WIM 10 Borough of Wimbledon Annual Report OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER For the Year 1937 Borough of Wimbledon. ANNUAL REPORT of the Medical Officer of Health for the Year ended 31st December, 1937 Public Health Committee Chairman: Councillor E. Fielder. Vice-Chairman: Councillor Miss D. H. Carver, Members: The MAYOR (Alderman J. S. Holland Abbott, J.P.), ex-officio. Alderman A. W. Hickmott Councillor W. B. James, J.P. Councillor P. T. Bowen. „ A. R. Kelly. „ G. D. Chambers „ W. A. Lines. (appointed 22nd ,, J. E. G. McSheehy. September, 1937). „ Lady Roney, J.P. „ A. A. Drake, J.P. „ S. B. Stone. „ G. Frost. (died 26th June, 1937). Maternity and Child Welfare Committee Chairman: Councillor Lady Roney, J.P. Vice-Chairman: Councillor T. E. Jenner. Members: The MAYOR (Alderman J. S. Holland Abbott, J.P.), ex-officio. Alderman A. W. Hickmott. Councillor A. A. Drake, J.P. Councillor F. T. Bowen. „ E. Fielder. „ Miss D. H. Carver. „ W. B. James, J.P. „ T. R. Daniel. Mrs. Chard. ,, Daniel. „ Fielder. „ Sheerman. STAFF Whole-Time: Medical Officer of Health; School Medical Officer; Medical Superintendent of the Infectious Diseases 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: J Effie M. D. Craig, M.B., Ch.B. Senior Sanitary Inspector: *R. T. Avis, M.R.San.I., M.S.I.A., (c), (e), (/). Sanitary Inspectors: *D. F. S. Flynn, (e), (/). *L. E. Trigg, M.S.I.A., (e), (/). C. J. Cattell, (e), (/), (appointed 8th February, 1937). Health Visitors—School Nurses: Miss V. B. Woodroff, (b), (c), (g). Miss A. Thompson, (a), (b), (d). Miss P. N. Nash, (a), (b), (d). Miss J. C. Moffat, (a), (b), (d), (h). Matron of Infectious Diseases Hospital: Miss L. McCrory. Matron of Day Nursery: Miss I. Cutler. Senior Clerk: A. L. Taylor. Clerks: H. R. Fry. J. E. Field. Clerk to the Maternity and Child Welfare Department: A. L. Taylor. Part-Time: Leslie H. W. Williams, F.R.C.S., F.C.O.G., Obstetric Consultant. Jocelyn A. M. Moore, F.E.C.S., M.C.O.G., Medical Officer to Ante-natal Clinic. Mary M. Tulloch, M.B., B.S., Medical Officer to Maternity and Child Welfare Centres. W. L. Galvin, M.B., B.Ch., Deputy Medical Attendant Infectious Diseases Hospital. Arthur Miller, F.R.C.S., Consulting Oto-Laryngologist to Infectious Diseases Hospital. R. J. Furlong, F.R.C.S., Orthopædic Surgeon. R. J. Cann, M.S., Surgeon to Aural Clinic. 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. S.C.M. c. Certificate Sanitary Inspectors Examination Board (London). d. New Health Visitor's Certificate, Royal Sanitary Institute. e. Certificate Royal Sanitary Institute for Inspector of Nuisances. f. Certificate Royal Sanitary Institute for Inspector of Meat & Other Foods. g. Diploma Board of Education (Health Visitors' Training) Regulations, 1919. h. Certificate of Fever Training. Borough of Wimbledon. Public Health Department ANNUAL REPORT of the Medical Officer of Health for the Year ended 31st December, 1937 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, 1937. The Report for 1937 is an ordinary Report, set out on the lines suggested in Circular 1650 of the Ministry of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres—Census, 1931) 3,221 Population (Census, 1931) 59,524 Population (Estimated, 1937, R.G.) 58,440 Number of inhabited houses :— 1921 (Census) 11,926 1931 (Census) 13,325 1937 (According to Rate Books) 15,800 Number of families or separate occupiers:— 1921 (Census) 13,998 1931 (Census) 15,883 Rateable Value:—£781,317. Sum represented by a penny rate:—£3,255. Social Conditions.—A great many of the residents are engaged in professional and commercial occupations. In the southern part of the Borough there are a number of factories and workshops, three hundred and twenty-six premises being registered under the Factory and Workshop Acts. Most of these premises are small. There are eighteen laundries registered in the district and they employ a large number of women. 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. The nature of the work carried on in these factories and workshops does not exert any influence on the public health of the town. The figures for unemployment amongst Wimbledon residents registered at the Employment Exchange at the end of the year show an increase of one hundred and sixty-seven as compared with those at the same date in 1936. 4 The following table shows the position with regard to unemployment for the past seven years:— Classification. 31st Dec. 1931. 31st Dec. 1932. 31st Dec. 1933. 31st Dec. 1934. 31st Dec. 1935. 31st Dec. 1936 31st Dec. 1937 Male Adults 1,266 1,434 1,248 1,088 810 600 750 Male Juveniles 34 78 23 24 17 10 16 Female Adults 253 273 230 330 225 130 145 Female Juveniles 36 56 7 19 24 15 11 Totals 1,589 1,841 1,508 1,461 1,076 755 922 Extracts from Vital Statistics of the Year 1937. (Registrar-General's Figures). Total. M. F. Live Births Legitimate 583 306 277 Illegitimate 25 12 13 Total 608 318 290 Birth Rate per 1,000 of the estimated resident population 10.40 Total. M. F. Stillbirths Legitimate '21 10 11 Illegitimate — — - Total 21 10 11 Rate per 1,000 total (live and still) births 33.38 Total. M. F. Deaths 754 321 433 Death Rate per 1,000 of the estimated resident population 11.61 Percentage of Total Deaths occurring in Hospitals and similar Institutions 48.27 5 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 — — No. 30. Other puerperal causes 1 1.58 Total 1 1.58 Death Rate of Infants under one year of age:— All infants per 1,000 live births 65.79 Legitimate infants per 1,000 legitimate live births 66.89 Illegitimate infants per 1,000 illegitimate live births 40.00 Deaths from Cancer (all ages) 130 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 4 „ „ Diarrhœa (under 2 years of age) 3 6 Birth Rates, Death Rates, Analysis of Mortality, Maternal Death Rates, and Case Rates for Certain Infectious Diseases in the Year 1937. (Provisional Figures based on Weekly and Quarterly Returns). Wimbledon England and Wales 125 County Boroughs and Great Towns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Rates per 1,000 Population Births: Live 10.40 14.9 14.9 15.3 13.3 Still 0.36 0.60 0.67 0.64 0.54 Deaths: All Causes 11.61 12.4 12.5 11.9 12.3 Typhoid and Paratyphoid Fevers 0.00 0.00 0.01 0.00 0.00 Smallpox — — — — - Measles 0.00 0.02 0.03 0.02 0.01 Scarlet Fever 0.00 0.01 0.01 0.01 0.01 Whooping Cough 0.06 0.04 0.04 0.03 0.06 Diphtheria 0.05 0.07 0.08 0.05 0.05 Influenza 0.46 0.45 0.39 0.42 0.38 Violence 0.53 0.54 0.45 0.42 0.51 Notifications: Smallpox — 0.00 — 0.00 - Scarlet Fever 0.94 2.33 2.56 2.42 2.09 Diphtheria 1.02 1.49 1.81 1.38 1.93 Enteric Fever 0.06 0.05 0.06 0.04 0.05 Erysipelas 0.29 0.37 0.43 0.34 0.44 Pneumonia 0.78 1.36 1.58 1.20 1.18 Rates per 1,000 Live Births Infant Mortality: Deaths under 1 year of age 65 58 62 55 60 Deaths from Diarrhœa and Enteritis (under two years of age) 4.93 5.8 7.9 3.2 12.0 Maternal Mortality: Puerperal Sepsis 0.00 0.97 * * * Others 1.64 2.26 Total 1.64 3.23 Rates per 1,000 Total Births (i.e., Live and Still) Maternal Mortality: Puerperal Sepsis 0.00 0.94 * * * Others 1.58 2.17 Total 1.58 3.11 Notifications: Puerperal Fever ... 3.17 13.93 17.59 11.52 4.15 Puerperal Pyrexia 7.94 14.34 *Not available. 7 Population, Birth, and Death Rates for each Ward in 1937. WARD. Population. Birth Bate. Death Bate. St. Mary's 6.630 7.69 15.08 St. John's 5,050 8.71 18.61 Cottenham Park 7,422 9.29 14.55 Wimbledon Park 4,371 8.69 11.89 North Wimbledon 23,473 8.60 15.08 Dundonald 7,794 9.87 13.60 Trinity 11,540 12.39 12.99 South Park 8,415 11.88 9.98 Haydon Park 7,218 12.46 8.31 South Wimbledon 34,967 11.72 11.43 Whole District 58,440 10.40 11.61 Births.—The statistics supplied by the Registrar-General show that during 1937 the total number of registered live births belonging to Wimbledon amounted to six hundred and eight (three hundred and eighteen males and two hundred and ninety females). This gives a birth rate equal to 10.40 per thousand of the population. Twenty-five (or 4.11 per cent.) of the births were illegitimate. Of this number, twelve were males and thirteen females. In addition, twenty-one stillbirths (ten males and eleven females) were registered. The following table gives the birth rates in Wimbledon for the past eleven years, together with the comparative figures for England and Wales. In 1923, the birth rate in Wimbledon was 14.9. Since that year the figure has been steadily falling, although during 1935 and 1936 a slight increase in the rate is to be noted. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Wimbledon: Number of Births 717 691 769 766 642 667 602 590 600 630 608 BirthRate 12.3 11.6 12.7 12.9 10.9 11.2 10.2 10.09 10.29 10.78 10.40 Birth Rate for England & Wales 16.7 16.7 16.3 16.3 15.8 15.3 14.4 14.8 14.7 14.8 14.9 8 Notification of Births Acts, 1907 and 1915. Public Health Act, 1936. During the year, six hundred and ninety-five births were notified by the following persons:- Parents 11 Midwives 269 Doctors 57 Other persons 358 Total 695 Twenty of these notifications were in respect of stillbirths. Of the six hundred and ninety-five notifications, two hundred and eighty-seven 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, ninety confinements occurred in Wimbledon amongst women whose homes were situated in other districts. The net number of notified births belonging to Wimbledon is therefore six hundred and five. Deaths.—The total number of deaths registered in the district was five hundred and twenty-seven (two hundred and fourteen males and three hundred and thirteen females), equal to a death rate of 9.01 per thousand of the population. The deaths occurring outside the district, of persons belonging to this Borough, were three hundred, namely:— Kingston and District Hospital 79 Nelson Hospital, Merton 33 S.C.C. Sanatorium 4 St. Thomas's Hospital 6 Richmond Institution 20 Brookwood Mental Hospital 8 Others 150 Total 300 9 The deaths occurring within the district, of persons not belonging thereto were seventy-three, namely:— Wimbledon Hospital 29 Infectious Diseases Hospital 2 Private Nursing Homes 40 Others 2 Total 73 Taking these figures into consideration, the total number of deaths properly belonging to Wimbledon is seven hundred and fifty-four and the crude death rate 12.90 per thousand of the population. The rate for England and Wales for the same period was 12.4 per thousand. The crude death rate again shows an increase on the figure for the previous year and is slightly higher than that for England and Wales. The following table gives the crude death rate in Wimbledon for the past eleven years together with the figures for England and Wales:— 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Wimbledon : No. of Deaths 620 632 774 648 724 713 636 673 662 667 754 Death Rate 10.6 10.7 13.03 10.9 12.3 11.9 10.8 11.5 11.3 11.4 12.9 Death Rate for England & Wales 12.3 11.7 13.4 11.4 12.3 12.0 12.3 11.8 11.7 12.1 12 4 The crude death rate for Wimbledon is, strictly speaking, not comparable with the figure for England and Wales. In order to provide for this the Registrar-General has introduced a comparability factor. This factor, for Wimbledon, is 0.90. The adjusted death rate for Wimbledon for 1937 is consequently 11.61 per thousand of the population as compared with a figure of 12.4 per thousand for England and Wales. 10 Graph showing Birth Rates and Death Rates per thousand of the population for Wimbledon and England and Wales. 11 Table II gives the causes of, and ages at, death during 1937. Deaths due to notifiable infectious diseases are given on page 86. The principal causes of death (excluding zymotic diseases) were as follows:— Cancer 130 Heart Disease 193 286 Cerebral Hæmorrhage 46 Aneurysm 2 Other Circulatory Diseases 45 Pneumonia 52 Bronchitis 16 Other Respiratory Diseases 5 Influenza 27 Tuberculosis (Respiratory) 29 Over half the total deaths which occurred amongst Wimbledon residents in 1937 were due to cancer and diseases of the heart and circulation. Owing to the falling birth rate the mean age of the population is steadily rising. For this reason it is unlikely that the deaths from cancer and heart disease etc., will show any diminution during the coming years. Cancer. Cancer and malignant disease were responsible for one hundred and thirty deaths or 17.24 per cent, of the total deaths recorded. The following table gives the percentage figures since 1922:— Deaths from Cancer. Year Total Deaths Cancer Deaths Percentage 1922 616 91 14.77 1923 546 68 12.45 1924 645 86 13.33 1925 638 90 14.10 1926 579 104 17.96 1927 620 75 12.09 1928 632 84 13.29 1929 774 103 13.30 1930 648 106 16.35 1931 724 103 14.22 1932 713 104 14.58 1933 636 92 14.46 1934 673 92 13.67 1935 662 116 17.52 1936 667 84 12.61 1937 754 130 17.24 12 It will be noted that the number of deaths from cancer is the highest recorded for the past sixteen years. Diseases of the Heart and Circulation. One hundred and ninety-three deaths were due to heart disease. In addition there were forty-six deaths from cerebral haemorrhage, two from aneurysm and forty-five from other circulatory diseases. Thus, two hundred and eighty-six deaths occurred from diseases of the heart and circulation. This figure represents 37.93 per cent. of the total number of deaths recorded. The following table, which gives the figures for the past eleven years, indicates that diseases of the heart and circulation are very important factors in the causation of death in Wimbledon. 1927 1928 1929 1930 1931 1932 1983 1934 1935 1936 1937 Deaths from Diseases of the Heart and Circulation 171 179 208 188 243 219 208 249 213 259 286 Total Deaths (all causes) 620 632 774 648 724 713 636 673 662 667 754 Percentage of Deaths from Heart & Circulatory Diseases in relation to Total Deaths 27.58 28.32 26.87 29.01 33.56 30.71 32.70 36.99 32.17 38.88 37.93 Bronchitis, Pneumonia, and Other Respiratory Diseases. Sixteen deaths were due to bronchitis, fifty-two to pneumonia and five to other respiratory diseases. This gives a total figure of seventy-three, or 9.68 per cent, of the total deaths occurring amongst residents of the Borough during 1937. 13 The following table gives the figures for these diseases for each year since 1927 :— 1927 1928 1929 1930 1931 1982 1933 1934 1935 1936 1937 Deaths from Bronchitis, Pneumonia & other Respiratory Diseases 89 81 117 79 80 88 69 72 68 63 73 Total Deaths, (all causes) 620 632 774 648 724 713 636 673 662 667 754 Percentage of Deaths from Bronchitis, Pneumonia other Respiratory Diseases in relation to Total Deaths 14.35 12.81 15.11 12.19 11.04 12.34 10.84 10.69 10.27 9.46 9.68 Deaths due to Violence. The figures set out below give an indication of the manner in which twenty-seven Wimbledon residents died as the result of violence. It will be noted that nine of the deaths, equal to 1.19 per cent. of the total deaths occurring amongst Wimbledon residents, were due to traffic accidents. Six of these occurred outside the Borough. Eight of the other deaths from violence were caused by fractures due to falls, occurring for the most part in elderly people. Traffic deaths 9 Fractures due to falls 8 Other causes 10 Total 27 Three persons living outside the Borough were killed in Wimbledon as the result of traffic accidents. In addition to the above, four cases of suicide occurred amongst Wimbledon residents during 1937. Infantile Mortality. There were forty infant deaths (including transferable deaths) giving an Infantile Mortality Rate of sixty-five per thousand live births. In 1936 the figure was fifty per thousand. During 1937 the Infantile Mortality Rate for England and Wales was fifty-eight. 14 The following table gives the Infantile Death Rate in Wimbledon for the past eleven years together with the comparative figures for England and Wales:— 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Wimbledon : No. of Infantile Deaths 37 38 35 38 45 45 30 32 33 32 40 Infantile Death Bate Iper thousand births) 50 55 46 49 70 67 49 54 55 50 65 Infantile Death Kate for England and Wales 69 65 74 60 66 65 64 59 57 59 58 Of the forty children under one year who died, the cause of death in fifteen cases was prematurity and debility. Four died as the result of congenital defects. Three deaths were due to whooping cough, one to pneumonia, and five to bronchopneumonia. Infantile diarrhoea was responsible for three deaths. The Infantile Death Rate for illegitimate children in Wimbledon was forty per thousand illegitimate live births. 15 The following table shows the causes of death, and ages at death, of infants under one year:— Infantile Mortality during the Year 1937. Causes of Death. Under 1 week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. Whooping Cough ... ... ... ... ... ... 1 2 ... 3 Pneumonia ... ... ... ... ... ... ... ... 1 1 Broncho-Pneumonia ... ... ... ... ... ... 3 1 1 5 Gastro-Enteritis ... ... ... 1 1 1 ... 1 ... 3 Asphyxia ... ... ... ... ... 1 1 ... ... 2 Prematurity 11 ... 1 ... 12 1 ... ... ... 13 Atelectasis 1 ... 1 ... 2 ... ... ... ... 2 Spina Bifida ... ... ... ... ... 1 1 ... ... 2 Congenital Defects 1 1 1 ... 3 1 ... ... ... 4 Birth Injury 1 1 ... ... 2 ... ... ... ... 2 Other Causes 1 ... ... ... 1 2 ... ... ... 3 Totat 15 2 3 1 21 7 6 4 2 40 Neo-natal Mortality. Twenty-one deaths occurred amongst infants during the first four weeks of life. This is equal to a mortality rate of 34.53 per thousand total live births. Fourteen of these deaths were due to prematurity and debility, one to gastro-enteritis, three to congenital defects, two to injuries at birth, and one to other causes. 16 Graph showing Infantile Mortality Rates per thousand births for Wimbledon and England and Wales. 17 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Public Health Officers of the Local Authority. A complete list of the Staff of the Public Health Department is given at the commencement of this report. Laboratory Facilities. The Corporation employ a part-time bacteriologist for the examination of pathological specimens. The number of specimens sent by medical practitioners for examination is shown in the following table:— Positive Negative Total Diphtheria Swabs 29 620 649 Tuberculosis (Sputum) 7 141 148 Typhoid (Blood, and other specimens) 4 36 40 Dysentery ... 3 3 Total 40 800 840 In addition to the above facilities, the laboratory provided at the Health Centre is utilised for the examination of pathological specimens from the Infectious Diseases Hospital. This work is carried out by the staff of the Public Health Department. One thousand eight hundred and seventyfive specimens were examined in 1937. Most of these specimens were swabs taken from the nose and throat of suspected diphtheria patients or from contacts in the homes or schoolg. The following additional specimens from the Hospital and Health Centre were also reported upon:— Hair (Ringworm) 3 Urine Specimens 63 Smears 5 Blood Films 2 Sputum 2 Ambulance Facilities. (i) For Infectious Diseases.—Two motor ambulances are maintained by the Wimbledon Borough Council at their Infectious Diseases Hospital, Gap Road, one for the removal of infectious patients and the other for disinfecting purposes. 18 (ii) For Non-infectious Cases and Accidents.—One motor ambulance is maintained by the Wimbledon Borough Council at the Fire Station, Queen's Road. The British Red Cross Society also provide a motor ambulance for Wimbledon and the surrounding district. A full day and night service is maintained and the ambulance may be obtained by telephoning Wimbledon 4567. Professional Nursing in the Home. Geneial and Midwifery.—The Wimbledon District Nursing and Midwifery Association, which is supported by voluntary contributions, has a staff of a Superintendent and eleven nurses. Seven of the staff are district nurses, three district midwives, and one a senior nurse. In 1937 the Council made arrangements with the Association for the provision of a whole-time service of domiciliary midwives under Section I of the Midwives Act, 1936. Full particulars are given later in the report under the section dealing with Midwifery and Maternity Services. The Association attended two hundred and twenty-one midwifery cases during the year. One hundred and seventy-seven of these were midwives cases and forty-four were cases with doctors in attendance. In all, 4,233 visits were paid to maternity cases. Furthermore, one thousand four hundred and forty-nine ante-natal visits were made by the nursing staff of the Association. The total number of cases dealt with during 1937, including midwifery, amounted to 1,590, the total visits paid to these cases being 32,508. In addition to the payment made for the provision of a domiciliary service of whole-time midwives the Wimbledon Borough Council also make an annual contribution of ten guineas to this Association. 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. (b) Health Centre, Pelham Road, Wimbledon. Every Tuesday and Friday from 2 p.m. to 4.30 p.m. 19 (ii) Ante-natal Clinic. Wandle Park House, Wandle Bank, Wimbledon. Every Thursday from 2 p.m. to 4.30 p.m. (iii) Mothercraft Classes. (a) Health Centre, Pelham Road, Wimbledon. Every Thursday from 3 p.m. to 4 p.m. (b) Wandle Park House, Wandle Bank, Wimbledon. Every Thursday from 3 p.m. to 4 p.m. (iv) Dental Treatment Centre. Health Centre, Pelham Road, Wimbledon. Daily (including Saturday) from 9.15 a.m. (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. (c) Orthopaedic Clinic. Second Wednesday in each month from 2 p.m. to 4 p.m. (d) Aural Clinic. Every fourth Wednesday from 2 p.m. to 4 p.m. (e) Ophthalmic Clinic. Every Monday from 2 p.m. to 4 p.m. (Additional Sessions on Wednesday after- noons as required). (f) Diphtheria Immunisation Clinic. Every Saturday from 10 a.m. to 11 a.m. (vi) Day Nursery. Hubert Road, Wimbledon. The above are provided and maintained by the Wimbledon Borough Council. (vii) Tuberculosis Dispensary. 30 Worple Road, Wimbledon, S.W. 19. The Dispensary is provided and maintained by the Surrey County Council:— Every Wednesday from 1.30 p.m. to 3.30 p.m. Every Friday from 9.30 a.m. to 11.30 a.m. First Tuesday in each month from 5.30 p.m. to 7.30 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 principal London Hospitals. 20 Hospitals. (i) Tuberculosis.—Most Wimbledon patients suffering from pulmonary tuberculosis are admitted to the Sanatorium at Milford which is under the administration of the Surrey County Council. The majority of the cases of surgical tuberculosis are sent to St. Anthony's Hospital, Cheam, or The Royal Sea Bathing Hospital, Margate, or similar institutions. (ii) Maternity.—The Maternity Block of the Nelson Hospital has accommodation for twenty beds, together with an Ante-natal Department. Although this hospital is situated just outside the boundary, one hundred and forty Wimbledon mothers were admitted for their confinements during 1937, a decrease of seven on the figure for the previous year. One hundred and six of these were admitted to the general maternity ward and thirty-four to the private maternity wards. Ninety-five Wimbledon mothers were also admitted to the Maternity Department of the Kingston County Hospital for their confinements. (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 London hospitals such as Great Ormond Street and Tite Street. (iv) Infectious Diseases.—The Corporation's Infectious Diseases 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. Cases of measles and whooping cough are also admitted when the home conditions render this desirable. In addition, treatment is provided for certain cases of puerperal sepsis. The Wimbledon Corporation admit to their Infectious Diseases Hospital all cases of scarlet fever and diphtheria requiring hospital treatment from the Royal Borough of Kingston-upon-Thames. 21 General Hospitals. 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 County Hospital, which is at Norbiton, has five hundred beds. This hospital was administered by the Public Assistance Committee, and was appropriated by the Public Health Committee of the Surrey County Council as from 1st April, 1937. Institutions for unmarried mothers. The Southwark Diocesan Maternity Home at 56, Gap Road, has accommodation for twelve mothers. 