AC4413(1) Library 11 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES 1963 THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1964 KIN 37 1 THE HEALTH OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES 1963 THE ANNUAL REPORT of The Medical Officer of Health and the Chief Public Health Inspector PUBLIC HEALTH DEPARTMENT, GUILDHALL, KINGSTON-UPON-THAMES. JUNE, 1964 1 ANNUAL REPORT 1963 TABLS OF CONTENTS Page. Preface i ,ii ,iii,iv Population i Births i Deaths i Infant Mortality Rate- 1959/1963- Rate per 1,000 live births ii Causes of Death ii Infectious Disease iii Diphtheria iii Food Poisoning iii Housing and Rehousing iii Staff iv Constitution of Public Health Committee 1 Staff of Public Health Department 1 SECTION A Statistics and Social Conditions (1) General Statistics 2 (2) Social Conditions 2,3,4 (3) Extract from Vital Statistics of the Year 4 (a) Live Births 5 (b) Stillbirths 5 (c) Total Live 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 1959/1963 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 1 Page Table I- Extract from Vital Statistics for the years 1959/1963 9 Table II- Comparison of Vital Statistics 1934/l963 10 Table III- Causes of Death 11 SECTION B. General Provisions of Health Services (1) (i) Laboratory Facilities 12 (ii) Hospitalsr:- (a) Infectious Diseases 12 (b) Smallpox 12 (c) General 13 (2) Health Services Provided by other Authorities:- Surrey County Council- Health Department 13,14,15. Surrey County Council- Education Department 15 Surrey County Council- Welfare Department 16 Surrey County Council- Social & Geriatric Services 17 Surrey County Council- Children's Department 17 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 20,21 (6) Sanitary Inspection of the Area 21,22 (7) Shops 22 (8) Factories Act, 1937 22,23 (9) Camping Sites 23 (10) Atmospheric Pollution 24,25,26, 27,28,29, 30,31,32, 33,34 (11) Swimming Baths and Pools 35 (12J Eradication of Bed Bugs 35 (13) Complaints 35 (14) Rodent and Insect Pest Control 36,37 1 Page. SECTION D. Housing General 38 Statistical Statement, 1963 39 SECTION E. Inspection and Supervision of Food (a) Milk Supply 40 (b) Designated Milks 40 (c) Bacteriological Examination of Milk 40,41 (d) Ice Cream 41 (e) Meat and Other Poods 42,43 (f) Food Hygiene 43,44 Food Hygiene Regulations 1955 45 Food and Drugs Act, 1955 45 Tabulated Statement of Samples Submitted to the Public Analyst during 1963 46,47,48 Foods subject of complaint 48,49,50,51 Merchandise Marks Act, 1926 51 SECTION F. Infectious Diseases Notifiable Diseases 52 Table IV Notifiable Diseases during 1963 53 Table V Comparative Statement of Notifications of Certain Infectious Diseases 54 Whooping Cough 55 Enteric Fever (Typhoid or Paratyphoid) 55 Measles 55 Ophthalmia Neonatorum 55 Puerperal Pyrexia 56 Smallpox 56 Scarlet Fever 57 Poliomyelitis 57 Dysentery 57,58 Tuberculosis 58,59,60 Table VI & Graph- Notified cases and Deaths from Tuberculosis in 1963 61,62 1 (i) TELEPHONE NO: KIN&STON 2121. PUBLIC HEALTH DEPARTMENT, GUILDHALL, KIN&STON-UPON-THAMES. JUNE, 1964. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE ROYAL BOROUGH OF KINGSTON-UPON-THAMES. ANNUAL REPORT. 1963. 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 1963. As in previous years the report follows the general lines indicated by the Minister of Health, and is in accordance with Circular l/64o Population - The Registrar General's estimated mid 1963 home population figure is given as 36,050 (resident population figure - used for calculation of the statistical data in this report). 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 1963 is 664 and compares with 614 for 1962. The crude birth rate is 18.4 per 1,000 population compared with 17.0 for 1962. Deaths - The number of deaths recorded in 1963 is 479 compared with 463 for 1962. This makes a crude death rate of 13o3 as compared with 12.8 for 1962. The excess of births over deaths was 185 compared with 151 for the previous year. The number of infant deaths (under 1 year of age) in 1963 is 9 which gives an Infant Mortality rate per 1,000 live births of 13.o5. The corresponding figures for 1962 were 18 infant deaths and an Infant Mortality of 29.3o. The following table shows the rate for the five years 1959 to 1963. 1 (ii) INFANT MORTALITY RATE Total No. Deaths 1959 1960 1961 1962 1963 13 6 10 18 9 RATE PER 1,000 LIVE BIRTHS 23.0 10.4 15.06 29.3 13.5 No maternal deaths (i„e„ from pregnancy, childbirth, abortion) were recorded out of a total of 667 live and stillbirths. Causes of Death - Main conditions causing death during 1963 weres- 1963 1962 Heart Disease 152 143 Cancer 77 92 Vascular Lesions of the Nervous System 64 54 National attention has been drawn in recent years to the general increase in the number of deaths attributable to lung cancer and its possible association with cigarette smoking. 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. Deaths from cancer of the lung and bronohus 1959 I960 1961 1962 1963 Total Total Total Total Total 26 23 21 29 26 M F M F M F M F M F 23 2 20 3 19 2 24 5 20 6 1 (iii) Infectious Disease- The number of infectious disease notifications received in 1963 was 506 compared with 81 in 1962, a difference of 425 which is mainly accounted for by the notification of 385 more cases of measles than in 1962. Active protection of the child population against diphtheria, whooping cough, tetanus, smallpox, tuberculosis and poliomyelitis was continued at a good pace. Diphtheria- For the sixteenth year in succession no cases of diphtheria occurred in Kingston. Continued freedom from any illness creates a complacency in the minds of the people but this must be combated particularly in regard to diphtheria which is always likely to reappear, and will do so if protective immunisation of children is not kept up to a high level. Parents are constantly encouraged to take full advantage of the immunisation service provided, particularly the initial protection given in a child's first year of life. Intensive campaigns are also 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. Food Poisoning- It is pleasing to record that whilst there are so many restaurants, cafes and food shops in the town, no cases of food poisoning were reported which could be attributed to such premises. Twentynine cases of food poisoning were notified during the year and of these, two related to mild isolated cases, one to a patient who was admitted to hospital, and the remaining twentysix notifications were in respect of an outbreak which occurred in a hospital. I am pleased to report that the constant hard work of the inspectors on food handling is being rewarded by the maintenance by the proprietors of a high (standard of food hygiene in the town. Housing and Rehousing- We are glad to note the progress in new homes for the people by completed schemes and others commenced in 1963. There is still a constant need for further housing and particularly one would mention young people setting up for the first time. The old people also require further provision of specially designed dwellings where they can be assisted in case of emergency. An additional point on provision is that many old people are in under-occupied Corporation houses and if they could be provided with suitable accommodation and persuaded to move, accommodation would quickly become available for others. 1 (iv) Staff- Details of the staff of the Public Health Department are set out on Page 1. I am indebted to Mr. G.C. Smith, Chief Public Health Inspector, with special reference to Sections C- E, for assistance in compiling the report. At the time of going to press, I have just been appointed Medical Officer of Health for the new Royal Borough of Kingston upon Thames, I would like to record here my grateful thanks to all loyal supporters over many years of efforts to promote the health of the burgesses, and my thanks too for the opportunity to help in the organising and direction of the more comprehensive health services of the new Borough. I record also my thanks for the support and encouragement I have received in my present 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. 1 1 ROYAL BOROUGH OF KINGSTON-UPON-THAMES PUBLIC HEALTH DEPARTMENT Public Health Committee for the Municipal Year 1963/64. Councillor Parrish (Chairman) Councillor Eades Alderman Knowlden (Vice-Chairman) " Pringle Councillor Marshall (Mayor) " Mrs. Thomas Miss Tapping (Deputy Mayor) " Mace Alderman McDonald " Hollins Miss Alexander " Donald Councillor Mrs. Cope STAFF OF THE PUBLIC HEALTH DEPARTMENT AS AT 51st DECEMBER. 