KIN 9 The Royal Borough of Kingston-upon-Thames Annual Reports FOR 1931 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 1931 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, 1931. 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, 1932. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1931. Circular 1206 (Ministry of Health) indicates the lines to be followed by the Annual Report of the Medical Officer of Health for 1*931, and draws attention to the necessity for revision of headings under which housing statistics have been given in recent years in view of the alterations made by the Housing Act, 1930. In May, the Public Health Department, previously housed in Clattern Lodge, High Street, and the Maternity and Child Welfare Centres previously held at the Y.M.C.A. Hall, Eden Street, and St. Peter's Hall, Washington Road, were transferred to the new building in Grange Road, which is described in the Report of the School Medical Officer. This Centralisation of Public Health, School Medical, and Maternity and Child Welfare Services under one roof has greatly facilitated administration, and has resulted in closer co-ordination of these services with increased efficiency and benefit to the Borough. The discontinuance of my motor-car allowance on April 1st has restricted my personal activities in the district since that date. It is fortunate that the year under review has been one of exceptional freedom from infectious diseases, measles having been completely absent, an immunity which is reflected in the very high percentage attendances in the Public Elementary Schools, 4 Maternity and Child Welfare work has been carried on as before, and the attendances at the Ante-natal Clinic show a substantial increase. The duties under the Children Act, 1908, which were transferred last year to the Corporation under the Local Government Act, 1929, have thrown considerable additional work on the Staff. No less than 557 visits have been made by the Health Visitors alone in connection with this Act. The Birth Rate was 12.6 and the Death Rate 12.8 per 1,000 population, compared with 15.8 and 12.3 respectively for England and Wales. I thank Mr. H. T. Perry, Senior Sanitary Inspector, and Miss A. Gill, Senior Health Visitor, for their help, and all members of the Staff of the Public Health Department for their willing support throughout the year. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 5 GENERAL STATISTICS. Area 1,133 acres. Population, 1931 (Registrar General): For birth-rate 38,760 For death-rate 38,510 Census (1931) 39,052 Rateable Value—General Rate £384,515 Sum represented by a Penny Rate £1,528 Amount of Poor Law Relief £3,878 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births— Total. Male. Female. Legitimate 450 217 233 Birth Rate (R.G.) per 1,000 population 12.6 Illegitimate 39 20 19 489 237 252 Still Births— Total. Male. Female. Legitimate 16 6 10 Illegitimate 2 1 1 18 7 11 Deutlis— Total. Male. Female. 493 242 251 Death Rate (R.G.) per 1,000 population 12.8 Number of women dying in, or in consequence of, child-birth— From Sepsis 1 From other causes 1 6 Deaths of Infants under one year— Total. Male. Female. Legitimate 26 13 13 Illegitimate 2 2 0 28 15 13 Deaths of Legitimate Infants under one year per 1,000 Legitimate births 58 Deaths of Illegitimate Infants under one year per 1,000 Illegitimate births 51 Total Deaths of Infants under one year of age per 1,000 births 57 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under two years of age) — Birth Rate Death Rale Rate Per 1000 Births Diarrhœa under 2 years. Total Deaths under 1 year England and Wales 15.8 12.3 6.0 66 159 Smaller Towns 15.6 11.3 4.0 62 London 15.0 12.4 9.7 65 Kingston-upon-Thames 12.6 12.8 0.0 57 CAUSES OF DEATH. (Civilians only.) Causes oj Death. Male. Female. All Causes 242 251 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria 1 3 6. Influenza 6 5 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever 1 — 9. Tuberculosis of the Respiratory System 15 14 10. Other Tuberculous Diseases 3 2 11. Syphilis — — 12. General Paralysis of the Insane, tabes dorsalis 1 1 7 13. Cancer, Malignant Disease 19 38 14. Diabetes 1 8 15. Cerebral Haemorrhage, etc. 12 21 16. Heart Disease 42 54 17. Aneurysm 1 1 18. Other Circulatory Diseases 6 7 19. Bronchitis 17 6 20. Pneumonia (all forms) 28 17 21. Other Respiratory Diseases 2 1 22. Peptic Ulcer 7 1 23. Diarrhoea, etc. (under two years) — — 24. Appendicitis 1 1 25. Cirrhosis of Liver 2 2 26. Other Diseases of Liver, etc. — 2 27. Other Digestive Diseases 4 6 28. Acute and Chronic Nephritis 8 8 29. Puerperal Sepsis — 1 30. Other Puerperal Causes — 1 31. Congenital Debility, Premature Birth, Malformations, etc. 5 8 32. Senility 12 19 33. Suicide 5 — 34. Other Violence 15 7 35. Other Defined Diseases 27 16 36. Causes Ill-defined or Unknown 1 1 Special Causes (included in No. 35 above):— Smallpox — — Poliomyelitis — — Polioencephalitis — — 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. 8 METEOROLOGY, 1931. Temperature of Air Rainfall Inches Highest Lowest Mean Max. Mean Min. January 53 22 43 33 1.20 February 60 23 47 32 1.54 March 68 16 50 33 0.20 April 71 32 59 41 3.90 May 82 37 69 46 2.48 June 88 42 78 52 1.55 July 88 45 79 53 2.96 August 82 41 73 53 5.22 September 74 37 64 46 2.09 October 72 24 59 41 0.67 November 61 26 52 40 2.08 December 61 20 48 36 0.49 22.38 The average annual rainfall (Greenwich) for the hundred years, 1821-1920, was 24.39 inches. 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) Infections 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. Mid-wives. The Midwives are under the administrative control of the Surrey County Council. There were twelve registered as practising in the Borough at the end of the year. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. 9 Clinics and Treatment Centres. Centre. Situation. Accommodation. Provided by Maternity and Child Welfare Grange Road Consultation The Corporation Ante-natal Clinic Consultation The Corporation School Clinic Consultation & Treatment of Minor Ailments, Refractions, Dental Treatment The Education Committee Day Nursery Canbury Park Road 9 Babies and 16 Infants Vol. Committee Red Cross Curative Post Coombe Road Out-Patients, Massage, Electrical, Light and Orthopaedic Treatment British Red Cross Society Tuberculosis. Cases of Tuberculosis in the Borough come under the administrative control of the Surrey County Council. Maternity and Nursing Homes. There are three private Homes in the Borough, viz.:— 1. Miss Rowan: 197, Park Road. 6 beds. Maternity Home. 2. Mrs. Burns: 9/11, Minerva Road. 8 beds. Maternity and Nursing Home. No patients have been treated in this Home during the year. 3. Miss Roe: 24, Albany Park Road. 12 beds. Nursing Home for Chronic and Senile Patients, 10 Under the Nursing Homes Registration Act, 1927, powers of inspection (but not of registration) are delegated by the Surrey County Council to the Corporation. Under this arrangement the above Maternity and Nursing Homes have been visited by me from time to time during the year. 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. No 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. 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. 11 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. Three investigations were made 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 222 accident cases and 100 private cases were removed by this ambulance. LIST OF ADOPTIVE ACTS AND BYE-LAWS IN FORCE IN THE BOROUGH. Adoptive Acts. Date of Adoption. Public Libraries Acts, 1892-1901 Baths and Washhouses Acts 28th July, 1896 Public Health Acts Amendment Act, 1890 1st July, 1891 Private Street Works Act, 1892 19th Jan., 1897 Public Health Acts Amendment Act, 1907 27th Nov., 1922 Part II. (except Sect. 23), Parts III. to VI., Part VII. (Sects. 81 and 85 only), Part VIII., Part X. (except Sect. 94). 12 Public Health Act, 1925, Parts II. to V. 26th Jan., 1926 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 ,, 17th December, 1929 Nuisances „ 1st May, 1930 Anti litter „ 25th June, 1930 Gas Poisoning „ 20th May, 1931 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 two houses during the year. The number of premises known to be supplied with water from wells at the end of 1931 was 50, which compares with 271 in 1919. Samples almost invariably show a high chlorine content, which suggests a polluted source of supply. After filtration through the sub-soil, and in view of the free and albuminoid ammonia not being in excess, and the absence of oxidised nitrogen, the samples have usually been classified as usable drinking water. Samples were chemically examined by Mr. P. G. Lloyd during the year. Suspicious waters are sent to the Clinical Research Association for bacteriological examination. 13 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. SCHOOLS. A general review of the sanitary condition of the Public Elementary Schools was given in 1925. The repairs and improvements carried out during 1931 will be found in the Annual Report of the School Medical Officer. OTHER SANITARY CIRCUMSTANCES. In order to prevent duplication, the Inspection and Supervision of Food, Smoke Abatement, Ashbins, Offensive Trades, Common Lodging Houses, etc., are included in the Report of the Sanitary Inspector. SALE OF FOOD AND DRUGS ACTS. These Acts are administered by the Surrey County Council, and the following table shows action taken in the Borough during the year:— Articles. ANALYSED. ADULTERATED OR DETERIORATED. Milk 70 1 Cream 3 — Butter 7 — Cheese 1 — Margarine 1 — Other Articles 12 — Totals 94 1 No prosecutions were made under these Acts in the Borough during the year. 14 HOUSING. A statement of the provisional proposals of the Corporation with regard to Housing was set out in last year's Annual Report. In the Quinquennial Statement, it was estimated that the number of houses to be repaired under Part II of the Housing Act, 1930, during the five years would be approximately 1,700. It was then not realised that it is impracticable to transfer all activities in connection with Housing from the Public Health Act to the Housing Act as had been anticipated. It is now estimated that approximately 500 houses will be dealt with under the Housing Act, 1930, during the five years, and the Ministry of Health was informed accordingly. It is to be understood, however, that action will still be taken in the case of about 1,700 houses under all Acts and Bye-laws during the five years. House-to-house inspection has been steadily carried out by the Sanitary Inspectors throughout the year, with the result that 177 dwelling-houses have been recorded under the Housing Consolidated Regulations, 1925. The majority of the houses thus recorded are in Acre Road and the Bittoms. Overcrowding is not prevalent in the Borough, and special reference to this subject will be found in the report of the Sanitary Inspector. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 603 (b) Number of inspections made for the purpose 851 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 177 (b) Number of inspections made for the purpose 251 15 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation P.H. Acts 337 Housing Acts 157 2. Remedy of Defects during the Year without vice of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers:— P.H. Acts 366 Housing Acts 86 3. Action Under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were dered fit after service of formal notices:— (а) By Owners Nil (б) By Local Authority in default of Owners Nil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 53 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 35 (b) By Local Authority in default of owners 4 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930:— 16 (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil E.—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 F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 17 FACTORIES. WORKSHOPS. AND WORKPLACES. The work carried out in connection with the inspection of factories and workshops is summarised in tabular form below. As regards action taken in matters referred by H.M. Inspectors of Factories as remediable under the Public Health Acts, only one notification was received during the vear. 1—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections Written Notices. Occupiers prosecuted Factories—(including Factory Laundries) 192 — Nil Workshops—(includingWorkshop Laundries) Workplaces—(other than Outworkers' premises) Total 192 Nil II—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 3 3 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances — — — — Sanitary Accommodation Insufficient 2 l — — Unsuitable or Defective — — — — Not separate for sexes — — — — is Offences under Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s. 101) — — — — Other Offences—(Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921 3 3 — — Total 8 7 — — *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. 19 Notifiable Diseases during the Year. Cases. Deaths. Under I year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Total Cases Notified Cases admitted, to Hospital Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Total Deaths Scarlet Fever 1 — 3 1 1 31 15 1 6 2 — — 61 38 — — — — — — — — — — — — — Diphtheria 7 — 1 3 4 22 4 5 7 — — — 53 52 — — — — — 4 — — — — — — 4 Enteric Fever including Paratyphoid — — — — — — — — — — 1 — 1 1 — — — — — — — — — — — — — Pneumonia 2 2 — 1 1 4 — 3 5 5 5 3 31 9 — — — — — — — — — — 1 1 2 Erysipelas — — — — — — — — 1 2 4 5 12 2 — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 2 11 1 — — 14 5 — — — — — — — — — — — — 1 Ophthalmia Neonatorum 4 — — — — — — — — — — — 4 — — — — — — — — — — — — — — Malaria — — — — — — — — — — 1 — 1 1 — — — — — — — — — — — — — 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 5 1 3 2 3 1 17 — 1 — — 1 4 2 2 1 1 3 15 F. — — — — — 3 7 1 2 1 — 14 — — — 1 2 4 3 1 1 1 1 14 Total — — — 1 1 8 8 4 4 4 1 31 — 1 — 1 3 8 5 3 2 2 4 29 (b) Non-Pulmonary M. — 1 1 — — — — — — — — 2 — 1 — — — — — 1 1 — — 3 F. — — 1 2 1 — — — — — — 4 — — — 1 — — — — — 1 — 2 Total — 1 2 2 1 — — — — — — 6 — 1 — 1 — — — 1 1 1 — 5 20 INFECTIOUS DISEASE. The following table gives a comparative statement of notifications received during the last thirteen years:— Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid 1919 98 142 1 1920 139 82 2 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 1926 82 27 7 1927 87 65 3 1928 135 152 7 1929 74 113 1 1930 78 100 5 1931 61 53 1 SCARLET FEVER. The type of case has been mild and no death was attributed to this disease during the year. From the above table it will be seen that the number of cases notified is the lowest since the War. This is mainly attributable to the fact that the usual autumnal rise in the incidence did not take place, but instead there was a period of six weeks up to the end of November during which only one case was notified. DIPHTHERIA. There were two small outbreaks at the Kingston and District Hospital in February and April. Only 40 cases were notified from addresses in the Borough itself, which compares very favourably with the number recorded for the last few years. Four deaths were attributed to this disease. The issue of Diphtheria Antitoxin is made through two Chemists and is available at all times. The Schick Test has not been employed. ENTERIC FEVER (including Paratyphoid). In August a man, aged 45, was notified as a case of Enteric Fever. He was removed to the Wimbledon Isolation Hospital, where he made an uneventful recovery. No source of infection was traced, and there appears to be considerable doubt as to the diagnosis. 21 PNEUMONIA. The number of cases notified was 28 compared with 29 last year and 57 in 1929, which is accounted for by the fact that there has been no prevalence of influenza during the last two years. PUERPERAL FEVER, PUERPERAL PYREXIA & OPHTHALMIA NEONATORUM. Comment on these diseases will be found under the Maternity and Child Welfare Section of this Report. 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. 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. The year has been notable for the complete absence of Measles, and the very low incidence of infectious disease generally. There was a small outbreak of Chicken-pox at Bonner Hill Road Infants' School in the spring, but apart from this the Public Elementary Schools have enjoyed a year of freedom from any epidemic. 22 There was very little Influenza, though just before the end of the year there were indications of an increasing incidence of 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. 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, were maintained by the Town Council until May, when the Centres were transferred to the new School Clinic in Grange Road. A description of the building is given in the Report of the School Medical Officer. As before, the meetings are held on Tuesdays and Fridays, when Dr. Olive Aubrey attends, and much valuable help is given by many voluntary workers. The large waiting room, the treatment room for weighing the babies, and the doctor's consulting room are used for the meetings. A shed is provided for perambulators, and a strip of land has been turfed and fenced in order that it may be used as a lawn for the toddlers under supervision, while the mothers interview the doctor with their babies. The use of this strip of land was very kindly sanctioned by the Education Committee. During the year there were the following number of attendances:— Attendances. Meetings. New Cases. Total. Tuesday 51 140 1,873 Friday 50 146 2,848 2.1 The Health Visitors paid the following number of home visits:— First Visits. Total Visits. Expectant Mothers 73 116 Infants under one year 526 2,455 Children, one to five years — 3,878 Incidental and Infectious — 247 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. There is an excellent Clothing Stall at which 45 mothers have purchased garments during the year. Owing to the move it was not possible to celebrate Baby Week this year, but the Garden Party for Welfare Mothers and Babies was held in the grounds of St. Peter's Vicarage in July. The sale of National Savings Certificates at the Centre has been continued, with the result that 60 mothers have invested £42 7s. 10d. during the year. STAFF. There has been no change in the Staff during the year. The work of the Nurses both as Health Visitors and Infant Life Protection Visitors 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, until May, when the Clinic was moved to Grange Road, and the times of the meetings were changed to the second and fourth Wednesday afternoons. During the year 132 expectant mothers attended, making 291 visits to the Clinic, which is an average of 12 per session as compared with 9 per session in the previous year. 24 The Kingston Nursing Association continue to support the Clinic by sending their cases, and the midwives in private practice appear less reluctant to advise their patients to attend. 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. 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 14 cases were notified as Puerperal Pyrexia under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Immediate investigation was made into the circumstances of each case, and a copy of the notification sent to the County Medical Officer of Health. Of the 14 cases notified as Puerperal Pyrexia, 11 were either admitted to or already in-patients at the Kingston and District Hospital, and one died. 25 Six of the cases occurred in the Maternity Ward of the Kingston and District Hospital during August. The temperature in these cases only persisted for a few days and the patients made a good recovery. The Medical Superintendant reported that, in his opinion, the cause of the trouble was a mild form of influenza. The consultant, Dr. Andrew McAllister, was not summoned during the year. OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1930:— Notified. At Home. Treated In Hospital. Vision unimpaired. Vision impaired Total Blindness. Deaths. 3 3 - 3 - — - Arrangements have been made with the Metropolitan Asylums Board for the reception and treatment of cases of Ophthalmia Neonatorum from the Borough at St. Margaret's Hospital, Kentish Town, N.W.5. 