C4413(1) KINGSTON upon THAMES Sune KIN 19 Royal Barough of Kingston-upon Themes ANNUAL REPORT 1945 Medical Officer of Health AND Chief Sanitary Inspector TO THE , • Town Council AND THE Ministry of Health GUILDHALL, KINGSTON-UPON-THAMES DECEMBER, 1946 ' " > • • • ' t > Royal Borough of Kingston-upon Thames ANNUAL REPORT 1945 Medical Officer of Health AND Chief Sanitary Inspector TO THE Town Council AND THE Ministry of Health GUILDHALL, KINGSTON-UPON-THAMES DECEMBER, 1946 ANNUAL. REPOT 1945 TABLE OF CONTENTS. SECTION A Statistics and Social Conditions. Page. (i) General Statistics (ii) Social Conditions 1 (iii) Extracts from Vital Statistics 1,2,3, 4 (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 9 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 19 (iv) Health Visitors 19 (v) Child Life Protection 20 (iv) Treatment (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 Contd. SECTION C Sanitary Circumstances. Page. 1. (i) Water 26 (ii) Drainage and Sewerage 26 2. Rivers and streams 26 3. (i) Closet Accommodation 27 (ii) Public Cleansing 27 (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 30 SECTION E Inspection and Supervision of Food. (a) Milk Supply 31 (b) Meat and Other Foods 32,33,34 (c) Adulteration - Food and Drugs Act 35,36,37 SECTION F Infectious Diseases. Notifiable Diseases 39,40,41 Diphtheria Immunisation 42 Tuberculosis 43 44 Sonne Dysentery 45 Scabies 46 ,47 Infestation by Head Lice 48 PREFACE. TO TEE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. 0 ANNUAL REPORT, 1945. Mr. Mayor, Ladies and Gentlemen, As directed by the Minister of Health, this report for 1945 is restricted to essential matters relating to Public Health and social medicine. It is in the same form as that for 1944. Vital Statistics. The Registrar-General's estimate of the population was 35,760, an increase of 980 on the figure for 1944. The number of live births was 593 giving a birth rate of 16.58 as compared with 578 and a rate of 16.62 for 1944. The number of deaths was 505 giving a crude death rate of 14.12 as compered with 474 and a rate of 13.63 for 1994. The excess of births over depths in 1.945 was 88 as compared with 104 in 1944. The number of deaths of infants under one year of age was 26 as compared with 28 in 1944. The rate per 1,000 live births (Infant Mortality Rate) was 43.84 compared with 48 .44 in 1944 . The Infant Mortality Rate, averaged for successive quinquennial periods from 1925 onwards to 1944, declined from 69 for the period ending 1925 to 55 for the period ending 1944. The actual rate for 1925 was 73, for 1944 was 48, for 1945 43.84 as above. The highest rate in the series was 76 in 1924, the lowest 26 in 1939. The downward trend of this figure is continued in 1945, A lower figure must be aimed at because some of the infant deaths at present occurring can be considered preventable. General Health of the People. Judged upon such information as is directly available, the health of the people generally remained good. Three factors of great influence upon the health of the people stand out as problems of an acute character calling for energetic measures towards solution:- 1. Housing - There is a desperate shortage of Swelling houses for all sections of the community which has led to considerable and in many instances gross overcrowding. The crowding of more then one family into houses which were not designed for plural occupation and the subnormal standard of living thus imposed has a most damaging effect upon the physical end moral well-being of the occupants. This situation hps called forth vigorous efferts on the part of the Council but constant danger to the health of the people remains with such conditions. ' • . J , . V V 2. Food - Full credit must be accorded to the excellent rationing system in force which still ensures an even distribution of essential foodstuffs to the whole of the population. But it must be noted that there is now little, if any, margin of safety as regards nutrition to meet emergencies of illness, strain or epidemics. Fats are definitely at a very low level. Monotony is a feature of readily available diets. There is considerable difficulty for the housewife to provide for the heavy manual worker, the fast-growing school child and herself in carrying out her increasingly heavy duties for her family, 3. Care of the Aged - From the number of appeals for help on behalf of aged sick or infirm persons, it is evident that provision for them is another acute problem demanding solution. Alongside the heavy demand on housing, hospitals and food supplies for the more active members of the community must come the provision for the aged of suitable housing accommodation with communal amenities and increased nursing and welfare facilities. The Number of Births. In 1945 the number of births registered was 615; a rise from 539 in 1941 but not so high as 660 in 1943. It should be noted that the figure of illegitimate live births from 1941 onwards was 38, 39, 49, 53 and 64 in 1945 - a steady rise. It is to be expected that the number of registered births will remain high or increase in 1946. It may be expected that the number of illegitimate births may fall in a year or two. Nursery Occupied Places. It is obvious that the peak of occupied nursery places had not been reached at the beginning of 1945. The total attendances recorded were 1941 - 2,715; 1942 - 24,018; 1943 - 51,453; 1944 - 56,037; 1945 56,819. This is the situation notwithstanding the closure of St. Peter's War-time Nursery in June, 1945, and the redistribution of the children and staff attending. It is evident that all the day nursery accommodation provided at the and of the year is required to meet the demand for places. The general provision of health services has boon maintained throughout the year. Apart from a fairly widespread occurrence of measles commented upon in Section F of the report, no epidemic of notifiable infectious disease occurred in the period under review. 1945 has been a year of transition in which the first steps of change from war-time to peace-time conditions were taken. The difficulties experienced in winding-up emergency arrangements and in staffing are temporary. " . I wish to express thanks to ray senior colleagues for their co-operation throughout the year and to all members of my staff for their hard work. To the Mayor, Aldermen and Councillors, I return thanks for their interest and support throughout the year. I have the Honour to,be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. W. STARKEY, Medical Officer of Health. November, 1946. 1945 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 WIILS, M.D. (Prague), (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. PERRY,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.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. BAKER, S.R.N., S.C.M., H.V. Cert. MISS E. EVANS, S.R.N., C.M.B., Cert.Part I, H.V.Cert. MISS B. DYSON, S.R.N. S.C.M. H.V. Cert. Clerical Staff not listed. (a) Certificates as Sanitary Inspectors and Meat and Food Inspectors. 1 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statisties. Area in Acres 1,390 Population (Registrar General) 35,760 Number of inhabited houses (approx.) 11,028 Rateable Value - General Rate £532,000 Sum represented by Penny Rate £2,100 Amount of Outdoor Relief £5,273 (ii) Social Conditions. The character of the Borough has not changed during the year. During the latter half of 1945, there was a gradual change over from wartime to peacetime production. The chief industries of the area are general and motor engineering and manufacture and repair of aircraft. The Manager of the Local Employment Exchange reports that there was little or no unemployment during 1945, but towards the end of the year there was a marked tendency on the part of women to leave industry. The district is still residential in character over the greater part of the area. (iii) Extracts from Vital Statistics of the Year. Live Births- Total Male Female Legitimate 529 272 257 Illegitimate 64 34 30 Totals- 593 306 287 Birth Rate (Registrar General) 16.58 Still Births- Total Male Female Legitimate 21 12 9 Illegitimate 1 — 1 Totals - 22 12 10 Rate per 1,000 total (live and still) births 35.77 Deaths - Total Male Female 505 262 243 Death rate (Registrar General) 14.12 : 0 1 (iii) Extracts from Vital Statistics. 1941 1942 1943 1944 1945 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS. Legitimate 482 271 211 512 276 236 588 291 297 525 565 260 529 272 257 Illegitimate 38 18 20 39 20 19 49 31 18 53 27 26 64 34 30 TOTALS 520 289 231 551 296 255 637 322 1315 578 292 286 593 306 287 Birth rate (R.G.) per 1,000 pop. 14.46 15.26 17.77 16.62 16.58 STILL BIRTHS j J Legitimate 15 11 4 12 5 7 20 14 6 17 8 9 21 12 9 Illegitimate 4 3 1 1 — 1 3 2 1 1 — 1 1 — 1 TOTALS 19 14 5 13 5 8 23 16 7 18 8 10 22 12 10 Rate per 1,000 total (live and still) births. 35.25 23.05 34.84 30.20 35.77 DEATHS. 