KIN 39 THE HEALTH AND WELFARE of the ROYAL BOROUGH of KINGSTON UPON THAMES 1965 73686 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1965 JOHN C. BIRCHALL, M.B., Ch.B., D.P.H. HEALTH AND WELFARE DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: ELMBRIDGE 5111 3 To the Mayor and Members of the Council. I have the honour to submit my first Annual Report on the health and welfare of the new Royal Borough. This is a compulsory report complying with Circular 1/66 of the Ministry of Health. Although the new borough only came into existence on the 1st April, the report covers the whole year by including data for the first three months supplied by the constituent authorities. Despite the short life of the new borough I am the second Medical Officer of Health. The death at the end of July of Dr.J.W.Starkey, so well known and loved, was a great loss to all. It was a joy to him to be at the head of a combined Health and Welfare Department of an all purpose authority and it was his great wish that the new department should be well established before his impending retirement. The integration of the three public health departments of the constituent district authorities and the separate divisional health and welfare departments of the Surrey Comity Council into one department was accomplished without any dislocation of the services or inconvenience to the public. This was due in no small measure to the assistance given by officers of the County Council as regards the transferred services. The death rate, infant mortality rate, and also the birth rate were well below the national average. Of 363 deaths from cancer 102 (80 men and 22 women) were attributed to cancer of the lung, caused no doubt in many instances by cigarette smoking. It is interesting to compare the 102 deaths from lung cancer with the 48 deaths from accidents of all types, including 21 road accidents. 1965 was an epidemic year for measles. There were no cases of poliomyelitis reported for the fourth successive year, and there have been no cases of diphtheria since 1947 in the district. The amalgamation produced few special problems for the Environmental Health Section but I should like to pay tribute to Mr.P.E.Kinton, Chief Public Health Inspector, for the efficient manner in which he dealt with this and for his co-operation at all times. 5 The Council decided to introduce smoke control to the whole borough and also to ask the Metropolitan Water Board to fluoridate the water. However, if it is the intention of the Board to wait until all the authorities that they serve decide in favour of fluoridation before any action is taken, it will probably be a long time before the water supply to the borough is fluoridated. The Personal Health Services are those formerly the responsibility of the County Council as local health authority. All six clinics and the two day nurseries continued to operate satisfactorily. There was no particular change in the health visiting service, but arrangements were made for the secondment of the first health visitor to work for part of her time in a general practice as from the 1st January 1966 The experience gained will, it is hoped, indicate the value of such attachments and the special duties of the health visitor in these arrangements. If successful the service will be extended, when possible, but at present there are few groups of general practitioners in the borough. The health visiting service was ably supervised by Miss F.I.Arnold, who has since retired. There were shortages of district nurses and midwives throughout the year and there has been additional call on the time of the midwives due to more cases of early discharges of mothers and babies from hospitals.. Co-operation with the consultant obstetrician and his staff was excellent and even closer collaboration is probable in the future,, The Council is fortunate in having Miss P.M.Stanley, Superintendent of Hone Nursing Service and Non-Medical Supervisor of Midwives, in charge of this service. There was a serious shortage of home helps throughout the year; this is a very difficult service to maintain in an area where there is so much competition for female labour. An intensive recruitment campaign is planned for 1966. As regards the mental health service a new combined junior and adult training centre for subnormals was taken over from the Surrey County Council; 25 of the 93 places were allocated to the London Borough of Richmond upon Thames. It soon became obvious that the centre was too small to meet the demand, and that it would be necessary to find an alternative site for the adult workshops. Only one mental welfare officer was transferred from the County Council, but in spite of many difficulties several excellent and well qualified officers were appointed, including Mr.E.V. oram, as Principal Mental Welfare Officer. 7 The welfare section of the department, under Mr. F.J. Meacock, Chief Welfare Officer, faced many difficulties, particularly in connection with accommodation for the elderly. Only six old converted properties, none with lifts, in addition to 40 beds in an old type institution in Richmond, were transferred from the County Council. The full benefits of combined health and welfare in one department are in the main still to come when services for the prevention, care and after-care of the sick under the National Health Service Acts, and the welfare services for the aged and the permanently and substantially handicapped under the National Assistance Acts are fully integrated. The Ten-Year Development Plan for the health and welfare services was prepared during the year and approved by the Council and the Ministry of Health. The Plan includes in the first five years new premises to replace the clinics at South Place, Surbiton, and Grange Road, Kingston, and the building of old people's homes. The establishment of a combined health and welfare department has increased the potential for helping problem families and families with problems. There is now a good team of social welfare officers under Miss M.Birley, Senior Social Welfare Officer, dealing with the welfare and prevention of break-up of families, in addition to the care of the aged and the handicapped,, The demand for the chiropody service for expectant mothers, old people and the handicapped, increased considerably during the year. I am pleased to be able to report that the health of school children in the borough is very satisfactory. Out of 5,7l6 children examined at routine medical inspections in schools, only 11 were classified as being in an unsatisfactory physical condition. Better housing, clothing and feeding and health education have played their part in the improvement in the health of children in recent years. An important factor too is the close co-operation that exists between hospital, specialist, general practitioner and local authority health services. This benefits particularly the handicapped child whose needs, through increasing knowledge and awareness of the problems, are met more fully and at an earlier age. The generally improved health of the school child may in the near future permit experimental variation in the method of deploying the school health staff to be of the greatest service to those in the greatest need. During the year this service took a more active interest in health education in schools with gratifying results. Medical officers and health visitors were invited on many occasions by head teachers to give talks and initiate what usually 9 became lively discussions on various health topics, including drug taking. As regards the latter, adolescents are a new challenge in the care of the "vulnerable". Widespread drug taking by young people is a frightening problem which must be tackled vigorously. Every endeavour has been made, and will continue to be made, to develop the school health service, which, together with the welfare and mental health services, will become part of the great family service which is visualised in the combined health and welfare department, thus enabling social medicine in the fullest meaning of the term to be practised. The dental service for expectant mothers and children of all ages functioned satisfactorily under the direction of Mr.G.Power, Chief Dental Officer. I am indebted to Dr.V.Wills, Senior Medical Officer;, who undertook much of the day to day administration of the school health service. I should like to express my thanks to all the field staff and office staff of my department for their help during a most difficult first year. In particular I must record my appreciation of the assistance I received from Mr.H.A.Sears, my Chief Administrative Officer, to whom nothing was too much trouble, and who worked long hours with me, particularly in the last six months of the year whilst I was Acting Medical Officer of Health with no Deputy,, I am indebted to many hospital consultants and medical social workers, the Public Health and Kingston Hospital Laboratory staffs, the general practitioners, and to all other officers of statutory and voluntary organisations too numerous to mention, who have assisted the department and contributed to the health and welfare of the citizens of this borough. A feature of the year was the close co-operation that was established with other departments of the authority, particularly Education, Children's, and Housingo I am grateful to Chief Officers, Heads of Departments, and their staffs. I wish to record my appreciation of the assistance given by the late Chairman of the Health and Welfare Committee, and to express my thanks to the Vice-Chairman, the Chairman and Vice-Chairman of the Establishment Committee, and to the members of both Committees for the support given to the department and myself during the year, I should like to thank also the Education (Schools) SubCommittee and the Education Committee for the way in which my reports on the school health service were received. JOHN CoBIRCHALL. Medical Officer of Health and Principal School Medical Officer. 11 ROYAL BOROUGH OF KINGSTON UPON THAMES HEALTH AND WELFARE COMMITTEE AS AT DECEMBER 1965 Mayor: Alderman C.M. JUDGE, J.P. Chairman: Alderman S.E.F. Gooding, M.D.,J,P. Vice-Chairman: Councillor H.W.PAYNE, A.R.Ae.S. Aldermen; A.C.Healey, M.Sc., Ph.D., F.R.I.C. D.AoMcDonald Councillors: E.F.G.Absolon G.H.Archer, M.I.O.M. J.A.H.Cook K.S.Cooley D.G.Evans, F.I.M.L.T. S.T.Ferebee H.J.Halford J„Harrison, M.I.Prod.E. J.SoIsitt, BoSc.(Edin.) Mrs.A.I.Pamment E.C.Pinfold, J.P., S.R.N., R.M.N. C.E.Potts, A.C.I.S. F.J.Steptoe F,J.F.Stone R.G.Sutton Co-opted Members: Dr.R.H.Bartley Dr.J.S.Bearcroft Miss B.Cowell E.C.Grant Mrs.C.E.Hottklrk F.R.Hooker Dr.C.Steer Mrs.A.Woodgate Local Medical Committee Consultant Psychiatrist Long Grove Hospital Midwife Teachers' Training College Local Dental Committee Kingston upon Thames Association of Old People's Welfare Committees Kingston and District Hospital Management Committee Local Medical Committee South West London and Surrey Executive Council 12 STAFF OF THE HEALTH AM) WELFARE DEPARTMENT Medical Officer of Health Deputy Medical Officer of Health Senior Medical Officers Chief Dental Officer Chief Public Health Inspector Chief Welfare Officer Psychiatrist (Child Guidance) Superintendent Health Visitor Superintendent Home Nursing Services and Non-Medical Supervisor of Midwives Principal Mental Welfare Officer Senior Social Welfare Officer Home Help Supervisor Chief Administrative Officer J.W.Starkey, M.B., Ch.B., D.P.H. (died 30.7.65.) J.C.Birchall, M.B., Ch.B., D.P.H. (appointed 13.10.65.) J.C.Birchall, M.B., Ch.B., D.P.H. R.G.Isaac, LoR.C.S.,M.R.C.P.,D.P.H. Valerie Wills, M.D. G.F.Power, L.D.S., R.C.S. P.E.Kinton, M.R.S.H., M.A.P.H.I. F.J.Meacock Beryl G.Anscombe, M.B., Ch.B., D.(0bst.) R.C.O.G., D.P.M. Miss F.I.Arnold, S.R.N., S.C.M., H.V. Certificate Miss P.M.Stanley, S.R.N., S.C.M., Q.I.D.N., H.V.Certificate E.V.Oram, A.A.P.S.W.,S.R.N.,R.M.D.N. Miss M.Birley, A.I.M.S.W. Mrs.IcE.Roobottom H.A.Sears, D.M.A. STAFFING ESTABLISHMENT AS AT 31ST DECEMBER 1965 Assistant Medical Officers 4 + 1 P.T. Senior Dental Officer 1 Dental Officers 3+1 P.T. Orthodontic Surgeon 1 Dental Surgery Assistants 6+1 P.T. Dental Auxiliary 1 P.T. Health Visitors 22 Clinic Nurses 3 Deputy Superintendent Home Nursing Services and Non-Medical Supervisor of Midwives 1 District Nurses/Midwives 38 Nursing Auxiliaries 3 (continued) 13 STAFFING- ESTABLISHMENT AS AT 31ST DECEMBER 1965 (continued) Consultant - Bedelsford School (Part-time) 1 Speech Therapists 4 Physiotherapists 6 Audiologist (Part-time) 1 Audiometrician (Part-time) 1 Ophthalmologist (Sessional) 1 Chest Physician 1 Psychotherapist (Part-time) ) Child Guidance Clinic 1 Psychiatric Social Workers ) 3 Day Nursery Matrons 2 Deputy Matrons 2 Wardens 2 Staff Nursery Nurses 7 Student Nursery Nurses 4 Deputy Chief Welfare Officer 1 Senior Social Welfare Officer 1 Social Welfare Officers 6 Welfare Assistants 2 Geriatrician (Part-time) 1 Matrons of Welfare Homes 5 Superintendent of Home 1 Senior Occupational Therapists 2 Technical Instructor 1 Chest Clinic Almoner 1 Chest Clinic Welfare Assistant 1 Assistant Home Help Supervisor 1 Home Helps 60 Psychiatrist (Part-time) 1 Casework Supervisor 1 Administrative Mental Welfare Offioer 1 Mental Health Social Workers 5 Training Centre Supervisor 1 Workshops Supervisors 3 Assistant Supervisors 7 Guide Assistants 3 + 1 P.T. Deputy Chief Public Health Inspector 1 Senior Public Health Inspectors 3 District Public Health Inspectors 9 Pupil Public Health Inspectors 2 Technical Assistants 5 Administrative and Clerical Staff 56 14 The Royal Borough of Kingston upon Thames is located to the south-west of London and on its northern boundary is only seven miles from Charing Cross. The town was famous in early English history and today is one of the largest shopping centres in the south-east. The River Thames runs along the western boundary and the Boroughs of Richmond, Wandsworth, Merton, Sutton and Epsom and Ewell and the Urban District of Esher are immediate neighbours. Residents of the Borough enjoy the advantages of easy access both to central London and to the attractions of the Surrey countryside. The ancient market in the centre of Kingston was established by Royal Charter granted to the Borough by Charles I in 1628 and on week-days Kingston itself is a magnet for shoppers from many miles around. The Borough is also a centre for education, including a College of Technology and an Art School. Numerous industries, producing chiefly light engineering products and consumer goods, are located in the main in Kingston and Chessington. The Borough is well served by road and rail communications with excellent services to Waterloo from Kingston, Surbiton and New Maiden, with the main line from Waterloo to Portsmouth, Southampton and the south-west. The A.3. bisects the Borough on its route from London to Portsmouth and there is ready access to both London and Gatwick Air Ports. Kingston Baths comprise two modern indoor swimming pools and a learner pool, and Surbiton Lagoon is a large open air pool. There are many open spaces, together with riverside walks and several industrial and commercial undertakings have chosen the area for their sports clubs. In Maiden there are three private golf courses. Richmond Park and Wimbledon Common abut the boundaries in the north; to the south there i3 the Green Belt with the Surrey countryside. Much of the housing in the Borough was constructed between the wars and many residents travel daily to London. The whole of the Borough is extremely well provided for by voluntary organizations catering for the needs of the young and the elderly. VITAL STATISTICS AND GENERAL SERVICES 17 VITAL STATISTICS Area, 9,28l acres. Population, estimate of Registrar General at Mid-year 1965, 146,470 Rateable Value at 1st April 1965 £9,558,509 Product of a Penny Rate, at 1st April 1965, £39,050 Separately Rated Dwellings, at 1st April 1965, 47,031 Live Births: Males Females Total Percentage Legitimate 1,139 1,056 2,195 92.8 Illegitimate 102 69 171 7.2 Totals 1,241 1,125 2,366 100.0 Crude Birth Rate per 1,000 estimated population 16.2 Adjusted Birth Rate for purposes of comparison using the comparability factor 1.01 16.3 (England and Wales) 18.1 Still Births: (17 males and 13 females) 30 Rate per 1,000 live and stillbirths 12.5 (England and Wales) 15.8 Total Births 2,396 Deaths: Total (742 males and 804 females) 1,546 Crude death rate per 1,000 population 10.6 Adjusted death rate for purposes of comparison using the comparability factor 0.93 9.8 (England and Wales) 11.5 Maternal deaths Nil Maternal Mortality rate (including abortion) per 1,000 total live and still births Nil (England and Wales) 0.25 Infant Mortality: Infant deaths (infants under one year): Males Females Total Legitimate 20 8 28 Illegitimate 1 1 2 Totals 21 9 30 (cont.) 18 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 12.7 (England and Wales) 19.0 Mortality rate of legitimate infants per 1,000 legitimate live births 12.8 Mortality rate of illegitimate infants per 1,000 illegitimate live births 11.7 Mortality rate of male infants per 1,000 male live births 16.9 Mortality rate of female infants per 1,000 female live births 8.0 Neonatal deaths (under 4 weeks of age) (17 males and 7 females) 24 Neonatal mortality rate per 1,000 live births . 10.1 (England and Wales) 13.0 Early Neonatal deaths (under 1 week of age) (13 males and 7 females) 20 Early Neonatal Mortality rate per 1,000 live births 8.9 (England and Wales) 10.8 Perinatal Mortality (still births plus deaths under 1 week) 50 Perinatal Mortality rate per 1,000 total live and still births 20.9 (England and Wales) 26.9 NEO-NATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Accidental by drowning (unattended birth) 1 - - 1 Anoxia (cerebral damage) - 2 - 2 Anoxia due to cord round neck 1 - - 1 Asphyxia (Placenta Praevia) 1 - - 1 Atelectasis 1 - - 1 Broncho Pneumonia - 1 1 2 Congestive Cardiac Failure - 1 - 1 Multiple Congenital Abnormalities 1 - - 1 Prematurity 5 2 2 9 Prolapsed Cord 1 - - 1 Renal Agenesis 1 - - 1 Respiratory Distress Syndrome 2 - — 2 Septicaemia secondary to Broncho-Pneumonia - - 1 1 Totals 14 6 4 24 19 CAUSES OF DEATH BY AGE Cause of Death Sex Total all Age3 Under 4 Weeks 4 Weeks and Under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and Over 1. Tuberculosis, Respiratory M 1 - - - - - - - - 1 — — F 1 - - - - - - - - - - 1 2. Tuberculosis, Other M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - 3. Syphilitic Disease M - - - - - - - - - - - - F 7 - - - - - - - - - 2 5 4. Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5. Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6. Meningococcal Infections M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - 7. Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F — — - — - — — — — — — — 9. Other Infective and Parasitic Diseases M 3 - - - - - 1 1 - - 1 - F 1 — — — 1 - - — - - — — 10. Malignant Neoplasm, Stomach M 17 - - - - - - - - 6 3 8 F 10 - - - - - - - - 3 1 6 11. Malignant Neoplasm, Lung,Bronchus M 80 - - - - - - 3 8 28 25 16 F 22 — - — - - - 2 5 5 4 6 12. Malignant Neoplasm, Breast M 1 - - - - - - - 1 - - - F 28 - - - - - 1 1 8 8 7 3 (Continued.) 20 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and Under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and Over 13. Malignant Neoplasm, Uterus F 11 - - - - - - 2 5 1 2 1 14. Other Malignant and Lymphatic Neoplasms M 91 - - - - 1 1 2 10 26 17 34 F 92 - — — 1 - 3 4 8 14 22 40 15. Leukaemia, Aleukaemia M 6 - - - - - - 1 1 3 1 - F 5 - - - - - - - - - 3 2 16. Diabetes M 3 - 1 2 F 5 - - - - - - - - - 2 3 17. Vascular Lesions of Nervous System M 62 - - - - 1 - 1 2 8 23 27 F 127 - - - - - - - 5 12 16 94 18. Coronary Disease Angina M 200 - - - - - - 8 25 55 60 52 F 125 - - - - - - - 3 15 39 68 19. Hypertension with Heart Disease M 15 - - - - - - - - 4 5 6 F 22 - - - - - - - - 1 7 14 20. Other Heart Diseases M 51 - - - - - 1 - 2 8 13 27 F 95 - - - - - - - 2 2 19 72 21. Other Circulatory Disease M 23 - - - - - - 1 2 2 6 12 F 55 - - - - 1 2 1 1 2 9 39 22. Influenza M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - 23. Pneumonia M 39 3 - 1 - 1 - - 1 3 6 24 F 48 - - - - - 1 - - 3 6 38 24. Bronchitis M 35 - - - - - - - 2 4 15 14 F 21 - - - - - - - - 3 4 14 25. Other Diseases of Respiratory System M 8 - - - 1 - - - 1 2 1 3 F 3 - - - - - - - - - 1 2 (Continued) 21 CAUSES OF DEATH BY AGE ( continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and Under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and Over 26. Ulcer of Stomach and Duodenum M 6 - - - - - - - 1 - 3 2 F 3 - - - - - - - - 1 1 1 27. Gastritis, Enteritis and Diarrhoea M 6 - - - - - - - - 3 1 2 F 3 - - - - - - - - 1 - 2 28. Nephritis and Nephrosis M 3 - - 1 - - - - - - - 2 F 1 - - - - - - - - - - 1 29. Hyperplasia of Prostate M 1 - - - - - - - - - - 1 30. Pregnancy, Childbirth F - - - - - - - - - - - - 31. Congenital Malformations M 7 2 4 - - - - - - 1 - - F 4 - 1 - 1 - - - 1 - 1 - 32. Other Defined and Ill-Defined Diseases M 44 12 - 1 1 1 1 2 3 4 5 14 F 79 6 1 — — - 1 2 5 9 11 44 33. Motor Vehicle Accidents M 13 - - - - 4 1 - - 3 3 2 F 8 - - - - 1 - - 2 3 - 2 34. All Other Accidents M 14 - - 1 - 1 3 1 2 1 - 5 F 13 1 - - - 1 - - - 2 1 8 35. Suicide M 9 - - - - - 1 1 - 3 2 2 F 14 - - - - 1 2 1 8 2 - - 36. Homicide and Operations of War M 2 - - 1 - - - 1 - - - - F - - - - - - - - - - - - TOTAL ALL CAUSES M 742 17 4 5 2 9 9 22 61 166 191 256 F 804 7 2 - 3 4 10 13 53 87 159 466 22 INFECTIOUS DISEASES The undermentioned diseases are notifiable by medical practitioners to the Medical Officer of Health: Anthrax Membranous Croup Cholera Meningococcal Infection Diphtheria Ophthalmia Neonatorum Dysentery Plague Encephalitis (Acute) Pneumonia, Acute Primary Enteric (Typhoid or Pneumonia, Acute Influenzal Paratyphoid) Fever Poliomyelitis (Acute) Erysipelas Puerperal Pyrexia Food Poisoning (or Relapsing Fever suspected food poisoning) Scarletina or Scarlet Fever Leprosy Smallpox Malaria Tuberculosis Measles Typhus Whooping Cough The following table shows the numbers of cases notified during 1965 by age groups: Disease Under 5 5-14 15-44 45-64 65 and over Age Unknown Total Scarlet Fever 10 17 2 — - — 29 Whooping Cough 13 7 - - - - 20 Measles 1106 840 12 1 - 12 1971 Dysentery 12 31 10 1 - - 54 Acute Pneumonia 1 1 8 6 - 1 17 Paratyphoid Fever - 1 1 1 1 - 4 Erysipelas - - - 2 2 - 4 Food Poisoning - 1 3 - - - 4 Puerperal Pyrexia - - 40 - - 1 41 Tuberculosis Respiratory 1 1 13 17 — — 32 Tuberculosis-Other — — - 1 1 — 2 Totals 1243 899 89 29 4 14 2178 23 Sonne Dysentery Of the 54 cases of Sonne dysentery, 49 had symptoms and 5 were found to have an infection when tested as contacts and were thus carriers. 38 of the cases and all 5 carriers were concerned in one outbreak when 19 children from one infants' school were affected. With the co-operation of the school spread of infection was restricted to 8 other school children, 6 pre-school children and 5 adults. The other 16 cases were isolated incidences unconnected with this outbreak. It cannot be too strongly emphasized that sonne dysentery is an infection which can readily spread in the community. Prevention can be achieved by immediate notification of all cases of diarrhoea occurring in infant and junior schools, ready co-operation of parents in implementing a rigid exclusion policy of patients and children and food handler contacts. It is emphasized that the practice of teaching pre-school children to wash their hands after visiting the W.C. and the continuance of this practice in school is to be encouraged. Paratyphoid Four cases of paratyphoid, all caused by the organism Salmonella para-typhi B, occurred in unconnected cases. One was a woman employed in a mental hospital in an adjoining borough, and another a boy suspected of having contracted the infection whilst on holiday abroad. Similarly a woman was thought to have contracted the infection abroad, and in the fourth case, a man, the source of infection could not be traced. Food Poisoning Four cases of food poisoning were notified and confirmed during the year and of those, three were caused by the organism Salmonella typhimurium, the infection being contracted whilst on holiday on the Continent. In the fourth case the organism responsible was Salmonella enteritidis contracted whilst attending a wedding reception in another area. Meningococcal Infection A woman aged 68 died from a meningococcal infection, but the disease had not been previously notified. 