Ac E 43371 KIN 41 THE HEALTH AND WELFARE of the ROYAL BOROUGH of KINGSTON UPON THAMES 1967 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1967 JOHN C. BIRCHALL, M.B., Ch.B., D.P.H. HEALTH AND WELFARE DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: 01-399 5111 1 To the Mayor, Aldermen and Councillors, Royal Borough of Kingston upon Thames. I have pleasure in presenting my report on the Health and Welfare services in the Royal Borough for 1967, this being the third annual report. Statistics The birth rate is again lower in line with a national decline, and remained below the national average. The infant mortality rate was again well below the national average. I am pleased to report that the perinatal mortality rate which showed an inexplicable rise in 1966 returned to nearer the 1965 rate, also below the national average. The general death rate was the same as the previous year and marginally below the national average. Just over 72 per cent of deaths were in persons aged 65 and over. There was a slight increase in the number of deaths from cancer of the lung, which formed 28.4 per cent of cancer deaths. Communicable Diseases 1967 showed the usual biennial increase in measles, the outbreak having started in the autumn of 1966. By the end of the year it was expected that a measles vaccine would become generally available early in 1968. General Services Health education showed continued progress and there was a general expansion in all sections of the work. The first health education officer to the borough was appointed on 1st September. A highly successful health exhibition was held in Chessington in November, aimed at the youth of the borough, and co-operation continued with the Kingston Hospital Postgraduate Education Committee in arranging lectures in Kingston Medical Centre. Personal Health Services The number of children cared for in private day nurseries and by child minders registered under the Nurseries and Child Minders Regulation Act 1948 increased during the year. It was decided to offer a course of 12 lectures to persons in charge. The response was so great that two 2 courses were held and arrangements made for another longer course to be held in January 1968. Further requests were received from general practitioners for attachment of or liaison with health visitors, district nurses and midwives, and by the end of the year the numbers of such attachments were 3 midwives, 3 district nurses and 5 health visitors. During the year a group of practitioners enquired about the possibility of the Manor Drive Clinic being converted to a health centre, and it is hoped to establish one with this group of four family doctors. The borough's first health clinic for the elderly started in January in Acre Road clinic and a second in November at Manor Drive clinic. One health visitor worked full time as a geriatric health visitor throughout the year, additional to the one attaehed to the geriatrician at Kingston Hospital and shared with Surrey County Council and the London Borough of Richmond. I am grateful to Dr. Wills, whose keenness and energies were largely responsible for establishing these clinics. Owing to laboratory facilities for cervical cytology being extended to the borough, it was possible to start a limited service for well women at four of the borough clinics during the year. The home help service continued well below the minimum establishment necessary to meet the needs of the borough, and this state is likely to continue in an area with so much part time work available in light industry in a period of full employment. The number of treatments under the chiropody service again showed a sizeable increase and this service is valuable in helping to keep the elderly active. Mental Health Service The mental health service continued to function in close co-operation with the psychiatric services at Long Grove, Brookwood and Kingston Hospitals. The day centre for the mentally ill was started in temporary premises towards the end of the year, from which valuable experience for the future will be gained. A club previously functioning in clinic premises also transferred to this centre. An expansion of the special care unit and the erection of a prefabricated workshop in the grounds of Kingston Training Centre, together with other alterations were started at the end of the year and will help relieve the overcrowding. 