??? THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES 1960 THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector 1960 THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT GUILDHALL, KINGSTON UPON THAMES JUNE, 1961 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES 1960 THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT GUILDHALL, KINGSTON-UPON-THAMES JUNE, 1961 ANNUAL REPORT I960 TABLE OP CONTENTS Page Preface i,ii,iii,iv,v. Population 1 Births i Deaths i Infant Mortality Rate-1956/l960-Rate per 1,000 lire births ii Causes of Death ii Infectious Disease ii Diphtheria iii Housing and rehousing iii,iv. Royal Commission on Local Government in Greater London iv. Food Poisoning 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 4 (a) Live Births 5 (b) Stillbirths 5 (c) Total Lire and Stillbirths 5 (d) Deaths 5 (i) Death Rate 5 (ii) Infant Deaths 5 (iii) Maternal Deaths 5 (e) Maternal Mortality Rate 5 Infant Mortality Rate 1956/1960 6 Quinquennial Infant Mortality Rate 6 Causes of Death of Children under 1 year 7 (iv) Deaths from Other Causes 8 Introduction to Tables on Vital Statistics 8 Table I - Extract from Vital Statistics for the years 1956/60 9 Table II - Comparison of Vital Statistics 1931/1960 10 Table III - Causes of Death 11 Page SECTION B Greneral Provisions of Health Servioes (1) (i) Laboratory Faoilities 12 (ii) Hospitals:- (a) Infectious Diseases 12 (b) Smallpox 12 (c) Greneral 13 (2) Health Services provided by other Authorities Surrey County Council - Health Department 13,14,15. Surrey County Council - Eduoation Department 15,16. Surrey County Council - Welfare Department 16,17. Surrey County Council - Sooial A Seriatrio Services 17 Surrey County Council - Children's Department 18 Surrey Executive Council 18 (3) National Assistance Act, 1948 National Assistance (Amendment) Act, 1951 19 SECTION C Sanitary Circumstances (1) Water Supply 20 (2) Drainage and Sewerage 20 (3) Rivers and Streams 20 (4) Closet Accommodation 20 (5) Public Cleansing 21 (6) Sanitary Inspection of the Area 21,22. (7) Shops 22 (8) Factories Act, 1937 22,23,24. (9) Camping Sites 24 (10) Atmospheric Pollution 24,25,26,27, 28,29,30. (11) Swimming Baths and Pools 31 (12) Eradication of Bed Bugs 31 (13) Complaints 31 (14) Rodent and Insect Pest Control 32,33,34. SECTION D Housing General 35,36. Statistical Statement, 1960 36 Page SECTION E Inspection and Supervision of good (a) Milk Supply 37 (b) Designated Milks 37 (c) Bacteriological Examination of Milk 37 (d) Ice Cream 38 (e) Meat and Other Foods 38,39,40. (f) Food Hygiene 40,41. Food Hygiene Regulations, 1955 42 Food and Drugs Act, 1955 42,43. Tabulated Statement of Samples submitted to the Public Analyst during 1960 43,44,45. Merchandise Marks Act, 1926 46 SECTION F Infectious Diseases Notifiable Diseases 47 Table IV. Notifiable Diseases during 1960 48 Table V. Comparative Statement of Notifications of certain Infectious Diseases 49 Whooping Cough 50 Enteric Fever (Typhoid or Paratyphoid) 50 Measles 50 Ophthalmia Neonatorum 50 Puerperal Pyrexia 50,51. Smallpox 51 Scarlet Fever 52 Diphtheria - Immunity Index 52 Poliomyelitis 53 Dysentery 53,54. Tuberculosis 54,55,57. Table VI A Graph - Notified cases and Deaths from Tuberculosis in 1960 56,58. TELEPHONE NO: KINGSTON 2121. (i) PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES. June, 1961. TO THE MAYOR, ALDERMEN AND COUNCILLORS OP THE ROYAL BOROUGH OP KINGSTON-UPON-THAMES. ANNUAL REPORT. I960. 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 1960. As in previous years the report follows the general lines indicated by the Minister of Health, and is in accordance with Circular 1/6l. Population - The Registrar General's estimated mid 1960 home population figure is 38,630 (resident population figure - used for calculation of the statistical data in this report) an estimated increase of 40 persons compared with 1959. The estimated day population is about 300,000 persons who enter the town for business, education, and recreation purposes. This influences the volume of work and responsibility of the Corporation. Births - The number of live births for 1960 is 578 and compares with 564 for 1959. The crude birth rate is 15.1 per 1,000 population compared with 14.5 for 1959. Deaths - The number of deaths recorded in 1960 is 432 compared with 416 for 1959. This makes a crude death rate of 11.2 as compared with 10.8 for 1959. The excess of births over deaths was 146 compared with 148 for the previous year. The number of infant deaths (under 1 year of age) in 1960 is 6 which gives an Infant Mortality rate per 1,000 live births of 10.4. This is leas than half the number of infant deaths recorded in 1959 and is the lowest infant mortality rate per 1,000 live births on record for Kingston-uponThames. While we are greatly encouraged by the exceptional low figure, we must expect, now and again, one or two inevitable deaths occurring in a future year which will again increase the infant mortality rate figure. The corresponding figures for 1959 were 13 infant deaths and an Infant Mortality rate of 23.0 The following table shows the approximate average rate for the previous five years. (ii) INFANT MORTALITY RATE 1956 1957 1958 1959 1960 Total No, Deaths 13 7 8 13 6 RATE PER 1,000 LIVE BIRTHS 23.6 12.8 14.9 23.0 10.4 No maternal deaths (i.e. from pregnancy, childbirth, abortion) were recorded out of a total of 586 live and stillbirths. Causes of Death - Main conditions causing death during 1960 were 1960 1959 Heart Disease 146 105 Cancer 98 99 Vascular Lesions of the Nervous} System 53 54 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. 1956 1957 1958 1959 1960 Deaths from cancer of the lung and bronchus Total Total Total Total Total 22 16 25 26 23 M F M F M F M F M F 21 1 10 6 23 2 23 3 20 3 Infectious Disease - The incidence of infectious disease was satisfactorily low and it is gratifying to record that the number of infectious disease notifications received in 1960 was 136, as compared with 433 in 1959. This is accounted for by a reduction in the entire range of the commoner infections with the exception of puerperal pyrexia cases which showed an increase of 17 as compared with 1959, and are nearly all related to cases from other areas being nursed in Kingston Hospital. (iii) Active protection of the child population against diphtheria, whooping cough, tetanus, smallpox, tuberculosis and poliomyelitis was continued at a vigorous pace. Diphtheria. For the thirteenth year in succession no cases of diphtheria occurred in Kingston. Outbreaks of the disease occurred in unimmunised children in some areas which only emphasised the importance of keeping the child population as highly immunised as possible and particularly for initial protection to be given in their first year. Parents are therefore constantly encouraged to take full advantage of the immunisation service provided and intensive campaigns are carried out to immunise the school and pre-school population against this disease. This is done under my direction as Medical Officer of Health as well as Divisional Medical Officer for North Central Division of Surrey, at the Surrey County Council Clinics and by General Medical Practitioners. As at the 31st December, 1960 4,510 Kingston children have been immunised during the past 5 years for the first time or received reinforcing "booster" injections. It is calculated that during 1960 the proportion of Kingston babies immunised before they reached the age of 1 year was 89% Every effort should be made to maintain this very satisfactory figure. Housing and Rehousing. No Corporation housing units were built during 1960. Fortythree flats and maisonettes, 6 houses and 1 bungalow, were erected by private enterprise, giving a total of 50 new housing units in Kingston during the year. The points mentioned in my previous reports on the question of housing and rehousing still apply and are emphasized by the Chief Medical Officer of Health of the Ministry. An extract of his Report for 1959 Part II Chapter XVIII page 249 follows?