miss A. Gill, Senior Health Visitor, for their able assistance, and all members of the staff of the Public Health Department for their loyal support. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 5 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—General Rate £375,278 Sum represented by a Penny Rate £1,554 Amount of Poor Law Relief £4,418 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. Male. Female. Birth Rate (R.G.) per 1,000 population 14.3 Legitimate 520 263 257 Illegitimate 33 15 18 553 278 275 Still Births— Total. Male. Female. Legitimate 24 10 14 Illegitimate — — — 24 10 14 Deaths— Total. Male. Female. 423 220 203 Death Rate (R.G.) per 1,000 population 11.0 Number of women dying in, or in consequence of, child-birth— From Sepsis 2 From other causes 2 6 Deaths of Infants under one year- Total. Male. Female. Legitimate 20 14 6 Illegitimate 4 2 2 24 16 8 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 38 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 121 Total Deaths of Infants under one year of age per 1,000 births 43 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhœa (under two years of age) 2 Birth Rate Death Rate Rate per Diarrhœa under 2 years, 1000 Births Total Deaths under 1 year England and Wales 16.3 11.4 6.0 60 159 Smaller Towns 16.2 10.5 4.4 55 London 15.7 11.4 9.9 59 Kingston-upon-Thames 14.3 11.0 3.6 43 CAUSES OF DEATH. (Civilians only.) Causes of Death. Male. Female. All Causes 220 203 1. Enteric Fever — — 2. Smallpox — — 3. Measles 1 — 4. Scarlet Fever — — 5. Whooping Cough 1 — 6. Diphtheria 2 1 7. Influenza 2 — 8. Encephalitis Lethargica — — 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 16 13 11. Other Tuberculous Diseases — — 12. Cancer, Malignant Disease 28 22 13. Rheumatic Fever — 1 14. Diabetes — 3 15. Cerebral Hæmorrhage, etc. 9 13 16. Heart Disease 32 46 17. Arterio-Sclerosis 6 4 18. Bronchitis 10 8 7 19. Pneumonia (all forms) 17 13 20. Other Respiratory Diseases 1 1 21. Ulcer of Stomach or Duodenum 3 1 22. Diarrhoea, etc. (under two years) 2 — 23. Appendicitis and Typhlitis 2 — 24. Cirrhosis of Liver 2 — 25. Acute and Chronic Nephritis 16 5 26. Puerperal Sepsis — 2 27. Other Accidents and Diseases of Pregnancy and Parturition — 2 28. Congenital Debility and Malformation, Premature Birth 8 5 29. Suicide 4 2 30. Other Deaths from Violence 15 10 31. Other Defined Diseases 42 51 32. Causes ill-defined or unknown 1 — Cancer, Heart and Respiratory Diseases account for the majority of deaths. When requested, the Public Health Department carries out disinfection after deaths from Cancer. Notified cases of Pneumonia have been followed up, in order to ensure that they are being nursed under satisfactory conditions. Disinfection is carried out in pulmonary tuberculosis whenever premises are vacated by cases, either on account of their removal, admission to Hospital or Sanatorium, or death. METEOROLOGY, 1929. Temperature of Air Rainfall Inches Highest Lowest Mean Max. Mean Min. January 56 28 54 38 2.85 February 58 26 44 34 0.59 March 67 22 53 38 1.68 April 79 29 60 40 1.41 May 77 36 68 46 2.89 June 88 43 81 52 1.60 July 87 45 72 53 1.61 August 89 45 75 53 2.59 September 80 45 70 51 2.60 October 72 30 66 44 0.85 November 59 22 52 36 3.91 December 53 27 45 34 1.65 Total 94.93 The average annual rainfall (Greenwich) for the hundred years, 1821-1920, was 24.39 inches. 8 GENERAL PROVISION OF HEALTH SERVICES. Professional Nursing in the Home. (a) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (b) Infectious Diseases.—In Measles, Whooping Cough, and Epidemic Diarrhoea, the Health Visitors are under instructions to visit the cases and give practical advice as to the best methods of nursing them. If attended by District Nurses the fees may be paid by the Corporation. Midwives. The Midwives are under the administrative control of the Surrey County Council. There were ten registered as practising in the Borough at the end of the year. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. 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 Conner Consultation The Corporation Clinic School Clinic Hill 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 9 Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. Maternity and Nursing Homes. 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 Rowan: 197, Park Road. 6 beds In March, under the Nursing Homes Registration Act, 1927, powers of inspection (but not of registration) of Nursing Homes in the Borough were delegated by the Surrey County Council to the Corporation. This arrangement has worked satisfactorily. The Kingston and District Hospital (Surrey C.C.) has Maternity Wards. Children. (a) The Kingston and District Hospital (Surrey C.C.) (b) The Kingston Victoria Hospital (Voluntary). 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. One case of Smallpox occurred in the Borough during the year. Other. Other Hospitals situated in the Borough available for the District are:— (a) The Kingston and District Hospital (Surrey C.C.). (b) The Kingston Victoria Hospital, supported by voluntary contributions. 10 This Voluntary Hospital provides for 10 male and 11 female patients, and a children's ward for 9 children. In addition, there are 8 single rooms and 1 double room providing accommodation for 10 private patients. A number of the inhabitants of the Borough attend the Royal Hospital, Richmond, and the Corporation made a contribution of £50 to its funds. Maternal Mortality. The investigation of maternal deaths is carried out by the Medical Officer of Health, who addresses confidential reports to the Senior Medical Officer, Ministry of Health, in the form specified by the Ministry. Five cases occurred during the year. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. The local branch Shelter of the Kingston, Surbiton and District Voluntary Society, which is affiliated to the Southwark Diocesan Association for Rescue and Preventive Work, is situated at No. 18, Richmond Park Road. The Central Relief Institution, Kingston. 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. (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 221 accident cases and 41 private cases were removed by this ambulance, 11 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., 192C Bye-laws relating to the following matters are in force within the Borough:— Sanitary Conveniences allowed 11th May, 1899 Houses Let in Lodgings ,, 31st October, 1911 Tents, Vans, Sheds and Similar Structures ,, 28th November, 1924 New Streets and Buildings ,, 15th January, 1927 Underground Rooms ,, 26th July, 1927 Smoke Abatement ,, 6th October, 1927 Offensive Trades ,, 5th March, 1928 Slaughter-houses ,, 14th November, 1928 Common Lodging Houses ,, 27th December, 1928 Fouling of Footpaths ,, Nth December, 1929 Nuisances ,, 1st May, 1930 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. The use of well water was discontinued at twelve houses during the year. 12 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 1930 will be found in the Annual Report of the School Medical Officer. HOUSING. A general survey of the Borough was carried out by the Sanitary Inspector and myself, when it was found that the general standard of housing was good, and there were no areas which came within the meaning of "Clearance" Areas (Housing Act, 1930). The Borough is almost entirely built over, and the houses are contiguous with those of adjacent areas. The Sanitary Inspector, Mr. H. T. Perry, reports as follows:— Overcrowding. (a) Seven cases of overcrowding were found during 1930. (b) Four cases were abated during 1930. (c) Five cases were remaining on the registers at the end of the year. House-to-House Inspections. No special areas were dealt with during the year, but 28 premises were inspected in the following roads:— Acre Road 10 Park Road 12 Elm Road 5 Bittoms 1 13 Underground Dwellings. There were eight cases in all dealt with for underground rooms. STATISTICS. Number of New Houses erected during the year:— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons 17 houses and 16 flats. (b) With State assistance under the Housing Acts: (i) By the Local Authority (a) For the purpose of Part II of the Act of 1925 Nil (b) For the purpose of Part III of the Act of 1925 Nil (c) For other purposes Nil (ii) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— Houses Inspected. No. of Inspections. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 754 1,009 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made 28 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 Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 581 14 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 525 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 55 (2) Number of dwelling-houses in which fects were remedied after service of formal notices: (a) By owners 58 (b) By Local Authority in default of owners 1 (C)—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil 15 (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 4. Number of houses owned by the Local Authority distinguishing those built in the last two years and held under (1) Part III of the Housing Act, 1925, (2) Part II of the Housing Act, 1925, and (3) other powers 522 (Held under Housing Financial Provisions Act, 1924.) REPORT. In December a report on the provisional proposals of the Royal Borough of Kingston-upon-Thames with regard to Housing, pursuant to Section 25 of the Housing Act, 1930, was submitted to the Minister of Health by the Corporation, and read as follows:— Since March, 1924, the Kingston-upon-Thames Corporation have erected 522 houses for the working classes; of these, 40 are of the parlour type, the remaining 482 being of the non-parlour type. There have been erected 432 of these houses at varying periods during the last five years. As the Corporation are at the moment faced with a waiting list which contains the names of 711 applicants, it is the intention of the Corporation to continue their housing programme as far as is reasonably possible on the scale operating during the last five years, and this figure has accordingly been entered in the notes below. The Corporation has been up to the present, and is at the moment, unfortunately placed with regard to the erection of houses for the working classes on account of the shortage of available building land in the Borough. Out of the 522 Bouses erected by the Corporation up to the date of the submission of this report, only 182 of such houses have been erected within the area of Kingston-upon-Thames, the Corporation having had to purchase land within the area of the Maidens and Coombe Urban District Council in order that the remaining 340 might be erected in which to house Kingston applicants. It is estimated that there are only 33 acres of building land in Kingston, and this is widely scattered and not suitable or available for the erection of dwellings for the working classes. 