AC 4413(1) Kingston-upon-Thames KIn 21 ??? Royal Borough of Kingston-Upon-Thames ANNUAL REPORT 1947 OF THE Medical Officer of Health AND Chief Sanitary Inspector GUILDHALL, KIN GSTON-UPON-THAMES DECEMBER, 1948 v \ :—v t * - / > Royal Borough of Kingston-upon-Thames ANNUAL REPORT 1947 OF THE Medical Officer of Health AND Chief Sanitary Inspector GUILDHALL, KINGSTON-UPON-THAMES DECEMBER, 1948. ANNUAL REPORT. 1 9 4 7. TABLE OF CONTENTS. Preface. Page Staff of the Public Health Department 1, 2 SECTION A. Statistics and Social Conditions. (i) General Statistics 3 (ii) Social Conditions 3 (iii} Extracts from Vital Statistics 3,4,5, 6 (iv) Causes of Death 7 SECTION B. General Provisions of Health Services. 1. (i) Public Health Officers 8 (ii) (a) Laboratory Facilities 8 (b) Ambulance Facilities 8 (c) Nursing in the Home 9 (d) Clinics and Treatment Centres 10 (e) Hospitals 11 2. Institutional Medical Service Omitted (Surrey County Council) 5. Maternity and Child Welfare - (i) (a) Midwifery Service 12 (b) (i) Maternal Mortality 13 (ii) Infant Mortality 14 (iii) Puerperal Pyrexia 15 (ii) (a) Ante-Natal Services 15 (b) Post-Natal Services 16 (c) Infant Welfare Services 17, 19 (iii) (a) Institutional Treatment for Mothers and Children 19 (b) Day Nurseries 19 (c) Care of Premature Infants 20 (d) Care of Illegitimate Children 21 (iv) Health Visitors 21 (v) Child Life Protection 22 (vi) Treatment - (a) Dental Treatment 22 (b) Ophthalmic 23 (c) Artificial sunlight 24 (d) Tonsils and Adenoids 24 (e) Orthopaedic Treatment 24 (f) Treatment of Scabies 25 (g) Convalescent Treatment 25 (h) (i) Diphtheria Immunisation 25 (ii) Vaccination 25 (vii) Home Helps 25 Nursing Homes 26 SECTION C. Sanitary Circumstances. Page Introduction 27, 28 1. (i) water 29 ( i i) Drainage and Sewerage 29 2. Rivers and Streams 29 3. (i) Closet accommodation 30 (ii) Public Cleansing 30 (iii) Sanitary Inspection of the area 30 (iv) Shops and Offices 31 (v) Camping Sites 31 (vi) Smoke Abatement 31, 32 (vii) Swimming Baths and Pools 33 (viii) Eradication of Bed Bugs 33 4. Complaints 33 5. Rodent Control 34 , 35 6. Insect Pest Control 36 7. Rag Flock 36, 37 SECTION D. Housing. (a) General appreciation of the position 38 (b) Number of dwellings erected 38 (c) Building Licences issued 39 (d) Special Report to Housing Committee 39, 40 (e) Town Planning - Draft outline plan 41, 42,43,44 (f) Aged and Infirm People 44 SECTION S. Inspection and supervision of Food. (a) Milk Supply 44 (b) Designated Milks 44 (c) Bacteriological Examination of Milks 45 (d) Biological examination of Milk for the presence of Tuberculosis 45 (e) Pasteurised Milk 45 (f) Bacteriological Examination of Ice Cream 45 (g) Meat and other Foods 46, 47 (h) Food and Drugs Act, 1938 - adulteration 48, 49 (i) Factories act, 1937 50, 51 SECTION P. Infectious Diseases. Notifiable Diseases 52, 53, 54, 56 Diphtheria Immunisation 55 Tuberculosis 57, 58 scabies 59, 60, 61 Infestation by Head Lice 62 PREFACE. to the mayor, hLDERMEN and councillors of the royal borough of kingston-upon-thames. annual report, 1347. Mr. Mayor, Ladies and Gentlemen, The Annual Report for 1947 is given in the same form as that for 1946 and, as directed by the Minister of Health, is confined to essential matters relating to the Public Health and Social Medicine. The vital statistics for the year are remarkably good. Mo serious epidemics have been recorded, but notifications of Poliomyelitis and Polioencephalitis have numbered more than in previous years. This was in common with experience throughout the country. VITAL STATISTICS. Population - The Registrar-General's estimate of the population for 1947 is 40,780, an increase of 1,110 over the figure for 1946. Live births - The number of live births for 1947 is 870, giving a Birth Rate of 21.33 per 1,000 of the population, compared with a rate of 20.02 for 1946, and is the highest rate since 1921, when a rate of 20.12 was recorded. Deaths - The number of deaths recorded for 1947 is 495, giving a Death Rate of 12.13, compared with 460 deaths, and a rate of 11.60, for 1946. Excess of births over deaths - The excess of births over deaths in 194.7 is 375, compared with 334 in 1946. Infantile Mortality Rate - The number of deaths of infants under one year of age in 1947 is 19, giving a rate per 1,000 total (live and still) births of 21.84, as compared with a rate of 28.97 in 1946 with 23 deaths. This is an encouraging new low level for Infantile Mortality and can be taken as some return for the Maternity and Child welfare work carried out on behalf of the mothers of the town. The number of Births - The actual number of births among Kingston residents during the year 1947 shows an increase, i.e., 870, as against 823 for 1946. This figure may prove to be a peak, and a slight decline may be evident in 1948. The Exercise Clinic for Mothers - In February, 1947, there was introduced to the services offered at the Health Centre, Grange Road, a session for instruction in ante- and post-natal exercises for mothers. These immediately proved popular and have been taken up with enthusiasm by many of the mothers. Although space at the Health Centre for the conduct of this class is very restricted, the numbers of mothers taking advantage of it has grown steadily throughout the year. Much good work has been done and favourable reports on the beneficial effect of the exercises during the conduct of labour have been received from the practising midwives and the mothers themselves. (i) The Pauses of Death - The main conditions causing death, as recorded in the table for 1947, are Heart Disease, 155; Cancer, 79; and Intra-cranial Vascular Lesions, 56. Day Nursery occupied places - In the four Day Nurseries operating at the end of 1947, 46,804 attendances were recorded, as compared with 42,495 in 1945 and 42,743 in 1946. An increasing demand for nursery places is being experienced„ Infectious Diseases - There was a marked decrease in the number of notifications of infectious disease during 1947 - 345, as against 466 in 1946. Social Conditions - (i) Housing - The provision of satisfactory housing for a very large section of the population continues to be a most pressing and urgent problem. Crowding of several families into houses not designed for plural occupation, and overcrowding of rooms exists to an extent which undermines health. The need for homes at the end of 1947 is still a major factor affecting the health and efficiency of the people. (ii) An increasing number of cases of aged persons in need of special housing provision come to notice. Satisfactory provision for aged persons who can no longer look after themselves and have no relatives to care for them is one of the most acute problems requiring solution. Although a certain amount of assistance is given to some by the granting of Domestic Helps, this service can, as yet, only bring temporary relief to a small number of cases. (iii) Domestic Help Service is also given to a few Cases of Tuberculosis remaining at home. The need for such service is increasing, because of the long waiting period before such patients can be sent to sanatoria or hospitals. The provision of such domestic help in suitably selected cases enables a measure of home treatment of the condition to be carried out with some degree of success. An increasing volume of enquiry is being experienced in the department. The people have become more aware of the Public Health Department as a source of help in time of trouble. Many problems brought in this way are soluble by existing facilities within or without the Health Services proper, but very many are the outcome of illness, or stress of living conditions, for which only a sympathetic hearing and tentative advice may be given. I record my thanks to my senior colleagues and all the members of my staff for their constant help and co-operation throughout the year. I acknowledge gratefully the continued support and encouragement of the Mayor, aldermen and Councillors in the work my department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, J. STARKEY, Medical Officer of Health,, (ii) 1 1947 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 Officers: W. H. KINSTRIE, M.B., Ch.B„ (Edin.), D.P.H. (Returned from service with K. M. Forces 1.6.47) VALERIE WILLS, M.D., (Prague) Consultant under Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations 1926: J.V. 0'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: G.C. SMITH, A.R.San.I. fa) (b) A. CLEGG, M.R.San.I. (a) lb; J.B. FACER, A.R.San.I. (a) (b) N.L.G. TUBB,M.R.San.1. (a) (b) (appointed 1.9.47) Junior Sanitary Inspector: E.S. HERBERT (a) (resigned 13.4.47) Assistant Rodent Officer: F.Wo STAGG (appointed 2.6.47) Senior Health Visitor: MISS C.A. HOOKWAY, S.R.N., S.C.M., H.V.Cert. (resigned 14.11.47) MISS F.I. ARNOLD, S.R.N.,S.C.M., H.V.Cert. (appointed 14.11.47) Health Visitors: 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. (resigned 1.2.47) MISS E.D. WOODLEY, S.R.N., S.C.M., H.V.Cert. (appointed 1.8.47) MISS K.M. WRIGHT, S.R.N., S.C.M., H.V.Cert. (appointed 1.8.47 MISS E. LEWIS, S.R.N., S.C.M., H.V.Cert. (appointed 20.10.47) Day Nursery Matrons: MRS. M. SHEPHERD, S.R.C.N. MISS M.E. HARVEY, N.N. (College Trained) Miss D. DENNIS, S.R.F.N. 2 Administrative Officer: P.D. HARVEY, M.R.San.I. (a) (b) Clerical Staff as at 31st. December, 1947 MRS. D. A. PATRICK MISS C.L. FOISTER MISS V. NEELD MISS B.M. JERVIS MRS. I. ROOBOTTOM P.M. DALE MRS. V. ETHERIDGE MISS A.M. LAMING MISS J.M. MITCHELL MISS M. HARRA.LL MISS S. COX (Part-time) MRS. M. WALKER (Part-time) A.R. ASTON (appointed 17.11.47) (a) Certificate as Sanitary Inspector (b) Certificate as Meat and Poods Inspector 3 SECTION A. STATISTICS AND SOCIAL CONDITIONS. (i) General Statistics. Area in Acres 1,390 Population (Registrar General) 40,780 Number of inhabited houses (approx.) 11,051 Rateable Value - General Rate £543,294 Sum represented by Penny Rate £2,234 Amount of Outdoor Relief £5,663 (ii) Social Conditions. The Manager of the local Employment Exchange states that there was an increase in employment in the area during 1947. 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, approximately 2,000 more men, and 300 less women, were employed than in 1946. The total figure of employed persons was some 6,000 more than in 1939. The percentage figure for unemployed was very small. Towards the end of the year, signs of a desire to return to work on the part of married women was noticed, and the numbers on the womens' register was higher than for some years. As a result of the raising of the school leaving age, there were only 222 leavers as compared with the usual 600, so that the supply of juvenile labour was not nearly sufficient to meet the demand. I am indebted to the Manager of the local Employment Exchange for this, and other useful information, and for the ready co-operation of his department throughout the year. 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 838 432 406 Illegitimate 22 20 12 870 452 418 Birth Rate (Registrar General) per 1,000 population 21.33 Still Births - Total Male Female Legitimate 14 6 8 Illegitimate 1 – 1 15 6 9 Rate per 1,000 total (live and still) births 16.95 4 (iii) Extracts from Vital Statistics for Years 1943 to 1947 inclusive. 1943 1944 1945 1946 1947 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 588 291 297 525 265 260 529 272 257 738 367 371 838 432 406 Illegitimate 49 21 18 53 27 26 64 34 30 56 34 22 32 20 12 TOTALS 637 322 315 578 292 286 593 306 287 794 401 393 870 452 418 Birth rate (R.G) per 1,000 pop. 17.77 16.62 16.58 20.02 21.33 STILL BIRTHS Legitimate 20 14 6 17 8 9 21 12 9 24 13 11 14 6 8 Illegitimate 3 2 1 1 – 1 1 – 1 5 2 3 1 – 1 TOTALS 23 16 7 18 8 10 22 12 10 29 15 14 15 5 9 Rate per 1,000 (live and still) births 34.84 30.20 35.77 35.24 16.95 DEATHS 500 226 274 474 239 235 505 262 243 460 236 224 495 228 267 Death rate (R.G.) per 1,000 pop. 13.92 13.63 14.12 11.60 12.13 5 Deaths - Total Male Female 495 228 257 Death rate (Registrar General) per 1,000 population 12.13 Deaths Rate per 1.000 total (live & still) births. Puerperal Sepsis 1 1.13 Other Maternal Causes – 0.00 (b) Death Rate of Infants under one year of age. All infants per 1,000 live births 19 21.84 Legitimate infants per 1,000 legitimate live births 17 20.29 Illegitimate infants per 1,000 illegitimate live births 2 62.50 (c) Other Deaths - No. of Deaths Deaths from Cancer (all ages) 89 Deaths from Measles (all ages) Nil. Deaths from Whooping Cough (all ages) Nil. Deaths from Diarrhoea (under 2 years 3 of age) Birth-rates, Civilian Death rates, and Case-rates for certain Infectious Diseases in the Year 1947. 