®b« JvddhI borough of llungstoit-Hpon-fljanus Annual Reports FOR 1 9 3 7 OF THE. MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THE SANITARY INSPECTOR The Royal Borougb of Kingston-upon-Thames Annual Reports FOR 1 9 3 7 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 Medical Officer of Health and School Medical Officer : J. W. STARKEY, M.B., Ch.B. (Edin.), D.P.H. (Appointed 1st December, 1937.) E. W. MATTHEWS, M.B., B.S., (Lond.), M.R.C.S.. L.R.C.P., D.P.H., (Resigned 31st August, 1937). Acting Medical Officer of Health and School Medical Officer : OLIVE G. AUBREY, B.A., M.D., B.Ch. (From 1st September 1937, to 30th November 1937) Maternity and Child Welfare Clinic : *OLIVE G. AUBREY, B.A., M.D., B.Ch. Ante-natal Clinic : *BEATRICE TURNER, M.B., F.R.C.S., (Edin.) Diphtheria Immunisation : *D. S. MURRAY, B.S., 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). (Resigned, 20th February 1937). N. SMITH, A.R.S.I. (a), (e). (4) J. A. CUMMINS, (a). (Appointed 8th March, 1937). 3 Health Visitors and School Nurses : (Senior) Miss A. GILL, (b), (c), (d),. (Resigned 31st August, 1937). Miss C. A. HOOKWAY, (b), (c), (d). (2) Miss L. G. SALWAY, (b), (c). (3) Miss F. I. ARNOLD, (b), (c), (d). (4) Miss M. M. DUKE, (b), (c), (d). (appointed 13th September, 1937). * Dental Attendant—Clerk : Mrs. P. M. JEFFCOATE. 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. (e) Certificate as Smoke Inspector. 4 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH Public Health Department, Guildhall, Kingston-upon-Thames. May, 1938. To the Mayor, Aldermen and Councillors of the Royal Borough of Kingston-upon-Thames. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for the year 1937. Circular 1650 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1937 requests that the Council will direct the Annual Report of the Medical Officer of Health for 1937 to be drawn upon the lines indicated therein. The circular states, also that the Annual Report for 1937 should contain information in regard to the matters specified in Appendix 1, set out as far as possible in the order there given, under headings (a) to (f). This I have done, but as my term of office as Medical Officer of Health commenced on the 1st December 1937, the Report refers almost entirely to work of my predecessors. I am indebted to the members of the staff for their assistance in preparing the Report. Dr. E. W. Matthews resigned his office as Medical Officer of Health on the 31st August 1937, after eighteen year's service with the Corporation, during which time he rendered most valuable service to the Borough, both as an administrator and in the Clinics. From the 1st September to the 30th November, Dr. Olive Aubrey acted as Medical 5 Officer of Health and on the 1st December I took over personal supervision of the department. Other changes of staff during the year were as follows Mr. L. Kluth, Additional Sanitary Inspector, resigned in February 1937. Mr. J. A. Cummins appointed vice Mr. Kluth, commenced duty on 8th March 1937. Miss A. Gill, Senior Health Visitor resigned 31st August 1937, and Miss C. A. Hook way was appointed Senior Health Visitor. Miss M. M. Duke appointed additional Health Visitor commenced duty on 13th September 1937. The form of the Report is of necessity identical with that for 1936. Generally the statistics for the year compare favourably with those recorded for previous years. I would like to record my appreciation of the warm welcome extended to me by the Mayor and Corporation, and of the friendly co-operation shewn by my fellow officers. It will be my endeavour to continue the good work already carried on and to extend it where extension would seem to be required in the interest of public health. I am, Ladies and Gentlemen, Your obedient servant, J. W. STARKEY, Medical Officer of Health. 6 SECTION A STATISTICS AND SOCIAL CONDITIONS (i) General Statistics. Area 1,390 acres Population 1937 (Registrar General) 39,850 Number of inhabited houses approx 10,000 Rateable Value—General Rate £495,935 Sum represented by Penny Rate £1,970 Amount of Poor Law Relief £5,765 (ii) Social Conditions. The Borough has become, to some extent, an industrial town, the chief businesses including engineering and aeroplane works. The unemployment figures remained low so far as the engineering and allied trades were concerned, but there was a fairly large increase in unemployment in connection with building operatives, particularly among those classed as skilled workers. (iii) Extracts from Vital Statistics of the Year. Live Births— Total. Male. Female. Legitimate 514 276 238 Birth Rate (R.G.) per 1,000 pop. 13.52 Illegitimate 25 15 10 539 291 248 Still Births— Total. Male. Female. Legitimate 14 7 7 Rate per 1,000 total (live and still) births 27.07. Illegitimate 1 1 — 15 8 7 7 Deaths— Total. Male. Female. 540 256 284 Death Rate (R.G.) per 1,000 pop. 13.55. Death Rate corrected for age and sex constitution, 11.92 per thousand population (factor for correction 0.88, 1931 Census). Deaths from puerperal causes— Deaths Rate per 1,000 total (live and still) births Puerperal Sepsis Other Puerperal Causes 4 7.22 Death Rate of Infants under one year of age—- All infants per 1,000 live births 51.9 Legitimate infants per 1,000 legitimate live births 50.5 Illegitimate infants per 1,000 illegitimate live births 80 Deaths from Cancer (all ages) 85 Deaths from Measles (all ages) ... Nil. Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 4 Birth Rate Death Rate Rate per 1,000 Births Diarrhoea Total Deaths Under 2 years Under 1 year England and Wales 14.9 12.4 5.8 58 148 Smaller Towns 15.3 11.9 3.2 55 London 13.3 12.3 12.0 60 Kingston-upon-Thames 13.52 11.92 7.4 51.9 (iv) Causes of Death. Male Female All Causes 255 284 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — 1 5. Diphtheria 1 — 6. Influenza 13 16 7. Encephalitis Lethargica — — 8 8. Cerebro-spinal Fever — — 9. Tuberculosis of the Respiratory System 16 9 10. Other Tuberculous Diseases — 3 11. Syphilis — 1 12. General Paralysis of the Insane, tabes dorsalis — — 13. Cancer, Malignant Disease 40 45 14. Diabetes 1 6 15. Cerebral Haemorrhage, etc. 9 12 16. Heart Disease 61 69 17. Aneurysm 1 1 18. Other Circulatory Diseases 10 18 19. Bronchitis 5 — 20. Pneumonia (all forms) 18 21 21. Other Respiratory Diseases — 4 22. Peptic Ulcer 6 3 23. Diarrhoea, etc. (under two years) 3 1 24. Appendicitis 1 1 25. Cirrhosis of Liver 1 1 26. Other Diseases of Liver, etc. 1 3 27. Other Digestive Diseases — 4 28. Acute and Chronic Nephritis 11 29. Puerperal Sepsis — — 30. Other Puerperal Causes — 4 31. Congenital Debility, Premature Birth, Malformations, etc. 14 4 32. Senility 8 8 33. Suicide 3 4 34. Other Violence 10 15 35. Other Defined Diseases 22 23 36. Causes Ill-defined or Unknown — — Special Causes (included in No. 35 above) :— Smallpox — — Poliomyelitis — — Polioencephalitis — — 9 METEOROLOGY, 1937 The following table is compiled from records taken by Mr. P. G. Lloyd. Temperature of Air Highest Lowest Mean Max. Mean Min. Rainfall Inches January 55 30 48 38 3.64 February 57 31 50 39 3.63 March 56 26 47 34 2.59 April 69 31 59 44 1.89 May 83 40 67 50 1.99 June 83 42 74 55 2.14 July 84 52 75 58 0.55 August 88 51 76 58 3.43 September 78 43 67 51 1.57 October 68 38 59 48 2.36 November 60 26 48 38 1.23 December 53 27 44 35 3.84 28.86 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 as shewn on pages 2 & 3. Changes of staff during the year have been recorded in the preface to the report. 10 (ii) (a) Laboratory Facilities. An arrangement exists with the Clinical Research Association for the examination or analysis of clinical material, water, milk, etc., and in addition Dr. D. S. Murray, Pathologist to the Royal Hospital, Richmond, undertakes bacteriological examinations. (b) Ambulance Facilities. (1) For infectious cases: Cases removed to Wimbledon Isolation Hospital are transported by the Motor Ambulance attached to that Hospital. (2) For non-infectious and accident cases :—A Motor Ambulance is provided by the Corporation. Accident cases are removed free, but a charge is made for its use in private cases. During the year 273 accident cases and 186 private cases were removed by this ambulance. The ambulance service appears to be adequate for the area. (c) Nursing in the Home. (1) General.—This is carried out by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees are defrayed by the Council. (2) Infectious Diseases.—In Measles, Whooping Cough and Epidemic Diarrhcea, 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. 11 (d) 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. 12 (e) Hospitals. (1) Fever.—Arrangements are made whereby Wimbledon Isolation Hospital accepts cases occurring in the Borough, and payment is made for the maintenance of patients by the Corporation. (2) Smallpox.—The Surrey Smallpox Hospital, East Clandon (Surrey C.C.). (3) Other.—General Hospitals situated in the Borough available for the District are :— The Surrey County Hospital. 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. MATERNITY AND CHILD WELFARE (i) Midwifery and Maternity Services. (a) Midwives. The Midwives are under the administrative control of the Surrey County Council, which is the local supervising authority. The Surrey County Council scheme under the Midwives Act, 1936, operates within the district. There were ten registered as practising in the Borough at the end of the year. (b) Maternal Mortality. The investigation into maternal deaths is carried out bv the Medical Officer of Health, who addresses confidential reports to the Senior Medical Officer, Ministry .of Health, in the form specified by the Ministry. 