16 At the present time Kingston's population density is 31.9 persons to the acre (the largest population density except one of non-county boroughs throughout England and Wales). If vacant land becomes available as a consequence of Section 46 of the Local Government Act, 1930, or otherwise, the question will automatically right itself, but as to how far the Corporation are prepared at the present time to indicate the extent which they are prepared to develop land in a neighbouring authority in the future, is a matter which the Council are not prepared to bind themselves at the moment, and which will be dependent on the question for subsequent consideration as to whether or not the Corporation are prepared to house their people outside their area and thereby deplete their population and the product of a penny rate. The Corporation have just entered into a contract for the erection of a further 140 houses to be erected on land recently purchased by them and situate within the area of the Urban District Council of the Maidens and Coombe, and it is understood that these houses will be completed during the next year or so. This figure is, of course, included in the number set forth in the statement below and as being contemplated to be erected during the course of the next five years. Owing to the large number of applications received, the Housing Committee of the Corporation have up to the present only granted tenancies of Corporation houses to applicants who have at the date of their application two or more children, and who have resided in the Borough of Kintrston-upon-Thames for upwards of ten vears. Below is given particulars of the houses erected each year in the Borough during the last five years by private enterprise, but few of the small number of houses so erected could be considered to be houses of the working-class type : Year. Total number of houses erected by private enterprise. 1925 85 1926 81 1927 85 1928 38 1929 28 17 With regard to the question of clearance areas, improvement areas and the demolition and repair of individual houses, it must be stated that Kingston-upon-Thames generally is not too greatly affected by so many of the provisions of the Act as relate to unsatisfactory housing. As will be seen from the particulars inserted in the form below, it is considered that there are no areas in Kingstonupon-Thames which could during the course of the next five years be treated as clearance areas. The nature of a large proportion of the property in Kingston is, it is true, of the working-class type, but such property is arranged in rows of good average width generally, and the houses are for the most part constructed in pairs, or, at any rate, in small blocks, and so many of the provisions of this Act as relate to the making of improvement areas consequent on the opening up thereof, do not generally apply to this district. However, as will be seen below, it is the intention of the Corporation to deal under the Act with certain areas in the Borough as improvement areas, and it is intended that a general survey of the whole of the town will be made during the next five years, and advantage in every possible respect taken of the provisions of the Act to obtain satisfactory housing accommodation for the inhabitants of the Borough. FORM OF QUINQUENNIAL STATEMENT. Name of local authority—Royal Borough of Kingston-upon- Thames. Population (estimated figure for middle of 1929) 38,420 Number of inhabitated houses (according to rate books) 8„732 A. Estimated production of houses by the local authority during the next five years approximately 509 B. Estimated production of new1 houses of working-class type by private enterprise during the next five years— (i) with subsidy under the Act of 1924 (ii) under arrangements made under Section 29 of the Act of 1930 (iii) otherwise Practically nil, having regard to the fact that there is no suitable land available upon which to construct houses of the type contemplated by the Act. 18 C. Estimated number of new houses to be allocated by the local authority during the next five years to the purposes of the Housing Act, 1930 (i.e., the purposes mentioned in E and F) approximately 40 D. Estimated number of new houses to be allocated by the local authority during the next five years to the purposes of the Act of 1924 (i.e., new housing) approximately 460 Total approximately 500 E. Estimated number of houses to be demolished during next five years— (i) in clearance areas Nil (ii) in improvement areas: (a) for opening the area (b) as unfit houses (iii) individual houses outside clearance and improvement areas 10 Total 36 F. Estimated number of persons to be displaced during the next five years— (i) by any of the processes mentioned in E approximately 150 (ii) to abate overcrowding in improvement areas approximately 70 Total approximately 220 G. Estimated number of houses to be repaired under Part II of the Housing Act, 1930, during the next five years approximately 1700 OTHER SANITARY CIRCUMSTANCES. In order to prevent duplication, the Sanitary Inspection of the Area, Ashbins, Smoke Abatement, Inpection and Supervision of Food, etc., are entirely included in the Annual Report of the Sanitary Inspector. 19 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 40 — Cream 2 — Butter 2 — Confectionery and Jam 5 — Spirits 5 2 Drugs 2 — Other Articles 21 — Totals 77 2 No prosecutions were made under these Acts in the Borough during the year. 20 Notifiable Diseases during the Year. Cases. 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 Cases admitted to Hospital Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Total Death Smallpox — — — — — — — — — — 1 — 1 1 — — — — — — — — — — — — — Scarlet Fever — — — 4 1 31 17 9 11 4 1 — 78 57 — — — — — — — — — — — — — Diphtheria 7 9 7 3 3 45 14 5 5 2 — — 100 97 — 2 I — 1 1 — — — — — — 5 Enteric Fever including Paratyphoid — — — — — — 1 — 3 1 — — 5 5 — — — — — — — — — — — — — Pneumonia 1 1 2 2 — — — 2 4 3 5 4 29 8 — 1 — — — — — — — — 1 1 3 Erysipelas — — — — — — 2 5 1 1 6 6 21 2 — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 5 3 — — 8 3 — — — — — — — — 3 2 — — 5 Puerperal Fever — — — — — — — — — — — — 1 — — — — — — — — — — — — — — Ophthalmia Neonatorum 2 — — — — — — — — — — — 2 — — — — — — — — — — — — — — 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 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 & over. Total. Tuberculosis (a) Pulmonary M. — — — — 1 1 3 4 4 1 1 15 — — — — — 1 — 3 8 2 2 — 16 F. — — — — 3 4 5 — 1 — — 13 — — — — 1 — 4 4 2 1 — 1 13 Total — — — — 4 5 8 4 5 1 I 28 — — — 1 1 4 7 10 3 2 1 29 (b) Non-Pulmonary M — — 1 1 2 — — — 1 — — 5 — — — — — — — — — — — — — F. — — 1 1 — 1 3 — — — — 6 — — — — — — — — — — — — — Total — — 2 2 2 1 3 — 1 — — 11 — — — — — — — — — — — — — 21 INFECTIOUS DISEASE. The following table gives a comparative statement of notifications received during the last twelve 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 1930 78 100 5 SCARLET FEVER. The type of case has been mild and no death was attributed to this disease during the year. It will be seen from the above table that the incidence of Scarlet Fever has been low this year. The majority of cases are admitted to Isolation Hospitals, but when they can be satisfactorily islolated, they are nursed at home. There were no return cases after discharge from Hospital, and those kept at home did not give rise to any secondary case. The Dick Test has not been used, or any artificial method of immunization employed. DIPHTHERIA. The cases varied widely in virulence; and three deaths were attributed to the disease. The total number notified has again declined, and had not an outbreak occurred in the Children's Ward at the Kingston & District Hospital in the Spring, the fall would have been considerable. During this outbreak, Dr. P. V. Davies, the Medical Superintendent, and myself were in constant consultation. The circumstances were complicated by the existence of Measles in the Children's Ward at the time the outbreak commenced. 22 The following is a brief history of the outbreak:— During the month of March, Measles occurred in the Children's Ward. At first it was possible to segregate the cases in various side wards in other parts of the Hospital buildings. As the infection spread rapidly, affecting a large number of children, adequate isolation became impossible with the existing accommodation. On March 20th, a case of Diphtheria was discovered in the Children's Ward making the situation still more complicated. Thereafter no fewer than twenty cases of Diphtheria were discovered between that date and May 2nd. These cases included three of the nurses in attendance. At the onset prophylactic doses of serum were given to all contacts among the patients and staff. The cases were removed to various Isolation Hospitals as they occurred. Six of the cases were cross infected with Measles, and these had to be retained in the Kingston & District Hospital. To add to the difficulty was the fact that cases of Measles were being sent in by the outside practitioners. The situation eventually became so serious that all sections of the Ward had to be closed against further admissions. The greater number of cases consisted of Nasal Diphtheria, and were fortunately of a mild type. Virulence Tests were carried out on the last eight cases, of that number only one gave a positive result. Two cases were attended with fatal results, death in one instance being due to Broncho-Pneumonia following Whooping Cough, which evinced itself after admission to the Isolation Hospital. Of the twenty cases only four had their home addresses in the Borough. A few cases of Diphtheria occurred at Richmond Road Schools in the Autumn, and the children were kept under daily supervision, with the result that two unsuspected bacteriological cases were discovered and isolated. The issue of Diphtheria Antitoxin is made through two Chemists and is available at all times. The Schick Test has not been employed. 23 ENTERIC FEVER (including Paratyphoid). Five cases of Paratyphoid B. were notified during the year. There were no fatal cases. (1) On May 12th a young woman, aged 21, was admitted to the Kingston Victoria Hospital from a comfortable home. She had first complained of illness on May 2nd. It appears probable that she was infected during a walking tour at Easter, April 20th, though no definite source of infection was traced. (2) (3) and (4) On July 5th two young women, aged 21 and 25, were notified from Kingston Victoria Hospital. They were employees at a Kingston shop. On July 11th a man aged 36 was notified and removed to Isolation Hospital. He was employed at the same shop. Everything pointed to a common source of infection, but in spite of exhaustive investigations and special examination of a cook as a possible carrier, no definite source was found. No further cases occurred among the large number of employees at this shop. (5) On August 18th, a girl, aged 11, was notified from the Kingston Victoria Hospital. The origin of this case is obscure. SMALLPOX. One case of smallpox occurred in a man aged 64. He was under observation as a contact of a case in London. I visited him on Sunday, March 23rd, and found the rash had appeared, and he was removed to the Smallpox Hospital at East Clandon the same day. There were six contacts, five of whom were revaccinated. The remaining contact being an old lady, who had had smallpox when young. None of the contacts contracted the disease. PNEUMONIA. The number of cases notified was 29 compared with 57 last year. The reduction is accounted for by the fact that there was no prevalence of influenza during the year. PUERPERAL FEVER, PUERPERAL PYREXIA & OPHTHALMIA NEONATORUM. Comment on these diseases will be found under the Maternity and Child Welfare Section of this Report. 