CI WIM 3 Ac 4413 (1) WIMBLEDON Borough of Wimbledon. Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year 1926. Together With The Report of THE SCHOOL MEDICAL OFFICER AND OF THE SANITARY INSPECTOR. Borough of Wimbledon. With the Medical Officer of Health's Compliments. Borough of Wimbledon. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. FOR THE Year ended 31st December, 1926. Public Health and Baths Committee: Chairman: Councillor F. W. Daffen. Vice-Chairman: Councillor C. B. Heaton. Members: The Mayor (Councillor Hatherill-Mynott, J.P.), Alderman Wiggins Councillor A. W. Hickmott Councillor E. J. Chard E. Fielder „ H. H. Coote „ A. J. Penman „ H. Dormer „ Lady Roney „ A. A. Drake „ J. Townsend Maternity and Child Welfare Sub committee: Chairman: Councillor Daffen. Members: Councillor Dormer Councillor Hickmott „ Drake „ Penman „ Heaton „ Lady Roney Mrs. Chard „ Daniel „ Fielder „ Sheerman STAFF. Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer. t*A. Gilmour, M.D.. M.R.C.P.E., D.P.H. Assistant Medical Officer of Health, School Medical Officer and Maternity and Child Welfare Officer: ‡ Effle M. D. Craig, M.B., Ch.B. Chief Sanitary Inspector: a * † Henry Johnson. Assistant Sanitary Inspectors: ¶ a † R. T. Avis. a † D. P. S. Flynn. Health Visitors—School Nurses: ¶ § || Miss M. Giles. c || Mrs. G. M. Street. c || Miss E. M. Skelton. Clerks: Miss N. Low. Miss M. Winslade (appointed September, 1926), Clerk to the Maternity and Child Welfare Department: Miss M. A. Weller (resigned August, 1926). Miss N. Low (appointed September, 1926). Part-time: Bacteriologist: J. H. Johnston, M.Sc., F.I.C. * Salary contribution under Public Health Acts. † „ „ by Exchequer Grants. a Certificate of the Royal Sanitary Institute for Inspector of Nuisances, † Certificate of the Royal Sanitary Institute for Inspector of Meat and other Poods. || Certificate of the Central Midwives Board. § Certificate of the Royal 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 Staff and Administration 5 Natural and Social Conditions of the Area 7 Vital Statistics for 1926 8 Population, Birth and Death Rates for each Ward, 1926, 9 Births 9 Deaths 9 Infantile Mortality 10 Poor Law Relief 11 General Provision of Health Services in the Area 11 List of Local Acts, Orders and Adoptive Acts, in force 13 Sanitary Circumstances of the Area 14 Sanitary Inspection of District 15 Factories and Workshops 16 Sanitary Inspector's Report— Notices Served 18 Opening Up of Drains 18 House Drainage 19 House to House Inspection 19 House Inspection 19 Overcrowding 19 Houses let in Lodgings 20 Verminous Rooms 20 Common Lodging Houses 20 Van Dwellings 20 Dairies, Cowsheds and Milkshops 21 Infectious Disease and Disinfection 21 School Disinfection 22 Yard Paving 22 Stable Refuse 22 Inspections under the Factory and Workshop Act, 1901 22 Shops Acts, 1912-1913 22 Slaughter Houses and Food Inspection 23 Sale of Food and Drugs Acts, 1875 to 1907 23 Petroleum Acts 24 Diseases of Animals Acts, 1894 to 1925 24 The Public Health (Meat) Regulations, 1924 25 Rent (Restrictions) Acts, 1920 and 1923 25 Water Supply 26 Employment Agencies 26 Employment of Children Bye-laws 27 Summary Table—Nuisances Abated 29 Medical Officer's Report—continued. Housing Statistics for the year 1926 30 Inspection and Supervision of Food 31 Prevalence of, and Control over, Infectious Diseases 32 Notifiable Diseases and Deaths, 1926, in age-groups, etc. 33 Death-rate from Zymotic Diseases, for the last ten years 34 3 Medical Officer's Report—continued. page Ward Distribution of Infectious cases notified in 1926 34 Scarlet Fever 35 Diphtheria 36 Tuberculosis 36 Laboratory Work 37 Disinfection 38 Wimbledon Isolation Hospital 39 Maternity and Child Welfare 42 Ophthalmia Neonatorum 43 Supply of Milk to Expectant and Nursing Mothers and Infants 44 South Wimbledon Day Nursery 45 Table I.—Vital Statistics 46 Table II.—Causes of Deaths, etc. 47 School Medical Officer's Report— Staff 50 Administration 51 School Buildings 54 Findings of Medical Inspection 56 Group V.—Uncleanliness 57 Minor Ailment 57 Tonsil and Adenoid Cases 58 Tuberculosis Cases 58 Skin Disease 58 Eye Disease and Vision 59 Ear Disease and Hearing 59 Dental Defects 59 Crippling Defects and Orthopoedics 59 Infectious Diseases 59 Following Up 60 Open-air Education 61 Provision of Meals 61 School Baths 61 Co-operation of Parents, Teachers, etc. 61 Defective Children 61 Queen's Road Special School 62 Employment of Children and Young Persons 63 Table I.—Return of Medical Inspection 64 „ II.—Return of Defects 65 „ III.—Return of all Exceptional Children 67 „ IV.—Treatment Table 70 4 Borough of Wimbledon. Public Health Department. ANNUAL REPORT OF THE Medical Officer of Health FOR THE Year ended 31st December, 1926. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Mr. 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, 1926, together with my Report as School Medical Officer. The Annual Report of the Medical Officer of Health for 1926 is an Ordinary Report, prepared on the lines suggested in Circular 743, issued by the Ministry of Health on 20th December, 1926. Staff and Administration. (a) Changes in Staff:—Miss M. A. Weller, clerk to the Maternity and Child Welfare Department, resigned on appointment to the Battersea Borough Council in August, 1926. Miss N. Low was promoted to additional duties as clerk to the Day Nursery and Milk Sub-Committees, and Miss Winslade was appointed clerk to the general office of the Public Health Department. 5 (b) New Premises:—The Public Health Department was removed from the Town Hall, to 20, Queen's Road. The Dental Clinic was removed from Southey Hall, to 58, Pelham Road (v. Report of the School Medical Officer). New Day Nursery:—Sketch plans have been submitted to the Ministry of Health for approval. (c) New Committees:—In November 1926, the work of the Public Health Department was placed under 1.—The Public Health Committee, dealing with the general health conditions of the area, the sanitary conditions, and with the Isolation Hospital; 2.—The Maternity and Child Welfare Committee, dealing with the Maternity and Child Welfare Acts, the medical inspection and treatment of School Children, the Day Nursery, etc. (d) New Acts and Regulations:— 1.—Public Health Act, 1925; 2.—Housing Act, 1925; 3.—Surrey County Council Act, 1925, Section 53,-— inspection of Maternity Homes. The duty of inspecting Maternity Homes, registered under this Act, in the Borough of Wimbledon, is placed on the local Medical Officer of Health. There are six Registered Maternity Homes in the area. Surrey County Council Act, 1925, Section 72,— Registration of Employment Agencies. Mr. Johnson, Chief Sanitary Inspector, was appointed Inspector for this Section in Wimbledon. 4.—The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Committee has arranged for the provision of consultant specialists and hospital treatment as recommended in these regulations. 5.—The Public Health (Ophthalmia Neonatorum) Regulations. The Committee has arranged for notification, treatment and hospital treatment of such cases. 6.—The Public Health (Prevention of Tuberculosis) Regulations, 1925. 7.—Milk and Dairies Orders, 1926. 6 (e) Other Administrative Changes:— 1.—Employment of Children Bye-laws. Mr. Johnson, Chief Sanitary Inspector, and Mr. Avis, Chief Assistant Sanitary Inspector, were appointed to carry out these duties under the Education Acts; 2.—Isolation Hospital—Admission of Measles cases from Kingston. In January, 1926, it was arranged that exceptional cases of Measles should be admitted from Kingston, subject to the necessary accommodation being available; 3.—Special Leave. Dr. E. M. D. Craig was granted special leave for two months during 1926. Dr. M. Martin acted as locum tenens for the Maternity and Child Welfare and School work during Dr. Craig's absence; 4.—Examination of Employees. By Resolution of Council, all sick employees or candidates for appointments are examined when required by the Medical Officer of Health. 150 examinations were made in the year 1925-6; 5.—Welfare Milk Charges. v. Maternity and Child Welfare Section. 6.—Payment Scheme, School Clinics. v. Report of School Medical Officer. Natural and Social Conditions of the Area. Area (acres) 3,173 Population (Census, 1921) 61,700 Population (Estimated, 1926, R.G.) 58,030 Number of inhabited houses:— 4921 11,926 Number of families or separate occupiers:— 1921 13,998 Rateable Value:—£530,217. Sum. represented by a penny rate:—£2,185. Social Conditions:—v. Annual Report, 1925. 7 Extracts from Vital Statistics of the Year (1926). (Registrar General's figures). Total. M. F. Births Legitimate 769 406 363 Birth Rate (R.G.) 13.9 Illegitimate 38 18 20 Deaths 579 268 311 Death Rate (R.G.) 9.9 Number of women dying in, or in consequence of, childbirth from sepsis 1 do. do. other causes 2 Total 3 Death-rate of Infants under one year of age per 1,000 births 33 Number of deaths of infants—legitimate 26 „ „ „ —illegitimate 1 27 Deaths from Measles (all ages) 6 „ „ Whooping Cough (all ages) — „ „ Diarrhoea (under 2 years of age) - Vital Statistics for 1926 (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 17.8 11.6 70 105 Great Towns 18.2 11.6 73 157 Smaller Towns 17.6 10.6 67 LONDON 17.1 11.6 64 WIMBLEDON 13.9 9.9 33 8 BOROUGH OF WIMBLEDON. Population, Birth and Death Rates for each Ward, 1926. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6744 8.4 7.7 Wimbledon Park 3.88 4440 13.2 6.08 St. John's 4.77 5182 8.1 10.03 Cottenham Park 4.33 7018 8.2 14.3 North Wimbledon 4.36 23384 9.2 9.9 Dundonald 5.15 7646 15.1 9.9 Trinity 5.59 11626 17.3 9.7 South Park 4.63 8540 14.4 9.4 Haydon Park 5.47 6834 21.9 11.2 South Wimbledon 5.21 34646 17.05 10.01 Whole District 4.83 58030 13.9 9.9 Births:— The number of births registered in the district was 722 (373 males and 349 females), an increase of 10 against last year, and equal to a birth-rate of 12.4 on a population of 58,030. The corrected birth-rate produced by transferable births notified to us by the Registrar-General, is 13.9. 38 (or 4.7 per cent.) of the births were illegitimate. Notification of Births Acts, 1907 and 1915. During the year, 593 births were notified by the following persons:—Parents, 59; Midwives, 421; Doctors, 74; other persons, 39. Five notifications of still-births were received. Deaths:— The total number of deaths registered in the district was 479 (199 males, 280 females) equal to a death rate of 8.2 per thousand of the population (R.G.) per annum. The deaths occurring outside the district, of persons belonging to this Borough, were 183, viz.:— Kingston and District General Hospital 94 Brookwood Asylum, Woking 10 Nelson Hospital, Merton 24 Others 55 Total 183 The deaths occurring within the district, of persons not belonging thereto, were 83, viz.:— 9 Isolation Hospital 1 North Wimbledon Hospital 11 Others 71 Total 83 Taking those into consideration, the total number of deaths properly belonging to Wimbledon, is 579, and the death rate 9.9. The rate for England and Wales for the same period was 11.6. Table showing the births, deaths, and death-rates in the Borough of Wimbledon in the last five years. 