The Royal Brough of Kingston-upon Thames Annual Reports FOR 1 9 3 5 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report ON THE SANITARY INSPECTOR The Royal Brough of Kingston-upon Thames Annual Reports for 1 9 3 5 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, 1935. 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. Diphtheria Immunisation: *D. S. MURRAY, B.Sc., M.B., Ch.B. Dental Surgeon: *H. A. L. MORRIS, M.C., L.D.S., R.C.S. Consultant under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926: *a. McAllister, m.b, b.s.Lond., f.r.c.s. Sanitary Inspectors: (Senior) H. T. PERRY, M.R.S.I. (a). (2) F. D. HARVEY, A.R.S.I. (a) (Chief Clerk). (3) H. H. MADAMS, A.R.S.I. (a). Health Visitors and Scho.ol 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 F. I. ARNOLD, (b), (c), (d). Clerk: 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, Guildhall, Kingston-upon-Thames. April, 1936. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1935. Circular 1492 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1935 requests that the Council will direct the Annual Report of the Medical Officer of Health for 1935 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 1935 should contain information in regard to the matters specified in Appendix I, set out as far as possible in the order there given, under the main heads A to F. 4 There have been two changes in the Staff. Miss F. I. Arnold, Health Visitor—School Nurse, was appointed to fill the vacancy created by the resignation of Miss E. G. Couzens, who had obtained a post at Harrow. Miss Arnold commenced her duties on February 11th, 1935. Mr. H. H. Madams was appointed as additional Sanitary Inspector to fill the vacancy caused by the resignation of Mr. G. H. Cockell, who had obtained a post at Finchley. Mr. Madams commenced his duties on the 28th August, 1935. In April the Maternity and Child Welfare Services were extended to include dental treatment for mothers and infants, operative treatment of tonsils and adenoids at the Kingston Victoria Hospital, the services of Dr. B. Turner as Consultant Obstetrician, and an additional ante-natal session a month. Another advance was the establishment in April of an Immunisation Clinic against diphtheria, and the demand for this was amply justified by the numbers seeking protection through this service. The above additional activities have considerably increased the work of the Health Visitors, who are also School Nurses, and Infant Life Protection Visitors under the Children and Young Persons Acts. Since it appeared certain that home visiting would suffer in consequence of these extra duties, the appointment of a dental attendantclerk to the Maternity and Child Welfare and School Medical Services was considered early in 1936 and approved to take effect from 1st April, 1936. The work of the Sanitary Inspectors in connection with Housing, Meat and Food Inspection, and general sanitation has been well maintained. The subject of Housing is dealt with under Section D of the Report and the progress is steady and satisfactory. 5 The Survey under Section I of the Housing Act 1935, to ascertain the extent of overcrowding in the Borough, was commenced on December 30th, and temporary additional staff was engaged to assist in this work. The incidence of notifiable infectious diseases has remained low, and there has been a remarkable absence of non-notifiable infectious disease, since there has been no measles and only a few cases of whooping cough. I thank the staff for their willing assistance at all times. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statistics. Area 1,390 acres Population, 1935 (Registrar General) 39,030 Number of inhabited houses approx. 10,000 Rateable Value—General Rate £466,278 Sum represented by Penny Rate £1,825 Amount of Poor Law Relief £5,136 (ii) Extracts from Vital Statistics of the Year. Live Births— Total. Male. Female. Legitimate 474 238 236 Birth Rate (R.G.) Illegitimate 36 15 21 per 1,000 pop. 13.0. 510 253 257 Still Births— Total. Male. Female. Legitimate 15 7 8 Rate per 1,000 total Illegitimate - - - (live and still) births 28.6 15 7 8 Deaths— Total. Male. Female. 482 237 245 Death Rate (R.G.) per 1,000 pop. 12.3. Death Rate corrected for age and sex constitution, 10.8 per thousand population (factor for correction 0.88, 1931 Census). 7 Deaths from puerperal causes— Deaths Rate per 1,000 total (live and still) births Puerperal Sepsis — - Other Puerperal Causes l 1.9 Total l 1.9 Death Rate of Infants under one year of age— All infants per 1,000 live births 57 Legitimate infants per 1,000 legitimate live births 53 Illegitimate infants per 1,000 illegitimate live births 111 Deaths from Measles (all ages) Deaths from Whooping Cough (all ages) Deaths from Diarrhoea (under 2 years of age) 2 Birth Rate. Death Rate. Rate per 1,000 Births. Diarrhoea Total Deaths under 2 years Under 1 year England and Wales 14.7 11.7 5.7 57 140 Smaller Towns 14.8 11.2 3.8 55 London 13.3 11.4 11.2 58 Kingston-upon-Thames 13.0 10.8 3.9 57 (iii) Causes of Death. Male Female All Causes 227 245 1. Typhoid and Paratyphoid Fevers - — 2. Measles - — 3. Scarlet Fever - — 4. Whooping Cough — — 5. Diphtheria - — 6. Influenza - 3 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever 1 1 9. Tuberculosis of the Respiratory System 10 7 10. Other Tuberculous Diseases 1 2 11. Syphilis — — 12. General Paralysis of the Insane, tabes dorsalis - 1 8 13. Cancer, Malignant Disease 35 41 14. Diabetes 2 2 15. Cerebral Haemorrhage, etc. 6 11 16. Heart Disease 53 53 17. Aneurysm 1 1 18. Other Circulatory Diseases 9 15 19. Bronchitis 10 9 20. Pneumonia (all forms) 18 13 21. Other Respiratory Diseases 1 1 22. Peptic Ulcer 7 1 23. Diarrhoea, etc. (under two years) 1 1 24. Appendicitis 3 2 25. Cirrhosis of Liver 2 1 26. Other Diseases of Liver, etc. — 2 27. Other Digestive Diseases 4 13 28. Acute and Chronic Nephritis 13 14 29. Puerperal Sepsis — — 30. Other Puerperal Causes — 1 31. Congenital Debility, Premature Birth, Malformations, etc. 10 6 32. Senility 7 19 33. Suicide 3 1 34. Other Violence 13 13 35. Other Defined Diseases 17 11 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, has proceeded apace, and some 830 houses have been completed in this area. The building of a new junior mixed and infants school nearby was commenced in December, and will be ready for occupation in the Autumn of 1936. 9 METEOROLOGY, 1935. The following table is compiled from records taken by Mr. P. G. Lloyd. Temperature of Air. Rainfall Inches Highest Lowest Mean Max. Mean Mm. January 53 28 45 36 0.99 February 58 28 49 38 2.42 March 65 30 54 38 0.29 April 66 30 57 41 2.85 May 77 30 64 44 1.13 June 88 48 74 54 3.21 July 88 50 80 58 1.40 August 87 46 76 56 2.29 September 78 40 68 52 2.86 October 69 29 58 45 2.25 November 62 28 51 40 4.09 December 63 25 44 35 2.18 Total inches 25.95 The average annual rainfall at Greenwich is about 24½ inches. 10 (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 C.C.). (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. 11 The Corporation made a contribution of £50 to the Kingston Victoria Hospital. A number of the inhabitants of the Borough attend the Royal Hospital, Richmond, and the Corporation made a contribution of £50 to its funds. (vi) Ambulance Facilities. (a) For infectious cases : Those cases removed to Wimbledon Isolation Hospital are transported by the Motor Ambulance attached to that Hospital. The Corporation has a light Ford motor ambulance which is used for removing bedding to the steam disinfector, and for transporting patients in emergencies. (b) For non-infectious and accident cases : A motor ambulance for non-infectious and accident cases is provided by the Corporation,. Accident cases are removed free, but a charge is made for its use in private cases. During the year 288 accident cases and 121 private cases were removed by this ambulance. 12 (vii) Clinics and Treatment Centres. Clinic or Dispensary. Where held. When held. Diphtheria Immunisation School Clinic, Grange Road, Kingston. Mondays at 2 p.m. Maternity and Child Welfare Centre School Clinic, Grange Road, Kingston. Tuesdays & Fridays at 2.15 p.m. Ante-Natal Clinic School Clinic, Grange Road, Kingston. Second and fourth Wednesdays in each month at 2 p.m. Post-Natal Clinic School Clinic, Grange Road, Kingston. First Wednesday in each month at 2p.m. School Clinic — Minor Ailments School Clinic, Grange Road, Kingston. Daily at 9.15 a.m. Consultations School Clinic, Grange Road, Kingston. Tuesdays & Fridays at 10.30 a.m. Dental Treatment School Clinic, Grange Road, Kingston. Mondays, Tuesdays, Wednesdays and Thursdays at 9.30 a.m. and Thursdays at 2 p.m. Eye Clinic School Clinic, Grange Road, Kingston. Third and fourth Thursdays in each month at 2.15 p.m. Orthopaedic Clinic Red Cross Curative Post, Coombe Lane, Kingston. By appointment. Tuberculosis Dispensary (S.C.C.) South Place, Surbiton Weds., 5.30 p.m. Fridays, 1.30 p.m. Day Nursery (Vol. Committee) 53 and 55 Canbury Park Road, Kingston. Mondays to Fridays. Kingston Nursing Association (Vol. Committee) 33 Birkenhead Ave., Kingston. Apply to Matron. 13 MATERNITY AND CHILD WELFARE. (i) Mid wives. The Midwives are under the administrative control of the Surrey County Council. There were twelve registered as practising in the Borough at the end of the year. The Kingston Nursing Association, 33, Birkenhead Avenue, undertake District Midwifery work. (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. During the year 8 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 8 cases notified, 6 were either admitted to or already in-patients at the Kingston and District Hospital. There was no death among these notified cases. The consultant, Mr. Andrew McAllister, was not summoned during the year. (iii) Ante-Natal Services. The Ante-Natal Centre was held fortnightly until April, when it was found necessary to hold a further session per month owing to the large number of attendances. 14 Miss Beatrice Turner, M.B., F.R.C.S., (Edin.) presided at the Centre and is recognised as Consultant Obstetrician for the Borough. 