AC44130 KINGS CON ZIN 20 Royal Borough of Kingston Upon-Thames ANNUAL REPORT 1946 OF THE Medical Officer of Health AND Chief Sanitary Inspector GUILDHALL, K1NGSTON-UPON-THAMES DECEMBER, 1947 Royal Borough of Kingston Upon-Thames. ANNUAL REPORT 1946 OF THE Medical Officer of Health AND Chief Sanitary Inspector GUILDHALL, KINGSTON-UPON-THAMES DECEMBER, 1947 A NNUAL REPORT 19 4 6 TABLE OF CONTENTS Preface. Staff of the Public Health Department. SECTION A Statistics and Social Conditions. Parte. (i) General Statistics (ii ^ Social Conditions 1 (iii; Extracts from Vital Statistics 1, 2, 3, 4 (iv) Causes of Death SECTION B General Provisions of Health Services. 1, (i) .Public Health Officers (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 Y/elfare (i) (a^ Midwifery Service 10 (b) (i) Maternal Mortality11 (ii) Infant Mortality 12 (iii) Puerperal Pyrexia 13 (ii) (a) Ante-Natal Services13 (b) Post-Natal Services14 (c) Infant Welfare Services 15, 16 (iii) (a) Institutional Treatment for Mothers and Children 17 (b) Day Nurseries 17 ic) Care of Premature Infants 18 (d) Care of Illegitimate Children 19 (iv) Health Visitors 19 (v) Child Life Protection 20 (vi) Treatment (a) Dental Treatment 20 (b) Ophthalmic 21 (c) Artificial Sunlight22 (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 SECTION C Sanitary Circumstances. Pane. 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 • Complaints 29 5. Rodent Control 29 6. Rag Flock 30 7. Other duties 31 SECTION D Housing General appreciation of the position 31 SECTION E Inspection and Supervision of Pood. Milk Supply Designaoed MiIks 3 Bacteriological Examination of Milks 33 Biological Examination of Milk for the presence of Tuberculosis 34 Pasteurised Milk 34 Bacteriological Examination of Ice-Cream 34 Meat and other Foods 35 Shops, Vehicles, etc 35 Tabulated list of Condemned Foodstuffs 3& Food and Drugs Act, 1938 - Adulteration 37 Ministry of Food Orders, 1946 38 SECTION F Infectious Diseases. Notifiable Diseases 40, 41, 42 Diphtheria Immunisation 43 Tuberculosis 44, 45 Sonne Dysentery and Smallpox 46 Scabies 47, 48 Infestation by Head Lice 49 ... . ■ ■ • . PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OP KIKGSTON-UPON-THAMES. ANNUAL REPORT, 1946. Mr. Mayor, Ladies and Gentlemen, The Annual Report for 1946 is in the same form as that for 1945 and as directed by the Minister of Health is confined to essential matters relating to the Public Health and Social Medicine. Vital Statistics. The Registrar General's estimate of the population for 1946 is 39,670, an increase of 3,910 on the figure for 1945. The number of live births for 1946 is 794, giving a birth rate of 20.02 per 1,000 of the population. This is higher than the rate of 16.58 for 1945 and the highest rate since 1921, when a birth rate of 20.12 was recorded. The number of deaths for 1946 is 460 giving a crude death rate of 11.60, compared with 505 deaths and a rate of 14.12 for 1945, The excess of births over deaths in 1946 is 334 compared with 88 in 1945. The number of deaths of infants under 1 year of age in 1946 is 23, giving a rate per 1,000 total (live and still) births of 28.97 as compared with a rate of 43.84 in 1945. This rate, the Infant Mortality rate, is falling. Prom 1925 onwards in successive quinquennial periods it has declined from 69 in the period ending 1925 to 52 for the period ending 1945. The actual rate for 1925 was 73, for 1945, 41 and for 1946 it is 29. Inference - While it may be said that the trend$ of these rates is good and if continued would lead to an increased and more vital population, it should be remembered that the sample of population is very small and the rising trend in the birth rate may not be continued for very long. The Number of Births. The expected increase in the number of births taking place in 1946 was realised, 823 births being recorded as against 615 for 1945. The expected fall in the illegitimate births .in 1946 was also realised, 61 were recorded as against 64 for 1945. The Causes of Death. The main conditions causing death as recorded in the table for 1946 are Heart Disease 129, Cancer 80, and Intra Cranial Vascular Lesions 55. Nursery Occupied Places. In the four Day Nurseries operating at the end of 1946, £2,743 attendances were recorded as compared with 42,495 in the same Nurseries during 1945. A continuing demand for Nursery places is being experienced. . Infectious Diseases. There was a definite decrease in the number of notifications of infectious disease during the year 1946. Social Conditions . (i) Housing. The remarks made in last year's Report in reference to housing and overcrowding apply with equal force to 1946, The need for satisfactory homes for a very large number of families, crowded into dwellings not designed for plural occupation, is desperate. In spite of all the efforts of the Housing Authority the need for homes is still at the end of 1946 a major factor affecting the health of the people. (ii) Care of the Aged. Again reference must be made to this acute problem. The provision of suitable housing and care for aged persons, many of whom,left on their own resources,find themselves unable to maintain a reasonable standard of living, is a most pressing problem,to which an answer is being sought. I wish to thank my senior colleagues and the members of my staff for their co-operation and assistance toughout the year. I acknowledge gratefully the continued support of the Mayor, Aldermen and Councillors in the work of-my department. I have the Honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J .V/. STARKEY Medical Officer of Health. December, 1947. 1 9 46 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Office-' of Health,Maternity and Child Welfare. Officer and School Helical Officer. J. 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.N., Forces). VALERIE WILLS, M.D. (Prague) (Temporary Appointment) 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) Senior Sanitary Inspector: H. T. PERRY, F.S.I.A., (a) (b) Additional Sanitary Inspectors: P.B. HARVEY, A.B.San.I.. (a) (b) (resigned 31.3.46) G.C. SMITH, A.R. San.I.(a) (b) A, CLEGG, M.R.San., I, (a) {b) J.B. FACER, A.R. San., I. (a) (b) (appointed 13.5.46) Junior Sanitary Inspector: E.G. HERBERT (a) (returned from service with H.M. Forces 18. 2. 46,) Senior Health Visitor: MISS C. A. HOOKWAY, S.R.N., S.C.M., H.V. Cert. Health Visitors: 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 B. DYSON, S.R.N., S.C.M., H.V. Cert. Day Nursery Matrons: MRS. M. SHEPHERD. S.R.C.N. MISS. M.E.HARVEY., N.N. (collage trained) MISS. D. DENNIS, S.R.F.N.. Administrative Officer: F.D. HARVEY. A.R.San.I. (a) (b) (appointed 1 ,4,46,) Clerical Staff as at 31st December, 1946: MRS. D.A. PATRICK MISS C.L. FOISTER. MISS. V. NEELD., MISS B.M, JERVIS MRS. I. ROOBOTTOM. MR. P.M. DALE mrs. v. ETHERIDGE. MISS A.M. LAMINO. MISS J.M,. MITCHELL. MISS M. HARRALL MI1S S. COX (Part-tine) MRS. '".ALKSR (Part-tine) ( Certificate as Sanitary Inspector Cc. tificato -s Meat and Foods Inspector SECTION A. STATISTICS AND SOCIAL CONDITIONS. (1) General Statistics. Area in Acres 1,390 Population (Registrar General) 39,670 Number of inhabited houses (approx.) 10,964 Rateable Value - General Rate £538,394 Sum represented by Penny Rate £2,163 Amount of Outdoor Relief £5,543 (ii) Social Conditions. The Manager of the local Employment Exchange states that the change-over from war-time to peace-time production proceeded without creating unduly high unemployment. In the Boroughs of Kingston, Maiden and Coombe, and Surbiton, and the Esher Urban District, which is the area with which the local Employment Exchange deals, there were approximately 6,000 more men and 5,000 less women employed compared with 1945. During the year there was little or no unemployment affecting women and, with the abolition of controls, women have become much more selective with regard to their choice of employment. The principal industries of the area are general engineering, motor engineering, building, manufacture of radio components and construction and repair of aircraft. 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 738 367 371 Illegitimate 52 34 22 Totals 794 401 393 Birth Rate (Registrar General) per 1,000 population 20.02 Still Births Total Mai e Female Legitimate 24 13 11 Illegitimate 2 Totals 29 15 14 Rate per 1,000 total (live and still) births .... 35.24 Deaths - Total Male Female 460 236 224 Death Rate (Registrar General) per 1,000 population 11.60 (iii) Extracts from Vital Statistics for Years l942 to 1946 inclusive. LIVE BIRTHS. Legitimate Illegitimate TOTALS 1942 1943 1944 1945 1946 Total m. F. Total M. F. Total m. F. Total M. F. Totail m. F. 512 39 276 20 236 19 583 49 291 31 297 18 525 53 265 27 260 26 529 64 272 34 257 30 738 56 367 34 371 22 551 296 255 637 322 315 578 292 286j 593 306 287 794 401 393 Birth rate (R.G.) per 1,000 population 15.26 17.77 16.62 16.58 20.02 STILL BIRTHS Legitimate 111 egit imate TOTALS 12 1 5 7 1 20 3 14 2 6 1 17 1 8 9 1 21 1 12 9 1 24 5 13 2 11 3 13 5 8 23 16 7 18 8 10 22 12 10 29 15 14 Rate per 1,000 total (live and still)births 23.05 34.84 30.20 35.77 35.24 DEATHS 491 260 231 500 226 274 474 239 235 505 262 243 460 236 224 Death rate (R.G.) per 1,000 population 13.6 13.92 13.63 14.12 11.60 3 (a) Deaths from Maternal Causes - Deaths. Rate ner 1.000 total (live & still) births. Puerperal Sepsis - 0.00 Other Maternal Causes 2 2.43 (b) Death Bate of Infants under one year of age. All infants per 1,000 live births 23 Legitimate infants per 1,000 legitimate live births 22 Illegitimate infants per 1,000 illegitimate live births. 