Royal Borough of Kingston-upon-Thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 GUILDHALL, KINGSTON-UPON-THAMES JUNE, 1953 Royal Borough of Kingston-upon-Thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952 GUILDHALL, KINGSTON-UPON-THAMES JUNE, 1953 ANNUAL REPORT 1952 TABLE OF CONTENTS Preface Page Staff of the Public Health Department 1 SECTION A Statistics and Social Conditions (l) General Statistics 2 (2) Social Conditions 2 (3) Extracts from Vital Statistics of the Years:- (a) Live Births 3 (b) Still Births 3 (c) Deaths - Total 3 (i) Death Rate - Total 3 (ii) Maternal Death Rate 3 (iii) Infant Death Rate - Quinquennial Infant Mortality Rate - Causes of Death of Children under one year3,4 (iv) Deaths from Other causes 5 Introduction to Tables on Vital Statistics 5 Table I - Extracts from Vital Statistics for years 1948 - 1952 inclusive 6 Table II - Comparison of Vital Statistics 1923 - 1952 7 Table III - Birth Rates, Death Rates, and Case Rates for certain infectious diseases in the year 1952 8 Table IV - Causes of Death 9 SECTION B General Provisions of Health Services (1) (i) Public Health Officers 10 (ii) Laboratory Facilities 10 (iii) Ambulance Facilities 10 (iv) Hospitals:- (a) Infectious Diseases 10 (b) Smallpox 11 (c) General 11 (2)National Assistance Act, 1948 11,12 National Assistance (Amendment) Act, 195111,12 SECTION C Sanitary Circumstances (1) Water Supply 13 (2) Drainage and Sewerage 13 (3) Rivers and Streams 13 (4) Closet Accommodation 13 (5) Public Cleansing 14 (6) Sanitary Inspection of the Area 14,15 (7) Shops 15 (8) Factories Act, 1937 15,16 (9) Camping Sites 16 Pa£« (10) Atmospheric Pollution 17,18,19 (11) Swimming Baths and Pools 20 (12) Eradieation of Bed Bugs 20 (13) Complaints 20 (14) Rodent and Insect Pest Control 20,21,22 (l5) Rag Flock Act22 SECTION D Housing General 22,23 SECTION E Inspection and Supervision of Food (a) Milk Supply 23 (b) Designated MilkS 23 (c) Bacteriological Examination of Milk 23,24 (d) Biological Examination of Milk24 (e) Ice Cream 24 (f) Iced Lollies 24,25 (g) Meat and Other Foods 25,26 (h) Food Hygiene 26 Food and Drugs Act, 1938 26,27 Tabulated Statement of Samples Submitted to the Public Analyst during 1952 27,28 Merchandise Marks Act, 1926 28 SECTION F Infectious Diseases Notifiable Diseases 29 Table v - Notifiable Diseases during 1952 30 Tabla VI - Comparative Statement of Notifications of Certain Infectious Diseases 31 Scarlet Fever 31,32 Diphtheria 32 Poliomyelitis 32 Acute Infective Encephalitis 32 Enteric Fever (Typhoid and Paratyphoid)32 Measles 32 Ophthalmia Neonatorum 32 Table VII - Comparative Statement of Diphtheria Imnunisation during the years 1950, 1951 and 1952 33 Puerperal Pyrexia 34 Food Poisoning 34 Tuberculosis 34-37 Table VIII - Notified Cases of Deaths from Tuberculosis in 1952 36 Whooping Cough 37 Scabies 37 Infestation by Head Lice 37 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT. 1952 Mr, Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the public health and sanitary circumstances of the Borough for 1952. The Report follows a similar pattern to that for 1951, gives information on essential matters affecting the Public Health, and is in accordance with Ministry of Health Circular 42/51. I am indebted to Mr. G.C. Smith, Senior Sanitary Inspector,for the drafting and compilation of much of the Report, especially the details relating more particularly to the work of the Sanitary Inspectors. Population - The estimated raid 1952 hone population given by the Registrar General is 39,990, an increase of 70 persons over 1951. This figure is the resident night population, and has been used for the calculation of the statistical data now presented. The actual day population has been estimated to be about 300,000 persons who congregate in the town for business, education, entertainment and recreation purposes. This is a special feature of the town, and influences the volume of work and responsibility of the Public Health Department. Infectious Disease - In general the health of the people has been good. The number of infectious disease notifications received in 1952 was considerably lower than in 1951, and this was due to a greatly decreased incidence of measles and whooping cough. A reduction in the number of cases of scarlet fever is also recorded. Once again, for the fifth year in successions, no case of diphtheria was notified, and further progress was made in the active immunisation and protection of the child population against this deadly and disabling disease. In, some cases combined prophylaxis against diphtheria and whooping cough was employed and this method of active immunisation is now being extended. Vaccination against Smallpox - is voluntary and a calculation shows that by the end of 1952 some 57% of the children born, between 1st. July 1951 and 30th. June 1952 have been vaccinated. Births - The number of live births for 1952 is 576, and compares with 574 for 1951. The Birth Rate is 14.40 per 1,000 of the population, compared with l4.39 for 1951. Deaths - The number of deaths recorded in 1952 is 499 compared with 556 for 1951. This makes a Death Rate of 12.48 for 1952 compared with 13.93 for 1951. The excess of births over deaths was 77 compared with 18 for the previous year. The number of deaths of infants under 1 year of age in 1952 is 14, which gives an Infant Mortality Rate, per 1,000 live births of 24.39. These figures are exactly the same as those for 1951. The Causes of Death - The main conditions causing death as recorded in the table for 1952 are Heart Disease - l40; Cancer - 80; and Vascular Lesions of the Nervous System -66. Housing - During the year under review an important contribution to the public health was made by the completion of 158 housing units, 24% of which had to be constructed outside the Borough. The Borough is now completely built up and presents a density of dwellings and population which exceeds that of most of the Municipal Boroughs. The town is saved from sane of the deleterious effects of high density by being surrounded by open spaces and the river. Nevertheless these circumstances of high density, together with the presence of many obsolete houses referred to in Section D, page 22, make it imperative that the Council consider and plan for REHOUSING a portion of its population in modern type blocks of dwellings, which give housing amenities to the maximum number of families, with the minimum occupation of ground space. Only by such development can the existing amenities of the riverside be enhanced, and the over congestion in the centre of the town be relieved. A first step in this direction could be to allocate a proportion of new dwellings to occupants of properties which should now be demolished because they are worn out and not repairable at reasonable expense. Staff - 1952 saw the retirement of Mr. H. T. Perry, 0.B.E. who had held office as Chief Sanitary Inspector for 3k years and to whom reference was made in the letter to the Report for 1951. The year also saw the appointment of Mr. George Carl Smith who brings to the office the fruits of long experience in Sanitary Inspector's work, and who had previously been on our staff as Sanitary Inspector for nine years, thus being thoroughly familiar with the special problems of the town. We welcome him and look forward to a successful association with him in the work of the Department. I wish now to record my appreciation of the help given me by my colleagues in all departments and especially of the public health department, and I respectfully ackowledge the 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. i 1952 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M .B., Ch.B. (Edin.) D.P.H. Chief Sanitary Inspector: H.T. PERRY, O.B.E., F.S.I.A. (a) (b) (Retired 30.6.52) Senior Sanitary Inspector: G.C. SMITH, M.R.San.I, M.S.I.A. (a) (b) (From 1.9.52) Administrative Officer: F.D. HARVEY, M.R. San. I. (a) (b) Additional Sanitary Inspectors: A. CLEGG, M.R. San. I. (a) (b) J.B. FACER, A.R. San. I. (a) (b) N.L.G. TUBB, D.P.A. (Lond.), M.R.San.I. (a) (b) W.H. DUNSTAN, M.R.San. I. (a) (b) Junior Sanitary Inspector: (vacancy) Assistant Rodent Officer: F.W. STAGG Clerical Staff During 1952: M.E. POWELL, D.P.A. (Lond.) MISS C.L. FOISTER MISS V.E. NEELD MRS. B.M. HILL G. NORTHWOOD (Called for National Service 31.12.52) T.J. MITCHELL (Resigned 15.7.52) A.G. BELL (Appointed 7.4.52) C.J. WILSON (Appointed 11.8.52) V.L. LERIGO (Appointed 13.10.52 - Temporary vice G. NORTHWOOD) (a) Certificate as Sanitary Inspector. (b) Certificate as Meat and Foods Inspector. ø Subject to a sharing arrangement with the Surrey County Council. 9 £> SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area In Acres 1,390 Total Population (including Service personnel)39,990 Number of inhabited houses (approx.) 