AC 4413(1) Wimbledon Borough of Wimbledon Annual Report of the MEDICAL OFFICER OF HEALTH For the year 1932 Together with the Report of THE SCHOOL MEDICAL OFFICER and of THE SANITARY INSPECTOR WIM 8 Borough of Wimbledon ANNUAL REPORT of the Medical Officer of Health for the Year ended 31st December, 1932. Public Health Commiitee Chairman: Councillor E. Fielder. Vice-Chairman: Councillor Miss D. Carver. Members: The MAYOR (Councillor J. W. Ramshaw, J.P.), ex-officio. Alderman A. W. Hickmott Councillor W. B. James Councillor E. J. Chard ,, A. R. Kelly ,, H. A. Crowe, O.B.E. ,, Lady Roney A. W. Hughes ,, S. B. Stone Clarke ,, J. W. Watts ,, A. A. Drake Maternity and Child Welfare Committee Chairman: Councillor Lady Roney Vice-Chairman: Councillor A. A. Drake Members: The MAYOR (Councillor J. W. Ramshaw, J.P.), ex-officio. Alderman A. W. Hickmott Councillor T. R. Daniel Councillor F. T. Bowen ,, T. E. Jenner ,, G. T. Burrows Mr. G. Edwardes-Jones, K.C. ,, Miss D. Carver Mrs. Chard ,, Daniel ,, Fielder Sheerman Borough of Wimbledon. With the Medial Officer of HEalth's Compliments. STAFF Whole-time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Isolation Hospital; Maternity and Child Welfare Officer: ‡* Harold Ellis, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officer of Health, Assistant School Medical Officer: ‡Effie M. D. Craig, M.B., Ch.B. Chief Sanitary Inspector: * Henry Johnson, M.B.E., F.R.San.I., F.S.I.A., (g), (h). Sanitary Inspector: * R. T. Avis, M.R.San.I., M.S.I.A., (d), (g), (h). Assistant Sayiitary Inspector: D. F. S. Flynn, (g), (h). Health Visitors—School Nurses: Miss M. Giles, (6), (d), (/). Miss E. M. Skelton, (a), (6), (f). Miss G. Hyde, (a), (b), (c) (resigned 30th September, 1932). Miss H. A. Blackburn, (a), (b), (c), (r), (g) (appointed 1st October, 1932). Senior Clerk: A. L. Taylor. Clerks: R. L. Brown. H. R. Fry. Clerk to the Maternity and Child Welfare Department: A. L. Taylor. Matron of Isolation Hospital: Miss L. McCrory. Matron of Day Nursery: Miss I. Cutler. Part Time: Dr. Dan McKenzie, Consulting Oto-Laryngologist to Isolation Hospital. R. W. Butler, M.Ch., F.R.C.S., Orthopcedic 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., L.S.A., Bacteriologist. * Salary contribution under Public Health Acts. ‡ by Exchequer Grants. a. S.R.N. b. C.M.B. c. Certificate Fever Training. d. Certificate Sanitary Inspectors Examination Board (London). e. New Health Visitor's Certificate, Royal Sanitary Institute. f. Health Visitor's Certificate Royal Sanitary Institute. g. Certificate Royal Sanitary Institute for Inspector of Nuisances. h. Certificate Royal Sanitary Institute for Inspector of Meat & Other Foods. 3 Borough of Wimbledon. Public Health Department. ANNUAL REPORT OF the Medical Officer of Health for the Year ended 31st December, 1932. 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, 1932, together with my Report as School Medical Officer. The Report for 1932 is an ordinary Report, set out on the lines suggested in Circular 1269 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 1932, one hundred and nineteen employees were medically examined by the Medical Officer of Health. In addition thirty-two candidates were medically examined for superannuated posts under the Wimbledon Borough Council. 5 Natural and Social Conditions of the Area. Area (in acres—Census, 1931) 3,221 Population (Census, 1931) 59,524 Population (Estimated, 1932, R.6.) 59,440 Number of inhabited houses:— 1921 (Census) 11,926 1931 (Census) 13,325 1932 (According to Rate Books) 14,157 Number of families or separate occupiers:— 1921 (Census) 13,998 1931 (Census) 15,883 Rateable Value£700,618. Sum represented by a penny rate:—£2,919. Social Conditions.—Wimbledon is one of the suburbs on the outer ring, and may be regarded mainly as a dormitory for workers in London. A great many of these are engaged in professional and commercial occupations. Wimbledon is fortunate in possessing such beautiful open spaces as The Common, and Wimbledon Park. These not only make the Borough most attractive from a residential point of view, but also contribute, to a large extent, towards the excellent health enjoyed by the inhabitants. There is no doubt that it is one of the most healthy districts in London. In the southern part of the Borough there are a number of factories and workshops. Three hundred and sixty-eight premises are registered under the Factory and Workshop Acts. For the most part these premises are small. There are twenty-four laundries registered in the district, employing a large number of hands. In addition, there are leather works, gas mantle works, tool and file works, and a railway stock and repair depot, which employ a considerable number of people. These works cannot be said to exert any particular influence on the public health of the district. 6 Extracts from Vital Statistics of the Year 1932. (Registrar-General's Figures). Total. M. F. Live Births Legitimate 635 320 315 Illegitimate 32 15 17 Birth Rate per 1,000 of the estimated resident population 11.22 Stillbirths 12 7 5 Rate per 1,000 total (live and still) births 17.66 Deaths 713 332 381 Death Rate per 1,000 of the estimated resident population 11.99 Percentage of Total Deaths occurring in Hospitals and similar Institutions 37.58 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths. Rate per 1,000 total (live & still) births. No. 29. Puerperal sepsis 1 1.47 No. 30. Other puerperal causes — ... — Total 1 ... 147 Death Rate of Infants under one year of age:— All infants per 1,000 live births 67.46 Legitimate infants per 1,000 legitimate live births 61.41 Illegitimate infants per 1,000 illegitimate live births 187.50 Deaths from Measles (all ages) 4 „ „ Whooping Cough (all ages) — „ „ Diarrhoea (under 2 years of age) 4 7 BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1932 (Provisional Figures.) (The Rates for England and Wales have been calculated on a population estimated to the middle of 1932, but those for the towns have been calculated on populations estimated to the middle of 1931. The mortality rates for England and Wales refer to the whole population, but for London and the towns to divilians 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 Typhoid and Paratyphoid Fevers Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea and Enteritis (under two years) Total Deaths under One Year Certified by Registered Medical Pra- titioners Inquest Cases Certified by Coroner after P.M. No Inquest Uncertified Causes of Death England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 65 91.10 6.20 1.80 0.90 118 County Boroughs and Great Towns, in eluding London 15.4 0.70 11.8 0.00 0.00 0.11 0.01 0.08 0.07 0.23 0.48 8.9 09 91.30 5.90 2.30 0.50 126 Smaller Towns t Estimated Resident Populations, 25,000 to 50,000 at Census 1931) 15.4 0.69 10.8 0.00 0.00 o.06 0.01 0.06 0.03 0.31 0.42 4.5 58 91.90 5.80 1.30 1.00 London 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.27 0.53 12.6 66 89.40 6.20 4.40 0.00 W'dn (Estimated Population 59,440) 11.2 0.20 11.9 0.01 0.00 0.06 0.00 0.00 0.01 0.33 0.53 5.9 67 88.63 10.09 1.12 0.14 8 Population, Birth and Death Rates for each Ward in 1932. WARD. Factor. Population. Birth Rate. Death Rate. St. Mary's 4.46 6782 7.66 13.27 St. John's 4.77 5151 5.04 14.17 Cottenham Park 4.33 7487 7.74 14.29 Wimbledon Park 8.88 4436 9.91 10.59 North Wimbledon 4.36 23856 7.54 11.17 Dundonald 5.15 7925 13.37 12 23 Trinity 5.59 11767 13.85 11.21 South Park 4.63 8620 10.55 11.60 Haydon Park 5.47 7272 18.01 9.21 South Wimbledon 5.21 35584 13.79 11.12 Whole District 4.20 59440 11.22 11.99 Births.—The statistics supplied by the Registrar-General show that during 1932 the total number of registered live births belonging to Wimbledon amounted to 667 (335 males and 332 females). This gives a birth rate equal to 11.22 per thousand of the population. Thirty-two (or 4.79 per cent.) of the births were illegitimate. Of this number, fifteen were males and seventeen females. In addition, twelve stillbirths (seven males and five females) were registered. The following table gives the birth rates in Wimbledon for the past ten years, together with the comparative figures for England and Wales. It will be noted that the birth rate in Wimbledon shows a slight increase over the figure for the previous year. For the second year in succession the birth rate in the Borough is slightly lower than the death rate. 1923 1924 1925 1926 1927 1928 1929 1930 1981 1932 Wimbledon: Number of Births 868 814 760 807 717 691 769 766 642 667 Birth Rate 14.9 14.01 13.06 13.9 12.3 11.6 12.7 12 9 10 9 11.2 Birth Rate for England & Wales 19.7 18.8 18.8 17.8 16.7 16.7 16.3 16.3 15.8 15.3 9 Notification of Births Acts, 1907 and 1915. During the year, six hundred and eighteen notified by the following persons:— births were Parents 17 Midwives 325 Doctors 40 Other persons 236 Total 618 Twelve of these notifications were in respect of stillbirths. Of the six hundred and eighteen notifications two hundred and twenty were received from Medical Officers of Health of outside areas, and related to births which had occurred to Wimbledon residents confined outside the Borough. Similarly, seventy-four confinements occurred in Wimbledon amongst women, whose homes were situated in other districts. Deaths.—The total numiber of deaths registered in the district was five hundred and six (217 males and 289 females), equal to a death rate of 8.51 per thousand of the population per annum. The deaths occurring outside the district, of persons belonging to this Borough were two hundred and seventyfive, namely:— Kingston and District Joint Hospital 119 Nelson Hospital, Merton 25 S.C.C. Sanatorium, Godalming 4 St. Thomas's Hospital 10 Others 117 Total 275 The deaths occurring within the district, of persons not belonging thereto were sixty-eight, namely:— North Wimbledon Hospital 16 Isolation Hospital 4 Atkinson Morley Hospital — Private Nursing Homes 38 Others 10 Total 68 Taking these into consideration, the total number of deaths properly belonging to Wimbledon is seven hundred and thirteen, and the death rate 11.99 per thousand of the 10 population. The rate for England and Wales for the same period was 12.0 per thousand. The death rate shows a decrease 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 tend 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 increasing. For this reason the death rate in the Borough will probably show an increase in the future. The following table gives the death rate in Wimbledon for the past ten years together with the comparative figures for England and Wales:— — 1923 1921 1925 1926 1927 1928 1929 1930 1931 1932 Wimbledon : No. of Deaths... 546 645 638 579 620 632 774 648 724 713 Death Rate 9.4 11.1 10.9 9.9 10.6 10.7 13.03 10.9 12.3 11..9 Death Rato for England & Wales 11.6 12.2 12.2 1.16 12.3 11.7 13.4 11.4 12.3 12.0 Table II. gives the causes of, and ages at. death during 1932. Deaths due to notifiable infectious diseases are given on page 52. The principle causes of death, apart from zymotic deaths, are as follows:— Cancer 104 Heart Disease 148 Cerebral Haemorrhage 36 219 Aneurysm 1 Other Circulatory Diseases 34 Pneumonia 49 Bronchitis 28 88 Other Respiratory Diseases 11 Influenza ... 20 Tuberculosis (Respiratory) ... 41 Cancer— Cancer and malignant disease were responsible for 104 deaths or 14.5 per cent, of the total number recorded. 11 The following table gives the percentage figures since 1921:— Deaths from Cancer. Year Total Deaths CaDcer Deaths Percentage 1921 634 83 13.08 1922 616 91 14.7 1923 546 68 12.4 1924 645 86 13.3 1925 638 90 14.1 1926 579 104 17.9 1927 620 75 12.09 1928 632 84 13.2 1929 774 103 13.3 1930 648 106 16.3 1931 724 103 14.2 1932 713 104 14.5 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 forty-eight deaths were due to heart disease. In addition there were thirty-six deaths from cerebral haemorrhage, one from aneurysm and thirty-four from other circulatory diseases. Thus, two hundred and nineteen deaths occurred from diseases of the heart and circulation. This figure represents 30.71 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, in spite of the fact that the figure is slightly less than that for the preceding year. 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Deaths from discases of the heart and Circulation 142 171 193 143 171 179 208 188 243 219 Total deaths (all causes) 546 645 638 579 620 632 774 648 724 713 Percentage of deaths from heart it circulatory dis cases in relation to total deaths 26.00 26.51 30.02 24.69 27.58 28.32 23.87 29.01 33.56 30.71 12 Bronchitis, Pneumonia, and Other Respiratory Diseases. Twenty-eight deaths were due to bronchitis, forty-nine to pneumonia and eleven to other respiratory diseases. This gives a total figure of eighty-eight, or 12.34 per cent, of the total deaths occurring amongst residents of the Borough during 1932. The following table gives the figures for these diseases for each year since 1923. 19SI3 1924 1925 1926 1927 1928 1929 1930 1931 1982 Deaths from Bronchitis, Pneun onia & other Kespira tory Diseases 84 101 98 102 89 81 117 79 80 88 Total Deaths, (all causes) 546 645 638 579 620 632 774 648 724 713 Percentage of Deaths from Bronchitis, Pneumonia & other Respirnrory Diseases in relation to Totnl Deaths 15.38 17.20 15.36 17.61 14.35 12.81 15.11 12.19 11.04 12.34 Gastric and Duodenal Ulcer. There were seven deaths from these diseases, five occurring in males and two in females. In four cases the cause of death was haemorrhage, in one case perforation, whilst in the remaining two cases the immediate cause of death was not stated. During the previous year eleven deaths occurred from gastric or duodenal ulcer. The more frequent use of radiography has added considerably to the accuracy of diagnosis in these diseases. In spite of this, peptic ulcer is a condition which appears to be definitely on the increase. Little or nothing is accurately known of its causation. Infantile Mortality. There were forty-five infant deaths during the year (including transferable deaths) giving an Infantile Mortality 13 Rate of sixty-seven per thousand births. This figure shows a slight decrease over that of seventy per thousand for the previous year. During 1932 the Infantile Mortality Rate for England and Wales was sixty-five. The following table gives the Infantile Death Rate in Wimbledon for the past ten years together with the comparative figures for England and Wales:— 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Wimbledon : No. of Iufautile Deaths 38 59 46 27 37 38 35 38 45 15 Infantile Death Rate iper thousand births) 44 70 60 33 50 55 46 49 70 67 Infantile Death Kate for England and Wales 69 75 75 70 69 65 74 60 66 65 Of the forty-five children under one year who died, the cause of death in seven cases was broncho-pneumonia or acute bronchitis. This was largely accounted for by the prevalence of influenza during the latter part of 1932. In another eighteen cases death was due to prematurity, marasmus, debility, etc. Infantile diarrhoea was responsible for four deaths. The Infantile Death Rate for illegitimate children in Wimbledon was 187.5 per thousand births. 14 Tho following table shows the causes of death, and ages at death, of infants under one year:— Infant Mortality during- the year 1932. Causes of Death. Under 1 week . 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months, 6-9 Months. 9-12 Months. Total Deaths under One Year. Measles ... ... ... ... ... ... ... ... 1 1 Influenzal-pneumonia ... ... ... ... ... ... ... ... 1 1 Pneumonia ... ... ... ... ... ... ... 1 ... 1 Broncho-Pneumonia ... ... ... ... ... 2 ... ... 1 3 Bronchitis ... ... 1 ... 1 ... ... 1 1 3 Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Infective enteritis ... ... ... ... ... 2 1 1 ... 4 Intussusception ... ... ... ... ... ... ... ... 1 1 Prematurity 10 ... 1 1 12 2 ... ... ... 14 Marasmus ... ... 1 ... 1 2 ... ... ... 3 Congenital Debility 1 ... ... ... 1 ... ... ... ... 1 Asphyxia 3 ... ... ... 3 ... ... ... ... 3 Pyloric Stenosis ... ... ... ... ... 1 ... ... ... 1 Spina Bifida ... 1 ... ... 1 ... ... ... ... 1 Congenital Heart Disease 1 ... ... ... 1 ... ... ... ... 1 Other Congenital Defects ... ... ... ... ... 1 ... ... ... 1 Birth Injury 2 1 ... 1 4 ... ... ... ... 4 Convulsions ... ... ... ... ... ... ... 1 ... 1 Total ... 17 2 3 2 24 10 2 4 5 45 15 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Public Assistance:—The following information has been furnished by the Chief Public Assistance Officer concerning relief in this district:— Amount paid in Out-door Public Assistance in 1932 £8,376 Average weekly number of persons in receipt of Domiciliary Assistance 509 Average weekly number of persons in receipt of Medical Relief only 6 Number of persons admitted to the Public Assistance Institutions from Wimbledon Area :— (a) Hospital 484 (b) Institution 49 HOSPITALS. (1) Hospitals provided or subsidised by the Local Authority or the Surrey County Council:— (i) Tuberculosis.—Most Wimbledon patients suffering from piulmonary 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. (ii) 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, one hundred and twenty-seven Wimbledon patients were admitted for their confinements during 1932. Ninety-four of these patients were admitted to the general maternity ward and thirty-three to the private maternity wards. (iii) 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. 16 (iv) Infectious Diseases.—The Corporation's Isolation Hospital, at Gap Road, has accommodation for one hundred and six 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. (v) Others—None. (2) 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 seventy-two bed cases. In addition there is the Nelson Hospital for Wimbledon, Merton and District, which is situated just outside the boundary. This hospital has sixty-two beds for medical and surgical cases and twenty beds for maternity patients. The Kingston and District Hospital, which is at Norbiton, has five hundred beds. This hospital is administered by the Public Assistance Committee of the Surrey County Council. (3) Institutions for unmarried mothers: — The Southwark Diocesan Maternity Home at 56, Gap Road, has accommodation for twelve mothers. (4) Ambulance facilities:— (i) For Infectious Diseases.—Two motor ambulances are maintained by the Wimbledon Borough Council at their Isolation Hospital, Gap Road. A new well-equipped Austin ambulance was purchased during July for the removal of infectious patients, the other ambulance being retained for disinfecting purposes. (ii) For Non-infectious Cases and Accidents.—One motor ambulance is maintained by the Wimbledon Borough Council at the Fire Station, Queen's Road. (5) Clinics and Treatment Centres:— (i) Maternity and Child Welfare Centres. (a) Wandle Park House, Wandle Bank, Wimbledon. Every Wednesday from 2 p.m. to 4.30 p.m. 17 (b) Health Centre, Pelham Road, Wimbledon. Every Friday from 2 p.m. to 4.