Ac 4413(1) THE HEALTH Room 319, Chicham Hse. OF THE 5.Library. s.Row KIN 35 ROYAL BOROUGH OF KINGSTON-UPON-THAMES I96l THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1962 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES I96l THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1962 ANNUAL REPORT 1961 TABLE OF CONTENTS Page Prface i,ii,iii,iv,v,vi,vii, Population i Births i Deaths i Infant Mortality Rate-1957/l96l-Rate per 1,000 live births ii Causes of Death ii Infectious Disease iii Diphtheria. iii Housing and rehousing iii,iv. Local Government in Greater London iv Food Poisoning v The Aged v,vi. Cigarette Smoking vi Staff vi Constitution of Public Health Committee I Staff of Public Health Department I SECTION A Statistics and Social Conditions (l) General Statistics 2 (2) Social Condition 2,3 (3) Extracts from Vital Statistics of the Year 4 (a) Live Births 5 (b) 5 (c) 5 (d) Deaths 5 (i) 3 (ii) Infant Deaths 5 (iii) Maternal Deaths 5 (e) Maternal Mortality Rate 5 Infant Mortality Rate 1957/1961 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 Population, 1951 Census Figures, Percentage age distribution of the population, etc. 9, 10 Page Table I - Extract from Vital Statistics for the years Table II - Comparison of Vital statistics 1933/1961 12 Table III - Causes of Death 13 SECTION B General Provisions of Health Services (1) (i) Laboratory Facilities 14 (ii) Hospitalss:- (a) Infectious Diseases 14 (b) Smallpox. 14 (c) General 15 (2) Health Services provided by other Authorities:- Surrey County Council - Health Department 15,16,17 Surrey County Council - Education Department 17 Surrey County Council - Welfare Department 18,19 Surrey County Council - Social & Geriatric Services 19, 20 Surrey County Council - Children's Department 20 Surrey Executive Council 20 (3) National Assistance Act, 1948 21 National Assistance (Amendment) Act, 1951 SECTION C Sanitary Circumstances (1) Water supply 22 (2) Drainage and Sewerage 22 (3) Rivers and Streams 22 (4) Closet Accommodation 22 (5) Public Cleansing 23 (6) Sanitary Inspection of the Area 23 (7) Shops 24 (8) Factories Act, 1937 24,25,26 (9) Camping Sites 26 (lO) Atmospheric Pollution 26,27,28, 29,30,31, 32,33 (11) Swimming Baths and Pools 34 (12) Eradication of Bed Bugs 34 (13) 34 (14) Rodent and Insect Pest Control 35,36 Page SECTION D Housing General 37 Statistical Statement, 1961 38 SECTION E Inspection and Supervision of Food (a) Milk Supply 39 (b) Designated Milks 39 (c) Bacteriological Examination of Milk 40 (d) Ice Cream 40,41 (e) Meat and Other Poods 41 (f) Pood Hygiene. 42,43,44 Pood Hygiene Regulations, 1955 44 Pood and Drugs Act, 1955. 45 Tabulated Statement of Samples submitted to the Public Analyst during 196l 46,47 Foods subject of complaint. 48,49 Merchandise Marks Act, 1926. 49 SECTION P Infectious Diseases Notifiable Diseases. 50 Table IV Notifiable Diseases during 1961 51 Table V Comparative Statement of Notifications of certain Infectious Diseases 52 Whooping Cough 53 Enteric Fever (Typhoid or Paratyphoid) 53 Measles 53 Ophthalmia Neonatorum 53 Puerperal Pyrexia 53,54 Smallpox 54 Scarlet Fever 54 Poliomyelitis 55 Dysentery 55,56 Tuberculosis 56,57,58 Table VI & Graph. - Notified cases and Deaths from Tuberculosis in 1961 59,60 (i) TELEPHONE NO: PUBLIC HEALTH DEPARTMENT, KINGSTON 2121. GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1962. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT. 1961. 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 196l. As in previous years the report follows the general lines indicated by the Minister of Health, and is in accordance with Circular 1/62. Population - The Registrar General's estimated mid 1961 home population figure is given as 35,990 (resident population figure used for calculation of the statistical data in this report). This figure showing a reduction in the home population of 2,640 persons as compared with 1960 is based on the preliminary results of the Census enumeration of 23rd April, 196l, 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 1961 is 639 and compares with 578 for 1960. The crude birth rate is 17.1 per 1,000 population compared with 15.1 for 1960. Deaths - The number of deaths recorded in 1961 is 462 compared with 432 for 1960. This makes a crude death rate of 12.8 as compared with 11.2 for 1960. The excess of births over deaths was 177 compared with 146 for the previous year. The number of infant deaths (under 1 year of age) in 1961 is 10 which gives an Infant Mortality rate per 1,000 live births of 15.6. The corresponding figures for 1960 were 6 infant deaths and an Infant Mortality rate of 10.4. The following table shows the approximate average rate for the -previous five years. (ii) INFANT MORTALITY RATE 1957 1958 1959 1960 1961 Total No. Deaths 7 8 13 6 10 RATE PER 1,000 LIVE BIRTHS 12.8 14.9 23.0 10.4 15.6 No maternal deaths (i.e. from pregnancy, childbirth, abortion) were recorded out of a total of 649 live and stillbirths. Causes of Death - Main conditions causing death during 1961 were:- 1961 1960 Heart Disease 133 146 Cancer 112 98 Vascular Lesions of the Nervous System. 55 53 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. 1957 1958 1959 1960 1961 Deaths from cancer of the lung and bronchus Total Total Total Total Total 16 25 26 23 21 M F M F M F M F M F 10 6 23 2 23 5 20 5 19 2 (iii) Infectious Disease - The number of infectious disease notifications received in 1961 was 560, as compared with 136 in 1960, a difference of 424 which is accounted for by the notification of 439 more cases of measles than in 1960, Active protection of the child population against diphtheria, whooping cough, tetanus, smallpox, tuberculosis and poliomyelitis was continued at a vigorous pace. Diphtheria - For the fourteenth year in succession no cases of diphtheria occurred in Kingston. Outbreaks of the disease occurred in unimmunised children in some areas which only emphasized 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, It is estimated that at the 31st December 1961, 4605 Kingston children have been immunised during the past 5 years for the first time or received reinforcing "booster" injections. It is calculated that during 1961 the proportion of Kingston babies immunised before they reached the age of 1 year was Every effort is made to maintain this very satisfactory figure. Housing and Rehousing - During 1961 the Corporation provided 20 housing units comprising 2 staff house; 11 old people's bungalows, and 7 single bed-sitting rooms. In addition 16 houses, 24 flats and 10 maisonettes were built by private enterprise, giving a total of 70 new housing units in Kingston during the year. Future housing policy and needs are at present under review by the Corporation, It is to be anticipated that the rate of building will eventually increase to enable the various outstanding categories of rehousing applications to be dealt with, including special consideration for the housing of old people. In February 1961, a White Paper entitled "Housing in England and Wales" was presented to Parliament, outlining the Government proposals now contained in the Housing Act, 1961. This White Paper suggests that fresh impetus and attention should be given by local authorities to solving the housing and slum clearance problems of big towns and cities; speed up building for old people; start a drive against overcrowding and squalid conditions in houses in multi occupation; point (iv) the way to a new development in building to let; and hasten the modernising of thousands of older houses. These, and a continued high rate of new buildings, are the prime needs of the next few years. It is emphasised that there is a need to concentrate on slum clearance and building for old people and those who are living in overcrowded squalid conditions though not in unfit houses, who cannot rehouse themselves by their own efforts. The increased provision of suitable housing accommodation is one of the most important services for old people. An increasing proportion of local authority housing is of this type, but there is considerable leeway to be made up, There is no doubt that many of the elderly are greatly handicapped by remaining in dwellings that are too big for their needs, or, beyond their physical capabilities. Old