a Royal Borough of Kingston-upon-Thames ANNUAL REPORTS FOR 1939, 1940, 1941, 1942, 1943 Medical Officer of Health AND Chief Sanitary Inspector TO THE Town Council AND THE Ministry of Health GUILDHALL, KINGSTON-UPON-THAMES FEBRUARY, 1945 Royal Borough of Kingston-upon-Thomas ANNUAL REPORTS FOR 1939, 1940, 1941, 1942, 1943 Medical Officer of Health AND Chief Sanitary Inspector TO THE Town Council AND THE Ministry of Health GUILDHALL, KINGSTON-UPON-THAMES FEBRUARY, 1945 ANNUAL REPOTS. 1939 - 1943. TABLE OF CONTENTS. SECTION A. Page. (i) General Statistics 1 (ii) Social Conditions 1 (iii) Extracts from Vital Statistics 2,3,4,5,6,7,8 (iv) Causes of Death 9 SECTION B. 1. (i) Public Health Officers 10 (ii) (a) Laboratory Facilities 10 (b) Ambulance Facilities 10 (c) Nursing in the Home 10,11 (d) Clinics and Treatment Centres 12 (e) Hospital (l) Fever 13 (2) Smallpox 13 (3) Other 13 2. Institutional Medical Service (Surrey County Council) Omitted, 3. Maternity and Child Welfare: (i) Midwifery Service 14 (a) Midwifery Service (Surrey County Council) 14 (b) (i) Maternal Mortality 15 (ii) Infant Mortality 16,17,18 (iii) Puerperal Pyrexia 19 (ii) Maternity Services: (a) Ante-Natal Services 19,20 (b) Post-Natal Services 20 (c) Infant Welfare Services 21 (i) Domiciliary Visits 21 (ii) Infant Welfare Clinics 21 (iii) Institutional Treatment for Mothers and Children 23 (a) Home for Unmarried Mothers 23 (b) War-Time Nurseries 23,24 (iv) Health Visitors 25 (v) Child Life Protection 26 (vi) Treatment 26,27 (a) Dental Treatment 26,27 (b) Ophthalmic 27 (c) Artificial Sunlight 27 (d) Tonsils and Adenoids 28 (e) Orthopaedic 28 (f) Scabies 28 (g) Convalescent 29 (h) Prevention of spread of Infectious Diseases 29 (i)Diphtheria Immunisation 29 (ii) Vaccination 29 (iii) Whooping Cough 29 (vii) Home Helps 29 Nursing Homes (Surrey County Council) 29,30 Contd. Page. SECTION C. Sanitary Circumstances of the Area: 1, (i) Water 31 (ii) Drainage and Sewerage 31,32 2. Rivers and Streams 32 3. (i) Closet Accommodation 32 (ii) Public Cleansing 32 (iii) Sanitary Inspection of the Area 32,33 (iv) Shops and offices 33,34 (v)Camping Sites 34 (vi) Smoke Abatement 34 (vii) Swimming Baths and Pools 34 (viii) Eradication of Bed Bugs 34 4. Schools 34,35 5. Sanitary Complaints 35 Rodent Control 35,36 SECTION D. Housing - General appreciation of the position 37 SECTION E. Inspection and Supervision of Food 38 (a) Milk Supply 38 (b) Meat and Other foods 39,40 (c)Adulteration 41,42 SECTION F. Prevalence of and Control over, Infectious and other Diseases. 1. Notifiable Diseases 43 Immunisation 44,45 Tables of Incidence 46,47,48,49,50 2. (Surrey County Council) Omitted. 3. Tuberculosis 51,52 Scabies 52,53,54 Infestation Mead Lice 54 ANNUAL REPORT. To: The Mayor, Alderman and Councillors Mr, Mayor, Ladies and Gentlemen, At the request of the Ministry of Health these Reports are abbreviated, and of an interim nature. They are confined to essential and a few urgent matters which have affected the Public Health during the period. The period has been one of extraordinary conditions in every way. The clerical technical and professional staff has been depleted, due to the absence on war service of several members, Immediate replacement on the same level has not always been possible. Not with standing all difficulties, essential Health Services have been kept going, and additional War Services have been successfully overtaken. The personal Health Services especially in Maternity and Child Welfare have been expanded to meet growing need. The environmental Services have had to be modified owing to lack of staff and preoccupation with urgent war duties, but all essential safeguards have been taken. The health of the people has been remarkably good throughout the whole period. I believe this to be due in great measure to the success of the National Scheme of food Rationing and the increasing confidence, in the services provided by the Council, shown by the people. I have been privileged to serve the people under conditions of enemy attack and wish to pay tribute to the fine courage displayed by the Burgesses especially by the women, and by the Civil Defence and permanent staff of the Council, I wish to pay tribute also to the staff of the Department who by unselfish personal sacrifice and devotion to duty have through these years fully answered all extra calls upon their time and energies, The presentation of these reports under present circumstances is not an easy task. A special acknowledgement is due to Mr. F.D. Harvey and the office staff whose labour has made it possible. On the grounds of National Security complete tables of local population or references to War Time activities must not bo made public, I am, Sir, Ladies and Gentlemen, Your obedient Servant, J.W. STARKEY, Medical Officer of Health, Guildhall, February, 1945. Kingston upon Thames, STAFF OF THE PUBLIC-HEALTH DEPARTMENT. Medical Officer of Health and School Medical Officer: J. W. STARKEY, M.B., Ch.B. (Edin, ), D.P.H. Assistant Medical Officer: W, H, KINSTRIE, M.B,,Ch.B.(Edin.),D.P.H. (Appointed 1.4.39) (To H,M, Forces 26.11.43) RUTH CAMPBELL, M.R.C.S., L.R.C.P. (Temporary appointment from 1.11.43) + OLIVE G. AUBREY, B.A. ,M,D.,B.Ch. (Maternity and Child Welfare Appointment ceased 31,3,39) + BEATRICE TURNER, M,B, ,F.R.C.S. , (Edin.) (Ante-Natal Clinic - Appointment ceased 6,9.39) + D.S, MURRAY, B.S., M.B., Ch,B., (Diphtheria Immunisation - Appointment ceased 31,3,39) Consultant under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations 1926): + A.McALLISTER, M.B., B.S., (London), F.R.C.S., (From January to September, 1939) + J.V.0'SULLIVAN, M,D., F.R.C.S. (From September 1939) Dental Surgeon: + H,A,L,MORRIS, M.C.,L.D.S.,R.C.S, (Died 6th, June 1943) + L, IDE, L.D.S., R.G.S., (Appointed 30.8.43) Sanitary Inspectors: (Senior) H. T. PERRY, M.R.S.I, (a) F.D. HARVEY, A.R.S.I, (a) Chief Clerk. N.SMITH. A.R.S.I. (a) (b) (Resigned 26th, August, 1939) J.A. CUMMINS (a) (Resigned 24th, June 1939) + Part-time appointments," (a) Certificates as Sanitary Inspectors and Meat and Food Inspectors, (b) Certificate as Smoke Inspector, Sanitary Inspector (contd.) H. RATOUGH (a) (Appointed l6th, October 1939) (Resigned 13th, November 1940) T. B. TOMKINS (a) (Appinted 9th October 1939) (Resigned 30 th April 1940) G. 0, SMITH (a) (Appointed 20th, May 1940) J. J. GALSWORTHY (a) (Appointed 1st, April 1941) (Resigned 30th. April 1943; A. CLEGO (a) (Appointed 15th, June 1943) Health Visitors: (Senior) Miss C.A. HOOKWAY,S.R.N., S.C.M., H.V. Cert. Miss L. SALWAY, S.R.N., S C. M. , H. V. Cert. (Resigned 3lst. December, 1940) Miss F.I.ARNOLD,S.R.N.,S.C.M.,H.V.Cert. Miss M.M.DUKE,S.R.N.,S.C.M.,I.V.Cert. (Resigned 3lst. August 1940) Mrs.A.M.McI. BAKER, S.R.N., S.C.M.H.V.Cert. (Appointed 15th, October 1940) Miss D.KERRIDGE, S.R.N.,S,C.M., H.V.Cert. (Appointed 1st April 1941) Miss H.M.COUSENG, S.R.N.,S.C.M.,R.S.C.N.,H.V.Cert. (Appointed 28th January, 1941; (Resigned 12th, April, 1941) Clerical Staff not listed. (a) Certificates us Sanitary Inspectors and Meat and Food Inspectors. 1. SECTION A. Statistics and Social Conditions. (i) General Statistics. 1939 1940 1941 1942 1943 Area in Acres 1,390 1,390 1,390 1,390 1,390 population (Registrar General) 39,970 37,430 35,970 36,090 35,900 No.of inhabited houses approx. 11,040 10,800 11,000 11,000 11,000 Rateable Value - General Rate £527,138 535,527 534,294 535,643 532,263 Sum represented byPenny Rate £2,080 £2,106 £2,106 £2,112 £2,169 Amount of Poor Law Relief £1,149 £6,833 £4,810 £4,438 £2,457 (ii) Social Conditions. The Borough is still residential in character over the greater part of the area, but many industrial businesses have developed, particularly within recent years. The chief industries of the town are the manufacture of aircraft and component parts, scientific and general instrument manufacture, sparking plugs, and general engineering. There has been a considerable increase in the number of small firms engaged on sub-contracting for the larger firms or for the supply department direct. There is also a considerable number of persons engaged in the distributive trades owing to Kingston being a main shopping centre. Building has declined considerably owing to diversion of men to urgent war contracts and this applies also to civil engineering and to smaller industries, affected by the concentration of certain industries. Unemployment is practically non-existent. 2 (iii) Extracts from Vital statistics of the Tear. 4 1939 1940 1941 1942 1943 LIVE BIRTHS. Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. Legitimate 504 258 246 483 257 226 482 271 211 512 276 236 588 291 297 Illegitimate 29 11 18 36 17 19 38 18 20 39 20 19 49 31 18 TOTALS 533 269 264 519 274 245 520 289 231 551 296 255 637 322 315 Birth rate (R.G.)per 1,000 pop. 13.33 13.86 14.46 15.26 17.77 STILL BIRTHS. . Legitimate 9 4 5 14 8 6 15 11 4 12 5 7 20 14 6 Illegitimate – – – 2 1 1 4 3 1 1 •– 1 – 2 1 TOTALS 9 4 5 16 9 7 19 14 5 13 5 8 23 16 7 Rate per 1,000 total (live & still )births 16.6 29.9 35.25* 23.05 34.84 DEATHS 450 224 226 659 334 f 325 525 253 272 491 I 260 231 500 226 274 Death rate (R.G. )per 1,000 pop. 11.4 17.6 14.59 13.6 13.92 3 Deaths from Puerperal Causes. Year Deaths Rate per 1.000 total (live and still) births. Puerperal Sepsis Other puerperal causes Puerperal Sepsis Other puerperal Causes 1939 - - - - 1940 - - - - 1941 1 - 1.9 - 1942 2 x - 3.54 - 1943 1 x - 1.5 - x Cases of abortion not appearing in list of Causes of Deaths (Registrar General). Death Rate of Infants under one year of age. 1939 1940 1941 1942 1943 All infants per 1,000 live births 26.26 55.9 57.69 63.52 48.7 Legitimate infanta per 1,000 legitimate live births 15.87 41.4 58 .09 62.5 51.0 Illegitimate infants per 1,000 illegitimate live births 206.89 250.0 51.79 76.92 20.4 Deaths from Cancer (all ages) 64 90 71 87 83 Deaths from Measles (all ages) - - - - - Deaths from looping Cough (all ages) 2 - 4 - - Deaths from Diarrhoea (under 2 yrs of age) . 2 4 5 10 7 • ( J- ... k t* ' 4. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY and CASE-RATES for certain Infectious Diseases in the Year, 1939. England and Wales 126 County Boroughs & Great Towns including London. 148 Smaller Towns (Res. Pop.) 25,000 to 50,000 at 1931 Census London Administrative County Kingston-upon-Thames Rates per 1,000 population. Births:- Live 15.0 14.8 15.6 12.3 13.33 Still 0.59 0.59 0.57 0.44 0.22 Deaths:- All Causes 12.1 12.0 11.2 11.9 11.4 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.01 0.01 0.01 0.00 0.00 Scarlet Fever 0,01 0.00 0.00 0.00 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.05 Diphtheria 0.05 0.05 0.04 0.02 0,05 Influenza 0.21 0.19 0.20 0.18 0.35 Notifications:- Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.89 1.96 1.78 1.53 1.75 Diphtheria 1.14 1.21 1.16 0.98 0.48 Enteric Fever 0.04 0.03 0.04 0.03 0.03 Erysipelas 0.34 0.40 0.31 0.37 0.26 Pneumonia 1.02 1.21 0.89 0.99 0.7 Rates per 1,000 Live Births. Deaths under 1 year of age 50 53 .40 48 28 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 3.75 5 BIRTH-RATES, BEAT -RATES. ANALYSIS 0F MORTALITY AND CASERATES for certain Infectious Diseases in the year 1940. England and Wales 126 County Boroughs & Great Towns including London. 