1963. Medical Officer of Health: J.W. STARKEY, M,B., Ch.B. (Edin.), D.P.H. Deputy Medical Officer of Health: 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 Publio Health Inspectors: S.W. SIMPSON-SCOTT, M.A.P.H.I. (a)(b) K. APPLETON, A.R.S.H M.A.P.H.I. (a)(b) Pupil Public Health Inspector: A„R. WEST (appointed 2.9,63). Chief Administrative Assistant: M. FRANKELL, D.M.A., A.C.C.S., L.M.R.S.H. Technical Officer- Smoke Control Areas: W,A HUCKIN. Clerical Staff: MISS C.L. FOISTER. MISS M.W. FILBEE. I.D. REID. A. HEDGES (resigned 22.9.63). MISS E. HANCOCK (appointed 23.9.63). Pest Control Officer: F.W. STAGG, A.R.I.P.H.H. Rodent Operatives and General Assistants: G.H. LOCKE. F.J. PERRY. (a) Certificate as Public Health Inspector. (b) Certificate as Meat and Other Foods Inspector. 1 2 SECTION A. STATISTICS AND SOCIAL CONDITIONS 1. General Statistics. Area in Acres 1,408 Toted Population (including Service personnel) 36,050 Number of inhabited houses (approx.) 11,728 Rateable Value- General Rate (1,4.63) £3,398,518 Sum represented by Penny Rate (year 1963/64) £13,800 Total number of hereditaments 14,932 Domestic Dwellings 78% of total hereditaments Commercial Dwellings 19% of total hereditaments Number of premises classified as industrial, entertainment, public utility, educational and miscellaneous 418 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, Mr, G.A. Gout, has kindly provided the following information regarding employment in Kingston and District:- "1963 began with heavier than usual unemployment in the Kingston Employment Exchange area although it represented but 1% of the working population in that area, and at no time during the year did it approach the national average. At the beginning of the year the minor recession in trade, mentioned in my last year's report, continued. This was reflected in. the fewer outstanding vacancies in the early part of the year- the lowest recorded for many years- and in a worsening of opportunities for placing people in employment. 1 3 The rise in the unemployed registers was, of course, exacerbated by the acute wintry weather and at the end of January there were 1,290 adults unemployed in the Employment Exchange area, the highest level since the end of the war (apart from the time of the fuel crisis in February, 1947, which was only of a few weeks duration). These very high registers were maintained almost until the middle of March when the weather began to improve and the building trade workers, who at the peak period comprised 40% of the numbers unemployed, were able to return to work. From Easter onwards, however, there was a noticeable improvement in the situation with a stepping up of labour demands for both men and women. By the end of the year there were as many vacancies available in the area for women as for men, and sometimes more. It was pleasing to note this still continuing improvement in the employment situation at the end of the year when the total unfilled demands for labour were higher than in September and much higher than at the end of 1962. The shortage of female labour was acute, particularly for the many outstanding factory vacancies, and it became a cause of serious concern to many local employers, Some factories resorted to evening shifts for women. It was not until October, 1963, however, that the number of unemployed finally fell below the comparable figures of 1962, and from then until the end of the year, contrary to the normal trend, the figures remained steady and were about the same as in the summer. At the end of December, 1962, there were 705 men and 129 women unemployed, but by the end of 1963 these totals had fallen to 509 and 88 respectively. The industries in the Borough are diverse, the main ones being aircraft manufacture, motor engineering, building, printing, plastic moulding, beer and wine bottling, paint and cellulose manufacture, retail distribution, and national and local Government, The number of engagements of labour through the Exchange were 286 fewer than in the previous year largely because of the fewer vacancies prevailing in the early part of the year for reasons stated earlier in this report. By the end of the year, however, there were more than twice as many notified outstanding vacancies for men as there were at the same time in 1962, There was a considerable increase in the demands for women as well. During 1963 the Exchange placed 3,052 men in local work and 134 in work in other areas, 971 women were found work locally and 34 in other areas. Of those placed 194 men and 33 women were disabled. The number of ex-Regular service men (other ranks) who sought help in their resettlement into civilian employment in 1963 was 52, Of these 19 were placed in employment and 5 accepted for courses of vocational training to fit them for specific occupations in civilian life. 1 k There was no short-time working in the Borough during the year, neither were there any trade disputes. Some redundancies occurred- not on a large scale and mainly where firms closed down completely or left the area. Arrangements were generally made to see the workers before final discharge in order to make efforts to find alternative jobs before expiry of notice. Recruitment of workers has continued from N.E. England and other parts of the country and allowances towards lodgings and/ or final removal have been granted under the Department's Resettlement Schemes. Conversely about 25 key workers employed by a large Maiden firm, some of whom lived in Kingston, have also been assisted by the Ministry to move their households to the Isle of Wight to train local labour at the Company's new factory. Others will go in the early part of 1964. In the local aircraft industry the labour force was comfortably held with a combination of different types of production work. Towards the end of the year there were increased demands for technical staff to cope with the expected orders for the P.1154 whose future unfortunately was in doubt at the turn of the year. The general feeling of all employers at the end of the year was one of cautious optimism. Relating the numbers of unemployed to the local working population, I think it is true to say that the area was virtually one of full employment at the end of 1963. There is always some labour turnover and much of it is of the workers´ own doing, but it should not be forgotten that about 2 out of 5 unemployed men were over 60 years of age, and the same proportion of women over 50. The problems this brings are well known and constant approaches are made to employers on behalf of the elderly worker. It is relevant to note that the 1961 census figures published in 1963 show that Surrey has more old people than most other counties of England and Wales and the proportion is beginning to grow". 3. Extract 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 1.00; Deaths 0.89. 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 (a) Live Births - Legitimate Male Female Total 1963 Total 1962 310 304 614 (564) Illegitimate 26 24 50 ( 50) 336 328 664 (614) Live Birth Rate per 1,000 population 18.4 (17.0) Adjusted Birth Rate 18.4 (17.0) England and Wales Live Birth Rate 18.2 (18.0) Illegitimate Live Births per cent of total Live Births 7.5 ( 8.8) Male Female Total 1963 Total 1962 (b) Stillbirths - Legitimate 1 1 2 ( 6) Illegitimate - 1 1 ( 2) 1 2 3 ( 8) Rate per 1,000 total Live and Stillbirths 4.5 (13.0) England and Wales Stillbirths Rate 17.3 (18.1) Male Female Total 1963 Total 1962 (c) Total Live and Stillbirths - Legitimate 311 305 616 (570) Illegitimate 26 25 51 ( 52) 337 330 667 (622) Male Female Total 1963 Total 1962 (d) Deaths - 222 257 479 (463) (i) Death Rate per 1,000 population 13.3 (12.8) Adjusted Death Rate 11.8 (11.3) England and Wales Death Rate 12.2 (11.9) * (ii) Infant Deaths - Total No„ of Deaths 9 ( 18) Infant Mortality Rate per 1,000 Live Births 13.5 (29.3) Infant Mortality Rate per 1,000 Live Births - Legitimate 10.5 (22.8) Illegitimate 3.0 ( 6.5) Infant Mortality Rate for England and Wales 20.9 (21.4) ** Neo Natal Mortality Rate per 1,000 Live Births 10.5 (21.1) (iii) Maternal Deaths (including abortion) total Nil Nil (e)Maternal 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 1963 and the rates sine 1959 are shown for purposes of comparison. 1959 I960 1961 1962 1963 Kingston-upon-Thames 23 10 16 29 13 England and Wales 22 22 21 21 20 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 - I960 17 The following table gives the numbers in age groups of Kingstonupon-Thames infants who died during 1963 before reaching the age of one year, together with the cause of death. It will be noted that of the 9 deaths, 4 occurred within 24 hours of birth and another 3 within 1 month. 