-30 p.m. (ii) Ante-natal Clinic. Wandle Park House, Wandle Bank, Wimbledon. Second and fourth Thursday in each month from 2 p.m. to 4.30 p.m. (iii) Mothercraft Classes. (a) Health Centre, Pelham Road, Wimbledon. Every Tuesday from 3 p.m. to 4.30 p.m. (b) Wandle Park House, Wandle Bank, Wimbledon. Every Thursday from 3 p.m. to 4.30 p.m. (iv) Dental Treatment Centre. Health Centre, Pelham Road, Wimbledon. Every morning (including Saturday) from 9.15 a.m. to 12 noon. (v) School Clinic. Health Centre, Pelham Road, Wimbledon. (a) Minor Ailment Clinic. Every morning (including Saturday) from 9 a.m. to 12 noon. (b) Special Inspection Clinic. Every Wednesday from 9 a.m. to 12 noon. (vi) Day Nursery. Hubert Road, Wimbledon. All the above are provided and maintained under the Wimbledon Borough Council. (vii) Tuberculosis Dispensary. Council Schools, Aston Road, Raynes Park, S.W.20. The Dispensary is provided and maintained by the Surrey County Council and is available to Wimbledon patients as follows:— Every Wednesday from 1.30 p.m. to 4 p.m. Every Friday from 9.30 a.m. to 12 noon. First Tuesday in each month from 5.30 p.m. to 7 p.m. (viii) 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. 18 Public Health Officers of the Local Authority. (See p. 3). 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 seven nurses. Five of the staff are district nurses, and two district midwives. The Association attended one hundred and fiftythree midwifery cases during the year. One hundred and eighteen of these were midwives cases and thirty-five were cases with doctors in attendance. In all, 2,299 visits were paid to maternity cases. Furthermore, two hundred and eightyfour ante-natal visits were made by the nursing staff of the Association. The total number of cases dealt with during ]932, including midwifery, amounted to nine hundred and fifty-five, the total visits paid to these cases being 20,510. The Wimbledon Borough Council make an annual contribution of ten guineas to this Association. Midwives Acts, 1902-1926. The Borough Council is the Local1 Supervising Authority for the Midwives Acts in Wimlbledon. Twenty-two midwives notified their intention of practising in the Borough during the year, together with four midwives resident in outside areas. Six of the former eventually removed to other districts, leaving sixteen practising midwives in Wimbledon at the end of 1932. There are, in addition, a number of midwives acting purely as maternity nurses in maternity homes in the district. Three hundred and seventy-six confinements were attended by the midwives and one hundred and fifty-three by the maternity nurses. In the latter cases, of course, doctors had been engaged by the patients. 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, showed that the records, bags, instruments, etc., were being maintained in a satisfactory manner. In one or two cases midwives were found to be giving insufficient attention to the ante-natal side of their work. It was pointed out to them that the rules of the Central Midwives Board would be rigidly enforced, and subsequent inspections showed that the warnings given had had the desired effect. Where necessary, a midwife was shown, in detail, how the new ante-natal record books were required to be kept. 19 No uncertified women living in Wimbledon were known to be attending confinements under the direction and supervision of registered medical practitioners. During September, the Surrey County Council, as the Local Supervising Authority for Surrey, arranged a course of lectures and demonstrations for the midwives in their area. The midwives in Wimbledon were kindly invited to attend, if they so desired, and a number availed themselves of the opportunity of being present. Several lectures wrere also given to the Wimbledon mid\vives by the Medical Officer of Health at the Town Hall during the year. A local branch of the Mid-wives' Institute has been formed and the Chairman of the Maternity and Child Welfare Committee of the Wimbledon Borough Council accepted the office of President. The following notifications were received from midwives practising in the district:— Stillbirths 5 Artificial Feeding 1 Liability to be a Source.of Infection 9 Notification of Death 1 Total 16 Medical Aid forms were received from midwives in one hundred and six instances, and the following table shows the conditions for which medical help was obtained:— Albuminuria 7 Ante Partam Haemorrhage 6 Delayed Labour 14 Delay in third stage (including Retained Placenta) 3 Malpresentation 8 Premature Labour 8 Post Partum Haemorrhage 5 Ruptured Perineum 27 Pyrexia 6 Inflamed Eyes 11 Miscellaneous 11 Total 106 Nursing Homes Registration Act, 1927. The Wimbledon Borough Council is responsible for the supervision of nursing homes in Wimbledon. At the end of 20 the year there were nineteen 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 Maternity and Chronic Cases 1 Nursing Homes for General Medical and Chronic Cases 2 Nursing Homes for Chronic Cases 9 Total 19 Certificates of registration or re-registration were issued by the Council in respect of:— Nursing Homes for Medical, Surgical and Maternity Cases 1 Nursing Homes for General Medical and Chronic Cases 1 Total 2 Intimation was received that one Nursing Home for maternity cases was being discontinued. These homes were periodically inspected and supervised. In a few 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 postmortem room, and an amount for this purpose has been included in the estimate of rate for the current year. It is hoped that work will be comimenced on the new building during 1933. Prom information received from the Superintendent of the Cemetery there were ninety-eight bodies received into the mortuary during 1932. Inquests were held by the Coroner with respect to ninety-four bodies, equalling 18.57 per cent, of the deaths registered as occurring in the Borough. 21 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 Y.—17th December, 1890. Public Health Acts (Amendment) Act, 1907. Part II. (Streets, Buildings)—Sections 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 29, 31, 32, 33; and Sections 25, 27 and 30 with modifications. Part III. (Sanitary provisions)—Sections 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and 51, and Section 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). 22 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. 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. 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 Seconds-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. 23 SANITARY CIRCUMSTANCES OF THE AREA 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 1932. Reason of Visit. No. Infectious Diseases 831 House Inspections 2,979 House to House Inspections 1,290 Rent Act Inspections 51 Houses Let in Lodgings; Inspections 531 Inspection of Factories, Workshops, Work-places and Out-workers' Premises 354 Common Lodging Houses; Inspections 9 Dairies and Cowsheds; Inspections 64 Inspections under Shop Acts 684 Application of Tests to Drains 176 Inspections under Diseases of Animals Acts 21 Obtaining Samples of Foods and Drugs 5 Miscellaneous (including Inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,696 8,691 Seven hundred and sixty-nine preliminary or informal notices were served in respect of six hundred and ninety-nine houses. One hundred and two statutory notices were served in respect of one hundred and fifty-seven houses. The necessary work was executed in all but one hundred and two cases, which were not completed by the end of the year. In sixty-eight 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 staff of the Public Health Department. 24 FACTORIES, WORKSHOPS AND WORKPLACES. 1. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 105 5 ... Workshops (Including Workshop Laundries) 184 9 ... Workplaces (Other than Outworkers' Premises) 65 1 ... Total 354 15 ... 2. Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts:—* Want of Cleanliness 8 8 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 1 1 ... ... Sanitary Accommodation— Insufficient ... ... ... ... Unsuitable or Defective 11 11 ... ... 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, 19.21.) ... ... ... ... Totals 20 20 ... ... *Including those specified 1 in sections 2, 3, 7 anil 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 25 Outwork in Unwholesome Premises—(Section 108). Nature of Work Instances Notices Served Prosecutions Wearing Apparel — Making, Etc. ... ... ... Others ... ... ... Outwork in Infected Premises—Sections 109-110 Nil. HOME WORK. Lists received:— Twice in the year — Number of Out-workers — Once in the year 1 Number of Out-workers 2 Number of addresses received from other Councils 43 Number of addresses forwarded to other Councils 12 Notices served on occupiers as to keeping or sending lists — Prosecutions—Failing to keep Outworkers' Lists — Prosecutions—Failing to furnish lists — Inspections of Out-workers' premises 28 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 seven Factory Bakehouses) 24 Boot Repairing 59 Builders 11 Coach Builders 3 Cycles 7 Dining Rooms 17 Dressmaking 33 Furniture Repairers Jewellers and Watch Repairers 11 26 Laundries 24 Millinery 6 Motors 29 Printing 10 Smiths 4 Tailoring 17 Woodworkers 22 Miscellaneous 80 368 OTHER MATTERS. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act — Action taken in matters referred by H.M. In spector as remedial under the Public Health Acts. Notified by H.M. Inspector Reports of action taken sent to H.M. Inspector — Underground Bakehouses in use at the end of the year 3 I submit herewith the report of Mr. Johnson, the Chief Sanitary Inspector. The report deals in detail with the work of the Sanitary Inspectors during the year. I should like to take this opportunity of again expressing my appreciation of the manner in which Mr. Johnson and the inspectorial staff have carried out their duties. REPORT OF CHIEF SANITARY INSPECTOR I beg to submit my Report of the work carried out for the year ended 31st December, 1932. Table III gives a summary in detail of the various nuisances abated and sanitary improvements effected. Notices Served.—Seven hundred and nine Preliminary Notices or intimations were served during the year in respect of 727 houses. It was found necessary to serve 102 Statutory Notices upon the owners or occupiers of 56 houses. Six hundred and fifty-one enquiries received from the Town Clerk's Department were replied to, regarding 756 properties where negotiations for sale were in progress. 27 Legal Proceedings.—Legal proceedings were instituted in two cases with the results stated:— (a) For failing to comply with Notice to abate nuisance. Case adjourned for attendance of Defendant. At resumed hearing summons dismissed as nuisance had been abated. (b) For failing to comply with Notice to abate nuisance. £1 l1s. 6d. costs, and ordered to execute works within fourteen days. For failing to comply with Magistrates' Order, defendant was ordered to pay daily penalty (for 14 days) of 5/-, together with costs of £4 4s. 0d., a total of £7 14s. 0d. 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 test, application was made to the Local Authority with respect to the opening up of drains at one house. House Drainage.—The drainage systems and sanitary arrangements of 9 houses have been entirely reconstructed, extensive amendments or repairs were carried out at 58 houses, and at 13 houses the drainage systems have been made watertight by the patent internal process. House to House Inspection.—During the year house to house surveys were carried out at 330 houses. The following list shows the particular streets, and the number of houses inspected in each. A list of the work carried out at the houses is included in Table III, p. 36. Beehive Buildings 52 Hardy Boad 1ll Milton Boad 57 Nelson Boad 110 330 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, 1,370 houses were visited. Table III shows 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 28 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 a 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 immediately, the remainder of the work is permitted to be done in stages. This oftentimes leads to more work being done than is actually required by the Notice, as the owner appreciates the assistance given to him, and is anxious to keep his property in as good condition as possible. On a piece of land in the Borough a family, consisting of man, wife and three young children, were found to be occupying two wood structures. One, formed of two bus bodies, resting on brick piers, was used as living room and bedroom, and the other, just an ordinary rough shed, was used as a bedroom for two children. The water supply was obtained from a main tap about 120 yards away, and the only convenience provided was a pit latrine which during wet weather became flooded, with the result that the surrounding ground was frequently fouled. The man was unemployed and could not afford to pay more rent. The owner was called upon to remedy the insanitary conditions existing, and to cause the structures to be vacated. The Notice was complied with and the sheds are now being used as storerooms by the owners of the land. Overcrowding.—In addition to cases of overcrowding discovered during general inspections, ten complaints were received and investigated. Following verbal advice, the conditions were altered in two of the cases. In one case an ejectment order was obtained, and in another case, where the tenant was found to be extremely neglectful, the nuisance was abated following the service of a Notice and the subsequent threat of a summons. In the other six cases, the complaints were found to be unjustified, and were evidently made in the hope that a visit from your Inspector would result in possession of the rooms being obtained without an appeal to the Magistrates. This time-worn ruse is adopted by a number of persons, but when the facts are known to the Public Health Department the complainant is advised as to the proper procedure. One of the problems met with is that of separation of sexes, and the provision of adequate sleeping accommodation in mixed 29 families. In the majority of cases they are quite unable to find more suitable premises; firstly, because they cannot afford to pay a larger rent and, secondly, because landlords hesitate to let to large families. The question of purchasing a house is, only too often, but a " castle in the air," and cannot for a moment be considered by those referred to. The only real solution is, undoubtedly, the provision of houses to be let at a weekly inclusive rent such as these families could afford without depriving themselves of the essentials of life. Houses Let in Lodgings.—There are now 73 of these houses on the Register. Five hundred and thirty-one 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, 54 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 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, 1932 to 31st December, 1932. 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. Van Dwellings.—During the year 246 visits have been paid to the caravans in the district, and, although it has been necessary to serve Notices regarding one or two minor defects, the vans as a whole have been kept in a fairly reasonable condition. In some instances the sites still continue to be crowded, but every endeavour is being made to reduce the numbers. In one case three caravans and two other vans have been removed. In another case, where there are four vans only one is occupied, and in a further case, one caravan has been removed. 30 Dairies, Cowsheds and Milkshops.—Twelve 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. Sixty-four 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. As in previous years, much attention has been paid to retailers of milk in the Borough, particularly with regard to bottling in the streets. Milk is an article of diet which demands scrupulous cleanliness and care in handling, and I am convinced that the time spent by the Department's officers in supervision is well repaid. The fact that offenders, whom I am sure are few in number, are difficult to catch is evident by the fact that not a single case has been reported to the Authority throughout the year. I am, however, satisfied that in course of time this type of offender will be stamped out, and no one will be more pleased than the conscientious Dairyman. Infectious Disease and Disinfection,—During the year, visits for the purpose of investigating cases of notifiable infectious disease were made to 215 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 23 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. The number of rooms disinfected was 499, and the number of articles, bedding, wearing apparel, etc., 11,292, full details of which are given in the Report of the Medical Officer of Health, under the heading "Disinfection." 31 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 63 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 137 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 368 factories, workshops, and workplaces on the Register, to which 354 visits of inspection were made. Five written notices were served referring to sanitary conveniences and other nuisances. Shops Acts, 1912-28. —Six hundred and eighty-four visits were made for the purpose of observing contraventions of the Acts, advising shopkeepers regarding the Regulations in force, and in cases of complaints. In six cases legal proceedings were instituted, with the following results:— (a) For failing to close premises on weekly half-holiday. Fined 20/-. (b) For failing to close premises on weekly half-holiday. Fined 20/-. (c) For failing to close premises on two weekly half- holidays. Fined 10/- in each case. (d) (i) For failing to close premises on weekly half- holiday. Fined 20/-. (ii) For failing to affix "Mixed Shop" Notice. Fined 10/-. (e) For selling after closing hour on week day. Fined 5/-. (f) For selling after closing hour on week day. Fined 5/-. 32 It appears to me to be very surprising that, whilst the Public Health Department is always willing and anxious to assist the traders, so many offenders plead ignorance and suggest that they should receive notification of the laws affecting them. They do not seem to consider it their duty to make enquiries in the proper quarters. Notwithstanding the statements in the foregoing paragraphs, it is a pleasure to state that, on the whole, the observance of the Shops Acts in Wimbledon reflects credit on the persons concerned. As in previous years, the Home Secretary made on 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, a number of enquiries were dealt with by the Public Health Department. Observations were kept during the week preceding Christmas and throughout the holiday, including Boxing Day and the additional Bank Holiday. The result of these observations was reported to the Local Authority in January, 1933. Slaughter Houses and Food Inspection.