KIN 31 AC 4413(1) KINGSCON-UPON-THAMES. THE HEALTH of the ROYAL BOROUGH OF KINGSTON-UPON-THAMES Surrey 1957 The ANNUAL REPORT of the Medical Officer of Health and the Chief Public Health Inspector public health department, guildhall, kingston-upon-thames, june 1958 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES SURREY 1957 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND THE CHIEF PUBLIC HEALTH INSPECTOR PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES JUNE, 1958 ANNUAL REPORT 1957 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 (l) 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) Infant Death Rate-Quinquennial Infant Mortality Rate-Causes of Death of Children under one year 4, 5. (iii) Deaths from Other Causes 6. Introduction to Tables on Vital Statistics 6. Table I - Extracts from Vital Statistics for years 1953-1957 inclusive 7. Table II - Comparison of Vital Statistics 1928-1957 8. Table III - Causes of Death 9. SECTION B General Provisions of Health Services (1) (i) Laboratory Facilities 10. (ii) Hospitalss:- (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, 1951) 13. SECTION C Sanitary Circumstances (1) Water Supply 14. (2) Drainage and Sewerage 14. (3) Elvers and Streams 14. (4) Closet Accommodation 14. (5) Public Cleansing 14, 15. (6) Sanitary Inspection of the Area 15. (17) Shops 16. Page (8) Factories Act, 1937 16, 17. (9) Camping Sites 17. (10) Atmospheric Pollution 17, 18, 19, 20, 21. (11) Swimming Baths and Pools 21. (12) Eradication of Bed Bugs 21. (13) Complaints 22. (l4) Rodent and Insect Pest Control 22, 23, 24. SECTION D Housing General 2 4 , 2 5. Statistical Statement, 1957 26, SECTION E Inspection and Supervision of Food (a) Milk Supply 26. (b) Designated Milks 26, 27. (c) Bacteriological Examination of Milk 27. (d) Ice Cream 27. (e) Meat and Other Foods 27, 28. (f) Pood Hygiene-Food Hygiene Regulations, 1955 28, 29, 30. Pood and Drugs Act, 1938 30, 31. Tabulated Statement of Samples Submitted to the Public Analyst during 1957 31, 32, 33. Merchandise Marks Act, 1926 33. SECTION F Infectious Diseases. Notifiable Diseases 34. Table IV. Notifiable Diseases during 1957 35. Table V. Comparative Statement of Notifications of Certain Infectious Diseases 36. Smallpox 37. Scarlet Fever 37. Diphtheria 37, 38. PoliomyelitiS 38. Acute Infective Encephalitis 38. Enteric Fever (Typhoid and Paratyphoid) 38, 39. Dysentery 39. Measles 39. Whooping Cough 39. Ophthalmia Neonatorum 40. Puerperal Pyrexia 40. Food. Poisoning 40, 41. Tuberculosis 41, 42. Table VI. Notified Cases and Deaths from Tuberculosis in 1957 43. PREFACE TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT. 1957. 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 1957. 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 1/58. I am indebted to Mr. G.C. Smith, Chief Public Health Inspector, with special reference to Sections C-E, and Mr. M.E. Powell, Administrative Officer, for assistance in compiling the Report. Population.- The estimated mid 1957 home population given by the Registrar General is 38,590 an estimated decrease of 200 persons compared with 1956. 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 1957 was 664, which is 434 more than in 1956. The increase is due to a greater incidence of measles. Only 2 cases of poliomyelitis were notified during the year, each in respect of a person who had not been protected by vaccination. Further progress was made in the active immunisation of the child population against diphtheria, Special attention being given to administering "Booster" doses to school children. Vaccination again poliomyelitis - This new protective inoculation proceeded throughout the year at a pace determined by the supply of vaccine. Suitable arrangements were in hand to use the material to the best advantage as soon as it was received, Vaccination against smallpox -This is voluntary and calculations show that by the end of 1957 some 51% of the children born between 1st July, 1956 and the 30th June, 1957 have been vaccinated. Every effort should be made to raise this figure. In general the health of the people was very good, and a high standard of hygiene was maintained. Births- The number of live "births for 1957 is 548 and compares with 550 for 1956. The crude birth rate is 14.20 per 1,000 population compared with 14.18 for 1956. Deaths- The number of deaths recorded in 1957 is 432 compared with 442 for 1956. This makes a crude death rate of 11.2 for 1957 compared with 11.4 for 1956. The excess of births over deaths was 116 compared with 108 for the previous year. The number of deaths of infants tinder 1 year of age in 1957 is 7 which gives an Infant Mortality rate per 1,000 live births of 12.8. The corresponding figures for 1956 were 13 infant deaths and an Infant Mortality rate of 23.64. The approximate average rate for the previous five year. (1952-56) is 21. The Infant Mortality Sate of 12.8 for 1957 is the lowest yet recorded for the Royal Borough of Kingston-uponThames. This is getting nearer to an irreducible minimum. There were no maternal deaths (i.e. from pregnancy, childbirth, abortion). These rates are very satisfactory and are not likely to be bettered to any great extent in the future, or in any other communities where accurate vital statistics are kept from year to year. Causes of Death- The main conditions causing death during 1957 were Heart Disease-121, Cancer-76 and Vascular Lesions of the Nervous System-74. 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. 1953 1954 1955 1956 1957 M F M F M F M F M F 13 2 16 2 24 4 21 1 10 6 Total Total Total Total Total Deaths from cancer of the lung and bronchus 15 18 28 22 16 Housing- During 1957 the Corporation completed only 4 Housing Units which were 1-bedroom flats. A further 28 Housing Units were provided by private enterprise. The Borough is almost completely built up and the work of dealing with obsolete houses is being proceeded with but is dependent to some extent upon the availability of suitable alternative accommodation for displaced families. It is necessary somehow to stimulate provision of houses suitable for aged couples or persons living alone and to continue to encourage the transfer of aged persons occupying larger houses to more modest accommodation suited to their needs, remembering the amenities and social services necessary to counterbalance the loss of security and disturbance of emotions in making a move from homes in which they are deeply rooted. The "Aged". In spite of all that is done, for the welfare of the people who are becoming aged and infirm, by the statutory bodies and by voluntary organizations in the Royal Borough of Kingsten-upen-Thames and the neighbouring districts of Surbiton, Malden, Esher, there are still those who, having outlived most, of their relatives and friends, have become unable to help themselves, unco-operative, and have fallen into a decline These require to maintain them extraordinary services beyend those available. It is not possible nor is it right in every such case to put them into hospital. Extraordinary and heavy demands are made on official and unofficial resources to meet these desperate situations when they are revealed. I acknowledge most gratefully the splendid humanitarin self-saerificing efforts made in personal service toward the relief of such cases. I am confident that when faced with such problems to solve on behalf of anyone who has come to their latter days, I will continue to find persons willing to help them live out their time in. befitting decency and comfort. I gladly record my thanks for the support and encouragement to me in my work, to The Worshipful The Mayor, Aldermen and Councillors. I specially record my 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 my fellow Chief Officers. I have the honour to be, Your obedient Servant, J.W. STARKEY. Medical Officer of Health. 