Borough of Wimbledon. Annual Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1928. Together With the Report of THE SCHOOL MEDICAL OFFICER AND OF THE SANITARY INSPECTOR. Borough of Wlimbledon ANNUAL REPORT op the MEDICAL OFFICER OF HEALTH for the Year ended 31st December, 1928. Public health Committee: Chairman: Councillor E. Fielder. Vice-Chairman: Councillor C. B. Heaton. Members: The Mayor (Alderman Hickmott, J.P.), Councillor E. J. Chard Councillor C. J. Eyres „ H. H. Coote „ S. Murray „ F. W. Daffen „ A. J. Penman „ H. Dormer „ Lady Roney „ A. A. Drake „ C. Snell 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 Murray „ Drake „ Lady Roney „ Fielder Mr. (J. Edwardes-Jones, K.C. Mrs. Guard „ Daniel „ Fielder „ Siieerman STAFF. Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer. ‡*A. Gilmour. M.D., M.R.C.P.E., D.P.H. Assistant Medical Officer of Health, Assistant School Medical Officer. ‡ Effie M. D. Craig, M.B., Ch.B. Chief Sanitary Inspector: a *† Henry Johnson. Assistant Sanitary Inspectors: ¶ a † R. T. Avis. a †. F. S. Flynn. Health Visitors—School Nurses: ¶ § || Miss M. Giles. § c || Miss E. M. Skelton. c || Miss J. E. D. Elder (Resigned). § c || Miss K. Kenion. 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 Maternity and Child Welfare Committee 1 Staff 2 Staff and Administration 5 New Premises 5 Natural and Social Conditions of the Area 6 Vital Statistics for 1928 7 Population, Birth and Death Rates for each Ward, 1928 7 Births 8 Deaths 8 Infantile Mortality 9 Poor Law Relief 10 General Provision of Health Services in the Area 10 List of Local Acts, Orders and Adoptive Acts, in force 12 Sanitary Circumstances of the Area 14 Sanitary Inspection of District 15 Factories and Workshops 10 Sanitary Inspector's Report— Notices Served 19 Legal Proceedings 19 Opening up of Drains under Section 41 of the Public Health Act, 1875, and Amending Acts 20 House Drainage 20 House to House Inspection 20 House Inspection 21 Overcrowding 21 Underground Dwellings 21 Houses Let in Lodgings 21 Verminous Rooms 21 Common Lodging Houses 22 Van Dwellings 22 Dairies, Cowsheds and Milkshops 22 Infectious Disease and Disinfection 23 School Disinfection 24 Yard Paving 24 Stable Refuse 24 Inspections under the Factory and Workshop Act, 1901 24 Shops Acts, 1912-28 24 Slaughter Houses and Food Inspection 25 Sale of Food and Drugs Acts, 1875 to 1907 25 Petroleum Acts 26 Diseases of Animals Acts, 1894 to 1925 20 The Public Health (Meat) Regulations, 1924 27 Rent (Restrictions) Acts, 1920 and 1923 27 Water Supply 27 Employment Agencies 27 Employment of Children Bye-laws 28 Fouling of Footways by Dogs 28 Public Health (Smoke Abatement) Act, 1926 28 Housing Act, 1925 29 Summary Table—Nuisances Abated 30 3 Medical Officer's Report—continued Housing Statistics for tlie Year 1928 31 Inspection and Supervision of Food 33 Prevalence of, and Control over, Infectious Diseases 33 Notifiable Diseases and Deaths, 1928, in age- groups, etc. 35 Death-rate from Zymotic Diseases, for the last ten years 36 Ward Distribution of Infectious cases notified in 1928 36 Scarlet Fever 37 Diphtheria 37 Tuberculosis 38 Laboratory Work 39 Chemical Work 40 Disinfection 40 Wimbledon Isolation Hospital 41 Scarlet Fever 41 Diphtheria 42 Enteric and Paratyphoid Fever 42 Erysipelas 42 Encephalitis Lethargica 42 Maternity and Child Welfare 43 Maternal Mortality 43 Record of Home Visitation worl; and at Centres 44 Supply of Milk to Expectant and Nursing Mothers and Infants 45 Dental Surgery 45 South Wimbledon Day Nursery 45 Table I.—Vital Statistics 47 Table II.—Causes of Deaths, etc. 48 School Medical Officer's Report— Staff 50 Administration 51 New School Clinic and Welfare Centre 52 Medical Inspection 52 Findings of Medical Inspection 52 Minor Ailments 52 Tonsil and Adenoid Cases 52 Tuberculosis Cases 52 Skin Diseases 53 Eye Disease and Vision 53 Ear Disease and Hearing 53 Dental Defects 53 Crippling Defects and Orthopoedics 53 Co-operation with Parents, Teachers and Attendance Officers 53 Defective Children 53 Physically Defective Children 54 Employment of Children and Young Persons 54 Table I.—Return of Medical Inspections 55 ,, II.—Return of Defects 56 ,, III.—Return of all Exceptional Children 58 ,, IV.—Treatment Table 61 4 Borough of Wimblebon. Public Health Department. ANNUAL REPORT of the Medical Officer of Health for the Year ended 31st December, 1928. 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, 1928, together with my Report as School Medical Officer. The Annual Report of the Medical Officer of Health for 1928 is an Ordinary Report, prepared on the lines suggested in Circular 939. issued by the Ministry of Health on 13th December, 1928. Dr. Gilmour, the late Medical Officer of Health, died on 13th May, 1928. As I commenced my duties as Medical Officer of Health on 4th February, 1929, the Report for the year under review has been drawn up on similar lines to the Annual Report for the year 1927. Staff and Administration. (a) Changes in Staff:—Miss J. E. D. Elder, School NurseHealth Visitor resigned in May, 1928, and Miss K. Kenion commenced duty in November, 1928. (b) New Premises:— (i) New Day Nursery :—These new premises situated in Hubert Road, South Wimbledon, were opened on the 16th July, 1928. The Nursery is constructed on modern lines. There are two main wards, one with accommodation for 5 twenty babies and the other with accommodation for thirty toddlers. There is also a small isolation ward. The Nursery has also been equipped with suitable domestic accommodation and the necessary sanitary offices. The Day Nursery is wellattended and meets a real need in the district. A charge of sixpence a day is made for each child. (ii) New Conjoint Clinic :—The new Conjoint Clinic, situated in Pelham Road, was opened on the 6th November, 1928. This building has been well-designed and provides good accommodation for the Minor Ailment and Ophthalmic Clinics, the Dental Clinic, and also for a Maternity and Child Welfare Centre. Two rooms have also been set aside for the Bacteriological Laboratory. The centralisation which has been effected should greatly increase the efficiency of the work carried out. (c) Other Administrative Measures:— Examination of Employees:— During the year 1928, 131 employees were medically examined by the Medical Officer of Health. Natural and Social Conditions of the Area. Area (acres) 3.220 Population (Census, 1921) 61,700 Population (Estimated, 1928, R.G.) 59,070 Number of inhabited houses:— 1921 11,926 Number of families or separate occupiers:— 1921 13,998 Rateable Value:—£528,337. Sum represented by a penny rate:—£2,135. Social Conditions:—v. Annual Report, 1925. Extracts from Vital Statistics of the Year (1928). (Registrar-General's Figures). Total M. F. Births Legitimate 652 345 307 Birth Rate (R.G.) 11.6 Illegitimate 39 14 25 Deaths 634 317 317 Death Rate (R.G.) 10.7 Number of women dying in, or in consequence of, childbirth from sepsis 1 do. do. other causes 1 Total 2 6 Death-rate of Infants under one year of age per 1,000 births 55 Number of deaths of infants—legitimate (R.G.) 35 „ „ „ —illegitimate (R.G.) 4 Total 39 Deaths from Measles (all ages) 7 „ „ Whooping Cough (all ages) 5 „ „ Diarrhoea (under 2 years of age) 2 Vital Statistics for 1928 (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 11.7 65 107 Great Towns 16.9 11.6 70 156 Smaller Towns 16.6 10.6 60 LONDON 15.9 11.6 67 WIMBLEDON 11.6 10.7 55 BOROUGH OF WIMBLEDON. Population, Birth and Death Rates for each Ward, 1928. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6838 7.8 10.5 Wimbledon Park 3.88 4477 11.8 10.4 St. John's 4.77 5238 6.6 10.1 Cottenham Park 4.33 7414 8.7 10.2 North Wimbledon 1.36 23967 8.6 10.3 Dundonald 5.15 7864 15.005 10.4 Trinity 5.59 11708 13.4 10.7 South Park 4.63 8611 10.2 11.1 Haydon Park 5.47 6920 17.3 11.5 South Wimbledon 5.21 35103 18.7 10.9 Whole District 4.83 59070 11.6 10.7 7 Births :— The number of births registered in the district w as 637 (337 males and 300 females), a decrease of 34 against last year, and equal to a birth-rate of 10.7 on a population of 59,070. The corrected birth-rate produced by transferable births notified to us by the Registrar-General is 11.6. 