A C 4413(1) LIBRARY KIN 33 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON- UPON- THAMES SURREY 1959 THE ANNUAL REPORT of the Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT GUILDHALL KINGSTON- UPON- THAMES MAY, 1960 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON- UPON- THAMES SURREY THE ANNUAL REPORT of the Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT GUILDHALL KINGSTON- UPON- THAMES MAY, 1960 1959 ANNUAL REPORT. 1959 TABLE OF CONTENTS. Page Preface i, ii, iii, iv. Population i Births i Deaths i Causes of Death i - ii Infectious Disease ii Housing and rehousing ii - iii Clean Air Act iii "Problem" Families and Social Reclamation iii - iv The "Aged" iv Constitution of Public Health Committee 1 Staff of Public Health Department 1 SECTION A Statistics and Social Conditions (1) General Statistics 2 (2) Social Conditions 2, 3 (3) Extracts from Vital Statistics of the Year 3 (a) Live Births 4 (b) Stillbirths 4 (c) Total Live and Stillbirths 4. (d) Deaths 4 (i) Death Rate 4 (ii) Infant Deaths 4 (iii) Maternal Deaths 4 (e) Maternal Mortality Rate 4 Infant Mortality Rate 1955-1959 5 Quinquennial Infant Mortality Rate 5 Causes of Death of Children under 1 year 5 (iv) Deaths from Other Causes 6 Introduction to Tables on Vital Statistics 6 Table I - Extract from Vital Statistics for the years 1955-1959 7 Table II - Comparison of Vital Statistics 1930-1959. 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 Surrey County Council - Education Department 12 Surrey County Council - Welfare Department. 13 Surrey County Council - Social & Geriatric Services 13 Surrey County Council - Children's Department 13 Surrey Executive Council 13 (3) National Assistance Act, 1948 14 National Assistance (Amendment) Act, 1951) Page. SECTION C Sanitary Circumstances (l) Water Supply 15 (2) Drainage and Sewerage 15 (3) Rivers and Streams 15 (4) Closet Accommodation 15 (5) Public Cleansing 15 (6) Sanitary Inspection of the Area 15,16 (7) Shops 16 (8) Factories Act, 1937 17 ^9 4 Camping Sites 13 (10) Atmospheric Pollution 18,19,20, 21,22 (11) Swimming Baths and Pools 22 112) Eradication of Bed Bugs 23 (13} Complaints 23 (lk) Rodent and Insect Pest Control 23,24,25 SECTION D Housing General 25,26 Statistical Statement, 1959 26 SECTION E Inspection and Supervision of Food (a) Milk Supply 27 (b) Designated Milks 27 (c) Bacteriological Examination of Milk 27 (d) Ice Cream 27,28 (e) Meat and Other Foods 28,29 (f) Food Hygiene - Food Hygiene Regulations 1955. 29,30 Food and Drugs Act, 1955 31,32 Tabulated Statement of Samples Submitted to the Public Analyst during 1959 32,33 Merchandise Maries Act, 1926. 33 SECTION F Infectious Diseases Notifiable Diseases 34 Table IV. Notifiable Diseases during 1959 35 Table V. Comparative Statement of Notifications of certain Infectious Diseases 36 SmallpOX 37 Scarlet Fever 37 Diphtheria 37 Poliomyelitis 38 Enteric Fever (Typhoid. or Paratyphoid) 38 Dysentery 38,39 Measles 39 Whooping Cough 39 Ophthalmia Neonatorum 39 Puerperal Pyrexia 39 Pood Poisoning 40 Tuberculosis 40 Table VI Notified cases and Deaths from Tuberculosis in 1959 41,42 (i) TELEPHONE NO: PUBLIC HEALTH DEPARTMENT, KINGSTON 2121. GUILDHALL, KINGSTON-UPON- THAMES, SURREY. MAY, 1960. TO THE MAYOR, ALDERMEN AND COUNCILLORS OP THE ROYAL BOROUGH OP KINGSTON-UPON-THAMES. ANNUAL REPORT. 1959. 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 1959. The Report is of a similar pattern to that for previous years and follows the general lines indicated "by the Minister of Health, and is in accordance with Circular 1/60. I am indebted to Mr. G.C. Smith, Chief Public Health Inspector, with special reference to Sections C - E, and Mr. M. Frankell, Administrative Officer, for assistance in compiling the Report, Population - The estimated mid 1959 home population given by the Registrar General is 38,590 an estimated decrease of 210 persons compared with 1958, 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. Births - The number of live births for 1959 is 564 and compares with 536 for 1958., The crude birth rate is 14.5 per 1,000 population compared with 13.8 for 1958. Deaths - The number of deaths recorded in 1959 is 416 compared with 434 for 1958. This makes a crude death rate of 10.8 as compared with 11.2 for 1958. The excess of births over deaths was 148 compared with 102 for the previous year. The number of deaths of infants under 1 year of age in 1959 is 13 which gives an Infant Mortality rate per 1,000 live births of 23.0. The corresponding figures for 1958 were 8 infant deaths and an Infant Mortality rate of 14.9 The approximate average rate for the previous five years (1954 1958) is 17. There were no maternal deaths (i.e. from pregnancy, childbirth, abortion). Causes of Death - The main conditions causing death during 1959 were Heart Disease - 105, Cancer - 99 and Vascular Lesions of the Nervous System - 54 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. (ii) 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. 1955 1956 1957 1958 1959 Total Total Total Total Total Deaths from cancer of the lung and bronchus 28 22 16 25 26 M F M F M F M F M F 24 4 21 1 10 6 23 2 23 3 Infectious Disease - The number of infectious disease notifications received in 1959 was 433 which is 36 less than in 1958 and is accounted for by a reduction in the number of eases of whooping cough. Further progress was made in the active protection of the child population against diphtheria, whooping cough, tetanus, smallpox, tuberculosis and poliomyelitis. In general the health of the people was very good, and a high standard of hygiene was maintained. Housing and Rehousing. During 1959 the Corporation provided 22 flats comprising 6-1 bedroom units, 12-2 bedroom units and 4-1 bedroom old people's dwellings. In addition 4 houses and 77 flats were built by private enterprise, giving a total of 103 new housing units in Kingston. During the year the Corporation rehoused several families in the Frimley/Camberley area as well as other New Towns. The rate of building has been so slow, that slum clearance needs are the only matters which can be dealt with. Even so rehousing displaced families is dependent upon the availability of suitable alternative accommodation. As a result of the failure to provide new houses for these families, continued hardship is maintained among many with high priority on the waiting list. This constitutes a definite menace to health and is contributing to domestic breakdowns. Overcrowding is also a problem and numbers of applications are constantly received from families living in crowded, unsuitable conditions. It is essential for the Corporation to renew their efforts to provide a sufficiency of houses for the purpose of rehousing families who come within the category of such urgent and priority eases as well as for aged couples or persons living alone. Although several old people were rehoused by the Corporation in 1959, encouragement should be given to the transfer of aged persons occupying larger houses to move to more modest accommodation suited to their needs and in doing so to consider the amenities and social services necessary to counterbalance loss of security and possible disturbance of emotions in making a move from houses to which they are deeply attached. (iii) Another step forward would be to give urgent consideration to the improvement of older properties which are structurally sound, and provide modern amenities such as baths, hot water supplies and internal W,Cs, These items are no longer to be looked upon as luxuries, but are required, and should be provided, as present day essentials. Clean Air Act. During the year consideration was given to implementing the Clean Air Act in stages until the whole town could become a "smokeless" area. Householders require encouragement to use smokeless fuels for all purpose and to fireplaces adapted fop buring Efforts to encourage the use of such fuels will successful if not hampered by the inadequate supplies of suitsable fuel to meet normal increasing demand. Many householders Who are prepared to utilise smokeless fuels have been unable to obtain such supplies during the winter months. Although we are subject to occasional fogs by the river and across the Ham area to Richmond Park, we have been fortunate that the final months of 1959 were in the main free of fog These areas are also "smog" Zones and it is "smog" which causes a great deal of chest trouble in the winter and "carries off" so many old people. Such areas should be made into smokeless zones to eliminate "smog" and reduce illness and deaths. She saving in cleaning also obtained in smokeless zones will compensate for the time. trouble, and cost of work undertaken to effect them. "Problem" Families and Social Reclamation. A difficult part of the work of a Medical Officer of Health is the rehabilitation of so-called problem families. The causes of such family failures are many and varied and it is usually due to either one, or tooth parents of such families "being unstable, sub-normal in intelligence, and incapable of being educated,, The house is often squalid and dirty; the household management feckless and improvident. In the curative field many remedial measures are undertaken, as follows:- 1. Rehousing., 2. Removal of "Problem" families to hostels provided for the purpose. 