K4413 (1) Kingston up2 KIN 11 Annual Reports FOR — 1 9 3 3 — OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THE SANITARY INSPECTOR The Royal Borough of Kingston-upon-Thames The Royal Borough of Kingston-upon-Thames Annual Reports FOR — 1 9 3 3 — OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THE SANITARY INSPECTOR 2 Staff of the Public Health Department on 31st December, 1933. 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, and Meat and Foods 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 E. G. COUZENS, 1/2 time. 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 Annual Report OF THE Medical Officer of Health. Health Department, Grange Road, Kingston-upon-Thames. April, 1934. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1933. Circular 1346 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1933 requests that the Council will direct the Annual Report of the Medical Officer of Health for 1933 to be drawn upon the lines indicated therein, and that the Annual Report shall be an Ordinary Report. The Circular also states that the Annual Report for 1933 should contain, as a minimum, information in regard to the matters specified in Appendix I, set out as far as possible in the order there given, under the main heads A to F. The incidence of notifiable infectious diseases was low and there was no outbreak of Measles this year. 4 The extension of the Borough, which is referred to under Section A of the Report, will undoubtedly materially increase the work and time occupied in visiting by Health Visitors and Sanitary Inspectors, as the new added area is developed. Work in connection with Maternity and Child Welfare and under the Children and Young Persons Act has been fully maintained by the Health Visitors, two of whom have continued to use their own bicycles, thus saving valuable time in home visiting, following up and school visiting. The work of the Sanitary Inspectors in connection with Housing has been particularly heavy and the results achieved must be regarded as highly satisfactory. At the same time the inspection of Meat and Foods and the work involved in General Sanitation has been kept up to a high standard. There has been no change in Staff, but Dr. Ruth C. Townshend tendered her resignation as Medical Officer to the Ante Natal Clinic to take effect at the end of the year, owing to extension of her work at Carshalton, where she is Medical Officer for Maternity and Child Welfare. All will regret she finds herself unable to continue her special work in Kingston, where for four years she has proved herself a most efficient and popular Medical Officer. I thank the Staff for their willing assistance at all times. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statistics. Area 1,390 acres Population, 1933 (Registrar General) 38,690 Number of inhabited houses 9,050 Rateable Value—General Rate £389,896 Sum represented by Penny Rate £1,599 Amount of Poor Law Relief £3,169 (ii) Extracts from Vital Statistics of the Year. Live Births— Total. Male. Female Legitimate 429 244 185 Birth Rate (R.G.) per 1,000 pop. 12.2. Illegitimate 41 22 19 470 266 204 Still Births— Total. Male. Female. Legitimate 13 5 8 Rate per 1000 total live and still) births 26.9 Illegitimate — — — Deaths— Total. Male. Female. 464 234 230 Death Rate (R.G.) per 1,000 pop. 12.0. Deaths from puerperal causes— Rate per 1000 total (live Deaths and still) births Puerperal Sepsis 1 2.07 Other Puerperal Causes — — Total 1 2.07 6 Death Rate of Infants under one year of age— All infants per 1,000 live births 59 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1000 illegitimate live births 98 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 2 Birth Rate. Death Rat e. Rate per 1000 Births. Diarrhoea under 2 years Total Deaths Under 1 year England and Wales 14.4 12.3 7.1 64 132 Smaller Towns 14.5 11.0 4.9 56 London 13.2 12.2 11.6 59 Kingston-upon-Thames 12.2 12.0 4.2 59 (iii) Causes of Death. Male. Female. All Causes 234 230 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough 1 2 5. Diphtheria — 1 6. Influenza 9 9 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — — 9. Tuberculosis of the Respiratory System 21 11 10. Other Tuberculous Diseases 1 1 11. Syphilis — — 12. General Paralysis of the Insane, tabes dorsalis 1 2 13. Cancer, Malignant Disease 29 40 14. Diabetes 1 2 15. Cerebral Haemorrhage, etc. 9 10 16. Heart Disease 50 53 17. Aneurysm — 1 18. Other Circulatory Diseases 11 8 19. Bronchitis 5 9 20. Pneumonia (all forms) 21 19 21. Other Respiratory Diseases — — 7 22. Peptic Ulcer 5 2 23. Diarrhoea, etc. (under two years) 2 — 24. Appendicitis 4 3 25. Cirrhosis of Liver — 1 26. Other Diseases of Liver, etc. 2 5 27. Other Digestive Diseases 3 2 28. Acute and Chronic Nephritis 3 2 29. Puerperal Sepsis — 1 30. Other Puerperal Causes — — 31. Congenital Debility, Premature Birth, Malformations, etc. 11 4 32. Senility 9 16 33. Suicide 3 2 34. Other Violence 12 11 35. Other Defined Diseases 21 13 36. Causes Ill-defined or Unknown — — Special Causes (included in No. 35 above):— Smallpox — — Poliomyelitis 1 1 Polioencephalitis — — (iv) Natural and Social Conditions. On April 1st, 1933, the Borough boundaries were extended by the addition of a portion of Ham, amounting to 234 acres, under the provisions of the Surrey (Riverside Areas) Order 1933, and a portion of Maiden, amounting to 25 acres, under the provisions of the Surrey (Kingston and the Maidens) Order 1933. The estimated population of the added areas was 770. The portion of Ham added consists of flat low lying land along the Northern boundary of the Borough. Building of small private dwelling houses is progressing along and adjacent to the Richmond Road, and the works of Leyland Motors Ltd. and Cellon Ltd. are situated in this area. The added portion of Maiden is continuous with the above land and consists of the rising ground extending to the boundary of Richmond Park. 8 Upon this area there were 26 dwellings, drained into cesspools. The sewage from that part of Ham which is now included within the Borough of Kingston is received and treated by the Richmond Main Sewerage Board, and this arrangement will continue pending the completion of a main sewer to take this sewage to the Kingston Corporation Sewage Works. The transferred areas ceased to be within the district of the Tolworth Joint Hospital Board, and as reported under Section B of this Report a fresh agreement was entered into with the Wimbledon Corporation for the admission of cases of infectious disease to the Wimbledon Isolation Hospital from the whole Borough. The Kingston Council became the authority for the purposes of the Notification of Births Acts 1907 and 1915, and the Maternity and Child Welfare Act 1918, in the added areas. METEOROLOGY, 1933. The year has been an exceptionally dry one, which is illustrated in the following table from records taken by Mr. P. G. Lloyd. Temperature of Air. Rainfall Highest Lowest Mean Max. Mean Min. Inches January 55 21 42 32 1.24 February 57 22 46 34 2.41 March 64 30 55 37 1.93 April 76 30 61 40 0.64 May 83 40 69 47 2.47 June 88 45 76 53 1.20 July 93 54 80 58 1.52 August 92 48 79 57 0.65 September 80 42 70 54 2.28 October 69 31 59 45 1.51 November 58 31 48 38 0.75 December 46 25 39 31 0.35 16.95 The average annual rainfall (Greenwich) for the hundred years, 1821-1920, was 24.39 inches. 9 SECTION B. GENERAL PROVISION OF HEALTH SERVICES. (i) Public Health Officers. The Staff of the Public Health Department is set out at the beginning of the Report. (ii) Nursing in the Home. (a) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (b) Infectious Diseases.—In Measles, Whooping Cough, and Epidemic Diarrhoea, the Health Visitors are under instructions to visit the cases and give practical advice as to the best methods of nursing them. If attended by District Nurses the fees may be paid by the Corporation. (iii) Laboratory Facilities. Arrangements are made with the Clinical Research Association for the examination or analysis of clinical material, water, milk, etc. (iv) Legislation in force. A list of adoptive Acts and Bye-laws in force in the Borough was given in the Annual Report for 1931. (v) Hospitals. (a) Fever.—Arrangements are made whereby Wimbledon Isolation Hospital accepts cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. In April the admission of cases to the Molesey Isolation Hospital ceased upon the incorporation of the Molesev Urban District with Esher, 10 Arising from a survey of hospital accommodation for infectious diseases throughout the County, a fresh agreement was entered into with the Wimbledon Corporation for all cases recommended for Hospital treatment from this Borough to be admitted to the Wimbledon Isolation Hospital. (b) Smallpox.—The Surrey Smallpox Hospital, East Clandon, Surrey, is subsidised by the Council. (c) Other.—Other Hospitals situated in the Borough available for the District are:— The Kingston and District Hospital (Surrey C.C.) The Kingston Victoria Hospital, supported by voluntary contributions. The Corporation made a contribution of £50 to the Kingston Victoria Hospital. A number of the inhabitants of the Borough attend the Royal Hospital, Richmond, and the Corporation made a contribution of £50 to its funds. (vi) Ambulance Facilities. (a) For infectious cases: Those cases removed to Wimbledon Isolation Hospital are transported by the Motor Ambulance attached to that Hospital. The Corporation has a light Ford motor ambulance which is used for removing bedding to the steam disinfector, and for transporting patients in emergencies. (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 212 accident cases and 121 private cases were removed by this ambulance. 11 (vii) Clinics and Treatment Centres. A list of Clinics and Centres, giving their situation and accommodation, was set out in the Annual Report for 1931. There have been no alterations or additions during the year. MATERNITY AND CHILD WELFARE. (i) Midwives. The Midwives are under the administrative control of the Surrey County Council. There were eleven registered as practising in the Borough at the end of the year. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. (ii) Maternal Mortality. The investigation into 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. Two investigations were made during the year. During the year 10 cases were notified 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 10 cases notified, 4 were either admitted to or already in-patients at the Kingston and District Hospital. There were no deaths among these notified cases. The one death from puerperal sepsis recorded by the Registrar General was an inward transfer whose death occurred at Hampstead, but whose usual residence was in Kingston. The consultant, Mr. Andrew McAllister, was not summoned during the year. 12 (iii) Ante-Natal Services. The Ante-Natal Centre is held fortnightly and serves not only the purpose of an examination clinic, but also as a centre of education for mothers and midwives. A full description of the Ante-Natal Services was given in last year's Annual Report. Dried milk may be obtained by expectant mothers at the Centre at cost price, and fresh milk is supplied at a reduced cost or free in necessitous cases, in accordance with the income scale in force. During the year 123 expectant mothers attended, making 320 visits to the Clinic. (iv) The Centre. The Centre is held at the School Clinic in Grange Road, which was descrbed in the Annual Report for 1931. As before, the meetings are held on Tuesday and Fridays, when Dr. Olive Aubrey attends, and much valuable help is given by many voluntary workers. 