1926 1925 1924 1923 1922 1921 Births 807 760 814 868 868 1033 Deaths 579 638 645 546 616 634 Death-rates 9.9 10.9 11.1 9.4 9.9 10.2 Table II. gives the causes of, and ages at. deaths during 1926. Deaths due to notifiable infectious diseases are given on p. 33. The principal causes of death, a part from Zymotic deaths, are as follows:— Cancer 104 Heart Disease 92 Pneumonia 50 Bronchitis 47 Cerebral Haemorrhage 31 Tuberculosis (Respiratory) 30 Infantile Mortality:—There were 27 infant deaths during the year (including transferable deaths), giving a rate of 33 per thousand registered births, a decrease of 19 per thousand on last year's figures, when there were 46 deaths and a rate of 60. The infantile death-rate calculated on the RegistrarGeneral's figures, is 33 per thousand births. The infant death rate for illegitimate children was 26 per thousand illegitimate births. The following table shows the causes of death, and ages at death, of Infants under one year:— 10 Infant Mortality during the year 1926. (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. Measles - - - - - - - - 1 1 Pneumonia (all forms) - - - 1 1 1 2 3 3 10 Coma, Convulsions & Acute Pneumonia - - - - - - - 1 - 1 Congenital Atelectasis & Convulsions 1 - - - 1 - - - - 1 Premature Birth 5 1 - - 6 1 — — — 7 Congenital Debility & Exhaustion 1 - - - 1 - - - - 1 Marasmus, Pneumonia & Cardiac Failure - - - - - - - 1 - 1 Syncope, Haemorrhage & want of attention at Birth 1 - - - 1 - - - - 1 Asphyxia Neonatorum 1 - - - 1 - — — — 1 Bronchial Obstruction (Mucus) 1 — - — 1 - — — — 1 Marasmus, Capillary Bronchitis Ileo Colitis - - - - - - 1 - - 1 Dermatitis, Multiple Pyaemic Abscesses — — — — — — 1 — — 1 Total 10 1 — 1 12 2 4 5 4 27 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 1926 £13,960 8s. 8d. Average weekly number of persons in receipt of relief 579 Number of persons admitted to the Guardians' Institution from Wimbledon area 470 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. 11 (5) Small-pox—Cheam Small-pox Hospital, Surrey, Croydon and Wimbledon Joint Board and Surrey Smallpox Hospital, Clandon. (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 school children. (c) Institution for unmarried 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. 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, Haydon's Road, Wimbledon, under the Wimbledon Borough Council. School Clinic:—Southey Hall, Southey Road, Wimbledon. under the Wimbledon Education Committee. School Dental Clinic:—58, Pelliam Road. 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 12 small contribution is made by the Wimbledon Borough Council in respect to cases of Ophthalmia, Neonatorum. (b) Infectious Diseases—None. Midwives:—Under the supervision of the Surrey County Council. There are 14 midwives practising in the district. MORTUARY. From information received from the Superintendent of the Cemetery, there were 55 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 41 bodies, equal to 8.5 per cent. 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. Public Health Amendment Act, 1907. Part II. (Streets, Buildings)—Sections 15, 16, 17, 18. 19, 20, 21, 22, 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 modifications), 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. 13 (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 Employment Agencies. 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. 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 OP THE AREA. The following information is supplied by the Borough veyor, Mr. J. Bowen:— Roads:—Surfacing of roads for hygienic reasons has been carried out with bituminous materials, including asphalte in 14 the case of Durnsford Road and wood paving in Worple and Merton Roads. Beverley Brook:—This brook has been deepened 2-ft. 6-ins. at Coombe Bridge, tailing out to the Wandsworth boundary. The work has reduced the level of the sub-soil water in the Merton and Wimbledon districts. Acuba Road Ditch:—A section of this ditch has now been culverted. Refuse Collection:—2 covered motor vehicles for removal of house refuse have been found economical and hygienic and others have , been ordered. Housing:—The Council are erecting 60 houses in Durnsford Road, consisting of living room, 13-ft. 5-ins. × 12-ft.; kitchenette, 9-ft. 10-ins. × 9-ft. 5-ins. with larder, bathroom and W.C. on ground floor. There are three bedrooms on the first floor, size, 13-ft. 7-ins. × 9-ft. 9-ins.; 11-ft. 9-ins. × 8-ft. 4-ins.; and 8-ft. × 8-ft. 9-ins. The average frontage of ground to each house is 19-ft., and depth, 150-ft. 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 1926, as reported by the Sanitary Inspector. Reason of Visit. No. Infectious Disease 501 House Inspections 2,999 House to House Inspections 1,681 Rent Act Inspections 35 Houses Let in Lodgings; Inspections 613 Inspection of Factories, Workshops, Workplaces and Out-workers' Premises 74 Common Lodging Houses; Inspections 3 Dairies and Cowsheds; Inspections 31 Inspection under Shop Acts 2,223 Application of Test to Drains 219 Inspections under Diseases of Animals Acts 136 Obtaining Samples of Foods and Drugs 14 Miscellaneous (including Inspections of Food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,316 9,845 15 One thousand and nine preliminary or informal notices were served in respect of 1,128 houses. One hundred and fifty-eight statutory notices were served in respect of 172 houses. The necessary work was executed in all but 121 cases, which were not completed by the end of the year. In 55 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 26 - - Workshops 39 4 — Workplaces 9 — — Total 74 4 — DEFECTS FOUND. NATURE. Number of Defects. Prosecutions. Found. Remedied. Referred to h.m. Inspector. Want of Cleanliness 4 4 — — Want of Ventilation — — — — Other Nuisances — — — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective — — — - Not Separate for Sexes — — — - Other Offences — — — — Totals 4 4 — — HOME WORK. Lists received:— Twice in the year 13 Number of Out-workers 68 Once in the year — Number of Out-workers — Number of addresses received from other Councils 66 16 Number of addresses forwarded to other Councils 18 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 — 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 57 Bakehouses (including four Factory Bakehouses) 27 Laundries 32 Tailoring 34 Millinery 15 Dining Rooms 20 Motors and Cycles 31 Other trades 195 464 OTHERS MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act — Action taken in matters referred by H.M. Inspector as remedial under the Public Health Acts. Notified by H.M. Inspector 5 Reports of action taken sent to H.M. Inspector 5 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, 1926. 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. 1926. Table III. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—One thousand and nine Preliminary Notices or intimations were served during the year in respect of 1,128 houses. It was found necessary to serve 158 Statutory Notices upon the owners or occupiers of 172 houses. 486 letters, respecting 554 houses, were received through the Town Clerk's Department, and answered, en- • quiring if any sanitary notices were outstanding with respect to properties for which negotiations for sale were in progress. Opening Up of Drains under Section 41 of the Public Health Act, 1875, and Amending Acts.—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 one house, authority first having been obtained from the Council and due written notice given to the occupier. The conditions found were duly reported to the Public Health Committee, and notice served on their 18 instruction requiring the reconstruction or amendment of the defective drains, etc., as the circumstances required. It was unnecessary in eight other cases to exercise the powers granted, as in each case the owner's builder exposed the drains and afterwards effected the necessary repairs or renewals. House Drainage.—The drainage systems and sanitary arrangements of 13 houses have been entirely reconstructed, extensive amendments or repairs were carried out at 49 other houses, and at 19 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 245 houses. The followinglist 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. 29. Graham Road 8 Caroline Road 14 Herbert Road 55 Gladstone Road 168 245 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, 883 houses were visited. Table III. shows a list of sanitary works executed at these houses, together with defects remedied during house to house inspection. Overcrowding.—This matter still causes the Department much anxiety, particularly on account of the fact that whilst cases of overcrowding are observed and reported to the Authority, the remedy is as elusive as before. In the majority of cases the persons affected would be only too pleased to obtain more suitable accommodation, providing they could do so at an economic rent, but when a suitable house becomes vacant it is most times found that the rent to the new tenant —should the house be again let—is exorbitant. In two cases within my knowledge, houses which had been let at 14s. per week, on being re-let, were rented at 30s. per week. In another case the rent was a little over 12s., and is now 18s. per week. In a. number of instances flats, some of which are not self-contained, comprising usually three rooms, are being let at 30s. per week. 19 It is, therefore, patent to all who understand the average earnings of the working-class people, that it is impossible for them to be able to rectify their unfortunate positions. When inspecting premises in connection with overcrowding, the Officer is usually met with the remark "If I could find another place, I would clear out to-morrow!" followed by the vexed question "Do you know where there is a house to let?" There are, however, cases in which we find the overcrowding is due to recent sub-letting, where the accommodation had only been sufficient for the tenants themselves. In these cases notices have been served for the abatement of the nuisance. In one such case where the notice had not been complied with at the end of the year, action is still being taken. In July. 1926, the erection of sixty houses on the Council's land, Durnsford Road, suitable for the occupation of the working classes, was commenced, but none were occupied until early 1927. Houses Let in Lodgings.—There are 67 of these houses on the Register, and 613 visits of inspection were made during the year, to ensure that the Bye-laws were being observed. Verminous Rooms.—During the year 38 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, Merton High Street, for which Annual Certificates of Registration were granted from 1st January, to 31st, December, 1926. Three 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 Dwellings.—The difficulties in dealing with van dwellers in certain parts of the district continue, and the inadequacy of the Bye-laws for Tents, Vans and Sheds, and and the provisions of the Wimbledon Corporation Act of 1914 are more and more clearly demonstrated. During the year a suggestion was made to the Public Health Committee that application should be made to the Ministry of Health for sanction to adopt Section 43 of the Public Health Act, 1925, 20 and that new Bye-laws, dealing with Tents, Vans and Sheds should be framed. The Committee made the necessary recommendation (Minute No. 2744), which was approved by the Council, but up to the end of the year, these additional powers had not been obtained. In one of the worst yards, with respect to the number of people on the site, four caravans have either been removed from the ground or disused as dwellings, and on another site the use of one van as a dwelling has been discontinued. Dairies, Cowsheds and Milkshops.