AC 4413(1) kingston-upon-Thames kin 22 Royal Borough of Kingston-upon-Thames ANNUAL REPORT 1948 OF THE Medical Officer of Health % AND Chief Sanitary Inspector GUILDHALL, KINGSTON-UPON-THAMES NOVEMBER, 1949 Royal Borough of kingston-upon-Thames ANNUAL REPORT 1948 OF THE Medical Officer of Health AND Chief Sanitary Inspector GUILDHALL. KINGSTON-UPON-THAMES NOVEMBER. 1949 ANNUAL REPORT 1948 TABLE OF CONTENTS Preface. Letter from Chairman of the Public Health Committee, 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 (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. Maternity and Child Welfare- Comment 13 (i) (a) Midwifery Service 15 (b) (i) Maternal Mortality 17 (ii) Infant Mortality 17 (iii) Puerperal Pyrexia 18 (ii) (a) Ante-Natal Services 18 (b) Post-Natal Services 21 (iii) Infant Welfare Services 21 (i) Domiciliary Visits 21 (ii) Infant Welfare Sessions 25 (iii) Voluntary Workers at Welfare Clinics 26 (iv) (a) Institutional Treatment for Mothers and Children 26 (b) Day Nurseries 27 (c) Care of Premature Infants 29 (d) Care of Illegitimate Children 30 (v) Health Visitors 30 (vi) Child Life Protection 31 (vii) Treatment - (a) Dental Treatment 32 (b) Ophthalmic 33 (c) Artificial sunlight 33 (d) Tonsils and Adenoids 33 (e) Orthopaedic Treatment 33 (f) Treatment of Scabies 34 (g) Convalescent Treatment 34 (h) Prevention of Infectious Diseases (i) Diphtheria Immunisation 34 (ii) Vaccination 34 Page 3. Home Helps 35 4. Nursing Homes 35 Rough Graph No. 1 - Birth Rate 12 " No. 2 - Infant Mortality 14 No. 3 - Ante-Natal Attendances 20 " No. 4 - Domiciliary Visits 22 " " No. 5 - Infant Clinic Attendances 24 SECTION C Sanitary Circumstances Introduction 36 1. Water Supply 37 2. Drainage and Sewerage 37 3. Rivers and Streams 38 4. Closet Accommodation 38 3. Public Cleansing 38 6. Sanitary Inspection of the Area 39 7. Shops and Offices 39 8. Factories Act, 1937 40 9. Camping Sites 41 10. Smoke Abatement 41 11. Swimming Baths and Pools 42 12. Eradication of Bed Bugs 42 13. Complaints 42 14. Rodent Control 42 15. Insect Pest Control 43 SECTION D Housing, Statistical Information 44 Housing Act, 1936 44 SECTION E Inspection and Supervision of Food (a) Milk Supply 45 (b) Designated Milks 45 (c) Bacteriological Examination of Milks 46 (d) Pasteurised Milk 46 (e) Ice Cream Bacteriological Examination 46 (f) Meat and other Foods 47 Tabulated list of condemned foodstuffs 48 Food and Drugs Act, 1938 - Adulteration 50 Food Hygiene 52 SECTION F Infectious Diseases Notifiable Diseases 53 Table of Notified Diseases during 1948 54 Comparative Statement of Notifications of Scarlet Fever, Diphtheria, and Enteric Fever 55 Scar1et Fever 55 Diphtheria 55 Table of the state of Diphtheria Immunisation during the years 1946, 1947, and 1948 56 Poliomyelitis 57 Measles 57 Tuberculosis 57 Tuberculosis-Table of cases and deaths 58 Scabies 59 Infestation by Head Lice 62 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OP THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES . ANNUAL REPORT„ 1948 Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for 1948, which is in similar form to that for 1947, and is confined to essential matters relating to the Public Health and Social Medicine. VITAL STATISTICS. Population - The Registrar General's estimate of the population for 1948 is 40,780 which is the same figure as that for 1947. Live Births - The number of live births for 1948 is 722 giving a Birth Rate of 17.73 per 1,000 of the population compared with 870 births and a rate of 20.02 for 1947-a decline of 148 births from the post war peak of 1947, Deaths - The number of deaths recorded for 1948 is 455 giving a Death Rate of 11.17 compared with 495 and a Death Rate of 12.13 for 1947. Excess of Births over Deaths. The excess of births over deaths in 1948 is 267 compared with 375 in 1947. The Infant Mortality Rate - The number of deaths of infants under one year of age in 1948 is 17, giving a rate per 1,000 total (live and still) births of 23.04 as compared with 19 infant deaths and a rate of 21.84 in 1947. The Causes of Death-The main conditions causing death as recorded in the table for 1948 are-Heart disease 135; Cancer 83; and Intra-Cranial Vascular Lesions 44. Infectious Disease - The number of notifications of infectious disease 1948 was 487 as against 345 in 1947. The increase was due to the high incidence of whooping cough. There has been a remarkable diminution in the incidence of infectious disease generally over the last ten years. In particular, in 1948 for the first time, no cases of diphtheria were notified throughout the year. The absence of deaths under 2 years of age from enteritis and diarrhoea is also recorded with satisfaction. There was an increase in the number of cases of Respiratory Tuberculosis notified as also in the number of deaths from the same cause. HOUSING. The need for adequate housing accommodation continues to be most pressing. The damaging effects of inadequate housing conditions is still a major factor in many of the health problems which are brought to our notice. Notwithstanding what has already been done to rehouse the most urgent cases, the provision of satisfactory homes for the new families is and will continue to be, a most urgent problem., THE NATIONAL HEALTH SERVICE ACT. 1946. July 5th. 1948 saw the beginning of the operation of most of the provisions of this Act, which profoundly alters the administration of much of the work formerly undertaken by your Council. HOSPITALS. General - The Kingston County Hospital and the Victoria Hospital passed into the control of the newly formed Regional Hospital Board, and both Hospitals are grouped in the Kingston Group Hospital Management Committee. Admissions to these hospitals continues in similar manner as before the change. Infectious Disease - The Wimbledon Isolation Hospital which had been receiving infectious cases from Kingston, also passed under the control of the Regional Hospital Board. After a period of transition it was decided to send Kingston cases of infectious disease to Tolworth Isolation Hospital in the first instance. This change "brought to an end a long and valuable period of service to Kingston by the Wimbledon Corporation, and their Medical Officer of Health. Since 1920 by mutual agreement, Kingston cases had been accommodated in the first instance at the Wimbledon Hospital, where they received all necessary nursing and medical or specialist care. The professional and administrative collaboration between your Medical. Officer of Health and the M.O.H. of Wimbledon and his staff, has been at all times very close and successful. I wish to record my personal appreciation of this important service, rendered to the Royal Borough of Kingston upon Thames, by Dr. Ellis, the Medical Officer of Healtti of Wimbledon, Dr. Doody, his deputy, and the Matron and Staff of the Isolation Hospital. MATERNITY AND CHILD WELFARE. The responsibilities for the general services given under the title Maternity and Child Welfare also passed from the Council to the Surrey County Council on July 5th. Later in the report I make observations In more detail upon the effect of the transfer and refer to some of the work done. Here, I take opportunity most gratefully to record my personal appreciation of the encouragement and support I have always received from your Council, and the Chairmen and Members of its Public Health Comn ittee and Sub-Committees, in carrying out my duties as Maternity and Child Welfare Officer. The keen interest displayed and the policy followed by your Council has contributed largely to the Health and Welfare of Mothers and young children in the Borough, in which work I am happy to have taken part. Much important Public Health work remains with the Council as the Local Sanitary Authority, in the Environmental Field, Food, Prevention of Disease and Health Education, Housing, Special Problems of Aged Persons, and others. The incidence of Infectious Diseases is changing„ As old enemies of the Public Health are conquered, new threats appear, and in turn will be overcome. I record my thanks to my senior colleagues and all members of ray staff for their hard work and co-operation throughout the year. I have the Honour to be, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, J.W. STARKEY Medical Officer of Health. Letter from the Chairman of the Public Health Committee. Alderman Mrs. E.H.R. Oldfield, M.B. Ch. B. D. P. H., J. P. (Ex Mayor) To the Mayor, Alderman and Councillors of the Royal Borough of Kingston-upon-Thames. Mr. Mayor, Ladies en d Gentlemen, I am particularly pleased to add a few words to this Annual Report of 1948, as, during that year, I had the honour to be Mayor, as well as Chairman of the Public Health Committee, and had a unique opportunity of seeing every section of the community at work and play. This is the last time "that this report will include Maternity and Child Welfare Services, since, with the Ambulance Service, they passed to the County Council on 5th0 July. The Corporation handed over with regret, feeling that local people best know the needs of their own area, and that we became but one of many units in the County. We are gLad that Dr. Starkey has become Divisional Medical Officer and will continue to make Kingston's interests his ooncern, and to propose improvements as they become necessary„ We are proud of the services we handed over, but well know that they must not be allowed to remain static. The important and ever-changing branch of the work dealing with Infectio\3S Diseases has been greatly altered by the introduction, in which I can claim same small share, of Diphtheria Immunisationo I would like to add, to that of the Medical Officer of Health, my tribute for the services rendered to our town, by the Wimbledon Isolation Hospital, their Medical Officer of Health, and his assistants, particularly because in the years before Dr. Starkey came to Kingston, we had occasion to use that Hospital a great deal more than of late„ It would take too long and use too much space to draw attention t o all the important factors in the report, so I will conclude by saying that the Committee, and, indeed, the whole Council, recognise the great work in the interests of the Royal Borough done by the Medical Officer, the Chief Sanitary Inspector and the whole Public Health Department, not forgetting the voluntary committee and helpers at the Clinics. (Sgd.) ELSPETH H.R. OLDFIELD. Chairman. 1 1948 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health, Maternity and Child Welfare Officer and Divisional School Medical Officer ; J. W. STARKEY, M.B., Ch.B. (Edin. ),D.P.H. Assistant Medical Officers; ØW.H. KINSTRIE, M.B., Ch.B. (Edin.). D.P.H. ØVALERIE WILLS, M.D., (Prague) Consultant under Public Health (Notification of Puerpera Fever and Puerperal Pyrexia) Regulations 1926; J.V. O'SULLIVAN, M.D., F.R.C.S., F.R.C.O.G. Dental Surgeons ØL. 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. (a) (b) A. CLEGG, M.R.San.I. (a) (b) J.B. FACER, A.R.San.I. (a) (b) N.L.G. TUBB, M.R.San.I. (a) (b) Junior Sanitary Inspectors (vacancy) Assistant Rodent Officer; F.W. STAGG Senior Health Visitor; ØMISS F.I. ARNOLDs, S.R.N., S.C.M., H.V.Cert. Health Visitors; ØMRS o A.M. BAKER, S.R.N.S.C.M.,H.V.Cert. ØMISS E. EVANS, S.R.N., C.M.B., Cert.Part I, H.V.Cert. ØMISS E.D. WOODLEY, S.R.N., S.C.M., H.V.Cert. ØMISS K.M. WRIGHT, S.R.N., S.C.M., H.V.Cert. ØMISS E. LEWIS, S.R.N., S.C.M., H.V.Cert. Day Nursery Matrons; ØMRS. M. SHEPHERD, S.R.C.N. ØMISS M.E. HARVEY, N.N. (College Trained) ØMISS D. DENNIS, S.R.F.N. ØTransferred to Surrey County Council on 5th. July, 1948. (a) Certificate as Sanitary Inspector. (b) Certificate as Meat and Foods Inspector. 2 Administrative Officer; * F.D. HARVEY, M.R.San.I. (a) (b) Clerical Staff as at 31st. December, 1948 MRS. D.A. PATRICK (resigned 25.6.48) MISS C.L. FOISTER. *MISS V. NEELD MISS B.M. JERVIS ØMRS. I. ROOBOTTOM P.M. DALE ØMRS . V. ETHERIDGE MISS A.M. LAMING- (resigned 21.5.48) MISS J. MITCHELL (resigned 22.10.48) ØMISS M. HARRALL ØMISS S. COX (Part-time) MRS. M. WALKER (Part-time) (Resigned 13.2.48) A.R. ASTON MISS J. DILLIWAY (appointed 6.9.48) ØMISS B. STRINGER ØMRS. E. LAWRENCE (part-time) (appointed 16.2.48) (a) Certificate as Sanitary Inspector (b) Certificate as Meat and Poods Inspector *Prom 5th. July, 1948 subject to a sharing arrangement with the Surrey County Council. ØTransferred to Surrey County Council on 5th. July, 1948. 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.) 