7 INFANT DEATHS AGE TOTAL Prematurity Laryngeal hypoplasia Respiratory failure Haemorrhagic disease of newborn Hydrocephalus Asphyxia Cerebral Oedema 0-24 Hours 4 2 1 1 - - - - 24 Hours - 1 Mth. 3 1 - - 1 1 - - 1 Month - 1 Yr. 2 - - - - - 1 1 Totals 9 3 1 1 1 1 1 1 e (iv) DEATHS FROM OTHER CAUSES IN I963. NO. OF DEATHS. Heart Disease 152 Cancer 77 Vascular Lesions of the Nervous System 64 Circulatory Disease other than Heart 31 Bronchitis 16 Pneumonia 35 Influenza 3 The following Tables I, II, III summarise certain vital statistics. Table I shows the figures for live births, stillbirths, and deaths for the years 1959 - 19&3 inclusive. The figures in Table II are the Registrar General's estimates for successive years since 1934. 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. 6 EXTRACT FROM VITAL STATISTICS FOR YEARS 1959-1963 INCLUSIVE. TABLE I LIVE BIRTHS 1959 I960 1961 1962 1963 Total M. F. Total M. F . Total M. F. Total. M. F. Total M. F. Legitimate 536 273 263 545 269 276 596 286 310 564 272 292 614 310 304 Illegitimate 28 17 11 33 21 12 43 26 17 50 25 25 50 26 24 564 290 274 578 290 288 639 312 327 614 297 317 664 336 328 Birth rate(R„G„) per 1,000 pop. 14.5 15.1 17.1 17.0 18.4 STILLBIRTHS Legitimate 4 1 3 7 3 4 10 6 4 6 2 4 2 1 1 Illegitimate — — — 1 1 — — — — 2 — 2 1 — 1 4 1 3 8 4 4 10 6 4 8 2 6 3 1 2 Rate per 1,000 (live and stillbirths) 6.1 13.5 15.6 13.0 4.5 DEATHS 416 200 216 432 223 209 462 243 219 463 237 226 479 222 257 Death rate(R.G.) per 1,000 pop. 10.8 11.2 12.8 12.8 13.3 10 COMPARISON OF VITAL STATISTICS 1934 - 1963. 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 1934 38270 470 12.3 422 11.0 45 59 1935 39030 510 13.0 482 12.3 57 57 1936 39880 573 14.4 502 12.6 52 59 1937 39850 539 13.5 540 13.6 52 58 1938 39790 528 13.2 468 11.8 43 53 1939 39970 533 13.3 450 11.4 28 50 1940 37430 519 13.9 659 17.6 55 55 1941 35970 520 14.5 525 14.6 57 59 1942 36090 551 15.3 491 13.6 63 49 1943 35900 637 17.8 500 13.9 48 49 1944 34780 578 16.6 474 13.6 48 46 1945 35760 593 16.6 505 14.1 43 46 1946 39670 794 20.0 460 11.6 29 43 1947 40780 870 21.3 495 12.1 22 41 1948 40780 722 17.7 455 11.2 23 34 1949 40660 729 17.9 500 12.3 20 32 1950 4L950 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 13o9 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 23 22 I960 38630 578 15.1 432 11.2 10 22 1961 35990 639 17.1 462 12.8 16 21 1962 35990 614 17.0 463 12.8 29 21 1963 36050 664 18.4 479 13.3 13 20 11 CAUSES OF DEATH - REGISTRAR GENERAL'S TABLES, TABLE III. 1959 1960 1961 1962 1963 M F M F M F M F M F All Causes 200 216 223 209 248 223 237 226 222 257 Tuberculosis, respiratory 1 2 3 - 2 - 1 1 3 1 Tuberculosis, other - - - - - - - - - 1 Syphilitic disease 1 1 - - 1 - - - - - Diphtheeeria - - - - - - - - - - Whooping Cough - - - - - - - - - - Meningococcal Infections - 1 - - - - - - - - Acute Poliomyelitis - - - - - - - - - - Measles - - - - - 1 - - - - Other infective and parasitic diseases - 1 - - - - - - 2 - Malignant neoplasm stomach 2 11 4 1 7 10 4 1 5 1 Malignant neoplasm, lung,bronchus 23 3 20 3 19 2 24 5 20 6 Malignant neoplasm, uterus - 1 - 1 - 4 - 7 - 1 Malignant neoplasm, breast - 11 - 11 - 12 - 9 - 3 Other malignant and lymphatic neoplasms. 29 19 30 28 32 26 23 19 22 19 Leukaemiap aleukaemia 1 2 1 1 - 2 2 - 3 4 Diabetes 1 2 1 - 2 1 - 2 - 5 Vascular lesions of the nervous system 22 32 21 32 24 31 24 30 22 42 Coronary disease, angina 35 21 51 38 60 32 47 38 52 35 Hypertension with heart disease 1 10 5 4 7 4 3 5 6 9 Other heart disease 12 26 20 27 9 21 22 28 15 35 Other circulatory disease 9 9 11 14 13 20 13 13 10 21 Influenza 6 6 - - 1 3 1 6 1 2 Pneumonia 9 17 14 13 11 13 17 15 10 25 Brinchitis 14 6 14 2 20 9 18 9 10 6 Other diseases of respiratory system 2 1 - - 8 - 1 - 2 1 Ulcer of stomach and duodenum Gastritis, enteritis, and diarrhoea 4 1 1 2 2 3 2 3 1 4 1 2 5 2 2 1 Nephritis and nephrosis 1 3 1 1 2 - - - - 2 Hyperplasia of prostata 2 - 2 - 1 - 2 - 2 - Pregnancy, childbirth, abortion - - - - - - - - - - Congenital malformations 1 1 - 2 2 2 2 1 2 5 Other defined and ill-defined diseases 12 23 10 21 15 20 15 25 17 22 Motor vehicle accidents 4 1 5 3 2 2 6 3 4 1 All other accidents 5 4 4 2 3 3 4 1 4 5 Suicide 3 1 3 3 2 1 4 5 3 2 12 SECTION B, GENERAL PROVISIONS OF' HEALTH SERVICES 1. (1) Laboratory Facilities. Bacteriological examinations are carried out by Dr. D„S„ Murray at the Laboratory, 37, Coombe Road, Kingston, 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 and other foods for bacteriological examination 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.1. (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, Sixtyfive cases of infectious disease were treated in hospital during the year, but 62 of these had already been notified from Kingston Hospital„ Puerperal pyrexia accounted for 36 and an outbreak of food poisoning in the hospital was responsible for the remaining 26„ To Kingston Hospital 62 "Tolworth" 3 (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 out-patient 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, Surrey County Council - Health Department. The County Council is tbe Local Health Authority under the National Health Service Act, 1946, and provides the following services in the Borough: - (a) Ante-natal and Post-natal Clinics. Health Centre, Grange Road. Wednesday afternoon. (b) Infant Welfare Clinics. Health Centre. (Kingston 726l). Tuesday and Friday afternoons. Acre Road Clinic, 204, Acre Road. (Kingston 5812). Monday and Thursday afternoons. (c) Dental Clinics. Health Centre. Tuesdays, Wednesdays and Thursdays. Acre Road Clinic. Daily by appointment, (except Saturday) (d) Immunisation and Vaccination Clinics. Health Centre. Thursday forenoon. Acre Road Clinic. Friday forenoon. 14 (e) Day Nursery- 53-55, Canbury Park Road„ Approved accommodation 46 places. This day nursery admits children aged 0-5 years and a small charge is made for the care of the children, (f) Midwifery Service, Certified midwifes 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, Penrhyn Road, Kingston-upon-Thames, (Kingston 5072). (h) Health Visitors, Health Visitors also act as sehool 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-Cars, The eare and after-care of tuberculous persons is dealt with by the Care Almoner at the Chest Clinic, Out-Patients' Department, Kingston Hospital, Wolrerton Avenue, Kingston-upon-Thames, Among other things, the County Council scheme provides for the admission of persons, not in need of medical or nursing care, to recuperative holiday homes and for this a charge is made according to the persons' circumstances. 15 (k) Mental Health, Under the Mental Health Act, 1959, Local Health Authorities are required to provide the following services concerning the after-care of patients discharged from mental hospitals?- 10 Residential accommodation,, 2„ Occupational and/or Training Centres, 3o Mental Welfare Officers, 4o GuardianshipSo 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. Treatment Clinics, (i) Minor Ailments, Health Centre, Monday forenoon, Tuesdays to Fridays 9 - 10 a„m. Acre Road Clinic, Friday forenoon. (ii) Medical Consultation, Health Centre, Monday forenoon. Acre Road Clinic, Friday forenoon. (iii) Eye Clinic, Acre Road Clinic, Tuesday forenoon. 16 fiv} 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. Monday afternoons. Acre Road Clinic. Monday forenoons and Thursdays. Welfare Department. This service is concerned with the welfare ofs- 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, the Surrey County Council implement 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 follows;- 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. 324.)6 17 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, 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 domieilliary and advisory services. The County Council also makes grants to voluntary organisations towards initial expenses of buying and equipping properties. 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, Kingston-upon-Thames. 18 Surrey Executive Council. This body is responsible for the provision under the National Health Service Act, 194-6, 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 5722). 19 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 cases 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. 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. During the year 23 samples from this source were submitted for examination; all were reported to be satisfactory, 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 and successfully provides very effective purification and disposal for the sewage of Epsom & Ewell, Surbiton, Maiden & Coombe and Kingston-upon-Thames population. 3, RIVERS AND STREAMS. The River Thames forms the Western Boundary of the Borough and is under the control of the Thames Conservancy Board, The Hogsmill River, a tributary of the Thames, flows through the Borough, A considerable portion of the flow of this river comprises the effluent from the 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. 