3. Accommodation of mother and in some cases her children in special Recuperative Centres for rehabilitation and education. 4. Temporary or permanent removal of children into Local Authority care. A large contributing factor to the degeneration of domestic conditions is inadequate or unsuitable housing. In some cases where rehousing has taken place it is interesting to find that the more adequate accommodation has succeeded in giving the mother a new confidence and self-respect. (iv) It has also given the children suitable conditions in which to live and play. and father too can take pride in keeping up his decent home. Such measures go a long way to preserving the family during the period of the growing up of the children. which gives them a "better chance to learn to be successful parents in their time. The "Aged". Increasing organisation for the welfare of the aged and infirm is required of both statutory bodies and voluntary organisations in the Royal Borough of Kingston-upon-Thames and the neighbouring districts of Surbiton, Maiden and Esher. Progress by effective geriatric services is being made but more is necessary. in particular, the fuller integration and co-ordination of available services. It is felt that a centralised local agency would assist in ascertaining those who are in need and provide a "follow-up" in this respect. Information as to need and where it is most needed is an essential factor in dealing with the aged and although much good work is being done, more stringent efforts are required towards the means for rehabilitation of all active old persons by these services which undertake such an important aspect of community life. I am pleased to record thanks for the support and encouragement I have received in my works, 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. i ROYAL BOROUGH OF KINGSTON-UPON-THAMES PUBLIC HEALTH COMMITTEE During the Municipal Year 1959-60 the Public Health Committee was constituted as follows:- Alderman Oldfield (Chairman) Councillor Denny " Knowlden (Vice-Chairman) " Eades Councillor Guymer (Mayor) " Evans Alderman Judge (Ex-Mayor) " Lees " Lacey " Marshall " McDonald " Prince Councillor Baker " Tapping STAFF OP 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. Chief Public. Health Inspector: G,C. SMITH, F.R.S.H., M.A.P.H.I. (a)(b) Senior Additional Public Health Inspector: L. BURROWS, M.A.P.H.I. (a)(b) Additional Public Health Inspectors: S.W.SIMPSON-SCOTT, M.R.,S.H., M.A.P.H.I., M.R.I.P.H.H. (a)(b) K. APPLETON., A.R.S.H., M.A.P.H.I. (a)(b) Junior Public Health Inspector: (vacant) Chief Clerk: M.E. POWELL, D.P.A.(Lond.) (resigned 2.8.59). M. FRANKELL, D.M.A. (appointed 22.9.59). Clerical Staff: MISS C.L. FOISTER. MISS M.W. FILBEE. G. N0RTHW00D (resigned 2. 8.59). D. HAWKINS (appointed 8.10.59). A. HYDE (resigned 6.2.59). R. SMITH (appointed 2.2.59). Assistant Rodent Officer: F.W. STAGG, A.R.I.P.H.H. Rodent Operatives: G.H. LOCKE. F.J. PERRY. Disinfector/Driver: D. WILKINSON. (a) Certificate as Public Health Inspector. (b) Certificate as Meat and Foods Inspector. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS I. General. Statistics. Area in Acres 1,408 Total Population( including Service personnel) 38,590 Number of inhabited houses (approx.) 11,744 Rateable Value-General Rate (1.4.59) £1,122,385 Sum represented by Penny Rate (Year 1959/60) £1 3,989 The total number of hereditaments is 14,389 of which 80% are domestic dwellings. There are 2,396 commercial premises in the town being 16% of the total hereditaments. The remaining premises totalling 430 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 south bank of the river Thame. 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, "My review of the employment situation at December 1958, ended on a note of caution. Despite slightly increased numbers of persons placed in employment during 1958, unemployed registers were somewhat higher than at the end of 1957. In the first few weeks of 1959 the numbers of unemployed continued to rise, but from February onwards the registers declined almost without interruption untill early October, when the usual seasonal increase in unemployment began. The increase proved to be shortlived, however, and at Christmas the lowest unemployed figures of the year were recorded - 357 men and 90 women, compared with 515 men and 95 women at the beginning of the year. During the year 3,585 men and 1,135 women were placed in employment in the area of the Kingston Employment Exchange compared with 3,594 and 1,303 in 1958, Additionally, 232 men and 80 women were found employment in other Exchange areas, almost entirely within daily travelling distance. This overall total of 5,032 compares with a total of 5,184 placed in work in 1958, and with 4,945 in 1957. Among 15 workers for whom work was obtained in new or expanded towns in 1959. 3 were residents of Kingstone In the building trade the prolonged fine weather allowed work to continue at a high level late: into the Autumn, and the usual seasonal increase in unemployment towards the end of the year was less pronounced than is normally the case. Considerably fewer workers were placed in the aircraft industry than in 1958, and small redundancies and customary wastage have resulted in a reduction in the numbers employed in the industry, but at the end of 1959 it still had more workers than it had a year previously. 3 The improvement in the general employment situation is reflected in the number of notified vacancies unfilled at the end of the year, These were 448 for men and 393 for women, covering a wide range of occupations and industries, A year earlier there were only 260 unfilled vacancies for men and 229 for women,, Skilled male workers in the engineering and electronics industries continued in short supply and amongst women there were shortages of experienced office workers and shop assistants,, The ratio of unfilled vacancies to unemployed workers, which stood at .8 in December 1958, has thus risen to 1.9 a most gratifying improvement. During 1959 the Employment Exchange continued to carry out its specialist services for- assisting men and women seeking professionals, managerial or executive posts and employers with such vacancies to fill; the rehabilitation and resettlement of disabled persons; the resettlement in civilian life of officers and men leaving all branches of K.M, Forces, It is evident that in 1959 Kingston enjoyed a period of increasing activity, more than, seemed likely when the year began. Persons leaving employments for one reason or another, generally obtained alternative work with little difficulty. The percentage of unemployment locally fell from .68 to .5, and is almost negligible when compared with the national figure of 2%. The prospect for 1960 can, I feel, be regarded as hopeful, though the full effect of Government policy in some directions - for example, the policy of encouraging continued amalgamation of companies in the aircraft industry cannot yet be assessed. There is every reason to suppose, however, that Kingston will continue to share fully in the nationally improved position which became apparent in 1959 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-upon-Thames are Births 0.971 Deaths 0.91. 