39 (or 6.1 per cent.) of the births were illegitimate. Notification of Births Acts, 1907 and 1915. During the year, 615 births were notified by the following persons:—Parents, 47; Midwives, 389; Doctors, 85; other persons, 94. Nineteen notifications of still-births were received. Deaths :— The total number of deaths registered in the district was 476 (226 males, 250 females), equal to a death-rate of 8.05 per thousand of the population (R.G.) per annum. The deaths occurring outside the district, of persons belonging to this Borough, were 240, viz.:— Kingston and District General Hospital 105 Brook wood Asylum, Woking 13 Nelson Hospital, Merton 25 Others 97 Total 240 The deaths occurring within the district, of persons not belonging thereto, were 84, viz.:— Atkinson Morley Hospital 1 Isolation Hospital 9 North Wimbledon Hospital 15 Others 59 Total 84 Taking those into consideration, the total number of deaths properly belonging to Wimbledon, is 632, and the death-rate 10.7. The rate for England and Wales for the same period was 11.7. 8 Table showing the births, deaths, and death-rates inthe Borough of Wimbledon in the last seven years. 1928 1927 1926 1925 1924 1923 1922 Births 691 717 807 760 814 868 868 Deaths 632 620 579 638 645 546 616 Death-rates 10.7 10.6 9.9 10.9 11.1 9.4 99 Table II. gives the causes of, and ages at, deaths during 1928. Deaths due to notifiable infectious diseases are given on p. 35. The principal causes of death, apart from Zymotic deaths, are as follows :— Heart Disease 112 Cancer 84 Pneumonia 46 Arterio Sclerosis 42 Tuberculosis (Respiratory) 35 Bronchitis 29 Infantile Mortality :—There were 38 infant deaths during the year (including transferable deaths), giving a rate of 55 per thousand registered births, an increase of 5 per thousand on last year's figures, when there were 37 deaths and a rate of 50. The infantile death-rate calculatcd on the RegistrarGeneral's figures, is 56 per thousand births. The infant death rate for illegitimate children was 102 per thousand illegitimate births. The following table shows the causes of death, and ages at death, of Infants under one year:— 9 Infant Mortality during the Year 1928. (Deaths from stated causes at various ages under One Year of Age.) Causes of Death. Under week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Congenital Malformation — 1 — — 1 — — — — 1 Congenital Debility,—Prematurity, etc 11 1 1 — 13 3 1 — — 17 Whooping Cough — — — — 1 — 1 — 2 Pneumonia, &c. — 2 — 1 3 2 4 1 2 12 Gastro Enteritis, &c. — — — — — 1 — — 1 2 Respiratory Diseases 1 — — — 1 — 1 — — 2 Other Causes 1 — — — 1 — 1 — — 2 total 13 4 1 1 19 7 7 2 3 38 Poor Law Relief.—The following information has been furnished by the Clerk of the Kingston Union respecting Poor Law Relief in this District:— Amount paid in Out-door telief in 1928 ... £9,956 Average weekly number of persons in receipt of Out-door relief 509 Average weekly number of persons in receipt of Medical Relief only ... ... ... ... 31 Number of persons admitted to the Guardians' Institution from Wimbledon Area:— Hospital ... ... ... ... ... 439 Central Relief Institution ... ... ... 82 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. 10 (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) Others—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 (52 beds). Kingston Infirmary, Kingston (500 beds). Contributions are made to the local hospitals by the Wimbledon Borough Council in respect to (a) treatment of employees; (b) treatment of school children. (c) Institution for unmarried mothers :— Southwark Diocesan Maternity Home, 56, Gap Road, Wimbledon. Ambulance Facilities:— (a) For infectious cases—two motor ambulances, Isolation Hospital, Gap Road. (b) For Non-Infectious cases and Accidents—one motor ambulance, Fire Station, Queen's Road, under the Wimbledon Borough Council. Clinics and Treatment Centres:— Maternity and Child Welfare Centres:— (1) Wandle Park House, Wandle Bank, Wimbledon. (2) Pelham Centre, Wimbledon. Both under the Wimbledon Borough Council. (3) Ante-Natal Clinic, Wandle Park House, Wandle Bank. Day Nursery, Hubert Road, Wimbledon, under the Wimbledon Borough Council. School Clinic :—Pelham Road, Wimbledon, under the Wimbledon Education Committee. School Dental Clinic :—Pelham Road. Tuberculosis:—Dispensary, 145, Merton Road, Wimbledon, under the Surrey County Council. Venereal Diseases:—Richmond, under the Surrey County Council. 11 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 15 midwives practising in the district. MORTUARY. From information received from the Superintendent of the Cemetery, there were 72 bodies received into the mortuary during the year. Inquests were held by the Coroner with respect to 48 bodies, equal to 10.08 per cent. of all deaths registered in the Borough. LOCAL ACTS, SPECIAL LOCAL ORDERS, OR GENERAL ADOPTIVE ACTS IN FORCE IN THE BOROUGH. Infectious Diseases (Prevention) Act, 1890—17th December, 1890. Public Health Acts (Amendment) Act, 1890 : Parts II., III. and V.)—17th December, 1890. Housing of the Working Classes Act, 1890 : (Part III.)—7th June, 1899. Public Health Amendment Act, 1907. Part II. (Streets, Buildings)—Sections 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 29, 31, 32, 33, and Sections 25, 27 and 30, with modifications. Part III. (Sanitary provisions)—Sections 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and 51, and Sections 35 and 38, with modifications. Part IV. (Infectious Diseases)—Sections 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 64, 65, 67 and 68, and Section 59, with modifications. Part V. (Common Lodging Houses)—Sections 69, 70, 71, 72, 73, 74 and 75. Part VI. (Recreation Grounds)—Section 76 (with modi fications), and Section 77. 12 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 (Revised 1928) do. do. Common Lodging Houses. do. do. Slaughter-houses (Revised 1922). do. do. Nuisances. Bye-laws with respect to tents, vans, sheds and similar structures. Bye-laws as to Employment Agencies. Bye-laws with respect to the keeping of water-closets supplied with sufficient water for flushing. 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. 13 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. T. Webster:— General Sanitary Conditions of the Area—Good. Refuse Removal:—The Corporation have five motor lorries in use and contemplate the purchase of an additional one. These vehicles are still proving to be a marked success Doth from an economical and sanitary point of view. During the last financial year the quantity of refuse collected has increased considerably, causing the present destructor to be worked at its full capacity. The Committee concerned are now considering the purchase of the latest type of gully emptier which, it is hoped, will be a great improvement on the present manual method of emptying the street gullies. Housing, under Municipal Schemes:—During the past year five houses have been built in Birkbeek Road by the Corporation. They are built of brick and are of the nonparlour type. These have been sold under the Small Dwellings Acquisition Act. On the Durnsford Road site, previously used for allotments, forty-four houses, in ten blocks of four and two semi-detached blocks, and forty-eight flats, in four blocks of twelve have been built by the Corporation, and arc just completed. 14 The houses are of the non-parlour type, built of brick, and have been sold under the Small Dwellings Acquisition Act. The flats are three stories high, the walls being built of brick, and the floors constructed of reinforced concrete. The tenements are of the non-parlour type and are let at the inclusive rent of 15s. per week. Clinic, Pelham Road :—A new clinic has been erected at Pelham Road. This is a two-storey building and has been equipped for the treatment of dental, minor ailment and ophthalmic cases and serves the purpose of a child welfare centre. An up-to-date laboratory has also been provided. Baths, Latimer Road:—An extension to the existing public baths in Latimer Road has been built and is now practically completed. It comprises a first-class swimming bath 40-ft. x 100-ft. together with dressing-boxes, showers, footbath, waiting-rooms, club-rooms and all necessary lavatory accommodation. An efficient filtration, plant has been installed to enable the water of the new bath to be cleansed as often as necessary. 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 1928, as reported by the Sanitary Inspector. Reason of Visit. No. Infectious Disease 965 House Inspections 2,102 House to House Inspections 2,932 Rent Act Inspections 56 Houses Let in Lodgings; Inspections 5 Inspection of Factories, Workshops, Workplaces and Out-workers' Premises 443 Common Lodging Houses; Inspections 10 Dairies and Cowsheds; Inspections 103 Inspections under Shop Acts 464 Application of Tests to Drains 303 Inspections under Diseases of Animals Acts 143 Obtaining Samples of Foods and Drugs 3 Miscellaneous (including Inspections of Food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 2,029 9,558 One thousand three hundred and seventy-three preliminary or informal notices were served in respect of 1.188 houses. 