KIN 30 THE HEALTH of the ROYAL BOROUGH OF KINGSTON-UPON-THAMES Surrey 1956 The ANNUAL REPORT of the Medical Officer of Health and the Chief Public Health Inspector public health department, guildhall, kingston-upon-thames. june 1957 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON -UPON- THAMES SURREY 1956 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND THE CHIEF PUBLIC HEALTH INSPECTOR PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON- UPON- THAMES JUNE, 1957 ANNUAL REPORT 1956 TABLE OP 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) Extracts from Vital Statistics of the Year:- 3 (a) Live Births 4 (b) Stillbirths 4 (c) Deaths 4 (i) 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 1952 - 1956 inclusive 7 Table II - Comparison of Vital Statistics 1927 - 1956 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) General 10 (2) Health Services provided by other Authorities:- Surrey County Council - Health Department 11, 12 Surrey County Council - Education Department 12 Surrey County Council - Welfare Department 13 Surrey County Council - Children's Department 13 Surrey Executive Council 13 (3) National Assistance Act, 1948) National Assistance (Amendment) Act, 195l) 13,14 SECTION C Sanitary Circumstances (1) Water Supply 15 (2) Drainage and Sewerage 15 (3) Rivers and Streams 15 (4) Closet Accommodation 15 (5) Public Cleansing16 (6) Sanitary Inspection of the Area 16,17 (7) Shops 17 Page (8) Factories Act, 1937 17,16 (9) Camping Sites 13 (10) Atmospheric Pollution 18,19,20, 21,22,23 (11) Swimming Baths and Pools 23 (12) Eradication of Bed Bugs. 24 (13) Complaints. 24 14 Rodent and Insect Pest Control 24,25 (15) Rag Flock Act 9 1951 25 SECTION D Housing General 26,27 SECTION B Inspection and Supervision of Food (a) Milk SUpply 27 (b) Designated Milks 27,28 (c) Bacteriological Examination of Milk 28 (d) ICe Cream 28 (e) Meat and Other Foods 28,29 (f) Food Hygiene - Food Hygiene Regulations, 1955 30,33,32 Pood and Drugs Act, 1938 32 Tabulated Statement of Samples Submitted to the Public Analyst during 1956 32,33 Merchandise Marks Act, 1926 33 SECTION F Infectious Diseases Notifiable Diseases 34 Table IV. Notifiable Diseases during 1956. 35 Table V. Comparative Statement of Notifications of Certain Infections Disease 35 Smallpox 57 Scarlet Fever 57 Diphtheria 37,38 Poliomyelitis 38 Acute Infective Encephalitis 38 Enteric Fever (Typhoid and Paratyphoid) 39 Dysentery 39 Measles 39 Whooping Cough 39,40 Ophthalmia Neonatorum 40 Puerperal Pyrexia 40 Food Poisoning 40 Tuberculosis 41,42 Table VI. Notified Gases and Deaths from Tuberculosis in 1956 43 PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON- UPON- THAMES. ANNUAL REPORT. 1956 Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report on the public health and social conditions of the Borough for 1956. 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 health of the people and the Report is in accordance with Ministry of Health Circular 19/56. I am indebted to Mr. G.C. Smith, Chief Public Health Inspector, 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 1956 home population given by the Registrar General is 38.790 an estimated decrease of 280 persons compared with 1955. It is always necessary to draw attention to the fact that this figure relates to the resident population of the town and is used for the calculation of the statistical data now presented. The actual day population has been estimated to be about 300,000 persons who come to the town for business, education and recreation purposes. This is a special feature of the town which influences the volume of work and responsibility of the Corporation. Infectious Disease - The number of infectious disease notifications received in 1956 was 230, which is 77 lower than in 1955- The drop is mainly due to a considerable decrease in the incidence of measles. In general the health of the people was very good. There were no outbreaks necessitating special attention and a high standard of hygiene was maintained. 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. Vaccination against poliomyelitis - A great event of the year was the introduction of poliomyelitis vaccination when in May, for the first time, we had in our hands a successful defence weapon to prevent the occurrence of this infection. Although supplies were extremely limited, due to the complexity and cost of manufacture on a commercial scale, such stocks as were made available were administered immediately to registered applicants. Three cases of poliomyelitis occurred during the year. Each notification was in respect of a child who had not received an immunising injection. Vaccination against Smallpox - This is voluntary and calculations show that by the end of 1956 some 53% of the children born between 1st July, 1955 and the 30th June, 1956 have been vaccinated. Births- The number of live births for 1956 is 550 and compares with 543 for 1955. The birth rate is 14.18 per 1,000 of population compared with 13.89 for 1955. Deaths- The number of deaths recorded in 1956 is 442 compared with 424 for 1955. This makes a death rate of 11.39 for 1956 compared with 10.85 for 1955. The excess of births over deaths was 108 compared with 119 for the previous year. The number of deaths of infants under 1 year of age in 1956 is 13 which gives an Infant Mortality rate per 1,000 live births of 23.64. The corresponding figures for 1955 were 8 infant deaths and an Infant Mortality rate of 14.73. The approximate average rate for the previous five years (1951-55) is 21. With a smaller total population and an increased number of infants dying it is inevitable that the rate will be higher. Causes of Death- The main conditions causing death during 1956 were Heart Disease- 122; Caner2- 95; and Vascular Lesions of the Nervous System-61. 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 relevant 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. 1952 1953 1954 1955 1956 M F M F M F M F m F 10 1 13 2 16 2 24 4 21 1 Total Total Total Total Total Deaths from cancer of the lung and bronchus 11 15 18 28 22 Housing- During 1956 the Corporation completed 51 Housing Units. These were 2-bedroom flats and all had to be constructed outside the Borough. By private development 68 houses have been completed in the Borough, of which 56 are flats on the Ham Farm Estate. The Borough is almost completely built up and the work of dealing with obsolete houses is being proceeded with at a pace determined by the availability of suitable alternative accommodation for displaced families. Staff- Details of the staff of the Public Health Department and the changes which have taken place throughout the year are set forth on page 1. I welcome the appointment of Dr. W.H. Kinstrie as Deputy Medical Officer of Health occasioned by an extension of my own responsibilities to include the duties of Medical Officer of Health for the Borough of Surbiton as well as Divisional Medical Officer, North Central Division, Surrey County Council. The heavier strain placed on my own services has made it necessary to retain an experienced public health doctor to be made readily available to assist and deputise. I gladly record my thanks for the support and encouragement to me in ray work, to The Worshipful The Mayor, 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 acknowledge my gratitude for the hard work and loyal support of the staff of the Public Health Department;, and the unfailing co-operation and advice of ray fellow Chief Officers. I have the honour to be, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. 