24 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. The efficiency of notification of Tuberculosis is good, and there have been no cases of wilful neglect or refusal to notify. No cases have arisen during the year in which any action became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or the Public Health Act, 1925, Section 62. Disinfection of premises is carried out in all cases of death, or when patients are admitted to hospital or sanatorium. It is unfortunate that frequently information regarding the movements of patients is not received until several days after their departure, thereby causing unnecessary delay in disinfection. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. The Medical Practitioners in the Borough also supply much valuable data on occasions. There were outbreaks of Measles at Richmond Road Infants' School in February and March, and at Bonner Hill Road Infants' School in April. One death was attributed to Measles. There has been comparatively little influenza this year, and only two deaths were caused by this disease. GENERAL PROCEDURE. In addition to isolation of patients, exclusion of school contacts, and routine disinfection of premises, in cases of notifiable infectious diseases, careful inquiries are made with regard to washing, books, and attendance at Sunday Schools, and the Laundries, Libraries and Sunday Schools concerned are informed and advised as regards any action deemed necessary. 25 MATERNITY AND CHILD WELFARE. Two centres, one at the Y.M.C.A. Hall, Eden Street, and the other at St. Peter's Hall, Washington Road, .are maintained by the Town Council. Dr. Olive Aubrey attends each Centre once a week and much valuable help is given by many voluntary lady workers. During the year there were the following number of attendances at the Centres :— Meetings. Attendances New Cases. Total. Eden Street 51 223 3,486 Washington Road 48 98 1,749 The Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers 74 91 Infants under one year 599 2,648 Children, one to five years — 2,798 Incidental and Infectious — 276 The above figures show an increase in work, despite the fact that for two months 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 41 mothers have purchased 136 garments during the year. In February a similar Clothing Stall was commenced at the Washington Road Centre, where 30 mothers purchased 112 garments before the end of the year. Baby Week was held from July 6th to 11th, when the Infant Welfare Centres and Day Nursery were open to visitors on certain days. 26 The following programme was carried out :— Sunday, July 6th.—Special reference in local churches and Sunday Schools. Special displays of Parentcraft at St. Peter's Hall, Washington Road, on Tuesday, July 8th, and at the Y.M.C.A. Hall, Eden Street, on Friday, July 11th. Wednesday, July 9th.—Garden Party for Infant Welfare Mothers and Babies. Thursday, July 10th.—Lecture, "Foundations of Health," by Dr. Sophia Seekings Friel. Friday, July 11th.—^Entertainment by the Welfare Centre Mothers at All Saints' Church Hall. The Centres again competed in the National Welfare and Baby Week Mothercraft Competition, gaining 13th place, which is extremely creditable. Certificates were awarded to seven parents, two obtaining honours. Also a first class Certificate for Records. 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. In March the sale of National Savings Certificates was started at both Centres with satisfactory results. £39 12s. 9d. was invested by GO mothers before the termination of the year. STAFF. Miss A. Gill took over the duties of Senior Health Visitor on January 1st, and Miss D. Rucklidge reported for duty on the same day. Miss Rucklidge was appointed on probation for 3 months and left the service on March 31st. Some difficulty was experienced in filling the vacancy with the result that the staff was short of one half-time Health Visitor for a period of two months. 27 Miss A. G. Gumbleton was then appointed and took up her duties on June 2nd. The work of the Health Visitors has been further increased by their appointment as Infant Life Protection Visitors under the Children Act, 1908. Their work has been most ably carried out under the direction of Miss A. Gill. ANTE-NATAL CLINIC. The Ante-Natal Clinic was held on the first and third Tuesday in each month at the School Clinic, Bonner Hill Road. During the year 107 expectant mothers attended, making 220 visits to the Clinic, which is an average of 9 per session. The Kingston Nursing Association continue to support the Clinic by sending their cases, but Midwives in private practice still appear reluctant to advise their patients to attend. Many women from the Borough now arrange to enter the Kingston and District Hospital for confinements and receive Ante-Natal care at the Hospital Clinic. Dr. Ruth Townshend is the presiding Medical Officer under the direction of the Medical Officer of Health. 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. 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. 28 If possible they contribute towards their own support, and assist by doing domestic work while in the home. They are transferred for confinement to the Kingston and District Hospital or other Maternity Home, returning after the puerperium with the infant to the " Shelter " for a further period of residence until the infant is three months old. The infant is then placed with a foster mother, and the parent is found a suitable situation in domestic service. PUERPERAL PYREXIA. During the year 8 cases were notified as Puerperal Pyrexia and one as Puerperal Fever 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 case of Puerperal Fever was admitted to the Kingston and District Hospital and recovered. Of the eight cases notified as Puerperal Pyrexia six were admitted to the Kingston and District Hospital and five died, three of these being from the Borough. The consultant, Dr. Andrew McAllister, was summoned to see one case of Puerperal Pyrexia in January at the patient's home. This case was nursed at home and made a good recovery. OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1929:— Notified. At Home. Treated . In Hospital. Vision unimpaired Vision impaired. Total Blindness. Deaths 2 2 – 2 – – – 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, 29 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 7 infants received out-patient treatment, making 255 attendances. The cost of out-patient treatment was £25 10s., and the contributions paid by parents towards this expenditure amounted to £3 8s. 6d. CHILDREN ACT, 1908. On April 1st the administration of Part I of the Children Act, 1908, was transferred to the Corporation under the Local Government Act, 1929. The duties imposed by the Children Act were entrusted to the Maternity and Child Welfare Sub-Committee of the Public Health Committee. No additional staff was engaged to carry out this extra work. The Medical Officer of Health was appointed as the Officer of the Corporation to whom all notices shall be sent under the said Act, the Health Visitors were designated Infant Life Protection Visitors, and the Town Clerk was authorised to take all necessary steps to advertise from time to time the provisions of the Act. The general procedure adopted is as follows:— Application for registration as a foster mother is made on a specified form to the Medical Officer of Health. The circumstances are investigated, and a recommendation is submitted to the Maternity and Child Welfare Sub-Committee. If the registration be approved, the foster mother is served in person with a notice specifying the number of infants in respect of whom she is registered. 30 A certified copy of this notice signed by the Infant Life Protection Visitor as to the date of service is retained. On April 1st there were 23 foster mothers on the Register in charge of 32 infants. Up to the end of the year 4 new registrations were approved and 4 foster mothers either removed from the Borough or ceased to have charge of infants. Registration was cancelled in respect of one foster mother on account of overcrowding, but subsequently she was re-registered when the overcrowding had been abated, and she had put her premises into a satisfactory condition. On December 31st there were 23 foster mothers on the Register in charge of 33 infants. It is the routine duty of an Infant Life Protection Visitor to visit every foster mother at least once a month, and more frequently when found necessary. From April 1st to the end of the year 355 visits were paid, and the extra work entailed has been most satisfactorily carried out by the Health Visitors. —INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections Written Notices. Occupiers prosecuted Factories—(including Factory Laundries) 31 — Nil Workshops—(includingWorkshop Laundries) Workplaces—(other than Outworkers' premises) Total 31 Nil 31 11—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 7 7 – – Want of Ventilation — — — – Overcrowding — — — — Want of drainage of floors — — – – Other nuisances — — — – Sanitary Accommodation Insufficient 3 l — Unsuitable or Defective 1 l – – Not separate for sexes — — — — Ofjences wider Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s. 101) Other Offences—(Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers)Order, 1921 5 5 – – Total 16 14 – – *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. 32 Report of the Chief Sanitary Inspector To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the honour to present to you my Twelfth Annual Report on the work carried out by your Sanitary Inspectors during the year 1930 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 7,312, as compared with 7,879 during the year 1929. On 636 premises sanitary defects to the number of 3,205 were discovered. Arising out of these defects, it was found necessary to serve 536 "preliminary" and 26 "verbal" notices. In 55 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 683 fresh entries were added to the Register of Sanitary Defects, this being an increase of 154 compared with the previous year. In 657 cases entries were cancelled following completion of necessary works. On December 31st, 1930, 335 separate entries remained under review compared with 310 at the end of 1929. Despite the increase of 154 in the number of entries in the register during 1930 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 only 25 above the corresponding figure for the previous year. In order to keep down the number of outstanding entries of premises under review to the lowest possible figure, frequent re-inspections are made, but no entry is crossed off until the notices have been complied with. 33 The standard of work of sanitary inspection in the Borough has, 1 believe, been raised during the past decade from what was admittedly a very low standard to one which will bear comparison now with that of any other similar Borough. Whilst it is always desirable to strive for an ideal in one's work, yet occasionally one may be permitted to take a retrospect view and to derive encouragement for the future, from what small success one may have achieved in the past. Particularly is this the case in the work of sanitary inspection, the greater part of which is carried out necessarily without any publicity. By reason of the very nature of the slow, quiet progress in the work, it frequently happens that the public does not realise what has, and is being