13 Puerperal Pyrexia. During the year 32 cases of Puerperal Pyrexia were notified under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, and the Public Health Act, 1936. Such cases are all now notified under the heading Pueperal Pyrexia, as from the 1st October 1937. Immediate investigation was made into the circumstances of each case, and a copy of each notification sent to the County Medical Officer of Health. Of the 32 cases notified, 28 were either admitted to, or already in-patients at, the Surrey County Hospital. There were no fatal cases. The consultant, Mr. Andrew McAllister, was not summoned during the year. (c) Ante-Natal Services. The Ante-Natal Centre was held four times a month. Miss Beatrice Turner, M.B., F.R.C.S., (Edin.) presided at the Centre and is recognised as Consultant Obstetrician for the Borough. A full description of the Ante-Natal Services was given in the Annual Report for 1932. Dried milk may be obtained by expectant mothers at the Centre at cost price, and fresh milk is supplied at a reduced cost or free in necessitous cases, in accordance with the income scale in force. During the year 192 expectant mothers attended, making 749 visits to the Clinic. Forty-two mothers made post-natal visits to the Clinic. (d) 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. 14 During the year there were the following number of attendances :— Attendances. Meetings. New Cases. Total Tuesday ... 50 201 3,177 Friday 50 197 3,463 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 110 mothers have purchased 304 garments during the year. During the year the sale of National Savings Certificates was resumed and was well supported. Baby week was held from 4th to 10th July. Special announcements were made in the local Churches and Sunday Schools, and the Centre was open to Visitors on Tuesday and Friday. The Day Nursery in Canbury Park Road was open daily to visitors. On Thursday, July 8th, a Garden Party was given at St. Peters' Vicarage, where the mothers and infants spent a most enjoyable afternoon. (e) 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 ansethetist. 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. 15 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. During the year the following work was carried out :— 63 mothers and 57 infants made 366 attendances. Extractions of permanent teeth 294 Extractions of temporary teeth 206 Filling of permanent teeth 24 Filling of temporary teeth 16 Scalings 7 Dentures supplied 14 Anaesthetics given 118 (f) 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. Under this scheme one infant 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. (ii) Institutional Provision for Mothers or Children. 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. 16 (iii) Health Visitors. The Health Visitors paid the following number of home visits :— First Visits. Total Visits. Expectant Mothers 184 304 Infants under one year .. 504 3,093 Children, one to five year; — 4,777 Incidental and Infectious — 437 As a routine procedure the Health Visitors make their first visits at the end of fourteen 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 are now very few unnotified births, but in each case 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. (iv) Child Life Protection. The duties imposed by the Children and Young Persons Acts and by the Public Health Act, 1936, are entrusted to the Maternity and Child Welfare Sub-Committee of the Public Health Committee. The general procedure adopted was fully described in the Annual Report for 1930. During the year 7 new registrations were approved and 4 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 26 foster mothers in charge of 29 infants. 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 536 visits were paid, this work being most satisfactorily carried out by the Health Visitors, 17 (v) Orthopoedic Treatment. Under the scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, three infants received out-patient treatment during the year. On attaining the age of five years, infants undergoing Orthopaedic Treatment continue such treatment through the School Medical Service. Inspection of 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 Public Health Act, 1936, 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 from time to time during the year. SECTION C SANITARY CIRCUMSTANCES 1. (i) Water. The Water Supply of the town is furnished by the Metropolitan Water Board. There are still some shallow wells, and the policy is to advise owners to have their property connected to the Main Suppy of the Metropolitan Water Board. The use of well water was discontinued at 8 houses during the year. 18 The number of premises known to be supplied with water from wells at the end of 1937 was 23, which compares with 271 for 1919. Samples were chemically examined by Mr. P. G. Lloyd during the year. (ii) Drainage and Sewerage. The programme for the construction of manholes on the existing sewerage system has been continued. New Soil and Surface Water Sewers have been provided on the Richmond Park and Riverview Estates. 2. 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. 3. (i) Closet Accommodation. The closets in the Borough are on the water-carriage system. (ii) 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. (iii), (iv), (v) and (vii). Sanitary Inspection of the Area; Shops, Smoke Abatement, and Eradication of bed bugs.. 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 on pages 38, 53, 54 and 55 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 Special Classes of Premises and Occupations subject to control of the Local Authority, and under the Rag Flock Acts, 1911 and 1928. • 19 (vi) Szw.mm.ing Baths and Pools. (a) Public. A new swimming bath was constructed by the Corporation and opened in 1937. The bathing accommodation consists of two pools, both of which are in use during the summer, and one in the winter months. A purification and filtration plant is installed. (b) Private. There are no privately owned swimming baths or pools open to the public in the Borough, but facilities for bathing have been provided by a private company at a bathing station on the banks of the river Thames. 4. Schools. Information with regard to the sanitary condition and improvements in the public elementary schools is given each year in the report of the School Medical Officer. The recommendations for the prevention of the spread of infectious disease contained in the Memorandum on Closure of and Exclusion from School, 1927, have been closely folowed. 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. (5) Factories, Workshops and Workplaces. The work carried out in connection with the inspection of factories and workshops is summarised in tabular form below. I—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Number of Premises Inspections Written Notices. Occupiers prosecuted Factories — (including Factory Laundries) 119 7 Nil Workshops — (including Workshop Laundries) ... 153 2 Nil Workplaces — (other than Outworkers' premises) Tota 272 9 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 9 16 — — Want of Ventilation — — — — Overcrowding — — — — Wantof drainageof floors — — — — Other nuisances 6 14 — — Sanitary Accommo- dation Insufficient 1 — — — Unsuitable or Defective 8 11 — — Dirty Not separate 11 6 — — 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 11 — — Total 45 58 *including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 21 III—OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. No action was found to be necessary in connection with the above. SECTION D HOUSING Statistics relating to action taken under the Housing Acts have been prepared on lines suggested in Circular 1650 issued by the Minister of Health and are shewn on pages 24 and 25. In addition, the summaries that have appeared in previous annual reports shewing the action taken in regard to (a) clearance areas, and (b) "individual" houses found to be unfit for human habitation, have been revised again to shew the positions at the end of 1937. The following table gives particulars of building development during the year :— (1) Number of new houses erected by the Corporation during the year ended 31st December, 1937 32 Flats (2) Number of houses erected by private enterprise during the year ended 31st December, 1937 70 Houses 121 Flats (3) Total number of houses for the workingclasses erected by the Corporation since March, 1924 732 Houses 56 Flats 22 CLEARANCE AREAS Clearance Area No. of bouses in area Date of represent ation 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 Counc il Confirmed by Minister of Health No. I 3 12.10 33 19 12.33 9. 4 34 3 3 ———— No. 1 3 12.10 33 19.12.33 14.8.34 — — 3 3 ———— No. 3 3 12.10.13 19.12.33 14.8.34 — — 3 3 ———— Canbury 19 3o.l1.33 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 Area "B" 31 9. 1.36 25.2.36 5.8.36 (with modifications) — — 12 Nil The modified Order excluded 1 house Canbury Area "C " 5 9. 1.36 25. 2.36 5.8.36 — — Nil Nil — 23 INDIVIDUAL HOUSES, SEPARATE TENEMENTS AND UNDERGROUND ROOMS Year(s) No. of dwelling houses found to be unfit for human habitation No. of dwelling houses in respect of which Demolition Orders were made No. of dwelling houses in respect of which "undertakings" were given by owners No. of dwelling houses demolished in pursuance of Demolition Orders made No. of separate tenements or underground rooms in respect of which Closing Orders were made. No. of separate tenements or underground rooms in respect of which "undertakings" were given by owners Remarks. 1930-1936 127 102 12* 74 4 3 *Four houses in respect of which an "undertaking" had been given by the owner were subsequently demolished voluntarily by the owner, during 1934. 1937 22 15 3 34 3 — Total 149 117 15 108+ 7 3 tin addition four houses were demolished in anticipation of formal action under Housing Acts. 24 Housing Statistics. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 526 (b) Number of inspections made for the purpose 567 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 123 (b) Number of inspections made for the purpose 129 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 22 (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 378 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 408 3. Action Under Statutory Powers during the Year: A.—Proceedings under sections 9, 10 and 16 of Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were dered fit after service of formal notices:— (a) By Owners Nil (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 15 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By Owners 17 (b) By Local Authority in default of Owners 1 C.—Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made ... 