1 28.97 29.81 17.86 . (c ) Other Deaths - Ho. of Deaths. Deaths from Cancer (all ages) 80 Deaths from Measles (all ages} Nil. Deaths from Whooping Cough (all ages) Nil, Deaths from Diarrhoea (under 2 years of age) 2 Birtheratas, Civilian Death-rates, and Case rates for certain Infectious Diseases in the year 1946. Provisional figures based on Weekly and Quarterly Returns. England and Wales 126 C„Bs. and Great Terns including London., 148 Small'eu?, towns Resident; Pop.25*000 -50 .000 at Census London Adra, County Kingston upon Thames Rates per 1,000 Civilian population. Live Births Still Births 19.1 0,53 22.2 0.67 21.3 0. 59 21.5 Or 54 20.02 0.73 Deaths All Causes .11.5 12.7 11.7 1-2 11.60 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 0.02 0.02 0.00 Diphtheria 0,01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.08 Smalljiox 0.00 0.00 0.00 0.00 0.00 Measles 0.00 0.01 0.00 0,01 0.00 Rates per 1,000Live Births: Deaths under 1 year of Age Deaths from Diarrhoea and Enteritis under 2 years of age 43 46 37 41 28 4.4 6.1 2.8 4.2 2.52 Per 1,000 related births Rates per 1.000 Total population 4  England and Wales. 126 C.Bs. and Great Towns including London. 148 Smaller Towns Resident Pop. 25,poo - 0,000 at 1931 census London Adm. County Kingston upon Thames Notifications:Typhoid Fever Rates per 0.01 1,000 0.01 Civilian Population:0.01 0.01 0.00 Paratyphoid, Fever 0,02 0.02 0.01 0.01 0.03 Cerebro Spinal Fever 0.05 0.05 0,04 0.06 0.03 Scarlet Fever 1.38 1.51 1.33 1.42 0.86 Whooping Cough 2,28 2.48 2.05 2.22 . 1.69 Diphtheria 0.28 0.32 0.31 0.24 0.20 Erysipelas 0,22 0,25 0.22 0.27 0.13 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 7.13 Pneumonia 0.89 1.02 0.74 0.75 0.55 Rates per 1,000 Total Births (live and Still):(a) Notifications:- Puerperal Fever Puerperal Pyrexia 8.50 10.35 7.63 (1.62 (9.68) 1.03 Including Puerperal Fever. 15 (iv) Causes cf Death. Registrar General's Tables. All Causes 1942 1943 1944 1945 46 M. F. M. F. M. F. M. F. M. F. 260 231 226 274 239 235 262 243 236 224 1 Paratyphoid and Typhoid Fevers - - - - - - - - - - 2 Cerebrc-Spinal fevers- - -- - - - - - - 1 1 3 Scarlet Fever - - - - - - - - - — 4 Shooping Cough - - - — — 1 — — — — 5 Diphtheria - 6 Tuberculosis of Respiratory System 13 9 12 13 12 7 10 9 6 4 7 Other forms cf Tuberculosi 1 1 - 1 1 3 3 4 3 — 8 Syphiliti-c Diseases 3 - 2 2 - 1 3 — 3 1 9 Influenza - 4 8 7 2 2 2 — 3 — 10 Measles - - - - — — — 2 — — 11 Acute Poliomyelitis & Polioencephalitis - - - - - - - - - — 12 Acute Infantile Encephalitis - - - - - - - - - - 13 Cancer of B.Cav. & oesephagus (M) uterus (F) 4 4 2 3 5 2 7 1 3 5 14 Cancer of Stomach or Duodenum 6 4 10 5 11 6 7 5 4 7 15 Cancer of Br-east — 5 - 10 - 10 - 6 — 8 16 Cancer of all other sites 35 31 25 28 23 19 30 23 34 19 17 Diabetes 2 - - - 1 - 4 5 3 1 18 Intra-cran, vascular lesions 18 31 15 32 18 35 14 36 24 31 19 Heart Disease 70 70 52 67 64 60 69 65 65 64 20 Other diseases of circulatory system r _ 6 17 15 11 16 22 9 18 21 Bronchitis 8 7 14 20 12 6 20 7 14 8 22 Pneumonia 10 4 19 10 15 10 14 7 16 9 23 Other Respiratory diseases 2 4 1 5 4 3 — 2 1 24 Ulcer of Stomach or Duodenum 3 1 3 1 1 1 9 1 8 2 25 Diarrhoea under 2 years 5 5 6 1 3 2 1 — — 2 26 Appendicitis 3 - - - - - — — 1 1 27 Other digestive diseases 5 6 8 2 5 5 3 8 8 5 28 Nephriti 7 6 4 2 4 6 5 4 1 6 29 Puerperal Causes Re sorded under — 1 — — — — 30 Other maternal causes, Other headings - 2 - - — 2 31 Premature birth 6 1 1 7 5 5 3 - 1 5 32 Congenital Malformation Birth injuries _ 4 4 7 5 8 2 33 Suicide 3 — 2 1 2 1 4 3 4 2 34- Boad Traffic Accidents 3 1 4 1 4 1 2 1 35 Other violent causes 7 12 2 7 12 16 5 10 1 6 36 All other causes — — — — 16 19 23 19 12 13 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 1946 bacteriological examinations were carried out by Dr. D.S. Murray at the Laboratory, 37, Coombe Road, as part of a pathological service administered by the Surrey County Council. In addition, the Ministry of Health Laboratory at Epsom is available for consultations and, if an occasion should arise, for the investigation of any important outbreaks of disease. Bacteriological examinations of milk are also undertaken by the Clinical Research Association and samples under the Pood 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 194 Private Cases 205 Maternity Cases 50 Calls for Ambulance not required 35 Calls dealt with for hospitals. County Hospital 74 558 The St. John Ambulance dealt with a considerable number of accident, private and sickness cases throughout the year. This service proved invaluable as a supplement to the Corporation Accident Ambulance Service. 7 (c) Nursing in the Home, (1) 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). 1942 1943 1944 1945 1946 Cases Cases on books on 1st. January 54 67 67 75 72 New cases 569 626 609 660 693 Results of Cases: Convalescent 431 466 435 506 488 Transferred to Hospital 59 81 59 56 64 Died 63 77 92 93 101 Removed for other causes 3 2 15 6 11 Still on books 67 67 75 72 101 Visits: General Nursing 15,891 16,974 16,979 !19£51 19,950 Casual 204 150 124 223 187 (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 fees may be paid by the Corporation, but during the period under review no claims for payment were received. 8 (d) Clinics and Treatment Centres as at 31st. December, 1946 Clinic or Dispensary Where held When held Diphtheria Immunisation Health Centre, Grange Road, Kingston Tuesdays & Fridays at 4 p.m. Maternity & Child Welfare Centre Health Centre, Grange Road, Kingston Tuesdays & Fridays at 2 p.m. Maternity & Child Welfare Centre Latchmere Road School Mondays & Thursdays at 3 p.Bi. Ante-Natal Clinic Health Centre, Grange Road, Kingston Wednesdays 1.45 p.m. Post-Natal Clinic -do- -do- Wednesdays 1.45 p.m. School Clinic Minor Ailments -do- -do- Daily at 9ol5 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- Every Thursday at 10 a.m. by appointment . Speech Training -do- -do- Mondays & Wednesdays at 2 p.m. Ultra Violet Ray Clinic -do- -do- Tuesdays & Fridays at 9 am. an d 3.30 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. 1 "Surrey Villa", 1 Knights Park,Kingston For admission apply to Medical Officer of Health . Day Nursery No. 3 "Kilnwood", 213 Richmond Road, Kingston -do- Cay Nursery No. 5 53/55 Can bury Park Road Kingst on. -do- Cay Nursery No. 6 Messrs. Bentalls, Clarence St. Kingston Apply Staff Controller, Messrs .Bentalls Kingston Nursing Association (Vol.Committee) 33 Birkenhead Avenue Kingston Apply to Matron for District Nurses 9 (e) Hospitals. (1) Infectious Disease. An arrangement exists with the Wimbledon Corporation whereby cases nay be admitted to the Wimbledon Isolation Hospital, and payment is made by the Kingston Corporation for the maintenance of patients. Owing to staffing difficulties and the need for conservation of accommodation, it has been necessary to send patients to other hospitals. During the year 77 cases were admitted as follows:- To Wimbledon Isolation Hospital 68 To Tolworth Isolation Hospital 8 To Barnes Isolation Hospital 1 (2) Smallpox. The Surrey Smallpox Hospital, East Clandon (Surrey County Council). (3) Other. Genral Hospitals situated in the Borough available for the District are:- The Kingston County Hospital (Surrey County Council). The Kingston Victoria Hospital, supported by voluntary contribut ions. The Corporation made a contribution of £50 to the Kingston Victoria Hospital during 1946. 10 3. MATERNITY AND CHILD WELFARE, (i) MIDWIFERY SERVICE. (a) Midwifery Service (Surrey County 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 en d of 1946 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 1942 1943 1944 1945 1946 No. notified by Midwives 147 158 153 132 250 No. notified by General Practitioners and Medical Superintendent, Kingston County Hospital. 424 506 408 498 569 Total 571 664 561 630 819 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 1942 1943 1944 1945 1946 M. F. M. F. M. F. M. F. M. F. Live Births: Legit imate 276 236 291 297 265 260 272 257 367 371 Illegitimate 20 19 31 18 27 26 34 30 34 22 Still Births: Legitimate 5 7 14 6 8 9 12 9 13 11 Illegitimate — 1 2 1 - 1 - 1 2 3 Totals: Male & Female 301 263 338 322 300 296 318 297 416 407 Grand Totals 564 660 596 615 823 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. It was not found necessary to call upon the services of the consultant in this respect during the year. (b) (i) Maternal Mortality. The Medical Officer of Health investigates all maternal deaths, and obtains full reports from the practitioner attending. There were two maternal deaths during 1946. The figures for the years 1942-1945 are given for comparison: Cause 1942 1943 1944 1945 1946 Cardiac Failure Toxaemia of pregnancy - - 3 - 2 Septic abortion 1 - - - - Septic abortion self-induced 1 1 - - - 12 (b) (ii) Infantile Mortality. The following are the numbers of Kingston children who died during 1946 in the Borough before reaching the age of one year, together with the cause of death and age:- Age. Total Cause of Death 0-24 hours 5 3 Prematurity 1 Anencephalous 1 Spina Bifida 24 hours - 1 month 9 3 Prematurity 2 Pneumonia 1 Congenital Heart Disease 1 Acute Bronchitis 1 Asphyxia 1 Erythroblastosis Foetalis 1 month - 1 year 9 3 Pneumonia 2 Men ingococcal Meningitis 2 Gastro Enteritis 1 Acute Bronchitis 1 Patent Ductus. Arteriosus with interventricular septum. Mongolism. The approximate infantile mortality rate for 1946 is as follows, and in addition the rates for 1942 to 1945 (inclusive) are shown for comparative purposes:- 1942 1943 1944 1945 1946 Kingston -upon -Thames 63 48 48 43 29 England and Wales 49 49 46 46 43 London Area 60 58 61 53 41 The infantile mortality rate of 29 is lower than the rate of 43 for 1944. It is, with one exception (26.26 in 1939) lower than any ether infantile mortality rate recorded for Kingston in the last fifteen years. It is lower than the figure of 43 for England and Wales, and lower than the figure of 41 for the London Administrative County Area. Ophthalmia Neonatorum. One case was notified during 1946. 