KIN 16 The Royal Boraugh of Kingston-upon-Thames MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER INCLUDING THE Annual Report OF THIS SANITARY INSPECTOR Baker the Printed 40. High Street, Kingston, 3/40. The Royal Borough of Kingston-upon-Thames Annual Reports FOR 1 9 3 8 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. 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) N. SMITH, A.R.S.I. (a), (b). (4) J. A. CUMMINS, (a). 3 Health Visitors and School Nurses : (Senior) Miss C. A. HOOKWAY,S.R.N.,S.C.M.,H.V.Cert. (2) Miss L. G. SALWAY, S.R.N., S.C.M., H.V.Cert. (3) Miss F. I. ARNOLD, S.R.N., S.C.M., H.V.Cert. (4) Miss M. M. DUKE, S.R.N., S.C.M., H.V.Cert. * Dental Attendant—Clerk : Mrs. P. M. JEFFCOATE. Clerks: E. S. HERBERT. Miss D. A. BRIGINSHAW. P. M. DALE. Disinfector: C. BENSON. * Part-time Appointments. (a) Certificates as Sanitary Inspector and Meat and Foods Inspector. (b) Certificate as Smoke Inspector. 4 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. Public Health Department, Guildhall, Kingston-upon-Thames. November, 1939. 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 1938. Circular 1728 (Ministry of Health) as to the contents and arrangement of the Annual Reports of Medical Officers of Health for 1938 requests that the Council will direct the Annual Report of the Medical Officer of Health for 1938 to be drawn upon the lines indicated therein. The circular states also that the Annual Report for 1938 should contain information in regard to the matters specified in Appendix I, set out as far as possible in the order there given, under headings (A) to (F). The form of the Report is of necessity identical with that for 1937. I would like to record my appreciation of the friendly co-operation shewn by my fellow officers, and by the members of the Council. The publication of this Report has been delayed by the preparation for War. The general Public Health and Welfare work of the Corporation, however, has been maintained. I am, Ladies and Gentlemen, Your obedient servant, J. W. STARKEY, Medical Officer of Health. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS (i) General Statistics. Area in Acres 1,390 Population 1938 (Registrar General) 39,790 Number of inhabited houses approx 10,150 Rateable Value—General Rate £512,684 Sum represented by Penny Rate £2,000 Amount of Poor Law Relief £6,183 (ii) Social Conditions. The Borough is still residential in character over the greater part of the area, but many industrial businesses have developed, particularly within recent years. The chief industries in the town are general engineering, motor engineering and construction, aircraft manufacture, building, paint manufacture, works of construction, a brewery, and distributive services. There are, in addition, a few minor industries such as knitted goods, optical accessories, wireless goods, etc., which in the aggregate afford employment to a good number of work-people. I am indebted to the Manager of the Ministry of Labour Employment Exchange, Kingston-upon-Thames for the following information:—At the beginning of 1938 there was a fair amount of unemployment due to slackness in the building trade. Owing to the fact that Kingstonupon-Thames and districts in the immediate vicinity have become built-up areas, operatives in the local building industry have had to rely to a large extent on the rebuilding of business premises, and the building of factories, etc. This difficulty persisted all through the year, and the summer of 1938 particularly was a bad one for all classes of building trade workmen. There was also a considerable amount of unemployment among painters, due it is thought, to a reaction from the Coronation year (1937) when business in house decoration was very brisk. Employment was good for all other trades during the year. 6 General engineering, motor engineering, aircraft construction and their allied trades were almost working to capacity. The distributive trade also was brisk, and unemployment in this category was largely among elderly applicants and married women. The manager of the Employment Exchange comments that there is little scope in this district for married women, either in factory or shop. (iii) Extracts from Vital Statistics of the Year. Live Births— Birth Rate (R.G.) per 1,000 pop. 13.2 Total Male Female Legitimate 487 247 240 Illegitimate 41 20 21 Totals 528 267 261 Still Births— Total Legitimate 15 Illegitimate Total Deaths— Male Female 9 6 15 Total 468 Male Female 243 225 Rate per 1,000 total (live and still) births 27.62 Death Rate (R.G.) per 1,000 pop. 11.76 Death Rate corrected for age and sex constitution, 10.34 per thousand population (factor for correction 0.88, 1931 Census). Deaths from puerperal causes— Deaths Puerperal Sepsis 1 Other Puerperal Causes — Rate per 1.000 total (live and still) births 1.84 Death Rate of Infants under one year of age— All infants per 1,000 live births 43.5 Legitimate infants per 1,000 legitimate live births 41.0 Illegitimate infants per 1,000 illegitimate live births 73.1 Deaths from Cancer (all ages) 92 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 6 7 Birth-Rates, Death-Rates, Analysis of Mortality and Case-Rates for certain Infectious Diseases in the year 1938. England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Res. Pop.) 25,000 to 50,000 at 1931 Census. London Administrative County. Kingston-upon-Thames. Rates per 1,000 Population. Births :— Live 15.1 15.0 15.4 13.4 13.2 Still 0.60 0.65 0.60 0.48 0.37 Deaths :— All Causes 11.6 11.7 11.0 11.4 10.34 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.02 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.04 0.05 0.03 0.06 0.00 Scarlet Fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.00 Diphtheria 0.07 0.07 0.06 0.05 0.07 Influenza 0.11 0.10 0.11 0.06 0.05 Notifications :— Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 2.41 2.60 2.58 2.05 1.53 Diphtheria 1.58 1.85 1.53 1.90 1.80 Enteric Fever 0.03 0.03 0.04 0.05 0.02 Erysipelas 0.40 0.46 0.39 0.46 0.35 Pneumonia 1.10 1.28 0.98 0.98 0.45 Rates per 1,000 Live Births. Deaths under 1 year of age 53 57 51 57 43 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 11.3 8 (iv) Causes of Death. Male Female All Causes 243 225 1. Typhoid and Paratyphoid Fevers 1 — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria 2 1 6. Influenza 1 1 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — 1 9. Tuberculosis of the Respiratory System 11 8 10. Other Tuberculous Diseases 1 — 11. Syphilis 1 1 12. General Paralysis of the Insane, tabes dorsalis 3 _ 13. Cancer, Malignant Disease 47 45 14. Diabetes 5 5 15. Cerebral Haemorrhage, etc. 2 9 16. Heart Disease 66 60 17. Aneurysm — — 18. Other Circulatory Diseases 17 17 19. Bronchitis 1 2 20. Pneumonia (all forms) 9 8 21. Other Respiratory Diseases 3 6 22. Peptic Ulcer 3 — 23. Diarrhoea, etc. (under two years) 4 2 24. Appendicitis 3 2 25. Cirrhosis of Liver — 1 26. Other Diseases of Liver, etc. — 2 27. Other Digestive Diseases 8 5 28. Acute and Chronic Nephritis 6 5 29. Puerperal Sepsis — 1 30. Other Puerperal Causes — — 31. Congenital Debility, Premature Birth, Malformations, etc. 12 3 32. Senility 3 10 33. Suicide 4 5 34. Other Violence 8 6 35. Other Defined Diseases 21 19 36. Causes Ill-defined or Unknown 1 — Special Causes (included in No. 35 above) :— Smallpox — — Poliomyelitis — — Polioencephalitis — — 9 METEOROLOGY, 1938 The following table is compiled from records taken at the Sewage Works, Kingston-upon-Thames. Temperature of Air Highest Lowest Mean Max. Mean Min. Rainfall Inches January 54 32 48 38 2.08 February 57 30 47 36 0.19 March 68 32 59 40 0.31 April 66 31 57 39 0.08 May 76 33 64 46 1.411 June 81 42 75 55 0.465 July 82 49 75 56 1.03 August 87 47 74 57 2.68 September 77 43 68 53 2.15 October 65 34 58 45 2.17 November 65 33 55 45 3.34 December 55 22 44 36 2.93 18.836 The average annual rainfall at Greenwich is about 24£ inches. SECTION B. GENERAL PROVISION OF HEALTH SERVICES (i) Public Health Officers. The Staff of the Public Health Department is as shewn on pages 2 and 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, at Kingston Victoria Hospital. (b) Ambulance Facilities. (1) For infectious cases: Cases removed to Wimbeldon 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 274 accident cases and 199 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 Diarrhoea, the Health Visitors are under instructions to visit the cases and give practical advice as to the best methods of nursing them. If attended by District Nurses the fees may be paid by the Corporation. 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 Mondays (from 2nd May, 1938) Tuesdays & Fridays at 2 p.m. Ante-Natal Clinic School Clinic,Grange Road, Kingston Second, third and fourth Wednesdays, also fifth Wednesday from June 1938, in each month at 2 p.m. Post-Natal Clinic ... School Clinic,Grange Road, Kingston First Wednesday in each month at 2 p.