Borough of Wimbledon Annual Report of the MEDICAL OFFICER OF HEALTH For the Year 1931. 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, 1931. Public Health Committee Chairman: Councillor E. Fielder. Vice-Chairman: Councillor D. Carver. Members: The MAYOR (Sir Joseph Hood, Bart., J.P.) (died 10th January, 1931) ex-officio. „Alderman J. M. Bathgate, J.P. Alderman Hickmott Councillor W. B. James Councillor E. J. Chard „ A. R. Kelly „ H. A. Crowe „ Lady Roney „ A. W. Hughes „ S. B. Stone Clarke „ J. W. Watts „ A. A. Drake Maternity and Child Welfare Committee Chairman: Councillor Lady Roney. V ice-Chairman: Councillor A. A. Drake. Members: The MAYOR (Sir Joseph Hood, Bart., J.P.) (died 10th January, 1931) ex-ofjicio. „ Alderman J.M.Bathgate,J.P. Alderman Hickmott Councillor H. Dormer Councillor F. T. Bowen „ T. R. Daniel „ G. T. Burrows, J.P. Mr. G. Edwardes-Jones, K.C. „ D. Carver 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 Officer: ‡ Effie M. D. Craig, M.B., Ch.B. Chief Sanitary Inspector: g, h, * Henry Johnson, M.B.E., F.R.San.I., F.S.I.A. Sanitary Inspector: * R. T. Avis, M.R.San.I., M.S.I.A., d, g, h. Assistant Sanitary Inspector: D. F. S. Flynn, g, h. Health Visitors—School Nurses: Miss M. Giles, b, d, f. Miss E. M. Skelton, a, b, f. Miss G. Hyde, a, b, c. Clerks: Miss N. Low. Miss M. Winslade. R. L. Brown. Clerk to the Maternity and Child Welfare Department: Miss N. Low. Matron of Day Nursery: Miss I. Cutler. Matron of Isolation Hospital: Miss L. McCrory. Part Time: Dr. Dan McKenzie, Consulting Oto-Laryngologist to Isolation Hospital. R. W. Butler, M.Ch., F.R.C.S., Orthopædic Surgeon. A. McAllister, F.R.C.S., Consulting Obstetrician under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Col. E. Middleton 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). 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— Public Health Committee 1 Maternity and Child Welfare Committee 1 Staff 2 Staff and Administration 5 Natural and Social Conditions of the Area 5 Vital Statistics for 1931 6 Birth Rate, Death Rate, and Analysis of Mortality 7 Population, Birth and Death Rates for each Ward, 1931 8 Births 8 Deaths 9 Infantile Mortality 12 Public Assistance 13 General Provision of Health Services in the Area 13 Professional Nursing in the Home 15 Midwives Acts, 1902-1926 15 Nursing Homes Registration Act, 1927 16 Mortuary 17 List of Local Acts, Orders and Adoptive Acts, in force 17 Sanitary Inspection of District 19 Factories and Workshops 21 Sanitary Circumstances of the Area 23 Sanitary Inspector's Report— Notices Served 24 Legal Proceedings 24 Opening up of Drains under Section 41 of the Public Health Act, 1875, and Amending Acts 24 House Drainage 24 House to House Inspection 25 House Inspection 25 Overcrowding 25 Houses Let in Lodgings 26 Verminous Rooms 26 Common Lodging Houses 26 Van Dwellings 27 Dairies, Cowsheds and Milkshops 27 Infectious Disease and Disinfection 27 School Disinfection 28 Yard Paving 28 Stable Refuse 28 Inspections under the Factory and Workshop Act, 1901 28 Shops Acts, 1912-28 28 Slaughter Houses and Food Inspection 29 Sale of Food and Drugs Acts, 1875 to 1928 29 Petroleum Acts 29 Diseases of Animals Acts, 1894 to 1925 29 The Public Health (Meat) Regulations, 1924 30 Rent (Restrictions) Acts, 1920 to 1923 30 Water Supply 30 Employment Agencies 30 Employment of Children Bye-laws 31 Fouling of Footways by Dogs 31 Small-pox Contacts 31 Mosquitoes 31 Offensive Trades 31 Summary Table—Nuisances Abated 32 Medical Officer's Report—continued. Housing Statistics for the Year 1931 33 Overcrowding 35 Inspection and Supervision of Food 38 Prevalence of, and Control over, Infectious Diseases 39 3 Medical Officer's Report—continued Notifiable Diseases and Deaths, 1931, in age-groups, etc 40 Death-rate from Zymotic Diseases, for the last ten years 41 Ward Distribution of Infectious cases notified in 1931 41 Notified Cases of Infectious Disease, 1922-1931 42 Scarlet Fever 42 Diphtheria 43 Tuberculosis 44 Small-pox 45 Food Poisoning 46 Typhoid and Enteric Fever 46 Encephalitis Lethargica 46 Puerperal Pyrexia and Puerperal Fever 46, 54 Ophthalmia Neonatorum 47, 56 Laboratory Work 48 Chemical Work 48 Food and Drugs (Adulteration) Act, 1928 49 Disinfection 50 Wimbledon Isolation Hospital 51 Scarlet Fever 52 Diphtheria 53 Erysipelas 54 Enteric Fever 54 Meningitis 54 Measles 54 Maternity and Child Welfare 55 Children Act 56 Maternal Mortality 57 Record of Home Visitation Work and at Centres 58 Supply of Milk to Expectant and Nursing Mothers and Infants 59 Dental Surgery 59 Municipal Day Nursery 60 Table I.—Vital Statistics 63 Table II.—Causes of Deaths, etc 64 School Medical Officer's Report— Staff 66 Co-ordination 67 Reorganisation 68 School Hygiene 68 Medical Inspection 69 Findings of Medical Inspection 70 Infectious Disease 74 Following up 76 Medical Treatment 76 Orthopædic Clinic 79 Speech Clinic 81 Open Air Education 82 Physical Training 82 Provision of Meals 82 School Baths 83 Co-operation of Parents and Teachers 83 Co-operation of Voluntary Bodies 83 Blind, Deaf, Defective and Epileptic Children 84 Nursery Schools 86 Secondary Schools 86 Employment of Children and Young Persons 86 Special Enquiries 86 Health Propaganda 87 Table I.—Return of Medical Inspections 88 „ II.—Return of Defects 89 „ III.—Return of all Exceptional Children 91 „ IV.—Treatment Table 95 4 Borough of Wimbledon. Public Health Department. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year ended 31st December, 1931. 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, 1931, together with my Report as School Medical Officer. The Report for 1931 is an ordinary Report, set out on the lines suggested by Circular 1206 of the Ministry of Health. 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. Examination of Employees:—During the year 1931, 117 employees were medically examined by the Medical Officer of Health. In addition 25 candidates were medically examined for superannuated posts under the Wimbledon Borough Council. Natural and Social Conditions of the Area. Area (acres) 3,220 Population (Census, 1931) 59,520 Population (Estimated, 1931, R.G.) 58,840 5 Number of inhabited houses:— 1921 11,926 1931 13,990 Number of families or separate occupiers:— (Census, 1921) 13,998 Rateable Value:—£689,571. Sum represented by a penny rate:—£2,873. 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. Three hundred and eighty premises are registered under the Factory and Workshops Acts. For the most part these premises are small. There are twenty-four 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 people. The works in the district cannot be said to exert any particular influence on Public Health. Extracts from Vital Statistics of the Year (1931). (Registrar-General's Figures). Total. M. F. Live Births Legitimate 604 301 303 Illegitimate 38 15 23 Still Births 26 16 10 Deaths 724 358 366 Percentage of Total Deaths occurring in Public Institutions 40.05 Number of women dying in, or in consequence of childbirth from Sepsis Nil do. do. other causes 5 Death-rate of Infants under one year of age per 1,000 live births legitimate 62 do. do. illegitimate 184 Total 70 6 BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1931. (Provisional Figures.) (The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only). Rate per 1000 Total Population Annual Death-rate per 1000 Population Rate per 1000 Live Births Percentage of Total Deaths Live Births Stillbirths All Causes Enteric Fever Smallpo Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea and Enteritis (under two years) Total Deaths under One Year Certified byRegistered Medical Practitioners Inquest Cases Certified by Coroner after P.M. No Inquest Uncertified Causes of Death England and Wales 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0 36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.67 12.3 0.00 0.00 0.10 0.01 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2 24 0.49 159 Smaller Towns (1921 Adjusted Populations, 20,000-50,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.01 W'dn (Estimated Population 58,840) 10.9 0.44 12.3 0.00 0.00 0.00 0.00 0.06 0.00 0.28 0.59 7.7 70 85.63 10.22 4.14 0.00 7 Deaths from Measles (all ages) Nil „ „ Whooping Cough (all ages) 4 „ „ Diarrhœa (under 2 years of age) 5 Population, Birth and Death Rates for each Ward, 1931. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6744 7.4 11.8 Wimbledon Park 3.88 4382 7.7 10.2 St. John's 4.77 5127 5.4 11.5 Cottenham Park 4.33 7421 7.9 14.5 North Wimbledon 4.36 23674 7.2 12.3 Dundonald 5.15 7879 9.7 11.9 Trinity 5.59 11683 11.9 11.6 South Park 4.63 8578 8.5 13.4 Haydon Park 5.47 7026 17.7 12.3 South Wimbledon 5.21 35166 11.8 12.2 Whole District 4.20 58840 10.9 12.3 Births.—The number of births registered in the district was 600 (299 males and 301 females), a decrease of ninety-one as compared with last year, and equal to a birth-rate of 10.2 per thousand on a population of 58,840. The corrected birth rate produced by transferable births notified to us by the RegistrarGeneral is 10.9. Thirty-eight (or 5.9 per cent) of the births were illegitimate. The birth rate in Wimbledon continues to fall, the figure for 1931 being two per thousand below that for the previous year. The following table gives the birth rate in Wimbledon for the past ten years together with the comparative figures for England and Wales. At present the birth rate in Wimbledon is lower than the death rate. - 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Wimbledon: Number of Births 868 868 814 760 807 717 691 759 766 642 Birth Rate 14.0 14.9 14.01 13.06 13.9 12.3 11.6 12.7 12.9 10.9 Birth Rate for England & Wales 20.6 19.7 18.8 18.3 17.8 16.7 16.7 16.3 16.3 15.8 8 Notification of Births Acts, 1907 and 1915. During the year, 645 births were notified by the following persons:— Parents 21 Midwives 431 Doctors 66 Other persons 127 Fourteen notifications of stillbirths were received. Deaths.—The total number of deaths registered in the district was 524 (227 males and 297 females), equal to a death rate of 8.9 per thousand of the population per annum. The deaths occurring outside the district, of persons beloning to this Borough were two hundred and eighty, namely:— Kingston and District Joint Hospital 138 Nelson Hospital, Merton 27 S.C.C. Sanatorium, Godalming 12 St. Thomas's Hospital 9 Others 94 Total 280 The deaths occurring within the district, of persons not belonging thereto were eighty, namely:— North Wimbledon Hospital 22 Isolation Hospital 3 Atkinson Morley Hospital 1 Private Nursing Homes 27 Others 27 Total 80 Taking these into consideration, the total number of deaths properly belonging to Wimbledon is 724, and the death rate 12.3 per thousand of the population. The rate for England and Wales for the same period was also 12.3 per thousand. The death rate shows an increase over the figure for the previous year. Although the expectation of life has continued to increase and people are dying at a later age it is more than probable that the death rate in Wimbledon will continue to rise. Owing to the declining birth rate there are fewer children and younger people in the community. The infantile deaths are now a small proportion of the total deaths. The mean age of the population is steadily rising. For this reason the death rate in the Borough will probably continue to increase. 9 The following table gives the death rate in Wimbledon for the past ten years together with the comparative figures for England and Wales:— - 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Wimbledon : No. of Deaths 616 547 645 639 579 620 634 774 648 724 Death Rate 9.9 9.4 11.1 10.9 9.9 10.6 10.7 13 03 10.9 12.3 Death Rate for England & Wales 12.9 11.6 12.2 12.2 11.6 12.3 11.7 13.4 11.4 12.3 Table 11 gives the causes of, and ages at, death during 1931. Deaths due to notifiable infectious diseases are given on page 40. The principal causes of death, apart from zymotic deaths, are as follows:— Cancer 103 Heart Disease ... 170 243 Cerebral Haemorrhage 39 Aneurysm 1 Other Circulatory Diseases 33 Pneumonia 46 80 Bronchitis 31 Other Respiratory Diseases 3 Tuberculosis (Respiratory) 51 Cancer- Cancer and malignant disease were responsible for 103 deaths or 14.2 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 76 12.1 1928 632 84 13 2 1929 774 103 13.3 1930 648 106 16.3 1931 724 103 14.2 10 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. One hundred and seventy deaths were due to heart disease. In addition there were thirty-nine deaths from cerebral haemorrhage, one from aneurysm and thirty-three from other circulatory diseases. Thus, 243 deaths occurred from diseases of the heart and circulation. This figure represents 33.56 per cent. of the total number of deaths recorded. The following table, which gives the figures for the past ten years, seems to indicate that diseases of the heart and circulation are becoming increasingly important factors in the causation of death in Wimbledon. - 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Deaths from diseases of the heart and Circulation 133 142 171 193 143 171 179 208 188 243 Total deaths (all causes) 616 546 645 638 579 620 632 774 648 724 Percentage of deaths from heart & circulatory diseases in relation to total deaths 21.59 26.00 26.51 30.02 24.69 27.58 28.32 26.87 29.01 33.56 Bronchitis, Pneumonia and other Respiratory Diseases. Thirty-one deaths were due to bronchitis, forty-six to pneumonia and three to other respiratory diseases. This gives a total figure of eighty, or 11.04 per cent. of the deaths occurring amongst residents of the Borough during 1931. 11 Infantile Mortality. There were forty-five infant deaths during the year (including transferable deaths) giving an Infantile Mortality Rate of 70 per thousand births. This figure shows a considerable increase over that of 49 per thousand for the previous year. During 1931 the Infantile Mortality Rate for England and Wales was 66. The following table gives the Infantile Death Rate in Wimbledon for the past ten years together with the comparative figures for England and Wales:— - 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Wimbledon: No. of Infantile Deaths 50 38 59 46 27 37 38 35 38 45 Infantile Death Rate (per thousand births) 58 44 70 60 33 50 55 46 49 70 Infantile Death Rate for England and Wales 77 69 75 75 70 69 65 74 60 66 Of the forty-five children under one year who died, the cause of death in sixteen cases was broncho-pneumonia or acute bronchitis. This was largely accounted for by the prevalence of influenza during the latter part of 1931. In another sixteen cases death was due to malnutrition, prematurity, debility, etc. Infantile diarrhoea and gastro-intestinal diseases were only responsible for three deaths. The Infantile Death Rate for illegitimate children in Wimbledon was 184 per thousand births. 