11,115 Rateable Value-General Rate £ 540,822 Sum represented by Penny Rate £ 2,287 (ii) Social Conditions. I am indebted to the Manager of the local Employment Exchange for the following information regarding employment in his area which includes the Boroughs of Kingston, Maiden & Coombe, and Surbiton, and the Urban District of Esher. Unemployment during 1948 did not exceed 1.2% of the industrial population at any time, and the greater part of this was short term unemployment of two weeks or less. On the 5th. July, 1948, the National Insurance (1946) Act came into force, and this had the effect of bringing many more workpeople than hitherto, within the scope of unemployment insurance. It was possible to find alternative employment for the majority of the redundancies caused by the removal of Messrs. Ley lands from the area before they actually left this firm, and Messrs. Hawker (Aircraft) Ltd. vho took over the factory, were able to transfer their Kingston domiciled workpeople from their Langley factory as well as taking on some of the ex-Leyland people. There was a noticeable falling off in demand for women factory workers, but the demand for women to work in shops, laundries, and offices remained steady. The supply of daily domestic workers exceeded the demand for the first time in some years. The supply of juvenile labour was not nearly sufficient to meet the demand, a total of only 85 boys, and 65 girls, leaving Kingston schools during the year. The principal industries of the area, which is still in the main of a residential character, are Building, Motor Engineering, general engineering, and the construction and repair of aircraft. (iii) Extracts from Vital Statistics of the Year. Live Births - Total Male Female Legitimate 677 345 332 Illegitimate 45 21 24 722 366 356 Birth Rate (Registrar General) per 1,000 population 17.73 (iii) Extracts from Vital Statistics for Years 1944 to 1948 inclusive. 1944 1945 1946 1947 1948 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS. Legitimate 525 265 260 529 272 257 738 367 371 838 432 406 677 345 332 Illegitimate 53 27 26 64 34 30 56 34 22 32 20 12 45 21 24 TOTALS 578 292 286 593 306 287 794 401 393 870 452 418 722 366 356 Birth rate (R.G.) per 1,000 pop. 16.62 16.58 20.02 21.33 17.73 STILL BIRTHS. Legitimate 17 8 9 21 12 9 24 13 11 14 6 8 16 7 9 Illegitimate 1 - 1 1 1 5 2 3 1 - 1 - - - TOTALS 18 8 10 22 12 10 29 15 14 15 6 9 16 7 9 Rate per 1,000 (live and still) births 30.20 35.77 35.24 16.95 21.62 DEATHS 474 239 235 505 262 243 460 236 224 495 228 267 455 227 228 Death rate (R.G.) per 1,000 pop. 13.63 14.12 11.60 12.l3 11.17 5 Still-Births- Total Male Female Legitimate 16 7 9 Illegitimate _ _ _ 16 7 9 Rate per 1,000 total (live and still) births 21.62 Deaths Total Male Female 455 227 228 (a) Death rate (Registrar General per 1,000 population 11.70 Deaths Rate per 1,000 total (live & still) births Puerperal Sepsis 1 1.35 Other Maternal Causes _ 0.00 (b) Death Rate of Infants under one year of age. All infants per 1,000 live birth Legitimate infants per 1,000 17 23.55 legitimate live births 16 23.63 Illegitimate Infants per 1,000 illegitimate live births 1 22.22 (c) Other Deaths-No. of Deaths Deaths from Cancer (all ages) 83 Deaths from Measles (all ages) _ Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) _ Birth-rates, Civilian Death rates, and Case-rates for certain infectious diseases, in the Year, 1948. 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 births Rates per 1,003 Civilian population:- Live Births 17.9(a) 20.0 19.2 20.1 17.73 Still Births 0.42(a) 0.52 0.43 0.39 0.39 Deaths All Causes 10.8(a) 11.6 10.7 11.6 11.17 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.01 0.00 Contd. 6 England and Vales 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 Deaths(cont.) Tuberculosis 0.51 0.59 0.46 0.63 0.59 Influenza 0.03 0.03 0.04 0.02 0.05 Smallpox _ _ _ _ 0.00 Acute poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 0.02 Pneumonia 0.41 0.38 0.36 0.54 0.47 Notifications (corrected) Typhoid fever 0.01 0.00 0.01 0.00 0.00 Paratyphoid fever 0.01 0.01 0.01 0.01 0.00 Cerebro-spinaL fever 0.03 0.03 0.02 0.03 0.00 Scarlet fever 1.73 1.90 1.82 1.37 0.83 Whooping cough 3.42 3.51 3.31 3.13 4.91 Diphtheria 0.08 0.10 0.09 0.10 0.00 Erysipelas 0.21 0.23 0.21 0.22 0.07 Smallpox — _ — — — Measles 9.34 9.75 8.84 9.17 4.84 Pneumonia 0.73 0.84 0.60 0.57 0.49 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.07 Acute Polioencephalitis 0.00 0.00 0.00 0.00 0.00 Rates per 1,000 live births Deaths All causes under 1 yr. of age 34(b) 39 32 31 23.55 Enteritis & Diarrhoea under 2yrs. 3.3 4.5 2.1 2.4 0.00 of age Rates per 1,000 total (live and still) births. Notifications (corrected) Puerperal fever and pyrexia 6.89 8.90 4.71 7.34 (c) 12.2 (a) Rates per 1,000 total population (b) Per 1,000 related births (c) In London Puerperal fever alone was 0.6l 7 (iv) Causes of Death Registrar General's Tables 1944 1945 1946 1947 1948 M. F. M. F. M. F. M. F. M. F. All Causes 239 235 262 243 236 224 228 267 227 228 Paratyphoid and Typhoid Fevers - - - - - - - - - - Cerebro-Spinal Fevers — - - - 1 1 - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - 1 - - - - - - - - Diphtheria - - - - - - - - - - Tuberculosis of Respiratory System 12 7 10 9 6 4 10 7 13 9 Other forms of Tuberculosis 1 3 3 4 3 - 3 1 1 1 Syphilitic Diseases - 1 3 - 3 1 4 4 2 2 Influenza 2 2 2 - 3 - - 3 1 1 Measles - - - 2 - - - - - - Acute Poliomyelitis & Polioencephalitis - - - - - - - - 1 - Acute Infantile Encephalitis - - - - - - - - - - Cancer of B.Cav. & oesephagus (M) uterus (F) 5 2 7 1 3 5 4 8 2 6 Cancer of Stomach or duodenum 11 6 7 5 4 7 5 8 10 8 Cancer of Breast - 10 - 6 - 8 - 13 - 7 Cancer of all other sites 23 19 30 23 34 19 32 19 34 16 Diabetes 1 - 4 5 3 1 - 1 1 - Intra - Cran, vascular lesions 18 35 14 36 24 31 30 26 19 25 Heart disease 64 60 69 65 65 64 71 84 60 75 Other diseases of circulatory system 15 11 16 22 9 18 15 21 7 11 Bronchitis 12 6 20 7 14 8 13 14 10 5 Pneumonia 15 10 14 7 16 9 10 12 11 8 Other respiratory diseases 4 - 3 - 2 1 3 2 6 4 Ulcer of Stomach or Duodenum 1 1 9 1 8 2 2 1 5 2 Diarrhoea under 2 years 3 2 1 - - 2 1 2 - - Appendicitis - - - - 1 1 1 - 3 2 Other digestive diseases 5 5 3 8 8 5 5 7 3 8 Nephritis 4 6 5 4 1 6 1 4 3 1 Puerperal Causes - 1 - - - - - 1 - 1 Other maternal causes - 2 - - - 2 - - - - Premature birth 5 5 3 - 1 5 1 2 3 3 Congenital malformation Birth injuries 4 4 7 5 8 2 1 8 4 3 Suicide 2 1 4 3 4 2 4 - 5 5 Road Traffic Accidents 4 - - 1 2 1 1 - 4 1 Other violent causes 12 16 5 10 1 6 1 2 6 8 All other causes 16 19 23 19 12 13 10 17 13 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 1948 bacteriological examinations were carried out by Dr. D.S. Murray at the Laboratory, 37, Coombe Road as part of a pathological service administered by the Surrey County Council from the 1st January. 1948. to 4th July. 1948. and by the South West Metropolitan regional Hospital Board from the 5th July. 1948. 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: Prior to the 5th July. 1948 cases were removed to Wimbledon Hospital, and transported by the Motor Ambulance attached to that hospital. Subsequent to the 5th July, 1948, under the new arrangements, infectious patients were accommodated at Tolworth Isolation Hospital, and were removed by ambulance attached to that hospital. For noninfectious and accident cases: A motor amublance is provided by the Corporations 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 period 1st January, 1948 to 5th July, 1948, the following numbers of accident. and private cases were removed Corporation Ambulance - Accident Cases 146 - Private Cases 141 - Maternity Cases 27 Calls for Ambulance not required 7 Calls dealt with for hospitals - County Hospital 7 Calls dealt with for other Authorities 31 359 9 (c) Nursing in the Home. Generals 'This is carried out, in the main, by District Nurses from the Kingston Nursing Association The following Statistical Report is taken from the Annual Report of the Kingston Nursing Association (From the 5th July, 1948, Home Nursing became part of the National Health Service, and as such the responsibility of the Local Health Authority, in this case the Surrey County Council). Statistical Report in District Nursing. (Extracted from Annual Reports of the Kingston Nursing Association). 1944 1945 1946 1947 1948 Cases: Cases on books on 1st January 67 75 72 101 98 New cases 609 660 693 704 761 Results of Cases: Convalescent 435 508 488 549 601 Transferred to Hospita1 59 56 64 53 53 Died 92 93 101 93 105 Removed for other causes 15 6 11 12 9 Still on books 75 72 101 98 91 Visits: General Nursing 16,79 19,851 19,950 19,832 19,707 Casual 124 223 187 230 325 This figure comprises- This figure comprises- 345 to 30.6.48. 9381 to 30.6.48. 416 1.7.48 - 31.12.48. 10,326 1.7.48 - 31.12.48. 7ery valuable service is being rendered by the District Nurses in the care of the aged, sometimes assisted by domestic helps from the Home Help Scheme. (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,1948. Clinic or Dispensary Where Held When Held Diphtheria Immunisation Health Centre Grange Road. Kingston. Fridays at 3.15 p.m. do. Burton Road Clinic, Kingston. Tuesdays at 2.30 p.m. Maternity & Child Welfare Centre Heal th Centre, Grange Road. Tuesdays & Fridays at 2 p.m. do. Burton Road. Clinic. 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. Wednesdays at 1.45 p.m. do. Burton Road Clinic. Tuesdays at 10 a.m. Post- Satal Clinic Health Centre, Grange Road. Wednesdays at 1.45 p.m. do. Burton Road Clinic. Tuesdays at 10 a.m. School Clinic Minor Ailments Health Centre. Grange Road. Daily at 9.15 a.m. Consultations do. Tuesdays and Fridays at 9.30 a.m. Dental Treatment do. Monday to Friday Opthalmic Clinic do. Every Thursday at 10 a.m. (by appointment) Speech Therapy do. Mondays & Wednesdays at 10 a.m. and 2 p.m. Ultra Violet Light Clinic do. Mondays & Fridays at 9.30 a.m. Tuesdays & Fridays at 2 p.m. Orthopaedic Clinic Red Cross Curative Post. Coombe Lane. Kingston. By appointment. Tuberculosis Dispensary ( S.C.C.) Keeldar Clinic. Queens Road. Kingston. 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. Cont... il Cont/ (d) Clinics and Treatment Centres as at 31st December, 1948. Clinic or Dispensary Where Held When Held Day Nursery No. 3. 'Kilnwood', 213, Richmond Road, Kingston. For admission apply to Medical Officer of Health. Day Nursery No. 5. 53/55, Canbury Park Road , Kingston . - do - Day Nursery No. 6. Messrs. Bental 1s, Clarence Street, Kingston. Apply Staff Controller, Messrs. Bental 1s . Kingston Nursing Association. (Vol. Committee) 33, Birkenhead Avenue, Kingston . Apply to Superintendent for District Nurses. (e) Hospitals . (1) Infectious Diseases. Up to 5th July, 1948, an arrangement existed with the Wimbledon Corporation whereby cases were admitted to the Wimbledon Isolation Hospital, and payment was made by the Kingston Corporation for the maintenance of patients. Owing to staffing difficulties and the need for conservation of accommodation, it was necessary to send patients to other hospitals. During the year 37 cases were sent to hospital for treatment or diagnosis, as follows To Wimbledon Isolation Hospital 27 To Tolworth Isolation Hospital 7 To Goldie Leigh Hospital 1 To Barnes Isolation Hospital 1 To Western Hospi tal 1 (2) Smallpox. The Surrey Smallpox Hospital, East Clandon (Surrey County Council). (3) Other. General Hospitals situated in t he Borou available for the District ares- The Kingston County Hospital (Surrey County Council). The Kingston Victoria Hospital, supported by voluntary contributions. 12 13 2. MATERNITY AND CHILD WELFARE. National Health Service Act, 1946 - Comment. On July 5th. 1948, the provisions of the National Health Service Act, 1946, transferred the liabilities of the Council for the Maternity and Child Welfare Services to the Surrey County Council. This transfer brought to an end a long period of valuable public welfare work by your Council which began in 1918. By the transfer some 84 members of the Council's staff passed overnight to the County Council, and buildings and equipment concerned became the responsibility of the County Council, together with the function of directing policy. Your Medical Officer continues to direct the work in the Royal Borough of Kingston-upon-Thames, which is grouped with its immediate neighbours, the borough is of Maiden and Coombe, Surbiton, and the Urban District of Esher, to form the North Central Division of Surrey, for which he has been appointed Divisional Medical Officer. It is natural, upon such a fundamental change, to consider what has been accomplished by your Committees and staff, and what may reasonably be expected to happen to the services which were developed during their period of responsibility. The available records are complete from the year 1921 and the vital statistics from then to the year under review make interesting reading. The population in 1921 was recorded as 39,520. It slightly increased in the succeeding years, reaching a figure of 40,430 in 1924. This was followed by a slight decline, and in 1937 it was 39.970. The war years saw a progressive drop to 34,780 in 1944, succeeded by a rise to 39,670 in 1946, end to 40,780 in 1947, which is also the figure for 1948. Turning first to the Birth Rate and the annual number of Live Births a rough graph No. 1, shows a steady decline from 1921, when the birthrate was 20 per 1,000 of the population, to the low figure of 11.8 per 1,000 in 1932 since when there has been a gradual rise with small peaks in 1936, 1943. and a post war peak in 1947 when the rate was 21.3 per 1,000 of the population. The curve for 1948 is again downward the rate being 17.7 per 1,000. Thus, in the special post war circumstances of 1947, the number of live births slightly exceeded those fbr 1921, i.e. 870 as against 799, which numbers can be roughly compared as the total population differs but slightly. The number of live births in 1948 has fallen to 722, so it is apparent that the downward trend has again set in. The infant mortality rate is considered a fairly sensitive index of the welfare of mothers and young children, and a glance at rough graph No,2, gives the story in figures from 1921 to the present day. With a comparatively small population such as that of Kingston, and with less than 1,000 births each year, it is to be expected that the course of the graph will not be smooth, because particularly adverse factors in any one year, plus a small number of births, will tend to increase the infant mortality rate. It is clear, however, that notwithstanding many recessions in particular years, the trend of the curve is steadily downwards. The main check to the downward progress occurred in t he war years 1940 - 42, since when the curve takes a steeper downward course to reach an all-time low level in 1947s with a very similar rate for 1948. The infant mortality rate for 1921 was 60 per 1,000 live births for 1947 it was 21.84, and for 1948 23.55. 