15 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 34* D.—Proceedings under section 12 of the Housing Act, 1936: — (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil * In addition, "undertakings" were received in respect of three premises, and two houses were demolished by the owners in anticipation of formal action under the Housing Acts. 4. Housing Act, 1936, Part IV., Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 11 (2) Number of families dwelling therein 12 (3) Number of " equivalent" persons dwelling therein 66 (b) Number of new cases of overcrowding reported during the year 5 (c) (1) Total number of cases of overcrowding relieved during the year 33 (2) Total number of " equivalent " persons concerned in such cases 2211 (3) Number of cases of overcrowding in part of Council's housing estate situate 26 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) 92 (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 1 SECTION E INSPECTION AND SUPERVISION OF FOOD (a) and (b) Milk Supply, Meat and other Foods. Particulars of action taken with regard to milk, meat and other foods, including inspection of meat, slaughterhouses, shops and places where food is prepared, are given on pages 47 to 52 in the Report of the Sanitary Inspector. (c) Adulteration. The following table shows the action taken by the Surrey County Council in the Borough during the year, under the Food and Drugs (Adulteration) Act, 1928:— ARTICLES ANALYSED ADULTERATED OK DETERIORATED PROSECUTIONS CONVICTIONS Formal Informal Total Formal Informal Total Milk 57 – 57 3 – 3 – – Butter – 1 1 – 1 1 – – Lard 3 — 3 – – – – – Meat 3 — 3 – – – – – Tea 1 – 1 – – – – – Sausages – – 1 – – – – – Jam – 5 5 – – – – – Spirits(Whisky) 5 – 5 – – – – – Other Articles 2 15 17 – 1 1 – – Totals 72 21 93 3 2 5 — – 27 (d) Chemical and bacteriological examination of food. No examinations under this head were necessary during the year. (e) Nutrition. At the Welfare Centre and in the Schools, elementary information on food values, dietetics, and budgeting is given. Apart from the Health Campaign in the later months of the year, the subject of Nutrition was presented to the general public, school children and mothers attending the Clinics by films, exhibits, posters, pamphlets and talks. SECTION F INFECTIOUS AND OTHER DISEASES The following table gives a comparative statement of notifications received during the last nineteen 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 27 6 1937 51 21 1 28 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 I5 — 20 20—35 35—45 45—65 65 & over Total Deaths Scarlet Fever – 3 6 – 1 20 6 4 0 — – – 51 46 – – – – – – – – – – – – – Diphtheria 1 – 1 – 2 8 4 3 1 – 1 – 21 20 – – – – – – – 1 – – – – 1 Enteric Fever including Paratyphoid – – – – – – – – – – – – 1 1 – – – – – – – – – – – – – Pneumonia 2 1 – 3 – 1 1 – 1 1 4 8 22 6 – – – – – – – – – – 2 6 8 Erysipelas 1 – – – – – – – 1 2 3 6 13 0 – – – – – – – – – – – – – Puerperal Pyrexia – – – – – – – 4 24 4 – – 32 28 – – – – – – – – – – – – – Ophthalmia Neonatorum 3 – – – – – – – – – – – 3 1 – – – – – – – – – – – – – Meningococcal Meningitis – – – – – – – 1 – – – – 1 1 – – – – – – – – – – – – 1 Anterior Polio-Myelitis – – – – – – – – 1 – – – 2 2 – – – – – – – – – – – – – B. Dysenteria (Sonne) 1 – 1 – — 3 1 — 2 — 1 1 10 10 – – – – – – – – – – – – – 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 7 4 4 4 2 25 — — — – 4 1 4 5 2 16 F. — 1 2 5 0 1 2 3 20 — 1 2 1 2 2 — 1 2 11 Total — I 2 9 13 5 4 6 5 45 — 1 2 1 6 3 4 6 4 27 (b) Non-Respiratory M — 1 1 1 – – – – – 3 – – – – – – – – – — F — 1 2 – 1 — — — 1 5 – – – – – – – – 1 1 Total — 2 3 1 1 — — – 1 8 – – – – – – – – 1 1 29 SCARLET FEVER. The incidence of Scarlet Fever remains low, and the majority of cases were of a very mild character. There were no deaths from this disease. DIPHTHERIA. Twenty-one cases were notified during the year, and is the lowest number in the Borough since 1924. There was one fatal case. Immunisation. 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 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 1937 is as follows:— Number of sessions 44 Number of attendances 2101 Number of Schick Tests 287 Number of Injections 862 Number of posterior Schick Tests 373 Number of Certificates issued 339 Number of Re-schick Tests after 2 years 114 Number of readings after Re-schick 109 Of the 287 cases Schick tested 16 were found to be immune. There were only 2 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. One case of enteric fever was notified during the year, and was admitted to the Surrey County Hospital, Kingstonon-Thames. The source of infection could not be traced. 30 PNEUMONIA. The number of cases notified was 22, compared with 32 and 21 for the last two years. PUERPERAL FEVER AND PUERPERAL PYREXIA. Comment on these diseases will be found under Section B of the Report (Maternity and Child Welfare, Sub-Section b), on page 13. OPHTHALMIA NEONATORUM. A Health Visitor is instructed to visit immediately upon notification, and inquire into the circumstances of the case. Cases notified during 1937. Notified. Treated At Home. In Hospital. Vision unimpaired Vision impaired. Total Blindness. Deaths. 3 2 1 2 — — — One case remained under treatment on 31st December 1937. 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. One case was sent to the Hospital under this scheme during the year. CEREBRO-SPINAL FEVER. One case was notified during the year, and occurred in a girl aged 15 years. The patient was admitted to the Surrey County Hospital, and died three days after admission. ANTERIOR POLIOMYELITIS. Two cases were notified during the year. Both received hospital treatment, and made good recoveries. 31 DYSENTERY. Ten cases of Bacillary Dysentery of the Sonne type were notified, all of which were in-patients at the Surrey County Hospital, Kingston. The illness generally was of a mild type and there were no fatal cases. TUBERCULOSIS. Cases of Tuberculosis notified in the Borough come under the administrative control of the Surrey County Council. Every effort is made to assist the County Medical Officer and Tuberculosis Officer in their activities in the area. A Sanitary Inspector is detailed to visit each notified case and report on the condition of the premises, and also to advise all contacts to consult the County Tuberculosis Officer. The efficiency of notification of Tuberculosis is 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 : 4.6. 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, or Section 172 of the Public Health Act, 1936. 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 NOTIFIABLE DISEASES. No cases of smallpox or encephalitis lethargica have been notified this year. 32 NON-NOTIFIABLE ACUTE INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. The Medical Practitioners in the Borough also supply much valuable data on occasions. It was not necessary to recommend school closure during the year. The Sanitary Inspector, Mr. H. T. Perry, reports as follows:— 33 Report of Chief Sanitary Inspector To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I beg to submit the Annual Report on the work carried out by your Sanitary Inspectors during the year 1937, in connection with the various Statutes and Byelaws relating to Public Health in force within the Borough. The present Report is the nineteenth annual statement I have had the honour to present to you. The total number of inspections and visits made during the past year was 9944 as compared with 9431 during the year 1936. In the Register of Sanitary Defects, 526 new entries were made, and 634 previous entries were cancelled following upon compliance with notices served. On December 31st, 1937, 408 separate entries remained on the Register, compared with 516 at the end of 1936. Included in the 408 entries referred to, 60 were in respect of houses awaiting demolition, etc., and 30 in respect of houses in Elton Road where redrainage is contemplated. The remaining entries were in respect of premises upon which sundry sanitary defects were found. Four hundred and ninety "preliminary" and 40 verbal notices were served during 1937. In 21 instances this informal action did not bring about the desired result and it was necessary to serve " statutory " notices. 34 During the year 1937, 565 enquiries under the Land Charges Act, 1925, respecting property in the Borough were received from the Town Clerk and replied to. The corresponding figure for 1936 was 577. 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 so much work carried out as the result of persuasive action, as against compulsion by statutory powers vested in the Corporation as the Sanitary Authority. In no case was legal action found necessary. For convenience of reference the inspections and visits are set out in the following tabular form:— INSPECTIONS AND VISITS The following list shows the number of Inspections made in regard to each section of the works, and the total of all inspections. Rent Restrictions Act Inspections 2 Re-inspections 2323 Visits to Works in Progress 1829 Factories 89 Workshops and Workplaces 143 Cowsheds, Dairies and Milkshops 67 Ice Cream Premises 43 Foodshops and Food Preparing Rooms 648 Infectious Disease Enquiries 247 Markets 174 35 Inspection of Houses etc. (including complaints) 1010 Examination of Drains 261 Slaughterhouses 303 Offensive Trades 59 Sanitary Conveniences 73 Common Lodging Houses 12 Canal Boats 14 Theatres, Cinemas, etc. 30 House to House 129 Verminous Premises 71 Bakehouses 40 Smoke Observations 56 Stables and Yards 51 Enquiries re Housing Applicants 11 Rats and Mice Destruction 438 Shops Acts 1249 Schools 9 Disinfection Station 126 Caravans (Fair Grounds) 3 Housing Act, 1935 (Overcrowding) 409 Miscellaneous Visits 25 Total 9944 SUMMARY OF SANITARY IMPROVEMENTS 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. 