C.I. AC 4413(1) WIMBLE DEN e Borough of W imbledon. Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year 1927. 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, 1927. Public health Committee: Chairman: Councillor F. W. Daffen. Vice-Chairman: Councillor C. B. Heaton. Members: The Mayor (Alderman Hickmott, J.P.), Councillor E. J. Chard Councillor S. Murray „ H. H. Coote „ A. J. Penman „ H. Dormer „ Lady Roney „ A. A. Drake „ C. Snell „ E. Fielder „ J. Townsend Maternity and Child Welfare Committee: Chairman: Councillor C. B. Heaton. Vice-Chairman: Councillor E. J. Chard. Members: The Mayor (Alderman Hickmott, J.P.), ex-officio. Councillor Dormer Councillor Fielder „ Drake „ Lady Roney Mrs. Chard „ Daniel „ Fielder „ Sheerman STA F F . Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer. ‡*A. Gilmour, M.D., M.R.C.P.E., D.P.H. Assistant Medical Officer of Health, School Medical Officer and Maternity and Child Welfare Officer: ‡ Effie M. D. Craig, M.B., Ch.B. Chief Sanitary Inspector: a * † Henry Johnson. Assistant Sanitary Inspectors: ¶a† R. T. Avis. a † D. F. S. Flynn. Health Visitors—School Nurses: ¶ § || Miss M. Giles. c || Mrs. G. M. Street (Resigned). c || Miss E. M. Skelton. c || Miss J. E. D. Elder. Clerks: Miss N. Low. Miss M. Winslade. Clerk to the Maternity and Child Welfare Department : Miss N. Low. 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 Foods. ║ 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 Committee 1 Staff 2 Staff and Administration 5 New Premises 7 New Acts and Regulations 7 Natural and Social Conditions of the Area 8 Vital Statistics for 1927 9 Population, Birth and Death Rates for Each Ward, 1927 9 Births 10 Deaths 10 Infantile Mortality 11 Poor Law Relief 12 General Provision of Health Services in the Area 13 List of Local Acts, Orders and Adoptive Acts, in force 14 Sanitary Circumstances of the Area 16 Sanitary Inspection of District 17 Factories and Workshops 18 Sanitary Inspector's Report— Notices Served 21 Opening Up of Drains 22 House Drainage 22 House to House Inspection 22 House Inspection 23 Overcrowding 23 Houses let in Lodgings 24 Verminous Rooms 24 Common Lodging Houses 24 Van Dwellings 24 Dairies, Cowsheds and Milkshops 24 Infectious Disease and Disinfection 25 School Disinfection 25 Yard Paving 25 Stable Refuse 25 Inspections under1 the Factory and Workshop Act, 1901 26 Shops Acts, 1912-13 26 Slaughter Houses and Food Inspection 26 Sale of Food and Drugs Acts, 1875 to 1907 27 Petroleum Acts 27 Diseases of Animals Acts, 1894 to 1925 28 The Public Health (Meat) Regulations, 1924 29 Rent (Restrictions) Acts, 1920 and 1923 29 Water Supply 30 Employment Agencies 30 Employment of Children Bye-laws 30 Summary Table—Nuisances Abated 32 Medical Officer's Report—continued. Housing Statistics for the year 1927 33 Inspection and Supervision of Food 34 Prevalence of, and Control over, Infectious Diseases 35 3 Medical Officer's Report—continued. page Notifiable Diseases and Deaths, 1927, in age-groups, etc. 38 Death-rate from Zymotic Diseases, for the last ten years 39 Ward Distribution of Infectious cases notified in 1927 39 Scarlet Fever 40 Diphtheria 40 Tuberculosis 41 Laboratory Work 43 Disinfection 44 Wimbledon Isolation Hospital 45 Maternity and Child Welfare 48 Ophthalmia Neonatorum 48 Supply of Milk to Expectant and Nursing Mothers and Infants 50 South Wimbledon Day Nursery 50 Table I.—Vital Statistics 51 Table II.—Causes of Deaths, etc 52 School Medical Officer's Report— Staff 54 Administration 55 School Buildings 58 Findings of Medical Inspection 58 Group V.—Uncleanliness 59 Minor Ailments 59 Tonsil and Adenoid Cases 59 Tuberculosis Cases 59 Skin Diseases 59 Eye Disease and Vision 60 Ear Disease and Hearing 60 Dental Defects 60 Crippling Defects and Orthopoedics 60 Infectious Diseases 60 Co-operation of Parents, Teachers, etc 61 Defective Children 61 Queen's Road Special School 61 Employment of Children and Young Persons 62 Table I.—Return of Medical Inspections 63 „ II.—Return of Defects 64 „ III.—Return of all Exceptional Children 66 „ IV.—Treatment Table 69 4 Borough of Wimbledon. Public Health Department. ANNUAL REPORT OF THE Medical Officer of Health FOR THE Year ended 31st December, 1927. 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, 1927, together with my Report as School Medical Officer. The Annual, Report of the Medical Officer of Health for 1927 is an Ordinary Report, prepared on the lines suggested in Circular 834, issued by the Ministry of Health on 15th December, 1927. Staff and Administration. (a) Changes in Staff:—Mrs. G. M. Street. School NurseHealth Visitor resigned in March, 1927, and Miss J. E. D. Elder commenced duty in April, 1927. (b) New Duties of Medical Officers—Bacteriological Work:—Prior to 1915, the bacteriological work of the Borough was carried out by a part-time officer, but in that year a Municipal Laboratory was opened and staffed by the whole time medical officers. The Laboratory was closed after three months working, and the part-time officer resumed duty, on 5 the Medical Officer of Health proceeding on active service. After the war the laboratory was not re-opened, at first because the premises were occupied by the military, and later on account of the increased work of the Public Health Department. In October, 1926, I received instructions to report on the question of this work being again taken up by the wholetime medical staff. I pointed out that while the staff remained of the same size as in 1914, the Public Health work had increased by the addition of an entirely new Section under the Maternity and Child Welfare Act,, 1918, by an extension of School Medical Treatment (1920), by the admission of cases to the Wimbledon Isolation Hospital from outside areas (1920), by the examination of sick employees of the Council (1925), and by the natural growth of the Borough and by the passing of new Acts, Orders and Regulations (1915-1926). It was, therefore, obvious that the medical staff could not devote the same time to bacteriological work as in 1914. I advised that there should be a slight re-arrangement of the duties of the medical staff to permit of better "team" work and that a trial run should be made by carrying out the hospital bacteriological work only, as there is less urgency as to the results of these examinations than with specimens handed in by general medical practitioners. After twelve months' experience on the above lines I am of opinion that no further work can be undertaken without additional assistance. During "outbreak" conditions the hospital bacteriological work increases so greatly that in spite of working in the evenings, etc., the carrying out of some routine medical duties must of necessity be postponed for an indefinite time until the rush is over. By so doing the efficiency of the department is jeopardised. This question of bacteriological work is still under consideration by the Public Health Committee and I have no doubt it will be suitably adjusted. The need for economy in all public departments is still very pressing, and in this respect the Public Health Department has admirably seconded the efforts of the Borough Council as is evident from previous Annual Reports. There is, however, a limit to which economy can be carried in regard to Public Health, and the addition of further new duties will undoubtedly necessitate an increase of staff. The value of a public health department is in the amount of preventive work that can be undertaken, and the results of such work, unfortunately, cannot be given in stated terms, for the better the prevention the less there is to show. 6 When conditions arise which are detrimental to the public health, efforts must be concentrated on ameliorating such conditions, and the preventive side of the work may be neglected. This is incorrect. The staff—medical and nonmedical—has at all times cheerfully worked extra hours to overtake these sudden emergencies, but the fact that this is necessary should be reported to the Council. (c) New Premises:— (i) New Day Nursery:—These new premises situated in Hubert Road, South Wimbledon, are in course of erection, and should be ready for occupation about May, 1928. (ii) New Conjoint Clinic:—The proposal to erect a Conjoint Clinic for School Medical and Maternity and Child Welfare work is a further effort to obtain more efficient work by centralisation. The present premises are scattered and under the new scheme there should be not only economy in rent, caretaking, etc., but in administration. At the new Clinic all the work of the Maternity and Child Welfare Section would be concentrated, and the Queen's Road Centre, Southey Hall Clinic, the Dental Clinic and the laboratory would be transferred. A site has been acquired by the Council in Pelham Road, admirably situated and capable of further development, if required. Sketch plans have already been forwarded both to the Ministry of Health and Board of Education and final approval only is awaited. The premises should be ready for occupation by the end of 1928. (d) New Acts and Regulations:— 1.—Public Health Act, 1925—Certain sections adopted (v. p. 15). 2.—Public Health (Smoke Abatement) Act, 1926. 3.—Births and Deaths Registration Act, 1926. This Act came into force on 1st July, 1927, and requires, inter alia, the registration of still-births. 4.—Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Scheme submitted by the Wimbledon Borough Council for the treatment of such cases has been approved by the Ministry of Health. 5.—Public Health (Infectious Diseases) Regulations, 1927. These regulations amend the procedure in 7 relation to certain cases of Pneumonia, Malaria and Dysentery. 6.—New Bye-laws (v. p. 15). (e) Other Administrative Measures:— 1.—Mosquito Control:—Early in 1927, a meeting of representatives of the different Local Authorities in the County of Surrey was held under the auspices of the Surrey County Council to discuss measures to be taken for the control of the mosquito pest. In this matter the Wimbledon Borough Council has always taken an active and leading interest, but no measures were arranged for conjoint action. 2.—Isolation Hospital:—Admission of overflow cases from Caterham Military Hospital was arranged during the outbreak of Diphtheria. 3.