525 253 272 491 260 231 500 226 274 474 239 235 505 262 243 Death rate (R.G.) per 1,000 pop. 14.59 13.6 13.92 13.63 14.12 rj (a) Deaths from Maternal Causes- Deaths. Rate per 1,000 Tota1 (Live & still)births. Puerperal Sepsis - 0.00 Other Maternal Causes - 0.00 (b) Death Rate of Infants under one year of age. All infants per 1,000 live births 43.84 Legitimate infants per 1,000 legitimate live births 41,59 Illegitimate infants per 1,000 illegitimate live births 62,50 (c) Other Deaths- Deaths from Cancer (all ages) 79 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under 2 years of age) 1 Birth-rates,, Civilian Death-rates, Analysis of Mortality, Maternal Mortality.and Case rates for certain Infectious diseases in the year 1945. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C.Bs. and Great Towns including London. 148 Smaller Towns Resident Pop;25,000 -50,000 at 1951 Census London Ada. County. Kingston upon Thames. * Rates per 1,000 Civilian Population:- Live Births 16.1≠ 19.1 19;2 15.7 16.58 Still Births 0.46≠ 0.58 0.53 0.40 0.61 Deaths:- - - - * All Causes 11.4≠ 13.5 12.3 13.8 14.12 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 0.02 0.02 0.01 0.02 0.00 Diphtheria 0.02 0.02 0.02 0.01 0.00 Influenza 0.08 0.07 0.07 0.07 0.05 Smallpox - - - - - Measles 0.02 0.02 0.02 0.01 0.05 Rates per 1.000 Live Births:- Deaths under 1 yr.of age 46/- 54 43 53 43 Deaths from Diarrhoea & Enteritis under 2 yrs. 5.6 7.8 4.5 7.6 1.69 ??? A dash (-) signifies that there were no deaths. ??? Per 1,000 related births. ≠ Rates per 1,000 Total Population. A 4  England and Wales. 126 C.Bs. and Great Towns including London. 148 Smaller Towns Resident Fop. 25,000 -50,000 at 1931 Census London Adm. County Kingston. upon Thames Rates per 1.000 Civilian Population:- Notifications Typhoid Paver 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.00 0.01 0.00 0.00 Cerebro Spinal fever 0.05 0.05 0.05 0.05 0.03 Scarlet Fever 1.89 2.02 2.03 1.57 0.78 Whooping Cough 1.64 1.65 1.47 1.25 2.35 Diphtheria 0.46 0.52 0.56 0.31 0.45 Erysipelas 0.25 0.28 0.24 0.31 0.14 Smallpox 0.00 0.00 - 0.00 0.00 Measles 11.67 10.89 11.19 9.03 11.38 Pneumonia 0.87 1.03 0.72 0.78 0.53 Rates per 1,000 Total Births (Live and Still) (a) Notifications:- Puerperal Paver )9.93 12.65 8.81 (3.60 . Puerperal Pyrexia ) 37.39 ≠ Including Puerperal fever. 5 (iv) Causes of Death. Registrar General's Tables All Causes 1941 1942 1943 1944 1945 M. F. M. F. M. F. M. F. M. F. 253 272 260 231 226 274 239 235 262 243 1 Typhoid and typhoid Fevers - - - - - - - - - - 2 Cerebro-Spinal fevers 3 1 - - - - - - - - 3 Scarlet Fever - - - - - - - - - - 4 Whooping Cough 3 1 - - - - - 1 - - 5 Diphtheria 1 - - - - - - - - - 6 Tuberculosis of Respiratory System 9 9 13 9 12 13 12 7 10 9 7 Other forms of Tuberculosis 3 1 1 1 - 1 1 3 3 4 8 Syphilictic Diseases 1 1 3 - 2 2 1 3 9 Influenza 3 2 - 4 8 7 2 2 2 - 10 Measles - - - - - - - - - 2 11 Acute Poliomyelitis & Polioencephalitis - - - - - - - - - - 12 Acute Infantile Encephalitis - - - -i- - - - - - - 13 Cancer of B,Cav. & oesophagus (M) uterus (F) 4 5 4 4 2 3 5 2 7 1 14 Cancer of Stomach or Duodenum 7 5 6 4 10 5 11 6 7 5 15 Cancer of breast - 5 - 5 - 10 - 10 - 6 16 Cancer of all other sites 24 21 35 31 25 28 23 19 30 23 17 Diabetes 2 4 2 - - - 1 - 4 5 18 Intra-cran, vascular lesions 21 26 18 31 15 32 18 35 14 36 19 Heart Disease 64 70 70 70 52 67 64 60 69 65 20 Other diseases of circulatory system 7 13 - - 6 17 15 11 16 22 21 Bronchitis 18 16 8 7 14 20 12 6 20 7 22 Pneumonia 17 14 10 4 19 10 15 10 14 7 23 Other Respiratory diseases 3 4 2 4 1 5 4 - 3 - 24 Ulcer of Stomach or duodenum 2 - 3 1 3 1 1 1 9 1 22+. Diarrhoea under 2 years 3 2 5 5 6 1 3 2 1 — 26 Appendicitis - - 3 - - - - - - - 27 Other digestive diseases 4 9 5 6 8 2 5 5 3 8 28 Nephritis 5 6 7 6 4 2 4 6 5 4 29 Puerperal Causes ) ( - 1 — — 30 Other Maternal ) Causes ) Recorded under other headings. - 2 - - 31 Premature birth 5 3 6 1 1 7 5 5 3 - 32 Congenital Malformation Birth injuries - - - - - - 4 4 7 5 33 Suicide - - 3 - 2 1 2 1 4 3 34 Road Traffic Accidents 6 2 3 1 4 1 4 - - 1 35 Other violent causes 17 24 7 12 2 7 12 16 5 10 36 All other causes - - - - - - 16 19 23 19 n D 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 th'o year have been recorded in the preface, (ii) (a) Laboratory Facilities. During 1945 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 nov; 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 Food and Drugs Acts are submitted to the Public Analyst. (b) Ambulance Facilities. (1) For infectious cases: Cases removed to 7imbledon 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 servicc 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 171 Private Cases 235 Maternity Cases 27 Calls for Ambulance not required 31 Calls dealt with for hospitals. County Hospital 123 St. Helier Hospital 2 Total 589 St. John Ambulance - Accident Cases 88 Private Cases 341 Air Raid Casualties 8 Total 437 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.) 1941 1942 1943 1944 1945 ....... . Cases. Cases on books on 1st January 62 54 67 67 75 New cases 520 569 626 609 660 Results of Cases: Convalescent 398 431 466 435 508 Transferred to Hospital 57 59 81 59 56 Died 70 63 77 92 93 Removed for other causes 3 3 2 15 6 Still on books 54 67 67 75 72 Visits. General Nursing 12,551 15,891 16,974 16,979 19,851 Casual 118 204 150 124 223 (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 be paid by the Corporation, but during the period under review no claims were received. 8 (d) Clinics and Treatment Centres as at 31st. 'December, 1945. 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, Grange Road, Kingston. Wednesdays 1.45 p.m. Post-Natal 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 and 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 3.3O p.m. Orthopaedic Clinic. Red Cross Curative Post, Coombe Lane, Kingston. By appointment. Tuberculosis Dispensary (s.c.c.) South Place, Surbiton. Wednesdays & Fridays at 1.30 p.m. Day Nursery No.l, "Surrey Villa", 1 Knights Park, Kingston. For admission apply to Medical Officer of Health. Day Nursery No.3. "Kilnwood", 213 Richmond Road, Kingston. -do - Day Nursery No.4. "Fairfield", Fairfield East, Kingston. -do- Day Nursery No.5. 53/55 Canbury Park Road, Kingston. -do- Day Nursery No,6. Messrs. Ben tails, Clarence Street, Kingston. Apply Staff Controller, Messrs. Bentalls Ltd. Kingston Nursing Association (Vol.Committee) 33 Birkenhead Avenue, Kingston. Apply to Matron for District Nurses. 9 (e) Hospitals. (1) Fever. An arrangement exists with the Wimbledon Corporation whereby cases may be admitted to the "'"imbledon 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 heen 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 hy voluntary contributions. The Corporation made a contribution of £50 to the Kingston Victoria Hospital during 1945. ••• l0 3• MATTilRNITY AND CHILD WELFARE. (i) MIDVIFERY SERVICE. (a) Midwifery Sorvice (Surrey County Council) The Midwifery Service is under the administrative control and supervision of the County Mcdical Officer of Health and can be divided into two main sections Domiciliary Midwifery Service, Institutional Midwifery Service, At the end of 1945 there were four 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 Hospital; Births Notified 1941 1942 1943 1944 1945 No. notified by Midwives 115 147 158 153 132 No. notified by General Practitioners and Medical Supe r in ten den t, Kingston County Hospital. 419 424 506 408 498 Total 534 571 664 561 630 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 1941 1942 1943 1944 1945 M. F. M. F. M. F. M. F. M. F. Live Births: Legitimate 271 211 276 236 291 297 265 260 272 257 Illegitimate 18 20 20 19 31 18 27 26 34 30 Still Births: Legitimate 11 4 5 7 14 6 8 9 12 9 Illegitimate 3 1 - 1 2 1 — 1 — 1 Totals: Male & Female 303 236 301 263 338 322 300 296 318 297 Grand Totals 539 564 660 596 615 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. One case arose during 1945 requiring his services, (b) (i ) Maternal Mo rtality._ The Medical Officer of Health investigates all maternal deaths, and obtains full reports from the practitioner attending. There were no maternal deaths during 1945. The figures for the years 1941 - 1944 are given for comparison: Cause 1941 1942 1943 1944 1945 Mitral Stenosis Cardiac Failure Toxaemia of Pregnancy 1 - - 3 - Septic abortion - 1 - - - Septic abortion, self-induced - 1 1 - - 12 (b) (ii ) Infant Mortality. The following are the numbers of Kingston children who died during 1945 in the Borough before reaching the age of one year, together with the cause of death and age: Ago Total Cause of Death. 0-24 hrs. 8 6 Prematurity, 1 Atelectasis, Bilateral Pneumonia . 1 Asphyxia, inhalation of fluids and Meconiumc Conviction of Manslaughter. 24 hrs. - 1 lath. 6 1 Prematurity. 1 Cerebral haemorrhage, lacerated cerebellum. 1 Atelectasis, Bilaterial Pneumonia . 1 Intra cranial haemorrhage, Broncho pneumonia. 1 Congenital Atresia of Oesophagus. 1 Gastro Enteritis. 1 mth. - 1 year. 12 4 Broncho Pneumonia 2 Acute Bronchitis 1 Congenital heart disease. 1 Marasmus. 1 Broncho pneumonia and measles. 1 Purpura haemorrhagiCR. 