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 1937 £9,338 Average weekly number of persons in receipt of Domiciliary Assistance 448 Average weekly number of persons in receipt of Medical Relief only 5 Number of persons admitted to the Public Assistance Institutions from Wimbledon Area:— (a) Hospital 231 (b) Institution 92 22 MATERNITY AND CHILD WELFARE Continued progress has been maintained in the work of this section of the Public Health Department. The further development of the Maternity and Child Welfare Services has made necessary an increase of staff and an additional Health Visitor will be appointed to take up duty early in 1938. The total number of visits paid by the Health Visitors during 1937 amounted to 5,901, the figure for the previous year being 6,387. Details of the home visits carried out are given below:— Number of Infants visited—First visits 564 Number of Infants visited—Re-visits 1,172 Number of Toddlers visited 1,796 Ante-natal—First visits 174 Ante-natal—Re-visits 58 Visits re Infant Deaths 8 „ „ Stillbirths 15 „ „ Ophthalmia Neonatorum 37 „ „ Puerperal Fever and Pyrexia 6 „ „ Non-notifiable Infectious Diseases 3 „ „ Milk Applications '29 „ „ Foster Children 368 „ „ Midwives 11 Miscellaneous 66 Total welfare visits 4,307 Visits—School Medical Service 534 Tuberculosis—Home visits 80 Visits to Nursing Homes 31 Other visits 1 Ineffectual visits 948 1,594 Total visits 5,901 Half-days at Schools 247 Half-days at Welfare Centres 477 Half-days at Clinics 640 23 The attendance of the children at the Centres has continued to be most satisfactory. The additional sessions held every Tuesday afternoon at the Health Centre, Pelham Road, have been thoroughly justified and have resulted in the lowering of the average attendance from 122 in 1936 to 93 in 1937. In spite of this, both the Tuesday and Friday afternoon sessions are still too large and in all probability additional centres will be established by the Council in 1938 in other parts of the Borough. The average attendance per session at the Wandle Park Centre was 71.44, a slight decrease on the figure of 74.10 in 1936. The Medical Officer reports that the health and progress of the children continued to be satisfactory. Whooping cough was prevalent during the summer and affected a considerable number of children in South Wimbledon. This caused a falling off in the attendances at the Wandle Park Centre and led to an unusual number of coughs during the winter. Apart from this the commonest disorder was a gastro-enteritis which affected infants and toddlers and was prevalent during the autumn. Only one of the cases was seriously ill and this child was admitted to hospital. During this period there were a number of cases of mild dysentery of the Sonne type in Wimbledon and surrounding districts. Eight cases of rickets were seen during the year. One was admitted to Pyrford under the Orthopaedic Scheme of the Maternity and Child Welfare Committee. For the most part the other cases were mild and were either kept under observation or referred to the Orthopaedic Surgeon at the Health Centre. Forty-seven other orthopaedic cases were seen at the Centres. These were chiefly cases of knock knee, flat feet, etc. Fifty-five children and forty-nine nursing mothers were referred to the Dental Clinic for treatment. During the latter months owing to the increased number of unemployed in Wimbledon there were an unusually large number of applications for free milk. In necessitous cases cod liver oil was also granted. Ante-natal Clinic. For many years the Ante-natal Clinic has been held at Wandle Park House on the second and fourth Thursday in the 24 month. The average attendance in 1937 was 18.56 per session as compared with 12.82 in 1936. The number of expectant mothers who attended the Antenatal Clinic in 1937 was one hundred and sixty-seven, equal to 27.60 per cent. of the total number of live births and stillbirths notified. The percentage in 1936 was 18.95. This gratifying increase in the attendances fully justified the establishment of weekly sessions of the Clinic and these were commenced towards the end of the year. Owing to the general increase in the work of the public health services, the Council made arrangements for the Antenatal Clinic to be conducted in 1938 by an obstetrician and Dr. Jocelyn Moore, F.R.C.S., M.C.O.G., was appointed for this purpose. This will enable women attending the Post-natal Clinic to be referred when necessary to the South London Hospital for Women for treatment. It should be noted that in addition to the mothers who attended the Corporation's Ante-natal Clinic a considerable number attended the Ante-natal Clinics at the Nelson and Kingston County Hospitals, where two hundred and thirty-five women living in the Borough of Wimbledon were admitted for their confinements. During 1934, the Corporation made arrangements whereby midwives are compensated for the loss of their patients when these are referred to hospital for their confinements after attendance at the Ante-natal Clinic. The rate of compensation paid to the midwives is ten shillings per case. Lectures for Mothers. Classes for mothers are held at both of the Centres. Home nursing, mothercraft, hygiene, and singing, are taught. The average attendance of mothers at the Pelham Centre was 25.72, and at the Wandle Park Centre 13.78. Midwifery and Maternity Services—Midwives Act, 1936. The Midwives Act, 1936, came into operation on 30th July, 1937. As stated in last year's Report the Council decided to enter into an agreement with the Wimbledon District Nursing and Midwifery Association for the provision of a service of whole-time domiciliary midwives. Three midwives were appointed at the commencement, provision 25 being made for the appointment of a fourth midwife at a later date should this he found to be necessary. The agreement provides for a payment of £400 per annum to the District Nursing Association by the Corporation. The fee for the services of a midwife acting either as a midwife or a maternity nurse is £2 in respect of a first confinement and thirty shillings in respect of a subsequent confinement, A scale is also in force for the purpose of determining what proportion of the full fee is to be paid by the patient or her husband or other person liable to maintain her. This is determined in accordance with the financial circumstances of the family. When the net weekly income per head of the family, after making the usual deductions, is below seventeen shillings no charge is made for the services of the midwife. There is every reason to hope that as this service of whole-time domiciliary midwives becomes more widely known to the public greater use will be made of the facilities available under the Act, A Joint Committee was formed consisting of three representatives of the Council's Maternity and Child Welfare Committee and three representatives of the Nursing Association. This Committee acts in an advisory capacity and forms a liaison between the two bodies concerned. At the end of 1936 the domiciliary midwives had attended forty-four cases, ten as midwives and thirty-four as maternity nurses. In addition, forty-seven cases had been booked for the early part of 1938. The Council dealt with one claim for compensation from a midwife who surrendered her certificate voluntarily under Section 5 of the Act. The compensation paid in this case amounted to £391 12s. 3d., a small proportion of which was payable by a neighbouring Authority in whose district the midwife had also practised. In a second case the Council made a payment of £20 0s. 4d. to the Surrey County Council, representing the proportion of the compensation due to a midwife living in that area who had voluntarily surrendered her certificate and a part of whose practice was in the Borough of Wimbledon. A third midwife, residing in Wimbledon, surrendered her certificate at her own request. She was not eligible for compensation as she had not practised as a midwife within the prescribed time prior to the passing of the Midwives Act, 1936. 26 During the year the Council have given careful consideration to Circular 1622 of the Ministry of Health on the subject of Maternal Mortality. As the result of this, they decided to provide the services of an Obstetric Consultant who would be available to assist medical practitioners, undertaking domiciliary midwifery, in any case of doubt or difficulty arising during the ante-natal period, at the time of confinement, or during the puerperium. The Council, for a number of years, have had a scheme for the hospital treatment of complicated obstetric cases in the Maternity Department of the Nelson Hospital, which is under the charge of Leslie Williams, Esq., F.R.C.S., F.C.O.G. It was felt that the maternity services would be best co-ordinated if Mr. Williams acted as Obstetric Consultant for the Borough and arrangements were made accordingly. The fee for the Consultant's attendance at the patient's home is paid by the Council and relatives are required to contribute in accordance with their financial circumstances. A circular letter was addressed to the local medical practitioners in November, 1937, giving full details of the scheme and information of the procedure to be adopted in order to obtain the services of the Consultant. Doctors desiring to get into touch with Mr. Williams between the hours of 9.30 a.m. and 5.30 p.m. should ring up his Secretary (Telephone No.: Welbeck 6174). Between 6 p.m. and 9 a.m. application should be made at Mr. Williams' private residence (Telephone No.: Western 6174). These facilities had only been utilised in one case by the end of the year. Negotiations were also commenced between the Council and representatives of the Nelson Hospital for the provision of a suitable emergency unit. This will enable the services of one of the Honorary Obstetric Assistants at the hospital, together with a nurse and the necessary emergency equipment, to be available at short notice for the treatment in their own homes of patients whose condition is too grave to allow of their removal to hospital. It is hoped that satisfactory arrangements will be completed early in 1938. A scheme for the provision of Home Helps was approved by the Council in December, 1937. Considerable difficulty has been experienced in obtaining suitable women to take up these duties, but it is hoped that this will be overcome in the succeeding months. The payment to be made to Home Helps has 27 been fixed at twenty-five shillings per week. Relatives are required to contribute towards the cost in accordance with their financial circumstances. Applicants for these appointments are interviewed by the Chairman of the Maternity and Child Welfare Committee and the Medical Officer of Health in order that their suitability for the work may be investigated. As indicated earlier in the Report the Council have also made arrangements for the services of a Consultant Obstetrician to take charge of the Ante-natal Clinic. Institutional Provision for Mothers or Children. With the exception of the Day Nursery, which has accommodation during the day for fifty children under five years of age, the Corporation make no institutional provision for mothers or young children. Details of the work of the Day Nursery are given on page 37. The Council, however, in certain cases, arrange convalescent treatment for children under school age. During 1937 eighteen children were sent to convalescent institutions for varying periods. The arrangements for convalescence are made through the local branch of the Invalid Children's Aid Association. Midwives Acts, 1902-1926. The Council is the Local Supervising Authority for the Midwives Acts in Wimbledon. Twenty-eight midwives residing in the Borough notified their intention of practising during the year, together with six midwives resident in outside areas. Eleven of the former eventually removed to other districts and one surrendered her certificate voluntarily under the Midwives Act, 1936, leaving sixteen practising midwives in Wimbledon at the end of 1937. There are, in addition, a number of midwives acting purely as maternity nurses in the maternity homes. Two hundred and thirty-eight confinements were attended by midwives and seventy-seven by maternity nurses. Regular inspection of the midwives was carried out by the Assistant Medical Officer, who is the Inspector of Midwives for the Borough. These inspections showed that the records, bags, instruments, etc., were being maintained in a satisfactory manner. They also indicated that on the whole 28 the Rules of the Central Midwives Board were being well complied with. One midwife and one maternity nurse, residing outside the Borough, failed to notify their liability to be a source of infection in accordance with Rule 9. The Inspectors of Midwives of the areas concerned were immediately notified and the matter promptly dealt with. In October, 1937, a complaint was received as to the conduct of a midwife acting as a maternity nurse. The circumstances of the case were carefully investigated and the matter was subsequently reported to the Central Midwives Board under Section 8 (2) of the Midwives Act, 1902. The case is being heard by the Board early in 1938. The attention of the proprietors of the maternity homes in Wimbledon was again called to the need of midwives acting as maternity nurses in these institutions complying with the Rules of the Central Midwives Board to which they are liable. An abstract of these Rules was sent to each maternity home with the request that they should be exhibited in the staff room. Maternity nurses were also reminded of their obligation to notify their changes of address as this is a requirement which they frequently overlook. Midwives are invited to attend with their patients at the Ante-natal Clinic, and provision is made for their compensation if patients referred by them are found to require hospital treatment. The compensation paid is at the rate of ten shillings per case. No uncertified women living in Wimbledon were known to be attending confinements under the direction and supervision of registered medical practitioners. During October, the Surrey County Council, as the Local Supervising Authority for Surrey, arranged a course of lectures and demonstrations for the midwives in their area as in previous years. Through the courtesy of the County Medical Officer for Surrey the midwives in Wimbledon were invited to attend, and invitations were sent out to them from the Town Hall. A number availed themselves of the opportunity of attending this Course. The local branch of the Midwives' Institute, of which the Chairman of the Maternity and Child Welfare Committee of the Wimbledon Borough Council is President, continued to meet every month in the room placed at their disposal at the Town Hall. 29 The following notifications were received from midwives practising in the district:— Stillbirths 3 Artificial Feeding 9 Liability to be a Source of Infection 21 Notification of Death 1 Laying out Dead Body 3 Total 37 Medical Aid forms were received in one hundred and eleven instances, and the following table shows the conditions for which medical help was obtained:— Albuminuria 4 Eclampsia 2 Placenta Prævia 1 Abortion and Miscarriage 3 Post Partum Hæmorrhage 5 Delayed Labour 13 Disproportion 1 Malpresentation 3 Adherent Placenta 4 Retained Membranes 1 Ruptured perineum 32 Rise of Temperature 10 Prematurity, Congenital Defects, etc. 8 Sticky Eye 12 Pemphigus Neonatorum 2 Other conditions (Mother) 8 Other Conditions (Infant) 8 The total fees paid to doctors by the Corporation during the year under Section 14 (1) of the Midwives Act, 1918, amounted to £112 l1s. 6d. The amount recovered from the patients' relatives was £43 14s. 7d. 30 Centres.-The work carried out at the centres during 1937 is indicated in the following table:- 1937 PELHAM ROAD WANDLE PARK Infant Welfare Consultations (Tuesday) Infant Welfare Consultations (Friday) Classes for Mothers Infant Welfare Consultations Ante-Natal Clinic Classes for Mothers Month No. of Sessions Children under 1 Year Children from 1-5 Years Total Average Attendance No. of New Cases 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 1 Attendance No. of New Cases No. of Sessions Attendance Average Attendance No. of Sessions Attendance Average Attendance Infants Toddlers j Infants Toddlers Infants 1oddlrrs January 3 115 59 174 58.00 14 3 4 178 177 355 88.75 8 ... ... ... ... 3 76 129 205 68.33 9 3 1 15 15.00 1 14 14.00 February 4 133 89 222 55.50 10 1 5 226 202 428 85.60 8 2 3 77 25.66 4 103 193 296 74.00 8 ... 2 30 15.00 4 48 12.00 March 4 151 92 243 60.75 8 4 4 181 158 339 84.75 10 7 4 118 29.50 4 113 204 317 79.25 6 3 2 38 19.00 3 43 14.33 April 4 159 105 264 66.00 12 7 4 195 175 370 92.50 12 1 3 86 28.66 4 131 208 339 84.75 9 2 3 67 22.33 3 33 11.00 May 5 194 108 302 60.40 15 2 5 231 208 439 87.80 18 4 2 58 29.00 4 125 197 322 80.50 6 2 2 43 21.50 2 29 14.50 June 4 189 99 288 72.00 14 6 4 186 200 386 96.50 16 ... 3 72 24.00 4 137 193 330 82.50 7 2 2 44 22.00 3 40 13.33 July 5 267 123 390 78.00 17 5 4 189 225 414 103.50 8 8 ... ... ... 4 106 187 293 73.25 5 1 2 42 21.00 1 15 15.00 August 3 149 76 225 75.00 6 4 4 215 148 363 90.75 15 1 ... ... ... 4 96 143 239 59.75 11 4 2 31 15.50 ... ... ... September 4 188 146 334 83.50 11 10 4 176 214 390 97.50 9 8 2 38 19.00 4 96 148 244 61.00 6 2 2 42 21.00 3 49 16.33 October 5 262 209 471 94.20 13 6 5 207 326 533 106.60 15 11 3 70 23.33 4 96 141 237 59.25 2 4 2 38 19.00 3 50 16.66 November 3 178 121 299 99.66 10 6 3 121 172 293 97.66 9 4 2 47 23.50 3 88 132 220 73 33 6 4 1 19 19 00 2 32 16.00 December 5 273 169 442 88.40 20 1 5 187 251 438 87.60 12 6 3 77 25.66 5 130 186 316 63.20 8 3 4 55 13.75 3 33 11.00 Totals 49 2258 1396 3654 74.57 150 55 51 2292 2456 4748 93.09 140 52 25 643 25.72 47 1297 2061 3358 71.44 83 30 25 464 18.56 28 386 13.78 Public Health Act, 1936 (Child Life Protection); Children and Young Persons Act, 1932; Children Act, 1908 (Part 1).— The following figures relate to the administration of the above Acts in Wimbledon during 1937:— (i) Number of foster-mothers on the Register— (a) At the beginning of the year 35 (b) At the end of the year 28 (ii) Number of children on the Register— (a) At the beginning of the year 60 (b) At the end of the year 50 (c) Who died during the year — (d) On whom inquests were held during the year — Every foster-child was visited regularly and if the conditions were not satisfactory, more frequent visits were paid. In all, three hundred and sixty-eight visits were made to the homes of foster-mothers. The four Health Visitors hold appointments under Section 2 (2) of the principal Act. Each Health Visitor is responsible for the supervision of the foster-children in her area. The standard of care devoted to the foster-children in Wimbledon was found to be very satisfactory. Attention was also paid to the provision of suitable fireguards in the home of every foster-mother. 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. In no case was it necessary for an order to be obtained from a Justice under Section 67 of the Act of 1932, or under Section 212 of the Public Health Act, 1936, with a view to the removal of a child from the home of a foster-mother. It was not necessary to take any legal proceedings under the Act. Orthopædic Treatment.—The orthopedic scheme of the Wimbledon Borough Council provides for the treatment of school-children as well as for children below school age. The Surgeon visited the Orthopedic Clinic at the Health Centre once every month. The Orthopaedic Nurse, who supervises the remedial exercises and massage, attended two 31 sessions each week, except during the school holidays when the Orthopædic Clinic was closed. There were three children under the age of five years admitted to Pyrford for in-patient treatment. One was suffering from congenital club feet and two from rachitic deformity of the legs. The two latter cases were discharged during the year. 32 38 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 1933 1934 1935 1936 1937 Examined by the Surgeon—New Cases 3 9 10 11 8 10 12 —Old Cases ... 12 33 36 30 25 40 Referred to Pyrford for treatment 1 1 2 2 2 3 3 Referred to St. Thomas's Hospital for X-ray Examination ... 1 ... ... ... ... ... Referred to St. Thomas's Hospital for In-patient Treatment ... ... ... 1 ... ... 1 Referred to St. Thomas's Hospital for Oul^Patient Treatment ... ... ... ... ... 1 1 For whom Surgical Appliances or Special Boots were ordered 1 6 9 7 6 ... 5 Referred for Remedial Exeroises at the Health Centre 1 1 ... ... ... 1 2 No. of Attendances made for Remedial Exercises 8 9 ... ... ... 20 20 Ophthalmia Neonatorum.—The following table shows that three cases of ophthalmia neonatorum were notified. Home nursing was provided through the Wimbledon District Nursing Association in two cases. These cases were mild and no impairment of vision resulted. In 1937 the Public Health Committee decided that, when cubicle accommodation was available in the Infectious Diseases Hospital, severe cases of ophthalmia neonatorum should be admitted and that the services of an Ophthalmic Surgeon should be provided. CASES. Vision Unimpaired. Vision Impaired Total Blindness. Deaths Notified. Treated. At Home. Hospital. 3 2 ... 3 ... ... ... Ophthalmic Treatment.—Nine new cases from the Maternity and Child Welfare Centres were seen by the Ophthalmic Surgeon at the refraction clinic during the year and glasses were prescribed for all of these. Three children who were already wearing glasses were re-tested. In addition to the above, three expectant mothers were seen by the Surgeon and glasses were prescribed in each case. Treatment of Minor Ailments.—Seventy-one children below school age attended the Health Centre for treatment. These children made two hundred attendances. The conditions treated consisted chiefly of septic sores, impetigo, running ears, blepharitis, and miscellaneous skin conditions. Treatment of Tonsils and Adenoids.—Arrangements were made for the operative treatment of tonsils and adenoids in forty-five cases under the Council's Maternity and Child Welfare scheme. Ear Diseases and Defective Hearing.—Facilities are available at the Health Centre for the treatment of children below school age suffering from ear diseases and defective hearing. As stated in the Report of the School Medical Officer an Aural Clinic was established in September, 1937, in charge of 34 a consulting ear, nose and throat surgeon. Four children below school age were examined and made five attendances. Two of these cases were referred for treatment at the Clinic and one for observation. In the fourth case no treatment was found to be necessary and the child was discharged. Maternal Mortality. There was one maternal death amongst Wimbledon mothers in 1937. This was due to retained placenta and post-partum haemorrhage. The death occurred in the patient's own home. It is gratifying to report that there has been 110 death from puerperal sepsis amongst Wimbledon mothers since 1932. During 1936 no maternal death occurred. The following table gives the maternal mortality rates for Wimbledon and also for England and Wales:- 1937 Puerperal Sepsis Others Total Wimbledon: Per 1000 Live Births . 0 00 1.64 1.64 Per 1000 Total Births 0.00 1.58 1.58 England and Wales: Per 1000 Live Births 0.97 2.26 3.23 Per 1000 Total Births 0.94 2.17 3.11 Hospital Treatment for Complicated Obstetric Cases.— The Council have an arrangement 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. During 1937 nine patients received treatment under this scheme for the following conditions:— Toxaemia of Pregnancy — threatened eclampsia 1 Congenital heart—for induction later 1 35 Contraction of pelvis. Previous difficult forceps deliveries 1 Acute cystitis 1 Albuminuria and raised blood pressure. Twins 1 History of Eclamptic fits at previous confinement 1 Adherent placenta 1 Albuminuria and raised blood pressure 1 Raised blood pressure—twins 1 These facilities appear to have been an important factor in reducing the number of maternal deaths occurring among Wimbledon mothers during past years. The cost of maintenance and treatment of the above patients under this scheme amounted to £62 5s.lld., of which £12 14s. 1d. was recovered from the relatives. Supply of Milk to Expectant and Nursing Mothers and Infants.—There were eight hundred and five applications for supplies of free milk under the Maternity and Child Welfare Scheme from two hundred and eight families, compared with seven hundred and seven applications from one hundred and fifty-four families in the preceding year. Seven hundred and twenty-one of the applications were granted, an increase of eighty-nine on the figure for 1936. The milk is granted on medical grounds and the circumstances of each case are carefully considered by the SubCommittee dealing with this question. In 1937 the Council decided that the scale of family circumstances should be interpreted more generously and that milk should be available to expectant mothers at any stage of pregnancy. Cod liver oil and malt was also to be supplied where necessary for nursing and expectant mothers and children below school age. Dental Treatment. Dental treatment is 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. Ninety-three mothers and eighty-six children under school age attended for treatment. One hundred and fifty-eight general anaesthetics and nineteen local anaesthetics were administered. Where 36 sary, nursing and expectant mothers are provided with dentures. Thirty-nine dentures were supplied to mothers through the Dental Clinic during 1937. In addition, one denture was repaired. A close co-operation has been established between the Dental Clinic at the Health Centre and the Ante-natal Departments of the Nelson and Kingston County Hospitals, who are referring an increasing number of expectant mothers for dental treatment. The following table gives an indication of the work carried out by the Dental Surgeon in connection with the Maternity and Child Welfare Department:- Mothers—attendances for treatment 323 „ teeth extracted 322 „ teeth filled 11 „ scalings 39 „ other operations 43 Mothers—dentures supplied 39 „ „ repaired 1 Children—attendances for treatment 157 „ teeth extracted 182 „ „ filled 7 „ „ other operations 13 Total number of fillings inserted 22 „ „ „ local anaesthetics administered 19 general do. do. 158 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. These helpers give a great deal of their time to the Centres at Pelham Road and Wandle Park House. The work which they so unobtrusively carry out plays an important part in the success of Child Welfare work in this Borough. Municipal Day Nursery.-The work at the Day Nursery at Hubert Road continued to be most satisfactory. The total attendances made by children amounted to 11,538 whole days. The average daily attendance was 46.71. These children came from one hundred and forty-eight families, five families sending three children, nineteen families two 37 children, and the remainder one child each. The number of children on the register on 31st December, 1937, was sixty-five. Particulars with regard to the accommodation at the Nursery have been given in previous Reports. Several additions were made in the dietary of the children during 1937. Amongst these were the inclusion of Marmite, honey, tomatoes, tripe, liver, etc. Babies over three months old now have beef and veal bone broth daily in bottles. The number of small babies admitted during the year continued to be high. In several cases arrangements were made for the mothers to feed them morning and evening, bottles being given at the Nursery during the day. Infants up to eighteen months are weighed weekly. Children from eighteen months to three years are weighed monthly. Toddlers from three to five years are weighed every three months unless under observation, when they are weighed more frequently. During 1937 one thousand one hundred and ninety-two " weighings " were recorded. All the clothing worn by the children at the Nursery is made by the staff. A charge of sixpence per day is made for each child attending the Nursery. The revenue from this source amounted to £279 0s. 0d. during 1937. The children at the Day Nursery were medically inspected four times during the year. One child suffering from corneal ulcers was referred to hospital for in-patient treatment. She was re-admitted to the Nursery later in the year quite cured. One child suffering from squint was referred to the Eye Clinic for examination by the Oculist and the necessary glasses prescribed. The Orthopaedic Surgeon saw one child from the Day Nursery. Alterations to her shoes were prescribed and two attendances were made. No operative treatment was found to be necessary for the removal of tonsils and adenoids. On the whole, the health of the children attending the Day Nursery continued to be excellent. All toddlers were dentally inspected twice. The Dental Surgeon reports that the condition of the teeth was good. Fourteen children received treatment at the Dental Clinic. 