C44 13 (1) KINGSTON-upon Phames KIN 18 Royal Borough of Kingston-upon-Thames ANNUAL REPORT 1944 \ • Medical Officer of Health and Chief Sanitary Inspector TO THE « Town Council AND THE Ministry of Health guildhall, kingston-upon-thames november, 1945 V Royal Borough of Kingston-upon-Thames ANNUAL REPORT 1944 Medical Officer of Health AND Chief Sanitary Inspector TO THE Town Council AND THE Ministry of Health guildhall, kingston-upon-thames november, 1945 ANNUAL REPORT 1944 TABLE OF CONTENTS. SECTION A Statistics and Social Conditions. Page (i) General Statistics 1 (ii) Social Conditions 1 (iii) Extracts from Vital Statistics 1,2,3 (iv) Causes of death 5 SECTION B General Provisions of Health Services. 1. (i) Public Health Officers 6 (ii) (a) Laboratory Facilities 6 (b) Ambulance Facilities 6 (c) Nursing: in the Home 7 (d) Clinics and Treatment Centres 8 (e) Hospitals 3 2. Institutional Medical Service Omitted (Surrey County Council). 3. Maternity and Child Welfare. (i) (a) Midwifery Service 10 (b) (i) Maternal Mortality 11 (ii) Infant Mortality 12 (iii) Puerperal Pyrexia 13 (ii) (a) Ante-Natal Services 13 (b) Post-Natal Services 14 (c) Infant Welfare Services 15,16 (iii) (a) Institutional Treatment for Mothers and Children 17 (b) Wartime Nurseries 17 (c) Care of Premature Infants 18 (d) Care of Illegitimate Children 18 (iv) Health Visitors 10 (v) Child Life Protection 20 (vi) (a) Dental Treatment 20 (b) Ophthalmic 21 (c) Artificial Sunlight 22 (d) Tonsils and Adenoids 22 (e) Orthopaedic Treatment 22 (f) Treatment of Scabies 23 (g) Convalescent Treatment 23 (h) (i) Diphtheria Immunisation 23 (ii) Vaccination 23 (vii) Home Helps 23 4. Nursing Homes 24 # • , • V < » I « • * » » • * * f • • • Contd. Page. SECTION C Sanitary Circumstances. 1. (i) Water 26 (ii) Drainage and Sewerage 26 2. Rivers and Streams 26 3. (i) Closet Accommodation 26 (ii) Public Cleansing 26 (iii) Sanitary Inspection of the Area 27 (iv) Shops and Offices 28 (v) Camping sites 28 (vi) Smoke Abatement 28 (vii) Swimming Baths and Pools 28 (viii) Eradication of Bed Bugs 29 4. Schools 29 5. Complaints 29 6. Rodent Control 29 7. Other duties 30 SECTION D Housing General appreciation of the position 31 SECTION E Inspection and Supervision of Food. (a) Milk Supply 32 (b) Meat and Other Foods 33 & 34 (c) Adulteration - Pood and Drugs Act 35,36,37 SECTION F Infectious Diseases. Notifiable Diseases 38, 39, 40, 42 Diphtheria Immunisation 41 Tuberculosis 42,43 Sonne Dysentery 44 Scabies 45,46 Infestation by Head Lice 47 P R E F A C E . TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON -UPON -THAMES. Mr, Mayor, Ladies and Gentlemen, I have the honour to submit my Report for the year 1944, As directed by the Minister of Health, the Report is abbreviated and confined to essential and urgent matters relating to the public Health and Social Medicine, Apart from War Emergency considerations the general health of the people remained good throughout the year. The Registrar General's estimate of the population was 34,780, a decrease of 1,120 from the figure for 1943. The number of Live Births was 578 giving a rate of 16,62 as compared with 637 and a rate of 17,77 for 1943. The number of deaths was 474 giving a crude death rate of 13.63 as compared with 500 and a rate of 13.92 for 1943. The excess of births over deaths in 1944 was 104 as compared with 137 in 1943. The number of deaths of infants under one year of age was 28 as compared with 31 in 1943. The rate per 1,000 live births (infantile Mortality Rate) was 48,44 as compared with 48,7 for 1943. The Infantile Mortality Rate, averaged for successive quinquennial periods from 1925 onwards to 1944, demonstrates a decline from 69 for the period ending 1925 to 55 for the period ending 1944. The actual rate for 1925 was 73, the rate for 1944 was 48, The highest rate in the series was 76 in 1924, the lowest 26 in 1939. The downward trend of this figure is encouraging and is some return for the Maternity and Child Welfare efforts during the period, I believe, however, that the rate of decline is capable of accelleration. • In general it must be stated that several factors are known to influence favourably, the infantile mortality rate. These include medical, nursing and welfare services; stable economic circumstances in the home allowing of minimal family budgets to maintain nutrition; good housing conditions with adequate sanitary amentities and absence of overcrowding; together with other factors, which may operate, constantly or intermittently. If a combination of these factors can be brought to bear on the population in the coming years, continued improvement in the infantile mortality rate may be looked for. After the changes which the war years have brought, fuller and more accurate information is required, to co-ordinate the work of medical practitioners, health visitors, sanitary inspectors, surveyors and social welfare workers, which, subject to scientific analysis and report will, no doubt, indicate lines of effective policy. The general provision of health services has been maintained throughout the year. No epidemnic of notifiable disease occurred during the year, hut reference is made on page 44 to several cases of sonne dysentery. During the year War Emergency measures occupied a share of our attention, and from air attacks 17 persons were killed, 55 seriously and 46 slightly wounded. I record thankfully my appreciation of the effective work of all concerned in dealing with the results of those attacks, the courage and steadiness of the people, and the strenuous and co-ordinated efforts of all the Civil Defence services. Finally, I wish to express my personal thanks to my Senior Colleagues for their co-operation throughout the year and to all members of my staff for their very hard work through many difficult periods. To the Mayor, Alderman and Councillors, I return thanks for their interest and support throughout the year. I have the honour to he, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. . . » . 1944 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health, Maternity and Child Welfare Officer 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. (With H.M. Forces). VALERIE WILLS, M.D. (Temporary Appointment). BEATRICE TURNER, M. B. , F.R.C.S. (Edin.) Ante-Natal Consultant (on War Service) Consultant under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations 1926: J. V. O 'SULLIVAN, M.D., F.R.C.S., F.R.C.O.G. Dental Surgeon: L. IDE, L.D.S. R.C.S. Part-time appointment. Sanitary Inspectors: (Senior) H.T. FERRY, F.S.I.A. (a) F.D. HARVEY,A.R.San I. (a) Chief Clerk. G.C. SMITH, A.R.San I. (a) A. CLEGG, M.A.R.San I. (a) Health Visitors: (Senior) MISS C.A. HOOKWAY, S.R.N., S.C.M., H.V.Cert. MISS F.I. ARNOLD, S.R.N., S.C.M., H.V. Cert. MRS. A.M. McI. BAKER, S.R.N,, S.C.M., H.V.Cert. MIES D. KERRIDGE, S,R,N,, S.C.M., H.V, Cert. (Resigned 30th. September, 1944). Temporary Appointments: MISS CALLAGHAN, S.R.N., S.C.M., from 2nd, Nov. 1944. MISS McNAMARA, S.R.N., S.C.M., from 6th. Nov. 1944. Clerical staff not listed. (a) Certificates as Sanitary Inspectors and Meat and Food Inspectors. -A 1 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statistics, Area in Acres l,390 Population (Registrar General) 34,780 Number of inhabited houses (approx.) 10,900 Rateable Value - General Rate £536,500 Sura represented by Penny Rate £2,125 Amount of Outdoor Relief £4,689 (ii) Social Conditions. The character of the Borough has changed very little during the past few years. The position during 1944 was the same as mentioned in my report for the years 1939-43, i.e. the district is still residential in character over the greater part of the area, but many industrial businesses have developed during recent years. (iii) Extracts from Vital Statistics of the Year. Live Births - Total Male Female Legitimate 525 265 260 Illegitimate 53 27 26 Totals 578 292 286 Birth Rate (Registrar General) per 1,000 population 16.62. Still Births - Total Male Female Legitimate 17 8 9 Illegitimate 1 - 1 Totals 18 8 10 Rate per 1,000 total (live and still) births 30.20 Deaths - Total Male Female 474 239 235 Death rate (Registrar General) per 1,000 population - 13.63. (iii) Extracts from Vital Statistics of the Year. 1940. 