148 Smaller Towns (Res. (Pop.) 25.000 to 50,000 at 1931 Census. London Administrative County. Kingston upon Thames. Rates per 1,000 population. Births:- Live 14.6 16.0 15.7 13.7 13.86 Still 0.55 0.64 0.55 0.44 0.43 Deaths:- All Causes 14.3 15.8 12.8 17.8 17.6 Typhoid & Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.02 0.02 0.02 0.01 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.00 0.00 Diphtheria 0.06 0.07 0,05 0.01 0.05 Influenza 0.32 0.29 0.30 0.10 0.45 Notifications:- Smallpox 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 1.63 1.53 1.57 0.02 1.2 Diphtheria 1.16 1.29 1.21 0.61 1.41 Enteric Fever 0.07 0.06 0.10 0.06 0.08 Erysipelas 0.33 0.36 0.30 0.35 1.32 Pneumonia 1.20 1.37 1.00 0.87 1.17 Rates per 1,000 Live Births. Deaths under 1 year of age 55 61 54 50 55 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 5.9 4.4 5.8 7.71 6, BIRTH-RATES, DEATH -RATES, ANALYSIS OP MORTALITY and CASE-RATES for certain Infectious Diseases in the Year 1941. England and Vales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Res. Pop.) 25,000 to 50,000 at 1931 Census. London Administrative County Kingston-upon-Thames Rates per 1,000 population. Births:- Live 14.2 14.7 16.4 8.9 14.46 Still 0.51 0.58 0.60 0.33 0.53 Deaths:- All Causes 12.9 14.9 13.0 16.3 14.59 Typhoid & Paratyphoid 0.00 0.00 0.00 0.01 0.00 Scarlet Fever 0.00 0.00 0.01 0.00 0.00 Whooping Cough 0.06 0.07 0.06 0.04 0.11 Diphtheria 0.07 0.08 0.06 0.03 0.03 Influenza 0.19 0.17 0.20 0.15 0.14 Small pox 0.00 0.00 0.00 0.00 0.00 Measles 0.03 0.03 0.03 0.02 0.00 Notifications:- Typhoid Fever 0.03 0.02 0.03 0.04 0.00 Paratyphoid Fever 0.09 0.12 0.09 0.05 0.19 Cerebro-Spinal Fever 0.25 0.31 0.20 0.30 0.53 Scarlet Fever 0.47 1.49 1.51 1.01 1.50 Whooping Cough 4.39 4.37 4.50 3.50 7.53 Diphtheria 1.25 1.53 1.19 0.93 0.43 Erysipelas 0.30 0.30 0.27 0.50 0.22 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 10.35 8.27 10.47 4.77 9.2 Pneumonia 1.25 1.53 1.04 1.07 0.75 ! Rates per 1,000 Live Births. Deaths under 1 year of age 59 71 56 66 57 Deaths from Diarrhæa & Enteritis under 2 yrs.of age 5.1 7.5 4.6 6.8 9.62 7 BIRTH-RATES, DEATH-RATES, ANALYSIS OF NORTALITY AND CASERATES, for certain Infections Diseases in the year 1942. England and Wales l26 County Coroughs and Great Towns including London : 148 Smaller Towns (Res. Pop.) 25,000 to 50,000 at 1931 Census. London Administrative County Kingston-upon-Thames Rates per 1,000 population. Births:- i Live 15.8 17.3 18,4 14.0 15,26 Still 0.54 0.66 0,62 0.48 0.36 Deaths:- All Causes 11.6 13.3 12.1 13.9 13.60 Typhoid & Paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.03 0.02 0.04 0.00 Diphtheria 0.05 0.06 0.04 0.02 0.00 Influenza 0.09 0.09 0.10 0.07 0.11 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.01 0.02 0.01 0.01 0.00 Notifications:- Typhoid Fever 0.01 0.01 0.01 0.02 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebro Spinal Fever 0.14 0.17 0.12 0.15 0.08 Scarlet Fever 2.19 2.49 2.34 1.86 2.19 Whooping Cough 1.73 1.97 1.58 2,72 2.74 Diphtheria 1.05 1.35 0.91 0.76 0.22 Erysipelas 0.30 0.36 0.26 0.43 0.27 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 7.46 9.27 7.39 8.62 10.39 Pneumonia 1.07 1.30 0.94 0.94 0.96 Rates per 1,000 Live Births. Deaths under 1 year of age 49 59 46 60 63 Deaths from Diarrhoea and Enteritis under 2 years of age 5.2 7.5 4.8 8.6 18.15 1 . / ' 8. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY AND CASE-RATES lor Certain Infectious Diseases in the Year 1943. England and Wales 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Res. Pop.) 25,000 to 50,000 at 1931 Census. London Administrative County Kingston-upon-Thames Rates per 1,000 population. Births:- Live 16.5 18.6. 19.4 15.8 17.77 Still 0.5 0.63 0.01 0.45 0.64 Deaths:- A11 Causes 12.1 14.2 12.7 15.0 13.92 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whopping Cough 0.03 0.03 0.03 0.03 0.00 Diphtheria 0.03 0.04 0.04 0.02 0.00 Influenza 0.37 O.36 0.37 0.27 0.41 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.02 0.02 0.02 0.02 0.00 Notifications:- Typhoid Fever 0.01 0.01 0.02 0.01 0.02 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebre Spinal Fever 0.08 0.10 0.06 0.09 0.02 Scarlet Fever 3.01 3.29 3,54 3.80 3.06 Whooping Cough 2.54 2.82 2.25 2.68 4.2 Diphtheria 0.88 1.12 0.77 0.74 0.08 Erysipelas 0.31 0.35 0.27 0.42 0.17 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 9.88 9.23 9.77 9.17 7.99 Pneumaonia 1.34 1.62 1.16 1.27 1.11 Rates per 1,000 Live Births. Deaths under 1 year of age 49 58 46 58 48 deaths from Diarrhoea and Enteritis under 2 years of age 5.3 7.9 4.4 20.4 10.9 9. (iv) Causes of Death. Registrar General's Tables. 1939 1940 1941 1942 1943 M. F. M. F. M. F. M. F. M. F. All Causes 224 226 334 325 253 272 260 231 226 274 1 Typhoid and Paratyphoid Fevers _ _ _ _ _ _ _ _ _ _ 2 Cerebro-Spinal Fevers mm ; 3 1 3 1 _ _ _ _ 3 Scarlet Fever — — — — — — — — — — 4 Whooping Cough 1i 1 _ — 3 1 — — — — 5 Diphtheria — 2 1 1 1 — — — — — 6 Tuberculosis of the Respiratory system 9 7 15 12 9 9 13 9 12 13 7 Other forms of Tuberculosis — 2 3 — 3 1 1 1 — 1 8 Syphilitic Diseases 5 2 1 2 1 1 3 — 2 2 9 Influenza 7 7 5 12 3 2 — 1 5 7 10 Measles — — — — — — — — — — 11 Acute Poliomyelitis and Polioencephalitis — — — — — — — — — — 12 Acute Infantile Encephalitis — — — — — — — — —— — 13 Cancer of B.cav.& oesophagus (M) Uterus F. — — 3 6 4 5 4 4 2 3 14 Cancer of Stomach & Duodenum — — 5 4 7 5 6 4 10 5 15 Cancer of Breast ) — — 0 9 — 5 — 5 — 10 16 Cancer of all other sites 38 26 34 29 24 21 33 31 25 28 17 Diabetes 3 2 3 5 2 4 2 — — — 18 Intra-cran, vascular lesions 14 15 21 34 21 26 18 31 15 32 19 Heart Disease 55 85 96 94 64 70 70 70 52 67 20 Other diseases of circulatory system 21 12 11 11 7 13 — — 6 17 21 Bronchitis 4 5 23 20 18 16 9 7 14 20 22 Pneumonia 9 7 19 19 17 14 10 4 19 10 23 Other Respiratory Diseases I 2 2 3 4 3 4 2 4 1 5 24 Ulcer of Stomach or Duodenum 7 1 2 1 2 — 3 1 3 1 25 Diarrhoea under 2 yrs. 1 1 3 1 3 2 5 5 6 1 26 Appendicitis 1 1 2 3 — — 3 — — — 27 Other Digestive Diseases 5 4 3 7 4 9 5 6 8 2 28 Nephritis 6 3 11 7 5 6 7 6 4 2 29 Puerperal Causes — — — — — — — — — — 30 Other maternal causes 31 premature birth — — — — — _ - 1 — — 32 Congenital Malformation Birth Injuries 4 4 4 2 5 3 6 1 1 7 33 Suicide 1 — 3 — — — 3 - 2 1 34 Road Traffic Accidents — — 7 — 6 2 3 1 4 1 35 Other violent causes 13 7 17 16 117 24 7 12 2 7 36 Other causes 18 30 30 22 18 25 31 14 24 26 Special cause( included in 36 above Smallpox — — — — — — — — — — 10. SECTION .B. General Provision of Health Services 1. (i) Public Health Officers. The Staff of the Public Health Department is as shown in preface to the Report. Changes of staff during the years under review have been recorded in the preface to the Report, (ii) (a) Laboratory Facilities. From 1st January, 1939, to the commencement of the war bacteriological examinations were carried out by Dr,D.S.Murray, by arrangement, but on the outbreak of war Dr. Murray's laboratory was taken over by the Ministry of Health as part of the Emergency Pathological Service. In effect there have been no differences as specimens for examination have been sent in exactly the same way as previously. In addition bacteriological examinations of milk are undertaken by the Clinical Research Association, and samples under the Foods and Drugs Acts arc submitted to the Public Analyst. (b) Ambulance Facilities. (1) For infectious cases: Cases removed to Wimbledon Isolation Hospital are transported by the Motor Ambulance attached to that Hospital (2) For non-infectious and accident cases: A Motor Ambulance is provided by the Corporation, Accident cases are removed free, but a charge is made for its use for private cases. During the period under review the following number of accident cases and private cases were removed by this ambulance: Cases 1939 1940 1941 1942 1943 Accident 128 414 353 519 264 Private 193 164 . 186 158 415 There is, in addition, an ambulance which is maintained by 124th Kingston Ambulance Division and 96th Kingston Nursing Division of the Order of St .John of Jerusalem, and which is used to a great extent for the conveyance of maternity cases, by private arrangement. (c) Nursing in the Home. (l) General. This is carried out, in the main, by District Nurses from the Kingston Nursing Association, and in necessitous cases the fees may be defrayed by the Council. During the period under review no claims under this head were made. 11. Statistical Report in District Nursing. (Extracted from Annual Reports of the Kingston Nursing Association.) 1939 1940 1941 1942 1943 Cases. Cases on books on 1st January. 46 41 62 54 67 New Cases 449 534 520 569 626 Results of Cases: Convalescent 343 371 398 431 466 Transferred to Hospital 48 48 57 59 81 48 91 70 63 77 Removed for other 15 3 3 3 2 Still on books 41 62 54 67 67 Visits General Nursing 10,555 11,468 12,551 15391 16,974 229 181 118 204 150 (2) Infectious Diseases. In Measles, Whooping Cough and Epidemic' Diarrhæa", "the Health Visitors are under instruction to visit the cases and give practical advice as to the best methods of nursing them. If attended by District Nurses, the fees may be paid by the Corporation, but during the period under review no claims were received. 12 (d) Clinics and Treatment Centres as at 31st. December, 1943 Clinic or Dispensary. There held. When held. Diphtheria Immunisation Health Centre,Grange Road, Kingston. Tuesdays & Fridays at 4 p.m. Maternity and Child Welfare Centre Health Centre,Grange Road, Kingston. Tuesdays & Fridays at 2 p.m. Maternity and Child Welfare Centre Latchmere Road School. Mondays & Thursdays at 3 p .m . Ante-Natal Clinic Health Centre,Grange Road, Kingston. Wednesdays 1.45 p.m. Post-Natal Clinic Health Cent re, Grange Road, Kingston. Wednesdays 1.45 p.m. School Clinic Minor Ailments -do - -do - Daily at 9.15 a.m. Consultations -do - -do - Tuesdays & Fridays at 9.30 a.m. Dental Treatment -do - -do - Mondays & Thursdays at 9.15 a.m. & 1,30 p.m, Eye Clinic -do - -do - First & third Thursdays in month at 10.a.m. Speech Training Centre -do - -do - Mondays & Wednesdays at 2 p.m. Ultra Violet Ray Clinic -do - -do- Tuesdays & Fridays at 9.a.m. & 3.30 p.m. Orthopaedic Clinic Red Cross Curative Post, Coombe Lane,Kingston By appointment Tuberculosis Dispensary (s.c.c.) South Place, Surbiton. Wednesdays at 5.30 pm. Fridays at 1.30 p,m. War-time Nursery "Surrey Villa", 1 Knights Park, Kingston. For admission apply to Medical Officer of Health. War-time Nursery "St.Peter's School", Hawks Rd.,Kingston. -do - War-time Nursery "Kilnwood", 213 Richmond Road, Kingston. -do - War-time Nursery "Fairfield", Fairfield East Kingston. , -do- Bentalls Nursery Messrs. Bentalls, Clarence Street,Kingstor Apply Staff Controller, Messrs. Bentalls Ltd. Day Nursery (Vol. Committee) 53/55 Canbury Park Road, Kingston. Mondays to Fridays & Saturday mornings. Kingston Nursing Association (Vol. Committee) 33 Birkenhead Avenue, Kingston Apply to Matron for District Nurses. 13 (e) Hospitals, (1) Fever. An arrangement exists with the Wimbledon Corporation whereby cases may be admitted to the Wimbledon Isolation Hospital, and payment is made by the Kingston Corporation for the maintenance of patients. Owing to war difficulties and the need for conservation of accommodation it has been necessary on occasions to send patients to other hospitals. (2) Smallpox. The Surrey Smallpox Hospital, East Clandon, (Surrey County Council). (3) Other, General Hospitals situated in the Borough available for the District are:- The Kingston County Hospital (Surrey County Council). The Kingston Victoria Hospital, supported by voluntary contributions. The Corporation made annual contributions of £50. to the Kingston Victoria Hospital, during the years 1939 1943 (inclusive). A number of the inhabitants of the Borough attend the Royal Hospital, Richmond, and the Corporation made annual contributions of £50 to its funds, during the years 1939 - 1943 (inclusive). . V1 'J * _ . ■ . » * ' ; V • r ' • 14. 3. (i) Midwifery and Maternity Services. (a) MIDWIFERY SERVICE. The Midwifery Service is under the administrative control and supervision of the County Medical Officer of Health and can be divided into two main sections:- Domiciliary Midwifery Service. Institutional Midwifery Service. At the end of 1943 there were three midwives in the Borough who undertake confinements at home. Complete arrangements for medical assistance and, if necessary, admission to the Kingston County Hospital, are made by the Surrey County Council. Institutional treatment is mainly at the Kingston County Hospital, but, if necessary, cases are transferred to one of the other County Hospitals. In March, 1942, a small private maternity home was opened in Kingston and a number of confinements of Borough cases have occurred there. The following are the details of the notifications of births (Kingston residents only) to the Medical Officer of Health by (a) Midwives: (b) General Practitioners and the Superintendent of Kingston County Hospital: Births notified 1939 1940 1941 1942 1943 No. notified by Midwives 174 159 115 147 158 No. notified by General Practitioners and Medical Superintendent, Kingston County Hospital 379 364 419 424 506 Total 553 523 534 571 664 The following table supplied by the Registrar General and amended by transfers in and out, divides the total registered births into (a) Live: and (b) still births: 15. Births Registered. 