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 1931 Census London Adm. County Kingston upon Thames Rates per 1,000 Civilian Population:– Births Live Births 20.5† 23.3 22.2 22.7 21.33 Still Births 0.50† 0.62 0.54 0.49 0.37 deaths All Causes 12.0† 13.0 11.9 12.8 12.14 typhoid and typhoid 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.03 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.09 0.09 0.08 0.08 0.07 smallpox 0.00 0.00 0.00 0.00 0.00 Measles 0.01 0.02 0.02 0.01 0.00 † Rates per 1,000 total population. 6  England and Wales 126 C.Bs. and Great Towns including London. 148 Smaller towns Resi dent Pop.25,000 -50,000 at 1931 Census London Adm. County Kingston upon Thames Rates per 1,000 live Births:– Deaths All causes under 1 year of age 41 47 36 37 22 Enteritis and Diarrhoea under 2 years of age 5.8 8.0 3.7 4.8 3.4 Rates per 1,000 Civilian Population:– Notifications Typhoid Fever 0.01 0.01 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.02 Cerebro-Spinal Fever 0.05 0.06 0.05 0.03 0.00 Scarlet Fever 1.37 1.54 1.37 1.31 0.58 Whooping Cough 2.22 2.41 2.02 2.80 0.93 Diphtheria 0.l3 0.15 0.14 0.14 0.02 Erysipelas 0.19 0.21 0.18 0.22 0.12 Smallpox 0.00 0.00 0.01 0.00 0.00 Measles 9.41 9.13 9.38 5.29 5.37 Pneumonia 0.79 0.89 0.68 0.64 0.47 Rates per 1,000 total (live and still births) Notifications Puerperal Fever 7.16 8.99 6.27 1.21 6.07 Puerperal Pyrexia 6.94X † Per 1,000 related births x Including Puerperal Fever 7 (iv) Causes of Death. Registrar General's Tables All Causes 1943 1944 1945 1946 1947 M. F . M. F. M. F. M. F. M. F. 226 274 239 235 262 243 236 224 228 267 Paratyphoid and Typhoid Fevers - - - - - - - - - - Cerebro-Spinal Fevers - - - - - - 1 1 — — Scarlet Fever - - - - - - - - - - Whooping Cough – – – 1 – – – – – – Diphtheria – – – – – – – – – – Tuberculosis of Respiratory System 12 13 12 7 10 9 6 4 10 7 Other forms of Tuberculosis - 1 1 3 3 4 3 3 1 Syphilitic Diseases 2 2 - 1 3 – 3 1 4 4 Influenza 8 7 2 2 2 — 3 — – 3 Measles - - — - — 2 — – – Acute Poliomyeltis & Polioencephalitis - - - - - - - - - - Acute Infantile Encephalitis - - - - - - - - - - Cancer of B.,Cav. & oesephagus (M) uterus (F) 2 3 5 2 7 1 3 5 4 8 Cancer of Stomach or duodenum 10 5 11 6 7 5 4 7 5 8 Cancer of Breast — 10 — 10 — 6 — 8 13 Cancer of all other sites 25 28 23 19 30 23 34 19 32 19 Diabetes — - 1 — 4 5 3 1 1 Intra-cran, vascular lesions 15 32 18 35 14 36 24 31 30 26 Heart disease 52 67 64 60 69 65 65 64 71 84 Other diseases of circulatory system Bronchitis 6 14 17 20 15 12 11 6 16 20 22 7 9 14 18 8 15 13 21 14 Pneumonia Other respiratory disease 19 1 10 5 15 4 10 14 3 7 16 2 9 1 10 3 12 2 Ulcer of Stomach or Duodenum 3 1 1 1 9 1 8 2 2 1 Diarrnhœa under 2 years 6 1 3 2 1 – – 2 1 2 Appendicitis - – - - - - 1 1 1 – Other digestive diseases 8 2 5 5 3 8 8 5 5 7 Nephritis 4 2 4 6 5 4 1 6 1 4 Puerperal Causes ) Recorded under other headings - 1 - - - - - 1 Other maternal causes ) - 2 — — — 2 — - Premature birth 1 7 5 5 3 — 1 5 1 2 congenital Malformation Birth injuries - - 4 4 7 5 8 2 1 8 Suicide 2 1 2 1 4 3 4 2 4 - Road Traffic Accidents 4 1 4 - - 1 2 1 1 - Other violent causes 2 7 12 16 5 10 1 6 1 2 All other causes - - 16 19 23 19 12 13 10 17 8 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 1947 bacteriological examinations were carried out by Dr. D.5. 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 Food 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 277 Private Cases 196 Maternity Cases 28 Calls for Ambulance not required 14 Calls dealt with for hospitals. County Hospital 16 531 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, and its value is indicated by the fact that 560 cases were carried of which 92 were accident cases within the borough and 12634 miles were covered. This is entirely a voluntary service for night runs and at weekends. There was one paid driver for day duty. 9 (c) Nursing in the Home. (1) General, This is carried out, in the main, byDistrict 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.) 1943 1944 1945 1946 1947 Cases: Cases on books on 1st January 67 67 75 72 101 New cases„ „ 626 609 660 693 704 Results of Cases: Convalescent 466 435 508 488 549 Transferred to Hospital 81 59 56 64 53 Died 77 92 93 101 93 Removed for other causes 2 15 6 11 12 Still on books 67 75 72 101 98 Visits: General Nursing . 16,974 16,979 19,851 19,950 19,832 Casual 150 124 223 187 230 Very valuable service is being rendered by the District Nurses in the care of the aged, sometimes assisted by domestic helps from the Corporation Home Help Scheme. It is interesting to note that one-third of the cases treated by the District Nurses were over seventy years of age. (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. 10 (d) Clinics and Treatment Centres as at 31st December, 1947. Clinic or Dispensary- Where held When held Diphtheria Immunisation Health Centre, Grange Road, Kingston Tuesdays & Fridays at 3.15 p.m. Maternity & Child Welfare Centre do. Tuesdays & Fridays at 2 p.m. do. Burton Road Clinic, Kingston Mondays &. Thursdays at 2 p.m. and Fridays at 9.30 a.m, Toddlers' Clinic Health Centre, Grange Road Thursdays at 2 p.m. (by appointment) Ante-Natal Clinic do. Tuesdays at 10 a,m. and Wednesdays at 1.45 p.m. Post-Natal Clinic do. Tuesdays at 10 a.m. and Wednesdays at 1.45 p.m. (School Clinic ( Minor ailments do. Daily at 9.15 a.m. ( Consultations do. Tuesdays and Fridays at 9.30 a.m. Dental Treatment do. Mondays & Thursdays at 9 .15 a.m. & 1.30 p.m. ana Fridays at 9.15 a.m. Ophthalmic Clinic do. Every Thursday at 10 a.m. by appointment Speech Therapy do. Mondays & Wednesdays at 10 a.m. and 2 p.m. Ultra Violst Light Clinic do. Tuesdays & Fridays at 9 a.m. and 2 p.m. Orthopaedic Clinis Red Cross Curative Post, Coorabe Lane, Kingston By appointment Tuberc ulosis 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. Day Nursery No.5 53/55, Canbury Park Road, Kingston do. Day Nursery No. 6 Messrs. Bentalls, Clarence Street, Kingston Apply Staff Controller, Messrs. Bentalls Kingston Nursing Assoc iat ion (Vol. Committee) 33, Birkenhead Avenue, Kingston Apply to Superintendent for District Nurses 11 (e) Hospitals. (l) Infectious Diseases. An arrangement exists with the Wimbledon Corporation whereby cases may be admitted to the Wimbledon Isolation Hospital, and payment is made by the Kingston Corporation for The maintenance of patients. Owing to staffing difficulties and the need for conservation of accommodation, it has been necessary to send patients to other hospitals. During th e year 52 cases were sent to hospital for treatment or diagnosis, as follows To Wimbledon Isolation Hospital 34 To Tolworth Isolation Hospital 12 To Southall Isolation Hospital 1 To Barnes Isolation Hospital 3 To Wandle Valley Isolation Hospital 2 . (2) Smallpox. The Surrey Smallpox Hospital, East Clandon (Surrey County Council). (3) Other. General Hospitals situated in the Borough available for the District are:- The Kingston County Hospital (Surrey County Council). 'The Kingston Victoria Hospital, supported by voluntary contributions. The Corporation made a contribution of £50 to the Kingston Victoria Hospital during 1947. 12 3. maternity and child walfare. (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 end of 1947, there were five midwives in the Borough who undertook confinements in the home. Complete arrangements for medical assistance, and, if necessary, admission to the Kingston County Hospital, were made by the Surrey County Council, Hospital treatment was provided mainly at the Kingston County Hospital, but, if necessary, cases were transferred to one of the other County Hospitals, The following are the details cf 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 1943 1944 1945 1946 1947 No, notified by Midwives 158 153 132 250 343 No. notified by General Practitioners and Medical Superintendent, Kingston County Hospital 506 408 498 569 537 Total 664 561 630 819 880 The figure of 880 notified births shows a marked increase on the figure for the previous years, and may prove to be a peak figure. 13 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 1943 1944 1945 1946 1947 M. F. M. F. M. F. M. F. M. F. Live Births - Legitimate 291 297 265 260 2 72 257 367 371 432 4 06 Illegitimate 31 18 27 26 34 30 34 22 20 12 Still Births- Legitimate 14 6 8 9 12 9 13 11 6 8 Illegitimate 2 1 1 «=>. 1 2 3 — 1 Totals - Male and Female 338 322 300 296 318 29 7 416 407 458 427 Grand Totals 660 596 615 823 885 a part-time consultants, 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 was one maternal death during 1947. The figures for the years 1942-1946 are given for comparison:- Cause 1942 1943 1944 1945 1946 1947 Cardiac Failure Toxaemia of pregnancy - - 3 2 - Puerperal Sepsis - - - - - 1 Septic abortion 1 - - - - - Septic abortion self-induced 1 1 - - - - 14 (b) (ii) Infantile Mortality. By the Infantile Mortality rate is meant the number of deaths of infants under one year per 1,000 live births in the same period. The following are the numbers of Kingston children who died during 1947 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 3 2 Prematurity. 1 Atelectasis. Birth Injury. Face Presentation. Contracted. 24 hours - 1 month 6 1 Broncho-pneumonia. Enteritis. 1 Empyema. Pneumonia. Prematurity. Eclampsia of mother. 1 Patent intra auricular septum. 1 Intracranial haemorrhage. 1 Fractured skull. Birth Injury. 1 Meningocele. Spina Bifida. 1 month - 1 year 10 2 Gastro Enteritis. 2 Broncho-pneumonia. 1 Hydrocephalus. Meningocele. Spina Bifida. 1 Terminal pneumonia. Marasmus. 1 Acute pyelonephritis of infancy. 1 Acute bronchiolitis. 1 Circulatory failure. Infective enteritis. 2. Broncho-pneumonia. Gastro enteritis The approximate infantile mortality rate for 1947 is as follows and, in addition, the rates for 1643 to 1946 (inclusive) are shown for comparative purposes:- 1943 1944 1945 1946 1947 Kingston-upon-Thames 48 48 43 29 22 England and Wales 49 46 46 43 41 London Area 58 61 53 41 37 The infantile mortality rate of 22 is lower than the rats of 29 for 1946. It is lower than any other infantile mortality rate recorded for Kingston in the last fifteen years. It is lower than the figure of 41 for England and Wales, and lower than the figure of 37 for the London Administrative County Area. This trend is satisfactory and is a measure of the success of infant and maternal welfare practice. Ophthalmia Neonatorum. One case was notified during 1947. 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. 15 (b) (iii) Puerperal Pyrexia. Twenty-eight cases were notified during 1947. An analysis is shown below, together with figures for the years 1943-1946 for purposes of comparison - Cases 1943 1944 1945 1946 1947 (a) Total notified 18 15 23 41 28 (b) Number included in (a) of (i) Kingston residents 4 2 9 9 6 (ii) Extra district residents 14 13 14 32 22 (c) Number included in (a) notified from Kingston County Hospital 17 14 21 39 27 (d) Number included in (a) notified by private doctors 1 1 2 2 1 (e) Number of cases included in (d) removed to hospital other than those included in (c) „ - - 1 2 - 3. (ii) Maternity services. (a) ante-Natal Services. The Ante-Natal Services in the Borough are 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 be admitted to hospital or nursing home outside the Borough. These patients were 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 were 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 Who attended the Borough Ante-Natal Clinics during 1947, and preceding year?, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation:- 1343 1944 1945 1946 1947 No, of patients 144 142 126 232 256 No. of attendances 744 701 671 1,328 1,752 Ante-Natal patients referred to Kingston County HosDital 35 29 23 24 16 Special attention is paid at ante-natal clinics to the general health and nutrition of expectant mothers. Under the Ministry of Food Scheme, all expectant mothers can obtain one pint of milk-daily at reduced rate, and, in addition, are considered priority cases for eggs. Supplementary nourishment in the form of dried milk, etc., was supplied at the Ante-Natal Clinic, either free or at cost prise, dependent upon the cireurostances. There was also a Government Scheme for the distribution of cod liver oil and orange juice, and the Borough provided, on medical prescriptions, other vitamin preparations and Dried Milk with Iron, either free or at cost price, after application of the income scale set out below - No. in family Scale of income per head of family after deducting rent, rates and insurance Full cost remitted Half cost remitted 2 12s. 6d. 14s. 6d. 3 11s. 0d. 13s. 0d. 4 9s. 0d. 11s. 0d. 5 and 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. These visits are made by the Health Visitors, who decide whether home conditions are suitable for confinement at home and a recommendation, in accordance with the home conditions, is forwarded to the Almoner. Other visits to expectant mothers are made by the Health Visitors from time to time, and the following table gives the number of visits that were made during 1947 and preceding years Ante-natal visits by Health Visitors. 