14 15 The progress of this rate towards the improved figure quoted has been in keeping with the trends of the rate for England and Wales, and for London which are also shown in the graph. The rate for Kingston was lower than that for England and Wales and for London in 1921, and is also lower than these rates in 1948. The above figures show a marked saving in infant life. That Maternity and Child Welfare Services, with their home visiting of infants, infant consultations, ante and post natal care, provision of milk foods and other accessories, and the continual health education carried out by the doctors and Health Visitors at the clinics and in the homes,have made a large contribution to the saving is beyond doubt. It may, therefore, be said that the efforts made, and expenses incurred, by your Committees to do this work have met with progressive success in the last 30 years. A very important factor of the work was the close tion between your Committees and their Chairmen, with the officers and their clinic workers. The timely decisions which were made to forward the work, and to help difficult cases so that urgent needs were met and situations resolved worked to the immediate benefit of the people. Under the new system, the population to be served is much greater (197,000), with a resulting larger number of workers and clinics to be supervised and maintained at efficient level. Therefore a constant aim must be to keep close personal attention to peripheral needs, and by every means possible to facilitate progress as needs change. The whole of the resources of the County organisation will be readily available to all parts of the Division, and may be expected to meet the varying needs of the different specialised services. (i) MIDWIFERY SERVICE - Annual Report for Kingston-upon-Thames,1948. (a) Midwifery Service (Surrey County Council) The Midwifery Service was under the administrative control and supervision of the County Medical Officer of Health and could be divided into two main sections Domiciliary Midwifery Service Institutional Midwifery Service. At the end of 1948, there were 5 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. 16 The following are the details of the notifications of births (Kingston residents only) to the Medical of Health by (a) Midwives; (b) General Practitioners and the Superintendent of Kingston County Hospitals- Births notified 1944 1945 1946 1947 1948 Up to 5th July After 5th July No. notified by Midwives 153 132 250 343 110 147 No. notified by General Practitioners and Medical Superintendent. Kingston County Hospital 408 498 569 537 179 188 Total- 561 630 819 880 189 335 624 The figure of 624 notified births shows a decrease on the figure for the previous three years. It would appear that the post war peak has been passed. The following table supplied by the Registrar General, and amended by transfers in and out, divides the total registered births into (a) Live,0 and (b) Still births:- Births Registered 1944 1945 1946 1947 1948 M. F. M. F. M. F. M. F. M. F. Live Births - Legitimate 265 260 272 257 367 371 432 406 345 332 Illegitimate 27 26 34 30 34 22 20 12 21 24 Still Births- Legitimate 8 9 12 9 13 11 6 8 7 9 Illegitimate - 1 - 1 2 3 - 1 - - Totals- Male and Female 300 296 318 297 416 407 458 427 373 365 Grand Totals 596 615 823 885 738 A part-time consultant, Mr. J.V. O' Sullivan, F.R.C.S., was available in the Borough for consultation for any case of midwifery or puerperal pyrexia where the confinement took place at home. It was not found necessary to call upon the services of the consultant in this respect during the year. 17 (b) (i) Maternal Mortality. The Medical Officer of Health investigated all maternal deaths and obtained full reports from the practitioner attending. There was one maternal death during 1948. The figures for the years 1944 - 1947 are given for comparisons- Cause 1944 1945 1946 1947 1948 Cardiac Failure Toxaemia of pregnancy 3 - 2 - - Puerperal Sepsis - - - 1 1 (b) (ii) Infant Mortality. By the Infant 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 Kings ten children who died during 1948 in the Borough before reaching the age of one year, together with the cause of death and age;- Age Total Cause of Death 0-24 hours 5 3 Prematurity 1 Atelectasis of lungs 1 Atelectasis, prematurity, hydramnios (twin pregnancy) 24 hours - 1 month 9 1 Broncho-pneumonia, intestinal obstruction 1 Heart failure, prematurity (twin pregnancy) 1 Haemorrhage from respiratory tract, prematurity 1 Meningitis, prematurity 1 Broncho - pneumonia, prematurity 1 Streptycoccal pneumonia 1 Atelectasis, prematurity 1 Pneumonia, congenital morbiscordis 1 Meningitis, infected dermoid cyst of cerebellum 1 month - 1 year 3 1 Reflex shock during operation for reduction of torsion of testis. 1 Heart failure, pulmonary fibrosis 1 Pneumonia 18 The approximate infant mortality rate for 1948 is as follows, and, in addition, the rates for 1944 to 1947 (inclusive) are shown for comparative purposes:- 1944 1945 1946 1947 1948 Kingston -upon -Thames 48 43 29 22 23 England and Wales 46 46 43 41 34 London Area 6l 53 41 37 31 The infantile mortality rate of 23 is slightly higher than the rate of 22 for 1947. It is lower than the figure of 34 for England and Wales, and lower than the figure of 31 for the London Administrative County Area. Ophthalmia Neonatorum. No cases were notified during 1948. Special arrangements were in operation 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. (b) (iii) Puerperal Pyrexia. Thirty cases were notified during 1948. An analysis is shown below, together with figures for the years 1944 - 1947 for purposes of comparison - Cases 1944 1945 1946 1947 1948 (a) Total notified 15 23 41 28 30 (b) Number included in (a)of (i) Kingston residents 2 9 9 6 9 (ii) Extra district residents 13 14 32 22 21 (c) Number included in (a) notified from Kingston County Hospital 14 21 39 27 29 (d) Number included in (a) notified by private doctors 1 2 2 1 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 were divided into two parts (a) For patients whose confinement was undertaken by a midwife at home of the mother, or for a Kingston mother who was to be admitted to hospital or nursing home outside the Borough. These patients were seen at the Ante-Natal Clinic, Grange Road. 19 (b) For patients who had 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 confinements were undertaken by midwives, attended the Kingston Ante-Natal Clinic. Others received ante-natal care from their family doctors, under private arrangements. The following table gives the number of patients who attended the Kingston Ante-Natal Clinics during 1948, and preceding years, together with the total attendances made and the numbers referred to Kingston County Hospital for further investigation:- 1944 1945 1946 1947 1948 Up to 5th July After 5th July No. of patients 142 126 232 256 117 90 No. of attendances 701 671 1,328 1,752 1,032 727 Ante-Natal patients referred to Kingston County Hospital 29 23 24 12 10 Special attention was paid at ante-natal clinics to the general health and nutrition of expectant mothers. Under the Ministry of Food Scheme, expectant mothers obtained one pint of milk daily at reduced rate, and, in addition, were considered priority cases for eggs. Supplementary nourishment in the form of dried milk, etc., was supplied at the AnteNatal Clinic, either free or at cost price, dependent upon the circumstances. 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 l6s. 19s. 3 15s. 18s. 4 14s. 17s. 5 13s. l6s. 6 12s. 15s. 7 and over l1s. 14s. Owing to the limited accommodation for midwifery cases in the Kingston County Hospital, the Almoner of the Hospital requested visits to be made to the homes of all mothers applying for admission to hospital. These visits were made by the Health Visitors, who decided whether home conditions were suitable for confinement at home and a recommendation, in accordance with the home conditions was forwarded to the Almoner. 20 21 Other visits to expectant mothers were made by the Health Visitors from time to time., and the following table gives the number of visits that were made during 1948 and preceding years:- Ante-Natal Visits - by Health Visitors. 1944 1945 1946 1947 1948 Up to 5th July After 5th July No. of home visits (individual cases) 159 199 292 266 127 120 Total number of visits 260 307 449 426 179 169 (b) Post-Natal Services. The Post-Natal Services were incorporated with the AnteNatal Services and arrangements indicated in Section 1 apply in this section. The number of mothers who attend the Post-Natal Clinics has been smalls, but the period under review showed an increase, i.e. 182 (Up to 5.7.48 -127; After 5.7.48 -55) as compared with 106 in 1947. The steady increase from 1926 onwards in the number of patients attending Ante-Natal Clinics, and work at these clinics, is convincingly shown in the following rough graph No.3. With two minor recessions of the numbers of new cases in 1929 and 1933, and the inevitable drop during the war from 1940 - 1945, there was a continual increase up to 1947. The drop in 1948, I believe to be a temporary one with two explanations, one due to the new arrangements under the National Health Service Act, under which general medical practitioners were more favourably placed financially to undertake ante-natal care, and many women took advantage of the new provisions, to attend their family doctors without the payment of a fee. The other explanation is the drop in the number of births in the year. It will be noted at the same time that those attending the Ante-Natal Clinics came oftener so that the use of the Ante-Natal Clinics was maintained at a high level. (iii) INFANT WELFARE SERVICES. (i) Domiciliary Visits. An initial visit by a Health Visitor was paid to all infants twelve to fourteen days after confinement, where a midwife was in attendance, of 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 were paid according to the domestic circumstances. Where a family doctor was in attendance, no further visits were made unless by request of the mother. In a majority of cases, visits were 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 were made where there were difficulties with infant feeding or illness. 22 23 Regular visits at intervals of one to three months, according to circumstances, were made between the ages of one to five years. Every effort was made to find children who had entered the Borough since their birth and regular visits were also made to those cases. The following was the total number of visits made during 1948 and preceding years:- Domiciliary visits by Health Visitors. 1944 1945 1946 1947 1948 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5 0-1 1-5  First visits 524 - 567 - 770 - 854 - 751 2 Total visits 3308 7007 2662 6194 3639 7434 4431 7053 4865 8438 The figures for 1948 are made up as follows:- 0-1 1-5 First visits (Up to 5th. July 372 2 (After 5th. July 379 - Totals 751 2 Total visits (Up to 5th.July 2483 4145 (After 5th.July 2382 4293 4865 8438 Rough Graph No. 4 shows the volume of work of home visiting by Health Visitors, first visits to new babies (left hand scale) and total visits annually to infants under one year (right hand scale). Other visits to children from 1 to 5 years are also shown. First visits to new infants are probably the most useful work done from the department. This is the time when appropriate help and advice is brought to young mothers when they need it. Those visits, together with the attendances of the mothers with their infants at the welfare clinics represent a vital part of infant welfare which has steadily increased in volume during the last ten years. It is noticeable that there is good cover for the 1 - 5's also. This effective day to day work all the year round, by the Health Visitors is worthy of high commendation and the Council has been well served by their Senior Health Visitor and her colleagues. The importance of good health visiting can hardly be overestimated and it is worthy of note that there are authorities today who claim that the infantile mortality rate is lowered in direct proporation to the number of health visitors at work in the area. This influence can be seen in different countries and in different parts of England and Wales. On the Continent also it would seem significant that countries with a good health visiting and welfare organisation have low infant mortality rates. 24 (ii) Infant Welfare Sessions. Infant Welfare sessions were conducted at two centres in the borough, Burton Road and Grange Road. 