1939 1940 19.41 19.42 1943 M. F. M. F. M. F. M F. M. F. Live Births: Legitimate 258 246 257 226 271 211 276 235 291 297 Illegitimate 11 18 17 19 18 20 20 19 31 18 Still Births: Legitimate 4 5 8 6 11 4 5 7 14 6 Illegitimate - - 1 1 3 1 - 1 2 1 Totals: Male & Female 253 269 283 252 303 236 301 263 338 322 Grand Totals 542 535 - 539 564 660 A part-time Consultant was available in the Borough for consultation for any case of midwifery or puerperal pyrexia where the confinement took place at home. Mr, A.McAllister, F.R.C.S., was Consultant until March 1st. 1940, and Mr, J. V. O'Sullivan, F.R.C.S., since that date. The consultant services were used as follows: 1943 1940 1941 1942 1943 — 2 — 1 — (b) (i) Maternal Mortality. The Medical Officer of Health investigates all maternal deaths, and obtains full reports from the practitioner attending. The following are the number of deaths in the period under review together with the cause: Cause. 1939 1940 1941 1942 1943 Mitral Stenosis Cardiac Failure Toxaemia of Pregnancy - - 1 - - Septic Abortion - - - 1 - Septic Abortion, self-induced - - - 1 1 . 16-. (b) (ii) Infant Mortality. The following are the numbers of children who died in the Borough before reaching the age of one year, together with the cause of death and age: Year. Age Total Cause of Death. 1939 0-24 hours 4 4 Prematurity. 1939 24 hrs.-1 month 5 1 Broncho Pneumonia and Prematurity, 1 Prematurity. 1 Trachio Retropharyngeal Fistuls 1 Cardiac Debility. 1 Haematemesis. 1939 1 mth.-1 year 5 1 Ileon Colitis. 1 Syncope,Infectire Arthritis Right Knee. 1 Asphyxia due to suffocation by a covering blanket. 1 Infantile Malnutrition. 1 Acute Bronchitis. 1940 0 - 24 hours 3 1 Congenital Heart Disease. 2 Prematurity. 1940 24 hrs.-1 month 10 1 Pulmonary Atelectosis. 3 Prematurity. 1 Broncho Pneumonia, 1 Toxaemia, Prematurity. 1 patent interventricular septum of heart. 1 Haemorrhage disease of new born. 1 Enteritis. 1 Inanition Spina Bifida. 1940 1 mth.-l year l6 1 Marasmus Mongolism. 1 Broncho Pneumonia, Congenital heart disease. 1 Broncho pneumonia Influenza. 2 Gastro Enteritis. 1 Gastro Enteritis. 1 Acute Broncho Pneumonia, 2 Acute Bronchitis, 2 Meningococcal Meningitis. 1 Congenital Heart Disease. 1 Broncho Pneumonia, Acute Bronchitis, Malnutrition, 1 Broncho Pneumonia and Pre- maturity. 1 Due to War Operations, 1 Exhaustion Pneumoccic Meningitis, 1941 0-24 hours 9 7 Prematurity. 1 Torn tentorium Cerebelli Bystocia. 1 Subdural Haemorrhage following tentorial tear. 24 hrs,-l month 7 1 Intracranial Haemorrhage Hystocia. . • ' ■ 1 • ?. I ' ' ! ■ ■ ■ ; • . i - . * • t .. . • w ... . . . • -1 . p. * • •••". . } ' r - - .-. . 4 * ■ • . ' . J ' • I • ' ' ♦ . . | ...... . i •* » : ..... ? • V i. ■ 17. (b) (ii) Infant Mortality (Contd.) Year Age Total Cause of Death. 1941 24 hrs - 1 mth. 7 (contd.) 2 Gastro Enteritis. 1 Streptococcal Meningitis 1 Birth Injury (Tentorial tear). 1 Cerebral birth injuries (forceps delivery;. 1 Premature birth. 1 month - 1 year 14 1 War Injury 1 Meningococcal Meningitis 4 Gastro Enteritis 1 Asphyxia caused when her face became buried in a soft pillow. 7 Broncho pneumonia. 1942 1 - 24 hrs 11 1 Shock due to tion . 1 Haemorrhage. 5 Prematurity. 1 Heart Failure. 3 Birth Injury. 24 hrs. - 1 month 8 1 Asphyxia 2 Marasmus 1 Subdural Haemorrhage 1 Gastro Enteritis 3 Prematurity 1 mth. - 1 year 16 1 Drowning 6 Gastro Enteritis 2 Broncho Pneumonia. 1 Prematurity 1 Asphyxia 1 Toxaemia 1 Heart Failure 3 Marasmus. 1943 0 - 24 hrs. 4 2 Prematurity. 1 Dead body found in River Thames. 1 Cerebral Haemorrhage, 24 hrs. - 1 month 9 5 Prematurity. 2 Intracranial Haemorrhage 1 Marasmus. 1 Spina Bifida. 1 month - 1 year 18 1 Prematurity 6 Gastro Enteritis 4 Pneumonia 2 Infantile Convulsions. 1 Influenza. 1 Shock following operation for Intussusception 1 Toxaemia. 1 Asphyxia caused by pressure of face in bed covering. 18. (b) (ii) Infant Mortality (Contd.) Year Age. Total Cause of Death. 1943 1 mth. - 1 year 18 (contd.) 1 Raised intracranial pressure. The approximate infant mortality rate for these years is as follows:- 1939 1940 1941 1942 1943 Kingston upon Thames 26 55 57 63 48 England and Wales 50 55 59 49 49 London Area 48 50 68 60 58 It will be observed that the Infant Mortality rate for the Borough has been below that of the England and 'Vales and the London Area figure, with the exception of 1942, when the figure was slightly above, and in 1940 when the London Area Rate was exceeded. The. year 1939 was an exceptional year, the infant mortality rate being about half of the figure for England and Wales. Prom the details given regarding infant deaths, it will be observed that 22% of the infant deaths for the five years period occurred in infants under the age of 24 hours, and that approximately 50% occurred during the first month of life. This is in accordance with figures for other areas, and though the Infant Mortality Rate has decreased during the past 50 years in children between one month and one year, it has remained almost constant in the neo natal period. Of the children who died between the age of one month and one year, an increased number died as a result of Gastro Enteritis. These deaths on the whole can be considered preventable, since Gastro Enteritis is often due to infected food. Every effort is made by the staff of the Public Health Department to advise and train mothers to prepare infant feeds in such a way as to minimise the possibility of infection. Ophthalmia Neonatorum. The number of cases notified were as follows:1919 1940 1941 l942 1943 3 3 - 3 - Special arrangements for the admission of serious cases of Ophthalmia Neonatorum have been made and one infant with its mother was admitted to Swanley L.C.C. Hospital, Kent, 19 (b) (iii) Puerperal Pyrexia. The following numbers of cases of Puerperal Pyrexia were notified during the period under review:- Cases 1939 1940 1941 1942 1943 (a) Total notified 66 63 37 23 18 (b) Number of (i) Kingston residents 16 24 3 5 4 (ii) Extra district residents 50 39 34 18 14 (c) Number included in (a) Notified from Kingston County Hospital 64 6l 34 20 17 (d) Number notified by private doctors 2 2 3 3 1 (e) Number of cases included in (d) removed to hospital - - 1 1 - 3 II. a. ANTE-NATAL SERVICES. Until the outbreak of war a part-time Consultant Obstretrician (Dr. Turner) presided at the Borough Ante-Natal Clinics, assisted by the Health Visitors. In August, 1939, Dr. Turner, under the Emergency Medical Services Midwifery Scheme, was transferred to a hospital in Buckinghamshire. During September and October, 1939, the Assistant Medical Officer of Health carried out ante-natal clinics, both for midwives cases and hospital cases living in the Borough. In November, 1939, this work was undertaken by the Medical Officer and staff of the Kingston County Hospital Ante-Natal Service, assisted by the Health Visitors. Arrangements were made to hold the joint antenatal clinics at the Health Centre, since the ante-natal rooms at the Hospital were required for other purposes as result of the war. This arrangement continued until November, 1942, when the two ante-natal clinics were again run independently, the Kingston County Hospital Medical Officer presiding at the Borough Ante-Natal Clinic, with the assistance of the Health Visitors. The majority of ante-natal cases whose confinement is undertaken by a midwife, attend the Borough Ante-Natal Clinic, a lesser number of cases attending their family doctor. The following table gives the number of patients attending the Borough Ante-Natal Clinics during the period under review, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation: 1939 1940 1941 1942 1943 No. of Patients 202 124 134 134 144 No. of attendances 982 650 603 548 744 Defects referred to Kingston County Hospital 26 35 34 39 35 : 90 The Ante-Natal Services in the Borough can be divided into two parts:- (a) Borough Ante-Natal Services - for cases where confinement is undertaken by a midwife at home of the mother. (b) Hospital Ante-Natal Service - for cases who have arranged to be admitted to the Kingston County Hospital for the confinement. Special attention is paid at ante-natal clinics to the nutrition of expectant mothers. Under the Ministry of Food Scheme all expectant mothers can obtain one pint of milk daily at reduced rate and, in addition, are considered priority oases for eggs. Supplementary nourishment in the form of dried milk, cod liver oil, etc., is supplied at the Antenatal clinic, either free or at cost price, depending upon the circumstances. The following are the circumstances Scales which have been in operation during the period under reviews: No. in family Scale of income per head of family after deducting rent and rates, not exceeding per week. 1939 1940 1941 1942 1943 Free Half Cost Free Half Cost Free Half Cost Free Half Cost Free Half cost 2 10/5 11/6 12/1 13/1 12/6 14/6 12/6 14/6 12/6 14/6 3 9/- 10/- 10/4 11/4 11/- 13/- 11/- 13/- 11/- 13/- 4 7/6 8/6 8/8 9/8 9/- 11/- 9/- 11/- 9/- 11/- 5 & Over 7/- 8/- 8/1 9/1 8/6 10/6 8/6 10/6 8/6 10/6 Owing to the limited accommodation for midwifery cases in tho Kingston County Hospital, the Almoner of the Hospital requests a visit to be made to the homes of all mothers applying for admission to hospital. These visits are made by the Health Visitors, who decide whether home conditions are suitable for confinement at home and a recommendation, in accordance with the homo conditions, is forwarded to the Almoner. Other visits to expectant mothers are made by the Health Visitors from time to time, and the following table gives the number of visits that were made during the period under review: 1939 1940 1941 1942 1943 No. of home visits (individual cases) 245 227 247 266 271 Total No. of Visits 335 347 377 367 395 (b) POST-NATAL SERVICE In view of the small number of mothers who attend the Post-Natal Clinics, these services are incorporated with the Ante-Natal Services and arrangements indicated in Section 1 apply in this section. It is regretted that the number of mothers who attend the Post-Natal Clinics has been small during the period under review. The following are the total numbers: 1939 1940 1941 1942 1943 30 10 13 13 40 ■ • 21 Every effort is made by the Health Visitors to arrange for all mothers confined at home to attend the Post-Natal Clinics, "but the majority of mothers who consider that they are fit and well a few weeks after the confinement fail to attend. ( c) THE INFANT WELFARE. (i ) Domiciliary Visits. The initial visit by a Health Visitor is paid to all infants 12 - 14 days after confinement where a midwife has been in attendance, or where the confinement took place in the Kingston County Hospital, and 28 days after the birth where a General Practitioner was in attendance. Advice is given by the Health Visitor on infant feeding, hygiene, and general management. Further visits are paid according to the domestic circumstances where a family doctor is in attendance, no further visits are made unless by request of the mother. In a majority of cases, visits are made every month, or more often if necessary, during the first six months, and every two months between six months and one year, and every three months between one and five years. More frequent visits are made where there are difficulties, infant feeding or illness. Regular visits at intervals of one to three months, according to circumstances, are made between the ages of one to five years. Every effort is made to find children who have entered the Borough since their birth and regular visits are also made to these cases. The following are the total number of visits made during the period under review:- 1939 1940 1941 1942 1943 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 First Visits 551 - 506 - 503 - 529 - 642 - Total Visits 3465 5432 2884 5227 2915 5175 2922 5410 2758 5368 (ii) Infant Welfare Services. Prom 1st January, 1939, until August 1940, three Infant Welfare Clinics were held weekly at the Health Centre, Grange Road. In August, 1940, an Infant Welfare Clinic was commenced at Latchmere School. Prom that date, two Clinics were held weekly at both the Health Centre and Latchmere School. The Medical Officer of Health or his Assistant attend all these Clinics, examine the children regularly, and advise regarding infant feeding etc. The following table shows the number of sessions held, the number of new cases seen, subsequent visits made, and the numbers seen by the Medical Officer. 