LIBRARY AC 4413(1) KINGSTON UPON THAMES KIN 23 Royal Borough of kingston- upon- Thames ANNUAL REPORT 1949 of the Medical Officer of Health and Chief Sanitary Inspector GUILDHALL. KINGSTON-UPON-THAMES OCTOBER, 1950 Royal Borough of kingston- upon- Thames ANNUAL REPORT 1949 of the Medical Officer of Health and Chief Sanitary Inspector guildhall, kingston-upon-thames october, 1950 ANNUAL REPORT 19 4 9 TABLE OF CONTENTS Preface. Page Staff of Public Health Department 1 SECTION A. Statistics and Social Conditions (1) General Statistics 2 (2) Social Conditions 2 (3) Extracts from Vital Statistics of the Year 2 (a) Live Births 2 (b) Stillbirths 2 (c) (i) Deaths - Total 3 (ii) Deaths of Infants under one year of age - total and infant mortality rate 3 Causes of deaths of children under one year of age 4 (iii ) Other deaths 4 Table I - Extracts from Vital Statistics for years 1945 - 1949 inclusive 5 Table II - Comparison of Vital Statistics 1920 - 1949 6 Table III - Birth-rates, Civilian Deathrates, and Case-rates for certain infectious diseases, in the year 1949 7 Table IV - Causes of Death 8 SECTION B. General Provisions of Health Services. (1) (i) Public Health Officers 9 (ii) Laboratory Facilities 9 (iii) Ambulance Facilities 9 (iv) Hospitals (a) Infectious Diseases 9 (b) Smallpox 10 (c) General 10 (2) National Assistance Act, 1948 10 Table V - List of Geriatric Cases 11 SECTION C. Sanitary Circumstances. Introduction 12 (1) Water Supply 13 (2) Drainage and Sewerage 13 (3) Rivers & Streams 13 (4) Closet Accommodation 14 (5) Public Cleansing 14 (6) Sanitary Inspection of the Area 14 Page (7) Shops and Offices 15 (8) Factories Act, 1937 16 (9) Camping Sites 17 (10) Atmospheric Pollution and Smoke Abatement 17 Table 1 - Tabulated Statement of Deposit of Solids, Wind Direction and Rainfall 19 Table 2 - Atmospheric Pollution 1949 21 (11) Swimming Baths and Pools 22 (12) Eradication of Bed Bugs 22 (13 ) Complaints 22 (14) Rodent and Insect Pest Control 22 SECTION D. Housing General 24 SECTION E. Inspection and Supervision of Food. (a) Milk Supply 26 (b) Designated Milks 26 (c) Bacteriological Examination of Milk 26 (d) Ice Cream - Bacteriological Examination 27 (e) Meat and other Foods 27 Tabulated list of Condemned Foodstuffs 28 (f) Food Hygiene 29 (g) Underground Bakehouse 30 Food and Drugs Act, 1938 30 Tabulated Statement of Samples Submitted to the Public Analyst during 1949 32 Conclusion 33 SECTION F- Infectious Diseases. Notifiable Diseases 34 Table VI - Notifiable Diseases during 1949 35 Table VII - Comparative Statement of Notifications of certain Infectious Diseases 36 Scarlet Fever 36 Diphtheria36 Table VIII - Comparative Statement of Diphtheria Immunisation during the years 1947, 1948 & 1949 37 Poliomyelitis 38 Po1ioncephalitis 38 Table IX - Brief Summary of Cases of Poliomyelitis and Polioencephalitis 38 Enteric Fever (Typhoid and Paratyphoid) 39 Measles 39 Ophthalmia Neonato rum 39 Puerperal Pyrexia 40 Tuberculosis 40 Table X - Notified Cases, and deaths from Tuberculosis in 1949 41 Scabies 42 Infestation by Head Lice 43 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT. 1949. Mr, Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for 1949 which is confined to essential matters relating to Public Health and Social Medicine,, It is prepared on similar lines to previous reports and deals with matters within my responsibility, VITAL STATISTICS. Population - The Registrar-General's estimate of the civilian population for 1949 is 40,660, which is the figure used throughout the report in the calculation of vital statistics. The total population, including Service personnels is 41,6800 This figure represents only the resident night population and does not indicate the very much higher concentration of day population for business, education, entertainment and recreation purposes. Live Births - The number of live births for 1949 is 729s, giving a Birth Rate of 17,96 per 1,000 of the population compared with 722 births and a rate of 17,73 for 1948 - maintaining almost the same level of 1948 and lower than the postwar peak of 1947 when the Birth Rate was 21.3. Deaths - The number of deaths recorded for 1949 is 500, giving a Death Rate of 12,32, compared with 455 and a Death Rate of 11,17 for 1948, Excess of Births over Deaths - The excess of births over deaths in 1949 is 229, compared with 267 in 1948, The Infant Mortality Rate - The number of deaths of infants under one year of age in 1949 is 15, giving a rate per 1,000 (registered live) births of 20.31, as compared with 17 infant deaths and a rate of 23.04 in 1948. This is a new record low level. The Causes of Death - The main conditions causing death, as recorded in the table for 1949, are - Heart disease, 147; cancer, 94; and intra-cranial vascular lesions, 47. The increase of 26 deaths from these causes accounts for more than half of the aggregate increase of deaths compared with 1948. Infectious disease - The number of notifications of infectious disease in 1949 was 699, as against 487 in 1948, The increase was due to the higher incidence of measles. In particular, it is recorded with satisfaction that, in 1949 for the second year in succession, no cases of diphtheria were notified. There was a decrease in the number of cases of Respiratory Tuberculosis notified, as also in the number of deaths from the sane cause, namely 40 notifications and 10 deaths in 1949, compared with 55 and 22, respectively, in 1948. Vaccination against Smallpox- is now on a voluntary basis and a calculation relating the number of children under 12-months vaccinated during 1949 to the number of children born between 1st July, 1948 and 30th June, 1949, inclusive, gives a figure of 51% vaccinated. Approximately two-thirds of these were vaccinated at the Health Centre, Grange Road, and the remaining one-third by general practitioners. HOUSING. During the year, notwithstanding the new housing accommodation already completed and contemplated, the provision of an adequate standard of housing accommodation for those in need of it continued to be an urgent problem. The completely built-up nature of the Borough, its situation on the outer fringe of London, and the existence of certain areas of older unsatisfactory accommodations, together with the constant pressing demand for more living accommodation, tends to perpetuate the crowding of families in existing accommodation with consequent impairment of health for a portion of the population. We are constantly reminded of this by the number of complaints received throughout the year and the number of appeals for rehousing. Many people are living in what is, from the health point of view, an overcrowded state, and others, though not badly overcrowded, are forced to reside in shared accommodation and uncongenial surroundings, which, especially in the cases of young children and elderly people, are not conducive to health. During the year, the visits of some seventy persons, who called to seek intervention in their housing problems were recorded. A further two hundred people have tendered medical certificates issued by their private doctors supporting their claim for rehousing. These persons represent only the most acute cases and, for each one known to us, there are several who have not come directly to our notice. Communications have also been received by me from the Care Almoner of the Kingston and District Tuberculosis Care Committee in respect of badly housed tuberculosis sufferers. Some of these patients have been in urgent need of separate bedrooms, in order to assist their own recovery, and to help prevent the spread of infection. I record my appreciation, both as Medical Officer of Health and Chairman of the Tuberculosis Care Committee, for the co-operation and help the Housing Committee and the Rehousing Officer have been able to give to such cases. In addition to these particular aspects of the problem, I acknowledge the continuous activity of the Chief Sanitary Inspector in connection with maintaining a satisfactory standard of structural repair in all dwellings, the details of which are set out in Section D of this report. It is a matter for some satisfaction that the vital statistics are still improving, notwithstanding the housing conditions afore-mentioned, which speaks well for the social welfare activities and the general sanitary efforts carried out by all departments of the Corporation,, Nevertheless, the difficult housing situation has brought to light an amount of physical and mental ill health which is not shown in the mortality statistics,, The completion of approximately 300 new houses or home units during the year, and the expectation of some 211+ others for early completion in 1950, is a considerable contribution to the solution of the problem,, This report covers the first full year of the regime under the new National Health Service Act, 1946, when the personal health services were administered by the Surrey County Council. The year has been one of adaptation to new administrative conditions. Much effort has gone to achieving a smooth transition and maintaining a high level of efficiency. Again I record my thanks to senior colleagues and the staff of the department for their whole-hearted co-operation and hard work throughout the year. I respectfully acknowledge the continued support and encouragement of the Chairman and Members of the Public Health Committee and the Worshipful the Mayor, Members and Aldermen of the Council. I have the honour to be, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. October, 1950. 