1957 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 1957-58 the Public Health Committee was constituted as follows:- Alderman Oldfield (Chairman) Councillor Evans " Digby (Vice-Chairman) " Marshall Councillor Alexander (Mayor) " Prince Alderman Knowlden (Ex-Mayor) " Parker " Eggleton " Tapping Councillor Lacy " Lees " Eades " Wells STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M.B., Ch.B. (Edino), D.P.H. Deputy Medical Officer of Healths (part-time). W.H. KINSTRIE, M.B., Ch.B. (Edino), D.P.H. Chief Public Health Inspect or: 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. (a) (b) (c) Additional Patlic Health Inspectors: S.W. SIMPSON-SCOTT, M.R.S.H., M.A.P.H.I. (a) (b) M.G. TOMKINS, M.A.P.H.I. (a) (b) Junior Public Health Inspectors (vacant) Chief Clerk; M.E. POWELL. D.P.A. (Londo) Clerical Staff: MISS C.L. FOISTER, M.I.P.S. MISS M.W. FILBEE. G. NORTHWOOD. H. SHARP. Assistant Rodent Officer: F.W. STAGG. Rodent Operatives: G.H. LOCKE. F.J. PERRY. Disinfector/Driver: F.C. LOCK (resigned 26.8.57) D. WILKINSON (appointed 2.9.57) (a) Certificate as Public Health Inspector. (b) Certificate as Meat and Foods Inspector. (c) Certificate as Smoke Inspector. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres 1,390 Total Population (including Service personnel) 38,590 Number of inhabited houses (approx.) 11,706 Rateable Value-General Rate (l.4.57) 1,055,657 Sum represented by Penny Rate (Year 1957/58) £4,821 The total number of hereditaments is 14,258 of which 81% are domestic dwellings. There are 2,319 commercial premises in the town being 16% of the total hereditaments. The remaining premises totalling 428 are classified as industrial, entertainment, public utility, educational and miscellaneous. 2. Social Conditions. The Royal and Ancient Borough of Kingston-upon-Thames is a thriving market town situated in the County of Surrey on the bank of the river Thames, and in the Greater London area. 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 high employment and the Manager of the local Employment Exchange has kindly provided the following information regarding employment in Kingston and the surrounding districts. "The employment position in the area is encouraging and throughout 1957 there was an atmosphere of industrial activity. The redundancies in the Aircraft Industry were not as heavy as first anticipated and following upon orders from abroad many employees were recalled. It is expected that present contracts will ensure steady employment for the next few years, but, of course, the position of the aircraft industry as a whole is uncertain at the moment. At the commencement of the year there were 434 men and 121 women registered as unemployed. During the year 10,968 men and 3,402 women registered for employment but turnover of labour continued at a high rate and at the end of the year only 380 men and 89 women were unemployed. Long term unemployment was again restricted to elderly men and some disabled persons. The current unemployment figure for this area represents .4% of the insured population and compares very favourably with the National figure of 1.5%. At the end of the year there were over 600 local vacancies for men and over 500 for women,, During the year some 3,268 men and 1,394 women were placed in employment in this area. 3 The demand for skilled workers continues especially in the aircraft, building and engineering industries. 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 be 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 509 245 264 Illegitimate 39 17 22 548 262 286 Birth Rate per l,000 population (Crude Birth Rate) 14.2 Adjusted Birth Rate 13.6 England and Wales Birth Rate 16.1 (b) Stillbirths- Total Male Female Legitimate 8 3 5 Illegitimate - - - 8 3 5 Rate per l,000 total (Live and Stillbirths) 14.4 England and Wales Stillbirth Rate 22.1 (e) Deaths- Total Male Female 432 202 230 (i) Death Rate per 1,000 population (Crude Death Rate) 11.2 Adjusted Death Rate 10.3 England and Wales Death Rate. 11.5 (ii) Infant Death Rate (deaths of all infants under one year of age. Total No. of Deaths Rate per l,000 live births 7 12.8 England and wales Rate 23.0 NO. of Deaths Legitimate Infants Rate per l,000 legitimate live births 7 13.8 All Infants under 4 weeks of age (included in above). Total No. of Deaths Rate per l,000 live births 5 9.1 5 The approximate infant mortality rate for 1957 and the rates since 1953 are shown for purposes of comparison. 1953 1954 1955 1956 1957 Kingston-upon-Thames 24 20 15 24 13 England said Wales 26 25 25 24 23 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. 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 Kingstonupon-Thames children who died during 1957 before reaching the age of one year, together with the cause of death. Age Total Deaths Cerebral Haemorrhage Congenital Deformities Atelectasis Pneumonia Acute Laryngotrachea Bronchitis Meningomyelocele 0-24 hours. 3 - 1 2 - - - 24 hrs. -1 mth. 2 1 - - 1 - - 1 mth. -1 yr. 2 - - - - 1 1 Totals 7 1 1 2 1 1 1 6 (iii) Deaths from Other Causes. No. of Deaths. Deaths from Heart Disease 121 Deaths from Cancer 76 Deaths from Vascular Lesions of the Nervous System 74 Deaths from Circulatory Disease other than Heart 26 Deaths from Bronchitis 36 Deaths from Pneumonia 20 Deaths from Influenza 6 The following tables I, II, III, summarise certain vital statistics,. Table I shows the figures for live births, stillbirths, and deaths for the years 1953 - 1957 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1928. 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 Cause© of Death. 7 EXTRACT PROM VITAL STATISTICS FOR YEARS 1953 - 1957 INCLUSIVE. TABLE I. 1953 1954 1955 1956 1957 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 564 290 274 498 246 252 491 253 238 508 260 248 509 245 264 Illegitimate 45 24 21 36 22 14 52 23 29 42 21 21 39 17 22 609 314 295 534 268 266 543 276 267 550 281 269 548 262 286 Birth, rate (R.G.) per 1,000 pop. 15.25 13.64 13.89 14.18 14.20 STILLBIRTHS Legitimate 18 12 6 13 4 9 8 3 5 10 4 6 8 3 5 Illegitimate 1 1 = 2 1 1 - - - 2 2 — - - - 19 13 6 15 5 10 8 3 5 12 6 6 8 3 5 Rate per 1,000 (live and stillbirths) 30.25 29.14 14.52 21.35 14.38 DEATHS 465 240 225 450 206 244 424 212 212 442 214 228 432 202 230 Death rate (R.G.) per 1,000 pop. 11.64 11.49 I0.85 ll.39 11.19 8 COMPARISON OP VITAL STATISTICS 1920-1957. TABLE II. Year Estimated Population Live Births Birth Rate per 1,OOO Population Deaths Death Rate per 1,000 Population Infantile Mortality Rate per l,000 live births Kingston upon Thames England and Wales 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 31780 578 l6.6 474 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.l 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 1957 38590 548 l4.2 432 11.2 13 23 9 TABLE III Causes of Death Registrar General's Tables 1953 1954 1955 1956 1957 M F M F M F M F M F All Causes 240 225 206 244 212 212 214 228 202 230 Tuberculosis, respiratory 5 3 - 3 6 - 2 - 5 1 Tuberculosis, other — 1 1 — — — - — — 1 Syphilitic disease - 1 - - 1 - 1 - - 2 Diphtheria 1 - — - - - - - — - Whooping Cough. - - - - - - - - - - Meningococcal infections, - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - Measles 1 - - - - - - - - - Other infective and parasitic diseases. - 2 - 1 1 1 2 1 1 - Malignant neoplasm, stomach 4 4 2 3 4 6 4 5 3 7 Malignant neoplasms, lung, bronchus 13 2 16 2 24 4 21 1 10 6 Malignant neoplasm, Uterus - 3 - 1 - 3 - 4 - 5 Malignant neoplasm,breast - 10 - 6 - 5 - 12 - 7 Other malignant and lymphatic neoplasms 25 34 22 20 27 16 19 29 19 19 Leukaemia, aleukaemia 1 2 — 1 3 1 1 - — 3 Diabetes — 2 1 1 — 3 1 2 1 - Vascular lesions of the nervous system. 