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. 21 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 13,660 tons of refuse were sent from this Borough in 1963. 6. SANITARY INSPECTION OF THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors which totalled 10,789 as compared with 9,204 for 1962. House inspections, defects, etc 519 Drainage 922 Factories Outworkers 21 Atmospheric Pollution 325 Dairies, milk shops, etc 183 Food Premises 1090 Restaurants and cafes 431 Infectious disease enquiries 129 Cinemas 1 Verminous premises 29 Rodent Control 52 Shops Act 328 Schools 11 Housing Act 82 Markets 815 Public Sanitary Conveniences 102 Fireguards 66 Merchandise Marks Act 266 Interviews 468 Mi scellaneous 1104 Smoke Control Inspections 1132 Smoke Control. Revisits 740 N01se Complaint V1sits 121 9092 Reinspections and works in progress l697 10,789 Disused Drains. Section 19 of the Public Health Act, 1961 requires demolition contractors or other persons responsible to seal off drains which become disused or unnecessary as a result of drainage or demolition works. During the year it was necessary to trace and supervise the sealing of 23 drains consequent upon the demolition of buildings. It is important to ensure that the requirements of this Section of the Act are properly observed in order to avoid future trouble from rat infestations and other nuisances. 22 NOTICES SERVED. Informal. (a) Verbal 105 (b) Written 239 Statutory. (a) Housing Acts 8 (b) Public Health Acts 21 (c) Clean Air Act 1 NOTICES COMPLIED WITH. Informal o (a) Verbal (b) Written 318 Statutory. (a) Housing Acts 5 (b) Public Health Acts 21 (c) Clean Air Act 7 7. SHOPS. There are some 891 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. 1961. 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 Farts I and VIII of the Factories Act. ' 23 PART I OP THE ACT 1, INSPECTIONS. Premises No. on Register Number of Inspections Written Notices Prosecutions Factories in which Sec. 1, 21,3,4 & 6 are enforced by the Corporation 32 4 - - Factories not included above in which Sec. 7 is enforced by the Corporation 266 140 - 09 Other premises excluding outworkers 12 11 - 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 Making of wire brushes and pot scourers 6 Wearing apparel - making etc. 4 Lampshades 1 9. CAMPING- SITES„ There are no camping sites within the Borough. 24 10. ATMOSPHERIC POLLUTION. Clean Air Act. 1956 - Smoke Control Areas. Smoke Control Order No. 3 became operative on the 1st Octobers, 1963 covering an area of approximately 135 acres bounded by Cambridge Road, London Road, Kingston Hill and the Municipal Boundary with Maiden & Coombe. The number of premises affected is as follows - Domestic 1,271 Commercial 110 Industrial 2 Other 7 In December, the Minister of Housing and Local Government confirmed the making of the No. k Smoke Control Order, the operative date being October 1st, 1964, covering an area of approximately 141 acres bounded by Portsmouth Road, The Bittoms, Grove Crescent, Grove Lane, Lingfield Avenue and Uxbridge Road. The number of premises affected is as follows - Domestic 1,151 Commercial 71 Industrial 3 Other 24 During the year survey work was started in Area No. 5 which covers approximately 142 acres and includes over 1,130 dwellings and commercial premises in the south west part of the town. This will extend from Areas 1, 2 and 4 via Bonner Hill Road to the Municipal Boundary with Maiden & Coombe. By the end of the year the area covered by Smoke Control Orders made or confirmed, comprised some 437 of the Borough's 1,408 acres. To some who may be impatient at what may appear to be a slow rate of progress, it must be explained that this is dependent upon the production of approved appliances and the availability of labour for fixing, bearing in mind that the neighbouring boroughs also are proceeding with similar smoke control programmes. Much depends upon the assured adequate supply of alternative smokeless fuels particularly in view of the demands which vary as the changing trends in domestic heating make themselves apparent. At the present time there is a marked preference for gas room heaters and the sales of these appliances have increased remarkably during the last year. More recently there has been a similar interest in openable stoves which will burn coke satisfactorily and are capable of providing a limited amount of central heating. 25 Smoke Nuisance. Thirty-four complaints were received in respect of smoke nuisance, seventeen 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 a complete disregard of the rights and feelings of others who are subjected to considerable annoyance from smoke, disagreeable fumes and ash. Much nuisance would be avoided if soft rubbish such as lawn mowings could be composted. As the soil in the area is mainly light, the addition of humus would help to enrich it. Tree trimmings and woody stems should be laid on a wire mesh rack and when dried, this material will burn quickly with a minimum of smoke. Six premises were the subject of twelve complaints. One of these was Kingston Hospital where from time to time soot emission is excessive. The difficulty here lies in the inherent obsolete layout of the plant and the means whereby the boilers are connected to the chimney. This was designed and constructed for the use of natural draught with solid fuel boilers at relatively low efficiency. The replacement of the present installation by a new boiler house is the answer to the problem. It is hoped that this work, which has been delayed on a number of occasions, will soon be commenced. The chimneys of two laundries and a garage heating plant also gave cause for complaint of excessive soot emission. In the former cases it was a matter of maintenance and adjustment of the oil burning equipment, and in the latter case it is hoped to replace the present rather primitive form of heating with something more efficient. The other premises concerned were a car breaker's yard where certain of the unsalvable material was being disposed of by burning, and the bonfires lit by the contractors upon the demolition of the Tannery Buildings, These fires were the cause of much unnecessary atmospheric pollution, and it is to be deplored that adequate legal sanctions are not available to effectively control this type of nuisance. The five remaining complaints were domestic in character, and advice was given in these cases. Chimney Heights, In May the long awaited memorandum on chimney heights was published by the Ministry of Housing and Local Government, This gives guidance to Local Authorities when considering plans of certain buildings which include proposals for new chimneys. The method recommended in the memorandum is based on the expected sulphur dioxide emission calculated by reference to the maximum load on the proposed boilers and the sulphur content of the fuel to be used. Charts are provided by means of which, first an uncorrected and then a corrected height is obtained, the result depending on the type of district 26 and the height and length of the building to which the chimney is attached. The height so obtained is intended as a guide rather than a mathematically precise answer. It needs to be interpreted in the light of other factors such as ground contours and the height and disposition of any neighbouring tall buildings. Section 10 of the Clean Air Act, which gives Local Authorities power to reject the plans if the chimneys are not sufficiently high, unfortunately expressly excludes from its application, residences, shops and offices. This omission is particularly important in this Borough where factory chimneys are rarely constructed but new blocks of shops and offices are very common. Central heating boilers in such blocks are often oilfired, with chimneys terminating a few inches above a flat roof. Sulphur dioxide emissions in such circumstances are likely to give rise to nuisances in upper storeys of the building and in nearby buildings due to "down-wash" of fumes caused by air currents flowing over the top and down the sides of the building. In order to safeguard the health of office workers and other occupants of tall buildings, this problem will need to be given careful attention, particularly in view of the imminent redevelopment of the town centre. Architects should seriously consider how the standards laid down in the memorandum oan be achieved. In view of the likelihood of heights above roof line of twenty feet and more being required, the design of the chimney must obviously be considered at an early stage. It is without question that health must always take precedence over visual amenity, but it is hoped that architects will accept the challenge and design chimneys which are acceptable in appearance. Recording of Atmospheric Pollution. Instruments are maintained on the Guildhall roof and at Tiffin Girls® School 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 tables and graphs indicate the results obtained. Starke and sulphur dioxide are expressed in mierogranes per cubic metre. 