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. Forty-one cases were notified during 1946. An analysis is shown below, together with figures for the years 1942 1945 for purposes of comparison. Cases 1942 1943 1944 1945 1946 (a) Total notified 23 18 15 23 41 (b) Number of (i) Kingston Residents 5 4 2 9 9 (ii) Extra district residents 18 14 13 14 32 (c) Number included in (a) Notified from Kingston County Hospital 20 17 14 21 39 (a) Number included in (a) Notified by private doctors 3 1 1 2 2 (e) Number of cases included in (d) removed to hospital 1 - - 1 2 3. II MATERNITY SERVICES. (a) Ante-Natal Services. The Ante-Natal Services in the Borough can he divided into two parts:- (a) The Borough Ante-Natal Services - for patients where confinement is undertaken by a midwife at home of the mother, or for a Kingston mother who is to bo admitted to hospital or Nursing Home outside the Borough, These patients are seen at the Borough Ante-Natal Clinic, Grange Load. (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. The majority of ante-natal cases whose confinement is undertaken by a midwife, attend the Borough .Ante-Natal Clinic. Others receive ante-natal care from their family doctors, under private arrangements. The following table gives the number of patients attending the Borough Ante-Natal Clinics during 1946, and preceding years, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation:- 1942 1943 1944 1945 1946 No. of patients 134 144 142 126 232 No. of attendances 548 744 701 671 1328 ^.N. Patients referred to Kingston County Hospital 39 35 29 23 24 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 con 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 Arte-Nutal Clinic, either free or at cost price, defending 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 Full cost remitted Half cost remitted 2 12 s. 6d. 14s. 6d. 3 11s. 0d. 13s. 0d. 4 9s. 0d. 11s. 0d. 5 & over 8s. 6d. 10s. Sd• cling 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 oil 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 Icr-varded 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 cf visits that were made during 1946 and preceding years. 1942 1943 1944 1945 1946 No. of home visits (individual cases) 266 271 159 199 292 Total No. of visits 367 395 260 307 449 Home helps are also referred to in a later paragraph. (b)POST-NATAL SERVICES . The Post Natal Services are incorporated with the 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 small during the period under review. In 1946 fifty three mothers attended for post-natal examination. 14 15 (c) INFANT WELFARE SERVICES. (i) Domiciliary Visits. The initial visit by a Health Visiter 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. lore frequent visits are made where there are difficulties with 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 those cases. The following is the total number of visits made during 1946, and preceding years:- 1942 1943 1944 1945 1946 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 First vis its 529 - 642 - 524 - 567 - 770 - Total visits 2922 5410 2758 5358 3308 7007 2662 6194 3639 7434 (ii) Infant Welfare Clinics. ) Two Clinics were held weekly at both the Health Centre and Latchmere School. The Medical Officer of Health or his Assistant attend all these Clinics, examine the children regularly and advise regarding infant feeding, etc. The following table shows the number of sessions held, the number of new cases seen, subsequent visits made, and the numbers seen by the Medical Officer:- 16  Health Centre, Grange Road Tuesdays & Fridays Latchmere Road School Mondays & Thursdays 1942 1943 1944 1945 1946 1942 1943 1944 1945 1946 No. of sessions held 102 103 102 102 101 101 99 100 98 97 No. of new cases seen 362 383 322 407 435 222 269 195 204 315 Total attendances made 6251 7167 5574 5625 6930 5524 6380 4657 4485 5923 No. seen by M. O. 2442 2541 2425 2550 2537 2085 2120 1783 1850 2185 Dried milk and supplementary Vitamins, etc., are supplied at the Clinics to all cases recommended by the Medical Officer, either at approximately cost price, or half-price, or free of charge in necessitous cases. The income scale referred to in Section 2 (a) also applies to dried infant foods, etc. The following table gives details of the supply of infant food and dried milk during the period under review:- Amount in lbs. 1942 1943 1944 1945 1946 Sold, cost price and Sold, half price 8,555 12,817 10,198 11,449 13,087 Free of charge 2,626 2,093 432 182 155 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. 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:- 1942 1943 1944 1945 1946 No. of mothers who bought 321 256 287 291 346 No. of garments 1,025 762 823 880 1,091 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 t he 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 Diocosan Association for moral welfare. There are nineteen beds. Admission is not confined to Kingston residents, but is extended to girls residing anywhere in, or occasionally beyond, the Southwark diocese. TJie expectant mothers enter the home about two months before confinement which takes place at Kingston County Hospital, 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 are made to secure them suitable employment. A social welfare worker keeps in touch with the girls after they leave the home. There 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 home during the past five years:- 1942-58 1943-59 1944-32 X 1945-50 1946-58 x The home was closed from mid-June, 1944, until 1st. October, 1944, during the flying bomb attacks. As many of the cases as possible were sent home; others were evacuated under the Government Evacuation Scheme. This acoounts for the low numbers cf admissions to the home during 1944. DAY NURSERIES. (b) On the 1st. January, 1945, there were five day nurseries in the Borough, four of which were administered by the local authority, with the approval of the Ministry of Health. The remaining nursery operated under private direction but received a grant from the Corporation of 1s. per day, per attendance, part of which is recoverable from the Ministry of Health. On 1st. April, 1946, Fairfield Day Nursery was transferred to the administrative control of the Surrey County Council as a Nursery School, and admits children from 2-5 years of age. At Surrey Villa Day Nursery the upper age limit is 3 years. The remaining nurseries, Canbury Park and Kilnwood admit children whose ages range from 1 month to 5 years. 18 The following table gives the total attendances from the commencement to date:- Year Surrey Villa St. Peter's Kilnwood Fairfield Kingston Day Nursery Ben talls 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 3,300/ 6,824* 11,024 9,866 17,199 1946 8,570 9,156 2,642+ 8,567 16,450 / Attendances are recorded, for the purpose of this report from June, 1943> "being the date the nurseries were approved officially as war-time nurseries. / Figures for St. Peter's up to and including 9.6.45 when nursery was closed. x 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. + Figures for Fairfield are for 1.1.46 to 31.3.46 when Nursery was taken over by Surrey County Council. The greatest difficulty is experienced in recruiting suitably qualified persons, and the staff is seldom up to full establishment. Staff is chosen with special reference to their experience in the handling of children under the age of five years. The essentials of adequate nutrition have been carefully watched in the diet of the children. I gratefully acknowledge the hard work carried out by all those working in the Nurseries. (c) CARE OF PREMATURE 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 1945. They are as follows (a) Total number of premature births notified during 1946, born- (1) At home 6 (2) In hospital 29 (b) Number of those born at home- (1) Who were nursed entirely at home 6 (2) Who died during the first 24 hours (3) Who survived at the end of one month 6 (c) Number of those born in hospital - (1) Who died during the first 24 hours - (2) Who survived at the end of one month 29 19 When the mother end infant are kept at home, close supervision by the Health Visitors is carried out and all practical assistance possible is rendered. A separate bedroom for mother and infant is advocated; instructions on improvisation and (detailed advice on the care of the infant are given. The services of a paediatrician can be called upon and a home help provided where necessary. (d) CARE OF ILLEGITIMATE CHILDREN. The provisions of Ministry of Health Circular 2866 are followed and most of the suggestions outlined in the Circular are covered with the exception that a separate welfare worker has not been appointed. Close co-operation, however, exists between the officers of the Welfare Authority and Welfare Workers at the Kingston Deanery Home and generally. Financial contribution of 50% (the Surrey County Council paying the other 50% towards the salary of a fall-time Welfare Worker at the Deanery Home was granted by the Corporation during the year. Approximately 50% of the time of the worker to b e spent on Kingston cases. During the pre-natal stages, Health Visitors are in touch with expectant mothers and, when necessary, contact the grandparents, welfare workers in factories, hospitals, almoners, moral welfare workers and others. Similar contacts are made during the post-natal stager, and, in addition, admissions to Day Nurseries are arranged, foster-mothers are visited and attendance at the Maternity and Child Welfare Clinics is encouraged. Assistance is given also by hospital almoners and associated workers who help the mothers to find work and lodgings. (iv) HEALTH VI SITORS . 