26 35 21 45 25 46 22 39 24 50 Coronary disease, angina. 43 18 34 28 44 22 43 26 43 25 Hypertension with heart disease. 4 8 6 10 1 6 2 7 5 6 Other heart disease. 16 31 18 34 12 35 18 26 17 25 Other circulatory disease 22 11 17 20 12 21 8 19 11 15 Influenza. 4 7 1 1 — 2 1 2 — 6 Pneumonia 11 10 9 14 9 12 9 8 9 11 Bronchitis 16 15 15 9 17 6 16 9 24 12 Other diseases of respiratory system 4 4 2 7 - - 3 - 4 1 Ulcer of stomach and duodenum 6 - 3 1 3 - 8 1 - - Gastritis, enteritis, and diarrhoea 2 2 - 3 1 3 1 - - 1 Nephritis and nephrosis. 5 - 4 2 1 - 2 - 5 2 Hyperplasia of prostate 8 - 5 - 2 — 4 - 3 - Pregnancy, childbirth, abortion - - - - - 1 - 2 - - Congenital malformations. 2 — 4 1 3 1 3 3 3 3 Other defined and illdefined diseases 14 18 16 21 8 10 17 23 11 15 Motor vehicle accidents. 3 — 4 — 2 1 2 — 1 3 All other accidents 3 — 3 4 2 5 2 4 2 3 Suicide 1 2 1 5 4 2 2 5 1 - Homicide and operations Of War - - 1 1 - - - - - 1 10 SECTION B GENERAL PROVISIONS OF HEALTH SERVICES 1. (i) Laboratory Facilities. During 1957 bacteriological examinations were carried out by Dr. D.S. Murray at the Laboratory, 37. Coombe Road, as part of a pathological service administered by the South West Metropolitan Regional Hospital Board. In addition, the Ministry of Health Laboratory at Epsom is available for consultations and, if an occasion should arise, for help in the investigation of any important outbreaks of disease. There are also occasions on which special use is made of the services of the Public Analyst in chemical sampling which may become necessary in the interests of public health. Bacteriological examinations of milk are undertaken by the Ministry of Health Laboratory, Epsom, and samples under the Pood and Drugs Acts are submitted to the Public Analyst, Mr. D.D. Moir, at the Analytical Laboratory, Southwark Street, S.E.l. (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 76 infectious disease cases were treated in hospital, but 59 of these were notified from Kingston Hospital in the first instance and related to puerperal pyrexia. To Kingston Hospital 9 „ Tolworth Isolation Hospital, Surbiton 16 „ St. Helier Hospital, Carshalton. 1 (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 Boroughs- (a) Ante-natal and post-natal clinics. Health Centre, Grange Road. Wednesdays, p,m. (b) Infant welfare clinics. Health Centre. Tuesdays & Fridays, p.m. a Park Road Clinic, St. Paul's Hall, Park Road. Mondays & Thursdays, p.m. (c) Immunisation and vaccination clinics. Health Centre. Fridays, p.m. Park Road Clinic. (Tuesdays , p.m. (Fridays, a.m. (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". a The address of this Clinic is now (1958) 25, Queen's Road, Kingston-upon-Thames. 12 (i) 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. (d) 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 359 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. (d) Ascertainment of handicapped pupils in need of special education. (e) Treatment clinics as under:- (i) Minor ailments. Health Centre. Daily, 9-10 a.m. Park Road Clinic. " 9-10 a.m. (ii) Medicai consultation Health Centre. Mondays, a.m. Park Road Clinic. Fridays, a.m. (iii) Eye clinic. Health Centre. Thursday, 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 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 359 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-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. (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 1957, but the problems associated with aged persons do not diminish. All necessary help and advice was given to each individual case coming to the notice of the Public Health Department, and everything done to improve the well-being and living conditions of the old persons concerned. There is a close co-operation between the Physician Superintendent of Kingston Hospital, the Welfare Officer, local Doctors, and your Medical Officer of Health. The Superintendent of Kingston Hospital is assisted by a Geriatrician and Geriatric Health Visitor and 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. 14 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 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 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 is under the control of the Thames Conservancy Board. The Hogsmill River, a tributary of the Thames, flows through the Borough. When the Hogsmill Valley Joint Sewerage Board fully 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 be sewage effluent for a very high percentage of its volume. It is hoped, however, that the increased flow will bring about an improvement in the condition of the river. 4. CLOSET ACCOMMODATION. All elosets 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 refuse from this Borough, Surbiton and Maiden is transferred to large capacity road vehicles anc3 transported to the tip by the contractor. The refuse is now weighed on a weighbridge and 11,425 tons of refuse have been sent from this Borough in 1957. 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 10,450 as compared with 10,381 for 1956:- House inspections, defects, etc. 447 Drainage 66 Factories 92 Outworkers Atmospheric Pollution 814 Dairies, Milk Shops, etc. 52 Food Premises 1,410 Restaurants and Cafes 493 Infectious Disease Inquiries 19 Theatres and Cinemas 6 Verminous Premises 38 Rodent Control 252 Shops 281 Schools 32 Housing Act 30 Market s 1,040 Public Sanitary Conveniences 62 Fireguards 95 Merchandise Marks Act 450 Misce1laneous 1,558 7,314 Reinspections and works in progress 3,136 10,450 NOTICES SERVED., Informal. (a) Verbal 219 (b) Writ ten 195 Statutory. (a) Housing Acts - (b) Public Health Acts 14 NOTICES COMPLIED WITH. Informal. (a) Verbal 439 (b) Written Statutory. (a) Housing Acts - (b) Public Health Acts 19 16 7. SHOPS. There are 984 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, 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 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 281 inspections were made during the year and eleven Notices were served; seven of these referred to early closingp two to the condition of sanitary accommodation and two related to the structural conditions. 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 Sec, 1,2,3,4 & 6 are enforced by the Corporation 74 12 1 - Factories not included above in which Sec.7 is enforced by the Corporation 289 177 12 - Other premises excluding Outworkers 9 1 1 - 17 2. CASES IN WHICH DEFECTS WERE FOUND. 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 1 - 1 — Over-crowding - - - 1 - Unreasonable Temperature — - - — — Inadequate Ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences- (a) Insufficient 2 - — 1 — (b) Unsuitable or defective 12 6 - - - (c) Not separate for sexes 1 - - - - Others 6 3 - 4 - 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. 7 Cardboard boxes 1 Clocks 1 Wire brushes and pot scourers 9 Fuses 1 19 9. CAMPING SITES. There are no camping sites within the Borough, but during the year a temporary licence was issued to station a caravan on a site at the Crescent Riding School, The caravan remained on the site for a period of less than two months. 10. ATMOSPHERIC POLLUTION. Fifteen complaints were received with regard to smoke or grit emission. A total of 184 visits were made to "boiler installations situated in industrial or institutional premises. 