AC P.C Ach, 6854 my AC 4413(I) KINESION-up or - THAMES KIN 27 Met Met Ropal Borough of Kingston-upon-Thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1953 GUILDHALL, KINGSTON-UPON-THAMES JUNE. 1954 Ropal Borough of Kingston-upon-Thames ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR 1953 guildhall, kingston-upon-thames JUNE, 1954 ANNUAL REPORT 195 3 TABLE OF CONTENTS Preface Page Staff of the Public Health Department 1 SECTION A Statistics and Social Conditions (1) General Statistics 2 (2) Social Conditions 2,3,4,5 (3) Extracts from Vital Statistics of the Year:- (a) Live Births 6 (b) Still Births 6 (c) Deaths - Total 7 (i) Death Rate - Total 7 (ii) Maternal Death Rate 7 (iii) Infant Death Rate - Quinquennial Infant Mortality Rate - Causes of Death of Children under one year 7,8 (iv) Deaths from Other Causes 9 Introduction to Tables on Vital Statistics 9 Table I - Extracts from Vital Statistics for years 1949 - 1953 inclusive 10 Table II - Comparison of Vital Statistics 1924 - 1953 11 Table III - Birth Rates, Death Rates, and Case Rates for certain infectious diseases in the year 1953 12 Table XV - Causes of Death 13 SECTION B General Provisions of Health Services (1) (i) Public Health Officers 14 (iij Laboratory Facilities 14 (iii) Ambulance Facilities 14 (iv) Hospitals (a) Infectious Diseases 14,15 (b) Smallpox 15 (c) General 15 (2) National Assistance Act, 1948 15 National Assistance (Amendment) Act, 1951 15 SECTION C Sanitary Circumstances (l) Water Supply 16 (2) Drainage and Sewerage 16 (3) Rivers and Streams 16 (4) Closet Accommodation 16 (5) Public Cleansing 17 (6) Sanitary Inspection of the Area 17,18 (7) Shops 18 (8) Factories Act, 1937 18,19 (9) Camping Sites 19 Page (10) Atmospheric Pollution 19,20, 21,22 (11) Swimming Baths and Pools 23 (12) Eradication of Bed Bugs 23 (13) Complaints 23 (14) Rodent and Insect Pest Control 23,22,25 (15) Rag Flock Act 25 SECTION D Housing General 25,26 SECTION E Inspection and Supervision of Food (a) Milk Supply 26 (b) Designated Milks 26 (c) Bacteriological Examination of Milk 27 (d) Ice Cream 27 (e) Meat and Other Foods 27,28,29 (f) Food Hygiene 29,30 Food and Drugs Act, 1938 30,31 Tabulated Statement of Samples Submitted to the Public Analyst during 1953 31 Merchandise Marks Act, 1926 31 SECTION F Infectious Diseases Notifiable Diseases 32 Table V - Notifiable Diseases during 1953 33 Table VI - Comparative Statement of Notifications of Certain Infectious Diseases 34 Scarlet Fever 34,35 Diphtheria 35 Poliomyelitis 35 Acute Infective Encephalitis 35 Enteric Fever (Typhoid and Paratyphoid) 35 Measles 35 Whooping 'Cough 36 Ophthalmia Neonatorum 36 Puerperal Pyrexia 36 Food Poisoning 36 Tuberculosis 37,38,39 Table VII - Notified Cases of Deaths from Tuberculosis in 1953 38 Scabies 40 Infestation by Head Lice 40 Prevention of Infectious Disease - Diphtheria Immunisation 40 Table VIII - Comparative Statement of Diphtheria Immunisation during the years 1951, 1952, and 1953 41 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT, 1953 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 1953. The Report follows a similar pattern to that for 1952, gives information on essential matters affecting the Public Health, and is in accordance with Ministry of Health Circulars 42/51, and 1/54. I am indebted to Mr. G.C. Smith, Senior Sanitary Inspector, and Mr. M.E. Powell, Chief Clerk, for much help in drafting and compiling the report. Population - The estimated mid 1953 home population given by the Registrar General is 39,940, an estimated decrease of 50 persons compared with 1952. This figure is the r esident 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. The corrected figure of the population of Kingston at the 1951 Census is now given as 40,172 and certain additional figures published by the Registrar General are given in the following summary. Administrative Area Acreage (Land & Inland Water) Ponulat ion 1931 1951 Persons Persons Males Females Persons Per Acre Kingstonupon Thames 1,408 39,825 40,172 18,422 21,750 28.5 Wards: Caribury 491 9,571 12,054 5,596 6,468 24.5 Hill 308 10,755 10,388 4,586 5,802 33.7 Norbiton 251 9,642 8,941 4,173 4,768 35.6 Town 358 9,857 8,789 4,077 4,712 24.6 * cf. 3.5 3.5 10.2 All Surrey: Esher: Richmond: 18.1 19.7 14.4 12.9 Wimbledon. Croydon C.B. : Maiden: Surbiton: At the Census 96.5% of the population lived in dwellings occupied by private households; the remaining 3.5% lived in hotels, educational establishments,, hospitals, defence establishments, and the like. For every 1,000 males there were 1,158 females. 38.8% of the population were single, 52.1% married, and 9.1% widowed or divorced. Percentage Age Distribution of the Population 7.6% aged 0-4 years 11.2% " 5-14 " 42.6% " 15-44 " 25.5% " 45 - 64 " 13.15 " 65 and over Infectious Disease - In general the health of the people has been good. The number of infectious disease notifications received in 1953 was higher than in 1952, but this was due to an increased incidence of measles and whooping cough. A reduction in the number of cases of scarlet fever is recorded. Once again, for the sixth year in succession, 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. Vaccination against Smallpox - is voluntary and a calculation shows that by the end of 1953 some 70% of the children born between 1st. July 1952 and 30th. June 1953 have been vaccinated. Births - The number of live births for 1953 is 609 and compares with 576 for 1952. The Birth Rate is 15.25 per 1,000 of the population, compared with 14.40 for 1952. Deaths - The number of deaths recorded in 1953 is 465 compared with 499 for 1952. This makes a Death Rate of 11.54 for 1953 compared with 12.48 for 1952. The excess of births over deaths was 144 compared with 77 for the previous year. The number of deaths of infants under 1 year of age in 1953 is 15, which gives an Infant Mortality Rate per 1,000 live births of 24.63. The corresponding figures for 1952 were 14 infant deaths and an Infant Mortality Rate of 24.39. The Causes of Death - The main conditions causing death as recorded in the table for 1953 are Heart Disease - 120; Cancer - 95; and Vascular Lesions of the Nervous System - 6l. National attention has been drawn of late to the general increase in the number of deaths attributable to cancer of the lung, and the following table shows the relevant figures for the past four years in respect of Kingston residents. The Registrar General couples cancer of the lung with cancer of the bronchus in his abbreviated list of causes of death, but this does not detract from the interest of the figures shown below. Deaths from Cancer of the lung and bronchus 1950 1951 1952 1953 M 8 F 3 M 8 F 2 M 10 F 1 M 13 F 2 Total Total Total Total 11 10 11 15 Housing - During the year under review a valuable contribution to the public health was made by the completion by the Corporation of 44 housing units, 18% of which had to be constructed outside the Borough. A further 25 units were erected by private enterprise. The Borough is almost completely built up, and important facts on the density of the resident population are to be found in Section A of the Report, which is recommended for study. The question of dealing with obsolete houses claims inmediate attention, and the remarks made on this subject in my letter to the Annual Report for 1952 are still valid. The time has come for the demolition of those dwellings which are incapable at reasonable cost of being made fit. On the other hand there are in Kingston many dwellings, the useful life of which ought to be extended by immediate repair, and the provision of basic sanitary amenities such as baths and internal sanitation. Staff - 1953 was the first full year of office for Mr. G. C. Smith as Senior Sanitary Inspector, and I take this opportunity of acknowledging his valuable work in reorganising the Sanitary Department, and his welcome help and support in all matters affecting the public health. It also saw the untimely death of Mr. F.D. Harvey, Administrative Officer, quite suddenly after operation. Mr,, Harvey was one of those specially valuable officers, who had 30 years continuous service to the Health Department. For many years he upheld the late Mr. H.T. Perry in the work of the Sanitary Inspector, and latterly more generally in the Public Health Department as Administrative Officer. Mr. Harvey's work was highly conscientious, and his service to Local Government in all aspects always devoted. His sudden departure was a great loss to the Department and the Corporation. In conclusion I gratefully record my thanks for support and encouragement in my work to His Worship the Mayor, Aldermen and Corporation, and my professional colleagues on the staff of the Corporation and in the Public Health Department® I have the honour to be, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. 