15 One hundred, and seven statutory notices were served in respect of 97 houses. The necessary work was executed in all but 178 cases, which were not completed by the end of the year. In 119 of these, the work was actually in hand at the close of the year. Table 111. 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 69 10 Workshops 317 37 — Workplaces 15 3 — Total 401 50 — DEFECTS FOUND. PARTICULARS. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:-* Want of Cleanliness 17 17 — — Want of Ventilation — — — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other Nuisances 37 35 — — Sanitary Accommodation— Insufficient 4 4 — — Unsuitable or Defective 21 21 — — Not Separate for Sexes — — — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) — — — — Totals 80 78 — — " Including those specified in sections 2, 3 7 and 8 of the Factory and Workshop Act. 1901, as remediable under the Public Health Acts. 16 HOME WORK. Lists received:— Twice in the year 10 Number of Out-workers 54 Once in the year 4 Number of Out-workers 6 Number of addresses received from other Councils 58 Number of addresses forwarded to other Councils 7 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 15 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 57 Dressmaking 59 Bakehouses (including four Factory Bakehouses) 25 Laundries 32 Tailoring 27 Millinery 14 Dining Rooms 22 Motors and Cycles 30 Builders' Yards 35 Underclothing 5 Other trades 150 456 17 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 1 Action taken in matters Notified by H.M. referred by H.M. In- Inspector 4 spector as remedial Reports of action under the Public taken sent to Health Acts. H.M. Inspector 4 Underground Bakehouses in use at the end of the year 3 18 Borough of Wimblebon. Sanitary Department. ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE Year ended 31st December, 1928. 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, 1928. Table iii. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—One thousand three hundred and seventy three Preliminary Notices or intimations were served during the year in respect of 1,188 houses. It was found necessary to serve 107 Statutory Notices upon the owners or occupiers of 97 houses. Six hundred and fifty-eight letters, respecting 765 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. Legal Proceedings.—Legal proceedings were instituted in the following cases with the results stated: — 1.—For failing to comply with Notice to Abate Nuisance. Two Guineas Costs, and ordered to execute work in fourteen days. 19 2.—For failing to vacate premises on which Closing Order had been made. Order made for premises to be vacated within twenty-one days. 3.—For failing to comply with Notice to Abate Nuisance. Fined Five Pounds and Three Guineas Costs and Order made for Notice to be complied with within fourteen days. 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, application was made to the Local Authority with respect to the opening up of drains at three houses, but it was found unnecessary 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 17 houses have been entirely reconstructed, extensive amendments or repairs were carried out at 62 houses, and at 21 houses the drainage systems have been made watertight by the patent internal process. House to House Inspection.—During the year house to house surveys were carried out at 468 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. 30. Amity Grove 96 Belvedere Cottages 17 Crooked Billet 78 Denmark Road 73 Durnsford Road 11 Hillside 5 Lancaster Cottages 7 Oldfield Road 14 Richmond Road 3 Ridgway 7 Southdown Road 65 South Place 12 Strachan Place 8 Sunnyside 5 Thurstan Road 16 Thornton Road 31 West Court 5 West Place 9 Westside 6 468 20 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, 1,009 houses were visited. Table iii. shows a list of sanitary works executed at these houses, together with defects remedied during house to house inspection. Overcrowding.—This matter is still the cause of considerable anxiety on the part of the Department, for despite the number of buildings that have been erected during the year I am unable to report any improvement in the conditions existing. In families where accommodation is very limited each year adds to the difficulty, for the children are becoming adults and it is extremely difficult, if not impossible, for them to be properly housed. When more suitable accommodation is found the families requiring it are unable to pay the exorbitant rents demanded. In a few cases of overcrowding, caused by families coming into the town from outside districts, action has been taken by the Department, and, as a result of the service of Notices, the conditions have been remedied. Underground Dwellings.—As anticipated in my Report for last year, the new Regulations under Section 18 of the Housing Act, 1925, were made and afterwards confirmed by the Ministry of Health. These give the Department additional powers with respect to the use as sleeping places of underground rooms, and apply to all such rooms used for that purpose. Prior to the adoption of these Regulations the Local Authority was only able to deal with underground rooms which were let separately. I am fairly confident that when these Regulations are applied to certain premises which have come to the notice of this Department it will be the means of preventing such rooms being used in the future. Houses Let in Lodgings.—There are 67 of these houses on the Register, and 5 visits of inspection were made during the year, to ensure that the Bye-laws were being observed. New Bye-laws under Section 6 of the Housing Act, 1925, were made by the Council and approved at the end of July. These will greatly assist the Department in the control of the houses let to two or more families where the rent is considerably above that stipulated in the old Bye-laws, which have now been repealed. As a result, reports have been made on a number of premises with a view to their being placed on the Register and this will be done early in the New Yeaj-. Verminous Rooms.—During the year 25 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 21 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 one registered Common Lodging House, namely No. 42, Merton High Street, for which an annual Certificate of Registration was granted from 1st January, 1928, to 31st December, 1928. These premises have been visited from time to time when a few minor defects have been found. These have always been remedied immediately the owner's attention has been directed to them. The premises are kept in a satisfactory condition. Van Dwellings.—During the year, 125 visits have been paid to the caravans in the district and it has been found necessary to serve Notices with respect to two of them. Generally speaking, the vans have, as far as practicable, been kept in a fairly reasonable condition. New Regulations with respect to these dwellings are being adopted and will be put in force early in the new year. Dairies, Cowsheds and Milkshops.—Seventeen applications were received during the year from persons desirous of being registered under the Milk and Dairies (Consolidation) Act, 1915, the Milk and Dailies (Amendment) Act, 1922, and the Milk and Dairies Order, 1926. One hundred and three inspections have been made of the Prenlises of dairymen and purveyors of milk in the district, during which three matters were discovered which required to be dealt with by the Department. In addition to the visits to premises, observations have been kept in the early hours of the morning when milk is being delivered, as it is at this time that the chief offence, namely, the buttling and careless handling of milk, is most likely to take place. This work is very exacting and it has taken careful watching for weeks, and sometimes months, before a suspected offender has been actually observed committing a breach of the Regulations. The seriousness of this offence cannot be too strongly emphasised for it is always possible that a dirty bottle from one house is filled in the streets and delivered to another house. I think it is only fair to point out that it is not a general practice, but there are a few offenders who appear to have no respect for the commodity they are handling or for the Regulations in force. Legal proceedings were instituted in the following cases with the results as stated: — 1.—For selling milk in dirty bottle. Dealt with under First Offenders' Act on payment of Costs, £8 12s. 22 2.—For carrying on business as Dairyman on unregistered premises. Fined £5 with daily penalty of forty shillings, in default one month's imprisonment. 3.