18 Upon investigation, not all the complaints were justified. Very often when attention is drawn by occupiers of houses near industrial premises to nuisance from soot particles, it is found that the cause is of domestic origin. There is no doubt that, with very few exceptions, the industrial plants in the town, most of which have been converted to oil firing, are maintained at a high degree of efficiency and are operating well within the limits which are likely to be required by Regulation,, One can only reiterate what has been stated in earlier reports, namely, that the main source of avoidable atmospheric pollution in the town is from domestic fires.Raw coal is such a valuable national asset that we cannot afford to burn it wastefully in open domestic grates. Some Interest was aroused in last year's report on the fuel economies which can be effected by the fitting of restricters in the flues of fireplaces. There must be an immense number of firegrates in the town which could be improved by simple modification and consequently enable more heat to be made available by the use of less fuel. There should be a national policy of clean air and a close co-operation between the national boards which produce and use fuelo At present it is more difficult to obtain smokeless fuel than coal. Co-operation between the Coal and Gas Boards could reverse this position. It must be again repeated that the occupiers of the prefabricated bungalows in the town could materially improve the condition of the atmosphere around their dwellings if they used coke instead of ccal. The grates installed in these bungalows are designed to burn coke. With regard to the recording of atmospheric pollution in Kingston, three standard deposit gauges have been maintained by the Corporation and were located after consultation with the Department of Scientific Researchp in Canbury Gardens, at Tiffin Girls' School and the Cemetery, Bonner Hill Road. They are, for the purposes of report, referred to as 'A', 'B' and 'C' respectively. It was, however, decided during the year to discontinue records from the instrument located at the Cemetery,, It was felt that the costs of maintaining this instrument could be better devoted to the provision of a daily volumetric smoke and sulphur dioxide instrument. This instrument is fixed on the roof of the Guildhall, but it was not possible to commence recording during the year. 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 sources towards the recording stations. 19 CANBURY GARDENS - Station 'A'. Deposit in Tons per sqemile Wind Direction Rainfall in Inches 1957 Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times SE - SW January 14.39 7.69 22.08 81 43 1.56 February 10.74 9.52 20.26 72 63 2.94 Mareh 13.20 5.28 18.48 78 59 0.88 April 6.49 2.81 9.30 88 18 0.29 May 18.01 5.62 23.63 81 39 1.61 June 15.88 5.90 21.78 75 15 0.53 July 15.31 6.03 21.34 81 39 3.10 August 8.67 5.82 14.49 81 35 5.67 September l1.04 7.65 18.69 78 36 2.36 October 80.4O 4.03 12.43 81 45 1.84 November 7.55 10.93 18.48 78 30 2.41 December 20.45 7.55 28.00 72 45 2.65 Totals 150.l3 78.83 228.96 — - 25.84 Average 1957 12.51 60.57 19.08 — — 2.15 Average 1956 10.01). 8.96 19.00 — — 1.74 TIFFIN GIRLS5 SCHOOL - Station 'B'. 1957 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 5o6l 5.24 10.85 81 43 1.31 February 5.24 8.20 13.44 72 63 2.88 March 6.01 5.91 11.92 78 59 0.85 April 3.68 2.85 6.53 88 18 0.23 May 9.36 5.H 14.47 81 39 1.52 June 6.90 5.71 12.61 75 15 0.73 July 5.64 5.24 10.88 81 39 2.90 August 1.46 4.68 6.14 81 35 6.02 September 3.12 3.15 6.27 78 36 1.16 October 1.99 2.12 4.11 81 45 0.87 November O066 3.72 4.38 78 30 0.99 December 2o46 3.39 5.85 72 45 0.93 Totals 52.13 55.32 107.45 - - 20.39 Average 1957 4.34 4.61 8.95 — - 1.70 Average 1956 4.67 5.28 9.95 — - 1.71 20 CEMETERY - Station 'C'. 1957 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 2.95 3.4l 6.36 81 - l.l46 February 3.35 5.24 8.59 72 3 2.70 March 2.88 4.54 7.42 78 7 0.70 April 3.94 2.22 6.l6 88 10 0.25 Total 13.l2 15.4l 28.53 - — 5.1l Average 1957 * 3.30 3.85 7.l3 - 1.28 Average 1956 hoik kol5 8.89 - - 1.64 Average l4./12ths Station A Station B. 1957 Station C. 1957 ¼ Total Cumu Lative ¼ Total Cumulative ¼ Total Cumulative First Qtr. 60.82 60.82 36.21 36.21 22.37 22.37 Second Qtr. 5l.71 115.53 33.6l 69.82 - - Third Qtr. 54.52 170.05 23.29 93.l1 — — Fourth Qtr. 58.91 228.96 14.34 107.45 - - GENERAL0 Station A Station B Station C Total Deposit 228.96 107.45 28.53 4/12. Average Monthly Deposit 19.8 80.95 7.l3 Total Rainfall 25.84 20.39 5.11 Average Rainfall 2.15 l.70 l.28 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, and a similar figure for 1957, of the readings in respect of Station 'A' at this stage cannot be readily explained. It remains to be seen what trends are revealed by the results of further observations,, ATerapce 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) l4.34 (6/12) 1951 22.19 12.47 12.03 1952 19.l2 12.49 12.84 1953 17.58 10.32 9.95 1954 18.70 10.21 lO.OO 1955 15.85 9.l3 (H/12) 10.15 (10/12) 1956 19.00 9.95 8.89 .1957 19.08 8.95 7.13 21 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 32 hours during bathing periods. In hot weather the filters are working continuously day and night. Chlorination is marginal and the residual guantity 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 seven premises were disinfested. One of these was a house under the control of the Corporation. 22 13. COMPLAINTS. The number of complaints received from the general public during the year was 429 compared with 500 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 19571- Sanitary defects 86 Rodents 14O Defective Ashbins 2 Drains and sanitary arrangements 76 Overcrowding 5 Pood 31 Nuisance from Smoke 15 Defective Yards and Paving 5 Insect Pests 15 Accumulations 9 Animals 1 Water 3 Others 41 429 14. RODENT AND INSECT PEST CONTROL. As in previous years, it is pleasing to report that 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. When infestations have been dealt with which require co-ordinated effort, excellent co-operation has been received from the officers of adjacent Authorities and the contractors to British Railways. During 1957 three treatments were carried out to the sewers. One hundred and seven of the manholes known by previous experience to require attention were treated. Owing to shortage of labour the first treatment was by a contractor using a highly toxic substance - sodium fluoracetate. This is the first occasion on which it has been used for this purpose outside the City of London and after considering all the factors involved, permission to use the substance was given by the Ministry of Agriculture, Fisheries and Food. Using methods devised by the Department, this proved to be a very economical means of dealing with sewer infestation. The results of two subsequent treatments using other poisons confirmed that the use of sodium fluoracetate is a distinct advantage in dealing with rodents in sewers. The need for this work is emphasized by the fact that many surface rat infestations are traceable to defective drains, and more rarely to faults in the sewers. During the year 2+2 defects of drainage systems were traced which had been proved to be the cause of the infestation. 23 Rodent Control - Statistical Statement. 