24 A comparative table of notifications of certain infectious diseases during the past seven years is given below: Disease 1959 1960 1961 1962 1963 1964 1965 Scarlet Fever 90 48 48 28 31 19 29 Measles 1782 40 2154 410 1482 235 1971 Whooping Cough 35 93 23 21 42 49 20 Puerperal Pyrexia 75 90 89 38 37 18 41 Poliomyelitis - - 2 - - - - Acute Infective Encephalitis - - - 1 - 1 - Diphtheria - - - - - - - Ophthalmia Neonatorum - - - - - - - Typhoid and Paratyphoid Fevers - 2 1 - 3 2 4 Food Poisoning 17 12 18 7 37 6 4 Dysentery 236 21 9 94 96 10 54 Meningococcal Infection 1 1 - 2 2 - - Laboratory Service Bacteriological and viral specimens are dealt with by the Public Health Laboratory at Epsom and also by Kingston Hospital Laboratory. 25 GENERAL SERVICES HEALTH EDUCATION Health Education is an important function of the Health and Welfare Department. The World Health Organisation describes health as "a state of complete physical, mental, and social well being". A good deal of positive health education is part of the everyday work of all professional staff of the department, particularly health visitors who have a major responsibility in this field. Public health inspectors also have a special responsibility as regards health education on food hygiene. Medical officers, health visitors, social workers, public health inspectors and others visiting homes must be prepared to undertake home safety education. During the first year of the new borough it was not possible to have the co-ordination at top level as regards health education that should be expected. This was due to a certain extent to the fact that there was no appointment of a Health Education Officer. Nevertheless much work has been undertaken, particularly by medical officers and health visitors, in homes, clinics, and schools. There have been several planned health education projects in schools, clinics, clubs, and for women's organisations; also special campaigns in clinics, dealing with home and road safety, care of the teeth, clean food, care with fireworks, care of the feet, immunisation and vaccination. Notices about venereal diseases were displayed in the clinics and the subject was discussed in lectures and at meetings dealing with family planning. NATIONAL ASSISTANCE ACT 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT 1951 Action can be taken under these Acts for compulsory removal of persons to suitable premises in circumstances where they are: (a) suffering from grave chronic disease or being aged infirm or physically incapacitated are living in insanitary conditions; (b) unable to look after themselves and are not receiving proper care and attention from other persons. There were no cases during the year in which action had to be taken under the above-mentioned Acts. 26 REGISTRATION OF NURSING HOMES Since 1st April 1965, the Borough Council has been the registration authority for nursing homes under Part VI of the Public Health Act 1936, and since then one additional home, providing 25 beds, has been registered,, At the end of the year there were five registered nursing homes in the borough and these provided a total of 108 beds for chronic sick and medical patients. None provides any maternity beds. LICENSING OF NURSES' AGENCIES On the 1st April 1965 the Borough Council took over the powers of the Surrey County Council with regard to the licensing of persons who carry on agencies for the supply of nurses under the Nurses' Agencies Act 1957. Such licences expire on the 31st December each year and consideration has to be given to their renewal. At the end of the year three such agencies were licensed by the Borough Council. Fees for licences are as follows: Application for a new licence £2.2s.0d Application for renewal of existing licence £l.ls.0d Alteration to licence 2s.6d The Council impose conditions upon the grant of such licences in order to secure the appropriate conduct of the agency and regularise the fees charged by the agency for the services of the nurses employed,, Refusal to grant a licence could be on one of the following grounds: l. Applicant under 21 years of age or unsuitable to hold a licence. 2. Premises unsuitable. 3. Agency has been or is being improperly conducted. 4. The agency has committed offences under the statutes regulating the conduct of such agencies. Applicants for new licences or the renewal of old ones have the right to be heard by the licensing authority before any application is refused and they also have a right of appeal to a Court of Summary Jurisdictiono 27 CREMATIONS The Medical Officer of Health, Deputy Medical Officer of Health and a Senior Medical Officer are recognised by the Home Office and act as Medical Referees to the borough crematorium in Kingston. During the year there were 1,272 cremations. None was rejected and none was referred to the Coroner, although queries were raised on various points in several cases. MORTUARY SERVICES These have been arranged jointly with Kingston Hospital. ADULT MEDICAL EXAMINATIONS 202 candidates for appointment to the Council's staff were examined as to their fitness for employment,, 40 also were accepted on completion of medical history forms without actual examination. In addition 138 candidates for admission to teachers' training colleges were medically examined. HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital. Services Available Royal Eye Hospital, Upper Brighton Road, Surbiton. Ophthalmic, Refraction Sessions. Kingston Hospital, Wolverton Avenue, Kingston upon Thames. Medical, Surgical, Fracture, Paediatric, Gynaecology, Ear Nose and Throat, Maternity, Orthopaedic, Psychiatric, Rheumatology, Geriatric, Diabetic, Dermatology, Ophthalmology, Pathology, Chest Diseases. Tolworth Hospital, Red Lion Road, Tolworth. Infectious Diseases, Chest Diseases, Geriatric. Surbiton General Hospital, Ewell Road, Surbiton. Medical, Surgical, Ear Nose and Throat, Fracture, Orthopaedic, Genito-Urinary, Gynaecological, Pathology. PERSONAL HEALTH SERVICES 30 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN The Borough Council took over eight clinic premises from Surrey County Council and the following tables show the numbers of ante and post-natal sessions held by medical officers and health visitors and the attendances at each of the clinics during the Year. The Kingston Vale and Hamilton Avenue sessions were carried out by staff from the Roselands and South Place clinics respectively and no separate records are available. Address of Clinic Number of sessions held during the year Number of women who attended Total Attendances Ante-Natal Post Natal Grange Road, Kingston. 50 160 56 746 Acre Road, Kingston. 49 77 36 536 Roselands, New Maiden. 47 88 41 650 Kingston Vale. - - - - Manor Drive, Worcester Park. 47 52 10 290 South Place, Surbiton. 47 80 33 379 Hamilton Avenue, Tolworth. — — — — Gosbury Hill, Hook. 43 72 36 339 TOTALS 283 529 212 2940 Midwives also attended at the majority of these sessions and in addition there were 174 sessions held by midwives only, at which 820 women made 3,687 attendances. 5,565 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed above. 31 CHILD WELFARE CENTRES Child welfare clinics are also held at the premises referred to in the previous paragraph. At these advice is given by medical officers and health visitors, and help is given by voluntary workers who assist with keeping records and the sale of welfare foods. These welfare foods are sold at all the centres listed below, except South Place, Surbiton, and Hamilton Avenue, Tolworth. They are also sold at the Women's Voluntary Service Centres at Kingston, Maiden, Surbiton, and the Fairmead Day Nursery, as follows: Surbiton W.V.S., 154 Ewell Road. Mon. Tues. Thurs. Frid. 10.0. - 12.noon. 2.0. - 4 p.m. & Wed.10-12 Kingston W.V.S., 23a Fife Road. Mon. Tues. Thurs. Frid. 10.45.-4. p.m. Wed: 10.45.-12.45. New Malden W.V.S., Blagdon Road. Mon. Tues. 2.0.-4.30. Wed. 10-12 Thurs. Frid: 10 - 12.45. Tolworth - Fairmead Day Nursery, Ewell Road. Monday 2.0. - 4.p.m. The following table shows the sessions held and attendances at each of the various child welfare clinics: Address of Clinic Number of Sessions during year Number of children who attended Total Attendances Grange Road, Kingston. 111 846 6,553 Acre Road, Kingston. 103 890 5,838 Kingston Vale. 23 55 362 Roselands, New Maiden. 117 733 4,684 Manor Drive, Worcester Park 137 759 4,283 South Place, Surbiton. 112 1,306 7,205 Hamilton Avenue, Tolworth. 41 390 3,178 Gosbury Hill, Hook. 108 814 5,884 TOTALS 752 5,793 37,987 DENTAL SERVICE FOR EXPECTANT AND NURSING MOTHERS AND YOUNG CHILDREN The tables overleaf show the number of mothers and young children provided with the various forms of dental care and treatment during the year. 32 Mothers Dental Care and Treatment Clinic Sessions devoted to treatment Examined Treated Completed treatment Scalings and gum treatment Fillings Silver nitrate treatment Crowns Inlays Extractions General anaesthetics Dentures Provided Radiographs Full Partial Grange Road 9⅜ 16 13 12 12 66 - - - 34 - 4 2 1 Acre Road * 31⅛ 35 35 35 44 136 - 1 2 50 - 4 2 11 Roselands * 3⅝ 8 5 5 5 14 2 - 1 12 - - - - Manor Drive 2¼ 4 4 4 3 17 - - - 2 - - 1 - South Place 1⅜ 5 3 2 2 5 1 - - 1 - 3 1 - Gosbury Hill 5⅝ 10 4 10 5 19 - - - 5 2 - - - TOTALS 53⅜ 78 64 68 71 257 3 1 3 104 2 11 6 12 * There are two dental surgeries at each of these clinics. 33 Children Dental Care and Treatment Clinic Sessions devoted to treatment Examined Treated Completed treatment Scalings and gum treatment Fillings Silver nitrate treatment Crowns Inlays Extractions General anaesthetics Dentures Provided Radiographs Full Partial Grange Road 17⅞ 34 23 47 34 88 - - - 43 - 2 - - Acre Road * 44⅝ 144 87 77 34 308 36 - - 53 2 - 1 2 Roselands * 29⅛ 71 69 85 2 151 44 11 - 48 29 - - - Manor Drive 6⅝ 25 13 13 - 34 7 - - - - - - - South Place 3⅝ 14 7 15 - 21 11 - - - - - - - Gosbury Hill 17⅛ 32 17 53 2 54 42 - - 17 8 - - - TOTALS 119 320 216 290 72 656 140 11 - 161 39 2 1 2 There are two dental surgeries at each of these clinics. 34 DAY NURSERIES Two day nurseries were taken over from the Surrey County Council. These are Fairmead, Ewell Road, Tolworth, (42 places) and Canbury Park Road, Kingston, (46 places). Admission to day nurseries is restricted to the following priority categories: 1. Where the mother is the sole wage earner. 2. Where there is sickness in the family or where home conditions exist which are likely to prejudice seriously the health of the child. 3. Where, upon consideration of individual circumstances, it appears to the Council that admission is necessary in the interests of the child. All children are under supervision by the medical staff of the department. The following table shows the position as regards numbers on the registers and the waiting lists at the end of the year, and the average attendance during the year: Day Nursery Number of approved places Number on Register at 31.12.65. Average daily attendance during the year Number on waiting list at 31.12.65. Under 2 Age 2-5 Under 2 Age 2-5 Fairmead Tolworth. 42 11 31 7 24 43 Canbury Park Kingston. 46 7 32 7 28 22 TOTALS 88 18 63 14 52 65 35 The Nurseries and Child Minder3 Regulations Act 1948. The Borough Council is responsible under this Act for the registration of private day nurseries and daily minders. At the end of the year 19 nurseries providing a total of 387 places and 37 daily minders, authorised to care for up to 218 children, were registered. CHILDREN'S HOMES The Children's Committee has four homes in the borough and two in Esher. The premises are inspected quarterly by a medical officer of the Health and Welfare Department and a report is made on general conditions, cleanliness, ventilation etc. and on sleeping quarters, kitchens, dietary etc. Treatment of the children in all the homes is undertaken by the general practitioners concerned but in the four homes within the borough, departmental medical officers undertake the routine medical inspections when visiting, and on admission and discharge; they advise generally on the promotion of positive health of the children. HOMES FOR MOTHERS AND BABIES There are no homes for mothers and babies in the borough and there is no evidence that the demand would justify one During the period April to December 195 Council accepted financial responsibility for 35 unmarried expectant mothers sent to homes run by other authorities or voluntary organisations. The usual period of acceptance is for six weeks before and six weeks after confinement. CHILDREN "AT RISK" Cases of children who are thought to be specially susceptible to handicaps are reported at birth by midwives on special cards printed for the purpose. Prom these reports the "at risk" register is compiled and the medical and nursing staff pay particular attention to the babies who are included. Screening tests for impaired hearing are carried out and the babies are also watched carefully in case any evidence of the relevant abnormalities develops. The following are the 31 categories of babies included in the "at risk" register: A. Those with a family history of: 1. Deafness, blindness, neurological diseases, cerebral palsy, epilepsy, etc. 36 2. Congenital malformations (including congenital dislocation of the hip). 3. Mental disorder. 4. Mother unusually young or elderly. 5. Family in a "social problem" group. B. Those whose mothers suffered from any of the following illnesses during pregnancy: 6. Rubella (certainly) and other virus infections (possibly) in early pregnancy. 7. Toxoplasmosis. 8. Hyperemesis. 9. Threatened abortion. 10. Severe illness necessitating chemotherapy or major surgery occurring in the early months. 11. Exposure to radio-active substances during pregnancy. 12. Blood group incompatibilities. 13. Maternal diabetes. 14. Maternal thyrotoxicosis. 15. Toxaemia, 16. Uterine haemorrhage. 17. Hydramnios. 18. Multiple pregnancy. C. Babies born prematurely or displaying the following symptoms during the first week after birth: 19. Premature birth (i„e. 36 weeks and earlier). 20. Low birth weight in relation to gestational age. 21. Postmature birth (i.e. 42 weeks and later). 22. Abnormal presentation. 23. Prolonged, precipitate or instrumental labour. 24. Birth asphyxia. 25. Neonatal jaundice. 26. Presence of any congenital abnormality. 37 D. Babies showing the following difficulties or defects during the post-natal period: 27. Difficulties in sucking and swallowing. 28. Convulsions. 29. Cerebral palsy. 30. Meningitis or Encephalitis. 31. Any serious illness or infection in first few months of life. Children remain on this register until the age of five years when the information is transferred to the school health records. The total number of children on this register at 31st December 1965 was 2,208. Hitherto the number of babies born "At risk" have been given statistically at about 20% of the infant population, but of the 2,366 children born alive in the borough during 1965, 1,092 were added to the "at risk" register, a percentage of 46.5. Many of these develop normally and can be taken off the register when it is sure they are within the normal range. In addition the register is used to indicate children in the 0-5 age group who are likely to require special educational facilities. This also forms a basis for co-ordination between the mental health section and the other sections and departments concerned with the welfare and observation of pre-school children. Congenital Malformations 42 babies were notified at birth as congenitally malformed. Of these, 5 were stillborn and 7 subsequently died, 6 of the deaths being a direct result of the abnormality notified. 30 babies had survived at the end of 1965. Details were as over. 38 CONGENITAL MALFORMATIONS Total Malformations Reported Central Nervous System Eye Ear Alimentary System Heart and Great Vessels 49 (42 children) 13 2 6 5 1 Anencephalus 1 Absence of Right Auricle 5 Cases of Hare-lip or Cleft Palate or both 4 Congen ital Heart Disease 1 Microcephalus 1 Spina Bifida 1 Enlarged Left Pinna 1 Multiple abnormalities of heart 1 Anencephalus and Spina Bifida 1 Intestinal Atresia 4 Hydrocephalus and Spina Bifida 3 Stillborn 1 Stillborn 2 Died 2 Died 3 Hydrocephalics survived and discharged home 39 CONGENITAL MALFORMATIONS RespiratorySystem Urogenital System Limbs Other Skeletal Other Systems Other Malformations 2 4 14 - 1 2 1 Defect of Diaphragm 2 Renal Agenesis 10 Talipes Cyst on Neck 2 Cases of Mongolism 1 Multiple abnormalities of respiratory organs 1 Absent Foreskin 2 Polydactyly 1 Hydrocele 1 Syndactyly 1 Deformity of middle toe 1 Died 1 Stillborn 1 Died Cause unrelated to malformation (Notified talipes) 1 Died 40 THE WELFARE AND PREVENTION OF BREAK-UP OF FAMILIES Of the many social services available to promote the welfare of families, a high proportion are provided under the National Health Service Acts and are under-written by Housing Acts, the National Assistance Act, 1948, and the Children's and Young Persons' Act, 1963, Section 1. The need to co-ordinate the provision of the various services has long been recognised,, A joint circular issued to local authorities in July 1950, by the Home Office, the Ministry of Health and the Ministry of Education, gave suggestions for the setting up of local machinery to effect such co-ordination through meetings under the chairmanship of a co-ordinating officer. The medical Officer of health is the appointed officer for the borough. The majority of families are self-sufficient or may require a modicum of external help at particular times, e.g. illness giving rise to the need for a home help or a recuperative holiday, but there are some families whose social equilibrium is so finely balanced that any stress may put them "at risk". Such families often have multiple difficulties that can only be treated by infinite patience and skill, and require early diagnosis to ensure early treatment. This is likely to be more effective and to carry a higher chance of success in terms of prevention of break-up as well as being more economical of time than intensive work carried out at a later stage when break-up may be imminent. The health visitor plays an important part in early diagnosis and is supported in treatment by specially trained social workers within the department. Some families, however, are already known to workers in other departments, e.g. child care officers, probation officers, or may come to light through other symptomatic behaviour such as failure to pay rent or erratic school attendance. The formulation of a co-ordinated treatment plan may be made at case conferences called by the medical officer of health on being notified of families "a,t risk" and the general position and policy reviewed at co-ordinating meetings. During the year one co-ordinating meeting and eighteen case conferences were held. The position during the year was as follows; Date Number of families "At Risk" Number of children 1. 1.65. 49 212 31. 3.65. 43 176 Balance transferred to Esher 1. 4.65. 32 139 31ol2065. 67* 253 * In only five cases were neither health visitor nor social welfare officer involved. 41 The causes of failure or difficulty may be classified as follows: Cause No. of Families Marital 20 (29.8%) Material (Housing, Employment, Financial) 55 (83.5%) Disorders (Physical, Mental, Psychological) 34 (50.7%) Care of Home and Children 20 (29.8%) Desertion 8 (11.9%) Delinquency 6 (8.9%) Other Reasons 3 (4.5%) The total percentage is more than 100 as most families are included under more than one heading. One family sent to Frimhurst Recuperative Home because of low standards of child and home care, returned after six months' training to fresh accommodation provided by the Housing Department, and although still under supervision, has presented no major problems since. During the school holidays boys whose unsupported mothers found their care difficult in holiday time were financed for three weeks at camp. Recuperative holidays were also arranged for mothers and young children and for the children in one family so that the holiday coincided with their mother's confinement. Although much work with families "at risk" is carried out by staff of the Health and Welfare Department, the successful or even partially successful outcome in the majority of cases could not be effected without the close co-operation and assistance offered by other statutory and many voluntary organisations. PARTICIPATION IN SOCIAL WORK TRAINING The report of the Younghusband Committee in 1959 drew attention to the difficulties of ensuring adequate numbers of suitably trained staff to man the social work services, staff who would be able to perform "the essential function of social workers in health and welfare services, to assess the disturbance of equilibrium in a given 42 handicapped person and his family and social relationships so as to give appropriate help". The report recommended the setting up of courses at technical colleges to provide the necessary training in theory and practice, the latter to be carried out under the supervision of professionally trained workers selected by college authorities. During the year, which covers part of two academic years, a firm link has been established with Croydon Technicl College, following the request by the Lecturer in Charge of the Course of Social Work Training that suitably qualified staff should act as supervisors to the college's students,, Three members of staff have acted in this capacity and five students were placed within the department, as follows; one first-year student with the principal mental welfare officer, one first-year and one second-year student with the senior social welfare officer, and two second-year students with a psychiatric social worker at the child guidance clinic. A second-year student who completed training at the college in July 1965, was subsequently appointed to the staff of the child guidance clinic as a social welfare officer. MIDWIFERY SERVICE Mothers confined at home were cared for by 10 full-time midwives, 4 other full-time staff who devoted part of their time to home nursing and 3 part-time maternity nurses„ These were staff employed by the thorough Council and supervised by a non-medical supervisor and deputy, both of whom combined their posts with supervisory posts in the home nursing service. These midwives attended 618 domiciliary confinements and cared for a further 313 patients who were discharged from hospitals within ten days after confinement. They summoned medical aid in 76 cases. During the year 1,732 confinements took place in hospitals in the borough so that the domiciliary midwives dealt with 26.3% of all births occurring, and the hospital service with 73.7%. Training The training of midwives includes a period of three months with local authority midwives who have been approved as teachers. There were eight midwives who had been so approved in the borough's service, and during the year twentyfour pupil midwives received their three months' training. 43 HEALTH VISITING- At the end of 1965 the health visiting staff consisted of the superintendent health visitor, 16 full-time health visitors, 1 tuberculosis visitor, 4 part-time health visitors and 6 part-time clinic nurses. Approximately 20% of the health visitors' time is devoted to the school health service. The health visitor works from the clinic and her district covers a defined area. Most of her work is done in the home where she can talk with individuals in their own environment. She assesses the health potential of the individual and family group and teaches appropriate health education. The health visitor also assesses the health needs of the handicapped of all age groups, the implication of their care on the family, and their continued maintenance and support in the community. The health visitor is present at most of the clinics held at her centre. She co-operates with general practitioners, local hospitals, other social services, and voluntary organisations. Part of her time is spent in assessing the needs of the elderly, and her geriatric caseload has increased. Within the school health service, the health visitor acts a3 the chief link in health and social matters between the school and the home. She has close contact with the teaching staff and undertakes the health supervision of children of all ages, as well as the teaching of health education. The following table shows the numbers of cases of various categories visited by health visitors during 1965: Types of cases visited by Health Visitors during 1965 Number of Cases Children born in 1965 2,504 Children born in 1964 2,248 Children born 1960 - 1963 5,368 Persons over 65 484 Mentally disordered persons 136 Expectant mothers 745 Persons (other than maternity cases) discharged from hospital (other than mental hospitals) 21 Tuberculous households 5 The number of individual visits made to each case depends on the circumstances, for example, children under one year are usually visited more frequently than those over one year. In addition to the foregoing, the tuberculosis visitor visited 244 tuberculous households. 