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. During the year 173 expectant mothers attended, making 503 visits to the Clinic. Twenty-two 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. Total. Tuesday 52 173 2,594 Friday 51 185 3,044 In necessitous cases, babies and nursing mothers are provided with free milk on the recommendation of the presiding medical officer. Careful investigation is made into the circumstances of each case to ascertain whether it falls within the approved scale, and when recommended it is endorsed by the Medical Officer of Health and approved by the Committee, 15 Dried milk is supplied at cost price. There is an excellent Clothing Stall at which 62 mothers have purchased 129 garments during the year. The sale of National Savings Certificates at the Centre has been continued with the result that 30 mothers have invested £11 10s. 8d. during the year. Baby Week was held from July 1st to 7th. Special announcements were made in the local Churches and Sunday Schools, and the Centre was open to Visitors on Tuesday and Friday. A speaker from the National Baby Week Council gave lectures at Bentalls on the Monday, Tuesday, Thursday and Friday. At the Centre, Miss Mackintosh gave instructive addresses on the value of milk as a food. The Day Nursery in Canbury Park Road was open daily to visitors. On Wednesday, June 26th, a Garden Party was given at St. Peter's Vicarage, where the mothers and infants spent a most enjoyable afternoon. (v) Health Visiting. The Health Visitors paid the following number of home visits :— First Visits. Total Visits. Expectant Mothers 100 177 Infants under one year 521 2,525 Children, one to five years 3,988 Incidental and Infectious — 387 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. 16 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. (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, 1935, there were 34 foster mothers on the Register in charge of 37 infants. During the year 8 new registrations were approved and 17 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 25 foster mothers in charge of 31 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 798 visits were paid, this work being most satisfactorily carried out by the Health Visitors. (vii) Orthopcedic Treatment. Under the scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, three infants 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. 17 (viii) Dental Treatment. Dental Treatment for expectant and nursing mothers and infants under five years of age was commenced in April, 1935. The work was carried out at the School Clinic by Mr. H. A. L. Morris, the School Dentist, and Dr. O. G. Aubrey acted as anæthetist. It was considered avisable at first to make appointments for patients to attend for treatment at the termination of regular School Dental Sessions, rather than hold separate Maternity and Child Welfare Sessions, until such time as the numbers demanded the latter course. A flat rate was charged of 1/- per infant, and 2/6 per woman for a completed treatment. Where dentures are supplied, the patient is expected to contribute to the cost according to her means, the charge being paid by instalments. The amount payable for dentures is certified by the Medical Officer of Health and confirmed by the Committee. From April to the end of the year the following work was carried out:— 37 mothers and 28 infants made 145 attendances. Extractions of permanent teeth 205 Extractions of temporary teeth 87 Filling of permanent teeth 4 Filling of temporary teeth 11 Scalings . 5 Dentures supplied 1 Anaesthetics given 56 18 (ix) Tonsils and Adenoids. The operative treatment for tonsils and adenoids in infants under school age was undertaken in April, 1935. The scheme is similar to that followed in the School Medical Service. The cases are referred by the Medical Officer presiding at the Welfare Centre to the Medical Officer of Health, who arranges their admission to the Kingston Victoria Hospital. The cases remain in Hospital for one night following the operation. The Hospital make a charge of 28/6d. per case and parents are required to contribute towards the cost according to their means. Under this scheme four infants received operative treatment before the end of the year. The cases are visited by the Health Visitors on their discharge from Hospital and are later re-inspected by the Medical Officer of Health. (x) 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. (xi) Maternity and Nursing Homes. 1. Maternity Home at 197, Park Road. Six beds. Kept by Miss Henry. 2. Nursing Home at 24, Albany Park Road. Twelve beds. Kept by Miss Roe. This Home accommodates chronic and senile patients. 19 3. Maternity Home at 8, Norbiton Avenue. Three beds. Kept by Miss Barnes. 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 1 house during the year. The number of premises known to be supplied with water from wells at the end of 1935 was 34, 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. No outstanding works of importance have been carried out on the drainage system during the year. 20 The programme for the construction of manholes on the existing sewerage system has been continued, and approximately £750 has been spent this year for the purpose. The portion of Gloucester Road between Kingston Hill and Coombe Road has been sewered for surface water drainage. The ditch running along the boundary of the Corporation Depot in Villiers Road has 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 burned in the Destructor. (vi) Sanitary Inspection of the Area. A classified statement of the number of premises visited, the defects or nuisances discovered, and the action and result of action taken in regard to these, appears in the Report of the Sanitary Inspector, which follows the Main Report. Also included in his Report are particulars of 21 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) Workshops—(including Workshop Laundries 200 2 Nil Workplaces—(other than Outworkers' premises) Total 200 2 Nil 22 II—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect to which Prosecutions were instituted. Found. Remediec Referred to H.M. Inspector Nuisances under the Public Health Acts*— Want of Cleanliness l l - - Want of Ventilation — — - — Overcrowding — — - - Want of drainage of floors — — - - Other nuisances 5 5 - - Sanitary Accommodation Insufficient Unsuitable or Defective Not separate for sexes — — - — Offences under Factory and Workshop Acts— Illegal occupation of Underground Bakehouse (s.101) - - - - Other Offences — (Excluding offences relating to outwork and offences under the Section mentioned in the Schedule to the Ministry of Health [Factories and Workshops Transfer of Powers] Order, 1921) 4 4 - - Total 10 10 *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. 23 SECTION D. HOUSING. During 1935 considerable progress was made in connection with the five years' programme submitted to the Minister of Health, though no clearance areas were represented during the year. It will be recalled that at the end of 1934 Clearance Orders were outstanding in respect of five areas, one of which (Canbury Area "A") was the subject of an action pending in the Court of Appeal. The owner of certain houses in the Area in question had appealed previously (during 1934) to the High Court against the Clearance Order and on judgment being given against him, had decided to go to the Court of Appeal. The matter was left at that stage at the end of 1934. The case was heard in due course in 1935, and the judgment given in the High Court was confirmed by the Court of Appeal. During the time the Clearance Order had been subjudice, clearance action had been deferred, but following the result of the appeal, action was resumed and the proper machinery set in motion to clear the site. The houses were vacated towards the end of the year but had not been demolished by the 31st December, 1935. The displaced tenants were all given the opportunity of moving either to Council houses or Council flats. With regard to the other clearance areas outstanding at the end of 1934, no special difficulties were encountered and the houses were demolished during 1935. Apart from action taken under Part I of the Housing Act, 1930, thirty-two Demolition Orders were made under Sections 19 and 21 in respect of " individual " unfit houses. Last year I prepared a summary showing 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 24 only to action taken since the passing of the Housing Act, 1930 and has been amended so as to show the position as the end of 1935. With regard to overcrowding, three cases were found during the year. One case was carried over from 1934 but three were abated during the year, leaving one known case outstanding on the 31st December, 1935. During the year the Housing Act, 1935 had been passed and provides interalia for a general survey to be made of the district so far as overcrowding was concerned. Arrangements were in hand at the en.d of the year for the survey to be commenced. 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, 1935 One block of 24 flats. Number of houses erected by private enterprise during the year ended 31st December, 1935 408 houses 240 flats. Total number of houses for the working classes erected by the Corporation since March, 1924 732 houses. One block of 24 flats, CLEARANCE AREAS Clearance Area No. of houses in area Date of represent ation Date ot Clearance Order Date of Compulsory Purchase Order No. of houses vacated at end of 1935 No. of houses demolish ed at end of 1935 Remarks Made by Council Confirmed by Minister of Health Made by Counc il Confirmed by Minister of Health No. I 3 12.1033 19.12.33 9. 4.34 3 3 — No 2 3 12.1033 19.12.33 14.8.34 — — 3 3 — No. 3 3 12.10.33 19.12 .33 14.8.34 — — 3 3 — Canbury 19 30.11.33 27- 2.34 14 8.34 — — 19 1 — Area "A" — No. 5 10 8. 2 34 27.4.34 3.9.34 (with modifications) 2 2 The modified Order excluded 8 houses 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 I 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 - 1934 62 48 12* 34 *Four houses in respect of which an "undertaking" had been given by the owner were subsequently demolished voluntarily by the owner, during 1934. 1935 46 32 — 17 In addition, one house was demolished by the owner in anticipation of formal action under Sec. 19, H.A. 1930. Total 108 80 12 51 26 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) 534 (b) Number of inspections made for the purpose 666 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 160 (b) Number of inspections made for the purpose 181 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 46 (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. 