- "It is well known that many of the elderly are unsuitably housed. They may be remaining in houses which have become too big for their physical limitations or where the amenities are inadequate or so badly sited that they are unable to make full use of them. The Rowntree Committee recommended that five per cent of all dwellings, whether private or municipal, should be suitable for and available to old people and an increasing proportion of new housing, usually in the form of bungalows or flats, is of this type. It is thought that the older person would be able to retain his independence far longer in the smaller suitably designed dwelling, particularly where a warder is appointed to a group of such dwellings. (iv) "The rehousing of old people in areas remote from their former environment presents its own problems of the intense loneliness experienced during the day and of the comparatively high incidence of senile dementia and other illnesses among those transferred In recognition of the fact that the health of old people does not usually remain static and that some, in the course of time, require rather more help, the concept of building a small welfare home in proximity to a group of old people's dwellings is beginning to gain ground." Due to the scarcity of housing vacancies during the year it was found necessary to close the Corporation waiting list to all prospective applicants. The Corporation are, however, determined to renew their efforts to provide a sufficiency of houses for the purpose of rehousing those families who come within a priority category and this programme will include a fairly substantial proportion of one-bedroom units suitable to older people although not old people's units as such. Royal Commission on Local Government in Greater London. Last October this Royal Commission made revolutionary proposals for the future government of London. Two of the main suggestions are A. That a Counoil for Greater London with powers different from those of the London County Council be set up. B. That the primary units of Local Government should be the Greater London Boroughs each having populations of 100,000 250,000 effected by amalgamation of existing units of local authorities and comprising in all a total of 52 "most purpose" boroughs instead of the existing collection of 96 County Council, Metropolitan and Municipal Boroughs, and Urban Districts. The Minister of Housing and Local Government has pointed out that before the Government can reach any conclusion on the report of the Royal Commission, opportunity must be given for the expression of public opinion on the far reaching recommendations made by the Commission, and in particular the Government will wish to hear the views of local authorities concerned. Food Poisoningo It is a welcome fact that in spite of the very large number of eating places and food shops in Kingston, no cases of food poisoning occurred during 1960 which could be attributable to lack of hygiene in the trade. Constant 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 every day. (v) A total of 3 sporadic cases of food poisoning occurred during 1960 and there was a total absence of outbreaks. The particular food or vehicle of infection implicated in these cases was cooked meat allowed to cool slowly in a warm oven. Although people are spending more on food than ever before, it is possible that one of the causes of food poisoning might be partly due to changes in our food habits. Processed foods are more readily available - deep frozen foods, partly prepared foods, etc., all of which require intelligent handling and proper storage by the housewife. For example difficulty can arise from failure to follow exactly the instructions on the label or package of foods which have been processed or partially prepared. Furthermore, some prepared foods require little or no cooking and may become contaminated before consumption. Staff. No staff changes took place during the year. 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. I am also pleased to record my thanks for the support and encouragement I have received in my work, to The Worshipful The Mayor, Aldermen and Councillors and to the Chairman of the Public Health Committee. I also acknowledge my gratitude for the hard work and loyal support of the staff of the Public Health Department, and the co-operation of Dr.Kinstrie, Deputy Medical Officer of Health, and of my fellow Chief Officers. I have the honour to be, Your obedient Servant, J.W.STARKEY. Medical Officer of Health. 1 ROYAL BOROUGH OF KINGSTON-UPON-THAMES PUBLIC HEALTH COMMITTEE Publio Health Committee for the Municipal Year 1960-61. Alderman McDonald (Chairman) Councillor Croll " Knowlden (Vice-Chairman) " Denny Councillor Guymer (Mayor) " Eades Alderman Judge (Ex-Mayor) " Kimber " Lacey " Lees " Oldfield " Marshall Councillor Baker " Tapping STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: J.W. STARKEY, M.B., Ch.B. (Edin.), D.P.H. Deputy Medical Officer of Health: (Part-time). W.H. KINSTRIE, M.B., Ch.B. (Edin.), D.P.H. 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. FRANKELL, D0M.A. Clerical Staff: MISS C.L.FOISTER. MISS M.W.FILBEE. D. HAWKINS. R. SMITH. Pest Control 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 1. General Statistics. Area in Acres 1,408 Total Population (including Service personnel) 38,630 Number of inhabited houses (approx.) 11,811 Rateable Value - General Rate (1.4.60) £1,151,481 Sum represented by Penny Rate (year I960/6I) £ 4,656 Total number of hereditaments 14,529 Domestic dwellings 80% of total hereditaments Commercial premises 16% of total hereditaments Number of premises classified as industrial, entertainment, public utility, educational and miscellaneous 449 2. Social Conditions. Kingston-upon-Thames is a Royal and Ancient Borough situated upon the south bank of the River Thames, within the County of Surrey and the Greater London area. Although it is renowned as a prosperous market town and for its extensive shopping centre, which provides the main economic function, there is also important industrial activity in Aircraft and Engineering. Kingston is not only a centre for education and recreation, but is a "commuting" area for business people travelling daily to and from London. The social conditions are influenced by the trend of the high level of employment which exists in the town and the Manager of the local Employment Exchange, Miss M.Bond, has kindly provided the following information regarding employment in Kingston and District:- "In reviewing the employment situation obtaining during 1960, I am happy to be able to report that the year was one of continuing stability, with unemployed registers in general consistently lower than they were in 1959. In December there were 338 men and 92 women registered as unemployed in Kingston Employment Exchange (19 fewer men and 2 more women), it is notable that even lower figures were recorded during the year, the lowest being 317 men and 66 women. The Exchange found employment in its own area for 3,718 men and 1,163 women in 1960, 110 of the women's placings being in part-time work. Additionally, 121 men and 75 women were placed in work in other Exchange areas. The overall total of 5,077 is an inorease of 45 over 1959. Thirtyeight of the men and 118 of the women placed were people already in work who were, for a number of reasons, seeking other positions. Fortysix men were submitted to vacancies in new or expanded towns, and 9 were successful, 3 4 of these being Kingston residents. The results of 8 of the remaining 37 submissions are still awaited. The Exchange was able to place 60 of the 89 ex-regular servicemen who sought its help in their resettlement into civilian life, while 4 were allotted places in Government Training Centres for training in civilian occupations. Also included in the total of 5,077 are 277 men and 42 women who were in some way disabled, whether or not they were registered under the Disabled Persons (Employment) Acts. Despite the poor summer, unemployment among building trade workers was no higher than in 1959, while unfilled vacancies in the industry were frequently three times as many as those becoming unemployed from building work. In other industries business has in general been maintained at a high level throughout the year. The local aircraft industry during 1960 recruited only highly qualified technicians and other skilled workers. In the main, wastage was not replaced and over the year there was a decrease of 380 in the numbers employed in the industry. This wastage was gradual, however, and no large redundancies occurred. The position at the end of the year had stabilised and the present labour force is fully occupied. One advantage locally of the merger with other aircraft companies is that spare capacity at Kingston has been used by undertaking production for other firms in the group. There is some movement of firms out of the Exchange area to those districts where the shortage of labour is not so aoute, while others from central London, notably those employing considerable numbers of clerical workers and experiencing labour recruitment problems, have come or are seeking to come to Kingston, hoping to attract workers who at present are having to travel daily to town, as well as young persons leaving school. The end of 1959 showed increases in unfilled vacancies, for both men and women, as compared with the position at the end of the previous year. At the end of 1960 the number of unfilled vacancies had risen still further, to 726 men and 512 women. These are increases over December, 1959, of 278 and 119 respectively, and the ratio of unfilled vacancies to registered unemployed, which in 1959 rose from .8 to 1.9, rose yet again to 2.9 in 1960. The area has so far been unaffected by the short time working which has been so heavy in some parts of the country, particularly those where the motor manufacturing firms are situated. A few workers employed in that industry in districts nearby signed the unemployment register at Kingston intermittently during the autumn, but full time working was resumed early in January, 1961. The percentage of unemployment locally, again only .5, compared with a national figure of 1.9, is gratifyingly low, and it is hoped that with its considerable diversity of industry, Kingston will in 1961 continue to enjoy stable, and even expanding, conditions." 