38 In no case was treatment refused and in many instances it was carried out at the request of the parents. During 1937 very few cases of infectious disease occurred at the Day Nursery. Four children developed chicken-pox and four whooping cough. They were all excluded for the necessary period. No infectious disease occurred amongst the staff. Seven children and three members of the staff were immunised against diphtheria. Particulars of these cases are given in the section of the Eeport dealing with Infectious Disease. All members of the staff are Schick tested on coming to the Nursery and are immunised when necessary. There is no doubt that the Nursery meets a very real need in South Wimbledon, and usually there is a waiting list for admission. The children attend very regularly and vacancies are few. No children residing outside the Borough are admitted although quite a number of applications are received from such sources. Each application for admission is carefully considered. A child is only admitted when it is genuinely necessary for the mother to go out to work. The Corporation now grant a Certificate to the Nursery Nurses who, after a two years' course of training, pass an examination in written and practical work in the theory and practice of nursery nursing. Two nurses were awarded Certificates during 1937. After they have completed their two years' training at the Day Nursery many of the nurses proceed to take their general and fever training. 89 Nursing Homes Registration Act, 1927. Public Health Act, 1936—Part VI. The Wimbledon Borough Council is responsible for the supervision of nursing homes in Wimbledon. At the end of the year there were fifteen registered nursing homes, namely:- Nursing Homes for Maternity Cases 1 Nursing Homes for Medical, Surgical, and Maternity Cases 3 Nursing Homes for Medical, Surgical, Chronic, and Maternity Cases 1 Nursing Homes for General Medical and Chronic Cases 2 Nursing Homes for Chronic Cases 8 Total 15 Certificates of registration were issued by the Council in respect of a nursing home for maternity cases and a nursing home for chronic cases during 1937. One maternity home and two nursing homes for chronic cases were discontinued. The nursing homes were periodically inspected and supervised. Forty-seven visits of inspection were made. Two were in connection with applications for registration, thirty were routine visits and fifteen special visits. The nursing homes in Wimbledon were again found to be maintained and run in a satisfactory manner. Close supervision was paid during the visits to the way in which the records of the homes were kept, and in a few cases it was necessary to draw the attention of the proprietors concerned to the requirements of the Bve-laws. Section 123 of the Surrey County Council Act, 1936, provides for the making of additional Bye-laws with regard to infectious diseases occurring in nursing homes. The Council decided to utilise these powers and the Bye-laws which they made came into operation on 1st November, 1937. These Bye-laws require persons carrying on nursing homes to notify the Medical Officer of Health (a) within a period of twenty-four hours of infectious disease occurring in such a home; 40 (b) forthwith, of a rise of temperature of any maternity patient to 100.4 degrees Fahrenheit for twenty-four hours or its recurrence within that period. A copy of these Bye-laws was duly sent to every nursing home in the Borough. Examination of Employees. During the year 1937, two hundred and twenty-six employees were medically examined. In addition fifty-seven candidates were medically examined for superannuated posts under the Council. Mortuary. 1 am indebted to the Superintendent of the Cemetery for the figures regarding the use of the new mortuary during 1937. Ninety-three bodies were received into the mortuary and post-mortems were conducted on sixty-six of these. This figure is equivalent to 12.52 per cent, of the deaths registered as occurring in the Borough. Local Acts, Special Local Orders, or General Adoptive Acts in Force in the Borough. Infectious Diseases (Prevention) Act, 1890—17th December, 1890. Public Health Acts (Amendment) Act, 1890: Parts II, III and V- 17th December, 1890. Public Health Acts (Amendment) Act, 1907. Part II (Streets, Buildings)—Sections 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 26, 28, 29, 31, 32, 33; and Sections 25, 27 and 30 with modifications. Part III (Sanitary provisions)—Sections 34, 36, 37, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 and 51, and Sections 35 and 38 with modifications. Part IV (Infectious Diseases)—Sections 52, 53, 54, 55, 56, 57, 58, 60, 61, 62, 63, 64, 65, 67 and 68, and Section 59 with modifications. Part V (Common Lodging Houses)—Sections 69, 70, 71, 72, 73, 74 and 75. Part VI (Recreation Grounds)—Section 76 (with modifications), and Section 77. 41 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 preceding 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). The Wimbledon Corporation Act, 1933—28th July, 1933. Surrey County Council Act, 1925: Parts II, III, V, VI, and VIII—7th August, 1925. Surrey County Council Act, 1931: Parts III, V, VI, and VII, and Part VIII as amended by the Town and Country Planning Act, 1932—31st July, 1931. Surrey County Council Act. 1936 : Parts II, IV, V, VI, and X—31st July, 1936. 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 1934). do. do. Nuisances. do. do. Offensive Trades. do. do. Nursing Homes. do. do. Nursing Homes (Additional), do. do. Hairdressers or Barbers' Premises. Bye-laws with respect to Tents, Vans, Sheds and Similar Structures. 42 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 for Regulating the Employment of Children in the Borough. Bye-laws for the Good Rule and Government of the Borough. Regulations as to the Movement of Sheep. Regulations as to Underground Sleeping Places (Section 18 [i] Housing Act, 1925). Provisional and other Orders affecting the Borough:— Order of Local Government Board, under the Public Health Acts (Amendment) Act, 1907, declaring certain trades to be offensive. Dated 14th January, 1914. Order of Town Council, under Shops Acts, 1912 and 1913, relating to Second-hand Clothes Dealers. Dated 5th November, 1913. The Wimbledon General Half-Holiday Order, 1914. Dated 6th June, 1914. The Wimbledon Credit Drapers' Half-Holiday Order, 1914. Dated 2nd July, 1914. The Wimbledon Barbers' and Hairdressers' Closing Order, 1919. Confirmed 27th October, 1919. The Wimbledon Fruiterers' and Greengrocers' Half-Holiday Order, 1931. Confirmed 15th July, 1931. 43 SANITARY CIRCUMSTANCES OF THE AREA Water.-The Metropolitan Water Board is responsible for the water supply of the Borough. In a great number of houses the drinking water is obtained from a supply tank on the premises. Attention is paid to these tanks by the Inspectors during their house-tohouse visits. The tanks require periodical cleansing, and in many cases it is found that this is not carried out as frequently as necessary. Only in a few instances are the occupiers of houses dependent on an outside water supply, which in each case is situated in the same curtilage. The supply was withdrawn from ninety-nine houses during the year, as follows:—fifty-five by request; thirty-nine owing to arrears of water rates; and five for other reasons. In all cases the houses were inspected and, where found to be occupied, notices were served on the occupiers requesting that the water supply be restored within a reasonable time. In no case was it necessary to apply to the Magistrates for an Order to enforce compliance with the Notice. Rainfall.—The following table gives details of the monthly rainfall in inches in Wimbledon during 1937, together with the mean for each month during the period from 1929 to 1932 inclusive. The rainfall in 1937 was above the average, and was the highest recorded during the last five years. Year. Rainfall in Inches. Total for Year. Jan. Feb. Mar. Apr May June July Aag. Sept. Oct. Nov Dec. Mean for four years 1929-1932 inclusive. 1.73 0.74 0.87 2.21 2.85 l.11 2.14 2.90 2.11 2.44 3.33 1.94 24.37 1933 1.27 2.75 2.36 0.62 2.46 1.56 1.46 0.63 2.95 1.55 0.92 0.34 18.87 1934 1.59 0.24 2.16 2.08 0.46 0.91 2.22 2.34 1.40 1.30 2.04 5.05 21.79 1935 1.11 2.64 0.29 2.90 1.09 3.77 1.30 2.30 2.57 2.90 4.59 2.51 27.97 1936 3.99 1.81 1.08 1.75 0.55 3.15 2.56 0.69 2.18 1.97 3.14 2.14 25.01 1937 3.83 3.90 2.77 1.92 2.30 1.91 0.59 2.80 1.72 2.54 1.38 4.07 29.73 44 Drainage, Sewerage, and Refuse Collection.-All the houses in Wimbledon are provided with adequate water closet accommodation, none of the premises being dependent on closets of the conservancy type. There are only four houses in the district without separate water closet accommodation. Two of these houses are in North Wimbledon and the other two in the southern part of the town. In both instances there is an outside water closet which is used in common. I am indebted to the Borough Engineer and Surveyor for the following information:— “The sewage works are in course of modernisation. A scheme is under consideration for the provision of a further eight or ten filters. This final extension will enable the whole of the present flow of sewage to be dealt with by means of efficient filters. For the past two years regular analyses have been carried out and daily results recorded showing that the filters are discharging very efficient effluent into the River Wandle. A good deal of work has been done during the year in the cleansing and repair of the sewerage system, and closer investigation is being carried out in order to restore, as much as possible, the old sewers to proper condition. Refuse collection is carried on by a fleet of covered motor vehicles. The collection of waste-paper is incorporated with the collection of refuse, with financially beneficial results to the Corporation.” Sanitary Inspection of District.—The following is a statement showing the number and nature of inspections made for the year 1937:— Reason of Visit. No. Infectious Diseases 548 House Inspections 5,279 Inspections under Housing Act, 1936 801 House to House Inspections 2,100 Rent Act Inspections 5 Houses Let in Lodgings Inspections 235 Inspection of Factories, Workshops, Work-places and Out-workers' premises 647 Dairies and Cowsheds Inspections 86 Inspections under Shops Acts 232 45 Reason of Visit. No. Application of Tests to Drains 212 Inspections under Diseases of Animals Acts 6 Obtaining Samples of Foods and Drugs 5 Miscellaneous (including Inspections of food, slaughter-houses, mews, stables, caravans, Petroleum Acts, water supply, piggeries, mosquitoes, etc.) 1,809 Total 11,965 Notices Served.-One thousand four hundred and sixteen preliminary notices or intimations were served in respect of one thousand four hundred and seventy-eight houses. It was found necessary to serve one hundred and eightyone Statutory Notices upon the owners or occupiers of one . hundred and sixty-six houses. The necessary work was executed in all but one hundred and fifty cases. In one hundred and seven of these the work was actually in hand at the close of the year. In two cases legal proceedings were instituted:— (1) Failure to comply with Notices to abate nuisances in respect of two houses. Magistrates ordered that work be completed within fourteen days and awarded £2 2s. Od. costs. (2) Failure to comply with Notice to abate nuisance. Case withdrawn on payment by defendants of 10s. 6d. costs, the work having been completed before the hearing. Seven hundred and forty-three enquiries received from the Town Clerk's Department were replied to regarding eight hundred and fifty-five properties where negotiations for sale were in progress. House Drainage.—The drainage systems and sanitary arrangements of forty-two houses were entirely reconstructed. Extensive alterations or repairs were carried out at eighty houses. At seventeen houses the drainage systems were made water-tight by the patent internal process. 46 Rent (Restrictions) Acts, 1920-1933.—Three applications for inspections under the provisions of these Acts were received. In two cases Certificates were issued. In the third case the owner carried out the necessary repairs before the matter could be brought to the notice of the Sanitary Authority. House-to-House Inspection. — House-to-house surveys were carried out at four hundred and eighty-six houses. The following list shows the particular streets and the number of houses inspected in each:— Belvedere Square 25 Caroline Road 6 Church Road 12 Coppermill Lane 3 Crooked Billet 49 Dryden Road 66 Gladstone Road 20 Hotham Road 41 Lancaster Cottages 8 North Road 58 Quicks Road 88 Ridley Road 13 South Road 64 Wandle Bank 33 486 House Inspection.—As the result of inspections made on complaint, or in consequence of the occurrence of infectious disease, or for other reasons, two thousand four hundred and forty-eight houses were visited. This figure shows an increase of six hundred and thirty-two as compared with 1936. At thirty-one houses, from which cases of notifiable infectious disease had been reported, defective drains or other insanitary conditions were found to exist. All these were subsequently remedied under the supervision of the officers of the Department. The following table gives a summary of the nuisances abated and the sanitary improvements carried out, together with the defects remedied, as the result of house-to-house inspection under the supervision of the Sanitary Inspectors:- 47 Accumulations removed 39 Cisterns provided 12 Cisterns repaired, cleansed or covered 19 Drains, new, provided 42 Drainage systems made water-tight by patent process 17 Drains, repaired or altered 63 Drains, stoppages removed 49 Dustbins provided 168 Flushing cisterns, new, provided 36 Flushing cisterns repaired 48 Manure receptacles provided Rain-water pipes disconnected 2 Roofs repaired 237 Rooms stripped and cleansed 1,022 Verminous rooms cleansed 73 Soilpipes, new, provided 20 Soilpipes, repaired or altered 4 Vent pipes, new, provided 9 Vent pipes, repaired or altered 13 Waste pipes, new, provided 87 Waste pipes, repaired, disconnected or trapped 36 Water-closets, new, provided 89 Water-closets, repaired or ventilated 18 Water services restored 37 Yards paved 26 Yards repaired 59 Guttering repaired 118 Floors ventilated 12 Nuisances from damp walls abated 308 Water supply tap direct from main 9 Sinks provided 47 Rooms fumigated 507 Other nuisances 1,777 Total 5,003 Houses-Let-in-Lodgings.—There are now sixty-nine of these houses on the register. Some of them require constant supervision by the Sanitary Inspectors and for this reason two hundred and thirty-five visits of inspection were made 48 to these premises during 1937. In addition, during the periodical house-to-house inspection, a number of the houses-let-inlodgings were inspected. These visits appear in the report on house-to-house inspection. Common Lodging Houses.—There are now no premises in the Borough registered as Common Lodging Houses. Van Dwellings.—One hundred and twenty-six visits were paid to these van dwellings in South Wimbledon. Earlier in the year twelve sites were occupied by these structures. In December, however, there were nine sites used by van dwellers and these were situated in Trinity and Haydon Park Wards. The water for each site is provided by means of a draw-off tap from the main supply. Each of the sites is also provided with a water closet. In certain cases the sanitary provision is inadequate. Many of the yards are neither paved nor drained. On four of the sites stables are situated, and when these are in use it becomes increasingly difficult to maintain anything like a reasonable standard of sanitation. In consequence of action taken by the local authority the following results were effected:—(a) The caravans were removed from one site and the owner gave an undertaking that the land would not, in future, be used for this purpose; (b) in a second case the caravan dwellers erected a six-roomed dwelling-house on the site and later removed the caravan which had been in use there; (c) in a third case the caravan, which was only in occasional use, was removed from the site. As the result also of action by the local authority three of the seven structures were removed from another site and the owner erected on a part of the land a nine-roomed dwellinghouse. Four old trams, which are all occupied, still remain on this site. Towards the end of the year further action was being taken by the Council in regard to a number of the remaining sites. 49 50 The following table shows the position on 31st December, 1937. Situ. No. of Dwellings. Type. No. Of Families. Occupants. A. C. Total. Adjoining 33, Deburgh Road 4 4 old trams 3 7 4 11 Adjoining 49, Deburgh Road 2 2 motor caravans 2 9 ... 9 Between 84 & 86, Deburgh Road 1 1 motor trailer 1 2 ... 2 Rear of 7, East Road 4 2 caravans 2 4 ... 4 1 motor trailer 1 tent Rear of 11, East Road 1 old tram 1 5 1 6 Rear of 13, East Road 1 caravan 1 1 ... 1 Adjoining 4, Hubert Road 1 caravan ... ... ... ... Rear of 61, Norman Road 3 2 Rly. Coaches 2 6 2 8 1 caravan Adjoining 39, South Road 7 1 bungalow 3 7 3 10 4 caravans 2 trailers Totals 24 15 41 10 51 FACTORIES, WORKSHOPS AND WORKPLACES. 1. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections. Written Notices. 1 rosecutions. Factories (Including Factory Laundries) 162 17 Workshops (Including Workshop Laundries) 419 17 Workplaces (Other than Outworkers' Premises) 21 5 Total 602 39 2. Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects. Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances wider the Public Health Acts:—* Want of Cleanliness 52 52 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other Nuisances 33 33 ... ... Sanitary Accommodation— Insufficient 2 2 ... ... Unsuitable or Defective 15 15 ... ... Not Separate for Sexes ... ... ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s.101) ... ... ... ... Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) ... ... ... ... Totals 102 102 ... ... * Including those specifled in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 51 Outwork in Infected Premises—Sections 109-110 Nil. HOME WORK. Lists received:— Twice in the year 1 Number of Out-workers 1 Once in the year 1 Number of Out-workers 1 Number of Out-workers' premises on Register 39 Number of addresses received from other Councils 30 Number of addresses forwarded to other Councils 3 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 45 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 eight Factory Bakehouses) 20 Boot Repairing 53 Buildei's 19 Coach Builders 2 Cycles 6 Dining Rooms 13 Dressmaking 19 52 Outwork in Unwholesome Premises—(Section 108). Nature of Work instances Notices Served Prosecutions Wearing Apparel — Making, Etc. Others Furniture Repairers 3 Jewellers and Watch Repairers 9 Laundries 18 Millinery 5 Motors 22 Printing 9 Smiths 3 Tailoring 16 Woodworkers 17 Miscellaneous 92 Total 326 OTHER MATTERS. Underground Bakehouses in use at the end of the year 3 Matters notified to H.M. Inspector of Factories:— Failure to affix Abstracts of Act Nil Action taken in mat- Notified by H.M. ters referred by H.M. Inspector Nil Inspector as remedial Reports of action under the Public taken sent to Health Acts. H.M. Inspector Nil Offensive Trades.—There were fifteen fish-frying premises on the register at the end of the year. These were periodically inspected and found to be carried on without nuisance. Disinfection.—The number of rooms disinfected was five hundred and seven, and the number of articles, bedding, wearing apparel, etc., 4,837. Special attention was given to cases of tuberculosis. Whenever such patients were removed to sanatoria, or changed their home addresses, a special visit was paid at the earliest possible moment by one of the Sanitary Inspectors with a view to thorough disinfection of rooms, bedding and clothing being carried out. A considerable amount of disinfection after cancer was also carried out at the request of relatives. Eradication of Bed Bugs.-The number of houses dealt with under this heading was as follows:- 53 Infested. Disinfested. (a) Council houses 5 5 (b) Other houses 66 66 In fifty-one cases the disinfestation was carried out by the Local Authority and in twenty cases the work was done by private persons under the supervision of the Sanitary Inspectors. The procedure adopted is as follows. A careful inspection of the premises is made by one of the Sanitary Inspectors who gives the necessary advice to the occupiers or owners for the eradication of the vermin. After the skirtings, mouldings and picture rails have been eased from the walls or removed, and the floor coverings taken up, either sulphur dioxide or a reliable insecticide is used. When necessary, the paper is stripped from the walls and ceilings and burned. Bedding and clothing are removed to the disinfecting station and treated with steam. Occupiers are further advised to thoroughly cleanse the premises with disinfectant solution and to maintain a careful watch for any stray bugs. Subsequent inspections are made by the Sanitary Inspectors and where necessary the disinfestation process is repeated. When new tenants are to be moved into a Council house an inspection is first made of their premises, bedding and furniture. If evidence of vermin is discovered, disinfestation is carried out prior to the tenants removal. No contractors are employed by the Local Authority for the purpose of disinfestation. Mosquitoes.—As in previous years, the lakes, pools, ditches, and other known breeding places of mosquitoes were efficiently sprayed with paraffin on three occasions. Stable Refuse.—In order to control as far as possible the nuisance arising from flies during the latter part of the summer special attention was paid to stable premises and to allotments where such refuse was being deposited prior to use. Occupiers of stables were warned as to the necessity for frequent removal. Allotment holders were persuaded either to cover accumulations with a layer of clean earth at least six inches deep, or to dig them into the ground as soon as possible. The Inspectors found that the persons concerned were willing to 54 co-operate and in only seven cases was the service of a Notice found to be necessary. Diseases of Animals Acts.—No case of notifiable disease, within the meaning of these Acts, was reported to the Authority during the year. There were, however, a number of Orders made by the Ministry of Agriculture, particularly with regard to outbreaks of foot and mouth disease. A number of enquiries were dealt with by the Department. In a few instances licences for the movement of animals were issued. Foot and Mouth Disease (Packing Materials) Amendment Order, 1926.—Paragraph 1 of this Order states that no hay or straw from any source, which has been used for packing purposes, shall be brought into contact with any animal in Great Britain, or be removed from any premises, except as packing or for the purpose of destruction, or of being returned in a crate or box to the sender thereof for further use as packing. A local firm was found to be contravening this Order by selling and offering for sale packing cases containing packing material. The provisions of the order were explained to the proprietors of the business premises. The facts were subsequently reported to the Local Authority who instructed that a written warning be issued. Shops Acts, 1912-1934.—In addition to general surveys of the shops during holiday periods, and in connection with evening closing hours, two hundred and thirty-two visits were made for the purpose of observing contraventions of the Acts, for advising shopkeepers regarding the Regulations in force, and for the investigation of complaints. In five cases legal proceedings were instituted, with the following results:— (a) Failure to close shop on weekly half-holiday—Fined £1 and 4/- costs. (b) Failure to close shop on weekly half-holiday—Fined 10/- and 4/- Court costs. (c) Failure to close shop on weekly half-holiday—Fined 10/- and 4/- Court costs. (d) Failure to close shop on weekly half-holiday—Fined 10/- and 4/- Court costs. (e) For selling non-exempted articles after the statutory evening closing hour. This was a "mixed" shop. Case proved, but dismissed on payment of 10/- costs. 55 It should be emphasised again that the type of offence most difficult to detect is that in connection with the "mixed" shop, where exempted and non-exempted goods are sold. Observations are kept over long periods without an offence being detected, whilst at the same time it is known that breaches of the Act are being committed. it is more in the nature of an accident that an offender is caught red-handed, and in such a case it is usually followed by a plea of a first offence. The hawkers who come into the district on the weekly half-holiday continue to receive attention, and quite a number received written warnings from the Department that further contraventions would result in proceedings being taken against them. Some difficulty was experienced in connection with canvassers making house to house calls for orders on the weekly half-holiday. In each case the canvasser was warned and a communication was afterwards sent to the employer, setting out details of the contravention. The Shops Act, 1934, which came into operation on the 30th December, 1934, has added considerably to the work of the Local Authority, particularly in connection with the employment of "young persons." An additional duty has been placed upon the Local Sanitary Authority by Section 10 which deals with the health and comfort of shop workers. This section requires the provision of sufficient and suitable sanitary conveniences, washing facilities, etc. In order to comply with the Act it is necessary for a complete inspection to be made of all shops in the district. An additional Inspector was appointed to the Department early in the year and every effort is being made to complete the survey as soon as possible. On the 14th July, 1937, two additional Acts, the Shops Act, 1936, and the Retail Meat Dealers' Shops (Sunday Closing) Act, 1936, received the Royal Assent. The former provides for the application of the Shops Acts, 1912 to 1934 to premises and places where the business of lending books or periodicals is carried on for purposes of gain. The second Act provides, subject to certain exceptions, for the compulsory closing of retail meat trading shops and stalls on Sundays. 