Borough of Wimbledon. Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year 1930. Together with the Report of THE SCHOOL MEDICAL OFFICER AND OF THE SANITARY INSPECTOR. Borough of Wimbledon. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year ended 31st December, 1930. public health Committee Chairman: Councillor E. Fielder. Vice-Chairman: Councillor D. Carver. Members: The Mayor (Councillor Burrows, J.P.), Alderman Hickmott Councillor F. W. Daffen ,, A. J. Penman ,, A. A. Drake Councillor E. J. Chard ,, C. B. Heaton ,, H. A. Crowe ,, A. R. Kelly ,, A. W. Hughes ,, Lady Roney Clarke ,, S. B. Stone Maternity and child Welfare Committee: Chairman: Councillor Lady Roney. Vice-Chairman: Councillor A. A. Drake. Members: The Mayor (Councillor Burrows, J.P.), ex-officio. Alderman Hickmott Councillor T. R. Daniel Councillor Carver ,, C. B. Heaton ,, A. W. Hughes Mr. G. Edwardes-Jones, K.C. Clarke ,, H. Dormer Mrs. Chard ,, Daniel ,, Fielder ,, Sheerman STAFF Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer. ‡ * Harold Ellis, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health, Assistant School Medical Officer. ‡ Effie M. D. Craig, M.B., Ch.B. Chief Sanitary Inspectorg, ft, * Henry Johnson, M.B.E., F.B.San.I., F.S.I.A. Assistant Sanitary Inspectors: R. T. Avis, d, g, h. D. F. S Flynn, g, ft. Health T'isitors—School Nurses: Mi ss M. Giles, b, d, f. Miss E. M. Skelton, a, b, f. Miss K. Kenion, a, b, c, e (Resigned April, 1930). Miss G. Hyde, a, b, c (Appointed May, 1930). Clerics: Miss N. Low. Miss M. Winslade. Clerk: to the Maternity and Child Welfare Department: Miss N. Low. Part Time: Dr. Dan McKenzie, Consulting Oto-Laryngologist to Isolation Hospital. A. McAllister, F.B.C.S., Consulting Obstetrician under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia). Regulations, 1926. Col. E. Middletom Perry, C.B.E., F.R.C.V.S., Veterinary Inspector. J. H. Johnston, M.Sc., F.I.C., Bacteriologist. * Salary contribution under Public Health Acts. ‡ ,, ,, by Exchequer Grants. a. S.R.N. b. C.M.B. c. Certificate Fever Training. d. Certificate Sanitary Inspectors Examination Board (London). e. New Health Visitor's Certificate Royal Sanitary Institute. f. Health Visitor's Certificate Royal 'Sanitary Institute. g. Certificate Royal Sanitary Institute for Inspector of Nuisances. h. Certificate Royal Sanitary Institute for Inspector of Meat and Other Foods. 2 CONTENTS Medical Officer's Report— Page Public Health Committee 1 Maternity and Child Welfare Committee 1 Staff 2 Stuff and Administration 5 Natural and Social Conditions of the Area 6 Vital Statistics for 1930 6 Population, Birth and Death Rates for each Ward, 1930 7 Births 8 Deaths 8 Infantile Mortality 10 Public Assistance 10 General Provision of Health Services in the Area 11 List of Local Acts, Orders and Adoptive Acts, in force 13 Sanitary Inspection of District 15 Factories and Workshops 17 Sanitary Circumstances of the Area 19 Public Swimming Baths 19 Sanitary Inspector's Report— Notices Served 20 Legal Proceedings 20 Opening up of Drains under Section 41 of the Public Health Act, 1875, and Amending Acts 20 House Drainage 20 House to House Inspection 21 House Inspection 21 Overcrowding 21 Underground Dwellings 22 Houses Let in Lodgings 22 Verminous Rooms 22 Common Lodging Houses 22 Van Dwellings 23 Dairies, Cowsheds and Milkshops 23 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 1928 25 Petroleum Acts 25 Diseases of Animals Acts, 1894 to 1925 25 The Public Health (Meat) Regulations, 1924 26 Rent (Restrictions) Acts, 1920 to 1923 26 Water Supply 26 Employment Agencies 26 Employment of Children Bye-laws 27 Fouling of Footways by Dogs 27 Public Health (Smoke Abatement) Act, 1926 27 Small-pox Contacts 28 Mosquitoes 28 Examination of Sludge 28 Offensive Trades 28 Summary Table—Nuisances Abated 30 Housing Statistics for the Year 1930 31 Overcrowding 34 Inspection and Supervision of Food 36 Prevalence of, and Control over, Infectious Diseases 37 3 Medical Officer's Report—continued Page Notifiable Diseases and Deaths, 1930, in age-groups, etc. 38 Death-rate from Zymotic Diseases, for the last ten years 39 Ward Distribution of Infectious cases notified in 1930 39 Scarlet Fever 40 Diphtheria 40 Tuberculosis 41 Smallpox 43 Psittacosis 43 Food Poisoning 44 Typhoid and Enteric Fever 44 Puerperal Pyrexia and Puerperal Fever 45 Encephalitis Lethargica 45 Laboratory Work 46 Chemical Work 46 Disinfection 47 Wimbledon Isolation Hospital 48 Scarlet Fever 48 Diphtheria 50 Erysipelas 51 Enteric Fever 51 Meningitis 51 Measles 51 Maternity and Child Welfare 53 Maternal Mortality 55 Record of Home Visitation Work and at Centres 56 Supply of Milk to Expectant and Nursing Mothers and Infants 56 Dental Surgery 57 Children Act 57 Municipal Day Nursery 58 Table I.—Vital Statistics 61 Table II.—Causes of Deaths, etc. 62 School Medical Officer's Report— Staff 64 Co-ordination 65 Reorganisation 66 School Hygiene 67 Medical Inspection 67 bindings of Medical Inspection 68 Infectious Disease 73 Following up 74 Medical Treatment 75 Speech Clinic 78 Open Air Education 79 Physical Training 80 Provision of Meals 80 School Baths 80 Co-operation of Parents and Teachers 80 Co-operation of Voluntary Bodies 81 Blind, Deaf, Defective and Epileptic Children 81 Nursery Schools 83 Secondary Schools 83 Employment of Children and Young Persons 83 Special Enquiries 84 Health Propaganda 84 Table I.—Return of Medical Inspections 85 ,, II.—Return of Defects 86 ,, III.—Return of all Exceptional Children 88 „ IV.—Treatment Table 91 4 Borough of Wimbledon. Public Health Department. ANNUAL REPORT of the Medical Officer of Health for the Year ended 31st December, 1930. To the Mayor, Aldermen, and Councillors of the Borough of Wimbledon. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the work of the Public Health Department for the year ending 31st December, 1930, together with my Report as School Medical Officer. The Report for 1930 is of a more simple character than the full survey report which was prepared in 1925. It contains, however, information on certain matters in more detail than has been given for the last four years, i.e., (a) the transfer of the Poor Law functions in pursuance of the Local Government Act of 1929. In Wimbledon, the only functions transferred are those under Part I. of the Children Act 1908. (b) Additional information concerning Housing conditions in the district. Staff and Administration. A full list of the staff of the Public Health and School Medical Departments is given at the commencement of the respective Annual Reports. One of the Health Visitors, Miss Kenion, left to take up an appointment elsewhere and Miss Hyde was appointed in her place. Examination of Employees:—During the year 1930, 82 employees were medically examined by the Medical Officer of Health. In addition 47 candidates were mcdically examined for superannuated posts under the Wimbledon Borough Council. 5 Natural and Social Conditions of the area. Area (acres) 3,220 Population (Census, 1921) 61,700 Population (Estimated, 1929, R.G.) 59,370 Number of inhabited houses:— 1921 11,926 1930 13,592 Number of families or separate occupiers:— (Census, 1921) 13,998 Rateable Value:—£680,397. Sum represented by a penny rate:— £2,766. Social Conditions:— As pointed out in the report for the year 1925, Wimbledon is situated on the outer ring and may be regarded mainly as a dormitory for workers in London. A large group of these workers are engaged in professional and commercial occupations. Business premises have sprung up locally and extended to meet the needs of the residents. 436 premises are registered under the Factory and Workshops Acts. For the most part these premises are small. There are 31 laundries, employing a large number of hands, registered in the Borough. In addition there are Leather Works, Gas Mantle Works, Tool and File Works, and a Railway Stock and Repairing Depot which employ a considerable number of hands. The works in the district cannot bo said to exert any particular influence on Public Health. Extracts from Vital Statistics of the Year (1930). (Registrar-General's Figures). Total M. F. Live Births Legitimate 722 386 336 Illegitimate 44 23 21 Still Births 22 14 8 Deaths 648 317 331 Percentage of Total Deaths occurring in Public Institutions 37.1 Number of women dying in, or in consequence of, childbirth from Sepsis 2 do. do. other causes 3 6 Death-rates of Infants under one year of age per 1,000 live births legitimate 46 do. do. illegitimate 113 Total 49 Deaths from Measles (all ages) 10 ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhœa (under 2 years of age) 2 Vital Statistics for 1930 (Provisional Figures). (Registrar-General's Returns). Annual Rates per 1,000 living. Infant Mortality of infants under 1 year per 1,000 Births. Live Births. Still Birlhs. Deaths from all Causes. England and Wales 16.3 0.69 11.4 60 107 Great Towns 16.3 0.71 11.5 64 159 Smaller Towns 16.2 0.69 10.4 55 LONDON 15.7 0 56 11.4 59 WIMBLEDON 12.9 0.37 10.9 49 BOROUGH OF WIMBLEDON. Population, Birth and Death Rates for each Ward, 1930. WARD. Factor. Population. Birth Rata. Death Rate. St. Mary's 4.46 6827 9.08 13.1 Wimbledon Park 3.88 4463 8.9 6.4 St. John's 4.77 5209 9.5 11.7 Cottenham Park 4.33 7505 9.06 12.3 North Wimbledon 4.36 24004 9.1 11.3 Dundonald 5.15 7929 12.8 9.7 Trinity 5.59 11733 12.4 10.2 South Park 4.63 8628 14.6 11.5 Haydon Park 5.47 7076 24.3 11.02 South Wimbledon 5.21 35366 15.4 10.6 Whole District 4.83 59370 12.9 10.9 7 Births— The number of births registered in the district was 691 (376 males and 315 females), a decrease of 14 against last year, and equal to a birth-rate of 11.6 on a population of 59,370. The corrected birth-rate produced by transferable births notified to us by the Registrar-General is 12.9. 85 (or 12.3 per cent.) of the births were illegitimate. Notification of Births Acts, 1907 and 1915. During the year, 683 births were notified by the following persons:—Parents, 24: Midwives, 448; Doctors, 89; other persons, 122. Fourteen notifications of still-births were received. Deaths— The total number of deaths registered in the district was 444 (196 males, 248 females), equal to a death-rate of 7.4 per thousand of the population (R.G.) per annum. The deaths occurring outside the district, of persons belonging to this Borough, were 261 viz:— Kingston and District General Hospital 115 Brook wood Asylum, Woking 9 Nelson Hospital, Merton 37 Others 100 Total 261 The deaths occurring within the district, of persons not belonging thereto, were 57, viz.:— Atkinson Morley Hospital 1 Isolation Hospital 5 North Wimbledon Hospital 11 Others 40 Total 57 Taking those into consideration, the total number of deaths properly belonging to Wimbledon, is 648, and the death-rate 10.9. The rate for England and Wales for the same period was 11.4. Table showing the births, deaths, and death-rates in the Borough of Wimbledon in the last seven years. 1930 1929 1928 1927 1926 1925 1924 Births 766 759 691 717 807 760 814 Deaths 648 774 632 620 579 638 645 Death-rates 10.9 13.03 10.7 10.6 9.9 10.9 11.1 8 Table II. gives the causes of, and ages at, death during 1930. Deaths due to notifiable infectious diseases are given on p. 38. The principal causes of death, apart from zymotic deaths, are as follows:— Cancer 106 Heart Disease 128 188 Cerebral Hæmorrhage 35 Arterio Sclerosis 25 Pneumonia 44 79 Bronchitis 23 Other Inspiratory Diseases 12 Tuberculosis (Respiratory) 34 Cancer— Cancer and malignant disease were responsible for 106 deaths or 16.3 per cent. of the total number recorded. The following table gives the percentage figures since 1921. Deaths from Cancer. Year Total Deaths Cancer Deaths Percentage 1921 634 83 13 08 1922 616 91 14.7 1923 546 68 12.4 1924 645 86 13 3 1925 637 90 14.1 1926 579 104 17.9 1927 619 75 12.1 1928 632 84 13 2 1929 774 103 13.3 1930 648 106 16.3 Although these figures vary considerably from year to year, there appears to be no direct evidence that cancer is on the increase in Wimbledon. Diseases of the heart and circulation. 128 deaths were due to heart disease. In addition there were 35 deaths from cerebral hæmorrhage and 25 from arteriosclerosis. Thus, 188 deaths occurred from diseases of the heart and circulation. This figure represents 29 per cent. of the total number of deaths recorded. Bronchitis, pneumonia and other respiratory diseases. 23 deaths were due to bronchitis, 44 to pneumonia and 12 to other respiratory diseases. This gives a total figure of 79, or 12 per cent. of the deaths occurring amongst residents of the borough during 1930. 9 Infantile Mortality:—There were 38 infant deaths during the year (including transferable deaths), giving a rate of 49 per thousand registered births, an increase of 3 per thousand on last year's figures, when there were 35 deaths and a rate of 46. The infant death rate for illegitimate children was 113 per thousand illegitimate births. The following table shows the causes of death, and ages at death, of infants under one year:— Infant Mortality during the Year 1930. (Deaths from stated causes at various ages under One Year of Age ) Causes of Death. Under 1 week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Measles — — — — — — — 1 1 2 Broncho-Pneumonia and Whooping Cough — — — — — 1 — — — 1 Influenza — — — — — — — — — 1 Septic Meningitis and Acute Mastoiditis — — — — — — 1 — 1 T.B. Meningitis — — — — — — — — 1 1 Bronchitis — — — — — 1 — — — 1 Pneumonia — — 1 — — 2 4 1 1 9 Gastritis — — — — — 1 — — — 1 Acute Enteritis — — — — — 1 1 — — 2 Asphyxia 2 — — — 2 — — — — 2 Congenital Debility,—Prematurity, etc. 11 1 1 — 13 — — 1 — 14 Other Causes 1 — — — 1 2 — — — 3 Total 14 1 2 — 17 8 7 3 3 38 Public Assistance:—The following information has been furnished by the Chief Public Assistance Officer repecting Relief in this District. Amount paid in Out-door relief in 1930 £6,908 Average weekly number of persons in receipt of Domiciliary Assistance 400 Average weekly number of persons in receipt of Medical Relief only 9 Number of persons admitted to the Institution from Wimbledon Area 554 10 General Provision of Health Services in the Area. (a) Hospitals provided or subsidised by the Local Authority or the Surrey Comity Council:— (1) Tuberculosis.—Most Wimbledon patients suffering from pulmonary tuberculosis are admitted to the Sanatorium at Milford which is under the administration of the Surrey County Council. The majority of the cases of surgical tuberculosis are sent to St. Anthony's Hospital, Cheam, or similar institutions. (2) Maternity.—There are at present no Maternity Hospitals in the area. An extension to the Nelson Hospital is at present under construction. This will provide 20 maternity beds. It is hoped that this maternity block will be opened in September. In addition, an Ante-natal Department will be established. (3) Children.—There are no special Children's Hospitals in Wimbledon. The general hospitals in the area are available for the purpose. Many of the children in the Borough receive treatment from the large London Hospitals such as Great Ormond Street and Tite Street. (4) Infectious Diseases.—The Corporation's Isolation Hospital, at Gap Road, has accommodation for 100 beds for the treatment of patients suffering from scarlet fever, diphtheria, enteric, erysipelas, meningitis, etc. In addition, treatment is provided for certain cases of puerperal sepsis. (5) Others.—None. (b) Hospitals available for the area:— There is only one general hospital in the district, viz.: the Wimbledon Hospital, Thurston Road, Copse Hill, which has accommodation for 72 bed cases. In addition there is the Nelson Hospital for Wimbledon, Merton and District, which is situated just outside the boundary. At present this hospital has 62 beds. The Kingston and District Hospital, which is in Norbiton, has 500 beds. This hospital is administered by the Public Assistance Committee of the Surrey County Council. (c) Institutions for unmarried mothers:— Southwark Diocesan Maternity Home at 56, Gap Road, has accommodation for 12 mothers. 21 Ambulance facilities:— (a) For infectious diseases.—2 motor ambulances are maintained by the Wimbledon Borough Council at their Isolation Hospital, Gap Road. One of these ambulances is utilised for the removal of patients, whilst the other is utilised for disinfecting purposes. (b) For non-infectious cases and accidents—one motor ambulance, Fire Sation. 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) Health Centre, Pelham Road, Wimbledon. (3) Ante-Natal Clinic, Wandle Park House, Wandle Bank. All under the Wimbledon Borough Council. Day Nursery, Hubert Road, Wimbledon, under the Wimbledon Borough Council. School Clinic:—Health Centre, Pelham Road, Wimbledon, under the Wimbledon Education Committee. School Dental Clinic:—Health Centre, Pelham Road. Tuberculosis:—Dispensary, 64a, Hill Road, Wimbledon, under the Surrey County Council. Venereal Diseases:—Under the scheme of the Surrey County Council, facilities for treatment are available through the out-patient departments of the large London Hospitals. Public Health Officers of the Local Authority. (See p. 2). Professional Nursing in the Home. General and Midwifery:—The Wimbledon and District Nursing and Midwifery Association, which is supported by voluntary contributions, has a staff of a Matron and six nurses. Four of the stuff are district nurses, and two district midwives. The Association attended 164 midwifery cases during the year. 110 of these were midwives cases and 54 were cases with doctors in attendance. In all 2,373 visits were paid to maternity cases. Furthermore, 320 ante-natal visits were made by the nursing staff of the Association. The total number of cases dealt with during 1930, including midwifery, amounted to 716, making the total number of visits paid 12,801. The Wimbledon Borough Council make an annual contribution of 10 guineas, to this Association. 