1 1956 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 may have jurisdiction. During the Municipal Year 1956-57 the Public Health Committee was constituted as follows:- Alderman Oldfield (Chairman) Councillor Evans " Digby (Vice-Chairman) " Marshall " Knowlden (Mayor) " Hatfield-Hall " Picton (Ex-Mayor) " Parker " Eggleton " Tapping Councillor Lacey " Lucy " Chalk " Wells STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M.B., Ch.B. (Edin.), D.P.H. Deputy Medical Officer of Health: (part-time). W.H. KINSTRIE, M.B., Ch.B. (Edin.), D.P.H. (appointed 1.4.56) Chief Public Health Inspector: G.C. SMITH, M.R.S.H., M.A.P.H.I. (a) (b) Senior Additional Public Health Inspector: G. HOLMES, M.A.P.H.I.(appointed 28.9.56) (a) (b) Additional Public Health Inspectors: A. CLEGG, M.R.S.H. (resigned 31.1.56) (a) (b) H.W. GILES, M.R.S.H. (resigned 31.7.56) (a) (b) S.W. SIMPSON-SCOTT, M.R.S.H., M.A.P.H.I. (a) (b) M.G. TOMKINS, M.A.P.H.I. (appointed 2.1.56) (a) (b) Junior Public Health Inspector: (vacant) Chief Clerk: M.E. POWELL, D.P.A.. (Lond.) Clerical Staff: MISS C.L. FOISTER, M.I.P.S. MISS M.W, FILBEE. G. NORTHWOOD. A.G. BELL, (resigned 4.3*56) H. SHARP, (appointed 9.4.56) Assistant Rodent Officer: F.W. STAGG. Rodent Operatives: G. DEACON (resigned 11.5.56) G.H. LOCKE. F.J. PERRY, (appointed 14.5-56) Disinfector Driver: F.C. LOCK. (a) Certificate as Public Health 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) 38,790 Number of inhabited! houses (approx.) 11,755 Rateable Value - General Rate (1.4.56) £1,184,844 Sum represented by Penny Rate (Year 1956/57). £ 4,821 The total number of hereditaments is 14,182 of which 80% are domestic dwellings. There are 2,329 commercial premises in the town being 16% of the total hereditaments. The remaining premises totalling 508 are classified as industrial, entertainment, public utility, educational and miscellaneous. 2. Social Conditions. The Royal and Ancient Borough of Kingston- upen- Thames ia a thriving market town situated in the County of Surrey on the bank of the river Thames. The shopping centre provides the main economic function, but there is also an important industrial activity mainly in Aircraft and Engineering. Kingston is also a busy centre for education and recreation, and is to some extent a dormitory town for London business people. An outstanding factor influencing the social conditions is the fact of low unemployment and 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 year 1956 was a good year from the employment point of view, despite some redundancy in the aircraft industry. At the commencement of the year there were only 251 men and 95 women unemployed; in July there were 208 men and 94 women on the registers. The highest point reached was at the end of the year when there were 400 men and 155 women unemployed. During the year some 16,000 men and women registered as unemployed, but there were never more than 555 unemployed at one time. The little long terra unemployment was restricted to elderly men and some disabled persons. There was an unsatisfied demand for skilled labour of all types during the year; some 4,000 men and l,700 women were placed in local vacancies and there were 500 men's and 350 women's vacancies remaining to be filled in December. The most important industries were aircraft and motor manufacture and repair (9,000), building (4,500) and engineering (4,000) whilst retail distribution employed some 8,700." 3 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 0.96; Deaths 0.92. The birth and death rates in respect of the town are shown overleaf and for the purpose of providing some comparison the rates for England and Wales are also shown. It will he noticed that the rates for Kingston-upon-Thames are lower than for the country as a whole. 4 (a) Live Births- Total Male Female Legitimate 508 260 248 Illegitimate 42 21 21 281 26^ Birth Rate per 1,000 population (crude Birth Rate) 14.2 Adjusted Birth Rate 13.6 England and Wales Birth Rate 15.7 (b) Stillbirths- Total Male Female Legitimate 10 4 6 Illegitimate 2 2 — 12 6 6 Rate per 1,000 total (Live and Stillbirths) 21.4 England and Wales Stillbirth Rate 23.0 (c) Deaths- Total Male Female 442 214 228 (i) Death Rate per 1,000 population (crude Death Rate) 11.4 Adjusted Death Rate 10.5 England and Wales Death Rate 11.7 (ii) Maternal Death Rate (deaths caused by pregnancy, childbirth abortion). No. of Deaths Rate per 1,000 total (live and still)births 2 3.6 (iii) Infant Death Rate (deaths of all infants under one year of age). Total No. of Deaths Rate per 1,000 live births 13 23.6 England and Wales Rate 23.8 No. of Deaths Legitimate Infants Rate per 1,000 legitimate live births 12 23.6 No. of Deaths Illegitimate Infants Rate per 1,000 illegitimate live births 1 23.8 All Infants under 4 weeks of age (included in above). Total No. of Deaths Rate per 1,000 live births 9 16.4 5 The approximate infant mortality rate for 1956 and the rates since 1952 are shown for purposes of comparison. 1952 1953 1954 1955 1956 Kingston- upon- Thames 24 24 20 15 24 England and Wales 27 26 25 25 24 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 further. Period Infant Mortality Rate 1921-1925 69 1926-1930 56 1931-1935 56 1936-1940 46 1941-1945 52 1946-1950 25 1951-1955 21 The following are the numbers in age groups of Kingatonupon-Thames children who died during 1956 before reaching the age of one year, together with the cause of death. The very favourable Infant Mortality Rate of 1955 has not been attained this year owing to the occurrence of 4 deaths of infants between the age of 1 month-1 year, none of which could reasonably be said to be preventable. The only preventable infant death was one abandoned at birth. Age Total Deaths Prematurity Cerebral Haemorrhage Congenital Heart Disease Cardiac Failure Congenital Deformities Icterus Neonatorum Suppurative Broncho Pneumonia Diabetes Mellitua Meningocele Inhalation of Birth Fluids 0-24 hours 5 2 - - 1 - - - - 1 1 24 fairs. -1 mth. 4 1 1 - - 1 1 - - — - 1 mth. - 1 yr. 4 - — 1 1 - - 1 1 - - Totals 13 3 1 1 2 1 1 1 1 1 1 6 (iv) Deaths from Other Causes. No. of Deaths Deaths from Heart Disease 122 Deaths from Cancer 95 Deaths from Vascular Lesions of the Nervous System 61 Deaths from Circulatory Disease other than Heart 27 Deaths from Bronchitis 25 Deaths from Pneumonia 17 Deaths from Influenza 3 The following tables I, II, III, summarise certain vital statistics. Table I shows the figures for live births, stillbirths, and deaths for the years 1952-1956 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1927. 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 estimated population figure is to remain just below 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 PROM VITAL STATISTICS FOR YEARS 1952 - 1956 INCLUSIVE. TABLE I. 1952 1953 1954 1955 1956 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 531 283 248 564 290 274 498 246 252 491 253 238 508 260 248 Illegitimate 45 22 23 45 24 21 36 22 14 52 23 29 42 21 21 576 305 271 609 314 295 534 268 266 543 276 267 550 281 269 Birth rate (R. G.) per 1,000 pop. 14.40 15.25 13.64 13.89 14.18 STILLBIRTHS Legitimate 17 4 13 18 12 6 13 4 9 8 3 5 10 4 6 Illegitimate — — — 1 1 — 2 1 1 — — — 2 2 — 17 4 13 19 13 6 15 5 10 8 3 5 12 6 6 Rate per 1,000 (live and stillbirths) 28.63 30.25 29.14 14.52 21.35 DEATHS 499 254 245 465 240 225 450 206 244 424 212 212 442 214 228 Death rate (R.G.) per 1,000 pop. 12.48 11.64 11.49 10.85 11.39 8 COMPARISON OF VITAL STATISTICS 1927 - 1956. 