44 Attachment of Health Visitors to General Practitioners Arrangements have been made to commence in January 1966 for a health visitor to be attached to a group practice. She will visit at the request of the doctors and also advise at their infant welfare clinic. Health Visitors' Training In September 1965 an important change in the training of the health visitor was introduced. The Royal Society of Health ceased to be responsible for the examination of the student health visitor and responsibility for this duty became that of the newly established council for the training of health visitors. At the same time a new syllabus designed to cater for the much extended range of the health visitor's work was introduced. This syllabus is divided into five sections, as follows: Section I Development of the Individual Section II The Individual in the Group Section III Development of Social Policy Section IV Social Aspects of Health and Disease Section V Principles and Practice of Health Visiting. A further feature of the new training scheme was the introduction of fieldwork instructors. For this purpose one health visitor in the borough was selected for a course of training. During the year two student health visitors were admitted to the Surrey County Council Course and did their practical training in the borougho Immigrant Health The medical officer of health is notified by airports and seaports of new arrivals in the country and the address to which they are going. The health visitors then attend to offer advice on services and persuade them to register with a general practitioner and to have a chest X-ray if this had not been done on entry. 75 such immigrants were visited during the year. 45 HOME NURSING At the end of December 1965, the staff of the home nursing service consisted of the supervisor and her deputy who also acted as non-medical supervisors of the midwifery service, 15 full-time and 12 part-time home nurses and the 4 full-time persons who shared their time between the home nursing and midwifery services. The services of the district nurses are made available at the request of general practitioners. Evening calls are covered by a rota of nurses. Altogether 2,248 persons were nursed during 1965, involving a total of 84,559 visits. 44 cases (involving 421 visits) were under five years of age at the time of the first visit, and 1,453 cases (involving 66,647 visits) were over 65 at the time of the first visit. Special pads are supplied to incontinent patients who are receiving care from a district nurse. Training of District Nurses Training of district nurses was undertaken in co-operation with the Surrey County Council. The training courses for state registered nurses are of four months® duration, but if a nurse is also a state certified midwife, a shorter course of three months* duration is provided. Three weeks are spent on theoretical work at Brooklands Technical College, Weybridge, and the remaining time is devoted to practical training, the nurses being based at the Council's nurses' home at 21/23 Upper Brighton Road, Surbiton. During 1965, 10 students completed their district training and 3 of these were subsequently appointed to the staff of the department. VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation is reasonable in the borough, but in order to improve this it is proposed to have a national campaign during the forthcoming year. 46 Figures for the year were as follows: Smallpox (Under 16 years) Age at time of Vaccination Total Numbers Complications Reported Vaccinated Revaccinated 0-3 months - - - 3-6 months 7 - - 6-9 months 17 - - 9-12 months 32 - - 1 year 1,308 - - 2-4 years 104 - - 5-15 years 40 10 - TOTALS 1,508 10 - Diphtheria, Whooping Cough and/or Tetanus and/or Poliomyelitis (Under 16 years) Complete Primary Course Boosters Diphtheria only 2 26 Whooping Cough only 2 1 Tetanus only 217 62 Combined Diphtheria and Whooping Cough 3 3 Combined Diphtheria and Tetanus 23 1,941 Combined Diphtheria, Whooping Cough and Tetanus 2,077 1,088 Poliomyelitis only* 2,612 1,703 Quadruple 21 54 *These figures include 65 primary courses of SALK (injection) vaccine and 1 booster injection of SALK, the rest being oral type Sabin vaccine. 47 Total children receiving immunisation against the four illnesses whether given separately or combined: Primary Course Booster Diphtheria 2126 3112 Whooping Cough 2103 1146 Tetanus 2338 3145 Poliomyelitis 2633 1757 Smallpox vaccination of adults and injections for Typhoid, Paratyphoid and Cholera are normally given by the family doctor when requested for travel abroad. Yellow Fever vaccination is controlled by the World Health Organization and only certain centres are recognised for this, Grange Road Clinic, Kingston, being the one in this area. A fee of 10s.6d is charged far the vaccination. During 1965, 817 persons were vaccinated against yellow fever. 48 AMBULANCE SERVICE The Borough Council is not an ambulance Authority, this service being the responsibility of the Greater London Council. The service in the borough is co-ordinated from the main area control centre in New Maiden. PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis During 1965, 34 cases were reported in the borough and of these 32 were of respiratory tuberculosis. The 2 non-respiratory notifications referred to the glands of the neck and the spine. The corresponding figure for 1964 was 32, of which 44 were respiratory cases. On the 1st January 1965 there were 507 cases on the register and at the end of the year this figure had decreased to 478: Pulmonary N on-Pulmonary Total Males 271 14 285 Females 168 25 193 TOTALS 439 39 478 Whilst it can be claimed that fear and pessimism concerning tuberculosis have been largely removed from people's minds, and there is a 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 ineffectually of treatment are continually possible in these cases. It is to be hoped that in due course continued effects of improved living conditions, advances in therapeutic treatment,and facilities for early detection of tuberculosis by public mass X-ray sessions and B.C.G. vaccination of school children, will eventually bring the disease to the point of eradication. It is of special importance for the middle-aged and elderly to attend mass X-ray units. 49 The following tables show the work undertaken by the chest clinic at the Kingston Hospital during the period 1st April to 31st December 1965 insofar as it affects patients resident in the borough: Number of chest clinic sessions held 315 Number of attendances: New Patients 486 Old Patients 2,980 Total 3,466 Average attendances per session 11 Tuberculin Tests and B.C.G.Vaccinations Contacts School Children and Students Others Skin tested 101 10 31 Found positive 28 5 15 Found negative 62 4 13 Failing to return 11 1 3 Vaccinated 58 3 8 There were 2 pulmonary and 1 non-pulmonary deaths during the year. The non-pulmonary case was not known to the department and was not notified posthumously. It therefore had no effect on the final position of the register. The following table shows comparative figures of notified cases and deaths for the years 1961 - 1965 inclusive: Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratocry Total 1961 59 8 67 10 1 11 1962 62 2 64 6 - 6 1963 54 8 62 13 1 14 1964 44 8 52 8 2 10 1965 32 2 34 2 1 3 50 The efficiency of notification has been good and there is no reason to suspect refusal or neglect. Throughout the year no action was 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 tuberculous and other chest disease patients and their dependants by the Kingston and District Care Committee. During 1965, 72 families in the borough were helped by the committee in the form of grants for extra nourishment, clothing, fuel, removals, bedding, holidays, fares, pocket money etc. This is an invaluable service and is greatly appreciated by all those who receive its benefits. The following table gives an analysis by age groups of the new cases and deaths from tuberculosis during the year: Category New Cases Deaths Male - Female Under 1 year 1-4 years 5 - 14 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65 and over TOTAL Under 1 year 1-4 years 5-14 years 15-24 years 25-34 years 35-44 years 45-54 years 55 - 64 years 65 and over TOTAL Respiratory Tuberculosis M - 1 1 1 5 3 8 6 - 25 - - - - - - - 1 - 1 F - - - 3 1 1 1 1 - 7 - - - - - - - - 1 1 T - 1 1 4 6 4 9 7 - 32 - - - - - - - 1 1 2 NonRespir atory Tuberculosis M - - - - - - - - - - - - - - - - - 1 - 1 F - - - - - - - l 1 2 - - - - - - - - - - T - - - - - - - 1 1 2 - - - - - - - 1 - 1 51 Occupational Therapy Eleven chest patients received occupational therapy at the unit at 104 Westbury Road, New Maiden, and of these 7 suffered from tuberculosis. Persons admitted to Tolwarth Hospital with various chest complaints are also entitled to receive occupational therapy tfrwatment, but this i3 terminated upon their discharge from hospital unless the patient expressly asks for it to continue. Mass Radiography The following is a summary of the work of the Mass Radiography Units in the borough: Males Females Totals Total persons X-rayed 4,988 4,329 9,317 Cases found to be suffering from tuberculosis 7 2 9 Cases found to be suffering from lung cancer 8 2 10 Recuperative Holidays Patients are sent for recuperative holidays upon the recommendation of their general practitioners or hospital consultants, and during the year 35 recommendations were received, of which 21 came from general practitioners. 25 patients subsequently accepted the arrangements made far their recuperative holidays but one returned home before the expiry of the booked period. FAMILY PLANNING- The Borough Council made grants to each of the Kingston and Maiden, and Surbiton branches of the Family Planning Association and encouragement is given to the holding of sessions both in the evenings and, where possible, in the day time, at clinics. During 1965 a total of 234 sessions were held, at which 799 patients from the borough attended for the first time during the year, and altogether these patients made 6,504 attendances. 52 Family Planning Clinics Roselands, Tues.and Thur3. 6o30.p.m.-7.30opom. 163 Kingston Road,New Maiden. Alternate Mond. 6.30op«m.-7.30opomo South Place, Mond.and Thurs. 6o30opom„-7o30.p.m„ Surbiton. 1st Wed. each month. 6o30opom.-7.30op.mo Fridays 10.a.m.- 12.noon. 204 Acre Road, Kingston. Wednesdays 6„30.p.m.-7.30.p.m. LOAN OF NURSING EQUIPMENT The Kingston and Surbiton Divisions of the British Red Cross Society operate a scheme for the loan of nursing equipment on behalf of the Borough Councilo The scheme is intended to facilitate simple short term nursing care in the patients" homes, and under the arrangements deposits are collected from the patients by the British Red Cross Society and returned to the patients when the equipment is returned. Altogether 931 loans of nursing equipment were made during the year and the following table gives the details: Article Number on Inventories Total Loans during 1965 Periods for which loans were made Under 3 months 3-6 months Over 6 months Air Beds 1 2 2 - - Dunlopillo Mattresses - - - - - Air Bellows 2 2 2 - - Air Rings 36 61 60 1 - Bed Rests 30 77 61 14 2 Perfection Bed Pans 49 172 150 20 2 Bed Tables/Trays 9 14 12 2 - Invalid Chairs - Push Type 24 135 115 17 3 Invalid Chairs - Self propelling 2 2 2 . Commodes 16 149 116 28 5 Cradles 14 61 54 7 - Crutches-pairs 18 32 32 - - Douche Cans 4 - - - - Feeding Cups 12 12 12 - - Inhalers 5 - - - — Mackintosh Sheets (draw) 48 88 79 9 — Mackintosh Sheets (long) 12 24 18 5 1 Pillow Cases - Jaconet - - - - - Steam Kettles - - - — — Male Urinals 21 46 42 3 1 Female Urinals 9 11 8 3 - 53 In addition to the loans listed in the table, the Surbiton Depot loaned the following items of additional equipment during the year. The details as to the numbers on the inventory and length of period of the loans are not available: Walking Sticks 26 Bed Blocks 6 Sputum Cup 1 Bath Seat 1 Extending Grip 1 Carrying Chairs 3 Tripod Crutches 2 Walking Aids 2 Infra-Red Lamp 1 The Borough Council makes a grant to the British Red Cross Association in respect of the running of this service. 54 HOME HELP SERVICE The function of the Home Help Service is to meet the needs of people who for various reasons, such as home confinements, sickness, or old age, and who are either permanently or temporarily unable to carry out housework or who need assistance towards such tasks as shopping, cleaning or cooking. The service is permissive under Section 29 of the National Health Service Act 1946, and a charge, based upon the wages of the home help, is made for the service according to the number of hours of service given. Where the financial position of the family is such that they cannot afford to pay at this rate, either a reduced charge according to means is made qr the service is provided free. The staff consisted of a home help supervisor and her assistant and the equivalent of 60 full-time home helps. The great majority of home helps work part-time and the level of staffing was considerably below the approved establishment throughout the year, The following are details of the households assisted during the year: Category Number Assisted Persons aged 65 or over at time of first visit 620 Chronic sick and tuberculous 63 Mentally disordered 7 Maternity cases 222 Others 99 TOTAL 1,011 The total number of hours worked by the home help service was 54,575. 55 CHIROPODY The Borough Council took over the chiropody arrangements in operation under the Surrey County Council,, The service assists elderly persons, expectant mothers and the permanently and substarltially handicapped. There are direct and indirect schemes in operation. Under the direct scheme the patients receive treatment from the chiropodist of their own choice if approved by the Council.11 Chiropodists were so approved as at 31st December 1965. The indirect scheme was operated by the Surrey Association for the Elderly, acting as agents for the borough. The following is a summary of the number of persons treated: A. Persons Treated from l3t April - 31st December 1965. Local Authority Voluntary Organizations Total Persons aged 65 and over 1,234 699 1,933 Expectant Mothers 1 - 1 Physically Handicapped under 65 29 - 29 Blind, under 65 3 - 3 Totals 1,267 699 1,966 Note: Deletions during this time due to persons having died or leaving the district totals 61 persons. B. Treatments Given from 1st April - 31st December 1965. Local Authority Voluntary Organisations Total In Clinics None 3,636 3,636 In Patients' Homes 1,346 291 1,4-37 In Old People's Homes 404 Nil 404 In Chiropodists' Surgeries 4,561 Nil 4,561 Totals 6,111 3,927 10,038 MENTAL HEALTH SERVICES 59 MENTAL HEALTH It is pleasing to report the good progress made during 1965 in the services for the community care of the mentally disordered,, Kingston was fortunate in taking over a new combined junior and adult training centre for the subnormal0 The expansion of the combined mental health social worker and mental welfare officer staff has been most encouraging. Arim-i nistration The medical officer of health is responsible for the administration of the services, and the deputy and two senior medical officers are approved for the purpose of the Mental Health Act. A consultant psychiatrist from Long Grove Hospital;, who also holds outpatient clinics at Kingston Hospital, serves as a co-opted member on the Health and Welfare Committee0 He also acts as psychiatric adviser to the medical officer of health in regard to the appointment of mental health staff, and directs the mental health social work at the outpatient clinics. Even closer integration of hospital and community services is looked for in the future. Excellent relationships have also been established with the physician superintendent of Botley's Park Hospital and the staff of Queen Mary's Hospital for Children, Carshaltonj both these hospitals admit subnormals from the bprough. Staff The establishment consists of a principal mental welfare officer and seven other mental health social workers, of whom only three were appointed by 1st Aprils and only one of whom had acted as a mental welfare officer, By the 31»t December the staff had increased to a total of six, five of whom were authorised to act as mental welfare officers under the Mental Health Act, 1959c There is a national shortage of suitably qualified staff but the department has been singularly fortunate as regards recruitment. One of the original staff was a mental welfare officer of thirty years' experience, and two others, one of whom has since left the area, had several years' experience as mental health social workers. The principal mental welfare officer, appointed on 4th April, is a qualified psychiatric social worker, and during the year two university graduates with appropriate postgraduate diplomas joined the staff. Another member of staff, appointed on 1st April, is a psychiatric nurse of considerable experience who will be seconded for social work training at an early date. 6o It is intended that staff will be adequately qualified and experienced. The principal mental welfare officer is recognised as a supervisor of student training, and all staff will receive adequate in-service training. Mental Illness The mental health social workers under the principal mental welfare officer undertake psychiatric social work in the community with the mentally ill and their families including, where necessary, admission to hospital under the Mental Health Act, 1959. In the first part of the year primary consideration was given to cases necessitating hospital admission, because of shortage of staff. During the year considerable progress was made in the development of a comprehensive service. Particular effort was directed to establishing liaison with the hospitals serving the area, and mental health social workers from this authority now attend regular conferences at Long Grove and Brookwood Hospitals, and are responsible for the psychiatric social work at six out-patient clinics at Kingston Hospital. This close co-operation with the hospital service has led to increased contact with general practitioners, who may also request mental health social workers to carry out the functions of a mental welfare officer when compulsory admissions are contemplated. The social workers are authorised by the Mental Health Act, 1959 to request a domiciliary visit by a psychiatrist when acting as mental welfare officers. The dual role of mental health social workers has resulted in a welcome co-operation between the hospital, local authority and general practitioner services. The mental health social workers dealt with 367 patients discharged from hospital, attending out-patient clinics, or referred by doctors or other social work agencies. 2,208 domiciliary visits were made in addition to interviews at hospital out-patient clinics. Patients and their families may themselves seek help directly from the social workers. Admissions to Hospital On 1st April 1965 the whole borough was in the catchment area of Brookwood Hospital, Knaphill, Woking. On 1st October, Long Grove Hospital, Epsom, became the catchment hospital for the areas of the former boroughs of Kingston and Maiden, and will at a future date become responsible for admitting from the whole of the new borough. This has the advantage that it is about four miles distant from Tolworth, whereas Brookwood is twenty miles away. Between 1st January and 31st December, mental health social workers were asked to assist in the admission of 116 patients. 61 Admissions to Psychiatric Hospitals Quarter Total Referred Under Mental Health Act Informal with Psychiatric Consultation Emergency With Psychiatric Consultation 31st Jan to 31st March 24 22 2 Nil 1st April to 30th June 22 15 3 4 1st July to 30th Septem. 36 6 16 14 1st Oct. to 31st December 34 4 14 16 TOTAL 116 47 35 34 The practice has now been established that, except in cases of extreme urgency, the patient's own doctor or mental health social worker will arrange for the patient to be seen by a psychiatrist before compulsory admission under the Mental Health Act. The social worker acts in liaison with the doctor and psychiatrist and works in a supportive and reassuring role with the patient and the family in situations which are sometimes delicate and often unpredictable. The excellent co-operation between the doctors and social workers, and access to appropriate out-patient clinics by social workers has considerably reduced the number of acute emergency admissions, and many patients referred for compulsory admissions have entered hospital inf ormally. A marked change is evident in the mode of admission The table shows that over the year the number of acute emergency admissions fell from 22 in the first quarter to only 4 in the fourth quarter. Of the 34 patients notified in the last quarter, 30 were seen jointly by the general practitioner, psychiatrist, and social worker, and more than half (l6) accepted informal admission. There has been an increase in the number of patients referred for admission, but no increase in the numbers admitted under compulsory procedures. The increase has been wholly absorbed by informal admissions. This may indicate the growing confidence of doctors and psychiatrists in the ability of mental health social workers to alleviate the distress sometimes associated with compulsory admissions and has led to early referrals from which a fall in the number of future compulsory admissions might be expected. 62 Hostel Accommodation There is no hostel accommodation in the borough, and this has been provided by arrangement with the Mental After Care Association, the Cheshire Home Foundation and Richmond Fellowship. Special accommodation for confused elderly ladies has been available at the Woodbury Home organised by the Women's Voluntary Service, but unfortunately this home has now closed down because of administrative and staffing difficulties. During the year financial responsibility was accepted for hostel accommodation of 14 patients, as follows: Mental After Care Association 3 Female Cheshire Homes 3 Female Richmond Fellowship 1 Female and 2 Male Woodbury Home for Aged (W.V.S.) 5 Mentally confused elderly ladies. Social Club An informal social club, mainly for the interest of young adults, was formed two years ago on the initiative of one of the Surrey County Council social workers. Although without premises, they meet weekly, and as a group have joined a private club, from which social outings have been arranged, including visits to a promenade concert, the Commonwealth Arts Festival, a pantomime, and Hampton Court. It is intended that a similar club for housewives will also be started shortly. Mental Subnormality At the end of 1963 there were about 400 mentally subnormal adults known to the department whose home addresses were within the boundaries of the borougho Of these, 175 were reported as receiving hospital care and 225 living within the community. Of the latter number 37 were attending the adult training centre. In addition there were 86 mentally handicapped children under the age of sixteen. 38 of these children were known to be in hospital or in residential care and 37 children of school age were attending the junior training centre. Hospital Care The borough is within the catchment area of Botley's Park Hospital to whom application is made for the admission of all adult mentally subnormal patients. Children are referred either to Botley's Park Hospital or to Queen Mary's Hospital for Children, Carshalton, which also has provision for children with psychiatric problems or multiple handicaps. 