—Examination of Employees:— During the year 1927, 152 employees were medically examined by the Medical Officer of Health. Natural and Social Conditions of the Area. Area (acres) 3,173 Population (Census, 1921) 61,700 Population (Estimated, 1927, R.G.) 58,150 Number of inhabited houses:— 1921 11,926 Number of families or separate occupiers:— 1921 13,998 Rateable Value:—£517,639. Sum represented by a penny rate:—£2,070. Social Conditions:—v. Annual Report, 1025. Extracts from Vital Statistics of the Year (1927). (Registrar-General's Figures). Total. M. F. Births (Legitimate 688 344 344 Birth Rate (R.G.) 12.3 1 Illegitimate 29 14 15 Deaths 620 316 304 1 Death Rate (R.G.) 10.6 Number of women dying in, or in consequence of, childbirth from sepsis 1 do. do. other causes 1 Total 2 8 Death-rate of Infants under one year of age per 1,000 births 50 Number of deaths of infants—legitimate 32 „ „ „ —illegitimate 4 Total 36 Deaths from Measles (all ages) — „ „ Whooping Cough (all ages) 3 „ „ Diarrhoea (under 2 years of age) 2 Vital Statistics for 1927 (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 16.7 12.3 69 107 Great Towns ... 17.1 12.2 71 155 Smaller Towns 16.4 11.3 68 LONDON 16.1 11.9 59 WIMBLEDON 12.3 10.6 50 BOROUGH OF WIMBLEDON. Population, Birth and Death Rates for each Ward, 1927. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6754 8.7 9.4 Wimbledon Park 3.88 4450 12.8 8.9 St. John's 4.77 5192 5.5 12.7 Cottenham Park 4.33 7053 8.3 12.6 North Wimbledon 4.36 23449 8.6 11.04 Dundonald 5.15 7666 15.1 11.08 Trinity 5.59 11636 15.2 11.5 South Park 4.63 8550 11.1 8.4 Haydon Park 5.47 6849 18.3 10.2 South Wimbledon 5.21 34701 14.7 10.4 Whole District 4.83 58150 12.3 10.6 9 Births:— The number of births registered in the district was 671 (344 males and 327 females), a decrease of 51 against last year, and equal to a birth-rate of 11.5 on a population of 58,150. The corrected birth-rate produced by transferable births notified to us by the Registrar-General, is 12.3. 29 (or 4.04 per cent.) of the births were illegitimate. Notification of Births Acts, 1907 and 1915. During the year, 638 births were notified by the following persons:—Parents, 65; Midwives, 428; Doctors, 64; other persons, 81. Ten notifications of still-births were received. Deaths:— The total number of deaths registered in the district was 494 (231 males, 263 females), equal to a death rate of 8.4 per thousand of the population (R.G.) per annum. The deaths occurring outside the district, of persons belonging to this Borough, were 219, viz.:— Kingston and District General Hospital 109 Brookwood Asylum, Woking 3 Nelson Hospital, Merton 22 Others 85 Total 219 The deaths occurring within the district, of persons not belonging thereto, were 93, viz.:— Atkinson Morley Hospital 1 Isolation Hospital 1 North Wimbledon Hospital 16 Others 75 Total 93 Taking those into consideration, the total number of deaths properly belonging to Wimbledon, is 620, and the death rate 10.6. The rate for England and Wales for the same period was 12.3. 10 table showing the births, deaths, and, death-rates in the Borough of Wimbledon in the last five years. 1927 1926 1925 1924 1923 1922 Births 717 807 760 814 868 868 Deaths G20 579 638 645 546 616 Death-rates 106 9.9 10.9 11.1 9.4 9.9 Table II. gives the causes of, and ages at, deaths during 1927. Deaths due to notifiable infectious diseases are given on p. 38. The principal causes of death, apart from Zymotic deaths, are as follows:— Heart Disease 101 Cancer 75 Pneumonia 45 Cerebral Hæmorrhage 40 Tuberculosis (Respiratory) 40 Bronchitis 38 Infantile Mortality:—There were 37 infant deaths during the year (including transferable deaths), giving a rate of 50 per thousand registered births, an increase of 17 per-thousand on last year's figures, when there were 27 deaths and a rate of 33. The infantile death-rate calculated on the RegistrarGreneral's figures, is 50 per thousand births. The infant death rate for illegitimate children was 137 per thousand illegitimate births. The following table shows the causes of death, and ages at death, of Infants under one year:— 11 Infant Mortality during the year 1927. (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. j 6-9 Months. 9-12 Months. Total Deaths under One Year. Congenital Malformation 1 1 - - 2 1 — — 3 Congenital Debility,—Prematurity, etc 7 4 1 1 13 — 1 — - 14 Want of Attention at Birth 2 - - - 2 1 - — - 3 Accidents in Infancy - - - - - - - 1 1 2 Respiratory Diseases 1 1 2 — 4 — 1 2 — 7 T.B. General and Meningitis — — - — — — — — 2 2 Infective Enteritis - - - - - - - 1 - 1 Whooping Cough - - - - - - - 1 — 1 Other Conditions,- Erysipelas, Intussusception, etc - - - - - - 2 1 1 4 Total 11 6 3 1 21 2 4 6 4 37 The infantile death-rate for 1927 shows a considerable increase over 1926, which was the lowest rate recorded for Wimbledon. Of the 37 infant deaths, 6 were premature—3 at the 6th month and 3 at the 7th. Of these premature cases, 2 were twin pregnancies, of which only one infant survived. In addition to these cases one infant was found "dead." one died of "want of attention at birth," 3 had congenital defects with which they could not have lived, and 2 infants were born "precipitately." These cases unfortunately increase a rate which otherwise would call for little remark. Poor Law Relief.—The following information has been furnished by the Clerk of the Kingston Union respecting Poor Law Relief in this District:— 12 £ s. d. Amount paid in Out-door Relief in 1927 11,546 12 0 Average weekly number of persons in receipt of relief 528 Number of persons admitted to the Guardians' Institution from Wimbledon area 446 General Provision of Health Services in the Area. (a) Hospitals provided or subsidised by the Local Authority or by the County Council:— (1) Tuberculosis—Crooksbury Sanatorium, under the Surrey County Council. (2) Maternity—None. (3) Children—see Hospitals for area (b). (4) Fevers—Isolation Hospital, Gap Road, Wimbledon Borough Council, 105 beds. (5) Small-pox—Cheam Small-pox Hospital, Surrey, Croydon and Wimbledon Joint Board and Surrey Small-pox 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. 13 (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, Pelham 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 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. There are 8 Maternity Homes registered in Wimbledon, under the Surrey County Council Act, 1925. All were visited during the year by the Medical Officer of Health and were found to be conducted satisfactorily. MORTUARY. From information received from the Superintendent of the Cemetery, there were 74 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 43 bodies, equal to 8.7 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. 14 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. (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. (Sections to, be amended:—50, 51, 52, 53, 57, 58, 60, 75, 76, 80, 91, 101, 102, 110). Public Health Act, 1925. Part II. (Streets and Buildings)—Sections 13. 14, 15, 16, 17, 18, 19, 21, 23, 24, 25, 26, 27, 28, 30, 31, 32, 33, 34, 35. Part III. (Sanitary Provisions)—Sections 41, 43, 44. Part IV. (Verminous Premises, etc.)—Sections 45, 46, 47, 48, 49, 50. Part V. (Watercourses, streams, etc.)—Sections 51, 52, 53, 54, 55. 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. 15 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. Bye-laws for the Management, Use and Regulation of Public Baths. Bye-laws under Advertisements Regulations Act, 1907. Bye-laws with respect to the Fouling of Footways by Dogs. Regulations as to Underground Sleeping Places (Section 18 [i]) Housing Act, 1925. Regulations with respect to Dairies, Cowsheds and Milkshops. The Public Health (Meat) Regulations, 1924. Provisional and, other Orders affecting the Borough:— Croydon & 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 OF THE AREA. The following information is supplied by the Borough Surveyor, Mr. J. Bowen:— General Sanitary Conditions of the Area—Good. Refuse Removal:—The Corporation have three motor lorries in use and two on order which are expected very shortly. The adoption of these vehicles has proved to be a marked success, both from a sanitary and economical point of view. Housing, under Municipal Schemes:—During the past year 60 houses of the non-parlour type have been erected in concrete for the Corporation, by the Triangular Construction Company of East Molesey. These have been sold under the Small Dwellings Acquisition Act for £500 each. Instructions have been given for additional houses as follows:— Number 5:—On the Birkbeck Road site. These will be of the Parlour Type and somewhat larger than those mentioned above. Number 24:—On the Durnsford Road site. These will be similar to the 60 previously erected but will be built of brick instead of concrete. An additional site has been arranged for in Durnsford Road, upon which it is hoped to build a further 60 or more houses. Progress of Day Nursery, etc.:—Plans, specifications and bills of quantities have been prepared by the Borough Engineer and Surveyor for the erection of a new Day Nursery in Habert Road to accommodate twenty-five infants and twentyfive toddlers. The building will be of two stories except the large rooms provided for the children, which will be covered with concrete and asphalte flats. Provision is also made for a Doctor's, Committee and Isolation Rooms, W.C's., Bathrooms, Laundry, Kitchen and Scullery on ground floor, with a spare bedroom which could be used as an Isolation Ward or Emergency accommodation, if required. Access is made from this floor to the asphalte flats already mentioned, which could thus be used for playground or open-air treatment, if required. The building is now in course of erection and it is hoped to have possession early in May. 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 1927, as reported by the Sanitary Inspector. 17 Reason of Visit. No. Infectious Disease 590 House Inspections 2,342 House to House Inspections 3,620 Rent Act Inspections 41 Houses Let in Lodgings; Inspections 52 Inspection of Factories, Workshops, Workplaces and Out-workers' Premises 80 Common Lodging Houses; Inspections 17 Dairies and Cowsheds; Inspections 136 Inspections under Shop Acts 1,503 Application of Tests to Drains 215 Inspections under Diseases of Animals Acts 179 Obtaining Samples of Foods and Drugs 11 Miscellaneous (including Inspections of Food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,480 10,266 One thousand three hundred and three preliminary or informal notices were served in respect of 1,330 houses. One hundred and fifteen statutory notices were served in respect of 130 houses. The necessary work was executed in all but 206 cases, which were not completed by the end of the year. In 107 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 28 3 — Workshops 39 5 — Workplaces 13 — — Total 80 8 — 18 DEFECTS FOUND. NATURE. Number of Defects. Proseoutions. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 4 4 — — Want of Ventilation 1 1 — — Other Nuisances 2 2 — — Sanitary Accommodation— Insufficient — — — — Unsuitable or Defective 3 1 — — Not Separate for Sexes — — — — Other Offences 2 2 — — Totals 12 10 — — HOME WORK. Lists received:— Twice in the year 8 Number of Out-workers 46 Once in the year 1 Number of Out-workers 4 Number of addresses received from other Councils 46 Number of addresses forwarded to other Councils 8 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 13 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 59 Dressmaking 56 Bakehouses (including four Factory Bakehouses) 27 Laundries 32 Tailoring 33 19 Millinery 16 Dining Rooms 20 Motors and Cycles 36 Builders' Yards 48 Underclothing 8 Other trades 143 478 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 1 Action taken in matters referred by H.M. In-spector as remedial under the Public Health Acts. Notified by H.M. Inspector Reports of action 4 taken sent to H.M. Inspector 4 Underground Bakehouses in use at the end of the year 3 20 Borough of Wimbledon. Sanitary Department. ANNUAL. REPORT OF THE SANITARY INSPECTOR FOR THE Year ended 31st December, 1927. 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, 1927. Table III. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—One thousand three hundred and three Preliminary Notices or intimations were served during the year in respect of 1,330 houses. It was found necessary to serve 115 Statutory Notices upon the owners or occupiers of 130 houses. Six hundred and forty-four letters, respecting 748 houses, were received through the Town Clerk's Department, and answered, enquiring if any sanitary notices were outstanding with respect to properties for which negotiations for sale were in progress. 21 Legal Proceedings.—Legal proceedings were instituted in the following eases with the results stated:— 1.—For wilfully obstructing drain. Fined Forty Shillings and Three Guineas Costs. 2.—For failing to comply with Notice to Abate Nuisance. Case dismissed on payment of Two Guineas Costs and owner giving written undertaking to immediately comply with Notice. 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 two houses, 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 instruction requiring the reconstruction or amendment of the defective drains, etc., as the circumstances required. It was unnecessary in thirteen 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 6 houses have been enlirely reconstructed, extensive amendments or repairs were carried out at 56 houses, and at 14 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 620 houses. The following list shows the particular streets, and the number of houses inspected in each. A list of the work carried out at the houses is included in Table III., p. 32. Newton Road 33 William Road 32 Trevor Road 17 Goodenough Road 31 Cochrane Road 30 Dundonald Road 55 Hartfield Crescent 85 Beulah Road 2 22 Palmerston Grove 21 Hotham Road 84 Wandle Bank 33 Grove Road 33 Quicks Road 82 Cowper Road 82 620 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, 751 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.—I regret I am unable to report any improvement with respect to overcrowding. Conditions are, if anything, more unsatisfactory and more houses which were formerly occupied by one family are now being let off to two, three and four families at, what must be described as, exorbitant rents, and with inadequate sanitary arrangements, as that which was efficient and sufficient for one family is far from satisfactory now and is the cause of an amount of feeling by the tenants having to use sanitary and washing conveniences in common. Underground Dwellings.—This matter has caused the Department no little concern during the year in view of the fact that in consequence of overcrowding a number of persons have been found to be' occupying rooms in some cases entirely underground and in others so much below the ground as to become cellar dwellings as defined by the Public Health Acts. In one case a person suffering from Tuberculosis was found to be occupying an underground room, the only means of ventilation being by a window, which opened directly into a food shop. In this instance, notice was immediately served, and the room was closed without the necessity of legal proceedings being instituted. In another case the basement of a shop formerly used as a store-room had been partitioned and made into two rooms which were used as bedrooms. The walls were damp and the only natural lighting was by means of a small opening under the shop window. This part was occupied by two separate families. There are several other almost similar cases where large houses have been let out to several families and in each case the basements have been let as distinct from other portions of the house. 23 Under the Public Health Act, 1875, the Regulations regarding cellar dwellings only apply if the cellar is let separately; if it is let with rooms in any other part of the house we cannot bring it under this Act, but the Housing Act, 1925 gives additional powers, one of which is the making of Regulations under Section 18. The matter was fully reported to the Public Health Committee and, after discussion, it was decided to make the necessary Regulations and apply to the Ministry of Health for sanction. This has been done and as soon as the Regulations have been approved, action will immediately be taken with regard to the cases already mentioned and any others which may come to the notice of the Department. Houses Let in Lodgings.—There are 67 of these houses on the Register, and 52 visits of inspection were made during the year, to ensure that the Bye-laws were being observed. Verminous Rooms.—During the year 23 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 is now only one registered Common Lodging House, namely No. 42, Merton High Street, for which an annual Certificate of Registration was granted from 1st January. 1927 to 31st December, 1927. On 1st January, 1927, an annual Certificate of Registration was granted in respect of No. 188, Merton High Street, but on the 28th February, the premises were closed, having been purchased for the purpose of an entirely different business. The Certificate was accordingly cancelled on the 15th March. Van Dwellings.—This matter is still continuing to receive the attention of the Department and visits have been made at irregular times, but the consent of the Ministry of Health to the adoption of certain Clauses of the Public Health Act, 1925, authorising the Council to make Bye-laws has not yet been given. Dairies, Cowsheds and Milkshops.—Thirteen applications were received during the year from persons desirous of being registered under the Milk and Dairies (Consolidation) Act, 1915, the Milk and Dairies (Amendment) Act, 1922 and the Milk and Dairies Order, 1926. 24 One hundred and thirty-six inspections have been made of the premises of dairymen and purveyors of milk in the district, during which five matters were discovered which required to be dealt with by the Department. Infectious Disease and Disinfection. During the year, visits for the purpose of investigating cases of notifiable infectious disease were made to 275 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 27 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 512, and the number of articles, bedding, wearing apparel, etc. 11,037, full details of which are given in the Report of the Medical Officer of Health under the heading of "Disinfection." School Disinfection.—With the exception of one school and two departments of another school, 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, 81 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, 33 visits having been made to such premises during the year. 25 Inspections under the Factory and Workshop Act, 1901.— There are 478 factories, workshops and workplaces on the Register, to which 82 visits of inspection were made. Six written noticcs were served, referring to sanitary conveniences and other nuisances. At the end of the year a revision of these premises was in progress. Shops Acts, 1912-1913.—One thousand five hundred and three visits were made to the occupied shops in the district for the purpose of observing contraventions of the Acts. In two cases legal proceedings were instituted as under: 1.—Against a firm for failing to close four of their shops on the usual weekly half-holiday. Fined Five Guineas (including Costs). 2.—For failing to close shop at 8 p.m. on a Sunday. Fined One Pound (including 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, 1927, inclusive. As is usual, this did not relieve occupiers of the obligation to comply with the weekly half-holiday order in force in the district, and, as a result, numerous questions as to the position of local shopkeepers 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. One hundred and eighty-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. The following is a list of organs, etc. condemned and destroyed, together with the cause for such action:— 1 Sheep's Liver Caseous Lymphadenitis. 1 Sheep's Lungs Strongylus Rufescens. 1 Sheep's Pluck 1 Pig's Liver Echinococcus Cysts. 13 Ox Livers (183-1bs.) Flukes. 4 Pig's Plucks Pneumonia. 26 2 Ox Livers 1 Sheep's Pluck 1 Pig's Pluck 1 Leg of Pork Abscesses. 1 Ox Liver (16-1bs.) Cirrhosis. 1 Pig Inflammation. 1 Heifer (688-1bs.) Peritonitis. Generalised T.B. 1 Ox Liver (14-1bs.) Tumours. In addition, 248 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:— 4 Loins Pork (64-1bs) Putrefaction. Beef (57-1bs.) Bone Taint. Rump Steak (Foreign Meat) Cysticercus Bovis. 1 Lamb (New Zealand) Bone Taint. 2 Boxes Pineapples (32) Mildewed. 1 Box Mackerel Unsound. 2 Stone Skate Unsound. Sale of Food and Drugs Acts, 1875 to 1907.—Fifteen preliminary or test samples of milk and one of sugar were examined by the Council's Analyst, fourteen of which were genuine, one being adulterated or inferior and another slightly inferior or deteriorated. With regard to the one which was adulterated or inferior, it was found to have been issued by a dealer outside the district, and information was transmitted to the Inspector in charge of the district concerned. Petroleum Acts.—Seventy-one applications were received for permission to keep petroleum, 66 being for the renewal of existing licences, and 5 for new ones. Three hundred and sixty-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. 27 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. Legal proceedings were instituted against a garage proprietor for wilfully turning or permitting to enter the sewer petrol, oil or other deleterious substance. The case was dismissed, the Magistrates not being satisfied that the action was wilful on the part of the owner, but that it had been committed by a servant without the knowledge of the proprietor. Diseases of Animals Acts, 1894 to 1925. Swine Fever.—No outbreak of this disease was notified in the district during the year, but the district was included in the Restricted Area during one or two outbreaks and, in consequence, a number of mavement licences were issued. On the 18th November, information was given to me that a pig was found dead in a cattle truck on the railway siding. On investigation I found that the animal was one of a consignment of fifty-six sent from Wales the previous day. This particular animal was examined by a veterinary surgeon at one of the stations en route and placed in a separate truck. I immediately examined the carcase and, in view of its condition, reported the circumstances to the Council's Veterinary Surgeon who made an inspection and decided that a post mortem examination would be necessary. I conveyed the carcase to his surgery where the cause of death was found to be inflammation of the stomach. I had previously taken details of the other animals and their destination, which was a local slaughter-house. 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 28 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 of doubt, advice has been sought and freely given. 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 and 1923.—Under these Acts seven applications were received from occupiers of premises requesting that inspections be made, as in their opinion the owners had failed in their obligations. In each case, a complete survey of the house, both internal and external was made, and a notice prepared specifying the works to be executed in order to make the premises in all respects reasonably fiti 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. In three cases the certificates were subsequently issued as the work required to be done had not been satisfactorily executed. In one case where a Certificate had been issued to the tenants the owner had the necessary work executed and then applied for a Certificate that the premises were, at that time, in a reasonable state of repair. After considering the report, the Local Authority granted the Certificate. Two cases were still being dealt with at the close of the year. 29 1 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 case be the subject of legal proceedings. Water Supply.—The water supply was withdrawn from 39 houses during the year for the following reasons—4 by request, 29 owing to arrears of rates, and 6 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 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, carried 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 pupose of gain or reward or not) for, or in connection with the employment of persons in any capacity. 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. 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. 30 The major portion of this work is done before and after office hours and on Sundays and public holidays. As a result of reports to the Education Authority proceedings were instituted against a man for employing a boy in contravention of the Bye-laws in respect of two days, and he was fined twenty shillings in each case. I would mention that this particular offender had been warned on a number of occasions, but failed to appreciate the seriousness of his offence. Fouling of Footways by Dogs.—The Bye-laws made by the Borough Council in this matter were confirmed by the principal Secretary of State for the Home Department and came into operation in April. Considerable time has been devoted to work in connection with these Bye-laws in the evenings when the offences are most prevalent and many offenders have been warned. One of the chief evasions of the Bye-law is that immediately the dogs are brought outside the premises they are released from their leads thus bringing them outside the control of the Bye-laws. 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. 31 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 30 Cisterns provided 1 Cisterns repaired, cleansed or covered 89 Drains, new, provided 6 Drainage systems made water-tight by patent process 14 Drains, repaired or altered 56 Drains, stoppages removed 75 Dustbins provided 115 Flushing cisterns, new, provided 51 Flushing cisterns repaired 110 Manure receptacles provided 2 Overcrowding nuisances abated 6 R.W. pipes disconnected 10 Roofs repaired 227 Rooms stripped and cleansed 883 Verminous rooms cleansed 9 Soilpipes, new, provided 14 Soilpipes, repaired or altered 13 Vent pipes, new, provided 20 Vent pipes, repaired or altered 39 Waste pipes, new, provided 71 Waste pipes repaired, disconnected or trapped 60 Water-closets, new, provided 72 Water-closets, repaired or ventilated 8 Water services restored 39 Yards paved 11 Yards repaired 70 Guttering repaired 180 Floors ventilated 15 Nuisances abated from damp walls 181 Water supply direct from main 6 Sinks provided 41 Rooms fumigated 512 Other nuisances 2215 5,251 32 MEDICAL OFFICER'S REPORT —Continued from p. 20. Housing Statistics for the year 1927. Number of new houses erected during the year:— (a) Total, including (b), (i), (ii) 234 (b) With State Assistance under the Housing Acts— (i) By the Local Authority 60 (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) 1543 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 620 (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 1136 II.—Remedy of defects without service of Formal Noticcs. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 843 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 33 (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 130 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 87 (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, 22 dairymen, 31 dairymen and purveyors, and 8 purveyors on the Registers on 31st December, 1927, 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 Supplementary 3 34 (3) No licences were refused or revoked. (4) Bacteriological examinations:—All samples satisfactory. (b) Meat:—See Sanitary Inspector's Report (p. 29). SLAUGHTER HOUSES. In 1920. In Jan. 1927. In Dec. 1927. Registered 4 2 2 Licensed 1 — — Total 5 2 2 (c) Other Foods:—See Sanitary Inspector's Report (p. 27). PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The incidence of infectious diseases in the area continues to be low. 169 cases of Scarlet Fever and 52 cases of Diphtheria were notified, of which 142 and 48 respectively were removed to the Isolation Hospital (v. Report on Isolation Hospital). Outbreaks of influenza, whooping cough and chickenpox occurred early in the year but never reached serious proportions. Smallpox:—In March, 1927, one of the medical practitioners of the borough asked me to visit a case of suspected Smallpox. The patient was the surgeon of a liner from which a case of virulent smallpox had been transferred at Gibraltar on the voyage from India. I diagnosed smallpox and the diagnosis was confirmed bv the County Medical Officer and by Dr. Wanklyn, L.C.C. The routine measures were taken to prevent spread of infection. The patient was transferred to the Clandon Smallpox Hospital, Surrey County Council, and the house and clothing were thoroughly disinfected. All contacts were visited and revaccination was carried out. Contacts were kept under observation throughout the period of quarantine. The vaccination officer, public vaccinators, medical practitioners of the area, and neighbouring authorities were informed as well as the Ministry of Health. I was called out in consultation to several other suspect cases during the quarantine period, but no fresh cases were discovered. The fact that the patient was a medical man who had revaccinated himself immediately after exposure to 35 tion and had exercised strict precautions throughout his own quarantine period, had much to do with the successful limitation of the outbreak. Observation over "contacts" removing into Wimbledon from other areas in which smallpox was prevalent has also been strictly carried out during the year, but no other cases have developed within the Borough. Typhoid Fever and Paratyphoid:—There was a slight increase in the number of cases notified during 1927—4 cases of typhoid and 7 paratyphoid "B" cases. No source of infection could be traced in any case, and there was certainly no possibility of one case having infected another. Three of the cases had been on holiday shortly before notification. Puerperal Fever and Pyrexia:—One case of puerperal fever and 9 cases of puerperal pyrexia were notified, of which the case of fever and 3 cases of pyrexia were removed to hospital. A case of true scarlet fever developing Puerperal Fever was admitted to the Wimbledon Isolation Hospital (v. Hospital Report.) Under the new Regulations the medical practitioner in charge of such cases may either order the removal of the patient to hospital or may continue domiciliary treatment and ask the Local Authority to provide obstetric and bacteriologist consultants. In Wimbledon the former course has always been adopted, and no requests for assistance otherwise have been made. Encephalitis Lethargica.—Two cases were notified and one (mild in type) was admitted to hospital. "Return" cases of Scarlet Fever:—v. Hospital Report. No cases of malaria, dysentery or trench fever were notified. Control of Infectious Outbreaks:—In connection with outbreaks of infectious diseases many local authorities, advised by their medical officers, are placing less importance than formerly on the value of chemical disinfection of the home. Some, indeed, have abolished disinfection in many of the milder diseases, and rely entirely on a thorough soap and water cleansing and "flushing" of rooms by fresh air. Much depends on the views that the medical officer holds in regard to the way in which these diseases are spread and carried. The arranging of disinfection is occasionally a matter of some difficulty, more especially in these days of overcrowding when families occupy only one room in a house. 36 During outbreaks of infectious diseases in schools many requests are received by the Public Health Staff from Head Teachers for classrooms to be disinfected. In this connection the "Memorandum on the Closure of and Exclusion from School "issued jointly by the Ministry of Health and the Board of Education—a copy of which is in the hands of each Head Teacher—contains the following points which might be quoted:— "There is little doubt that infection in Schools is spread to a much greater extent by infectious persons than by infected things, and that by systematically obtaining the information as to infectious cases and by adopting the measures of exclusion of patients and of recent 'contacts' with them the common source of infection can be controlled." "Disinfection of special classrooms or of particular articles should be undertaken when there is reason to believe that these have been infected." "The frequent and thorough washing of classrooms and cloakrooms is an efficient means of removing both dust and infection." These quotations are given to show that each outbreak must be considered individually, that disinfection is not always necessary, and, indeed, may be wasteful, more especially if carried out at the wrong time. Reference must also be made to one other preventive measure on which too much value is occasionally placed, namely, the swabbing of "contacts" in school when a case of diphtheria occurs. This swabbing of throats and noses is undoubtedly useful if cases continue to crop up in some particular classroom, but the discovery of bacteriological " carrier " cases should always be followed up by having a virulence test made of the germ found. 37 38 TABLE A.—NOTIFIABLE DISEASES—1927. 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 52 1 2 2 4 21 11 3 3 3 1 1 48 Deaths — — — — — 1 1 — — — — — 2 .03 Scarlet Fever Notified 169 — 5 3 11 9 80 32 11 12 5 1 — 146 Deaths — — — — — 1 — — — — — — 1 .01 Enteric Fever Notified 4 — — — — — — 1 1 2 — — — 4 Deaths — — — — — — — — — — — — — — Puerperal Fever Notified 1 — — — — — — — — 1 — — — 1 Deaths — — — — — — — — 1 — — — 1 .01 Pneumonia Notified 51 2 2 2 1 — 7 3 3 10 6 14 1 2 Deaths 5 4 — — — 1 — 1 2 2 9 21 45 .7 Erysipelas Notified 24 1 — 1 — — — — 2 4 3 9 4 4 Deaths 1 — — — — — — — — — 1 — 3 .05 Encephalitis Lethargica Notified 2 — — — — 1 1 — — — — — — 1 Dentin — — — — — — — — 1 — 2 — 3 .05 Cerebro-Spinal Meningitis Notified 2 — 1 — — — — — 1 — — — — 2 Deaths — — — — — — — — — — — — — — Ophthalmia Neonatorum Notified 4 4 — — — — — — — — — — — 1 Deaths — — — — — — — — — — — — — — Smallpox Notified 1 — — — — — — — — — — 1 — 1 Deaths — — — — — — — — — — — — — — Puerperal Pyrexia Notified 9 — — — — — — — — 6 3 — — 3 Deaths — — — — — — — — — — — — — — Para Typhoid Notified 7 2 — 2 1 — 1 1 4 Deaths — — — — — — — — — — — — — Tuberculosis Notified 75 3 — — 1 1 5 6 5 25 14 13 2 40 Deaths 2 — — 1 — — 2 4 19 9 7 3 47 .8 Totals Notified 401 11 10 6 15 15 116 53 28 64 34 40 9 257 Deaths 8 4 1 1 — 3 3 5 23 11 19 24 102 1.7 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. 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 1927 .94 — .01 .03 — .05 — .03 .8 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 1927, 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. St. Mary's Ward. Wimbledon Park 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) 52 2 5 1 6 6 15 11 6 48 Erysipelas 24 2 5 — 2 1 7 3 4 4 Scarlet Fever 169 6 15 10 9 25 41 30 33 146 Enteric Fever 4 — — — 1 — 1 2 — 4 Puerperal Fever 1 — — — — — 1 — — 1 Cerebro-spinal Meningitis 2 — — — — — 2 — — 2 Pulmonary Tuberculosis 56 8 3 5 8 1 16 9 6 37 Other forms of Tuberculosis 19 2 3 1 2 2 2 2 5 3 Ophthalmia Neonatorum 4 — — — — — 2 — 2 1 Encephalitis Lethargica 2 — — — — 1 1 — — 1 Pneumonia 42 3 3 1 1 8 10 7 9 2 Influenzal Pneumonia 9 1 — — 2 2 2 1 1 — Small Pox 1 — — 1 — — — — — 1 Puerperal Pyrexia 9 2 — — 2 1 2 1 1 3 Para-Typhoid 7 2 — 1 1 1 1 1 — 4 Totals 401 28 34 20 34 48 103 67 67 257 39 Scarlet Fever.—The total number of cases notified during the year was 169 from 142 houses. The attack rate was 2.9 per thousand of the population. There was one death. Attack-Rate. Death-Rate. 1891-1895 4.8 .02 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 per thousand of the population. In five houses there were three cases, in seventeen houses two cases, and in the remaining 120 houses, one case. 143 or 85 per cent. of the cases were treated in the Borough Isolation Hospital, Gap Road. 68 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 112 attended the following schools:— Cottenham Park, Mixed 1 Effra Road Girls' and Infants' Schools 21 Durnsford Road Mixed and Infants' Schools 20 Queen's Road Girls' and Infants' Schools 5 Queen's Road Boys' School 5 Pelham Road Boys' School 4 Pelham Road Girls' and Infants' Schools 12 Dundonald Road Boys' School 2 Dundonald Road Girls' and Infants' Schools 3 Russell Road Mixed School 2 Russell Road Infants' School 1 Haydons Road Girls' School 5 Haydons Road Infants' School 6 Haydons Road Boys' School 1 Private Schools 11 Schools outside the district 13 Total 112 Diphtheria:—The total number of cases notified during the year was 52 from 44 houses. The attack-rate was .8 per thousand of the population. 40 In one house there were four cases, in five houses two cases, and in the remaining thirty-eight houses, one case. There were two deaths. 48 or 92 per cent. of the patients were treated in the Isolation Hospital. 65 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 32 attended the following schools:— Cottenham Park Mixed and Infants' 2 Haydons Road Boys' 2 Russell Road Infants' 1 Queen's Road Girls' and Infants' Schools 2 Haydons Road Girls' and Infants' Schools 4 Pelham Road Infants' School 4 Effra Girls' and Infants' 7 Queen's Road Boys' 2 Pelham Central 1 Private Schools 2 Schools outside the district 5 Total 32 Tuberculosis.—The administrative control of Tuberculosis is placed under the County Medical Officers, but District Medical Officers are also required to keep special registers under the Tuberculosis Regulations. The difficulties of accurate keeping of such registers and of securing some uniformity between the Registers of the County and District Medical Officers are well known. During 1927, the Surrey County Medical Officer has been endeavouring to obtain greater accuracy in records and for this purpose furnished lists of cases on his registers to the District Medical Officers. The final adjustment of registers has still to be made, but it is apparent that there are considerable discrepancies. In actual numbers the errors did not appear to be great, but a comparison of lists of actual cases showed that 65 names were on the Central list which were not on the District list, and 73 cases were on the District list which were not on the Central register. Thus while the totals only differed by 8 cases, the actual difference was 138. These errors had arisen through "transfers" from other areas, change of address, and cases classified as "cured." Of the lists as given by the County Medical Officer the numbers within the Wimbledon area might be classified as follows:— 41 LIST A. Pulmonary. Non-Pulmonary. Stales 162 49 Females 160 38 Totals 322 87— 409 Allowing, however, for "cures," "removals," etc., the final adjustment will more probably be as under:— LIST B. Pulmonary. Non-Pulmonary. Males 145 33 Females 157 24 Totals 302 57=359 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 2 — — 1 1 — 1— 5 „ — — 1 1 — — 1 — 5 — 10 „ — 3 2 — — — — 10 — 15 „ — 1 3 2 — 1 — 1 15 — 20 „ 3 2 — — 2 2 — — 20 — 25 „ 7 5 — — 5 2 1 — 25 — 35 „ 5 7 1 — 7 3 1 — 35 — 45 „ 6 7 1 — 5 3 1 — 45 — 55 ,, 8 2 — — 5 1 — — 55 —65 „ 2 — — 1 1 — — — 65 upwards 1 — — 1 2 — — 1 Totals 32 25 11 7 27 13 5 2 42 Public Health (Prevention of Tuberculosis) Regulations 1925, Public Health Act 1925, Section 62:—No action was necessary either in regard to Tuberculous employees in the milk trade or in regard to persons suffering from pulmonary tuberculosis who required compulsory removal to hospital. Of the 40 deaths from Pulmonary Tuberculosis, 20 died outside the district (12 males and 8 females), i.e., notification of death was transferred to Wimbledon. Of the 7 Non-Pulmonary deaths, 3 males and 1 female died outside the district. Of the 7 non-Pulmonary Tuberculosis deaths, 3 were due to Meningitis, 2 to Peritonitis, and one each to Spine and Enteritis. LABORATORY WORK. The Municipal Laboratory was re-opened towards the end of March 1927 (v. p. 5). The work undertaken consisted of the examinations of nose and throat swabs of patients in the Isolation Hospital, of "contacts" in certain public elementary schools, and of a few isolated "contacts." 1048 examinations had been made by the end of 1927 by the medical staff. Bacteriological examinations of pathological specimens and the use of antitoxin were first undertaken in the Wimbledon area about 1896. The number of specimens of throat swabs, sputum and blood submitted by the general practitioners of the Borough to Mr. J. H. Johnston, M.Sc., F.I.G., 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. 43 Bacteria Found. Bacteria Not Found Total. Diphtheria Secretion 56 397 453 Phthisis (Sputum) 10 99 109 Pus — 4 4 Reaction Obtained. Reaction Not Obtained. Total. Typhoid (Blood) 10 54 64 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. 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 487 187 62 763 1073 75 67 3740 251 6705 Diphtheria 118 48 25 215 266 19 14 877 63 1645 Typhoid Fever 14 13 1 38 43 1 1 128 6 245 Erysipelas 8 5 3 27 34 1 — 49 10 137 Tuberculosis 38 26 13 133 104 11 5 191 88 609 Cancer Pneumonia and 14 4 5 50 33 1 — 46 25 178 Influenza 10 1 2 34 18 — — 11 5 81 Encephalitis Lethargica 2 2 6 7 — — 5 2 24 Vermin 2 1 1 5 13 — — 4 14 40 Sundries 100 28 10 243 230 13 7 694 48 1370 Totals 791 315 124 1514 1821 121 94 5745 512 11037 44 Wimbledon Isolation Hospital. Carried over from 1926 Under 5 years. Over 5 years. Total. Deaths. Remarks. Under 5 years Over 5 years. Total. Scarlet Fever 4 17 21 — — — Daily average number of cases, 39. Diphtheria — 6 6 — — — Cases admitted in 1927. From Wimbledon Scarlet Fever 24 118 142 — 1 1 Scarlet Fever (Staff) — 1 1 — — — Scarlet Fever and Puerperal Fever — 1 1 — — — Average number of days in hospital, 43 Diphtheria 7 41 43 1 1 2 Pneumonia 1 — 1 — — — Typhoid Fever — 4 4 — — — Para Typhoid — 3 3 — — — Erysipelas 1 1 2 1 — 1 Encephalitis Lethargica 1 — 1 — — — From Kingston. Total Kingston cases, 89 Scarlet Fever 4 22 26 — — — Diphtheria 7 56 63 — 1 1 From Caterham. Diphtheria — 15 15 — — — From Merton. Scarlet Fever — 1 1 — — — Total Treated in 1927 49 286 335 2 3 5 During the first half of the year the admissions to the hospital were below the average, but from September onwards the numbers considerably increased. An outbreak of diphtheria in Kingston, and the admission of overflow cases of diphtheria from the Caterham Military Hospital, added greatly to the work in the diphtheria wards without, however, stressing the accommodation. In this connection it should be remembered that the number of beds in the Isolation Hospital (105) actually exceeds the local requirements, and the admission of cases from outside areas is not only a financial advantage to the Borough, but provides better training for the nursing staff. One difficulty, which is experienced in all hospitals at the present time, is in regard to staffing. The regulations and standards for the training of nurses have been raised and the strict training and long hours appear to be deterrents to the best type of nurses coining forward and remaining in the service. 45 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £24,000. 308 cases were admitted to the Wimbledon Isolation Hospital during 1927, making a total of 335 cases under treatment during the year, 27 cases remaining under treatment from 1926. 203 cases were from Wimbledon, 89 from Kingston, 15 from Caterham, and 1 from Merton. Scarlet Fever:—173 cases were admitted as scarlet fever, of which 4 were not scarlet—2 dermatitis, 1 German Measles, and 1 transient erythema. 3 cases were admitted desquamating. 75 per cent. were classed as "mild," 21 per cent. were "moderately severe" and 4 per cent. were "severe." 1 case admitted with cerebral symptoms died (Death rate 0.5 per cent.). 3 cases developed mastoid diseases (2 radical operations and 1 Wilde's operation), and 3 cases developed suppurative adenitis. Three cases of "surgical" scarlet fever (all burns) were admitted from local hospitals and discharged cured. Serum Treatment:—Serum treatment was given to 57 cases which were selected partly by the temperature and partly by the intensity of the rash. Of these 57 cases 46 had temperatures on admission between 100 deg. and 102 deg., and 11 had higher temperatures. In 16 the temperature fell by crisis and all were normal by the fourth day. Of the untreated cases (98) in 50 the temperature was under 100 deg. on admission and in 48 it was between 100 deg. and 102 deg. In 19 an irregular temperature was maintained for about seven days. It is difficult to tabulate the results of this treatment but, briefly, the results may be summarised as follows:— Treated. Untreated. No. of Cases 57 98 Detention in Hospital 4'2 days 44 davs Deaths 1 — All complications 40% 74% Severe complications 5.3% 13% Return cases 5 3 In the above table any discharge from the nose, etc., slight septic spots, etc., were classified as complications (early or late together) and as severe were classed the otorrhoeas, mastoids, late albuminurias and nephritis, suppurative adenitis, arthritis, etc. 46 It can, therefore, be stated that serum treatment quickly reduces the fever and early symptoms, prevents to some extent the development of complications, and shortens the detention in hospital. Diphtheria.—124 cases were admitted notified as diphtheria, of which 6 were not cases—1 broncho-pneumonia, 1 croup and 4 septic tonsilitis. In addition to these, 9 cases were admitted as "bacteriological diphtheria," and 1 case was a double infection of diphtheria and scarlet fever. Of the true cases, 28 per cent. were mild, 52 per cent. were moderately severe, and 19 per cent. were very severe. 3 cases—all of the haemorrhagic type—died—(death rate 3.0 per cent.). 69 per cent. of the cases were uncomplicated; 28 developed signs of paralysis, and 3 cases developed otitis media. Enteric and Paratyphoid Fever:—3 true enteric and 3 paratyphoid B cases were admitted—2 of which were moderately severe. One case, admitted as a doubtful blood reaction to typhoid, ran a typical clinical course, but never gave a true reaction to the enteric or paratyphoids. There were no deaths and no complications. Erysipelas:—Two cases of idiopathic erysipelas were admitted and one—an infant of 10 months—developed general septicaemia and died on the nineteenth day. Encephalitis Lethargica:—One child (4 years) suffered from a mild attack of this disease. Puerperal Fever.—This case was admitted, notified as scarlet fever, with a typical scarlet fever rash, sore throat and tongue. She was isolated throughout in the observation ward as she had been confined three days previously. On the day following admission signs of slight puerperal infection developed and she was treated as a true puerperal case. This case is interesting from the close association between puerperal fever and scarlet fever. There was a distinct history of possible "contact" with scarlet fever shortly before confinement, and the case on admission could undoubtedly be classed as a true scarlet fever case in a woman in her puerperium. Whether there was a secondary infection giving rise to true puerperal fever, or whether there was a primary puerperal infection with an early puerperal rash is a matter of dispute, but the former is possibly correct. No "cross-infections" occurred. 47 Maternity and Child Welfare. Steady progress has characterised this section of public health work and there will be still further progress when the new conjoint clinic is built. It is gratifying to record an increase in the attendances at the Centres, more especially in regard to the Lectures to Mothers and in the Ante-natal Clinic. The value of these two sections cannot be over-emphasised. The thanks of the staff are due to the ladies who so kindly give their voluntary services to what may be termed the social "side of the work, for this establishes contact with the mothers and leads to greater co-operation in the medical side of welfare work. Maternal Mortality:—The crusade at present being conducted to reduce maternal mortality and morbidity should prove of great service, but it must be remembered that results cannot be obtained at once, nor will the only remedy be found in the provision of maternity homes and hospitals. The two deaths of Wimbledon mothers during 19.27 occurred in hospitals where the best attention was given. It is possible that both lives might have been saved had suitable measures been taken before the confinement began, and therein lies the necessity for ante-natal consultations. Education of expectant mothers, with careful medical examinations, are necessary, and the problem is to find some way of inducing all mothers to seek advice beforehand, and not to rely on the notion that the confinement will be a natural and simple process. 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. Hospital. 1 3 1 — — — — There were no deaths from measles, or whooping cough, and no cases of epidemic diarrhoea notified. 48 During 1927, the record of Home Visitation work was as follows:— Number of births notified 638 ,, „ ,, registered 761 Number of births visited 562 ,, ,, ,, re-visited—under 1 yr. 1,619 „ ,, ,, —over 1 yr. 2,324 ,, ,, Still-births and Deaths 15 ,, ,, Ophthalmia cases visited 6 ,, ,, Expectant mothers visited 59 ,, ,, re-visits to expectant mothers 103 ,, ,, ineffectual visits 1,394 ,, ,, Special visits 303 Total welfare visits 6,385 Number of puerperal fever visits 9 ,, ,, tuberculosis visits 75 ,, ,, malaria visits — ,, ,, school visits (half-day) 138 ,, ,, visits to parents of school children 71 6,678 During 1927, the record of work at the Centres was as follows:— Infant Welfare Consultations. Queen's Hall Centre. Wandle Park Centre. Number held 51 50 Total number of attendances 2,728 1,603 Average number of attendances 53 32 Total number seen by Doctor 878 694 Ante-Natal Clinic Consultations. Number held — 17 Total number of attendances — 77 Average number of attendances — 4.5 Classes for Mothers. Number held 47 41 Total number of attendances 1,583 1,370 Average number of attendances 33 33 Subjects taught Home Nursing Infant Care Singing Home Nursing Infant Care Hygiene Mothercraft First Aid Physiology Singing 49 Supply of Milk to Expectant & Nursing Mothers & Infants. 86 families applied for free milk supplies, and it was granted to 72. 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 applications refused. The following work was carried out in connection with the Welfare Centres, by the Dental Surgeon for the year ending December 23rd, 1927. Mothers treated 39 ,, Attendances for treatment 158 ,, Teeth extracted 76 ,, ,, filled 24 ,, other operations 49 ,, Scalings 21 ,, Dentures supplied 26 ,, ,, repaired and re-modelled 4 ,, other Prosthetic operations 95 Babies treated 81 ,, Attendances for treatment 184 ,, Teeth extracted 119 ,, ,, filled 56 ,, other operations 63 Total number of fillings inserted 34 ,, ,, ,, Local Anaesthetics administered 14 ,, ,, ,, General ,, ,, 13 ,, ,, ,, ,, ,, administered (by Dr. Scott), joint 108 South Wimbledon Day Nursery:— The number of children on the register was 57, representing 50 families. The total attendances were 9,433, of which 1,327 were half-day attendances. Daily average, 46. I desire to thank all the members of my staff for their loyal assistance and co-operation on all occasions. 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, 1928. 50 51 TABLE 1.—Vital Statistics of Whole District during 1927 and Previous Years. YEAR. Population estimated to middle of each Year. Births. Total, Deaths Registered in the District. Transferable Deaths Nett Deaths Belonging to the District. Uncorrected Number. Nett. Under 1 year of Age At all Ages. Number. Rate. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Nett Births. Number. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 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 58,000 838 868 14.9 439 7.6 65 172 38 43.7 546 9.4 1924 58,090 763 814 14.01 495 8.5 49 199 59 70 645 11.1 1925 58,170 712 760 13 06 524 9.0 85 199 46 60 638 10.9 1926 58,030 722 807 13.9 479 8.2 83 183 27 33 579 9.9 1927 58,150 671 717 12.3 494 8.4 93 219 37 50 620 10.6 52 TABLE II—Causes of, and Ages at, Deaths during the year 1927. 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. l— 2— 3— 4— 5— 10— 15— 20— 35— 45— 05 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All Causes Certified 619 37 6 2 3 — 8 5 10 39 29 154 326 113 Uncertified 1 — — — — — 1 — — — — — — — Enteric Fever — — — — — — — — — — — — — — Small-pox — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — Scarlet Fever 1 — — — — — 1 — — — — — — 1 Whooping Cough 3 1 — 1 1 — — — — — — — — — Diphtheria and Croup 2 — — — — — 1 1 — — — — — 2 Influenza 24 — 2 — 1 — — — — 3 2 3 13 3 Encephalitis Lethargica 3 — — — — — — — — 1 — 2 — — Meningococcal Meningitis — — — — — — — — — — — — — — Tuberculosis of Respiratory System 40 1 — — — — — 1 4 17 8 7 2 1 Other Tuberculous Diseases 7 1 — — 1 — — 1 — 2 1 — 1 2 Cancer, malignant disease 75 — — — — — — — 1 — 4 31 39 5 Rheumatic Fever — — — — — — — — — — — — — — Diabetes 8 — — — — — — — — 2 — 1 5 — Cerebral Haemorrhage 40 — — — — — — — — 1 — 10 29 23 Heart Disease 101 — — — — — — 2 — — 5 23 66 10 Arterio Sclerosis 30 — — — — — — — — — — 8 22 4 Bronchitis 38 1 — — — — — — — — — 3 34 9 Pneumonia (all forms) 45 5 4 — — — 1 — 1 2 2 9 21 10 53 TABLE II,—continued. CAUSES OP DEATH. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether OP '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 6 — — — — — — — — — — 3 3 — Ulcer of Stomach, or Duodenum 11 — — — — — — — — — 1 5 5 5 Diarrhoea, &c. (under 2 years) 2 2 — — — — — — — — — — — — Appendicitis and Typhilitis 10 1 — — — — 1 — — — 1 4 3 4 Cirrhosis of Liver 5 — — — — — — — — — 1 3 1 — Acute and Chronic Nephritis 14 — — — — — — — — — 1 4 9 2 Puerperal Sepsis 1 — — — — — — — — 1 — — — — Other Accidents and Diseases of Pregnancy and Parturition 1 — — — — — — — — 1 — — — — Congenital Debility & Malformations Premature Birth 16 16 — — — — — — — — — — — 2 Suicide 7 — — — — — — — — — 1 6 — 1 Other Deaths from Violence 21 3 — — — — 2 — 2 — 2 1 11 6 Other Defined Diseases 109 6 — 1 — — 3 — 2 4 — 31 62 23 Causes ill-defined or unknown — — — — — — — — — — — — — — Totals 620 37 6 2 3 — 9 5 10 39 29 154 326 113 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. Giles. * Miss E. M. Skelton. *Mrs. G. M. Street, Resigned April, 1927. *Miss J. E. D. Elder, Appointed April, ]927. Dental Attendant: Miss N. Burges. Cleansing Attendant: Mrs. M. Potts. Clerk: Miss C. Coysh. (b) Part-time Officers: Oculist: F. Moxon, O.B.E., MB., B.S. Anaesthetist: J. C. Scott, M.D. * Maternity and Child Welfare Officers. ‡ Public Health Officers. 54 Borough of Wimbledon. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1927. 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, 1927. The Report has been prepared on the lines suggested by the Chief Medical Officer of the Board of Education in 1920, and in accordance with the Schedule to Form 6M (15th November, 1927). Administration:— (a) Staff:—Mrs. Street, School Nurse—Health Visitor, who resigned in February, 1927, was fortunately able to continue in office until her successor, Miss J. E. D. Elder, commenced duty. (b) Duties:—A slight re-arrangement of the duties of the medical officers was made in April, 1927, to permit the carrying out of bacteriological work (v. Report of Medical Officer of Health). 55 (c) Opening of School Clinics during School Holidays:— During 1927, it was decided, as a result of a review by the Wimbledon Borough Council of the amount of annual leave of officials, that the school clinics should remain open during the school holidays. This opening of clinics during holidays has been tried on previous occasions, but was abandoned as the children failed to attend for treatment. It can quite rightly be contended that the minor ailments and dental defects which require treatment are not due to school environment and that, therefore, treatment is equally necessary during the holidays, but the part played by the school teachers in securing the regular attendance of the scholars at the clinics must not be forgotten. There is also the fact that many children, very naturally, regard their attendance at the Clinics as a pleasant relief from school work, who would look on similar attendance during holidays as a waste of time. Dental treatment by appointment can easily be arranged with the co-operation of parents, but the attendance for the treatment of minor ailments is a different matter and can only be developed by educating the parents. Other work in connection with the scheme can also be suitably arranged during holiday time. (d) Payment Schemes at the Clinic:—In my Annual Report for 1926, the reasons were detailed which led the Committee to adopt an increased scale of payments for treatment given. The results of over one year's working are very gratifying. No case was refused treatment on the grounds of inability to pay, and no complaints were received. The receipts of the Dental Clinic were practically doubled, the numbers treated remaining the same. (1s. 11d. per head as against 1s.). In the Minor Ailments Clinic the receipts show a slight increase from £5 to £5 10s., with an increase of about one hundred children treated. The amount recovered from parents for Tonsil and Adenoid Operations was also increased from the average of 7s. 6d. per head to 11s. per head. (e) Savings Associations:—Agreements have now been made with both the Hospital Savings Association and with the Hospital Saturday Fund, whereby the children of contributors to these Associations are treated for tonsil and adenoid operations on presentation of the Voucher of the Association. 56 This agreement also extends to the provision of spectacles at special terms in the case of the Hospital Savings Association. (f) Ultra-Violet Ray Treatment:— An arrangement was also made with the Nelson Hospital for the Treatment of cases at special rates, if required. (g) Central School—Transfer of Medical Record Cards:— This school, established for the purpose of providing more advanced education for promising scholars from the Wimbledon Public Elementary Schools, was opened in September, 1927, in the Pelham Road School. The children (about 175 Boys and 175 Girls) will be admitted at the age of eleven years and may remain at school until the July following the attainment of 15 years. The Medical Record Cards were transferred within a week of re-opening, but all the children had been recently examined medically. A new Age-period group (14-15 years) for "Routine" medical examinations will be begun this year. (h) New School Clinic and Welfare Centre:— The proposal to erect a new Conjoint Clinic for School Medical purposes and Welfare work, is a result of the benefits derived from the amalgamation of those sections. At present separate premises, not always too suitable, are occupied, and a centralisation will provide more efficient work, and a greater continuity of records. The Wimbledon Borough Council has acquired an excellent site in Pelham Road, close to the position of the Old School Clinics. Plans have been placed before the Ministry of Health and Board of Education, and it is hoped to commence building shortly. At this new Centre, accommodation for the main work of Medical Inspection and Treatment of School Children and the Maternity and Child Welfare work including that at present carried out in Queens Hall, together with a small laboratory will be provided. Provision can be made for extensions later, if required. There are very few Conjoint Centres of this kind at present in existence, but there is no doubt that the principle of having some such scheme (if possible) is the correct one. Co-ordination:—From the above remarks it wall be evident that co-ordination between the different branches of the work and between the different sections of the Public Health Department is steadily advancing with increasing benefit to the work as a whole. 57 The School Medical Service in Relation to Public Elementary Schools. School Buildings:— Heating:—The heating systems have been improved by the provision of new boilers in the following schools:— Dundonald Road School, Pelham Road School, and Queen's Road Manual Training Centre. The heating and electric light installations in the second half of Wimbledon Park School have been completed. Central School:—The Classrooms and staircases of this new school were re-decorated throughout. One classroom in each department was converted into a Science laboratory. Dundonald School:—The old trough water closets were converted into modern single flush closets. Cottenham Park:—Dual desks replaced the old long desks. 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"). The routine inspections at the Special School for Mentally Defective Children are not included in the Tables. Total "Routine" inspections in 1927=1954 (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. The percentages of defects requiring treatment given in Table II. B, Appendix, are higher this year than in previous years. This is due to the fact that children are included this year who were undergoing treatment at hospitals and who had been classed in previous years as "not requiring treatment." 251 (58.6%) of the children actually found to have defects were already receiving treatment. 76% of these 251 children were being treated by private general practitioners and 24% at hospitals. The children requiring observation were practically all cases of chronic nose and throat conditions, defects of vision, lung cases, and a few deformities. 58 (a) GROUP V.—UNCtEANLINESS AND VERMINOUS CONDITION. 1. Average number of visits per school made during the year by the School Nurses 12 2. Total number of examinations of children in the Schools by School Nurses 35,299 3. Number of individual children found unclean 216 4. Number of children cleansed under arrangements made by the Local Education Authority †622 5. Number of cases in which legal proceedings were taken: — a. Under the Education Act, 1921 — b. Under School Attendance Bye-laws - † Includes 406 skin cases. Nine children only out of over 1,954 examinations made by the Medical Officers were noted as verminous (.4%). (b) Minor Ailments:—1,562 children attended for treatment and made 5379 attendances. 52% of these were classed as "miscellaneous" (40% septic sores, 30% minor injuries, and 30% suspected infections), 32% were suffering from various skin diseases, 8% were external eye cases and 8% ear cases. (c) Tonsil and Adenoid Cases:—At the end of 1926, 25 children were awaiting treatment and these with other 76 children were operated on at local hospitals during the year. All these cases are kept under observation for some months after treatment. (d) Tuberculosis Cases:—A register of all known cases is carefully kept, and at the end of each year a copy of the register is sent to the Tuberculosis Officer for checking. Several cases were cured, others had removed out of the district, and at the end of 1927, the numbers were as follows: Active. Arrested. Lungs 0 3 Bones and Joints 7 4 Glands 5 10 Total 12 17 These cases are kept under close observation and all "infective" cases are excluded from schools or sent to special institutions. (e) Skin Diseases:—These cases were practically all treated at the Clinic and bathing of the children is carried out when necessary by the Special Attendant. Only the most obstinate cases of ringworm of the scalp, receive treatment by X-rays. 59 (f and g) Eye Disease and Vision:—A few cases of simple external eye diseases were treated. Four cases were admitted for treatment to the local hospitals under special arrangement with the Education Authority. New Cases, 1st Time 156 Old Cases, lie-tested 236 Re-attendances 517 Total 909 Glasses Supplied. Classification (New Cases) 120 Hypermetropia 89 Myopia 21 Mixed Astigmatism 4 Anisometropia 3 Emmetropia 8 External diseases 24 Not completed 7 Including 14 cases of Squint. Total ... 