1943 1944 1945 1946 1947 No. of home visits (individual cases) 271 159 199 292 266 Total number of visits 395 260 307 449 426 Home helps are also referred to in a later paragraph. (b) Post-Natal Services, The Post-Natal Services are incorporated with the Ante Natal Services and arrangements indicated in Section 1 apply in this section,, The number of mothers who attend the Post-Natal Clinics has been small, but the period under review showed an increase, i.e., 106 cases in 1947 as compared with 53 in 1946. 17 (c) INFANT WELFARE SERVICES (i) Domiciliary Visits. An initial. visit by a Health Visitor is paid to all infants twelve to fourteen days after confinement, where a midwife has been in attendance, or where the confinement took place in the Kingston County Hospital, and twenty-eight days after the birth where a General Practitioner had attended Advice is given by the Health Visitor on infant feeding hygiene, and general management of mother and infant. Further visits are paid according to the domestic circumstances, Where a family doctor is in attendance, no further visits are made unless by request of the mother. In a majority of cases, visits are made every month, or more often, if necessary, during the first six months, and every two months at one year, and every three months between one and five years. More frequent visits are made where there are difficulties 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 1947 and preceding years:- Domiciliary visits by Health Visitors. 1943 1944 1945 1946 1947 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 First visits 643 - 524 - 567 - 770 - 354 - Total visits 2,758 5,358 3,303 7,007 2,662 6,194 3,639 7,434 4,431 7,053 (ii) Infant Welfare Sessions „ Two sessions were held weekly at both the Health Centre and Latchmere School up to 3rd June, 1947. The Assistant Medical Officers attend all these Clinics, examine the children regularly and advise regarding infant feeding, etc. After 3rd June, 1947, premises adapted for use as a temporary maternity and child welfare clinic were occupied, and accommodated three infant welfare sessions weekly. On 5th June also, at the Health Centre, Grange Road, a special Toddlers' Clinic was instituted once a week, in addition to the existing two infant welfare sessions. 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 Officers:- 18  Health Centre Grange Road Latchmere Road School (and later) Burton Road 1943 1944 1945 1946 1947 1943 1944 1945 1946 1947 No. of sessions held 103 102 102 101 124 99 100 98 97 129 No. of new cases seen 383 322 407 435 432 269 195 204 315 380 Total attendances made 7167 5574 5625 6930 7823 6380 4657 4485 5923 8614 No. seen by M .O. 2541 2425 2550 2537 3223 2120 1783 1850 2185 3064 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. 1943 1944 1945 1946 1947 Sold, cost price and Sold, half price 12,817 10,198 11,449 13,087 14,147 Free of charge 2,093 432 182 155 177 The Medical Officer of Health records special appreciation of the help given by voluntary workers at the infant welfare centres,, Many workers have given years of devoted service in various ways. During the year, some of the voluntary workers who were knitting for the clothing stall found themselves unable to continue and we were not able to replace them, hence the drop in numbers of garments sold, as shewn below:- 1943 1944 1945 1946 1947 No. of mothers who bought 256 287 291 346 248 No. of garments 762 823 880 1,091 679 19 (iii) Institutional Treatment for Mothers and Children. (a) There is no provision in the Borough for institutional treatment for mothers and children, provided by the Corporation, but private arrangements exist for the reception of expectant unmarried mothers at the Kingston Deanery Home for Friendless Girls, 18, Richmond Park Road. The home is administered by a voluntary body, the Kingston Deanery Moral Welfare Committee, affiliated to the Southwark Diocesan Association for moral welfare. There are nineteen beds, admission is not confined to Kingston residents, but is extended to girls residing anywhere in, or occasionally beyond, the Southwark diocese. The expectant mothers enter the home about two months before confinement, 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. The girls are given training in mothe rcraft, care of the home, light laundry, etc. A social welfare worker keeps in touch with the girls after they leave the home. There is a permanent staff consisting of Matron, S.C.M. Nurse, House Matron and a cook. The following table shows the numbers of admissions to the home during the past five years:- 1943-59 1944-32 X 1945-50 1946-58 1947-44 * 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 accounts for the low numbers of admissions to the home during 1944. DAY NURSERIES. (b) On 1st January, 1947, there were four day nurseries in the Borough, three 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 Is. per day, per attendance, part of which is recoverable from the Ministry of Health. At Surrey Villa Day Nursery the upper age limit is still three years. The remaining nurseries, Canbury Park and Kilnwood, admit children whose ages ran&e from 1 month to five yearso 20 The following table gives the total attendances from the commencement to date:- Year Surrey Villa St. Pater's Kilnwood Fairfield Kingston Day Nursery Bentalls 1941 873 1,837 — — — — 1942 11,733 9,140 3,155 — — — 1943 10,899 .0,607 9,732 6,533 5,364ł 8,268 ł 1944 8,131 8,173 7,177 9 ,840 8,056 14,655 1945 3,606 3 ,300ø 5,824* 11,024 9,866 17,199 1946 8,570 — 9,156 2,642$ 8,567 16,450 1347 8,164 — 9,741 — 9 ,820 19,079 ł 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 are 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. $ Figures for Fairfield are for 1.1.46 to 31.3.46 when Nursery was taken over by Surrey County Council us a nursery school. It is important to note that, excluding Fairfield for 1946, and comparing the other four day nurseries, an increase of 4,061 occupied places was recorded for 1947. Nursery staff is chosen with special reference to 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, including voluntary workers who contributed much valuable assistance. (c) CARE OF PREMATURE INFANTS. The recommendations of Ministry of Health Circular 2C/44 are followed and records are kept giving details of the number of premature births notified during 1947. They are as follows:- (a) Total number of premature births notified during 1947 born- (1) At home 4 (2) In hospital 23 (b) Number of those born at home- (1) Who were nursed entirely at home 3 (2) Who died during the first 24 hours - (3) Who survived at the end of one month 4 (c) Number of those born in hospital- (1) Who died during the first 24 hours - (2) Who survived at the end of one month 23 21 When the mother and 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 full-time Welfare Worker was granted by the Corporation during the year, approximately 50% of the time of the worker to be spent on Kingston cases. During the pre-natal stages, Health Visitors are ia touch with expectant mothers and, when necessary, contact the grand-parents, welfare vorkers in factories, hospitals, almoners, moral welfare workers and others. Similar contacts are made during the post-natal stages, 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 VISITORS. The changes in the personnel of the Health Visitors are indicated at the beginning of this Report. The Health Visitors are also School Nurses and Child 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 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 birth rate, a considerable strain "as put on the existing health visiting staff in the earlier Part of the year, but the situation was remedied by the appointment of additional health visiting staff in the later months. 22 (v) CHILD LIFE PROTECTION. The duties imposed by the Public Health Act, 1936, are entrusted to the Maternity and Child Welfare Subcommittee 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 shown below. Figures are included also in respect of preceding years for purposes of comparison:- 1943 1944 1945 1946 1947 524 386 283 290 232 The following table gives details regarding numbers of children under the care of foster-mothers, and other relevant information:- 1943 1944 1945 1946 1947 No, on register at beginning of year 35 33 26 20 19 No. of new registrations 9 2 3 5 7 No. ceasing to have charge of infants 11 9 9 6 11 No. on register at end of year 33 26 20 19 15 Total number of children 33 24 22 19 15 The 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:- 23 TREATMENT OF DENTAL DEFECTS (MATERNITY AND CHILD WELFARE ONLY). 1943 1944 1945 1946 1947 Sessions devoted to treatment 21 20 21 19 46 No. treated- (i) Mothers 59 78 51 60 83 (ii) Infants 36 41 39 32 56 Attendances made for treatment 329 357 318 288 521 Fillings- (i) Permanent teeth 40 36 35 40 53 (ii) Temporary teeth 4 33 36 32 29 Extractions- (i) Permanent teeth 242 322 245 307 416 (ii) Temporary teeth 88 60 61 77 106 Other operations- (i) Permanent teeth 14 15 9 64 225 (ii) Temporary teeth 43 101 76 32 79 Supply of dentures 15 9 8 5 39 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 of cost to be paid by the mother is assessed. The total cost of dentures supplied and the amount paid by the mothers is as follows 1943 1944 1945 1946 1947 £ s. d. £ S. d. £ s. d, £ s. d. £ s. d. Total Cost 70 4 11 49 7 10 39 6 9 28 14 3 132 14 0 Contributions by mothers 22 14 0 35 12 3 21 5 8 11 14 3 113 16 7 (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 1947 and preceding years:- 1943 1944 1945 1946 1947 Defective vision — — 1 1 — Squint 26 19 16 14 26 Other conditions 1 3 — 6 4 24 (c) Artificial Sunlight. Children under 5 years of age requiring artificial sunlight treatment are referred from the Infant Welfare Clinic, and the following are the total number of children attending and the total number of attendances during 1947 and preceding years:- 1943 1944 1945 1946 1947 No. of children under five years attending 120 131 72 49 49 Total number of attendances 1,522 1,938 740 481 411 (d) Tonsils and adenoids. Arrangements have been made with the Kingston Victoria Hospital for operative treatment for tonsils and adenoids. The following are the number of children under five, who had operative treatment during 1946 and preceding years. During 1947 no children were sent for operative treatment. 1943 1944 1945 1946 1947 Total number of cases 12 1 2 1 — Total cost £17 2s. £1 8s. 6d. £2 17s. £1 8s.6d. - Contributions made by parents £2 9s.6d. 4s. — — — (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 1947 and preceding years 1343 1944 1945 1946 1947 No. seen by Surgeon 24 27 17 8 12 No. of treatments given by staff 182 263 128 28 47 No. of cases discharged 1 - 4 3 2 No. admitted to Hospital 3 2 1 1 - . 25 (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. (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 fifty per cent. (vii) HOME HELPS. Arrangements have been made in the Borough for domestic assistance to mothers whose confinements 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, 103 applications were received for home or domestic helps. The following table shows the number of cases who applied for home or domestic helps during 1947 and preceding years:- 1943 1944 1945 1946 1947 Home Help Maternity 13 13 26 30 72 Domestic Emergency. - - 11 18 31 In other cases assistance is given by the Queen,s Nurses of the Kingston and District Nursing association. 2 3 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, 1947, 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. 27 ANNUAL REPORT OP THE CHIEF SANITARY INSPECTOR FOR THE YSiiR 1947. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMBS. Mr, Mayor, Ladies and Gentlemen, It affords me much pleasure to present for your consideration the following review of the work of your Sanitary Inspectors for the year 1947. It is submitted in the hope that it will prove informative to the reader, and of some assistance to those who are interested in the subject of sanitation, or what, nowadays, is more familiarly known as environmental hygiene. The Report covers the twenty-ninth year that I have been privileged to serve your Corporation and the people of this town, and for convenience, it is divided into three Sections, viz:- Sanitary Circumstances (Section C); Housing (Section D); and Inspection and Supervision of Pood (Section E). Looking back over the year, there were two periods during which the abnormal weather conditions created unwelcome problems for the department. The first, of course, was that extremely cold period which I believe commenced on 22nd January and continued without a break for over six weeks. During this period, sanitary and water fittings, and plumbing arrangements generally, suffered severely as the result of frost. The second period was the exceptionally hot spell which caused considerable damage to, and loss of, foodstuffs. It was the cause also of a good deal of extra work in the way of inspections necessary to safeguard the food supply. The combined effect of the cold spell and the fuel crisis on the supplies of sanitary fittings and building materials was very noticeable by the late Spring, by which time it was virtually impossible to obtain locally certain earthenware and stoneware fittings. The supplies of plaster board, roofing slates and cast iron pipes and fittings also were stringently restricted. The sense of frustration which resulted from these several circumstances may well be understood, as well as the fact that it was not overcome without effort. 23 - 2 - In april 1947, Mr. S.S.Herbert, who had returned from H.M.Forces in February 1946, resigned on his appointment as Additional Sanitary Inspector to the Folkestone Corporation. Mr.N.L.G.Tubb was appointed Additional Sanitary Inspector in September 1947. The vacant post of Junior Sanitary Inspector was not; filled by the end of the year. In conclusion, I desire to offer my personal thanks to the Chairman and Members of the Public Health Committee, for their continued consideration and support, and to all ray colleagues, without whose loyal help the work outlined in the Report could not have been accomplished. I have the honour to remain, Mr. Mayor, Ladies and Gentlemen, Yours faithfully, HAROLD T. PERRY. Chief Sanitary Inspector. Guildhall, Kingston-upon-Thames. May 1948. 29 SANITARY CIRCUMSTANCES. Section C. 1. (i) Water Supply. The Metropolitan Water Board is responsible for the public water supply in the borough. Throughout the year the water supply has been satisfactory both as to quality and quantity. The Board's chemists and bacteriologists carry out extensive and thorough examinations of the raw water before treatment, and further examinations are made during the purification processes and finally, complete tests are made of the water as it enters the supply mains. The water in this area is not liable to plumbosolvent action. No complaints regarding the public water supply were received during the year, and accordingly it was not necessary to consult the Board regarding the piped supplies. Although there are over 11,000 inhabited premises in the borough, only 13 were known to be supplied with water derived from wells. Of these 13 premises, 7 are provided also with a piped supply from the Board's mains. The other 6 rely entirely upon the wells. These wells are all of the 'shallow' type, i.e., the well is no- deep enough to penetrate the impervious stratum, and therefore, the well is fed from the surrounding area and is liable to become polluted. Samples are taken from these wells periodically and are subjected to bacteriological examination. Usually the discontinuance of the use of well water has been brought about as the result of this periodical examination, and it is not uncommon to find that the occupants of the houses concerned were drinking the water in complete ignorance of the fact that it was not a safe supply. (ii) Drainage and Sewerage. The erection of the new Electricity Power Station and the consequent interruption of work of sewage purification, rendered this task more difficult than ever during the year. Owing to the removal of the filter beds, the site of which was required for the generating station, all the sewage had to be specially treated and chlorinated before discharge into the river. In connection with the proposal to convey the sewage to the West Middlesex Main Drainage Board's Works at Mogden, a commencement was made with the new pumping main from the Sewage ¥orks in Downhall Road to the head of the sewer in Hampton Wick on the Middlesex side of the River Thames. 2. RIVERS AND STREAMS. The borough is bounded on the West by the River Thames and the only other watercourse is the Hogsmill River which is a tributary of the Thames, which it joins at a point a short distance above Kingston Bridge. The effluent from the Sewage Works continued to be discharged into the river and every endeavour was made to maintain a standard of purification acceptable to the Thames Conservancy Board, which is the Authority charged with the duty of prevention 30 of pollution of the Thames and its tributary, the Hogsmi11. This latter river receives the effluents from the sewage works within the boroughs of Maiden and Coombe, and Epsom and Ewell. The proposed widening of the Hogsmill River was not commenced during the year. The number of boats used for human habitation and which are moored within the borough boundary varies from time to time, but seldom exceeds twenty. Control of these craft by the Corporation is very limited as they do not constitute 'houses' for all parts of the Public Health Act 1936. It is probable that some degree of pollution of the river does arise as the result of the use of some of the craft for human habitation, but appropriate action is this respect can be taken only by the Thames Conservancy Board 3. (i) CLOSET ACCOMODATION. Without exception, all closets in the Borough are on the water carriage system. (ii) PUBLIC CLEANSING. The collection and disposal of house and trade refuse is the responsibility of the Borough Surveyor, who states that, after salvable articles have been recovered, the refuse is disposed of partly by burning and partly by tipping, the proportions being approximately 30 to 70 respectively. Some 100 tons of materials are salvaged each month, including waste food suitable for pig-feeding. In pre-war years, much of the waste food was deposited in the household refuse bins, where quite often it proved to be a cause of nuisance and annoyance. This fact is often forgotten by aggrieved occupiers of houses who have reason to complain about waste food bins placed in proximity to their houses. Until a more satisfactory method of collecting the waste household food is evolved, it will be necessary to continue the present method, for it is inconceivable that this material should be burned or be disposed of by tipping. Burning would be an expensive method, and when it is tipped, it encourages the breeding of rodents. Complaints regarding the waste food bins were received during the year, most of them during the short but extremely hot spells of weather which occurred. In an effort to bring about an improvement, arrangements were made for a more frequent collection, and the system of cleansing, and exchange of, food bins received close attention. (iii) SANITARY INSPECTION OP THE AREA. (a) The following is a tabulated list of visits and inspections which totalled 7,172 compared with 6,936 the previous year:- Houses, etc. 919 Drainage 278 Reinspections and Works in progress 3,458 Factories etc. 197 Outworkers 12 Dairies etc. 79 Pood Premises 882 I.D. Enquiries 89 Common Lodging Houses 23 C/Fwd. 5,937 31 Sanitary Inspections of the Area (Cont/d. ) B/Fwd. 5,937 Theatres 11 Verminous Premises 90 Rodent Control 570 Shops Acts 144 Housing Act (Permitted Numbers) 31 Housing Accommodation (Applications) 73 Building Licence Applications 35 Schools 14 Smoke Observations 40 Miscellaneous 227 7,172 (b) 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 altogether comparable with the number served, as the former number may have reference to some notices which were served in a previous year. NOTICES SERVED. Informal. (a) Verbal 555 (b) Written Statutory. (a} Housing Acts — (b) Public Health Acts 8 NOTICES COMPLIED WITH. Informal. (a) Verbal 456 (b) Written Statutory. (a) Housing Acts — (b) Public Health Acts 10 (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 its provisions., Apart from specific instances where complaints were received, circumstances again prevented any extensive improvements being carried out during the period under review. Your Inspectors are responsible also for the administration of the Shops Acts in relation to closing hours, and half day closing of shops, and with respect to holidays and hours of work of shop assistants and young persons. (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. The subject of smoke abatement has not generally aroused much interest in the public mind in the South and for this reason, I am particularly grateful for the encouragement received from your Council in the efforts made to prevent this borough from suffering from the scourge of smoke. 32 Smoke Abatement.(Cont/n.) From correspondence received in the office, however, it is becoming clear that there is a gradual awakening to the reality of the need for concerted action in this important subject. It is gratifying also to find, in conversation with housewives - who are the sufferers from, as well as in many instances the cause of, the nuisance - and factory executives, that they are thinking about the problem and are anxious to avoid causing unnecessary smoke. In Kingston we are fortunate in that we may enjoy clear skies and atmosphere for the greater part of the year for there are no industries such as smelting in the borough. Metallurgical processes are responsible for heavy pollution of the atmosphere with sulphur dioxide, and they continue to so pollute the air the whole year round. But, nevertheless, in this town there is the smoke problem from domestic house chimneys and from time to time this is accentuated by nuisance from factory chimneys. Perhaps because of the comparatively clean atmosphere, it seems that when a factory chimney does offend, it is not long before it is observed by near-by residents, and the attention of the Inspector is drawn to it. Not infrequently the complaint arrives after the offence had been officially observed and appropriate action had been taken. During the year 15 complaints were received and were investigated. It may not be generally known that in legal terms the word 'smoke' includes grit, and this form of nuisance has been met with in several instances. Reference was made in the previous annual report to one such case, and during 1947 the installation of a natural draught griu arrester was completed in connection with the steam raising plant at the laundry premises which were the subject of that reporto The equipment appears to have proved effective and no further complaints have been received. Amongst the complaints which were received was one regarding the emission of grit from a chimney stack of a factory engaged in dyeing and cleaning. Investigations showed that the grit was of heavy character and accordingly was falling within a well defined circumscribed area around the offending chimney. Whilst in this case it could not be considered that the stoking was efficient, there were contributory causes for the nuisance in the form of unsatisfactory fuel and inherent defects in the design of the plant. In order to show that improvement could be effected by more efficient stoking, the co-operation of the Ministry of Fuel and Power was invited. A competent stoker was brought to the factory to demonstrate to the boiler house staff how the furnace should be stoked. During this demonstration firing over a period of 24 hours, the amount of grit emitted was very much reduced. Unfortunately this high standard was not maintained by the normal staff, and the nuisance continued and was not abated at the end of the year. At that time the question of installing a suitably designed grit arrester was under consideration, but there were very considerable technical difficulties in the way of adopting this form of remedy. Arising out of this case and others of less degree of severity, consideration was given to the question of arranging training classes for stokers and boiler house staffs in the town. These consultations were not completed in 1947, but it was hoped that classes would be available in boiler house practice at the local Technical Institute before the following Winter. 