—Eight applications were received during the year from persons desirous of being registered under the Dairies, Cowsheds and Milkshops 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 one matter was 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 226 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 44 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 540, and the number of articles, bedding, wearing apparel, etc., 14,264, full details of which are given in the Report of the Medical Officer of Health under the heading of "Disinfection." 21 School Disinfection.—With the exception of one Department 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, 47 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, 28 visits having been made to such premises during the year. Inspections under the Factory and Workshop Act,, 1901.— There are 464 factories, workshops and workplaces on the Register, to which 74 visits of inspection were made. Four written notices were served, referring to sanitary conveniences and other nuisances. Shops Acts, 1912-1913.—Two thousand two hundred and twenty-three visits were made to the occupied shops in the district for the purpose of observing contraventions of the Acts. In one case legal proceedings were instituted as under— Against a firm for failing to close three of their shops on the usual weekly half-holiday. Fined £4 4s. 0d. (including costs). As mentioned in my Report for the year 1925, a number of contraventions were noted during Christmas week of that year. The occupiers of these premises were subsequently summoned before the local Magistrates with the following results:— (a) For failing to close shop on weekly half-holiday. Fined £1 and £3 3s. 0d. costs. (b) For failing to close shop on weekly half-holiday. Fined £1 and £2 2s. 0d. costs. (c) For failing to close shops (two) on weekly halfholiday. Fined £1 and £2 2s. 0d. costs in each case. (d) For failing to close shop on weekly half-holiday Fined £1 and £1 1s. 0d. costs. Towards the end of November, the Home Secretary made an Order suspending the operation of the General Early Closing Order from 17th to 24th December, 1926, inclusive. 22 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 Christmas week, when the provisions of the Act were found to have been rigidly adhered to. Slaughter Houses and Food Inspection.—The number of registered slaughter-houses is five. Three of these, however, have not been used for some considerable time. Towards the close of the year it was evident that it is the intention of the occupiers of the other two slaughter-houses to make fuller use of their premises. Twenty-one inspections have been made during the year whilst slaughtering was in progress, and all animals killed in the town have been examined prior to being exposed for sale. In addition, 228 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 1 barrel. Cherries 3 boxes. Chicken 12 Chads 1 box. Cod 8 stone. Dogfish 2½ stone. Greens 4 bags. Herrings 4 stone. Prawns 1 tin. Pig 1 carcase & offal. Skate 1 box. Strawberries 130 lbs. AVinkles 3 bags. 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. 23 Particulars of Samples of Food and Drugs taken and submitted for Analysis, Year ended 31st December, 1926. ARTICLES. Test Samples. No. Genuine. Adulterated or Inferior. Slightly Inferior or Deteriorated. Milk 12 10 1 1 Butter 2 2 — — Apples 1 — 1 — Sausages 1 1 — — Spirits 6 6 - - Total 22 19 2 1 Petroleum Acts.—Seventy-three applications were received for permission to keep petroleum, 64 being for the renewal of existing licences, and 9 for new ones. Two hundred and forty-one inspections were made of the various premises in respect of which licences had been issued. During the last few years the provision of underground tanks for the storage of petroleum has been increasing. The installation of these tanks calls for considerable amount of supervision, both during the progress of the work, and on its completion. Prior to a tank being installed, plans are submitted, carefully scrutinised, and if found in accordance with the regulations, permission is given for the work to be executed The ground is excavated and after inspection, a concrete box is formed, into which the tank is lowered. An air pressure test is then applied, and if the result is satisfactory, the space surrounding the tank is filled in with either sand or concrete. The pump is then erected and the various pipes connected to it. These also are subjected to a test, and if found to be in order, the necessary filling in is allowed to be proceeded with. On completion of the work a final test is made and a licence issued. Diseases of Animals Acts, 1894 to 1925. Swine Fever.—No outbreak of this disease was notified in the district during the year, but during the examination of the carcases of two pigs killed at a local slaughter-house, it was found that one of the animals had been affected with 24 Swine Fever. The carcase was detained until the following day when it was examined by the Council's Veterinary Surgeon, who confirmed the diagnosis. On enquiries being made it was found that the animals had been brought here from a piggery in a neighbouring district and that there were other pigs still on those premises. The full facts were immediately communicated to the Ministry of Agriculture, after which the carcase and offal were destroyed at the Council's destructor and notices for the cleansing and disinfection of the premises served. Foot and Mouth Disease.—No case of this disease was notified in the district, but numerous Orders were made by the Ministry of Agriculture, which included Wimbledon in the Infected or Restricted Areas. As a result of these Orders, a number of enquiries were dealt with and Licences issued where necessary. In view of the number of Orders issued and the wide areas affected, great care was necessary in the issuing of Licences and replying to enquiries. Tuberculosis.—No outbreak of this disease has been reported during the year. The usual quarterly returns, under the provisions of the Tuberculosis Order of 1925, have been rendered to the Ministry of Agriculture. In connection with the importation and exportation of animals, the Department has dealt with numerous enquiries, licences and notices of quarantine. The Public Health (Meat) Regulations, 1924.—Careful attention has been paid to the provisions of these Regulations and I am pleased to report that no breach has been observed. In several cases advice has been sought and freely given in cases of doubt. The notice required when animals were to be slaughtered was given in every case, thereby facilitating the examination whilst killing was actually in progress. When killing has taken place on Sunday, notice has usually been received on the day preceding. Rent (Restrictions) Acts, 1920 & 1923.—Under these Acts six 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 fit for human habitation. The applications were submitted to the Committee, . together with a report as to the conditions existing, and in five cases the issuing of a certificate was authorised. The 25 sixth application was received too late for submission to the December Meeting and, consequently, will not be included in this Report. In two eases the certificates were subsequently issued as the work required to be done had not been satisfactorily executed. In two cases where a Certificate had been issued to the tenants the owners 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 Certificates. In one case the owner's agent applied for a Certificate that the premises were kept in a reasonable state of repair, as the tenant was withholding his rent. On inspection, it was found that one or two slight defects required attention and, in consequence, the agent was notified that until these matters had received attention the Local Authority was unable to issue 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. The problem of the dirty tenant has always been one which has occasioned great anxiety to officers of public health departments, and the continuation of the Rent (Restrictions) Act, has resulted in this being intensified. Such tenants know well that the landlord cannot obtain an ejectment order without the consent of the County Court judge, and these are obtainable only for non-payment of rent (and in this respect the order is usually suspended so long as the tenant pays the current rent and something like sixpence or a shilling a week off the arrears), for being a nuisance or annoyance to adjoining occupiers, or as being convicted of using the premises for illegal purposes. The knowledge that a landlord will generally suffer the nuisance of a dirty tenant rather than be put to the expense of applying to the County Court with little probability of success, has made these tenants extremely neglectful. Water Supply.—The water supply was withdrawn from 43 houses during the year for the following reasons—15 by request, 23 owing to arrears of rates, and 5 for other reasons. Employment Agencies.—In October, 1925, the Public Health Committee considered and agreed to the suggestion of the Watch and Fire Brigade Committee, that I should 26 undertake the duties in connection with Female Domestic Servants Registries, and I was, accordingly, appointed the officer. At the time of my taking over the duties there were five Keepers registered under Section 85 of the Public Health Act (Amendment) Act, 1907. By the Surrey County Council Act, 1925, every person who, after the 1st July, 1926, carries on within the Administrative County an Employment Agency as defined, without a licence from the Surrey County Council or otherwise than in accordance with the terms and conditions of such a licence, or obtains a licence by wilful misrepresentation, or by wilfully omitting to give any required particulars, shall be liable to a penalty not exceeding £50, and to a daily penalty not exceeding £20. The Act states "Employment Agency," means any agency or registry in the County carried on or represented as being or intended to be carried on (whether for the purpose of gain or reward or not) for, or in connection with the employment of persons in any capacity. Early in the year I visited all Registered persons and left with them an extract of the Act and explained the procedure to be adopted in applying for a Licence. At the end of the year there were six Licensed Keepers on the register, to whose premises periodical visits have been made, and I have also accompanied the Surrey County Council's Officer for the purpose of explaining the provisions of the Bye-laws, book-keeping, etc. With a few minor exceptions the Bye-laws have been well-observed. In two cases applications for Licences had been submitted, but were withdrawn when it was found that the Authority intended to object. Employment of Children Bye-laws.