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 1927 39330 517 13.1 486 12.4 37 69 1928 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 35970 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 14.1 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 1956 38790 550 14.2 442 11.4 24 24 9 TABLE III Causes of Death Registrar General's Tables 1952 1953 1954 1955 1956 M F M F M F M F M F All Causes 254 245 240 225 206 244 212 212 214 228 Tuberculosis, respiratory 7 2 5 3 — 3 6 — 2 — Tuberculosis, other — 2 — 1 1 — — — — — Syphilitic disease 1 2 — 1 — — 1 — 1 — Diphtheria — — 1 — — — — — — — Whooping Cough — — — — — — — — — — Meningococcal infections. — — — — — — — — — — Acute poliomyelitis — — — — — — — — — — Measles — — 1 — — — — — — — Other infective and parasitic diseases — 1 — 2 — 1 1 1 2 1 Malignant neoplasm, stomach 7 4 4 4 2 3 4 6 4 5 Malignant neoplasm, lung, bronchus 10 1 13 2 16 2 24 4 21 1 Malignant neoplasm, uterus. — 2 — 3 — 1 — 3 — 4 Malignant neoplasm,breast — 7 — 10 — 6 — 5 — 12 Other malignant and lymphatic neoplasms 29 20 25 34 22 20 27 16 19 29 Leukaemia, aleukaemia 1 — 1 2 — 1 3 1 1 — Diabetes — 4 — 2 1 1 — 3 1 2 Vascular lesions of the nervous system 27 39 26 35 21 45 25 46 22 39 Coronary diseases, angina. 29 31 43 18 34 28 44 22 43 26 Hypertension with heart disease 12 3 4 8 6 10 1 6 2 7 Other heart disease 28 37 16 31 18 34 12 35 18 26 Other circulatory disease 16 20 22 11 17 20 12 21 8 19 Influenza 2 3 4 7 1 1 — 2 1 2 Pneumonia 14 10 11 10 9 14 9 12 9 8 Bronchitis 29 19 16 15 15 9 17 6 16 9 Other diseases of respiratory system 5 1 4 4 2 7 — — 3 — Ulcer of stomach and duodenum 3 1 6 — 3 1 3 — 8 1 Gastritis, enteritis, and diarrhoea 1 — 2 2 — 3 1 3 1 — Naphritis and nephrosis 3 4 5 — 4 2 1 — 2 — Hyperplasia of prostate 2 — 8 — 5 — 2 — 4 — Pregnancy, childbirth, abortion — — — — — — — 1 — 2 Congenital malformations. 5 — 2 — 4 1 3 1 3 3 Other defined and illdefined diseases 15 22 14 18 16 21 8 10 17 23 Motor vehicle accidents 3 — 3 — 4 — 2 1 2 — All other accidents 3 6 3 — 3 4 2 5 2 4 Suicids 2 4 1 2 1 5 4 2 2 5 Homicide and operations War — — — — 1 1 — — — — 10 SECTION B GENERAL PROVISIONS OF HEALTH SERVICES 1, (i) Laboratory Facilities. During 1956 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.I. (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 Hospitals, which is under the direction of the Physician Superintendent of Kingston Hospital. During the year 97 infectious disease cases were treated in hospital, but. 88 of these were notified from Kingston Hospital in the first instance and related to puerperal pyrexia,, To Kingston Hospital 88 " Tolworth Isolation Hospital, Surbiton 9 (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 2177, or 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 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. Health 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 Borough:- (a) Ante-natal and post-natal clinics. Health Centre, Grange Road. Wednesdays, p.m. (b) Infant welfare clinics. Health Centre. Tuesdays & Fridays, p.m. Dinton Road Clinic, St. Agatha's Mondays & Thursdays,p.m. Church Hall. (Now closed 1957)- Temporary premises 1957 St. Paul's Hall, Park Road. (c) Immunisation and Vaccination clinics. Health Centre. Fridays, p.m. Dinton Road Clinic. Tuesdays, p.m. " " " (Fridays, a.m. from 1.3.57) (d) Dental clinics. Health Centre. Daily. "Keeldar", 25, Queen's Road. Daily by appointment. (Orthodontic only) (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 Cross Society at the B.R.C.S. H.Q., 73, Penrhyn Road, Kingston-upon-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". 12 (1) Home 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 but in assessing what the charge should be consideration is given to the means of the persons concerned. (3) Prevention of Illness, 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 County 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-Tham.es (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. (d) Ascertainment of handicapped pupils in need of special education. (e) Treatment clinics as under:- (i) Minor ailments. Health Centre. Dally, 9-10 a.m. Dinton Road Clinic. " 9 - 10 " (ii) Medical consultation. Health Centre. Mondays, a.m. Dinton Road Clinic. Fridays, a.m. (iii) Eye clinic. Health Centre. Thursdays, from 10 a.m. by appointment. (iv) Dental clinic. (see under Health) Immunisation clinic. ( Department ) (v) Child guidance clinic. Cases referred to clinic held at "Roselands", Kingston Road, New Maiden. (vi) Speech therapy. Health Centre. Mondays & Thursdays by appointment. 13 Surrey Comity 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 there of. The address of the Welfare Officer for the Borough is 35, Coombe Road, Kingston-upon-Thames, (KIN,4402). Surrey County Council - Children's Department. This Department discharges responsibility for the welfare of children who have been deprived of a normal home life. It has important functions in connection with child life protection and adoption and deals with children taken into or committed to the care of the County Council, supervision of foster children, child neglect etc. The Children's Officer for the Borough works from the County Hall, Penrhyn Road, Kingston-upon-Thamas. 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, Swell Road, Surbiton, Surrey, (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 1956. The problems associated with aged persons do not diminish,, but fewer geriatric cases are coming to the notice of the Public Health Department direct. 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 reports, continues. The Superintendent of Kingston Hospital is assisted by a Geriatrician and Geriatric Health Visitor 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 cases are improved. The problems of the provision of additional hospital beds, domiciliary help, and nursing remain. 14 Your Medical Officer of Health, in his capacity of Divisional Medical Officer for the North Central Division of the Surrey County Council, acts as co-ordinating officer "between all the centrally, locally and voluntarily administered services in the town. Every effort is made (a) to ensure that no old person who is in need of care and attention is unknown to the Health Department, and (b) to maintain regular visiting, domiciliary help, medical attention and etc., to all known geriatric cases. 15 SECTION C. SANITARY CIRCUMSTANCES. 1. WATER SUPPLY, The town's water supply is provided by the Metropolitan Water Board who successfully maintain constant supervision over the parity 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 supply, 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 Board. This arrangement is a temporary one pending completion of the Hogsmill Valley Joint Sewerage Board's works, and the construction of the pumping station at Kingston to transfer the Kingston sewage to the new works. 3. RIVERS AND STREAMS. The River Thames forms the Western boundary of the Borough and this river is under the control of the Thames Conservancy Board. The Hogsmill River, a tributary of the Thames, flows through the Borough,, The chemical and "bactericlogical condition of the stream is very unsatisfactory. This is due to lack of natural dilution for the sewage effluent carried in its flow. When the Hogsmill Valley Joint Sewerage Board operate the new purification works, the treated effluent from that works and the storm overflows will run into the Hogsmill River, which will continue to he sewage effluent for a very high percentage of its volume. The quality of this effluent coming from the new works may be expected to be highly satisfactory, but the other components of the river will have to be controlled with every due regard to the Public Health if an end is to be made to the present unsatisfactory state. During the year in several instances it was found that sanitary fittings had been wrongly connected to the surface water sewer draining into the Hogsmill River 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 being given to the Public Health Department of proposed connections of new or altered sanitary fittings to drainage systems. CLOSET ACCOMMODATIONc All closets in connection with dwelling houses in the Borough are on the water carriage system. 