KIN 14 The Rogal Barough of Kingston - open - Dhames Annual Reports FOR 19 3 6 OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THE SANITARY INSPECTOR The Rogal Barough of Kingston - open - Dhames Annual Reports FOR 19 3 6 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, 1936. 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 arid 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) L. KLUTH, A.R.S.I. (a). (4) N. SMITH, A.R.S.I. (a). Health Visitors and School Nurses: (Senior) Miss A. GILL, (b), (c), (d). (2) Miss C. A. HOOKWAY, (b), (c), (d). (3) Miss L. G. SALWAY, (b), (c). (4) Miss F. I. ARNOLD, (b), (c), (d). * Dental Attendant—Clerk: Miss P. M. INGILLSON. Clerks: E. S. HERBERT. Miss D. a. briginshaw. Disinfector: 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, 1937. To the Corporation of Kingston-upon-Thames. Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1936. Circular 1561 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1936, requests that the Council will direct the Annual Report of the Medical Officer of Health for 1936 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 1936 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. There have been the following changes in the Staff:— Mr. L. Kluth was appointed as additional Sanitary Inspector to fill the vacancy caused by the resignation of Mr. H. H. Madams who had obtained a post at Barking. Mr. Kluth commenced his duties on February 3rd, 1936. On March 30th, 1936 Mr. N. Smith was appointed as additional Sanitary Inspector. This was necessary owing to the great increase in work chiefly in connection with Housing and the survey to ascertain the extent of overcrowding. 4 On April 1st, 1936 Miss P. M. Ingillson was appointed Dental Attendant—Clerk, her duties being equally apportioned between the School Medical and Public Health Services. On October 5th, 1936 Miss D. A. Briginshaw was appointed Clerk to fill the vacancy caused by the resignation of Miss Dilliway upon her marriage. The subjects of Housing, Infectious Disease, and Maternity and Child Welfare are dealt with under their respective Sections of the Report, where it will be seen that steady progress has been maintained. I thank the Staff for their willing assistance at all times throughout a strenuous year. I am, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, Medical Officer of Health. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statistics. Area 1,390 acres Population, 1936 (Registrar General) 39,880 Number of inhabited houses approx. 10,000 Rateable Value—General Rate £474,605 Sum represented by Penny Rate £1,885 Amount of Poor Law Relief £5,486 (ii) Extracts from Vital Statistics of the Year. Live Births— Total. Male. Female. Legitimate 528 266 262 Birth Rate (R.G.) Illegitimate 45 20 25 per 1,000 pop. 14.36. 573 286 287 Still Births— Total. Male. Female. Legitimate 14 6 8 Rate per 1,000 total Illegitimate 1 — 1 (live and still) births 25.5. 15 6 9 Deaths— Total. Male. Female. 502 237 265 Death Rate (R.G.) per 1,000 pop. 12.58. Death Rate corrected for age and sex constitution, 11.07 per thousand population (factor for correction 0.88, 1931 Census). 6 Deaths from puerperal causes— Deaths Rate per 1,000 total (live and still) births Puerperal Sepsis l 1.7 Other Puerperal Causes — — Total l 1.7 (iii) Causes of Death. Male Female All Causes 238 264 1. Typhoid and Paratyphoid Fevers — — 2. Measles 1 — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — 3 6. Influenza 4 5 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — — 9. Tuberculosis of the Respiratory System 12 10 10. Other Tuberculous Diseases 2 2 11. Syphilis — 1 12. General Paralysis of the Insane, tabes dorsalis — — Death Rate of Infants wider one year of age— All infants per 1,000 live births 52 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 111 Deaths from Cancer (all ages) 63 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) — Birth Rate. Death Rate. 1 Under Rate per Diarrhœa 2 years 1,000 Total Under Births. Deaths 1 year England and Wales 14.8 12.1 5.9 59 143 Smaller Towns 15 11.5 3.4 55 London 13.6 12.5 14.4 66 Kingston-upon-Thames 14.36 12.58 — 52 7 13. Cancer, Malignant Disease 27 36 14. Diabetes 2 4 15. Cerebral Haemorrhage, etc. 12 24 16. Heart Disease 62 79 17. Aneurysm 1 — 18. Other Circulatory Diseases 15 14 19. Bronchitis 7 3 20. Pneumonia (all forms) 17 16 21. Other Respiratory Diseases — 1 22. Peptic Ulcer 3 — 23. Diarrhoea, etc. (under two years) — — 24. Appendicitis 2 1 25. Cirrhosis of Liver 2 1 26. Other Diseases of Liver, etc. 1 — 27. Other Digestive Diseases 9 3 28. Acute and Chronic Nephritis 10 8 29. Puerperal Sepsis — 1 30. Other Puerperal Causes — — 31. Congenital Debility, Premature Birth, Malformations, etc. 8 10 32. Senility 9 21 33. Suicide 2 — 34. Other Violence 11 9 35. Other Defined Diseases 19 12 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 in the Ham area was continued, also many blocks of flats are going up. The new Latchmere Road School was completed and occupied in the Autumn. There is comparatively little unemployment in the Borough. 8 METEOROLOGY, 1936 The following table is compiled from records taken by Mr. P. G. Lloyd. Highest Temperature of Air. Rainfall Inches Lowest Mean Max. Mean Min. January 56 25 44 37 3.82 February 55 22 45 33 1.58 March 64 28 53 40 0.97 April 67 29 54 38 1.65 May 81 37 68 47 0.62 June 89 44 75 54 2.79 July 88 49 75 57 2.72 August 81 51 74 56 0.60 September 78 40 68 55 1.98 October 66 36 58 44 1.96 November 57 32 47 40 2.62 December 55 27 48 37 1.80 Total inches 23.11 The average annual rainfall at Greenwich is about 24½ inches. SECTION B. GENERAL PROVISION OF HEALTH SERVICES. (i) Public Health Officers. The Staff of the Public Health Department is set out at the beginning of the Report. (ii) Nursing in the Home. (a) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (b) Infectious Diseases.—In Measles, Whooping Cough and Epidemic Diarrhœa, 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. 9 (iii) Laboratory Facilities. Arrangements are made with the Clinical Research Association for the examination or analysis of clinical material, water, milk, etc. Also Dr. D. S. Murray, Pathologist to the Royal Hospital, Richmond, undertakes bacteriological examinations. (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 Bdrough, 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. 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. (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 317 accident cases and 169 private cases were removed by this ambulance. The ambulance service is adequate for the area. 10 (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, third 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. First and second 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 and Sat. mornings. Kingston Nursing Association (Vol. Committee) 33 Birkenhead Ave., Kingston. Apply to Matron. 11 MATERNITY AND CHILD WELFARE. (i) Mid-wives. The Midwives are under the administrative control of the Surrey County Council. There we're ten 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. Puerperal Fever and Puerperal Pyrexia. During the year 19 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 19 cases notified, 16 were either admitted to, or already in-patients at, the Kingston and District Hospital. There was one death among these notified cases. The consultant, Mr. Andrew McAllister, was not summoned during the year. (iii) Ante-Natal Services. The Ante-Natal Centre was held three times a month until April, when it was found necessary to hold a further session per month owing to the large number of attendances. Miss Beatrice Turner, M.B., F.R.C.S., (Edin.) presided at the Centre and is recognised as Consultant Obstetrician for the Borough. 12 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. Dtfring the year 185 expectant mothers attended, making 740 visits to the Clinic. Twenty-five 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 50 191 3,445 Friday 49 201 3,162 In necessitous cases, babies and nursing mothers are provided with free milk on the recommendation of the presiding medical officer. Careful investigation is made into the circumstances of each case to ascertain whether it falls within the approved scale, and when recommended it is endorsed by the Medical Officer of Health and approved by the Committee. Dried milk is supplied at cost price. There is an excellent Clothing Stall at which 87 mothers have purchased 217 garments during the year. 13 Owing to lack of support, the Sale of National Savings Certificates at the Centre, was discontinued. Baby Week was held from June 29th to July 5th. Special announcements were made in the local Churches and Sunday Schools, and the Centre was open to Visitors on Tuesday and Friday. At the Centre, Miss Gilder 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, July 8th, 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 106 182 Infants under one year 551 2,812 Children, one to five years — 4,370 Incidental and Infectious — 571 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. There has been a considerable increase in the number of home visits paid by the Health Visitors, a result of the appointment of a dental attendant-clerk in April, who took over certain clinic duties from the Nurses, so affording them more time to carry out their important duty of Home Visiting. 14 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 Welfa're Sub-Committee of the Public Health Committee. The general procedure adopted was fully described in the Annual Report for 1930. During the year 6 new registrations were approved and 15 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 19 foster mothers in charge of 25 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 583 visits were paid, this work being most satisfactorily carried out by the Health Visitors. (vii) Orthopaedic Treatment. Under the scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, four 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. (viii) Dental Treatment. 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 anaesthetist. 15 Miss P. M. Ingillson was appointed Dental AttendantClerk on April 1st. It was considered advisable 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:— 47 mothers and 38 infants made 231 attendances. Extractions of permanent teeth 215 Extractions of temporary teeth 136 Filling of permanent teeth 15 Filling of temporary teeth 7 Scalings 14 Dentures supplied 12 Anaesthetics given 70 (ix) Tonsils and Adenoids. 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. 16 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. 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. (xii) The Garden. The Clinic was re-decorated, and a double doorway constructed from the waiting room to the garden. The layout of the garden was altered to enable toddlers to run between the waiting room and the lawn. The lawn is completely enclosed by light fencing and seats for parents have been provided. 17 These improvements have been a great asset, since the congestion in the waiting room is relieved, and the toddlers benefit by playing in the open air during their stay at the Centre. The garden is on the South side of the building and is in use from ea'rly Spring until late Autumn in fine weather. 