4 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 0.97; 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. 5 VITAL STATISTICS Male Female Total Total 1960 1959 (a) Live Births - Legitimate 269 276 545 (536) Illegitimate 21 12 33 ( 28) 290 288 578 564 Live Birth Rate per 1,000 population 15.1 (14.5) Adjusted Birth Rate 14.6 (14.l) England and Wales Live Birth Rate 17.1 (16.5) Illegitimate Live Births per cent of total Live Births 6.1 ( 4.9) Male Female Total Total 1960 1959 (b) Stillbirths - Legitimate 3 4 7 (4) Illegitimate 1 - 1 (-) 4 4 8 4 Rate per 1,000 total Live and stillbirths 13.5 ( 6.1) England and Wales Stillbirth Rate 19.7 (20.7) Male Female Total Total 1960 1959 (c) Total Live and Stillbirths - Legitimate 272 280 552 (540) Illegitimate 22 12 34 ( 28) 294 292 586 568 Male Female Total Total 1960 1959 (d) Deaths - 223 209 432 (416) (i) Death Rate per 1,000 population 11.2 (10.8) Adjusted Death Rate 10.3 ( 9.8) England and Wales Death Rate 11.5 (11.6) ¤ (ii) Infant Deaths Total No. of Deaths 6 (13) Infant Mortality Rate per 1,000 Live Births 10.4 (23.0) Infant Mortality Rate per 1,000 Live Births - Legitimate 11.0 (22.3) Illegitimate Nil (35.7) Infant Mortality Rate for England and Wales 22.0 (22.0) ¤¤ Neo Natal Mortality Rate per 1,000 Live Births 8.5 (12.4) (iii) Maternal Deaths (including abortion) total Nil (a) Maternal Mortality Rate per 1,000 live and Stillbirths Nil ¤ Under 1 year of age ¤¤ Under 4 weeks of age . 6 The approximate infant mortality rate for l960 and the rates since 1956 are shown for purposes of comparison. 1956 1957 1958 1959 1960 Kingston-upon-Thames 24 13 15 22 11 England and Wales 24 23 22 22 22 It will be seen from the following figures that since the war ended the Quinquennial Infant Mortality Rate was more than halved by 1950, and has since dropped even further. QUINQUENNIAL INFANT MORTALITY RATE Years Infant Mortality Rate 1926 - 1930 56 1931 - 1935 56 1936 - 1940 46 1941 - 1945 52 1946 - 1950 25 1951 - 1955 21 1956 - 1960 17 The following table gives the numbers in age groups of Kingstonupon-Thames children who died during 1960 before reaching the age of one year, together with the cause of death. 7 INFANT DEATHS. Age Total Acute Suppurative Otitis Media Congenital Atelectasis. Cycloeephalism Maldevelopment. Prematurity. Broncho Pneumonia following Imperfect Oesophagus. Acute Suppurative Bronchitis 0-24 Hours. 4 - 1 1 1 - 1 24 Hrs. - 1 Mth. 1 - - - - 1 - 1 Mth. - 1 Yr. 1 1 - - - - - Totals 6 1 1 1 1 1 1 8 (iv) DEATHS FROM OTHER CAUSES IN 1960. NO. of DEATHS. Heart Disease 146 Cancer 98 Vascular Lesions of the Nervous System 53 Circulatory Disease other than Heart 25 Bronchitis 16 Pneumonia 27 Influenza — The following Tables, I, II, III summarise certain vital statistics Table I shows the figures for live births, stillbirths, and deaths for the years 1956 - i960 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1931. They give the population, number of live births, birth rate per 1,000 population, number of deaths, and 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. Thje trend of the estimatedpopulation figure is to remain below 40,000. The causes of deaths shown in Table III are in accordance with the 36 headings based on the Abbreviated List of the International Statistical Classification of Diseases, Injuries and Causes of Death. EXTRACT FROM VITAL STATISTICS FOR YEARS 1956 - 1960 INCLUSIVE. TABLE I. 1956 1957 1958 1959 I960 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 508 260 248 509 245 264 506 244 262 536 273 263 545 269 276 Illegitimate 42 21 21 39 17 22 30 17 13 28 17 11 33 21 12 550 281 269 548 262 286 536 261 275 564 290 274 578 290 288 Birth rate (R.G.) per 1,000 pop. 14.2 14.2 13.8 14.5 15.1 STILLBIRTHS Legitimate 10 4 6 8 3 5 14 8 6 4 1 3 7 3 4 Illegitimate 2 2 - - - - 1 1 - - - - 1 1 - 12 6 6 8 3 5 15 9 6 4 1 3 8 4 4 Rate per 1,000 (live and stillbirths) 21.4 14.4 27.2 6.1 13.5 DEATHS 442 214 228 432 202 230 434 228 206 416 200 216 432 223 209 Death rate (R.G.) per 1,000 pop. 11.4 11.2 11,2 10.8 11.2 10 COMPARISON OP VITAL STATISTICS 1951 - 1960. 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 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 1936 39790 528 13.2 468 11.8 43 53 1939 39970 533 13.3 450 11.4 28 50 1940 37430 519 13.9 659 17.6 55 55 1941 35970 520 14.5 525 14.6 57 59 1942 36090 551 15.3 491 13.6 63 49 1943 35900 637 17.8 500 13.9 48 49 1944 34780 578 16.6 474 13.6 48 46 1945 35760 593 16.6 505 14.1 43 46 1946 39670 794 20.0 460 11.6 29 43 1947 40780 870 21.3 495 12.1 22 41 1948 40780 722 17.7 455 11.2 23 34 1949 40660 729 17.9 500 12.3 20 32 1950 41950 619 14.8 492 11.7 30 30 1951 39920 574 14.4 556 13.9 24 29 1952 39990 576 14.4 499 12.5 24 27 1953 39940 609 15.3 465 11.6 24 26 1954 39160 534 13.6 450 11.5 20 25 1955 39070 543 13.9 424 10.9 15 25 1956 38790 550 14.2 442 11.4 24 24 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 1960 38630 578 15.1 432 11.2 11 22 11 CAUSES OF DEATH - REGISTRAR GENERAL'S TABLES0 TABLE III 1956 1957 1958 1959 I960 M F M F M F M F M F All Causes 214 228 202 230 228 206 200 216 223 209 Tuberculosis, respiratory 2 — 5 1 2 - 1 2 3 - Tuberculosis, other - - - 1 1 2 - - - - Synthetic disease 1 - - 2 - - 1 1 - - Diphtheria - - - - - - - - - - Wooping Cough - - - - - - - - - - Meningococcal Infections - - - - - - - 1 - - Acute poliomyelitis - - - - - - - - - - Measles - - - - - - - - - - Other infective and parasitic diseases 2 1 1 - - 2 - 1 - - Malignant neoplasm, stomach 4 5 3 7 9 5 2 11 4 1 Malignant neoplasm, long, bronchus 21 1 10 6 23 2 23 3 20 3 Malignant neoplasm, uterus - 4 - 5 - 6 - 1 - 1 Malignant neoplasm, breast - 12 - 7 - 5 - 11 - 11 Other malignant and lymphatic neoplasms 19 29 19 19 20 21 29 19 30 28 Leukaemia, aleukaemia 1 - - 3 - 1 1 2 1 1 Diabetes 1 2 1 - 3 1 1 2 1 - Vascular lesions of the nervous system 22 39 24 50 19 42 22 32 21 32 Coronary disease, angina 43 26 43 25 49 32 35 21 51 38 Hypertension with heart disease. 2 7 5 6 9 4 1 10 5 4 Other heart disease 18 26 17 25 20 33 12 26 20 27 Other circulatory disease 8 19 11 15 19 13 9 9 11 14 Influenza 1 2 - 6 - 1 6 6 - - Pneumonia 9 8 9 11 10 6 9 17 14 3 Bronchitis 16 9 24 12 19 5 14 6 14 2 Other diseases of respiratory system 3 - 4 1 2 6 2 1 - - Ulcer of stomach and duodenum 8 1 - - — - 4 1 1 - Gastritis, enteritis, and diarrhoea 1 - - 1 - 1 - - 2 2 Nephritis and nephrosis 2 - 5 2 - - 1 3 1 1 Hyperplasia of prostate 4 - 3 - 1 - 2 - 2 - Pregnancy, childbirth, abortion. - 2 - - - - - - - - Congenital malformations 3 3 3 3 1 1 1 1 - 2 Other defined and ill-defined diseases 17 23 11 15 12 10 12 23 10 21 Motor vehicle accidents 2 - 1 3 4 - 4 1 5 3 All other accidents 2 4 2 3 3 5 5 4 4 2 Suicide 2 5 1 - 2 2 3 1 3 3 Homicide and operations of war - - - 1 - - - - - - 12 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. The Ministry of Health Public Health Laboratory at Epsom is available for consultations and for help in the investigation of any important outbreaks of disease. On occasions special use is made of the services of the Public Analyst in chemical sampling which may become necessary in the interests of public health. Samples of milk for bacteriological examinations are submitted to the Public Health Laboratory, Epsom, and samples under the Food and Drugs Acts to the Public Analyst, Mr. D.D. Moir, at the Analytical Laboratory, Southwark Street, S.E.l. (ii) Hospitals. (a) Infectious Diseases. The provision of beds for cases of infectious disease is the responsibility of the South West Metropolitan Regional Hospital Board, Patients are admitted direct to Tolworth Isolation Hospital, which is under the direction of the Physician Superintendent of Kingston Hospital, Ninetytwo cases of infectious disease were treated in hospital during the year, but 89 of these had already been notified from Kingston Hospital and related to puerperal pyrexia. To Kingston Hospital 90 " Tolworth Isolation Hospital 2 (b) Smallpox. Arrangements exist whereby cases of smallpox or suspected smallpox can be transported by the London County Council Ambulance Service to special isolation, (Telephone - Whitehall 2177, or Waterloo 3311). 