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 third Thursdays in each month at 10 a.m. Orthopaedic Clinic Red Cross Curative Post, Coombe Road, 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 Av., 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 21 registered as practising in the Borough at the end of the year. (b) Maternal Mortality. The investigation into maternal deaths is carried out by the Medical Officer of Health, who addresses confidential reports to the Senior Medical Officer, Ministry of Health, in the form specified by the Ministry. 13 Puerperal Pyrexia. During the year 47 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 Puerperal 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 47 cases nofified, 43 were either admitted to, or already in-patients at, the Kingston County Hospital. None of the cases notified ended fatally. The consultant, Mr. Andrew McAllister, was not summoned during the year. (c) Ante-Natal Services. The Ante-Natal Clinic 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 either free, or at reduced or 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 207 expectant mothers attended, making 789 visits to the Clinic. Forty mothers made post-natal visits to the Clinic. (d) The Infant Welfare Clinic. The Clinic is held at the Health Centre in Grange Road, which was described in the Annual Report for 1931. Meetings are held on Mondays, Tuesdays and Fridays, when Dr. Olive Aubrey and the Medical Officer of Health attended and much valuable help was given by many voluntary workers. 14 During the year there were the following number of attendances :— Attendances Meetings New Cases Total Monday 32 81 1496 Tuesday 51 197 3408 Friday 50 215 3418 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 or less according to the family circumstances. There is an excellent Clothing Stall at which 129 mothers have purchased 320 garments during the year. During the year the sale of National Savings Certificates was continued and was well supported. Baby week was held from 3rd to 9th July. Special announcements were made in the local Churches and Sunday Schools, and the Centre was open to Visitors on Monday, Tuesday and Friday. On July 5th a lecture was given by Councillor King, on " Safety First in Home." The Day Nursery in Canbury Park Road was open daily to visitors. On Friday, July 8th, a Garden Party was given at St. Peter's Vicarage, where the mothers and infants spent a most enjoyable afternoon. The Mayor and Mayoress attended, and an address was given by Councillor Dr. Oldfield. (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. Aubrev acted as anaesthetist. 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:— 86 mothers and 56 infants made 418 attendances. Extractions of permanent teeth 557 Extractions of temporary teeth 216 Filling of permanent teeth 22 Filling of temporary teeth 12 Scalings 18 Dentures supplied 18 Anaesthetics given—General 159 „ „ —Local 7 (f) Tonsils and Adenoids. The scheme is similar to that followed in the School Medical Service, but relates to children under five years of age. 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 three infants received operative treatment before the end of the year. The cases are visited by the Health Visitors on their discharge from Hospital and are later re-inspected by the Medical Officer of Health. (ii) Institutional Provision for Mothers or Children. A large number of women receive in-patient treatment in the maternity wards of the Kingston County Hospital, which is administered by the Surrey County Council. 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 16 The Local Branch Shelter is at No. 18, Richmond Park Road. (iii) Health Visitors. The Health Visitors paid the following number of home visits :— First Visits Total Visits Expectant Mothers 261 403 Infants under one year 517 3089 Children, one to five years — 5085 Incidental and Infectious — 479 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, or more often when necessary. 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. (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 5 new registrations were approved and 3 foster mothers either removed from the Borough or ceased to have charge of infants, so there remained at the end of the year 28 foster mothers in charge of 30 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 502 visits were paid, this work being most satisfactorily carried out by the Health Visitors. 17 (v) Orthopaedic Treatment. Under the scheme for the Orthopaedic Treatment of children under school age at the Kingston, Surbiton and District Red Cross Curative Post, Norbiton, five 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. At the beginning of the year there were two registered Nursing Homes subject to inspection by the Local Authority. They were as follows :— 1. Maternity Home, 197, Park Road. 6 Beds. Kept by Miss Henry. 2. Nursing Home at 24, Albany Park Road. 12 Beds. Kept by Miss Roe. This home accommodates chronic and senile patients. Under the Public Health Act 1936 power of inspection but not of registration are delegated by the Surrey County Council to the Corporation and under this arrangement the Homes were visited from time to time during the year. The home at 197, Park Road was closed in April 1938 owing to the matron leaving the district. 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 Supply of the Metropolitan Water Board. The use of well water was discontinued at six houses during the year, and two further cases were found of houses supplied with water from private wells. 18 The number of premises known to be supplied with water from wells at the end of 1938 was 20, 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 under private enterprise on the Richmond Park Estate. 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 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 remained is burned in the Destructor. (iii), (iv), (v), (vi) and (viii). 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 later 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 (vii) Swimming 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 followed. No school closure has been necessary during the year. Head Teachers are in possession of instructions issued by me with regard to the incubation and exclusion periods of the commoner infectious diseases. INSPECTION OF FACTORIES. The work carried out in connection with the inspection of factories is summarised in tabular form below. Premises Number of Inspection* 3 Written Notices Occupiers prosecuted Factories with mechanical power 164 — Nil Factories without mechanical power 136 — Nil 20 Other premises under the Act (including works of building and engineering construction but not including outworkers' premises 8 Nil Total 308 Nil DEFECTS FOUNI Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness 21 23 — — Ineffective drainage of floors — — — — Overcrowding 1 1 — — Unreasonable temperature 1 1 — — Inadequate ventilattion Sanitary iences Insufficient 2 2 — — Unsuitable or Defective 27 28 — — Not separate for sexes — — — — Other Offences 2 2 — — Totals 54 57 — — 21 OUTWORK IN UNWHOLESOME PREMISES. No action was found to be necessary in connection with the above. Statistics relating to action taken under the Housing Acts have been prepared on lines suggested in Circular 1728 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 1938. 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, 1938 38 Houses 12 2-Bedroom Flats (2) Number of houses erected by private enterprise during the year ended 31st December, 1938 96 Houses 150 Flats (3) Total number of houses for the working-classes erected by the Corporation since March, 1924 770 Houses 68 Flats SECTION D. HOUSING 22 CLEARANCE AREAS. Clearance Area No. of houses in area Date of representation Date oi Clearance Order Date of Compulsory Purchase Order No. of houses vacated at end of 1938. No. of houses demolished at end of 1938. Remarks Made by Council Confirmed by Minister of Health Made by Council Confirmed by Minister of Health No. 1 3 12.10.33 19.12.33 9. 4.34 3 3 — No. 2 3 12.10.33 19.12.33 14. 8.34 - 3 3 — No. 3 3 12.10.33 19.12.33 14. 8.34 3 3 — Canbury 19 30.11.33 27. 2.34 14. 8.34 19 19 — Area "A ' No. 5 Canbury Area "B" 10 8. 2.34 27. 4.34 3. 9.34 (with modifications) — — 2 2 The modified Order excluded 8 houses* 31 9. 1.36 25. 2.36 5. 8.36 (with modifications) — 30 29 The modified order excluded 1 house Canbury Area "C" 5 9. 136 25. 2.36 5. 8.36 — — 5 5 — *These eight houses were closed subsequently during 1938 as the result of an "undertaking" given by the owner under the Housing Acts. INDIVIDUAL HOUSES. SEPARATE TENEMENTS AND UNDERGROUND ROOMS Year(8) 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 1930-1937 149 117 15* 108 7 3 *Four houses in respect? of which an "undertaking" had been given by tne owner were subsequently demolished voluntarily by by the owner, during 1934 1938 31 8 15 9 — — — Total 180 125 30 117+ 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) 614 (b) Number of inspections made for the purpose 711 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 93 (b) Number of inspections made for the purpose 104 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 31 (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 471 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 372 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 42 25 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By Owners 4 (b) By Local Authority in default of Owners Nil 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 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 9* 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 Nil (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil * In addition, "undertakings" were received in respect of fifteen premises, and thirty-four houses were demolished in Clearance Areas. 