—The number of slaughter houses on the Register at the beginning of the year was two. At one, very few animals were killed during the year, and the requisite notices having been received prior to the slaughtering, it was possible for complete examinations to be made before the carcases, etc., were removed. In the case of the second slaughter house, which had not been used as such for four years, a detailed report was made to the Local Authority, who decided that the entry relating to these premises be removed from the Register. In addition, 328 visits have been made to shops of butchers, fishmongers and fruiterers, and other places where food is prepared or exposed for sale, and the following were surrendered and destroyed as trade refuse, being unfit for human food:— 30 bags sprouts Wet and rotting. 2 boxes witches Foul. 1 box herrings Stale. 1 box kippers Very foul smelling. 1 box ,, fillets Very foul smelling. 14 barrels apples Wet and rotting. 1 box halibut Foul. 38 st. beef Decomposing, through 23 st. lamb failure of 15 st. fat and dripping refrigerator. 1 box herring roes (12-lbs) Foul. 1 ham (5-lbs) Maggotty. 33 Sale of Food and Drugs Act, 1875 to 1928.—One sample of milk, suspected to be the cause of illness, was submitted to the Council's Analyst. He reported that the sample of milk was a good one, free from preservative and up to standard and unlikely to be the cause of illness complained of. Petroleum Acts.—Eighty-three applications were received for permission to keep petroleum, seventy-seven being for the renewal of existing licences. Four hundred inspections were made of the various premises in respect of which licences had been issued. Diseases of Animals Acts, 1894 to 1925.— Parasitic Mange.—Only one case of this disease was reported during the year. The necessary inspections were made, detention notices served, and a report made to the Ministry of Agriculture and the Local Authority. After a certificate of recovery had been received from the Veterinary Surgeon, the necessary disinfection was carried out, following which the detention notice was withdrawn, and the usual return was rendered to the Ministry. Swine Fever.—No outbreak of this disease was notified in the district during the year. Foot and Mouth Disease.—No case of this disease was notified in the district, but numerous Orders were made by the Ministry of Agriculture, which included Wimbledon in the Infected 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 issuing Licences and in replying to enquiries. Tuberculosis.—No outbreak of this disease has been reported during the year. The usual quarterly returns, under the provisions of the Tuberculosis Order of 1925, have been rendered to the Ministry of Agriculture. In connection with the importation and exportation of animals, the Department has dealt with numerous enquiries, licences and notices of quarantine. The Public Health (Meat) Regulations, 1924.—Careful attention has been paid to the provisions of these Regulations, and I am pleased to report that no breach has been observed. In several cases of doubt, advice has been sought and freely given. 34 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, three 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 one case the certificate was subsequently issued as the work required to be done had not been satisfactorily executed. Water Supply.—The water supply was withdrawn from 37 houses during the year, for the following reasons:—16 by request; 16 owing to arrears of rates; and 5 for other reasons. Employment Agencies.—There were ten licensed Keepers on the Kegister at the end of the year and periodical visits have been made to each of the premises. 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. 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 four cases to report the circumstances to the Education Authority. Fouling of Footways by Dogs.—Whilst every endeavour is being made to enforce the Bye-law and to maintain the Borough's standard of cleanliness, it is regrettable that some dog owners should make such a Bye-law necessary. The practice of taking dogs for exercise is commendable and will, I trust, be continued; but there should be no need to ask those in charge to be mindful of the comfort of human beings by preventing the fouling of our footways. In one case legal proceedings were instituted, the defendant being fined 2s. 6d. 35 Smallpox Contacts.—In connection with the smallpox cases occurring in the district and local contacts of cases occurring outside the district, 277 visits of enquiry were made. As the majority of these contacts are persons employed in London, it necessitated the visits being paid during the evenings and week-ends, after they had returned from their business or occupation. Mosquitoes.—Lakes, pools, ditches and other breeding places of mosquitoes have been thoroughly sprayed on several occasions during the early months of the year. From various enquiries made, and in consequence of visits paid, I am of opinion that this spraying has been beneficial. In a number of instances, tenants of houses with cellars have complained of mosquitoes and, after adopting the advice given, considerable improvement has been noted. Offensive Trades.—During the year an inspection was made of the 16 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 96 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. 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 34 Cisterns provided 6 Cisterns repaired, cleansed or covered 24 Drains, new, provided 9 Drainage Systems made water-tight by patent process 13 Drains, repaired or altered 45 Drains, stoppages removed 37 Dustbins provided 159 Flushing cisterns, new, provided 45 36 Flushing cisterns repaired 63 Manure receptacles provided — Overcrowding nuisances abated 4 R.W. pipes disconnected 9 Roofs repaired 142 Rooms stripped and cleansed 873 Verminous rooms cleansed 21 Soilpipes, new, provided 14 Soilpipes, repaired or altered 4 Vent pipes, new, provided 21 Vent pipes, repaired or altered 27 Waste pipes, new, provided 50 Waste pipes repaired, disconnected or trapped 39 Water-closets, new, provided 77 Water-closets, repaired or ventilated 2 Water services restored 24 Yards paved 9 Yards repaired 54 Guttering repaired 87 Floors ventilated 7 Nuisances abated from damp walls 114 Water supply direct from main 2 Sinks provided 23 Rooms fumigated 499 Other nuisances 1373 3910 The following information is supplied by Mr. T. Webster, Borough Surveyor:— 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. In addition, the modernisation of the sewage disposal works is being proceeded with and four new filters are being constructed. 37 Refuse Collection.—The motor lorries used for the collection of house refuse are fitted with covers which securely enclose the refuse, thus preventing the usual nuisances connected with the open type of lorry. An additional covered vehicle has been purchased to supplement the existing fleet. Street Gully Cleansing.—The gullies are 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. HOUSING (a) HOUSING STATISTICS FOR THE YEAR 1932. 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) 1,370 (b) Number of inspections made for the purpose 4,269 (2) (a) Number of dwelling-houses (included under sub-head [1] above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 330 (b) Number of inspections made for the purpose 1,290 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 699 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 769 38 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 Nil (2) Number of dwelling-houses which were ered fit after service of formal notices: (a) By owners Nil (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 157 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 149 (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 E.—Proceedings under Section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices became operative requiring repairs Nil 39 (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 dosing Orders became operative 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 became operative Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Note.—Section 3 and 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 Notices, Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Notices and Orders must continue to be dealt with under the relative provisions of the Act of 1925. (b) HOUSING CONDITIONS. There are no changes to report in the housing conditions of the Borough and the observations made during previous years, to a large extent, still apply. Seventy-eight houses and fifteen flats were erected by private enterprise during 1932. According to the Registrar-General's estimate for the middle of 1932 there has been no increase in the population since the 1931 Census. 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. It has been previously pointed out that the economic factor is undoubtedly of great importance from the point of view of overcrowding. It is also largely responsible for the amount of sub-letting which is taking place. In many cases the accommodation sub-let is by no means adequate for the needs of the subtenants and the rent charged is often far higher than the circumstances justify. Many people to-day, however, who 40 are either unemployed or partially employed are quite unable to find the rent for the houses which they have occupied in the past, and sub-letting offers a solution to their difficulty. It is not easy to deal with the overcrowding which arises from this practice. In the worst cases, the Authority is empowered to place the premises on the register of houses let-in-lodgings, in order that the accommodation may be governed by the bye-laws which have been made for controlling such establishments. In accordance with the procedure which has been adopted in previous years a table is appended hereunder giving 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, that is, for adults 360 cubic feet, and for children under ten years of age 250 cubic feet. ROAD Total No. of Houses No of Separate Lettings No. of Occupiers Average No. of Rooms per Letting Average No. of O'cupiers per Room Average Rent per Room per Letting Under 10 Years Over 10 Years Nelson Road 110 116 21 380 4.8 0.72 2/9 Milton Road 56 80 60 266 3.7 1.07 2/10 Beehive Buldings 52 55 28 146 2.8 1 10 3/2 Total 218 21 109 792 4.05 0.88 2/11 Road No. of Separate Lettings Consisting of 1 room 2 rooms 3 rooms 4 looms 5 rooms 6 rooms Nelson Road 2 4 3 5 94 8 Milton Road 5 6 31 6 23 9 Beehive Buildings 2 21 20 7 5 ... Total 0 31 54 18 122 17 41 Overcrowding, based on the standard of the bye-laws for houses let-in-lodgings, was found to exist as follows:— Road Lettings Overcrowded by 1 Child 2 Children 1 Adult 1 Adult & 1 Child 2 Adults 3 Adults & 1 Child Nelson Road 2 ... ... ... ... ... Milton Road 1 3 3 1 1 ... Beehive Buildings 2 1 1 1 ... 1 Total 5 4 4 5 1 1 It will thus be seen that in the two hundred and eighteen houses inspected in detail, overcrowding was found to exist to the extent of fourteen adults and nineteen children. No difficulties were experienced during the year in taking action under the Public Health Acts when dealing with housing conditions. Many houses are continually coming to the notice of the Public Health Department on account of sanitary defects. These defects are remediable under the provisions of the Public Health Acts. They were continuously dealt with throughout the year. Such houses can be, and are being, rendered perfectly fit in every way for human habitation when the nuisances are abated. Houses of this nature do not require to be dealt with by the Local Authority in any other manner. Overcrowding, which undoubtedly exists in all urban areas to-day, does not. in itself, imply that the dwellinghouses themselves are insanitary. Tents, Vans, and Sheds. During 1932 considerable attention was devoted to the land occupied by vans in South Wimbledon. In two yards the number of vans was reduced by three and in the third yard the number of vans was reduced by one. This helped to remedy the overcrowding on space, which was undoubtedly existing. These yards were kept under constant observation by the staff and frequent visits were paid in order to see. that the requirements of the byelaws dealing with such structures were being complied with. 42 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-eight dairymen, fourteen dairymen and purveyors, and thirteen retail purveyors on the registers on 31st December, 1932. Frequent periodical inspections of the dairies were made. The conditions under which the milk is stored and distributed were found to be satisfactory. A number of dairymen residing outside the Borough were found to be retailing milk in Wimbledon without having been registered by this Authority. The purveyors were informed of these contraventions, and as a result of this, applications for registration were received. In all cases registration was granted. It was not necessary to take any action under the Milk and Dairies Order, 1926, during the year. No action was necessary as to tuberculous milk or cattle. The number of licences granted under the Milk (Special Designations) Order, 1923, was as follows:— Pasteuriser's Licence 1 Dealers Licences: Certified Milk 4 Grade A (T.T.) Milk 4 Grade A Milk 2 Pasteurised Milk 1 Supplementary Licences 10 Bacteriological Examination.—All the samples of milk taken for this purpose were found to be satisfactory. SLAUGHTER HOUSES. In 1920 In Jan. 1932. In Dec. 1932. Registered 4 2 1 Licensed 1 ... ... Totals 5 2 1 One slaughterhouse, which had not been used for this purpose for a period of four years, was removed from the Register. 43 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 1932. ARTICLES ANALYSED adulterated or Deteriorated Formal formal Total Formal Informal Total Milk 69 1 70 6 ... 6 Cream 6 ... 6 ... ... ... Artificial Cream ... 1 1 ... ... ... Batter ... ... ... ... ... ... Meat 6 ... 6 ... ... ... Tea ... ... ... ... ... ... Sausages ... ... ... ... ... ... Confectionery and Jam 15 1 16 3 1 4 Spirits 3 ... 3 1 ... 1 Sultanas 1 ... 1 ... ... ... Raisins 5 ... 5 ... ... ... Fish and Meat Pastes ... 2 2 ... ... ... Tinned Fruits 1 ... 1 ... ... ... Totals 106 5 111 10 1 11 44 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES There was no marked change in the incidence of the notifiable infectious diseases as compared with the previous year. One hundred and twenty-six cases of scarlet fever were notified. During 1931 the figure was seventy-five. The notifications of diphtheria amounted to sixty-four and were ten less than in 1931. There were no local outbreaks of either of these diseases. The number of cases of diphtheria notified has shown a steady decline since 1928, when the figure was one hundred and seventy. There was no death in Wimbledon in 1931 from either scarlet fever or diphtheria and in 1932 there was no death from scarlet fever and only one from diphtheria. The deaths from the non-notifiable infectious diseases for the past three years were as follows:— 1930. 1931. 1932. Measles 10 Nil 4 Whooping Cough 2 4 Nil Diarrha;a (under 2 years) 2 5 4 Measles.—Measles was prevalent in epidemic form during March, April, and May of 1932. Most of the schools suffered severely, but Wimbledon Park, Effra Road, Cottenham Park, Old Central, Pelham Road, and Haydon's Road schools were chiefly affected. Altogether, three hundred and thirty-one children were notified by Head Teachers as absent from school on this account. No figures are available for the children affected below the age of compulsory school attendance. Four deaths occurred. In three cases, the cause of death was broncho-pneumonia. One of these children, aged eighteen months, died in the Isolation Hospital. The second child, also aged eighteen months, died in the Kingston and District Hospital. The third child, aged three years, died at home. The fourth death from Measles occurred in a child six years of age who was suffering from diabetes complicated by coma. This child also was nursed at home. 45 Twenty cases of measles were admitted to the Isolation Hospital as the home circumstances were such as to render satisfactory domiciliary nursing impossible. Diarrhœa (under two years).—Four deaths occurred from this cause. Two of the children died in hospital and two in their own homes. The ages at death were one month, one month, four months, and six months respectively. Influenza.—In the latter part of the year influenza was prevalent in epidemic form. Compared with many areas, Wimlbledon did not suffer severely. Speaking generally, the disease was of a mild type. During the whole of 1932 twenty deaths occurred from this cause. Seventeen of these were females and three were males. Most of the fatal cases occurred in elderly people. In all but three instances the cases which terminated fatally had been complicated by pneumonia. As influenza itself is not notifiable no figures are available as to the total number of the population who suffered during the epidemic. Thirty-three notifications were received of patients suffering from influenzal pneumonia. Of the seventeen patients who died from influenzal pneumonia, death occurred in three instances outside the Borough. No notifications would be received in respect of these latter three cases. It is thus apparent that of the thirty-three eases of influenzal pneumonia notified in Wimbledon fourteen terminated fatally. Smallpox.—No ease of smallpox was notified in Wimbledon in 1932. There was only one case in the preceding year. 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, two hundred and thirteen 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 seventy-seven visits were paid to the houses of smallpox contacts. As in 1931, it was not considered necessary to make chicken-pox notifiable in Wimbledon. Scarlot Fever.—The total number of cases notified during the year was one hundred and twenty-six from one hundred and seventeen houses. The attack rate was 2.11 per thousand of the population. 46  Attack Rate. Death Rate. 1891 1895 4.80 0.02 Per thousand of the Population. 1896-1900 3.30 0.04 1901-1905 2.30 0.02 1906-1910 4.07 0.05 1911-1915 3.03 0.01 1916-1920 1.80 0.01 1921-1925 3.04 0.02 1926-1930 2.40 0.003 In one house there were three cases, in eight houses there were two cases, and in the remaining one hundred and eight houses, one case. One hundred and ten or eighty-seven per cent. of the cases, were treated in the Borough Isolation Hospital, Gap Road. There were no deaths. Sixty-four per Cert. of the cases notified were children of school age, five to fifteen years, and of these, seventy-seven attended the following schools:— Dundonald Road Boys' School 1 Dundonald Road Girls' and Infants' Schools 15 Wimbledon Park School 11 Russell Road Mixed School 3 Haydon's Road Boys' School 1 Haydon's Road Girls' School 1 Haydon's Road Infants' School 1 Cottenham Park School 2 Queen's Road Boys' School 4 Queen's Road Girls' School 6 Queen's Road Infants' School 2 Effra Road Girls' School 7 Effra Road Infants' School 4 Pelham Road Infants' School 5 Central School for Girls 1 Private Schools 8 Schools outside the Borough 5 Total 77 47 Diphtheria.