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 adviseowners to have their property connected to the Main Supply of the Metropolitan Water Board. The use of well water was discontinued at 3 houses during the year. The number of premises known to be supplied with water from wells at the end of 1936 was 31, which compares with 271 for 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. 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. New Soil and Surface Water Sewers have been provided on the Park View Estate. 18 (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 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. 19 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) 107 16 Nil Workshops—(including Workshop Laundries) 133 15 Nil Workplaces—(other than Outworkers' premises) Total 240 31 Nil 20 II—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect to which Prosecutions were instituted. Found Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts*— Want of Cleanliness 18 9 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 21 8 — — Sanitary Accommodation Insufficient — — — — Unsuitable or Defective 15 7 — — 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) 10 7 — — Total 65 32 — — *Including those specified in section 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. 21 SECTION D. HOUSING. Substantial progress was made during the year in connection with the quinquennial programme of action proposed to be taken under the Housing Acts. In my report for 1935 I referred to the special ci'rcumstances that had necessarily delayed operations in connection with Canbury Area "A", and mentioned that the houses had been vacated, but not demolished, on 31st December, 1935. No further difficulties we're encountered and demolition of the houses in that area proceeded during the early part of 1936. All the properties were demolished by the owners and the Corporation did not have to exercise any powers in that connection. Two other Clearance Areas were represented during 1936 and were known as Canbury "B" and "C" 'respectively. As the name suggests, the properties were situated in areas adjacent to Canbury "A" Clearance Area and formed part of an irregula'rly shaped piece of land situated off the west side of Richmond Road and adjacent to the Goods yard of the Southern Railway. The official representations were made on 9th January, 1936, and the number of houses included in the two proposed areas was 36. Notice of the Council's intention to make clearance orders was given as prescribed by the Housing Acts, and as the result of objections being lodged by most of the owners of houses in "B" Area, a public inquiry into the circumstances of the area was held at the direction of the Minister of Health on 12th May, 1936. The inquiry lasted the whole of the day and the houses were visited on the day following by the Inspector who conducted the inquiry. Objections were not received in respect of Canbury "C" Area. With one slight modification (the exclusion of one house from Canbury "B" Area) both orders were confirmed subsequently by the Minister, but at the same time the Minister directed that payments should be made in respect of three houses under the provision of Sec. 64 of the Housing Act, 22 1935, which, briefly, provides that in certain circumstances payment shall be made to the owner of a house which, though unfit for human habitation and therefore properly included in a clearance order has been as well maintained as is practicable in all the circumstances. A scheme for the rehousing of all persons to be displaced from the proposed areas was put in hand, but the houses had not been vacated by the end of the year. Apart from action taken in connection with Clearance Areas, twenty-two demolition orders were made in respect of "individual" unfit houses. The summary that has appeared in my annual report for the past two years showing the action taken 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, has been again revised so as to show the position at the end of 1936, but I must reiterate that it is intended to refer only to action taken since the passing of the Housing Act, 1930 and does not include houses demolished or otherwise dealt with before 1930. Building development by private enterprise has also proceeded during the year and the following table gives particulars of the total houses erected during 1936:— (1) Number of new houses erected by the Corporation during the year ended 31st December, 1936 Nil. (2) Number of houses erected by private enterprise during the year ended 31st December, 1936 106 170 Flats. (3) Total number of houses for the workingclasses erected by the Corporation since March, 1934 732 24 Flats. Statistics relating to action taken under the Housing Acts have been prepared on lines suggested in Circular 1561 issued by the Minister of Health and are shown on pages 25 to 28. They are similar to the tables shown (Continued on page 25) 23 CLEARANCE AREAS Clearance Area No. of houses in area Date of representation Date of Clearance Order Date of Compulsory Purchase Order No. of houses vacated at end of 1936 No. of houses demolished at end of 1936 Remarks Made by Council Confirmed by Minister of Health Made by Council Confirmed by Minister of Health No. I 3 12.1033 — — 19-12 33 9.4 .34 3 3 — No. 2 3 12.1033 1912.33 14. 8.34 — — 3 3 — No. 3 3 12.10.33 19.12.33 4. 8.34 — — 3 3 — Canbury 19 30.11.33 27. 2.34 14 .8.34 — — 19 19 — Area "A" — No. 5 10 8. 2.34 27. 4.34 3.9.34 (with modifications) — — 2 2 The modified Order excluded 8 houses Canbury 31 9. 1.36 25. 2.36 5.8.36 (with modifications) — — Nil Nil The modified Order excluded 1 house Area "B" Canbury 5 9. 1.36 25. 2.36 5.8.36 — — Nil Nil Area "C' 24 1ND1V1DUAL HOUSES, SEPARATE TENEMENTS AND UNDERGROUND ROOMS Year(s) No. of dwelling houses found to be unfit for human habitation (vide S. 19, H.A. 1930) No. of dwelling houses in respect of which Demolition Orders were made unders Secs. 19 and 21, H.A. 1930. No. of dwelling houses in respect of which "undertakings" were given by owners (vide Sec. 19 H.A. 1930). No. of dwelling houses demolished in pursuance of Demolition Orders made under Secs. 19 and 21, H.A. 1930. No. of separate tenements or underground rooms in respect of which Closing Orders were made, under Sec. 20, H.A. 1930. No. of separate tenements or underground rooms in respect of which "undertakings" were given by owners (vide Sec. 20, H.A. 1930). Remarks. 1930—1935 127 102 12* 51 2 — *Four houses in respect of which an "undertaking" had been given by the owner were subsequently demolished voluntarily by the owner, during 1934. 1936 19 22 — 23 2 3 Total 146 124 12 74† 4 3 †1n addition two houses were lemolished in anticipation of formal action under Set; 19, H.A. 1930. 25 in my reports for previous years, with the exception that this year an item has been included concerning action taken in connection with overcrowding under the Housing Act, 1935. 1t will be recalled that in my report for 1935 1 referred to the arrangements that were then in hand for a general survey of the district so far as overcrowding was concerned. This survey was carried out during 1936 and a report submitted to the Minister of Health as required by the Act. 1t is unnecessary in a report of this kind to reproduce all the information obtained as the result of the survey, and 1 think it is sufficient to say that the degree of overcrowding was found to be very slight, being under 1% of the houses visited. This, however, did not relieve the Local Authority of its obligation to provide accommodation to abate overcrowding, and proposals, in this connection, accordingly were submitted to the Minister of Health. 1 should at this point, perhaps, mention that the survey to which reference has just been made was national in its application and was the beginning of a se'rious attempt to relieve overcrowded conditions. The Housing Act contained specific provisions for the abatement and prevention of overcrowding, and included a standard by which overcrowding could be measured. Previous to the passing of the Housing Act, 1935 a standa'rd had not been provided. Details of the cases of overcrowding will be found in item 4 of the statistical tables. Housing Statistics. 1. 1nspection of Dwelling—houses during the year:— (1) (a) Total number of dwelling—houses inspected for housing defects (under Public Health or Housing Acts) 916 (b) Number of inspections made for the purpose 1126 (2) (a) Number of dwelling—houses (included under sub—head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 236 26 (b) Number of inspection made for the purpose 251 (3) Number of dwelling—houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 61 (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 584 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 528 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 6 (2) Number of dwelling—houses which were dered fit after service of formal notices:— (a) By Owners 7 (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 17 (2) Number of dwelling—houses in which defects were remedied after service of formal notices:— (a) By Owners 18 (b) By Local Authority in default of Owners 1 27 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 22 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 23* D.—Proceedings under section 20 of the Housing Act 1930. (1) Number of separate tenements or ground rooms in respect of which Cosing Orders were made 2† (2) . Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil * 1n addition, 18 houses were demolished under a Clearance Order. † 1n addition, "undertakings" were received in respect of three premises. 4. Housing Act, 1935—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 39 (2) Number of families dwelling therein 40 (3) Number of "equivalent" persons dwelling therein 270 (b) Number of new cases of overcrowding 'reported during the year 75 (c) (1) Total number of cases of overcrowding relieved during the year 35 (2) Total number of "equivalent" persons concerned in such cases 226 28 (3) Number of cases of overcrowding in part of Council's housing estate situate within the Borough boundary, and included in (1) above, relieved during the year 12 (4) Total number of "equivalent" persons concerned in such cases (3) 90 (d) Cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for abatement of overcrowding Nil (e) Cases relieved in course of slum clearance operations Nil SECT1ON E. 1NSPECT1ON AND SUPERV1S1ON 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:— ART1CLES ANALYSED ADULTERATED OR DETER1ORATED PROSECUT1ONS CONV1CT1ONS Formal 1nformal Total Formal 1nformal Total Milk 37 1 38 2 2 Cream 1 — 1 — — — — — Butter 2 — 2 — — — — — Lard 2 — 2 — — — — — Meat 2 — 2 — — — — — Flour — 3 3 — — — — — Sausages 8 — 8 — — — — — Confectionary — 2 2 — — — — — Other Articles 3 2 5 — 1 1 — — Totals 55 8 63 2 1 3 — — 29 (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 whe're food is prepared, are given in the Report of the Sanitary 1nspector, which is included at the end of the Main Report. (iii) Nutrition. No special work has been done on this subject. 