33 Smoke Abatement. (Cont/n.) One further case might be reported, this time in connection with a Cinema in the town. The two boilers were using solid fuel of definitely low grade and otherwise unsuitable for that type of boiler. After careful consideration of all the factors, it was decided to convert the boilers to oil firing, and this work was commenced in December 1947. (vii) SWIMMING BATHS AM) POOLS. (a) Public. The Corporation Baths are situate in Denmark Road and comprise two pools, one of which was in use throughout the whole of 1947, whilst the other, which, during the war years had been used for civic restaurant purposes, was brought back into use for swimming in August. During the Winter months this bath is converted for use as a Public Hall for concerts, dancing, etc. The purification and chlorination plant in connection with the baths is modern in d design and quite adequate for the purpose. (b) Private. There are no privately owned swimming baths or pools open to the public, in the borough. (viii) ERADICATION OF BED BUGS. The fact that there were nearly double the number of verminous houses dealt with during 1947 compared with the previous year must not be taken as an indication that this loathsome condition is rapidly increasing generally. The actual numbers were 56 houses in 1947 compared with 29 during 1946, and appropriate steps were taken according to the circumstances of each individual case, to destroy the vermin. 4. COMPLAINTS. Once again there was an increase in the number of recorded complaints compared with the previous year - 920 in 1947 as against 833 during 1946. It is true that the rise was not, so sharp as in previous years, but when one remembers that in 1939 only 207 complaints were received, the fact is brought out clearly that we are a long way from complete recovery from the devastation of the war years. Whilst there was a decrease in the number of complaints in respect of dwelling houses, this type of complaint will doubtless continue at a high level for some years and until the arrears of maintenance can be made good. The increase in the cost of repairs and other overheads is placing a heavy burden upon owners of property subject to controlled rents, and some just settlement of this problem is overdue. In several instances which have come to the knowledge of the Department, the owners of such properties have actually paid out more for maintenance, etc. over a period of years than has been received by way of rente Where there is genuine hardship of this kind, it is not a simple task to effect the necessary repairs and improvements. The following is a brief tabulated list of causes for complaints received during 1947 and the previous year:- 34  1946. 1947. Sanitary Defects 411 357 Rodent Infestation 129 164 Vermin Infestation 21 38 Non-removal of house refuse. 19 25 Defective Ashbins 24 22 Drains and Sanioary Arrangements 131 171 Water Supply 9 17 Overcrowding 12 3 Unpaved Yard and Passage 1 2 Nuisance from Smoke 2 15 Miscellaneous 74 106 833 920 5. RODENT CONTROL. Early in the year 1947 a special Report was considered by the Public Health Committee on the subject of Rodent Control in this borough. In that Report the importance attached to the subject by the Ministry of Food was stressed, together with the request that local authorities should view the work in a serious light. With this object in view the Ministry invited local authorities to adopt a scheme of free service to private dwellings, but to continue to charge for services in connection with business premises. After very careful consideration it was decided not to accept the scheme as outlined by the Ministry, but to adopt a modified plan which, whilst providing for free service to dwelling houses, would not involve so much expenditure on labour, buu would, nevertheless, fulfil the particular needs of this borough. The only additional staff to be appointed was one Assistant Rodent Officer, an additional Operative and a junior clerk. This scheme was approved and the new arrangement commenced to operate on 1st April, 1947. Operation of Scheme. (a) Private Dwellings. Information regarding infestations is obtained either by direct complaint by occupiers or by routine inspections. In both cases the immediate area is surveyed in order to ascertain the extent of the infestation, the probable source and any other information. needed to determine the most suitable action and methods of control. It has been established that the most frequent cause for infestations is the unsatisfactory manner in which poultry are usually kept in gardens. The poultry houses are seldom properly constructed and unused food is allowed to remain in the runs instead of being collected. Another frequent attraction for rodents is food which is strewn about by occupiers for the benefit of wild birds, or which is placed around for domestic pets. Where such causes are found, suitable advice is given to those responsible for the malpractices. Food spilled around waste food bins cannot be ignored as a definite encouragement and food supply for rats. (b) Business Premises. Owing to the very considerable damage and Iobs which may be sustained by the presence of only one rat, in certain classes of business premises, information Regarding infestations is usually readily supplied. In all cases surveys of surrounding property are made and the occupiers of infested premises are informed of the probable cost of treatment if undertaken by the department, and that it is open to them to stain the services of commercial firms if they so desire. A written instruction to the department and acceptance of the 35 Rcdent Control - Business Premises (Cont/n. ) estimate of cost is insisted upon in all cases before treatment is commenced. The service available to business houses in the borough was utilised during 1947 to an increasing extent. Apart from periodical visits, urgent requests for treatment of premises always receive attention at short notice. This is a distinct advantage to the traders concerned and is greatly appreciated. (c) Sewers. There is little doubt that in any old town, and particularly if it happens to be situate on a river or other waterway, sewers are a common source of rodent infestation. It is equally certain that there is a definite connection between surface or ground infestations, and those found in sewers. This has been proved more than once locally. Lack of adequate supervision in the past has led to disused sewer connections being allowed to remain unsealed, thus providing a very convenient means of transit for the rats. Old lengths of drains and sewers also have remained unsealed after they have ceased to function and have been discovered only as the result of investigations into rodent infestations in the immediate locality. The bald statement that the sewers have been treated gives very little indication of the work involved, and the following facts may, therefore, prove informative. Over 600 sewer manholes were baited during 1947; to do this manhole covers were lifted approximately 2,500 times. The length of highway dealt with is over 40 miles. 4 cwt. of bait was prepared and used in the manholes at the rate of 4 ozs. each deposit of bait. 1079 manholes or inspection lampholes were plotted for position on plans. A number of manholes not constructed with benchings were provided with metal wall-trays upon which baits were deposited. The sewers in the central part of the borough received a 'maintenance' treatment and 26% of the manholes baited were found to be infested. In the remainder of the town the sewers received what is technically known as two 'initial' treatments, the first of which revealed evidence of 25% infestation and the second showed a 15% positive result. It will be seen from the above that your Corporation has set a good example as owners, by dealing thoroughly with their sewers. This work and the results achieved will undoubtedly prove of much benefit to the town generally. The usual method of baiting is twice with clean bait and then to follow up with a third bait containing poison. The poison baits are laid only in those manholes where there were 'takes' of the first or second 'clean' baits. (d) Refuse Tips and other Corporation Properties. Periodical surveys were made and infestations dealt with by poison baits or by gassing, according to circumstances. The refuse tips were reported to be free from infestation at the end of 1947. The treatments given during that year proved very effective. 36 Rodent Control - Destruction Methods in Use, The following methods were used either singly or in combination:- Poison baits; Traps; Gassing (Cyanide). Poisons. Basis of Baits. 1. Zinc Phosphide. 1. Sausage Rusk. 2. Arsenic. 2. Stale Bread. 3. Red Squill. 3. Condemned Food 4. Cymag (Cyanide). (if suitable). The approximate number of rats involved in an infestation is calculated from the amount of bait taken, according to a formula based on scientific investigation. It is obvious that this can be but a rough guide, but it is a useful basis on which to work. Statistical Statement - Year 1947. Private Dwellings. Number of premises inspected 155. " " visits 753. Business Premises. Number of premises visited 122. „ „ visits 2786. Total number of Premises Inspected and Visits during 1947:- Number of Visits - Private Dwellings 908 - Business Premises 2908 3816 Prom the results achieved, and the known costs,it is clear the action of your Corporation in authorising the extension of the work has proved to be fully justified. It would appear that the nett cost to the local authority is comparatively small, in spite of the fact that private dwellings have been treated free of cost since the end of March, 1947. 6. INSECT PEST CONTROL. This comparatively new feature of departmental activity consists, in the main, of treatment of food premises and large buildings such as blocks of flats for the eradication of cockroaches, steam flies, beetles, etc. This service fills a much wanted need and is run in conjunction with rodent control work with the same staff for both services. 7. RAG FLOCK ACTS. A special reference was made to the subject of rag flock and other bedding and upholstery fillings in my Report for the year 1946, and no apology is needed for again referring to this subject. It will be remembered that at the end of 1946, the British Standards Institution had under consideration specifications for several types of fillings, and also prescribed tests for cleanliness. 37 The task of finding acceptable formulae was not an easy one and the Technical Commitee and the Advisory Panel, upon both of which I served during 1947, continued their labours in conjunction with the various trade interests, and by the end of the year, considerable progress had been made. Amongst the conclusions reached, the following are definitely important from the public health point of view:- The various chemical tests which were suggested as an index of cleanliness, e.g. free and albuminoid ammonia, nitrates, phosphates chlorine, oxygen absorbed, etc., etc., are of themselves unreliable and unsatisfactory. Samples of fillings tested by these methods in different laboratories seldom give concordant and reproducible test figures. Bacteriological standards would be difficult, if not impossible, to apply in practice. That the main consideration is whether the materials are clean or dirty in the sense in which the housewife regards them as clean or dirty. In other words some sort of washing test, which, in practice gives reliable figures as a measure of the dirt extracted, is the best index of cleanliness. As the result of the foregoing and other conclusions it was agreed to prepare a specification of each type of filling, which would incorporate not only a limit of impurity content as determined by the standard washing test, but also requirements for the necessary cleaning operations during the manufacturing processes. The work was not completed by the end of 1947, but it was sufficiently advanced as to make it a reasonable presumption that the Standards would be approved early in 1948, just about ten years from the time when the matter was first discussed on a wide basis, at the request of the National Bedding Federation. Long before that time, however, public health officers had realised the weakness of the Rag Flock Acts and had urged the Ministry of Health to take appropriate action, but I recall that it was not until 1938 that the Inter-Departmental Committee on the Rag Flock Acts was set up under the chairmanship of The Rt. Hon. Lord Merthyr and I had the privilege of submitting evidence on the matter from the sanitary inspectors' point of view. The outbreak of war in 1939 caused the suspension of activities of the Committee and the Report was not presented until July 1946. It has been stated, probably with a considerable degree of accuracy, that there is no direct evidence of disease or illhealth having been transmitted by dirty filling materials. But it cannot be gainsaid that there is a very reasonable presumption that disease may arise from the use of fillings made from some of the materials I have known to be used in the manufacture of fillings. In this connection the fact must not be lost sight of that the public may spend as much as, or more than, one-third of their time in contact with unclean fillings made up into upholstery, bedding, (including pillows) cushions, etc., and this is all the more important in the case of young infants who, apart from those articles already mentioned, may be exposed to some risk from the almost continuous contact with toys whose outward attractive appearance may completely belie the foul and impure "ature of the stuffing material. That some kind of control Is, absolutely necessary must, is submitted, be accepted, particularly as there is, in the ordinary way of purchasing an article, no opportunity of examining its contents and in any case, a visual examination would not necessarily disclose the presence of potentially harmful impurities. 