22.  Health Centre,Grange Road Tuesdays and Fridays Latchmere Road School Mondays and Thursdays. 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 No. of sessions held 149 142 102 102 103 - 30 99 101 99 No. of new cases seen 497 503 348 362 383 - 72 237 222 269 Total attendances made 8342 7419 5562 6251 7167 - 1004 4467 5524 6380 No. seen by M.O. 5471 3826 2300 2442 2541 - 660 1842 2085 2120 Until July, 1940, fresh, milk was supplied to necessitous cases by the Corporation. At this date the Ministry of Food introduced a scheme whereby all children under five could be supplied with one pint of milk, either at a cheaper rate or free of charge if under the Ministry of Food Necessitous Scale. In December, 1941, the Ministry of Food introduced tho Vitamin scheme Cod Liver Oil, Orange Juice, and Black Currant Puree, as an extension of the milk scheme. Dried milk and supplementary nourishment are supplied at the Clinics to all cases recommended by the Medical Officer, either at approximately cost price, or half-Price, or free of charge in necessitous cases. The income scale referred to in Section 2(a) also applies to dried infant foods, etc. The following table gives details of the supply of infant food and dried milk during the poriod under review:- Amount in lbs. 1939 1940 1941 1942 1943 Sold, cost price and Sold, half price 4654 6290 6215 8555 12,817 Free of charge 2765 2907 2189 2626 2,093 The Medical Officer of Health expresses appreciation of the help given by voluntary workers at the Infant Welfare Centres, A number of voluntary workers have attended regularly during the period under review, their work being arranged and co-ordinated by Mrs. Udale. In addition to assistance in clerical work, voluntary workers have organised two clothing stalls, one at each Centre, where infant clothes are sold at the cost price of the material used. These garments are made by the voluntary workers in their homes. The total number of garments sold during the period under review was as follows:- 1939 1940 1941 1942 1943 No. of mothers who bought 185 279 261 321 256 No. of garments 433 930 974 1025 762 In addition, a War Savings Group under the supervision or Mrs.Udale, is run at the Infant Welfare Clinics. »' ' • • - i - '*» r . -r:;V'-.v: . ' : ' ' ' ; " i jJ •; ' 'i ''! ■ " v' • •••' ; !— • • • v • - •> • ' • • • . ■ ' - , t « > • , . : i r **> l . '• ■ v ' j ■: .»• . .. . I .. .. \ » •- .■. . t . .. .• • •• ''•••; : i : : - i • . . • n . . > i ' f ■ 1 H ' * • •. v .. * •<** ' ;.t- . 5 r, . aj.- : ... i j' i r ; '1 •: i " ; 1 ' ' : • . ... . : 1 ' * 1 • •* . :. . '~J 1 r • ' ' * r v.« . » ' . ' * -» » ' • J * • • • -k >• • j v 7 t ^ • / » • I.- ! » / > : » '■ ! • . v-" - i • •. • : .. 5 . • ... ['ty^ j.« v; : •;. 1 r u iL. U.N r-t'-'i j v \:t,. - • • % , , { j ... ; . ^ J -'•v I . : V r: ?»•'., • \ > ••• • • v : yj . 1 ' «. . . .; •" V. , ;X. , ' V • .1 \ V" , . >v . ••••*. * . ' ■ r* • . ••• K f ■■ - ' .V. • . > V ; ». . v> ..*• *' . . • . . •. . • • k liy ♦ • • i - * . •. - .• ■ ... .. x - •• ... • .. '. ' / • • 1 •• " .. a " ' '• ; - • ; j < V _ • . , . , ? • i > • .... | • ... - ^ . . s • i 1 ■ ' ■ ■, '■ * ' .• ••• K • "■ . ; / ? > * 1 ~l. t ■ • : <: ^ . ; 1 * ' 1 ' 5 '■ r' ' ■ ' :| ■ . •; ^ ; .■ ' .r ; : " I ! ' ^ : X •'! ' " • • ' ' 23. Until the introduction of rationing, voluntary workers suppled tea and refreshments to all mothers attending the Clinic at 1d. per cup. (iii) Institutional treaimpnt» (a) There is no provision in the Borough for institutional treatment for mothers and children, provided by the Corporation, hut private arrangements exist for the reception of expectant unmarried mothers at the Kingston Deanery Home for Friendless Girls, 18 Richmond Parle Road. The home is administered by a voluntary body, the Kingston Deanery Moral Welfare Committee, affiliated to the Southwark Diocesan Association for moral welfare. There are fourteen beds. Admission is not confined to Kingston residents, but is extended to girls residing anywhere in, or occasionally beyond, the Southwark diocese. The expectant mothers enter the home about two months before confinement, and it is a condition of their acceptance that they stay for at least two months after confinement, at tho end of which period efforts are made to secure them suitable employment. A sooial welfare worker keeps in touch with the girls after they leave the homo. There is a permanent staff consisting of a Matron, a S.C.M. Nurse, and a Cook-Housekeeper. The following table shews the numbers of admissions to the house during the period under review:- 1939 68 1940 81 1941 59 1942 58 1943 59 WAR-TIME. NURSERIES. (b) In May 1941, the Local Authority was approached by the Ministry of Health, and the Ministry of Labour and National Service regarding the provision of Nurseries for the accommodation of children under the age of five years, whose mothers were on war work. Plans were immediately put in operation for the adaptation of Surrey Villa, Knights Park, as a war-time nursery. Owing to the demand for accommodation before the adaptations at Surrey Villa had been completed, the Surrey Villa children were temporarily housed in unoccupied class rooms at St. Peter's School, This occupation commenced on the 2nd September 1941, Surrey Villa was completed early in November 1941, and the children were transferred from St Peter's to Surrey Villa on the 17th November 1941. It was realised that the demand for Nursery accommodation was increasing, and the Ministry of Health were approached regarding the adaptation of class rooms at St,Peter's School for a Nursery School, i.e. for children between the ages of 2 and 5 years. Those adaptations were completed early in December 1941, and the Nursery School was opened on the l6th December 1941. The demand for Nursery accommodation continued to increase, and a third Nursery at Kilnwood, 213 Richmond Road, was adapted and opened on the 10th August 1942; followed by a fourth Nursery at Fairfield East which opened on 24th May 1943. This last mentioned Nursery is a pre-fabricated . . * r . * . . ■ *' I •' . J ••• ' • ' .. I « < 1 . . , • , • •1f\ ■ ' 24 building supplied by the Ministry of Health and was erected by direct labour. In addition nursery accommodation was available at the Kingston Day Nursery, Canbury Park Road, and at Messrs. Bentalls Ltd. The former has been in existence for many years and during the period under review was administered by a voluntary committee of which the Medical Officer of Health was a member. (A local doctor acted as Honorary Medical Advisor to the Nursery). The latter was established in 1943 by Messrs. Bentalls Ltd. as a private nursery to accommodate the children of their employees between the ages of 1 - 5 years. The firm's doctor acted as Medical Officer for nursery purposes, but in this case and the Kingston Day Nursery the Medical Officer of Health was available for consultation and full co-operation was obtained. In June 1943, approval was given by the Ministry of Health to the recognition of both Nurseries as war-time Nurseries to the extent that both were to continue to operate under private direction but were to receive a grant of 1/- per day per attendance subject to supervision by the Ministry of Health and the local authority. It should be noted that the grant represented only a small proportion of the expense involved in running each nursery, and both the Kingston Day Nursery Voluntary Committee and Messrs .Bentalls are to be congratulated on their public spirited effort in helping to meet the demand for nursery accommodation. The following table gives the total attendances during the years 1941, 1942 and 1943:- Year Surrey Villa St. Peters Kilnwood Fairfield Kingston Day Nursery Bentalls 1941 878 1,337 - - - - 1942 11,733 9,140 3,155 — — — 1943 10,899 10,607 9,732 6,583 5,364* 8,268* *Attendances are recorded, for the purpose of this report from June 1943, being the date the Nurseries were approved, officially, as war-time nurseries. Special attention has always been paid to the care of the children in the War-time Nurseries. Staff have been chosen for their experience in handling children under the age of five years. The essentials of adequate nutrition has been carefully watched in the diets of the children. I would like to take this opportunity of expressing my appreciation of all the good work carried out at the Nurseries both by full time staff, and by the Health Visitors, voluntary workers, and the Nursing Auxiliaries from First Aid posts, "A" and "B"• 25 (iv) HEALTH VISITORS. The changes in the personnel of the HBalth Visitors are indicated at the beginning of this Report, The Health Visitors are also School Nurses and Child Life Protection Visitors. There has been considerable expansion of the work in Maternity and Child Welfare as evidenced by the figures showing the number of Domiciliary Visits and Clinics held. There has also been a considerable addition to the work of the Health Visitors in regular visits of inspection to the War-Time Nurseries recently established. All tho Health Visitors have contributed much to Civil Defence by Acting as Trained Nurses for the First Aid Posts and Mobile Units and by undertaking the Nursing supervision of shelters and a Shelter Aid Post when required. Miss Hookway, Senior Health Visitor, has rendered outstanding service by dealing successfully with all the additional calls due to War Organisation and the increase in Routine Work with the same number of colleagues throe as before tho war. There is no doubt that an inorease in the staff of tho Health Visitors is necessary. . , ... i . - • . . . : ' '• - ' ' " ■ ' 26 3 (v) CHILD LIFE PROTECTION. The duties imposed by the Children and Young Persons Acts and hy the Public Health Act, 1936, are entrusted to the Maternity and Child Welfare Sub-Committee of tho Public Health Committee. It is the routine duty of an Infant Life Protection Visitor to visit every foster mother at least once a month, and more frequently when found necessary. During the year under review visits were paid as shewn below: 1939 1940 1941 1942 1943 494 556 545 765 524 The following table gives details regarding numbers of children under the care of foster mothers and other relevant information: 1939 1940 1941 1942 1943 No. on Register at beginning of year 31 33 26 28 35 No. of new registrations 5 8 5 11 9 No. ceasing to have charge of infants 3 15 3 4 11 No. on Register at end of year 33 26 28 35 33 Total No. of children 23 22 38 45 33 Infant Life Protection Visitors are also Health Visitors. 3. (vi) (a) DENTAL TREATMENT. Arrangements for dental treatment have been made in conjunction with the dental scheme of the School Medical Service. All children under five requiring dental treatment are referred to the dental clinic by the Medical Officer, and expectant and nursing mothers from the Ante-Natal Clinics of both the Borough and the Hospital. The following arc the details of the attendances and treatment carried out: . 27. TREATMENT OF DENTAL DIRECTS. (MATERNITY & CHILD WELFARE ONLY). 1939 1940 1941 1942 1943 Sessions devoted to treatment 31 23 16 17 21 No. treated: (i) Mothers 79 57 39 66 59 (ii)Infants 64 74 56 51 36 Attendances made for treatment 471 349 228 306 329 Fillings: (i) Permanent teeth 38 28 1 36 40 (ii)Temporary teeth 15 38 10 29 27 Extractions: (i) Permanent teeth 477 259 181 266 242 (ii )Temporary teeth 222 194 124 137 88 Other operations: (i) Permanent teeth 28 21 7 15 14 (ii)Temporary teeth 160 88 50 23 43 Supply of dentures 23 13 - 13 15 Dentures are supplied when necessary either at cost price, free of charge or part cost, depending upon the circumstances. Each case is considered or) its merits by the Maternity and Child Welfare Committee and the proportion, if any, to he paid by the mother, is assessed. The total cost of dentures supplied, and the amount paid by the mothers is as follows:- 1939 1940 1941 1942 1943 Total Cost £111 9 0 £58 8 0 £46 8 0 £62 12 10 £70 4 11 Contribution by mothers £59 9 3 £15 4 0 £20 1 0 £16 5 0 £22 14 0 (b) Ophthalmic Clinic. Ophthalmic treatment is not often required for children under five years of age, but when necessary these children are seen at the same time as school children. The following number of children were seen during the period under review:- 1939 1940 1941 1942 1943 Defective vision 1 - 2 - - Squint - 4 9 16 26 Other conditions - 1 1 1 1 (c) Artificial Sunlight. Children under 5 years of age requiring artificial sunlight treatment arc referred from the Infant welfare Clinic, and the following are the total number of children attending and the total number of attendances during the period under review: 28  1939 1940 1941 1942 1943 No. of children under five years attending. 