27 Results obtained from the Volumetric Instrument at the Guildhall. Month Stooke S02 Monthly Average Highest Value Lowest Value Monthly Average Highest Value Lowest Value January 207 1061 76 366 1442 228 February 154 243 95 317 488 164 March 82 284 15 133 513 36 April 42 124 12 139 449 41 May 22 67 3 65 259 24 June (26 days) 17 50 3 71 239 24 July 14 42 2 52 159 18 August (28 days) 12 31 4 37 147 12 September 35 66 7 73 155 18 October 43 168 6 74 208 24 November 94 656 2 95 440 16 December 212 496 12 319 604 42 28 Smoke and Sulphur Dloaxide , 1963. Results obtained from the Volumetric Instrument at guildhall. 29 Tiffin Girls' School, This instrument, durine term time- is operated by the pupils. The co-operation of the Headmistress„ the staff and pupils in this work is greatly appreciated. The following are the results obtaineds- Month Smoke S02 Monthly Average Highe st Value Lowest Value Monthly Average Highest Value Lowest Value January 209 604 68 333 773 119 February 165 332 73 259 459 69 March 79 86 16 119 150 19 April 55 155 19 116 455 26 Kay 25 65 6 70 241 12 June 21 61 3 65 275 14 July 16 37 2 58 115 22 August 15 38 4 41 195 16 September 45 231 13 81 187 31 October 58 172 12 93 202 46 November 110 636 3 124 420 37 December 207 398 24 301 622 57 30 Smoke and Sulphur Dioxide, 1965. Re suits a obtained from the Volumetric Instrument at Tiffin Girls' School, 31 In addition to the instruments 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. They are, for the purposes of report, referred to as and 'B‛Aۥ respectively. 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. CANBURY GARDENS - Station ‛Aۥ. 1963 Deposit in Tons per sq. mile Wind Direction Rainfall in Inches Insoluble Solids Soluble Solids Total Solids No. of Observations Wo. of times S.E. —S .W . January 5.05 7.10 12.15 23 3 0.75 February 5.21 3.52 8.73 20 7 0.28 March 27.08 6.77 33.85 20 13 2.28 April 13.08 5.99 19.07 21 11 2.32 May 9.89 2.81 12.70 23 13 1.81 June 14.05 17.27 31.32 19 13 1.06 July 10.13 4.94 15.07 23 17 1.10 August 11.69 4.74 16.43 21 12 3.03 September 10.78 2.91 13.69 21 13 1.73 October 21.26 14.22 35. 48 23 13 1.42 November 5.59 7.58 13.17 21 14 3.46 December 9.92 5.22 15.14 20 5 0.75 Totals 143.73 83.07 226.80 19.99 Average 1963 11.98 6.92 18.90 1.66 Average 1962 13.01 7.62 20.63 1.83 32 TIFFIN GIRLS' SCHOOL - Station ‛Bۥ. 1963 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 5.16 7.24 12.40 23 3 0.63 February 2.92 2.92 5.84 20 7 0.16 larch 9.43 8.07 17.50 20 13 2.64 April 5.74 6.64 12.38 21 11 2.25 May 2.02 2.82 4.84 23 13 1.65 June 4.25 3.32 7.57 19 15 1.02 July 2.95 2.72 5.67 23 17 1.06 August 3.12 4.90 8.02 21 12 2.92 September 4.65 2.79 7.44 21 13 1.77 October 3.85 2.79 6 .64 23 13 1.54 November 11,68 5.84 17.52 21 14 3.73 December 5.64 4.85 10.49 20 5 0.71 Totals 61.41 54.90 116.31 20.08 Average 1963 5.32 4.57 9.69 1.67 Average 1962 6.40 5.73 12.13 1.74 33 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 Canbury Gardens Station B Tiffin Girls' School Total Solids Insoluble Solids Total Solids Insoluble Solids 1949 20.41 12.04 ■ a 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 1959 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(11/12) 20.03(11/12) 12.69(11/12) 6.79 (11/12) 1962 20.63 13.01 12.13 6.40 1963 18.90 11.97 9.69 5.11 34 35 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 BSD BUGS. During the year thirteen premises were disinfested. Four 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 588 compared with 364 for the previous year. The following is a brief list of causes for complaints received during 1963r- Accumulations 33 Animals 5 Ashbins 3 Dampness 17 Drains & Sanitary Arrangements 177 Foods 31 General Housing Arrangements 62 Insects and pests 28 offensive odours 28 Noise 16 Rodents 108 Smoke 34 Water 25 Others 21 588 36 14. RODENT AND INSECT PEST CONTROL. During the year under review, the volume and character of the work has been similar to that of previous years. Householders still provide harbourage for rodents in their gardens by hoarding old furniture, perambulators and other rubbish. The Corporation have provided a free service for the collection of domestic rubbish, including perambulators, mattresses and unwanted furniture, provided reasonable notice is given and the accumulation is not excessive. It would appear that ratepayers do not take sufficient advantage of this service. Thirty-six vertical block control schemes were carried out, together with four treatments of sewer control. Ten defects of sewers and drains were found which had been the cause of rat infestation. Rodent control in sewers is now carried out more economically by treating more frequently known areas of persistent infestation in the system. The percentage method previously used has, by experience, been proved to be unnecessary. The pest control service provided on a contract basis to the industrial and commercial interests in the town is appreciated and an efficient and readily available control has been maintained. The Authority's service is held in esteem by the officers of the Ministry of Agriculture, Fisheries and Food. During the year instructions and demonstrations were given to 74 colonial students and field officers. We on our part readily acknowledge the co-operation of the officers of the Ministry, particularly with regard to identification of unusual inserts. 37 Rodent Control - Statistical Statement 1963. Local Authority Property Dwelling: Houses Business & factory premises Totals No, of properties inspected as a result of notification - 92 16 108 No, of properties inspected in the course of surveys 8 153 141 302 Totals 8 245 157 410 Premises infested Rats 5 68 29 102 Mice 1 30 57 88 Totals 6 98 86 190 Total inspections including reinspections 128 534 2,132 2,794 No, of 'block' or 'vertical' control schemes 1 13 22 36 No, of poison baits deposited 117 291 9522 1,360 38 SECTION D. HOUSING. During the year five applications for Certificates of Disrepair under the Rent Act, 1957 were made, as compared with one in 1962. A Clearance Order was made in respect of Nos. 22/50 (even) Canbury Fassage, and Closing Orders were made on Nos. 9 and 11, St. Peter's Road, two basement rooms and two lean-to structures at No. 36, Lower Ham Road and the basement flat of No. 15, Gloucester Road. No. 49, Eden Street and Nos. l/7, Union Street were demolished during the year in compliance with Orders previously made. 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 81 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 4 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 136 4. Number of representations made to the Local Authority with a view to:- (a) The serving of notices requiring the execution of works 43 (b) The making of demolition or closing orders (Number of houses involved) 6 5. Number of formal notices served requiring the execution of works 21 6. Number of houses which were rendered fit after the service of formal notices 25 7. Number of demolition or closing orders made 5 (involving 19 premises) 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 7 39 Housing - Statistical Statement„ 1963. Total number of permanent dwellings erected by the Corporation since March 1924 to 31st Decembe. 1963. Houses and Bungalows (including 930 outside Borough) 1167 Flats (including 372 outside Borough) 972 Bed-sitting room Units of Accommodation for Old People 57 Total number of temporary dwellings erected up to 31st December. 