13 (c) General. Kingston Hospital, Wolverton Avenue, Kingston-upon-Thames (Telephone - Kingston 5692), is the main General Hospital situated in the Borough and is a large comprehensive hospital with a full range of general and special departments, and has highly organised outpatient departments fully supported to meet all surgical, medical, and psychological emergencies. 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 is the Local Health Authority under the National Health Service Act, 1946, and 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). Queen's Road Clinic, 27, Queen's Road. (Kingston 5812). Tuesday and Friday afternoons. Thursday afternoon (Toddlers) Monday and Thursday afternoons. (c) Dental Clinics. Health Centre. "Keeldar", 25, Queen's Road. (Orthodontic only). Daily Daily by appointment (except Saturday) (d) Immunisation and Vaccination Clinics. Health Centre. Queen's Road Clinic. Thursday afternoon Friday forenoon 14 (e) Day Nursery, 53-55, Canbury Park Road. Approved accommo- dation 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. Home Nursing is undertaken by nurses of the Queen's Institute of District Nursing. Nursing equipment required for use in the home can be supplied on loan through the British Red Cross Society,, at the B.R.C.S., H.Q., 73, Ptenrhyn Road, Kingston-upon-Thames, (Kingston 5072) (h) Health Visitors. Health Visitors also act as school nurses working in the clinics and do home visiting. Their work is largely educational and social, 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." (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 usually made for this service but 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-uponThames. 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 persons' circumstances. 15 (k) Mental Health. As a result of the Mental Health Act, 1959, Local Health Authorities are now empowered and in certain circumstances required to provide the following services concerning the after-care of patients discharged from mental hospitals 1. Residential accommodation. 2. Occupational and/or Training Centres. 3. Mental Welfare Officers. 4. Guardianships. 5. Necessary ancillary or supplementary services. 6. Care and training of school children of compulsory school age not considered suitable on medical grounds to attend any sort of school. The Act repeals the Mental Deficiency Acts and abolishes the expression "mental defective"„ and "mental defectiveness" and introduces new terms, "severe subnormality", "subnormality" and "psychopathic disorder". The office of the Mental Welfare (Duly Authorised) Officer for the Borough is at 35, Coombe Road, Kingston-upon-Thames (Kingston 3302) Surrey County Council - Eduoation Department. The School Health Service is staffed by the County Health Department and provides the following servicess:- (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 Centra Monday forenoon Tuesdays to Fridays Queen's Road Clinic Friday forenoon (ii) Medical Consultation. Health Centre Monday forenoon Queen's Road Clinic Friday forenoon 16 (iii) Eye Clinic. Health Centre. Thursdays, from 10 a.m. by appointment. (iv) Dental Clinic (See under Health) Immunisation Clinic ( Department ) (v) Child Guidance Clinic. Cases referred to clinic at "Roselands", Kingston Road, New Maiden. (vi) Speech Therapy. Health Centre. Mondays & Thursdays by appointment. Surrey County Council - Welfare Department. This service is concerned with the welfare of:- 1. Aged persons, 2. Physically and mentally infirm. 3. Blind and partially sighted. 4. Deaf and dumb. 5. Epileptic and crippled persons. 6. The provision of temporary accommodation for persons in need thereof. The address of the Welfare Officer for the Borough is 35, Coombe Road, Kingston-upon-Thames, (Kingston 4402). In addition, and since the 1st April, 1959, the Surrey County Council have been implementing a scheme for the provision of welfare services for handicapped persons under the National Assistance Act, 1948, other than for blind, partially sighted and deaf and dumb. The voluntary Association for Surrey Disabled acts as the Council's agents, but certain services are, however, provided by the Council direct. They are as followss:- 17 A. Occupational therapy B. Training and Rehabilitation. C. Hostel accommodation and workshop facilities. D. Adaptations to Homes - In approved cases the Council will assist handicapped persons in arranging for the carrying out of works of adaptation in their homes for their greater comfort and convenience. Further particulars are obtainable from the Handicapped Persons Section, County Health Department, County Hall, Kingston-upon-Thames, (Kingston 1050, Ext,326). Surrey County Council - Social and Geriatric Services. Social and Geriatric Services for old people are steadily developing and improving. 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, Recreational activities are provided by these voluntary associations. For those who are beginning to fail and require assistance to maintain themselves in their own homes all the resources of the Divisional Health Services are readily available and much assistance from home helps, district nurses and health visitors as well as from voluntary agencies is given. For those who are in need of more, such as medical or nursing care and who cannot maintain themselves in their own homes the specialised services of a physician, 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 Divisional Health Headquarters, The Health Centre, Grange Road, Kingston-upon-Thames, (Kingston 726l), 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. 18 Surrey Couhty Council - Children's Department. This Department is responsible 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, Kingst on-upon-Thames. Surrey Executive Council. This body is responsible for the provision under the National Health Service Act, 1946, 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). 19 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 persons in need of care and attention removed to suitable premises. 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 1960. 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 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 co-ordinating officer between all the central, local, 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, etc., to all known geriatric cases. 20 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 and a dairy, but is not used as a domestic supply, all the houses in the town being provided with a main water supply. In the case of the dairy, well water is used for cooling and bottle washing. Regular and frequent samples are taken for examination, During the year it was necessary to renew the suction pipe of the pump and the consequent disturbance of the well caused a marked deterioration in the bacteriological condition of the water. Use of the water for washing purposes was discontinued for six months until the samples proved to be consistently satisfactory. In all, forty-six samples from this source were submitted for examination, 2. DRAINAGE AND SEWERAGE. The sewage from the Borough gravitates to the Corporation Pumping Station and is then pumped to the North Surrey Joint Sewage 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 & Ewell, Surbiton, Maiden & Coombe, and Kingston-uponThames 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 North Surrey Joint Sewage Board Works. 4. CLOSET ACCOMMODATION. All closets in connection with dwelling houses in the Borough are on the water carriage system. 21 5. PUBLIC CLEANSING-. The Borough Surveyor is responsible for the collection and disposal of house and trade refuse. Disposal is carried out by tipping into a worked-out gravel pit provided by the haulage contractor. The refuse from this Borough, Surbiton and Maiden is transferred to large capacity road vehicles and transported to the tip by the contractor. The refuse is weighed on a weighbridge and 12,307 tons of refuse were sent from this Borough in 1960. 6. SANITARY INSPECTION OF THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors which totalled 8,629 as compared with 8,705 for 1959. House inspections, defects, etc. 442 Drainage 447 Factories 174 Outworkers 14 Atmospheric Pollution 150 Dairies5 milk shops, etc. 145 Food premises 639 Restaurants and cafes 249 Infectious disease enquiries 194 Cinemas 5 Verminous premises 27 Rodent control 51 Shops Act 140 Schools 6 Housing Act 117 Markets 706 Public sanitary conveniences 33 Fireguards 34 Merchandise Marks Act 143 Interviews 400 Miscellaneous 1,291 Smoke Control Inspections 1,409 Smoke Control Revisits 182 Reinspections and works in progress 6,998 1,631 8,629 22 NOTICES SERVED Informal (a) Verbal 100 (b) Written 173 Statutory. (a) Housing Acts 1 (b) Public Health Acts 26 NOTICES COMPLIED WITH. Informal (a) Verbal 266 (b) Written Statutory Public Health Acts 36 7. SHOPS There are some 933 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 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. 