56 These Acts came into operation on the first day of January, 1937. The Shops (Sunday Trading Restriction) Act, 1936, received the Royal Assent on 31st July, 1936. It became operative as from 1st May, 1937. As in previous years, the Home Secretary made an Order suspending the operation of the general Early Closing Order from 18th 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 Department. Petroleum Acts.—One hundred and four applications were granted for permission to keep petroleum, ninety-two of these being for the renewal of existing licences. Sixty-three inspections were made of the various premises in respect of which licences had been issued. Fouling of Footways by Dogs.—Only two complaints were received regarding this matter during the year, and they were investigated immediately. As I have pointed out in previous Reports, a considerable amount of time is taken up by the Inspectors in these investigations as the complaints usually refer to a portion of the district without a definite road or place being mentioned. It must be clearly understood that the Bye-laws in force apply only to dogs on a lead. I would again emphasise that the closest co-operation on the part of the general public and dog owners in particular is needed if these Bye-laws are to be made really effective. Employment Agencies.—Visits were paid, at irregular intervals, to the premises of the twelve licensed keepers. Only one breach of the Bye-laws was observed. In this case the occupier had failed to notify change of address, but did so after the Inspector's visit. Employment of Children Bye-Laws.—In connection with the employment of children, observations were made during the year and two hundred and forty-seven breaches reported to the Education Authority. This work is done mainly outside office hours, on Sundays, and public holidays. Further details relating to this matter are given in the Report of the School Medical Officer. 67 Smoke Abatement.—Five complaints of nuisance from smoke were received. It was found that improper stoking was the cause of the trouble. Instructions were immediately given for proper attention to be paid to the fires, and occupiers were also warned of the provisions of the Act in force. It is customary for the Sanitary Inspectors to observe, from time to time, the condition of any chimney likely to be the cause of a nuisance. Rats and Mice (Destruction) Act, 1919.—Sixty-two complaints were received. In investigating a complaint it is invariably necessary for a number of premises to be inspected as it is rarely found that only one house or garden is concerned. I am confident that as the matter is one which is now being dealt with by the Local Authority residents are more eager to seek advice. The usual procedure is for the Inspector to endeavour to ascertain the cause of the infestation and to give advice to the persons concerned as to the best method of dealing with the matter. In a number of eases where it had been suggested that the services of a rat catcher should be obtained it was generally found that this advice was acted upon. Hairdressers and Barbers.—Early in the year the Public Health Committee recommended the Council to make Byelaws for the purpose of securing cleanliness of these premises and of instruments, towels, equipment and materials used in connection with the business. The Bye-laws were confirmed on 4th June, 1937, and became operative on 1st August, 1937. There are fifty-three hairdressers and barbers premises in Wimbledon, to which eighty visits of inspection were paid. At the first visit of inspection a copy of the Bye-laws was handed to the proprietor of each of the premises concerned. In several instances suitable receptacles for hair clippings, etc., had not been provided. The occupiers were requested to rectify this matter. 58 SCHOOLS. Information concerning the sanitary condition of the schools, together with the means adopted to prevent the spread of infectious diseases among school children, is given in the section of the report dealing with the School Medical Service. All the Public Elementary Schools in the district were thoroughly disinfected during the year, the work being done during the Easter, Summer and Christmas Holidays. 59 HOUSING (a) HOUSING STATISTICS FOR THE YEAR 1937. 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) 2,448 (b) Number of inspections made for the purpose 8,574 (2) (a) Number of dwelling-houses (included under sub-head [1] above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 486 (b) Number of inspections made for the purpose 2,100 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses, exclusive of those referred to under the preceding subhead found not to be in all respects reasonably fit for human habitation 1,478 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 1,162 3. Action under Statutory Powers during the year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners Nil (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 166 60 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 163 (b) By local authority in default of owners Nil C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (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 12 of the Housing Act, 1936:— (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 4. Housing Act, 1936.—Part IV.—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 88 (2) Number of families dwelling therein 146 (3) Number of persons dwelling therein 717 (b) Number of new cases of overcrowding reported during the year 9 (c) (1) Number of cases of overcrowding relieved during the year 28 (2) Number of persons concerned in such cases 153 (d) Particulars of any cases in which dwellinghouses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil On 31st December, 1937, the two hundred and fourteen cases of overcrowding found at the original survey had been reduced to eighty-eight. This was effected by overcrowded families obtaining additional accommodation in their present dwellings, by removing to available empty houses, or by the Local Authority re-housing overcrowded families in Council houses whenever suitable vacancies occurred. 61 Of the eighty-eight cases remaining at the end of the year, twenty-three families were overcrowded to the extent of only half a unit (child under ten years), and fifteen others by only one unit. Nine new cases of overcrowding were reported during 1937, of which two were abated before the end of the year. In the remaining seven cases, the overcrowding had occurred prior to the "appointed day," and therefore did not constitute an offence under the Act. The Minister of Health, by an Order dated 26th June, 1936, fixed the 1st July, 1936, as the "appointed day" for Wimbledon for the purposes of Section 62 of the Housing Act, 1936. The effect of this was to require that by the 1st January, 1937, every rent book used in relation to a "dwelling house" should contain a summary in the prescribed form of certain provisions of the Act, and a statement of the permitted number of persons who could occupy the house without causing it to be overcrowded. Overcrowding occurring after 1st January, 1937, with certain exceptions, thus becomes an offence. Up to 31st December, 1937, three thousand three hundred and ninety-five certificates as to "permitted numbers" had been issued by the Department to owners or agents of properties in the Borough. Nine hundred and twenty-nine of these were issued during 1937, and necessitated measurements being carried out in three hundred and five houses. Each applicant was also supplied with a summary of the provisions of the Act as to overcrowding. The provisions of the Act, and information as to the "appointed days," were widely published throughout the district and in the local press in 1936. (b) HOUSING CONDITIONS. Seventy-four houses and one hundred flats were erected by private enterprise during 1937; in addition, eleven houses were converted into twenty-eight flats. According to the Registrar-General's estimate for the middle of 1937, the population in Wimbledon was 58,440 as compared with 58,390 in 1936. As has been previously stated, there is an absence of suitable building sites in Wimbledon for the erection of houses for persons of smaller means. 62 No difficulties were experienced during the year in taking action under the Public Health Acts when dealing with housing conditions. In several instances it was found more practicable to deal satisfactorily with properties by means of negotiations with the owners rather than by taking formal action under the Housing Acts. In the Report for 1936, mention was made of the re-conditioning which was being carried out in a block of buildings comprising forty-eight self-contained flats. By the end of 1937 twenty-four of these flats had been dealt with. Considerable alterations have been made to the sanitary conveniences, additional windows have been provided, and the lighting of the rooms very much improved. The owner has undertaken to complete the work for the whole of the flats within the time given by the Council. In 1937 a block of five dwelling-houses, which were unfit for human habitation, had become empty, the owner having previously given an undertaking to the Council not to re-let them when vacancies occurred. The last remaining tenant was re-housed under arrangements made by the Council. By the end of the year an undertaking was given that these dwellinghouses would be demolished and the site cleared, thus obviating the necessity of the Council making a Clearance Order. 63 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. Four applications were received from persons desirous of being registered under the Milk and Dairies Acts and Orders. Registration was granted in each case. There were on the registers at 31st December, 1937, one cow-keeper, thirty dairymen, twenty-one dairymen and purveyors and twenty-nine retail purveyors. Eighty-six inspections were made of the premises of dairymen and purveyors of milk in the district. Conditions discovered requiring attention were promptly dealt with. Continued attention was paid to the prevention of the bottling of milk in the streets. No action was necessary with regard to tuberculous milk or cattle. The number of licences granted under the Milk (Special Designations) Order, 1936, was as follows:— Pasteuriser's Licence 1 Dealers Licences: Tuberculin Tested Milk 10 Accredited Milk 1 Pasteurised Milk 17 Supplementary Licences 13 Under the provisions of the Milk (Special Designations) Order, 1936, which came into operation on 1st June, 1936, the number of grades is reduced to three, namely, Tuberculin Tested, Accredited, and Pasteurised. Bacteriological Examination.—Fifteen samples of milk were taken for bacteriological examination under the Milk (Special Designations) Order; four were found not to comply wholly with the bacteriological standards laid down. In each ease the dealer was informed of the result of the examination and advised to take adequate steps to comply with the conditions of the licence. Subsequent samples were taken with satisfactory results. 64 Slaughter of Animals Act, 1933.—This Act came into operation on 1st January, 1934. The Act makes the licensing of slaughtermen compulsory. Two licences were granted by the Corporation. Humane slaughtering has been compulsory under the Bye-laws in the Borough for a number of years. Slaughter Houses.—There was one slaughter-house on the register at the end of the year. Very few animals are killed here. The requisite notices are received prior to slaughtering, thus making it possible for complete examination of the carcases to be carried out. Continued attention is being devoted to the Public Health (Meat) Regulations, 1924. One hundred and sixty-six visits were made to the shops of butchers, fishmongers, fruiterers and other premises where food is stored, prepared, or exposed for sale. Unsound Food.—The following were surrendered and destroyed as trade refuse, having been found unfit for human food:— 87 lbs. of beef Bone taint. 13 chickens Decomposed. 3 crabs Stale. 5 boxes kippers Foul-smelling. 1 box oranges Rotting. 12 cwts. potatoes Diseased. 4 stones queens Stale. 2 salmon (21 lbs.) Foul-smelling. In addition to the foregoing, a loaf of bread, sold by a local shop-keeper, was found to contain foreign matter. The case was immediately investigated, and the baker questioned. An examination of the bakehouse and utensils was carried out. Both the shop at which the bread was sold and the bakery were found in a satisfactory condition. The foreign matter would appear to have been contained in the flour which was used. The occupier was recommended to provide a suitable screen to the flour chute, in order to prevent the possibility of a recurrence. In another case, a bag of flour which had been sold was found to be dirty and unfit for food. An inspection of the shop premises led to the conclusion that the trouble was due to carelessness on the part of an assistant. 65 In a further case, a complaint was received as to the condition of preserved ginger sold and being offered for sale. The complaint referred mainly to a shop in a neighbouring district, and a communication was sent to the Public Health Department concerned. Exhaustive enquiries were made, and as the result of the action taken, and the co-operation of the traders concerned, no further complaint was received. Legal proceedings were instituted against one firm for selling cooked meat which was unfit for human consumption. The Magistrates inflicted a fine of £2 2s. 0d., with £2 2s. 0d. costs. 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 1937. ARTICLES analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 43 ... 43 3 ... 3 ... ... Cream 2 ... 2 ... ... ... ... ... Artificial Cream ... ... ... ... ... ... ... ... Butter 6 ... 6 ... ... ... ... ... Margarine ... ... ... ... ... ... ... ... Lard ... ... ... ... ... ... ... ... Meat 8 ... 8 ... ... ... ... ... Flour ... ... ... ... ... ... ... ... Tea ... ... ... ... ... ... ... ... Cocoa ... ... ... ... ... ... ... ... Sugar ... ... ... ... ... ... ... ... Sausages 1 ... 1 ... ... ... ... ... Spirits ... ... ... ... ... ... ... ... Drugs ... ... ... ... ... ... ... ... Orange Squash 1 ... 1 ... ... ... ... ... Lemon Squash ... ... ... ... ... ... ... ... Lemonade ... ... ... ... ... ... ... ... Cornish Cream Sandwich 1 ... 1 1 ... 1 ... ... Sultanas ... ... ... ... ... ... ... ... Totals 62 ... 62 4 ... 4 ... ... 66 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES During 1937, three hundred and four cases of infectious disease were notified. These were eighteen more than in 1936. For several years the incidence of notifiable infectious disease in Wimbledon has been low. Full enquiries were made by the Sanitary Inspectors into the circumstances of each case, and visits were paid to one hundred and forty-four houses for this purpose. Scarlet Fever.—Fifty-five cases of scarlet fever were notified, as compared with one hundred and five in 1936. The attack rate was 0.94 per thousand of the population. Attack Rate. Death Rate. Per thousand of the Population. 1891-1895 4.80 0.02 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 2.44 0.003 1931-1935 1.84 0.003 In one house there were three cases, in three houses there were two eases, and in the remaining forty-six houses one case. Fifty, or 90.90 per cent of the cases were treated in hospital. The disease was in most cases of a mild character, and responded readily to treatment. There was no death from scarlet fever amongst Wimbledon residents. Of the cases notified 60.00 per cent. were children of school age, five to fifteen years, and of these twenty-seven attended the following schools:— Dundonald Junior Girls' and Infants' School 2 Wimbledon Park Junior Mixed School 4 All Saints Junior Mixed School 1 All Saints Girls' and Infants' School 3 Cottenham Park Infants' School 1 Queen's Road Infants' School 3 Pelham Road Infants' School 1 Old Central School 1 Central School 1 Holy Trinity Senior Mixed School 2 67 Private Schools 3 Schools outside the Borough 5 Total 27 Diphtheria.—The number of cases of diphtheria showed a slight increase, there being sixty notifications in 1937 as compared with forty-nine in the previous year. The attack rate was 1.02 per thousand of the population. Attack Rate. Death Rate Per thousand of the Population. 1891-1895 1.06 0.312 1896-1900 1.42 0.208 1901-1905 1.20 0.110 1906-1910 1.42 0.121 1911-1915 1.74 0.104 1916-1920 1.88 0.170 1921-1925 1.68 0.097 1926-1930 1.83 0.027 1931-1935 0.85 0.017 in one house there were three cases, in seven houses there were two cases, and in the remaining forty-three houses, one case. Fifty-nine, or 98.33 per cent. of the patients received hospital treatment. Three deaths occurred, giving a death rate of 0.05 per thousand of the population. Of the cases notified, 63.33 per cent. were children of school age, five to fifteen years, and of these thirty-eight attended the following schools:— Queen's Road Infants' School 4 All Saints Junior Girls' and Infants' School 9 All Saints Junior Mixed School 8 Wimbledon Park Junior Mixed School 1 Old Central School 3 Dundonald Junior Girls' & Infants' School 3 Cottenham Park Infants' School 1 St. Mary's R.C. School 6 Holy Trinity Senior Mixed School 1 Pelham Road Infants' School 2 Total 38 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 68 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. Diphtheria Immunisation. Sessions of the Immunisation Clinic were held every Saturday morning at the Health Centre. A preliminary Schick test is carried out on all children over seven years of age. Immunisation is effected by means of three injections of T.A.F., with a week's interval between the first and second injection, and a fortnight's interval between the second and third. In no case was any unpleasant reaction noted. Eighteen children and four members of the Day Nursery staff were Schick tested. Nine children and three of the staff were found to be positive and then immunised. In all, one hundred and twenty-one children, and three members of the Day Nursery staff, were immunised. Three hundred and sixtyseven attendances were made for this purpose. It is not possible in very many cases to get the parents to attend with the children for a posterior Schick test. It is to be hoped that in the future much more use will be made of this Immunisation Clinic. Advice regarding immunisation is given at all the Welfare Centres, and leaflets are also sent to the parents of all children to be medically examined in the Infants Schools. Smallpox.—There were no cases of smallpox in Wimbledon in 1937. Enteric Fever.—Five cases of enteric fever were notified. In one case, however, the diagnosis was not sustained. The remaining four eases all proved to be due to paratyphoid B infection. Two were removed to the Infectious Diseases Hospital, and one to a general hospital in London, whilst the fourth case was nursed at home. There was no connection between any of these four cases. One patient lived outside the Borough. She was admitted to a general hospital in Wimbledon, where the condition was first diagnosed. In no circumstances could the infection be attributed to water or to any article of food. No death occurred from this disease amongst Wimbledon residents in 1937. 69 Food Poisoning.—Three complaints were received of illness suspected to he due to food poisoning. In one case the patient died, and it was thought that his illness might have been due to the eating of tinned fish. Bacteriological investigations carried out after the post mortem examination were negative in so far as organisms of the food poisoning group were concerned. Samples of the tinned fish were also examined bacteriologically, with negative results. Although this patient died with symptoms of acute gastro-enteritis, the accumulated evidence indicated that food poisoning was not the cause. In another instance, three members of a family became ill after eating fish paste. Pull bacteriological investigation was made. No organisms of the food poisoning group, however, were isolated. Cerebro-Spinal Fever.—No case of this disease was notified during the year. Acute Poliomyelitis.—One case of poliomyelitis occurred. This patient was removed to a general hospital in London, where the case terminated fatally. Encephalitis Lethargica.—One case of encephalitis lethargica was notified. This patient was nursed at home, and subsequently died of the disease. Erysipelas.—Notifications were received in respect of seventeen cases of erysipelas. In ten instances these were nursed at home. One patient requiring removal was treated at the Kingston County Hospital, and six at the Infectious Diseases Hospital at gap Road. There was no death. Influenza.—A considerable number of cases of influenza occurred in 1937. Twenty-seven deaths (six males and twentyone females) were due to this disease. Twenty cases of influenzal-pneumonia were notified during the year. Ophthalmia Neonatorum.—Three eases of ophthalmia neonatorum were notified. They were all treated at home, the nursing being provided by the staff of the District Nursing Association. Fortunately these cases were mild, and no impairment of vision resulted. Malaria, Dysentery, etc. No notification of malaria was received. One patient was notified as suffering from amoebic dysentery. He had returned recently from abroad, and received treatment at the Hospital for Tropical Diseases. 70 Nineteen other cases of dysentery were notified. These were proved, on bacteriological investigation, to be due to infection by the Sonne type of dysentery bacillus. There were many eases of mild diarrhœa occurring at this time. Although only nineteen cases were notified as dysentery, there is on doubt that many of the other patients were suffering from an attack of mild dysentery of the Sonne type. Careful enquiries were made in these cases, but it was impossible to trace the source of the infection of any article of food or drink. Puerperal Fever and Puerperal Pyrexia.—In accordance with the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 and 1928, the Council have an arrangement with an obstetric physician who acts as consultant in this area. This consultant was called in to one case in 1937. Facilities are also available for bacteriological diagnosis. Hospital treatment is provided at the following institutions:— (i) Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith; (ii) Borough of Wimbledon Infectious Diseases Hospital. Two cases of puerperal fever, and five cases of puerperal pyrexia were notified. Four of these patients were removed to the Queen Charlotte's Maternity Hospital Isolation Block, Hammersmith. In addition, two were treated in nursing homes and one was treated at home. In 1936 there were two cases of puerperal fever and seven cases of puerperal pyrexia notified to the Department. There was no death from puerperal sepsis amongst the seven patients notified under the Regulations. The cost to the Council in respect of the patients treated in the Queen Charlotte's Maternity Hospital Isolation Block was £48 16s. 6d., of which amount £22 16s. 9d. was recovered from the patients or their relatives. Under the provisions of the Public Health Act, 1936, cases of puerperal fever are now notifiable as puerperal pyrexia. Non-notifiable Diseases.—The deaths from the non-notifiable infectious diseases during the past eight years have been as follows:— 71 Disease 1930 1931 1932 1933 1934 1935 1936 1937 Measles 10 ... 4 1 3 ... 4 ... Whooping Cough 2 4 ... 3 3 1 ... 4 Diarrhœa (under 2 years) 2 5 4 2 2 3 8 3 Total 14 9 8 6 8 4 12 7 Measles.—Only seven cases of measles came to the notice of the Public Health Department. There wore no deaths. In 1936 information was received of six hundred and fortythree cases, and four deaths were registered as being due to this disease. Whooping Cough.—Whooping cough was again prevalent, ninety cases being notified to the Public Health Department by the Head Teachers of the Public Elementary Schools. Four deaths occurred. Diarrhœa (under two years).—Three deaths occurred from this cause. All these children died in institutions outside the district. The ages at death arc given in the Infantile Mortality Table. 78 TABLE A.—NOTIFIABLE DISEASES DURING 1937. 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 ... 1 1 4 5 18 12 2 9 2 1 ... 55 50 Diphtheria (including Membranous Croup) ... 4 1 3 3 32 6 4 4 3 ... ... 60 59 Enteric Fever (including Paratyphoid) ... ... ... ... ... ... 1 ... 1 1 1 ... 4 3 Puerperal Fever ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Puerperal Pyrexia ... ... ... ... ... ... ... ... 3 2 ... ... 5 2 Acute Primary Pneumonia ... ... 3 ... ... 1 ... 1 1 4 8 8 26 2 Acute Influenzal Pneumonia ... ... ... ... ... ... ... ... 2 3 8 7 20 ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Dysentery ... ... 2 ... 2 2 1 1 3 3 3 3 20 1 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... Erysipelas ... ... ... ... ... ... ... ... 2 1 11 3 17 7 Tuberculosis (all forms) ... ... 1 1 ... 4 3 3 41 19 13 5 90 50 Totals 3 5 8 8 10 57 23 12 68 38 46 26 304 177 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 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria(including Membranous Croup) ... ... ... ... ... 3 ... ... ... ... ... ... 3 Enteric Fever (including Paratyphoid) ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Primary Pneumonia 1 ... ... ... ... ... ... ... ... 1 8 10 20 Acute Influenzal Pneumonia ... ... ... ... ... ... ... ... ... ... 2 15 17 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... 1 ... ... ... ... 1 Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... 1 ... 1 Malaria ... ... ... ... ... ... ... ... ... ... 1 ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis (all forms) ... ... ... ... ... ... ... 1 9 7 11 5 33 totals 1 ... ... ... ... 3 ... 2 9 8 23 30 76 The figures given in this table are those obtained after correction by inward and outward transfers of deaths. 74 Table showing Zymotic Death Rate, the Death Rates from Zymotic Diseases, and Death Rate from Tuberculous Diseases. 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. 1925 1.01 0.00 0.03 0.01 0.00 0.10 0.00 0.08 0.77 1926 0.70 0.00 0.00 0.00 0.00 0.00 0.10 0.00 0.60 1927 0'94 0.00 0.01 0.03 0.00 0.05 0.00 0.03 0.80 1928 1.10 0.00 0.00 0.10 0.00 0.08 0.11 0.03 0.70 1929 1'06 0.01 0.00 0.10 0.00 0.08 0.00 0.05 0.80 1930 0.99 0.00 0.00 0.06 0.00 0.03 0.16 0.03 0.69 1931 0.15 0.00 0.00 0.00 0.00 0.06 0.00 0.08 0.90 1932 0.16 0.00 0.00 0.01 0.01 0.00 0.06 0.06 0.80 1933 0.13 0.00 0.00 0.03 0.00 0.05 0.01 0.03 0.71 1934 0.17 0.00 0.01 0.01 0.00 0.05 0.05 0.03 0.77 1935 0.10 0.00 0.00 0.01 0.01 0.01 0.00 0.05 0.51 1936 0.28 0.00 0.00 0.03 0.00 0.00 0.06 0.18 0.54 1937 0.17 0.00 0.00 0.05 0.00 0.06 0.00 0.05 0.56 * 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. 