—Duties in connection with these Bye-laws were transferred to the Public Health Department on 1st April, 1926, Mr. Avis and I being appointed. Any contravention observed is reported to the Chief School Attendance Officer, and reports are rendered to the School Attendance Sub-Committee, giving particulars of observations, etc. The major portion of this work is done before and after office hours and on Sundays and public holidays. 27 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. F.S.I.A., M.R.S.I., Chief Sanitary Inspector. 28 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 3 Cisterns repaired, cleansed or covered 57 Drains, new, provided 13 Drainage systems made water-tight by patent process 19 Drains, repaired or altered 49 Drains, stoppages removed 57 Dustbins provided 348 Flushing cisterns, new, provided 31 Flushing cisterns repaired 94 Manure receptacles provided 2 Overcrowding nuisances abated 4 R.W. pipes disconnected 15 Roofs repaired 159 Rooms stripped and cleansed 851 Verminous rooms cleansed 6 Soilpipes, new, provided 16 Soilpipes, repaired or altered 6 Vent pipes, new, provided 23 Vent pipes, repaired or altered 22 Waste pipes, new, provided 71 Waste pipes repaired, disconnected or trapped 41 Water-closets, new, provided 89 Water-closets, repaired or ventilated 10 Water services restored 43 Yards paved 7 Yards repaired 40 Guttering repaired 87 Floors ventilated 21 Nuisances abated from damp walls 122 Water supply direct from main 21 Sinks provided 62 Rooms fumigated 540 Other nuisances 1605 4562 29 Housing Statistics for the year 1926. Number of new houses erected during the year;— (a) Total, including (b), (i), (ii) 186 (b) With State Assistance under the Housing Acts— (i) By the Local Authority — (ii) By other bodies or persons — I.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,306 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 245 (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 1,128 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 895 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 (2) 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 30 (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 172 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 112 (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, 27 dairymen, 32 dairymen and purveyors, and 16 purveyors on the Registers on 31st December, 1926. The general 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 6 Pasteurisers (Holder process) 1 31 (3) No licences were refused or revoked. (4) Bacteriological examinations:—All samples satisfactory. (b) Meat:—See Sanitary Inspector's Report (p. 25). SLAUGHTER HOUSES. In 1920. In Jan. 1926. In Dec. 1926. Registered 4 2 2 Licensed 1 — — Total 5 2 2 (c) Other Foods:—See Sanitary Inspector's Report (p. 23). PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The area has been remarkably free from infectious diseases during 1926. 165 cases of scarlet fever and 26 cases of diphtheria were notified, of which 140 and 23 were removed to the Isolation Hospital (v. Report on Isolation Hospital). Puerperal Fever:—The 3 cases of puerperal fever were notified under the old notification scheme. No cases were notified under the Public Health (Notification of Puerperal Fever and Pyrexia) Regulations. Pneumonia and Influenza:—These diseases became prevalent during December, but only one death from influenza occurred before the end of 1926—the outbreak of influenza was commencing. Encephalitis Lethargica:—3 cases were notified. 2 cases were mild with a history of "influenza" and transient symptoms. The third case had severe signs. No source of infection was traced. Poliomyelitis:—4 cases were notified. 1 patient had been on holiday in Broadstairs during the outbreak there, but no direct contact could be traced. This case died. In the other 3 cases the attacks were mild in character. Non-notifiable diseases have been very prevalent, and a return of cases intimated from schools is given in the Report of the School Medical Officer. The home supervision and control of such cases is carried out by the Health-VisitorSchool Nurses. 32 TABLE A.—NOTIFIABLE DISEASES—1926. 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. Total Deaths. Death Rates. Diphtheria Notified 26 - 1 1 - 1 14 2 1 5 - 1 - 23 Deaths — — - - - — — — — - - - — - Scarlet Fever Notified 165 — 1 12 4 16 73 40 7 7 5 — — 140 Deaths — — — — — — — — — — — — — — Enteric Fever Notified 4 - - - - - - - 1 2 — 1 — 2 Deaths - - - - - - - - - - 1 — 1 .01 Puerperal Fever Notified 3 - - - - - - — — 2 1 — — 2 Deaths — — — — — — — — — 1 — — 1 .01 Pneumonia Notified 40 1 3 1 1 2 2 1 5 6 5 10 3 — Deaths 11 6 1 — — 1 — 1 3 5 9 13 50 .8 Erysipelas Notified 17 - - - - - - - - 1 5 6 5 7 Deaths - - - - - - - - - - 3 1 4 .06 Encephalitis Lethargica Notified 3 — — — — - 1 — — — — 1 1 — Deaths - - - - - - - - - - - - - - Cerebro-Spinal Meningitis Notified 1 — — — — — — — 1 — — — — 1 Deaths — — — — — — — 1 — — — — 1 .01 Malaria Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - — Dysentery Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Polio Encephalitis Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - — - Para Typhoid Notified - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - — Anterio Poliomyelitis Notified 4 — — 1 — 1 — — 1 1 — — — — "Deaths — — — — - — — — 1 — — — 1 .01 Tuberculosis Notified 54 - - - - - - - 5 25 12 10 2 64 Deaths — 1 — — - — - 4 10 11 7 2 35 .6 totals Notified 317 1 5 15 5 20 90 43 21 49 28 29 11 239 Deaths 11 7 1 — — 1 — 6 14 17 20 16 93 1.6 33 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'los Diseases. 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 1926 .706 - — - - - .103 - .6 The figures given in this Table are those obtained after correction by exclusion of "Non-Residents" and the inclusion of "Residents" beyond the district. Table showing the Ward Distribution of Infectious cases notified in 1926, 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) 26 2 2 - 1 2 13 3 3 23 Erysipelas 17 3 2 — 2 4 2 2 2 7 Scarlet Fever 165 12 9 7 6 36 40 30 25 140 Enteric Fever 4 - 1 3 — — — — — 2 Puerperal Fever 3 1 — — — - 1 — 1 2 Cerebro-spinal Meningitis 1 1 — — — — — - - 1 Pulmonary Tuberculosis 48 6 1 4 5 8 15 5 4 58 Other forms of Tuberculosis 6 — — 1 — — 2 2 1 6 Ophthalmia Neonatorum 3 — 1 — — — 1 — 1 — Encephalitis Lethargica 3 — 1 — 1 — - - 1 - Pneumonia 39 1 — 1 4 7 9 12 5 — Influenzal Pneumonia 1 — — — 1 — — — — — Anterio Poliomyelitis 4 — — — — — 3 1 — — Totals 320 26 17 16 20 57 86 55 43 239 34 Scarlet Fever.—The total number of cases notified during the year, was 165 from 133 houses. The attack rate, was 2.8 per thousand of the population. There were no deaths. 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 The type of Scarlet Fever was extremely mild, many cases presenting great difficulty in diagnosis. In one house there were four cases, in six houses three cases, in seventeen houses two cases, and in the remaining 109 houses, one case. 134 or 81 per cent. of the cases were treated in the Borough Isolation Hospital, Gap Road. 69 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 108 attended the following schools:— Special School, Queen's Road 1 Cottenham Park, Mixed 5 Effra Road Girls' and Infants' Schools 13 Durnsford Road Mixed and Infants' Schools 6 Queen's Road Girls' and Infants' Schools 7 Queen's Road Boys' School 5 Pelham Road Boys' School 5 Pelham Road Girls' and Infants' Schools 16 Dundonald Road Boys' School 3 Dundonald Road Girls' and Infants' Schools 1 Russell Road Mixed School 3 Russell Road Infants'School 2 Haydons Road Girls' School 1 Haydons Road Infants' School 4 Haydons Road Boys'School 3 Private Schools 13 Schools outside the district 20 Total 108 35 Diphtheria:—The total number of cases notified during the year was 26 from 26 houses. The attack-rate was .4 per thousand of the population. There were no deaths. 21 or 80 per cent. of the patients were treated in the Isolation Hospital. 61 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 13 attended the following schools:— Russell Road Infants' 1 Queen's Road Girls' and Infants' Schools 1 Haydons Road Girls' and Infants' Schools 1 Pelham Road Infants' School 8 Private Schools 1 Schools outside the district 1 Total 13 Tuberculosis. The following table shows the number of new cases notified during the year, and the number of deaths from tuberculous diseases. NEW CASES. DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary Males. Females. Males. Females. Males. Females. Males Females. Under 1 year - - - - - - - - 1- 5„ — — — 1 — — — 1 5 — 10 - - - - - - - - 10 — 15 „ - - - - - - - - 15 — 20 „ 4 1 — — 2 1 1 — 20 — 25 „ 5 6 — — 2 3 — 1 25 — 35 „ 7 4 1 1 1 2 1 — 35 - 45 „ 6 4 1 — 9 2 — — 45 — 55 „ 5 3 1 1 1 1 1 — 55 — 65 „ — 1 — — 3 1 — - 65 upwards — 2 — — 1 1 - — Totals 27 21 3 3 19 11 3 2 36 Of the 30 deaths from Pulmonary Tuberculosis, 15 died outside the district (10 males and 5 females), i.e., notification of death was transferred to Wimbledon. Of the 5 Non-Pulmonary deaths, 2 males and 1 female died outside the district. Of the 5 non-Pulmonary Tuberculosis deaths, 2 were due to Meningitis, and one each to Kidneys, Spine, and Knee and Hip. 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 95 763 858 Phthisis (Sputum) 11 93 104 Reaction Obtained. Reaction Not Obtained. Total Typhoid (Blood) 7 39 46 Chemical Work:—Mr. J. H. Johnston, M.Sc., F.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 the 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. 37 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 668 204 82 900 1387 92 123 4765 252 8473 Diphtheria 56 32 9 107 152 11 9 438 34 848 Typhoid Fever 21 4 1 24 41 3 5 210 3 312 Erysipelas 36 16 7 64 122 15 11 526 22 819 Tuberculosis 41 30 26 127 120 10 2 239 71 666 Cancer 35 14 14 131 101 8 — 422 28 753 Pneumonia and Influenza 10 4 5 38 20 - - 23 5 105 Encephalitis Lethargica 4 1 - 6 8 - - 2 2 23 Vermin 5 — 1 6 5 — — 121 33 171 Sundries 128 50 19 290 409 22 22 1604 90 2634 totals 1004 355 164 1693 2365 161 172 8350 540 14804 38 225 cases were admitted to the Wimbledon Isolation Hospital during 1926, making a total of 278 cases under treatment during the year, 53 cases remaining under treatment from 1925. 224 cases were from Wimbledon, and 54 from Kingston. Scarlet Fever:—Of the 167 cases admitted as scarlet fever, 4 were not scarlet—3 being transient erythemas and one a case of German Measles. 8 cases were admitted desquamating. 98% of the cases were mild and 2% moderately severe. There were no deaths. 3 cases developed mastoid disease and one case (with a history of transient rash), was admitted with acute mastoiditis. All were successfully operated on—3 by radical operation and one by Wilde's operation. 