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:- Health Centre, Grange Road 1944 1945 1946 1947 1948 Up to 5th July After 5th July No of sessions held 102 102 101 124 78 67 No of new cases seen 322 407 435 432 217 160 Total attendances made 5574 5625 6930 7823 4407 3440 No. seen by Medical Officer 2425 2550 2537 3223 1963 1560 Burton Road 1944 1945 1946 1947 1948 Up to 5th July After 5th July No. of sessions held 100 98 97 129 80 78 No. of new cases seen 195 204 315 380 172 141 Total attendances made 4657 4485 5923 8614 4808 4234 No. seen by Medical Officer 1783 1850 2185 3064 1987 1638 Rough graph No. 5 shows the course of the attendances at Infant Welfare Clinics in the Borough, distinguishing between the number of new cases seen and the total number of attendances made yearly. The story is simple and requires no comment save the obvious one of continual progress broken only by the war time recession in the years 1944 and 1945 when evacuation of mothers and infants was carried out, because of enemy attack by flying bombs and rockets. These over, the work resumed its growing proportions to a peak coincidental with the 1947 post-war peak of live blrths. It is obvious that the present generation of mothers is fully acquainted with the value of the Maternity and Child Welfare Services provided and makes good use of them. 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. 26 The following table gives details of the supply of infant food and dried milk during the period under review:- Amount in lbs. 1944 1945 1946 1947 1948 Sold, cost price and Sold, half price 10,198 11,449 13,087 14,147 9,689 Free of charge 432 182 155 177 116 Reduced sales were due to the Ministry of Food Order of the 25th. April, 1948, where by Mothers purchasing Proprietory Infant Milk Foods have to forego the seven pints of priority milk on the infant's ration book. Also National Dried Milk is now available at the Clinics at 10½d. per tin, and many Mothers obtain this. (iii) Voluntary Workers at Welfare Clinics. 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. Several have been regularly associated with the work of the centres throughout nearly the whole time of their existence, Many mothers have had good reason to be thankful for their helpful presence, as also the nurses and the doctors. The following table indicates their activities in connection with the clothing stall instituted by them for the benefit of mothers. 1944 1945 1946 1947 1948 No. of mothers who bought 287 291 346 248 143 No. of garments 823 880 1,091 679 416 (iv) Institutional Treatment for Mothers and Children. (a) There was no provision in the Borough for institutional treatment for mothers and children, provided by the Corporation, but private arrangements existed for the reception of expectant unmarried mothers at the Kingston Deanery Home for Friendless Girls, 18 Richmond Park Road. The Home was administered by a voluntary body, the Kingston Deanery Moral Welfare Committee, affiliated to the Southwark Diocesan Association for moral welfare. There were nineteen beds. Admission was not confined to Kingston residents, but was extended to girls residing anywhere in, or occasionally beyond, the Southwark diocese. The expectant mothers entered the home about two months before confinement, which took place at Kingston County Hospital, and it was a condition of their acceptance in the Deanery Home that they stayed for at least two months after confinement, at the end of which period efforts were made to secure for them suitable employment. 27 The girls were given training in mothercraft, care of the home, light laundry, etc. A social welfare worker kept in touch with the girls after they left the home. There was 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 years:- 1939 - 68 1940 - 81 1941 - 59 1342 - 58 1943 - 59 1944 - 32 1945 - 50 1946 - 58 1947 - 44 1948 - 50 * 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, 1948 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 1s. per day, per attendance, up to 5th. July, 1948, and after which date a similar grant from the Surrey County Council, part of which is recoverable from the Ministry of Health. At Surrey Villa Day Nursery the upper age limit for children was three years. The remaining nurseries, Canbury Park and Kilnwood, admitted children whose ages ranged from 1 month to five years. After 5th. July, 1948, the responsibility for maintaining and supervising the Day Nurseries passed to the Surrey County Council to whom your Medical Officer of Health is the responsible officer. The following table gives the total attendances from the commencement to date:- Year Surrey Villa St. Peter' s Kilnwood Fairfield Kingston Day Nursery Bentalls Total 1941 878 1,837 - - - - 2,715 1942 11,733 9,140 3,155 - - - 24,028 1943 10,899 10,607 9,732 6,583 5,364 8,268 51,453 1944 8,131 8,178 7,177 9,840 8,056 14,655 56,037 1945 8,606 3,300 6,824 11,024 9,866 17,199 56,819 1946 8,570 - 9,156 2,642 8,567 16,450 45,385 1947 8,164 — 9,741 — 9,820 19,079 46,804 1948 4,592 — 4, 555 - 4,764 8,943 **22,854 ** Up to 5.7.48 28 Throughout the year continued pressure for places in the nurseries was experienced and a considerable waiting list was compiled for children of each age group taken. Most of these applicants were in urgent need of the accommodation, because of some special hardship which necessitated the mother going to work to keep or help to keep the family. In filling vacancies priority was given to hardship cases as far as possible. At the 30th. June, 1948, there were 78 children on the waiting list requiring admission. Notwithstanding the granting of priority of admission to the most urgent cases there was a time interval before admission, of weeks in the urgent cases, and of months in other cases. The total attendance figures up to July 5th. and estimated figures to the end of the year, show that there was a slight increase in the number of attendances in 1948 as compared with 1947, at the three Day Nurseries, Surrey Villa, Kilnwood and Kingston Day Nursery. This shows that the increased demand for nursery places noted in the report for 1947 has been maintained. When on July 5th. the responsibility for Day Nurseries passed to the Surrey County Council certain minor alterations of day to day administration were introduced. It is a pleasure to record that since 1941 when War-Time Nurseries were called for, the Maternity and Child Welfare Committee have successfully accomplished the task of providing and maintaining several day nurseries, increasing the number as the need was proved. In the beginning, of necessity, quick adaptations had to be employed, so in 1941 "Surrey Villa" (50 places) was taken over, and part of St. Peter's School (60 places). In 1942 Kilnwood (60 places) in Richmond Road was also taken and adapted. In 1943 an appropriately designed prefabricated building was quickly erected in Fairfield and occupied as a War-Time Nursery of 60 places. In that year also Messrs. Bentail's Ltd. increased their existing Nursery School to admit children of a younger age group and adapted the Nursery accommodation to suit the new admissions, which arrangements were recognised by the Ministry of Health as a War-time Nursery and became eligible for grant and supervision alongside the Municipal War-time Nurseries. From 1943 until 1945 inclusive all six nurseries were in full operation sustaining 51,453, 56,037 and 56,818 attendances respectively. In 1945, in view of the better accommodation in the other nurseries it was found possible to close down the adapted nursery in St. Peter's school. In the following year 1946, due to the operating of the Education Act of 1945, the Fairfield War-time Nursery was passed on the Surrey Education Authority as a Nursery School for children under five years of age. These changes left, operating in 1947 and 1948, the three Kingston Corporation Day Nurseries, plus the privately owned Bentalls Nursery, and provided for 46,804 actual, and an estimated 45,708, attendances. At the transfer of the Nurseries in July, 1948 they were fully occupied and had resistant waiting lists, evidence of a strong demand for places. 29 The responsibility for the care of children in the Day Nurseries is heavy and the presence of so many very young children for six days in the week requires a large and skilled staff. The staffing is complex, because of the different types of experience, training and skill needed adequately to meet the varying requirements of children at different stages of development. To maintain the nurseries at a reasonable level of efficiency is very costly therefore it has been necessary to practise a careful system of selection of children for admission. Prior to 1st. April, 1946, the Ministry of Health gave a 100% grant to make up the deficiency on cost of running the Nurseries after the income from mothers' payments was taken into account. Since that date the grant has only approximated 44% of the nett cost of the nurseries the remainder having to come from local rates. It is clear from the statistics that the nurseries have met a definite and urgent need of a not inconsiderable section of the people and in view of the waiting lists for admission this need continues. The Nurseries have been very successful in providing for the children, as proved by their excellent physical and mental development and their condition when they reach school admission at the age of five years. The Council's policy is being repaid in the health and progress of these children. I gratefully acknowledge the contribution made by all who worked in and for the Nurseries, Including voluntary workers and especially the Matrons. Care of Premature Infants. When the mother and infant were kept at home, close supervision by the Health Visitors was carried out and all practical assistance possible was rendered. (c) The recommendations of Ministry of Health Circular 20/44 was followed and records were kept giving details of the number of premature births notified during 1948. They are as follows:- (i) Total number of premature births notified during 1948- Total Up to 5th. July After 5th. July (l) At home 2 2 — (2) In hospital 22 14 8 (ii) Number of those born at home- (l) Who were nursed entirely at home 1 (2) Who died during the first 24 hours — (3) Who survived at the end of one month 2 (4) Who were transferred to hospital 1 (iii) Number of those born in hospital- Total Up to 5th. July After 5th. July (l) Who died during the first 24 hours - - - (2) Who survived at the end of one month 19 12 7 30 A separate bedroom for mother and infant as advocated; instructions on improvisation and detailed advice on the care of the infant were given. The services of a paediatrician was available and a home help provided when necessary. Care of Illegitimate Children. (d) The provisions of the Ministry of Health Circular 2866 were followed and most of the suggestions outlined in the circular were covered with the exception that a separate welfare worker was not appointed. Close co-operation, however, existed between the officers of the Welfare Authority and Welfare Workers at the Kingston Deanery Home. 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 up to the 5th. July, 1948. Approximately 50% of the time of the worker was spent on Kingston cases. During the pre-natal stages, Health Visitors kept in touch with expectant mothers and, when necessary, contacted the grand-parents, welfare workers in factories, hospital almoners, moral welfare workers and others. Similar contacts were made during the post-natal stages, and, in addition, admissions to Day Nurseries were arranged, foster-mothers visited and attendance at the Maternity and Child Welfare Clinics encouraged. Assistance was given also by hospital almoners and associated workers who helped the mothers to find work and lodgings. (v) Health Visitors. The position as regards personnel of Health Visitors is 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, were under the administration of the Surrey County Council, which is the Education Authority for the Area. The school nurses dealt with Kingston schools under the North Central Divisional Executive Committee, which covers Kingston, Malden, Esher and Surbiton, and for which your Medical Officer of Health is also Divisional School Medical Officer. Towards the end of 1947 the Council lost the services by resignation to retirement, of Miss C.A.Hookway, S.R.N., S.C.M. H.V. who had been Health Visitor with the Council from 31.5.26 and Senior Health Visitor from 1.9.37. It is pleasing to record that her going was regretted by all who worked at the clinics. Her personal sincerity and devotion in all her work was a tremendous influence for good among mothers, teachers, clinic workers, nurses, doctors and others. We were fortunate to be able to appoint in her place Miss F.I.Arnold who had worked with her far many years, and fortunate again that she was later appointed by the Surrey County Council as Divisional Health Visitor for the North Central Division. Miss Arnold brings to her duties her own particular enthusiasm and leadership in the high tradition of the post. 31 (vi) Child Life Protection. Up to the 5th. July, 1948, the duties imposed by the Public Health Act, 1936, were entrusted to the Maternity and Child Welfare Sub-Committee of the Public Health Committee. After the 5th. July, 1948, the duties passed to the Surrey County Council and the same Health Visitors acted. As a routine duty, the Child Protection Visitors visited every foster-mother at least once a month, and more frequently when necessary. During the period under review, visits were paid as shown below. Figures are included also in respect of preceding years for purposes of comparison Year No.of visits  1931 557 1932 530 1933 666 1934 765 1935 798 1936 583 1937 536 1938 502 1939 494 1940 556 1941 545 1942 765 1943 524 1944 386 1945 283 1946 290 1947 232 1948 101 * * Up to 5.7.48 The following table gives details regarding numbers of children under the care of foster-mothers, and other relevant informations- 1944 1945 1946 1947 1948 No. on register at beginning of year 33 26 20 19 15 No. of new registrations 2 3 5 7 2 No. ceasing to have charge of infants 9 9 6 11 6 No. on register at end of year 26 20 19 15 11 Total number of children 24 22 19 15 10 32 (vii) Treatment. (a) Dental Treatment. Arrangements for dental treatment were made in conjunction with the dental scheme of the School Medical Service. All children under five requiring dental treatment were referred to the dental clinic by the Medical Officer, as also were 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:- Treatment of Dental Defects (Maternity and Child Welfare only). 