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. ORTHOPEDIC 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 11 infants received out-patient treatment, making 508 attendances. The cost of out-patient treatment was £50 16s., and the contributions paid by parents towards this expenditure amounted to £,10 2s. 6d. 26 CHILDREN ACT, 1908. The duties imposed by the Children Act are entrusted to the Maternity and Child Welfare Sub-Committee of the Public Health Committee. The general procedure adopted was fully described in last year's Annual Report. On January 1st, 1931, there were 23 foster mothers on the Register in charge of 33 infants. During the year 5 new registrations were approved and 3 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 25 foster mothers in charge of 33 infants. One application for registration was disapproved. 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. During the year 557 visits were paid, this extra work being most satisfactorily carried out by the Health Visitors. 27 Report of the Chief Sanitary Inspector To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the honour to present to you my Thirteenth Annual Report on the work carried out by your Sanitary Inspectors during the year 1931 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 8,133, as compared with 7,312 during the year 1930. On 533 premises sanitary defects to the number of 5,573 were discovered. Arising out of these defects, it was found necessary to serve 463 "preliminary" and 8 "verbal" notices. In 56 instances the informal action did not have the desired effect, and it was necessary to serve "statutory" notices. During the year under review, 578 fresh entries were added to the Register of Sanitary Defects. In 572 cases entries were cancelled following completion of necessary works. On December 31st, 1931, 341 separate entries remained under review, compared with 335 at the end of 1930. The increase in the number of inspections is due to the second additional Inspector, whose assistance became available during the year. In accordance with the policy of your Public Health Committee, work under the Housing Acts was considerably extended during the year, and 177 inspections were made under the Housing Consolidated Regulations, 1925, as compared with 28 during the previous year. The bare statement of the increased number of inspections is not fully indicative of the work involved by the change of procedure. An ordinary inspection of a house, following a complaint or a case of infectious disease, can usually be carried out in about 25 per cent, of the time which a housing inspection of similar property would take. The reason is 28 that in the latter type of inspection very full details have to be recorded, not only of sanitary defects found to exist, but also of the condition of the whole building, together with information respecting the tenancy and ownership. The results of the inspections are transferred to permanent record sheets, which are then filed away for future reference, after any necessary notices have been complied with. It will be readily understood, therefore, that any considerable increase in action under the Housing Acts must cause much extra clerical work and result in a smaller total of inspections. The high standard of sanitary inspection in the Borough has been maintained, and it is pleasing to be able to report that it was found unnecessary to resort to legal proceedings against any property owner for non-compliance with sanitary notices. The good effect of co-operation with owners, as against arbitrary legal action, is shown by the large amount of work which has been executed, especially in connection with working-class houses during the year. The greater part of this work is the outcome of informal notices and letters containing suggestions as well as requirements. This satisfactory avoidance of friction also shows the great value of personal interviews with owners or their representatives. These friendly discussions create a feeling of confidence between property owners and the Corporation, and usually lead to the removal of difficulties and misunderstandings. During 1931, 303 enquiries under the Land Charges Act, 1925, respecting property in the Borough, were received from the Town Clerk's Department and replied to. For convenience and reference the inspections and visits are set out in the following tabular form:— INSPECTIONS AND VISITS. The following list shows the number of Inspections rrade in regard to each section of the work, and the total of all inspections. Rent Restrictions Act Inspections 7 Re-inspections after Order or Notice 1638 Visits to Works in Progress 1577 Factories and Workshops 192 Cowsheds, Dairies and Milkshops 76 Ice Cream Premises 29 Foodshops and Food Preparing Rooms 414 29 Infectious Disease Enquiries 235 Special Small Pox Enquiries 34 Markets 91 Special Inspections (Complaints, etc.) 1256 Slaughter-houses 1670 Offensive Trades 37 Sanitary Conveniences 126 Common Lodging-Houses 21 Canal Boats 11 Theatres, Cinemas, etc. 17 House to house 254 Bakehouses 32 Smoke Observations 13 Stables and Yards 7 Enquiries re Housing Applicants 169 Well Water Enquiries 8 Miscellaneous Visits 219 Total 8,133 SUMMARY OF SANITARY IMPROVEMENTS. During 1931, a Circular, No. 1202a, was received from the Government, asking the Corporation, in common with other local authorities, to expedite, as far as possible, the carrying out of repairs to house property, in order to relieve unemployment in the building trades. In this connection, Kingston can claim to have succeeded, despite the very difficult times and the increased financial burdens placed upon property owners. The cost of repairs is still between 80 per cent. and 100 per cent. above pre-war level, and the undermentioned tabulated lists of sanitary and other works carried out as the result of notices served, indicate that the total expenditure on repairs to dwelling houses must have been very considerable. Practically every item is much higher compared with the previous year, whilst in some cases the figure is nearly three times as much as the corresponding number for 1930. 30 DRAINAGE. Number of Houses and Premises re-drained 68 Number of Drains repaired or amended 2 Drains or Gullies unstopped or cleansed 37 New Manholes provided 84 Existing Manholes altered or repaired 1 Intercepting Traps fixed 25 Fresh-air Inlet Shafts repaired or renewed 28 New Gully Traps fixed 161 Gully Curbs renewed or repaired 14 New Soil Pipes and/or Ventilating Shafts 53 Ventilating Shaft repaired 4 Sanitary accomodation provided to workshop 1 WATER CLOSETS AND SANITARY FITTINGS. New W.C. Basins fixed 118 W.C. Flushing Tanks repaired or renewed 68 New W.C. Apartments provided 11 W.C. Apartments lighted, repaired or ventilated 69 W.C. Apartments cleansed and limewashed 73 New Impervious Sinks provided 80 New lavatory basins fixed 3 New Trapped Waste Pipes fixed 106 Existing Waste Pipes trapped or repaired 10 New Urinals constructed Urinals cleansed or repaired 7 Miscellaneous 11 GENERAL REPAIRS. Roofs renewed 7 Roofs repaired 106 New Gutters and Stack Pipes provided to roofs 25 Eaves Gutters renewed or repaired 74 Stack Pipes renewed or repaired 57 Stack Pipes disconnected from drains 77 Dampness abated 128 Defective Walls repaired, re-pointed, etc. 259 Chimney Stacks rendered, rebuilt or repaired 35 New Chimney Pots fixed 8 Ventilation provided beneath floors 59 Ventilation provided to rooms 24 Staircases lighted or stairs repaired 55 31 Handrails to staircases provided or refixed 34 Sites of houses concreted 3 Sites of houses cleansed after flooding 5 Yards paved 93 Yard Paving repaired and yards cleansed 22 Paved Pathways constructed 43 Paving of Passageways repaired 1 Forecourts paved or repaired 3 Floors of Rooms repaired 124 New Floors of rooms 54 Rooms repaired, cleansed and distempered 565 Larders ventilated and cleansed 5 Food Store provided 16 New Ceilings 20 New Sculleries built 12 Premises limewashed 10 Windows repaired, renewed or made to open 337 New Windows provided 2 Door and Window Sills renewed or repaired 73 Doors renewed or repaired 37 New Portable Ashbins provided 216 Accumulations of manure and refuse removed 3 Nuisance from overcrowding abated 10 Water Supply provided direct from rising main 60 Water supply provided over sink in lieu of common tap in yard 12 Service Water Cisterns removed 14 Service Water Cisterns repaired, cleansed or covered 5 Water Supply reinstated 3 Service water pipe repaired 4 Use of Well-Water discontinued and M.W.B. supply laid on 2 Disused Pump removed 2 Stoves and Firegrates repaired or renewed 104 Fireplace surrounds or hearths repaired 21 Coppers repaired or renewed 45 Door Locks renewed or repaired 58 Dilapidated Sheds demolished 2 Nuisance from animals abated 1 Illegal use of basement rooms discontinued 1 Houses repainted externally 12 Miscellaneous 15 32 SMOKE ABATEMENT. The number of complaints received during 1931 in respect of alleged nuisance from smoke or grit was four. Thirteen observations of chimneys were made. On a few occasions proof that grit was permitted to escape from a chimney was obtained, and in one case a fine ash, as distinct from grit, was emitted, so as to cause a contravention of the Statute. The ash was undoubtedly due to the burning of wood chips, and when this form of fuel was discontinued, the deposit of ash in the neighbourhood also ceased. It is very seldom now that dense black smoke is emitted in excess of the two-minute period allowed by the Byelaws, although in a few instances the total emission in thirty minutes may approach the limit closely. In these cases the black smoke is emitted in short bursts of a few seconds' duration each and the offence is, therefore, more difficult to detect than in those cases where the emission is sustained for several minutes. COMMON LODGING HOUSES. There are only two registered common lodging houses in the Borough, viz:— Nos. 8 and 10, Vicarage Road (Othen's)—50 beds for men only. No. 52, Canbury Passage (Marsh's)-—35 beds for men only. As will be seen, there is no accommodation for married couples or for children in the registered lodging houses. There are other premises in the town where