11,629 Rateable Value - General Rate £566,856 Sum represented by Penny Rate £ 2,3l6 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. "There was not much change in the general pattern of unemployment during 1952 except that, for the first time since the war, there was a marked increase in long term unemployment affecting the unskilled worker, particularly those in the older age groups and those registered under the Disabled Persons (Employment) Act, 1944. "The lowest level of unemployment during the year was in early June when 544 (321 men and 223 women) and the highest in mid November when 827 (467 man and 360 women) were registered as unemployed. There were 421 men and 212 women registered at the beginning of the year, and 514 men and 218 women at the end. "The insured population of this Employment Exchange area is estimated to be 80,000 persons and unemployment, at its peak, was slightly more than 1% of this figure. The aircraft and general engineering industries have continued to make the greatest demand on available manpower and are very heavily committed. The heaviest demand on us has been for skilled aircraft fitters, engineers and skilled building trade operatives. Seasonal slackness in the building industry contributes largely to unemployment during the winter months when as many as 70 painters were unemployed at one time. "The demand for women for factory work was lower than in previous recent years and part-time employment in factories was practically non-existent. "Shope and offices had numerous vacancies for men and women under 25 years of age but there was little scope for the older commercial types which formed a large part of the unemployed registers. "During 1952 7,370 men and 3,435 women were placed in vacancies in the Exchange area. 3 3. Extracts from Vital Statistics of the Year. (a) Live Births - Total Male Female Legitimate 531 283 248 Illegitimate 45 22 23 576 305 271 Birth Rate (Registrar General) per 1,000 population 14.40 (b) Still Births - Total Male Female Legitimate 17 4 13 Illegitimate - - - 17 4 13 Rate per 1,000 total (live and still) births,28.63 (c) Deaths - Total Male Female 499 254 245 (i) Death Rate (Registrar General) per 1,000 population 12.48 (ii) Maternal Death Rate (deaths caused by pregnancy, childbirth, abortion). No. of Deaths Rate per 1,000 total (live and still)births (iii) Infant Death Rate (deaths of all infants under one year of age). Total No. of Deaths Rate per 1,000 live births 14 24.39 Legitimate Infants No. of Deaths Rate per 1,000 legitimate live births 12 22.59 Illegitimate Infants No. of Deaths Rate per 1,000 illegitimate live births 2 44.44 All infants under 4 weeks of age (included in above) Total No. of Deaths Rate per 1,000 live births 9 15 .63 Legitimate Infants No. of Deaths Rate per 1,000 legitimate live births 8 15.07 Illegitimate Infants No, of Deaths Rate per 1,000 illegitimate live births 1 22.22 4 The approximate infant mortality rate for 1952 and the rates since 1947 are shown for purposes of comparison. 1947 1948 1949 1950 1951 1952 Kingston-upon-Thames 22 23 20 30 24 24 England and Wales 4l 34 32 30 29 27 London Area 37 31 29 26 26 24 It will "be seen from the following figures that since the war ended the Quinquennial Infant Mortality Rate has been more than halved. Period Infant Mortality Rate 1921 - 1925 69 1926 - 1930 56 1931 - 1935 56 1936 - 1940 46 194l - 1945 52 1946 - 1950 25 The following are the numbers in age groups of Kingston children who died during 1952 in the Borough before reaching the age of one year, together with the cause of deaths:- Age Total Deaths Acute Suppurative Bronchitis Meningitis - Meningo myelocele Inanition Prematurity Atelectasis Suppurative Broncho Pneumonia Asphyxia due to drowning Mesenteric Thrombosis 0 - 24 hours 3 — — — 1 1 — 1 — 24 hrs. - 1 mth. 6 — — 1 2 2 — — 1 1 month - 1 year 5 2 1 — — — 2 — — Totals l4 2 1 1 3 3 2 1 1 5 (iv) Deaths from Other Causes. f Deaths. Deaths from Heart Disease 140 Deaths from Cancer 80 Deaths from Vascular Lesions of the Nervous System 66 Deaths from Bronchitis 48 Deaths from Circulatory Disease other than heart 36 Deaths from Pneumonia 24 Deaths from Influenza 5 The following tables I, II, III, IV summarise certain vital statistics. Table I shows the figures for live births, still births, and deaths for the years 1948 - 1952 inclusive. It is noted that the number of births has declined in this period, but has remained practically the same for 1951 and 1952, namely 574 and 576 respectively. It is interesting to note also that in these last two years, 1951 and 1952, in the total live births the number of males born exceeded that of females more substantially than in the previous three years. The number of still births is very high and shows a specially high figure for females. The number of deaths remains about the same, and is 499 for 1952. The figures in Table II are the Registrar General's estimates for successive years since 1923. They give the population, number of live births, birth rate per 1,000 population, number of deaths, the death rate per 1,000 population, and also the infant mortality rate per 1,000 live births of Kingston-upon-Thames, England and Wales, and the London Area. The trend of the population figure is to remain at about 40,000. Table III is largely self-explanatory and compares certain rates (births, deaths, and notifications of infectious disease) in England and Wales, 160 large towns, 160 small towns, London Administrative County, and Kingston-upon-Thames, Discussion of the number of notifications of infectious disease received during 1952 in Kingston-upon-Thames appears later in this report in Section F. The causes of deaths shown in Table IV are now in accordance with the 36 headings based on the Abbreviated List of the International Statistical Classification of Diseases, Injuries and Causes of Death. These differ from the headings used in some earlier years, and, in order to provide comparative figures, the causes of death used for 1948, and 1949, have been converted as far as possible to the new classifications. Pi Extract from Vital Statistics for Years 1948-1952 inclusive. TABLE I 1948 1949 1950 1951 1952 Total P. Total M, F, Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 677 345 332 679 344 335 578 279 299 535 281 254 531 283 248 Illegitimate 45 21 24 50 23 27 41 19 22 39 21 18 45 22 23 722 366 356 729 367 362 619 298 321 574 302 272 576 305 271 Birth rate (R.G.) per 1,000 pop. 17.73 17.96 14.76 14.39 14.40 STILL BIRTHS Legitimate 16 7 9 8 5 3 9 4 5 11 5 6 17 4 13 Illegitimate - - - 2 - 2 2 1 1 2 1 1 - - - 16 7 9 10 5 5 11 5 6 13 6 7 17 4 13 Rate per l,000 (live and still births) 21.62 13.53 17.46 22.16 28.63 DEATHS 455 227 228 500 250 250 491 215 276 556 277 279 499 254 245 Death rate (R.G.) per 1,000 pop. 11.17 12.32 11.73 13.93 12.48 *7 Comparison of Vital Statistics 1923 - 1952 TABLE II Year Estimated Population Live Births Birth Rate per 1,000 populat ion Deaths Death rate per 1,000 population Infantile Mortality Rate per 1,000 live births Kingston upon Thames England and Wales London Area 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 13.1 486 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.l 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 1950 41950 619 14.8 492 11.7 30 30 26 1951 39920 574 14.4 556 13.9 24 29 26 1952 39990 576 14.4 499 12.5 24 27 24 8 TABLE III Birth-rates, Death-rates, and Case-rates for certain infectious diseases in the Year 1952. Provisional figures based on Quarterly Returns. England and Wales 160 C.Bs. and Great Towns including London* 160 Smaller towns Resident Pop.25,000 -50,000 at 1951 Census London Adm. County Kingston upon Thames Rates per 1,000 Home Population Births Live Births 15.3 16.9 15.5 17.6 14.40 Still Births 0.35 0.43 0.36 0.34 0.43 22.6(a) 24.6(a) 23.0(a) 19.2(a) 28.63 Deaths All Causes 11.3 12.1 11.2 12.6 12.5 Typhoid & Paratyphoid 0.00 0.00 0.00 - - Whooping cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.24 0.28 0.22 0.31 0.28 Influenza 0.04 0.04 0.04 0.05 0.13 Smallpox 0.00 - - - - Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.00 0.01 0.00 Pneumonia 0.47 0.52 0.43 0.58 0.60 Notifications (Corrected) Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.00 Meningococcal infection 0.03 0.03 0.03 0.02 0.00 Scarlet Fever 1.53 1.75 1.58 1.56 0.73 Whooping cough 2.6l 2.74 2.57 1.66 2.55 Diphtheria 0.01 0.01 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.14 0.00 Smallpox 0.00 0.00 0.00 - 0.00 Measles 8.86 10.11 8.49 9.23 7.00 Pneumonia 0.72 0.80 0.62 0.57 0.18 Acute poliomyelitis (including polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.08 Non-paralytic 0.03 0.03 0.02 0.03 0.00 Pood Poisoning 0.13 0.16 0.11 0.18 0.08 Puerperal pyrexia 17.87(a) 23.94(a) 10.22(a) 30.77(a) 39.93 Deaths Rates per 1,000 Live Births All causes under 1 year of age. Enteritis and 27.6(b) 31.2 25.8 23.8 24.4 diarrhoea under 2 years of age. 1.1 1.3 0.5 0.7 0.0 (a) Per l,000 Total (live and still) Births (b) " " related live births. 