1944 1945 1946 1947 1948 Up to 5th July After 5th July Sessions devoted to treatment 20 21 19 46 26 32 No. treated - (i) Mothers 78 51 60 83 32 33 (ii) Infants 41 39 32 56 30 35 Attendances made for treatment 357 318 288 521 178 196 Fillings - (i) Permanent teeth 36 35 40 53 30 34 (ii) Temporary teeth 33 36 32 29 27 26 Extractions - (i) Permanent teeth 322 245 307 416 62 74 (ii) Temporary teeth 60 61 77 106 38 39 Other operations - (i) Permanent teeth 15 9 64 225 26 28 (ii ) Temporary teeth 101 76 32 79 6 8 Supply of dentures 9 8 5 39 16 33 Dentures were supplied either at cost price, free of charge or part cost, depending upon the circumstances. Each case was considered on its merits by the Maternity and Child Welfare Committee and the proportion of cost to be paid by the mother assessed. After the 5th. July, 1948 the treatment was free of charge under the provisions of the National Health Service Act, 1946. The total cost of dentures supplied and the amount paid by the mothers is as follows:- 1944 1945 1946 1947 1948 £ s. d. £ S. d. £ s. d. £ s. d. £ s. d. Total cost 49 7 10 39 6 9 28 14 3 132 14 0 147 1 8 Contributions by mothers 35 12 3 21 5 8 11 14 3 113 16 7 57 14 2 ¢for period 1.1.48 - 5.7.48 only. 33 (b) Ophthalmic. Ophthalmic treatment was not often required for children under five years of age, but, when necessary, these children were seen at the same time as school children. The following number of children were seen during 1948 and preceding years:- 1944 1945 1946 1947 1948 Up to 5th July After 5th July Defective vision - 1 1 - - - Squint 19 16 14 26 21 9 Other conditions 3 - 6 4 1 - (c) Artificial Sunlight. Children under 5 years of age requiring artificial sunlight treatment were referred from the Infant Welfare Clinics, and the following are the total number of children attending and the total number of attendances during 1948 and preceding years:- 1944 1945 1946 1947 1948 Up to 5th July After 5th July No. of children under five years attending 151 72 49 49 54 16 Total number of attendances 1,938 740 481 411 498 105 (d) Tonsils and Adenoids. Arrangements were in operation 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 and 1948 no children were sent for operative treatment. 1944 1945 1946 1947 1948 Total number of cases 1 2 1 - - Total cost £1 8s 6d. £2 17s. 0d £1 8s 6d. - — Contributions made by parents 4s - - - - (e) Orthopaedic Treatment. Children under five years of age requiring orthopaedic treatment were referred to the Consultant at the Red Cross Curative Post, and arrangements were made for attendance at this Post for exercises, massage, etc. When necessary inpatient treatment was arranged at St. Vincent's Orthopaedic Hospital. 34 The following are the numbers who attended the Post during 1948 and preceding years:- 1944 1945 1946 1947 1948 No. seen by Surgeon 27 17 8 12 16 No. of treatments given by staff 263 128 28 47 15 No. of cases discharged - 4 3 2 1 No. admitted to Hospital 2 1 1 - - (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 trader five, together with other age groups, since January, 1942. (g) Convalescent Treatment. A scheme operated whereby convalescent treatment was provided for children under five years of age, subject to medical recommendation. All cases were referred to the Maternity and Child Welfare Sub-Committee who accepted financial responsibility with provision for parental contribution in certain cases. During the period 1st. January to 4th. July, 1948, one case was dealt with, but several cases were sent to Convalescent Homes in preceding years. (h) Prevention of the spread of Infectious Diseases. Maternity and Child Welfare Section. (i) Diphtheria Immunisation. The policy with regard to active immunisation was to have as many children immunised before the first birthday as possible; some time after the sixth month, probably about the eighth month, was the period of choice. The extent of the work accomplished is shown in a table in Section F (Infectious Disease). (ii) Vaccination. Prior to 5th. July, 1948, compulsory vaccination of infants, by the age of six months, was in operation, but there was a "conscientious objection" clause in operation, very largely used, whereby parents, by declaration before a Justice of the Peace, could state a conscientious objection to the procedure and so avoid it. Upon the coming into force of the National Health Service Act, 1946, vaccination of infants became a voluntary procedure. Under the old regime the work was carried out by the Vaccination Officer and the Public Vaccinator who were Officers of the Surrey County Council. Now, vaccination is made available at the Clinics and can be clone by families' medical practitioners. 35 From the information available at the time of operation of the new Act, it is probable that only about one-third of all infants were vaccinated. 3. HOME HELPS. Arrangements were in force in the Borough for domestic assistance to mothers whose confinements took place at home, and in certain cases of illness at home. In the case of those who require financial assistance, part or whole of the cost was, up to 5th. July, 1948, borne by the Corporation. The amount to be paid by t he mother was assessed by the Maternity and Child Welfare Committee. During the period under review 82 applications were received for home or domestic helps for Kingston households. The following table shows the number of cases who applied for home or domestic helps during 1948 and preceding years:- Home Help 1944 1945 1946 1947 1948x Maternity 13 26 30 72 43 Domestic Emergency - 11 18 31 39 x Up to 5.7.48 only In other cases assistance was given by the Queen's Nurses of the Kingston and District Nursing Association. The Home Help Scheme began in 1940 in a small way, when the Corporation engaged suitable women to undertake domestic duties where mothers were having home confinements, and the pressure on hospital maternity beds was excessive. These women were known as Home Helps. Some of them, and some others, specially reserved for the purposes, undertook similar duties as domestic helps in households where, on account of illness, such help was needed. To begin with, the number of applications for Home Helps was small, but increased in the succeeding years, till, at the time of transfer of the responsibility for the service to the Surrey County Council, in July, 1948, four full-time and six part-time Home and Domestic Helps were employed. At that time the service was rapidly developing and had become a busy and difficult part of the work of the department. NURSING HOMES (Surrey County Council) The Surrey County Council is the Authority for registration but delegated power of inspection to this Authority. On 1st. January, 1948, 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 seven beds for chronic and senile Patients. The other, at 6 Queens Road, is registered as a Maternity Home with accommodation for ten patients. Each Nursing Home was inspected at regular intervals during the year. This responsibility is unaffected by the introduction of the National Health Service Act, 1946. 36 ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR. To the Mayor, Aldermen and Councillors, of the Royal Borough of Kingston-upon-Thames. Mr. Mayor, Ladies and Gentlemen, It is my privilege to submit for your consideration this Report on the work of your sanitary inspectors for the year 1948. The Report is submitted in the hope that the information it contains, brief though it is, will prove informative to the reader, and, perhaps, of some assistance to those who are interested in the subject of sanitation, now more familiarly known as environmental hygiene. The preparation of this Report has afforded me more than usual pleasure, as it covers the thirtieth year that I have been permitted to serve your Corporation and the inhabitants of this historic old Borough. In accordance with the desire of the Ministry of Health, as well as being a convenient form of record, the following pages are divided into three Sections, viz:- Sanitary Circumstances (Section C); Housing (Section D); and Inspection and Supervision of Food (Section E). For the first time for several years, there was no change in the technical staff, thus the work continued without any of those unwelcome breaks which had occurred so frequently in previous years. In an attempt to obtain reliable data regarding the deposit of solid matter in the atmosphere, authority was given for the installation of a standard deposit gauge on a site in the Canbury Gardens. Estimations of the amount of deposit commenced in June 1948 and continued monthly during the year. Treatment was again given to refuse tips in the Borough to prevent, as far as possible, the breeding of flies and crickets. Complete success cannot be claimed, but there was considerable reduction in the number of these insects compared with previous years. Once again I desire to offer my sincere thanks to the Chairman, Alderman Dr. E. H. Oldfield, and the Members of the Public Health Committee and the Corporation generally, for their continued consideration and support; also to all my colleagues, without whose loyal assistance my duties would have proved much more arduous. Yours faithfully, HAROLD T. PERRY. Chief Sanitary Inspector. Guildhall, Kingston-upon-Thames. October, 1949. 37 SANITARY CIRCUMSTANCES. Section C. l. WATER SUPPLY. The Metropolitan Water Board is responsible for the public water supply in the Borough. Throughout the year 1948, the water supply proved quite satisfactory as to both quality and quantity. There is a piped supply of water throughout the Borough. No complaints regarding the water supply were received during 1948. This is not surprising, as the chemists and bacteriologists of the Water Board carry out extensive and thorough examinations of the raw water (derived from the River Thames) before treatment, and further examinations are made during the purification processes until finally, complete tests are made of the water as it enters the supply mains. In the majority of cases, houses are provided with a tap off the rising main for a supply of drinking water, and where, upon inspection, such a tap is not found, steps are taken to bring about this desirable improvement. The public water supply in this Borough is hard and is not liable to plumbo-solvent action. It was not necessary during 1948 to consult the Water Board's Officers regarding the supply. There are over 11,000 inhabited premises in the Borough all of which, with the exception of four, have the benefit of a water supply from the public mains. The four houses without a piped supply rely entirely upon water derived from shallow wells. There are two other houses supplied with well water, but these two houses are also provided with a piped supply from the Board's mains. There are two further known shallow wells, but these supply water, for industrial use only, to premises within the Borough. There were, therefore, only eight premises in all, known to be supplied with well water at the end of 1948, compared with thirteen at the end of 1947, the reduction in number being due to continued efforts to have the potentially dangerous shallow well water supply discontinued, in favour of the safe public supply. There is only one small group of cottages (in a potential obsolescent area) supplied with water by means of standpipe. 2. DRAINAGE AND SEWERAGE. Owing to the erection of the New Power Station on the site of the old Sewage Purification Works, and the consequent removal of filter beds, it was necessary to continue to specially treat and chlorinate the sewage before it could be discharged into the river. This process continued up to March 1948 when the new pumping main from the Sewage Works in Downhall Road to the head of the main sewer on the Hampton Wick side of the river, was completed and put into commission. Prom Broom Road, Teddington, the sewage is conveyed by gravitation to the West Middlesex Main Drainage Board's Works at Mogden, where it is treated and purified. 