33 Finally, there is the point of view to be considered of those whose work it is to make up the finished articles from unclean materials, and apart altogether from any question of direct risk to health, of the workers, or the Public, it must be agreed that from the aesthetic point of view, the use of unclean materials is repugnant. All these points of view received careful consideration by the Merthyr Committee, and- also those who have striven to raise the standards, an' the result of their combined work will be watched with interest by all. . It is not too much to hope that in due course legislation will be introduced to give statutory effect to the cleanliness standards in course of preparation, and which are likely to be voluntarily adopted by responsible sections of the trades concerned, when officially adopted as British Standards. Section D. HOUS7 _TG. (a) During 1947, the shortage of building materials and labour continued to have a serious effect upon housing so far as repairs and maintenance were concerned. Until conditions return very much nearer to the normal, it must be clear that recourse to demolition or closing of dwelling houses, can be had only in extreme cases, where there is actual danger to the occupants. For similar reasons statutory action in respect of repairs was limited to the provisions of The Public Health Act, 1936. During 1947, Closing Orders were made in respect of part of each of the undermentioned premises, under the provisions of Section 12, Housing Act, 1936.- No. 6, Grove Crescent (Ground floor flat) No. 215, Richmond Road (Flat over central buildings in yard) No. 52, High 'Street (The greater part of the structure) One Demolition Order was made - in respect of No. 22 Gordon Road. This house had subsided to a marked degree and was no longer safe. Two further houses, which were the subject of Closing Orders in July 1939, and which had become decrepit and unsafe, were also demolished. (b) The following information has been kindly supplied by the Borough Surveyor:- No. of dwellings erected by the Corporation during 1947. New Construction. War Damaged. Houses 12 (built under Cire 92 outside Nil. Borough - Chessington) Flats 55 „ 3 3 No. of dwellings erected by Private Enterprise - 1947. New Construction. war Damaged. Houses 7 Houses 8 Flats 12 Total number of working class permanent dwellings erected by the Corporation since March 1924, up to 3lst December, 1947. New Construction War Damaged. Houses 794 (including 12 out- Houses 8 side borough) Plats 16 Number of Temporary Dwellings completed during 1947. Arcon 79 Aluminium 70 Total 149. Total number of Temporary Dwellings erected up to 51st December,1947. Arcon 132 Aluminium 70 Two year Huts 126 Total 328. (c) During the year, Building Licences were issued to the value of £168,718. It does not necessarily follow that this sum represents the amount expended upon building works in the borough during that year. (d) Special Report to Housing Committee - January 1947. Arising out of consideration which was being given to No. 85, Surbiton Road, the Housing Committee asked for a Report upon the house and on the area immediately around it. The following extract from that Report is included herein as it provided an indication of bousing conditions in an area which might be regarded as an average cross-section of the Borough. The Plan which accompanied the Report and the Statements regarding the Individual Properties in the area are omitted for economy reasons. REPORT OF CHIEF SANITARY INSPECTOR ON AREA ADJACENT TO NO. 85. SURBITON ROAD. In accordance with your Committee's request, I submit the following report which covers an area bounded by parts of Penrhyn Road, Surbiton Road, Beaufort Road, Fassett Road and the whole of Southsea Road as shown on the attached plan. Whilst it has not been possible to make a detailed inspection of the premises, the information afforded will provide your Committee with a general picture of the area. The properties dealt with include the following, which are, in the main, dwelling-houses Nos. 39-97 (odd). Surbiton Road. Nos. 38-76 (even), Fassett Road. Nos. 63-79 (odd), Penrhyn Road. Nos. 1-16 Southsea Road. .The total area is 6.87 acres and within it there are ixty-nine buildings intended for human habitation, of which sixty-seven are actually occupied and housing 102 separate families. Two of the premises, namely, flats over Nos. 59/63, Surbiton Road, are vacant and derelict. In addition to the Premises already mentioned, there are twenty shops, one Iicensed premises, thirteen offices, factories or other places business. The area is, therefore, of a mixed character. 4 0 Generally speaking, the standard of maintenance of the properties is good and, with the exception of three premises which are subject to Saniary Notices an the present time, the properties in Fassett Road and Nos. 87-97, Surbiton Road, call for no further action by the Corporation. The same comment applies to Nos. 63-79, Penrhyn Road, where, with the exception of rooms used for business storage purposes, the property is well maintained. It is in Southsea Road that one finds the lowest standard of maintenance of cottage property in the area and it should be realised that these properties are probably the oldest of any in the area, approaching ninety years. These cottages are already receiving the attention of the Public Health Committee under the provisions of the Public Health Act. It is anticipated that the action already taken, or to be taken, will result in these properties being brought up to a reasonable standard sufficient to tide over the next five or so years. With regard to the shop properties in Surbiton Road, all of which have dwelling accommodation on the upper floors, the general condition varies from that of a high standard, down to the lowest possible standard in the case of Noso 59/63, which require a very heavy expenditure in order to render them fit for habitation# It should be remembered that this terrace received damage as a result of enemy action and that some repairs remain outstanding. No. 85, Surbiton Road, which was the property under consideration when this report was requested, is a large detached house let off at present in thirteen flats or combinations of rocms0 The property is maintained in fair internal condition with the exception of the basement roomso "Externally, repairs are required and this matter is being dealt with by the Public Health Committee. Leaving the question of the physical condition of the premises, it is interesting to note that no case of overcrowding was discovered although it might have been expected in Southsea Roado The following tabulated statement shows the distribution of the number of persons per family and also the number of persons per house. The three highest numbers of persons per house refer to large premises sub-let into flats. persons per family. Families Persons per house. (Sub-divided premises counted as 1 house.) Houses. person per family. 16 1 person per house 2 persons „ „ 32 2 persons „ „ 13 3 „ „ „ 22 3 16 4 „ „ „ 16 4 „ „ „ 12 5 „ „ „ 10 5 „ „ „ 8 6 „ „ „ 6 6 „ „ „ 8 7 „ „ „ — 7 „ „ „ 8 „ „ „ — 8 „ „ „ 3 9 „ „ „ 9 „ „ „ 2 10 „ „ „ <—> 10 „ „ „ - 11 „ „ „ 1 13 „ „ „ 1 17 „ „ „ 1 102 67 Individual Properties. Appended will be found brief statements with regard to the various properties included in the area. January, 1947. Chief Sanitary Inspector. 41 (e) TOWN PLANNING - DRAFT OUTLINE PLAN. Obsolescent Areas etc. Early in the year 1947 your Public Health Committee instructed me to submit comments upon those parts of the Borough which had been included in the Draft Outline Plan as obsolescent areas. Accordingly, a special Report was submitted to the Committee on 10th March, 1947 and the Medical Officer of Health indicated that he agreed with the comments. Report referred to above. In accordance with the instructions of your Committee I submit the following comments upon the Draft Outline Plan, more particularly in regard to obsolescent areas. Beyond a doubt, there may be a definite relationship between redevelopment areas within the meaning of (i) The Housing Act 1936 and (ii) The Town and Country Planning Act, 1944, but it is feasible that blocks of property which are badly laid out, of obsolete development or mainly business in character would come within the scope of the latter Act rather than Section 25 of the Housing Act 1936. For this reason no comment is offered upon the central or business part of the borough, although there is, within that area, residential property which is of a low standard and ripe for appropriate housing action, as and when the opportunity presents it self. Examples of this type of premises are situate as follows:- Young's Buildings, Eden Street. Brook Street. Bishops Hall. Bath Passage. St.James Road. Union Street. Eden Street. Vicarage Road. Water Lane. Approximately 59 low grade occupied houses are within this central area. In the Report already submitted by the Town Planning Consultant, certain areas were set out as being suitable for redevelopment. For convenience it is proposed to comment on each area in the same order as in the previous Report. (i) Canbury Passage area. To the area already dealt with prior to the outbreak of war, and which has been cleared, should be added the following:- Canbury Passage 21 premises,, Canbury Place 2 „ Queens Place 8 „ Walter Street 3 „ Richmond Road 24 „ Total 56 „ (ii) Acre Road etc. area. This area should embrace the whole of Acre Road, Cowleaze Road, Elm Crescent, Elm Grove, and Hudson Road, together with part of Canbury park Road and East Road. In this area there are approximately 325 houses. ' 4 2 (iii) Florence/York Road Area. York Road contains property which is not typical of Kingston,, Built originally for use in connection with the Barracks, these houses are of extremely low standard of accommodation and const ruction., Florence Road is not much better, but contains a different type of house. To this area should be added part of Lowther Road and Elm Roads- Florence Road 20 premises. York Road 76 „ Lowther Road (Part)12 „ Sim Road (Part) 7 „ Total 115 (iv) Borough and Princes Road, Arthur Road area. This is a compact area but it should include part of East side of Park Road:- Borough Road 40 premises. Princes Road 31 „ Arthur Road 24 „ Park Road (Part) 14 „ Total 109 „ (v) Elton Road area. To this area should be added properties in other roads in the immediate neighbourhood as follows:- Elton Road 57 premises. Park Road (Part) 23 „ Orchard Cottages 8 „ Clifton Road 15 „ Total 103 „ (vi) Triangular site - London Road - Coombe Road and Station Road, This also is a compact site and one which has long been due for redevelopment. At the present time it is only partly residential, the bulk of the main frontages being used for business. The approximate number of occupied residential premises in the area is 37o (vii) Washington Road, Hawks Road. Cambridge Road, Norbiton Sports Ground and Bonner Hill Road area. The area as defined would include roads in which the properties are definitely of a higher standard than those envisaged in redevelopment areas. These few roads are:- Portman Road. Piper Road. Linden Crescent. Somerset Road. Rowlls Road. The area as a whole is a large one and in general may be described as being unusual in lay-out when one remembers that the houses were built somewhere towards the end of the last century, when it was common to place as many houses as possible on the smallest area of ground,. Apart from Asylum Road, there are no long blocks of terrace houses. On the contrary most of the houses stand singly or in pairs with reasonable free air space. These houses, however, are ill designed, and whilst some might be capable of being improved, e.g., by the provision of bathrooms, the majority of them are not so adaptable, and future action to be taken must be guided by these and other facts. The following are the roads and premises which should be included in the area:- 43 Kawks Road 62 premiseso Cambridge So ad 25 " Hampden Road 20 " Bonner Kill Road (Part) 25 " Gladstone Road 8 " Cambridge Grove Rdo74 " Vincent Road 36 n Burritt Road 45 " ".Vashington Road 78 " Franklin Road 37 " Asylum Road 33 " Bureka Road 28 " Bxcelsior Road 34 " -l -+. al 505 " (viii) Mill Street area. This area is fairly compact and it contains some quioe old cottages as well as others built towards the latter part of the last century0 The area is ill planned from a lay-out point of view and the design of the houses also is of low standard, so it is one which is ready for redevelopmento Mill Street 66 premises© Mill Place 56 " Fairfield Place 35 H Fairfield South 8 " Grange Road (passage) 12 " Total 177 w (ix) Southsea Road area0 This has already been the subject of a recent reporto Additional area - Victoria Roado Around this road there is a fairly compact area which contains old property although some of the houses have been maintained in a fairly good state, having regard to ageQ Church Road 12 premises0 Albert Road 12 " Victoria Road 24 " Cambridge Road (Part) 18 " Total 66 " Other simi 1 properties - not forming areas0 As one would expect in a town of this character, there are many small groups of, or individual, houses which by reason of age, construction, disrepair etc,, should be included in any review of housing conditions. Accordingly the following figures are included, although it is unlikely that the premises would be dealt with other than as individual unfio houses in due course. London Road 15 premises. Burnham Street 6 „ Can bury Park Road 32 „ Elm Road 128 „ Short lands Road 46 „ Cross Road 24 „ Kings Road (Part) 66 „ Richmond Park Road 9 „ Tudor Road 6 „ New Road 8 „ C/Fwd. 340 „ 44 B/Fwd.340 premises. Gibbon Road 21 „ Beaufort Road 8 „ Bloomfield Road 16 „ Denmark Road 7 „ Alfred Road 29 „ Portland Road 26 „ Palmer Crescent 7 „ Oaklea Passage 17 „ Kent Road 10 „ Fairfield Road 12 „ Fairfield East 28 „ South Lane 4 „ Total. 