1957. Private Dwellings and Corporation Property. Rats. Mice. Total NO.of complaints received in office 86 32 118 No. of premises inspected as a result 399 No. of premises found to be infested 112 36 l48 No. of separate infestations treated 171 33 204 No. of visits for treatment and reins pections 1,392 116 1,538 No. of premises treated by occupier or other agency 4 6 10 NO. of poison baits deposited 293 Business and Factory Premises. Rats. Mice. Total. No. of complaints received in office 10 12 22 No. of No. of premises inspected, including these under Service Agreement premises in which slight 181 tions were found 51 103 154 No. of separate infestations treated 78 326 404 No. of visits for treatment and inspections 694 1,701 2,395 No. of premises treated by occupier or other agency 7 4 11 No. of poison baits deposited 2,243 Summary. No. of complaints received 140 No. of premises inspected 580 No. of premises infested 302 No. of visits 3,600 No.of premises treated by occupier or other agency 21 No. of poison baits deposited 2,536 Insect Pest Control. Insect pest control and maintenance treatments with regard to antS, 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. 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. 24 The use of insecticidal lacquers referred to in previous years has continued with good results, The long period of toxicity of such materials compared with the use of powders is the means of a considerable saving in labour. With insects, as with rodents, it is essential to maintain strict watch and control, particularly in food premises. Infestations can readily build up if proper hygiene work is not done. There is also risk of re infestation by insects being introduced with new stock. SECTION D. HOUSING. During the year the Rent Act, 1957 came into operation. This important piece of legislation will have considerable effect on existing properties which, in many cases, were deteriorating because the income was insufficient for them to be maintained in good repair. Whilst this enactment is strictly a matter between landlords and tenants, the Local Authority is concerned with the issue of Certificates of Disrepair where these are requestedp and the consequent certification of the repair works involved. The following is a tabulated statement of action taken from 6th July to 31st December, 1957. Number of Applications 77 Number of satisfactory Undertakings received 49 Number of Certificates of Disrepair issued 16 Number of Proposals to issue Certificates of Disrepair outstanding pending expiry of three weeks 1 Certificates of Disrepair made under 1957 Act. Number of applications for cancellation 2 Number of objections - Number cancelled - Certificates of Disrepair made under 1954 Act. Number of applications for cancellation 2 Number of objections 1 Number cancelled 1 The number of applications received is a fair average for towns of similar population figure and character. In the case of houses which remain under control, there appears to be little difficulty in applying the provisions of the Act. Pew of the applications have been made out of a sense of injustice and the relatively high number of undertakings which have been given is an indication that the owners are prepared to carry out works of repair which can be considered to be reasonable in extent. 25 There has "been a tendency on the part of owners when confronted with what appear to "be excessive demands by the tenants, to use the Local Authority as arbitrators. This, of course, was ant icipated, and so far no difficulty has been experienced in dealing with these cases. It is to be hoped that sufficient labour will be available to enable the works to be completed within the six months period prescribed. The 1957 Act, it is felt, will succeed where that of 1954. failed in that owners will receive a rent return which will enable the houses to be maintained in a better condition. With regard to Statutory Action under the provisions of the Housing Act, 1936, two Closing Orders were made - one in respect of No, 72, Passett Road and the other for the front and back rooms (top floor) of No, 36, Tudor Road, Undertakings were also received that the premises would not be used for human habitation from the owners of No, 2, Bishops Hall -and No. 72, Cambridge Road (basement). 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 22 2. Number of houses which, on inspection, were considered to be unfit for human habitation 2 (a) Parts of houses which, oh inspection, were considered to be unfit for human habitation 2 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 151 4. Number of representations made to the Local Authority with a view tog- (a) The serving of notices requiring the execution of works - (b) The making of demolition or closing orders 1 5. Number of formal notices served requiring the execution of works 14 6. Number of houses which were rendered fit after the service of formal notices 19 7. Number of demolition or closing orders made 2 8. Number of houses in respect of which an undertaking was accepted under sub-section 3 of section 11 of the Housing Act, 1936 2 9. Number of houses demolished 15 26 Housing - Statistical Statement, 1957. The following information is supplied by the Borough Surveyor who indicates that four flats were built by the Corporation during the year - all in the Borough. Total number of permanent dwellings erected by the Corporation since March 1924 to 31st December. 1957. Houses 1,137 Inc. 876 outside Borough) Flats 841 inc. 326 outside Borough) Total number of temporary dwellings erected up to 31st December. 11957. Still remaining,, Arcon 132 129 Aluminium 7O 57 2 year huts 113 21 315 207 Number of 2 year huts demolished during 1957 - 11 Number of dwellings erected by private enterprise during 1957. Houses 16 Flats 12 _28 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 19519 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 1957 under the provisions of the Milk (Special Designations) Regulations. All the licences were in force at the end of the year. 27  Pasteurised Sterilised Tuberculin Tested To pasteurise 1 - - To deal 11 11 6 Supplementary 10 7 10 (c) Bacteriological Examination of Milk. During the year 79 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 144. This figure also 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 soldo These premises are hot required to be registeredo By far the greater part of the ice cream sold in the town is obtained from manufacturers whose premises are situate outside the Borougho 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 90 samples submitted to the Public Health Laboratory at Epsom during 1957o Owing to the numerous factors governing the hygienic quality df ice cream, undue attention is not paid to the bacteri logical results on any single sample whilst Grades I and II can be considered to be satisfactory, Grades III and IV cannotp and appropriate action is taken in respect of any vendor whose samples do not fall consistently into Grades I or II. Ice Cream GRADE I 11 III IV Total 69 16 5 90 (e) Meat and Other Poods. (i) There are no slaughter houses in the Borougho 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 modetn abattoir at Guildfordo (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 detailo Tabulated list of Condemned Foodstuffs showing causes for condemnation and the Weights. Article of Food. Reason for Action. Weight. lbs. lbs. Raw Meat Bovine Decmposit ion 228¾ Ovine „ 385½ Porcine „ 243¼ Total quantity of raw meat 857½ Raw Fish Decomposition 686 Poultry.ame.etc. „ 13 Dried Fruit „ 17½ Canned Goods Meat and Meat Products 650½ Fruit 1,033½ Jam 5½ Vegetables Punctured, Blown, 134 Milk Damaged, 127¾ Soup Decomposition 14¼ Fish and Fish Paste 16½ Others 16¼ 1,998¼ Food in Glass Containers, Jams and Preserves Glass contamina- 2¼ Pickles and Pastes tion,Mould, 12¼ Others Deterioration 1 15½ Other Foods condemned for Various Reasons, 153½ Sausages Meat 472¾ Nuts 37 Cheese 226 Ravioli & Beans 118¾ Christmas Pudding 10 Milk 200 Cakes,Bread and Biscuits 54¾ Others 54¾ 1,327½ Unsound food is disposed of by incineration at the refuse destructor at the Merton and Morden Urban District Council or on occasions it is made in a condition that recovery is impossible and placed in vehicles for conveyance to a tip. (f) Food Hygieneo Food Hygiene Regulations.1955.Nine teen-fifty-seven was the first full year in which all the provisions of the Food Hygiene Regulations, 1955 were in force.Whilst the majority of the food premises in the town were maintained at a higher standard than that demanded by the legislation then in force, experience in applying the Regulations has been to confirm that it is possible to make further improvements and also to expect a better standard from the employee. The weak link in the chain of food handling is invariably the employee who by his thoughtlessness or carelessness exposes food unreasonably or unnecessarily to risk of contamination. Such instances are the placing of food trays on the pavement or road or putting trays on to the floors of premises and then transferring them to the benches,shelves or counters. 