1941 1942 1943 1944 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS. Legitimate 483 257 225 482 271 211 512 276 236 588 291 297 525 265 260 Illegitimate 36 17 19 38 18 20 39 20 19 49 31 18 53 27 26 TOTALS 519 274 245 520 289 231 551 296 255 637 322 315 578 292 286 Birth rate (R.G.) per 1,000 pop. 13.86 14.46 15.26 17.77 16.62 STILL BIRTHS Legitimate 14 8 6 15 11 4 12 5 7 20 14 6 17 8 9 Illegitimate 2 1 1 4 3 1 1 - 1 3 2 1 1 - 1 TOTALS 16 9 7 19 14 5 13 5 8 23 15 7 18 8 10 Rate per 1,000 total (live and still) births 29.9 35.25 23.05 34.84 30.20 DEATHS. 659 334 325 525 253 272 491 260 231 500 226 274 474 239 235 Death-rate (R.G.) per 1,000 Pop. i" 17.6 14.59 13.6 13. 92 13.63 2 3 (a) Deaths from Maternal Causes - Deaths. Rate per 1,000 total (live & still) births. Puerperal Sepsis 1 1.67 Other Maternal Causes 2 3.35 (b) Death Rate of Infants under one year of age. All infants per 1,000 live births Legitimate infants per 1,000 48.44 legitimate live births 51.43 Illegitimate infants per 1,000 illegitimate live births 18.87 (c) Other Deaths - Deaths from Cancer (all ages) 76 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhœa (under 2 years of age) 5 Biifth-ratcs, Civilian Death~ratess Analysis of Mortality, Maternal Mortality and Case rates for certain Infoctious diseasos in tho Year 1944. Provisional figures based on Weekly and Quarterly Returns,, England and Wales 126 C. Bs and (Trent Towns including London 143 Smaller Town Resident Pop, 25,000 -50,000 at 1931 Census London Adm. County Kingston upon Thames ≠ Rates per 1,000 Civilian Population: Live Births 17.6≠ 20.3 20.9 15.0 16.62 Still „ 0.50≠ 0.64 0.61 0.42 0.51 Deaths All Causes 11.6≠ 13.7 12.4 15.7 13.63 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 Whooping Cough 0.03 0.03 0,02 0.04 0.03 Diphtheria 0.02 0.03 0.03 0.01 0.00 Influenza 0.12 0.10 0.11 0.08 0.12 Smallpox 0.00 - - - 0.00 Measles 0.01 0.01 0.01 0.00 0.00 Rates per 1,000 Live Births:- Deaths under 1 yr. of ago 46 † 52 44 61 4.8 Deaths from Diarrhoea & Enteritis under 2 yrs. 4.8 7.3 4.4 10.1 8.65 ж A dash (-) signified that there were no deaths. † Per 1,000 related births. ≠ Rates per 1,000 Total population. 4  England and Wales 126 c-B3* and Great Towns including London. 143 Smaller Towns, Resident Pop. 25,000 50,000 at 1931 census. London Adm. County. Kingston upon Thames. Case rates per 1,000 civilian Population:- Notifications. Typhoid 0.01 0.01 0.01 0.01 0.00 Paratyphoid fever 0.01 0.00 0.01 0.01 0.00 Cerebro Spinal Fever 0.05 0.06 0.04 0.04 0.09 Scarlet Fever 2.40 2.41 2.67 1.57 1 .41 Whooping Cough 2.49 2.49 2.29 2.90 2.10 Diphtheria 0.58 0.67 O.69 0.31 0.20 Erysipelas 0.29 0.32 0.28 0.37 0.37 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 4.16 4.51 3.94 2.98 0.95 Pneumonia 0.97 1.13 0.82 0.93 0.35 Rates per 1,000 Total Births, (Live and Still) (a) Notifications:- Puerperal Fever 10.34 13.13 9.25 ( 3.61 3.34 Puerperal Pyrexia (14.14† †Including puerperal Fever. 5 (iv) Causes of Death. Registrar General's Tables. All Causes 1940 1941 1942 1943 1944 M. F. M, F. M. F. M. F. M. F. 334 325 253 272 360 231 226 274 239 235 1 Typhoid and Paratyphoid Fevers. - - - - - - - - - - 2 Cerebro-spinal fevers 3 1 3 1 - - - - - - 3 Scarlet Fever - - - - - - - - - - 4 Whooping Cough - - 3 1 - - - - - 1 5 Diphtheria 1 1 1 - - - - - - - 6 Tuberculosis of Respiratory System 15 12 9 9 13 9 12 13 12 7 7 Other forms of Tuberculosis 3 - 3 1 1 1 - 1 1 3 8 Syphilitic Diseases 1 2 1 1 3 - 2 2 - 1 9 Influenza 5 12 3 2 - 4 8 7 2 2 10 Measles - - - - - - - - - - 11 Acute poliomyelitis & cephalitis - - - - - - - - - - 12 Acute Infantile Encephalitis - - - - - - - - - - 13 Cancer of B.Cav. & cosophagus (M) Uterus (F) 3 6 4 5 4 4 2 3 3 2 14 Cancer of Stomach & Duodenum 3 4 7 5 6 4 10 6 11 6 16 Cancer of breast - 9 - 5 - 5 - 10 - 10 16 Cancer of all othcr sites 34 29 24 21 31 31 25 28 23 19 17 Diabetes 3 6 2 4 2 - - - 1 - 18 Intra-cran, vascular losions 21 34 2.1 26 18 31 15 32 18 35 19 Heart disease 96 94 64 70 70 70 52 67 64 60 20 Other diseases of circulatory system 11 11 7 13 - - 6 17 15 11 21 Bronchitis 23 20 18 16 8 7 14 20 12 6 S2 Pneumonia 19 19 17 14 10 4 19 10 15 10 23 Other Respiratory diseases 3 4 3 4 2 4 1 5 4 - 24 Ulcer of Stomach or duedonum 2 1 2 - 3 1 3 1 1 1 25 Diarrhœa under 2 years 3 1 3 2 5 5 6 1 3 2 26 Appendicitis 2 3 - - 3 - - - - - 27 Other digestive diseases 3 7 4 9 5 6 8 2 5 5 28 Nephritis 11 7 5 6 7 6 4 2 4 6 29 Puerperal Causes Recorded under other hoadings - 1 30 Other Matornal ) Causos ••• ) - 2 31 Premature birth 4 2 5 3 6 1 1 7 5 5 32 Congenital Malformation Birth injuries - - - - - - - - 4 4 33 Suicide 3 - - - 3 - 2 1 2 1 34 Road Traffic Accidents 7 - 6 2 3 1 4 1 4 - 35 Other violent causes 17 16 17 24 7 12 2 7 12 16 36 All other causes - - - - - - - - 16 19 6 SECTION. B. General Provisions of Health Services. 1. (i) Public Health Officers. The staff of the Public Health Department is as shown in the preface to the report. Changes of staff during the year have been recorded in the preface*. (ii) (a) Laboratory Facilities. During 1944 bacteriological examinations were carried out by Dr. D.S. Murray, at the laboratory, 37, Coombe Road, Kingston-upon-Thames, as part of the emergency pathological service. Arrangements are in force whereby private practitioners send specimens for examination direct to the laboratory, and in most cases the cost is charged to the Corporation. One small change was made during the year in that charges are now based on units of work instead of a set sum per: specimen. In actual fact this has made very little difference to the total cost of the laboratory service. In addition bacteriological examinations of milk are undertaken by the Clinical Research Association and samples under the Poods and Drugs Acts are 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. A supplementary ambulance service was also provided by the St. John Ambulance Brigade. Accident cases are removed free but a charge is made for the use of the ambulance for private cases. During the year the following numbers of accident and private cases were removed:- Corporation Ambulance - Accident Cases 127 Private Cases 215 St. John Ambulance - Accident Cases 19 Private Cases 149 7 (c) Nursing in the Home. (l) General. This is carried out, in the main, by District Nurses" from the Kingston Nursing Association. The following Statistical Report is taken from the Annual Report of the Kingston Nursing Association - Statistical Report in District Nursing. (Extracted from Annual Reports of the Kingston Nursing Association.) 1940 1941 1942 1943 1944 Cases. Cases on books on 1st January 41 62 54 67 67 New Cases 534 520 569 626 609 Results of Cases: Convalescent 571 398 431 466 435 Transferred to Hospital 48 57 59 81 59 Died 91 70 63 77 92 Removed for other causes 3 3 3 2 15 Still on books 62 54 67 67 75 Visits. General Nursing 11,468 12,551 15,891 16,974 16,979 Casual 181 118 204 150 124 (2) Infectious Diseases. In Measles, Whooping Cough and Epidemic Diarrhoea, 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 he paid by the Corporation, but during the period under review no claims were received. 8 (d) Clinics and Treatment Centres as at 31st. December, 1944. Clinic or Dispensary Where 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, Orange Road, Kingston. Wednesdays 1.45 P.m. Post-Fatal Clinic. Health Centre, 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. and 1.30 p.m. Eye Clinic -do- -do- First & Third Thursdays in month at 10 a.m. Speech Training -do- -do- Mondays & Wednesdays at 2 p.m. Ultra Violet Ray Clinic. -do- -do- Tuesdays & Fridays at 9 a.m. and 3.30 p.m. Orthopaedic Clinic. Red Cross Curative Post, Coombe Lane, Kingston. By appointment. Tuberculosis Dispensary (s.c.c.) South Place, Surbiton. First and Third1 Wednesdays,5.30 p.m. Second,fourth and fifth Wednesdays, 1.30 p.m. Fridays 1.30 p.m. Wartime Nursery No .1. "Surrey Villa", 1 Knights; Park, Kingston. For admission apply to Medical Officer of Health. Wartime Nursery No. 2« "St.Peter's", Hawks Road, Kingston. -do- Wartime Nursery No.3. "Kilnwood", 213 Richmond Road, Kingston. -do- Wartime Nursery No. 4. "Fairfield", Fairfield East, Kingston. -do- Wartime Nursery 53/55, Canbury Park Road, Kingston. -do- wartime Nursery No .6. Messrs. Bentalls, Clarence Street, Kingston. Apply Staff Controller,Messrs. Bentalls Ltd. Kingston Nursing Association (.Vol. Committee) 33, Birkenhead Avenue, Kingston. Apply to Matron for District Nurses. v •; 9 (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 Carrey 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 Victor a Hospital, supported by voluntary contributions# The Corporation made contributions of £50 each to the Kingston Victoria Hospital and the Royal Hospital, Richmond, during 1944. 