1 1953 ROYAL BOROUGH OF KINGSTON-UPON-THAMES STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M.B., Ch.B. (Edin.) D.P.H. Senior Sanitary Inspector; G.C. SMITH, M.R. San.I., M.S.I.A. (a) (b) Administrative Officers: Ø F.D. HARVEY, M.R.San.I. (Until 29.3.53) (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) (Resigned 31.1.53) W.H. DUNSTAN, M.R. San. i. (a) (b) (Resigned 1.3.53) H.W. GILES, m.r. San. i. (a) (b) (Appointed 4.5.53) Junior Sanitary Inspector: (vacancy) Chief Clerk: M.E. POWELL, D.P.A. (Lond.) (Since l.4.53) Clerical Staff: MISS C.L. FOISTER, M.I.P.S. MRS. B.M. HILL MISS V.E. NEELD G. NORTHWOOD (Called for National Service 31.l2.52) V.L. LERIGO A. G. c.j. WILSON (Resigned 22.8.53) Assistant Rodent Officer; F.W. STAGG (a) Certificate as Sanitary Inspector. (b) Certificate as Meat and Foods Inspector. Ø Subject to a sharing arrangement with the Surrey County Council. The Public Health Committee is responsible for the consideration of all questions affecting the health of the inhabitants of the Borough over which the Council may have jurisdiction. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres l,390 Total Population (including Service personnel) 39,940 Number of inhabited houses (approx,) 11,641 Rateable Value - General Rate £578,699 Sum represented by Penny Rate £ 2,369 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. "The employment position, in this Employment Exchange area, throughout 1953 was better than in 1952, good as it was then. At its highest the total unemployment represented only slightly over 1% of what is estimated to be the working population. There is some long term unemployment affecting men in the over 50 age group and it would be true to say that at all times half the unemployed men are over 50 years of age. At the end of the year 25% of the men registered as unemployed were over 60 years of age. Retired civil servants, bank and insurance officials, elderly clerks and shop assistants mainly comprised this group but it also included ederly and physically handicapped unskilled men most of whom are registered disabled persons. Aircraft, general engineering and building have made the greatest demand on the available manpower. The area is heavily committed to work in connection with the defence programme and there is always a large unsatisfied demand for skilled engineers and aircraft workers. The main demand for women has been, as always, for domestic workers in private households, and hospitals, but work is always available for the right type in factories, retail distribution and offices. There is a tendency on the part of employers to impose an upper age limit of 40 when notifying vacancies for shops and offices. Mention has been made in the Preface to this Report of the surrey County Report based upon the 1951 Census. The Registrar General indicates therein that at the time of the Census there were in Kingston 13,823 males (occupied and retired) aged 15 and over in the following social classes. 746 (or 54 per 1,000) Social Class I (professional etc.occupations) 2615 (or 189 per l,000) " " II (intermediate occupations) 7757 (or 561 per l,000) " " III (akilled occupations) 1238 for 90 per 1,000) " " IV (partly skilled occupations) 1467 (or 106 per 1,000) " " V (unskilled occupations). 3 Further use has been made of the excellent Census of 1951 County Report for Surrey, which gives copious information regarding social conditions generally in the county, by reproducing hereunder certain sections of the tables and comments compiled by the Registrar General. "In Surrey the main differentials are between the areas of older housing adjacent to London, in which recent population increase has been relatively small, the more recently developed dormitory areas on the fringe of the Metropolitan Area, and the towns and rural districts beyond. In the County as a whole the number of dwellings has increased by 60 per cent since 1931, and by comparison the increases for Barnes (13 per cent), Wimbledon (20 per cent), Croydon (28 per cent), Kingston-upon-Thames (30 per cent) and Richmond (32 per cent) have been small. These areas on the fringe of the County of London have the highest proportions of households sharing dwellings, the highest proportion of one person households and, with the exception of Croydon, the highest proportion of households with non-married heads. At the other extreme six local authority areas have more than doubled their numbers of dwellings, viz. Epsom and Ewe 11 with 184 per cent increase, Carshaltan with 137, Banstead with 136, Surbiton 126, Maiden and Coombe 125, and Merton and Morden 107". There are 11,537 structurally separate dwellings in Kingston-upon-Thames (increase of 30.2% since 1931). The average number of rooms per dwelling is 4.88, and only 3.14% have one or two rooms only. These figures together with other associated figures appear below in the extract tables. Structurally Separate Dwellings Administrative Area Occupied and vacant Occupied Number % increase 1931-1951 % vacant Unfurnished Rooms per Dwelling % with 1 or 2 rooms only. 1951 1931 Kingston 11,537 30.2 0.87 4.88 5.48 3.31 Esher 15,423 89.1 1.13 5.19 5.86 2.30 Surbiton 17,640 126.5 0.58 4.82 5.79 4.05 Maiden 13,096 124.6 0.34 5.11 5.59 0.87 Wimibledon 16,435 20.1 0.89 5.19 6.12 4.36 Richmond 11,489 32.4 1.04 4.87 6.07 7.88 4 Private Households These are broadly defined by the Registrar General as comprising single persons living alone or groups of individuals voluntarily living together under a single menage in the sense of sharing the same living room, or eating at the same table. The following tables show the number of private households in Kingston, together with figures giving the density of population. Admin Area Number % increase 19311951 % sharing a dwelling Rooms per household % occupying 1 or 2 rooms only Per sons per household % of 1 person households 1951 1931 Kingston 12,865 27.1 22.0 4.29 12,4 3.01 3.69 11.7 Esher 15,598 88.6 7.4 4.98 5.4 3.21 3.79 8.0 Surbiton 18,965 127.9 14.6 4.38 11.4 3.14 3.51 9.4 Maiden 13,713 129.0 11.8 4.80 5.8 3.24 3.79 6.l Wimbledon 19,185 20.8 29.2 4.33 14.1 2.94 3.65 14.9 Richmond 13,758 30.8 31.8 3.95 20.1 2.88 3.43 17.6 Density of Occupation (Persons per Room) Administrative Area Persons per Room Percentage population at density Percentage households at density Heads of household percentage nonmarried Over 2 Over 1½ Over 2 Over 1½ Kingston 0.70 1.1 5.7 0.7 3.7 26.5 Esher 0.65 0.9 4.0 0.5 2.3 21.7 Surbiton 0.72 1.4 5.7 1.0 3.9 20.6 Maiden 0.68 0.8 3.9 0.5 2.2 17.7 Wimbledon 0.68 1.3 6.3 0.7 4.1 29.9 Richmond 0.73 1.5 7.8 0.9 5.2 31.8 5 Private Households in Separate Dwellings at Successive Densities Admin. Area Total Numbers of Households Over 3 3 & over 2 2 & over 1½ 1½ & over 1 1 or less Kingston 12,865 13 80 389 1,172 11,211 Surbiton 18,965 37 145 548 1,607 16,628 Esher 15,598 14 66 286 1,065 14,167 Maiden 13,9713 8 58 230 972 12,445 Wimbledon 19,185 23 124 651 1,558 16,829 Richmond 13,758 22 99 596 1,375 11,666 Admin. Area Total Percentages Over 3 3 & over 2 2 & over 1½ 1½ & over 1 1 or less Kingston 12,865 0.1 0.6 3.0 9.1 87.2 Surbiton 18,965 0.2 0.8 2.9 8.5 87.6 Esher 15,598 0.1 0.4 1.8 6.8 90.9 Maiden 13,713 0.1 0.4 1.7 7.1 90.7 Wimbledon 19,185 0.1 0.6 3.4 8.1 87.8 Richmond 13,758 0.2 0.7 4.3 10.0 84.8 6 3. Extracts from Vital Statistics of the Year. The crude birth and death rates for local areas cannot properly be compared by reason of the fact that the populations on which they are based may be of widely differing sex and age constitutions. Consequently the Registrar