525 „ In all the areas and individual roads set out above, the total approximate number of sub-standard houses is 2079. It must be emphasized thai, this figure has been reached without any actual survey and only from personal knowledge of the district. Whilst it is, considered that these houses fail to reach what I am sure your Committee would agree is a reasonable standard of fitness for human habitation, yet it must not be interpreted as meaning that the houses are unfit for habitations The information herein will provide a rough indication of the present position, but a true picture can be produced only by a complete surveyc In this connection, I understand that the Report upon Rural Housing (just published) makes reference to the requirements of a fit house, and it is reasonable to expect that the Ministry of Health will soon give formal recognition to a standard of fitness which can be applied nationally. Until such a standard is available, any survey which may be made can be of local significance only, and, therefore, of limited value. (f) AGED AND INFIRM PEOPLE. From time to time, with, I fear, increasing regularity, the sanitary inspectors come across rooms which are occupied by aged and/or infirm people who, for one reason or another, are unable to maintain themselves in a reasonably clean and healthy condition These cases create a problem which cannot be solved by any known text-book procedure. • The conditions, are usually most distressing, and they cannot be alleviated without the exercise of tact and discretion, and the sympathetic action of your officers. During 1947 several cases of this kind were dealt with in this Borough. INSPECTION AM) SUPERVISION OF FOOD. Section E. (a) MILK SUPPLY. The number of dairymen registered under the provisions of the Milk and Dairies Order, 1926 with the Corporation for the sale of Milk at the end of 1947, was 17. (b) Designated Milks. Apart from the Registrations referred to above, Licences were issued to dairymen, (excluding Producers of which there is none in Kingston) permitting the sale of Designated Milks. The details are as follows:- 45 Designated Milk Licences. Tuberculin Tested Pasteurised To Pasteurise 1 – Deal 7 6 Supplementary 6 4 (c) Bacteriological Examination of Milks During the year 1947, 73 samples of milk were submitted for examination and were sent to The Clinical Research Association Laboratories and/or The Public Health Laboratories, Epsom. The milks are usually examined for the present of B.Coli; the Plate Count (i.e. the number of bacilli); and the Methylene Blue Reductase test, according to the type of milk. The results were very satisfactory, only one sample showed a high plate count, and two were reported as containing B.Coli. All the samples submitted to the Methylene Blue test proved satisfactory. (d) Biological examinations for the presence of Tuberculosis. Two samples of milk were submitted during the year, and in neither sample was the presence of tubercle bacilli confirmed, (e) Pasteurised Milk. Milk can be sold as 'pasteurised' only if it has been' heattreated according to the conditions attached to the Licence, especially in relation to temperature and time period The test which is used to ascertain whether the milk has been adequately heat-treated is that known as the 'Phosphatase' teste Forty-nine samples were submitted for examination and all of them proved satisfactory (f) ICE CREAM. BACTERIOLOGICAL EXAMINATIONS. The Ice-Cream (Heat Treatment) Regulations 1947, made by the Minister of Health, came into force, with certain exceptions, on the 1st May These Regulations were brought about, in part at least, by pressure of public opinion, and whilst the powers vested in local authorities by the Regulations are not all that public health officers hoped for, they represent - as the Minister stated in the accompanying Circular - as much as it was practicable to enforce at the time The Regulations lay down no bacteriological standard for icecream, but the application of a modified Methylene Blue test, such as is used in connection with samples of milk, was suggested as a guide. Subject to the results obtained from this colour test, the ice-cream should fall within one of four suggested Grades, and if samples from a particular source consistently fail to fall within Grades I or II, the Minister states that it would be reasonable to regard this fact as an indication that all was not well with the Process of manufacture. Fifty-eight samples were examined during 1947 with the following results:- GRADES. I II III IV 13 17 18 10 Total 58 46 Ice Cream (Cont/d.) Of the 10 samples placed in Grade IV, 9 were of icecream produced outside the borough. The colour test referred to above is not suitable for the examination of flavoured and coloured ice-cream, or of chocolate covered ices The dyes and the chocolate interfere with the operation of the test and accordingly any such samples are submitted to the Plate Count and are examined for the presence of B, Coli as alternative tests. Five samples were thus examined, and in two instances unsatisfactory reports were received. (g) MEAT AND OTHER FOODS. (i) Slaughterhouses. There are no licensed slaughterhouses in the borough. (ii) Meat Depot. There are no changes to record in the arrangements for the distribution of meat in this area® The Ministry of Food Meat Depot in Wood Street, serves the needs of the Boroughs of Barnes, Kingston, Maiden and Coombe, Richmond, Surbiton and Wimbledon, and the Urban District of Esher. Having regard to the wide are involved, it will be understood that a very large amount of meat, including offals, passes through this depot each week. The quantity distributed during 1947 was approximately 11,000 tons. The inspection of this food requires daily visits, but apart from one period in the year when, owing to a strike, a considerable quantity of meat and offals remained overlong at the Depot, the amount of food condemned as unsound is very small, when compared with the total quantity handled,, On the occasion of the strike, the meat and offals remained in the closed Depot until arrangements were made for distribution by the Military Authorities. By this time, there was some deterioration in the condition of the meat, all of which had to, be closely inspected before being passed for human consumption,, As might be expected, the loss of offals was high, nearly one ton being totally unfit when examined, The urgency of this work caused considerable additional calls on the time of the inspectors, but their willing help enabled the meat to be cleared with the utmost dispatch and thus an even greater potential loss of valuable food supplies was avoided,, It need hardly be pointed out than the handling which is necessary for the proper examination of meat and offals in such a state, is a far from agreeable occupation. The loss occasioned by decomposition in transit during spells of hot weather indicates once again the need for improvement in methods of transport of food, particularly meat and offals. The attention of the Ministry of Food was drawn to the very unsatisfactory condition of the meat transport vehicles, and also to the unsuitable manner in which the carcases were packed. Some attention was directed to this matter, but, a Permanent improvement has not been effected yet in this area. (iii) UNBOUND FOODS. The following is a tabulated statement of foodstuffs condemned during the year, together with the cause for condemnation:- 47 Tabulated List of Condemned Foodstuffs showing cause for Condemnation and the Weights. Article of Food. Reason for Action. Weight. Bovine. Beef, Hindquarters Bruised 73 lbs. „ „ Internal Decomposition 4649 „ „ „ Fibrosis 28 „ „ „ Abscess 19½ „ „ „ Decomposition Mould 49 „ Trimmings Decomposition 1625½ „ Fillets of Beef Brine Stain 17 „ Parts of Hindquarters (Veal) Decomposition 26 „ 706 Ox Tails „ 1978 „ 24 Skirts „ 26½ „ 81 Kidneys „ 104 „ 19 Livers „ 169 „ Kidney Knob Nephritis 5 „ Liver Abscess 9 „ Mutton Shoulders Abscess 20½ „ Leg of Lamb „ 4½ „ Loin „ „ 2½ „ Trimmings Brine Stain 5 „ „ Contaminated by foreign matter 3 „ „ Black Spot Mould 87 „ Parts of Carcase Decomposition 1849½ „ „ „ „ External Bruising 42½ „ Liver Distomatosis l½ „ „ Mould & Decomposition 8½ „ Canned Goods Meat - 2467 tins Blown, Decomposition etc. .7965½ „ Fish - 1305 „ - do - 420 „ Soup - 241 „ - do - 259 „ Vegetables - 629 tins - do - 1184 „ Fruit - 268 tins - do - 636 „ Milk - 1092 - do - 986 „ Jam & Marmalade - 184 tins - do - 364 „ Macaroni - 10 tins - do - 10 „ Sponge Pudding - 2 tins - do - 3 „ Malted Food - 4 tins Moth Infestation 2 „ Ovaltine - 134 tins Deterioration due co Prolonged Storage 33½ „ Fish. Herrings Decomposition 448 „ Dabs „ 74„ Cod „ 428 „ Sole „ 14 „ "hiding „ 390 „ Kippers „ 406 „ Coal Fish „ 406 „ Skate Wings „ 140 „ Haddock „ 112 „ Mackerel „ 98 „ Miscellaneous. Poulury „ 163½ „ Rabbits „ 404 „ Bacon „ 5½ „ Sliced Beef „ 20 C/Fwd. 25,781 „ 48 Article of Food. Reason for action. Weight. B/Fwd. 25,781 lbs. Miscellaneous.(Cont/d) Beef Sausage Meat Decomposition 94 lbs. Black Pudding „ 100 Oats Contaminated by mice 41 „ Flour „ „ „ 54 „ „ 12 pkts. Damaged by water 36 „ Wheat Flakes - 18 pkts „ „ „ 9 " Deterioration due to prolonged storage 158 „ Barley - do - 20 „ Biscuits - do - 34 „ Cake mixture - 54 pkts. - do - 27 „ Sauce " 37 " - do - 9 „ Semolina Moth Infestation 165½ „ Rusk - 27 pkts. „ „ „ 7 „ Savoury Mixture 12 pkts. „ „ „ 6 „ Beans Deterioration due to prolonged storage 422 „ Split Peas - do - 622 „ Sugar Damaged by water 26 » Dried Fruit Decomposition 109 " Cheese tt 12 M Oranges tt 275 M Chestnuts Decomposition and nuo weevil 1950 " Eggs - 461 Decomposition Duck Eggs - 20 tt Egg Powder Deterioration due to prolonged storage 41 " Dried Milk - do - 38 " Preserves - do - 190 " Fruit - 2 bottles Decomposition 4 » Preserves - 41 jars Contaminated by foreign matter 48 » Pickles & Sauce - 20 jars Decomposition 21 " G-ravy Browning - 19 jars tt to tal 30,299-5 „ (iv) FOOD HYGIENE. The maintenance of a high standard of hygiene in food premises and of vehicles used for distribution of foods lias always been the aim of the department, and no opportunity has been lost of keeping this important matter in the minds of all persons concerned with the food trades. Structural improvements were not easily obtained owing to building licence limitations, but numerous alterations, small in themselves, were carried out as the result of consultations with retailers. The constant importance of personal hygiene was stressed during the course of routine and special visits to Food premises. (h) POOD & DRUGS ACT. 1938 - ADULTGRATION. During the year 107 samples were submitted to the Public Analyst for examination, and details of the samples are shown in the list overleaf. Food and Drugs Act, 1938. 