3 The Minister of Health has indicated he hopes to be able to recommend loan sanction for the building of a 100-place adult training centre and workshop in New Maiden in 1969/70. It is hoped that there will be at a later date an occupational therapy unit for handicapped persons alongside, sharing kitchen, dining room and other facilities. Environmental Health Section Once again the report shows the enormous amount of routine inspection, visiting and sampling that goes on to ensure the fitness of our food and drink, and that our homes, places of work and atmosphere and environment are as healthy as possible. I record with regret the death of Mr.D.D.Mair, M.Sc., F.R.I.C., Public Analyst, in January 1968. He gave a valuable service to the new borough and to the constituent councils prior to the amalgamation, and to many other local authorities in the adjoining parts of Surrey. Welfare Section The report shows the wide variety of services available for the welfare of the aged and handicapped. A particularly valuable service is the temporary admission of elderly persons to give relatives a break or holiday. It is pleasing to report that the building of the first new old people's home in the borough is likely to start early in 1968. Additional accommodation of all types for the continually increasing number of elderly people is very necessary, ranging right through from flats and bungalows, warden controlled premises, accommodation provided by voluntary housing associations, to Part HI accommodation and hospital beds. The care of the confused elderly continues to be a difficult problem. There was an expansion in the meals on wheels and occupational services during the year. The recruitment of social workers at a time of national shortage remained a very difficult problem, and the full establishment was again never reached. The outlook should soon be brighter owing to the expanding output from courses for the qualification in social work training now taking place. This year our first trainee welfare assistant was seconded to such a two-year course. I hope that a future report not too far ahead will indicate a well co-ordinated service provided by a full complement of staff. 4 THE SCHOOL HEALTH SERVICE General The health of the school children in the borough remained satisfactory. This service is essentially a preventive one, calling for the closest possible co-operation not only between various services provided within the school health service but with the other branches of the Health Service. Every endeavour is made to promote co-operation and a good relationship with the staff of the hospitals and with the general practitioners in the area. As in the environmental health service, much of the work of the school health service is of a routine, unspectacular nature, which leads to gradual improvements in the health and maturity of our future citizens. School Medical Inspections I am pleased to report that the pilot scheme of selective medical examinations in the eight year old group of children in three of the borough schools during the year proved successful. The Education Committee have given authority for the selective basis to be fully implemented in these schools in 1968, and a similar trial scheme to be extended to the remaining junior schools at this age level. Audiology It is hoped to extend the sweep testing of children to new entrants to the secondary schools in 1968. Treatment of Psychiatric Illness During 1967 two major events have facilitated the investigation and treatment of psychiatric illness in families affecting children in the borough. In the first place the Child Guidance Clinic was rehoused in November from their cramped accommodation in Roselands Clinic to more spacious quarters in Mecklenberg House. The second event was the opening of the Mecklenberg Day Unit in the premises attached to Mecklenberg House for the accommodation of children too emotionally disturbed for normal school, yet not requiring removal from the home environment. 