General provides a comparability factor for each area. When the crude rate of any area is multiplied by this factor an adjusted rate is produced which can be used to compare with the adjusted rate of any other area, or with the crude death rate for England and Wales as a whole (where the comparability factor is unity). The comparability factors for Kingston are Births .95 Deaths 86. The various birth and death rates in respect of the town are shown below and for the purpose of providing some comparison the Birth and Death Rates for England and Wales are also shown below. It will be noticed that both the adjusted rates for Kingston are lower than for the country as a whole. No comment need be made regarding the death rate but a comparatively low birth rate causes some concern. The number of live births recorded for 1953 in Kingston is however a little higher than last year, and it is to be hoped that this may be the start of a slight upward trend. It should be borne in mind also, when considering the birth rate, that, as has been mentioned in a previous report, there is a tendency for the younger child-producing families to be rehoused by the Corporation in houses which have been built in adjoining sanitary districts. This is a consequence of the physical features of the town and its lack of new building space, and to some extent tends to leave us with a population with a diminished birth rate. (a) Live Births - Total Male Female Legitimate Illegitimate 564 45 290 24 274 21 609 214 2.95 Birth Rate per 1,000 population (Crude Birth 15.25 Adjusted Birth Rate 14.5 England and Wales Birth Rate 15.5 (b) Still Births - Total Male Female Legitimate Illegitimate 18 1 12 1 6 19 13 6 Rate per 19000 total (live and still) births 30.25 7 (c) Deaths- Total Male Female 465 240 225 (i) Death Rate per 1,000 population (Crude Death Rate) 11.64 Adjusted Death Rate 10.0 England and Wales Death Rate 11.4 (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 15 Rate per l,000 live births 24.63 No. of Deaths Legitimate Infants 13 No. of Deaths Illegitimate Infants 2 Rate per 1,000 legitimate live births 23.05 Rate per l,000 illegitimate live births 44.44 All infants under 4 weeks of age (included in above). Total No. of Deaths 9 No. of Deaths Legitimate Infants 8 No. of Deaths Illegitimate Infants 1 Rate per l,000 live births 14.77 Rate per 1,000 legitimate live births 14.18 Rate per l,000 illegitimate live births 22.22 8 The approximate infant mortality rate for 1953 and the rates since 1948 are shown for purposes of comparison. 1948 1949 1950 1951 1952 1953 Kingston-upon-Thames 23 20 30 24 24 24 England and Wales 34 32 30 29 27 26 London Area 31 29 26 26 24 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 1941-1945 52 1946-1950 25 The following are the numbers in age groups of Kingston children who died during 1953 in the Borough before reaching the age of one year, together with the cause of death:- Age Total Deaths Acute Suppurative Bronchitis Myocarditis Inanition Prematurity Atelectasis Broncho Pneumonia Septicaamia, pneumonia Congenital heart disease Intra-Uterine anoxia (maternal placenta praevia) Erythroblastosis Foetalis 0-24 hours 4 - - - 3 - - - - 1 - 24 hrs. -1 mth. 5 - - - 2 1 1 - - - 1 1 mth. -1 year 6 1 1 1 - - 1 1 1 - - Totals 15 1 1 1 5 1 2 1 1 1 1 9 (iv) Deaths from Other Causes. No. of Deaths Deaths from Heart Disease 120 Deaths from Cancer 95 Deaths from Vascular Lesions of the Nervous System 61 Deaths from Circulatory Disease other than Heart 33 Deaths from Bronchitis 31 Deaths from Pneumonia 21 Deaths from Influenza 11 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 1949-1953 inclusive., It is noted that the number of births has increased as compared with the last two years, and that the number of deaths has decreased as compared with the last four years. The number of still births is high and shows a figure twice as high for males as for females. The figures in Table II are the Registrar General ®s estimates for successive years since 1924. They give the population, number of live births, birth rate per l,000 population number of deaths, the death rat© per l,000 population, and also the infant mortality rate per 1,000 live births of Kingstan-up on-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 Kingstonupon-Thames. Discussion of the number of notifications of infectious disease received during 1953 Kingstonupon-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 before 1950 and, in order to provide comparative figures, the causes of death used for 1949 have been converted as far as possible to the new classifications. 10 Extract from vital Statistics for Years 1949-1953 inclusive. TABLE I LIVE BIRTHS 1949 1950 1951 1952 1953 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. 679 344 335 578 279 299 535 281 254 531 283 248 564 290 274 Legitimate Illegitimate 50 23 27 41 19 22 39 21 18 45 22 23 45 24 21 729 367 362 619 298 321 574 302 272 576 305 271 609 314 295 Birth rate (R.G.) per 1,000 pop. 17.96 14.76 14.39 14.40 15.25 STILL BIRTHS 8 5 3 9 5 11 5 6 17 4 13 18 12 6 Legitimate Illegitimate 2 - 2 2 1 1 2 1 1 - - - 1 1 - 10 5 5 11 5 6 13 6 7 17 4 13 19 13 6 Rate per l,000 (live and still births) 13.53 17.46 22.16 28.63 30.25 DEATHS " " 500 250 250 491 215 276 556 277 279 499 254 245 465 240 225 Death rate (R.G.) per 1,000 pop. 12.32 11.73 13.93 12.48 11.64 11 Comparison of Vital Statistics 1924-1953 TABLE II Year Estimated Population Live Births Birth Rate per 1,000 population Deaths Death rate per 1,000 population Infantile Mortality Rate per 1,000 live births Kingston upon Thames England and Wales London Area 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 15o5 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 ll.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 ll.4 28 50 48 1940 37430 519 13.9 659 17.6 55 55 50 1941 35970 520 34.5 525 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 20o0 460 ll.6 29 43 41 1947 40780 870 21.3 495 12.3 22 41 37 1948 40780 722 17.7 455 l1.2 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 1953 39940 609 15.3 465 11.6 24 26 24 12 TABLE III Birth-rates, Death-rates, and Case-rates for certain infectious diseases in the Year 1953. Provisional figures based on Quarterly Returns of the Registrar General England and Wales l60 C.Bs. and Great Towns includ ing 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 15.5 17.0 15.7 17.5 15.25 Still Births ( 0.35 0.43 0.34 0.38 0.48 ( 22.4(a) 24.8(a) 21.4(a) 21.0(a) 15.72 Deaths All Causes 11.4 12.2 11.3 12.5 11.64 Typhoid & Paratyphoid 0.00 0.00 - - - Whooping Cough 0.01 0.01 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 - 0.00 Tuberculosis 0.20 0.24 0.19 0.24 0.23 Influenza 0.16 0.15 0.17 0.15 0.27 Smallpox 0.00 0.00 0.00 - — Acute poliomyelitis (including polioencephalitis) 0. 01 0.01 0.01 0.01 0.00 Pneumonia 0.55 0.59 0.52 0.64 0.53 Notifications (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 — Paratyphoid Fever 0.01 0.01 0.01 0.01 — Meningococcal infection 0.03 0.04 0.03 0.03 _ Scarlet fever 1.39 1.50 1.44 1.02 0.53 Whooping Cough 3.58 3.72 3.38 3.30 3.15 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 - Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 7.56 Pneumonia 0.84 0.92 0.76 0.73 0.41 Acute poliomyeltitis (including polioencephalitis) Paralytic 0.07 0.06 0.06 0.07 0.05 Non-paralytic 0.04 0.03 0.04 0.03 0.07 Food poisoning 0.24 0.25 0.24 0.38 0.10 Puerperal pyrexia 18.23(a) 24.33(a) 12.46(a) 28.61(a) 23.9 Deaths Rates per 1,000 live births All causes under 1 year of age 26.8(b) 30.8 24.3 24.8 24.6 Enteritis and diarrhoea under 2 years of age. 1.1 1.3 0.9 1.1 1.6 (a) Per 1,000 Total (live and still) Births (b) ,, ,, related live births. 13 Causes of Death TABLE IV Registrar General's Tables 1949 1950 1951 1952 1953 M P M F M F. M. F M F. All Causes 250 250 215 276 277 279 254 245 240 225 Tuberculosiss respiratory 4 6 7 5 7 5 7 2 5 3 Tuberculosis, other. 