75 Table showing Ward Distribution of Infectious Cases in 1937. DISEASE. Cases Notified at All Ages. Cases Notified in each Ward. Total Cases removed to Hospital. St. Mary's St. John's Cottenham Park Wimbledon Park Dundonald Trinity South Park Haydon Park Smallpox ... ... ... ... ... ... ... ... ... ... Scarlet Fever 55 8 2 7 10 3 8 6 11 50 Diphtheria (including Mem branous croup) 60 2 2 6 1 9 20 10 10 59 Enteric Fever (including Paratyphoid) 4 ... 2 1 ... ... ... ... 1 3 Puerperal Fever 2 ... 1 ... ... 1 ... ... ... 2 Puerperal Pyrexia 5 ... ... 4 ... ... ... ... 1 2 Acute Primary Pneumonia 26 ... 4 4 2 ... 7 5 ... 2 Acute Influenzal Pneumonia 20 1 2 3 2 3 2 6 1 ... Cerebrospinal Fever ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis 1 ... l ... ... ... ... ... ... 1 Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... 1 ... ... Malaria ... ... ... ... ... ... ... ... ... ... Dysentery 20 1 2 14 ... 2 ... 1 ... 1 Ophthalmia Neonatorum 3 ... 1 ... ... ... 2 ... ... ... Erysipelas 17 ... 1 4 2 1 7 2 ... 7 Pulmonary Tuberculosis 75 0 7 13 7 8 18 9 7 46 Non-pulmonary Tuberculosis 15 1 ... 3 1 4 1 3 2 4 Totals 304 19 •25 59 25 35 65 43 33 177 70 Table showing Number of Cases of Infectious Diseases Notified during each year from 1926 to 1937. Disease 19-26 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Smallpox ... 1 ... 2 2 1 ... 3 ... ... ... ... Scarlet Fever 165 169 126 131 127 75 126 126 130 87 105 55 Diphtheria (including Membranous Croup) 26 52 170 150 140 ... 64 21 47 45 49 60 Enteric Fever 4 4 4 7 ... 1 ... ... ... ... ... 1 Paratyphoid Fever ... 7 6 ... 2 1 2 1 ... 2 2 3 Puerperal Fever 3 1 2 2 4 4 3 2 2 1 2 2 Puerperal Pyrexia ... 9 6 12 9 3 5 3 3 7 5 Acuto Primary Pneumonia 39 42 32 39 23 21 28 22 22 11 21 26 Acute Influenzal Pneumonia 1 9 3 9 1 7 33 20 5 ... 6 20 Cerebro spinal Fever 1 2 1 2 2 1 1 2 ... ... ... ... Acute Poliomyelitis 4 ... 1 ... ... ... ... 1 1 1 ... 1 Acute Polio-encephalitis ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 3 0 1 ... 1 ... 1 ... ... ... 1 1 Malaria ... ... 2 ... ... ... 1 ... ... ... 1 ... Dysentery ... ... ... ... ... ... 1 ... ... 3 1 20 Ophthalmia Neonatorum 3 4 8 1 3 4 7 3 2 1 5 3 Erysipelas 17 24 19 33 29 29 18 29 25 20 22 17 Pulmonary Tuberculosis 48 £6 85 56 56 67 81 70 58 56 53 75 Non-pulmonary Tuberculosis 6 19 14 13 5 13 8 7 16 11 11 15 Totals 320 401 455 457 404 301 18l 312 311 241 286 304 TUBERCULOSIS. Ninety cases of tuberculosis were notified. This figure shows an increase of twenty-six on the number for the previous year. The deaths from tuberculosis were one more than in 1936, the total figure being- thirty-three. Of the twenty-nine deaths from pulmonary tuberculosis, seventeen died outside the district (seven males and ten females). These deaths were transferred to Wimbledon by the RegistrarGeneral. There were four non-pulmonary deaths (two males and two females). One male and one female died outside the district. The causes of death 111 these cases were as follows:— Tuberculous Meningitis 2 Intestinal and Peritoneal Tuberculosis 1 Tuberculosis of the Kidneys 1 At the end of the year there were three hundred and eighty-two cases remaining on the tuberculosis register, two 77 hundred and eighty-two being cases of pulmonary, and one hundred cases of non-pulmonary tuberculosis. The register is revised quarterly as the result of information given by the Tuberculosis Officer of cases in attendance at the Dispensary. An inspection of the home conditions and sanitary environment of every tuberculous patient is carried out by (he staff of the Public Health Department as soon as the notification is received. As the result of the large number of visits which are paid by the members of the sanitary and nursing staff much is done to improve insanitary conditions. Where possible arrangements are made for patients to sleep in separate bedrooms. Disinfectants are supplied free of charge and sputum flasks are available on application at the Public Health Department. Leaflets giving advice as to what precautions should be taken by the patient are also left in the home. Subsequently routine visits are paid by the Health Visitor attached to the Tuberculosis Dispensary, from whom regular reports on the home conditions are received. Information concerning home contacts in attendance at the public elementary schools is forwarded to the School Medical Department, where arrangements are made for their special observation. Similar information concerning contacts under school age is passed to the Health Visitor of the district concerned, in order that special efforts may be made to persuade parents to attend with them at the Child Welfare Centres. In a certain number of cases convalescent treatment is 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 1937, fifty 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. 78 6 L 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 Undor 1 year ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1—5 ... ... ... 1 ... ... 1 ... ... ... 1 1 ... ... ... ... 5 — 10 1 ... 1 ... 1 1 ... ... 2 1 1 ... ... ... ... ... 10 — 15 ... 1 1 ... 1 ... ... ... 1 1 1 ... ... ... ... ... 15 — 20 3 ... ... ... ... ... ... ... 3 ... ... ... ... 1 ... ... 20 — 25 6 3 ... ... ... 3 ... ... 6 6 ... ... 1 2 ... ... 25 — 35 4 12 2 4 ... 6 1 ... 4 18 3 4 ... 5 ... ... 35 — 45 6 8 1 ... 3 1 ... ... 9 9 1 ... 2 3 ... ... 45 — 55 6 1 ... ... 1 ... ... ... 7 1 ... ... 2 2 ... ... 55 — 65 1 2 1 ... ... 1 ... ... 1 3 1 ... 3 4 ... ... 65 and over 2 1 1 1 ... ... ... ... 2 1 1 1 3 1 ... 1 29 28 7 6 6 12 2 35 40 9 6 11 18 2 2 57 13 18 2 75 15 29 4 Totals 70 20 90 33 90 Wimbledon Infectious Diseases Hospital disease Cases admitted Deaths Under 5 Years Over 5 Years Total Under 5 Years Over 5 Years Total Brought forvard from 1936 Scarlet Fever 3 10 13 ... ... ... Diphtheria 3 17 20 ... ... ... Cases admitted in 1937 From Wimbledon— Scarlet Fever 9 41 50 ... ... ... Diphtheria 11 51 62 ... 5 5 ?Diphtheria... ... 2 2 ... ... ... Diphtheria & Chicken-pox ... 1 1 ... ... ... Typhoid Fever ... 3 3 ... ... ... Paratyphoid Fever ... 1 1 ... ... ... Puerpural Sepsis ... 1 1 ... ... ... Puerperal Sepsis (Baby) 1 ... 1 ... ... ... Erysipelas ... 6 6 ... ... ... Measles 1 1 2 ... ... ... Chicken-pox 2 1 3 ... ... ... Whooping Cough 3 ... 3 ... ... ... From Kingston— Scarlet Fever 9 33 42 ... ... ... ?Scarlet Fever 1 ... 1 ... ... ... Diphtheria 5 18 23 ... 2 2 ?Typhoid Fever ... 1 1 ... ... ... Erysipelas ... 1 1 ... ... ... Dysentery 1 1 ... ... ... ... Enteritis ... 1 1 ... ... ... Measles ... 1 1 ... ... ... Chicken-pox ... 1 1 ... ... ... Mumps ... 1 1 ... ... ... From Fulham— Diphtheria... ... 1 1 ... ... ... Totals 49 194 243 7 7 Daily Average Number of Cases in Hospital 22 Average Number of Days in Hospital (per Case)... 37 Total Number of Kingston Cases treated ... 85 The revenue derived from the admission of patients from outside areas since 1919 now exceeds £38,480. Two hundred and ten cases were admitted to the Infectious Diseases Hospital during 1937. As there were thirty-three cases in hospital at the end of 1936, the total number of cases under treatment during the year amounted to two hundred and forty-three. One hundred and fifty-seven of these cases were from Wimbledon, and eighty-five from Kingston. There were thus forty-two fewer eases admitted to the Hospital in 1937 as compared with the previous year. 80 Scarlet Fever.—Ninety-two patients were admitted to hospital suffering from scarlet fever during the year, together with one patient who was found to be suffering from scarlet fever and chicken pox. The following complications were noted amongst the cases under treatment:— Rhinitis 1 Acute Otitis Media 3 Mastoiditis 1 Adenitis 4 Acute Haemorrhagic Nephritis 2 Rheumatism 9 Whitlows 1 The most frequent complication noted was rheumatism. In the majority of cases the rheumatism was slight, and no cardiac complications occurred. One child suffering from suppurative adenitis required three operations before the condition cleared up. Paracentesis was performed when necessary. In all patients with ear complications the discharge had ceased before they left hospital, and hi 110 case had any apparent deafness resulted. Two patients developed acute haemorrhagic nephritis which necessitated a prolonged stay in hospital before complete recovery had taken place. As in previous years, anti-scarlatinal serum was used fairly extensively. Nearly all patients, except those who had the disease in a mild form, received an injection of serum on admission. In most of the cases sulphonamidc preparations were also given, either in conjunction with anti-scarlatinal serum or alone. The results were very gratifying. In a few cases sulphhsemoglobinaemia developed. These symptoms, however, were mild, and rapidly passed off when the sulphonamide preparations were discontinued. There were no deaths from scarlet fever. Two "return" cases occurred. These amounted to 2.19% of the patients discharged. Diphtheria.—Eighty-eight patients were admitted as cases of diphtheria. This was an increase of eighteen on the figure for 1936. Of the eighty-eight admissions, only fifty-seven proved to be suffering from true clinical diphtheria. These latter cases included four children with laryngeal diphtheria. Twelve 81 patients were admitted as the result of positive swabs. They were found to be harbouring bacilli in the nose or throat, but not actually suffering from the disease. Nineteen other patients on admission were found to be suffering from non-diphtheritic infections of the throat. Amongst the fifty-seven clinical cases of diphtheria, paralysis occurred as a complication in fourteen patients. The symptoms of paralysis noted amongst these latter cases were as follows:— Palatal paralysis 11 Ciliary paralysis 6 Pharyngeal paralysis 3 Paresis of legs 7 Paresis of external rectus 2 Tachycardia 1 It will be observed from the above that when postdiphtheritic paralysis occurred, it tended to be rather severe and widespread. The other complications noted amongst the patients admitted to hospital as cases of diphtheria were as follows:— Otorrhcea 2 Otitis Media (without Otorrhoea) 2 Rheumatism 1 Nephritis 1 Seven deaths occurred amongst the eight-eight patients admitted to hospital as suffering from diphtheria. One of these proved not to be due to diphtheria, the clinical symptoms being those of acute hemorrhagic ileo-colitis. Two of the deaths from diphtheria occurred in patients admitted from outside the Borough. It will thus be noted that four Wunbledon patients died from this disease during 1937. One of these was a case of laryngeal diphtheria. Tracheotomy was performed but death ensued from broncho-pneumonia a few days later. As in previous years, three negative swabs were obtained from the nose and throat of all patients prior to discharge. Three patients gave persistent positive swabs from the throat. After the organisms present had been proved to be virulent, the patients were operated on by the oto-laryngologist attached to the hospital and the tonsils dissected out. Negative swabs were then obtained and the patients discharged. No "return" cases of diphtheria were reported during the year. 82 Enteric Fever.—Pour patients were admitted as eases of typhoid fever and one as paratyphoid fever. In two eases, the diagnosis of typhoid fever was not confirmed. The remaining three patients proved to be suffering from a paratyphoid B infection. One of these patients, after discharge, developed acute cholecystitis and was found to be still harbouring the bacilli, although two negative reports had been received prior to his discharge from hospital. He was consequently readmitted. Complete recovery ensued and lie was ultimately discharged free from infection. Dysentery.—Three children suffering from Sonne dysentery were admitted from outside the Borough. One of these cases was an infant suffering from marasmus. The dysentery was of a mild type, and the three children made rapid recoveries. Erysipelas.— Seven cases of erysipelas were under treatment. Six of Ihcse were cases of erysipelas of the face. In one patient the illness followed an operation for mastoid disease. Symptoms of thrombosis of the cavernous sinus developed. This was confirmed by two ear, nose and throat surgeons who saw her. She was treated with sulphonamide and ultimately made a complete recovery. Puerperal Pyrexia.—One patient suffering from puerperal sepsis was admitted to the hospital from a neighbouring maternity home. She responded well to treatment and made a complete recovery. Non-Notifiable Diseases.—Five cases of chicken pox, three of whooping cough, and one of mumps were also under treatment. Three other patients were admitted as cases of measles. One proved to be a case of drug rash. This patient was admitted from a local hospital, where she had been under treatment for recurring attacks of acute pyelitis. Thirty-four patients remained in hospital at the end of 1937. Fourteen of these were suffering from scarlet fever, sixteen from diphtheria, one from paratyphoid, one from measles, and two from dysentery. Hospital Staff.—The health of the staff. on the whole, continued to be satisfactory. There were two eases of scarlet 83 fever and two cases of mild tonsillitis amongst the junior nurses. Nine nurses were Schick tested on joining the staff. Three were found to be positive. They were immunised but left the hospital before they could be re-Schick tested. Five probationer nurses who were immunised the previous year were re-tested and all found to be negative. In concluding this report I should like to express my deep appreciation to the Chairman and members of the Public Health and Maternity and Child Welfare Committees for the consideration and courtesy which they have again shown me during 1937. It is also a pleasure to draw attention to the help and co-operation which I have received from all members of the staff. My thanks are due to Dr. Craig, the Assistant Medical Officer, and Mr. Avis, the Senior Sanitary Inspector. I am indebted to Mr. Taylor, the Senior Clerk, for his assistance in the preparation of this report. From my colleagues in other Departments I have at all times received the most ready assistance and co-operation. I have the honour to be Your obedient servant, HAROLD ELLIS. 84 85 TABLE 1.—Vital Statistics of Whole District during 1937 and Previous Years. YEAR. opulation 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 Non residents registered in the District. of Residents not registered in the District. Number. Rate per 1000 Net Births. Number. Crude Rate. 1924 58,090 763 814 14.01 495 8.5 49 199 59 70 645 11.1 1925 58,170 712 760 13.06 524 9.0 85 199 46 60 638 10.9 1926 58,030 722 807 13.90 479 8.2 83 183 27 33 579 9.9 1927 58,150 671 717 12.30 494 8.4 93 219 37 50 620 10.6 1928 59,070 637 691 11.60 476 8.05 84 240 38 55 632 10.7 1929 59,370 705 759 12.70 573 9.6 81 282 35 46 774 13.03 1930 59.370 691 766 12.90 444 7.4 57 261 38 49 648 10.9 1931 58,840 600 642 10.90 524 8.9 80 280 45 70 724 12.3 1932 59,440 519 667 11.22 506 8.5 68 275 45 67 713 11.9 1933 58,770 389 602 10.24 466 7.9 62 232 30 49 636 10.8 1934 58,450 383 590 10 09 490 8.38 72 255 32 54 673 11.5 1935 58,270 388 600 10.29 482 8.27 67 247 33 55 662 11.3 1936 58,390 393 630 10.78 492 8.42 78 253 32 50 667 11.4 1937 58 440 409 608 10.40 527 9.01 73 300 40 65 754 12.9 86 TABLE II Causes of, and Ages at, Deaths during the year 1937 CAUSES OF DEATH. ALL AGES Net Deaths at the subjoined ages of " Residents" whether occurring within or withoui the District. Totad Deaths whether of 'Residents' oh ' NonResidents' in Institutions in the District. Under 1 year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 j 65 and 45—65 over. All Causes Certified 754 40 1 1 1 5 2 6 19 31 179 469 143 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4. Whooping Cough 4 3 ... 1 ... ... ... ... ... ... ... ... ... 5. Diphtheria 3 ... ... ... ... ... 3 ... ... ... ... ... ... 5 6. Influenza 27 ... ... ... ... ......... ... ... ... ... 1 3 23 7 7. Encephalitis Lethargica 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 8. Cerebro spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system '29 ... ... ... ... ... ... ... 1 8 5 11 4 1 10. Other Tuberculous diseases 4 ... ... ... ... ... ... ... ... 1 2 ... 1 4 11. Syphilis 2 ... ... ... ... ... ... ... ... ... ... ... 2 12. General paralysis of the insane, tabes dorsalis 5 ... ... ... ... ... ... ... ... ... ... 4 1 ... 13. Cancer, malignant disease 130 ... ... ... ... ... ... ... ... 2 4 51 73 28 14. Diabetes 8 ... ... ... ... ... ... ... 1 ... ... 1 6 2 15. Cerebral Haemorrhage 46 ... ... ... ... ... ... ... ... ... ... 12 34 8 16. Heart Disease 193 ... ... ... ... ... ... ... 1 3 5 39 145 17 17. Aneurysm 2 ... ... ... ... ... ... ... ... 1 ... ... 1 18. Other Circulatory Diseases 45 ... ... ... ... ... ... ... ... ... 1 4 40 16 19. Bronchitis 16 ... ... ... ... ... ... ... ... ... ] o 13 '2 20. Pneumonia (all forms) 52 6 ... ... ... ... ... ... ... ... 1 16 29 9 87 TABLE II,—continued CAUSES OF DEATH. All Ages Net Deaths at the subjoined ages of " Residents " whether occurring within or without the District. Total Deaths whkthell of 'Residents' oh 'nonresidents' in Institutions in the Disthict. Under t year. 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—05 65 and over. 21. Other Respiratory Diseases 5 ... ... ... ... ... ... ... ... ... ... ... 5 1 22. Peptic Ulcer 8 ... ... ... ... ... ... ... ... ... 1 3 4 3 23. Diarrhoea, etc. (under 2 years) 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 24. Appendicitis 4 ... ... ... ... ... ... ... 1 ... ... 1 2 2 25. Cirrhosis of Liver 2 ... ... ... ... ... ... ... ... ... 1 ... 1 1 26. Other Diseases of Liver, etc. 4 ... ... ... ... ... ... ... ... ... ... 1 3 1 27. Other Digestive Diseases 10 ... ... ... 1 ... ... 1 ... ... 1 2 5 4 28. Acute and Chronic Nephritis 20 ... ... ... ... ... ... 1 ... ... 1 5 13 3 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal Causes 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 31. Congenital Debility, Premature Birth, Malformations, etc. 25 25 ... ... ... ... ... ... ... ... ... ... ... 3 32. Senility 28 ... ... ... ... ... ... ... ... ... ... ... 28 5 33. Suicide 4 ... ... ... ... ... ... ... ... 1 1 2 34. Other Violence 27 2 ... ... ... ... ... ... 1 2 3 7 12 8 35. Other Defined Diseases 44 1 1 ... ... ... 2 ... 1 1 2 14 22 12 36. Causes Ill-defined or unknown 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... Totals 754 40 1 1 1 ... 5 2 6 19 31 179 469 143 Special Causes (included in No. 35 above). Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Borough of Wimbledon. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1937 Education Committee Chairman: Alderman J. M. Bathgate, J.P. Vice-Chairman: E. Trim, Esq., J.P. Members: Alderman A. W. Hickmott Councillor J. E. G. McSheehy Councillor A. E. Baxter, Councillor Lady Roney, J.P. O.B.E., J.P. Councillor J. P. C. Watson (appointed 17th March, 1937) Mrs. A. Colley Councillor G D Chambers (died 12th may, 1937) (appointed 22nd Sept., 1937)Mrs. H.A. Crowe Councillor A. A. Drake, J.P. (appointed 17th Feb., 1937) Councillor E. Fielder Mrs. D. pEATTIE Councillor G. Frost E. R. H. Dicken, Esq. (died 27th June, 1937) Bernard Ely, Esq. Councillor G. H. Groves (resigned 17th March, 1937)A. Mclvor, ESQ. Councillor W. E. Hamlin W. Mitchell Esq. Councillor W. E. Hamlin (dled 21st January, 1937) Councillor W. B. James, J.P. Rev. A. M. Paterson Councillor W. A. Lines (appointed 17th Feb., 1937) Rev. Canon A. H. Phelips 89 STAFF (a) Whole-time Officers: School Medical Officer-. Harold Ellis, M.B., B.S. (Lond.), M.R.G.S., L.R.C.P., D.P.H. Assistant School Medical Officer: Effie M. D. Craig, M.B., Ch.B. School Dental Surgeon : * A. MacGregor Whyte, L.D.S., R.F.P.S.G. Health Visitor—School Nurses: * (6), (d), (/). Miss V. B. Woodroff * (a), (b), (e). Miss A. Thompson * (a), (6), (e). Miss P. N. Nash * (a), (b), (c), (e). Miss J. C. Moffat Senior Clerk Public Health Department: * A. L. Taylor. Dental Attendant: Miss C. O'Hara. School Medical Clerk: Miss C. Coysh. (b) Part-time Officers: Orthopcedic Surgeon : R. J. Furlong, F.R.C.S. Surgeon to Aural Clinic: R. J. Cann, M.S. Oculist: A. D. Belilios, M.B., M.R.C.S., D.P.H. Ancssthetist: S. Taylor Harris, M.R.C.S., L.R.C.P. * Maternity and Child Welfare Officers. + Public Health Officers. (a) S.R.N. (b) S.C.M. (c) Certificate of Fever Training. (d) Certificate San. inspect. (e) New Health Visitors Certificate H.S.I. (/) Diploma Board of Education (Health Visitors' Training) Regulations, 1919. 90 Borough of Wimbledon. Education Committee ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER FOR THE Year ended 31st December, 1937 To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Annual Report for the year 1937 on the work of the School Medical Department. There are sixteen public elementary schools under the control of the Local Education Authority, providing accommodation for 5,714 children. This figure includes the accommodation for fifty children at the Special School, Queen's Road. The average number of children on the school registers during the year ended 31st March, 1937, was 4,706. The average number in attendance was 4,159. This gives an average attendance of 88.37 per cent. 1. STAFF. Full particulars of the staff of the School Medical Service are given at the commencement of this report. 91 2. CO-ORDINATION. There are four School Nurse-Health Visitors on the staff each devoting one half of her time to the School Medical Service. Their districts for health visiting are arranged so as to include, as far as possible, the schools for which they are responsible as school nurses. Full particulars of this reorganisation were given in the report for 1936. This has ensured a close co-operation between the School Medical Service and the Maternity and Child Welfare Department. The School Medical Department with its Ophthalmic, Dental, Minor Ailment, and Orthopedic Clinics is centralised in the Health Centre at Pelham Road, and two of the three Maternity and Child Welfare Centres in the Borough are conducted in this same building. When any of the children attending the Maternity and Child Welfare Centres or the Day Nursery attain the age of five years, their medical records are forwarded to the office of the School Medical Department in order that they may be incorporated with their school medical inspection cards. The School Medical Service in Relation to Public Elementary Schools. 3. SCHOOL HYGIENE. The sanitary condition of the Public Elementary Schools in Wim'bledon continues to be satisfactory. An additional building for Special Subjects has been provided at the Boys' and Girls' Central School. This building contains a Handicraft Room, a Domestic Subjects Room, two Science Rooms, and two Art Rooms. At St. Mary's R.C. School two classrooms were enlarged and a hot-water heating system was installed in some of the other classrooms. In the Dundonald Road School an additional window was provided in one of the classrooms and the step flooring was removed from two other classrooms and replaced by level floors. Internal decoration was carried out throughout the whole of the Queen's Road Schools, including the Special School, Domestic Subjects Centre and Manual Training Centre. A hot-water supply was provided for the lavatory basins in the 92 cloakrooms of the Infants Department. Improvements were also carried out to the electric lighting of the classroom formerly used as a hall in the Senior Girls' Department. A further portion of the tar-paved playground was re-laid and the old cinder portion tar-paved. At the All Saints Junior Girls' and Infants' School the electric lighting was improved in two of the classrooms. A new stove was installed in the babies' room at the Cottenham Park School. Improvements were carried out to the tar-paving of the playground at the Wimbledon Park School with a view to preventing rainwater accumulating. With regard to equipment, wallboards were provided for classrooms in the following schools:— Dundonald Road Junior Boys' ... one classroom Dundonald Road Junior Girls' and Infants' one classroom Wimbledon Park two classrooms Cottenham Park one classroom Forty-eight dual table desks with flat tops and ninety-six chairs for use with these tables were provided in the All Saints Junior Girls' and Infants' School to replace old dual desks. 4. MEDICAL INSPECTION. (a) The children medically examined were those in the three groups required by the Code of the Board of Education. These included:— (i) Entrants: i.e., tho'se children admitted to school for the first time since the last routine medical inspection. (ii) Second Age Group: i.e., those children who have attained their eighth birthday since the last routine medical inspection, or who will be nine years of age during the current year. (iii) Third Age Group: i.e., those children who have attained their twelfth birthday since the last routine medical inspection, or who will be thirteen years of age during the current year. (iv) Children in an additional Age Group were medically examined in the Boys' and Girls' Central School. These were scholars who had attained the age of fourteen years during 1937. 