1942 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M.B., Ch.B. (Edin.) D.P.H. Senior Sanitary Inspector: H.T. PERRY, O.B.E., 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) J.B. FACER, A.R.San.I. N.L.G. TUBB, M.R. San. I. (a) (b) * (Resigned 31.l2.49) Junior Sanitary Inspecter: (vacancy) Assistant Rodent officer: F.W. STAGG Administrative Officer: ø F.D. HARVEY, M.R.San.I. (a) (b) Clerical Staff as at 31st. December, 1949s M.E. POWELL, D.P.A. (appointed 9.5.49) MISS C.L. F.ISTER ø MISS V.E. NEELD MISS B.M. JERVIS MISS J.A. DILLIWAY P.M. DALE (resigned 6.2.49) A.R. ASTON L.A. PALMER (appointed 21.3.49) D.W. RUSSELL (appointed 2.5.49 resigned 14.10.49) (a) Certificate as Sanitary Inspector. (b) Certificate as Meat and Foods Inspector. Subject to a sharing arrangement with the Surrey County Council. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres 1,390 Civilian Population (Registrar General) 40,660 Total Population (including Service 41,680 personnel) Number of inhabited houses (approx.) 11,221 Rateable Value - General Rate £545,295 Sum represented by Penny Rate £ 2,223 2. Social Conditions. Mr. P.R.Smith, the Manager of the local Employment Exchange has kindly provided the following information regarding employment in Kingston and the surrounding districts. "A high level of employment was maintained throughout the year, and unemployment did not at any time exceed 1% of the industrial population. Long term unemployment was restricted in the main to elderly workers, and those of poor physique. There were approximately 100 registered disabled persons on the register throughout the year. Youth employment was taken over by the Education Authority on 1st, October, since when young people between school leaving age and eighteen years of age have been dealt with at the Surrey County Council's Youth Employment Bureau in Penrhyn Road. The principal industries in the area, which is still mainly residential, are Building, Motor, General, and Aircraft Engineering". 3. Extracts from Vital Statistics of the Year® (a) Live Births- Total Male Female Legitimate 679 344 335 Illegitimate 50 23 27 729 367 362 Birth Rate (Registrar General) Per 19,000 population 17.96 (b) Still Births - Total Male Female Legitimate 8 5 3 Illegitimate 2 - 2 10 5 2. Rate per 1,000 total (live and still) births 13.53 It is satisfactory to note a fall in the still-birth rate which indicates a further saving in child life, and an indication of success in ante-natal and obstetric work. 3 (c) Deaths Total Male Female (i) Death rate (Registrar General) per 1,000 population 500 250 250 12.32 Deaths Rate per 1,000 total (live & still) births Puerperal Sepsis - 0.00 Other Maternal Causes - 0.00 (ii) Death Rate of Infants under one year of age. All infants per 1,000 live births 15 20.58 Legitimate infants per 1,000 legitimate live births 13 19.15 Illegitimate infants per 1,000 illegitimate live births 2 40.00 The infant mortality rate is the number of deaths of infants under one year during the year per 1,000 live births registered in the year. The rate 20.58 is the lowest ever recorded for Kingston. It is also lower than the figure of 32 for England and Wales, and lower than the figure of 29 for the London Administrative County Area. The approximate infant mortality rate for 1949 and the rates since 1945 are shown for comparative purposes:- 1945 1946 1947 1948 1949 Kingston-uponThames 43 29 22 23 20 England and Wales 46 43 41 34 32 London Area 53 41 37 31 29 4 The following are the numbers of Kingston children who died during 1949 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 4 2 Congenital debility Twin birth - prematurity 1 Cerebral haemorrhage 1 Asphyxia. Large patent inter-auricular septum 24 hours - 1 month 9 4 Prematurity 1 Intra-cranial haemorrhage Extreme prematurity. 1 Atelectasis - prematurity 1 Uraemia. Congenital abnormalities of urinary tract. 1 Pneumonia. Congenital heart disease. Mongolism 1 Atelectasis - complete placenta praevia 1 month - 1 year 2 1 Broncho pneumonia 1 Prematurity (iii) Other Deaths - No. of Deaths Deaths from Cancer (all ages) 94 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) - Deaths from Diarrhoea (under 2 years of age) 1 The following tables (I) (II) (III) (IV) summarise certain vital statistics. The figures in Table (II) are the Registrar General's estimate. The proposed census of 1951 should give valuable information on the present sex and age distribution of the population, which is required for the accurate interpretation of the rates given. Extracts from Vital Statistics for Years 1945 — 1949 inclusive. TABLE I 1945 1946 1947 1948 1949 Total M. F. Total M. F. Total M. F. Total M. P. Total M. P. LIVE BIRTHS. Legitimate 529 272 257 738 367 371 838 432 406 677 345 332 679 344 335 Illegitimate 64 34 30 56 34 22 32 20 12 45 21 24 50 23 27 593 306 287 794 401 393 870 452 418 722 366 356 729 367 362 Birth rate (R.G.) per 1,000 pop, 16.58 20.02 21.33 17.73 17.96 STILL BIRTHS. Legitimate 21 12 9 24 13 11 14 6 8 16 7 9 8 5 3 Illegitimate 1 - 1 5 2 3 1 - 1 - - - 2 - 2 22 12 10 29 15 14 15 6 9 16 7 9 10 5 5 Rate per 1,000 (live and still) births 35.77 35.24 16.95 21.62 13.53 DEATHS 505 262 243 460 236 224 495 228 267 455 227 228 500 250 250 Death rate (R.G.) per 1,000 pop. 14.12 11.60 12.13 11.17 12.32 6 TABLE II Comparison of Vital Statistics 1920 - 1949 Year Estimated Population Live Births Birth Rate per 1,000 population Deaths Death rate per 1,000 population Infantile MortalityRate per 1,000 Live Births Kingston upon Thames England and Wales London Area 1920 39067 923 29.9 437 11.3 66 1921 39520 799 20.2 457 11. 5 60 83 80 1922 39940 698 17.5 515 12.9 61 77 74 1923 40320 706 17 .5 416 10.3 73 69 60 1924 40430 642 15.9 502 12.5 76 75 69 1925 40220 599 14.9 454 11.1 73 75 67 1926 39479 619 15.5 466 11.7 74 70 64 1927 39330 517 13.l 486 12.4 37 69 59 1928 39330 560 14.2 475 12.1 69 65 67 1929 38760 556 14.3 517 13.4 56 74 70 1930 38760 553 14.3 423 11.0 43 60 59 1931 39052 489 12.6 493 12.8 57 66 65 1932 38250 450 11.8 480 12.5 60 65 66 1933 38690 470 12 .2 464 12.0 59 64 59 1934 38270 470 12.3 422 11.0 45 59 67 1935 39030 510 13.0 482 12.3 57 57 58 1936 39880 573 14.4 502 12.6 52 59 66 1937 39850 539 13.5 540 13.6 52 58 60 1938 39790 528 13.2 468 11.8 43 53 57 1939 39970 533 13.3 450 11.4 28 50 48 1940 37430 519 13.9 659 17.6 55 55 50 1941 35970 520 14.5 525 14.6 57 59 68 1942 36090 551 15.3 491 13.6 63 49 60 1943 35900 637 17.8 500 13.9 48 49 58 1944 34780 578 16.6 474 13.6 48 46 61 1945 35760 593 16. 6 505 14.1 43 46 53 1946 39670 794 20.0 460 11.6 29 43 41 1947 40780 870 21.3 495 12.1 22 41 37 1948 40780 722 17.7 455 11.2 23 34 31 1949 40660 729 17.9 500 12.3 20 32 29 7 TABLE III Birth-rates, Civilian Death rates, and Case-rates for certain infectious diseases, in the Year, 1949. Provisional figures based on Weekly and Quarterly Returns England and Wales 126 C.Bs. and Great Towns including London 148 Smaller towns Resident Pop.25,000 —50,000 at 1931 Census London Adm. County Kingston upon Thames Rates per l,000Civilian population:- Births Live Births 16.7(a) 18.7 18.0 18.5 17.9 Still Births 0.39(a) 0.47 0.40 0.37 0.25 Deaths All Causes 11.7(a) 12.5 11.6 12.2 12.3 Typhoid and paratyphoid 0.00 0.00 0.00 0.00 0.00 Whooping cough 0.01 0.02 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.45 0.52 0.42 0.52 0.27 Influenza 0.15 0.15 0.l4 0.11 0.12 Smallpox 0.00 0.00 - - — Acute poliomyelitis & polioencephalitis 0.01 0.02 0.02 0.01 0.07 Pneumonia 0.51 O.56 0.49 0.59 0.69 Notifications (Corrected) Typhoid fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid fever 0.01 0.02 0.01 0.01 0.00 Cerebro-spinal fever 0.02 0.03 0.02 0.02 0.00 Scarlet fever 1.63 1.72 1.83 1.46 1.79 Whooping cough 2.39 2.44 2.39 1.70 1.99 Diphtheria 0.04 O.O5 0.04 0.07 0.00 Erysipelas 0.19 0.20 0.19 0.17 0.07 Smallpox 0.00 0.00 O.OO 0.00 0.00 Measles 8.95 8.91 9.18 8.54 11.89 Pneumonia 0.80 0.91 0.65 0.55 0.42 Acute poliomyelitis 0.13 0.13 0.12 0.18 0.19 Acute polioencephalitis 0.01 0.01 0.02 0.01 0.07 Pood poisoning 0.14 0.l6 0.14 0.19 0.00 Rates per 1,000 Live Births Deaths All causes under 1 year of age 32(b) 37 30 29 20 Enteritis and diarrhoea under 2 years 3.0 3.8 2.4 1.7 1.4 Rates per 1,000 Total (Live & Still) Births Notifications (Corrected) Puerperal fever and pyrexia 6.31 8.14 5.30 6.82 5.54 (a) Rates per 1,000 total population (b) Per 1,000 related live births 8 Causes of Death TABLE IV Registrar General's Tables All Causes 1945 1946 1947 1948 1949 M. F. M. F. M. F. M. F. M. F. 262 243 236 224 228 267 227 228 250 250 Paratyphoid and Typhoid Fever - - - - - - - - - - Cerebro-Spinal Fevers - - 1 1 — — — — - — Scarlet Fever - - - - - - - - - - Whooping Cough - - — — — — — — — — Diphtheria — — — — — — - - — — Tuberculosis of Respiratory System 10 9 6 4 10 7 13 9 4 6 Other forms of Tuberculosis 3 4 3 - 3 1 1 1 1 — Syphilitic Diseases 3 - 3 1 4 4 2 2 5 2 Influenza 2 — 3 — - 3 1 1 3 2 Measles - 2 - — - - - - 1 - Acute Poliomyelitis & Polioencephalitis - - - — - — 1 — 1 2 Acute Infective Encephalitis - - - — - - — — 1 - Cancer of B. Cav. & oesophagus (M) uterus (F) 7 1 3 5 4 8 2 6 2 4 Cancer of Stomach or duodenum 7 5 4 7 5 8 10 8 10 5 Cancer of Breast — 6 — 8 — 13 - 7 - 13 Cancer of all other sites 30 23 34 19 32 19 34 16 40 20 Diabetes 4 5 3 1 - 1 1 - - 2 Intra-Cran, vascular lesions 14 36 24 31 30 26 19 25 18 29 Heart disease 69 65 65 64 71 84 60 73 66 81 Other diseases of circulatory system 16 22 9 18 15 21 7 11 11 20 Bronchitis 20 7 14 8 13 14 10 5 23 10 Pneumonia 14 7 16 9 10 12 11 8 12 16 Other respiratory diseases 3 - 2 1 3 2 6 4 5 - Ulcer of Stomach or Duodenum 9 1 8 2 2 1 5 2 4 1 Diarrhoea under 2 years 1 - - 2 1 2 - - 1 - Appendicitis - - 1 1 1 - 3 2 2 — Other digestive diseases 3 8 8 5 5 7 3 8 4 4 Nephritis 5 4 1 6 1 4 3 1 4 3 Puerperal Causes - - - - - 1 - 1 — — Other maternal causes - - - 2 - - - — — — Premature births 3 — 1 5 1 2 3 3 4 2 Congenital malformation Birth Injuries 7 5 8 2 1 8 4 3 6 4 Suicide 4 3 4 2 4 - 5 5 2 3 Road Traffic Accidents - 1 2 1 1 - 4 1 1 2 Other violent causes 5 10 1 6 1 2 6 8 4 5 All other causes 23 19 12 13 10 17 13 17 15 14 9 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) Laboratory Facilities. During 1949 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 South West Metropolitan Regional Hospital Board. 