1 - - - - 1 - 2 - 1 Syphilitic disease 5 2 2 - 2 2 1 2 - 1 Diphtheria - - - - - - - - 1 - Whooping cough - - - - - - - - - - Meningococcal infections 1 - - - - - - - - - Acute poliomyelitis 1 2 - - — — - - - — Measles 1 - - - - 1 - -= 1 - Other infective and parasitic disease - - 1 1 - 1 - 1 - 2 Malignant neoplasm, stomach 10 5 8 5 11 5 7 4 - 4 Malignant neoplasm, lung, bronchus 8 3 8 2 10 1 13 2 Malignant neoplasm, uterus - 7 - 1 - 2 - 3 Malignant neoplasm, breast - 13 - 10 - 10 - 7 - 10 Other malignant and lymphatic neoplasms 20 17 19 24 29 20 25 34 Leukaemia, aleukaemia - 2 3 - 1 - 1 2 Diabates - 2 2 1 2 1 - 4 - 2 Vascular lesions of nervous systsm 18 29 18 47 29 39 27 39 26 35 Coronary disease, angina Hypertension with heart disease 66 81 31 8 23 12 46 11 25 14 29 12 31 3 43 4 18 8 Other heart disease 21 41 36 41 28 37 16 31 Other circulatory disease 11 20 14 18 18 18 16 20 22 11 Influenza - 4 2 9 2 3 4 7 Pneumonia 12 16 10 11 16 26 14 10 11 10 Br onohitis 23 10 11 11 24 5 29 19 16 15 Other diseases of respiratory system 5 - 3 3 3 3 5 1 4 4 Ulcer of stomach and duodenum 4 1 4 2 7 6 3 1 6 - Gastritis, enteritis, and diarrhoea 1 - - 1 1 - 1 - 2 2 Nephritis and nephrosis 4 3 3 - 1 2 3 4 5 - Hyperplasia of prostate 7 - 4 - 2 - 8 - Pregnancy, childbirth, abort ion - - - 4 - 1 - - - - Congenital malformations 6 4 3 2 2 1 5 - 2 - Other defined and illdefined diseases 22 31 14 27 15 22 14 18 Motor vehicle accidents 1 2 1 - 2 - 3 - 3 - All other accidents 4 5 5 12 6 5 3 6 3 - Suicide 2 3 5 3 3 3 2 4 1 2 Homicide and operations of war 1 - - 1 - - - - Separate figures not available for the year 1949 owing to different classifications being in use prior to 1950. 14 SECTION B GENERAL PROVISIONS OF HEALTH SERVICES l. (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. Consequent upon the death of Mr. P.D. Harvey mentioned in the Preface to this Report, Mr. M.E. Powell was promoted to Chief Clerk from Senior Clerk on l.4.53 Unlike Mr. Harvey's appointment, which was dual in that he was Administrative Officer for the Public Health Department of the Royal Borough of Kingston-upon-Thames and the North Central Division of the Surrey County Councils, Mr. Powell's appointment relates solely to the former Authority. (ii) Laboratory Facilities. During 1953 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 help in 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 samples under the Pood and Drugs Acts are submitted to the Public Analyst Mr. D.D. Moir, at the Analytical Laboratory, Southwark Street,S.E.1. (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 Sto 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. 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 95 infectious disease cases were treated in hospital, and 80 of these were notified from hospital in the first instance. 15 To Tolworth Isoldtion Hospital 11 South Middlesex Hospital 1 Kingston Hospital 80 * Weymouth Infectious Disease Hospital 1 ** Surbiton Hospital 2 * 79 notified from hospital,, ** 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 intended 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. It was not necessary to use these powers in respect of any person resident within the Borough during 1953. Although the problems associated with aged persons do not diminish, the number of geriatric cases coming to the notice of the Public Health Department during the year was less than in previous years. All necessary help and advice was given in each individual case, and everything done to improve the conditions found upon inspection. 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, and many cases were dealt with by voluntary arrangement. There is acute lack of adequate bed provision for the accommodation of selected and needy chronic sick. 16 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. 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. 3o 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 Malden, Surbiton, Epsom and Kingston has been completed. Two instances occurred during 1953 of pollution of the Hogsmill River on its course through the Borough. One was found to be due to the discharge of factory waste into a surface water sewer, and the firm concerned, upon being informed of the fault, immediately made arrangements for the drain to be connected to the foul water sewer. With regard to the second case, at the close of the year an investigation was in progress with a view to tracing the entry of foul water into a surface water sewer. Complaint was also received that oil was reaching the Thames through the discharge from a surface water sewer. Investigations revealed that, in all probability, the pollution was due to overflow from a garage petroleum interceptor, Such cases as this emphasize the need for regular and frequent, cleansing of these installations. CLOSET ACCOMMODATION. All closets in connection with dwelling houses in the Borough are on the water carriage system. 17 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 involvedo Approximately 12,800 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 Hogsmill 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 OF THE AREA. The following is a tabulated list of visits and inspections which totalled 7,l99:- House inspections-defects, etc. 445 Drainage 503 Factries 429 Outworkers 11 Atmospheric Pollution 144 Dairies, milk shops, etc. 124 Food Premises 1344 Restaurants and Cafes 364 Infectious disease enquiries 145 Theatres & Cinemas 9 Verminous premises 42 Rodent Control 111 Shope Act 456 Schools 43 Housing Act 9 Marrkets 286 Miscellaneous 1059 5524 Reinspections and works in progress 1675 7199 NOTICES SERVED. Informal (a) Verbal 81 (b) Written 261 18 Statutory, (a) Housing Acts - (b) Public Health Acts 2 NOTICES COMPLIED WITH. Informal (a) Verbal (b) Writte 402 Statutory, (a) Housing Acts - (b) Public Health Acts 2 7. SHOPS. Regular inspections are made with regard to the provisions of the Shops Act, 1950 which are concerned with sanitary accommodations, washing facilities, heating, lighting and ventilation. 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. A total of 456 inspections were made during the year and 46 notices were served; seven of these referred to sanitary arrangements as defined in Section 38. The remainder were in respect of the exhibition of notices and the sale from mixed shops of groceries, etc. on the early closing day or on Sunday. 8. FACTORIES ACT.937. 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 Secs.l,2,3,4 & 6 are enforced by the Corporation 80 122 4 - Factories not included above in which Sec.7 is enforced by Corpn. 282 281 18 - Other premises excluding outworkers 6 18 - - 19 2. CASES IN WHICH DEFECTS WERE FOUND. Particulars No. of cases in which defects found Found Remedied Referred No. of Prosecutions To H.M. Inspector By H.M. Inspector Want of cleanliness – – – – – Overcrowding – – – – – Unreasonable Temperature – – – – – Inadequate Ventilation – – – – – Ineffective drainage of floors – – 1 – – Sanitary Conveniences - (a) Insufficient 1 1 – 1 – (b) Unsuitable or defective 11 11 – 6 – (c) No ventilated space or lobby 2 2 – – – (d) Lighting (absence of) 4 4 – 1 – Others 4 4 1 – – PART VIII OF THE ACT. Outwork Nature of Work No. of Outworkers Wearing Apparel Making etc. 15 Brass & Brass Articles 33 Fuses 4 Lampshades 1 52 9. CAMPING SITES. There are no camping sites within the Borough and no licences to station caravans in accordance with Section 269 of the Public Health Act, 1936 were issued during the year. 10. ATMOSPHERIC POLLUTION. The serious consequences of the "smog' which blanketed the Greater London Area in December of 1952 have focussed attention upon the need for early and positive action to reduce the incidence of atmospheric pollution. The Interim Report of the Committee on Air Pollution outlines the problem in a very concise way and makes recommendations for remedial action. 