98 There were medically inspected in the schools during the year 1937:— Entrants 604 Second Age Group 500 Third Age Group 458 Fourth Age Group 136 Total 1,698 In addition there were one hundred and fourteen other routine inspections in the schools, making a total of 1,812. Apart from these routine inspections there were 2,728 special inspections and 6,237 re-inspections carried out at the Health Centre. The total number of routine and non-routine medical inspections during the year, excluding the 6,237 re-inspections, amounted to 4,540. The number of children examined at the routine inspections in the schools shows an increase of seventy-seven as compared with the figure for the previous year. This is largely due to the medical inspection of the one hundred and thirty-six scholars at the Central Schools in the fourteen year age group. It was again necessary to check off from the school registers all children clue to be examined in the second and third age groups. This ensured that no child who was due to be examined was missed at the routine inspections. This has been found advisable owing to the transfer of scholars which takes place every year as the result of the re-organisation of the schools. The number of special inspections and re-inspections at the Health Centre shows an increase of one thousand two hundred and forty-six. (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. The reorganisation of the schools has resulted in improved facilities for inspection. Whereas in former years it has been necessary in some instances to carry out this work in premises situated near at hand, it is now possible for the medical 94 95 inspections to take place in those schools. The only exception is St. Mary's R.C. Mixed and Infants School at Russell Road. As this school is quite near the Pelham Road Health Centre, the medical inspection of these scholars is carried out there. The Head Teacher's room is utilised for this purpose in twelve of the schools, staff rooms in two others, and in the two remaining schools a classroom is available. 5. FINDINGS OF MEDICAL INSPECTION. In Table IIa (which is given in the Appendix) a list of all defects found during medical inspection, whether routine or non-routine, is shown. Table Ic gives the number of individual children found at the routine medical inspections to require treatment, excluding defects of nutrition, uncleanliness and dental diseases. There were 1,812 children examined at the routine medical inspections. Two hundred and thirty-six, or 13.02% were found to be suffering from defects (excluding defects of nutrition, uncleanliness and dental diseases) requiring treatment. The figures relating to the number of defects found in the various age groups are given in Table Ic in the Appendix. Among the 2,728 children specially examined there were found 1,621 defects requiring treatment and one hundred and forty-nine requiring to be kept under observation. Although the character of the defects ascertained varies somewhat from year to year, on the whole, the health of the school children in Wimbledon showed no apparent change as compared with 1936. (a) Malnutrition. Malnutrition again received special attention during 1937. Table IIb gives a classification of the nutrition of those inspected in the routine age groups. Of the 1,812 children examined as routines the nutrition was found to be bad in four cases, or 2.20 per thousand of those inspected. The nutrition was slightly subnormal in eighty-three children, or 45.80 per thousand of those examined as routines. These figures are based on the lines laid down in Administrative Memorandum No. 124 dated 31st December, 1934, and correspond very closely to those obtained during the previous year. 96 The table given below indicates the extent of malnutrition discovered at the routine inspections. Age Groups. Number of Children Inspected Classification. C (Slightly Subnormal) D (Bad) Number Found % Number Found % Entrants 604 32 5.29 2 0.33 Second Age Group 500 25 5.00 1 0 .20 Third Age Group 458 22 4 80 1 022 Other Routine Inspections 250 4 1.60 ... ... Total 1812 83 4 58 4 022 (b)Uncleanliness. Since 1933 a record of every unclean child found by the nurses in their inspections has been kept, no matter how slight or trivial the degree of uncleanliness. At present, the standard in Wimbledon is undoubtedly high. At the routine medical inspections only three children, or 0.16% of those examined were found to be unclean and excluded from school. During 1936, one child, or 0.05% of those examined as routines 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 MidSummer 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 13,200. On an average, the nurses paid seven visits to each school. The total number of individual unclean children found by the nurses during their systematic inspections of the schools during .1937 amounted to three hundred and sixty-one. During 1936 the number was four hundred and sixteen. 97 Clothing and Footgear. The standard of clothing and footgear of the children on the whole continued to be satisfactory. Cases are, of course, always arising where the parents, through unemployment or poverty, find it difficult to provide adequate and satisfactory clothing and footgear for their children. It was possible to help a number of these cases during 1937. Boots and shoes, together with garments suitable for school children, which were no longer considered serviceable at the Infectious Diseases Hospital were again passed over to the Attendance Department after thorough disinfection had been carried out. These were then distributed to the most needy families. Assistance of this nature was also granted by the local branch of the Invalid Children's Aid Association. (c) Minor Ailments and Diseases of the Skin. The minor ailments found at the routine and special inspections are indicated in Table II. Ringworm of the body, scabies, impetigo, other skin diseases, minor injuries, diseases of the ears and eyes (including otorrhoca and blepharitis) together with miscellaneous conditions such as sores and chilblains were the common ailments detected. Of the children examined as routine cases in the schools, 0.82% were found to be suffering from skin diseases. Six were suffering from impetigo and eight from other minor skin ailments. Three hundred and sixty-five, or 13.37% of the special cases examined at the Health Centre were discovered to be suffering from diseases of the skin. There were one ease of ringworm of the scalp, twenty cases of ringworm of the body, nineteen cases of scabies, one hundred and twenty-seven of impetigo, and one hundred and ninety-eight of other skin conditions. Ringworm of the scalp is not of frequent occurrence amongst school children in Wimbledon. (d) Visual Defects and External Eye Disease. There were eight cases of external eye disease amongst the 1,812 routine children examined. This gives a figure of 0.44%. Six of the cases were due to blepharitis and two to conjunctivitis. At the special inspections there were seventy-four cases or 2.71% due to external eye disease. Forty-four were due to blepharitis, and thirty to conjunctivitis. 98 Serious conditions such as keratitis and corneal opacities are fortunately not common amongst the school children in Wimbledon. Defective vision is one of the most important defects discovered. At the routine medical inspections, sixty children were found to be suffering from defective vision requiring treatment, and eight to be suffering from squint. This makes a total of sixty-eight cases requiring treatment or 3.75% of the children examined. The figure for the previous year was 5.47%. The actual incidence of defective vision requiring treatment is, however, higher than 3.75%. Of the 1,812 children examined as routine cases six hundred and four were entrants and in the majority of these it was impossible to carry out subjective visual tests on account of their age. In addition, one hundred and nine children with slighter degrees of defective vision were found at school. These cases did not require treatment but required to be kept under observation. Of the children examined as special cases at the Health Centre there were fifty-one with defective vision and four with squint requiring treatment, and twelve 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. 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. (d) Nose and Throat Defects. At the routine medical inspections there were twenty-two cases of enlarged tonsils, one case of adenoids, twenty-four eases of adenoids with enlarged tonsils, and two cases with other conditions of the nose and throat requiring treatment. Thus out of 1,812 children examined in the routine way, forty-nine or approximately 2.70% were found to need operation. In addition, there were sixty-seven other children or 3.69% with defects of the nasopharynx, most of them suffering from enlargement of both tonsils and adenoids. At the Health Centre eighty-five cases were found on special examination to require treatment for these conditions. (f) Ear Diseases and Defective Hearing. At the routine inspections three children were found to be suffering from defective hearing, three from otitis media, and one from other ear disease, all requiring treatment. There were also one child 99 with defective hearing, and one with otitis media requiring to be kept under observation. In other words 0.49% of the children examined in the schools were found to be suffering from defective hearing or from discharging ears. Furthermore, five children with defective hearing, fifty-five with otitis media, and thirty-five with other ear diseases, all requiring treatment, were examined as special cases at the Health Centre. (g) Dental Defects. At the routine inspections by the Medical Officer one hundred and ninety children, or 10.48% of the children examined, were found to have dental caries to such an extent as to require treatment. During the year 1936 the percentage was 9.51. Amongst the 2,728 children who attended the Health Centre as special cases, twenty-nine were found to lie suffering from dental defects requiring treatment. (h) Orthopaedic and Postural Defects. At the routine inspections fifteen cases of deformity due to previous rickets were discovered. Seven of these cases required treatment and eight required to be kept under observation. In addition there were five cases of spinal curvature, two requiring treatment and three requiring to be kept under observation. There were also thirty-seven other cases of orthopaedic and postural defects, twenty-seven of which required treatment and ten required to be kept under observation. At the special inspections at the Health Centre two cases of deformity due to previous rickets were detected, both requiring treatment. Thirty-two other cases of orthopaedic and postural defects were found at these inspections, twentyeight of which were referred to the Orthopædic Clinic and four kept under observation. The conditions found at the routine and special inspections, and classified under "other deformities," were due to flat foot, knock knee, congenital deformities, deformities due to old injuries, etc. (i) Heart Disease and Rheumatism. Particulars regarding children suffering from heart defects at the routine and special inspections are shown in Table IT. Amongst the routines, six children with organic disease of the heart requiring treatment and four children in which the condition was quiescent and required to be kept under observation were found. One child with chorea requiring treatment and six children with functional heart disease requiring observation were also discovered. 100 At the special inspections one of the children examined was found to have organic disease of the heart, and one functional heart disease. Both these eases required treatment. In addition, two children were found to be suffering from chorea requiring treatment and one requiring observation. Most of the cases of organic disease of the heart occurring amongst school children are of rheumatic origin. A few are due to congenital heart disease. Special attention was again devoted to the incidence of rheumatism. The figures given below do not accurately indicate the incidence of rheumatism amongst school children. In the routine inspections, unless the parents are present, and in the absence of any abnormality of the heart, it is obvious that the mildest and most insidious forms of rheumatism are easily missed unless the child itself complains to the doctor of "growing pains" or symptoms of a similar nature. Amongst the 1,812 children examined as routines, nine, or 0.49% were found to be suffering from rheumatism in its milder and sub-acute forms. In the case of the 2,728 special inspections there were twenty-eight children, or 1.02%, with symptoms of rheumatic disease. (j) Tuberculosis. Cases of tuberculosis are not frequently found amongst school children in Wimbledon. During 1937 one suspected case of pulmonary tuberculosis was discovered at the routine inspections. In addition, two children with tuberculosis affecting the bones and joints were found, one requiring treatment and one requiring to be kept under observation. One case of tuberculous glands was found amongst the 2,728 children examined at the special inspections. All suspected cases are referred to the Tuberculosis Physician between whom and the School Medical Staff a close co-operation exists. (k) Other Defects and Diseases. A considerable number of children were found at the routine and special inspections to be suffering from conditions not designated as specific defects in Table II. These conditions are shown in the Table under the heading "Other defects and diseases." Many of these conditions were due to colds, influenza, and infectious diseases. There were also many children found to be suffering from debility, gastro-intestinal disturbances, slight accidents, chilblains, and other minor ailments. 101 Additional Age Group at Central School. The Education Committee decided in 1937 to provide for the routine medical inspection of an additional age group in the Boys' and Girls' Central School. As stated earlier in the Report, the children examined were those who had attained their fourteenth birthday during the year. The total number inspected in this group amounted to one hundred and thirty-six. 1 he defects found amongst these scholars were as follows:— Requiring Treatment. Requiring Observation. Blepharitis 1 — Defective vision 3 10 Other eye conditions 1 — Enlarged tonsils — 7 Dental defects 5 — Minor orthopaedic defects 4 1 Other defects and diseases 1 1 Total 15 19 These defects are included in the figures shown in Table II. It would appear that the routine medical inspection of this additional age group has been amply justified. 6. FOLLOWING UP. The procedure of following up defects discovered during the routine medical inspection in 1937 was as follows:— Parents were informed of the defects detected in their children during the routine medical inspections in the schools. Where the defects were 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 reexamination card was made out for each such child. As soon as possible after the inspection of the school had finished the nurse returned to the school with the re-examination cards of those children whose defects required special attention. When necessary, home visits were also paid to such cases and the parents interviewed. The Medical Officer visited each school in the district twice during the year in order to carry out the routine medical 102 inspections and twice to conduct the re-inspection of children who had been previously found to be suffering from defects. Six hundred and thirty-seven of these latter re-inspections were undertaken in 1937, special re-examination cards being utilised for this purpose. The particulars of every child for whom glasses have been prescribed are also entered up on a special eye card. These cards are also taken to the school at each re-visit of the medical inspector. In all three hundred and forty reinspections of such children were carried out. Lastly, a special record is kept of delicate children, children suffering from heart disease, rheumatism and similar conditions. These children are also re-examined during the Medical Officer's re-visits to the schools. During 1937 one hundred and eighty-two such re-inspections were conducted. 7. ARRANGEMENTS FOR TREATMENT. Table IV gives a return of the defects treated during the year under arrangements made by the Education Committee. (a) Malnutrition. As in 1936 two surveys were carried out in the schools with a view to detecting further cases of malnutrition amongst the children. One of these surveys was held in the Spring and the other in the Autumn. Special attention was also paid to the nutrition of the children during the routine inspections and also during the special inspections at the Health Centre. As the result of these inquiries one hundred and two children were provided with free milk in school by the Education Committee after full investigation of the family circumstances had been carried out. These children were re-examined and weighed every three months and full particulars of their cases entered up on special cards. In the majority of cases the provision of free milk was extended for further periods during the year. Only pasteurised milk was supplied in the schools. Where the special Sub-Committee dealing with these cases was of opinion that the financial circumstances of the families were such that they were able to provide the milk for the children themselves letters were sent out requesting the parents to make the necessary provision. These cases were also followed up in the schools by the School Nurses. In a small number of cases the excuse was given that the children were not able to take milk. On the whole, however, 103 the scheme has worked well and the majority of the children showed a satisfactory gain in weight. (b) Uncleanliness. The Education Committee have, for a number of years, made arrangements for the cleansing of children with unclean heads at the Health Centre. A cleansing room has been equipped with all the necessary facilities for this work, which is carried out by the nursing staff. During 1937, seventy-two children were cleansed at the Health Centre. This represents a decrease on the figure of one hundred and thirty-three for the previous year. It is felt that no child should be cleansed at the Health Centre unless the mother, on account of illness or other bona fide reasons, is unable to carry this out herself. Many cases, however, have been dealt with at the Health Centre in order to minimise the long absence from school which is often caused by this trouble. No legal proceedings under the Education Act, 1921, or the Attendance Byelaws, were taken against the parents of such children during 1937. Forty-one warning letters, however, were sent and these produced the desired effect. (c) Minor Ailments and Diseases of the Skin. The work of the Minor Ailment Clinic at the Health Centre is shown in Table IV. This Clinic is well attended. The number of defects dealt with was nine hundred and sixty-five, an increase of one as compared with the figure for the previous year. A school nurse is in attendance at this clinic daily, including Saturdays, from 9 to 11 a.m. The Committee have made arrangements for the treatment of children with ringworm of the head by means of X-rays at the St. John's Hospital at a cost of £1 10s. Od. per case. The parents are required to contribute according to their circumstances. One child with ringworm of the scalp, twenty children with ringworm of the body, nineteen with scabies, one hundred and thirty-one with impetigo and one hundred and ninety-two with other diseases of the skin received treatment at the minor ailment clinic. (d) Visual Defects and External Eye Disease. Details of the work of the Refraction Clinic are given in Table IV, Group II. This clinic is held every Monday afternoon from 2 to 4. Occasionally during the year it is necessary to hold further sessions on Wednesday afternoons. 104 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) 100 Old Cases (re-examinations) 172 Re-attendances 233 Total 505 During 1936 the number of attendances amounted to seven hundred and eighteen. As has been mentioned in section 6 of the Report the children attending the Refraction Clinic are now followed up in the schools by the school medical inspector and appointments to re-attend at the Refraction Clinic are arranged as the result of these re-examinations. This has lessened to a great extent the congestion which formerly occurred at this clinic when children automatically returned at the end of a certain period. Glasses were prescribed in one hundred and sixty-seven cases, and the following table indicates the errors of refraction found. Hypermetropia 17 Hypermetropia and Astigmatism 50 Hypermetropic Astigmatism 15 Myopia 19 Myopia and Astigmatism 41 Myopic Astigmatism 4 Mixed Astigmatism 21 Included in the above table are fifteen children whose degree of myopia was found to be greater than minus four dioptres. Where necessary, instructions were sent to the Head Teachers of the schools which these children attended, modifying the curriculum with a view to preventing the condition becoming more marked. Similar advice was also given to the parents. Children suffering from myopia are re-examined at the clinic on an average twice a year. In the case of children with high myopia, arrangements are made for them to attend a myope or sight-saving school when the degree of short sight is found to be increasing. Two such children were admitted to myope schools during 1937. In very few instances is difficulty experienced in persuading parents to provide spectacles for their children. The 105 assistance of the N.S.P.C.C. is of the greatest help in dealing with such parents. Two children suffering from squint were referred from the Refraction Clinic to hospital for operative treatment. The following defects were discovered amongst the children attending this clinic during 1937:—old choroiditis, congenital nystagmus, phlyctenular conjunctivitis, nystagmus and partial optic atrophy. One hundred and nine children with external eye disease received treatment at the Health Centre. A few of the more serious cases were referred to the Oculist at the Refraction Clinic. Many of these children 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 it 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. 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. No child of school age was referred for treatment under this arrangement in 1937. (e) Nose and Throat Defects. Four children were operated on for enlarged tonsils, and fifty-three for enlarged tonsils and adenoids during 1937 at the Nelson and 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, one child was operated on for enlarged tonsils privately. This makes a total of fifty-eight children who received surgical treatment. It will thus be seen that forty-one fewer children were submitted to operation for the removal of tonsils and adenoids during 1937 as compared with the previous year. Where children are operated on under the Education Committee's Scheme the cost to the Local Authority is £1 6s. Od. for each case. This includes the operation, the 106 anaesthetist's fee, and one night in hospital. In a number of cases it has been found necessary to keep the children in hospital for a longer period. Under such circumstances the Committee has made a payment of 2/6 for each additional day. In all, nineteen children have been maintained in hospital for eighty-seven additional days at a cost of £10 17s. 6d. The parents contribute towards the cost in accordance with their financial circumstances. Where they have been unable to afford this, financial assistance has been granted by the Invalid Children's Aid Association. Full details are outlined in Table IV., Group III. (f) Ear Diseases and Defective Hearing. Eighty-six children with minor ear defects were treated at the Health Centre. As indicated in the Report for 1936, the Committee agreed to establish an Aural Clinic in charge of a consulting ear, nose, and throat surgeon. Mr. R. J. Cann, who is on the staff of Guy's Hospital, was appointed for this purpose at a fee of three guineas a session. The necessary equipment was obtained and the first session was held at the Health Centre in September and once a month during the remainder of the year. The following table gives an indication of the work carried out at this Aural Clinic:— Total number of sessions 4 Average number of children attending per session 15 Total number of individual children seen 43 Total number of attendances made 60 Number of individual children referred for treatment to minor ailment clinic 16 Number of individual children referred to hospital for operative or other treatment 7 The Education Committee decided to hold this Aural Clinic in association with the Maternity and Child Welfare Committee and particulars of the attendances of children below school age are given in the report of the Medical Officer of Health. (g) Dental Defects. The routine dental inspections include all the children attending the public elementary schools. In 1937 there were 4,157 children dentally inspected in the routine age groups. A further four hundred and twenty-eight 107 children were inspected as special cases. The total number of children thus examined amounted to 4,585. This represents a decrease of four hundred and eighty on the figure for 1936. There were 3,313, or 72.25%, found to require treatment and their parents were notified accordingly. During the previous year the figure was 68.35%. The number of children actually treated was 1,771, or 53.45% of those 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 sessions continue to show a good average attendance. Forty-three half days were devoted to dental inspection in the schools and three hundred and sixty-four half days to treatment at the Health Centre. The number of attendances made by children for treatment amounted to 3,826. This is ninety-two fewer than the figure for the previous year. The average number of children attending for treatment per session was 10.51, a slight decrease as compared with the figure of 11.59 for 1936. The total number of fillings amounted to 2,541 or eightynine less than during the previous year. The number of teeth extracted shows a decrease of two hundred and ten, the total figure for the year being 2,979. Seven hundred and forty-nine general anaesthetics were administered for dental extractions, an increase of thirteen as compared with the figure for 1936. It will be noticed that very little time is now devoted to the filling of temporary teeth, only fourteen being filled during the year. It is considered essential to devote as much of the available time as possible to the preservation of permanent teeth. (h) Orthopaedic and Postural Defects. Sessions of the Orthopaedic Clinic were held every month with the exception of August. Sixty-one new cases were seen and one hundred and ninety re-examinations were carried out. The average number of children seen by the Orthopædic Surgeon per session was twenty-three. During the previous year the figure was thirtythree. 