5 cases developed secondary attacks of Scarlet Fever during the stay in hospital—3 untreated by Anti-scarlet serum and 2 cases treated by serum. These cases may be accounted 39 Wimbledon Isolation Hospital. Carried, over from 1925 Under 5 years. Over 5 years. Total. Deaths. Remarks. Under 5 years Over 5 years. Total. Scarlet Fever 10 30 40 - - - Daily average number of cases, 30. Diphtheria 2 10 12 - - - Erysipelas - 1 1 - - - Cases admitted in 1926. From Wimbledon. Scarlet Fever 26 108 134 - - — Diphtheria 2 19 21 - - — Enteric Fever — 2 2 - 1 1 Measles l 1 2 1 — 1 Cerebro Spinal Meningitis - 1 1 - 1 1 Average number of days in hospital, 48 Chickenpox - 1 1 - — — Mumps l — 1 - — — ? Diphtheria — 2 2 - — — Total Kingston cases, 54 Erysipelas — 5 5 - 2 2 Erysipelas (Staff) — 1 1 - - - From Kingston. Scarlet Fever 8 25 33 - — — Diphtheria 7 12 19 - 1 1 Measles 1 — 1 - — — Enteric Fever — 1 1 - — — From Wandsworth Measles — 1 1 — — — Total Treated in 1926 58 220 278 1 5 6 for by the first attack being so mild that the patient did not develop sufficient antitoxin naturally to confer immunity. In the cases treated by serum, it is possible that the injection of serum inhibited the natural development of antitoxin. The only other explanation of such cases may be that the germ of scarlet fever may have different "strains," producing distinct blood reactions. One case of scarlet fever of the mild variety (untreated by serum), developed a petechial rash at the end of the first week, with gastric and intestinal haemorrhages. This case had been strictly isolated in a separate cubicle from admission. A good recovery was made. There were 10 "return" cases—a percentage of 6. Serum Treatment:—During the year, 50 cases have been treated with the new serum for scarlet fever. The cases selected were those regarded as more severe, but no severe toxic cases were admitted. After injection, the temperature falls rapidly (almost by crisis), the rash fades and in the great majority there is no further rise in temperature. In a few cases a secondary and smaller rise occurred about the 4th day, and lasted until the end of the first week or ten days. In these oases the dosage (10c.c.), was probably too small. The numbers treated are probably too small to be definitely accurate, but the following were the results observed. Taking all complications, the percentage was the same in treated and untreated, namely, 44%; taking the more serious complications only, such as mastoiditis, otorrhœa, suppurative adenitis, nephritis, rheumatism and chorea, the percentage in the untreated was 32, as against nil in the treated. Serum given late in the disease, appears to have no effect on the complications. Early complications appear to be cured quickly. "Cross-Infection" occurred 4 times during the year— thrice in Scarlet wards, and once in the Diphtheria block. These outbreaks were all due to children admitted, incubating the second disease. The outbreaks were, Chickenpox on three occasions, and German Measles on one. Diphtheria:—42 cases were admitted as diphtheria. 8 were not true cases—3 being follicular tonsillitis, 2 Vincent's Angina, 2 "croup," in rieketty infants, and 1 a case of Quinsy. Of the true cases, 33% were mild, 26% moderately severe, and 41% severe. 8 true laryngeal cases were admitted, but tracheotomy was not required. 1 death occurred on the 8th day from heart failure, giving a case mortality of 2.4% 40 Complications:—9 cases developed signs of paralysis (3 ocular, 4 nasal, and 2 of lower extremities). Erysipelas:—6 cases were admitted; 2 deaths (both in elderly patients) occurred from hypostatic pneumonia and heart failure. Measles :—4 cases, all complicated by pneumonia, were admitted. One child, aged 1 year and 10 months, died of double pneumonia. Enteric Fever:—3 cases were admitted. One, aged 54, died of exhaustion—a true enteric. The other 2 were Paratyphoid B. in type. Chickenpox and Mumps:—1 case of each was admitted from other hospitals for isolation purpose—(1 from the Atkinson Morley Convalescent Home and the other from the Belgrave Hospital). Cerebro Spinal Fever:—1 case of the htemorrhagic type died at the end of the third week. Staff:-1 nurse suffered from idiopathic erysipelas. 2 of tonsillitis, and 1 of pneumonia, made good recoveries. 41 Maternity and Child Welfare. The work in connection with this section of the Public Health Department has maintained its high standard of efficiency. The record of attendances at the Centres and the number of home visits paid, etc., are tabulated below. In connection with the classes for Mothers at the Welfare Centres, both classes entered for the Annual Mothercraft Competitions held under the National League for Health Maternity and Child Welfare, and Wandle Park Centre Was grouped second, and Queen's Hall Centre grouped seventh of the 85 competing centres from England and Wales. The work of the Welfare Centres has a social side as well as a strictly "welfare" function, and the thanks of the staff and of the mothers are due to those ladies who so generously assisted voluntarily with the work. During the year the issue of free milk has been carried on as in previous years, but the Committee felt that greater control should be exercised over the purchase of food and medicinal preparations at Welfare Rates. A scale of income was drawn up within which purchases could be made, and those whose incomes are over the scale are required to purchase from local dealers. In this connection it should be remembered that the Welfare Centres were primarily formed to give mothers instruction in Mothercraft, more especially with reference to the prevention of disease. Simple conditions are remedied by altering diet or by other simple measures, but no effort is made to treat established diseases. Such eases are referred to the family doctors or to hospital, if necessary. In the same way the Centres do not exist for the issue of food or medicinal preparations at reduced rates to mothers. Such preparations should be purchased from local dealers whenever possible, and it is only the exceptional cases that should be permitted to purchase at the Centres. A certain amount of latitude must be granted, however, for while the mothers may be able to purchase dried milk from dealers, the additional nourishment necessary in ailing eases may be beyond their means. The Committee give careful consideration to all cases and the recommendations of the Medical Officer in special cases are always granted. The attendances at the Centre have not been affected by the new arrangement to any noticeable extent. 42 During the year, 3 cases of puerperal fever were notified. Two of these cases died, one being a true case of Puerperal Septicæmia. The second death is classified in Table II. under the heading "other accidents and diseases of pregnancy," being more correctly attributable to exhaustion following prolonged labour. The following table shows the number of cases of Ophthalmia Neonatorum, and the result of the early treatment. CASES. Vision. Unimpaired. Vision Impaired Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 3 3 — — — — — There were no deaths from measles, or whooping cough, and no cases of epidemic diarrhoea notified. During 1926, the record of Home Visitation work was as follows:— Number of births notified 593 „ „ „ registered 722 Number of births visited 568 „ „ „ re-visited—under 1 yr. 1,969 „ „ „ „ —over 1 yr. 3,002 „ „ Still-births and Deaths 11 „ „ Ophthalmia cases visited 8 „ „ Expectant mothers visited 106 „ „ re-visits to expectant mothers 115 „ „ ineffectual visits 1,215 „ „ Special visits 236 Total welfare visits 7,230 Number of puerperal fever visits 11 „ „ tuberculosis visits 73 „ „ malaria visits — „ „ school visits (half-day) 163 „ „ visits to parents of school children 17 264 7,494 43 Supply of Milk to Expectant and Nursing Mothers and Infants. 83 families applied for free milk supplies, and it was granted to 79, 3 of which were later referred to the Guardians. 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 4 applications refused. The following work was carried out in connection with the Welfare Centres, by the Dental Surgeon for the year ending December, 23rd, 1926. Mothers treated 32 „ Attendances for treatment 114 „ Teeth extracted 145 „ „ filled 13 „ other operations 22 „ Scalings 20 „ Dentures supplied 12 „ „ repaired and re-modelled 4 „ other Prosthetic operations 52 Babies treated 69 „ Attendances for treatment 149 „ Teeth extracted 111 „ „ filled 60 „ other operations 37 44 During 1926, the record of work at the Centres was as follows:— Infant Welfare Consultations. Queen's Hall Centre. Wandle Park Centre. Number held 50 50 Total number of attendances 2,532 1,626 Average number of attendances 50.6 32.5 Total number seen by Doctor 855 701 Ante-Natal Clinic Consultations. Number held ... 21 Total number of attendances ... 103 Average number of attendances ... 4.9 Classes for Mothers. Number held 48 43 Total number of attendances 566 984 Average number of attendances 11.8 22.8 Subjects taught Home Nursing Mothercraft SingingPhysiology Needlework Home Nursing Mothercraft Singing Physiology Needlework Total number of fillings inserted 88 „ „ „ Local Anaesthetics administered 9 „ „ „ General „ „ 63 „ ,, „ „ „ half-sessions administered (by Dr. Scott) 34 „ ,, „ Patients rendered dentally sound 56 South Wimbledon Day Nursery:—Outbreaks of Chickenpox and Measles reduced the number of attendances at the beginning of the year. The number of children on the register, was 53, representing 45 families. The total attendances were 7,739, of which 1.120 were half-day attendances. Daily average, 33. Public Health (Prevention of Tuberculosis) Regulations, 1925:—No action was necessary under these Regulations. Public Health Act, 1925. Section 62:—No cases dealt with. 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, 1927. 45 TABLE 1.—Vital Statistics of Whole District during 1926 and Previous Years. YEAR. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths Belonging to 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 1919 62,283 Birth - rate 59,791 Death-rate 869 861 13.8 512 8.5 64 186 43 50 634 10.6 1920 62,311 Birth - rate 62,174 Death-rate 1124 1144 18.3 462 7.4 58 153 71 62 557 8.9 1921 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 58,000 833 868 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 60 638 10.9 1926 58,030 722 807 13.9 479 8.2 83 183 27 33 579 9.9 46 TABLE II.