156 (h) Ear Disease and Hearing:—The great majority of these conditions comprised cases where simple treatment by syringing or ear drops, was all that was necessary. (i) Dental Defects :—Table IV. Group IV. Appendix. There is nothing of an outstanding nature which calls for special report. (j) Crippling Defects and Orthopoedics:—Close co-operation with the local hospitals in the treatment of these defects is maintained. Infectious Diseases:—During 1927, there has been comparatively little infectious disease in the Borough, either of the notifiable or non-notifiable nature. The notifiable diseases are dealt with in the report of the Medical Officer of Health. Of the non-notifiable diseases small outbreaks of whooping cough occurred in the early part of the year. A few cases of chickenpox were reported in February and March and again in December. A small outbreak of Mumps was reported in July. 60 The actual numbers reported from schools were as follows:— Whooping cough 239 Chickenpox 64 Mumps 24 Co-operation with Parents, Teachers and Attendance Officers:—63% of the parents attended the Routine Inspections, and the great majority of children receiving treatment were accompanied by parents. We have again to thank the different Voluntary Welfare Associations for assistance given in special cases. The co-operation with teachers and attendance officers could not be bettered, and the medical staff deeply appreciates how much success is due to this fact. Defective Children (a) Mentally Defective:— Children suspected of being mentally defective or reported as dull and backward are kept under observation in school by the Assistant Medical Officer. If the child makes little progress the parent is interviewed and all preliminary information is obtained. An examination, both physical and mental, is made later by the School Medical Officer, in the presence of the parent, and the results are discussed. In this way a decision is mutually arrived at, usually satisfactory to all concerned, and every allowance is made for the benefit of the child. It is exceptional to have a decision questioned. Queen's Road Special School:—The year's work has been remarkably successful in every way. The general cleanliness and behaviour of the children were very good, and the attendance has been above the average. Practically all the children remain to mid-day meal. No complaints were received, and no outbreaks of infectious disease occurred. All the children were examined physically by the Medical Officer, and the Dental Officer carried out his annual inspection and treatment. No transfers were made during the year to the Littleton Street Special School for boys. 4 boys and 5 girls were admitted during the year, and 10 names were removed from the register. Of these 10 children, one boy attends hospital for special training (6 months exemption) and one girl has been passed into a special 61 school for high myopes (defective vision). 2 boys have removed to other areas, and one has been sent to a private school. One girl was removed to Institutional Care and one other girl was reported to Surrey County Council for AfterCare supervision. Three pupils (2 girls and 1 boy) have obtained good situations and are doing well. (b) Physically Defective Children:—There is no School for Physically Defective children in Wimbledon, and this subject was discussed in my last Annual Report. During 1927, the information brought to my knowledge did not assist me further in arriving at a decision. The following special cases were dealt with:— 2 (1 boy, 1 girl) admitted to "Myope" schools. 1 boy „ „ School for Deaf and Dumb Children. 2 boys „ „ Cripple (Residential) Schools. 1 boy „ „ an Open Air School. 1 girl „ „ a Recovery School. 2 epileptic cases (girls) awaiting admission to Epileptic Homes. In addition to the above cases arrangements were made for the treatment and supervision of six other cases, the majority of whom were dealt with by Voluntary Associations. Employment of Children and Young Persons:—109 children were specially examined and certified as to employment. Six Teachers were medically examined. In conclusion I desire to thank the members of my staff for loyal co-operation and service on all occasions. I have the honour to be, Your obedient servant, A GILMOUR, School Medical Officer. 20, Queen's Road, Wimbledon. 14th February, 1928. 62 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1927. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections :— Entrants 789 Intermediates 444 Leavers 666 Total 1,849 Number of other Routine Inspections 105 B.—OTHER INSPECTIONS. Number of Special Inspections 2,621 Number of Re-Inspections 6,272 Total 8,893 63 TABLE II. A.—RETURN OP DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 3IST DECEMBER 1927. DEFECT OR DISEASE Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Ret (Hiring 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) Malnutrition — — 18 12 Skin Ringworm—Scalp 1 - 13 - Body — — 48 — Scabies — — 16 — Impetigo 17 — 261 — Other Diseases (Non-Tuberculous) 36 — 113 — Eye Blepharitis 11 2 69 - Conjunctivitis 1 — 18 — Keratitis 2 — 1 — Corneal Opacities — — — — Defective Vision (excluding Squint) 77 30 252 17 Squint 10 2 4 — Other Conditions 1 1 20 4 Ear Defective Hearing 17 1 6 8 Otitis Media 3 — 61 — Other Ear Diseases 11 2 12 10 Nose and Throat Enlarged Tonsils only 30 36 40 10 Adenoids only 4 6 8 3 Enlarged Tonsils and Adenoids 39 42 41 22 Other Conditions 6 2 118 105 Enlarged Cervical Glands (Non-Tuberculous) 14 4 20 40 Defective Speech 2 3 — — Heart and Circulation Heart Disease: Organic 3 6 5 11 Functional 4 15 7 5 Anaemia 2 1 8 - 64 TABLE II.—continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects, No. of Defects. Hequiring 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 26 12 34 26 Other Non-Tuberoulous Diseases 2 - 8 5 Tuberculosis Pulmonary : Definite 1 - 1 — Suspected 2 - 3 — Non-Pulmonary: Glands — - — — Spine — - — — Hip — - 1 — Other Bones and Joints — - 1 — Skin 1 - 1 — Other Forms 2 - — — Nervous System Epilepsy 7 1 5 3 Chorea 1 - 4 3 Other Conditions 2 1 8 10 Deformities Rickets 3 1 3 1 Spinal Curvature 1 - 7 — Other Forms 11 1 8 — Other Defects and Diseases 78 10 751 63 B.—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). GROUP. (1) Number of Children. Percentage of Children found to require Treatment. (4) Inspected (2) Found to require Treatment. (3) Code Groups Entrants 739 198 26.7 Intermediates 444 96 21.6 Leavers 666 96 14.4 Total (Code Groups) 1849 390 21.0 Other Routine Inspections 105 21 20.0 65 TABLE III. NUMERICAL RETURN OP ALL EXCEPTIONAL CHILDREN IN THE AREA IN ]927. Boys. Girls. Total. Blind (including partially blind.) (i.) Suitable for training in a School or Class for the totally blind. Attending C e r t i fi e d 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 1 1 2 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. 3 1 4 Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the deaf. - - - Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution - — — Mentally Defective. Feebleminded (cases not notifiable to the Local Control Authority.) Attending Certified Schools for Mentally 29 23 52 Defective Chi Id ren †3 — †3 Attending Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — 66 TABLE III.—Continued.  Boys. Girls. Total Mentally Defective contd. Notified to the Local Control Authority during the year Feebleminded - 1 1 Imbeciles — — - Idiots - - - Epileptics Suffering from severe epilepsy Attending Certified Special Schools for Epileptics - - - In Institutions other than Certified Special Schools - - - Attending Public Elementary Schools - - - At no Schcol or Institution — 2 ‡2 Suffering from epilepsy which is not severe. Attending Public Elementary Schools 6 5 11 At no School or Institution — — — Physically Defective Infectious pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions — - — At no School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 2 4 6 At other Institutions — — — At no School or Institution 1 — ‡1 67 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 - 1 1 At Certified Day Open Air Schools - - - At Public Elementary Schools 16 26 42 At other Institutions — — — At no School or Institution — — — Active non-pulmonarv tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 5 5 At Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools - - - At Certifnd Residential Cripple Schools 1 - 1 At Certified Day Cripple Schools - - - At Public Elementary Schools 25 27 52 At other Institutions — — — At no School or Institution 1 — ‡1 † In Littleton Street, Special School, L.C.C. ‡ Awaiting Admission to Special Institutions. 68 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31ST DECEMBER 1927. 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 14 — 14 Body 48 — 48 Scabies 15 1 16 Impetigo 260 18 278 Other skin disease 119 30 149 Minor Eye Defects— 110 13 123 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 91 19 110 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, ete.) 759 70 829 Total 1416 151 1567 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 thfl Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including Squint). 392 22 - 414 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 10 1 - 11 Total 402 23 — 425 Total number of children for whom spectacles were prescribed :— a. Under the Authority's Scheme 120 b. Otherwise 9 Total number of children who obtained or received spectacles :— a. Under tha Authority's Scheme 120 b. Otherwise 9 69 TABLE IV.—continued. GROUP III—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other form 8 of Treatment. Total number Treated. Under the Authority's Schema. in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (6) 101 Awaiting Treatment 33 134 152 286 GROUP IV.—DENTAL DEFECTS. 1. Number of Children who were: — a. Inspected by the Dentist: Routine Age Groups Aged 5 172 6 495 7 625 8 434 9 193 Aged 10 159 11 198 12 144 13 91 14 73 Total 2584 Specials 617 Grand Total 3201 b. Found to require Treatment 2490 c. Actually Treated 1157 d. Re-treated during the year as the result of periodical amination 664 2. Half-days devoted to:— Inspection, 40. Treatment, 373 Total 413 3. Attendances made by Children for Treatment 2483 4. Fillings:— Permanent Teeth, 852. Temporary Teeth, 372 Total Teeth 1224 Total Fillings 1586 5. Extractions:— Permanent Teeth, 201. Temporary Teeth, 2008 Total 2209 6. Administrations of general anaestheticsjfor extractions 399 7. Other Operations :— Permanent Teeth, 362. Temporary Teeth, 629 Total 99 70