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 Protection Visitors. The Health Visitors while acting as School Nurses are under the administration of the Surrey County Council which is the Education Authority for the Area. The school nurses deal with Kingston schools under the North Central Divisional Executive Committee which covers Kingston, Maiden, Esher and Surbiton, and for which Committee your Medical Officer of Health is also Divisional School Medical Officer. The work of the Health Visitors in Maternity and Child Welfare continues to increase. The Supervision and regular inspection of the day nurseries forms an important section of the increase. In consequence of the increased numbers attending the clinics and the increased birthrate, a considerable strain is put on the existing health visiting staff. 20 (v) CHILD LIFE PROTECTION. The duties imposed by the Public Health Act, 1936, are entrusted to the Maternity anil Child Welfare Sub-Committee of the Public Health Committee. As a routine duty the Child Protection Visitors visit every foster mother at least once a month, and more frequently when found necessary. During the year under review visits were paid as shov/n below. Figures are included also in respect of preceding years for purposes of comparison:- 1942 1943 1944 1945 1946 765 524 386 283 290 The following table gives details regarding numbers of children under the care of foster mothers, and other relevant information:- 1942 1943 1944 1945 1946 No. on register at beginning of year 28 35 33 26 20 No. of new registrations 11 9 2 3 5 No. ceasing to have charge of infants 4 11 9 9 6 No. on register at end of year 35 33 26 20 19 Total No. of children 45 33 24 22 19 Child 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. 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 AND CHILD WELFARE ONLY) 1942 1943 1944 1945 1946 Sessions devoted to treatment 17 21 20 21 19 No. treated: (i) Mothers 66 59 78 51 60 (ii) Infants 51 36 41 39 32 Attendances made for treatment 30b 329 357 318 288 Fillings: (i) Permanent Teeth 36 40 36 35 40 (ii) Temporary Teeth 29 4 33 36 32 Extractions: (i) Permanent Teeth 266 242 322 245 307 (ii) Temporary Teeth 137 88 60 61 77 Other operations: (i) Permanent Teeth 15 14 15 9 64 (ii) Temporary Teeth 23 43 101 76 32 Supply of dentures 13 15 9 8 5 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:- 1942 1943 1944 1945 1946 Total. cost £62.12.10 £70. 4.11 £49. 7.10 £39. 6.9 £28.14.3 Contribution by mothers £16. 5. 0 £22.14. 0 £35.12. 3 £21. 5.8 £11.14.3 (b) Ophthalmic. Ophthalmic treatment is not often required for children under five years of age, but when necessary these children are seen at the same time as school children. The following number of children were seen during 1946 and preceding years. 1942 1943 1944 1945 1946 Defective vision - - - 1 1 Squint 16 26 19 16 14 Other conditions 1 1 3 — 0 22 (c) Artificial Sunlight. Children under 5 years of age requiring artificial sunlight treatment are referred from the Infant Welfare Clinic, and the following arc the total number of children attending and the total number of attendances during 1946 and preceding years:- 1942 1943 1924 1945 1946 No. of children under five years attending 101 120 151 72 49 Total number of attendances 1547 1522 1938 740 481 (d) Tonsils and Adenoids. Arrangements have been made with the Kingston Victoria Hospital for operative treatment for tonsils and adenoids, xhe following are the number of children under five, who had operative treatment during 1946 and preceding years. 1942 1943 1944 1945 1946 Total No. of cases 8 12 1 2 1 Total cost £11.8.0 £17.2.0 £1.8.6 £2.17.0 £1.8.6 Contributions made by parents £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 1946 and preceding years 1942 1943 1944 1945 1946 Ho. seen by Surgeon 18 24 27 17 8 Ho. treatment given by staff 169 182 263 128 28 No. of cases discharged 5 1 - 4 3 Ho. admitted to Hospital 2 3 2 1 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 Cleansing Centres 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 County Hospital. In a small number of cases arrangements may be made by the Medical Officer of Health. (h) Prevention of the spread of Infectious Diseases. Maternity and Child Welfare. (i) Diphtheria Immunisation. The 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. Ho 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) HOME HELPS. Arrangements have been made in the Borough for domestic assistance to mothers whose confi nements take 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 33 applications were received for home or domestic helps. The following table shows the number of cases who applied for home or domestic helps during 1946, and preceding years:- 1940 1 941 1942 1 943 1944 1945 1946 3 7 - 13 13 26 maternity 30 cases 11 domestic 18 In other cases assistance is given by the visits of the Queen's Purses of the Kingston and District Pursing Association 24 4. NURSING HOLIES. (Surrey County Council). The Surrey County Council is the Authority for registration but has delegated power of inspection to this authority. On 1st. January, 1946, there were two registered nursing homes in the Borough and both were still on the register at the end of the year. One, at 20, Grove Crescent, has nine beds for chronic and senile patients. The other, at 6 Queens Road, is registered as a Maternity Home with accommodation for eight patients. Each Nursing Home was inspected at regular intervals during the year. 25 ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR. To the Mayor, Aldermen and Councillors: ladies and Gentlemen, The following Report upon the work of your sanitary Inspectors for the year 1946 is submitted for your consideration. The Report refers to that part of public health activities which is now generally known as environmental hygiene. The main sections of the work are those most conveniently included under the headings of general Sanitary Circumstances (Section C), Housing (Section D), and inspection and Supervision of rood (Section E). This is the twenty-eighth such Report I have been permitted to present to your corporation. If it is accepted that the health of the people depends primarily upon the conditions under which they live and work, it is unnecessary to lay further stress upon the importance of the work. Practically everything upon which depends the comfort of the family and of the individual, e.g., reasonable housing, pure and wholesome food supplies, and clean air to breathe etc., are matters which receive attention from the sanitary inspectors. The very title of sanitary inspector', however, is one which completely fails to indicate to the man in the street' the full extent of the duties which the modern counterpart of the old-time 'inspector of nuisances' is now required to perform. Hut I must refrain from pursuing this line of thought, interesting though it may be, as the need for brevity is as great now as during any of the war years, for this reason also, the report is in the main a factual statement, with little, or no, embellishments beyond those which are necessary to make it readable. Early in the year Mr.E. S.Herbert returned after six years service in H.K. Forces. Mr. Herbert was a clerk and qualified as a sanitary inspector in July 1939; he enlisted at the outbreak of war. On his return he was appointed as junior additional sanitary inspector, and almost immediately he settled down to his new duties, and commenced to study for the further qualification of inspector of meat and other foods. Lr.J.B.Facer was appointed additional sanitary inspector in iay 1946 to fill the vacancy created by the transfer of Mr.F.D.Harvey to clerical duties. Mr. P.M .Dale, clerk, returned to the office at the end of May, and took over the duties previously carried out by Mr. Herbert. The establishment was not complete by the end of the year. 