9 Causes of Death TABLE IV Registrar General's Tables 1948 1949 1950 1951 1952 M F M F M F M F M F All Causes 227 228 250 250 215 276 277 279 254 245 Tuberculosis, respiratory 13 9 4 6 7 5 7 5 7 2 Tuberculosis, other 1 1 1 — — — — 1 — 2 Syphilitic disease 2 2 5 2 2 — 2 2 1 2 Diphtheria — — — — — — — — — — Whooping cough — — — — — — — — — — Meningococcal infections — — 1 — — — — — — — Acute Poliomyelitis 1 — 1 2 — — — — — — Measles — — 1 — — — — 1 — — Other infective and parasitic diseases — 1 1 — 1 — 1 Malignant neoplasra, stomach 10 8 10 5 8 5 11 5 7 4 Malignant neoplasm, lung, bronchus 8 3 8 2 10 1 Malignant neoplasm, uterus — 7 — 1 — 2 Malignant neoplasm, breast — 7 — 13 — 10 — 10 — 7 Other malignant and lymphatic neoplasms 20 17 19 24 29 20 Leukapmia, aleukaemia — 2 3 — 1 — Diabetes 1 — — 2 2 1 2 1 — 4 Vascular lesions of nervous system 19 25 18 29 18 47 29 39 27 39 Coronary disease, angina 31 23 46 25 29 31 Hypertension with heart disease 60 75 66 81 8 12 11 14 12 3 Other heart disease 21 41 36 41 28 37 Other circulatory disease 7 11 11 20 14 18 18 18 16 20 Influenza 4 2 9 2 3 Pneumonia 11 8 12 16 10 11 16 26 14 10 Bronchitis 10 5 23 10 11 11 24 5 29 19 Other diseases of respiratory system 6 4 5 — 3 3 3 3 5 1 Ulcer of stomch and duodenum 5 2 4 1 4 2 7 6 3 1 Gastritis, enteritis, and diarrhoea — — 1 — — 1 1 — 1 _ Nephritis and nephrosis 3 1 4 3 3 — 1 2 3 4 Hyperplasia, of prostate 7 — 4 — 2 — Pregnancy, Childbirth, abortion — 1 — — 4 _ 1 — Congenital malformations 4 3 6 4 3 2 2 1 5 — Other defined and illdefined diseases 22 31 14 27 15 22 Motor vehicle accidents 4 1 1 2 1 — 2 — 3 — All other accidents 6 8 4 5 5 12 6 5 3 6 Suicide 5 5 2 3 5 3 3 3 2 4 Homicide and operations of War 1 — — 1 — — * Separate figures not available for years 1948 - 1949 inclusive owing to different classifications in use during those years. ■ 10 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, where changes during the year have been recorded. It will be noted that Mr. H.T. Perry, Chief Sanitary Inspector retired 30.6.52. He had completed 34 years service with the Corporation which, with his previous service elsewhere gave him over 40 years in local government as a Sanitary Inspector. During that time Mr, Perry had seen the Department grow up and the work extend to the scale of present times, and to him is due in large measure the character of the sanitary practice in Kingston-upon-Thames today. (ii) Laboratory Facilities. During 1952 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. • There are also occasions on which special use is made of the services of the Public Analyst in chemical sampling which may become necessary in the interests of public health. Bacteriological examinations of milk are undertaken by the Ministry of Health Laboratory, Epsom, and by the Clinical Research Association, and samples under the Food and Drugs Acts are submitted to the Public Analyst, (iii) Ambulance Facilities. The ambulance service is provided by the Surrey County Council from their control station for Kingston and the surrounding area at Kingston Hospital, Wolverton Avenue, and is supported by the St, John Ambulance Brigade from their station in Fairfield Car Park. (iv) Hospitals. (a) Infectious Diseases. The South West Metropolitan Regional Hospital Board is responsible for the provision of beds for cases of infectious disease. Patients are admitted directly to Tolworth Isolation Hospital, which is under the direction of the Physician Superintendent of Kingston Hospital. 11 If on occasions beds are not available at Tolworth admittance can be arranged with the South Middlesex Hospital, and in the event of beds not being available there the removal may be 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 92 infectious disease cases were treated in hospital, and 84 of these were notified from hospital in the first instance. To Tolworth Isolation Hospital 7 South Middlesex Hospital 1 ¥ Kingston Hospital 82 ¥ Teddington Hospital 1 Hospital for Sick Children 1 ¥ ¥ Cases notified from hospital. (b) Smallpox. No cases occurred in the Borough during the year. Arrangements are in existence whereby the first cases that may occur are to be admitted to the Joyce Green Hospital, Dartford, Kent, after consultation with a named smallpox consultant. This hospital is always standing by to receive any such cases within a defined area, which includes Kingston, and the above arrangements are adequate to cover any initial emergency action. (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). This is a large comprehensive General Hospital with a full range of general and special departments. It has also a busy and highly organised Out-Patient Department fully supported to meet all surgical, medical, and psychological emergencies. 2. National Assistance Act. 1948. National Assistance (Amendment) Act, 1951. Under Section 47 of the 1948 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. The 1951 Act enables local authorities to deal more speedily with very urgent cases by initial removal, for a period not exceeding three weeks. The conditions under which an elderly lady (80) was living were reported to your Medical Officer of Health who visited the premises concerned. It was ascertained that this person was living alone and was in no condition to look after herself. She steadfastly refused to go into a Welfare Establishment and compulsory action was taken, A certificate was issued by the Medical Officer of Health and the General Practitioner attending the patient, to the effect that she was living alone, and being aged, infirm and living in insanitary conditions, was unable to devote to herself, and was not receiving from other persons, proper care and attention A Court Order was obtained under the National Assistance (Amendment) Act, 1951 and the old lady was removed to a Surrey County Council Residential Establishment. 12 After the expiration of the three weeks for which the Order was valid a further Order, for a period of three months was obtained under the 1948 Act. After a short while the condition of the old lady had much improved, and she was quite happy to agree to stay voluntarily in the care of the Surrey County Council permanently. The number of problems associated with aged persons does not diminish, and considerable advice and help is given by the Public Health Department to many different types of case, only very few of which require compulsory measures. The close co-operation between the Physician Superintendent of Kingston Hospital, the Welfare Officer, local doctors, and your Medical Officer of Health, mentioned in my last report continues. 12 SECTION C SANITARY CIRCUMSTANCES. 1. WATER SUPPLY. The town's water supply is provided by the Metropolitan Water Board who maintain constant supervision over the purity and adequacy of the supply. During 1952, the Corporation arranged for a supply from the Board's mains to the only dwelling house in the Borough which was not so supplied. So far as is known, there are now no houses drawing their water supply for domestic purposes from a well. This is in marked contrast to the position in the year 1920. At that time it was estimated that 120 houses depended upon a water supply from private wells. Well water is used for industrial purposes at certain factories in the town. 2. DRAINAGE AND SEWERAGE. The Borough Surveyor reports that the position regarding disposal of sewage remains the same as last year, namely, that the sewage from the Borough is pumped across the river into a sewer in the Teddington area, for treatment at the Mogden Disposal Works of the West Middlesex Main Drainage Board. This arrangement is, of course, a temporary one pending completion of the Hogsmill Valley Joint Sewerage Board's scheme for the construction of new sewage disposal works. 3. RIVERS AND STREAMS. The River Thames forms the Western boundary of the Borough and this river is under the control of the Thames Conservancy Board. The Hogsmill River, a tributary of the Thames, flows through the Borough. The chemical and bacteriological condition of the stream is very unsatisfactory, and is in large measure due to lack of natural dilution for the sewage effluent carried in its flow. It is doubtful if any improvement in. the condition of the Hogsmill Stream through the Borough can be expected until the Hogsmill Valley Joint Sewerage Scheme for the construction of the new sewage disposal works for Maiden, Surbiton, Epsom and Kingston has been completed. It is hoped that the construction of the new works will commence in the near future. 