63 Community Care Visiting Visiting of subnormal patients is carried out by the mental health social workers or health visitors and, with the co-operation of health visitors, special attention has been paid to the need of the pre-school child. This has indicated that there is a special need for nursery care or classes and some special home visiting in the future. Special Training Centre Kingston Training Centre received its first trainees on the 6th January 1965 under Surrey County Council. The centre was transferred to Kingston on 1st April and was officially opened by The Worshipful the Mayor, Alderman C.MoJudge, J.P., on Friday the 10th September 1965. The centre was originally built to accommodate a total of 93 trainees but by the end of the year 98 trainees were attending. 25 places are at present allocated for trainees resident in the London Borough of Richmond upon Thames. The centre comprises a special care unit for severely subnormal children, a junior training centre for children between the ages of five and sixteen, and an adult training centre and workshops for both sexes over the age of sixteen. The junior centre is divided into three classes at present. The children in Class I have an age range of five to eight years. This is the admission class and the programme is geared to the basic training of a two-year old child, the emphasis being therefore on play therapy, basic training habits, i.e. toilet training, feeding, and dressing themselves. It is hoped to start a new class for children under five so that training can start even earlier, but this is dependent upon the prior provision of other adult workshops. Transfer to Class II is decided at staff meetings, not on chronological age, but on the child's emotional stability and educational development In this class the age range is eight to twelve years. More formal education now begins, with concentration on recognition of everyday words and applying them to a given situation. By this time the children are usually toilet trained and able to act on their own initiative, but still under supervision. In Class III the age range is twelve to sixteen years, and here the results of training through the centre begin to appear. The children are taken out in small groups with the teacher to put into practice the things they have been learning in the class room. As they approach their sixteenth birthday they spend short sessions in the workshops learning the different routine of a work situation compared with a school situation. 64 At the age of sixteen years the pupils transfer to the adult centre, with wprkshops and domestic science and social training room. The workshops are run as far a3 possible like a factory, and special contracts for assembly out work have been obtained from local light engineering firms. These contracts are broken down into different stages of varying complexity so that every trainee can contribute to the completed part to the best of his or her ability. Trainees are paid for the work they do on a points basis, these being awarded for aptitude, output, social behaviour and attendance. Most of the trainees are so handicapped that they are most likely always to need some form of protected employment, but one young man managed to obtain normal employment during the year and it is hoped he will be the first of many. It is hoped to obtain a time clock for the trainees as a further incentive to a work situation, at some future date. Social and domestic training is also carried out for all the trainees. The young ladies in particular are responsible for all the laundry for the centre, including ironing. They prepare and serve staff teas and their own, and lay the staff and pupils' tables. They learn the care of their hair, personal hygiene, bed making etc. Cookery lessons are held twice weekly, which concentrate on the simple skills, with cooking of simple breakfasts and dinners. Trainees® education is continued with outings to shops, where they are responsible for their own purchases and giving and receiving correct change. The Staff of the Junior Centre This consisted of one supervisor and six assistant supervisors, together with three guide/assistants, who combine coach duties with domestic duties. Where necessary, social work on behalf of the families of children attending the centre is undertaken by a social worker. During the year two students were seconded to the centre from the National Association for Mental Health Training School for practical training for a period of six weeks each. The adult centre is staffed by three workshop supervisors. A physiotherapist attends for two sessions each week and a speech therapist for four sessions each week. Outings A combined outing for juniors and adults was arranged by the Kingston Voluntary Association in June to the Salvation Army playing fields. In addition, the juniors went to Bertram Mills Circus in November and the adults went to the Royal Tournament and the Wembley Ice Show. Sixteen children went to a summer holiday camp at Pirates Spring, by arrangement with the Surrey County Council. Activities in the centre included a harvest festival service in September, The Reverend E.M. Pi Ikington officiating. Produce collected was sent the next day, to various Homes in the district. A Christmas play and carol singing was also undertaken by the pupils of the training centre. 65 Kingston Society for Mentally Handicapped Children This voluntary society has been very active in assisting the centre in many ways. They have provided a good deal of equipment including slides, swings, a projector, record player, wireless, tank of fish etc. They also arranged a number of outings. Their generosity and interest are very much appreciated,, Residential Care There are no hostels in the borough for the mentally subnormal, but during the year financial responsibility was accepted for residential care of subnormal patients unable to be cared for at heme and not requiring hospital admission, as follows: Adults Place Organisation Category of Patients Boarded out Guardianship Society Two adult females StoTeresa's Convent The Sisters of the Sacred Heart of Jesus and Mary Two adult females National Hostels and Workshops, Slough. One adult male (now transferred to training centre, Surrey County Council). Children Place Organisation Category of Patients Sendhurst Grange Surrey County Council Two girls and one boy St. Francis School, Buntingford. The Sisters of the Sacred Heart of Jesus and Mary One boy The Grange, Hindhead. Private Home One girl WELFARE SERVICES 69 WELFARE OF THE AGED The following six residential establishments for the accommodation of aged persons were taken over from the Surrey County Council: Establishment Beds 12 Langley Avenue, Surbiton. 21 14 Langley Avenue, Surbiton. 27 26 Langley Avenue, Surbiton. 27 Fircroft, 96 Ditton Road, Surbiton. 26 Fairlawn, Warren Road, Kingston Hill. 31 Coombe Oak, Warren Road, Kingston Hill. 33 Total 165 In addition the Borough Council was allocated 40 beds in Kingsmead, Richmond, a large general establishment administered by the London Borough of Richmond. Two other residential homes situated within the borough, 45 Langley Avenue, Surbiton, 31 beds, and Maiden Homes, Percy Gardens, Worcester Park, 110 beds, were allocated to the London Boroughs of Croydon and Sutton respectively,, All the establishments taken over are converted houses of about 60 to 80 years standing, and were originally acquired by the Surrey County Council for evacuees during the early war years. Although a certain amount of adaptation had been carried out they were in poor condition, and inconvenient for the purpose for which they are being used. Shortly after the new borough came into being a full inspection of all the homes was carried out by a Ministry of Health Regional Welfare Officer, who reported that all the establishments were overcrowded by Ministry standards, and stated that an overall reduction of 14 residents, including 7 ground floor female beds, would be required at the earliest possible time. It was indicated that the report to the Minister would include a recommendation that the most sympathetic consideration should be given to any applications for loan sanction to improve the conditions and provide additional accommodation. Waiting List On the 1st April 1965. 26 men and 66 women were awaiting admission to residential accommodation. During the year 11 men and 47 women were admitted to homes administered by the Borough Council, and at 31st December 1965, there were 25 men and 71 women awaiting admission. Many of these have been on the list for two or more 70 years because of the lack of suitable accommodation, mainly ground floor beds, and the high incidence of emergency admissions of persons who had only recently, or not previously, applied. On several occasions there have been no vacancies in the Council's homes, notwithstanding extra beds being put up (resulting in further overcrowding), and emergencies have only been met with the assistance of other welfare authorities. Holiday Admissions It has, for some years, been the practice of welfare authorities to allocate a proportion of vacancies for short-term admissions to enable relatives who are caring for aged persons within their own homes to take a holiday themselves. In the year under review 11 such admissions were made. There will be considerable difficulty over the allocation of vacancies for this purpose during the coming year, in view of the pressure on beds, but every effort will be made to satisfy at least the most urgent demands. The most difficult aspect of this service is the impossibility of guaranteeing vacancies in advance to enable relatives to book holidays. Casual vacancies at short notice can rarely be used to advantage for this purpose. New Accommodation In an effort to overcome the immediate shortage of accommodation, the Health and Welfare Committee are considering the purchase of a privately run home for old people outside the borough. This home, equipped for 23 residents, has been inspected by the Regional Welfare Officer of the Ministry of Health, who is prepared to recommend loan sanction, and if negotiations are satisfactorily concluded, the establishment could be brought into use with minimal delay and would go some way towards relieving the more immediate shortage of accommodation. Approval has also been given by the Ministry for the erection of a new purpose-built home for 50 residents in the grounds of Coombe Oak, Warren Road, Kingston Hill. It is also proposed to install a "Shepherd" lift to the first floor at Coombe Oak and Fairlawn to enable the beds on these floors to be used by the more infirm type of resident. Provision has been made in the Council's capital estimates for 1966/67 for the projects enumerated above, but it is not anticipated that the new building at Coombe Oak will be available before 1968 at the earliest. In addition provision was made in Revenue Estimates for the improvement as far as possible of existing accommodation. 71 Also included for the forthcoming year in the Ten-Year Plan was an extension to Pircroft, 96 Ditton Road, Surbiton, to provide accommodation for 24 extra residents and to bring the existing accommodation up to Ministry of Health standards for both residents and staff, but the Council decided that this project should be withdrawn from the estimates for 1966/67 in view of the need for financial economies. Staff Great difficulty has been experienced in the recruitment of suitable staff for the residential homes. Non-resident daily staff find that the shift work does not fit in with their private lives and the ready availability of more congenial work with regular hours at the many industrial establishments within the borough adds to the difficulties„ So far as residential staff is concerned, recruitment has been greatly hampered by the lack of accommodation of a standard nowadays demanded by staff. The staff bedrooms are generally small and ill equipped and there are virtually no facilities for the entertainment of relatives or friends when off duty. However ways and means of improving these facilities without detriment to the number of beds occupied by residents will be sought and put into effect as and when possible. Homes Administered by Voluntary Organisations Many voluntary organisations maintain their own homes for aged persons who satisfy their individual requirements for admission, for example, past profession, religion or domicile, and the accommodation thu3 provided makes a valuable contribution to the welfare of the old people„ To offset the acute shortage of vacancies within the borough considerable use has been made of these facilities, including holiday provision, during the year under review, the Council accepting financial responsibility in each case for maintenance costs. 72 Persons resident in accommodation provided by voluntary organisations: Physical Category Age Sex 1.4.65. 31.12.65. Not materially handicapped Aged M 12 15 F 36 34 Not Aged M - _ F — — Blind Aged M — — F 3 6 Not Aged M - - F 1 1 Epileptic Aged M 2 2 F — - Not Aged M 4 5 F - — Others physically handicapped Aged M 1 1 F 1 1 Not Aged M 4 4 F 6 5 Deaf Aged M — — F 1 - Not Aged M - - F - - Totals 71 74 The persons listed are living in 31 homes in all parts of the country. These homes cater for people requiring specialised care or a particular sectarian environment together with those who provide general care and attention exclusive of any admission requirements. It is anticipated that the use of this type of home will continue until the Ten-Year Plan for borough welfare services is nearly complete and probably even afterwards. 73 The majority of people for whom residential accommodation is provided are elderly and the main difficulty in their plaqement is simply pressure of numbers. With other types of disability the problem is more profound and is giving rise to much anxiety. In south-east England the average time a person remains on a waiting list is now two years. This varies from six months for the blind (although this period is much increased for people over the age of eighty, the majority of Kingston cases at the present time) to, in one instance, five years for a person suffering from multiple sclerosis. The homes for the aged provided by Kingston, Maiden,and Surbiton Old People's Welfare Committees or Voluntary Committees, also make a most valuable contribution to this problem, as do other facilities provided by them. Residential Accommodation in other Local Authorities' Homes 140 old people from the borough are accommodated by other local authorities; many of these were taken over from the Surrey County Council. Sometimes for family or sentimental reasons a resident of the borough asks to be accommodated in some other area, and where possible appropriate arrangements are made. However, most other authorities are in the same position and this cannot always be arranged. Twice during the year other local authorities have assisted with emergency vacancies when it has not been possible to provide accommodation locally, and thanks are tendered to the London Borough of Barnet and to the Surrey County Council for their generous help. 74 residents in the borough Council's Homes are the responsibility of other local authorities. The Borough Council maintains one epileptic at Langho Colony, near Blackburn, which is a Manchester Corporation Home. All residents outside the borough for which this authority has accepted financial responsibility are visited once a year by welfare officers from the authority in which their home is situated, who submit reports. Registration and Inspection of Disabled Persons' and Old Persons' Homes Under Section 37 of the National Assistance Act, l948, the Council is responsible for the registration and inspection of disabled persons' and old persons' homes and there are now four registered voluntary homes and thirteen registered old persons' homes within the borough. Included in the thirteen are two homes which were registered during the year. 74 The registered homes have been regularly inspected and have continued to be run satisfactorily. Thirty-five visits were made during the year. Domiciliary Services Meals on Wheels Service The purpose of a meals on wheels service is to provide an adequate mid-day meal delivered to the home of any aged, infirm or physically handicapped person who would benefit materially from the service. During the year under review a meals on wheels service has been operated by four separate voluntary organisations, as follows: Total per week Surbiton Old People's Welfare Committee 10 meals 5 days a week at ls.6d 50 British Red Cross 40 meals 3 days a week at ls.6d 120 Maiden and Coombe Old People's Welfare Committee 40 meals 4 days a week at ls.4d 160 Kingston Women's Voluntary Service 100 meals 3 days a week at 1s.3d 300 Total 630 The meals provided and the cost of transport has been subsidised from the General Rate Fund by both direct and indirect grant and members of the voluntary organisations concerned have donated their services. Great difficulty has been experienced by the voluntary organisations in maintaining this service. In particular the Kingston Women's yoluntary Service, who have had the meals cooked by a cafe under contract arrangements, were informed by the proprietors that the cafe was to be sold. It could not be expected that the new owners would be prepared to continue to provide this service, but efforts to arrange alternative cooking arrangements were unsuccessful. 75 The maintenance and expansion of this service is considered vital to the proper conduct of the welfare services and accordingly the Borough Council decided to supplement the service for the maintenance of the meals on wheels service whilst at the same time continuing to make full use of the voluntary workers who have hitherto given so generously of their time., To this and the former staff canteen situated at the rear of the Surbiton Council Offices has "been allocated for use as a meals on wheels kitchen and the service will he inaugurated early in 1966. Staff will he employed on the establishment to cook and serve the meals which will continue to be distributed by the voluntary organisations. The value of a meals on wheels service is in direct relation to its availability in that persons who cannot provide their own hot meals require help as often as possible. Past experience has shown that relatives and neighbours almost invariably provide help at week-ends but that during the working week it is frequently necessary to provide a home help on those days that meals on wheels are not available. It is intended that the Council's meals on wheels service will provide meals on five days a week wherever they are required. WELFARE OF THE HANZDICAPPED A register of physically handicapped persons is maintained in accordance with Section 29 of the National Assistance Act, 1948, whereby a local authority has power to make arrangements for promoting the welfare of those persons who are blind, deaf or dumb, and others who are substantially and permanently handicapped by illness, injury, congenital deformity or any other disability that may be prescribed by the Minister of Health. The Blind Register A register is kept of those persons who wish to obtain the advantages of registration and come within the definition of blindness given in the Appendix III to the Ministry of Health Circular 4/55, namely, "so blind as to be unable to perform any work for which eyesight is essential". This disability refers to any work and not the particular occupation of the person being examined, and does not take account of any other physical or mental defect. 76 The following is a summary by age of persons appearing on this register at 31st December 1965: Age Period Registered Blind Persons at 31st December 1965. New Cases Registered in 1965. Male Female Total Male Female Total Under 1 - - - - - - 1 - - - - - - 2 - - - - - - 3 - - - - - - 4 - - - - - - 5-10 3 - 3 - - - 11 - 15 - 1 1 - - - 16 - 20 - 1 1 - - - 21 - 29 1 3 4 - - - 30 - 39 5 3 8 - - - 40-49 10 7 17 - - - 50 - 59 22 5 27 1 - 1 60-64 3 11 14 - - - 65 - 69 8 22 30 1 4 5 70 - 79 23 48 71 1 5 6 80-84 14 36 50 1 5 6 85 - 89 8 30 38 - 2 2 90 and over 9 27 36 1 1 2 Unknown - - - - - - Totals 106 194 300 5 17 22 Of the four children aged under sixteen on the register, two are attending special schools for the blind. The other two are unsuitable for education at school; one is at home and one is in a hospital for mentally subnormal children. 77 Five-sixths of the registered blind are over the age of sixty. The age of onset of blindness is as follows: Age Period Age at onset of Blindness Male Female Total Under 1 13 12 25 1 - - - 2 - 2 2 3 - - - 4 - - - 5-10 - 1 1 11 - 15 1 3 4 16 - 20 3 1 4 21 - 29 10 2 12 30 - 39 12 6 18 40-49 8 12 20 50 - 59 7 14 21 60-64 5 11 16 65 - 69 6 18 24 70 - 79 20 53 73 80-84 7 33 40 85 - 89 5 15 20 90 and over 4 3 7 Unknown 5 8 13 Totals 106 194 300 78 Employment of Registered Blind Persons The following tables indicate the pattern of full-time employment of persons on the register: Persons in full employment under ordinary conditions Age Groups: 16-20 21-39 40-49 50-59 60-64 65 and over Total Employed Male - 4 8 12 2 2 28 Female - 3 5 - 1 1 10 Totals - 7 13 12 3 3 38 The people in this table are engaged in the following occupations: Physiotherapist 1 Boot and Shoe Repairer 1 Lecturer 1 Piano Tuner 1 Musician 1 Production Process Typists 5 Workers i.e. Factory Telephone Operators 7 Hands 10 Shop Assistant 1 Labourers 2 Gardener 1 Porter 1 Machine Tool Operators 2 Miscellaneous Workers 3 Storekeeper 1 Total = 38 In addition, the Council is responsible for one home worker and two employees in sheltered workshops. Homes for the Blind The Borough Council has 20 people in residential accommodation provided under Part III of the National Assistance Act, 1948. Only 7 of these are in designated homes, and it is becoming increasingly difficult to find vacancies in this type of accommodation. There are relatively few homes within reasonable travelling distance, and the pressure on these is likely to become more acute. The waiting list contains 15 names of persons who really 79 need a specialised home, and it seems unlikely that this will be forthcoming. Some blind people have been admitted to the Council's Old People's Homes. This arrangement has not always been successful because the properties are old and thus unsuitable for this type of resident. Many vacancies are required for this category of handicapped person. Although no home for the blind is envisaged in the Plan, no difficulty is foreseen in accommodating a small number of blind persons in purpose built old people's homes. The borough is being extensively redeveloped and many of those people on the Blind and Handicapped Persons Registers live in older property which is to be demolished. In consequence the health and welfare department has been called upon and will continue to be called upon to accommodate those people whom the housing department is unable to help, viz. those too old to be granted a tenancy, or too infirm to transfer to warden controlled accommodation. Whilst provision has been made in the Ten-Year Plan for this eventuality, it serves to emphasise that the Plan is conceived as a realistic attempt to meet the needs of the borough. Several voluntary organisations have been particularly helpful this past year. The British Diabetic Association who kindly allowed the use of beds at Frederick Banting House, Kingston Hill, on a short term basis, and the Society for Foreigners in Distress who made beds available on a permanent basis at Libury Hall, near Ware, both extending help beyond the scope of their respective constitutions. For these and many other individual services this authority is very grateful. Social Welfare Officers for the Blind With 300 people on the Blind Register and 52 on the Partially Sighted Register, the borough's two social welfare officers with special responsibility in this field, being qualified home teachers, have larger caseloads than those suggested by the Minister of Health in Circulars 3/51,4/63, namely, 100 blind persons and 20 partially sighted persons per officer. Their duties are to visit the blind and give instruction in reading and writing embossed type (Braille and Moon), and various handicrafts etc. They assist the blind generally by reading aloud, writing letters, helping to solve domestic problems, and assisting the newly blind to adapt to their handicap. They also run a weekly handicraft class in Surbiton. 