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 Examinations of the piped supply are carried out by the Board, and it was not found necessary to refer to the Board during 1946 in regard to any specific complaint. comparatively few shallow wells remain in the townthere being only 19 premises known to be supplied with well water at the end of 1946. (ii) Drainage and Sewerage. There were no main drainage works undertaken during the year. 2. RIVER AND STREAMS. The effluent from the Corporation Sewage Disposal Works is discharged into the Thames. Owing to the loss of the filter beds which were dismantled to clear the site of the new Electricity Works, it was found necessary to continue the chlorination of the effluent before discharge 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. Owing to the shortage of housing accommodation, there has been a tendency for river craft of various kinds to be used as temporary accommodation. These craft are not numerous within the borough boundary, but the fact that certain boats are regularly used as homes is indicated by the display cf the weekly washing strung the length of the decks, and by other signs of habitation. The questions of drinking water supply and of sanitary accommodation have been considered, but these boats are not houses which come within the appropriate provisions ofthe Public Health Act, 1936, and, therefore, appropriate action to prevent river pollution can be taken only by the Conservancy .Board. The Hog smill River is a tributary of the rhames. It flows through the Southern part of the Borough and joins the Thames at a point a short distance above Kingston Bridge. The Hogsmill River receives sewage effluents from Malden and Epsom and Ewell, at points before reaching the Borough boundary. A scheme for widening the Hogsmill River was prepared by the Surrey County Council prior to the outbreak of war when the plans were suspended. 97 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 Purveyor, 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 96 tons of salvage material are extracted each month, including waste food for pig feeding which in prewar years was deposited in the ashbins. The siting of the pig food bins caused difficulty from time to time. Complaints were received from the occupiers of a few houses outside of which bins were sited, and the complaints were usually accompanied by a request that the bins should be removed and be replaced outside other houses, rhe complaints were dealt with as diplomatically as possible, but the experience thus far gained indicates that if the collection of waste food is to be continued on a more or less permanent basis, some better scheme will need to be devised, particularly during periods of hot weather. (iii) SANITARY INSPECTION OF THE AREA, (a) The following is a tabulated list of visits and inspections:- Inspection of Houses, etc. 1,037 Inspection of Drainage 172 Reinspections and Works in Progress 2,713 Special Inspection of Properties in Fernhill Gardens Area 187 Inspection of Properties for vacant Accommodation 213 Factories, etc. 112 Outworkers 12 Dairies, etc. 105 Food Premises 567 I.D. Enquiries 135 Common Lodging Houses 20 Theatres 6 Verminous Premises 53 Rodent Control 411 Shop Acts 138 Housing Act (Permitted numbers) 149 Housing Act (Applications) 437 Building Licence Applications 29 Schools 6 Smoke Observations 18 . Miscellaneous 416 6936 lb) (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 Complaint with is not strictly comparable with the number served is the former number may include notices which were served in a previous year. 28 NOTICES SERVED. Informal. (a) Verbal 613 (b) Written Statutory. (a) Housing Acts - (b) Public Health Acts 26 NOTICES COMPLIED WITH. Informal. (a) Verbal 413 (b) Written Statutory. (a) Housing Acts - (b) Public wealth Acts 21 (iv) SHOPS AND OFFICES. 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 again prevented any systematic improvements being carried out during the period under review. (v) CAMPING SITES. Apart from the limited use of Stevens Ait, a small island opposite the northern end of Canbury Gardens, there are no camping sites in the Borough. (vi) SMOKE ABATEMENT. During 1946 work was commenced in connection with the conversion of the steam raising plant referred to in the Report for 1945. This plant had used creosote pitch mixture as substitute fuel for some years, and the resulting nuisance from dense black smoke was most marked. After many attempts to abate the nuisance by modification of the burners etc. had failed, the Ministry of Fuel and Power finally gave permission for a return to the use of fuel oil. The opportunity was taken to install an additional boiler of greater capacity and a new chimney shaft also was constructed. Since the return to, the use of oil, no further emission of black smoke has been recorded in connection with this particular plant. In another case it was necessary to take action in respect of grit emission from the steam raising plant of a laundry, In this instance the nuisance is in no small measure due to the use cf lav grade fuel. In an effort to prevent further trouble, an order has been placed for a grit arrester to be fitted at the base of the chimney-stack and it is hoped that this work will be completed early in 1947. (Vii) SWIMMING BATHS AND POOLS. (a) Public. The Corporation Swimming Baths are situate in Denmark Road and comprise two pools, only one of which was available for swimming during 1946. The other bath- 29 hall was used as a British Restaurant during the day-time, and for dances and other functions from time to time. There is an adequate purification and chlorination plant in connection with the swimming baths. (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 29 premises, In each case the premises were subjected to disinfestation processes appropriate to the circumstances. 4. COMPLAINTS. The year saw another marked increase in the number of complaints received, the total being 833 compared with 532 for the previous year and a total for the year 1939 of 207. There is no doubt that the continued increase in the number of complaints received is due in part to arrears of house repairs and maintenance. Very little in the way of repair was possible during the latter war years, and war damage repairs remained uncompleted. It is also true that owners of properties, particularly those subject to pre-1914 controlled rents, are reluctant to carry out repairs owing to the sharp rise in the cost of building labour and materials, which seriously affects the return on their investments. The following is a brief tabular statement of the various causes for complaint Sanitary Defects 411 Rodent infestation 129 vermin infestation 21 Non-removal of refuse 19 Defective Ashbins 24 Drains and Sanitary Arrangements 131 Water Supply 9 Overcrowding 12 Unpaved Yard and Passage 1 Miscellaneous 74 Nuisance from Smoke 2 5. RODENT CONTROL. In previous Reports reference has been made to the marked increase in public interest in this subject, compared with the pre-war period. This welcome interest was again maintained during 1946. There is little doubt that war-time conditions, such as the need for home food production, and damage to drainage systems and to property due to enemy action have encouraged rodent infestations. Apart from treatment of business premises and dwelling houses on behalf of occupiers, the Corporation sewers and refuse tips were systematically baited during 1946 with good results. The need for a review of the organisation for rodent control became apparent during the year, and particularly the question as to whether dwelling houses should continue to be the subject of charge for services rendered, often these amounted to a few shillings only and the cost of recovery 30 might easily exceed the amount demanded. A full Report was prepared but it was not considered by the Public Health Committee until early in 1947. 5. RAG FLOCK. There are no large factories in the borough engaged in the making of new bedding and upholstery, but there are several places at which furniture is reupholstered and bedding is remade, customers' own materials being used. In several of these workplaces some Rag Flock also is used. Rag Flock is made by tearing new or used rags, and because unclean rags and other materials are sometimes used, The Rag Flock Acts of 1911 and 1928, and the regulations of 1912 provide a standard of cleanliness for the finished product. It has been generally agreed that the prescribed standard is not adequate as it refers only to the soluble chlorine fin the form of chlorides) content, which must not exceed 30 parts in 100,000 parts of the flock. The Ministry of Health, being aware of the adverse criticism directed against existing legislation, appointed an Inter- Departmental Committee in 1938, with terms of reference which were wide enough to enable a thorough investigation to be made of the subject. The Report of the Committee was published by the Ministry of Health during 1946, and indicated, among other things, that the objects of existing legislation have not been achieved. This decision did not come as a surprise to health officers, as many materials, other than rag flock, are used as fillings for bedding, furniture, cushions, toys and other household articles, and there is no existing cleanliness standard for these other fillings. Apart from the opinion of the person who uses the articles, there is the matter of the wellbeing of the worker , who has to handle the fillings in the course of his labour. This is a very important aspect of the subject. It is gratifying to note the recommendations contained in the report, but it will be even more heartening when new legislation to give effect to new standards, is submitted to Parliament. It is but fair to state that the various trade interests have for some years shown commendable interest in the matter of improved standards, and they voluntarily approached The British Standards Institution with a view to the preparation and adoption of new specifications and tests of cleanliness for all types of fillings including hair, fibres, kapoc, feathers, rag flock (wool and cotton) etc., both new and second-hand. As one of two representatives of the Sanitary Inspectors Association I served on the technical and advisory Committees dealing with this important work, which was not completed by the end of 1946. There is every likelihood that when agreement is reached, the new specifications and tests will be incorporated in future legislation, after a period of preliminary trial. 