12 Midwives:—During the year under review the Surrey County Council were the Local Supervising Authority under the Midwives Act, 1902-26. There are 17 midwives practising in the district. Application was made under Section 62 of the Local Government Act, 1929, for the Wimbledon Borough Council to be made the Local Supervising Authority under the Midwives Acts, 1902-26. An Order was made by the Minister of Health directing that the Wimbledon Borough Council should become the Local Supervising Authority for the distict as and from April 1st, 1931. MATERNITY AND NURSING HOMES During 1930 the Surrey County Council were the Local Supervising Authority under the Nursing Homes Registration Act, 1927. In all, there are 18 nursing homes in Wimbledon. 10 are maternity homes and 8 nursing homes for acute or chronic cases. During the latter part of the year, application was made by the Wimbledon Borough Council for delegation of the powers under Section 9 (2) of the Act of 1927. The application was successful and the Borough Council become the Local Supervising Authority under the Act as and from April 1st, 1931. MORTUARY. The mortuary is situated within the grounds of the Cemetery at Gap Road. The Council have under consideration the question of the erection of a new mortuary, and an amount for this purpose has been included in the estimate of rate for the current year. From information received from the Superintendent of the Cemetery there were 62 bodies received into the mortuary during 1930. Inquests were held by the Coroner with respect to 52 bodies equalling 11.7 per cent. of the 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: Sec. 74. 13 Public Health Acts (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 amended:—46, 48, 49, 50, 51, 52, 53, 57, 58, 60, 75, 76, 80, 84 , 91. 100, 101, 102, 104, 108, 109, 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. 14 Bye-laws with respect to Tents, Vans, Sheds and Similar Structures. live-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 and Wimbledon Joint Small-pox Hospital Order, 1898. Do. do. do. 1903. Do. do. do. 1908. Do. do. do. 1912. Order of Local Government Board, under the Public Health Acts (Amendment) Act, 1907, declaring certain trades to be offensive. Dated 14th January, 1914. Order of Town Council, under Shops Acts, 1912 and 1913, relating to Second-hand Clothes Dealers. Dated 5th November, 1913. The Wimbledon General Half-Holiday Order, 1914. 6th June, 1914. The Wimbledon Credit Drapers' Half-Holiday Order, 1914. 2nd July, 1914. Tho Wimbledon Barbers' and Hairdressers' Closing Order, 1919. 27th October, 1919. 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 1930. 15 Reason of Visit. No. Infectious Diseases 985 House Inspections 3,473 House to House Inspections 2,027 Rent Act Inspections 58 Houses Let in Lodgings; Inspections 472 Inspection of Factories, Workshops, Workplaces and Out-workers' Premises 561 Common Lodging Houses; Inspections 11 Dairies and Cowsheds; Inspections 119 Inspections under Shop Acts 627 Application of Tests to Drains 216 Inspections under Diseases of Animals Acts 21 Obtaining Samples of Foods and Drugs 6 Miscellaneous (including Inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 2,217 10,793 923 preliminary or informal notices were served in respect of 831 houses. 98 statutory notices were served in respect of 90 houses. The necessary work was executed in all but 124 cases, which were not completed by the end of the year. In 51 of these, the work was actually in hand at the close of the year. Table XII. gives a summary of the nuisances abated, and improvements carried out under the supervision of the Sanitary Staff of the Public Health Department. 16 Factories and Workshops:—In the Table below is shown the work done in the supervision of workshops and work-places:— PREMISES. Inspections. Written Notices. Prosecutions. Factories 185 29 — Workshops 243 22 — Workplaces 97 6 — Total 525 57 — DEFECTS FOUND. Number of Defects. Prosecutions. PARTICULARS. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts:— Want of Cleanliness 25 25 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 25 24 — — Sanitary Accommodation— Insufficient 6 5 — — Unsuitable or Defective 12 12 — — Not Separate for Sexes 2 2 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s.101) — — — Othnr 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 70 68 — — *Including those specified in sections 2, 3 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. HOME WORK. Lists received:— Twice in the year 9 Number of Out-workers 67 17 Once in the year 3 Number of Out-workers 3 Number of addresses received from other Councils 70 Number of addresses forwarded to other Councils 18 Notices served on occupiers as to keeping or sending lists — Prosecutions—Failing to keep Out-workers' lists — Prosecutions—Failing to furnish lists — Inspections of Out-workers' premises 36 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 52 Dressmaking 51 Bakehouses (including five Factory Bakehouses) 25 Laundries 31 Tailoring 19 Millinery 12 Dining Rooms 22 Motors 22 Cycles 12 Builders 18 Woodworkers 30 Coach Building 7 Furniture Repairing 12 Jewellers and Watch Repairers 14 Printing 12 Smiths 8 Miscellaneous 89 436 18 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act — Action taken in matters referred by H.M. Inspector as remedial under the Public Health Acts. Notified by H.M. Inspector 11 Reports of action taken sent to H.M. Inspector 10 Underground Bakehouses in use at the end of the year 3 PUBLIC SWIMMING BATHS:— The following is the report on a sample of water taken for bacteriological examination from the Corporation's Swimming Baths:— (1) Quantitative. The average number of organisms producing visible colonies on gelatine plates incubated at 20 degrees C. for 3 days 39 per c.c. Average number of organisms producing visible colonies on agar plates incubated at 37.5 degrees C. for 2 days 8 per c.c. (2) Qualitative. B. Coli not found in 100 c.c. Streptococci not found in 30 c.c. B. Enteritidis Sporogenes not found in 100 c.c. Organisms of an excremental type were not found and those which developed were chiefly hardy Staphylococci with a few water saprophytes and moulds. It was obvious from this report that the filtration-chlorination plant was dealing with the water efficiently. SANITARY CIRCUMSTANCES OF THE AREA. I submit herewith the report of Mr. Johnson, the Chief Sanitary Inspector, on the sanitary circumstances of the area. The report deals in detail with the work carried out during the year. I should like to take this opportunity of expressing my appreciation of the efficient and conscientious manner in which Mr. Johnson and the inspectorial staff have carried out their duties. 19 REPORT OF THE CHIEF SANITARY INSPECTOR. I beg to submit my Report of the work carried out for the year ended 31st December, 1930. Table iii. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—Nine hundred and twenty-three Preliminary Notices or intimations were served during the year in respect of 831 houses. It was found necessary to serve 98 Statutory Notices upon the owners or occupiers of 90 houses. Six hundred and forty-two letters, respecting 786 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 two cases with the results stated:— For failing to comply with Notice to Abate Nuisance. Two Guineas Costs, and ordered to execute work in fourteen days. For failing to comply with Notice to Abate Nuisance. Two Pounds Costs and ordered to abate nuisance forthwith. 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. House Drainage.—The drainage systems and sanitary arrangements of 19 houses have been entirely reconstructed, extensive amendments or repairs were carried out at 39 houses, and at 10 houses the drainage systems have been made water tight by the patent internal process. 20 House to House Inspection.—During the year house to house surveys were carried out at 164 houses. The following list shews 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. Leyton Road 3 Deburgh Road 95 Caroline Road 14 Ridley Road 52 164 House Inspection.—As a result of inspections made on complaint, or in consequence of the occurrence of infectious disease, request by occupiers, or other general inspections, 1,115 houses were visited. Table iii. shews a list of sanitary works executed at these houses, together with defects remedied during house to house inspection. I would like to point out in this connection the amount of difficulty experienced in having the necessary repairs, etc., effected. In the majority of cases this is not due to any wilful negligence on the part of the owners, nor to any desire to evade their responsibility, but to their inability through lack of funds. In a number of cases, on receipt of communication, the owner calls at the Office and states plainly the circumstances of the case and an arrangement is then come to whereby, providing the serious defects such as roofs, gutters, dampness, etc., are remedied, the remainder of the work is permitted to be done at a later date. This oftentimes leads to more work being done than is required by the Notice, as the owner appreciates assistance rendered to him and is anxious to keep his property in as good condition as possible. There are, of course, certain owners who appear to have made a rule to do no work whatever until the receipt of a Statutory Notice from the Local Authority, followed by a letter from the Town Clerk. Fortunately, these owners are few in number. Overcrowding.—My Report on this subject is but a repetition of previous Reports. Notwithstanding the number of houses erected during the year conditions have not materially improved, mainly because the houses are built for sale and are not of the type required, or which could be afforded, by the families affected. A typical case which one finds extremely difficult to deal with is as follows:—A man and his wife with two small children moved into a flat consisting of two bedrooms and one living room about eighteen years ago. The family has now increased and there are seven children ranging from three years to twenty-five 21 years. One problem is adequate separation of sexes and the provision of sufficient accommodation for sleeping. These people have made numerous applications for more suitable accommodation but owing to the fact that there are so many children, landlords refuse to accept them. They are working-class people and are unable to purchase a house. To serve them with a Statutory Notice and subsequently prosecute them for failing to comply with it would be an action most difficult to justify. In some instances by a little re-arrangement of the family it is possible to reduce the amount of overcrowding and where this advice is acted upon it is felt that the persons concerned are doing their best in the circumstances. In some cases it is found that overcrowding is due to sub-letting to persons coming into the district from another area. In these latter cases notices are always served and enforced for the abatement of overcrowding. In a number of instances successful applications for ejectment are made by the tenants to the local Magistrates, supported by evidence from the Sanitary Staff. Underground Dwellings.—The new Regulations made under Section 18 of the Housing Act, 1925, are now in force within the Borough. As soon as possible a complete survey of premises where underground rooms are suspected of being used will be made, and measures taken to prevent the illegal use of unfit rooms. Houses Let in Lodgings.-There are now 73 of these houses on the Register. Four hundred and seventy-two visits of inspection have been made, and in addition, during the periodical house to house inspection, a number of the houses let in lodgings were inspected, but these visits will appear in the report of house to house inspection. Verminous Rooms.—During the year 41 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 Public Health Department at the owner's expense, after the walls had been stripped as required. Common Lodging Houses.—There is one registered Common Lodging House, namely, 42, Merton High Street, for which an annual Certificate of Registration was granted from 1st January, 1930, to 31st December, 1930. 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. 22 Van Dwellings.—During the year 148 visits have been paid to the caravans in the district and it has been found necessary to serve Notices with respect to minor defects. Generally speaking, the vans have, as far as practicable, been kept in a fairly reasonable condition; but overcrowding of sites still continues. Dairies, Cowsheds and Milkshops.—Eight 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. One hundred and nineteen inspections have been made of the premises of dairymen and purveyors of milk in the district, during which certain matters were discovered which required to be dealt with by the Public Health Department. Throughout the year observations have been kept in the early mornings with a view to checking the careless handling of milk and the bottling of milk other than on registered premises. The offence, I need hardly point out, is a serious one, and one which offers great difficulty in discovering. Apart from the fact that in these cases milk is bottled in the streets, often times a bottle which has been standing outside a house over night is the receptacle used, and a disc, possibly taken from a dirty pocket, forced into the bottle by a none too clean finger. Despite warnings and prosecutions there are still some offenders and you can rest assured I shall continue my endeavours to detect and bring them to the Authority's notice in the hope that in course of time I shall be able to submit a more satisfactory report. Infectious Disease and Disinfection.—During the year, visits for the purpose of investigating cases of notifiable infectious disease were made to 319 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 into this country, on which cases of infectious disease had occurred, and of which notice had been received at the Public Health Office from the Port Sanitary Authorities concerned. At 17 houses from which cases of notifiable infectious disease hud 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 Public Health 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. 23 The number of rooms disinfected was 647 and the number of articles, bedding, wearing apparel, etc., 16,160, full details of which are given in the Report of the Medical Officer of Health under the heading of "Disinfection." School Disinfection.—All the Public Elementary Schools in the district were thoroughly disinfected duning the summer vacation. Yard Paving.—In the course of the inspections made during the year, 48 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.—In consequence of complaints of flies which were thought to have been due to accumulations of refuse, particular attention has this year been paid to stable and other premises where manure was deposited. In all, 428 visits of inspection and re-inspection were made. In the case of stable premises, occupiers were warned that the removal of manure must be done at least once every seven days, or oftener, according to circumstances, and in the case of allotment holders they were advised that all fresh manure deposited should be immediately covered with at least four to six inches of clean earth, in order to prevent the hatching out of flies. During the year a circular letter was sent to all allotment holders calling their attention to this matter and on subsequent visits it was found that the persons concerned had done their best to mitigate the nuisance. Inspections under the Factory and Workshop Act, 1901.— There are 436 factories, workshops, and workplaces on the Register, to which 561 visits of inspection were made. Fiftyseven written notices were served referring to sanitary conveniences and other nuisances. Shops Acts, 1912-28.—Six hundred and twenty-seven visits were made for the purpose of observing contraventions of the Acts, advising shopkeepers regarding the Regulations in force, and in cases of complaints. 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 20s. and £1 Is. Advocate's Fee in each case. As in previous years, the Home Secretary made an Order suspending the operation of the general Early Closing Order from 19th to 24th December, inclusive. This did not, of course, relieve occupiers of the obligation to comply with the Weekly Half-Holiday Order in force, and as a consequence, quite a number of enquiries were dealt with by the Department. A 24 number of traders appeared to experience difficulty in understanding the regulations and, as a result, special visits were paid for the purpose of advising them, and although observations were kept during the holiday period no breach of the Acts was observed. Slaughter Houses and Food Inspection.—The number of registered slaughter houses is five. Four of these, however, have not been used for some considerable time, and in the other one slaughtering has been spasmodic. Very few animals were killed and in each case notice was always received prior to slaughter, so that complete examination could be made. In addition, 309 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:— 18 stone, 4 lbs. Beef Putrefaction. 167 lbs. Beef Caseous Lymphadenitis. Sale of Food and Drugs Acts, 1875 to 1928.—One sample of milk was submitted to the Council's Analyst as it was suspected of being deficient in cream. The Analyst's report, however, stated that the sample was of good quality, containing all its cream, and was about the usual quality of a pasteurised milk. Petroleum Acts.—Seventy-two applications were received for permission to keep petroleum, all being for the renewal of existing licences. Three hundred and sixty-six inspections were made of the various premises in respect of which licences had been issued. Diseases of Animals Acts, 1894 to 1925.— Parasitic Mange.—No outbreak of this disease was notified in the district during the year. Swine Fever.—No outbreak of this disease was notified in the district during the year. 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 is necessary in the issuing of Licences and replying to enquiries. 