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. 23 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 35 35 - - Factories not included above in which Sec. 7 is enforced by the Corporation 282 121 3 - Other premises excluding outworkers 13 18 - - 2. CASES IN WHICH DEFECTS WERE FOUND. No. of cases in which defects found Found Remedied Referred No. of Prosecutions To H.M. Inspector. By H.M. Inspector. Want of Cleanliness _ _ _ _ _ Over-crowding - - - - - Unreasonable temperature - - - - - Inadequate Ventilation 1 1 - 1 - Ineffective drainage of floors _ _ _ Sanitary Conveniences - (a) Insufficient - - - - - (b) Unsuitable or defective 2 2 - 2 - (c) Not separate for sexes - - - - - others - - - - - 24 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. 4 Brass & brass articles 2 Brush making 7 Lampshades 2 15 9. CAMPING SITES. There are no camping sites within the Borough. 10. ATMOSPHERIC POLLUTION. Clean Air Act, 1956 - Smoke Control Areas. During the year the Corporation decided to carry out a programme which, over a period of years, would make the whole Borough a smoke control area. The preliminary work with regard to Area No. 1 was completed in December and an application was made to the Minister of Housing and Local Government for permission to make the appropriate Order. This area is in the centre of the town and extends southwards from the railway to the junction of South Lane with Portsmouth Road, and eastwards from the river to a boundary on the east which is formed by Clarence Street, Eden Street and Brook Street. The Area comprises the following premises - Domestic Approximately 270 Commercial " 560 Industrial " 15 Other " 20 This involves the adaptation of 335 appliances and the replacement of approximately 300 tons of bituminous fuel by smokeless fuel. 25 Smoke Nuisance, Seven complaints were received during 1960 in respect of smoke and grit emission. These related to six premises, two of which were domestic. With regard to the commercial premises, in two instances the cause for complaint was the misuse of coke stoves. Advice was given on the manner in which the stoves could be operated without causing nuisance, with particular reference to the procedure for lighting up. Another complaint referred to smoke emanating from an industrial type incinerator. Here again the nuisance, which was intermittent and infrequent, wa3 eliminated by care in using the plant. The firm concerned are considering the removal of the plant, or redesigning it to include an afterburner. This will effectively consume any smoke which may be generated. The remaining complaint referred to excessive grit emission from the Power Station, With the type of fuel which is now used at these premises, there will always be the possibility that from time to time grit deposition will be apparent. This takes place when there is a breakdown, or when operational faults occur. Also in spite of the efficiency of the grit collecting equipment, the small percentage of solid matter which escapes this equipment is of some significance. 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 the graph overleaf indicate the results obtained. Smoke 13 expressed in milligrams per 100 cubic metres and the sulphur dioxide in parts per 100 million. Results obtained from the Volumetric Instrument at the Guildhall, Month Smoke 302 Monthly Average Highest Value Lowest Value Monthly Average Highe st Value Lowe st Value January 20.16 77 1 8.39 23.3 1.4 February 13.80 44 1 6.40 13.5 0.5 March 9.30 23 1 7.10 16.2 1.1 April 5.10 19 1 4.00 15.0 0.7 May 3.30 10 1 3.60 8.5 0.8 June 1.90 5 0 2.80 11.1 0 July 0.94 3 0 0.80 2.0 0 August 1.70 5 0 1.20 4.5 0.2 September 3.70 7 0 2.50 4.9 0.4 October 7.80 39 3 3.60 10.1 1.0 November 8.00 43 0 3,90 13.9 0.6 December 18.00 47 1 8.80 32.8 0.9 26 27 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'. 1960 Deposit in Tons per sq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times S.E - S.W January 9.14 4.81 13.95 19 6 1.85 February 11.89 6.94 18.83 24 6 1.68 March 10.59 6.57 17.16 27 3 1.75 April 9.65 4.61 14.26 24 7 0.69 May 7.62 8.06 15.68 26 6 1.73 June 0.61 5.11 5.72 25 10 1.37 July 30.68 19.57 50.25 25 15 4.20 August 2.84 5.18 8.02 27 11 2.86 September 15.95 5.11 21.06 26 12 2.46 October 10.59 11.61 22.20 27 9 4.99 November 15.40 9.82 25.22 26 17 3.45 December 24.14 13,89 38.03 25 12 2.68 Totals 149.10 101.28 250.38 29.71 Average 1960 12.42 8.44 20.86 2.47 Average 1959 13.62 6.12 19.75 1.61 28 TIFFIN GIRLS' SCHOOL - Station 'B'. 1960 Deposit in Tons per sq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times S.E - S.W January 5.34 5.11 10.45 19 6 1.65 February 6.44 6.71 13.15 24 6 1.52 March 5.41 7.04 12.45 27 3 1.47 April 6.04 4.05 10.09 24 7 0.63 May 5.31 3.92 9.23 26 6 1.38 June 7.07 4.95 12.02 25 10 1.03 July 4.42 4.08 8.50 25 15 3.93 August 8.33 5,08 13.41 27 11 2.45 September 2.56 6.34 8.90 26 12 3.06 October 2.95 8.79 11.74 27 9 4.53 November 5.68 7.20 12.88 26 17 3.48 December 10.46 7.60 18.06 25 12 2.55 Totals 70.01 70.87 140.88 27.68 Average 1960 5.83 5,90 11.74 2.30 Average 1959 6.40 5.20 11.51 1.37 29 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 1949 20.42 - 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 1960 20.86 11.74 30 Total Solids - Tons per Square Mile. 31 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. 12. ERADICATION OF BED BUGS. During the year 13 premises were disinfested. One of these was a house under the control of the Corporation. 13. COMPLAINTS„ The number of complaints received from the general public during the year was 400 compared with 442 for the previous year. The following is a brief list of causes fofr complaints received during 1960:- Accumulations 25 Animals 3 Ashbins 2 Drains and sanitary arrangements 61 Food 30 Insects and pests 18 Overcrowding 3 Rodents 135 Sanitary defects 58 Smoke 7 Water 5 Others 53 400 32 14. RODENT AND INSECT PEST CONTROL. It is very pleasing to record that during the year no legal action was required under the provisions of the Prevention of Damage by Pests Act, 1949. This is some 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. As reported in previous years, infestations of domestic properties are very often due to the shelter provided to rodents by the 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. It is hoped that arrangements will be made in the near future to provide a service for the collection of such articles. Effective control was sought by a thorough inspection of buildings in forty-two different blocks. This is known as 'block control'. Rodent Control- Sewers. The 10% test treatment commenced late in 1959 was completed early in I960 after which the fourth and final treatment of a series was completed. The results fully justified the use of sodium fluoracetate as a labour-saving technique. It will be recalled that the weather during most of 1960 was very wet and mild, resulting in constant surcharging, the heavy condensation on the underside of many manhole covers simply washed the bait away, and several attempts at treatment had to be abandoned. It is hoped, however, that with the descaling of sewers well under way, and better weather conditions, it will be possible to apply successful treatments next year. During surveys and inspections, the incidence of rodents revealed seventeen faulty drains, two broken sewers, four choked drains and seven interceptor caps missing. It is pleasing to report that co-operation with the staff in the Ministry of Agriculture, Fisheries and Food Laboratory at Tolworth has not only been maintained but extended in that groups of colonial and foreign students have been sent to us for demonstrations 33 and instruction. The Corporation's representative on the Local Workable Area Committee for Pest Control also spent a very enjoyable and instructive afternoon in the laboratory,, 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. Besides the usual treatments for insect pests, the department dealt successfully with a large infestation of biscuit beetle in a pets' food shop and with "Pharoahs Ants" a very minute insect in a restaurant kitchen. 