[???] KIN 12 The Royal Borough of Kingston - upon-Thames Annual Reports FOR 1 9 3 4 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THE SANITARY INSPECTOR Royal Borough of Kingston-upon-Thames Annual Reports FOR 1 9 3 4 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, 1934. Medical Officer of Health and School Medical Officer : E. W. MATTHEWS, M.B., B.S.Lond., M.r.C.S., L.R.C.P., D.P.H. Maternity and Child Welfare Clinic : *OLIVE G. AUBREY, B.A., M.D., B.Ch. Ante-natal Clinic : *BEATRICE TURNER, M.B., F.R.C.S., Edin. Consultant under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regidations, 1926: *a. McAllister, m.b., b.s.Lond., f.r.c.s. Sanitary Inspector : H. T. PERRY, m.R.S.I, (a) First Additional Sanitary Inspector and Chief Clerk: F. D. HARVEY, A.R.S.I. (a) Second Additional Sanitary Inspector: G. H. COCKELL, A.R.S.I. (a) Health Visitors and School Nurses: (Senior) Miss A. GILL, (b), (c). (d). (2) Miss C. A. HOOKWAY, (b), (c), (d). (3) Miss L. G. SALWAY, (b), (c). (4) Miss E. G. COUZENS, (b), (c), (d). Clprks: Miss T. P. DILLIWAY. E. S. HERBERT. Disinfector and Ambulance Driver. C. BENSON. *Part-time Appointments. (a) Certificates as Sanitary Inspector and Meat and Foods Inspector. (b) General Hospital Training. (c) C.M.B. Certificate. (d) New Health Visitors Certificate. 3 Annual Report OF THE Medical Officer of Health. Health Department, Grange Road, Kingston-upon-Thames. April, 1935. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1934. Circular 1417 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1934 requests that the Council will direct the Annual Report of the Medical Officer of Health for 1934 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 1934 should contain information in regard to the matters specified in Appendix I, set out as far as posible in the Order there given, under the main heads A to F, 4 The incidence of notifiable infectious diseases has remained low throughout the year. Miss Beatrice Turner was appointed Medical Officer for the Ante Natal Clinic to fill the vacancy created by the resignation of Dr. Ruth Townshend at the end of 1933. Miss Turner commenced her duties at the first meeting of the year and very quickly proved herself a congenial and efficient colleague. Mr. E. S. Herbert was appointed clerk in July to replace Mr. R. H. Felgate who resigned on obtaining a post as commercial clerk. The increasing work in connection with Maternity and Child Welfare and under the Children and Young Persons Act has been efficiently carried out by the Health Visitors who are also School Nurses. The work of the Sanitary Inspectors in connection with Housing, Meat and Foods inspection and general sanitation has been kept up to a high standard. The subject of Housing is dealt with under Section d of the Report and the progress made must be regarded as satisfactory. I thank the Staff for their willing assistance throughout a busy year. 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, 1934 (Registrar General) 38,270 Number of inhabited houses 9,536 Rateable Value—General Rate £450,733 Sum represented by Penny Rate £1,775 Amount of Poor Law Relief £3,673 (ii) Extracts from Vital Statistics of the Year. Live Births— Total. Male. Female. Legitimate 412 200 212 Birth Rate (R.G.) Illegitimate 58 29 29 per 1,000 pop. 12.3. 470 229 241 Still Births— Total. Male. Female. Legitimate 19 11 8 Rate per 1000 total (live and still) births 40.8 Illegitimate 1 — 1 20 11 9 Deaths— Total. M ale. Female. 422 212 210 Death Rate (R.G.) per 1,000 pop. 11.0. Death Rate corrected for age and sex constitution, 9.7 per thousand population (factor for correction 0.88, 1931 Census), 6 Deaths from puerperal causes—- Deaths Rate per 1.000 total (live and still) births Puerperal Sepsis - - Other Puerperal Causes 2 4.1 Total 2 4.1 Death Rate of Infants under one year of age— All infants per 1,000 live births 45 Legitimate infants per 1,000 legitimate live births 36 Illegitimate infants per 1,000 illegitimate live births 104 Deaths from Measles (all ages) 5 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 2 Birth Rate. Death Rate. Rate per 1000 Births. Diarrhoea Total Deaths under 2 years Under 1 year England and Wales 14.8 11.8 5.5 59 132 Smaller Towns 15.0 11.3 3.6 53 London 13.2 11.9 12.6 67 Kingston-upon-Thames 12.3 9.7 4.3 45 (iii) Causes of Death. Male Female All Causes 212 210 1. Typhoid and Paratyphoid Fevers — — 2. Measles 4 1 3. Scarlet Fever — — 4. Whooping Cough — 1 5. Diphtheria 3 1 6. Influenza 3 — 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — — 9. Tuberculosis of the Respiratory System 23 13 10. Other Tuberculous Diseases - 4 11. Syphilis 1 — 12. General Paralysis of the Insane, tabes dorsalis 4 - 13. Cancer, Malignant Disease 22 40 14. Diabetes 1 2 15. Cerebral Haemorrhage, etc. 7 19 7 16. Heart Disease 44 45 17. Aneurysm 1 — 18. Other Circulatory Diseases 6 4 19. Bronchitis 9 8 20. Pneumonia (all forms) 16 8 21. Other Respiratory Diseases — 2 22. Peptic Ulcer 4 — 23. Diarrhoea, etc. (under two years) — 2 24. Appendicitis 5 1 25. Cirrhosis of Liver — — 26. Other Diseases of Liver, etc — 1 27. Other Digestive Diseases 6 7 28. Acute and Chronic Nephritis 11 b 29. Puerperal Sepsis — — 30. Other* Puerperal Causes — 2 31. Congenital Debility, Premature Birth, Malformations, etc. 8 4 32. Senility 5 17 33. Suicide 2 — 34. Other Violence 10 6 35. Other Defined Diseases 17 16 36. Causes Ill-defined or Unknown — — Special Causes (included in No. 35 above) :— Smallpox Poliomyelitis Polioencephalitis (iv) Natural and Social Conditions. The erection of small private dwelling houses on the portion of Ham added to the borough on April 1st, 1933, is progressing rapidly, and the building of a new infants' school nearby is under consideration. During the year works were completed for the Corporation Sewage Works to take the sewage from that part of Ham. This sewage was previously received and treated by the Richmond Main Sewerage Board. 8 METEOROLOGY, 1934. The summer 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 Inches Highest Lowest Mean Max. Mean Min. January 56 23 44 33 1.36 February 51 22 44 31 0.22 March 57 29 50 36 1.92 April 75 30 58 42 2.17 May 79 35 69 46 0.47 June 89 47 76 53 0.70 July 87 52 82 58 2.28 August 81 43 74 54 2.30 September 83 44 71 52 1.31 October 70 31 60 47 0.91 November 55 28 48 40 1.92 December 60 34 51 43 4.77 Total inches 20.33 The average annual rainfall at Greenwich is about 24£ inches. 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. 9 (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. (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. 10 (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 306 accident cases and 153 private cases were removed by this ambulance. (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 fourteen registered as practising in the Borough at the end of the year. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. 11 (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. Three investigations were made during the year. During the year 5 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 5 cases notified, 3 were either admitted to or already in-patients at the Kingston and District Hospital. There was one death among these notified cases. The consultant, Mr. Andrew McAllister, was not summoned during the year. (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. Miss Beatrice Turner, M.B., F.R.C.S. (Edin.) was appointed to fill the vacancy created by the resignation of Dr. Ruth Townshend at the end of 1933. She took up her duties at the first meeting in January and immediately proved herself a colleague with whom it is a pleasure to work. She has become popular both with the Staff and the mothers. A full description of the Ante-Natal Services was given in the Annual Report for 1932. 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. 12 During the year 131 expectant mothers attended, making 373 visits to the Clinic. Ten mothers made post natal visits to the Clinic. (iv) The Centre. The Centre is held at the School Clinic in Grange Road, which was described in the Annual Report for 1931. As before, the meetings are held on Tuesdays and Fridays, when Dr. Olive Aubrey attends, and much valuable help is given by many voluntary workers. During the year there were the following number of attendances:— Attendances. Meetings. New Cases. T otal. Tuesday 52 145 3,154 Friday 50 162 2,591 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 46 mothers have purchased 107 garments during the year. The sale of National Savings Certificates at the Centre has been continued, with the result that 35 mothers have invested £15 12s. 2d. during the year. Baby Week was held during the week commencing Sunday, July 1st, when special announcements were made in the local Churches and Sunday Schools. The Centre was open to visitors on Tuesday and Friday, when Miss Fischer gave most interesting and instructive addresses on the value of milk as a food. 13 On Wednesday, a Garden Party was given at St. Peter's Vicarage, the prizes for Mothercraft being distributed Dy Lady Penny. The Day Nursery in Canbury Park Road was open daily to visitors. A film on the advantages of taking infants regularly to Welfare Centres was exhibited at the " Kingston" Cinema. As a result of the effort our Centre was awarded a certificate of High Commendation upon gaining fourth place in the National Baby Week Council's Challenge Shield Competition for towns over 15,000 population. (v) Health Visitinn. The Health Visitors paid the following number of home visits :— First Visits. Total Visits. Expectant Mothers 149 231 Infants under one year 508 2,65 7 Children, one to five years — 3,556 Incidental and Infectious — 668 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. 