25 Tuberculosis.—No outbreak of this disease lias been Yeported • 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 rim 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. Rent (Restrictions) Acts, 1920 and 1923.—Under these Acts 8 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 three cases the certificates were subsequently issued as the work required to be done had.not been satisfactorily executed. I would point out that in all these cases it is most essential that the inspections and reports should be 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 14 houses during the year for the following reasons:—3 by request, . 6 -owing to arrears of rates, and 5 for other reasons. Employment Agencies.—There were eight Licensed Keepers on the Register at the end of the year and periodical visits have been made to each of the premises. Further visits were also made in company with the Surrey County Council's Officer with the object of explaining the provisions of the Bye-laws, etc., tc the Keepers. With one or two minor exceptions the Bye-laws have been well observed. 26 Employment of Children Bye-laws.—Observations in connection with the employment of children have been maintained throughout the year, but few breaches have been observed. Practically the whole- of the work is done outside office hours, on Sundays and public holidays. It was deemed advisable in eleven eases to report the circumstances to the Education Authority and as a result, in one case affecting the employment of three boys in prohibited employment, proceedings were instituted against the employer and the parents. The employer was fined 10s. in each of the three cases-and the parents were each fined 10s. Fouling of Footways by Dogs.—It is a matter for regret that persons exercising their dogs are not mindful of the comfort of other foot passengers. It is extremely difficult for offenders to be detected by your Officers but every endeavour is being made to maintain the Borough's standard of cleanliness. Public Health (Smoke Abatement) Act, 1926.—It will be remembered that the Second Conference at the Guildhall, of the Greater London Joint Smoke Abatement Committee, recpruended, amongst other things, the adoption by all Local Authorities in the Greater London area of the following:— That the emission of "black" smoke, for a period of two minutes in the aggregate within' any continuous period of thirty minutes from any one chimney in a building other than a private dwelling house shall, until the contrary is proved, be presumed to be a nuisance." In connection with this, Metropolitan Councils recommended the advisability of the London County Council, which is the Authority for making such Bye-laws in the County of London, to make a Bye-law under Section 2 of the Public Health (Smoke Abatement) Act, 1926. This was done and the London County Council advertised the draft Order' which met with considerable opposition, and the Ministry of Health recommended a conference should be held between the Local Authorities and the Federation of British Industries and the National Union of Manufacturers. As a result of this conference it was recommended the London County Council to make a bye-law in the following terms:— "The emission of black smoke for a period of three minutes, and after five years from the date of confirmation of this Bye-law, for a period of two minutes in the aggregate within any continuous period of thirty minutes from any one chimney of a building other than a private dwelling house shall until the contrary is proved be presumed to bo a nuisance liable to be dealt with summarily under the Public Health (London) Act, 1891." 27 A meeting of the Joint Abatement Committee was called at the Offices of the London County Council and confirmed this compromise. There is every likelihood of the Ministry of Health approving, as the Federation of British Industries and the National Union of Manufacturers agreed not to offer any further opposition to the making of a Bye-law in the above revised fonn. As a number of Local Authorities outside London had already made a Bye-law for two minutes which had received the approval of the Ministry of Health the conference decided that the recommendation should apply to the County of London only, the outside authorities being left to make Bye-laws for two or three minutes' duration, whichever the Ministry of Health would sanction. Numerous complaints were received in the early part of the year with respect to the black smoke from a certain laundry, but extensive alterations have been carried out, since which there have been no complaints received, and, although frequent observations have been made, there has been no further cause for complaint found. Small Pox Contacts.—111 connection with the small-pox cases occurring in the district and local contacts of cases occurring outside the district, 425 visits of enquiry were made. As the majority of these contacts are persons employed in London it necessitated the visits being paid during the evenings and week-ends, after they had returned from their business or occupation. Mosquitoes.—Lakes, pools, ditches and other breeding places of mosquitoes have been thoroughly sprayed on several occasions during the early months of the year. From various enquiries made, and in consequence of visits paid, I am of opinion that this spraying has been beneficial. In a number of instances, tenants of houses with cellars have complained of mosquitoes and after adopting the advice given considerable improvement has been noted. Examination of Sludge.—Following a complaint from one part of the district a considerable quantity of sludge was found to have gathered in a tributary of the River Wandle. This appeared to consist of tar and oil, and a sample was collected and submitted for analysis. This was confirmed by the analyst's report. My investigation clearly showed that this nuisance arose from premises outside the district and I accordingly reported the full facts to the Surrey County Council, who afterwards dealt with the matter. Offensive Trades.—During the year an inspection was made of all the fish-frying premises in the Borough and copy of the Bye-laws was left and signed for by each occupier. A number 28 of alterations were necessary in order to comply with these Byelaws and these points were explained to the occupiers concerned. In all 51 inspections and re-inspections were made and I am able to report that the Bye-laws are being we]l observed. I again take this opportunity of recording my appreciation of the loyal support and assistance rendered by the staff generally, and to acknowledge the kind co-operation of Dr. Ellis, the Medical Officer of Health, and my colleagues of other Departments. HENRY JOHNSON, M.B.E., F.R.San.I., F.S.I.A. Chief Sanitary Inspector. 29 TABLE IlI The fallowing is a summary of the nuisances abated, and sanitary improvements carried out under the supervision of the Sanitary Staff of the Public Health Department:— Accumulations removed 28 Cisterns provided 6 Cisterns repaired, cleansed or covered 60 Drains, new. provided 19 Drainage systems made water-tight by- patent process 10 Drains, repaired or altered 31 Drains, stoppages removed 29 Dustbins provided 174 Flushing cisterns, new, provided 38 Flushing cisterns repaired 110 Manure receptacles provided 3 Overcrowding nuisances abated 2 R.W. pipes disconnected 2 Roofs repaired 235 Rooms stripped and cleansed 1,184 Verminous rooms cleansed 41 Soilpipes, new, provided 14 Soilpipes, repaired or altered 3 Vent pipes, new, provided 19 Vent pipes, repaired or altered 26 Waste pipes, new, provided 56 Waste pipes repaired, disconnected or trapped 51 Water-Closets, new, provided 99 Water-closets, repaired or ventilated 11 Water services restored 14 Yards paved 3 Yards repaired 45 Guttering repaired 184 Floors ventilated 10 Nuisances abated from damp walls 175 Water supply direct from main 4 Sinks provided 31 Rooms fumigated 647 Other nuisances 1,939 5,303 30 The following information is supplied by the Borough Surveyor, Mr. T. Webster:— Baths Extension.—Additional Dressing Accommodation and provision for the storage of cycles has now been completed. Housing.—Nine parlour-type houses are now in course of erection in Faraday Eoad. Sewage Disposal Works.—The construction of new filters is now practically completed. Refuse Collection.—The motor lorries used for the collection of house refuse are now having covers fitted which will close tightly, thus preventing the usual nuisances connected with the open type of lorn,-. Street Gully Cleansing.—During the past year the gullies have been emptied and re-sealed with fresh water by means of a mechanical vehicle. The detritus is drawn straight into a sealed tank in the machine, thus obviating the practice of allowing the detritus to lie in the channels until collected. (a) HOUSING STATISTICS FOR THE YEAR 1930. Number of new houses erected during the year:— (a) Total, including numbers given separately under (b). (i) By the Local Authority— (ii) By other Local Authorities— (iii) By other bodies and persons 102 houses and 4 flats. (b) With State assistance under the Housing Acts:— (i| By the Local Authority. (a) For the purpose of Part ii. of the Act of 1925 Nil (b) For the purpose of Part iii. of the Act of 1925 Nil (e) For other purposes Nil (ii) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,115 Number of inspections made 7,269 31 (2) Number of dwelling-houses (included under sub-head (1) above, which were inspected and recorded under the Housing dated Regulations, 1925 164 Number of inspections made 2,027 (.3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding head) found not to be in all respects reasonably fit for human habitation 831 2.—Remedv 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 707 3.—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 (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 94 (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 32 (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 4.—Number of houses owned by Local Authority 124 Number of houses owned by Local Authority and built in last two years: (a) Held under Part iii. of the Housing Act, 1925 48 (flats) (b) Held under Part ii. of the Housing Act, 1925 Nil (c) Other powers Nil (b) HOUSING CONDITIONS. (1) General observations as to housing conditions. The standard of the houses in Wimbledon is extremely good. The houses, with very few exceptions, are. well constructed, modern and sanitary. This applies not only to North Wimbledon, where there is an extremely valuable type of house property, but also to the southern parts of the Borough, which are more especially inhabited by the artisan and working classes. (2) Sufficiency of supply of houses. (a) The absence of suitable building sites for the erection of houses for persons of smaller means is largely responsible for the housing shortage in Wimbledon. (b) There has been no important change in the population of Wimbledon in the year under review. Neither is any change anticipated in the immediate future. (c) There are no suitable sites available in the district for providing new houses for the artisan and working classes. This is the principal difficulty confronting the Council in dealing with the housing problem. Nine houses are being constructed by the Council in Faraday Road, on one of the few available sites remaining in the Borough. 33 (3) Overcrowding. (a) The following table gives details of the housing conditions in four streets situated in different Wards. An indication is given of the extent to which overcrowding exists. The The estimate of the overcrowding is based on the legal requirements set out in the Bye-laws for houses let in lodgings, i.e., for adults 360 cubic feet and for children under 10 years 250 cubic feet. Total No. of Houses No. of Separate Lettings No. of Occupiers Average No. of Rooms per Letting Average No. of Ocupier6 per Room Average Rent per Room per Letting Under 10 Years Over 10 Years Deburgh Road 101 131 127 471 3.3 1.45 2/11 Caroline Road 12 24 29 97 3 1.7 3/1 Ridley Road 58 105 82 331 3.06 1.3 3/1 Dryden Road 77 96 109 280 4.08 1.007 3/3 248 356 347 1,179 3.1 1.3 3/1 NO. OF SEPARATE LETTINGS CONSISTING OF 1 room 2 rooms 3 rooms 1 rooms 5 rooms 6 rooms Deburgh Road 11 22 30 46 22 — Caroline Road — 1 22 1 — — Ridley Road 2 2 92 8 1 — Dryden Road 10 13 56 5 4 8 23 38 200 60 27 8 34 Overcrowding based on the standard of the Bye-laws for houses let in lodgings, was found to exist as follows:— LETTINGS OVERCROWDED BY 1 Child 2 Children 3 Children 1 Adult 1 Adult and 1 Child 1 Adult and 2 Children 2 Adults and 1 Child 2 Adults Deburgh Road 2 2 — 8 7 2 1 1 Caroline Road 2 2 — 1 — — — 1 Ridley Road 5 — 1 4 — -- 1 2 Dryden Road 4 — 1 — 4 — 1 — 13 4 2 13 11 2 9 3 4 It will thus be seen that in the 248 houses inspected in detail, overcrowding was found to exist to the extent of 40 adults and 45 children. (b) The difficulty with regard to overcrowding is two-fold. There is a general shortage of houses, more especially of the working class type. This applies at the moment to nearly all urban areas. in addition there is the economic difficulty in the case of a large number of people who are unable to afford the rent of an entire house for the accommodation of themselves and their families. Many of these people (especially those who are unemployed or partially employed) are only able to afford the rent of part of a house. Consequently two and three families not infrequently live in the same house. The economic factor is undoubtedly of great importance. It is responsible to a large extent for the concentration of the overcrowding to certain areas in the district. (4) Fitness of Houses. (a) No difficulties have been experienced during 'the year in taking action under the Public Health Actis in dealing with housing conditions. Only in one instance was action taken under Section 3 of the Housing Act of 1925. In this case the work was finally carried out by the owner. (b) It has not been necessary to adopt any special measures for the purpose of dealing with insanitary property. Speaking generally, house property in Wimbledon is of a very satisfactory type. Sanitary defects are dealt with as they arise under the Public Health Acts. 35 (c) 111 the whole of the Borough there are less than a dozen houses without a private inside water supply. (d) There are only four houses in the district without separate water-closet accommodation situated within their own curtilages. These four houses have two outside water-closets, which are used in common. (5) Unhealthy Areas. There are no unhealthy areas in Wimbledon. (6) Bye-laws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc. No difficulties have arisen in operating these Bye-laws. During 1929 the Council considered the new model Bye-laws of the Ministry of Health relating to tents, vans, sheds, etc. As the existing Bye-laws gave a more complete control over the sanitary arrangements and the requirements for the provision of drinking water, the Council decided not to adopt the new Bye-laws of the Ministry. INSPECTION AND SUPERVISION OF FOOD. (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 1 cowkeeper, 23 dairymen, 28 dairymen and purveyors, and 8 purveyors on the Registers on 31st December, 1930. 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:— Pasteuriser 1 Dealers in Certified Milk 2 ,, ,, Grade A Milk 2 „ Grade A (T.T.) Milk 4 ,, ,, Pasteurised Milk 2 Supplementary 8 (3) Bacteriological examinations:—All samples satisfactory. SLAUGHTER HOUSES. In In In 1920. Jan. 1930. Dec. 1910. Registered 4 2 2 Licensed 1 — — Total 5 2 2 36 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The incidence of infectious diseases was slightly less than in 1929. 127 cases of scarlet fever were notified. This was 4 less than during the preceding year. The notifications of diptheria were 10 less and amounted to 140. During 1930 the death rate from zymotic diseases showed a considerable decline. No deaths occurred from scarlet fever. The death rate from diphtheria, whooping cough, diarrhoea and tuberculosis were all lower than during 1929. Only in the case of measles was the figure increased. This is accounted for by the epidemic of measles which occurred in the early part of 1930. 37 TABLE A NOTIFIABLE DISEASES—1930. 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 140 1 7 1 4 • 8 49 87 20 8 1 4 137 .06 Deaths — 1 — — — 2 1 — — — — — 4 Soarlet Fever Notified 127 — 1 6 5 13 55 20 13 11 3 — — 111 — — Para Typhoid Notified 2 — — — — — — — 1 1 — — — 2 Deaths — — — — — — — — — — — — — Puerperal Fever Notified 4 — — — — — — — — 3 1 — — 4 .03 Deaths — — — — — — — — 1 1 — — 2 Pneumonia Notified 24 — 1 — 1 1 3 — 3 2 1 8 4 — Deaths 6 1 2 — 1 — — 1 4 3 14 12 44 •74 Erysipelas Notified 29 — 2 — — — — 1 1 2 8 12 3 9 Deaths — — — — — — — — — — — — — Smallpox Notified 2 — — — — — — — — — 1 1 — 2 Deaths — — — — — — — — — — — — — Cerebro spinal Meningitis Notified 2 1 — — — — — — — — — 1 — 1 2 .03 Deaths 1 — — — — — — — — — 1 — Ophthalmia Neonatorum Notified 3 3 — — — — — — — — — — — Deaths — — — — — — — — — — — — — Puerperal Pyrexia Notified 1 — — — — — — — — 8 1 — — 7 Deaths — — — — — — — — — — — — — — Encephalitis Lethargica. Notified 1 — — — — — — — — — — 1 — — .01 Deaths — — — — — — 1 — 1 Tuteroulosis Notified 61 1 2 — — — 1 2 3 32 10 7 3 21 Jeaths 1 2 — — — — 1 3 18 7 8 1 — 41 .69 TOTAL Notified Deaths 404 6 13 7 10 22 108 60 41 67 36 34 10 294 94 1.5 8 4 2 - 1 2 2 4 23 11 24 13 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. 