kin 29 Royal Borough of Kingston-upon-Thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1955 GUILDHALL, KINGSTON-UPON-THAMES. t JUNE, 1956 Royal Borough of Kingston-upon-Thames ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1955 GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1956 ANNUAL REPORT TABLE OF CONTENTS Preface Page Constitution of the Public Health Committee 1 Staff of the Public Health Department 1 SECTION A Statistics and Social Conditions (1) General Statistics 2 (2) Social Conditions 2. 3 (3) Extracts from Vital Statistics of the Year:- 3 (a) Lire Births 4 (b) Stillbirths 4 (c) Deaths 4 (1) Death Rate 4 (ii) Maternal Death Rate 4 (iii) Infant Death Rate - Quinquennial Infant Mortality Rate - Causes of Death of Children under one year 4, 5 (iv) Deaths from Other Causes 6 Introduction to Tables on Vital Statistics 6 Table I - Extracts from Vital Statistics for years 1951 - 1955 inclusive 7 Table II - Comparison of Vital Statistics 1926 - 1955 8 Table III - Causes of Death 9 SECTION B General Provisions of Health Services (1) (i) Laboratory Facilities 10 (ii) Hospitals?- (a) Infectious Diseases 10 (b) Smallpox 10 (c) Genera 10 (2) Health Services provided by other Authorities;- Surrey County Council Health Department 11 Surrey County Council Education Department 12 Surrey County Council Welfare Department 12 Surrey County Council Children's Department 13 Surrey Executive Council 13 (3) National Assistance Act, 1948 13 National Assistance (Amendment) Act, 1951 13 SECTION C Sanitary Circumstances (1) Water Supply 14 (2) Drainage and Sewerage 14 (3) Rivers and Streams 4 (4) Closet Accommodation 14 (5) Public Cleansing 4 (6) Sanitary Inspection of the Area 15 (7) ShOp 16 Page (3) Factories Act, 193716,17 (9) Camping Sites 17 (10) Atmospheric Pollution 18,l9,20,21 (11) Swimming Baths and Pools 21 (12) Eradication of Bed Bugs 21 (13) Cnmplainta, 21,22 (lin Rodent and Insect Pest Control. 22,23,24 (15) Rag Flock Act„ 1951 24 SECTION D Housing Genera 24,25,26 SECTION E Inspection and Supervision of Food (a) Milk Supply 26 (b) Designated Milks 26 (c) Bacteriological Examination of Milk 26,27 (d) Ice Cream 27 (e) Meat and Other Foods 27,28 (f) Food Hygiene 28,29 Pood and Drugs Act, 1938 39,30,31 Tabulated Statement of Samples Submitted to the Public Analyst during 1955 30,31 Merchandise Marks Act, 1926 31 SECTION F Infectious Diseases Notifiable Diseases 32 Table IV - Notifiable Diseases during 1955o 33 Table V - Comparative Statement of Notifications of Certain Infectious Diseases 34 Smallpox 35 Scarlet Fever 35 Diphtheria 35 Poliomyelitis 36 Acute Infective Encephalitis 37 Enteric Fever (Typhoid and Paratyphoid).. 37 Dysentery 37 Measles 37 Whooping 38 Ophthalmia Neonatorum 38 Puerperal Pyrexia 38 Food Poisoning 38 Tuberculosis 39 40 Table VI - Notified Gases and Deaths from Tuberculosis in 1955 41 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT,, 1955 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 1955. The Report is on a similar pattern to that for previous years and follows the general lines indicated by the Minister of Health. The information is given on essential matters affecting the public health and the Report is in accordance with Ministry of Health Circulars 17/55, 1/54 and 42/51. I am indebted to Mr. G.C. Smith, Senior Sanitary Inspectors, for joint authorship of the Report with special reference to Sections C - E and to Mr. M,E. Powell, Chief Clerk, for assistance in drafting and compiling. Population - The estimated mid 1955 home population given by the Registrar General is 39,070 estimated decrease of 90 persons compared with 1954. It is necessary to indicate that this figure relates to the resident population of the town and has been used for the calculation of the statistical data now presented,, The actual day population has been estimated to be about 300,0Q0 persons who come to the town for business, education and recreation purposes. This is a special feature of the town and influences its importance and the volume of work and responsibility of the Public Health Department, The level of resident population has remained remarkably constant during the past 30 years. At the 3 Censuses in 1921P 1931 and 1951 the respective populations were 39,514, 39,825 and 40,172. At the time of the latter census 68% of the population were in the age group 15-64 and 1395 were aged 65 or over. The percentage for the 65 and over group has increased. Infectious Disease - In general the health of the people has been very good. The number of infectious disease notifications received in 1955 was 307„ which is 262 lower than in 1954• This drop was mainly due to a considerable decrease in the incidence of measles and puerperal pyrexiae A reduction in the number of cases of scarlet fever is again recorded and there has been a further drop in the number of cases of whooping cough with the lowest figure since notification commenced in 1940. No case of diphtheria was notified and further progress was made in the active immunisation of the child population against this deadly and disabling disease, There was an increase in the number of cases of Poliomyelitis compared with previous years,, There was no undue incidence of influenza during the early months of 1955 but a close watch was maintained over the statistics so that any special action could be undertaken if necessary. Vaccination against Smallpox - This is voluntary and calculations show that "by the end of 1955 some 51%of the children "born between 1st July, 1954 and the 30th June, 1955 have been vaccinated. Births - The number of live births for 1955 is 543 and compares with 534 for 1954. The birth rate is 13.89 per l,OOO of population compared with 13,64 for 1954. Deaths - The number of deaths recorded in 1955 is 424 compared with 450 for 1954. This makes a death rate of 10.85 for 1955 compared with 11,49 for 1954. The excess of births over deaths was 119 compared with 84 for the previous year. The number of deaths of infants under 1 year of age in 1955 is 8 which gives an Infant Mortality rate per 1,000 live births of l4,73. It is clear, however, that one of these deaths must be considered preventable which would have left only 7 making an Infant Mortality rate of 12,80. The corresponding figures for 1954 were 11 infant deaths and an Infant Mortality rate of 20.60. The average rate for the previous five years (1950-54) is 24.4. There was 1 maternal deathp the first since 1951. Causes of Death - The main conditions causing death during 1955 were Heart Disease -120; Cancer - 89; and Vascular Lesions of the Nervous System - National attention has been drawn in recent years to the general increase in the number of deaths attributable to lung cancer and its possible association with cigarette smoking. The following table shows the releTant figures for the past five 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. 1951 1952 1953 1954 1955 M P M P M IP M F M P 8 2 10 1 1 13 1 2 16 2 24 4 Deaths from Total Tetal Total Total Total Cancer of the lung and bronchus 10 11 15 18 28 Cancer of all sites in the body is one of the main causes of death. There is still a reluctance , born of fear, to discuss this disease but there are now signs that dread is being replaced by a more open interest. It cannot be too strongly stressed that early treatment can stop the advance of malignant growths. Intensive research has as yet failed to produce a cure for every case or a method of prevention but the future prospects of sufferers who present themselves for medical advice and treatment in the early stages of the disease are good. Research workers have found that a very large proportion of persons suffering from cancer do not reveal the fact to a Doctor until the disease is so advanced that even the latest methods of surgical and radiation treatment cannot halt the growth. All persons who suspect that they may be suffering from cancer should go to their doctor immediately, voice their suspicions, and have the matter thoroughly investigated. . Housing - During 1955 the Corporation completed 5k Housing Units. These were 2-bedroom flats and all had to he constructed outside the Borough, The Borough is almost completely "built up and the work of dealing with obsolete houses is being proceeded with. It is of immediate urgency to clear the obsolete houses already scheduled, and which have been included in the 5 year programmee Many of these properties were unfit 20 years ago. The time has arrived for the demolition of those dwellings which are incapable, at reasonable cost; of being made fit® I gladly record my thanks for the support and encouragement to me in my work, to His Worship the Mayors Aldermen and Councillors,, I specially record ray appreciation of the understanding and help given by the Chairman of the Public Health Committee at all times to the Department. I also wish to acknowledge the hard work and loyal support of the staff of the Public Health Department, and the unfailing cooperation and advice of my fellow Chief Officers. I have the honour to be, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. 