55 45 126 101 120 Total number of attendances. 330 960 2302 1547 1522 The fallowing are examples of the type of defects for which children are referred:- Marasmus; rickets; Pink disease; Bronchitis; frequent colds; cervical glands. (d) Tonsils and Adenoilds. Arrangements have been made with the Kingston Victoria Hospital for operative treatment for tonsils and adenoids. The following are the number of children under five, who had operative treatment for the period under review: 1939 1940 1941 1942 1943 Total No. of cases 5 8 12 8 12 Total Cost £7 2 6 £11 8 0 £17 2 0 £11 8 0 £17 2 0 Contributions made by parents £1 2 6 £2 5 0 £3 15 0 £1 15 0 £2 9 6 ( e) Orthopaedic. Treatment. Children under 5 years of age requiring orthopaedic treatment are referred to the consultant at the Red Cross Curative Post, and arrangements are made for attendance at this Post for exercises, massage, etc. Then necessary, in-patient treatment is arranged at St, Vincent's Orthopaedic Hospital • The following are the numbers who attended the Post during the period under review: 1939 1940 1941 1942 1943 No. seen by Surgeon 10 16 15 18 24 No. treatment given by staff 169 351 194 169 182 No. of cases discharged 3 1 5 5 1 No. admitted to Hospital - 2 2 2 3 (f) Treatment of Scabies, A report on the treatment of scabies is given in Section F of this Report. Arrangements have been in existence for the treatment of scabies at the First Aid Posts for children under five, together with other age groups, since January,1942. 29 (g) Convalescent Treatment. In the majority of cases requiring convalescent treatment, arrangements are made by the Kingston County Hospital. In a small number of cases arrangements may be made by the Medical officer of Health, (h) Prevention of the Spread of Infectious Diseases. Maternity and Child 7elfare. (*) Diphtheria Immunisation. It is the endeavour of the Medical Officer of Health to have all children immunised as soon as possible after the first birthday of every child, Details on this subject will be found in Section F of this report, (ii) Vaccination. No detailed records are kept of the number of children vaccinated in age group 0-4 years inolusive. The approximate percentage vaccinated is probably less than 50 per cent and oomments have been made on this subject in the report of the School Medical Officer, (iii) Whooping Cough Immunisation. During 1942 a number of children under 5 years of age attending War-time Nurseries were given immunising doses of whooping cough vaccine. In November, 1940, the Medical Research Council supplied material and record cards for immunisation against whooping cough of children between six months and three years were kept. This immunisation was commenced in December, 1942, and an initial batch commenced immunisatior on the 30th, November, 1942. (vii) Home Helps, Arrangements have been made in the Borough for domestic assistance to mothers whose confinement takes place at home, the work being undertaken by home holps. In those cases requiring financial assistance part or whole of the cost is borne by the Corporation. The amount to be paid by the mother is assessed by the Maternity and Child Welfare Committee. The following is the number of cases who applied for financial assistance for home helps during the period under review: 1939 1940 1941 1942 1943 - 3 7 - 13 In other cases assistance is given by the visits of the Queen's Nurses of the Kingston and District Nursing Association, 30 4. Nursing' Homes. The Surrey County Council is the Authority for registration "but has delegated power of inspection to this authority. At the beginning of 1939 there was one registered Nursing Home subject to inspection by the Xjocal Authority. This Nursing Home was at 24, Albany Park Road. A total of twelve beds to accommodate chronic and senile patients were available, and the Nursing Home was under the charge of Miss Roe. In January, 1939, this Nursing Home was removed from the register. In March, 1942, a Private Nursing Home was opened at 20 Grove Crescent called the Nonsuch Nursing Home, under the direction of Miss Colclough Hoey. This Nursing Home has seven beds for chronic and senile patients. In March, 1942, a Private Maternity Home was opened at 6 Queens Road, under the charge of the Matron, Miss M.Keene. This Maternity Home can accommodate eight patients. Before registration of these two Nursing Homes, inspections were made by the County Medical Officer of Health, Borough Surveyor, and the Medical Officer of Health, and the proprietors were required to carry out certain alterations and improvements before registration was effected. 31. REPORT OT .CHIEP SNITARY INSPECTOR. To the Mayor, Alderman and Councillors. Ladies and Gentlemen, In presenting this conposite report upon the work carried out by your Sanitary Inspectors during the years 1939 - 1943 inclusive, I should like to make a fen brief introductory ooraments. First, the report deals with matters oorning within Sections C,D and E, which relate to environmental hygiene. Secondly, the period covered marks the close of a quarter of a century of my service with your Corporation. Thirdly, despite changes in personnel and reduced staff together with other war-time interruptions, every effort has been made to maintain as high a standard of work as circumstances would permit. Occasionally it proved necessary to restrict activities to urgent essential work, not necessarily covered by normal duties. It is, perhaps, worth recording that for one short period, owing to the changes referred to I was the sole technical officer and there was no available clerical assistance. Between than, the Sanitary Inspectors have manned the Burton Road Control Room and have taken in their stride other duties in several branches of Civil Defence before and during the war period. Fourthly, the report is restricted in extent and is mainly statistical. SANITARY CIRCUMSTANCES. Section C. 1«( i ) - 7AT331. The water supply of the town is furnished by the Metropolitan "rater Board. Notwithstanding the many disruptions v/hich have occurred, with consequent risk of contamination, the Board may be congratulated on the maintenance of an excellent supply both as regards quality and quantity. Intermittent periods of drought caused temporary restriction of the supply for non-domestic purposes but these were not of a serious character. Comparatively few shallow wells remain in the town - there being only 19 premises known to be supplied with well water at the end of 1943. During the year 1941, the supplies from 15 wells were examined bacteriologically and the 13 supplies which were found to be satisfactory were earmarked for use in case of emergency, ^ortunately, such a need did not arise. Bacteriological and chemical examinations of the piped supply are carried out by the Water Board, (ii). DRAINAGE AND SE7ERAGE. During the period under review the only main drainage work carried out, apart from routine and other repairs arising from enemy action, was the piping in of a ditch north of Lower Marsh Lane. 32. This was done to permit the use of the area as a tip for house refuse, and consisted of laying 12" and 15" pipes with requisite manholes for inspection and dragging purposes. The cost of the Work was approximately £300. 2. RIVERS AND STREAM The effluent from the Corporation Sewage works is discharged into the Thames, and despite war-time conditions every endeavour has been made to maintain a standard of purification satisfactory to the Thames Conservancy Board, which is the body responsible for checking pollution of the Thames and its tributaries . The Hogsmill River is one such tributary, and it flows through the Southern part of the Borough and joins the Thames at a point a short distance above Kingston Bridge. The Hogsmill River receives sewage effluents from Malden and Epsom and Ewell, at points before reaching the borough boundary. A scheme for widening the Hogsmill River was prepared by the Surrey County Council prior to the outbreak of war when the plans were suspended, 3.( i ) .CLOSET ACCOMMODATION. The closets in the borough are on the water carriage syStan . (ii) PUBLIC CLEAMSING. The removal and disposal of house refuse is the responsibility of the Borough Surveyor, who states that the refuse, after salvage has been extracted, is disposed of partly by burning and partly by tipping, the percentages being approximately 40 and 50 respectively. Some 100 tons of salvage material are extracted each months including waste food for pig feeding which in pre-war years was deposited in the ashbins. (iii ) SANITARY INTSPECTIOF of THE AREA. (a) The following is a tabulated list of visits and inspections. A perusal of the figures will show an upward or downward trend according to war conditions and further comment will be made under appropriate headings later in the report. INSPECTIONS AND VISITS. 1939 1940 1941 1942 1943 Total Insp. of Houses,etc. 940 365 791 668 710 3474 Insp. of Drainage. 52 126 128 270 103 679 Reinspections. 1808 905 1251 809 1207 5980 Works in Progress. 1010 273 343 348 297 2271 Factories,etc. 18S 41 240 304 343 1114 Outworkers. 21 19 13 9 12 74 Cowsheds,etc.Dairies 58 90 66 41 64 319 Ice Cream Premises. 19 13 - - - 32 Foodshops & Stores. 595 501 67b 687 731 3190 Bakehouses. 34 55 29 18 31 167 I .D .Enquiries. 172 249 207 246 225 1099 Markets. 171 56 63 108 160 558 Slaughterhouses. 191 15 3 3 12 224 Offensive Trades. 21 4 5 3 5 38 Vegetable Factory. - - 27 139 79 245 1939 1940 1941 1942 1943 Total re-Noxious smells & Effluvia. - - - 58 42 100 Com. Lodg,Houses. 23 14 12 23 25 97 Canal Boats. 10 4 — - - 14 Theatres,etc. 41 10 16 29 35 131 House to House. 70 - - - — 70 Verminous Premises. 40 71 78 77 123 389 Smoke observations. 5 4 5 12 23 49 Stables Yards. 25 2 8 12 7 54 Rats & Mice Dest. 31 107 315 374 427 1254 Shops Acts. 627 247 302 312 314 1802 Young Persons Emplt. 22 4 7 12 17 62 Housing Act (Accom'd'n) 357 103 106 58 52 676 Rag nock Acts. 10 2 5 8 7 32 "7ell "rater Supplies 41 31 66 2 6 146 R,R.A, 152 99 8 10 6 275 Billeting - 319 33 5 — 357 Houses after V,D. - 126 9b 87 - 309 Shops after W.D. - 67 33 - - 100 Miscellaneous 53 73 91 109 105 431 6785 3995 5023 4841 5168 25,812 (b)(c) The numbers of notices served and the result of the action taken is shown by the following statistical statements. It should be pointed out that the number of notices complied, is not strictly comparable with the number served in any one year, as the former number may refer to notices served in more than one year. Notices served. 1939 1940 1941 i " 1942 1943 Informal. (a) Verbal 22 2 - — - (b) 7ritten 447 349 246 104 241 Statutory. (a} Housing Acts. - 2 - - - (b) Public Health Acts. 15 13 10 2 Notices Complied with 1939 1940 1941 1942 1943 Informal. (a) Verbal 22 2 - - - (b) Written 483 352 227 112 215 Statutory. (a^ Housing Acts. - - 2 - - (b) public Health Acts. 20 13 10 - — 3. (iv) SHOPS. AND OFFICERS. Arrangements for the health and comfort of workers in shops are controlled by The Shops Act, 1934, whilst the Public Health Act, 1930, brought offices within certain of the provisions. Apart from specific instances where complaints were 34. received, circumstances prevented any systematic improvements being carried out during the period under review, (v) camping. SITES. Apart from limited use of Steven's Ait, there are no camping sites in the Borough. (vi) Si DIE. A AOS. BITT. The Greater London Regional Smoke Abatement Advisory Committee was formed in 1939, and your Corporation is represented thereon by the Chairman of your Public Health Committee and your Chief Sanitary Inspector. The outbreak of war caused a cessation in the Committee's work which was not resumed before the end of 1943. There has been a general lowering in the grades of coal used for steam raising and a substitute for heavy oil has been introduced for a similar purpose. It is, therefore, not a matter for surprise, particularly in the latter instance, that the production of black smoke has increased. A thorough investigation of complaints which arose failed to lead to the discovery of a cure although temporary improvement was effected by altering the angle of the jets of the liquid fuel furnaces. In this particular case the assistance of the Ministry of Fuel and Power was sought and one of their technical officers took part in the investigation. 