people prefer to spend their last years in a house of their own among their own possessions and memories; their own community of relatives and friends; but the provision of suitably designed and equipped homes enables the old person to retain his independence for longer than before. Local Government in Greater London - A White Paper on London Government was published at the end of November 196l, in which the Government agreed with the Commission in thinking that the boroughs should be the primary unit of local government in London, It was considered that the new boroughs should. be larger than proposed by the Royal Commission, A map issued by the Minister of Housing and Local Government showed details of the possible future local government groupings of 34- boroughs with a population range of 180,000 to 360,000. By the time this Report is published, it is likely that the Minister of Housing and Local Government will have concluded his Conferences with marginal and other local authorities and made clear where the boundary of Greater London will run. It is also possible that he will have indicated a modification: in the original grouping planned for Kingston and neighbouring authorities, and the size and grouping eventually decided of the Greater London Borough, It is proposed that the outlined changes in London Government will become effective in April 1965, (v) Food Poisoning - In spite of the very large number of eating places and food shops in Kingston, no cases of food poisoning occurred during 1961 which could be attributed to lack of hygiene in the trade. Three sporadic eases of food poisoning occurred during the year, and there was a total absence of outbreaks. No particular food or vehicle of infection was implicated. Every effort is made to maintain the highest possible standard in the many eating places in the town, which cater for thousands of visitors and business people daily. It is to some extent a measure of the success of the vigilance maintained and the standards practised which go a long way towards preventing possible contamination of foodstuffs. The Aged - As the aged increase so does the problem of their care. The proportion of old people, it is estimated, has increased from. 4.7% at the beginning of the century to 11.9% now, and by 1978 it is expected to reach 14.8% of the population,, This proportionate growth of aged persons in the population has taken place and will continue in the future because the number of persons surviving to 65 years of age has markedly increased. The average expectancy of life in 1900 was, for a male 44 years, now it is 71 years; for a female it was 52 years, now it is 73 years. This, therefore, poses the problem of increasing the organisation and co-ordination of existing effective services namely (A) The medical services (B) Local health and welfare services, and (C) The hospital services. The problems of dealing with the aged and chronic sick are always difficult. Apart from difficulties encountered in regard to shortage of vacancies in Old People's Homes and of hospital beds additional complications do arise when often the patients refuse to cooperate. Most of them prefer to remain in their own homes and to retain their independence despite existing difficulties and hardships. In this regard, however, the effective work done by the members of the local health authority services, the health visitor and social workers, the district nurse, and home helps enables many old people to remain in reasonable comfort in their own homes. No mention of the existing services for the aged is complete without referring to the valuable and important work undertaken by voluntary organisations. There is no doubt that the value of the work carried out on a voluntary basis reinforces the efforts and work of the statutory bodies, and is an aid to the special needs of old people extending the rang# of all provisions and services. (vi) The understanding of the personality factors of ageing has deepened and affects the way we assist aged persons in planning for themselves to the extent of their mental and physical capacities, and it is hoped that this understanding will gather strength as the years progress. Cigarette Smoking - Lung Cancer - Health Education - One of the complicated factors about health education today is the endeavour of the medical profession (Report on "Smoking and Health" recently published by the Royal College of Physicians) and authorities concerned with health education to bring home to the public at large, and the adolescent in particular the co-relation which has been found to exist between tobacco smoking and the high incidence of lung cancer, The right approach in this problem seems to be to tackle the young people, to eradicate the belief in the adolescent mind that tobacco smoking is an action which is identified with maturity, independence and success, and it is this aspect of the appeal against smoking which has to be faced, Tobacco smoking has to be debunked and deglamourised in the mind of the school child and the adolescent. If an attack on long cancer is the aim of health education and propaganda, and the attack is to be made in earnest there must be a completely new approach and outlook to the problem. There must be a sustained campaign at national level aimed at counteracting the high pressure exhortation of the advertising agencies in the press and on television who are constantly lauding the pleasures of smoking, Any campaign must give the lie to these implications, this incentive, this need for tobacco comfort, and should have as its background the proposition that lung cancer is a preventable disease and that health education has as its aim the eradication of the "smoking habit". Staff - Details ©f the staff of the Public Health Department are set out on Page 1, The following staff changes took place during the years:- Mr. W.A. Huckin, appointed as Technical Officer, Smoke Control Areas, May 1961, Mr, R,D, Smith, Junior Clerk, resigned in August, and was replaced by Miss J.M. Martin. Mr, D, Hawkins, General Clerk, resigned at the end of the year to take up an appointment with Surrey County Council, I am indebted to Mr, G.C. Smith, Chief Public Health Inspector, with special reference to Sections G. E. and Mr, M. Frankell, Administrative Officer, for assistance in compiling the report. (vii) 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. W.H. 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. ROYAL BOROUGH OF KINGSTON-UPON-THAMES PUBLIC HEALTH DEPARTMENT Public Health Committee for the Municipal Year 1961-62. Alderman McDonald (Chairman) Councillor Baker Councillor Mrs, Denny (Vice-Chairman) " Marshall " Miss Tapping (Mayor) " Frith " Guymer (Ex-Mayor) " Richards " Hooker " Brookes Alderman Knowiden " Eades " Mrs. Picton " Parrish STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Healths J.W. STARKEY, M.B., Ch.B. (Edin.), D.P.H. Deputy Medioal Officer of Healths (Part-time). W.H. KINSTRIE, M.B., Ch.B. (Edin.), D.P.H. Chief Public Health Inspector: G.C. SMITH, F.R.&.H., M.A.P.H.I. (a)(b) Senior Additional Public Health Inspectors L. BURROWS, M.A.P.H.I. (a)(b) Additional Public Health Inspectorss S.W. SIMPSON-SCOTT. (a)(b) K. APPLETON, A.R.S.H., M.A.P.H.I. Junior Public Health Inspectors (vacant) Chief Clerks M. FRANKELL, D.M.A., A.C.C.S., A.R.S.H. Technical Officer - Smoke Control Areas; W.A. HUCKIN (appointed 15.5.61). Clerical Staffs MISS C.L. FOISTER. MISS M.W. FILBEE. D. HAWKINS (resigned 31.12.6l). R. SMITH (resigned 31. 8.61). MISS J. MARTIN (appointed 25.9.61). Pest Control Officers: F.W. STAGG, A.R.I.P.H.H. Rodent Operativess: G. H. LOCKE. F.J. PERRY. Disinfector/Driver: D. WILKINSON. (a) Certificate as Public Health Inspector. (b) Certificate as Meat and Other Foods Inspector. 2 SECTION A STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres 1,408 Total Population (including Service personnel) 35,990 Number of inhabited houses (approx.) 11,808 Rateable Value - General Rata (l.4.6l) £1,153,570 Sum represented by Penny Rate (year 1961/62) £ 4,720 Total number of hereditaments.14,586 Domestic dwellings 80% of total hereditaments Commercial premises. 