12 The following table shows the causes of death, and ages at death, of infants under one year:— Infant Mortality during the Year 1931. Causes of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. | 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Convulsions 2 ... ... ... 2 ... ... ... ... 2 Malnutrition ... ... ... ... ... 1 . ... ... 1 Debility, atrophy (congenital) 2 ... ... ... 2 ... ... ... ... 2 Prematurity 9 1 ... ... 10 ... ... ... 1 11 Marasmus ... ... ... ... ... ... 1 ... 1 2 Broncho-Pneumonia ... ... ... ... ... 2 2 5 4 13 Acute Bronchitis ... ... ... ... ... 1 1 ... ... 2 Icterus Neonatorum 1 ... ... ... 1 ... ... ... ... 1 Asphyxia 1 ... ... ... 1 ... 1 ... ... 2 Infantile Diarrhoea ... ... ... ... 1 ... 1 ... ... 2 Gastro enteritis ... ... ... ... ... ... 1 ... ... 1 Infective enteritis ... ... ... ... ... ... 1 ... ... 1 Intestinal Intussusception ... ... ... ... 1 ... ... ... ... 1 Cerebral Haemorrhage 1 ... ... ... 1 ... ... ... ... 1 Glioma ... ... ... ... ... 1 ... ... ... 1 Congenital Heart Disease 1 ... ... ... 1 ... ... ... ... 1 Total 17 2 ... 1 20 5 8 6 6 45 Public Assistance:—The following information has been furnished by the Chief Public Assistance Officer concerning relief in this district. Amount paid in Out-door Relief in 1931 £7,577 Average weekly number of persons in receipt of Domiciliary Assistance 448 Average weekly number of persons in receipt of Medical Relief only 9 Number of persons admitted to the Institution from Wimbledon Area 564 General Provision of Health Services in the Area. (a) Hospitals provided or subsidised by the Local Authority or the Surrey County 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. 13 (2) Maternity.—The Maternity Block of the Nelson Hospital was opened in September, 1931, and has accommodation for twenty beds, together with an Ante-natal Department. Although this Hospital is situated just outside the boundary twenty-nine Wimbledon patients were admitted for their confinements up to 31st December, 1931. (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 106 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, Thurstan 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. This hospital has 62 beds for medical and surgical cases and twenty beds for maternity patients. 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 twelve mothers. Ambulance facilities: — (a) For infectious diseases.—Two 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 used for disinfecting purposes. (b) For non-infectious cases and accidents.—One motor ambulance is maintained at the Fire Station, Queen's Road, under the Wimbledon Borough Council. 14 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, Aston Road, Raynes Park, S.W.20, 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 staff are district nurses, and two district midwives. The Association attended 144 midwifery cases during the year. Ninety-four of these were midwives cases and fifty were cases with doctors in attendance. In all, 2,332 visits were paid to maternity cases. Furthermore, 404 ante-natal visits were made by the nursing staff of the Association. The total number of eases dealt with during 1931, including midwifery, amounted to 841, making the total number of visits paid 15,264. The Wimbledon Borough Council make an annual contribution of ten guineas, to this Association. Midwives Acts, 1902-1926. On 1st April, 1931, the Borough Council became the Supervising Authority for the Midwives Acts in Wimbledon. Nineteen midwives notified their intention of practising in the Borough during the year, together with five midwives resident in outside areas. Three of the former eventually removed to other districts, leaving sixteen practising midwives in Wimbledon at the end of 1931. Regular inspection of the midwives was carried out by the Assistant Medical Officer, who is the Inspector of Midwives for the Borough. These inspections, with few minor exceptions, shewed_that the records, bags, instruments, etc., were being maintained in a satisfactory manner. 15 There are, in addition, a number of midwives acting purely as maternity nurses in maternity homes in the district. Three hundred and fifty-seven confinements were attended by the midwives and one hundred and thirty-three by the maternity nurses. In the latter cases, of course, doctors had been engaged by the patients. Three uncertified women were known to be attending confinements in Wimbledon under the direction and supervision of medical practitioners but by the end of the year they had all ceased to do so. The following notifications were received from midwives practising in the Borough:— Laying out the dead 1 Stillbirths 5 Artificial feeding 1 Liability to source of infection 4 Notification of death 5 Medical Aid forms were received from midwives in one hundred and one instances during the nine months which elapsed after the administration of the Midwives Acts had been undertaken by the Wimbleon Borough Council. Nursing Homes Registration Act, 1927. On 1st April, 1931, the Borough Council became responsible for the supervision of nursing homes in Wimbledon. At the end of the year there were eighteen registered nursing homes, namely:— Nursing Homes for Maternity Cases 3 Nursing Homes for Medical, Surgical and Maternity Cases 3 Nursing Homes for Children and Maternity Cases 1 Nursing Homes for Medical and Maternity Cases 1 Nursing Homes for Maternity and Chronic Cases 1 Nursing Homes for Chronic Cases 9 Total 18 16 Certificates of registration or re-registration were issued by the Council in respect of:— Nursing Homes for Maternity Cases 1 Nursing Homes for Medical, Surgical and Maternity Cases 1 Nursing Homes for Chronic Cases 2 Total 4 Intimation was received that one Nursing Home for Chronic Cases was being discontinued. These homes were periodically inspected and supervised. In a number of cases alterations were required such as improvements in ventilation, better larder accommodation, and additional provision against the danger of fire. In all instances the requirements of the Council were complied with. The standard of the nursing homes in Wimbledon is good. 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 108 bodies received into the mortuary during 1931. Inquests were held by the Coroner with respect to 108 bodies, equalling 20.61 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. 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. 17 Part II. (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 repealed:—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, 38. 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. (All the above sections became operative from 1st January, 1928, except Section 38, which was adopted later and became operative from 1st February,, 1929). 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. do. do. Offensive Trades. 18 Bye-laws with respect to Tents, Vans, Sheds and Similar Structures. Bye-laws as to Employment Agencies. Bye-laws with respect to the keeping of Water-closets supplied with sufficient water for flushing. Bye-laws for the Management, Use and Regulation of Public Baths. Bye-laws under Advertisements Regulations Act, 1907. Bye-laws with respect to the Fouling of Footways by Dogs. Regulations as to Underground Sleeping Places (Section 18 [i]) Housing Act, 1925. Regulations with respect to Dairies, Cowsheds and Milkshops. The Public Health (Meat) Regulations, 1924. Provisional and other Orders affecting the Borough: — Croydon 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. Dated 6th June, 1914. The Wimbledon Credit Drapers' Half-Holiday Order, 1914. Dated 2nd July, 1914. The Wimbledon Barbers' and Hairdressers' Closing Order, 1919. Confirmed 27th October, 1919. The Wimbledon Fruiterers' and Greengrocers' Half-Holiday Order, 1931. Confirmed 15th July, 1931. 19 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 1931. Reason of Visit. No. Infectious Diseases 754 House Inspections 2,749 House to House Inspections 1,783 Rent Act Inspections 62 Houses Let in Lodgings; Inspections 210 Inspection of Factories, Workshops, Workplaces and Out-workers' Premises 322 Common Lodging Houses; Inspections 6 Dairies and Cowsheds; Inspections 37 Inspections under Shop Acts 719 Application of Tests to Drains 149 Inspections under Diseases of Animals Acts 6 Obtaining Samples of Foods and Drugs 4 Miscellaneous (including Inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,930 8,731 Eight hundred and sixty two preliminary or informal notices were served in respect of eight hundred and forty houses. One hundred and sixteen statutory notices were served in respect of ninety-seven houses. The necessary work was executed in all but eighty-one cases, which were not completed by the end of the year. In sixty-four of these, the work was actually in hand at the close of the year. Table III. gives a summary of the nuisances abated, and improvements carried out under the supervision of the Sanitary Staff of the Public Health Department. 20 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 108 4 ... Workshops 101 5 ... Workplaces 87 2 ... Total 296 11 ... DEFECTS FOUND. PARTICULARS. Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of Cleanliness ... ... ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 3 3 ... ... Sanitary Accommodation— Insufficient ... ... ... ... Unsuitable or Defective 3 3 ... ... Not Separate for Sexes ... ... ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1931.) ... ... ... ... Totals 6 6 ... ... *Including those specified in sections 2, 3 7 and 8 of the Factory and Workshop A.ct, 1901, as remediable under the Public Health Acts. HOME WORK. Lists received:— Twice in the year 5 Number of Out-worker 51 Once in the year 2 21 Number of Out-workers 2 Number of addresses received from other Councils 53 Number of addresses forwarded to other Councils 6 Notices served on occupiers as to keeping or sending lists — Prosecutions—Failing to keep Out-workers' Lists — Prosecutions—Failing to furnish lists — Inspections of Out-workers' premises 15 Number of unwholesome premises — Notices served to remedy — REGISTERED WORKSHOPS. The following are the principal classes of workshops on the register at the end of the year:— Bakehouses (including five Factory Bakehouses) 25 Boot Repairing 53 Builders 27 Coach Builders 5 Cycles 9 Dining Rooms 14 Dressmaking 41 Furniture Repairers 12 Jewellers and Watch Repairers 10 Laundries 24 Millinery 7 Motors 25 Printing 11 Smiths 5 Tailoring 28 Woodworkers 15 Miscellaneous 69 380 22 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to: affix Abstract of Act— Action taken in matters Notified by H.M. referred by H.M. In- Inspector— spector as remedial Reports of action under the Public taken sent to Health Acts. H.M. Inspector — Underground Bakehouses in use at the end of the year 3 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. 23 REPORT OF THE CHIEF SANITARY INSPECTOR. 1 beg to submit my Report of the work carried out for the year ended 31st December, 19-31. Table iii. gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—Eight hundred and sixty-two Preliminary Notices or intimations were served during the year in respect of 840 houses. It was found necessary to serve 116 Statutory Notices upon the owners or occupiers of 97 houses. Six hundred and twenty-eight letters, respecting 717 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 three cases with the results stated:— For failing to comply with Notice to Abate Nuisance. Six shillings costs, and ordered to abate nuisance within fourteen days. For failing to comply with Notice to Abate Nuisance. £2 8s. 6d. costs, and ordered to execute works within seven days. For failing to comply with Notice to Abate a Nuisance. £2 8s. 6d. costs, and ordered to execute work within one month. 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 six houses. House Drainage.—The drainage systems and sanitary ment of 25 houses have been entirely reconstructed, extensive Amendment or repairs were carried out at 45 houses, and at 13 houses the drainage systems have been made water-tight by the patent internal process. 24 House to House Inspection.—During the year house to house surveys were carried out at 386 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. 32. Balfour Road 37 Cecil Road 81 Coppermill Lane 17 Laburnum Road 65 Pelham Road 68 Plough Lane 2 Russell Road 116 386 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, 1,269 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 the 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, as will be noticed under heading Legal Proceedings." 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. 25 In addition to cases of overcrowding discovered during general inspections, seven complaints were received during the year. Of these, four were abated by the tenants removing after the service of Notices, and two by re-arrangement of the sleeping accommodation. In the other case the complaint was unfounded and appeared to be due to neighbours' quarrels. 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. Houses Let in Lodgings.—There are now 73 of these houses on the Register. Two hundred and ten 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 23 rooms have been dealt with. As previously, the necessary notices were served upon the persons responsible, whether occupier or owner. Every assistance has been given to those who were anxious to free their premises from vermin, and fumigants have been supplied, at cost price, or fumigation carried out by the 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, 1931, to 31st December, 1931. These premises have been visited from time to time when a few minor defects have been found. The defects have been remedied immediately the owner's attention has been directed to them, and the premises generally are kept in a satisfactory condition. 26 Van Dwellings.—During the year 154 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.—Two 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. Thirty seven 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 in 194 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 19 houses from which cases of notifiable infectious disease had been reported, defective drains or other insanitary conditions were found to exist, all of which were subsequently remedied under the supervision of the officers of the 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. 