—The total number of cases notified during the year was sixty-four from fifty-nine houses. The attack rate was 1.07 per thousand of the population. In five houses there were two cases, and in the remaining fifty-four houses, one case. Sixty-three, or ninety-eight per cent. of the patients, were treated in the Isolation Hospital. One death occurred, giving a death rate of 0.01 per thousand of the population. Fifty-nine per Cert. of the cases notified were children of school age, five to fifteen years, and of these, thirty-six attended the following schools:— Haydon's Road Boys' School 5 Haydon's Road Girls' School 4 Haydon's Road Infants' School 6 Queen's Road Girls' School 5 Queen's Road Boys' School 3 Queen's Road Infants' School 1 Dundonald Road Boys' School 1 Dundonald Road Girls' and Infants' Schools 3 Russell Road Mixed School 2 Wimbledon Park School 3 Cottenham Park School 1 Pelham Road Infants' School 1 Schools outside the Borough 1 Total 36 Careful investigation is carried out after each case of diphtheria has been notified. School children from infected houses are swabbed and not re-admitted to school until a negative result has been obtained. These swabs are either taken by the family doctor or by the staff of the Public Health Department, according to the circumstances of the case. Adult contacts living in the same house are also advised to have swabs taken from the nose and throat and in most cases they agree to this precaution being carried out. Enteric Fever.—Two cases of paratyphoid fever were notified. Both were nursed at home. One death occurred, equal to a mortality rate of 0.01 per thousand of the population. This patient was elderly and died of heart failure after the infection had subsided. Pull investigations were instituted as to the source of the infection. In neither instance had the disease arisen through the water or milk supply. 48 Food Poisoning.—No case of food poisoning was reported to the Public Health Department. Puerperal Fever and Puerperal Pyrexia.—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) Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith; (ii) Borough of Wimbledon Isolation Hospital; (iii) Kingston and District Hospital. It was only found necessary to call in the obstetric consultant on one occasion, to see a patient who was subsequently removed from a Maternity Home to the Isolation Hospital for treatment. Three cases of puerperal fever and seven cases of puerperal pyrexia were notified, as compared with four cases of puerperal fever and three cases of puerperal pyrexia in 1931. Seven of the cases notified were removed to hospital for treatment. Three of these patients were treated in the Kingston and District Hospital, three cases in the Borough of Wimbledon Isolation Hospital, and the remaining case at the Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith. All these patients made good recoveries. There was one death from puerperal sepsis, giving a mortality rate equal to 1.47 per thousand of the total births. This woman was treated in one of the large Maternity Hospitals in London. During the previous year there was no death from this cause. Pneumonia.—Twenty-eight cases of acute primary pneumonia and thirty-three cases of acute influenzal pneumonia were notified. Cerebro-Spinal Fever.—One case of meningococcal meningitis was notified and removed to the Isolation Hospital for treatment. This patient, who was a boy aged fourteen years, made a complete recovery. 49 Encephalitis Lethargica.—One person was notified as a case of encephalitis lethargica. This patient was removed to hospital for further investigation and treatment. Malaria, Dysentery, etc.—One case of malaria and one case of dysentery were notified, the disease in both instances having been contracted abroad. Ophthalmia Neonatorum.—.Seven cases of ophthalmia neonatorum were notified. Particulars regarding these cases are given in the section dealing with Maternity and Child Welfare. Erysipelas.—Notifications were received in respect of eighteen cases of erysipelas. In all but five instances these were nursed at home. There was one death, which gives a death rate of 0.01 per thousand of the population. The patients requiring removal were sent into the Kingston and District Hospital for treatment, as no separate accommodation was available at the Isolation Hospital. 50 51 TABLE A.—NOTIFIABLE DISEASES DURING—1932. DISEASE Number of Cases Notified in Various Age Groups Total Cases Notified Total Cases Removed to Hospital Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 and over. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 4 8 6 7 49 30 13 6 2 1 ... 126 110 Diphtheria (including Membranous Croup) 1 2 2 4 2 23 12 7 8 1 2 ... 64 63 Enteric Fever (including Paratyphoid ... ... ... ... ... ... ... ... ... ... 1 1 2 ... Puerperal Fever ... ... ... ... ... ... ... ... 2 1 ... ... 3 3 Puerperal Pyrexia ... ... ... ... ... ... ... 1 6 ... ... ... 7 4 Acute Primary Pneumonia ... ... ... ... 2 4 1 ... 5 3 5 7 28 ... Acute Influenzal Pneumonia 1 ... ... ... 1 1 ... 1 6 4 11 7 33 ... Cerebro-Spinal Fever ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... Dysentery ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... Malaria ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... Ophthalmia Neonatorum 7 ... ... ... ... ... ... ... ... ... ... ... 7 1 Erysipelas ... ... ... ... ... ... 1 ... 3 2 9 3 18 5 Tuberculosis (all forms) 1 ... ... ... ... 2 2 8 38 20 15 3 89 51 Totals 10 6 11 11 12 79 47 31 75 34 44 21 381 239 Table showing Ages at Death from Notifiable Infectious Diseases. Disease. Ages at Death. Total Deaths Under 1 Year 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 1 to 15 15 to 20 10 to 35 35 to 45 45 to 65 65 and over Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria(including Membranous Croup) ... ... ... ... ... ... ... ... ... 1 ... ... 1 Enteric Fever (including Paratyphoid) ... ... ... ... ... ... ... ... ... ... ... 1 1 Puerperal Fever ... ... ... ... ... ... ... ... ... 1 ... ... 1 Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia 3 3 3 ... ... 1 ... 1 ... 5 12 9 37 Acute Influenzal Pneumonia 1 ... ... ... ... ... ... ... 2 ... 3 6 12 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... 1 ... 1 Tuberculosis (all forms) 1 ... ... ... ... 1 ... 3 15 10 13 5 48 Totals 5 3 3 ... ... 2 ... 4 17 17 23 21 101 The figures given in this table are those obtained after correction by inward and outward transfers of deaths. Table showing Zymotic Death Rate, the Death Rates from Zymotic Diseases, and Death Rate from Tuberculous Diseases for the last ten years. YEAR. Death Rate Per 1,000 Population Zymotic Death-rate. Smallpox Scarlet Fever. Diphtheria. *Enteric Fever. Whooping Cough. Measles. Diarrhoea. Phthisis and other Tuberc'los Diseases. 1923 1.00 ... 0.05 0.08 ... 0.06 0.06 0.08 0.63 1924 1.10 ... 0.06 0.01 0.01 0.05 0.15 0.05 0.75 1925 1.01 ... 0.03 0.01 ... 0.10 ... 0.08 0.77 1926 0.70 ... ... ... ... ... 0.10 ... 0.60 1927 0.94 0.01 0.03 ... 0.05 ... 0.03 0.80 1928 1.10 ... 0.10 ... 0.08 0.11 0.03 0.70 1929 1.06 0.01 ... 0.10 ... 0.08 ... 0.05 0.80 1930 0.99 ... 0.06 ... 0.03 0.16 0.03 0.69 1931 0.15 ... ... ... 0.06 ... 0.08 0.90 1932 0.16 ... 0.01 0.01 0.06 0.06 0.80 *Including Paratyphoid. 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 Ward Distribution of Infectious Cases in 1932. DISEASE. Cases Notified at All Aces. Cases Notified in each Ward. Total Cases removed to Hospital. St. Mary's St. John's Cotteuham Park Wimbledon Park Dundonald Trinity South Park Haydon Park Smallpox ... ... ... ... ... ... ... ... ... ... Scarlet Fever 126 6 5 10 10 35 24 14 22 110 Diphtheria (including Membranous croup 64 2 2 2 3 6 22 7 20 63 Enteric Fever (including Paratyphoid) 2 ... ... 1 ... ... ... 1 ... ... Puerperal Fever 3 ... ... 2 ... ... ... 1 ... 3 Puerperal Pyrexia 7 ... ... ... 1 1 ... ... 5 4 Acute Primary Pneumonia 28 1 2 4 4 1 8 4 4 ... Acute Influenza! Pneumonia 33 4 3 7 2 5 6 4 2 ... Cerebr-spinal Fever 1 ... 1 ... ... ... ... ... ... 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... Enoephalitis Lethargic 1 ... ... ... ... 1 ... ... ... 1 Malaria 1 ... ... ... ... ... 1 ... ... ... Dysentery 1 1 ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 7 1 1 ... ... 1 ... ... 3 1 Erysipelas 18 2 1 2 2 5 3 2 1 5 Pulmonary Tuberculosis 81 7 3 14 4 10 21 9 13 44 Non-pulmonary Tuberculosis 8 ... ... ... ... 1 5 1 1 7 Totals 381 24 18 42 26 66 91 43 71 239 53 Table showing Number of Cases of Infectious Diseases Notified during each year from 1923 to 1932. Disease 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Smallpox ... ... ... ... 1 ... 2 2 1 ... Scarlet Fever 94 150 170 165 169 126 131 127 75 126 Diphtheria (including Membranous Croup) 88 42 33 26 52 170 150 140 74 64 Enteric Fever 2 3 3 4 4 4 7 ... 1 ... Paatyphoid Fever ... 6 ... ... 7 6 ... 2 1 2 Puerperal Fever 1 3 3 3 1 2 2 4 4 3 Puerperal Pyrexia ... ... ... ... 9 6 12 9 3 7 Acute Primary Pneumonia ... 10 16 39 42 32 39 23 21 28 Acute Influenzal Pneumonia ... 2 1 1 9 3 9 1 7 33 Cerebro spinal Fever ... 2 ... 1 2 1 2 2 1 1 Acute Poliomyelitis ... 2 ... 4 ... 1 ... ... ... ... Acute Polio-eneephalitis 1 2 ... ... ... ... ... ... ... ... Encephalitis Lethargica ... 10 5 ... 1 1 ... 1 ... 1 Mlaria ... 1 ... ... ... 2 ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... 1 Ophthalmia Neonatorum 5 2 3 3 4 3 1 3 4 7 Erysipelas 10 13 20 17 24 19 33 29 29 18 Pulmonary Tuberculosis 55 64 63 48 56 65 56 56 67 81 Non-pulmonary Tuberculosis 10 18 7 6 19 14 13 5 13 8 Totals 266 330 324 320 401 455 457 404 301 381 TUBERCULOSIS. Eighty-nine cases of tuberculosis were notified. This figure shows an increase of nine over the number for the previous year. The deaths from tuberculosis were five less than in 1931, the total figure being forty-eight. Of the forty-one deaths from pulmonary tuberculosis, twenty-four died outside the district (thirteen males and eleven females), that is, the deaths were transferred to Wimbledon by the Registrar-General. There were seven non-pulmonary deaths. Of these, five males and one female died outside the district. The causes of death in these cases were as follows:— Tuberculous meningitis 2 Miliary tuberculosis 2 Tuberculous disease of the spine 1 54 Tuberculous peritonitis 1 Tuberculosis of the caecum 1 At the end of the year there were three hundred and ninety-five cases remaining on the tuberculosis register, three hundred being cases of pulmonary, and ninety-five being cases of non-pulmonary tuberculosis. The register is revised quarterly as the result of information given by the Tuberculosis Officer regarding cases in attendance at the Dispensary. There is a close co-operation between the Public Health Department and the Tuberculosis Department of the Surrey County Council. An inspection of the home conditions and sanitary environment of every tuberculous patient is carried out by the staff of the Public Health Department as soon as the notification is received. 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 household concerned. A large number of visits are 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. Where necessary, disinfectants are also supplied. In a certain number of cases it has been possible for convalescent treatment to be arranged for children who are contacts of the disease. The Surrey County Council make all arrangements for the provision of sanatorium and hospital treatment. During 1932, fifty-one 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 this section of the Public Health Act, 1925. 55 TUBERCULOSIS.—The following table shows the number of new cases added to the register during the year, and the number of deaths from this disease. AGE GROUPS NEW CASES DEATHS Primary Notifications (Form A) New Cases discovered otherwise than by Notification Total New Cases Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females Under 1 year ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 1—5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 — 10 ... ... 1 1 ... ... ... ... ... ... 1 1 ... ... ... 1 10 — 15 1 ... ... 1 ... ... ... ... 1 ... ... 1 ... ... 15 — 20 ,, 2 3 ... ... ... 3 ... ... 2 6 ... ... 1 1 1 ... 20 — 25 5 7 ... 1 2 3 ... ... 7 10 ... 1 ... 4 1 ... 25 — 35 6 10 ... 1 3 ... ... ... 9 10 ... 1 6 2 2 ... 35 — 45 12 3 ... ... 1 4 ... ... 13 7 ... ... 7 3 ... ... 45 — 55 3 3 1 1 ... ... ... ... 3 3 1 1 6 3 ... 1 55 — 65 4 3 ... ... ... ... ... ... 4 3 ... ... 2 1 ... ... 65 and over 1 2 ... ... ... ... ... ... 1 2 ... ... 3 2 ... ... Totals 34 31 2 5 6 10 1 ... 40 41 3 5 25 16 5 2 65 7 16 1 81 8 41 7 72 17 89 48 89 LABORATORY WORK. The number of pathological specimens examined in the laboratory at the Health Centre during 1932 by the medical staff, amounted to 2,079. Most of these specimens were swabs taken from the nose and throat and were examined for the presence of diphtheria bacilli. The following additional specimens, principally from the Isolation Hospital, were also examined at the laboratory:— Blood 2 Ringworm 1 Cerebro Spinal Fluid 2 Urine Specimens 9 Sputum Nil Smears Nil The number of specimens of throat swabs, sputum, blood, etc., sent by general practitioners to the bacteriologist employed by the Council for examination during the year are indicated in the following table:— Bacteria Found. Bactcria Not Found Total. Diphtheria Swabs 32 510 542 Tuberculosis (Sputum) 17 133 150 Pus (Ophthalmia Neonatorum ... 1 1 Reaction Obtained. Reaction Not Obtained. Total Typhoid (Blood, and other specimens) ... 36 36 Positive. Negative. Total. Cerebro spinal Fluid 1 2 3 57 Disinfection.—The following table shows the number of rooms and articles disinfected. Disease. Bedding Disinfected Clothing Disinfected No. of Rooms Disinfected. Totals. Mattresses. Palliasses and Counterpanes. Beds. Pillows and Bolsters. Blankets and Sheets. Dresses Suits. Other Articles. Scarlet Fever 225 182 35 455 820 17 34 2662 165 4594 Diphtheria 134 90 16 269 500 14 29 1883 83 3018 Cancer 21 15 8 83 66 ... ... 49 21 263 Tuberculosis 41 25 9 122 111 1 1 162 75 547 Erysipelas 9 10 2 25 43 ... ... 101 15 205 Meales 66 36 4 107 259 7 15 1112 23 1629 Whooping Cough 2 2 ... 7 7 ... ... 118 4 140 Puprperal Fever 7 5 1 21 31 ... ... 15 5 85 Puerperal Pyrexia 5 2 1 9 11 ... ... 1 6 35 Pneumonia 6 10 1 21 19 ... ... 25 6 88 Enteric Fever 4 3 1 10 10 ... ... ... 5 33 Cerebro-Spinal Fever ... 1 ... 3 3 ... ... 27 2 36 Smallpox 1 1 ... 3 7 ... 2 45 1 60 Encephalitis Lethargica 1 2 ... 1 5 ... ... ... ... 9 Venereal Diseases ... ... ... ... 2 ... ... ... ... 2 Vermin 6 9 2 12 18 ... ... 28 54 129 Sundries 95 15 15 251 239 1 ... 269 31 918 Totals 623 408 95 1399 2151 40 81 6497 499 11,791 It will be noted that four hundred and ninety-nine rooms and eleven thousand two hundred and ninety-two 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. In spite of this the public often request disinfection to be carried out in many cases where it is not really essential. 58 Wimbledon Isolation Hospital Disease Cases admitted Deaths Under 5 Years Over 5 Years Total Under 5 Years Over 5 Years Total Brought forward from 1931 Scarlet Fever 4 9 13 ... ... ... Diphtheria 4 16 20 ... ... ... Cases admitted in 1932 From Wimbledon— ... ... ... ... ... ... Scarlet Fever 24 88 112 ... ... ... Diphtheria 12 51 63 ... 1 1 Diphtheria and Mumps ... 1 1 ... ... ... Puerperal Sepsis ... 3 3 ... ... ... „ „ (Baby) 3 ... 3 ... ... ... Puerperal Pyrexia ... 1 1 ... ... ... „ „ (Baby) 1 ... 1 ... ... ... German Measles ... 1 1 ... ... ... Measles 13 7 20 1 ... 1 Whooping Cough 1 ... 1 ... ... ... Meningitis and Whooping Cough 1 ... 1 ... ... ... Cerebro-spinal Meningitis ... 1 1 ... ... ... Enteric Fever ... 2 2 ... ... ... From Kingston— ... ... ... ... ... ... Scarlet Fever 12 16 28 ... ... ... Diphtheria 5 35 40 1 3 4 From Mitcham— ... ... ... ... ... ... Scarlet Fever 1 ... 1 ... ... ... TOTALS 81 231 312 2 4 6 Daily Average Number of Cases in Hospital 36 Average Number of Days in Hospital (per Case) 47 Total Number of Kingston Cases 68 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £30,010. Two hundred and seventy-nine cases were admitted to the Isolation Hospital during 1932. As there were thirty-three cases in Hospital at the end of 1931, the total number of cases under treatment during the year amounted to 312. Two hundred and ten of these eases were from Wimbledon, sixty-eight from Kingston, and one from Mitcham. There were thus thirty-two more cases admitted to the hospital in 1932 as compared with the previous year. 59 Scarlet Fever.—One hundred and forty-one cases were admitted to hospital during the year as scarlet fever. In one case, the patient was found to be suffering from measles, and in three other cases, German measles. No death from scarlet fever occurred. The following complications were noted amongst the cases under treatment:— Rhinitis 5 Otorrhœa 16 Mastoiditis 1 Adenitis 14 Nephritis 1 Albuminuria 3 Rheumatism 3 Whitlows 5 Jaundice 1 Superficial Abscesses and Boils 3 Bilateral Ethmoidal Abscess 1 Sequestrum of Frontal Bone 1 Cystitis 1 Quinsy 1 The most important complications that arose were those involving the ears, nose, and glands. Sixteen patients developed otorrhœa and one mastoiditis, making in all seventeen cases with ear complications. Paracentesis on one or both ears was performed in four cases. An operation for bilateral mastoid disease was carried out on one patient who was subsequently sent home with normal hearing and free from ear discharge. In nearly all the patients with ear complications the trouble completely subsided before they left hospital, and in no case did any apparent deafness result. One patient developed acute hæmorrhagic nephritis, and three albuminuria. These patients made complete recoveries. One child developed bilateral ethmoidal abscesses, which required surgical intervention. This resulted in complete cure. In another child a large sequestrum formed in the frontal bone. This patient was gravely ill and was operated on for the removal of the dead bone. The underlying brain was 60 found to be exposed. Fortunately, however, he made a complete recovery and was discharged from hospital with no apparent after-effect. Two children suffering from scarlet fever were incubating chickenpox on admission and developed the disease whilst in hospital. A further case of scarlet fever developed a severe and prolonged attack of erysipelas during the course of her illness. 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 previous years. Two "return" cases occurred. This amounts to 1.62 per Cert. of the patients discharged. Diphtheria.