31 7. OTHER DUTIES. Assistance was continued during the year under review, to various Government Departments as well as to other Corporation Departments, particularly with regard to 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 437 visits were made in connection with applications for housing accommodation, and reports were submitted, giving the particular circumstances of each case. Section J. HOUSING. During the war years all health officers were buoyed up with the hope that when hostilities ceased, it would be possible to make an early start towards catching up with the arrears of work. Those hopes were destined to be frustrated by circumstances completely outside the control of local government. The Ministry of Health made it abundantly clear that even very insanitary dwellings should not be demolished, if, by patching up they could be made tolerable for a further short period; furthermore, local authorities were urged to restrict the work of maintenance of houses in order that the utmost effort could be applied to the erection of new houses. It was indicated that repairs should be limited to the absolute minimum comparable with the standard of permitted works in connection with war damaged houses. These restrictions were necessary owing to the shortage of building materials and of suitable labour. Nevertheless, a very considerable amount of repair works was brought about during the year, mainly as the result of collaboration with the respective owners and their builders. The general deterioration in the condition of houses due to the enforced lack of maintenance was reflected in the increased number of complaints previously referred to in this report. In this connection thirty-nine Certificates of Want of Repair were granted during the year. During the year building licences were granted by the Corporation to the value of approximately £158,435 for work of repair and reconditioning of houses. This figure was in addition to that involved in the rebuilding of war damaged houses and the erection of new houses and flats. The following information has been supplied by the Borough Surveyor:- 1. Number of houses erected by the Corporation during 1946. New Construction. War Damage. 18 houses. - 6 flats 4 Total 24 4 32 2. Number of houses erected by private enterprise. New Construction. War Damaged. Nil under Circular 92. - houses 6 flats Total 6 3. Total number of permanent houses for the Working Classes erected by the Corporation since March 1924, up to the end of December 1946. 782 houses - 74 flats. 4 Total 856 4 4. Number of 'Arcon' temporary dwellings and the number of two-year huts completed during 1946. 53 ten-year dwellings. 12 two-year 65 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. One reads and hears a good deal about revolutions of one kind and another, but there is one big change which has taken place during the last few years which could well be described as a revolution, of the bloodless type, but it has not occasioned any lasting general public interest. This revolution is connected with the distribution of milk in this country. At the commencement of 1939, the number of registered dairymen in the borough was 77 and there was one cowkeeper. By the end of 1943 the number of dairymen had decressed to 40, at which figure it stood until 1946, when the number of dairymen actually retailing milk in Kingston dropped to 16. The last remaining herd of cows also left this congested urban area for pastures new during that year. This change is not localised for a similar large reduction has taken place all over the country, to a greater or lesser degree, according to the density of population, and it has been brought about by rationalisation of the distribution of milk. One can understand the regret of the small dairyman who fought so hard to retain his small business and who, ultimately, had to sell out to a larger firm, equally understandable, and no less to be deplored, was the 1oss of choice of dairyman, suffered by housewives. This may appear to some as being quite unimportant, but i t is not easy to change a custom which has existed for decades, particularly if it also entails a loss of freedom. 33 On the other hand it was inevitable that a change from the wasteful methods of prewar years had to come. The cost of distribution of milk is a heavy charge on the industry and one that must be borne by the consumer. It is difficult to believe that until comparatively recent times, numerous small one-man dairy businesses were struggling to maintain three deliveries each weekday, and two on Sundays. Yet such was the case and the resultant intense competition for business led to practices which could not be commended and which were, in the long run, detrimental to both dairyman and customer. It was a common sight to see several different dairymen delivering milk in the same road, and, on occasion, even to the same house, the first delivery being from 6.0 a.m. onwards and the last journey during the late afternoon, after which there was still the washing of cans and utensils to be done before the day's work was finished. Those were the days which even now are so often, and glibly, described as "the good old times", by those who have forgotten, or have not realised that there was another side to the picture. However, those days are gone, never to return. It must be conceded that compared with the numerous small traders, the smaller number of large firms have the necessary financial resources to enable them to provide efficient equipment and suitable buildings in which to handle such a precious foodstuff as milk. And there is the added advantage that standardised equipment may be evolved and thus simplify more of the remaining difficulties. One of the greatest advantages which has accrued from the change is that of the greatly reduced opportunity now afforded for milk to be tampered with. There is far less adulteration and manipulation to the prejudice of the purchaser now than at any previous time during the last fifty years. Another important effect has been to completely stop the sale of milk from the small general shop, where the open container was frequently found amidst most unsuitable commodities. Designated Milks. Apart from the Registrations under the provisions of the Milk and Dairies Order 1926, which number 16, and have been referred to above, licences are issued by the Corporation to Dairymen, other than actual Producers, to permit the sale of Jesignated milks. The licences issued during 1946 are set out below:- Designated Milk Licences. Tuberculin Tested. Pasteurised. Pasteurising 1 - Dealers ' 7 6 Supplementary 4 5 Bacteriological examination of Milks. During the year 120 samples of milk were submitted to the Clinical Research Association Laboratories, London. The usual examinations requested were for the presence of B.Coli, and the total number of bacilli (plate-count). Twelve of the 120 samples failed to reach the accepted standard, either because of the presence of B.Coli, or a high total count, or for both reasons. Some of the sub-standard samples were taken from the producers' churns at the time of delivery to the local dairyman's premises. In all cases appropriate information was passed to the local authority in whose district the relative producer's farm was situate, and it is hoped that suitable 'follow-up' action was taken, but information of such action was seldom subsequently received. 