16 of total hereditaments Number of premises classified as industrial, entertainment, public utility, educational and miscellaneous 459 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 Districts:- "In 1961, a year of some financial difficulty nationally, the Kingston area was fortunate in that unemployment increased only marginally. The number of men unemployed was on average 377, only 22 more than in 1960, while the women's unemployed register was actually, on average, slightly lower. Expressed as a proportion of the working population this is approximately .5%, the same as for the two previous years, and compared with the national percentage of 1.9%, does not give rise to concern. At December 11th 1961, the last date in the year for which figures are available, there were 400 men and 91 women unemployed. During the year there was a slight decrease in the demands for labour. The Exchange placed 3,530 men and. 1,035 women in work in its own area (which includes, in addition to Kingston itself, the whole of the boroughs of Surbiton and Maiden and Coombe, together with Teddington 3 and the Hamptons). 106 of the women were placed in part-time work. In addition 130 men and 80 women who registered at Kingston Exchange were placed in work in other Exchange areas. Most of these were in jobs within daily travelling distance of Kingston, hut 10 of the men were people on Local Authority Housing Lists for whom it was possible to find work in new or expanded towns, 4 being Kingston residents. In the absence of applications from suitably qualified persons on housing lists, 10 vacancies in new or expanded towns were filled by the submission of other registrants. The number of ex-Regular servicemen who sought help in their resettlement into civilian employment was only 34 in 1961, compared with 89 in 1960. Of this 34, 18 were found work while 2 were given courses in vocational training to fit them for specific occupations in civil life. Of all those placed 17 men and 63 women were persons already in work who for a number of reasons were seeking a change, while 228 men and 49 women were disabled. The overall total of persons placed in employment in the Exchange area shows a reduction of 316 which was a reflection of the slightly decreased demand mentioned above. There was a small increase (14) in those placed elsewhere. In general, employment continued at a satisfactory level throughout the year. There were small redundancies in some firms, but the workers who lost their employment were usually able to find further work quite readily, either by their own efforts or through the Exchange and wherever possible such persons were interviewed by Exchange staff at their places of employment before they became unemployed, to try to find them work before their notices expired. In the aircraft industry recruitment of labour during 1961 continued to be restricted in the main to skilled workers, while normal wastage resulted in a further small drop in the numbers employed. Further concentration of production is expected to throw up some redundancy, though it is understood production workers are unlikely to be affected. In the retail trade expansion and development continued both in firms already in the area and by the opening of premises by firms coming to Kingston to extend their field of activity. It is perhaps a reflection of the national position that at the end of 1961 the numbers of unfilled vacancies recorded at the Exchange were 531 for men and 365 for women, both appreciably lower than at the end of the previous year. The ratio of unfilled vacancies to registered unemployed fell from 2.9 to 1.9. In retrospect, however, I feel my hopes of continued prosperity in the area in 1961 have been fulfilled, and I am confident Kingston will share in the expansion in the national economy so urgently desired for 1962." 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 population 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 0.995 Deaths 0.88. The birth and death rates in respect of the town are shown over-leaf and for the purpose of providing some comparison the rates for England and Wales are also shown. 5 VITAL STATISTICS Male Female Total Total 1961 1960 (a) Live Births - Legitimate 286 310 596 (545) Illegitimate 26 17 43 (33) 312 327 639 (578) Live Birth Rate per 1,000 population. 17.1 (15.1) Adjusted Birth Rate 16.8 (14.6) England and Wales Live Birth Rate 17.4 (17.1) Illegitimate Live Births per cent of total Live Births. 7.2 (6.1) Male Female Total Total 1961 1960 (b) Stillbirths - Legitimate 6 4 10 (7) Illegitimate - - - (1) 6 4 10 (8) Rate per 1,000 total Live and Stillbirths. 15.6 (13.5) England and Wales Stillbirth Rate. 18.7 (19.7) Male Female Total Total 1961 1960 (c) Total Live and Stillbirths - Legitimate 292 314 606 (552) Illegitimate 26 17 43 (34) 331 649 (586) Male Female Total Total 1961 1260 (d) Deaths - 243 219 462 (432) (i) Death Rate per 1,000 population. 12.8 (ll.2) Adjusted Death Rate. 11.3 (10.3) England and Wales Death Rate. 12.0 (11.5) * (ii) Infant Deaths Total No. of Deaths 10 (6) Infant Mortality Rate per 1,000 Live Births 15.6 (10.4) Infant Mortality Rate per 1,000 Live Births Legitimate 16.8 (11.0) Illegimate Nil (Nil) Infant Mortality Rate for England and Wales. 21.4 (22.0) ** Neo Natal Mortality Rate per 1,000 Live Births 14.1 (8.5) (iii) Maternal Deaths (including abortion) total. Nil (Nil) (e)Matemal Mortality Rate per 1,000 Live and Stillbirths. Nil ( Nil) *Under 1 year of age, ** Under 4 weeks of age. 6 The approximate Infant Mortality Rate for 1961 and the rates since 1957 are shown for purposes of comparison. 1957 1958 1959 1960 1961 Kingston-upon-Thames 15 15 22 11 16 England and Wales 23 22 22 22 21 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 1961 before reaching the age of one year, together with the cause of death. 7 INFANT DEATHS AGE TOTAL Hydrocephalus Pneumonia Congenital Heart Disease, Prematurity Subdural Ventricular Haemorrhage. Vertibral artery haemorrhage due to birth trauma. 0-24 Hours 6 1 1 - 3 - 1 24 Hrs. - 1 Mth 2 - - - 1 1 - 1 Mth - 1 Yr. 2 - 1 1 - - - Totals 10 1 2 1 4 1 1 8 (iv) DEATHS FROM OTHER CAUSES IN 1961. NO. OF DEATHS. Heart Disease 133 Cancer 112 Vascular Lesions of the Nervous System 55 Circulatory Disease other than Heart 32 Bronchitis 29 Pneumonia 24 Influenza 4 The following Tables I, II, III summarise certain vital statistics. Table I shows the figures for live births, stillbirths, and deaths for the years 1957 - 1961 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1932. 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. The trend of the estimated population figure is to remain below 40,000. 9 POPULATION (A) The following table shows the estimated mid-year population figure for the last 10 years. 1952 39,990 1953 39,940 1954 39,160 1955 39,070 1956 38,790 1957 38,590 1958 38,800 1959 38,590 1960 38,630 1961 35,990 (B) CENSUS FIGURES 1901 34,375 1911 37,975 1921 39,514 1931 39,825 1951 40,172 (C) 1951 Census. At the Census 96.5% of the population lived in dwellings occupied by private households; the remaining 3.5% lived in hotels, educational establishments, hospitals, defence establishments and the like. For every 1,000 males there were 1,158 females, 38.8% of the population were single, 52.1% married and 9.1% widowed or divorced. (D) PERCENTAGE AGE DISTRIBUTION OF THE POPULATION 7.6% aged 0-4 years 11.25 „ 5 - 14 „ 42.6% „ 15 - 44 „ 25.5% „ 45 - 64 „ 13.l% „ 65 and over 10 (E) Administratire Area Acreage (Land and Inland Water) Population - 1951 Kingston-upon-Tham.es 1408 Persons 40,172 Males 18,422 Females 21,750 Wards Canbury 491 12,054 5,586 6,468 Hill 308 10,388 4,586 5,802 Norbiton 251 8,941 4,173 4,768 Town 358 8,789 4,077 4,712 11 EXTRACT FROM VITAL STATISTICS FOR YEARS 1957-1961 INCLUSIVE. TABLE I. 1957 1958 1959 1960 1961 Total M. F. Total M. F. Total M. F. Total M. F. Total M. F. LIVE BIRTHS Legitimate 509 245 264 506 244 262 536 273 263 545 269 276 596 286 310 Illegitimate 39 17 22 30 17 13 28 17 11 33 21 12 43 26 17 548 262 286 536 261 275 564 290 274 578 290 288 639 312 327 Birth rate (R.G.) per 1,000 pop. 14.2 13.8 14.5 15.1 17.1 STILLBIRTHS Legitimate 8 3 5 14 8 6 4 1 3 7 3 4 10 6 4 Illegitimate - - - 1 1 - - - - 1 1 - - - - 8 3 5 15 9 6 4 1 3 8 4 4 10 6 4 Rate per 1,000 (live and stillbirths) 14.4 27.2 6.1 13.5 15.6 DEATHS 432 202 230 434 228 206 416 200 216 432 223 209 462 243 219 Death rate (R.G.) per 1,000 pop. 11.2 11.2 10.8 11.2 12.8 12 COMPARISON OF VITAL STATISTICS 1932 - 1961. 