—One hundred and three patients were admitted to the Isolation Hospital as cases of diphtheria. The admissions were therefore twelve less than during 1931. Of these one hundred and three cases, eighty-one ultimately proved to be suffering from undoubted clinical diphtheria. Fourteen of the patients were contacts who had been swabbed and found to be harbouring diphtheria bacilli either in the nose or throat. In eight patients the diagnosis of diphtheria was not sustained after further investigations had been carried out subsequent to their admission to hospital. The following complications were noted amongst the one hundred and three patients under treatment:— Palatal Paralysis 15 Ciliary Paralysis 4 Multiple Neuritis 10 Pharyngeal Paralysis 2 Paralysis of External Rectus 2 Otitis Media 3 Adenitis 1 Nephritis 1 Secondary Tonsillitis 3 Bronchitis 1 61 Seven patients were admitted with respiratory obstruction. In five of these cases the obstruction proved to be due to laryngeal diphtheria and tracheotomy was performed in two instances. The patients who underwent tracheotomy both made good recoveries. One case of non-diphtheritic obstruction was found to be due to a retropharyngeal abscess. The second case was due to a septic throat complicated by pleurisy. In all, five deaths from diphtheria occurred amongst the one hundred and three cases admitted to hospital. This gives a fatality rate of 6.1 per Cert. for the eighty-one cases of clinical diphtheria under treatment. This figure is considerably above the fatality rate of 2.1 per Cert. for the previous year. Only one of the fatal cases was a Wimbledon patient, the remaining four having been admitted from outside the Borough. Three negative swabs were obtained from the nose and throat of all cases prior to discharge. Five patients, however, gave persistent positive swabs from the throat. Animal inoculation tests proved that the organisms present in these cases were virulent. These patients were operated on for the removal of their tonsils by the Ear, Nose and Throat Surgeon attached to the hospital, and were ultimately discharged after the usual negative swabs had been obtained. Three of these "carriers" were adults, two of them being over fifty years of age. A number of other patients were temporary "carriers" and this necessitated a longer stay in hospital than is usually the case before they eould be pronounced cured. No "return" cases of diphtheria were reported during the year. Enteric Fever.—Two patients were admitted to hospital as cases of enteric fever. In neither case, however, was the diagnosis confirmed on further investigation. One of the patients was found to be suffering from pleurisy. Both patients made good recoveries. Meningitis.—Two patients were admitted as cases of cerebro-spinal meningitis. In one case the patient was found to be suffering from whooping cough, and not meningitis. In the second case the disease was due to meningococcal meningitis. Both patients made good recoveries. 62 Measles.—Twenty-one patients were admitted to the Isolation Hospital during the year as cases of measles. Measles was epidemic in Wimbledon at the time and arrangements were made to provide beds for such cases as could not be adequately nursed at home. One patient suffering from measles was admitted with her baby from a Maternity Hospital on the day of her confinement. She made an uninterrupted recovery. After ten days the baby showed all the signs of developing measles and was given an injection of convalescent serum obtained from the mother. The symptoms rapidly subsided and the child became quite well within forty-eight hours. One patient was admitted suffering from encephalitis following measles. This boy made a good recovery. Another patient was found on admission to be suffering from German measles. The following complications were noted amongst the cases of measles under treatment:— Laryngitis 1 Broncho-pneumonia 1 Bronchitis 4 Pulmonary Collapse 2 Otorrhcea 3 Mastoiditis 1 Adenitis 2 Gluteal Abscess 1 The case of mastoiditis subsided without operation. One death occurred, due to broncho-pneumonia. This gives a fatality rate of 5 per Cert. for the cases of measles under treatment. Puerperal Fever and Puerperal Pyrexia.—Three patients were admitted to the hospital as cases of puerperal sepsis, and one as puerperal pyrexia. The patient with puerperal pyrexia was found to be suffering from mitral stenosis complicated by a severe microcytic anaemia. She also had a mild form of puerperal sepsis. Another patient had a severe attack of acute mastitis, which required surgical interference. In every case the baby was admitted to hospital with the mother. These patients all made good recoveries. 63 Other Diseases.—One child suffering from whooping cough was transferred to the Isolation Hospital at the request of one of the large children's hospitals in London. Another patient, suffering from mumps, was found to be a diphtheria carrier and was admitted into the Isolation Hospital for treatment. Fifty-four cases remained in hospital at the end of 1932. Thirty-one of these were scarlet fever cases, twenty-two diphtheria, and one whooping cough. Staff.—During the year under review one of the nurses contracted scarlet fever. Otherwise there was very little sickness of importance amongst the members of the hospital staff. I should again like to take the opportunity of thanking the matron and staff for the loyal and enthusiastic way in which they have carried out their duties. 64 MATERNITY AND CHILD WELFARE. Continued progress has been maintained in the work of this section of the Public Health Department in spite of the inevitable disturbance which resulted from a quite unusual incidence of sickness amongst the health visiting staff. The total number of visits paid by the Health Visitors during 1932 amounted to 5,603, the figure for the previous year being 6,259. The attendance of the children at the Centres has continued to be most satisfactory. At the Pelham Centre the average attendance per season was 77.56 as compared with 69 in 1931 and 64 in 1930. The average attendance per session at the Wandle Park Centre was 46.91, comparing very favourably with the figures of 42 in 1931 and 40 in 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 eight. The figure for the previous year was nine. Steady attendance has been maintained at the classes for mothers, which are held at both of the Centres. Home nursing, mothcrcraft, hygiene, and singing, are taught. The average attendance of mothers at the Pelham Centre was 24.16 and at the Wandle Park Centre 29.34. Ophthalmic Treatment.—Eight new cases from the Maternity and Child Welfare Centres were seen by the Ophthalmic Surgeon at the refraction clinic during the year. In addition to this, seven children who were already wearing glasses, were re-tested. Spectacles were prescribed for four children. Treatment of Minor Ailments.—Two hundred and nineteen children below school age attended the Health Centre for treatment. Fifty-two of these were new cases attending for the first time during the year and one hundred and sixtyseven were re-attendances. Treatment of Tonsils and Adenoids.—Arrangements were made for the operative treatment of tonsils and adenoids in two cases under Council's scheme. Orthopaedic Treatment.—The scheme of the Wimbledon Borough Council for orthopedic treatment, which came into 65 operation in July, 1931, provides for the treatment of schoolchildren as well as for children below school age. The Surgeon visited the Orthopedic Clinic at the Health Centre once every month. The Orthopædic Nurse, who supervises the remedial exercises and massage, attends two sessions each week, except during the school holidays when the Orthopaedic Clinic is closed. The following table indicates the work carried out under the Maternity and Child Welfare section of the scheme:— No. of Children under 5 Years of Age 1931 1932 Examined by the Surgeon New Cases 3 9 Old Cases ... 12 Referred to Pyrford for treatment 1 1 Referred to St. Thomas's Hospital for X-ray Examination ... 1 For whom Surgical Appliances or Special Boots were ordered 1 6 Referred for Remedial Exercises at the Health Centre 1 1 No. of Attendances made for Remedial Exercises 8 9 Ophthalmia Neonatorum.—The following table shows the number of cases of ophthalmia neonatorum notified and the final results of treatment. These cases were mild and no impairment of vision resulted. Home nursing was provided in four cases through the Wimbledon District Nursing Association:— CASE6. Notified. Treated. At Home. Hospital. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. 7 6 1 7 ... ... ... The infant who was treated in hospital was suffering from a very mild attack of ophthalmia. This child was sent into hospital with its mother on account of the latter having been notified as a case of puerperal pyrexia whilst an inmate of a maternity home in the Borough. Children Act, 1908 (Part 1).—The following figures relate to the administration of the above Act in Wimbledon during 1932:— (i) Number of foster parents on the Register— (a) At the beginning of the year 28 (b) At the end of the year 25 66 (ii) Number of children on the Register— (a) At the beginning of the year 34 (b) At the end of the year 31 (e) Who died during the year Nil (d) On whom inquests were held during the year Nil Every foster child was visited regularly throughout the year and if the conditions were not satisfactory, more frequent visits were paid. In all, one hundred and seventyeight 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. The standard of care devoted to the foster-children in Wimbledon was found to be very satisfactory. In a few cases it was necessary to insist on a suitable and proper cot being supplied for a child. These requirements were promptly complied with. Where a foster-child was found not to be making satisfactory progress the foster mother was informed that it was necessary for her either to obtain private medical attention or to take the child to the Health Centre. One foster-child who became seriously ill was transferred by its mother, at the request of the foster-mother, to a general hospital where it ultimately died. This child had received every attention and care before admission to hospital and all the requirements of the Children Act had been fully complied with. The Children and Young Persons Act, 1932, which comes into operation on 1st January, 1933, considerably amends the Children Act, 1908. One of the most important alterations is the raising of the age of the foster-child from seven to nine years. Furthermore, the Authority now has to receive seven days' notice before a woman undertakes the care of a foster-child for the first time. This is a valuable amendment of the existing regulations, as it allows time for full inquiry and investigation of the home circumstances of the foster-mother by the Infant Protection Visitor before the foster-child is received. Notice of these alterations was given to the general public in December by means of advertisements published in the local press, and by posters which were exhibited in various parts of the town. In no case was it necessary for an order to be obtained from a Justice under Section 5 (1) with a view to the removal of a child from the home of a foster-mother. 67 Neither was it necessary to take any legal proceedings under the Act. Maternal Mortality.—There was one maternal death amongst Wimbledon mothers in 1932. The cause of death in this case was puerperal sepsis. This patient died in one of the large London hospitals where all modern facilities for treatment were available. During the previous year there were five maternal deaths, none of which was due to puerperal sepsis. The following table gives the maternal mortality rates for Wimbledon and also for England and Wales:— 1932 Puerperal Sepsis Others Total Wimbledon: Per 1000 Live Births 1.49 0.00 1.49 Per 1000 Total Births 1.47 0.00 1.47 England and Wales: Per 1000 Live Births 1.61 2.63 4.24 Per 1030 Total Births 1.54 2.52 4.06 Ante-natal care is a most important factor in the reduction of maternal mortality. There are now two antenatal clinics immediately available for expectant mothers in Wimbledon. One is the ante-natal clinic of the Corporation which is held every fortnight at Wandle Park House. This is conducted by the lady Assistant Medical Officer. The other ante-natal clinic is run in conjunction with the new maternity block at the Nelson Hospital. Hospital Treatment for Complicated Obstetric Cases.—In July, 1932, the Council made arrangements with the Maternity Department of the Nelson Hospital for the treatment of complicated obstetric cases occurring in the Borough. The services of a consultant obstetrician are available together with facilities for any operative treatment that may be found necessary. Patients admitted to hospital under this scheme are required to contribute towards the cost of their maintenance, whilst undergoing treatment, in accordance with a scale which has been adopted by the Council. 68 The medical practitioners in the area were notified of these facilities. Up to the end of December, 1932, however, only one patient had received treatment under this scheme. These arrangements should ultimately prove to be an important factor in reducing the number of maternal deaths occurring among Wimbledon mothers. Home Visitation.—The record of home visitation work carried out by the Health Visitors during 1932 is as follows: Number of births notified 645 „ „ „ registered 600 „ „ „ visited 562 „ „ „ re-visited—under 1 yr 811 —over 1 yr 1,172 „ „ visits to Ophthalmia cases 24 „ „ expectant mothers visited 107 „ „ re-visits to expectant mothers 58 „ „ ineffectual visits 1,108 „ „ special visits 908 Total welfare visits 4,750 „ „ school visits (half-day) 215 „ „ visits to parents of school children 372 „ „ Tuberculosis visits 84 „ „ Puerperal Fever visits 4 „ „ visits re Children Act, 1908 178 853 Total of all visits ... 5,603 Centres.—The work carried out at the Centres during 1932 is indicated in the following table 09 Month PELLHAM ROAD WANDLE PARK Infant Welfare Consultations Classes for Mothers Infant Welfare Consultations Ante-Natal Clinic Classes for Mothers No. of Sessions Children under 1 Year Children from 1-5 Years Total Average Attendance No. of New Cases No. of Sessions Attendance Average Attendance No. of Sessions Children under 1 Year Children from 1-5 Years Total Average Attendance No. of New Cases No. of Sessions Attendance Average Attendance No. of Sessions Attendance Average Attendance January 5 263 81 344 68.80 28 4 103 25.75 4 112 50 162 40.50 9 2 16 8.0 4 98 24.50 February 4 191 64 255 63.75 18 4 98 24.50 4 91 35 126 31.50 10 2 19 9.5 4 106 26.50 March 3 177 44 221 73.66 14 3 55 18.33 4 129 26 155 38.75 19 2 17 8.5 4 114 28.50 April 5 319 72 391 78.20 35 4 48 12.00 4 162 45 207 51.75 12 2 12 6.0 4 114 28.50 May 4 220 45 265 66.25 14 4 55 13.50 4 144 24 168 42.00 9 2 8 4.0 4 124 31.00 June 4 263 64 327 81.75 27 4 124 31.00 5 190 42 232 46.40 20 2 20 10.0 5 168 33.60 July 5 851 81 432 86.40 29 2 35 17.50 4 155 45 200 50.00 17 1 7 7.0 2 42 21.00 August 3 239 34 273 91.00 23 2 33 16.50 4 199 52 251 62.75 27 2 12 6.0 1 16 16.00 September 5 367 86 453 90.60 23 4 132 33.00 4 189 48 237 59.25 8 2 15 7.5 5 162 32.40 October 4 275 52 327 81.75 18 4 112 28.00 4 181 35 216 54.00 14 2 24 12.0 4 152 38.00 November 4 266 68 334 83.50 21 5 150 30.00 5 199 21 220 44.00 17 2 23 11.5 4 118 29.50 December 4 222 34 256 64.00 19 3 94 31.33 3 114 11 125 41.66 4 2 12 6.0 2 48 24.00 Totals 50 3153 725 3878 77.56 269 43 1039 24.16 49 1865 434 2299 46.91 166 23 185 8.0 43 1262 29.34 70 Supply of Milk to Expectant and Nursing' Mothers and Infants.—During the year six hundred and fifty-seven applications for free milk supplies under the Maternity and Child Welfare Scheme were received from one hundred and fortythree families, compared with one hundred and eighty-six applications from seventy families in the preceding year. Six hundred and thirty-six of the applications were granted, an increase of four hundred and fifty-eight on the figure for 1931. The unemployment resulting from the prolonged industrial depression is principally responsible for the much higher number of applications dealt with. The milk is granted on medical grounds and the circumstances of each case are carefully considered by the SubCommittee dealing with this question. A close co-operation is maintained between the Sub-Committee and the Public Assistance Committee in dealing with applicants who are already in receipt of Public Assistance Benefit. 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. Fifty-four mothers and ninety-four children under school age attended for treatment. One hundred and twelve general anaesthetics and forty-nine 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 1932. 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, but there are indications that the necessity for this is becoming more generally realised. 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, 1932:— Mothers—attendances for treatment 210 „ teeth extracted 190 „ „ filled 32 71 „ scalings 27 „ other operations 52 „ dentures supplied 9 „ other Prosthetic operations 51 Children—attendances for treatment 173 „ teeth extracted 156 „ „ filled 7 „ other operations 46 Total number of fillings inserted 51 „ „ „ local anaesthetics administered 39 „ „ „ general do. do. 112 Voluntary Helpers.—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. Municipal Day Nursery.—The work at the Day Nursery at Hubert Road during 1932, continued to be most satisfactory. The total attendances made by children amounted to 9,015 whole days. The average daily attendance was fortyone. These children came from one hundred and fifteen families, one family sending four children, three families three children, nineteen families two children, and the remainder one child each. The number of children on the register on 31st December, 1932, was sixty. The Nursery has accommodation for fifty children— twenty infants and thirty 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. 72 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 1932, 853 "weighings" were carried out. The children respond well to the nursery life and show a satisfactory gain in weight. A charge of 6d. per day is made for each child attending the Nursery. No children residing outside the Borough are admitted. The revenue from this source amounted to £219 3s. 0d. during 1932. 