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. 4 (a) Live Births- Total Male Female Legitimate 536 273 263 Illegitimate 28 17 11 564 290 274 Live Birth Rate per l,000 population 14.5 Adjusted Birth Rate 14.1 England and Wales Live Birth Rate. 16.5 Illegitimate Live Births per cent of total Live Births. 4.9 (b) Stillbirths- Total Male Female Legitimate 4 1 3 Illegitimate — - — 4 1 3 Rate per 1,000 total Live and Stillbirths 6.1 England and Wales Stillbirth Rate 20.7 (g) Total Live and Stillbirths- Total Male Female Legitimate 540 274 266 Illegitimate 28 17 11 568 291 277 (d) Deaths- Total Male Female 416 200 216 (i) Death Rate per l,000 population 10.8 Adjusted Death Rate 9.8 England and Wales Death Rate 11.6 *(ii) Infant Deaths Total NO. of Deaths 13 Infant Mortality Rate per 1.000 Live Births 23.0 Infant Mortality Rate per l.000 Live Births Legitimate 22.3 Illegitimate 35.7 Infant Mortality Rate for England and Wales 22.0 ** Neo Natal Mortality Rate per 1.000 Live Births 12.4 (iii) Maternal Deaths (including abortion) total Nil (e) Maternal Mortality Rate per 1.000 Live and Still- births Nil * Under 1 year of age. ** Under 4 weeks of age. 5 The approximate infant mortality rats for 1959 and the rates since 1955 are shown for purposes of comparison. 1955 1956 1957 1958 1959 Kingston-upon-Thames 15 24 13 15 22 England and Wales 25 24 23 22 22 It will be seen from the following figures that since the war ended the Quinquennial Infant Mortality Rat© 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 Kingstonupon-Thames children who died during 1959 before reaching the age of one year together with the causes of death. Age Total Deaths Broncho Pneumonia Cerebral Haemorrhage Prematurity Atelectasis Pulmonary Oedema Respiratory obstruction by foreign body. Fallot's Tetralogy Acute Pneumonitis 0-24 hours. 3 - - 1 1 - - - 1 24 hrs. -1 mth. 4 1 1 1 - 1 - — — 1 mth. -1 yr. 6 3 - 1 - - 1 1 - Totals 13 4 1- 3 1 1 1 1 1 (iv) Deaths from Other Causes. No. of Deaths Deaths from Heart Disease 105 Deaths from Cancer 99 Deaths from Vascular Lesions of the Nervous System 54 Deaths from Circulatory Disease other than Heart 18 Deaths from Bronchitis 20 Deaths from Pneumonia 26 Deaths from Influenza 12 The following Tables I, II, III summarise certain vital statistics. Table I shows the figures for live births, stillbirths, and deaths for the years 1955 - 1959 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1930. 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 below 40,000c The causes of deaths shown in Table III are in accordance with the 36 headings based on the Abbreviated List of the International Statistical Classification of Diseases, Injuries and Causes of Death. ~7 EXTRACT FROM VITAL STATISTICS FOR YEARS 1955 - 1959 INCLUSIVE. TABLE Ia 1955 1956 1957 1958 1959 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 491 253 238 508 260 248 509 245 264 506 244 262 536 273 263 Illegitimate 52 23 29 42 21 21 39 17 22 30 17 13 28 17 11 543 276 267 550 281 269 548 262 286 536 261 275 564 290 274 Birth rate (R.G.) per 1,000 pop. 13.9 14.2 14.2 13.8 14.5 STILLBIRTHS Legitimate 8 3 5 10 4 6 8 3 5 14 8 6 4 1 3 Illegitimate - - — 2 2 - — - - 1 1 - - - - 8 3 5 12 6 6 8 3 5 15 9 6 4 1 3 Rate per 1000 (live and stillbirths) 14.5 21.4 14.4 27.2 6.1 DEATHS 424 212 212 442 214 228 432 202 230 434 228 206 416 200 216 Death rate (R.G.) per 1OOO pop. 20.9 Uo4 11.2 11.2 10.8 8 COMPARISON OF VITAL STATISTICS 1930 - 1959. 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 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.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 14o2 442 11.4 24 24 1957 38590 548 14.2 432 11.2 13 23 1958 38800 536 13.8 434 11.2 15 22 1959 38590 564 14.5 416 10.8 22 22 9 TABLE III CAUSES OF DEATH REGISTRAR GENERAL'S TABLES 1955 1956 1957 1958 1959 M F M F M F M F M F All Cause 212 212 214 228 202 230 228 206 200 216 Tuberculosis, respiratory 6 - 2 - 5 1 2 - 1 2 Tuberculosis, other - — - — — 1 1 2 — — Syphilitic disease 1 — 1 - - 2 - - 1 1 Diphtheria - - - - - - - - — - Whooping Cough - - - - - - - - - - Meningococcal infections. - - - - - - - - - 1 Acute poliomyelitis - - - - - - - - - - Measles — - - - - — — — — - Other infective and parasitic diseases 1 1 2 1 1 - - 2 - 1 Malignant neoplasm, Stomach 4 6 4 5 3 7 9 5 2 11 Malignant neoplasm, lung, 24 4 21 1 10 6 23 2 23 3 Malignant neoplasm, - 3 - 4 - 5 - 6 - 1 Malignant neoplasm,breast - 5 — 12 — 7 5 - 11 Other malignant and lymphatic neoplasms 27 16 19 29 19 19 20 21 29 19 Leukaemia, aleukaemia 3 1 1 — — 3 - 1 1 2 Diabetes - 3 1 2 1 — 3 1 1 2 Vascular lesions of the 25 46 22 39 24 50 19 42 22 32 Coronary disease, angina. 44 22 43 26 43 25 49 32 35 21 Hypertension with heart disease 1 6 2 7 5 6 9 4 1 10 Other heart disease 12 35 18 26 17 25 20 33 12 26 Other circulatory disease 12 21 8 19 11 15 19 13 9 9 Influenza — 2 1 2 — 6 — 1 6 6 Pneumonia 9 12 9 8 9 11 10 6 9 17 Bronchitis 17 6 16 9 24 12 19 5 14 6 Other diseases of respiratory system - - 3 - 4 1 2 6 2 1 Ulcer of stomach and duodenum 3 - 8 1 - - - - 4 1 Gastritis, enteritis, and i-arrhœa 1 3 1 - - 1 - 1 - - Nephritis and nephrosis 1 - 2 - 5 2 - - 1 3 Hyperplasia of prostate 2 - 4 - 3 - I - 2 - Pregnancy, childbirth, abortion - 1 - 2 - - - - - - Congenital malformations 3 1 3 3 3 3 1 1 1 1 Other defined and ill^sfined diseases 8 10 17 23 11 15 12 10 12 23 Motor vehicle accident 2 1 2 — 1 3 4 - 4 1 All other accidents 2 5 2 4 2 3 3 5 5 4 Suicide 4 2 2 5 1 — 2 2 3 1 Homicide and operations Of War - - - - - 1 - - - - 10 SECTION B GENERAL PROVISIONS OF HEALTH SERVICES 1. (i) Laboratory Facilities. Bacteriological examinations are 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 Public Health Laboratory at Epsom is available for consultations and, if the occasion should arises 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 Public Health Laboratory, Epsom, and samples under the Pood and Drugs Acts are submitted to the Public Analyst, Mr. D.Do Moir, at the Analytical Laboratory, Southwark Street, S. E. 1. (ii) Hospitals. (®) 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 directed by the Physician Superintendent of Kingston Hospital. During the year 76 cases of infectious disease were treated in hospital, but 70 of these had been already notified from Kingston Hospital and related to puerperal pyrexia. To Kingston Hospital 75 " Surbiton General Hospital 1 (b) Smallpox. Arrangements are in being 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. Wednesday afternoon. (b) Infant Welfare Clinics. Health Centre. (Kingston 7261). Tuesday and Friday afternoon Thursday afternoon. (Toddlers) Queen's Road Clinic, Monday and Thursday 27, Queen's Road. (Kingston 5812). afternoons. (c) Immunisation and Vaccination Clinics. Health Centre. Thursday afternoon. Queen's Road Clinic, Friday forenoon. (d) Dental Clinics. Health Centre. Daily. "Keeldar", 25, Queen's Road. Daily by appointment. (Orthodontic only). (e) Day Nursery. 53-55 Canbury Par* Roa*. Approved accommodation 46 places This day nursery admits children aged 0-5 years and a small 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. (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, (Kingston 5072). (h) Health Visitors. Health Visitors who also act as school nurses work in the clinics and also do 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 (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 hut in assessing what the charge should "be consideration is given to the means of the persons concerned. (j) 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, in process of revision and extension as a result of the Mental Health Act, 1959* provides for the ascertainment of cases of mental ill-health and mental deficiency, the statutory supervision and guardianship of mental defectives living in the community, and the provision of after-care for persons who have undergone treatment for mental illness. The office of the Mental Welfare (Duly Authorised) Officer for the Borough is at 35» Coombe Road, Kingston-upon-Thames, (Kingston 3302)o 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. Monday forenoon. Tuesdays to Thursdays 9-10 a.m. Queen's Road Clinic. Friday forenoon. (ii) Medical Consultation. Health Centre. Monday forenoon. Queen's Roadi Clinic. Friday afternoon. (iii) Eye Clinic. Thursdays, from 10 a.m. Health Centre. by appointment. (iv) Dental Clinic. (See under Health) Immunisation Clinic. ( Department ) (v) Child Guidance Clinic. Gases referred to clinic at "Roselands", Kingston Road, New Maiden. (Speech Mondays and Thursdays Health Centre. 