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 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 ll.0 45 59 1935 39030 510 13.0 482 12.3 57 57 1936 39880 573 14.4 502 12.6 52 59 1937 39850 539 13.5 540 13.6 52 58 1938 39790 528 13.2 468 11.8 43 53 1939 39970 533 13.3 450 11.4 28 50 1940 37430 519 13.9 659 17.6 55 55 1941 35970 520 14.5 525 14.6 57 59 1942 36090 551 15.3 491 13.6 63 49 1943 35900 637 17.8 500 13.9 48 49 1944 34780 578 16.6 474 13.6 48 46 1945 35760 593 16.6 505 14.1 43 46 1946 39670 794 20.0 460 11.6 29 43 1947 40780 870 21.3 495 12.1 22 41 1948 40780 722 17.7 455 11.2 23 34 1949 40660 729 17.9 500 12.3 20 32 1950 41950 619 14.8 492 11.7 30 30 1951 39920 574 14.4 556 13.9 24 29 1952 39990 576 14.4 499 12.5 24 27 1953 39940 609 15.3 465 11.6 24 26 1954 39160 534 13.6 450 11.5 20 25 1955 39070 543 13.9 424 10.9 15 25 1956 38790 550 14.2 442 11.4 24 24 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 1961 35990 639 17.1 462 12.8 16 21 13 CAUSES OF DEATH - REGISTRAR GENERAL'S TABLES. TABLE III 1957 1958 1959 1960 1961 M F M F M F M F M F All Causes 202 230 228 206 200 216 223 209 248 223 Tuberculosis, respiratory. 5 1 2 - 1 2 3 - 2 - Tuberculosis, other — 1 1 2 — - - - - - Syphilitic disease — 2 — — 1 1 - - 1 - Diphtheria — — — — — - - — - - Whooping Cough — — — - - — — - - - Meningococcal Infections — — — - - 1 - - - - Acute Poliomyelitis. - — — — — - - — - - Measles. - - - — — - - — - 1 Other infective and parasitic diseases. 1 - - 2 - 1 - - - - Malignant neoplasm, stomach 3 7 9 5 2 11 4 1 7 10 Malignant neoplasm,lung,bronchus 10 6 23 2 23 3 20 3 19 2 Malignant neoplasm, uterus - 5 — 6 - 1 - 1 - 4 Malignant neoplasm, breast — 7 — 5 - 11 — 11 - 12 Other malignant and lymphatic neoplasmso. 19 19 20 21 29 19 30 28 32 26 Leukaemia, aleukaemia — 3 - 1 1 2 1 1 - 2 Diabetes. 1 - 3 1 1 2 1 - 2 1 Vascular lesions of the nervous system. 24 50 19 42 22 32 21 32 24 31 Coronary disease, angina. 43 25 49 32 35 21 51 38 60 32 Hypertension with heart disease 5 6 9 4 1 10 5 4 7 4 Other heart disease 17 25 20 33 12 26 20 27 9 21 Other circulatory disease 11 15 19 13 9 9 11 14 13 20 Influenza — 6 - 1 6 6 - - 1 3 Pneumonia. 9 11 10 6 9 17 14 3 11 13 Bronchitis. 24 12 19 5 14 6 14 2 20 9 Other diseases ©f respiratory System 4 1 2 6 2 1 - - 8 - Ulcer of stomach and duodenum - - - - 4 1 1 - 3 3 Gastritis, enteritis, and diarrhoea. - 1 - 1 - - 2 2 2 1 Nephritis and nephrosis 5 2 — — 1 3 1 1 2 - Hyperplasia of prostate. 3 - 1 — 2 - 2 — 1 - Pregnancy, childbirth, abortion — — — - — - — — - - Congenital malformations 3 3 1 1 1 1 — 2 2 2 Other defined and ill-defined diseases. 11 15 12 10 12 23 10 21 15 20 Motor -vehicle accidents 1 3 4 - 4 1 5 3 2 2 All other accidents. 2 3 3 5 5 4 4 2 3 3 Suicide. 1 2 2 3 1 3 3 2 1 Homicide and operations of war - 1 - - - - - - - - lit SECTION B GENERAL PROVISIONS OF HEALTH SERVICES (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 examination are submitted to the Public Health Laboratory, Epsom, and samples under the Food and Drugs Acts to the Public Analyst, Mrc D0D0 Moir, at the Analytical Laboratory, Southwark Street, S.E.I. (ii) Hospitals (a) Infectious Diseases, The provision of beds for eases 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 ef the Pisysician Superintendent of Kingston Hospital, Ninetythree oases of infectious disease were treated is 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,3 (b) Smallpox, Arrangements exist whereby oases of smallpox or suspected smallpox can be transported by the London County Council Ambulance Service special isolation, (Telephone - Whitehall 2177, or Waterloo 3311). 15 (e) General. Kingston Hospital, Wolverton Avenue, Kings ton-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 in the North Central Division administered by the Surrey County Council The Ministry of Health has asked health and welfare authorities to draw up their plans for community services for the next ten years. Among the services to be considered by local authorities are health centres, care of mothers and young children, midwifery, health visiting, home nursing, vaccination and immunisation, ambulance service, domestic help, mental health, prevention of illness and care and after-care. Plans have to be submitted to the Minister by the 31st October, 1962. 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 Poat-natal Clinics. Health Centre, Grange Road Wednesday afternoon,, (b) Infant Welfare Clinics. Health Centre, (Kingston 726l). Tuesday and Friday afternoons. Thursday afternoon. (Toddlers) Queen's Road Clinic. Monday and Thursday 27, Queen's Road. (Kingston 5812). afternoons„ 16 (c) Dental Clinics. Health Centre. Daily. "Keeldar" 25 , Queen's Road Daily by appointment, (Orthodontic only). (except Saturday) (d) Immunisation and Vaccination Clinics. Health Centre. Thursday afternoon. Queen's Road Clinic. Friday forenoon. (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 ears of the children. (f) Midwifery Service. Certified addwives are employed for attendance as midwives or maternity nurses at domioiliary 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, Penrbyn Road Kingston-upen-Thames9 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. (k) Mental Health. Under 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 office of the Mental Welfare (Duly Authorised) Officer for the Borough is at 35, Coombe Road, Kingston-upon-Thames (Kingston 3302). Surrey County Council - Education Department. The School Health Service is staffed by the County Health Department and provides the following services:- (a) Routine medical inspection of pupils. (b) Cleanliness surveys of pupils. (c) Dental inspection of pupils. (d) Ascertainment of handicapped pupils in need of special education. 18 (e) Treatment clinics as under:- (i) Minor Ailments. Health Centre. Monday forenoon. Tuesdays to Fridays 9-10 a.m. Queen's Road Clinic. Friday forenoon. (ii) Medical Consultation. Health Centre. Monday forenoon. Queen's Road Clinic. Friday forenoon. (iii) Eye Clinic. Health Centre. Thursdays, from 10 a.m. by appointment. (if) 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 persona. 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). 19 In addition, the Surrey County Council implement a scheme for the provision of welfare services for handicapped persons wader the National Assistance Act, 194-8, other than for "blind, partially sighted and deaf and dumb, The voluntary Association for Surrey Disabled acts as the Council's agents, hut certain services are, however, provided by the Council directe They are as followss- 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 ©wn 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 7261), 20 The County Welfare Committee provides considerable services for the aged. These include different types of residential accommodation and many domicilliary 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 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, Penrbyn Road, Kingston-upon-Thames. Surrey Executive Council. This body is responsible for the provision wader 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, Swell Road, Surbiton, Surrey, (Elmbridge 5723). 21 National Assistance Act. 1948 National Assistance (Amendment) Act, 1951. Under Section 47 of the 1948 Act power is given to the Councils of County Boroughs and County Districts to apply to a Court of Summary Jurisdiction for an Order for removal and detention in a suitable hospital or other place of persons who:- (A) Are suffering from grave chronic disease, or being aged, infirm or physically incapacitated are living in insanitary conditions; and (B) Are unable to devote to themselves, and are not receiving from other persons, proper care and attention. The 1951 National Assistance (Amendment) Act enables local authorities to deal more speedily with very urgent cases by initial removal, for a period not exceeding 3 weeks. Although a number of eases were brought to the notice of the Public Health Department for investigation during the year it was possible to find a solution to each particular problem without resorting to compulsory methods. 