36 WATER CLOSETS AND SANITARY FITTINGS W.C. apartments lighted, repaired, or ventilated 8 W.C. apartments cleansed and limewashed 62 New W.C. apartments 11 Ventilated lobby to W.C. apartment 3 New W.C. basins 67 W.C. basins unstopped and/or cleansed 10 W.C. seats repaired or renewed 30 W.C. flushing tanks repaired or renewed 15 W.C. flush pipe connection repaired 6 Urinals repaired and cleansed 7 New sinks provided 30 Trapped waste pipes fixed to sinks 68 Sink waste pipe lengthened 3 Lavatory basins provided 2 Main waste pipes provided 4 Miscellaneous 5 DRAINAGE Number of houses and premises redrained 33 New branch drains 7 Drains unstopped or cleansed 20 Manholes provided or repaired 58 Cast-iron covers provided to manholes 3 New gully traps provided 97 Gratings fixed to gully traps 2 Gully curbs repaired or renewed 8 Intercepting traps fixed 15 Fresh air inlet shafts fixed 23 Soil pipes and/or ventilating shafts provided 31 Soil pipes and/or ventilating shafts repaired 11 New soakaway constructed 3 Cesspools emptied 3 Miscellaneous 10 37 GENERAL REPAIRS Rooms repaired and cleansed 333 Walls replastered 221 Ceilings repaired or renewed 109 Floors repaired 124 Windows repaired, renewed or made to open 354 Windows provided 11 Doors repaired or renewed 94 Door and window sills repaired or renewed 159 Firegrates, stoves and flues repaired or renewed 116 Wood surround to fireplace removed 6 Hearths repaired 3 Coppers repaired or renewed 14 Stairs repaired 19 Handrails fixed to stairs or passage 29 Additional light to stairs 69 Permanent ventilation to rooms 29 Ventilation grating to room unchoked 2 Cellars ventilated 3 Under floor ventilation provided 24 Floor ventilation grating unchoked 3 Larders ventilated 10 Larders provided 1 Additional light to scullery 1 Roofs repaired or renewed 82 Gutters repaired or renewed 80 Gutters provided 6 Rain water pipes repaired or renewed 28 Rain water pipes disconnected from drains 31 Chimneys repointed 5 Chimney stacks rebuilt 1 New chimney pots provided 2 Cowl provided to chimney 1 Walls rebuilt 3 38 Walls repointed 110 Damp proof courses inserted 26 Dampness abated 60 Yard paving repaired 30 Yards paved 42 Passages paved 12 Premises painted externally 13 Disused service water cistern removed 5 Water supply from main 18 Site concreted 1 Ashbins supplied 198 Cement plinths repaired 6 Refuse accumulations removed 11 Manure receptacles covered 2 Heating provided in shops 3 Workshops cleansed 7 Miscellaneous 20 SMOKE ABATEMENT There was a welcome decrease in the number of complaints received in respect of alleged excessive emission of smoke or grit from chimneys in the Borough during the year 1937 compared with the previous year, the figures being 4 and 16 respectively. No new sources of complaint have arisen, and in the case of works where complaint had arisen in previous years, steps were taken to abate the nuisance, or at least, to reduce it considerably. In respect of the Electricity Works, the Corporation decided to instal grit-arresting apparatus, details of which were under consideration at the end of the year. In another works, the steam raising plant was somewhat seriously overloaded and it was found necessary to instal a larger boiler. This work was completed during 1937, but the change-over did not prove altogether success- 39 ful. The nuisance from smoke was abated, but excessive grit was discharged and this caused even more annoyance to inhabitants in the immediate vicinity. The matter was still under consideration at the end of the year. The oft-repeated plea for joint action by all the local authorities in London and Greater London appeared to be nearer to fruition during 1937, when a suggestion that a Regional Joint Committee for the whole of the Metropolitan Police Area should be formed, was mooted. It is to be hoped that 1938 will see the scheme in actual being. 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 56 were made during 1937. The occupier of the works in such cases was interviewed as soon as possible after the offence was noted, and actual working conditions of the boiler plant investigated. Quite frequently the cause of the smoke is due to inefficient stoking, and it would be worth while for works managers to seriously consider the advisability of allowing stokers to attend special courses of technical instruction which are, or could be made available for stokers. Not only would a saving be affected in the coal bill, but the Borough would retain the asset of an atmosphere remarkably free from pollution. COMMON LODGING HOUSES There are only two registered common lodging houses in the Borough, viz:— Nos. 8 and 10, Vicarage Road (Othen's)—50 beds for men only. No. 52, Canbury Passage (Marsh's)—35 beds for men only. As will be seen, there is no accommodation for married couples or for children in the registered lodging houses. The Vicarage Road premises are not of modern design, but they have the advantage of having been designed for the reception and housing of lodgers. The Canbury Passage 40 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. It 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 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 came 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 necessary first to consider what alternative accommodation can be provided for the lodgers, as it is seldom that beds are vacant. Twelve visits were made to the registered common lodging houses during 1937, and the arrangements for disinfection of bedding etc. when occasion arises, which have been adopted for several years, have been continued. OFFENSIVE 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. 41 There is no change to report in the position regarding Rag and Bone Yards. The largest of these premises is situated in Acre Road, and as in the case of the smaller premises, it is situated in fairly close proximity to dwelling houses. An application for permission to extend the Acre Road premises was refused by the Corporation under their Town Planning powers. This refusal was upheld on appeal. Each of the Rag and Bone Yards was in existence at the time when the Corporation obtained an Order declaring the business to be an "Offensive Trade" and the buildings in use are not specially designed for the purpose. The trade is now included as an "Offensive Trade" in the new Public Health Act, 1936, and is controlled by Byelaws. At the end of 1937 there were 15 fried fish shops on the records. The following two applications were received during 1937 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. 270, Tudor Drive—Approved. (2) No. 1, Cranmer Court, Richmond Road—Approved. No complaints were received during the year in respect of offensive trades, and fifty-nine visits were made to the various premises. HOUSE DRAINAGE Thirty-three houses were completely redrained during 1937 and the drains of 7 other premises were repaired or amended to a substantial extent. The examination of drainage systems under the powers conferred by the Public Health Acts is one of the duties which is regarded as most important. These executive duties necessarily absorb a considerable amount of time, but it will be generally conceded that the labour involved is 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. 42 For various 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. (Note. The required new sewer was completed in the early part of the present year). In as many cases as possible where combined drains have to be reconstructed, plans and detailed specifications are prepared on behalf of the several owners free of cost. By undertaking such work it is possible to assure the use of good quality materials and to maintain more complete control over the workmanship throughout. The respective owners give instructions direct to their selected contractors and are responsible for the costs incurred. Premises Redrained The following list gives the situation and numbers of premises redrained during the year:— Birkenhead Avenue 2 Bonner Hill Road 1 Cambridge Grove Road 1 Cambridge Grove Road 2 Cambridge Grove Road 1 Clifton Road 2 Crescent Road 4 Cromwell Road 1 Fairfield South 1 Fassett Road 1 Hawks Road 4 High Street 1 Kings Road 2 London Road 1 Market Place 1 Richmond Road 1 Shortlands Road 1 Surbiton Road 1 43 Vicarage Road 1 Vincent Road 4 Drains Amended (including new branch drains) Cambridge Road 1 Canbury Avenue 1 Crescent Road 1 Deacon Road 1 London Road 1 Park Road 1 Springfield Road 1 COMPLAINTS One hundred and seventy-nine complaints were received during the year, as follows:— Condition of premises 62 Drains and sanitary arrangements 29 Evidence of rats and mice 17 Dampness 12 Accumulations of Refuse 12 Nuisance from Burning Refuse 8 Overcrowding 7 Nuisance from offensive smell 6 Flooding of basement premises 4 Condition of pathways 3 Nuisance from flies 3 Condition of stoves and firegrates 3 Nuisance from smoke or grit 4 Verminous premises 2 Nuisance from cesspool 1 Ant infestation 1 Non-collection of refuse 1 Miscellaneous 4 179 44 The complaints were investigated as early as possible and, where the Corporation possessed powers to intervene, immediate steps were taken to remove the cause of the complaint. HOUSING The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on pages 24, 25 and 26. It will be seen that 526 dwelling houses were inspected under the Public Health or Housing Acts. Of those 526 houses, 123 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 123 houses is set out below:— Bonner Hill Road 1 Cambridge Grove Road 43 Clifton Road 3 Fairfield South 8 Fairfield West 3 Fife Road 1 Franklin Road 5 Grove Crescent 1 Hudson Road 21 London Road 1 Mill Place 2 Park Road 16 Richmond Road 18 Of the 123 houses which were completely surveyed, 22 were found to be in such a state as to be unfit for human habitation. An unfit house which cannot be rendered fit for human habitation at reasonable cost, having regard to the estimated value of the house when repaired, is reported upon with a view to demolition or closing action under Sections 11, 12 and 13, Housing Act, 1936. Twenty-one such houses were reported upon during 1937 as set out below. 45 In addition to two houses in Albert Road demolished in anticipation of formal action, 34 "individual" houses were demolished in 1937, as set forth below:— No. 20 Fairfield North. Nos. 7 and 7a Bellevue Road. Nos. 2, 4 and 6 Burritt Road. Nos. 25 and 27 Fairfield North. Nos. 1, 3, 5, 7, 9, 11, 13, 15 and 17 Florence Road. No. 21 Cowleaze Road. Nos. 1, 2, 3, 4, Swan Cottages, Mill Street. Nos. 1, 2, 3, 4, 5, 6 Fountain Court, Thames Street. Nos. 21, 22, 23, 24, 25 Oaklea Passage. OVERCROWDING Following the survey in connection with overcrowding, to which reference was made in my report for 1936, it is pleasing to be able to record that at the end of 1937, only 11 dwellings were known to be overcrowded in the Borough. 