34 Biological Examination of Milk for the presence of Tuberculosis. Seven samples of milk were submitted during 1946 for what is commonly called the 'animal test', since the use of guinea pigs is involved. In no instance was the presence of tubercle bacilli detected. Pasteurised Milk. The test which is usually applied to milk to ascertain whether it has been satisfactorily pasteurised, is known as the Phosphatase test. It has been used as an unofficial standard for several years, but during 1946 it was officially recognised by the Ministry of Health. This action was generally welcomed by Health Officers, but the decision of the Minister to replace the plate-count by a half-hour methylene blue test was viewed with less favour. The object of the latter test is to ascertain the condition of the milk so far as cleanliness, and keeping quality, are concerned. Whilst it must be admitted that the plate-count was subject to wide variation in results, it was popular as a general guide to the degree of cleanliness, and it was a test which impressed the farmers. However, experience over a period of time will be required before a proper assessment may be made of the value of the change of test. During 1946 a new short term high temperature pasteurising plant was installed in a dairy in the borough. It was intended to be used for the heat treatment of T.T. milk to be bottled on the premises. Bacteriological Examination of Ice-Cream. The year 1946 marked a great increase in the interest shown by the public in the quality of ice-cream, but this interest, although encouraging to food officers, is still far below the degree of discrimination which one would wish to observe. It is an axiom that advances in legislation generally follow public demand. In the same way, if the efforts made by food officers to prevent the sale of unclean ice-cream were to receive the full support of the public, the presence of gaudily painted barrows and open ice-cream containers at street corners would automatically cease. whilst the public continues to purchase unsatisfactory icecream from these itinerant vendors, so long will responsible government departments accept the fact as an indication that all is well, and nothing further need be done. Food officers know only too well the weakness and dangers of the existing methods, but beyond constant but limited supervision of the place of manufacture, they are helpless by reason of the absence of any recognised and enforceable standards of cleanliness and quality. So far as cleanliness is concerned the Corporation has adopted as a guide a maximum bacterial count of 100,000 per cubic centimeter and absence of B.Coli in a dilution of 1/100th. This cannot be regarded as unreasonably high, yet no less than 20 samples failed to reach it out of 50 samples subjected to the tests during 1946. In those cases where the samples were of ice-cream made in the borough, every effort was made to trace the cause of the low standard. Inspections were made during the process of manufacture, and the cleansing of the equipment and utensils was carefully supervised. The most frequent cause for failure was found to be inadequate cleansing of utensils. 35 Meat and Other Foods. (1) Slaughterhouses. There are no licensed slaughterhouses in the borough. (2) Meat Depot. The Ministry of Food Meat Depot in this borough serves the needs of the boroughs of Barnes, Kingston, Maiden and Coombe, Richmond, Surbiton, and Wimbledon, and the Urban District of Esher. It will be realised that a very large quantity of meat and offals (frozen, chilled, fresh or canned) passes through this depot each week. Approximately 11,000 tons was distributed during 1946. It is gratifying that the number of complaints received regarding consignments delivered to retail premises within the area served is very low. In most of the cases investigated it was found that the complaints referred to conditions which could not be ascertained before the food was dispatched, owing to the fact that the articles were distributed in the frozen state, as received at the Depot. The tabulated list of condemned foodstuffs which is set out on following pages reflects the importance of the work of food inspection. Unfortunately, the total amount of food condemned during 1946 was much in excess of that during 1945. In the main this was due to a higher canned meat figure. One of the results of labour difficulties at the markets is that food is allowed to deteriorate pending settlement of the disputes. This means much extra work locally, as all the delayed foods have to be thoroughly examined and trimmed, where possible, before being distributed to shops. The exceptionally high figure for canned meats was due to the distribution of accumulated stocks held for emergency purposes. The same comment applied to canned fruits etc. In one instance over 800 cans of plums out of a large consignment were found to be In a condition known as "hydrogen swells". At the request of the Ministry of Food the consignment was returned to the canners for reconditioning . Following upon a serious outbreak of fire at business premises in the town, approximately one and a half tons of foodstuffs were removed for inspection. Prompt action in this case resulted in the saving for use of nearly a ton of foods. The condemned foods are indicated at the end of the following tabulated list. Shops, Vehicles etc. The hygiene of food premises is a subject constantly kept in the forefront of the departmental activities. It was not possible, however, because of shortage of labour and suitable materials, for business houses to carry out desirable improvements to food premises. It was difficult even to obtain the necessary permission to put in hand normal works of maintenance. Apart from inspection of the actual premises, no opportunity was lost to keep the attention of staffs of food premises focused on the need to exercise the greatest possible care in the handling of foods. Personal hygiene in food premises is a subject which is receiving ever increasing attention durirg the course of routine visits, and there is great scope for improvements in the coming years. 36 TABULATED LIST OF CONDEMNED FOODSTUFFS SHOWING CAUSE FOR CONDEMNATION AND THE WEIGHTS. Article of Food. Reason for Action. Weight. BOVINE. Beef, Hindquarters Decomposition, Black Spot Mould, etc. 1648½ lbs. " " Bruised 115½ " " " Abscess 65½ " Trimmings Bruised, Decomposition, etc. 254 " " " Brine Stain 16 " Offal Decomposition, etc. 67½ " Ox Liver Distomatosis 9 " 75 Calves Heads 73¾ " Feet Decomposition 507½ " MUTTON. 2 carcases Black Spot Mould 44 " Legs of Lamb Bruised 4½ " Shoulder Abscess 7 " Trimmings Contaminated by foreign matter 2 " Liver Decomposition 421½ " " PORCINE. Liver Decomposition 8½ " CANNED' GOODS. Meat - 2106 tins. Blown, Decomposition. 9575½ " Meat - 20 " Iron Sulphide Contamination. 120 " Fish - 371 " Blown, Decomposition 235½ " Vegetables - 258 tins. " " " " 303 " Jam & Marmalade - 158 tins. " " " " 257½ " Fruit - 46 tins. " " " " 73 " Condensed Milk - 500 tins. " " " " 438½ " Spaghetti & Macaroni 4 tins Blown, etc. 3 " Pudding - 2 tins. " " 2 " Orange Pulp - 4 tins. " " 28 " FISH. Haddock Decomposition 763 " Plaice " " 140 " Cod " " 434 " Skate " " 450 " Whiting " " 100 " Mackerel " " 252 " Coal Fish " " 56 " Kippers " " 560 " MISCELLANEOUS Rabbits " " 56 " Bacon " " 16 " 16 jars Pickles Mould 12 " Butter Contaminated by Foreign Matter 6½ " Margarine " " " " " " " " 1 lb. Cheese Decomposed 1½ lbs. 8 pkts. Flour Contaminated by Mice 18 " Flour Infested by Moth 46 " 39 Pkts. Flour Contaminated by foreign Matter 117 " C/FWD. 17,236 " 37 Article of Food. Reason for action. Weight. B/FWD. 17,236 lbs. Cereals Contaminated by Foreign Matter. 10 " Semolina Moth infestation. 24 " 60 pkts. Scone Mixture Contaminated by Foreign Matter. 30 " 218 " Pudding " Infested by Moth & Weevil 50 " Cake Mixture " " 18 " " " " " Infested by Mice 11½ " Confecti onery Cream soured 190 " " " Contaminated by Foreign Matter. 52½ " Biscuits " " 18 " 238 tins Soup Powder Deteriorated as result of moisture 1,666 " 5 jars Fish Paste Mould 1 " 60 " Herring Salad Decomposition 7¾ " 30 " Mustard " " 3¾ " Dried Fruit " " 40 " Raisins " " 50 " Prunes Mould & Decomposition 30 " Dates Decomposition. 91 " Oranges " " 248 1 box of Apples " " Strawberries " " 40 " Walnuta 355 Eggs Mould & Decomposition Decomposition. 212 " Flour Fire damage 112 " Macaroni " " 336 " Oatmeal " " 112 " Dried Peas " " 28 " Split Peas " " 28 " Cooking Fats " " 50 " Dates " " 60 " Tinned Peas " " 50 " Miscellaneous - unsortable " 560 " Total 21,365½ " FOOD & DRUGS ACT. 1938 - Adulteration. During the year 1946, 128 samples of foods were collected and submitted to the Public Analyst for examination. All the samples were reported to be genuine. In certain oases there is a legal standard, e.g., milk, whilst in other instances minimum standards are included in the appropriate Ministry of Food Orders, e.g., cordials, sausage meat, baking powder, etc. In the case of ice-cream, however, there is no legal standard of quality. The statement, therefore, that all the thirteen samples proved to be genuine is not so satisfactory as it might appear at first glance. It is of interest to examine the actual Reports received. Of the ingredients, the two most important are (1) fat and (2) solids not fat. The highest fat content reported was l0.7/%; the lowest was 0.2%. Five of the samples proved to contain less than 1% fat. The ice-cream produced by the better known makers had a fat content varying between 10.7% and 8.6%. The low percentages were confined to the products of smaller manufacturers and itinerant vendors. The wide variation shown is indicative of the opportunity afforded to unscrupulous manufacturers, and also of the need for a legal standard of quality, particularly when it is remembered that the price charged for this commodity Is often in inverse ratio to quality. 