accomplished, whilst the officers engaged in the work may hesitate when faced with fresh difficulties, overlooking the fact that possibly other more numerous and greater difficulties have been overcome in the past. This is, therefore, an opportune time to recall that less than fifteen years ago there was no proper sanitary inspection of the district, and no adequate supervision over sanitary works in connection with dwelling houses. Drains were altered and repaired without any real control, and usually without even the Local Authority being aware of the works. There was no systematic inspection of foodstuffs or even of premises where food was prepared or stored. These are but few of the conditions which existed and which come to mind readily. There were others which need not be recalled. The record of work accomplished during the year 1930 will demonstrate, I hope, a very considerable change in these sanitary circumstances in the Borough. The year 1930 was not an easy one so far as the amount of work was concerned, neither was it free from difficulties, and so one may be forgiven for succumbing to the temptation to review the past in order to derive encouragement to advance still further. The additional inspectorial assistance which your Public Health Committee were considering at the end of 1929, became effective in October, 1930, when Mr. G. Cockell, a clerk in the Department, having qualified by examination, was appointed an additional Sanitary Inspector. This necessitated a change in clerical staff, and the benefit of the additional assistance was not felt before the end of the year. 34 A very considerable amount of time is devoted to interviews with property owners or their architects, agents or builders, either at the office or at the premises under review. It is safe to assert that in the majority of cases these interviews prove the means of clearing away difficulties or misunderstandings which may exist, and they certainly avoid the necessity for legal proceedings in some cases. During the year under review 328 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 5 Re-inspections after Order or Notice 1870 Visits to Works in Progress 949 Factories and Workshops 31 Cowsheds, Dairies and Milkshops 27 Ice Cream Premises 4 Foodshops and Food Preparing Rooms 401 Infectious Disease Enquiries 330 Special Small Pox Enquiries 88 Markets 84 Special Inspections (Complaints, etc.) 1294 Slaughter-houses 1726 Offensive Trades 35 Sanitary Conveniences 119 Common Lodging-Houses 10 Canal Boats 6 Theatres, Cinemas, etc. 14 House to house 28 Bakehouses 22 Smoke Observations 9 Stables and Yards 9 Enquiries re Housing Applicants 14 Well Water Enquiries 52 Miscellaneous Visits 185 Total 7,312 35 SUMMARY OF SANITARY IMPROVEMENTS. When one observes the large amount of sanitary work carried out in connection with premises in the Borough it will be realised that the cost involved must be a very considerable sum per annum. The lists given refer only to works which arise from inspections and form only part of the total repair works to dwelling houses. Owners of property are, therefore, helping very considerably to relieve unemployment, not only in the building trades directly, but also in the manufacture of building materials. A point often lost sight of is that most of the works which are carried out after service of notices are supervised by your Council without cost to the owners of the property concerned. This is of very considerable assistance to owners and not only ensures that the work is properly done but often enables economies to be effected without reducing efficiency. 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 33 Number of Drains repaired or amended 3 Drains or Gullies unstopped or cleansed 29 New Manholes provided 47 Existing Manholes altered or repaired 2 Intercepting Traps fixed 19 Fresh-air Inlet Shafts repaired or renewed 24 New Gully Traps fixed 114 Gully Curbs renewed or repaired 8 New Gratings provided to gullies 3 New Soil Pipes or Ventilating Shafts 12 New Ventilating Shafts 27 Ventilating Shaft repaired 1 Smoke Tests applied 26 Water Tests applied 138 36 WATER CLOSETS AND SANITARY FITTINGS. New W.C. Basins fixed 63 W.C.s unstopped, cleansed or repaired 4 W.C. Flushing Tanks repaired or renewed 42 New W.C. Apartments provided 3 W.C. Apartments lighted, repaired or ventilated 33 W.C. Apartments cleansed and limewashed 59 New Impervious Sinks provided 45 New Trapped Waste Pipes fixed 47 Existing Waste Pipes trapped or repaired 6 Urinals cleansed or repaired 12 New Public House Urinals constructed 7 New Seats provided to W.C. 4 New Bath fixed 1 Miscellaneous 4 MISCELLANEOUS. Roofs renewed 3 Roofs repaired 78 Eaves Gutters renewed or repaired 64 Stack Pipes renewed or repaired 60 Stack Pipes disconnected from drains 47 Dampness abated 77 Defective Walls repaired, re-pointed or rebuilt 133 Walls strengthened by insertion of tie-rods 3 Chimney Stacks rendered or repaired 17 Ventilation provided beneath floors 24 Ventilation provided to rooms 11 Staircases lighted or stairs repaired 8 Handrails to staircases provided or refixed 17 Sites of houses concreted 2 Yards paved 82 Yard Paving repaired and yards cleansed 16 Paved Pathways constructed 26 Paving of Passageways repaired 1 Forecourts paved or repaired 7 Floors of Rooms repaired 49 New Floors of rooms 18 Rooms repaired, cleansed and distempered 364 Larders ventilated and cleansed 6 New Ceilings 20 Skylight reglazed 1 Workrooms cleansed 4 37 Premises limewashed 12 Windows repaired, renewed or made to open 135 New Windows provided 3 Door and Window Sills renewed or repaired 88 Doors renewed or repaired 14 New Portable Ashbins provided 299 Accumulations of manure and refuse removed 6 Manure Receptacles constructed 1 Nuisance from overcrowding abated 4 Water Supply provided direct from rising main 33 Service Water Cisterns removed 7 Service Water Cisterns repaired, cleansed or covered 3 Water Supply reinstated 31 Use of Well-Water discontinued and M.W.B. supply laid on 15 Stoves and Firegrates repaired or renewed 60 Coppers repaired or renewed 23 Flue provided to geyser 1 New Geyser fitted 1 Nuisance from smoke abated 6 Dilapidated Sheds demolished 2 Boundary Fences repaired or renewed 5 New Chimney Pots 6 Illegal use of basement rooms discontinued 8 Nuisance from animals abated 3 Nuisance from fish frying abated 1 New Door Locks 3 Passageway cleansed 1 Premises discontinued being improperly used for sleeping purposes 1 Verminous Premises cleansed 1 Houses repainted externally 8 Miscellaneous 18 SMOKE ABATEMENT. The number of complaints received during' 1930 in respect of alleged nuisance from smoke was five. Nine formal observations were made and in several instances excessive amounts of smoke were recorded. It is evident that the campaign, which is being waged against the pollution of the atmosphere by industrial smoke, is having some effect. In a few instances works managers have sought advice as to the best practicable means to 38 reduce the production and emission of smoke, and in these cases useful results have accrued. An arrangement has been made whereby, in the event of breakdown occurring at works in the borough, with consequent unavoidable emission of smoke from the chimneys—the fact may be telephoned to the Sanitary Inspector in order to avoid unnecessary observations being taken and consequent service of notices. This arrangement has proved useful and is appreciated by those in charge of furnaces and steam-raising plant. COMMON LODGING HOUSES. There are only two registered common lodging houses in the Borough, but there is one other building at least, 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. Generally speaking, there is an improvement in the condition of the registered lodging houses. That there is definite need for this class of accommodation in the Borough is proved by the fact that these premises seldom have vacant beds. The available accommodation is as follows:— Vicarage Road (Othen's)—50 beds for men only. Canbury Passage (Marsh's)—35 beds for men only. There is no accommodation for married couples or for children, but so far as I am aware the need for this class of accommodation has not arisen in the Borough. Many of the lodgers in the two registered houses are regular lodgers, and a few of them have resided in one or the other premises for several years. During 1930, 10 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. 39 The rag and bone yards give considerable trouble owing to their proximity to dwelling houses. The most frequent cause for complaint is the smells which arise from bones and fat awaiting removal. As may be understood, these complaints are most frequent during hot weather, but the year 1930 produced no complaints from that point of view. It is a matter for regret that the local authority cannot prohibit the continuance of the rag and bone yards in the midst of dwelling houses, for not only are they untidy and unsightly in the extreme, but they provide a home for rats, from which it is most difficult to eject the vermin. Thirty-five visits were made to premises in connection with offensive trades, in addition to reinspections after notices or warnings. One new fried fish shop was licensed during the year. A further application for a licence was refused, chiefly on the ground that adequate provision for the supply of this popular commodity already existed in the neighbourhood of the proposed new premises. Legal proceedings to enforce compliance with notices served were necessary in one case only during 1930. In this case the defendant, the occupier of a rag and bone yard, was summoned for failing to comply with the Byelaws relating to Rag and Bone Yards and for improperly allowing the premises to be used for sleeping and living purposes. The Court made an Order for the notices to be obeyed and fined the Defendant and costs. COMPLAINTS. One hundred and sixty-seven complaints were received during the year as follows:— Drains and sanitary arrangements 34 Overcrowding 6 Insanitary Condition of Premises 61 Absence of ashbins 8 Accumulation of manure and non-collection of house refuse 2 Condition of roadway 4 Flooding of basement 1 Unsafe Wall of house 1 40 Defective hot-water pipes 1 Yard improperly used for sleeping purposes 1 Dariipness and defective'roofs, gutters, etc. 28 Keeping of animals and fowls 3 Smoke nuisance from chimneys 5 Defective stoves and coppers 5 Defective gas appliances 1 Unpaved yards and passages 4 Miscellaneous 2 167 The complaints were investigated as early as possible, and where the Corporation possessed powers to intervene, immediate steps were taken to remove the cause of the complaint. The number of complaints during 1929 was 229, but this was an unusually high number, and was due to special circumstances. HOUSING. The statistical statement, etc., relating to Housing will be found in the report of the Medical Officer of Health. 