1nformation 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. SECT1ON F. 1NFECT1OUS AND OTHER D1SEASES The following table gives a comparative statement of notifications received during the last eighteen 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 1936 67 2/ 6 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 5 7 23 13 5 9 1 — — 67 46 — — — — — — — — — — — — Diphtheria — 1 2 1 2 11 3 3 4 — — — 27 26 — — — — — 1 1 1 — — — — 3 Enteric Fever including Paratyphoid — 1 1 — — 1 — 2 1 — — — 6 6 — — — — — — — — — — — — — Pneumonia 3 1 1 2 1 7 — — 2 3 3 9 32 6 1 — 1 — — 1 — — 1 — 2 — 11 Erysipelas — — — 2 1 — — — 1 3 1 1 9 2 — — — — — — — — — 1 1 — 2 Puerperal Pyrexia — — — — — — — 2 15 1 — — 18 15 — — — — — — — — — — — — 1 Puerperal Fever — — — — — — — — — — — — 1 1 — — — — — — — — — — — — — Ophthalmia Neonatorum 2 — — — — — — — — — — — 2 — — — — — — — — — — — — — — Cerebrospinal Meningitis — — — — — — 4 — — — — — 4 4 — — — — — — — — — — — — — New Cases. Deaths. under 1 year. 1—5 5—15 15—25 25—35 35—45 45—55 55—65 65 & over. Total. Under 1 year. 1—5 5—15 15—25 25—35 35—45 45—55 55—65 65 & over Total. Tuberculosis (a) Respiratory M. — — — 4 3 2 4 5 1 19 — — — 3 1 1 — 4 3 12 F. — 1 — 0 2 5 1 — — 18 — 1 — 3 4 — 1 — — 10 Total — 1 — 13 5 7 5 5 1 37 — 1 — 6 5 2 1 4 3 22 (b)Non—Respiratory M 1 — 1 — — — 1 — — — 3 1 — — — — — — — 1 2 F. 1 1 1 — — — — — — 3 1 1 — — — — — — — 2 Total 2 1 2 — — — 1 — — 6 2 1 — — — — — — 1 4 30 31 SCARLET FEVER. The incidence of Scarlet Fever remains low, and the great majority of cases are of a very mild characte'r. There were no deaths from this disease. D1PHTHER1A. 1n November, three fatal cases of Diphtheria were notified in one house in the Borough. The first was a girl aged 10 years who was found dead by Dr. X when he was called on November 15th. On examination he found that she had a sore nose so he took a nasal swab which proved positive to Diphtheria. The second case was notified next day in a sister aged 8 years who was sent into the 1solation Hospital where she died two days later. The third case was another sister aged 15 years who was notified on November 17th and sent into 1solation Hospital immediately, but died soon after admission. Three other members of this family, (A) girl aged 17 years, (B) girl aged 13 years and (C) a baby boy aged 3 years, were sent into the 1solation Hospital for observation. The mother and father refused to go to Hospital, but were given injections of anti—toxin. (A), (B) and (C) were all swabbed on admission and positive results were obtained from (B) and (C). (B) was reported by the parents to have had a bad sore throat about a month prior to the first known case, but no Doctor had been summoned. When admitted to Hospital, this girl showed undoubted results of a severe attack of Diphtheria. The Medical Officer of the 1solation Hospital, Dr. X and myself are all of opinion that the original case was (B) who had been ill about a month before the outbreak and for whom no medical aid was sought. A special Report on this outbreak was sent to the Ministry of Health. 1mmunisation. Dr. D. S. Murray carried 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 32 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. A summary of the work during 1936 is as follows:— Number of sessions 45 Number of attendances 2536 Numbe'r of Schick Tests 438 Number of 1njections 1098 Number of posterior Schick Tests 485 Number of Certificates issued 428 Of the 438 cases Schick tested, 77 were found to be immune. There were only 12 cases still positive on re—test after treatment and these received two further injections of T.A.M. The 150 boys in the Dalziel of Wooler Memorial Home (Dr. Barnardo's) are all immunized against diphtheria by their own medical officer. ENTERIC FEVER. Six cases of enteric fever were notified du'ring the year. Three were notified from the Kingston and District Hospital among patients admitted from outside the Borough. The three cases resident in the Borough were notified on May 4th, July 21st and Septembe'r 15th respectively, and the first two were sent into the Wimbledon 1solation Hospital and the third to the Kingston and District Hospital. They were isolated cases and though extensive investigations were made in each case, no source of infection was traced. There were no deaths. PNEUMON1A. The number of cases notified was 32, compared with 21 and 34 for the last two years. 33 PUERPERAL FEVER AND PUERPERAL PYREX1A. Comment on these diseases will be found under Section B of the Report (Maternity and Child Welfare, Sub—Section ii). OPHTHALM1A NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and inquire into the circumstances of the case. Cases notified during 1936. Notified. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 2 2 — 2 — — — 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. CEREBRO—SP1NAL FEVER. Four cases were notified during the year. Two were patients admitted to the Kingston and District Hospital from outside the Borough. The two Kingston cases were notified on January 6th and May 1st. The first was a girl aged 12 years who was admitted to the Kingston Victoria Hospital. She made a good recovery and was afterwards sent to the Open Air Day School for a time, and then returned to an ordinary elementary school. 34 The second was a girl aged 10 years who was admitted to the Kingston and District Hospital. She also made a good recovery and is attending the Open Air Day School. TUBERCULOS1S. Cases of Tuberculosis notified in the Borough come under the administrative control of the Surrey County Council. Every effort is made to assist the County Medical Officer and Tuberculosis Officer in their activities in the area. A Sanitary 1nspector 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 : 6.5. 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. The Tuberculosis Care Committee of the Surrey County Council report on cases discharged from sanatorium, when improved housing accommodation appears desirable. The Housing Committee favourably consider those cases recommended by the Medical Officer of Health for houses on the Corporation Housing Estate. OTHER NOT1F1ABLE D1SEASES. No cases of smallpox, encephalitis lethargica, or anterior poliomyelitis have been notified this year. 35 NON—NOT1F1ABLE ACUTE 1NFECT1OUS D1SEASE. 1nformation 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. Measles was prevalent from January to June, attacking the infants of all Schools in turn. School closure was not recommended in any of the outbreaks. There were several cases of chickenpox at Bonner Hill Road 1nfants' School in November. Towards the end of the year 1nfluenza became prevalent and posters on simple precautions were exhibited throughout the Bo'rough, and a special letter was sent to the Teachers. Nine deaths were attributed to 1nfluenza during the year. The Sanitary 1nspector, Mr. H. T. Perry, reports as follows:— 36 Report of Chief Sanitary 1nspector To the Mayor, Aldermen and Councillors. Ladies and Gentlemen, 1 beg to submit the Annual Report on the work carried out by your Sanitary 1nspectors during the year 1936, in connection with the various Statutes and Byelaws relating to Public Health in force within the Borough. The present Report is the eighteenth annual statement 1 have had the honour to present to you. The year 1936 proved a busy one. The Housing Act, 1935 required local authorities to carry out a survey of their district in order to ascertain the extent of overcrowding. This survey of the town was carried out during the early months of 1936 and will be commented upon later in the Report. The appointment of an additional inspector enabled more work to be dealt with and the effect is reflected in the brief summary and details which follow. The total number of inspections and visits made during the past year was 9431, as compared with 7460 during the year 1935. In the Registe'r of Sanitary Defects, 783 new entries were made and 725 previous entries were cancelled following upon compliance with notices served. On December 31st, 1936, 516 separate entries remained on the Register compared with 458 at the end of 1935. 1ncluded in the 516 entries referred to, 80 were in respect of houses awaiting demolition etc., 30 in respect of houses in Elton Road where redrainage is contemplated, and 24 in respect of houses in Cambridge Grove Road which had been surveyed under the Housing Acts, and at which works were in progress at the end of the year. The remaining 382 entries were in respect of premises upon which sundry sanitary defects were found. 37 Six hundred and fifty—nine "preliminary" and 60 verbal notices were served during 1936. 1n 25 instances this informal action did not bring about the desired result and it was necessary to serve "statutory" notices. During the year 1936, 577 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 1935 was 521. This brief introductory statement serves to summarise the year's work in general terms only, and does not include details of action taken under the Housing Acts and other headings. A very considerable amount of time is devoted to interviews with burgesses and owners of property, with, it is hoped, beneficial results. The policy of helpful cooperation has been continued and, despite the high standard of sanitary work which it is the constant aim to maintain, it is pleasing to be able to report that no less than 96.5% of the work was carried out as the result of "informal" action without recourse to the statutory powers vested in the Corporation as the Sanitary Authority, and that in no case was legal action found necessary. 1t is very doubtful whether any other town of similar character and size as Kingston can equal these records, which are the direct outcome of the policy of many years standing referred to above. For convenience of reference the inspections and visits are set out in the following tabular form:— 1NSPECT1ONS AND V1S1TS The following list shows the number of 1nspections made in regard to each section of the works, and the total of all inspections. Rent Restrictions Act 1nspections 3 Reinspections 2773 Visits to Works in Progress 1789 Factories 107 38 Workshops 133 Cowsheds, Dairies and Milkshops 118 1ce Cream Premises 38 Foodshops and Food Preparing Rooms 594 1nfectious Disease Enquiries 266 Markets 140 1nspection of Houses etc. (including complaints) 932 Examination of Drains 162 Slaughterhouses 447 Offensive Trades 34 Sanitary Conveniences 65 Common Lodging Houses 18 Canal Boats 15 Theatres, Cinemas, etc. 24 House to House 251 Bakehouses 64 Smoke Observations 55 Stables and Yards. 30 Enquiries re Housing Applicants 15 Sale of Poisons 6 Rats and Mice Destructions 233 Shops Acts 327 Schools 10 Disinfection Station 111 Caravans (Fair Grounds) 54 Housing Act, 1935 (Overcrowding) 462 Miscellaneous Visits 155 Total 9431 SUMMARY OF SAN1TARY 1MPROVEMENTS Below is a tabulated statement of works carried out at premises in the Borough during the past year. There is no statutory requirement that notice of intention to carry out works (apart from drains) shall be given to the Corporation, and although most of the work is inspected during progress it is by no means possible to do so in all cases. 