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 35, Goombe Road, Kingston-upon-Thames, (Kingston 4402). Surrey County Council - Social and Geriatric Services, For the old people Social and Geriatric Services are developing. Much is done for them by voluntary associations and many who are relatively fit in mind and body enjoy a fully active and interesting life enlivened by visits to Clubs, Meetings and other recreational activities provided by these voluntary associations. For those who are beginning to fail and are deemed to require assistance to help them to maintain themselves in their own homes all the resources of the Divisional Health Services are available as required and much help from home helps, district nurses and health visitors as well as from voluntary agencies is given. For those who need more in the way of medical or nursing care and cannot maintain themselves in their own homes the services of a physician and special health visitors and social workers are available from Kingston Hospital. The main purpose of this arrangement is rehabilitation. The social worker or the physician visits the home and assesses the need and urgency for a short stay in one of the appropriate hospitals. The family doctor is usually the person who first seeks assistance from the Home Help Supervisor, "but all enquiries on behalf of needy old people may be made to the Divisional Health Headquarters, The Health Centre, Grange Road, Kingston-upon-Thames, (Kingston 7261). The County Welfare Committee provides considerable services for the aged. These include different types of residential accommodation and many domiciliary and advisory services,, The County Council also makes grants to voluntary organisations towards initial expenses of buying and equipping properties. 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 etc0 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, Cental (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). 14 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 1959. 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 Geriatrician and Geriatric Health Visitors 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 coordinating 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 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 sewage from the Borough gravitates to the Corporation Pumping Station and is then pumped to the Hogsmill Valley Joint Sewerage Board's Works for treatment. This is a modern plant recently opened and successfully provides very effective purification and disposal for the sewage of Epsom & Ewe11, Surbiton, Maiden & Coombe, and Kingston-upon-Thames population. 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. A considerable portion of the flow of this river comprises the effluent from the Hogsmill Valley Joint Sewerage Board Works. 4. CLOSET ACCOMMODATION. All closets in connection with dwelling houses in the Borough are on the water carriage system. 5. PUBLIC CLEANSING. The Borough Surveyor is responsible for the collection and disposal of house and trade refuse. Disposal is still carried out by tipping into a worked out gravel pit provided by the haulage contractor. The refuse from this Borough, Surbiton and Maiden is transferred to large capacity road vehicles and transported to the tip by the the contractor. The refuse is now weighed on a weighbridge and 36,886 tons of refuse have been sent from this Borough in 1959. 6. SANITARY INSPECTION OF THE AREA. 16 The following is a tabulated list of visits and inspections made by the Public Health Inspectors which totalled 8,705 as compared with 8,095 for 1958. Houses Inspected, defected, etc. 495 Drainage 528 Factories 190 Outworkers 8 Atmospheric Pollution 139 Dairies, Milk Shops, etc 189 Food Permises 1,196 Restaurants and Cafes 317 Infectious Diseases Enquiries 245 Infectious and Cafes 3 Cinemas 43 Verminous Premises 55 Rodent Control 265 Shops Act 17 School 127 Housing Act 743 Markets 59 Public Sanitary Convenience 54 Fireguards 189 Merchandise Marks Act 482 Interviews 1,663 Miscellaneous 7,007 Reinspections and works in progress 1,698 8,705 NOTICES SERVED. Informal. (a) Verbal 233 (b) Written 88 Statutory. (a) Housing Acts - (b) Public Health Abts 18 NOTICES COMPLIED WITH. Informal,, (a) Verbal(b) Written 251 Statutory, Public Health Acts 18 7. SHOPS. There are some 980 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. 17 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 Sec. 1,2,3,4 & 6 are enforced by the Corporation 22 10 3 - Factories not included above in which Sec. 7 is enforced by the Corporation 259 115 1 - Other premises excluding outworkers 9 4 - - 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 2 2 — 3 - Over-crowding - - - - - Unreasonable Temperature - - - - - Inadequate Ventilation - - 1 - - Ineffective drainage of floors 1 1 — — - Sanitary Conveniences (a) Insufficient - — — 1 - (b) Unsuitable or defective 1 2 — - - (c) Not separate for sexes - - - - - Others — — — — — 18 PART VIII OF THE ACT. Outwork. The following table gives details of work which is carried on in private dwelling houses. The conditions obtaining have been found to be satisfactory. Nature of Work No. of Outworkers Wearing apparel Making etc. 7 Brass and Brass Articles 7 Box Making 1 Brush Making 5 Lampshades 2 22 9. CAMPING SITES. There are no camping sites within the Borough. 10. ATMOSPHERIC POLLUTION. During the year twelve complaints were received in respect of smoke or grit emission. None of these, however, related to large industrial or commercial installations. The matters referred to in general were minor ones due to lack of care and consideration by persons burning rubbish and waste material. The one case of smoke nuisance from an industrial plant mentioned in the last Report was brought under control by charging the fuel used from coal to coke. Technical Officers from the Gas Board were able to recommend a suitable grade of fuel and the plant for the past year has functioned satisfactorily. Following upon the receipt of memorandum 5/59 from the Ministry of Housing and Local Government, the Corporation considered proposals made with the object of declaring smoke control areas in the Borough. The Corporation decided, in principle, to implement the proposals but the defining of the areas and the order in which they would be dealt with was not decided during the year under review. Recording of Atmospheric Pollution - An instrument is maintained on the Guildhall roof for the recording of smoke and sulphur dioxide by the volumetric method. The advantage of this method over the deposit gauge is that it is possible to obtain daily readings of pollution and to observe more closely the effects of weather conditions on the state of the atmosphere. The following table and graph indicate the results obtained, Smoke is expressed in milligrams per 100 cubic metres and the sulphur dioxide in parts per 100 million. 19 Smoke and Sulphur Dioxide, 1959. Results obtained from the Volumetric Instrument at the Guildhall. 20 Results obtained from the Volumetric Instrument at the Guildhall. Month Smoke S02 Monthly Average Highest Value Lowest Value Monthly Average Highest Value Lowest Value January 20.4 99.8 1.2 12.0 56.7 0.7 February 12.2 66.7 3.8 9.7 31.3 2.9 March 8.4 26.3 1.2 4.8 11.7 0.9 April 5.8 17.5 l.O 4.2 9.4 0.5 May 4.3 8.2 1.9 4.6 9.4 o.9 June l.9 6.6 0.4 2.2 8.8 0.4 July l.5 4.4 0.2 l.9 5.3 0.4 August 1.6 4.4 0.2 1.6 4.1 0.4 September 2.6 6.6 0.4 2.9 8.6 0.4 October 2.7 15.0 - 1.8 3.8 - November 17.5 92.O 1.0 6.9 31.9 0.3 December 7.2 49.0 1.O 3.5 21.3 O.2 In addition to the instrument previously referred to, the Corporation maintains two deposit gauges which were located, after consultation with the Department of Scientific and Industrial Research, in Canbury Gardens and Tiffin Girls' School respectively. They are, for the purposes of report, referred to as 'A' and 'B'. 