1921 .63 — •01 •22 01 06 - •3 •79 1922 1.06 — •oo 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 1928 1.10 — — •1 — 08 •11 03 •7 1929 1.06 •01 .1 — •08 — 05 .8 1980 .99 — — 06 - •03 •16 •03 •69 The figures given in theis 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 1930, 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. Cotteuhain Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Haydon Park Ward. 1 2 3 4 5 6 7 8 Diphtheria (including branous croup' 140 7 21 3 7 19 46 17 20 137 Erysipelas 29 4 1 2 3 7 4 4 4 9 Scarlet Fever 127 11 7 6 7 24 30 24 18 111 Puerperal Fever 4 1 — — — 1 — a — 4 Cerebro-spinal Meningitis 2 1 — — 1 — — — — 1 Pulmonary Tuberculosis 56 7 1 2 3 9 17 8 9 18 Other forms of Tuberculosis 5 — — — — 2 1 2 — 3 Ophthalmia Neonatorum 3 — — — — — 1 1 1 Pneumonia 23 1 2 1 4 7 1 4 3 Influenzal Pneumonia 1 — — — — I Puerperal Pyrexia 9 — — — 1 1 4 1 a 7 Small-pox 2 — — — — — — 1 l a Para-Typhoid 2 — — — — 1 — — l a Encephalitis Lethargica 1 1 — — — — — - - — totals 404 33 32 14 26 71 105 64 59 294 39 Scarlet Fever.—The total number of cases notified during the year was 127 from 120 houses. The attack rate was 2.1 per thousand of the population. Attack Rate. Death Kate. 1891-1895 4.8 .02 Per thousand of the Population. 189(3-1900 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 1926-1930 2.4 .000 In one house there were six cases, in five houses two cases, and in the remaining 114 houses, one case. 110 or 86 per cent. of the cases were treated in the Borough Isolation Hospital, Gap Road. 63 per cent. of the cases notified were children of school age, five to fifteen years, and of these, 74 attended the following schools:— Commercial School 1 Old Central Schools 2 Cottenham Park, Mixed 2 Effra lload Girls' and Infants' Schools 8 Durnsford lload Mixed and Infants' Schools 5 Queen's Road Infants' School 1 Queen's Road Boys' School 4 Pelham Road Infants' School 8 Pelham Central Schools 2 Dundonald lload Girls' and Infants' Schools 5 Russell Road Mixed School 11 Haydons Road Girls' School 1 Haydons Road Infants' School 4 Haydons Road Boys' School 3 Private Schools 5 Schools outside the district 12 74 Diphtheria.—The total number of cases notified during the year was 140 from 106 houses. The attack rate was 2.3 per thousand of the population. 40 In one house there were six cases, in four houses four cases, in two houses three cases, in thirteen houses two cases, and in the remaining eighty-six houses, one case. 135 or 96 per cent. of the patients were treated in the Isolation Hospital. 61 per cent, of the cases notified were children of school age, five to fifteen years, and of these, 80 attended the following schools:— Old Central 5 Cottenham Park I Dundonnld Girls' and Infants' 5 Russell Road Mixed and Infants' 1 Haydons Road Boys' 7 Queen's Road Girls' and Infants' Schools 4 Haydons Road Girls' and Infants' Schools 12 Pelham Road Infants' School 5 Effra Girls' and Infants' 5 Queen's Road Boys' 2 Pelham Central 5 Durnsford Road Mixed 18 Schools outside the district 9 Private Schools 1 80 Careful investigation is carried out after each case of diphtheria has been notified. School children from infected houses are swabbed and not re-admitted to school until a negative result has been obtained. These swabs are either taken by the family doctor or by the staff of the Public Health Department, according to the circumstances of the case. Adult contacts living in the same house are also advised to have swabs taken from the nose and throat and in most cases they agree to this precaution being carried out. In the case of patients who are school children, special visits are paid to the schools in order that the class contacts may be carefully examined. 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. 41 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. NonPulmonarv. 1 Males. Females. Males. Females. Males. Females. Malrs Females. Under 1 rear — — 1 — — 1 — 1— 5 5 — 10 ,, 10 — 15 ,, — 1 2 1 1 — — 2 — — — — — — 1 — 15 — 20 ,, 2 1 — — — 2 1 — 20 — 25 ,, 1 6 6 — — 6 1 — — 25 — 35 ,, 10 9 1 — 5 6 — — 35 — 45 ,, 8 2 — — 5 1 — 1 45 — 55 ,, 1 1 3 — — 2 — 1 — 55 — 65 ,, 1 2 1 — — 3 2 — — 65 upwards1 2 1 — 1 — Totals 29 27 4 1 21 13 6 1 Public Health (Prevention of Tuberculosis) Regulations 1925.—No action was necessary in regard to tuberculous employees in the milk trade. Public Health Act, 1925, Section 6'2.—Gases arose in which careful consideration was given to the advisability of steps being taken under Section 62 of the Public Health Act, 1925. Although the patients had been discharged from sanatoria with the disease arrested, they were undoubtedly capable of transmitting the infection. The home conditions were very unsatisfactory, owing to the limited accommodation and to the number of children present in the house. Eventually it was found possible to get the patients into suitable institutions and it was not found necessary to take other measures. Difficulty often arises where patients are discharged from sanatoria with the disease still in an infective state. In most cases it has been possible to arrange for the patient to occupy a separate bedroom, thus limiting the chances of spreading the infection. 61 cases of tuberculosis were notified in 1930. 21 cases were admitted to sanatoria or hospitals. 41 deaths from tuberculosis occurred during the year. 42 Of the 34 deaths from pulmonary tuberculosis, 21 died outside the district (13 males and 8 females), i.e., notification of death was transferred to Wimbledon. Of the 7 non-pulmonary deaths. 3 males died outside the district. Of the non-pulmonary tuberculosis deaths 4 were due to meningitis, 1 to peritonitis, 1 enteritis and 1 to general tuberculosis. On receipt of notifications of new cases, visits are paid to the homes by the nursing staff of the Public Health Department. Advice is given regarding the precautions to be taken with the view to preventing the spread of the infection. Where necesssary disinfectants are also supplied. The Tuberculosis Department of the Surrey County Council make all arrangements for the provision of sanatorium and hospital treatment. Smallpox.—Smallpox continued to be prevalent throughout the country during the year. Two cases were notified in Wimbledon and both patients were removed to the Smallpox Hospital at Clandon. The disease was of a mild type and recovery rapidly ensued. One of the patients was employed by a large local firm. There were about 150 contacts at the works. These contacts w ere examined the day after the patient was removed to hospital and more than half of them were vaccinated or re-vaccinated. Daily supervision was maintained over the whole staff for 16 days. Absentees were visited at their homes and in the case of employees who resided outside the Borough notifications were sent to the Public Health Departments concerned. No secondary case occurred. In addition, information was received by the Public Health Department periodically throughout the year of persons resident in Wimbledon who had been in contact with cases of smallpox outside the Borough. In all, 88 contacts were notified from other Health Departments. They were kept under observation for 16 days by the sanitary staff. None of these contacts developed the disease. 425 visits were paid to the houses of smallpox contacts during the year. As in 1929, it was not considered necessary to make chicken-pox notifiable in Wimbledon. Psittacosis.—During the early part of 1930, three cases of psittacosis occurred. Two of the patients were from the same house. The first patient was taken ill on January 5th with symptoms of an influenzal nature, associated with pneumonia. The illness lasted for two weeks and was followed by recovery. The second patient in this house was taken ill on January 43 25th with similar symptoms, and was removed to hospital on February 4th. Death occurred on February 12th. A maid and one child in the same house had also been suffering from a mild illness during this period. A consignment of green parrots arrived at the house two weeks before Christmas. One parrot died on Boxing Day after having been drowsy for some time. The dead bird was burnt. A second bird died two or three days later and was disposed of in the same manner. A third bird died on February 6th with similar symptoms. There were also two budgerigars and one of these died on February 3rd. This bird was also burnt after death. The remaining 5 parrots and budgerigars were forwarded to the Laboratory of the Ministry of Health for observation. They were ultimately destroyed. The third case of psittacosis occurred in a patient who had returned to Wimbledon after staying at the seaside, where shc had been residing with her brother. A green parrot, which had been bought as a Christmas present for her nephew, died on New Year's Day. The brother-in-law was taken ill with symptoms that were suspicious of psittacosis, and died on January 18th. On returning to Wimbledon the patient became seriously ill, suffering from an undoubted attack of psittacosis, from which she untimately recovered. No further case occurred in Wimbledon during the year. Outbreak of Food Poisoning.—In the latter part of June an outbreak of food poisoning occurred in the Borough. In all, 18 persons were taken ill, the predominant symptoms being sickness and diarrhoea. All the patients stated that they had eaten a certain type of cooked meat which had been prepared outside Wimbledon. The Bacillus aertrycke, an organism often responsible for food poisoning, was isolated from a number of the patients. Information was forwarded to the Medical Officer of Health of the area in which the food was prepared. The patients made good recoveries. Typhoid and Enteric Fever.—Two cases were notified during the year. In both cases the infection was due to the type known as paratyphoid B. These cases were removed to the Isolation Hospital at Gap Road, where they made rapid recoveries. Full investigations were made into the cause of the infection, but the actual source 44 was not discovered. In no instance had the disease arisen through the water or milk supply. One death from paratyphoid occurred in a patient whose home address was in Wimbledon, but who died outside the district . During the previous yean 7 cases of typhoid were notified. Encephalitis Lethargica.—T case of encephalitis lethargica was notified during the year. The patient was nursed at home. The disease ended fatally. Puerperal Fever and Puerperal Pyrexia.—Nine cases of puerperal pyrexia and four cases of puerperal fever were notified during the year, in accordance with the Public Health (Notification of Puerpetal Fever and Puerperal Pyrexia) Regulations, 1926. During 1929 there were notified two cases of puerperal fever and twelve cases of puerperal pyrexia. The figures for the last two years have thus remained practically constant. In three cases—two notified as puerperal pyrexia and one as puerperal sepsis—the temperature rapidly subsided and the patients made quick recoveries. Although thesis patients had to be notified in accordance with the Regulations, the cause of the temperature was found to be due to minor disturbances associated with childbirth. The remaining ten cases were removed to hospital for treatment. Eight of these patients were treated in the Kingston and District Hospital. The other two cases were removed to the Nelson and the Elizabeth Garrett Anderson Hospitals respectively. Two deaths from puerperal sepsis occurred. One patient died in the Nelson Hospital and the other in the Kingston and District Hospital. During the previous year the number of deaths from puerperal sepsis amounted to three. In accordance with the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, the Council has made provision for consultant aid, hospital treatment, and bacteriological diagnosis in these cases. On receipt of a notification, enquiries are carried out by the staff of the Public Health Department. Where hospital treatment is considered advisable by the doctor in attendance, arrangements are made for the removal of the patient and the necessary disinfection is carried out. 45 Ophthalmia Neonatorum.—Three cases of ophthalmia neonatorum were notified. No impairment of vision resulted. Malaria.—No notifications of this disease were received. LABORATORY WORK. 3,969 pathological specimens were examined in the laboratory at the Health Centre during 1930 by the medical staff. Most of these specimens were swabs taken from the nose and throat which were examined for the presence of diphtheria bacilli. The following additional specimens, principally from the Isolation Hospital, were also examined at the laboratory:— Smears 2 Blood 1 Ringworm 2 Sputum 1 Cerebro Spinal Fluids 1 Urine Specimens 24 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. Bacteria Found. Bacteria Not Found Total. Diphtheria Swabs 94 680 774 Phthisis (Sputum) 13 107 120 Pus (Ophthalmia Neonatorum) 4 4 Typhoid (Blood, Urine and Faeces) Reaction Reaction Total Obtained. Not Obtained. 3 40 43 Virulence Tests Positive. Negative. Total. 4 37 41 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. 46 Disinfection.—The following table shows the number of rooms and articles disinfected:— Bedding Disinfected. Clothing. Disease. Mattresses. Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Presses Suits. Other Articles. No. of Room Disinfected. Tot.m.s. Scarlet Fever 369 198 39 611 1173 30 65 3545 201 6231 Diphtheria 407 208 53 720 1263 43 9G 3785 191 6766 Typhoid Fever 2 3 1 8 5 — - — — 19 Erysipelas 15 9 6 31 55 1 4 162 14 297 Tuberculosis 49 26 18 138 127 1 — 161 61 581 Cancer 11 5 4 61 22 — — 66 28 197 Pneumonia and Influenza 1 1 — 3 6 — — 1 2 14 Smallpox 2 5 2 8 17 — — 12 9 55 Vermin 5 — — 9 14 — — 1 41 70 Sundries 136 45 13 360 460 4 11 1448 100 2577 Totals 997 500 136 1949 3142 79 176 9181 647 168j7 Details of this work are given in the report of the Chief Sanitary Inspector. It will be noted that 647 rooms and 16,160 articles of bedding, wearing apparel, etc., were disinfected by the Public Health Department. Speaking generally, infections diseases are chiefly spread by mild unrecognised cases and " carriers " and not by inanimate objects. Otherwise many infectious diseases would have been stamped out long ago. Experience has shown that thorough cleansing with soap and water together with the free admission of sunlight and fresh air into infected rooms is a safe and wholesome procedure to adopt. The modern tendency is to rely less upon the older methods of disinfection. 47 Wimbledon Isolation Hospital. Carried, over from 19X9 Under 5 years. Over 5 years. Total. Deaths. Remarks. Under 5 years Over 5 years. Total. Scarlet Fever 1 23 24 Daily average number Diphtheria 4 22 26 — — of cases. 46 Cases Admitted in 1930. From Wimbledon. Scarlet Fever 24 87 111 — — Diphtheria 22 115 137 1 2 3 Diphtheria and Measles 1 1 1 — Diphtheria and Average Whooping Cough — 1 1 — — — number of Erysipelas 2 2 — — — davs in Measles 2 2 4 — — hospital, 45 Cerebro Spinal Meningitis 1 — 1 1 — 1 Para Typhoid 2 2 — — From Kingiton. Scarlet Fever 2 36 38 — — — Total Diphtheria 10 61 71 1 2 3 Kingston Measles 1 - 1 1 - 1 cases, 110 Total treatein 1930 68 352 420 4 4 8 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £"27,000. 370 cases were admitted to the Isolation Hospital during 1930. As there were 50 cases in Hospital at the end of 1929, the total number of cases under treatment during the year amounted to 420. 260 of these cases were from Wimbledon, and 110 from Kingston. There were thus 49 less cases admitted to the hospital in 1930 as compared with the previous year. Scarlet Fever.—146 cases of scarlet fever were admitted to hospital during the year. In addition, three other patients were admitted with scarlatiniform rashes. In one case the 48 disease proved to be measles. The other two cases were found to be suffering from septic rashes. The following complications were noted amongst the 146 cases of scarlet fever under treatment:— Rhinitis 7 Otorrhœa 4 Otitis Media (without Otorrhœa) 2 Mastoiditis 3 Adenitis 11 Nephritis 9 Albuminuria 5 Rheumatism 11 Whitlows 6 In most of the cases the disease was of a mild type, and no deaths from scarlet fever occurred in the hospital during the year. Anti-scarlatinal serum was used fairly extensively. Most of the patients, with the exception of those who had the disease in a very mild form, received an injection of this serum on admission. The serum appeared to lower the temperature considerably and to make the patient much more comfortable. The liability to complications, however, did not appear to be appreciably diminished. The same result has been experienced in preceding years. The most important complications which arose were those involving the ear and kidneys. Four patients developed otorrhœa and' two otitis media, which subsided under treatment without perforation of the ear drum. In addition three patients developed mastoiditis. These latter were operated on by Dr. Dan McKenzie, the Consulting Oto-laryngologist to the hospital. Two of the patients were also suffering from acute hæmorragic nephritis, associated in one case with manifestations of mild pyæinia. The three patients made complete recoveries and were discharged from hospital free from ear discharge and with normal hearing. It is only rarely that a patient who has developed ear complications is discharged from hospital with a discharging ear. Complications of the kidney were of unusually frequent occurrence, 9.6 per cent. of the patients admitted with scarlet fever developing nephritis or albuminuria. The nephritis was generally associated with some infective condition such as otitis media or adenitis. Most of the patients on admission were 49 treated with alkalis with a view to preventing the onset of this complication. Speaking generally, the nephritis was mild in character. Only in two cases was the blood pressure raised, and uremic manifestations were slight and infrequent. All the patients affected made complete recoveries. They showed no evidence on discharge of any impairment of renal function. Three " return " cases occurred during the year. This amounts to 2 per cent. of the patients discharged. Convalescent patients are treated in separate wards from the acute cases. For several days prior to discharge patients are kept in special side wards away from all sources of infection. Diphtheria.