3. (vi i) SV/Ij 1JUG BATHS. AlTD POOLS. (a) PBT3LIC. A new swimming bath was constructed by the Corporation and opened in 1937. The accommodation comprises two pools, both of which were in use during the summer, and one in the winter months during the early war years. A purification and filtration plant is installed. During the year 1941, one of the baths was converted for use as a British Restaurant, for which purpose it has continued in use until the present date. The other swimming bath has remained in use throughout winter and summer. (b) PRIVATE. There are no privately owned swimming baths or pools open to the public, in the Borough, (viii) ERADICATION OF BHD BUGS. The following table shows the number of premises" each year in connection with which action was found to be necessary. In every case the premises wore subjected to disinfestation processes appropriate to the circumstances. VERMINOUS PREMISES DISINFECTED 1939 1940 1941 1942 1943 Premises 35 43 20 20 56 4. schools. Information with regard to the sanitary condition of schools is given in the report of the School Medical Officer 35 The recommendation for the prevention of the spread of infectious disease contained in the memorandum on closure of and exclusion from school, 1927, hive been closely followed. It was not necessary to close my school owing to infectious disease, or on public health grounds during the period under review. 5. COMPLAINTS. As one might expect, the number of complaints received fell off considerably during the weeks immediately following the outbreak of war, but the reduction did not persist more than two or three months. It is strange, but nevertheless true, that a few people have considered it incumbent upon them to register complaints regarding comparatively minor defects in their houses, when at no great distance from their homes, other houses have been destroyed or so seriously damaged that they were rendered uninhabitable. Often complaints refer to defects or conditions which have obviously given the housewife a good deal of unnecessary worry e.g. the presence of ants or beetles inside the house, or of rats or mice on the premises. In all such cases, every assistance has been rendered, and where it has been possible to do so, the cause for the complaint has been eradicated. The total number of complaints received and recorded respectively each year was as follows: 1939 1940 1.941 19A2. 19.43 207 257 257 436 466 The work which may follow an apparently simple oomplaint is exemplified by the following brief record. Complaints of obnoxious odours were received from a few business premises in the centre of the town. By an eliminating process and certain common features in each case, the smell was eventually traced to drain inlets. At the same time, the character of the odour was recognised as being very similar to that which had given rise to complaints in connection with a factory at the other side of the town. A close investigation at the factory disclosed that foul water was being discharged through an old drain into the surface water sewer instead of into the foul or soil sewer. There was not sufficient rainfall at that time to effectively wash and scour the surface water sewer and the foul liquid gradually found its was through the town to the sewer outlet. The gases had escaped through gully traps in which the water seal had been broken by evaporation. The necessary remedial worics were carried out and there has been no repetition of the cause for complaint. It is interesting to note that there was a large increase in the number of complaints regarding rodents in 1943. This increase coincided with the publicity campaign of the Ministry of Food* RODENT CONTROL. This is the official designation for work which had previously been known more generally as rats and mice destruction, and it is a section of the work which has been carried on by your Corporation for several years through their own staff. Apart from loaning the services of staff for rat destruction on private property, work which is self supporting financially, an intensive campaign was carried out in the autumn of 1943 in connection with the public sewers in certain parts of the town. This work was carried out 36. in collaboration with the Ministry of Food, Rodent and Insect Pest Control Division# The results were very satisfactory and provided much useful experience and information, but it is not possible to give further details in this brief report, BUILDING MATERIALS AND WORKS. A war-time addition to duties has been in the form of assistance to various government departments, and one such instance, the certifying of applications for permits to purchase timber, slates, etc., has extended over several years, whilst more recently, there has been the issue of certificates of essentiality in respeot of applications for building work licences. 37 SECTION D. HOUSING. It is suggested by the Ministry that only a general appreciation be given of the housing position, shoving the extent to which housing matters have been affected by the changed conditions in respect of the period covered, by this Report. The following observations are therefore based on a general understanding of the district instead of on statistics, which are not now available. In any case, it is rather doubtful whether statistics in regard to such matters as over crowding etc, would be of much value in view of the movement of population during war-time. There is no doubt that additional housing accommodation is required and the Housing Committee is giving the problem their close \ attention. Housing matters have undoubtedly been affected by the following factors* (a) The partial suspension of action, under the Housing Acts, in regard to insanitary areas, from the commencement of the war. (b) The cessation of building. (c) Damage by enemy action. (d) The influx of war population, many of whom have had to be billeted in private houses. (e) Shortage of building operatives and building materials. Judged by the applications received for housing accommodation the demand is much higher now than before the war. This is due partly to the larger number of marriages taking place. Many of the men who have married are with H.M.Forces and they must be regarded as potential householders who will need housing accommodation when they return. There is a larger proportion of houses originally intended for the occupation of one family only, which now are providing accommodation for two or more families. Since it has been impossible during recent years to make structural alterations, it will be understood that many of these families must be living under difficult and unsatisfactory circumstances* There is, therefore, an urgent and present need for additional housing accommodation. The fallowing table gives particulars of building development during the period under review: 1939 1940 1941 1942 1943 (l) Number of new houses erectod by the Corporation during the period under review Nil Nil Nil Nil Nil (2) Number of houses erected by private enterprise during the period under review 49 houses 2 Nil Nil Nil 75 flats (3) Total number of Houses for the working classes erected by the Corporation since March 1924 764 hses. 764 hses• 764 hses. 764 hses. 764 hses 68 flats 68 flats 68 flats 68 flats 68 flat 38. SECTION E, INSPECTION AND SUPERVISION OF FOOD. It need hardly be stressed that important as food inspection is in norms!, times, it is much more so in times of national emergency buch as we have experienced; hence, every care has been taken to ensure, as far as practicable with limited staff, the continuance of a pure and wholesome food supply. (a) MILK SUPPLY. At the commencement of the year 1939, there wore 77 persons registered as Dairymen in the borough. During the following years this number was considerably reduced for one reason or another, but principally as a result of th€ government scheme of rationalisation-of milk delivery. At the end of 1943 there were 40 persons registered as dairymen but some of these have no dairy in the town. There is only one cowkeeper in the borough. Below will be found a tabular statement of the number of licences issued under the provisions of the Milk (Special Designations) Regulations 1936 to 1942. DESIGNATED MILK LICENCES (DEALERS'). T.T. Accredited. Pasteurised. 1939 14 1 18 1940 14 1 18 1941 13 1 18 1942 13 1 15 1943 12 1 12 During' the five years under review 136 samples of milk were taken for bacteriological examination and 56 samples for biological examination. The yearly total and the numbers of unsatisfactory samples are shown below. The high proportion of unsatisfactory samples in 1943 was due almost entirely to delays in transport consequent upon the reorganisation of the wholesale supplies. MILK AND DAIRIE3. Samples Talc en. 1939 11940 1941 1942 1543 Bacteriological: Satisfactory 23 20 28 19 46 Not Satisfactory 1 5 3 2 28 Biological Satisfactory 17 14 13 2 10 Not satisfactory - - - - - Phosphortase: ' Satisfactory 2 - 5 5 20 Not satisfactory - - - - 4 39 (b ) MEAT AND OTHER FOODS. . The total number of animals slaughtered in the borough during 1939 was 2,177, compared with 2,190 for 1933• A further 233 animals were killed by 15th January, 1940, the date upon which the Livestock (Restriction on Slaughtering) Order, S,R.O, 1940, No <41, became effective. After that date no further animals were slaughtered in the borough for sale# The following table, prepared in the form suggested by the Ministry, shows the number of animals killed, the carcases inspected and the results of the inspection* It will be noted that 100^ of the animals slaughtered were examined either at the time of slaughter or before removal of the carcase from the slaughterhouses, and when associated organs were available fb r inspection. Cattle. Calves Sheep & Lambs. Pigs. L939 1940 1939 1940 1939 1940 1939 1940 Number killed 105 21 44 8 249 5 1779 207 Number inspected 105 21 44 8 249 5 1779 207 ALL DISEASES EXCEPT TUBERCULOSIS Tfhole carcases condemned. - - - - - - 2 - Carcases of which some part or organ was condemned - - - 1 - - 16 2 Percentage of the number inspected affected with disease other than tuberculosis - - - 12.5 - - - - TUBERCULOSIS ONLY ^.Vhole carcases condemned 3 - - - - - 1 - Carcases of which some part or organ was condemned 1 - 4 1 - - 34 5 Percentage of the number inspected affected with tuberculosis 3.9 - 9.09 12.5 - - 1.9 2,4 40 UNSOUND FOOD. In order to simplify the statement as far as possible no detailed reasons for condemnation are given in the tabular statement below as v;as the practice in previous years. The causes for condemnation have been grouped under three main headings, a reference to which is given at the end of the statement. No special comment is necessary or even desirable at the present time. The figures given are a sufficient indication of the work involved by food inspection. Should a more detailed report be called for at a later date, attention might be directed to the comparative figures for each of the five years. Food Condemned. 1939 1940 1941 1942 1943 lbs - lbs, lbs. lbs. lbs. Beef (D) * 1944 185 27 181 40 " (P) 398 2387 3675 697 732 Offal(D) 233 114 75 25 47 " (P) 110 962 93 183 13 Beef (E.A.) - 590 - - - Pork (D) 352 891 26 - - "(P) lGo 541 29 - 17 Offal (D) 203 95 2 - - " (P) - 245 75 48 5 Mutton (D) - 210 40 17 10 " (P) 1030 72 83 147 107 Offal (D) - 159 6l — — " (P) 1894 4354 110 — 8 Pish (p) 495 293 312 811 70 Canned Poods (P) - - 16 08 4884 9911 11 " (E.A.) - - 6 tons - - Sausage (p) - 21 600 90 - Bacon (P) - - - 69 - Rabbits (P) - - 600 - - Cheese (P) — — 174 - 26 Nuts (p) — - 350 - - Bread ("Ropd") - - 3½ tons - Miscellaneous (P) 84 - 116 - 76 " (E.A.) - 933 392 — _ * "D" denotes - diseased. "P" " - putrefaction or decomposition. "E.A." " - damaged by enemy action. All weights in lbs. unless otherwise stated. . 