4. Housing Act, 1936, Part IV., Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 6 (2) Number of families dwelling therein 6 (3) Number of persons dwelling therein 35 (b) Number of new cases of overcrowding reported during the year 27 (c) (1) Total number of cases of overcrowding relieved during the year 32 (2) Total number of persons concerned in such cases 211 (d) Cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for abatement of overcrowding Nil 26 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 45 to 49 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 OR DETERIORATED PROSECUTIONS CONVICTIONS Formal Informal Total Formal Informal Total Milk 39 - 39 6 - 6 - - Butter 3 — 3 - - - - - Lard 1 — 1 - - - - - Tea 2 — 2 — — — - — Cream 2 — 2 — — — - — Sugar 2 — 2 — — — — — Confectionery and Jam 4 - 4 - - - - - Other Articles 5 12 17 1 l 2 - — TOTALS 58 12 70 7 l 8 — — (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. The subject of Nutrition was presented to the general public, school children and mothers attending the Clinics by films, exhibits, posters, pamphlets and talks. 27 The Corporation distributes after medical inspection cheap or free milk to necessitous mothers, infants and school children. SECTION F. INFECTIOUS AND OTHER DISEASES The following table gives a comparative statement of notifications received during the last twenty years :— Year Scarlet Fever Enteric Fever Diphtheria (includingParatyphoid) 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 1938 61 72 1 The table of infectious disease notified during the year shows no alarming features, but exhibits a sharp increase in the number of Diphtheria notifications and an increase in Scarlet Fever notifications. hO 00 Notifiable Diseases during the Year. CASES DEATHS Under 1 year 1—2 2—3 3—4 ,4—5 5—10 10—15 15—20 20—35 35-45 45—65 65 & over Total Cases Notified. Cases admitted to Hospital. Under 1 year 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35-45 45—65 65 & over Total Deaths. Scarlet Fever — 2 1 4 2 32 6 5 8 1 — - 61 46 - - - - - - - - - - - - Nil Diphtheria 1 4 1 5 2 29 18 7 5 — — - 72 71 - - - - - 3 1 - - - — — 4 Enteric Fever - - - - - - - - - - 1 - 1 including Paratyphoid - - - - - - - - - - 1 - 1 1 - - - - - - - - - - 1 - 1 Anterior Poliomyelitis — — — — — — — 2 — — — - 2 2 - - - - - - - - - - - - Nil Puerperal Pyrexia - - - - - - - 5 35 7 - - 47 45 - - - - - - - - - - - - Nil Ophthalmia Neonatorum 2 - - - - - - - - - - - 2 1 - - - - - - - - - - - - Nil Cerebro-Spinal Fever - - - - - - - 1 - - - - 1 1 - - - - - - - 1 - - - - 1 Pneumonia — 1 1 3 1 3 — — 1 2 4 2 18 8 - 1 - - - - - - - - 2 2 5 Erysipelas 1 - - - - 1 1 1 3 2 3 2 14 7 - - - - - - - - - - - - Nil B. Dysenteria (Sonne) 5 4 5 3 3 6 — 2 1 — 2 1 32 31 1 - - - - - - - - - - 1 2 NEW CASES DEATHS Under I year 1—5 5—15 15—25 25—35 35—45 45—55 55-65 55 & over Total Under I year 1—5 5—15 15—25 25—35 35—45 45—55 55—65 55 & over Total Tuberculosis (a) Respiratory M - - - 1 6 3 - 2 - 12 - - - - 3 2 3 3 - 11 F - - - 6 5 - 1 1 1 14 - - - 3 2 2 - 1 - 8 Total - - - 7 11 3 1 3 1 26 - - - 3 5 4 3 4 - 19 (6) Non- M - 2 2 - - - - - - 4 — 1 - - - - - - - 1 Respiratory F - — 1 1 — — — — — 2 - - - - - - - - - — Total - 2 3 1 - - - - - 6 — 1 - - - - - - - 1 29 SCARLET FEVER. There is an increase of ten cases notified over the number for last year. Of the 61 cases, by far the largest number occurred in the 5 to 10 age group, in which 32 were notified. Although 61 cases were notified, only 46 were admitted to Hospital for treatment and there were no deaths. The type of illness was mild. DIPHTHERIA. A sharp rise in the number of cases is noted; seventytwo as compared with 21 the previous year. This figure is higher than for the last seven years and marks a rise which has been periodic during the last 20 years. None of the cases occurred in children who have been actively immunised. The largest number of cases occurred in the age group 5 to 10 years, and the second highest number in the age group 10 to 15 years. There were three deaths in the former age group and one in the latter. All but one of the cases were treated in Hospital. Immunisation against Diphtheria. Dr. D. S. Murray and the Medical Officer of Health carried out the work, which consisted of an initial Schick Test followed in those found positive by three injections of T.A.M. or two injections of Alum Precipitated Toxoid. A posterior Schick Test is done after three months, and if the child is immune, a certificate to that effect is issued. A Re-Test is made after two years. A summary of the work during 1938 is as follows :— Number of sessions 43 Number of attendances 1566 Number of Schick Tests 157 Number of Injections 519 Number of posterior Schick Tests 198 Number of Certificates issued 171 Number of Re-Schick Tests after 2 years 242 Number of readings after Re-Schick 232 Of the 157 cases Schick tested 22 were found to be immune. There were only 4 cases still positive on re-test after treatment and these received two further injections of T.A.M. 30 Number of Pre-School children immunised 62 Number of School children immunised 106 The importance of this work cannot be over emphasised. It is necessary to encourage all parents to have their children immunised and towards this end talk with parents, lectures, films and leaflet propaganda were tried. ENTERIC FEVER. One case of Enteric Fever was notified, and this was complicated by other conditions. The patient died in Hospital mainly from the other medical conditions present, after several weeks treatment. The patient was seen, in consultation, with his own Doctor and no evidence of the source of infection was traced, but all the evidence pointed to it having been contracted outside this district. PNEUMONIA. The number of cases notified was 18, compared with 22 for 1937. PUERPERAL FEVER AND PUERPERAL PYREXIA. Comment on these diseases will be found under Section B of the Report (Maternity and Child Welfare, SubSection 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 1938. Treated Vision Vision Total Notified At Home In Hospital unimpaired impaired Blindness Death 2 l l 2 - - - Arrangements have been made with the London County Council for the reception and treatment of cases of Ophthalmia Neonatorum from the Borough at St. Margaret's Hospital, Kentish Town, N.W.5. The charge is at the rate of 10s. per patient per day. No case was sent to the Hospital under this scheme during the year. 31 CEREBRO SPINAL FEVER. One case was notified during the year. This was a man 27 years old, who was notified from the Kingston County Hospital and who subsequently died of the disease. He was not a resident of Kingston. ANTERIOR POLIOMYELITIS. Two cases of this condition were notified during the year. Both cases occurred in girls aged 15 and 16 years respectively. They were not associated with one another. In one case the evidence pointed to the infection having been contracted in another part of the country where the condition was epidemic at that time. In the other case it was not possible, with certainty to determine the source of infection and the condition was comparatively mild, and a good recovery was made. In the other case the condition was more severe and the paralysis more extensive. Both girls were treated in the first instance in the Isolation Hospital at Wimbledon and later in the Orthopaedic Hospital where they responded well to a lengthy course of specialized treatment. DYSENTERY. Thirty-two cases of Bacillary Dysentery of the Sonne type were notified, all of which were in-patients at the Kingston County Hospital. The disease occurred in patients of all ages and two cases died, one under one year and one over sixty-five. 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. The ratio of non-notified to total deaths is 1 : 21. 32 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 sanatoria, 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. Even when these measures have been applied there is still a great need for more active measures to be taken towards the early diagnosis of new cases. It would appear also that further development of after care work is required because in many instances* the beneficial effects of sanatorium treatment are nullified by the circumstances in which the patients find themselves on return home. Any measures which could be adopted to strengthen the work of the Tuberculosis After Care Committee would be extremely valuable. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASE. Information with regard to these diseases is furnished by the School Nurses, Health Visitors, School Attendance Officers and Teachers. The Medical Practitioners in the Borough also supply much valuable data on occasions. The Sanitary Inspector, Mr. H. T. Perry, reports as follows :— 33 Report of the Chief Sanitary Inspector. To the Mayor, Aldermen and Councillors, Ladies and Gentlemen, I beg to submit the Annual Report on the work carried out by your Sanitary Inspectors during the year 1938, in connection with the various Statutes and Byelaws relating to Public Health in force within the Borough. The present Report is the twentieth annual statement I have had the honour to present to you, and it deals with matters coming within Sections C, D and E of Circular 1728—Annual Reports. The total number of inspections and visits made during the past year was 9646 as compared with 9944 during the year 1937. In the Register of Sanitary Defects, 663 new entries were made, and 578 previous entries were cancelled following upon compliance with notices served. On December 31st, 1938, 493 separate entries remained on the Register, compared with 408 at the end of 1937. Five hundred and fourteen "preliminary" and 51 verbal notices were served during 1938. In 42 instances this informal action did not bring about the desired result and it was necessary to serve "statutory" notices. 34 During the year 506 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 1937 was 565. 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. Sanitary Circumstances (Section C). WELL WATER (Sec. C 1 (i)). In the report for 1937 reference was made to the close surveillance over private water supplies derived from wells, and to the arrangements made at the end of the year for a series of samples to be taken for bacteriological examination. This surveillance was continued during 1938, and after consulation with the Medical Officer of Health, a communication was sent to the owner or occupier of every house where it was known that the water used for drinking or domestic purposes was being obtained from a well. It was pointed out that in all probability the well was of the "shallow" type and accordingly liable to pollution, and it was suggested that the "shallow" well should be discontinued and a new water supply laid on from the M.W.B. mains. Several owners expressed willingness to act on the suggestion made, but in other cases requests were made for further investigation. The following tabular statement indicates the number of samples taken and the results of examination. No. of samples of well water taken during 1938 No. of samples found to be satisfactory or " reasonably safe " No. of samples found to be " not satisfactory " Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological l 13* Nil 12 l l * In addition a sample of tap water from M.W.B. mains was submitted for bacteriological examination and found to be satisfactory. 35 No. of premises known to be supplied with well water at end of 1937 24 No. of further premises discovered during 1938 ... 2 No. of premises where use of well water was discontinued 6 No. of premises on register at end of 1938 20 INSPECTIONS AND VISITS 3 (iii). For convenience of reference the inspections and visits are set out in the following tabular form:— Inspection of Houses, etc. (including complaints) 902 Examination of Drains 349 Re-inspections 2443 Visits to Works in Progress 1818 Factories 308 Cowsheds, Dairies and Milkshops 108 Ice Cream Premises 33 Foodshops and Food Preparing Rooms 544 Infectious Disease Enquiries 255 Markets 169 Slaughterhouses 332 Offensive Trades 42 Common Lodging Houses 17 Canal Boats 19 Theatres, Cinemas, etc. 39 House to House 104 Verminous Premises 105 Bakehouses 50 Smoke Observations 54 Stables and Yards 28 Rats and Mice Destruction 244 Shops Acts 783 Disinfection Station 117 Caravans (Fair Grounds) 6 Housing Act, 1935 (Overcrowding) 195 Housing Act, 1935 (Permitted Numbers) 220 Housing Act Enquiries 173 Miscellaneous Visits 135 Rag Flock Acts 6 Well Water Supplies 48 Total 9646 36 SUMMARY OF SANITARY IMPROVEMENTS. Apart from alterations to drainage systems and the installation of sanitary fittings, there is no statutory requirement that notice of intention to carry out works of repair or maintenance shall be given to the Corporation. The following tabulated statement refers only to recorded works which were supervised by the department. WATER CLOSETS AND SANITARY FITTINGS. W.C. apartments lighted, repaired, or ventilated 44 W.C. apartments cleansed and limewashed 49 New W.C. apartments 17 Ventilated lobby to W.C. apartment 1 New W.C. basins 62 W.C. seats repaired or renewed 33 W.C. flushing tanks repaired or renewed 21 W.C. flush pipe connection repaired 4 New sinks provided 9 Trapped waste pipes fixed to sinks 68 Bath waste pipes trapped 2 Sink waste pipe lengthened 8 Lavatory basins provided 5 Main waste pipes provided 2 Miscellaneous 2 DRAINAGE Number of houses and premises redrained 51 New soil branch drains 4 Surface water drains repaired 2 Drains unstopped or cleansed 6 Manholes provided or repaired 72 New gully traps provided 84 Gratings fixed to gully traps 8 Gully traps unstopped or cleansed 3 Gully curbs repaired or renewed 2 Intercepting traps fixed 19 Fresh air inlet shafts fixed 29 Soil pipes and/or ventilating shafts provided 39 New soakaway constructed 2 37 GENERAL REPAIRS. Rooms repaired and cleansed 346 Walls replastered 163 Sculleries rebuilt 2 Ceilings repaired or renewed 115 Floors and skirtings repaired 89 Windows repaired, renewed or made to open 284 Doors and door furniture repaired or renewed 82 Door and window cills repaired or renewed 57 Firegrates, stoves and flues repaired or renewed 108 Surrounds to fireplaces repaired 13 Coppers repaired or renewed 22 Stairs repaired 9 Handrails fixed to stairs or passage 14 Additional light to stairs and passages 53 Permanent ventilation to rooms 11 Under floor ventilation provided 20 Larders provided 25 Coal stores repaired 3 Roofs repaired or renewed 79 Gutters repaired or renewed 48 Rain water pipes repaired or renewed 27 Rain water pipes disconnected from drains 7 Chimney stacks repointed, etc. 8 New chimney pots provided 5 Walls rebuilt 4 Walls repaired, repointed, etc. 118 Tie rods inserted in walls 2 Damp proof courses constructed 12 Dampness abated 46 Yard paving repaired 20 Yards paved 32 Passages paved 5 Premises painted externally 9 Service water cisterns removed or repaired 7 38 Water supply from main 10 Sites concreted 3 Ashbins supplied 153 Refuse accumulations removed 9 Heating provided in shops 2 Workshops and bakehouses cleansed or repaired 8 Miscellaneous 36 HOUSE DRAINAGE (1 (ii)). Fifty-one houses were completely redrained during 1938, compared with 33 during 1937. In addition the drains of 6 other premises were repaired or amended to a substantial extent. The reconstruction of drains of occupied houses presents problems which are usually nonexistent in the case of new buildings, and constant supervision of the works is required so as to avoid as far as possible inconvenience to the occupiers. In as many cases as possible where combined drainage systems 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. The following list gives the situation and numbers of premises redrained during the year :— Acre Road 10 Albany Park Road 1 Ashdown Road 1 Burritt Road 9 Canbury Park Road 4 Church Street 2 Clarence Street 1 Cromwell Road 2 Dinton Road 1 Gloucester Road 1 39 Grange Road 6 Grove Crescent 1 Hawks Road 2 Market Place 1 Park Road 2 Penrhyn Road 1 Portland Road 2 Union Street 1 Upper Park Road 1 Vincent Road 2 Drains Amended (including new branch drains) :— Fairfield Place 1 London Road 1 Mill Street 1 Orchard Road 1 Richmond Road 1 Queens Road 1 COMPLAINTS. One hundred and seventy-nine complaints were received during the year, as follows :— Condition of premises generally 64 Obstruction of light and air 3 Drains and sanitary arrangements 38 Unsound Food 2 Evidence of rats and mice 15 Dampness 8 Water Supply 2 Accumulations of Refuse 7 Nuisance from Burning Refuse 2 Overcrowding 1 Nuisance from offensive smell 17 Nuisance from animals 3 Flooding of basement premises 4 Fouling of footpath 1 40 Nuisance from flies 1 Nuisance from offensive trade 1 Condition of stoves and firegrates 3 Nuisance from smoke or grit 8 Verminous premises 1 Nuisance from urinal 1 Ant infestation 2 Defective ashbins 3 Miscellaneous 6 193 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. SANITARY CONVENIENCES. A report upon the condition of the sanitary conveniences attached to licensed premises 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 (Sec. C 3 (iv)). 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 783 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. 