39 WATER CLOSETS AND SAN1TARY F1TT1NGS W.C. apartments lighted, repaired, or ventilated 64 W.C. apartments cleansed and limewashed 81 New W.C. apartments 5 Ventilated lobby to W.C. apartment 2 New W.C. basins 105 W.C. basins unstopped and/or cleansed 7 W.C. seats repaired or renewed 6 W.C. flushing tanks repaired or renewed 32 W.C. flush pipe connection repaired 2 Urinals repaired and cleansed 5 Urinals lighted 1 New sinks provided 57 Trapped waste pipes fixed to sinks 78 Sink waste pipe lengthened 2 Lavatory basins provided 5 Baths renewed or re—enamelled 11 Trapped waste pipes fixed to baths 10 DRA1NAGE Number of houses and premises redrained 51 New branch drains 4 Drains repaired 9 Drains unstopped or cleansed 28 Gully traps unstopped or cleansed 2 Manholes provided or repaired 93 Cast—iron covers provided to manholes 9 New gully traps provided 123 Gratings fixed to gully traps 2 Gully curbs repaired or renewed 9 1ntercepting traps fixed 35 Fresh air inlet shafts fixed 40 Soil pipes and/or ventilating shafts provided 64 New soakaway constructed 1 Access pipes provided 2 Petrol intercepting chamber provided 1 Cesspools emptied 4 Cesspools abolished 5 40 GENERAL REPA1RS Walls repaired and repointed 193 Walls supported and tied 3 Walls cement rendered 5 Dampness abated 115 Roofs repaired 165 Chimney stacks repointed, rendered, etc. 14 New chimney pots fixed 11 Eaves guttering repaired or renewed 104 Stack pipes repaired or renewed 76 Stack pipes disconnected from drains 37 Rooms repaired and cleansed 676 Ceilings repaired or renewed 166 1nternal walls plastered 194 Floors repaired 190 Skirting board repaired or renewd 7 Firegrates, stoves and flues repaired or renewed 196 Fireplace surrounds or hearths repaired 8 Coppers renewed or repaired 31 Ventilation provided beneath floors 35 Ventilation gratings opened and cleansed 6 Ventilation provided to rooms 41 Doors repaired or renewed 67 Threshold repaired or renewed 4 Door frames repaired 13 Door locks repaired or renewed 105 Windows repaired, renewed or made to open 553 Door and window sills renewed or repaired 218 Stairs repaired 61 Tread nosings repaired or renewed 9 Additional light to stairs 75 Handrails provided to stairs 45 Water supply provided direct from rising main 17 Service water pipe repaired 1 Service water tanks removed, cleansed or covered 18 Yards paved 88 Yard paving repaired and yards cleansed 41 Paved pathways provided 10 Sites of houses concreted 13 New portable ashbins provided 57 Accumulations of refuse removed 11 41 Sheds and outbuildings demolished 2 Premises painted externally 25 Fence and gates repaired or provided 5 Dairy premises cleansed 1 Floor of dairy repaired 2 Verminous premises cleansed 17 Unsatisfactory bakehouse closed 1 Butcher's room cleansed 2 Workshops cleansed 2 Rat nuisances abated 8 Smoke nuisances abated 1 Miscellaneous 7 SMOKE ABATEMENT There was an increase of 10 in the number of complaints received in respect of alleged excessive emission of smoke or grit from chimneys during the year 1936, as compared with 1935, the figures being 16 and 6 respectively. Special attention was directed to this subject in the Report for 1935, and 1 regret to say that there is an increase in the amount of dense smoke which is being poured into the atmosphere from certain chimneys in the Borough. The ill—effects of smoke are too well known to need repetition, and it is common knowledge that unnecessary smoke from a chimney indicates wasted coal and heat. The oft—heard statement that smoke from the works' chimneys reflects prosperity in the various trades is neither true nor good sense. Black smoke means bad business, for the factory which permits it, for the people who are forced to inhale it, and for the owners of buildings which decay and crumple as the result of it. The casual observer may not perceive any cause for concern when a chimney gives forth dense smoke or a quantity of grit, and he will cease even to notice the fact when he turns the corner. Smoke, however, is a cumulative nuisance and it should be borne in mind that this town is situated on the outskirts of a huge built—up area in which there are hundreds of works' chimneys, and that without control, the resultant collective smoke cloud would soon blot out the last vestige of sunshine, 42 Excessive smoke is avoidable except when the furnace is being freshly lighted up, and it is an offence to permit the emission of black smoke for more than two minutes in any consecutive thirty minutes. This limit was exceeded on several occasions when smoke observations to the number of 55 were made during 1936. 1n one case of persistent excessive smoke, the offender was given final warning that failure to prevent the nuisance would be followed by statutory action on the part of the Corporation. This warning produced the desired effect and the improvement was maintained until the end of the year, but recent observations show a tendency to revert to a lower standard of efficiency. The period of improvement demonstrated quite clearly that the smoke could be prevented or reduced substantially, provided proper care was taken in stoking and management of the plant. COMMON LODG1NG HOUSES There are only two registered common lodging houses in the Borough, viz:— Nos. 8 and 10, Vicarage Road (Othen's)—50 beds for men only. No. 52 Canbury Passage (Marsh's)—35 beds for men only. As will be seen, there is no accommodation for married couples or for children in the registered lodging houses. The Vicarage Road premises are not of modern design, but they have the advantage of having been designed for the reception and housing of lodgers. The Canbury Passage house on the contrary was originally designed as a licensed premises known as the Queens Arms, and was only converted to its present use when the licence was referred to the compensation authority in 1906 and closed on the grounds of redundance. 1t is an old building with structural drawbacks, but it was maintained in reasonably clean condition by the late owner, Mr. Wm. Marsh, now deceased. Mr. Marsh controlled the premises in his own manner and exercised care in the choice of inmates, some of whom 43 resided there for years. Constant care is necessary to keep this old house free from vermin, and the continual user of the premises as a lodging house has been acquiesced in only in the absence of powers to remove them from the Register, and because they fill a very real need. The new Public Health Act, 1936, which comes into force in October, 1937, contains provisions which will enable the Corporation to deal with this particular lodging house, but when such action is taken it may be necessa'ry first to consider what alternative accommodation can be provided for the lodgers, as it is seldom that beds are vacant. Eighteen visits were made to the registered common lodging houses during 1936, and the arrangements for disinfection of bedding etc. when occasion arises, which have been adopted for several years, have been continued. OFFENS1VE TRADES The undermentioned trades which are established in the Borough are classed as "Offensive" within the meaning of the Public Health Acts 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 remaining oak—bark tanneries in this country is situated in the midst of 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. 44 At the end of 1936 there were 13 fried fish shops on the records. The following five applications were received during 1936 for permission to commence the trade of fish frying at the premises set forth, and the action taken is shown opposite the respective premises. (1) No. 134, London Road.—Application withdrawn. (2) No. 5a, Richmond Road.—Not granted. (3) No. 155, Park Road.—Not granted. (4) No. 5, Ham Common Parade.—Approved. (5) No. 210, Cambridge Road.—Approved. 1n the case of No. 4 the permission, although granted, was not acted upon up to the end of the year. Two complaints were received during the year in respect of offensive trades, and thirty—four visits were made to the various premises. HOUSE DRA1NAGE Fifty—one houses were completely redrained during 1936 and the drains of 13 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 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. For va'rious reasons the redrainage of the houses in Elton Road was not proceeded with during the year. Before this extensive work is put in hand a new length of sewer is necessary, and pending this improvement the common drain at the rear of the premises has been kept cleared from time to time. 45 1n 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 maintain more complete control over the workmanship throughout. The respective owners give instructions direct to their selected contractors and are responsible for the costs incu'rred. The discontinuance of cesspools in the Park Road area was continued, and five houses were connected to the public sewer. The old cesspools were filled in and abolished. 1t is expected that this particular area will be freed from cesspools during the present year, with the possible exception of one or two premises which cannot be connected to the sewer owing to the levels. Premises Redrained The following list gives the situation and numbers premises redrained during the year:— of Alexandra Road 1 Ashdown Road 3 Auckland Road 1 Borough Road 5 Cambridge Grove Road 4 Canbury Avenue 1 Caversham Road 1 Cromwell Road 1 Deacon Road 1 Elm Road 1 Excelsior Road 1 Fairfield East 4 Fassett Road 2 Florence Passage 4 Gibbon Road 2 Glenville Road 1 Grove Crescent 1 Kings Road 1 London Road 1 Market Place 1 Park Road 5 46 Penrhyn Road 2 Richmond Park Road 2 Richmond Road 1 Shortlands Road 2 Upper Park Road 1 Victoria Road 1 New Branch Drains Alfred Road 1 Fairfield West 1 Kings Road 1 Washington Road 1 Part of Drain Reconstructed Gibbon Road 2 Drains Repaired Excelsior Road 4 Fassett Roadoad 2 Cesspools Discontinued Park Road 5 COMPLA1NTS Two hundred and eighty—four complaints were received during the year, as follows:— Condition of premises 94 Drains and sanitary arrangements 54 Dampness and defective roofs etc. 24 Rats 21 Accumulation of manure and non—collection of house refuse 16 Smoke nuisance from chimneys 16 Overcrowding 9 Condition of roadway 9 47 Condition of firegrates and stoves 5 Water supply 4 Condition of fencing and garden wall 3 Coal dust and noise 4 Offensive trades 2 Condition of chimney stacks 2 Condition of yards and passages 2 1nsufficient light and ventilation 2 Storage of fish boxes 2 Verminous premises 2 Keeping of animals and fowls 1 Use of basement for sleeping 1 Unsound food 1 Condition of theatre stage 1 Condition of Hogsmill River 1 1nfestation by ants 1 Condition of ice—cream premises 1 Miscellaneous complaints 6 284 The complaints were investigated as early as possible and, where the Corporation possessed powers to intervene, immediate steps we're taken to remove the cause of the complaint. 48 HOUS1NG The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on pages 25 to 28. 