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 Ministry of Health Laboratory, Epsom, and samples under the Pood and Drugs Acts are submitted to the Public Analyst. (iii) Ambulance Facilities. Ambulance facilities are now provided by Surrey Ambulance Service. (iv) Hospitals. (a) Infectious Diseases. The responsibility for hospitalisation of infectious disease cases lies with the South Western Metropolitan Regional Hospital Board, and admission is now effected by direct contact with the Tolworth Isolation Hospital whenever possible. This hospital is intended to serve the district as an isolation unit and now comes under the direction of the Medical Superintendent of Kingston Hospital. On occasions, when beds are not available, admittance is arranged with the South Middlesex Hospital, and in the event of beds not being available there, the removal is put into the hands of the South Western Branch of the Emergency Bed Service which operates in conjunction with the Local Authorities and Hospital Boards. During the year 74 infectious disease cases were sent to hospital for treatment, or diagnosis, as follows:- To Wimbledon Isolation Hospital. 7 Tolworth Isolation Hospital 49 South Middlesex Hospital 8 The Western Hospital 1 TOOting HOSPital 1 Kingston Hospital 2 Hendon Hospital 1 Cuddington Hospital 1 Ottershaw Hospital 1 Wandle Valley Hospital 1 Victoria Hospital for Children, Chelsea 1 Hospital for Tropical Diseases 1 10 (b) Smallpox. Arrangements were in existence for some years whereby the first cases of smallpox could be admitted to the special Smallpox Hospital at Clandon, Surrey., These arrangements have now been superseded by a Regional Hospital Board provision for first cases to be admitted to Joyce Green Hospital, Dartford, Kent, after consultation with a named smallpox consultant. No cases occurred in the Borough during the year. (c) General. The main General Hospital situated in the Borough available for the District is The Kingston Hospital, Wolverton Avenue, Kingston-upon-Thames (Telephone KINgston 5692) 2. National Assistance Act, 1948. Under Section 47 of this Act, a Local Authority is empowered to apply to a Court of Summary Jurisdiction, to have removed to suitable premises, persons in need of care and attention. Your Medical Officer was satisfied after thorough enquiry and consideration, that an aged person occupying one room in Richmond Road, should be removed from the premises in her own interests, and in order to prevent injury to the health of other persons. She was unable to devote to herself, and was not receiving from other persons proper care and attention, and a certificate was issued to this effect. Application was made by the Town Council to the Court for removal to Kingston Hospital, and an Order was made authorising this for an initial period of three months. The removal was carried out, and it was learned subsequently that the old lady had passed away after being in the hospital for four weeks, the cause of death being (a) Hypostatic pneumonia (b) peritonitis (chronic) (c) Colitis and perforation of the bowel. The following is a brief summary of certain cases and the action taken, and/or advice given. While the picture, as conveyed by the summary, is distressing it relates to but a small percentage of all the aged. Happily as yet, by far the largest proportion of the aged are able to live out their lives in independence, and comparative vigour. 11 TABLE V List of Geriatric Cases During 1949 Description Date Notified tO M.O.H. & by whom General Condition Result Elderly lady 85 years ll.l.49 Sub-Tenant Alone,Incontinent, Senility Interviewed daughters who arranged mother's removal. Middle aged lady. 62 years 4.3.49 County Officer Border-line case as regards mentality. Sons informed. Private doctor contacted re certifiability. Elderly lady. 89 years 12.3.49 Bedridden,alone, Incontinent Arranged priority bed in Kingston Hospital. Lady. Age Unknown 24.3.49 District Nurse Alone, dirty, neglected, violent. Contacted private doctor re certifiability. Elderly lady 80+ years 1.7.49 Neighbour Unclean. In need of care and attention. Corresponded with private doctor. Arranged Home Help. Elderly lady 86 years 31.10.49 Neighbour Feeble, alone. Taken to live with her daughter. Elderly gentleman. 71 years 8.11.49 Son Colostomy. Wife unable to keep him clean. Referred to private doctor and Kingston Hospital who have agreed to endeavour to reconstitute the bowel. Elderly gentleman. 76 years 8.12.49 Son Senility. Incontinent Referred to private doctor who will obtain hospital admission. Elderly gentleman, 78 years 24.12.49 Daughter Bad fall. Cannot move. Weak bladder. Instructed daughter to refer matter to family doctor. Elderly lady, 73 years 7.4.49 Assistance Board Officer . Alone, poor health,separated from husband. Arranged with husband and daughters to visit regularly. Elderly lady 85 years 7.12.49 Member of Clergy Alone. Not receiving proper care & attention Referred to private doctor and Welfare Officer for institutional care. Lady, Age Unknown Old People's Club Asthma and heart trouble. Left to Old People's Club to assist. Elderly lady, 84 years 29.10.49 Occupier of house Incontinent. In need of care and attention. Refused hospital admission. Finally • decided to implement Nat. Assistance Act Section 47 12 ANNUAL REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1949. To the Mayor, Aldermen and Councillors, of the Royal Borough of Kingston-upon-Thames. Mr. Mayor, Ladies and Gentlemen, I have the honour to present for your consideration the following Report on the work of your sanitary inspectors for the year 1949. It has been written "Health is not valued until sickness comes". Those words are as true today as when they were written in the 17th Century, but the state of public health has changed (for the better) very considerably compared with those distant days. Having achieved a high standard of health it is the duty of everyone to do everything possible to maintain it. That is the particular sphere of sanitary inspectors, whose interest is not restricted to any one particular influence, but embraces all those conditions which might be associated in the physical sense with a healthy environment. The very word 'Sanitary' is derived from the Latin root for 'health' It is, therefore, our function to promote and protect the healthy state, as distinct from the equally necessary function of curing a state of sickness® The Report is divided into three sections - Sanitary Circumstances; Housing; Inspection and Supervision of Food. It is the thirty-first Annual Report I have had the privilege of submitting to your Corporation and despite its necessary brevity, I trust it will prove of interest,, There was one change of staff. Mr. G.C.Smith, who came to Kingston in 1940, resigned during the year to take up an appointment at Richmond as deputy chief inspector. In June observations were submitted to the Public Health Committee on obsolescent areas in the Borough The Report was based upon information gathered over a long period of years and the intimate knowledge of housing conditions in this town which can be obtained only by day by day work in those areas. Apart from general comments, the Report contained a suggested list of areas or properties, which may be dealt with under the Housing Acts at the appropriate time. It is not included in this Annual Report as there is very little likelihood that the necessary action envisaged in the comments can be inaugurated in the near future, but reference is made later in this Report, under Housing, to the need for a complete survey of housing conditions. The arrangement by which all plans, submitted for Building Bye-Law approval, are made available for perusal by the sanitary inspectors was continued throughout 1949 This co-operation is very valuable and is fully appreciated. It avoids difficulties which might arise at a later date after the new or altered buildings are completed and occupied. Yours faithfully, Guildhall, Kingston-upon-Thames. October, 1950. HAROLD T. PERRY. Chief Sanitary Inspector. 13 SANITARY CIRCUMSTANCES. Section C. 1. WATER SUPPLY. The Metropolitan Water Board, which is responsible for the public water supply in the Borough, continued that service during 1949 and there was no circumstance which necessitated any other than routine measures of control which the Metropolitan Water Board themselves exercised. At the beginning of the year,there were five dwelling houses in the Borough, the water supply of which was not derived from the Metropolitan Water Board's Mains, but from shallow wells. During the year 1949 three of these premises were provided with a water supply from the Board's mains "by the owners. At the end of the year there were only two houses in the Borough known to be entirely dependent on well water for domestic consumption. Two industrial premises also draw water from shallow wells for the purposes of their businesses. 2. DRAINAGE AND SEWERAGE. All sewage in the Borough gravitates to the site of the old Sewage Disposal Works at Down Hall Road whence it is pumped across the river and discharged into a trunk sewer of the West Middlesex Main Drainage Board at Broom Road, Teddington. From there it gravitates to the Mogden Disposal Works for treatment. This process of pumping into the West Middlesex Drainage area is a temporary measure which will be discontinued when the proposed new Disposal Works are constructed in the Lower Marsh Lane area for the Hogsmill Valley Joint Sewerage Board. Ministry of Health approval in principle has been granted for this scheme, and the Board's Consulting Engineers are proceeding therewith. 