—For bottling milk in public street on two occasions. Fined £2 and £3 3s. costs in each case, and employer, 4.—For failing to use due diligence to enforce execution of Regulations. Case dismissed. 5.—For bottling milk in public street. Fined £1 and £1 1s. Costs. 6.—For bottling milk in street. Fined £1 and £1 1s. Costs. 7.—For causing milk to be bottled in street. Fined £2 and £2 2s. Costs. In the case of one dairyman whose registration was refused, an appeal under Section 2 of the Milk and Dairies (Amendment) Act, 1922, from the decision of the Local Authority was made to the local Magistrates. This was dismissed without prejudice to a further application for Registration, when the premises were so altered as to comply with the Local Authority's requirements. In this case a prosecution followed for carrying on on unlicensed premises with the result quoted above (No. 2). Infectious Diseases and Disinfection.—During the year, visils for the purpose of investigating cases of notifiable infectious disease were made to 339 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 58 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 574, and the number of articles, bedding, wearing apparel, etc., 14,895, full details of which are given in the Report of the Medical Officer of Health under the heading of " Disinfection." 23 School Disinfection.- All the Public Elementary Schools in the district were thoroughly disinfected during the summer vacation. Yard Paving.— In the course of the inspections made during the year, 61 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, numerous visits having been made to such premises during the year. Inspections under the Factory and Workshop Act, 1901. There are 450 factories, workshops and workplaces on the Register, to which 401 visits of inspection were made. Fifty written notices were served referring to sanitary conveniences and other nuisances. Shops Acts, 1912-28.— Four hundred and sixty-four visits were made for the purpose of observing contraventions of the Acts. Advice and warnings were given where necessary. In one case legal proceedings were instituted as under:— Against a firm for failing to close five of their shops on the usual weekly half-holiday. Fined £5, including £1 1s. costs, in each case. 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, 1928, 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. Notwithstanding this, there appeared to have been quite a misunderstanding on the part of a number of shop-keepers with regard to the days on which the premises could legally be kept open. This, I think, may safely be said to be due to the fact that one of the holidays (Boxing Day) this year occurred on Wednesday, the normal half-closing day. Therefore, this day could not be used in substitution of the previous Wednesday half-closing day. Observations were kept on the shops in the district in the week preceding Christmas, and on the usual half-closing day only ninety-nine out of the total number of shops (1,150) were found to be closed. Further observations were kept during the holidays, when three premises were found to be open contrary to the Regulations'. The full particulars were reported at the first Meeting of the Local Authority in 1929 and details of this will appear in the Annual Report for that year. 24 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. Seventy-seven 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, with the cause for such action:— 3 sets Pigs' Lungs Ecchymosis 3 sets Pigs' Lungs and Heart Tumour 7 sets Pigs' Livers and Lungs. Inflammation 2 Hindquarters Pork. 1 1 Shoulder Pork Bruised 2 Bullocks' Lungs and Livers Multiple Abscesses 2 Bullocks' Livers Flukes Cow's Liver and Mesenteric Fat Tuberculosis It will be noticed that the number of inspections are less than in the previous year; this is due to the fact that one slaughter-house was not used for nearly six months. In addition 267 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:— 7 stone Skate Unsound 12 stone Sole Unsound 141b. Loin of Pork Tainted and foul smelling 6 stone Spragg Unsound Sale of Food and Drugs Acts, 1875 to 1907.- Two samples were submitted to the Council's Analyst, one being a sweetmeat and one a lemon. In the first case a child was stated to have purchased some sweets from a shop and after having eaten a portion of it he was taken with violent sickness. 1 immediately investigated the cause of the complaint and obtained a specimen which I submitted to the Analyst who reported that he was unable to find any matter which was likely to give rise to such a condition. I also communicated with the makers of the sweetmeat, who replied giving me the composition of the article in question. From my subsequent enquiries I found that the child had not suffered any further effects and could, therefore, only conclude that the sweetmeat could not have been the cause of the sickness, in view of the fact that a number of other children had had sweets from the same consignment without ill-effect. 25 With respect to the lemon, the purchaser noticed some green spots on the skins of some lemons which she had purchased locally. Her complaint was immediately investigated, and the whole of the lemons on the shop premises were examined and one specimen was submitted to the Council's Analyst who reported that the growth had started from a damaged portion of the rind and in growing caused a softening and rotting of the fruit and there was no arsenic or metallic poisoning present. Petroleum Acts.— Seventy-one applications were received for permission to keep petroleum, 65 being for the renewal of existing licences, and 6 for new ones. In the case of the new ones they were partly for can storage and partly for bulk storage. In the latter, the amounts range from 500 to 2,000 gallons. The petrol is stored in bulk in quantities varying from 500 to 14,000 gallons, each installation having been carefully supervised during fitting, and a final test being applied on completion prior to the granting of a Licence. The Licences are issued annually and towards the end of the year the Local Authority decided to use the powers granted by Section 25 of the Public Health Act, 1925 to insist on an Agreement being signed by the new licence-holder in cases where swing arms are to be used, undertaking to remove any swing arm which was found to be an obstruction. This applied to pumps erected near the front of the building abutting on the footpath and where there is no actual draw-in off the footway. These agreements are signed before the issuing of the Licence. Three hundred and sixty-two inspections were made of the various premises in respect of which licences had been issued. 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. 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 were issued where necessary. In view of the number of Orders issued and the wide areas affected, great care was necessary in the issuing of Licences and replying to enquiries. Tuberculosis.— No outbreak of this disease has been reported during the year. The usual quarterly returns, under the provisions of the Tuberculosis Order of 1925, have been rendered to the Ministry of Agriculture. 20 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 alien lion 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 live applications were received from occupiers of premises requesting that inspections be made, as in their opinion the owners had failed in their obligations. In each case, a complete survey of the house, both internal and external was made, and a notice prepared specifying the works to be executed in order to make the premises in all respects reasonably fit for human habitation. The applications were submitted to the Committee, together with a report as to the conditions existing, and in each case the issuing of a certificate was authorised. In two 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. I would point out that in all these cases it is most essential that the inspections and reports are very carefully made and prepared in order that clear evidence may be given should the case be the subject of legal proceedings. Water Supply.— The water supply was withdrawn from 15 houses during the year for the following reasons:—10 by request, 20 owing to arrears of rates, and 15 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. 27 At the end of the year there were nine Licensed Keepers on the Register, to whose premises periodical visits have been made. 1 have also accompanied the Surrey County Council's Officer for the purpose of explaining the provisions of the Byelaws, 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. 