10 3. MATERNITY AND CHILD WELFARE (i) MIDWIFERY SERVICE. (a) Midwifecy Service (SurreyCounty Council) 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 1944 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. 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 Hospitals Births notified 1940 1941 1942 1943 1944 No. notified by Midwives 159 115 ' 147 158 153 No, notified by General Practitioners and Medical Superintendent, Kingston County Hospital. 364 419 424 506 408 Total 523 534 671 664 561 11 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; Births Registered 1940 1941 1942 1943 1944 M. F. M. F. M. F. M. F. M. F. Live Births: Legitimate 257 226 271 211 276 236 291 297 265 260 Illegitimate 17 19 18 20 20 19 31 18 27 26 Still births: Legitimate 8 6 11 4 5 7 14 6 8 9 Illegitimate 1 1 3 1 — 1 2 1 — 1 Totals: Male & Female 283 252 303 236 301 263 338 322 300 296 Grand Totals 535 539 564 660 596 A part-time Consultant, Mr. J.V. O'Sullivan, F.R.C.S. was available in the Borough for consultation for any case of midwifery or puerperal pyrexia where the confinement took place at home, but no cases arose during 1944 requiring his services. (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 or deaths for 1944, together with those for the years 1940-1943 for comparative purposes: Cause 1940 1941 1942 1943 1944 Mitral Stenosis - 1 - - 3 Cardiac Failure Toxaemia of Pregnancy Septic abortion - - 1 - - Septic abortion, self-induced - - 1 1 - The three maternal deaths in 1944 were related to young mothers aged 22, 22, and 24 years. All were under specialist care in hospital and received AnteNatal care. 12 (b) (ii) Infant Mortality. The following are the numbers of Kingston children who died in the Borough before reaching the age of one year, together with the cause of death and age: Year Total Cause of Death 1944 0-24 hrs. 7 4 Prematurity. 2 Atelectasis. 1 Torn Tentorium Cerebelli. 1944 24 hrs. - 1 mth. 9 7 Prematurity. 1 Gastro Enteritis, 1 Broncho pneumonia. 1944 v . \ 1 mth, - 1 yr. 12 2 Prematurity. 4 Pneumonia, Broncho and Lober. 4 Acute Gastro Enteritis. 1 Gangrene of Bowels 1 Tuberculous meningitis. The approximate infant mortality rate for 1944 is as follows, and in addition the rates for 1940 to 1943 (inclusive) arc shown for comparative purposes:- 1940 1941 1942 1943 1944 Kingston upon Thames 55 57 63 48 48 England and Wales 55 59 49 49 46 London Area 50 68 60 58 61 The Infant Mortality rate of 48 is the same as for 1943. It is slightly higher than the figure 46 for England and Wales, and lower than the figure 61 for London Area, I am convinced that further improvement in this figure is possible as application of improved methods of caring for premature infants become possible, and prevention of infection in the first year is more successful. Ophthalmia Neonatorum. Two cases were notified during 1944. Special arrangements have boon made for the admission of serious cases to Swanley L.C.C. Hospital, Kent, but it was not necessary to use this service during the year. 13 (b) (iii) Puerperal Pyrexia. Fifteen cases were notified during 1944. An analysis is shown below, together with figures for the year 1940-43, for purposes of comparison. Cases 1940 1941 1942 1943 1944 (a) Total notified 63 37 23 18 15 (b) Number of (i) Kingston residents 24 3 5 4 2 (ii) Extra district residents 39 34 18 14 13 (c) Number included in (a) Notified from Kingston County Hospital. 61 34 20 17 14 (d) Number included in (a) Notified by private doctors 2 3 3 1 1 (c) Number of cases included in (d) removed to hospital - 1 1 - - 3. II MATERNITY SERVICES. (a) Ante-Natal Services. The Ante-Natal Services in the Borough can be divided into two parts:- (a) The Borough Ante-Natal Services - for patients where confinement is undertaken by a midwife at home of the mother. Those patients are seen at the Borough Ante-Natal Clinic, Grange Road, (b) The Hospital Ante-Natal Service - for patients who have arranged to be admitted to the Kingston County Hospital for the confinement, These patients are seen at the Kingston County Hospital Ante-Natal Clinics at Grange Road, The majority of ante-natal coses whoso confinement is undertaken by a midwife, attend the Borough Ante-Natal Clinic, and are seen by a member of the K.C.H. staff, a lesser number of cases attending their family doctor. The following table" gives the number of patients attending the Borough Ante-Natal Clinics during 1944 and preceding years, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation: 1940 1941 1942 1943 1944 No. of patients 124 134 134 144 142 No. of attendances 650 603 548 744 701 A.N. Patients referred to Kingston County Hospital 35 34 39 35 29 14 Special attention is paid at ante-natal clinics to the general health and 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 cases for eggs. Supplementary nourishment in the form of dried milk, cod liver oil, etc., is supplied at the Ante-Fatal clinic, either free or at cost price, depending upon the stances. There is also a Government Scheme for the distribution of Cod Liver oil and orange juice and the Borough provides on medical prescriptions other vitamin preparations and Dried Milk with Iron, either free or at cost price after the applications of the income scale. No. in family Scale of income per head of family after deducting rent, rates and insurance. 1944 Full cost remitted Half cost remitted. 2 12s. 6d. 14s. 6d. 3 11s. 0d. 13s. 0d. 4 9s. 0d. 11s. 0d. 5 & over 8s. 6d. 10s. 6d. Owing to the limited accommodation for midwifery cases in the Kingston County Hospital, the Almoner of the Hospital requests a visit to he 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 home 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 1944, and preceding years. 1940 1941 1942 1943 1944 No. of home visits (individual cases) 227 247 266 271 159 Total No. of visits 347 377 367 395 260 Home helps arc also referred to in a later paragraph. (b) POST-NATAL SERVICES. In view of the small number of mothers who attend the Post-Fatal 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 lander review. 1 . 15 Every effort is made by the Health Visiters to arrange for all mothers confined at home to attend, the Post-Natal Clinics for medical examination, but the majority of mothers in the absence of symptons which may not appear until later, think they are fit and well, and fail to attend. (c) INFANT WELFARE SERVICES, (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 of mother and infant. 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 at 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 the total number of visits made during 1944, and preceding years:- 1940 1941 1042 1943 1944 0-1 1-5 0-1 1-5 0-1 1-3 0-1 1-5 0-1 1-5 First visits 506 - 503 - 529 - 642 - 524 - Total visits 2884 5227 2935 5175 2922 5410 2758 5358 3308 7007 (ii) Infant Welfare Clinics Two Clinics wore hold 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 hold, the number of now cases seen, subsequent visits made, and the numbers Boon by the Medical Officer. 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. 