22 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. During the year 27 samples from this source were submitted for examination; all were reported to be satisfactory. 2. DRAIN AGE 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 Kingstonupon-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 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. 23 5. PUBLIC CLEANSING. The Borough Surveyor is responsible for the collection and disposal of house and trade refuse. Disposal is carried out bytipping 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 12,409 tons of refuse were sent from this Borough in 1961. 6. SANITARY INSPECTION OF THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors which totalled 7,500 as compared with 8,629 for 1960. House inspections, defects, etc 400 Drainage 420 Factories 134 Outworkers 29 Atmospheric Pollution 147 Dairies, milk shops, etc 181 Food Premises 780 Restaurants and Cafes 313 Infectious disease enquiries 95 Cinemas 6 Verminous premises 24 Rodent C ontrol 24 Shops Act 138 Schools 16 Housing Act 32 Markets 703 Public sanitary conveniences 41 Fireguards 34 Merehandi se Marks Act 248 Intervaiews 439 Miscellaneous 1,066 Smoke Control Inspections 744 Smoke Control Revisits 57 6,091 Reinspections and works in progress 1,409 17.500 24 NOTICES SERVED Informal (a) Verbal 99 (b) Written 189 Statutory (a) Housing Acts - (b) Public Health Acts 23 NOTICES COMPLIED WITH Informal Statutory Public Health Acts 16 7. SHOPS. There are some 953 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 aire submitted of new construction or alteration to shop premises9 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. 1937. The following are the particulars required to be furnished to the Ministry of labour and National Service respecting matters dealt with by the Corporation under Parts I and VIII of the Factories Acta 25 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 56 48 - - Factories not included above in which Sec. 7 is enforced by the Corporation 281 103 - - Other premises excluding outworkers 15 23 - - 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. Inspec- tor Want of cleanliness - - - - - Over-c rowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 4 - - 1 - Ineffective drainage of floors - - - - - Sanitary Conveniences (a) Insufficient - - - - - (b) Unsuitable or defective - - - - - (c) Not separate for sexes - - - - - Others 3 2 - - - 26 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 Outworkers Wearing apparel - making etc. 10 Brass & Brass Articles 5 Lampshades 1 16 9. CAMPING SITES. There are no camping sites within the Borough„ 10. ATMOSPHERIC POLLUTION. Clean Air Act„ 1956 - Smoke Control Areas. The Minister of Housing and Local Govemment confirmed the making of the No. 1 Smoke Control Area, the operative date being October 1st, 1962. The 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 number of premises afffected is as follows:- Domestic 275 Commercial 561 Industrial 14 Other 20 During the year the survey was completed upon Area No. 2 and application was made to the Minister for confirmation,, The area lies near the centre of the town and is bounded by Eden Street, Brook Street, Ashdown Road, The Fairfield, Minerva Road, London Road and the Railway, 27 The number of premises affected is as followst- Domestic 639 Commercial 156 Industrial 7 Other 28 In submitting this proposed Order, it was anticipated that the operative date would coincide with that of Area No. 1. Smoke Nuisance, Thirteen complaints were received in respect of smoke nuisance, six of which referred to the burning of rubbish. This type of nuisance is sometimes created by the thoughtless action of persons who are unaware of the proper means of disposal, but on many occasions it is caused by downright disregard of the rights and feelings of others who are subjected to considerable nuisance from smoke, disagreeable fumes and ash. Two complaints referred to industrial incinerators, one of which is not now in use. The other has been satisfactorily modified by the installation of a flue gas washing system which, so far, has proved to be very effective in eliminating smoke and fly ash. Industrial boiler chimneys were responsible for two complaints. These referred to oil fired plants and were minor in degree, being merely matters of adjustment. The remaining complaints were domestic in character and advice was given in these cases. In addition to the above a number of complaints were received of excessive grit emission from the Power Station. Mention has been made in a previous report of the possibility of this occurring from time to time due to the use of low grade fuels and when breakdowns or operational faults occur,„ A survey was being conducted with a view to assessing the extent Of the nuisance, but sufficient data was not to hand by the end of the year. It is obvious, however, by reference to the results from the deposit gauges that an increase is being recorded which bears a close relationship to the increased load which has been placed upon the Station. 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 28 atmosphere, The following table and the graph overleaf indicate the results obtained. Smoke and sulphur dioxide are expressed in microgrammes per cubic metre. Results obtained from the Volumetric Instrument at the Guildhall, Month Smoke S02 Monthly Average Highe st Value Lowest Value Monthly Average Highest Value Lowe st Value January 107 436 2 179 430 32 February (14 days only) 83 256 12 170 426 39 March 108 444 8 161 497 25 April 43 164 4 103 300 26 May 17 50 0 63 136 0 June 16 38 1 54 157 3 July 11 32 1 41 154 8 August 9 31 2 52 71 5 September 20 58 1 79 211 14 October 30 117 4 85 368 20 November 121 520 0 207 546 12 December 251 964 0 368 1494 18 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 effects when the prevailing wind was blowing from industrial sources towards the recording stations. 29 Smoke and Sulphur Dioxide, 1961 Results obtained from the Volumetric Instrument at Guildhall. 30 CANBURY GARDENS - Station 'A'. 1961 Deposit in Tons per sq.mile JUnd Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations No. of times S.E-S.W. January- 20 .065 8.02 28.67 26 9 2.29 February 16.60 6.23 22.83 12 9 2.11 March 8.54 3.59 12.13 27 6 0.64 April 16.90 4.81 21.71 24 17 1.32 May 12.53 4.74 17.27 27 9 0.90 June * - - — 25 16 - July 16.40 4.88 21.28 24 13 1.38 August 25.00 9.58 34.58 26 12 3.08 September 21.50 9.92 31.42 26 16 2.01 October 31.30 16.80 48.10 26 17 2.40 November 33.50 50.80 84.30 26 10 2.96 December 17.42 12.56 29.98 22 14 2.96 Totals 220.34 131.93 352.27 22.05 Average 1961 20.03 11.99 32.02 2.00 Average 1960 12.42 8.44 20.86 2.47 * Gauge interfered with - results not obtainable. 31 TIFFIN GIRLS' SCHOOL - Station »B'„ 1961 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 8.56 7.60 16.16 26 9 2.26 February 5.91 7.80 13.71 12 9 2.10 March 11.85 3.78 15.63 27 6 0.58 April 5.34 3.88 9.22 24 17 1.30 May 3.49 2.62 6 .11 27 9 0.90 June * - - - 25 16 - July 5.81 3.25 9.06 24 13 1.10 August 5.34 4.55 9.89 26 12 2.92 September 5.54 5.51 11.05 26 16 2.01 October 9.76 11.20 20.96 26 17 2.48 November 5.58 7.77 13.35 26 10 2.40 December 7.60 6.91 14.51 22 14 2.94 Totals 74.78 64.87 139.65 20.99 Average 1961 6.79 5.89 12.69 1.90 Average 1960 5.83 5.90 11.74 2.30 * Specimen inadvertently disposed of at Laboratory. 