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 in with 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 23 mothers have purchased 45 garments during the year. During the year there were the following number of attendances :— Attendances. Meetings. New Cases. Total. Tuesday 52 157 2,805 Friday 50 148 2,840 13 These figures are considerably lower than those of a few years ago, but it must be realized that mothers are knitting more themselves now, and also woollen garments can be purchased so cheaply to-day at the large stores. The sale of National Savings Certificates at the Centre has been continued, with the result that 35 mothers have invested £15 during the year. Baby Week was held during the week commencing Sunday, July 1st, when specail announcements were made in the local Churches and Sunday Schools. The Centre was open to visitors on Tuesday and Friday, when Miss C. M. Gilder from the National Milk Publicity Council gave most interesting and instructive addresses. On Thursday, a Garden Party was given at St. Peter's Vicarage, the prizes for Mothercraft being distributed by Councillor Oldfield, M.B. The Day Nursery in Canbury Park Road was open daily to visitors. As a routine procedure the Health Visitors make their first visits at the end of ten days in midwives' cases, and at the end of the first month in doctors' cases. Subsequent visits are paid every two months up to the age of six months, then every quarter up to the age of two years, and finally every six months up to the age of five. These arrangements have been satisfactory. There are now very few unnotified births. (v) Health Visting. The Health Visitors paid the following number of home visits :— First Visits. Total Visits. Expectant Mothers 123 202 Infants under one year 447 2,543 Children, one to five years — 3,744 Incidental and Infectious — 506 14 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. (vi) Infant Life Protection. The duties imposed by Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, are entrusted to the Maternity and Child Welfare Sub-Committee of the Public Health Committee. The general procedure adopted was fully described in the Annual Report for 1930. On January 1st, 1933, there were 23 foster mothers on the Register in charge of 29 infants. During the year 9 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 29 foster mothers in charge of 36 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 666 visits were paid, this work being most satisfactorily carried out by the Health Visitors. (vii) Ortlwpcedic 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 4 infants received out-patient treatment, making 73 attendances. The cost of out-patient treatment was £7 6s. 0d., and the contributions paid by parents towards this expenditure amounted to £1 16s. Od. One case was an in-patient at St. Vincent's Orthopaedic Hospital, Eastcote, Pinner from February to December, 1933, at no cost to the Corporation. On attaining the age of five years, infants undergoing Orthopaedic Treatment continue such treatment through the School Medical Service. 15 (viii) 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. (ix) Maternity and Nursing Homes. 1. Maternity Home at 197, Park Road. Six beds. Kept by Miss Rowan. 2. Nursing Home at 24, Albany Park Road. Twelve beds. Kept by Miss Roe. This Home accommodates chronic and senile patients. 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. SECTION C. SANITARY CIRCUMSTANCES. (i) 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 11 houses during the year. 16 The number of premises known to be supplied with water from wells at the end of 1933 was 38, which compares with 271 in 1919. Samples were chemically examined by Mr. P. G. Lloyd during the year. Suspicious waters, are sent to the Clinical Research Association for bacteriological examination. (ii) Drainage and Sewerage. Last year a brief summary was given of schemes carried out for the improvement of surface and foul water sewers for the relief of flooding. Upon extension of the Borough, works were commenced in order to take the sewage from the Ham area to the Corporation Sewage Works, and also to sewer the Park Road area where drainage was into cesspools. It is anticipated that these works should be completed by March 1934. The construction of necessary additional manholes on existing sewers was commenced, and will be continued until a satisfactory scheme is completed. Various small improvements have been carried out with a view to improving the flow in both foul and surface water sewers. During the year the remaining section of the Latchmere Ditch was piped in. (iii) Rivers and Streams. The effluent from the Corporation's Sewage Works discharges into the River Thames, and complies with the standard fixed by the Thames Conservancy. A Joint Scheme is still under consideration with regard to the Hogg's Mill Stream, which receives the sewage effluents from Maiden, Epsom and Ewell, before traversing the Borough to flow into the Thames. 17 Chemical Analysis of the water of the Hogg's Mill Stream indicates very serious pollution. (iv) Closet Accommodation. The closets in the Borough are on the water-carriage system. (v) Public Cleansing. 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 Destructor. (vi) Sanitary Inspection of the Area. A classified statement of the number of premises visited, the defects or nuisances discovered, and the action and result of action taken in regard to these, appears in the Report of the Sanitary Inspector, which follows the Main Report. Also included in his Report are particulars of action taken with regard to Smoke Abatement, Special Classes of Premises and Occupations subject to control of the Local Authority, and under the Rag Flock Acts, 1911 and 1928. (vii) Schools. Information with regard to the sanitary condition and improvements in the public elementary schools is given each year in my report as School Medical Officer. The recommendations for the prevention of the spread of infectious disease contained in the Memorandum on Closure of and Exclusion from School, 1927, have been closely followed. No school closure has been necessary during the year. Head Teachers are in possession of instructions issued by me with regard to the incubation and exclusion periods of the commoner infectious diseases, 18 (viii) Factories, Workshops and Workplaces. The work carried out in connection with the inspection of factories and workshops is summarised in tabular form below. I—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Number of Premises Inspections Written Notices Occupiers prosecuted Factories—(including Factory Laundries) 227 — Nil Workshops—(including Workshop Laundries) Workplaces—(other than Outworkers' premises) Total 227 Nil 19 II—DEFECTS FOUND IN FACTORIES, WORKSHOP! 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 5 4 — - Want of Ventilation 1 — — - Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 3 — — - Sanitary Accommodation Insufficient 1 1 — — Unsuitable or Defective 2 1 — — Not separate for sexes 1 1 - — 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 2 2 - - Total 15 9 - - *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, 20 SECTION D. HOUSING. In my Annual Reports for some years I have stated that the general standard of housing in the Borough was good and I still adhere to this opinion. There are no large areas comparable to the "slums" found in industrial cities and towns, consisting of squalid dwellings without sufficient light, ventilaton, proper sanitary accommodation, closelv packed together around courts and alleys, overshadowed by high adjacent buildings, etc. Such conditions justify the term "slum" area, but unfortunately the word "slum" is very difficult to define and has been used very loosely of late in connection with old property. In Kingston most of the old property consists of twostorey cottages either in pairs or terraces.. Some of these cottages are very old and worn out, and can be dealt with as individual houses under Section 19 of the Housing Act 1930, which gives the Local Authority power to order demolition of insanitary houses or to accept an undertaking from the owner that he will within a specified period carry out such works as will, in the opinion of the Authority, render the houses fit for human habitation. Eleven houses were dealt with in this way, " ndertakings "being given in three cases, while "demolition orders " were made in respect of the other eight houses. With regard to areas consisting of old property, the difficulty of forming an opinion as to the standard required to justify their representation as "Clearance Areas" is a real one. The Housing Act 1930, Section 62, gives a method upon which to judge the fitness or unfitness of a dwelling house, which is that it should be compared with "the provisions of any byelaws in operation in the district, or the general standard of housing accommodation for the working classes in the district," 21 If upon such comparison the premises fall short to any considerable extent of either the existing building byelaws or of the general housing standard it appears that it is the duty of the Council to adjudge the premises "unfit for human habitation." Bearing this in mind together with sanitary defects discovered, certain areas throughout the Borough have been scheduled as proposed Clearance Areas and a five year programme as required by the Ministry of Health Circular 1331 was submitted to the Minister. On October 12th, as Medical Officer of Health, in pursuance of Section 51 (2) of the Housing Act, 1930, I made an official representation to the Council as regards : Area No. 1—Nos. 25 and 27, Brook Street and 1, Orchard Road. Area No. 2.—Nos. 82, 84 and 86, Hawks Road. Area No. 3.—Nos. 47, 49 and 51, Acre Road. On November 30th, I made an official representation with regard to Area "A" which consisted of the following dwellings :— Canbury Place—Nos. 2, 3, 4, 5 and 6. Canbury Passage.