4. CLOSET ACCOMMODATION. All closets in connection with dwelling houses in the Borough are on the water carriage system. 14 5. PUBLIC CLEANSING. The Borough Surveyor is responsible for the collection and disposal of house and trade refuse. He states that the disposal method of tipping into a worked-out gravel pit situated at Thorpe in the area of the Egham U.D.C. is still in operation. Refuse from this Borough and the adjoining Boroughs of Surbiton and Maiden & Coombe is transported by road to the gravel pit at Thorpe in large vehicles from the central loading point situated at the Kingston Refuse Destructor, Villiers Road. This central loading point, where the refuse is transferred from the smaller collecting vehicles of Maiden, Surbiton and Kingston to the larger delivery vehicles of the contractor is, and will always be, a potential source of nuisance, calling for constant care and vigilance. It is understood that plans are in course of preparation to provide an improved loading bay with appropriate working methods designed to minimize, as far as possible, the risks involved. Approximately 12,000 tons of refuse per annum is sent from this Borough. A small quantity of suitable trade refuse, together with road sweepings and scarified material is disposed of by controlled tipping in the old bed of the Hogamill River. The Corporation's refuse destructor has not operated since 1st March, 1951. During the year no complaints were received in respect of any refuse tip in the Borough. 6. SANITARY INSPECTION OP THE AREA. The following is a tabulated list of visits and inspections which totalled 5,989:- House inspection, defects, etc 460 Drainage 399 Reinspections and Works in Progress 2139 Factories 361 Outworkers 17 Dairies, etc 26 Food Premises 1614 Infectious Disease Enquiries 162 Theatres 5 Verminous Premises 20 Rodent Control 57 Shops Act 335 Schools 38 Markets 95 Miscellaneous 261 5989 NOTICES SERVED. Informal (a) Verbal 497 (b) Written Statutory (a) Housing Acts Nil (b) public Health Acts 11 15 NOTICES COMPLIED WITH. Informal (a)Verbal 401 (b)Written Statutory (a)Housing Acts Nil (b) Public Health Acts 9 7. SHOPS. Regular inspections are made with regard to the health and welfare provisions of the Shops Act, 1950. Where plans are submitted of new construction or alteration to shop premises, due consideration is given to ensure that the proposals comply with the provisions of the statute. The Sanitary. Inspectors are also responsible for the administration of the law relating to shop hours, including early closing and Sunday trading. Contraventions of the law have been observed in a few cases but informal action taken has proved to be successful. The revocation during 1952 of the provisions of the Shops Acts relating to winter closing hours permits the return to the hours of closing which obtained before the war during these months. Certain shop-keepers are opening until 7 p.m. on Fridays, but otherwise there would appear to be no desire for a general extension of the present earlier evening closing hour. 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. 1. INSPECTIONS. Premises No. on Register Number of Inspections Written Notices Prosecutions Factories in which Sees. 1,2,3,& 6 are enforced by the Corporation 78 70 6 - Factories not included above in which Sec.7 is enforced by Corpn. 283 279 35 - Other premises excluding outworkers 6 12 - - 16 2, CASES IN WHICH DEFECTS WERE POUND. Particulars No. of cases in which defects found Referred Pound Remedied To H.M. Inspector By H.M. Inspector No. of Prosecutions Want of cleanliness 5 5 1 4 - Overcrowding - - - 1 - Unreasonable Temperature 1 1 - - - Inadequate Ventilation 2 2 - 1 - Sanitary Conventences (a) Insufficient - - - 1 - (b) Unsuitable or defective 16 15 - 5 - (c) No ventilated space or lobby 4 3 - 1 - (d) Lighting (absence of) 9 7 - 4 - Others 4 4 2 3 - PART VIII OP THE ACT, Outwork. Nature of Work No. of Outworkers. Wearing Apparel Making etc. 12 Brass & Brass Articles 28 Piles 2 Lampshades 4 Cardboard Boxes 1 47 9. CAMPING SITES. Licences in accordance with Section 269 of the Public Health Act, 1936 were granted to occupiers to station individual caravans on the under-mentioned sites:- Rear of No. 222, Park Road " " Nos„ 10/13, Market Place, and Adjoining No. 38 Chestnut Road. When applications for licences are received there is complete co-operation with the Town Planning Authority from whom separate permission must be obtained before the sites may be used. 17 10. ATMOSPHERIC POLLUTION. The control of smoke emission from industrial chimneys is, like most public health work, one of vigilance. Continual inspection is essential in order to counter any lapses which may take place on the part of the boiler house staff, and deterioration in the condition of the plant and equipment. Whilst many users of fuel are becoming more keenly interested in its economic use, there are still those who do not appreciate that the emission of excessive smoke is a waste of fuel. Allowance must he made for the variation in quality of fuels, and the fact that the regular delivery of any particular type of fuel cannot, even now, be relied upon. The recent popularity of the continuous burning domestic grate has probably increased atmospheric pollution. It must be borne in mind that, from smoke prevention point of view, these grates are perhaps no more efficient than the normal type basket grate, their main advantage is that the rate of combustion is more readily controlled. The most serious manifestation of atmospheric pollution during the year was, of course, the "Smog" which blanketed the London area for the four days December 5th to 8th. This period was marked by an unusual period of calm and a temperature inversion at what was an unusually low height of 200 - 500 feet. Into this shallow mass of air, four days' emission of smoke and polluted air was poured. Figures of smoke concentration taken in the London area during this period were from 14 to 26 times the normal for the time of the year. The increase in the number of deaths which may be attributable to the "Smog" in the Greater London area is illustrated by the rise in the weekly death rate from the normal figure of approximately 2,000for the week ending December 6th to that of 4,700 the following week. The weekly death rate had not recovered to normal by the end of the year. To the number of deaths must be added the far greater number who suffered serious illness or discomfort. The material damage to fabrics in stores and homes was also considerable. It is because similar atmospheric conditions can occur again that it is hoped that the lesson afforded by this disaster will not be forgotten. It is understood that investigations on a national basis are about to be made with a view to improving the situation. With regard to the recording of atmospheric pollution, three standard deposit gauges are maintained by the Corporation and were located after consultation with the Department of Scientific Research. The gauges are placed in Canbury Gardens, at Tiffin Girls' School and the Cemetery, Bonner Hill Road, and are, for the purposes of report, referred to as "A", "b" and "C" respectively. 18 The following tables give the results of analysis, together with rainfall and wind readings. These latter figures are "based upon observations which it is hoped give some indication when the stations are to windward of the Power Station and Gas Works, the area which is thought to "be the largest source of atmospheric pollution in the neighbourhood. CANBURY GARDENS - Station "A". 1952 Deposit in Tons per sq.mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of t ime s SE - SW January 9.00 5.21 14.21 93 26 1.83 February 8.09 4.03 12.12 84 4 0.86 March 17.37 10.77 28.14 93 39 2.96 April 16.83 4.94 21.77 90 33 1.36 May 19.61 6.40 26.01 93 34 2.25 June 15.47 4.64 20.11 90 27 2.56 July 13.58 5.38 18.96 93 15 0.52 August 11.52 9.07 20.59 93 46 3.18 September 3.76 5.79 9.55 90 10 3.19 October 11.18 6.37 17.55 93 36 2.73 November 8.77 6.20 14.97 90 12 3.00 December 19.77 5.79 25.56 93 20 2.23 Totals 154.95 74.59 229.54 - - 26.67 Average 1952 12.91 6.21 19.12 2.222 Average 19.51 14.34 7.85 22.19 2.695 TIFFIN GIRLS' SCHOOL - Station "B". 