16 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 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 weighed on a weighbridge and 11,420 tons of refuse have been sent from this Borough in 1956. 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. 6. SANITARY INSPECTION OF THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors which totalled 10,381 as compared with 8,547 for 1955:- House inspections, defects, etc. 600 Drainage 483 Factories 168 Outworkers 25 Atmospheric Pollution 138 Dairies, milk shops, etc. 222 Food premises 1,094 Restaurants and Cafes 457 Infectious disease enquiries 114 Theatres and Cinemas 5 Verminous Premises. 26 Rodent Control 221 Shops Act 411 Schools 22 Housing Act 61 Markets 772 Miscellaneous 1,738 6,557 Reinspections and works in progress 3,824 10,381 These figures show a marked increase in the number of inspections of restaurants, food premises and the market. This is a result of the re-assessment of these premises in the light of the introduction of the Pood Hygiene Regulations, 1955. NOTICES SERVED. Informal. (a) Verbal 117 (b) Written 303 Statutory. (a) Housing Acts - (b) Public Health Acts 29 17 NOTICES COMPLIED WITH. Informal (a) Verbal 374 (b) Written Statutory. (a) Housing Acts - (b) Public Health Acts. 26 7. SHOPS. There are 931 shops in the Borough and inspections are made with regard to those provisions of the Shops Act. 1950 which are concerned with sanitary accommodation, washing facilities;, heatings 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 Public Health Inspectors are also responsible for the administration of the law relating to shop hours, including early closing and Sunday trading,, A total of 411 inspections were made during the year and six Notices were served; three of these referred to early closing and the other three to provision of sanitary accommodation, lighting of W.C. compartments and provision of hot water supply. 8. FACTORIES ACT. 1957. 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 Corporation 77 25 – – Factories not included above in which Sec.7 is enforced by Corporation 291 143 8 – Other premises excluding Outworkers 9 9 – – 18 2. CASES IN WHICH DEFECTS WERE FOUND, Particulars NO. of cases in which defects found Found Reme died Referred To H.M. Inspector Ey H.M. Inspec tor No. of Prosecutions Want of Cleanliness 1 – – 1 – Over-crowding – – – – – Unreasonable Temperature – – – – – Inadequate Ventilation 1 – – – – Ineffective drainage of floors – – – – – Sanitary Conveniences— (a) Insufficient – – – – – (b) Unsuitable or defective 5 4 – 5 – (c) No ventilated space or lobby – – – – – (d) Lighting (absence of) – - - – – Others 1 – - – – 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 Apparel - Making etc. 8 Brass & Brass Articles 7 Artificial Flowers 1 Cardboard Boxes 2 18 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. Fifteen complaints were received with regard to smoke or grit emission and 8 observations were taken. A total of 138 visits were made to boiler installations situated in industrial or institutional premises. 19 During the year an important legislative step was taken in the passing of the Clean Air Act. This enactment, based upon the recommendations of the Committee on Air Pollution, will be welcomed by all who have laboured for years to bring about a reduction in the pollution of the atmosphere. It is the first determined attempt to deal with the problem comprehensively; the previous legislation had weaknesses which prevented it achieving its purpose. The provisions of the Clean Air Act, 1956, come into force by stages. Owners of industrial premises have seven years from the 5th July, 1956 in which to bring their boilers and equipment up to the required standard. Also any house built after this date cannot be the subject of a grant for the adaptation of the heating appliances should the area in which it lies be declared a smokeless zone. On the 31st December, 1956 provisions came into force requiring prior approval by Local Authorities of certain boiler installations and chimneys, also powers were given for the declaration of smokeless zones, The creation of smokeless areas must of necessity depend upon the availability of suitable smokeless fuels and whilst there may be differences of opinion as to which area. should be the first to be dealt with, there is much to be said in favour of improving the known 'black' areas as defined in the Report of the Committee on Air Pollution In fact, the Committee stated that the need for amelioration in these areas was most urgent. In Kingston at the present time, excluding the Power Stations, there can be no doubt that the main source of atmospheric pollution is from domestic chimneys. Bearing In mind that there is not an adequate supply for all dwellings, it is recommended that the smokeless fuel available should be used in those portions of Kingston where temperature inversion at certain times of the year is most marked, and particularly that this fuel should be used in the fires of bungalows and temporary prefabricated dwellings which discharge the chimney gases at a low level. The serious extent of pollution of the atmosphere from this source can be seen in the autumn and winter evenings and a clearly marked zone of polluted air is readily discernible. In spite of all the publicity on the subject, it is obvious that many people are not aware of the advantages of the use of coke and the various proprietary smokeless fuels. A considerable saving in the cost of valuable fuel can also be made by the adaptation of fireplaces which have a low efficiency. More attention should be given to the use of fireplaces in which there is adequate control of the air passing through the flue. It is not possible to warm a room properly if the throat of the flue is so large as to pass a considerable volume of air, thereby creating unnecessary draught. Greater efficiency in the use of fuel in domestic fires would lead to a reduction in consumption, would be an economic advantage, and would lead to a consequent reduction in the amount of pollution of the atmosphere. 20 The improvement reported in previous years with regard to the efficiency of the operation of the industrial plants in Kingston has been maintained, It is fortunate that the majority of the installations in the town are relatively small, many of them have been converted to oil firing with a consequent improvement in the final operation and a considerable diminution in the amount of smoke and grit. 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', 1956 Deposit in Tons per sq.mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No, of Observations No, of times SE SW January 6.84 9.65 16.49 93 40 3.55 February 6.64 5.82 12.46 87 7 0.23 March 10.23 5.52 15.75 93 30 0.69 April ll.92 7.42 19.34 90 1,15 May 9.28 3.32 12.60 93 18 0.16 June 7.01 4.47 ll.48 90 39 1.56 July 8.19 7.69 15.88 93 21 4.56 August 9.41 6.23 15.64 93 48 2.40 September 14.l9 10.26 24.45 90 15 2.56 October 17.44 30.38 47.82 93 5 1.07 November 8.77 5.45 14.22 90 12 0.42 December 10.50 11.31 21.81 93 35 2.57 Totals 120.42 107.52 227.94 - - 20.92 Average 1956 10.04 8.96 19.00 — - l.74 Average 1955 10.77 5.08 15.85 - - 1.66 21 TIFFIN GIRLS' SCHOOL - Station 'B'. 