20 During the year twenty-five complaints were received with regard to smoke or grit emission and thirty-five observations were taken. A total of 111 visits were made to premises with boiler installations situated in industrial or institutional premises.. At one factory, work was completed on the replacement of obsolete boilers and a new chimney-stack which incorporates a grit arrester has been constructed. Nuisance has been experienced over a long period by the emission of grit from a laundry chimney. The Management finally decided to convert the boiler from coal to oil firing and this work was in progress at the end of the year. It is hoped that the change will remove cause for complaint from occupiers of dwellings nearby. With regard to the Institution, after representations made by the Department, it is understood that contracts have been placed for the replacement of certain obsolete equipment, and that work will be started early in 1954. In the matters referred to above concerning industrial premises, much assistance was received from the staff of the Ministry of Fuel and Power. By this means it is possible to obtain expert second opinions from Officers of the Ministry who, like ourselves, have no interest in the matter other than to ensure that fuel is used efficiently. Heretofore the only other professional opinion which appeared to be available to the Sanitary Inspector was that obtained from persons engaged by the owners of the plant, or representatives of firms who desired to sell their own particular types of equipment. It is, therefore, very pleasing to be able to record our appreciation for the co-operation and assistance which has been given by the Officers of the Ministry of Fuel and Power. There would appear to be no doubt that there is progressive improvement in the industrial boiler installations and their operation, with a consequent reduction im the emission of smoke and grit from these sources. It is important, however, to bear in mind that similar improvement is both desirable and necessary in the domestic field - the source of approximately sixty per cent. of the atmospheric pollution which takes place. With regard to the recording of atmospheric pollution in Kingston, 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. 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. 21 CANBURY GARDENS – Station 'A'. 1953 Deposit in Tons per sq,mile Wind Direction Rainfall Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times SE - SW January 8.74 3.49 12.23 93 42 0.96 February 10.97 4.47 15.44 84 28 1.15 March 11.89 6.03 17.92 93 24 0.54 April 15.00 10.23 25.23 90 17 1.97 May 13.04 5.42 18.46 93 23 1.31 June 5.93 4.71 10.61 90 22 1.51 July 14.80 5.76 20.56 93 50 4.44 August 6.50 3.59 10.09 93 9 1.28 September 20.32 5.89 26.21 90 37 2.52 October 14.97 7.60 22.57 93 32 3.67 November 7.62 5.62 13.24 90 56 0.34 December 13.98 4.40 18.38 93 42 0.57 Totals 143.76 67.21 210.97 – – 20.26 Average 1953 11.98 5.60 17.58 1.69 Average 1952 12.91 6.21 19.12 2.222 1953 Deposit in Tons per sa. mile Wind Direction Rainfall in Inches. Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times SE - SW January l 3.25 3.95 7.20 93 42 0.90 February 5.34 8.76 14.10 84 28 1.03 March 6.84 5.71 12.55 93 24 0.55 April 5.74 5.24 10.98 90 17 1.84 May 5.58 6.71 12.29 93 23 1.18 June 3.49 6.37 9.86 90 22 1.45 July 4.58 4.98 9.56 93 50 3.85 August 3.55 31.2 6.67 93 9 1.33 September 4.91 6.01 10.92 90 37 2.33 October 4.91 9.00 13.91 93 32 3.48 November 1.86 3.92 5.78 90 56 0.34 December 5.01 5.08 10.09 93 42 0.56 Totals 55.06 68.85 123.91 18.84 Average 1953 4.59 5.73 10.32 1.57 Average 1952 5.80 6.61 12.49 2.16 22 CEMETERY - Station 'C' . 1953 Deposit in Tons per sq .mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of observations No. of times WNW - NNW January 3.45 3.55 7.0 93 24 0.92 February 6.56 4.97 11.53 84 17 1.13 March 6.63 4.61 11.24 93 5 0.45 April 6.26 6.53 12.79 90 10 1.80 May 7.36 6.26 13.62 93 5 1.15 June 3.74 6.00 9.74 90 21 1.36 July 4.54 6.86 11.40 93 6 3.79 August 3.48 3.82 7.30 93 16 1.23 September 4.67 5 .10 9.77 90 16 2.46 October 4.71 7.52 12.23 93 14 3.63 November 1.59 2.85 4.44 90 6 0.35 December 4.24 4.11 8.35 93 9 0.59 Totals 57.23 62.18 119.41 18.86 Average 1953 4.77 5.18 9.95 1.57 Average 1952 6.33 6.51 12.84 2.05 First Quarter Station A Station 6 Station C 1953 1953 1953 ¼ Total Cumulative ¼ Total Cumulative ¼ Total Cumulative 45.59 45.49 33.85 33.85 29.77 29.77 Second Quarter 54.33 99.92 33.13 66.98 36.15 65.92 Third Quarter 56.86 156.78 27.15 94.13 28.47 94.39 Fourth Quarter 54.19 210.97 29.78 123.91 25.02 119. 41 General Total Deposit Station A, Station B, Station C. 210.97 123.91 119.41 Average monthly Deposit 17.58 10.32 9.95 Total Rainfall 20.26 18.84 18.86 Average Rainfall 1.69 1.57 1.57 23 11. SWIMMING BATHS AM) POOLS. (a) Public - The Corporation swimming "baths are situate in Denmark Road and comprise two pools, one of which is in use throughout the year, whilst the other is used for swimming during the summer months and in the winter season is converted for use as a hall for concerts, dancing, etc. The pools are equipped with pressure filters capable of treating the water of both pools every 3½ hours during bathing periods. In hot weather the filters are working continuously day and night. Chlorination is marginal and the residual quantity is maintained at the deep end of the baths with a maximum of 0.6 parts per million available chlorine. (b) Private - There are no privately owned swimming baths or pools open to the public in the Borough. 12. ERADICATION OF BSD BUGS. During the year 27 premises were disinfested. Of these premises nine were properties under the control of the Corporation. Although the number of premises treated was greater than in the previous year, the figure is well below the average for the years since 1939. 13. COMPLAINTS . The number of complaints received during the year from the general public was 625 compared with 503 for the previous year. The highest number of complaints was 920 in 1947. The numbers until this year have been declining steadily. The following is a brief tabulated list of causes for complaints received during 19532:– Sanitary Defects 161 Rodents 174 Defective Ashbins 6 Drains and Sanitary Arrangements 154 Overcrowding 3 FOOd 21 Nuisance from Smoke 25 Various offensive odours 20 Insect Pests 29 Accumulations24 Water supply 8 625 14. RODENT AND INSECT PEST CONTROL. During 1953 no legal action under the provisions of the Prevention of Damage by Pests Act, 1949 was required. There was a slight increase in the number of complaints received and it is probable that the public are becoming better informed of the service the Corporation offers. Over 3000 poison baits were laid, and no complaints of injury to other animals were received. That none of these baits caused harm to anything but rats and mice is a cause for some satisfaction. 24 The close co-operation with the officers of the Ministry of Agriculture and Fisheries continues and on a number of occasions premises in Kingston have been used for joint research and experiment. It may "be of interest to review the causes for complaints which are made concerning rodents. Each year a number of infestations are traced to defects in drainage systems and occasionally in sewers. During this year ten such instances were recorded,, The more common causes, however,, are the badly constructed poultry houses which are not rat proof, and the indiscriminate feeding of wild birds, particularly where more food is put out than the birds can possibly consume. Shelter is also afforded to rodents by accumulations of junk and rubbish and householders in a closely built up town like Kingston should make every effort to keep gardens and yards clear of materials that provide harbourage to rats. Rodent Control - Statistical Statement, 1953. Private Dwellings and Corporation Property. Rats. Mice. Total. No. of complaints received in office 118 24 142 " " premises inspected as a result 413 " " " found to be infested 230 46 276 " " separate infestations treated 241 40 281 " " visits for treatment & reinspectioms 1079 115 1194 " " premises treated by occupier or other agency 1 35 36 " " premises inspected on routine survey approx. 