1 ROYAL BOROUGH OF KINGSTON-UPON-THAMES The Public Health Committee is responsible for the consideration of all questions affecting the health of the inhabitants of the Borough over which the Town Council mayhave jurisdiction. During the Municipal Year 1955-5& the Public Health Committee was constituted as follows: Alderman Oldfield (Chairman) Councillor Judge " Digby (Vice-Chairman) " Marshall Councillor Picton (Mayor) " Mitchell Alderman Lines (Ex-Mayor) " Parker M McDonald " Tapping " Kn owl den " Wells Councillor Guymer " Wood STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: JeWo STARKEYP MCB„, ChJBo (Edin.H DoP^ Senior Sanitary Inspector: G.C .SMITH, M.R.S.H., M.S.I.A. (a) (b) Additional Sanitary Inspectors: A. CLEGG, MoR.SeHe (a) (b) H.W. GILES, M.R.S.H„ (a) (b) LoA. PALMER, M0R0S0H0 (Resigned 31.12.55) (a) (b) S.W. SIMPS ON-SCOTT, M.R.S.H. (Appointed 1.11.55) (a) (b) Junior Sanitary Inspector: (vacant)™ Chief Clerks M.E. POWELL, D.P.A (Lond.) Clerical Staffs MISS C.L.FOISTER , MJ.P.S. MRS. B.M. HILL. (Resigned 30.4.55) MISS M.W. FILBEE. (Appointed 1.5.55) Go NORTHWOODc V.L. LERIGO. (Resigned 11.9.55) AeG. BELL. Assistant Rodent Officer: F.W. STAGG, Rodent Operatives: G. DEACON. G .H . LOCKE . Disinfector Drivers F .C .LOCK. (a) Certificate as Sanitary Inspector. (b) Certificate as Meat and Foods Inspector. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres 1,390 Total Population (including Service personnel) 39,070 Number of inhabited houses (approx,) 11,669 Rateable Value - General Rate £590,1?1 Sum represented by Penny Rate £ 2,410 The total number of hereditaments is 14,131 of which 80% are domestic dwellings providing 51% of the gross Rateable Value of the tore. The largest proportion of houses and flats fall within the £20-£30 Rateable Value group i..e. 41%., 31% have a Rateable Value less than £20, and 28% a Rateable Value above £30. There are 2.29k commercial premises in the town being 16# of the total hereditaments and providing 30% of the gross Rateable Value. The remaining premises totalling 533 are classified as industrial, entertainment, public utility, educational and miscellaneous. These provide 4# of the total and produce 19# of the total Rateable Value • Acknowledgment is due to Alderman McDonald, Chairman of the Finance Committee and Mr. A.R. Norris, F .I M .T .A. Borough Treasurer, for the above information which has been obtained from the Abstract of Accounts for the year ended 31st March 1955. 2. Social Conditions. The town of Kingston-upon-Thames is a compact commercial community bounded on the west by the River Thames, on the north by Richmond Park and adjacent at the south-west to Hampton Court Park with only the river intervening. Although not within the London postal region Kingston is in the Metropolitan Police Area, and together with the remainder of metropolitan Surrey can be considered to be a part of the outer London conurbation. The town is, however, geographically isolated from greater Loaded by an expansive green belt of park and common, through which the routes from the metropolis run. Kingston is the major market town for a considerable radius, and although the shopping centre provides the main economic function there is also an important industrial activity mainly in Aircraft and Engineering, Some 40,000 persons live in the Borough, many of whom travel daily to London for business purposes. An outstanding factor influencing the social conditions is the fact of full employment and Mr. P.R. Smithp the Manager of the local Employment Exchange has kindly provided the following information regarding employment in Kingston and the surrounding district.. "The employment position in this area is excellent and was so throughout 1955 At the commencement of the year 323en and 116 women were unemployed as compared with 503 men and 217 women at the corresponding time in 1954. In mid April, when unemployment reached its highest, 443 men and 122 women were registered as unemployed but 190 of these were temporarily stopped as an inanedlate result of the railway strike. From May onwards there was a gradual 3 reduction in the number of unemployed until at Christmas the registers were lower than at any time since the war, 196 men and 52 women being unemployed® The majority of those registered as unemployed were in process of changing their jobs but there was a hardcore of elderly people and some disabled persons who could not be placed in employment. Statistics relating to Kingston only are not available but it is probably true to say that approximately one-third of those on our Registers at any time are residents of Kingston, the remainder living in the adjoining Local Authority areas covered by this Employment Exchangee There was an unsatisfied demand for skilled labour of all types during the year, 5,208 men and 2,206 women were placed in employment in the Employment Exchange area during the year and at the end there were approximately 1,000 vacancies for men and 400 for women remaining unfilled, Ab in past years the greatest demand on available manpower has been from the aircraft, engineering and building industries• There are always vacancies for women in retail distribution, in offices and factories but the main demand is for domestic workers in private households and institutions," 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 rate for England and Wales as a whole (where the comparability factor is unity). The comparability factors for Kingston are Births O.95; Deaths 0.86. \ The birth and death rates in respect of the town are shown overlsaf and for the purpose of providing some cemparison the rates for England and Wales are also shown,. It will be notieed that the rates for Kingston-upon-Thames are lower than for the country as a whole • It is noticeable that the infant death rate and the stillbirth rate were very low in Kingston-upon-Thames during 1955. They are both in fact considerably lower than in previous years and are nearly half the national rate, A steady downward trend is hoped for in these rates each year but such a dramatic drop cannot be expected to be maintained in future years. It has to be borne in mind that although some infant deaths and stillbirths are preventable many are not, arising from abnormalities which cannot yet be rectified. METROPOLITAN BOROUGH OF WANDSWORTH WITH THE COMPLIMENTS OF THE MEDICAL OFFICER OF HEALTH MUNICIPAL BUILDINGS WANDSWORTH S.W. 18 VANDYKE 6464 4 (a) Live Births - Total Male Female Legitimate 491 253 238 Illegitimate 52 23 39 153 276 267 Birth Rate per 1,000 population (Crude Birth Rate) 13.9 Adjusted Birth Rate 13.2 England and Wale s Birth Rate 15.0 (b) Stillbirths - Total Male Female Legitimate 8 3 5 Illegitimate- - - 8 3 5 Rate per 1,000 total (live and stillbirths) 14.52 England and Wales Stillbirth Rate 23.1 (c) Deaths - Total Male Female 424 212 212 (i) Death Rate per 1,000 population (Crude Death Rate). 10.9 AdjUSted Deato. Rats 9.3 England and Wale s Death Rate 11.7 (ii) Maternal Death Rate (deaths caused by pregnancy, childbirth0 abortion). No. of Deaths Rate per 1,000 total (live and still)births 1 1.8 (lii) Infant Death Rate (deaths of all infants under one year of age). Total No. of Deaths Rate per 1,000 live births 8 14.7 England and Wales Rate 24.9 No. of Deaths Rate per 1,000 legitimate Legitimate Infants live births 7 14. 3 No. of Deaths Rate per 1,000 illegitimate Illegitimate Infants live births 1 19.2 All Infants under 4 weeks of age . Total No. of Deaths Rate per 1,000 live births 8 14.7 N.B. All the infant deaths occurred in babies under 4 weeks of age. 5 The approximate infant mortality rate for 1955 and the rates since 1950 are shown for purposes of comparison. 1950 1951 1952 1953 1954 1955 Kingst on-upon-Thame s 30 24 24 24 20 15 England and Wales 30 29 27 26 25 25 It will be seen from the following figures that since the war ended the Quinquennial Infant Mortality Rate was more than halved by 1950, and has since dropped even farther. The rate for Kingston-upon-Thames is the lowest ever recordedo Period 1921 - 1925 1926 - 1930 1931 - 1935 1936 - 1940 1941 - 1945 1946 - 1950 1951 - 1955 Infant Mortality Rata 69 56 46 52 25 21 The following are the numbers in age groups of Kingstonupen-Thames children who died during 1955 in the Boroagh before reaching the age of one year, together with the cause of deaths;- Age Total Deaths Prematurity Congenital Hear-Disease Aapbyxia due to preesure of face on pillow Aneaeephaly 0-24 hours 5 4 - - 1 24 hrs. - 1 mth. 3 - 2 1 - 1 mtho - 1 yr. - - - - - Totals 8 4 2 1 1 6 (iv) Deaths from Other Causes. No. of Deaths Deaths from Heart Disease 120 Deaths From Cancer 89 Deaths from Vascular Lesions of the Nervous System 71 Deaths from Circulatory Disease other than Heart 33 Deaths from Bronchitis 23 Deaths from Pneumonia 21 Deaths from Influenza 2 The following tables I, II, III, summarise certain vital statistics. Table I shows the figures for live births, stillbirths, and deaths for the years 1951 - 1955 inclusive. It is noted that the number of stillbirths is unusually low compared with previous years, and with England and Wales as a whole, and that there were fewer deaths than in any year since 1934. The figures in Table II are the Registrar General's estimates for successive years since 1926. 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 and England and Wales. The trend of the population figure is to remain at about 40,000. The causes of deaths shown in Table III are in accordance with the 36 headings based on the Abbreviated List of the International Statistical Classification of Diseases, Injuries and Causes of Death. 