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 280 new portable ash receptacles were provided as the result of notices served. It is the exception nowadays to find sundry old receptacles in use as ashbins, whereas a few years ago one could see ranks of old boxes, tubs and baths placed in front of houses awaiting the arrival of the dust cart. This marked improvement in the type of ash receptacles is due primarily to the wholesale inspections of whole streets and areas 41 which have been carried out during the past few years. Secondly, it is due to the greatly reduced price of galvanised iron goods. An ashbin which would have cost well over soon after the war can now be purchased for about 8s., and owners are naturally more ready to provide proper receptacles at such a reasonable cost. There are no ashpits in connection with dwelling-houses in the Borough, but every house is provided with some form of movable ash receptacle. Where more than one family reside in a house, additional receptacles are required to be provided. The collection of refuse is carried out under the supervision of the Borough Surveyor, and is weekly in the greater part of the district but twice weekly in the remainder. The refuse is part burned and part tipped. HOUSE DRAINAGE. Thirty-three houses were re-drained during the year, as compared with 38 during 1929. 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:— Bloomfield Road 1 Brook Street 1 Cambridge Grove Road 5 Cromwell Road 2 Elm Road 1 Elton Road 4 Glenthorne Road 3 Grange Road 1 Kingston Hill 1 Market Place 1 Portland Road 4 Portman Road 2 Richmond Road 2 Shortlands Road 1 Somerset Road 2 Willoughby Road 1 Wolverton Avenue 1 42 For years it was the practice to prepare a plan of each house retrained, and these plans have proved very useful for reference subsequently. Unfortunately this useful form of record had to be discontinued for a long period owing to insufficiency of staff, but it has now been recommenced, and I hope it will not be suspended again. 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. Where several owners are interested in the reconstruction of combined drains assistance has been rendered frequently by the preparation of plans and specifications for submission to contractors. This assistance by your Council is very much appreciated by the owners of property, and inasmuch that it is an act of grace entirely, it usually leads to a speedy and amicable settlement of any points of difference between the owners themselves or between the owners and your Council. Although it throws additional work on the department, in the end it usually saves time and trouble, by avoiding the necessity for your Council carrying out the works in default of the owners, and recovering the costs incurred thereby. INCREASE OF RENT AND MORTGAGE INTEREST ACTS. Five applications were received during the year from tenants for certificates under Section 2, Sub-section 2, of the above Act, as compared with 7 during 1929. 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 2 cases it was necessary to issue formal certificates to the tenants giving details of the works which should be carried out to put each of the dwelling houses into a reasonable state of repair within the meaning of the Act. 43 INSPECTION AND SUPERVISION OF FOOD. (a)—MILK SUPPLY. During 1930 4 persons were removed from the register of Dairies owing to business changes. Five dairymen were added to the register making a total of 41 on December 31st, 1930, compared with 40 for the corresponding date in the previous year. There is only one cowkeeper in the Borough. No licences have been issued to producers in the Borough in respect of Graded milk, but the following licences have been issued to dairymen:— Dealer's Licence to bottle and sell Grade A (Tuberculin Tested) Milk 1 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 (Trade A Milk 1 Supplementary licence to sell Grade A (Tuberculin Tested) Miik 1 Supplementary Licence to sell Pasteurised Milk 1 Licence to sell Pasteurised Milk 4 Total 13 By far the greater part of the milk sold in the Borough is contained in bottles, but a few retailers continue to send out milk in churns and hand cans for delivery on the second round. It is hardly necessary to say that the use of cans, etc., in the street is undesirable and is discouraged whenever opportunity occurs. There is a fair sale for sterilised milk and, of course, a marked proportion of the total milk sold in the Borough is pasteurised, but it is doubtful whether the average housewife knows exactly what class of milk she is buying. Certainly there is very much confusion in the public mind as to which of the several grades of milk is the best and safest, and this doubt is probably due to the official recognition given to various designations under which certain milk may be sold. It might easily be thought that "Grade A" milk would be the highest grade, but it is not, and I am of opinion that this fact should be made perfectly clear 44 when such milk is sold. "Certified" milk is the highest grade, but "Grade A" (Tuberculin Tested) milk is likely to be much safer than "Grade A," and is considerably less in price than " Certified." In the case of Certified and Grade A (T.T.) milks, the herds are subjected to the Tubercuhn test periodically, but tne standard of the milks is judged mainly by the number ot bacteria per cubic centimeter ot milk, this method certainly shows whether or not the milk is clean, but it does not distinguish between the bacteria which actually cause disease and those which do not. Whilst one feels bound to advocate the purchase of designated milks rather than ordinary milk (at least for children), yet there is no guarantee that any 01 the special designated milks will actually be free from tuoercle or other ot the pathogenic or diseasecausing bacteria, any more than ordinary milk is. Apart from this latter point, the undoubted confusion in the public mind would appear to justify the amendment of the Milk Orders so that the value of each class of milk may be more easily understood and recognised. The retailing of milk is receiving very careful consideration by those engaged in the business, and there is little doubt that further progress will be made. Owing to the high cost of bottles, the frequent breakages, and the lack of care bestowed on them by many people (some of whom never rinse the milk bottles out, but who leave them for several days before returning them, still dirty, to the dairy), one may expect to see further progress in the direction of non-returnable receptacles. Until this ideal is reached, however, an improved design in the bottles would be welcome so that the pasteboard disc and the ledge on which it rests inside the neck of the bottle could be eliminated. (b)—MEAT AND OTHER FOODS. There was a slight increase in the number of animals slaughtered in the Borough last year compared with the year 1929. The increase was very small (117) and tends to prove that the opinion expressed in my last report, namely, that the peak has been reached is a correct one. The following figures show the total number of animals killed 45 in the private slaughter-houses during the past five years:— 1926 7,636 1927 8,350 1928 11,093 1929 11,704 1930 11,821 The Meat Regulations, 1924, provide, inter alia, that notice of every intended slaughter shall be given to the Meat Inspector, and the carcases and organs must be left for a period of at least three hours after slaughter so as to allow time for inspection. In cases where regular hours of slaughter occur, a permanent notice may be given, and the carcases and organs may be removed immediately after slaughter. In connection with one slaughter-house a permanent notice of slaughter exists for Mondays, Tuesdays and Wednesdays, and in connection with another slaughter-house a similar notice is in force for Thursdays. In these cases several visits a day are necessary in order that carcases and organs may be inspected before removal. The general effect of the Regulations (apart from cases of regular slaughtering hours) is that the carcases of any animals slaughtered after 4 p.m. may not be removed from the slaughter-house without permission before 7 a.m. the next morning, but there is no power vested in the Local Authority to control the hours of slaughter. The busiest period of the year is from October to March, and at the height of the season it is quite a common experience to find that slaughtering continues until very late at night and also on Saturdays and Sundays. Despite the late hours and even the bad weather conditions, practically every animal was inspected last year. The exceptions were due to very dense fogs which occurred and which effectually prevented visits to the slaughter-houses before the carcases were removed. 99.6 per cent, of the animals were inspected. Early in the year under review, a dealer who used to slaughter a large number of animals in the town removed to a district in Middlesex. There is little doubt that this particular individual found the standard of inspection in Kingston somewhat irksome to him, and it is a reasonable presumpion that he moved away in the hope that he would not receive so many calls from the Sanitary Inspector in the new district. How far his hopes were gratified it is impossible to say, and although his removal saved many a 46 late evening call at his particular slaughter-house, yet it created work in another direction by the special need for inspection of any meat he brought into the town. I am glad to be able to say that, since the removal of this particular dealer, the work of meat inspection in the slaughterhouses has been rendered far more pleasant so far as relations with the trade are concerned. It is only fair to say that the trade as a whole do not wish to be associated with t,he type of dealer 1 have referred to, and his removal was not regretted by anyone. Had this removal not occurred, the number of animals killed last year would have been very much higher. 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, sausagemaking rooms, ice-cream premises, etc., etc., are visited. The total visits to premises having relation to the food supply during 1930 was 2,337. 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. 47 MEAT REGULATIONS, 1924. Summary for year ended December 31st, 1930. 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 Calves 948 89 6072 2523 3131 6 11,821 20 14 13 4 Inspections during Office Hours. Percentage of Total. Inspections made after Office Hours. Percentage of Total. 