80 During the year assistance was given as follows: 3 newly blind people were sent on social rehabilitation courses; 20 people were in attendance at the handicraft class; 26 people made articles in their own homes as occupational therapy; 4 people were taught Braille; 5 people were taught Moon; 16 people were given radio sets supplied by the British Wireless Fund for the Blind. Partially Sighted Register Partially sighted persons are defined as "substantially and permanently handicapped by congenitally defective vision, or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character". The following is a summary by age of those persons at present included on the register: Age Groups: 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - 1 - - 7 5 11 24 Females - - 2 - 3 4 20 29 Totals - 1 2 - 10 9 31 53 Six new cases were admitted to the register during the year. They were all over the age of sixty-five. Thanks are tendered to the Surrey Voluntary Association for the Blind who have helped to maintain these welfare services and who will continue to help until 31st March 1966. The services they carry out will be taken over by a new Kingston upon Thames Association for the Blind, which it is hoped will be established early in the new year. 81 The following table gives details of all handicapped persons on the register, other than those who are classified as blind, as at the 31st December 1965: Age Groups: Children under l6 Persons 16-64 Persons 65 and over Handicapped Persons (Deaf with Speech) M - 7 — F - 4 - Handicapped Persons (Deaf without Speech) M - 16 3 F — 16 1 Handicapped Persons (Hard of Hearing) M - 2 - F - 2 1 Handicapped Persons (General Classes) M 3 101 36 F 1 162 106 Totals 4 310 147 Social welfare officers visit those persons on the register and as far as possible efforts are made to integrate them into the community. Domiciliary Visiting In the combined health and welfare department the field work services are covered by a team of social welfare officers led by a senior social welfare officer, and have been organised into an integrated social work section responsible for the visiting of the aged, blind, handicapped and problem families. Two home teachers for the blind redesignated as social welfare officers are incorporated into this team. 82 The cases in each category being dealt with at the 31st December 1965, and the average monthly visits, including abortive visits, were as follows: Cases on the Register Average Monthly Visits Abortive Visits Aged 96 119 16 Blind and Partially Sighted 352 222 19 Deaf 52 7 1 Physically Handicapped 409 116 9 Problem Families 67 90 13 Temporary Accommodation 1 3 1 Occupational Therapy This service operates from the Occupational Therapy Centre, 104 Westbury Road, New Maiden. Surrey County Council were unable to hand over the centre on the 1st April 1965 as their new centre which was being erected at Leatherhead was not completed, and the centre was still being shared with the County Council at the end of the year. An occupational therapy class and an art class have been held at fortnightly intervals throughout the year and interest was well maintained, the patients undertaking a great variety of work. These classes were in the main held in the Methodist Church Hall, Ewell Road, Surbiton. By arrangement with the Surrey County Council a specially adapted ambulance vehicle was provided to collect patients from their homes and take them to the centre. It is an intention that these classes should be enlarged and will be held in the Council's own centre. Aids and Adaptations At the 1st April 1965 the Surrey County Council handed over 19 applications for adaptations and aid received from residents within the borough. 45 applications were received up to the 31st December 1965, and of these 36 were completed, leaving 28 still to be done. The 36 completed aids were as follows: Bathroom aids (special seats, rails, etc.) 14 Ramps for invalid chairs 4 Structural alterations to premises 7 Others (walking aids, lifting poles, etc.) 11 83 Employment Local authorities are given wide powers for promoting the employment of physically handicapped persons. Many of the persons included on the register are in fact fully employed and self supporting. During the year under review no one has been placed in sheltered employment, as distinct from residential accommodation under Part in of the National Assistance Act, 1948. Outwork A pilot scheme to introduce occupational therapy by means of simple work which patients could undertake in their own homes and at the same time enjoy financial benefit from their work, was introduced in July by arrangement with a commercial undertaking; this operated very satisfactorily until early December when the supply of work ceased. This scheme was very popular and it is hoped to introduce a permanent scheme in the coming year. Some difficulty was experienced in the collection and delivery of work, however, and the purchase of a suitable vehicle and driver was provided for in estimates for the coming year. It has been necessary to forego this because of the economies that have had to be made, which means that only a small number of persons will be able to enjoy the benefits of this scheme in the foreseeable future. Trade Orders Many of the patients are remarkably proficient at work such as toy making and canework. Articles made are sold to the trade and privately, and regular orders are received from a variety of firms. The patients pay for the materials supplied and receive the payment made by the purchasers for the articles produced. It is a source of great satisfaction to these workers that the articles they produce are able to withstand competition of the open market. Recaning of chairs has also been introduced during the year with considerable success, and orders are now being received regularly for this work. Sales of Articles A quantity of articles are constantly being produced for which there is no ready market. To assist with the disposal of these a window of the Women's Voluntary Service's Centre in Ewell Road, Surbiton, was lent for display purposes, but this will have to be discontinued as the Women's Voluntary Services Headquarters feel unable to allow the sale of articles on its premises. 84 Occupational Therapy at Homes for the Elderly Regular occupational therapy sessions are held at the Council's Old People's Homes and the residents take great interest in their work. Materials are purchased from the residents' comforts fund, and the finished articles are sold on the premises by the matrons for the benefit of the fund, although a resident wishing to purchase an article made may do so for the cost of the materials involved. Voluntary Workshops The Kingston Spastic Centre provides a workshop at 13 Geneva Road, Kingston upon Thames, for about 26 spastic and handicapped young persons, of whom approximately 15 live in the borough. The centre makes a good contribution to the welfare of the handicapped in the borough. Recreation and Voluntary Work The remainder of the services which are provided for physically handicapped persons can be described as recreational. These involve grants to clubs and provision of holidays. There are in the borough a number of organisations which run social clubs, as listed below, for handicapped persons, and receive grants from this authority. Their efforts in this field are much appreciated. In the year under review holidays for 30 handicapped people have been arranged by the Surrey Voluntary Association for the Disabled acting as agents of the Council. This service has now been assimilated in the health and welfare department and arrangements are well in hand for holidays for 1966. Clubs for the Handicapped Club Meetings Honorary Secretary Kingston and Surbiton Guild of the Crippled, Presbyterian Church Hall, Grove Crescent, Kingston upon Thames. Fortnightly Tuesday afternoon Mrs.J.Fraser Day, "Willowend" Manor Close, East Horsley. (cont.) 85 Club Meetings Honorary Secretary Kingston Endeavour Club, Bedelsford School, Grange Road, Kingston upon Thames. 2nd and 4th Thursday each month evenings Mrs.A.Carter, 4 Preston Close, Strawberry Hill, Twickenham. Multiple Sclerosis Society, Methodist Church Hall, Ewell Road, Surbiton. 3rd Tuesday each month afternoon Miss M.J.Sellers, 2 Bramley Mansions, Berrylands Road, Surbiton. Davis - Darby and Joan Club, Deaf and Dumb, Christ Church Hall, The Retreat, King Charles Road, Surbiton. Fortnightly Thursday afternoon Mr.G-.Gibbs, 27 Rodney Close, New Maiden. Surbiton Deaf Club, Meals on Wheels Canteen, Ewell Road, Surbiton. Fortnightly Thursday afternoon Mr.C.Marsh, 94 Manor Green Road Epsom. Spartan Swimming Club, Kingston Baths, Denmark Road, Kingston upon Thames. Weekly Thursday evening Miss L.Kilpatrick, 38 Thorkhill Road, Thames Ditton. Surbiton Blind Club, Meals on Wheels Canteen, Ewell Road, Surbiton. Alternate Tuesday afternoons Mrs.D.Yorke, 219 Ewell Road, Surbiton. Surbiton Blind Club, Meals on Wheels Canteen, Ewell Road, Surbiton. Alternate Wednesday evenings Miss M.Baughton, 30 Winterdown Road, West End, Esher. Kingston and District Social Club for the Blind, Congregational Hall, Union Street, Kingston upon Thames. Alternate Wednesday afternoons Mrs.E.Jutsen, 38 Chesham Road, Kingston upon Thame, 86 OTHER WELFARE SERVICES Receivership The Chief Welfare Officer has been appointed as the officer of the Borough Council responsible to act in matters of Receivership. A Receivership is required where,after considering medical evidence, the Court of Protection is satisfied that a person is incapable by reason of mental disorder of managing and administering his property and affairs. The appointment of a Receiver is at the discretion of the Court of Protection, and it may happen that although the Council take action to secure a Receivership, an officer of this authority is not appointed as Receiver. This has happened on one occasion during the year. There are three further cases which are in the process of being considered by the Court of Protection and this department. Burial and Cremation The Borough Council has a duty under Section 50 of the National Assistance Act, 1948, to cause to be buried or cremated, the body of any person who has died or been found dead in the borough, in any case where it appears that no suitable arrangements for the disposal of the body have been or are being made, otherwise than by the authority. Five persons were buried and one cremated under this Section this year. Four were residents in accommodation provided by the authority under Part III of the National Assistance Act,1948, one was recovered from private premises at the request of a doctor, and one from Kingston Hospital mortuary after an inquest. Safeguarding Property The Borough Council has a duty under Section 48 of the National Assistance Act, 1948, to protect or deal with any movable property where no suitable arrangements have been or are being made when a person is admitted to hospital or a residential home. There have been few calls on this service. Many of the responsibilities under this Section have been obviated by the appointment of a Receiver. ENVIRONMENTAL HEALTH SERVICES 89 ROYAL BOROUGH OF KINGSTON UPON THAMES. ANNUAL REPORT OF THIS CHIEF PUBLIC HEALTH INSPECTOR 1965. Tel; Elmbridge 5111 Environmental Health Section9 Ext. 203 Health and Welfare Department Tolworth Tower, Surbiton0 To the Mayor, Aldermen and Councillors of the Royal Borough of Kingston upon Thames,, Mr. Mayor, Ladies and Gentlemen, I have the pleasure of reporting upon the work of the Environmental Health Section of the Department during the first year since the inception of the new Royal Borough of Kingston upon Thames. For the first three months of the year the section worked in the offices of the former Authorities, located at Kingston, Surbiton and Maiden and it was during this time that the staff of the three Boroughs cooperated closely in preparation for the amalgamation on the 1st April and the move to Tolworth Tower was made during the first week of March„ From that time onwards the staff worked as a team and it is fitting to pay tribute to the willing co-operation of everyone making the transfer a smooth operation which, apart from the very severe problems of staff shortage. was accomplished with little detriment to the service provided to the general publico The staff shortages were most keenly felt among the workmen and it is regretted that it was not possible to maintain all the services of the three former Boroughs, but by the autumn the difficulties in this direction had been overcome and it is anticipated that in future the section will be able to provide a prompt and efficient service to the ratepayers. For the whole of the year there has been a shortage of Public Health Inspectors, but the willing co-operation of the inspectorate has enabled progress to be made. 90 As its title implies this section of the department is concerned with the health of the Borough in all matters relating to the environment in which we live. It will be the policy of the section to pursue a progressive outlook towards the problems associated with higher standards of living, for maintaining high standards where they exist and for securing improvements where they are necessary. In the past the problems associated with dirt and disease have been the main concern of the Health Department but in the future we will be concerned with health education,, the improvement of those houses which lack those amenities which in the 1970s will be regarded as essential, the maintenance of basically sound houses, the elimination of the pollutants from the atmosphere from whatever source they may emanate, the reduction of noise to ensure maximum enjoyment of leisure time and better conditions at work, improved standards in the techniques associated with the handling and presentation of foodstuffs and encouraging an awareness of the need for a high standard of comfort for workers in industrial and commercial premises. In the field of health education, much can be done by co-operation with the organisations in the Borough and it is hoped that those concerned with education and community welfare will take advantage of the services we can provide. The Council. being aware of the policies of the former Royal Borough of Kingston upon Thames and the Borough of Maiden & Coombe, decided to continue with the introduction of Smoke Control Areas as decided by those Authorities, and it has now been decided to extend this policy to the whole Borough,, This is a progressive step which, when completed by 1978 will have virtually eliminated pollution of the atmosphere by smoke from the area, made a valuable contribution to the campaign for cleaning the atmosphere in the Greater London Area and, so far as tho3e parts of the Borough which have little or no pollution, preserved for them the advantages of clean air which they now enjoy. According to the 1961 census there were 45,624 dwellings in the Borough; of these 1,384 were shared;, 4,641 lacked a hot water supply and 3,928 a fixed bath. Whilst many of these houses may not be suitable for improvement by reason of their age and condition, those which are basically sound should possess the essential amenities and an intensive campaign is to be pursued during 1966 to encourage the owners of such property to take advantage of the Council's improvement grant schemes. In recent years there has been a considerable change in marketing of food stuffs and this will continue, particularly with regard to the distribution of milk. The Council is aware of the hazards associated with the processing of food stuffs and will continue to pursue its policy of requiring a high standard of cleanliness in food premises and has recently 91 authorised an investigation into pesticidal residues in food stuffs; the Regulations concerning market trading are awaited with interest. The Report contains details of the work done to secure the implementation of the provisions of the Offices, Shops and Railway Premises Aot and as an indication of the Council's concern and desire for further progress, the staff will be augmented. It is emphasized that this section of the department does not work in isolation but regards itself as part of the health team and cooperatars closely with all sections of the Health and Welfare Department and also with the other Departments of the Council,, As an indication of this, many of the duties which might well be described as Public Control are carried out by the Public Health Inspectors working closely with the Town Clerk and his staff. The staff of this section and I are indebted to the Medical Officer of Health and colleagues in the Department and other Departments of the Council for their co-operation during this first year and I am particularly grateful to the late Chairman and to the Chairman and the Vice-chairman and meabers of the Committee for their co-operation and understanding of the problems associated with our work. P.E.KINTON Chief Public Health Inspector. 92 ENVIRONMENTAL HEALTH„ 1. WATER SUPPLY„ The whole of the area is supplied by the Metropolitan Water Board and the supply has been satisfactory both as regards quantity and quality,, In view of the large number of routine bacteriological and chemical examinations carried out by the Water Examination Department of the Board it was not considered necessary to make routine tests but three samples were taken when investigating complaints and proved to be satisfactory. Well water is used for industrial purposes at certain factories, but is not used for domestic consumption all the houses in the town being provided with a main water supply. Fluoridation is commented upon in the preamble to the report by the Medical Officer of Health„ 20 SWIMMING- BATHS AND POOLS. (a) Public. The Corporation's indoor swimming baths are situated in Denmark Road, Kingston upon Thames 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 and other purposes. In addition there is an instructional pool. The baths 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 chlorine. The Surbiton Lagoon, situated in Raeburn Avenue, Surbiton, is an open air pool 165 feet long and 90 feet wide, with a depth of three to nine feet0 There is also a paddling pool for small children0 The water is from Metropolitan Water Board mains and is treated by continuous pressure sand filtration, sterilisation by breakpoint chlorination and oxygenation over an ornamental cascade,. Periodical samples of water are taken by the Borough Surveyor and the plant is adjusted as necessary. In addition 25 samples were taken by the Health and Welfare Department for chemical and bacteriological examination, all of which proved to be satisfactory. 93 (b) School Baths .One private school has a small swimming bath which is used only by scholars and staff. Sterilisation is by hand dosing with chlorine with changes of water as necessary. Eight samples were taken by the Health and Welfare Department to ensure adequate chlorination and fitness for bathing. all of which proved to be satisfactory. There are also two swinging baths at primary schools with treatment plants. Sixteen samples were taken during the year and were satisfactory. 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.for some two miles forms the eastern boundary and thence flows through the Borough. In dry weather a considerable portion of the flow of this river comprises the effluent from the Hogsmill Valley Sewage Treatment Works. The Beverley Book, another tributary of the Thames, forms part of the eastern boundary. DRAINAGE AND SEWRAGE. With the exception of a small quantity which is discharged to the sewage disposal works of the London Borough of Sutton at Worcester Park and to the Wandle Valley Joint Sewage Board,the sewage of the district is treated at the Hogsmill Valley Sewage Treatment Works. This modem plant also deals with the sewage from the Borough of "Spsom & Ewell. There are a few houses in Surbiton which use cesspools, but the remaining houses in the Borough are connected to the main sewage 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. The refuse is transferred to large capacity road vehicles and transported to the tip by the contractor. The refuse is weighed on a weighbridge and 45,6ll tons of refuse were sent from the Borough in .1965. 6. INSPECTION OP THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors and Technical Officers other than visits made by Pest Control Officers. 94 Housing 1.787 Housing Act 267 Houses in Multiple Occupation 101 Improvement Grant Visits 1.028 Drainage 1.922 Factories 272 Outworkers 31 Atmospheric Pollution recording 738 Dairies and Milk Shops 87 Food Premises 1.464 Restaurants and Cafes 345 Bacteriological and Biological Visits 243 Food and Drugs Sampling 263 Unsound Food 450 Markets 495 Animal Boarding Establishments 27 Pet Animals Act 28 Riding Establishments Act 11 Rodent Control 139 Insect Pests l60 Pigeons 109 Infections Disease 1.930 Verminous Premises 27 Shops Act 971 School 66 Consumer Protection Act (Fire Guards) 35 Merchandise Marks Act 98 Interviews 938 Noise 394 Office, Shops & Railway Premises 598 Building Sites 71 Council House 58 Employment Agencies 43 Old People and Problem Families 92 Pharmacy & Poisons Act. 46 Rivers, Ditches and Ponds 35 Rent Act 34 Tents and Caravans 188 Vacant Land 43 Visits outside District 274 Water Supplies and Sampling 79 Betting and Gaming Act 27 Smoke Control Visits 5.310 Smoke Control Revisits 3.056 Attendance at Meetings 210 Miscellaneous 2.375 26.965 95 NOTICES SERVED. Informal. (a) Verbal 9 (b) Written 451 Statutory. (a) Housing Acts (b) Public Health Acts 39 (c) Clean Air Act 10 NOTICES COMPLIED WITH. Informal. (a) Verbal (b) Written 255 Statutory. (a) Housing Acts (b) Public Health Acts 14 (c) Clean Air Act 9 7. 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 Parts I and VIII of the Factories Act. PART I OF THE ACT. 1.INSPECTIONS. Premises No. on Register Number of Inspections Written Notices Prosecutions Factories in which Sec. 1, 2, 3, 4 & 6 are enforced by the Corporation 67 32 - - Factories not included above in which Sec. 7 is enforced by the Corporation 680 240 9 - Other premises excluding outworkers 20 71 - - 96 2. CASES IN WHICH DEFECTS WERE FOUND No, of cases in which defects found Found Remedied Referred No. of Prosecutions. To H.M. Inspector By H.M. Inspector Want of cleanliness - - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Ineffective drainage of floors Sanitary conveniences — — - - - (a) Insufficient - - - - - (b) Unsuitable or defective 6 7 - 2 - (c) Not separate for sexes - - - - - Others - - - 1 - PART VIII OF THE ACT. Outwork. The following table gives details of work which is carried on in private dwelling houses. The conditions obtaining have been found to be satisfactory. Nature of Work No. of Outworkers Wearing apparel - making etc. Curtains & Furniture 19 Hangings 2 Racquet & Tennis Balls 1 Lampshades 58 80 97 8. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963. The figures enumerated in the following tables are those submitted in accordance with the provisions of Section 60 of the Act and included in the Annual Report to the Ministry of Labour. Class of premises Number of Premises registered during the year Total Number of registered premises at end of year Offices 44 617 Retail shops 65 1,007 Whole sale shops, warehouses - 74 Catering establishments open to the public, canteens 8 150 Fuel storage depots 1 3 118 1,851 Class of Workplace Number of persons employed Offices 6,401 Retail shops 7,609 Wholesale departments, warehouses 750 Catering establishments open to the public 1,160 Canteens 204 Fuel Storage Depots 20 Total 16,144 During the year 598 inspections were made; of these 146 were general inspections to shops and catering establishments and 45 were to offices. General inspections are comprehensive and premises which have been the subject of such action would, upon completion, comply with all the requirements of the Act which are at the moment in force. Prior to amalgamation, the staff employed by the constituent Boroughs was insufficient to undertake the duties of the Act and appointments for this purpose were deferred until the new Borough had been created. In July one Technical Officer was appointed and authority was obtained to make a further appointment after the 1st April, 1966. 