33 cases of overcrowding were relieved during the year, and the number of new cases recorded was 5. Of the 33 cases of overcrowding abated, 12 were in part of the Council's Housing-Estate situate within the Borough boundary, and arrangements were made for the transfer of families from non-parlour to parlour type houses, and it was not necessary for new houses to be built in order to afford relief. In my previous Annual Report, 1 referred to the low percentage of overcrowding (.75%), and your Corporation may recall that I have expressed the view from time to time that the position would be eased very considerably by action on the part of the people themselves, and generally speaking, 1 feel these views have been justified. Situation No. Action Taken Bonner Hill Road 1 house(s) Demolition Order(s) made Florence Road 9 „ „ „ „ Fairfield North 2 „ „ „ „ Hawks Road 3 „ „ „ „ Elm Crescent 1 „ Closing Order made. Fairfield Road 1 „ „ „ „ Grove Crescent 1 „ „ „ „ London Road 1 „ Undertaking accepted. Vicarage Road 2 „ „ „ 46 The overcrowded houses have been revisited from time to time in order to keep before the tenants the need for abatement of the improper conditions. The border-line cases discovered at the time of the original survey were also revisited in order to keep the records of overcrowding up-to-date. It has been found that many of the potential cases of overcrowding did not develop, so as to require action by the Corporation, the tenants themselves having made necessary arrangements to meet altered conditions. The Housing Act also requires an owner of a working class house to insert in the rent book certain particulars, including the permitted number of occupants for the house. The permitted number is ascertained by measurement of the rooms, in accordance with the prescribed schedule to the Act. Up to the 31st December, 1937, 1979 certificates of permitted numbers had been issued to owners. It was necessary to engage temporary labour at the beginning of the year to assist in measuring the houses. WELL WATERS The close surveillance over private water supplies derived from wells has been maintained. Chemical analyses of representative samples were made, and the results showed that the waters in each case were usable. Having regard, however, to the possibility of bacteriological contamination, which might not be disclosed by the ordinary analysis, arrangements were made at the end of the year for a series of samples to be taken for bacteriological examination. The results of these examinations show that in each case the waters are usable, and in the majority of cases the bacteriological counts are remarkably low, with entire absence of harmful organisms. 47 At the end of the year there were 24 premises supplied with water from private wells, but in all probability the actual number of wells is less than the number of premises. The bacteriological examinations of the waters is being continued. INCREASE OF RENT & MORTGAGE INTEREST RESTRICTION 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 1 application was received during 1937, and a certificate was not granted. INSPECTION AND SUPERVISION OF FOOD (a) MILK SUPPLY The register of dairymen was again revised during 1937. Two names were removed either on account of business changes or cessation of business, and 7 fresh entries were added to the Register, leaving a total of 77 on the Register at the end of the year, compared with 72 at the end of 1936. There is only one cowkeeper in the Borough. 48 Six samples of milk were submitted to the Clinical Research Association laboratories for examination. All the samples gave satisfactory results, and it is interesting to record that they were up to the standard of the former designation Grade "A". Biological examinations were made in each case for the presence of tubercle bacilli and negative results were obtained. GRADED MILK LICENCES. There is no licensed producer of graded milk in the Borough, but 31 dealers' licenses (including supplementary licences) were issued during the year. The dealers licences were in respect of the following:— Tuberculin Tested 15 Accredited 1 Pasteurised 15 The designations referred to above are the only ones which may ordinarily be used in relation to graded milk. The title of "Accredited" is introduced for the first time. The conditions for this grade are similar for those prescribed in the Milk (Special Designations) Order 1923 for Grade "A" milk. (b) MEAT AND OTHER FOODS. The total number of animals slaughtered in the Borough was 2807, and compares with 3517 for 1936. I have commented on the decline in local slaughtering in previous reports, but it is probable that the figures will not vary to any great extent in the future. Practically all the animals slaughtered in the town are sold in the local shops, and very little meat is now sent to London or to other districts. There were no contraventions of the Public Health (Meat) Regulations 1924 noted during the year, and a meat marking scheme has not been adopted. 49 All the animals slaughtered in the Borough during the year were examined either at the time of slaughter or before removal from the slaughterhouses. The following table, that has been prepared in the form suggested in the Ministry of Health circular, shows the numbers of carcases inspected and condemned, and follows very closely the manner of presentation of such statistics in previous reports. Cattle exclling Cows Cows Calves Sheep & Lambs Pigs Number killed 10 – 6 283 2,508 Number inspected 10 — 6 283 2,508 ALL DISEASES EXCEPT TUBERCULOSIS Whole carcases condemned – – – – 1 Carcases of which some part or organ was condemned — — — — 20 Percentage of the number inspected affected with disease other than tuberculosis — — — .79% TUBERCULOSIS ONLY: Whole carcases condemned – — – — 1 Carcases of which some part or organ was condemned 1 — — – 57 Percentage of the number inspected affected with tuberculosis 10% — – – 2.27% 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 1,275 visits were made to food premises. 50 UNSOUND FOOD The following is a list of foodstuffs examined and condemned during the past year. PORK— 1 Carcase & Offal Suffocation Inspected & Condemned do. Tuberculosis do. 73 Heads & Necks do. do. 10 Plucks do. do. 12 Plucks Inflammation do. 4 Spleens do. do. 2 Spleens Tuberculosis do. 3 Mesenteric Fats do. do. 2 Livers do. do. 8 Livers Cirrhosis do. 2 Livers Cysts do. 1 Liver Necrosis do. 1 Liver Fatty degeneration do. 1 Liver Inflammation do. 4 Pairs Lungs Pleurisy do. 1 Pair Lungs Pneumonia do. 1 Pair Lungs Tuberculosis do. 2 Kidneys do. do. 2 Hearts Pericarditis do. 4 Pieces Loin Inflammation do. 9½ lbs. Pork Bruised Voluntarily Surrendered BOVINES— 4971bs. Beef Putrefaction Voluntarily Surrendered 1661bs. Beef Fibrosis do. 1731bs. Beef Mould & Putrefaction do. 1031bs. Beef Bruised do. 801bs. Beef Bone Taint do. 1601bs. Ox Kidneys Putrefaction do. 1 Ox Liver do. do. 201bs. Ox Liver do. do. 61bs. Ox Livers Distomatosis do. 121bs. Kidney Suet Putrefaction do. 1 Pair Ox Lungs Tuberculosis Inspected & Condemned MUTTON— 281bs. Mutton Oedema & Inflammation Voluntarily Surrendered 2441bs. Lambs Livers Putrefaction do. 51 MISCELLANEOUS— 2 Chickens Putrefaction Voluntarily Surrendered 8 Salmon do. do. 18 doz. Eggs do. do. 1 Tin Prawns do. do. 141bs. Skate Wings do. do. 6 Turkevs do. do. 491bs. Prunes Mould do. 1 Tin of Tomatoes Blown do. 11 Tins of Mixed Fruit do. do. I would like to draw attention to the reduced incidence of Tuberculosis found in pigs. Although statistics are not available of the actual number found to be infected in previous years, there is not the slightest doubt that the percentage of animals found to be diseased is now much lower than it was a few years ago. When this reduction was first noted, enquiries were made and it was found that the source of supply of pigs in respect of one large establishment had been changed from a market which derived its supply from a dairying district to a market in quite a different part of the country, where probably dairying did not form a stable part of the agricultural industry. The reduction was so marked that the butcher concerned expressed surprise, and naturally satisfaction. Incidentally, it may also be noted that the quality of pigs generally has improved greatly during the past decade. These observations are of course based on local conditions and would not necessarily apply to other parts of the country. The number of cattle slaughtered in the town remains very low. This is due to the proximity of the town to London markets and to the fact that imported beef is brought to wholesale depots in large quantities direct from the docks. PRIVATE SLAUGHTERHOUSES On December 31st, 1937, 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. 52 The first mentioned slaughter-house is the one in principal use, the number of animals slaughtered at the other two being comparatively small. The disused slaughter-house at the rear of No. 45 Cambridge Grove Road has been altered and is now used in connection with business other than slaughtering. 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 1937 there were 8 persons in possession of licences to slaughter animals in the Borough. The spare "Cash" captive bolt pistol which is so kindly loaned to the Corporation by the R.S.P.CA. has proved very useful in cases of emergency when privately owned guns have been out of action. Three hundred and three visits were made to slaughterhouses during the year 1937, compared with 447 during 1936. FACTORIES AND WORKPLACES Two hundred and seventy-two visits were made to factories and workplaces during 1937, compared with 240 in 1936. The results of these inspections are shown in the tables on pages 19 and 20. Factories remain subject to inspection by H.M. Inspector of Factories for all purposes except sanitary accommodation and means of fire escape. Workshop and workplace premises on the other hand are subject to inspection by the Local Authority. The new Factories Act, 1937, which is a consolidating and amending measure, will not come into force until the 1st July, 1938. Under its provisions practically all manufacturing establishments will be embraced, but the old distinctions between a factory and a workshop will be abolished, all such premises being termed " factories." It places more responsibility upon Local Authorities, but it may be welcomed as a mark of notable progress in legislation aimed to secure safety, health and welfare in industry. 