27 The number of rooms disinfected was 425 and the number of articles, bedding, wearing apparel, etc., 10,723, full details of which are given in the Report of the Medical Offieer of Health under the heading of "Disinfection." School Disinfection.—All the Public Elementary Schools in the district were thoroughly disinfected during the summer vacation. Yard Paving.—In the course of the inspections made during the year, 78 yards were found to be in an unsatisfactory state, due either to the absence of any paving or to the defective condition of that which existed. 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, 308 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 a number of 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 380 factories, workshops, and workplaces on the Register, to which 322 visits of inspection were made. Six written notices were served referring to sanitary conveniences and other nuisances. Shops Acts, 1912-28.—Seven hundred and nineteen visits were made for the purpose of observing contraventions of the Acts, advising shopkeepers regarding the Regulations in force, and in cases of complaints. 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 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. 28 Observations were kept during the week preceding Christmas, and throughout the holiday, including Christmas Day and Boxing Day. The result of these observations was reported to the Local Authority in January, 1932. 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, 276 visits have been made to shops of butchers, fishmongers and fruiterers, and other places where food is prepared and exposed for sale, and the following were surrendered and destroyed as trade refuse, being unfit for human food:— 12 lbs. tinned Ox Tongue Mildewed 7 lbs. Smoked Haddock Encysted worms 10 galls. Winkles Foul Sale of Food and Drugs Acts, 1875 to 1928.—One sample of cream, and one Chocolate Easter Egg suspected to be the cause of illness, were submitted to the Council's Analyst. He reported that the sample of cream was a good one, free from preservative and up to standard, and that the chocolate egg was quite wholesome. Petroleum Acts.—Seventy-nine applications were received for permission to keep petroleum, 71 being for the renewal of existing licences. Four hundred and three inspections were made of the various premises in respect of which licences had been issued. Diseases of Animals Acts, 1894 to 1925.— Parasitic Mange and Swine Fever.—No outbreak of these diseases was notified in the district during the year. Foot and Mouih 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 rnfected and/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. 29 Tuberculosis.—No outbreak of this disease has been reported during the year. The usual quarterly returns, under the provisions of the Tuberculosis Order of 1925, have been rendered to the Ministry of Agriculture. In connection with the importation and exportation of animals, the Department has dealt with numerous enquiries, licences and notices of quarantine. The Public Health (Meat) Regulations, 1924.—Careful attention has been paid to the provisions of these Regulations and I am pleased to report that no breach has been observed. In several cases of doubt, advice has been sought and freely given. The notice required when animals were to be slaughtered was given in every case, thereby facilitating the examination whilst killing was actually in progress. Rent (Restrictions) Acts, 1920 and 1923. —Under these Acts 12 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 four 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 22 houses during the year for the following reasons:—7 by request, 13 owing to arrears of rates, and 2 for other reasons. Employment Agencies.—There were nine 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., to the Keepers. With one or two minor exceptions the Bye-laws have been well observed. 30 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 five cases to report the circumstances to the Education Authority and as a result, in one case affecting the employment of a child under age, proceedings were instituted against the employer and the parent. The employer was fined 10s. and the parent was fined 5s. 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. We must all agree this nuisance is a disgusting one, but it is extremely difficult for offenders to be detected by your officers. Every endeavour is, however, being made to enforce the Bye-law and to maintain the Borough's standard of cleanliness. Small Pox Contacts.—In connection with the small-pox cases occurring in the district and local contacts of cases occurring outside the district, 290 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, ditchee 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. Offensive Trades.—During the year an inspection was made of all the fish-frying premises in the Borough. A number of alterations were necessary in order to comply with the Bye-laws and these points were explained to the occupiers concerned. In all 69 inspections and re-inspections were made and I am able to report that the Bye-laws are being well 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. 31 TABLE III. The following 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 27 Cisterns provided 4 Cisterns repaired, cleansed or covered 18 Drains, new, provided 25 Drainage systems made water-tight by patent process 13 Drains, repaired or altered 45 Drains, stoppages removed 44 Dustbins provided 1ll Flushing cisterns, new, provided 25 Flushing cisterns repaired 84 Manure receptacles provided — Overcrowding nuisances abated 7 R.W. pipes disconnected 4 Roofs repaired 169 Rooms stripped and cleansed 784 Verminous rooms cleansed 23 Soilpipes, new, provided 7 Soilpipes, repaired or altered 10 Vent pipes, new, provided 14 Vent pipes, repaired or altered 15 Waste pipes, new, provided 53 Waste pipes repaired, disconnected or trapped 44 Water-closets, new, provided 63 Water-closets, repaired or ventilated 3 Water services restored 9 Yards paved 4 Yards repaired 74 Guttering repaired 103 Floors ventilated 11 Nuisances abated from damp walls 107 Water supply direct from main 8 Sinks provided 18 Rooms fumigated 425 Other nuisances 1,430 3,781 32 The following information is supplied by Mr. T. Webster, Borough Surveyor:— Recreation Grounds.—A new Public Convenience for both sexes has been erected at Holland Gardens. Housing.—Nine parlour-type houses were erected in Faraday Road and are let to suitable tenants. Sewage Disposal Works.—Since the commencement of 1931 four additional percolating filters with appurtenant works have been put into operation. Two filters constructed about twenty years ago have been reconditioned. All these filters are giving a high degree of purification to the sewage. Refuse Collection.—The motor lorries used for the collection of house refuse have now been fitted with covers which securely enclose the refuse, thus preventing the usual nuisances connected with the open type of lorry. An additional lorry has been purchased to supplement the existing fleet. 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 1931. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,269 (b) Number of inspections made for the purpose 5,492 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 386 (b) Number of inspections made for the purpose 1,783 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 33 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 840 2. Remedy of defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 662 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 2 (b) By local authority in default of owners 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 77 (b) By local authority in default of owners Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under Section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 31 E.—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 intention to close Nil F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses, in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (3) Number of dwelling-houses in respect- of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Note.—Sections 11 to 15 of the Housing Act, 1925, have been repealed by the Housing Act, 1930, but the proviso to Section 64 of the Act of 1930 continues in force any Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Orders must continue to be dealt with under the relative provisions of tlje Act of 1925. (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. 35 (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 were built by the Council in Faraday Road, on one of the few available sites remaining in the Borough. (3) Overcrowding. (a) The following table gives details of the housing conditions in three streets which are fairly representative of an artisan area. An indication is given of the extent to which overcrowding exists. 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 ten years 250 cubic feet. Total No. of Houses No. of Separate Letting* No. of Occupiers Average No. of Rooms per Letting Average No. of O'cupiors per Room Average Rent per Room per Letting Under 10 Years Over 10 Years Russell Road 11G 171 78 522 3.64 0.96 2/11 Laburnum Road 65 81 52 303 4.44 0.99 2/4 Cecil Road 80 99 41 317 4.09 0 89 2/9 261 351 174 1142 3 95 0.94 2/9 No. of Separate Lettings Consisting of 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms Russell Road 12 16 51 48 81 11 2 Laburnum Road 4 12 6 13 17 29 ... Cecil Road 2 11 20 13 51 1 1 18 39 77 74 99 41 3 36 Overcrowding based on the standard of the bye-laws for houses let in lodgings, was found to exist as follows:— Letting* Overcrowded by 1 Child 2 Children 1 Adult 2 Adults Russell Read 1 ... 2 ... Laburnum Road 3 1 2 1 Cecil Road 2 ... 3 ... 6 1 7 1 It will thus be seen that in the two hundred and sixty-one houses inspected in detail, overcrowding was found to exist to the extent of nine adults and eight children. This reveals a satisfactory state of affairs in the area concerned. (b) The difficulty with regard to overcrowding in the Borough as a whole 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 Acts in dealing with housing conditions. Only in two instances was action taken under Sections 17, 18, and 23 of the Housing Act of 1930. In these cases the work was 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." 37 (c) In 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 one cowkeeper, thirty-two dairymen, nineteen dairymen and purveyors, and thirteen retail purveyors on the Registers on 31st December, 1931. 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 6 ,, ,, tirade A (T.T.) Milk 6 ,, ,, Grade A Milk 5 ,, ,, Pasteurised Milk 3 Supplementary 8 (3) Bacteriological examinations:—All samples satisfactory. SLAUGHTER HOUSES. In 1920. In Jan 1931. In Dec. 1931. Registered 4 2 2 Licensed 1 ... ... Totals 5 2 2 38 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The incidence of the notifiable infectious diseases was considerably less than in 1930. Seventy-five cases of scarlet fever were notified as compared with 127 notified during the preceding year. The notifications of diphtheria amounted to seventy-four, and were sixty-six less than in 1930. In both the diseases the illness was of a relatively mild type. In fact, there were no deaths in Wimbledon from either disease during 1931. The deaths from the non-notifiable infectious diseases in 1930 and 1931, were as follows:— 1930. 1931. Whooping Cough 2 4 Measles 10 Nil. Diarrhœa (under 2 years) 2 5 39 40 TABLE A.—NOTIFIABLE DISEASES—1931. 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— 46— 65 and over. Cases admitted to Hospl. Total Deaths. Death Rates. Smallpox Notified 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever Notified 75 ... 1 2 5 8 33 10 4 10 2 ... ... 64 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria Notified 74 ... 2 ... 3 6 31 13 8 8 2 1 ... 72 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Notified 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Para typhoid Notified 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever Notified 4 ... ... ... ... ... ... ... ... 2 2 ... ... 3 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia Notified 3 ... ... ... ... ... ... ... 1 2 ... ... ... 3 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas Notified 29 2 1 1 ... 1 ... 1 ... 4 3 8 8 10 Deaths ... ... ... ... ... ... ... ... ... ... ... 1 1 .017 Pneumonia Notified 28 ... 1 ... ... ... 6 ... 2 5 2 11 1 2 Deaths 8 4 1 ... ... 1 1 1 1 4 11 14 46 .78 Ophthalmia Neonatorum Notified 4 4 ... ... ... ... ... ... ... ... ... ... ... 1 Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis Notified 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Deaths ... ... ... ... ... ... ... ... ... ... 1 ... 1 .017 Encephalitis Lethargica Notified — ... ... ... ... ... ... ... ... ... ... ... ... ... Deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Notified 80 1 ... 1 1 ... 5 1 10 42 7 10 2 72 Deaths ... 1 ... ... ... ... ... 1 24 11 15 1 53 .9 TOTALS Notified 301 7 5 4 9 16 75 25 25 75 18 31 11 230 Deaths 8 5 1 ... ... 1 1 2 25 15 27 16 101 1.71 Table showing the death-rate from Zymotic Diseases, including Tuberculous Diseases, for the last ten years. YEAR. Zymotic Death-rate. Death-Rate Per 1,000 Population Small Pox. Scarlet Fever. Diphtheria. " Fever." Whooping Cough. Measles. Diarrhœa. Phthisis and other Tuberc'lo8 Diseases. 1922 1.06 ... .00 .1 ... .08 .00 .05 .76 1923 1.00 ... .05 .08 ... .06 .06 .08 .63 1924 1.10 ... .06 .01 .01 .05 .15 .05 .75 1925 1.01 ... 03 .01 ... .1 ... .08 .77 1926 .706 ... ... ... ... ... .103 ... .6 1927 .94 ... .01 .03 ... .05 ... .03 .8 1928 1.10 ... ... .1 ... .08 .11 .03 .7 1929 1.06 .01 ... .1 ... .08 ... .05 .8 1930 .99 ... ... .06 ... .03 .16 .03 .69 1931 .15 ... ... ... ... .06 ... .08 .90 The figures given in this Table are those obtained after correction by exclusion of "Non-Residents" and the inclusion of "Residents" beyond the district. Table showing the Ward Distribution of Infectious cases notified in 1931, and the numbers removed to hospital. Notifiable disease. All Ages. Total Gases Notified in Each Locality (e g. Parish or Ward) of the District. Total Cases removed to Hospital. St. Mary's Ward. Wimbledon Park Ward St. John's Ward. Cottenham Park Ward. Dundonald Ward. Trinity Ward. South Park Ward. Haydon Park Ward. 1 2 3 4 5 6 7 8 Diphtheria (including Membranous croup) 74 2 4 1 2 18 14 7 26 72 Erysipelas 29 1 2 4 3 1 9 5 3 10 Scarlet Fever 75 4 3 7 7 10 16 13 15 64 Puerperal Fever 4 ... ... ... 