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. CANBURY GARDENS - Station 'A'. 1959 Deposit in Tons Per sq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Soilids Total Solids No. of Observations. No. of times SE-SW January 5.79 5.89 11.68 27 12 2.28 February 9.62 4.40 14.02 23 14 0.90 March 14.35 3.76 18.11 25 12 1.94 April 14.67 8.74 23.41 25 13 1.92 May 13.20 5.99 19.19 24 5 1.10 June 11.71 3.79 15.50 25 8 0.82 July 19.67 7.55 27.22 26 13 1.39 August 7.15 3.22 10.37 25 12 1.04 September 9.l8 2.74 11.92 25 8 — October 18.01 8.65 26.66 26 19 2.08 November 23.63 10.74 34.37 23 13 2.77 December l6.56 8.09 24.65 25 16 3.13 Totals 163.54 73.56 237.10 19.37 Average 1959 13.62 6.12 19.75 1.61 Average 1958 9.22 6.63 15.86 2.40 21 TIFFIN GIRLS' SCHOOL-Station 'B'. 1959 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- Gauge not in operation due to defect. February 5.64 3.32 8.96 23 14 0.06 March 6.44 2.89 9.33 25 12 1.86 April 6.21 6.71 12.92 25 13 2.00 May 9.43 7.04 16.47 24 5 1.01 June 6.47 4.05 10.52 25 8 0.71 July 5.14 3.25 8.39 26 13 1.26 August 2.62 2.56 5.18 25 12 0.89 September 4.48 2.89 7 . 37 25 8 - October 5.68 7.60 13.28 26 19 1.95 November 9.06 8.6l 17.67 23 13 2.47 December 9.23 8.30 17.53 25 16 2.91 Totals 70.40 57.22 127.62 15.12 Average 1959 6.40 5.20 11.51 1.37 Average 1958 4.10 5.31 9.42 2.35 The following additional table, illustrated with a graph, is of interest in showing the trend of atmospheric pollution over the years. Average Monthly Deposit - Total Solids. Tons per Sq.Mile. Year Station A. Canbury Gardens Station B. Tiffin Girls' School 1948 28.38 (7/12) - 1949 20.41 - 1950 22.17 14.98 (6/12) 1951 22.19 12.47 1952 19.12 12.49 1953 17.58 10.32 1954 18.70 10.21 1955 15.85 9.13 (11/12) 1956 19.00 9.95 1957 19.08 8.95 1958 15.86 (11/12) 9.42 1959 19.75 11.51 22 Total Solids-Tons per Square Mile. Canbury Gardens Tiffin Girls' School. 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. (b) Private - There are no privately owned swimming baths or pools open to the public in the Borough. 23 12. ERADICATION OF BED BUGS. During the year 30 premises were disinfested. Fifteen of these were houses under the control of the Corporation. 13. COMPLAINTS. The number of complaints received from the general public during the year was 442 compared with 424 for the previous year. The following is a brief list of causes for complaints received during 1959:- Sanxtary defects 75 Ashblns 2 Rodents 154 Drains and sanitary arrangements 72 Overerowding 3 Food 44 Nuisance from Smoke 11 Defective Yards and Paving 2 Insect Pests 30 Accoumulations 11 Animals 3 Water 2 Others 33 442 14. RODENT AND INSECT PEST CONTROL. During the year no legal action was required under the provisions of the Prevention of Damage by Pests Act, 1949. This is a very pleasing state of affairs and is an indication of the co-operation which exists between the department, householders and business people. A good liaison is maintained, through servicing agreements, between the department and the majority of commercial and industrial interests in the town. The work is carried out with efficiency and economy and this service is much appreciated. With regard to domestic properties, many of the infestations are due to accumulation of rubbish and unwanted articles such as prams, bedsteads, cycles, odds and ends of furniture and furnishings, and other items not normally collected by the refuse collectors. Arrangements should be made to assist householders by making special collections of this type of material. Effective control was sought by a thorough inspection of buildings in thirty-seven different blocks. This is known as 'block control'. Sewers - The second and third treatments in a series of four commenced in 1958 were given during the year, and test baiting of the whole sewer system prior to the fourth treatment was commenced in the area north of the railway to ascertain the efficacy of the baiting which had been carried out using sodium fluoracetate. The sewer system north of a line drawn from Lower Ham Road along King's Road to Queen's Road showed that no rats were using the main system in that area. Whether rats are in the branch drains is a matter for conjecture and can only be ascertained by inspection at each house. It is significant, however, that no surface infestation has been found in this area attributable to defective drains. 24 During the year eighteen drainage defects were "brought to light by inspections following complaints of rodent infestation. The department has continued to co-operate with the Laboratory of the Ministry of Agriculture, Fisheries and Food at Tolworth and recognition of our assistance to it has been mentioned three times in bulletins issued by the Ministry. Rodent Control - Statistical Statement. 1959. Private Dwellings and Corporation Property. Rats. Mice. Total. No. of complaints received in office 104 23 127 No. of premises inspected as a result 275 43 318 No. of premises found to be infested 135 43 178 No. of separate infestations treated 155 43 198 No. of visits for treatment and reinspections 913 125 1,038 No. of premises treated by occupier or other agency 4 - 4 No. of poison baits deposited 421 Business and Factory Premises. Rats . Mice. Total. No. of complaints received in office 10 17 27 No. of premises inspected, including those under Service Agreement 95 135 230 No. of premises in which slight infestations were found 60 121 181 No. of separate infestations treated 44 363 407 No. of visits for treatment and inspections 844 1,833 2,677 No. of premises treated by occupier or other agency 16 13 29 No. of poison baits deposited 1,878 Summary. No. of complaints received 154 No. of premises inspected 548 No. of premises infested 359 No. of separate infestations treated 605 No. of visits 3,715 No. of premises treated by occupier or other agency 33 No. of poison baits deposited 2,299 Insect Pest Control. The department carried out control and maintenance treatments in all types of premises. During the year requests were received to deal with infestations which involved the following insects: ants, cockroaches, carpet beetles, fruit flies, flour moths, clothes moths, mosquitoes, woodworm and house flies. Three cases were reported of large swarms of fruit flies which caused both nuisance and damage. Two infestations were treated by the department, and in the third instance, where a large industrial undertaking was infested, the management were advised upon the methods to be adopted to effect a clearance. 25 a- In addition, the department was asked to identify insects submitted by members of the public and in this connection we acknowledge gratefully the assistance given by the Ministry of Agriculture, Fisheries and Food Laboratory at Tolworth. SECTION D. HOUSING During the year 16 applications were made for Certificates of Disrepair, compared with eighty for 1958. The rate of applications has diminished to such an extent that it is reasonable to assume that the Act is functioning satisfactorily and in the main, landlords are able to meet the tenants' requirements as to repairs. It will be remembered that the function of the Local Authority with regard to the Act is generally one of arbitrator between landlord and tenant and during the twelve months under review this duty has been discharged without difficulty. With regard to statutory action under the provisions of the Housing Act, 1957, Closing Orders were made in respect of No, 70, Cambridge Grove Road and No. 95, Richmond Road (basement). A Demolition Order was made in respect of a houseboat 'Mathis' and the following Clearance Orders were made - Park Road Clearance Order (Nos, 77a-99 Park Road. Twelve properties) Cowleaze Road Clearance Order (Nos, 45, 47 and 49, Cowleaze Road, Three properties) With regard to the Statutory Notice served last year under the provisions of Section 9 of the Housing Act, 1957, for repairs at No, 84, Cambridge Grove Road, the works were carried out by the Corporation in default of the owners. 