—210 patients were admitted to the Isolation Hospital as cases of diphtheria during the year. The admissions were therefore 37 less than during 1929. Of these 210 cases, 139 ultimately proved to be suffering from undoubted clinical diphtheria. 45 of the patients were contacts who had been swabbed and found to be harbouring diphtheria bacilli either in the nose or throat. In 26 of the cases admitted as diphtheria, the diagnosis was not confirmed by further bacteriological investigation. The following complications were noted among the 210 patients under treatment:— Nasal Paralysis 19 Pharyngeal Paralysis 3 Intercostal Paralysis 1 Otitis Media 2 Mastoiditis 1 Adenitis 2 Nephritis 1 Albuminuria 1 Broncho-Pneumonia 1 Bronchitis 1 Multiple Arthritis 1 Included in this number were 20 patients who were admitted with respiratory obstruction due to laryngeal diphtheria. Tracheotomy was performed in four cases. Three of these patients made complete recoveries. The fourth patient died on the sixth day from heart failure. 50 Another patient was admitted after tracheotomy had been performed outside. This patient also died on the sixth day from heart failure. In all, 7 deaths occurred among the 210 cases admitted as diphtheria. Amongst the 139 clinical cases of diphtheria 6 deaths occurred giving a fatality rate of 4.3 per cent. 1 death from broncho-pneumonia following measles occurred amongst the non-diphtheritic cases. This patient was incubating measles on admission to hospital. 3 negative swabs were obtained from the nose and throat of all cases prior to discharge. No return cases of diphtheria occurred during the year. Erysipelas.—2 cases of erysipelas were admitted to the Isolation Hospital during 1930. One of these cases was transferred from the Nelson Hospital. In this case the disease was complicated by extensive suppurative phlebitis and a large gluteal abscess, which required considerable operative interference. Both patients made complete recoveries. Enteric Fever.—2 cases of enteric fever were admitted to hospital. In both cases the infection was due to the Paratyphoid B Bacillus. The course of the disease was mild and convalescence uninterrupted. Meningitis.—Only one case of meningitis was admitted to hospital during 1930. This case was transferred from the North Wimbledon Hospital. The patient was an infant and found to be suffering from meningococcal meningitis. Death occurred four days after admission. Measles.—Measles was prevalent in the district during the early part of the year. On account of the home conditions three children were admitted to hospital suffering from this disease. The attack was of moderate severity in all three cases. It was not considered possible for them to receive adequate nursing at home. The average daily number of patients in hospital throughout the year was 46. This figure is 9 less than that for 1929. The average number of days spent in hospital by each patient was 51 45. At the end of 1930 there were 61 patients remaining in hospital. 40 of these were suffering from diphtheria and 21 from scarlet fever. Staff.—dn October Miss L. McCrory, the Acting Matron, was appointed Matron of the hospital. There was very little sickness amongst the members of the staff during the year and no case of infectious disease occurred amongst them. 52 Maternity and Child Welfare. Steady progress has been maintained in the work of this section of the Public Health Department, and a considerable amount of re-organisation effected. New medical record cards have been introduced at each centre. The forms which were previously used have therefore been discontinued. This has afforded rapid and easy reference and has greatly facilitated the filing system. It is now possible for the record of a child attending one of the Centres to be attached to its school medical record card as soon as it commences school. A card index system has also been introduced in the Ante-Natal Clinic. In addition, registers are now kept at all the Centres. The total number of visits paid by the Health Visitors during 1930 amounted to 6,422. This represents a large increase over the figure for the previous year, which amounted to 5,192. The attendance of the children at the Centres has continued to be most satisfactory. At the Pelham Centre the average attendance per session has risen from 46 in 1929 to 64 in 1930. The average attendance per session at the Wandle Park Centre was 40, comparing very favourably with the figure of 41 during 1929. There is no doubt that this figure would have been considerably higher had it not been for the fact that extensive repairs and decorations at the Centre had necessitated the sessions being transferred to the Health Centre at Pelham Road during the last four months of the year. Wandle Park Centre has now been redecorated throughout internally. The lighting of some of the lower rooms has been greatly improved and the repair work that has been carried out on the exterior has now rendered the premises entirely free from dampness. The Ante-natal Clinic is held at Wandle Park House in the afternoon on the second and fourth Thursday in the month. The average attendance per session at this Clinic was 6. Here again a certain amount of disorganisation was inevitable owing to the necessity for temporarily transferring this Clinic to the Health Centre, Pelham Road, whilst the above mentioned repairs were taking place. Since the commencement of the present year the number of attendances at the Ante-natal Clinic has shown a gratifying increase. 53 Steady attendance has been maintained at the Classes for Mothers which are held at both of the Centres. Home nursing, mothercraft and hygiene are taught. The thanks of the department are again due to the ladies who have so unsparingly given their services in organising the social side of the work. The centres at Pelham Road and Wandle Park House are fortunate in having such enthusiastic voluntary helpers. This side of the Maternity and Child Welfare scheme is greatly appreciated by the mothers. 53 children from the Maternity and Child Welfare Centres were seen by the Ophthalmic Surgeon at the Refraction Clinic during the year. Spectacles were prescribed in G eases. In addition 221 children from the Maternity and Child Welfare Centres attended the Minor Ailment Clinic for treatment. Arrangements were made for the operative treatment of Tonsils and Adenoids in 3 cases. The following table shows the number of cases of ophthalmia neonatorium notified and the final result of treatment. These cases were mild and no impairment of vision resulted. cases were mild and no impairment of vision resulted. In one instance home nursing was provided by the Council through the Wimbledon District Nursing Association. CASES. Vision Unimpaired. Vision Impaired Total Blindness. Deaths. Notified. Treated. At Home. Hospital. 3 5 - 3 - — — Measles was prevalent in the early months of the year and 423 cases amongst school children were notified by the Head Teachers in Wimbledon. In addition to this there were a considerable number of cases in children below school age of whom the Public Health Department received no direct information. There were 10 deaths from Measles in 1930. 9 of these occurred in children under 4 years of age. 54 There were also two deaths from whooping cough. Both of these occurred in children under the age of two years. Measles and whooping cough are most fatal in the first few years of life. It is of the greatest importance that everything possible should be done by parents to protect young children from contracting the infection. Older children are much less liable to develop fatal complications. Maternal Mortality.—Two deaths from Puerperal Sepsis occurred during the year. This gives a death rate from Puerperal Sepsis of '2.5 per 1,000 children born. This compares unfavourably with the figure for England and Wales which was 1.8 in 1929. Particulars of these cases are given under the Section on Puerperal Fever and Puerperal Pyrexia. In addition three other maternal deaths were recorded. In one case no doctor or midwife was in attendance. The two other cases were treated in Hospital where the best attention was available for them. One patient was operated on for a serious complication of early pregnancy. The operation was successful but unfortunately the patient died during convalescence. In all, there were five maternal deaths during 1930. This is the same figure as that for the previous year. Great benefit will undoubtedly arise from the new Maternity Department which is being erected at the Nelson Hospital. Accommodation is being provided for 20 beds, together with an Ante-natal Department. Hitherto there has been no adequate provision in Wimbledon for the treatment of complicated cases of pregnancy and childbirth, amongst the poorer members of the community. These cases have been dealt with in the maternity departments of the large hospitals in other areas. To solve this problem it is essential that every expectant mother should receive constant ante-natal care. This is largely a matter of continuous propaganda. In addition, hospital accommodation with consultant aid should be available in the Borough for all complicated cases. 55 During 1930, the record of Home Visitation work was as follows:— Number of births notified 683 „ ,, ,, registered 691 Number of births visited 572 „ ,, ,, re-visited—under 1 yr. 1,135 „ „ ,, ,, —over 1 yr 1,674 ,, ,, Ophthalmia cases visited 3 ,, ,, expectant mothers visited 85 ,, ,, re-visits to expectant mothers 90 ,, ,, ineffectual visits 1,295 ,, ,, special visits 912 Total welfare visits 5,766 ,, ,, school visits (half-day) 221 ,, „ Malaria visits — ,, ,, Tuberculosis visits 88 ,, ,, Puerperal Fever visits 14 ,, ,, visits to parents of school children 333 Total of all visits 6,422 During 1930, the record of work at the Centres was as follows:— Infant Welfare Consultations. Pelham Centre. Wandle Park Centre. Number held 49 48 Total number of attendances 3,166 1,929 Average number of attendances 64 40 Ante-Natal Clinic Consultations. Number held 23 Total number of attendances 157 Average number of attendances 6 Classes for Mothers. Number held 29 29 Total number of attendances 1,233 1,359 Average number of attendances 42 47 Subjects taught Hygiene Home Nursing Mothercraft Singing Hygiene Home Nursing Mothercraft Singing Supply of Milk to Expectant and Nursing Mothers and Infants. During the year, 148 applications for free milk supplies were received from 54 families, 140 of which were granted. Each case is considered individually by the Sub-Committee, and a full 56 statement of income from all sources, including pension and Public Assistance, children working, etc., has to be submitted by the applicant. Dental Treatment. Dental treatment is also available for children under school age and for nursing and expectant mothers. The Dental Surgeon devotes one session a week at the Clinic to Maternity and Child Welfare cases. 195 mothers and 142 children under school age attended for treatment during the year. 58 general anaesthetics were administered. Where necessary, nursing and expectant mothers are provided with dentures. 11 dentures were supplied to mothers through the Dental Clinic during 1030 and in 2 cases dentures were repaired and remodelled. It is difficult to over-estimate the importance of this side of the work, as it is impossible for a mother to rear a healthy child unless her mouth is in a satisfactory condition and she is able to masticate her food properly. Many of the mothers still show considerable reluctance to having requisite dental attention. The following table gives an indication of the work carried out by the Dental Surgeon in connection with the Maternity and Child Welfare Department for the year ended 31st December, 1930:— Mothers—Attendances for treatment 195 ,, Teeth extracted 141 ,, ,, filled 35 ,, other operations 61 „ Scalings 33 ,, Dentures supplied 11 ,, ,, repaired and re-modelled 2 ,, other Prosthetic operations 54 Children—Attendances for treatment 142 ,, Teeth extracted 156 ,, ,, filled 20 ,, other operations 62 Total number of fillings inserted 62 ,, ,, ,, Local Anæsthetic administered 26 „ ,, ,, General do. do. 58 ,, ,, ,, Anesthetic Sessions at- ,, ,, ,, tended by Dr. TaylorHarris 21 Children Act, 1908.—In April the Wimbledon Borough Council became the Local Authority for the administration of Part 1 of the Children Act, 1908, in accordance with the Local Government Act, 1929. 57 At the end of the year there were 32 registered foster mothers and 34 foster children in the Borough. The Council appointed the three Health Visitors to be Infant Protection Visitors under the Act. Visits were paid by the Health Visitors every month and where necessary at more frequent intervals. The total number of these visits amounted to 268. In two cases it was found necessary to remove the children to a place of safety. These children were not in the care of registered foster mothers. In every case where the child left its foster mother, information was sent to the Medical Officer of the area concerned, in order that the circumstances could be duly investigated. In no case was it necessary to institute proceedings under the Act. Municipal Day Nursery.—The work at the Day Nursery at Hubert Road during 1930 was most satisfactory. The number of children on the Register at the end of the year was 106. These children came from 81 families. The total attendances made by the children amounted to 8,513 whole days. The average daily attendance was 36.5. The Nursery has accommodation for 50 children—20 infants and 30 toddlers. Infants are admitted from the age of four weeks and toddlers remain until they commence school at five years. The children are brought to the Nursery between 7.30 and 8.45 a.m. They are then undressed, bathed, and re-dressed in nursery clothes. Their heads are washed at the Nursery once a week. The children are provided with three meals during the day. Infants up to the age of eight or nine months are bottle-fed, whilst the older children receive an excellent dietary suitable to their age. This is supplemented by fruit juice, and cod liver oil and malt or virol. Infants up to the age of eight months are weighed weekly, and thereafter monthly up to the age of one year. Toddlers up to the age of five years are weighed every three months. During 1930, 476 " weighings " were carried out. The children respond well to the nursery life and show a satisfactory gain in weight. 58 A charge of 6d. per day is made for each child attending the Nursery. No children residing outside the Borough were admitted during the year. The revenue from this source amounted to £252 12s. 9d. during 1930. A medical record card is made out for each child. This card has been drawn up to conform with those used in the Maternity and Child Welfare and School Medical Departments. This enables the medical record to be transferred with the child and attached to its school medical record when it commences school. All the toddlers in the Nursery were inspected by the Dental Surgeon in January and June. The condition of the teeth of the older children was remarkably good. Over 50 per cent. of them were entirely free from dental caries. 8 children were found to require treatment. In 7 of these cases the treatment was carried out at the dental clinic. Only in one case was treatment refused. Regular routine medical inspection of children at the Nursery was also undertaken. As far as possible the children are examined every three months. Any child whose condition is not considered satisfactory is brought to the attention of the mcdical staff during the weekly visits. Any child who on admission to the Nursery is found to be suffering from any suspicious illness is immediately placed in the isolation room and all precautions taken until it has been medically examined. In 2 cases during the year children were found to be suffering from scarlet fever when admitted to the Nursery. They were immediately sent home and the necessary disinfection and precautionary measures taken. No further cases occurred. In May, measles was prevalent in Wimbledon, and the number of children attending the Nursery dropped to 11. At the same time several Nursery children were reported to be ill at home with measles. Consequently the Nursery was closed from the 13th June to the 30th June and the premises thoroughly disinfected. Every week the Public Health Department forwards to the Matron of the Day Nursery the names and addresses of school children who are absent on account of infectious diseases. This enables the Matron to ascertain whether any of the Nursery children are coming from infected homes. Such children are immediately excluded. 59 Two members of the Day Nursery staff contracted infectious diseases during the year. The first case was a member of the nursing staff who developed scarlet fever. This patient was removed to the Isolation Hospital over the week-end, and in order to allow thorough disinfection to be carried out, the Nursery was closed on the following Monday and Tuesday. No further cases occurred. Towards the end of the year a member of the domestic staff was removed to the Isolation Hospital suffering from diptheria. All the staff and children were examined and swabbed. No secondary cases arose. In October arrangements were made with the Froebel Institute for two student teachers to attend at the Nursery two mornings a week to give instruction to the older children. The instruction consisted chiefly of musical games and individual play, and was of considerable benefit to the toddlers. There is no doubt that the Nursery meets a very real need in South Wimbledon. Each application for admission is carefully considered. A child is only admitted when it is genuinely necessary for the mother to go out to work. During 1930 continued progress has been made in the work of the Public Health Department. A considerable amount of re-organisation has been carried out and I am indebted to the staff for the loyal and efficient way in which they have supported me. I should also like to thank my colleagues in other departments for their help and co-operation. I have the honour to be, Your obedient servant, HAROLD ELLIS. 