1 Spina bifida, 1 Tuberculous -neningitis. The approximate infant mortality rate for 1945 is as follows, and in addition the rates for 1941 to 1944 (inclusive) are shown for comparative purposes:- 1941 1942 1943 1944 1945 Kings ton-upon-Thames 57 63 48 48 43 England and Wales 59 49 49 46 46 London Area 68 60 58 61 53 The Infant Mortality rate of 43 is lower than the rate of 48 for 1944. It is lower than the figure of 46 for England and Wales and lower than the figure of 53 for the London Administrative County Area. Improved provision for the care of infants is called for to maintain a downward trend of this figure which is capable of further reduction. Ophthalmia Neonatorum. Two cases were notified during 1945. Special arrangements have been 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. Twenty-three cases were notified during 1945. An analysis is shown below, together with figures for the years 1941 - 1944 for purposes of comparison. Cases 1941 1942 1943 1944 1945 (a) Total notified 37 23 18 15 23 (b) Number of (i) Kingston residents 3 5 4 2 9 (ii) Extra district residents 34 18 14 13 14 (c) Number included in (a) Notified from Kingston County Hospital. 34 20 17 14 21 (a) Number included in (a) Notified by private doctors 3 3 1 1 2 (e) Number of eases included in (d) removed to hospital 1 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. These 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 cases whose confinement is undertaken by a midwife, attend the Borough Ante-Natal Clinic, and are seen by a member of the Kingston County Hospital 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 1945 and preceding years, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation: 1941 1942 1943 1944 1945 No. of patients 134 134 144 142 126 No. of attendances 603 548 744 701 671 A.N. Patients referred to Kingston County Hospital 34 39 35 29 23 14 Spccial attention is paid at anto-natal clinics to the general health and nutrition of expectant mothers. Under the Ministry of Pood Schema 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, etc. is supplied at the AnteNatal Clinic, either free or at cost price, depending"upon the circumstances. 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 application of the income scale. No. in family Scale of income per head of family after deducting rent, rates and insurance. Pu.ll cost remitted Half cost remitted. 2 12s. 6d. 14s. 6d. 3 l1s. Od, 13s. Od. 4 9s. Od. l1s. Od. 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 be made to the homes of all mothers applying for admission to hospital. Those visits are made"by the Health Visitors, who decide whether home conditions are suitable for confinement at home and a recommendation, in accordance with tho 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 1945 and preceding years. 1941 1942 1943 1944 1945 No. of homo visits (individual cases) 247 266 271 159 199 Total No. of visits 377 367 395 260 307 Home helps are also referred to in a later paragraph. (b) POST-I.TATAI SEEVICES. The Post Natal Services arc incorporated with tho AnteNatal 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 Email during the period under review. 15 Every effort is made by the Health Visitors 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 symptoms which may not appear until later, think thoy aro fit and well, and fail to attond. (c ) INEANT WELFARE SERVICES. (i) Domiciliary Visits. The initial visit by a Health Visitor is paid to all infants 12 - 14 days aftor confinomont whoro a midwifo has boon in attondanco, or whoro tho confinement took placo in tho Kingston County Hospital, and 28 days aftor the birth whoro a General Practitioner was in attendance. Advico is given by the Health Visitor on infant feeding hygiene, and general management of mother and infant. Further visits are paid according to tho domestic circumstances. Where a family doctor is in attendance, no further visits are made unless by request of tho mothor. In a majority of cases, visits are mode every month, or more often if nooessary, during tho first sir months, and every two months at one year, .md every three months between one and five years. More frequent visits are mado where there are difficulties, infant feeding or illness. Regular visits at intervals of one to three months, according to circumstancos, are made betwocn tho ages of one to fivo years. Every effort is mado to find children who have ontorod tho Borough sinco their birth and regular visits arc also mado to those casos. The following is tho total number of visits made during 1945, and precoding yoars:- 1941 1942 1943 1944 1945 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 First visits 503 - 529 - 642 - 524 567 - Total visits 2915 5175 2922 5410 2758 5358 3308 7007 2662 6194 (ii) Infant Welfare Clinics. Two Clinics wcro held weekly at both the Hoalth Centre and Latchmorc School. The Medical Officer of Health or his Assistant attend all these Clinics, examine tho childron regularly and advise regarding infant feeding, otc. The following table shows tho number of sessions held, tho number of now c^.sos seen, subsequent visits mado, and tho numbers seen by the Medical Officer:- The following table shows the number of sessions hold, tho number of now cases seen, subsequent visits made, and tho numbers seen by the Medical Officer:- 16  Health Centre, Grange Road Tuesdays & Fridays Latchmere Road School . Mondays & Thursdays 1941 1942 1943 1944 1945 1941 1942 1943 1944 1945 No. of sessions held 102 102 103 102 102 99 101 99 100 98 No. of new cases seen 348 362 383 322 407 237 322 269 195 204 Total attendances made 5562 6251 7167 5574 5625 4467 5524 6380 4657 4485 No. seen by M.O. 2300 2442 2541 2425 2550 1842 2085 , 2120 1783 1850 Dried milk and supplementary Vitamins, etc., are supplied at the Clinics to all cases recommended by the Medical Officor, either at approximately cost prico, or half-price, or free of charge in necessitous cases. The incomo scale referred to in Section 2 (a) also applies to driod infant foods, otc. The following table gives details of tho supply of infant food and dried milk during tho period under rcviow:- Amount in lbs. 1941 1942 1943 1944 1945 Sold, cost price and Sold, half price 6,215 8,555 12,817 10,198 11,449 Free of charge 2,189 2,626 2,093 432 182 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 tho period under reviow. In addition to assistance in clorical work, voluntary workers have organised two clothing stalls, one at oach Centre; horo infant clothes are sold at tho cost price of tho matorial used. Those garments aro made by tho voluntary workors in their homos. The total number of garments sold during tho period under roviow was as follows:- 1941 1942 1943 1944 1945 No. of mothers who bought 261 321 256 287 291 No. of garments 974 1,025 762 823 880 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 Doanory Homo for Friendless Girls, 18, Richmond Park Road. The homo is administorod by a voluntary body, the Kingston Doanory Moral Wolfaro Committoc, affiliatod to the Southwark DiocOsan Association for moral wolfaro. There aro fourteen bods. Admission is not confincd to Kingston residents, but is oxtondod to girls residing anywhoro in, or occasionally boyond, the Southwark dioccso. The oxpectant mothers ontor the home about two months before confinement, and it is a condition of their acceptance that they stay for at loast two months aftor confinement, at the end of which period efforts arc made to secure them suitable omployment, A social wolfaro worker keeps in touch with the girls aftor thoy leavo tho homo. There is a permanent staff consisting of a Matron, S.C.M. Nurse and a Cook-Housokeeper. 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 1945 - 50 s The homo was closed from mid-Juno, 1944, until 1st October, 1944, during flying bomb attacks. As many of tho casos as possible were sent homo; others wcro ovacuatod undor tho Governmcnt Evacuation Schome. This accounts for the low numbers of admissions to tho homo during 1944. WAR-TIME NURSERIES. (b) On tho 1st January, 1945, there woro six wartime nursories in the Borough, fivo of which were administorod by tho local authority, with the approval of tho Ministry of Hoalth. The remaining nursery operated undor privato direction but received a grant from tho Corporation, which was recoverable from the Ministry of Hoalth, of Is. per day, por attendance. On 9th June, 1945, War-Time Nursery No. 2 at St. Peter's School was closod and the children and staff transferred to War-Time Nursery No. 4 at Fairfield, East. The ago range at Fairfield for tho admission of children was established at 2 - 5 years and at War-time Nursery No. 1, Surrey Villa, the upward limit of ago for admission was roduced to 3 years. 