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 as under. I would mention that one particular offender (a) had been warned on a number of occasions, but failed to appreciate the seriousness of his offence. (a) For employing a boy (a) without a card, and (b) during prohibited hours. Fined £2 in each case. (b) For employing a boy (a) without a card, and (b) during prohibited hours. Fined £1. 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, 1927. 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-laws 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. Public Health (Smoke Abatement) Act, 1926.— A number of complaints have been received during the. year alleging nuisances from smoke and grit from chimney stacks of factories and similar premises. The complaints have been investigated immediately and when found to be justified the occupiers have had written intimations. Following this, observations have been kept from time to time in order to see that the nuisance has been abated. In each case full reports have been made to the Public Health Committee but on no occasion has it been necessary to institute legal proceedings. Housing Act, 1925.— As will be observed from the details in the Medical Officer of Health's Report, two houses were closed as being unfit for human habitation. As the Officer appointed 28 under the Housing Acts I reported the details of the two premises which were in my opinion extremely dangerous to the occupiers owing to their dilapidated condition. After considering the report t-he Committee authorised the service of a closing order and as the premises were not vacated on the expiration of the notice, proceedings were instituted and a case was heard before the local Magistrates, who made an order for the premises to be vacated within twenty-one days. This order was obeyed and the owners of the property have since submitted plans for the reconstruction of the buildings. At the time of making this report reconstruction work has not been commenced and the Local Authority will, therefore, be asked to serve demolition orders. The Staff of the Department heard with deep regret on 14th May of the sudden death on the previous day of Dr. Gilmour, the Medical Officer of Health, and desire to record their acknowledgment of his kindness of heart and consideration at all times. I again desire to record my appreciation of the loyal support and assistance rendered by my Staff generally, and to acknowledge the kind co-operation of my colleagues of other Departments. I am, Ladies and Gentlemen, Your obedient Servant, HENRY JOHNSON, F.S.I.A., F.R.S.I. Chief Sanitary Inspector. 29 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 37 Cisterns provided 9 Cisterns repaired, cleansed or covered 23 Drains, new, provided 17 Drainage systems made water-tight by patent process 21 Drains, repaired or altered 62 Drains, stoppages removed 74 Dustbins provided 103 Flushing cisterns, new, provided 58 Flushing cisterns repaired 90 Manure receptacles provided - Overcrowding nuisances abated 5 R.W. pipes disconnected 5 Roofs repaired 200 Rooms stripped and cleansed 873 Verminous rooms cleansed 10 Soilpipes, new. provided 17 Soilpipes, repaired or altered 7 Vent pipes, new, provided 25 Vent pipes, repaired or altered 32 Waste pipes, new, provided 71 Waste pipes repaired, disconnected or trapped 39 Water-closets, new, provided 102 Water-closets, repaired or ventilated 8 Water services restored 45 Yards paved 6 Yards repaired 55 Guttering repaired 129 Floors ventilated 11 Nuisances abated from damp walls 124 Water supply direct from main 16 Sinks provided 43 Rooms fumigated 574 Other nuisances 1,586 4,477 30 MEDICAL OFFICER'S REPORT— Con tinned from p. 18. Housing Statistics for the Year 1928. Number of new houses erected during the year:— (a) Total, including (b), (i), (ii)154 (b) With State Assistance under the Housing Acts— (i) By the Local Authority 5 (ii) By other bodies or persons — I.— UNFIT DWELLING-HOUSES. I—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1.00!) (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 468 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 756 //.—Remedy of defects without service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 960 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 31 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners Nil (1)) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intentions to close Nil B:—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 97 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 50 (b) By Local Authority in default, of owners Nil C:— Proceedings under Sections 11. 14, and If) of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 2 (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 2 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 32 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, 20 dairymen, 30 dairymen and purveyors, and 13 purveyors on the Registers on 31st, December, 1928. 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 8 Supplementary 32 (3) One licence was refused. See Sanitary Inspector's Report (p. 23). (4) Bacteriological examinations:—All samples satisfactory. (b) Meat:— See Sanitary Inspector's Report (p. 27). SLAUGHTER HOUSES. In 1920. In Jan. 1928. In Dec. 1928 Registered 4 2 2 Licensed 1 — — Total 5 2 2 (c) Other Foods:— See Sanitary Inspector's Report (p. 25). PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The incidence of infectious diseases in the area was slightly higher than in 1927. 126 cases of Scarlet Fever and 170 cases of Diphtheria were notified, of which 102 and 157 respectively were removed to the Isolation Hospital (v. Report on Isolation Hospital). Outbreaks of influenza, whooping cough and chicken pox occurred during the year but never reached serious proportions. 33 Smallpox:—No cases occurred during the year. Typhoid Fever and Paratyphoid:—There was a slight decrease in the number of cases notified during 1928—4 cases of typhoid and 6 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. Puerperal Fever and Pyrexia:—Two cases of puerperal fever and 6 cases of puerperal pyrexia were notified, of which the 2 cases of fever and 2 cases of pyrexia were removed to hospital. Encephalitis Letliargica.—One case was notified and admitted to hospital. Two cases of malaria 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. 34 35 TABLE A.— Notifiable diseases—1928. Table showing the total cases notified and deaths in age groups, the numbers removed to hospital, and the total deaths. DISEA8E. Total cases Notified. Under 1 Year. 1— 2— 3— 4— 5— 10— 15— 20—1 35— 45—j 55 and over. Cases admitted to Hospl. Total Deaths Death Rates. Diphtheria Notified 170 1 2 7 9 5 77 31 14 14 7 3 - 162 Deaths — — — 2 — 4 — — — — — — 6 1 Scarlet Fever Notified 126 — 2 6 9 8 42 29 8 18 1 3 — 104 Deaths — — — — — — — — — — — — — — Enteric Fever Notified 4 - - - - - - - - 2 1 1 — 2 Deaths - - - - - - - - - - — — Puerperal Fever Notified 2 - - - - - - - - 1 1 — — 2 Deaths — — — — — — — — 1 — — — 1 01 Pneumonia Notified 35 1 1 6 — 3 3 1 2 3 2 8 5 1 Deaths 12 1 2 — — 1 — — 3 2 10 15 46 7 Erysipelas Notified 19 1 - - - - - 1 — 3 5 9 — 6 Deaths - - - - - - - - - - - - - - Encephalitis Lethargica Notified 1 1 — — — 1 Deaths — — — — — — — 1 — — — — 1 01 Cerebro-Spinal Meningitis Notified 1 — — — — — — — 1 — — — — 1 Deaths — — — — — — — 1 — — — — 1 01 Ophthalmia Neonatorum Notified 3 3 - - - - - - - - - - - - Deaths - - - - - - - - - - - - — - Anterio Poliomyelitis Notified 1 — — — — — — — 1 — — — — — Deaths — — — — — — — 1 — — — — 1 01 Puerperal Pyrexia Notified 6 - - - - - - - - 3 3 — — 2 Deaths - - - - - - - - - - - - - Para Typhoid Notified 6 — — — — — 2 1 — 3 — — — 2 Deaths — — — - - - - - - - - - - - Tuberculosis Notified 79 — 2 — — 1 9 — 11 33 7 14 2 31 Deaths — 2 — — — 5 — 3 11 4 17 3 45 '7 Malaria Notified 2 — — — — — — — — 2 — — — — Deaths - - - - - - - - - - - - — — totals Notified 455 6 7 19 18 17 133 63 38 82 27 38 7 314 Deaths 12 3 2 2 — 10 6 15 6 27 18 101 17 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 Tuberculosis Diseases. 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 1.01 — .06 .01 .01 05 .15 .05 .75 1925 101 — .03 .01 — .1 — .08 .77 1926 .706 — — — — — .103 — .6 1927 .94 — .01 .03 — .05 — .03 .8 1928 1.10 - - .1 - 08 .11 03 .7 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 1928, 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. Hay don Park Ward. 1 2 3 4 5 6 7 8 Diphtheria (including Membranous croup) 170 6 4 5 6 18 70 35 26 162 Erysipelas 19 1 1 1 1 1 7 5 2 6 Scarlet Fever 126 15 9 8 17 19 29 14 15 104 Enteric Fever 4 2 1 — — — 1 — — 2 Puerperal Fever 2 — — — — — 1 — 1 2 Cerebro-spinal Meningitis 1 — - — — 1 — — — 1 Pulmonary Tuberculosis 65 6 10 4 8 3 12 15 7 29 Other forms of Tuberculosis 14 1 3 — — 2 2 4 2 2 Ophthalmia Neonatorum 3 — - — — - 2 1 - - Encephalitis Lethargica 1 — — — — 1 — - — 1 Pneumonia 32 — 4 — 2 5 10 4 7 1 Influenzal Pneumonia 3 — — — — 2 1 - - Anterio Poliomyelitis 1 — — — 1 - - - — - Puerperal Pyrexia 6 1 — — — — 2 1 2 2 Para-Typhoid 6 1 — 3 — 2 — — — 2 Malaria 2 — 1 — — — — 1 — Totals 455 33 33 21 35 52 138 81 62 314 36 Scarlet Fever:—The total number of cases notified during the year was 126 from 115 houses. The attack rate was 2.1 per thousand of the population. Attack-Kate. Death — Rate 1891-1895 4.8 .02 per thousand of the population. 