1t will be seen that there was a very considerable increase in this branch of the work during 1936 compared with previous years. Nine hundred and sixteen dwelling houses were inspected under the Public Health or Housing Acts, as against 534 in 1935. Of those 916 houses, 236 were surveyed thoroughly in accordance with the Housing Consolidated Regulations, 1925, and the details of ownership, tenancy, structure and general condition etc. together with a copy of the informal notice (if any) served in respect of each house were filed for future reference. The situation of these 236 houses is set out below:— Bellevue Road 2 Burritt Road 27 Cambridge Grove Road 41 Canbury Place 2 Canbury Passage 12 Clifton Road 8 Coombe Road 1 Cowleaze Road 2 Elm Crescent 11 Elton Road 6 Excelsior Road 2 Fairfield North 2 Fairfield Road 7 Fassett Road 1 Florence Road 28 Grove Crescent 1 Hawks Road 4 High Street 2 Kings Road 1 London Road 1 Mill Street 6 Oaklea Passage 6 49 St. James' Road 1 Uxbridge Road 1 Victoria Road 6 Vincent Road 53 Windsor Road 2 The number of houses completely surveyed during 1936 is 50% more than the number during the previous year, and it will be seen that the Norbiton area received special attention. Burritt Road, Cambridge Grove Road and Vincent Road were dealt with house by house, but were not completed by the end of the year. Norbiton is a typical working class area and the roads situated between Cambridge Road and Bonner Hill Road are laid out with cottages in pairs or small groups, and only an occasional terrace. This excellent lay-out provides ample air space and light to the cottages and makes up for a possible lack of other amenities. It also reflects credit on the foresight of those responsible for framing the early building byelaws which prohibited the erection in Kingston of those monotonous terraces which are to be found in other towns and in and around London. The works of repair and improvement now being carried out to cottages in this part of the Borough should render these cottages quite useful homes for many years to come. Of the 236 houses which were completely surveyed, 19 were found to be in such a state as to be unfit for human habitation. When it is considered that an unfit house cannot be rendered fit for human habitation at reasonable cost, having regard to the estimated value of the house when repaired, it is reported upon with a view to demolition or closing action under Sections 19 and 21, Housing Act, 1930. Twenty-seven such houses were reported upon during 1936 as set out below. 50 Situation No. Action Taken. Mill Street 4 house(s) Demolition Order  High Street 3 „ „ „ „ Cowleaze Road 1 „ „ „ „ Cambridge Road 1 „ „ „ „ Bellevue Road 2 „ „ „ „ Canbury Place 1 „ „ „ „ Excelsior Road 1 „ „ „ „ Oaklea Passage 6 „ „ „ „ Elm Road 3 „ „ „ „ Fairfield West 1 „ Closing Order made. Uxbridge Road 1 „ „ „ „ Eden Street 1 „ Undertaking accepted. St. James Road 2 „ „ „ In Florence Road a short terrace of 9 cottages were found to be in bad condition and at the end of the year the question of demolition of these cottages was still under consideration. In addition to 18 houses demolished in Canbury "A" Clearance Area, 23 "individual" houses were demolished during 1936, as set forth below:— No. 3, Smith's Cottages, Acre Road. Nos. 112, 118 & 120, Cambridge Road (Cambridge Square). Nos. 28, 30 & 32, Cowleaze Road. Nos. 18, 22, 24, 26, 28, 30, 32 & 34, Fairfield North. Nos. 47, 49 & 49a, High Street. Nos. 4, 6, 8, 52 & 54, Washington Road. Overcrowding Survey In the early months of 1936 a survey of the Borough was made in accordance with the requirements of the Housing Act, 1935 to ascertain what overcrowding existed. The survey was an extensive one having regard to the absence of any clear definition of what constitutes a working 51 class house, and 10,047 houses or parts of houses were visited. To enable the survey to be carried out expeditiously a temporary staff of six enumerators was engaged. The result of the survey was fully reported upon in a report to your Council in April, 1936. The percentage of overcrowding (.75%) was very low compared with similar towns, and this satisfactory state of affairs was due in no small measure to action taken by the Corporation in previous years, by (1) close following up and abatement of cases of overcrowding brought to light by routine inspections and (2) the provision of working class houses. INCREASE OF RENT & MORTGAGE INTEREST RESTRICTIONS ACTS The small number of applications received for certificates under Section 2 (2) of the Principal Act since the Act was passed is not easily explained. The Act provides that where the statutory increase (40%) of rent has been paid in respect of a house and the house has not been kept in a reasonable state of repair by the owner, the tenant may apply to the local authority for a certificate which should contain particulars as to what works of repair are required. Only one application was received during 1936, and as the owner carried out the necessary repairs a certificate was not granted. Two applications were 'received during 1935. INSPECTION AND SUPERVISION OF FOOD (a) MILK SUPPLY. The register of dairymen was revised during the year. It was known that a number of dairymen with premises outside the Borough, but who were on the register, had either sold their businesses to large combines, or had ceased business altogether, and enquiries were addressed to neighbouring Authorities, 52 There were four dairymen outside the Borough who had sold their businesses to either the Express Dairy Co. or the United Dairies Ltd., and in one other case (Mr. Thirlby, of Brook Farm, New Maiden), the business was sold to Messrs. Offer & Son, Dairymen. A careful revision of the Register was made and visits were made to all the dairymen on the register. Twenty-three names (including the 5 referred to above) were removed either on account of business changes or cessation of business, and 16 fresh entries were added to the Register, leaving a total of 72 on the Register at the end of the year, compared with 79 at the end of 1935. There is only one cowkeeper in the Borough. GRADED MILK LICENCES. There is no licensed producer of graded milk in the Borough, but 29 dealers' licences (including supplementary licences) were issued during the year. The dealers' licences were in respect of the following: Certified 5 Grade "A" (Tuberculin Tested) 12 Grade "A" 1 Pasteurised Grade "A" 1 Pasteurised 10 Five samples of milk were submitted to the Clinical Research Association labo'ratories for examination. All the samples proved to be well within the bacteriological standard and only one contained Bacillus Coli. Each of the samples was submitted to an animal test for Tubercle and the result in all cases was negative. (b) MEAT AND OTHER FOODS. The number of animals slaughtered in the Borough is again low, but it approximates very closely to that for last year, viz.:— 3,517 compa'red with 3,677 for 1935. A few years ago there were many more animals slaughtered locally, but they were not destined for local consumption. The butchers were dealers who used the local 53 houses, and the carcases were sent to the central markets or to surrounding districts. Practically all the animals slaughtered in the town now are for local shops, and it is satisfactory to note that practically all are examined at the time of slaughter or before removal from the slaughterhouses. 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, 1936 Number of Notices Received Number of Animals Slaughtered Beasts Pigs Calves Sheep Goats Total 262 24 2808 56 629 — 3517 Carcases not Examined Percentage of Total Animals Examined Pigs Sheep Calves — 10 — 99.6 Visits were also made to the markets and all other places where foodstuffs are handled or prepared, such as restaurants, sausage making rooms, ice cream premises, etc. In all 1,401 visits were made to food premises. 54 UNSOUND FOOD The following is a list of the foodstuffs examined and condemned during the past year. PORK— 5 Carcases & Offal Tuberculosis Inspected & Condemned 3 Carcases & Offal Fevered do. 1 Carcase & Offal Jaundice do. 1 Sow's Carcase & Offal Tuberculosis do. 96 Heads and Necks do. do. 16 Plucks do. do. 1 Pluck Cirrhosis do. 7 Pairs Lungs Tuberculosis do. 16 Pairs Lungs Pleurisy do. 4 Pairs Lungs Pneumonia do. 16 Livers Cirrhosis do. 1 Liver Cysts do. 7 Spleens Tuberculosis do. 11 Spleens Inflammation do. 1 Mesenteric Fat Tuberculosis do. 1 Leg do. do. 121bs. Kidneys Putrefaction Voluntarily Surrendered 231bs. Pigs' Trotters do. Seized. BOVINES— 4 Heads Tuberculosis Inspected & Condemned 3 Pairs Lungs do. do. 2 Mesenteric Fats do. do. 2 Livers Distomatosis do. 4101bs. Beef Putrefaction Voluntarily Surrendered 381bs. Beef Bruised do. 2211bs. Beef Fibrosis do. 2 Livers (271bs.) Putrefaction do. VEAL— 3 Carcases & Offal Immaturity Inspected & Condemned 741bs. Veal Putrefaction Voluntarily Surrendered 4 tins Jellied Veal do. do. 55 MUTTON— 2 Pairs Lungs Parasitic Disease Inspected & Condemned 2 Livers do. do. 151bs. Liver Putrefaction Voluntarily Surrendered 221bs. Lamb Atrophy do. 2 Shoulders Lamb (61bs.) Putrefaction do. 3 tins Livers (301bs.) do. do. FISH— 1 Box Witch Soles (weight 1 stone) Putrefaction Voluntarily Surrendered 11 Stone Skate Wings do. do. 561bs Cod Fillet do. do. MISCELLANEOUS— 5 Chickens Putrefaction do. 44 Rabbits do. do. 1 tin Prawns do. do. 321bs. Cheshire Brawn do. do. In those cases where it is stated that the articles were inspected and condemned, it is an indication that the condemnation followed examination at the time of slaughter. In the other cases the foodstuffs were submitted for examination voluntarily. The list shows the varied causes for condemnation and in one respect needs comment. Under the heading Pork, there is an item of 23 lbs. of pigs' trotters. A routine visit was made to a Butcher's shop early one morning and the trotters were "seized" as being unfit for human consumption. Subsequent investigation showed that the refrigerator had broken down and apart from the food formally seized a further large quantity was subsequently destroyed. Having regard to the circumstances, no further action was taken against the retailer. 56 PRIVATE SLAUGHTERHOUSES On December 31st, 1936, 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 slaughter-house is the one in principal use, the number of animals slaughtered at the other two being comparatively small. An old registered slaughter-house at the rear of No. 45, Cambridge Grove Road is still in existence, but it will not be used as a slaughter-house in future. The building was last used as a slaughter-house in 1934 and the registration is now cancelled. 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 1936 there were 9 persons in possession of licences to slaughter animals in the Borough. The spare "Cash" captive bold 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. Four hundred and forty-seven visits we're made to slaughter-houses during the year 1936, compared with 579 during 1935. FACTORIES AND WORKPLACES Two hundred and forty visits were made to factories and workplaces during 1936, compared with 200 in 1935. The results of these inspections are shown in the tables on pages 19 and 20. 57 During the year the register of Factories and Workshops had been reviewed and it reveals how many such premises are situated in the Borough. Several years ago I drew attention to the fact that Kingston was then becoming quite an industrial beehive, and today the numbers of industrial premises in the Borough is no less, and is probably higher. 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 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 1936, 205 rooms in 174 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 compounds were used. Especial attention was given to rooms (and their contents) occupied by prospective tenants of Corporation houses. By arrangement between the Housing and Public Health Committees, visits we're 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 was also 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. 