5 Health Education This is referred to above and details will be found under the section on General Services in my report on page 19. It is essential that to be successful, health education in its widest sense must become a normal part of education and of the curriculum in the schools. I hope that the health education officer will be able to further this aim. I should not like to leave the subject of the school health services without paying tribute to Dr. Wills, who has staunchly supported me and has been responsible for the day to day administration of these services. I thank all my staff for their efforts throughout the year, and my fellow chief officers and heads of departments for their friendly support. I also wish to express my appreciation of the help and co-operation of my colleagues in the hospital and general practitioner services, and of the valuable work undertaken by the many voluntary organisations in the borough. Finally, I am pleased to acknowledge the support given to the department by members of the Council and particularly by the Chairmen, Vice-Chairmen and Members of the Health and Welfare, Education and Establishment Committees. JOHN C. BIRCHALL Medical Officer of Health and Principal School Medical Officer 6 ROYAL BOROUGH OF KINGSTON UPON THAMES HEALTH AND WELFARE COMMITTEE AS AT DECEMBER 1967 Mayor: Councillor R.Pearse Oliver,A.C.I.S.,F.B.S.,J.P. Chairman: Councillor H.W.Payne,A.R.Ae.S. Vice-Chairman: Alderman A.C.Healey,M.Sc.,Ph.D.,F.R.I.C. Alderman: D.A.McDonald (died 23.12.67) Councillors: G.H.Archer,M.I.O.M. J.A.H.Cook,L.A.Eng. K.S.Cooley R.H.Gibbs J.A.Gordon H.J.Halford J.Harrison,M.I.Prod.E. Mrs,D.M.Judge M.E.Mace Mrs.A.I.Pamment E.C0Pinfold,S.R.N.,R.M.N.,J.P. D.Scott F.A.Speller,F.C.I.S.,A.I.A.C. F.J.Steptoe R.G.Sutton A.H.Williams Co-opted Members: R.H.Bartley,M.R.C.S.,L.R.C.P. R.A.Baylis,L.D.S.,R.C.S. J.S.Bearcroft,M.D.,M.R.C.P.,D.P.M. Miss B.Cowell,S.R.N.,S.C.M.,M.T.D., D.M.,J.P. Mrs.C.E.Hobkirk,J.P. F.R.Hooker,F.C.I.S. Mrs.E.R.Knight R.E.Wirgman,M.B.,B.S. Mrs.A.Woodgate,J.P. Local Medical Committee Local Dental Committee Consultant Psychiatrist, Long Grove Hospital Midwife Teachers' Training College Kingston upon Thames Association of Old People's Welfare Committees Kingston and Long Grove Group Hospital Management Committee Kingston upon Thames Association for the Blind Local Medical Committee South West London and Surrey Executive Council 7 STAFF OF THE HEALTH AND 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) Health Education Officer Superintendent Health Visitor Superintendent Home Nursing Services and Non-Medical Supervisor of Midwives Principal Mental Welfare Officer Senior Social Welfare Officer (Aged and Handicapped) Senior Social Welfare Officer (Problem Families) Home Help Supervisor Chief Administrative Officer J.C.Birchall, M.B.,Ch.B.,D.P.H. A.G.Bailey, M.B.,Ch.B.,D.P.H. R.G.Isaac, M.R.C.S.,L.R.C.P.,D.P.H. Valerie Wills, M.D. Miss A.Hobley, L.D.S.,R.C.S. (Appointed 10.5.67) 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.0.G., D.P.M. Mary L.Goodyear, M.B.,Ch.B. (Appointed 1.9.67) Mrs.C.M.Owen, S.R.N.,H.V.Certificate Miss P.M.Stanley, S.R.N.,S.C.M., Q.