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 123 2. Number of houses which, on inspection, were considered to be unfit for human habitation 17 (a) Parts of houses which, on inspection, were considered to be unfit for human habitation 1 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 100 26 4. Number of representations made to the Local Authority with a view to:- (a) the serving of notices requiring the execution of works 19 (b) the making of demolition or closing orders (number of houses involved) 3 5. Number of formal notices served requiring the execution of works 18 6. Number of houses which were rendered fit after the service of formal notices 2 7. Number of demolition or closing orders made 3 8. Number of houses in respect of which an undertaking was accepted under sub-section 4 of section 16 of the Housing Act, 1957 - 9. Number of houses demolished 15 Housing-Statistical Statement. 1959. The following information is supplied by the Borough Surveyor who indicates that 22 flats were built by the Corporation during the year-all within the Boroughc Total number of permanent dwellings erected by the Corporation since March 1924 to 31st December,, 1959. Houses 1,9137 (lnc.876 outside Borough) Flats 926 Inc. 326 outside Borough) Total number of temporary dwellings erected up to 31st December, 1959. Still remaining. Arcon 132 129 Aluminium 70 43 2 year huts 113 Nil 315 172 Number of dwellings erected by private enterprise during 1959. Houses 4 Flats 77 81 27 SECTION E. INSPECTION AND SUPERVISION OF FOOD, (a) Milk Supply. All milk supplies in the town are brought in from outside sources, there being no milch herds in the Borough. All known sources of supply are regularly sampled,, The quality generally has proved to be satisfactory throughout the year. Under the provisions of the Milk (Special Designations) (Special Areas) Order 1951, the Borough of Kingston-upon-Thames 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 1959 under the provisions of the Milk (Special Designations) Regulations. All the licences were in force at the end of the year. Pasteurised Sterilised Tuberculin Tested To Pasteurise 1 - - To Deal 19 17 6 Supplementary 9 10 9 (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 in which ice cream may be stored or from which it may be sold is l69. This figure also includes five producers. In addition to these dealers and producers there are other premises, such as restaurants, canteens, cinemas, etc. upon which ice cream is sold. These premises are not required to be registered. By far the greater part of the ice cream sold in the town is obtained from manufacturers whose premises are situate outside the Borough, More than ever the production of ice cream is being confined to the few large manufacturers. 28 The following table shows the results of examinations in respect of 70 samples submitted to the Ministry of Health Public Health Laboratory at Epsom during 1959. 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. It is significant to note that during the year under review all the samples came within Grades I and II. This is considered to be satisfactory. Where samples fall within Grades III and IV these are not considered to "be so, and appropriate action is taken with the persons concerned so that a satisfactory standard may be achieved. GRADE I II III IV Total Ice Cream 68 2 - - 7O (e) Meat and Other Foods. (i) There are no slaughterhouses in the Borough. The supply of meat for the town arrives from Smithfield and through the local wholesale shops. A certain amount of home killed meat also comes from the modern abattoir at Guildford. (ii) Foodstuffs condemned as unfit. The following tabulated statement shows the amounts of various foods which were condemned during the year and the causes for condemnation. The quantities involved are small in comparison with the amount of food which is handled in the town. The list is very much condensed to avoid unnecessary detail,, Tabulated list of Condemned Foodstuffs showing causes for condemnation and the weights. Article of Food. Reason for Action. Wight. lbs» lbSo Raw Meat. Bovine Decomposition 29l½ Ovine „ 513 Porcine „ 393 Total quantity of raw meat 1,197½ Raw Fish. Decomposition 100 Poultry, Game, etc. „ 442 Dried Fruit „ 2 Canned Goods Meat and Meat Products Punctured, blown, damaged or decomposition 817½ Fruit 2,330 Jam 22 Vegetables 238¾ Milk 130¼ Soup 5½ Fish & Fish Paste 77 Others 10½ 3,631¼ 29 Food in Glass Containers. lbs. lbs. Confectionery Glass contamination, mould, deterioration 7½ Fish and Fish Paste 7¾ Fruit ¼ Jam and Preserves 3 Meat 3½ 22 Other Food condemned for various reasons Cheese 15½ Dried Milk 8 Margarine 2 Milk 150 Rice & Rice Pudding 58 Sugar 8 Potatoes 5,187 Onion Powder 3½ Pie 2 Cream ¼ Lemon Juice ¼ Sausages 63 5,497½ Unsound food is turned into a condition that recovery is impossible and placed in vehicles for conveyance to a tip, Where this method of disposal would be unsatisfactory, arrangements can be made for incineration at the refuse destructor of the Merton and Morden Urban District Council. (f) Food Hygiene. Food Hygiene Regulations, 1955. During the period under review the supervision of food premises continued satisfactorily. The standard which has been achieved is the measure of the cooperation which exists between the managements concerned and the Public Health Inspectors. In the catering and food retailing trade there are frequent changes of staff. In such circumstances regular routine visiting by the Public Health Inspectors is essential to ensure the continuance of satisfactory methods of food hygiene. 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. The following tabulated statement shows the nature of the defects for which Notices were served during the years- PART IV. Defects requiring Notices Complied Sanitary Conveniences. Lack of Wash Your Hands Notices 4 3 Fittings cleansed or repaired 5 6 Walls and ceilings cleansed 6 6 Sinks. Renewed, repaired, draining boards 4 3 Washing Facilities for Staff. Absence of, defective or inadequate hand basins 8 2 Absence of hot water 2 3 Absence of cold water 1 - Provision of towels, soap & nail-brushes 11 7 30  Defects Requiring Notices Complied Repairs to Pood Rooms. Floors cleansed 5 6 Walls and ceiling cleansed 7 6 Additional ventilation required 3 - Protection of Pood against contamination. Smoking 3 2 To be kept 18" off ground 7 3 Covers provided for food 18 15 Others 9 10 Uncleanliness Personal 1 1 Kitchens and equipment 17 13 Pood Stores 5 5 Preparation Rooms 2 2 Refrigerators 6 5 Shops 2 3 Dining rooms — 2 Utensils. Unclean and/or replaced 1 2 Others. 12 6 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. Pood Premises. No. of Premises Visits Bakehouses and Bakers' Shops 25 94 Dairies and Milk Shops 25 189 Butchers 40 150 Greengrocers and Stalls 89 466 Public Houses 58 90 Fishmongers and Stalls 19 222 Ice Cream Premises registered 169 136 Grocers and General Provisions and Stalls 132 560 Restaurants and Cafes 69 317 Kitchens and canteens (including factory, school and shop) 35 Public Houses (not included under restaurants but at which restaurant services are provided) 17 38 Meat Distribution Depots 5 51 Visits to Pood Premises re Unsound Pood 132 683 2,445 31 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. Canned Beef Steak with Gravy - The Analyst reported that the sample contained 65% of meat,but that in his opinion a reasonable minimum meat content for beef steak with gravy should be 75%. Follow-up procedure revealed that the standard required for such products was being discussed between the trade and the Ministry of Agriculture, Fisheries and Food. Beef Steak and Kidney Pie contaminated with Mould GrowthA thorough investigation was made of the manner in which this commodity came to be sold. As the result of representations to the vendor, the department suggested the adoption of a complete new code of practice, including date stamping of all perishable meat products, storage at 40ºF. and a maximum shelf life of forty-eight hours. The firm extended the system to all their branches and so far it has functioned with complete satisfaction. Chocolate Cream Bun- This article contained a substance which resembled cream but was, in fact, imitation cream. The firm were notified, and it transpired that the article had been labelled contrary to the directions of the management. An undertaking was given to label such articles satisfactorily in future. Beef Steak and Kidney Pies contaminated