414 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 357 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 4 27 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By Owners 3 (b) By Local Authority in default of Owners Nil B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 24 (2) Number of dwelling-houses in which defects were remedied after service of formal (a) By Owners 18 (b) By Local Authority in default of Owners Nil C.—Proceedings under sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling houses in respect of which Demolition Orders were made 32 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 17 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 28 SECTION E. INSPECTION AND SUPERVISION OF FOOD (i) Adulteration. The following table shows the action taken by the Surrey County Council in the Borough during the year under the Food and Drugs (Adulteration) Act, 1928 :— ARTICLES ANALYSED ADULTERATED OR DETERIORATED PROSECUTIONS CONVIC TIONS Formal Informal Total Formal Informal Total Milk 2 7 27 — — — — — Cream 4 — 4 — — — — — Cheese I — I — — — — — Meat 3 — 3 — — — — — Sausages 1 — 1 — — — — Wine 3 3 1 1 — — Spirits 4 — 4 i — 1 — — Drugs 4 4 — — — — — Other Articles 10 7 17 3 — 3 — — Totals 53 ] i 64 5 — 5 — — (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. The number of animals slaughtered at private slaughterhouses during the last seven years is shown in the following table :— 1929 11,704 1930 11,821 1931 9,629 1932 10,181 1933 6,928 1934 6,413 1935 3,677 29 The large decrease in the number of animals slaughtered this year is chiefly due to a certain dealer removing from the district. (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 seventeen 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 1935 54 50 2 30 SCARLET FEVER. The incidence of Scarlet Fever remains low, and the great majority of cases are of a very mild character. 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. No death 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. Barnardo's) are all immunized against diphtheria by their own medical officer. IMMUNISATION. Last year I suggested in my Annual Report that the time appeared opportune to consider whether immunisation against diphtheria should be offered to the public. I reported to the Public Health Committee on the Schick Test and immunisation against diphtheria, and the Committee recommended that an Immunising Clinic be set up, and in April a weekly session was opened on Monday afternoons. Dr. D. S. Murray was appointed to carry out the work, which consisted of an initial Schick Test followed in those found positive by three injections of T.A.M. The first two injections are given at an interval of one week and the third a fortnight later. A posterior Schick Test is done after three months, and if the child is immune a certificate to that effect is issued. In order to deal with the most susceptible, it was deemed advisable to commence through the Infant Welfare Centre and the Infants' Schools. The number who asked that their children should be immunised was so large that it was considered useless to invite older children since more than 100 infants were on the waiting list at the end of the year. Notifiable Diseases during the Year. Cases. Deaths. Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15-20 20—35 35—45 45—65 65 & over. Total Cases Notified Cases admitted to Hospital! Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over Total Deaths Scarlet Fever — 1 1 2 4 25 11 4 5 1 — — 54 48 — — — — — — — — — — — — — Diphtheria 2 — 1 4 2 16 12 6 6 — 1 — 50 50 — — — — — — — — — — — — — Enteric Fever including Paratyphoid — _ 1 1 — — 2 2 — — — — — — — — — — — — — Pneumonia — — 1 1 — 2 — 2 2 1 6 6 21 5 — — — — — — — — — 1 3 4 Erysipelas 1 — — — — 1 — 1 2 2 9 — 16 2 — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 7 1 — — 8 — — — — — — — — — — — — — — Ophthalmia Neonatorum 3 — — — — — — — — — — — 3 — — — — — — — — — — — — — — Cerebro Spinal Fever 2 — — — — — — — — — — — 2 2 2 — — — — — — — — — — — — New Cases. Deaths. Under I year. 1—5 5—10 10-15 15—20 20—25 25-35 35—45 45—55 55—65 65 & over. Total. Under 1 year. 1—5 5-10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 & over. Total. Tuberculosis (a) Respiratory M — — — — 1 3 1 4 1 2 12 — — — — — 2 1 4 — — 1 10 F 3 4 6 2 2 1 18 — — — — 2 1 1 1 l 1 — 7 Total — — — — 4 7 7 6 3 1 2 30 — — — — 2 3 4 5 1 1 1 17 (b)Non-Respiratory M — — — — 1 1 1 — — — — 3 — — — — 1 — — — — — — 1 F — 2 — — — — — — — — — — 2 Total — — — — 1 1 1 — — — — 3 2 — — — 1 — — — — — — 3 32 A summary of the work from April to December 31st is as follows :— Number of sessions 33 Number of attendances 1987 Number of Schick Tests 435 Number of Injections 1053 Number of posterior Schick Tests 219 Number of Certificates issued 208 Of the 435 cases Schick tested, 68 were found to be immune. There were only 8 cases still positive on re-test after treatment and these received two further injections of T.A.M. No cases of Diphtheria were notified during the year among immunised children. ENTERIC FEVER. Two cases of enteric fever were notified during August. Ihey were admitted to the Kingston & District Hospital and made good recoveries. The sera in both cases agglutinated suspensions of B. Typhosus. There was no connection between the cases, and exhaustive investigations into the circumstances failed to trace the source of infection. PNEUMONIA. The number of cases notified was 21, compared with 34 and 43 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). 33 OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and inquire into the circumstances of the case. Cases notified during 1935 :— Treated Vision Vision Total Notified. At Home. In Hospital, unimpaired, impaired. Blindness. Deaths. 3 2 1 3 — — — Arrangements have been made with the London County Council for the reception and treatment of cases of Ophthalmia Neonatorum from the Borough, at St. Margaret's Hospital, Kentish Town, N.W.5. Application for the admission of cases to be made by the Medical Officer of Health of the Borough, who will arrange for the conveyance of patients to and from the Hospital. The charge is to be at the rate of 10s. per patient per day. No case was sent to Hospital under this scheme during the year. The case treated in Hospital was an infant born in the Maternity Wards at the Kingston & District Hospital and transferred to the London Lock Hospital with the mother. CEREBRO-SPINAL FEVER. Two cases were notified, one in April, a baby of four months, and the second in November, one of seven months. They were admitted to the Kingston & District Hospital and both died The special form of report was forwarded to the Ministry of Health through the Medical Superintendent of the Hospital. TUBERCULOSIS. Cases of Tuberculosis notified in. the Borough come under the administrative control of the Surrey County Council. 34 Every effort is made to assist the County Medical Officer and Tuberculosis Officer in their activities in the area. A Sanitary Inspector is detailed to visit each notified case and report on the condition, of the premises, and also to advise all contacts to consult the County Tuberculosis Officer. The efficiency of notification of Tuberculosis is 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 1:5. 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. No cases of smallpox, encephalitis lethargica, 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. The Schools have enjoyed a year of remarkable freedom from infectious disease. There has been no measles and only a few cases of whooping cough at the Infants' Schools. 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:- 35 Report of the Chief Sanitary Inspector To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, I beg to submit the Annual Report on the work carried out by your Sanitary Inspectors in respect of the year 1935, in connection with the various Statutes and Byelaws relating to Public Health in force within, the Borough. The present report is the seventeenth such report I have had the honour to present to you. During the past year 7460 inspections were made, as compared with 7603 during the year 1934. In the Register of Sanitary Defects 521 new entries were made and 477 entries were cancelled following completion of necessary works. On December 31st, 1935, 458 separate entries remained outstanding compared with 414 at the end of 1934. Included in the 458 entries referred to above were 45 houses awaiting demolition, 36 houses subsequently dealt with in Canbury Areas " B " and " C " and 45 houses which were under consideration for redrainage works. The remaining 332 premises were included owing to sundry sanitary defects. In previous reports it has been customary to state the number of sanitary defects discovered and the number of premises affected thereby. During 1935, however, the design of the Register of Defects was very much simplified in order to reduce clerical labour and the tabulation of premises and defects was discontinued for a similar reason. 36 Four hundred and eighteen "preliminary" and seventeen "verbal" notices were served during 1935. In thirty instances informal action did not bring about the desired result and it was necessary to serve "statutory" notices. During the year 1935, 521 enquiries under the Land Charges Act, 1925, respecting property in the Borough were received from the Town Clerk and were replied to. The corresponding figure for 1934 was 620. The resignation of Mr. G. C. Cockell towards the middle of the year occurred at an inconvenient time owing to the holiday season. The decision, early in 1936 to appoint a third additional inspector will assist the work of the department considerably. The avoidance of unnecessary friction with owners of property and business people is the continued policy of your inspectors and despite the comparatively large amount of work carried out it is pleasing to be able to report that legal action to enforce compliance with notices served proved unnecessary. When a difference of opinion does arise, owners are invited to discuss the matter at the property under consideration either personally or through a skilled representative. This gesture usually has the desired effect and a satisfactory settlement is arrived at. 