228 23.01 763 76.99 48 The following tabulated list shows the various amounts of foodstuffs condemned during the year. Where the action taken is stated to be "inspected and condemned" the inspection was made at the slaughterhouse at the time of slaughter. In the other cases a request for inspection was made by the owner. Articles of Food. Reason for Condemnation Action taken PORK— 20 Carcases and offal Tuberculosis Inspected & Condemned 1 Carcase and offal Swine Fever ,, ,, ,, 1 Carcase and offal Pneumonia ,, ,, ,, 1 Carcase and offal Jaundice ,, ,, ,, 98 Heads and Necks Tuberculosis ,, ,, ,, 1½ Heads and Necks Abscess ,, ,, ,, 51 Plucks Tuberculosis ,, ,, ,, 1 Pluck Abscess ,, ,, ,, 1 Liver Tuberculosis ,, ,, ,, 1 Livers Cirrhosis ,, ,, ,, 2 Livers Fatty Infiltration ,, ,, ,, 1 Liver Necrosis ,, ,, ,, 1 Liver Pleurisy ,, ,, ,, II pairs Lungs Tuberculosis ,, ,, ,, 6 ,, ,, Congestion ,, ,, ,, 1 ,, ,, Pleurisy ,, ,, ,, 13 Mesenteries Tuberculosis ,, ,, ,, 6 Spleens 11 „ ,, ,, ,, 1 Kidney ,, ,, ,, ,, ,, 2 Loins ,, „ ,, ,, ,, 1 Loin Abscess ,, ,, ,, 1 Pore Quarter Bruised ,, ,, ,, BEEF— 11 Ox Heads & Tongues Tuberculosis ,, ,, ,, 1 Ox Head and Tongue Actinomycosis ,, ,, ,, 20 pairs Lungs Tuberculosis ,, ,, ,, 1 Pair Lungs Congestion ,, ,, ,, S Mesenteries Tuberculosis ,, ,, ,, 1 Udder Tuberculosis ,, ,, ,, 1 Udder Mastitis ,, ,, ,, 6 Livers Tuberculosis ,, ,, ,, 9 Livers Distomatosis ,, ,, ,, 3 Livers Cvsts ,, ,, ,, 1 Spleen Bruised ,, ,, ,, 1 11 Tuberculosis ,, ,, ,, 6 Skirts Inflammation ,, ,, ,, 2 Plucks Tuberculosis ,, ,, ,, 1 Top Piece (Hindqtr) Inflammation ,, ,, ,, 41 lbs. Ox Kidney Putrefaction Voluntarily surrendered 43 lbs Liver ,, ,, ,, ,, ,, ,, 1401 lbs. Beef ,, ,, ,, ,, ,, ,, 31 lbs of Fat ,, ,, ,, ,, ,, ,, 49 VEAL— 4 Carcases and offal Tuberculosis Inspected and Condemned 1 Carcase and offal Bruised „ „ 1 Carcase and offal Slaughtered in Comatose Condition ,, „ „ 8 Plucks Tuberculosis „ „ ,, 1 Liver „ „ „ „ 1 Liver Abscess „ „ „ 1 Fore Quarter Inflammation „ „ ,, 2 Fore Quarters Fevered „ „ „ 10 lbs of Veal Putrefaction Voluntarily Surrendered MUTTON— 1 Carcase and offal Inflammation Inspected and Condemned 2 Carcases and offal Csyticercus „ „ „ Tenuicollis „ „ „ 2 Plucks Inflammation „ „ „ 2 Livers Distomatosis „ „ „ 38 lbs Liver Putrefraction Voluntarily Surrendered 24 lbs. Mutton ,, „ „ „ FISH— 6 Boxes Dog Fish „ „ „ „ ,, 1 Box Smoked Haddocks „ „ „ „ „ 10½ lbs of Halibut „ 9¼ lbs Prawns „ „ „ „ ,, 24 lbs Herrings „ „ „ „ „ 8 lbs Codling ,, „ „ „ „ POULTRY— 84 Chickens „ „ „ „ „ RABBITS— 161 Rabbits „ „ „ „ „ FRUIT— 2½ lbs Currants „ „ „ „ „ PRIVATE SLAUGHTERHOUSES. There are five private slaughterhouses in the Borough, all of which have been in use during 1930. They are situated as follows:— Adjoining No. 76, Cambridge Road. No. 45, Cambridge Grove Road. No. 120, London Road. No. 90, Acre Road. Rear of No. 34, Richmond Road. 50 The old registered slaughterhouse situate in Bath Passage was purchased by the Corporation and is not now in use. This change did not affect the work of inspection much, as for some considerable time previously, killing took place only at intervals of several months, and only then in order to retain the registration of the premises as a slaughterhouse. One thousand seven hundred and twenty-six visits were paid to these premises during the year, as compared with 1,891 during 1929. There is no alteration in the structure of the slaughterhouses to report. As I have reported in past years, the buildings are old, and they are kept in as good condition as possible, having regard to their age and type. The occupiers are willing, usually, to comply with reasonable requirements and to observe the Bylaws. The Bylaw dealing with the humane slaughter of animals has now been in operation long enough to show any weakness, and I am glad to be able to say that it has proved quite workable. All kinds of animals are stunned by a mechanical instrument before slaughter, and although there have been upwards of 12,000 animals dealt with per annum recently, I know of no case where the carcase has been damaged or harmed by the use of the gun. The only complaint I have received was from one slaughterman. He complained that the gun was not reliable, but investigation proved that the trouble he had experienced was due entirely to lack of care in the treatment of the instrument and total disregard of the instructions issued by the makers. IMPROPER FIXING OF GAS APPLIANCES. During the past few years several instances of improper fixing of gas appliances have been noted, and in some cases every effort to induce the owner of the house to remedy the defective condition has failed. The defect referred to generally is the fixing of a geyser (of a type in which complete combustion of gas does not take place) without a sufficient flue to the open air. In such cases the use of the gas appliance may be highly dangerous, owing to the production of carbon monoxide, a gas which has no odour and, 51 fore, cannot be readily detected. There are other gas appliances which do not permit complete combustion of the gas, but these fittings are usually fixed in rooms where some means of permanent ventilation exists and the evil results are reduced accordingly. In the case of bathrooms it is quite a usual practice for the window to be closed during use, and if no sufficient flue is provided to a geyser, the effect on an occupant of the room may be very dangerous and it has been known to prove fatal. The position with regard to new buildings is satisfactory, as a new Byelaw has been passed which prohibits these improper practices. With regard to existing buildings, however, the position is extremely unsatisfactory, and it does not appear that the absence of a proper flue can be dealt with under present legislation. WELL WATER SUPPLIES. There are still several premises in the Borough which derive their water supply from shallow wells. The action taken in regard to these premises over a number of years has been very satisfactory in effect, and it is unlikely that any further marked reduction in the number of premises which rely upon wells for their domestic water supply will take place. The reason for this opinion is two-fold. First, all the known polluted wells have been closed already. Secondly, where wells remain, it is generally the desire of the occupiers of the houses that the wells should not be closed. It is very seldom indeed that any request for closure of a well is made by the occupier. On the contrary, I am usually met with the hope expressed by the housewife, " You are not going to condemn this water? It is a beautiful water and so cool in Summer." Sometimes an opinion as to purity has been added, but quite often the analysis has shown such water to be badly polluted. No seriously polluted sample was found amongst the four samples submitted to the Corporation Analyst, Mr. P. G. Lloyd. 52 The results of the chemical analysis of the samples are given below, expressed in parts per 100,000:— Sample Chlorine Free Ammonia Albuminoid Ammonia Nitrites Poisonous Metals Remarks 1 6.0 .002 .003 nil nil A useable drinking water, but chlorine figure indicates a polluted source of supply 2 4.45 .001 .006 nil nil -do.- 3 6.8 .002 .002 nil nil - do.- 4 3.5 .018 .006 nil nil A suspicious sample of water as indicated by the Free Ammonia content In the case of sample No. 2, the well supplied four cottages in London Road and the owner decided to discontinue the use of the well water and to substitute a supply from the M.W.B. mains. Sample No. 4 was taken from a well beneath a lock-up shop where the water was used solely for washing of fish. In this case, your Council decided to take no further action, having regard to the limited use of the water and also to the fact that the unexpired term of the lease on the premises was a very short one. Apart from the result of direct action by sampling and analysis of well water, there were other premises where use of well water was discontinued during 1930, the total for the year being 15 premises:— Albert Road 1 Alfred Road 3 Burton Road 2 Canbury Park Road 1 Clarence Street 2 East Road 1 Fairfield Road 1 Kings Road 2 Mill Street 1 Richmond Park Road 1 15 53 The following summary is interesting :— November, 1919—271 premises in the Borough known to be supplied by well water. January, 1928—82 premises still so supplied. December, 1929—67 premises still so supplied. December, 1930—52 premises still so supplied. Since the first survey was made in 1919, other premises have been added to the records, and so the total number of premises where the wells have been abolished is more than 219, which is the actual difference between 271 and 52. This result may be considered satisfactory. DISINFECTION AND INFECTIOUS DISEASE. The amount of work in connection with disinfection was slightly less in 1930, compared with 1929. There were 201 rooms in 174 houses sprayed and fumigated with formalin; 1,430 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. Thirty-one visits were made to Factories and Workshops, etc., compared with 20 during 1929. Other details with respect to these premises are contained in the tables on pages 30 and 31. There are seven "Outworkers" known to be resident in the Borough, and the premises so used are inspected periodically. 54 A new Register of Factories and Workshops was prepared during the year on the card index system. It is surprising, when one looks through this register, how many such places exist in the town. Kingston is becoming more a town of industry than the mere dormitory for London which it was supposed to be. The chief increase is in small workshops and workplaces, and now that the register is complete, more frequent visits will be made to these premises. 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. 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. Fourteen 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 Managements, and it was necessary to report to your Council on the condition of one of the premises in the Borough. Remedial works were put in hand in this case, but the progress was very slow indeed and the work was not completed by the end of the year. In all other instances the managements have co-operated and shown their desire to keep their premises up to a good standard. CANAL BOATS ACTS, 1877 TO 1884. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to report as follows:— During the year 1930, six visits were made in connection with the Canal Boats Acts. Although more boats 55 appear to be using the wharves at Kingston, very few of them are used for sleeping and living purposes, or are subject to inspection under the Canal Boats Acts. 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. New sanitary conveniences were constructed in connection with the following premises :— "Two Brewers" P.H.—Wood Street. "Albert" Hotel—Kingston Hill. "Three Fishes" P.H.—Richmond Road. "Swan" P.H.—Mill Street. "Dolphin" P.H.—Clarence Street. "Railway" Hotel—Coombe Road. RAG FLOCK ACTS, 1911 AND 1928. There are at least two, and probably several more, premises on which Rag Flock is used in the making of upholstery, cushions and bedding, but no opportunity occurred during 1930 for the taking of samples. This is a branch of the work which will be given more attention in the near future. PUBLIC ELEMENTARY SCHOOLS. ST. PAUL'S SCHOOL, BOROUGH ROAD. The Managers of St. Paul's School decided to make an improvement in the sanitary accommodation of the school by re-arranging the lay-out of the buildings, providing additional modern ranitary fittings a d replacing all old fittings. 56 This work involved certain new drainage, and an investigation showed that practically the whole of the existing drainage system was defective. The proposed works could not be carried out whilst the school was in use, and it was arranged, therefore, to be completed as far as possible during the Christmas vacation. Despite very adverse weather conditions, the contractors made good progress, but the works were not completed by the end of the year and no details are included in the present Report. It is anticipated that further works will be carried out during the Summer vacation of 1931. 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. June, 1931. 57 Report of the School Medical Officer. March, 1931. 