1956 Deposit In Tons -per sq.mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times SE - SW January 3.78 6.45 10.23 93 40 3.12 February 3.29 3.29 6.58 87 7 0.l8 March 5.34 5.ll 10.45 93 30 0.64 April 4.91 5.44 10.35 90 — 1.11 May 4.48 2.26 6.74 93 18 0.08 June 6.21 6.84 13.05 90 39 1.96 July 4.88 5.44 10.32 93 21 4.67 August 5.28 7.83 13.11 93 48 2.32 September 4.05 4.71 8.76 90 15 2.43 October 3.88 4.42 8.30 93 5 1.10 November 3.35 4.15 7.50 90 12 O.39 December 6.54 7.47 14.01 93 35 2.50 Totals 55.99 63.41 119.40 - - 20.50 Average 1956 4.67 5.28 9.95 - - 1.71 Average * 1955 4.80 4.33 9.13 - - 1.43 * Average ll/12ths. CEMETERY - Station 'C' 1956 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 3.05 5.43 8.48 93 6 3.22 February 6.46 4.28 10.74 87 12 0.24 March 5.53 3.51 9.04 93 15 0.65 April 5.73 5.24 10.97 90 33 l.l0 May 6.00 2.39 8.39 93 — 0.l5 June 5.53 5.83 11.36 90 23 2.04 July 4.37 4.84 9.21 93 — 3.73 August 4.41 4.94 9.35 93 15 2.24 September 3.12 2.98 6.10 90 - 2.55 October 3.38 2.65 6.03 93 30 0.98 November 5.14 3.22 8.36 90 9 0.43 December 4.18 4.51 8.69 93 29 2.31 Totals 56.90 49.82 106.72 - — 19.64 Average 1956 4.74 4.l5 8.89 - — 1.64 Average * 1955 5.22 4.93 10.15 — - 1.53 * Average 10/l2ths. Station A Station B Station C 1956 1956 1956 1/4 Total Cumulative 1/4 Total Cumulative 1/4 Total Cumulative First Qtr. 44.70 44.70 27.26 27.26 28.26 28.26 Second Qtr. 43.42 88.12 30.14 57.40 30.72 58.98 Third Qtr. 55.97 114.09 32.19 89.59 24.66 83.64 Fourth Qtr. 83.85 227.94 29.81 119.40 23.08 106.72 GENERAL. Station A Station B Station C Total Deposit 227.94 119.40 106.72 Average Monthly Deposit 19.00 9.95 8.89 Total Rainfall 20.92 20.50 19.64 Average Rainfall 1.74 1.71 1.64 The following additional table, illustrated with a graph, is of interest in showing the trend of atmospheric pollution over the years. The increase in 1956 of the readings in respect of Station "A" at this stage cannot he readily explained. It remains to he seen what trends are revealed by the results of further observations. Average Monthly Deposit. Total Solids - Tons per Sq.mile. Year Station A. Canbury Gardens Station B. Tiffin Girls' Sch. 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) 1956 19.00 9.95 8.89 23 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, 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. Private - There are no privately owned swimming baths or pools open to the public in the Boroughs 24 12. ERADICATION OF BED BUGS. During the year only 3 premises were disinfested. One of these was a house under the control of the Corporation. The figures are the lowest ever recorded and are a reflection ©f improved social conditions. 13. COMPLAINTS. The number of complaints received from the general public during the year was 500 compared with 544 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,, The following is a brief tabulated list of causes for complaints received during 1956:- Sanitary Defects 129 Rodents 140 Defective Ashbins 4 Drains and Sanitary Arrangements 107 Overcrowding 7 Food 24 Nuisance from smoke 15 Defective Yards and Paving 8 Insect Pests 17 Accumulations 13 Animals 1 Others 35 500 14. RODENT AND INSECT PEST CONTROL. During 1956 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. It is pleasing to record the excellent co-operation of the officers of adjacent Authorities and the contractors to British Railways when infestations have been dealt with which require a co-ordinated effort. Many rat infestations are traceable to defective drains, and, more rarely, to faults in sewers. During the year 19 defects of drainage systems were traced which had been the cause of the infestation, Rodent Control-Statistical Statement, 1956, Private Dwellings and Corporation Property. Rats Mice Total No. of complaints received in office 102 23 125 „ „ premises inspected as a result 330 „ „ „found to be Infested 157 17 174 „ „ separate infestations treated 174 10 184 „ „ visits for treatment and reinspections 1,401 92 1,493 „ „ premises treated by occupier or other agency 2 7 9 „ „ poison baits deposited 769 25 Business and Factory Premises Rats Mice Total No. of complaints received in office 7 8 15 „ „ premises inspected, including those under Service Agreement 204 „ „ premises in which slight infestations were found 45 104 149 „ „ separate infestations treated 291 „ „ visits for treatment and reinspections 842 1,438 2,280 „ „ premises treated by occupier or other agency 4 7 11 „ „ poison baits deposited 1,539 Sewerage System. No. of foul water manholes in system 810 Summary. No. of complaints received 140 No. of premises Inspected 534 No. of premises Infested 323 No. of visits 3,773 No. of premises treated by occupier or other agency 20 No. of poison halts deposited 2,308 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 he remembered that practically every foodstuff or material has its own particular past, e.g. the bacon beetle, flour moth, cocoa moth and carpet beetle,, to name only a few. 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. Quite 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. This is particularly so in the case of ants, which previously had proved to be very difficult to eradicate. With regard to cockroaches it was mentioned last year that treatments had been carried out with insecticidal lacquers. The confidence placed in this form of treatment has been well Justified. An indication of the manner In which pests are disseminated is the fact that during an examination of pigeons' nests in buildings, these were found to be infested with Indian meal worm and other Insects which attack textiles, such as carpets and woollen goods. 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 1956. 26 SECTION D. HOUSING In the furtherance of the Corporation's proposals to deal with the unfit dwellings in the Borough? during the year the following action was taken. Mill Street and Cambridge Grove Road Clearance Order which involves the demolition of Nos. 1, 2, 3, 4, 5, & 6, Barnyard Cottages and Nos. 1 & 2, Fairview Cottages (demolished during the year). Demolition Orders made in respect of the following 19, 21, 27 & 29, Mill Place. A Closing Order was also made in respect of four rooms at Wanderings Farm House, Cambridge Road. Following upon the completion of work to the satisfaction of the Corporation, the Closing Order which was operative on No. 9, Hudson Road was revoked. During the year only two applications were made for Certificates of Disrepair under the Housing Repairs and Rents Act, 1954. One Certificate was granted. Works were carried out at 9 houses and the Certificates of Disrepair were revoked. The number of Certificates issued in the previous year was 38. 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. (1) Number of houses inspected and recorded 20 (2) Number of houses which, on inspection? were considered to be unfit for human habitation 12 (a) Parts of houses which, on inspection, were considered to be unfit for human habitation 1 (3) Number of houses? the defects in which were remedied in consequence of informal action, by the Local Authority or its officers 174 (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 (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 12 (7) Number of demolition or closing orders made 6 27 (8) Number of houses in respect of which an undertaking was accepted under sub-section 3 of section 11 of the Housing Act, 1936 - (9) Number of houses demolished 2 Housing - Statistical Statement 1956. The following information is supplied by the Borough Surveyor who indicates that 51 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., 1956. Houses l,137 (lnc.876 outside Borough) Flat 837 (Ins,326 outside Borough) Total number of temporary dwellings erected up to 31st December, 1956. Still Remaining. Arcon 132 132 (1 sold) Aluminium 70 60 2 year Huts 113 32 Number of 2 year huts demolished during 1956 - 81, Number of dwellings erected by private enterprise during 1956. Houses 12 Plats 56 68 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 1951p 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 1956 Tinder the provisions of 28 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 65 samples of milk, all of which, were pasteurised, were sent to the Public Health Laboratory at Epsom for examination,, The samples were submitted for the phosphatase and methylene blue tests, which are respectively tests of adequate pasteurisation and satisfactory bacteriological condition,. 