53 For many years efforts have been made to cooperate with H.M. Inspector of Factories for this district, with a view to prevention of overlapping and to the keeping of accurate records. DISINFECTION AND DISINFESTATION DISINFECTION. Two hundred and forty-seven visits were made in connection with infectious disease inquiries. The results of the investigations were passed to the Medical Officer of Health. The number of houses disinfected varies from year to year according to the prevalence of infectious disease. During 1937 one hundred and sixty six rooms in one hundred and twenty six houses were sprayed and fumigated with formalin in the case of ordinary infectious disease, but in the case of verminous premises special action as set out below was taken. ERADICATION OF BED BUGS. (1) During the year 1937, forty seven houses were found to be infested with bed bugs, thirty live of such houses being situate on the Council's Housing Estate. All the infested houses were specially treated by methods set out in paragraph 2. (2) The woodwork and mouldings of infested rooms and premises were removed, the exposed surfaces were thoroughly sprayed with Zaldecide, after which the rooms were sealed and fumigated. The fumigant used was produced by Lawes' block disinfestators. Bedsteads and furniture in occupied rooms was also sprayed with Zaldecide the bedding itself being subjected to steam treatment. (3) Special attention was given to rooms and their contents occupied by prospective tenants of Corporation houses. By arrangement between the Housing and Public Health Committees, similar treatment as set out in paragraph 2 above, was applied to these premises. Where necessary disinfestation work was carried out at the time of the removal, and furniture and bedding delivered to the new dwelling house after adequate treatment. (4) The whole work is carried out by local authority. 54 (5) Advice is given to occupiers of houses in the detection of vermin, and eradication methods, and it is suggested that a supply of suitable insecticide should be made available for Council house tenants, in order that they may themselves take prompt measures immediately the least sign of vermin is detected. It is thought that this suggestion may be received favourably by tenants who would prefer, in many cases, to act for themselves, rather than to allow neighbours to learn the condition of the house as the result of action taken by the local authority. SANITARY CONDITIONS OF MUSIC HALLS, CINEMAS, ETC. Thirty visits were made to places of public entertainment during the year. The principal object of these visits is to ascertain the condition of dressing rooms, sanitary conveniences and other parts of the buildings, especially parts such as beneath the stage, where accumulations of rubbish are likely to exist. The ventilation of the premises is important, especially in summer-time, and where natural means of ventilation are depended upon to keep the atmosphere reasonably satisfactory. Visits in connection with ventilation are made at irregular periods and whilst the performances are on, but it is very difficult to obtain reliable information as to the condition of the atmosphere by the "senses" only. CANAL BOATS The administration of canal boats is now incorporated in the Public Health Act, 1936, the whole of the Canal Boat Act, 1884, being repealed, and the greater part of the Canal Boat Act, 1877. Most of the old law has been re-enacted, but there are slight amendments. There is nothing new to report in connection with canal boat traffic on the river. Most, if not all, of the boats are manned by crews with living quarters on shore. It is exceptional on this part of the river to find a boat with living accommodation. The Canal Boat Regulations remain in force, but the annual report on supervision of canal boats is now required by Section 249 of the Public Health Act, 1936. 55 Fourteen visits were made in connection with canal boats during the year. SANITARY CONVENIENCES The conveniences attached to licensed premises in this Borough compare very favourably with similar places in all other towns 1 have visited. Practically all the premises now have glazed slabs or stalls, and the minimum of labour is required to keep the conveniences in clean condition. Comparatively few of the licencees have failed to keep the premises in order. A report upon the condition of the sanitary conveniences is supplied to the Licensing Bench upon request, and the very satisfactory conditions which now exist are due in no small measure to the support and co-operation afforded by the Bench to your Council. SHOPS ACTS—1912 to 1936 Your Sanitary Inspectors are appointed as Shops Inspectors for all purposes of the Acts and not only in respect of sanitary and health provisions contained in the 1934 Act. During the past year the Retail Meat Dealers Shops (Sunday Trading) Act, 1936, and the Shops (Sunday Trading Restriction) Act, 1936, came into force. The former Act prohibits the business of retail dealer in butcher's meat being carried on on Sundays ; the second Act restricts Sunday trading generally, but as with all other Shops Acts, the exemptions and provisos are so numerous that it is doubtful if the intention of the legislature will, in fact, be accomplished. The difficulties in the administration of the Shops (Sunday Trading Restriction) Act, which was so extensively reported in the Press, were not experienced to any considerable degree in this Borough, but the two Acts have jointly added considerably to the duties of Shops Inspectors. During the past year no less than 1249 visits have been made to shops solely in connection with Shops Acts, and it may be accepted that the administration of these Acts in this Borough is well above the average for the whole country. By reason of the various restrictions, the 56 Acts are not popular with all classes of traders neither can it be said that the public as a whole use their best endeavours not to place temptation in the way of business houses. On the other hand, the better class of trader appears to be most anxious to comply with the law, and often the opinion has been expressed that compulsory closing of all shops earlier than the present latest hour on weekdays, and for the whole of Sundays, would be welcome. In this connection it is manifestly unfair that a shop should be required to close one half day per week, when itinerate vendors from other districts may come into the town and sell the very goods that the ratepaying shop-keeper is precluded from selling. So far as can be seen, the only remedy for this anomoly is a general Closing Order on one specified half day per week, instead of as at present, it being left to the individual trader to choose his half day. The difficulty of the half day closing is accentuated in the case of mixed shops, i.e. those premises which need not be closed entirely on any half dav of the week. Many of the occupiers of these shops would welcome a Closing Order, but on the other hand, there are occupiers of smaller shops who would object strongly to enforced closing. These shop keepers are often placed in a difficult position by customers who ask for articles which cannot legally be sold on the half day. Having regard to the complexity of the Shops Act law, one can readily understand the lack of understanding displayed by many shop keepers, and it is felt that the time has arrived when the Shops Laws could be codified and clarified with considerable advantage to everyone concerned. Particular attention was paid during the year to the heating, ventilation and lighting of shops, and many interviews and consultations on these subjects took place. The fact that no legal proceedings were found necessary against any shop keeper during 1937 is indicative of their general desire to co-operate with the Local Authority, and having regard to the large number of shops situate within the Borough, this helpful attitude on the part of the business community is very gratifying. 57 RATS AND MICE (DESTRUCTION) ACT, 1919 Seventeen complaints were received in respect of rat infested premises during the past year. It is to be hoped that these complaints indicate a greater interest on the part of the public in the need for the eradication of this expensive vermin. The accumulative damage and loss occasioned by rats is not generally recognised, and no effort should be spared to destroy them. After careful consideration it was decided not to hold a special Rat Week in the Borough during 1937, but activity in connection with this important matter was continued throughout the year. As must be expected in a Borough as old as this, rats are known to exist in certain of the sewers. These sewers were baited with rat poison periodically with very satisfactory results, large numbers of carcases being observed at the sewer outfall at the Sewage works. In addition to this work, rat extermination was proceeded with at the Refuse Tip, and during the year no less than 474 rats were destroyed on the Tip. The occupiers of infested property are given every assistance and advice regarding rat destruction, but it is to be regretted that neighbours so often decline to co-operate one with another in this object. CONCLUSION I desire to thank you, Mr. Chairman, and the Members of the Public Health Committee and Corporation generally, for your continued consideration and support, and your other Officers who have afforded me assistance and information whenever required. I 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, 1938. 58 Report of the School Medical Officer May, 1938. 