38 3. RIVERS AND STREAMS. The Borough is bounded on the West by the River Thames and the only other watercourse in the Borough is the Hogsmill River, a small tributary which, rising at Ewell, joins the Thames a short distance South of Kingston Bridge. The Hogsmill River receives the effluent of certain sewage purification works before it enters the Borough boundary, and occasionally other types of contamination have been suspected, such as that which caused so many fatalities amongst the fish population during the year under review. The proposed widening of the Hogsmill River and diversion of part of the stream had not been commenced at the end of the year. There is no change to report in the number of boats used for human habitation and moored within the Borough boundary. The number seldom exceeds twenty. Control of these craft by the Corporation is very limited as the boats do not legally constitute "houses" within the meaning of all parts of the Public Health Act, 1936. That some degree of pollution of the river does take place as the result of the use of these boats for human habitation, there can be little doubt, but appropriate action to prevent this pollution can be taken only by The Thames Conservancy Board with which authority your officers co-operate to the fullest possible extent. 4. CLOSET ACCOMMODATION. Without exception, all closets in the Borough are on the water carriage system. 5. 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 houseso 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 tippingo Burning would be an expensive method, and when it is tipped, it encourages the breeding of rodents. In an endeavour to find a more satisfactory method of waste food collection than that of bins at the side of the footway, which so frequently give rise to cause for complaint, an experiment in the use of individual waste food pails was made in a small area in the Borough. These pails which are specially made for the purpose and are provided with lids, were supplied to individual householders who were prepared to place them out with their contents on the appointed days ready for the collectors. The available data, whilst not indicating any greatly increased collection, did show that the individual pail system was more hygienic. 39 6. SANITARY INSPECTION OF THE AREA. The following is a tabulated list of visits and inspections which totalled 7,677 compared with 7,172 the previous year:- Houses, etc. 760 Drainage 498 Reinspections and Works in Progress 3435 Factories 423 Outworkers 17 Dairies etc. 73 Food Premises 1115 I.D. Enquiries 124 Common Lodging Houses 25 Theatres 16 Verminous Premises 48 Rodent Control 609 Shops Acts 233 Schools 39 Visits re Well Water Supplies 34 Houseboats 16 Miscellaneous 187 Housing Act 25 7677 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 (b) Written 499 Statutory. (a) Housing Acts - (b) Public Health Acts 18 NOTICES COMPLIED WITH. Informal. (a) Verbal (b) Written 459 Statutory. (a) Housing Acts - (b) Public Health Acts 14 7. 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. As opportunity occurred inspections of offices were made, but pressure of other work and circumstances generally, prevented any extensive action. 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. 40 8. 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 of Inspections Written Notices Prosecutions Factories in which Secs.l,2, 3,4 & 6 are enforced by Corporation. 98 35 5 - Factories not included above in which Sec.7. is enforced by Corporation. 250 266 27 - Other Premises excluding outworkers. 3 5 - - 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars No. of cases in which defects were found Found Remedied Referred No. of cutions To H. M. Inspector By H.M. Inspector Want of cleanliness 4 5 - 5 - Unreasonable temperature - - - 1 - Sanitary conveniences. a. Insufficient 3 2 — 4 - b. Unsuitable or defective 28 18 - 15 - Total 35 25 - 25 - 41 PART VIII OF THE ACT. Outwork. Nature of Work. No.. of out-workers. Wearing apparel Making etc. 8 Brass and brass articles 20 Total 28 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. 9. 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. 10. SMOKE ABATEMENT. During 1948, complaints continued to be received regarding alleged grit emission from a dyeing and cleaning works, which were mentioned in the 1947 Report. Investigations were continued, and after consultations with the Ministry of Fuel and Power, arrangements were made for a supply of smokeless fuel pending delivery of a specially designed grit arrester, which, although it had been ordered early in the year, and certain parts had reached Kingston, delivery had not been completed by the end of the year. Further complaints were also received in respect of heavy smoke emission from an engineering works. In this case also, difficulty was experienced in obtaining delivery of suitable fuel. Some improvement was obtained, however, by a review of stoking methods. This factory changed hands in October, and with subsequent increased pressure on the steam raising plant, further nuisance occurred. After consultation with the firm's specialist engineer, a change of fuel was arranged as a temporary expedient until a complete review of the steam raising plant could be effected. During the autumn of 1948 a serious nuisance occurred by the emission of dense black smoke from the chimney of a brewery. The onset of the nuisance was sudden and, upon investigation, was found to be due to a change of fuel from coal to pitch creosote mixture. Unfortunately both boilers at these works had been converted to the new fuel so it was impossible to avoid continuance of the nuisance during the initial period, and until modifications could be effected. Investigations showed that adequate tests of the flues had not been made prior to the installation of the new burners. Many air leaks were found and eventually the boilers were completely reset and the flues were completely overhauled. When this work was completed and the stokers had become experienced in their duties, the plant was operated efficiently with production of a negligible amount of smoke. 42 The complaints received during the year were not all concerned with pollution of the atmosphere by smoke. One exception is worthy of note. Complaints were received regarding the emission of fine wood powder from a factory. It was found that the receiving hopper for the waste material from the saw-mills was in a defective condition, and fine powder was allowed to escape into the surrounding atmosphere, and it was then blown into neighbouring houses. Immediate action was taken and after suitable repairs had been carried out, the nuisance ceased. In an endeavour to improve the standard of stoking in the Borough, arrangements were made for courses in boiler house practice in local Technical Institutes. These courses were commenced during 1948, but attendance of stokers is not readily arranged. 11. SWIMMING BATES AND POOLS. (a) Public. The Corporation Baths are situate in Denmark Road and comprise two pools, one of which was in use throughout the year, whilst the other is used for swimming in the summer months and during the winter months is converted for use as a Public Hall for concerts, dancing, etc. (b) Private. There are no privately owned swimming baths or pools open to the public, in the Borough. 12. ERADICATION OF BED BUGS. During the year 35 premises were disinfested compared with a figure of 56 for the year 1947. Only 3 Corporation controlled houses were dealt with by the Department during the year. l3. COMPLAINTS. For the first time since 1939 the number of recorded complaints has shown a decrease, the figure for the year being 783 compared with 920 for l947. This lower figure would appear to indicate that whilst much work has to be done to maintain the older properties in the Borough in a habitable condition, a certain amount of arrears of maintenance of the war years has now been made good. The following is a brief tabulated list of causes for complaints received during 1948:- Sanitary Defects 278 Rodent Infestation 123 Vermin Infestation 24 Non-removal of Refuse 17 Defective Ashbins 17 Drains and Sanitary Arrangements 155 Overcrowding 10 Nuisance from Smoke 32 Miscellaneous 127 783 14. RODENT CONTROL. There is now no need to stress the importance of this branch of environmental hygiene. The elimination of the rat population is an ever present duty which has a definite sanitary significance. It will be recalled that following upon representations made by the Ministry of Food to all local authorities in 1947, your Corporation adopted a modified scheme of rodent control, which, whilst it provided for free service to private dwelling 43 houses, required payment in respect of services in connection with, business premises. That these services are appreciated by all sections of the community is shown by the correspondence files, which contain many expressions of thanks and satisfaction from occupiers of both commercial and private premises. Sewers. There can be little doubt that sewers, particularly in an old town such as this Borough, constitute a common habitat for rodents. It is not an uncommon experience to find that rodent infestation of premises has been due to local infestation of sewers, and the rats have entered the premises by way of old disused drain connections. These connections were doubtless improperly sealed off at the time the estates were developed, probably with stoppers made with wood. In course of time, the wood has rotted, thus allowing free means of egress for the rodents. Where more permanent means of closing the openings has been used, it frequently happens that defects have developed over the course of years. In all such cases, notice is given to the Borough Surveyor, and the old drain connections to the sewers have been properly sealed off with concrete. During 1948, the sections of public sewers treated were, in the main, those in which evidence of rodent infestation was found during 1947. In March and August a total of 253 sewer manholes were baited. In those cases where it was definitely established that a connection existed between infestations in sewers and neighbouring surface premises, the areas were subjected to what is known as 'vertical control'. Statistical Statement - 1948. Private Dwellings. Number of premises inspected 355 " " " found to be infested 241 " " infestations treated 297 " " visits for treatment and re-inspections 2301 Business Premises. Number of premises inspected 185 " " " found to be infested 135 " " visits for treatment and re-inspections 4669 Total Number of premises inspected during 1948. Private Dwellings 355 Business Premises 185 540 Number of Visits - Private Dwellings 2,301 " " " -Business Premises 4,669 6,970 The co-operation of neighbouring authorities has been sought and has been readily given when premises on the boundary of the Borough have been the subject of treatment, Similar cooperation has been met with when properties belonging to statutory undertakings have been involved. l5. 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. 44 Section D. HOUSING. Statistical Information. The following details have been kindly supplied by the Borough Surveyor:- No. of Dwellings Erected by Private Enterprise during 1948. New Construction. War Damaged. Houses 1 3 Total number of working class permanent dwellings erected by the Corporation since March 1924 up to 51st Dec. 1948. New Construction. War Damaged. Houses 930 8 (Inc. 62 outside Borough) Plats 16 Number of Temporary Dwellings completed during 1948. Nil Total Number of Temporary Dwellings erected up to 31st December, 1948. Arcon - 132. Aluminium - 70. 2-year Huts - 126. Total - 328. Number of 2-year Huts demolished during the year. 5. During the year under review efforts to catch up on the arrears of repairs to houses were continued. The Building Industry had not returned to normal working conditions, but considerable assistance resulted from the raising of the limit of expenditure on building works without need of a licence from £10 to £100. Owing to the continued limitations on building, however, statutory action in respect of repairs was limited to the appropriate provisions of the Public Health Act, 1936. Housing Act. 1936. During 1948, one house was demolished owing to its dangerous state; the Demolition Order was made in 1947. A further Demolition Order was made during the year in respect of a house in Lower Ham Road. Apart from the need for further housing accommodation which is too well known to warrant special comment here, a definite improvement in the general sanitary condition of dwelling houses might properly be recorded for the year 1948. To a considerable degree, this state of affairs might be attributed to the huge amount of war damage repairs which were carried out. There has been close co-operation between the department and War Damage Commission, and it is pleasing to acknowledge the courtesy and assistance received from the Regional Officer in Kingston at all times. 