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 following is a list of the Statutes and Regulations at present in force:— 41 The Shops Act 1912. „ „ 1913. „ „ (Hours of Closing) Act 1928. „ „ Act 1934. „ 1936. The Retail Meat Dealers' Shops (Sunday Closing) Act 1936. The Shops (Sunday Trading Restriction) Act 1936. The Young Persons (Employment) Act 1936. Shops Regulations 1912, 1913, 1934, 1937. Having regard to the complexity of these Acts, with their numerous special provisos and exemptions, it is not surprising that many shopkeepers fail to realize their obligations under the Acts until their attention is directed to particular requirements. There is a real need for the application to Shops Law of the three 'c's'—Consolidation, Codification and Clarification. The fact that no legal proceedings were found necessary against any shopkeeper during 1938, is indicative of their general desire to co-operate with the Local Authority. OFFICES. Offices are now regarded as coming within the scope of the Public Health Act 1936 as workplaces and are subject to inspection. Such matters as cleanliness, ventilation, sanitary conveniences and air space receive particular attention. There are not a great number of these premises in the town but it is intended to inspect all offices as opportunity presents itself. SMOKE ABATEMENT (C 3 (vi)). Eight complaints of alleged excessive smoke or grit were received during the year 1938, compared with four during the year 1937. These complaints were caused by purely local conditions and were investigated and dealt with immediately. The smoke nuisance, however, is not one which knows boundaries, and this Borough may easily suffer from smoke produced in other districts. It is for this reason that the problem can best be dealt with in a regional manner, and it is satisfactory to be able to report that the formation of an Advisory Committee on Smoke Abatement for the Greater London Area was well in hand at the end of the year 1938. (Note.—The Committee has since been formed). 42 DISINFECTION AND DISINFESTATION (C 3 (viii). Two hundred and fifty-five 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 1938, one hundred and eighty-three rooms in one hundred and fifty-one 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 1938, fifty-two houses were found to be infested with bed bugs, twenty-five 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. A blow lamp was applied to the exposed surfaces which were subsequently thoroughly sprayed with Zaldecide. The rooms were sealed and fumigated. The fumigant used was produced by Lawes' block disinfestators. Bedsteads and furniture in occupied rooms was sprayed with Zaldecide, the bedding itself being subjected to steam treatment. (3) Special attention was given to rooms and 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 possible disinfestation work was carried out at the time of removal so that furniture and bedding might be delivered to the new dwelling house after treatment. (4) The whole work is carried out by the Local Authority. (5) Advice is given to occupiers of houses in the detection of vermin, and upon suitable methods of eradication. Disinfested houses are re-visited from time to time with a view to checking re-infestation. 43 HOUSING (Section D). The statistical statement relating to Housing is set out in the manner suggested by the Ministry of Health on pages 24 and 25. It will be seen that 614 dwelling houses were inspected under the Public Health or Housing Acts. Of these 614 houses, 93 were surveyed thoroughly in accordance with the Housing Consolidated Regulations, 1925 and 1932, 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 93 houses is set out below :— Crescent Road 1 Fairfield Road 15 Fairfield West 5 Fassett Road 2 Franklin Road 5 Hampden Road 30 Hawks Road 3 Mill Place 2 Mill Street 1 Park Road 6 Portland Road 16 Southsea Road 1 Victoria Road 6 Of the 93 houses which were completely surveyed, 31 were found to be in an unfit state and in need of substantial repair. 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 of the Housing Act 1936. Of the 31 houses referred to above, action was taken as shown below in respect of 23 houses :— 44 Situation No. Action Taken Crescent Road 1 House(s) Undertaking' accepted Fairfield Road 8 „ „ „ Fairfield Road 7 „ Demolition Orders made Fairfield West 4 „ Undertaking' accepted Fassett Road 1 „ „ „ Mill Street 1 „ Demolition Order made Southsea Road 1 „ ' Undertaking' accepted The remaining 8 were under consideration at the end of the year. During the year 43 houses were demolished, 34 of which formed the greater part of Canbury Clearance areas B and C. The remaining 9 were "individual" houses. The premises demolished are as follows :— 145 Bonner Hill Road. 38 Excelsior Road. 1-7 Spring Cottages, Fairfield Road. Canbury Passage, 2, 4, 6, 8, 10, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27. Canbury Place, 7, 8, 9, 10, 11, 12, 13, 14. Walter Street, 4, 5, 6, 7, 8, 9, 10, 11, 12. OVERCROWDING. Twenty-seven new cases of overcrowding were reported during the year, but of this number, the majority arose as the result of a review of ' border line' cases carried out at the beginning of the year. At the date of the original survey (1935) many cases were noted where the accommodation was so limited that any further growth of the family would result in overcrowding within a few years. These cases were re-visited at the appropriate date but for one reason or another few new cases of actual overcrowding were discovered. This result bears out the view expressed in previous reports that the overcrowding position would resolve itself to a considerable extent by action on the part of the people themselves. Of the 27 new cases, 6 were found on the Housing Estate, and 5 of these 6 cases were relieved, bv transferring the tenants to parlour type dwellings. The remaining case was under consideration at the end of the year. 45 In all, 32 cases of overcrowding were abated during the year and only 6 known cases remained at the end of the year. Certificate of Permitted Numbers. Applications were received during the year from owners of working class houses for certificates showing the permitted number of occupants for the respective properties, and up to the 31st December 1938 a total of 2173 Certificates of permitted numbers had been supplied on request to owners of property for insertion in Rent Books as required by the Housing Act. The object of this requirement was to prevent an owner or tenant from pleading ignorance of the proper number of occupants of a house, but it may have the opposite effect. The knowledge that a house may legally be occupied by an increased number creates a temptation to sublet a house which may not be suitable for occupation by more than one family. INSPECTION AND . SUPERVISION OF FOOD (Section E). (A) MILK SUPPLY. A revision was again made of the register of dairymen during 1938. Eleven names were removed, either on account of business changes or cessation of business, and 12 fresh entries were added to the register, leaving a total of 78 on the register at the end of the year, compared with 77 at the end of 1937. There is only one cow-keeper in the Borough. Twenty-eight samples of milk were submitted to the Clinical Research Association laboratories for bacteriological and biological examination. No. of samples taken during 1938 No. examined for bacterial count, B. Coli and Tubercle Bacilli No. examined for bacterial count and B. Coli (but NOT tubercle Bacilli) Pasteurised Milk Examined and included also in columns 1 and 2 Satisfactorily Pasteurised 28 15 13 3 3 46 It is satisfactory to report that Tubercle Bacilli were not found in any of the samples. In those cases where a positive Coli report was received the dairies were visited and further samples taken after possible causes for the unsatisfactory conditions had been removed. GRADED MILK LICENCES. There is no licensed producer of graded milk in the Borough, but 37 dealers' licences (including supplementary licences) were issued during the year. The licences were in respect of the following:— Tuberculin Tested—17. Accredited—1. Pasteurised—19. (B) MEAT AND OTHER FOODS. The total number of animals slaughtered in the Borough was 2190, compared with 2807 for 1937. 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. All the animals slaughtered in the Borough during the year were examined either at the time of slaughter or before removal from the slaughterhouses, when associated organs were available for inspection. The following table, prepared in the form suggested in the Ministry of Health circular, shows the numbers of carcases inspected and condemned. 47  Cattle excluding Cows Cows Calves Sheep & Lambs Pigs Number killed 17 — 16 372 2,190 Number inspected 17 — 16 372 2,190 ALL DISEASES EXCEPT TUBERCULOSIS Whole carcases condemned — - — — 4 Carcases of which some part or organ was condemned — — — — 22 Percentage of the number nspected affected with disease other than tuberculosis — — — — 1.18 TUBERCULOSIS ONLY Whole carcases condemned - - — — — Carcases of which some part or organ was condemned 2 - — — 67 Percentage of the number inspected affected with tuberculosis 11.76 — — — 3.05 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 1,236 visits were made to food premises. (C) UNSOUND FOOD. The following is a list of foodstuffs examined and condemned during the year. 48 PORK. 2 Carcases and Offal Fevered Inspected & Condemned 1 Carcase and Offal Oedema do. 1 do. Pleurisy & Fever do. 1 do. Suffocation do. 59 Heads and Necks Tuberculosis do. 8 Pairs Lungs Pleurisy do. 7 do. Tuberculosis do. 3 do. Pneumonia do. 2 do. Inflammation do. 2 Hearts Pericarditis do. 5 Plucks Tuberculosis do. 3 do. Inflammation do. 2 Spleens do. do. 2 do. Tuberculosis do. 5 Livers Cirrhosis do. 2 do. Necrosis do. 7 Mesenteric Fats Tuberculosis do. 4ilbs. Smoked Bacon Bone Taint Voluntarily Surrendered BOVINES. 