1896-1900 3.3 .04 1901-1905 2.3 .02 1906-1910 4.07 .05 1911-1915 3.03 .01 1916-1920 1.8 .01 1921-1925 3.04 .02 In one house there were four cases, in one house three eases, in six houses two eases, and in the remaining 108 houses, one ease. 102 or 80 per cent, of the eases were treated in the Borough Isolation Hospital, Gap Road. 58 per cent, of the cases notified were children of school age, five to fifteen years, and of these, 64 attended the following schools:— Old Central Schools 5 Cottenham Park, Mixed 1 Effra Road Girls' and Infants' Schools 2 Durnsford Road Mixed & Infants' Schools 8 Queen's Road Girls' and Infants' Schools 4 Queen's Road Boys' School 3 Pelham Road Infants' School 2 Pelham Central Schools 3 Dundonald Road Girls' & Infants' Schools 1 Russell Road Infants' School 5 Haydons Road Girls' School 2 Haydons Road Infants' School 3 Haydons Road Boys' School 2 Private Schools 14 Schools outside the district 9 Total 64 Diphtheria:— The total number of cases notified during the year was 170 from 143 houses. The attack-rate was 2.8 per thousand of the population. In three houses there were three cases, in twenty-one houses two cases, and in the remaining one hundred and nineteen houses, one case. 37 There were six deaths. 157 or 92 percent, of the patients were treated in the Isolation Hospital. 66 per cent, of the cases notified were children of school age, five to fifteen years, and of these, 99 attended the following schools:— Dundonald Boys' 3 Dundonald Girls' and Infants' 10 Cottenham Park Mixed and Infants' 1 Haydons Road Boys' 12 Old Central School 4 Queen's Road Girls' and Infants' Schools 3 Haydons Road Girls' and Infants' Schools 27 Pelham Road Infants' School 11 Effra Girls' and Infants' 15 Queen's Road Boys' o O Pelham Central 2 Private Schools 4 Schools outside the district 4 Total 99 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 following table shows the number of new cases notified during the year, and the number of deaths from tuberculous diseases. NEW CASES. DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males Females. Under 1 year - - - - - - - — 1— 5 ,, — — 2 1 — — 2 — 5 — 10 ,, 1 1 5 2 — — 2 3 10—15 ,, — — — — — — .— — 15 — 20 ,, 2 8 1 — 2 1 — — 20 — 25 ,, 4 10 — 2 2 2 — — 25 — 35 ,, 8 9 — — 3 4 — — 35 — 45 ,, 6 1 — — 1 3 — — 45 — 55 ,, 6 — — — 8 2 - — 55 — 65 ,, 7 1 — — 3 3 - 1 65 upwards — 1 — 1 — 1 — 2 Totals 34 31 8 6 19 16 4 6 38 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 35 deaths from Pulmonary Tuberculosis, 14 died outside the district (8 males and 6 females), i.e., notification of death was transferred to Wimbledon. Of the 10 NonPulmonary deaths, 2 males and 2 females died outside the district. Of the 10 non-Pulmonary Tuberculosis deaths, 6 were due to Meningitis, 1 to Peritonitis, and one each to Spine, Kidneys and Pelvis. LABORATORY WORK. The Municipal Laboratory was re-opened towards the end of March, 1927. 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." 1,917 examinations had been made by the end of 1928 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.C., 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. 30 Bacteria Pound. Bacteria Not Found Total. Diphtheria Swabs 226 1194 1420 Phthisis (Sputum) 20 103 123 Pus — 2 2 Reaction Obtained. Reaction Not Obtained. Total. Typhoid (Blood) 8 47 55 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 analysis 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 542 164 38 768 1255 63 107 4093 201 7231 Diphtheria 302 191 45 631 894 33 49 1930 208 4283 Typhoid Fever 6 9 1 14 35 - — 108 3 176 Erysipelas 11 16 2 32 55 118 14 248 Tuberculosis 41 15 18 99 91 16 — 130 56 466 Cancer 21 20 23 108 38 4 — 82 22 318 Pneumonia and Influenza 13 3 3 34 27 - - 18 4 102 Encephalitis Lethargica - - 1 3 - - - - 1 5 Vermin 16 1 — 13 4 — — 90 18 142 Sundries 90 58 21 258 224 7 6 1787 47 2498 totals 1042 477 152 1960 2623 123 162 8356 574 15469 40 Wimbledon Isolation Hospital. Carriied over from 1927 Under 5 years. Over 5 years. Total. Deaths. Remarks. Under 5 years Over 5 years. Total. Scarlet Fever 4 22 26 — — — Daily average number of cases, 57. Diphtheria 7 3g 43 — — — Cases admitted in 1928. From Wimbledon Scarlet Fever 20 76 96 - - - Scarlet Fever and Para Typhoid - 1 1 - 1 1 Diphtheria 24 136 160 2 4 6 Diphtheria Contact 1 — 1 — — Average number of days in hospital, 43 Diphtheria and Appendicitis - 1 1 - - - Diphtheria and 8carlct Fever - 1 1 - - - Erysipelas — 4 4 - — — Measles 2 — 2 - — — Typhoid Fever — 3 3 - — — From Kingston. Scarlet Fever 15 44 59 - - - Total Kingston cases, 201 Diphtheria 20 120 140 2 6 8 Encephalitis Lethargica - 1 1 - 1 1 Diphtheria and Measles - 1 1 - - - From Caterham. Diphtheria - 8 8 - - - Front Wandsworth. Scarlet Fever — 1 1 — - - Total Treated in 1928 93 455 548 4 12 16 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £24,000. 479 cases were admitted to the Wimbledon Isolation Hospital during 1928, making a total of 548 cases under treatment during the year, 69 cases remaining under treatment from 1927. 269 cases were from Wimbledon, 201 from Kingston, 8 from Caterham, and 1 from Wandsworth. Scarlet Fever:— 57 cases were admitted as scarlet fever. Serum treatment was given to all the more serious cases of Scarlet Fever on admission to hospital. No deaths from scarlet fever occurred in hospital during the year amongst the 157 cases treated. The chief complications that arose were otorrhœ, rhinitis and adenitis. There were two cases of albuminuria and one case that developed acute nephritis. 41 Three "return" cases, occurred. This amounts to approximately 2 per cent, of the cases discharged. One case admitted from a local hospital as Scarlet Fever, died following operation for Appendicitis. Diphtheria:— 311 cases were admitted notified as diphtheria. This shows a big increase over the number of cases— 124—admitted during the previous year. In all, 14 deaths occurred, giving a case mortality for diphtheria of 4.5 per cent. Tracheotomy was performed in one case of laryngeal diphtheria. This child made an uneventful recovery. The following complications occurred amongst 311 cases treated during the year:— Adenitis 4 Otorrhœa 8 Pneumonia 2 Paralysis of Palate 26 Ciliary Paralysis 8 Pharyngeal Paralysis 7 Other complications 2 Two consecutive negative swabs were obtained from all cases before discharge from hospital. Enteric and Paratyphoid Fever:—1 true enteric and 2 paratyphoid B cases were admitted—1 of which was moderately severe. There were no deaths. Erysipelas:— Four cases of idiopathic erysipelas were admitted. One developed double otorrhœa. Encephalitis Lethargica:— One case of encephalitis lethargica was admitted and died two days after admission to hospital. 42 Maternity and Child Welfare. Steady progress has characterised this section of public health work, and there will be still further progress now that 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 overemphasised. 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 1928 occurred in hospitals where the best attention was given. Education of expectant mothers, with careful medical examinations, is 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. 3 3 — — - — — There were 7 deaths from measles, and 5 from whooping cough. No eases of epidemic diarrhoea were notified. 43 During 1928, the record of Home Visitation work was as follows:— Number of births notified 615 „ „ „ registered 637 Number of births visited ... 531 „ „ „ re-visited—under 1 yr. 1,356 „ „ ,, „ —over 1 yr. 1,440 „ „ Ophthalmia cases visited 3 „ „ Expectant mothers visited 51 „ „ re-visits to expectant mothers 146 „ „ ineffectual visits 942 „ „ Special visits 469 Total welfare visits 4,938 Number of puerperal fever visits 4 „ „ tuberculosis visits 93 „ „ malaria visits — „ „ school visits (half-day) 59 „ „ visits to parents of school children 37 5,131 During 1928, the record of work at the Centres was as follows:— Infant Welfare Consultations. Queen's Hall Centre. Wandle Park Centre. Number held 49 51 Total number of attendances 3,040 1,687 Average number of attendances. 