98 Despite the national and local publicity given at various times regarding the requirements of the Act , general experience indicates that many employers have little idea of their obligations and the number of employees who are aware of the existence of this legislation is even less. Bearing this in mind, an essential part of the work is that of education both of employees and employers. With regard to the administration of the specific sections of the Act, the following comments may be of interest. Cleanliness in shops has been of a high standard but in some cases attention has been drawn to the need for cleansing in store and stock rooms. Offices were found generally to be satisfactory. Pew cases of overcrowding were noted; in some butchers' shops the installation of large cold rooms had reduced the effective area for cutting and preparation and thereby the risk of accident was increased. With regard to overcrowding in offices, the operative date for this provision for those offices which were in existence on the 31st July, 1963 is August 1967, but the co-operation of managements is expected to be such that in the few cases where improvement is necessary, it will not be delayed until this date. Offices provided after the 31st July, 1963 must comply with the provisions relating to overcrowding, Reasonable standards of heating are provided in offices, in fact the tendency is towards over heating. In shops the conditions are also satisfactory, but butchers, greengrocers and fishmongers generally take advantage of the section provided in the Act for shops where perishable foods are sold. In such cases, however, every effort is made to provide 'warm points' for the use of the staff. Ventilation was perhaps the most difficult problem encountered due, in the main, to internal alterations to both shops and offices where partitions, walls and shelving had been erected in such a manner as to hinder or completely prevent through ventilation. The tendency in the design of modern shop fronts is to make no provision for ventilation; in fact from the number of times the attention of shop-fitters has been drawn to this matters, one forms the opinion that there is a deep rooted aversion to ventilation. The standard of lighting in offices varies considerably, but it is evident that the need for good lighting standards is being appreciated on the grounds of efficiency. It has been found in the main that when an employer has been confronted with the results of a lighting survey where low readings have been quoted, he has been surprised but, on the other hand, has been pleased to effect an improvement. In shops the disparity between the shopping area and the stock room is often most marked and our efforts have been directed to improvements at the rear of shops on the grounds of safety. 99 Sanitary accommodation in the main has been adequate, but difficulty is experienced where additional W.Cs. are required, mostly on the grounds of restricted space. Common faults are the use of the W.C. compartment as storage space and the absence of artificial lighting. With regard to washing facilities, the main deficiency has been that of hot water. It will be remembered that prior to the passing of the Act, it was not possible to enforce the provision of hot water for washing purposes, except in food premises. An important provision of the Act relates to safety; the main hazards are slicing and chopping machines, mechanical hoists and conveyers. In a number of instances advice was given on the provision of suitable guards on machines and the elimination of trapping points on conveyers. Attention has also been given to the guarding of openings in floors. A total of 86 accidents were officially reported during the year. There were fortunately no fatal or serious accidents. Of the total accidents recorded all except three came from large multiple firms and 72% came from three of these firms only. It is obvious that there must have been more accidents as only 23 firms made reports during the year out of a total of some 1,800 registered premises. Not all employers are aware of their obligations to notify accidents, and the accident figures quoted above would not appear to represent a proper indication of the accident rate. To summarise, it is felt that a good start has been made and based upon the experience which has been gained, it is anticipated that progress in implementing the provisions of the tot will accelerate considerably. 9. MOVEABLE DWELLINGS.- The following sites remained licensed under the Caravan Sites and Control of Development Act, 1960:- 1. The Riverhill Estate, the lease of which is held by a local Sports Club and where 36 caravans are permitted. 2. One caravan in the orchard of a private house. As in previous years, some trouble was caused by itinerant caravandwellers who placed their vehicles on sundry open sites in the Borough and were reluctant to move on. One of these sites, however, has now been fenced and it is hoped that it will not again be used. All the offenders were eventually removed after some difficulty. In one case it was necessary to tow the vehicles away. There are nine effective Orders under the Surrey County Council Act in force in the Borough prohibiting the parking of moveable dwellings. 100 10. ATMOSPHERIC POLLUTION . Clean Air Act 1956. Smoke Control Areas. Kingston upon Thames No. 5. Maiden & Coombe No.5 and Norbiton Estate No.1 Smoke Control Orders became operative on the 1st October. 1950. They cover approximately 267 acres in the Villiers Road district of Kingston. the Pembury Avenue district of Worcester Park and the Norbiton Estate. The number of premises affected is as follows:- Kingston upon Thames No.5 Maiden & Coombe No. 5 Norbiton Estate No. 1 Domestic 1219 445 392 Commercial 56 2 — Industrial 5 - - Other 13 2 — In August. the Council made Smoke Control Orders No. 6, 7 and 8. These were confirmed by the Minister of Housing and Local Government in November and come into operation on 1st October, 1966. Particulars of these areas are as follows:- Area 6 7 8 Locality Kingston upon Thames Worcester Park Norbiton Estate Acreage 66 235 16 Premises Domestic 1172 1362 194 Commercial 72 33 - Industrial 8 4 - Other 4 16 1 During the year survey work was started on Area 9 in the George Road, Coombe area and Area 10 in the Kings Road. Kingston upon Thames area, with a view to the making of Orders which should be operative on 1st October, 1967 . In May 1966 the Council approved a time table designed to make smoke control orders covering the whole of the Borough by 1978 . 101 The technical problems of pollution of the air by smoke have been largely solved, so that by the progressive introduction of smoke control areas and by other means a comparatively smokeless atmosphere should be achieved in the Greater London area by the early 1970s. The other main pollutant, sulphur dioxide, about which there has lately been some publicity, cannot be dealt with so easily. It was recognised when the Clean Air Act was passed in 1956 that there were no satisfactory means available of reducing sulphur dioxide emissions from chimneys at reasonable cost, but provision was made in that Act for control over the heights of new industrial chimneys. This control has been reinforced by the introduction of the Memorandum on Chimney Heights, which gives a method of calculation based on a maximum permissible ground level concentration of sulphur dioxide. It has been found possible in this way to restrict the amount of sulphur dioxide reaching ground level. Owing to higher standards of heating now expected by the public, and the great increase in energy requirements by industry, much more fuel is being consumed and the emission of sulphur dioxide from chimneys has, in this area, nearly doubled in the last ten years. However, this has not been accompanied by any measurable increase in the average sulphur dioxide concentration at ground level. Sulphur dioxide is a gas which disperses upwards three times more rapidly than smoke (which consists of small solid particles) so that the policy of increasing chimney heights is justified and is proving useful in practice. A close watch is being kept on the problem locally and measurements of smoke and sulphur dioxide concentrations are taken daily at four sites in the Borough. Observations have not been taken for a long enough period to estimate the extent of any change. It must be emphasised that records over an extended time are necessary to cancel the effects of climatic conditions. In London, however, there has been a dramatic reduction in the amount of smoke recorded at 24 sites. This has taken place during a period when the consumption of domestic coal has been reduced from 36 million tons to less than l½ million tons and the consumption of oil for domestic purposes rose from 3,000 to 186,000 tons. The present increased rate of conversion of domestic solid fuel grates to gas room heaters is an encouraging trend which will do much to reduce low level sulphur dioxide as will also the greater use of electricity and to a lesser extent the conversion of open grates to the more efficient solid fuel room heaters. A tightening of the law on chimney heights would be of great value for at present there is no legal control over the heights of chimneys for flats, offices and shops. Air Pollution complaints. There were 58 complaints from the public about nuisance from smoke and grit; 33 of these concerned bonfires, 14 smoke from factory chimneys, 8 smoking domestic chimneys and 3 concerned smut emissions. 102 In investigating the bonfire complaints, advice was given to householders and commercial concerns on the disposal of rubbish without causing nuisance to neighbours. Several excessive smoke emissions from factory chimneys were due to mechanical defects and maladjustments in oil-fired boilers, which were quickly put right. Three complaints related to acid smuts from a factory chimney and it was found on investigation that the boiler was too large for the load placed upon it, giving rise to condensation in the flue. Modifications were carried out and no further complaints have been received. There were two complaints about the Kingston Hospital chimney but dark smoke emissions have been rare. Although the engineer is operating the obsolete plant at maximum efficiency, breakdowns are still liable to occur. Preparatory work on the new boiler house was commencedduring the year and the height and design of the new chimney stack was finalised after wind tunnel tests. Chimney Heights. Six plans were submitted for determination of chimney heights under Section 10 of the Clean Air Act, 1956. In six further cases advice was given where new chimneys, exempted from the provisions of this section were about to be erected. Recording of Air Pollution. Instruments for measuring the amount of smoke and sulphur dioxide in the air are maintained at the Guildhall, Tiffin Girls' School, Council Offices, New Maiden and Alpha Road Public Health Depot. It was found necessary to discontinue readings at the Kingston Vale site in May on account of the excessive travelling time involved. The remaining four instruments operate continuously and readings are taken five times a week. The figures are submitted monthly to the Ministry of Technology's Warren Spring Laboratory, for inclusion in the national survey of atmospheric pollution. The Maiden readings, which are typical, are shown at Figs, 1 and 2 in graph form. It is noteworthy that the highest winter readings are about ten times as great as the summer ones. Since the power demands of factories do not vary a great deal over the seasons, the increase in winter, apart from climatic conditions, must be due to domestic smoke and emissions from commercial central heating plants. Figure 3 compares the annual readings for the four sites and Figure 4 shows the Guildhall annual readings for smoke and sulphur dioxide since 1958, as compared with some London sites. The Guildhall readings have been used for this comparison as the site has been in operation longer than the other three. Deposit Gauges. 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, Figure 5 shows the average deposit at the two sites for the years 1950 to 1965. 103 104 105 106 107 108 ll. COMPLAINTS. The number of complaints received from the general public during the year was 3,316 . The following is a brief list of causes for complaints received during 1965:- Accumulations 45 Animals 13 Caravans 6 Dampness 45 Drainage 637 Flooding 15 Foods 79 General Housing Defects 105 Insects 87 Noise 43 Offensive Odours 53 Pigeons 35 Rodents Rats 1353 Mice141 1494 Smoke 57 Squirrels 27 Wasps 507 Water 5 Others 3316 12. RODENT AND INSECT PEST CONTROL. Upon the merger of the Boroughs. this section of the department was faced with an acute shortage of staff. and this was accentuated by the issue of the booklet with its message to the citizens of the new Borough, which drew the attention of many people to facilities of which they were previously unaware. In the case of rodent control it brought forth an avalanche of complaints and for a time it was impossible to deal with them in a prompt and efficient manner. In some cases the staff were operating in districts with which they were unfamiliar and their task was rendered more difficult by the lack of name boards on both sides of by-roads or, in some cases, the complete absence of name boards. The numbers of many house 8, and particularly in rows of shops,, are either missing or not prominently displayed. There is no doubt that there would be fewer complaints of rats if people would keep their yards and gardens reasonably tidy for frequently shelter is provided for the rats by accumulations of rubbish or unwanted furniture. 109 Another source of infestation and re-infestation is to be found in the tributaries of the Hogsmill River which in some areas run between the gardens that back on to these streams. Piping of these tributaries in built-up areas would be advantageous. The accompanying tabulated statement is an indication of the work carried out during the year. Owing to the difficulties outlined above, it was not possible to carry out any treatment of rodent control in the sewers. A number of complaints were received of nuisance caused by pigeons. These generally arise from the creation of feeding habits by misguided persons and in some instances control is extremely difficult because of the lack of co-operation by some members of the public. A number of birds were trapped during the year but on one occasion a trap was removed from its position and destroyed. It is not generally known that pigeons are carriers of disease and it is better to keep their numbers down to reasonable proportions rather than expose residents to a health hazard and to the obvious nuisance they become when encouraged. If the practice of feeding pigeons was discontinued their numbers in towns would be reasonable. When complaints of nuisance from squirrels are received, advice is given on trapping or proofing. The extensive damage which can be caused by these pests is not realised until the buildings have been invaded. Here again, people are not easily convinced that they should not feed them if they do not wish to attract them to the vicinity of dwellings. Over 500 complaints were received concerning wasps. These were dealt with in the main by giving advice to the complainants on suitable methods of destruction, or if the nests were well above ground and not causing nuisance, to leave them alone. In some cases nests were destroyed by the staff. 110 Rodent Control - Statistical Statement 1965. Local Authority Property. Dwelling Houses Business & Factory Premises Totals Number of properties inspected as a result of notification 15 1,403 190 1,608 Number of additional properties inspected in the course of surveys 21 764 21 806 Totals 36 2,167 211 2,414 Premises infested Rats 10 1,752 131 1,893 Mice 6 116 66 188 16 1,868 197 2,081 Total visits 88 10,274 720 11,082 111 HOUSING. Closing Orders under the Housing Act, 1957 were made in respect of the following:- 78, Alpha Road, Surbiton Ground floor back and back addition rooms; first floor back and back addition rooms. 94, Cambridge Grove Road, Whole of premises. Kingston upon Thames 12, Crescent Road, Kingston Basement back room. upon Thames 20, Mill Place, Kingston upon Whole of premises. Thames and Demolition Orders were made in respect of- 241, 243, 249, 251, 253, 265, 267, 269, 271, 273, 275, Kingston Road, New Maiden. Closing Orders made by the former Royal Borough of Kingston upon Thames on the basement rooms of 1, Queen's Road and the basement flats at 13 & 15, Gloucester Road, Kingston upon Thames were determined during the year and a Demolition Order made by the former Borough of Maiden & Coombe on 24, Acacia Grove, New Maiden was revoked, works having been carried out at all these properties to make them fit for human habitation. 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 includedo 1. Number of houses inspected and recorded 252 2. Number of houses which, on inspection, were considered to be unfit for human habitation 13 (a) Parts of houses which, on inspection, were considered to be unfit for human habitation 2 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 100 Cont/d. 112 Number of representations made to the Local Authority with a view to:(a) The serving of notices requiring the execution of works 51 (b) The making of demolition or closing orders (Number of houses involved) 16 5. Number of formal notices served requiring the execution of works 46 6. Number of houses which were rendered fit after the service of formal notices 25 7. Number of demolition or closing orders made 15 8. Number of houses in respect of which an undertaking was accepted under sub-section 4 of Section 16 of the Housing Aet.1957 - 9. Number of houses demolished 2 Houses in Multiple Occupation - Housing Act. 196l. There are no common lodging houses in the Borough. The number of houses in multiple occupation in the Borough is estimated to be between 350 and 400. Due to the shortage of staff and the pressure of other duties little progress was made in the inspection of these houses beyond remedial action following complaint. In May 1966 the Council adopted a Standard Code of requirements to be applied to such premises and the introduction of this standard throughout the Borough will provide guidance for landlords and tenants and its implementation will enable proper and adequate facilities to be available in houses in multiple occupation. Improvement grants. The Housing Acts. 1958- 1964 provide for Local Authorities to make grants for the conversion or improvement of dwellings. There are two types of grant available. the "Standard" Grant. which, subject to compliance with the Act. can be claimed as a right. and the "Discretionary" Grant. in the use and extent of which the Council, as the title implies, has a discretion. The Council decided to make both standard and discretionary grants to applicants as appropriate. The maximum amount of Standard Grant is 50% of the cost incurred of carrying out the works reasonably required to provide, for the first time in a house,all or any of the following standard amenities, subject to the following limits:- 113 Where it is impracticable to provide a bathroom in any way other than by more extensive works of construction, the Housing Act, 1964 allows the Council to substitute in the table above a figure higher than £25 based on half the estimated costs of providing a bath in a bathroom, subject to an overall upper limit of £550 grant. The Council must approve a grant provided that the facilities are for the exclusive use of the occupants of the dwelling; that the dwelling will be fit for human habitation on completion of the works and with normal maintenance will be likely to remain so fit for not less than 15 years; and that the applicant has a freehold interest or a leasehold interest of which not less than 15 years remain unexpired. Discretionary grants may be given for the conversion of houses and other buildings into self-contained dwellings and for more comprehensive works of improvement to bring such dwellings provided or improved to a modern standard higher than that envisaged for standard grants and can cover certain classes of improvement other than the standard grant amenities. In the case of discretionary grants, the Council must be satis- fied that the dwelling has an expected life of not less than 30 years and the grant payable is 50% of the costs of improvement works or conversion, subject to a maximum of £400 in respect of each dwelling provided or improved. During the year numerous enquiries were received and advice given, mostly culminating in applications being made. The following table summarises the applications dealt with, and shows significant interest from the owners of tenanted properties, a trend which it is hoped will increase ® £ A fixed bath or shower in a bathroom 25 A wash hand basin 5 A hot and cold water supply at a fixed bath or shower 35 A hot and cold water supply at a wash hand basin 15 A hot and cold water supply at a sink 25 A water closet if practicable in and accessible from within the dwelling 40 A satisfactory food store 10 114 Improvement Grants - Standard. Owner/occupiers Tenanted Applications Received 28 13 „ Approved 31 10 Dwellings improved 30 9 Amount paid in grants £ s. d. 3,962. 13. 6. Average per house 101. 12. 2. Amenities provided - (a) fixed bath 25 (b) shower 1 (e) wash hand basin 32 (d) hot water supply (to any fittings) 33 (e) water closet within dwelling 27 (f) food store 19 Improvement Grants - Discretionary. Owner /occupiers Tenanted Applications Received 36 16 „ Approved 45 11 „ Refused 3 - Dwellings improved 34 10 Amounts paid in grants £ s. d. 11,747. 19. 9. Average per house 267. 0. 0. In many cases where grants are made, works of repair and improvement not eligible for grant - are carried out, so that the general standard of housing is greatly improved. Eighty-three dwellings, many of them recently acquired by the applicants, have been improved in various ways with grants averaging £186 per house. Of this sum £46. 10.0. is borne by the Council, the remainder is recovered from the Exchequer. Without this encouragement it is unlikely that in the majority of cases the improvement would have taken place or at least not in such a comprehensive or thorough manner. The effect must be an increase in well-being and good health within the community. 115 RENT ACT. 1957. Applications for Certificates of Disrepair. Applications 14 Decisions not to issue certificates Nil Certificates issued 1 Undertakings given by landlords under paragraph 5 First Schedule 9 Undertakings refused by Local Authority Nil Applications for Cancellation of Certificates. By Landlord 1 Objections by tenants to cancellation Nil Certificates cancelled 1 116 INSPECTION AND SUPERVISION OF FOOD. Milk Supply, The following table shows the number of premises from which milk is sold and the types of licences in force during 1965 under the provisions of the Milk (Special Designations) Regulations i960 and 1963. These Regulations prescribe that the licences shall cover the period expiring on the 31st December, 1965 and all are dealers' licences to sell prepacked milk. Premises and Type of Licence Number Premises in which milk is sold 1 81 Pasteurised milk 80 Sterilised milk 31 Ultra Heat Treated Milk 13 Untreated Milk 21 Bacteriological Examination of Milk. During the year 144 samples of milk were sent to the Public Health Laboratory at Epsom, and the following is a tabulated statement of the results:- Phosphatase Test Methylene Blue Test Turbidity Test Pass Fail Pass Fail Void Pass Fail Pasteurised 113 - 113 - - - - Sterilised - - — - - 15 - Untreated - - 10 5 1 - - The only cases where failures were reported related to the five samples of untreated milk; one of these was from bottled milk and the remaining four were of cartoned milk which was produced at the same premises and retailed from vending machines. 