—Causes of, and Ages at, Deaths during the year 1926. CAUSES OF 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— 45— 65 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All Causes Certified 579 27 11 3 1 2 3 1 13 25 45 143 305 106 Uncertified - - - - - - - - - - - - - - Enteric Fever 1 - - - - - - - - - - 1 - 1 Small-pox — — — — — — — — — — — — — — Measles 6 1 2 1 - 2 - - - - - - - 1 Scarlet Fever - - - - — - - — — - - - — Whooping Cough — — — — — — - — — - - - - - Diphtheria and Croup — — — — — — - — - - - - - 1 Influenza 16 - - 1 - - - - - 1 1 4 9 1 Encephalitis Lethargica - - - - - - - - - - - - - X Meningococcal Meningitis 1 — — — — — - — 1 — - - - 1 Tuberculosis of Respiratory System 30 - — - - - - - 3 8 11 6 2 1 Other Tuberculous Diseases 5 - 1 - - - - - 1 2 - 1 - 1 Cancer, malignant disease 104 - - - - - - - - 1 4 40 59 13 Rheumatic Fever 2 - - - - - - - - 1 - - 1 - Diabetes 5 - — — — — - — 1 - - 2 2 1 Cerebral Hæmorrhage 31 - - - - - - - - - 1 12 18 21 Heart Disease 92 - - - - - - 1 - 1 6 23 61 6 Arterio Sclerosis 20 - - - - - - - - - - 3 17 8 Bronchitis 47 — — — — — - — — — 1 13 33 2 Pneumonia (all forms) 50 11 6 1 - - 1 - 1 3 5 9 13 6 47 TABLE II,—continued. CAUSES OF 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— 45— 65 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Other Respiratory Diseases 5 - - - - - - - - - - 1 4 1 Ulcer of Stomach, or Duodenum 7 - - - - - - - - 1 2 2 2 3 Diarrhœa, &c. (under 2 years) - - - - - - - - - - - - - - Appendicitis and Typhilitis — — — — — — — — — — — — — 1 Cirrhosis of Liver 3 - - - - - - - - - - 1 2 — Acute and Chronic Nephritis 9 - - - - - - - - 1 1 4 3 2 Puerperal Sepsis 1 — - — — — — — — — 1 — - - Other Accidents and Diseases of Pregnancy and Parturition 2 - - - - - - - - 1 1 - - - Congenital Debility & Malformations Premature Birth 9 9 - - - - - - - - - - - - Suicide 5 - - - - - - - - 1 3 - - - Other Deaths from Violence 14 - - - - - - - 3 1 - 3 7 - Other Defined Diseases 114 6 2 - 1 - 2 - 3 3 8 17 72 31 Causes ill-defined or unknown - - - — - — - — - - - - - - Totals 579 27 11 3 1 2 3 1 13 25 45 143 305 106 48 STAFF. (a) Whole-time Officers: School Medical Officer: *‡ A. Gilmour, M.D., M.R.C.P.E., D.P.H. Assistant School Medical Officer: * ‡ 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, Health Visitor—School Nurses: * Miss M. Gil,es. * Mrs. G. M. Street, # Miss E. M. Skelton. 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. ‡ Public Health Officers. 50 Borough of Wimbledon. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1926. 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, 1926. 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 6M1 (15th November, 1926). Administration:— (a) Staff:—No change. (b) New Dental Clinic:—For some years the accommodation at the Southey Hall Clinie has proved unsatisfactory for the purposes of a conjoint medical and dental treatment Clinic. The dental operating room was too small and in warm weather the atmosphere became stifling; there was no "recovery" room in which the children could rest after a general anesthetic; and the waiting room was liable to overcrowding during conjoint sessions. 51 Early in 1926, 58, Pelham Road, became vacant through the transfer of the Education Offices to more central premises and the rooms on the ground floor were adapted for the purposes of a dental clinic. A well-lighted operating room with an electric dental engine, a "recovery" room, and a large waiting room were provided. The improved working conditions have been beneficial both to patients and staff. (c) Payment Schemes at the Clinics:—In considering estimates for 1926-7, the Local Education Authority gave very careful consideration to the complete schemes of medical inspection and treatment and a special sub-committee was appointed to investigate. The amount spent in 1925-6 on inspection and treatment of children in public elementary schools was £2,552 3s. 6d., and the average amount recovered from parents in payments for treatment over the previous 5 years was approximately £150 per annum. The cost per child in Wimbledon was 8s. 3d. Was this money being expended to the best advantage? It was decided that the scheme of Inspection could not be reduced or simplified. In regard to Treatment it was felt that the duty placed on the Authority under Section 81 (1) of the Education Act, 1921, should be further considered. That section of the Act requires that, where a local education authority provide for the medical treatment of children attending any school, there shall be charged to the parent of every child in respect of any treatment provided for that child such an amount, not exceeding the cost of treatment, as may be determined by the local education authority. Circular 1300 of the Board of Education, dated 16th March, 1923, contains further information on the working of this Section 81 (1). While it is recognised that no child should be deprived of treatment on account of the inability of its parents to pay for it, it is emphasised that "some scale of charges for parents whose income is over the limit for free treatment is necessary. The income scale and the charges should naturally be related." Income scale and charges depend largely on local conditions and are left to the Local Authorities concerned. At the Wimbledon School Clinic the charges for treatment were very small. Minor ailments were treated free; vision testing was free, but parents paid cost price for spectacles; dental treatment was 1s. per child, plus 1s. extra for general anæsthetic; and the cost to the parent of operative treatment for tonsil and adenoid cases rarely exceeded 7s. 6d. per child. The total amount recovered in payment annually has already been stated. From 1923 onwards, a box had 52 been placed in a prominent position in the Clinic, and parents were invited to contribute voluntarily towards the cost of treatment, but the total result was under £10 annually. The inhabitants of Wimbledon cannot be called "poor" in any strict sense, and therefore the Committee had no other alternative than to draw up a more rigid scale of payment. A provisional scheme was put in force, but was abandoned at the end of one month's trial for the following reasons. It was found that children with minor ailments did not return to the Clinic for treatment, and that the conditions became rapidly aggravated from want of treatment and spread to other members of the family or to other children. Such conditions are due in many cases to poverty, dirt and overcrowding, and are unfortunately regarded by the parents as trifling in their early stages. Eighty per cent. of all minor ailments come from the four schools with the poorest scholars. It was, therefore, decided by the Committee that, as early treatment was essential from a strictly preventive standpoint, these conditions should be treated free of charge for the first week. and thereafter, at a rate of 6d. per week to a maximum of two shillings. The intention of retaining any payment is to encourage home co-operation. Children attending the dental clinic under the trial scheme also failed to return for treatment, but in this case the reason was entirely different. It had previously been noted that the acceptances of the offer of treatment had varied with the class of scholar attending the school—86% accepting in the better class schools, and 30% in the poorer. The parents in the better class schools under the new scheme requested the treatment and were prepared to pay fees, but they were unwilling to disclose the family income, and treatment consequently was refused. The scheme and scale of payments were therefore revised, and have now been in operation for 6 months and are proving satisfactory. Emergency treatment, vision testing and cleansing are carried out free of charge; the charges for minor ailments are stated above; and tonsil and adenoid operations and dental treatment are based on income scale, but the enquiries are made personally and informally, and a certain amount of latitude is allowed to the medical and dental officers. No ease is refused treatment. (d) Savings Associations:—During 1926, arrangements were made with these Associations whereby the contributions made by parents to these Societies would be recognised for school children requiring operations for tonsils and adenoids and recommended by the local School Medical Officers. This arrangement has removed a distinct hardship to many parents. 53 Co-ordination:—The work of the School Medical Service and of the Maternity and Child Welfare Section has been still further co-ordinated by placing the entire administration in the hands of one Committee—the Maternity and Child Welfare Committee. This Committee is responsible for the Ante-natal Clinics, the Infant Welfare Centres, the Day Nursery, the issue of free milk to mothers and infants, and th° entire schemes of medical inspection and treatment of school children. No difficulties are experienced although financial matters affect two Authorities—the Local Authority, and the Local Education Authority. The closer control over the work and better continuity in records should undoubtedly result in more efficient service in the future. There are no Nursery Schools in the Wimbledon Area. The Committee has under consideration a scheme whereby the school medical clinic, the dental clinic, and one welfare centre—at present in separate buildings—may all be grouped in suitable and convenient premises. The treatment of children under school age and of nursing and expectant mothers will thus be facilitated, and delay and trouble in going from one clinic to the other will be avoided. In this way also, the progress of debilitated children under school age will be more closely supervised. The School Medical Service in Relation to Public Elementary Schools. School Building's:— (a) Wimbledon Park Netv School:—The following information is supplied by Mr. J. Bowen, Borough Surveyor. "The buildings comprise main School Buildings, Boys' Offices, Girls' and Infants' Offices, and Caretaker's Cottage. "The main School Building is designed on the bungalow type and comprises 13 classrooms, eight of which have accommodation for 50 scholars each, size, 22-ft. 9-ins. x 22-ft., and five with accommodation for 40 scholars each, size 22-ft. x 22-ft, making a total of 600 scholars. All classrooms are 13-ft. high. "The Classrooms are placed mainly with a South-East aspect, one only facing North-East. At the South-West end provision is made for an extension, comprising an Infant's room for 50 children, which can be divided off by means of a folding partition to provide a play room for infants as well. "The Walls of Classrooms are finished with a 'Carterite' dado, with sirapite plaster walls above. The floors are l½-ins., grooved and tongued flooring on concrete. 54 "Two Cloakrooms are provided, one at each end, each being divided into two by means of a 4½-in. partition. These are fitted with ranges of white glazed lavatory basins, the walls being finished with white glazed tiling 4-ft. high, with a terrazzo floor. The cloakrooms are heated. "A Caretaker's Lobby is provided at each end, fitted with cupboards and sinks, and a reinforced concrete staircase leads to staff rooms on 1st floor over cloakrooms. "The Staff Rooms comprise head teacher's room, male assistant teachers' room, with stock room and lavatory accommodation at one end, with similar rooms for assistant mistresses at the other end. "Two main entrance Lobbies are provided next to the cloakrooms. "In the centre of Building on the North side, an Assembly Hall is provided, 70-ft. long x 30-ft. wide, with a curved plastered ceiling on hyrib construction. The walls are panelled out in oak, to a height of 6-ft., with ornamental plasterwork round doors and windows and to pilasters, the whole being surmounted with a bold plaster cornice on top. The floor will be of wood blocks laid in mastic on concrete. "The whole of the Classrooms, Cloakrooms and the Assembly Hall open out to a main corridor 9-ft. wide, running the whole length of the building with an asphalt flat over, access to which is gained from the staff rooms on the first floor at each end. "The Walls of the Corridor are finished with 'Carterazzo' wall lining and capping with a coved skirting and floor of terrazzo paving. "Four Emergency Exits are provided from Assembly Hall and Corridor. "The whole school is provided with natural ventilation, the classrooms, by means of cross ventilation, and the Assembly Hall by means of No. 4. ventilating dormers in roof, ventilating gratings in ceiling and the windows. "The heating is supplied by a low pressure heating system. "Duplicate boilers are provided in Boiler House,, which is centrally situated under Classroom No. 9, and the system is designed to maintain a temperature of 60°F. for Classrooms with 3 changes of air per hour and of 55°F. for corridor with fewer changes of air per hour, and with an outside temperature of 32°F. "The whole of the school is fitted up with Electric Lighting. 