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 submit the Annual Report for the year 1937. With the exception of the work done during the month of December, the Report refers to the work carried out by Dr. Matthews and Dr. Olive Aubrey. The form of the report is almost identical with that for 1936. The average number of children on the school register for the year was 3,817. In addition there were 39 children on the books of the Special Open Air School at the end of the year. Medical Inspection, orthopaedic, eye, nose and 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 61% of the school population taking milk at school compared with 60% in 1936 and 20% before the scheme operated. Dr. Matthews resigned the office of School Medical Officer as from 31st August 1937. Dr. Olive Aubrey was appointed Acting School Medical Officer as from 1st September, 1937, and served the Council as such till 30th November, 1937. On 1st December 1937, I became School Medical Officer, 59 On 31st August 1937, Miss Gill resigned office as Senior School Nurse, and on 13th September 1937, Miss Duke was appointed School Nurse. On 1st September 1937, Miss Hookway was appointed Senior School Nurse. I am pleased to acknowledge the good services of all members of the Staff on the occasion of my taking over duties as School Medical Officer and in preparing the material for this report. I am pleased also to acknowledge the helpful collaboration of the Secretary for Education (Mr. Harper), and the Headmasters and Headmistresses of the various schools. I am, Mr. Chairman, ladies and Gentlemen, Your obedient servant, J. W. STARKEY, School Medical Officer. 60 Staff, 1937 School Medical Officer : E. W. MATTHEWS, m.b., b.s. (lond), m.r.c.s., l.r.c.p., d.p.h. (Resigned 31st August 1937. J. W. STARKEY, m.b., ch.b. (edin), d.p.h. (Appointed 1st December 1937.) OLIVE G. AUBREY, b.a., m.d., b.ch. (Acting School Medical Officer, 1st September to 30th November 1937.) Oculist : TVOR AUBREY, M.C., m.r.c.s., l.r.c.p. Dental Surgeon : H. A. L. MORRIS, M.C., l.d.s., r.c.s. (eng). Ancesthetist: OLIVE G. AUBREY, b.a., m.d., b.ch. *Health Visitors and School Nurses : (Senior) Miss C. A. HOOKWAY. Miss A. GILL. (2) Miss L. G. SALWAY. (3) Miss F. I. ARNOLD. (4) Miss M. M. DUKE. * Dental Attendant—Clerk : Mrs. P. M. JEFFCOATE. Clerk : Miss J. E. PARTNER. *The time of the Nurses and Dental Attendant—Clerk is apportioned equally between the School Medical and Public Health Services. 61 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 at Guildhall. SCHOOL HYGIENE Certain improvements were carried out in some of the schools during the year. Bonner Hill Road School. The galleries were removed in all the classrooms in the Infants' Department and one gallery removed in the Junior School. Minor redecorations were carried out and a new sink and stove fixed in the Domestic Subject portion of the school. Richmond Road School. Galleries were removed from the Senior School and a wall was rebuilt adjoining the outside pavilion. The general hygienic conditions of the Schools has benefited by these improvements. MEDICAL INSPECTION All Departments of every School are visited by the School Medical Officer 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. 62 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 Card 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 out. 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. 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. 63 All cases for urgent 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 208 187 89 Girls 168 145 86 Second Age Group Boys 180 120 66 Girls 180 141 77 Third Age Group Boys 251 116 45 Girls 146 69 47 The attendance of parents at routine medical inspections of boys of the Third (leaver) Age Group is always rather poor, and this is to be regretted. The percentage of parents attending with their boys of this third age group is also considerably lowered, because many of the boys come from Dr. Barnardo's Home. FINDINGS OF MEDICAL INSPECTION (a) Malnutrition. There are eleven 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. 64 In addition thirty-seven 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 forty-nine 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. 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 twelve cases during the year, resulting in lines being imposed in nine 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. 65 (d) Visual defects and external eye disease. During the year 74 children were found requiring treatment for defective vision, and 19 for squint. (e) Nose and throat defects. There were 58 children suffering from enlarged tonsils and adenoids referred for treatment. (f) Ear disease and defective hearing. The minor ear diseases have been referred for treatment at the Clinic. Defective hearing is not common in children, except in those suffering from adenoids. (g) Dental defects. At. his inspection the School Dentist found 1,911 children requiring treatment. (h) Orthopaedic and postural defects. Three 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. Two new cases of organic heart disease were discovered this year. Nine 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. 66 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. 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. 67 The following table specifies some of the work carried out by the School Nurses during 1937 Number of children prepared for Routine Medical Inspection 1,223 Number examined at Schools for uncleanliness 13,275 Number of following-up home visits 456 Number of visits to the Schools 435 Number of Clinic Sessions 401 Clinic Sessions—Dental Attendant 177 TREATMENT (a) Minor Ailments and Diseases of the Skin. The treatment of minor ailments and diseases of the skin was undertaken daily at the Clinic during school terms, 6123 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. (c) Nose and Throat Defects. As before, operative treatment of tonsils and adenoids has been 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. 37 cases were treated under this Scheme during the year at a cost of £52 14s. 6d. towards which the parents contributed £6 7s. 6d. (d) Ear Disease and Hearing. Minor ear defects in the cases of 19 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals. 68 (e) Dental defects. Of the 1911 children requiring treatment found by the School Dentist. 992 were actually treated, 774 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 30 sessions were given to inspection at the schools, and 177 to treatment at the Clinic. The programme for the year was similar to that of 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 School—Latchmere Road—were inspected and treated early in the year. The addition of this School brought about a slight increase in the total number of children inspected. It is satisfactory to report a decrease in the number of children found to require treatment and the condition of the mouths of the majority of the children is good. More care appears to be given to mouth hygiene. Pamphlets on the care of the teeth supplied by the Dental Board were distributed. Arrangements were made for demonstrations and lectures to the older children at the schools. There is a definite improvement in the condition of the mouths of the younger children, this, I consider, is due to the pre-school care and attention, the work of the Welfare Centre and the treatment of these children which is now available; Also to the care given to mouth hygiene, the importance of which is always being stressed. The exceptionally good condition of the teeth in the children from Dr. Barnardo's Home, who are resident at the Home, is still maintained. The programme as carried out last year will be continued. In conclusion I should like to thank all concerned for their efficient help and enthusiastic co-operation. H. A. L. Morris. 69 (f) Crippling Defects and Orthopedics. During the year 17 individual children received electrical, massage and other forms of treatment at the Red Cross Curative Post, Norbiton, making 372 total attendances. The cost of the above out-patient treatment amounted to £37 4s., towards which the parents contributed £12 10s. 4d. Six children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment. The total cost of in-patient treatment amounted to £160 17s. 10d. towards which the parents contributed £17 10s.0d. (g) Heart Disease and Rheumatism. Eight children suffering from heart disease are attending the Special Open Air Day School for delicate children They are kept under constant supervision, and instructions are given to parents as to their care. The nine children suffering from Rheumatism are followed-up, and their parents advised as to treatment. INFECTIOUS DISEASE The arrangements previously in force for the notification and intimation of Infectious Disease among school children were continued. A low incidence was maintained throughout the year. Mumps was recorded in April at Richmond Road junior School, Latchmere Road and Bonner Hill Junior Mixed and Infants' Schools. Whooping Cough occurred in May and June at Latchmere Road, St. Paul's and Richmond Road Junior Schools. Chicken Pox occurred in St. Paul's School in December. Scarlet Fever appeared in a few cases at Latchmere Road during November and December. 70 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. School journeys were made by St. Luke's Church Central School for Girls to Derbyshire, and by Bonner Hill Road Central School for Girls to Shanklin, Isle of Wight. Both parties derived great benefit from these visits. 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. Organised games are held during school terms in the various recreation grounds throughout the area. There is no Area Organiser for the Borough. 