29 The maintenance of good food handling practice depends to a considerable extent upon the sustained effort of the Public Health Inspectors. In conditions of full employment there is in some food premises constant change of staff and in such circumstances regular routine visiting is necessary to ensure that satisfactory methods are continued. As with other matters with which the Department is concerned, when plans and proposals are submitted for the alteration of existing, or the establishment of new, businesses, it is possible to ensure that the premises will comply with the Regulations in the first instance. This service is appreciated by the proprietors and excellent co-operation has been experienced,, During the year 153 Notices were served under these Regulations and 135 were complied. The following tabulated statement shows the nature of the Notices served and complied. PART IV. Defects requiring Notices Complied. Sanitary Conveniences. Lack of Wash Your Hands Notices 6 5 Fittings cleansed or repaired 1 1 Absence of Ventilated Lobby 1 1 Lighting Provided 1 1 Sinks. Renewed or repaired, also draining boards 8 8 Cleansed 4 4 Washing Facilities for Staff. Absence of, defective or inadequate hand basins 9 6 Absence of hot water 8 6 " " cold water 5 3 " " water heaters, or repaired 1 1 Provision of towels, soap and nailbrushes 3 7 Repairs to Food Rooms. Floors cleansed 2 2 Walls and ceiling cleansed 1 1 Protection of Food against contamination. Smoking 9 8 Food to be kept 18" off ground 23 22 Covers provided for food 8 9 Display shelves cleansed 2 — Others b b Uncleanliness. Personal 1 l Kitchens and equipment 19 18 Food Stores 5 3 Preparation rooms and equipment 3 3 Delivery Vans 2 2 Refrigerators 3 2 Shops 3 4 Dining Rooms 3 2 Cupboards, counters and shelves 5 6 C/Fwd. 14O 130 30  Defects requiring Notices Complied B/Fwdo l4O 130 Utensils Unclean and/or replaced 9 8 Boxes cleansed or repaired 4 5 Others 12 12 Food. To be kept in food store rooms 6 6 Notices re food 1 1 Others 3 2 Others 5 5 180 169 In accordance with the request of the Minister of Health the following is a tabulated statement of inspections made during the year of the various types of food premises. Food Premises. No. of Premises. Visits. Bakehouses and Bakers' Shops 4 54 Dairies and Milk Shops 16 39 Butchers 36 212 Greengrocers and Stalls 98 402 Public Houses 47 20 Fishmongers and Stalls 24 422 Ice Cream premises 144 272 Grocers and general provisions and stalls 133 688 Restaurants and cafes 77 Kitchens and Canteens (including factory, school and shop) 23 493 Public Houses (not included in the figure above but at which restaurant services are provided) 11 16 Meat Distribution Depots 4 85 Visits to Food Premises re unsound food 130 617 2,833 FOOD AND DRUGS ACT- 1955. Details of samples submitted to the Public Analyst during the year are set out in the attached tabulated statement. The following are the reports of action taken in respect of samples which were the subject of adverse comment. Buttered Bun - This was found to contain margarine. The vendor-was Informed of the contravention and .he arranged in future for butter to be used. Cream Bun and Cream & Chocolate Layer Cake - It was reported that these articles contained imitation cream. Following representations from the Department, the owners of the respective businesses undertook to display appropriate notices in order that customers may be properly informed as to the nature of the fillings used. 31 Crean. Caramels - Upon examination it was found that these contained no cream, butter or milk, and accordingly should not have teen called cream caramels. The retailer was asked to amend his description. This he agreed to do. Cream Slice - The cream used was imitation and of inferior quality. The manufacturers have been approached and the matter is still under discussion. Frig Ice - This sample did not comply with the requirements of the Labelling of Pood Order, 1957 as the sodium alginate it contained was not properly designated. The manufacturers were informed and have arranged for the labels to be reprinted. Pruit Loaf This loaf contained a cigarette end. Legal proceedings were instituted and a fine of £10.0.Od. with £2.2.0d. costs was imposed. Piping Jelly - The Analyst was of opinion that the term glucose on the label did not indicate the true nature of the actual ingredients, namely liquid glucose. As this is a matter which is under discussion with the Ministry of Agriculture, Fisheries and Pood, and the trade interests concerned, further action on both samples has been withheld. Salad Cream - The Analyst commented that this sample, although not unfit for human consumption was unfit for sale. The retailer was informed and the remainder of his stock of this product was withdrawn from sale, French Nougat - The wrapping paper of the nougats was soiled with dust. The confectionery however was free from contamination. The retailer was informed and adequate steps were taken to prevent the foodstuff from further risk of contamination. Tabulated Statement of Samples Submitted to the Public Analyst during 1957, Commodity NOoOf Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Infor mal Formal Informal Assorted Toffees _ 1 — 1 _ _ Batter Mix 1 — 1 - - Bread — 1 - 1 - - Bread & Butter — 1 1 - — Browning - 1 — 1 - - Butter 1 1 — — — Buttered Bun — 1 - - - 1 Buttered Roll — - 3 - - Buttered Toasted Tea Cake =, 1 - 1 - - Casserole Steak ■= 1 - 1 - — Cheese Spread - 1 - 1 — — Cheese Spread with Ham - 1 — 1 — — Chicken & Ham Paste - 1 — 1 — — Chocolate Coated Honeycomb 1 - 1 — — Chocolate Spread «= 1 - 1 C/Pwd, 1 16 1 15 - 1 32 Commodity No.of Samples Genuine Not Genuine or otherwise irregular For- mal Informal Formal Informal Formal Informal B/Fwd. 1 16 1 15 — 1 Coffee & Chicory — 1 — 1 - - Coffee (Ground) - 1 — 1 - - Cornflour — 1 — 1 - - Crab — 1 — 1 - - Crab Paste — 1 - 1 - - Cream — 1 - 1 - - Cream Bun — 1 - ca — 1 Cream Caramels — 1 - - — 1 Cream & Chocolate Layer Cake — 1 — — — 1 Cream Doughnut - 1 - 1 - - Cream Slice — 1 — — - 1 Curry Powder — 1 - 1 - - Devon Scone - 1 — 1 - — Drink Crystals - 1 — 1 — - Dressed Crab — 1 — 1 — — Flip (Strawberry flavoured drink) — 1 — 1 — — French Mustard — 1 — 1 - — French Nougat - 1 - 1 - — Frig Ice (Ice Cream Powder) — 1 — — 1 Fruit Chews — 1 - 1 - - Fruit Chutney — 1 — 1 — - Ham & Beef Roll - 1 - 1 — — Ham & Chicken Galantine — 1 — 1 — — Honey — 1 - 1 — — Horseradish Sauce — 1 — 1 — - Ice Cream — 4 — 4 — — Icing Sugar — 1 — 1 - — Instant Coffee — 1 - 1 - - Instant Potato — — — 1 — — Jubbly (Orange Drink) — 1 — 1 — — Kool Cup — 1 - 1 — — Lemon Curd — 1 - 1 — — Lemon Juice — 1 - 1 - - Meat Rissoles — 1 - 1 — — Meringue — — — 1 — — Milk 2 22 2 22 — — Mincemeat — 1 - 1 — - Mint Jelly — 1 - 1 — — Mixed Fruit — 1 — 1 — — Mushroom Soup — 1 — 1 - — Olive Oil — 1 - 1 — — Peanut Butter — 1 - 1 — - Piping Jelly — — - — — 2 Potted Salmon — 1 - 1 — — Potted Shrimps - 1 - 1 — — Pork & Goose Liver Pate — 1 — 1 — — Powdered Celery Soup — 1 — 1 — — Rum Baba — 1 _ 1 — — C/Fwd. 3 89 3 81 - 8 33 Commodity No.of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Pwd. 3 89 3 81 — 8 Sandwich Cream — 1 — 1 — — Salad Cream — 1 — — - 1 Salmon Spread — 2 - 2 — - Sardines — 1 - 1 - - Sauce — 1 — 1 - - Sausages — 1 — 1 - - Saveloys — 1 — 1 - - Seedless Raisins — l — 1 — - Shredded Beef Suet — 1 — 1 — — Stewed Steak — 5 - — — - Steak & Kidney Pie — 1 — 1 — — Strawberry Essence Flavour — 1 — 1 — Sultana Loaf — 1 — — — 1 Sweet Cigarettes — 1 — 1 - - Table Jelly — 1 — 1 — - Tea — 1 — 1 - — Tomatoes (Italian Peeled) — 1 — 1 — — Tomato Ketchup - 1 - 1 — — Trifle — 1 - 1 - - Cup Cake Mix — l — 1 - - Instant Icing — 1 — 1 — — 3 115 3 105 _ 10 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. 