55 "The buildings are constructed in brickwork, with red facings and Portland stone dressings in quoins and Entrance Lobbies. The facings to Assembly Hall are panelled out in rough cast with pilasters in red brick facings. The roofs are covered with red Brindled Broseley tiles. "There are two blocks of offices, one for Boys, and one for Girls and Infants. These are built with red brick facings, glazed bricks and rough cast, with tiled roofs over water closets." (b) General Notes:—The school buildings are regularly and thoroughly inspected each year, and structural alterations and improvements are carried out whenever opportunity arises. During 1926, internal redecoration was carried out in the following schools:—Dundonald, all departments; Haydons Girls' and Infants' Schools; Old Central School; and Cottenham Park Mixed School. Dundonald School was also painted externally and the conversion of the old trough closets into six separate single closets was completed in the Girls' School. The play-ground of Cottenham Park Girls' School was resurfaced. Electric lighting replaced gas lighting in Cottenham Park School, and anthracite stoves for heating were placed in three classrooms. New heating stoves have also been placed in four rooms of Effra Infants' School. The lighting (gas) in Old Central School has been improved. (c) Desks:—The School furniture is gradually being brought up to date by the conversion of the old long desks into dual desks, or by entirely new furniture. The schools are taken in rotation. Medical Inspection:—The children inspected in routine manner in accordance with the Board's schedule, were (i.) all new admissions ("Entrants"); (ii.) those of 8-9 years of age ("Intermediates"); and (iii.) those of 12-13 years of age ("Leavers"). All the children in the Queen's Road Special School were examined. Total "Routine" inspections in 1926= 1759 (v. Table I., Appendix). Finding's of Medical Inspection:—(v. Table II., Appendix). Routine Inspections are conducted as above. "Special" inspections (any age) are made daily, 9.30 a.m., at the Treatment Clinic (Southey Hall), or at the "Inspection" Clinic on Tuesday afternoon sessions. A casual glance at the numbers of defects discovered at such inspections might lead to the hasty and very erroneous conclusion that the medical inspection of school children had brought about little or no improvement in conditions since its 56 institution almost twenty years ago. This is far from being the case, as those who have been engaged in the work fully know. The actual numbers of defects may show little diminution, but the nature of the defects discovered and how they are discovered has entirely altered. In the early days of inspection, such conditions as uncleanliness of clothing or person, ringworm, scabies and other skin diseases were frequent in spite of special preparation of the scholars by the parents for the inspection. Conditions such as heart disease, defective vision, and enlarged tonsils and adenoids, required careful and full explanation to the parents as to necessity for treatment. Other defects and their remedies were disregarded, and the attitude of the parents generally towards inspection was, at best, that of "armed neutrality." A glance at Table II. perhaps will be the best evidence of the change. Where formerly defects were discovered practically only at "Routine" inspections, now the great majority are discovered at "Special" Inspections. In other words, the parents bring their children at once to the Clinic for advice if any defect is observed—the parents have learned the value of prevention and early treatment. The number of conditions requiring to be kept "under observation" also emphasises this point, and a considerable number of children attending the Clinic are only reporting under observation, and are not receiving any treatment. This last point should be remembered when statements are made to the effect that children attend and are being actively treated at the Clinics who should be attending the family doctor. Under such circumstances there is very little that can be added to previous reports. (a) croup v.—un cleanliness 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 42,111 iii. Number of individual children found unclean 266 iv. Number of children cleansed under arrangements made by the Local Education Authority 1397 v. Number of cases in which legal proceedings were taken: — a. Under the Education Act, 1921 Nil b. Under School Attendance Bye-laws Nil t Includes skin disease cases. 32 children only out of over 1,750 examinations made by the Medical Officers were noted as verminous. (1.8%). (b) Minor Ailments:—Many of these cases are extremely trifling and should never be sent to the Clinic. Small cuts, 57 scrapes, and bruises which could, and ought to be, treated at home, are sent daily for dressing. It is difficult to know whether these children actually are sent to the clinic by parents or come on their own statement to escape school. The teacher cannot undo the bandage to examine the urgency of the case, and although the child is told not to return to the Clinic many do. 1338 children attended the minor ailment clinic in 1926. (v. Table IV., Group I.). (c) Tonsil and Adenoid Cases:—57 children were operated on, and 25 are awaiting operation. These cases are kept under careful observation in many cases for 6 to 12 months before operation is recommended. (d) Tuberculosis Cases:—Close co-operation is maintained with the Tuberculosis Officer in regard to children suffering from, or suspected of, tuberculosis. Many children attend both the Clinic and Tuberculosis Dispensary who are merely "chesty," and teachers who know that such children attend the Dispensary are apt to regard them all as Tuberculous. Diagnosis can only be made in many cases after observation over an extended period during which the weight and general health are carefully recorded. After special investigation, it can be definitely stated that the following table represents the numbers of school children suffering from tuberculosis. Active. Arrested. Lungs 1 0 Bones and Joints 7 4 Glands 8 6 Total 16 10 Of the 16 "active" cases, 3 are in hospital, 2 are bedridden, 2 are in special sanatoria schools, and 1 has gone abroad. The other 8 cases (non-infectious), and the 10 arrested cases all attend elementary schools. It might be considered that an "open air" school would be more beneficial for such children, but each case must be considered individually and is kept under observation. Many of these children are better physically and in general health than so-called normal children. (e) Skin Disease:—Of the 397 children cleansed under the arrangements of the Local Authority, several were suffering from scabies or other skin diseases for which special baths were given. 58 (f and g) Eye Disease and Vision:—There were very few cases of external eye disease—chiefly minor conjunctivitis and blepharitis. Three cases were admitted for treatment to local hospitals under special arrangement with the Education Authority (1 Detached Retina, 1 Dacryocystitis, 1 perforatoring injury to the Cornea and Lens). The defects of vision (Table IV., Group II.), comprised 224 cases treated for the first time. 148 were old cases reexamined, either myopes under observation, or other cases for re-testing for spectacles. 810 total attendances were made. (h) Ear Disease and Hearing:—The majority of these defects were slight. The number of cases of Otitis Media ("running ears") remains fairly constant each year. It should be remembered that this condition is liable to recur. Two cases of acute Mastoiditis were brought to the Clinic, and both were admitted at once to hospital for immediate operation on the recommendation of the School Medical Officers. (i) Dental Defects:—(Table IV., Group IV.). The number of cases treated maintains a high standard. Attention might be drawn to the large number of fillings (1,501), indicating a high degree of conservancy treatment. Report on Irregularity and Malocclusion of the Teeth and Jaws. During the year 1926, particulars have been recorded of the frequency of irregularity or crowding of the teeth and malocclusion of the jaws in children coming under observation during treatment. These conditions are serious causative and predisposing factors in the incidence and frequency of caries (decay) of the teeth. The conditions were found in 10% of the cases treated. 6% had teeth extracted at the Clinic with a view to remedy of the irregularity. In addition, Dental Hospital tickets were given to 8 cases, and other forty cases were recommended to attend Private Dentists or Dental Hospitals for supply of Regulation Appliances—4% of the cases treated. (i) Crippling Defects and Orthopoedics:—The number of such cases requiring active treatment is comparatively small. A few cases of slight Scoliosis, Flat Feet, and Paralysis attend the Orthopoedic Centre at the Nelson Hospital for massage and exercises, but none required surgical interference (see also Physically Defective Children). Infectious Diseases:—The following numbers of scholars were notified during the year as absent from school, suffering from, or in contact with non-notifiable infectious diseases. 