58 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 circumstances, is made in respect of such work. Two hundred and sixty-six visits were made in connection with infectious disease inquiries. The results of the investigations were passed to the Medical Officer of Health. SANITARY CONDITIONS OF MUSIC HALLS, CINEMAS, ETC. Twenty-four visits were made to places of public entertainment during the yea'r. 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. One complaint was received during the year regarding the condition of a theatre. Immediate investigations were made and it was found that the statements made were without foundation, and were obviously written without knowledge of the normal working of a theatre. CANAL BOATS ACTS In accordance with Section 3 of the Canal Boat Acts, 1884, I beg to report as follows : — During the year 1936, 15 visits were made in connection with the Canal Boats Acts. The wharves are seldom free 59 from barges but 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. 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 ate due in no small measure to the support and co-operation afforded by the Bench to your Council. SALE OF POISONS Six 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 suitable places. The poisons which are the subject of these visits are used in connection with horticulture and agriculture in the form of weed killers. The administration of the Act passed to the County Council in May, 1936, and the Corporation is not now responsible for this work. SHOPS ACTS 1912-1934 Your Sanitary Inspectors are appointed as Shops Inspectors for all purposes of the Acts and not only in respect of the sanitary and health provisions contained in the 1934 Act. 60 The administration of these Acts is by no means a light task. The laws are extremely complicated and difficult by reason of the numerous provisos and exceptions they contain, and it is realised that shop-keepers may easily contravene the less known and more obscure provisions of the Acts without any wilful intention; accordingly, every care is taken to administer the law with discretion and with the object of pointing out to shop-keepers contraventions which may be noted as the result of inspections. In this connection, advice and information is freely given when occasion arises. It has been estimated that Kingston contains well over 900 shops, in which approximately 6,000 assistants are employed, including about 1,000 under the age of 18 years, classed as " young persons ". It will be understood, therefore, that the executive duties are very heavy, but progress is being made. During 1936 an effort was made to arrange the inspections systematically and although most of the visits were to shops in the central a'rea, the smaller shops in outlying roads were not omitted altogether. Three hundred and twenty-seven visits were made during 1936, compared with 223 during 1935. With regard to the closing of shops during periods of public holidays, e.g. Christmas, it is unfortunate that the local agreement which is usually reached by a majority vote of the business community is not generally observed. I do not refer to foodshops in this connection but to trades which may be classed as "luxury trades". Experience has shown that where these shops remain open on a day when most other shops are closed, the amount of business done has been negligible and the only apparent result of the action of the owners has been to deprive their assistants of the extra day of rest. The local authority cannot require all shops to close on the days not counted as Bank Holidays, but when attention was drawn to cases where intention to remain open was known, the occupiers of the shops were interviewed and I am glad to say that with the exception of one case during Christmas, 1936, the efforts made to secu're uniformity proved successful. 61 Attention is now being given to the ventilation, warming and lighting of shops, etc., in accordance with the requirements of the Shops Acts, 1934, and this work will be continued during 1937. Legal proceedings were taken against the occupier of one shop in which a female " young person " was employed for many more hours per week than the statutory limit. The defendant, who pleaded guilty, was fined a total of £2, and £3 3s. costs were awarded to the Corporation. RATS AND MICE (DESTRUCTION) ACT, 1919 The effort to create public interest in this subject has been continued, but without marked success. Concerted action is difficult to achieve because occupiers of premises adjacent to these known to be infested, decline to accept any responsibility. One week each year is usually designated by the Ministry of Agriculture and Fisheries as National Rat Week, but it would be advantageous if every week could be so designated. These rodents cause very considerable damage and ruin to foodstuffs, materials and buildings, and it is estimated that each rat may cause a loss of £1 per annum. Be this as it may, it is incontrove'rtible that they are unwelcome guests anywhere and no effort should be spared to keep the town free from their visitations. During Rat Week the following action was taken:— (1) 5,000 handbills were distributed through the Schools and through the various departments of the Corporation. (2) Intensive action in connection with rat destruction was taken on all Corporation property by means of rat catchers, dogs and ferrets, and the following number of rats were destroyed:— 59 Bucks 63 Does Total 122 62 (3) Rat poison was laid in sewer manholes in various parts of the Borough, and investigation showed that the baits were taken in many cases. (4) Advice was given to several enquirers on the best methods for exterminating rats. The action taken by your Corporation should act as an incentive to others, and it is safe to assume that if everyone followed the example given, the rat population in the Borough would be very much reduced. The baiting of sewers proved very successful, and will be continued from time to time during the present year and not only during Rat Week. 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 whenever required. T am. Ladies and Gentlemen, Your obedient servant, HAROLD T. PERRY, f.s.i.a., m.r.s.i., Chief Sanitary Inspector. Guildhall, Kingston-upon-Thames. May 15th, 1937. 63 Report of the School Medical Officer. March, 1937. 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 1936. The average number of children on the school register for the year was 3585. In addition there were 39 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 60% of the school population taking milk at school compared with 20% before the scheme operated. During the first six months of the year Measles was prevalent, attacking all the infants' Departments. The incidence of notifiable infectious disease remained low. In April, Miss P. M. Ingillson was appointed Dental Attendant-Clerk, her duties being equally apportioned between the School Medical and Public Health Services. At the same time, Miss J. E. Partner was engaged as Junior Clerk to the School Medical Service, to fill the vacancy caused by the promotion of Miss J. M. Ingillson. These arrangements relieved the Nurses of dental inspections and clinics (except gas sessions), so enabling them to cope with their increased duties. I wish to thank all members of the Staff for their untiring help, and for their work which has been carried out in that team spirit which results in efficiency. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, E. W. MATTHEWS, School Medical Officer. 64 Staff to the School Medical Service DECEMBER 31st, 1936. School Medical Officer. E. W. MATTHEWS, m.b., b.s.(lond.), m.r.c.s., l.r.c.p., d.p.h. Oculist : IVOR AUBREY, M.C., m.r.c.s., l.r.c.p. Dental Surgeon : H. A. L. MORRIS, M.C., l.d.s., r.c.s. (eng.). Anesthetist : OLIVE G. AUBREY, b.a., m.d., b.ch. *Health Visitors and School Nurses : (SeniorJ Miss A. GILL, (2) Miss C. A. HOOKWAY, (3) Miss L. G. SALWAY, (4) Miss F. I. ARNOLD. *Dental Attendant—Clerk : Miss P. M. INGILLSON. Clerk : Miss J. E. PARTNER. *The time of the Nurses and Dental Attendant—Clerk is apportioned equally between the School Medical and Public Health Serrices. 65 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 Offices of the Public Health Department and the Education Secretary are now at the Guildhall. LATCHMERE ROAD SCHOOL. The Latchmere Road School was opened in the Autumn. It is designed to take 400 children, comprising Junior Mixed and Infants, with due regard to future development. The Authority was fortunate in having at its disposal a site fronting on the quiet Latchmere Road. The school overlooks a new recreation ground, which will eventually be scheduled as a permanent open space. The accommodation consists of nine classrooms, one of which is used as a Practical Room, Central Hall, Headmaster's Room, Staff Room, Medical Inspection and Waiting Room, numerous book stores, heating chambers, together with the necessary cloakrooms, lavatories and offices for the children and staff. A gallery overlooks the Central Hall. The Caretaker has quarters on the First Floor over the centre portion of the school. All the classrooms are linked by a continuous open glazed covered-way facing South. By means of folding windows practically the whole of one side of the classrooms may be thrown open, and cross ventilation effected by means of the windows on the North aspect. The school is heated throughout by a low pressure hot water system. There are two boilers installed in the Heating Chamber, one serving as a standby. The regular boiler is automatically fed and thermostatically controlled. Hot water is provided to all lavatories. 66 In general the school is pleasing in appearance, and is entirely free from any feeling of harshness so often associated with the older type of school building. It is proposed next spring to plant small trees and shrubs in the grounds, and in time this will undoubtedly lend an atmosphere to the building. Plans of the school were prepared by the Borough Surveyor of Kingston, and the work was carried out by Messrs. E. Clarke & Sons, Contractors, of Melton Mowbray. With the opening of this school, the Junior Mixed and Infants' Departments of Richmond Road School were amalgamated and accommodated on the ground floor of the main building, and the rooms vacated by the Infants were adapted as a Gymnasium, and two woodwork and metalwork rooms for the use of Richmond Road Central School for Boys. SCHOOL HYGIENE. Certain external painting and internal decorations were carried out at Bonner Hill Road, Richmond Road, and St. Luke's Schools, and asphalting at St. Luke's and St. Peter's Schools. The School Clinic was re-decorated, and a doorway constructed from the waiting room to the garden. Alterations were carried out at Richmond Road School on the removal of the Infants' Department, which was converted into a Gymnasium and two rooms for woodwork and metalwork. Towards the end of the year the Education Secretary made a survey of the desks with the object of urging some acceleration of replacements. Certain changes at Bonner Hill Road Central School for Girls gave an opportunity for providing new furniture for the pupils. This furniture conformed to the modern practice of providing lower writing and working surfaces and lowe'r seats. New desks were purchased for Latchmere Road School to supplement the existing stock, and also for Richmond Road Central School for Boys. These new desks were made to smaller dimensions of up-to-date standards. 