108 The following table shows the nature of the defects from which the children were suffering. Infantile Paralysis 2 Trauma 12 Deformities due to previous Rickets 11 Spinal Curvature 7 Tuberculous joints (arrested) 1 Tenosynovitis 2 Flat foot, knock-knee, pes cavus, etc. 42 Postural defects 59 Internal derangement of knee joint 5 Torticollis 2 Other congenital defects 5 Other defects 10 Total 158 An indication of the treatment carried out through this Clinic is given hereunder :— Number of children referred for in-patient treatment at Pyrford 3 Number of children referred to St. Thomas's Hospital for out-patient treatment 7 Number of children referred to St. Thomas's Hospital for in-patient treatment 6 Number of children referred to St. Thomas's Hospital for X-ray examination 2 Number of children transferred to P.D. Schools 1 Number of children referred for alterations to surgical boots, etc. 13 Number of children referred for exercises and massage at the Health Centre 36 Total 68 The Orthopaedic Nurse attended seventy-seven sessions at the Health Centre in order to carry out the remedial exercises and massage. Thirty-six children were referred by the Orthopædic Surgeon for such treatment. Five hundred and fifty-six attendances were made. The average number of children attending at each session for exercise and massage was 7.2. 109 Cases requiring prolonged treatment are sent to Pyrford, whilst children who only require a short period in hospital for operative treatment are referred to St. Thomas's Hospital. The volume of work at the Orthopaedic Clinic has remained about the same as in previous years. Three children, suffering from congenital internal rotation of the tibia, pes planus, and spinal curvature respectively, were referred from the Orthopaedic Clinic to Pyrford for operative treatment. The child suffering from pes planus was subsequently admitted to St. Thomas's Hospital for in-patient treatment. During the year five other children were admitted to St. Thomas's Hospital, two suffering from torticollis, and the other three from congenital club foot, congenital bilateral talipes equinus, and recurrent dislocation of the patella respectively. In addition, one child suffering from osteomyelitis of the lower end of the left femur was admitted to Pyrford. This child had been under treatment at one of the London hospitals for some months and it was considered advisable for her to have education as well as treatment while recovering from the operation. A girl with chronic septic osteomyelitis of the right ilium was transferred from Pyrford to the Heritage Craft Schools at Chailey. Seven children were referred to the Orthopædic Out-patient Department at St. Thomas's Hospital for treatment, and two for X-ray examination. Thirteen children were referred for alteration to surgical boots, etc. The simpler forms of alteration, such as wedging, are carried out locally, as it is found that this saves the parents a considerable amount of time and expense. Thirty-six children were referred by the Orthopaedic Surgeon to the Exercises Clinic at the Health Centre, which is attended by the Orthopaedic Nurse every week. Most of these children were suffering from flat foot, postural defects, etc. They are reexamined from time to time by the Orthopaedic Surgeon. The attendances at this Clinic on the whole were good. Many of the children seen by the Orthopaedic Surgeon are referred by the School Medical staff for diagnosis. This ensures early treatment being secured. Suitable after-care is provided for children discharged from hospital. These cases are referred back to the Ortho- 110 pædic Clinic and in most instances receive further remedial treatment at the Exercises Clinic. The work relating to children below school age is indicated in the section of the Annual Report dealing with the Maternity and Child Welfare Department. (i) Heart Disease and Rheumatism. Children suffering from heart disease and rheumatism are sent to Certified Special Schools for treatment when necessary. Two children suffering from rheumatism were sent to the following institutions during the year by the Education Committee:— St. John's Open-Air School, Woodford Bridge 1 Brooklands Home, Worthing 1 Another child, suffering from congenital heart disease, was admitted to the Frogmore Road School for Physically Defective Children as a day scholar. Arrangements were made for the child to be conveyed to and from school every day in an ambulance. During 1937 four children suffering from heart disease were discharged from the undermentioned Homes:— Heart Home, West Wickham 2 St. John's Home, Kemptown 1 Edgar Lee Heart Home 1 Many of these children with heart disease require to be away for several months before their convalescence is sufficiently established for them' to be returned home with any degree of safety. They are then kept under periodical observation by the School Medical Staff and suitable instructions are sent to the Head Teachers of the schools which they attend, advising any necessary modifications in their school lives. Children who had previously received institutional treatment were also kept under continuous observation. Three children with heart disease who had previously been allowed to attend school half-time under close medical supervision were allowed to attend school full time during 1937. A fourth case with acquired heart disease was allowed to attend school half-time. This child was later admitted to a local hospital where he remained until the end of the year. (j) Tuberculosis. The Surrey County Council is the authority responsible for the treatment of tuberculosis in Wimbledon. Ill One girl suffering from pulmonary tuberculosis was admitted to the Holy Cross Sanatorium, Haslemere, early in 1937. Three children suffering from tuberculous glands of the neck were admitted to the following institutions:— Royal Sea Bathing Hospital, Margate 1 Victoria Home, Margate 2 In addition there were two cases of tuberculous disease of joints, one a tuberculous hip and the other a tuberculous knee, both of which were admitted to the Heatherwood Hospital, Ascot. One child with a tuberculous left hip was discharged from the Royal National Orthopædic Hospital's Country Branch at Stanmore in December and consequently was not attending any school or institution at the end of the year. Two children with non-pulmonary tuberculosis in whom the disease was arrested were in attendance at public elementary schools. These children were under the care of the Tuberculosis Physician and attended periodically at the Dispensary. The Tuberculosis Dispensary at 30, Worple Road, is in a central position and readily accessible to parents attending with school children. (k) Other Defects and Diseases. Children suffering from defects other than those indicated above obtain treatment either through private practitioners or at the outpatient departments of the local or big London hospitals. Very little difficulty is experienced in getting parents to obtain the necessary treatment as there are so many facilities available in this area. Artificial Light Treatment. During 1936 the Education Committee made arrangements with the Nelson Hospital for children referred from the School Medical Department to receive ultra-violet ray treatment at that institution. The charge made by the Hospital is one shilling for each attendance. As a rule the course of treatment is found to require twelve attendances. Nine children were referred for treatment from the School Medical Department during 1937. Six of these were suffering from rheumatism, two from bronchitis, and one from bronchiectasis. 112 SPEECH CLINIC. The following table shows the number of Wimbledon Children treated at the Speech Clinic:— Defect. Number attending at commencement of year. Number admitted during the year. Number discharged during the year. Number attending at end of year. Stammerers 14 8 10 12 Defective Speech 4 8 6 6 Total 18 16 16 18 In 1936, at the request of the Surrey Education Committee, arrangements were made for some of the Surrey children living near the Wimbledon boundary, who were suffering from speech defects, to attend the Clinic at Pelham Road. The following table shows the number of Surrey children dealt with:— Defect. Number attending at commencement of year. Number admitted during the year. Number discharged during the year. Number attending at end of year. Stammerers ... 4 1 3 Defective Speech 3 3 ... Total 3 4 4 3 Stammerers attend two classes each week. The average number attending this class was six. Children with defective speech attend twice a week and are dealt with by the teacher individually. Miss Sinclair, who is in charge of this Clinic, reports that the work has been very satisfactory during 1937 and that all the children attending have shown improvement. At the end of each term reports were received from the Head Teachers of the schools which these children attended. These reports were very helpful. In all cases some improvement had been noted and in many the improvement had been very marked. Relaxation, together with rhythmic movements with the help of a gramophone, were important features of the treatment carried out. It is essential that children should attend these speech classes regularly. Difficulty was experienced with 113 some of the Surrey children owing to the distances which they had to come. As in previous years every effort was made to obtain the co-operation of the parents in overcoming these defects of speech as it is essential that the principles laid down in the Speech Clinic, as far as possible, be carried out in the home. 8. INFECTIOUS DISEASES. The means adopted to prevent the spread of infectious diseases among school children are :— (a) The exclusion of children suffering from infectious diseases or coming from infected houses; (b) Closure of schools or departments; (c) Disinfection of schools. (a) To-day, the first procedure is the one which is almost entirely relied upon. As.soon as a case of infectious disease is notified a visit is paid to the house by one of the members of the Sanitary Staff. Home contacts are excluded from school until the end of the necessary quarantine period. Notices to this effect are sent out from the Public Health Department to the Head Teachers concerned and also to the School Attendance Department. (b) School closure is rarely resorted to to-day and on no occasion was it found necessary to recommend this during the year under review. When the attendance, however, falls below 60%, certificates may be supplied by the School Medical Officer to that effect as outlined in Paragraph 15 (ii) of Administrative Memorandum No. 51, 1927. No certificates in accordance with this Rule were issued during 1937. (c) During the holidays the disinfection of each school was carried out as in previous years. Disinfection of classrooms was also carried out periodically as the necessity arose. Much less reliance is now placed in the efficacy of this procedure for the control of infectious diseases. Frequent visits were paid to the schools after children had been removed to the Infectious Diseases 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 instances swabs were taken for bacteriological examination. Carriers detected in this manner are promptly excluded 114 Under Article 22 of the Education Code it was found necessary to exclude one hundred and fifty-one children from school for the following reasons:— Suffering from Scarlet Fever 27 Scarlet Fever contacts 35 Suffering from Diphtheria 38 Diphtheria contacts 51 Total 151 Further particulars of these cases are given in the Report of the Medical Officer of Health. No case of smallpox occurred amongst school children in Wimbledon during the year. Valuable information is obtained from the weekly returns of absences due to infectious diseases furnished by the Head Teachers. The numbers of cases of non-notifiable infectious diseases reported from the schools during 1937 were as follows:— Measles 7 German Measles 5 Whooping Cough 90 Mumps 40 Chicken-pox 328 Chicken-pox and whooping cough were the principal infectious diseases noted amongst the school children during 1937. Chicken-pox was prevalent during the greater part of the year. The schools chiefly affected were Wimbledon Park, All Saints Junior Mixed, All Saints Girls' and Infants', Cottenham Park Infants' and Queen's Road Infants'. On the whole, serious infectious disease was much less prevalent than in 193(5. In accordance with Article 20(b) of the Education Code, eighty-three children were excluded from school during 1937 for the following conditions :— Ringworm (scalp) 1 Ringworm (skin) 1 Conjunctivitis 4 Scabies 19 Impetigo 8 Mumps 11 Chicken-pox 21 Whooping Cough 36 Other contagious or infectious conditions 25 Total 126 9. OPEN-AIR EDUCATION. There are no Day Open-Air Schools nor Residential Open-Air Schools in Wimbledon. Where circumstances permit, in the summer months some of the classes in the schools are conducted in the open air. Another holiday camp was arranged during the year by the Wimbledon Rotary Club. Twenty-four boys from various elementary schools in the district were selected and sent away to Swanage for two weeks during August. The children were medically examined before leaving Wimbledon. Besides having a very enjoyable holiday the boys improved considerably in health. Arrangements were made through the School Journey Association for a party of sixty-one girls of twelve and thirteen years of age from the Girls' Central School to visit Sandown, Isle of Wight, for a period of two weeks during May. All these children were medically examined at the Health Centre before leaving Wimbledon, They were accompanied by three members of the staff and an additional helper. The hotel at which the children stayed was situated on the sea front. Arrangements were made for all these girls to receive milk daily under the scheme of the National Milk Publicity Council. Many visits were paid to places of interest on the Island and the children undoubtedly had a most instructive and beneficial holiday. 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. Arrangements have been made with the Surrey Education Committee for a man and a woman physical training organiser, employed by that Committee, to be available one day each month to visit the Elementary Schools in the Borough and advise as to physical training instruction. 115 A great deal of physical training apparatus has been supplied to the schools in order that the syllabus of the Board of Education may be carried out. 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 three halfpence for each child and this is paid by the Education Committee. Under this arrangement 22,487 attendances were made. This is nearly twice the number made in 1935. 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. Particulars of the meals supplied are given under the section of this report dealing with the Special School. No meals were provided during the year for children attending the other schools. The Education Committee, however, supplied one hundred and two children suffering from subnormal nutrition with milk in school, a decrease of eleven on the figure for the previous year. These cases were selected by the School Medical Inspector during the periodical surveys which were held, and the grant of free milk was made after the financial circumstances of the family had been investigated by a Sub-Committee specially appointed for the purpose. Formerly, the milk was supplied for a period of three months. The children are weighed at the commencement and then re-inspected and re-weighed at the end of this period. Later in the year it was decided to grant the milk for a period of six months and to supply it to these children during morning and afternoon sessions. At the same time the Committee decided to adopt the policy of interpreting their scale on wider and more generous lines. Arrangements are available in all the schools for scholars to receive milk daily, at the cost of the parents, under the scheme of the National Milk Publicity 116 Council. Only pasteurised milk is supplied and this is contained in sealed bottles holding one-third of a pint. The cost to the parents is one half-penny. It is still a matter of regret that many more parents do not avail themselves of the opportunity of providing their children with milk in school every day. It has been conclusively demonstrated that by so doing the children benefit greatly in health. In a very few cases, it is true, children are not able to take this milk. There appears, however, to be no adequate reason for the fact that only about fifty or sixty per cent. of the children in Wimbledon are receiving milk in school regularly under the scheme. 12. CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS, AND VOLUNTARY BODIES. Co-operation of Parents. Parents are invited to be present at the school during the routine inspection of their children. Out of 1,812 children examined at the routine inspections, one thousand and five, or 55.46% were accompanied by one or other parent. The percentage of parents attending these inspections in the schools is lower than that desired but is not. due to any real lack of interest on the part of the parents in the health of their children. Many of the mothers go out to work and are consequently unable to spare the necessary time to attend. There is a great advantage in obtaining the co-operation of the parents as it enables the School Medical Inspector to give detailed advice in the ease of children found to be suffering from defects. A large number of parents also attended at the special examinations at the Health Centre. 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 the past, by bringing to the notice of the School Medical Staff those children who, in 117 their opinion, are likely to benefit by receiving free milk in school, and by arranging for their attendance at the Health Centre. Co-operation of School Attendance Officers. A close cooperation has been maintained between the School Medical Department and the School Attendance Officers. As in previous years a considerable number of children have been 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. Co-operation of Voluntary Bodies. The Invalid Children's Aid Association is the principal voluntary organisation dealing with school children and children below school age in Wimbledon. As in previous years it continued to render invaluable service during 1937. Convalescent treatment was provided for fifty-eight Wimbledon school children during the year under review, twenty-seven of these having been referred from the School Medical Department. These were chiefly eases of debility following pneumonia, bronchitis, rheumatism and chorea. Education is nearly always provided for the children whilst they are away. In addition, the Invalid Children's Aid Association made the necessary arrangements for the admission of seven children to special hospital schools, the Education Committee undertaking the cost of maintenance and treatment. Surgical appliances and special boots were provided in three cases. Eleven children were supplied with clothes. Included in this number were some of the children who were sent to convalescent homes. The approximate number of children who were on their books, and being visited, in 1937, was three hundred and forty-eight. It is pleasant to record that in every case in which the assistance of the Invalid Children's Aid Association was requested by the School Medical Department it was most readily and freely given. The Local Representative of the National Society for the Prevention of Cruelty to Children has always been ready to co-operate in every way with the staff of the School Medical 118 Department. His services were especially useful in persuading parents of children suffering from defective vision to submit them to examination by the Education Gommittee's Oculist and to provide spectacles when these had been found necessary. Other cases in which this officer was asked to interest himself were those in which the home conditions and care were found to be unsatisfactory and repeated visits by the nursing staff had failed to effect the desired improvement. 13. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. A special register is kept in the School Medical Department of all defective children. Information regarding new cases is furnished by the Head Teachers, School Attendance Officers, and School Nurse-Health Visitors. The School Medical Inspector devotes on an average two sessions per week to visiting the schools for the purpose of ascertaining and examining suspected cases of mental deficiency. Communications are also addressed periodically to the Head Teachers of the schools asking them to forward lists of all children considered to be defective within the meaning of Part V of the Education Act, 1921. As the result of these measures one hundred and fourteen such special examinations or re-examinations were carried out in 1937. Children requiring education in Myope or Sight-saving Schools are referred by the Oculist from the Refraction Clinic, whilst physically defective children in need of education in Special Schools are brought forward from the Orthopaedic Clinic. Children with impaired hearing are specially examined at the Health Centre with a view to ascertaining their suitability for admission to Partially Deaf Schools. Most of these children have at one time or another attended the outpatient departments of hospitals in London. Special reports from the surgeons, under whose charge they have been, are requested and in every case their assistance is readily forthcoming. Later in the year, such cases were the subjects of special reports by the Ear, Nose and Throat Consultant in charge of the Aural Clinic. Blind and Partially Sighted Children. There was only one blind child on the register at the end of 1937. This boy was in attendance at the Linden Lodge (L.C.C.) School for the 119 Blind, Wandsworth Common. He is a child suffering from optic atrophy following a fracture of the skull. Another boy, who was at the Swiss Cottage School for the Blind, was taken over in July by a neighbouring Authority as his parents had removed into their district. One boy and three girls were in attendance at the Stonhouse School for the Partially Sighted (L.C.C.) at Clapham, and one boy was at the Kingwood Road (L.C.C.) School for the Partially Sighted, Fulham. One girl was discharged during the year as she had obtained suitable employment. These were all cases of high myopia. Deaf and Partially Deaf Children. One deaf girl was in attendance at the Royal School for the Deaf and Dumb, at Margate. There were, in addition, two partially deaf girls and one partially deaf boy attending Special Schools during .1937, one girl being at the Oak Lodge (L.C.C.) School for Elder Girls, Clapham Common, and one girl and one boy at the Oldridge Road (L.C.C.) Partially Deaf School, Balham. This boy's parents removed during the year to the district of another Authority who took over responsibility for his care. Epileptic Children. One girl, suffering from severe epilepsy requiring institutional treatment, was at the Chalfont Colony, Bucks. One boy suffering from severe epilepsy was at the Maghull Home, Liverpool. PHYSICALLY DEFECTIVE CHILDREN. (a) Tuberculous Children. The Surrey County Council is the Authority responsible for the treatment of tuberculosis in Wimbledon. One girl suffering from pulmonary tuberculosis was admitted to the Holy Cross Sanatorium in 1937. Two girls and four boys suffering from non-pulmonary tuberculosis were also at certified Special Schools at the end of the year. These included one boy and one girl with tuberculous glands of the neck who were admitted to the Victoria Home, Margate. Another boy with tuberculous glands of the neck was sent to the Royal Sea Bathing Hospital, Margate. A girl with lupus of the nose was admitted to the Lord Mayor Treloar's Home at Alton whilst two boys, with a tuberculous hip and tuberculous knee respectively, were sent to the Heatherwood Hospital, Ascot. A further boy, who had been under treatment at the Royal National Orthopaedic Hospital's 120 Country Branch at Stanmore for tuberculous disease of the hip, was discharged in December and was at no school or institution at the end of the year. Two boys with arrested non-pulmonary tuberculosis were attending public elementary schools in Wimbledon. (b) Delicate Children. Four delicate children (three boys and one girl) were at the undermentioned institutions at the end of the year:— Brooklands Home, Worthing 1 Oak Bank Open Air School, Sevenoaks 1 Hamilton House, Seaford 1 Farningham Home for Boys, Swanley 1 Six other delicate children were discharged from similar institutions during the course of 1937 and subsequently attended ordinary elementary schools. In addition, two children (a boy and a girl) were taken over by another Authority when their parents removed from the district. Twenty-eight delicate children attending public elementary schools were under the observation of the School Medical Staff. (c) Crippled Children. At the end of December, there were six crippled children at Certified Special Schools, one undergoing treatment in the orthopaedic wards of St. Thomas's Hospital, four attending public elementary schools, and one at no school or institution. The six cases at Certified Special Schools were at the following institutions:— St. Nicholas' and St. Martin's Orthopaedic Hospital and Special School, Pyrford 2 St. Vincent's Orthopaedic Hospital, Pinner 1 Frogmore Road (L.C.C.) P.D. School 1 Heritage Craft Schools, Chailey 2 Three children who had been undergoing orthopaedic treatment were discharged during 1937 from the St. Nicholas' and St. Martin's Orthopaedic Hospital and Special School, Pyrford. Two of these cases had been taken over from the Maternity and Child Welfare Committee on the children attaining the age of five years. Three of the four crippled children in the public elementary schools attended the Orthopaedic Clinic and were periodically examined by the Surgeon. In 1935, arrangements were made, with the approval of the Board of Education, for a physically defective child 121 suffering from a large meningocele to be educated in his own home by a teacher provided by the Education Committee. This boy, on account of his physical condition, is unsuitable for attendance at either a day or residential special school. During 1937 his general condition showed improvement and it was found that he was deriving considerable benefit from the education he is receiving at home. (d) Children with Heart Disease. At the end of 1937, two boys, one with rheumatic heart disease and the other with a severe congenital heart, were undergoing treatment at the following institutions:— Frogmore Road (L.C.C.) Special School 1 St. John's Open Air School, Woodford Bridge 1 Four other children, suffering from rheumatism or chorea with cardiac complications, were discharged from Certified Special Schools during the course of the year. One of these was at the Edgar Lee Heart Home, one at St. John's Home, Kemptown, and the other two at the Children's Heart Home, West Wickham. The child discharged from the Edgar Lee Heart Home was admitted later in the year to a local hospital, where he was still under treatment at the end of 1937. Eight children with heart disease were in attendance at public elementary schools at the end of December. They were kept under observation periodically and the school curriculum was modified in a manner suitable to their requirements. SPECIAL SCHOOL. The Education Committee has its own Special School with accommodation for fifty children. At the end of 1937 there were thirty children (thirteen boys and seventeen girls) in attendance. In addition, one boy was receiving education in a special residential institution. The total number of children attending such Special Schools at the end of the year was thirty-one, the same figure as at the end of 1936. Two boys and two girls were admitted to the Special School during 1937. Two boys left the school on attaining the age of sixteen years and one boy was removed from the register as his parents had left the district. 