3. RIVERS AND STREAMS. Apart from the River Thames which forms the Western boundary of the town, and which is controlled by the Thames Conservancy Board, the only other water course in the Borough is the Hogsmill River. The Surrey County Council maintains the bed of the Hogsmill free from growth obstruction, and apart from one instance where a mosquito nuisance existed, no action was necessary during 1949 in respect of this river. An Improvement Scheme for the Hogsmill River has been prepared with a view to straightening the course, but work was not commenced before the end of the year. Increasing pollution of the Thames was the subject of concern to some riparian Authorities, but action to prevent such pollution can be taken only by joint effort, and by more complete control of possible sources of contamination, such as riverside temporary dwellings and river craft. The continued shortage of housing accommodation is likely to lead to the increased use of boats oa the river for living purposes. In recent years the number has seldom exceeded twenty at any one time within the Borough boundary. During the winter months this number is usually much reduced, but it would appear that this seasonal decline is not a 14 permanent feature, and there is now a tendency for a greater proportion of boat dwellers to use their river dwellings continuously throughout the year, How far this change is due to a growing regard for the river, or to sheer necessity, it is difficult to say, but when information was sought from the occupants of two craft in use throughout the winter months, they expressed themselves as completely satisfied with their limited accommodation which they had no desire to exchange for a house. 4. CLOSET ACCOMMODATION. All the closets in connection with dwelling houses 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 the disposal methods of burning and tipping have continued during the year,, Salvaged material recovered monthly is approximately 75-tons including waste food suitable for pig feeding. The Corporation is under 'Direction' to collect waste food which is conveyed to Twickenham for conversion into pigfood. Despite efforts which have been made to ensure satisfactory sanitary conditions at collecting points in the streets, complaints from nearby residents continued to be received. It remains an urgent necessity for all available waste food to be salvaged but the need for a more hygienic system than the one in use is equally essential. The individual collecting pail system which was tried out in a small area of the town has not been extended. Further reference to the refuse tips will be found under the heading of Rodent and Insect Pest Control. 6. SANITARY INSPECTION OP THE AREA. The following is a tabulated list of visits and inspections which totalled 7,252 compared with 7,677 the previous years:- Houses, etc. 872 Drainage 610 Re inspections and Works in Progress 2929 Factories 238 Outworkers 41 Dairies, etc. 57 Food Premises 1170 I.D.Enquiries 133 Theatres 11 Verminous Premises 65 Rodent Control 174 Shops Acts 336 Schools 19 Visits re Well Water Supplies 5 Housing Inspections (Consolidated Housing Regulations) 223 Housing Act 18 Markets 91 Miscellaneous 260 7,252 15 The number of notices served and the result of the action taken is shown by the following statistical statements. It should be pointed cut that the number of notices complied with during 1949 is not comparable with the number served during the same period as the former number may have reference to some notices which were served in the previous year. NOTICES SERVED. Informal. (a) Verbal 587 (b) Written Statutory. (a) Housing Acts - (b) Public Health Acts 9 NOTICES COMPLIED WITH. Informal. (a) Verbal (b) Written 564 Statutory. (a) Housing Acts - (b) Public Health Acts 7 7. SHOPS AND OFFICES. The Shops Act 1934 is the Statute which controls the arrangements to be made for the health and welfare of shop workers. The Shops Acts 1912 to 1936 relate to the general conduct of business, and such matters as meal times, general closing hours, half-day closing, etc. The Public Health Act, 1936 brought offices within certain of its provisions. During the year particular attention was paid to hours of closing and Sunday Trading. As supplies of goods, particularly in the food trades, returned to the shops, it was felt that no hardship would be caused by requiring a more strict adherence to the requirements of the appropriate Acts. It was known that illegal Sunday trading had increased, and this matter was the first to receive attention. Most traders willingly responded to the advice given. Some expressed their relief and pleasure that they need no longer remain open on Sundays in order to retain the patronage of their customers. The only objections received were from traders who had commenced retail business for the first time during the war years and who were, therefore, not familiar with the legal enactments. At the end of the year the matter was still receiving attention, but generally speaking, traders were complying with the Law. The action taken did much to ensure that one trader could not take unfair advantage of his fellow shopkeeper by trading outside permitted hours. The Law relating to shops is extremely complicated and difficult to administer. It is in need of amendment, apart from simple consolidation, which was under consideration at the end of 1949. Inspections of offices have been continued during the year, as opportunity occurred. The standard of office accommodation in the town is reasonably good. 16 8. FACTORIES ACT. 1937. The following are the particulars required to be furnished to the Ministry of Labour and National Service respecting matters dealt with by the Corporation under Parts I and VIII of the Factories Act. PART I OF THE ACT. l. INSPECTIONS. Premises No. on Register Number of Inspections Written Notices Prosecutions. Factories in which Secs.1,2, 3,4 & 6 are enforced by Corporation 72 18 5 - Factories not included above in which Sec. 7 is enforced by Corporation 279 132 16 - Other premises excluding outworkers. 3 - - - 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars. No. of cases in which defects were found. Found Remedied Referred by H.M. Inspector No. of Prosecutions. Want of cleanliness. 4 4 4 - Overcrowding 1 1 1 - Unreasonable temperature 3 3 3 - Sanitary conveniences (a) Insufficient 2 2 2 — (b) Unsuitable or defective 6 5 4 - (c) No ventilated space or lobby 3 2 3 - (d) Lighting (absence of) 4 3 4 - Total 23 20 21 - 17 PART VIII OP THE ACT. Outwork. Nature of Work No. of Out-workers. Wearing apparel Making etc. 5 Brass and brass articles 33 Total 38 The above details are an extract from Form 572 (Revised). 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. ATMOSPHERIC POLLUTION AND SMOKE ABATEMENT. During 1949 Complaints received in the Department regarding alleged nuisances from smoke and grit, numbered just under one half of those received during the previous year. Attention continued to be paid to steam raising plants in local factories and advice and assistance was given in an endeavour to improve the condition of the atmosphere. Since the early part of the war years the quality of fuel available for industrial undertakings has been below the pre-war standard,. It was still below that standard at the end of 1949, and constant care and attention remained necessary on the part of managements as well as staffs in order to maintain the gradual improvement which was discernible during the year. One common cause of smoke emission from steam raising plant is that of the overloaded boiler. The plant has to be forced in order to reach and maintain the required amount of steam, and smokeless combustion of fuel under such circumstances is extremely difficult, if not actually impossible, to achieve. In one such case during 1949 much trouble was encountered; additional steam raising plant had been on order for a long time but delivery was not effected by the end of the year. General Observations. The types of atmospheric pollution which occur in densely populated districts can conveniently be classified as follows:- 1. Smoke: Pine particles of carbon and liquid tarry matter which remain suspended in the air for a long time. 2. Ash: Particles of mineral matter, mostly large enough to be deposited fairly quickly, near to their place of origin. 