7 Extract from Vital Statistics for Years 1951 ° 1955 inclusive- TABLE I» 1951 1952 1953 1954 1955 Totar M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 535 281 254 531 233 248 564 290 274 498 246 252 491 253 238 Illegitimate 39 21 18 45 22 23 45 24 21 36 22 14 52 23 29 574 302 272 576 305 271 609 314 295 534 268 266 543 276 267 Birth rate (R.G.) per l,000 pop. 14.39 14.40 15.25 13.64 13.89 STILLBIRTHS Legitimate 11 5 6 17 4 13 18 12 6 13 4 9 8 3 5 Illegitimate 2 1 1 - - - 1 1 - 2 1 1 - - - 13 6 7 17 4 13 19 13 6 15 5 10 8 3 5 Rate per 1,000 (live and stillbirths) 22.16 28.63 30.25 29.14 14.52 DEATHS 556 277 279 499 254 245 465 240 225 450 206 244 424 212 212 Death rate (R.G.) per l,000 pop. 13.93 12.48 11.64 11.49 10.85 8 COMPARISON OF VITAL STATISTICS 1926 - 1955 TABLE II Year Estimated Population Live Births Birth Rata per 1,000 Population Deaths Death Rata par 1,000 Population Infantile Mortality Rate per 1,000 live births Kingston upon Thames England and Wales 1926 39479 619 15.5 466 11.7 74 70 1927 39330 517 13.1 486 12.4 37 69 1926 39330 560 14.2 475 12.1 69 65 1929 38760 556 14.3 517 13.4 56 74 1930 38760 553 14.3 423 11.0 43 60 1931 39052 489 12.6 493 12.8 57 66 1932 38250 450 11.8 480 12.5 60 65 1933 38690 470 12.2 464 12.0 59 64 1934 38270 470 12.3 422 11.0 45 59 1935 39030 510 13.0 482 12.3 57 57 1936 39880 573 14.4 502 12.6 52 59 1937 39850 539 13.5 540 13.6 52 58 1938 39790 528 13.2 468 11.8 43 53 1939 39970 533 13.3 450 11.4 28 50 1940 37430 519 13.9 659 17.6 55 55 1941 55970 520 14.5 525 14.6 57 59 1942 36090 551 15.3 491 13.6 63 49 1943 35900 637 17.8 500 13.9 48 49 1944 34780 578 16.6 474 13.6 48 46 1945 35760 593 16.6 505 14.l 43 46 1946 39670 794 20.0 460 11.6 29 43 1947 40780 870 21.3 495 12.1 22 41 1948 40780 722 17.7 455 11.2 23 34 1949 40660 729 17.9 500 12.3 20 32 1950 41950 619 14.8 492 11.7 30 30 1951 39920 574 14.4 556 13.9 24 29 1952 39990 576 14.4 499 12.5 24 27 1953 39940 609 15.3 465 11.6 24 26 1954 39160 534 13.6 450 11.5 20 25 1955 39070 543 13.9 424 10.9 15 25 9 TABLE III Causes of Death Registrar General's Tables 1951 1952 1953 1954 1955 M F M F M F M F M F All Causes 277 279 254 245 240 225 206 244 212 212 Tuberculosis, respiratory 7 5 7 2 5 3 — 3 6 — Tuberculosis, other — 1 — 2 — 1 1 — — — Syphilitic disease 2 2 1 2 — 1 — — 1 — Diphtheria — — — — 1 — — — — — Whooping Cough — — — — — — — — — — Meningococcal infections. — — — — — — — — — — Acute poliomyelitis — — — — — — — — — — Measles — 1 — — 1 — — — — — Other infective and parasitic diseases — 1 — 1 — 2 — 1 1 1 Malignant neoplasm, stomach 11 5 7 4 4 4 2 3 4 6 Malignant neoplasm, lung, bronchus 8 2 10 1 13 2 16 2 24 4 Malignant neoplasm, uterus — 1 — 2 — 3 — 1 — 3 Malignant neoplasm,breast — 10 — 7 — 10 — 6 — 5 Other malignant and lymphatic neoplasms 19 24 29 20 25 34 22 20 27 16 Leukaemia, aleukaemia 3 — 1 — 1 2 — 1 3 1 Diabetes 2 1 — 4 — 2 1 1 — 3 Vascular lesions of the nervous system 29 39 27 39 26 35 21 45 25 46 Coronary disease, angina. 46 25 29 31 43 18 34 28 44 22 Hypertension with heart disease 11 14 12 3 4 8 6 10 1 6 Other heart disease 36 41 28 37 16 31 18 34 12 35 Other circulatory disease 18 18 16 20 22 11 17 20 12 21 Influenza 2 9 2 3 4 7 1 1 — 2 Pneumonia 16 26 14 10 11 10 9 14 9 12 Bronchitis 24 5 29 19 16 15 15 9 17 6 Other diseases of atory system 3 3 5 1 4 4 — 7 — Ulcer of stomach and duodenum 7 6 3 1 6 — 3 1 3 — Gastritis, enteritis, and diarrhœa 1 — 1 — 2 2 — 3 1 3 Nephritis and nephrosis 1 2 3 4 5 — 4 2 1 — Hyperplasia of prostate. 4 — 2 — 8 — 5 — 2 — Pregnancy, childbirth, abortion — 1 — — — — — — — 1 Congenital malformations. 2 1 5 — 2 — 4 1 3 1 Other defined and illdefined diseases 14 27 15 22 14 18 16 21 8 10 Motor vehicle accidents 2 — 3 — 3 — 4 — 2 1 All other accidents 6 5 3 6 3 — 3 4 2 5 Suicide 3 3 2 4 1 2 1 5 4 2 Homicide and operations of war — 1 — — — — 1 1 — — SECTION B GENERAL PROVISIONS OF HEALTH SERVICES 1. (i) Laboratory Facilities. During 1955 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 Food and Drugs Acts are submitted to the Public Analyst Mr, D.D. Moir, at the Analytical Laboratory, Southwark Street, S.E.1 (ii) 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. During the year infectious disease cases were treated in hospital, but 68 of these were notified from Kingston Hospital in the first instance and related to puerperal pyrexiae To Kingston Hospital 69 Tolworth Isolation Hospital, Surfeiton 11 Claremont Hospital, Surbiton 2 Western Hospital, Fulham. 2 68 Notified from Hospital (b) Smallpox. Arrangements are in existence whereby any case of smallpox or suspected smallpox can be transported by the London County Council Ambulance Service to special isolation. (Telephone Whitehall 2177s Waterloo 3311). (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 busy and highly organised Out-Patient Departments fully supported to meet all surgical, medical, and psychological emergencies. 11 2. Heath Services provided by other Authorities. The Medical Officer of Health is the Divisional Medical Officer responsible for the personal health services administered by the Surrey County Council. Surrey County Council - Health Department., The County Council which is the Local Health Authority under the National Health Service Act, 1946, provides the following services in the Boroughs:- (a) Ante-natal and post-natal clinics. Health Centres, Grange Read. Wednesday, p.m (b) Infant welfare clinics. Health Centre, Grange Road. Tuesdays & Fridays p.m. St. Agatha's Church Hall, Dintion Road. Mondays & Thursdays, p.m. (c) Immunisation and Vaccination clinics. Health Centre, Grange Road. Dinton Road. Fridays, p.m. Tuesdays p.m. (d) Dental clinics. Health Centre, Grange Road. "Keeldar", 25, Queen's Road. Daily Daily by appointment. (e) Day Nursery. Approved accommodation 53-55, Canbury Park Road. 46 places This day nursery admits children aged 0-5 and a charge is made for the care of the children. (f) Midwifery Service. Certified midwives are employed for attendance as midwives or maternity nurses at domiciliary confinements. Gas and air analgesia is available. (g) Home Nursing. This is undertaken by nurses of the Queen's Institute of District Nursing. Where nursing equipment is required for use in the home, arrangements have been made for this to be supplied on loan through the British Red Gross Society at the B.R.C.S. H.Q., 73, Penrhyn Road, Kingstonupon-Thames (KIN .5072). (h) Health Visitors. Health Visitors who also act as School Nurses work in the' clinics and also do the home visiting. Their work is largely educational and social, and is defined in the Act as "giving advice as to the care of young children, persons suffering from illness, and expectant and nursing mothers, and as to the measures necessary to prevent the spread of infection." (1) Domestic Helps. Home helps are employed to provide domestic help for households "where such help is required owing to the presence of any person who is ill, lying-in, an expectant mother, mentally defective, aged, or a child not over compulsory school age." A charge is made for this service and in assessing this, regard is had to the means of the persons concerned. 12 (5) Prevention of Illiness, Care and After-care. The care and after-care of tuberculous persons is dealt with by the Care Almoner at the Chest Clinic, Queen's Road, Kingston-upon-Thames. Among other things, the Country Council scheme provides for the admission of persons, not in need of medical or nursing care, to recuperative holiday homes and for this a charge is made according to the person's circumstances, (k) Mental Health. This service provides for the ascertainment of cases of mental ill-health and mental deficiency, the statutory supervision and guardianship of mental defectives living in the community, and the provision of after-care for persons who have undergone treatment for mental illness. The office of the Mental Welfare (Duly Authorised) Officer for the Borough is at 35, Coombe Road, Kingston-upon-Thames (KIN.3302)„ Surrey County Council-Education Department. The School Health Service is staffed by the County Health Department and provides the following services:- (a) routine medical inspection of pupils (b) cleanliness surveys of pupils (c) dental inspection of pupils (&) ascertainment of handicapped pupils in need of special education (e) treatment clinics as under:- (i) Minor ailments. Health Centre & Dinton Road Clinic. Daily, 9-10 a.m. (ii) Medical consultation. Health Centre Mondays, a.m. Dinton Road Fridays, a.m. (iii) Eye Clinic. Health Centre Thursdays, from 10 a.m. by appointment (iv) Dental clinic Immunisation clinic ) (see under Health) (Deparment) (v) Child guidance clinic. Gases referred to Clinic held at "Roselands", Kingston Road, New Maiden. (vi) Speech therapy Health Centre-Mondays & Thursdays, by appointment. Surrey County Council-Welfare Department. This service is concerned with the welfare of aged, physically and mentally infirm, blind and partially sighted, deaf and dumb, epileptic and crippled persons and the provision of temporary accommodation for persons in urgent need thereof. The address of the Welfare Officer for the Borough is 35, Coombe Road, Kingston-upon-Thames, Telephone (KIN.4402). 13 Surrey County Council - Children,s Department, This Department deals with children taken into or committed to the care of the County Council, supervision of foster ehildren, adoption, child neglect, etc. The Children's Officer for the Borough works from County Hall, Penrhyn Road, Kingston-upon-Thames. Surrey Executive Council,, This body is responsible for the provision under the National Health Service Act of the general practitioner, dental (other than Local Health Authority provision for expectant and nursing mothers, young children), pharmaceutical and supplementary ophthalmic services. The headquarters of the Council is at 187, Ewell Road, Surbiton, Surrey. Telephone-Elmbridge 5723. 3. 