16 Health Centre,Grange Road, Tuesdays & Fridays Latchmere Road School Mondays & Thursdays 1940 1941 1942 1943 1944 1940 1941 1942 1943 1944 No. of sessions held 142 102 102 103 102 30 99 101 99 100 No. of new cases seen 503 348 362 383 322 72 237 222 269 195 Total attendances made 7419 5562 6251 7167 5574 1004 4467 5524 6380 4657 No. seen by M.O. 3826 2300 2442 2541 2425 660 1842 2085 2120 1783 Dried milk and supplementary Vitamins, etc., arc supplied at the Clinics to all coses 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 period under review:- Amount in lbs. 1940 1941 1942 1943 1944 Sold, cost prices and Sold, half price) 6290 6215 8555 12,817 10,198 Free of charge 2907 2139 2626 2,093 432 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. Odale. In addition to assistance in clerical work, voluntary workers have organised two clothing stalls, one at each Centre, here 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:- 1940 1941 1942 1943 1944 No. of mothers who bought 279 261 321 256 287 No. of garments 930 974 1025 762 823 In addition, a War Savings Group under the supervision of Mrs. Udale, is run at the Infant Welfare Clinics. ... '■ X ■ ■ ■■ ■ , .. 17 (iii) Institutional Treatment, for Mothers and Children. (a) There is no provision in the Borough for institutional treatment for mothers and children, provided by the Corporation. but private arrangements exist for the reception of expectant unmarried mothers at the Kingston Deanery Home for Friendless Girls, 18 Richmond Park 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 diecese 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 the end of which period efforts arc made to secure them suitable employment. A social welfare worker keeps in touch with the girls after they leave the home.. The re is a permanent staff consisting of a Matron, S.C.M. Nurse, and a Cook-Housekeeper. The following table shows the numbers of admissions to the house during the period under review: - 1940 - 81 1941 - 59 1942 - 58 1943 - 59 1944 - 32 ж ж The homo was closed from mid June, 1944, until 1st October, 1944, during flying bomb attacks. As many of the cases as possible were sent home; others were evacuated under the Government Evacuation Scheme. This accounts for the low numbers of admissions to the homo during 1944. WAR-TIME NURSERIES. (b) On the 1st January, 1944, there were six wartime nurseries in the Borough, four of which were administered by the local authority, with the approval of the Ministry of Health. The remaining two Nurseries were operated under private direction, but each received a grant, from the Ministry of Health, of 1/- per day, per attendance. As the result of representations by the Kingston Day Nursery Voluntary Committee, the nursery at 53/55 Canbury Park Road, was taken over by the Corporation, with the approval of the Ministry of Healthy as a fully recognised war-time nursery, on 1st April 1944, leaving only one nursery at Messrs. Bentalls, Ltd., to be administered by private direction. 18 The following table gives the total attendances during the years 1941, 1912, 1913 and 1944: Year Surrey Villa St. Peters Kilnwood Fairfield ston Day Nursery Bentalls 1941 878 1,837 - - - - 1942 11,733 9,140 5,155 - - - 1943 10,899 10,607 9,732 6,583 5,364† 8,268† 1944 8,131 8,178 7,177 9,840 8,056 14,655 † 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 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". (c) CARE OF PREMATURE INFANTS. The Council has considered the Ministry of Health Circular 20/44 on the Care of Premature Infants and as a result the existing facilities were supplemented by the purchase of certain special equipment for use in the home as found necessary. For the most part oho recommendations of the circular are the usual practice in Kingston. (d) CARE OF ILLEGITIMATE CHILDREN. Ministry of Health Circular No.2866 has been considered by the Council. In Kingston we have ments which in general go as far as the circular advises, and in some respects even further. 19 Close liason is maintained with the Kingston Deanery Home for Friendless Girls as described in the previous page. The Health Visitors are in touch as early as possible with the expectant mother and make the necessary contacts with grand parents, welfare workers, hospital almoners, moral welfare workers, and others. Full care and supervision during all stages is provided and later admissions to Day Nurseries, or arrangements for Foster Mothers are made. The moral welfare worker at the Deanery Home advises on legal proceedings and adoption and, where necessary, help is given to the mothers to find work and lodgings. (iv) HEALTH VISITORS. The changes in the personnel of the Health 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 attendances as compared with pre-war figures. There has also been an addition to the work of the Health Visitors in regular visits of inspection to the War-time Nurseries recently established. All the 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 of Routine Work with the same number of colleagues, three as before the war. ? f5 (V) CHILD LIFE PROTECTION. The duties imposed by the Children and Young Persons Acts and by the Public Health Act, 1936, are entrusted to the Maternity and Child Welfare Sub Committee of the 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. Figures have been included also in respect of preceding years for purposes of comparison:- 1940 1241 1942 1243 1944 556 545 765 524 386 The following table gives details regarding numbers of children under the care of foster mothers, and other relevant information:- 1940 1941 1942 1943 1944 No. on register at beginning of year 33 26 28 35 33 No. of new registrations 8 5 11 9 2 No. ceasing to have charge of infants 15 3 4 11 9 No. on register at end of years 26 23 35 33 26 Total No. of children 22 38 45 33 24 Infant Life Protection Visitors are also Health Visitors. (vi) TREATMENT. (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, as also are expectant and nursing mothers from the Ante-Natal Clinics of both the Borough and the Hospital. The following are the details of the attendances and treatment carried out in respect of mothers, and children under five years of age. 21 TREATMENT OP DENTAL DEFECTS (MATERNITY & CHILD WELFARE ONLY) 1940 1941 1942 1943 1944 Sessions devoted to treatment 23 16 17 21 20 No. treated: (i) Mothers 57 39 66 59 78 (ii) Infants 74 5 6 51 36 41 Attendances made for treatment 349 338 306 329 357 Fillings: (i) Permanent teeth 28 1 36 40 36 (ii) Temporary teeth 38 10 29 4 33 Extractions: (i) Permanent teeth 259 181 266 242 322 (ii) Temporary teeth 194 124 137 88 60 Other operations: (i) Permanent teeth 21 7 15 14 15 (ii) Temporary teeth 88 50 23 43 101 Supply of dentures 13 - 13 15 9 Dentures are supplied when necessary either at cost price, free of charge or part cost, depending upon the circumstances. Each case is considered on its merits by the Maternity and Child Welfare Committee and the proportion, if any, to be paid by the mother, is assessed. The total Cost of dentures supplied, and the amount paid by the mothers is as follows:- 1940 1941 1942 1943 1944 Total cost £58.8.0. £46,8.0. £62,12.0. £70. 4,11. £49. 7.10. Contribution by mothers £15.4.0. £20.1.0, £1??? 5 , 0 , £22.14. 0. £35.12. 3. (b) Ophthalmic. Ophthalmic treatment is not often required for children under five years of age, but when necessary these children are seen at the some time as school children. The following number of children were seen during 1944 and preceding years. 1940 1941 1942 1943 1944 Defective vision 2 Squint 4 9 16 26 19 _other conditions 1 1 1 1 3 22 (c) Artificial Sunlight. Children under 5 years of age requiring artificial sunlight' treatment are referred from the Infant Welfare Clinic, and the following are the total number of children attending and the total number of attendances during 1944 and preceding years:- 1940 192a 1942 1943 1944 No. of children under five years attending. 45 126 101 120 151 Total number of attendances. 960 2302 1547 1522 1938 The following are examples of the type of defects for which children are referred:- Marasmus; rickets; Pink disease; Bronchitis; frequent colds; cervical glands. (d) Tonsils and Adenoids. 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 during 1944 and preceding years. 1940 1941 1942 1943 _2244 Total No. of cases 8 12 8 12 1 Total cost £11.8.0. £17. 2.0. £11. 