3. Sulphur Dioxide: A gas, which in the presence of water and air, is slowly converted to sulphuric acid. 18 There are other kinds of pollution which may result from the combustion of coal, but the above three are the most important. It will be appreciated that the amount each of smoke, ash and sulphur dioxide recorded in any one particular spot, would not necessarily correspond exactly to the constitution of the products of combustion as emitted from the chimney or group of chimneys in the neighbourhood. Ash, for instances, being a mineral body, falls more rapidly to earth than do the lighter particles in the form of smoke. The very small particles which form visible smoke, being dependent on their own weight for depositions, are carried over a mucn larger area than the heavier particles of ash and grit. Gases, such as sulphur dioxide, etc. are spread over an even larger area than the smoke and ash. Some of the sulphur deposit is removed from the air by the process of being dissolved in the rain and water droplets of cloudS. The height at which the pollution is discharged into the atmosphere is a very important factor. On June 1st, 1948 a standard deposit gauge was installed on a site which was decided upon after consultation with the Department of Scientific & Industrial Research. The site is at the Canbury Gardens near to the new Power Station. At the time the deposit gauge was installed the construction of the new Electricity Power Station Buildings was not completed. It was hoped, by means of the gauge, to obtain data which would show the effect, (if any) of the Power Station on the amount of atmospheric pollution in the area. After the gauge was installed, a new wing was built on to the station at the North end, near to the gauge, and dust from building operations had a distinct effect on the amount of solids deposited. Following the opening of the Power Station in October 1948, one chimney stack only was used, and this remained the case throughout the remainder of 1948 and the whole of 1949. The gauge is so situate as to be within the proximity of other potential sources of atmospheric pollutions, namely, the Gas WorkS, and the Railway Goods sidings. Wind blowing from any point between South West and South East could carry pollution from any one or more of these sources and in order to assist in determining the comparative effect of wind direction on atmospheric pollution, wind readings have been taken three times daily throughout the year. Table I overleaf sets out the monthly rainfalls, the deposit in tons per square mile, and the number of times the wind was observed in the quarters mentioned. The table covers the period from the date that observations were commenced, to the end of 1949. 19 TABLE I. Smoke Abatement. Month Deposit in Tons per Sq. mile. Wind Direction Rainfall in inches. Insoluble Solids Soluble Solids Total Solids No. of observations. No. of times wind from SE. to SW. l948. June 15.10 11.65 26.75 90 30 1.70 July 11.36 ll.78 23.14 93 34 .75 August 11.40 11.93 23.33 93 35 3.38 September 18.66 13.27 31.93 90 46 1.24 October 17.62 12. 44 30.06 93 37 2.24 November 13.73 8.17 21.90 90 40 1.60 December 22.79 18.79 41.58 93 50 2.75 1949 January 10.43 5.44 15.87 93 42 0.70 February 12.00 6.70 18.70 84 36 1.01 March 6.40 6.55 12.95 93 17 0.93 April 11.84 8.56 20.40 90 35 1.56 May 13.66 8.58 22.24 93 35 2.15 June 10.83 11.18 22.01 90 28 0.70 July 11.27 10.92 22.19 93 20 1.19 August Apparatus out of commission September 10.86 8.57 19.43 90 37 0.49 October 16.56 9.82 26.38 93 75 5.12 November 15.47 8.36 23.83 90 48 2.23 December 13.14 7.41 20.55 93 44 1.43 Total (1949) 132.46 92.09 224.55 17.51 Average (1949) 12.04 8.37 20.41 1.59 It is, as yet, too soon to draw conclusions from the limited data obtained, but there is reason to believe that at times when the wind is from the direction between S.E. and S.W. and in wet weather (which usually accompanies a S.W.wind) the amount of deposit in the gauge is increased. Conversely, when those two conditions are absent, there is a corresponding reduction in the recorded deposit. One fact is abundantly clear, however, namely that the local atmosphere contains more pollution than is generally realised. The gauge showed that the average monthly deposit at Canbury Gardens was equivalent to 20.41 tons per square mile, or, if it is assumed that the pollution is evenly spread over the whole of the Borough, then the total amount would be 44.3 tons per month and 531.6 tons per annum. To meet the criticism that the figures given are probably on the high side for the Borough as a whole, similar calculations based on the lowest recorded month (March 1949) give a monthly total of 28.1 tons and 337.2 tons per annum, truly formidable amounts of deposit in a Borough such as Kingston. The results so far indicate the need to arouse the public conscience in the field of smoke abatement and it is submitted that they also Justify the action already taken by your Corporation. They also point to the need for joint action by all interested bodies. In this connection it became apparent that the British Electricity Authority had taken steps to obtain similar data at various points in the neighbourhood 20 and an approach was made to that Authority with a view to an exchange of data. The suggestion was not accepted. (Notes Arrangements have since been made whereby the data obtained by the B.E.A. will be made available to the Corporation.) The graph on the next page sets out the monthly details of rainfall and both soluble and insoluble solids as indicated by the gauge at the Canbury Gardens« The diagram below shows the orientation of the gauge in relation to the sources of possible pollution mentioned in the text of the Report. 21 22 11. SWIMMING BATHS 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 was used for swimming during the summer months and for the winter months was converted for use as a hall for concerts, dancing, balls, etc. (b) Private. There are no privately owned swimming baths or pools open to the public in the Borough. 120 ERADICATION OF BED BUGS. During the year 51 premises were disinfested, compared with a figure of 33 for the previous year. Thirteen Corporation controlled houses were dealt with by the Department during the year. The long warm summer of 1949 was undoubtedly a contributory factor in this rather large increase of work in this connection. 13. COMPLAINTS. The total figure of 781 is almost exactly the same as during the previous year, viz; 783. A feature worthy of note was the number of communications which related to the quality or soundness of foodstuffs. The number of these letters was 43 or of the total complaints,. This is not a high percentage in all the circumstances and if viewed in the light that it reflects a growing food hygiene conscience amongst the public, then it is a feature to be welcomed by those who are concerned with safeguarding the food supplies.Not all of the lettters dealt with matters under the control of the Corporations, and some were based on incorrect assumptions® All such complaints, however, receive full consideration and, where necessary, appropriate action is taken. The following is a brief tabulated list of causes for complaints received during 1949:- Sanitary Defects 266 Rodents 118 Vermin Infestation 52 Non-removal of Refuse 13 Defective Ashbins 20 Drains and Sanitary Arrangements 153 Overcrowding 17 Pood (Quality, Soundness, etc) 43 Nuisance from Smoke 19 Miscellaneous 80 781 14® RODENT AND INSECT PEST CONTROL. In July 1949 an important enactment - The Prevention of Damage by Pests Act, 1949 - received the Royal Assent. This Act replaces the Rats and Mice Destruction Act, 1919, which had certain inherent weaknesses and which was not at all popular with those whose task it was to eliminate rodent infestations. The new Act contains important provisions regarding the structural repair and proofing of infested premises. 23 The Minister of Agriculture and Fisheries has been given power to issue regulations to control the methods used by servicing firms in the destruction of rodents. Scarcely anyone can wish to see additional controls imposed upon traders, but there would appear to be good reason for the introduction of the proposed new regulations if they serve to eliminate the potential danger to human beings by the use of certain types of material for destroying rats and mice, etc. The new Act comes into force on 31st March, 1950. The servicing of private dwelling houses is carried out free of cost to the tenants but business premises are charged the actual cost to the Corporation, plus the usual establishment charges,. Attention has been directed in previous years to the most common cause for rodent infestation in private dwellings the domestic poultry and rabbit keeper. If care is exercised over feeding of the animalS, and the runs and hutches are kept clean, the risk of infestation is very much reduced. But ideally hygienic conditions are seldom found- Poultry are more frequently overfed than underfed. Surplus unwanted food is seldom removed from the runs as it should be, and it affords a readily available source of supply to visiting rodents who usually also share the water in drinking troughs. It is not sufficiently well known how fast rats breed if they are comfortably housed and fed. One pair can produce several litters in a year. The offspring may themselves breed from three months of age. A little mental arithmetic will indicate the possible results of undisturbed breeding on the rat population, Fortunately, by constant work of rat destruction in the town, the numbers are kept down, but by reason of local circumstances it is virtually impossible to obtain 100% destruction of rats. The following statistical statement gives some indication of the work carried out during 1949;- Statistical Statement - 19U9. Private Dwellings. Number of premises inspected 359 „ „ „ found to be infested 250 „ separate infestations treated 291 „ „ visits for treatment and re- inspections 1530 Business Premises. Number of premises inspected 182 " " found to be infested 132 " " visits for treatment and re- inspections 4170 Total Number of premises inspected during 1949. Private Dwellings 359 Business premises 182 Number of Premises found to be Infested. Private Dwellings 250 Business Premises 132 382 24 Number of Visits - Private Dwellings 1,530 „ „ „ - Business Premises 170 5,700 This number includes only premises visited after notifications of suspected infestations are received in the Department. Over 1,000 premises were inspected also in connection with routine surveys. Insect Pest Control is carried out with the same staff as that engaged in rodent control works This arrangement is an economical one, as frequently one