—Nos. 29, 31, 33, 35, 37, 39, 41, 43, 45 and 47, 49, 51, 53, 55 and 57. The inspection of houses in order to schedule sanitary defects entails a great amount of detailed work and occupies much time, but the progress made must be regarded as very satisfactory, the total of 874 houses inspected being by far the highest ever recorded in any one year. Included in this total are 117 houses which have been inspected and recorded under the Housing Consolidated Regulations 1925, which though a rather lower number than last year, it is gratifying that it has been possible to maintain such a good figure, in veiw of the special work at present in hand. In the course of concentration on housing inspection, eight cases of overcrowding have been discovered. There were 12 cases carried over from 1932, making a total of 20. During this year 14 were abated leaving 6 outstanding on December 31st, 1933. Thirty new houses were in course of erection by the Corporation in New Maiden at the end of the year. Eighty houses have been erected by private enterprise during the year. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 874 (b) Number of inspections made for the purpose 1090 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 117 (b) Number of inspections made for the purpose 188 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 39 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 659 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 583 3. Action Under Statutory Powers during the Year: A.—Proceedings under sections 17, 18 and 23 of Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 23 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By Owners 5 (b) 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 45 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 48 (b) By Local Authority in default of Owners Nil *C.—Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 9 D.—Proceedings under section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or ground rooms in respect of whch 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 *In addition to Demolition Orders there were three houses in respect of which "undertakings" were given by the owners. It should be noted that under Section 3 (Statutory Action taken) of the above statistical statement, action taken does not necessarily refer only to houses inspected during the year under review. 24 SECTION E. INSPECTION AND SUPERVISION OF FOOD (i) Adulteration. The following table shows the action taken by the Surrey County Council in the Borough during the year under the Food and Drugs (Adulteration) Act, 1928 :— ARTICLES ANALYSED ADULTORATED OR DETERIORATED PROSECUTIONS CONVICTIONS Formal Informal Total Formal Informal [ Total Milk 45 1 46 1 - 1 - Cream 2 — 2 - - - - - Butter 2 — 2 - - - - - Meat 3 — - - - - - - Sausages 1 — 1 —- — — — — Whiskey — 2 2 — — — — — Other Articles 2 7 9 — — — — — Totals 55 10 65 1 - 1 — — (ii) Milk Supply, Meat and Other Foods. Particulars of action taken with regard to milk, meat, and other foods, including inspection of meat, slaughterhouses, shops, and places where food is prepared are given in the Report of the Sanitary Inspector, which is included at the end of the Main Report. 1 made a personal inspection of the four private slaughterhouses which are situated at: 1. No. 120, London Road. 2. Behind No. 34, Richmond Road. 3. Adjoining No. 76, Cambridge Road. 4. No. 45, Cambridge Grove Road. The buildings are old and by no means ideal, but on the whole are well kept. With regard to No. 45, Cambridge Grove Road which is an old wooden building, where very little slaughtering takes place, it seems a pity that this structure continues to be maintained for the purpose. 25 The number of animals slaughered at private slaughterhouses during the last five years is shewn in the following table:— 1929 11,704 1930 11,821 1931 9,629 1932 10,181 1933 6,928 The sudden large decrease this year is mainly due to the fact that at the end of 1932, a private slaughterhouse at No. 90, Acre Road was closed. Up to that time much killing had been done at this particular slaughterhouse, most of which has now been transferred to slaughterhouses outside the Borough. (iii) Nutrition. No special work has been done on this subject. Information and knowledge on this matter is disseminated by the Medical Officers presiding at the Centre, and good work in this direction is done by the Nurses when home visiting. SECTION F. INFECTIOUS AND OTHER DISEASES. The following table gives a comparative statement of notifications received during the last fifteen years:— Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid) 1919 98 142 l 1920 139 82 2 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 1926 82 27 7 1927 87 65 3 1928 135 152 7 1929 74 113 1 1930 78 100 5 1931 61 53 1 1932 56 47 1 1933 125 30 2 26 SCARLET FEVER. As will be seen there has been a rise in the incidence cf Scarlet Fever of a mild type, which at no time became epidemic, the most prevalent period occurring during the month of July. Nineteen of the cases were nursed at their homes and there were no deaths from this disease. DIPHTHERIA. From the above table it will be seen that the number of cases notified is lower than last year and there has been a steady decrease since the peak year of 1928. All cases were admitted to the Wimbledon Isolation Hospital, and only one death occurred from 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. In August the Princess Louise Home in Gloucester Road was occupied by Dr. Barnardo's Homes, and is now known as the Dalziel of Wooler Memorial Home. This Home accommodates about 150 boys, who are artificially immunized against diphtheria by their own Medical Officer. 27 Notifiable Diseases during the Year. Cases. Total Cases Notified Cases admitted to Hospital 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 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 — I 2 4 13 64 26 1 10 3 1 - 125 106 - - - - - - - - - - - - - Diphtheria — 3 I 1 3 4 7 S S 1 — - 30 30 - - 1 - - - - - - - - - 1 Enteric Fever including Paratyphoid - - - - - - - - 1 - - _ 2 1 - - - - - - - - - - - - - Pneumonia 2 2 1 1 2 1 2 — 4 3 9 5 32 7 1 - - - - - - - - - 2 — 3 Erysipelas 1 - - - - - 1 — 4 4 5 2 17 6 - - - - - - - - - - - - - Puerperal Pyrexia — — — — — — — — 5 3 — — 8 — - - - - - - - - - - - - - Puerperal Fever — — — — - — — — 2 — — — 2 1 - - - - - - - - - - - - - Anterior Poliomyelitis 1 — — — — — 1 1 — — — - 3 3 1 - - - - - - - - - - - 2 Encephalitis Lethargica — — — — — — — — — 1 1 — 2 - —- - - - - - - - - 1 1 - 2 New Cases. Deaths. Under I year. 1—5 5—10 10 - 15 15—20 20—25 25—35 35—45 45-55 55—65 65 & over. Total. Under 1 year. 1-5 5—10 10—15 15—20 20—25 25—35 35—45 45-55 55-5 65 & over. Total. Tuberculosis (a) Pulmonary m. - - - - 2 1 2 2 1 3 1 12 - - - - 3 2 4 3 6 2 1 21 F - - - - - 4 2 2 2 1 11 — — — — 1 1 1 2 4 1 1 11 Total - - — - 2 5 4 4 3 4 1 23 — — — — 4 3 5 5 10 3 2 32 (b) Non-Pulmonary M. 1 — - 2 1 — — — — — - 4 - - - - 1 - - - - - - 1 F. - - 1 1 3 1 - - - - - 6 - - - - 1 - - - - - - 1 Total 1 — 1 3 4 1 - - - - - 10 - - - - 2 - - - - - - 2 28 ENTERIC FEVER. Two cases of Typhoid Fever were notified during the year. The first was received on August 31st in respect of a young woman aged 20, who was an in-patient at the Kingston Victoria Hospital. Her home was in Kingston, but she had been staying in Cornwall on holiday prior to her illness over a period which included the probable moment of infection. Her movements on holiday were ascertained and the places where she consumed food or drink noted. She was in the habit of having ice cream. Correspondence with the Medical Officers of the districts concerned failed to prove anything, but in my opinion there is little doubt she contracted the disease while on holiday. She made a good recovery. The second case was notified on September 29th in a young man aged 18, who was an in-patient at the Kingston and District Hospital. He had been admitted to Hospital from his home in Wimbledon. He was a baker's roundsman and was in the habit of drinking from water fountains. The Medical Officer of Health of Wimbledon after exhaustive inquiries was unable to discover the source of infection. He made a good recovery. ENCEPHALITIS LETHARGICA. Two cases were notified during the year. The first was a woman aged 43 years, admitted to the Kingston and District Hospital on February 1st, and died there on February 14th. Her home address from which she was admitted to Hospital was situated in Albury, Surrey. 29 The second occurred in a woman aged 48 years, who was admitted to Kingston and District Hospital from Surbiton and died on March 16th. It will be observed that neither of these cases were actually residents of the Borough but were notified after the diagnosis had been made upon their admission to Hospital. ANTERIOR POLIOMYELITIS. Three cases were notified during the year. The first was in a baby girl of six months who had been admitted to the Kingston Victoria Hospital on July 16th. The onset had been sudden on July 9th with convulsions and squint. She was not notified as Acute Poliomyelitas until August 2nd. She died on August 8th, 1933. The second case occurred in a young woman aged 18 years who was admitted to the Kingston Victoria Hospital on July 29th and notified as Acute Poliomyelitis on August 3rd. She developed extensive paralysis of an arm and leg. The third case was notified on August 28th from the West London Hospital in a boy aged 12 years. He had been taken ill with a "stiff neck" on August 25th and on August 28th, his doctor arranged for his admission to the West London Hospital, where he died suddenly the same evening. PNEUMONIA. The number of cases notfied was 32, compared with 43 and 28 for the last two years. The majority of the cases occurred during the prevalence of Influenza at the beginning of the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Comment on these diseases will be found under Section B of the Report (Maternity and Child Welfare, Sub-section ii). 30 OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1933 :— Treated Vision Vision Total Notified. At Home. In Hospital. unimpaired. impaired. Blindness. Deaths. 2 2 2 Arrangements have been made with the Metropolitan Asylums Board for the reception and treatment of cases of Ophthalmia Neonatorum from the Borough at St. Margaret's Hospital, Kentish Town, N.W.5. 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. 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. A Sanitary Inspector is detailed to visit each notified case and report on the condition of the premises, and also to advise all contacts to consult the County Tuberculosis Officer. 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. 