38 With regard to the 'solids not fat', all the samples contained over 20%, which in the circumstances might be considered satisfactory. Food and Drugs Act, 1938. Tabulated Statement of Samples taken during 1946. Articles Analysed Report. Formal. Informal. Total. Milk - 80 80 Genuine. Ice Cream - 13 13 " Orange Flavour Essence - 1 1 " Orange Cordial - 1 1 " Sausage, beef 3 3 6 " Sausage Meat, beef 4 - 4 " Sausage, pork - 1 1 " Sausage Meat, pork 4 - 4 " Sausage, liver - 1 1 " Meat Paste - 3 3 " Soup, Meat - 1 1 " Saccharin Tablets - 2 2 " 'Antikamnia' " - 1 1 " Aspirin - 1 1 " Coffee & Chicory essence. - 1 1 " Chocolate Flavoured Mixture - 1 1 " Gelatine - 2 2 " Lemonade Crystals - 1 1 " Vinegar, Malt - 1 1 " Baking Powder - 1 1 " Bicarbonate of Soda - 2 2 " 11 117 128 MINISTRY OF FOOD PIPERS - 1946 During 1946 the following Orders were issued, each of which had relation to the work of food inspection:- No. 157. Food Standards (Self Raising Flour) Reduction of minimum amount of available Carbon Dioxide, and repeal of maximum figure of total Carbon Dioxide. No. 265. Increase of rate of extraction of National flour from 80% to 82½%. No. 312. Further increase of extraction rate of National flour from 82½% to 85% and of 'W' flour from 82½% to over 85%. No. 385. Labelling of table jellies. No. 537. Cessation of control of production and distribution of Vitamin C. No. 662. Further increase of extraction rate of National flour from 85% to 90% and of 'W' flour from over 85% to over 90%. 39 No. 727 Cessation of control of Vitamin Bl. No. 945 Contents of soft drinks. No. 1355 Meat content of certain Meat Products, etc. No.1536 Reduction of extraction rate of National flour from 90% to 85% andof "W" flour from over 9 0% to over 85%. No.1727 Fish content of fish paste. No.2169 Labelling of Intoxicating liquors and canned processed peas. CONCLUSION. The above Report, although brief, will, it is hoped, prove of interest to the reader and afford information on some aspects of the work of sanitary inspection, which are not generally known. Once again I desire to offer my thanks to the Chairman and Members of the Public Health Committee and the Corporation generally, for their continued consideration and support, and to all my colleagues, without whose assistance my duties would have been more arduous. Yours faithfully, HAROLD T. PERRT. Chief Sanitary Inspector. Guildhall, Kingston-up on-Thames . 40 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 influenza]). Cerebro-sninal 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 1946 a total of 466 notifications of infectious disease was received. The following table shows how the cases were dealt with. NOTIFIABLE DISEASES DURING 1946. DISEASE CASES DEATHS Age Groups Age Groups Under 1 yr. 1-2 2 - 3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35-45 45 - 65 65 & over Total cases notified Cases admitted to Hospital Under 1 yr. : 1 - 2 2 - 3 3 - 4 4-5 5-10 : 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total Scarlet Fever - - - 2 - 13 14 - 4 1 - - 34 23 - - - - - - - - - - - - - Diphtheria 2 - - - - 2 2 1 — 1 - - 8 8 - - - - - - - - - - - - - Enteric Fever including Paratyphoid - - - - - - - - - - - - 1 1 - - - - - - - - - - - - - Acute Poliomyelitis - - - - - 1 1 - - - - - 2 2 - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 1 32 8 - - 41 41* - - - - - - - - - - - - - Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 - - - - - - - - - - - - - - Cerebro-Spinal Fever 1 - - - - - - - - - - - 1 - 2 - - - - - - - - - - - 2 Pneumonia 1 - 3 1 1 5 - 1 3 - 4 3 22 1 5 - - - - - - - - - 5 18 28 Erysipelas - - - - - - - - - 1 4 - 5 3 - - - - - - - - - - - - - B.Dysenteria (Sonne) - - - - - - - - - - 1 - 1 1 - - - - - - - - - - - - - Measles 9 18 44 39 37 123 9 2 1 1 - - 283 6 - - - - - - - - - - - - - Whooping Cough 9 7 10 12 12 15 1 - 1 - - - 67 5 - - - - - - - - - - - - - * of these, 39 were notified from hospital. 41 42 The following tables gives a comparative statement of Notifications received during the last twenty years, in respect of Scarlet Fever, Diphtheria, and Enteric Fever:- Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid) 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 - 1946 34 8 1 Scarlet Fever. Thirty-four cases of Scarlet Fever were notified, twentyseven of whom were of school age. No deaths occurred and no "return" cases. Twenty-three of the cases notified were removed to an infectious diseases hospital for treatment, Diphtheria. Eight cases of Diphtheria were notified in 1946, two from Kingston County Hospital and six from within the Borough, Two of the cases notified occurred in children under one year of age, four in children of school age, and two in adults. All eight were removed to hospital for treatment and recovered. Of the six notified from addresses in the Borough, only two had been immunized. Intensive work has been carried out to immunize the school and pre-school population against diphtheria, and the table on the following page shows the stage reached by the end of 1946. 43 DIPHTHERIA IMMUNISATION - 31st DECEM3ER 1946. 0-5 Age Group. Birth date No. completely immunised 1946 10 1943 274 1944 403 194 374 1942 366 Total 1,427 Percentage - 49.7 5-15 Age Group. Birth date No. completely immunised 1941 405 1940 520 1939 377 1938 402 1937 359 1936 376 1935 357 1934 318 1933 271 1932 279 Total 3,664 Percentage - 83.2 Record of work done at Diphtheria Immunisation Clinics 1946 Total number of Clinics held 90 Number completely immunised 645 Number of schick tests 1,214 Number of postive schick tests and reinnoculations 90 Total attendances 3,716 Average attendance 41 44 Enteric Fever (Typhoid or Paratyphoid). One case of paratyphoid B was notified during the year and admitted to Hospital. It occurred in a female aged 11 years. Despite many enquiries the source of infection was not traced. Measles. There was a decrease in the number of cases of measles notified during 1946, as compared with 1945 (407), the number being 283, of whom six only were removed to hospital. There were no deaths recorded from this group. The 5-10 year age group contained the largest number of notifications (123), the majority of the remainder being spread over the 2-5 year age period. 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 years l942 - 1946 (inclusive). Year. Cases notified. Deaths. Respiratory Non-respiratory Respiratory Non-respiratory 1942 67 11 22 2 1943 63 8 25 1 1944 56 11 19 4 1945 41 12 19 7 1946 41 9 10 3 (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:- 1942 1943 1944 1945 1926 1 : 8 1 : 8 1 : 12 1 : 5 1 : 3 During 1946 no action became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 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. TUBERCULOSIS, 1946. NEW CASES DEATHS Under 1 yr. 1 - 5 5-15 15-25 25 - 35 35-45 45 - 55 55 - 65 65 & over Total Under 1 yr. 1-5 5-15 15 - 25 25 - 35 35 - 45 ... , 45 - 55 55 - 65 65 & over Total Tuberculosis (a) Respiratory M. — — 1 3 2 b 5 1 - 18 - - - 1 - - - 3 2 6 P. - - 3 9 7 3 - - 1 23 - - - - 1 1 - - 2 4 Total - - 4 12 9 9 5 1 1 41 - - - 1 1 1 - 3 4 10 (b) Nonrespiratory M. 1 1 1 1 - 1 - 1 - 6 - 1 1 1 - - - - - 3 F. - - - 1 1 - - 1 - 3 - - - - - - - - - - Total 1 1 1 2 1 1 - 2 - 9 - 1 1 1 - - - - - 3 46 Sonne Dysentery. During the year only one case of Sonne Dysentery was notified, compared with thirty-seven in 1945. This case was in the 45 - 65 year age group, and was admitted to Hospital. Small Pox. There were no cases of Snail Pox notified in 1946, but fiftytwo contacts were notified and observed. None developed the disease. 47 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 part-time attendants working under supervision of Health Visitors . The following tables show the numbers of persons treated during the year 1946, and the four 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" Coombe Road Cleansing Station Opened 20.2 .46 1942 89 135 - 224 1943 349 261 - 610 1944 575 368 - 943 1945 Closed 31.12.44. 592 - 592 1946 Closed 31.l.46. 342 342 Analysis into arte croups 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 "3" Analysis not available. 1943 First Aid Post "A" 22 40 67 19 39 162 1943 First Aid Post "3" 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 1946 Coombe Road Clean sing Station 23 48 77 19 69 106 48 Analysis of oases treated during 1944. 1945, and 1946. Year No. of cases treated at Total cases treated First Aid Post "A" First Aid Post "B" Coombe Road Cleansing Station 1944 391 270 - 661 1945 - 341 - 341 1946 - - 152 152 Analysis into age groups of cases treated. Year Treatment Centre. Males Females Under 5 years 5 yrs. to. 14yrs. Over M 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" 32. 83 — 29 70 57 1945 First Aid Post "B" •25 72 60 9 53 122 1946 Coombe Road Cleansing Stat ion 13 27 32 4 37 39 Analysis of contacts treated during 1944. 1945 and 1946. Year No. of contacts treated at Total contacts treated. First Aid Post "A" First Aid Post "B" Coombe Road Cleansing Station 1944 184 98 - 282 1945 - 251 - 251 1946 - - 190 190 49 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 14vrs. 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 1946 Coombe Road Clean sing Station 10 21 45 15 32 67 Prior to 1942, no scheme existed for notification of cases of scabies, and pre-war only a few cases came to the Public Health Departments 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. During 1946 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.