lodgers arc taken for short periods, but in these cases the beds are not let for one night only and there is no common room for the use of the lodgers. Buildings of this class are not subject to the Byelaws respecting Common Lodging Houses. The lodging houses are inspected frequently, and I am glad to report that the registered occupiers show willingness to comply with your Council's requirements at all times, and there is much less need for official action nowadays compared with some years ago. 33 OFFENSIVE TRADES. The following offensive trades are established in the Borough:— Leather Tanning and Fellmongering. Rag and Bone Yards. Fish Frying. The two latter trades are of such a nature that, unless every possible care is taken, their existence may become very noticeable through the olfactory sense. In the case of rag and bone yards, this trade usually forms part of a larger business, namely, the collection of waste and scrap material, and when the markets are bad the premises become filled with huge accumulations of scrap metal, waste paper and old motor tyres, etc., all of which form a hideous sight to nearby residents and passers-by. These accumulations also provide a secure harbour for vermin. It is difficult to deal effectively with these premises with the very limited powers vested in the local authority, as the accumulations, as such, are not composed of offensive matter and they only cause an annoyance in an indirect manner. A rag and bone yard was removed from the register of permitted premises during 1931 on the grounds that the trade had been discontinued for more than six months. It is unlikely that permission would be granted for the trade to be recommenced in the future, as the place in question was attached to a private house. Fish frying need cause no nuisance whatever nowadays, if proper care is taken; the modern frying apparatus is constructed so as to collect the steam and vapour from the pans into condensers, or so that the vapours are converted by heat into non-odourous gases. Unfortunately, some fryers leave the pans open during the cooking process and the fumes from the boiling fat escape freely into the atmosphere. Possibly this result is not altogether unintentional, as the location of the shops may thus be drawn to the attention of potential customers. 34 Two applications for permission to commence the trade of fish frying were considered during the year. One application was granted, but the other one was refused on the ground that ample provision to meet the public demand already existed in the neighbourhood. Thirty-seven visits were made to offensive trade premises during 1931. These visits were in addition to re-inspections after notices or warnings. COMPLAINTS. One hundred and ninety-five complaints were received during the year, as follows:— Drains and sanitary arrangements 41 Overcrowding 9 Condition of premises 69 Absence of ashbins 3 Accumulations of manure and non-collection of house refuse 5 Defective rain water pipes 1 Dampness and defective roofs, gutters, etc. 21 Smoke nuisance from chimneys 4 Obstruction of light to living room 1 Defective stoves and coppers 7 Rats 6 Water supply 3 Defective service water pipe 3 Condition of ditch 1 Keeping of animals and fowls 5 Unpaved yards and passages 1 Flooding of basement 2 Nuisance from flies 1 Miscellaneous 12 195 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 1930 was 167. The slight increase in the number of complaints was probably due to the abnormally wet period, with consequent additional defects becoming apparent. 35 HOUSE DRAINAGE. Sixty-eight houses were completely redrained during the year, as compared with 33 during 1930. The large increase in this work was due principally to the investigation of nearly the whole of one side of York Road, as the result of which 25 houses were redrained. This work took up a great deal of time, but the result fully justified the effort. The same comment applies to the block of twelve two-roomed houses in Park Road, all of which were redrained. In several instances the premises were drained by means of systems of combined drains, and these cases necessitated careful and extended negotiation with the owner or owners concerned. The following list shows the situation and numbers of premises redrained during the year:— Acre Road 5 Ashdown Road I Borough Road (including St. Paul's School) 7 Canbury Passage 1 Clarence Street 1 Crescent Road 2 Deacon Road 3 Lower Ham Road 1 Mill Street 1 Orchard Road 1 Park Road 12 St. James Road 4 Shortlands Road 1 Thorpe Road 3 York Road 25 36 HOUSING. The statistical statement relating to housing which is required by the Ministry has been completed and will be found on pages 14, 15 and 16 of the Report of the Medical Officer of Health. It will be seen that 177 houses were inspected under the Housing Consolidated Regulations, 1925. Of these houses twelve were found to be unfit for human habitation, viz. :— Bittoms Area 11 premises. Acre Road 1 ,, Each of these twelve houses was under consideration for demolition in accordance with Section 19 of the Housing Act, 1930, at the end of the year. Of the total number (603) of dwelling houses inspected, 494 were found to be below the accepted standard and to require action. It is satisfactory to be able to record that 452 houses were rendered fit during the year as the result of informal action. OVERCROWDING. A special analysis of 176 housing inspection records has produced interesting results. It can be said that legal overcrowding is practically non-existent in the borough, their being only four rooms overcrowded in the 176 houses. The houses were not specially selected for investigation, and are made up as follows:— Acre Road 100 The Bittoms 13 Generally 63 Total 176 37 The following information is extracted from the analysis:— Occupants, Adults 677 Children under 12,-169 Total 846 Average occupants per house 4.8 Separate families 234 Living rooms 350 Average persons per room 2.29 Bedrooms 453 „ „ „ „ 1.75 Bed-living rooms 28 „ „ „ „ 1.75 Rooms sublet 53 Rooms overcrowded 4 Detailed Analysis of Bedrooms. Total number Occupied by 453 1 person 2 persons 3 persons 4 persons 5 persons unoccupied 123 169 77 20 5 59 The above figures confirm the opinion I have expressed for the past few years that overcrowding is gradually diminishing each year. The fact that there were only 4.8 persons in each house and that no less than 59 bedrooms were unoccupied is particularly interesting when one bears in mind that the houses were typical working-class property in the borough. It does not necessarily follow that because a room is occupied by five persons that it is overcrowded. The degree of overcrowding is calculated upon the amount of cubic space and floor area available per person. A further indication that serious overcrowding is being eliminated is shown by the following particulars :— Cases on record Jan. 1st, 1931 5 Cases added during 1931 7 Total 12 Cases abated during 1931 10 Cases on record Dec. 31st, 1931 2 This position should be regarded as satisfactory as all cases of overcrowding which are brought to notice are recorded and dealt with. 38 ASH RECEPTACLES AND COLLECTION. During the past year new galvanised iron ashbins have been provided to dwelling houses after service of notices, at the rate of approximately four per week. This is only a small proportion of the total new bins provided annually in the Borough, the remainder being provided without the need of official intervention. Unfortunately, there are many owners of property who make a point of buying the cheapest receptacle obtainable, and they often express surprise when the ashbins are speedily worn out. With every notice requiring the proyision of new ashbins a recommendation is sent that the new receptacle should be of a prescribed minimum size and quality. It has been found that the greater number of owners do pay heed to this recommendation. An unsuccessful attempt has also been made to obtain the cooperation of all retailers of ash receptacles by requesting them not to stock any below the suggested standard, which is a very reasonable one. Not all the blame for speedy deterioration of ashbins can be allotted to poor quality and manufacture. The almost general misuse of ashbins by tenants is surprising in these days of enlightenment and it is a difficult practice to control. The average housewife resents even the mildest hint that anything wet should not be placed in the bins and usually suggests that the defective condition is due to rough handling by the dust collectors. The number of houses where it is a requirement that the ashbins shall be deposited on the forecourt in readiness for the collectors was considerably reduced during the past year in accordance with the decision of your Council. The complete discontinuance of this practice is very desirable from all points of view. The collection and disposal of refuse is carried out under the supervision of the Borough Surveyor, who informs me that in twenty-six roads, where it used to be customary for the ashbins to be deposited on the footpaths or forecourts on collection days, they are now emptied from the rear of the houses. Comparatively few roads now remain to be dealt with. 39 INCREASE OF RENT AND MORTGAGE INTEREST ACTS. Five applications were received during the year from tenants lor certificates under Section 2, Sub-section 2, of the above Act, as compared with 5 during 1930. 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. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. During 1931, two persons were removed from the register of Dairies owing to business changes, but two fresh registrations were permitted. Hence the total number of 41 at the end of December, 1931, remained unchanged from the previous year. There is only one cowkeeper in the Borough. No milk producer in the district is licensed in respect of Graded Milk, but no less than 20 licenses have been issued to retail dairymen to sell Graded Milk. This number compares with 13 for the previous year, and if it is an indication that there is a growing demand for Graded Milk it may be regarded as highly satisfactory. In my last annual report, attention was drawn to the urgent need for a more simple and clear method of designating Graded Milk. This plea for a new system has found supporters in almost every part of the country, but so far it appears not to have received favourable consideration by the Department concerned. Until the designations are changed there must be confusion in the public mind as to the respective merit of the Graded Milks. The correct order is as follows: (1) Certified, (2) Grade "A" (Tuberculin Tested), (3) Grade "A," (4) Grade "A" Pasteurised, and (5) Pasteurised Milk. It will be seen that Grade "A," which many people believe to be the best, is, in fact, only third on the list. 40 The cost of producing "Certified" milk is high, and unless a real demand for it exists it is only to be expected that producers will cease to take out licences for it. In Kingston, however, " Certified " milk can be obtained at twopence a quart more than ordinary milk. This appears to be very reasonable, especially when one recalls that at first the price was usually twice that of ungraded milk. The use of glass bottles, in the absence of anything more suitable for delivery of milk, continues. It seems almost impossible to educate the public against placing empty milk bottles on the footpaths where they can be so easily fouled, and where they appear to form an almost irresistible attraction to a certain class of youth who delight in smashing the bottles. The improper disposition of milk bottles should be prohibited. During the past year 7 samples of ordinary milk were taken for bacteriological examination. In two instances the counts were not satisfactory compared with the usual standard of milk sold in the Borough. The two retailers were interviewed and considerable improvement effected. Tubercle bacilli were not found in any of the samples. The retailing of milk from churns and hand cans is discouraged in the district, and only a very small percentage of the total milk is sold under these conditions. (b) Meat and Other Foods. The number of animals slaughtered in the Borough during 1931 was 9,629, compared with 11,821 during the previous year. This reduction was not unexpected, for in the 1929 report the opinion was expressed that the peak had then been reached. The reduction affected one slaughterhouse principally. The late occupier of these premises (a dealer) died during the year and his successor used the slaughterhouse much less. The following figures show the total number of animals killed in the private slaughterhouses during each of the past five years:— 1927 8,350 1928 11,093 1929 11,704 1930 11,821 1931 9,629 41 Statistics regarding meat inspection are now much more reliable compared with the period prior to 1925 when the Meat Regulations came into force. The Regulations require notice of every intended slaughter to be sent to the Meat Inspector and for carcases and organs to be retained for a prescribed period in order to give an opportunity for examination. The Regulations are not as strong as many could have wished them to be, but they have enabled the work of meat inspection to be carried out much more thoroughly than was possible previously; moreover, meat retailers are now much less likely to receive on to their premises any diseased meat,, and the risk of unwelcome legal proceedings is correspondingly reduced. The total visits to food premises, including restaurant kitchens, sausage-making rooms, ice-cream premises, etc., during 1931 was 2,236. The following table shows the number of slaughter notices received, the number and variety of animals referred to, etc. More than two-thirds of the total visits to slaughterhouses are made during the evenings or during week-ends. Having regard to this it may be considered very satisfactory that practically 100 per cent, of the animals were inspected. MEAT REGULATIONS, 1924. Summary for year ended December 31st, 1931. Number of Notices Received. Number of Animals Slaughtered. Beasts Figs Calves Sheep Goats Total. 844 50 5859 1496 2222 2 9,629 Carcases not Examined. Percentage of Total Animals Examined Pigs Sheep Calves 1 42 1 99.5 41 The following list shows the various amounts of foodstuffs condemned during the year. Where the action taken is stated to be " inspected and condemned " it is an indication that the articles referred to were inspected at the slaughterhouses at the time of killing. In the remaining cases a request for inspection was made by the owner. Apart from being a mere record, the list is interesting as it demonstrates the variety of causes for condemnation. Amongst those not associated with the work it is quite commonly thought that the only examination made is in order to detect the presence of Tuberculosis, but this is, of course, incorrect. Artides of Food. Reason for Condemnation. Action taken PORK — 19 Carcases and organs Tuberculosis Inspected & Condemned 3 „ „ „ „ Fever „ „ „ 1 „ „ „ „ Emaciation „ „ „ 1 „ „ „ „ Parturition Fever „ „ „ 1 „ „ „ „ Pleurisy and Perintonitis „ „ „ 1 „ „ „ „ Enteritis „ „ „ 95 Heads and Necks Tuberculosis „ „ „ ½Head Abscess „ „ „ 7 pairs Lungs Tuberculosis „ „ „ 1 pair „ Stronglyus Paradoxus „ „ „ 2 pairs ,, Congestion „ „ „ 12 Plucks Tuberculosis „ „ „ 2 Plucks Pleurisy „ „ „ 2 Livers Tuberculosis „ „ „ 1 Liver Cirrhosis „ „ „ 12 Mesenteries Tuberculosis 5 Spleens „ „ „ „ „ 1 Spleen Inflammation „ „ „ 1 Kidney Nephritis „ „ „ 2 Hind Quarters Tuberculosis „ „ „ 1 Set Udders Mastitis „ „ „ 1 Heart Pericarditis „ „ „ 1 Fre Quarter Bruised „ „ „ BEEF— „ „ „ 2 Ox Heads & Tongues Tuberculosis „ „ „ 1 Ox Head and Tongue Actinomycosis „ „ „ 2 Ox Tongues Putrefaction Voluntarily Surrendered 40 lbs. Ox Tongue „ „ Tuberculosis Inspected & Condemned 5pairs Lungs 2 Livers Distomatosis „ „ „ 1 Liver Echinococcus Cysts „ „ „ 1 Set Lungs Tuberculosis „ „ „ 11 lbs. Suet Putrefaction Voluntarily Surrendered „ „ „ 3294J lbs. Beef „ „ 10 lbs. Tripe „ „ „ „ „ 11 lbs Liver „ „ „ „ „ 88 lbs of Fat Trimmings „ „ „ „ „ 43 VEAL— 1 Carcases and organs Tuberculosis Inspected and Condemned 1 Flack Tuberculosis „ „ „ 2 pieces Bruised Voluntarily Surrendered 1 Heart Neoplasm Inspected and Condemned 1 pair Lungs Neoplasm „ „ „ MUTTON— 1 Carcase and organs Emaciation Inspected and Condemned 1 target of Lamb Pleurisy „ „ „ 2 Livers Necrosis „ „ „ 1 i.iver Distomatosis „ „ „ 16 lbs Mutton Putrefraction Voluntarily Surrendered 9 lbs. Lambs' Liver „ „ „ „ „ „ FISH— 3 Boxes Dog Fish „ „ „ „ „ „ l stones Skate Wings „ „ „ „ „ „ 8 boxes White Fillet „ „ „ „ „ „ 21 Crabs „ „ „ „ „ „ i tin Prawns „ „ „ „ „ „ FRUIT— „ „ „ 7 crates Bananas „ „ „ „ „ 13 boxes Apples Apple Hot „ „ „ PRIVATE SLAUGHTERHOUSES. There are five private slaughterhouses in the Borough, all of which have been in use during 1931. These 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. One thousand six hundred and seventy visits were paid to these premises during the year, as compared with 1,726 during 1930. There is no alteration to report in the structure of any of the premises. 44 The By-law requiring all animals to be stunned by means of a mechanical instrument previous to slaughter has continued to work satisfactorily. Occasionally, a gun has been temporarily out of action, but this difficulty has now been overcome. By courtesy of the R.S.P.C.A., a gun with ammunition has been loaned to the Borough for use when any of the privately-owned instruments are under repair. It is kept at the office and may be obtained on application to your Sanitary Inspector. WELL WATER SUPPLIES. Eight samples of water from wells were taken during the year and submitted to the analyst, Mr. P. G. Lloyd. The results of the chemical analyses of the samples are given below, expressed in parts per 100,000. Sample Chlorine Free Ammonia Albuminoid Ammonia Nitrites Poisonous Metals Remarks 1 50 .001 .0064 nil nil A usable drinking water, but chlorine figure indicates a polluted source of supply 2 5.6 .001 .0118 nil nil This is a suspicious sample of drinking water. Chlorine figure indicates a polluted source of supply 3 5.91 .001 .0066 nil nil - do.- 4 8.2 0034 .008 nil nil Organically a usable drinking water. Chlorine figure however indicates a polluted source of supply 5 5.6 .0014 .0082 nil nil - do.- 6 5.2 .0006 .0038 nil nil - do. - 7 7.3 .0014 .0042 nil nil - do.- 8 5.5 .0006 .006 nil nil This would be classed as a usable drinking water. Chlorine figure however, indicates a polluted source of supply, no distinct smell or taste noticeable on boiling 45 In the case of sample No. 2, the premises were situated in Minerva Road. Sample No. 5 was taken from London Road, and the owners of both premises accepted the advice offered and took steps to obtain a supply from the M.W.B. mains. In the case of No. 4, taken from Canbury Park Road, the owner decided to defer action for a year or so. The report showed that the water was usable and there was no alternative but to agree to the postponement. None of the samples taken could be described as sufficiently polluted to warrant statutory action to close the wells. At the end of 1931, there were fifty premises in the Borough known to be supplied by water from wells. DISINFECTION AND INFECTIOUS DISEASE. The amount of work in connection with disinfection was slightly less in 1931, compared with 1930. There were 167 rooms in 155 houses sprayed and fumigated with formalin; 1,410 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 AND WORKPLACES. One hundred and ninety-two visits were made to factories and work-places during 1931, as compared with 31 for 1930. Other details with respect to these premises are contained in the tables on pages 17 and 18. The increase in the number of visits was anticipated in my last report, and is rendered less difficult now that a register of the premises exists. 