with Mould Growth At least three pies were sold to different customers and it was ascertained that they had been sold four days after delivery to the vendor. The firm were prosecuted and were fined £45 and ordered to pay 11 guineas costs. Pork Pie contaminated with Mould Growth - In this case the pie had been retained by the retailer for a period of nine days. Legal proceedings were authorised, but the complainant was unwilling to give evidence. As she was a material witness it was considered advisable not to proceed. Frankfurter Sausages containing evidence of mould growth These sausages were sold to the complainant twenty days after they had been packed. As the result of exhaustive enquiries it was concluded that the shopkeeper was not to blame and that some error was made by the employees of the manufacturers. Legal proceedings were instituted, the firm pleaded guilty and a fine of £10 was imposed together with costs amounting to four guineas. Rice - This sample consisted of broken rice, but the description did not appear conspicuously and in a prominent position on the label as is required by the Labelling of Food Order 1956. The packers of this commodity were informed of the Analyst's comments and they undertook to label their products properly in future. As was mentioned last year, the frequency with which complaints are made concerning the sale of pre-packed perishable articles which are stale suggests that such products should be clearly marked with the date of manufacture. There are considerable difficulties in making date stamping a legal requirement, but it is felt that sooner or later manufacturers of perishable products will require to adopt a satisfactory method of marking so that if there is laxity on the part of the retailers or manufacturers the consumer has an opportunity of checking whether or not the article is fresh. Some firms go to great 32 lengths to retain the secrecy of their codes, "but it would "be to the advantage of all concerned if the codes were less complicated and particularly if the retailer were made fully aware of the manufacturer's system. Tabulated Statement of Samples Submitted to the Public Analyst during 1959. Commodity No. of Samples Genuine Not Genuine or otherwise irregullar Formal Informal Formal Informal Formal Informal Biscuits — 1 - 1 - — Beef Steak & Kidney pie 1 3 - - 1 3 Beef Steak with Gravy — 1 - - - 1 Blancmange - 1 - 1 - - Blackberries in Syrup — 1 - 1 - - Bread-White — 1 - 1 - - Cheese-Parmesan — 1 — 1 — - Cheese-Spread — 2 - 2 - - Chocolate Cream Bun - 1 — - - 1 Chocolate Drink — 1 — 1 - — Chutney — 2 - 2 - — Coconut-Desiccated - 1 — 1 - - Codeine Linctus — 1 — 1 — — Confectionery-flour - 2 - 2 - - „-sugar — 6 — 6 — — Cordial — 1 — 1 - - Cough Syrup - 1 - 1 - - Crab-dressed — 1 — 1 — — Cream — 1 - 1 — — Currants — 1 — 1 - - Custard Powder — 1 - 1 - — Diabetic Chocolate - 1 - 1 - - Fruit-Dried — 1 - 1 - - „-Laxative — 1 - 1 - - „-Salad — 1 — 1 — - „-Dried Salad — 1 — 1 - - Gelatine — 1 — 1 - - Hamburger - 1 - 1 - - Harricet Beans — 1 — 1 — — Ice Cream - 4 - 4 - - Jam - 1 - l - - Jelly-Table - 1 - l - - Ketchup-Tomato - 2 - 2 - — Lemon Curd - 1 — 1 — — Lentils — 1 — 1 - - Luncheon Meat — 1 - 1 - - Margarine - 1 - 1 — — Marmalade - 1 — 1 — — Marzipan - 1 - 1 — — Milk - 16 - 16 — — Milk-Channel Islands — 1 — 1 - - Mint Sauce - 1 - 1 — — Mint Jelly - 1 - 1 — — Minced Pork — 1 - 1 — — Mustard-prepared - 1 - 1 — — Paste-Pish — 1 — 1 — — Paste-Meat — 2 - 2 - - Peas — 1 - 1 - — Pickle — 1 — 1 - - Pie Pilling — 1 — 1 - - C/Fwd 1 80 — 75 1 5 33 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. 1 80 - 75 1 5 Pork Pie — 2 — 1 — 1 Port flavoured Beverage - 1 - 1 - - Prawns Peeled - 1 — 1 — — Plums — 1 — 1 — - Rice — 1 — — — 1 Rum Butter — 1 — 1 — — Runner Beans — 1 — 1 — Salmon with Butter — 1 — 1 — — Sardines — 1 — 1 — - Sauce ~ 1 — 1 — - Salt — 1 — 1 — — Sausages-Frankfurter - 1 — — — 1 Sausages-Pork - 1 — 1 — — Soup - 4 - 4 - - Smoked Salmon Mayonaise - 1 - l » - Sponge Mixture — 1 — 1 - - Steak-Stewed - 1 — l — — Steak & Kidney Pudding & Pie - 3 - 3 - - Suet — 1 — 1 — — Syrup - 1 - 1 — — Sugar - 4 - 4 - - Tea — 2 — 2 — - Tapioca — 1 - 1 — - Tomato Juice — 2 — 2 — - Turkey Croquettes — 1 - 1 - - Vinegar - 2 - 2 - - 1 118 - 110 1 8 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 1959 a total of 433 notifications of infectious disease was received, and these are analysed and commented upon in the following tables and reports. 35 NOTIFIABLE DISEASES DURING 1959. TABLE IV CASES DEATHS Age Groups Age Groups Under 1 year 1-2 2-3 3-4 4-5 5-10 10-5 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 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever — 1 2 4 2 11 7 - - - — - 27 — — - - - - - - - - - - - - Measles 3 23 30 39 35 120 7 - — - 1 - 258 — — — — - — — - - - - - - — Whooping Cough - - - - - 3 - — — - - - 3 — - - - - = = = = - = - = = Acute Poliomyelitis: Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Non-Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Infective Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection. - - - - - - - - - - - - - - — - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 11 58 3 - - 72 70 - - - - - - - - - - - - - Dysentery - 2 2 — — 8 2 1 8 1 1 - 25 - - - - - - - - - - - - - - Food Poisoning 2 — — - — - 31 — 2 - - l 6 - - - - - - - - - - - - - - Pneumonia 2 - 2 1 2 3 6 3 3 3 10 5 40 5 5 - - - - - - - - - 7 14 26 Erysipelas - - - - - = — - — — 1 — 1 - - - - - - - - - - - - - - Ophthalmia Neonatorum - - — - - - - - - - - - - — - - - - - - - - - - - - - Pemphigus Neonatorum 1 - - - - - - - - - - - 1 1 - - - - - - - - - - - - - Totals 8 26 36 44 39 145 23 15 71 7 13 6 433 76 5 - = - - - - - - - 7 14 26 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 Measles Whooping Cough Puerperal Pyrexia Poliomyelitis Acute Infective Encephalitis Diphtheria Ophthalmia Neonatorum Enteric Fever (including Para-Typhoid) 1930 78 not notifiable- until 1940 not notifiableuntil 1940 9 - - 100 2 5 1931 61 14 — — 53 4 1 1932 56 13 2 - 47 — 1 1933 125 10 3 - 30 2 2 1934 40 5 — — 42 3 2 1935 54 8 - - 50 3 2 1936 67 19 - - 27 2 6 1937 51 32 2 — 21 3 1 1938 61 47 2 — 72 2 1 1939 69 66 1 - 19 3 1 1940 45 373 22 63 - - 53 3 3 1941 54 331 271 37 1 — 15 - 7 1942 79 375 99 24 — - 8 3 - 1943 110 287 151 18 1 - 3 - 1 1944 49 33 73 15 1 — 7 2 — 1945 28 407 84 23 1 — 16 2 — 1946 34 233 67 41 2 - 8 1 1 1947 24 219 38 28 5 3 2 1 1 1948 34 197 200 30 3 — - - - 1949 73 483 81 29 7 3 - - - 1950 51 132 41 23 4 - - - - 1951 37 443 222 41 - 1 - - — 1952 29 280 102 84 3 - - - - 1953 21 302 126 80 5 — — — — 1954 16 419 21 96 -- 1 - - 1955 11 170 17 72 10 1 - - - 1956 17 35 58 88 3 - - - - 1957 13 483 55 59 2 1 - - - 1958 11 200 9 60 - — 1 — 1959 27 258 3 72 - - - - - 37 Smallpox. There were no cases recorded in Kingston during 1959, but the disease is 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 come by air from countries where outbreaks have occurred. The majority of countries now insist upon an International Certificate of Vaccination being produced before travellers are allowed to land. In this connections 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 Kingston babies are known to be vaccinated during their first year and in an effort to obtain a higher level, of vaccination, all Kingston doctors were informed of the position), pointing out the need to raise this figure to at least 15%. Scarlet Fever. Twenty-seven cases were notified during 1959, 18 of which were of school age. The cases were not serious and there were no deaths. Scarlet fever is a streptococcal infection and is therefor© 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 twelfth 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. Continued freedom from any illness creates a complacency in the minds of the people but this must be combated particularly in regard to diphtheria which is always likely to reappear, and will do so if protective immunisation of children is not kept up to a high level. During 1959, 4, 044 Kingston children were immunised for the first time or received reinforcing "booster" injections. A figure known as the immunity index, which is shown as a percentages, is computed each year. This relates to the proportion of the child 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 and the total index for all children under the age of 15 is 62%. The intensive campaign to immunise as many children as possible is being maintained, and it is calculated that during 1959 the proportion of Kingston babies immunised before they reached the age of 1 year was 84%. 