41 Action taken under the Pood and Drugs Act, 1938. Articles. Analysed Adulterated or Deteriorated Prosecutions . Convictions • PormaJ. Informal Total Formal Info rmal Total 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 1939 1940 1941 1942 1943 Milk 23 — 3 4 3 2 45 40 56 54 25 46 43 60 57 4 1 — 1 1 1 2 1 4 1 2 2 2 - - 1 - 1 - - 1 - 1 Butter Lard Tea Cream 1 1 1 1 Sugar 1 1 1 1 Confectionary & J an 2 1 2 9 1 1 4 9 1 2 1 1 1 1 2 1 Other Articles 3 2 3 1 4 5 12 43 14 7 5 14 46 15 1 2 1 1 6 1 1 2 TOTALS 29 ж 5 7 5 9 ж 6o 32 100 69 38 ж 60 57 107 74 6 ж 2 2 3 1 1 2 9 3 7 ж 1 2 2 6 - ж — 1 — 2 - ж - 1 - 1 ж Samples taken during 1939 "by S.C.C. under Pood and Drugs (Adulteration) Act 1928. 42 (ii ) SLAUGHTERHOUSES. None of the three private slaughterhouses which" was in use in 1938 is now licensed. Animals which are brought to the Cattle Market as fatstock are sent to government slaughter houses in other districts. (iii) SHOPS. (iv) STALLS AND VEHICLES, (v) PLACES TCRE TOOD IS PRERARED,., | In all the ahove premises a reasonably high standard was maintained in 1939, hut with the advent of war it became increasingly difficult to do so owing to depleted staffs due to the claims of National Service. ( C ) ADUJiPJRATIONETC . The table on the preceding page gives details of the samples taken and other action under the provisions of the Pood & Drugs Act during each of the fiv-3 years. It should be noted that your Corporation became the 'oods C: Drugs Authority for the Borough on 1st October, 1939. Prior to that date the duties were carried out by the Surrey County Council. C.OipLUSION.. . Once again I desire to offer my thanks to the Chairman and Members of the Public Health Committee and the Corporation generally, for their continued consideration and support, and to all my colleagues, without whose assistance my duties would have been more arduous. I am, Ladles and Gentlemen, Your obedient Servant, Harold T.Perry, F.S.I.A. Chi ef Sani tary Insp eot or. Guildhall, Kingston-upon-Thames. 43. SECTION F. PREVALENCE OF, AMD CONTROL OVER: INFECTIOUS AND OTHER DISEASES, The following Infectious diseases are notifiable to the Medical Officer of Health of the Borough: Scarlet Pever, ''/hooping Cough. Diphtheria (including membranous croup). Measles (excluding rubella). Acute pneumonia (primary or influenzal) Cerebro-spinal fever. Acute poliomyelitis. Acute polioencephalitis. Acute encephalitis lethargica. Dysentery. Ophthalmia neonatorum. Puerperal pyrexia. Smallpox. Paratyphoid fevers. Enteric or Typhoid fever excluding paratyphoid. Erysipelas. Malaria. Cholera. Plague. Typhus fever. Relapsing fever. Tuberculosis. The following table gives a comparative statement of Notifications received during the last twenty years :- Year. .Scarlet Fever. Diphtheria Enteric Fever, (including Paratyphoid) 1924 143 20 6 1925 213 25 7 1926 82 27 7 1927 87 65 3 1928 135 152 7 1929 74 113 1 1930 78 100 5 1931 61 53 1 1932 56 47 1 1933 125 30 2 1934 40 42 2 1935 54 50 2 1936 67 27 6 1937 51 21 1 1938 61 72 1 1939 69 19 1 1940 45 53 3 1941 54 15 7 1942 79 8 - 1943 110 3 1 It will be noticed there was an increase in the number of cases of Scarlet Fever notified during 1943 as compared with previous years. This was not unexpected and has no particular significance. All cases are investigated promptly and any possible sources of infection are followed up. 44. Generally the cases were mild in extent, and it is probable that this has relationship to the increase in numbers, by reason of cases not being seriously ill at the commencement of the infective period, resulting in contact with other persons for a longer period than would otherwise have been the case. The drop in the numbers of notified cases of diphtheria is both interesting and satisfactory, and it is reasonable to assume that the decline is due in great measure to diphtheria immunisation, The rise in the number of notified cases of diphtheria for 1940 was due to a local outbreak in children, most of whom attended an elementary school in the borough, or who lived at homes in which one or more children attended the same school. Very prompt investigations were made, and on two occasions every child in the school was examined. Pour carriers were eventually found and removed to hospital, after which the cases rapidly decreased. The following tables show the number of children immunised against diphtheria: 0-5 Group. Birth date. No.completely immunised at Clinic. 1943 204 1942 292 1941 281 1940 347 1939 331 Total 1455 58.2 5-15. Group Birth date. Nft. completely immunised at Clinic, 1938 319 1937 309 1936 295 1935 327 1934 281 1933 242 1932 255 1931 257 1930 258 1929 230 Total 2733 64.8% Additional Immunisation. 0-5 group General Practitioners 16 Immunised elsewhere 12 Grand Total 1483 59.32% 5-15 group General Practitioners 34 Dr. Barnardo's Home 150 S.C.C. Home 25 Immunised elsewhere 172 Grand Total 3154 73.7 % 43. The material used for immunisation is alum precipitated toxoid. Schick Testing is carried out at 3 months and 2 years approximately after immunisation, Further reference to this subject will be found in the report of the School Medical Officer. Close attention is given to the following up of contacts of cases of Enteric Fever. In one instance in 1943, the patient was not a Kingston resident but visited Kingston for the purpose of attending a wedding a few days before the onset of the disease. Enquiries were set on foot immediately and it was ascertained that there were about 50 persons present at the wedding. Difficulties were encountered in that it was not possible to obtain a complete list of the guests immediately, with the results that many visits had to be made to the persons in the district and enquiries made of Medical Officers of Health in the neighbouring Authorities to check up everyone who was present. Every family represented at the wedding was interviewed and many communications were written regarding the case and contacts. No further cases occurred in relation to this patient which was satisfactory after the amount of following up which was undertaken. Another case, in respect of which detailed investigations were necessary, occurred in 1942. This case was notified in another district, but the patient had stayed in a common lodging house in Kingston-upon-Thomes up to the date of the onset of the illness. The lodging house was visited the same day and all the occupants were interviewed. In certain cases, arrangements were made for bacteriological examinations, all of which proved negative, The keeper of the lodging house undertook nc to accept new lodgers for a specified period, and daily visits were made, mostly at night, in regard to The state of health of all the occupants. No further cases arose in relation to this patient. The incidence of enteric fever (including paratyphoid fever) v/as low generally during the period under review, and in no case was the source of infection definitely established. The highest notified in any one year was seven in 1941, . but these cases occurred at intervals during the year, and there was no indication of a common source of infection, despite detailed investigation. The following tables show in detail the numbers of cases of notifiable infectious diseases notified during the past five years: 46 NOTIFIABLE DISEASES DURING 1939, CASES . DEATHS. Under 1 year 1-2 2-3 3-4 4-5 5 -10 10-15 15-20 20-35 35-45 45-65 65 & over Total cases notified Oases admitted to hospital. Under 1 year 1-2 2-3 7-4 4- - 5 5 -10 10-15 15-20 20-35 35-45 45-65 65 & over Total Deaths. Scarlet Fever 2 2 — 6 3 30 7 8 9 2 — — 69 55 - - - - - - - - - - - - - Diphtheria 1 1 - 2 2 5 3 2 2 - - - 19 18 - - - - 1 1 - - - - - - 2 Typhoid Fever - - - - 1 - - - - - - - 1 1 - - - - - - - - - - - - - Anterior Poliomyelitis - - - - - - 1 - - - - - 1 1 - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 6 51 9 - — 66 64 - - - - - - - - - - - - - Ophthalmia Neonatorum 3 — — - — — - — — - 3 3 - - - - - - - - - - - - - Pneumonia 1 — 1 1 — 3 — — 2 4 9 7 28 10 - - - - - - - - - - 1 - 1 Erysipelas — — - - - 1 1 - 2 2 3 1 10 6 - - - - - - - - - - - - - NEW CASES. DEATHS. Tuberculosis Under 1 year 1- 5 5 -15 15 -25 25 -35 35 -45 45 -55 55 -65 65 & over Total Under 1 year 1-5 5 -15 15 -25 25 -35 35 -45 45 -55 55 -65 65 & over Total (a) Respiratory M - - - 5 4 3 5 5 1 23 — - - - 1 1 2 2 1 7 F — — — 4 4 1 l 4 1 15 - — — — 4 — — — 3 2 9 Total — - - 9 8 4 6 9 2 38 — - — 4 1 1 2 5 3 16 (b) Non-Respiratory M — — — 4 — — — — — 4 — — — — — — — — - - F - - 2 1 - — - - 3 - - - - - - - - - — Total - - 2 4 - - - - - 7 - - - - - - - - - - -a NOTIFIABLE DISEASES DURING 1940. CASES. DEATHS. Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over Total Cases Notified Cases admitted to Hospital Under 1 year 1-2 2-3 3-4 4-5 5 -10 10-15 15-20 20-35 35-45 45-65 65 & over Total Deaths. Scarlet Fever 2 3 1 2 1 18 10 - 7 1 - - 45 34 - - - - - - - - - - - - Nil Diphtheria — 2 2 1 7 28 7 1 4 — I — 53 53 -- - - - - - 2 - - - - - 2 Enteric Fever including Paratyphoid - - - - - - - 1 1 - - - 2 2 - - - - - - - - - - - - Nil Puerperal Pyrexia - - - - - - - 6 47 10 - — 63 62 - - - - - - - - - - - - Nil Ophthalmia Neonatorum 3 - — — — — — — — — — — — - - - - - - - - - - - - Nil Cerebro-Spinal Fever 2 - 4 — 1 2 2 4 7 1 2 - 25 23 2 - - - - 2 - - - - - - 4 Pneumonia - 1 1 — - 8 2 3 6 5 8 10 44 10 '- - - - - - - - - - 1 4 0 Erysipelas — — — — — 1 - — 1 2 3 5 12 2 - - - - - - - - - - - 1 1 B.Dys en teria( Sonne) — — — — — — — — — — — 1 1 1 - - - - - - - - - - - - Nil Measles 7 22 27 53 59 222 10 4 7 1 1 - 373 7 - - - - - - - - - - - - Nil Whooping Cough 5 1 4 - 2 10 — - - — - — 22 — - - - - - - - - - - - - 1 Typhoid Fever - - - - - - - - 1 - - - 1 1 - - - - - - - - - - - - Nil NEW CASES. DEATHS. Tuberculosis Under 1 vear 1 -5 5 -15 15-25 25-35 35-45 45-55 55-65 65 & 0ver Total Under 1 year 1-5 5 -15 15 -25 25 -35 35- 45 45 -55 55 -65 65 & Over Total (a) Respiratory M — - — 5 6 6 3 — 1 21 - - - - 3 4 3 2 1 13 F — - 6 7 1 1 1 — 16 - — 1 5 4 - 2 — 1 12 Total - - ' 1 11 13 7 4 - 1 37 - - 1 3 7 5 5 2 2 25 (b) Non-Respiratory M - - - - - - - - - - — — 1 — - - — - 1 F. — - 1 5 2 1 1 — — 10 - - - - - - - - - - Total - - - 1 5 2 1 1 - — 10 - - - - - - - - - - s NOTIFIABLE DISEASES DURING 1941. CASES. DEATHS. Under 1 year 1-2 2-3 3-4 4-5 5 -10 10-15 15-20 20-35 35-45 45-65 65 & over Total cas Notified. Cases adm: ed to Hospital Scarlet Pever 1 4 4 4 1 23 10 4 2 1 - - 54 46 - - - - - - - - - - - - Nil Diphtheria — 1 6 - — 4 2 - 2 — — - 15 14 - - - - - - - - - - - - 1 Enteric Pever including Paratyphoid - - - - - - - 1 5 1 - - 7 7 - - - - - - - - - - - - Nil Anterior Poliomyelitis — - - - - 1 — — — - - - 1 1 - - - - - - - - - - - - Nil Puerperal Pyrexia - - - - - - - 6 28 3 — - 37 34 - - - - - - - - - - - - Nil Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - Nil Cerebral-Spinal Pever 1 1 1 2 — 2 2 1 7 — 1 1 19 18 1 — 1 1 — - — 1 — — - — 4 Pneumonia 1 3 3 1 2 3 - - 2 2 4 6 27 4 1 1 - - - - - - - - - - 2 Erysipelas 1 — — — — — — — 5 1 3 — 8 2 - - - - - - - - - - - - Nil B.Dys en teria( Sonne) - - - - - - - - - - - - - - - - - - - - - - - - - - Nil Whooping Cough 27 42 53 27 30 82 3 3 mmm 2 1 ?71 31 1 2 1 - - - - - - - - - 4 Measles 8 29 30 34 38 156 22 8 4 1 1 - 331 22 - - - - - - - - - - - - Nil NEW CASES. DEATHS. Tuberculosis Under 1 vear 1-5 5 -15 15-25 25 -35 35 -45 45 -55 55 -65 65 & over Total Under 1 year 1-5 5 -15 15-25 25-35 35-45 45-55 55-65 65 & over Total (a) Respiratory M. — — 1 5 3 - 4 4 2 19 - 1 - 3 1 - 2 3 - 10 F. - 1 1 8 6 1 2 5 1 25 - — 1 3 2 - 2 — 1 9 Total - 1 2 13 9 1 6 0 3 35 — 1 1 6 3 — 4 3 1 19 (b) Respiratory M. 1 — 2 1 1 — - - - 5 — 1 - 1 - - - - 2 F. - - 2 1 - - - - 1 4 — — — — 1 — — — — 1 Total 1 - 4 2 1 — - - 1 9 - - 1 — 1 — — - 1 3 49 NOTIFIABLE DISEASES DURING 1942. CASES. DEATHS. Under 1 year 1 -.2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over Total cases notified. Cases admitted to Hospital Under 1 year 1-7 2-3 2-4 4-5 5 -10 10 -15 15 -20 20 -35 35 -45 45 -65 55 & over Total Deaths. Scarlet Fever — 5 6 8 3 42 7 3 5 — — — 79 62 - - - - - - - - - - - - - Diphtheria — 2 1 1 — 2 1 1 — — — - 8 8 - - - - - - - - - - - - - Puerperal Pyrexia mm mm mm _ ? 