200 " " poison baits deposited 932 Business and Factory Premises. No. of complaints received in office 16 16 32 " " premises inspected including those under Service Agreement 177 " " " in which slight infestations were found 39 101 140 " " visits for treatment and reinspections 1428 1782 3210 " " premises treated by occupier or other agency 8 " " poison baits deposited 2137 Sewerage System. No. of foul water manholes in the system 810 " " " " baited 178 No. in which bait was taken by rate 63 Summary. No. of complaints received 174 " premises inspected 790 " " infested4l6 " " Visits 4604 " premises treated by occupier or other agency 44 " poison baits deposited 3132 25 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, cocoamoth and carpetbeetle, to name only a few. Not many complaints are now received concerning insects which were once common pests, namely, bugs, fleas and lice; with regard to other insect pests, the Department is often called upon, and is ready to give advice on the means of dealing with them. 15. RAG FLOCK ACT. 1951. There are in the Borough three premises registered under the provisions of the Act for upholstering or bedding manufacture. No samples of material were taken during 1953. SECTION D HOUSING The introduction by the Government of the Housing Repairs and Rents Bill stimulated interest and discussion on the subject of housing and slum clearance, and its final passing into law is now awaited. Action taken during the year under the provisions of the Housing Act, 1936 was as follows:- Nos. 62 & 64, Cowleaze Road - Demolished under Order made in 1952. No- 4, Barnyard Cottages - Undertaking accepted that premises would not again be let for human habitation. No. 38, Tudor Road - Closing Order made on basement rooms. No. 1, Hawks Passage - Demolition Order made. Housing - Statistical Statement. 1953. The following information, supplied by the Borough Surveyor, indicates that eight houses and thirty-six flats were built by the Corporation during the year. No. of dwellings erected by private enterprise during 1953. 25. 26 Total number of permanent dwellings erected by the Corporation since March 1924 to 31st December. 1953. Houses 1,081 (Inc.820 outside Borough) Plats 732 (Inc.221 outside Borough) Total number of temporary dwellings erected up to 31st December. 1953. Arc on 132 Aluminium 79 2 year huts 126 328 Number of 2 year huts demolished during 195 3 - 13 SECTION E INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. 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 1953, under the provisions of the Milk (Special Designations) Regulations. All the licences were in force at the end of the year. To Pasteurise Pasteurised Sterilised Tuberculin Tested. 1 – – To Deal 10 7 5 Supplementary 10 7 8 27 (c) Bacteriological Examination of Milk, During the year, 112 samples of milk were sent to the Public Health Laboratory at Epsom for examination. The total of 112 was made up as follows:- Pasteurised 101 T.T. (Pasteurised) 5 Sterilised 6 The Pasteurised Milk was submitted for the phosphatase and methylene blue tests and the Sterilised Milk for the turbidity test. All samples passed the tests to which they were submitted. (d) 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 129. 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 143 samples submitted to the Public Health laboratory at Epsom during 1953. GRADE Ice Cream I II III IV Total 111 15 16 1 143 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 satisfactory. The figure of 88.11% 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, 1947. At that time only 64% of the samples were placed in these Grades. (e) Meat and Other Foods. (i) There are no licensed slaughter-houses in the Borough. The Ministry of Pood 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. Each year in this Report some reference has been made to the unsatisfactory manner in which meat is transported and handled. This year is no exception and with the prospect that 28 meat will "be freed from control in the not too distant future, nothing has been done with regard to the provision of more suitable vehicles. With regard to meat condemnation, during the first two weeks of August there occurred another instance of the appalling waste which, since the onset of rationing, has repeated itself practically every year in periods of hot weather. Very heavy deliveries of meat were made to the local Depot in these weeks, and the Sanitary Inspectors were employed for the whole of their time on inspecting and supervising the trimming of meat, both pork and beef. Although much overtime was worked, they were at times overwhelmed by the amount of meat to be inspected and arrangements were made for the Sanitary Inspectors of adjoining districts and the districts where meat manufacturers' premises were situate to inspect the meat after delivery. Of a total of 535,082 lbs. of meat which passed through the Kingston Meat Depot, 13,000 lbs. were condemned at Kingston, Wimbledon, Surbiton and at manufacturers' premises situate outside these districts, All the meat was home killed and it is a matter for some regret that the Scotch beef was some of the finest quality that has been seen at the Depot for some years. It is this meat which was in a decomposing condition on arrival. It is fitting to report that the efforts of the staff at the Depot and the Sanitary Inspectors, together with the splendid co-operation, patience and skill shown by the local butchers, were the means of saving a considerable amount of meat which would otherwise have been condemned. (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. With the exception of the instance referred to above, the quantities involved are small in comparison with the amount of food which is handled in the town. Tabulated List of Condemned Foodstuffs showing causes for Condemnation and the Weights Article of Food. Reason for Action. lbs. Weight. lbs. Raw Meat Ovine Decomposition 85½ Contamination 12¼ 97¾ Bovine Decomposition 4665¾ Disease 70½ Contamination 19 4755¼ Porcine Decomposition 806 Total weight Raw Meat 5659 Raw Fish Decomposition 532 Poultry, Game. etc„ Rabbits 296 Chicken 60 356 29 Article of Food Reason for Action lbs. Weight lbs. Canned Goods Meat & Meat Products Punctured, 2615¾ Fruit 1788 Jam Damaged, Blown, 345½ Vegetables 484½ Milk Decomposition, 182 Soup 36¼ Fish & Fish Paste 42¾ Others 137 5614¾ Dried Fruit Infestation 241¾ Food in Glass Containers - Glass contamination, mould, deterioration 106¾ Other foods condemned for various reasons - Cheese 8 Confectionery 738½ Sausages 32 Meats 17½ Nuts 450 Shell Eggs 4164 (Number) With regard to the disposal of this unsound food, condemned meat is coloured with dye and collected by firms who specialise in the extracting of fat and manufacture of feeding meals. The canned goods and other foodstuffs are transported to the refuse destructor of a nearby Authority and are incinerated. (f) Food Hygiene . The work of providing and maintaining a clean food supply is one of continuous endeavour. The problems before us remain the same, but only gradually can improvements be made. The stage has now been reached when the most important factor in food distribution and handling is the attitude of mind of the individual person. All who are employed in the food industry must realise the need for personal and general hygiene and be aware of the consequences of their actions. There is in the Borough a very good relationship between traders and the Public Health Department and this willing co-operation is much appreciated. There are, however, a few who do not realize the need for greater care in the handling of cooked meats and pies etc., enquiries revealed that in several shops no satisfactory code of practice was in being for such products. Instances can be quoted where even during hot weather, meat pies were being kept for periods of a week before being sold. All reputable manufacturers and retailers of course recommend that the pies be removed from sale at the end of the day after that of delivery. The care in handling of cooked meats cannot be too strongly emphasized. Such foods are eaten without further processing and should contamination take place, it cannot readily be detected or removed. 