visit will serve the dual purpose of dealing with "both classes of infestation. Considerable success has "been achieved in food premises where it is now very unusual to find even a moderately large infestation,, In fact, treatment is now applied more frequently as a deterrent rather than as an actual agent of destruction. Insects are frequently imported with goods into "business premises and less often into housese An interesting case of the former occurred during 1949, It referred to an unusual type of beetle found in a wine store. A specimen was brought to the office for identification. It turned out to be the golden ground beetle, a native of Prancep and it had doubtless been imported in the wine cases. The proprietor had become alarmed at the increasing number of these beetles, but prompt action prevented what might have been a serious infestation had it not been detected and subjected to treatment at an early stage. Section P. HOUSING. The need for a complete survey of housing conditions has been stressed in previous Reports and it is a matter for regret that the Minister of Health did not find it possible to issue a directive during 1949 so that action on a national scale could be commenced. It is not possible to estimate with accuracy the housing needs of this town or of the country as a whole until a complete picture of the state of housing is available. As a first step a standardized fom of record is requisite and it has been understood that such a form has been under consideration by the Ministry for the past year or two. Uniformity throughout the country in. the standard of survey is very necessary, so that the needs of each area may be assessed by the same yard stick. It is hoped that a survey of the Borough will not be long delayedo In the meantime all possible action has been, and will be, taken to deal with houses in need of repair. The high cost of housing repairs compared with pre-war costs, and the fact that in the majority of cases, there has been no compensating increase in incomes from houses, is an important limiting factor on the extent to which demands can be made for any extensive repair worke It is not at all infrequent to come across cases where outgoings have exceeded income from small house property over a number of years. This is a problem which is likely to recur more often in the future and it is one which produces many headaches for your sanitary inspectors in their efforts to improve or even to try to maintain present housing standards. 25 During 1949 three unsafe unfit houses were demolished by the respective owners. The Housing Act, 1949 received the Royal Assent in July. 1949. The Act contains provisions for the granting of financial aid to owners who are prepared to make their houses fit in all respects for human habitations, works to include provision of bathrooms. hot water supplies, additional bedrooms, etc. The cost of such improvement works is to be between £100 and £600 and the houses are to be made fit in all respects and must have a minimum life of 30-years., So far no formal applications are known to have been made in this Borough. Common Lodging House - Vicarage Road. This building, known as Othen's Lodging House ceased to be used as such late in the year 1948. At the time it was closed there were about twenty regular users, most of whom were employed locally,. About a dozen of the occupants applied to the Surrey County Council for alternative accommodations, and it is understood that five old men who were eligible were admitted to certain Surrey homes for elderly, infirm men. Not all the occupants were elderly, some being quite young, and in regular employment,, Proposals were made to convert the building for use as a hostel, with separate cubicles, but this idea was not proceeded with. The following statistical information has been supplied by the Borough Surveyors- NO. of Dwellings erected by -private enterprise during 1949» Houses. New Construction - 39 War Damaged - 4 a This includes 15 flats at New Maiden which are occupied by tenants from Kingston Corporation's Housing Listo Total Number of working class permanent dwellings erected by the Corporation since March 1924 to 31st December, 1959. New Construction. War Damaged. Houses 973 4 (Including 710 outside Borough) Plats 347 3 (Including 4 outside Borough) No. of temporary dwellings completed during 1949. Nil Total NO. of temporary dwellings erected up to 31st DeCol949> Arcon - 132 Aluminium - 70 2-year Huts - 126 Total - 328. 26 Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The changes in administration regarding milk and dairies, which were included in the Pood and Drugs (Milk and Dairies) Act, 1944, came into force in 1949, the Appointed day' being 1st October. The main change consists in the transfer of responsibility for the supervision of milk production from Local Authorities to the Ministry of Agriculture & Fisheries. When the Act was in the Bill stage, considerable opposition to the proposals for transfer of functions to the Ministry was voiced. It was felt that milk production was essentially a public health matter. Those misgivings remain in the minds of many people experienced in the business. The change had no effect in this Borough as there are no milch herds in the town. Local Authorities remain responsible for supervision of the distribution of milk after it leaves the farms. The new Milk and Dairies Regulations, 1949 replaced the earlier Regulations, and made necessary the compilation of a new Register of premises used as dairies and of persons engaged in the trade of milk distributor. (b) Designated MilkS. These milks became subject to special regulations, involving the issue of licences to the persons engaged in the distribution of such milks. The following is the number of licences in force at the end of 1949:- Tuberculin Tested Pasteurised To Pasteurise 1 - To Deal 7 3 Supplementary 7 6 (c) Bacteriological Examination of Milk. During the year 1949, 83 samples of milk were submitted for examination to the Public Health Laboratory at Epsom. Of these 83, 73 were of 'Pasteurised' or 'Heat Treated. Milk and all samples satisfied the Phosphatase and Methylene Blue Tests, with two exceptions. In these two instances, the Phosphatase Test was satisfied, but the samples failed to pass the Methylene Blue Test. Of the milk sold as 'Ordinary', 3 samples contained B, Coli in 1/100 ml. or less. 27 (d) Ice Cream. Bacteriological Examinations. The number of samples of ice-cream obtained for bacteriological examination during 1949 showed an increase of 28% over those taken the previous year -1145compared with 113. The samples were placed in provisional Grades as follows:- Grade I Grade II Grade III Grade IV Total 72 35 31 7 145 Samples in Grades I and II are recognised as quite satisfactory® The general standard of these results is an improvement on that of the previous year, when 49 samples, or 43% of the total were reported as Grade I compared with 72, or 50% during 19U9. The summer of 1949, to which reference has already been made, was a long and warm one and the sale of icecream increased enormously. Samples were taken regularly at the sources of production and retailers were frequently visited and conditions of sale noted; the itinerant trader with his motile van or cycle was not overlooked, for it is recognised that in a large number of cases, people selling from vehicles engage in week-end trading only for the greater part, and have not the same outlook towards the need for maintaining high standards of cleanliness such as the actual producers of the commodity or the shop-keepers have "by reason of frequent discussions with the sanitary inspector on the best ways and means of producing and selling bacteriologically pure ice-cream. Despite the large increase in the sale of the commodity during 19U9, it is unlikely that the limit of the market for ice-cream has yet been reached, and an increasing sale over the next few years must be expected., (e) Meat and Other Foods. (i) Slaughterhouses, There are no licensed slaughterhouses within the Borough. (ii) Meat Depots The Depot in Wood Street continues to be the distribution centre for meat for Kingston and the neighbouring districts of Esher, Surbiton, Wimbledon, Richmond, Maiden & Coombe, and Barnes. Close attention was paid to the Depot during the year, There was no unusual circumstance that merited special mention, apart from the extra work which devolves upon the Department when deliveries of meat are delayed for one reason or another. This occurs when unexpected strikes take place and it may not be generally realised that one result of such action may be a serious loss of meat because of the delays in handling and also unsatisfactory temporary arrangements for storage. (iii) The following is a tabulated statement of foodstuffs condemned during the year, together with the cause for condemnations:- 28 Tabulated List of Condemned Foodstuffs showing causes for Condemnation and the Weights. Article of Food. Reason for Action. Weight. Bovine. Parts of 41 Hindquarters Internal Decomposition 1339½-lbs. „ „ 17 „ Bruised 152l½ „ „ „ 6 „ Fibrosis 366½ „ „ „ 8 „ Black Spot Mould 52½ „ Part of Hindquarter Contaminated by broken glass & mercury 23½ „ „ „ „ Abscess 19 „ Shoulder of Veal „ 4½ „ Veal Decomposition 4½ „ „ Trimmings „ 3 „ Sausage & Sausage Meat „ 24 „ Tripe „ 46 „ Liver „ 21½ „ Ovine. 15 parts of Sheep Internal decomposition 482½ „ 8 „ „ carcases „ „ 308 „ Trimmings Brine Stain 8 „ Equine 2 Carcases Insufficiently Bled 650 „ Porcine 17 Forequarters Internal Decomposition 310 Canned GoodS. 