1963. Still remaining Arc on 132 127 Aluminium 70 25 2-year Huts 113 Nil 315 152 Number of dwellings erected by private enterprise during 1963. Houses 21 Flats & Maisonettes 46 Bungalows 2 69 40 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 1963, under the provisions of the Milk (Special Designations) Regulations I960. These 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 11 Sterilised Milk 4 Tuberculin Tested Milk 1 Pasteurised and Sterilised Milk 4 Pasteurised and Tuberculin Tested Milk 7 Pasteurised, Sterilised and Tuberculin Tested Milk 7 To Pasteurise 1 55 (c) Bacteriological Examination of Milk, During the year 113 samples of milk were sent to the Public Health Laboratory at Epsom, and the following is a tabulated statement of the re suits:- Phosphatase Test Methylene Blue Test Pass Pass Fail Void T.T.Pasteurised 60 60 - - Pasteurised 32 28 4 - Tuberculin Tested — 18 3 - 92 106 7 - All the samples of pasteurised milk passed the phosphatase test which indicates that the milk has been properly pasteurised. The methylene blue test is a measure of the bacteriological condition of the milk and in accordance with the standard set by the Milk (Special Designations) Regulations I960, this test is void if the atmospheric shade temperature exceeds 70°F. during the period of the test. Pour pasteurised samples failed this test. The three samples of tuberculin tested milk which failed the test were from a vending machine. Appropriate follow-up action was taken and it is hoped that trouble from this source will not recur, (d) Ice C ream. The number of registered premises in the Borough in which ice cream may be stored or from which it may be sold is 173. This figure also includes four producers. In addition to these dealers and producers, there are other premises, such as restaurants, canteens, cinemas, etc, where 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 84 samples submitted to the Ministry of Health Public Health Laboratory at Epsom during 1963. 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. Adequate follow-up action is taken where samples fall within the latter grades. GRADE Total I II III IV Ice Cream 63 5 11 5 84 42 (e) Meat and Other Food. (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 Guildfordo (ii) Foodstuffs condemned as unfit. The following tabulated statement shows the amounts of various foods which were condemned during the year and the causes for condemnation,, The quantities involved are small in comparison with the amount of food which is handled in the town. The list is very much condensed to avoid unnecessary detail. Tabulated list of Condemned Foodstuffs showing causes for condemnation and the weights,, Article of Food Reason for Action Weights lbs. lbs. Raw Meat Bovine Decomposition etc. 3,62l½ Ovine " 698 Porcine " 2,584 Total raw meat 6,903½ Raw Fish Decomposition 221 Poultry, Game, etc. " 266 Canned Goods Meat & Meat Products ) Punctured, blown, damaged or decomposition 654¾ Fruit 1,894 Jam 58 Vegetables 142¾ Milk 112¾ Soup 16 Fish & Fish Paste 27 Others 31½ 2,936¼ Other Foods condemned for various reasons. Flour 140 Jam & Preserves 18 Pickles 1 Sausages 2¼ Meat 2¾ Others 32 196 43 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. Recent developments in food retailing have re-introduced hazards which had previously been eliminated. For instance, the creation of a demand for soft ice cream has been one of the means whereby effective control of production has been removed from the relatively safe conditions of the factory to the ice cream vehicle, thus each selling point for this product becomes a place of manufacture with the consequent risk of contamination being increased. The introduction in cafes of refrigerated dispensing units for milk has also created a problem,, These appliances owing to their form of construction are required to be dismantled, thoroughly cleansed and sterilized daily if they are to provide a safe source of milk supply. It is not suggested that this cleansing is beyond the capability of the staff employed in such premises, but if this is to be done properly, it necessitates detailed instruction and as in many cafes the turnover of staff is very frequent, it is not easy to ensure that the instructions are passed on and the correct procedure maintained,, 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. 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 use of paper sacks in food shops and restaurants is being extended with a consequent improvement in hygienic conditions. Proprietors appreciate the advantages of the system, particularly when storage space is limited or access by the refuse collection service is difficult. The sacks are supplied by the Corporation at cost price and a suitable paper sack holder can be obtained from the makers for about the price of an ordinary refuse bin. 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 44 and managers is almost invariably given to the Public Health Inspectors who, on their part, seek to give assistance by advice and encouragement. The following tabulated statement shows the nature of the defects for which Notices were served during the years:- PART IV Defects Requiring Notices Complied Sanitary Conveniences. Lack of "Wash your Hands Notices" 6 5 Fittings cleansed, repaired or extended 14 6 Walls and ceilings cleansed 1 1 Ventilation Provided 3 1 Sinks Renewed or repaired, also draining boards 5 5 Cleansed — 1 Washing Facilities for Staff Absence of, defective, inadequate hand basins 3 7 Absence of hot water 7 4 " " cold water 4 2 Provision of Towels, Soap and Nailbrushes 5 5 Absence of, or defective, water heaters 3 2 Repairs to Pood Rooms Walls and ceilings cleansed or repaired 5 8 Additional ventilation required 2 3 Floors repaired 1 4 Other structural repairs 4 3 Protection of Food against Contamination, Food to be kept 18" off ground 1 1 Covers provided for food 5 5 Smoking 2 2 Others 4 5 Uncleanliness Kitchens and Equipment 8 4 Insects 1 1 Floors 14 7 Personal 4 3 Food Stores 5 3 Dustbins Cleansed and/or repaired 1 — General Repairs 6 3 Cleansing-General 5 2 First Aid Kit 3 4 Others 2 3 124 100 45 Food 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 84 Dairies and Milk Shops 25 47 Butchers 40 221 Greengrocers and fruiterers 89 94 Public Houses (a) Providing restaurant services 17 23 (b) Not providing restaurant services 41 Fishmongers and Stalls 16 69 Ice Cream Premises registered 173 92 Grocers and general provisions 132 207 Restaurants and Cafes 69 Kitchens and canteens (including factory, school and shop) 35 431 Wholesale meat distribution depots 6 112 Visits to food premises re unsound food 151 Open Market, Pood Stalls, Barrows 815 668 2,346 FOOD AND DRUGS ACT. 1955. During the year, 102 samples were submitted to the Public Analyst in accordance with the provisions of the Pood and Drugs Act, 1955 and the Labelling of Pood Order and other relevant Orders and Regulations. Seven samples were the subject of adverse comment and six of these related to contraventions of the Labelling of Food Order, In all caees new or amended labels were produced. The remaining sample which was of T.T. Fasteurised Milk, was deficient in milk fat but a formal follow-up sample yielded a remarkably high fat content. This indicated that at the dairy in question the milk was not being properly mixed prior to being cartoned. The matter was taken up with the farmer concerned through the Milk Marketing Board and there is every reason to believe that future samples will be satisfactory. 46 Tabulated Statement of Samples Submitted to the Public Analyst during 1963. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Inforinal Formal Informal Actal Tablets — 1 — 1 — — Alphabet Noodle Soup — 1 — 1 — — Antiseptic Lozenges — 1 — 1 — — Apple Sauce — 1 — 1 — — Asparagus Soup — 1 — 1 — — Batter Mix — 1 — 1 — — Beef & Vegetable Curry- — 1 — 1 — — Beef Goulash — 1 — 1 — — Blackberries in Heavy Syrup — 1 — 1 — — Blackcurrant Jam — 2 — 2 — — Blackcurrant Table Jelly — 1 — 1 — — Blue Cheese Spread — 1 — — — 1 Butter Beans — 1 — 1 — — Buttercrisp Tea-time Biscuits — 1 — 1 — — Candied Chestnut Spread — 1 — — — 1 Caramel Flavour Dessert Powder — 1 — 1 — — Carmelle with Caramel Topping — 1 — 1 — — Chicken Sausages — 1 — 1 — — Chicken Noodle Soup — 1 — 1 — — Chiffon Dessert — 1 — 1 — — Chili Con Carne — 1 — 1 — — Chocolate Dessert Powder — 1 — 1 — — Choledyl Tablets — 1 — 1 — — Chopped Pork and Ham — 1 — 1 — — Cod Fillets in Parsley Sauce — 1 — 1 — — Corned Beef (lean out) — 1 — 1 — — Corn Oil — 1 — 1 — — Crab — 1 — 1 — — Crab Spread — 1 — 1 — — Cream — 1 — 1 — — Creamed Mushrooms — 1 — 1 — — Creamed Rice Milk Puddling — 1 — 1 — — Cream, Danish — 2 — — — Cu-bits Relish — 1 — 1 — — Daladin Tablets — 1 — 1 — — Dessert Prunes — 1 — — 1 Dried Fruit Mixture — 1 — 1 — — Fig Bar — 1 — 1 — — Fish Paste (Salmon & Anchovy) — 1 — 1 — — C/Fwd. — 41 — 38 — 3 47 Food and Drugs Act - Samples Cont/d. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. — 41 — 38 — 3 Fish Paste (Salmon & Shrimp) — 1 — 1 — — Fruit Salad in Heavy Syrup — 1 — 1 — — Honey Spice American Cake — 1 — 1 — — Horseradish Sauce — 1 — 1 — — Iced Gem — 1 — 1 — — Ice Paps — 1 — — — 1 Imposon Tablets — 1 — 1 — — Indian Pellao Curry Rice — 1 — 1 — — Indigestion Tablets — 1 — 1 — — Instant Coffee — 1 — 1 — — Lamb Chops with Gravy — 1 — — — 1 Lambs Tongues — 1 — 1 — — Lemon Puff Biscuits — 1 — 1 — — Liver Pate with Truffles. — 1 — 1 — — Madeira Wine Sauce — 1 — 1 — — Middle Cut Scotch Salmon — 1 — 1 — — Milk 1 14 1 13 — 1 Minced Chicken in Jelly — 1 — 1 — — Mulberry Conserve — 1 — 1 — — Mushroom Ketchup — 1 — 1 — — Mushroom White Sauce — 1 — 1 — — Onion Sauce (White) — 1 — 1 — — Onions (Cocktail) — 1 — 1 — — Onion Soup — 1 — 1 — — Orange Essence — 1 — 1 — — Orange Drink — 1 — 1 — — Pease Pudding — 1 — 1 — — Piccalilli — 1 — — — 1 Portuguese Real Sardines in Pure Olive Oil — 1 — 1 — — Potato Crisps — 1 — 1 — — Ravioli — 1 — 1 — — Red Cherries in Light Syrup — 1 — 1 — — Rusks — 1 — 1 — — Salmon Red Sockeye — 1 — 1 — — Savoury Mince Steak — 1 — 1 — — 3hort Pastry Mix — 1 — 1 — — Shrimps — 1 — 1 — — Steak & Kidney Padding — 1 — 1 — — Strawberries in Syrup — 1 — 1 — — Strawberry Jam — 1 — 1 — — _ Sucron — 1 — 1 — — C/Fwd. 1 95 1 88 — 7 48 Food and Drugs Act-Samples Cont/d. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal, Informal Formal Informal Formal Informal B/Pwd. 1 95 1 88 — 7 Tomato Paste (Double concentrated) — 1 — 1 — — Tomato Puree (Condensed) — 1 — 1 — — Veal Sorrento — 1 — 1 — — Vitamin Tablets — 1 — 1 — — White American Cake — 1 — 1 — — Zinc and Castor Oil Cream — 1 — 1 — — 1 101 1 94 — 7 Other Foods which were the subject of Complaint. Steak and Kidney Pie. The complainant alleged that he had diarrhoea and sickness during the night after consuming the pie. No other complaints were received and when investigations proceeded the next day it was found that all pies in the same consignment as the offending one had been consumed, therefore eliminating the chance to check the code numbers on the pie wrapping. In the circumstances there was no way of proving the pies were stale or out of condition and no further action could be taken. Glass in Wheatmeal Loaf. The glass was found to be that which is commonly used for tableware etc. and not heat resistant or lead glass. The shape and characteristics of the larger pieces were consistent with being derived from a broken rim of a dish. No glass whatsoever is allowed in the manufacturer's factory. This was checked and confirmed. It seemed very doubtful that the glass entered the loaf during manufacture and it was therefore not possible to pursue the matter further. Tin of Mandarin Oranges. A slight phenol flavour was noted by the complainant. The tin had been bought a month prior to being opened but the complainant could not furnish any details with regard to the name or address of the retailer. 49 Foreign Matter in Procea Loaf'. The millers stated that outside contractors had been working above the storage bins and could have dislodged such material as was found in the loaf and that a fault in the collection box, which is situate at the end of a conveyor belt and traps any foreign material that might be present, allowed this rejected material to fall back to the main conveyor,, In view of this explanation and the immediate precautions that were taken to prevent a recurrence it was felt that a warning letter be sent to the miller,, It was obvious that the baker was not to blame. Peppermint Cremes. The complainant alleged that she broke her dentures on one of the cremes. A few of the cremes were quite hard and the manufacturers were of the opinion that the cream filling must have hardened during prolonged storage„ The dealer was advised with regard to proper storage rotation. Insect (Moth) in Loaf,, The bakery had been fumigated immediately prior to the complaint; this had the effect of stupefying the moths and may have made them liable to fall. A warning letter was sent. Mould on Puff Pastry. No code mark was pinched on to the wrapper, so it was virtually impossible to trace with any certainty the point in the chain of distribution where the pastry became out of condition. Skinless Beef Sausages. The sausages were found to be affected by green mould when unwrapped on the day of purchase, The manufacturer's system of distribution appeared to be satisfactory. The fault seemed to be due to carelessness in the handling of perishable goods on the part of the retailer's staff,, A very serious view was taken in this instance and the retailer was advised that any repetition of the incident would render him liable to prosecution. Alleged Dirty Milk Bottle. The 'dirt' was found to be abrasions on the outside of the bottle and would therefore in no way affect the inner surface or the cleanliness of the milk. Pork Pie. This pie was said to have been the cause of illness. A bacteriologist's report on a portion of the pie showed that cultures were sterile. It was not possible, therefore, to ascertain the cause of illness. The coding on the wrapper indicated that the pie was sold in a perfectly fresh condition. Tin of Pork Luncheon Meat. The meat was affected by mould growth, and it appeared that there was a fault in the seam of the can which prevented a proper seal being made. Insect in Ice Cream Cornet. Bought by a child. The insect was identified as one of a species that lives on vegetation. It was thought to have dropped from an overhanging branch of a tree, as the child was passing below. The shop where the cornet was purchased proved to be very clean and hygienic, and no blame could be attached to the shopkeeper. 50 English Cheddar Cheese. This was alleged to have been in an unsatisfactory condition when bought. The method of storage, display and sale at the retail premises was perfectly satisfactory, and similar portions of cheese on display were quite normal in appearance and taste. However, it was found that, on exposure to room temperature for a few hours the cheese became oily on the surface. This was thought to be a fault in manufacture. The whole of the stock was, therefore, withdrawn by the producers who were anxious to trace the cause and rectify it. Corned Beef Loaf. The meat was unfit for consumption and the can was slightly perforated beneath the metal tab to which the key was attached. It was impossible to ascertain, due to the prolonged storage by the complainant, when the perforation or the decomposition of the meat occurred. Mouldy Packet of Prunes. Mould was found on the fruit although the packets appeared to be new. A number of other packets of this product were opened, but no mould growth of any kind was detected. However, to avoid any risk, all the stock bearing the same code mark as the offending packet was returned to the importers. Assorted Cakes. The cakes were sold in a stale condition. The manufacturer's system of distribution appeared to be satisfactory, the fault, however, seemed to lie in the absence of a proper method of stock rotation at the place of purchase. The Manager and staff were given advice and a stern warning to exercise greater care. Lamb Chops (Foreign Matter). This matter was found, upon examination, to be animal faeces which had become lodged under a fold in the animal fat when the carcase was dressed by the slaughterman, and which remained there when the fat set during the freezing process. Milk Bottle containing Cap. It was ascertained that the cap had been cleansed during the bottle washing process, but obviously its presence was undesirable. The Company promised to exercise greater vigilance in the checking of bottles before refilling. Mould Growth in Pork Pie. Following upon a complaint that a mouldy pie had been sold from a shop in the town, enquiries elicited the fact that the article had been sold ten days after receipt from the manufacturer. Investigations revealed considerable laxity in stock rotation on the part of the retailer and also that the manufacturer's methods of distribution were in need of revision. Legal proceedings were instituted against the shopkeeper and a fine of £5. was imposed, in addition to costs of 2 guineas. The remaining twelve cases of complaint related to a number of minor matters mainly concerned with alleged odd flavours or food sold out of condition. Often in these cases the product is brought to the office some time after purchase when it is not possible to assess its condition at th6 time of sale. All such cases are, however, investigated, as on occasions these enquiries reveal faults in handling which require attention. 51 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. 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. 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 - mainly imported apples and tomatoes. Ten warning notices were given, but it was not considered necessary to take any legal enforcement action. 52 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 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 1963 a total of 506 notifications of infectious disease was received, and these are analysed and commented upon in the following tables and reports. 53 NOTIFIABLE DISEASES DURING 1963. 