45 The need for a complete survey of housing conditions is becoming increasingly apparent. Such a survey based only on a comparatively small local area, however, would be of little value. To obtain a true picture it is essential to take the country as a whole and to carry out the survey on a similar basis in all districts. To this end, it is known that the Ministry of Health had in mind a national form of Housing Survey, but the labours of the subcommittee of the Central Housing Advisory Council which, it was understood, was considering the matter had not reached finality by the end of 1948. Until such a survey has been made it is not possible to give more than a general idea of the state of housing and the prevalence of overcrowding. The repair of houses has been referred to above, but the question of overcrowding has not been touched upon. During 1948, ten complaints regarding overcrowding were received. These were investigated, but where the complaint was found to be justified, formal action was impossible owing to the housing shortage. At the same time, the general impression formed as the result of the intimate knowledge of housing which is acquired in the course of normal duties, indicates that there is not a high degree of overcrowding (within the 1936 Housing Act standard) in the Borough. It should be emphasized that this is only a general impression, and the true position can be ascertained only as the result of a careful survey. It is to be hoped that before this survey is authorised the present legal standard of overcrowding will be amended, so as to exclude living rooms as recognised available sleeping accommodation. This is extremely important because, although a place may not be legally overcrowded, to have every room used as a bedroom by night and some of the rooms used for living purposes during the day, gives rise to a condition which must prove extremely nerve racking to the housewife. Furthermore, when young children form part of the family, it often means that they cannot have the proper rest and sleep which is necessary for their healthy upbringing. Again, such a state of affairs is bad enough when only one family is involved, but should there be a second family or in-laws' to be housed in the same house, the patience and tolerance required from every member of the household needs to be experienced to be fully understood. It is having such cases in mind, that I have emphasized above that the opinion on overcrowding is a general impression, and is not intended to take into account these very special isolated cases where there is no spare room at all. INSPECTION AND 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 1948, 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:- 46  Tuberculin Tested Pasteurised To Pasteurise 1 - To Deal 7 6 Supplementary 6 4 (c) Bacteriological Examination of Milks. During the year 1948, 71 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 presence of B. Coli; the Plate Count (i.e. the number of bacilli); and the Methylene Blue Reductase test, according to the type of milk. Of 13 samples of untreated milk submitted, 3 samples failed to pass the Methylene Blue Reductase test and in only one case was B. Coli present in a sample. (d) Pasteurised Milk. Milk can be sold as 'Pasteurised' only if it has been heat-treated 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' test. Sixty-eight samples were submitted for examination and all of them proved to be satisfactorily heat-treated and only two samples failed to pass the Methylene Blue test. (e) ICE CREAM. BACTERIOLOGICAL EXAMINATIONS. The Ice-Cream (Heat Treatment) Regulations 1947, made by the Minister of Health, continued in force, with certain exceptions, throughout the year. 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. Owing to the shortage of suitable equipment, it was not possible to enforce the whole of the regulations. It is of interest to note the results of eight months working of the regulations during 1947 and the year 1948. Prom the results tabulated below it would appear that there has been a marked improvement in the bacteriological standard of ice cream. The Regulations lay down no bacteriological standard for ice-cream, 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 . 47 One hundred and thirteen samples were examined during 1948 with the following results GRADES. I II III IV 1948 49 24 26 14 - Total 113 1947 13 17 18 10 - " 58 B.Coli was found in sixty-two of the samples. These were placed in the following Grades respectively:- Grade I II III IV 13 14 23 12 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. Nine samples were thus examined, and in four instances unsatisfactory reports were received. (f) 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 area involved, it will be understood that a very large amount of meat, including offals, passes through this depot each week. The quantity distributed during 1948 was approximately 9,750 tons. The inspection of this food requires daily visits but the amount of food condemned as unsound is very small, when compared with the total quantity handled. 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 had not been effected in this area by the end of 1948. (iii ) UNSOUND FOODS. The following is a tabulated statement of foodstuffs condemned during the year, together with the cause for condemnation:- 48 Tabulated List of Condemned Foodstuffs showing cause for Condemnation and the Weights. Article of Food. Reason for Action. Weight. BOVINE. Parts of 66 hindquarters Internal Decomposition 3295½ lbs. " " 12 " " " 115 " " " 2 " Fibrosis 29½ " Rump and Loin Internal Decomposition 51 " Kidneys Decomposition 27 " Various joints Contaminated by Ammonia from burst refrigerator 168½ " Tripe " " " 13 " Veal " " " 19 " Trimmings Decomposition 634¼ " " Contaminated by foreign matter 3 " " Fibrosis 5 " " Abscess 2 " OVINE. Parts of Sheep Internal Decomposition 27 " " " Forequarter Abscess 27 " Liver Black Spot Mould 811 ¼ " Trimmings " " " 788 " " Abscess and Brine Stain 7 " " Decomposition 12½ " Parts of Carcase Contaminated by Ammonia from refrigeration plant 128 " PORCINE. Knuckle of Pork Decomposition 3 " Trimmings " 12½ " CANNED GOODS. 1804 tins Beef Blown, Decomposition, etc. 7664 " 11 tins Pork Luncheon Meat " 8 " 15 " Stewed Steak " 15 " 7 " Sausages " 6¾ " 18 " Bacon " 32¼ " 13 " Beef Loaf " 20¼ " 342 " Fish " 311½ " 38 " Soup " 32½ " 495 " Vegetables " 907½ " 260 " Milk " 243½ " 240 " Fruit " 569¾ " 22 " Fruit Juice " 36½ " 120 " Jam & Marmalade " 21l¾ " FISH. Coal Fish Decomposition 168 " Kippers " 28 " Herrings " 266 " Dog Fish " 154 " Haddock " 308 " Cod Fillets " 300 " Skate " 511 " Hake " 70 " Golden Cutlets " 28 " Megrims " 70 " Witches " 84 " Prawns " 112 " Crabs " 56 " C/Fwd. 18,393¼ " 49 Article of Pood. Reason for Action. Weight. MISCELLANEOUS. B/Fwd. 393¼-lbs. 4 packets Flour Contaminated by mice 17 ,, Cake Mixture ,, ,, ,, 5 ,, Sponge 113-lbs. 1 packet Porridge Oats 27 packets Dessert Mould Semolina Infested by Weevil 303 ,, 11 bags flour Contaminated by mice 23 ,, Macaroni ,, ,, ,, 9 ,, Oats Insect infestation 4 ,, Soya Flour ,, ,, 112 ,, 2 Boxes Rusks Decomposition 1½ ,, 21 packets Melba Toast Infested by Weevil 1 sack Milk Powder Contaminated by liquid foreign matter 112 ,, Cereals Insect Infestation 6½ ,, Split Peas Musty 24 ,, Dried Figs Insect Infestation 120 ,, Prunes Mould & Decomposition 172 ,, Dates Contaminated by foreign matter 69 ,, Currants Moth Infestation 109 ,, Tea Contaminated by noxious liquid 33 ,, 42 bottles Ketchup Fermentation 18 ,, 62 jars Pickles Mould 45¾ ,, 1 jar Sauce Contaminated by broken glass 1 ,, 4 jars Olives Contaminated by foreign matter 2 ,, 2 ,, Gherkins Decomposition 1 ,, 1 bottle Vinegar ,, 2 jars Beetroot Contaminated by broken glass 2 ,, 2 ,, Cabbage ,, ,, ,, 1¼ ,, 2 ,, Strawberry Puree ,, ,, ,, 2 ,, 7 bottles Plums Mould 7½ ,, 5 jars Cherries Decomposition 7 ,, 1 jar Rhubarb ,, 1 ,, 12 jars Jam Contaminated by broken glass 12 ,, 4 ,, Cherries Decomposition 6 ,, 1 keg Glace Ginger Contaminated by foreign matter 28 ,, Sweets Damaged by fire & contaminated by foreign matter 2½ ,, Sweets & Chocolates Spoiled 13½ ,, Mixed Chocolates Contaminated by broken glass & foreign matter 21¼ ,, 1 jar Chocolate Contaminated by broken glass 1 ,, 1 Goose Decomposition 4¾ ,, 1 Chicken ,, 2½ ,, 6 Ducks ,, 18 ,, Rabbits ,, 444 ,, Cheese ,, 7¾ ,, Cooked Chip Potatoes ,, 30 ,, 16 cases Oranges ,, 1 bottle Lemon Squash ,, 766 Eggs ,, Total 20,303 " All the above foodstuffs suitable for salvage processes were disposed of in accordance with approved arrangements. The remaining articles were destroyed, 50 FOOD AND DRUGS ACT 1938. Adulteration. During the year, 110 samples of food were submitted to the Public Analyst for examination. It is customary in this Borough to obtain samples in an informal manner in the first instance, and to follow up with a formal sample should an adverse report be received in respect of an informal sample. Much time and unnecessary labour and expense are avoided by this procedure, but in special cases, as, for Instance, when a particular doubtful consignment is thought unlikely to be available for more than a short time, a formal sample is taken immediately„ It will be appreciated that in order to administer the adulteration sections of the Act successfully, an element of surprise is essential. For this reason sampling is carried out at irregular periods and generally informal samples are purchased by an agent, the retailer not being aware that the foodstuff is to be examined. In the case of formal samples, the article purchased has to be divided into three parts in the presence of the seller, and after each separate part has been suitably packed and sealed, one part is sent to the Public Analyst, another part is handed back to the seller, whilst the remaining third part is retained in a safe place as, in the event of legal proceedings being instituted, the third sample has to be produced in court. In case of dispute regarding the accuracy, of the Analyst's Certificate, this part may be sent to the government analyst for examination. Tabulated Statement of Samples taken during 1948. Articles Analysed Report Formal Informal Total Livear - 1 1 Genuine Salmon & Shrimp Paste - 1 1 ,, Ham &. Beef Paste - 1 1 ,, Dried Milk - 1 1 ,, Margarine 1 - 1 ,, White Pepper - 1 1 ,, Black 1 — 1 ,, Semolina - 1 1 ,, Plum Jam — 1 1 ,, Malt Vinegar - 1 1 ,, Saccharin - 1 1 ,, Non-brewed Vinegar - 1 1 ,, Anchovy Paste - 1 1 ,, Aspirin Tablets — 1 1 ,, Curry Powder - 1 1 ,, Tomato Sauce - 2 2 ,, ,, Ketchup - 1 1 ,, Teaseed Oil - 1 1 ,, Ginger Wine - 1 1 ,, Milk 4 52 56 2 not genuine Ice-Cream - 7 7 1 contained extraneous matter Liver Sausage - 1 1 Genuine Pork Sausage Meat — 3 3 ,, Pork Sausage - 1 1 ,, Beef Sausage — 8 8 In 2 cases meat content 30% & 25% respectively Beef Sausage Meat - 3 3 Genuine Saveloys — 1 1 ,, Steak Pies - 6 6 2 factory. Meat Pies - 4 4 1 unsatisfactory. Totals 6 104 110 51 It will be seen that eight of the samples were reported as being not genuine, and the following notes on these samples may prove of interest. The two unsatisfactory samples of milk were taken from consignments from one producer whose farm is situate in Hampshire. The first sample was stated to contain a trace of added water. A second sample contained 3% of added water. Having regard to the comparatively small quantity of water, it was decided to warn the producer. In the case of the ice-cream, small grain beetles and a small amount of mineral dirt were stated to be present in the sample. The ice-cream was being manufactured in a London borough and accordingly the local authority concerned was immediately notified. Upon further investigation it was found that the manufacturer had been using some stale ingredients, but when visited by the local food inspector, the stock of raw materials then in use was found to be satisfactory. The first sample of beef sausage (informal) was found to contain only 3% of meat instead of 50% as prescribed by Regulation. A subsequent follow-up sample proved to be genuine. The case was kept in mind and at a later date in the year a further sample was taken and this proved to contain only 25% meat. The sausages were not properly labelled, and when a formal sample of beef sausage was asked for, the shop assistant stated that they were not beef, but meat and vegetable sausages. This type of sausage could be manufactured only under licence from the Ministry of Food, and it appeared that a loophole existed by which it was possible for these inferior articles to be made and to be sold at a higher price than genuine meat sausages. The matter was, therefore, taken up with the Ministry, and subsequently the sale of this type of sausage was discontinued. When is a pie properly described as a 'meat', or 'steak' pie? This question arose when it was found that a pie which had been submitted to the Analyst contained less than 5% of meat, the remainder of the filling consisting essentially of a paste of cooked cereal. The Analyst stated that in his opinion the filling of a steak pie should consist of pieces of meat with gravy and thickening, and the proportion of meat should be not less than one-half of the filling and one-tenth of the pie. In all, ten pies were examined, and it will be seen from the tabulated statement below that not only was there wide variation in the meat content, but what was even more surprising was the fact that the three least satisfactory articles were retailed at a higher price than those which could be regarded as genuine meat pies. Details of Analyses of Ten Meat Pies. Percentage Analyst's Report. Crust Filling Meat Price No. 744 Steak Pie 77 23 4.6 6d. Not genuine ,, 758 ,, ,, 73 27 16. 