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 138. This figure includes six producers. In addition to these dealers and producers there are other premises, such as refetaurants, canteens, cinemas, etc, upon which ice cream is soldo 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 68 samples submitted to the Public Health Laboratory at Epsom during 1956. 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 46 14 8 - 68 (e) Meat and Other Foods. (i) There are no slaughter houses in the Borough,, The supply of meat for the town arrives from Smlthfield 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. 29 Tabulated List of Condemned Foodstuffs showing causes for condemnation and the Weights. Article of Food. Reason for Action. Weight. lbs. lbs. Raw Meat Bovine Decomposition 1,304½ Ovine „ 89½ Porcine „ 247 Total quantity of raw meat 1,641 Raw Fish Decomposition 210 Poultry,, Game. etc. Chickens „ 27 Canned Goods Meat and Meat Products „ 844¼ Fruit 75l¼ Jam Punctured, 36¼ Vegetables Blown, Damaged, 172¼ Milk Decomposition. 112 Soup 26 Fish and Fish Paste 14¾ Others 23¾ 1,981 Dried Fruit 1,240½ Food in glass containers Jams and Preserves Glass contamination, 6o Pickles and Pastes Mould, Deterioration. 8½ 68½ Other Foods condemned for Various Reasons. Cereals 3½ Sausages 95 Cheese 107 Vermicelli 22 Flour 28 Mussels 56 Butter Sultana Cake 72 Sprouts 20 Assorted Foodstuffs (Canned, glass containers, packets, etc.) 112 5l5i Approximately 2 tons of unsound food were disposed of by incineration at the refuse destructor of the Merton and Morden Urban District Council,. The remainder was made in a condition that recovery was impossible and placed with normal house refuse for disposal at the controlled tip. (f) Food Hygiene. Food Hygiene Regulations. 1955. Certain of these Regulations came into force on the 1st January, 1956 and the remainder, which related to structural requirements, "became enforceable six months later. 30 The publicity which preceded the Regulations materiallyassisted in their enforcement,, Owners of food businesses realised that improvements were essential and desirable and co-operated to a considerable extent. This in spite of the fact that the expense involved had to be met at a time when costs had increased as a result of the re-rating of business propertieS. During the year reconstruction and considerable improvements were carried out to cafes, butchers', grocery, and fish shops and a bakery. Some l40 Notices were served relating to 216 defects, of which 151 had been remedied by the end of the year. With regard to the Ancient Market, work is proceeding on the adaptation of the Market House to provide washing facilities and sanitary accommodation for the use of the stall holders. Where plans were submitted for new buildings, it was possible to incorporate recommendations based on the requirements of the Regulations,, Not all existing premises have yet been dealt with, and the long view was taken where it would not be good policy to press at this stage for minor improvements when major works were anticipated,. With possibly only two exceptions, the work has been carried out with every co-operation on behalf of the proprietors,, It is to be hoped that improvements in premises will be matched by corresponding standards of personal hygiene on the part of those employed in handling food. Whilst some improvement has taken place, attention must still be given to the protection of food in transit. With regard to the meat trade, although some progress has been made by the more enlightened and progressive firms by the provision of approved vehicles, the trade in general appears to be slow to adopt measures better calculated to protect the meat during its journey from abattoir or market to the shop. As a matter of interest, the following is a table of Notices served under the Food Hygiene Regulations. Notices Served. Complied. PART IV Sanitary Conveniences. Cleansed and/or redecorated 5 2 Lack of notices 6 k Fittings cleansed or repaired 1 1 Absence of ventilated lobby 1 — SinkS. Renewed or repaired 2 - Water supply to sink 1 1 Accommodation for clothing. Lockers provided 2 1 Clothes removed from food rooms 4 4 Washing Facilities for Staff. Absence of, or defective, hand basin 8 5 " cold water supply 20 9 " " hot water supply 22 11 " " water heater, or repaired 4 2 Provision of towels, soap and nailbrushes 5 4 C/Fwd. 81 44 31 PART IV (Cont/d.) Notices Served. Complied B/Fwd. 81 44 Repairs to Pood Rooms. Floors cleansed etc. 6 4 Walls and ceiling cleansed etc. 11 5 Protection of Pood against Contamination. Smoking 8 8 Spitting 1 1 Pood to "be kept 18" off ground 24 23 Covers provided for food 8 8 Uncleanliness. Personal 1 1 Kitchens and equipment 8 5 Pood Stores 3 3 Preparation rooms and equipment 3 2 Delivery Vans 1 - Refrigerators 1 1 Shops 17 13 Dining Rooms 8 5 Utensils. Unclean 5 3 Others. Dustbins provided or renewed 3 2 Yard cleansed, repaired 13 9 Accumulation removed 1 1 Others 9 9 PART V. Lack of name and address hoard 1 1 PART VI. Meat handling 1 1 Protection of meat in vans 1 1 Drainage unsuitable or defective 1 1 216 151 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 29 Dairies and Milk Shops 16 20 Butchers 46 184 Greengrocers and Stalls 52 812 Public Houses 52 45 Fishmongers and Stalls 21 77 Ice Cream premises 138 68 Grocers and general provisions 133 308 Restaurants and cafes 92 Kitchens and Canteens (Factory, 123 457 School and Shop) 31 Public Houses (not included in the figure above but at which restaurant service is provided ) 11 15 C/Fwd. 596 2,015 32 Food Premises. No. of Premises. Visits. B/Fwd. 596 2,015 Meat Distribution Depots 4 86 Visits to Food Premises re Condemnation of unsound Food 177 600 2,278 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. *Butter flavoured with Rum- The Analyst commented that this sample contained spice which was not declared on the label as one of the ingredients, as is required by the Labelling of Pood Order, 1953. Upon the matter being drawn to their notice the makers agreed to make the necessary amendments to the label. *Pork pies- These samples were taken as the result of a complaint concerning a perk pie which it was stated was sold in a mouldy condition. No visible mould growths were detected on one pie, but in the other, mould judged to be at least four days old, was founds. Following upon the institution of legal proceedings, the firm concerned in the manufacture and sale of the pie were fined £5 with £4.4.0. costs. Tabulated Statement of Samples Submitted to the Public Analyst during 1956. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal 1 Informal Formal Informal Formal Informal Buttered Macaroons — 1 — 1 — — Butter flavoured with Rum — 1 — *1 — 1 Butter Pats (Sweets) — 1 — 1 — — Butter, Pure dairy — 1 — 1 — — Cake mix — 1 — 1 — — Cheese Spread — 1 — 1 — — Chocolate (Milk) — 1 — 1 — — Coffee and Chicory Essence — 1 — 1 — — Crab Fish Paste — 1 — 1 — — Craw Fish — 1 — 1 — — Dressed Crab — 1 — 1 — — Pish Paste — 1 — I — — Fresh Orange Drink — 1 — 1 — — Ground Almonds — 1 — 1 — — Honeycomb — 1 — 1 — — Ice Cream — 9 — 9 — — Jam (Black Currant) — 1 — 1 — — Lemon Curd — 1 — 1 — — C/Fwd. — 26 — 26 — 1 33 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. — 26 — 26 — 1 Lemon Juice — 1 — 1 — — Milk 4 30 4 30 — — Minced Chicken — 1 — l — — Minced Turkey — 1 — 1 — — Nut Paste — 1 — l — — Peas — 1 — 1 — — Pilchards — 1 — 1 — — Pineapple Flavouring — 1 — l — — Pork Pies — 2 — *l — 1 Salmon with Potato Salad — 1 — 1 — — Sauce — 2 — 2 — — Soup — 1 — 1 — — Sponge Mixture — 1 — 1 — — Stewed Steak — 1 — 1 — — 4 71 4 70 — 2 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 apple, but it was not considered necessary to take any legal enforcement action. 