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. Miss J.M.Hodgetts Mrs.I.E.Roobottom H.A.Sears, D.M.A. 8 CONTENTS VITAL STATISTICS AND GENERAL SERVICES 10 PERSONAL HEALTH SERVICES 24 MENTAL HEALTH SERVICES 57 WELFARE SERVICES 69 ENVIRONMENTAL HEALTH SERVICES 95 SCHOOL HEALTH SERVICE 155 VITAL STATISTICS AND GENERAL SERVICES 10 VITAL STATISTICS Area, 9281 acres. Population, estimate of Registrar General at Mid-year 1967 145,240 Rateable Value at 1st April 1967, £10,08131,013 Produce of a Penny Rate at 1st April 1967, £40,400 Separately Rated Dwellings, at 1st April 1967 47,885 Live Births: Males Females Total Percentage Legitimate 1,005 966 1,971 92.1 Illegitimate 94 74 168 7.9 Totals 1,099 1,040 2,139 100.0 Crude Birth Rate per 1,000 estimated population 14.7 Adjusted Birth Rate for purposes of comparison using the comparability factor 1.01 14.8 (England and Wales) 17.2 Still Births: (15 males and 13 females) 28 Rate per 1,000 live and stillbirths 12.9 (England and Wales) 14.8 Total Births 2,167 Deaths: Total (790 males and 816 females) 1,606 Crude death rate per 1,000 population 11.1 Adjusted death rate for purposes of comparison using the comparability factor 0.92 10.2 (England and Wales) 11.2 Maternal deaths Nil Maternal Mortality rate (including abortion) per 1,000 total live and still births Nil (England and Wales) 0.20 Infant Mortality: Infant deaths (infants under one year): Males Females Total Legitimate 19 8 27 Illegitimate 2 3 5 Totals 21 11 32 (contd.) 11 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 15.0 (England and Wales) 18.3 Mortality rate of legitimate infants per 1,000 legitimate live births 13.7 Mortality rate of illegitimate infants per 1,000 illegitimate live births 29.8 Mortality rate of male infants per 1,000 male live births 19.1 Mortality rate of female infants per 1,000 female live births 10.6 Neonatal deaths (under 4 weeks of age) (13 males and 9 females) 22 Neonatal mortality rate per 1,000 live births 10.3 (England and Wales) 12.5 Early neonatal deaths (under 1 week of age) (12 males and 7 females) 19 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) 47 Perinatal mortality rate per 1,000 total live and still births 21.7 (England and Wales) 25.4 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Asphyxia Neonatorum (thick pus in respiratory tract) 1 - - 1 Atelectasis (Cerebral Haemorrhage) - 1 - 1 Cerebral Haemorrhage (Birth Anoxia) - 1 - 1 Congenital Heart Disease - - 1 1 Craniostenosis 1 - - 1 Haemorrhage (Following resection for coarctation of Aorta) - - 1 1 Intestinal Atresia (Peritonitis) - 1 - 1 Prematurity 2 - 1 - „ (Foetal Anoxia) 1 - - 1 „ (Hyaline Membrane Disease) - 1 - 1 „ (RespiratoryDistress Syndrome) 2 7 - 9 „ (Respiratory Failure) - 1 - 1 Totals 7 12 3 22 12 CAUSES OP DEATH BY AGE 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 1. Tuberculosis, Respiratory M 2 — — — — — — — 1 — 1 — F — — — — — — — — — — — — 2. Tuberoulosis, Other M — — — — — — — — — — — — F 1 — — — — — — — — — — 1 3. Syphilitic Disease M 1 — — — — — — — — — 1 — F 7 — — — — — — — — 2 1 4 4. Diphtheria M — — — — — — — — — — — — F — — — — — — — — — — — — 5. Whooping Cough M — — — — — — — — — — — — F — — — — — — — — — — — — 6. Meningococcal Infections M — — — — — — — — — — — — F — — — — — — — — — — — — 7. Acute Poliomyelitis M — — — — — — — — — — — — F — — — — — — — — — — — — 8. Measles M — — — — — — — — — — — — F — — — — — — — — — — — — 9. Other Infective & Parasitic Diseases M — — — — — — — — — — — — F 2 — — — — — 1 — 1 — — — 10. Malignant Neoplasm, Stomach M 16 — — — — — — — — 5 3 8 F 15 — — — — — — 1 — 3 6 5 11. Malignant Neoplasm, Lung, Bronchus M 86 — — — — — — 3 5 25 37 16 F 18 — — — — — — — 3 6 4 5 12. Malignant Neoplasm, Breast M 3 — — — — — — — — 1 1 1 F 35 — — — — — — 1 7 6 13 8 13. Malignant Neoplasm, Uterus F 17 — — — — — — — — 7 3 7 14. Other Malignant and Lymphatic Neoplasm M 76 — 1 1 — 1 1 3 8 17 22 22 F 86 — — 1 — — 1 6 7 14 22 35 (continued) 13 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 15. Leukaemia, Aleukaemia M 9 - 1 - - - - - - 2 2 4 F 5 - - - - - - - - 1 2 2 TOTAL all forms of Cancer 366 - 2 2 - 1 2 14 30 87 115 113 16. Diabetes M 3 - - - - - - 1 - - - 2 F 6 - - - - - - - - 1 2 3 17. Vascular Lesions of Nervous System M 76 - - - - - - 1 1 10 24 40 F 133 - - - - - - - 4 8 20 103 18. Coronary Disease, Angina M 210 - - - - - - 5 17 70 58 60 F 154 - - - - - - - 4 17 42 91 19. Hypertension with Heart Disease M 10 - - - - - - - - 3 4 3 F 19 - - - - - - - - 1 2 16 20. Other Heart Diseases M 38 - - - - 1 