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 1930. The average number of children on the school register for the year was 4,057. Medical Inspection was carried out on the same lines as before, and no objection to medical examination of a child was received from any parent. Five half-days a week were devoted to Dental work, affording treatment of children up to the age of twelve. The Scheme for Orthopaedic 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. The Eye Clinic met on Wednesday afternoons during the School terms, 21 meetings in all being necessary during the year. The Scheme for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital worked satisfactorily, 36 children receiving treatment under the Scheme. The work of the Inspection and Minor Ailments Clinic continues to increase, there having been 7,448 attendances during the year. In June a Scheme to complete the School Medical Service was presented. The Scheme entailed three additional Dental Sessions a week in order that the whole School population might come under dental inspection and 58 treatment, the appointment of an Anaesthetist and Dental Attendant, and also arrangements for the X-ray treatment of ringworm. An anaesthetist was appointed, and arrangements for the X-ray treatment of ringworm were made, but the extension of Dental work was deferred for further consideration until the Grange Road Building was completed, since no additional sessions could be held at the premises now temporarily occupied by the Clinic. The disposal of those feeble-minded children who are unfit to attend an ordinary Elementary School, but considered fit to attend a Special Day School for MentallyDefective Children, is a very difficult problem. I thank all members of the Staff of the School Medical Service for their co-operation and loyal support at all times. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, School Medical Officer. 59 Staff of the School Medical Service on 31st DECEMBER, 1930. 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.). Ancesthetist : OLIVE G. AUBREY, b.a., m.d., b.ch. School Nurses : Miss A. GILL (Senior) 1/2 time. Miss C. A. HOOK WAY 1/2 time. Miss L. G. SALWAY 1/2 time. Miss A. G. GUMBLETON 1/2 time. Clerk : Miss P. M. INGILLSON. Dr. Olive G. Aubrey was appointed Anaesthetist to the Dental Clinic and commenced her duties at the beginning of September. Miss A. Gill took over the duties of Senior Nurse on January 1st, and Miss D. Rucklidge reported for duty on the same day. Miss Rucklidge was appointed on probation for three months, and left the service on March 31st. 60 Some difficulty was experienced in filling the vacancy, with the result that the staff was short of one half-time School Nurse for a period of two months. Miss A. G. Gumbleton was then appointed, and took up her duties on June 2nd. CO-ORDINATION. The School Medical Officer being also Medical Officer of Health, and the Nurses' duties being arranged so that each Nurse gains experience in all branches of both School and Maternity and Child Welfare Work, secures that the Staff looks after infants both before and after they reach school age, and makes for efficient working between the various ramifications of the Public Health Services. Medical Record Cards of those infants who have attended the Maternity and Child Welfare Centres are transferred to the School Medical Service as soon as these infants attain the age of five. Close touch is kept between the School Attendance Officers and the School Medical Department. The office and Clinic are temporarily housed at the Domestic Subjects Centre in Bonner Hill Road, but they will be transferred to the new building now in the course of erection in Grange Road on its completion in the Spring of 1931. SCHOOL HYGIENE. Richmond Road Infants' School. A portion of land was purchased for the purpose of enlarging the playground. Richmond Road and Bonner Hill Road Schools. The above Schools have been redecorated internally. 61 St. Peter's School. This School has been decorated both internally and externally. New floors have been laid down and new gas fittings installed. St. Agatha's and St. John's Schools. Electric light has been installed in the above Schools. St. Luke's School. New gas fittings of an improved type have been fixed. MEDICAL INSPECTION. All Departments of every School are visited by the School Medical Officer each term for the purpose of carrying out:— 1. Routine Inspections of (a) Entrants, as soon as possible after entry. (b) Intermediates, age 8. (c) Leavers, age 12 and over. A Medical Card is made out for all Entrants, and any children in the other age groups not already possessing one, and on these cards the results of Medical Inspection are entered. In addition to the Medical Card a " Following-up " Card is made out for each child found to be suffering from any defect, and a letter is handed or sent to the parent advising consultation with their own doctor with regard to the defect. In Orthopaedic cases the children are referred to the Specialist attending the Red Cross Post for his advice and treatment. In cases of visual defect, an Ophthalmic Card is completed, and the parent is informed that the child will be warned as soon as possible to attend the Clinic for the purpose of being examined by the Oculist. 62 In cases requiring- to be kept under observation, but in need of no immediate active treatment, a " Followingup " Card is also made out. The Health Report on the Juvenile Employment Card is filled in by the School Medical Officer for each child of the Leaver Group. 2. Re-Inspections. Systematic re-inspections are made each term at the School by the School Medical Officer of all children for whom " Following-up '' cards have been made out at previous Routine or other Inspections, and the results of treatment are ascertained and entered on the card. When it is found that no advice has been sought or treatment obtained, a second notice is issued to the parents again calling their attention to the defect, and recommending them to seek advice forthwith. Further failure in procuring treatment is dealt with by home visits by the School Nurses. All cases referred for urgent treatment are kept under observation by the School Nurses under the direction of the School Medical Officer, who may re-inspect the children at any time. 3. Special Inspections. Children are brought before the School Medical Officer at the Schools by the Teachers for his opinion and advice. In keeping Medical Records, the dossier system is employed, in which all cards relating to an individual child are filed in one covering envelope. Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows:— No. of children Examined. No. of parents Present. Percentage. Entrants : Boys, 253 198 78 Girls, 193 161 84 Intermediates : Boys, 269 183 70 Girls, 274 189 70 Leavers : Boys, 133 55 41 Girls, 148 93 63 In no instance did any parent object to Medical Examination of a child. 63 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. 1926 17,585 944 8 1927 19,012 874 4 1928 18,638 652 5 1929 16,325 648 2 1930 15,336 641 3 It was observed that still more parents are allowing their girls' hair to grow long, and it is feared that should this become general, we may revert to the state of uncleanliness which existed before the advent of the shingled head. (b) Tonsils and Adenoids. There were 58 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. There were 19 cases of ringworm of the scalp referred for treatment during the year. (e) Vision. During the year 62 children were found requiring treatment for defective vision, and 21 for squint. (f) Dental Defects. At his inspection the School Dentist found 2,030 children needing treatment, 64 MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily at the Clinic during School Terms, 7,448 attendances being registered during the year. This is the highest figure ever recorded. (b) Tonsils and Adenoids. The Scheme for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital has worked satisfactorily. Thirty-six cases were treated under this Scheme during the year at a cost of £51 6s., towards which the parents contributed £15 5s. 6d. (c) Skin Diseases. The treatment of impetigo, ringworm and other skin diseases has been undertaken at the Minor Ailments Clinic. In September arrangements were made for the treatment of ringworm of the scalp by X-rays. Cases are referred by the School Medical Officer to Dr. N. H. Linzee, of St. Mark's Hill, Surbiton, who undertakes the X-ray treatment at the rate of £2 2s. per case. Under the Scheme parents are expected to contribute towards the cost according to their means. Two such cases were referred to him before the end of the year, but one eventually refused treatment, and the other preferred to go to a London Hospital. (d) Vision. Cases of defective vision are referred by the School Medical Officer to the Oculist, who has prescribed spectacles for 111 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 20 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (f) Dental Defects. Of the 2,030 children requiring treatment found by the School Dentist, 836 were actually treated, 647 being rendered dentally fit before the end of the year, 65 Remarks by the School Dentist are given under the paragraph on the Dental Clinic. (g) Crippling Defects and Orthopœdics. During the year 24 individual children received electrical massage and other forms of treatment at the Red Cross Curative Post, Norbiton, making 718 total attendances. The cost of the above out-patient treatment amounted to £74 2s., towards which the parents contributed £14 9s. 2d. Four children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment at a total cost of £38 8s. 10d., the parents only being able to contribute 2s. towards this expenditure. INFECTIOUS DISEASE. There was no School Closure during the year for infectious disease. There were outbreaks of measles at Richmond Road Infants' School in February and March, and at Bonner Hill Road Infants' School in April. Apart from these outbreaks there has been little infectious disease, and the number of absentees on its account has been low. A few cases of diphtheria occurred at Richmond Road Schools in the autumn, and the children were kept under daily supervision, with the result that two unsuspected bacteriological cases were discovered and isolated. On the whole, the Schools have enjoyed a year of comparative freedom from infectious disease. 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. 66 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. In other instances the School Nurse visits the home and interviews the parents in order to point out the necessity of treatment, and to advise and help them in the right way of getting this carried out. The work of the School Nurses may be briefly summarised as follows:— 1. To attend the Clinic daily at 9.15 a.m. to undertake the treatment of minor ailments. 2. To prepare beforehand for Routine Medical Inspections at the Schools by weighing, measuring, and applying rough vision tests. 3. To assist the School Medical Officer at Routine Medical Inspections and Re-inspections. 4. To assist the Dental Surgeon at his Inspections at the Schools and at his sessions at the Clinic. 5. To apply atropine ointment to children warned to attend the Clinic for refractions. 6. To assist the Ophthalmic Surgeon at the Clinic. 7. To follow-up by paying home visits. 8. To carry out cleanliness surveys at the Schools. 9. To re-examine those children found unclean after a short interval. 10. To bring obstinate cases of uncleanliness before the School Medical Officer. 