46 There is little doubt that the centre of industry is moving southward and the districts on the fringe of London are absorbing quite a number of new workshops, etc. Kingston is receiving its share, and it contains several very important works. Factories are subject to inspection by H.M. Inspector of Factories, but it is the duty of the Local Authority to see that sanitary defects are remedied. No difficulty was experienced in this direction during the past year. SANITARY CONDITION OF MUSIC HALLS, CINEMAS, ETC. It is pleasing to be able to report that no complaints were received in respect of any of the places of entertainment. Visits were made when almost every seat was occupied, but no undue vitiation of the air was noticed. It is probable, however, that an instrument such as the "Katathermometer " would have indicated the condition of the atmosphere more accurately than it is possible to do by relying upon the natural sense and the effect of "stuffiness." CANAL BOAT ACTS, 1877 TO 1884. In accordance with Section 3 of the Canal Boats Act, 1884, I beg to report as follows:— During the year 1931, eleven visits were made in connection with the Canal Boats Acts. The wharves are seldom free from barges but very few of the boats have living quarters. The boats are worked in short stages and the crews usually come ashore each night. It was not necessary to serve any notices on owners or masters during 1931. SANITARY CONVENIENCES. The conveniences attached to licensed premises in this Borough compare very favourably with similar places in all other towns I have visited. Practically all the premises now have glazed slabs or stalls, 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. 47 A report upon the sanitary conveniences is usually supplied to the Licensing Bench annually, and the very satisfactory conditions which now exist are due in no small measure to the support and co-operation afforded by the Bench to your Council. RAG FLOCK ACTS 1911 AND 1928. An enquiry was made during the past year to ascertain upon how many premises Rag Flock is used in the making of upholstery, bedding and cushions. Although a considerable amount of this work is done in the district, in no instance was Rag Flock discovered in use. The materials used, such as Kapoc, etc., do not come within the definition of Rag Flock. It was not necessary, therefore, to take any samples. PUBLIC ELEMENTARY SCHOOLS. St. Paul's School, Borough Road. The work of reconstructing the soil drains, which was commenced during the Christmas vacation, 1930, was completed during the month of January, 1931. In connection with this work, the whole of the sanitary conveniences were modernised and a great improvement was effected thereby. Richmond Road Schools. In accordance with the instructions of your Committee, the drainage system of the schools was examined and a report was duly submitted. The works required were too extensive to be carried out whilst the schools were in use, and it is intended to deal with the drains during the summer vacation of this year. 48 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 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. Grange Road, Kingston-upon-Thames . May, 1932. 49 Report of the School Medical Officer March, 1932. 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 1931. The average number of children on the school register for the year was 3,982. 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. The Eye Clinic met on Wednesday afternoons during the School terms, 22 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, 39 children receiving treatment under the Scheme. The number of attendances at the Inspection and Minor Ailments Clinic was 5,391. The new building in Grange Road to accommodate the offices of the School Medical Service, Elementary Education, Clinics, and the Open Air School was completed and occupied on May 4th, and the Official Opening by the Mayor, Councillor William Bell, J.P., took place on May 14th, 1931. 50 The centralisation of the Medical Services and the occupation of a building designed for these services immediately proved a boon to parents, children, and the Staff. Now that the work is carried out under proper conditions the efficiency of the School Medical Service is greatly enhanced. I thank all members of the Staff for their loyal support. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, School Medical Officer. 51 Staff of the School Medical Service on 31st DECEMBER, 1931. 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.). Anaesthetist: OLIVE G. AUBREY, b.a., m.d., b.ch. School Nurses: Miss A. GILL (Senior) 1/2 time. Miss C. A. HOOKWAY 1/2 time. Miss L. G. SALWAY 1/2 time. Miss A. G. GUMBLETON 1/2 time. Clerk: Miss P. M. INGILLSON. 52 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. In May the new building in Grange Road was completed, when the School Medical Service, Elementary Education Offices, Maternity and Child Welfare, and Public Health Department were all centralised under one roof. As a result co-ordination between the various branches is easy, and the efficiency of the Medical Services generally has been enhanced. SCHOOL HYGIENE. Bonner Hill Road School. External painting has been carried out in all departments. The Domestic Subjects Centre has been painted externally and decorated throughout internally. Richmond Road School. The Boys' and Girls' Departments have been painted externally. St. Luke's School. In the Boys' and Girls' Departments, head teachers' rooms were added, and also additional cloakrooms. The School was redecorated inside and out, and in parts the flooring was renewed. St. Paul's School. A considerable amount of the flooring was renewed and improved gas fittings fixed. Drainage works were carried out and completed before the School reopened in January. St. Peter's School. Two stoves were renewed. 53 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. 2. Re-Inspections. 3. Special Inspections. A full description of the procedure adopted at these inspections was set out in last year's Annual Report. 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 No. of Parents Per. centage. Examined. Present. Entrants : Boys 192 159 83 Girls 222 188 84 Intermediates : Boys 249 143 57 Girls 213 137 65 Leavers : Boys 213 87 41 Girls 201 121 60 In no instance did any parent object to Medical Examination of a child. 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 is satisfactory to note that in one case only was it necessary to take legal proceedings. The tendency towards the fashion of long hair for girls noted last year does not appear to have increased. 54 Parents are advised to have their girls' hair kept short during School life. (b) Tonsils and Adenoids. There were 97 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 58 children were found requiring treatment for defective vision, and 16 for squint. (f) Dental Defects. At his inspection the School Dentist found 1,857 children needing treatment. MEDICAL TREATMENT. (a) Minor Ailments. The treatment of Minor Ailments was undertaken daily at the Clinic during School Terms, 5,391 attendances being registered during the year. (b) Tonsils and Adenoids. The Scheme for the operative treatment of tonsils and adenoids at the Kingston Victoria Hospital has worked satisfactorily. Thirty-nine cases were treated under this Scheme during the year at a cost of £55 4s., towards which the parents contributed £16 15s. 6d. 55 (c) Skin Diseases. The treatment of impetigo, ring-worm and other skin diseases has been undertaken at the Minor Ailments Clinic. Three cases of ringworm of the scalp were referred by the School Medical Officer to Dr. N. H. Linzee for treatment by X-rays. The parents contributed £3 3s. of the total cost of £6 6s. Ten children suffering from ringworm of the scalp were treated by X-rays at various London Hospitals. (d) Vision. Cases of defective vision are referred by the School Medical Officer to the Oculist, who has prescribed spectacles for 109 children during the year. (e) Ear Disease and Hearing. Minor ear defects in the cases of 15 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (f) Dental Defects. Of the 1,857 children requiring treatment found by the School Dentist, 948 were actually treated, 821 being rendered dentally fit before the end of the year. Remarks by the School Dentist are given under the paragraph on the Dental Clinic. (g) Crippling Defects and Orthopaedics. During the year 21 individual children received electrical, massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 597 total attendances. The cost of the above out-patient treatment amounted to £12 9s. 3d., towards which the parents contributed £20 8s. 5d. One child was admitted to the Royal National Orthopaedic Hospital for in-patient treatment at a cost of £10 10s. 2d., the parents only being able to contribute £1 5s. towards this expenditure. 56 INFECTIOUS DISEASE. There was no School Closure during the year for infectious disease. The year has been notable for the complete absence of Measles, and the very low incidence of notifiable infectious disease. There was a small outbreak of Chickenpox at Bonner Hill Road Infants' School in the spring. FOLLOWING-UP. The following-up of children suffering from defects is carried out by the School Medical Officer and School Nurses, aided in some instances by the Teachers and Attendance Officers. The procedure adopted and the various duties of the School Nurses were set out in detail in last year's Annual Report. The following table specifies some of the work carried out by the School Nurses during 1931:— Number of children prepared for Routine Medical Inspection 1,378 Number examined at Schools for uncleanliness 15,144 Number of following-up home visits 385 Total number of visits to the Schools 530 Total Number of Clinic Sessions 427 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. 