2 ... 2 ... ... 3 Cerebro-spinal Meningitis 1 ... ... ... 1 ... ... ... ... 1 Pulmonary Tuberculosis 67 6 5 3 5 16 12 8 12 67 Other forms of Tuberculosis 13 ... ... ... 2 1 4 3 3 5 Ophthalmia Neonatorum 4 1 ... ... ... ... 1 ... 2 ... Pneumonia 21 ... 1 2 6 1 3 5 3 ... Influenzal Pneumonia 7 ... ... 1 1 2 2 1 ... ... Puerperal Pyrexia 3 ... ... ... ... ... ... ... 3 3 Small-pox 1 ... ... ... ... ... ... 1 ... 1 Para-Typhoid 1 ... ... ... ... ... 1 ... ... ... Encephalitis Lethargica 1 ... ... ... 1 ... ... ... ... ... TOTALS 301 14 15 18 30 50 64 43 67 226 41 Table showing Number of Cases of Infectious Diseases Notified during each Year from 1922 to 1931. Disease 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Smallpox ... ... ... ... ... 1 ... 2 2 1 Scarlet Fever 2 27 94 150 170 165 169 126 131 127 75 Diphtheria (including Membranous Croup) 159 88 42 33 26 52 170 150 140 74 Enteric Fever 4 2 3 3 4 4 4 7 ... 1 Paratyphoid Fever ... ... 6 ... ... 7 6 ... 2 1 Acute Primary Pneumonia 11 ... 10 16 39 42 32 39 23 21 Acute Influenzal Pneumonia 6 ... 2 1 1 9 3 9 1 7 Puerperal Fever 3 1 3 3 3 1 2 2 4 4 Puerperal Pyrexia ... ... ... ... ... 9 6 12 9 3 Cerebro-spinal Fever 1 ... 2 ... 1 2 1 2 2 1 Acute Poliomyelitis ... ... 2 ... 4 ... 1 ... ... ... Acute Polio-encephalitis ... 1 2 ... ... ... ... ... ... ... Encephalitis Lethargica 4 ... 10 5 3 2 1 ... 1 ... Dysentery 1 ... ... ... ... ... ... ... ... ... Malaria 1 ... 1 ... ... ... 2 ... ... ... Ophthalmia Neonatorum 3 5 2 3 3 4 3 1 3 4 Erysipelas 11 10 13 20 17 24 19 33 29 29 Pulmonary Tuberculosis 62 55 64 63 48 66 65 56 56 67 Non-pulmonary culosis 16 10 18 7 6 19 14 13 5 13 Totals 509 266 330 324 320 401 455 457 404 301 Scarlet Fever.— The total number of cases notified during the year was seventy-five from sixty-nine houses. The attack rate was 1.27 per thousand of the population. Attack Rate. Death Rate. 1891-1895 4.8 .02 Per thousand of the Population. 1896-1900 3.3 .04 1901-1905 2.3 .02 1906-1910 4.07 .05 1911 -1915 3.03 .01 1916-1920 1.8 .01 1921-1925 3.04 .02 1926-1930 2.4 .003 In six houses there were two cases, and in the remaining sixty-three houses, one case. Sixty-one, or 81 per cent of the cases, were treated in the Borough Isolation Hospital, Gap Road. 42 Sixty per cent of the cases notified were children of school age, five to fifteen years, and of these, forty-one attended the following schools:— Old Central Schools 2 Effra Road Girls' and Infants' Schools 6 Durnsford Road Mixed and Infants' Schools 6 Pelham Road Infants' School 6 Pelham Central Schools 2 Dundonald Road Girls' and Infants' Schools 2 Russell Road Mixed School 6 Haydons Road Girls' School 1 Haydons Road Infants' School 1 Special School 1 Private Schools 5 Schools outside the district 3 41 Diphtheria.— The total number of cases notified during the year was seventy-four from sixty-one houses. The attack rate was 1.25 per thousand of the population. In four houses there were three cases, in five houses two cases, and in the remaining fifty-two houses, one case. Seventy-one, or 96 per cent. of the patients, were treated in the Isolation Hospital. Fifty-nine per cent. of the cases notified were children of school age, five to fifteen years, and of these, forty-two attended the following schools:— Dundonald Boys' 1 Cottenham Park 2 Dundonald Girls' and Infants' 4 Russell Road Mixed and Infants' 3 Haydons Road Boys' 2 Queen's Road Girls' and Infants' Schools 10 Haydons Road Girls' and Infants' Schools 6 Pelham Road Infants' School 1 Effra Girls' and Infants' 4 Queen's Road Boys' 2 Durnsford Road Mixed 4 Schools outside the district 2 Private Schools 1 42 43 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 cither 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 arc also advised to have swabs taken from the nose and throat and in most cases they agree to this precaution being carried out. Tuberculosis.— The following table shows the number of new eases notified during the year, and the number of deaths from this disease. AGE GROUPS NEW CASES. DEATHS. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Males. Females. Males. Females. Males. Females. Males Females. Under 1 year ... ... 1 ... ... ... ... ... 1—5 ... ... 2 ... 1 ... ... ... 5 — 10 1 ... 2 2 ... ... ... ... 10 — 15 1 ... ... ... ... ... ... ... 15 — 20 4 4 1 1 ... 1 ... ... 20 — 25 5 10 2 ... 2 7 ... ... 25 — 35 14 11 ... ... 8 5 2 ... 35 — 45 „ 1 5 1 ... 7 4 ... ... 45 — 55 5 2 1 ... 7 2 ... ... 55 — 65 2 ... ... ... 6 ... ... ... 65 upwards 1 1 ... ... ... 1 ... ... Totals 34 33 10 3 31 20 2 ... 67 13 51 2 80 53 Eighty cases. of tuberculosis were notified. This figure shows an increase of nineteen over the number for the previous year. The deaths from tuberculosis were twelve more than in 1930, the total figure being fifty-three. Of the fifty-one deaths from pulmonary tuberculosis, thirty-two died outside the district (21 males and 11 females), i.e., the notifications of death were transferred to Wimbledon. 44 Of the two non-pulmonary deaths, one male died outside the district. One of these deaths was due to tuberculosis of the bladder and one to meningitis. There is a close co-operation between the Public Health Department and the Tuberculosis Department of the Surrey County Council. A report is received on the home conditions and sanitary environment of every tuberculous patient. In many cases the isolation of patients who are nursed at home is far from satisfactory. A great deal, however, has been done to try and improve conditions and mitigate the risk of infection to other members of the households concerned. A large number of visits haire been paid by the sanitary and nursing staff. Insanitary conditions have been remedied and arrangements made, where possible, for the patients to sleep in separate bedrooms. In a certain number of cases it has been possible for convalescent treatment to be arranged for children who were contacts of the disease. On the receipt of a notification of a new case of tuberculosis. a visit is paid to the home by one of the nursing staff of the Public Health Department. Advice is given with regard to the precautions necessary for preventing the spread of infection and where necessary disinfectants are also supplied. The Public Health Department of the Surrey County Council make all arrangements for the provision of sanatorium and hospital treatment. During 1931, seventy-two Wimbledon patients were admitted to sanatoria or hospitals. 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 62.—No action was required under the above section of the Public Health Act, 1925. Smallpox.— One case of smallpox was notified in Wimbledon and the patient was removed to the Smallpox Hospital at Clandon. The disease was of a mild type ,and recovery rapidily ensued. The usual observation was kept over the contacts and no further case arose. 45 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, one hundred and seventy-nine contacts were notified from other Health Departments. They were kept under observation for sixteen days by the sanitary staff. None of these contacts developed the disease. Two hundred and ninety visits were paid to the houses of smallpox contacts. As in 1930, it was not considered necessary to make chicken-pox notifiable in Wimbledon. Food Poisoning.—The only case of food poisoning that occurred in the Borough during 1931. arose from a cooked foodstuff which had been purchased in an outside district. Two children were affected, with sickness and diarrhoea. Bacteriological examination showed that infection was due to an organism of the Salmonella group. Both cases recovered. Information was forwarded to the Medical Officer of Health of the area in which the food was prepared. Typhoid and Enteric Fever — Three cases were notified. One case was notified as typhoid fever but the diagnosis was not confirmed on further bacteriological investigation The remaining two cases were due to a Paratyphoid B. infection. Two of these cases were removed to the Isolation Hospital at Gap Road, where they recovered. Pull investigations were instituted as to the source of the infection. In no instance had the disease arisen through the water or milk supply. No death occurred during the year from the enteric group of diseases. Encephalitis Lethargica.— One case of encephalitis lethargica was notified. This patient was removed to hospital for further investigation, as the result of which the notification was withdrawn. Puerperal Fever and Puerperal Pyrexia.—Four cases of puerperal faver and three cases of puerperal pyrexia were notified during the year, in accordance with the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. During 1930 there were notified four eases of puerperal fever and nine cases of puerperal pyrexia. 46 Six of the cases notified were removed to hospital for treatment. Three of these patients were treated in the Kingston and District Hospital, two cases were treated at the Borough of Wimbledon Isolation Hospital, and the remaining case at the Clapham Maternity Hospital. No death from puerperal sepsis occurred. During the previous year there were two deaths from this cause. In accordance with the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. the Council have appointed an obstetric physician to act as consultant in this area. Facilities are also available for bacteriological diagnosis. Hospital treatment is provided for at the following institutions:— (i) the Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith; (ii) the Borough of Wimbledon Isolation Hospital; and (iii) the Kingston and District Hospital. The arrangements with Queen Charlotte's Hospital were made towards the end of the year. Ophthalmia Neonatorum. —Four cases of ophthalmia neonatorum were notified. In three of the cases, at the request of the Public Health Department, the District Nursing Association provided the necessary nursing assistance in the homes. The fourth case, which was very slight, occurred in an Institution. No impairment of vision resulted. Malaria.— No notifications of this disease were received. 47 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 Pound. Bacteria Not Pound Total. Diphtheria Swabs 43 528 571 Phthisis (Sputum) 11 119 133 Pus (Ophthalmia Neonatorum) ... ... ... Reaction Obtained. Reaction Not Obtained. Total Typhoid (Blood, Urine and Faeces) 2 52 54 Positive. Negative. Total. Virulence Tests ... 3 3 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 Drug's Acts, the analysis of water, gas, and sewage effluents required by the Wimbledon Corporation, and of food samples suspected of contamination or adulteration. 48 LABORATORY WORK. The number of pathological specimens examined in the laboratory at the Health Centre during 1931 by the medical staff, amounted to 3,141. Most of these specimens were siwalbs 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 6 Blood 1 Ringworm 11 Sputum Nil Cerebro Spinal Fluids 4 Urine Specimens 30 Food and Drugs (Adulteration) Act, 1928. The Public Analyst under the Food and Drugs Acts is appointed by the Surrey County Council. I am indebted to the County Medical Officer of Health for the information set out in the table below, which deals with the work carried out in Wimbledon during the year 1931. ARTICLES analysed Adulterated or Deteriorated Formal Informal Total Formal Informal Total Milk 71 ... 71 1 ... 1 Cream 5 1 6 ... ... ... Butter 1 ... 1 ... ... ... Meat 2 ... 2 ... ... ... Tea 7 ... 7 ... ... ... Sausages 4 ... 4 ... ... ... Confectionery and Jam 4 ... 4 ... ... ... Spirits 7 ... 7 ... ... ... Lemonade Powder 3 ... 3 ... ... ... Lemon Squash 1 1 ... ... ... Orange Squash ... 1 1 ... ... ... Pickles 1 ... 1 ... ... ... Arrowroot 5 ... 5 ... ... ... Vinegar 3 ... 3 ... ... ... Apples ... 1 1 ... ... ... Totals 114 3 117 1 ... 1 49 Disinfection.—The following table shows the number of rooms and articles disinfected:— Disease. Bedding Disinfected. Clothing. No. of Rooms Disinfected. Totals. Mattresses. Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Dresses Suits. Other Articles. Scarlet Fever 325 142 12 638 1185 40 66 2870 122 5400 Diphtheria 128 94 14 265 450 12 27 1539 90 2619 Typhoid Fever 10 5 ... 15 73 ... ... 161 3 267 Erysipelas 13 16 1 37 67 1 1 240 15 391 Tuberculosis 47 39 15 144 153 ... 3 224 69 694 Cancer 15 12 6 68 32 2 ... 74 25 234 Pneumonia and Influenza 8 4 ... 20 12 ... ... 20 6 70 Small pox 1 2 1 3 2 ... 2 3 3 17 Vermin 3 5 1 10 15 ... ... 9 52 95 Sundries 128 24 13 401 344 4 ... 407 10 1361 Totals 678 343 63 1601 2333 59 99 5547 425 11,148 Details of this work are given in the report of the Chief Sanitary Inspector. It will be noted that 425 rooms and 10,723 articles of bedding, wearing apparel, etc., were disinfected by the Public Health Department. Speaking generally, infectious diseases are chiefly spread by mild unrecognised cases and "carriers" and not by inanimate objects. 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. 50 Wimbledon Isolation Hospital. Disease Under 5 years. Over 5 years. Total. Deaths. Remarks. Under 5 years Over 5 years. Total. Carried over from 1930 Scarlet Fever 3 18 21 ... ... ... Daily average number of cases. 32 Diphtheria 4 36 40 ... ... ... Cases admitted in 1931. From Wimbledon. Scarlet Fever 15 54 69 ... ... ... Diphtheria 10 58 68 ... ... ... Erysipelas 3 4 7 ... ... ... Measles 1 ... 1 ... ... ... Cerebro-spinal Meningitis ... 1 1 ... 1 1 Typhoid ... 1 1 ... ... ... Average number of days in hospital, 46 Paratyphoid B. ... 1 1 ... ... ... Puerperal Sepsis ... 1 1 ... ... ... „ ,, (Baby) 1 ... 1 ... ... ... Puerperal Pyrexia ... 1 1 ... ... ... „ „ (Baby) 1 ... 1 ... ... ... Whooping Cough & Bronchitis 1 ... 1 ... ... ... Other Diseases ... 1 1 ... 1 1 From Kingston. Scarlet Fever 1 16 17 ... ... ... Total Kingston cases, 65 Diphtheria 14 32 46 1 2 3 Diphtheria and Scarlet Fever ... 1 1 ... ... ... Enteric Fever ... 1 1 ... ... ... Total treated in 1931 54 226 280 1 4 5 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £28,175. Two hundred and nineteen cases were admitted to the Isolation Hospital during 1931. As there were sixty-one cases in Hospital at the end of 1930, the total number of cases under treatment during the year amounted to 280. One hundred and fifty-three of these cases were from Wimbledon, and sixty-five from Kingston. There were thus 151 less cases admitted to the hospital in 1931 as compared with the previous year. 51 Scarlet Fever.