1 1 2 3 13 17 F 76 - - - - - - - 1 3 5 67 21. Other Circulatory Diseases M 42 - - - - - - - 1 6 12 23 F 58 - - - - - - - 1 1 5 51 TOTAL Heart and Circulatory Diseases 818 - - - - 1 1 7 31 122 185 471 22. Influenza M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 23. Pneumonia M 45 - 4 - - - - - 1 3 10 27 F 59 - 1 - - - - - - 3 8 47 24. Bronchitis M 61 - - - - - - - 2 15 13 31 F 14 — - - - - - - - 5 - 9 25. Other Diseases of Respiratory System M 7 - - - - - - - 1 1 2 3 F 6 - - 1 - - - - - - - 5 (continued) 14 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 11 - - - - - - 1 1 2 2 5 F 6 - - - - - - - - - 2 4 27. Gastritis, Enteritis and Diarrhoea M 2 - - - - - - - 1 - - 1 F 8 - - - - - - 1 - 1 2 4 28. Nephritis and Nephrosis M 4 - - - - - - - - 2 1 1 F 2 - - - - - - - 1 - - 1 29. Hyperplasia of Prostate M 8 - - - - - - - - - 2 6 30. Pregnancy, Childbirth F - - - - - - - - - - - - 31. Congenital Malformations M 5 2 - 1 - 1 - - - - 1 - F 5 1 1 2 - - - - - - 1 - 32. Other Defined and Ill-defined Diseases M 44 11 2 3 1 1 2 2 1 4 8 9 F 56 8 - 1 1 - 1 - 3 5 15 22 33. Motor Vehicle Accidents M 15 - - - - 4 1 1 2 1 1 5 F 8 - - - 1 - - - 1 2 2 2 34. All Other Accidents M 8 - - - 1 - 1 1 - 1 1 3 F 12 - - - - - - 3 - - 2 7 35. Suicide M 8 - - - - - 1 1 1 3 2 - F 4 - - - - - - 1 - 1 1 1 36. Homicide and Operations of War M - - - - - - - - - - - - F - - - - - - - - - - - - TOTAL Accidents Suicide and Violence 55 - - - 2 4 3 7 4 8 9 18 TOTAL ALL CAUSES M 790 13 7 5 2 8 7 20 45 174 221 287 F 816 9 2 5 2 - 3 13 33 87 160 502 15 ANALYSIS OF MARRIAGES 1967 1203 marriages were registered in the borough during 1967. Of these, 498 were Church of England marriages and 705 took place either in other Churches or in Register Offices. The following table shows an analysis by age groups of the 705 marriages conducted via the Register Offices within the borough during 1967. No such analysis of the 498 Church of England marriages is available. Age of Parties Marriages in Register Offices Marriages in NonConformist Churches Where Registrar Attends Marriages in Churches Where Minister Registers Own Ceremony M F M F M F Under 21 61 137 16 32 16 35 21 - 30 230 205 76 67 59 51 31-40 83 65 14 10 20 11 41-50 47 38 3 5 - 1 Over 50 61 37 9 4 10 7 Totals 482 482 118 118 105 105 16 INFECTIOUS DISEASES The following table shows the numbers of cases notified during 1967 by age groups: Disease Under 5 5-14 15-44 45-64 65 and over Age Unknown Total Scarlet Fever 12 19 2 - - - 33 Whooping Cough 13 21 - - - - 34 Measles 1174 711 14 - - - 1899 Dysentery 20 43 7 - - 2 72 Acute Pneumonia 2 1 2 2 2 - 9 Acute Encephalitis Post-Infective - - 1 - - - 1 Typhoid Fever - - 1 - - - 1 Erysipelas - - - 3 - - 3 Food Poisoning 1 1 2 - - - 4 Puerperal Pyrexia - - 58 - - - 58 Tuberculosis, Respiratory 3 7 17 14 5 — 46 Tuberculosis, Other - - 1 - - - 1 Totals 1225 803 105 19 7 2 2161 Encephalitis - Post-infective The case of post-infective encephalitis occurred in a person who had been suffering from mumps. Sonne Dysentery 72 cases occurred during the year, 43 of these and 8 carriers being in an outbreak involving a number of schools in the borough. The other 29 cases were isolated incidents. 17 Food Poisoning Four cases occurred in one family due to the consumption of chicken infected with Clostridium Welchii. This infection is normally associated with inadequate cooking, slow cooling and reheating of meat, and its occurrence in chicken emphasises the need to ensure thorough cooking and rapid cooling of all meat products and the avoidance of reheating. Typhoid One case of typhoid was notified and investigated. This involved an 18 year old female who had attended a youth camping expedition in Morocco. All members of the party had been advised to have T.A.B. inoculation but the patient did not obtain this protection. The investigation was protracted and painstaking but no further cases were reported and the patient recovered. Comparative Table of Notified Infectious Diseases 1961-1967 Disease 1961 1962 1963 1964 1965 