31 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. Influenza was prevalent in the Borough at the beginning of the year. Eighteen deaths were attributed to this disease. There was no outbreak of Measles, but Mumps was prevalent at St. Peter's Junior Mixed School in July and at Richmond Road Schools in November and December. The Sanitary Inspector, Mr. H. T. Perry, reports as follows:— 32 Report of the Chief Sanitary Inspector To the Mayor, Alderman and Councillors. Ladies and Gentlemen, I have the honour to present my fifteenth Annual Report on the work carried out by your Sanitary Inspectors during the year 1933 in connection with the various Statutes and Byelaws relating to Public Health in force within the Borough. The total number of inspections made during the year was 7718, as compared with 7251 during the year 1932. On 732 premises sanitary defects to the number of 5569 were discovered. Arising out of these defects, it was found necessary to serve 547 "preliminary" and 27 "verbal" notices. In 53 instances the informal action did not have the desired effect, and it was necessary to serve "statutory " notices. During the year under review, 775 fresh entries were added to the Register of Sanitary Defects. In 726 cases entries were cancelled following completion of necessary works. On December 31st, 1933, 344 separate entries remained under review, compared with 295 at the end of 1932. During 1933, 352 enquiries under the Land Charges Act 1925, respecting property in the Borough, were received from the Town Clerk's Department and replied to. The year under review has been one of continued effort. The results achieved may not have been spectacular in character but none the less they may be regarded as having proved very satisfactory. . The annual work of sanitation and food protection cannot be shown in the form of the ordinary 33 commercial balance sheet. The credit balance of public health is indicated by continued improvement in the hygienic condition of the town, by better environment, higher standard of housing and a safe food supply. Kingston may justly lay claim to each of these attributes. The comparatively few areas of low standard houses, together with those individual properties recommended for demolition, are being dealt with in accordance with the housing programme approved by the Corporation. Up to the end of 1933 no appeals had been entered against action taken by the Corporation in respect of individual houses under the Housing Acts. This is due probably to the policy of helpful co-operation which the Corporation extends to owners of property, rather than the strictly formal procedure laid down by the statutes. This freedom from the need to resort to legal action applies to business premises also so far as action under the Public Health Acts is concerned. For convenience of reference the inspections and visits are set out in the following tabular form:— INSPECTIONS AND VISITS. The following list shows the number ot Inspections made in regard to each section of the work, and the total of all inspections. Rent Restrictions Act Inspections 5 Re-inspections 1749 Visits to Works in Progress 1235 Factories and Workshops 227 Cowsheds, Dairies and Milkshops 107 Ice Cream Premises 89 Foodshops and Food Preparing Rooms 570 Infectious Disease Enquiries 281 Markets 198 Special Inspections (including complaints, etc.) 1002 Slaughter-houses 844 Offensive Trades 37 Sanitary Conveniences 103 Common Lodging-Houses 21 34 Canal Boats 29 Theatres, Cinemas, etc. 29 House to house 188 Bakehouses 47 Smoke Observations 33 Stables and Yards 53 Enquiries re Housing Applicants 38 Well Water Enquiries 55 Sale of Poisons 22 Shops Acts 356 Schools 23 Miscellaneous Visits 377 Total 7718 SUMMARY OF SANITARY IMPROVEMENTS. Below will be found a rather formidable list of works carried out by owners of property in the Borough at the request, or on the advice, of the Corporation. The works represent the expenditure of a very considerable sum of money. Add to this the cost of works which are carried out voluntarily without reference to the Corporation, and it will be seen that maintenance costs of property aggregate a much larger sum than is generally realised. As far as possible all works are supervised during progress. This surveillance is more in the interests of the owner than for any benefit the Corporation may derive from it. Unfortunately it is not always known when works are in progress and occasionally the work is not inspected until completion. WATER CLOSETS AND SANITARY FITTINGS. New W.C. Basins fixed 62 W.C. Flushing Tanks repaired or renewed 44 New W.C. apartments 2 W.C. Apartments lighted, repaired or ventilated 56 W. C. Apartments cleansed and limewashed 56 W.C. Seats renewed or repaired 19 New W.C. Apartments 5 W.C. Pans cleansed 24 New Baths provided 2 New Impervious Sinks provided 20 35 ]$$$]Sinks refixed 5 New Lavatory Basins fixed 3 New Trapped Waste Pipes fixed 35 Existing Waste Pipes trapped or repaired 32 New Urinals constructed 1 Urinals cleansed or repaired 14 Miscellaneous 13 DRAINAGE. Number of Houses and Premises re-drained 27 Number of Drains repaired or amended 5 New branch drains 10 Drains or Gullies unstopped or cleansed 41 New Manholes provided 55 Existing Manholes altered or repaired 4 Intercepting Traps fixed 18 Fresh-air Inlet Shafts repaired, renewed or provided 46 New Gully Traps fixed 106 Gully Curbs renewed or repaired 9 New Soil Pipes and/or Ventilating Shafts 26 Ventilating Shaft repaired 1 Sanitary Accommodation to Workshop amended 1 Miscellaneous 20 GENERAL REPAIRS. Roofs repaired, new fillets, soakers, etc. 86 New Gutters and Stack Pipes provided to roofs 17 Eaves Gutters renewed or repaired 65 Stack Pipes renewed or repaired 47 Stack Pipes disconnected from drains 40 Dampness abated 92 Defective Walls repaired, re-pointed, etc. 168 Defective walls "tied" 2 Defective wall taken down and rebuilt 1 Chimney Stacks rendered, rebuilt or repaired 39 New Chimney Pots fixed 3 Ventilation provided beneath floors 42 Ventilation provided to rooms 71 Staircases lighted or stairs repaired 53 36 Handrails to staircases provided or refixed 40 Sites of houses concreted 1 Yards paved 33 Yard Paving repaired and yards cleansed 21 Paved Pathways constructed or repaired 22 Floors of Rooms repaired 90 New Floors of rooms 14 Rooms repaired, cleansed and distempered 345 Larders ventilated and cleansed 8 Food Store provided 6 New Ceilings 32 Premises limewashed 26 Windows repaired, renewed or made to open 279 Additional light to rooms 7 Door and Window Sills renewed or repaired 102 Doors renewed or repaired 54 Frame joints re-made 47 Door locks repaired or renewed 37 New Portable Ashbins provided 381 Accumulations of manure and refuse removed 6 New Manure receptacle 1 Nuisance from overcrowding abated 14 Water Supply provided direct from rising main 24 Service water pipes repaired 10 Service water tanks cleansed, covered or removed 12 Use of Well-Water discontinued and M.W.B. supply laid on 11 Stoves and Firegrates repaired or renewed 88 Fireplace surrounds or hearths repaired 15 Flues repaired i Coppers repaired or renewed 46 Dilapidated Sheds demolished 1 Illegal use of basement rooms discontinued 4 Houses repainted externally or internally 13 Boundary fences repaired or renewed 4 Hot-Water apparatus provided or overhauled 4 Insanitary Houses demolished (Housing Act) 9 Verminous premises cleansed 4 Improper sleeping rooms discontinued 3 Miscellaneous 49 37 SMOKE ABATEMENT. The number of complaints of excessive smoke or grit received during 1933 was 10. Thirty-three observations of chimneys were made. The use of low grade or unsuitable fuel is found to be the most usual cause for smoke and grit. In some cases the stoker has other duties to perform and is prevented from stoking as often and as regularly as he should. The bye-law in force in the Borough prohibits the emission of black smoke for more than two minutes in any consecutive thirty minutes. Observations are taken over periods of forty minutes and contraventions of the Act are notified either by telephone or by personal visit to the offending works. The retorts at the Gas Works were not used during part of last Summer and the reduced emission of smoke was distinctly noticeable. 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. The Vicarage Road premises were designed for the purpose of a lodging houses at the time of erection. The Canbury Passage house on the other hand was converted to its present use from that of a public house. The latter premises has several drawbacks but it is maintained in clean condition and good repair having regard to the age and lay out of the building. There were changes in the person of the registered deputy at each of the premises during 1933. Twenty-one visits were made to the lodging houses during the year. 38 OFFENSIVE TRADES. There are but three trades within the Borough which may be described legally as " Offensive " trades. They are : Leather Tanning and Fellmongering. Rags and Bone Yards. Fish Frying. Each of these trades require to be carried on with particular care to prevent annoyance or nuisance. It is doubtful if more than a small percentage of passers-by realize that a tannery is situated so close to the business centre of the town, so seldom can its presence be detected. No complaints have been received in respect of the tannery for several years, but one complaint was received during the year regarding one of the other trades. There has been no change in the number of rag and bone yards in the Borough. Frequent visits are necessary to these premises to see that all possible steps are taken to prevent the occurrence of nuisances. During the year permission was sought to commence the trade of fish frying in Surbiton Road. The suggestion was not approved, and no formal application was made. Towards the end of the year one small fish shop in Acre Road ceased to function and has now been converted into a meat shop. Fish frying was commenced without permission at premises in Hawks Road but the business was terminated after notice from the Corporation. Likewise the trade of rag collection was recommenced for a short period at premises in Acre Road without the necessary permission of the Corporation. In this case the business was carried on at a private house and permission to continue the trade was refused. Only a few of the fishmongers in the town have not availed themselves of the facilities for the daily removal of fish waste by one contractor. The arrangement has proved very satisfactory. The contractor delivers clean galvanised iron bins of heavy gauge fitted with sound fitting lids each 39 evening and removes the full bins. There is no spilling of material and the daily collection enables the waste to be removed before advanced decomposition can take place. The contractor makes his own terms with the shopkeepers and has been engaged by the Markets Committee to collect the waste from the fish stalls in the Market. Thirty-seven visits were made to offensive trade premises during 1933. These visits were in addition to reinspections after notices or warnings. COMPLAINTS. Two hundred and forty complaints were received during the year, as follows:— Drains and sanitary arrangements 60 Overcrowding 6 Overcrowding of Workroom 1 Condition of Premises 70 Accumulations of manure and non collection of house refuse 12 Dampness and defective roofs, gutters, etc. 15 Smoke nuisance from chimneys 10 Defective stoves and copper 6 Rats 6 Water supply 6 Keeping of animals and fowls 5 Unpaved yards and passages 3 Nuisance from flies 2 Condition of roadway 2 Defective Geyser 1 Flooding of basement 2 Nuisance from burning refuse 6 Defective ashbins 2 Unsafe chimney stacks 2 Nuisance from refuse tip 4 Nuisance from cesspools 3 Offensive Trade premises 1 Obstruction of Light and Air to premises 3 Miscellaneous 12 Total 240 40 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. HOUSE DRAINAGE. Twenty-seven premises were completely redrained during 1933 in addition to 11 other premises where drains were repaired or reconstructed in part. The work of examination of existing drainage is extremely important and is carried out thoroughly under the powers contained in the Public Health Acts, when there is reason to believe the condition of drains is not good. Frequent visits are made to all drain reconstruction works in progress and final tests are applied to all new work above or under the ground upon completion. The following list gives the situation and numbers of premises redrained during the year:— Acre Road 2 Albany Park Road 1 Franklin Road 1 Grove Lane 2 Elm Road 1 Fairfield West 8 Kings Road 3 London Road 1 Mill Street 1 Norbiton Avenue 1 Princes Road 1 Queens Road 1 Richmond Road 1 Shortlands Road 2 Wolverton Avenue 1 27 41 HOUSING. The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on pages Eight hundred and seventy four houses were inspected completely or in part under the Public Health or Housing Acts. The houses visited under the Housing Regulations are inspected thoroughly from top to bottom and full details of the structure, general conditions, tenancy, ownership, etc., etc., are recorded for future reference. The inspections were not limited to any one part of the Borough as the following list of roads will show:— Acre Road 3 Ashdown Road 1 Brook Street 2 Canbury Park Road 5 Canbury Passage 14 Canbury Place 16 Cambridge Grove Road 1 Cambridge Road 3 Church Road 1 Cowleaze Road 5 Elm Road 1 Elton Road 2 Fairfield Road 10 Fairfield North 2 Gibbon Road 1 Hawks Road 5 Hardman Road 2 Hudson Road 1 Kings Road 2 Mill Place 1 Osborne Road 1 Oaklea Passage 1 Orchard Road 1 Princes Road 1 Richmond Park Road 1 42 Richmond Road 18 Southsea Road 1 Vincent Road 1 Washington Road 1 Walter Street 13 117 Thirty-nine of the houses were considered to be unfit for human habitation, and of these, 28 were duly represented as forming four clearance areas. The remaining 11 houses reported for action under Section 19 of the Housing Act 1930 were dealt with as follows : Situation. No. Action Taken. Princes Road 1 house (s) "Undertaking" accepted Cowleaze Road 3 „ "Demolition" Order made Cowleaze Road 1 „ "Undertaking" accepted Canbury Passage 1 „ "Undertaking" accepted Canbury Passage 2 „ "Demolition" Order made Bath Passage 1 „ "Demolition" Order made Cambridge Road 2 „ "Demolition" Order made The following 9 houses were demolished during the year in pursuance of Demolition Orders made in 1932 and 1933: Nos. 1 & 3, Denmark Road.—1932. Nos. 1, 2 & 3, Oaklea Passage.—1932. Nos. 25, 27 & 29, The Bittoms.—1932. No. 2, Bath Passage.—1933. Six other houses in the Bittoms remain vacant in pursuance of "undertakings" which have been accepted. The owner of one block of four intends to redevelop the site whilst the other two have been purchased by the Corporation and will be demolished shortly. 43 ASH RECEPTACLES AND REFUSE COLLECTION. The manner in which house refuse is stored near dwelling houses between collection times is a subject which too often receives scant attention. Not only should the receptacle be suitable but the position of the ashbin should be chosen with care. The first of these conditions is controlled by the Public Health Acts but the second depends very much upon the occupiers of premises. Likewise the very nature of the refuse is dependent upon the occupiers. In those cases where proper precautions are not taken, the ashbin may become an intolerable nuisance, not only from the point of view of smells but also by encouraging the presence of rats. The use of a standard size of ashbin, viz. 30 inches by 18 inches is encouraged in the Borough. The steady improvement in the type of ash receptacles used has continued and it is exceptional to find odd boxes and old baths in use for the purpose. The elimination of those undesirable and unsightly objects has been accomplished by systematic inspections street by street, and by the aid of reports received from the refuse collectors. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACTS. The number of applications for certificates under Section 2 (2) of the principal Act remains low—there being 3 only during 1933. The experience of this Borough in this matter is not unusual for it appears to be general throughout the country. For some reason not at all clear, tenants do not avail themselves of the opportunities afforded by the Acts. In one case only during 1933 a certificate was granted to an applicant. Of the remaining two applications, one house was found upon inspection to be in reasonable repair, and the owner of the other house carried out necessary repairs. There were four applications during 1932. 44 INSPECTION AND SUPERVISION OF FOOD (a) MILK SUPPLY. During 1933 ten names were removed from the Register of Dairymen for various reasons, chiefly business changes. In one case the removal was by order of the Corporation. Twenty-seven fresh entries were added to the register, leaving a total at the end of the year of 63, compared with 46 at the end of 1932. The increase is due mostly to the sale of sterilised milk in bottles, which accounts for no less than 21 out of the total of 63 registrations. The premises on which this milk is sold are not dairies, the registration being of the person carrying on the business. The milk is sold in the unopened bottles as received on the premises. There is only one cowkeeper in the Borough. Graded Milks. There is no licensed graded milk producer in the Borough, but 19 dealers' licenses for the sale of graded milk were issued during the year, compared with 26 for the year 1932. There is not a great demand for the higher grades of milk, and this fact discourages milk producers from applying for the necessary licenses. The license fee payable in respect of the production of certified milk is £5. In addition, the producer of this high grade milk has to meet the cost of periodical veterinary examination and tuberculin testing of his herd, and suffer losses by the sale of cows which re-act to the test. On the other hand the ordinary cowkeeper pays no annual fee and is not required to have his herd tested etc. The price obtainable for the higher grade milk does not compensate the producer for the extra cost of production. The retailing of milk from churns and hand cans is discouraged in the Borough, but is not forbidden by law. (b) MEAT AND OTHER FOODS. The number of animals slaughtered in the Borough during 1933 was 6,928, showing a large decrease compared with the previous year. This reduction was foreshadowed in my last report. It is due in chief to the closing of the slaughterhouse in Acre Road. The butcher who used these premises now slaughters in a district in Middlesex. 45 The comparative figures of the number of animals killed in the private slaughterhouses during each of the past five years is shown on page The Meat Regulations 1924, require notice of intended slaughter of animals to be sent to the Meat Inspector, and for carcases and organs to be retained for a prescribed period of hours in order to permit an examination of the meat to be made. The proper use of these Regulations has enabled accurate data regarding meat inspection work to be collected. Other food premises, such as restaurant and hotel kitchens, sausage and cooked food rooms, ice cream premises, bakehouses, are all visited from time to time and at irregular periods. The total visits to food premises during 1933 was 1,855. 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. The only class of animals not examined in every case was sheep. Sheep are much less the subject of disease than bovines or swine. The following table shows the number of slaughter notices received, the number and variety of animals referred to, etc. MEAT REGULATIONS 1924 Summary for year ended December 31st, 1933 Number of Notices Received Number of Animals Slaughtered Beasts Pigs Calves Sheep Goats Total 542 21 4707 741 1459 — 6928 Carcases not Examined Percentage of Total Animals Examined Pigs Sheep Calves — 52 — 99.25 46 ARTICLES OF FOOD CONDEMNED. 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. Articles of food. Reason for condemnation. Action taken. Pigs:— 12 carcases & organs Tuberculosis Inspected & Condemned 1 carcase & organs Fevered „ „ „ 2 carcases & organs Pleurisy „ „ „ 1 carcase & organs Peritonitis „ „ „ 1 carcase & organs Oedema „ „ „ 1 carcase & organs Suffocation „ „ „ 157 heads and necks Tuberculosis „ „ „ li heads & necks Abscess in Jaw „ „ „ 27 plucks & 8 pairs lungs Tuberculosis „ „ „ 13 plucks & 14 pairs lungs Inflammation „ „ „ 15 Livers Cirrhosis „ „ „ 2 Livers Necrosis „ „ „ 1 Hindquarter Tuberculosis „ „ „ 621bs. „ „ „ „ 3 Hearts Pericarditis „ „ „ 53 Mesenteries Tuberculosis „ „ „ 16 Spleens „ „ „ 6 Spleens Putrefaction „ „ „ 2 Hams Voluntarily surrendered. 3 Kidneys Tuberculosis Inspected & Condemned 1 Kidney Nephritis „ „ „ 601bs. Kidneys Inflammation „ „ „ 47 BOVINES.— 1 Carcase & organs Tuberculosis „ „ „ 2 Heads & Tongue „ „ „ 1 Head & Tongue Actinomycosis „ „ „ 5 pairs Lungs Tuberculosis „ „ „ 1 pair Lungs Parasitic „ „ „ 3 Livers Distomatosis 401bs. Ox Kidney Putrefaction Voluntarily surrendered. 51bs. Ox Liver „ „ „ 6291bs. Beef „ „ „ 401bs. Beef. Injury „ 41bs. Beef Necrosis „ „ 121bs. Fat Putrefaction „ „ 1 Tin Corned Beef „ „ „ VEAL.— 3 Carcases & organs Tuberculosis Inspected & Condemned 2 Plucks it „ „ „ „ MUTTON.— 1 Carcase & organs Emaciation „ „ „ 1 Liver Abscess „ „ „ 10 Livers Distomatosis „ „ „ 7 pairs Lungs Strongylus Rufescens „ „ „ 1431bs. Livers Putrefaction Voluntarily surrendered. 271bs. Mutton „ „ „ 291bs. Kidneys „ „ „ FISH.— 6 boxes Cod Fillets Putrefaction „ „ 761bs. Prawns „ „ „ PRIVATE SLAUGHTERHOUSES. On December 31st, 1933, there were four private slaughterhouses in the Borough, all of which had been in use during the year. The premises situated in Acre Road which were purchased by the Corporation during 1932 were not used after December 31st of that year. The slaughterhouses are situated as follows :— Adjoining No. 76, Cambridge Road. No. 45, Cambridge Grove Road. No. 120, London Road. Rear of No. 34 Richmond Road, 48 There is no alteration in the structure of the slaughter houses to report. The slaughterhouse in Cambridge Grove Road is used irregularly and then only for a few animals on each occasion. It is a wooden structure and judging by its age it would appear to be a registered premises. During the year the Slaughter of Animals Act 1933 was passed and came into force on January 1st, 1934. So far as this Borough is concerned, the Act was retrogressive rather than progressive in one respect. For the past six years the bylaws relating to slaughterhouses in the borough required that all animals must be stunned by a mechanically operated instrument previous to slaughter. The new Act excluded certain animals from this requirement but provided that such animals might be included by special resolution of a local authority. The requisite resolution was duly passed by the Corporation and ALL animals continue to be humanely stunned in the slaughterhouses. The Act also, for the first time, provided for licensing of slaughtermen. Twelve applications were received of which 9 were granted, 1 was withdrawn and 2 were not granted. There is no provision in the Act for any condition to be attached to licences and this gives rise to difficulty. A man who may be quite satisfactory when handling small animals is not always able to deal with beasts, but his license to slaughter covers all animals. A further point is that no provision has been made in the Act for apprentices and learners. It is too soon, however, to urge for amendments and further experience of the working of the Act may indicate the appropriate remedies for apparent defects. The spare gun kindly loaned to the Borough by the R.S.P.C.A. has been used on several occasions when guns belonging to butchers have been temporarily out of action. Eight hundred and forty four visits were made to slaughterhouses during the year, 49 FACTORIES AND WORKPLACES. Two hundred and twenty-seven visits were made to factories and workplaces during 1933 as compared with 218 in 1932. Other details with respect to these premises are contained in the tables on pages Factories are subject to inspection by H.M. Inspector of Factories, but it is the duty of the Local Authority to inspect the sanitary accommodation and to see that any sanitary defects are remedied. H.M. Inspector sends notification of any defects he has discovered so that appropriate action may be taken. For some years now a spirit of helpful co-operation has existed between H.M. Inspector for the district and your officers. Notes are compared at convenient intervals, and overlapping is avoided. DISINFECTION AND INFECTIOUS DISEASE. The numbers of rooms disinfected and articles passed through the steam disinfector during 1933 were higher than for several years previously. There were 232 rooms in 174 houses sprayed and fumigated with formalin in the case of ordinary infectious diseases and in the case of verminous rooms, special insecticide liquids were used together with sulphur dioxide. Spraying and fumigation of rooms and steam treatment of bedding etc. is carried out at the request of occupiers in cases other than ordinary notifiable diseases. A charge, sufficient to cover the cost of the work, is made in such cases. The infectious disease ambulance is constructed for the dual purpose of removing patients to hospital and for the conveyance of bedding to and from the disinfecting station. Two hundred and eighty-one visits were made in connection with infectious disease enquiries. The results of the investigations were passed to the Medical Officer of Health. 50 SANITARY CONDITIONS OF MUSIC HALLS, CINEMAS, ETC. Twenty-nine formal visits were made to places of public entertainment during the year. The inspections are made to ascertain the condition of dressing rooms, sanitary accommodation and other parts of the premises, such as under the stage where accumulations of rubbish are likely to be found. Visits are also made at irregular times when the premises are in use to ensure that the ventilation apparatus is not only in order but is in use. No complaints were received during the year regarding places of entertainment, and the premises were found to be in satisfactory condition when visited. CANAL BOAT ACTS. In accordance with Section 3 of the Canal Boat Acts, 1884, I beg to report as follows : During the year 1933, 29 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 at night. Small matters found to require attention were dealt with without need for service of notices. 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 licencees have failed to keep the premises in order. 51 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. There are no known work-places in the town where Rag Flock, or materials coming within the legal definition of Rag Flock, are used. No samples of material were taken for analysis. SALE OF POISONS. Twenty-two visits were made to premises other than pharmacies to ascertain that the proper records of sales of poisons were being kept and that the poisons were being kept in a safe place. The poisons are used in connection with horticulture and agriculture. Four licences were issued during 1933. SHOP ACTS 1912 TO 1931. Three-hundred and fifty-six visits were made in respect of the administration of the Shops Acts. There appears to be a general desire on the part of the shopkeepers to comply with the Acts, and but few complaints were received during the year. Advice has been given to shopkeepers respecting the various provisions of the Acts and especially with regard to the proper notices which should be exhibited in the shops regarding the halfday closing and the half-holiday for assistants. In cases where a shop is not closed at the proper time the occupier is interviewed. This is followed up by a letter giving particulars of the closing times, and a warning that any further contravention will be reported to the 52 appropriate Committee. This procedure usually had the desired effect, but in two instances legal proceedings were instituted against shopkeepers for serving customers after proper closing hours. In both cases previous warning had been given. Convictions were recorded in each instance, and fines of 10/- each with 21/- costs were imposed. CONCLUSION. I desire to thank you, Mr. Chairman, and the Members of the Public Health Committee and Corporation generally, for your continued consideration and support, and your other Officers and Staffs who have afforded me assistance and information on numerous occasions. 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. April 1934. 53 Report of the School Medical Officer. March, 1934. To the Chairman and Members of the Education Committee of the Royal Borough of Kingston-uponThames. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1933. The average number of children on the school register for the year was 3,812. In addition there were 45 children on the books of the Special Open Air Day School at the end of the year. Medical inspection, orthopaedic, eye, nose, throat, and dental work were carried out on the same lines as before. The centralisation of the Health Services at Grange Road greatly facilitates administration, and results in easy and close co-operation between the Public Health and School Medical Services. The Schools have enjoyed a year of comparative freedom from notifiable infectious diseases. The year may be regarded as a very satisfactory one in which much work was carried out, and the efficiency of the Service well maintained. There was no change in the Staff of the School Medical Service, all members of which I thank for their loyal support throughout the year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, School Medical Officer. 54 Staff of the School Medical Service on DECEMBER 31st, 1933. School Medical Officer : E. W. MATTHEWS, m.b., b.s.(lond.), m.r.c.s., l.r.c.p., d.p.h. Oculist : IVOR AUBREY, M.C., m.r.c.s., l.r.c.p. Dental Surgeon : H A. L. MORRIS, M.C., l.d.s., r.c.s. (eng.). Ancesthetist : OLIVE G. AUBREY, b.a., m.l>., b.ch. School Nurses : Miss A. GILL (Senior) 1/2 time. Miss C. A. HOOKWAY 1/2 time. Miss L. G. SAL WAY 1/2 time. Miss E. G. COUZENS, 1/2 time. Clerk : Miss P. M. JNGILLSON. 55 RE-ORGANISATION OF COUNCIL SCHOOLS. In August 1932 as a first stage towards the re-organisation of the Council Schools of the Borough along the lines laid down in the Report of the Board of Education Consultative Committee "The Education of the Adolescent," the departments at the two Council Schools were re-organised so as to provide separate departments for children over the age of eleven. At Bonner Hill Road School the Girls' Department became a school for senior girls, to which girls over eleven years of age who had previously attended Richmond Road School and Bonner Hill Road School were drawn, and the Boys' Department become a Junior Mixed School for those children between the ages of seven-and-a-half and eleven years of age who had previously attended' Bonner Hill Road School. At Richmond Road School t he Girls' Department became a school for senior boys, to which were drawn all those boys over eleven years of age who had previously attended Richmond Road and Bonner Hill Road Schools. The Boys' Department became a Junior Mixed School for those children between the ages of seven-and'-ahalf and eleven who had previously attended Richmond Road School. At each school the Infants' Department remained unaffected. By this re-organisation the Council Schools came into line with the Church Schools which were already re-organised into Infant and Junior Schools, and Senior Departments for boys and girls over the age of eleven. The re-organisation of both Church and Council Schools affects the School Medical Service, since children attending the Senior Schools are now drawn from all parts of the Borough. Formerly a School Nurse had a visiting area limited to the district immediately surrounding her School, whereas under the new arrangement, School Nurses in charge of Senior Schools each make following-up visits throughout the whole area, 56 It is doubtful whether this can be avoided since it is essential that a School Nurse should have personal knowledge of the home conditions of the children attending her particular School. Again it must be borne in mind that in outbreaks of infectious disease the contacts from one family may be distributed in two or three Schools, a potential source of infection, which was formerly confined to the departments of one School only. Hence the limitation of such outbreaks to one area in the Borough appears to be less likely. CO-ORDINATION. The School Medical Officer is also Medical Officer of Health. The School Nurses are also Health Visitors, and each carries out Maternity, Child Welfare, Infant Life Protection and School work. Records of infants are transferred to the School Medical Service as soon as these infants attain the age of five. The Offices of the School Medical Service, Elementary Education, and Public Health Department together with the Clinics and Open Air School are all centralised at the building in Grange Road, which makes co-ord'ination and co-operation between the Health Services easy and complete. SCHOOL HYGIENE. Bonner Hill Road School. New lavatory accommodation was provided by the erection of a block of an additional ten water closets for the Junior Girls and five for the Infants. The woodwork of the Infants' Department was revarnished. 57 All Saints' School. Internal and external decorations were carried out. Only minor repairs and decorations were necessary in other Schools. MEDICAL INSPECTION. All Departments of every School are visited by the School Medical Officer each term for the purpose of carrying out Routine, Special and Re-inspections. A full description of the methods employed at these inspections was set out in the Annual Report for 1930. In no instance did any parent object to Medical Examination of a child. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. Malnutrition from actual want may be regarded as almost non-existent in the Borough. Delicate children exhibiting varying degrees of malnutrition are followed-up at School, and if recommended by the School Medical Officer they are transferred to the Grange Road Open Air Day School, provided the parents concur in the proposal. Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows :— No. of Children Examined. No. of Parents Present. Per centage. Entrants: Boys 195 162 83 Girls 184 157 85 Second Age Group: Boys 212 145 68 Girls 181 120 66 Third Age Group: Boys 226 75 33 Girls 205 105 51 58 (b) Uncleanliness. In my Annual Report last year I set out in detail the action adopted in cases of uncleanliness where legal proceedings were likely. The same course was pursued this year, and eleven prosecutions were made resulting in fines being imposed in ten cases. It appears that the procedure now in force has had the desired effect, since the eleven prosecutions were all made before the middle of July, and none were found necessary for the remainder of the year. The School Nurses have been most conscientious in this section of their work, all children in the Schools having been inspected within a fortnight after each holiday period, and afterwards at regular intervals. The great majority of parents have kept their girls' hair short during School life as advised. (c) Minor ailments and diseases of the skin. The number of minor ailments and skin diseases discovered and dealt with remains fairly constant in recent years, but this year only five cases of ringworm of the scalp were found and in no case was it necessary to employ X-ray treatment. (d) Visual defects and external eye disease. During the year 49 children were found requiring treatment for defective vision, and 17 for squint. (e) Nose and throat defects. There were 62 children suffering from enlarged tonsils and adenoids referred for treatment. This is rather a lower figure than those of the last few years. 59 (f) Ear disease and defective hearing. The minor ear diseases have been referred for treatment at the Clinic. Defective hearing is not common in children, except in those suffering from adenoids, which when removed effect a cure. (g) Dental defects. At his inspections the School Dentist found 2,364 children needing treatment. (h) Orthopædic and postural defects. Five cases of rickets, and six of spinal curvature have been referred for treatment. From time to time cases such as infantile paralysis, deformities, and results of accidents are found, and these are referred to the Orthopaedic Specialist. (i) Heart disease and rheumatism. Only one new case of organic heart disease was discovered this year. Fifteen children were recorded as suffering from rheumatism in some form and following-up cards were made out in all cases. (j) Tuberculosis. Cases of suspected Tuberculosis are referred to the Surrey County Council Tuberculosis Officer. (k) Other defects and diseases. These consist chiefly of the results of minor injuries, defective speech, thyroid enlargement, etc. With regard to defective speech, a survey was made throughout the Schools during the Autumn term when it was found that eighteen children suffering from speech defects were in the opinion of the School Medical Officer suitable for instruction in a Special Class under a teacher qualified in speech training. 60 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 the Annual Report for 1930. The following table specifies some of the work carried out by the School Nurses during 1933 :— Number of children prepared for Routine Medical Inspection 1356 Number examined at Schools for uncleanliness 14797 Number of following-up home visits 576 Total number of visits to the Schools 558 Total number of Clinic Sessions 434 TREATMENT. (a) Minor Ailments and Diseases of the Skin. The treatment of minor ailments and diseases of the skin was undertaken daily at the Clinic during school terms, 5463 attendances being registered during the year. Owing to the removal of Dr. N. H. Linzee from Surbiton, arrangements for X-ray treatment of ringworm were made with Mr. G. G. Blake of 10, Onslow Road, Richmond, at the rate of one guinea per case. (b) Visual Defects and External Eye Disease. Most of the external eye defects have been treated at the Minor Ailments Clinic, but when necessary they are referred to either the School Oculist or the Royal Hospital, Richmond. Cases of defective vision and squint are referred by the School Medical Officer to the Oculist who has prescribed spectacles for 100 children during the year. 61 (c) Nose and Throat Defects. As before, operative treatment of tonsils and adenoids has been satisfactorily carried out at the Kingston Victoria Hospital. The cases are visited by the School Nurses on their discharge from Hospital, and later are examined by the School Medical Officer before re-admission to School. Thirty-nine cases were treated under this Scheme during the year at a cost of £55 11s. 6d., towards which the parents contributed £14 4s. 6d. (d) Ear Disease and Hearing. Minor ear defects in the cases of 21 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (e) Dental defects. Of the 2364 children requiring treatment found by the School Dentist, 929 were actually treated, 768 being rendered dentally fit before the end of the year. There were 385 gas cases during the year. Mr. H. A. L. Morris, the School Dentist, reports as follows :— " During the year five sessions per school week were devoted to dental inspection and treatment. In all, 32 sessions were given to inspection at the Schools and 186 to treatment at the Clinic. The programme for the year was similar to that for 1932, and included inspection of all the age groups, and treatment of those for whom consent was obtained. Also all the children attending the Open Air School were inspected and treated. There is no special feature to report, but it is very satisfactory that all the School children are brought within the scope of treatment. For those who take advantage of the offer, it ensures a sound dental condition while at school, and renders them dentally fit on leaving." 62 (f) Crippling Defects and Orthopedics. During the year 9 individual children received electrical, massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 158 total attendances. The cost of the above out-patient treatment amounted to £15 16s., towards which the parents contributed £4 5s. 1d. In addition to the above children who received treatment under the Authority's Scheme, there were two who were in-patients at the Kingston and District Hospital, and one at the Royal National Orthopaedic Hospital. (g) Heart Disease and Rheumatism. Eight children suffering from heart disease are attending the Special Open Air Day School for delicate children. They are kept under constant supervision, and instructions are given to parents as to their care. These cases undoubtedly benefit from the individual attention given at this School, and also from the good midday meal and rest afterwards. Two children suffering from rheumatism not complicated by heart disease are also attending this School. No arrangements for treatment by Artificial Sunlight are in operation. INFECTIOUS DISEASE. Influenza was prevalent during January, the attendance at Bonner Hill Infants' School falling to just under 60% for a brief period. A circular was issued to all Head Teachers on simple precautions to be taken against influenza. An outbreak of Mumps occurred at St. Peter's Junior Mixed Schools in July and at Richmond Road Infants and Junior Mixed Schools in November and December, 63 With regard to notifiable infectious disease there has not been any definite outbreak in the Schools. The incidence of Diphtheria has been lower than in recent years, and Scarlet Fever has been mild. No School closure was necessary on account of Infectious disease. OPEN AIR EDUCATION. (a) Playground classes. In summer classes are held in the playground whenever possible at every School. (b) Open air classrooms. There is a bungalow classroom at Richmond Road Infants' School, two sides of which can be opened. (c) School journeys and camps. Educational visits are made to the country and local parks for nature study, etc. Thirty-nine girls from Bonner Hill Road Central School visited Sandown, Isle of Wight, from May 12th to 26th. A programme was arranged for each day, and as the weather was exceedingly fine no alteration had to be made. Almost all the work was done out of doors. Short walking excursions were taken at first with a definite object in view, such as the collection of wild-flowers, sea-weeds, etc. Then followed whole day excursions for instruction in map reading, stream tracking, geological studies, etc. Excursions were also made to places of historical interest or of architectural value. As most of the girls were able to swim, sea bathing was a favourite form of recreation. On their return the girls shewed that they had derived great benefit from the journey. 64 PHYSICAL TRAINING. The Board of Education Syllabus of physical training is followed in the schools. This is carried out as much as possible in the open air. The School Medical Officer advises as to children who are not suitable for physical training. Organised games are held during school terms in the various recreation grounds throughout the area. There is no Area Organiser for the Borough. PROVISION OF MEALS. There is no scheme operating for the provision of meals. On occasions, when recommended by the School Medical Officer, a child has been given free milk, the cost of which has been met out of a voluntary fund. Milk in bottles is delivered to the schools daily and a great many children buy this at 1d. per bottle. Miss C. M. Gilder from the National Milk Publicity Council has given most instructive lectures in the schools during the year, and also demonstrations in simple cookery. to the senior girls. CO-OPERATION OF PARENTS, TEACHERS, Etc. From the table given under the heading Medical Inspection it will be seen that the high percentage of parents attending Routine Medical Inspections has been maintained. Parents also attend Dental Inspections in satisfactory numbers. The teachers have been most helpful at Routine Medical Inspections, and have also aided in following-up children brought to their notice by the School Medical Officer, and in seeing that children with defective vision or squint wear their spectacles constantly. A revised list of children who should be wearing spectacles is sent to the Head Teachers every term. 65 The School Attendance Officer is very nelpful, particularly in getting children to attend the Clinic when required to do so by the School Medical Officer or Nurses. The Central Aid Society has helped in obtaining letters for Hospitals, etc., in cases where parents cannot afford to pay, and also in sending children away for convalescence to the seaside. The National Society for Prevention of Cruelty to Children has aided in following up obstinate cases when notified by the School Medical Officer. VACCINATION. At Routine Medical Inspections an entry is made on the Medical Record Card of every child not exhibiting evidence of previous vaccination. The percentage of entrant infants showing vaccination marks was 63. SCHOOL CLINIC. The School Clinic in Grange Road was described in detail in the Annual Report for 1931. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. 66 (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. There were 5463 attendances during the year. (c) Ophthalmic Clinic. Dr. Ivor Aubrey, the School Oculist, attends fortnightly on Wednesday afternoon during School terms to deal with cases referred to him by the School Medical Officer. Those children who have errors of refraction attend the Clinic three times a day on the Monday and Tuesday preceding the meeting for the purpose of having atropine ointment applied by the School Nurse. There were 385 attendances at the 20 sessions held during the year, 211 being new cases and 174 re-inspections. Refractions numbered 118, and spectacles, were prescribed in 100 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. Children for whom spectacles are prescribed are re-inspected by the School Medical Officer when he visits the School each term. (d) Dental Clinic. During the year five sessions per School Week were devoted to Dental Inspection and Treatment. In all, 32 half-days were given to Inspection and 186 to Treatment. There were 385 gas cases during the year. 67 A representative from the Dental Board visited various schools in the Borough and gave " talks " to the children on oral Hygiene etc., and displayed models and charts. Dental Board leaflets on the Care of the Teeth are distributed to all children shortly before they leave school. 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. There is no Special Day School for mentally defective Children. There are special classes at Bonner Hill Road Infants School, where instruction is based upon the Montessori System, at the Junior Mixed, and Central Girls' and also at Richmond Road Central Boys' School. Very backward and feeble minded children in the Borough are transferred to these special classes on the recommendation of the School Medical Officer. There is one feeble minded child at a Certified School for Mentally Defective Children. There are two deaf children at Certified Schools for the Deaf. There are two partially blind children, one of whom is , an in-patient at Hospital, and the other is attending School while undergoing treatment as an out-patient. 68 One case of severe epilepsy was excluded from school while undergoing treatment and had so far recovered by the end of the year that he was considered fit to return to an ordinary Elementary School. Nine crippled children and seven suffering from heart disease are attending the Special Open Air Day School. In addition there are thirty delicate children suffering from various defects attending this School. The formation of a class for children with defective speech was under consideration at the end of the year. OPEN AIR DAY SCHOOL. The Special School for Physically Defective and delicate children was fully described in the Annual Report for 1931. No. on register December, 1932 45 No. admitted during 1933 21 No. transferred to ordinary Schools 14 No. left School 7 No. on register December, 1933 45 It is satisfactory to note that as stated above fourteen children were rendered fit to return to ordinary Public Elementary Schools. In two instances parents refused the offer to admit to the Special School, children recommended by the School Medical Officer. A midday hot meal is provided at a charge of 4d., or less, and any financial loss has been met out of a voluntary fund raised by ladies of the Committee. The children are under the supervision of the School Medical Officer, who, as a routine practice, examines them at least twice each term, and certain individual cases more frequently as circumstances require. 69 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. 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. The following is a brief summary of the work carried out at this Special School: Medical Inspections Regular (twice a term) 224 Special 636 Dental Inspections 40 Found to require treatment 22 Actually treated 10 Orthopaedic Treatment Residential 3 Non-residential 4 Defective Vision and Squint t Cleanliness Surveys 182 Individual children found unclean 18 Twenty-five physically defective children received nampers from the Treloar Childrens' Christmas Hamper Fund. On December 22nd the distribution of the hampers was very kindly made by the Mayor, Sir Alfred Woodgat.e, C.B.E., J.P., at the Open Air School. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 37 school children over 12 years of age were issued with certificates under the Bye-laws permitting their employment on milk and paper rounds. 70 SCHOOL BATHS. During the summer months 599 children from the Boys' and Girls' Departments of all the Schools attended the Corporation Baths during School hours for instruction in swimming. GARDENING CENTRES. Since the re-organisation of the Council Schools the Gardening Centres appear as follows :— Richmond Road Central Boys' School at Tudor Road, Albert Road, and at Bonner Hill Road School. St. Luke's Boys' School at the rear of St. John's School. Open-Air School at the School. St. Agatha's School is without a Gardening Centre. 71 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Code Group Inspections— Entrants 389 Second Age Group 393 Third Age Group 421 Total 1,203 Number of other Routine Inspections 153 B—Other Inspections. Number of Special Inspections 1,267 Number of Re-Inspections 5,622 Total 6,889 TABLE II. A Return of Defects found by Medical Inspection in the Year ended 31st December, 1933. Defect or Disease Routine Inspec. Special Inspec. No. of Defects. No. of Defcets. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — 1 — Skin Ringworm, Scalp — — 5 – Body — — 4 – Scabies — — 12 – Impetigo 3 — 77 — Other diseases (non Tb] 16 — 200 17 Eye Blepharitis 3 — 8 — Conjunctivitis 1 — 10 — Keratitis — — 1 — Corneal Opacities — — — — Defect.vision exc.Squint 38 12 11 3 Squint 12 1 5 — Other Conditions 1 1 38 — Ear Defective Hearing 1 — 7 — Otitis Media 2 — 3 — Other Ear Diseases 2 — 32 — Nose and Throat Chronic Tonsillitis only 18 11 19 — Adenoids only 1 — 3 — Chronic Tonsillitis and Adenoids 5 – 16 – Other Conditions 3 – 67 — Enlarged Cervical Glands (non Tb) 6 4 23 2 Defective Speech 3 1 1 — Heart and Circulation Heart Disease—Organic – — 1 1 Functional 1 1 — — Anaemia 1 — 1 — Lungs Bronchitis 3 — 7 2 Other non Tb. Diseases 4 – 8 – Tuberculosis Pulmonary — Definite – — — Suspected 1 3 1 — Non- Pulmonary-Glands — — 1 — OtherBones & Joi nts — — – — Skin – — – — Other Forms – — – — Nervous System Epilepsy – — 4 — Chorea 3 — 2 — Other Conditions 2 — 6 — Deformities Rickets 5 3 – — Spinal Curvature 5 — 1 — Other Forms 11 3 14 1 Other Defects and Diseases 12 8 302 5 (excluding Uncleanliness and Dental Diseases) 73 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 379 49 12.9 Second Age Group 393 55 14.0 Third Age Group 431 32 7.4 Total Code Groups 1203 136 11.3 Other Routine Inspections 153 13 8.4 74 TABLE III. Return of all Exceptional Children in the Area. Children suffering from multiple defects, i.e. any combination of the following types of defect:— blindness, deafness, mental defect, epilepsy, active tuberculosis, crippling, heart disease Nil Exceptional Children At Certified Special Schools At Certified Special Schools for the partially blind or deaf At Public Elementary Schools At other Institutions At no School or Institution TOTAL Blind Partially Blind — — 1 1 — 2 Deaf 2 — — — — 2 Partially Deaf — — — — — — Mentally Defective (feeble minded) 1 1 Epileptic — — — 1 1 Physically Defective (a) Tuberculosis 1. Pulmonary — — — — — 2. Non-pulmonary 3 7 — — 10 (b) Delicate 27 3 — — 30 (c) Crippled 9 14 — — 23 (d) Heart Disease 7 18 — 25 75 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1933. Treatment Table Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI.) Disease or Defect, Number of Defects treated or under treatment during the year Under the Authority's Scheme. Otherwise. Total Skin—Ringworm, Scalp (Show separately in brackets the numbers which were treated by X-Rays) 4 (0) l 5 Ringworm, Body 3 1 4 Scabies 8 4 12 Impetigo 80 — 80 Other Skin Disease 182 12 194 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 36 3 39 Minor Ear Defects 21 9 30 Miscellaneous—e.g., minor injuries, bruises, sores, chilblains, etc. 195 35 230 Total 529 65 594 Group II.—Defective Vision and Squint (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. By private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total Errors of refraction (including Squint) 118 26 5 149 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) I7 4 21 Total 135 30 5 170 Total number of children for whom spectacles were prescribed (a) Under the Authority's Scheme 100 (6) Otherwise 24 Total number of children who obtained or received spectacles (a) Under the Authority's Scheme 95 (6) Otherwise 24 76 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received operative treatment Under the Authority's scheme, in Clinic or Hospital (i) 28 (ii) 11 By Private Practitioner or Hospital apart from the Authority's scheme. (i 11 (ii) 1 (iii) 32 Total (i) 39 (ii) 1 (iii) 43 Received other forms of treatment 17 Total number treated 100 (i) Tonsils only (ii) Adenoids only (iii) Tonsils and Adenoids (iv) Other defects of the nose and throat Group IV. Orthopaedic and Postural Defects Number of Children treated under the Authority's Scheme. Residential treatment with education — Residential treatment without education — Non-residential treatment at an Orthopaedic Clinic 9 Otherwise. Residential treatment with education 2 Residential treament without education 1 Non-residental treatment at an Orthopaedic Clinic — Total number treated 12 77 Group V. Dental Defects (1) Number of Children who were :— (a) Inspected by the Dentist : Aged 5 6 7 8 9 10 11 12 13 14 224 386 311 322 382 453 434 410 524 154 - Total 3600 Specials 4 Grand Total 3604 (b) Found to require treatment 2364 (c) Actually treated 929 (2) Half-days devoted to:— Inspection 32 Treatment 186 Total 218 (8) Attendances made by children for treatment 2138 (4) Fillings :— Permanent teeth 1127 Temporary teeth 134 Total 1261 (5) Extractions: — Permanent teeth 233 Temporary teeth 1642 Total 1875 (6) Administrations of general anaestheticsforextractions 385 (7) Other operations :— Permanent teeth 205 Temporary teeth 241 Total 466 78 . Group VI. —Uncleanlinsss and Verminous Conditions (i.) Average number of visits per school made during the year by the School Nurses 13 (ii.) Total number of examinations of children in the schools by School Nurses 14,797 (iii.) Number of individual children found unclean 618 (•v.) 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 11