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 works, and the total of all inspections. Rent Restrictions Act Inspections 8 Reinspections 1629 Visits to Works in Progress 1371 Factories and Workshops 200 37 Cowsheds, Dairies and Milkshops 102 Ice Cream Premises 54 Foodshops and Food Preparing Rooms 521 Infectious Disease Enquiries 254 Markets 187 Inspections of Houses, etc. (including complaints) 926 Examination of Drains 272 Slaughterhouses 579 Offensive Trades 28 Sanitary Conveniences 120 Common Lodging Houses 20 Canal Boats 11 Theatres, Cinemas, etc. 26 House to House 181 Bakehouses 58 Smoke Observations 38 Stables and Yards 39 Enquiries re Housing Applicants 111 Sale of Poisons 22 Rats and Mice Destruction 157 Shops Acts 223 Schools 10 Miscellaneous Visits 313 Total 7460 SUMMARY OF SANITARY IMPROVEMENTS. Below will be found a 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 owners 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. 38 WATER CLOSETS AND SANITARY FITTINGS. New W.C. Basins fixed 94 W.C. Flushing Tanks repaired or renewed 30 New W.C. apartments 5 W.C. apartments lighted, repaired or ventilated 59 W.C. apartments cleansed and limewashed 70 W.C. Seats renewed or repaired 9 W.C. apartments demolished 4 W.C. Pans unstopped and/or cleansed 5 Baths renewed or painted 3 New Impervious Sinks provided 29 Sinks refixed 1 New trapped Waste Pipes fixed 39 Existing Waste Pipes trapped or repaired 28 Urinals cleansed and repaired 7 Urinal reconstructed 1 Miscellaneous 5 DRAINAGE. Number of Houses and Premises redrained 50 Number of Drains repaired or amended 6 New branch drains 1 Drains or Gullies unstopped or cleansed 23 New Manholes provided 75 Existing Manholes repaired 4 Intercepting traps fixed 31 Fresh air Inlet Shafts repaired, renewed or provided 37 New Gully Traps fixed 145 Gully Curbs renewed or repaired 5 New Soil Pipes and/or Ventilating Shafts 40 Soil Pipes and/or Ventilating Shafts repaired 3 Cesspools Emptied 4 Cesspools Abolished 7 New Soakaways constructed 6 Miscellaneous 5 39 GENERAL REPAIRS. New roofs 2 Roofs repaired, new fillets, soakers, etc 86 New gutters and stack pipes provided to roofs 19 Eaves gutters renewed or repaired 41 Stack Pipes renewed or repaired 38 Stack Pipes disconnected from drains 33 Dampness abated 93 Walls rebuilt 1 Defective walls repaired, repointed, etc. 109 Defective walls cement rendered, etc. 29 Internal walls plastered 24 Chimney stacks rendered, repointed etc. 14 New Chimney Pots fixed 2 Ventilation provided beneath floors 28 Air gratings cleansed or renewed 8 Ventilation provided to rooms 37 Staircases lighted or stairs repaired 83 Handrails to staircases provided or refixed 25 Sites of Houses concreted 7 Yards paved 61 Yard paving repaired and yards cleansed 22 Paved pathways constructed or repaired 32 Floors of Rooms repaired 92 New floors of Rooms 26 Rooms repaired, cleansed or distempered 471 Larders ventilated and cleansed 6 New ceilings 41 Premises limewashed 2 Windows repaired, renewed or made to open 314 Additional light to rooms and passages 3 Door and window sills renewed or repaired 89 Doors renewed or repaired 44 Frame joints remade 26 Door locks repaired or renewed 43 Door frames repaired 22 New Portable Ashbins provided 124 Accumulations of manure and refuse removed 10 Manure receptacles repaired 2 40 Nuisance from overcrowding abated 3 Water supply provided direct from rising main 15 Service Water Pipe repaired 3 Service Water Tanks cleansed, covered or removed 5 Use of Well Water discontinued and/or M.W.B. supply laid on 1 Stoves and Firegrates repaired or renewed 102 Fireplace surrounds or hearths repaired 21 Flues repaired 2 Coppers repaired or renewed 20 Illegal use of Basement Room discontinued 1 Houses repainted externally or internally 33 Insanitary Houses demolished (Housing Act) 17 Verminous premises cleansed 9 Skirting repaired or renewed 8 Brickwork repaired or repointed 18 Cupboards cleansed, repaired or renewed 15 Sheds and outbuildings demolished 6 Sites of Houses cleansed 5 Miscellaneous 37 SMOKE ABATEMENT. During the year, 6 complaints were received in respect of alleged excessive emission of smoke or grit from chimneys. Whilst it is, perhaps, true to say that a serious nuisance does not exist in this Borough yet we must continue to take an active interest in the general subject of smoke abatement. Except when an ordinary furnace is being freshly lighted up excessive smoke is avoidable. The number of industrial chimneys in the Borough is comparatively small but if each chimney were permitted to pour soot laden smoke into the atmosphere our town would soon present a very different aspect to what it does at present. The question of atmospheric pollution is not one which can be dealt with satisfactorily by each local authority independently of neighbouring authorities. For this reason 41 the work of the Regional Smoke Abatement Committees, such as that which operates in the Greater London Area, should receive support from every district concerned. At certain times of the year when climatic conditions prevent the rapid dispersal of smoke over London, this Borough is darkened as if a lid had been closed down upon it. The ' lid ' is a huge smoke laden cloud which effectually shuts out light, but it does not descend low enough to be described as an ordinary fog. The nuisance from grit which was referred to in the last Report was further investigated during 1935. It is only fair to say that as a result it was found that the cause of the grit could not be attributed solely to the retorts at the Gas Works, although they may have been a contributory cause. The forced draught in. the steam raising plant together with the class of coal used at the Electricity Works was, doubtless, another contributory cause. The use of forced draught at the works was discontinued in the early months of 1936 and a marked improvement was observed as a result. Apart from the investigation just referred to, 38 smoke observations were made. Bylaws made under the Smoke Abatement Act, 1926 are in force in the borough. The emission of black smoke for more than two minutes in any consecutive thirty minutes from a chimney (other than that of a private dwelling house) is an offence. The observations are usually taken over periods of 40 minutes and any contravention of the Bylaw is notified in the first case by telephone or by a personal visit to the offending works. In the event of temporary breakdown of boiler plant an arrangement exists whereby notice of the breakdown may be sent to the office, thus avoiding unnecessary official action. 42 COMMON LODGING HOUSES. There are only two registered common lodging houses in the Borough, viz.:— Nos. 8 and 10, Vicarage Road (Othen,'s) SO beds for men only. No. 52, Canbury Passage (Marsh's)—35 beds for men only. As will be seen, there is no accommodation for married couples or for children in the registered lodging houses. The Vicarage Road premises were designed for the purpose of 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. Occasionally a lodger in a verminous condition is admitted to one or other of the Houses. Immediately such conditions are found to exist action is taken to ensure the effectual cleansing of the bedding etc. When cleansing is impracticable the bedding is destroyed and is replaced by new. There were no changes of ' deputies' in charge of the Lodging Houses during 1935. Twenty visits were made to the registered Common Lodging Houses during the past year. OFFENSIVE TRADES. The undermentioned trades which are established in the Borough are classed as " Offensive " within the meaning of the Public Health Acts :— 43 Leather Tanning and Fellmongering. Rag and Bone Yards. Fish Frying. The first mentioned trade may be the source of a pronounced nuisance if the raw hides are not stored properly whilst awaiting treatment and if waste material, consisting of trimmings, scrapings, etc. are not removed frequently. Fortunately, complaints are seldom received with respect to the Tanning Company's activities and it is safe to assert that not many burgesses are aware that one of the few oak-bark tanneries of this country is situated in the shopping and business part of the town. There is no change to record in the position regarding Rag and Bone Yards. Constant observation is necessary to prevent as far as possible nuisances from rats, mice and flies. At the end of 1935 there were 11 fried fish shops on the records. Permission to commence the trade at a new shop in Ham Common Parade was granted, but the applicant did not pursue the matter further. Three complaints were received during the year, two of which referred to Rag and Bone Yards and the other to fried fish premises. Twenty-eight visits were made to offensive trade premises. HOUSE DRAINAGE. Fifty houses were completely redrained during 1935 and the drains of 7 other premises were repaired or amended to a substantial extent. The examination of drainage systems under the powers conferred by the Public Health Acts is one of the duties which is regarded as most important. These executive duties necessarily absorb a considerable amount of time but it will be generally conceded that the labour involved is 44 well worth while. An isolated defective drain may not cause much harm, but the cumulative effect of hundreds of such leaking pipes, polluting the subsoil and sites of houses would be very serious. In addition to the 50 houses mentioned above the examination of the drainage systems of 45 houses had been completed, or was nearing completion, at the end of the year, but necessary works of reconstruction had not been agreed upon between the respective owners. The improvement proposed in respect of the drainage of the lower end of Elton Road was not arranged by the end of the year owing to the difficulty of reaching agreement between the many owners affected. In as many cases as possible where combined drains have to be reconstructed plans and detailed specifications are prepared on behalf of the several owners free of cost. By undertaking such work it is possible to assure the use of good quality materials and to control the workmanship throughout. The owners give instructions direct to the selected contractor and are responsible for the costs incurred. The following list gives the situation and numbers of premises redrained during the year :— PREMISES REDRAINED. Acre Road 3 Borough Road 5 Cowleaze Road 1 Canbury Park Road 2 Elm Road 2 Franklin Road 2 Grange Road 1 Hawks Road 1 Princes Road 1 Park Road 7 Shortlands Road 2 Washington Road 10 York Road 13 50 45 COMPLAINTS. Two hundred and sixty-nine complaints were received during the year, as follows :— Drains and sanitary arrangements 52 Overcrowding 4 Condition of Premises 99 Accumulations of manure and non collection of house refuse 16 Dampness and defective roofs, gutters, etc. 9 Smoke nuisance from chimneys 6 Defective stoves and copper 7 Rats 24 Water supply 4 Keeping of animals and fowls 4 Unpaved yards and passages 1 Nuisance from flies 2 Condition of roadway 4 Flooding of basement 5 Nuisance from burning refuse 4 Defective ashbins 5 Verminous premises 4 Unsound Food 5 Offensive Trade Premises 3 Infestation by beetles 1 Improper storage of Fish Boxes 5 Miscellaneous 5 Total 269 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. HOUSING. The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on 46 pages 26 and 27. 