16 6 — — 24 23 - - - - - - - - - - - - - Ophthalmia Neonatorum 3 — — — mm — — - — — — 3 - - - - - - - - - - - - - - Cerebro-Spinal Fever — - - — - — — 1 — 1 1 - 3 2 - - - - - - - - - - - - - Pneumonia 3 2 1 — 2 5 1 1 1 1 7 11 35 11 3 - - - - - - - - 1 4 6 14 Erysipelas _ 1 1 ? 5 1 10 - - - - - - - - - - - - - S.Dysenteria (Sonne) 3 3 1 - 1 2 1 11 7 - - - - - - - - - - - - - ^/hooping Cough / 6 4 .3 • .5 53 — — _ — 99 1 - - - - - - - - - - - - - Measl es 6 2 52 3 6 +5 ! ?3 ] L80 10 6 7 — — — 375 9 - - - - - - - - - - - - - NEW CASES DEATHS Under 1 year 1-5 5 -15 15-25 25-35 35-45 45-55 55-65 65 & over Total Under 1 year 1-5 5 -15 15-25 25-35 35-45 45-55 55-65 65 & over Total Tuberculosis (a) Respiratory M 2 6 9 7 4 7 1 36 - - 1 4 - 1 3 4 - 13 F — — 3 13 9 4 1 1 31 - - — 2 1 4 1 — 1 9 Total - mm 5 19 18 11 5 7 2 67 - - 1 6 1 5 4 4 1 22 (b) Non-Respiratory M. — mm 1 2 1 — - - — 4 - - — — — — 1 - — 1 F - 1 — 3 1 1 1 - - 7 - - — - - 1 - - - 1 Total - 1 1 5 2 1 1 - - 11 - - - - - 1 1 - - 2 30 NOTIFIABLE DISEASES DURING 1943- CASES. DEATHS. Under l year 1-2 2-3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total case notified Cases admitted to Hospital Under 1 year 1-2 2-3 3-4 4-5 5 - 10 10 - 15 15 - 20 20-35 35 - 45 45 - 65 65 & over Total Deaths Scarlet Fever 1 3 5 9 13 57 10 4 4 2 1 1 110 83 - - - - - - - - - - - - - Diphtheria 1 — - - — 1 - — 1 — — - 3 3 - - - - - - - - - - - - - Enteric Fever including Typhoid & paratyphoid - - - - - - - - - - - 1 1 1 - - - - - - - - - - - - - Anterior Poliomyelitis - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 2 11 5 — — 18 17 - - - - - - - - - - - - - Cerehro Spinal Fever """ — 1 — — — — — — — 1 1 - - - - - - - - - - - - - -Pneumonia 5 6 2 1 — 9 3 — 3 1 4 6 40 9 5 1 — — — 1 — — — 2 9 11 29 Erysipelas - — - — — - - — 1 — 4 1 6 2 - - - - - - - - - - - - - B.Dys enteria(So nn e) 1 — - - — 2 — 1 4 2 9 33 52 9 - - - - - - - - - - - - - Whooping Cough lb 10 13 16 28 67 1 — — — — — 151 4 - - - - - - - - - - - - - Measles 7 34 29 2b 47 12b 8 4 4 2 - - 287 14 - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - 1 - - - 1 1 - - - - — - - - 1 - - - 1 NE7 CASES. DEATHS. Tuberculosis Under 1 year 1-5 5-15 15- 25 25 -35 35 -45 45 -55 55 -65 65 & over Total Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total (a) Respiratory M - — 1 11 7 6 2 5 1 33 — - — 1 2 3 3 2 1 12 F - 1 — 7 10 5 3 2 2 30 — — — 1 5 3 3 — 1 13 Total - 1 1 18 17 11 5 7 3 63 - - - 2 7 6 6 2 2 25 (b)Non-Respiratory M - - ] - 1 1 - - 3 — — — - - - - - - F - - 2 ] - 2 — - - 5 - - - - - - - - - 1 Total - - 2 2 - 3 1 - - 8 - - - - - - - - - 1 51. It will "be noticed that there was an increase in the number of cases of dysentery notified during 1943. This is accounted for by an outbreak during September and October at the Central Relief Institution, from where 39 cases were notified. In addition, and during the same period, eight cases occurred at the Kingston County Hospital, all of whom were connectcd directly or indirectly with the Institution. One death occurrad in an elderly person, who was seriously ill from another complaint and the death was due mainly to other causes. Investigations into the cause of the outbreak were carried out, and your Medical Officer of Health was in daily consultation with the Medical Superintendent of the hospital, and the County Medical Officer. Arrangements were made with the Ministry of Health emergency laboratory, Epsom for bacteriological examinations and the outbreak subsided v/ithout any unduly serious consequences. Measles. If it is considered useful our practice is to give Immune Globulin to the immediate susceptible contacts of measles, especially when they are very young children, in order to prevent an attack or to attenuate the illness should it develop. Material is also supplied to General Medical Practitioners for the same purpose and children in the "far-time Nurseries and occasionally children in Infant Schools roceive this protection. Who oping. Cough. Reference is made to what is done on whoopTng cough immunisation in Section B of this Report. TUBERCULOSIS. Cases of tuberculosis are dealt with from the treatment point of view by the Surrey County Council. Good liason exists between your Medical Officer and Tuberculosis Officer. Each case notified is visited by an officer of the Public Health Department, and all contacts are advised to consult the County Tuberculosis Officer. The efficiency of notification is good and there have been no cases of wilful ncglect or refusal to notify. As was anticipated, the numbers of cases notified increased year by year as the war progressed, and the following table shews comparative figures of notified cases and deaths for the year 1939 - 1943 (inclusive) Year Cases notified. Deaths. Respiratory Non-rospiratory Respiratory Non-respiratory 1939 38 7 16 - 1940 37 10 25 1 1941 44 9 19 3 1942 67 11 22 2 1943 63 8 25 1 52. action "became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 172 of the Public Health Act 1936. Disinfection of premises is carried out in all cases of death, or when the patients are admitted to hospital or sanatoria. Very close contact is maintained with the Kingston and District Tuberculosis Care Committee, of which body the Medical Officer of Health was Honorary Secretary for several years. Considerable assistance has been given to patients, and there is no doubt that the Care Committee is fulfilling its proper function of helping towards the rehabilitation of patients. As the result of co-operation with the Care Committee and the National Association for the Prevention of Tuberculosis, meetings were held and films shown, in the Borough. Each meeting v/as well attended, particularly those at local factories. The opportunity was taken to distribute leaflets all dealing with measures necessary to combat Tuberculosis, and in several cases applications have been made for further supplies. Acknowledgment must be made of the whole-hearted co-operation of, and interest shown by, the managements of the works concerned and the shop stewards. At several of the meetings, one of which was addressed by the County Medical Officer, reference was made to mass radiography, and the co-operation of the factory workers v/as invited. SCABIES... At the request of the Ministry of Health special reference is made to the subject. Owing to the general increase in the number of cases of scabies, the Ministry of Health issued a memorandum giving advice on the measures for prevention and care of this condition, and the treatment and disinfestation of members of households among whom cases of scabies were knovn to exist, In addition to the memorandum a special order, known as the Scabies Order, 1941, was made by the Minister of Health under Regulation 33A of the Defence (General) Regulations 1939. This order strengthened considerably the powers of Local Authorities, as it gives authority for the inspection of premises in which Persons found to be verminous are, or have been, accommodated and for the examination and treatment of any other persons in these premises who may be verminous. It will be noted that this is a general authority in regard to verminous persons and premises, but scabies itself noed not necessarily be associated with verminous conditions. It was felt, however, that special measures were necessary to combat the increase of scabies which has^rcsulted from war-time conditions such as overcrowding and difficulty in maintaining personal cleanliness. Accordingly arrangements were made for the treatment of cases of scabies at the Cleansing stations attached to the two First Aid Posts in the Borough and this commenced in January, 1942, It started first as an experiment, and provided mostly for the treatment of school children, but adults attended from time to time, and with the knowledge that further cases would in all probability arise, all of whom would require treatment, local doctors wore invited to a meeting, which v/as presided over by the Medical Officer of Health, on the 14th September, 1942. The Doctors were asked to co-operate by giving notification of cases which came to their notice, and from that meeting a system of notification v/as evolved whi ch has worked very well, and which is voluntary on the part of the doctors. In brief,the notification form consiits of two parts, one of which gives information to the 53 Medical Officer of Health for record purposes, while the other part Is completed and detached by the doctor, so that it may be handed to the patient to present at the cleansing station. This safeguards the position of a person presenting himself for cleansing without having first been seen by a doctor. In addition provision is made on the form for the doctor to express his views regarding disinfestation etc. The cleansing is undertaken by Civil Defence personnel attached to the First Aid Posts, under the supervision of the Health Visitors and First Aid Post trained nurses. This opportunity is taken to acknowledge their billing assistance. The following tables shev; the nunbers of cases treated during 1942 and 1943:- Cases of Scabies treated. Year No .of cases treated at First Aid Post "A" First Aid Post "B" Total cases treated 1942 89 135 224 1943 349 261 610 Analysis into age groups of .cases treated. Year Treatment Centre Males Females Under 5 years 5 yrs, to 14 yrs. Over 14 years Under 5 Years 5 yrs. to 14 yrs. Over 14 Years 1942 First Aid Post "A" 4 7 20 5 11 42 1942 First Aid Post "B" Analysis not available. 1943 First Aid Post "A" 22 40 67 19 39 162 1943 First Aid Post "B" 27 82 - 30 _ 90 32 Prior to 1942, no schorae existed for notification of cases of scabies, and pre-war only a few cases came to the notice of the Public Health Department, The figures given above indicate that the condition had become fairly widespread, although there is reason to believe that cases are now becoming fewer in number. Active measures were taken to ensure that all contacts are followed up when necessary,although in most cases it is found that if one member of a family attends for cleansing, he or she, especially if an adult, will act on the advice given and ensure that other members of the same family attend for prophylactic treatment. It was not necessary to invoke the spccial powers given 54 under the Scabies Order for the examination of persons or pram is e. Further reference to this subject, especially with regard to school children will he found in the Report of the School Medical Officer. In order to publicise the need to combat scabies, a film entitled "Diagnosis and Treatment" was shewn on 20th. July, 1943. The film was shewn twice and the total attendances were approximately 180. The audience consisted mostly of doctors, pharmacists, nurses, and others who were concerned with the treatment of scabies. The film was shewn in the theatre of the Nurses Home of the County Hospital, wolyerton Avenue, 7e are grateful to the Matron and Medical Superintendent for the facilities granted. INFESTATION BY HEAD LICE,. This condition has been the subject of special comment by the Ministry of Health, and in a circular (2831 - July,1943) the Medical Officer of Health was asked to make special reference in the Annual Report, to the steps taken in pursuance of the circular. The circular deals generally with the measures to be undertaken to assist mothers and young children in the promotion of cleanliness and good habits and the elimination of verminous conditions. It is suggested that with regard to children under 5 years, the Health Visitors should include the examination of children's heads as part of their work both in the homes and in the clinics. The Ministry of Health suggests also the use of Lethane Hair Oil. It is not possible to give specific results in regard to action taken as part of the Maternity and Child "relfarc scheme, but further and more complete data .as regards school children will be found in the Roport of the School Medical Officer. A routine practice has been established of examining children's heads, before admission to the war-time Nurseries, and in addition the children's heads are combed thoroughly at least once a week. S . «•. ;■ .. ■