—Eighty-six cases of scarlet fever were admitted to hospital during the year. The following complications were noted amongst the cases under treatment:— Rhinitis 3 Otorrhœa 6 Mastoiditis 2 Adenitis 11 Nephritis 3 Albuminuria 2 Rheumatism 6 Whitlows 4 Jaundice 1 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 that arose were those involving the ear and kidneys. Six patients developed otorrhcea and two mastoiditis, making in ail eight cases with ear complications. Where necessary, paracentesis was performed. The cases of mastoiditis subsided without operation. All these cases were discharged with normal hearing and free from ear discharge. Three patients developed acute nephritis and two albuminuria. One of the cases of acute nephritis was of considerable severity and associated with uraemic manifestations. All these patients made complete recoveries. The other important complications which occurred were adenitis, rhinitis, and rheumatism. Only rarely was surgical interference required in the cases of adenitis. No cardiac complications arose in the six patients who suffered from scarletinal rheumatism. One "return" case occurred. This amounts to 1.2 per cent. of the patients discharged. 52 Diphtheria.—One hundred and fifteen patients were admitted to the Isolation Hospital as cases of diphtheria during the year. The admissions were therefore 95 less than during 1930. Of these 115 cases, 94 ultimately proved to be suffering from undoubted clinical diphtheria. Nineteen of the patients were contacts who had been swabbed and found to be harbouring diphtheria bacilli either in the nose or throat. In two of the cases admitted as diphtheria, the diagnosis was not confirmed by further bacteriological investigation. The following complications were noted among the 115 patients under treatment:— Nasal Paralysis 14 Ciliary Paralysis 5 Multiple Neuritis 6 Bell's Palsy 1 Paralysis of External Rectus 1 Otitis Media 5 Adenitis 3 Nephritis 1 Pleurisy 1 Secondary Tonsilitis 9 Included in this number were nine patients who were admitted with respiratory obstruction due to laryngeal diphtheria. Tracheotomy was performed in two cases. Another patient was admitted after tracheotomy had been performed outside. All these patients made good recoveries. In all, three deaths occurred among the 115 cases admitted as diphtheria. Amongst the ninety-four clinical cases of diphtheria two deaths occurred giving a fatality rate of 2.1 per cent. One death from cerebral hæmorrhage following birth injury occurred in an infant admitted as a case of nasal diphtheria. Most of the cases of diphtheria under treatment were mild in type. Three negative swabs were obtained from the nose and throat of all cases prior to discharge. No "return" cases of diphtheria occurred during the year. 53 Erysipelas.—Seven cases of erysipelas were admitted to the Isolation Hospital during 1931. Two cases were complicated by suppurative bursitis and abscess of the neck respectively. Both these required operative interference. No deaths from this disease occurred amongst the patients under treatment. Enteric Fever.—Two patients were admitted to hospital as cases of enteric fever, the diagnosis in one case not being confirmed on further investigation. A third case was due to a Paratyphoid B. infection. No complications occurred and all the patients made good recoveries. Meningitis.—Two patients were admitted as cases of cerebrospinal meningitis during 1931. One patient was found to be suffering from meningococcal meningitis and died in spite of receiving large doses of the appropriate serum. The second case was admitted from a general hospital and died on the day of admission. A post mortem examination showed that the cause of death was cerebral hæmorrhage due to subacute bacterial endocarditis. Measles.—One case of measles was treated in hospital during the year. This patient was sent in as a doubtful case of scarlet fever. Puerperal Fever.—One case of puerperal fever and one case of puerperal pyrexia were removed to the Isolation Hospital from Maternity Homes in the Borough during 1931. Both cases made complete recoveries. Thirty-three cases remained in hospital at the end of 1931. Thirteen of these were scarlet fever cases and twenty diphtheria. Staff.—During the year under review one the the nurses contracted scarlet fever. Otherwise there was very little sickness amongst the members of the hospital staff. I should like to take this opportunity of thanking the matron and staff for the loyal and enthusiastic way in which they have carried out their duties. 54 Maternity and Child Welfare Good progress has been maintained in the work of this section of the Public Health Department, and a considerable amount of re-organisation effected. The total number of visits paid by the Health Visitors during 1931 amounted to 6,259, the figure for the previous year being 6,422. 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 64 in 1930 to 69 in 1931. The average attendance per session at the Wandle Park Centre was 42, comparing very favourably with the figure of 40 during 1930. 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 nine. The figure for the previous year was six. Steady attendance has been maintained at the classes for mothers, which are held at both of the Centres. Home nursing, mothercraft, hygiene, and singing, are taught. The average attendance of mothers at the Pelham Centre was fifty-five and at the Wandle Park Centre twenty-six. Ophthalmic Treatment.—Twenty-seven 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 two cases. Treatment of Minor Ailments.—Two hundred and two children below school age attended the Health Centre for treatment. Treatment of Tonsils and Adenoids.—Arrangements were made for the operative treatment of tonsils and adenoids in six cases. Orthopaedic Treatment.— A joint scheme for the treatment of crippling defects was adopted by the Maternity and Child Welfare and Education Committees, and came into operation in July, 1931. Details of the Scheme are given in the report of the School Medical Officer. 55 Three children under school age were examined by the Surgeon at the Orthopaædic Clinic. One child was referred for hospital treatment, a second child was advised exercises and massage at the Health Centre under the Orthopaedic Nurse, and the third child required suitably altered boots. These were supplied through the arrangements made with the Kensington Surgical Supply Depot. Ophthalmia Neonatorum—The following table shows the number of cases of ophthalmia neonatorum notified and the final result of treatment. These cases were mild and no impairment of vision resulted. Home nursing was providedin three cases through the Wimbledon District Nursing Association:— CASES. Vision Unimpaired. Vision Impaired Total Blindness. Deaths. Notified. Treated. At Home. Hospital. 4 4 ... 4 ... ... ... Children Act, 1908 (Part 1).—The following figures relate to the administration of the above Act in Wimbledon during 1931:— (i) Number of foster parents on the Register— (a) At the beginning of the year 25 (b) At the end of the year 28 (ii) Numfber of children on the Register— (a) At the beginning of the year 47 (lb) At the end of the year 31 (c) Who died during the year 1 (d) On whom inquests were held during the year None Every foster child was visited, on an average, once every month. If the conditions were not satisfactory, more frequent visits were paid. In all, 232 visits were made to the homes of foster mothers. Although three of the Health Visitors hold appointments under Section 2 (2) of the Act, it has been found expedient to make one Health Visitor responsible for the entire visiting. 56 In two cases it was necessary for orders to be obtained from a Justice under Section 5 (1) with a view to the removal of the children from the homes. In no case were proceedings taken under the various sections of the Act. Maternal Mortality.— There were five maternal deaths amongst Wimbledon mothers in 1931. The causes of death are shown hereunder:— Eclampsia 2 Placenta praevia (ante-partum hæmorrhage) 2 Lobar pneumonia 1 Puerperal sepsis Nil During the previous year there were five maternal deaths, two of which were due to puerperal sepsis. The five maternal deaths which occurred in 1931 took place in institutions outside the district. Four occurred in large modern hospitals where every facility was available for treatment, and the fifth in a well equipped maternity home. The following table gives the maternal mortality rates for Wimbledon and also for England and Wales. Puerperal Sepsis Others Total Wimbledon: Per 1000 Live Births 0.00 7.78 7.78 Per 1000 Total Births 0.00 7.48 7.48 England and Wales: Per 1000 Live Births 1.66 2.45 4.11 Per 1000 Total Births 1.59 9.35 3.95 Ante-natal care is a most important factor in the reduction of maternal mortality. The Ante-natal Clinic which was opened in conjunction with the new Maternity Block at the Nelson Hospital should materially contribute towards reducing the number of maternal deaths in Wimbledon. 57 During the latter part of 1931 the Council had under consideration a scheme for providing hospital treatment, including the services of a consultant obstetrician, for all complicated maternity cases in the Borough. It is hoped that this scheme will come into operation early in 1932. During 1931 the record of Home Visitation work was as follows Number of births notified 645 „ „ „ registered 600 „ „ „ visited 468 „ „ „ re-visited—under 1 yr. 1033 „ „ „ „ —over 1 yr. 1579 „ „ visits to Ophthalmia cases 16 „ „ expectant mothers visited 96 ,, ,, re-Jvisits to expectant mothers 90 „ „ ineffectual visits 1247 „ „ special visits 934 Total welfare visits 5463 „ „ school visits (half-day) 232 „ „ Tuberculosis visits 94 „ „ Puerperal Fever visits 2 „ „ visits to parents of school children 236 „ „ „ re Children Act, 1908 232 796 Total of all visits 6259 During 1931, the record of work at the Centres was as follows:— Infant Welfare Consultations. Pelham Centre. Wandle Park. Centre. Number held 48 50 Total number of attendances 3346 2125 Average number of attendances 69 42 Ante-Natal Clinic Consultations. Number held 19 Total number of attendances 175 Average number of attendances 9 Classes for Mothers. Number held 31 34 Total number of attendances 1704 884 Average number of attendances 55 26 Subjects taught Mothercraft. Mothercraft. Home Nursing. Home Nursing. Singing. Singing. Hygiene. 58 Supply of Milk to Expectant and Nursing Mothers and Infants. During the year, one hundred and eighty-six applications for free milk supplies were received from seventy families, one hundred and seventy-eight of which were granted. Each case is considered individually by the Sub-Committee, and a full statement of income from all sources, including pension and 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 Health Centre to Maternity and Child Welfare cases. Thirty-eight mothers and eighty-two children under school age attended for treatment. Seventy-four general anæsthetics and sixteen local anæsthetics were administered. Where necessary, nursing and expectant mothers are provided with dentures. Nine dentures were supplied to mothers through the dental clinic during 1931 and in four 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, 1931:— Mothers—attendances for treatment 130 „ teeth extracted 84 „ ,, filled 18 „ scalings 19 „ other operations 48 „ dentures supplied 9 „ „ repaired & remodelled 4 „ other Prosthetic operations 60 Children—attendances for treatment 157 „ teeth extracted 152 „ „ filled 20 „ other operations 55 59 Total number of fillings inserted 49 „ „ „ local anaesthetics administered 16 „ „ „ general do. do. 74 I should again like to draw attention to the work which is being carried out by the voluntary helpers in the Maternity and Child Welfare movement in Wimbledon. The Centres at Pelham Road and Wandle Park House are fortunate in having such enthusiastic workers. Their activities are much appreciated by the mothers in Wimbledon. During the latter part of the year a highly successful Baby Show was held at the Municipal Baths. A great number of mothers entered their children for this Show, and the standard of the children was extremely good. Municipal Day Nursery.— The work at the Day Nursery at Hubert Road during 1931 was most satisfactory. The number of children on the register at the end of the year was ninety-three. These children came from eighty-two families. The total attendances made by the children amounted to 10,239 whole days. The average daily attendance was 47. The Nursery has acommodation for 50 children—20 infants and 30 toddlers. Infants are admitted from the age of three weeks and toddlers remain until they commence school at five years. The children are brought to the Nursery between 7.30 and 9.0 a.m. They are then undressed, bathed, and re-dressed in nursery clothes, their own clothes being placed in numbered string bags and fumigated. Their heads are washed at the Nursery once a week, and oftener if this is found necessary. 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 nine months are weighed weekly, and thereafter monthly up to the age of two years. Toddlers up to the age of five years are weighed every three months. During 1931, 700 "weighings" were carried out. The children respond well to the nursery life and show a satisfactory gain in weight. 60 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 £256 3s. Od. during 1931. 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. Fourteen children were found to require treatment, and this was carried out at the dental clinic. In no case was treatment refused. Three children were also seen by the oculist at the Health Centre. Glasses were prescribed in two cases. 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 medical 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. Towards the end of the year a number of cases of chicken-pox occurred amongst the children attending the Nursery. One of the nursing staff also developed the disease. Apart from these cases the children at the Nursery remained remarkably free from infectious diseases. The health of the children and staff was very satisfactory throughout the year. 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. There is no doubt that the Nursery meets a very real need in South Wimbledon. 