122 Every child attending the school is examined once a year in addition to the routine medical inspections. The Medical Officer visited the school, on an average, once a week for this purpose. Nine children were examined in the routine way in the following prescribed groups:— Entrants 1 Second Age Group 3 Third Age Group 4 Number of Other Routine Inspections 1 The following defects requiring treatment were found:— Bronchitis 1 Defective Vision 1 Defective Teeth 1 The defects requiring observation were:— Defective Vision 1 In addition there were twenty-six special inspections and thirty-four re-inspections at the Health Centre of children attending this school. Nine children were referred from the special inspections for treatment at the Minor Ailment Clinic, with the undermentioned defects:— Impetigo 1 Other Diseases of the Skin 3 Otorrhcea 1 Other conditions 4 Three children were re-tested by the Oculist at the Refraction Clinic and three attended for re-examination. New spectacles were prescribed in two instances. One new case attended the Orthopaedic Clinic. Another child, suffering from a deformity of the chest, who had previously been examined by the Surgeon, was recommended to the Massage and Exercises Clinic and made thirteen attendances. A child suffering from otorrhoea was seen at the Aural Clinic and referred by the Surgeon for treatment at the Health Centre. At the routine dental inspections twenty-five children were examined. Eighteen of these were found to require treatment. Eight of the children were actually treated and made twenty attendances at the Dental Clinic. Eleven temporary teeth and fourteen permanent teeth were extracted. Eight general anaesthetics were administered. Fourteen permanent teeth were filled and eleven other operations were carried out. 128 The school nurse paid fourteen visits to the school. Three hundred and ten inspections were carried out. It was only found necessary to exclude one child during these visits. Provision is made for children attending this school to receive a bath once a week and a special attendant is employed by the Education Committee for the purpose. Many of the parents are glad for their children to take advantage of these facilities. A cooked mid-day meal of excellent quality is served at the school. On an average, twenty children stayed for this meal for which a charge of threepence is made. In seven eases it was found necessary to forego the amount owing to the financial circumstances of the parents. One child was given cod liver oil and malt in school free of charge. Over half of the children received milk in school daily under the scheme of the National Milk Publicity Council. In addition to the routine class teaching, special attention is paid to handicraft instruction. Carpentry, gardening, cookery, and laundry-work are taught. A list is kept of all retarded school children in the district. These children are examined by the School Medical Inspector on an average every six months in order to ascertain their suitability for transference to the Special School. The Head Teachers are also requested twice a year to forward lists of all retarded children in attendance at their schools. Children who leave the Special School on attaining the age of sixteen and who are in need of supervision and care are notified to the Local Authority under the Act of J913, as amended. In certain cases, where the school report is satisfactory, the home influence good, and the prospect of employment favourable, the names are passed on instead to the Committee of the Guild of Social Welfare which acts in Wimbledon as the Local Committee of the Surrey Voluntary Association for Mental and Physical Welfare. The two boys who left school on attaining the age of sixteen years had made very good progress and it was considered that they would readily obtain suitable employment, Their cases were carefully gone into by the School Medical Inspector and Head Teacher and the conclusion arrived at that notification for supervision was not required. These boys are now employed in a box factory and an electric equipment works respectively. 124 One boy was notified to the Local Authority under Article 2 of the Mental Deficiency (Notification of Children) Regulations, 1928. Children leaving the Special School after attaining the age of sixteen years in nearly all cases succeed in obtaining employment. The boys take up work in the local factories, or on milk and paper rounds, or acting as carriers for local business houses. The girls are generally employed in factories, laundries, in indoor service or doing daily work. 14. FULL-TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS. The Surrey County Council is the Authority responsible for Higher Education for blind, deaf, defective, and epileptic children. Recommendations are sent to the Surrey County Council by the Wimbledon Education Authority, in suitable cases, where Higher Education for such defective children is considered desirable. 15. NURSERY SCHOOLS. No Nursery Schools have been established in Wimbledon. The question of providing Nursery Classes was under consideration by the Education Committee in 1937. The Committee have decided, subject to the approval of the Board of Education, to begin by establishing a Nursery Class in the Dundonald Road Junior Girls' and Infants' School in 1938. This class will accommodate not more than thirty-five children between three and five years of age. Arrangements will be made for the class to be staffed by a certified mistress and helper. The Municipal Day Nursery has accommodation for thirty toddlers under five years of age. Particulars of the medical and dental inspection of these children are given in the Maternity and Child Welfare Section of the Medical Officer of Health's Report. The medical record cards of these children follow them when they enter the elementary schools on attaining the age of five years. 16. SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. The medical inspection of Secondary Schools in Wimbledon is under the control of the Surrey County Education Authority. 125 17. PARENTS' PAYMENTS. The parents of children attending public elementary schools are required to contribute towards the cost of treatment in accordance with approved scales adopted by the Education Committee. Contributions from parents are required in respect of treatment given at the Minor Ailment and Dental Clinics, operative treatment for tonsils and adenoids, and hospital treatment under the orthopedic scheme. No charge is made for the examination of children at the Refraction Clinic but the parents are required to pay the cost of the spectacles which are obtained for their children at a contract price. In exceptional cases of financial difficulty the Committee, after considering all the circumstances, provide the spectacles free of charge. Where children are receiving residential treatment for other conditions under arrangements made by the Education Committee, the financial circumstances of the parents are considered in each case and their contributions assessed accordingly. These latter cases include children suffering from rheumatism and heart disease, delicate children, etc. 18. HEALTH EDUCATION. The National Health Campaign was inaugurated in October. The first Health Day in Wimbledon was on Thursday, 14th October, and commenced with a morning display of films dealing with health matters in one of the local cinemas. Senior scholars from all the elementary schools were present and were accompanied by teachers. In addition, parties of senior scholars gave physical training demonstrations at the evening meeting in the Town Hall. The second health day was held on 18th November, and a display of films was again arranged in the morning. The scholars on this occasion were taken from the secondary schools. Leaflets dealing with each month's subject were supplied to all the schools for distribution. 19. SPECIAL INQUIRIES. No special inquiries were undertaken by the School Medical Department during 1937. 126 20. MISCELLANEOUS. Every candidate appointed as a teacher under the Education Committee is required, as a condition of the appointment, to pass a satisfactory medical examination. Ten such examinations were carried out by the School Medical Staff during the year. Employment of Children and Young Persons. On the 1st February, 1935, the new Bye-laws made under the Children and Young Persons Act, 1933, came into operation. These Bye-laws make it obligatory for every school child over the age of twelve years seeking employment to be medically examined by the School Medical Officer before an employment card is issued. Apart from this change, the hours and conditions of employment are substantially the same as those under the previous Bye-laws, which were made under the Education Act, 1921. Employment in or in connection with any racing course or track or other place where any like sport is carried on, or as an assistant in any business conducted therein, is now prohibited under the new Bye-laws. One hundred and sixty-nine employment cards were issued to school children. One hundred and sixty-three 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. Legal proceedings were instituted against six employers for ten contraventions of the Bye-laws. A fine of five shillings and costs was imposed in respect of each contravention. Warnings were issued to thirteen employers. Full particulars of the observations made are given below:— Number of boys questioned 674 Number of boys warned 143 Number of employers warned 13 Number of cases reported to Education Authority 247 Number of employers against whom legal proceedings were instituted 6 During the routine visits of the nurses to the schools after the three principal holidays, special inquiries are made with regard to the number of children in the senior schools who are employed out of school hours. Full particulars of 127 these cases are forwarded to the Education Department in order that they may be checked off with the employment cards that have been issued. The Bye-laws made under the Education Act, 1921, with regard to street trading by young persons between fourteen and sixteen years of age have now been repealed, and new Bye-laws relating to this matter have been made under the Children and Young Persons Act, 1933. The Surrey County Council is the Authority for the administration of this part of the Act. The duties of supervising these Bye-laws concerning street trading in Wimbledon are undertaken by the Wimbledon Corporation on behalf of the Surrey County Council. The necessary work of supervision is carried out by the officers of the Public Health Department. I desire to take this opportunity of again expressing my appreciation of the co-operation which I have received from the members of the staff during the year under review. I am, Your obedient servant, HAROLD ELLIS. 128 Wimbledon Education Authority. MEDICAL INSPECTION RETURNS. Year ended 31st December, 1937. TABLE I. MEDICAL INSPECTIONS OF CHILDREN ATTENDING PUBLIC ELEMENTARY SCHOOLS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups:— Entrants 604 Second Age Group 500 Third Age Group 468 Total 1,562 Number of other Routine Inspections 250 Grand Total 1,812 B.—OTHER INSPECTIONS. Number of Special Inspections 2,728 Number of Re-inspections 6,237 Total 8,965 129 C.—CHILDREN FOUND TO REQUIRE TREATMENT. Number of individual children pound at Routine medical Inspection to Reqdire Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). note.—No individual child is counted more than once in any column of this Table; for example, a child suffering from defective vision and from adenoids appears once in Column 2, once in Column 3 and once only in Column 4. Similarly a child suffering from two defects other than defective vision appears once only in Column 3 and once in Column 4. Group. (1) For defective vision(excluding Squint) For all other conditions recorded in Table II A. Total. (2) (3) W Entrants 4 95 90 Second Age Group 26 50 67 Third Age Group 16 35 49 Total (Prescribed Groups) 46 180 206 Other Routine Inspections 14 21 30 Grand Total 60 201 236 180 TABLE II A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1937. 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) Skin (1) Ringworm—Scalp ... ... 1 ... (2) „ Body ... ... 20 ... (3) Scabies ... ... 19 ... (4) Impetigo 6 ... 127 ... (5) Other Diseases (Non'Tuberculous) 8 1 198 ... TOTAL (Heads 1 to 5) 14 1 365 ... Eye (6) Blepharitis 6 ... 44 ... (7) Conjunctivitis 2 ... 30 ... (8) Keratitis ... ... ... ... (9) Corneal Opacities ... ... ... ... (10) Other Conditions (excluding Defective Vision and Squint) 2 ... 48 2 TOTAL (Heads G to 10) 10 ... 122 2 (11) Defective Vision (excluding Squint) 60 103 51 9 (12) Squint 8 6 4 3 Ear (13) Defective Hearing 3 1 5 ... (14) Otitis Media 3 1 55 ... (15) Other Ear Diseases 1 ... 35 ... Nose and . Throat (16) Chronic Tonsillitis only 22 58 61 1 (17) Adenoids only 1 2 ... 1 (18) Chronic Tonsillitis and Adenoids 24 6 24 ... (19) Other Conditions 2 1 133 1 181 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) (5) (20) Enlarged Cervical Glands (NonTuberoulous) 2 7 10 1 (21) Defective Speech 2 5 9 12 Heart and Circulation Heart Disease: (22) Organic 6 4 1 ... (28) Functional 6 1 2 (24) Anaemia . 1 1 ... Lungs (25) Bronchitis 18 4 23 3 (26) OtherNon-Tuberculous Diseases 5 4 20 ... Tuberculosis 'Pulmonary:— (27) Definite ... ... ... ... (28) Suspected 1 ... ... ... Non-Pulmonary : (29) Glands ... ... 1 ... 130) Bones and Joints 1 1 ... (31) Skin ... ... ... ... (32) Other Forms ... ... ... ... TOTAL (Heads 29 to 32) 1 1 1 Nervous System (33) Epilepsy ... ... 6 ... (34) Chorea 1 2 1 (35) Other Conditions 5 2 5 ... Deformities (36) Rickets 7 8 2 ... (37) Spinal Curvature 2 3 ... (38) Other Forms 27 10 28 4 (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 33 21 652 109 Total number of defects 258 255 1621 149 TABLE II. continued. B.—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. AGE-GROUPS No. of ChildreDinspecfced A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 604 157 25.98 413 68.38 32 5.29 2 0.33 Second Age-group 500 90 18.00 384 76.80 25 5.00 1 0.20 Third Age-group 458 75 16.38 360 78.60 22 4.80 1 0.22 Other Routine Inspections 250 65 26.00 181 72.40 4 1.60 ... ... Total 1812 387 21.36 1338 73.84 83 4.58 4 0.22 TABLE III Return of all Exceptional Children in the Area BLIND CHILDREN. At Certified Sehools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 ... ... ... 1 PARTIALLY SIGHTED CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Sighted At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. ... 4 3 ... ... 7 DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 ... ... ... 1 PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. ... 2 ... ... ... 2 134 TABLE III-continued. MENTALLY DEFECTIVE CHILDREN. FEEBLE-MINDED CHILDREN. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 31 ... ... ... 31 EPILEPTIC CHILDREN. CHILDREN SUFFERING FROM SEVERE EPILEPSY. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 1 ... ... 3 PHYSICALLY DEFECTIVE CHILDREN. A.—TUBERCULOUS CHILDREN. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands). At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 1 ... ... ... 1 11.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above). At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 6 2 I 9 135 TABLE III—continued B.—DELICATE CHILDREN. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 4 28 ... 32 C.—CRIPPLED CHILDREN. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 6 4 1 1 12 D.—CHILDREN WITH HEART DISEASE. At Certified Special Schools. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 2 8 1 ... 11 CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Children suffering from any combination of the following types of defect:— Blindness (excluding partially sighted children). Deafness (excluding partially deaf children). Mental Defect (Feeble-minded). Severe Epilepsy. Active Tuberculosis. Crippling (as defined in Section C above). Heart Disease. Combination of Defect. At Certified Special Schools. At Public Elementary Schools At other Institutions. At no School or Institution. Total. Crippled and Mentally Defective 1 ... ... ... 1 136 TABLE IV. TREATMENT TABLES. GROUP I.—MlNOR AILMENTS (excluding Uncleanliness, for which see Table VI.). 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. (i) X-Ray Treatment ... ... ... (ii) Other ,, 1 ... 1 Ringworm-Body 20 ... 20 Scabies 19 ... 19 Impetigo 131 2 133 Other skin disease 192 14 206 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 109 2 111 Minor Ear Defects 86 1 87 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 407 49 450 Total 965 68 1033 187 TABLE IV.—continued. GROUP II.—defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Number of Defects dealt with. Under the Authority's Scheme Otherwise. Total. ERRORS OF REFRACTION (including squint) 246 46 292 Other defect or disease of the eyes (excluding those recorded in Group I) 26 11 37 Total 272 57 329 Under the Authority's Scheme Otherwise. Total. No. of Children for whom spectacles were (a) Prescribed 167 33 200 (b) Obtained 164 33 197 138 TABLE IV.—continued. GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (i) (2) (3) (4) (5) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 4 ... 53 ... 1 ... ... ... 5 ... 53 ... 100 158 189 (1) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. TABLE IV.—continued. GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS Number of Children Treated Under the Authority's Scheme (1) Otherwise (2) Total Number Treated Residential treatment with education Residential treatment without education Non-residential treatment at an orthopedic clinic Residential treatment with education Residential treatment without education Non-residential treatment at an orthopaedic clinic 8 4 103 ... ... 9 120 140 TABLE V.—DENTAL INSPECTION AND TREATMENT. 1. Number of children inspected by the Dentist a. Routine age-groups AGE 5 6 7 8 9 10 11 12 13 14 15* 16* TOTAL Number 126 350 487 468 411 460 508 439 418 381 90 19 4157 * Central School b. Specials 428 c. TOTAL(Routine and Specials) 4585 2. Number found to require Treatment 3313 3. Number actually Treated 1771 4. Attendances made by children for treatment 3826 5. Half-days devoted to:— Inspection 43 Treatment 364 Total 407 7. Extractions:— Permanent Teeth 643 Temporary Teeth 2336 Total 2979 6. Fillings:— Permanent Teeth 2527 Temporary Teeth 14 Total 2641 8. Administrations of general anaesthetics for extractions 749 9. Other Operations:— Permanent Teeth 2179 Temporary Teeth 449 Total 2628 141 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. 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 13,200 3. Number of individual children found unclean 361 4. Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 19'21 72 6. Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 ... (b) Under School Attendance Bye-laws ... 142 INDEX Committee, Maternity and Child Welfare 1 „ Public Health 1 ,, Education 89 Medical Examinations 40, 128 Staff, official 2, 90 Statistics and Social Conditions of the Area 4-17 Area 4 Birth Rate 5, 8 ,, ,, Graph showing 11 Births, Registered 5, 8 ,, Notification of Cancer 6, 12 Death Rate 5, 10 ,, ,, Graph showing 11 Deaths 5, 6, 9 Families, number of 4 Houses, inhabited 4 Infantile Mortality 6, 14 „ ,, Graph showing 17 Mortality, analysis of 7 Mortality, Cancer 6, 12 Bronchitis and Respirators' Diseases 13, 11 Heart and Circulatory Diseases 13 Infantile 6, 14 Neonatal 16 Violence Penny Rate, product of 4 Population 4 Rateable Value 4 Social Conditions 4 Stillbirths 5 Unemployment 5 Vital Statistics, Extracts from 5 Ward, Birth Rates 8 „ Death Rates „ Population 8 General Provision of Health Services in the Area 18-43 Ambulance Facilities 18 Ante-natal Clinic 20 , 24 , 25 Assistance, Public Clinics and Treatment Centres 19 Day Nursery 20. 37 Dental Treatment 20 Dispensary, Tuberculosis Facilities— Ambulance Laboratory 18 Hospitals, Tuberculosis Children's 21 General 22 Infectious Diseases Maternity 21 143 Institutional Provisions for Mothers and Children Laboratory Facilities Legislation in force Midwifery and Maternity Services 25 Midwives Act, 1936 25 Midwives' Acts 28 Medical Aid 30 Mortuary 40 Mothercraft Classes 25 Nursing Homes 39 Inspection of 39 Nursing in the Home 19 General 19 Midwifery 19 School Clinic 20 Venereal Diseases 20 Maternity and Child Welfare 23-39 Children Act, 1908 (Part [); Children and Young Persons Act, 1932 31 Day Nursery 37 Dental Treatment 36 Ear Diseases and Defective Hearing 34 Home Visitation 23 Maternal Mortality 35 Minor Ailments, Treatment of 34 Obstetric Cases, Treatment for Complicated 35 Ophthalmia Neonatorum 34 Ophthalmic Treatment 34 Orthopaedic Treatment 32 Supply of Milk 36 Table of Attendances at Centres 30a Tonsils and Adenoids, Treatment of 34 Voluntary Helpers 37 Sanitary Circumstances of the Area 44-59 Barbers and Hairdressers 58 Bed Bugs, Eradication of 54 Common Lodging House 49 Diseases of Animals Acts 55 Disinfection 53 School 59 Drainage, House 46 Drainage and Sewerage 45 Employment Agencies 57 Employment of Children 57 Factory and Workshop Acts 51 Inspections under 51 Foot and Mouth Disease 55 Fouling of Footways by Dogs 57 Hairdressers and Barbers 58 Home Work 52 Houses let-in-lodgings 48 Inspection of District 45 Inspection, House to House 47 House 47 Legal Proceedings 46, 55 144 Mosquitoes 54 Notices served 46 Nuisances Abated, Table of 48 Offensive Trades 53 Petroleum Acts 57 Rainfall 44 Rats and Mice (Destruction) Act 58 Refuse Collection 45 Rent (Restrictions) Acts 47 Schools 59 Sewage Disposal 45 Shops Acts 55 Smoke Abatement 58 Stable Refuse 54 Van Dwellings 49 Verminous Rooms 54 Water Supply 44 Workshops, Registered 52 Housing 60-63 Action under Public Health Acts 60 Housing Act, 1936 60, 62 Housing Conditions 62 Overcrowding 62 Statistics for the Year 60 Tents, Vans and Sheds 49 Inspection and Supervision of Food 64-66 Bacteriological examination 64 Food and Drugs (Adulteration) Act, 1928 66 Inspection 65 Licences issued under Milk (Special Designations) Order, 1923 and 1936 64 Milk 'Supply 64 Registrations 64 Slaughter of Animals Act, 1933 65 Slaughter Houses 65 Prevalence of, and Control over Infectious and other Diseases 67-84 Cerebro-spinal Fever 70 Chicken-pox 83 Diarrhoea (under two years) 72 Diphtheria 68. 81 Complications Noted 82 Immunisation 69 Dysentery 70, 83 Encephalitis Lethargica 70 Enteric Fever 69, 83 Erysipelas 70, 83 Food Poisoning 70 Infectious Diseases Hospital 80 Cases admitted, Table of 80 Revenue 80 Staff 84 145 Infectious Diseases. Incidence of 73 „ „ Non-Notifiable 72, 83 Influenza Laboratory Work Malaria, Dysentery, etc 70 Measles 72, 83 Ophthalmia Neonatorum 70 Pathological examinations Pneumonia Poliomyelitis 70 Puerperal Fever and Puerperal Pyrexia 71, 83 Scarlet Fever 67, 81 Complications Noted 81 Smallpox 69 Table showing number of Cases Notified during year 73 ,, ,, Admission in Infectious Diseases Hospital 80 Ages at Death from Notifiable Diseases 74 ,, Cases and Deaths from Tuberculosis 79 ,, ,, Number of Cases Notified in last eleven years 77 ,, ,, Ward Distribution of Cases 76 ,, Zymotic and Tuberculosis Death Rates 75 Tuberculosis 77 Whooping Cough 72 Table I—Vital Statistics 85 Table II—Causes of, and Ages at Death 86. 87 School Medical Service 89-142 Arrangements for Treatment 102 Artificial Light Treatment 111 Aural Clinic 106 Blind, Deaf, Defective and Epileptic Children 119 Full-time Courses of Higher Education for 126 Blind and Partially Blind Children 119 Clothing and Footgear 97 Co-operation of Parents 117 School Attendance Officers Teachers 117 Voluntary Bodies 118 Co-ordination Crippled Children 121 Crippling Defects 99 Deaf and Partially Deaf Children 120 Defective Hearing 98, 106 Defective Vision 97. 103 Delicate Children 121 Dental Defects 99. 106 Disinfection of Schools 113 Ear Diseases and Defective Hearing 98, 106 Employment of Children and Young Persons 128 Epileptic Children 120 Eye Disease, External 97, 103 Following up 101 146 Health Education 127 Heart Disease and Rheumatism 99, 110 Heart Disease, Children with 110, 123 Infectious Disease 113 Malnutrition 95, 102 Meals, provision of 116 Medical Inspection 93 „ Findings of 95 Medical Treatment 102 Milk in School 102 Minor Ailments 97, 103 Miscellaneous 128 Nose and Throat Defects 98, 105 Nursery Schools 126 Open Air Education 115 Orthopaedic Treatment 99. 107 Parents' Payments 127 Physical Training 115 Physically Defective Children 120 Po6tural Defects 99. 107 Provision of Meals 116 Rheumatism and Heart Disease 99, 110 School Accommodation 91 School Baths 125 School Disinfection 113 School Hygiene 92 Secondary Schools, etc 126 Skin Disease 97, 103 Special Inquiries 127 Special School 123 Speech Clinic 112 Staff 90 Swimming Instruction 116 Table I—Return of Medical Inspections 130 „ II—Return of Defects 132 ,, III—Return of All Exceptional Children 135 „ IV—Treatment Table 138 Tonsils and Adenoids 98, 105 Treatment, Arrangements for 102 Tuberculosis 100, 111, 120 Uncleanliness 96, 103, 143 Visual Defects 97, 103 147