1952 Deposit in Tons per sq.mile Wind Direction : Rainfall in Inches No. of Observations No. of times SE - SW uble Solids Soluble Solids Total Solids January 4.42 4.65 9.07 93 26 1.80 February 4.98 4.25 9.23 84 4 0.82 March 6.64 8.33 14.97 93 39 2.30 April 6.31 6.24 12.55 90 33 1.27 May 6.84 8.03 14.87 93 34 2.82 June 5.71 6.27 11.98 90 27 2.69 July 4.71 5.68 10.39 93 15 0.49 August 7.57 8.16 15.73 93 46 3.16 Septembe r 7.50 5.38 12.88 90 10 2.97 October 4.28 5.94 10.22 93 36 2.70 November 5.91 9.09 15.00 90 12 2.81 December 5.78 7.30 13.08 93 20 2.16 Totals 70.65 79.32 149.97 25.99 Average 1952 5.88 6.61 12.49 2.16 Average 1951 5.22 7.24 12.47 2.48 19 CEMETERY - Station "C" 1952 Tons per sq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times WNW-NNW January 4.20 4.27 8.47 93 30 1.65 February 5.84 4.44 10.28 84 48 0.90 March 11.78 7.71 19.49 93 3 2.68 April 7.12 5.24 12.36 90 6 1.35 May 8.42 7.19 15.61 93 11 2.14 June 6.26 6.89 13.15 90 33 2.05 July 6.60 7.29 13.89 93 24 0. 64 August 4.74 10.14 14.88 93 10 2.61 September 6.13 8.22 14.35 90 16 3.17 October 4.14 6.10 10.24 93 21 2.47 November 6.76 6.13 12.89 90 25 2.78 December 3.98 4.51 8.49 93 33 2.17 Totals 75.97 78.13 154.10 24.61 Average 1952 6.33 6.51 12.84 2.05 Average 1951 5.58 6.44 12.03 2.56 Station A. 1952 Station B. 1952 Station C. 1952 ¼ Total Cumulative ¼ Total Cumulative ¼ Total Cumulative First Quarter 54.47 54.47 33.27 33.27 38.24 38.24 Second Quarter 67.89 122.36 39.40 72.67 41.12 79.36 Third Quarter 49.10 171.46 39.00 111.67 43.12 122.48 Fourth Quarter 58.08 229.54 38.30 149.97 31.62 154.10 GENERAL. Station A. Station B« Station C. Total Deposit 229.54 149.97 154.10 Monthly Average Deposit 19.12 12.49 12.84 Total Rainfall 26.67 25.99 24.61 Average Rainfall 2.22 2.16 2.05 20 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 during the winter season it was converted for use as a hall for concerts, dances, balls, 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 13 premises were disinfested, compared with 26 for the previous year. Five Corporation controlled houses were dealt with by the Department during the year. The continued diminution of the number of premises found to be infested by the bed bug is a pleasing feature of the postwar period. The general improvement in sanitary conditions has brought about a changed attitude on the part of occupiers. No longer do they accept as inevitable the infestation of their houses by such insects, Control measures have been greatly improved by the production of D.D.T. and similar insecticides. It is possible now to apply an invisible coating to wall surfaces of lasting deposits of such material. 13. COMPLAINTS. The number of complaints received during the year was 503 compared with 636 for the previous year. Since the peak year of 1947 when the figure was 920, there has been a consistent decline in the number of complaints recorded. The following is a brief tabulated list of causes for complaints received during 1952. Sanitary Defects 171 Rodent Infestation 152 Defective Ashbins 7 Drainage and Sanitary Arrangements 89 Overcrowding 6 Food ( quality, soundness, etc.) 28 Smoke and Grit Emission 9 Miscellaneous 41 503 14. RODENT AMD INSECT PEST CONTROL. It has not been found necessary during the year to take legal action under the provisions of the Prevention of Damage by Pests Act, 1949 • To control rat and mouse infestation, very thorough treatment and maintenance of regular inspection and supervision is necessary. Invariably persistent infestations are found to be due tc defective drains. Whilst the work of rodent control in sewers has considerably restricted the extent of infestation, drains and sewers are still a very common means by which the rat gains access to the premises. During the year fifteen such cases were revealed. There is also a possibility, particularly in the case of business premises, of re-infestation during the delivery of bulk merchandise® This work is carried out in close co-operation with the Rodent Control Section of the Ministry of Agriculture and Fisheries, and the advice and assistance given by the Minister's Officers and the Research Department at Tolworth is much appreciated. 21 Sewers and Drains. The conditions under which the Ministry of Agriculture and Fisheries give financial aid require the Corporation to carry out two treatments per year to the sewers in the town, and it has "been customary for this to "be done in the months of March and September. Experience over the last few years has proved that March is usually a very wet month, and this, coupled with the fact that most of Kingston is a flat and low lying area, has caused a large number of baits to be washed away when the sewers were charged during heavy rain. Meteorological records give December as being the driest month of winter and it was decided, therefore, to carry out the Rodent Control campaigns in December and June. This arrangement necessitated three treatments during the year, when, because of the improved conditions now prevailing, only 245 manholes were baited as against 300 last year. It is hoped to reduce the incidence of rats in sewers still further by intensifying our efforts in the areas where infestation is persistent. Rodent Control - Statistical Statement, 1952. Private Dwellings and Corporation Property. Rats Mice Total No. of complaints received in office 144 No. of premises inspected as a result of these complaints 592 No. of premises found to be infested 205 38 243 No. of separate infestations treated 225 43 268 No. of visits for treatment and re inspections 1383 156 1539 In addition, 710 premises and a number of back gardens and other properties were inspected in connection with routine surveys. Business and Factory Premises, Rats Mice Total No. of complaints received in office 8 No. of premises inspected, including those under service agreement 122 No. of premises in which slight infestations were found 36 84 120 No. of visits for treatment and reinspections 1685 2115 3800 SUMMARY. No. of complaints received 152 No. of premises inspected 1424 No. of premises infested 363 No. of visits for treatment, reinspections and surveys 6049 Insect Pest Control. Insect Pest Control and maintenance treatments with regard to cockroaches, flies, etc. are carried out by the Department in all types of premises. It should be remembered that practically every foodstuff or material has its own particular pest, e.g., the bacon beetle, flour moth, cocoa moth and carpet beetle, to name only a few. As stated previously in the Report, the incidence of bed bugs ln Kingston continues to decline. With regard to infestations by 22 other pests, the Health Department is always ready to advise the public on how to get rid of them. If the insect is one which we have not dealt with before, the entomologist at the British Museum of Natural History, or the Infestation Laboratory of the Ministry of Agriculture and Fisheries at Tolworth is consulted. Information is always forthcoming both on identification and control. 15. RAG FLOCK ACT, 1951. There are in the Borough three premises registered under the provisions of the Act for upholstering or bedding manufacture. During 1952 four samples of materials were taken and each complied with the standard of cleanliness required by the Rag Flock and Other Filling Materials Regulations made under the above Act. SECTION D. HOUSING Throughout the country considerable numbers of houses are deteriorating by reason of the fact that for many years the net income has been insufficient to enable essential repairs to be carried out. In Kingston also there is a number of similar properties. Because of this situation, considerable emphasis has been laid, in Parliament; on the Radio, and in the National Press, upon the need for an early amendment of the Rent Restrictions Acts. In Kingston there are many houses which are nearing the end of their useful life, and provision will have to be made for their replacement. It is possible by informal action to keep most properties reasonably habitable, but adequate reconditioning as was intended when the Housing Act, 1936 became law, is at the present time,, practically impossible. Housing - Statistical Statement - 1952. The following information, supplied by the Borough Surveyor, indicates that thirty-eight houses and one hundred and twenty flats were built by the Corporation during the year. No. of Dwellings erected by private enterprise during 1952. New construction (Houses and Flats) 12 War Damage - rebuil 1 By conversion of existing houses into flats (additional accommodation provided) 5 Total number of permanent Dwellings erected by the Corporation since March 1924 to 31st December, 1952. New Construction War Damage Houses 1073 4 (Inc.812 outside Borough) Flats 696 3 (Inc.221 outside Borough) 23 Total No. of Temporary Dwellings erected up to 31st December, 1952. Arc on 132 Aluminium 70 2 year Huts 126 328 No. of 2 year Hut3 demolished during 1952 2 SECTION E. INSPECTION AND SUPERVISION OP POOD. (a) Milk Supplyo All milk supplies in the town are brought in from outside sources, there being no milch herds in the Borough. All known sources of supply are regularly sampled- The quality generally has proved to be satisfactory. Under the provisions of the Milk (Special Designations) (Special Areas) Order, 1951, the Borough of Kingston forms part of Specified Area No® 1. By the provisions of the Order, it is an offence to sell in the Borough milk which is not either Pasteurised, Sterilised or Tuberculin Tested. The sale of raw undesignated milk is therefore entirely prohibited within the Borough. (b) Designated Milks. The following table shows the number and type of licences issued by your Corporation during 1952, under the provisions of the Milk (Special Designations) Regulations., All the licences were in force at the end cf the year. Pasteurised Sterilised Tuberculin Tested To Pasteurise 1 - - To Deal 9 7 5 Supplementary 9 7 8 (c). Bacteriological Examination of Milk. During the year, 103 samples of milk were sent to the Public Health Laboratory at Epsom for examination. The total of 103 was made up as follows Pasteurised 82 T.T.