8.0. £17.2.0 £1.8.6. Contributions made by parents £2.5.0. £ 3.15.0. £ 1.15.0 £2.9.6 4.0 (e) Orthopaedic Treatment. Children under five 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 When necessary, in-patient treatment is arranged at St. Vincent's Orthopaedic Hospital. The following are the numbers who attended the Post during 1944 and preceding years:- 1940 1941 1942 1943 1944 No. seen by Surgeon 16 15 18 24 27 No. treatment given by staff 351 194 169 182 263 No. of cases discharged 1 5 5 1 - No. admitted to Hospital 2 2 2 3 2 23 (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. (g) Convalescent Treatment. In the majority of cases where children under five years of age require convalescent treatment, arrangements are made by the Kingston Comity Hospital. In a small number of cases arrangements may be made by the Medical Officer of Health, Two children were sent away in 1944. (h) Prevention of the Spread of Infectious Diseases. Maternity & Child Welfare. (i) 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 P of this Report. (ii) Vaccination. No detailed records are kept of the number of children vaccinated in age group 0-4 years Inclusive. The approximate percentage vaccinated is probably less than 50 per cent and comments have been made on this subject in the report of the School Medical Officer. There appears to be an increasing reluctance on the part of parents to have their children vaccinated. (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 helps. In the case of those who require 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. During the year under review 23 applications were received for Home Helps, of these 13 received financial assistance. The following table shows the number of cases who applied for financial assistance for home helpc during 1944, and preceding years. 1940 1940, 1942 1943 1944 3 7 - 13 13 In other cases assistance is given by the visits of the Queens Nurses of the Kingston and District Nursing Association. 24 4. NURSING HOMES. (Surrey County Council). The Surrey County Council is the Authority for registration but has delegated power of inspection to this authority. On 1st, January, 1944 there were two registered nursing homes in the Borough and both wore still on the register at the end of the year. One, at 20, Grove Crescent, has seven beds for chronic and senile patient. The other., at 6, Queens Eoad. is registered as a Maternity Ecmo with accommodation for eight patients,* Each Cursing Home was inspected at regular intervals during the year. 25 REPORT OP CHIEF SANITARY INSPECTOR. To the Mayor Aldermen and Councillors: Ladies and Gentlemen, It is with pleasure that I submit the following report upon the work of your Sanitary Inspectors during the year 1944 - a year which could justly he described as one of the most difficult of the war years so far as the work of this Department was concerned. In the sphere of Civil Defence the Sanitary Inspectors continued to man the Burton Road Control Room on night duty. They also shared the task of training a team of 60 men and women who had volunteered to carry out the unpleasant work involved in the treatment of gas contaminated foodstuffs. Little has been heard of this particular branch of Civil Defence as it was not one which lent itself to exciting and spectacular demonstration, But quietly, these volunteers came along, usually straight from their shops or other businesses to attend lectures and practices. Fortunately they were not required to carry out the duties for which they were prepared, but had it been otherwise I am sure they would have given a good account of themselves. Similarly there were two other smaller teams who were trained to deal with contaminated protective gas clothing and civilian clothing. These teams also continued their practices during the yoar, so that they might keep themselves prepared for action. Ih November of 1944, when the Borough Surveyor was hard pressed for technical staff to oope with war damage repairs, Mr»Clegg was loaned to assist in that important urgent work. Ho did not return to normal duties until March 1945* Apart from those matters, the frequency and severity, of enemy action caused considorable interruption of the normal work of the Department. The Report covers what may be described as environmental and food hygiene and is, of necessity, restricted in character. 26 SANITARY CIRCUMSTANCES. Section C. 1. (i) Wator. The water supply of the town is furnished by the Metropolitan Water Board, and has been satisfactory in quality and quantity. Bacteriological and chemical examination of the piped supply are carried out by the Bpard, and it was not found necessary to refer to the Board during 1944 in regard to any specific complaint. Comparatively few shallow wells remain in the town there being only 19 premises known to be supplied with well water at the end of 1944. (ii) Drainage and Sewerage. There were no main drainage works undertaken during the year. 2. RIVERS AND STREAMS. The effluent from the Corporation Sewage Works is discharged into the Thames, and 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. It flows through the Southern part of the Borough and jgins the Thames at a point a short distance above Kingston Bridge. The Hogsmill River receives sewage effluents from Maiden 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 ACCOMODATION. The closets in the Borough are on the water carriage system. (ii) PUBLIC CLEAFSINC. 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 percentage being approximately 40 and 6o respectively. Some 100 tons of salvage material are extracted each month including waste food for pig feeding which in pre-war years was deposited in the ashbins. 27 (iii) SANITARY INSPECTION THE AREA. (a) The following is a tabulated list of visits and inspections. Insp. of Houses, etc. ... 767 Insp. of Drainage. ... 144 Reinspcctions. ... 650 Works in Progress, ... 161 Factories, etc. ... 321 Outworkers. ... 12 Cowsheds, etc. Dairios. ... 77 Ice Cream Promisos. ... 1 Foodshops and Stores. ... 470 Bakehouses. ... 42 I.D.Bnquiries. ... 116 Markets. ... 172 Slaughterhouses. ... 6 Offensive Trades. ... 19 Vegetable Factory. ... 26 re-Noxious smells & Effluvia. ... 10 Common Lodg .Houses. ... 14 Canal Boats. ... - Theatres, etc. ... 12 House to House. ... - Verminous Premises. ... 117 Smoke Observations. ... 17 Stables and Yards. ... 18 Rats and Mice Dest. ... 653 Shops Acts. ... 284 Young Persons Enpit. ... 6 Housing Act. (Accom'd'n) ... 29 Rag Flock Acts. ... 6 Well Water Supplies. ... - R.R.A. ... 8 Billeting. ... - Houses after W.D, ... - Shops after W.D. ... 63 Miscellaneous. ... 251 Total 4452 (b) (c) The number of notices served and the result of the action taken is shown Toy the following statistical statements. It should be pointed out that the number of notices conplied with is not strictly comparable with the number served as the former number may refer to notices whicih were served in more than one year. Notices served. Informal. (a) Verbal - 307 (b) Written - 169 Statutory. (a) Housing Acts - 1 (b) Public Health Acts. 1 28 Notices Gonplied ed with: Informal. (a) Verbal - 253 (b) Written - 121 Statutory. (a) Housing Acts - (b) Public Health Acts 1 ( iv) SHOPS AND OFFICES. Arrangements for the health and comfort of workers in shot's are controlled by the Shops Act 1934, whilst the Public Health Act, 1936, brought offices within certain of the provisions. Apart from specific instances where complaints were 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) SMOKE ABATEMENT. The continuance of war conditions prevented anything more than advisory work being done. Owing to the scarcity of skilled stokers there were several cases of excessive emission of black smoke, which upon investigation were shown to be due to inefficient firing of the furnaces. It was not an unusual circumstance to find that a principal of the business or another person not at all used to the work of stoking was making the best possible effort to keep the fires burning, and the steam pressure up, in the absence of a regular fireman. In such cases one could do no less than admire the determination) of the substitute stoker and tactfully to refrain from offering what would probably be considered to be unnecessary advice. In other instances poor quality coal, or substitute fuel, was responsible for the smoke and in such cases it was almost, if not quite, impossible to effect a cure without a change of fuel, and alternative fuels were seldom available. (vii) Swimming- baths and pools . (a) public. The Corporation swimming bath comprises two.pools one of which remained closed during 1944 for use as a British Restaurant. The other swimming bath remained in use throughout the year.' A purification and filtration plant is installed. (b) Private. There arc no privately owned swimming batho or pools open to the public, in the Borough. 