67 The lighting of all departments at Bonner Hill Road School was under consideration at the end of the year. The electric lights of the Needlework Room in the Central Girls' Department were modernised. 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. 1.—Routine Inspections (a) Entrants, as soon as possible after entry. (b) Second Age Group, age 8. (c) Third Age Group, age 12 and over. A Medical Card is made out for all Entrants, and any children in the other age groups not already possessing one, and on these cards the results of Medical Inspection are entered. In addition to the Medical Card a "Following-up" Card is made out for each child found to be suffering from any defect, and a letter is handed or sent to the parent advising consultation with their own doctor with regard to the defect. In Orthopaedic cases the children are referred to the Specialist attending the Red Cross Post for his advice and treatment. In cases of visual defect, an Ophthalmic Ca'rd is completed, and the parent is informed that the child will be warned as soon as possible to attend the Clinic for the purpose of being examined by the Oculist. In cases requiring to be kept under observation, but in need of no immediate active treatment, a " Followingup " Card is also made otic. The Health Report on the Juvenile Employment Card is filled in by the School Medical Officer for each child of the Leaver Group, and School Leaving Cards for those suffering from defects rendering them unfit for certain forms of employment. 68 2.—Re-Inspections. Systematic re-inspections are made each term at the School by the School Medical Officer of all children for whom " Following-up" Cards have been made out at previous Routine or other Inspections, and the results of treatment ascertained and entered on the card. When it is found that no advice has been sought or treatment obtained, a second notice is issued to the parents again calling their attention to the defect, and recommending them to seek advice forthwith. Further failure to procure treatment is dealt with by home visits by the School Nurses. All cases for u'rgent treatment are kept under observation by the School Nurses under the direction of the School Medical Officer who may re-inspect the children at any time. 3.—Special Inspections. Children are brought before the School Medical Officer at the Schools or sent to the Clinic by the Teachers for his opinion and advice. In keeping Medical Records, the dossier system is employed, in which all records relating to an individual child are filed in one covering envelope. Parents are always warned beforehand as to the hour their children are to be medically examined at Routine Inspections, and during the year attended as follows:— No. of Children Examined. No. of Parents Present. Per centage. Entrants Boys 182 167 92 Girls 193 173 90 Second Age Group: Boys 185 128 69 Girls 183 131 72 Third Age Group: Boys 128 31 24 Girls 130 70 54 In only one instance did a parent object to Medical examination of a child. This was in the case of an extra-district child attending St. Joseph's School, and was the first objection received for very many years. 69 The attendance of parents at routine medical inspections of boys of the Third (leaver) Age Group is always rather poor, which is a pity, since so often advice may be given with regard to the suitability of contemplated employment on leaving school. The percentage of parents attending with their boys of this third age group is also considerably lowered, since many of the boys come from Dr. Barnardo's Home. The number of Routine Inspections of the Third Age Group is rather low this year, since it was decided not to medically examine children attaining the age of twelve during the term when they were still attending a Junior Department, but rather to wait until they were promoted to a Senior School. In future therefore all Third Age Group Medical Inspections will be carried out at the Senior Schools, so it is anticipated that the number of Routine Inspections of this Group will be high during 1937. FINDINGS OF MEDICAL INSPECTION. (a) Malnutrition. There are twenty 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 forty 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 thirty-six attending ordinary Elementary Schools the milk has been supplied free, the cost being met from voluntary sources. (b) Uncleanliness. The School Nurses inspect all children in the schools within a fortnight after the holiday period, and afterwards at regular intervals, 70 On discovery that a child has an unclean head, a School Nurse sends the child home with a notice to the parent calling attention to the fact with instructions for the child to report at the Clinic on the following morning. If the verminous condition is not remedied forthwith, the child is brought before the School Medical Officer, who excludes her from School, when the Education Secretary sends a warning letter to the parent, stating that unless the child 'reports clean within seven days, legal proceedings will be taken for contravention of the School Attendance Bye-laws. There is no doubt that the only way to cure verminous heads is by frequent and regular inspection by the School Nurses of every scholar in the Schools. It is gratifying to note that there has been a very marked improvement in the standard of cleanliness during the past ten years due to the persistent and tactful work of the School Nurses in this somewhat unsavoury duty. Parents are advised to have their girls' hair kept short during School life. Legal proceedings were taken under the School Attendance Bye-Laws in six cases during the year, resulting in fines being imposed in five instances. (c) Minor ailments and diseases of the skin. The number of minor ailments has 'remained fairly constant in recent years. There were only two cases of ringworm of the scalp. (d) Visual defects and sxternal eye disease. During the year 40 children were found Requiring treatment for defective vision, and 31 for squint. (e) Nose rind throat defects. There were 88 children suffering from enlarged tonsils and adenoids referred for treatment. (f) Ear disease and defective hearing. The minor ear diseases have been referred for treatment at the Clinic. Defective hearing is not common in children, except in those suffering from adenoids. 71 (g) Dental defects. At his inspection the School Dentist found 2,038 children needing treatment. (h) Orthopedic and postural defects. Four cases of spinal curvature have been referred for treatment. From time to time cases such as infantile paralysis, are referred to the Orthopaedic Specialist. (i) Heart disease and rheumatism. Four new cases of organic heart disease were discovered this year. Nineteen 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. 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 Officer. The School Medical Officer completes a Following-up Card for each child found defective, and he re-examines the child on re-visiting the School each term until satisfactory treatment has been obtained. In more urgent cases the child is seen at the Clinic at more frequent intervals. In other instances the School Nurse visits the home and interviews the parents in order to point out the necessity of treatment, and to advise and help them in the right way of getting this carried out. The work of the School Nurses may be briefly summarised as follows :— 1. To attend the Clinic daily at 9.15 a.m. to undertake the treatment of minor ailments. 72 2. To prepare beforehand for Routine Medical Inspections at the Schools by weighing, measuring and applying rough vision tests. 3. To assist the School Medical Officer at Routine Medical Inspections and Re-inspections. 4. To assist the Dental Surgeon at gas sessions. 5. To apply atropine ointment to children warned to attend the Clinic for 'refractions. 6. To assist the Ophthalmic Surgeon at the Clinic. 7. To follow-up by paying home visits. 8. To carry out cleanliness surveys at the Schools. 9. To re-examine those children found unclean after a short interval. 10. To bring obstinate cases of uncleanliness before the School Medical Officer. 11. The Senior School Nurse to supervise the work of the Clerks, and the keeping of all records and cards under the direction of the School Medical Officer. The following table specifies some of the work carried out by the School Nurses during 1936:— Number of children prepared for Routine Medical Inspection 1232 Number examined at Schools for uncleanliness 12845 Number of following-up home visits 446 Number of visits to the Schools 432 Number of Clinic Sessions 386 Clinic Sessions—Dental Attendant 149 TREATMENT. (a) Minor Aliments and Dissases of the Skin. The treatment of minor ailments and diseases of the skin was undertaken daily at the Clinic during school terms, 5875 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 87 children during the year. 73 (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-seven cases were treated under this Scheme during the year at a cost of £52 14s. 6d., towards which the parents contributed £12 3s. 6d. (d) Ear Disease and Hearing. Minor ear defects in the cases of 25 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. . (e) Dental defects. Of the 2038 children requiring treatment found by the School Dentist, 972 were actually treated, 843 being rendered dentally fit before the end of 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 31 sessions were given to inspection at the Schools, and 189 to treatment at the Clinic. The programme for the year was similar to that for the previous year, and included inspection of all the age groups and treatment of those for whom consent was obtained from the Parent or Guardian. All the children attending the Open Air School were inspected and treatment offered where necessary. The children attending the new Latchmere Road School, which was opened in the autumn, will be inspected in January, 1937. The condition of the mouths of the majority of the children is good, more care is being given to mouth hygiene generally. It is interesting to note the exceptionally good condition of the teeth in the children from Dr.Barnardo's Home. There is no special feature to report. 74 Pamphlets on the care of the teeth supplied by the Dental Board were distributed. I should like to thank all concerned for their efficient help and enthusiastic co-operation." (f) Crippling Defects and Orthopedics. During the year 18 individual children received electrical, massage, and other forms of treatment at the Red Cross Curative Post, Norbiton, making 748 total attendances. The cost of the above out-patient treatment amounted to £74 16s., towards which the parents contributed £20 5s. Id. Three children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment. One child received in-patient treatment at the Royal Orthopaedic Hospital. The total cost of in-patient treatment amounted to £245 9s. 5d., towards which the parents contributed £17 17s. 6d. (g) Heart Disease and Rheumatism. Ten 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. The nineteen children suffering from Rheumatism are followed-up, and their parents advised as to treament. INFECTIOUS DISEASE. The incidence of notifiable infectious disease has remained low throughout the year and there has been no definite outbreak. Measles was prevalent from January to June, attacking the infants of all Schools in turn. School closure was not recommended in any of the outbreaks. There were several cases of chickenpox at Bonner Hill Road Infants' School in November. 