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 & over Total . Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — 1 — 11 — — — — — — 12 — — — — — — — — — — — — — — Measles 4 4.0 67 51 70 164 7 1 — — — — 404 — — — — — — — — — — — — — — Whooping Cough 2 1 2 2 1 4 — — 1 — — — 13 1 — — — — — — — — — — — — — Acute Poliomyelitis: Paralytic — — — — — — — — — — — — — — — — — — — — — — — — — — — Non-paralytic — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Infective Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — — Meningococcal Infection — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 6 28 3 — — 37 36 — — — — — — — — — — — — — Dysentery — — 1 — 1 1 1 — — — 1 — 5 — — — — — — — — — — — — — — Food Poisoning — — 1 — — — — 3 11 2 7 5 29 27* — — — — — — — — — — — — — Pneumonia — — 1 — — 1 — — — 1 — 2 5 1 — — — — — — — — — — 10 25 35 Erysipelas — — — — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — — — — — — — — — — — Para-Typhoid Fever — — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — Totals 6 41 72 54 72 181 8 10 40 6 9 7 506 65 — — — — — — — — — — 10 25 35 * 26 were already in hospital for some other condition. 54 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) 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 — — — — — 1962 4 19 5 38 — — — — — 1963 12 404 13 37 — — — — 1 * Measles - Not notifiable until 1940. * Whooping Cough - Not notifiable until 1940. 55 Whooping Cough. There were 13 cases of whooping cough notified during 1963. Of these 2 cases were infants under the age of 1 year, one being a baby of 6 weeks, who was admitted to hospital. The remaining 11 cases comprised 6 pre-school children, 4 attending school, and 1 adult. The number of cases notified for the years 1958-1963 are shown in the table below for the purposes of comparison. 1958 1959 1960 1961 1962 1963 9 3 11 — 5 13 Immunisation against whooping cough is usually performed as a combined process with diphtheria immunisation, and practically 100% of the children being immunised for the first time receive "combined" material which affords protection against both these diseases. Enteric Fever (Typhoid or Para-Typhoid). During 1963 one case of para-typhoid fever was notified. The patient was a man who was allowed to be treated at home since it was a mild case and the home conditions were satisfactory. Unfortunately, he became a carrier for several months but eventually was cured following intensive courses of anti-biotics. There was no spread of infection. The source of infection was not definitely established since samples of suspect foods had been destroyed 3 to 4 weeks before diagnosis was made. (There is an incubation period of 12/l6 days). Measles. There were 404 cases of measles notified during 1963 compared with 19 in 1962. Generally speaking the illness was of a mild type with little by way of complications and all cases were nursed at home. The majority of the illnesses (232) occurred in children in the 0/5 group, and (164) in the 5/10 age group. Ophthalmia Neonatorum. No cases of ophthalmia neonatorum occurred during 1963. 56 Puerperal Pyrexia. The maternity block at Kingston Hospital serves Kingston and a large surrounding area embracing a population of some 285,000 persons. During 1963, 1,949 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 in accordance with the regulations which define the illness as a febrile condition occurring in a woman in whom a temperature of 100.4°F. or more has occurred within fourteen days after childbirth or miscarriage. During 1963, 37 cases were notified, 36 of whom were notified from Kingston Hospital, of which 8 were Kingston residents. These figures compare with 38 and 9 respectively for 1962. An analysis for the years back to 1959 is shown below. Cases 1959 1960 1961 1962 1963 (a) Total notified 72 89 89 38 37 (b) Number included in (a) of (i) Kingston residents 24 19 24 9 9 (ii) Extra district residents 48 70 63 29 28 (c) Number included in (a) notified from Kingston hospital 70 89 89 38 36 (d) Number included in (a) notified by private doctors 2 — — — 1 (e) Number of cases included in (d) removed to hospital other than included in (c) — — — — — Smallpox. There were no cases recorded in Kingston during 1963. 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 accordance with regulations. During 1963, as a result of a recommendation from the Ministry of Health, vaccination of infants is now carried out about the age of one year and follows other immunisation procedures instead of during the first few months of life. As a result of this change in age, the number of vaccinations carried out in very young infants during 1963 was considerably less than in previous years but by the end of the year the vaccination of children at the age of one year was proceeding at about the same level as previously. 57 Scarlet Fever. Twelve cases were notified during 1963, eleven of which were of school age. No serious cases or deaths were reported and all were treated at home. 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. Poliomyelitis. No cases of poliomyelitis have been notified in Kingston since 1957. Vaccination against poliomyelitis by the oral method was continued throughout the year. The bulk of the work in prevention of poliomyelitis by active immunisation of the population up to 40 years of age has now been completed. The main groups which were immunised during 1963 were infants commencing at the age of six months, and school children and adults who had failed to attend for immunisation in previous years. At all ages up to 21 years, the percentage immunised is about 90% which can be considered a satisfactory figure. There still remains a number of young adults who have not so far been protected against poliomyelitis but many of these are likely to be immunised when they become parents and take their children for immunisation either to the family doctor or to a clinic. Oral vaccine by mouth, not only provides protection but also prevents protected persons from harbouring poliomyelitis virus and spreading the disease to unprotected persons. This type of vaccine is of great value during em epidemic because it works quickly. The vaccine is available for the immunisation of everyone between six months and 40 years, and in addition for those who may be in contact with poliomyelitis as a result of their work. Dysentery (Sonne). A total of 5 cases of dysentery were notified during 1963 compared with 8 during 1962, These notifications were in respect of 3 individual cases and 1 family in which 2 young children were concerned. 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. 58 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, During 1963 in Kingston 14 cases were reported and of these 10 referred to lungs. Compared with 1962, there is a decrease in the number of lung cases, when the total of 20 notifications all referred to lungs. Whilst we can claim that fear and pessimism concerning tuberculosis have been largely removed from people's minds, and there is considerable satisfaction to be derived from the decline in the number of new cases, there are 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 cases. It is to be hoped that in due course continued effects of improved living conditions of the populace, continued advances in therapeutic treatment, facilities 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. The following table shows comparative figures of notified cases and deaths for the years 1954 to 1963 (inclusive):- 59 Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory Total 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 1962 20 — 20 2 — 2 1963 10 4 14 4 1 5 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 and District Care Committee for Tuberculosis and Other Chest Diseases. 60 Considerable help is given to tuberculosis and other chest disease patients and their dependants by the Kingston and District Care Committee for Tuberculosis and Other Chest Diseases. During 1963, 115 families within the area covered by the Committee were helped in the form of grants for extra nourishment, clothing, fuel, removals, bedding, fares, pocket-money, etc., and a total of £2,188. was expended from the funds of the Committee on this work. An analysis of the total notified cases during 1963 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. 61 NOTIFIED CASES OF, AND DEATHS FROM, TUBERCULOSIS IN 1963. 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 1 4 — — — — — 2 — 1 — 3 F — — — 1 1 — 1 1 2 6 — — — — — — — 1 — 1 Total — — — 1 1 1 2 2 3 10 — — — — — 2 — 2 — 4 (b) Non-respiratory M — — — — 1 — 1 — — 2 — — — — — — — — — — F — — — 1 — 1 — — — 2 — — — — — — — 1 — 1 Total — — — 1 1 1 1 — — 4 — — — — — — — 1 — 1 62 RESPIRATORY TUBERCULOSIS