29 (viii) . ERADICATION OF BED BUGS During the year it was necessary to take action in respect of 58 premises. In each case the promises were subjected to disinfestation processes appropriate to the circumstances . 4. SCHOOLS. Information with regard to the sanitary condition of schools is given in the report of the School Medical Officer. The recommendations for the prevention of the spread of infectious disease contained in the memorandum on closure of an exclusion from school, 1927 have been closely followed. It was not necessary to close any school owing to infectious disease, or on public health grounds during the period under review* 5 CCMPLAIETS. The number of complaints recorded during the year was 443, a figure which shows little change from each of the two previous years. Owing to staff problems the number of complaints recorded is probably loss than those actually received and dealt with. Approximately one quarter of all complaints had reference to rats, or mice, or both types of rodent, and further particulars of this section of the work will bo found in the following paragraph. Most of the remaining complaints referred to disrepair of houses, and doubtless a fair proportion of them arose through the inability of owners to carry out work of maintenance. Many of the remaining skilled building trade operatives were directed to the more urgent work of war damage repairs and the ranks had already boon depleted by the needs of H.M.Forces. Apart from labour, there was an acute shortage of materials. The number of complaints of alleged unsound food was not excessive having regard to war-time difficulties. Several of the complaints proved to be well founded and appropriate action was taken, but the majority of the food complaints arose as the direct result of war time methods of storage, transport and distribution, all three of which at one time or another caused food losses, as will be seen in the section dealing with Pood. 6. RODENT CONTROL. It will be remembered that in the last Report (1943) reference was made to the large increase in the number of complaints of rodent infestation and the increase was attributed to the Ministry of Pood publicity campaign. During 1944 the increase was fully maintained and it is quite evident that the public have become more alive to the dangers of rodent infestation and the need to report all signs of rodents on their promises . 30 Investigations show that back-yard poultry keepers are responsible for the presence of rats in at least 90% of the infested promises. The encouragement givon by the Ministry of Pood to this forn of food production has added considerably to the difficulties of rodent control, for it is usually found that although the rats obtain food and water where the poultry arc kept, they make their homes in nearby gardens where no poultry are kept. This fact has an unfortunate result in many cases, as the responsibility for rat destruction falls upon the occupier of the premises where the rodents are harbouring, and so it often happens that an innocent party has to bear at least part of any expense incurrod. The Corporation undertakes the work of clearing infested premises on behalf of occupiers and a charge, based on time and materials, is made for the service. Although the service has been self-supporting over a number of years it is increasingly being felt that where tho cost is small, say not exceeding 5/-, the service should be free to ratepayers. The Ministry of Pood scheme of reimbursement of costs incurred, however, does not at present permit free service. The Corporation also undertakes large scale rat control work for periods up to twelve months on business or other premises in the town. During 1944 a further course of sewer baiting was carried out with good results. It was possible to do this important work once only during the year, but the results proved satisfactory. Similar baiting and gassing was carried out on the refuse tips and part of the banks of the Hogsmill River. 7. OTHER DUTIES. The special war-time assistance of one kind or another afforded to various government departments was continued. Those included the certification of applications for permits to purchase timber and other building materials, and the issue of Certificates of Essentiality in respect of applications for building work liconces. 31 SECTIOND. HOUSING. Apart from further looses due to enemy action, the housing situation did not change materially during 1944, compared with the previous year. The general appreciation of the position which was given in the last Annual Report is still applicable. Owing to the extensive damage to dwelling houses and to other well known circonstances, there was an increased demand for accommodation during the year. Evcry effort was made to bring hack into early use damaged houscs and all available and suitable properties were requisitioned to rehouse displaced families. Reference has already been made to the assistance given in the work of war damage repairs, but another and no less important form of help has been that of visiting housing applicants in their homes in order that their needs may be fairly assessed. This procedure has been followed in this Borough for many years and it is of interest to note that the Ministry of Health now recommend it for general adoption. It is important that the investigations should be made by an. officer with wide experience of housing conditions and one who possesses a sympathetic but clear understanding of the position and requirements. It is believed that the reports submitted have proved of assistance to the Housing Committee in their very difficult task of selection of tenants. 32 INSPECTION AND SUPERVISION OP FOOD. SECTION E. The task of maintaining the standard of food inspection during the period under review was a hard one, particularly in the new year, and again from June onwards to the end of the year. Visits to food preparing premises;, such as restaurant kitchens, and other similar routine work just had to be dropped owing to pressure of urgent dayby-day demands, more particularly as the result of enemy activity, upon the services of the limited technical staff. It became a matter of deciding which job could be omitted with the least consequent and possible dagger to food supplies and public health. It was an anxious time for all concerned and there is good reason and justification for thankfulness that despite the state of emergency, a safe and wholesome food supply was maintained. (a) Milk Supply. There was no change in the number of persons registered as dairymen in the Borough; the figure at the end of the year remained at 40, although it should be understood that this number includes several firms whose premises are outside the Borough boundary. There is only one dairy herd in the Borough. Designated Milks. Apart from registration under the Milk and Dairies Order, 1926, the following tabular statement shows the number of licences issued under the provisions of the Milk (Special Designations) Regulations 1936-1942. Designated Milk Licences - 1944. T.Tested. 7 6 Supplementary. 4 5 Bacteriological Examinatlor The number of samples taken in 1944 was much less than during the previous year, for the reasons given abovo. Of the 22 samples submitted to the plate count and the B.Coli tests, 6 proved not to be entirely satisfactory. 