38 Poliomyelitis. No cases of poliomyelitis were notified in Kingston during 1959. The last case was notified in October, 1957. During the week commencing 22nd June 1959, a special Poliomyelitis Vaccination Week was inaugurated and twenty special vaccination sessions were held at clinics in the Division in an effort to persuade young persons up to age of 26 years to have their first injections against paralytic poliomyelitis. Appointments were not necessary and every new person attending was given a date for his second injection when he received the first. Following a widespread and massive publicity campaign which was mounted during the week commencing 15th June 1959, a total of 3,872 vaccinations were given, of which 3,181 were first injections. The number for Grange Road Clinic was 821. This was made possible by the co-operation of a large number of paid and voluntary workers especially the staffs of County District Public Health Departments, who were responsible for publicity in their own areas. Civil Defence Staff and volunteers, voluntary organisations including British Red Cross Society, St. John Ambulance Brigade, and Women's Voluntary Service, and shopkeepers and factory managements who displayed and distributed publicity materials Local newspapers also showed a helpful interest in the campaign, despite their own difficulties at the time and British Railways Advertising Service extended full co-operation. The week's campaign was applied to the whole of the North Central Division and included the Boroughs of Maiden and Coombe, Surbiton, and the Urban District of Esher. I record my appreciation and thanks for the unfailing help given to me by all concerned in making the Poliomyelitis Vaccination Week such an outstanding success. This effort was successful not only in the specific field of poliomyelitis vaccination but in the inspiration which all who took part found in the week's work. Enteric Fever (Typhoid or Paratyphoid). There were no cases of typhoid or paratyphoid B notified in Kingston during 1959 and this is the twelfth successive year without notification of enteric fever. Infection that does occur is mostly imported from abroad through contaminated foodstuffs, but polluted water courses and streams can carry the organism and indiscriminate bathing and drinking of contaminated impure water can be dangerous. Dysentery (Sonne). A total of 25 oases of dysentery was notified during 1959 compared with 167 during 1958. These notifications were all in respect of individuals or individual families. No outbreaks occurred during the year. Sporadic individual dysentery cases are becoming a normal occurrence each year. The illness is mild but it has a possible serious effect on young babies and debilitated persons. Every effort is made to prevent the spread of possible infection although the disease can and does run rapidly through schools, etc, Its presence in a nursery, for example, can be a serious matter. 39 / 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 emphasizing this fact to members of the general public, and especially those concerned with food handling and the care of young children. Measures such as these tend to decrease the spread of the disease and also act as an education in personal hygiene. Measles. There were 258 cases of measles notified during 1959 compared with 200 in 1958. Generally speaking the illness was of a mild type with little "by way of complications and all caseswere nursed at home. The majority of the illnesses (130) occurred in children in the 0/5 age group, and (120) in the 5/10 age group. Whooping Cough. During 1959, only 3 cases of whooping cough were notified compared with 9 in 1958. Ophthalmia Neonatorum. No cases of ophthalmia neonatorum occurred during 1959» Puerperal Pyrexia. The maternity block at Kingston hospital serves Kingston and a large surrounding area embracing a population of some 285,000 persons. During 1959, 1,669 deliveries took place in the hospital, and inevitably some cases of puerperal pyrexia occurred, all of which were notified to the Medical Officer of Health of Kingston in accordance with the regulations which define the 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 1959, 72 cases were notified, 24 of which referred to Kingston residents, and 70 of whom were notified from Kingston hospital. These figures compare with 60, 18 and 60 respectively for 1958. An analysis for the years back to 1955 is shown below. Cases 1955 1956 1957 1958 1959 (a) Total notified 72 88 59 60 72 (b) Number included in (a) of (i) Kingston residents 17 21 8 18 24 (ii) Extra district residents. 55 67 51 42 48 (c) Number included in (a) notified from Kingston hospital 69 88 59 60 70 (d) Number included in (a) notified by private doctors 3 - - - 2 (e) Number of cases included in (d) removed to hospital other than those included in (c) - - - - - 40 Food Poisoning. In spite of the very large number of eating places and food shops in Kingston, no cases of food poisoning occurred during 1959 which could be attributable to lack of hygiene in the trade. A total of 6 sporadic cases of food poisoning occurred during 1959? and there was a total absence of outbreaks. No particular food or vehicle of infection was implicated. 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. Tuberculosis. In accordance with the national trend the number of new cases of tuberculosis notified continues to be satisfactorily low. In 1959 in Kingston 19 cases were reported, 18 of which referred to the lungs. The corresponding total figure for 1958 was 18 of which 16 referred to lungs. A total of 5,589 persons were x-rayed during a visit of the South West Metropolitan Regional Hospital Board X-Ray Unit in March - (2,545 males, 3,044 females). The figure is 2,043 less than last year. This can be accounted for to some extent by a smaller number of sessions available to the general public. A total of 4 cases (3 males, 1 female) of active pulmonary tuberculosis was discovered and referred for immediate treatment. These figures do not necessarily relate only to Kingston residents. Whilst there is considerable satisfaction to be derived from the steady decline in the number of new cases appearing there are still very many cases, a large proportion of whom are chronic, on the register and receiving treatment and attention at the Chest Clinic. Breakdowns and consequent periods of infectivity are continually possible in these cases and the infection is therefore still within the community. It will be many years before the combined effects of improved living conditions of the population, advances in therapeutic treatment, facility for early detection of tuberculosis by public mass x-ray sessions and B.C.G. vaccination of school children, bring the disease to the point of eradication. The following table shows comparative figures of notified cases and deaths for the years 1950 to 1959 (inclusive):- Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 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 1958 16 2 18 2 3 5 1959 18 1 19 3 mm 3 41 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1959. 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 2 1 5 2 12 - — _ _ _ _ — _ 2 2 F - - 1 1 - 1 - 1 2 6 - - - - - 1 - - - 1 Total - - 1 2 1 3 1 6 4 18 - - — - - 1 - - 2 3 (b) Non-respiratory M — - — — - — — — — — - — - — — — — «- — F - - 1 - - - - - - 1 - - - •= - - - - - - Total - - 1 - - - - - - 1 - - - - - - - — - - 42 The efficiency of notification has been good and there is no reason to suspect refusal or neglect to notify. 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 dependants by the Kingston and District Tuberculosis Care Committee. During 1959, 94 families were helped in the form of grants for extra nourishment, clothings fuel, removals, bedding, fares, pocket-money, etc., and a total of £1,403 was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1959 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.