1966 1967 Acute Pneumonia 26 17 27 13 17 52 9 Scarlet Fever 48 28 31 19 29 42 33 Measles 2154 410 1482 235 1971 736 1899 Whooping Cough 23 21 42 49 20 16 34 Puerperal Pyrexia 89 38 37 18 41 43 58 Poliomyelitis 2 - - - - - - Ac.Infective Encephalitis: Post-Infective - - - - - - 1 Infective - 1 - 1 - - - Erysipelas 1 5 1 5 4 2 3 Diphtheria - - - - - - - Ophthalmia Neonatorum - - - - - - - Typhoid & Paratyphoid Fevers 1 - 3 2 4 1 1 Food Poisoning 18 7 37 6 4 - 4 Dysentery 9 94 96 10 54 146 72 Meningococcal Infection - 2 2 - - - - Tuberculosis, Respiratory 76 68 66 64 32 27 46 Tuberculosis, Other 10 5 9 9 2 6 1 18 Laboratory Service Bacteriological and viral specimens are dealt with by the Public Health Laboratory at Epsom and also by Kingston Hospital Laboratory. Venereal Diseases The following figures were taken from returns submitted by the physicians in charge of the treatment centres shown, and they relate to new cases occurring among borough residents: Treatment Centre Totals all Conditions Syphilis Gonorrhoea Other conditions Primary and Secondary Other St.Thomas' Hospital, S.E.1. 65 - 2 10 53 The London Hospital, Whitechapel, E.1. - - - - - St.Bartholomew's Hospital, E.C.1. 17 - 1 2 14 Croydon General Hospital 2 - - - 2 St.Helier Hospital, Carshalton 68 - - 13 55 Totals 152 - 3 25 124 19 GENERAL SERVICES HEALTH EDUCATION Expansion in the field of health education continued throughout 1967 and the health education officer, Dr. Mary L.Goodyear, was appointed on the 1st September. Monthly displays were held at clinics and discussions in mothers' club3, and certain topics were chosen each month. These were as follows: January Home Safety July Clean Food February Alcoholias and Drug Addiction August Litter and Safety on Holiday March Smoking and Lung Cancer September Immunisation October Fireworks April Dental Health November Road Safety May Functions of the Clinic December Christmas Decorations and Home Safety at Christmas time June Mental Health Quarterly co-ordinating and planning meetings have been continued and attended by representatives from the Health and Education Departments. There has also been co-ordination with youth leaders and the health education team consisting of the deputy medical officer of health, chief public health inspector, health education officer and superintendent health visitor, have attended youth leaders' meetings every three months. At one of these meetings it became evident that there was a need for a health exhibition for the youth of the borough and a very successful exhibition called "Till Death Us Do Part" was held at the Chessington Youth Centre during November when over 700 young people attended during the two days. There were displays and experts to answer questions, and films dealing with the following topics: Immigration Venereal Disease Clean Air Marriage Guidance Road Safety Dental Care Drugs Nutrition First Aid 1967 was the silver jubilee year of the Royal Society for the Prevention of Accidents and the London boroughs were asked to co-operate in a campaign on home safety from 16th September to 30th November. A slogan competition suitable for all ages was arranged. Home safety talks were given 20 in eleven schools and illustrated by films, either "How To Have An Accident", a Walt Disney production, or "Accidents Don't Happen", a Mr.Pastry farce, as appropriate. Members of the health education team projected films and film strips, gave lectures and handed out 20,000 competition forms to schools, young wives, church groups, mothers' and old people's clubs, to support the R0SPA campaign. Lectures on topics of medical and or educational interest were again arranged in co-operation with the Kingston Hospital Postgraduate Education Committee, in the Kingston Medical Centre as follows: 19th January 1967 A meeting on "Drug Addiction in Young People and School children" - attended by a large audience including magistrates and head teachers. 22nd September 1967 A meeting on "Neonatal Resuscitation". 