259 lbs. Beef Bone Taint do. 136 lbs. Beef Bruised do. 74 lbs. Beef Fibrosis do. 60 lbs. Beef Mould do. 60 lbs. Beef Abscess do. 33 lbs. Beef Putrefaction do. 44 lbs. Ox Kidneys do. do. 16 lbs. Kidney Blood Stained do. 11 lbs. Bones & Kidney Melanosis do. 5 lbs. Kidney Fat Infiltrated with Blood do. 9 lbs. Beef Suet do. do. 8 lbs. Beef Suet Putrefaction do. 2 Pairs Lungs Tuberculosis Inspected & Condemned 1 Head and Tongue do. do. MUTTON. 1 Lamb's Carcase (25 lbs) Brine Stain Voluntarily Surrendered 5 lbs. Lamb Bruised do. 5 lbs. Mutton do. do. 415 lbs. Lambs' Livers Putrefaction do. MISCELLANEOUS. 3 doz. Eggs Putrefaction Voluntarily Surrendered 2 Tins (60 lbs.) Frozen Egg Yolks do. do. 3 Tins Hungarian Whole Eggs (99 lbs.) do. do. 13 Stone Dog Fish do. do. 1 Stone Skate Wings do. do. 2 Boxes Plaice do. do. 6 lbs. Corned Beef do. do. 84 Pears do. do. 49 PRIVATE SLAUGHTERHOUSES. On December 31st, 1938, there were three private slaughterhouses in use in the Borough. They are situated as follows:— Adjoining No. 76, Cambridge Road. Rear of No. 120, London Road. Rear of No. 34, Richmond Road. The first mentioned slaughter-house is the one in principal use, the number of animals slaughtered at the other two being comparatively small. 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 1938 there were 9 persons in possession of licences to slaughter animals in the Borough. The spare "Cash" captive bolt pistol which is so kindly loaned to the Corporation by the R.S.P.C.A. has been in request on several occasions when privately owned guns have been out of action. Three hundred and thirty-three visits were made to slaughter-houses during the year 1938 compared with 303 during 1937. FACTORIES AND WORKPLACES Three hundred and eight visits were made to factories and workplaces during 1938, compared with 272 in 1937. The results of these inspections are shown in the tables on pages 19 and 20. The new Factories Act 1937, which is a consolidating and amending measure, came into force on 1st July 1938. Under its provisions practically all manufacturing establishments are classed as factories. The old distinction between a factory (where mechanical power is employed) and a workship (where no mechanical power is used) is abolished, but responsibility of the Local Authority is limited mostly to non-mechanical factories. The Act has added considerably to the duties of local authorities, especially in this Borough where there are many factory premises. 50 From time to time consultations are arranged with H.M. Inspector of Factories for this district, with a view to close co-operation. 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. At the end of 1938 there were 15 fried fish shops on the register. One application was received during 1938 for permission to commence the trade of fish frying at Surbiton Road. The application was not approved. One complaint was received during the year with regard to alleged sorting of rags at a private house. The complaint was well founded and action was taken to cause the practice to cease. The rags were subsequently disposed of to a Registered Dealer. RAG FLOCK REGULATIONS 1912 These Regulations are aimed at the prevention of the use in bedding and upholstery of rag flock which does not comply with the required standard of cleanliness. Visits are made to the various workshops where rag flock is used, and during 1938 one sample of flock was taken. The analysis showed that the flock conformed to the standard. THEATRES, CINEMAS, etc. Although there is no specific statutory duty upon the Local Authority to keep theatres and places of public entertainment under supervision from the hygienic point of view, a circular issued by the Ministry of Health some years ago requested Local Authorities to arrange for periodical inspection of these premises, and that special regard should be paid to the ventilation, condition of dressing rooms, sanitary arrangements, etc. 51 In the event of any unsatisfactory conditions being not remedied, a report would be passed to the County Council, as the Licensing Authority, for their consideration. It has not been necessary to take any such action in the case of theatres or cinemas in the Borough. It should be noted that visits are made during performances as well as in the morning when cleaning is in progress. 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. Seventeen visits were made td the registered common lodging houses during 1938, and the arrangements for disinfection of bedding, etc., when occasion arises, which have been adopted for several years, have been continued. 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, together with 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 in use. 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. 52 Twelve visits were made in connection with canal boats during the year. RATS AND MICE (DESTRUCTION) ACT, 1919 Fifteen complaints were received in respect of rat infested premises during the year. Amongst a comprehensive Public Health exhibit in the Civic Festival Week exhibition, was one dealing with the rat problem, and it received considerable attention from visitors, many of whom subsequently sought further information and advice from the department. The policy of baiting the public sewers was continued with satisfactory results. The Corporation properties also were dealt with throughout the year, thus showing an excellent example to property owners in the Borough. CONCLUSION I desire to offer my thanks to the Chairman and Members of the Public Health Committee and Corporation generally, for their continued consideration and support, and to the 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. 53 Report of the School Medical Officer. November, 1939 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 1938. The form of the report is identical with that for 1937. The average number of children on the school register for the year was 3,440. In addition there were 45 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. For the first time during the year a new age group of boys and girls was specially included in the medical inspection programme when leavers, i.e., aged 14 years, were medically inspected before leaving school to enter employment. 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 75% of the school population taking milk at school compared with 61% in 1937 and 20% before the scheme operated. 54 I have pleasure in acknowledging the good services of all members of the Staff throughout the year. I am pleased also to acknowledge the helpful collaboration of the Chairman and members of the Elementary Education Sub-Committee, also 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. 55 Staff, 1938. School Medical Officer: J. W. STARKEY, m.b.,ch.b.(edin.), d.p.h. Oculist: IVOR AUBREY, M.C., m.r.c.s., l.r.c.p. Dental Surgeon : H. A. L. MORRIS, M.C., l.d.s., r.c.s. (eng.). Anaesthetist: OLIVE G. AUBREY, b.a., m.d., b.ch. *Health Visitors and School Nurses: {Senior) (1) Miss C. A. HOOKWAY. (2) Miss L. G. SALWAY. (3) Miss F. I. ARNOLD. (4) Miss M. M. DUKE. * Dental Attendant—Clerk : Mrs. P. M. JEFFCOATE. Clerks: Miss J. E. PARTNER. Miss M. E. GOODSPEED. *The time of the Nurses and Dental Attendant—Clerk is apportioned equally between the School Medical and Public Health Services. 56 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 The general condition of the schools is improving : further improvements, in washing, sanitary and cloakroom accommodation is called for. A programme of works is being carried out towards this end. 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 7-8. (c) Third Age Group, age 11-12. (d) Leaver Group, children leaving School on the current term, aged 14 years. 57 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 tthe 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. 58 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 Percentage Entrants: Boys 204 181 89 Girls 178 142 79 Second Age Group: Boys 197 139 71 Girls 200 157 79 Third Age Group: Boys 142 47 33 Girls 192 101 52 Leaver Age Group: Boys 208 14 7 Girls 182 45 23 The attendance of parents at routine medical inspections of boys of the Third and Leaver Age Groups is always rather poor, and this is to be regretted. The percentage of parents attending with their boys of these age groups is also considerably lowered, because many of the boys come from Dr. Barnado's Home. FINDINGS OF MEDICAL INSPECTION (a) Malnutrition. There are 17 delicate children who show varying degrees of faulty nutrition attending the Open Air Day School, where they receive a good hot mid-day meal and milk in the morning and afternoon. 