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. The children at the Day Nursery were medically inspected five times during the year. During these inspections suitable advice was given with regard to their diets and where defects were discovered the parents were notified accordingly. Children suffering from minor ailments were referred to the Health Centre for treatment. Two children suffering from squint, and one child with congenital nystagmus were referred to the Oculist. Suitable glasses were prescribed for two of these children. It was not found necessary to refer any case to the Orthopædic Clinic, neither was there any child who was considered to be in need of operative treatment for tonsils and adenoids. In addition to the above routine inspections, any child whose condition was not considered satisfactory was brought to the attention of the medical staff during the frequent periodical visits which were paid to the Nursery. All the toddlers were inspected by the Dental Surgeon in January and June. The condition of the teeth of the older children continued to be remarkably good. Over fifty per cent. of them were found to be entirely free from dental caries. In all, four children were found to require dental treatment and this was carried out at the Health Centre. In no case was treatment refused. Any child who, on admission to the Nursery, was found to be suffering from any suspicious illness, was immediately placed in the isolation room and all precautions were taken until it had been medically examined. This room is now fully 73 equipped, a new "Auto-lock" Safety Cot and white enamelled locker having been obtained. During May, six cases of measles occurred amongst toddlers attending the Nursery. No case occurred amongst the infants. It was considered advisable to close the Nursery for a period of two weeks. The necessary fumigation and cleaning were carried out and no further case occurred. Three of the six children suffering from measles were treated at the Isolation Hospital where they all made good recoveries. Apart from this, the children at the Nursery remained remarkably free from infectious diseases and the health of the children and staff continued to be 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. 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. Progress was made in carrying out the programme of re-decoration of the interior of the nursery. Additional equipment was procured for the infants' and toddlers' rooms. 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. 74 75 TABLE 1.—Vital Statistics of Whole District during 1932 and Previous Years. YEAR. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. transferable Deaths Net Deaths Belonging to the District. Uncorrected Number. Net. Under 1 year of Age At all Ages. Number. Rate. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Net Births. Number. Rate. 1921 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 60 636 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 1932 59,440 519 667 11.2 506 8.5 68 275 45 67 713 11.9 76 TABLE II—Causes of, and Ages at, Deaths during the year 1932. CAUSES OF DEATH. ALL AGES Net Deaths at the subjoined ages of " Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' or 'NonResidents in Institution in the District. 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. All Causes Certified 712 45 7 5 1 ... 6 2 10 38 53 174 371 92 Uncertified 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1. Typhoid and Paratyphoid Fevers 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2. Measles 4 1 1 ... 1 ... 1 ... ... ... ... ... ... 1 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria 1 ... ... ... ... ... ... ... ... ... 1 ... ... 5 6. Influenza 20 1 ... ... ... ... ... ... ... 3 1 4 11 ... 7. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system 41 ... ... ... ... ... ... ... 2 12 10 12 5 ... 10. Other Tuberculous diseases 7 1 ... ... ... ... 1 ... 1 3 ... 1 ... ... 11. Syphilis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 12. General paralysis of the insane, tabes dorsalis 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 13. Cancer, malignant disease 104 ... ... ... ... ... ... ... ... 1 10 37 56 6 14. Diabetes 11 ... ... ... ... ... ... ... ... ... ... 6 5 ... 15. Cerebral Hæmorrhage 3G ... ... ... ... ... ... ... ... ... ... 9 27 12 16. Heart Disease 148 ... ... ... ... ... ... 1 ... 3 4 31 108 20 17. Aneurysm 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 18. Other Circulatory Diseases 34 ••• ••• ... ... ... ... ... ... ... 2 4 28 5 19. Bronchitis 28 3 ... ... ... ... ... ... ... ... 1 4 20 4 20. Pneumonia (all forms) 49 4 2 4 ... ... 1 ... 1 2 5 15 15 1 77 TABLE 11.—continued CAUSES OF DEATH. All, Ages Net Deaths at the subjoined ages of " Residents " whether occurring within or without the District. Total Deaths Whether Of 'Residents' Or 'Non. Residents' in Institu- District. Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—16 15—20 20—35 35—45 45—65 6". and over. 21. Other Respiratory Diseases 11 1 ... ... ... ... ... ... ... ... ... 3 7 1 22. Peptic Ulcer 7 ... ... ... ... ... ... ... ... ... 1 2 4 2 23. Diarrhoea, etc. (under 2 years) 4 4 ... ... ... ... ... ... ... ... ... ... ... 5 24. Appendicitis 12 ... ... ... ... ... ... ... ... 1 2 5 3 7 25. Cirrhosis of Liver 9 ... ... ... ... ... ... ... ... 1 1 5 2 1 26. Other Diseases of Liver, etc. 3 ... ... ... ... ... ... ... ... ... 1 ... 2 1 27. Other Digestive Diseases 17 2 ... ... ... ... 1 ... 1 ... 2 3 7 2 28. Acute and Chronic Nephritis 10 ... ... ... ... ... ... ... ... ... ... 2 8 2 29. Puerperal Sepsis 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 30. Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, Premature Birth, Malformations, etc. 26 26 ... ... ... ... ... ... ... ... ... ... ... 3 32. Senility 26 ... ... ... ... ... ... ... ... ... ... ... 26 3 33. Suicide 9 ... ... ... ... ... ... ... ... 1 3 5 ... ... 34. Other Violence 23 ... ... ... ... ... 1 ... 1 6 ... 4 11 5 35. Other Defined Diseases 67 2 4 ... ... ... 1 ... 3 5 8 21 23 6 36. Causes Ill-defined or unknown 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... Totals 713 45 7 5 1 ... 6 2 10 39 53 174 371 92 Special Causes (included in No. 35 above). Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... STAFF (a) Whole-time Officer: 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 Dentel Surgeon: * A. MacGregor Whvte, L.D.S., R.F.P.S.G. School and Treatment Clinic Nurse: (a), (c), (f). Miss A. M. L. Holman. Health Visitor—School Nurses: * (b), (d), (f). Miss M. Giles. * (a), (b), (f). Miss E. M. Skelton. * (a), (b), (c). Miss G. Hyde (resigned 30th Sept., 1932). * (a), (b), (c), (d), (e). Miss H. A. Blackburx (appointed 1st Oct., 1932). Dental Attendant: Miss K. O'Hara. Clerk: Miss C. Coysh. (b) Part-time Officers: Orthopœdic 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 Visitors Certificate R.S.I. (f) Health Visitors Certificate R.S.I. 78 Borough of Wimbledom. Education Committee. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1932 To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Annual Report for the year 1932 on the work of the School Medical Department. There are ten public elementary schools, with nineteen 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, 1932, was 5,191, and the average attendance 4,585, thus making an average attendance of 88 per cent. The Special School at Queen's Road has accommodation for fifty 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. 79 The School Medical Service with its Ophthalmic and Dental branches, and the Maternity and Child Welfare Department are centralised in the Health Centre at Pelham Road. This promotes a very complete co-ordination of the services. (ft) 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. The School Medical Service in Relation to Public Elementary Schools. 3. SCHOOL HYGIENE. The sanitary condition of the Public Elementary Schools in Wimbledon continues to be satisfactory. Seven new dual locker desks and fourteen chairs of a modern type were provided during the year in order to complete the full number at the Boys' Central School. External painting was carried out at the Health Centre in Pelham Road. A considerable amount of internal decoration was also done. The greater part of the interior of the Health Centre has now been painted with washable paint. The equipment for the Orthopædic Room was also completed during the year. The wall bars were fixed, a suitable mirror installed, and one large high plinth, three small plinths and a strip of "Sorbo" rubber flooring provided. Re-decoration was also carried out in the Caretaker's Rooms on the first floor. 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. 80 (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 1932:— Entrants 578 Intermediates 623 Leavers 447 Total 1648 In addition there were sixty-five other routine inspections in the schools, making a total of 1,713. Apart from these routine inspections there were 2,588 special inspections and 6,326 re-inspections carried out at the Health Centre. The total number of routine and non-routine medical inspections during the year amounted to 4,301. The number of children examined at the routine inspections in, the schools shows a decrease of 192 as compared with the figure for the previous year. The decrease is accounted for by the fact that there were 153 fewer entrants for inspection and 57 fewer intermediates. The continually declining birth rate is responsible for the drop in these figures. On the other hand the number of leavers examined in 1932 was sixty-four more than during the previous year. The number of special inspections and re-inspections at the Health Centre shows a decrease of 1,863. This has been the result of fewer school-children attending the Health Centre for medical examination during the morning sessions. A larger number of children are now referred to their private doctors for treatment. Consequently the numbers have been more manageable. (b) The Board's Schedule of Medical Inspection has been adhered to in every respect. (c) Medical inspection causes a certain amount of disturbance, especially in the older type of schools. In nine departments the inspection is carried out in the Head Teachers' rooms. In the older schools a classroom is utilised for this purpose. Owing to the fact that no classroom is available at Haydous Road Girls' School, nor at Haydons Road Infants' School, the medical inspection of these scholars was carried out as in previous years at the Church Institute which is situated quite near. The accommodation here for the purposes of medical inspection is 81 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 IIB gives the number of individual children found at the routine medical inspection to require treatment, excluding uncleanliness, and dental diseases. 1,713 children were examined at the routine medical inspection. 311 or 18.1% were found to be suffering from defects (excluding uncleanliness and dental diseases) requiring treatment. The percentage of defects was found to be slightly higher amongst the "intermediates" than amongst the "entrants" and "leavers." During 1931 the percentage of children with defects found at the routine medical inspections throughout the country was 20.0. Among the 2,588 children specially examined there were found 1,394 defects requiring treatment and 317 requiring to be kept under observation. (a) Uncleanliness. Eight or 0.46% of the children examined at the routine medical inspection were found to be unclean and excluded from school. In addition one was found to require further observation in school on account of this condition, and was kept under supervision. During the year 1931, fourteen children or 0.7% 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 11.886. This means that nearly every child was inspected for uncleanliness three times during the year. On an average, the nurses paid seven 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. 82 Fifty-eight children were cleansed at the Health Centre in accordance with the arrangements made by the Education Committee. This figure is considerably less than that for the previous year. The total number of unclean children found by the nurse6 during their systematic inspections of the schools during 1932 amounted to 180. During 1931 the number was 205. 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 case were legal proceedings necessary. (b) Minor Ailments. The miner ailments found at the routine and non-routine inspections are indicated in Table II. Ringworm of the head and body, scabies, impetigo, other skin diseases, minor injuries, diseases of the ears and eyes (including otorrhœa and blepharitis) together with miscellaneous conditions such as sores and chilblains were the common ailments detected. (c) Tonsils and Adenoids. At the routine medical inspection there were thirty-four cases of enlarged tonsils, one case of adenoids, and thirty-three cases of adenoids with enlarged tonsils requiring treatment. Thus out of 1,713 children examined in the routine way, sixty-eight or approximately 3.9% were found to need operation. In addition, there were 130 children or 7.5% with enlarged tonsils or with adenoids and enlarged tonsils requiring to be kept under observation but not requiring treatment. At the Health Centre seventy-three other cases were found on special examination to require operation for this condition. The percentage figure for those requiring treatment is lower than that for the preceding year. There are fewer cases recommended for the removal of tonsils and adenoids now than formerly. (d) Tuberculosis. One suspected case of pulmonary tuberculosis requiring treatment was discovered at the routine medical inspection. Suspected cases are referred to the Tuberculosis Physician between whom and the School Medical Staff a close co-operation exists. (e) Skin Disease. Of the children examined as routine cases in the schools, 0.75% were found to be suffering from skin diseases. One was suffering from impetigo and eleven from other minor skin ailments. 243 or 9.4% of the special eases examined at the Health Centre were discovered to be suffering from diseases of the skin. 83 A great number of these cases were sent up by the teachers and attendance officers. There were four cases of ringworm of the scalp and thirty-four cases of ringworm of the body. Nineteen of the cases were due to scabies, sixty-two to impetigo, and 126 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 nine cases of external eye disease amongst the 1,713 routine children examined. This gives a percentage of 0.5%. Seven of the cases were due to blepharitis and some of these were very mild. In addition, there were two cases of conjunctivitis. No cases of keratitis were discovered. At the Special Inspection there were fifty-seven cases or 3.3% due to externa] eye disease. Thirty-two were due to blepharitis, and twenty-five 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 fifty-nine children were found to be suffering from defective vision requiring treatment, and twelve to be, suffering from squint. This makes a total of seventy-one cases requiring treatment or 4.1% of the children examined. The figure for the previous year was 4.4%. The actual incidence of defective vision requiring treatment is, however, higher than 4.1%. Of the 1,713 children examined as routine cases 578 were entrants and in the majority of these it was impossible to carry out subjective visual tests on account of their age. In addition, sixty-two 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 thirty with defective vision and eight with squint requiring treatment, and eleven 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. 84 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 I would again stress the necessity of all children's books and papers having a large, clear, type. There is considerable danger of short sight developing when children convalescing after illness are permitted to read in bed, especially by artificial light. (h) Defective Hearing. At the routine inspection four children were found to be suffering from defective hearing, and eleven from otitis media, all requiring treatment. There were also seven 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, eight children with defective hearing, fifty-three with otitis media, and forty-two 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 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, occuring 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 143 children were found to have defective teeth requiring treatment, and 96 to have defective teeth requiring to be kept under observation. Thus out of a total of 1,713 children examined in school, 239 or 13.9% were found to have dental caries 85 to such an extent as to require treatment or to require their being kept under observation. During the year 1931 the percentage was 19.8. This figure has shown a gratifying and continuous fall from 22.0% in 1930. Amongst the 2,588 children who attended the Health Centre as special cases, twenty-two were found to he suffering from dental defects which required treatment. (j) Crippling Defects. Four cases of spinal curvature requiring treatment were found at the routine inspections. There was no case of deformity due to rickets requiring treatment, but three slight cases requiring to be kept under observation. In addition, there were a number of cases of mild deformity due to round shoulders, that foot, etc. Twenty-three of these required treatment and four required to be kept under observation in school. At the special inspections at the Health Centre there were fourteen cases of spinal curvature and one case of rickets requiring treatment. (k) Malnutrition. Malnutrition is not common amongst school children in Wimbledon. 1,713 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 approximately 4.1 per 1,000 as compared with 3.6 per 1,000 for the previous year. There has been a tendency for this figure to show a slight increase during the past three years. In 1930 the incidence of malnutrition amongst school children was 3 per 1,000 of those examined in the routine way. It is impossible to draw 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 1931 amounted to 11.2 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 1932 had any obvious effect on the nutrition of the school children in the Borough. At the special examinations at the Health Centre, fourteen children were found to be suffering from malnutrition requiring treatment. 