18 The following table gives the total attendances during the years 1941, 1942, 1943, 1944 and 1945:- Year Surrey Villa St. Peter's Kilnwood Fairfield Kings ton Day Nursery Bentalls 1941 878 1,837 - - - - 1942 11,733 9,140 3,155 — - - 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 1945 8,606 3,300ø 6,824* 11,024 9,866 17,199 † Attendances are recorded, for the purpose of this report from June, 1943, being the date the nurseries were approved officially as war-time nurseries. ø Figures for St. Peter's up to and including 9.6.45 when nursery was closed. * Kilnwood Nursery admissions were stopped from 7.7.45 to 21.7.45 owing to the prevalence of measles and whooping-cough in the district. Admissions restarted on 23.7.45. Spocial attention has always boon paid to the care of the childron in the War-Time Nurseries. Staff have been choson for their experience in handling children under tho ago of five yoars. The essentials of adequate nutrition havo been carefully watchod in the diet of tho childron. I would like to tako this opportunity of expressing my appreciation of the good work carried out at tho Nurseries both by full-time staff, and by tho Health Visitors and voluntary workers. (c) CARE OF PREMATURS INFANTS. The recommendations of Ministry of Health Circular 20/34 are followed and records are kept giving details of the number of premature births notified during 19-15. They are as follows:- (a) The total number of premature births notified during 1945 who were born - (1) At homo - 5. (2) In hospital - 26. (b) The number of those born at home - (1) Who wcro nursed entirely at homo - 5. (2) Who died during tho first 24 hours - 2. (3) Who survivod at the and of one month - 3 . (c) The number of those born in hospital - (1) Who died during the first 24 hours - 2. (2) Who survived at the end of one month - 23. 19 When the mether and infant are kept at home, clese supervisien "by the Health Visiters is carried eut and all practical assistance possible is rendered. A separate bedreem for mether and infant is advecated; instructiens en imprevisatien and detailed advice en the care ef the infant are given. The services ef a paediatrician can be called upen if necessary and a home help provided where necessary. (c1) CARE eF ILLEGITIMATE CHILDREN. The previsiens of Ministry ef Health Circular 2866 are fellewed and mest ef the suggestiens eutlined in the Circular are covered with the exceptien that a separate welfare werker has net been appeinted. Clese ce-eperatien, hewever, exists between the efficers ef the Welfare Autherity and Welfare Werkers at the Kingsten Deanery Heme and generally. Financial contributien ef 50%, the Surrey County Ceuncil paying the ether 50% tewards the salary ef a full-time Welfare Werker at the Deanery Heme was decided upen at the end ef the year, appreximately 50% ef the time ef the werker te be spent en Kingsten caces. - During tfcie pre-natal stages, Health Visiters are in teuch with expectant methers and, where necessary, centact the grand-parents, welfare werkers in facteries, hespitals, almeners, meral welfare werkers and ethers. Similar centacts are made during the pest-natal stages and, in additien, admissiens te Day Nurseries are arranged, fester-methers are visited and attendance at the Maternity and Child Welfare Clinics is enceuraged. Assistance is given alse by hespital almeners and asseciated werkers whe help the methers te find werk and ledgings. (iv) HEALTH VISITeRS. The changcs in the persennel ef the Health Visiters are indicated at the beginning ef"this Repert. The Health Visiters are alse Scheel Nutses and Child Life Pretectien Visiters. Frem 1st April, 19^5, the Health Visiters acting as Scheel Nurses have ceme under the administratien ef the Surrey Ceunty Ceuncil which is the Educatien Autherity fer the Area. The same nurses deal with the Kingsten scheels under the Nerth Central Divisienal Executive Cemmittee which cevers Kingsten, Maiden, Esher and Surbiten, and fer which Cemmittee yeur Medical efficer ef Health is alse Divisienal Scheel Medical efficer. There has been censiderable expansien ef the werk in Maternity and Child Welfare. There has alse been an additien te the werk ef the Health Visiters in regular visits ef inspeetien te the War-Time Nurseries recently established. All this werk ef Maternal and Infant Welfare puts a very heavy strain en the existing health visiting staff. The number ef clinics held and the premises used are inadequate fer the velume and nature ef the werk being done. 20 (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. The following table gives details regarding numbers of children under the care of foster mothers, and other relevant information:- 1941 1942 1943 1944 1945 No. on register at beginning of year 26 28 35 33 26 No. of new registrations 5 11 9 2 3 No. ceasing to have charge of infants 3 4 11 9 9 No. on register at end of years 28 35 33 26 20 Total No. of children 38 45 33 24 22 Infant Life Protection Visitors are also Health Visitors. (yi ) 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 requiringdental treatment are referred to the dental clinic by the Medical Officer, as also are expectant and nursing mothers from the AnteNatal 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. 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 1941 1942 1943 1944 1945 545 765 524 386 283 21 TREATMENT OP DENTAL DEFECTS (MATERNITY AND CHILD WELFARE ONLY) 1941 1942 1943 1944 1945 Sessions devoted to treatment 16 17 21 20 21 No, treated: (i) Mothers 39 66 59 78 51 (ii) Infants 56 51 36 41 39 Attendances made for treatment 338 306 329 357 318 Fillings : (i) Permanent Teeth 1 36 40 36 35 (ii) Temporary teeth 10 29 4 33 36 Extract ions: (i) Permanent teeth 181 266 242 322 245 (ii) Temporary teeth 124 137 88 60 61 Other operations: ( i) Permanent teeth 7 15 14 15 9 (ii) Temporary teeth 50 23 43 101 76 Supply of dentures - 13 15 9 8 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:- 1941 1942 1943 1944 1945 Total cost £46.8. 0. £62.12.10. £70. 4.11. £49.7.10. £39.6. 9. Contribution by mothers £20.1.0. £16.5. 0. £22.14.0 £35.12. 3. £21.5.8, (b) Ophthalmic . 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. following number of children were seen during 1945 and preceding years. The following number of children were seen during 1945 and preceding years. 1941 1942 1943 1944 1945 defective vision 2 - - - 1 Squint 9 16 26 19 16 Other conditions 1 1 1 3 - 22 (c) Artifical 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 1945 and preceding years:- 1941 1942 1943 1944 1945  No. of children under five years attending. 125 101 120 151 72 Total number of attendances . 2302 1547 1522 1938 740 The following are examples of the type of defects for which children are refcered:- Marasmus; rickets; Pink disease; Bronchitis; frequent colds; cervical glands, anaemia, general debility,, (&) 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 1945 and preceding years. 1941 1942 1943 1944 1945 Total No. of eases 12 8 12 1 2 Total cost £17.2.0 £11.8.0 S17.2.0 £1.8.6 £2.17.0 Contributions made by parents __ _ £ 3.15.0 £ 1.15.0 £2,9.6 4.0 - (e ) Orthopaedic Treatment. Children under five years of age requiring orthopaedic treatment arc 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 3t. Vincent's Orthopaedic Hospital, The following are the numbers who attended the Post during 1945 and preceding years 1941 1942 1943 1944 1945 No. seen by Surgeon 15 18 24 27 17 No. treatment given by staff 194 169 182 263 128 No. of cases discharged 5 5 1 - 4 No, admitted to Hospital 2 2 3 2 1 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, sinco January, 1942. (g) Convalescent Treatment. In the majority of cases where children under five years of age require convalescent treatment, arrangements are made by tho Kingston County Hospital. In a small number of cases arrangements may bo made by the M^dioal Officer of Hoalth. One child was sent away in 1945. (h) Prevention of the spread of Infectious Diseases. Maternity and Child Welfare. (i) Diphtheria Immunisation. Tile policy with regard to active immunisation now is to have as many children immunised before the first birthday as possible; some time after the sixth month, probably about the eighth month, is the period of choice. Attempts are being made to get two injections in at four to six weeks' interval before the age of one year. (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. (vii) HOMEHELPS . Arrangements have been mado in tho Borough for domostic assistance to mothers whoso confinement takes placo at home, the work being undertaken by homo helps. In tho case of those who require financial assistance, part or whole of tho cost is borne by tho Corporation. Tho amount to bo paid by the mother is assessed by tho Maternity and Child Welfare Committoe. During the year under review 37 applications were received for home helps; of these 16 recoivod financial assistance. Tho following tablo shov/s tho numbor of cases who applied for financial assistance for homo helps during 1945, and proccding yoars:- 1940 1941 1943 1945 1944 1945 3 7 13 13 26 maternity cases 11 domestic In other eases assistance is given by tho visits of tho Queen's 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, 1945, there were two registered nursing homes in the Borough and both wore still on the register at the end of tho year. One, at 20, Grove Crescent, has nine beds for chronic and senile patients. The other, pt 6, Queen's Road, is registered as p Maternity Home with accommodation for eight patients. Each Nursing Home was inspected at regular intervals during the year. 25 REPORT OP THE CHIEF SANITARY INSPECTOR. To the Mayor, Aldermen and Councillors: Ladies and Gentlemen, The following Report upon the activities of your sanitary inspection staff for the year 1945 is the twenty-seventh annual statement it has been my privilege to submit to you. It covers that part of public health work which is referred to as environmental hygiene, and includes housing, food and general sanitary circumstances. For the first three months of the year under review Mr.Clegg was loaned to the Borough Surveyor to assist with war damage repairs and during part of this same period also, the remaining staff was fully engaged in connection with the V2 incident in Park Road, The interruption caused to normal duties by war-time conditions was in itself serious enough, but staffing resources were strained still further by the loss of Mr. Smith's services for a month, owing to an attack of mumps. Generally, the depletion of staff which had continued during the war years was not made good by the end of the year. The Report is restricted in character and is principally a factual record. 