59 In addition 214 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 158 attending ordinary Elementary Schools the milk has been supplied free. The cost of this has been met from the rates since 1st June, 1938. Previous to this voluntary funds were available. (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. (c) Minor ailments and diseases of the skin. The number of minor ailments has remained fairly constant in recent years. The were only five cases of ringworm of the scalp. 60 (d) Visual defects and external eye disease. During the year 77 children were found requiring treatment for defective vision, and 9 for squint. (e) Nose and throat defects. There were 110 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 1,835 children requiring treatment. (h) Orthopaedic and postural defects. No 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. Six new cases of organic heart disease were discovered this year. Six children were recorded suffering from rheumatism in some form and followed-up. (j) T uberculosis. No 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. 61 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. 62 The following table specifies some of the work carried out by the School Nurses during 1938 :— Number of children prepared for Routine Medical Inspection 1,642 Number examined at Schools for uncleanliness 13,041 Number of following-up home visits 658 Number of visits to the Schools 486 Number of Clinic Sessions 424 Clinic Sessions—Dental Attendant 184 Visits to School—Dental Attendant 40 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, 6798 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 106 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. 36 cases were treated under this Scheme during the year at a cost of £51 6s. Od. towards which the parents contributed £8 12s. Od. (d) Ear Disease and Hearing. Minor ear defects in the cases of 40 children have been treated at the Clinic; other ear diseases and deafness were referred to private practitioners and hospitals, 63 (e) Dental defects. Of the 1835 children requiring treatment found by the School Dentist, 1025 were actually treated, 841 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 29 sessions were given to inspection at the schools, and 182 to treatment at the clinic. The programme for the year was similar to that of the previous years 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 additional gas sessions were beneficial in enabling me considerably to reduce the waiting list and complete treatment sooner, for these children. The efforts to stimulate the persistent refusals to accept treatment resulted in some measure of success, unfortunately in the majority of these cases the teeth are too badly decayed to permit of any treatment except extractions, but this of course is beneficial to the child by removing possible sources of infection. This factor is accountable for the increase in the number of teeth extracted during the year, together with the additional gas sessions. There was a decrease in the number of children inspected, due I think, to removal to the new estates outside the Borough, but I anticipate the numbers, in this respect, now remaining steady. It is interesting to note that the Entrants group remains steady. I did not notice any appreciable difference in the conditions of the mouths and teeth in general from last year, but there is a vast improvement now, than from the earlier inspections. 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. 64 (f) Crippling Defects and Orthopaedics. During the year 11 individual children received electrical, massage and other forms of treatment at the Red Cross Curative Post, Norbiton, making 151 total atttendances. The cost of the above out-patient treatment amounted to £15 2s. Od. towards which the parents contributed £7 7s. 7d. Four children were admitted to St. Vincent's Orthopaedic Hospital, Eastcote, for in-patient treatment. The total cost of in-patient treatment amounted to £105 18s. 6d. towards which the parents contributed £1 0s. Od. (g) Heart Disease and Rheumatism. Eleven children suffering from heart disease are attending the Special Open Air Day School for delicate children. They are kept under constant supervision, and instructions are given to parents as to their care. 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. An epidemic of Measles was experienced from February to May. No serious epidemics were experienced throughout the year. 65 OPEN AIR EDUCATION (a) Playground Classes. In summer, classes are held in the playground whenever possible at every School. (b) Open air classrooms. 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. A school journey was made by St. Luke's Church Central School to North Wales, with great benefit to all concerned. 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 Arrangements are now in force whereby the services of two County Physical Training Organisers are available within the Borough. 66 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 75% of the children in attendance were taking School Milk. This is an advance on the previous year, when 61 % 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 of cost by the Education Authority. 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 Inspection 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. 67 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 convalesence 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 59. SCHOOL CLINIC The School Clinic in Grange Road was described in detail in the Annual Report for 1931. (a) Inspection Clinic. The School Medical Officer holds his Inspection Clinic on Tuesday and Friday mornings during School terms, when he sees children referred to him by Nurses, Teachers, School Attendance Officers, etc., advising as to their treatment and disposal. He also re-inspects children previously excluded from School by him, and also those under treatment for minor ailments. (b) Minor Ailments Clinic. The Clinic is open at 9.15 a.m. on week-days, when the School Nurses 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 6,798 attendances during the year. 68 (c) Ophthalmic Clinic. Dr. Ivor Aubrey, the School Oculist, attends fortnightly on Thursday mornings 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 419 attendances at the 23 sessions held during the year, 220 being new cases and 199 re-inspections. Refractions numbered 109, and spectacles were prescribed in 106 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, 29 half-days were given to Inspection and 184 to Treatment. There were 530 gas cases during the year. Dental Board leaflets on the Care of the Teeth are distributed to all children shortly before they leave school. DEFECTIVE CHILDREN Exceptional children are brought to the notice of the School Medical Officer by the School Nurses, Health Visitors and Attendance Officers. The Teachers are invited to bring any children they consider defective before the School Medical Officer. If suffering from a physical defect, they are admitted to the Special Open-Air Day School if considered unsuitable to attend an ordinary Public Elementary School. 69 There is no Special Day School for mentally defective children. There are special classes for retarded children at Bonner Hill Road Infants' School, where instruction is based upon the Montessori System, at the Junior Mixed and Central Girls' and also at Richmond Road Central Boys' School. Very backward and feeble minded children in the Borough are transferred to these special classes on the recommendation of the School Medical Officer. There is one feeble minded child at a Certified School for Mentally Defective Children. There is one deaf child at a Certified School for the Deaf. There is one partially sighted child attending a Certified School. Four mild cases of epilepsy are attending ordinary Elementary Schools. Fourteen crippled children and eleven suffering from heart disease are attending the Special Open Air Day School. In addition there are seventeen delicate children suffering from various defects attending this School. SPEECH TRAINING A class for children suffering from defective speech is held on Monday and Wednesday afternoons. A description of the work was set out in the Annual Report for 1934. Miss Badcock, who is in charge of the Class, reports as follows:— REPORT ON THE SPEECH CLINIC FOR 1938 Betwen January 1st 1938 and December 31st 1938, thirty-one children have attended the Speech Clinic. Two of these children left the clinic on attaining school leaving age, one left the district, and six were discharged and returned to their schools with normal speech. Twenty-two children were left on the register at the end of the year. 70 Of the thirty-one children who have attended during 1938, twelve have been stammerers, and the remaining nineteen suffering from varying forms of disordered articulation. Where mental retardation accompanies the speech disorder, as has been the case with five of these children, progress is slow, but at the end of 1938, all twenty-two children then attending were showing improvement. Since the Speech Clinic opened in April 1934, twentyfive children have been discharged and returned to their schools speaking satisfactorily. After each child has been discharged for a period of six months or more, he is notified to attend the