60 61 TABLE 1.—Vital Statistics of Whole District during 1930 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. Pate per 1000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1928 59,070 637 691 11.6 476 8.05 84 240 38 55 632 10.7 1929 59,370 705 759 12.7 573 9.6 81 282 35 46 774 13.03 1930 59.370 691 766 12.9 444 7.4 57 261 38 49 648 10.9 62 TABLE II.—Causes of, and Ages at, Deaths during the year 1930. CAUSES OF DEATH. Nett Deaths at the subjoined ages of " Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' on' NonResidents' in Institutions in the District. All Ages. Under 1 year. 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All Causes Certified 648 38 13 3 3 1 11 3 9 48 34 165 320 89 Uncertified — — Enteric Fever 1 - - - - - - - - - 1 - - - Small-pox — - — - — — — — — — — — - — Measles 10 2 4 1 2 — — — 1 - - - - 1 Scarlet Fever - - - - - - - - - - - - - - Whooping Cough 2 1 1 - - — - - - - - - - - Diphtheria and Croup 4 - 1 - — — 2 1 — - - - - 6 Influenza 3 1 — - — — — — — — — 1 1 1 Encephalitis Lethargica 1 - — — — — — — — — — 1 - — Meningococcal Meningitis 1 - — — — — — — — — - 1 - 1 Tuberculosis of Respiratory System 34 - - - - - - - 2 18 6 7 1 1 Other Tuberculous Diseases 7 1 2 — — — — 1 1 — 1 1 - 2 Cancer, malignant disease 106 - 1 — — — 1 — — 3 7 41 53 12 Rheumatic Fever 6 - — — — — — — 2 1 1 2 - Diabetes 8 - — — — — — — 1 — - 3 4 2 Cerebral Hæmorrhage 35 - — — — — — — — 1 - 10 24 6 Heart Disease 128 2 — — — — 1 — — 4 3 28 90 11 Arterio Sclerosis 25 — — - - - - - - - - 4 21 2 Bronchitis 23 — 2 - - - - - - - - 2 19 1 Pneumonia (all forms) 44 6 1 2 — 1 — — 1 4 3 14 12 6 63 TABLE II,—continued CAUSES OF 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 Bespiratory Diseases 12 - - - - - - - - - - 7 5 2 Ulcer of Stomach, or Duodenum 8 - - - - - - - - - 2 5 1 2 Diarrhcea, &e. (under 2 years) 2 2 - - - - - - - - - - - - Appendicitis and Typhilitis 7 - 1 - - - - - - 1 - 1 4 1 Cirrhosis of Liver 4 — - - - - - - - - - 2 2 - Acute and Chronic Nephritis 19 — — — — — 1 — - - 1 2 15 3 Puerperal Sepsis 2 — — — — — — — — 1 1 - - - Other Accidents and Diseases of Pregnancy and Parturition 3 - - - - - - - - 2 1 - - 2 Congenital Debility & Malformations Premature Birth 13 13 - - - - - - - - - - - 2 Suicide 10 — - — - — - - - 2 - 5 3 1 Other Deaths from Violence 24 — - — 1 — 4 — 1 4 1 7 6 4 Other Defined Diseases 106 10 - — — — 2 1 2 6 6 22 57 20 Causes ill-defined or unknown - - - — — — — — — — - — — - Totals 648 38 13 3 3 1 11 3 9 48 34 165 320 89 STAFF. (a) Whole-time Officers: School Medical Officer: * ‡ Harold Ellis, M.B., B.S. (Lond.), M.R.C.S., L.R.C.P., 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: (a), (c), (/). Miss A. M. L. Holman. Health Visitor—School Nurses: * (b), (d), (/). Miss M. Giles. * (a), (b), (f). Miss E. M. Skelton. * (a), (6), (c). Miss G. Hyde. Dental Attendant: Miss K. O'Hara. Cleansing Attendant: Mrs. M. Potts. Clerk: Miss C. Coysh. (b) Part-time Officers: Oculist: J. P. Crawford, M.D. Ancesthetist: S. Taylor Harris, M.R.C.S., L.R.C.P. * Maternity and Child Welfare Officer!. ‡ Public Health Officers. (a) S.R.N. (b) C.M.B. (c) Certificate of Fever Training. (d) Certificate San. Inspect. (e) New Health Visitors Certificate R.S I. (f) Health Visitors Certificate R.S.I. 64 Borough of Wimbledon. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1930 To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Annual Report for the year 1930 on the work of the School Medical Department. There are 10 public elementary schools, with 19 departments under the control of the Local Education Authority. These schools provide accommodation for 7,019 children. The average number of children on the school registers during the year was 5,270, and the average attendance 4,638, thus making an average attendance of 88 per cent. The Special School at Queen's Road has accommodation for 50 children. 2. CO-ORDINATION. (a) There is complete co-ordination between the work of the School Medical Service and that of the Maternity and Child Welfare Department. In addition to the Senior School Nurse, who devotes her whole time to the School Medical Service, there are three School Nurse-Health Visitors. These latter devote two-thirds of their time to Maternity and Child Welfare work, and one-third to the School Medical Department. Children attending the Infant Welfare Centres remain under the supervision of the same Health Visitor after they commence school. The work of the School Medical Service with its Ophthalmic and Dental branches, and the Maternity and Child Welfare Department are now centralised in the new Health Centre at 65 Pelham Road. This promotes a very complete co-ordination of the services. (b) No Nursery Schools have been established in Wimbledon. (c) Children between the ages of 12 months and 5 years are visited twice a year by the Health Visitors. Debilitated children are visited more frequently. The Maternity and Child Welfare Committee have made arrangements whereby debilitated children requiring convalescent treatment can be sent to recognised convalescent institutions. REORGANISATION. A considerable amount of reorganisation was carried out in the School Medical Department during the year. Previously, the routine medical record cards of the children were kept in class order in the schools. There are many disadvantages to this system. Consequently these record cards were transferred to the central office in the Health Centre and placed in card index cabinets. Here the cards of each department are kept in alphabetical order. The staff are now able to refer quickly to the medical record of any child in school. Furthermore there is no danger of any of the cards becoming lost. There is also greater accuracy in arranging for the routine medical inspection of the children in the respective age groups. The cards of the children due for examination are taken to the schools and checked with the registers. This new arrangement is working admirably. A re-examination card is now made out for every child found to be defective at the routine medical inspection. This provides the school nurse with a complete record of all the children attending that school who require to be followed up. These children are also re-examined by the Medical Officer at the next visit to the school. This ensures every defective child being seen by the doctor at least twice a year. After every routine medical inspection has been completed, a form is sent to the Head Teacher of the school containing the recommendations of the School Medical Officer concerning children found to be suffering from defects. Such defects as impaired hearing, faulty posture, defective sight, etc., have an important bearing on a child's educational progress. Other conditions may render drilling or swimming inadvisable, and it is essential that, the Head Teacher should be in possession of this information in a readily accessible form. The records of the children examined as special cases at the Health Centre have also been considerably simplified. Previously it was possible for a child to have three or four different medical record cards. This system has been discontinued, and a simpler and quicker method adopted. A similar reorganisation has been effected in the Minor Ailments Clinic. 66 The School Medical Service in Relation to Public Elementary Schools. 3. SCHOOL HYGIENE. Speaking generally, the sanitary condition of the Public Elementary Schools in the district is very satisfactory. During the year painting at the following schools was carried out by the Borough Surveyor's Department: — Pelham Road Infants—internal painting. Wimbledon Park School—internal and external painting. A drinking water service off the Water Board's mains has been installed at the following schools: — Dundonald School. Queen's Road School. Effra Road School. Haydons Road Boys. Haydons Road Girls and Infants. Old Central School. The remaining schools are now being dealt with. Schools that have the least satisfactory dual desks for senior scholars are being equipped with modem locker-desks. 4. MEDICAL INSPECTION. (a) The children medically examined were those in the three groups required by the Code of the Board of Education. These included:— (i) Entrants: i.e., those children admitted to school for the first time since the last routine medical inspection, (ii) Intermediates: i.e., those children who have attained their 8th birthday since the last routine medical inspection, or who will be 9 years af age during the current year. (iii) Leavers: i.e., those children who have attained their 12th birthday since the last routine medical inspection, or who will be 13 years of age during the current year. There were medically inspected in the schools during the year 1930:— Entrants 620 Intermediates 694 Leavers 437 Total 1751 In addition there were 140 other routine inspections in the schools, making a total of 1,891. 67 Apart from these routine inspections, 2,819 children were specially inspected at the Health Centre, and 7,186 re-inspected. The total number of children examined during the year as routine or non-routine cases was 4,710. The number of children examined at the routine inspection in the schools shows a decrease of 49 below the figure for the previous year. In the same way, the number of special inspections and re-inspections at the Health Centre is 191 less than during the year 1929. (b) The Board's Schedule of Medical Inspection has been adhered to in every respect. (c) Medical inspection causes a certain amount of disturbance, especially in the older type of schools. In 9 departments the inspection is carried out in the Head Teachers' rooms. In the older schools a classroom is utilised for this purpose. Owing to the fact that no classroom was available at Havdons Road Girls' School, nor at Haydons Road Infants' School, the medical inspection of these scholars was carried out at the Church Institute which is situated quite near. The accommodation here for the purposes of medical inspection is quite suitable. The same difficulty has arisen in connection with St. Mary's Junior and Senior Mixed School at Russell Road. As this school is situated quite near the Pelham Road Health Centre, the medical inspection of these scholars was carried out at the School Clinic. 5. FINDINGS OF MEDICAL INSPECTION. In Table 11a (which is appended) is given a list of all defects found during medical inspection, whether routine or non-routine. Table 11b gives the number of individual children found at the routine medical inspection to require treatment, excluding uncleanliness, and dental diseases. 1,891 children were examined at the routine medical inspection. 428 or 22.6% were found to be suffering from defects (excluding uncleanliness and dental diseases) requiring treatment. The percentage of defects was found to be slightly higher amongst the " entrants " and " intermediates " than amongst the "leavers." During 1929 the percentage of children with defects found at the routine medical inspections throughout the country was 20.8%. (a) Uncleanliness. 9 or 0.5% of the children examined at the routine medical inspection were found to be unclean and excluded from school. In addition 53 were found to require further observation in school on account of this condition, and were kept under supervision. This shews a considerable improvement over the previous year when 32 or 1.6% of the children examined at the routine medical inspection required exclusion from school on account of uncleanliness. 68 The Cleansing Attendant was absent from duty on account of illness throughout the year, and towards the end of 1930 was superannuated for reasons of ill health. The School NurseHealth Visitors continued to carry out the systematic inspection of all the scholars in their schools three times a year, i.e., after the Christmas, Easter, and Mid-Summer holidays. This inspection reveals not only unclean children, but also children suffering from defective vision, minor ailments, anaemia, malnutrition, etc. These latter children are referred either to their own doctors or to the Health Centre where they are seen by one of the school medical staff. The number of examinations of children carried out in the schools by the School Nurses amounted to 12,704. This means that nearly every child was inspected for uncleanliness three times during the year. On an average, the nurses paid 7 visits to each school. A much higher standard of cleanliness has been insisted upon and there is no doubt that a considerable improvement has been effected. 75 children were cleansed at the Health Centre in accordance with the arrangements made by the Education Committee. This figure is 25% loss than that for the previous year. Now that the services of a Cleansing Attendant are no longer available, a larger number of children are being cleansed by their parents at home. Apart from a small number of cases where the mothers are unable through illness or other bona fide reasons to cleanse the children themselves, this is in every way the more desirable method of dealing with the problem. The fact that a slightly higher number of unclean children were found by the nurses in school during the year is accounted for by the considerably enhanced standard of cleanliness which has been insisted upon. In no cases were legal proceedings necessary. (b) Minor Ailments. See below and also sections under Medical Treatment. (c) Tonsils and Adenoids. At the routine medical inspection there were 48 cases of enlarged tonsils, 3 cases of adenoids, and 45 cases of adenoids with enlarged tonsils. Thus out of 1,891 children examined in the routine way, 96 or approximately 5% were found to require operation. In addition there were 164 children or 8.6% with enlarged tonsils or with adenoids and enlarged tonsils requiring to be kept under observation but not requiring treatment. At the Health Centre 110 other cases were found on special examination to require operation for this condition. These percentages are slightly higher than those for the preceding year. (d) Tuberculosis. Three suspected cases of pulmonary tuberculosis requiring treatment and one suspected case requiring observation were discovered at the routine medical inspection. 69 In addition seven other cases of tuberculosis were found, two being cases of tuberculous glands and one a case of tuberculous hip. These children were under treatment and the disease was in an arrested condition. At the special inspections conducted at the Health Centre there were two suspected cases of pulmonary tuberculosis and and one other non-pulmonary case. The suspected cases were referred to the Tuberculosis Physician between whom and the school medical staff a close co-operation is maintained. The other case was already under treatment. (e) Skin Disease. Of the children examined as routine cases in the schools 2% were found to be suffering from skin diseases. There were 38 cases in all. Two were suffering from ringworm of the scalp, twelve from impetigo and 24 from other minor skin ailments. 349 or 12.4 % of the special cases examined at the Health Centre were discovered to be suffering from diseases of the skin. A great number of these cases are sent up by the teachers and attendance officers. There were six cases of ringworm of the scalp and 48 cases of ringworm of the body. 17 of the cases were due to scabies, 148 to impetigo, and 130 to other skin conditions. Very few cases of scabies and ringworm of the scalp occur amongst school children in Wimbledon. Impetigo however, is of fairly frequent occurrence. (/) External Eye Disease. There were 26 cases of external eye disease amongst the 1,891 routine children examined. This gives a percentage of 1.4. 21 of the cases were due to blepharitis and some of these were very mild. In addition there were 4 cases of conjunctivitis and one due to keratitis. At the Special Inspection there were 81 cases or 2.8% due to external eye disease. 