117 The failure of these later samples was the subject of correspondence both with the producer and the Divisional Milk Officer of the Ministry of Agriculture, Fisheries and Pood who is responsible for the supervision of milk production. Repeat samples proved to be satisfactory. Ice Cream. The number of registered premises in the Borough in which ice cream may be stored or from which it may be sold is 343. This figure also includes six producers. In addition to these dealers and producers there are other premises which are not required to be registered such as restaurants, canteens and cinemas where ice cream is sold. By far the greater part of the ice cream sold in the Borough is obtained from manufacturers whose premises are situate outside the Borough. The following table shows the results of examination in respect of 156 samples submitted to the Public Health Laboratory at Epsom during 1965. Owing to the numerous factors governing the hygienic quality of ice oream, 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. Seven of the Grade IV samples were of soft ice cream taken on the same day from mobile vehicles operating from a local depot. The results and subsequent tests indicated poor sterilisation of equipment. The depot is no longer in operation. G R A D E Total I II III IV Ice Cream 120 14 9 13 156 Meat and Other Foods. There are no slaughterhouses in the Borough. The supply of meat arrives from Smithfield and through the local wholesale shops. A certain amount of home killed meat also comes from the modem abattoir at Guildford. 118 Foodstuffs Condemned as unfit. The following unfit foodstuffs were voluntarily surrendered and destroyed:- lbs. Canned Goods Cream 16 Pish and Pish Paste 176 Fruit 1,740 Jam 131 Meat and Meat Produce 1,537 Milk 49 Sauce 35 Soup 17 Vegetables 602 Other 493 Fruit 6 Meat 13,153 Milk 76 pints Vegetables 788 Pood Hygiene. There are 1,464 food premises in the Borough and whilst the standard of hygiene has been maintained at a reasonably satisfactory level, it is a subject which calls for constant attention by the Public Health Inspectors. The need to educate and remind food handlers of the necessity to exercise scrupulous cleanliness with regard to their hands, clothing, and equipment remains unremitting. not only do surfaces and equipment coming into contact with foodstuff require to be visibly clean but becteriologically satisfactory. The value of chemical sterilising agents in cleansing procedures is not generally appreciated or practised. The public are becoming more and more conscious of the need for cleanliness in the handling of food and this gives encouragement to those traders whose standards are high. 119 The following tabulated statement shows the nature of the infringements to which attention was drawn. PART IV Defects Requiring Notices Sanitary Conveniences. Lack of "Wash your Hands" Notices 7 Fittings cleansed, repaired or extended 5 Walls and ceilings cleansed 4 Ventilation provided 2 Lighting provided 3 Sinks. Renewed or repaired, also draining boards 5 Washing Facilities for Staff, Absence of, defective, inadequate hand basins 11 Absence of hot water 8 „ „cold water 7 Provision of towels, soap and nailbrushes 11 Absence of, or defective, water heaters 2 Repairs to Food Rooms. Walls and ceilings cleansed or repaired 21 Floors repaired 6 Ventilation 2 Other structural repairs 2 Protection of Food against Contamination. Food to be kept 18" off ground 4 Covers provided for food 5 Others 10 Uncleanliness. Kitchens and Equipment 6 Insects 1 Food Stores 2 Preparation Rooms 1 Dustbins. Insufficient 1 Cleansed and/or repaired 1 C/Fwd. 127 120  Defects Requiring Notices B/Fwd. 127 General. Cleansing - General 2 First Aid Equipment 5 Defective Roofing 2 Defective Drainage 3 Provision of Head Coverings 1 Provision of Splash Back 2 Provision of Cupboard for outdoor Clothing 8 Use Clean Water for Washing up 1 Provision of Intervening Ventilated Space 3 Defective Yard Paving 1 155 Food Hygiene (General) Regulations. 1960. The following is a tabulated statement of inspections made during the year of the various types of food premises. No. of Premises Visits Bakehouses and Bakers' Shops 42 112 Butchers 73 254 Confectioners 137 36 Fish Shops (Wet or Fried) 36 63 Greengrocers 92 100 Grocers 177 369 Ice Cream - Manufacture 6 64 Ice Cream - Sale 343 147 Institutions 32 31 Milk Shops & Depots 81 87 Office and Works Canteens 100 33 Public Houses, Hotels & Licensed Premises 102 67 Restaurants and Cafes 123 345 School Canteens 68 35 Sports Clubs 50 16 Open Markets 2 495 1,464 2,254 121 FOOD AND DRUGS ACT. 1955. The following tabulated statement gives details of 336 samples of foodstuffs submitted to the Council's Public Analyst to ascertain whether they complied with the Pood and Drugs Act, 1955, Labelling of Pood Order, 1953 and other relevant legislation. Commodity No. of Samples Genuine Not Genuine or otherwise irregular Pormal Informal Formal Informal Formal Inform mal Ale 1 - 1 - - - Alfonal Spread - 1 - 1 - - Almonds, ground - 3 - 3 - - Amylobarbitone Sodium Capsules 1 . 1 - - - Anchovy Essence - 1 - 1 -. - Apple Pie - 1 - 1 - - Apple Pie Pilling - 1 - 1 - - A.P.C. Tablets - 1 - 1 - - Apricot Pie - 1 - 1 - - Apricot Pie Pilling - 1 - 1 - - Apricots - 1 - 1 - - Apricots, Dried - 1 - 1 - - Arrowroot - 1 - 1 - - Aspirin Tablets - 1 - 1 - - Baby Food - 1 - 1 - - Barbitone Sodium Tablets 1 - 1 - - - Beans with ham - 1 - 1 - - Beef with Butter, potted - 1 - 1 - - Beetroot, Sweet Sliced - 1 - 1 - - Belladonna & Phenobarbitone 1 - 1 - - - Bendrofluazdde 1 - 1 - - - Benztropine Methane sulphorate Tablets 1 - 1 - - - Biscuits - 7 - 7 - - Bitter Beer 3 - 3 - - - Blackcurrant Health Drink - 1 - 1 - - Blackcurrants - 1 - 1 - - Braised Steak - 1 - 1 - - Bread - 7 - 7 - - Breakfast Spread - 1 - 1 - - Brisling - 1 - 1 - - Broth - 5 - 3 - - Butobarbitone Tablets 1 - 1 - - - Butter 3 — 5 — - — C/Fwd. 13 40 13 40 - - 122 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. 13 40 13 40 - - Cakes - 4 - 4 — - Capers in spirit, vinegar & salt - 1 - 1 - - Caraway, ground - 1 - 1 - - Cheese - 2 - 2 - - Cheese Spread, Buttered - 1 — 1 - - Cherries, Cocktail - 1 — 1 - - Chestnut Puree, Fresh - 1 - 1 - - Chicken Dinner - 1 - - - 1 Chicken Stock Tablets - 1 — - — 1 Chocolate, Drinking - 1 - 1 - - Chocolate Spread - 1 - 1 - — Chutney, Tomato - 1 - 1 - - Cinnamon, Ground - 2 - 2 — - Cloves - 2 — 2 - - Cochineal - 1 — 1 - — Coconut Desiccated — 1 — 1 - - Codeine Tablets _ 1 — 1 - - Coffee - 4 — 4 — - Coffee & Chicory Essence - 1 - 1 - - Cooking Oil - 1 - 1 - - Corn Flakes - 1 - 1 - — Crab, Dressed — 1 — - - 1 Crab Paste - 1 - 1 - - Crab Spread with Butter - 1 - 1 — — Cream, Sterilised - 3 — 3 - - Crisps, Hongkong - 1 - - - 1 Currants - 2 - 1 — 1 Curry - 3 - 3 - - Custard Powder - 2 — 2 - — Dates - 1 — 1 - - Distilled Witch-Hazel - 1 — 1 - - Dream Topping - 1 - 1 - - Egg Custard - 1 - 1 - - Faggots - 1 - 1 - - Figs in Sugar Syrup - 1 - - - 1 Fish Dinner, Creamed - 1 - 1 - - Flour - 5 - 5 - - Fresh Calcium Drink - 1 - 1 - - Frucadian Sandwich - 1 - 1 - - C/Fwd . 13 98 13 92 - 6 123 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. 13 98 13 92 - 6 Fruit, Dried - 2 - 2 - - Fruit , Mixed — 1 - 1 - - Fruit Squash - 4 - 4 - -- Gelatine — 1 - 1 - - Ginger Ale, Dry - 1 - 1 - - Ginger Beer - 2 - 1 - 1 Ginger. Ground - 3 - 3 - — Grapefruit,Tinned — 1 — 1 - - Gooseberries in Heavy Syrup - 1 - 1 - - Gravy Mix Cakes - 1 - 1 - - Gravy Powder - 1 - 1 - - Haliborange Tablets - 1 - 1 - - Ham & Beef Roll - 1 - - - 1 Ham with Pork, Chopped - 1 - 1 - - Hamburgers - 1 - 1 - - Honey - 4 - 4 - - Horseradish, Creamed - 1 - 1 - - Horseradish Relish - 1 — 1 - - Icing - 2 - 2 - - Ice Cream 2 - 2 - - - Ice Cream, Dairy 2 - 2 — — - Instant Whip - 1 - 1 — - Iron & Brewers Yeast Tablets - 1 — 1 - - Jam - 12 - 12 - - Jelly, Table - 7 - 7 - - Ketchup (mushroom) - 1 - 1 - - Lamb Dinner - 1 - 1 - - Lambs Tongues - 1 - 1 - - Lemon Barley with Glucose - 1 - 1 - - Lemon Barley Water - 1 - 1 - - Lemon Drink - 2 - 2 - - Lime Barley Water - 1 - 1 - - Lime Cordial and Lager - 1 - 1 - - Lime Juice Cordial - 1 - 1 - - Lime, Sparkling - 1 - - - 1 Livers, Bacon & Onion with Rich Gravy - 1 - 1 - Marzipan, Chocolate (Raw Sugar) - 1 - 1 - - Marzipan - 5 - 4 — 1 C/Fwd. 17 167 17 157 - 10 124 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal B/Fwd. 17 167 17 157 - 10 Meat Paste - 3 - 3 — - Meatless Steak - Rich Gravy - 1 — - - 1 Milk 15 8 15 8 - - Milk, Channel Islands 7 - 7 — — — Milk, Condensed Sweetened - 1 - 1 — — Milk,, Dried Skimmed - 1 - 1 - - Milk, Evaporated - 3 - 3 - - Milk, Full Cream, Dried - 2 - 2 — - Milk, Half Cream, Dried - 1 — 1 - - Milk-Shake - 1 - 1 - - Milk, Skimmed, Instant Non-Fat - 1 - 1 - — Minced Beef - 1 - 1 - - Minced Beef with Onion & Gravy 1 1 - - 1 1 Minced Steak - 1 - 1 - - Minced Turkey in Jelly - 1 - 1 - — Mint, Dried - 1 - 1 - - Nutmegs - 1 - 1 - — Nuttalene - 1 - 1 — - Oil of Eucalyptus - 1 - 1 - - Olive Oil - 1 - 1 - - Orange Drink - 1 - 1 - - Oranges, Mandarin in Syrup - 1 - 1 - - Orange and Passion Fruit Drink - 1 - 1 - - Orange Squash - 1 - 1 - - Parrishes Syrup - 1 - 1 - - Parsley, Dry - 1 - 1 - - Pate-de-Foie - 1 - 1 - - Pate, Pork & Goose Liver — 1 - 1 - - Peanut Butter - 1 - 1 - - Peas, Dried - 1 - 1 - - Peel, Mixed - 1 - 1 - — Pepper, Paprika - 1 - 1 - - Pepper, White - 3 - 3 - - Picallili Sweetened - 1 - 1 - — Pickles - 1 - 1 — - Pineapple Pieces - 1 - 1 - - Porage Oats, Scotch - 1 - 1 - - Pork Luncheon Meat - 1 - l - - C/Fwd. 40 218 39 206 1 12 125 Commodity No. of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal mal B/Fwd. 40 218 39 206 1 12 Potato Salad in Mayonnaise - 1 - 1 - — Prawn Curry with Rice - 1 - 1 - - Prawns, Peeled - 1 - 1 - - Prunes - 1 - 1 - - Pudding, Golden Syrup - 1 - 1 - - Pudding, Meat - 1 - 1 - - Pudding, Pease - 1 - 1 - - Quick Jel - 2 - 2 - - Raisins - 3 - 3 - - Raising Powder - 1 - 1 - - Rhubarb in Syrup - 1 - 1 - - Rice & Chicken - 1 — 1 - - Rice - 1 - 1 - - Rice Flour — 1 - 1 - - Salmon Spread with butter - 1 - 1 — - Sardines - 1 - 1 - - Sauce Napolitaine - 1 - 1 - - Sausage Meat - 1 - 1 — - Soft Drink Powder - 1 - 1 - - Soup - 7 - 7 - - Spice, Ground Mixed - 2 - 2 - - Spice, Pickling - 1 - 1 - - Sponge Mixture - 1 - 1 - - Steak & Kidney Pie - 1 - 1 - - Steak & Kidney Pudding - 1 - 1 - - Steak, Minced - 1 - 1 - - Steak, Savoury Minced - 1 - 1 - - Steak, Stewed - 1 — 1 - - St.raweberry & Apple Pie - 1 - 1 - - Sugar, Brown - 1 - 1 - - Sultanas — 5 - 5 - - Sweets - 1 - 1 - - Swiss-cup — 1 - 1 - - Tapioca Milk Pudding - 1 - 1 - - Tarragon Vinegar - 1 - 1 - - Tea - 5 - 5 — - Tomato Puree, Condensed • 1 - 1 - - Tonic Water, Indian - 1 — 1 — — Top of the Milk — 1 - 1 - - Tortillas - 1 - 1 — - Vegetable Salad, with Mayonnaise - 1 - 1 - - C/Fwd. 40 284 39 272 1 12 126 Commodity No, of Samples Genuine Not Genuine or otherwise irregular Formal Informal Formal Informal Formal Informal 40 284 39 272 1 12 Vegetables & Kidney - 1 - 1 - - Vegetables, Mixed - 1 - 1 - - Vinegar - 1 - 1 - - V.I.P.Tonic Tablets - 1 - 1 — — Vitamin Health Drink - 1 — 1 - — Vitanut Special - 1 - 1 - - Walnuts, Shelled - 1 - 1 - - Welsh Rarebit, Instant - 1 - - - 1 Whisky 1 - 1 - - - Wine, Cherry - Non Alcoholic - 1 - - - 1 Wine, Ginger — 2 — 2 — - 41 295 40 281 1 14 It will be seen that 15 samples were the subject of adverse comment and the following are the details of the action taken in respect of these samples - Golden Pigs in Syrup. Contaminated with lacquer from inner surface of the can but no evidence of significant contamination of contents by tin or iron. The stock of this product was withdrawn from sale. Ham and Beef Roll. Unsatisfactory labelling using generic terms and not appropriate designation. The manufacturers agreed to amend the label. Cherry Flavour Wine, Non-Alcoholic. Sample of soft drink containing less than 1,2 per cent of proof spirit. The article was described on the label as 'Non-alcoholic Cherry Flavour Wine' and stated to be 'Compounded from a vinous base containing not more than 2% proof spirit%. In the Public Analyst's opinion the description 'non-alcoholic wine' was self contradictory and misleading as to the nature of the drink and the second statement false in that a 'vinous base' will contain more than 2% of proof spirit. It was ascertained that the manufacturers had been acquired by another firm three years previously and that the product has been renamed 'Non-alcoholic Cherry Cordial'. Currants, 14% of this sample included a stalk or part of a stalk whereas currants of ordinary commercial quality may include a small proportion with stalks, but no more than 2 or 3 per cent is to be expected. The matter was taken up with the wholesalers and they in turn raised it with the importers. Since the retailer had exhausted his stock of this particular brand of currants it was not practicable to obtain further samples. 127 Chicken Dinner, Contained 24% chicken meat including fat whereas in the opinion of the Public Analyst an article so described must contain not less than 35%. The manufacturers stated they aimed to pack 35% and surmised that low chicken meat content in this sample was due to inaccuracy of packing. Hongkong Crisps. Ingredients not specified on label as required by Labelling of Pood Order 1953. Following correspondence the importers arranged with their suppliers for the labels to be amended so as to comply. Meatless Steaks in Rich Gravy. Ingredients not specified as required by Labelling of Pood Order. The Manufacturers made the necessary alteration to the label on this product. Ginger Beer. Whilst not unfit an off flavour had developed which was attributed to prolonged storage and although the sample contained a permitted artificial sweetener this was not declared on the label as required by the Soft Drinks Regulations,'1964. Following investigation the retailers concluded that the sample must have been inadvertently missed when stock was checked. Dressed Crab. Ingredients were not specified on the label as required by Labelling of Food Order, 1953. The importers agreed to advise the packers that labels on future stocks should be amended to include a list of ingredients. Minced Beef with Onion and Gravy. Two samples were taken and contained only 38% and 40% of meat whereas in the opinion of the Public Analyst a reasonable meat content is of the same order as canned meat with gravy, i.e., 70%. No legal standard exists for an article of this description but proposed Regulations would prohibit the labelling of products similar to these samples in such a manner as to imply that meat was the main ingredient. Following correspondence with the manufacturers who stated they manufactured to a 45% meat content, the Council decided to inform the Minister of Agriculture, Fisheries and Food that they supported the proposed Regulations and forwarded details of these samples. Chicken Stock Tablets, Concentrated. The illustration, taken in conjunction with the ingredients listed, could be misleading to the purchaser. The manufacturers agreed to alter the list of ingredients to include "vegetable extract" which is made from a mixture of vegetables. Sparkling Lime. Composition was of a citrus crush as defined in Soft Drinks Regulations, 1964, but it was not so described on the label. The manufacturers confirmed that the sample was manufactured prior to the 1964 Regulations and arranged for remaining stocks to be withdrawn. 128 Instant Welsh Rarebit. Contained an excessive proportion of rusk, namely 26% Retailer confirmed that sample was old stock and arranged for destruction of the remainder. Marzipan, Sample contained preservative 'sorbic acid' but the nature of the preservative was not declared on the label. Manufacturers agreed to amend the list of ingredients on the label. OTHER FOODS WHICH WERE THE SUBJECT OF COMPLAINT. A total of 99 complaints about articles of food were received during the year, all were thoroughly investigated and appropriate action was taken. A considerable proportion concerned bread and the two main troubles were contamination with lubricants from baking machinery and mould growth. There tends to be an increase in the wrapping of bread at the bakery, and whilst this is to be commended from the point of view of hygiene, if wrapped before being adequately cooled, mould is inclined to develop, particularly in warm weather. Failure to manage effective stock rotation has resulted in foodstuff being sold out of condition on occasion. Not all complaints are justified although they may well be in good faith, A worm alleged to have emerged from a can of salmon was found to be an earth worn which had not been subjected to heat and therefore could not have been in the can during processing and was presumed to have come from lettuce which was in the kitchen of the complainant. The following were considered to be sufficiently serious to necessitate report to the Health and Welfare Committee for their instructions:- Foreign Matter in Sliced Loaf. A resident found metal and brown material in a loaf purchased from a shop in the Borough, The foreign matter was identified as an aluminium rivet, brass washer and piece of leather, which were presumed to have come from a conveyer belt in the bakery. The matter was considered with the manufacturers and the Council decided to institute legal proceedings. At the hearing the defendants pleaded guilty to the offence under Section 2 of the Food & Drugs Act, 1955, and were fined £25,0,0d, and ordered to pay costs of £3,3.0d. 129 Unsound Chicken. A housewife purchased a roasting chicken from a shop in the Borough and on returning home discovered that it was decomposing. When the shop was visited a quantity of chicken was found to be in unsaleable condition and was thus surrendered. The Council decided to institute legal proceedings and the retailers were fined £350.0d. with £7.10.0d. costs. Dark Material in White Sliced Loaf. A white loaf purchased from a local bakery was found on opening to have dark material in several slices. The foreign matter was subsequently identified as pieces of compact stale dough containing wheat flour and miscellaneous dirt. It was concluded that there was a failure to cleanse the machinery at the bakery. The matter was investigated with the manufacturers and the Council decided to warn them of the consequences of a repetition. Mouldy Pork Pie. A visitor to the Borough purchased a pork pie from a snack bar and a few hours later found that there was mould inside. The Council, after considering all the circumstances including the explanation of the retailers, resolved that the retailer be warned in this instance. Corned Beef - Mould. Shortly after purchase, slices from the top of a freshly opened can of corned beef were found to be green. On investigation it was found that there was corrosion of the disc around the edges used for sealing the can, indicating that air had gained entry, possibly through a hole so fine as to be invisible. The Council decided that legal proceedings be instituted and the retailers were fined £25.0.0. with £6.6.0d. costs. Apple Fruit Pie - Mould. On cutting the fruit pie the complainant observed green mould in one half. On analysis it was found that the soluble solids contained in the filling in one half ware appreciably lower than those in the other so permitting mould to develop. The stock remaining from the same batch of fruit pies was examined and found to be in good condition. The matter was taken up with the manufacturers and the Council decided that a warning letter be sent. 130 Foreign Matter in Bottle of Milk. Having poured moat of the milk out of a bottle, a local resident observed an object in the milk which was later identified as a potato sprout. Analysis indicated that it had been through the bottle washing process but the shape had prevented it being washed out. After considering the explanation of the dairy, the Council resolved that a warning letter be forwarded. Metal in Walnut Loaf. A complaint was received regarding a small piece of metal found in a walnut loaf. The matter was raised with the manufacturers and the Council decided to institute legal proceedings. At the court hearing a fine of £20. 0. 0. with £9. 3. 0. costs was imposed. Pork Pie - Mould. A pork pie out on the day of purchase was found to be mouldy. Having considered the observations of the retailer, the Council resolved to institute legal proceedings. At the court hearing the retailer pleaded guilty and was fined £30 with £10.4.0. costs. MERCHANDISE MARKS ACT. 1926. During routine visits to food shops. inspections were carried out under this Act to ensure that articles were appropriately labelled. Warnings were given where necessary but no formal action was taken. SCHOOL HEALTH SERVICES 133 SCHOOL HEALTH SERVICE Area and Population The Royal Borough of Kingston upon Thames comprises the former boroughs of Kingston, Maiden and Surbiton. The population of the borough, estimated by the Registrar General was 146,470 at mid-1965. At the 31st December 1965 the number of pupils on the registers of maintained schools,was 17,270. Approximately 800 pupils attended direct grant and independent schools which are served by the school health service. The number of maintained schools in the borough on 31st December 1965 was 54-14 secondary, 37 primary, 1 nursery, 2 special. One direct grant and one independent school were included in the school health service under the terms of Section 78 of the Education Act, 1944. Staff The Medical Officer of Health and his Deputy are also Principal and Deputy Principal School Medical Officer respectively, and are assisted by two senior and four other medical officers. The services of sessionally employed medical officers are also used to maintain the programme of fixed appointments at clinics and as reliefs for leave and sickness. The health visiting staff consisting of a superintendent health visitor and twenty health visitors, carry out the functions of school nurses, devoting about 20% of their time to duties in connection with the school health service. Sessionally employed state registered nurses work with medical officers at medical inspections in secondary schools, immunisation sessions and general medical clinics, and are responsible for vision testing of thirteen year old pupils. It was not possible to maintain a full establishment of school nurses, there were four vacancies during the greater part of the year. 134 Periodic Medical Inspection The figures given in this and all other sections of the report relate to schools as classified by the Education Act, 1944, and are, broadly speaking, in accordance with the statistical requirements of the Department of Education and Science. During 1965 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 5,716 children being examined. The present arrangements for periodic medical inspection are summarised below: On entry to infant and nursery schools; On entry to the junior school; On entry to the secondary school; During the year in which age fifteen is reached; During the year prior to leaving school (if more than one year after last routine inspection). In addition to these complete medical examinations, the hearing of every child in an infants' school or department is tested at the age of six years (approximately) by a pure tone audiometer, and secondary school pupils aged thirteen are given an additional eye test. Those whose hearing or vision is found to be subnormal are referred for audiometric or ophthalmic examination and treatment as appropriate. General Condition as Recorded at Periodic Inspection Of the 5,716 pupils inspected, 5,705 were deemed to be of satisfactory general condition. This is a personal assessment by the inspecting medical officer which takes into account general body contour and covering, general muscle tone, facial complexion, appearance of mucous membranes and eyes, posture, alertness and poise. In modern times it is more common to find pupils who are over nourished rather than underweight. Obesity has many disadvantages in school life, as well as carrying increased risk to normal health in later years. In most cases obesity is preventable or can be cured, and merits more serious consideration by parents and teachers than is usually given. The 11 children whose general condition was deemed unsatisfactory consisted of 5 born in 1960, 1 in 1959, 1 in 1957 and 4 in 1954. 