61 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. The whole of the ground floor at the Nursery was redecorated with washable paint during the mid-summer vacation. A part of the ground in front to the Nursery was turfed. This lawn is much enjoyed by the children during the dry weather. Towards the end of the year the Public Health Department was transferred from 20, Queen's Road, to the new Town Hall. I should like to take this opportunity of expressing my gratitude to the staff for the loyal and efficient way in which they have carried out their duties, and to thank my colleagues in other departments for their kind help and co-operation. I have the honour to be, Your obedient servant, HAROLD ELLIS. 62 63 TABLE I.—Vital Statistics of Whole District during 1931 and Previous Years. YEAR. 1 Population estimated to middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths Belonging to the District. Uncorrected Number. 3 Nett. Under 1 year of Age At all Ages. Number. 4 Rate. 5 Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of Residents not registered in the District. 9 Number. 10 Rate per 1000 Nett Births. 11 Number. 12 Rate 13 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 1931 58,840 600 642 10.9 524 8.9 80 280 45 70 724 12.3 TABLE II.—Causes of, and Ages at, Deaths during the year 1931. CAUSES OF DEATH. Nett Deaths at the subjoined ages of " Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' or 'NonResidents' in Institutions in the District. 14 All Ages. 1 Under 1 year. 2 1—2 3 2—3 4 3—4 5 4—5 6 5—10 7 10—15 8 15—20 9 20—35 10 35—45 11 45—65 12 65 and over. 13 All Causes Certified 724 45 8 3 - - 7 3 7 52 44 184 371 100 Uncertified - - — — — — — — — — — — — — 1. Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - 2. Measles - - - - - - - - - - - - - - 3. Scarlet Fever - - - - - - - - - - - - - - 4. Whooping Cough 4 1 2 1 — — - - — - - - - 1 5. Diphtheria - - - - - - - - - - - - - - 6. Influenza 17 - - - - — - - - 1 1 8 7 5 7. Encephalitis Lethargica - - - — — — — - — - - - - - 8. Cerebro spinal Fever 1 - - - - - - - - - - 1 - 2 9. Tuberculosis of respiratory system 51 - 1 — — — — — 1 22 11 15 1 — 10. Other Tuberculous diseases 2 - - — — — - - - 2 - - - 1 11. Syphilis — - — — — — — - — - - - - — 12. General paralysis of the insane, tabes dorsalis 2 - - - - - - - - 1 - 1 - 1 13. Cancer, malignant disease 103 - — — — — — 1 — 2 6 41 53 8 14. Diabetes 10 - — — — - - - - 1 - 1 8 1 15. Cerebral Hæmorrhage 39 - — — — — — — — 1 2 10 26 10 16. Heart Disease 170 - — — — — — — 2 3 4 39 122 15 17. Aneurysm 1 - — — — — — — — - — - 1 18. Other Circulatory Diseases 33 - — — — — — — — - — 5 28 3 19. Bronchitis 31 2 — — — - - - 1 - 1 3 24 2 20 Pneumonia (all forms) 46 8 4 1 - - 1 1 1 1 4 11 14 2 65 TABLE II,—continued CAUSES OF DEATH. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' or nonResidents' in Institutions in the District. All Ages. Under 1 year. 1—2 2—3 3—4 4—5 5—10 10-15 15—20 20—35 35—45 45—65 65 and over. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 21. Other Respiratory Diseases 3 - - - - - - - - - - 2 1 1 22. Peptic Ulcer 11 — — — - - - — — 1 1 6 3 2 23. Diarrhœa, etc. (under 2 years) 5 5 — - — - - — — — — — - - 24. Appendicitis. 12 - - - - - - - 2 1 1 6 2 5 25. Cirrhosis of Liver 2 — — — — - - — - — — - 2 1 26. Other Diseases of Liver, etc. 3 — — — — - - — — 2 — 1 - 3 27. Other Digestive Diseases 21 2 - — — - 2 1 — 2 1 8 5 2 28. Acute and Chronic Nephritis 18 — — — — - — — - 2 — 7 9 4 29. Puerperal Sepsis — — — — — - — — — — — — — — 30. Other Puerperal Causes 5 — — — — - — — — 4 1 — — 1 31. Congenital Debility, Premature Birth, Malformations, etc. 18 18 - - - - - - - - - - - 4 32. Senility 25 — — — — - — — — — — — 25 9 33. Suicide 8 — — — — - — — - 1 2 3 2 3 34. Other Violence 27 2 — — — - 3 — — 4 5 4 9 8 35. Other Defined Diseases 56 7 1 1 — - 1 — — 1 4 12 29 6 36. Causes Ill-defined or unknown Totals 724 45 8 3 — — 7 3 7 52 44 184 371 100 Special Causes (included in No. 35 above). Smallpox — — — — — - — — — - — - - - Poliomyelitis — — — — — - — — — — — — — - Polioencephalitis - - - - - - - — — — - — — — 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. I.. Holman. Health Visitor—School Nurses: * (b), (d), (f). Miss M. Giles. * (a), (b), (f). Miss E. M. Skelton. * (a), (b), (c). Miss G. Hyde. Dental Attendant: Miss K. O'Hara. Clerk: Miss C. Coysh. (b) Part-time Officers: Orthopredic Surgeon: R. W. Butler, M.Ch., F.R.C.S. Oculist: J. P. Crawford, M.D. Anœsthetist: S. Taylor Harris, M.R.C.S., L.R.C.P. *Maternity and Child Welfare Officers. ‡Public Health Officers. (a) S.R.N. (b) C.M.B. (c) Certificate of Fever Training. (d) Certificate San. Inspect. (e) New Health Visitore Certificate R.S.I. (f) Health Visitors Certificate R.S.I. 66 Borough of Wimbledon. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31 st December, 1931 To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Annual Report for the year 1931 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 7,069 children. The average number of children on the school registers on March 31st, 1931, was 5,186, and the average attendance 4,492, thus making an average attendance of 87 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 67 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. RE-ORGANISATION. The re-organisation which was carried out in the School Medical Department during 1930 was further consolidated during the year under review. The routine medical record cards, which are now kept in the office, were carefully checked with all the school registers in order to ascertain that every child had a medical record card and was being examined regularly in the correct age group. The advantage of centralising the records became increasingly apparent. All the medical cards of each school are kept in alphabetical order; this allows of easy and rapid reference. Re-examination cards were made out for all children found to be defective at the routine medical inspection. This has greatly simplified the following up of these cases. After the completion of each routine medical inspection, a form was sent to the Head Teacher of the school, containing the recommendations of the School Medical Inspector concerning children found to be suffering from defects. The simplification which was effected in 1930 in the record cards of children examined as special cases at the Health Centre was found to work very satisfactorily. Further improvements were also made in the organisation of the Eye Clinic. The School Medical Service in Relation to Public Elementary Schools. 3. SCHOOL HYGIENE. The sanitary condition of the Public Elementary Schools in Wimbledon is very satisfactory. During 1931 painting at the following schools was carried out by the Borough Surveyor's Department:— Cottenham Park Mixed—Internal painting. Dundonald Road—External painting. Modern and hygienic drinking fountains with a main water supply were installed in the playgrounds of the following schools:— 08 Queen's Hoad—Girls' and Infants'. Effra Iioad—Girls' and Infants'. St. Mary's School—Boys' and Girls'. One hundred and sixty new dual locker desks and 320 chairs of a modern type were provided during the year. 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 of 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 1931:— Entrants 731 Intermediates 680 Leavers 383 Total 1794 In addition there were 111 other routine inspections in the schools, making a total of 1,905. Apart from these routine inspections, 2,708 children were specially inspected at the Health Centre, and 8,069 re-inspected. The total number of routine and non-routine medical inspections during the year amounted to 4,613. The number of children examined at the routine inspection in the schools shows an increase of 14 over the figure for the previous year. In the same way, the number of special inspections and re-inspections at the Health Centre is 772 more than during the year 1930. (6) 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 69 to the fact that no classroom was available at Haydons 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 there. 5. FINDINGS OF MEDICAL INSPECTION. In Table IIa (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. 1,905 children were examined at the routine medical inspection. 332 or 17.4% were found to be suffering from defects (excluding uncleanliness and denial diseases) requiring treatment. The percentage of defects was found to be slightly higher amongst the "intermediates" than amongst the "entrants" and "leavers." During 1930 the percentage of children with defects found at the routine medical inspections throughout the country was 20.9. (a) Uncleanliness. 14 or 0.7% of the children examined at the routine medical inspection were found to be unclean and excluded from school. In addition 9 were found to require further observation in school on account of this condition, and were kept under supervision. During the year 1930, 9 children or 0.5% of those examined at the routine medical inspection required to be excluded from school on account of uncleanliness. The School Nurse-Health 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 12,694. 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 during the last few years and there is no doubt a very considerable improvement has been effected. 70 91 children were cleansed at the Health Centre in accordance with the arrangements made by the Education Committee. Although this figure is slightly in excess of that for the previous year the total number of unclean children found by the nurses during their systematic inspections of the schools during 1931 amounted to 205. During 1930 the number was 354. This indicates a marked improvement in the standard of cleanliness of the children. As a rule, no school child is now cleansed at the Health Centre unless the mother, on account of illness or other bona fide reasons, is unable to cleanse the child herself. 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 32 cases of enlarged tonsils, 1 case of adenoids, and 51 cases of adenoids with enlarged tonsils requiring treatment. Thus out of 1,905 children examined in the routine way, 84 or approximately 4.4% were found to need operation. In addition, there were 129 children or 6.7% with enlarged tonsils or with adenoids and enlarged tonsils requiring to be kept under observation but not requiring treatment. At the Health Centre 116 other cases were found on special examination to require operation for this condition. These percentages are slightly lower than those for the preceding year. (d) Tuberculosis. One suspected case of pulmonary tuberculosis requiring treatment was discovered at the routine medical inspection. In addition, two other cases of tuberculosis were found, one being a case of tuberculous glands. 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 requiring treatment and one suspected case requiring to be kept under observation but not requiring treatment. Two other cases of tuberculosis were also found at the Health Centre to be requiring treatment. One was a case of tuberculosis of the skin. Suspected cases are referred to the Tuberculosis Physician between whom and the School Medical Staff a close co-operation exists. (c) Skift Disease. Of the children examined as routine cases in the schools, 1% were found to be suffering from skin diseases. Four were, suffering from impetigo and 15 from other minor skin ailments. , 71 305 or 11.2% 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 were sent up by the teachers and attendance officers. There were 5 cases of ringworm of the scalp and 36 cases of ringworm of the body. 22 of the cases were due to scabies, 99 to impetigo, and 143 to other skin conditions. Ringworm of the scalp and scabies are not of frequent occurrence amongst school children in Wimbledon. Impetigo, however, is common amongst all school children. As it is contagious, many children suffering from impetigo have to be excluded temporarily from school. It is a minor ailment which is responsible for a not inconsiderable loss of school attendance. (f) External Eye Disease. There were 13 cases of external eye disease amongst the 1,905 routine children examined. This gives a percentage of 0.7. 9 of the cases were due to blepharitis and some of these were very mild. In addition, there were 4 cases of conjunctivitis. No cases of keratitis were discovered. At the Special Inspection there were 08 cases or 2.5% due to external eye disease. 31 were due to blepharitis, and 37 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 09 children were found to be suffering from defective vision requiring treatment and 15 to be suffering from squint. This makes a total of 84 cases requiring treatment or 4.4% of the children examined. The figure for the previous year was 5%. The actual incidence of defective vision rerequiring treatment is, however, higher than 4.4%. Of the 1,905 children examined as routine cases 731 were entrants and in the majority of these it was impossible to carry out subjective visual tests on account of their age. In addition, 52 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 39 with defective vision and 4 with squint requiring treatment, and 3 with defective vision or squint 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. 72 ERRATUM. Page 73, line 10, should read: "clear type, and reading in bed by artificial light, especially when children are'' These children are re-examined by the Medical Officer when the school is next visited. If necessary, they are then referred to the refraction clinic for examination by the Ophthalmic Surgeon. The eyes of nearly all infants are inclined to be long sighted. As children grow up the eyes become increasingly used for reading and study and a tendency to short sight develops. For this reason it is most important that children should only bo allowed to read in a good light. Their books should have large clear type, and reading in bed, especially when children are convalescing after illness, should be forbidden. In many of the popular children's papers the print is poor. There is no doubt that the constant reading of these papers, especially in a poor light, tends to give rise to myopia or short sight. (h) Defective Hearing. At the routine inspection, 3 children were found to be suffering from defective hearing, 15 from otitis media, and one from other ear disease, all requiring treatment. There were also four children with defective hearing requiring to be kept under observation. In other words 1.2% of the children examined in the schools were found to be suffering from defective hearing or from discharging ears. Furthermore 8 children with defective hearing, 53 with otitis media, and 46 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 children 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 supervision in the pre-school period would also undoubtedly help to reduce the incidence of these defects. (i) Dental Defects. At the routine inspection by the Medical Officer 232 children were found to have defective teeth requiring treatment, and 145 to have defective teeth requiring to be kept 73 under observation. Thus out of a total of 1,905 children examined in school, 377 or 19.8% 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 1930 the percentage was 22.0. (j) Crippling Defects. Four cases of spinal curvature requiring treatment were found at the routine inspections. There was also one case of deformity due to rickets requiring treatment and two slight cases requiring to be kept under observation. In addition, there were a number of cases of mild deformity due to round shoulders, flat foot, etc. 13 of these required treatment and 15 required to be kept under observation in school. At the special inspections at the Health Centre there were 9 cases of spinal curvature requiring treatment and one case requiring observation. Six other children were found to be suffering from deformities requiring treatment and 3 requiring observation. (k) Malnutrition. Malnutrition is not common amongst school children in Wimbledon. 