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. The use of insecticidal lacquer continues to bring very satisfying results. Birds. The control of feral pigeons is well under way, although it is made more difficult than need be by certain misguided people. The control of sparrows in a large industrial canteen and kitchen is now complete, but the danger of these birds swooping about in factories, particularly where operatives are working on high speed machines, needs no emphasizing and this problem is receiving our attention. A bird nest was found in the vent of a gas water heater which might have had unfortunate results if not found in time. In a school class room, maggots were descending on very young children, through a ceiling where a young bird had died in a nest built in the roof space. 34 Rodent Control - Statistical Statement, 1960. Private Dwellings and Corporation Property. Rats Mice Total No. of complaints received in office 85 27 112 No. of premises inspected as a result 266 43 309 No. of premises found to be infested 126 40 166 No. of separate infestations treated 137 31 168 No. of visits for treatment and reinspections 956 115 1,071 No. of premises treated by occupier or other agency 3 9 12 No. of poison baits deposited 276 Business and Factory Premises No. of complaints received in office 13 10 23 No. of premises inspected, including those under service agreement 105 225 330 No. of premises in which slight infestations were found 43 88 131 No. of separate infestations treated 65 201 266 No. of visits for treatment and inspections 798 1,824 2,622 No. of premises treated by occupier or other agency 2 7 9 No. of poison baits deposited 1,772 Summary No. of complaints received 135 No. of premises inspected 639 No. of premises infested 297 No. of separate infestations treated 434 No. of visits 3,693 No. of premises treated by occupier or other agency 21 No. of poison baits deposited 2,048 35 SECTION D HOUSING During the year only seven applications for Certificates of Disrepair under the Rent Act, 1957 were made, as compared with sixteen in 1959 and eighty in 1958. With regard to statutory action under the provisions of the Housing Act, 1957, Closing Orders were made in respect of No. 9, Gloucester Road and Nos. 171, 173 and 175, London Road. A Demolition Order was made in respect of No. 152, Canbury Park Road and the Clearance Order made in 1959 in respect of Nos. 77A- 99 (odd) Park Road was confirmed by the Minister during the year. 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 117 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 - 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 97 4. Number of representations made to the Local Authority with a view to:- (a) the serving of notices requiring the execution of works 7 (b) the making of demolition or closing orders (number of houses involved) 5 5. Number of formal notices served requiring the execution of works 71 6. Number of houses which were rendered fit after the service of formal notices 12 continued overleaf 36 Housing (Consolidated) Regulations continued. 7. Number of demolition or closing orders made 3 80 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 13 Housing - Statistical Statement. 1960. The following information is supplied by the Borough Surveyor wha indicates that no housing units were built by the Corporation during 1960. Total number of permanent dwellings erected by the Corporation since March 1924 to 31st December. 1960. Houses 1,137 (Inc.876 outside Borough) Flats 926 (lnCo326 outside Borough) Total number of temporary dwellings erected up to 31st December, 1960. Still remaining Arcon 132 127 Aluminium 70 32 2-year huts 113 Nil 315 159 Number of dwellings erected by private enterprise during 1960. Houses 6 Flats & Maisonettes 43 Bungalows 1 50 37 SECTION E INSPECTION AND SUPERVISION OP 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 1960 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 Pasteurised 1 - - To Deal 19 17 6 Supplementary 8 8 8 (c) Bacteriological Examination of Milk. During the year 54 samples of Pasteurised and one sample of Sterilised Milk were sent to the Public Health Laboratory at Epsom for examination. The samples of Pasteurised Milk 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 th«y were submitted. The sample of Sterilised Milk passed the turbidity test which is the appropriate one for this type of milk. 38 (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 172. 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. The following table shows the results of examinations in respect of 73 samples submitted to the Ministry of Health Public Health Laboratory at Epsom during 1960. 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. Those which are placed within Grades I and II are considered to be satisfactory and those within Grades III and IV not so. In the year under review a larger proportion of the samples were placed in the latter groups. This was not due to any lapse on the part of manufacturers but to a change of emphasis in sampling from pre-packed ice cream to that which is served from bulk. It will be appreciated in the latter case that unless strict attention is paid to the cleanliness of servers and other equipment, there is a risk that the bacteriological quality of the ice cream may deteriorate. Ice Cream GRADE I II III IV Total 62 – 7 4 73 (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. 39 (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 comparision with the amount of food which is handled in the town. The list is very much condensed to avoid unnecessary detail. Tabulated list of Condemned Foodstuffs showing causes for condemnation and the weights. Article of Food Reason for Action Weight lbs. lbg. Raw Meat Bovine Decomposition 1,754 „ Disease 144½ Ovine Decomposition 206½ Porcine It 731 Total - Raw Meat 2,836 Raw Fish Decomposition 78 Poultry, Game, etc. „ 201½ Canned Goods Meat & Meat Products 409 Fruit 1,731½ Jam Punctured, 20½ Vegetables Blown, 302½ Milk Damaged or 382½ Soup Decomposition 11 Fish & Fish Paste 52 Other 66½ 2,631½ Food in Glass Containers Fish & Fish Paste 28½ Fruit Glass contamination, 924½ Jam & Preserves 10 Pickle s Sauce - Tomato Mould, deterioration 26½ 2 991* Other Foods condemned for various reasons Cheese 5½ Eggs (Chinese Egg Whites) 792 Mayonnaise 16 Meat 6½ Mixed Salads 24 Semolina 32 876 40 Unsound food is turned into a condition from which 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. During the year the generally high standard of management of food premises was maintained. This has been due to regular attention by the Public Health Inspectors and to ready co-operation of the managements concerned. The maintenance of high standards is a matter of education rather than enforcement and this method of approach over many years has been proved to yield the best results. The food retailing industry, like many others, is changing in character to a marked extent. The pre-packing of all kinds of food, from meat to greengrocery and the widening of the range of frozen foods, together with the change to self-servioe, has been the means of extending the range of goods sold from grocers' shops. Retailers now appreciate that the public expect to shop from clean looking, bright, and modern premises, and the improvement in shops over the past few years has been remarkable,This is apparent equally in the small shops in the back streets as in the branches of large multiple firms. As in the past when plans and proposals are submitted for the alteration of existing, or the establishment of new, businesses, every effort is made to ensure that the premises will comply with the Regulations in the first instance. This is a service which is appreciated by the proprietors. The following tabulated statement shows the nature of the defects for which Notices were served during the year:- PART IV Defects requiring Notices Complied Sanitary Conveniences Lack of Wash your Hands Notices 3 4 Fittings cleansed or repaired 7 5 Walls and ceilings oleansed 2 2 Sinks Renewed or repaired, also draining boards 2 3 Cleansed 1 1 C/Fwd. 15 15 continued overleaf 41 Pood Hygiene - Tabulated Statement continued. PART IV Defects requiring Notices Complied B/Pwd. 15 15 Washing facilities for Staff Absence of, defective, inadequate hand basins 3 3 Absence of hot water 6 6 " " cold water 3 2 Absence of, or defective,water heater 1 1 Provision of towels, soap, nailbrushes 5 7 Repairs to Pood Rooms» Floors cleansed 1 1 Walls and ceilings cleansed 4 4 Additional ventilation required 5 4 Protection of Pood against contamination Pood to be kept 18" off ground 1 2 Covers provided for food 8 12 Others 1 2 Uncleanlinesa Personal – 1 Kitchens & Equipment 15 16 Food Stores 3 3 Preparation Rooms - 1 Delivery Vans 1 2 Refrigerators 1 2 Shops 2 2 Dining Roorn.3 2 1 Utensils Unclean and/or replaced 1 1 Others 10 10 Total 88 98 42 Pood Hygiene Regulations, 1955. 