30 During the year, on a number of occasions, the attention of manufacturers and "bakers was drawn to the unsatisfactory condition of delivery vehicles. The Sanitary Inspectors spent much time during the year on education in food hygiene by constant visits to food premises and by advice and discussion with the management and employees. In accordance with the request of the Minister of Health the following is a tabulated statement of inspections made during the year to the various types of food premises. food Premises No. of Premises No. of Visits Bakehouse 8 64 Dairies & Milk Shops 12 124 Butchers 38 110 Greengrocers & Stalls 89 400 Publis houses 51 20 Fishmonger & Stalls 26 79 Ice Cream Premises 129 161 Grocers & General Provisions 130 193 Restaurants & Cafes 104 364 Meat Distribution Depot 1 227 Visits to Food Premises re Condemnation of Unsound Food 382 588 2124 FOOD AM) 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 five samples upon which an adverse report was received. A bread roll submitted for examination was found to contain a mouse droppings The Local Authority in whose area the roll was manufactured were informed and a warning letter was sent to the firm concerned,, The informal sample of ice cream was reported to contain 4% of fat; the amount prescribed by regulation is 5% A subsequent follow-up sample was taken and found to be genuine. The Analyst reported that the sample of table jelly failed to pass the setting teste This sample was taken from a children s home, It was subsequently ascertained that the jellies were part of a consignment which had been presented to the Home, probably because they did not comply with the Order, Whilst the jellies failed to pass the required test, they were, in fact, quite wholesome. Of the fifty-seven samples of milk submitted, an adverse report was received in only one Instance. This was an informal sample which was stated to contain 2%of added water. A subsequent follow-up sample, however, proved to be genuine. As the milk came from a fairly large dairy, situate outside the Borough it was thought that the matter justified further enquiry. a thorough investigation was carried out and tests made® it was ascertained that the adulteration took place in such circumstances as to affect a small quantity of milk only and was due to the action of an operative in charge of the neat treatment plant, Precautions have been taken to prevent a repetition of this occurrences 31 With regard to the sample of pork sausage, the Public Analyst reported that the meat content was 57% only and that in his opinion it was not of ordinary commercial quality, It was felt that a meat content of such a product should be 65%. The matter was taken up with the vendors„ a large multiple firnip who immediately withdrew the stocks from all branches. An assurance was also received from the importers by other traders in the town that a meat content for their product would be maintained at not less than 65%. Tabulated Statement of Samples submitted to the Public Analyst during 1953 Commodity No. of Sampler Genuine Not Genuine or otherwise irregular. Formal Informal Formal Informal Formal Informal Almond , ground – 1 – 1 – – Bread Roll 1 – – – 1 – Butter 1 1 1 1 – – Cheese - Danish Blue – 1 – 1 – – Coconut – Desiccated – 1 – 1 – – Coffee – pure – 1 – 1 – – Cream – Synthetic – 1 – 1 – – Dripping – Beef – 1 – 1 – – Ice Cream – 18 – 17 – 1 Jam 1 3 1 3 – – Jelly – 2 – 1 – 1 Jelly Crystals – 1 – 1 – – Lemonade Powder – 1 – 1 – – (Sweetened) – 1 – 1 – – Lollies – 2 – 2 – – Margarine – 1 – 1 – – Marmalade 1 – 1 – – – Marzipan – 1 – 1 – – Mincemeat 1 – 1 – – – Milk 4 53 4 52 – 1 Milk (Channel Islands) 2 9 2 9 – – Pepper – 1 – 1 – – Peel – cut mixed – 1 – 1 – – Beef Sausages 2 2 2 2 – – " " (Preserved) 1 – 1 – – – Pork Sausages 2 2 1 2 1 – " " (Preserved) 3 – 3 – – – " Sausagemeat 1 – 1 – – – Spice – mixed – 1 – 1 – – Vinegar – 2 – 2 – – Wine – non-alcoholic – 1 – 1 – – Total 20 109 18 106 2 3 MERCHANDISE MARKS ACTo 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. 3 2 SECTION F INFECTIOUS AND OTHER DISEASES The following infectious diseases are notifiable to the Medical Officer of Health of the Borough:- Scarlet Fever Whooplag Cough Diphtheria (including Membranous Croup) Measles (excluding Rubella) Acute Pneumonia (primary or influenzal) Meningococcal Infection 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 Chickenpox Malaria Cholera Plague Typhus Fever Relapsing Fever Tuberculosis Leprosy is notifiable by General Medical Practitioners direct to the Chief Medical Officer of the Ministry of Health In 1953 a total of 563 notifications of infectious disease was received compared with 510 in 19520 This increase is due to a rise in the number of notifications of measles and whooping cough. The following table gives an analysis of the cases into age groups. 33 NOTIFIABLE DISEASES DUEING 1953 TABLE V 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 2 15 _ 1 1 - - - 21 2 - - - - - - — - - - - - Nil. Diphtheria - - - - - - - - - — - - — =- - - - — - - - - — - 1 - 1 Enteric Fever includlag Para-typhoid - - - - - - - - - - - - — - - - - — - - - — - - - - Nil. Acute Poliomyelitis Paralytic - - - - 1 - - - 1 - - - 2 2 - — - - - - — - - - • - Nil. Nonparalytic - - - - - 1 1 1 - - - - 3 3 - — - - - - — - - - - - Nil. Acute Infective Encephalitis - - - - - - - — - - — — - - — — - - - - - - - - - Nil. Meningococcal Infection - — — - - - - — — - - — - — — — - - - - - - - - - - Nil. Puerperal Pyrexia - - - - - - - 10 64 6 - — 80 78 - - - - - - - - - - - - Nil. Ophthalmia Neonatorum - - - - — - - - — — — - — — - - — - - - - - - - - - Nil. Pneumonia - - - - - 2 - - - 3 7 4 16 2 - 1 - - — - — - 3 — 3 17 21 Erysipelas - — - - — - - - - — — — — — — - - - - - - - - - - - Nil. B. Dysenteria (Sonne). - 2 1 - - - — _ 4 1 1 - 9 — — — - - - - - - - - - — Nil. Measles - 16 38 44 44 144 7 5 — — - - 302 4 - 1 — - - — - - — - - - 1 Whooping Cough 4 9 19 16 24 52 2 - - - — — 126 3 - - — - - - - — - - - - Nil. Chickenpox - - - - — - — — - — — - — — - - — - - - - - - - - - Nil. Food Poisoning - 1 - - - - - - - 1 2 - 4 1 - - - - - - - - - - - - Nil. Totals 8 28 59 61 71 214 10 17 70 11 10 4 563 95 - 2 - - - - - - - - 4 17 23 3 4 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 Partyphoid) Diphtheria Ophthalmia Neonatorum 1924 143 - - 1 6 20 4 1925 213 4 - 3 7 25 5 1926 82 4 — 2 7 27 2 1927 87 9 Not notifiable - Not notifiable - - 1 3 65 3 1928 135 9 1 7 152 4 1929 74 5 - - 1 113 3 1930 78 9 - - 5 100 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 61 47 - - - 2 1 72 2 1939 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 - - - 1953 21 80 302 126 - 5 - — — Scarlet Fever. Twenty-one cases of mild scarlet fever were notified, fifteen of which were of school age. No deaths occurred and no "return" cases. Only two of the cases notified were removed to an infectious diseases hospital for treatment and the remainder were treated at home. Attention was drawn in the last report to the significant fact that each year shows a reduction in the proportion of cases of scarlet fever which have to be sent to hospital for treatment. 35 During 1953 only 10% of the patients were not treated at home as compared with 17% in 1952, 55% in 1951, 65% in 1950, and 73% in 1949. It is to be hoped that these figures indicate a continuation of the tendency for this disease to become diminished in its prevalence and severity during recent years. Diphtheria No cases of diphtheria were notified, for the sixth successive year. Intensive work was continued to immunise the school and pre-school population against diphtheria, and the table at the end of this report shows the stage reached by the 31st. December, 1953. It is intended to continue with a vigorous immunisation campaign to prevent any possible diminishing of public interest in this service, occasioned by six 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,, It will be seen that one death has been recorded from this cause although no cases occurred during the year. This is explained by the fact that a man aged 55 years died from heart failure, the primary cause of which was diphtheria which he contracted many years ago. Poliomyelitis. Five cases were notified during 1953. two being paralytic and three non-paralytic. All were treated in hospital. The two cases involving paralysis were in respect of a housewife (27 years) and a girl (4 years) and they were classified as "severe" and "moderate" respectively. Both patients made satisfactory recoveries, and it was ascertained that suitable arrangements were made for them to receive physiotherapy treatment,, as hospital out-patients, for resulting muscle weaknesses. The