34 SECTION F PREVALENCE OF, AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES The following infectious diseases are notifiable to the Medical Officer of Health of the Borough:- Scarlet Fever Whooping Cough Diphtheria (including Membranous Croup) Measles (excluding Rubella) Acute Pneumonia (primary or 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 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 1956 a total of 230 notifications of Infectious disease was received, compared with 307 in 1955. The decrease is due mainly to a drop in the number of notifications of measles. The following table gives an analysis of the cases into age groups. 35 notifiable diseases during 1956 table iv 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 - - - 2 1 8 2 4 - - - - 17 3 - - - - - - - - - - - - - Diphtheria — - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis: Paralytic - - - - - 1 - - - - - - 1 1 - - - - - - - - - - - - - Non-paralytic - - - - 1 1 - - - - - - 2 2 - - - - - - - - - - - - - Acute Infective Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection. - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 10 71 7 - - 88 88 - - - - - - - - - - - - - Pneumonia - - - - - 1 - - - 2 2 - 5 - 1 - - - - - - - 1 - 6 9 17 Dysentery - 1 1 2 1 7 3 - 3 3 - - 21 2 - - - - - - - - - - - - Measles 2 2 5 3 3 16 - 4 - - - - 35 - - - - - - - - - - - - - - Whooping Cough 2 5 2 3 3 37 3 1 1 1 - - 58 - - - - - - - - - - - - - - Pood Poisoning - 1 1 - - - - - - - 1 - 3 1 - - - - - - - - - - - - - Total 4 9 9 10 9 71 8 19 75 13 3 - 230 97 1 - - - - - - - 1 - 6 9 17 36 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 Acute Infective Encephalitis Poliomyelitis Enteric Fever (including Para-typhoid) Diphtheria Ophthalmia Neonatorum 1927 87 9 - - - 1 3 65 3 1928 135 9 - 1 7 152 4 1929 74 5 not notifiable until 1940 not notifiable until 1940 - - 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 - - - 1954 16 96 419 21 1 - - - - 1955 11 72 170 17 1 10 - - - 1956 17 88 35 58 - 3 - - - 37 Smallpox. There were no cases recorded in Kingston during 1956. This disease is still very prevalent in many parts of the world and constant vigilance is necessary,, Whilst no cases have been recorded in the country for 3 years the possibility of it being introduced at any time is always present. Particular surveillance has to be maintained 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 Vaccination 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 during their early months. This is carried out by General Practitioners and at the Surrey County Council clinics. Vaccination and re-vaccination is available free for persons of all ages. At present some 50% of children are vaccinated during their first year and it is desirable that all efforts should be made to raise this figure to at least 75%. Scarlet Fever. Seventeen cases were notified during 1956, 10 of which were of school age. Most of the cases were mild and only 3 were removed to hospital for treatment. There were no deaths. Scarlet Fever is a streptococcal infection and cannot therefore always be expected to take the form of the mild illness which it has in fact tended to become in the majority of cases occurring since the war. There is always the possibility of complications and a reversion to an illness of greater severity. Modern drugs still prove to be a good weapon against this infection. Diphtheria. For the ninth year in succession no cases of Diphtheria occurred in Kingston. An intensive campaign is carried out to immunise the school and pre-school 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 immunisation. There is no guarantee that the disease will not return, in fact during 1956 in England and Wales 63 cases of diphtheria were notified and there were 16 deaths. These figures compare with 3,575 notifications and 156 deaths in 1948. Only a population with a high level of immunity will be safeguarded, and prevention by immunisation is still an essential public service. The method employed during 1956 was to provide a combined immunisation process against diphtheria and whooping cough carried out in 3 injections at monthly intervals. Single injection "boosters" are given within a period of 5 years after the primary inoculation. 38 During 1956, 3,100 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 percentage, is computed each year. This relates to the proportion of 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 75% and the total index for all children under the age of 15 is 48%. 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 1956 the proportion of babies immunised before they reached the age of 1 year was 69%. Poliomyelitis. Limited vaccination against poliomyelitis was inaugurated during the year under review and was completed by the end of June. A total of 98 Kingston children between the age of 2 and 9 years received 2 injections and a further 14 children received 1 injection. Preparations were put in hand to co-operate with the Medical Research Councils, the Surrey County Council, and the Physician Superintendent of Kingston Hospital in the provision of information etc., arising from epidemiological enquiries made by the Public Health Department into any cases of poliomyelitis occurring during the year. The Medical Research Council particularly required information regarding cases appearing in children who had been vaccinated or registered for vaccinations, and to cases notified in households containing a person who had been vaccinated or registered. A total of 3 cases occurred during 1956, only one of which came into the categories above. Two sisters aged 4 and 6 years respectively arrived in Kingston in August from their home town in Sussex. The following day one girl fell ill and was put to bed at home and kept under observation. A week later her sister became unwell and both children were admitted to Tolworth Isolation Hospital and were notified as cases of non-paralytic poliomyelitis. Upon enquiries being made in the patients' home town it was learnt that a boy had died there earlier in the month from polioencephalitis and that he was a playmate of the children ill in Kingston. The two illnesses were comparatively mild and both girls made uneventful recoveries. Type I virus was isolated from a specimen from one girl but a negative result was obtained from the other. The third case of poliomyelitis notified during 1956 referred to an illness occurring in a boy aged 7 years and notified by the family doctor in November. There was at first some doubt about the diagnosis but eventually a virus Type I was isolated. This boy had been registered for vaccination against poliomyelitis but not vaccinated. The patient suffered a weakness of muscles and upon discharge from hospital was referred to the Orthopaedic Department at Kingston Hospital as an out-patient. Acute Infective Encephalitis. No cases occurred during 1956. 