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 1957 a total of 664 notifications of infectious disease was received, compared with 230 in 1956, a difference of which is more than accounted for by the notification of 448 more cases of measles than last year® The following table gives an analysis of the cases, admissions to hospitalp and deaths into age groups„ NOTIFIABLE DISEASES DURING 1957 TABLE IV CASES DEATHS Age Groups Age Groups Under 1 year 1—2 2-3 3-| 4-5 5-10 10-15 15-20 20-35 35-h5 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 Diphtheria — 0 — — — — — — — — — — — — — — — — — — — - — — - - Scarlet Fever — — — 2 1 8 2 — — — — — 13 — — — — — — — — — — «=» Measles 15 41 59 54 58 245 8 1 — - 2 - 483 6 — — — — — — — — — — — — — Whooping Cough 4 3 8 3 8 25 2 1 — - - 1 55 5 — — — — — — — — — — — — Acute Poliomyelitis: Parslytic — — — 1 — — — — 1 — — — 2 2 — — — — — — — - — - - - — Non-paralytic - - — — — — — — — — — — — — — — — — — — — — — — — — — Acute Infective Encephalitis — — — — — — 1 — — — — — 1 1 — — — — — — — — - — - - — Meningococcal Infection — - — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 13 39 6 1 — 59 59 — — — — — — — — — — — — — Dysentery — — 2 1 1 3 1 — 4 1 — — 13 1 — — — — — — — — — — — — — Food Poisoning 1 — 1 1 1 1 1 1 2 2 7 2 20 1 — — — — — — — — — — — — — Pneumonia — — - — — — — — 3 - 7 5 15 1 — — — — — — — — 1 1 5 13 20 Erysipelas — — — — — — — — — — 3 — 3 — — — — — — — — — — — — — — Total 20 44 70 62 69 282 15 16 49 9 20 8 664 76 — - - — - — - — 1 1 5 13 20 35 36 The following table gives a comparative statement of notifications of certain infectious diseases received during the last thirty years:- TABLE V Year Diphtheria Scarlet Fever Measles Whooping Cough Poliomyelitis Acute Infective Encephalitis Puerperal Pyrexia Enteric Fever (including Para-typhoid) Ophthalmia Neonatorum 1928 152 135 1 — 9 7 4 1929 113 74 not notifiable until 1940 not notifiable until 1940 — — 5 1 3 1930 100 78 — — 9 5 2 1931 53 61 — — 14 1 4 1932 47 56 2 — 13 1 — 1933 30 125 3 — 10 2 2 1934 42 40 — — 5 2 3 1935 50 54 — 8 2 3 1936 27 67 — - 19 6 2 1937 21 51 2 — 32 1 3 1938 72 61 2 — 47 1 2 1939 19 69 1 — 66 1 3 1940 53 45 373 22 — — 63 3 3 1941 15 54 331 271 1 — 37 7 — 1942 8 79 375 99 _ — 24 — 3 1943 3 110 287 151 1 — 18 1 — 1944 7 49 33 73 1 — 15 — 2 1945 16 28 407 84 1 — 23 — 2 1946 8 34 283 67 2 — 41 1 1 1947 2 24 219 38 5 3 28 1 1 1948 - 34 197 200 3 — 30 — — 1949 - 73 483 81 7 3 29 — — 1950 — 51 132 41 4 — 23 — — 1951 — 37 443 222 — 1 41 — — 1952 — 29 280 102 3 — 84 — 1953 — 21 302 126 5 — 80 — — 1954 — 16 419 21 1 96 — — 1955 — 11 170 17 10 1 72 — — 1956 — 17 35 58 3 — 88 — — 1957 — 15 483 55 2 1 59 — — 37 Smallpoxu There were no cases recorded in Kingston during 1957 but the disease is still very prevalent in many parts of the world and constant vigilance is necessary,Particular surveillance has to be maintained over persons arriving from abroad particularly when they have been contacts of cases or suspected cases. During the summer a diagnosis of smallpox was made in an unvaccinated child in London. Investigation revealed a chain of events which in all probability started with the arrival in this country of a traveller from West Africa. All Medical Officers of Health were alerted and the necessary measures in respect of possible contacts in Kingston were taken. 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 51% of Kingston babies are vaccinated during their first year and there is every need to raise this figure to at least 75% Scarlet Fever. Thirteen cases were notified during 1957 10 of which were of school age. The cases were mild and were all nursed at home. There were no deaths. Scarlet Fever is a streptococcal infection and is therefore always viewed as potentially dangerous. Modern drugs however prove to be a good weapon and the illness now usually takes a mild form. Diphtheria. For the tenth 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 direction 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, which is the main protection against it. The method employed during 1957 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. During 1957, 3,705 Kingston children were immunised for the first time or received reinforcing "Booster" injections, some 600 more than during 1956. A figure known as the immunity index, which is shown a® a percentage, is computed each year. This relates to the proportion of the child 38 population which is known to have received inoculation during the previous 5 years. The immunity index in Kingston for the 1/4 age group is 79% and the total index for all children under the age of 15 is 56%. Both of these percentages are an improvement on 1956. 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, and it is calculated that during 1957 the proportion of Kingston babies immunised before they reached the age of 1 year was 74% Pollomyelitis. Further progress was made toward the protection of the child population. Supplies of vaccine were unfortunately very limited, and it will not be until 1958 that full scale protection can be accomplished,, Co-operation with the Medical Research Council, the Surrey County Council and the Physician Superintendent of Kingston Hospital in connection with the provision and exchange of information gained from epidemiological enquiries continued,, A total of 2 cases were notified in Kingston during 1957 one occurring at the very beginning and one at the end of the year. In early January, 1957 a young lady, aged 23, was admitted to Tolworth Hospital with severe symptoms. Poliomyelitis virus type II was isolated from her faeces® Six days before she became ill the patient had looked after 2 children in another household who had recently had transient febrile illnesses. Poliomyelitis virus type II was isolated from the faeces of both these children also. After some 6 weeks in Tolworth Hospital the patient was transferred to an Orthopaedic Hospital for prolonged treatment in respect of considerable paralysis of the legs. The second ease occurred in a boy, aged 3½ at the end of October. Upon admission to hospital there was slight muscle weakness and poliomyelitis virus type I was isolated from the faeces. He was discharged after 5 weeks in hospital completely recovered. Neither of the above persons had received vaccination against poliomyelitis. Acute Infective Encephalitis. One case occurred during 1957 in a girl, aged 12½. This patient was admitted to Tolworth Hospital and on admission was a typical encephalitis, the illness following chickenpox. The girl male a rapid recovery with no apparent sequelae and was discharged home after 2 weeks in hospital® Eateries Fever (Typhoid or Paratyphoid). There were no cases of typhoid or paratyphoid B notified in Kingston during 1957 and this is the tenth successive year without notification of Enteric Fever. Infection that does occur throughout England and Wales is mostly imported from abroad through contaminated foodstuffs. 