33 Five of those 6 wore found to have come from one wholesaler whose premises were not situate in Kingston. There was no reason to attribute the unsatisfactory condition to any act or default on the part of the local retailers. Biological Tests. Two check samples of mixed milk were taken from the local herd and submitted for biological test for the presence of T.B. The results showed absence of T«B. in both samples. Pasteurisation. In order to ascorurin whether milk has been properly pasteurised it is sdujocted to the Phosphatase test. Duing 1944, 3 samples wore tested and all proved satisfactory. (b) Meat and other Foods. (i ) Slaughterhouses. There arc now no licensed private slaughterhouses in the Borough. A few of the buildings which were used for the purpose prior to the war remain in existence, and small pig-keepers have used the premises for the slaught of an occasional pig under Ministry of Food licence. It was considered that this arrangement had much to commend it, as it ensured the humane slaughter of the animals,under better sanitary conditions than would obtain on the owner's own premises, whore there would bo little, or no opportunity for supervision. (ii) Moat Depot and Emergency Foods. Although no animals were slaughtered in the Borough for sale, it may now be stated that a Ministry of Food Meat Distribution depot is situate in Kingston,through which passes all meat intended for the Boroughs of Barnes, Esher, Maiden, Surbiton, Richmond and Wimbledon, as well, of course, as Kingston. No less than 213 visits were paid to this meat depot. It is pleasing to be able to record that the manager of the depot has at all times co-operated with the Corporation most helpfully and there exists a feeling of mutual trust and confidence without which your Officers could not have carried out their task. It was only on infrequent occasions that any part of a consignment was returned to the depot because of alleged unfit condition of the meat, and this despite the fact that approximately 200 tons of meat pass through the depot weekly. As might be expected, there were times when a consignment had suffered rather badly as the result of defective refrigeration or storage, giving rise to white spot or black spot mould. Such instances required constant attendance whilst the meat was examined and trimmed as necessary. Canned meats also were handled at the depot. 34 Apart from what vras in fact the meat rations at the depot, there were other Ministry of Food Emergency Pood Stocks in the Borough which wore visited, and inspected, periodically. One of the moro difficult tasks encountered during the year was the salvaging of war damaged food stocks. In one incident alone, (Acre Road, 21st July) approximately 16 tons of mixed food stuffs were removed from tho site to the disinfection station where, after sorting, cleaning and careful examination no loss than 15 tons were salved and utilised for human consumption. All condemned foodstuffs as far as possible.wore disposed of for animal feeding purposes or for conversion into fertilisers. The following is a statement of the foodstuffs condemned during tho year as unfit for human consumption, together with the cause for condemnation, and the weight. Articles of Food. Reason for Action. height. Ox Cheek. Docompobition. 210 lbs. Ox Liver. Diseased. 28 " Beef. Diseased or Bono Taint. 345 " Veal. Black Spot Mould. 375 " Pork. Diseased. 18£ " Pork. Mould. 458 " Pork. Decomposition. 48 " Pork Sausage. ditto. 51 " Mutton. Diseased. 36 » Mutton. Black Spot Mould. 1481 " Oannod Meat. Blown,decomposition,etc. 441 " Misc.Canned Goods. diI to. 1004 " Misc. Foods. Mould, dccompo sit ion. et c. 115 " Carrots. Decomposition. 336 » Dried Fruits. ditto. 44 " Tomatoes. ditto. 56 " Br ealcfastor oal. Infested Moth & "To evil. 183 " Packetod pudding Mix. dlt to . 558 " Fi sh. Decomposition. 1435 " Canned Goods. Damaged by enemy action. 415 11 Macaroni. ditto. 40 " Flour Goods. ditto . 42 " J am,Pickles & Sauces. Brolcn jars , co n t am j. n a t od . 141 " Tea. Contam.by foroigh mat tor . 58 " Misc.Foods. Damaged by en en y action. Total 002240 " 3,15½ lbs. 35 (iii ) Shops, Vchicles, etc. The shortage of assistants in shops and of drivers for vehicles, becane even more acute during 194. nevertheless, and despite the difficulties a reasonable degree of cleanliness was generally achieved. Appropriate action was taken in several instances whore foodstuffs were being transported in unclean vehicles. (c) Adulteration - Pood and Drugs Act,1938. The table on the next page gives details of the samples taken during the year. This part of food inspection duties aims at the detection of fraud as distinct from the question as to whether or not the food is good or bad, sound or unsound. In the case of the sausages the sample was found to contain 100 parts per million of preservative and a technical offence was thereby committed by the retailor, who had failed to display the requisite notice to that effect. A warning was given. The Baking Powders were found to contain amounts of available and residual carbon dioxide not in accordance with the Ministry of Pood standards for such articles. A similar Report was received in respect of the Egg Substitute Powders, The Baking Powders and Egg Substitute were the products of one manufacturing firm and it was subsequently proved that the packages wore old stock produced and disposed of by the manufacturer a considerable time before the appropriate Pood Standard became operative. Warnings were issued to both Manufacturer and Retailer and all the goods in question were withdrawn from stock. Action taken under the Food and Drugs Act. 1938. 1944, Articles, Analysed. Adulterated of Deteriorated,, Prosecutions. Action Takeno Fornalo Informal, Totale Formal, Informal, Total o Horseradish Sauce 1 1 Iodised Throat Tablets 1 1 Heat Extract 1 1 Milk 4 17 21 Milk Malted 1 1 Mustard liquid 1 1 Saccharine Tablets 1 1 sausages 5 5 1 1 - Warning given. Sausages preserved 1 1 Soya Flour 1 1 Baking Powder 1 1 2 1 1 2 Warning given. Butter 2 2 Cake Fixture 1 1 Celery Salt 1 1 Cheese 2 2 Cocoa 1 1 Egg Substitute Ponder 1 1 2 1 1 2 Warning given. Grape Fruit Squash 1 1 Lemon Squash 1 1 Pudding Powder 1 1 Sauce 1 1 Sponge Fixture 1 1 \ Yinegar _ non-brewed 2 2 Flour, self-raising 1 1 Grin 1 1 Pepper 1 1 i TOTALS 12 43 55 2 3 5 37 Regulations as to Food. By the Defence (Sale of Pood) Regulations, 1943, the Minister of Pood become the authority to make regulations for imposing requirements as to labelling of food and generally for regulating the composition of Pood. Such powers were exercised during 1944 in the following Orders:- The Food Standards (General Provisions) Order 1944. " " " (Self-Raising Flour) " " " " " (shredded Suet) " " " " " (Baking Powder & Golden Raising Powder) Order 1944. " " " (Mustard) (No.2) Order 1944. " " " (preserves) Order. 1944. all of which are together kwun as the Food Standards Orders, 1944. The Labelling of Pood Order 1944. The Minister of Pood was also responsible for this Order which is very comprehensive in character and contains important provisions. The Order carries into effect the policy announced in paragraphs 8 and 9 of the White Paper presented to Parliament in Movember 1943. The Order was not operative before the end of 1944 and further comment is not necessary at this time. CONCLUSION. The above report is but a very brief and attenuated description of some of the activities of your sanitary inspectors during 1944. Much must remain unrecorded. What has been written, however, will at least serve to indicate that some useful work of an unspectacular character was accomplished, by the help and support of the members of Corporation and my colleagues. I am, Ladies and Gentlemen, Your obedient Servant, Harold T.Perry, F.S.I.A. Chief Sanitary Inspector. Guildhall, Kingston-upon-Thames. 38 SECTION F. PREVALENCE OF. AND CONTROL OVER. INFECTIUTS AND OTHER DISEASES. The following infectious diseases are notifiable to the Medical Officer of Health of the Borough: Scarlet Feyrer. Whooping Cough. Diphtheria (including membranous croup). Measles (excluding rubella). Acute phouracrda (primary or influenzal). Cerebrospinal 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. Relapsing fever. Tuberculosis. In 1944 a total of 235 notifications of infectious disease was reooived. The following table shows how the cases were dealt with. NOTIFIABLE DISEASES DURING 1944. CASES. 