410 tins Beef Damaged & Punctured 2460 „ 357 „ „ Blown, Decompositionj, etc l662 „ 12 „ Pork „ 28 „ 12 „ Luncheon Meat 41¾ „ 21 „ Sausage tt 22½ „ 252 „ Fish tt 72½ „ 26 „ Soup tt 44½ „ 416 „ Vegetables tt 726 „ 267 Milk 249½ „ 192 „ Fruit & Fruit Juice tt 473½ „ 187 „ Jam & Marmalade tt 240 „ 7 „ Rabbit 25 „ 15 „ Spaghetti tt 16 „ 56 Brawn 186½ „ 27 „ Meat & Vegetable *S 11 75 „ 1+6 „ Jellied Veal tt 103½ „ 1 „ Ox Tongue tt 6 „ 9 „ Baked Beans tt 3 „ 22 „ Apples tt 220 „ 29 „ Peas tt 36 „ 1777 „ Tomato Paste Metallic contamination 277 „ Fish. Kippers Decomposition 140 „ Dog Fish „ 161 „ Haddock „ 168 „ Cod Fillets „ 168 „ Skate „ 504 „ Prawns „ 75 „ Bloaters „ 28 „ Plaice „ 168 „ Cod Roes „ 157 „ Whiting „ 120 „ C/Fwd. 12,472½ „ 29 Article of Food. Reason for Action. Weight. Miscellaneous. B/Fwd. 12,472½ lbs. Camembert Cheese Decomposition 32½ lbs. Dried Cabbage „ 5 „ Tomatoes „ 1752 „ Dates „ 44 8 Jars of Fruit „ 12 „ 2 „ „ Pickles „ 2 „ 3 Boxes small Chickens „ 180 „ Chickens „ 35½ 294 Eggs „ Cheese „ 12½ „ Australian Blue Vein Cheese „ 60 „ 25 Ducks „ 85 „ 360 Demi-Sel-Cheeses „ 66 „ Gorgonzola Cheese „ 22 „ Maltose Syrup Contaminated by Foreign Matter 120 „ Marshmallow „ 4 „ Stuffing Mixture „ 13 „ Lemon Conserve „ 28 „ Sultanas „ 23 „ Toffee „ 7½ „ Artificial Cream Out of condition 4½ galls. Bacon Trinmings Damaged by fire 308 lbs Christmas Puddings Damaged by rats (in transit) 5 „ 142 packets Pudding & Cake Mixture Deterioration 79½ „ 4 tins dried Egg „ 16 jars Mayonnaise Deterioration due to storage Jam „ 62 „ Currants Infested by Moths 50 „ Rabbits Deterioration due to breakdown of refrigerat 45 „ Scraps, bones, etc. „ 28 „ 23 pktS. Shredded Suet Mould 11½ „ 5 bottles Plums „ 8 „ 192 Choeolate covered Sponge Cakes „ 8 „ 18 bottles Tomato Ketchup „ 15 jars Piceallili „ 12 „ 17 „ Mustard „ 2½ „ Total 15,596, 4% galls. (f) Food Hygiene„ During the year your Inspectors continued to give a large measure of attention to premises in which food is produced or prepared and although in a matter of this kinds one can never afford to be satisfied, nevertheless it is true to say that the hygienic standard of food preparation kitchens and premises in Kingston is high and may be favourably compared with other towns. These results have not been achieved by any spectacular Pood Trade Guild Scheme or similar action but, as I have indicated from time to time. they are due to the continuous hard work put into this particular section of the work by the sanitary inspectors, particularly since the end of the war, and to the cooperation of the traders. It may not be appreciated that a considerable 30 proportion of staffs employed in restaurant kitchens, for one reason or another, make changes in their place of employment and this frequent change of personnel creates for the employer a definite problem. To maintain a high standard of hygiene in and around food premises is difficult at most times but it is rendered more so if new staff has to be trained every few monthS. During the year structural improvements have been made and new and more modern fittings and equipment have been installed at various premises. There remains a good deal of work to be done and your Committee may rest assured that this aspect of environmental hygiene will continue to receive careful and detailed attention. A feature to which attention was directed during the year is the construction and equipment of vehicles used as mobile canteens or for the sale of fried fish, ice-cream and other foods. As the result of action taken there was a general improvement in these classes of vehicles. The Law provides limited control over such vehicles, but your Committee approved the adoption of Model Bye-Laws issued by the Ministry of Food under Section 15 of the Pood and Drugs Act, 1938, dealing with the Handling, Wrapping and Delivery of Pood for Human. Consumption, and these Bye-Laws come into force in 1950 and will strengthen the hands of the Corporation in dealing with mobile food vehicleso There is one further matter to which attention could properly be drawn. I refer to the unrinsed condition of milk bottles after use in the school milk service. Efforts have been made to foster the training of school children in the care of milk bottles and to encourage them to rinse the bottles after the milk has been consumed. Little success has been achieved. Bottles continue to be returned to suppliers unrinsed, and in some cases, partly filled with milk® This would appear to be a promising field for food hygiene training for I am convinced that a great deal could be done by example to young persons of school age, whilst their minds are receptive of learning® (g) Underground Bakehouse. The second periodical examination of the only underground bakehouse in the Borough, viz: 53, Kingston Hills was made in accordance with the provisions of the Factories Act 1937 and a Report was submitted to the Public Health Committee in January, 1949. After full consideration of all the circumstances, the Certificate of Suitability (issued originally under the Factory and Workshop Act 1901) was extended for a period of five years without prejudice to the power of your Corporation to revoke the Certificate as the result of subsequent examination. FOOD AND DRUGS ACT 1958. Adulteration, During the year, 124samples 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 31 special cases, as, for instances, 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,. On the following page is a tabulated statement showing particulars of samples submitted to the Public Analyst during 1949, and the following notes on particular samples should be read in conjunction with that tabulated statement. x There being no legal standard for fat content of ice-cream no legal proceedings were taken but the attention of the producers was drawn to the very low fat content. An improvement was subsequently noted. The informal sample was followed up "by a formal sample of the same jam. The formal sample proved genuine. £ A warning letter was sent in the first case. In the case of the other sample, the deficiency of 531$ in fat content, a full investigation was made. Records were checked, and finally it was concluded that some error had arisen in the sampling . -e©- Two formal samples taken subsequently proved genuine. xx A warning letter was sent to the "bakery. + The manufacturer had a dispensation from the Ministry of Pood to add the salt and no further action was taken. ■ 32 Tabulated Statement of Samples Submitted to the Public Analyst during 1949. Article. No. of Samples Genuine. Not Genuine Remarks upon samples reported as not genuine. Formal Informal Formal Informal Formal Informal Bi-carbonate of Soda - 2 - 2 - - Honey - 2 — 2 - — Horseradish Sauce — 1 - 1 - X Ice-Cream 1 30 - 28 1 2 Fat content 0.8%, 2.0%, 0.8% Jam 1 3 1 2 - 1 Deficient in fruit content ø Meat Extract - 1 - 1 — - Meat Paste - 2 - 2 - - Milk - 46 - 44 - 2 (1% deficient in N/F. solids: (53% deficient in fat ≠ Liver sausage 2 4 2 3 - 1 9% deficient in meat cont. Tomato soup - 1 — 1 — - " ketchup - 1 - 1 - Bread Roll — 1 — - - 1 Contaminated with coal dust xx Cake filling cream - 1 - 1 - - Lemon Barley Crystals - 1 - 1 - - Olive Oil - 1 - 1 - - Salad Cream - 2 - 2 - - Pork Sausage Meat — 3 - 3 — — Beef Sausages - 3 - 3 — — Malt Vinegar - 1 - — - 1 0.9% added salt Beef & Pork Spread - 2 — 2 — - Maralyn Milk Plus — 1 - 1 — - Tinned Peas - 2 - 2 — - Beef Suet — 1 — 1 - — Jelly Powder & Crystals - 3 — 3 — - Coffee & Chicory Essence - 1 - 1 - - Mustard — 1 - 1 - - Gelatine - 1 - 1 — — Aspirin - 1 — 1 - - Lung Syrup - 1 — 1 - - 4 120 3 112 1 8 33 CONCLUSION. It only remains once again to express my sincere thanks to the Chairman of the Public Health Committee, Alderman Dr. E.H.R. Oldfield, and the Members of the Committee and the Corporation generally, for their continued encouragement and support; my thanks are offered also to my fellow officers for their cooperation and to all my colleagues, without whose unremitting efforts this record of a year's work could not have been compiled.. HAROLD T. PERRY. Chief Sanitary Inspector. 34 SECTION F PREVALENCE OF. AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES The following infectious diseases are notifiable to the Medical Officer of Health of the Borough:- Scarlet Fever Whooping Cough Diphtheria (including membranous croup) Measles (excluding Rubella) Acute pneumonia (primary or influenza) Cerebro-Spinal Fever Acute Poliomyelitis Acute Polioencephalitis Acute Encephalitis Lethargica Acute Infective Encephalitis Dysentery Food Poisoning Ophthalmia Neonatorum Puerperal Pyrexia Smallpox Paratyphoid Fevers Enteric or Typhoid Fever(excluding Paratyphoid) Erysipelas Malaria Cholera Plague Typhus Relapsing Fever Tuberculosis In 1949 a total of 699 notifications of infectious disease was received, compared with 487 in 1948. The increase is due to a considerable rise in the notification of measles among young children. The following table gives an analysis of the cases into age groups. 