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 1955. The problems associated with aged persons do not diminish, but fewer geriatric cases came to the notice of the Public Health Department during the year 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. The Superintendent of Kingston Hospital is assisted by a Geriatrician to whom General Practitioners are able to refer cases direct, where previously the intervention of the Medical Officer of Health, Divisional Welfare Officer, and etc., was sought. The present facilities for dealing with geriatric eases are improved. The problems of the provision of additional hospital beds, domiciliary help, an,d nursing remain® Full co-ordination is attempted between the Geriatrician and your Medical Officer of Health in his capacity of Divisional Medical Officer for the North Central Division of the Surrey County Council. 1 4 SECTION G. 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, but is not used as a domestic supply. all the houses in the town being provided with a main water supplyo 2. DRAINAGE AND SEWERAGE. The position regarding disposal of sewage remains the same as for 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 Boardo This arrangement is a temporary one pending completion of the Hogsmill Valley Joint Sewerage Board's works which is now in course of construction. 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 bactericlogical condition of the stream is very unsatisfactory. This ia due to lack of natural dilution for the sewage effluent carried in its flow. During the year in several instances it was found that sanitary fittings had been wrongly connected to the surface water sewer, and it was necessary for alterations to be made to the drainage systems so that the fittings could properly be connected to the sewer. These cases emphasize the need for due notice to be given to the Department of intention to connect sanitary fittings to drainage systems. 4. CLOSET ACCOMMODATION All closets in connection with dwelling houses in the Borough are on the water carriage system. 5. PUBLIC CLEANSING. The Borough Surveyor is responsible for the collection and disposal of house and trade refuse. Disposal is still carried out by tipping into a worked out gravel pit provided by the haulage contractor. The new loading bay has now been operating since 1st April, 1955, and the refuse from this Borough, Surbiton and Maiden is transferred to large capacity road vehicles and transported to the tip by the contractor. The refuse is now 15 weighed on a weighbridge and approximately 11,000 tons of refuse per annum is sent from this Borough. A small quantity of suitable trade refuse. together with road sweepings and scarified materials, 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 OP THE AREA. The following is a tabulated list of visits and inspections which totalled 8,547 as compared with 8,613 for 1954:- 1955. 1954. House inspections - defects. etc. 564 528 Drainage 441 560 Factories 261 268 Outworkers 7 18 Atmospheric Pollution 93 131 Dairies, milk shops, etc. 144 165 Food Premises 847 1,096 Restaurants and Cafes. 297 451 Infectious disease enquiries 139 131 Theatres and Cinemas 1 6 Verminous Premises 53 57 Rodent Control 159 75 Shops Act 467 421 Schools 38 16 Housing Act 132 173 Markets 342 330 Miscellaneous 1,094 1,104 5,079 5,530 Reinspections and works in progress 3,468 3,082 8,547 8,6l3 NOTICES SERVED. Informal. (a) Verbal 101 (b) Written 370 Statutory. (a) Housing Acts - (b) Public Health Acts 14 notices complied with. Informal. (a) Verbal 55 (b) Written Statutory. (a) Housing Acts - (b) Public Health Acts 5 1 6 7. SHOPS. There are 895 shops in the Borough and inspections are mad© 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 467 inspections were made during the year and 21 Notices wexe served; five 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 o n Sunday. 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 Secs.1,2,3,4 & 6 are enforced by the Corpcration 78 75 2 - Factories not included above in which Sec.7 is enforced by Corpn. 287 164 9 - Other premises excluding outworkers - 9 19 - - 2. CASES IN WHICH DEFECTS WERE POUND. Particulars No. of cases in which defects found Found Reme died Referred No. of Prosecutions TO H.M. Inspector By H.M. Inspector Want of cleanliness 1 2 - - - Over-crowding - - - - - Unreasonable Temperature - - - - - Inadequate Ventilation 1 - 1 - - Ineffective drainage of floors - - - - - Sanitary Conveniences - fa) Insufficient - - - - - (b) Unsuitable or defective 7 8 - 2 - (c) No ventilated space or lobby - - - - - (d) Lighting (absence of) - - - - - Others 3 3 1 3 - PART VIII OF THE ACT. Outwork. The following table gives details of work which is carried on in private dwelling houses. In all cases the conditions obtaining have been found to be satisfactory. Nature of Work No. of Outworkers. Wearing ApparelMaking etc. 5 Brass & Brass Articles 19 Stuffed Toys 1 Lampshades 3 Cardboard Boxes 2 30 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. 18 10. ATMOSPHERIC POLLUTION, Nineteen complaints were received with regard to smoke or grit emission and seven observations were taken,, A total of ninety-three visits were made to boiler installations situated in industrial or institutional premises. Changes which have taken place in the industrial field have all tended to further the improvement in atmospheric pollution from this source. During the year one of the foundries in the town which had been established for some time closed down, also production ceased at the Gas Works and one more industrial plant, as well as the boilers of the Corporation Baths, were changed over to oil firing. It is interesting to note the reduction in atmospheric pollution as recorded on the Corporation deposit gauges. The following is a table of the average deposit since the gauges were installed. Average Monthly Deposit« Total Solids - Tons per Sq0 Mile0 Year Station A. (Canbury Gdns.) Station B. (Tiffin's) Station C. (Cemetery) 1948 28.38 (7/12) - - 1949 20.41 - - 1950 22.17 14.98(6/12) 14.34(6/12) 1951 22.19 12.47 12.03 1952 19.12 12.49 12.84 1953 17.58 10.32 9.95 1954 18.70 10.21 10.00 1955 15.85 9.13(11/12) 10.15(10/12) Explanation of these figures is not a simple matter as many variable factors are involved, but the results may be considered in the light of the following information concerning the use in the Borough of fuels which have some effect upon the condition of the air we breaths. There are some twenty industrial plants in the town and of this number, eleven have been adapted to use either oil or creosote pitch fuel and it is understood that in the near future three more will be converted to oil firing. The reduction in the consumption of solid fuel brought about by these conversions amounts to some 10,000 tons per annum and taking into account the higher efficiency and the more effective control of combustion of oil fuel compared with solid fuel, there must be a considerable reduction in atmospheric pollution. Another factor which must have a marked bearing on the degree of pollution in part of the town is the closing of the Gas Works referred to above. Production ceased on the 31st March, 1955, and the saving in consumption of solid fuels amounts to some 11,200 tons in a full year. There can be no doubt that these premises were the largest single source of pollution at low level in the Borough. Prior to the closing of the Works, smoke and dust: given off at times when the retorts were emptied and recharged could be seen at distances up to a quarter of a mile from the retort house; this operation took place three times per hour throughout the day and night. Some nuisance was also caused by dust and grit being 19 blown by the wind from the stored fuel. Residents in nearby houses have noticed a remarkable improvement since the Works closed. It may be interesting to compare the quantities of fuel consumed by industrial premises with that consumed in the open grates of private houses. The consumption of coal in domestic premises in the town, based on registration and allocation, is in the region of 24,000 tons per annum. This is in addition to anthracite and coke used for domestic boilers. It will be apparent that much progress has been made in the industrial sphere and it is to be hoped that the supply of smokeless fuel and improved appliances will make possible a corresponding improvement in the domestic field. At the moment the main form of restraint is that imposed by the high cost of coal. No reference has been made to the Power Station which, during the winter months, consumed between 800 and 1,000 tons of coal and coke per twenty-four hours. These figures dwarf those in respect of the remainder of the town, but there is the saving grace that the fuel is burned to maximum efficiency, and the waste gases are discharged at a comparatively high level. 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. The figures are from observations made to show the effect when the prevailing wind was blowing from industrial works towards the recording; stations. CANBURY GARDENS- Station 'A'. 1955 Deposit in Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. Of times SE - SW January 18.89 8.06 26.95 93 38 2.30 February 12.46 4.47 16.93 84 12 l.33 March 11.34 3.62 14.96 93 21 0.93 April 8.46 3.62 12.08 90 27 0.64 May 12.09 5.99 18.08 93 73 3.57 June 11.08 7.01 18.09 90 74 2.58 July 7.72 4.37 12.09 93 65 0.47 August 12.93 5.18 18.11 93 77 0.78 September 8.26 3.89 12.15 90 15 1.88 October 8.09 4.88 12.97 93 29 2.51 November 9.30 4.40 13.70 90 7 0.77 December 8.57 5.49 14.06 93 23 2.22 Totals 129.19 60.98 190.17 - - 19.98 Average 1955 10.77 5.08 15.85 - - 1.66 Average 1954 12.29 6.41 18.70 - - 2.31 20 TIFFIN GIRLS' SCHOOL - Station 'B'. 