57 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 73. SCHOOL CLINIC. Since January, 1929, the School Clinic was accommodated temporarily at the Domestic Subjects Centre in Bonner Hill Road. The New Building in Grange Road to accommodate the Offices of the School Medical Service, Elementary Education, Clinics, and Open-Air School was completed, and removal from the temporary quarters took place on May 4th. The following is a brief description of the building:— It is situated on a site facing Grange Road, with an approximate frontage of 280 feet, and flanking on to Knight's Park, with the Hoggs Mill Stream at the rear. The front of the building faces north, so it was necessary to design it to suit a long frontage, and also at the same time to have most of the important rooms facing south. The difficulty was overcome by through-rooms on the Ground floor with two Classrooms at the rear, and on the first floor by a corridor and rooms at the back. The accommodation on the Ground floor consists of a large Dining Hall and Rest Room with Kitchen and Caretaker's Quarters to the left of the Main Entrance, and on the right, Teachers' Room, large Waiting Room, Minor Ailments Room, Consulting Room, Dental Room, Dental Recovery Room, and Lavatories for each sex, the exit from the Clinic Rooms being so arranged that the children do not have to return through the Waiting Room after having been seen. At the rear of the building there are two Open-Air Classrooms, having glazed sliding windows and doors on each side. 58 These Classrooms are approached by a glazed open covered way, adjacent to the Cloakrooms, leading from the main building. On the first floor, to the left of the main entrance are the Elementary Education Offices, consisting of Waiting Room, General Office, Secretary's Room, Chief Clerk's Room, Typists' Room, School Attendance Officer's Room, Library, two Stores, and Lavatory accommodation. On the right are the Offices of the School Medical Service and Health Department, consisting of Waiting Room, General Office, Medical Officer's Room, Sanitary Inspector's Room, additional Sanitary Inspectors' Room, Nurses' Room, Records Room, two Stores, and Lavatory accommodation. The building is carried out in multi-coloured bricks with red dressings. There is a central feature of artificial stone at the Main Entrance, and the roof is covered with red sand-faced tiles. The site is fenced at the back and two sides with iron unclimbable fencing, and in front with a dwarf wall and wrought-iron entrance gates. The building is approached by a drive with way in and out. The ground in front is laid out as a grass lawn, with evergreens along the dwarf wall, and at the side a portion is paved as a Children's Playground, while the remainder is left for cultivation by the children. The building is centrally heated by hot water, and in most rooms there are power points. The lighting is by Electricity of the latest design; gas is also connected to the Kitchen and other rooms on the Ground Floor. The windows of the Classrooms, Dining Hall, and Rest Room are glazed with Vita glass. All lavatory basins, etc., are of the latest design and all fittings of stainless steel. The floors of the Dining Hall and Rest Room, Waiting Room, and Teachers' Room have been laid in oak blocks, while the Main Entrance, Minor Ailments Room, Dental Room, and Recovery Room, and all Lavatory floors are laid in Terrazzo. The floor of the Children's Cloakroom is Granolithic. In the Consulting Room, Classrooms, and Caretaker's Quarters Oregon pine blocks are laid, while the whole of the first floor is carried out with 4-inch Oregon pine, stained and polished. 59 The Kitchen and Larder have quarry tiled floors and walls of white glazed tiles. The Minor Ailments Room, Consulting Room, Dental Room and Recovery Room are painted in Ripolin. All other walls are distempered, except the woodpanelled dado in the Waiting Room, the painted dado in the Dining Hall and Rest Room, and the tiled dado in the Main Entrance, Classrooms and Lavatories. A shed is provided for perambulators. (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. The equipment of the Minor Ailments Room includes an electric sterilizer, electric kettle, glass trolley table, cupboard with glass shelves, special waste bins, and an enamelled table. There is a special glazed shelf and a glazed draining board to a large sink, which is fitted with stainless steel taps having arm pieces. The walls, ceiling, and plain Hospital doors are finished in Ripolin, and the floor is laid in Terrazzo. (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, 60 Those children who have errors of refraction attend the Clinic three times a day on the Monday and Tuesday preceding the meeting for the purpose of having atropine ointment applied by the School Nurse. There were 425 attendances at the 22 sessions held during the year, 192 being new cases and 233 re-inspections. Refractions numbered 120, and spectacles were prescribed in 109 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. The work is carried out in the Consulting Room, which is fitted with the necessary equipment, and has special blinds to the windows for darkening the room. (d) Dental Clinic. During the year five sessions per School Week were devoted to Dental Inspection and Treatment. In all, 33 half-days were given to Inspection and 185 to Treatment. There were 411 gas cases during the year. The equipment of the Dental Room includes an Electric engine, electric sterilizer, dental chair, dental stool, glass cupboard, special waste bin, tiled shelf, and a glazed draining board to a large sink. There is also a lavatory basin. The Recovery Room contains a couch and a long glazed trough fitted with a special perforated flushing sparge pipe along the edges. The sparge pipe is held away from the trough by brackets, in order that it may be cleaned underneath. All fittings are of stainless steel. The walls, ceiling, and smooth "Hospital" doors of both the Dental and Recovery Rooms are finished in Ripolin, and the floors are laid in Terrazzo. The arrangement of the rooms is such that a child does not return to the Waiting Room after treatment. 61 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 each per school week, directed to children aged 5 to 12, also all the children in the Open-Air School, and "Specials" (i.e., children not eligible for routine treatment referred by the School Medical Officer, etc.). "The time and programme of work for the year was similar to the year 1930. The extension, to include another age group, was inadvisable owing to the arrears of work, and in view of the number of sessions not being increased. I am pleased to be able to report that the arrears have now been cleared off and the work is well in hand. "Treatment was available shortly after the inspections at the Schools. This is most satisfactory in several ways. "In the first place, any urgent cases seen at the School Inspection can be dealt with immediately in a routine manner. Conservative work (fillings) executed in the early stages prevents a lot of tooth destruction, and does not occupy so much time. "Secondly, the nature of the treatment coincides with the condition of the mouth as described to the parent at the inspection, whereas when a long interval elapses between Inspection and Treatment the condition of the mouth naturally varies. "Thirdly, any septic condition is quickly followed up and remedied. "The reason why a larger number of children were treated is due partly to the increase in the number of gas cases dealt with during the additional time given to gas sessions, and also to the increase in the number of retreated cases, that is, children who have previously been rendered dentally fit, and who consequently require very little treatment. "The number of permanent teeth extracted, while showing a steady percentage decrease, is still more than I should wish; but, unfortunately, we shall always have people who do not consent to treatment until the children have toothache, and by that time the tooth is unsaveable. "The percentage actually treated compares very favouraby with most dental reports," 62 63 64 65 OPEN AIR DAY SCHOOL. The Special School for Physically Defective Children was temporarily accommodated on the ground floor of the Domestic Subjects Centre in Bonner Hill Road. In May, 1931, the children were transferred to the OpenAir Day School, which forms part of the new Grange Road building. The school consists of two classrooms, separated from each other by a movable glass partition, and designed to accommodate fifty pupils. The classrooms, which face south, have sliding windows glazed with Vita glass to within two feet of the floor. On the other side the sliding windows operate from floor level, since outside there is a glazed open covered way which turns at right angles, skirting the cloakrooms, to enter the main building. There are separate cloakrooms for boys and girls, with entrances from the covered way. These cloakrooms are supplied with hot and cold water, have lavatory accommodation, are heated, and have drying racks for boots and clothes. The classrooms are so planned that two more classrooms could be added if necessary without alteration to or extension of the main building or cloakrooms. The Dining and Rest Room, 41 x 24 feet, is in the main building, and has a floor of oak blocks. Leading out of this room is the kitchen, which is carried out in white tiles and is fitted with a range and gas stove. The Caretaker's quarters are situated on the further side of this kitchen, and consist of three rooms and a bathroom. There is a large amount of land behind and to the west of the building available for gardening instruction, and immediately adjacent to the classrooms is an asphalt playground. A careful survey of all delicate children attending the ordinary Public Elementary Schools was made, and the selection of those suitable for transfer to the Open-Air School was necessarily slow, but by the end of the year there were 45 children on the register of this School. 66 Among the children recommended for such transfer parents were unwilling to permit this in 3 instances. A charge of 4d., or less in necessitous cases, is made for the midday hot meal, and any financial loss has been met out of a voluntary fund raised by ladies of the Committee. Every effort is made to induce parents to allow their children to stay to dinner and for the rest period afterwards. Also mid-morning milk can be bought at 1d., and the great majority of the children partake of this milk. Folding canvas couches are used for the rest period, and a rug is provided for each child, so that the rest may be taken in the open air during suitable weather. The children come under the supervision of the School Medical Officer, who, as a routine practice, examines them at least twice each term and records the results of such examinations. Cards, on which are entered instructions of the Medical Officer to the Head Teacher, are kept at the school. The fact that the school is situated at headquarters provides advantages to both Medical and Teaching Staffs, who are, therefore, so easily able to consult with regard to the care of the children. The curriculum has been set out in consultation with the Education Secretary and Head Teacher. Dental inspection and treatment was carried out during the year, and children needing orthopaedic treatment attend the Red Cross Curative Post, Norbiton, under the visiting Orthopaedic Specialist. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 49 school children over 12 years of age were issued with certificates under the Bye-laws permitting their employment on milk and paper rounds. 67 SCHOOL BATHS. During- the summer months 709 children from the Boys' and Girls' Departments of all the Schools attended the Corporation Baths during School hours for instruction in swimming. 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, and in Albert Road. Richmond Road Boys' School at Tudor Road. St. Luke's Boys' School at the rear of St. John's School. Open-Air School at the School. At present, St. John's, St. Peter's, and St. Agatha's Schools are without Gardening Centres. DEFECTIVE CHILDREN. Exceptional children are brought to the notice of the School Medical Officer by the School Nurses, Health Visitors and Attendance Officers. The Teachers are invited to bring any children they consider defective before the School Medical Officer. If suffering from a physical defect, they are admitted to the Special Open-Air Day School if considered unsuitable to attend an ordinary Public Elementary School, 68 SUMMER CAMP. St. Peter's Girls' School. For the last ten successive years Miss A. Thompson, the Head eacher, has raised funds to enable her to take a party of girls to the seaside for a week. She decided this year not to repeat the excursion, as she found that these trips were not being sufficiently appreciated, but she hopes that, by allowing a year to lapse, greater interest will be taken by parents in the benefit thus provided for their children. It is hoped that Miss A. Thompson and her Assistants will again take up this work, which has been such a success in the past, giving a free seaside holiday to so many girls from poor homes. 69 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 414 Intermediates 462 Leavers 414 Total 1,290 Number of other Routine Inspections 88 B,—Other Inspections. Number of Special Inspections 1,185 Number of Re-Inspections 5,478 Total 6,663 TABLE II. A Return of Defects found by Medical Inspection in the Year ended 31st December, 1931. Defect ok Disease Routine Inspec. Special Inspec. No. of Defects. No. of Defect*. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring tobe kept under observation but not requiring Treatment. Malnutrition — — — - Uncleanliness — (See Table lV.GroupV.) 110 — 484 — Skin Ringworm, Scalp — - 19 — Body 2 — 36 - Scabies 1 — 6 — Impetigo 6 - 100 — Other diseases (non Tb) 19 1 195 21 Eye Blepharitis 2 - 4 — Conjunctivitis — - 13 — Keratitis — - — — Corneal Opacities - - — — Defect.vision exc.Squint 24 2 34 1 Squint 12 1 4 1 Other Conditions 1 3 29 — Ear Defective Hearing 1 — 12 — Otitis Media 1 — 6 — Other Ear Diseases 2 — 16 — Nose and Throat Enlarged Tonsils only 27 8 24 2 Adenoids only 2 2 18 2 Enlarged Tonsils and Adenoids 6 - 20 - Other Conditions 6 1 45 1 Enlarged Cervical Glands (non Tb) 9 4 9 — Defective Speech 1 2 1 — Teeth—Dental Diseases (see Table IV., Group IV.) 1 — 7 — Heart and Circulation Heart Disease—Organic 2 1 1 1 Functional — 3 — — Anaemia 1 3 1 - Lungs Bronchitis 2 - 13 - Other non Tb. Diseases 2 6 10 1 Tuberculosis Pulmonary—Definite ... — — 1 — Suspected 1 3 1 1 Non-Pulmonary-Glands — - - - Spine — — — — Hip — — 2 — OtherBones & Joints — - - 1 Skin - - - - Other Forms 1 - - - Nervous System Epilepsy 3 — - — Chorea 2 1 3 — Other Conditions 3 3 1 — Deformities [Rickets 1 8 - — Spinal Curvature 4 - 1 1 Other Forms 3 1 5 1 Other Defects and Diseases 25 18 210 13 TABLE II.—continued. B. Number of Individual Children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases) Group. Number of Children. Percentage of children found to require Treatment. Inspected. Found to Require Treatment, Code Groups—Entrants 414 59 14 Intermediates 462 41 9 Leavers 414 31 7.5 Total Code Groups 1250 131 10 Other Routine Inspections 88 15 17 TABLE III. Return of all Exceptional Children in the Area — — — Boys. Girls. Total Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness. Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis, Crippling or Heart Disease - - - Blind(including partially blind) (i) Suitable for training in a School for the totally blind. At Certified Schools for the Blind 1 1 At Public Elementary Schools - - - At other Institutions - - - At no School or Institution — — — (ii) Suitable for training in a School for the partially blind. At Certified Schools for the Blind - - - At 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 for the totally deaf or deaf and dumb. At Certified Schools for the Deaf i l 2 At Public Elementary Schools - - - At other Institutions - — — At no School or Institution - — — (ii.) Suitable for training in a School for the partially deaf. At Certified Schools for the Deaf or partially Deaf - - - At Public Elementary Schools - - - At other Institutions — — At no School or Institution — — — Mentally Defective Feebleminded At Certified Schools for Mentally Defective Children 1 - 1 At Public Elementary Schools 18 17 35 At other Institutions — — - At no School or Institution — — — TABLE III— Continued. — — — Boys Girls. Total. Mentally Defective Notified to the Local Deficiency Authority during the year. 4 — 4 Epileptics Suffering from severe epilepsy At Certified Schools for Epileptics - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air - - - Schools - 1 1 At Public Elementary Schools - - - At other Institutions - - - At no School or Institution - 1 1 Suffering from epilepsy which is not severe. At Public Elementary Schools 5 2 7 At no School or Institution — — — Active pulmonary tuberculosis (including pleura and intrathoracic glands). At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - Al Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools At other Institution — — - At no School or Institution — — — Physically Defective Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Hoard... - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 1 - 1 At Public Elementary Schools At other Institutions 2 2 4 At no School or Institution - - - Tuberculosis of the peripheral glands At Sanitoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 1 - 1 At Public Elementary Schools At other Institutions 3 4 7 At no School or Institution — — — TABLE III.—Continued — — — Boys. Girls Total. Abdominal 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 1 I 2 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools - — — At other Institutions — — — At no School or Institution — — — Tuberculosis of other organs (skin, etc.). At Sanatoria or Hospital Schools approved by (he Ministry of Health or the Board - - - At Public Elementary Schools — — — At other Institutions — — — At 110 School or Institution - — - Physically Defective continued Delicate children (i.e., all children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 11 1O 21 At Public Elementary Schools 4 4 8 At other Institutions — - — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life. At Certified Hospital Schools - - - At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools 8 7 15 At Public Elementary Schools — 1 1 At other Institutions — — — At no School or Institution — — - Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. At Certified Hospital Schools - - - At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools I 2 3 At Public Elementary Schools — — - At other Institutions — — - At no School or Institution — — — 74 TABLE IV. Return of Defects Treated during the Year ended 31st Dkcember, 1931. 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 8 11 19 Ringworm, Body 37 1 38 Scabies 6 l 7 Impetigo 99 1 100 Other Skin Disease 175 15 190 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 28 7 35 Minor Ear Defects... 15 6 21 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 138 18 156 Total 506 60 566 Group 11 .—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I ). No. of Defects dealt with. Defect or Disease Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total Errors of refraction (including Squint) 120 16 6 142 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 7 3 10 Total 127 19 6 152 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 109 (b) Otherwise 6 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 108 (b) Otherwise 6 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital 39 By Private Practitioner or Hospital apart from the Authority's scheme. 35 Total 74 Received other foinis of treatment 17 Total number treated 91 Group IV. Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist : Ages 5 6 7 3 9 10 n 12 13 14 209 310 348 419 430 468 513 336 — Total 3033 Specials 16 Grand Total 3049 (b) Found to require treatment 1867 (c) Actually treated 948 (2) Half-days devoted to:— Inspection 33 Treatment 185 Total 218 (8) Attendances made by children for treatment 2090 (4) Fillings Permanent teeth 991 Temporary teeth 98 Total 1089 (5) Extractions: — Permanent teeth 241 Temporary teeth 1985 Total 2226 (C) Administrations of general anæsthetics for extraction 8411 (7) Other operations:— Permanent teeth 181 Temporary teeth 360 Total 541 76 Group V. —Uncleanliness and Verminous Conditions (i.) Average number of visits per school made during the year by the School Nurses 32 (ii.) Total number of examinations of children in the schools by School Nurses 15144 (iii.) Number of individual children found unclean 699 (iv.) Number of children cleansed under arrangements made by the Local Education Authority - (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-Laws 1