26 SANITARY CIRCUMSTANCES. Section C. 1. (i) Water. 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 Board, arid it was no found necessary to refer to the Board during 1945 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 1945. (ii ) Drainage and Sewerage . There were no main drainage works undertaken during the year. 2. RIVERS AND STREAMS. The effluent from the Corporation Sewage Disposal Works is discharged into the Thames. Owing to the loss of that area formerly occupied by the filter beds to the new Electricity works, it has been found necessary to further chlorinate the effluent before it is discharged into the Thames. 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 joins 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. During the year one case of river pollution was reported by the Thames Conservancy Board. It was stated that numerous fish had been killed by cyanide poisoning. The Beard sought assistance in tracing the source of contamination . Investigations were made and it was ascertained that a vat containing cyanide solution used in connection with metal processes at a factory had been emptied and cleaned out at a time which approximated very closely to the estimated period of contamination of the river. The contents of the vat had improperly been discharged into the sewerage system, thus allowing the cyanide to contaminate the sewage effluent which is discharged into the river. The occupiers of the factory were immediately notified of the results of their action and were advised how safely to dispose of the solution in future. No further complaint has since been received. 27 3. (i) CLOSET ACCOMMODATION. The closets in the Borough are on the water carriage system. (ii) PUBLIC CLEANSING. 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 20 and 80 respectively. Some 72 tons of salvage material are extracted each month, including waste food for pig feeding v/hich in pre-war years was deposited in the ashbins. (iii) SANITARY INSPECTION OF THE AREA. (a) The following is a tabulated list of visits and inspections. Insp. of Houses, etc 648 Insp. of Drainage 183 Reinspections 471 Works in Progress 89 Factories, etc 211 Outworkers 13 Cowsheds, etc. Dairies 53 Ice Cream Premises 48 Foodshops & Stores 457 Bakehouses 2 I.E.. Enquiries 79 Markets 205 Slaughterhouses 7 Offensive Trades 3. Common Lodging Houses 15 Theatres 7 Verminous Premises 113 Smoke Observation 14 Stables & Yards 5 Rodent Control 339 Shop Acts 193 Housing Act (Permitted Numbers) 27 Housing Act (Applications) 379 Rag Flock Acts 6 Rent Restrictions Acts 13 Houses after Far Damage 230 Shops 60 Building Licence Appns 29 Schools 4 Piggeries 17 Miscellaneous 183 Total 4103 (b) (c) The number 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 with is not strictly comparable with the number served as the former number may refer to notices which were served in more than one year. 28 Notices served. Informal.(a) Verbal 280 (b) Written 214 Statutory. (a) Housing Acts (b) Public Health Acts 1 Notices complied with. Informal (a) Verbal 249 (b) Written 199 Statutory. (a) Housing Acts 1 (b) Public Health Acts 1 (iv) SHOPS AND OF?ICES. Arrangements for the health and comfort of workers in shops 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 Stevens Ait, there are no camping sites in the Borough. (vi) SMOKE ABATEMENT. During the year under review, the difficulties experienced in obtaining suitable fuels were the cause of several instances of smoke nuisance. Advice was given as to the best practicable means of preventing the nuisance. In one instance it was necessary in 1944 to seek the assistance of the Ministry of Fuel A Power v/ith a view to eliminating a nuisance from black smoke due to the use of a creosote pitch mixture, During the year under review certain modifications to the plant in question were carried out but; the result were disappointing, and later in the year it was necessary again to approach the Ministry further on the matter. Permission was given for a return to the use of fuel oil. No further cause for complaint has been noted. One case of alleged nuisance from fumes in connection v/ith an enamelling oven at a factory in the town was reported. After a thorough study of the process involved, suggestions for the improvement of the plant were made and the nuisance was abated. (vii ) SHIMMING BATHS AND POOLS. (a) Public. The Corporation swimming bath comprises two pools one of which remained closed during 1945 for use as a British Restaurant. The other swimming bath remained in use throughout the year. A purification and filtration plant is installed. 29 (b) Private. There are no privately owned swimming baths or pools open to the public, in the Borough. (viii ) ERADICATION OF BED BUGS. During the year it was necessary to take action in respect of 39 premises. In each case the premises 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 and 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. COMPLAINTS. During the year 532 complaints were recorded compared with the figure of 443 for the previous year. As stated in last year's report, the figure recorded is probably less than the actual number received. The number of complaints is rising steadily each year from the 1939 figure of 207. The increase this year is no doubt due to the fact that little housing repair and maintenance has been possible for the last five years, and the understandable desire of tenants to have their dwellings put into order again now the war is ended. The following is a brief tabular statement of the various causes of complaint Drainage 89 General Defects of houses 220 Pood 65 Insect Infestation 23 Rodent Infestation 103 Miscellaneous 32 532 6. RODENT CONTROL. In previous Reports reference has been made to a marked increase in public concern in this subject compared with the pre-war period. This welcome interest was maintained during 1945. There is little doubt that wartime conditions, such as the need for home food production, enemy action, resulting in damage to drainage systems,and destruction of property, has seriously encouraged rodent infestations. The need for continuous effort cannot be over-emphasized. 30 Apart from treatment of business premises and dwelling houses on behalf of occupiers, the Corporation sewers and refuse tips were systematically baited during 1945. 7. OTHER DUTIES. Assistance to various Government Departments was continued during the year under review, as well as co-operation with other Corporation Departments, particularly with regard to survey of war damaged properties and the issue of Certificates of Essentiality in connection with applications for building work licences and for permits to purchase timber and other building materials. To assist the Housing Committee in the selection of tenants, 379 visits were made in connection with applications for housing accommodation, and reports were submitted, giving the particular circumstances of each case. Section D. HOUSING. The general appraisement of the housing position as set out in the Report for 1943 was equally applicable in 1945• In all probability the increase in the marriage rate was the principal cause of the demand for housing accommodation, and led to a still further increase in the number of houses, originally designed for the occupation of one family, being used by two or more families. In common with other parts of the Greater London area, there were indications also of a continued inward movement of population. Early in the year the position was made very acute by reason of the widespread havoc caused by the V2 incident in Park Road in which about 2,000 houses were affected in varying degree, and including a large group which were a total loss. Some of these 2,000 houses had suffered damage in previous incidents and had not long been made fit for habitation. The wastage of labour and materials in this respect was most unfortunate. Every effort was made to bring back into early use all damaged houses, and every available and suitable property was requisitioned to rehouse displaced families. At the end of 1945 no less than 208 premises were under requisition. In addition to the