4½d. ,, 759 ,, ,, 77 23 4.6 6d. Not genuine ,, 760 Meat ,, 78 22 5.5 6d. ,, ,, ,, 761 Steak ,, 79 21 13. 5½d. ,, 763 Meat ,, 78 22 12. 1/- ,, 767 Steak ,, 74 26 19. 4½d. ,, 768 ,, ,, 61 39 33. 5d. ,, 769 Meat ,, 71 29 17. 5½d. ,, 785 ,, ,, 71 29 22. 5d. 52 With the exception of sample No. 763, all the pies were of similar size and weighed approximately 6½— ozs each. On the facts as shown by the Analyst's Reports, it appeared that a purchaser of the inferior pies was being prejudiced, but as no legal standard for meat pies had been set up, an approach was made to the Ministry of Food to obtain their views. Unfortunately, and it is a matter for regret, owing to certain technical difficulties concerned with sampling and accurate reproducible analysis, the Ministry of Food has not yet found it possible to establish a standard for meat pies. It remains, therefore, for the public to safeguard their interests by exercising care and discrimination in the purchase of 'meat' and 'steak1 pies. FOOD HYGIENE. During the year efforts to ensure the hygienic condition of food premises in the Borough were continued. It will be remembered that immediately after the cessation of hostilities, attention was first directed to restaurants, canteens etc. It was recognised that owing to food difficulties and rationing, more people were taking meals away from home. This mass feeding very naturally produced conditions in which large numbers of persons might be affected in the event of food being contaminated in the kitchens. Having dealt with structural conditions as far as was possible within the limits of building licences, attention was directed to the personnel employed in and around food premises. This work is most valuable, but inevitably it is of a non-stop character, mainly owing to frequent changes of staff, but also to the fact that lessons in hygiene are most effective, when addressed to individuals or small groups of persons. Their own personal errors can be pointed out in a quiet tactful manner and an explanation can be given them, together with advice how to avoid the errors in future. This work goes on daily, not only in food premises, but also in the home, where it is sometimes noticed that foodstuffs are kept and handled most improperly. In these latter cases, experience teaches that extreme tact is necessary, for it is strangely true that a few housewives have been known to resent all too readily a word of advice regarding a thoughtless act which, if performed by a shop assistant in their presence, would bring down upon that hapless individual indignant reproaches. At a rough guess, for these figures are not published, there must be upwards of 70,000 food registrations effective in this Borough, and the absence of serious illnesses which have been traced without doubt to foodstuffs purchased in the town is an indication of the reasonably high standard which has been achieved and maintained. This good fortune is gratifying, but it is not allowed to lead to a feeling of complacency. Work in the field of Food Hygiene continues without a break. 53 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 1948 a total of 487 notifications of infectious disease was received, compared with 345 in 1947. The increase is mainly due to a considerable rise in the notification of whooping cough among young children. The following table gives an analysis of the cases into age groups. 54 notifiable diseases during 1948 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 pases admitted to Hospital Under 1 year 1-2 2 - 3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - h5 45 - 65 65 & over  Scarlet Fever - 1 2 2 1 22 5 1 - - - - 34 22 - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever including Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - 1 2 - - - 3 3 — — — — — - — 1 — - - - 1 Polioencephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - — - - - 1 23 6 - - 30 29* — - - — - - - - - - - - - Ophthalmia Neonatorun - - - - - - - _ - - - - - - _ - - - _ - _ - - - - - - Cerebro-Spinal Fever - - - - - - - — - - — - - - _ - - - - - _ - - - - - - Pneumonia 2 1 - 4 2 2 - - 1 1 5 2 20 1 4 - — - - - - - - 1 5 9 19 Erysipelas 1 - - - - _ - - - _ 1 1 3 2(1)* - - - — - — - — - — - — — B. Dysenteria (Sonne) = - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 13 29 17 26 20 35 2 2 2 - 1 - 197 5(2)* - — — — - - - - - - - - — Whooping Cough 17 26 17 22 40 74 3 - 1 - - - 200 10(1)* - - - - - - - - - - - - - TOTALS 33 57 56 54 63 183 10 5 29 7 7 3 487 72 4 - - - - - - 1 - 1 5 9 20 *Number of cases already in hospital at time of notification. 55 The following table gives a comparative statement of notifications received during the last twenty-eight years in respect of Scarlet Fever, Diphtheria and Enteric Fever:- Year Scarlet Fever Diphtheria Enteric Fever (including Paratyphoid) 1921 302 79 4 1922 238 74 1 1923 118 17 1 1924 143 20 6 1925 213 25 7 1926 82 27 7 1927 87 65 3 1928 135 152 7 1929 74 113 1 1930 78 100 5 1931 61 53 1 1932 56 47 1 1933 125 30 2 1934 40 42 2 1935 54 50 2 1936 67 27 6 1937 51 21 1 1938 61 72 1 1939 69 19 1 1940 45 53 3 1941 54 15 7 1942 79 8 - 1943 110 3 1 1944 49 7 - 1945 28 16 - 1946 34 8 1 1947 24 2 1 1948 34 - - Scarlet Fever. Thirty-four cases of mild Scarlet Fever were notified, thirty-three of which were of school age. No deaths occurred and no "return" cases. Twenty-two of the cases notified were removed to an infectious diseases hospital for treatment and the remainder were treated at home. Diphtheria. No cases of diphtheria were notified, for the first time in the years for which records are available. This is a particularly gratifying result from the intensive work which has been going on during recent years to protect children against this deadly and weakening disease. The success obtained by immunisation requires to be fought for with renewed vigour, because parents are now unfamiliar with the disease. Each new generation of infants requires to be immunised early, and as the process is voluntarily accepted, it is necessary to keep up continual propaganda in order to convince parents, in the absence of the disease, of the necessity for protecting their children by inoculation. Intensive work is continued to immunize the school and pre-school population against diphtheria, and the table on the following page shows the stage reached by the en d of 1948. 56 DIPHTHERIA IMMUNISATION. Comparative Statement for the Years 1946, 1947 and 1948. (Provided by Dr.W.H.Kinstrie). Year of Birth. No. completely Immunised. 1946 1947 1948 1948 - - 59 1947 - 48 557 1946 10 480 529 1945 274 411 419 1944 403 425 437 1943 374 388 422 1942 366 406 424 1941 405 386 387 1940 520 407 420 1939 377 383 390 1938 402 383 389 1937 359 367 385 1936 376 373 364 1935 357 319 321 1934 318 304 290 1933 271 242 1932 279 0-4 Age Group. Total number Completely Immunised as at 3l. l2. l946. 1427 Percentage 1946 - 49.7 as at 3l. 12. 1947. 1752 ,, 1947 - 55.1 as at 3l.12.1948. 2001 ,, 1948 - 62.4 5 1.5 Age Group Total number Completely Immunised as at 31.12.1946. 3664 Percentage 1946- 83.2 as at 3l.l2.l947. 3570 ,, 1947 - 78.6 as at 3l.l2.1948. 3792 ,, 1948 - 86.5 Record of work done at Diphtheria Immunisation Clinics. 1946 1947 1948 Total number of Clinics held 90 99 98 Number Completely Immunised 645 748 832 Number of Schick Tests 1214 1138 1294 Number of Positive Schick Tests) and re-inoculations ) 90 106 133 Total at tendances 3716 3807 3965 Average at tendances 41 38.4 40.5 57 Poliomyelitis. During the year three 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. All three cases were Kingston residents. One was sent to Tolworth Isolation Hospital, one to Wimbledon Isolation Hospital, and the third case to Western Hospital. The results were that two patients were discharged in varying degrees of paralysis, and the patient who was sent to Wimbledon Hospital died a few days after admission. Polioencephalitis. No cases were notified during 1948. Enteric Fever (Typhoid or Paratyphoid). No cases of typhoid or paratyphoid B were notified during 1948. Measles. There were 197 cases of measles notified durirg 1948, (compared with 219 in 1947), of whom five only were removed to hospital. There were no deaths recorded in this group. The 5-10 year age group contained the largest number of notifications (85), the majority of the remainder being spread over the 1-5 year age period. Tuberculosis. Cases of tuberculosis were dealt with from the treatment point of view, before the 5th. July, by the Surrey Covinty Council, and after that date, by the South West Hospital Regional Board. Good liaison exists between your Medical Officer and Chest Physician, and his staff. Each case notified is visited by an officer of the Public Health Department, and all contacts are advised to consult the Chest Physician. The efficiency of notification is good and there have been no cases of wilful neglect or refusal to notify. The following table shows comparative figures of notified cases and deaths for the years 1939 - 1948 (inclusive):- Year Cases notified Dea ths Respiratory Nonrespiratory Respiratory Nonrespiratory 1939 38 7 16 - 1940 37 10 25 1 1941 44 9 19 3 1942 67 11 22 2 1943 63 8 25 1 1944 56 11 19 4 1945 41 12 19 7 1946 41 9 10 3 1947 43 3 17 4 1948 55 3 22 2 (Note - An analysis of the total notified cases during 1948 in age groups is shown on the following page). NOTIFIED CASES. AND DEATHS. OF TUBERCULOSIS IN 1948 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. - 3 - 6 14 2 2 3 - 30 - - - 1 2 3 4 1 2 13 F. - - 1 8 5 6 2 1 2 25 - - - 2 1 5 - 1 - 9 Total - 3 1 14 19 8 4 4 2 55 - - - 3 3 8 4 2 2 22 (b) Non- Respiratory M. - - - - - - 1 - - 1 - 1 - - - - - - - 1 F. - - - 1 1 - - - - 2 - - - - - - 1 - - 1 Total - - - 1 1 - 1 - - 3 - 1 - - - - 1 - - 2 59 The ratio of non-notified cases to total deaths for 1948 and the preceding four years is as follows:- 1944 1945 1946 1947 1948 1 : 12 1 : 5 1 : 3 1 : 7 1 : 24 During 1948 no action became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 172 of the Public Health Act, 1936. Very close contact is maintained with the Kingston and District Tuberculosis Care Committee, whose field of work is coincidental with the North Central Division, of which body the Medical Officer of Health is Chairman, and 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. The Care Committee was formed for the purpose of encouraging and assisting sufferers from tuberculosis towards recovery. Thus, recognition was given officially to the special need for the care of tuberculous persons, because tuberculosis is infectious, and the treatment required for a cure involves a long period of complete rest. This en forced loss of earning power is a very serious matter to the family particularly if the patient is the wage earner. During 1948, 157 families were helped, the form of help being extra nourishment, clothing, money grants for removals, bedding, fares, pocket money, correspondence courses, and miscellaneous items, and a total of £1,282 was expended from the funds of the Committee on this work. Scabies - During the year the scheme for treating cases and contacts of scabies continued to operate as described in previous reports. The work was carried out on a sessional basis,, at the Cleansing Station, Burton Road, by part-time attendants working under the supervision of Health Visitors. The number of cases and contacts still further decreased during 1948, and no special difficulties were encountered. The incidence of scabies has markedly diminished. The following tables show the numbers of persons treated during the year 1948, and the four preceding years. Cases of Scabies and Contacts Treated. Year No. of cases and contacts treated at Total cases and contacts treated First Aid Post "A" First Aid Post "B" Coombe Road Clean sing Stat ion and (later) Burton Road 1944 575 368 — 943 1945 Closed 31.12.44 592 - 592 1946 — Closed 31.1.46 342 342 1947 - - 196 196 1948 - - 145 145 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. 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 1948 Burton Road 12 33 25 14 18 43 Analysis of cases treated during 1944, 1945, 1946, 1947 and 1948 Year No. of cases treated at Total cases treated First Aid Post "A" First Aid Post "B" Coombe Road Clean sing Stat ion and (later) Burton Road 1944 391 270 - 661 1945 - 341 — 341 1946 - - 152 152 1947 - - 108 108 1948 - - 63 63 81 Analysis into age groups of cases treated. Year Treatment Centre Males Females Under 5 Years. 5 yrs. to 14vrs. 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 Road Clean sing Station 13 27 32 4 37 39 1947 Coombe Road and Burton Road 7 25 8 13 28 27 1948 Burton Road 7 22 5 8 11 10 Analysis of contacts treated during 1944, 1945, 1946, 1947 and 1948 Year Noe of contacts treated at Total contacts treated First Aid Post "A" First Aid Post "B" Coombe Road Cleansing Station and (later) Burton Road 1944 184 98 - 282 1945 - 251 - 251 1946 - - 190 190 1947 - - 88 88 1948 - - 82 82 62 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 Road 3 19 18 10 12 26 1948 Burton Road 5 11 20 6 7 33 INFESTATION BY HEAD LICE During 1948 there was no evidence of special incidence of infestation by head lice. D.D.T. preparations were used in addition to the usual cleansing by water and soft soap or shampoo. The measures described In previous reports 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.