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 14 Dairies and milk shops 25 30 Butchers 40 91 Greengrocers and fruiterers 89 35 Public houses (a) Providing restaurant services 17 9 (b) Not providing restaurant services 41 Fishmongers and stalls 16 41 Ice Cream premises registered 172 49 Grocers and general provisions 132 176 Restaurants and cafes 69 Kitchens and canteens (including factory, school and shop) 33 249 Meat distribution depots 6 66 Visits to food premises re unsound food 134 Open Market, food stalls, barrows 706 667 l,600 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 comment. Hamburgers Orange Drink - Concentrated The ingredients were not specified on the labels and the manufacturers were approached in both cases. They gave undertakings to print new labels to comply with the provisions of tha Food Labelling Order, 1953• 43 Tbmato Soup - Dehydrated. It was reported that the tomato solids content of this soup mix amounted to 10 per cent and when prepared according to instructions the soup, as consumed, would contain the equivalent of about 17 per cent of tomatoes. &ood quality tomato soups prepared in the home or commercially in cans contain a far higher proportion of tomatoes and it was considered doubtful whether the description Tomato Soup was justifiable. No action was taken on this particular sample as it was thought advisable to await the result of negotiations between the Trade and the Local Authorities Joint Advisory Committee on Food Standards. It is understood that discussions on this and other soups are at present in progress. Tabulated Statement of Samples Submitted to the Public Analyst during I960 Commodity No. of Samples G-enuine Not G-enuine or otherwise irregular Formal Informal Formal Informal Formal Informal Almond Marzipan – 1 – 1 – – Baby Foods — 4 – 4 — — Blackcurrant Drink — 1 – 1 — — Butter — 4 — 4 — — Cake Mix — 2 — 2 – – Cheese Spread - 2 - 2 - - " Cottage - 1 - 1 - - " Creamy - 1 - 1 - - " Farmer — 1 — 1 — — Chicken Snack — 1 — 1 _ — Chicken in Jelly — 1 — 1 — Cinnamon — 1 — 1 — — Clotted Cream — 1 — 1 — — Condensed Milk — 1 — 1 — — Confectionery - Sugar - 3 - 3 - - Conserve - Loganberry - 1 - 1 - - Cough Mixture - 1 - 1 - - Crab - dressed — 1 - 1 — — " - tinned — 1 — 1 — — Cream - double — 2 - 2 — — " - sterilised - 2 – 2 - - C/Fwd. - 33 – 33 - - Continued overleaf 44 Food and Drugs Act - Samples continued. Commodity No., of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. - 33 _ 33 – — Cube with chicken meat & fat 1 — 1 — — Cube with Meat Extract — 1 _ 1 — — Corned Meat - tinned — 3 — 3 _ — Flour - self-raising - 2 — 2 — — Fruit Cocktail 1 _ 1 — French Angelica — 1 — 1 — — Hamburgers - 4 — 3 — 1 Ice Cream — 2 _ 2 — — Jam — 3 — 3 — — Jelly - 4 - 4 — — " - table — 1 — 1 — — Kidneys - braised — 1 — 1 — — Lard — 1 — 1 — _ Lemons — 1 — 1 _ — Margarine — 3 — 3 — — Milk — 6 - 6 - — " - Channel Islands — 1 — 1 — - " - Evaporated - 3 - 3 - - Minced Chicken & Jelly- - 1 - 1 - — Mint Sauce — 1 — 1 — — Orange Drink 1 1 1 1 — — " " (Concentrated) - 1 - - - 1 Paste - Fish — 1 — 1 — - 11 - Meat — 1 _ 1 — — Peas - dried — 1 — 1 — — Peel - Lemon & Orange - 1 - 1 - — Pheasant Savoury - 1 - 1 - - Preserve - Fig - 1 - 1 — — Pork Luncheon Meat _ 1 — 1 — — Raisins — 1 _ 1 — — Rice - whole — 1 _ 1 — _ Rice - Creamola — 1 _ 1 — — Rice - Creamed _ 1 _ 1 — _ Sardines — 1 — 1 — — Sausages - Chicken — 1 — 1 — — Savoury minced beef — 1 — 1 — — Soup - Tomato — 1 — — — 1 Soup — 1 — 1 — — Spice - mixed - 1 - 1 - - C/Fwd. 1 93 1 90 - 3 Continued overleaf 45 Food and Drugs Act - Samples continued. Commodity No. of Samples G-enuine Not G-enuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. 1 93 1 90 — 3 Stewed Steak — 2 - 2 - - " " with gravy – 2 _ 2 — — Sultanas - 1 1 - - Table Dessert - 1 — 1 - - Tea - instant _ 1 — 1 — - Turkey - minced _ 1 — 1 - - Vinegar — 2 — 2 — — Total 1 103 1 100 - 3 Other foods which were the subject of Complaint. Mould G-rowth in Cornish Pastie; This was sold from a shop in the town and enquiries revealed that the article had been retained in the shop for at least seven days. Legal proceedings were instituted and the vendor, who pleaded guilty, was fined £25. Of the twenty-nine other complaints concerning food, six related to the presence of insects and an equal number referred to glass, metal, or other inorganio foreign matter. All the cases were thoroughly investigated and were the subjeot of informal action. Whilst every oase of food contamination must be regarded as serious, the number of complaints are few in relation to the very large amount of food which passes through the shops in the town. Consideration must also be given to the number of transactions involved and the persons concerned in processing, packing and handling the food. Food traders and manufacturers are very sensitive to complaints and the trade in general co-operate fully in an effort to avoid any cause for repetition. There were six cases of food allegedly sold out of condition, and the remainder related to a variety of oauses. Emphasis must again be given to the need for scrupulous care in stock rotation. This is vitally important in respect of perishable artioles and foods such as dried fruit and pre-packed flour goods. These are, by their nature, very susceptible to insect infestation. 46 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. Four warning notices were given, but it was not considered necessary to take any legal enforcement action. 47 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 Boroughs- Scarlet Fever Whooping Cough Diphtheria (including Membranous Croup) Measles (excluding Rubella) Acute Pneumonia (Primary or Influenzal) Meningococcal Infection Acute Polionyelitis - 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 Anthrax Leprosy is notifiable by General Medical Practitioners direct to the Chief Medical Officer of the Ministry of Health. In 1960 a total of 136 notifications of infectious disease was received,, and these are analysed and commented upon in the following tables and reports. NOTIFIABLE DISEASES DURING 1960. TABLE IV CASES DEATHS Age Croups Age Croups Under 1 Year 1-2 2-3 3-4 4-5 5-10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 A over Total cases notified Cases admitted to hospital 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 )Xpb th6t i&oantoesoigii – – – – – – – – – – – – – – – – – – – – – – – – – – – Scarlet Fever - - - 1 - 7 2 – 1 — — — 11 1 – – – – – – – – – – – – – Measles - 1 - - 4 3 – – – – – – 8 — – – – – – – – – – – – – – Whooping Cough - 3 3 - 2 3 – – – – – – – – – – – – – – – – – – – – – Acute Poliopyelitia; Paralytic – – – – – – – – – – – – – – – – – – – – – – – – – – – Non-Paralytic – – – – – – – – – – – – – – – – – – – – – – – – – – – Acute Infective Encephalitis – – – – – – – – – – – – – – – – – – – – – – – – – – – Meningococcal Infection - – – – – – – – – – – – – – – – – – – – – – – – – – – Puerperal Pyrexia - - - - - - - 12 71 6 – - 89 89 – – – – – – – – – – – – – Dysentery 1 - - - - 2 - - 1 2 — - 6 1 – – – – – – – – – – – – – Food Poisoning - - - - 1 - 1 - - - 1 — 3 – – – – – – – – – – – – – – Pneumonia 1 - - - - - — - 1 1 2 2 7 1 – – – – – – – – – 12 – 15 27 Erysipelas – – – – – – – – – – – 1 1 – – – – – – – – – – – – – – Ophthalmia Neonatorum – – – – – – – – – – – – – – – – – – – – – – – – – – – Pemphigus Neonatorum – – – – – – – – – – – – – – – – – – – – – – – – – – – Totals 2 4 3 1 7 15 3 12 74 9 3 3 136 92 – – – – – – – – – 12 - 15 27 48 49 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 Aoute Infective Encephalitis Diphtheria Ophthalmia Neonatorum Enteric Fever (including para-typhoid) 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 34 283 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 - - - - - I960 11 8 11 89 - - - — - Measles - Not notifiable until 1940. Whooping Cough - Not notifiable until 1940. . 50 Whooping Cough. There were 11 cases of whooping cough notified during i960 as compared with 3 in 1959• Although this is an increase of 8 cases as compared with the previous year, the continued low incidence of the disease, which is considered to be one of the most serious of childhood illnesses, is very encouraging. The number of oases notified during the previous five years are given below. 1955 1956 1957 1958 1959 17 58 55 9 3 Immunisation against whooping cough is usually performed as a combined process with diphtheria immunisation, and practically 10096 of the children being immunised for the first time receive a "combined" material which affords protection against both these diseases. Enteric Fever (Typhoid or Paratyphoid) There were no cases of typhoid or paratyphoid B notified in Kingston during 1960 and this is the thirteenth successive year without notification of enteric fever. Measles. There were 11 cases of measles notified during 1960 compared with 258 in 1959. All were of a mild type and nursed at home. Ophthalmia Neonatorum. No cases of cphthalml a neonatorum ocourred during 1960. Puerperal Pyrexia. The maternity block at Kingston hospital serves Kingston and a large surrounding area embracing a population of some 285,000 persons. During i960, 1,913 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. Qr more has occurred within fourteen days after childbirth or miscarriage. 