135 Defects found at Periodic Medical Inspections During 1965, 988 (17.3%) of the total number of children inspected were found to need treatment for diseases or defects other than uncleanliness and dental diseases, as shown in the following table: Age groups by year of birth Number of pupils inspected Pupils found to require treatment (excluding dental diseases and infestation with vermin) For defective vision (excluding squint) For any other condition Total individual s 1961 and later 115 2 14 16 1960 1217 13 142 146 1959 235 2 37 39 1958 62 - 13 13 1957 896 45 88 129 1956 248 23 56 43 1955 66 8 11 17 1954 1070 106 92 179 1953 504 64 54 109 1952 28 4 4 7 1951 26 5 2 7 1950 and earlier 1249 219 68 283 Totals 5716 491 581 988 136 Defects noted at periodic medical inspections during 1965 (whether or not they were already under treatment or observation) are analysed below: Defect or Disease Requiring Treatment Observation Skin 53 67 Eyes: (a) Vision 491 244 (b) Squint 80 34 (c) Other 13 10 Ears: (a) Hearing 13 50 (b) Otitis Media 16 48 (c) Other 10 3 Nose and Throat 64 239 Speech 42 19 Lymphatic Glands 28 63 Heart 2 50 Lungs 22 79 Development: (a) Hernia 2 16 (b) Other 9 100 Orthopaedic: (a) Posture 65 35 (b) Feet 122 64 (c) Other 28 38 Nervous System: (a) Epilepsy 11 16 (b) Other 1 17 Psychological: (a) Development 6 84 (b) Stability 5 105 Abdomen 9 19 Other 26 22 Total: 2540 1118 1422 Children with defects noted at periodic or special medical inspections are re-inspected at appropriate intervals by the school medical officers. The number of such re-inspections carried out in 1965 was 1,170. 137 Special Inspections Special inspections of pupils who are not due for periodic inspection are carried out at any age, at the request of parents, teachers, family doctors, or school health service staff, either at school or a school clinic. Defects noted on the 731 pupils examined at these inspections are analysed below: Defect or Disease Requiring Treatment Observation Skin 22 15 Eyes: (a) Vision 29 22 (b) Squint 3 4 (c) Other 1 — Ears: (a) Hearing 83 40 (b) Otitis Media 3 10 (c) Other - 1 Nose and Throat 14 28 Speech 24 1 Lymphatic Glands 2 13 Heart - - Lungs 20 9 Development: (a) Hernia - 2 (b) Other 2 23 Orthopaedic: (a) Posture 9 8 (b) Feet 41 24 (c) Other 4 3 Nervous System: (a) Epilepsy 2 2 (b) Other - 1 Psychological: (a) Development 28 20 (b) Stability 11 16 Abdomen 6 1 Other 38 12 Total: 587 332 255 138 Treatment of Diseases and Defects The number of defects known to be treated by all sources during the year 1965 is shown in the following table: Defect or Disease Number Skin: Ringworm - (a) Head - (b) Body - Scabies - Impetigo - Other 37 Vision and Squint 1305 Other Eye Conditions 38 Ear, Nose and Throat 97 Speech 357 Lymphatic Glands 2 Heart 3 Lungs 20 Development 11 Orthopaedic 104 Nervous Diseases 2 Abdomen 6 Other 37 Total 2019 A general medical session attended by a school medical officer with a school nurse in attendance is held weekly at the major clinics in the borough, A short minor ailments session is also held early on most weekday mornings at the major clinics, where school children may attend to receive dressings etc. from the school nurse on duty. Diseases and Defects of Ear Nose and Throat The following is a summary of the treatment of defects by the ear, nose, and throat consultant: Operative Treatment Tonsils and Adenoids 4 Other Nose and Throat conditions 6 Received other forms of treatment 4 139 Speech Therapy The staff comprises the senior speech therapist, Mrs. D. Freedman, and the equivalent of 1.9 other full-time speech therapists. The year has seen considerable re-organisation of the speech therapy service and a gradual growth in the numbers of children referred for treatment. Speech therapy sessions are held in all the major clinics in the borough. Twenty-nine sessions per week were provided,including the separate arrangements for treatment at the Bedelsford and St.Philip's special schools. In addition to clinical work the therapists have held two meetings and hope to continue this practice next year to discuss common problems and keep up to date with new equipment and the current trends in treatment. Details of the work undertaken by the speech therapists are as follows: Centre Present Number of Sessions Initial Caseload Children Treated Remaining for Next Year Acre Road 2 21 37 25 Bedelsford School 8 19 23 19 Grange Road 2 11 14 9 Hook 2 25 33 30 Roselands 5 53 115 61 St.Philip's School 4 31 33 27 Surbiton 2 20 30 15 Tolworth 2 23 33 20 Worcester Park 2 27 39 34 Totals 29 230 357 240 140 Analysis of Cases Treated Children Treated During 1965 Discharged Remaining at end of Period Covered Stammering 63 17 46 Cluttering 1 - 1 Dyslalia 223 77 146 Idioglossia 6 3 3 Anarthria Dysarthria 17 5 12 Aphasia Dysphasia 2 - 2 Aphonia Dysphonia 2 1 1 Cleft Palate 6 1 5 Hyperrhinophonia 4 1 3 Hyporhinophonia - - - Defective Speech Due to: Amentia Dementia 5 3 2 Deafness 2 1 1 Retarded Speech 26 8 18 Totals 357 117 240 Analysis of Children Discharged By Therapist 73 Because of Non Co-operation of Parents 8 Because of Transfer to another District 13 Because of Transfer to Special Schools 10 For other Reasons 13 Ophthalmic Clinics During the year 1,343 children were examined at the school eye clinics; 468 were prescribed glasses, which were dispensed by National Health Service opticians. Immediately after children obtain their spectacles they are re-examined at the eye clinics. Children requiring orthoptic treatment are referred to hospital. Vision testing of all school children is carried out at the time of their routine medical examinations, and also at thirteen years of age. 141 Audiology All pupils have a routine hearing test between the ages of six and seven years together with any other children specially referred by head teachers and medical officers, and each school is now visited annually by the audiometrician. The audiology clinic is staffed by a medical officer specially trained in this work. The services of the audiologist were previously shared with the Surrey County Council, and the borough now have an arrangement with the London Borough of Merton by which the services of an audiologist are provided on a sessional basis. The audiologist is assisted by an audiometrician and a teacher for the deaf. The latter also visits children who are wearing hearing aids both to ensure that maximum benefit is being obtained from the aids and to train those children who have been newly supplied with hearing aids. Many children are handicapped to some degree by a hearing loss, and the health visitors examine children in their first year of life to establish those with any hearing defect. A hearing loss may not be apparent to the parents and the teachers, but in a large crowded classroom with the child in an unfavourable position slow progress and apparent retardation could so easily result from inability to hear correctly. These children are being detected by routine school audiometry of the six and seven year old age group. Those who fail the test are medically examined and subsequently referred to the audiology clinic, placed in favourable positions in class, referred to ear, nose and throat consultants, or put under the supervision of a teacher of the deaf, as appropriate. Parents and teachers are informed about the hearing loss and the probable effect in school and at home. Details of the work undertaken in schools are as follows: Children tested - 1,595. Children who failed test - 178. Result of investigations by school medical officers: No significant hearing loss on clinical examination 69 No significant hearing loss, but child appears mentally retarded 2 Hearing loss confirmed and attributed to: (i) Catarrhal condition (with or without inflammation of ear) 55 (ii) Old otitis media 14 (iii) Injury (iv) Other causes 15 (v) Undetermined causes 10 Investigations: (i) Incomplete at end of year 13 (ii) Not possible - left district or otherwise unavailable for examination (cont.) 142 Recommendations "by school medical officers in the first instance: (i) No action required 43 (ii) For observation only 57 (iii) Refer to audiology clinic 12 (iv) Refer to general practitioner 11 (v) Refer to ear, nose and throat consultant 11 (vi) Favourable position in class 31 * * These 31 new recommendations were made during the year in respect of children who failed the audiometer test. It was known that 26 school children were in possession of hearing aids, of whom 4 were provided with hearing aids in 1965. Audiology Clinic Of the 123 attendances during the year, 78 children were under five years of age. Details are as follows: Age Group Totals Under 2 2-4 5-7 8-11 11+ New cases referred from all sources 18 32 19 10 8 87 Cases carried over from 1964 2 - 1 1 1 5 Found to have normal hearing 14 24 17 5 5 65 Deaf in one or both ears - 3 - - 3 6 Found to have remediable hearing loss - - 2 3 - 5 Impaired hearing requiring auditory training and/or hearing aid 2 3 1 - - 6 Not fully assessed at end of 1965 4 2 - 3 1 10 Attendances 34 44 23 13 9 123 143 Physiotherapy Physiotherapy sessions are held weekly at four clinics, and the physiotherapist also attends St.Philip's Special School. The results obtained are very beneficial and details of the actual work undertaken are as follows: Numbers Sessions held 209 Children treated 227 Attendances 3063 New cases admitted 129 Cases discharged 143 Epileptic Children As a result of periodic medical inspections, 11 of the children examined were referred for treatment and 16 others were noted for observation at a later date. Of the 4 children examined as "specials" for this illness, 2 required treatment and 2 were noted for further observation. Enuresis This is a distressing condition, often difficult to overcome, and parents frequently seek advice from the school medical officers. Some children are referred to the child guidance clinic, and others are given the use of an electric alarm apparatus for varying periods. Three children used this apparatus during 1965. Cleanliness The work of school nurses in connection with uncleanliness and verminous conditions in schools is summarised below: Numbers Visits to schools by school nurses 63 Examined 10,999 Cases with nits 32 Cases with lice 4 Cases with verminous bodies Nil Present standards of cleanliness and freedom from infestation have enabled discretion concerning the frequency of hygiene inspections to be used, resulting in fewer examinations being carried out. 144 Infectious and Contagious Diseases The number of children prevented from attending school because they were suffering from, or in contact with, infectious or contagious diseases, including any who were excluded on suspicion, is shown in the following table: Numbers Smallpox - Diphtheria - Scarlet Fever 12 Enteric Fever - Measles 497 Whooping Cough 8 German Measles 54 Chicken Pox 476 Mumps 69 Jaundice - Dysentery 48 Other 58 Total 1222 Immunisation and Vaccination It is now usual for children to be immunised fully against diphtheria, whooping cough, tetanus and poliomyelitis by the time they enter school at five years of age. In addition, the majority are vaccinated against smallpox. The necessary re-inforcing injections are made available to children while they are in school. The percentage of children immunised can be regarded generally as satisfactory, and the co-operation of head teachers in making arrangements for medical officers to visit the schools is very much appreciated. 145 Diphtheria Primary Immunisation Number who completed a primary course 63 Re-inforcing Number who received re-inforcing injections 2099 Total 2162 Tetanus Protection against tetanus is now much in demand and the great majority of infants are simultaneously inoculated against diphtheria, whooping cough, and tetanus. In order to maintain protection a booster dose is required on commencing school at the age of five. Primary Course Number who completed a primary course 260 Re-inforcing Number who received a re-inforcing injection 2148 Total 2408 Smallpox Number who completed a primary vaccination 50 Re-inforcing Number who received re-vaccination 10 Total 60 Poliomyelitis Primary Course Number who completed a primary course 174 Re-inforcing Number who received a re-inforcing dose 1575 Total 1749 146 Vaccination against Tuberculosis Children are offered B.C.G. (Bacillus Calmette-Guerin) vaccination between their thirteenth and fourteenth birthday. Pulmonary tuberculosis is steadily being brought under control by early diagnosis and rapid and efficient treatment. During the year under review two school children were notified by the chest clinic as positive cases. The following summarises the work undertaken:- B.C.G. Offered Consented Absent Mantoux Positive Vaccinated No. Percentage of those Tested No. Percentage of those Offered 1,528 1,432 (93.75%) 52 51 3.7% 1,329 81% Child Guidance The Child Guidance Clinic, under the medical direction of Dr.B.G.Anscombe, operating from Roselands, New Maiden, is staffed by two educational psychologists who are on the establishment of the Education Department, one full-time and two part-time psychiatric social workers, a part-time psychotherapist and clerical staff. In addition to work in the clinic, educational psychologists visit the schools to advise teachers on educational problems which do not necessitate the pupil's attendance at the clinic. 347 The following table shows the work done during the year: Caseload brought forward from 1964 299 Waiting list at December 1964 11 310 Number of cases referred by: Court 6 School Health Service 40 Hospitals 6 Private Practitioners 22 Child Guidance Clinics 1 Direct Non-Medical 51 126 Reasons: Nervous disorders 16 Behaviour problems 66 Habit disorders 21 Psychosomatic disorders 1 Organic disorders 2 Psychotic illness 0 Educational problems 20 Total of new cases 126 126 Total caseload during year 436 New cases initially seen by psychiatrist during the year 117 New caseload initial distribution: Psychiatrist 46 Psychiatric Social Worker 34 Psychologist 31 Psychotherapist 6 117 All cases - Closures during year; Treatment completed 76 Advice only 82 Non co-operative 31 Other arrangements made 55 Failed to attend 13 257 Caseload on treatment at end of year 172 On waiting list at end of year 7 436 148 Dental Service It is encouraging to report that the dental services were well maintained with almost a full establishment of dental officers. In addition to the chief dental officer there are three full-time and two part-time dental officers assisted by a dental auxiliary for four sessions each week, and four full-time and five part-time dental surgery assistants. The part-time auxiliary is normally occupied with conservative work and extraction of deciduous teeth and is specially helpful in the education of infants and difficult children to overcome fear of dental treatment in later life. The orthodontic clinic at Acre Road, Kingston, is staffed by two part-time orthodontists and a dental surgery assistant. Great difficulty was experienced in retaining dental surgery assistants mainly due to the low salary scales. Approximately 90% of the time of the dental staff is spent on the dental care of school children and the remainder on the treatment of expectant and nursing mothers, children below school age and children attending Kingston Training Centre. The school dental officers endeavour to inspect each school child once annually. Urgent treatment is given immediately and routine treatment within a few weeks. Of all school children inspected, it was found that 52% required some form of dental treatment. The Council's approval of water fluoridation was a major step towards dental health for future generations. Health Education was carried out by dental officers at clinic sessions and also by medical officers and health visitors at all times. During the year Professor G.L.Slack of the Dental School of the London Hospital Medical College carried out a survey at a senior school in the borough as part of a major survey he is conducting in London and the Home Counties to obtain more knowledge of the pattern of dental diseases in children, A mobile unit accommodating equipment and instruments was used. The head teacher gave every possible assistance and this was much appreciated by Professor Slack. 349 The following is a summary of the work undertaken: General Dental Cases Numbers Inspected: Routine 14,375 Special l,0l6 15,391 Found to require treatment 7,664 Offered treatment 6,718 Treated 3,563 Attendances for treatment 11,389 Sessions for inspection 146 Sessions for treatment 2,099 Fillings: Permanent teeth 6,045 Temporary teeth 2,529 8,574 Filled: Permanent teeth 5,087 Temporary teeth 2,309 7,396 Extractions: Permanent teeth 521 Temporary teeth 1,4o6 1,927 General anaesthetics 394 Other operations: X-rays 147 Prophylaxis 800 Silver Nitrate 502 Root teeth filled 50 Crowns and Inlays 41 Other treatment 6,144 7,684 Orthodontic Cases Commenced during the year 85 Brought forward from previous year with plates 282 Brought forward from previous year under observation during development 368 Total number of individuals attending 735 Completed during the year 111 Discontinued during the year 24 Referred to Hospital Consultant 5 Removable appliances fitted 237 Fixed appliances fitted 1 Total attendances 2,690 Under treatment or observation end of year 595 150 Special Schools and Hostels Category- Number attending at end of 1965 Recommended for Placement-Parents Refused Consent Receiving Home Tuition On Waiting List for Special School Day Special Schools Boarding Special Schools Kingston Other Other Boys Girls B G B G B G B G B G Blind 1 1 Partially Sighted 1 2 1 Deaf 2 2 2 2 Partially Hearing 2 Educationally Subnormal 49 35 3 1 8 7 2 3 1 Epileptic 1 1 Maladjusted 3 5 18 5 2 1 Physically Handicapped 10 8 2 4 2 2 Delicate 1 3 1 1 Speech Defect Totals 59 43 11 13 36 19 2 3 2 3 3 1 Bedelsford School, Grange Road, Kingston. It has recently been decided to raise the number of places at the school from 72 to 85. This will be achieved by adding a larger hall, and two more practical rooms to the existing accommodation. These new arrangements will make it possible to open a nursery unit in 1966. It was an interesting year, as the pupils originally entering the Cerebral Palsy Unit in September 1953 have left school and some are now at the Kingston Work Centre. Other less severely handicapped pupils are at various centres for training, e.g. Queen Elizabeth's Training College, Leatherhead, and at Stockport Training Centre taking 151 a commercial course. During 1965 two pupils were placed in open employment by the youth employment officer, but one has proved to be unsuitable due to a progressive lesion. Children at the school with severe physical handicaps are given the opportunity of receiving social training, and physiotherapy, and those pupils with speech defects are treated by the speech therapist. During 1965 twenty-five children at this school had their intelligence quotients re-ascertained. St.Philip's School for Educationally Subnormal Children Fleetwood House, Leatherhead Road, Chessington. Since the Borough Council assumed responsibility for this school, it has been the policy to admit children from the age of five and not from the age of seven, as previously. This step found approval not only by the school but also by the parents, who feel that their children now have a better chance than hitherto when they, as pupils of an ordinary infant school, had to compete with children of a higher intelligence than their own. This often had a severe adverse psychological effect on them. The older children continue to do well at swimming, and were awarded several medals by the Amateur Swimming Association. A total of 20 children left the school during 1965 and with only a few exceptions were able to maintain themselves in good and regular employment. Contact is maintained through the St.Philip's Youth Club run by members of the staff, and girls who have married visit the school with their babies; they appear to be doing well as wives and mothers. 65 children had their intelligence quotients re-ascertained. Some of the boys who return drive their own cars, having in some cases passed the Ministry of Transport driving test at the second attempt. Types of employment in which success has been achieved: Factory Hand Nursery Gardener Council Labourer Builder's Labourer Factory Baker Storekeeper Butcher Electrician's Mate Machinist Landscape Gardener Laundry Assistant Stockroom Assistant Garage Hand Cake Decorator Milkman Waitress Canteen Worker Groundsman Plumber's Mate Railway Porter Sheet Metal Worker Timberyard Worker Trainee Silk Screen Printer 152 HANDICAPPED PUPILS I am grateful to Mr.E.C.Cooke, Headmaster of Bedelsford School, and Miss F.A.Lloyd, Headmistress of St.Philip's School, for their collaboration in this section of the report. The borough is well served as regards the provision of Special Schools both for physically handicapped and for educationally subnormal children. A total of 22 children left St.Philip's and Bedelsford Schools during 1965, 20 from St.Philip's and 2 from Bedelsford. These children either found employment themselves or were placed in suitable occupations by the youth employment officers. Special Education of Handicapped Pupils Children ascertained in 1965 as requiring special educational treatment Category Number Blind Nil Partially Sighted 1 Deaf Nil Partially Hearing 1 Educationally Subnormal 14 Epileptic Nil Maladjusted 14 Physically Handicapped 5 Delicate 2 Speech Defect Nil Total 37 153 Remedial Unit for Retarded Children This small unit has been in operation since September 1965. The pupils who attend are of at least average intelligence, but for a variety of reasons very backward educationally. A number, although of secondary school age, are non-readers, and all require individual attention and special coaching. There is a high degree of co-operation between the work of the teacher at the unit and the child's normal school. * Including register brought forward on 1st October 1964. I am indebted to Mr.F.S.Robinson, Principal Youth Employment Officer, for his assistance in compiling the sections of this report dealing with school leavers. Part-time Employment of School Children In accordance with the Children and Young Persons Act, medical officers were called upon to examine children for the purpose of undertaking part-time employment, and in addition to these initial and re-examinations, children were also medically examined in connection with applications on their behalf for the issue of entertainment licences. Youth Employment Service - Year Ended 30th September 1965. Number Boys and girls living in the borough known to have left school 1,405 New entrants into National Insurance: School Leavers 985 First advisory interviews 1,260 Interviewed who continued full-time education at school or college 289 Applications for employment* 1,331 First applications included in above figure 686 Vacancies notified* 2,127 Kingston boys and girls placed in local employment 776 Kingston boys and girls placed in other districts 138 Local residents included in above figures who were placed in first situations 428 Total of vacancies filled in Kingston area 926 154 The number of examinations for these purposes, and the results of the examinations, are shown in the following table: Numbers Examinations for employment certificates 255 Children examined for entertainment licences 3 Found to be unfit — Based on September 1965 Returns Numbers Children in attendance 16,267 Taking milk 13,948 Percentage taking milk 85.69% Taking meals 12,234 Percentage taking meals 75.1% Cost of meal to pupil ls.Od Percentage taking meals at: Full cost 96.894% Free 3.106% School Milk and Meals Service The provision of milk and school meals plays a very important part in the maintenance of good health. The standard charge for a school meal is one shilling per day, and milk is provided free. There is close collaboration between the Environmental Health Section and the School Meals Service in order to ensure continued high standards of hygiene. Equipment is continually improved and the quality of the meals is good. The provision of milk and meals in school is very valuable particularly to those children whose mothers are in employment, and the following figures are of interest: INDEX VITAL STATISTICS AND GENERAL SERVICES 17 PERSONAL HEALTH SERVICES 30 MENTAL HEALTH SERVICES 59 WELFARE SERVICES 69 ENVIRONMENTAL HEALTH SERVICES 89 SCHOOL HEALTH SERVICES 133