1955 Deposit in Tons per simile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times SE - SW January Bottle broken by frost. 93 38 - February 5.24 4.42 9.66 84 12 1.07 March 5.01 4. 12 9.13 93 21 0.76 April 3.55 2.49 6.04 90 27 0.53 May 6.67 6.34 13.01 93 73 3.50 June 5.08 5.31 10.39 90 74 2.05 July 5.21 3.32 8.53 93 65 0.28 August 6.24 3.72 9.96 93 77 0.52 September 4.45 4.15 8.60 90 15 2.00 October 4.28 4.08 8.36 93 29 2.26 November 3.39 3.95 7.34 90 7 0.61 December 3.72 5.74 9.46 93 23 2.11 Totals 52.84 47.64 100.48 - - 15.69 *Average 1955 4.80 4.33 9.13 - - 1.43 Average 1954 4.63 5.58 10.21 - - 2.12 * Average 11/12ths. CEMETERY - Station 'C'. 1955 Deposit in Tons per aq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of tions No. of times WNW - UHW January Bottle broken by frosts 93 12 - February 84 21 - March 7.52 3.55 11.07 93 47 0.91 April 3.18 2.32 5.50 90 22 0.59 May 1.39 5.97 7.36 93 - 3.07 June 11.14 7.l6 18.30 90 - 2.30 July 5.17 6.16 11.33 93 - 0.28 August 8.72 7.62 16.34 93 - 0.92 September 3.55 5.10 8.65 90 21 1.79 October 4.11 3.31 7.42 93 19 2.56 November 3.98 3.21 7.l9 90 12 0.69 December 3.48 4.87 8.35 93 5 2.21 Totals 52.24 49.27 101.51 - - 15.32 Average 1955 5.22 4.93 10.15 - - 1.53 Average 1954 4.67 5.33 10.00 - - 2.29 Average 10/12ths. 21  Station A Station B Station C 1955 1955 1955 ¼ Total Cumulative ¼ Total Cumulative ¼ Total Cumulative First Quarter 58.84 58.84 18.79 18.79 11.07 11.07 Second Quarter 48.25 107.09 29.44 48.23 31.16 42.23 Third Quarter 42.35 149.44 27.09 75.32 36o32 78.55 Fourth Quarter 40.73 190.17 25.16 100.48 22.96 101.51 GENERAL. Station A Station B Station C Total Deposit 190.17 100.48 101.51 Average monthly deposit 15.85 9.l3* 10.15* Total Rainfall 19.98 15.69 15.32 Average Rainfall 1.66 1.43* 1.53* * Station 'B' - 11 readings Station 'C' - 10 readings Bottles broken by frost. 11. SWIMMING BATHS AND 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, dancings, 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 BED_BUGS. During the year 19 premises were disinfested. Of these premises 11 were properties under the control of the Corporation, The figures recorded are well below the average for the years since 1933. 13. COMPLAINTS. The number of complaints received from the general public during the year was 544 compared with 548 for the previous year. The highest number of complaints recorded was 920 in 1947 and, with the exception of the year 1953? the figures recorded have shown a steady decline. 22 The following is a brief tabulated list of causes for complaints received during 1955:- Sanitary Defects Rodents 182 Defective Ashbins 3 Drains and Sanitary Arrangements 97 Overcrowding 2 Food 23 Nuisance from Smoke 19 Defective Yards and Paving 6 Insect Pests 22 Accumulations 9 Water Supply 3 Others 34 544 14. RODENT AND INSECT PEST CONTROL. During 1955 no legal action was required under the provisions of the Prevention of Damage by Pests Act, 1949. This is in itself an indication of the co-operation received from householders and business people. As mentioned in previous reports, many rat infestations are traceable to defective drains, and, more rarely, to faults in sewers. During the year 30 defects of drainage systems were revealed during rodent control investigation (5 of which were on bomb sites) and of this number, 24 were found to be the cause of the infestation. During the year two maintenance treatments were carried out to the sewer system in the town. During the second treatment very heavy rainfall was experienced and it was not possible to assess accurately the number of instances where the poison bait was taken by the rats. It is for this reason that the figure recorded with regard to instances where bait was taken, in the statement below, is higher than that recorded last year. Rodent Control - Statistical Statements 1955. Private Dwellings and Corporation Property. Rats Mice Total No. of complaints received in office 134 25 159 „ „ premises Inspected as a result 405 „ „ „ found to be infested 203 44 247 „ „ separate infestations treated 183 26 209 „ „ visits for treatment and re- inspections 1,307 94 1,401 „ „ premises treated by occupier or other agency 25 26 51 „ „ „ inspected on routine survey approx. 90 „ „ poison baits deposited 404 23 Business and Factory Premises, Rats Mice Total No. of complaints received in office 17 6 23 „ „ premises inspected, including those under Service Agreement 207 „ „ premises in which slight infestations were found 23 134 157 „ „ visits for treatment and reinspections 1,004 1,742 2,746 „ „ premises treated by occupier or other agency 23 „ „ poison baits deposited 2,121 Sewerage System. No. of foul water manholes in system 810 „ „ „ „ „ baited 206 No. in which bait was taken by rats 108 Summary No. of complaints received 182 No. of premises inspected 612 No. of premises infested 404 No. of visits 4,147 No. of premises treated by occupier or other agency 74 No. of poison baits deposited 2,525 It is again necessary to emphasize the conditions which generally bring about infestation, namely the badly constructed poultry houses which are not rat proof, and the indiscriminate feeding of wild birds, particularly when more food is put out than the birds can possibly consume. Shelter is also afforded to rodents and other pests by accumulations of junk and rubbish, mush of which is not disposed of by normal refuse collecting and remains a constant potential harbourage. This is a problem that calls for much thought and action, if only on grounds of hygiene., Leptospirosis (Well's Disease): This disease affects man and is usually associated with rodent infestation as rats are known to infect streams and sewers. This organism enters the body usually through cuts and abrasions during immersion in the water. For this reason, upon receipt of notification that a Surrey County Council workman employed in the Hogsmill River was suffering from Weil's disease a thorough investigation was made of the banks of the stream in its course through the Borough. In the upper reaches a heavy infestation of river vole was found, but no evidence of rats. In the lower reaches, however, a fairly heavy infestation of rats was found and effectively dealt with. The body of one rat was submitted for pathological examination, but no evidence of the disease producing organism was found. Insect Pest Control. Insect peat 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. 24 Not many complaints are now received concerning insects which were once common pests, namely, bugS, fleas, and lice. A number of complaints are received with regard to insect pests in stored food products and those which cause damage to textiles. Quits a number of complaints have been dealt with and it is interesting to note that the new insecticides which are now being developed have proved very satisfactory in dealing with these insects. With regard to cockroaches, use is being made of insecticidal lacquers, and where treatments have been carried out with this material the results have been encouraging. 15. RAG FLOCK ACT, 1951. There are in the Borough four premises registered under the provisions of the Act for upholstering or bedding manufacture. No samples of material were taken during 1955. SECTION D HOUSING 1955 was the first full year of the operation of the Housing Repairs and Rents Act, 1954. In accordance with the provisions of Section 1 of the Act, proposals were submitted to the Ministry of Housing and Local Government in respect of unfit houses in the Borough. The Ministry approved the Corporation's proposals to demolish within 5 years 96 unfit houses within the Borough. Of this figure 16 properties are already owned by the Corporation. In addition to the houses referred to above, it is also intended to demolish all the 88 curved asbestos huts which were occupied at the end of the year. With regard to the other provisions of the Act aimed at arresting the decay of the older types of rent controlled property, it can only be said that in this respect the Act has failed. The small increase in rent which is permitted is not commensurate with the cost involved in putting the houses into good repair. Therefore it is only in the case of the better class property in fairly good repair that rent increases have been claimed. The net result of the operation of the Act in its present form, is to make good houses better and the poorer properties which it was designed to gave, worse. During the year thirty-eight applications were made for Certificates of Disrepair and thirty-one Certificates were granted. Works were carried out at twenty-six houses and the Certificates of Disrepair were revoked. The number of Certificates issued in the previous year was fifty-four and these applications related to the four months period during which the Act was in force. The small number asked for in the year is an indication of, failing interest. The action taken during the year under the provisions of the Housing Act was as follows:- 25 No. 74, Cambridge Road - Closing Order made in respect of front and rear basement rooms. No. 14, Mill Place - Closing Order made. No. 21, Park Road - Closing Order made in respect of front and two rear basement rooms. Housing - Statistical Statement, 1955. The following information is supplied by the Borough Surveyor who indicates that 54 flats were built by the Corporation during the year - all outside the Borough. Total number of permanent dwellings erected by the Corporation since March 1924 to 31st December. 