534 dwelling houses were inspected completely or in part under the Public Health or Housing Acts. One hundred and sixty houses were surveyed thoroughly as required by the Housing Consolidated Regulations 1925, and the details of sttacture, general conditions, tenancy, ownership, etc., together with a copy of the informal notice served (if any) in respect of each house were filed for future reference. The situation of these 160 houses is as follows :— Acre Road 1 Burritt Road 26 Crescent Road 1 Elm Road 2 Excelsior Road 1 Fairfield West 4 Fairfield Road 1 Grove Crescent 1 High Street 1 Mill Street 4 St. James Road 2 Shortlands Road 1 Thames Street 7 Vicarage Road 3 Washington Road 105 The number of houses so dealt with is more than double that for the previous year. A special effort was made to deal with the Norbiton area and it will be seen that Washington Road was completed and Burritt Road was commenced. The results achieved are plainly visible to those who care to look around. Washington Road> composed in the main of cottage property, has taken on a new lease of life and has a much improved appearance although all the works are not yet completed. Five of the houses in the road were found to be beyond repair and were the subject of demolition orders. Another block of cottages was considered to be in a similar state, but the owner carried out extensive works (including the re-building of 47 the flank gable wall) at a cost which he alone considered to be 'reasonable' within the meaning of the Housing Acts. Houses which cannot be rendered fit for human habitation at reasonable cost, having regard to the ultimate value of the premises (i.e. after the repairs are executed) and which are not included in Clearance Areas, are dealt with as individual houses under Sees. 19 and 21 of the Housing Act 1930. Thirty-two such houses were reported to the Corporation with results as set out below. In view of possible opposition considerable care is necessary in the preparation of estimated costs of necessary repairs and of ultimate values of the properties. Situation No. Action Taken. Acre Road 1 house (s) Demolition Order made Burritt Road 3 ,, ,, ,, Coombe Road 1 ,, ,, ,, Cowleaze Road 1 ,, ,, ,, Dinton Road 1 ,, ,, ,, Fairfield North 9 ,, ,, ,, Fairfield West 3 ,, ,, ,, Grove Crescent 1 ,, ,, ,, Thames Street 6 ,, ,, ,, Union Street 1 ,, ,, ,, Washington Road 5 ,, ,, ,, The following houses were demolished during 1935 in pursuance of individual demolition Orders made. No. 45, Acre Road. No. 54, Canbury Passage. No. la, Coombe Road. " Rufway," Dinton Road. Nos. 25a, 26a, and 27a, Fairfield West. No. 14, Grove Crescent. No. 43, and " The Chestnuts," High Street. Nos. 73, 75 & 77, London Road. No. 20, Union Street. Nos. 12, 14, & 16, Water Lane. 48 The following 9 houses also, in Clearance Areas were demolished :— Nos. 25, & 27, Brook Street. No. 57, Canbury Passage. Nos. 1, & 2, Francis Place. Nos. 82, 84, & 86, Hawks Road. No. 1 Orchard Road. Whilst it is but right that old worn out cottages should be demolished to make room for new ones, yet cottages which can be given a useful life of even five or ten years by a reasonable amount of repair should be saved— provided of course, that they do not form part of an area which should be cleared. In furtherance of this policy 376 houses were repaired during the year. ASH RECEPTACLES AND REFUSE COLLECTION. It must be expected that by reason of continuous and close supervision of ash receptacles in the Borough over a good few years now, the number of renewals required annually will be reduced gradually. The average annual number for the past five years was 214, but during 1935 the number dropped to 124. This may be taken as an indication that almost every house has a proper portable refuse bin and the new bins are actually renewals and not replacement of old boxes or baths by approved receptacles. The arrangement whereby the dust collectors report houses where the ashbins are defective or insufficient continues to prove of great help. Although it is possible to require every house to be provided with an ashbin, it is impracticable to enforce every occupier to use the receptacle in a proper manner. Too little thought is given to the ashbin. which may often prove a serious cause for complaint especially in warm weather. Only two complaints of the presence of excessive numbers of flies were received, but if all refuse were to be properly stored pending collection and disposal by the local authority the numbers of flies could be very much reduced. 49 INCREASE OF RENT & 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 1935. The experience of this Borough in this matter is not unusual for it appears to be general throughout the country. For some reason, not at all clear, tenants do not avail themselves of the opportunities afforded by the Acts. In one case only during 1935 a certificate was granted to the applicants. The houses referred to in the other applications were inspected and found to be in reasonable repair. There were three applications during 1934 INSPECTION AND SUPERVISION OF FOOD. (a) MILK SUPPLY During 1935, four names were removed from the Register of Dairymen owing to business changes. Twelve fresh entries were added to the Register leaving a total of 79 at the end of the year compared with 71 at the end of 1934. In all but one of the additions the milk is sold in hermetically sealed containers as received on the premises. The other registration was in respect of a dairyman outside the Borough but actually he did not commence the sale of milk in the town. There is only one cowkeeper in the Borough. GRADED MILK LICENCES. There is no licensed producer of graded milk in the Borough but 27 dealers' licences (including supplementary licences) were issued during the year. 50 The dealers licences were in respect of the following:— Certified 4 Grade "A" (Tuberculin Tested) 9 Grade "A" 1 Pasteurised 13 , The four samples of milk taken during the year for bacteriological and biological examination proved quite satisfactory and free from Tuberculosis. (b) MEAT AND OTHER FOODS. A reduction in the number of animals slaughtered in the Borough annually was not unexpected, and in fact was anticipated in my last Report, although to a smaller extent than is actually the case. During 1935, the number amounted to 3677 compared with 6413 during the previous year. The only class of animal which has maintained the supply is that of beasts of which 40 were slaughtered compared with 34 during 1934. Pigs were reduced by approximately one third, sheep by one half, and calves from 865 to 61. The latter striking reduction is difficult to explain. So far as one can see the supply of calves is no less, but possibly the number slaughtered for the London markets has been reduced. 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, 1935 Number of Notices Received Number of Animals Slaughtered Beasts Pigs Calves Sheep Goats Total 286 40 2949 61 627 — 3677 Carcases not Examined Percentage of Total Animals Examined Pigs Sheep Calves - 18 — 99.51 51 Visits were also made to the markets and other food premises, such as restaurants, sausage making rooms, etc. In all, 1501 visits were made to the various classes of food premises. UNSOUND FOOD. The following is a list of the foodstuffs examined and condemned during the past year. PORK— 27 Carcases & Offal Tuberculosis Inspected & Condemned 2 Carcases & Offal Oedema do. 2 Carcases & Offal Suffocation Voluntarily Surrendered 1 Carcase & Offal Emaciation Inspected & Condemned 89 Heads & Necks Tuberculosis do. 30 Plucks do. do. 3 Plucks Inflammation do. 1 Pluck Pleurisy do. 19 Spleens Tuberculosis do. 2 Spleens Inflammation .do. 5 Pair Lungs Tuberculosis do. 5 Pair Lungs Pleurisy do. 9 Livers Tuberculosis do. 4 Livers Cirrhosis do. 1 Liver Parasitic Disease do. 951bs. Liver Putrefaction Voluntarily Surrendered 2 Legs Bruised Inspected & Condemned 1 Leg (cooked) Putrefaction Voluntarily Surrendered 4 Pieces Flare Inflammation Inspected & Condemned 15 Mesenteric Fats Tuberculosis do. 251bs. Pork do. do. 2 Kidneys do. do. 521bs. Kidney Putrefaction Voluntarily Surrendered BOVINES— 7351bs. Beef Putrefaction Voluntarily Surrendered 1801bs. Beef Bruised do. 301bs. Trimmings Putrefaction do. 241bs. Fat do. do. 241bs. Tripe do. do. 1 Head & Tongue Tuberculosis Inspected & Condemned 2 Livers Distomatosis do. 1 Liver Tuberculosis do. 131bs. Liver Putrefaction Voluntarily Surrendered 3 Pairs Lungs Tuberculosis Inspected & Condemned 1 Pair Lungs Inflammation do. 52 VEAL— 2 Carcases & Offal Immaturity Inspected & Condemned 1 Carcase & Offal Tuberculosis do. MUTTON— 891bs. Livers Putrefaction Voluntarily Surrendered 4 Tins Liver do. do. 1 Pair Lungs Strongylus Inspected & Condemned Rufescens 201bs. Mutton Putrefaction Voluntarily Surrendered 41bs. Mutton (Imptd.) Caseous do. (Remainder of Carcase not traced.) Lymphadenitis FISH— 8 Boxes Cod Fillet Putrefaction do. 13 Boxes Haddock Fillet do. do. 5 Stone Kit Haddocks do. do. 1 Box Mixed Fish (4 stone) do. do. MISCELLANEOUS— 4 Bags Walnuts Decay do. 22 Boxes South African Plums (131bs. per box) Damaged by frost do. 13 tins Cherries " Blown " do. 72 tins Fruit do. do. 10 Turkeys Putrefaction do. 18 Rabbits do. do. 71bs. Tinned Corned Beef do. do. 1 tin Jellied Veal do. do. 1 tin Jellied Ham do. do. 53 The list shows the varied causes for condemnation and in one respect needs comment. Under the heading mutton, there is an item of 41bs. which was condemned on account of Caseous Lymphadenitis. This disease affects the Lymph glands or what are more commonly known as 'kernels' and is not always easy to detect. It is not at all common. In the case in question the meat was cooked before it was brought for examination and the remainder of the carcase, which was imported and therefore the subject of a veterinary certificate of inspection, could not be traced owing to the fact that it had all been sold a day or two previously. No other complaint was received and it is reasonable to presume that the only lesion in the carcase was that one in the piece of meat brought for examination. PRIVATE SLAUGHTERHOUSES. On December 31st, 1935, there were three private slaughter-houses in use in the Borough. They are situated as follows:— 1. Adjoining No. 76, Cambridge Road. 2. Rear of No. 120, London Road. 3. Rear of No. 34, Richmond Road. The first mentioned slaughterhouse is the one in principal use, the number of animals slaughtered at the other two being comparatively small. The provisions of the Slaughter of Animals Act, 1933, are observed and ALL animals are humanely stunned before slaughter in this Borough. At the end of 1935 there were ten persons in possession of licences to slaughter animals in the Borough. The spare "Cash" captive bolt pistol which is so kindly loaned to the Corporation by the R.S.P.C.A. has proved very useful in cases of emergency when privately owned guns have been out of action. Five hundred and seventy-nine visits were made to slaughterhouses during the year 1935, compared with 801 visits during 1934. 54 FACTORIES AND WORKPLACES. Two hundred visits were made to factories and workplaces during 1935 compared with 280 in 1934. Other details with respect to these premises are contained in the tables on pages 21 and 22. 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 as far as possible overlapping is avoided. DISINFECTION AND INFECTIOUS DISEASE. The number of houses disinfected varies from year to year according to the prevalence of infectious disease. During 1935, 201 rooms in 143 houses were sprayed and fumigated with formalin in the case of ordinary infectious diseases, but in the case of verminous premises, special insecticide liquids and sulphur dioxide were used. Especial attention was given to rooms (and their contents) occupied by prospective tenants of Corporation. Houses. By arrangement between the Housing and the Public Health Committees visits were made to a number of such prospective tenants and where any evidence of the presence of vermin was discovered the bedding was subjected to steam treatment and furniture also was dealt with by other processes in order to eradicate the vermin.. This work was carried out at the time of removal and the articles were delivered to the new dwelling after treatment. Spraying and fumigation of houses and steam treatment of bedding etc. is carried out at the request of occupiers in cases other than ordinary notifiable diseases. A suitable charge, having regard to the circuinctances, is made in respect of such work. 55 Two hundred and fifty four visits were made in connection with infectious disease enquiries. The results of the investigations were passed on to the Medical Officer of Health. SANITARY CONDITIONS OF MUSIC HALLS, CINEMAS, ETC. Twenty-six visits were made to places of public entertainment during the year. The principal object of these visits is to ascertain the condition of dressing rooms, sanitary conveniences and other parts of the buildings, especially parts such as beneath the stage where accumulations of rubbish are likely to exist. The ventilation of the premises is important, especially in Summer time and where natural means of ventilation are depended upon to keep the atmosphere reasonably satisfactory. Visits in connection with ventilation are made at irregular periods and whilst the performances are on, but it is very difficult to obtain reliable information as to the condition of the atmosphere by the " senses" only. No complaints were received during the year regarding places of entertainment, and the premises were found to be in a satisfactory condition, having regard to design and age. CANAL BOATS ACTS. In accordance with Section 3 of the Canal Boat Acts, 1884, I beg to report as follows : During the year 1935, 11 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 are usually dealt with without need for service of notices. 56 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 condition of the sanitary conveniences is supplied to the Licensing Bench upon, request, 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. During the year new glazed stalls were provided at the Barley Mow P.H. in place of old type fittings. SALE OF POISONS. Twenty-two visits were made to premises other than pharmacies to ascertain that the proper records of sales of poisons were being kept and that the poisons were stored in a safe place. The poisons referred to are used in connection with horticulture and agriculture, and are usually in the form of weed killers. Three licences were issued during the year, but as the future supervision of such premises is being undertaken by the County Council this will be the last occasion a report will be made to your Corporation. SHOPS ACTS 1912 to 1934. Two hundred and twenty-three visits were made to shops. The Shops Acts are extremely complicated and difficult to administer. A strict interpretation of all the provisions of the Act's would undoubtedly endanger the good feeling 57 which exists between the business people and the Corporation. For this reason, action under the Acts is carefully considered, and, except in cases of contravention after due notice has been given, the action taken is in the form of advice and information. The Shops Act, 1934 added very considerably to the duties of the local authority but owing to the pressure of other work it was not possible to give more time to shops. It is hoped that when the pressure of housing work is reduced more time will be available for this work. A special report on the subject was in the course of preparation at the end of the year and was submitted to the General Purposes Committee in January, 1936. A reliable estimate of the number of shops (wholesale and retail) in the town is 925 and the number of shop assistants is approximately 6,000, of which about 1,000 may be counted as "young persons" within, the meaning of the Acts. These figures provide some indication of the task of carrying out the executive duties of the Shops Acts in the Borough and will afford an explanation as to why more detailed work cannot be undertaken at the present time. It should be made clear that, with few exceptions, the business people have shown a real sympathy with the objects of the Acts and whilst the many intricate forms and records which they have to prepare and keep are tolerated as legal obligations, there is a general desire to safeguard the position of shop assistants. RATS AND MICE DESTRUCTION ACT. The administration of the provisions of this Act, (a duty which was placed upon the department last year) has not proved an easy task, 58 One of the first difficulties met with was how to create public interest in the subject. It is seldom that an individual house or building is affected and so it is advisable to deal with areas rather than with single buildings. Occupiers of premises adjacent to those where rats have actually been seen usually deny any responsibility, and appear reluctant to take an active part in rat prevention work, even although it is their duty to do so. However, when premises are known to be troubled by rats, etc. notices are served not only on the occupier of those premises but upon neighbouring occupiers also. By this means some attempt at concerted action is made possible. During National Rat Week, November 4th—9th, 1935, a special effort was made to arouse public interest in the subject. Special posters were exhibited throughout the town and handbills were distributed. A lantern lecture was given at the Public Library which was fairly well attended and the managers of the local theatres etc., cooperated by showing slides drawing attention to the subject. It is difficult to say what effect these special efforts had. There were many applications for visits and advice and there can be no doubt that public interest was aroused, for the time being at any rate. It remains to discover some method of maintaining the interest throughout the year and not for one week only. During 1935, 157 visits were made in connection with rats and mice destruction. An arrangement has been made by your Council whereby residents may obtain the services of a skilled rat catcher upon payment of reasonable fees. This fact is not so well known as it should be, as there is a distinct advantage in employing a rat catcher working under official supervision. 59 CONCLUSION. I desire to thank you, Madam 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. Guildhall, Kingston-cpon-Thames. May 7th, 1936. 60 Report of the School Medical Officer. March, 1936. 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 1935. The average number of children on the school register for the year was 3,535. In addition there were 32 children on the books of the Special Open Air Day School at the end of the year. Medical inspection, orthopaedic, eye, nose, throat, and dental work were carried out on the same lines as before. The special class for speech defects was continued with satisfactory results. The scheme for the provision of milk in Schools was carried on during school terms and resulted in between 50% and 60% of the school population taking milk at school compared with 20% before the scheme operated. In August the Public Health Department removed from the Health Centre, Grange Road, to the Guildhall. This year there has been a remarkable absence of infectious disease in the schools. The only change in the Staff was the appointment of Miss F. I. Arnold as School Nurse—Health Visitor to fill the vacancy caused by the resignation of Miss E. G. Couzens on obtaining a post at Harrow. Miss Arnold commenced her duties on February 11th, 1935. I thank all members of the Staff for their willing help throughout the year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, School Medical Officer. 61 Staff of the School Medical Service. on DECEMBER 31st, 1935. 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.). Anasthetist: 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 F. I. ARNOLD 1/2 time. Clerk : Miss P. M. INGILLSON. 