(Pasteurised) 13 Sterilised 8 The Pasteurised Milk was submitted for the phosphatase and methylene blue tests and the Sterilised Milk for the turbidity test. Only one sample of Pasteurised Milk failed to pass the phosphatase test, demonstrating a fault in pasteurisation. Of the hundreds of samples taken from this particu- 24 lar firm, whose plant is situate outside the Borough, this was the only recorded case of failure. The matter was thoroughly investigated and the firm stated that they were at a complete loss to account for the failure reported both from Kingston and from the Sanitary Inspector of an adjoining Borough. Further additional precautions were instituted at the plant, and all subsequent samples taken have proved to be satisfactory. In addition to the above, one sample did not comply with the mpethylene blue test as to bacteriological condition. This sample was also supplied from a dairyman whose premises are situate in an adjoining Borough. The necessary 'follow-up' action was taken and all further samples since taken from the same source have proved to be satisfactory. (d) Biological Examination of Milk. Twenty-one samples were submitted during the year for examination for tubercle bacilli, All the samples proved to be negative. (e) Ice Cream. The number of registered premises in the Borough upon which ice cream may be stored or from which it may be sold is 134. This figure includes eight producers. In addition to these dealers and producers there are 38 other premises, such as restaurants, canteens, cinemas, etc. upon which ice cream is sold. These premises are not required to be registered. By far the greater part of the ice cream sold in the town is obtained from manufacturers whose premises are situate outside the Borough. The following table shows the results of examinations in respect of 208 samples submitted to the Public Health Laboratory at Epsom during 1952. GRADE I II 1ll IV Total Ice Cream 141 41 9 17 208 In addition to the above, six iced lollies were submitted for bacteriological examination and all were placed in Grade I. These results may be considered to be very satisfactory. The figure of 87.5% placed in Grades I and II is a considerable improvement over the results obtained in the first year's working of the Ice Cream (Heat Treatment) Regulations, 1947At that time only 64% of the samples were placed in these grades. (f) Iced Lollies. Iced Lollies appear to have become very popular with children and it is probable that there is a greater consumption by the younger generation of this product than the more conventional ice cream. All lollies sampled so far have been 25 placed in Provisional Grade I, and this high bacteriological grading is to be expected, as in the main, the product does not contain media which are favourable to bacteriological growth® There is, however, a tendency to incorporate ice cream mixtures into certain types which are called cream or milk lollies. For this reason there is need to maintain similar supervision over the manufacture of these confections as that required in connection with ice cream. (g) Meat and Other FoodSe (i) There are no licensed slaughter-houses in the Borough. The Ministry of Food Meat Depot in Wood Street continued as the distributing centre for meat sold in Kingston, Esher, Surbiton, Wimbledon, Richmond, Maiden & Coombe, and Barnes. Daily visits are made to the Meat Depot and routine inspections are carried out. During the last 13 years there appears to have been little improvement in the transport and handling of the meat either to or from the Depot. In the main the vehicles are structurally unsuitable for the work of transporting carcases, and no provision is made in them for hanging the meat clear of floors, over which the men must walk, in order to unload. A measure of protection would be provided if the meat were wrapped or covered with suitable clean material. (ii) Foodstuffs condemned as unfit: The following tabulated statement shows the amounts of various foods which were condemned during the year and the causes for condemnation. The list is very much condensed to avoid unnecessary detail. The quantities involved are small in comparison with the amount of food which is handled in the town. The meat which is condemned each year by reason of decomposition is to be deplored. Such condemnation usually takes place during warm weather and it would appear that even now facilities for cooling at slaughter houses and abattoirs are far from adequate. Tabulated list of Condemned Foodstuffs showing cause for Condemnation and the Weights Article of Pood. Reason for Actions Weight lbs. Raw Meats Ovine Decomposition 170 Disease 60½ Contamination 365 595½ Bovine Decomposition 1482¼ Disease 22 Contaminat ion 1539¾ Porcine Decomposition 250½ Toeal weight Raw Meat 2385¾ Raw Pish Decomposition 154 Poultry. Game, etc. Ducks Decomposition 8 Turkey „ 60 Rabbits „ 154 222 Dried Pruit Infestation 142½ Cont/d. 26 Article of Food Reason for Action Weight lbs. Canned Goods Meat & Meat Products) 2048 Fruit Punctured, 2153½ Jam 225 Vegetables Damaged., Blown, 459½ Milk 192 Soup Decomposition 111 Fish & Fish Paste 37½ Others 282 5508½ Glass contamination, Food in Glass Containers.mould. deterioration 40¼ Packet Foodstuffs Contamination, insect i0nfestation Sausages Decomposition 52 Sweets and Confectionery Contamination 411¼ Shell Eggs 1732 (Number) (h) Food Hygiene- During the year under review,work has continued particularly in the application of the Food Handling Byelaws. Attention has been directed to the protection of food where exposed for sale. The improved supply of wrapping material has enabled manufacturers to extend the range of food supplies which are pre-wrapped or packed at the factory or bakery ready to be served to the customer. Gradual improvements have been made in the structural condition of many food premises with beneficial results® In the main, however, further advancement in clean food handling must be directed towards the use of proper methods, By constant visits, discussion and advice, the Sanitary Inspectors play a considerable part in this work of improvement. As stated earlier in the Report, no outbreak of food poisoning was reported during the year; three isolated cases only were notified. FOOD AND DRUGS ACT, 1938. Details of samples submitted to the Public Analyst during the year are given in the tabulated statement. The following are the results of action taken in respect of seventeen samples upon which an adverse report was received. Two samples of beef sausage were deficient in meat content to the extent of 10% and 40% respectively; both cases were referred to the Ministry of Food and in respect of the larger deficiency, legal proceedings were instituted and fines totalling £30. and costs of £20. were imposed. A sample of greengages taken from stock proved, upon examination, that the contents had greatly deteriorated due to chemical reaction upon the metal of the can, rendering the article unsuitable for sale for human consumption. The remaining stock was withdrawn from sale. An informal sample of milk proved to be 16% deficient in milk fat, but a formal sample taken later from the same source proved to be genuine. 