1955. Houses 1,137 (Inc.876 outside Borough) Plata 786 (Inc.275 outside Borough) Total number of temporary dwellings erected up to 31st December, 1955. Arcon 132 Aluminium 70 2 year huts 113 315 Number of 2 year huts demolished during 1955 - 19 Number of dwellings erected by private enterprise during 1955. Houses 5 Plats 4 9 In accordance with Ministry of Health Circular 28/54 the following information in tabular form as required by Article 31 of the Housing (Consolidated) Regulations is included. (l) Number of houses inspected and recorded 104 (2) Number of houses which, on inspections, were considered to be unfit for human habitation 1 (a) Parts of houses which, on inspections, were considered to be unfit for human habitation 2 (3) Number of houses, the defects in which were remedied in consequence of Informal action, by the Local Authority or its officers 259 (4) Number of representations made to the Local Authority with a view to:- (a) The serving of notices requiring the execution of works - (b) The making of demolition or closing orders - 26 (5) Number of formal notices served requiring the execution of works - (6) Number of houses which were rendered fit after the service of formal notices - (7) Number of demolition or closing orders made 3 (8) Number of houses in respect of which an undertaking was accepted under subsection 3 of section 11 of the Housing Act, 1936 - (9) Number of houses demolished - 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 throughout the year. 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 1955, under the provisions of the Milk (Special Designations) Regulations. All the licences were in force at the end of the year. Pasteurised Sterilised Tuberculin Tested To Pasteurise 1 - - To Deal 11 11 6 Supplementary 10 7 10 (c) Bacteriological Examination of Milk. During the year 107 samples of milk were sent to the Public Health Laboratory at Epsom for examination The total of 107 was made up as follows:- Pasteurised 100 (T.T.)Pasteurised 2 Sterilised 3 T.T. Raw Milk 2 27 The Pasteurised Milk was submitted for the phosphatase and methylene blue tests, which are respectively tests of adequate pasteurisation and satisfactory bacteriological condition; the Sterilised Milk for the turbidity test. All samples passed the test for 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 134. This figure includes six producers. In addition to these dealers and producers there are 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. More than ever the production of ice cream is being confined to the few large manufacturers. The following table shows the results of examinations in respect of 72 samples submitted to the Public Health Laboratory at Epsom during 1955. Owing to the numerous factors governing the hygienic quality of ice cream undue attention is not paid to the bacteriological results on any single sample. However, whilst Grades I and II can be considered to be satisfactory, Grades III and IV are not, and appropriate action is taken in respect of any vendor whose samples do not fall consistently into Grades I or II : GRADE I II III IV Total Ice Cream 41 12 15 4 72 In addition to the above, 5 iced lollies were submitted for bacteriological examination and all were placed in Grade I. (e) Meat and Other Foods. (i) There are no slaughter houses in the Borough. The supply of meat for the town arrives from Smithfield and through the local wholesale shops. A certain amount of home killed meat also comes from the modern abattoir at Guildford. (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 quantities involved are small in comparison with the amount of food which is handled in the town. The list is very much condensed to avoid unnecessary detail. Tabulated List of Condemned Foodstuffs showing causes for Condemnation and the Weights. Article of Food. Reason for Action. Weight. Raw Meat lbs. lbs. Ovine Decomposition 217 Disease 60 277 Bovine Decomposition 1,191½ Disease 40 1,231½ Porcine Decomposition 57 Disease 7½ 64½ Total quantity of raw meat 1,573 28 Article of Food. Reason for Action. Weight. lbS. lbS. Raw Fish Decomposition 416½ Poultry, Game, etc. Chicken Decomposition 36 Canned Goods Meat & Meat Products Punctured, 1,775¼ Fruit 557@ Jam 76 Vegetables Damaged, Blown, 395¾ Milk 68¾ Soup Decomposition. 80 Fish and Fish Paste 21 Others 13¾ 2,987¾ Dried Fruit Infestation 439 Food in Glass Containers Glass contaminations, 44¾ mould, deterioration. Other Food Condemned for Various Reasons- Cereals 9 Meat (Cooked) 160 Nuts 966 Cheese 149 Lard 2½ Jellies 2½ Pepper 1½ Pea Flour 1¼ Dehydrated Potatoes 257 1,548¾ Shell Eggs 1164 (number) Unsound food is disposed of by incineration in the refuse destructor of a nearby Authority. (f) Food Hygiene. One can only repeat what has been said before, namely that the work of providing and maintaining a clean food supply is one of continuous endeavour. The problem before us remains the same, but only gradually can improvement 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 cooperation is much appreciated. During the year much work was done on maintenance and improvement of food premises, both with regard to structural repairs, the cleansing and painting of food rooms and shops and provision of modern equipment. The Sanitary Inspectors spent much time on education in food hygiene by visits to food premises and by advice and discussion with the management and employees - an essential duty in view of the constant and frequent changes which take place in the staffs. 29 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 Visits Bakehouses 4 41 Dairies and Milk Shops 16 18 Butchers 45 103 Greengrocers & stalls 52 431 Public Houses 52 23 Fishmongers & stalls 21 63 Ice Cream Premises 134 59 Grocers & General Provisions 133 215 Restaurants & Cafes 91 275 Kitchens & Canteens (Factory, School & Shop) 31 Public Houses (not included in the figure above but at which restaurant service is provided) 12 22 Meat Distribution Depots 4 12 Visits to Food Premises re Condemnation of unsound food 164 595 1,426 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 samples which were the subject of adverse comment. The Public Analyst, in commenting on two samples of Complete Cake Mix, stated that in his opinion the labels were misleading as the illustrations on the boxes depicted iced cakes and the packets did not contain any icing materials. The Analyst's views were conveyed to the firms concerned. Another sample of cake mixture was found to be infested with moth. The stock from which the sample was obtained was surrendered for destruction. Two informal samples of milk were found to be defective in fat to the extent of 25% and 9% respectively. The milk was the product of a nearby farm and the method of milking and despatch was such that it was possible to trace the origin to certain cows in the herd which were yielding milk of low fat content. After these animals had been removed, subsequent samples were found to be of excellent quality. The contents of a tin of smoked herring spread were found to be contaminated with tin and iron to such an extent as to affect adversely the taste of the article. This contamination took place as the result of failure of the lacquer. The sample was obviously old stock. It was not possible, however, to trace the remainder of the stock as it had already been disposed of. A sample of smoked sliced sea salmon of German origin was considered by the Analyst to be labelled in such a manner as to be misleading. The fish was, in fact, smoked saithe. In addition the processing and packing was such that the product readily decomposed. As the result of representations made, the importing of this article was discontinued. 30 Tabulated Statement of Samples submitted to the Public Analyst during 1955. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal Baking Powder — 1 — 1 — — Butter — 2 — 2 — — Butter Brazils — 1 — 1 — — Butter Brazil Tit—Bits — 1 — 1 — — Butterscotch Spangles — 1 — 1 — — Cake Mixture — 5 — 2 — 3 Candy Buttons — 1 — 1 — — Caramel Bars — 1 — 1 — — Chicken Paste — 1 — 1 — — Chicken Vol-au-Vent — 1 — 1 — — Chocolado — 1 — 1 — — Chocolate — 1 — 1 — — Chutney — 1 — 1 — — Coffee & Chicory Essence — 1 — 1 — — Cocoa — 1 — 1 — — Cornflour — 1 — 1 — — Crabmeat — 1 — 1 — — Crab Paste — 1 — 1 — — Cream — 5 — 5 — — Creamy Whirls — 1 — 1 — — Curry Powder — 1 — 1 — — Dressed Crab — 2 — 2 — — Essence of Rennet — 1 — 1 — — Gee Whiz — 1 — 1 — — Gob Stopper — 1 — 1 — — Ground Almonds — 1 — 1 — — Honey — 1 — 1 — — Jam — 2 — 2 — — Lemon Cheese — 1 — 1 — — Lemon Juice — 1 — 1 — — Liver & Bacon Paste — 1 — 1 — — Lucky Dip Kiddies Fountain — 1 — 1 — — Lucky Dip Sherbet Sucker — 1 — 1 — — Marmalade — 1 — 1 — — Milk — 59 — 57 — 2 Minced Beef Loaf — 1 — 1 — — Mint Sauce — 1 — 1 — — Mixed Fruit — 2 — 2 — — Non—Brewed Condiment — 1 — 1 — — Mustard — 1 — 1 — — Nipits — 1 — 1 — — Piccalilli — 1 — 1 — — Pickling Spice — 1 — 1 — — Pudding Mix — 1 — 1 — — Salad Dressing — 1 — 1 — — Salmon Spread — 1 — 1 — — Salmon & Shrimp Paste — 1 — 1 — — Sauce — 3 — 3 — — Sausages — 7 — 7 — — Scotch Broth — 1 — 1 — — Sherbet Sucker — 1 — 1 — — C/Fwd. — 129 — 124 — 5 31 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. — 129 — 124 — 5 Smoked Herring Spread — 1 — — — 1 Smoked Sliced Sea Salmon — 1 — — — 1 Spice — 1 — 1 — — Sponge Mixture — 1 — 1 — — Suet (beef), — 1 — 1 — — Sweet Crayons — 1 — 1 — — Tapioca Flakes — 1 — 1 — — Tea — 1 — 1 — — Tinned Tomatoes — 1 — 1 — — Tomato Ketchup — 3 — 3 — — Tomato Pulp (Concentrated ) — 1 — 1 — — Vinegar — 1 — 1 — Wine Tonic — 1 — 1 — — Total — 144 — 13 7 — 7 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. Prom time to time attention was drawn to infringements,, particularly in. respect of tomatoes and apples, but it was not considered necessary to take any legal enforcement action. 