51 Puerperal Pyrexia continued. During 1960, 89 cases were notified, 19 of which referred to Kingston residents, and 89 of whom were notified from Kingston hospital. These figures compare with 72, 24 and 70 respectively for 1959. An analysis for the years back to 1956 is shown below. Cases 1956 1957 1958 1959 1960 (a)Total notified 88 59 60 72 89 (b) Number included in (a) of (i) Kingston residents 21 8 18 24 19 (ii) Extra district residents 67 51 42 48 70 (c) Number included in (a) notified from Kingston hospital 88 59 60 70 89 (d) Number included in (a) notified by private doctors – – – 2 – (e) Number of cases included in (d) removed to hospital other than included in (c) – – – – – Smallpox. There were no cases recorded in Kingston during 1960. Constant vigilance is however necessary and in particular surveillance has to be maintained over persons arriving from abroad particularly when they have come by air from countries where outbreaks have occurred. Most countries 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 acoordance with regulations. Smallpox vaccination is voluntary and every effort is made to maintain a high immunity level in the population by vaccinating 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. The figures of infants vaccinated in 1960 showed a marked increase over previous years, giving an approximate percentage of children vaccinated in their first year of nearly 80%. All Kingston doctors are kept constantly informed of the position and every effort is made to obtain and to retain a high level of vaccination. 52 Scarlet Fever. Eleven cases were notified during 1960, nine of which were of school age, No serious cases or deaths were reported. As a streptococcal infection scarlet fever is always viewed as potentially dangerous. Modern drugs however, prove to be a good weapon, and the illness usually takes a mild form. Diphtheria Immunity Index. Annual Return for Year ended 31st December, 1960. The Immunity Index is the number of children immunised (primary or booster) during the last five years (total of item A) expressed as a percentage of the total estimated mid-year child population (total of item C.). Age on 31.12.60. (i.e. born in year) Under 1 1960 1-4 1956 - 1959 5-9 1951 - 1955 10-14 1946 - 1950 Under 15 Total A. Number of children whose last course (primary or booster)was completed in the period 1956-1960 182 1,550 1,480 1,298 4,510 B. Number of children whose last course (primary or booster) was completed in the period 1955 or earlier – – 484 1,303 1,787 C. Estimated mid-year child population 510 1,750 4,300 6,560 Immunity Index 100 A C 35.8 88.6 64.4 68.7 53 Poliomyelitis. In February, 1960 the poliomyelitis vaccination scheme was extended to include all persons up to the age of 40 years at the date of registration and also to the following small groups:- A. Hospital staff who come in contact with patients. B. Practising dental surgeons, dental students, dental hygienists, student hygienists and dental surgeons' chairside assistants, and their families. C. Practising nurses not working in hospitals (those working in hospitals are already eligible) and their families. D, Public health staff who may come in contact with poliomyelitis cases,and their families. Further progress was made during the year towards the protection of the priority groups for which vaccine had been issued by the Ministry of Health. These groups were:- 1. Children and young persons born on or after 1st January 1933, providing that in the case of babies they have reached the age of 6 months. 2. Expectant mothers. Vaccination consists of one initial injection given into the arm and approximately 4 weeks later followed by a second. After a period of 7 months a 3rd injection is given, and at an interval of 1 year a further injection will be called for. This is known to give a reasonable level of protection in most subjects for a number of years. No cases of poliomyelitis were notified in Kingston during 1960. Dysentery (Sonne). A total of 6 cases of dysentery were notified during 1960 compared with 25 during 1959. These notifications were all in respect of individuals or individual families. No outbreaks occurred during the year. Although the type of cases which occur are normally sporadic individual dysentery cases there is always an awareness that such infection can be widely spread by contagion from person to person, and that the illness can have a serious effect on babies and debilitated persons. Most of the notifications received concern children of school age and under, requiring treatment at home with appropriate segregation during the carrier stage either by exclusion from school or day nursery. 54 No effort is spared to prevent the spread of the disease and there is close liaison with general medical practitioners who are kept fully informed of developments inoluding up-to-date information as to drug sensitivity of organisms. An essential and important factor undertaken by the public health inspectors is the opportunity to stress the necessity for personal hygiene, especially to those concerned with food handling and the care of young children. Every effort is also made to ensure that personal hygiene is intensified and adhered to during outbreaks. Furthermore, everything possible is done to prevent contact of individuals, in particular children, with persons outside the infected home until the whole family is free from infection. Measures such as these tend to decrease the spread of the disease and also act as an education in personal hygiene. Tuberculosis. In accordance with the national trend the number of new cases of tuberculosis notified continues to be satisfactorily low. In 1960 in Kingston 14 cases were reported, 13 of which referred to the lungs. The corresponding total figure for 1959 was 19 of which 18 referred to lungs. Whilst we can claim that fear and pessimism concerning tuberculosis has been largely removed from people's minds; that statistics show a declining death rate and a satisfactory reduction in the number of new cases there are, however, many oases on the register and receiving treatment and attention at the Chest Clinic. It is, therefore, necessary, to remember that breakdown and infectivity are continually possible in these cases. It is to be hoped that in due course the continued effects of improved living conditions of the populace, continued advances in therapeutic treatment, facility for early detection of tuberculosis by public mass x-ray sessions and B.C.G. vaccination of school children will eventually bring this disease to the point of eradication. A total of 7,921 persons were x-rayed during a visit of the South West Metropolitan Regional Hospital Board X-Ray Unit in October and November (4,079 males, 3,842 females). The figure is an increase of 2,332 as compared with 1959. This can to some extent be accounted for by an increase in examinees from factory staffs. A total of 14 cases (6 male and 8 female) of active pulmonary tuberculosis was discovered and referred for treatment or close clinical supervision. As the Mass X-Ray service is open to all, the figures given above include persons living outside the Kingston District, and do not necessarily relate only to Kingston residents. Table of notified oases and deaths for 1951 - 1960 overleaf. 55 The following table shows comparative figures of notified cases and deaths for the years 1951 to 1960 (inclusive) Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 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 - 3 1960 13 1 14 3 - 3 56 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. The Committee, after a great deal of consideration, altered their constitution to include and help people suffering from long term chest illnesses providing they attend the Kingston Chest Clinic. This change in precedent has also been adopted by all Surrey Care Committees and also by the Standing Conference itself. During 1960, 98 families were helped in the form of grants for extra nourishment, clothing, fuel, removals, bedding, fares, pocketmoney, etc., and a total of £1,563 was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1960 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. 57 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1960, 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 2 2 3 10 - - - - - - - 2 1 3 F - - - - 1 1 1 - = 3 - - - - - - - - - - Total - - - 1 2 2 3 2 3 13 - - - - - - - 2 1 3 (b) Non-reapiratory M - - - - - 1 - - - 1 - - - - - ~ - - - - F - - - - - - - - - - - - - - - - - - - Total - - - - - 1 - - - 1 - - - - - - - - - - 58 RESPIRATORY TUBERCULOSIS