53 were due to blepharitis, and 28 to conjunctivitis. Serious conditions- such as keratitis and corneal opacities are fortunately only rarely found amongst the school children in Wimbledon. (g) Defective Vision. Defective vision is one of the most important defects discovered amongst school children. At the routine medical inspection 74 children were found to be suffering from defective vision requiring treatment and 21 to be suffering from squint. This makes a total of 95 cases requiring treatment or 5% of the children examined. The figure for the previous year was 4.3%. The actual incidence of defective vision requiring treatment is, however, higher than 5%. Of the 1,891 children examined as routine cases 620 were entrants and in the majority of these it was impossible to carry out subjective visual 70 tests on account of their age. In addition, 38 children with slighter degrees of defective vision were found at school. These cases did not require treatment but required to be kept under observation. In the absence of medical inspection a large number of children would undoubtedly be handicapped in their school life by uncorrected defective vision, and their education would suffer very considerably. Of the children examined as special cases at the Health Centre there were 47 with defective vision and 8 with squint requiring treatment, and 9 with defective vision requiring to be kept under observation. The cases which are kept under observation and not referred for immediate treatment are those with minor defects of vision. They are inspected periodically and referred if necessary at a later date for examination by the Ophthalmic Surgeon at the Refraction Clinic. It is a pity that the print of many of the children's popular papers is not of a larger and clearer type. Children read these papers extensively, and often in a poor light. Only too frequently they are allowed to read in bed especially when convalescing from illnesses. These factors are liable to produce myopia or short sight. (h) Defective Hearing. At the routine inspection 13 children were found to be suffering from defective hearing, 14 from otitis media, and one from other ear disease, all requiring treatment. There was also one child with otitis media requiring to be kept under observation. In other words 1.5% of the children examined in the schools were found to be suffering from defective hearing or from discharging ears. Furthermore 11 children with defective hearing, 49 with otitis media, and 27 with other ear diseases, all requiring treatment, were examined as special cases at the Health Centre. Deafness and running ears are still of too frequent occurrence amongst school children. A discharging ear is a source of considerable discomfort and unpleasantness to a child. The impairment of hearing which is nearly always associated with it gives rise to a considerable handicap in school life. The chronic discharging ear is also a source of danger owing to complications of the mastoid region which are liable to arise. Infectious diseases such as measles and scarlet fever are common causes of discharging ears. Nearly all the cases of scarlet fever, however, that occur in the Borough are treated in the Infectious Diseases Hospital, and it is quite uncommon for a child to be discharged with a running ear or with impaired hearing. Infections such as measles, scarlet fever, influenza and the common cold, occurring in a child with enlarged tonsils and adenoids are the chief causes of ear trouble. Dental sepsis is also an important contributory factor. Removal of enlarged tonsils and adenoids and attention to oral and nasal hygiene are the principal measures for preventing ear diseases. Greater 71 supervision in the pre-school period would also undoubtedly help to reduce the incidence of these defects. (/) Dental Defects. At the routine inspection by the Medical Officer 262 children were found to have defective teeth requiring treatment, and 154 to have defective teeth requiring to be kept under observation. Thus out of a total of 1,891 children examined in school, 416 or 22% were found to have dental caries to such an extent as to require treatment or to require their being kept under observation. During the year 1929 the percentage was 22.3. (j) Crippling Defects. One case of spinal curvature requiring treatment and 7 requiring observation were found at the routine inspections. There were also 2 cases of slight deformity due to rickets which did not require treatment. Tn addition there were a number of cases of round shoulders, ten of which required treatment and 28 observation. During July a further enquiry was instituted into the incidence of crippling amongst: — (1) Children of school age. (2) Children under school age. In all 33 cases were examined. 28 of these cases were school children and 5 children under school age. These cases may be tabulated as follows: — School. Maternity and Child Welfare. Rickets 3 4 Infantile Paralysis 9 - Other forms of Paralysis 3 - Congenital Malformations 5 1 Other causes 8 - Total 28 5 Nearly all these cases were undergoing treatment or had already received attention at the various hospitals in London. In order to secure consecutive treatment and proper after care tor crippled children, the Education and Maternity and Child Welfare Committees had under consideration during the latter part of the year a scheme for orthopaedic treatment. Particulars of this scheme are given under the section dealing with Medical Treatment. (k) Malnutrition. Malnutrition is not common amongst school children in Wimbledon. 1891 children were examined during the year as routines and only six were found to be 72 ing from malnutrition to such an extent as to require treatment. This gives an incidence of just over 3 per 1,000. The incidence amongst school children for the whole of England and Wales for the year 1929 amounted to 9.5 per 1,000. It is thus evident that the position in Wimbledon as compared with the rest of the country is very favourable. In addition to the six children requiring treatment, there were 35 children whose nutrition could not be regarded as satisfactory. They did not require treatment but required to be kept under observation. At the special examinations at the Health Centre 12 children were found to be suffering from malnutrition requiring treatment and 2 requiring observation. The standard of clothing and footgear was also very satisfactory. 6. INFECTIOUS DISEASE. The means adopted to prevent the spread of infectious disease amongst school children are:— (a) Exclusion of children actually suffering from infectious diseases or coming from infected houses. The Memorandum of the Board on Closure of and Exclusion from School is closely followed in this particular. ((>) Closure of Schools. (c) Disinfection of Schools. (a) In the case of notifiable diseases occurring in houses where there are children attending school, notices on special exclusion forms are sent out from the Public Health Department to the Head Teachers and Chief Attendance Officer. Children from such infected houses are excluded until the necessary re-admission forms have been issued. The notifiable infectious diseases occurring amongst school children are dealt with in the report of the Medical Officer of Health. (b) School closure is rarely resorted to to-day for the purpose of controlling infectious diseases. During 1930 it was not found necessary to close any of the schools in the district for this purpose. (c) The routine disinfection of each school was carried out by the Sanitary Staff during the mid-summer holiday. Disinfection of classrooms was also carried out periodically as the necessity arose during the course of the year. (d) Valuable information is obtained from the weekly returns of absences due to infectious diseases furnished by the Head Teachers. The numbers of cases of non-notifiable diseases reported from the schools during 1930 were as follows:— 73 Measles 423 German Measles 5 Whooping Cough 30 Mumps 50 Chicken Pox 57 During the early part of the year measles was very prevalent and accordingly the attendance in the Infant Departments suffered severely. Repeated visits were paid to the Infants' Schools with the view to excluding children with suspicious prodromal symptoms. In many of the cases the early symptoms appeared to be extremely indefinite. A number of the children who were sickening simply appeared to be a little listless and apathetic. This rendered it much more difficult to check the spread of the disease in the schools. After a slight recrudescence of the epidemic in May the number of new cases rapidly fell and by June the schools were practically free. Some of the cases were of considerable severity. In accordance with Article 53 of the Education Code, 260 children were excluded from school during 1930 for the following conditions:— Conjunctivitis 3 Impetigo 27 Ringworm of Head 6 Ringworm of Body 34 Scabies 17 Other Causes 91 Total 178 No cases of smallpox occurred amongst school children in Wimbledon during the year. One school child was a contact of a case of smallpox, and she was kept under observation daily until the period of quarantine had expired. 7. FOLLOWING UP. The procedure of following up defects discovered during the routine medical inspection in 1030 was as follows:— Parents were informed of the defects detected in their children during the medical inspection in the schools. Where the defect was of a minor nature they were informed verbally. In the case of more important defects the parents received a printed notice advising them of the nature of trouble and of the need for obtaining treatment. A re-examination card was made out for each such child. As soon as convenient, after the inspection of the school had finished, the nurse returned to the school with all the re-examination cards. The nurse then ascertained in each 74 case whether the defect from which the child had suffered was receiving attention. When necessary, visits to the homes were paid and the parents interviewed. The Medical Officer visits each school in the district at least twice a year in order to carry out the routine medical inspections. The re-examination cards of all children with defects are taken to the school at each of these visits. Children suffering from defects are thus re-examined by the school doctor at least twice a year. If the defect has not received attention a further notice is sent to the parents. Previously the following up was carried out at a Special Inspection Clinic which was held at the Health Centre every Tuesday afternoon. This clinic has now been discontinued. 8. MEDICAL TREATMENT. Table IV gives a return of the defects treated during the year under arrangements which have been provided by the Education Committee. (a) Minor Ailments. The Health Centre at Pelham Road is open daily for the treatment of minor ailments. In order to provide greater continuity facilities are now available for the treatment of minor ailments on Saturday mornings. With the exception of bank holidays, the Health Centre was open throughout the year. (b) Tonsils and Adenoids. 91 children were operated on for enlarged tonsils and adenoids during 1930 at the Nelson and North Wimbledon Hospitals under the Education Committee's scheme. These patients remain in hospital overnight after their operations. The children are again examined by the Medical Officer at the Clinic before they return to school. In addition, 30 other children were operated on for enlarged tonsils and adenoids by private practitioners or at the voluntary hospitals. This makes a total of 121 children who received surgical treatment. Full details are outlined in Table IV., Group III. (c) Tuberculosis. Cases of tuberculosis, together with suspected cases, whether discovered as Routines or Specials, were referred to the Tuberculosis Physician. (d) Skin Diseases. 6 cases of ringworm of the head were referred to the St. John's Hospital for treatment by means of X rays under the scheme of the Education Committee. Three other cases of skin disease were also referred to this hospital for treatment. 48 children with ringworm of the body, 17 with scabies, 148 with impetigo, and 71 children suffering from other skin diseases were treated at (he Minor Ailment Clinic at the Health Centre 75 (e) External Eye Diseases. 87 children with external eye diseases received treatment at the Health Centre. The more serious cases were referred to the Ophthalmic Surgeon attending the refraction clinic. Many of these children suffering from external eye diseases require daily treatment over fairly long periods. As in the case of many other minor ailments it is very difficult for a great number of the parents to carry out this treatment adequately at home. At the Health Centre the treatment is done by the School Nurses under the guidance of one of the Medical Staff. If the children are irregular in their attendance they are followed up at home. These defects are consequently more rapidly rectified and a considerable gain in school attendance results. 5 children suffering from diseases of the eye were sent to hospital for treatment. (f) Vision. At the end of the Easter term Mr. Moxon resigned his appointment as Oculist to the Education Committee and Dr. J. P. Crawford was appointed to fill the vacancy. Details of the work of the refraction clinic are given in Table IV, Group II. This clinic is held every Monday afternoon from 2 to 4.30. Frequently during the year it was necessary to hold further sessions on Thursday afternoons. The refraction clinic continued to be well attended and is much appreciated by the parents. 338 children were examined by the Ophthalmic Surgeon during the year. Glasses were prescribed in 126 cases and in 125 cases the spectacles were obtained. The remaining case had not received the spectacles at the end of the year, as they had not arrived from the optician. Every child is seen again at the clinic by the Ophthalmic Surgeon after the spectacles have been obtained. In cases of myopia the children are re-examined twice a year. Children suffering from other types of defective vision are re-tested at the refraction clinic at the end of twelve months. It is only very occasionally that any difficulty is experienced in persuading parents to provide glasses for a child. In no case was there a persistent refusal. (g) Ear Diseases. 87 children, with minor ear defects were treated at the Health Centre. Most of these cases were suffering from otorrhoea, wax in the ear, or eczematous conditions of the meatus. It is most important that children with running ears should receive regular treatment. Here again it is often difficult for parents to carry out this properly at home. These children attend daily at the Health Centre until the condition is cured. Where necessary, operative treatment is provided for the removal of the tonsils and adenoids. (h) Dental Treatment. During 1930 the routine inspection by the School Dental Surgeon was extended so as to include all 76 children up to the age of 12 years. In 1931 the dental inspections will be still further extended and will include all children attendin-; the public elementary schools. During the year under review 4,270 children were dentally inspected. This represents an increase of 1,233 over the figure for the previous year. 3,179 or 74.4% were found to require treatment and their parents were notified accordingly. The number of children actually treated was 1,858 or 58% of those who were found to require treatment. It is still difficult to obtain consent for treatment in a considerable number of cases. When appointments are not kept visits are paid to the homes by the School Nurses, and every effort is made to get the parents to attend with their children at the dental clinic. The Saturday morning dental clinics which were started during 1930 have been entirely justified, and have shewn a good average attendance. 40 half days were devoted to dental inspection in the schools and 411 half days to treatment at the Health Centre. The number of attendances made by children for treatment amounted to 3,713. This is 782 more than the figure for the previous year. The average number of children attending for treatment per session was 9, a slight increase over the figure for 1929. The total number of fillings amounted to 2,318 or 497 more than during the previous year. Far more attention has been paid to the filling of permanent teeth. In consequence the number of temporary teeth filled shews a very considerable drop. The number of teeth extracted shews an increase of 682, the total figure for the year being 3,434. 517 general anaesthetics were administered for dental extractions. (i) Crippling Defects and Orthopaedics. During the latter part of the year the Education and Maternity and Child Welfare Committees considered the question of the provision of an orthopaedic scheme for children below school age and also for children attending school. Under this scheme the following arrangements have been made with St. Thomas' Hospital. (i) The Orthopaedic Clinic will be held at the Health Centre, Pelham Road, Wimbledon. (ii) Patients will be collected by the School Medical Officer or his department. (iii) An Orthopaedic Surgeon from St. Thomas' Hospital will attend the clinic once a month or at such other intervals as may be arranged. (iv) In-patient treatment will be carried out at St. Thomas' Hospital or at Pyrford, according to the nature of the case. 77 (v) An Orthopaedic Nurse from St. Thomas' Hospital or Pyrford will attend the Orthopaedic Clinic one session per week to carry out the necessary after-care. These sessions will be increased if found necessary. Children sent into Pyrford will receive education whilst undergoing treatment. It is hoped that this scheme will be put into operation early in 1931. (i) Artificial Light Treatment. Arrangements were made during the year for 12 children attending the Health Centre to receive Artificial Light Teatment. The children selected for this treatment were suffering from malnutrition and anaemia often associated with manifestations of rheumatism. SPEECH CLINIC. The Speech Clinic in 1930 was continued on the same lines as during the previous year. Sanction was obtained from the Board of Education at the end of each session for its continuance for a further period of three months. As there was no delay in obtaining this sanction the classes were held regularly in accordance with the school terms. The Easter Term started on 15th January and terminated on 10th April. The following cases were treated:— Stammerers 11 Defective Speech 16 Total 27 During this term, owing to disparity in the ages, it was considered advisable to divide the stammerers' class into two, with very satisfactory results. By the end of the term two cases of defective speech had been cured. Classes in the Summer Term began on 30th April and terminated on 17th July. The following cases were treated:— Stammerers 10 Defective Speech 12 Total 22 One stammerer and six children with defective speech were cured and discharged. 78 The Autumn Term began on 17th September and ended on 17th December. The following cases were treated:— Stammerers 15 Defective Speech 8 Total 23 By the end of the term the following were cured and discharged:— Stammerers 1 Defective Speech 1 Total 2 A report on each child is kept at the Clinic and details of the progress are filled in by the Head Teacher at the end of each term. The reports for this year have been very favourable, showing that considerable progress has been made by each child attending the Clinic. I am indebted to Miss Crickmay and Miss Gardener for the above particulars. There is no doubt that the Speech Clinic is meeting a real need. The work is of the greatest importance and encouraging results are being obtained. In order to effect a cure many of the children require prolonged treatment and continuity of the classes is essential. Arrangements have been made for the Speech Clinic to be continued during 1931. 