62 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 together with the Clinics, Welfare Centre, and Open Air Day School are situated at the Health Centre in Grange Road. The Public Health Department was transferred from the Health Centre to the Guildhall in August. SCHOOL HYGIENE. Certain external painting and internal decorations were carried out at Bonner Hill Road, Richmond Road, and St. John's Schools, and asphalting at St. Luke's and St. Peter's Schools. MEDICAL INSPECTION. All Departments of every School are visited by the School Medical Officer each term for the purpose of carrying out Routine, Special and Re-inspections. A full description of the methods employed at these inspections was set out in the Annual Report for 1930. Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows:— No. of Children Examined. No. of Parents Present. Per centage. Entrants Boys 172 146 85 Girls 200 167 83 Second Age Group: Boys 201 132 65 Girls 193 134 70 Third Age Group: Boys 235 67 28 Girls 170 78 46 In no instance did any parent object to Medical Examination of a child. 63 FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. There are sixteen 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 twenty-six 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, the cost in certain instances being met by the parents, while for five children at the Open Air Day School and nineteen attending ordinary Elementary Schools the milk has been supplied free, the cost being met from voluntary sources. (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 three prosecutions were made resulting in fines being imposed in all cases. 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 has remained fairly constant in recent years. There was only one case of ringworm of the scalp. 64 (d) Visual defects and external eye disease. During the year 40 children were found requiring treatment tor defective vision, and 21 for squint. (e) Nose and throat defects. There were 72 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. (g) Dental defects. At his inspections the School Dentist found 2,048 children needing treatment. (h) Orthopadic and postural defects. One case of rickets and three of spinal curvature have been referred for treatment. From time to time cases such as infantile paralysis, deformities, and results of accidents are found, and these are referred to the Orthopaedic Specialist. (i) Heart disease and rheumatism. Three new cases of organic heart disease were discovered this year. Fourteen children were recorded suffering from rheumatism in some form and followed-up. (j) Tuberculosis. Two 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. 65 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 1935:— Number of children prepared for Routine Medical Inspection 1373 Number examined at Schools for uncleanliness 13848 Number of following-up home visits 412 Total number of visits to the Schools 441 Total number of Clinic Sessions 507 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, 5937 attendances being registered during the year. (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 85 children during the year, 66 (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-two cases were treated under this Scheme during the year at a cost of £45 17s. 0d., towards which the parents contributed £7 5s. 6d. (d) Ear Disease and Hearing. Minor ear defects in the cases of 19 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. (e) Dental defects. Of the 2048 children requiring treatment found by the School Dentist, 969 were actually treated, 812 being rendered dentally fit before the end of the year. There were 443 gas cases during the year. Mr. H. A. L. Morris, the School Dentist, reports as follows :— "During the year five sessions per school week were devoted to dental inspection and treatment. In all 30 sessions were given to inspection at the Schools and 181 to treatment at the Clinic. The programme for the year was similar to that for 1934, and included inspection of all age groups, and treatment of those for whom consent was obtained. Also all the children attending the Open Air School were inspected and treatment carried out. The total number of children inspected remained about the same so that it is still possible to continue inspection and treatment for the school population in the time now given. 67 There was a slight decrease in the number of permanent teeth extracted, but unfortunately we still have the factor, common to all Clinics, of people who ignore our advice for early treatment. The condition of the children's mouths on the whole is very good, especially among those attending schools where we get enthusiastic co-operation of the Head Teachers. I anticipate in time to see an improvement in the dental condition of the entrants, due to the pre-school treatment now available. A very careful watch is kept at the Welfare Centre, and pre-school children requiring treatment are referred from there. The School Medical Officer also makes a feature of including an examination of the teeth during his Medical Examinations, and is often able to obtain the parents consent for treatment in children suffering from obviously septic mouths. The School Nurses also follow-up and visit in cases of neglected dental conditions and missed appointments. In conclusion I should like to thank all concerned for their efficient help and enthusiastic co-operation. The programme as carried out last year will be continued. Pamphlets supplied by the Dental Board were distributed in the Schools, and lectures were given by an official from the Board." (f) Crippling Defects and Orthopedics. During the year 15 individual children received electrical, massage, and other forms of treatment at the Fed Cross Curative Post, Norbiton, making 444 total attendances. The cost of the above out-patient treatment amounted to £44 8s., towards which the parents contributed £15 6s. 6d. 68 One child was admitted to St. Vincent's Orthopaedic Hospital Eastcote, for in-patient treatment. Two children received in-patient treatment at the Royal Orthopaedic Hospital. The total cost of in-patient treatment amounted to £35 10s. 1d., towards which the parents contributed £4 0s. 10d. (g) Heart Disease and Rheumatism. Eleven 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 another year of remarkable freedom from infectious disease. With regard to notifiable infectious disease, there has been no definite outbreak. There has been no Measles, and only a few cases of Whooping Cough at the Infants' Schools, and no School closure has been necessary. OPEN AIR EDUCATION. (a) Playground Classes. In summer, classes are held in the playground whenever possible at every School. (b) Open air classrooms. There is a bungalow classroom at Richmond Road Infants' School, two sides of which can be opened. 69 (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 following is an extract from a report on a School Journey by a party of girls from St. Luke's Central School : The second annual educational journey had its headquarters at Llanfairfechan, North Wales, from May 10th to 17th, 1935. Thirty-five girls with two mistresses had comfortable quarters right on the sea front. Before embarking upon this expedition all girls were examined by the School Medical Officer. Notes received from parents after the journey, testify to the physical benefits attained by the girls. A guide book, skilfully compiled by one of the mistresses in charge, and systematically studied by the girls, laid the foundations for a very full week's programme, every minute of the time being carefully mapped out, in order to secure the fullest possible mental, moral and physical benefit from the expedition. Walks along the shore, and in the district, included many beauty spots, such as Aber Falls and Carreg Fowr, whilst longer motor excursions took them to such places as the Nant Ffrancon Pass, Capel Curig, Pen-y-Pass, Wanberts, Betys-y-Coed, Llyn Ogwen, etc. The wild, rugged beauty of Wales was fully appreciated on the great day they climbed Snowdon. Industries of the district were observed at Penmaenmawr (Welsh Granite Company), Bethesda and Warberis (State Quarries), Dolgarrog (Electric Power Station and Aluminium Works). The great engineering feats seen included the tubular bridge across the Menai Straits and the suspension bridge at Conway. 70 History became real when visiting the castles at Conway, Caernarvon and Beaumaris. Valuable, above all, was the living together in a small community and having ample opportunities to exercise the habits of honesty, forbearance, unselfishness, self-reliance and self control. May we quote Ruskin, "The entire object of true education is to make people not merely do the right things, but enjoy the right things." Here is the great objective of the educational school journey. 2 Bonner Hill Road Central School for Girls. A school journey was made by a party of twenty-four girls from Bonner Hill Road Central School under the supervision of two mistresses. They spent a fortnight at Holmbury St Mary and lived in a bungalow in a field at the edge of the woods. The object of the journey was "education through nature" and this spot was chosen because it is in the heart of one of the loveliest parts of the girls' native county. A detailed programme was arranged including nature study rambles, visits to places of historical and literary interest, map reading, a drive through the country to the coast, reading and memorising of passages of poems by Belloc, Kipling, etc., and physical exercises in the field. The domestic arrangements were excellent, the weather was good and the girls profited both physically and mentally from their fortnight of life and work in the open. 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 trainnig. 71 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 has been continued throughout the year during school terms. The source and quality of the milk, which is drawn from an efficiently pasteurised supply, is approved by the Medical Officer of Health. At the commencement of the year 65% of children in attendance were in receipt of school milk. There was a steady fall in numbers till 52% were taking milk in the summer, and then some recovery took place during the autumn resulting in 56% receiving milk at the end of the year. 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. All undernourished children recommended for milk by the School Medical Officer are weighed regularly and followed-up. In necessitous cases the milk is supplied free, the cost being met from a voluntary fund. 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. 