39 One or two eases however have been traced to the consumption of shellfish? notably cockles, which were gathered from stretches of shore situated near sewage outfalls. Rivers and streams which are known to contain paratyphoid organisms are also a source of danger particularly to children who may play and bathe in them. Dysentery (Some). A total of 13 cases of dysentery was notified during 1957 compared with 21 during 1956. 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 serious matter. The 13 Kingston cases were all in respect of individuals or individual families; one case only was 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 bygiene. 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 Schools receive special attention, particularly the infant schools. Measles. There were 483 cases of measles notified during 1957 compared with 35 in 1956. 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 (245) occurred in children in the 5/10 age group? and 227 in younger children. Whooping Cough. This is one of the most serious of childhood illnesses and immunisation has been offered to all children for five 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. During 1957, 55 eases of whooping cough were notified compared with 58 in 1956? 17 in 1955, 21 in 1954, 126 in 1953, 102 in 1952. The average number of cases occurring during the previous five years was 65? and in the preceding 5 years 116. The cases of whooping cough occurring during 1957 were mild with no deaths. Only 4 occurred in infants under the age of 1 year, and 22 in children between the ages of 1 and 5 years. 40 Ophthalmia Neonatoram. For the tenth successive year no cases of ophthalmia neonatorum have been notified. Puerperal Pyrexiae 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 1957, 59 cases were notified, 8 of which referred to Kingston residents and all of whom were notified from Kingston Hospital, These figures compare with 88, 21 and 88 respectively for 1956. An. analysis for the years back to 1953 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 1957, 1,773 deliveries took place in the hospital, Cases 1953 1954 1955 1956 1957 (a) TOtal notified 80 96 72 88 59 (b) Number included in (a) of (i) Kingston residents 15 27 17 21 8 (ii) Extra district residents, 65 69 55 67 51 (c) Number included in (a) notified. from Kingston Hospital 78 96 69 88 59 (d) Number included in (a) notified by private doctors 2 – 3 - - (e) Number of eases included in(d) removed to hospital other than those included in (e) - - - - - Food Poisoning A total of 20 eases of food poisoning occurred during the third quarter of the year 1957 These comprised 7 individual unrelated cases and 2 small outbreaks comprising 3 and 10 cases respectively*. Of the individual cases 5 were attributed to a salmonella organism and 2 to staphylococcus aureus. In the cases of the latter the food causing the illness was proved to be chicken and ham, unconsumed portions of which were available for bacteriological examination which, indicated the same type of staphylococcus that was isolated from the patients® stools. Of the salmonella eases 2 persons, a baby aged 2 months and its father were proved to be suffering from salmonella Heidelberg. No particular item of food was proved to be incriminated in these illnesses Similarly the outbreak concerning 3 persons was also due to salmonella organism but no particular food was found to be the cause. These 3 persons comprised one family and cross Infection had apparently occurred. This was a clean household with co-operative parents and the matter was quickly resolved without further spread. 41 The outbreak involving 10 persons although small was of a more serious nature. A number of persons became violently ill and some were treated in hospital during the first week in July, a period of very hot humid weather® They had all eaten cooked ham bought off the bone from a shop in Kingston. Samples of the ham yielded staphylococcus aureus and the same organism and type was isolated from swabs taken from the ham carver employed by the shop. Upon notification of the illnesses and the ham being suspected, immediate action was taken to remove the ham from sale. The department of the shop concerned was put out of action until sterilisation of utensils benches and all implements had taken place9 and work was not resumed until continuing danger from this source was excluded. The number of consumers at risk was incalculable. The ham was sold at the week-end in weather ideal for cold and salad meals. A number of revisits were made to the shop and helpful co-operation was afforded by the management. A strong contributory factor to the growth of organisms with which the ham was contaminated was extraordinarily hot and humid weather (Temperature 880F Humidity 19.1 mb.) plus the fact that in a number of households the purchased ham was kept over night in unrefrigerated larders. The above action appeared to be successful as no further cases were reported. The Medical Officer of Health particularly acknowledges the help rendered by the Epsom Public Health Laboratory (Dr. D.M. Stone) and the Pathological Department at Kingston Hospital (Dr. D. Stark Murray). Tuberculosis. During 1957 the number of new eases notified in Kingston was 27, 26 of which referred to respiratory disease. The corresponding figures for 1956 were 27 and 25. The South Wast Metropolitan Regional Hospital Board Mass X-Ray Unit was unable to make its customary annual visit to the town because it had to be diverted to participate in a special survey in Glasgow. A strict comparison between 1957 and 1956 with regard to new cases notified may be prejudiced by this, but there is no reason to believe that any active cases remain undiscovered because of the absence of the Unit from the town for one month of the year. The following table shows comparative figures of notified cases and deaths for the years 1948 to 1957 (inclusive) Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 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 1957 26 1 27 6 1 7 42 The efficiency of notification has been good and there is no reason to suspect refusal or neglect to notify# One posthumous notification was received during 1957. 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. Considerable help is given to tuberculosis patients and their dependents by the Kingston and District Tuberculosis Care Committee. During 1957, 92 families were helped in the form of grants for extra nourishment, clothing, fuel, removals, bedding, fares, pocket-money, etc, and a total of £1,315 was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1957 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 past 15 years NOTIFIED CASES OF. AND DEATHS FR0M. TUBERCULOSIS IN 1957. TABLE VI. NEW CASES DEATHS Under 1 year 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65 & over Total Under 1 year 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65 & over Total Tuberculosis (a) Respiratory M - 1 1 1 3 6 4 2 - 18 - - - - - 1 1 1 2 5 F - - 1 1 1 2 - 1 2 8 - - - - - - - - 1 1 Total - 1 2 2 4 8 4 3 2 26 - - - - - 1 1 1 3 6 (b) Non-respiratory M - - - - - - - - 1 1 - - - - - - - - - - F - - - - - - - - - - - - - - - - - 1 — 1 Total - - - - - - - - 1 1 - - - - - - - 1 - 1 43