4 9 Tabulated Statement of Samples taken during 1947. Articles Analysed Report Formal Informal Total Milk 16 29 45 2 not genuine Ice Cream — 6 6 Genuine Pork Sausage Meat — 1 1 " Beef " " 1 3 4 2 not genuine Beef Sausage 1 3 4 Genuine Meat Broth — 1 1 " Meat Paste — 2 2 " Anchovy Paste — 1 1 " Cocoa — 4 4 ½ Drinking Chocolate — 1 1 Incorrect label. Coffee — 1 1 Genuine Chocolate Cup — 1 1 " Jam _ 6 6 " Marmalade — 1 1 " Vegetable Soup — 1 1 " Baking Powder — 2 2 " Pepper — 2 2 " Maclean Powder — 1 1 " Malted Milk _ 1 1 " Rivitone Tonic _ 1 1 " Butter 1 1 2 " Self Raising Flour 1 _ 1 " Golden Raising Powder _ 2 2 " Halt Cho co Spread _ 1 1 " Malt Tabs — 1 1 " Grape Puree — 1 1 " Cinnamon — 1 1 " Rum Flavouring — 1 1 " Mustard — 1 1 " Bicarb.of Soda — 1 1 " Malt Vinegar — 1 1 " Non-brewed Vinegar _ 1 1 " Gelatine — 3 3 " Aspirin Tabs. — 1 1 " Curry Powder — 1 1 " Arrowroot — 1 1 " Table Jelly _ 1 1 " Total 20 87 107 ) With five exceptions, all the samples were reported as genuine. The two samples of milk shown as not genuine were derived Room a milk supply produced in Hampshire. The first was taken during a complete check on all the suppliers to one dairy in Kingston, and it contained 4% added water. A formal sample taken subsequently from the same supply was found to contain 5% added water. An appeal to cow sample taken at the Hampshire farm contained no added water, but the 'fat' content was high (4.07%) whilst the 'solids not fat' were low (8,14%), Having regard to all the circumstances of the case, a warning was sent to the Producer and appropriate information was passed to the Hampshire 50 Pood and Drugs Act. 1938 (Cont/n.) War Agricultural Executive Committee, in order that the farmer might have the benefit of advice from the officers of that Conmittee. In the case of the sausages, which were deficient in meat content, the relative papers were passed to the Pood Control Committee who instituted legal proceedings against the vendor. A conviction was obtained and the defendant was fined. The label on the drinking chocolate contained a statement that the contents of the tin included milk solids'. It was considered that this term should be used only if the 'milk solids' consisted of all the solids normally contained in whole milk, whereas the milk solids in the sample were probably derived from skimmed milk The matter was referred to the appropriate Department of the Ministry of Pood and at their suggestion was taken up with the Manufacturers. After prolonged discussion a new label was issued, the writing on which complied with the requirements of the Labelling of Pood Order. (i) FACTORIES ACT. 1937. The following are the prescribed particulars to be furnished to the Ministry of Labour and National Service with respect to matters under Part I and Part VIII of the Act, which are administered by the Corporation. PART I OF THE ACT. 1. INSPECTIONS. Premises No on Register Number nf Inspections. Written Notices. Prosecutions Factories in which Secs.l, 2,3,4 & 6 are enforced by Corporation. 57 23 2 — Factories not included above in which Sec.7 is enforced by Corporation. 313 174 9 _ Other Premises excluding outworkers. _ _ _ _ (Continued) 51 Factories Act. 1937. (Cont/d.) 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars No. of cases in which defects were found Found Remedied Referred No. of Prosecutions To H.M. Inspector By H.M. Inspector Want of cleanliness 2 2 – 2 – Sanitary conveniences. a. Insufficient 3 3 – 3 – b.Unsuitable or defective c.Not separate 8 8 – 4 – for sexes 1 1 — 1 — Total 14 14 10 PART VIII OF THE ACT. Outwork. Nature of Work. No. of out-workers. Wearing apparel a. Making etc. 9 b. Cleaning and washing – Brass and brass articles 8 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 1 Total 18 The above details are an extract from Form 572 (Revised) and apart from the figures given, there is a 'nil' return in respect of other questions. 52 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, Puerperal Pyrexia. Smallpox. Paratyphoid Fevers. Enteric or Typhoid Fever (excluding Paratyphoid). Erysipelas. Malaria. Cholera. Plague. Typhus. Relapsing Fever. Tuberculosis. In 1947 a total of 345 notifications of infectious disease was received, compared with 466 in 1946. The following table gives an analysis of the cases into age groups:- DISEASE CASES DEATHS Age Groups Age Groups Under 1 year 1-2 2-3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total cases notified Cases admitted to Hospital , " - Under 1 year 1-2 2-3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total Scarlet Fever — — 1 — 3 10 4 2 2 2 — — 24 18 — — — — — — — — — — — — — Diphtheria — — — — 1 — — — 1 — — — 2 2 — — — — — — — — — — — — — Enteric Fever including Paratyphoid _ — — — — — — — — 1 — — 1 1 — — — — — — — — — — — — — Acute Poliomyelitis — — — 1 — 2 — — 1 1 — — 5 4 — — — — — — — — — — — — — Polioencephalitis — — — — — 1 1 — — 1 — — 3 3 — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 2 16 9 1 — 28 27* — — — — — — — — — — — — — Opthalmia Neonatorum 1 — — — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia 2 — 1 — — 3 — — 1 1 7 4 19 1 2 1 — — — — — — — — 6 13 22 Erysipelas — — — — — — — — 1 1 2 1 5 2 — — — — — — — — — — — — — B. Dysenteria (Sonne) — — — — — — — — — — — — — — — — — — — — — — — — — — — Measles 8 33 35 28 38 66 5 — 5 1 — — 219 13 — — — — — — — — — — — — — Whooping Cough 7 7 5 4 5 10 — — — — — — 38 2 TOTAL 18 40 42 33 47 92 10 4 27 17 10 5 345 73 2 1 — — — — — — — — 6 13 22 * These cases were already in hospital at time of notification. 54 The following table 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) 1923 135 152 7 1929 74 113 1 1930 73 100 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 1947 24 2 1 Scarlet Fever. Twenty-four cases of mild Scarlet Fever were notified, eighteen of which were of school age. No deaths occurred and no "return'' cases. Eighteen of the cases notified were removed to an infectious diseases hospital for treatment and the remainder were treated at home. Diphtheria. Two cases of Diphtheria were notified in 1947. One was a boy (4½ years) resident in the Borough. The other was an adult case from a nearby extra-district military establishment, notified from the Kingston County Hospital out-patients' department, and transferred to an infectious diseases hospital for treatment. One school girl was found to be a diphtheria "carrier", and received hospital treatment. Intensive work was continued 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 1947. 55 DIPHTHERIA IMMUNISATION - 31st DECEMBER, 1947. 0-4 Age Group. Birth date No. comoletely immunised 1947 43 1946 480 1945 411 1944 425 1943 388 1,752 Percentage - 55.1. 5-15 Age Group. Birth date No. completely immunised 1942 406 1941 386 1940 407 1939 383 1938 383 1937 367 1936 373 1935 319 1934 304 1933 242 3,570 Percentage - 78.6. Record of work done at Diphtheria Immunisation Clinics, 1947. Total number of Clinics held 99 Number completely immunised 748 Number of Schick tests 1,138 Number of positive Schick tests and re-inoculations 106 Total attendances 3,807 Average attendances 38.4 56 Poliomyelitis. During the year, five confirmed cases of poliomyelitis were notified, which was a low incidence compared with the prevalence of the disease during the year generally in the country and in the surrounding areas of Surrey. Of the five confirmed cases, four were Kingston residents, and one an extra-district case. They were dealt with as follows:- 1 admitted to Wimbledon Isolation Hospital. 1 admitted to Barnes Isolation Hospital. 1 was an in-patient, and diagnosed at, Kingston County Hospital. 1 was nursed at home. 1 (extra-district) was notified from Kingston County Hospital and transferred to Tolworth Isolation Hospital. There were no deaths in the series. The cases all recovered but with varying degrees of paralysis. Polio-encephalitis. During the year, three cases were notified, but two of them, both adults, were from the Kingston County Hospital, and lived outside Kingston. The remaining case was that of a young boy resident in the Borough, who was treated at Wimbledon Isolation Hospital and returned home recovered. 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 35 years. Many enquiries were made throughout the country in regard to possible contacts, but a direct link of infection was not established. It is satisfactory to note also that no further cases arose, owing to prompt isolation of the patient, and the follow-up of immediate contacts. Measles. There was a decrease in the number of cases of measles notified during 1947, as compared with 1946 (283), the number being 219, of whom 13 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 (66), the majority of the remainder being spread over the 2-5 year age period. 57 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 comparetive figures of notified cases and deaths for the years 1943–1947 (inclusive):– Year Cases notified Deaths Respiratory Nonrespiratory Respiratory Nonrespiratory 1943 63 8 25 1 1944 56 11 19 4 1945 41 12 19 7 1946 41 9 10 3 1947 43 3 17 4 Note - An analysis of the total notified cases in age groups is shown on the following page.) The ratio of non-notified to total deaths is as follows:– 1943 1944 1945 1946 1947 1:8 1:121: 5 1:3 1:7 During 1947 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. 58 NOTIFIED CASKS. AND DEATHS, OF TUBERCULOSIS IN 1947 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. — — — 6 8 6 5 3 2 30 — — - 1 1 2 1 2 3 10 F. — 1 — 7 3 1 — — 1 13 — — 3 — 2 1 — 1 7 Total — 1 - 13 11 7 5 3 3 43 - - - 4 1 4 2 2 4 17 (b) Non- re spiratory M. — — — — — — — — 1 1 — 1 — — — — 1 — 1 3 F. — — — 1 — — 1 — — 2 — — — — — 1 — — 1 Total - - - 1 - - 1 - 1 3 - 1 - - - 2 - 1 4 59 Scabies - During the year the scheme for treating cases and contacts of scabies continued to operate as described in previous reports. The premises described as Coombe Road Cleansing Station were vacated on 19.4.47, as the accommodation was required by the Kingston Victoria Hospital. It was found possible, however, to establish the station in a building at Burton Road which was erected during the war for civil defence purposes, and the Cleansing Station re-opened there on 28.4.47. On the 31st. December, 1947, Regulation 33A of the Defence (General) Regulations, 1939, under which the Scabies Order was made, expired, and accordingly the Scabies Order ceased to be operative after that date. The Regulation, and the Scabies Order, were introduced as an emergency war-time measure to combat an exceptional increase of scabies, which threatened to be detrimental to the war effort. The Minister of Health was of the view that it would not be warrantable to keep in force, any longer, the drastic powers of entry into residential premises, and of compulsory examination and treatment, which were justified under the stress of war. Accordingly, there was, after 31st. December, 1947 a reversion to the normal statutory powers, as contained in the Public Health Acts for dealing with verminous condit ions. It was not necessary during 1947 to invoke the special powers given under the Scabies Order for the examination of persons or premises, but active measures were taken to ensure that all contacts were followed up. It will be noticed that the number of cases and contacts treated decreased during 1947, and this was anticipated, but the system of voluntary notification by doctors is continuing, and the service has proved to be of great value. 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 1947, and the fe ur 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 and (later) Burton Road 1943 349 261 - 610 1944 575 368 - 943 1945 Closed 31.12.44 592 - 592 1946 - Closed 31.1. 46 342 342 1947 - - 196 196 60 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 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 1946 Coombe Road Cleansing Station 23 48 77 19 69 106 1947 Coombe Road and Burton Road 10 44 26 23 40 53 Analysis of cases treated during 1944. 1945. 1946 and l947 Year No. of cases treated at Total oases treated First Aid Post "A" First Aid Post "B" Coombe Road Cleansing Station and (later) Burton Road 1944 391 270 - 661 1945 - 341 - 341 1946 - - 152 152 1947 - - 108 108 61 Analysis into acre 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 1946 Coombe Roac Clean sing Station 13 27 32 4 37 39 1947 Coombe Roac and Burton Road 7 25 8 13 28 27 Analysis of contacts treated during 1944. 1945, 1946, and 1947 Year No. of contacts treated at Total contacts treated. First Aid Post "A" First Aid Post "B" Coombe Road Clean sing Station and (later) Burton Road 1944 184 98 ~ 282 1945 - 251 - 251 1946 - - 190 190 1947 - - 88 88 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 1946 Coombe Road Cleansing Station 10 21 45 15 32 67 1947 Coombe Road and Burton Rd. 3 19 18 10 12 26 62 INFESTATION W HEAD LICE. During 1947 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.