27 Three samples of sausage were reported by the Analyst to contain added preservative, but in no case was there any declaration that the sausages did, in fact, contain preservative. The attention of the vendors and manufacturers was drawn to this omission, which was rectified. A sample of tomato sauce contained ingredients not specified on the lately and thereby contravened the Labelling of Pood Order, 1951- The matter was taken up with the manufacturers with a view to amendment of the label. Two informal samples of milk reported to be slightly deficient in milk fat and non-fatty solids were followed by four formal samples from the same sources. These showed deficiencies which were not sufficient to justify formal action. A sample of milk was found to be deficient to the extent of 1% in non-fatty solids. A 'follow-up. sample in this case proved to be genuine. Reporting upon an informal sample of jelly crystals, the Public Analyst stated that in his opinion, the sample would fail to pass the setting test prescribed by the Pood Standards (Table Jellies) Order 1949. The sugar content, whilst above that prescribed by the Order, did not conform with the statement on the label. The attention of the manufacturer was drawn to the infringement and as far as possible all stocks were withdrawn from sale. A sample of grated horseradish was stated by the Public Analyst to be devoid of aroma and pungency, and upon further investigation it was ascertained that the sample had been in stock for some time* The shopkeeper subsequently surrendered for destruction the remainder of his stock of the substance. Tabulated Statement of Samples submitted to the Public Analyst during 1952. Commodity No. of Sample s Genuine Not Genuine Formal Informal Formal Informal Formal Informal Arrowroot - 1 - 1 - - Butter — 1 — 1 — — Coffee, pure — 1 - 1 — - Cake flour & egg - 1 — 1 — - Gelatine _ 2 _ 2 - - Gelatine (dessert) - 1 — 1 — - Greengages, canned — 1 - - — 1 Horseradish - 1 — — 1 Ice Cream — 6 — 6 — - Jellies, table — 3 — 3 — — " , crystals - 2 - 1 1 Lemonade Powder - 1 — 1 - — Lemon Squash - 1 — 1 — Liver Sausage - 1 - 1 — — Marmalade 1 — 1 — - - Mincemeat — 3 _ 3 - - Margarine — 2 2 — — Meat Paste _ 1 1 - Milk (Channel Island) 2 14 2 13 — 1 C/Fwd• 3 43 3 39 - 4 ?8 Coramodity No.of Samples Genuine Not Genuine Formal Informal Formal Informal Formal Informal B/Fwd. 3 43 3 39 - 4 Milk 7 49 3 46 4 3 Orange Squash 2 - 2 — — - Pepper - 1 — 1 — — " white - 1 — 1 —> - " black — 1 — 1 _ — Pork brawn — 1 _ 1 _ _ Salami 1 — 1 — _ _ Saveloys - 1 - 1 — - Strawberry jam 1 — 1 — — - Stomach powder - 1 — 1 — - Sunny spread _ 1 — 1 — - Syrup, cough - 1 - 1 - - Tomato puree - 1 — 1 — - Tomato sauce - 1 — — — 1 Vinegar malt 2 1 2 1 - " , malt & caramel - 1 - 1 -- Beef sausages 9 1 7 1 2 - Beef sausagemeat 4 1 4 1 - _- Pork sausages 9 4 9 3 2 1 Pork sausagemeat 1 — 1 — — - " " (preserved) - 1 1 — - Totals 39 111 33 102 8 9 MERCHANDISE MARKS ACT. 1926 Regular and frequent inspections were made during the year with regard to the labelling and display of appropriate notices, in compliance with the Orders made under the above Act In respect of certain foods. The co-operation of traders was very noticeable and it was not necessary to take any legal enforcement action. A contravention of the Act of 1887 in respect of non-brewed vinegar was referred to a local authority in whose area the wholesaler's premises were situate. The legal proceedings subsequently taken resulted in a conviction. 29 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) Meningococcal Infection s Acute Poliomyelitis - paralytic " - non-paralytic Acute Encephalitis - infective " - post infectious Dysentery Ophthalmia Neonatorum Puerperal Pyrexia Smallpox Para-typhoid Fevers Enteric or Typhoid Fever (excluding Paratyphoid) Food Poisoning Erysipelas Chiekenpox Malaria Cholora Plague Typhus Fever Relapsing Fever Tuberculosis ( Acute poliomyelitis includes acute polioencephalitis). Leprosy is notifiable by General Medical Practitioners direct to the Chief Medical Officer of the Ministry of Health, In 19f- a total of 510 notifications of infectious disease was reeelved, compared with 763 in 1951. This decrease is due to a decline in the number of notifications of scarlet fever, measles, and whooping cough, and a general improvement over last yeti is apparent. Ths following table gives an analysis of the cases into age groupSo . 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 Fev - - - 2 5 22 - - - - - 29 5 - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Paver in - - - - - - - - - - - - - - - - - - - - - - - - - - - cluding Paratyphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis; - 1 - - - - 1 - 1 - - - 3 2 - - - - - - - - - - - - - Non-Paralyti - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Infective - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - 16 57 11 - - 84 82 - - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 2 3 7 1 2 - - - - - - - 1 1 6 14 24 Erysipelas - B.Dysenteria(Sonne) - - - - - 1 - - - - - - 2 - - - - - - - - - - - - - - 2 19 29 41 38 143 4 3 1 - - - 280 - - - - - - - - - - - - - - 5 11 11 9 19 41 2 - 1 - - - 102 - - - - - - - - - - - - - - Chickenpoxo - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 — 2 - - - 3 - - - - - - - - - - - - - - Totals 7 32 41 52 62 208 7 19 63 13 3 3 510 92 2 - co CO - - <= - 1 1 6 14 24 31 The following table gives a comparative statement of notifications of certain infectious diseases received during the last thirty years TABLE VI Year Scarlet Fever Puerperal Pyrexia Measles Whooping Cough Acute Infective Encephalitis Poliomyelitis Enteric Fever(including Para-typhoid) Diphtheria Ophthalmia Neonatorum 1923 118 2 Not notifiable until 1940 Not notifiable until 1940 - - 1 17 5 1924 143 — - 1 6 20 4 1925 213 4 — 3 7 25 5 1926 82 4 — 2 7 27 2 1927 87 9 _ 1 65 3 1928 135 9 — 1 7 152 4 1929 74 5 — — 1 113 3 1930 78 9 - — 100 2 1931 61 14 _ — 1 53 4 1932 56 13 - 2 1 47 - 1933 125 10 - 3 2 30 2 1934 40 5 - - 2 42 3 1935 54 8 — — 2 50 3 1936 67 19 — — 6 27 2 1937 51 32 — 2 1 21 3 1938 1939 61 47 - 2 1 72 2 69 66 - - — 1 1 19 3 1940 45 63 373 22 — — 3 53 3 1941 54 37 331 271 - 1 7 15 - 1942 79 24 375 99 _ — - 8 3 1943 110 18 287 151 — 1 1 3 - 1944 49 15 33 73 — 1 — 7 2 1945 28 23 407 84 — 1 — 16 2 1946 34 41 283 67 - 2 1 8 1 1947 24 28 219 38 3 5 1 2 1 1948 34 30 197 200 - 3 - - - 1949 73 29 483 81 3 7 - - - 1950 51 23 132 41 - 4 — — — 1951 37 41 443 222 1 — — — — 1952 29 84 280 102 - 3 — - — Scarlet Fever. Twenty nine cases of mild scarlet fever were notified, twenty two of which were of school age. No deaths occurred and no "return" cases. Only five of the cases notified were removed to an infectious diseases hospital for treatment and the remainder were treated at home. It is interesting to note the great drop in the proportion of cases of scarlet fever which now have to be sent to hospital. In 1952 17% of cases went to hospital as compared with 55% in 1951; 65% in 1950; and 73% in 1949. 32 Scarlet Fever (Continued) Where home conditions are suitable for isolation most cases can now be nursed at home. This is due to the lessened severity of the disease generally and the use of modern drugs in treatment, and although precautions still have to be taken in view of the possibility of complications it is possible to avoid taking up some hospital beds which are left free for more urgent cases. Diphtheria, No cases of diphtheria were notified, for the fifth successive year. Intensive work was continued to immunise the school and pre-school population against diphtheria, and the table on following page shows the stage reached by the end of 1952, It is intended to continue with a vigorous inmunlsation campaign to prevent any possible diminishing of public interest in this service, occasioned by five years freedom from the disease, and the complacency which may result. Immunisation is just as necessary in the absence of diphtheria as when it occurs. Poliomyelitis, Three cases were notified during 1952, all of them having some symptoms of muscle weakness. Two of the persons concerned were children (ages l½ and 11 years) and fortunately the illness was slight in each case. The third case was more severe and occurred in an adult female (aged 25 years) who developed sane paralysis of the legs and arms. There was no connection between any of these cases and they all occurred in families having no known contact with each other. Acute Infective Encephalitis. No cases were recorded during 1952, Enteric Fever (Typhoid or Paratyphoid). No cases of typhoid or paratyphoid B were notified during 1952, This is the fifth successive year in which no oases of typhoid or paratyphoid fever were notified. Measles. There were 280 cases of measles notified during 1952 (compared with 443 in 1951), of whom one only was removed to hospital, and generally speaking the illness was of a mild type with little by way of complications. The 5-10 year age groups contained the largest number of notifications (143) the majority of the remainder being spread over the 1-5 year age period (129), and only 8 at other ages. Ophthalmia Neonatorum. No cases were notified during 1952, This is the fifth successive year in which we have had no cases of ophthalmia neonatorum notified. 