59 The notifiable cases are given in the Report of the Medical Officer of Health:— Measles 827 Chickenpox 246 Mumps 219 Whooping Cough 107 Conjunctivitis 3 German Measles 1 1,403 Measles and Chickenpox were most prevalent in February and March; Mumps in March, October and November; and Whooping Cough in February and from September to the end of the year. No schools or departments were closed for infectious diseases during the year. The children of two classes in Wimbledon Park School were excluded on account of Chickenpox and Measles respectively for a limited period. These exclusions were made more on account of reduced numbers in classes than by the hope of benefit. An outbreak of Conjunctivitis in one class was checked by the exclusion of individual scholars. In June 1926 3 cases of Diphtheria were admitted to the Isolation Hospital at intervals of a few days from Pelham Infants School. I visited the School, examined all the scholars, and swabbed suspicious cases in classes. One child was , positive and was admitted to the Isolation Hospital until a virulence test was carried out. This result proved virulence. Meanwhile, the teacher and another child who had been absent, were notified as Diphtheria, and I therefore closed classes V. and VI. for 10 days. No further cases occurred during closure, or on re-opening. In an outbreak such as this, the classrooms are thoroughly disinfected, more especially as to class equipment. In the case of non-infectious diseases, disinfection of classrooms during an outbreak is of little or no value. The diseases are spread from case to case, either by direct contact or "droplet" infection, and there is no evidence that the actual classroom or equipment plays any part in the spread. A thorough ventilation and cleansing of the classrooms is all that is necessary. FOLLOWING UP:—The arrangements made for securing the treatment of defects discovered are very complete, 60 and it may be stated that every ease is re-examined by the School Medical Officers, or visited by the nurses at home when the parents can be interviewed. Open-air Education:—Arrangements for open-air education are 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:—No special provision of meals by the Authority is necessary under Sections 82-86 of the Education Act, 1921. Necessitous and debilitated children, however, are granted extra nourishment in the form of milk and similar food stuffs 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 Baths Committee grants 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.:—64% of the parents attend the Routine Inspections. Practically every child attending the Inspection and Dental Clinics is accompanied by the parent, and the parents also attend the treatment clinic in many cases. Close co-operation is maintained with school teachers, attendance officers, and with the different Voluntary Welfare Societies, and the thanks of the medical inspection department are due to those who have assisted us on all occasions. Defective Children (a) Mentally Defective: During the year the School Medical Officer paid special visits to all schools to receive progress reports on cases under observation, and to examine new cases. 27 new cases and 116 old cases were reviewed. 22 cases were specially tested by the Binet Simon method. 8 children were admitted to the Special School. At the end of the year, 101 children remain under observation. This system of keeping children under observation in public elementary schools before passing definitely into a special school for mentally defective children is undoubtedly the most satisfactory and fairest way, although it adds considerably to the work. Children do not progress educationally 61 at the same rate. Some "hang fire" for months, others progress very irregularly and long observation may be necessary. The progress made from the time of admission and under different teachers can be observed, and teachers have less hesitation in presenting cases when they know the child is only under observation. Queen's Road Special School:—During 1926, 2 boys and 8 girls were admitted, and 7 boys and 5 girls were passed out, giving a roll at the end of the year of 31 boys and 22 girls. All the children were examined by the medical and dental officers during the year, and dental treatment was offered to those requiring it. Of the 12 cases passed out, 3 were returned to Public Elementary Schools as being educationally backward only; 3 were exempted on obtaining special employment; 2 (girls) were notified to the Board of Control; 2 (boys) were transferred to Littleton Street Special School under the L.C.C.; 1 girl was reported on attaining 16 years for supervision in her own home; and 1 for further discipline before coming to school. (b) Physically Defective Children:—The actual number of such children in the Wimbledon area is difficult to estimate but from our records it is below 1 per cent. This may be because some of the most delicate are educated in private schools. Of the cases known the present and future interests of many are best considered by permitting them to attend the ordinary public elementary schools under observation. In other words, a physical defect does not necessarily imply a "special education," and such may indeed be inadvisable. As stated in previous reports, these numbers do not justify the establishment of a school for physically defective children only, and even the number of "delicate" children (see Table III.) is no argument for a special "open-air" school. From considerable experience in special schools there can be no doubt that such are necessary, but, on the other hand, once established there is a tendency "to fill places" by children who can quite well and should attend ordinary elementary schools. Thus, of the 8 active, but non-infectious, tuberculous cases mentioned above, both the Tuberculosis and School Medical Officers are convinced there is no need for special education for any of them. Yet, if there were an "open-air" school, these cases would probably help to keep up the numbers. 62 Under these circumstances it is extremely difficult to know what to recommend, as there is as great a danger of overestimating as of under-estimating. The whole question is being very carefully considered in view of future developments, and meanwhile, I can state definitely that no child is at present suffering from want of special facilities. 60 special interviews were given to parents during the year in regard to such special eases. Employment of Children and Young Persons:—35 children were specially examined and certified as to employment. Special bye-laws, on the lines recommended by the Home Office, are enforced in Wimbledon. Two Teachers were examined with a view to employment. In conclusion, I desire to thank the members of my staff for loyal co-operation, and to congratulate them on the work carried out during the year. I have the honour to be, Your obedient servant, A. GILMOUR, School Medical Officer. 20, Queen's Road, Wimbledon. 15th February, 1927. 63 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1926. 64 TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections :— Entrants 582 Intermediates 516 Leavers 569 Total 1,667 Number of other Routine Inspections 92 B.—OTHER INSPECTIONS. Number of Special Inspections 2,513 Number of Re-Inspections 6,289 Total 8,820 TABLE II. A.—RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1926. DEFECT OR DISEASE Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to bp kept under observanon, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 1 - 12 18 Skin Ringworm—Scalp 1 - 13 - Body 4 - 48 - Scabies — - 15 - Impetigo 6 - 235 - Other Diseases (Non-Tuberculous) 18 - 77 - Eye Blepharitis 4 - 34 - Conjunctivitis — 1 24 - Keratitis - - 2 - Corneal Opacities — - 1 - Defective Vision (excluding Squint) 90 7 358 8 Squint 7 1 8 8 Other Conditions 4 - 25 1 Ear Defective Hearing 9 1 10 17 Otitis Media 2 - 42 — Other Ear Diseases 9 2 1 1 Nose and Throat Enlarged Tonsils only 54 61 72 - Adenoids only 2 9 2 5 Enlarged Tonsils and Adenoids 19 22 20 22 Other Conditions 12 3 3 4 Enlarged Cervical Glands (Non-Tuberculous) 3 11 10 28 Defective Speech — 4 — 6 Heart and Circulation Heart Disease: Organic 4 6 — 12 Functional 10 21 6 12 Anaemia 3 - 6 - 65 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) Lungs Bronchitis 13 12 21 46 Other Non-Tuberculous Diseases 3 1 2 3 Tuberculosis Pulmonary: Definite — — 2 — Suspected — 1 — 6 Non-Pulmonary: Glands — 1 1 1 Spine — — — — Hip — 1 — 1 Other Bones and Joints — — — — Skin 1 — — — Other Forms 1 — — — Nervous System Epilepsy 1 1 — 8 Chorea — — 5 — Other Conditions 3 1 4 2 Deformities Rickets 1 — — - Spinal Curvature 3 — 2 1 Other Forms 5 1 6 4 Other Defects and Diseases 27 18 625 222 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 582 127 20.8 Intermediates 516 69 13.3 Leavers 569 113 19.8 Total (Code Groups) 1667 309 19.2 Other Routine Inspections 92 11 12.0 66 TABLE III. NUMERICAL RETURN OP ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1926. 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 — — — (it.) 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. Peeb1eminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally Defective Children.. 31 22 53 +3* — +3* Attending Public Elementary Schools - - - At other Institutions.. — — At no School or Institution — — — * In Littleton Street, Special School, L.C.C. 67 TABLE III.—Continued. Boys. Girls. Total Mentally Defective contd. Notified to the Local Control Authority during the year Feebleminded 2 2 Imbeciles — — - Idiots - - - Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics - - - In Institutions other than Certified Special Schools - - - Attending Public Elementarv Schools - - - At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 6 6 12 At no School or Institution — — — Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 1 1 At other Institutions - — — At no School or Institution — — — Physically Defective 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 2 4 6 At other Institutions 1 — 1 At no School or Institution - — — 68 TABLE III.—Continued. Boys. Girls. Total. Physically Defective (continued) Delicate children (e.g., pre - or latent tuberculosis, malnutrition, debility, ansemia, etc.) At Certified Residential Open Air Schools At Certified Day Open Air Schools _ At Public Elementary Schools 18 24 42 At other Institutions — — — At no School or Institution — — — Active non - pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 - 1 At Public Elementary Schools 1 - 1 At other Institutions — 2 2 At no School or Institution 2 - 2 Crippled Children (other than those with active tub erculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools - - - At Certified Residential Cripple Schools 2 2 4 At Certified Day Cripple Schools - - - At Public Elementary Schools 26 30 56 At other Institutions — — — At no School or Institution — — — 69 TABLE IV.—return of defects treated during the year ended 31st December 1926. 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 13 1 14 Body 48 4 52 Scabies 15 — 15 Impetigo ... 225 16 241 Other skin disease 87 8 95 Minor Eye Defects— 62 3 65 (External and other, but excluding cases falling in Group ii.) Minor Ear Defects 63 10 73 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 825 120 945 Total 1338 162 1500 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). 358 28 — 386 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 14 — - 14 Total 372 28 — 400 Total number of children for whom spectacles were prescribed:— a. Under the Authority's Scheme 200 b. Otherwise 2 Total number of children who obtained or received spectacles :— a. Under the Authority's Scheme 200 b. Otherwise 2 70 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. (i) (2) (3) (4) (5) 57 Awaiting Treatment 25 82 39 121 b. Pound to require Treatment 2341 c. Actually Treated 1184 d. Re-treated during the year as the result of periodical amination 64 2 2. Half-days devoted to:— Inspection, 42. Treatment, 364 Total 406 3. Attendances made by Children for Treatment 2238 4. Fillings:— Permanent Teeth, 752. Temporary Teeth, 400 Total Teeth 1152 Total Fillings 1501 5. Extractions:— Permanent Teeth, 229. Temporary Teeth, 1830 Total 2059 6. Administrations of general anaesthetics for extractions 348 7. Other Operations:— Permanent Teeth, 362. Temporary Teeth, 558 Total 920 71 GROUP IV.—DENTAL DEFECTS. 1. Number of Children who were:— a. Inspected by the Dentist: Routine Age Groups Aged Aged Total 2478 5 155 10 277 2 522 11 222 7 433 12 140 8 388 13 131 9 204 14 6 Specials 573 Grand Total 3051