72 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. 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 64. SCHOOL CLINIC. The School Clinic in Grange Road was described in detail in the Annual Report for 1931. 73 (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 5937 attendances during the year. (c) Ophthalmic Clinic. Dr. Ivor Aubrey, the School Oculist, attends fortnightly on Thursday 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 Tuesday and Wednesday preceding the meeting for the purpose of having atropine ointment applied by the School Nurse. There were 409 attendances at the 21 sessions held during the year, 212 being new cases and 197 re-inspections. Refractions numbered 111, and spectacles, were prescribed in 85 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. 74 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, 30 half-days were given to Inspection and 181 to Treatment. There were 443 gas cases during the year. Dental Board leaflets on the Care of the Teeth are distributed to all children shortly before they leave school. DEFECTIVE CHILDREN. Exceptional children are brought to the notice of the School Medical Officer by the School Nurses, Health Visitors and Attendance Officers. The Teachers are invited to bring any children they consider defective before the School Medical Officer. If suffering from a physical defect, they are admitted to the Special Open-Air Day School if considered unsuitable to attend an ordinary Public Elementary School. There is no Special Day School for mentally defective children. There are special classes 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 are two feeble minded children at Certified Schools for Mentally Defective Children, 75 There are three deaf children at Certified Schools for. the Deaf. There is one partially sighted child attending a Certified School. There are no cases of severe epilepsy but four mild cases are attending ordinary Elementary Schools. Twelve crippled children and eleven suffering from heart disease are attending the Special Open Air Day School. In addition there are seventeen delicate children suffering from various defects attending this School. SPEECH TRAINING. A class for children suffering from defective speech is held on Monday and Wednesday afternoons. A description of the work was set out in last year's Annual Report. Miss Badcock, who is in charge of the Class, reports as follows:— "Between January 1st, 1935 and December 31st, 1935, twenty-six individual children attended the Class. During this period six children were discharged and returned to their schools with normal speech. Three children left upon attaining the age of fourteen, and two more left the district, leaving fifteen on the register at the end of the year The speech of the three children who left at the age of fourteen was in every case much improved. In one case the improvement was outstanding. A boy was admitted suffering from a severe stammer and after a few months treatment his speech was so much improved that he was able to pass the oral examination for employment in the General Post Office without any difficulty. 76 A number of the children are admitted suffering from undeveloped speech and showing symptoms of mental retardation. In nearly every case as the speech improves a corresponding improvement is noticed in the general mental condition. The psychological effect also is very marked. A child suffering from retarded speech often appears shy, sullen, and sometimes spiteful because he feels at a disadvantage, but as his speech develops he learns to take his place among other children on an equal footing. Parents often attend the clinic to see their children receiving treatment, so that they may help the children to carry out the treatment at home. The teachers also show a great interest in the work and very helpful co-operation is always to be had from both schools and homes." 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, 1934 37 No. admitted during 1935 13 No. transferred to ordinary schools 11 No. left School 7 No. on register December, 1935 32 It is satisfactory to note that as stated above eleven 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. 77 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. 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 in this Special School:— Medical Inspections. Regular (twice a term) 115 Special 267 Dental Inspections 26 Found to require treatment 14 Actually treated 9 Orthopaedic Treatment Residential 2 Non-residential 4 Defective Vision and Squint 4 Cleanliness Surveys 131 Individual children found unclean 4 Nineteen physically defective children received hampers from the Treloar Childrens' Christmas Hamper Fund. On December 23rd the distribution of the hampers was very kindly made by the Mayor and Mayoress at the Open Air School. EMPLOYMENT OF CHILDREN. The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year 103 school children over 12 years of age were issued with certificates under the Byelaws permitting their employment. 78 SWIMMING. The total number of attendances for instruction made by the Elementary School children to the Kingston Swimming Baths during 1935 was 7,356. GARDENING CENTRES. Richmond Road Central Boys' School at Tudor Road, Albert Road, and at Bonner Hill Road School. St. Luke's Boys' School at the rear of St. John's School. St. Joseph's School at Albert Road. Open Air School at the School. 79 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. Entrants 372 Second Age Group 394 Third Age Group 405 Total 1,171 Number of other Routine Inspections 202 Grand Total 1,373 B—Other Inspections. Number of Special Inspections 1,300 Number of Re-Inspections 6,135 Total 7,435 C.—Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups. Entrants 47 Second Age Group 23 Third Age Group 20 Total (Prescribed Groups) 90 Other Routine Inspections 27 Grand Total 117 80 TABLE II. A Return of Defects found by Medical Inspection in the Year ended 31st December, 1935. 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. Skin (1) Ringworm, Scalp - - 1 - (2) „ Body 1 - 3 - (3) Scabies - - 20 - (4) Impetigo 4 - 91 - (5) Other diseases (non Tb) 9 - 275 16 TOTAL (Heads 1 to 5) 14 - 390 16 Eye (6) Blepharitis 6 - 12 - (7) Conjunctivitis 2 - 22 - (8) Keratitis - - - - (9) Corneal Opacities - - - - (10) Other Conditions (excluding Defective Vision and Squint) 2 - 36 - TOTAL (Heads 6 to 10) 10 - 70 (11) Def' ve Vision (excl. bqt.) 26 14 14 - (12) Squint 20 2 1 - (13) Defective Hearing 1 - 5 - (14) Otitis Media - - 5 - (15) Other Ear Diseases 2 1 24 - (16) Chronic Tonsillitis only 24 5 26 - (17) Adenoids only - - 4 - (18) Chronic Tonsillitis and Adenoids 4 1 14 1 (19) Other Conditions 2 - 56 1 (20) Enlarged Cervical Glands (non Tb) 5 2 7 - (21) Defective Speech 3 1 2 - Heart and Heart Disease (22) Organic 1 - 2 - Circulation (23) Functional - 3 - - (24) (Anæmia - - - - 81 TABLE II — continued. (25) Bronchitis 2 - 5 - Lungs (26) Other non Tb. Diseases - - 8 - Pulmonary (27)Definite - - - - (28) Suspected - - 1 - Non-Pulmo'y(29)G1ands - - - - Tuberculosis (30) Bones & Joints - - - - (31)Skin - - - - (32)Other Forms - - - - TOTAL (Heads 29 to 32) - - - - Nervous (33) Epilepsy 1 - - - System (34) Chorea - - 4 - System (35) Other Conditions 1 1 11 - (36) Rickets 1 1 - - Deformities (37 Spinal Curvature 1 1 2 - (38) Other Forms 10 1 7 - (39) Other Defects and Diseases (excl. Uncleanliness & Dental Diseases) 13 2 298 1 Total 141 35 956 19 B. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age-groups Number of Children Inspected A Excellent B Normal C Slightly Subnormal D Bad No. % No. % No. % No. % Entrants 372 43 11.5 289 77.7 39 10.5 1 .3 Second Age Group 394 25 6.3 325 82.5 44 11.2 - - Third Age Group 405 48 11.8 323 79.8 34 8.4 - - Other Routine Inspections 202 30 14.9 159 78.7 13 6.4 - - Total 1,373 146 10.6 1096 79.8 130 9.5 1 .1 82 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) 2 - - - - 2 Epileptic - - - - - Physically Defective (a) Tuberculosis 1. Pulmonary - - - - - 2. Non-pulmonary 1 3 1 - 5 (b) Delicate 16 9 - - 25 (c) Crippled 12 11 - - 23 (d) Heart Disease 11 8 - 19 83 TABLE IV. Return of Defects Treated During the Year Ended 31st December, 1935 Treatment Tables. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table 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 - - - (ii) Other Treatment - l 1 Ringworm, Body 4 - 4 Scabies 20 - 20 Impetigo 91 91 Other skin disease 272 1 273 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 44 6 50 Minor Ear Defects 19 6 25 Miscellaneous—(e.g., minor injuries, bruises, sores, chilblains, etc.) 218 14 232 Total 668 28 696 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Disease or Defect. Number of Defects dealt with. Under the Authority's Scheme Otherwise Total. Errors of Refraction (including squint) 1ll 22 133 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 1 3 4 Total 112 25 137 No. of children for whom spectacles were prescribed:— (i) Under the Authority's Scheme 85 (ii) Otherwise 22 Total 107 No. of children for whom spectacles were obtained:— (i) Under the Authority's Scheme 83 (ii) Otherwise 20 Total 103 84 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 8 74 18 1 13 - 6 - 28 - 24 1 41 - (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. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Number of children treated. 1 1 15 - - - 17 85 Table V- Dental Inspection and Treatment. (1) Number of Children who were inspected by the Dentist. (a) Routine Age Groups. Aged 5 6 7 8 9 10 11 12 13 14 210 319 297 349 368 341 385 393 440 188 Total 3290 (b) Specials 22 (c) TOTAL (Routine and Specials) 3312 (2) Found to require treatment 2048 (3) Actually treated 969 (4) Attendances made by children for treatment 2119 (5) Half-days devoted to:— Inspection 30 Treatment 181 Total 211 (6) Fillings:— Permanent teeth 1139 Temporary teeth 161 Total 1300 (7) Extractions:— Permanent teeth 250 Temporary teeth 1790 Total 2040 (8) Administrations of general anaesthetics for extractions 443 (9) Other operations:— Permanent teeth 214 Temporary teeth 233 Total 447 86 Table VI.—Uncleanliness and Verminous Conditions (i) Average number of visits per school made during the year by the School Nurses 13 (ii) Total number of examinations of children in the Schools by School Nurses 13848 (iii) Number of individual children found unclean 537 (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 3