32 The following additional table, illustrated with a graph, is of interest in showing the trend of atmospheric pollution over the years. Average Monthly Deposit - Tons per Square Mile. Year Station A C anbury Gardens Station B. Tiffin Girls' School Total Solids Insoluble Solids Total Solids Insoluble Solids 1949 20 12.04 - - 1950 22.17 13.92 14.98(6/12) 5.27(6/12) 1951 22.19 14.34 12.47 5.22 1952 19.12 12.91 12.49 5.88 1953 17.58 11.98 10.32 4.59 1954 18 .70 12.29 10.21 4.63 1955 15.85 10.77 9.13(11/12) 4.80(11/12) 1956 19.00 10.04 9.95 4.67 1957 19.08 12 .51 8.95 4.34 1958 15.86(11/12) 9.22(11/12) 9.42 4.10 1959 19.75 13.62 11.51 6.40 I960 20.86 12.42 11.74 5.83 1961 32.02 20.03 12.69 6.79 33 Total Solids - Tofts per Square Bile,, Canbury Gardens 34 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 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 ten premises were disinfested. Five 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 456 compared with 400 for the previous year. The following is a brief list of causes for complaints received during 1961:- Accumulations 33 Animals 8 Ashbins 5 Drains and Sanitary Arrangements 94 37 Insects and Pests 19 Overcrowding 1 Rodent s 126 Sanitary Defect s 68 Smoke 13 Water 3 12 Yard Paving 2 35 456 35 14. RODENT AND INSECT PEST CONTROL,, The good public relations cultivated between the department, business managements, and private householders have produced again the pleasing factor that no legal action has been taken under the Prevention of Damage by Pests Act, 1949. The department's work, to a certain extent, has been complicated by the fact that more married women now go out to work, and this means that frequently there is no one at home when a call is made. It is necessary, therefore, to make special appointments and revisits,, Time spent on the car and watching television has meant that back gardens tend more and more to become neglected and littered with rubbish and unwanted articles. Because of this, some difficulty is sometimes experienced in controlling rodent infestations. Infestations on new building sites are often due to the careless habits of workmen and it is necessary to maintain regular inspections of such premises. The routine inspection of drainage systems continues to yield good results in that fourteen defects were found in drains and three in sewers, all of which have been dealt with by the appropriate department. Such an instance is of an unsealed and disused drain connected to horse stables of a house .many years ago, the site of which is now covered by a block of flats. Control of the sewerage system was again effectively maintained; during the course of this work an observation was made which was effective proof of the efficiency of modern rodenticides. A small colony of rats was exterminated and the circumstances in which this took place were considered to be of such interest that officers of the Ministry of Agriculture, Fisheries and Pood considered that the matter should receive publication. This was done in the December issue of "The Sanitarian". Insect Pest Control; The department has 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, spider beetles, biscuit beetles, woodworm and house flies. 36 A Surrey County Council property and a kindergarten school had some of their ceilings almost black with tiny flies and they were dealt with, not by insecticidal baits but by, of all things, a vacuum cleaner,. 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. Rodent Control - Statistical Statement, 196l. Local Authority Property Dwelling Houses Business & factory Premises Totals No. of properties inspected as a result of notification Nil 95 33 126 No. of properties inspected in the course of surveys 7 225 215 447 Totals 7 318 2 48 573 Premises infested Rats 6 76 86 168 Mice 1 30 134 165 Totals 7 106 220 333 Total inspections including reinspections 198 602 2,646 3,446 No. of "block'' or "vertical" control schemes 2 13 21 36 No. of poison baits deposited 128 236 1,446 1,810 37 SECTION D. HOUSING. During the year nine applications for Certificates of Disrepair under the Rent Act, 1957 were made, as compared with seven in 1960. With regard to statutory action under the provisions of the Housing Act, 1957, Demolition Orders were made in respect of Nos. l/3, Gibbon Road and a Closing Order in respect of the basement at No. 32, Alexandra Road. 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 52 2. Number of houses which, on inspection, were considered to be unfit for human habitation 2 (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 95 4. Number of representations made to the Local Authority with a view tos(a) the serving of notices requiring the execution of works 25 (b) the making of demolition or closing orders (number of houses involved) 3 5. Number of formal notices served requiring the execution of works 15 6. Number of houses which were rendered fit after the Service of formal notices 6 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 2 38 Housing - Statistical Statement, 1961. The following information is, supplied by the Borough Surveyor who indicates that twenty housing units were provided by the Corporation during the year. Total number of permanent dwellings erected by the Gorporation since March 1924 to 31st December. 1961. Houses and Bungalows 1,150 (lnc.876 outside Borough) Plats 940 (Inc.326 outside Borough) Total number of temporary dwellings erected up to 31st December, 196l. Still remaining Arcon 132 127 Aluminium 70 28 2-year huts 113 Nil 135 Number of dwellings erected by private enterprise during 19 6l. Houses. 16 Flats and Mai sone tt e s 34 50 39 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 types of licences in force during 1961 under the provisions of the Milk (Special Designations) Regulations 1960. The new Regulations prescribe that the licences shall cover a five-year period, and with the exception of one pasteuriser's licence, all are dealer's licences to sell prepacked milk. Type of Licence Number Pasteurised milk 10 Sterilised„ 4 Tuberculin Tested Milk 1 Pasteurised & Sterilised Milk 4 Pasteurised & Tuberculin Tested Milk 3 Pasteurised, Sterilised and Tuberculin Tested Milk 6 To Pasteurise 1 29 40 (c) Bacteriological Examination of Milk. During the year the following samples of milk were sent to the Public Health Laboratory at Epsom for examinations:- Type of Milk No. of Samples Pasteurised 48 T.T. Pasteurised 43 Sterilised 1 Tuberculin Tested 6 98 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 they were submitted. The sample of sterilised milk passed the turbidity test which is the appropriate one for this type of milk. (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 77 samples submitted to the Ministry of Health Public Health Laboratory at Epsom during 1961. 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. 41 Of the 77 samples taken, 44 were from the producers in the town and the remainder from the retailers. The results are considered to be most satisfactory and indicate a good standard of hygiene. GRADE I II III IV Total Ice Cream 71 2 3 1 77 (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 Weight lbs. lbs. Raw Meat. Bovine Decomposition 2,447 Ovine „ 354 Porcine „ 836 Total - Raw Meat 3,637 Raw Fish Decomposition 105 Poultry, Game, etc. „ 335 continued overleaf 42 Condemned Foodstuffs continued. Article of Food Reason for Action Weight lbs. lbs. Canned Goods. Heat & Meat Products 814 Fruit 2,133 Jam 23½ Vegetables Punctured 222 Milk Blown 22½ Soup Damaged or 34 Fish & Fish Paste Decomposition 142 Others 59½ 3,450½ Food in Glass Containers. Fish and Fish Paste Glass contamination, 2 Fruit Mould 89 Jam and Preserves Deterioration 9 100 Other Foods condemned for Various Reasons. Sausages 30 Meat 2 Cheese 80 Eggs 156 268 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. The normal routine inspection of food premises was carried on throughout the year. Generally speaking it was found that a very satisfactory standard of food hygiene was being maintained. In the few instances where slackness or structural defects were encountered, appropriate action was taken. The active co-operation of proprietors and managers is almost invariably given to the Public Health Inspectors who, on their part, seek to give assistance by advice and encouragement. 43 The modernisation and structural improvement of food premises is still being voluntarily undertaken by both large and small firms, in many cases prompted by the increased prepacking of foodstuffs and the continuing preference of the public for the self-service type of shop. New restaurants and cafes are opened from time to time and appear to flourish, indicating an unsatisfied demand for meals and snacks in the better class of establishment. The general public are undoubtedly becoming more receptive to exotic and unusual foods and to meet the demands which have been created there are now in the town a number of thriving Chinese and Indian restaurants. Specialised equipment for preparing oriental dishes is also being installed in other restaurants. 