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:— 86 (a) Exclusion of children actually suffering from infectious diseases, or coming from infected houses. The Memorandum of the Ministry of Health and 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 arc 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 1032 it was not found necessary to close any of the schools in the district for this purpose. When the attendance falls below 60%, certificates max be supplied by the School Medical Officer to that effect as outlined in Para. 15 (ii) of Administrative Memorandum No. 51, 1927. No certificates in accordance with this Rule were required to be issued during the year under review. (c) The routine disinfection of each school was carried out by the Public Health Department during the mid-summer holiday. Disinfection of classrooms was also carried out periodically as the necessity arose. (d) Valuable information is obtained from the weekly returns of absences due to infectious diseases furnished by the Head Tcachers. The numbers of cases of non-notifiable diseases reported from the schools during 1932 were as follows:— Measles 331 German Measles 1 Whooping Cough 13 Mumps 8 Chicken Pox 45 Measles was prevalent in epidemic form during the months of March, April, and May. 87 The schools most severely affected were Wimbledon Park, Effra Road, Cottenham Park, Old Central, Pelham Road and Haydons Road. The attendances in the Infants' Departments suffered severely. The previous epidemic year for measles was 1930, when 423 children were notified as being absent on account of this disease. Very few cases occurred among school children in Wimbledon during the year 1931, only seven cases being notified to the Public Health Department by the Head Teachers. On the other hand, there was a great fall in the number of children suffering from whooping cough in 1932. The number of cases notified by the Head Teachers was thirteen as compared with eighty during the previous year. Cases of German measles and mumps were few in number. Forty-five children were notified as being absent from school on account of chicken-pox. In some of the older children, the chicken-pox was of rather unusual severity. No case of smallpox occurred amongst school children in Wimbledon during 1932. Two school children were contacts of a case of smallpox and they were kept under daily observation until the period of quarantine had expired. Frequent 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 the class 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 20(b) of the Education Code, 121 children were excluded from school during 1932 for the following conditions:— Conjunctivitis 9 Impetigo 11 Ringworm of Head 4 Ringworm of Body 9 Scabies 19 Other contagious or infectious conditions 69 Total 121 7. FOLLOWING UP. The procedure of following up defects discovered during the routine medical inspection in 1932 was as follows:— 88 Parents were informed of the defects detected in their children during the medical inspection in the schools. Where the defect was of a minor nature they were informed verbally. In the case of more important defects the parents received a printed notice advising them of the nature of 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. I he 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 been discontinued. 8. MEDICAL TREATMENT. Table IV gives a return of the defects treated during the year under arrangements which have been provided by thw Education Committee. (a). Minor Ailments. The Health Centre at Pelham Eoad 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 Seventy-eight children were operated on for enlarged tonsils and adenoids during 1932 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, seventeen other children were operated on for enlarged tonsils and adenoids by private practitioners or at the voluntary hospitals. This makes a total of ninety-five children who received surgical treatment. It will thus be seen that thirty-five fewer children were submitted to operation for the removal of tonsils and adenoids during 1932 as compared with the previous year. Full details are outlined in Table IV., Group 111. 89 (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. Three school children, all boys, were undergoing treatment at sanatoria or sanatorium schools in 1932. One was a case of active pulmonary tuberculosis, another a case of tuberculous peripheral glands, whilst the third child was suffering from tuberculosis of bones and joints. (d) Skin Diseases. Four 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. Thiry-two children with ringworm of the body, nineteen with scabies, sixty-two with impetigo, and 126 children suffering from other skill diseases were treated at the Minor Ailment Clinic at the Health Centre. (c) External Eye Diseases. One hundred and twenty-five children with external eye diseases received treatment at the Health Centre. The more serious cases were referred to the Ophthalmic Surgeon who has been appointed as Oculist to 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. Three children suffering from diseases of the eye were sent to hospital for treatment. The Education Committee have an arrangement with the Nelson Hospital whereby school children suffering from eye disease are admitted for in-patient treatment at a cost of three shillings per day. One of these three children received treatment under this scheme at a cost of £1 10s. Od. to the Education Committee. This boy had undergone an operation some years ago for the removal of one eye, and required further operative treatment in order to allow of his wearing an artificial eye. (f) Vision. Details of the work of the Refraction Clinic are given in Table IV, Group II. 90 This clinic is held every Monday afternoon from 2 to 4.30. Occasionally during the year it was necessary to hold further sessions on Thursday afternoons. The Refraction Clinic continued to be well attended and the table given hereunder shows the number of children who received treatment. New cases (examined for the first time) 114 Old cases (re-examinations) 186 lie-attendances 326 Total 626 Glasses were prescribed in ninety-four cases, and the following figures indicate the errors of refraction found. Hypermetropia 13 Myopia 28 Myopic and Hypermetropic Astigmatism 53 Of the twenty-eight cases of myopia examined, ten were found to have a refractive error greater than minus four dioptres. Where necessary, instructions were sent to the Head Teachers of the schools which the children attended, modifying the curriculum with a view to preventing the short sight from becoming more marked. Similar advice was also given to the parents. The children suffering from myopia are re-examined at the clinic twice a year. Children suffering from other types of defective vision are re-tested at the end of twelve months. In all cases the children are seen by the Oculist after the glasses have been obtained. In several instances difficulty was experienced in persuading parents to provide spectacles for their children. The assistance of the N.S.P.C.C. was of the greatest help in dealing with these parents, and in every case spectacles were ultimately obtained. Seven children were referred from the Refraction Clinic to hospital for further treatment. These children were found to be suffering from the following defects:— Nystagmus 2 Keratitis 1 Cataract 1 Other Defects 3 (g) Ear Diseases. One hundred and three 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 91 that children with running ears should receive regular treatment. Here again it is often difficult for parents to carry this out 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 w as extended so as to include all children attending school. 5,139 children were dentally inspected in the routine age groups in school. A further 133 children were inspected as special cases. The total number of children thus examined amounted to 5,272. This represents an increase of 286 over the figure for 1931. 3,996 or 75.8% were found to require treatment and their parents notified accordingly. During the previous year the figure was 77.9%. The number of children actually treated was 1,918 or 48% 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 continue to show a good average attendance. Forty-four half days were devoted to dental inspection in the schools and 376 half days to treatment at the Health Centre. The number of attendances made by children for treatment amounted to 4,111. This is 259 more than the figure for the previous year. The average number of children attending for treatment per session was 10.9, a slight increase over the figure for 1931. The total number of fillings amounted to 2,300, or 232 less than during the previous year. The number of teeth extracted shows an increase of 107, the total figure for the year being 3.360. 707 general anæsthetics were administered for dental extractions. The work of the Dental Clinic has shown a progressive increase during the, past four years. All the children attending school are now dentally inspected annually. The average attendance per session of children undergoing treatment has risen to 10.9. This is a satisfactory figure and it is gratifying to note that the average number of children attending for treatment per session has been continuously increasing during the past four years. 92 In addition, much greater time is devoted to the filling of permanent teeth. As a consequence of this, the number of temporary teeth tilled has dropped from 356 in 1929 to 17 in 1932. (i) Crippling Defects and Orthopædics. The Orthopaedic Clinic, which was commenced in July, 1931, was held every month during 1932. Fifty new cases were seen and 176 cases were re-examined. The average number of children seen by the Orthopaedic Surgeon per session was twenty-two. During the previous year the figure was nineteen. The following table shows the nature of the defects from which the children were suffering. Congenital Defects 8 Infantile Paralysis 6 Hemiplegia and Diplegia 3 Old cases of Osteomyelitis 2 Old amputations of limbs 2 Trauma 3 Rickets 4 Tuberculous joints (arrested) 1 Pseudo-coxalgia 1 Flat foot, knock knee, pes cavus, etc. 15 Postural defects 46 Other defects 8 Children not suffering from orthopaedic defects 8 Total 107 The following table gives an indication of the treatment carried out through this Clinic:— Number of children referred to Pyrford for in-patient treatment 5 Number of children referred to St. Thomas's Hospital for out-patient treatment 2 Number of children referred to St. Thomas's Hospital for X rays 2 Number of children referred for alterations to surgical boots, etc. 20 Number of children referred for exercises and massage 42 Total 71 93 The five children sent in to Pyrford, under the Orthopaedic Scheme, for in-patient treatment were suffering from the following defects:— Pseudo-coxalgia (left hip) 1 Spastic Diplegia 1 Spastic Hemiplegia 1 Old Osteomyelitis (right femur) 1 Contractures of hand and ankle following burns 1 One case of infantile hemiplegia which received hospital treatment at Pyrford was ultimately sent to the Heritage Craft Schools at Chailey. The Orthopædic Nurse attended one hundred sessions in order to carry out the remedial exercises and massage. Forty-two children were referred by the Orthopæedic Surgeon for treatment of this nature. 623 attendances were made. The average number of children attending at each session for exercise and massage was just over twelve. The Orthopædic Nurse reports that most of the children appear to enjoy attending the classes for exercises and that on the whole the parents have co-operated well. When this has been the case, the progress made has been much more marked than when the parents have been unable to attend, owing to their own domestic work preventing them, or owing to lack of interest. By far the greatest number of children attending have been cases of poor posture and flat foot. The Orthopædic Clinic in Wimbledon is fulfilling a very definite need, and the work during 1932 has been most successful. I am indebted to Mr. R. W. Butler, the Orthopædic Surgeon, for the following review of the cases seen at the Health Centre. "The cases seen at the orthopaedic. Clinic in the past year fall into three main classes. Firstly, children still suffering from the effect of some past injury or ailment requiring simply to be kept under observation from time to time. Old fractures, old cases of infantile paralysis, or old congenital foot deformities, most of which simply require to be seen to ascertain that they are going on well, and that if any splint or raised shoe or other apparatus is being used such apparatus is in good trim and does not require repairing or enlarging. Secondly, children with flat feet, knock knees or bad spina) posture referred from the School Medical Officer, many of whom 94 simply require training of their muscles and the firm establishment of good habits of balance to give them a perfectly normal control. It is impossible to emphasise the value of obtaining treatment for such children early, especially those with round shoulders and slack backs. Once the faulty posture is established by a few years of growth the difficulty of obtaining improvement is enormously increased both for the child itself and those undertaking its treatment. In my opinion we are obtaining exceptionally good results with these postural deformities of the spine. The masseuse in charge of the treatment is very skilled at this type of work and in enlisting the co-operation of the parents so that the treatment may be continued at home. Thirdly, a certain number of children are seen from time to time requiring resident hospital treatment over a considerable period. Pseudocoxalgia of the hip and certain cases of old infantile paralysis requiring operation or prolonged muscle re-education can be given very adequate treatment in the open air at Pyrford. Spastic paralysis again is a condition almost impossible to treat while the child is living at home. The child is backward mentally and physically, and requires concentrated training by one who is used to dealing with such cases, and an escape from the unavoidable neglect which occurs between treatments if an attempt is made to treat the child while living in its own home." (i) Artificial Light Treatment. Fifteen children. attending the Health Centre were recommended artificial light treatment. The children selected for this treatment were suffering from malnutrition and anaemia, 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 1932 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 three years that this Clinic has been in existence the number of children in attendance has never fallen below twenty. Fresh cases have always been available to take the place of those discharged. Stammerers attend twice a week and cases of defective speech only once. The following table shows the number treated and discharged during the year:— 95 No. treated Cured Stammerers 16 4 Defective Speech 17 5 Total 33 9 The parents of the 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 eight years old. In the autumn a circular li tter 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 all vacancies were tilled and ten cases still await treatment. The work of the Speech Clinic is of the greatest importance. Treatment of this nature not only has the greatest hearing on the educational progress which the children are able to make in school, but also has a profound influence on their ultimate chance of obtaining suitable and remunerative employment. Stammering is considered a neurotic symptom, and relaxation, and the gradual building up of the child's self-confidence is the basis of treatment. Defective speech is the inability to pronounce certain sounds, and includes cases of lisping, tailing, cleft palate, and retarded speech. Here, treatment is phonetic. The formation of each sound is explained and progressive exer cises are practised, until the sound can be introduced into speech without difficulty. 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 ciromstances 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. Twenty-one 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. Sixteen boys were re-weighed after their return. Whilst a few of the boys were found to have lost weight the average gain was 1½ lbs. Besides having a very enjoyable holiday the boys improved considerably in health. Fifty-five scholars from the Central Girls' School were medically examined before leaving for a fortnight's stay at Sandown in June. 96 This visit was arranged through the School Journey Association. The curriculum of the children whilst away included geography, history, art, literature and nature study. Many educational visits were paid to places of interest in the island. Ample time was also available for physical training and sports. 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. Under this arrangement 17,688 attendances were made. 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. No meals were provided during the year for children attending the other schools. Eighteen children, however, on account of malnutrition and ansemia received half a pint of milk daily in school. In the undermentioned schools arrangements have been made through the Milk Publicity Council for children to be supplied with milk each day. Haydons Road (Girls and Infants). St. Mary's B.C. (Mixed and Infants). Dundonald Road (Boys, Girls and Infants). Old Central (Mixed and Infants). Queen's Road (Boys, Girls and Infants). Effra Road (Girls and Infants). 97 The milk is supplied in a sealed bottle containing one-third of a pint, at a cost of 1d. to the parent. The reports from the Head Teachers indicate that the children in receipt of this milk benefited considerably. It is to be hoped that this scheme will be adopted later by other public elementary schools in Wimbledon, and that more of the parents will avail themselves of the facilities offered. 12. SCHOOL BATHS. The arrangements for the bathing of the children attending the Special School are given under Section 17. 13. CO-OPERATION OF PARENTS. Parents are invited to be present at the school during the routine inspection of their children, and on the whole the response has been gratifying. Out of 1,713 children examined at the routine inspections, 1,022 or 60% were accompanied by one or other parent. This, unfortunately, shows a considerable fall (23%) in the number of parents who attended at the medical inspections as compared with the previous year. There is a great advantage in obtaining the co-operation of the parents. It 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. I have again to acknowledge the valuable assistance which the teachers have rendered 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 during the routine cleansing examinations, and when following up cases found to be defective. 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 between the School Medical Department and the School Attendance Officers. A considerable number of children were medically examined at the request of the Attendance Department on account of prolonged absence from school through ill-health. As the result of these examinations many children were returned to school considerably earlier than would otherwise have been the case. 98 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. The Local Branch of the Invalid Children's Aid Association arranged convalescent treatment for fifty-five children in 1932. Ten of these cases were referred from the School Medical Department. Unfortunately, the parents refused this help in four cases. The other children, however, were sent away for varying periods. Some of these cases had been recently discharged from hospitals where they had been undergoing treatment for pneumonia, debility, and rheumatism, etc. The other cases had been discovered at the routine or special inspections and were found to be suffering from debility and malnutrition. Education is generally provided for the children whilst they are away. Great assistance has been received from the Invalid Children's Aid Association in connection with the orthopaedic scheme of the Education Committee. In six cases they kindly arranged for the transport of patients to Pyrford by car. Four children attending the Orthopædic Clinic were also provided with boots. Special dental treatment, such as the provision of an obturator in the case of cleft palate, was obtained for two children. In another case, a boy who had had one eye removed by operation some years previously was supplied with an artificial eye through the Association. This is but a small part of the work which the Association is carrying out. The approximate number of children who were on their books, and being visited, in 1932 was 264. Surgical requirements were provided in seven cases, whilst in another eight, suitable clothing was granted. This work is of the greatest assistance to the School Medical Service, and is much 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 \ 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. 99 (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. Two partially blind boys attend the Ravenstone Myope School (L.C.C.) at Balham. 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 girl attends the Hearnville Road (Partially Deaf) School at Balham. (d) Epileptic Children. There were no school children in the area suffering from severe epilepsy requiring institutional treatment. (e) Physically Defective Children. Two physically defective boys are at the Heritage Craft Schools at Chailey. Four boys and one girl are undergoing orthopaedic treatment at the St. Nicholas' and St. Martin's Hospital and Special School, Pyrford. The girl is a school child suffering from multiple defects. (f) Delicate Children. Three children are at the following institutions:— One boy at Farningham Home for Little Boys, Swanley; one boy at St. Catherine's Home, Ventnor, and one boy at St. Patrick's Open Air School, Hayling Island. In addition, one girl with rheumatic heart disease is at the West Wickham Hospital and Home of Recovery for Children. There are also eighty-one delicate children (35 boys and 46 girls) attending schools in the Borough. A great number of these are home contacts of cases of tuberculosis. Many of them are under the observation of the Tuberculosis Officer at the Dispensary. Eighteen delicate children were specially recommended to receive free milk daily in school at the cost of the Education Committee for an average period of three months. These were principally children suffering from malnutrition, anaemia, and debility. 100 Re-examination at the end of the three months almost invariably showed a definite improvement in their condition. The rest of the children who were regarded as delicate were suffering from rheumatism and catarrhal conditions, etc. (g) Special School. The Education Committee has its own Special School, with accommodation for fifty children. This is sufficient to meet the requirements of the Borough. At the end of 1932 there were thirty-four children (fifteen boys and nineteen girls) in attendance. In addition, two boys were attending the Littleton Street Special School and one boy was at Besford Court. The total number of Wimbledon children attending such Special Schools at the end of the year amounted to thirty-seven. Four boys and six girls were admitted during 1932. One boy and four girls left the school as their parents had removed into other areas. Two boys and five girls attained the age of sixteen years and their names were removed from the register. One boy was notified (as no longer educable) to the Local Authority under the Mental Deficiency Act, 1913, as amended by the Act of 1927, and his name was removed from the register. 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 attendant is employed by the Education Committee for this purpose. A cooked mid-day meal of excellent quality is also served. On an average twenty children stayed for this meal, for which a charge of 3d. is made. In some cases the charge is reduced to 2½d. and in six cases it was found necessary occasionally to forego the amount owing to the financial circumstances of the parents. Three children also received milk in school on medical grounds. In two cases this milk was given free. 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 one of the School Medical Staff 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 Act of 1913, as amended. 101 One boy and two girls were notified for this purpose. In other cases, where the home influence is good and the prospect of employment favourable, the names are passed on to the Committee of the Guild of Social Welfare which acts in Wimbledon as the Local Oommittee of the Surrey Voluntary Association for Mental and Physical Welfare. Two boys and two girls who were not attending any school and who were unsuitable for the Special School were also notified to the Local Authority under Article 2 of the Mental Deficiency (Notification of Children) Regulations, 1928. Of the two boys who left on attaining the age of sixteen years one is being trained as a shoemaker, and the other for work in a match factory. Furthermore, one of the boys who attended the Littleton Street Special School, and who attained the age of sixteen years during 1932 has been satisfactorily employed as an. errand boy. Of the five girls who attained school-leaving age one is working at a laundry, another is engaged in domestic service, whilst a third is doing domestic work at home. The two girls who were notified as requiring supervision are at home, and it is not likely that they will obtain satisfactory employment. 18. NURSERY SCHOOLS. No Nursery Schools have been established in Wimbledon. The Municipal Day Nursery, however, has accommodation for thirty toddlers under five 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 Bye-Laws any school child over the ago of twelve years may be employed for two hours from 5 p.m. to 7 p.m. and on week days when the school is not open for five hours between 7 a.m. and 7 p.m. Certain forms of employment are prohibited. During 1932 ninety-eight employment cards were issued to school children in accordance with the above conditions. Children who are employed for not more than one 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 one hour after school and then not later than 7 p.m. 102 Forty-eight children were medically examined for employment during the year. They were all granted medical certificates of fitness for delivering newspapers and for work in connection with milk rounds. Two prosecutions were taken under the Bye-Laws for illegal employment, with the following results:— One parent—summons dismissed on payment of costs. One employer—fined 10/-. 21. SPECIAL ENQUIRIES. No special enquiries were undertaken in 1932. 22. HEALTH PROPAGANDA. During the year, 2,000 copies of "Better Health" were issued monthly in Wimbledon. 1,070 of these copies were distributed every month 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 regularly by the Public Health Department. There has been considerable sickness amongst the School Nurse-Health Visiting Staff during 1932 and the work has been carried on under difficulties. In spite of this, steady progress has been maintained. 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 staff during the year under review. I am, Your obedient servant, HAROLD ELLIS. 103 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS, 1932. TABLE 1. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections:— Entrants 578 Intermediates 628 Leavers 447 Total 1,648 Number of other Routine Inspections 65 B.—OTHER INSPECTIONS. Number of Special Inspections 2,588 Number of Re-inspections 6,826 Total 8,914 104 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER 1932. 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 - Uncleanliness 8 1 4 — Skin Ringworm— Scalp — - 4 - Body — — 32 - Scabies — — 19 - Impetigo 1 — 62 - Other Diseases (Non-Tuberculous) 11 1 126 - Eye Blepharitis 7 - 32 - Conjunctivitis 2 - 25 - Keratitis - - - - Corneal Opacities — - - - Defective Vision (excluding Squint) 59 48 30 8 Squint 12 14 8 3 Other Conditions 2 — 68 13 Ear Defective Hearing 4 7 8 - Otitis Media 11 - 53 - Other Ear Diseases — — 42 - Nose and Throat Enlarged Tonsils only 34 103 22 6 Adenoids only 1 - - 1 Enlarged Tonsils and Adenoids 33 27 51 3 Other Conditions 8 1 121 1 Enlarged Cervical Glands (Non-Tuberculous) 9 11 24 - Defective Speech 3 14 14 1 Teeth—Dental Diseases 143 96 22 — Heart and Circulation Heart Disease: Organic 4 3 1 — Functional 1 8 — 3 Anæmia - - 3 — 105 TABLE II.—continued. DEFECT OR DISEASE. Routine Inspections. Special Inspections. No of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Lungs Bronchitis 6 19 21 3 Other Non-Tuberculous Diseases 5 - — - Tuberculosis Pulmonary: Definite — - — - Suspected 1 - — - Non-Pulmonary: Glands — - — - Spine — - — - Hip — - — - Other Bones and Joints — - — - Skin .— - — - Other Forms — - — - Nervous System Epilepsy 4 - 2 - Chorea — 1 5 1 Other Conditions 1 - 1 — Deformities Rickets — 3 1 - Spinal Curvature 10 — — - Other Forms 23 4 14 - Other Defects and Diseases 52 34 565 274 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 578 101 17.5 Intermediates 623 128 20.5 Leavers 447 72 16.1 Total (Code Groups) 1648 301 18.3 Other Routine Inspections 65 10 15.4 106 TABLE III RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1932. 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 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 Elementary Schools - - - 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 2 1 3 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 - - - 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 - — — 107 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 - - - 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 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 — — — Abdominal tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools - - - At other Institutions — — — At no School or Institution 2 — 2 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 1 - 1 At Public Elementary Schools - - - At other Institutions - — — At no School or Institution — — — 108 TABLE III.—Continued. Boys. Girls. Total Mentally Defective. Feebleminded. At Certified Schools for Mentally Defective Children 18 19 37 At Public Elementary Schools 1 1 2 At other Institutions.. — — At no School or Institution - - — Notified to the Local Mental Deficiency Authority during the year Vide Form 307M 6 4 9 Epileptics Suffering from severe epilepsy At Certified Schools for Epileptics - - - 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 6 5 11 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 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 — — — 109 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 - 1 1 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 3 - 3 At Certified Day Open Air Schools - - - At Public Elementary Schools 35 46 81 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 4 - 4 At Certified Residential Cripple Schools 2 - 2 At Certified Day Cripple Schools - - - At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools 16 8 24(16) 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 - 1 1 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 1 5 6 At other Institutions - - - At no School or Institution — — — 110 TABLE IV.—Return of defects treated during the year ended 31st December 1932. TREATMENT TABLE. GROUP I.—MINOR ATLMENTS (excluding Uncleanliness, for which see Group V.). DISEASE OR DEFECT. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise. Total, (1) (2) (3) (4) Skin— Ringworm—Scalp 4 — 4 Body 32 — 32 Scabies 19 — 19 Impetigo 62 — 62 Other skin disease 126 — 126 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 125 - 125 Minor Ear Defects 103 — 103 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 506 506 Total 977 — 977 GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). DEFECT OR DISEASE. Number of Defects dealt with. Under the Authority's Scheme Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of refraction (including Squint). 283 24 - 307 Other Defects or Disease of the Eyes (excluding those recorded in Group I.) 17 — - 17 Total 300 24 — 324 Total number of children for whom spectacles were prescribed a. Under the Authority's Scheme 94 6. Otherwise 11 Total number of children who obtained or received spectacles:— a. Under the Authority's Scheme 92 b. Otherwise 11 111 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (2) (2) (4) (5) 78 17 95 125 220 GROUP IV.—DENTAL DEFECTS. 1. Number of Children who were : — a. Inspected by the Dentist. Aged Aged 5 260 10 598 Routine 6 542 11 592 Age 7 518 12 667 Total 5139 Groups 8 494 13 452 9 570 14 446 Specials 133 Grand Total 5272 Found to require Treatment 3996 c. Actually Treated 1918 d. Re-treated during the year as the result of periodical amination 1336 2. Half-days devoted to:— Inspection, 44. Treatment, 376 Total 420 3. Attendances made by Children for Treatment 4111 4. Fillings:— Permanent Teeth, 1850. Temporary Teeth, 17 Total Teeth 1867 Total Fillings 2300 5. Extractions:— Permanent Teeth, 530. Temporary Teeth, 2830 Total 3360 6 Administrations of general anaesthetics for extractions 707 7. Other Operations:— Permanent Teeth, 2710. Temporary Teeth, 308 Total 3018 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 11,886 3. Number of individual children found unclean 180 4. Number of children cleansed under arrangements made by the Local Education Authority 58 5. Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 — (b) Under School Attendance Bye-laws — 112 INDEX. Committee, Maternity and Child Welfare 1 „ Public Health 1 Medical Examinations 5 Staff, official 3, 78 Natural and Social Conditions of the Area 6-15 Area 6 Birth Rate 7 Births, Registered 7, 9 „ Notification of 10 Cancer 11, 12 Death Rate 7 Deaths 7, 10, 11 Families, number of 6 Houses, inhabited 6 Infantile Mortality 7 Mortality, anaylsis of S Mortality, Cancer 11, 12 Bronchitis and Respiratory Diseases 13 Gastric and Duodenal Ulcer 13 Heart and Circulatory Diseases 12 Infantile 7, 13, 14, 15 Penny Rate, product of 6 Population 6 Rateable Value 6 Social Conditions 6 Stillbirths 7 Vital Statistics, Extracts from 7 Ward, Birth Kates 9 General Provision of Health Services in the Area 16-23 Ambulance Facilities 17 Ante-natal Clinic 18, 70 Assistance, Public 16 Clinics and Treatment Centres 17, 18, 70 Day Nursery 18, 72, 73, 74 Dental Treatment 18, 71 Dispensary, Tuberculosis 18 Hospitals, Tuberculosis 16 Children's 16 General 17 Infectious Diseases 17 Maternity 16 Legislation in force 22, 23 Midwives' Acts 19, 20 Medical Aid 20 Mortuary 21 Mothercraft Classes 18, 70 Nursing Homes 20, 21 Inspection of 21 Nursing in the Home 19 General 19 Midwifery 19 School Clinic 18 Venereal Diseases 18 113 Sanitary Circumstances of the Area 24-38 Common Lodging House 10 Dairies, Cowsheds and Milkshops 31 Diseases of Animals Acts 34 Disinfection 31 School 32 Drainage, House 28 Drains, opening up under Section 41 28 Employment Agencies 35 Employment of Children 35 Factory and Workshop Acts 25, 26 Inspections under 32 Food and Drugs Acts 34, 44 Food Inspection 33 Foot and Mouth Disease 34 Fouling of Footways by Dogs 35 Homo Work 26 Houses let-in-lodgings 30 Infectious Disease 31 Inspection of District 24 Inspection, House to House 28 House 28, 29 Legal Proceedings 28 Mosquitoes 36 Notices served 24. 27 Nuisances Abated, Table of 36, 37 Offensive_Trades .Mi Overcrowding 29, 311 Parasitic Mange 34 Petroleum Acts 34 Public Health (Meat) Regulations 34 Refuse Collection 38 Rent (Restrictions) Acts 35 Sanitary Inspector's Report 27 Sewage Disposal 37 Shops Acts 32, 33 Slaughter Houses 33 Smallpox Contacts 36 Stable Refuse 32 Street Gully Cleansing 38 Swine Fever 34 Tuberculosis Order, 1925 34 Van Dwellings 30 Verminous Rooms 30 Water Supply 35 Workshops, Registered 26, 27 Yard Paving 32 Housing 38-42 Action under Public Health Acts 42 Housing Conditions 40, 41 Overcrowding 29, 30, 42 Statistics for the Year 38, 39, 40 Tents, Vans and Sheds 30, 42 Inspection and Supervision of Food 43, 44 Bacteriological examination 43 Food and Drugs (Adulteration) Act, 1928 44 Inspection 43 Licences issued under Milk (Special Designations) Order, 1923 43 114 Milk Supply 43 Registrations 43 Slaughter Houses 43 Prevalence of, and Control over Infectious Diseases 45-64 Cerebro-Spinal Fever 49, 62 Diarrhoea (under two years) 46 Diphtheria 48, 61, 62 Disinfection 58 Encephalitis Lethargica 50 Enteric Fever 48, 62 Erysipelas 50 Food Poisoning 49 Infectious Diseases, Incidence of 45 „ „ Non-Notifiable 45 Influenza 46 Isolation Hospital 59-64 Cases admitted, Table of 59 Staff 64 Laboratory Work 57 Malaria, Dysentery, etc. 50 Measles 45, 63 Ophthalmia Neonatorum 50, 66 Pathological examinations 57 Pneumonia 49 Puerperal Fever and Puerperal Pyrexia 49, 63 Scarlet Fever 46, 47, 60, 61 Smallpox 36, 46 Table showing number of Cases Notified during year 51 „ „ Admission to Isolation Hospital 59 „ „ Ages at Death from Notifiable Diseases 52 „ „ Cases and Deaths from Tuberculosis 56 „ „ Disinfection carried out 58 „ „ Number of Cases Notified in last ten years 54 „ „ Ward Distribution of Cases 53 „ „ Zymotic and Tuberculosis Death Rates 53 Tuberculosis 54, 55 Maternity and Child Welfare 65-74 Children Act, 1908 (Part I) 66, 67 Day Nursery 72, 73, 74 Dental Treatment 71, 72 Home Visitation 69 Maternal Mortality 68 Minor Ailments, Treatment of 65 Obstetric Cases, Treatment for Complicated 68, 69 Ophthalmic Neonatorum 66 Ophthalmic Treatment 65 Supply of Milk 71 Table of Attendances at Centres 70 Tonsils and Adenoids, Treatment of 65 Voluntary Helpers 72 Table I—Vital Statistics 75 Table II—Causes of, and Ages at Death 76-77 115 School Medical Service 78-112 Artificial Light Treatment 95 Blind, Deaf, Defective and Epileptic Children 99, 10(1 Co-operation of Parents 98 School Attendance Officers 98 Teachers 98 Voluntary Bodies 99 Co-ordination 79 Crippling Defects 86, 93, 94, 93 Defective Hearing 85, 91, 92 Defective Vision 84, 85, 90, 91 Dental Defects 85, 85, 92 Employment of Children and Young Persons 102, 103 Eye Disease, External 84, 90 Following up 88, 89 Health Propaganda 103 Infectious Disease 86, 87, 88 Malnutrition 86 Medical Inspection 80, 81 „ „ Findings of 82 Medical Treatment 89-95 Minor Ailments 83, 89 Nursery Schools 102 Open Air Education 9(i Orthopaedic Treatment 93, 94, 95 Physical Training 97 Provision of Meals 97 School Baths 98 School Hygiene 80 Secondary Schools 102 Skin Disease 83, 84, 90 Special Enquiries 103 Special School 101, 102 Speech Clinic 95, 96 Staff 78 Table I—Return of Medical Inspections 104 „ II—Return of Defects 105, 106 „ III—Return of All Exceptional Children 107, 110 „ IV—Treatment Table 111, 112 Tonsils and Adenoids 83, 89 Tuberculosis 83, 90 Uncleanliness 82, 83 116