1,905 children were examined during the year as routines and only seven were found to be suffering from malnutrition to such an extent as to require treatment. This gives an incidence of 3.0 per 1,000 as compared with 3 per 1,000 for the previous year. It is impossible to draw any deductions from the small increase in this figure. The incidence of malnutrition amongst the school children of the whole of England and Wales for the year 1930 amounted to 10.6 per 1,000. It is thus evident that the position in Wimbledon as compared with the rest of the country is very favourable. There is no real evidence that the economic depression which prevailed throughout 1931 had any obvious effect on the nutrition of the school children in the Borough. In addition to the seven children requiring treatment there were 14 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, 14 children were found to be suffering from malnutrition requiring treatment and 2 requiring observation. The standard of clothing and footgear continued to be 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. 74 The Memorandum of the Ministry of Health aqnd the Board of Education on Closure of and Exclusion from School is closely followed in this particular. (b) 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 1931 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 1931 were as follows:— Measles 7 German Measles 11 Whooping Cough 80 Mumps 36 Chicken Pox 28 During the year under review there was comparatively little sickness amongst school children from the non-notifiable infectious diseases. Whooping cough was responsible for the largest number of cases. Only seven cases of measles occurred. During 1930 measles was very prevalent and 423 school children contracted the disease. No case of smallpox occurred amongst school children in Wimbledon during 1931. Two school children were contacts of a case of smallpox and they were kept under daily observation until the period of quarantine had expired. Erequent visits were paid to the schools after children had been removed to the Isolation Hospital suffering from diphtheria or scarlet fever. It is quite common for children to attend school whilst sickening for these diseases. In all such cases flic class 75 contacts were carefully examined and in a number of cases swabs were taken for bacteriological examination. Several carriers were detected in this manner and promptly excluded. In accordance with Article 53 of the Education Code, 203 children were excluded from school during 1931 for the following conditions:— Conjunctivitis 14 Impetigo 24 Ringworm of Head 5 Ringworm of Body 18 Scabies 22 Other contagious or infectious conditions 120 Total 203 7. FOLLOWING UP. The procedure of following up defects discovered during the routine medical inspection in 1931 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 ad vising them of the nature of the 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 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 visited each school in the district three times during the year in order to carry out the routine medical inspections. The re-examination cards of all children with defects were taken to the school at each of these visits. These children were then re-examined. If the defects had not received attention further notices were sent to the parents. Previously, the following up had been 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. 76 (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 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. 118 children were operated on for enlarged tonsils and adenoids during 1931 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 examined by the Medical Officer at the Health Centre before they return to school. In addition, 12 other children were operated on for enlarged tonsils and adenoids by private practitioners or at the voluntary hospitals. This makes a total of 130 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. The Surrey County Council are the Authority responsible for the treatment of tuberculosis in Wimbledon. (d) Skin Diseases. 5 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. 36 children with ringworm of the body, 22 with scabies, 99 with impetigo, and 143 children suffering from other skin diseases were treated at the Minor Ailment Clinic at the Health Centre. (e) External Eye Diseases. 107 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. 2 children suffering from diseases of the eye were sent to hospital for treatment. (f) Vision. Details of the work of the refraction clinic are given in Table IV, Group II. 77 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. 332 children were examined by the Ophthalmic Surgeon during the year. Glasses were prescribed for 114 children and in every case the spectacles were obtained. These children are again examined by the Ophthalmic Surgeon at the Health Centre after they have received their spectacles from the optician. 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. In several cases, difficulty was experienced in persuading parents to provide glasses for their children. In one case, pressure was brought to bear on the parents through the Inspector of the N.S.P.C.C. In other cases, letters were written to the parents threatening exclusion of their children from school. In no case was there a persistent refusal. (g) Ear Diseases. 107 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 1931 the routine inspection by the School Dental Surgeon was extended so as to include all children attending school. In the year under review, 4,623 children were dentally inspected in the routine age groups in school. A further 363 children were inspected as special cases. The total number of children thus examined amounted to 4,086. This represents an increase of 716 over the figure for 1930. 3,884 or 77.9% were found to require treatment and their parents notified accordingly. During the previous year, 74.4% of the children inspected were found to require treatment. The number of children actually treated was 1,941 or 50% 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 shown a good average attendance. 78 45 half days were devoted to dental inspection in the schools and 375 half days to treatment at the Health Centre. The number of attendances made by children for treatment amounted to 3,852. This is 139 more than the figure for the previous year. The average number of children attending for treatment per session was 10.3, a slight increase over the figure for 1930. The total number of fillings amounted to 2,532 or 214 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 shows a very considerable drop. The number of teeth extracted shows a decrease of 181, the total figure for the year being 3,253. 611 general anaesthetics were administered for dental extractions. The work of the dental clinic has shown a progressive increase during the past two years. All the children attending school are now dentally inspected annually. The average attendance per session of children undergoing treatment has risen to 10.3. In addition, much greater time is devoted to the filling of permanent teeth. (i) Crippling Defects and Orthopædics. In July, 1931, the first session of the Orthopædic Clinic was held at the Health Centre. Further sessions were held once a month during the remainder of the year. The Orthopaedic Surgeon from St. Thomas's Hospital attends this Clinic and is accompanied by an Orthopaedic Nurse. When in-patient treatment is required, arrangements are made with the St. Nicholas' and St. Martin's Hospital at Pyrford. Children requiring remedial exercise and massage attend at the Health Centre once a week when the necessary treatment is carried out under the supervision of the Orthopaedic Nurse. Arrangements were made with the Kensington Surgical Supply Company to carry out repairs and alterations to surgical boots at a very reasonable charge. The cost of these repairs was undertaken by the parents in every case. CO new cases were examined during the year and 35 cases re-examined. The average number of children seen by the Orthopaedic Surgeon per session was 19. The following table shows the nature of the defects from which the children were suffering: Congenital defects 5 Infantile Paralysis 5 Old Amputation of Limbs 2 Old cases of Osteomyelitis 3 79 Rickets 2 Spastic Paraplegia 1 Tuberculous Joints (arrested) 2 Postural defects 35 Other defects 5 Total 60 Most of these children had been previously under treatment at various hospitals in London and very few cases required further in-patient treatment. The following table gives an indication of the treatment carried out at the Clinic:— Number of children referred to Pyrford for in-patient treatment 1 Number of children referred to St. Thomas's Hospital for out-patient treatment 1 Number of children referred to St. Thomas's Hospital for X rays 7 Number of children referred for alterations to surgical boots, etc. 14 Number of children referred for exercises and massage 49 Total 72 The Orthopaedic Nurse attended for 16 sessions in order to carry out the remedial exercises and massage. 49 children were referred by the Orthopædic Surgeon for treatment of this nature. 165 attendances were made. The average number of children attending at each session for exercise and massage was just over 10. In order that the maximum benefit could be obtained, the parents of the children were encouraged to be present. Many of the exercises taught by the Orthopædic Nurse could then be carried out daily in the homes. Great importance was attached to obtaining the co-operation of the parents. The majority of them were quite keen to take their share in this work. The results are always slow in this type of case, but one or two of of the children were allowed to carry on at home without further attendance at the Health Centre. The Surgeon sees these children from time to time to note their progress and to see that no relapse occurs. There is no doubt that the scheme has been a great success in Wimbledon, and is greatly appreciated by the parents. Already the number of sessions per week of the Orthopaedic Nurse has 80 had to be increased to two. During the present year arrangements have been made to complete the equipment necessary for this Clinic. (j) Artificial Light Treatment. 13 children attending the Health Centre were recommended artificial light treatment. The children selected for this treatment were suffering from malnutrition and anæmia, often associated with manifestations of slight rheumatism. The parents were informed how to obtain this treatment through neighbouring hospitals and institutions. There are no facilities for obtaining this treatment at the Health Centre and as the number of cases requiring artificial light treatment is small there does not appear to be any indication at present for this provision. SPEECH CLINIC. At the commencement of the year 1931 a sufficient number of cases were reported from the Schools to necessitate the continuation of the Speech Clinic. It is interesting to note that during the two years that this Clinic has been in existence the number of children in attendance has never fallen below 20. Fresh cases have always been in readiness to take the place of those discharged. A slight re-organisation of the work was effected in January, the children being treated three hours per week instead of four. Under this arrangement stammerers attend twice a week and cases of defective speech only once. The following table shows the number treated and discharged during the year:— No. treated Cured Stammerers 22 9 Defective Speech 19 7 Total 41 16 Further cases of stammering have been brought to notice from the Infants' Schools. Parents of these children were seen and given suggestions as to home treatment. Very young children, however, are unable to exert the concentration and mental effort necessary for their cure. Consequently it is found inadvisable to admit them to the classes until they are 8 years old. In the autumn a circular letter was sent to the Head Teachers of all the schools asking for the names of any new children with defective speech. As a result of this 14 children requiring treatment were reported. Miss Crickmay and Miss Gardner, who are in charge of this class, report that the year's work on the whole has been very satisfactory. 81 Fear is considered the fundamental cause of stammering, its effect being apparent, mentally, in the stammerers' negative habit of thought and physically in their persistent muscular tenseness. Treatment is directed along these lines. Relaxation is consciously practised, and, relieved of all physical and mental tension, the children find they are able to speak without effort. Continued practice in this way leads to the gradual acquisition of habits of relaxation and selfconfidence. I am indebted to Miss Crickmay and Miss Gardner for the above particulars of the year's work. 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. Another holiday Camp was arranged during the year by the Wimbledon Rotary Club. 21 boys from various Elementary Schools in the district were selected and sent away to Swanage for two weeks. The children were weighed and medically examined before leaving Wimbledon. Besides having a very enjoyable holiday the boys improved considerably in health. 