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„ 6 4 Fittings cleansed or repaired 3 3 Walls and ceilings cleansed 5 3 Lighting Provided 1 - Sinks Renewed or repaired, also draining boards 4 8 Washing Facilities for Staff. Absence of, defective, inadequate hand basins 4 3 Absence of hot water 3 6 „ „ cold water 2 3 Provision of towels, soap, nailbrushes 8 12 C/Fwd. 36 42 continued overleaf 44 Food Hygiene - Tabulated Statement Continued. PART IV. Defects requiring Notices Complied B/Fwd. 36 42 Repairs to Food Rooms. Walls and ceilings cleansed 3 2 Additional ventilation required 8 6 Protection of Food against Contamination. Food to be kept 18„ off ground - 1 Covers provided for food 1 3 Smoking 1 2 Others 6 1 Uncleanliness. Kitchens & Equipment 23 25 Food Stores 6 8 Preparation Rooms 1 - Delivery Vans 1 1 Refrigerators 1 2 Shops 1 3 Utensils. Unclean and/or replaced 2 2 Others 22 Total 121 120 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. Food Premises No. of Premises Visits Bakehouses and bakers' shops 25 25 Dairies and milk shops 25 32 Butchers 40 84 Greengrocers and fruiterers 89 41 Public houses (a) Providing restaurant services 17 7 (b) Not providing restaurant services 41 Fishmongers and stalls 16 35 Ice cream premises registered 172 102 Grocers and general provisions 132 211 Restaurants and cafes 69 313 Kitchens and canteens (including factory, school and shop) 35 Wholesale meat distribution depots 6 86 Visits to food premises re unsound food 159 Open Market, food stalls, barrows 703 667 1,798 45 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. Egg Mundels (Soup Noodles). The Public Analyst reported that the product had been incorrectly labelled. The Labelling of Food Order requires that the ingredients should be specified in the order of the proportion in which they are used. In this case eggs were specified before flour when there were 62 parts of flour to 47 parts of egg. The manufacturers have been approached in the matter and they state that in future the proportion of egg will be such that the Order will be complied with. Cake Mix. This sample was found to be infested by insects. Following an approach to the manufacturers the whole of the stock of this commodity was withdrawn from the shop. Canned Lunch Tongues. These proved to be pigs' tongues. The firm stated that this line has now been discontinued and if it is again imported the product will be correctly labelled. Canned Casserole Steak. It was reported that this sample contained 63% meat and that there was no evidence that it had ever been prepared 'en casserole'. The sample was of Australian origin and the observations of the Analyst were passed to the importers for their comments, Action is withheld pending report of the Food Standards Committee. Mixed Herbs and Stuffing. This was found to contain mixed herbs only and the suppliers have agreed to amend the label in accordance with the provisions of the Labelling of Food Order. Rhubarb in Syrup. The internal lacquering of this can had failed. Whilst the contents were not so affected as to be unfit for foods the storage life of the product was thereby limited. and the retailers agreed to withdraw the whole of their stock from sale. Bread Crumbs. This sample was incorrectly labelled - reference to colouring matter had been omitted. The suppliers agreed to amend the label in accordance with the provisions of the Labelling of Food Order. 46 Tabulated Statement of Samples Submitted to the Public Analyst during 1961. Commodity No. of Samples Genuine Not Genuine or otherwise irregular. Formal Informal Formal Informal Formal Informal Apricot Dumpling - 1 - 1 - - Beans, baked - 1 - 1 - - „ French dried - 1 - 1 - — Black pudding - 1 - 1 - - Bread Crumbs -- 1 - - - 1 Cake Mix - 1 - — - 1 Casserole steak (canned) - 1 - - - 1 Cheese - Parmesan - 1 - 1 - - Spread with mushrooms - 1 - 1 - - „ Sandwich biscuit - 1 - 1 - - Chicken fillets - 1 - 1 - - „ fritter® - 1 - 1 - - „ minced in jelly - 1 - 1 - - „ pasties - 1 - 1 - - Cold cure - 1 - 1 - - Corned beef loaf - 1 - 1 - - Cream - Danish - 1 - 1 - — Cornish pasties - 2 - 2 - - Cough Sweets - 1 - 1 - - Desiccated Coconut - 1 - 1 - - Dressed Crab - 2 - 2 - - Eclairs - milk chocolate - 1 - 1 - - Egg Mundels - 1 - - - 1 Flaked Rice - 1 - 1 - - Flavouring - almond - 1 - 1 - - „ lemon - 1 - 1 - - „ vanilds - 1 - 1 - - Frankfurter sausages in brine - 1 - 1 - - Ham - chopped - 1 - 1 - - Ham & Beef Roll - 1 - 1 - - C/Fwd. - 32 - 28 - 4 Continued overleaf 47 Food and Drugs Act - Samples continued. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. - 32 - 28 - 4 Hamburgers in meat sauce - 1 - 1 - - Herbs - mixed - 1 - - - 1 Horseradish Sauce - 1 - 1 - - Ice Cream - 1 - 1 - - Instant Whip - 1 - 1 - - Irish beef with gravy - 1 - 1 - - Jam - 2 - 2 - - Jelly fruit salad - 2 - 2 - - Liver sausage - 1 - 1 - - Lancashire Rarebit - 1 - 1 - - Lunch tongues (canned) - 1 - - - 1 Mace - Powdered - 1 - 1 - - Meat Paste - 1 - 1 - - Milk - 1 - 1 - - „ Block - 1 - 1 - - „ Evaporated - 1 - 1 - - Mustard - German prepared - 1 - 1 - — Onion Mix - 1 - 1 - - Parsley - 1 - 1 - - Pate' de Pole Truffe - 1 - 1 - - Peel - Candied - 1 - 1 - - Pork Brawn - 1 - 1 - - Prunes in Syrup - 1 - 1 - - Ravioli in Tomato Sauce - 1 - 1 - - Rhubarb in syrup - 2 - 1 - 1 Rice - ready cooked - 1 - 1 - — Sage & Onion Stuffing - 1 - 1 - — Sardines - 1 - 1 - - Savoury Minced Beef - 1 - 1 - - Shredded Beef Suet - 1 - 1 - - Soup - 7 - 7 - - Soup Seasoning - 1 - 1 - - Steak & Kidney Pie & Pudding - 3 - 3 - - Sweet red Peppers - 1 - 1 - - Turmeric - 1 - 1 - — Vanillin Sugar - 1 - 1 - - Westphalia Rye Slices - 1 - 1 - - Total - 80 - 73 - 7 48 Other Foods which were the subject of Complaint. Cooked ham thought to have been the cause of illness. It was ascertained that the ham was kept above refrigeration temperature and it was recommended that some form of cool display be provided at a temperature of about 40oF. The ham was not considered to be in such a condition as to cause illness. Rabbit alleged to have been sold for chicken at a restaurant. The bones submitted by the complainant were, in fact, from a chicken; no rabbit was found in the stock at the premises. The complaint was considered not to be justified. Chicken Pasty. This was alleged to have contained bacon. The pasty was submitted to the Public Analyst and reported to be genuine. Liver Sausage said to have contained mouse droppings. The foreign matter referred to was found to be congealed blood. Tinned Mushrooms and Rice alleged to have contained maggots. Upon examination no maggots were found; apparently the complainant had mistakenly assumed that the rice grains were, in fact, maggots. Leg of Lamb. An abscess was found in this joint when it had been carved. The matter was referred to an adjoining Borough where the joint was purchased. Chicken alleged to have been sold in unsound condition. This article was not seen in the department until at least two days after purchase. Upon being approached, the retailer agreed to replace the article. Chicken said to have been sold in unsound condition. This was found, upon examination, to be fit for consumption and in addition it was submitted to the Public Health Laboratory. A report was received that no food poisoning organisms were found in the chicken. Orange Drink contaminated with paraffin. The manufacturers were approached and it was learned that their attention had already been drawn to this matter. A thorough investigation had been carried out and it appeared that the consignment of oranges used in the production of the orange squash had been contaminated with diesel fuel on board ship. Yellow Cling Peaches containing an insect. The distributors stated that this was the first complaint they had received regarding the particular brand. The shippers had been approached and a letter was received from the canners in Cape Town stating that the matter was viewed in a very serious light and instructions had been issued to ensure that, as far as possible, a complaint would not arise in the future. 