75 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. The new Latchmere Road School is constructed on Open Air lines. (c) School journeys and camps. Educational visits are made to the country and local parks for nature study, etc. 1. St. Luke's Church Central School for Girls. In May a party of 36 girls accompanied by two Assistant Mistresses from Kingston (St. Luke's) Church Central School for Girls went on an educational journey to the Peak District. It was a most valuable week with unique opportunities for viewing industrial conditions such as coal mining, pottery making and other factory work, and for observing geographical and geological facts, as well as appreciating literary and historical associations with this English beauty spot. The Head Mistress is convinced of the moral, social and health-giving advantages of this journey. No School Journey was made by girls of Bonner Hill Road Central School this year. 2. Open Air Day School. Towards the end of June, 21 children from the Open Air Day School went to Pewsey, Wiltshire, for a fortnight. Delicate children attending this School, greatly benefit from this change of air. PHYSICAL TRAINING. The Board of Education Syllabus of physical training is followed in the schools. This is carried out as much as possible in the open air. The School Medical Officer advises as to children who are not suitable for physical training. 76 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 end of the year 60% of the children in attendance were taking School Milk. This is an advance on the p'revious year, when 56% were recorded as receiving School Milk. 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 bv 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. 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. 77 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 62. SCHOOL CLINIC. The School Clinic in Grange Road was described in detail in the Annual Report for 1931. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days, when the School Nurses ca'rry out the treatment of minor ailments under the direction of the School Medical Officer. No charge is made, but a box is provided foV voluntary contributions. There were 5875 attendances during the year. 78 (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 388 attendances at the 20 sessions held during the year, 183 being new cases and 205 re-inspections. Refractions numbered 103, and spectacles were prescribed in 87 instances. Parents are charged the cost price of spectacles, except in really necessitous cases, when the Committee is prepared to pay part or the whole cost. Children for whom spectacles are prescribed are re-inspected by the School Medical Officer when he visits the School each term. (d) Dental Clinic. During the year five sessions per School Week were devoted to Dental Inspection and Treatment. In all, 31 half-days were given to Inspection and 188 to Treatment. There were 454 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. 79 There is no Special Day School for mentally defective children. There are special classes for retarded children at Bonner Hill Road Infants' School, where instruction is based upon the Montessori System, at the Junior Mixed, and Central Girls' and also at Richmond Road Central Boys' School. Very backward and feeble minded children in the Borough are transferred to these special classes on the recommendation of the School Medical Officer. There is one feeble minded child at a Certified School for Mentally Defective Children. There is one deaf child at a Certified School 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. Ten crippled children and ten suffering from heart disease a're attending the Special Open Air Day School. In addition there are twenty 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 wo'rk was set out in the Annual Report for 1934. Miss Badcock, who is in charge of the Class, reports as follows:— "Between January 1st. 1936 and December 31st. 1936, twenty one children have been attending the clinic. During this period four children were discharged with normal speech, three left school at the age of fourteen, and three left the district leaving eleven children on the registe'r at the end of the year. Of the four children who were discharged with normal speech, two were stammere'rs. 80 One case was particularly severe. The child was admitted at the age of seven having stammered ever since he could speak. The defect became worse when he went to school, and at the time he was admitted to the clinic it was beginning to have a serious psychological effect upon him. He attended the clinic regularly twice a week, and received all possible help and encouragement at home, and was finally discharged with normal speech. The other case of stammering was not so severe, and the child quickly responded to treatment. The other two children who were discharged we're admitted suffering from disordered articulation. In one case the speech had failed to develop owing to the fact that " baby talk " had been encouraged at home. In the other case the speech was quite unintelligible, and the child expressed himself by gestures and noises which were only understood by his mother. He attended the clinic regularly and carried out daily practice at home and was discharged speaking and reading quite normally. The eleven children who are attending at present are making satisfactory progress. 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, 1935 32 No. admitted during 1936 19 No. transferred to ordinary schools 8 No. left school 4 No. on register December, 1936 39 It is satisfactory to note that as stated above eight 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. 81 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. 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) 133 Special 276 Dental Inspections 35 Found to require treatment 22 Actually treated 11 Orthopaedic Treatment. Residential 2 Non-residential 4 Defective Vision and Squint 3 Cleanliness Surveys 98 Individual children found unclean 1 Eighteen physically defective children received hampers from the Treloar Children's Christmas Hamper Fund. On December 21st 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 120 school children over 12 years of age were issued with certificates under the Byelaws permitting their employment. 82 SWIMMING. The total number of attendances for instruction made by the Elementary School children to the Kingston Swimming Baths during 1936 was 9,894. In addition 104 pupils attended each week for Life Saving instruction. 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. 83 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. Entrants 375 Second Age Group 368 Third Age Group 276 Total 1,010 Number of other Routine Inspections 222 Grand Total 1,232 B —Other Inspections. Number of Special Inspections 1,486 Number of Re-Inspections 5,807 Total 7,293 C.—Children Found to Require Treatment. Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Prescribed Groups. Entrants 65 Second Age Group 39 Third Age Group 23 Total (Prescribed Groups) 127 Other Routine Inspections 39 Grand Total 166 84 TABLE II. A Keturn of Defects found by Medical Inspection in the Year ended 31st December, 1936. 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 — 1 — (2) Body 2 — 13 — (3)Scabies — — 9 — (4) Impetigo 1 — 143 — (5) Other diseases (non Tb) 19 — 369 9 TOTAL (Heads 1 to 5) 23 — 535 9 Eye (6) Blepharitis — — 8 — (7) Conjunctivitis 2 — 24 — (8) Keratitis — — — (9) Corneal Opacities 1 — — — (10) Other Conditions (excluding Defective ion and Squint) 1 — 36 1 TOTAL (Heads 6 to 10) 4 68 1 (11) Def've Vision (excl. Sqt.) 30 5 10 1 (12) (Squint 20 — 11 — (13) (Defective Hearing 5 5 — (14) Otitis Media — 2 — (15) Other Ear Diseases 1 — 26 — (16) Chronic Tonsillitis only 33 5 25 — (17) Adenoids only 2 — 9 — (18) Chronic Tonsillitis and Adenoids 10 1 9 (19) Other Conditions 1 — 53 — (20) Enlarged Cervical Glands (non Tb) 9 2 11 — (21) Defective Speech 5 1 6 — Heart and Circulation Heart Disease (22) Organic 1 1 3 — (23) Functional 1 1 — 1 (24) Anaemia 2 — — — 85 TABLE II.—continued. Lungs (25) Bronchitis 4 - 3 (26) Other non Tb. Diseases 11 1 14 — Tuberculosis Pulmonary (27) Definite — - — — (28)Suspected 2 - — — Non-Pulmo'y(29) Glands — - — — (30) Bones & Joints — - 1 — (3l)Skin — - - - (32)Other Forms - 1 - — TOTAL (Heads 29 to 32) - 1 1 — Nervous System (33) Epilepsy - - - (34) Chorea - - 1 - (35) Other Conditions 1 - 2 - Deformities (36) Rickets 3 - 3 — (37) Spinal Curvature 2 - - (38) Other Forms 10 3 1 - (9) Other Defects and Diseases - 5 - (excl. Uncleanliness & Dental Diseases) 28 3 266 - Total 208 25 1070 12 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 375 28 7.5 271 72.3 76 20.2 — — Second Age Group 368 49 13.3 267 72.6 52 14.1 — — Third Age Group 267 39 14.6 181 67.8 47 17.6 — — Other Routine Inspections 222 34 15.3 170 76.6 18 8.1 — — Total 1,232 150 12.2 889 72.1 193 15.6 — — 86 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 1 — — — — 1 Partially Deaf - - - - - - Mentally Defective (feeble minded) 1 1 Epileptic — — — — — Physically Defective (a) Tuberculosis 1. Pulmonary - - - - - 2. Non-pulmonary — — 2 — 2 (b) Delicate 20 11 — — 31 (c) Crippled 10 8 2 — 20 (d) Heart Disease 10 13 — — 23 87 TABLE IV. Return of Defects Treated During the Year Ended 31st December, 1936 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 — 2 2 Ringworm, Body 15 — 15 Scabies 8 1 9 Impetigo 142 2 144 Other skin disease 323 19 342 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 57 3 60 Minor Ear Defects 25 — 25 Miscellaneous—(e.g., minor injuries, bruises, sores, chilblains, etc.) 184 27 211 Total 754 54 808 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) 103 27 130 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 4 4 8 Total 107 31 138 No. of children for whom spectacles were prescribed (i) Under the Authority's Scheme 87 (ii) Otherwise 18 Total 105 No. of children for whom spectacles were obtained:— (i) Under the Authority's Scheme 87 (ii) Otherwise 18 Total 105 88 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) 27 2 8 — — — 12 — 27 2 20 — 7 56 (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 Otherwise. Total number treated (1) (2) Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated. 4 1 18 — — 2 25 89 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 14 256 285 333 312 351 352 322 359 403 213 Total 3186 (b) Specials 17 (c) TOTAL (Routine and Specials) 3203 (2) Found to require treatment 2038 (3) Actually treated 972 (4) Attendances made by children for treatment 2073 (5) Half-days devoted to:— Inspection 31 Treatment 188 Total 219 (6) Fillings:— Permanent teeth 1205 Temporary teeth 175 Total 1380 (7) Extractions:— Permanent teeth 245 Temporary teeth 1758 Total 2003 (8) Administrations of general anaesthetics for extractions 454 (9) Other operations:— Permanent teeth 171 Temporary teeth 236 Total 407 90 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 12845 (iii) Number of individual children found unclean 530 (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 6