71 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 61% of the children in attendance were taking School Milk. This is an advance on the previous year, when 60% 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 by the School Medical Officer are weighed regularly and followed-up. In necessitous cases the milk is supplied free, the cost being met from a voluntary fund. CO-OPERATION OF PARENTS, TEACHERS, Etc. From the table given under the heading Medical Inspection it will be seen that the high percentage of parents attending Routine Medical Inspections has been maintained. Parents also attend Dental Inspections in satisfactory numbers. The teachers have been most helpful at Routine Medical Inspections, and have also aided in following-up children brought to their notice by the School Medical Officer, and in seeing that children with defective vision or squint wear their spectacles constantly. A revised list of children who should be wearing spectacles is sent to the Head Teachers every term. The School Attendance Officer is very helpful, particularly in getting children to attend the Clinic when required to do so by the School Medical Officer or Nurses. 72 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 67. 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 bv Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days, when the School Nurses carry out the treatment of minor ailments under the direction of the School Medical Officer. No charge is made, but a box is provided for voluntary contributions. There were 6,123 attendances during the year. 73 (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 435 attendances at the 22 sessions held during the year, 222 being new cases and 273 re-inspections. Refractions numbered 109, 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 reinspected by the School Medical Officer when he visits the School each term. (d) Dental Clinic. During the year five sessions per School Week were devoted to Dental Inspection and Treatment. In all, 30 half-days were given to Inspection and 177 to Treatment. There w ere 426 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 Pubic Elementary School. 74 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 Richmnod 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 is one case of severe epilepsy but four mild cases are attending ordinary Elementary Schools. Thirteen crippled children and eleven suffering from heart disease are attending the Special Open Air Day School. In addition there are eleven delicate children suffering from various defects attending this School. SPEECH TRAINING A class for children suffering from defective speech is held on Monday and Wednesday afternoons. A description of the work was set out in the Annual Report for 1934. Miss Badcock, who is in charge of the Class, reports as follows:— REPORT ON SPEECH TRAINING CLASS, 1937 Between January 1st 1937, and December 31st 1937, twenty one children have been attending the clinic. During that period three children were discharged with normal speech, and two left at the age of fourteen on leaving school. Sixteen children were on the register at the end of the year. 75 The three children who were discharged with normal speech had all been admitted suffering from disordered articulation. In every case the speech was quite unintelligible. The home circumstances varied, one child came from a good home where a careful mother helped him with his exercises, the other two had very little help or encouragement at home. Of the two children who left at the age of fourteen, one had a cleft palate and the other was a stammerer. In both cases the speech had improved to some extent. Of the sixteen children at present attending, thirteen are making satisfactory progress. One boy in particular, who, at the age of eleven was admitted in June suffering from a severe stammer, can now read and speak almost normally. The unsatisfactory progress of the other three children is due, in two cases to continued absence, and in the third to retarded mental development. During 1937, three discharged cases reported at the clinic; one case having been discharged for six months, and two cases having been discharged for a year. In every case the speech was quite normal. 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, 1936 39 No. admitted during 1937 12 No. transferred to ordinary schools 10 No. left school 2 No. on register December, 1937 39 It is satisfactory to note that as stated above ten 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. 76 A mid-day hot meal is provided at a charge of 3d., 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 orthopœdic 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) 150 Special 456 Dental Inspections 28 Found to require treatment 15 Actually treated 5 Orthopaedic Treatment. Residential 2 Non-residential 1 Defective Vision and Squint 6 Cleanliness Surveys 150 Individual children found unclean 1 Sixteen physically defective children received hampers from the Treloar Chidren's Christmas Hamper Fund. On December 22nd the distribution of the hampers was very kindy 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 eighty-three school children over 12 years of age were issued with certificates under the Byelaws permitting their employment. 77 SWIMMING The total number of attendances for instruction made by the Elementary School children to the Kingston Swimming Baths during 1937 was 14,855. In addition 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. 78 STATISTICAL TABLES. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. Entrants 376 Second Age Group — 360 Third Age Group 397 Total— 1,133 Number of other Routine Inspections 161 Grand Total 1,294 B —Other Inspections. Number of Special Inspections 1,405 Number of Re-Inspections 5,978 Total— 7,383 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 32 Second Age Group 23 Third Age Group 32 Total (Prescribed Groups) 87 Other Routine Inspections 22 Grand Total 109 79 TABLE II. A Return of Defects found by Medical Inspection in the year ended 31st december, 1937. Defect ok Disease Routine Inspec. No. of Defects. Special Inspec. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiting to be kept undtr observation but not requiring Treatment. (1) Ringworm, Scalp - - 3 — (2) „ Body — — 13 — Skin (3n Scabies 3 - 21 — (4) Impetigo 3 - 110 — (5) other diseases (non Tb) 6 1 379 7 TOTAL (Heads 1 to 5) 12 1 526 7 (6) Blepharitis - - 9 - (7) Conjunctivitis — 1 17 1 (8) Keratitis — - — — (9) Corneal Opacities — - — — Eye (10) Other Conditions (excluding Defective Vision and Squint) - - 26 - (11) TOTAL (Heads 6 to 10) - 1 52 1 Def've Vision (excl. Sqt.) 45 8 27 1 (12) Squint 15 2 4 - (13) 'Defective Hearing 2 - 2 1 (14) Otitis Media 1 - 1 — (15) Other Ear Diseases 1 2 26 — (16) Chronic Tonsillitis only 20 53 24 1 (17) Adenoids only - 2 7 1 (18) Chronic Tonsillitis and Adenoids 2 2 5 1 (19) Other Conditions 2 - 49 — (20) Enlarged Cervical Glands (non Tb, 2 5 12 — (21) Defective Speech 4 2 8 1 Heart and (Heart Disease (22) Organic 2 — - — Circulation] (23) Functional 1 13 — — V (24) Anaemia 1 — 2 — 80 TABLE II.—continued. (25) Bronchitis 1 4 3 - Lungs (26) I Other nonTb. Diseases 2 8 35 — Pulmonary (27) Definite — — - — (28)Suspected — — - — Non-Pulmo'y(29)Glands — — - — Tuberculosis (30)Bones & Joints — — - — (3l)Skin - — - — (32)Other Forms 1 1 - — TOTAL (Heads 29 to 32) 1 1 - - Nervous (33) Epilepsy - — - - (34) Chorea - - - - System (35) Other Conditions 2 - - - (36) Rickets - - - - Deformities (37) Spinal Curvature 1 - - - (38) other Forms 3 4 4 - (9) Other Defects and Diseases (excl. Defects of Nutrition, Uncleanliness & Dental Diseases) 13 5 289 1 Total 135 113 1,076 15 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 376 84 22.3 255 67.9 37 9.8 — — Second Age Group 360 64 17.8 277 76.9 19 5.3 — — Third Age Group 397 102 25.7 268 67.5 27 6.8 — - Other Routine Inspections 161 48 29.8 110 68.3 3 1.9 — — Total 1,294 298 23.0 910 70.3 86 6.7 — - 81 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 Schools for the partially sighted 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 — — 1 — 1 Physically Defective (a) Tuberculosis 1. Pulmonary — — - — — 2. Non-pulmonary — 3 1 — 4 (b) Delicate 11 15 - — 26 (c) Crippled 6 8 2 — 16 (d) Heart Disease 8 10 — - 18 82 TABLE IV. Return of Defects Treated During the Year Ended 31st December, 1937 Treatment Tables. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table VII 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 1 - l (ii) Other Treatment 2 — 2 Ringworm, Body 11 — 11 Scabies 11 5 16 Impetigo 108 1 109 Other skin disease 349 13 362 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 42 2 44 Minor Ear Defects 16 2 18 Miscellaneous—(e.g., minor injuries, bruises, sores, chilblains, etc.) 233 38 271 Total 773 61 834 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) 108 33 141 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 2 4 6 Total 110 37 147 83 No. of children for whom spectacles were prescribed:— (i) Under the Authority's Scheme 87 (ii) Otherwise 21 Total 108 Mo. of children for whom spectacles were obtained:— (i) Under the Authority's Scheme 72 (ii) Otherwise 21 Total 93 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) (ivl (>) (ii) (iii) (iv) (i) (ii) (iii) (iv) 28 1 8 — 5 - 1 — 33 1 9 — 12 55 (i) Tonsils only, (ii) Adenoids only, (iii) Tonsils and adenoids, (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Total number treated Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Non-residential treatment at an orthopaedic clinic. (iii) Number of children treated. 6 — 17 1 — 6 30 84 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 14 313 316 320 351 311 355 345 308 386 239 Total 3,244 (b) Specials 35 (c) TOTAL (Routine and Specials) 3,379 (2) Found to require treatment 1,911 (3) Actually treated 992 (4) Attendances made by children for treatment 2,110 (5) Half-days devoted to:— Inspection 30 Treatment 177 Total 207 (6) Fillings:— Permanent teeth 1,239 Temporary teeth 163 Total 1,402 (7) Extractions:— Permanent teeth 273 Temporary teeth 1,466 Total 1,739 (8) Administrations of general anaesthetics for extractions 426 (9) Other operations:— Permanent teeth 218 Temporary teeth 223 Total 441 85 Table VI.—Uncleanliness and Verminous Conditions (i) Average number of visits per school made during the year by the School Nurses 15 (ii) Total number of examinations of children in the Schools by School Nurses 13,275 (iii) Number of individual children found unclean 388 (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 . 12