WIM042 19/3 Borough of Wimbledon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT of the medical Officer of Health for the YEAR ENDED 31st DECEMBER, 1913. PUBLIC HEALTH COMMITTEE, 1913. Chairman. Councillor G. H. Odell. Vice-Chairman. Councillor beatrice McGregor, M.B. Members. The Mayor (Alderman E. L. McSheehy). Alderman J. Brasier. Councillor S. R. Collier. „ G. Clement. „ W. N. Peel. Councillor J. S. H. Abbott. „ A. J. Penny. „ J. Buckley. STAFF. Clerks. Mr. A. S. Allen. Mr. E. Partridge. Inspectors. *† Mr. R. T. Avis. * Mr. D. H. pickard. *† Mr. d. F. S. Flynn. Chief Inspector. *† Mr. Henry Johnson. Health Visitor. *§ ||¶H Miss F. Hulse. Medical Officer of Health and School Medical Officer. Elwin H. T. Nash, D.P.H. * Certificate of the Royal Sanitary Institute for Inspector of Nuisances. † Certificate of the Royal Sanitary Institute for Inspector of Meat and other Foods. § Certificate of the Central Midwives Board. || Certificate of the Royal Sanitary Institute for School Nurse and Health Visitor. ¶ Certificate of University College, Liverpool, for Sanitary Knowledge. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Gentlemen, As required by the General Orders of the Local Government Board of December, 1910, I beg to present my fifth Annual Report for the year 1913. The statistics, though not so satisfactory as last year, which was the best year on record, are still very good. There is an increase in the nett death-rate, but much of this is due to the large number of transferable deaths which have been credited to this district, namely, 154. By referring to Table I. it will be seen that whereas before the new arrangement the deaths of residents not registered in the district which were credited to Wimbledon were 71 in 1908, 64 in 1909, and 49 in 1910, since then the figures have been, in 1911, 119; in 1912, 119; and in 1913, the year under report, 154. By referring, however, to column 6, Table I., it will be seen that the death-rate for the district proper is 8.6, which is extremely satisfactory. The Zymotic death-rate is 1.28, there being 75 deaths notified under this heading, which is 42 more than last year. The returns of vital statistics and infectious diseases drawn up on forms supplied by the Local Government Board are appended in Tables I., II., III., and IV. Physical Features and General Characteristics of the District.—The district is wholly situated on London clay. In the higher portions of Wimbledon Common and the district surrounding, the clay is capped with gravel, which seldom attains a depth of more than eight feet. The gravel covers a considerable area, roughly speaking about 800 acres. Beds of sand are met with in South Wimbledon, which are shallow, not more than three feet deep, and are simply the filling in of pot holes. The clay is covered with an alluvial deposit along the valley of the Wandle and the extreme southern portion of Cottenham Park. The underground water on the low-lying ground near the Wandle is only materially altered by flooding, and is very close to the surface, so much so that special bye-laws are made controlling the erection of houses in this district. On 3 the higher ground the variation in underlying water in the gravel beds on Wimbledon Common is about live feet between extreme dry and wet periods. The lowest portion of the Borough is along the valley of the Wandle, which is 44 feet above sea level, and the higher part round and on Wimbledon Common is 183 feet above sea level. Population.—The calculations for the deaths and other rates in the Tables of this Report are based on an estimated population at the middle of the year of 58,156, which is the figure obtained from the Registrar-General, based on the Census. Area.—The area of the Borough (exclusive of the area covered by water) is 3,173 acres, and the density of the population is 17.5 per acre. Population, Birth and Death Rates for each Ward, 1913. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.19 10628 16.6 8.8 St. John's 4.68 5365 8.9 9.1 Cottenham Park 4.34 6969 14.2 9.6 North Wimbledon 4.34 22962 14.1 9.1 Dundonald 4.11 7684 18.6 11.1 Trinity 4.59 11878 26.01 13.2 South Park 4.36 15632 21.7 11.1 South Wimbledon 4.25 35194 22.5 11.8 Whole District 4.36 58156 19.1 10.7 Births.—The number of births registered was 1,084 (547 males, 527 females), which is 18 less than last year, and equal to a birth-rate of 18.6, which shows a decrease on last year's figure (19.4), and which is 2.6 below the average for the previous five years. The corrected birth-rate, however, produced by transferable births, notified to us by the Registrar-General is 19.1. The corresponding rate for England and Wales for the same period is given as 23.9 in the report of the RegistrarGeneral. 4 The rates for the respective Wards of the district were as follows:— St. Mary's 16.1 St. John's 8.01 Cottenham Park 13.4 Dundonald 17.9 Trinity 25.5 South Park 21.3 As will be seen from the birth-rates for the respective Wards, the highest rates are recorded in the Wards where most of the working classes are housed. Deaths.—The total number of deaths registered in the district was 500 (233 males, 267 females), equal to a deathrate of 8.6 per thousand of the population per annum. This is 1 per thousand higher than last year. The deaths occurring outside the district of persons belonging to this Borough were 154, viz. :— Kingston Union Infirmary 68 Essex and Colchester Asylum 1 Royal Victoria Hospital 3 Isolation Hospital, Mortlake 3 Nelson Hospital, Merton 11 Putney Hospital 1 Bolingbroke Hospital 1 Belgrave Hospital, Clapham Road 3 Royal Waterloo Hospital 4 Childrens Hospital, Great Ormond Street 3 St. George's Hospital 3 Hospital of St. John and St. Elizabeth 1 Friedenheim Hospital 1 New Hospital for Women 2 Charing Cross Hospital 1 Netherne Asylum, Merstham 1 Croydon Rural Isolation Hospital, Car- shalton 1 Brookwood Asylum, Woking 4 Linford Sanatorium 1 Norfolk and Norwich Hospital 1 Park Hospital 1 Hostel of God, Clapham 2 St. Thomas' Hospital 5 St. Bartholomew's Hospital 1 Marylebone Infirmary 1 Westminster Infirmary 2 Middlesex Hospital 1 University College Hospital 2 St. Peter's Home 1 5 Aberystwyth Hospital 1 Sanitary Hospital 1 Royal National Hospital 1 Consumption Hospital 1 St. Mary's Hospital 1 Swandene Hospital, Durrington 1 Private Residences 14 Others 4 Total 154 The deaths occurring within the district of persons not belonging thereto were 26, viz.:— Atkinson Morley Convalescent Hospital 2 North Wimbledon Cottage Hospital 3 Others 21 After taking these into account, the total number of deaths properly belonging to the district is found to be 628, and the death-rate 10'7. The rate for England and Wales for the same period was 13.4. The corrected death-rate for the year is 10'9. This is obtained by multiplying the net death-rate by the factor for correction, 1.0196, which is supplied by the RegistrarGeneral as a result of the last census. This factor is provided so as to make the death-rate comparable with that of other districts and the country as a whole on the basis of a similar age and sex distribution for Wimbledon, as compared with the country as a whole. Apart from the transferable deaths, 94 deaths of children under one year of age were registered, and this infantile mortality is represented by a ratio of 86 deaths per thousand registered births, an increase of 25 per thousand on the previous year, and 9.2 on the average for the past five years. The rate for England and Wales was 109. By the Zymotic death-rate, we understand the number of deaths per thousand of the population which are due to the seven common epidemic diseases:— (1) Small Pox. (2) Measles. (3) Scarlet Fever. (4) Diphtheria. (5) Whooping Cough. (6) Fever, including Typhus, Typhoid and Ill-defined Fevers. (7) Diarrhœa. 6 These seven epidemic diseases may be divided into notifiable and non-notifiable, and of the former 6 deaths were due to Diphtheria, 4 to Enteric Fever, and 1 to Scarlet Fever; of the latter 3 were due to Whooping Cough, 21 to Measles, and 40 to Diarrhoea, making an aggregate of 75 deaths, as against 33 last year, or equal to a Zymotic death-rate of 1.28 and .58 last year per thousand of the population. In addition to the deaths from Zymotic diseases, the principal causes of death were as follows:— Broncho-Pneumonia 17 Pneumonia 31 Bronchitis 36 Other Respiratory Diseases 3 Cancer 54 Phthisis 51 Other forms of Tuberculosis 10 Nephritis and Bright's Disease 22 Congenital Debility and Malformation (including Premature Births) 36 Organic Heart Disease 47 For the purpose of comparison the following Table is compiled from the returns of the Registrar General:— Vital Statistics for 1913 (Provisional Figures). Annual Rates per 1,000 living. Infant Mortality of infants under 1 year per 1,000 Births. Births. Deaths from all Causes. England and Wales 23.9 13.4 109 96 Great Towns 25.1 14.7 116 145 Smaller Towns 23.9 13.0 112 England and Wales, less the 241 Towns 22.2 12.1 96 WIMBLEDON 19.1 10.7 104 Table A shows the births, deaths (registered in district) and death-rates, and the deaths at certain ages and for specified causes for the past five years. Table B shows for the same years the number of infectious cases notified, and the deaths from each disease. Table C shows the death-rates from Zymotic Diseases, Phthisis, and other forms of Tuberculosis for the past ten years. 7 For the past three years the figures given in these Tables are those obtained after correction by exclusion of "NonResidents" and the inclusion of "Residents" beyond the District. Table A. 1913 1912 1911 1910 1909 1908 Births 1116 1120 1134 1159 1181 1144 Deaths 628 528 593 426 451 454 Death-rates 10.7 9.3 10.7 7.3 79 8.3 DEATHS— Under 1 year 117 76 125 86 91 82 Over 1 year and under 65 years 311 264 306 205 190 221 Above 65 years 200 188 162 135 171 151 From Measles 21 0 43 4 10 5 „ Scarlet Fever 1 1 1 0 3 3 ,, Small Pox 0 0 0 0 0 0 ,, Diphtheria 6 3 6 2 7 9 ,, Diarrhœa 40 17 51 9 9 8 „ Whooping Cough 3 10 7 12 12 4 ,, Enteric Fever 4 2 1 2 0 1 ,, Puerperal Fever 1 3 2 0 1 1 „ Erysipelas 1 1 0 0 1 1 ,, Influenza 15 8 5 3 8 18 Table B. DISEASES. 1913 1912 1911 1910 1909 1908 Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Small Pox 0 0 0 0 0 0 0 0 0 0 0 0 Diphtheria 129 6 67 3 99 6 65 2 90 7 94 9 Erysipelas 29 1 36 1 36 0 31 0 35 1 35 1 Scarlet Fever 147 1 117 I 146 1 147 0 316 3 131 3 Enteric Fever 8 4 23 2 13 1 9 2 4 0 5 1 Puerperal Fever 2 1 5 3 0 2 1 0 2 1 1 1 Totals 315 13 248 10 294 10 253 4 447 12 266 15 8 Table C. Year. Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria "Fever." Whooping Cough. Measles. Diarrhoea. sis and other Tuberc'los Diseases. 1904 1.9 - - .12 .08 .29 .48 .9 .83 1905 .78 - .06 .04 .12 .20 .02 .31 .82 1906 2.7 — .1 .18 .1 .08 .38 1.8 1.1 1907 1.3 - .09 .11 .05 .58 .19 .32 1.1 1908 .55 — .05 .16 .01 .07 .09 .14 .9 1909 .72 — .05 .12 — .21 .17 .15 .75 1910 .49 — - .03 .03 .2 .06 .15 .6 1911 1.9 — .01 .1 .01 .1 .77 .79 .81 1912 .58 — .01 .05 .03 .17 - .29 .95 1913 1.2 — .01 .1 .06 .05 .36 .68 .08 Small-Pox.—There have been no cases of Small-Pox during the year. Scarlet Fever.—The total number of cases notified during the year was 147 from 119 houses, as against 117 and 146 for 1912 and 1911 respectively. In one house there were 6 cases, in one house 5, in two houses 3, in fifteen houses 2, and in the remainder 1 each. The disease occurred in the following numbers at the various ages:— Under one 3 One to five 18 Five to fifteen 93 Fifteen to twenty-five 21 Twenty-five to forty-five 12 The following was the Ward incidence:— St. Mary's 21 Removed to Hospital 19 Attack Rate 1.97 St. John's 7 ,, ,, 1 ,, ,, 1.3 Cottenham Park 17 ,, ,, 5 ,, ,, 2.43 Dundonald 20 „ ,, 17 „ ,, 2.6 Trinity 30 „ ,, 32 ,, „ 2.52 South Park 52 „ „ 38 ,, ,, 3.32 147 112 2.52 There was one death, which is equal to a death-rate of .01 per thousand of the population. The average attack and death-rates for the last four quinquennial periods were as follows:— Attack Rate. Death Rate. 1891-1895 4 8 .02 per thousand of the population. 1896-1900 3.3 04 „ „ 1901-1905 2.3 .02 1906-1910 4.07 .05 9 One hundred and nine, or 74.1 per cent., of the patients were treated at the Isolation Hospital. Sixty-three per cent. of the cases notified were children of school age, viz., five to fifteen years, and of these 78 attended the following schools:— Cottenham Park School 1 Effra Road Girls' and Infants' School 11 Durnsford Road Mixed and Infants' School 7 Queen's lload Girls' and Infants' School 8 Queen's Road Boys' School 4 Pelham Road Boys' School 2 Pelham Road Girls' and Infants' School 13 Haydon's Road Girls' and Infants' School 7 Haydon's Road Boys' School 2 St. Mary's Mixed School 2 St. Mary's Infants' School 1 Central Mixed School 1 Dundonald Road Boys' School 2 Dundonald Road Girls' and Infants' School 5 Private Schools 10 Schools outside the district 2 On 26th September a case of Scarlet Fever was notified, which attended one of the private schools in the district. A second case occurred on October 6th, and a further case on the 9th. On the occurrence of this case the school was closed. Two further cases occurred on the 13th, and one which was notified on the same day by the Medical Officer of Health of Wandsworth of a child having been taken ill on the 9th. No further cases occurred after the re-opening of the school. Diphtheria.—The total number of cases notified during the year was 129 from 101 houses, the attack rate being 2'2 per thousand of the population; this rate is l.l higher than last year. In one house there were five cases, in three houses 4 cases, in three houses 3 cases, in nine houses 2 cases, and in the remainder 1 each. The cases occurred in the following numbers at the various ages:— Under one 1 One to five 17 Five to fifteen 93 Fifteen to twenty-five 8 Twenty-five to forty-five 8 Forty-five to sixty-five 2 10 The following was the Ward incidence:— St. Marys 16 Removed to Hospital 9 Attack Rate 1.5 St. John's 3 ,, ,, 2 ,, ,, .55 Cottenham Park 4 „ ,, 1 ,, ,, .57 Dundonald 8 ,, ,, 7 ,, ,, 1.04 Trinity 35 ,, ,, 35 „ ,, 2.94 South Park 63 ,, ,, 53 ,, ,, 4.03 North Wimbledon 18% South Wimbledon 82% One hundred and six or 82.1 per cent. of the patients were treated in the Isolation Hospital. Seventy-two per cent. of the cases notified were children of school age, namely, five to fifteen years, and of these, 89 attended the following schools :— Queen's Road Girls' and Infants' Schools 23 Queen's Road Roys' School 6 Haydon's Road Boys' School 1 Haydon's Road Girls' and Infants' Schools 20 Central Mixed School 1 Dundonald Road Girls' and Infants' Schools 3 Dundonald Road Boys' School 4 Durnsford Road School 3 Effra Road Girls' and Infants' Schools 10 Pelham Road Girls' and Infants' Schools 4 Pelham Road Boys' School 5 St. Mary's Mixed School 1 St. Mary's Infants' School 2 Private Schools 1 Schools outside district 5 89 During the early part of April and May a considerable number of cases of Diphtheria kept occurring in the Haydon's Road district. Seven of these were scholars in the two top classes in Haydon's Road Infants' School. These two classes in rooms 1 and 2, which communicate, interchange for different subjects, so that the half of the class in room 1 consisting of boys is transferred to room 2, and the girls from room 2 take the place of the boys in room 1, and vice versa. The accompanying plans show the position of the various cases in their ordinary classes, and also the position when the interchange takes place. 11 The school was visited on various occasions, and all the children who had been away were examined, and also all the children in the classes. Later I swabbed all of those who had been away with a suspicion of sore throat, and found a carrier (a girl) who had been under treatment with a doctor for tonsillitis, and had been back at school for a fortnight. This child was immediately isolated in the Hospital. On the occurrence of another case I immediately swabbed every child in the two classes, and the three teachers concerned in their instruction. One carrier case was found amongst these, and was immediately isolated in the Hospital. This child had never sat in proximity to any of the other notified cases. 12 In addition I had all the pencils removed from both classes, and sent to the bacteriologist for cultivations to be made, to ascertain if Diphtheria Bacilli were to be found. Mr. Johnston reported that the organisms present on the pencils in class 1 were Staphylococcii aureus and albus sarcinae yeasts and B. subtilis., and in class 2 Staphylococcii aureus and albus diplococci and Gram-negative bacilli. The Staphylococci in question are the common organisms of suppuration. It was found that practically all the pencils showed teeth marks and evidences of having been sucked. The pencils are common property, and are collected after each lesson and redistributed at the beginning of the next. One cannot help feeling that such communal utensils are often the source of spread of sore throats and other diseases, as it is quite impossible to stop the average small child from sucking his pencil. Inquiries and examination of the pens and pencils at the other Infants' Schools showed that by far the majority of the utensils had been bitten or sucked by the children. As a result of this I advised the Education Committee to provide some form of receptacle, so that each child should in future keep its own pencil for its own use. Owing to the prevalence of Diphtheria, our accommodation at the Hospital was found inadequate, and a new block is being erected which will provide 18 beds in place of the present 12, and the present 12-bed block will be available for Enteric Fever and other complaints, which will thereby set free the cubicles for their legitimate use. The number of cases of Diphtheria during the year was higher than for some considerable time. This must be put down largely to increased vigilance in bacteriological examination. For instance, as a result of investigations amongst the schools, I personally found 9 cases, some of which were actually attending school. There were six deaths, corresponding to a death-rate of 1 per thousand of the population. 13 Year. Total Cases. Cases treated in Hospital. Deaths in Hospital. Percentage of Deaths in Hospital. Cases treated at Home. Deaths at Home. Percentage of Deaths at Home. Attack Rate. Case Mortality Rate. 1890 10 3 2 66.6% 7 3 42.8% .4 50% Durnsford Lodge used for all Infectious Diseases except during 1893 when, owing to the prevalence of Scarlet Fever, Diphtheria patients could not be admitted. It was closed on Oct. 10th, 1895, because of its insanitary condition. Bacteriological examination and the use of Anti-Toxin first adopted in Wimbledon. Iron Hospital, Durnsford Road, in use except for Diphtheria. 1891 16 2 1 50% 14 6 42.8% .5 43.7% 1892 18 2 1 50% 16 8 50% .6 50% 1893 39 Nil. Nil. — 39 4 10.2% 1.3 10.2% 1894 44 24 6 25% 20 4 20% 1.4 22.7% 1895 39 27 8 29.6% 12 10 83.3% 1.1 46.1% 1896 30 Nil. Nil. — 30 3 10% .9 10% 1897 43 Nil. Nil — 43 7 16.2% 1.1 16.2% 1898 60 Nil. Nil. - 60 7 11.6% l.0 11% 1899 64 Nil. Nil. — 64 12 18.7% 1.5 18.7% 1900 64 2 Nil. Nil. 62 10 16.1% 1.4 15.6% 1901 60 38 3 7.9% 22 3 13.6% 1.4 10% Present Hospital, Gap Road, opened December, 1900. 1902 80 29 6 20.7% 51 1 1.9% 1.8 8.7% 1903 58 35 1 2.8% 23 0 13% 12 6.9% 1904 36 27 5 18.5% 9 1 11.1% .7 16.6% 1905 39 25 2 8% 14 Nil. Nil. .8 5.1% 1906 55 28 3 10.7% 27 6 22.2% 1.1 16.3% 1907 83 59 6 10.1% 24 Nil. Nil. 1.6 7.2% 1908 94 66 7 10.6% 28 2 7.1% 1.7 9.5% 1909 90 67 3 4.4% 23 4 17.3% 1.5 7.7% 1910 65 46 1 2.1% 19 1 5.2% 1.1 3.07% 1911 99 62 4 6.4% 37 2 5.4% 1.7 6.06% 1912 67 57 3 5.2% 10 Nil. Nil. 1.1 44% 1913 129 106 5 4.7% 23 1 4.3% 2.2 4.6% 1890—1895 Average Attack Rate .8 Average cas e Mortality Rate 37.1% 1896—1900 „ „ „ 1.2 „ „ „ „ 14.3% 1901—1911 „ „ „ 1.2 „ „ „ „ 9.1°/ 1911—1913 „ „ „ 1.7 „ „ „ „ 5.1% 14 CHART SHEWING WEEKLY NOTIFICATIONS OF SCARLET FEVER Enteric or Typhoid Fever.—During the year 8 persons in 7 different houses were notified as suffering from this disease. The following was the Ward incidence:— St. Mary's 1 Cottenham Park 2 Trinity 4 South Park 1 The cases occurred at the following times:— February 2 August 1 September 1 October 3 November 1 The attack rate was '13, and there were four deaths, corresponding to a death-rate of "06 per thousand of the population. In no instance could the source of the disease be traced. Puerperal Fever.—Two cases were notified during the year, one of which died. Although one is glad to report that Puerperal Fever is comparatively rare, the mortality amongst such cases is extremely high, and the difficulties of dealing with the cases in the poorer homes, where they mostly occur, are very great; so much so, that I suggested to the Committee arising out of a case which had come to my notice, that in future cases of Puerperal Fever should be admitted to the Isolation Hospital and treated in cubicles. The Committee asked me to report on the number of cases that had occurred during recent years, and as to the possibilities of these cases being treated. As a result, a report was submitted (part of which is appended), and the Committee authorised the admission of these cases provided accommodation could not be found for them elsewhere. "With respect to the admission of cases of Puerperal Fever to the Hospital for treatment in the cubicles, the following is a list of notified cases and deaths for the last six years:— 1912. 1911. 1910. April 15th 1 No cases August 5th ... 1 July 24th 1 notified. November 25th 1 December 9th 1 December 24th 1 Total 5 Total ... 1 Deaths 3 Deaths 2 Deaths 0 17 1909. 1908. 1907. August 16th 1 August 3rd 1 January 14th 2 November 1st ... 1 August 20th 1 Total 2 Total 1 Total 3 Deaths 1 Deaths 1 Deaths 2 It will be seen that the highest number of cases notified in any year was 5, and it will also be seen how serious the mortality is, considering that the total number notified during this period was 12, and that during the same period 9 deaths occurred. Owing to there being no facilities for treatment, I am inclined to think that there is a hesitancy in notifying Puerperal Fever in its early stages, and I think this is borne out by the fact that in 1911 there were 2 deaths certified as Puerperal Fever which were not notified. The mortality is generally recognised to be about 50 per cent. of the cases, and I think there is considerable probability that if facilities were given for treatment, earlier notification of the disease, together with skilled nursing, might do something to decrease this terrible percentage of deaths. I cannot too strongly emphasize the economic importance of attempting to save these mothers, as we are all familiar with the difficulties which arise amongst the poorer homes on the death of the mother, where there is a family of young children." During the preparation of this report 4 cases of Puerperal Fever have occurred, in which the infection was traced to two midwives, and these cases bring out more strongly than ever the inconvenience and delay which occurs as a result of the control of the midwives being in the hands of the County Authority and not in those of the Borough Council. Whooping Cough was the registered cause of death in three instances, representing a death-rate of .05, as against 10 last year and 7 the previous year, with a death-rate of .17 and .12 respectively. The deaths were distributed over the age periods as follows:— Under one year 1 One to five years 2 and they occurred in the following Wards:— Dundonald 1 Trinity 1 South Park 1 I should again like to draw your attention to the heavy mortality from Whooping Cough year by year, as will be seen from the following figures, giving the respective deaths during the last ten years from Whooping Cough, Scarlet Fever, and Diphtheria. 18 Year. Whooping Cough. Scarlet Fever. Diphtheria. 1903 9 l 4 1904 14 0 6 1905 10 3 2 1906 4 5 9 1907 30 5 6 1908 4 3 9 1909 12 2 7 1910 12 0 2 1911 7 1 6 1912 10 1 3 1913 3 1 6 115 22 60 Erysipelas.—There were 29 cases of Erysipelas notified during the year from 28 houses, and there was 1 death, which is equal to a death-rate of .01 per thousand of the population. Influenza was certified as the cause of fifteen deaths. Last year there were eight, and in 1911 there were five. The deaths were distributed through the Wards as follows:— St. Mary's 2 Cottenham Park 3 Dundonald 2 Trinity 3 South Park 5 Measles.—There were 21 deaths from Measles during the year, as compared with no deaths last year, and 43 the previous year, with a death-rate of 0 and '77 respectively. Phthisis and other Tuberculous Diseases were the assigned causes of the deaths of 63 persons (38 males, 25 females) during the year, equal to a death-rate of 1.08 per thousand of the population. Last year there were 54 deaths, and the previous year 64. The total number of cases notified during the year was 221:— 109 being primary notifications of Pulmonary Tuberculosis. 39 being primary notifications of other forms of Tuberculosis. 73 being secondary notifications, 19 Brompton Hospital 28 Frimley Sanatorium 4 Crooksbury Sanatorium 20 St. Thomas' Hospital 9 Waterloo Hospital 8 Kingston Infirmary 7 Pinewood Sanatorium 4 Ventnor Sanatorium 4 St. Mary's Hospital 4 Royal Sea Bathing Hospital, Margate 3 King's College Hospital 3 Benenden Sanatorium 3 Ipswich Sanatorium 2 St. Mary's House, Broadstairs 2 St. George's Hospital 2 University College Hospital 2 Alexandra Hospital 2 City of London Hospital 2 Boys' Surgical Home, Banstead 2 Home Sanatorium, Bournemouth 1 St. John's Hill Infirmary, Wandsworth 1 Chilton Hill House, Sudbury 1 Great Northern Hospital 1 Charing Cross Hospital 1 Guy's Hospital 1 Victoria Hospital, Chelsea 1 Great Ormond Street Hospital 1 Charing Cross Hospital 1 County Hospital, Hunts 1 Lambeth Infirmary 1 London Homoeopathic Hospital 1 Long Grove Asylum, Epsom 1 Maltings Farm Sanatorium, Colchester 1 National Hospital for Consumption, St. Lawrence, Isle of Wight 1 Nelson Hospital 1 North Wimbledon Cottage Hospital 1 St. Michael's Home, Asbridge, Somerset 1 Tooting Home, Wandsworth 1 130 Private Practitioners 87 School Medical Officer 4 Sanatoria and Hospitals 130 221 20 The following was the age incidence:— Tuberculosis. Under 1 1-5 5-15 15-25 25-45 45-65 Over 65 All ages Pulmonary 1 ... 15 30 44 17 2 109 Other forms ... 9 19 5 4 2 — 39 The following was the Ward incidence:— St. Mary's St. John's Cottenham Pk. Dundonald Trinity South Park Total Pulmonary 25 7 8 8 22 39 109 Other forms 5 1 5 7 8 13 39 The following particulars were found on investigation, concerning the cases notified :— Sputum examined, 48 per cent. Positive, 46'5 per cent. Negative, 1.5 per cent. History of Consumption in family, 44'78 per cent. Previous history of pleurisy, 73 per cent. Average length of illness before notification, 37 weeks. Longest period, 16 years. Shortest period, 1 day. Average length of time since leaving work, 19 weeks, 5 days. Working at time of notification, 10.5 per cent. In regular work, 82 per cent. Irregular work, 18 per cent. Average size of house, 5.69 rooms. Average population per house—Adults, 3.76; Children, 1.66. The treatment which had been obtained previous to notification was:— Private practitioners 79 Private practitioners and hospital 12 Private practitioners and Sanatorium 6 Infirmary 4 Hospital 8 21 Twenty-five per cent. declined disinfection after death of a patient. In order to show the economic importance to the community, herewith are shown particulars of married men and women who have been notified as suffering from consumption with their average age and the number of children, who, in the case of the death of the father will be left without a bread winner, and in the case of the death of the mother, often more or less neglected, and at the best lacking the care and control so necessary at the earlier years. Married men with dependents, 18. Average age, 38.5 years. Average number of dependents under 14—1.2 Average number of dependents over 14—l.l Actual number of dependents under 14—22 Actual number of dependents over 14—20 Married men with no dependents, 6. Average age, 51 years. Married women with dependents, 13. Average age, 38.8 years. Average number of dependents under 14—2.2 Average number of dependents over 14— .3 Actual number of dependents under 14—29 Actual number of dependents over 14— 4 Married women with no dependents, 3. Average age, 53 years. Total number of dependents:— Under 14 years—51. Over 14 years—24. Single men—24. Average age, 26 years. Single women—22. Average age, 27 years. Under 16 years—15. Average age, 8 years. From this it will be seen that the average age of the married men works out at 38.5 years, i.e., men in the prime of life bringing up a family of young children. This will give some idea of the importance of doing everything to secure the return of these individuals to such a condition of health as will enable them to provide for their families until such time as they are self-supporting. It will be noticed that there is a difference of 12.5 years in the average age of the single men as compared with the married, and of 14.2 years in the single women as compared with the married women in the incidence of the disease. 22 The notifications occurred in the houses of the following rentals:— 16 or 15.38 per cent. were in houses of less than £20 per annum. 28 or 26 9 per cent. were in houses of from £20 to £26 per annum. 48 or 46 per cent. were in houses from £26 to £40 per annum. 8 or 7.69 per cent. were in houses from £40 to £60 per annum. 4 or 3.85 ner cent were in houses over £60 per annum. The following list gives the occupations of the cases of consumption notified during the year:— OCCUPATIONS. Men. Insured. Not Insured. Total. Clerks 8 2 10 Labourers 3 1 4 Accountant 1 1 Analytical Chemist 1 1 Book-maker's clerk 1 1 Carpenter 1 1 Compositor 1 1 Coachman 1 1 Commercial traveller 1 1 Draper 1 1 Decorator 1 1 Dental operator 1 1 Engineer 1 1 Fishmonger's assistant 1 1 Golf Club maker 1 1 Green keeper 1 1 Ironmonger 1 1 Kitchen porter 1 1 Miner 1 1 Musician 1 1 Messenger boy 1 1 Plasterer 1 1 Professional singer 1 1 Publisher's manager 1 1 Railway mechanic 1 1 Postman 1 1 Stableman 1 1 Stock-keeper 1 1 Typist 1 1 Watchmaker 1 1 Wheelwright 1 1 Retired 3 3 No occupation 3 3 Total 24 25 49 23 Women Insured. Not Insured Total. Housewife 16 16 Domestic servant 6 ... 6 Laundress 4 ... 4 Draper's assistant 3 ... 3 Teacher 2 ... 2 Tailoress 1 ... 1 House-keeper 1 ... 1 Nurse (children's) 1 ... 1 Nurse (hospital) 1 ... 1 Total 19 16 35 OTHER FORMS OF TUBERCULOSIS. Cervical glands 8 Lupus of arm 1 Cervical glands and chest ,, ,, hand 1 wall 1 Hip 4 Kidney 2 Ankle 1 Peritoneum 1 Tarsal bones 1 Intestines and peritoneum 1 Oscalcis 1 Mesenteric glands 1 Elbow 1 Abdomen 1 Elbow and humerus 1 Caecum and appendix 1 Clavicle 1 Inguinal glands 1 Knee 1 Testicle 1 Spine 1 Multiple abscesses 1 Rib 1 Lupus of nose 3 Foot 1 „ „ ear 1 Of the above cases notified, 2 died. Treatment for the foregoing cases was obtained in the following manner:— Hospital in-patient 15 Hospital out-patient 12 Private practitioner 11 Infirmary 1 24 OCCUPATIONS. Men. Women. Painters 2 Domestic servants 3 Clerk 1 Housewife 1 Engineer 1 Dressmaker 1 Gardener 1 Typist 1 Plasterer 1 Labourer 1 No occupation 1 Under 16 25 INSURED PATIENTS. MEN. Average age, 30'5 years. Married, 10. Average age of those receiving Sanatorium treatment, 26.5 years. WOMEN. Average age, 29.5 years. Married, 2. Average age of those receiving Sanatorium treatment, 28.8 years. DETAILS OF TREATMENT RECEIVED BY INSURED PATIENTS. MEN. Treatment. Result. Hospital, out-patient, 1 Did not return to Wimbledon. month. Sanatorium Domiciliary, 2 months. Improvement maintained 7 Sanatorium, 3 months months afterwards. ing old occupation as clerk. Domiciliary, 7 months. Did not return to old address. Hospital in-patient 1 month. Sanatorium Domiciliary, 2 months. 7 months afterwards much im- Sanatorium, 3 months provement, but finds culty in getting suitable employment. Domiciliary, 9 months. Age Seriously ill. 52 25 Men. Treatment. Result. Domiciliary, 3 months. Sanatorium, 3 months Improved on discharge, but obliged to go back to unsuitable occupation. Domiciliary. Age 57 Removed. No information. Domiciliary, 2 months. Sanatorium, 3 months. Improvement maintained 7 months afterwards. Following old occupation. Domiciliary, 2 months. Hospital in-patient, 5 weeks 4 months afterwards doing light work. Under doctor for gastric trouble. Hospital treatment, inpatient Did not return to old address. Domiciliary, 2 months. Hospital, 1 month( in-patient). Sanatorium, 3 months Still in Sanatorium. Domiciliary, 1 month. Hospital, 1 month (in-patient). Still in Hospital. Infirmary, 1 month. Hospital in-patient Domiciliary, 5 months. Unwilling to go to Sanatorium Following occupation 5 months after. Domiciliary, 2 weeks. Infirmary, 6 weeks. Domiciliary again till sick pay expired, then Infirmary. Age 56 Still in Infirmary. Domiciliary, 7 months. Hospital, in-patient, 3 months. Domiciliary, 1 month Still having Domiciliary treatment. Domiciliary, 3 months Still having Domiciliary treatment. Domiciliary, 3 months Domiciliary, 5 weeks. Sanatorium, 2 months Now on sea voyage. Domiciliary, 4 months. Age 54 Still having Domiciliary treatment. Domiciliary, 9 weeks. Sanatoriurn, 1 month Now on sea voyage. Domiciliary, 2 months. Hospital, in-patient. Previously been in Hospital 5 months and Sanatorium, 7 months, before living in Wimbledon Still in Hospital. Domiciliary, 3 months. Still having Domiciliary treatment. Has heart disease. 26 Men. Treatment. Result. Domiciliary, 1 month. Sanatorium, 3 weeks Had to leave Sanatorium as wife taken ill with hæmoptysis. Domiciliary, 8 months. Hospital, 7 days Discharged from Hospital at own request. Died 10 days later. WOMEN. Treatment. Result. Domiciliary, 2 months. Sanatorium, 3 months Improvement maintained 4 months later. Domiciliary, 5 months. Sanatorium, 3 months Improvement maintained 3 months later. Hospital, 2 months. Domiciliary, 1 month Employment in light work in Nursing Home, 3 months. Taken ill with Chorea and removed to Infirmary. Domiciliary, 5 months. Sanatorium, 3 months Improvement maintained 3 months later. Domiciliary, 4 months. Sanatorium, 3 months Improvement maintained 3 months later. Domiciliary, 3 months Improvement maintained 6 months later. Following old occupation. Domiciliary, 5 months. Sanatorium, 3 months 4 months later not making much progress. Domiciliary, 1 month. Infirmary, 2 months. Sanatorium Has not returned to old address Domiciliary, 2 weeks. Hospital out-patient, 4 months. Still in Sanatorium. Hospital in-patient, 2 months. Sanatorium Domiciliary, 2 months In Sanatorium abroad. Domiciliary, 3 months. Hospital, 1 month. Home of Rest Still in Nursing Home. Domiciliary, 11 weeks. torium Still in Sanatorium. Hospital out-patient, 1 month Left this district. Domiciliary, 2 months. Sanatorium Still in Sanatorium. Domiciliary, 3 weeks Left this district. Domiciliary, 1 month Removed. Domiciliary, 1 month. Hospital in-patient, 1 month. Sanatorium, 3 months Much improved. Left Wimbledon to stay at seaside. 27 Average length of time before going to Sanatorium— Men, 7.1 weeks; Women, 11.6 weeks. Average length of time before going to Hospital—Men, 14.2 weeks; Women, 3 weeks. Average length of stay in Sanatorium, 3.01 months. The average time which elapsed before patients entitled to insurance benefit were admitted to the Sanatorium was two months, whereas I am given to understand that in the case of the Post Office employees the period averages 7 days. One cannot help feeling very strongly that unless this period of two months can be very materially shortened, we are not getting the real value from the Sanatorium treatment, as during these two months the patient has probably progressed considerably for the worse, and that period of time may often turn the scale on the wrong side. On 1st February, 1913, the new Regulations with regard to the notification of Tuberculosis, which included nonpulmonary forms which were to be notified on the strength of evidence other than that derived solely from tuberculin tests, came into force. Anthrax.—No cases were notified during the year. Ophthalmia Neonatorum.—One case occurred during the year. Cancer.—During the year 54 deaths have been registered as due to the different forms of malignant disease or Cancer, 17 males and 37 females. The distribution of the deaths through the Wards was as follows:— St. Mary's 11 Attack Rate 1.03 St. John's 1 „ •18 Cottenham Park 13 „ 1.86 Dundonald 9 „ 1.17 Trinity 10 „ •84 South Park 10 „ .63 The death-rate for the year was .92 as against 1.07 last year, and .91 in 1911, the average for the past five years being •87. 28 The following table shows the different parts of the body invaded and the age incidence:— Part Affected. Male. Female. Total. Age Incidence. Male. Female. Total. Stomach and Bowels 8 11 19 Under 35 years 1 1 2 Liver 2 4 6 35 to 40 ,, 1 1 2 Urinary and Generative Organs 3 11 14 40 to 45 „ - 3 3 45 to 50 ,, 1 4 5 Tongue, Neck and Throat 4 1 5 50 to 55 ,, 4 5 9 Breast - 6 6 55 to 60 ,, — 5 5 Other Parts — 4 4 60 to 65 ,, 4 3 7 65 to 70 ,, 1 4 5 70 to 75 ,, 4 5 9 75 to 80 ,, 1 4 5 80 and upwards — 2 2 Total 17 37 54 Total 17 37 54 Ward. Male. Female. Total. St. Mary's 3 8 11 St. John's - 1 1 Cottenham Park 4 9 13 Dundonald 3 6 9 Trinity 4 6 10 South Park 3 7 10 Total 17 37 54 29 Diarrhœa and Enteritis were responsible for 40 deaths, corresponding to a death-rate of .68. The deaths were distributed through the Wards as follows:— St. Mary's 2 Dundonald 4 St. John's 2 Trinity 15 Cottenham Park 1 South Park 16 North Wimbledon 5 South Wimbledon 35 During the year there was an excellent instance of the way in which other influences may affect the health of an infant. In one of the houses in South Wimbledon one infant was seriously ill for a considerable time as a result of acute gastro-enteritis, which was undoubtedly due to the proximity of a fish shop whose yard abutted on the side of the house in question. The fishmonger's boxes and offal tin were kept in his backyard, and during the hot weather there were swarms of flies which infested the neighbouring house, and were the undoubted cause of the child's illness, the flies being the carriers of infection. Everything was done to get the boxes cleansed and the offal removed as soon as possible, but even then the place was always swarming with flies. The shopkeeper in question would undoubtedly be much hurt if he were taxed with being the cause of this child's illness and the expense and anxiety to which the parents were put, and yet there is no doubt whatever that the condition of his premises was the direct cause of the child's illness. Houses in the same row, further removed from the shop in question, were little bothered with flies. Infantile Mortality.—By the term "Infantile Mortality" is meant the proportion of infants who died before reaching the age of twelve months to the total number born during the year. This is the method required by the Local Government Board in their Statistical Tables, and permits of accurate comparison. To calculate the infantile death-rate on the population, or on the deaths at all ages, as is sometimes done, is absolutely valueless. There were 117 such deaths during the year (including transferable deaths), or 104 per thousand registered births, showing an increase of 37 on last year's rate, when there were 76 deaths and a rate of 67. The previous year there were 125 deaths, and the rate was 110. The average for the past five years is 801. The infantile mortality amongst illegitimate children was 115, as compared with 84 for the legitimate. 30 The infantile mortality rates for the different Wards are as follows:— St. Mary's 79.09 St. John's 41.6 Cottenham Park 60.6 Dundonald 83.9 Trinity 139.1 South Park 117.6 During the period (the past eleven years) that records |have been obtainable of infantile mortality in the various Wards, it has been found that South Park Ward has had the highest rate in five years, St. Mary's Ward in two years, Trinity Ward in three years, and Dundonald Ward in one year. Twenty-two babies, or 18.8 per cent. of the total deaths, failed to survive the first week of life, and 40 the first month. One of the institutions undoubtedly influencing the infantile mortality of the district is the South Wimbledon Day Nursery, which caters largely for the mothers who have to go out to work, and who are faced by the alternative, without such an institution, of going to work and neglecting the children or staying at home to look after the children on a wage which is insufficient for their needs. Speaking from experience of one of the first and largest day nurseries in the country, one would like to see more of these institutions, for, although one is opposed to mothers going out to work as an ideal, one has to face the hard facts as they are, and in the case of many of the labourers, and particularly men in casual work, the only way the home can be kept together is by the woman working, and it means a great deal when one knows that their children are kept under such conditions of cleanliness and comfort as are found in these institutions, in addition to which one is certain that they are properly fed. Notification of Births Act, 1907.—During the year 885 births have been notified by the following persons:—Parents, 421; Midwives, 300; Doctors, 151; and other persons, 13. During the same period 1,094 births were registered. The number of infants visited was 483. The number of re-visits made was 3,858. 31 The Ward incidence was as follows:— Trinity 218 South Park 174 Dundonald 79 Cottenham Park 6 St. Mary's 6 Average size of house, 4.2 rooms. Average rental, 8s. 4d. per week. Average number of persons per house—Adults, 2.3; Children, 3.5. Infant Feeding.—Calculating from records made at first visit, 93 per cent. were breast fed. By examining the complete records of those infants who attained the age of one year at the end of 1913, of which there are 258:— 233 or 90.6 per cent. completely breast fed for less than 1 month. 221 or 85.6 per cent. completely breast fed for 1 month. 200 ,, 77.5 ,, ,, ,, ,, 2 months. 182 „ 70.5 „ „ „ „ 3 „ 167 „ 64.7 „ „ „ „ 4 „ 163 ,, 63 ,, ,, ,, ,, 5 ,, 154 ,, 59.6 ,, ,, „ ,, 6 146 „ 56.59 „ ,, ,, ,, 7 ,, 141 „ 54.6 ,, ,, ,, ,, 9 18 were artificially fed practically from birth. In 34 of the cases, the breast feeding was changed to artificial feeding, but 65 of the mothers were able to partially feed their babies, 29 until 9 months old, the remaining 36 were subsequently artificially fed. There were thus:— 54.6 per cent. breast fed. 11.2 per cent. partially breast fed. 34.1 per cent. artificially fed. A few of the mothers working near home have been allowed to come home to feed their babies. There were several cases of temporary supplementary feeding, the mother working for a short period only. These babies have been included in the list of breast fed babies. The cases of non-breast feeding or partial breast feeding were due to:— 32 Milk insufficient or poor, 62, or 53 per cent. Illness or poor health of mother, 21, or 18 per cent. Mother working, 32, or 27.3 per cent. Removal of baby to hospital, 2, or 12 per cent. Fresh cow's milk was used in 64 per cent. of cases. Condensed milk was used in 30 per cent. of cases. Proprietary foods were used in 5'5 per cent. of cases. There were several cases where dried milk or condensed milk were used temporarily. Boat bottles were found to be in use in 75 per cent. of cases, the number of mothers who were eventually prevailed upon to use boat bottles instead of tubes bringing the percentage up to 80. Insurance Benefit.—Of the 483 patients visited, 467, or 96.7 per cent., obtained insurance benefit; 30, or 6.2 per cent., obtained double benefit, viz., £3; 16, or 3.3 per cent., received no benefit. Of the 16 who received no benefit:— 7 were in business for themselves. 2 husbands abroad. 4 in arrears, run out of benefit. 1 husband dead. 2 illegitimate child. Mother no occupation. There was 1 voluntary contributor. Mothers' and Babies' Welcome.—Number of cases sent on during the year, 193. Number of cases referred back, 99, or 51.29 per cent. Un-notified birth inquiries, 214. Infant Deaths.—Thirty-seven infants under one year of age died from the following causes:— Prematurity. Inanition 9 Diarrhœa. Enteritis 9 Tubercular Enteritis 1 Dentition. Acute Vomiting. Diarrhœa 1 Bronchitis. Pneumonia 9 Acute Phthisis 1 Whooping Cough. Pneumonia 1 Meningitis. Pneumonia 1 Cerebral Meningitis 1 Cerebral Haemorrhage 1 Hydrocephalus 1 Found dead in bed 2 33 Six others, suffering from Marasmus, died in hospital. Of the 37 7, or 19 per cent., took no food. 15, or 40.5 per cent., were breast fed. 16, or 43.2 per cent., were artificially fed. Ten of the mothers, or 27 per cent., went out to work. Of the 11 babies whose deaths were due to diarrhoea and enteritis, 9, or 81.8 per cent., were artificially fed. Of the 6 who died in hospital, all, or 100 per cent., were artificially fed from birth. Isolation Hospital.—The following Table, furnished by the Hospital Medical Attendant, Dr. Clapham, gives the number of patients treated in the Hospital for each disease during the year. Cases Admitted in 1913. Over 5 years. Under 5 years. Total. Deaths. Remarks. Over 5 years. Under 5 years. Total. Scarlet Fever 91 15 106 - - - Daily average number of cases 28. Diphtheria 91 15 106 2 1 3 Enteric Fever 5 - 5 1 - 1 Pneumonic Measles 1 — 1 — - - Tonsilitis. Staff. 3 — 3 — — — Asthma. Staff. 1 - 1 - - - Erythema Nodosum 1 — 1 — — — 193 30 223 3 1 4 Average number of days in Hospital 40. Carried over from 1912 Scarlet Fever 12 7 19 - - - Diphtheria 14 - 14 — 1 1 Total number of cases treated during 1913 219 37 256 3 2 5 34 Disinfection.—The following Table shows the number of rooms and articles disinfected:— Disease. Bedding Disinfected. Clothing. No. of Rooms Disinfected. Total. Mattresses Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Dresses. Suits. Other Articles Scarlet Fever 214 257 89 462 936 96 37 4550 222 6863 Diphtheria 147 239 92 354 595 89 25 2648 183 4372 Typhoid Fever 11 6 4 29 32 2 - 76 11 171 Erysipelas 7 14 8 25 31 1 - 65 8 159 Puerperal Fever 3 1 1 7 7 - - 15 1 35 Consumption 31 22 13 94 104 3 2 341 42 654 Tuberculosis — - 1 - — — - 5 1 7 Cancer 18 4 3 73 19 11 - 141 9 278 Measles 51 46 6 81 189 13 16 957 99 1458 Chicken-pox 9 2 - 6 19 1 - 68 2 107 Whooping Cough 4 2 - 5 3 - - 11 5 30 Mumps 4 1 - 5 15 1 2 24 2 54 Vermin 2 5 3 6 6 — 5 15 20 62 Septic Cases 1 - - 2 2 - - - - 5 Sundries 33 11 5 109 83 10 3 588 271 1113 Totals 537 610 225 1258 2041 227 90 9504 876 15368 There were 41 library books disinfected. Diagnostic Tests.—The number of specimens of serum, sputum and blood submitted for bacteriological examination during the year in doubtful cases of Diphtheria, Pulmonary Tuberculosis and Typhoid Fever, and the results of such examinations, are given below. Eighty-four bottles of anti-diphtheretic serum were supplied through the Public Health Department for use by medical practitioners for the treatment of Diphtheria. The antitoxin syringe which is kept at the Fire Station was borrowed on two occasions by the medical practitioners in the district. 35 It will be noted that the examinations of sputum have been much more numerous than on any previous occasion. Diagnostic Tests. Bacillus found. Bacillus not found. Total. Diphtheria Secretion 101 490 591 Phthisis (Sputum) 24 103 127 Ringworm — 1 1 Reaction obtained. Reaction not obtained. Total. Typhoid (Blood) 5 13 18 Four Swabs submitted for Vincent's Angina. Result: — Positive 3 Negative 1 One Swab submitted for Diphtheria. Result: — Diphtheria absent; Vincent's Angina present. Mortuary.—From information received from the Superintendent of the Cemetery, there were 61 bodies received into the mortuary during the year, and 56 post-mortems held. Inquests were held by the Coroner with respect to 38 bodies, equal to 7.6 per cent. of all deaths registered in the Borough. Factories and Workshops.—In the Tables below is shown the work done in the supervision of workshops and workplaces. Premises. Inspections. Written Notices. Prosecutions. Factories 65 6 — Workshops 348 22 — Workplaces 39 3 — Total 452 31 — 36 Defects found. Nature. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness 25 25 — — Want of Ventilation — 1 — — Overcrowding 3 1 — — Want of drainage of floors 3 1 — — Other Nuisances 52 49 — — Sanitary Accommodation- Insufficient — — — — Unsuitable or Defective 6 6 — — Not Separate for Sexes 1 — — — Breach of Special Sanitary Requirements for Bakehouses 5 5 — — Other Offences — — 1 — Total 95 88 1 — Home Work. Lists received:— Twice in the year 16 Number of Out-workers 33 Once in the year 11 Number of Out-workers 23 Number of addresses received from other Councils 40 Number of addresses forwarded to other Councils 16 Notices served on occupiers as to keeping or sending lists 8 Prosecutions — Failing to keep Outworkers' lists 0 Prosecutions—Failing to furnish lists 0 Inspections of Out-workers' premises 84 Number of unwholesome premises 7 Notices served to remedy 7 37 Registered Workshops. The following are the principal classes of workshops on the register at the end of the year:— Boot Repairing 54 Dressmaking 53 Bakehouses (including four Factory Bakehouses) 27 Laundries 30 Tailoring 23 Millinery 14 Dining Rooms 18 Cycles 19 Other Trades 83 Total 321 OTHER MATTERS. Matters notified to H.M. Inspector of Factories :— Failure to Affix Abstract of Act 7 Action taken in matters (Notified by H.M. referred to H.M. Inspector Inspector 1 as remedial under the Reports of action Public Health Acts. taken sent to H.M. Inspector 1 Underground bakehouses in use at the end of the year 3 As a result of the inspection of the workrooms, workshops, and workplaces in the Borough, it was found that for the most part they were in a satisfactory condition, and that the requirements of the Act were duly observed by the occupiers. Systematic examination has been made of the eatinghouses, cookshops, and other places where food is prepared for sale, and the occupiers of these, generally speaking, have kept their places in good and cleanly order. In no instance was it necessary to take legal proceedings to enforce compliance with the requirements set out in the notices served for the abatement of nuisances. In addition to the ordinary inspections made of outworkers' premises, each address contained in the lists received in the early part of the year, i.e., previous to February, and not including those received in August, were visited in order to ascertain if work was still carried on, and if breaches of the Act had been made by reason of the employer failing to notify the name and address of the outworker. 38 Food Poisoning.—Only one case of food-poisoning was brought to my notice during the year, in which case two families showed symptoms of poisoning which were attributed to sardines. Microscopical examination of contents of the tins revealed short bacilli which could not be grown on any medium, so one may presume that there was no bacterial infection. As all the members of the two families partook of pork on the same day, it is impossible to say what was the actual cause. Those members affected awoke within a few minutes of one another the following morning with persistent sickness and diarrhœa, accompanied by pain. In another instance there was considerable abdominal pain, and in some of the other members, nausea. The medical man in attendance reported that he had a previous definite case of food poisoning from the same brand of sardines comparatively recently. Water Supply.—On the whole the water has been more satisfactory this year, owing to the mixture of the supplies, but owing to the trouble which has been experienced with regard to the hardness, I was instructed by the Committee to make periodic analysis of the water in various parts of the town. Information was received that the water supply had been withdrawn during the year from 12 houses, for the following reasons:—1, owing to leakages; 2, by request; 6, owing to arrears of rates; 1, premises empty; and 2, for other reasons. Supervision of the Erection of New Houses.—This is under the control of the Surveyor, and there is a special Inspector whose duty is solely devoted to the supervision of the erection of new houses and additions. Slaughterhouses.—The number of registered slaughterhouses remains as last year, viz., six. The visits to these have been, as far as possible, timed to take place whilst the animals were being slaughtered and dressed for food, this being the best time for inspection, as the whole of the organs and carcase can then be examined together. I may mention that the Officers of your Sanitary Department have made inspection of such premises outside the prescribed hours of their duty, in order that their visits may coincide with the usual time that the various licensees of slaughterhouses do their killing. The Bye-laws as to the periodical limewashing of walls, and the removal of garbage, offal, etc., have been complied with, no neglect in this respect having been found. 39 The Chief Inspector, Mr. Henry Johnson, the First Assistant Inspector, Mr. R. T. Avis, and the Third Assistant Inspector, Mr. D. F. S. Flynn, all hold certificates of the Royal Sanitary Institutes for Inspectors of Meat and other Foods. Dairies, Cowsheds and Milkshops Orders.- Twenty persons applied for registration under the Dairies, Cowsheds and Milkshops Orders during the year, 2 as Cowkeepers, 8 as Dairymen and Purveyors of Milk, and 10 as Purveyors only. The names of 8 persons were removed from the register during the year owing to removals from the district, the discontinuance of the business, or the premises used for such trading being closed. On the 31st December, 1913, there were 6 Cowkeepers, 58 Dairymen, and 31 Purveyors on the register, showing a net increase of 12 upon last year. An exact record is kept in the Public Health Department of the sources of supply of all the milk which comes into Wimbledon to the known purveyors. Inspection Of Dairy Cows.—All dairy cows kept in the Borough are inspected and reported upon once in every quarter by the Council's Veterinary Inspector. Housing, Town Planning Act, 1909.—As this matter was delegated by the Council to the Sanitary Inspector, the report of any action will be found under his Report. River Pollution.—This matter, which was under the consideration of the Public Health Committee last year, was referred to the County Council, who had the matter under consideration with a view to taking action in the matter. Administration of General Adoptive Acts in Force in the District.—General Acts in force: Infectious Disease (Prevention) Act, 1890; adopted 17th December, 1890. Public Health Acts (Amendment) Act, 1890. Housing of the Working Classes Act, 1890, Part III.; adopted 7th June, 1899. The Baths and Washhouses Acts; adopted 4th August, 1897. The Notification of Births Act, 1907; adopted 26th July, 1909. The Public Health Acts (Amendment) Act, 1907, Parts VII. (except Sections 82 and 83, Section 81 modified), VIII., and IX.; adopted 21st December, 1908. The Public Health Acts (Amendment) Act, 1907, Parts II., III., IV. (except Section 66), V., VI., and X. (except Section 94). 40 Application has been made to the Local Government Board for an Order declaring these parts of the Public Health Acts (Amendment) Act, 1907, to be in force, and the order was made on 9th June, 1913. On 25th September, 1913, the following trades were scheduled as offensive trades within the meaning of the Public Health Acts (Amendment) Act, 1907:—Blood-drier, Tanner, Leather-dresser, Fat-melter or Fat-extractor, Gluemaker, Size-maker, Gut-scraper, Dealer in Hags and Bones, and Fish-frier. Local Acts.—There are no local Acts in force in the district. The following is a statement showing the number and nature of inspections made, the number of informal and statutory notices served, with the result of such notices, for the year 1913, as reported by the Sanitary Inspector:— Reason of Visit. No. Infectious Disease 989 House to House Inspection 3435 House Inspection 2423 Houses let in Lodgings, Inspection 354 Inspection of Factories, Workshops, Work-places, Outworkers' premises, etc. 554 Common Lodging House Inspection 45 Dairy Inspection 151 Inspection under Shops Act 1307 Application of tests to drains 699 Inspection under Diseases of Animals Acts, and Orders of Board of Agriculture 154 Obtaining samples of Food and Drugs 294 Miscellaneous (including inspections of slaughter-houses, mews and stables, smoke observations, measuring up, etc.) 1896 Total 12,301 Seven hundred and ninety-nine preliminary or informal notices were served in respect of 1,390 houses. One hundred and fifty-eight Statutory Notices were served in respect of 200 houses. 41 The necessary work was executed in every case except one, when the Council carried out drainage work in default of the owners. I wish to place on record my appreciation of the way in which the work has been carried out by the entire Staff. I am, Gentlemen, Your obedient Servant, ELWIN H. T. NASH. 42 Borough of Wimbledon. SANITARY DEPARTMENT. ANNUAL REPORT OF THE Sanitary Inspector FOR THE YEAR ENDED 31st DECEMBER, 1913. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Gentlemen, I beg to submit to you my report of the work carried out in my Department for the year ended 31st December, 1913, in connection with the abatement and suppression of nuisances and other matters under the Public Health Acts, Factory and Workshop Act, Sale of Food and Drugs Acts, Shops Act, Diseases of Animals Acts, etc.; also in connection with the enforcement of the various Bye-laws and Regulations made by the Local Authority, and as the result of house to house inspection, the supervision and testing of drains, the inspection of Workshops, Bakehouses, Restaurants, Slaughter-houses, Butchers' and Fishmongers' premises, Dairies, Cowsheds, and Milkshops, etc. Much of the substance contained herein will, of necessity, be but a repetition of matters to which the attention of the Council has already been directed through the medium of my monthly reports, but this Report will give a clearer and more comprehensive record of the work carried out during the year than it is possible to obtain from them. Table V. gives a summary in detail of the various nuisances abated and sanitary improvements effected. 43 Notices Served. — Seven hundred and ninety-nine Preliminary Notices or intimations were served during the year in respect of 1,390 houses, and it was only found necessary to serve 158 Statutory Notices upon the owners or occupiers of 200 houses. I have pleasure in acknowledging that owners and agents of property in the district have generally shown willingness to co-operate with me in dealing with the numerous insanitary conditions discovered, and have in almost every instance readily complied with suggestions I have been able to make from time to time in order to effect a general improvement in the condition of their property. The policy of sending an intimation notice or letter to the person in default, pointing out the defects, etc., found, and the work necessary to remedy the same, is a good one, inasmuch as owners or agents generally readily fall into line and comply with its requirements much more willingly than if the matter had been first brought to their notice by means of a Statutory Notice served by order of the Local Authority. They realise that it is my desire, on behalf of the Local Authority, to obtain the abatement of the nuisance, or the remedying of the breach of bye-law, with as little friction as possible, and that I am always ready to offer suggestions in order to enable them to attain the desired end with as little cost as is compatible with efficiency. There is always a tendency to resent compulsion, and therefore any method which secures a maximum amount of work being carried out with a minimum of friction is the one to be aimed at, for the reason that by meeting the owner or agent at the property and discussing the faults or defects found, and the best and most economical way of remedying them, it is often possible to secure more work being done than could ever be enforced by a nuisance notice. Opening up of Drains under Section 41 of the Public Health Act, 1875.—As the result of applications of the smoke or chemical test, it was found necessary to exercise the powers with respect to the opening up of ground and exposing of drains granted to the Local Authority by this Section at 21 houses, authority first having been obtained from the Council, and due written notice given to the occupier, in each case. The conditions found were duly reported to the Public Health Committee and notices served on their instructions requiring the re-construction or amendment of the defective drains, etc., as the circumstances required. In only one instance was the notice not complied with. In this case as the work had not been executed on the expiration of the time specified in the notice, I 44 reported the matter to the Public Health Committee, and it was then resolved that the drains he relaid and such other sanitary provisions made, and that the cost of the work necessary for that purpose be recovered from the owners. An arrangement was afterwards entered into by the Council and the owners whereby the latter, at their request, agreed to pay the cost of the foregoing work, plus interest, in four quarterly instalments. They are now doing this. House Drainage.—The drainage systems and sanitary arrangements of 44 houses have been entirely reconstructed, and repairs or extensive amendments were carried out at 118 other houses. It is very gratifying to me to be able to report that in only one instance was it necessary to take legal proceedings to enforce the abatement of a nuisance from defective drainage. In this case a "nuisance order" was obtained from the Magistrates who also imposed upon the defendant a penalty of £1 8s. 6d., including costs, for failing to comply with the statutory notice of the Local Authority, and ordered that the work be completed within three days, in default of which a further penalty of 10s. would be incurred. The opinion I have expressed in previous reports as to the unreliability of stoneware pipes as at present used for house drainage, especially when in a clay soil, and the advantages gained by the use of cast iron pipes, has been strengthened by observations I have made during the year. It cannot be denied that stoneware drains as at present constructed are unreliable, and in many instances rapidly develop defects which render them neither smoke nor water-tight. Property owners will be well advised to use cast iron pipes for drainage; they will find them in the end by far the cheaper method of construction, as under ordinary circumstances they maintain a nearly permanently water-tight drain. House to House Inspection.—During the year house to house surveys were carried out at 973 houses. The following lists (a and b) show the particular streets and the number of houses inspected in each, together with the remedial works executed at 628 houses. In no case was it found necessary to serve a closing order: — 45 (a) Coppermill Lane 17 houses. Dryden Road 18 ,, Hamilton Road 90 ,, Hardy Road 111 ,, Hartfield Crescent 10 ,, High Street, North 7 ,, High Street, South 6 ,, Milton Road 63 ,, Nelson Road 110 ,, North Road 63 ,, Palmerston Road 115 ,, Quicks Road 87 ,, Ridley Road 58 ,, Russell Road 154 ,, Tennyson Road 11 ,, Wandle Bank 33 ,, Total 973 ,, (b) Accumulations removed 3 Cisterns provided 2 Cisterns repaired, cleansed or covered 108 Drains, new provided 6 Drains, repaired or altered 11 Drains, stoppages removed 22 Dustbins provided 54 Flushing boxes, new provided 11 Flushing boxes, repaired 78 Manure receptacles provided 2 Overcrowding nuisances abated 3 Rainwater pipes disconnected 26 Roofs repaired 150 Rooms stripped and cleansed 273 Soil pipes, new provided 4 Soil pipes, repaired or altered 5 Ventilating pipes, new provided 24 Ventilating pipes, repaired or altered 7 Waste pipes, new provided 20 Waste pipes, repaired, disconnected or trapped 60 Water closets, new provided 34 Water closets, repaired or ventilated 3 Water services restored 1 Yards cleansed 5 Yards paved 110 Guttering repaired 92 Floors ventilated 143 Nuisances abated from damp walls 141 Other nuisances abated 208 Total 1606 46 Housing and Town Planning Act.—Prior to last year there were very few houses in the district to which Sections 14 and 15 of the Housing and Town Planning Act, 1909, applied, that is, which had been let at a rental below £16 per annum since the commencement of the Act. The last Official Census, however, showed the population of the borough to exceed 50,000, in which case the standard of rent is raised by the Act to £26 per annum; consequently the number of houses or parts of houses let at rentals below that figure probably amounts to over four thousand. Of these it is impossible to say in how many cases the contract to let has been made since the Act came into operation, thereby bringing them within the provisions of Sections 14 and 15. Of the 973 houses which were house to house inspected during the year, 347 were found to come below the rental mentioned in Section 14. The nature of the defects found in many houses was as follows:—Excessive dampness of walls, due either to decayed brickwork or the absence of any damp-proof course, or both; defective floor timbers and flooring; absence of an impervious material over the site; want of ventilation under the floors; dilapidated condition of roofs, etc. The remedial work necessary, i.e., the insertion of dampproof courses, provision of cement concrete over the sites of the houses and means of adequate ventilation under the floors, etc., is of such a nature as to necessitate almost daily re-inspection while it is being carried out, otherwise portions may be scamped or improperly done, and the benefit of the expenditure incurred in great measure nullified. In a number of the houses visited where the waste pipes to the sink are of 2½in. stoneware, of considerable length, constructed under the scullery floor and not trapped, the tenants complained of the very bad smells noticed. I communicated with the Agents of the properties, and also met and discussed with them the advisability of trapping these waste pipes; this to my mind being the only reliable remedy. In every case they agreed to my suggestions, and after the work had been executed the premises were again visited, and not in a single instance had smells been noticed since the work had been done. 47 48 STATEMENT, REQUIRED BY LOCAL GOVERNMENT BOARD, UNDER ARTICLE V. OF THE HOUSING (INSPECTION OF DISTRICT) REGULATIONS, 1910, IN REGARD TO THE INSPECTION OF DWELLING-HOUSES UNDER SECTION 17 (l) OF THE HOUSING, TOWN PLANNING, ETC., ACT, 1909. Number of dwelling-houses inspected under and for the purposes of the Section 973 Number of such dwelling-houses which were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation Number of dwelling-houses in respect of which representations were made to the local authority with a view to the making of closing orders — Number of dwelling-houses in respect of which closing orders were made by the local authority — Number of dwelling-houses the defects in which were remedied without the making of closing orders 628 Number of dwelling-houses which, after the making of closing orders, were made fit for human habitation — General character of the defects found to exist in the dwelling-houses inspected *Excessive dampness of walls, due to either the decayed brickwork or the absence of any damp proof course, or both; defective floor timbers and flooring; absence of impervious material over site; want of ventilation under floors; absence of or defective condition of yard paving or defective drains and sanitary fittings. House Inspection.—Either as the result of inspections made on complaint, in consequence of the occurrence of infectious disease, requests by occupiers and other general inspections, the following work was executed at 1,040 houses; these, together with the 973 previously mentioned, making a total of 2,013 houses where the details of inspection have included those required by the Housing (Inspection of District) Regulations made under Section 17 of the Housing and Town Planning Act:— Accumulations removed 91 Cisterns provided 29 Cisterns repaired, cleansed or covered 53 Drains, new provided 38 Drains, repaired or altered 107 Drains, stoppages removed 106 Dustbins provided 72 Flushing boxes, new provided 33 Flushing boxes, repaired 117 Manure receptacles provided 8 Overcrowding nuisances abated 42 Rainwater pipes disconnected 136 Roofs repaired 46 Rooms disinfected 871 Rooms stripped and cleansed 616 Soil pipes, new provided 22 Soil pipes, repaired or altered 26 Ventilating pipes, new provided 50 Ventilating pipes, repaired or altered 32 Waste pipes, new provided 93 Waste pipes, repaired, disconnected or trapped 36 Water closets, new provided 75 Water closets, repaired or ventilated 31 Water services restored 20 Yards cleansed 21 Yards paved 115 Guttering repaired 25 Floors ventilated 81 Nuisances abated from damp walls 147 Other nuisances abated 522 Total 3661 One of the chief outstanding facts revealed by these inspections is the almost total absence of any proper accommodation for the occupiers to store food. The general provision appeared to be a cupboard under the stairs in the passage or kitchen, or one improvised by means of an old box in the 49 scullery: all without any light or ventilation to the external air. It is unfortunate that the Building Bye-laws do not permit the Local Authority to insist upon the provision of adequate accommodation for the storage of food. Re-inspections made of property where sanitary improvements and alterations have been carried out, such as paving of spaces round dwellings, repairing of defective plastering to walls, cleansing of rooms, etc., have shown that in the majority of cases such alterations, etc., are appreciated by the tenants; they constitute a strong factor in inducing them to keep their premises in a cleanly condition, and a marked improvement has been maintained in many cases. Nothing is more disheartening to a housewife than to go into a house where the plastering to walls is defective, walls and ceilings dirty, and flooring with holes in it. Under such circumstances there is no inducement to the occupier to put or keep the house and its surroundings in a proper state. In the poorer parts of the district people have very little choice in the matter of house accommodation, and are very often compelled to enter into occupation under conditions such as those mentioned above because they are unable to afford to pay more rent than that at which many of these houses and tenements are let. Houses Let in Lodgings.—There are 64 of these houses on the Register, and 332 visits of inspection were made during the year. Twelve houses, formerly let in lodgings, were during 1911 converted from double tenements into single houses, consequently the bye-laws do not now apply, and they have been removed from the Register. In all but a few instances the owners have carried out the work required under the bye-laws, such as periodical cleansing of walls and ceilings, etc., readily, but considerable difficulty has been experienced in dealing with matters for which the occupiers are responsible. For some reason, in certain houses most dirty and indolent tenants have obtained possession; I have heard that they are. principally those who have been ejected from property in London, and have found Wimbledon the first district outside where they could obtain accommodation at anything like the same rents they have hitherto paid. Whenever the Inspectors call, whether it be morning, afternoon, or evening, and the dirty condition of the floors, etc., is pointed out to them, their usual response is that they are "Just going to clean up or they try in some other way to justify their own default, complaining of the condition of the structure of the premises, apparently forgetting that they themselves are responsible for much of their dilapidated condition. In some instances the tenants have been ejected by the owners principally for their gross neglect and dirty habits. 50 The owner of a certain block of these premises is continually changing her agent, and just as the effect of one agent's effort to get a better class of tenant are beginning to bear fruit, she admits some undesirable persons who are soon followed by others of a similar character, and thus drives out the more respectable families. During the year one agent took proceedings in the police court and obtained ejectment orders against the majority of the tenants, and stripped and cleansed the rooms throughout, only to find that he had the same to do again a few months later. The condition of other tenements is, by their scrupulous cleanliness and neatness, a pleasure to see, reflecting the greatest credit on the occupiers, many of whom are in very poor circumstances, which fact makes it all the more creditable to them. Verminous Rooms.—This matter has continued to receive the attention of the department during the year, 58 rooms having been dealt with. As previously the necessary notices were served upon the person responsible, whether occupier or owner. Every assistance has been given to those who were anxious to free their premises from vermin, and fumigants have been supplied at cost price, or fumigation carried out by the disinfector at the owners' expense after the walls had been stripped, as required. Intimations from the Medical Officer of Health, or from Teachers of the Public Elementary Schools, were received in respect of the verminous condition of 52 children from 44 houses. Inspections were made resulting generally in the improved condition, as regards cleanliness, of the children's clothing, and in the cleanly state of the rooms and bedding, where these were found verminous or insanitary. In the worst instances a large number of visits were necessary before the desired improvements were obtained. Common Lodging Houses.—The Keeper of the Common Lodging House, 188, High Street, South Wimbledon, died on 7th February, 1913, and the premises were closed shortly afterwards. I reported on the matter to you in my Monthly Report, and it was resolved that the house be struck off the Register; this was done. Towards the close of the year I was approached by the Owner's Agent with a view to his again letting the premises for the same purpose as previously. I met him on the property and pointed out that certain works would be required to be done before I could report the house suitable. These works, including the provision of new lavatory basins, alterations to 51 drains, cleansing and painting and colour-washing of the interior of all rooms and cubicles, repaving of yard, etc., were satisfactorily executed. An application for the premises to be registered was received on 6th October, .1913, from the intending occupier, when the Public Health Committee resolved that the house be registered and that a Certificate of Registration be granted for a period of 12 months, viz., 1st January to 31st December, 1914, and that the Certificate be renewed from time to time, subject to a satisfactory report of the premises being received. A similar certificate was granted for the premises, 42, High Street, South Wimbledon. Inspections of these premises have been made from time to time at irregular intervals, and I am pleased to report that all provisions of the bye-laws were rigidly observed. No complaint was received during the year respecting either Common Lodging House. Van Dwellings.—At irregular intervals throughout the year inspections were made of the vans occupied as dwellings; there have also been special visits made as the result of complaints received from time to time respecting the vans in certain yards. There are in all 37 vans on 12 separate premises, the most in one yard being seven. The internal measurements of all these vans have been taken for the purpose of calculating their cubic capacity. With one or two exceptions these dwellings have been found clean and well-kept, and the provisions of bye-laws relating to Tents, Vans and Sheds complied with. In the few instances mentioned, a verbal warning was sufficient to obtain compliance. The complaints received referred principally to noise, or were the outcome of a sentimental objection to plots of land adjoining the dwelling-houses of the complainants being so used, but not with respect to any breach of the byelaws. The occupiers of the vans appear to be a very healthy set of people, only one case of infectious disease (Scarlet Fever) having occurred amongst them during- the whole of the year. This case was not removed to the Isolation Hospital, consequently it necessitated a daily visit of inspection for the purpose of seeing that all precautions were being observed with a view to preventing the spread of infection. Dairies, Cowsheds and Milkshops.—Twenty new applications were received during the year from persons desirous of being registered under the Dairies, Cowsheds and Milkshops 52 Orders. Before the applications were submitted to the Public Health Committee by the Medical Officer of Health, the premises at which it was proposed to carry ou business were in each case inspected in order to ascertain whether they were of a suitable character from the points of view of lighting, ventilation, cleanliness, drainage, water supply, etc. In certain cases minor alterations were required in order to make them comply with the Regulations of the Local Authority. Periodical inspections have been made of all the premises of dairymen and purveyors of milk in the district, during which 12 matters were discovered which required to be dealt with by the Department, consisting chiefly of the necessity of white-washing and cleansing, and the provision or repairing of paving adjoining milk stores. All the necessary work was satisfactorily carried out by the persons responsible without it being necessary to serve Statutory Notices. Infectious Disease and Disinfection.—During the year visits for the purpose of investigating cases of notifiable infectious disease were made to 326 houses. Special visits were also made, as required, for the purpose of following up and inquiring after the health of persons who had been passengers on vessels coming to this country, on which cases of infectious disease had occurred, and of which notice had been received from the Port Sanitary Authorities concerned. The information obtained was handed to the Medical Officer of Health. At 57 houses from which cases of notifiable infectious disease had been reported, defective drains, or other insanitary conditions were found to exist, all of which were subsequently remedied under the supervision of the officers of the Department. Disinfections of rooms, bedding, clothing, etc., was duly carried out after the removal to hospital or recovery of eacli patient. Where necessary the walls of the rooms from which the cases had been removed were stripped and re-papered. The number of rooms disinfected was 876, and the number of articles of bedding, wearing apparel, etc., 14,497, full details of which are given in the Report of the Medical Officer of Health under the heading of "Disinfection." School Disinfection.—All the Public Elementary Schools in the district were thoroughly disinfected during the Summer Vacation. Yard Paving.—At houses where general nuisances or insanitary conditions were discovered, especially in the poorer parts of the district, special attention was given to the 53 sions of suitable impervious paving laid with a fall so as to carry surface water into the drains provided, in order to prevent it, together with various kinds of filth, being absorbed by the soil or walls of the dwellings. Where this improvement is carried out there is no excuse for the occupier who does not keep the surface of the yard in a cleanly and tidy condition. In the course of the inspections made during the year no less than 225 yards were found to be in an unsatisfactory state, due either to the absence of any paving, or the defective condition of that which did exist. The power to deal with this class of nuisance has been greatly strengthened by the adoption of Section 25 of the Public Health Acts (Amendment) Act, 1907. Several complaints were again received respecting the condition of the passage-ways adjoining and at the rear of houses on the Ashen Grove Estate and other parts of the district. This matter has now been before the Council for some years without a satisfactory remedy being found or applied. Consequently powers to effectually obviate a continuance of this nuisance are being sought for by the inclusion of provisions in the Wimbledon Bill, now before Parliament. Stable Refuse.—Continued attention has been paid to the mews and stable yards in the district, 907 visits having been made to such premises during the year. Less difficulty was experienced than formerly in securing the prompt removal of manure, etc., from stables, the chief reason for which is, I think, that with the advent of the motor car, and the consequent reduction in the number of horses, stable manure has become more valuable, and is therefore more sought after by the market gardeners and farmers in the neighbourhood. Inspections under the Factory and Workshop Act, 1901.— Sixty-five inspections of factories were made during the year, and six written notices served referring to sanitary conveniences or other nuisances. One intimation was received from His Majesty's Inspector of Factories, of defects or insanitary conditions which had been found by him when visiting Factories and Workshops, and one communication was sent to His Majesty's Inspector informing him of the action taken to secure the remedying of the defects or insanitary conditions to which he had called attention. With regard to Workshops and Worlplaces, the Borough Council's duty of supervision may be classed under four heads: 54 1. The sanitary condition generally, which embraces:— (a) Cleanliness, (b) Air space, (c) Ventilation, (d) Drainage of floors, and (e) Sanitary conveniences. 2. The provision of means of escape in case of fire. 3. Special Sanitary Regulations for Bakehouses. 4. Homework. The supervision of means of escape in case of fire is carried out by the Borough Surveyor's Department. There are 321 Workshops and Workplaces on the Register, to which 387 visits of inspection were made. Sanitary Condition of Workshops. (a) Cleanliness. The larger workshops are generally found to be in a cleanly condition, but it cannot be said that the smaller ones are always satisfactory in this respect. Twenty-five workshops were cleansed and whitewashed at the request of the department during the year. (b) Air Space.—Generally speaking, workshops are rarely found to be overcrowded, except on the occasion of the initial inspection; the occupiers are then informed of the maximum number of workers who can be accommodated in each workroom, and this number is seldom found to be exceeded. Three nuisances under this heading were discovered during the year; one of these was remedied, the other two were outstanding at the end of the year. (c) Ventilation. Few cases of insufficient ventilation are discovered, and when found are for the most part generally at newly occupied workshops. It is sometimes found that although sufficient means of ventilation are provided, proper ventilation is not being maintained. One instance of insufficient ventilation, or of ventilation not being maintained was dealt with during the year. 55 (d) Drainage of Floors where "Wet Processes" are carried on. The majority of the premises which come under this heading are small laundries, of which there are 26 on the register. It was found necessary to serve three notices in regard to this matter during the year. One was remedied, and the other two were allowed to stand over till weather conditions were suitable. (e) Provision of suitable and sufficient Sanitary Accommodation. At 7 workshops or factories the sanitary accommodation was found to be insufficient, defective and unsuitable, or not properly separated for the sexes as required by the Home Office Order of 190-3. The requirements of the Department were carried out in six instances, and in the one remaining the necessary work was not completed by the end of the year. Other general nuisances to the number of 52 were discovered during the inspection of workshops, 49 of which were remedied before the close of the year. Special Sanitary Regulations for Bakehouses.— Breaches of these numbered 5, consisting principally of neglect to carry out periodical cleansing and limewashing. All the necessary work was duly carried out satisfactorily. Homework.—Eighty-four visits of inspection were made to Outworkers' premises. It was found necessary to serve 6 notices, chiefly with regard to want of cleanliness of rooms, etc.; these were readily complied with. It was again only found necessary to send eight communications to employers reminding them of the necessity of forwarding lists of their Outworkers, and in each case they were promptly sent in. Details of the visits paid to Factories and Workshops and Workplaces are given on the forms supplied for that purpose by the Home Office, and particulars will be found in the Report of the Medical Officer of Health. Shops Acts, 1912 and 1913.—Thirteen hundred and seven visits were made of the 903 occupied shops in the district to ascertain if the provisions of the Acts were being complied with. The following is a tabulated statement of the result of these inspections 56 57 SUMMARY OF INSPECTIONS UNDER SHOP ACTS, 1912 and 1913. Premises Inspected. Closing Day. Section 4 (3). Young Persons. Section 2 (3). Assistants Half-Holiday. Section 1 (2). Provision or Seats for Female Assistants. Section 3 (2). Employed. Not Employed. Notice Exhibited. Notice not Exhibited. Exempt from affix ing Notice Notice Exhibited. Notice not Exhibited. Exempt. Provided. Not Provided. Notice Exhibited. Notice not Exhibited. 903 287 390 226 103 117 668 109 303 491 236 1 57.6% ... ... 53.1% ... ... 73.5% ... ... .04% It will be seen from the foregoing: that quite a large number of shopkeepers failed to discharge their obligations under the Act, chiefly by not affixing the various notices required by the Statute. On each occasion the provisions of the Act were clearly pointed out to the shopkeepers by the Inspector. During the inspections several complaints were received that shopkeepers were contravening the Act, and observations were consequently kept, and the matters reported to the Public Health Committee, who resolved that legal proceedings be taken in three instances, two for selling non-exempted articles on the closing day, and one for employing four young persons (under age of 18 years) more than the prescribed number of hours (74 per week, including meal times), and also for failing to close the shop on one half-day during a certain week. Only one of these cases was heard during the year, the fine being 1s. and 1s. costs; the other two cases were reported at the close of the year, consequently proceedings were not instituted till 1914. In two other cases a warning was issued, and in forty-one cases where the shopkeepers failed to close their shops on one half-day in the week preceding Christmas week, the Committee resolved that having regard to the special circumstances, the Committee is not prepared to expend public money on proceedings which might be regarded as oppressive, and which would not be conducive to the observance of the Act. Slaughterhouses and Food Inspection.—Two hundred and fifty-six inspections of the six registered slaughter-houses in the district have been made during the year, and I have endeavoured to so arrange these visits that they have taken place whilst slaughtering was in progress, and so that all food animals killed in the town can be examined prior to being exposed for sale. The number of animals examined was 543, comprising: 104 cattle, 3 calves, 270 pigs, and 166 sheep; and out of this number it was only found necessary to condemn and destroy the following as being unfit for human consumption:— 3 bullocks' livers. 1 bullock's offal. 1 heifer's pluck. 3 pigs' carcases. 22 pigs' plucks and offal. 2 sheeps' livers. 58 The chief causes of the condemnation of these articles were Tuberculosis, Abscesses, Flukes and Eckinococcus Cysts. Towards the end of the year there was found to be a prevalence of the Tenuicollis Cyst affecting the cauls of sheep, but in such a degree as not to interfere with the carcase, which, in each case, was passed as fit for human food, after the removal of the affected portions. I can only ascribe this affection to the fact that the sheep had for some prior to slaughter been grazed on marshy land. Frequent visits of inspection have been made not only to the slaughterhouses, but also to the shops of butchers, fishmongers and fruiterers, and other places where food is prepared or exposed for sale, and the following were surrendered and destroyed, being uufit for food:— 12 stones of Whiting. 6 stones of Mackerel. 7 stones of Codling. 3 stones of Gurnard (or Gurnet). 79 lbs. of Walnuts. Sale of Food and Drugs Acts, 1875 to 1907. The following table shows the number and nature of articles purchased and submitted for analysis during the year. The preliminary or test samples were examined by the Council's Analyst, and those taken in accordance with the Acts were submitted to the Public Analyst for the County of Surrey:— Particulars of Samples of Food and Drugs taken and submitted for Analysis. Year ended 31st December, 1913. ARTICLE. Test Sampi.es. Official Samples. Prosecutions No. Genuine Adulterated or Inferior Slightly inferior or deteriorated. No. Genuine. Adulterated or Inferior Slightly nferior or deteriorated. Milk 89 67 10 12 1 1 ... ... ... Butter 112 100 9, 3* 1 ... 1 ... 1 Gin 2 2 ... ... ... ... ... ... ... Brandy 2 2 ... ... ... ... ... ... ... Rum 2 2 ... ... ... ... ... ... ... Whiskey 2 2 ... ... ... ... ... ... ... Cocoa 3 3 ... ... ... ... ... ... ... Demerara Sugar 6 6 ... ... ... ... ... ... ... Coffee 16 10 ... ... ... ... ... ... ... Cream of Tartar 2 2 ... ... ... ... ... ... ... Citric Acid 2 ... ... 2 ... ... ... ... ... Tartaric Acid 2 2 ... ... ... ... ... ... ... Mustard 3 3 ... ... ... ... ... ... ... Pepper 4 4 ... ... ... ... ... ... ... White Precipitate of Lead 1 1 ... ... ... ... ... ... ... Ham 1 1 ... ... ... ... ... ... ... Total 249 213 19 17 2 1 1 ... 1 *Renovated. 59 Observations.—Milk. Of the 89 test samples taken 10 were reported as adulterated or not genuine, 5 by the abstraction of fat varying in amount from 2 to 15 per cent., 3 by the addition of water varying from 2 to 12 per cent., and one being skimmed milk. One official sample was afterwards taken from one of the vendors of the test samples found adulterated, and the Public Analyst's certificate stated that the sample was genuine. Compared with last year there was an increase in the percentage of adulterated samples of milk, 19 or 17.4 per cent. then being found not genuine, against 22 or 24.7 per cent. this year. Butter.—One hundred and twelve test samples of butter were obtained. Of these 9 were reported as not pure, 8 being margarine, and the other 1 containing an excess of water and salt. There was an increase in the percentage of adulterated test samples of butter, 11 or 10'6 per cent. being found not genuine last year, as against 12 or 10'7 per cent. this year. Legal proceedings was taken in one instance for offences under the Sale of Food and Drugs Acts. The particulars are as follows:— For selling margarine as butter in an unmarked wrapper. The defendant was fined £13 1s. 0d., including costs. Petroleum Acts.—Forty-three applications were received for permission to keep petroleum, thirty-three being for the renewal of existing licences, and ten for new ones. After an inspection of the premises and proposed place for storage had been made in each case, the licences were granted on the recommendation of the Public Health Committee. The quantity of petroleum authorised to be kept varied from 20 to 14,000 gallons. The majority were for from 20 to 100 gallons, but in four cases the amounts were 1,000, 2,000, 3,000 and 14,000 gallons respectively. The buildings for storing these latter quantities were specially constructed for the purpose, being built partially under the ground; the first and fourth are fitted with modern fire extinguishing appliances. The licence in respect of the 14,000 gallons was taken out by the London General Omnibus Co., Ltd., for their new Garage erected at High Street, South Wimbledon, at the end of the year. 60 The greater number of the licences were for the sale or storage of petrol, chiefly for use in motor cars; one was for benzoline and petrol; one for benzoline; and one for hydrocarbon produced at the London and South Western Railway Gas Works, Durnsford Road. Eighty-five inspections were made of the various premises in respect of which licences had been issued. Only one breach of the Acts was discovered; the facts are as follows:— A licence was granted for certain premises up to 31st December, 1912. Before the expiration of that licence two notices in writing were sent to the occupier calling attention to the necessity of a new licence being applied for, for the year 1913, but no reply to the communications was received. After purchasing two separate quantities of petrol, I obtained a magistrate's search warrant, and then searched the premises, whereon I found 18 two-gallon cans of petrol which I seized and brought away. Subsequently legal proceedings were instituted and a conviction secured, the defendant being fined £5, with £1 1s. advocate's fee, and 9s. 6d. costs. The petroleum seized was also forfeited, but later was re-sold to the defendants at 1/5 per gallon, realising £2 8s. 2d. Diseases of Animals Acts, 1894—1911. Parasitic Mange.—Four cases occurred at four separate stable premises, i.e., South Road, Haydons Road, Merton Road and Durham Road. In the two former cases information was given to me by an Inspector of the lt.S.P.C.A. that he suspected an animal to be suffering from Parasitic Mange, and I visited the premises in company with the Veterinary Surgeon, Mr. F. W. Chamberlain, who confirmed the diagnosis. Later I reported the matters to the Watch Committee, who, after carefully viewing the whole facts, considered the cases were not such as would warrant proceedings being taken. In the other two cases the respective owners called in a Veterinary Surgeon, who gave notice at once. As each case was notified the necessary detention notices were served, and returns made to the Board of Agriculture. On the recovery of the affected animals thorough disinfection of the premises, harness, etc., was carried out. Swine Fever.—Several outbreaks of this disease occurred in different parts of the country, one being so near the district as to include Merton, Morden, Mitcham, etc., within the limits of the infected area, but happily no case occurred in Wimbledon. 61 Foot and Mouth Disease.—A number of outbreaks were reported in various parts of tlie country during the year, tlie nearest to this district occurring at West Ham, near Eastbourne, Sussex. In consequence of this outbreak a warning telegram, followed by a confirmatory letter, was received by the Town Clerk from the Board of Agriculture and Fisheries, to the effect that we were to "warn all concerned and direct the Police to make careful inquiries with a view to immediate reports being made to the Board in case of any suspicious outbreak occurring amongst live stock." Immediately on receipt of this communication I visited all places where animals were kept and warned the persons in charge; but no case occurred in the district. In the early part of the year notices for distribution amongst persons concerned were received from the Board with reference to hay and straw used for the packing of foreign imported goods being likely to promote the spread of the disease if used for manure on farms. It. recommended that persons using such hay and straw should be warned of the element of danger which it contains, and of the risk of allowing it to come in contact with any animals; it also advised that where possible it should be burned. In all there were twenty-two various orders received from the Board during the year, chiefly respecting Foot and Mouth Disease in other parts of the country, landing of animals, etc., some of which had to be distributed locally for the guidance of persons likely to be affected by the orders. One hundred and fifty-four visits were made in connection with administration of these Acts during the year. The necessary weekly and special returns have been made to the Board of Agriculture as required. I have accompanied the Council's Veterinary Inspector when examining cows belonging to Cowkeepers in the district, and those of the Contractor supplying the Borough Isolation Hospital, for Mammary Tuberculosis. Five hundred and three examinations were carried out by him, and all the cows were found to be healthy. Tuberculosis Order, 1913.—On 1st May, 1913, this Order came into operation, and entailed an inspection of all dairy cows within the district immediately prior to this date. I accompanied your Veterinary Inspector (Mr. F. W. Chamberlain) to the various Cowsheds in the borough, and the necessary inspections were made by him. I am pleased to report that in no instance was any animal found to be affected with the disease. 62 The Order contains practically the same substance as the previous Order of 1909, which order did not, however, come into operation. The chief provisions include the compulsory notification by the Owner, or person in charge, of "any cow which is, or appears to be, suffering from "tuberculosis of the udder, indurated udder, or other "chronic disease of the udder; or any bovine animal "which is, or appears to be, suffering from tubercu"losis with emaciation." And it further requires a Veterinary Surgeon attending any such infected animal during his practice to notify the Local Authority. In this latter case a fee of 2s. 6d. is paid for each notification, except when several animals examined at the same time and place are notified at the same time, in which case only one fee is payable. Among other powers contained in the Order are provisions for inspection and examination of animals, for the slaughter of diseased animals, post-mortem examination of slaughtered animals, compensation, precautions to be adopted with respect to milk, etc., detention and isolation of suspected animals, cleansing and disinfection of cowsheds and premises, etc. It has not been in force sufficiently long for one to judge of its effect. At the same time, it is undoubtedly an order of great merit, and one of the most important steps in the right direction to fight against the dread disease, which, it is contended by the leading authorities, is largely conveyed to human beings through the medium of infected cow's milk. During September and October of this year several complaints respecting bad smells were received from residents in the neighbourhood of Plough Lane, Havelock Road, Garfield Road, Milton Road, and Haydon's Road, and from observations kept during the day and evening time by the staff of my department, I had no hesitation in reporting to the Public Health Committee that the complainants undoubtedly had just cause for their complaints. The Committee after careful consideration of all the facts resolved that the Town Clerk be directed to notify the Authority concerned of the complaints, and to ask for a specific assurance that steps would be taken at once by them so as to improve their Works, that no nuisance can arise therefrom, and that a copy of the correspondence which has passed between the Town Clerk and the Authority with respect to the nuisances from their Works since July, 1912, be sent to the Local Government Board. 63 The erection of a Motor Garage, with workshops, etc., by the London General Omnibus Company, in High Street, Merton, has been the means of bringing into the neighbourhood a large number of workers whose regular employment depends on their character and habits; these, with their families, number nearly 1,000 people. The influx has already had a satisfactory effect on the houses in some of the roads adjoining the Garage, the owners having put their property into a much better state of repair and the less respectable class of tenants having had to make room for the new comers. There have been several changes in the personnel of the staff during the year under review. Early in March Mr. E. S. Robinson, Senior District Inspector for many years, was successful in obtaining a position as Sanitary Inspector under the Corporation of the City of London. This necessitated a re-arrangement of the staff, and in consequence Mr. R. T. Avis was promoted to Senior Assistant Inspector, Mr. D. Pickard to Second Assistant Inspector, and Mr. D. Flynn, clerk, to Junior Assistant Inspector. In June Mr. G. H. Fowler, who had for over 3½ years been Clerk in my Department, obtained the position of Sanitary Inspector under the Borough Council of Finsbury. He had obtained the necessary qualifications and certificates for such a position during the time he was here. The work of the Department has of necessity suffered through these changes, Mr. Robinson's experience of some 15½ years, and Mr. Fowler's of 3½ years, being replaced by officers of less experience or quite new to the work, as well as the loss of nearly four months working time. I again have pleasure in acknowledging the loyal support I have received from all the staff, and to thank my colleagues in other departments for their co-operation so generously given me at all times. I am, Gentlemen, Your obedient Servant, HENRY JOHNSON, M.R.S.I. 64 STATISTICAL TABLES. 65 66 BOROUGH OF WIMBLEDON. TABLE 1. Vital Statistics of Whole District during 1913 and Previous Years. YEAR, Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. nktt Deaths belonging to the District. Uncorrected Number. Neit. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 51,166 1144 - 22.3 454 8.8 7 71 82 71 518 101 1909 52,536 1181 - 22.4 451 8.5 7 64 91 77 508 9.6 1910 53,519 1159 — 21.4 426 7.9 15 49 86 74 460 8.5 1911 55,317 1117 1134 20.5 496 8.9 22 119 125 110 593 10.7 1912 56,729 1102 1120 19.7 435 7.6 26 119 76 67 528 9.3 1913 58,156 1084 1116 19.1 500 8.6 26 154 117 104 628 10.7 Area of District in acres (land and inland water) 3173 Number of inhabited houses (at Census of 1911) 12,566 Total population at all ages (at Census of 1911) 54,875 Average Number of persons per house ,, 4.36 67 BOROUGH OF WIMBLEDON. tabse ii. Cases of Infectious Disease Notified during the Year 1913. notifiable disease. Number of Cases Notified. Total Cases Notified in Each Locality (e.g. Parish or Ward) of the District. Total Cases removed to Hospital. At all Ages. At Ages—Years. St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards i 2 3 4 5 6 Small-pox - - - - - - - - - - - - - - - Cholera (c) Plague (p) - - - - - - - - - - - - - - - Diphtheria (including Membranous croup) 129 1 17 93 8 8 2 - 16 3 4 8 35 63 106 Erysipelas 29 - - 5 - 6 12 5 2 5 1 4 3 14 - Scarlet fever 147 3 18 93 21 12 - - 21 7 17 20 30 52 108† Typhus fever - - - - - - - - - - - - - - - Enteric fever 8 - - 3 3 2 - - 1 - 2 - 4 1 5 Relapsing fever, Contd. fever - - - - - - - - - - - - - - Puerperal fever 2 - - - 1 1 - - - - - 1 1 - 1* Cerebro spinal Meningitis 2 - - 1 - - 1 - - - - - 1 1 1* Poliomyelitis - - - - - - - - - - - - - - - Pulmonary Tuberculosis 109 1 - 15 30 44 17 2 25 7 8 8 22 39 - Other forms of Tuberculosis 39 - 9 19 5 4 2 - 5 1 5 7 8 13 - Ophthalmia Neonatorum 1 1 - - - - - - - - - - 1 - - - Totals 466 6 44 229 69 77 34 7 70 23 37 48 105 183 221 * Wimbledon and Merton Hospital (Nelson Hospital). † Two cases removed to Western Hospital (Metropolitan Asylums Board) and one to London Fever Hospital. Isolation Hospitals:—Borough Isolation Hospital, Gap Road, Wimbledon; Croydon and Wimbledon Joint Small-pox Hospital, Cheam, Surrey. 68 BOROUGH OF WIMBLEDON. TABLE III. Causes of, and Ages at, Death during the year 1913. CAUSES OF DEATH. nett deaths at the subjoined ages ok "residents" whether occurring within or without the district. total deaths whether of "residents" or" nonresidents" in institutions in the district. All Ages. Under year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 628 117 37 16 22 19 78 139 200 41 Uncertified — — — — — — — — — - Enteric Fever 4 — — — 1 1 1 1 — 1 Small-pox — — — — — — — — — - Measles 21 2 13 4 2 — — — — - Scarlet Fever 1 — — 1 — — — — - Whooping Cough 3 1 2 — — — — — — - Diphtheria and Croup 6 - 1 2 2 1 — — — 4 Influenza 15 — 1 — — 1 2 7 4 — Erysipelas 1 — — — — — 1 — — — Phthisis (Pulmonary Tuberculosis) 51 1 1 1 1 5 24 14 4 1 Tuberculous Meningitis 2 — — — 2 — — — — — Other Tuberculous Diseases 10 1 1 3 1 2 2 — — — 69 Cancer, malignant disease 54 — — — — 1 5 27 21 7 Rheumatic Fever 3 — — — 1 1 - 1 - 1 Meningitis 10 3 — 1 4 — — 2 - - Organic Heart Disease 47 — 1 — 2 2 7 12 23 2 Bronchitis 36 8 1 — — - 1 4 22 - Pneumonia (all forms) 48 13 6 3 3 — 6 12 5 - Other Diseases of Respiratory organs 3 1 — — — — — 1 1 - Diarrhoea and Enteritis 40 30 5 1 - - 1 1 2 Appendicitis and Typhlitis 4 - — 1 — - 2 1 - - Cirrhosis of Liver 6 — — — - - - 4 2 - Alcoholism 2 - - - - - 1 1 - Nephritis and Bright's Disease 22 1 — — — - 2 6 13 3 Puerperal Fever 1 - - - - - 1 - - - Other accidents and diseases of Pregnancy and Parturition 3 1 - - - - 2 - - - Congenital Debility and Malformation, including Premature Birth 36 34 2 - - - - - - 1 Violent Deaths, excluding Suicide 7 4 - — - - 1 - 2 - Suicides 6 - — — — 1 3 2 - - Other Defined Diseases 183 17 3 — 2 4 14 42 101 21 Diseases ill-defined or unknown 3 — — — — — 2 1 - - Totals 628 117 37 16 22 19 78 139 200 41 Sub-entries included in above figures. Cerebro spinal Meningitis 2 - - - 1 - - 1 - - Poliomyelitis - - - - - - - - - - Broncho Pneumonia 19 9 5 2 1 — — 1 1 70 BOROUGH OF WIMBLEDON. TABLE IV Infant Mortality during the Year 1913. Nett Deaths from stated Causes at various ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3 4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Certified 22 6 4 8 40 30 17 18 12 117 Causes Uncertified - — — — — — — — — — Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - 1 1 2 Scarlet fever - - - - - - - - - - Whooping-cough - - - - - - - - 1 1 Diphtheria and Croup - - - - - - - - - - Erysipelas — — — - - - - — - - Tuberculous Meningitis — — — - - - - - - - Abdominal Tuberculosis.. - - - - - 1 - - - 1 Other Tuberculous Diseases - - - - - - - - 1 1 Meningitis (not Tuberculous) - - - - - - 1 2 - 3 71 Convulsions - 1 — — 1 - - - - 1 Laryngitis — — — — — — — — — - Bronchitis — — — 1 1 5 — 1 1 8 Pneumonia (all forms) — — — 2 2 1 3 6 1 13 Diarrhoea — — — — — 6 5 2 1 14 Enteritis — — — — — 5 4 2 2 13 Gastritis — — — — - 3 - - - 3 Syphilis - — — — — — — — - - Rickets — — — — — — - — - - Suffocation, overlying 1 — — 1 2 1 — — - 3 Injury at Birth 3 - — — 3 — — — — 3 Atelectasis 2 — — — 2 1 — — — 3 Congenital Malformations 2 1 1 — 4 — 1 — - 5 Premature Birth 7 2 1 — 10 3 — — — 13 Atrophy, Debility and Marasmus 5 1 2 4 12 3 1 — — 16 Other causes 2 1 — — 3 1 2 4 4 14 Totals 22 6 4 8 40 30 17 18 12 117 legitimate 1043. Nett Births in the year illegitimate 73. legitimate infants 111. Nett deaths in the year of illegitimate infants 6. TABLE V. The following is a summary of the nuisances abated and sanitary improvements carried out under the supervision of the Inspectorial Staff:— Accumulations Removed 94 Cisterns Provided 31 Cisterns Repaired, Cleansed or Covered 161 Drains, New Provided 44 Drains, Repaired or Altered 118 Drains, Stoppages Removed 128 Dustbins Provided 126 Flushing Boxes, New Provided 44 Flushing Boxes, Repaired 195 Manure Receptacles, Provided 10 Overcrowding Nuisances Abated 45 R.W. Pipes Disconnected 162 Roofs Repaired 196 Rooms Disinfected 871 Rooms Stripped and Cleansed 889 Soil Pipes, New Provided 26 Soil Pipes, Repaired or Altered 31 Ventilating Pipes, New Provided 74 Ventilating Pipes, Repaired or Altered 39 Waste Pipes, New Provided 113 Waste Pipes, Repaired, Disconnected, or Trapped 96 Water Closets, New Provided 109 Water Closets, Repaired or Ventilated 34 Water Services Restored 21 Yards Cleansed 26 Yards Paved 225 Guttering Repaired 177 Floors Ventilated 224 Nuisances Abated from Damp Walls 338 Other Nuisances 730 Total 5377 72 Borough of Wimblebon. EDUCATION DEPARTMENT. ANNUAL REPORT of the School medical Officer for the YEAR ENDED DECEMBER 31st, 1913. To the Members of the Education Committee of the Borough of Wimbledon. Ladies and Gentlemen, I beg to present my Annual Report of the medical inspection of the children attending the Public Elementary Schools in Wimbledon for the year .1913. On May 14th, the Committee decided to institute a School Clinic for the treatment of common skin diseases (including ringworm), minor external diseases of the eyes, discharging ears, and uncleanliness associated with pediculosis, and to provide dental treatment. Sanction was obtained for this, from the Board of Education, on December 6th, 1913, and one hopes that a large number of these untreated cases will be dealt with under this scheme. Southey Hall, the Inspection Centre, has been altered to provide the dental room, and facilities for a general clinic. By the establishment of the School Clinic one can look forward with confidence to a very considerable increase in the number of cases dealt with which require treatment for defects found during inspection. Cleanliness, I am glad to say, remains satisfactory, with the exception of a few families which it seems impossible to do anything with. Some of them have been fined repeatedly with very little benefit. 73 As during 1912 a very large proportion of the work has been followed up, i.e., endeavouring to obtain treatment for cases found, as a result of inspection to require it, but in spite of all efforts the percentage treated still remains about the same, that is, roughly fifty per cent. This is due mainly to the following causes:— (i) Poverty of the parents, combined with (ii) Want of facilities for getting certain classes of treatment, and (iii) The age period at which leavers are examined (i.e., from 13 to .14), which means that they are often examined within a few weeks of leaving school so that within a very short time they pass out of our control altogether, and one finds as a matter of experience that, particularly in the case of eye defects, as soon as the child leaves school the parents are apt to let the matter slide altogether. There are a certain number of cases which give considerable trouble in that they get no treatment as they say that they cannot afford either to pay for a doctor or to go to a hospital, and some of these, if referred to the Invalid Children's Aid Association, are returned as unlielpable, and they will not go to the Poor Law, and at the same time the defects for which treatment is required are of such a character that there would not be much chance of obtaining a conviction under the Children Act, with the result that these conditions go on indefinitely. Owing to the form in which the Chief Medical Officer of the Board of Education has asked for the statistics to be made out the majority of the tables are put together as an appendix. A.—" General review of the hygienic conditions prevalent in the Schools of the Local Education Authority in respect of such matters as surroundings, ventilation, lighting, warming, equipment, and sanitation, including observations on the type and condition of sanitary conveniences and lavatories, water supply for washing and drinking purposes, the cleanliness of schoolrooms and cloakrooms, arrangements for drying children's cloaks and boots, and the relation of the general arrangements of the School to the health of the children." Owing to the inefficient lighting at Haydon's Road Girls' and Infants' School I drew up a specification specifying, amongst other things, a minimum light on each desk of 3.5 74 foot candles. The Joint Committee on School Lighting recommended a minimum of two foot candles. My reason for specifying 3.5 was partly due to the number of eye defects in the school, and partly due to the class of children attending that school, in addition to which due allowance must be made for depreciation owing to the wear in the mantles. In order to find the best position for the lights which would give a left lateral light with even distribution in the room, the Gas Company put in several experimental installations and the final position of the lights are shown on the accompanying diagrams. Room 5 in the Girls' Department is a large room, 29ft. 6in. by 20ft., containing two classes. The lamps were placed at slightly different heights, and with the positions shown on the diagram one was able to obtain a minimum of four foot candles in the furthest corner of the room. The light in this case is extremely satisfactory, free from shadow, and on the whole rather higher than is necessary. In this room the old burners consumed 40 cu. ft. of gas per hour the new installation gives nine or ten times the light with a consumption of 48 cu. ft. per hour. In room 5 in the Infants' Department which is 23ft. 9in. by 20ft. more use was made of the reflecting surface of the walls and the lights placed only one foot from the left-hand wall so that again there is in this case left lateral lighting with freedom from shadow. The figures in this case show the lighting with the old and new installations as measured by the lumeter. It will be seen that in this case with the old burners the maximum light was .2G foot candles with a consumption of 40 cu. ft. per hour, whereas the new installation gives a minimum of 3.5 foot candles with a consumption of 24 cu. ft. per hour. In Room 6, eight lamps were installed of approximately 50 candle power each and consuming 2'5 cu. ft. per hour, but this installation was unsatisfactory, as owing to the smaller candle power it was necessary to bring the lights nearer to the desks, and, although the distribution of the lights was even, awkward shadows were produced. The various positions and characters of the lights were only arrived at after numerous experiments with different globes and burners and alterations in their positions, and numerous measurements with the lumeter. In Room 5 in the Infants' Department it was estimated that to produce the same illumination by electric light, that is, a minimum of 3.5 foot candles at the necessary distance, would have cost almost threepence per hour, whereas the cost of gas worked out at just over three-farthings per hour. 75 The introduction of the half-watt lamp has, however, opened up possibilities, and we propose to see whether something can be done in this direction. During the year I have also been instructed to report on the lighting of the Central Schools. 76 Class-room, No. V. Infants', lit by four batswing burners, burning 40 cub. ft. per hour. Owing to the ceiling being lit the vault of the room looks comparatively well lit. Compare the light on the floor and details in the right-hand corner with the next figure. Maximum light: '7 foot candles. This is greater than shown on the plan as new burners were installed for the photograph. The best comparison of the light on the desks is made by covering the upper part of this and the next diagram as low down as the top of the clock. The same class-room lit with six Bray's 1912 inverted burners, consuming 4 cub. ft. per hour at 30/10 pressure. Note the light on the desks and floor and details in right-hand corner. Cost rather over 3/4d. per hour. Equivalent light by electricity estimated at 3d. per hour. Maximum light, 5 foot-candles; minimum, 3.5 foot-candles. Plan of lights in re-lighting Haydons Road Infants' School. The larger figures show the new lighting in foot-candles, and the smaller figures the old. The present lighting is by 6 Bray's 1912 inverted burners consuming 4 cub. ft. an hour at 30/10 pressure. The candle-power is approximately 90 at an angle of 45º. Each lamp is fitted with a 12-in. enamelled iron reflector and "Nico" bulb of clear glass. Plan showing the disposition of the lights in Room 5 of the Girls' Department. The lighting of this Room is carried out by 6 "Nico" self-intensifying lamps of approximately 300 candle-power each at 45°. The consumption of the six lamps is 48 cub. ft. per hour at pressure. The globes used are of clear glass of the pear-shaped pattern. It was found impossible to get satisfactory lighting with anything but pear-shaped clear globes, several others being tried but they did not give nearly such satisfactory results as the pear-shaped pattern. The gas supply to the lamps is regulated by a 3/4" Governor of the Foster pattern. The figures show the lighting in foot-candles at the different positions. B.—"General description of the arrangements which have been made for the co-relation of the School Medical Service with the Public Health Service and for the organisation and supervision of medical inspection, and an account of the methods of inspection adopted." (a) Co-Relation of the School Medical Service with the Public Health Service. The School Medical Officer is also Medical Officer of Health. (b) Methods of Inspection. Owing to the delay in the installation of the heating apparatus at Southey Hall, and its inefficiency when installed the routine examinations at Haydon's Road, and St. Mary's Schools were upset as it was impossible to get an adequate temperature in the cold weather wherein to examine the children. This, however, has now been remedied. (c) Results of Notices sent to Parents with regard to Treatment. As will be seen from Table II. about 50 per cent. of the cases in which notices have been sent have obtained treatment, and the reasons for treatment not being obtained in the remaining cases are set forth in the above-mentioned table. The number of cases referred to the Invalid Children's Aid Association during the year was 109, these cases representing 127 different complaints as seen by the table. Of these 109 cases, 53 received treatment, the number of complaints treated being 60. Of the cases untreated, some absolutely refused treatment, some promised to, and did get treatment without the aid of the Association, a few were classed as not helpable by the Association, the dental cases were put down for treatment at the School Clinic, and the remainder are still on the books of the Association. List or Cases referred to the Invalid Children's Aid Association, 1913. Complaint. Number of cases referred. Number of cases which received help. Abscesses in Tooth Sockets 8 3 Abscess in Leg 1 1 Adenoids 2 1 Anaemia 1 1 Blepharitis 2 1 Carious Teeth 5 2 77 Complaint. Number of cases referred. Number of cases which received help. Conjunctivitis 4 — Defective Vision 53 30 Eustachian Obstruction 1 — General Debility 1 — Glands in Neck Enlarged 4 2 Heart Disease 1 — Hypermetropia 1 — Keratitis 1 1 Keratoconus 1 1 Lateral Nystagmus 1 — Malnutrition 3 2 Nasal Obstruction 11 4 Otitis Media 5 — Phlyctenular Ulcer of Cornea 1 1 Phthisis 3 1 ? Phthisis 1 1 Post Morbilli 1 1 Spectacles broken 2 — Spectacles required for Reading 1 1 Squint 4 2 Tonsils Enlarged 8 4 In addition to the above the following cases were referred to the South Wimbledon District Nursing Association, and I am glad to report the entirely satisfactory way in which these cases have been looked after and the records kept and returned, which was an immense improvement on previous years. This work, however, will be rendered unnecessary by the prospective opening of the School Clinic. Complaint. Number of cases. Blepharitis 5 Conjunctivitis 4 Impetigo 6 Otitis Media 2 Sores 1 Septic Sores 4 78 TABLE I. MEDICAL INSPECTION.—Summary of Cases followed up ddring 1913. Defect. Old Cases. New Cases. Total. No. of Visits. Treated. Untreated. Total untreated. Parents object. Parents indifferent. Parents say unnecessary. Doctor says unnecessary. Time insufficient. No reason. Left school. Left district. Total still on books. Serious Defect in Vision 24 29 56 11 18 1 — 1 1 8 3 3 1 14 37.93% 62.07% 3.45% 3.45% 3.45% 27.58% 10.34% 10.34% 3.45% 48.27% Defective Vision 7 44 51 103 20 31 2 1 1 — 9 13 3 2 26 39.21% 60.78% 3.92% 1.96% 1.96% 17.64% 25.5% 5.88% 3.92% 51.0% Carious Teeth 53 72 125 256 52 73 5 1 4 9 3 39 6 6 61 41.6% 58.4% 4.0% 0.8% 3.2% 7.2% 2.4% 31.2% 4.8% 4.8% 48.8% Nasal Obstruction 48 42 90 192 43 47 6 4 2 9 3 14 2 7 38 47.7% 52.2% 6.6% 4.4% 2.2% 10.0% 3.3% 15.5% 2.2% 7.7% 42.2% Otitis Media 2 8 10 14 7 3 — — — — 3 — — — 3 70.0% 30.0% 30.0% 30.0% Defective Hearing 1 7 8 16 4 4 — 1 — — 1 — — 2 2 50.0% 50.0% 12.5% 12.5% 25.0% 25.0% Enlarged Tonsils 24 13 37 82 12 25 5 1 2 1 4 10 2 — 23 32.43% 67.56% 13.51% 2.7% 5.4% 2.7% 10.8% 27.0% 5.4% 62.16% Tonsils and Adenoids 1 3 4 6 2 2 1 — — — 1 — — — 2 50.0% 50.0% 25.0% 25.0% 50.0% Enlarged Glands 18 27 45 58 32 13 — 1 2 1 3 1 2 3 8 71.1% 28.9% 2.2% 4.4% 2.2% 6.6% 2.2% 4.4% 6.6% 17.7% Heart Disease 2 1 3 7 — 3 — — — — — 1 2 — 1 100.0% 33.3% 66.6% 33.3% Other Complaints 8 8 16 20 14 2 — — — — — — 2 — — 87.5% 12.5% 12.5% Totals 169 249 418 810 197 221 20 9 12 21 35 81 22 21 178 47.13% 52.87% 4.76% 2.15% 2.87% 5.02% 8.37% 19.35% 5.26% 5.02% 42.32% 79 TABLE II. CLASS ROOM INSPECTION.—Summary of Cases followed up during 1918. Defect. Old Cases. New Cases. Total. No. of Visits. Treated. Untreated. Total Untreated. Parents Object. Parents Indifferent. Parents say Unnecessary. Doctor says Unnecessary. Time Insufficient. No Reason. Left School. Left District. Total still on Books. Serious Defect in Vision 13 18 31 51 17 14 — 3 — 2 — 2 5 2 7 54.8% 45.16% 9.68% 6.45% 6.45% 16.13% 6.45% 22.58% Defective Vision 33 70 103 219 55 48 — 2 2 7 4 20 5 8 35 53.4% 46.6% 1.94% 1.94% 6.8% 3.88% 19.41% 4.85% 7.76% 33.98% Carious Teeth 5 3 8 16 5 3 — — — — — 1 2 — 1 62.5% 37.5% 12.5% 25.0% 12.5% Nasal Obstruction 37 28 65 128 30 35 1 — 5 2 4 14 7 2 26 46.15% 53.84% 1.54% 7.7% 3.07% 6.15% 21.54% 10.77% 3.07% 40.0% Otitis Media 5 11 16 32 9 7 — — — 1 1 3 1 1 5 56.25% 43.75% 6.25% 6.25% 18.75% 6.25% 6.25% 31.25% Defective Hearing 5 1 6 9 3 3 — — 1 — — 1 — 1 2 50.0% 50.0% 16.6% 16.6% 16.6% 33.3% Enlarged Tonsils 6 6 12 24 5 7 2 1 1 — 2 1 — — 7 41.6% 58.3% 16.6% 8.3% 8.3% 16.6% 8.3% 58.3% Tonsils and Adenoids — 2 2 5 — 2 — — — — — 1 1 — 1 100.0% 50.0% 50.0% 50.0% Other Complaints 2 2 4 7 4 — — — — — — — — — — 100.0% Totals 106 141 247 491 128 119 3 6 9 12 11 43 21 14 84 51.82% 48.18% 1.21% 2.43% 3.64% 4.86% 4.45% 17.4% 8.5% 5.66% 34.0% Totals for Class and Medical Inspections 275 390 665 1301 325 340 23 15 21 33 46 124 43 35 262 48.87% 51.12% 3.45% 2.25% 3.15% 4.96% 6.92% 18.64% 6.47% 5.26% 39.4% 80 C.—"General statement of the extent and scope of the medical inspection carried out during the year." (I.)—Visits to Schools. I paid 164 visits to the schools during the year, and the School Nurses paid 725. (II.)—The following Groups of Children were examined:— A. (i.) Entrants under the Code. (ii.) Leavers under the Code. (iii.) Children at the Special School (Intermediate Group). B. Children whose names appear in the Medical Officer's book in each class and who have been seen during Classroom Inspection. (III.)—Number of Children Inspected. The number of children medically examined during the year was 1,361. (IV.)—The number of children referred for further examination was 665, made up of 390 new cases and 275 old cases brought forward from the end of 1912. A certain number of these were excluded from school on account of Heart Disease and Phthisis, and were under continued observation at Southey Hall. (V.) Time occupied by Inspection. The average number examined per hour is eight. D.—"Ceneral review of the facts disclosed by Medical Inspection, under the headings contained in the Schedule to Circular 582, including tables showing the height and weight of children inspected according to age at date of examination, and sex." (a) History of infectious Disease. The following table shows the percentage of the children inspected who have suffered from the various infectious diseases:— 81 TABLE III. INFECTIOUS DISEASE. INFECTIOUS DISEASE. Entrants. Leavers. Intermediate Group. Total. Boys Girls Total Per cent. Boys Girls Total Per Cent. Boys Girls Total Per Cent. Boys Girls Total Per Cent. Measles 286 302 588 60.87 112 124 236 65.9 10 14 24 64.86 408 440 848 62.3 Whooping Cough 183 211 394 40.78 51 80 131 36.6 6 10 16 43.24 210 301 541 39.8 Scarlet Fever 19 12 31 3.2 14 36 50 13.96 2 — 2 5 4 35 48 83 61 Diphtheria 9 5 14 1.44 6 7 13 3.6 — 1 1 2.7 15 13 28 2.06 Chicken Pox 125 130 255 26.4 44 72 116 32.4 6 5 11 29.7 175 207 382 28.1 82 (b) History of other Illnesses and Family History. This is still unsatisfactory owing to the number of parents who do not attend at the medical inspections. (c) Clothing and Footgear. On the whole I am inclined to think that there is still improvement in the condition of the clothing, particularly amongst some of the older boys. (d) Height and Weight. As I pointed out last year one cannot regard these figures with much satisfaction, as they represent such wide variations in ages within the age periods as to be almost useless for statistical purposes considering the small number of children in each age group. In order to try and get some really accurate figures I have arranged in certain of the schools for a certain number of the children to be weighed on. their birthdays and for some to be weighed once a month. This latter proceeding I asked Mr. Hill, the Headmaster of Cottenham Park School, to do, and I am indebted to him for the extremely careful and accurate way in which this has been done, and the results have shown that not only is the child's gain in weight not a regular process, but that during the summer months, up to the end of August, there is, not only in many cases very little gain in weight, but in a certain number of cases the weight remains quite stationary, and in a large proportion of cases there is actual loss in weight during this period. Attention has been drawn to the importance of keeping records of the children's weights with the idea that if a child is losing, or even is not gaining weight, it should be regarded as a danger signal and should create suspicion of some under-lying tubercular trouble. It was found that amongst these children who did not gain weight, or actually lost weight, were some whom one would class as amongst the most robust in the class. On the other hand, amongst those who gained most weight a very considerable proportion of them were those children who, if one had been casually asked to pick out the poorest developed and most likely subjects of tuberculosis, one would have included in that category. I have made arrangements to carry out this regular weighing throughout the year in three different types of schools. The following table shows the average heights and weights for boys and gills at the various ages in the different schools. 83 84 TABLE IV. TABLE SHOWING AVERAGE HEIGHTS AND WEIGHTS (IN INCHES AND LBS.) OF CHILDREN MEDICALLY EXAMINED, ACCORDING TO AGE AND SEX. Age Queen's Road. Haydon's Road. Dundonald Road. Central. Cottenham Park. Effra Road. Pelham. St. Mary's. Durnsford Road. Special. General Average Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. 5 Number 56 45 77 77 31 28 17 25 25 7 39 38 46 53 12 12 19 26 — — 325 310 Height 40.5 40.4 40.38 40.2 40.8 40.4 42.4 42.6 41.0 41.9 42.1 41.8 40.8 41.7 40.6 40.3 42.6 42.4 41.0 41.5 Weight 41.65 39.1 38.5 37.9 38.2 37.5 40.6 41.4 40.2 42.1 38.8 39.4 38.1 35.6 39.5 37.7 41.6 38.2 39.9 38.5 6 Number 22 11 50 54 — 3 5 2 7 3 8 15 13 9 1 3 12 15 — — 118 115 Height 42.1 42.6 41.88 41.9 42.5 42.6 44.5 42.9 42.3 44.3 42.3 43.2 43.2 43.5 41.2 45.8 43.9 43.8 42.4 Weight 42.5 44 1 40.9 42.4 41.2 43.7 45.5 42.3 41.7 45.5 41.6 42.3 41.1 40.0 40.7 45.25 42.9 42.3 42.4 7 Number 5 5 10 10 1 1 — 4 3 1 5 6 1 2 — 5 11 — — 37 33 Height 45.25 45.1 42.8 43.15 45.0 46.0 41.25 44.0 42.0 43.6 45.75 45.0 46.75 48.5 46.7 44.7 44.7 Weight 48.75 48.6 40.7 43.45 48.0 51.0 49.75 43.3 36.0 49.0 48.5 45.0 53.0 51.2 46.6 53.9 50.2 8 Number — — — 1 — — 1 — — 2 - — 1 1 1 1 4 3 3 2 10 10 Height 47.5 47.5 46.5 46.5 54.5 47.0 42.0 47.75 42.6 45.5 42.25 46.85 45.0 Weight 50.0 54.0 50.0 47.0 70.0 47.0 42.0 47.9 45.0 49.3 41.0 48.75 47.9 9 Number — — — — — — — — — — — — — — — — 6 1 3 5 9 6 Height 50.2 48.5 46.5 46.9 48.9 47.2 Weight 55.9 45.0 48.2 51.8 53.3 50.7 10 Number — — — — — 1 — — — — — — — ] — — 1 1 3 2 4 5 Height 49 5 49.5 54.0 52.0 50.2 51.0 51.2 50.6 Weight 51.0 51.0 60.0 52.0 60.7 62.0 60.5 55.6 11 N umber — — — 1 — — — — — — — — — — — — 1 — 5 2 6 3 Height 58.0 54.0 50.0 49.5 50.6 52.25 Weight 80.0 66.0 59.8 58.0 60.8 65.3 12 Number — — 2 — — — 1 — — — — — — — — — — 1 2 4 5 5 Height 56.0 55.0 60.0 53.25 54.4 54.7 55.5 Weight 81.0 79.0 88.0 75.0 69.0 78.2 72.8 13 Number 29 34 49 35 21 31 9 17 — — — 7 31 19 13 15 13 5 3 2 168 165 Height 56.6 57.3 56.45 57.5 57.1 57.8 57.6 57.5 61 9 55.5 58.4 55.5 58.4 57.6 59.3 50.8 55.25 56.3 57.9 Weight 79.7 79.3 77.6 85.4 81.1 79.9 83.7 86.0 93.3 81.4 80.9 74.3 76.3 89.0 83.0 67.8 77.0 79.8 81.9 14 Number — — 5 8 2 2 — . — — 3 1 — 1 1 2 1 11 15 Height 57.1 57.9 54.5 62.0 58.0 58.0 57.0 46.0 63.0 53.5 55.9 58.4 Weight 83.8 82.0 69.25 119.0 84.7 89.0 79.0 47.0 102.0 86.0 78.0 89.3 15 Number — — 1 — — — — — — — — — — — — — — — — — 1 — Height 56.0 56.0 Weight 81.0 81.0 (e) Nutrition. This is an extremely difficult matter to gauge and only those cases whose condition was very marked have been put down as abnormal. (f) Cleanliness and Condition of Head and Body. As during last year we have had considerable trouble through the immigration of unclean families, particularly from the County area. Some of these cases have had to be refused admission to school week after week and have not been fit to allow into school until the parents have been summoned, and I have no doubt whatever that if other Authorities would adopt the same policy that Wimbledon has there would be an allround improvement in the cleanliness of these people. This is instanced by the fact that some of the families have shaken the dust of Wimbledon off their feet owing to what they consider as the persecution of the Education Authority, and have returned to districts outside where, apparently, they are able to get their children into school before they are properly clean. The more I see of our system of having a definite day fixed for admission at each school and a Nurse examining each child presented for admission and refusing to admit any child unless absolutely clean, the more I am convinced that we are adopting the best means of keeping our schools clean. One cannot help remarking that one very rarely sees now children such as one was accustomed to see a few years ago, with their bodies covered with bites. The figures with regard to vermin are extremely small, totalling only .58 per cent., but then it must be remembered that even amongst the most uncleanly, a special effort is made to get the child ready for the routine medical inspection. The following is a summary of the action taken during the year in the worst cases with regard to children sent to school in a verminous condition:— Parents before Committee. Children before Committee. Summonses ordered if not sent clean. Cautioned by Committee. Summonses taken out. Fined 10/-. Fined 7/6. Fined 5/-. Fined 2/6. Fined 1/fi. Fined 1/-. Attendance Orders made. Adjourned. Withdrawn. Adjourned, still Sine die. Sent to Industrial School 135 176 147 29 55 8 3 6 7 1 3 10 16 13 1 1 (g) Teeth. This still remains the most unsatisfactory part of the work. It will be seen from the tables that of the total number of children examined only 44.0 per cent. were without carious 87 teeth and that 28.9 per cent. had four or more carious teeth, while 7.3 per cent. were suffering from oral sepsis, and yet of the total number of those suffering from dental defects only about 4 per cent. received treatment. On the one hand it is extremely difficult to get the parents to see the importance of treatment and, on the other hand, the majority of them cannot afford to spend money on what they regard as a necessary evil, in addition to which a certain number of the parents have a great reluctance to submitting their children to anything which may cause pain. One case may be quoted as an instance of the troubles arising from septic tooth. A child was brought to the school clinic on June 26th, with an abscess in the jaw and suppuration under the tooth socket with pus oozing out between the teeth and the jaw, and the whole condition would have been remedied at once by the removal of the tooth. Immediate removal of the tooth was advised but the statement was made that the child had been advised by a doctor that the tooth could not be taken out until the abscess had healed. As the child was apparently under treatment she was referred to her doctor. The following week the child failed to attend at the School Clinic and a fortnight later a message was received from the parents that they could not afford to go to a doctor, that the father and mother were out of work, and that they wanted a hospital letter, thereupon the child was referred to the Invalid Children's Aid Association whose record was as follows, from which it will be seen that two months were spent and nothing accomplished. 14/7/13.—Recommended child being taken to Guy's Hospital (no letter necessary). 26/7/13.—Has not gone to Hospital. School Nurse has called in the meantime and recommended child being taken to the Belgrave Hospital. Mrs. A. promises to take her next Wednesday. 16/8/13.—Out. 18/8/13.—Has not been. Saw father who promised to take her this week. 23/8/13.—Out. Saw child who said V. had not been to Hospital. 25/8/13.—Promises to take her to doctor to-night. 6/9/13.—Still not been. Gave mother severe talking to. 13/9/13.—Nothing done. Excuse now is no money. At this time the child's mouth was extremely foul, the breath very offensive, and nothing being done to the abscess which was discharging externally, except for the application 88 of a small piece of dry wool. On September 30th a notice was sent to the parents threatening action under the Children Act if the child was not immediately treated, with the result that three days later the child was taken to the Bolingbroke Hospital where the tooth was removed. Within six days the mouth was clean, and the external abscess healing. A sinus was, however, left, and this continued to discharge for a further five months. The child's health had been undermined by the prolonged septic absorption, and the child permanently disfigured, in addition to which the child had been absent from school for a period of nine months for what should ordinarily have been a matter of a week or ten days. I also find that of the children which I refer for treatment for abscesses in the tooth sockets a considerable number go to two unqualified dentists in the town, who make the same statement that the tooth cannot be taken out so long as there is any discharge, and I find this very difficult to combat as the parents of these children are not in a position to differentiate between a properly qualified dentist and a bogus practitioner who holds himself out to be a dentist. (h) Nose and Throat. As in previous years there has been considerable difficulty in getting cases of adenoids attended to owing to the long time they have to wait before admission to the hospital. There is a greater difficulty in getting enlarged tonsils attended to as many of the parents seem to think that the children will grow out of it. It is surprising how many parents will allow their children to remain untreated with tonsils so large as to almost meet. Although nowadays one does not see the extreme cases of nasal obstruction one used to see before medical inspection commenced there are still a large number of cases that require attention as instanced by the fact that 188 of these cases were under observation during the year, and more than half of these got no treatment. The only remedy that I can see for this state of affairs is the extension of the work of the Clinic to take in these conditions. (j) External Eye Disease. This table (XVI.) only refers to cases seen during the routine medical inspection. The total number of cases will be found by adding to these the cases seen at the School Clinic. (k) Vision. There is still considerable difficulty in getting some of these cases treated, but thirty have obtained spectacles through the Invalid Children's Aid Association, mostly having been 89 seen by Dr. Cowie, and a certain number have obtained spectacles after having visited one of the hospitals, through Councillor Odell by means of the St. James' Samaritan Fund. (l) Ear Disease. Although the number of cases of discharging ears found during medical inspection is comparatively small, reference to the list of diseases seen at the School Clinic will give some idea of the number that have been dealt with. Very few indeed of these cases get medical treatment whatever, a little perfunctory syringing with "boracic powder" being all that is thought necessary, and the children are often seen with the discharge dropping from the ears. (m) Hearing. Tests for hearing are carried out entirely by the whispered test, in the case of the entrants facing, and in the case of all other children with their backs turned so that no lip-reading can take place. (o) Mental Condition. Table XXX. shows the number of children with the various stages of mental incompetence. It is to be hoped that prospective legislation will do something to deal with the after-life of the children in the Special School. (p) Heart and Circulation. Table XXI. shows the number of children found at medical inspection during the year, with cardiac abnormalities. Some of these cases are very difficult to deal with and under better home circumstances several of these cases would be better away from school, but taking everything into consideration, and the well-ordered life and discipline which they get in school, I feel that they are better off attending school regularly than running the streets and, as happens in some cases, being made to do the duties of a household drudge. (q) Lung Disease and Tuberculosis. During the year a considerable number of children, as shown by Table XXII., have been under observation for chest trouble, some of them for prolonged periods. Some, after having been sent away for considerable periods, have obtained a fresh start, but for the majority I see no prospect of doing any permanent good until we have an Open-Air School. 90 I wish to take this opportunity of recording my thanks to Mrs. Paston Brown who, as Chairman of the Guardians, has done everything in her power for the cases which I have brought to her notice. In addition, I have been grateful to the Invalid Children's Aid Association for their help in respect to some of these cases. (t) Rickets. TABLE V. RICKETS. Entrants. Intermediate Group. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. Pigeon Breast 3 1 — — 1 1 Ankle 1 — — — — — (u) Deformities, Spinal Disease, etc. The following table shows the abnormalities coming under this heading which were found during the year. TABLE VI. ABNORMALITIES. Entrants. Intermediate Group. Leavers. Boys. Girls. Boys. Girls. Boys. Girls. Asymetry - - - 1 - - Bifid Uvula — — — - 1 - Deep Sternal Depression 3 1 — — — 1 Flat Chest 1 2 - — 2 2 Geographical Tongue 1 1 — — — — Harelip operated on — — — — — 1 Hernia operated on — — — — 1 1 Hydrocephalus — — — — 1 — Lateral Curvature — 1 — — — — Lordosis — — — - - 1 Narrow Arch Palate — — — — - 1 Round Shoulders 2 1 — - 1 - Scoliosis — 1 — — 4 5 Supernumary Nipples - - - - - 1 Talipes Valgus — — — — 1 — Torticollis - - - - — 1 (w) Other Disease or Defect. The following table shows the various other diseases and defects which were discovered amongst the children medically examined during 1912:— 91 TABLE VII. Disease or Defect. Entrants Intermediate Group Leavers Disease or Defect. Entrants Intermediate Group Leavers Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Boys. Girls. Abscess in jaw - - 1 - - - Naevus 1 3 - - - - Ancemia 3 1 — — 2 4 Pallor — 1 — — 3 1 Asthma — — — - 1 — Papillomata — 4 — — — 2 Birth-marks 1 — — - — — Paresis — 1 — — — — Cataract, several operations — — — - — 1 Phinosis — — 1 — — — Debility — — 1 - — — Pityriasis - - - - - 1 Dermatitis — 1 — — — — Scars 10 10 — — 7 3 Factitious Urticaria — — — — 2 — Septic Finger 1 - - - - - Furuncle — — — — 1 — Thyroid Enlarged — — — — — 1 Gait peculiar — 1 — — — — Threadworms — 1 — — — — General Hirsuties — — — — 1 — Tongue Tied — 1 — — — — Goitre — — — — — 3 Tonsillitis 1 - - - - - Growths in Neck? Cartilaginous — 1 — — — — Traumatic Sore 1 - - - - - Hyperidrosis — — — — 1 — Turbinate Bones? Enlarged — — — — — 1 Incontinence 2 - - - - - Turbinate Bone removed 1 - - - - - Jugular Vein Enlarged — 1 — — — — Ulcer in cheek 1 - - - - - Left Elbow Joint, Limitations due to Fracture - - - - 1 - Ulcerative Stomatitis 1 - - - - - Ulcerating Sore — 1 — — — — Mole 1 - - - - - Weakness of Bladder - 1 - - - - 92 F.—"Review of the methods employed or available for the treatment of defects, such as defective eyesight, carious teeth, nasal obstruction or adenoids, tonsillitis, discharging ears, pediculosis, ringworm or other skin diseases, including an account of the action of School Nurses in obtaining or assisting in the treatment of such defects." For the medical treatment of defects the following agencies are available in the district:— The Local General Practitioner. A comparatively small Provident Dispensary. Two Cottage Hospitals, which treat a number of cases of tonsils and adenoids. The Invalid Children's Aid Association, through whom a certain number of defects in vision are treated by a local practitioner, and other cases sent to Homes or Hospitals. The Poor Law Medical Service. On May 14th, 1913, the Committee passed the following Resolution "(a) That the School Nurses be allowed, in 'school' cases, viz., skin diseases, running ears, external eye disease, ringworm, and uncleanliness, where treatment is not otherwise available, to assist the parents in their own homes, or to administer treatment, at the request of the parent, and under the supervision of the School Medical Officer, at Southey Hall; "(b) That the School Medical Officer be directed to refer cases requiring treatment for defective eyesight, where treatment is not otherwise available, to the Invalid Children's Aid Association; "(c) That consideration of the question of dental treatment be deferred for further enquiry; "(d) That in cases where treatment provided at the request of this Committee by the Invalid Children's Aid, or other voluntary Association, involves the use of anaesthetics, such anaesthetics must be administered only at the parent's request and by an anæsthetic appointed by the Association apart from this Committee; and 93 "(e) That the School Medical Officer be directed to refer all other suitable cases, where treatment is recommended and is not otherwise provided, to the Invalid Children's Aid Association "; and on July 9th, 1913, the following further resolution with regard to dental treatment, viz.:— "(a) That the Education Committee be recommended to arrange for Dr. Guanziroli to attend at Southey Hall on one morning of each week (School Holidays excepted) to undertake dental treatment; "(b) That Dr. Guanziroli be paid at the rate of £50 per annum in respect of his services; "(c) That, in the first instance, the cases to be treated shall be those recommended by the School Medical Officer as those most needing treatment; "(d) That the Education Committee be recommended to authorise this Sub-Committee to make all the necessary arrangements for the establishment of the dental clinic." During the time that this report has been prepared the Clinic has commenced work. Ringworm. It will be seen that the process of rigid exclusion is making a steady decrease in the number of cases of Ringworm of the scalp, as shown by the following figures:— 1910 162 cases discovered. 1911 115 do. do. 1912 109 do. do. 1913 46 do. do. Of the 4G new cases that occurred during the year a certain number were children coming from other districts, where they had been attending school in an infective condition, and a certain number were children who had just reached school age and had applied for admission to school, and their condition was discovered by the Nurse at the time. There has still been trouble with two long-standing cases. The one to which I referred in my report for last year as having had ringworm for seven years was admitted to school on January 22nd of this year. She had been under treatment, and eventually the parents had consulted another specialist, one of the leading dermatologists of the present day, the report of whose action and findings is contained in the following extracts from his letter to the practitioner under whose treatment the child had been. 94 "I have never seen a ringworm go on in this way from the age of three months to eight years, and remaining localised to the two areas of scalp as indicated by the mother. "I have also carefully examined some hairs microscopically, but I have not been able to find any fungus: at any rate there is none in the hairs I examined. "Taking all the points into consideration and taking the history as correct (I cross-examined), the case would come in the category of a recurrent herpes. "I would suggest that the child be sent to school, the onus probandi lying with the School Medical Officer. If he finds undoubted fungus in the hairs then the case had better be X-rayed. Meantime I would recommend that nothing be applied locally, before she goes to the School Medical Officer. "I should like to know the upshot of this line of procedure." As a result of this the child was presented for re-admission to school but on examination I found ample evidence of fungus, and in order that there should be no doubt whatever on the matter I made a permanent specimen of the hairs showing the disease, and communicated with the specialist in question and forwarded to him the specimen that I had obtained, with the result that I received a letter from which the following extract is taken:— "I have received your letter and specimen. I have examined the latter, and the fungus is undoubted. When I saw the child in my consulting room on October 13th, I was not able to find fungus, nor did I discover any when I had another search that same afternoon." As a result of these combined opinions the child was X-rayed and is now back at school quite cured. This case is quoted at length as it is a very good instance of the difficulties that beset the School Medical Officer in dealing with some cases of ringworm. This parent has consulted various practitioners in different parts of London who have been recommended to her and has produced certificates that her child was not suffering from ringworm. It will be seen that one has to be adamant in pitting one's opinion even against letters from eminent specialists. The work entails a large amount of troublesome and careful examination of the heads, but the decrease in the number of cases shows the wisdom of the process, and also emphasises the value of the examination of all children before they enter school, as by this means many sources of infection are kept out of our schools. 95 The following is a summary of the Ringworm cases seen at Southey Hall during the year:— Ringworm of the Scalp. No. of cases brought forward from end of 1912 58 No. of new cases seen during 1913 46 104 No. of cases returned to school on first examination as cured 6 No. of other cases returned to school during the year 64 No. of cases left school or district 3 No. of cases still infectious 31 104 Ringworm of the Skin. No. of cases brought forward from end of 1912 5 No. of new cases seen during 1913 30 35 No. of cases returned to school 29 No. of cases still infectious at the end of year 6 35 Total loss of attendance on account of Ringworm during 1913, 2,147 weeks, or 49'7 years, giving an average loss of attendance of 15.45 weeks. Total attendance lost by these 139 cases during 1913 and period since the commencement of the disease, 4,334 weeks, or 98.5 years, giving an average loss of attendance of 31.1 weeks. The loss in Grant occasioned during 1913 by these 139 cases would be £75. Treatment. No. of cases treated by a Doctor 35 No. of cases treated at Hospitals 22 No. of cases treated by Chemists 23 No. of cases treated by domestic remedies 41 No of cases which received no treatment 4 No. of specimens examined during the year 162 No. of visits to Southey Hall during 1913 made by Ringworm cases 520 No. of visits to Southey Hall by other cases during 1913 3161 96 Ten cases of Ringworm of the Scalp were treated by X-Rays during the year, three of them being girls and seven boys, and in each case the whole head had to be treated, and the results were satisfactory. The majority of these cases had had prolonged treatment by other methods before they would have X-Rays treatment. The following is a summary of these cases:— No. Excluded. X-Rayed. Returned to School. Period of Exclusion. Time between X-Rays and return to School. Weeks. Weeks. 1 9.1.12 11.1.13 3.5.13 69 16 2 9 1.12 16.1.13 3.5.13 69 16 3 11.1.12 11.1.13 3.5.13 69 16 4 7.11.12 6.1.13 5.7.13 34 26 5 10.1.13 16.2.13 19.7.13 27 22 6 25.4.12 13.3.13 28.8.13 69 24 7 25.4.12 13.3.13 28.8.13 69 24 8 30.1.13 25.5.13 5.1.14 49 31 9 8.5.13 27.7.13 20.11.13 28 16 10 10.7.13 28.9.13 — — — Case No. 8 was first seen on January 30th, 1913, when applying for admission to school as an "entrant," but had had Ringworm for three years previous to this date. Since the commencement of X-Ray treatment in 1911 there has not been a recurrence found in any of the cases. The work at the Inspection Clinic clue to the increased amount of following up and re-examination has necessitated the addition of another half-day to this work, and this additional half-day has been devoted chiefly to skin diseases, so that now the whole of Thursday, and Friday morning, are devoted to this part of the work. The following is a summary of the cases seen during the past four years. 1910. 1911. 1912. 1913. Number of children seen 326 538 974 1319 Number of attendances made 558 1574 2569 3681 Average attendance on each Inspection day 34.8 47.7 59.7 73.6 During the winter we have had another outbreak of Impetigo. The amount of School Attendance lost through 97 Impetigo is enormous, averaging over six weeks per case, and is absolutely unnecessary, many of the cases going on month after month owing to on satisfactory treatment being obtained. During the year two cases of Phthisis who had returned from Sanatoria have been working in the Gardening Classes four days a week, and their progress has been, on the whole, entirely satisfactory, in addition to which they have been doing good work at the subject. The following table gives a list of the ailments from which the children who attended at the Inspection Clinic during 1913 were found to be suffering:— TABLE VIII. Defect. No. of Cases. Defect. No. of Cases. Abdominal Cyst 1 Cystic Hygroma 1 Abscesses 13 Debility 23 Abscesses, Dental 4 Defective Hearing 10 Acne 1 Defective Speech 3 Adenoids 7 Defective Vision 68 Alopecia 5 Delicate 1 Amentia 2 Dental Caries 4 Anæmia 12 Dermatitis 5 Anorexia 1 Dermatitis, Septic 7 Aphonia 1 Diarrhœa, Vomiting 3 Appendicotomy 1 Diphtheria 5 Asthma 3 Dyspepsia 1 Asymetrical Pupils 1 Earache 1 Bell's Palsy 2 Eczema 17 Bilious Attack 2 Emesis 3 Blepharitis 27 Enlarged Glands in Neck 24 Blepharospasm 2 Enlarged Glands, Cervical 1 Bronchial Catarrh 5 Enlarged Glands, Parotid 2 Bronchitis 16 Enlarged Glands, Post Auricular 1 Cardiac Arrythmia 3 Cephalalgia 4 Enlarged Glands, Submental 1 Cheiropompholyx 1 Enlarged Glands, Tubercular 2 Chilblains 1 Enlarged Glands, in Groin 2 Chorea 14 Epilepsy 4 ? Chorea 6 ? Epilepsy 3 Colic 1 Epiphora 2 Congenital Dislocation Right Elbow 1 Epistaxis 4 Eustachian Obstruction 5 Conjunctivitis 39 Exocardial Murmur 1 Conjunctivitis, Catarrhal 51 Febricula 3 Convulsions 1 Fracture, Right Elbow 1 Convulsive Tic 1 Fractured Nasal Bone 1 Corneal Nebulre 4 Furunculosis 14 Corneal Ulcer 2 Ganglion 2 Cough 20 Gastritis 2 Croup 1 Gastrodynia 4 Cuts (various) 4 General Depression 1 98 No. of Defect. Cases. Genu Valgum 1 Goitre 1 Hsematorrhœa 1 Headache 4 Headache, Constant 1 Heart Disease 12 Heart Disease 1 Hemichorea 1 Hernia, Rigli Inguinal 2 Herpes 2 Hordeolum 4 Impacted Cerumen 6 Impetigo 240 Incontinence 7 Infantile Paralysis 6 Injury to Head 1 Injury to Knee 1 Injury to Nose and Lip 1 Insomnia 1 Irritable Bladder 1 Jaundice 1 Keratitis 1 Laryngitis 1 Lateral Nystagmus 2 Lordosis 2 Lupus 3 Malnutrition 13 Mastoid Disease 1 Menorrhagia 1 Mentally Defective 2 Mentally Defective 1 Migraine 1 Mucous Colitis Multiple Papillomata Muscular Rheumatism 1 Nasal Obstruction 27 Neglect 7 Nervous 1 Night Terrors 3 Nits 2 Ocular Neuralgia 1 Orbicular Spasm 1 Otalgia 4 Otitis Media 53 Pain, Head and Left Side Pain, Right Groin Pain, Right Side 1 Pallor 2 Palpitation Papilloma on Heel 1 Paronychia 2 Parotitis 8 Ped. Vest 3 Pertussis 2 Pes Planus Petit Mai 1 Peliosis Rheum atica Pharvncitis 1 No. of Defect. Cases. Phlyctenule 6 Phlyctenular Ulcers 5 Phthisis 12 Phthisis 23 Pleurisy 1 Polypus 2 Psoriasis 1 Rashes,? Cause 2 Ilhagades 1 Rheumatism 14 Rhinitis 1 Rhinorrhœa 2 Scabies 17 Scar broken down? 1 Scarlet Fever 1 Scarlet Fever 1 School Fatigue 2 Scoliosis 6 Scrofulodermia 1 Seborrhœa 6 Septic Wound, Thickening 1 Sickness after Cookery Lessons 1 Sores 24 Sore Throat 11 Splinter in Buttock 1 ? Stone in Kidney 1 Strabismus, External 3 Strabismus, Internal 11 Streptococcal Infection 1 Syncope 9 Synovitis 1 Swelling, Right Elbow Joint, ? Cause 1 Talipes Equinus 1 Talipes Vagus 2 Threadworms 1 Tonsils Enlarged 21 Tonsillitis 4 Tonsillitis, Follicular 1 Tonsillotomy 1 Torticollis 1 Tremors in Writing 1 Tubercular Hip 1 ?Tubercular Dactylitis 1 ? Tubercular Leg 1 Tubercular Os Calcis 1 Turbinate, Right Inferior Enlarged 2 Ulcers 8 Ulcerative Stomatitis 1 Urticaria 3 Vaginitis 3 Varicella 1 99 Malnutrition. The arrangements for feeding the children during the winter months were the same as during 1912. It was not found necessary to open the meals kitchen during the latter part of the year. The number of children fed by the Voluntary Committee was 317; and the number of meals given was 6,350, the children being drawn from the following schools:— School. Number of Children. Number of M eals. Dundonald Road Boys' 3 102 Pelham Boys' 8 59 Pelham Girls' 2 26 Pelham Infants' 2 12 Queen's Road Boys' 32 705 Queen's Road Girls' 33 679 Queen's Road Infants' 75 1260 Special 12 153 Cottenham Park 12 459 Haydon's Road Boys' 84 1827 Haydon's Road Girls' 26 354 Haydon's Road Infants' 21 423 St. Mary's Mixed 3 91 St. Mary's Infants' 4 87 317 6237 The dietary in use, as drawn up by the School Meals Committee, as follows:— Monday. Pea Soup or Haricot Soup, and Bread. Tuesday. Cocoa, and Bread and Jam. Wednesday. Soup and Dumplings, and Bread. Thursday. Cocoa, Curant Bread, and Golden Syrup. Friday. Rice or Pearl Barley in Soup, and Bread. I have nothing whatever to do with this work. Infectious Disease. A full report 011 infectious disease in the schools appears in my report as Medical Officer of Health, on pages 10 to 13. H.—"Review of the methods adopted and the adequacy of such methods for dealing with the blind, deaf, mentally or physically defective and epileptic children under the Acts of 1893 and 1899." 100 Mentally Defective. The school for mentally defective children at Queen's ltoad has been practically full during the whole year, the average number 011 the books being 43'1, and the number of admissions 22. During the year several cases have been dealt with, some of which have given considerable trouble. One boy, whom I had deferred for six months as a doubtful imbecile, was afterwards admitted to the Special School to see if it was possible to do anything with him. He played truant, and without my knowledge was brought before the Court and was taken to an Industrial School, where it was found that he was quite unsuited for the discipline of such a place. I examined the boy again at the Industrial School, and was of the opinion that he was one of those cases of doubtful imbecility. In view of this I took the boy to St. Thomas's Hospital, where he was seen by Dr. Percy Smith, the mental specialist, who, after a prolonged investigation of the case, passed the boy as a high-grade imbecile rather than a lowgrade mentally defective, as a result of which it was arranged that the boy should be sent back to Wimbledon, and that I should strike him oft the books as ineducable. In the meantime, Dr. Branthwaite, medical adviser to the Chief Inspector of Reformatory and Industrial Schools, examined the boy on behalf of the Home Office, and thought that he might with advantage be removed to Sandwell Hall or Stoke Park, and, as a result of this, the boy was removed to Sandwell Hall. Another case which has given considerable trouble was that of a girl aged 12½ years, who came from the London County Council, where she had been attending a Deaf School. The girl had a certain amount of hearing, but I certified her, after examination, as a proper case for a Deaf School. The girl had learned a large amount of lip-reading at the Deaf School, and was in many ways an intelligent girl. The mother, however, who was a widow, and the brother, who was acting in loco parentis, were of the opinion that the girl had fair hearing, and objected to the idea of a Deaf School, and by order of the School Attendance Sub-Committee the child was admitted to the Queen's Road Special School, but made little progress, and as a result of the Head Teacher's Report in November, 1912, the child was admitted to Standard 0 in the Infants' Department of the Queen's Road School. The Head Teacher of the Infants' Department of the Queen's Road School found that the girl was unsuitable for the school, and as a result of a report from her the Managers of the School recommended 011 May 5th that "she should be 101 sent to a Special School for Deaf Children where she would learn lip-reading," with the result that on the same day the Clerk was directed to make arrangements for her to be admitted to a suitable school. While preparations were being made pending her removal to a Deaf School, that she might be taught needlework at which she was becoming particularly proficient, the child attained fourteen years of age, and the mother insisted on removing her from school. A member of the Care Committee called upon the mother to see what could be done for the child, and was practically told to mind her own business. Five cases are at the Deaf and Dumb School at Margate, one of whom was kept back for a time 011 account of ill-health. Four of the children are reported to be making excellent progress; the fifth, who was for some time in our Special School owing to difficulty with the parents, is much older, and the report of him is that he is "still backward, though some progress is being made; would have done better if he had entered earlier." One case, owing to extensive Choroido-retinitis and Optic Atrophy, was recommended for a Blind School, but owing to the onset of paralytic symptoms the matter could not be proceeded with. One case was recommended for a Special School for Progressive Myopia, and the Committee tried to make arrangements with the London County Council for his admission to one of their Schools, but owing to pressure on their accommodation this was impossible. In another case the parents applied to the Education Committee to contribute towards his expenses in a Special School outside the Borough, but as the boy was a very marked case of Mongolian Idiocy, I could not advise the Committee to be responsible for any expenditure, as the boy was quite ineducable. One physically defective boy lias been sent to the Dartmouth Home for Cripple Boys at Blackheath, as he is quite unable to use one arm, the muscles of the upper arm and shoulder being useless as a result of Infantile Paralysis. 1.—"Open-Air School." This matter has been under consideration by the Committee on several occasions and, owing to the very high price of land and the restricting covenants on practically all the available land in the district, it is impossible to deal with this matter by erecting a separate school, and the Committee propose to erect one on the roof of the new Garfield Road School. 102 K.—"School Nurse." In the early part of the year both of the School Nurses left, Nurse Gilbey at the ernl of January and Nurse Quinlan at the end of March. Nurse Cracknell was appointed to take the place of Nurse Gilbey 011 February 10th, and Nurse Holman to take the place of Nurse Quinlan 011 April 14th. The following is a summary of the work of the School Nurses during the year 1913:— New Scholars seen 011 admission, about 1,500 Visits paid to Schools 725 Visits paid to Homes 2,733 Heads examined 60,044 Number of Medical Inspections at which the Nurses assisted 1,361 Number of examinations at Inspection Clinic at which the Nurses assisted 3,681 In addition to which one of the Nurses is present at Classroom Inspection, at which every child in the schools passes under review at least once a year6,666 I cannot speak too highly of the work of the School Nurses, and my Clerk in this Department. I wish to acknowledge the cordial co-operation of the teachers in all matters in which the welfare of the children has been concerned, and also wish to tender to the Members of the Education Committee my thanks for their support and interest in the various phases of my work. • EL WIN H. T. NASH, School Medical Offi eer. 103 RETURN SHEWING THE PHYSICAL CONDITION OP CHILDREN INSPECTED. Table No. Condition. Entrants. Leavers. Intermediate Group. Total. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. TOTAL INSPECTED 495 471 966 - 180 178 358 - 19 18 37 - 694 667 1361 - IX. CLOTHING. Satisfactory 486 468 954 98.7 175 175 350 97 .8 15 18 33 89.2 676 661 1337 98.2 Unsatisfactory 9 3 12 1.3 5 3 8 2.23 4 - 4 10.8 18 6 24 1.76 X. FOOTGEAR. Satisfactory . 481 482 943 97.6 175 173 348 97.2 15 18 33 89.2 671 653 1324 97.3 Unsatisfactory 14 9 23 2.4 5 5 10 2.8 4 - 4 10.8 23 14 37 2.7 XI. CLEANLINESS OF HEAD. Clean 438 368 806 83.4 170 119 289 80.7 9 2 11 29.7 617 489 1106 81.25 N its only 51 96 147 15.2 10 56 66 18.4 7 16 23 62.2 68 168 236 17.3 Pediculi 6 7 13 1.34 - 3 3 0.84 3 - 3 8.1 9 10 19 1.4 XII. CLEANLINESS OF BODY. Clean 437 399 836 86.5 155 155 310 86.6 9 9 18 48.6 601 563 1164 85.5 Dirty 15 17 32 33 12 9 21 5.86 4 4 8 21.7 31 30 61 4.48 Flea-bitten or Vermin-bitten 49 64 113 11.7 16 19 35 9.77 9 8 17 45.9 74 91 165 12.1 Pediculi present 4 1 5 0.5 1 2 3 0.84 - - - - 5 3 8 0.58 XIII. NUTRITION. Excellent - - - - 2 - 2 0.56 - - - - 2- — 2 0.15 Normal 470 451 921 95.3 165 173 338 94.4 19 16 35 94.6 654 640 1294 95.07 Below Normal 3 4 7 0.72 3 1 4 11 - 2 2 5.4 6 7 13 0.95 Bad 22 16 38 3.9 10 4 14 3.9 - - - - 32 20 52 3.8 XIV. NOSE AND THROAT. No Defect 381 386 767 79.4 163 166 329 91.9 14 17 31 83.5 558 569 1127 82.8 MouthBreathers 39 24 63 6.52 4 1 5 1.4 1 1 2 5'4 44 26 70 5.14 Tonsils slightly 43 29 72 7.45 7 6 13 3.6 2 - 2 5.4 52 35 87 6.39 Tonsils much enlarged 14 15 29 3.0 4 3 7 1.9 0 - 2 54 20 18 38 2.79 Adenoids, slight 39 24 63 6.52 4 1 5 1.4 1 1 2 5.4 44 26 70 5.14 Adenoids, marked 18 17 35 3.6 2 2 4 11 - - - - 20 19 39 2.6 XV. Submaxillary Slightly enlarged 55 60 115 11. 13 15 28 7. -- - - - 68 75 143 10.5 GLANDS Much enlarged 41 40 81 8.4 4 8 12 3.35 - 1 1 2.7 45 49 94 6.9 Cervical Slightly enlarged 21 26 47 4.86 8 12 20 5 6 - - - - 29 38 67 4.92 Much enlarged 20 16 36 3.7 1 5 6 1.67 - - - - 21 21 42 3.08 XVI. EXTERNAL No Disease 494 460 954 98.7 179 175 354 98.8 18 16 34 91.9 691 651 1342 98.6 Blepharitis 1 11 12 1.3 - 2 2 0.56 - 1 1 2.7 1 14 15 1.1 Conjunctivitis - - - - 1 1 2 0.56 - 1 1 2.7 1 2 3 0.22 EYE DISEASE. Corneal Opacities - - - - - - - - - - - - - - - - Other Disease - - - - - - - - 1 - 1 2.7 1 - 1 0.07 XVII. EAR DISEASE. No Disease 489 465 954 98.7 179 175 354 98.8 19 18 37 100.0 687 658 1345 98.8 Obstruction, R. - - - - - - - - - - - - - - - - Obstruction. L. - - - - - - - - - - - - - - - - Otorrhoea, R. 4 3 7 0.72 1 2 3 0.84 - - - - 5 5 10 0.73 Otorrhcea, L. 1 3 4 0.4 - 1 1 0.28 - - - - 1 4 5 0.36 Other Disease 1 - 1 0.1 - - - - - - - - 1 - 1 0.07 XVIII. TEETH. Sound 218 203 421 43.6 78 93 171 47.7 9 10 19 51.4 305 306 611 44.9 Less than 4 caries 113 104 217 22.5 65 66 131 36 6 4 5 9 24.3 182 175 357 26.2 4 or more caries 104 164 328 34.0 37 19 56 14.8 6 3 9 24.3 207 186 393 28.9 Sepsis 45 52 97 10.0 2 — 2 0 56 1 - 1 2.7 48 52 100 7.3 XIX. VISION. % and 6/6 374 345 719 74.4 125 99 224 62.6 13 9 22 59 4 512 453 965 70.9 6/6 and 6/9 40 40 80 8-3 8 14 22 6.14 3 1 4 10 8 51 55 106 7.8 % and 6/12 3 4 7 0.72 2 1 3 0.84 - - - - 5 5 10 0.73 6/6 and 6/18 1 - 1 0.1 1 1 2 0.56 — 1 1 2.7 2 2 4 0.29 % and 6/36 2 - 2 0.2 3 - 3 0.84 - - - - 5 - 5 0.36 6/9 and 6/9 44 59 103 10.6 23 22 45 12.6 1 3 4 10.8 68 84 152 11.2 % and 6/12 5 8 13 1.34 8 4 12 3.35 - 1 1 2.7 13 13 26 1.9 6/9 and 6/18 4 1 5 0.5 1 2 3 0.84 - - - - 5 3 8 0.58 6/9and 6/24 1 1 2 0.2 - 1 1 0.28 - - - - 1 2 3 0.22 6/9and 6/36 - - - - - 4 4 1.1 - - - - - 4 4 0.29 6/9 and 6/90 2 1 3 0.3 - - - - - - - - 2 1 3 0.22 6/12 and 6/12 2 5 7 0.72 - 8 8 2.23 - - - - 2 13 15 1.1 RETURN SHEWING THE PHYSICAL CONDITION OP CHILDREN iNSPECTED-con^. Table No. Condition. Entrants. Leavers. Intermediate Group. Total. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. XIX. (Contd.) VISION. 6/12 and 6/18 4 1 5 0.5 — 4 4 1.1 1 — 1 2.7 5 5 10 0.73 6/12and 6/24 2 2 4 0.4 — 3 3 0.84 — — — — 2 5 7 0.51 6/12 and 6/36 1 — 1 0.1 - - - - - - - - 1 — 1 0.07 6/12 and 6/60 1 — 1 0.1 - - - - - - - - 1 — 1 0.07 6/18 and 6/18 4 3 7 0.7 4 4 8 2.23 — — — — 8 7 15 1.1 6/18 and 6/24 1 — 1 0.1 2 5 7 1.9 — — — — 3 5 8 0.58 6/18 and 6/60 1 1 2 0.2 — 2 2 0.56 — — — — 1 3 4 0.29 6/24and 6/21 3 — 3 0.3 1 3 4 1.1 1 2 3 8.1 5 5 10 0.73 6/24 and 6/36 — — — — — 1 1 0.28 — 1 1 2.7 — 2 2 0.14 6/36 and6/36 — — — — 2 — 2 0.56 — — — — 2 — 2 0.14 Squint 11 7 18 1.9 — 1 1 0.28 — 1 1 2.7 11 9 20 1.46 XX. HEARING. 20 and 20 493 468 961 99.5 174 170 344 96.1 — — — — 686 656 1342 98.6 20 and 10 — 1 1 0.1 2 2 4 11 — — — — 2 3 5 0.36 20 and 5 2 2 0.56 2 - 2 0.14 10 and 10 1 1 2 0 2 — 3 3 0-84 — — — — 1 4 5 0-36 10and 5 — — — — 1 — 1 0.28 — — — — 1 — 1 0.07 5 and 5 1 1 2 0.2 1 3 4 1.1 — — — 2 4 6 0.44 XXI. HEART AND CIRCULATION. No Disease 486 463 949 98.2 170 173 343 95.8 19 17 36 97.3 675 653 1328 97.6 Organic Disease 5 5 10 1.03 5 3 8 2.23 — 1 1 2.7 10 9 19 1.4 Functional Disease 1 2 2 0.2 - 1 1 0.28 - - - - - 3 3 0.22 Anæmia - - - - - - - - - - - - - - - - Other Defect. 4 1 5 0.5 5 1 6 1 .67 — — — — 9 2 11 0.8 XXII. LUNGS. No Disease 462 446 908 94.0 174 175 349 97.5 19 18 37 100.0 655 639 1294 95.07 Chronic Bronchitis and Bronchial Catarrh 18 45 4.66 1 1 2 05.6 — — — — 28 19 47 3.48 Tuberculosis - - - - - 1 1 0.28 - - - - - 1 1 0.07 Tuberculosis suspected 4 7 11 1.14 4 1 5 1.4 — — — — 8 8 16 1.17 Other Disease 2 — 2 0.2 1 — 1 0.28 — — — — 3 — 3 0.22 XXIII. NERVOUS SYSTEM. No Disease 492 468 960 99.4 177 177 354 98.8 19 18 37 100.0 688 663 1351 99.27 Epilepsy (Major or Minor) - - - - - - - - - - - - - - - - Chorea 1 — 1 0.1 - - - - - - - - 1 - 1 0.07 Other Disease 2 3 5 0.5 3 1 4 11 — — — — 5 4 9 0.66 XXIV. SKIN. No Disease 481 460 941 97 .4 171 169 340 95.0 18 18 36 97.3 670 647 1317 96.8 Ringworm body - - - - - - - - - - - - - - - - Ringworm, head - 1 1 0.1 - - - - - - - - - 1 1 0.07 Impetigo 8 1 9 0.93 1 1 2 0.56 1 — 1 2.7 10 2 12 0.89 Scabies — 2 2 0.2 — — — — — — — — — 2 2 0.14 Other Disease 6 7 13 1.34 8 8 16 4.5 — — — — 14 15 29 2.13 XXV. RICKETS. No Disease 491 471 962 99.6 179 176 355 98.2 19 18 37 100.0 689 665 1354 99.5 Slight 2 - 2 0.2 — — — — - — - - 2 - 2 0.14 Marked 2 — 2 0.2 1 2 3 0.84 — — — — 3 2 5 0.36 XXVI. DEFORMITIES. No Deformity 485 465 950 98.3 172 168 340 95.0 19 17 36 97.3 676 650 1326 97.4 Deformity present 10 6 16 1.66 8 10 18 5.0 — 1 1 2.7 18 17 35 2.6 XXVIII. TUBERCULOSIS (NONPULMONARY). No Disease 493 469 962 99.6 178 178 356 99.44 19 18 37 100.0 690 665 1355 99.57 Glandular 2 1 3 03 1 1 0.28 - - - - 3 1 4 0.29 Bones and Joints - - - - - - - - - - - - - - - - Other Forms - 1 1 0.1 1 — 1 0.28 — — — — 1 1 2 0.14 XXIX. SPEECH. Not Defective 475 458 933 96.6 175 174 349 97.5 18 18 36 97.3 668 650 1318 96.87 Defective Articulation 18 13 31 3 2 3 3 6 1.68 — — — — 21 16 37 2.7 Stammering 2 - 2 0.2 2 1 3 0.84 1 — 1 2.7 5 1 6 0.44 XXX. MENTAL CONDITION. Normal 495 467 962 99.6 169 171 340 95.0 — — — — 664 638 1302 95.66 Dull or - 4 4 0.4 11 7 18 5.0 - - - - 11 11 22 1.6 Mentally - — — — - — — — 18 18 36 97.3 18 18 36 2.64 Mentally Defective - — — — — — — — 1 - 1 2.7 1 — 1 0.07 TABLE XXXI. NUMBER OF CHILDREN INSPECTED (1st Jan.— 31st Dec., 1913.) A.—"Code" Groups. Age: Entrants. Leavers. Grand Total. 3 1 5 6 Other Ages. Total. 12 13 14 Other Ages. Total. Boys — — 325 118 52 495 3 165 11 1 180 675 Girls — — 310 115 46 471 1 163 14 — 178 649 Totals — — 635 233 98 966 4 328 25 1 358 1,324 B —Groups other than "Code." Intermediate Group. Special Cases and Ke-examinations. Boys 19 — Girls 18 — Totals 37 3,681 105