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. 14 (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, 1934, there were 29 foster mothers on the Register in charge of 36 infants. During the year 7 new registrations were approved and 2 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 34 foster mothers in charge of 37 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 765 visits were paid, this work being most satisfactorily carried out by the Health Visitors. (vii) Orthopaedic Treatment. Under the scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, only one infant received out-patient treatment during the year. On attaining the age of five years, infants undergoing Orthopaedic Treatment continue such treatment through the School Medical Service. (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. 15 (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 3 houses during the year. The number of premises known to be supplied with water from wells at the end of 1934 was 35, 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. In June, works were completed to take the sewage from the Ham and Park Road areas to the Corporation Sewage Works. 16 The private street portion of Park Road was sewered under the Private Street Works Act, 1892 at a cost of £1056. The sewer in Bath Passage has been entirely relaid at an improved gradient. The programme for the construction of additional manholes on the existing foul and surface water sewers has been continued. Approximately £1,000 has been spent for this purpose. Wanderings Farm ditch and the ditch running through the Villiers Road Depot have been 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. 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 17 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. (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. Premises Number of Inspections Written Notices Occupiers prosecuted Factories—(including Factory Laundries) 285 3 Nil Workshops—(including Workshop Laundries) Workplaces—(other than Outworkers' premises) Total 285 3 Nil 18 II—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Numbers of Defects Number of offences in respect to which Prosecutions were instituted. Particulars. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 2 3 - - Want of Ventilation - - - - Overcrowding - - - - Want of drainage of floors - - - - Other nuisances - 3 - - Sanitary Accommodation Insufficient Unsuitable 1 1 - - or Defective - 1 - - Not separate for sexes - - - - Offences under Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s. 101) - - - - Other Offences—(Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health [Factories and Workshops Transfer of Powers 1 - - - Order, 1921) 1 1 - — Total 4 9 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. III.—OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. No action was found to be necessary in connection with the above. 19 SECTION D. HOUSING. In my Annual Report for 1933 I commented on the housing conditions in the Borough and drew attention to the difficulty of forming an opinion of the standard required to justify the representation of certain areas as "Clearance Areas." Notwithstanding the experience gained during the past year, the difficulty of judging the standard of fitness or unfitness of a dwelling house still presents a problem not easy to solve. It will be recalled that durihg 1933 I made official representations to the Council, as Medical Officer of Health, under Section 51 (2) of the Housing Act 1930 in regard to the undermentioned areas :— Area No. 1.—Brook Street, Nos. 25 and 27. Orchard Road, No. 1. Area No. 2.—Hawks Road, Nos. 82, 84 and 86. Area No. 3.—Acre Road, Nos. 47, 49 and 51. Canbury Area A.—Canbury Place, Nos. 2, 3, 4, 5 and 6. Canbury Passage, Nos. 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55 and 57. Action in connection with these areas was continued during 1934 and in the case of Area No. 1 the Town Council decided to apply for a Compulsory Purchase Order which was subsequently approved by the Minister of Health. The owner of the houses in Area No. 3 did not oppose the proposed Clearance Order and this also was confirmed by the Minister in due course. 20 Area No. 2 and Canbury Area A. were the subject of public enquiries which were held on the 23rd May, 1934 by order of the Minister of Health, and Clearance Orders were later confirmed. An owner of certain houses in Canbury Area A. appealed against the Clearance Order in the High Court. His appeal was dismissed and he decided to go to the Court of Appeal. The hearing had not taken place at the end of the year. The final Order in respect of Area No. 2 was not opposed. During 1934 further progress was made and on the 8th February 1934 I made an official representation, as Medical Officer of Health, under Section 51 (2) of the Housing Act 1930, to the Council in regard to the following property :— Area No. 5.—Fairfield Road, Nos. 29, 31, 33, 35, 37, 39, 41 and 43 and Nos. 1 and 2, Francis Place. A public enquiry into the circumstances of the area was held by order of the Minister of Health on 28th June, 1934, and on 3rd September 1934 the Clearance Order was confirmed, in a modified form ( Nos. 29-43 Fairfield Road being excluded from the final Order.) The Order became operative in due course and Nos. 1 and 2 Francis Place, which were the subject of the Order, were vacated, but not demolished, by the end of the year. Apart from action taken under Part I. of the Housing Act 1930, 20 Demolition Orders were made under Sections 19 and 21 in respect of " individual " unfit houses. The following summary has been prepared for the purpose of showing the action taken during 1934 and the position at the end of the year, as regards (a) Clearance Areas and (b) "Individual" houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. The summary refers only to action taken since the passing of the Housing Act 1930. CLEARANCE AREAS Clearance Area No. of houses in area Date of representation Date of Clearance Order Date of Compulsory Purchase Order No. of houses vacated at end of 1934 No. of houses demolished at end of 1934 Remarks Made by Council Confirmed by Minister of Health Made by Council Confirmed by Minister of Health No. 1 3 12.io 33 — — 19.12.33 9.4.34 Nil Nil Tenants awaiting alternative accommodation No. 2 3 12.1033 19.2.33 14. 8.34 — — 2 Nil do. do. No. 3 3 12.10.33 19.12.33 4.8.34 — — 3 3 - Canbury 19 30.1133 27. 2.34 14.8.34 — — Nil Nil Appeal entered by owner Area "A" No. 5 10 8. 2 34 27.4.34 3.9.34 — — 2 Nil The modified Order excluded 8 houses (with modifications) INDIVIDUAL HOUSES Year No. of dwellinghouses found to be unfit for human habitation (vide S. 19, H.A. 1930). No. of dwellinghouses in respect of which Demolition Orders were made under Sees. 19 & 21, H.A. 1930. No. of dwellinghouses in respect of which "undertakings "were given by owners (vide Sec. 19. H A. 1930). No. of dwellinghouses demolished in pursuance of Demolition Orders made under Sees. 19 & 21, H.A. 1930. Remarks 1930 - 1933 39 28 7* 21 "Four houses in respect of which an "undertaking" had been given by the owner were subsequently demolished voluntarily by the owner, during 1934. 1934 23 20 5 13 In addition, one house was demolished by the owner in anticipation of formal action under Sec. 19. H.A. 1930. Total 62 48 12 34 22 Reference has been made in my Annual Reports for previous years to the five year programme submitted to the Minister of Health in accordance with the requirements of Circular 1331, and the progress made to the end of 1934 (as shown in the summary) in this connection is very satisfactory. With regard to overcrowding, seven cases were discovered during the year. There were six cases carried over from 1933, making a total of thirteen during 1934. Twelve were abated, leaving one known case outstanding on December 31st 1934. In my report for 1933, I mentioned that thirty houses were in course of erection by the Corporation at the end of that year. The building of these houses was completed during 1934 and the following table gives particulars of the total houses erected during the year :— Number of new houses for the working classes erected by the Corporation during the year ended 31st December 1934 30 Number of houses erected by private enterprise during the year ended 31st December 1934 432 Number of flats erected by private enterprise during the year ended 31st December 1934 192 Total number of houses for the working classes erected by the Corporation since March 1924 732 23 Housing Statistics. 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) 605 (b) Number of inspections made for the purpose 858 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 70 (b) Number of inspections made for the purpose 168 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 25 (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 453 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 411 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 10 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By Owners 13 (b) By Local Authority in default of Owners Nil 24 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 41 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By Owners 51 (b) By Local Authority in default of Owners 1 *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 20 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders ... 13 D.—Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground 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 five houses in respect of which "undertakings" were given by the owners. One house was demolished by the owner as the result of informal action. 25 SECTION E. INSPECTION AND SUPERVISION OF FOOD (i) Adidteration. 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 ADULTERATED OR DETERIORATED PROSECUTIONS CONVICTIONS Formal Informal Total Formal Informal Total Milk 57 — 57 5 — 5 — — Cream 2 — 2 — — — — — Cake — 1 1 — — — — — Meat 5 — 5 — — — — — Ground Rice 1 — 1 — — — — — Raisins 4 — 4 — — — — — Sultanas 1 — — — — — — Sausages 1 — 1 — — — — — Jam — 2 2 — — — — — Other Articles 3 2 5 — 1 1 — — Totals 74 5 79 5 1 6 — — (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. I remarked on the four private slaughterhouses in last year's Annual Report, particularly drawing attention to the old wooden building at No. 45 Cambridge Grove Road. 26 The number of animals slaughtered at private slaughterhouses during the last six years is shewn in the following table:— 1929 11,704 1930 11,821 1931 9,629 1932 10,181 1933 6,928 1934 6,413 At the end of 1932, a private slaughterhouse at No. 90, Acre Road was closed. (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 sixteen 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 1934 40 42 2 27 SCARLET FEVER. As will be seen there has been less Scarlet Fever this year than at any time since the war, which is due to the complete absence of the usual autumnal rise in the incidence. There were no deaths from this disease. DIPHTHERIA. The number of cases remained low but were somewhat higher than last year. From the above table it appears likely that there may be an increasing incidence in the next few years. In these circumstances it seems an opportune time to consider whether immunization against diphtheria should now be offered to the public, in order that those parents who wish to protect their children can obtain the necessary treatment through the Health Services. Four deaths occurred from this disease. The issue of diphtheria antitoxin is made through two chemists and is available at all times. The 150 boys in the Dalziel of Wooler Memorial Home (Dr. Barnado's) are all immunized against diphtheria by their own medical officer. ENTERIC FEVER. Two cases of paratyphoid B were notified during the year. They were two brothers aged 10 and 6, who were admitted to the Kingston and District Hospital. They both made good recoveries. Exhaustive investigation into the circumstances failed to trace the source of infection. C\i OO Notifiable Diseases during the Year. Cases. Deaths. Under I year. I—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45-65 65 & over. Total Cases Notified Cases admitted to Hospital Under 1 year. 1—2 2—3 3—4 4—5 5—10 IO—I5 15—20 20—35 35—45 45—65 65 & over Total Deaths Scarlet Fever — — I — 1 18 5 7 8 — — — 40 33 — — — — — — — — — — — — — Diphtheria — 1 7 3 — 13 10 4 3 — 1 — 42 40 — — — — — 3 — — 1 — — — 4 Enteric Fever including Paratyphoid — — — — — 1 1 — — — — — 2 2 — — — — — — — — — — — — — Pneumonia 2 6 2 1 1 1 3 — 1 2 4 11 34 7 — 1 — — — — — — — 1 — 5 7 Erysipelas — — — — — 1 — 1 3 1 6 4 16 2 — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 1 3 1 — — 5 — — — — — — — — — — 1 — — 1 Ophthalmia Neonatorium 3 — — — — — — — — — — — 3 — — — — — — — — — — — — — — New Cases. Deaths. Under 1 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—21 21—1S 3—45 45—55 55—65 65 & over Total. Tuberculosis (a) Respiratory M. — 1 — 3 — 3 8 4 3 3 I 26 — — — — 1 — 4 4 7 5 2 23 F. — — — — 3 2 2 2 2 1 2 14 — — — 1 3 — 3 3 2 1 1 14 Total — 1 — 3 3 5 10 6 5 4 3 40 — — — 1 4 — 7 7 9 6 3 37 (b) Non-Respiratory M. — — — — — — — — — — — — — — — — — — — — — — — F. — 1 — — — 1 — — — — — 2 — 1 — — — 1 — — — — — 2 Total — 1 — — — 1 — — — — — 2 — 1 — — — 1 — — — — — 2 29 PNEUMONIA. The number of cases notified was 34, compared with 43 and 32 for the last two years. 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). OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and enquire into the circumstances of the case. Cases notified during 1934:— Notified. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 3 3 — 3 — — — Arrangements have been made with the London County Council for the reception and treatment of cases of Opthalmia 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. No case was sent to Hospital under this scheme during the year. TUBERCULOSIS. Cases of Tuberculosis notified in the Borough come under the administrative control of the Surrey Countv Council. Every effort is made to assist the County Medical Officer and Tuberculosis Officer in their activities in the area. 30 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 fairly good, and there have been no cases of wilful neglect or refusal to notify, but the ratio of non-notified to total deaths is 13:100. No cases have arisen during the year in which any action became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or the Public Health Act, 1925, Section 62. Disinfection of premises is carried out in all cases of death, or when patients are admitted to hospital or sanatorium. OTHER NOTIFIABLE DISEASES. It is noteworthy that no cases of smallpox, encephalitis lethargica, cerebro spinal fever or anterior poliomyelitis have been notified this year. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. The Medical Practitioners in the Borough also supply much valuable data on occasions. There were small outbreaks of Measles at Bonner Hill Road Infants' and Richmond Road Infants' Schools in February and March. Chicken pox occurred at Richmond Road School in March and Whooping Cough at St. John's School in April. Three deaths were attributed to Influenza during the year and no undue prevalence was reported. The Sanitary Inspector, Mr. H. T. Perry, reports as follows:— 31 Report of the Chief Sanitary Inspector To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, I have the honour to present my sixteenth Annual Report on the work carried out by your Sanitary Inspectors during the year 1934 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 7,603 as compared with 7,718 during the year 1933. On 543 premises sanitary defects to the number of 3,927 were discovered. Arising out of these defects, it was found necessary to serve 410 "preliminary" and 25 " verbal " notices. In 60 instances the informal action did not have the desired effect, and it was necessary to serve " statutory " notices. During the year under review, 596 fresh entries were added to the Register of Sanitary Defects. In 526 cases entries were cancelled following completion of necessary works. On December 31st, 1934, 414 separate entries remained under review, compared with 344 at the end of 1933. During 1934, 620 enquiries under the Land Charges Act 1925, respecting property in the Borough, were received from the Town Clerk's Department and replied to. The corresponding figure for 1933 was 352. This brief introductory statement contains statistics which, unless they were amplified later in the report, would not reflect adequately the work carried out during the year. 32 The duties of Sanitary Inspectors are becoming broader as time goes on. There have been many changes in local government services, and sanitary inspectors, who were the first public health officers to be appointed, were expected 10 deal only with those very obvious nuisances which offended against the senses of sight and smell and which records inform us were to be found in abundance in cities, towns and villages. The removal of such crude nuisances nowadays, although very necessary for the comfort and well being of the burgesses, is, happily, very seldom called for and consequently forms but a very small fraction of the modern duties of sanitary inspectors. On the other hand, environmental hygiene is becoming increasingly important. It includes such matters as housing accommodation, and the condition of factories and workplaces etc. and together with the public milk and food supply it embraces in a general sense the work which sanitary inspectors are called upon to perform. Much time is taken up by interviews with owners of property and others seeking advice. It is pleasing to be able to report that increasing use is being made of sanitary inspectors in an advisory capacity. Owners of property in the borough are encouraged to seek assistance when in doubt as to what should be done to improve their property or to remedy obstinate troubles. These people used to show obvious reluctance in approaching the sanitary inspector. This state of mind still exists but in a much reduced degree. Presumably the fear was occasioned by the possibility that a visit to the sanitary inspector might result in the owner being called upon to carry out expensive works to the property under discussion. It is true that what an owner thinks is sufficient in the way of works of repair and what an experienced sanitary inspector considers to be necessary at the same house are not always synonymous. Wise owners, however, realize that their property will not continue to give a good return as an investment unless it is maintained properly and so they are pleased to avail themselves of the assistance and advice offered. Many appreciative letters are received from time to time from those who have received assistance, whilst the necessity to resort to legal action to enforce compliance with notices 33 served very seldom arises in the borough. 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 of Inspections made in regard to each section of the work, and the total of all inspections. Rent Restrictions Act Inspections 3 Re-inspections 1242 Visits to Works in Progress 1285 Factories and Workshops 288 Cowsheds, Dairies and Milkshops 153 Ice Cream Premises 62 Foodshops and Food Preparing Rooms 584 Infectious Disease Enquiries 215 Markets 155 Special Inspections (including complaints, etc.) 939 Examination of drains 280 Slaughter-houses 801 Offensive Trades 48 Sanitary Conveniences 126 Common Lodging-Houses 35 Canal Boats 19 Theatres, Cinemas, etc. 72 House to house 168 Bakehouses 66 Smoke Observations 42 Stables and Yards 26 Enquiries re Housing Applicants 74 Well Water Enquiries 41 Sale of Poisons 12 Rats and Mice Destruction 173 Shops Acts 323 Schools 5 Miscellaneous Visits 366 Total 7603 34 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 104 W.C. Flushing Tanks repaired or renewed 49 New W.C. apartments 11 W.C. apartments lighted, repaired or ventilated 23 W.C. apartments cleansed and limewashed 47 W.C. Seats renewed or repaired 7 W.C. apartment demolished 1 W.C. Pans cleansed 33 Baths renewed or painted 1 New Impervious Sinks provided 34 Sinks refixed 2 New Trapped Waste Pipes fixed 50 Existing Waste Pipes trapped or repaired 26 Cobweb gratings (complete) to sink wastes 21 Urinals cleansed and repaired 19 New Urinal constructed 1 Miscellaneous 7 DRAINAGE. Number of Houses and Premises re-drained 70 Number of Drains repaired or amended A 4 New branch drains 1 35 Drains or Gullies unstopped or cleansed 59 New Manholes provided 98 Intercepting Traps fixed 26 Fresh-air Inlet Shafts repaired, renewed or provided 31 New Gully Traps fixed 148 Gully Curbs renewed or repaired 2 New Soil Pipes and/or Ventilating Shafts 51 Ventilating Shaft repaired 2 Disposal of waste oil in surface water gully discontinued 1 Gully trap inside house discontinued 2 New surface water drain 1 Cesspool Emptied 2 Petrol Interceptor constructed 1 Miscellaneous 7 GENERAL REPAIRS. Roofs repaired, new fillets, soakers, etc. 75 New gutters and stack pipes provided to roofs 7 Eaves gutters renewed or repaired 36 Stack Pipes renewed or repaired 32 Stack Pipes disconnected from drains 34 Dampness abated 49 Defective walls repaired, repointed, etc. 83 Defective walls cement rendered 8 Chimney stacks rendered, repointed etc. 30 New Chimney Pots fixed 4 Ventilation provided beneath floors 24 Ventilation provided to rooms 25 Staircases lighted or stairs repaired 36 Handrails to staircases provided or refixed 8 Sites of Houses concreted 6 Yards paved 47 Yard paving repaired and yards cleansed 37 Paved pathways constructed or repaired 25 Floors of Rooms repaired 39 New floors of Rooms 29 Rooms repaired, cleansed or distempered 289 Larders ventilated and cleansed 3 New ceilings 20 36 Premises limewashed 11 Windows repaired, renewed or made to open 170 Additional light to rooms 1 Door and window sills renewed or repaired 70 Doors renewed or repaired 36 Frame joints remade 19 Door locks repaired or renewed 13 Door frames repaired 7 New Portable Ashbins provided 203 Accumulations of manure and refuse removed 8 Nuisance from overcrowding abated 12 Water supply provided direct from rising main 11 Service Water Pipe repaired 1 Service Water Tanks cleansed, covered or removed 7 Use of Well Water discontinued and/or M.W.B. supply laid on 3 Stoves and Firegrates repaired or renewed 63 Fireplace surrounds or hearths repaired 18 Flues repaired 4 Coppers repaired or renewed 27 Obstructive Buildings demolished 6 Illegal use of Basement Rooms discontinued 2 Houses repainted externally or internally 13 Insanitary Houses demolished (Housing Act and including one in anticipation of formal action) 21 Verminous premises cleansed 7 Skirting repaired or renewed 12 Brickwork repaired or repointed 10 Nuisance from animals abated 3 Miscellaneous 24 SMOKE ABATEMENT. The number of complaints of excessive smoke or grit received during 1934 was 7. Forty-two observations of chimneys were made. I have heard it said from time to time that smoke is not a problem which Kingston needs to bother about. This is true if one considers it unnecessary to take action until 37 the atmosphere has become as smoke laden as in some districts in the North. In certain parts of the town and with particular weather conditions, however, a distinctly unpleasant quantity of smoke and grit is noticeable. Yards need sweeping more often and curtains have to be cleansed much more frequently than is usual. In one case these conditions were due to unsuitably fuel in the particular type of boiler, whilst another case was not in connection with steam raising plant but was caused by the retorts at the Gas Works. During the summer, when the use of the retorts was discontinued, the emission of smoke and grit was reduced very considerably. It increased when the plant was in commission again before the Autumn. The production of smoke and grit cannot be entirely eliminated from the process of coke manufacture but possible means of reducing the nuisance are under consideration. The bye-law in force in the Borough prohibits the emission of black smoke for more than two minutes in any consecutive thirty minutes from any chimney other than that of a private dwelling house. Observations are taken over periods of forty minutes and any contravention of the bye-law is notified in the first case by telephone or by a personal visit to the offending works. An arrangement stands whereby notification of anv temporary breakdown of boiler plant is sent to the office so as to avoid unnecessary visits and correspondence. 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. 38 The Vicarage Road premises were designed for the purpose of 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, but the premises are difficult to keep free of vermin. There were changes in the person of the registered deputy at each of the premises during 1934. Thirty-five visits were made to the lodging houses during the year. OFFENSIVE TRADES. There has been no change to record in the number of premises upon which offensive trades are carried on in the Borough. The trades which may be described legally as offensive are:— Leather tanning and Fellmongering. Rag and Bone Yards. Fish frying. In the case of the first trade a nuisance may arise if the raw hides are not stored properly and all waste material removed frequently. Rag and bone yards are always a potential cause of nuisance not only from smell but also because the nature of the trade encourages the presence of rats, mice and flies. It is to be regretted that the Corporation does not possess the power to forbid the perpetuation of this trade where it is already established in connection with private dwelling houses. All that can be done, however, is to prevent further unsuitable premises being used for the trade. Legal proceedings were taken against the occupier of premises in Acre Road for commencing the trade of rag sorting and storage without first obtaining the sanction of 39 the Corporation. Permission to recommence the trade at the premises had been refused previously. The defendant pleaded guilty and was fined £2 with £2 2s. Od. costs. Fish frying may become unpleasant if the fat used in the process is unsuitable, if the apparatus is not used properly, or is not kept thoroughly clean. With modern frying ranges there is very little excuse for any emission of odour. This well known odour is described by different persons in various terms from "very appetising" to "intolerable" and "sickly," and possibly each one is correct from his or her point of view. The fried fish shop at No. 9 Cambridge Road closed during 1933 and in June 1934 a formal request was made by the tenant for permission to recommence the business. The trade had been discontinued for more than six months and having regard to the proximity of the shop to another fish shop occupied by the same person, the Corporation declined to accede to the request. No complaints were received during the year in respect of offensive trades. Forty-eight visits were made to offensive trade premises during 1934. COMPLAINTS. Two hundred and thirty-eight complaints were received during the year, as follows:— Drains and sanitary arrangements 44 Overcrowding 4 Condition of Premises 71 Accumulations of manure and non collection of house refuse 16 Dampness and defective roofs, gutters, etc. 16 Smoke nuisance from chimneys 7 Defective stoves and copper 8 Rats 15 Water supply 5 Keeping of animals and fowls 4 40 Unpaved yards and passages 2 Nuisance from flies 7 Condition of roadway 1 Flooding of basement 5 Nuisance from burning refuse 12 Defective ashbins 3 Unsafe chimney stacks 1 Verminous premises 6 Miscellaneous 11 Total 238 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. No less than seventy houses were completely redrained during 1934 in addition to 5 other premises where drains were repaired or amended in part. The majority of the old drainage systems were examined under the powers conferred upon the Corporation by Section 41 of the Public Health Act 1875 as amended by later Acts. This work necessarily means the expenditure of much time but the elimination of defective drains is very important from the public health point of view. The majority of the drainage systems served more than one house and the houses were mostly in different ownerships, making agreed schemes of redrainage more difficult to arrange. To avoid friction as far as possible the owners of each set of premises were brought together when agreement was usually reached on the main points at least. In the case of 54 of the houses detailed specifications and forms of tender were prepared on behalf of the owners free of cost. This assistance was much appreciated and doubtless tended to avoid objections. A great advantage accrues from this method of dealing with redrainage schemes. Good quality of materials employed and 41 best workmanship are assured whilst the layout of the scheme is controlled from the commencement. The extra work involved by the preparation of the necessary plans and specifications is, I think, well worth while and it is partly counter-balanced by the saving of time whilst the works are in progress, and the avoidance of legal proceedings. The following list gives the situation and numbers of premises redrained during the year:— Acre Road 2 Albert Road 1 Church Road 10 Deacon Road 1 East Road 2 Excelsior Road 2 Fairfield Place 11 Fairfield South 1 Gibbon Road 2 Gloucester Road, The Bittoms 4 Knights Park 4 Penrhyn Road 6 Thorpe Road 1 Vincent Road 2 Washington Road 4 York Road 17 70 HOUSING. The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on pages 23 and 24. Six hundred and five dwelling houses were inspected completely or in part under the Public Health or Housing Acts. 42 Seventy houses were surveyed thoroughly as required by the Housing Consolidated Regulations 1925, and the details of structure, general conditions, tenancy, ownership, etc. together with a copy of the informal notice served (if any) were filed for future reference. The situation of these 70 houses is as follows:— Acre Road 6 Alfred Road 1 Burnham Street 6 Cambridge Road 1 Canbury Park Road 1 Clifton Road 1 Coombe Road 1 Cowleaze Road 8 Eden Street 1 Fairfield North 9 Fairfield South 2 Franklin Road 1 Grove Crescent 1 Hawks Road 3 High Street 3 Hudson Road 1 Kings Road 2 London Road 5 Old Bridge Street 1 Park Road 1 Princes Road 1 Southsea Road 7 Union Street 1 Water Lane 6 Apart from the houses dealt with by Clearance Area procedure, the undermentioned houses were reported to the Corporation under Sections 19 and 21 of the Housing Act 1930. These sections relate to dwelling houses which cannot be made fit for human habitation at reasonable cost having regard to the ultimate value of the premises after repairs are executed. Full particulars of defects 43 and estimated costs of necessary repairs were prepared in each case together with the values of the respective premises. It is interesting to note that in no case, where owners or their representatives appeared before the Committee, was there any considerable variation in the estimated costs and values prepared for the purposes of official report compared with the owners' estimates. On the contrary the figures approximated closely. Situation. No. Action Taken. Acre Road 1 house (s) Demolition Order made. Cowleaze Road 6 „ 4 Demolition Orders made. 2 "Undertakings" accepted Cambridge Grove Road 1 „ "Undertaking" accepted. Fairfield South 2 „ Demolition Orders made. High Street 2 „ Demolition Orders made. Water Lane 6 „ Demolition Orders made. London Road 5 „ 3 Demolition Orders made. 2 "Undertakings" accepted The Bittoms 2 „ Demolition Orders made. The following 13 houses were demolished during 1934 in pursuance of demolition orders made under Sections 19 and 21 of the Housing Act, 1930:— Nos. 1 & 3 The Bittoms. No. 20 Canbury Passage. Nos. 29, 31, 39, 41 & 60 Cowleaze Road. Nos. 1 & 2 Brooks Cottages, Fairfield South. Nos. 2, 4 & 6 Water Lane. In addition the following 8 houses were demolished for reasons given :— Nos. 47, 49 and 51, Acre Road—Clearance Order. No. 47, Hawks Road—In anticipation of formal action. 44 Nos. 26, 28, 30 and 32, The Bittoms—Demolished voluntarily having been vacated after "Undertaking" had been given and accepted in 1932. Two other houses remain vacant in pursuance of undertakings given in previous years. The houses referred to are No. 1 Canbury Passage and No. 1 Cowleaze Road. 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 and flies. 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. Complaints of the presence of flies during the hot weather in the immediate vicinity of the Latchmere Lane tip were received and were investigated. 45 INCREASE OF RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS. The number of applications for certificates under Section 2 (2) of the principal Act remains low—there being three only during 1934. 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 two cases only during 1934, certificates were granted to applicants. The house referred to in the other application was inspected and found to be in reasonable repair. There were three applications during 1933. INSPECTION AND SUPERVISION OF FOOD (a) MILK SUPPLY. During 1934 three names were removed from the Register of Dairymen owing to business changes. Eleven fresh entries were added to the Register leaving a total of 71 at the end of the year compared with 63 at the end of 1933. This continued increase is due to the practice of small shops selling milk in bottles unopened as received on the premises. The shop in such a case is not a dairy but the person selling the milk has to be registered. There is only one cowkeeper in the borough. Graded Milks. There is no licensed graded milk producer in the borough, but twenty-nine dealers' licenses (including supplementary licenses) for the sale of graded milk were issued during the year. 46 The licenses were in respect of the following grades:— Certified 5 Grade A (Tuberculin Tested) 13 Grade A 1 Grade A (Pasteurised) 1 Pasteurised 9 Despite the many times attention has been drawn to the matter it has not yet been made an offence to place milk bottles and receptacles on the public footpaths and other places where they are liable to become contaminated. Great care is taken to ensure as far as possible that the milk itself is pure and wholesome, yet there seems to be an undiminished apathy on the part of many housewives and some milk roundsmen regarding the necessity to treat bottles with appropriate care. It cannot be pointed out too often that all milk bottles are not sterilized before being reused although they all go through some form of cleansing. It is quite a common occurrence to see milk bottles lying in the gutters or standing in proximity to fouled gate posts. When the Milk Act, 1934 was drafted an opportunity occurred to include clauses to cover this very apparent need, but unfortunately the opportunity was not used. The longer this desirable additional law is delayed, the more difficult it will be to change the habit of those people who persist in treating milk bottles so shabbily. (b) MEAT AND OTHER FOODS. The number of animals slaughtered in the Borough during 1934 was 6,413 which is only a few hundreds fewer than the previous year. It is very unlikely that the number will again increase to the record number of 11,821 killed in 1930. The private slaughterhouses in the borough will not accommodate conveniently more animals than are required for the normal business of the particular occupier, and those dealers who have made use of certain of the premises for several years have now transferred to slaughterhouses in neighbouring districts. The change is not to be 47 regretted as the proper inspection of a large number of carcases hanging up, closely packed together, was no easy task and certainly was far from being a pleasant one. A further reduction in the number of animals slaughtered in the borough may be expected. The Meat Regulations, 1924 which, inter alia, 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, continue to work well and have enabled accurate data regarding meat inspection work to be recorded. The following table shows the number of notices of slaughter received together with the number and class of animals dealt with:— MEAT REGULATIONS 1924 Summary for year ended December 31st, 1934 Number of Notices Received Number of Animals Slaughtered Beasts Pigs Calves Sheep Goats Total 519 34 4312 865 1202 6413 Carcases not Examined Percentage of Total Animals Examined Pigs Sheep Calves 1 — — 99.98 A reduction in the number of animals slaughtered is not followed necessarily by a proportionate decrease in the number of visits to be made to the premises, but the time taken in examination of the carcases is reduced. The percentage of animals inspected remains practically one hundred. 48 The number of other food premises such as restaurants and cooked food rooms continues to increase. There appears to be a bigger demand than ever for ready cooked foods, and if the sales continue to increase at the same rate one may envisage the day at no very distant date when home cooked meals will become important but infrequent events. The total number of visits to food premises during 1934 was 1,821. ARTICLES OF FOOD CONDEMNED. PORK— 23 Carcases & Offal Tuberculosis Inspected & Condemned 1 Carcase & Offal Swine Erysipelas ,, ,, ,, 1384 Heads & Necks Tuberculosis ,, ,, ,, 2 Heads & Necks Abscess ,, ,, ,, 34 Plucks Tuberculosis ,, ,, ,, 12 Plucks Inflammation ,, ,, ,, 1 Pluck Abscess ,, ,, ,, 25 Spleens Tuberculosis ,, ,, ,, 3 Spleens Inflammation ,, ,, ,, 3 Spleens Bruised ,, ,, ,, 11 Pairs Lungs Tuberculosis ,, ,, ,, 5 Pairs Lungs Pleurisy ,, ,, ,, 1 Pair Lungs Inflammation ,, ,, ,, 1 Pair Lungs Congestion ,, ,, ,, 1 Pair Lungs Pneumonia ,, ,, ,, 8 Livers Cirrhosis ,, ,, ,, 5 Livers Tuberculosis ,, ,, ,, 2 Livers Cysts ,, ,, ,, 1 Liver Fatty Degeneration ,, ,, ,, 16 Mesenteries Tuberculosis ,, ,, ,, 2 Pieces Flare Abscess ,, ,, ,, 1 Piece Flare Inflammation ,, ,, ,, 2 Kidneys ,, ,, ,, 1 Kidney Tuberculosis ,, ,, ,, 1 Kidney Uraemia ,, ,, ,, 491bs. Kidney Putrefaction Voluntarily Surrendered. 2 Hearts Inflammation Inspected & Condemned 1 Heart Pericarditis ,, ,, ,, 2 Udders Mastitis ,, ,, ,, 1 Udder Abscess ,, ,, ,, 1 Loin Tuberculosis ,, ,, ,, 701bs. Loin Putrefaction Voluntarily Surrendered. 2 Legs (24 lbs.) Abscess Inspected & Condemned 1 Piece Forequarter Tuberculosis ,, ,, ,, * Side Pork Oedema ,, ,, ,, 10lbs. Pork Putrefaction Voluntarily Surrendered. 49 BOVINES.— 3 Beasts' Heads and Tongues Tuberculosis Inspected & Condemned 7611bs. Beef Putrefaction Voluntarily Surrendered. 2671bs. Beef Fibrosis „ „ 401bs. Beef Injury „ „ 101bs. Beef Bruised „ „ 5 Livers Distomatosis Inspected & Condemned 1 Liver Angiomatosis „ „ „ 81bs. Liver Distomatosis „ „ „ 231bs. Liver Putrefaction Voluntarily Surrendered. 7 Pairs Lungs Tuberculosis Inspected & Condemned 1 Pair Lungs Inflammation „ „ „ 81lbs. Ox Kidney Putrefaction Voluntarily Surrendered. 1 Heart Inflammation Inspected & Condemned 1 Heart Pericarditis „ „ „ l1b. Corned Beef Putrefaction Voluntarily Surrendered. 61bs. Brisket Tuberculosis Inspected & Condemned 1 Mesentery „ „ „ „ 2 Udders Mastitis „ „ „ 101bs. Beef Trimmings Putrefaction Voluntarily Surrendered. 121bs. Suet ,, „ I. VEAL.— 3 Plucks Tuberculosis Inspected & Condemned 3 Carcases & Organs .. „ „ „ 1 Carcase & Organs Enteritis „ „ „ 1 Liver Tuberculosis „ „ „ MUTTON.— 1 Liver Strongylus Rufescens „ „ „ 2 Livers Distomatosis „ „ „ 301bs. Sheep's Livers Putrefaction Voluntarily Surrendered. 101bs. Lambs' Livers „ „ „ 71bs. Mutton „ „ „ 141bs. Suet „ „ „ VEGETABLES.— 2 Bags Greens Unmarketable „ „ RABBITS.— 110 Rabbits Putrefaction „ „ FISH.— 3 Boxes (71b. Box) Smoked Fillets „ „ „ 50 PRIVATE SLAUGHTERHOUSES. On December 31st, 1934, there were four private slaughterhouses in the borough, all of which had been in use during the year. They are situated as follows:— Adjoining No. 76. Cambridge Road. No. 45, Cambridge Grove Road. No. 120, London Road. Rear of No. 34, Richmond Road. The old slaughterhouse at No. 90, Acre Road which was purchased by the Corporation during 1932 and which had remained empty since then was sold during 1934 and was demolished soon after the end of the year. There is no alteration to report in the structure of the other slaughterhouses. The provisions of the Slaughter of Animals Act 1933 came into force on January 1st, 1934 and has been operated successfully. ALL animals are humanely stunned before slaughter in this borough. Twelve licenses to slaughter animals were issued during 1934. In case of emergency a spare gun is kept at the office and has been used on several occasions during the past year. The spare gun is the property of the R.S.P.C.A. and is kindly loaned to the borough. Eight hundred and one visits were made to slaughterhouses during the year 1934. FACTORIES AND WORKPLACES. Two hundred and eighty eight visits were made to factories and workplaces during 1934 as compared with 227 in 1933. Other details with respect to these premises are contained in the tables on pages 17 and 18. 51 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 1934 were lower than in the previous year. There were 161 rooms in 135 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. 1,282 articles were passed through the steam disinfector. 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 fifteen visits were made in connection with infectious disease enquiries. The results of the investigations were passed to the Medical Officer of Health. 52 SANITARY CONDITIONS OF MUSIC HALLS, CINEMAS, ETC. Seventy-two 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 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 1934, 19 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. 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. 53 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. Twelve 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 in a safe place. The poisons are used in connection with horticulture and agriculture. Four licences were issued during 1934. SHOP ACTS 1912 TO 1931. Three hundred and twenty-three visits were made to shops during the year. The Acts are extremely complicated and are difficult to administer where, as in Kingston, there is no universal day for the half holiday. The principal shopkeepers in the centre of the town close on Wednesday afternoons but many small shops have other closing days. There appears to be a general desire on the part of responsible shopkeepers to comply with the Acts. There is no reason for contraventions as shopkeepers can always obtain advice respecting the various provisions of the Acts especially with regard to the notices which have to be exhibited in the shops. In any case where contraventions of the Acts are noted the shopkeeper is interviewed. This is followed up by a letter giving any necessary information and containing a warning that any further contravention will be reported to the Corporation. 54 During the year legal proceedings were taken against a company for serving customers after closing time. The offence having been proved the defendants were convicted and were fined £4. 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 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 1935. 55 Report of the School Medical Officer. March, 1935. To the Chairman and Members of the Education Committee of the Royal Borough of Kingston-upon- Thames. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1934. The average number of children on the school register for the year was 3,840. In addition there were 48 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. A class for stammerers and children suffering from speech defects was established at Grange Road, and the results have already fully justified this training. The scheme for the provision of milk for school children at the reduced price of ½d. for a third of a pint instead of ld. was commenced on October 1st and resulted in 70% of the children taking milk at school compared with 20% before that date. 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. 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. 56 Staff of the School Medical Service. on DECEMBER 31st, 1934. 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. Denial Surgeon: H. A. L. MORRIS, M.C., l.d.s., r.c.s, (eng.). Anœsthetist: OLIVE G. AUBREY, b.a., m.d., b.ch. School Nurses: Miss A. GILL (Senior) 1/2 time. Miss C. A. HOOKWAY 1/2 time. Miss L. G. SALWAY 1/2 time. Miss E. G. COUZENS 1/2 time. Clerk : Miss P. M. INGILLSON, 57 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. The Offices of the School Medical Service and Public Health Department together with the Clinics, Welfare Centre, and Open Air Day School are situated at the Health Centre in Grange Road. This centralisation of Health Services, both administrative and executive, is ideal and forms the most efficient unit, possible. SCHOOL HYGIENE. External painting and internal decorations were carried out at Richmond Road and St. Peter's Schools. The School Clinic and Offices were painted externally. Part of the playground at St. John's School was paved with asphalt. The unoccupied Tiffin Boys' School was entirely reconditioned and altered to accommodate children from St. Agatha's School which closed at the end of July. The School is now known as St. Joseph's and will accommodate 280 pupils. 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. 58 Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows No. of Children No. of Present. Parents Per centage. Examined. Entrants: Boys 200 166 83 Girls 218 184 84 Second Age Group Boys 189 118 62 Girls 218 148 58 Third Age Group: Boys 212 63 30 Girls 209 112 54 In no instance did any parent object to Medical Examination of a child. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. There are fourteen delicate children who show varying degrees of undernourishment attending the Open Air Day School, where they receive a good hot mid-day meal and milk in the morning and afternoon. In addition twelve undernourished children who attend ordinary Elementary Schools were recommended by the School Medical Officer for milk at School. Milk has been provided for these children, in three instances the parents meeting the cost, while in the remaining nine cases it has been supplied free, the cost being met from a voluntary fund. (b) Uncleanliness. In my Annual Report for 1932 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 five prosecutions were made resulting in fines being imposed in four cases, 59 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 remains fairly constant in recent years. There were only three cases of ringworm of the Scalp, one of which was treated by X rays. There were rather more cases of Scabies, which is mainly accounted for by the fact that a whole family suffering from this skin disease arrived in the Borough from the North. (d) Visual defects and external eye disease. During the year 51 children were found requiring treatment for defective vision, and 27 for squint. (e) Nose and throat defects. There were 88 children suffering from enlarged tonsils and adenoids referred for treatment. (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 2,133 children needing treatment. (h) Orthopœdic and postural defects. Two cases of rickets, and four of spinal curvature have been referred for treatment. 60 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. Six new cases of organic heart disease were discovered this year. Seventeen children were recorded suffering from rheumatism in some form and followed-up. (j) Tuberculosis. Five children were 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. 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 in detail in the Annual Report for 1930. The following table specifies some of the work carried out by the School Nurses during 1934:— Number of children prepared for Routine Medical Inspection 1495 Number examined at Schools for uncleanliness 14528 Number of following-up home visits 611 Total number of visits to the Schools 485 Total number of Clinic Sessions 428 61 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, 5787 attendances being registered during the year. One case of ringworm of the scalp received X-ray treatment by Mr. G. G. Blake of Richmond. (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 98 children during the year. (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 £57 15s. 0d., towards which the parents contributed £16 3s. 0d. (d) Ear Disease and Hearing. Minor ear defects in the cases of 18 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (e) Dental defects. Of the 2133 children requiring treatment found by the School Dentist, 1022 were actually treated, 818 being rendered dentally fit before the end of the year. There were 444 gas cases during the year. 62 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, 33 sessions were given to inspection at the Schools and 184 to treatment at the Clinic. The programme for the year was similar to that for 1933, 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. A special effort was made to obtain the consent of parents who had consistently declined the annual offer of treatment for their children. This action resulted in an increased number of cases attending the Clinic. These cases present permanent teeth which are unsavable and require extraction. This method has the disadvantage of leading parents to believe that they can ignore advice as to early treatment and wait until the child is actually in pain before applying for an appointment. Previous policy has been to impress parents that early treatment to save the teeth is essential, and that should they neglect to take advantage of the offer the child may suffer later, when it will be difficult for them to obtain an appointment. Pamphlets on the care of the teeth supplied by the Dental Board were distributed." (f) Crippling Defects and Orthopœdics. During the year 15 individual children received electrical, massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 275 total attendances. The cost of the above out-patient treatment amounted to £27 10s., towards which the parents contributed £10 14s, 7d. Two children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote for in-patient treatment. 63 The Education Committee accepted the responsibility for one cripple at a Residential School at Bournemouth when the mother came to reside in Kingston. The total cost of in-patient treatment amounted to £86 18s. 7d., towards which the parents contributed £10 15s. (g) Heart Disease and Rheumatism. Twelve 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. One child suffering from rheumatism not complicated by heart disease is also attending this School. INFECTIOUS DISEASE. The Schools have enjoyed a year of remarkable freedom from infectious disease. There were small outbreaks of Measles at Bonner Hill Road Infants' and Richmond Road Infants' Schools in February and March. A little Chickenpox occured at Richmond Road School in March, and Whooping Cough at St. John's School in April. With regard to notifiable infectious disease there has not been any definite outbreak in the Schools. The incidence of Diphtheria remained low and there was complete absence of the usual annual rise in Scarlet Fever this Autumn. 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, 64 (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. 1 St. Luke's Central School for Girls. The school journey which was undertaken by 28 senior pupils and two mistresses of St. Luke's Central School for Girls was in every way a successful undertaking, the girls returned safely and physically very fit. Many valuable results of this educational week with its community life were observed, and an exhibition of the work was later given in the school. The girls proceeded to Llangollen, North Wales, for the first week in May, 1934. Some of the reasons for choosing Llangollen as a centre were:— 1. To study on the spot a type of country entirely different from our own. 2. To enjoy the beauties of the Dee Valley and the North Wales mountains. 3. To understand more clearly what working in a colliery means. 4. To realise under what conditions other people in Britain live. 5. To see a great port (Liverpool). 6. To realise that the art of building beautiful churches is not dead in this country (Liverpool Cathedral). 7. To see such historical places as Chester and Valle Crucis Abbey. Excellent accommodation was provided through the auspices of the School Journey Association, and reduced fares were offered by the Great Western Railway. 65 2 Bonner Hill Road Central School for Girls. A school journey to Hastings was undertaken by 40 pupils of Bonner Hill Road Central School for Girls from 1st to 15th June, 1934, in order to study the formation of the Weald, the changed coastline, the Cinque Ports, the Sussex iron industry and the chief styles of architecture of a castle. A great deal of work in art was undertaken, and the educational value of this visit has been widely recognised. 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 MILK. The scheme of the Milk Marketing Board for the supply of milk in Schools on the same lines as hitherto followed by the National Milk Publicity Council, but the price of milk to be ½d. instead of ld. per third of a pint, came into operation on October 1st, 1934. The source and quality of the milk which is drawn from an efficiently pasteurised supply, was approved by the Medical Officer of Health. It was ascertained that some 700 children or about 20% of those in attendance were in receipt of school milk prior to October 1st, 1934, when there was an immediate rise to 68% upon the scheme for cheaper milk coming into operation. 66 There was then a steady increased demand until the end of October, when 2,624 children or 76% of those in attendance were supplied. Subsequently there was a slow but steady fall to 69% at the end of the term. For the purpose of selection of children, the teachers are invited to bring before the School Medical Officer any whom they consider to be undernourished and who are not in receipt of milk at School. From the children submitted the School Medical Officer selected twelve before the end of the year. In three instances the parents agreed to meet the cost, whereas in the remaining nine cases the milk is supplied free, the cost being met from a voluntary fund. In addition there are fourteen undernourished delicate children attending the Special Open Air Day School, who are in receipt of school milk, which is supplied free, the cost being met from a voluntary fund. All undernourished children recommended for milk by the School Medical Officer are weighed regularly and followed-up. At Routine Medical Inspections parents are asked why their children are not having milk at school. The chief reasons given are as follows:— Distaste for milk, parents are of opinion that the children have plenty at home, parents object, or it spoils the appetite for the mid-day meal. Less common reasons given are that the child spends the money on sweets, milk upsets the child or is against doctor's orders, or poverty. Reasons given by the children themselves are distaste for milk, object to cold milk, object to warm milk, and in the Senior Schools many children especially boys consider themselves too old. It will therefore be realised that there is always likely to be a considerable number of children who will not be having milk at school. 67 It is early yet to form an opinion as to the percentage of children who will normally take milk at school in the future, as there is the danger that the novelty of the scheme will wear off resulting in a diminution in numbers having school milk. The large majority of the children not in receipt of school milk are found on examination to be healthy, alert, firm and well nourished, therefore it is difficult and perhaps unjustifiable to urge parents to provide the extra milk in these cases. Under the scheme about 70% of the children are having milk at school, whereas before the scheme 20% only, so the result must be regarded with satisfaction. The scheme has thrown additional duties on the teachers and staff of the School Medical Service, and every effort is being made to further its success. 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. The School Attendance Officer is very helpful, particularly in getting children to attend the Clinic when required to do so by the School Medical Officer or Nurses. 68 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 62. SCHOOL CLINIC. The School Clinic in Grange Road was decribed 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. (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 5787 attendances during the year. 69 (c) 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 398 attendances at the 20 sessions held during the year, 213 being new cases and 185 re-inspections. Refractions numbered 111, and spectacles, were prescribed in 98 instances. Parents are charged the cost price of spectacles, except in really necessitous cases, when the Committee is prepared to pay part or the whole cost. 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, 33 half-days were given to Inspection and 184 to Treatment. There were 444 gas cases during the year. Dental Board leafllet 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. 70 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 for retarded children 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 three deaf children at Certified Schools for the Deaf. There is one partially blind child attending the Special School for Delicate Children, while undergoing treatment as an out-patient at Hospital. There are no cases of severe epilepsy but five mild cases are attending ordinary Elementary Schools. Ten crippled children and twelve suffering from heart disease are attending the Special Open Air Day School. In addition there are twenty-six delicate children suffering from various defects attending this School. SPEECH TRAINING. A class for children suffering from defective speech was started in April and has proved a valuable addition to the Services. The children are selected by the School Medical Officer, from those brought forward by the Teachers. 71 Between April and December 30 children were admitted to the class which is held on Monday and Wednesday afternoons every week. During this period 6 children were discharged and returned to their schools with normal speech. One child left upon attaining the age of fourteen much improved after four months attendance. Three other children were discharged from the class as being unsuitable, leaving 23 on the register at the end of the year. Miss Badcock, L.R.A.M. (Elocution) who is in charge of the class reports as follows:— "A third of the children attending the speech training class have been stammerers. In two of these cases the stammer was obviously of psychological origin, and both have reacted to persuasion, that is they have been persuaded to discuss their hitherto unexpressed fears and repressions and so release an emotional tension. At the same time they have undergone a course of physical relaxation, rhythmic breathing, etc. The speech and general conditions in each case is steadily improving. Other cases of stammering include those of the "stutter" type. Excellent results in this type are obtained from speech guidance, encouraging slow smooth speech. One boy who six months ago was unable to read five words consecutively without a stutter, can now read normally as the result of this treatment. The stammerers are taken collectively for relaxing but also receive individual treatment. Cases of speech defects other than stammering include various types of lisping and lalling (undeveloped speech) and four cases of cleft palate. For lisping and lalling instruction is given in lip and tongue exercises and in practice combining the sounds of speech, which is followed by reading and talking exercises. 72 Of the four cases of cleft palate two have been fitted with obturators as advised by the Royal Dental Hospital. These children are instructed in breath directing, lip, tongue, and velum exercises. Progress in such cases is always slow, but the speech of these four children is progressing satisfactorily and their articulation is clearer, though the tone is still nasal. A most important part of the work in connection with the Speech Clinic consists in visiting the children's homes and schools, thereby obtaining the co-operation of parents and teachers. Of the six children discharged cured, two were stammerers, one was a lisper, and three were lallers." 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, 1933 45 No. admitted during 1934 14 No. transferred to ordinary Schools 16 No. left School 6 No. on register December, 1934 37 It is satisfactory to note that as stated above sixteen children were rendered fit to return to ordinary Public Elementary Schools. The children receive morning and afternoon milk, the cost of which in necessitous cases is met by a voluntary fund. 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. 73 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. 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) 222 Special 470 Dental Inspections 38 Found to require treatment 28 Actually treated 9 Orthopaedic Treatment Residential 2 Non-residential 2 Defective Vision and Squint 1 Cleanliness Surveys 172 Individual children found unclean 10 Twenty-three physically defective children received hampers from the Treloar Childrens' Christmas Hamper Fund. On December 21st the distribution of the hampers was very kindly made by the Mayoress, Lady Woodgate at the Open Air School. 74 EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 58 school children over 12 years of age were issued with certificates under the Byelaws permitting their employment on milk and paper rounds. SWIMMING. The total number of attendances for instruction made by the Elementary School children to the Kingston Swimming Baths during 1934 was 9,073. The number of individual children which this figure represents is not easily ascertained nowadays owing to the re-organisation of the schools whereby the name of any one child may appear on the register of one school during that part of the season prior to the summer vacation and on that of another school afterwards. 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'3 School. Open-Air School at the School. St. Joseph's School is without a Gardening Centre. 75 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. N umber of Inspections in the prescribed Groups. Entrants ..... ..... ..... ..... 418 Second Age Group ..... ..... ..... ..... 407 Third Age Group ..... ..... ..... ..... 421 Total ..... ..... 1,246 Number of other Routine Inspections ..... ..... 149 B —Other Inspections. Number of Special Inspections ..... ..... ..... 1,639 Number of Re-Inspections ..... ..... ..... 5,824 Total ..... ..... 7,463 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1934. Defect or Disease Routine Inspec. Special Inspec. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Malnutrition — — — — Skin Ringworm, Scalp — — 3 — Body — — 7 — Scabies — — 17 — Impetigo 5 — 99 — Other diseases (non Tb) 13 — 209 6 Eye Blepharitis 4 — 7 — Conjunctivitis 1 — 41 — Keratitis — — — — Corneal Opacities — — — — Defect. ision exc. quint 35 15 16 — Squint 21 1 6 2 Other Conditions 6 1 35 1 Ear Defective Hearing Otitis Media 1 I — 2 2 — Other Ear Diseases 5 1 33 — Nose and Throat Chronic Tonsillitis only 31 12 28 — Adenoids only — — 1 — Chronic Tonsillitis and Adenoids 10 2 18 — Other Conditions 6 51 — Enlarged Cervical Glands (11011 Tb) 3 4 23 — Defective Speech 5 — 16 1 Heart and Circulation Heart Disease—Organic 4 — 2 Functional 1 2 2 — Anaemia 1 — — — Lungs Bronchitis 3 3 9 — Other non Tb. Diseases 4 1 10 — Tuberculosis Pulmonary—Definite — — 2 — Suspected 1 1 1 — Non- Pulmonary-Glands 2 — — — Bones & Joints — — 1 Skin — — — Other Forms — — — Nervous System | Epilepsy — — 1 — Chorea 4 2 3 — Other Conditions Other Conditions 1 — 0 6 Deformities j Rickets 2 3 — Spinal Curvature 4 — 1 — Other Forms 7 9 — Oilier Defects and Diseases 36 7 313 2 (excl. Uncleanliness & Dental Diseases) Total — 217 55 972 12 77 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. Inspected. Found to Require Treatment. Prescribed Groups—Entrants 418 60 Second Age Group 407 41 Third Age Group 421 53 Total (Prescribed Groups) 1246 154 Other Routine Inspections 149 22 Grand Total — 1395 176 78 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 Sighted — — 1 — — 1 Deaf 3 — — — — 3 Partially Deaf — — — — — — Mentally Defective (feeble minded) 1 — 1 Epileptic — — — — — — Physically Defective — — — — — — (a) Tuberculosis 1. Pulmonary — 2 2 2. Non-pulmonary 3 — 1 — 4 (b) Delicate 26 — 12 1 — 39 (c) Crippled 10 — 16 1 — 27 (d) Heart Disease 12 — 21 — — 33 79 TABLE IV. Return of Defects Treated During the Year Ended 31st December, 1934. Treatment Table. Group 1.—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— (i) X-Ray Treatment. If none indicate by dash l — 1 (ii) Other Treatment l l 2 Ringworm, Body 7 — 7 Scabies 17 — 17 Impetigo 99 l 100 Other skin disease 197 12 209 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 21 5 26 Minor Ear Defects 18 8 26 Miscellaneous—(e.g., minor injuries, bruises, sores, chilblains, etc.) 203 20 223 Total 564 47 611 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). • Number of Defects dealt with. Disease or Defect. Under the Authority's Scheme Otherwise Total. Errors of Refraction (including squint) 1ll 18 129 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 7 2 9 Total 118 20 138 No. of children for whom spectacles were prescribed (i) Under the Authority's Scheme 98 (ii) Otherwise 18 No. of children for whom spectacles were obtained :— (i) Under the Authority's Scheme 94 (ii) Otherwise 18 80 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner "or Hospital, apart from the Authority's Scheme. Total. Received other forms of Treatment. Total number treated. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 27 2 10 — 11 — 29 — 38 2 39 — 19 98 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Total number treated Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated. 3 — 15 — — — 18 81 Group V.— Dental Defects. (1) Number of Children who' were :— (i) Inspected by the Dentist : Aged 5 6 7 8 9 10 11 12 13 14 242 283 315 349 337 372 410 383 459 193 Total 3343 Specials 20 Grand Total 3363 (ii) Found to require treatment 2133 (iii) Actually treated 1022 (2) Half-days devoted to :— Inspection 33 Treatment 184 Total 217 (3) Attendances made by children for treatment 2266 (4) Fillings:— Permanent teeth 1155 Temporary teeth 147 Total 1302 (5) Extractions :— Permanent teeth 276 Temporary teeth 1717 Total 1993 (6) Administrations of general anaesthetics for extractions 444 (7) Other operations :— Permanent teeth 227 Temporary teeth 278 Total 505 82 Group VI.— Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses ... 12 (ii) Total number of examinations of children in the Schools by School Nurses 14528 (iii) Number of individual children found unclean 569 (iv) Number of children cleansed under arrangements made by the Local Education Authority — (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws 5