use of existing houses, the Corporation erected 114 temporary hutments of the curved asbestos type, on the sites of demolished houses and on other sites acquired for the purpose, in an effort to make good the losses incurred by enemy action-. The erection of the first post-war permanent houses (l8) was also commenced during the year. 31 Section 5. INSPECTION AND SUPERVISION OF FOOD. INTRODUCTION. The importance of food inspection and supervision of food premises during war years has been referred to in previous Reports, but it cannot be over-emphasized. It is, perhaps, only to be expected that when supplies are short there will be an added temptation for the unscrupulous trader to take a chance and to place on the market foodstuffs of an inferior quality. During the year 65 complaints regarding food were received and investigated. In the main they referred to the alleged sale of unsound food, but there were several instances in which it was alleged that the customer had not received the article demanded. An example of the latter type of complaint can be found in the case of sausages, the contents of which, at the best of times, are commonly held to be uncertain. Some sausages contain no meat and these articles are sometimes known an "Savoury sausages", and seldom, if ever, by a description of their actual contents. On the other hand, beef and pork sausages are subject to control, so far as the minimum meat content is concerned. But all these sausages look very much alike in the shop window and it is only after the purchaser has attempted to cook the meatless sausages in the manner usually adopted for the normal sausage, that the difference becomes only too apparent, and complaint is made of alleged misrepresentation. In such cases the price paid for the article should usually afford a means of identification. The frequent inspection of restaurant kitchens and other food preparing premises, which in pre-war years was normal procedure, was impossible during 1945 by reason of continued shortage of staff and pressure of other work. But towards the end of the year visits were resumed to a few, more particularly the snack bars and similar premises. It was not possible, however, to enforce a really satisfactory standard owing to the difficulty experienced in obtaining licences from the Ministry of Works in those cases where necessary works involved use of materials in short supply. (a) Milk Supply. At the end of 1945, the number of registered dairymen remained at the figure of 40, which includes a number of firms whose premises are situate outside the Borough Boundary but who retail milk within the Borough# There is only one producer retailer in the Borough, and his herd does not remain at the premises in the borough all the year round, but during the winter months only. In the summer they are transported to a farm outside the boundary. Designated Milks. Apart from registrations 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 - 1943. Designated Milk Licences - 1945. T. Tested. Pasteurised. Dealers 7 6 Supplementary 4 5 32 Bacteriological Examinations. During the year 118 samples of milk were submitted to the plate count and B.Coli tests compared with 22 during 1944. Forty-eight of the 118 samples proved not to be entirely satisfactory. A number of these unsatisfactory samples were of milk taken at the time of delivery to retailers premises. The necessary representations were made to the authorities in whose district the suppliers were situate and appropriate'follow up" action was taken. Biological Tests. Eight samples of milk were submitted during 1945 for biological examination. Seven of the tests showed absence of tubercle bacilli but one sample (T.T.Milk) was reported as positive. This is the first recorded instance of the presence of tubercle bacilli in any milk sample in the Borough, and it is unfortunate that it should happen to be in connection with a grade of milk usually regarded as being free from such infection. The sample was taken from a bulked supply derived from five farms in the County of Hampshire. In an effort to isolate the source of infection, a sample was taken from each of twenty churns at the place of delivery to the dairy in Kingston and these 20 samples were submitted for microscopical exmaination for tubercle bacilli. The result in each case proved negative. At the same time, and immediately on receipt of the adverse report the Hampshire County Council was informed, in order that detailed "follow up" action could be taken at the farms in question. A report was subsequently received that all the farms had been visited, and that samples of milk from each of the herds had been taken for biological examination. A later report from Hampshire stated that all the samples had proved negative, and so far as known the source of infection was not discovered. Pasteurisation. During the year 43 samples of milk sold as "Pasteurised" were submitted for the Phosphatase Test to ascertain if the milk had been properly heat treated. In two instances the samples failed to pass the test and in both cases the suppliers were notified and "follow up" samples proved satisfactory. (b) Meat and Other Foods. (i ) Slaughterhouses. There are no licensed slaughterhouses in the borough. (ii) Moat Depot and Emergency Foods. Apart from the few pigs which were slaughtered for private use by, or on behalf of, pig keepers no animals were slaughtered in the borough for human consumption. There remains, however, the Ministry of Food meat distribution depot through which passes all meat and offals (including frozen, chilled, fresh, or canned) destined for the Boroughs of Barnes, Kingston, Maiden, Richmond, Surbiton, and Wimbledon, and the Urban District of Esher. On an average just over 200 tons of meat etc. pass through the depot each week, and the alertness and keeness of all concerned, from the Manager down to the most junior member of the staff of the depot, as well as of your food inspectionstaffwas 33 indicated by the very few occasions upon which any part of a consignment was considered to be unsound on arrival at retail shops within the area served by the depot. There were several occasions when consignments were found to be suffering from the effects of defective refrigeration and/or storage giving rise to white spot or black spot mould; also at times, consignments were delayed in transit. The task of inspecting these damaged consignments was no light one as in order to avoid further loss of valuable foodstuffs it was essential that at least one and sometimes two inspectors should be in constant attendance to direct and supervise all necessary trimming of the carcases before distribution, and to advise upon the disposal of foods which were not suitable for ordinary meat ration, but which could be quite properly directed for manufacturing processes. The result of this part of the work is amply reflected in the tabulated statement of condemned foodstuffs below. By the end of 1945 there were no further cases of foodstuffs damaged as the result of enemy action. In fact, the amount so damaged during 1945 was much less than the corresponding figure for 1944. There remained certain emergency food stocks in the borough and these stocks were g radually reviewed but were not finally cleared at the end of the year. Whilst the task of ensuring the wholesomeness of the food supply is paramount in importance yet it should not be overlooked that there is an economic viewpoint which in times of national emergency is of almost equal consequence - viz. salvage. The work outlined above enabled a comparatively large amount of food to be made available for human consumption which would otherwise have been wasted, and even that part which had to be condemned was utilised for animal feeding or was disposed of for conversion into fertilisers or poultry food. There is one further interesting point about the list of condemned foods and this is the prevalence of infestation by moth and weevil, two insect pests that can cause much havoc amongst cereals of all kinds, and the presence of moulds. Doubtless, when old stocks are used up and labour is more plentiful in stores and shops the loss of foods from these causes will be considerably reduced. In the meantime it is very important that only suitable premises should be used for storage purposes and that the utmost cleanliness should be observed in every place where cereals, or for that much, any foods are kept, as damage by insects and moulds is preventable by the use of ordinary care. It was gratifying to note that in no case during the year was it necessary to condemn any foodstuffs as the result of contamination by rodents. In the past too little attention has been paid to contamination by rats and mice. This type of contamination is highly dangerous and doubtless has given rise to illnesses which were wrongly attributed to other types of food contamination, when in point of fact the source of infection was due to contact with rodents. 