33 DIPHTHERIA IMMUNISATION TABLE VII Comparative Statement for the Years 1950. 1951. and 1952 (Provided by Dr. W.H. Kinstrie) No, completely immunised Year of Birth 195O 1951 1952 1952 38 1951 35 356 1950 38 376 418 1919 474 539 514 1948 471 484 475 1947 578 575 629 1946 544 571 585 1945 482 503 522 1944 448 461 477 1943 420 503 461 1942 401 407 401 1941 380 382 403 1940 415 397 377 1939 379 409 387 1938 375 343 345 1937 374 359 1936 366 0-4 Age Group Total number completely Immunised as at 31.12.1950 2105 percentage 1950 65.0 as at 31 .12 .1951 2009 „ 1951 6.5 as at 31.12.1952 1801 „ 1952 62.1 5 - 15 Apte Group Total number completely Immunised as at 31.2.1950 4040 percentage 1950 88.O as at 31.12.1951 4335 „ 1951 98.0 as at 31.12 el952 4587 „ 1952 97.5 Record of work done at Bipfetheria Immunisation Clinics 1950 1951 1952 Total number ©f clinics held 98 96 94 Number completely immunised 415 363 279 Number of Schick Tests 1172 1494 1287 Number of Positive Schick Tests amd Re-inoculations 84 82 61 Total Attendances 320k 3681 3241 Average Attendance s 32 38 30 34| Puerperal Pyrexia. Eighty-four cases were notified during 1952, 82 of which occurred in patients in Kingston Hospital. An analysis is shown below, together with figures for the years 1948 - 1951 for purposes of comparison. Twenty-three of the cases were Kingston residents, and the total which shows an increase of 43 cases over 1951 reflects the effect, as mentioned in my report for 1951, of the Puerperal Pyrexia Regulations, 1951, which modify the definition of the disease, and became operative in August, 1951. Cases 1950 1951 1952 30 29 23 41 84 (b) Number included in (a) of (i) Kingston residents 9 4 8 14 23 (ii) Extra district re sidents 21 25 15 27 61 (c) Number included in (a) notified from Kingston 29 28 21 40 82 (d) Number included in (a) notified by private doctors 1 1 2 1 2 (e) Number of cases included in (d) removed to hospital other than those included in (C) - - - - - Food Poisoning. A total of three cases of food poisoning was notified during 1952, compared with five cases in 1951- These were isolated, unconnected cases which fortunately did not produce severe illnesses. Two of the persons affected had eaten duck eggs, a food which is known to be quite a common vehicle for organisms capable of producing poisoning. Faeces specimens were taken from the patients, and a salmonella organism was isolated in respect of one of the patients. Nothing remained of the suspected food and laboratory tests could not therefore be made. Tests were carried out, however, on eggs taken from the stocks of the suppliers of the suspected eggs, but the results were negative for pathogenic organisms. The third case was one where no particular food was suspected although a faeces specimen from the patient had produced evidence of infection by a salmonella organism. Tuberculosis. Cases ©f tuberculosis are dealt with by the South West Metropolitan Regional Hospital Boards, and by the Surrey County Council. Good liaison exists between your Medical Officer and the Chest Physician, and his staff, and with the Surrey County Council. 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. Tuberculosis (Continued) The following table shows comparative figures of notified cases and deaths for the years 1942 - 1952 (inclusive) Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 1942 67 11 78 22 2 24 1943 63 8 71 25 1 26 1944 56 11 67 19 4 23 1945 41 12 53 19 7 26 1946 41 9 50 10 3 13 1947 43 3 46 17 4 21 1948 55 3 58 22 2 24 1949 40 6 46 10 1 11 1950 37 11 48 12 - 12 1951 38 9 47 12 1 13 1952 43 2 45 9 2 11 (Note - An analysis of the total notified cases during 1952 in age groups is shown on the following page) The ratio of non-notified cases to total deaths for 1952 and the preceding four years is as follows 11948 1949 1950 1951 1952 1:24 1:11 1:6 1:3 1:2 The total number of cases notified is lower than in any ©f the ten preceding years. The number of pulmonary cases has, however, risen as compared with the three previous years, and the number of non-pulmonary cases has shown a remarkable drop0 With regard to the pulmonary cases there is no doubt that an increased number of notifications in 1952 was due to the visit in November 1951 to Kingston of the Regional Hospital Board Mass Radiography Unit. Cases and suspected cases wore discovered during the survey, and by the time the persons concerned had been examined by the Chest Physician, and full tests made the notifications did not come forward until 1952. These facts are confirmed by the Chest Physician who also, by constantly checking contacts of known and suspected cases of pulmonary tuberculosis, has discovered further cases which may otherwise have gone undetected until the disease was much more advanced. During 1952 no action became necessary under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or Section 172 of the Public Health Act, 1936. Very close co-operation is maintained with the Kingston and District Tuberculosis Care Committee, whose field of work is coincidental with the North Central Division. The Medical Officer of Health is Chairman of the Care Committee and considerable assistance has been given to patients. There is no doubt that this body is fulfilling its function of helping towards the rehabilitation of tuberculous patients. Notifird cases of AND DEATHS FROM, TUBERCULOSIS IN 1952 TABLE VIII NEW CASES DEATHS Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 (5 & over Total Under 1 year 1-5 5-15 15 - 25 |25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total Tuberculosis 26 (a) Respiratory- M. — 2 2 4 3 3 3 4 5 - - - - - 1 1 3 2 7 F. - - 2 3 7 1 2 1 1 17 - - - - - - 1 1 2 Total - 2 - 7 10 - 5 5 6 43 - - - - - 1 2 3 3 9 (b) Non-Respiratory M. - - - - - - - 1 1 - - - - - - - - - P. - - - 1 - - - - - 1 - - - - - - 1 2 Total - - - 1 - - - - 1 2 - - - - - - 1 - - 2 37 Tuberculosis is an infectious condition, and the treatment required to cure pulmonary tuberculosis involves a long period of rest. When the infection comes to the bread-winner it is a very serious matter for the family and puts a great strain on the financial resources. There is also the necessity of preventing the spread of infection from the infected person to healthy members of the family circle. This requires isolation, nearly always at home, for long periods, throwing a further strain on already limited resources. The Kingston and District Tuberculosis Care Committee was formed for the purpose of encouraging and assisting sufferers from tuberculosis towards recovery. During 1952 166 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 £1492 was expended from the funds of the Conmittee on this work. Whoo-ping Cough. There were 102 cases of whooping cough notified during 1952 as compared with 222 in 1951- This is a debilitating infection occurring mostly in early childhood. Fifty-five of the above notifications were in respect of children under five years of age, and, of the common childhood illnesses, whooping cough is the most serious, and has the greatest national fatality and disability rates. The Surrey County Council received the approval of the Minister of Health during 1952 to make further arrangements for immunisation against whooping cough in Surrey. Your Medical Officer of Health was authorised to act as the agent of the Surrey County Council for this matter in Kingston, and immunisation against whooping cough is now being carried out in Kingston at clinics and by general practitioners. In some cases immunisation against diphtheria and vaccination against whooping cough is performed in a combined process. Scabies. During the year the scheme for treating cases and contacts of scabies continued to operate as described in previous reports, treatment being carried out at the Corporation Cleansing Station, Burton Road. Thirty cases and contacts were dealt with during 1952 as compared with thirty-one in 1951. It was. decided that the number of cases occurring was not sufficient to warrant the cost of providing and maintaining a oleanslng station, and consequently this service was discontinued with the approval of the Town Council at the end o£ 1952. Individual arrangements will be made in respect of any case being referred to the Public Health Department for scabies treatment in the future. INFESTATION BY HEAD LICE During 1952 there was no evidence of special incidence of Infestation by head lice. B.D.T. preparations were used in addition to the usual clearsing by water and soft soap or shampoo. It was not found necessary to take any statutory action for infestation by lice during the year.