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. Meals 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 the children remain for this meal. 82 No meals were provided during the year for children) attending the other schools. 11 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 supplied children with milk through the Milk Publicity Council. The milk is supplied in bottles containing one-third of a pint, at a cost of 1d. The reports from the Head Teachers indicate that the children have benefited considerably from receiving this milk. 12. SCHOOL BATHS. The arrangements for (he 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 1,905 children examined at the routine inspections, 1,593 or 83% 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 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. The Invalid Children's Aid Association, and the Wimbledon Guild of Social Welfare have rendered, as in past years, invaluable services to the school children of this Borough. 83 The Local Branch of the Invalid Children's Aid Association sent 57 children to convalescent homes for varying periods. Most of these children had been recently discharged from hospitals where they had been undergoing treatment for pneumonia, debility and rheumatism, or had been under the observation of the Tuberculosis Physician. In many cases education was provided whilst the children were away. Seven children were provided with instruments, and 256 were visited regularly and kept under supervision. Many children were provided with underclothing. The Association frequently arranged free transport for children going into hospital, or into convalescent institutions. This work is greatly appreciated by the parents, especially in the poorer parts of Wimbledon. 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, and the assistance which he is continually giving is of the greatest value. 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. (b) Blind and Partially Blind Children. There is only one blind child of school age and he is at the Royal Normal College and Academy of Music for the Blind at Upper Norwood. Three partially blind boys attend the Ravenstone 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 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. 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. 84 (f) Delicate Children. Five children are at the following institutions:— One boy at Farningham Home for Little Boys, Swanley; one boy at St. Catherine's Home, Ventnor; one boy at St. Patrick's Open Air School, Hayling Island; one boy at St. John's Open Air School, Woodford Bridge, Essex; one girl at West Wickham Hospital and Home of Recovery for Children. (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 1931 there were 38 children, 16 boys and 22 girls in attendance. In addition 5 boys were attending the Littleton Street Special School and one boy was at Besford Court. The total number of Wimbledon children attending Special Schools at the end of the year amounted to 44. At the end of 1931 there were the same total number of children in attendance at the Queen's Road Special School as at the end of 1930. 3 boys and 3 girls were admitted during the year. Every child attending the school is examined at least once a year in addition to the routine medical inspections. Children attending this school receive a bath once a week and a special bathing attendant is employed by the Education Committee for this purpose. A cooked mid-day meal of excellent quality is also served. On an average 33 children stayed for this meal, for which a charge of 3d. is made. In some cases the charge is reduced to 2½d. and in 6 cases it was found necessary occasionally to forego the amount owing to the financial circumstances of the parents. One child also received milk in school on medical grounds. The School Medical Officer visited the school on an average once a week for the purpose of examining the children. In addition to the routine class teaching a considerable amount of special handicraft instruction was given. Carpentry, gardening, cookery, and laundry-work were taught. A list is kept of all retarded school children in the district. 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 the 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 are in need of supervision and care are notified to the Local Authority under the Mental Deficiency Act, 1913, as amended by the Act of 1927. Two boys and one girl were notified for this purpose. One boy, and one girl who attended 85 from Surrey, were notified as being no longer educable. Two other children, a boy and one girl, who were not attending any school and who were unsuitable for the Special School were also notified to the Local Authority. After care is undertaken by 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. 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. 20. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. Under the ByerLaws 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 1931, 78 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. 53 children were medically examined for employment during the year. 51 children were granted medical certificates of fitness for delivering newspapers and for work in connection with milk rounds. 2 boys were found to be unfit and the medical certificates were withheld. Three parents and three employers were summoned under the Bye-Laws for illegal employment, with the following results:— One parent—summons dismissed on payment of costs. One employer—summons dismissed on payment of costs. Two parents—fined 5/- each. One employer—fined 5/^. One employer—fined 10/-. 21. SPECIAL ENQUIRIES. No special enquiries were undertaken during the year. 86 22. HEALTH PROPAGANDA. During the year 2,000 copies of "Better Health" were issued in Wimbledon. 1,600 of these copies were distributed to the schools. This publication deals with simple health matters, and there are many indications of the interest with which it is received. Short articles on health topics were contributed every month by the Public Health Department. 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. 87 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1931. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections:— Entrants 781 Intermediates 680 Leavers 883 Total 1,794 Number of other Routine Inspections 111 B.—OTHER INSPECTIONS. Number of Special Inspections 2,708 Number of Re-Inspections 8,069 Total . 10,777 88 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1931. DEFECT OR DISEASE Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 7 14 14 2 Uncleanliness 14 9 3 - Skin Ringworm— Scalp - — 5 - Body — — 36 - Scabies — — 22 - Impetigo 4 - 99 - Other Diseases (Non-Tuberculous) 14 1 143 — Eye Blepharitis 9 — 31 - Conjunctivitis 4 — 37 - Keratitis — — — - Corneal Opacities . — — — - Defective Vision (excluding Squint) 69 50 39 2 Squint 15 2 4 1 Other Conditions 2 2 47 4 Ear Defective Hearing 3 4 8 - Otitis Media 15 — 53 - Other Ear Diseases 1 — 46 — Nose and Throat Enlarged Tonsils only 32 98 18 4 Adenoids only ... 1 3 2 - Enlarged Tonsils and Adenoids 51 28 96 4 Other Conditions 1 2 136 1 Enlarged Cervical Glands (Non-Tuberculous) 2 - 22 1 Defective Speech 8 - 37 1 Teeth—Dental Diseases 232 145 23 — Heart and Circulation Heart Disease: Organic 4 - 3 1 Functional 2 - — 4 . Anaemia - - 2 1 89 TABLE II.—continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requirinig Treatment. (1) (2) (3) (4) (5) Lungs Bronchitis 7 15 28 6 Other Non-Tuberculous Diseases 3 — — — Tuberculosis Pulmonary: Definite — — - — Suspected 1 — 2 1 Non-Pulmonary: Glands 1 — -— — Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — 1 — Other Forms 1 1 1 — Nervous System Epilepsy 5 2 2 1 Chorea 1 - 3 - Other Conditions — - — Deformities Rickets 1 2 — 1 Spinal Curvature 4 — 9 1 Other Forms 13 15 6 3 Other Defects and Diseases 54 30 520 215 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 731 119 161 Intermediates 680 136 200 Leavers 383 62 162 Total (Code Groups) 1794 317 17.7 Other Routine Inspections 111 15 140 90 TABLE III RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1981. Boys. Girls. Total. Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness, Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis. Crippling (as defined in penultimate category of the Table), or Heart Disease. 1 1 2 Blind (including partially blind.) (i.) Suitable for training in a School for the totally blind. At Certified Schools for the Blind 1 - 1 At Public ElementarySchools - - - At other Institutions — - — At no School or Institution — - — (ii.) Suitable for training in a School for the partially blind. At Certified Schools for the Blind or partially Blind 4 1 5 At 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 for the totally deaf or deaf and dumb. At Certified Schools for the Deaf 1 1 2 At Public Elementary Schools - - - At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School for the partially deaf. At Certified Schools for the Deaf or Partially Deaf - 1 1 At Public Elementary Schools - - - At other Institutions... — — - At no School or Institution — — — 91 TABLE III.—Continued. Boys. Girls. Total Mentally Defective. Feebleminded. At Certified Schools for Mentally Defective Children 20 21 41 At Public Elementary Schools - - - At other Institutions.. — — — At no School or Institution - - — Notified to the Local Mental Deficiency Authority during the year Vide Form 307m 4 2 6 Epileptics Suffering from severe epilepsy At Certified Schools for Epileptics - 1 1 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions... - - — At no School or Institution - - - Suffering from epilepsy which is not severe. At Public Elementary Schools 7 3 10 At no School or Institution — — — Physically Defective Active pulmonary tuberculosis (including pleura and intrathoracic glands). 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 — — — 92 TABLE III.—Continued. Boys. Girls. Total Physically Defective (continued) Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands). At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - 1 1 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 1 1 2 At other Institutions - — — At no School or Institution - — — Tuberculosis of the peripheral glands. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools — 2 2 At Certified Day Open Air Schools - - - At Public Elementary Schools 1 - 1 At other Institutions — - — At no School or Institution — - — Abdominal tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 - 2 At Certified Residential Open Air Schools - - At Certified Day Open Air Schools - - At Public Elementary Schools 1 - 1 At other Institutions — - — At no School or tution - - - Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools - - - At other Institutions 1 - 1 At no School or Institution - — — 93 TABLE III.—Continued. Boys Girls. Total Physically Defective [continued) Tuberculosis of other organs (skin, etc.). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board - - - At Public Elementary Schools At other Institutions — — - At no School or Institution — — — Delicate Children, i.e., all children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools 4 1 5 At Certified Day Open Air Schools - - - At Public Elementary Schools 29 39 68 At other Institutions - — — At no School or Institution - — — Crippled Children (other than those with active tuberculous disease) who are suffering from a degree of crippling suffiently severe to interfere materially with a child's normal mode of life. At Certified Hospital Schools - - - At Certified Residential Cripple Schools 1 - 1 At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools 1 - 1 At Certified Day Open Air Schools - - - At Public Elementary Schools 16 6 22 (8) At other Institutions - - - At no School or Institution — 1 1(1) Children with heart disease, i.e., children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. At Certified Hospital Schools - - - At Certified Residential Cripple Schools - - - At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools. - - - At Public Elementary Schools - 4 4 At other Institutions — - - At no School or Institution — — — 94 TABLE IV.—RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31ST DECEMBER 1931. TREATMENT TABLE. GROUP I.—MINOR AILMENTS (excluding Unclejvnliuess, 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 5 — 5 Body 36 — 36 Scabies 22 — 22 Impetigo 99 — 99 Other skin disease 143 — 143 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 115 - 115 Minor Ear Defects. 107 — 107 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 565 565 Total 1092 — 1092 GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments-—Group I.). DEFECT OR DISEASE. Number of Defects dealt with. Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from thf Auihority'6 Scheme. Otherwise. Total. (i) (2) (3) (4) (5) Errors of refraction (including Squint). 316 14 — 330 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 16 — — 16 Total 332 14 — 346 Total number of children for whom spectacles were prescribed:— a. Under the Authority's Scheme 114 b. Otherwise 9 Total number of children who obtained or received spectacles:— a. Under the Authority's Scheme 114 b. Otherwise 9 95 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) (6) 118 12 130 74 204 GROUP IV.—DENTAL DEFECTS. 1. Number of Children who were:— a. Inspected by the Dentist: Aged Aged Total. 4623 Routine Age Groups 5 203 10 564 6 420 11 679 7 463 12 413 8 546 13 337 9 535 14. 463 , Specials 363 Grand Total 4986 b. Found to require Treatment 3884 c. Actually Treated 1941 d. Bo-treated during the year as the result of periodical examination 1348 2. Half-days devoted to:— Inspection, 45. Treatment, 375 Total 420 3. Attendances made by Children for Treatment 3852 4. Fillings:— Permanent Teeth, 1915. Temporary Teeth, 32 Total Teeth 1947 Total Fillings 2532 5. Extractions:— Permanent Teeth, 641. Temporary Teeth, 2612 Total 3253 6. Administrations of general anaesthetics for extractions 611 7. Other Operations:— Permanent Teeth, 1003. Temporary Teeth, 1370 Total 2373 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 12,694 3. Number of individual children found unclean 205 4. Number of children cleansed under arrangements made by the Local Education Authority 91 6, Number of cases in which legal proceedings were taken: — (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — 96