39 Enteric Fever (Typhoid or Paratyphoid). There were no cases of typhoid or paratyphoid B notified in Kingston during 1956 and this is the ninth successive year without notification of Enteric Fever. Such infection that does occur throughout England and Wales is mostly imported from abroad through contaminated foodstuffs. Foreign travellers may contract typhoid and have been known to return to this country with the infection. Dysentery (Sonne). A total of 21 cases of dysentery was notified during 1956 compared with 5 during 1955. These were all confirmed by laboratory reports on stool specimens taken from the patients and in each case the bacillary dysentery organism shigella sonne was shown to be present. The prevalence of sonne dysentery has increased throughout the country during the last few years, and although usually a mild illness with a low fatality rate, its presence causes a great deal of work in tracing contacts, and is of considerable nuisance. Every effort is made to prevent the spread of infection although the disease can and does run rapidly through schools etc. Its presence in a nursery for example can be a very serious matter. The 21 Kingston cases were all in respect of individuals or individual families; 2 cases only were treated in hospital, and all recovered without incident. Each case of dysentery is followed up intensively and all persons concerned are given advice regarding personal and general hygiene. It has been proved that the simple act of hand washing after using the W.C. can be of utmost importance in preventing the spread of sonne. The Public Health Inspectors take every opportunity of illustrating this fact to members of the general public, and especially those concerned with food handling, and the care of young children. Measles. There were 35 cases of measles notified during 1956 compared with 170 in 1955. Generally speaking the illness was of a mild type with little by way of complications and all cases were nursed at home. The majority of the illnesses (16) occurred in children in the 5/10 age group, and 15, in younger children. The remaining 4 notifications referred to the 15/20 age group. Whooping Cough. This is one of the most serious of childhood illnesses and immunisation has been offered to all children for four years now. This is usually done in a combined process in conMotion with diphtheria immunisation, and practically 100% of the children being immunised for the first time receive a "combined" material. During 1956, 58 cases of whooping cough were notified compared with 17 in 1955, 21 in 1954, 126 in 1953, 102 in 1952, and 222 in 1951. The average number of cases occurring during the previous five years was 97. 40 The cases of whooping cough occurring during 1956 were mild with no deaths. Only 2 occurred in infants under the age of 1 year, and 13 in children between the ages of 1 and 5 years. Of these 15 pre school-age children, 4 only are recorded as having received combined diphtheria/whooping cough injections. Two of these, both aged 4 years, ware immunised in 1952, and were not quite due for the normal "booster" injections, prior to contracting the disease. Ophthalmia Neonatorum. For the ninth 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 whom a temperature of 100.4°F or more has occurred within fourteen days after childbirth or miscarriage. During 1956, 88 cases ware notified, 21 of which referred to Kingston residents and all of whom were notified from Kingston Hospital. These figures compare with 72, 17 and 69 respectively for 1955. An analysis for the years back to 1952 is shown below. The maternity block at Kingston Hospital serves not only Kingston but a large surrounding area embracing a population of some 285,000 persons. During 1956, 1,763 deliveries took place in the hospital. Cases 1952 1953 1954 1955 1956 (a) Total notified 84 80 96 72 88 (b) Number included in (a) of (i) Kingston residents 23 15 27 17 21 (ii) Extra district residents 61 65 69 55 67 (c) Number included in (a) notified from Kingston Hospital 82 78 96 69 88 (d) Number included in (a) notified by private doctors 2 2 - 3 - (©) Number of cases included in (d) removed to hospital other than those included in (c) - - - - - Pood Poisoning. A total of 3 sporadic cases of food poisoning occurred during 1956, and there was a total absence of outbreaks. In each case a salmonella organism was isolated from specimens of stool, whilst the results obtained from family etc., contacts were all negative for pathogenic organisms. No particular food or vehicle of infection was implicated. Only one case was in respect of an adult, and he had suffered symptoms after eating in Calcutta. He reported to his doctor on arrival hare in the course of his duties as an airline pilot. All necessary precautions were taken and he remained off duty until fit and free from infection. The 2 other cases were in respect of young children. All efforts are made to maintain the highest possible standard in the many eating places in the town, which cater for thousands of visitors and business people each day. It is to some extent a measure of the success of the vigilance maintained and the standards practised that there were no confirmed incidents of food poisoning. 41 Tuberculosis. During 1956 the number of new cases notified in Kingston was 27, 25 of which referred to respiratory disease. This compares with the exceptionally low total of 20 (l4 of which were respiratory) for 1955. Deaths totalled 2 compared with 6 in 1955. In March and April the town was visited by the South West Metropolitan Regional Hospital Board Mass X-Ray Unit. A total of 6,305 persons were examined and 6 cases of pulmonary tuberculosis were discovered® This represents a rate of O.95 per 1,000 new active cases discovered. A further 200 inactive cases were recorded and also 145 non-tuberculous abnormalities. A part of this general survey was conducted in Norbiton, and although the above figures relate to Kingston as a whole, separate analysis shows a rate of l.6l new cases per 1,000 persona examined for Norbiton. The following table shows comparative figures of notified cases and deaths for the years 1947 to 1956 (inclusive):- Year Cases Notified Death® Respiratory Non-Respiratory Total Respirator piratory Total 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 1956 25 2 27 2 - 2 From the above it ©an be seen that the trend of notifications of respiratory disease is downwards vide graph on following page. This is in spite of vigorous methods e.g. Mass X-Ray and the follow up of contacts to find all possible new eases. It is also evident that fewer deaths are occurring attributed to pulmonary tuberculosis. This would be expected from the fact of fewer cases; It may quite well also be due to the fact that some chest conditions causing deaths which in former years might have been attributed to pulmonary tuberculosis, are now more accurately attributed to other conditions e.g. cancer of the lung or bronchus etc. The efficiency of notification has been good and there is no reason to suspect refusal or neglect to notify.. No posthumous notifications were received during 1956. Throughout the year 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. 42 Considerable help is given to tuberculosis patients and their dependents by the Kingston and District Tuberculosis Care Committee. During 1956, 122 families were helped in the form of grants for extra nourishment, clothing, fuelp removals,, bedding, fares, pocket-money, etc., and a total of £1,500 was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1956 in age groups is shown on the next page, and the following graph depicts the numbers of new cases and deaths in respect of respiratory tuberculosis occurring for the years since 1940. 43 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1956. TABLE VI. NEW CASES DEATHS Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - 45 U5 - 55 55 - 65 65 & over Total Under 1 year 1-5 5-15 15 - 25 25 - 35 35 - k5 k5 - 55 55 - 65 65 & over Total Tuberculosis (a) Respiratory M - - - 1 4 3 4 - 2 14 - - - - - 1 1 - - 2 F - - 1 3 2 1 3 1 - 11 - - - - - - - - - - Total - - 1 4 6 4 7 1 2 25 - - - - - 1 1 - - 2 (b) Non-respiratory M - - - - - - - - - - - - - - - - - - - - F - - - - 1 - 1 - - 2 - - - - - - - - - - Total - - - - 1 - 1 - - 2 - - - - - - - - - -