35 NOTIFIABLE DISEASES DURING 19^9 TABLE VI DISEASE CASES DEATHS Age Groups Age Groups Under 1 year 1-2 2-3 3 - 4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total cases notified Cases admitted to Hosp. Under 1 year 1-2 2-3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total Scarlet Fever 1 1 3 5 8 43 6 2 3 1 - - 73 53 - - - - - - - - - - - - - Diphtheria - - — - - - - - - - - - - - - - - — - - - - - - - - - Enteric Fever including Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis - 1 - 2 - 1 - 2 1 - - - 7 6 - - - 1 - - - — - - - - 1 Polioencephalitis - 1 - - - 2 - - - - - - 3 2 - - - - - 2 - - - - - - 2 Acute Infective Encephalitis - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 Puerperal Pyrexia — — — - - — — 4 18 7 - - 29 28 - - - — — — — — - — - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia 3 2 3 1 — 2 — <— — — 1 5 17 4 2 — - - - - - - - - 6 20 28 Erysipelas - - - - — - - - 1 - 2 - 3 1 - - - - - - - - - - - - - B. Dysenteria (Sonne) - - - - - 1 1 1 - - - - 3 1 - - - - - - - - - - - - - Measles 15 51 76 65 52 207 9 3 4 - 1 - 483 4 - - 1 - - - - - - - - - 1 Whooping Cough 7 8 6 12 14 30 4 - - - - - 81 4 - - - - - - - - - - - - - TOTALS 26 64 88 85 74 286 20 12 27 8 4 5 699 103 2 - 1 1 - 2 - - - — 7 20 33 16 The following table gives a comparative statement of notifications received during the last twenty-nine years in respect of certain infectious diseases:- TABLE VII Year Enteric Fever (including Paratyphoid) Scarlet Fever Diphtheria Puerperal Pyrexia Ophthalmia Neonatorum Measles Whooping Cough Acute Infective Encephalitis • Polioencephalitis Poliomyelitis 1921 4 302 79 1 6 - - 1 1922 1 238 74 1 6 - - - 1923 1 118 17 2 5 - - - 1924 6 143 20 - 4 - - 1 1925 7 213 25 4 5 - — 3 1926 7 82 27 4 2 — - 2 1927 3 87 65 9 3 - — 1 1928 7 135 152 9 4 - - 1 1929 1 74 113 5 3 - - - 1930 5 78 100 9 2 - - - 1931 1 61 53 14 4 — - — 1932 1 56 47 13 - — - 2 1933 2 125 30 10 2 — — 3 1934 2 40 42 5 3 — - - 1935 2 54 50 8 3 — — — 1936 6 67 27 19 2 - — - 1937 1 51 21 32 3 — - 2 1938 1 61 72 47 2 — - 2 193$ 1 69 19 66 3 - - 1 1940 3 45 53 63 3 373 22 - - - 1941 7 54 15 37 - 331 271 - - 1 1942 - 79 8 24 3 375 99 — — — 1943 1 110 3 18 - 287 151 - - 1 1944 — 49 7 15 2 33 73 - — 1 1945 - 28 16 23 2 407 84 - - 1 1946 1 34 8 41 1 283 67 - — 2 1947 1 24 2 28 1 219 38 - 3 5 1948 - 34 — 30 — 197 200 - - 3 1949 - 73 - 29 — 483 81 - 3 7 Scarlet Ffiver. Seventy-three cases of mild Scarlet Fever were notified, forty-nine of which were of school age,, No deaths occurred and no "return" cases. Fifty-three 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 second time in the years for which records are available,, Intensive work is continued to immunise the school and preschool population against diphtheria, and the table on the following page shows the stage reached by the end of 1949« 37 TABLE VIII DIPHTHERIA IMMUNISATION Comparative Statement for the Years 1947. 1948, and 1949 (Provided by Dr. W.H. Kinstrie) No. completely immunised Year of Birth 1947 1948 1949 1949 - - 43 1948 - 59 453 1947 48 557 602 1946 480 529 540 1945 411 419 423 1944 425 437 455 1943 388 422 423 1942 406 424 409 1941 386 387 384 1940 407 420 403 1939 383 390 384 1938 383 389 377 1937 367 385 379 1936 373 364 367 1935 319 321 322 1934 304 290 1933 242 0 - if Age Group Total Number Completely Immunised as at 31.12.1947 1752 Percentage 1947 - 55.1 as at 31.12.1948 2001 „ 1948 - 62.4 as at 31.12.1949 2061 „ 1949 - 64.7 5-15 Age Group Total Number Completely Immunised as at 31.12.1947 3570 Percentage 1947 - 78.6 as at 31.12.1948 3792 „ 1948 - 86.5 as at 31.12.1949 3903 „ 1949 - 88.0 Record of Work done At Diphtheria Immunisation Clinics 1947 1948 1949 Total number of clinics held 99 98 97 Number completely Immunised 748 832 545 Number of Schick Tests 1138 1294 1357 Number of Positive Schick Tests and Re-inoculations 106 133 134 Total Attendances 3807 3965 3791 Average Attendances 38.4 40.5 40 38 Poliomyelitis. During the year seven confirmed cases of poliomyelitis were notified, of which one died. All seven cases were Kingston residents in different parts of the Borough. All except one, a very mild case which recovered at home, were removed to Hospital for specialist treatment and after care. The incidence of cases began on 9th. August and continued until December. Three males and four females were affected, one male aged 14 months, one male and one female aged 3 years, one male and one female aged 16 and 19 years respectively, and one male aged 30 years. Polioencephalitis. Polioencephalitis attacked three cases in the Borough during the same period. One female aged 1 year who recovered, and one female aged 5 years and one male aged 6 years who died. It is not usual to find more than one case in a family but there was a tragic occurrence of 2 cases in one family of five girls, both of whom died, one from poliomyelitis and one from polioencephalitis, in spite of all treatment. A table giving brief summary of the cases follows:- TABLE IX Patient Age Sex Dates Notified & admitted to Hospital Final Diagnosis Clinical Results B.B. 16 yrs Male 9.8.49 Poliomyelitis Very mild case. Nursed at home. S.D. 19 yrs Female 8.9.49 Tolworth Hos. 8.9.49 Poliomyelitis Weakness of adductors & extensors of rt. leg. Improved considerably. After 4½ weeks trans. to orthopaedic hospital. P.S. 14 mths. Male 24.10.49 Tolworth Hos. 24.10.49 Poliomyelitis Weakness of left arm. Mild case. Considerable improvement in hospital. Discharged for OutPatient physio-therapy treatment. Mr.P. 30 yrs. Male 3.11.49 Tolworth Hos. 3.11.49 Poliomyelitis Very severe case. All limbs and abdominal muscles affected. Respiration difficult. Transferred to Rowley Bristow Hospital when able to move feet and hands. C.B. 3 years Female 26.11.49 Kingston Hos. 23.11.49 Poliomyelitis Seriously ill. Considerable paresis. In iron lung, but failed to improve. Died 29.11.49 Contd. 39 TABLE IX (Contd.) Patient Age Sex Dates Notified & admitted to Hospital Final Diagnosis Clinical Results A.D. 3 yrs. Male 6.12.49 Tolworth Hos. 5.12.49 Poliomyelitis Not a serious case. Slight paralysis in leg on admission to hospital. Improved considerably in hospital. V.S. 6 yrs. Female 7.12.49 Tolworth Hos. 7.12.49 Poliomyelitis Seriously ill when admitted to Hospital. No paralysis - meningeal type infection. Made rapid progress in hospital and was discharged on 22.12.49 having made complete recovery. G.M. 6 yrs. Male 25.8.49 Kingston Hos. 20.8.49 Polioencephalitis Stiff neck, difficulty in swallowing. Developed nasal voice with regurgitation of fluids. C.S.F. examination confirmed diagnosis. Died 24.8.49. J.H. 1 yr. Female 5.11.49 Victoria Hos. for Children 4.11.49 Polioencephalitis Paralysis of both arms on admission to hospital. Condition improved during stay in hospital. H.B. 5 yrs. Female 26.11.49 Polioencephalitis (Result of Post Mortem) Died at home on 25.11.49 after very short illness. Post mortem revealed Polioencephalitis. Enteric Fever (Typhoid or Paratyphoid). No cases of typhoid or paratyphoid B were notified during 1949. Measles. There were 483 cases of measles notified during 1949> (compared with 197 in 1948), of whom two only were removed to hospital, and two were notified from hospital. There was one death recorded in this group. The 5-10 year age group contained the largest number of notifications (307) the majority of the remainder being spread over the 1-5 year age period. Ophthalmia Neonatorum. No cases were notified during 1949. 40 Puerperal Pyrexia. Twenty nine cases were notified during 1949. An analysis is shown below, together with figures for the years 1945 - 1948 for purposes of comparison - Cases 1945 1946 1947 1948 1949 (a) Total notified 23 41 28 30 29 (b) Number included in (a) of (i) Kingston residents 9 9 6 9 4 (ii) Extra district residents 14 32 22 21 25 (c) Number included in (a) notified from Kingston County Hospital 21 39 27 29 28 (d) Number included in (a) notified by private doctors 2 2 1 1 1 (e) Number of cases included in (d) removed to hospital other than those included in (c) 1 2 - - - Tuberculosis. Cases of tuberculosis were dealt with by the South West Metropolitan Regional Hospital 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 - 1949 (inclusive):- Year Cases notified Deaths 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 1949 40 6 10 1 (Note - An analysis of the total notified cases during 1949 in age groups is shown on the following page). 41 NOTIFIED CASES OF. AND DEATHS FROM. TUBERCULOSIS TABLE X IN 1949 NEW CASES DEATHS Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total Tuberculosis (a) Respiratory M. — 1 1 8 4 3 5 1 1 24 — - — — 1 2 2 — — 5 P. - - - 8 5 1 2 - - 16 - — — 2 1 - - - 2 5 Total - 1 1 16 9 4 7 1 1 40 - - - 2 2 2 2 - 2 10 (b) Non- Respiratory M. - 1 1 1 - - - - 3 - - - - - - - - - - F. - - - 2 1 - - - - 3 - - - - - - - 1 - 1 Total - 1 1 3 1 - - - - 6 - - - - - - - 1 - 1 12 The ratio of non-notified cases to total deaths for 1949 and the preceding four years is as follows:- 1945 1946 1947 1948 1949 1:5 1:3 1:7 1:24 1:11 During 1949 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 enforced loss of earning power is a very serious matter to the family particularly if the patient is the wage earner. During 1949 189 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 £1,745 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. Arrangements exist for the treatment of scabies at the Cleansing Centre for school children, the cost being recharged to the Education Authority. Treatment of children under five and adults continues as a Borough Health Service. 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. Owing to the reduced number of cases it has been found possible to restrict the hours for which the station is kept open. The number of cases and contacts still further decreased during 1949 and no special difficulties were encountered. The incidence of scabies has markedly diminished. The tables overleaf show the numbers of persons treated during the year 1949, and the four preceding years. 13 Cases of Scabies and Contacts Treated Year No. Treated Total cases and contacts treated Cases Contacts 1945 341 251 592 1946 152 190 342 1947 108 88 196 1948 63 82 145 1949 27 18 45 Analysis into age groups of cases and contacts treated Year Males Females Under 5 Years 5 yrs to 14 yrs. Over 14 Years Under 5 Years 5 yrs. to 14 yrs. Over 14 Years 1945 35 113 137 17 80 210 1946 23 48 77 19 69 106 1947 10 44 26 23 40 53 1948 12 33 25 14 18 43 1949 1 10 11 7 4 12 INFESTATION BY HEAD LICE During 1949 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.