11. The Senior School Nurse to supervise the work of the Clerk, and the keeping of all records and cards under the direction of the School Medical Officer. The following table specifies some of the work carried out by the School Nurses during 1930:— Number of children prepared for Routine Medical 67 Inspection 1,387 Number examined at Schools for uncleanliness 15,336 Number of following-up home visits 467 Total number of visits to the Schools 520 Total Number of Clinic Sessions 424 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 66.5. SPECIAL SCHOOL. The Special School for Physically Defective Children is now temporarily accommodated on the ground floor of the new building in Bonner Hill Road, erected as a Domestic Subjects Centre. A new building is under construction in Grange Road to accommodate delicate children to which the physicallydefective children will be transferred about April, 1931. There are 26 physically-defective children on the register, 3 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. 68 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. The School Clinic is accommodated temporarily on the first floor of the new building erected as a Domestic Subjects Centre in Bonner Hill Road. This was described in last year's Annual Report. The new building under construction in Grange Road will permanently house the Clinics, and it is anticipated that it will be ready for occupation about April, 1931. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days, when the School Nurses carry out the treatment of minor ailments under the direction of the School Medical Officer. No charge is made, but a box is provided for voluntary contributions. (c) Ophthalmic Clinic. Dr. Ivor Aubrey, the School Oculist, attends fortnightly on Wednesday afternoon during School terms, to deal with cases referred to him by the School Medical Officer. Those children who have errors of refraction attend the Clinic three times a day on the Monday and Tuesday preceding the meeting, and also on the same morning, for the purpose of having atropine ointment applied by the School Nurse. 69 There were 398 attendances at the 21 sessions held during the year, 183 being new cases and 215 re-inspections. Refractions numbered 120, and spectacles were prescribed in 111 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 five sessions per School Week were devoted to Dental Inspection and Treatment. In all, 30 half-days were given to Inspection and 181 to Treatment. There were 323 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 five sessions of 2½ hours per School Week, directed to children aged 5 to 12, also the children in the Physically Defective School and "Specials'' (i.e., children not eligible for Routine Treatment referred by the 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 decision to include all children in the Routine Groups for inspection and treatment, and not to exclude those who have previously and consistently refused treatment or ignored appointments, made a big increase in the number inspected, and as the majority of these children have had no previous dental attention, it increased the percentage requiring treatment. In those cases where consent to treatment was received this time, it was usually due to the result 70 of toothache principally in the permanent teeth. This resulted in an increase in the number of permanent teeth extracted—teeth that were saveable by conservative measures when treatment was first offered; further, more time is required to render the older children dentally fit when they have not received previous treatment. "As it is not possible to treat the number of children found to require treatment at least once a year in the time now given, 1 advise excluding- children from Routine Treatment whose parents have refused for two years. This will make the factor of work and time more stabilised, which is necessary to allow a quick follow-up for treatment for those referred at the Routine Dental Inspection, and enable children of conscientious parents to derive the maximum benefit from the scheme. "It is very satisfactory to note the improved condition of the mouths at the Routine Inspections. "The parents are losing the antagonistic attitude towards dental treatment, which seems to have been handed down for generations, and when they have witnessed the benefit derived from treatment, are quite willing, and often enthusiastic about re-treatment. "Since there will be no immediate increase in the number of sessions in January next, it is inadvisable to add another age group, so the programme for 1931 is to inspect and treat children born 1919 onwards, and all the 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 40 school children over 12 years of age were issued with certificates under the Bye-laws permitting their employment on milk and paper rounds. 71 SCHOOL BATHS. During the summer months 678 children from the Boys' and Girls' Departments of all the Schools attended the Corporation Baths during School hours for instruction in swimming. In addition, a number of pupils from Richmond Road Boys' School attended the Baths on Wednesdays, after school hours, at their own expense at the reduced price of 1½d. per visit. On request, special tickets are issued to children attending the Public Elementary Schools entitling them to admission to the Baths at l½d. during the 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, and in Hawks Road. 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, 72 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 is a special class at Bonner Hill Infants' School where instruction is based upon the Montessori system, and there are special classes for backward children in the Boys' and Girls' Departments of the same School. 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 20th all the girls were examined by the School Medical Officer. The party consisted of 28 girls, 7 of whom were taken for the holiday entirely free, 15 paid in full, and 6 in part. Similar excursions have been made every year since 1922, and I think Miss Thompson is to be congratulated upon her success. 73 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 446 Intermediates 543 Leavers 281 Total 1,270 Number of other Routine Inspections 117 B,—Other Inspections. Number of Special Inspections 1,632 Number of Re-Inspections 6,932 Total 8,564 TABLE II. A Return of Defects found by Medical Inspection in the Year ended 31st December, 1930. Defect or Disease Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring tobe kept under observation but not requiring Malnutrition — — — Uncleanliness— (See Table IV.GroupV.) 66 — 575 — Skin Ringworm, Scalp — — 19 — Body 2 — 49 — Scabies 1 — 11 — Impetigo 8 — 181 — Other diseases (non Tb) 13 1 229 10 Eye Blepharitis 2 — 7 — Conjunctivitis 1 — 10 — Keratitis — — — — Corneal Opacities 1 — — — Defect.vision exc.Squint 32 3 30 — Squint 12 1 9 — Other Conditions 5 — 25 — Ear Defective Hearing 3 1 8 1 Otitis Media 2 1 6 — Other Ear Diseases 4 — 27 — Nose and Throat Enlarged Tonsils only 18 6 27 — Adenoids only 1 — 1 — Enlarged Tonsils and Adenoids 2 1 9 Other Conditions 2 — 49 — Enlarged Cervical Glands (non Tb) 3 6 35 — Defective Speech 2 — 3 — Teeth—Dental Diseases 9 — 10 — (see Table IV., Group IV.) — Heart and Circulation Heart Disease—Organic 6 2 2 — Functional — 2 — — Anaemia 1 — — — Lungs Bronchitis 7 4 9 Other non Tb. Diseases 3 12 Tuberculosis Pulmonary—Definite — Suspected 1 3 2 Non- Pulmonary-Glands 1 — Spine — Hip 1 — 1 Other Bones & Joints 1 Skin — — — Other Forms — — 2 — Nervous System Epilepsy — — 1 — Chorea 1 — 2 — Other Conditions — 2 2 — Deformities Rickets 4 3 — — Spinal Curvature 2 9 2 — Other Forms 10 1 2 Other Defects and Diseases 18 15 271 1 TABLE II.—continued 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 446 56 13 Intermediates 543 53 10 Leavers 281 22 8 Total Code Groups 1270 131 10 Other Routine Inspections 117 17 13 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 1 — 1 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending 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 18 7 25 At other Institutions — — — At no School or Institution 1 — 1 Notified to the Local Control Authority during the year. Feebleminded — — — Imbeciles — — — Idiots — — — TABLE III.—Continued. — — — Boys. Girls. Total. Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics — — — In Institutions other than Certified Special Schools — — — Attending Public Elementary Schools — — — At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 2 2 4 At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At other Institutions — — — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 3 3 6 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 31 30 61 At other Institutions — — — At no School or Institution — — — Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions 2 — 2 At 110 School or Institution — 1 1 Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those wUh severe heart disease. At Certified Hospital Schools — — — At Certified Residential Cripple Schools — — — At Certified Day Cripple Schools 13 10 23 At Public Elementary Schools 10 8 18 At other Institutions — — — At no School or Institution — — — 77 TABLE IV. Return of Defhcts Treated during the Year ended 31st December, 1930. Treatment Table Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.) Disease or Defect, Number of Defects treated, or under treatment during the year Under the Authority's Scheme. Otherwise. Total Skin—Ringworm, Scalp 14 8 22 Ringworm, Body 39 10 49 Scabies 6 2 8 Impetigo 177 1 178 Other Skin Disease 190 5 195 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 24 7 31 Minor Ear Defects 20 7 27 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 131 4 135 Total 601 44 645 Group II.—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme, Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total Errors of refraction (ineluding Squint) 120 18 5 143 Other Defect or Disease of the Eyes (excluding those recorded in Group I. 5 2 7 Total 125 20 5 150 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 111 (b) Otherwise 10 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 106 (b) Otherwise . 10 Group III.—Treatment of Defects of Nose and Throat, Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital 36 By Private Practitioner or Hospital apart from the Authority's scheme. 37 Total 73 Received other forms of treatment 13 Total number treated 86 Group IV. Dental Defects (1) Number of Children who were:— (a) Inspected by the Dentist: Agee 5 6 7 3 9 10 11 12 13 14 204 306 372 380 410 537 387 205 — — Total 2801 Specials 25 Grand Total 2826 (b) Found to require treatment 2030 (c) Actually treated 836 (d) Re-treated during the year as the result of periodical examination 322 (2) Half-days devoted to:— Inspection 30 Treatment 181 Total 211 (8) Attendances made by children for treatment 2114 (4) Fillings :— Permanent teeth 1081 Temporary teeth 75 Total 1156 (5) Extractions: — Permanent teeth 265 Temporary teeth 2046 Total 2311 (6) Administrations of general anasstheticsfor extractions 323 (7) Other operations : — Permanent teeth 215 Temporary teeth 190 Total 405 79 Group V.—Uncleanliness and Verminous Conditions (i.) Average number of visits per school made during the year by the School Nurses 60 (ii.) Total number of examinations of children in the schools by School Nurses 15336 (iii.) Number of individual children found unclean 641 (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 — (6) Under School Attendance Bye-Laws 3