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 eases notified Cases admitted to Hospital. Under 1 year 1-2 2-3 DEATHS. 10 -15 15-20 20 -35 35 -45 45 -65 65 & over Total 3-4 4-5 5 -10 1 Scarlet Fever 1 1 5 6 7 20 6 1 2 2 - - 49 34 - - - - - - - - - - - - - Diphtheria - 1 - 1 - 3 - - 2 - - - 7 7 - - - - - - - - - - - - - Acute Poliomyelitis - - 1 - - - - - - - - - 1 - - - - - - - - - - - - - - Malaria (Induced) - - - - - - - — - 1 - - 1 1 - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 2 7 6 — - 15 14 - - - - - - - - - - - - - Ophthalmia Neonatorum 2 - — — — — — — — — — — 2 1 - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - — - 1 1 1 — 3 3 - - - - - - - - - - - - - Pneumonia 2 1 - 1 - 1 - - 1 1 3 2 12 - 1 - - - - - - - 1 3 6 14 25 Erysipelas - - - - - - — - - 3 5 5 13 1 - - — - - - - - - - - - - B.Dysenteria (Sonne) 6 4 5 - 1 2 - 1 3 2 — 2 26 6 - - - - - - - - - - - - - Measles 1 4 3 3 3 9 3 2 3 2 - - 33 1 - - - - - - - - - - - - - Whooping Cough 14 8 12 12 3 24 — — — — — — 73 6 9 1 - - - - - - - - - - 1 40 The following table gives a comparative statement of Notifications received during the last twenty one years, in respect of Scarlet Fever, Diphtheria, and Enteric Fever 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 1944 49 7 - Scarlet Fever, There was a considerable drop in the number of civilian cases of Scarlet fever notified in 1944 and no deaths occurred. Most of the cases were school children. It was found necessary to send 34 of the 49 notified cases to Hospital. All made a good recovery. No "Return" cases occurred. Diphtheria. Seven cases of Diphtheria were notified in 1944, throe from the Kingston County Hospital, and four from within the Borough. Of the four from the Borough one aged 22 years had not been immunised, two were children under school age, one of whom had "been immunised two years previously hut had not "been post shick tested. The other, two years previously had an attack of laryngeal diphtheria. The occurrance of a second attack of diphtheria is most unusual. Steady work is "being done to immunise the school and pre-school population against diphtheria and the following table shows the stage reached by the end of the year 1944. 41 DIPHTHERIA IMMUNISATION FIGURES. 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. No. completely immunised at Clinic. 1938 319 1957 309 1936 295 1935 327 1934 281 1933 242 1932 255 1931 257 1930 258 1929 230 Total 2773 % 64.8 % Total Immunised in Kingston. O - 5 group. 5-15 group. G.P. 16 G.P. 34 Immunised elsewhere 12 Immunised elsewhere 172 Dr. Barnardo,s Home 150 Grand total 1483 S.C.C. Home 25 % 59.32. Grand total 3154 £ 73.7. 42 Enteric Fever (Typhoid or Paratyphoid). Ho notifications of enteric fever wore received during the year. Whooping Cough - A considerable drop in the notifications of whooping cough occurred in 1944, the number being 73, as compared with 151 in 1943; and 99 in 1942. There was one death of a child, lyr. 10 mths., attributed to whooping cough, and other contributary causes. The death took place in hospital while the child was evacuated. Measles. In 1944 a considerable drop in the number of notifications of measles took place. The number for 1944 being 33 with no deaths, as compared with 287 for 1943, with no deaths, and 375 for 1942, with no deaths. 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 neglect or refusal to notify. The following table shews comparative figures of notified cases and deaths for the year 1940 - 1944 (inclusive). Year Cases notified. Deaths. Respiratory Non- respiratory Respiratory Non-respiratary 1940 57 10 25 1 1941 44 9 19 3 1942 67 11 22 2 1943 63 8 25 1 1944 56 11 19 4 (Note - An analysis of the total notified cases in age groups is shewn on page 43. The ratio of non-notified to total deaths is as follows 1940. 1941 1942 1943 1944 1:8 1:3 1:8 1:8 1:12 During 1944 no 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 Distriet Tuberculosis Care Committee, of which body the Medical Officer of Health is Chairman. 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. 43 TUBERCULOSIS 1914. 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 65 & over Total Tuberculosis (a) Respiratory M. - - 1 10 1 9 5 8 2 36 - - - 1 1 3 2 3 2 12 F. - 2 2 7 3 3 - 2 1 20 - - - 2 2 - - 2 1 7 Total - 2 3 17 4 12 5 10 3 56 - - - 3 3 3 2 5 3 19 (b) Non- Respiratory M. - 1 1 3 1 - 1 — — 7 - - - 1 - - - - - 1 F. - - 2 1 1 - - - - 4 - 2 1 - - - - - - 3 Total - 1 3 4 2 - 1 - - 11 - 2 1 1 - - - - - 4 44 SOME DYSENTERY. During the year 26 casos of sonne dysontery were notified. Of these 6 were under 1 year of age, 4 aged 1-2 yoars, 5 aged 2-3 years, 1 agod 4-5 years, three were school children, and the remaining 8 were adults. No deaths occurred, and six of the 26 notifications wore removed to the infectious disease hospital for treatment. In September, 1944, several cases were discovered in one of the Wartime Nurseries. On investigation it was found that a member of the staff had boon ill with symptons suggestive of the condition, and one of the babies had rocurrent attacks of symptens also suggestive of the condition. A second member of the staff was also brought under investigation. The organism of sonne dysentery was isolated from specimens from all throo. All appropriate steps were taken to discover sources of infection and to prevent spread. Admissions to the Nursery were suspended ovor a lengthy period until all the children and staff producod satisfactory tests over an adequate period. In all, eight persons were excluded from tho Nursery and followed up. Eventually the whole situation was cleared up and the nursery re-admitted without further ineidence of the condition. 45 Scabies - During the year the scheme for treating cases and contacts of scabies continued to operate as described in previous reports. The cleansing was undertaken by Civil Defence personnel under the supervision of the Health Visitord and First Aid Post Trained Nurses. The following tables show the numbers of persons treated during the year 1944, and the two preceding years. Cases of Scabies and Contacts Treated. Year No. of cases and contacts treated at Total cases and contacts treated. First Aid Post "A". First Aid Post "B". 1942 89 135 224 1943 349 261 610 1944 575 368 943 Analysis into age groups of casos and contacts troatod. Year Treatment Centre. Males Females Under 5 Years 5 yrs. to 14yrs. Over 14 Years Under 5 years 5 yrs. to 14yrs. 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 1944 First Aid Post "A" 33 34 172 25 31 280 1944 First Aid Post "B" 35 102 - 34 84 113 46 Analysis of cases treated during 1944, Year No. of cases treated at Total Cases treated. First Aid Post "A" First Aid Post "B" 1944 391 270 661 Analysis into age groups of cases treated. Year Treatment Centre Males Females Under 5 Years 5 Years to 14Years Over 14 years Under 5 years 5 years to 14years Over. 14 Years 1944 First Aid Post "A" 23 28 105 19 17 199 1944 First Aid Post "B" 31 83 - 29 70 57 Analysis of contacts treated during 1944. Year No. of cases treated at Total cases treated. First Aid Post "A" First Aid Post "B" 1944 184 98 282 Analysis into age Groups of contacts treated. Year Treatment Centre. Males. Females Under 5 years 5 years to l4yoars Over 14 Years Under 5 Years 5 years to 14years Over 14 years 1944 First Aid Post "A" 10 6 67 6 14 81 1944 First Aid Post "B" 4 19 - 5 14 56 Prior to 1942, no scheme existed for notification of cases of scabies, and pre-war only a few cases came to the Public Health Department. Active measures are taken to ensure that all contacts are followed up. It was not necessary to invoke the special powers given under the Scabies Order for the examination of persons or premises. INFESTATION BY HEAD LICE. There has been no evidece during 1944 of infestation by head lico to occasion any apodal commont. The measures indicated in tho Report for 1943 are still in force.