9. OPEN AIR EDUCATION. There are no Day Open-Air Schools nor Residential OpenAir Schools in Wimbledon. Where circumstances permit in the summer months some of the classes in the schools are conducted in the open air. In August-, 40 Boys from Haydons Road School were taken to Camp at Dymchurch for 14 days. The ages of the boys ranged from 9 to 13 years. They were medically examined and weighed before leaving Wimbledon and were again weighed after their return. With few exceptions the children all shewed a satisfactory gain in weight. Lessons were given in Geography, History, Nature Study and Industry. These lessons were supplemented by visits to a number of places of interest in the neighbourhood. Ample facilities were available for safe bathing and for all forms of sport. The boys were fortunate in having excellent weather, the camp was thoroughly enjoyed, and resulted in considerable benefit to health. Another holiday Camp was arranged during the year by the Wimbledon Rotary Club. 28 boys from various Elementary Schools in the District were selected and sent away to Swanage for one week. The children were weighed and medically examined before leaving Wimbledon. Besides having a very enjoyable holiday the boys improved considerably in health. 79 These Holiday Camps are greatly appreciated by the children. Apart from the almost invariable improvement in health which occurs, the change of environment is associated with considerable educational value. 10. PHYSICAL TRAINING. Physical exercises and organised games are carried out In all the schools, the instruction being given by the class teachers on the lines laid down in the syllabus issued by the Board of Education. Swimming instruction is given at the Wimbledon Corporation Baths to children over ten years of age. The children attend once a week and the instruction is given by the class teachers. The cost of admission to the Baths is twopence for each child and this is paid by the Education Committee. Where swimming is considered inadvisable for a child on medical grounds, such as disease of the ears or heart, the Head Teacher is notified accordingly by the School Medical Department. 11. PROVISION OF MEALS. Meal's are provided mid-day by the Education Committee for the children attending the Special School. A good hot lunch is served. The quality of the food is excellent and the majority of children remain for this meal. No meals were provided during the year for children attending the other schools. 15 children however, on account of malnutrition and anaemia received half a pint of milk daily in school. Some of these children also received Cod Liver Oil and Malt in addition. More than half the Departments during the year started supplying children with milk through the Milk Publicity Council. The milk is supplied in bottles containing one-third of a pint, at a cost of Id. The reports from the Head Teachers indicate that the children have benefitted considerably from receiving this milk. 12. SCHOOL BATHS. The arrangements for the bathing of the children attending the Special School are given under Section 17. 13. CO-OPERATION OF PARENTS. Parents are invited to be present at the school during the inspection of their children, and on the whole the response has been very gratifying. Out of 1891 children examined at the routine inspections, 1,231 or 65% were accompanied by one or other parent. This enables the school medical inspector to give detailed advice in the case of children found to be suffering from 80 defects. A very large number of parents also attended at the special examinations held at the Health Centre. 14. CO-OPERATION OF TEACHERS. The teachers have rendered great assistance to the School Medical Department during the year. They have facilitated the medical inspection work in the schools, and given every assistance to the school nurses when following up cases found to be defective, and also during the routine cleansing examinations. They have also co-operated, as in past years, by bringing defective children to the notice of the school medical staff and arranging for their attendance at "the Health Centre. 15. CO-OPERATION OF THE SCHOOL ATTENDANCE OFFICERS. A close co-operation has been maintained throughout the year between the School Medical Department and the School Attendance Officers. 16. CO-OPERATION OF VOLUNTARY BODIES. A close co-operation exists between the School Medical Department and the Invalid Children's Aid Association and the Wimbledon Guild of Social Welfare. During the year 1980 the Local Branch of the Invalid Children's Aid Association sent 38 Wimbledon Children of school ago to Convalescent Homes for various periods. In 8 of these cases education was provided whilst they were away. 5 children were provided with instruments and about 220 children were kept under supervision during the year. The work of the Association has been especially valuable in the case of children who have been discharged from the London Hospitals convalescing from such diseases as chorea, suppurating glands of the neck, etc., and in the case of children who have been under observation by the Tuberculosis Physician. As the result of this convalescent treatment most of these children are rapidly restored to health and are enabled to return to school at a very much earlier date. The local representative of the National Society for the Prevention of Cruelty to Children is always ready to co-operate with the staff of the School Medical Department in promoting the welfare of the children in this area. 17. (a) Blind, Deaf, Defective, and Epileptic Children. A special register is kept in the School Medical Department of all children who are defective within the meaning of Part V of the Education Act, 1921. Furthermore, particulars of each of these children are entered on a special medical record card. Information concerning new cases is furnished by the teachers, Attendance Officers, and School Nurse-Health Visitors. 81 (b) Blind and Partially Blind Children. There is only one blind child of school age, and he is still at. the Royal Normal College and Academy of Music for the Blind at Upper Norwood. Three partially blind children, 2 boys and one girl, attend the Bavenstoue Myope School (L.C.C.) at Balham. Another partially blind boy is at the Brighton School for Blind Boys. A girl who is mentally defective and partially blind is at the Ellen Terry National Home for Blind Defective Children at Reigate. (c) Deaf Children. One boy and one girl are at the Royal School for Deaf and Dumb at Margate. One girl is at the Oak Lodge Residential (Deaf) School at Clapham Common. Another girl attends the Hearnville Road (Partially Deaf) School at Balham. (d) Epileptic Children. One girl is at the Chalfont Colony, Buckinghamshire. (e) Physically Defective Children. One physically defective child is at the Heritage Craft Schools at Chailey. (/) Delicate Children. Two delicate children remained during the year, at the St. Catherine's Home, Ventnor, and the Famingham Home for Little Boys, Swanley, respectively. (g) The Education Committee has its own Special School. There is accommodation for 50 children in this School and this is sufficient to meet the requirements of the Borough. At the end of 1930 there were 38 children, 15 boys and 23 girls in attendance. 3 Boys and 6 Gi'rls were admitted during the year. Four boys and two girls left on attaining the school leaving age. In addition 5 boys were passed for transfer to Littleton Street Special School (L.C.C.). Every child attending the school is examined at least once a year in addition to the routine inspection. Children attending this school receive a bath twice a week and a special bath attendant is employed by the Education Committee for the purpose. A cooked mid-day meal of excellent quality is also served. The majority of children stay for this meal for which a charge of 3d. is made. In the case of 4 children, however, the dinners were given free owing to the financial circumstances of the parents. 4 children also received milk or cod liver oil and malt in school on medical grounds. This is supplied free by the Education Committee. The School Medical Officer visited the school on an average once every week for the purpose of examining the children. In addition to the routine class teaching, special handicraft instruction was given in Gardening, Cobbling, Domestic Science and Carpentry. 82 A list is kept of all the regarded school children in the area. These children are examined on an average every six months in order to ascertain their suitability for transference to the Special School. In addition every school is visited periodically by the School Medical Officer with a view to ascertaining from the Head Teachers the number of backward children in attendance. Children who have left the Special School on attaining the age of 16 and who have been notified to the Local Authority under the Mental Deficiency Act, 1913, as amended by the Act of 1927 as being in need of supervision and care are brought to the notice of the Committee of the Guild of Social Welfare which acts in Wimbledon as the Local Committee of the Surrey Voluntary Association for Mental and Physical Welfare. This Committee does everything in its power to further the interests of these children after they have left school. 18. NURSERY SCHOOLS. No Nursery Schools have been established in Wimbledon. The Municipal Day Nursery, however, has accommodation for 30 toddlers under 5 years of age. 19. SECONDARY SCHOOLS. The medical inspection of Secondary Schools in Wimbledon is under the control of the Surrey County Education Authority. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Under the Bye-Laws any school child over the age of 12 years may be employed for 2 hours from 5 p.m. to 7 p.m. and on week days when the school is not open for 5 hours between 7 a.m. and 7 p.m. Certain forms of employment are prohibited. During 1930, 41 employment cards were issued to school children in accordance with the above conditions. Children who are employed for not more than 1 hour in the morning before school must be medically examined before an employment card is issued to them. Furthermore, such children may only be employed for 1 hour after school and then not later than 7 p.m. 36 children were medically examined1 for employment during the year. 35 children were granted medical certificates of fitness for delivering newspapers and for work in connection with milk rounds. One boy was found to be unfit and the medical certificate withheld. Six summonses were taken out under the Bye-Laws for illegal employment and fines of 10/- imposed in each case. 83 22. SPECIAL ENQUIRIES. A further enquiry was undertaken during the year into the incidence of crippling amongst school children, details of which are given earlier in the report. 23. HEALTH PROPAGANDA. During the latter part of the year arrangements were made for issuing every month 2,000 copies of " Better Health " in Wimbledon. This Publication deals with simple health matters. The greater number of these copies are distributed through the schools and there are many indications of the interest with which they have been received. I desire to take this opportunity of expressing my appreciation of the loyal co-operation which I have received from all the members of the School Medical Staff during the year under review. I am, Your obedient servant, HAROLD ELLIS. 84 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1930. TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections:— Entrants 620 Intermediates 694 Leavers 437 Total 1,751 Number of other Routine Inspections 140 B.—OTHER INSPECTIONS. Number of Special Inspections 2,819 Number of Re-Inspections 7,186 Total 10,005 85 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1930. DEFECT OR DISEASE Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to bd 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 6 35 12 2 Uncleanliness 9 53 10 — Skin Ringworm—Scalp 2 — 6 — Body — — 48 — J Scabies — — 17 — Impetigo 12 — 148 — Other Diseases (Non-Tuberculous) 21 3 130 — Eye Blepharitis 21 — 53 — Conjunctivitis 4 — 28 — Keratitis 1 — — — Corneal Opacities — — — — Defective Vision (excluding Squint) 74 38 47 9 Squint 21 — 8 — Other Conditions 6 2 45 5 Ear Defective Hearing 13 — 11 1 Otitis Media 14 1 49 — Other Ear Diseases 1 — 27 — Nose and Throat Enlarged Tonsils only 48 109 22 11 Adenoids only 3 14 4 2 Enlarged Tonsils and Adenoids 45 41 84 17 Other Conditions 4 3 172 1 Enlarged Cervical Glands (Non-Tuberculous) 7 8 41 9 Defective Speech 9 7 11 — Teeth—Dental Diseases 262 154 24 — Heart and Circulation Heart Disease: Organic 11 — — 6 Functional 1 19 — 5 Anaemia 8 5 5 3 86 TABLE II,—continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects. No. of Defects. Requiring Treatment. Requiring to he 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 21 6 10 14 Other Non-Tuberculous Diseases 8 — 1 — Tuberculosis Pulmonary : Definite — — — — Suspected 3. 1 2 — Non-Pulmonary : Glands 2 — — 1 Spine — — — — Hip 1 — — — Other Bones and Joints 1 — 1 — Skin — — — — Other Forms 2 1 — — Nervous System Epilepsy 5 — — 1 Chorea 2 1 4 2 Other Conditions — 1 — 1 Deformities Rickets — 2 — — Spinal Curvature 1 7 — — Other Forms 10 28 7 4 Other Defects and Diseases 40 48 514 204 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 620 160 26.0 Intermediates 694 155 22.3 Leavers 437 86 20.0 Total (Code Groups) 1751 401 23.0 Other Routine Inspections 140 27 19'3 87 TABLE III NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1980. Boys. Girls. Total. Blind (including partially blind.) (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 1 – 1 Attending Public Elementary Schools – – – At other Institutions – – – At no School or Institution – – – (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 3 2 5 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. 1 2 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. – 1 1 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 20 23 45 Defective Children 2 Attending Public Elementary Schools – – – At other Institutions – – – At no School or Institution – – – * Passed for Littleton 'Street L.C'.C. School 88 TABLE III.—Continued. Boys. Girls. Total Mentally Defective contd. Notified to the Local Control Authority during the year Vide Form 307M Feebleminded 4 1 5 Imbeciles 1 4 5 Idiots – – – Epileptics Suffering from Bevere epilepsy Attending Certified Special Schools for Epileptics – 1 1 In Institutions other than Certified Special Schools – – – Attending Public Elementary Schools – At no School or Institution – – – Suffering from epilepsy which is not severe. Attending Public Elementary Schools 6 3 9 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 – 2 2 At other Institutions – – – At no School or Institution – 1 1 Non-i n f ec tious 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 – – – At other Institutions – – – At no School or Institution 1 – 1 89 TABLE III.—Continued. Boys. Girls. Total Physically Defective 'continued) Delicate children (e.g., pre - or latent tuberculosis, malnutrition, debility, anæmia, etc.) At Certified Residential Open Air Schools 2 – 2 At Certified Day Open Air Schools – – – At Public Elementary Schools 42 36 78 At other Institutions – – – At no School or Institution – – – Active non - pulmonary tuberculosis At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 – 1 At Public Elementary Schools – – – At other Institutions – – – At no School or Institution – – – Crippled Children (other than those with active tub e r c u 1 o u s disease), e.g., children suffering from paralysis, etc., and including those with severe heart disease At Certified Hospital Schools 2 – 2 At Certified Residential Cripple Schools – – – At Certified Day Cripple Schools – – – At Public Elementary Schools 18 12 30 At other Institutions – – – At no School or Institution – – – 90 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31ST DECEMBER 1930. 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 6 – 6 Body 48 – 48 Scabies 17 – 17 Impetigo 148 – 148 Other skin disease 71 – 71 Minor Eye Defects— 126 – 126 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 87 – 87 Miscellaneous [e.g., minor injuries, bruises, sores, chilblains, eto.) 776 – 776 Total 1279 – 1279 GROUP II.—Defective Vision and Squint (excluding Minor Eye Defect 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. (l) (2) (3) (4) (5) Errors of refraction (including Squint). Other Defects or Disease of the Eyes (excluding those recjrded in Group I.) 324 14 21 — 345 14 Total 338 21 — 359 Total number of children for whom spectacles were prescribed :— a. Under the Authority's Scheme 126 b. Otherwise 8 Total number of children who obtained or received spectacles :— a. Under the Authority's Scheme 125 b. Otherwise 6 91 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 91 30 121 109 230 GROUP IV.—DENTAL DEFECTS. 1. Number of Children who were:— a. Inpacted by the Dentist: Routine Age Groups Aged Aged 5 221 10 725 Total 6 430 11 487 7 600 12 364 4130 8 568 13 52 9 622 14 60 Specials 140 Grand Total 4270 b. Found to require Treatment 3179 c. Actually Treated 1858 d. Re-treated during the year as the result of periodical amination 1094 2. Half-days devoted to :— Inspection, 40. Treatment, 411 Total 451 3. Attendances made by Children for Treatment 3713 4. Fillings :— Permanent Teeth, 1777. Temporary Teeth, 7G Total Teeth 1853 Total Fillings 2318 5. Extractions :— Permanent Teeth, 408. Temporary Teeth, 3026 . Total 3434 6. Administrations of general anaesthetics for extractions 517 7. Other Operations: — Permanent Teeth, 616. Temporary Teeth, 756 Total 1372 GROUP V.—UNCLEANLINESS AND VERMINOUS CONDITION. 1. Average number of visits per School made during the year by School Nurses 7 2. Total number of examinations of children in the Schools by School Nurses 12.704 3. Number of individual children found unclean 354 4. Number of children cleansed under arrangements made by the Local Education Authority 75 5 Number of cases in which legal proceedings were taken : — (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — 92