nonparalytic cases occurred in a girl (15 years) and two boys (5 and 11 years). The degree of severity of the girl's illness was "moderate", and of the boys' "slight". Each patient made a good recovery. All of these cases were actively investigated, and all necessary isolation, etc. precautions were taken. No connection could be discovered between any of them, and each occurred in a different month throughout the year. Acute Infective Encephalitis. No cases were recorded during 1953. Enteric Fever (Typhoid or Paratyphoid). No cases of typhoid or paratyphoid B were notified during 1953. This is the sixth successive year in which no cases of typhoid or paratyphoid fever were notified. Measles. There were 302 cases of measles notified during 1953 (compared with 280 in 1952, and 443 in 1951), of whom four only were removed to hospital. Generally speaking the illness was of a mild type with little by way of complications, and some increase as compared with last year was to be expected, owing to the characteristic two yearly rise and fall of the prevalence of this disease. The 5-10 year age groups contained the largest number of notifications (144) the majority of the remainder being spread over the 1 - 5 year age period (342) and only 16 at other ages. 36 Whooping Cough. There were 126 cases of whooping cough notified during 1953 as compared with 102 in 1952 and 222 in 1951. This is a debilitating infection occurring mostly in early childhood. Seventy-two 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. Immunisation against this disease 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. Ophthalmia Neonatorum. No cases were notified during 1953. This is the sixth successive year in which no cases of ophthalmia neonatorum have been notified. Puerperal Pyrexia. Eighty cases were notified during 1953. 78 of which occurred in patients in Kingston Hospital. An analysis is shown below, together with figures for the years 1949 1952 for purposes of comparison. Twenty-three of the cases were Kingston residents. Cases 1949 1950 1951 1952 1953 (a) Total notified 29 23 41 84 80 (b) Number included in (a) of (i) Kingston residents 4 8 14 23 15 (ii) Extra district residents 25 15 27 61 65 (c) Number included in (a) notified frcm Kingston Hospital 28 21 40 82 78 (d) Number included in (a) notified by private doctors 1 2 1 2 2 (e) Number of cases included in (d) removed to hospital other than those included in (c) - - - - - Pood Poisoning- A total offour cases of food poisoning was notified during 1953, compared with three cases in 1952. These were all mild isolated cases. The fullest investigations were made in each but it was not possible to prove that any particular foods had caused the illness. Faeces specimens were taken from each patient, and a salmonella organism was isolated in respect of one person only. All other specimens were found to be negative for pathogenic organisns. 37 Tuberculosis. Cases of tuberculosis are dealt with by the South West Metropolitan Regional Hospital Board, and by the Surrey County Conucil. Your Medical Officer and the Chest Physician and his staff work closely together and with the Surrey County Councilo 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 1943 to 1953 (inclusive) Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 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 1953 37 5 42 8 1 9 (Note - An analysis of the total notified cases during 1953 in age groups is shown on the following page). The ratio of non-notified cases to total deaths for 1953 and the preceding four years is as follows:- 1249 1950 1951 1952 1953 1: 11 1:6 1:3 1:2 1:5 NOTIFIED CASES OF. AND DEATHS FROM. TUBERCULOSIS IN 1953 TABLE VII 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. - - - 2 6 2 3 7 3 23 - - - - 2 1 - 2 - 5 F. - - 2 5 2 3 2 - - 14 - - - - - 2 - - 1 3 Total - - 2 7 8 5 5 7 3 37 - - - - 2 3 - 2 1 8 (b) Non-Respiratory M. - - — - 2 — 1 — - 3 - - - - - - — — - - F. - - - - 1 - - - 1 2 - - - - - - - - 1 1 Total - - - - 3 - 1 - 1 5 - - - - - - - - 1 - 3 8 39 Forty-two notifications of Tuberculosis were received during 1953, and thirty-seven of these were in respect of pulmonary cases. The total number of cases notified is lower than in any of the ten preceding years. This fact is especially encouraging when it is borne in mind that Kingston was visited for 1 month during 1953 by the Regional Hospital Board Mass Radiography Unite A total of 8251 persons were X-rayed, and 17 cases of active tuberculosis, 159 cases of inactive tuberculosis, and 34 cases for further Investigation were discovered. (These figures do not necessarily relate to Kingston residents only) During 1953 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. Tuberculosis is an infectious condition, and the treatment required to cure pulmonary tuberculosis involves a long period of rest. When infection comes to the bread-winner it is a very serious matter for the family and puts a great strain on 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, very often at home, for long periods, throwing a further strain on already limited resources. The Kingston and District Tuberculosis Care Conanittee was formed for the purpose of encouraging and assisting sufferers from tuberculosis towards recovery During 1953 129 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 £1048 was expended from the funds of the Committee on this work. 40 Scabies. At the end of 1952 the Corporation Cleansing Station was closed owing to the very few cases occurring and requiring attention. During 1953 arrangements existed for the home treatment of persons suffering from scabies. Pull instructions and a supply of treatment cream were given to each applicant referred by a General Practitioner, and this system has proved quite satisfactory for dealing with the minor infections occurring. INFESTATION BY HEAD LICE During 1953 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. It was not found necessary to take any statutory action for infestation by lice during the year. PREVENTION OF INFECTIOUS DISEASE The Table presented overleaf gives a comparative statement of diphtheria immunisation for the years 1951, 1952, and 1953, and is provided by Dr. W.H. Kinstrie, Assistant Medical Officer, Surrey County Council. Diphtheria immunisation is the responsibility of the Surrey County Council which is the Local Health Authority under the National Health Service Act 1946. The Act, however, enables County District Councils to act as agents of the Local Health Authority for imnunisation purposes, and by delegation the Council of the Royal Borough of Kingstonupon-Thames, through its Public Health Committee, undertakes the provision of this service within its boundaries. The work is done in the Surrey County Council Infant Welfare Clinics at Grange Road and Burton Road, and Dr. Kinstrie, who prior to the coming into force of the above Act was Deputy Medical Officer of Health to the Corporation, personally carries out the immunisation. This arrangement, made under the Surrey County Council general plan, continues to work most satisfactorily and the co-operation between the Corporation and County Council staffs concerned is of the highest order. 4 1 table: VIII diphtheria immunisation Year of Birth Children completely Immunised 1951 1952 1953 1953 - - 71 1952 — 38 370 1951 35 356 359 1950 376 418 384 1949 539 514 499 1948 484 475 515 1947 575 629 636 1946 571 585 540 1945 503 522 525 1944 461 477 463 1943 503 461 457 1942 407 401 386 1941 382 403 387 1940 397 377 375 1939 409 38 7 404 1938 343 345 1937 359 0-4 Age Group Total number completely Imnunised as at 31.12.1951 2009 percentage 1951 65.5 " as at 31.12.1952 1801 " 1952 62.1 " as at 31.12.1953 1683 " 1953 60.9 5-15 Age Group Total number completely Imnunised as at 31.12.1951 4335 percentage 1951 98.0 " as at 31.12.1952 4587 1952 97.5 as at 31.12.l953 4688 " 1953 97.7 Record of Work Done at Diphtheria Immunisation Clinics 1951 1952 1953 Total number of clinics held 96 94 93 number completely immunised 363 279 338 Number of Schick Tests 1494 1287 982 Number of Positive Schick Tests and Re-inoculations 82 61 27 Total attendances 3681 3241 3259 Average attendances 38 30 35