8th December 1967 A meeting on "General Practice at the Cross Roads", mainly concerning health centres and group practice. 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. However, many cases required investigation. REGISTRATION OF NURSING HOMES The Borough Council is the registration authority for nursing homes under Part VI of the Public Health Act 1936. No homes were registered during 1967, but two registrations were canoelled. At the end of the year there 21 were three registered nursing homes in the borough and these provided a total of 65 beds for chronic sick and medical patients. None provided any maternity beds. LICENSING OF NURSES' AGENCIES The Borough Council is responsible for licensing of Nurses' Agencies, under the Nurses' Agencies Act 1957. These licences are renewed on the 1st January each year. During the year three agencies were licensed to supply nurses to private cases at home, hospitals and nursing homes. 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 1247 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 323 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 414 were accepted on completion of a medical history form without actual examination. 173 newly appointed teachers and candidates for admission to teachers training colleges were medically examined as required by the Department of Education and Science. 260 teachers were considered fit upon completion of a medical history form of whom nine required medical examination, having regard to the details entered on the form. 22 HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital Royal Eye Hospital, Upper Brighton Road, Surbiton Kingston Hospital, Wolverton Avenue, Kingston upon Thames Tolworth Hospital, Red Lion Road, Tolworth Surbiton General Hospital, Ewell Road, Surbiton Services Available Ophthalmic, Refraction sessions Medical, Surgical, Fracture, Paediatric, Gynaecology, Ear, Nose and Throat, Maternity, Orthopaedic, Psychiatric, Rheumatology, Geriatric Diabetic, Dermatology, Ophthalmology Pathology, Chest Diseases Infectious Diseases, Chest Diseases, Geriatric Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Genito-Urinary, Gynaecology, Pathology PERSONAL HEALTH SERVICES 24 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and Post-natal Clinics There are six Council owned clinics at which ante and post-natal sessions are held. These are attended by medical officers and health visitors, and most of them by midwives. The following table gives the details: Address of Clinic Number of sessions held during the year Number of women who attended Total Attendances Ante-Natal Post-Natal Grange Road, Kingston 52 106 50 394 Acre Road, Kingston 48 92 30 466 Roselands, New Maiden) Kingston Vale 52 91 38 556 - - - - Manor Drive, Worcester Park 50 37 16 148 South Place, Surbiton Hamilton Avenue, Tolworth 48 98 26 503 - - - - Gosbury Hill, Hook St.Mary1s Church Hall, Chessington 52 80 38 451 - - - - Totals 302 504 198 2518 In addition midwives held 436 sessions at the above clinics and at the Surbiton and Maiden District Nurses Homes, at which 708 women made 2699 attendances. 5292 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed above. There were, in addition, 67 sessions held by general practitioners to whose practices borough midwives are attached. There were 620 attendances at these sessions. 25 Child Welfare Clinics Child welfare clinics are held at the six Council owned clinics referred to above and also in three rented premises in The Old School, Robin Hood Lane, Kingston Vale; St.George's Hall, Hamilton Avenue, Tolworth; and St. Mary's Church Hall, Che3sington. 