34 Tabulated List of Condemned Foodstuffs Showing Cause for Condemnation and the Weights. Article of Food, Reason for Action. Weight. Bovines. Beef Decomposition, Bone Taint, etc. 1341½ lbs Beef Contaminated by foreign matter 17 " Offal Decomposition 19½ " Ox Tongues " 594 " Ox Hearts " 248 " Sheep. Mutton Black Spot Mould 62½ " " Abscess 9 " " Contaminated by foreign matter 129 " Offal Decomposition 70½ " Porcine. Pork Internal Decomposition 170 " Pork Black Spot Mould 206½ " Ham Abscess 19 " Canned Foods. 1264 tins Meat Blown, decomposition,etc. 2941 " 660 " Fish do. 473 " 373 Vegetables do. 546 " 76 " Jam & Marmalade do. 146 " 4 " Fruit do. 54½ " 532 Condensed Milk do. 466 Miscellaneous. Rabbits Decomposition 531 " Sausage do. 36 " Pork Pies do. 35½ " Brawn do . 5 " 9 Boxes Pish do. 644 " Kippers do. 133 " Pickles etc„ Mould & Decomposition 40 " Rice Moth Infestation 100 " 1 Bag Semolina Weevil " 112 " 6 Pkts. Oats Mould & Foreign Matter 12 " Barley " 13½ " 6 Pkts. Cereals Moth & Weevil Infestation 8½ " Flour Foreign Matter 656 " Pea Flour Moth Infestation & Foreign Matter. 112 " Soup Powder Foreign Matter 32 " 76 Pkts. Pudding Moth & Weevil Infestation 38 " Mixture Ice Cream Powder Moth Infestation & 'Foreign Matter. 644 " Biscuits Mould & Decomposition 500 " Prunes Decomposition 5 " Peaches " 55 " Dates Decomposition & Mould 176 " Milk Cocoa Powder Infested with Moth & Veevil 278 " Milk Powder Foreign Matter 112 " Cheese Decomposition 4 " C/Fwd. 11,746½ " 35 Article of Food, Reason for Action, Weight. B/Fwd. 11,746½ lbs. Chocolate Mould 36 lbs. Confectionery Mould & Decomposition 31 " Cakes & Confectionery Contaminated by foreign matter due to enemy action 33 " Bread do. 226 " Cooked Meats do. 38 " Chocolate do 14½ " Groceries (Unidentifiable) do. 24 " Jam do. 23 " 501 Pkts.Cake Mixture do. 70 " Biscuits do. 11 " Miscellaneous Mould & Decomposition 8 " Total 12,261 " (iii) Shops, Vehicles, etc. For obvious reasons it was not possible to visit retail food shops in a systematic manner during the year, but they received attention as and when opportunity presented itself and, of course, in every case when a complaint was received. Apart from the actual inspection of foods there is the matter of hygiene of food shops','and personal hygiene on the part of staff employed in and about these premises. TheFood & Drugs Act covers all these subjects up to a point, but there are definite limitations in the scope of the Statute, Immediately sufficient staff is available for the purpose, systematic visits to all foodshops will be resumed,, During the course of the year it was found necessary on more than one occasion to draw attention to the unsatisfactory condition of food delivery vans0 As might be expected, the explanation offered was the usual one of inability the raise the standard owing to prevailing war conditions, but this was not altogether acceptable , The need for improvement was pressed and arrangements were made for more frequent cleansing of the interiors of the vehicles and for the provision of suitable trays and other equipment. The improvements which were effected filled the immediate requirements but generally, the subject of food'transport is one which needs constant supervision and indeed, it should be reviewed on a national basis, with the full co-operation of manufacturers, wholesalers, transport companies, retail traders, and technical experts, (c) adulteration - Food and Drugs Act, 1958, A total of 91 samples were submitted to the Public Analyst during the year. Of these 91, only 2 were the subject of adverse reports. The details are given in the tabulated statedment of action taken. In the case of Malted Soya Cream there were certain discrepancies between the contents described on the label and the actual ingredients in the package. There was also considerable doubt whether the claims set out on the label could be justified. Upon further investigation it was found that the package was part of a consignment which had been received at the shop from which it was purchased, at a date prior to the date when the Labelling of Food Order came into force. The firm in question submitted specimens of the new labels and copy of correspondence which had passed 36 between them and the Ministry of Food on the same subject. In these circumstances no formal sample was taken and a warning letter was sent. The pork sausage meat was an informal sample, that is, a sample not taken in the manner prescribed by the Act and, therefore, no legal proceedings could be instituted against the vendor in respect of that sale. A formal sample was taken at a subsequent date and proved to be genuine. The second sample was taken early in 1946 and is not shown in the tabulated statement. The sample of table jellies was purchased when the manufacture of these delectable sweets was prohibited by the Ministry of Food, mainly on account of the sugar content of normal table jellies. In the absence of any ruling on the matter by the Ministry of Food, the Analyst had to report that the samples" were genuine, even although they contained no sugar and only barely sufficient gelatine to enable the finished product to 'set'. The sale of the jellies provided a very lucrative occupation for the vendors. The Corporation was unable to institute legal proceedings, but the facts were passed to the Ministry of Food in the hope that the Ministry would themselves take action, but the matter was taken no further. It is interesting to note that not long afterwards prosecutions were taken in respect of similar transactions in other parts of the London area and convictions were obtained. The vendors of the jellies were not again permitted to occupy a stall in the Market Place. The various herbs were sample at a food preparing factory where they were being used in the manufacturing processes. The fact that no sample of m ilk failed to reach the prescribed standard is an indication that this valuable article of food is less often tampered with than was the case in the nnt too distant past. There are several possible explanations for this improvement, but in all probability, the principal reason is the frequency of sampling, and the fact that the samples are obtained at irregular intervals and without any possibility of any vendor being forewarned of intention to sample. The increase in the number of samples was due to a series of samples taken" from individual farm supplies at the place of delivery to local dairies. The question has been asked as to the basis upon which sampling is carried out. In the case of milk, the samples are taken over as wide a field as possible. Apart from those which are taken during the course of normal retail deliveries, visits are also made to restaurants and other catering establishments, so that samples may be taken from bulk supplies at the time of delivery. It should also be mentioned that the milk supplied to every day nursery and school in the Borough was sampled during the year. With regard to other articles of food, the selection depends entirely on circumstances, but every opportunity is taken to obtain a wide variety of samples and more particular attention is paid to foodstuffs about which rather glowing claims are made by the manufacturers. jsv-.o(3 and Drugs Act , 1938, Action taken during 1945. Articles Analysed. Adulte rated or Deteriorated. Total. Prosecutions. n Taken. Formal. Informal. Total. Formal Informal, Frutolla Sauce - 1 1 - - - - - Live Yeast Tablets - 1 1 — - - - - Garlic Tablets. — 1 1 - - - - - Soya Nut Meat — 1 1 - - - - - Almond Flavour - 1 1 - - - - - Malted Soya Cream - 1 1 - 1 1 - Label misleading. (Milk Chocolate Flavour) Malted Kelp Tablets 1 1 - - - - Warning given. Milk - 65 65 — — — - - Viking Junket 1 1 - - - - - Vi-Tic Drinking Chocolate - 1 1 - - - - - Non-Brewed Vinegar — 1 1 - - - - - Vegetable Savoury - 1 1 - - - - - Maltabs - 1 1 - - - - - Baking Powder - 1 1 - - - - - Pork Sausage Meat - 1 1 - - - - - Table Jellies 1 1 1 - - - - - Pork Sausages - 1 1 - 1 1 - Meat content below standard - warning given. Ginger - 1 1 - - - - - Rough Sage — 1 1 - - - - - Popper - 1 1 - - - - - Coriander — 1 1 - - - - - Ground Sage — 1 1 - - - - - Nutmegs — 1 1 - - - - - Pepper Compound — 1 1 - - - - - Mixed G-oason ing — 3 3 — — - - - 1 90 91 - 2 2 - - 37 38 MINISTRY OF FOOD ORDERS - 1945. During the year here were several changes in legislation of which the following examples are of most interest, as they had relation to the work of the department. The Food Standards ( Salad Cream and Mayonaise) Order 1945. with consequential amendment of Labelling of Food (No.2) order. In general terms these Orders prescribe a standard of composition for salad cream etc. but make provision that in certain cases the standard shall not apply; also that salad dressings not complying with the standard must bear on the label a statement of ingredients. The Labelling of Food (No.2) Order. This Order replaced the previous Labelling of Food Order and effected a postponement of the date of operation. It is a very important addition to food legislation and has for its aim the desire to ensure that what is on a label shall be a correct description of the contents of the container. The Order also deals with advertisements. The Dried Egg (Control of Use) Order, is designed to control conditions under which dried egg is used commercially in the manufacture of ice cream, synthetic cream and bakers'cream filling etc. The Food Standards (Liquid Coffee Essences) Order. As the title implies, the Order provides standards of composition of liquid coffee essences or extract and of liquid coffee etc. In addition to the above there were other Orders to which it is not necessary to refer in detail. When conditions have returned more to the normal there is little doubt that attention to the food supply will need to be given, particularly with regard to standards of composition. The Ministry of Food has already made a good start but much leeway has to be made good before the work may be considered as complete. CONCLUSION. It is hoped that the above report, brief and perhaps somewhat disjointed, will prove of interest to the reader, also that it will tend to throw light upon work which goes on day by day practically unnoticed by the general public, but which, if it were left undone, would soon cause a state of chaos in a town such as Kingston. HA.R0ID T. PERRY. Chief Sanitary Inspector. Guildhall, Kingston-upon-Thames. 