61 33 Ante-Natal Clinic Consultations. Number held 20 Total number of attendances 133 Average number of attendances 6 Classes for Mothers. Number held 44 42 Total number of attendances 1,676 1,601 Average number of attendances... 38 38 Subjects taught Home Nursing Infant Care Mothercraft Hygiene Sewing Singing Home Nursing Infant Care Mothercraft Hygiene Ante-Natal Hygiene Singing 44 Supply of Milk to Expectant & Nursing Mothers & Infants. During the year, 148 applications for free milk supplies were received from 54 families, 132 of which were granted. 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. The following work was carried out in connection with the Welfare Centres, by the Dental Surgeon for the year ending 23rd December, 1928. Mothers—Attendances for treatment 147 ., Teeth extracted 105 „ ., filled 45 „ other operations 64 „ Scalings 17 „ Dentures supplied 14 „ „ repaired and re-modelled 4 „ other Prosthetic operations 16 Babies—Attendances for treatment 110 „ Teeth extracted 95 „ „ filled 25 „ other operations 45 Total number of fillings inserted 86 „ „ „ Local Anæsthetics administered 12 „ „ „ General do. do. 53 „ „ „ „ do. do. (by Dr. Scott), joint 59 South Wimbledon Day Nursery:— The number of children on the register was 80, representing 60 families. The total attendances were 9,489, of which 1,644 were half-day attendances. Daily average, 38. 45 Owing to the unfortunate death of Dr. Gilmour, the work of the Public Health Department was carried on during the remainder of the year by Dr. E. M. D. Craig, the Assistant Medical Officer of Health, and Mr. Johnson, the Chief Sanitary Inspector. During the same period, Dr. W. Galvin was appointed to act as Medical Superintendent to the Wimbledon Isolation Hospital at Gap Road. The whole of the staff co-operated in an enthusiastic and loyal way in the work of the. department. I have the honour to be, Your obedient servant, HAROLD ELLIS, Medical Officcr of Health. Public Health Offices, 20, Queen's Road, Wimbledon, S.W.19. 16 47 TABLE 1.—Vital Statistics of Whole District during 1928 and Previous Years. YEAR. 1 Population estimated to middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths Belonging to the District. Uncorrected Number. 3 Nett. Under 1 year of Age At all Ages. Number. 4 Rate. 5 Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Number. 10 Pate per 1000 Nett Births. 11 Number. 12 Rate. 13 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 C38 10.9 1926 58.030 722 807 13.9 479 8.2 S3 183 27 33 579 9.9 1927 58,150 671 717 12.3 494 8.4 93 219 37 50 620 10.6 1928 59,070 637 691 j 11.6 476 8.05 84 240 38 55 632 10.7 48 TABLE II.— Causes of, and Ages at, Deaths during the year 1928. CAUSES OF DEATH. Nett Death at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' or 'Non-residents' in Institutions in the District. All Ages. Under 1 year 1— 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 630 38 9 6 4 1 13 3 14 37 27 169 309 92 Uncertified 2 - — - — — - — — — 2 — Enteric Fever - - - - - - - - - - - - - - Small-pox — - — — — — — - — — - — — — Measles 7 - 3 2 1 - 1 Scarlet Fever - - - - - - - - - - - - - - Whooping Cough 5 2 2 — — — 1 - — - - - - - Diphtheria and Croup 6 — — — 2 — 4 - — - - - - 14 Influenza 8 - - 1 - - - - 1 - - 2 4 - Encephalitis Lethargica 1 — — - - — - - 1 - - - - 1 Meningococcal Meningitis 1 — — — — — - - - - - 1 - - Tuberculosis of Respiratory System 35 - - - - - - - 3 11 4 16 1 - Other Tuberculous Diseases 10 — 2 - - - 5 - - - - 1 2 2 Cancer, malignant disease 84 - - - - - - - - 1 6 40 37 9 Rheumatic Fever 1 — — - - - - - - - - - - Diabetes 6 - - - - - - - - 1 1 - 4 1 Cerebral Hæmorrhage 25 — — — — — — - — - 1 4 20 1 Heart Disease 112 - - - - - - - 1 2 5 26 78 11 Arterio Sclerosis 42 — — — — - - - - - - 15 27 14 Bronchitis 29 1 1 4 23 7 Pneumonia (all forms) 46 12 1 2 — - 1 - — 3 2 10 15 - 49 TABLE II,—continued. CAUSES OP DEATH. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. Total Deaths whether of 'Residents' or 'non-resident' 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 - - - - - - - - 1 - 3 2 - Ulcer of Stomach, or Duodenum 9 - - - - - - - - 2 — 5 2 1 Diarrhoea, &c. (under 2 years) a 2 - - - - - - - - - - - 1 Appendicitis and Typhilitis 7 — — 1 2 — — 4 — 5 Cirrhosis of Liver 7 — — — — — — — — — — 4 3 1 Acute and Chronic Nephritis 18 - - - - - - - - 2 1 9 6 1 Puerperal Sepsis 1 - - - - - - - - 1 - - - - Other Accidents and Diseases of Pregnancy and Parturition 1 - - - - - - - - 1 - - - - Congenital Debility & Malformations Premature Birth 18 18 - - - - - - - - - - - 3 Suicide 5 - - - - - - - - l — 2 2 - Other Deaths from Violence 23 — — 1 — — — — 2 3 3 6 9 5 Other Defined Diseases 117 4 1 — 1 1 1 2 4 7 4 19 73 15 Causes ill-defined or unknown - - - — — - - - - - - - - - Totals 632 38 9 6 4 1 13 3 14 37 27 171 309 92 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, S.K.N. Health Visitor—School Nurses: * Miss M. Giles, C.M.B. * Miss E. M. Skelton, S.R.N. *Miss J. E. D. Elder, Resigned April, 1928. *Miss K. Kenion, S.R.N., Appointed November, 1928. Dental Attendant: Miss K. O'Hara. Cleansing Attendant: Mrs. M. Purrs. Clerk: Miss C. Coysh. (b) Part-time Officer*: Oculist: F. Moxon, O.B.E., M.B., B.S. Anesthetist: ††J. C. Scott, M.D. * Maternity and Child Welfare Officers. ‡ Public Health Officers. †Died 13th May, 1928. †† Died October, 1928. 50 Borough of Wimbledon. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1928. To the Members of the Education Committee of the Borough of Wimbledon. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit the Annual Report on the Medical Inspection and treatment of School children in the Wimbledon area for the year ending 31st December, 1928. Dr. Gilmour, your late School Medical Officer, died on the 13th May, 1928, and from that date until the end of the year, the work of the School Medical Department was carried on by Dr. E. M. D. Craig, the Assistant School Medical Officer. As I did not commence my duties as your School Medical Officer until February 4th, 1929, the Report has been issued in an abbreviated form and is chiefly of a statistical character. Administration. (a) Staff.— Miss J. E. D. Elder, School Nurse-Health Visitor, resigned in April, 1928, and was replaced by a temporary nurse, Miss Hulse, until November, when Miss K. Kenion was appointed. 51 New School Clinic and Welfare Centre. The new combined Clinic for School Medical Purposes and Welfare work, erected in Pelham Road, was opened in November, 1928. This new Clinic affords better facilities for carrying on the work, than that previously given. The Clinic is central and well equipped, and should prove a great boon. Medical Inspection. The children inspected in routine manner in accordance with the Board's Schedule were:— (1) All new admissions ("Entrants"); (2) Those of 8-9 years of age ("Intermediates"); and (3) Those of 12-13 years ("Leavers"). Total "Routine" Inspections in 1928—1,743 (v. Table I. Appendix). Findings of Medical Inspection, (v. Table II. Appendix). Routine Inspections are conducted as above. "Special" Inspections (any Age) are made daily 9.30 a.m. or at the "Inspection" Clinic on Tuesday afternoon sessions. The children requiring to be kept under observation were those suffering from chronic nose and throat conditions—heart and lung cases—defects of vision, and a few deformities. Minor Ailments. This Clinic is held every morning, and the children are sent either by the School teachers or their mothers. 1,633 children attended for treatment, and made 4,722 attendances. The cases treated were mostly minor injuries— septic sores—various skin diseases—external eye and ear eases. Tonsil and Adenoid Cases. An arrangement is made with the local hospitals for any case thought to require treatment. 100 cases have been operated on during the year. All these cases are kept under observation at the Clinic for some months after treatment. Tuberculosis Cases. Children thought to be suffering from Tuberculosis are referred to the County Tuberculosis Officer for treatment. These cases are kept under close observation and "infective" cases are excluded from school or sent to special Institutions. 52 Skin Diseases. Obstinate cases of ring-worm of the scalp are sent to Hospital for treatment by X-rays. Other cases of skin diseases are treated at the Clinic and bathing is carried out when necessary by a Special Attendant. Eye Disease and Vision. A few cases of simple external eye diseases were treated. Two cases were admitted for treatment to the local hospitals under special arrangement with the Education Authority. New Cases, 1st Time 167 Old Cases, Re-tested 218 Re-attendances 390 Total 775 141 children obtained or received spectacles under the Authority's scheme. 