49 With regard to the remainder of the complaints concerning food, ten related to instances where foods were sold out of condition because they had been retained in stock too long. One cannot lay too much stress upon the need for care in proper stock rotation,, In the absence of legible coding by the manufacturers, there is no reason why retailers should not establish their own system of marking goods to ensure that they are sold in the order in which they are received, or withdrawn from stock when the shelf life of the product has expired. During the year there were four instances of insects in food and five cases of minor foreign bodies. Only one complaint referred to a dirty milk bottle. Whilst every case 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. Pood 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. 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 foodsmainly imported apples and tomatoes. Three warning notices were given, but it was not considered necessary to take any legal enforcement action. 50 SECTION F PREVALENCE 0F, AND CONTROL 0VER 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 Anthrax Leprosy is notifiable by General Medical Practitioners direct to the Chief Medical Officer of the Ministry of Health. In 1961 a total of 560 notifications of infectious disease was received, and these are analysed and commented upon in the following tables and reports. 51 NOTIFIABLE DISEASES DURING 196l. TABLE IV. CASES DEATHS Age Groups Age Groups Under 1 Year 1 - 2 2 - 3 3 - 4 4 - 5 5 - 10 10 - 15 15 - 20 20 - 35 35 - 45 45 - 65 65 & over Total cases notified Cases admitted to 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 St over 1 Total Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - 1 3 1 2 3 - - 1 - - - 11 2 - - - - - - - - - - - - - Measles 15 51 56 52 64 193 13 2 1 - - - 447 1 - - - - - 1 - - - - - - 1 Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis Paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Non-paralytic - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Infective Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - — - - - - - - - - - - - - Puerperal Pyrexia - - - - - - - 15 59 15 - - 89 89 - - - - - - - - - - - — - Dysentery 1 - 1 - - 1 - 2 1 1 - - 7 1 - - - - - - - - - — - - - Food Poisoning - - - - - 1 - 1 1 - 1 - 4 — - — - - - - - — - - - - - Pneumonia - - - - - — - - - - 1 1 2 - 2 1 - - - - - — - - 2 19 24 Erysipelas - - - - - - - - - - - - - - - - - - — - - - - - - - - Ophthalmia Neonatorum - - - - - - - - — - - - - - - - - - - - - - - - - - - Totals 16 52 60 53 66 198 13 20 63 16 2 1 560 93 2 1 - - - 1 - - - - 2 19 25 52 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) 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 - - - — — 1960 11 8 11 89 - - - - - 1961 11 447 - 89 - - - - - * Measles - Not notifiable until 1940. * Whooping Cough - Not notifiable until 1940. 53 Whooping Cough. No notifications of whooping cough were recorded during the year. This is the first time, since whooping cough was designated and recorded as a notifiable infectious disease in 1940, that no such notifications have been received. While we are encouraged by the continued low incidence of the disease since 1958, which is considered to be one of the most serious of childhood illnesses, this can only be due to immunisation procedure early in life when practically 100% of infants are immunised against whooping cough in conjunction with diphtheria and tetanus. The number of eases notified during the previous five years are given below. 1957 1958 1959 1960 1961 55 9 3 11 - Enteric Fever (Typhoid or Paratyphoid). There were no oases of typhoid or paratyphoid B notified in Kingston during 1961 and this is the fourteenth successive year without notification of enteric fever. Measles, There were 447 cases of measles notified during 1961 compared with 8 in 1960. All were of a mild type and nursed at home. (See also page iii). Ophthalmia Neonatorum. No cases of ophthalmia neonatorum occurred during 1961. Puerperal Pyrexia. The maternity block at Kingston Hospital serves Kingston and a large surrounding area embracing a population of some 285,000 persons. Curing 1961, 1,972 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. 54 During 1961, 89 cases were notified from Kingston Hospital, 24 of which referred to Kingston residents. These figures compare with 89 and 19 respectively for 1960. An analysis for the years back to 1957 is shown below. Cases 1957 1958 1959 1960 1961 (a) Total notified 59 60 72 89 89 (b) Number included in (a) of (i) Kingston residents 8 18 24 19 24 (ii) Extra district residents 51 42 48 70 65 (c) Number included in (a) notified from Kingston hospital 59 60 70 89 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 1961. A series of outbreaks occurred in several Midland towns including some suspected cases in London. This brings to the fore the importance of maintaining constant vigilance and in particular surveillance over persons arriving from abroad 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 accordance 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. Scarlet Fever. Eleven cases were notified during 1961, three of which were of school age. No serious eases 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. 55 Poliomyelitis. No cases of poliomyelitis were notified in Kingston during 196l. Outbreaks of the disease did, however, occur in some Northern towns during the latter part of the year and an innovation introduced to check these outbreaks was mass immunisation of the population by vaccination with Sabin vaccine, The vaccination can be given in syrup from a spoon or taken on a lump of sugar. Three doses are recommended, separated by an interval of four to six weeks. The vaccine can be given at any age from infancy to adult life. Sabin vaccine given by mouth not only provides protection but also prevents protected persons from harbouring natural dangerous poliomyelitis virus and spreading disease to unprotected persons. This type of vaccine is of great value during an epidemic because it works quickly. Oral vaccine is now being introduced for all routine vaccination against poliomyelitis in the area and is to be made available for the immunisation of persons eligible under approved local health authority arrangements, i.e. "priority groups" namely those over six months and under 40 years of age and certain others at special risk. The following small groups are also included:- 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. Dysentery (Sonne). A total of 7 cases of dysentery were notified during 1961 compared with 6 during 1960. 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. 56 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. 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 including 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 1961 in Kingston 14 eases were reported, 13 of which referred to the lungs. The same number of oases were reported for i960. 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 cases on the register receiving treatment and attention at the Chest Clinic. It is, therefore, necessary, to remember that breakdown and infectivity are continually possible in these eases. 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. Table of notified eases and deaths for 1952 - 1961 overleaf. 57 The following table shows comparative figures of notified cases and deaths for the years 1952 to 1961 (inclusive):- Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory piratory Total 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 1961 13 1 14 2 - 2 58 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 respectively 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. Considerable help is given to tuberculosis and other chest disease patients and their dependants by the Kingston & District Care Committee for Tuberculosis and Other Chest Diseases. During 1961, 80 families were helped in the form of grants for extra nourishment, clothing, fuel, removals, bedding, fares, pocketmoney, etc., and a total of £1,842 was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1961 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. 59 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1961. 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 3 1 3 — 2 - 10 - - - - - — - 1 1 2 F - - - - - 1 - 2 - 3 - - - - - - - - - - Total - - 1 3 1 4 - 4 - 13 - - - - - - - 1 1 2 (b) Non-respiratory M - - - - - - 1 - - 1 - - - - - - - - - - F - - - - - - - - - - - - - - - - - _ - - Total - - - - - - 1 - - 1 - - - - - - - - - - 60 RESPIRATORY TUBERCULOSIS