39 SECTION F PREVALENCE OF. AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES. The following infectious diseases are notifiable to the Medical Officer of Health of the Borough: Scarlet Fever. Whooping 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. Paorperal pyrexia. Smallpox. Paratyphoid fevers. Enteric or typhoid fever excluding paratyphoid. Erysipelas. Malaria. Cholera. Plague. Typhus. Relapsing fever. Tuberculosis. In 1945 a total of 623 notifications of infectious disease was received. The following table shows how the cases were dealt with. NOTIFIABLE DISEASES DURING 1945. DISEASE CASES DEATHS Age Groups Total cases notified Cases acalitted. to Hospital Acs Greups Total under 1 year 1-2 2-3 3-4 4-5 5 - 10 10 - 15 15 - 0 0 20 -'35 35 - 45 45-65 65 6c over Under 1 year 1 - 2 1 2 - 3 | 3 - 4 4-5 5-10 10-15 15 - 20 J 2r' - 35 35 - 45 45 - 65 65 & over Scarlet Fever - - 3 3 - 13 4 1 4 - - - 28 25 - - - - - - - - - - - - - Diphtheria 1 — 1 1 2 7 1 - 3 - - - 16 16 - - - - - - - - - - - - - Acute Poliomyelitis — — — — 1 — - - - - - - 1 1 - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 1 20 2 - - 23 21 - - - - - - - - - - - - - Ophthalmia neonatorum 2 - - - - - - - - - - - 2 - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - 1 — — - - - - - - 1 1 - - - - - - - - - - - - - Pneumonia l 3 1 4 — 3 1 — 1 1 1 3 19 - - 4 - - - 1 - - 1 1 6 8 21 Erysipelas - - - - - - - - 1 1 3 - 5 - - - - - - - - - - - - - - B.Dysenteria (Sonne) 8 6 1 2 2 8 2 - 2 3 3 - 37 16 - - - - - - - - - - - - - Measles 18 55 55 49 46 163 11 3 5 2 - - 407 20 1 1 - - - - - - - - - - 2 Whooping Cough 4 13 19 10 11 20 7 - - - - — 84 4 - - - - - - - - - - - - - 40 41 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. Soarlet Fever. Diphtheria. Enteric Fever. (including Paratyphoid). 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 - 1945 28 16 — Scarlet Fever. There was a considerable drop in the number of civilian cases of Scarlet Fever notified in 1945 and no deaths occurred. Most of the cases were school children. It was found necessary to send 25 of the 28 notified cases to Hospital. All made a good recovery. No "Return" cases occurred. Diphtheria . Sixteen cases of Diphtheria were notified in 1945, nine from the Kingston County Hospital and seven from within the Borough. All the seven from the Borough were children who attended St. Peter's School. Of these only one was completely immunised, four had only received one injection, and two had not been immunised. All were admitted to Hospital and all recovered. 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 1945. The figures in brackets are for 1944. * 42 DIPHTHERIA IMMUNISATION FIGURES. 0-5 group. Birth date No. completely immunised at Clinic 1944 114 1943 478 (204) 1942 369 (292) 1941 317 (281) 1940 381 (347) 1331 [1939] ) Total 1,659 (1,455) Percentage - 66 (58.2) 5-15 group. Birth date No. complately immunised at Clinic 1939 371 1938 350 (319) 1937 328 (309) 1936 313 295) 1935 336 (327 ) 1934 293 (281) 1933 251 (242) 1932 264 (255 ) 1931 264 (257 ) 1930 259 (258) (230 [1929] ) Total 3,029 (2,773) Percentage - 72.6 (64.8) Total immunised in Kingston. 0 - 5 group. 5-15 group. immunised by general practitioners 32 (16) Immunised by general practitioners 38 (34) Immunised elsewhere 84 (12) Immunised elsewhere 222 (172) Immunised at Clinic 1,659 (1,455) Boys of Dr. Barnardo' s Home 156 (150) Immunised at Clinic S.C.C. Home 3,029 (2,773) (25) Grand total - 1,775 (1,403) Grand total 3,440 (3,154) Percentage - 70.7 (59.32) Percentage - 82.6 (73.7) 43 Enteric Fever (Typhoid or Paratyphoid). No notifications of enteric fever were received during the year. Measles. There was a great increase in the number of cases notified during the year, 407 in all, of whom 20 were admitted to hospital. Most of the cases were in the 1-5 age group, 205 being notified, and a further 163 in the age group 5-10 years. Two deaths occurred - One under 1 year and one between 1 and 2 years. Apart from the two deaths and four cases of pneumonia in the age group 1-2 years, the condition was comparatively mild but quickly spread through the susceptible population of pre-school and school children. Tuberculosis. Cases of tuberculosis are dealt with from the treatment point of view by the Surrey County Council. Good liaison 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 shows comparative figures of notified cases and deaths for the yearsl941 - 1945 (inclusive). Year Cases Notified. Deaths. Respiratory Non-respiratory Respiratory Non-respiratory 1941 44 9 19 3 1942 67 11 22 2 1943 63 8 25 1 1944 56 11 19 4 1945 41 12 19 7 (Note - An analysis of the total notified cases in age groups is shewn on the following page). The ratio of non-notified to total deaths is as follows:- 1941 1942 1943 1944 1945 1 : 3 1 : 8 1 : 8 1 : 12 1 : 5 During 1945 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 District 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. 4 4 TUBERCULOSIS, 1945. 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. 1 - - 8 4 3 2 6 1 25 - 1 - 1 1 1 1 3 2 10 F. - - - 6 6 - 1 1 2 16 - - - 1 1 4 1 1 1 9 Total - 1 - - 14 10 3 3 7 3 41 - 1 - 2 2 5 2 4 3 19 (b) Nonrespiratory M. - 1 1 - - 3 - - - 5 2 - - - 1 - - - - 3 F. - 1 2 2 1 1 - - - 7 - - - 1 1 - 1 1 - 4 Total - - 2 3 2 1 4 - - - 12 2 - - 1 2 - 1 1 - 7 45 SONNE DYSENTERY. During the year 37 cases of sonne dysentery were notified compared with 26 for 1944. Of these 8 were under 1 year of ago, 6 aged 1 - 2 years, 1 aged 2 - 3 years, 2 aged 3 - 4 years, 2 aged 4 - 5 years, 10 were school children, and the remaining 8 were adults. No deaths occurred, and l6 of the 37 cases notified were removed to the infectious disease hospital for treatment. SMALL POX. There were no cases of Small Pox notified in 1945, but seven contacts were notified and observed. None developed the disease. 46 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 supervision of Health Visitors and, with the disbandment of the Civil Defence Force in June, 1945, authority was given for the engagement of one male and female assistant, both of whom work part-time. The following tables show the numbers of persons treated during the year 1945, and the three 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 1945 First Aid Post "A" Station was closed 31.12.44. 592 592 Analysis into age groups of cases and contacts treated. 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 1945 First Aid Post "B". 35 113 137 17 80 210 47 Analysis of cases treated during 1944 and 1945. Year No. of cases treated at Total Cases treated. First Aid Post "A" First Aid Post "B" 1944 391 270 661 1945 — 341 341 Analysis into age groups of cases treated. 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 1944 First Aid Post "A" 23 28 105 19 17 199 1944 First Aid Post "B" 31 83 — 29 70 57 1945 First Aid Post "B" 25 72 60 9 53 122 Analysis of contacts treated during 1944.and 1945. Year No. of Contacts treated at Total Contacts treated First Aid Post "A" First Aid Post "B" 1944 184 98 282 1945 — 251 251 Analysis into age Groups of contacts treated. 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. 1944 First Aid Post "A" 10 6 67 6 14 81 1944 First Aid Post "B" 4 19 5 14 56 1945 First Aid Post "B" 10 41 77 8 27 88 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 Allowed up. It was not necessary to invoke the special powers given under the scabies Order for the examination of persons or premises. 48 INFESTATION BY HEAD LICE. During 1945 there was no evidence of special incidence of infestation by head lice. A considerable amount of work was carried out to cleanse school children and family contacts of these were dealt with concurrently. D.D.T. preparations were used in addition to the usual cleansing by water and soft soap or shampoo. The measures described in "the report for 1943 are still in force and fulfil the terms of Circular 2831, Ministry of Health. It was not found necessary to take any statutory action for infestation by lice during the year.