speech clinic again for re-inspection in order to ascertain that his progress has been maintained, and that the condition of the speech remains satisfactory. Thirteen children have been re-inspected up to date, and in eleven of these the speech has remained quite satisfactory, and the other two relapsed. Of these, one child who had been admitted to the Clinic on account of his very undeveloped speech, and who had been discharged after six months treatment speaking normally, developed fits a few days after discharge, and six months later began to stammer. He has been readmitted to the Speech Clinic and is still attending. The other was a case of a stammerer who is in the unfortunate position of living amongst stammering brothers and sisters, so that she finds it very difficult to control her own speech while hearing the rest of her family stammering around her. A question which is frequently asked in the Speech Clinic is " How long does it take to cure a child's stammer?" It is impossible to state any definite period, as the length of treatment required depends on the intelligence and emotional condition of the stammerer, on environmental circumstances, and on the ability and willingness of the parent or guardian to co-operate with the speech therapist. In the treatment of any kind of speech disorders, the most tedious time, is that stage in which the patient having learnt to speak correctly, though not spontaneously, is now learning to put his newly acquired speech into normal every day life. It is during this period that the sympathetic and intelligent help of parents and teachers is invaluable. 71 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, 1937 39 No. admitted during 1938 16 No. transferred to ordinary schools 3 No. left school 5 No. on register December, 1938 47 It is satisfactory to note that as stated above three children were rendered fit to return to ordinary Public Elementary Schools. The children receive morning and afternoon milk, the cost of which in necessitous cases is met by a voluntary fund. A 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 once each term, and certain individual cases more frequently as circumstances require. Dental inspection and treatment was carried out during the year, and children needing orthopaedic treatment attend the Red Cross Curative Post, Norbiton, under the visiting Orthopaedic Specialist. The following is a brief summary of the work carried out in this Special School:— Medical Inspections: Regular 104 Special 402 Dental Inspections 33 Found to require treatment 21 Actually treated 6 Orthopaedic Treatment: Residential — Non-residential 2 Defective Vision and Squint 7 Cleanliness Surveys 264 Individual children found unclean 2 72 Fourteen physically defective children received hampers from the Treloar Children's Christmas Hamper Fund. On December 22nd the distribution of the hampers was very kindly made by the Mayor and Mayoress at the Open Air School. EMPLOYMENT OF CHILDREN The School Medical Officer examines all applicants and issues certificates as to their physical fitness. During the year forty-two school children over 12 years of age were issued with certificates under the Byelaws permitting their employment. SWIMMING The total number of attendances for instruction made by the Elementary School children to the Kingston Swimming Baths during 1938 was 19,005. 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. 73 STATISTICAL TABLES. TABLE I, RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups. Entrants 382 Second Age Group 397 Third Age Group 334 Total 1,113 Number of other Routine Inspections 536 Grand Total 1,649 B.—Other Inspections. Number of Special Inspections 1,796 Number of Re-Inspections 6,275 Total 8,071 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). Group For defective vision (excluding squint). For all other conditions recorded in Table II A. Total Entrants l 55 56 Second Age Group 14 25 39 Third Age Group 16 13 29 Total (Prescribed Groups) 31 93 124 Other Routine Inspections 20 33 51 Grand Total 51 126 175 74 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1938. Defect or Disease Routine Inspec. Special Inspec. No. of Defects. No, of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring T reatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Skin (1) Ringworm, Scalp – – 6 – (2) Body – – 8 – (3) Scabies l – 17 – (4) Impetigo 4 – 71 – (5) Other Diseases (Non-Tub.) 7 l 363 – TOTAL (Heads 1 to 5) 12 l 465 – Eye (6) Blepharitis 1 l 15 – (7) Conjunctivitis 2 — 25 – (8) Keratitis — — – – (9) Corneal Opacities — — – – (10), Other Conditions (exclud. Def've Vision and Squint) 3 — 36 – TOTAL (Heads 6 to 10) 6 l 76 Ear (11) Def've Vision (exc. Squint) 51 6 26 – (12) Squint 5 1 4 – (13) Defective Hearing 3 2 3 (14) Otitis Media – 2 – – (15) Other Ear Diseases 7 3 40 1 Nose & Throat (16) Chronic Tonsillitis only 43 100 39 5 (17) Adenoids only – 4 4 — (18) ChronicTonsil.& Adenoids 4 4 20 1 (19) Other Conditions 6 2 118 1 (20) Enarged Cervical Glands(non-Tb) 46 67 46 3 (21) Defective Speech 2 1 8 – Heart Disease: Heart and Circulation (22) Organic 6 4 – – (23) Functional 2 12 2 — (24) Anaemia 53 3 6 — 75 TABLE II—continued. Lungs (25) Bronchitis – 2 4 — (26) Other Non-Tub. Diseases 3 1 6 — Pulmonary:— — Tuberculosis (27) Definite – – – – 28) Suspected – 1 – – Non-Pulmonary:— – (29) Glands – – 1 – (30) Bones and Joints – – 1 – (31) Skin – – – – (32) Other Forms – – – – TOTAL (Heads 29 to 32) – – 2 – Nervous System (33) Epilepsy 1 1 – – (34) Chorea – – 1 – \ / (35) Other Conditions 1 1 1 – Deformities (36) Rickets 2 1 – – (37) Spinal Curvature – 1 – – (38) Other Forms 2 4 3 – (39) Other Defects and Diseases (excl. Defects of Nutrition,Uncleanliness and Dental Diseases) 22 7 461 3 Total number of defects 277 232 1335 14 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 382 45 11.8 301 78.8 36 9.4 - - Second Age Group 397 53 13.4 300 75.5 44 11.1 - - Third Age Group 334 53 15.8 229 68.6 52 15.6 - - Other Routines Inspections 146 13 8.9 108 74. 25 17.1 - - 14 year old 390 83 21.3 281 72. 26 6.7 - - Total 1,649 247 15. 1219 73.9 183 11.1 - - 76 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 Physica0lly Defective (a) Tuberculosis 1.—Pulmonary — — 1 — — 1 2. Non-Pulmonary 4 5 1 — 10 (6) Delicate 17 11 4 — 32 (c) Crippled 3 — — 1 4 (d) Heart Disease 11 — — — 11 77 TABLE IV. Return of Defects Treated During the Year Ended 31st December, 1938. Treatment Tables. Group I Minor Ailments (excluding Uncleanliness, for which see Table VI). Disease or Defect. Number of Defects treated, or under treatmenr during the year. Under the Authority's Scheme Otherwise Total Skin—Ringworm, Scalp— (i) X-Ray Treatment. If none indicate by dash l — l (ii) Other Treatment 5 — 5 Ringworm, Body 8 — 8 Scabies 16 l 17 Impetigo 68 — 68 Other skin disease 344 1 345 Minor Eye Defects—(External and other, but excluding cases falling in Group II.) 71 — 71 Minor Ear Defects 32 l 33 Miscellaneous—e.g., minor injuries bruises, sores, chilblains, etc.) 347 19 366 Total 892 22 914 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) ... 126 29 155 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 16 3 19 Total 142 32 174 78 No. of children for whom spectacles were prescribed:— (i) Under the Authority's Scheme 106 (ii) Otherwise 26 Total 132 No. of children for whom spectacles were obtained:— (i) Under the Authority's Scheme 100 (ii) Otherwise 26 Total 126 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment, Received other forms of Treatment. Total number treated, Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme. Total (1) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 18 70 29 1 16 — 4 — 2 — 33 1 18 (1) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and throat. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme (1) Otherwise. (2) Total number treated. Residential treatment with education. Residential treatment without education. Non-residential treatment at an oithopaedic clinic. Residential treatment with education. Residential treatment without education. Non-residential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated. 4 — 11 11 l 11 16 79 TABLE V. Dental Inspection and Treatment. (1) Number of children who were inspected by the dentist, (a) Routine Age Groups Age 5 6 7 8 9 10 11 12 13 14 281 336 332 347 355 355 270 341 296 219 Total 3,132 (b) Specials 71 (c) TOTAL (Routine and Specials) 3,203 (2) Found to require treatment 1,835 (3) Actually treated 1,025 (4) Attendances made by children for treatment 2,027 (5) Half-days devoted to:— Inspection 29 Treatment 184 Total 213 (6) Fillings:— Permanent Teeth 1,200 Temporary Teeth 175 Total 1,375 (7) Extractions:— Permanent Teeth 402 Temporary Teeth 1,572 Total 1,974 (8) Administrations of general anaesthetics for extractions 530 (9) Other Operations:— Permanent Teeth 239 Temporary Teeth 212 Total 451 80 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 13,041 (iii) Number of individual children found unclean 342 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 (v) Number of cases in which legal proceedings were taken: (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —