WIM 2 AC 44 13(1)WIMBELDON C Borough of Wimbledon. Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year 1925. TOGETHER WITH THE REPORT of the SCHOOL MEDICAL OFFICER AND OF THE SANITARY INSPECTOR. J. B Blackmore & Co., Ltd., Printers, Wimbledon, S.W.19. Borough of Wimblebon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE Year ended 31st December, 1925. Public Health and Baths Committee: Chairman: Councillor F. W. Daffen. Vice-Chairman: Councillor C. B. Heaton. Members: The Mayor (George Pauling, J.P.) Alderman J. S. IT. Abbott Councillor Herbert Lee Councillor Mrs. Chalkley „ A. J. Penman „ H. Dormer „ Lady Roney „ A. A. Drake R. IT. Scott ;1 A. W. Hickmott „ J. Townsend Maternity and Child Welfare Sub-committee: Chairman: Councillor Daffen. Members: Alderman Abbott Councillor Hickmott Councillor Mrs. Chalkley „ Penman „ Dormer „ Lady Roney STAFF. Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer. ‡ * A. Gilmour, M.D., M.R.C.P.E., D.P.H. Assistant Medical Officer of Health, School Mcdical Officer and Maternity and Child Welfare Officer: ‡ Effie M. D. Craig, M.B.. Ch.B. Chief Sanitary Inspector: a * † Henry Johnson. Assistant Sanitary Inspectors: ¶ a. † R. T. Avis. a † D. F. S. Flynn. Health Visitors—School Nurses: ¶ § || Miss M. Giles. § a || Miss F. Hulse (resigned March, 1925). c || Mrs. G. M. Street (appointed April, 1925). c || Miss E. M. Skelton (appointed April, 1925). Clerk: Miss N. Low. Clerk to the Maternity and Child Welfare Department: Miss M. A. Wet.eer. Fart-time: Bacteriologist: J. H. Johnston, M.Sc., F.I.C. * Salary contribution under Public Health Acts, ‡ „ „ by Exchequer Grants. a Certificate of the Eoyal Sanitary Institute for Inspector of Nuisances, † Certificate of the Royal Sanitary Institute for Inspector of Meat an<l other Foods. || Certificate of the Central Midwives Board. § Certificate of the Eoyal Sanitary Institute for School Nurse and Health Visitor. ¶ Certificate of the Sanitary Inspectors' Examination Board for Sanitary Inspector, c Certificated Nurse—General Training. 2 CONTENTS. Medical Officer's Report— page Public Health Committee 1 Maternity and Child Welfare Sub-Committee 1 Staff 2 Natural and Social Conditions of the Area 5 Vital Statistics for 1925 6 Births 8 Deaths 8 Birth and Death Bates, in Wards, District, and England and Wales, 1921-1925 9 Infantile Mortality, 1925 10 Infantile Mortality, 1921-1925 11 Poor Law Relief 11 General Provision of Health Services in the Area 11 List of Local Acts, Orders and Adoptive Acts, in force 12 Sanitary Circumstances of the Area 14 Sanitary Inspection of the District 15 Factories and Workshops 15 Sanitary Inspector's Report— Notices served 18 Legal Proceedings 18 Opening up of Drains 19 House Drainage 19 House to House inspection 19 House inspection 19 Overcrowding 19 Houses let in Lodgings 20 Verminous Booms 20 Common Lodging Houses 20 Van Dwellings 20 Dairies, Cowsheds and Milkshops 20 Infectious Disease and Disinfection 21 Yard Paving 21 Stable Refuse 21 Inspections under the Factory and Workshops Act, 1901 21 Shop Acts, 1912-23 22 Slaughter Houses and Food Inspection 22 Sale of Food and Drugs Acts, 1875-1907 23 Petroleum Acts 23 Diseases of Animals Acts, 1894-1911 23 Public Health (Meat) Regulations, 1924 24 Rent (Restrictions) Acts, 1920-1923 24 Piggeries 25 Summary Table—Nuisances Abated 27 Housing 28 Housing statistics 29 Inspection and Supervision of Food 30 Prevalence of, and Control over, Infectious Disease 31 Notifiable Diseases, 1920-1925 32 Notifiable Diseases and Deaths, 1925, in age-groups, etc. 33 3 Medical Officer's Report—(Continued)— page Scarlet Fever 34 Diphtheria 35 Tuberculosis 36 Laboratory work 36 Disinfection 37 Wimbledon Isolation Hospital 38 Maternity and Child Welfare 40 Ophthalmia Neonatorum 41 Supply of Milk to Expectant and Nursing Mothers and Infants 42 South Wimbledon Day Nursery 43 Table I.—Vital Statistics 44 Table II.—Causes of Deaths, etc. 45 School Medical Officer's Report— Staff 48 Administration 49 School and Hygiene 51 Findings of Medical Inspection 51 IJncleanliness 52 Group V.—Table 52 Tonsils and Adenoids, Defects of Vision 53 Tuberculosis cases 53 Dental Inspections 53 Crippling Defects 53 Infectious Diseases 53 "Following up" 54 Medical Treatment 55 Tonsils and Adenoids 55 Errors of Refraction, etc. 55 Dental Treatment 55 Provision of Meals 56 Co-operation of Parents, Teachers, etc. 56 Blind, Deaf, Defective and Epileptic Children 56 Queen's Road Special School 57 Employment of Children and Young Persons 57 Table I.—Return of Medical Inspections 50 „ II.—Return of Defects 60 „ III.—Return of all Exceptional Children 62 „ V.—Treatment Table 65 4 Borough of Wimbledon. PUBLIC HEALTH DEPARTMENT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE Year ended 31st December, 1925. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Mb. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Reports on the work of the Public Health Department for the year ending 31st December, 1925, together with my Report as School Medical Officer. The Annual Report of the Medical Officer of Health for 1925 is the Survey Report, required every five years, showing the "Progress made in the area during the preceding five years in the improvement of the public health, and the extent and character of the changes made during that period in the public health services of the area." The Report has been prepared on the lines suggested in Circular 648, issued by the Ministry of Health on 10th December, 1925. Natural and Social Conditions of the Area. Area (acres) 3,173 Population (Census, 1921) 61,700 Population (Estimated, 1925, R.G.) 58,170 5 At the 1921 Census, a temporary Defence Corps of 3,757 persons was encamped on Wimbledon Common, and was included in the Census population. Deducting that figure, the actual estimated increase of population in the last five years is, according to the Registrar-General's figures, only 227 persons. Calculating by the number of new houses erected in the area in the same period, it is probable that the actual population of the district is about 60,000 persons. Physical features and general character of the area:—The soil of the district is London Clay, covered in the higher areas with grave) and in the lower with alluvial deposits from the River Wandle. The valley of the Wandle, the lowest part of the Borough, is 41 feet above sea level, and the underground waiter in this area is materially affected by flooding. For this reason special bye-laws have been made in regard to the erection of dwellings in this section of the district. The highest part of the Borough is adjacent to Wimbledon Common, which is 183 feet above sea level. Number of inhabited houses:— 1921 11,926 1925 12,719 Number of fumilies or separate occupiers:— 1921 13,998 1925 13,562 Rateable Value:—£529,900. Sum represented by a penny rate :—£2,190. Social Conditions:—Wimbledon, situated on the outer ring of London, must be regarded mainly as a dormitory for workers in London. This is confirmed by the classification of occupations given in the 1921 Census. Professional and commercial occupations, carried on mainly in London, form a very large group. Business premises have sprung up locally and extended to meet the needs of the residents, and though 458 premises are registered under the Factory and Workshops Acts, they are for the most part small. From its position, the Borough is regarded as a suitable site for laundries, and thirty-three, employing over 1,200 hands., are registered in the district. Leather works, gas mantle works, chemical processes works, and a railway stock and repairing depot, each give employment to between 100 to 300 hands. Such works cannot be said to exert any particular influence on Public Health. Extracts from Vital Statistics of the Year (1925). (Registrar General's figures.) Total. M. F. Births Legitimate 718 383 335 Birth Rate (R.G.) 13.06 Illegitimate 42 31 11 Deaths 639 287 352 Death Rate (R.G.) 10.9 6 Number of women dying in, or in consequence of, childbirth from sepsis 0 do. do. other causes 0 Total 0 Death-rate of Infants under one year of age per 1,000 births 61.8 Number of deaths of infants—legitimate 42 „ „ „ —illegitimate 5 47 Deaths from Measles (all ages) 0 „ „ Whooping Cough (all ages) 6 „ Diarrhœa (under 2 years of age) 5 Vital Statistics for 1925 (Provisional Figures). Registrar-General's Returns. 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 18.3 12.2 75 105 Great Towns 18.8 12.2 79 157 Smaller Towns 18.3 11.2 74 WIMBLEDON 13.06 10.9 60 BOROUGH OP WIMBLEDON. Population, Birth and Death Rates for each Ward, 1925. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6744 8.1 10.8 Wimbledon Park 3.88 4440 11.2 11.2 St. John's 4.77 5182 8.4 11.5 Cottenham Park 4.33 7018 8.2 12.8 North Wimbledon 4.36 23384 8.8 11.6 Dundonald 5.15 7646 13.9 10.2 Trinity 5.59 11674 15.2 8.6 South Park 4.63 8586 13.9 10.9 Haydon Park 5.47 6880 21.5 13.3 South Wimbledon 5.21 34786 15.8 10.4 Whole District 4.83 58170 13.06 10.9 7 Births :— The number of births registered in the district was 712 (377 males and 335 females), a decrease of 51 against last year, and equal to a birth-rate of 12.2 on a population of 58,170. The corrected birth-rate produced by transferable births notified to us by the Registrar-General, is 13.06. 42 (or 5.5 per cent.) of the births were illegitimate. Notification of Births Acts, 1907 and 1915. During the year, 622 births were notified by the following persons:—Parents, 76; Midwives, 465; Doctors, 72; other persons, 9. Fourteen notifications of still-births were received. Deaths:— The total number of deaths registered in the district was 524 (227 males, 297 females) equal to a death rate of 9.0 per thousand of the population (11.(1.) per annum. The deaths occurring outside the district, of persons belonging to this Borough, were 199, viz.:— Kingston and District General Hospital 76 Brookwood Asylum, Woking 6 Nelson Hospital, Morton 21 Others 96 Total 199 The deaths occurring within the district, of persons not belonging thereto, were 85, viz.:— Atkinson Morley's Convalescent Hospital 1 North Wimbledon Hospital 20 Others 64 Total 85 Taking those into consideration, the total number of deaths properly belonging to Wimbledon, is 638, and the death rate 10.9. The rate for England and Wales for the same period was 12.2. Table showing the births, deaths, and death-rates in the Borough of Wimbledon in the last five years. 1925 1924 1923 1922 1921 1920 Births 760 814 868 868 1033 1144 Deaths 638 645 546 616 634 557 Death-rates 10.9 11.1 9.4 9.9 10.2 8.9 8 Table II. gives the causes of, and ages at, deaths during 1925. Deaths due to notifiable infectious diseases are given on p. 32. The principal causes of death, apart from Zymotic deaths, are as follows:— Heart Disease 100 Cerebral Hæmorrhage 47 Arterio Sclerosis 46 Pneumonia 46 Bronchitis 46 Cancer 90 Acute and Chronic Nephritis 20 Birth and Death Rates for each Ward for Wimbledon and for England and Wales, 1921-1925. WARD. Birth Rate. 1925 1924 1923 1922 1921 St. Mary's 8.1 9 6 13.6 10.6 9.4 Wimbledon Park 11.2 11 9 St. John's 8.4 6 1 11.1 7.3 8.4 Cottenham Park 8 2 10 4 6.6 9.7 12.4 North Wimbledon 8.8 9.5 10.5 9.6 10.1 Dundonald 13.9 13.1 13.3 15.3 14.5 Trinity 15.2 15.2 15.6 15.8 21.3 South Park 13.9 18.7 18.7 16.3 23.7 Haydon Park 21.5 22.2 South Wimbledon 15.8 17.04 16.5 159 20.9 Whole District 13 06 14.01 14.9 13 5 16.7 England and Wales 18.3 18.8 19.7 20.6 22.4 WARD. Death Rate. 1925 1924 1923 1922 1921 St. Mary's 10.8 12.1 12.01 9.4 8.2 Wimbledon Park 11.2 9.0 St. John's 11.5 11 5 8.8 10.08 9.1 Cottenham Park 12.8 10.9 7.5 8 3 10.3 North Wimbledon 11.6 11.07 9.9 9.2 9.1 Dundonald 10.2 10.8 10 2 13.2 12.4 Trinity 8.6 10.9 7.7 10.03 10.8 South Park 10.9 10.9 9.6 9.3 10.4 Haydon Park 13.3 11.8 South Wimbledon 10.4 11.1 9.1 10.3 10.9 Whole District 10.9 11.1 9.4 9.9 10.2 England and Wales 12.2 12.2 11.6 12.9 12.1 9 Infantile Mortality:—There were 46 infant deaths during the year (including transferable deaths), giving a rate of 60 per thousand registered births, a decrease of 10 per thousand on last) year's figures when there were 59 deaths and a rate of 70. The infantile death-rate calculated on the Registrar(General's figures is 61.8 per thousand births. The infant death rate for illegitimate children was 119 per thousand illegitimate births. The following table shows the causes of death, and ages at death, of Infants under one year Infant Mortality during the year 1925. (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. Whooping Cough — — — — — — 1 2 3 Bronchitis — — 2 2 1 3 — — 6 Pneumonia (all forms) - — 1 — 1 - 2 1 4 8 Enteritis — — — — 1 1 1 2 5 Congenital Malformations 1 1 — — 2 - — — — 2 Premature Birth 9 2 — — 11 - — — — 11 Atrophy, Debility and Marasmus — 1 — — 1 - — — — 1 Tubercular Meningitis - - - - - - - 1 - 1 Malnutrition 1 Hydrocephalus — — — - — 1 — — 1 Atelectasis 1 — — 1 — — — 1 Meningitis 1 — 1 Otitis Media — — — — 1 — — — 1 Convulsions — — — 1 1 - 1 — — 2 Congenital Syphilis, Toxmmia, Syncope — — — — 1 — — 1 Asphyxia — — — — 1 ~~ ~ 1 Totals 11 4 1 3 19 5 1 9 5 8 46 Infant Mortality during the years 1921-1925. (Deaths at various ages under One Year of Age). Year. Under 1 week 1-2 Weeks '2-3 Weeks 3-4 Weeks Total under 4 weeks 1-3 Months 3-G Months 6-9 Months 9-12 Months Total Deaths under One Year. 1921 - - — - 29 - - - — 72 1922 11 i 2 2 16 5 10 6 4 41 1923 15 3 1 3 22 6 7 3 — 38 1924 24 2 3 1 30 6 8 5 10 59 1925 11 4 1 3 19 5 9 5 8 46 10 Infantile and Neo-Natal Death Rates per 1,000 Births, 1921-1925. 1925 1924 1923 1922 1921 Infantile Death Rate 60.0 70.0 43.7 58 0 69.0 Neo-Natal Death Rate 25.0 36.8 25.3 18.4 27 0 Poor Law Relief.—The following information has been furnished by the Clerk of the Kingston Union respecting Poor Law Relief in this District:— Amount paid in Out-door Relief in 1925 £7,740 3s. 6d. Average weekly number of persons in receipt of relief 418.6 Number of persons admitted to the Guardians' Institution from Wimbledon area 353 General Provision of Health Services in the Area. (a) Hospitals provided or subsidised by the Local Authority or by the County Council:— (1) Tuberculosis—Crooksbury Sanatorium, under the Surrey County Council. (2) Maternity—None. (3) Children—see Hospitals for area (b). (4) Fevers—Isolation Hospital, Gap Road, Wimbledon Borough Council, 105 beds. (5) Small-pox—Cheam Small-pox Hospital, Surrey, Croydon and Wimbledon Joint Board. (6) Other—None. (b) Hospitals available for the area Wimbledon Hospital, Thurston Road, Copse Hill (60 beds). The Nelson Hospital for Wimbledon, Merton and District, Kingston Road, Merton Rush (52 beds). Kingston Infirmary, Kingston (500 beds). Contributions are made to the local hospitals by the Wimbledon Borough Council in respect to (a) treatment of employees; (b) treatment of schoolchildren. (c) Institution for unmanned mothers:— Southwark Diocesan Maternity Home, 56, Gap Road, Wimbledon. Ambulance Facilities:— (a) For infectious cases—two motor ambulances, Isolation Hospital, Gap Road. (b) For Non-Infectious cases and Accidents—one motor ambulance, Fire Station, Queen's Road, under the Wimbledon Borough Council. 11 Clinics and Treatment Centres:— Maternity and Child Welfare Centres:— (1) Wandle Park House, Wandle Bank, Wimbledon. (2) Queen's Hall, Queen's Road, Wimbledon. Both under the Wimbledon Borough Council. Day Nursery, 176-180, Haydons Road, Wimbledon, under the Wimbledon Borough Council. School Clinic:—Southey Hall, Southey Road, Wimbledon, under the Wimbledon Education Committee. Tuberculosis:—Dispensary, 145, Merton Road, Wimbledon, under the Surrey County Council. Venereal Diseases:—Richmond, under the Surrey County Council Public Health Officers of the Local Authority. (See p. 2.) Professional Nursing in the Home. (a) General:—South Wimbledon District Nursing Association, supported by voluntary contributions. A small contribution is made by the Wimbledon Borough Council in respect to cases of Ophthalmia Neonatorum. (b) Infections Diseases—None. Midwives:—Under the supervision of the Surrey County Council. There are 14 midwives practising in the district. MORTUARY. Prom information received from the Superintendent of the Cemetery, there were 49 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 45 bodies, equal to 8.6 percent. of all deaths registered in the Borough. LOCAL ACTS, SPECIAL LOCAL ORDERS, OR GENERAL ADOPTIVE ACTS IN FORCE IN THE BOROUGH. Infectious Diseases (Prevention) Act, 1890—17th December, 1890. Public Health Acts (Amendment) Act, 1890: (Parts II., III. and V.)—17th December, 1890. Housing of the Working Classes Act, 1890: (Part III.)—7th June, 1899. 12 Public Health Amendment Act, 1907. Part II. (Streets Buildings)—Sections 15, 16, 17, 18, 19, 20, 21, 12,2, 23, 24, 26, 28, 29, 31, 32, 33, and Sections 25, 27 and 30 with modifications. Part III. (Sanitary provisions)—Sections 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and 51 and Sections 35 and 38 with modifications. Part IV. (Infectious Diseases)—Sections 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 64, 65, 67, and 68, and Section 59 with modifications. Part V. (Common Lodging Houses)—Sections 69, 70, 71, 72, 73, 74 and 75. Part VI. (Recreation Grounds)—Section 76 (with modificat ions), and Section 77. Part VII. (Police)—Sections 84, 85, 86, and section 81 with modifications. Part VIII. (Fire Brigade)—Sections 87, 88, 89 and 90. Part IX. (Sky Signs)—Section 91. Part X. (Miscellaneous)—Sections 92, 93 and 95. (All the above Sections of the 1907 Act were adopted on 28th July, 1913, except those in Parts VII., VIII. and IX., which became operative on 21st December, 1908.) The Wimbledon Corporation Act, 1914.—7th August., 1914. Bye-laws, Regulations, etc. :— Bye-laws with respect to Houses let in Lodgings. do. do. Common Lodging Houses. do. do. Slaughter-houses (Revised 1922). do. do. Nuisances. Bye-laws with respect to tents, vans, sheds and similar structures. Bye-laws as to Registries for Female Domestic Servants. Bye-laws with respect to the keeping of water-closets supplied with sufficient water for flushing. Regulations with respect to Dairies, Cowsheds and Milkshops. The Public Health (Meat) Regulations, 1924. Provisional and other Orders affecting the Borough:— Croydon and Wimbledon Joint Small-pox Hospital Order, 1898. Do. do. do. 1903. Do. do. do. 1908. Do. do. do. 1912. 13 Order of Local Government Board under the Public Health Acts (Amendment) Act, 1907, declaring certain trades to be offensive. Dated 14th January, 1914. Order of Town Council under Shops Acts, 1912 and 1913, relating to Second-hand Clothes' Dealers. Dated 5th November, 1913. The Wimbledon General Half Holiday Order, 1914. 6th June, 1914. The Wimbledon Credit Drapers' Half Holiday Order, 1914. 2nd July, 1914. The Wimbledon Barbers' and Hairdressers' Closing Order, 1919. 27th October, 1919. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply is obtained from the Metropolitan Water Board. Rivers and Streams:—The River Wandle forms the Southern boundary of the Borough. This river is vested as a sewer under the London Council for practically the whole length in the Wimbledon District, but the actual boundary is still in dispute between the Wimbledon Corporation, the Surrey Comity Council, and the London County Council. The river receives the . effluents from the Corporation Sewage Works, the effluent from the Wandle Valley Joint Sewerage Board, and several trade effluents. The surface water from sections of North Wimbledon and Wimbledon Park also drains into the Wandle. The Beverley Brook arising in the Maidens and Coombe areas, forms part of the North Western boundary of the township. This stream receives the surface water from the Cottenham Park and adjacent sections of the Wimbledon area. Drainage and Sewerage:—In 1924, the new extension of the sewage works in Durnsford Road was opened. A description of this extension was given in my Annual Report for 1923. Briefly, the settling tanks were improved and increased in capacity by 93,000 gallons. Six new percolating filters and dosing and humus tanks were introduced. Under this new scheme the effluent to the Wandle. both from the percolating filters and contact beds, has greatly improved. Scavenging:—House refuse is removed to the Corporation destructor once weekly, save in the case of certain service flats and other premises, where the removal is bi-weekly. Schools:—See report of School Medical Otffieer (pp. 49-66). 14 Sanitary Inspection of 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 1925, as reported by the Sanitary Inspector. Reason of Visit. No. Infectious Disease 669 House Inspections 1,842 House to House Inspections 2,920 Rent Act Inspections 165 Houses Let in Lodgings; Inspections 125 Inspection of factories, Workshops, Workplaces and Out-workers' Premises 388 Common Lodging Houses; Inspections 10 Dairies and Cowsheds; Inspections 31 Inspection under Shop Acts 857 Application of Test to Drains 230 Inspections under Diseases of Animals Acts 152 Obtaining Samples of Food and Drugs 11 Miscellaneous (including Inspections of Food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,200 8,600 One thousand two hundred and ninety-four preliminary or informal notices were served in respect of 1,155 houses. One hundred and seventy-three statutory notices were served in respect of 141 houses. The necessary work was executed in all but 132 eases, which were not completed by the end of the year. In 38 of these, the work was actually in hand at the close of the year. Table III. gives a summary of the nuisances abated, and sanitary improvement carried out under the supervision of the Inspectorial Staff. Factories and Workshops.—In the Table below is shown the work done in the supervision of workshops and workplaces:— PREMISES. Inspection. Written Notices. Prosecutions. Factories 103 5 - Workshops 207 24 - Workplaces 78 40 - Total 388 33 15 DEFECTS FOUND. NATUKE. Number of Defects. Prosecutions. Found. Remedied. Referred to h.m. Inspector. Want of Cleanliness 20 20 - — Want of Ventilation 1 1 - — Other Nuisances 12 - — Sanitary Accommodation— Insufficient — — - — Unsuitable or Defective — — - - Not Separate for Sexes — — - — Other Offences — — - — Totals 33 33 — — HOME WORK. Lists received:— Twice in the year 7 Number of Out-workers 61 Once in the year 5 Number of Out-workers 6 Number of addresses received from other Councils 61 Number of addresses forwarded to other Councils 14 Notices served on occupiers as to keeping or sending lists Prosecutions—Failing to keep Out-workers' lists Prosecutions—Failing to furnish lists Inspections of Out-workers' premises 6 Number of unwholesome premises Notices served to remedy REGISTERED WORKSHOPS. The following are the principal classes of workshops on the register at the end of the year:— Boot repairing 53 Dressmaking 53 Bakehouses (including four Factory Bakehouses 27 Laundries 33 Tailoring 30 Millinery 15 Dining Rooms 20 Motors and Cycles 30 Other trades 197 458 16 16 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act Action taken in matters {Notified by H.M. referred by H.M. In- {Inspector 3 spector as remedial {Reports of action under the Public{ taken sent to Health Acts. {H.M. Inspector 3 Underground Bakehouses in use at the end of the year 3 17 Borough of Wimbledon. SANITARY DEPARTMENT. ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE Year ended 31st December, 1925. To the Mayor, Aldermen and Councillors of the Borough of Wimbledon. Ladies and Gentlemen, I beg to submit to you my Report of the work carried out in my Department for the year ended 31st December, 1925. Table III. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—One thousand, two hundred and ninetyfour Preliminary Notices or intimations were served during the year in respect of 1,155 houses. It was only found necessary to serve 107 Statutory Notices upon the owners or occupiers of 141 houses. LEGAL PROCEEDINGS. No. Nuisance. Result 1 Overcrowding. Pined £2 2s. and costs, and Ejectment Order made. 266 letters, respecting 307 houses, were received through the Town Clerk's Department, and answered, enquiring if any sanitary notices were outstanding with respect to properties for which negotiations for sale were in progress. 18 Opening Up of Drains under Section 41 of the Public Health Act, 1875.—As a result of the application of the smoke or chemical tests, 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 four 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 instruction requiring the reconstruction or amendment of the defective drains, etc., as the circumstances required. House Drainage.—The drainage systems and sanitary arrangements of 17 houses have been entirely reconstructed, extensive amendments or repairs were carried out at 56 other houses, and at 22 houses the drainage systems have been made water-tight by the patent internal process. House to House Inspection.—During the year, house to house surveys were carried out at 451 houses. The following list shows the particular streets, and the number of houses inspected in each. A list of the work carried out at the houses is included in Table III., p. 27. Beehive Buildings 51 Ridley Road 52 Latimer Road 43 Wycliffe Road 37 Palmerston Road 115 Graham Road 153 451 House Inspection.—Either as a result of inspections made on complaint, in consequence of the occurrence of infectious disease, request by occupiers, and other general inspections, 704 houses were visited. Table III. shows a list of sanitary works executed at these houses, together with defects remedied, jluring house to house inspection. Overcrowding.—In previous Annual Reports, I have expressed my regret at being unable to report material improvements in the housing conditions existing in the district. My observations this year, I regret to say, must be a reiteration of these statements, owing chiefly to the fact that houses for the occupation of the working classes are not being erected, and the majority of persons living in overcrowded conditions are unable to avail themselves of the only remedy, that of purchasing their own houses. The Committee considered it would only be adding to the burdens of these persons if prosecutions were instituted in the Courts. As time goes on, the families concerned, in some 19 cases, increase, and in all cases the ages of the children make it more difficult for the sexes to be provided with decent and separate sleeping accommodation. In one gross case of overcrowding reported to the Local Authority, a prosecution was instituted, due mainly to the fact that the persons concerned had moved into the premises from another district, with a full knowledge of the scanty accommodation available. The result of the summons is reported under the heading "Legal Proceedings." Houses Let in Lodgings.—There are 67 of these houses on the Register, and 125 visits of inspection were made during the year, to ensure that the Bye-laws were being observed. Verminous Rooms.—During the year, 39 rooms have been dealt with. As previously, the necessary notices were served upon the persons 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 Department at the owner's expense, after the walls have been stripped as required. Common Lodging Houses.—There are two Common Lodging Houses in the district, viz., Nos. 42 and 188, High Street, South Wimbledon, for which Annual Certificates of Registration were granted from 1st January to 31st December, 1925. Ten inspections of the premises have been made from time to time at irregular intervals, and I am pleased to report that all the provisions of the Bye-laws were rigidly observed. Van Dwelling's.—Considerable attention has been paid to these dwellings, and on one plot of land an additional number of vans, old trams and 'buses were found to be used for human habitation by some sixty adults and children. The beds in the majority of cases were very crude, being formed by cupboards and shelves, with no provision for the proper separation of the sexes, and no permanent means of ventilation to the lower bunks. I repeatedly interviewed and cautioned the owner of the land, Avho is also the occupier of one of the vans, and, as a result, up to the end of the year two vans, one tram, one 'bus and twenty persons were ejected. The matter is still receiving the attention of the Department. With respect to the vans in other parts of the district, these have been regularly inspected and the provisions of the bye-laws enforced. Dairies, Cowsheds and Milkshops.—Ten applications were received during the year from persons desirous of being 20 registered under the Dairies, Cowsheds and Milk,shops Order, and the Milk and Dairies (Amendment) Act, 1922. Thirty-one inspections have been made of the premises of dairymen and purveyors of milk in the district, during which seven matters were discovered which required to be dealt with by the Department. Infectious Disease and Disinfection.—During the year, visits for the purpose of investigating cases of notifiable infectious disease were made to 237 houses. Special visits were also made, as required, for the purpose of following up and enquiring 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 69 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. Disinfection of rooms, bedding, clothing, etc., was duly carried out after the removal to hospital or recovery of each patient. Where necessary, the walls of the rooms from which the cases had been removed were stripped and re-papered or distempered. The number of rooms disinfected was 463, and the number of articles, bedding, wearing apparel, etc., 11,970, 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.—In the course of the inspections made during the year, 67 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. Stable Refuse.—Continued attention has been paid to the mews and stable yards in the district, 31 visits having been made to such premises during the year. Inspections under the Factory and Workshop Act, 1901.— There are 458 factories, workshops and workplaces on the Register, to which 392 visits of inspection were made. Thirty-three written notices were served, referring to sanitary conveniences and other nuisances. 21 Shops Acts, 1912-1913.—Eight hundred and fifty-seven visits were made to the occupied shops in the district for the purpose of observing contraventions of the Acts. In two cases, legal proceedings were instituted, as under— (a) Against an occupier for failing to close shop at 8 p.m. on two Sundays. Occupier was fined £1 on each summons and costs. (b) Against a firm for failing to close two of their shops oil the usual weekly half-holiday. A fine of 10s. and eosts in each case was inflicted. Towards the end of November, the Home Secretary made an Order suspending the operation of the General Early Closing Order from 18th to 24th December, 1925, inclusive. As is usual, this did not relieve occupiers of the obligation to comply with the weekly half-holiday order in force in the district, and, as a result, numerous questions as to the position of local shop-keepers were dealt with by the Department, Observations were kept throughout the district in the week preceding the Christmas week, when a number of contraventions were noted, details of which were reported to the Local Authority early in 1926. Slaughter Houses and Food Inspection.—The number of registered slaughter-houses remains the same as last year, viz., six. Three of these, however, have not been used for some considerable time, and one other has been converted into a motor garage. Thirty-one inspections have been made during the year, whilst slaughtering was in progress, and as far as possible all animals killed in the town have been examined prior to being exposed for sale. In addition, 257 visits have been made to shops of butchers, fishmongers and fruiterers, and other places where food is prepared or exposed for sale, and the following were surrendered and destroyed as trade refuse, being unfit for human food:— Apples 280 lbs. Cod 5 stone. Haddocks 1 box. Roes 2 stone. Oranges 12 cases. Shrimps 1 flat. Tomatoes 7 bundles & 481bs. Winkles 2 bags. 22 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. Particulars of Samples of Food and Drugs taken and submitted for Analysis, Year ended 31st December, 1925. articles. Test Samples. No. Genuine. Adulterated or Inferior. Slightly Inferior or Deteriorated. Milk 16 16 - - Porridge 1 1 — — Cream 3 3 — - Sugar 2 — 2 - Sausages 1 1 - - Total 23 21 2 — Petroleum Acts.—Sixty-five applications were received for permission to keep petroleum, 59 being for the renewal of existing licences, and six for new ones. Two hundred inspections were made of the various premises in respect of which licences had been issued. Diseases of Animals Acts, 1894 to 1911. Parasitic Mange.—Only one case of this disease was notified during the year, the information being received from the Veterinary Surgeon attending the case. Following investigations the usual notices for detention were served and the Ministry of Agriculture and the Police Authorities notified. The premises were kept under observation, and, on the animal recovering from the disease, disinfection notices were served. Subsequently, the restrictions were withdrawn and the clearance notices sent to the owner, the Ministry of Agriculture, and the Police Authorities. Foot and Mouth Disease.—No case of this disease was notified, but quite a number of Orders, which included Wimbledon in the Infected Area, and, later, in the Restricted Area, were received. As usual when such orders are in force, the Department dealt with a considerable number of enquiries, and issued the requisite movement licences. 23 The Public Health (Meat) Regulations, 1924.—These Regulations came into operation 011 the 1st April, 1925, and include a number of new provisions which are of great importance. One of the chief provisions is the obligation 011 the part of butchers to give notice of intended slaughter so that carcases and organs of all animals slaughtered for human consumption can be inspected prior to their being offered for sale. In this connection 1 would mention that it is necessary for a Local Authority to designate an Officer to whom such notices are to be sent. Advertisements to the effect that I was appointed the Officer, appeared in the local papers as required. There are several other provisions with respect to meat, as well as butchers' shops generally, dealing mainly with the protection of all meat exposed for sale. Although the regulations do not stipulate definitely that these shops should be provided with glass windows, it appears to me to be the only effectual means of preventing contamination from dust. As a result of conversation with several of the local butchers, I am pleased to report that in seven eases closed fronts have been constructed where the shops had previously been open, and I have every reason to hope that the remainder will fall into line in the near future. As one would expect, some little difficulty has been experienced, but this is gradually being overcome. No breaches of the regulations have had to be reported to the Local Authority. Rent (Restrictions) Acts, 1920 & 1923.—Under these Acts twenty-seven applications were received from occupiers of premises requesting that inspections be made, as in their opinion the owners had failed in their obligations. In each case, a complete survey of the house, both internal and external, was made, and a notice prepared specifying the works to be executed in order to make the premises in all respects reasonably tit for human habitation. The applications were submitted to the Committee, together with a report as to the conditions existing, and in each case the issuing of a certificate was authorised. In six cases the certificates were subsequently issued as the works required to be done had not been satisfactorily executed. In one case a request was received from the owner's solicitors that the matter be permitted to stand over pending the hearing of his case in the County Court. After hearing the circumstances, the Committee acceded to the request. 24 In another case where a Certificate had been issued to the tenant the owner had the necessary work executed and then applied for a Certificate that the premises were, at that time, in a reasonable state of repair. After considering the report, the Local Authority granted the Certificate. Two cases were still being dealt with at the close of the year. I would point out that in all these cases it is most essential that the inspections and reports are very carefully made and prepared in order that clear evidence may be given should the cases be the subject of legal proceedings. Piggeries.—Early in July a complaint was received from a number of householders that a serious nuisance existed on some land adjoining their houses. The complaint was immediately investigated and found to be due to improper keeping of pigs, the boiling of pig wash and the extraction of fat therefrom. The premises had recently been taken over by a pig dealer, who did not appear to possess even a primitive idea of hygiene. The sties were found to be dirty, the floors defective, and the drainage most inadequate. A rough wood structure had been constructed in which a vertical boiler had been erected. In and around this shed were a number of very large tanks containing foul-smelling pig food (hotel table refuse), and some bags of offensive bones, the whole appearing to be the Mecca of swarms of blow flies. Cleanliness seemed to be an unnecessary evil, whilst neglect was the dominating factor. The occupier was warned and the premises kept under observation for some time, but no material improvement was effected, notwithstanding the promises made. I made several surveys of the River Wandle upon which the piggeries abut, and found the water at this point to be very foul, due, undoubtedly, to drainage from the sties. In consequence of the occupier's failure to alter the prevailing conditions, the matter was reported to the Local Authority, who instructed me to serve a Notice, which 1 did. I afterwards had several interviews with the occupier, the result being that he gave an undertaking to vacate the premises at the end of the year. As he did not redeem his promise, instructions were given for legal proceedings to be instituted, but the premises were cleared and vacated before the summons could be served. 25 Water Supply:—The water supply was withdrawn from 48 houses during the year For the following reasons— 9 by request, 33 owing to arrears of rates, and 6 for other reasons. I desire to record my appreciation of the loyal support and assistance rendered by my Staff, and to acknowledge the kind co-operation of Dr. Gilmour, Medical Officer of Health, and my colleagues of other Departments. I am, Ladies and Gentlemen, Your obedient servant, HENRY JOHNSON, P.S.I.A., M.K.S.I., Chief Sanitary Inspector. 26 TABLE III. The following is a summary of the nuisances abated, and sanitary improvements carried out under the supervision of the Inspectorial Staff:— Accumulations removed 28 Cisterns provided 5 Cisterns repaired, cleansed or covered 73 Drains, new, provided 17 Drainage systems made water-tight by patent process 22 Drains repaired or altered 56 Drains, stoppages removed 66 Dustbins provided 96 Flushing cisterns, new, provided 61 Flushing cisterns repaired 143 Overcrowding nuisances abated 3 R.W. pipes disconnected 11 Roofs repaired 171 Rooms stripped and cleansed 1251 Verminous rooms cleansed 10 Soilpipcs, new, provided 21 Soilpipes repaired or altered 8 Vent pipes, new, provided 33 Vent pipes, repaired or altered 34 Waste pipes, new, provided Waste pipes repaired, disconnected, or trapped 93 60 Water-closets, new, provided 116 Water-closets repaired or ventilated 6 Water services restored 48 Yards paved 23 Yards repaired 44 Guttering repaired 177 Floors ventilated 12 Nuisances abated from damp walls 109 Water supply direct from main 13 Sinks provided 69 Rooms fumigated 463 Other nuisances 1870 5,212 27 Medical Officer of Health Report (Continued from page 17.) HOUSING. I.—General Housing Conditions in the area:- The general housing conditions are very good. It is difficult to estimate the actual housing conditions in Wimbledon, but it can reasonably be stated that if the houses were occupied only by persons employed in Wimbledon, or in the near neighbourhood, the housing accommodation would be sufficient. As previously stated, however, Wimbledon is one of London's dormitories, and there is a distinct shortage of houses for those applying for them, especially from other areas. New houses, whether erected by private or municipal enterprise, are occupied as soon as erected, and the cry is for " more." The erection of such houses, however, does little to combat the overcrowding which exists. Houses for occupation by the working-classes are not erected by private enterprise, and suitable sites for such houses under Municipal schemes are not easily found. The Municipal Housing Estate is being developed as rapidly as possible, but cannot be extended indefinitely. II.—Overcrowding:— Overcrowding exists in practically all sections of the town, but the extent to which this peril has grown cannot be given in figures. In many cases the dangerous states of overcrowding are only discovered on notification of infectious disease, or on receipt of some complaint as to sanitary conditions or rent. Even then, little can be done to remedy the conditions, for any legal action would merely increase the trouble existing elsewhere. The sub-letting of rooms shows no decrease, and the same conditions occur again and again. Local bye-laws might be passed restricting subletting to the families of those employed locally, but such measures would be difficult to administer. In regard to both the above sections, there have been no important changes or developments in the local conditions of employment or occupation, to render this shortage of houses more acute. The problem has ceased to be Municipal and has become National. III.—Fitness of Houses:— The general standard of house in the area is good. The defects found arc mainly what might be termed " upkeep " defects, due either to want of attention by the tenants or to want of capital by the owners. House-owners in this area are anxious to keep their property in good repair, and are willing to follow the advice given, and carry out the recommendations of the sanitary inspector. No legal action was necessary in any ease, beyond the service of the formal notice. 28 IV.—Unhealthy areas:— None. V.—Bye-laws relating to houses, houses let in lodgings, etc.—See report of the Sanitary Inspector (p. 20). VI.—General and Miscellaneous:— From the 26th-31st October, 1925, a " Health " Week was held at the Baths Hall, Latimer Road, Wimbledon. In addition to lectures and cinema displays on popular health topics, there was an excellent exhibit by the sanitary section, showing good and faulty household fittings (e.g., sinks, water-closets, dust-bins, etc.), as well as the simpler methods of eradicating household pests. Exhibits by other Municipal Departments, especially the Electricity Department in regard to cooking, heating and lighting by electricity, were much appreciated. It was estimated that over 10,000 persons (including 2,000 school children) visited the exhibition. Housing Statistics for the year 1925. Number of new houses erected during the year:— (a) Total, including (b), (i), (ii) 236 (b) With State Assistance under the Housing Acts— (i) By the Local Authority — (ii) By other bodies or persons — I—UN FIT DWELLING-HOUSES. I .—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,320 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 451 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 1,155 II.—Remedy of defects without service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 955 29 III.—Action under Statutory Powers. A:— Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (i2) Number of dwelling-houses which were rendered fit after service of formal notices (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect, of which Closing Orders became operative in pursuance of declarations by owners of intentions to close Nil B:— Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 141 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 68 (b) By Local Authority in default of owners Nil C:— Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders ... Nil (2) Number of dwelling-houses in respect of which Closing Orders were made ... Nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Inspection and Supervision of Food. (a) Milk Supply:— Practically all the milk for retail sale is brought into the area from other districts. A few cows are kept by private individuals for milk, but such milk is not retailed. There were 2 cowkeepers, 25 dairymen, 29 dairymen 30 and purveyors, and 17 purveyors on the Registers on 31st December, 1025. The genera] arrangements for the supply and distribution of the milk were adequate. (1) No action was necessary as to tuberculous milk or cattle. (2) Licences granted under the Milk (Special Designations) Order, 1923:— Dealers in Certified Milk 5 Pasteurisers (Holder process) 1 (3) No licences were refused or revoked. (4) Bacteriological examinations:— All samples satisfactory. (b) MeatSee Sanitary Inspector's Report (p. 24). SLAUGHTER HOUSES. In 1920. In Jan. 1925. In Dec. 1925. Registered 4 3 2 Licensed 1 — — Total 5 3 2 (c) Other Foods:—See Sanitarv Inspector's Report (p. 23). Prevalence of, and Control over Infectious Diseases. During the last five years, the notifiable infectious diseases were practically confined to oases of scarlet fever and diphtheria. The number of diphtheria oases has dropped each year since 1921. In the same year, scarlet fever cases became epidemic, and since then the number has dropped, but is again showing a slight increase. Cases of other notifiable infectious diseases have occurred, but these must be regarded as sporadic cases, no connection having been traced between the cases. Cases of Encephalitis Lethargica have been notified during the last two years, but these cases are usually discovered accidentally, having sought treatment, for other conditions, such as " double vision.'' The cases of diphtheria are being reported at an earlier stage of the illness each year. 32 bottles of anti-diphtheritic serum were supplied through the Public Health Department for use by medical practitioners for the treatment of diphtheria. The anti-toxin syringe, which is kept at the Fire Station, was borrowed on one occasion by a medical practitioner in the district. The Schick and Dick tests in diphtheria and scarlet fever, respectively, have not been used, and no immunisation methods have been adopted in the Borough. The new serum treatment of scarlet fever has been tried in the Wimbledon Isolation Hospital, and the results so far have been gratifying. The number of cases is too small, however, for a full report. 31 The non-notifiable diseases have been very prevalent, and a return of eases intimated from schools is given in the Report of the School Medical Officer. The home supervision and control of sucb cases is carried out by the Health-Visitor-School Nurses. The following Table shows the number of infectious cases notified, and the deaths from each disease in the district during the last five years (1920-1925). DISEASES. 1925 1924 1923 1922 1921 1920 Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. Cases Notified. Deaths. - - - - - - - - - - - - Diphtheria 33 1 42 1 88 5 159 7 181 14 123 12 Erysipelas 20 — 13 — 10 —' 11 1 10 — 30 2 Scarlet Fever 170 2 150 2 94 — 227 1 265 1 230 2 •Enteric Fever 8 — 3 — 2 — 4 — 4 1 3 — para-Typhoid - - 6 - - - - - - — - - Polio Encephalitis — — 2 1 1 - - - - - - - Puerperal Fever 3 — 3 — 1 — 3 1 1 1 3 — Encephalitis Lethargica 5 3 10 1 - - - - - - - - Cerebro-Spinal Meningitis - - 2 1 - - - - - - - - Anterio Poliomyelitis — — 2 — — — — — — — — — Totals 231 6 233 6 196 5 404 10 461 17 389 16 Table showing the death-rate from Zymotic Diseases, including Tuberculous Diseases, for the last ten years. YEAR. Zymotic Death-rate. Death-Rate From Small Pox. Scarlet Fever. Diphtheria. " Fever." Whooping Cough. Measles. Diarrhoea. Phthisis and other Tuberc'ios Diseases. 1916 .59 - .03 .16 .03 .1 .07 .18 .82 1917 1.25 — — .2 .05 .01 .65 .29 1.36 1918 .68 - — .13 .01 .23 .09 .19 1.27 1919 .26 - .01 .13 — — .03 .08 .8 1920 .46 — .03 .19 — .03 .09 .11 .72 1921 .63 — .01 .22 .01 .06 — .3 .79 1922 1.06 — .00 .1 — .08 .00 .05 .76 1923 1.00 — .05 .08 — .06 .06 .08 .63 1924 1.10 — .06 .01 .01 .05 .15 .05 .75 1925 1.01 - .03 .01 .1 - .08 .77 The figures given in these Tables are those obtained after correction by exclusion of " Non-Residents " and the inclusion of " Residents'" beyond the district. 32 TABLE A.—NOTIFIABLE DISEASES—1925. Table showing the total cases notified and deaths in age groups, the numbers removed to hospital, and the total deaths. DISEASE. Total cases Notified. Under 1 Year. 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65 and over. Cases admitted to Hospl. Totals Death Diphtheria Notified 33 - 2 — — 1 7 4 7 7 2 3 — 28 Deaths - 1 — — — — — — Scarlet Fever Notified 170 1 3 4 4 11 eo 57 14 11 1 4 - 139 Deaths — — — — — l — — 1 — — - - 2 Enteric Fever Notified 3 - - - - - — 1 — 1 1 — - 3 - Deaths - - - - - - - - - - - - - - Puerperal Fever Notified 3 — — — — — — — — 3 — — - - - Deaths - — — — — — — — — — — — - - - Pneumonia Notified 17 — — — — 1 3 — 1 3 1 6 2 — Deaths - 8 3 2 — 1 1 1 — 3 2 7 — 46 Erysipelas Notified 20 — — 1 — — 1 1 — 6 4 6 i 4 - Deaths — — — — — — — — — — — - - - Encephalitis Lethargica Notified 5 — 1 — — — 1 — — — — 2 i 2 - Deaths - - - - - - 1 — — — — 1 i - 3 Cerebro-Spinal Meningitis Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - - Malaria Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Polio Encephalitis Notified - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Para Typhoid Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Anterio Poliomyelitis Notified — — — — — — — — — — — — — - Deaths — — — — — — — — — — — — — — Tuberculosis Notified 70 1 2 8 32 12 14 i 51 Deaths 1 — — — — 1 1 7 15 7 12 i - 45 TOTALS Notified 321 1 - 5 4 13 73 65 30 63 21 35 5 — - Deaths 9 4 2 — 1 4 2 7 19 9 20 20 - 97 83 Table showing the Ward Distribution of Infectious cases notified in 1925, and the numbers removed to hospital. Notifiable Disease. All Ages. Total Cases Notified in Each Locality (e g. Parish or Ward) of the. District. Total Cases removed to Hospital. Wimbledon Park Ward St. Mary's Ward. St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Haydon Park Ward. 1 2 3 4 5 6 7 8 Diphtheria (including Membranous croup) 33 5 2 2 1 3 9 5 6 28 Erysipelas 20 1 3 — 2 2 6 3 3 4 Scarlet Fever 170 3 10 9 25 19 44 34 26 139 Enteric Fever 3 1 2 — 3 Puerperal Fever 3 — — — — 2 — 1 — 2 - - — - - — - — - Pulmonary Tuberculosis 63 5 2 6 8 8 21 7 6 46 Other forms of Tuberculosis 7 2 1 1 — 2 — — 1 5 Ophthalmia Neonatorum ... 3 — — — 2 — — — 1 3 Encephalitis Lethargica 5 — 2 — — — 3 — — 2 Pneumonia 16 2 1 — 1 2 3 4 3 — Influenzal Pneumonia 1 — — — — — 1 - — — totals 324 18 21 18 39 38 88 56 46 232 Scarlet Fever.—The total number of cases notified during the year, was 170 from 135 houses. The attack rate was 2.9 per thousand of the population. There were 2 deaths, corresponding to a death-rate of .03 per thousand of the population. 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 1911-1915 3.03 .01 1916-1920 1.8 .01 1921-1925 3.04 .02 In one house there were six cases, in three houses, four cases, in four houses, three cases, in thirteen houses, two cases, and in the remaining 114 houses, one case. 138 or 81 per cent. of the cases were treated in the Borough Isolation Hospital, Gap Road. The disease was of a mild type. 72 per cent, of the cases notified were children of School age, five to fifteen years, and of these, 113 attended the following schools:— 34 Cottenham Park, Mixed 8 Effra Road Girls, and Infants' Schools 10 Dunisford Road Mixed and Infants' Schools 1 Queen's Road Girls' and Infants' Schools 19 Queen's Road Boys' School 4 Pelham Road Boys' School 2 Pelham Road Girls' and Infants' Schools 18 Dundonald Road Boys' School 1 Dundonald Road Girls' and Infants' Schools 2 Russell Road Mixed School 1 Russell Road Infants' School 1 Haydons Road Girls' School 4 Haydons Road Infants' School 4 Haydons Road Boys' School 4 Private Schools 20 Schools outside the district 14 Total 113 Diphtheria:— The total number of cases notified during the year, was 33 from 33 houses. The attack-rate was .56 per thousand of the population. There was 1 death, corresponding to a death-rate of .01 per thousand of the population. 26 or 78 per cent. of the patients were treated in the Isolation Hospital. 33 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 11 attended the following schools:— Dundonald Boys' School 1 Queen's Road Girls' and Infants' Schools 1 Queen's Road Boys' School 1 Haydons Road Girls' and Infants' Schools 3 Effra Road Girls' and Infants' Schools 2 Pelham Road Girls' School 1 Private Schools 2 Total 11 Tuberculosis. The following table shows the number of new cases notified during the year, and the number of deaths from tuberculous diseases. 35 NEW CASES. DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males Females. Under 1 vear - - - - - - 1 — 1— 5 - - - - - - - - 5 — 10 — — — 1 — — 1 — 10—15 ,, — 1 1 — — 1 - — 15 — 20 „ 3 3 — 2 i 5 - 1 20 — 25 „ 2 8 — 2 — 4 - 3 25 — 35 ,, 8 11 — 1 i 6 - 1 35 — 45 ,, 9 3 — — 6 1 - — 45 — 55 ,, 6 2 — — 7 1 - — 55 — 65 „ 2 4 — — 2 2 - — 65 upwards — 1 - - - - - 1 Totals ... 30 33 1 c 17 20 2 6 Of tli'C 37 deaths fironi Pulmonary Tuberculosis, 13 died outside the district (6 males and 7 females), i.e., notification of death was transferred to Wimbledon. Of the 8 Non-Pulmonary deaths, 1 male and 1 females died outside the district. Of the 8 non-Pulmonary Tuberculosis deaths, 4 were due to Meningitis, and one each to Peritonitis, Kidney infection, Endocarditis, and General Tuberculosis. LABORATORY WORK. Bacteriological examinations of pathological specimens and the use of antitoxin, were first undertaken in the Wimbledon area about 1896. 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 result of such examinations are given below. Bacteria Found. Bacteria Not Found total. Diphtheria Secretion 84 999 1083 Phthisis (Sputum) 18 101 119 Reaction Obtained. Reaction Not obtained. Total. Typhoid (Blood) 3 21 24 36 Chemical Work:— Mr. J. H. Johnston, M.Sc., P.I.C., carries out the analytical work in connection with preliminary samples taken under the Food and Drugs Acts, the analyses of water, gas, and sewage effluents required by tbg Wimbledon Corporation, and of food samples suspected of contamination or adulteration. The reports of the Public Analyst under the Food and Drugs Acts are embodied in the Annual Report of the County Medical Officer. Disinfection:— The following table shows the number of rooms and articles disinfected:— Disease. Bedding Disinfected. Clothing. No. of Rooms Disinfected. Totals. Mattresses. Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Dresses Suits. Other Articles. Scarlet Fever 720 273 54 1023 1944 92 95 4353 240 8794 Diphtheria 69 37 13 122 240 9 8 524 33 1055 Typhoid Fever 3 3 1 12 16 1 — 6 — 42 Erysipelas 8 7 6 31 37 — — 64 11 164 Tuberculosis 47 23 16 129 94 5 4 204 76 598 Cancer 29 15 15 101 47 3 — 60 28 298 Pneumonia and Influenza 6 1 - 31 14 1 - 4 2 59 Encephalitis Lethargica 9 7 2 17 33 1 33 8 110 Vermin 6 6 — 8 7 7 — 37 29 100 Sundries 81 32 14 263 252 5 6 524 36 1213 Totals 973 404 121 1737 2684 123 114 5809 463 12433 37 Wimbledon Isolation Hospital. Carried over from 1924 Over 5 years. Under 5 years. Total. Deaths. Remarks. Over 5 vears. Under 5 years Total. Scarlet Fever 31 4 35 - - - Daily average number of cases, 39. Diphtheria 9 2 11 - — — Cases Admitted in 1925. From Wimbledon- Scarlet Fever 115 23 138 1 — 1 Average number of davs in hospital, 47 Diphtheria 24 2 26 - 1 1 Enteric Fever 1 — 1 - — — Scarlet Fever and Chickenpox 1 - 1 - - - Scarlet Fever and Diphtheria 1 - 1 - - - Diphtheria (Staff) 1 — 1 - — — Encephalitis Lethargica - 1 1 Erysipelas 2 — 2 - — — From Kingston. Scarlet Fever 96 18 114 — — Total Kingston cases, 133 Diphtheria 11 7 18 — — — Diphtheria and Measles — 1 1 — — — Total Treated in 1925 292 58 350 1 1 2 304 cases were admitted to the Wimbledon Isolation Hospital during 1925, making a total of 350 cases under treatment during the year, 46 cases remaining under treatment from 1924. 171 cases were from Wimbledon, and 133 from Kingston. Diphtheria :—44 cases were admitted as diphtheria. Of these causes, 5 proved not to be diphtheria—4 being oases of follicular tonsillitis, and 1 an abscess of the soft palate. 1 case Was baeteriiologically positive without clinical signs. A virulence test proved that the organism was a virulent, and the patient was discharged. Of the 38 true cases, 22 were mild, 18 moderately severe, and 4 very severe—3, laryngeal. One ease died on the 9th day after admission of heart failure, giving a case rate of 2.6 per cent. Complications:— 60 per cent. of the cases were uncomplicated. 6 oases showed signs of minor paralysis, and 4 had albuminuria. Scarlet Fever:252 cases were admitted on the diagnosis of scarlet fever. 6 were not scarlet fever cases. 3 had also diphtheria—clinically and bacteriologically. Of the true 38 scarlets, 67 per cent. were mild, 24 per cent. were moderately severe, and 8 per tent. were severe. 1 ease died, on the 9th day after admission, of toxic scarlet fever, with cerebral symptoms, giving a case rate of .4 per cent. A child of 4 months, admitted on the diagnosis of scarlet fever, for observation, died from malnutrition and gastroenteritis. Complications:— 48 per cent. of the cases were uncomplicated. 30 cases developed adenitis—5 suppurative. 14 cases developed rheumatism, of which 4 were severe. 3 cases developed mastoid disease and required operative treatment; 14 eases developed otorrhoea; 9 cases developed late nephritis; and the remaining complications consisted of septic sores, onychias, and other minor conditions. Mixed Cases:— As previously stated, 3 cases were mixed infections of scarlet fever and diphtheria—one admitted on the double diagnosis. One case was admitted as diphtheria, and measles, and one case as scarlet fever and chicken-pox. Enteric Fever:— This was of Paratyphoid B. type. The source of infection was not traced. Encephalitis Lethargica:— This case was very mild in type, and made an excellent recovery. Erysipelas:— 2 cases were admitted—both typical. One was complicated by acute nephritis, but made a good recovery. The other was uncomplicated, and also recovered. Staff:— One Sister developed a septic throat, and, as the swab was baeteriologically positive and virulent, was treated as a diphtheria. She made a good recovery. Cross-infection:— Two outbreaks of German Measles occurred, one at the beginning and one at the end of the year— two cases admitted as mild scarlet having proved to be German Measles. In the first outbreak, 7 other cases developed German Measles, and in the second 6. "Return" Cases:—5 "return" cases of scarlet fever occurred, giving a rate of 2 per cent. 3 cases, apparently uncomplicated, developed '' colds '' on returning home; in 2 no source of infection could be traced. Fever Nurses' Examination:— Two nurses received the senior certificate of the Fever Nurses' Association after examination, and five the junior certificate. 39 Maternity and Child Welfare. The activities in connection with this branch of the Public Health Service, are closely linked up with the work of the other departments. The staff consists of 3 Health Visitors, who also act as school nurses, under the direction of the medical officers. There are two Welfare Centres—Wandle Bank House and Queen's Hall—at each of which, " Welfare Sessions " are held twice weekly. One session is devoted to Infant and Toddler Welfare and Consultation work, and the other is given to class instruction in mothercraft, needlework, health talks, etc. Antenatal Clinics for expectant mothers are held twice monthly throughout the year. At the Welfare Centres, dried milks, and other similar food stuffs are sold at the usual rates for Welfare Centres. Applications for free milk are dealt with by a Special Sub-Committee, and each application is considered on its merits. The total income of the family from all sources is calculated and, after deducting rent and insurance, the average income per head per week, should not exceed 5s. Infants and children under 5 years of age are treated by arrangement at the School Clinic, Southey Hall, Southey Road. Operations for tonsils and adenoids are, after investigation as to income, etc., treated at the local hospitals by arrangement. Dental cases (both mothers and children) and errors of refraction, squint and similar cases, are also dealt with at the Clinic. Pregnant and Nursing Mothers requiring dental extractions or dentures, aire treated on the recommendations of the Medical Officers. Dentures are supplied at " cost rates," and in special cases, the Committee defrays part of the expenses. Cases requiring special operative treatment for obstetrical and gynaecological conditions or, in the case of children, for orthopoedio conditions, are carefully considered by the Medical Officer, and are given special letters to suitable hospitals. Such cases are kept under careful observation, both before admission and after dismissal from hospitals. In a similar way, close co-operation is carried out in connection with the different Voluntary Associations and Societies in the district, and in many cases suitable assistance or change of environment is obtained in this way. In cases of ophthalmia neonatorum, for example, the ease is reported to the South Wimbledon District Nursing Association, and the condition is treated under skilled direction. In the case of unmarried mothers, assistance and advice is given in all cases brought to notice, and, if necessary, arrangements are made through the Health Visitors, as to proper provision for the confinement. The Health Visitors also make 40 thorough investigation into all maternal deaths, still-births and infant deaths. During the year, 3 cases of puerperal fever were notified, and all made good recoveries. The following table shows the number of eases of Ophthalmia Neonatorum, and the result of the early treatment. CASES. Vision. Unimpaired. Vision Total Impaired- Blindness. Deaths. Notified. Treated. At Home. In Hospital. 3 3 — 3 — — — There were no deaths from measles, 3 infantile deaths were due to whooping cough. No cases of epidemic diarrhoea or of poliomyelitis were notified. During 1925, the record of Home Visitation work was as follows:— Number of births notified 622 „ „ „ registered 712 Number of births visited 5123 „ „ „ re-visited—under 1 yr. 1,690 —over 1 yr. 2,536 „ „ Still-births and Deaths 28 „ „ Opthalmia cases visited 3 „ ,, Expectant mothers visited 106 „ „ re-visits to expectant mothers 80 „ „ ineffectual visits 649 „ „ Special visits 139 Total welfare visits 5.754 Number of puerperal fever visits 4 „ „ tuberculosis visits 70 „ „ malaria visits — .j „ school visits (half-day) 156 ,, „ visits to parents of school children 94 324 6,078 41 Supply of Milk to Expectant and Nursing Mothers and Infants. 76 families applied for free milk supplies, and it was granted to 71. Each case is considered individually by the Sub-Committee, and a full statement of income from all sources, including pension and Guardian relief, children working, etc., has to be submitted by the applicant. This average was exceeded in the 3 applications refused. 2 applications were withdrawn, as the husbands had obtained work. The following work was carried out in connection with the Welfare Centres, by the Dental Surgeon for the year ending December 23rd, 1925. Mothers treated 29 „ Attendances for treatment 130 „ Teeth extracted 63 „ filled 15 „ other operations 27 „ Scalings 15 „ Dentures supplied 15 „ ,, repaired and re-modelled 6 „ other Prosthetic operations 82 Babies treated 64 Attendances for treatment 133 „ Teeth extracted 97 „ filled 45 „ Other operations 49 42 During 1925, the record of work at the Centres is as follows:— Infant Welfare Consultations. Queen's Hall Centre. Wandle Park Centre. Number held 49 49 Total number of attendances 2,573 1,782 Average number of attendances 52.5 36.4 Total number seen by Doctor 1,009 857 Ante-Natal Clinic Consultations. Number held 19 Total number of attendances 97 Average number of attendances . 5.1 Classes for Mothers. Number held 34 40 Total number of attendances 369 904 Average number of attendances 10.7 212.6 Subjects taught Mothercraft Needlework Health Talks Knitting Mothercraft Needlework Health Talks Elementary Physiology Total number of fillings inserted 74 „ „ „ Local Anaesthetics administered 26 „ „ General „ „ 36 „ ,, „ „ half-sessions administered (by Dr. Scott) 23 „ „ „ Patients rendered dentally sound 59 South Wimbledon Day Nursery:—Outbreaks of Mumps, Chicken-pox, and German Measles reduced the number of attendances during the year. The number of children on the register was 54, representing 41 families. The total attendances were 8,100, of which 1,569 were halt-day attendances. Daily average, 40. I desire to thank all the members of my staff for their loyal assistance and co-operation in the work of the Department. I have the honour to be, Your obedient servant, A. GILMOUR, Medical Officer of Health. Public Health Offices, 20, Queen's Road, Wimbledon, S.W.19. March, 1926. 43 TABLE 1.—Vital Statistics of Whole District during 1925 and Previous Years. YEAR. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths Belonging to the District. Uncorrected Number. Nett. Under 1 year of Age At all Ages. Number. Rate. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 . 13 1918 57,155 Birth - rate 51,009 Death-rate 779 759 13.2 613 12.01 51 180 57 76 742 14.5 1919 62,283 Birth - rate 59,791 Death-rate 869 861 13.8 512 8.5 64 186 43 50 634 10.6 1920 62,3U Birth - rate 62,174 Death-rate 1124 1144 18.3 462 7.4 58 153 71 62 557 8.9 1931 61,730 1033 1033 16.7 521 8.4 62 175 72 69 643 10.2 1922 61,730 834 868 14.0 485 7.8 70 201 50 58 616 9.9 1923 58,000 838 868 14.9 439 7.6 65 172 38 43.7 546 9.4 1924 58,090 763 814 14.01 495 8.5 49 199 59 70 645 11.1 1925 58,170 712 760 13 06 524 9.0 85 199 46 60 C38 10.9 TABLE II.—Causes of, and Ages at, Deaths during the year 1925. CAUSES OF DEATH. Nett Deaths at the subjoined ages of " Besidents" whether occurring within or without the District. Total Deaths whether of 'Residents' ob'NonResidents in Institutions in the District. All Ages. Under 1 year. 1— 2— 3— 4— 5— 10— 15— 0 20— 35— 45— 65 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All Causes Certified 637 46 7 3 2 1 6 7 12 34 29 173 317 103 Uncertified 1 1 Enteric Fever - - - - - - - - - - - - - - -Small-pox - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - Scarlet Fever 2 - - - - - - - - - - - 1 Whooping Cough 6 3 3 - - - - - - - - - - - Diphtheria and Croup . 1 — 1 — - - - - - - - - - 1 Influenza 13 — — — — — — 1 — — 2 3 7 1 Encephalitis Lethargica 3 - - - - - 1 - - - - 1 1 — Meningococcal Meningitis — — — — — — — — — — — — — — Tuberculosis of Be spiratory System 37 1 6 11 7 12 — 3 Other Tuberculous Diseases 8 1 — — — — 1 — 1 4 — — 1 — Cancer, malignant disease 90 - - - - - - - 3 4 44 39 13 Rheumatic Fever 5 - - - - - - - 1 - — 2 2 — Diabetes ... 5 - - - - - - - - - 1 2 2 — Cerebral Haemorrhage 47 - - - - - - - - - - 11 35 6 Heart Disease . 100 — — — — — — — 1 3 4 26 66 9 Arterio Sclerosis 46 - - - - - - - - - - 8 38 8 Bronchitis 46 6 - - 1 - - - - - - 4 35 4 Pneumonia (all forms) 46 8 3 2 - 1 1 1 - 3 2 7 18 2 45 46 TABLE II,—continued. CAUSES OP DEATH. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. Total Deaths whether OF Residents ' or 'nonResidents' in Institutions in the District. All Ages. Under 1 year. 1— 2— 3— 4— 5— 10— 15— 20— 35— 46— 65 and over. 1 2 3 4 5 1 6 I 7 1 8 9 10 11 12 13 14 Other Respiratory Diseases 6 - - - - - - - - - - 3 3 2 Ulcer of Stomach, or Duodenum 3 - - - - - - - - - - 1 2 — Diarrhoea, &c. (under 2 years) 5 5 - - - - - - - - - - 1 Appendicitis and Typhilitis 3 — — — — — — — — 1 — 1 1 1 3 - - - - - - - - - - 2 1 Acute and Chronic Nephritis 20 — — — — — — — — — 2 9 9 3 Puerperal Sepsis — — — — — — — — — — — — — — Other Accidents and Diseases of Pregnancy and Parturition - - - - - - - - - - - - - - Congenital Debility & Malformations Premature Birth 16 16 - - - - - - - - - - - - Suicide 8 — — — - — - — - - 2 5 1 1 Other Deaths from Violence 16 — — - 1 - 2 1 2 1 4 5 2 Other Defined Diseases 103 7 — 1 — 2 3 6 4 28 52 * 43 Causes ill-defined or unknown - — — — — — — — « — - — — - Totals 638 46 7 3 2 1 6 7 12 34 29 173 318 103 STAFF (a) Whole-time Officers: School Medical Officer: * J A. Gilmour, M.D., M.R.C.P.E., D.P.H. Assistant School Medical Officer: * i Effie M. D.» Craig, M.B., Ch.B. School Dental Surgeon: * A. MacGregor Whyte, L.D.S., R.F.P.S.G. School and Treatment Clinic Nurse: Miss A. M. L. Holman, S.R.N. Health Visitor—School Nurses: * Miss F. Hulse (resigned March, 1925.) * Miss M. Gil.es. * Mrs. G. M. Street, S.R.N, (appointed April, 1925.) * Miss E. M. Skelton, S.R.N, (appointed April, 1925.) Dental Attendant: Miss N. Burges. Cleansing Attendant: Mrs. M. Potts. Clerk: Miss C. Coysh. (b) Part-time Officers: Oculist: F. Moxon, O.B.E., M.B., B.S. Ancesthetist: J. C. Scott, M.D. * Maternity and Child Welfare Officers. J Public Health Officers. 48 Borough of wimbledon. EDUCATION COMMITTEE. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1925; To the Members of the Education Committee of the Borough of Wimbledon. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Medical Inspection and Treatment of School Children in the Wimbledon area for the year ending 31st December, 1925. The Report has been prepared on the lines suggested by the Chief Medical officer of the Board of Education in 1920, and in accordance with the Schedule to Form 6M (30th November, 1925). Administration.— (a)Staff:—At. the end of 1924 the resignation of one of the Health Visitor-School Nurses necessitated a careful consideration by the Medical Inspection and Maternity and Child Welfare Sub-Committees of the duties of the nursing staff, in order that the high efficiency and smooth working might be maintained. The resignation of a second Health Visitor-School Nurse—also on promotion—early in 1925, obviated any change in the scheme, and the Committees at once appointed two fully trained and qualified nurses to carry out the combined duties. The School 49 Medical work has been more closely linked up with the Maternity and Child Welfare work, and four nurses now carry out the work formerly requiring three Health Visitors and two School Nurses when the departments were separate. Each nurse is now responsible for definite schools and areas, and the increased record of work speaks for itself. (b)School Denial Clinic:—During the year, the Medical Inspection Sub-Committee gave full consideration to the report of the Inspecting Medical Officer of the Board of Education on the work of the Dental Clinic, in conjunction with the reports of the School Medical Officer and School Surgeon Dentist. The work and administration of Medical Inspection and Treatment, is at present under review. Consideration was also given to the question of making special appointments for "treatment" cases, with the view to prevention of undue waiting by parents at the Clinic. It was decided to continue the present arrangement of making appointments in batches for a further period. A considerable amount of propaganda work among parents and scholars has been undertaken in this section during 1925, and it is hoped to increase this important work in 1926. It is only by educating parents and children in the importance of strict dental hygiene that the best results can be attained. (c)Ophthalmic Clinic:—The Managers of both local Hospitals agreed to the resolution of the Wimbledon Education Committee passed early in 1925, to the effect that:— "This Committee would be prepared as from 1st January, 1925, to enter into arrangements for the inpatient treatment for eye complaints of school children, under the care of the school oculist, similar to those made for the performance at the hospitals of minor throat operations, the charge to this Committee for maintenance for each child undergoing such treatment, to be at the rate of £1 1s. 0d. a week." Co-ordination:—As stated above, the members of the School Medical Service work in close co-ordination with the other branches of the Public Health Service. The same Medical and Nursing staff carries out the combined duties of Maternity, Infant, and Child Welfare, together with the work among school children. The School Treatment Clinic is available for infants and children under 5 years, both in regard to minor ailments and to the treatment of eye, ear, nose and throat conditions. An endeavour is being made to summarise the medical histories of such children each year, which information will be of great importance when the children enter on their school career. There are no Nursery Schools in Wimbledon, but the children attending the Municipal Day Nursery are examined by the Medical Staff each week. 50 The School Medical Service in relation to Public Elementary Schools. School Hygiene:-The general arrangements of the schools in regard to lighting, ventilation, and sanitation, are fairly satisfactory. Alterations are carried out whenever opportunity arises or permits, more especially in regard to school furnishings and equipment. During the year, no large structural alterations to schools were made. New lighting by gas lamps was installed in the Central Schools, and in one classroom of Haydon's Road Boys School the experiment of heating by electric radiators has been tried. In two classrooms of the Cottenham Park School (temporary) better heating by anthracite stoves has been introduced. In Dundonald Road Girls' School the old trough water closets with automatic flush have been replaced by up-to-date pedestal closets with individual flush. Other minor improvements have been made, but in no school are there any arrangements for drying overcoats and boots of scholars in wet weather. This important point in safeguarding the health of the children should be remedied as soon as opportunity arises, and some such arrangements should be made in connection with the new school at Wimbledon Park now in course of erection. The Wimbledon Schools draw their scholars from areas close to the schools, so that no general arrangements require to be made for the warming up of meals brought to the schools by children. In certain cases as, for example, where both parents go to work, and the children bring their meals with them, the head teachers have made a point in interesting themselves in this matter. Medical Inspection:—The children inspected in routine manner according to the Board's schedule, were (i.) all new entrants ("Entrants"); (ii.) those of 8-9 years of age ("Intermediates"); and (iii.) those of 12-13 years of age ("Leavers"). (See Table I., Appendix). Findings of Medical Inspection:—Table II. (Appendix) is a return of defects found by Medical Inspection during the year. A "routine" inspection is one conducted according to the Board's schedule; a "special'' inspection is, briefly, an inspection carried out at any other time by a Medical Officer. It will be noted that the numbers of defects discovered at "special" inspections, exceed those discovered in "routine" manner. The reason for this is due to the keen interest taken by the teachers in the physical condition of their scholars. Children with obvious defects, such as sores on the head, face, or hands, are sent immediately to the Treatment Clinic, which is held daily at Southey Hall, from 9.30 a.m. Children with other conditions, such as defects of vision, general listlessness, etc., are referred to the " Inspection " Clinic, which is held on 51 Tuesday afternoons. This Clinic is extremely popular with parents, and many bring their children on their own initiative. 737 children attended during the year, and while the great majority were mild cases of transient or indefinite illnesses, several cases of heart and lung conditions, of glandular affections, of early rheumatic and nervous diseases were discovered, which, by their early treatment, were prevented from developing into more serious and crippling conditions. Children with definite diseases requiring hospital treatment also attend this Clinic, and admission to hospital is secured in many cases through the agency of the Medical Officers. The following is a summary of the cases attending the "Inspection" Clinic. General conditions—Debility, Anaemia, etc. 34 Tonsil and Adenoid cases 116 Chest cases 100 Ear, nose and throat conditions 90 Glandular conditions 55 Heart conditions 38 Orthopœdic cases 28 Rheumatic conditions 24 Nervous conditions 19 Other 233 737 Uncleanliness:—A special attendant is employed by the Wimbledon Education Authority to safeguard against the spread of verminous and similar conditions in schools through the agency of the scholars. Inspections are conducted both by "routine" manner and by "surprise" visits. The morning sessions are devoted to the cleansing of children at the School Clinic, Southey Hall. The following Table gives the record of work carried out. GROUP V.-UNCLEANLINESS AND VERMINOUS CONDITION. i. Average number of visits per school made during the year by the School Nurses 16 ii. Total number of examinations of children in the Schools by School Nurses 39,108 iii. Number of individual children found unclean 236 iv. Number of children cleansed under arrangements made by the Local Education Authority †293 v. Number of cases in which legal proceedings were taken:— a. Under the Education Act, 1921. b. Under School Attendance Bye-laws — †Includes skin disease cases. 73 children only out of over 2,000 examinations made by the Medical Officers were noted as verminous. 52 Tonsils and Adenoids.—Defects of Vision:—Owing to the close supervision exercised in the schools and at the "Inspection" Clinic, percentages of these defects found at "routine" inspections are quite unreliable. It may be stated, however, that practically every child with a defect is known and is kept under observation until remedy is secured. There were eleven refusals to submit children to operative treatment for tonsils and adenoids. Tuberculosis Cases:—Close co-operation is maintained with the Tuberculosis Officer in regard to children attending the Tuberculosis Dispensary under the Surrey County Council, and a Register of all known cases of Tuberculosis is kept at the Clinic. In addition to the supervision of actual cases, cooperation in the diagnosis in suspected cases of Tuberculosis is also carried out. Twenty-three cases of definite Tuberculosis are on the Register. Of these, 4 are cases of lung trouble; 12 cases are of bone or joint disease; and 7 of the glands. Of the 23 cases, 2 children are confined to bed, 3 are in Sanatoria, and the remainder are under observation conjointly at the Dispensary and School Clinic. No cases of "open" Tuberculosis are attending School. Dental Inspections:—37 afternoon sessions were given to inspections. 3,059 children were inspected, and 2,418 (79 per cent.) required treatment. Only 419 children were free from dental caries. Of the 2,418 offered treatment, 1.197 (61 per cent.) attended for treatment. 297 "casual" cases were also inspected and treated. In many cases extraction of teeth was carried out in order to correct irregularity and overcrowding of the teeth. The actual regulation of the teeth by mechanical appliances is carried out by the family dentist or at the Royal Dental Hospital. The Wimbledon Education Authority subscribes £2 2s. annually to the Hospital for such special cases. All children of 9 years of age and under were inspected, and those of 10, 11 and 12 years of age, who had previously accepted treatment, were re-inspected. Crippling Defects:—All children with crippling defects are kept under close observation. Special cards are filed under each defect, so that a failure to report is easily observed. Very few new cases were discovered during the year. Infectious Diseases:—The local regulations relating to periods of exclusion of school children on account of infectious diseases were revised in 1925, in order to conform with the periods suggested in the Memorandum on Closure of and Exclusion from School issued conjointly by the Ministry of Health and the Board of Education. 53 A special form (M.I.20) was issued to all School Teachers embodying these regulations and giving a short description of the early signs and symptoms of the different infectious diseases, as well as a revised interpretation of certain symbols used on the Medical Record Cards in connection with the Medical Inspection of School Children. During the year, 941 notifications of Non-notifiable Diseases were received from Head Teachers, namely:— Mumps 328 Whooping Cough 304 Chicken Pox 190 German Measles 67 Measles 49 Other 3 941 The outbreak of mumps lasted from February to July, the maximum being in May. Whooping cough was prevalent chiefly in March, June and July; German Measles cases were practically confined to April and May. No Schools, Departments or classes were closed on account of these outbreaks. 604 scholars were sent by class teachers or were brought by parents to the Clinic for diagnosis as to infectious diseases. 245 of these cases were suffering from sore throats or "influenzal attacks," and were returned to school after a few days' exclusion. 191 cases of Mumps, 72 cases of Chicken-Pox and 35 cases of Whooping Cough were excluded through the Clinic. 3 cases were found desquamating from Scarlet Fever, and 2 children with positive Diphtheritic throats were admitted to the Isolation Hospital. The early diagnosis and exclusion of such cases have assisted in reducing the outbreaks, and the quicker return to school of the non-infectious conditions has undoubtedly kept up the attendance percentage. Following up:—The "following up" by home visitation, of defects discovered at Routine Inspections in Schools in order to secure the necessary treatment, is seldom necessary in the Wimbledon area. The parents are keenly interested in the medical examinations, and practically all are present. Under these circumstances, the nature of the defect and the need for treatment or observation can be fully explained at once. If immediate treatment is required, the parent is instructed to place the child under the family doctor, or to bring the child to the Treatment Clinic. If the child is noted "for observation," a letter is sent to the parent at the end of the specified period, asking that the child should be brought to the Inspection Clinic for further examination. Only on failure to attend, or in certain difficult cases (such as operative treatment for 54 tonsils and adenoids, or the provision of spectacles), is it necessary for the nurse to make a home visit. Medical Treatment:—The following are the arrangements made for the treatment of the various defects:— All eases are referred to the family doctor on first discovery at routine inspection or on reporting at the Clinic. Many cases are returned to the Clinic by the family doctor, asking for treatment to be given. If the case is "necessitous," treatment is carried out at once. Cases attending hospitals are not treated at the Clinic, though they may attend for "exclusion" certificates which are not granted by hospitals. Minor ailments:— These include the different skin diseases, septic sores, and external defects of the eyes and ears. Ringworm eases arc treated by drugs, and only special cases are referred to hospitals for X-ray treatment. Tonsils and Adenoids:—All cases are kept under observation for some considerable period before operative treatment is recommended. Operations are carried out at the local hospitals by arrangement with the Education Authority. Errors of Refraction, etc., are treated by the oculist to the Education Authority at the School Clinic. The following is a list of the work carried out in connection with the Eye Clinic:— Myopia 32 Hypermetropia 68 Astigmatism 100 Mixed Astigmatism 7 Other 35 242 Cases admitted to Hospital:— Keratitis 2 Choroido-retinitis 1 Corneal Ulcer 1 Blepharitis, Ulcerative 1 5 Dental Treatment:—1,496 children were treated dentally, involving 2,862 attendances at the Clinic. 1,160 were rendered dentally sound, and 334 received partial treatment. 36½ "Gas" sessions were arranged, at which 380 children were treated. Local anaesthetics were given in 614 cases requiring extraction. 2,535 temporary, and 280 permanent teeth were extracted. 620 temporary and 779 permanent teeth were restored by fillings—1,781 fillings in all. 14 special dental operations were carried out where teeth had been broken by 55 accident, or required special treatment. 2,054 smaller operations were carried out, including treatment for abscesses, pyorrhœa, gum conditions or scalings of teeth. In addition to this routine work, much good has been achieved by small talks to parents on dental conditions as demonstrated by cases under treatment. Orthopœdic Treatment is not undertaken by the local Authority. Open-air Education:—The only arrangements in regard to open-air education in Wimbledon are those made by class teachers who, in summer, give instruction in the playgrounds of the schools. Physical Training:—This important part of the school curriculum is entirely in the hands of the teachers, except inasmuch as the School Medical Officers indicate individual scholars for whom certain drills or exercises are unsuited. Provision of Meals:—It has been found unnecessary in this area to make special provision of meals by the Authority, under Sections 82-86 of the Education Act, 1921. In the case of certain necessitous and debilitated children, however, extra nourishment in the way of milk, and similar food stuffs is granted by the Committee on the recommendation of the Medical Officers. School Baths:—In addition to the use of the Public Baths by school children for swimming instruction, the Public Health and Baths Committee grant special terms (one penny) to school children desiring hot baths, including the provision of soap and clean towels. Great use is made of this opportunity. Co-operation of Parents, Teachers, Attendance Officers, etc:—As stated in previous reports, it would be difficult to secure greater co-operation than at present. The parents not only attend the Inspections, but come with the children on subsequent occasions for re-inspect ion or treatment. Of 311 children found defective at Routine Inspection of School Children, 311 parents proved to be in attendance. The School teachers, attendance officers, and the different Voluntary Welfare Societies in the district, all work in hearty co-operation in safeguarding the welfare and health of the scholars, and in this respect I would like to thank all who have assisted us during the year, for their kind and willing assistance to us on all occasions. Blind, Deaf, Defective and Epileptic Children:—Each school is visited twice annually by the School Medical Officer and all children falling into the above categories are examined. Children not attending school are notified by the school 56 Attendance Officers or by the Health Visitors-School Nurses, to the Medical Officer, who examines the children either at home or at his office. During 1925, 34 new cases came under observation, making a total of 149 with old cases under observation from 1924. 19 children were examined with a view to admission to the Queen's Road Special School, and 12 were admitted. 3 children were notified to the Local Control Authority during the year—1 as imbecile and 2 as incapable of being educated in a Special School without detriment to other scholars. 89 cases remain under observation at the end of the year. 12 cases of "minor" epilepsy remain under observation. 2 cases of severe epilepsy were permitted to return to ordinary elementary school, having improved under treatment. 47 physically defective children were examined, and 2 were admitted to special residential schools. Queen's Road Special School:—At the end of 1924 there were 32 boys and 23 girls on the roll of this school. 9 boys and 3 girls were admitted after examination, and 2 boys were readmitted for further trial. 7 boys and 5 girls were passed out during the year, leaving a roll of 36 boys and 21 girls at the end of 1925. All the children were examined medically during the year, and careful supervision is exercised over physical and dental defects. Of the children leaving school, 2 were passed back into ordinary public elementary schools as "backward" only, 2 left the district, and the remainder are in suitable employment under the supervision of the After-care Committee. During the year, 2 former pupils (male) of this school, came under police supervision for theft. Both were placed in suitable institutions. Secondary and Continuation Schools come under the County Education Authority. Employment of Children and Young Persons:—Children of school-age desiring employment before or after school hours are subject to a special medical examination before a certificate is granted. Special bye-laws, founded on the model byelaws recommended by the Home Office, are strictly enforced, and special officers are employed to see that the bye-laws are observed. In the Wimbledon area, school children are practically employed in two occupations only—newspaper and milk delivery. 98 children (83, "paper delivery"; 13, "milk delivery," and 2 "errand boys") were passed physically fit. 3 children were also medically examined under the "Entertainments Regulations.'' Medical reports and assistance are also furnished in helping scholars leaving school to obtain suitable employment. 57 Teachers:—14 teachers and 7 other employees of the Wimbledon Education Committee were examined medically by the School Medical Officer. I have the honour to be, Your obedient servant, A. GILMOUR, School Medical Officer. 20, Queen's Road, Wimbledon. 22nd February, 1926. 58 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1925. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections:- Entrants 749 Intermediates 661 Leaver's 661 Total 2,071 Number of other Routine Inspections 53 B.—OTHER INSPECTIONS. Number of Special Inspections 2,887 Number of Re-Inspections 8,191 Total 11,078 59 TABLE II. A.—RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDING 31ST DECEMBER 1925. DEFECT OR DISEASE Routine Inspection. special Inspection. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Skin (1) (2) (3) (4) (5) Malnutrition 2 2 7 20 Uncleanliness (See Table IV., Group V.) - — — — Ringworms—Scalp Body Scabies Impetigo Other Diseases (Non-Tuberculous 1 — 12 — 3 — 57 — 9 — 17 — 25 — 306 — 16 — 77 7 Eye Blepharitis Conjunctivitis Keratitis Corneal Opacities Defective Vision (excluding Squint) Squint Other Conditions 3 1 50 — — — 34 — — — 1 — - - - — 96 26 242 — 20 — — 2 1 2 20 8 Ear Defective Hearing Otitis Media Other Ear Diseases 10 — 9 12 5 2 10 4 11 2 48 21 Nose and Throat Enlarged Tonsils only Adenoids only Enlarged Tonsils and Adenoids Other Conditions 17 45 9 8 3 10 — 2 16 30 65 11 2 4 11 10 Enlarged Cervical Glands (Non-Tuberculous) 4 7 20 35 Defective Speech 3 4 — 6 Teeth—Dental Diseases (See Table IV., Group IV.) — — — — Heart and Circulation Heart Diseases: Organic Functional Anaemia 4 5 2 18 2 22 2 16 4 2 3 4 60 TABLE II.—continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. (1) (2) (3) (4) (5) Lung Bronchitis Other Non - Tuberculous Diseases 10 32 15 46 — 2 14 12 Tuberculosis Pulmonary Definite Suspected Non-Pulmonary: Glands Spine Hip Other Bones and Joints Skin Other Forms 1 - - - — 1 — 13 1 - - — — - — — - - - — 1 — - — — — — — — — — Nervous System Epilepsy Chorea Other Conditions 3 - 2 6 — 1 3 - 3 2 4 4 Deformities Rickets Spinal Curvature Other Forms 3 1 — 2 — — 2 3 5 1 9 12 Other Defects and Diseases 29 25 606 948 B.—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). GROUP. Number of Children. Percentage of Children found to require Treatment, Inspected Found to require Treatment. (1) (2) (3) (4) Code Groups: Entrants 749 107 14.2 Intermediates 661 107 16.1 Leavers 661 97 14.6 Total (Code Groups) 2071 311 15.0 Other Routine Inspections 53 — — 61 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1925. Boys. Girls. Total. Blind (including partially blind.) (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 1 - 1 Attending Public Elementary Schools - - — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind - - - Attending Public Elementary Schools - - - At other Institutions - — - At no School or Institution - — — Deaf (including deaf and dumb and partially deaf.) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb Attending Certified Schools or Classes for the deaf. 2 2 4 Attending Public Elementary Schools - - - At other Institutions — — - At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the deaf - - - Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children 36 21 57 +3 - +3* Attending Public Elementary Schools At other Institutions - — At no School or Institution — — — * In Littleton Street, Special School, L.C.C. 62 TABLE III.—Continued. Boys. Girls. Total Mentally Defective contd. Notified to the Local Control Authority during the year Feebleminded - 2 2 Imbeciles — 1 1 Idiots - - - Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics - 1 1 In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no School or Institution - — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 7 5 12 At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions — - — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 6 5 11 At other Institutions — — — At no School or Institution - — — 63 TABLE III.—Continued. Boys. Girls. Total. Physically Defective (continued) Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, etc.) At Certified Residential Open Air Schools 1 1 2 At Certified Day Open Air Schools - - - At Public Elementary Schools 13 18 31 At other Institutions — — — At no School or Institution — — — Active non - pulmonary culosis At Sanatoria or Hospital School approved by the Ministry of Health or the Board - - - At Public Elementary Schools 4 3 7 At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tub e r c u l o u s disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools - - - At Certified Residential Cripple Schools 3 1 4 At Certified Day Cripple Schools - - - At Public Elementary Schools 21 22 43 At other Institutions — — — At no School or Institution — — — 64 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDING 31ST DECEMBER 1925. TREATMENT TABLE. GROUP I.—Minor Ailments (excluding Uncleanliness, for which see Group v.). DISEASE OR DEFECT. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise. Total, (1) (2) (3) (4) Skin— Ringworm—Scalp 11 2 13 Body 60 — 60 Scabies 17 9 26 Impetigo 306 25 331 Other skin disease 77 16 93 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 85 3 88 Minor Ear Defects 80 13 93 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, eto.) 1027 82 1109 Total 1663 150 1813 GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). defect or disease. Number of Defects dealt with. Under the Authority's Scheme Submitted to refraction ! by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including Squint). 242 31 - 273 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 20 — — 20 Total 262 31 — 293 Total number of children for whom spectacles were prescribed:— a. Under the Authority's Scheme 165 b. Otherwise 3 Total number of children who obtained or received spectacles:— a. Under the Authority's Scheme 165 b. Otherwise 3 65 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 65 Awaiting Treatment 21 86 30 116 GROUP IV.— DENTAL DEFECTS. 1. Number of Children who were:— a. Inspected by the Dentist: Routine Age Groups Aged Aged Total 3059 5 336 10 315 6 518 11 215 7 411 12 203 8 448 13 13 9 595 14 5 Specials 297 Grand Total 3356 b. Found to require Treatment 2715 c. Actually Treated 1494 d. Re-treated during the year as the result of periodical examination 768 2. Half-days devoted to:— Inspection, 37. Treatment, 383 Total 420 3. Attendances made by Children for Treatment 2862 4. Fillings:— Permanent Teeth, 779. Temporary Teeth, 620 Total Teeth 1399 Total Fillings 1781 5. Extractions:— Permanent Teeth, 280. Temporary Teeth, 2535 Total 2815 6. Administrations of general anaesthetics for extractions 380 7. Other Operations:— Permanent Teeth, 647. Temporary Teeth, 1407 Total 2054 66