32 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 Acute Poliomyelitis - Paralytic " " - Non-paralytic Acute Encephalitis - Infective " " - Post Infectious Dysentery Ophthalmia Neonatorum Puerperal Pyrexia Smallpox Para-typhoid Fevers Enteric or Typhoid Fever (excluding Para-typhoid) 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 1955 a total of 307 notifications of infectious disease was received, compared with 569 in 1954. This considerable decrease is due mainly to a drop in the number of notifications of measles and puerperal pyrexia. The following table gives an analysis of the cases into age groups. 33 NOTIFIABLE DISEASES 1955 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 & ofer 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 & oyer Total Scarlet Fever. — — 1 1 — 9 — — — — — — 11 — — — — — — — — — — — — — — Diphtheria. — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever including Para-Typhoid — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Poliomyelitis; Para-typhoid — — — — — 1 1 —> 1 — 1 — 4 4 — — —c — — — — — — — — — — Non-paralytic — — 1 — — — 1 — — — — — 6 6 — — — — — — — — — — — — — Acute Infective Encphalitis — 1 — — — — — — — — — — 1 1 — — — — — — — — — — — — — Meningococcal Infection — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 8 50 14 — — 72 68 — — — — — — — — — — — — — Ophthalmia Neonatorum.. — — — — — — — — — — — — — — — — — — — — — — —— _——— _ — — Pneumonia — 1 — — — — — — 3 2 2 10 18 2 — — — — — — — — — — — — 21 Erysipelas — — — — — — — — — 1 — 1 2 1 — — — — — — — — 1 — — — — Dysentery — — 1 — 3 — — — — — 1 — 5 — — — —-— —- — — — — — ——— — — — measles 3 13 22 2 7 25 68 4 — — — 1 — 170 — — — — — — — — — — — — — — Whopping Cough 1 1 2 — 2 10 1 — — — — — 17 — — — — — — — — — — — — — — Chicken pox — — — — — — — — — — — — — — — — — — — — — — — — — — Food Poisoning — — — — — — — — — 1 — — — — — — —" — — — — — — — — — — Total 4 22 27 28 30 92 7 9 54 18 5 11 307 84 — — — — — — — — — — 1 20 21 34 The following table gives a comparative statement of notifications of certain infectious diseases received during the last thirty years:- TABLE V Year Scarlet Fever Puerperal Pyrexia Measles Whooping Cough Aoute Infective Encephalitis Poliomyelitis Enterio Fever (inelud¬ua= lag Par-typhoid) Diphtheria Ophthalmia Necnatarass 1 1926 82 4 Not notifiable Not notifiable – 2 7 27 2 1927 87 9 – 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 1k – 1 53 4 1932 56 13 – 2 1 47 – 1933 125 10 – 3 2 30 2 1934 40 5 – – 2 42 3 1935 5k 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. 5k 37 331 271 – 1 7 15 – 1942 79 2k 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 12 – 5 – – – 1954 16 96 419 21 – 15 – – – 1955 11 72 170 17 – 10 – – – 35 Smallpox There were no eases recorded in Kingston during 1955 This disease is still very prevalent in many parts of the world and one of the modem dangers is from smallpox being imported by air travellers who travel long distances in times much less than the incubation period. Particular surveillance is kept over persons arriving in the town from abroad when they have been notified to the department as having been contacts of cases or suspected cases, The majority of countries now Insist upon an International Certificate of Vaecination being produced before travellers are allowed to land. In this connection a large number of certificates issued by Kingston doctors are officially authenticated in the Public Health Department each year in accordance with regulations. Vaccination is voluntary and every effort is made to maintain a high level of immunity to smallpox in the population by vaccinating the infants daring their early months. This is carried out by General Practitioners and at the Surrey County Council clinics. Vaccination and 3.c vaccination is available free for person of all ages. Scarlet Fever. Attention has been drawn in previous reports to the fact that there is a steady decline each year in the number of cases of scarlet fever occurring* Only 11 jases were notified during 1955, 9 of which were of school age. All off the cases were mild and not one of them had to be removed to hospital for treatment. There were no deaths or "return cases'". The total of 11 is the lowest ever recorded and the annual average number of cases over the previous 5 years is 31, Diphtheria. For the eighth year in succession no cases of Diphtheria were notified in Kingston. An intensive campaign is carried out to immunise the school and preschool population against this disease and this is done under the control of the Medical Officer of Health at the surrey County Council clinics and by the General Medical Practitioners. Freedom from diphtheria can create a complacency resulting in apathy towards immunisations but there is no guarantee that the disease will not return in fact during 1955 in England and Wales 161 cases of diphtheria were notified and there were 11 deaths. These figures compare with 3,575 notifications and 156 deaths in 1948. Only a population with a high level of immunity will be safeguarded9 and prevention by immunisation is still an essential public service. The present day method is to provide a combined immunisation process against diphtheria and whooping cough which is carried out in 3 injections at monthly intervals. Single injection "boosters" era given within a period of 5 years after the primary inoculation. During 1955, 3,024 Kingston children were immunised for the first time or received reinforcing "booster" injections, A figure known as the immunity index which is shown as a percentages is computed each year. This relates to the proportion off the child population which is known to have received inoculation during the previous 5 years. The immunity index for the 1/4 age group is 76% and the total index for all children under the age of 15 is 45% 36 The intensive campaign to immunise as many children as possible is being maintained with a special objective to secure the immunisation of 75% of babies before their first birthday. It is calculated that during 1955 the proportion of babies immunised before they reached the age of 1 year was 67%. Poliomyelitis. A total of 10 cases of Poliomyelitis was notified in Kingston during 1955 compared with nil during 1954. This total is the highest number recorded in one year in the town and the onset dates were distributed over 5 months (1 in July 2 in August, 2 in September„ 3 in October and 2 in November). There were no deaths and severe paralysis occurred in only 2 cases both being adult females; 4 of the cases were classified as paralytic and 6 as nonparalytic: 1 occurred in the 2/3 age group 5 in the 5/10 age group „ 2 in the 10/15 age group and there were 2 adults. The case in July was in respect of a visitor to the town who contracted the disease elsewhere but fell sick and was treated in Kingston. It is significant that the main incidence took place in the late summer and autumn 7 cases being notified during September or later. The incidence of poliomyelitis has been high in the neighbouring districts and your Medical Officer of Health who is also the County Divisional Medical Officer for these diffitriets, together with the Medical Officers of Health of the districtsP and the Physician Superintendent of the hospital concerned; was able to have special investigation and followup carried out in each case and many of the family contacts. This was a great step forward in the management of the cases and your Medical Officer of Health expresses warm thanks for the clinical and epidemiological help he received both with regard to Kingston and extra Kingston cases and also very sincere gratitude for the virologies! reports and typing of the infective agents received as a result of the close collaboration with the hospital and through the hospital with the Virological Laboratory. The identification of the virus from specimens was possible for the first time in eight of the Kingston cases® Two Kingston children who fell ill within 11 days of each other had Type 1 virus and investigation proved that they had a common playmate. The remaining S patients had Type 3 virus and the onset dates ranged from the end of August to beginning of November. A direct contact chain linking these 6 eases was not discovered. The most Interesting result was obtained in respect of a young family where a girl aged 2 yearsp was diagnosed with non-paralytic poliomyelitis. A followup survey revealed that the patient's 2 sisters, tooth school children had had symptoms a few days previously but had recovered. Specimens from the 3 children produced Type 3 virus in each case and apparently therefore the 2 sisters had suffered abortive attacks of poliomyelitis but had recovered spontaneously. With the exception of the 2 adults all cases made good recoveries and were discharged from hospital within 6 weeks of admission. Where there was some weakness or limp following paralytic attacks arrangements were made by the hospital for children to attend the out-patients Physiotherapy Department. 