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. Dental Defects. Table IV. Group IV. Appendix. Crippling Defects and Orthopoedics. Close co-operation with the local hospitals in the treatment of these defects is maintained. Co-operation with Parents, Teachers and Attendance Officers. 85% of the parents attended the "Routine" Inspections, and most of the children receiving treatment were accompanied by parents. Thanks are due to the different Voluntary Welfare Associations for assistance given in special cases. The cooperation with Teachers and Attendance Officers continues in the most cordial manner. Defective Children. 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. Practically all the children remain to mid-day meal. No complaints were received, and no outbreaks of infectious disease occurred. 53 All the children were examined physically by the Medical Officer, and the Dental Officer carried out his annual inspection and treatment. Two transfers were made during the year to the Littleton Street Special School for boys. Physically Defective Children. The following special cases were dealt with:— 1 boy Admitted to School for totally Blind. ;t (2 boys, 1 girl) ,, ,, Myope School. 3 (2 boys, 1 gill) ,, ,, School for Deaf and Dumb Children. 2 boys ,, ,, Cripple (Residential) Schools. 1 girl ,, ,, Special School for Epileptics. 1 girl ,, ,, Special Home for Epileptics. Employment of Children and Young Persons. 94 children were specially examined and certified as to employment. I am indebted to Dr. E. M. D. Craig, the Assistant School Medical Officer, for compiling this report on the work of the School Medical Department, and in conclusion I should like to draw the attention of the Committee to the able manner in which the staff have carried on their work during the year under review. 1 have the honour to be Your obedient servant, HAROLD ELLIS, School Medical Officer. 54 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1928. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.— ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections:— Entrants 577 Intermediates 520 Leavers 552 Total 1,649 Number of other Routine Inspections 94 B.— OTHER INSPECTIONS. Number of Special Inspections 2,661 Number of Re-Inspections 5,406 Total 8,070 55 TABLE II. A.— RETURN OF DEFECT8 FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1928. DEFECT OR DISEASE Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition - - 8 3 Skin ' Ringworm—Scalp 2 - 20 - Body — - 45 - Scabies 2 - 15 - Impetigo 5 - 291 - Other Diseases (non-tuberculous) 9 3 235 - Eye Blepharitis 8 - 22 Conjunctivitis 3 — 16 — Keratitis 1 — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 71 38 237 34 Squint 14 — 4 — - Other Conditions — 2 24 3 Ear Defective Hearing 2 1 6 7 Otitis Media 4 — 52 Other Ear Diseases 5 — 12 11 Nose and Throat Enlarged Tonsils only 13 30 50 16 Adenoids only — 3 7 2 Enlarged Tonsils and Adenoids 42 9 62 28 Other Conditions . 1 2 175 113 Enlarged Cervical Glands (non-tuberculous) 9 13 20 15 Defective Speech 5 — — — Heart and Circulation Heart Disease: Organic 3 3 5 14 Functional 5 4 9 6 Anæmia - - 5 — 56 TABLE II— continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but hot requiring Treatment. (1) (2) (3) (4) (5) Lungs Bronchitis 8 9 44 27 Other Non-Tuberculous Diseases 6 1 - - Tuberculosis Pulmonary: Definite — — - - Suspected — — - - Non-Pulmonary: Glands — — - - Spine — — - - Hip — — - - Other Bones and Joints 2 — - - Skin — — - - Other Forms — — - — Nervous System Epilepsy 2 4 4 2 Chorea 4 2 6 2 Other Conditions 1 2 4 3 Deformities Rickets 3 1 — 1 Spinal Curvature 4 — 2 — Other Forms 1 4 4 — Other Defects and Diseases 13 3 750 64 B.— NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 577 178 30.8 Intermediates 520 134 25.8 Leavers 552 123 22.8 Total (Code Groups) 1649 435 20.3 Other Routine Inspections 94 16 17.0 57 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1928. Boys. Girls. Total. Blind (including partially blind.) (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 1 - 1 Attending Public Elementary Schools - - - At other Institutions... — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes lor the Blind 2 1 3 Attending Public Elementary Schools At other Institutions — — — At no School or Institution — — — Deaf (including deaf and dumb and partially deaf.) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the deaf. 2 1 3 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. Feeble minded (cases not notifiable to the Local Control Authority). Attending Certified - - - Schools for Mentally Defective Children 29 26 55 Attending Public Elementary Schools - - - At other Institutions — — At no School or Institution 1 1 2 58 TABLE III.— Continued. Boys. Girls. Total Mentally Defective contd. Notified to the Local Control Authority during the year Feebleminded - - - Imbeciles — 2 2 Idiots - - - Epileptics S u ff e r i n g from severe epilepsy Attending Certified Special Schools for Epileptics - 1 1 In Institutions other than Certified Special Schools - 1 1 Attending Public Elementary Schools - - - At no School or Institution — — — Suffering from epilepsy which is not severe. Attending Public Elementary Schools 5 2 7 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 3 3 6 At other Institutions — — — At no School or Institution — — — 59 TABLE III.— Continued,. Boys. Girls. Total Delicate children (e.g., pre - or latent tuberculosis, malnutrition, debility, anaemia, etc.) At Certified Residential Open Air Schools ... - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 19 21 40 At other Institutions — — — At no School or Institution — — — Physically Defective (continued] Active non - pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 3 2 5 At Public Elementary Schools - - - At other Institutions — - — At no School or Institution — — — Crippled Children (other than those with active tubercu1ous disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools - - - At Certified Residential Cripple Schools 2 - 2 At Certified Day Cripple Schools - - - At Public Elementary Schools 23 24 47 At other Institutions — — — At no School or Institution — - — 60 TABLE IV.— RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER 1928. TREATMENT TABLE. GROUP I.— minor Ailments (excluding Uncleanliness, for which see Group v.). DISEASE OR DEFECT. Number of Defect treated, or under treatment during the year. Under the Authority's Scheme Otherwise. Total, (1) (2) (3) (4) Skin— Ringworm—Scalp 20 — 20 Body 45 — 45 Scabies 14 1 15 Impetigo 261 30 291 Other skin disease 200 35 235 Minor Eye Defects— (External and other, but excluding oases falling in Group II.) 70 6 76 Minor Ear Defects 40 6 46 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 536 60 596 Total 1186 138 1324 GROUP ii.— Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). defect or disease. Number of Defects dealt with. Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including Squint 379 17 - 396 Other Defects or Disease of the Eyes (excluding those recorded in Group i.) 6 — - 6 Total 386 17 — 402 Total number of children for whom spectacles were prescribed:— a. Under the Authority's Scheme 147 b. Otherwise — Total number of children who obtained or received spectacles:— a. Under the Authority's Scheme 141 b. Otherwise — 61 TABLE IV,— continued. GROUP III.— TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (2) (3) (i) (5) 100 23 128 150 278 GROUP IV.— DENTAL DEFECTS. 1. Number of Children who were:— a. Inspected by the Dentist: Aged Aged Routine Age Groups 5 246 10 26 Total 1798 6 430 11 14 7 463 12 18 8 554 13 10 9 18 14 19 Specials 708 Grand Total 2506 b. Found to require Treatment 2183 c. Actually Treated 1280 d. Re-treated during the year as the result of periodical examination 604 2. Half-days devoted to:— Inspection, 29. Treatment, 366 Total 395 3. Attendances made by Children for Treatment 2650 4. Fillings:— Permanent Teeth, 790. Temporary Teeth, 310 Total Teeth 1106 Total Fillings 1414 5. Extractions:— Permanent Teeth, 208. Temporary Teeth, 2317 Total 2525 6. Administrations of general anaesthetics for extractions 479 7. Other Operations:— Permanent Teeth, 560 Temporary Teeth, 1027 Total 1587 GROUP V.— UNCLEANLINESS AMD VERMINOUS CONDITION. 1. Average number of visits per School made during the year by School Nurses 12 2. Total number of examinations of children in the Schools by School Nurses 36,760 3. Number of individual children found unclean 208 4. Number of children cleansed under arrangements made by the Local Education Authority 200 5 Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — 62