37 Of the 2 adultsj, l, a housewife, aged 28 , had to he placed in a respirator. She made slow hut satisfactory progress, after severe respiratory paralysis and moderately severe weakness of all limbs, until ahle to "breathe without artificial respiration. Arrangements were made for her to be removed to a Rehabilitation Unit for treatment in connection with the weak muscles. The other adult case, aged 59p made a slow but uneventful recovery., Acute Infective Encephalitis. Only 1 case occurred during 1955 and this was in a baby just under 2 years of age. The child was treated in Kingston hospital and although seriously ill at the time made a good recovery. Enteric Fever (Typhoid or Paratyphoid) There were no cases of typhoid or paratyphoid B notified in Kingston during 1955. This is the eighth successive year without notification of Enteric Fever. Dysentery. During March it was reported that there was an outbreak of Dysentery in a Boys Home in the town. On investigation it was quickly discovered that a cook was a carrier of sonne dysentery and a total of 5 other boys produced faeces specimens from which shigella sonne was isolated. The cook was taken off duty immediately and the boys treated until specimens were completely negative. No further cases occured. A total of 5 other cases of dysentery was notified by General Practitioners during 1955 and in each very thorough investigations were made and every precaution taken to prevent the spread of infection. The 5 cases involved 3 families with no apparent connection with each other viz., a woman aged 68, who was treated in hospital and her grandson aged 4| a girl aged 4, and her brother aged 2j and a boy aged 4. The onset dates were all within 3 weeks during May and June. These were all cases where diarrhoea etc., had led to diagnosis and notification of dysentery although subsequent investigation did not identify specific organisms from faeces specimens. The illnesses may have been an air borne infection sometimes referred to as summer diarrhoea. The receipt of the notifications enabled full preventive measures to be put in hand and instruction given in hygiene. No further eases were reported. Measles, There were 170 cases of measles notified during 1955 compared with 419 in 1954 and an average of 315 for the years 1950/54 inclusive. Only 2 cases were removed to hospital and generally speaking the illness was of a mild type with little by way of complications. The largest number of notifications (96) occurred in children under the age of 5, the majority of the remainder being in the 5/10 age group (68) and only 6 at other ages. 38 Whooping Cough. This is one of the most serious of childhood illnesses and protection against it has been offered to all children for three full years now This is usually done in a combined process in conjunction with diphtheria immunisation, and practically 100% of the children being immunised for the first time receive a "combined" material which affords protection against both these diseases During 1955 only 17 cases of whooping cough were notified and this is the lowest total ever recorded in Kingston. In 1954 21 cases were notified, in 1953 126 cases in 1952 102 cases and in 1951 222 cases It is interesting to note that of the cases occurring in 1955 only if. are recorded as having been immunised against whooping cough, and the remaining 13 were not. Ophthalmia Neonatorum For the eighth successive year no cases of ophthalmia neonatorum have been notified Puerperal Pyrexia, The puerperal pyrexia regulations 1951 define this illness as a febrile condition occurring in a woman in whan a temperature of 100.4c or more has occurred within fourteen days after childbirth or miscarriage. During 1955 72 cases were notified 17 of which referred to Kingston residents and 69 of which were notified from Kingston Hospital. These figures compared with 96, 27 and 96 respectively for 1954c An analysis for the years back to 1951 is shown below. The maternity block at Kingston hospital serves not only Kingston but a large surrounding area embracing a papulation of some 285,000 persons. During 1955 1,686 deliveries took place in the hospital. Cases 1951 1952 1953 1954 1955 (a)Total notified 41 84 80 96 72 (b) Number included in (a) of (i) Kingston residents 14 23 15 27 17 (ii) Extra district residents. 27 61 65 69 55 69 (c) Number included in (a) notified from Kingston hospital 40 82 78 96 (d) Number included in (a) notified by private doctors 1 2 2 3 (e) Number of cases included in (d) removed to hospital other than those included in (c) – – – – – Food Poisoning. Only 1 case of food poisoning was notified during 1955. This was in respect of a man aged 44 who was acutely ill at the time. Faeces specimens were positive for salmonella typhi-murium Upon immediate investigation it was found that an outbreak had occurred among the patient0 work colleagues in a factorys and that the works canteen was considered to be the source of the food causing illness. factory in question is not in Kingston and the outbreak was dealt with by the Public Health Department concerned. 39 The Kingston patient was allowed to return to work, after consultation with, Ms own doctor and when he was well and free from infections Tuberculosis,, The total number of new cases of tuberculosis notified in respect of Kingston residents during 1955 was 20 and this is the lowest figure ever recorded in the town. The number of notifications referring to respiratory disease was 14* the remainder being cases where other parts of the body were affectede The efficiency of notification is good and there is no reason to suspect refusal or neglect to notify„ There has been established over the past few years a regular annual visit to the town by the South West Metropolitan Regional Hospital Board Mass X-Ray Unite The Unit was In Kingston during March and May 1955 and a total of 8,831 was examinedo As a result of X-Ray 6 cases of active pulmonary tuberculosis were discovered. A further 317 inactive cases were recorded and also a considerable number of non-tuberculous abnormalities. (It should be borne in mind that these figures do not necessarily relate to Kingston residents only). The rate of new active cases discovered in this way is less than 1 per l,000 and there is reason to believe that they were in the main early stage infections which should respond well to treatment. There is a double advantage to be gained in discovering tuberculosis in its early stages. Firstly, the condition is more easily and more certainly cared in a shorter time and secondlys the patient will have had less opportunity to spread the infection to others before receiving treatment The latest methods of treatment by drugs and surgery are increasingly successful and the death rate from tuberculosis is rapidly decreasing nationally. There were 6 deaths of Kingston residents from tuberculosis during 1955 and 3 of these persons were over 70 years of age. The following table shows comparative figures of notified cases and deaths for the years 1946 to 1955 (inclusive): - Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-ResDiratory Total 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 1954 26 4 30 3 1 4 1955 14 6 20 6 – 6 The ratio of non-notified cases to total deaths for 1955 and the preceding 4 years is as follows:- 1951 1952 1953 1954 1955 1 : 3 1:2 1 : 5 1:4 1 : 3 40 In comparison with previous remarks the longer a chronic sufferer is kept active "by modern treatment the greater the chance of spreading the infection This is a problem immediately to be lessened by health education, and constant efforts are made by the Surrey County Council Tuberculosis Health Visitors and the local Sanitary Inspectors, both of when visit notified cases of tuberculosis and inter alia advise on the precautions necessary, to prevent the spread of infection It is to be expected that the problem of tuberculosis generally should continue to decrease in the absence of a major economic or social upheaval During 1955 no action became necessary under the Public Health (Prevention of Tuberculosis) Regulations 1925 or Section 172 of the Public Health Act 1936 These regulations relate to the restriction of tuberculosis sufferers from employment in the handling of milk and the compulsory removal to hospital in certain circumstances of persons suffering from tuberculosis respectively A very close co-operation exists between Dr. S.R. Wilson, the Cheat Physician and the Medical Officer of Health who work closely together Each notified case Is visited and all contacts are X-Rayed at the Chest Clinic (Telephone KIN.6251) Considerable help is given to tuberculosis patients and their dependents by the Kingston and District Tuberculosis Care Committee. During 1955 133 families were helped in the form of grants for extra nourishment, clothing, fuel, removals, bedding, fares, pocket-money, etc. and a total of £976 was expended from the funds of the Committee on this work An analysis of the total notified cases during 1955 in age groups is shown on the following page 41 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1955. TABLE VI. NEW GASES DEATHS Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total Under 1 year 1 - 5 5-15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 & over Total Tuberculosis (a) Respiratory M  – – – 3 2 1 1 2 2 11 – – – – – – 1 2 3 6 F – – – 1 2 – – – – 3 – – – – – – – – – – Total – – – – 4 1 1 2 2 14 – – – – – – 1 2 3 6 ("b) Non-respiratory M – – – 1 – 1 – – – 2 – – – – –– – – – – F – – – 2 – 2 – – – 4 – – – – – – – – – – Total – – – – 3 – 3 – – 0 6 – – – – – – – – – –