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 Royal Voluntary Service Centres at Kingston, Maiden, Surbiton and the Fairmead Day Nursery, as follows: Surbiton W.R.V.S., Mon. Tues. 10.0 - 12 noon 154 Ewell Road Thurs. Frid. 2.0-4 p.m. and Wed. 10 - 12 noon Kingston W.R.V.S., Mon. Tues. 10.45 -4 p.m. Wed. 10.45 - 12.45 p.m. 23a Fife Road Thurs. Frid. New Maiden W.R.V.S., Mon. Tues. 2.0 -4.30 Thurs. Frid. Blagdon Road 10 - 12.45 P.m. Tolworth- Monday 2.0 - 4 p.m. Fairmead Day Nursery, Ewell Road 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 132 1116 6465 Acre Road, Kingston 126 1053 4248 Kingston Vale 24 114 391 Roselands, New Maiden 153 1345 5370 Manor Drive, Worcester Park 147 1099 4537 South Place, Surbiton 153 1182 5771 Hamilton Avenue, Tolworth 100 924 4824 Gosbury Hill, Hook 149 842 4526 St.Mary's Church Hall, Chessington 52 357 1511 Totals 1036 8032 37643 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. There are two dental surgeries at the Acre Road and Roselands Clinics. 26 Mothers Dental Care and.Treatment at Clinics Treatment Provided Grange Road Acre Road Roselands Manor Drive South Place Gosbury Hill TOTALS Treatment sessions 12 30 6 6 2 2 58 Examined 21 63 13 9 - 5 111 Treated 14 42 15 8 1 1 81 Completed courses of treatment 14 42 18 8 1 1 84 Scaling and gum treatment 24 35 19 14 1 3 96 Fillings 90 122 10 21 17 10 270 Silver nitrate - - - - - - - Crowns 1 - - - - - 1 Inlays - - - - - - - Extractions 13 26 3 2 - - 44 G«neral anaesthetics - - 1 - - 1 2 Dentures Provided Full - 1 2 - 2 1 6 Partial - - - - - 3 3 Radiographs - 22 - - - - 22 27 Pre-school Children Dental Care and Treatment at Clinics Treatment Provided Grange Road Acre Road Roselands Manor Drive South Place Gosbury Hill TOTALS Treatment sessions 20 48 36 23 13 20 160 Examined 66 207 123 73 26 62 557 Treated 38 104 124 58 30 36 390 Completed courses of treatment 37 118 134 56 13 32 390 Scaling and gum treatment 24 38 15 7 - 52 136 Fillings 104 407 136 77 64 92 880 Silver Nitrate treatment - 56 91 51 - 2 200 Crowns - - 3 1 7 11 Inlays - - - - - - - Extractions 26 71 85 3 6 12 203 General Anaesthetics - - 42 - - 3 45 Dentures Provided Full - - - - - - - Partial - - - - - - - Radiographs - - - - - - - 28 DAY NURSERIES The borough has two day nurseries. 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. The nursery staff have assisted in caring for six handicapped young children for a few sessions weekly, so as to relieve mothers of some responsibility. This has proved to be a great asset to both mothers and children. Other children in the nursery have also benefitted by wanting to be helpful and assisting in the care of disabled children. The nursery staff have also given great assistance to mothers of babies experiencing feeding difficulties and on several occasions have accepted babies into the nursery for a day and supervised mothers with the feeds. All children are under supervision by the medical staff of the department. During the year two nursery students completed their training and obtained the N.N.E.B. certificate. The following table shows the position as regards numbers on the registers and the waiting lists at the end of the year, with the average attendance during the year: Day Nursery Number of approved places Number on register at 31.12.67 Average daily attendance during the year Number on waiting list at 31.12.67 Under 2 Age 2-5 Under 2 Age 2-5 Fairmead Tolworth 42 12 30 9 23 ' 30 Canbury Park, Kingston 46 10 36 7 28 25 Totals 88 22 66 16 51 55 29 Nurseries and Child Minders Regulation Aot 1948 The Borough Council is responsible under this Act for registration of private day nurseries and daily minders. Registration under this Act has increased during the year and at the end of the year 31 nurseries provided a total of 673 places, and 39 daily minders 245 places. These figures represent a considerable increase, especially morning playgroups, and because of this and in view of the national interest in child minding, it was decided to provide some instruction on the day care of children. A course of twelve lectures was arranged in collaboration with the Education Department to cover such subjects as General Care and Home Safety, the Development of the Child, Nutrition and Menus, Psychological Problems, Value and Different Types of Flay, and the Organisation of Playgroups. It was originally hoped to enrol 24 students but the response was such that we had to admit 30 to the course which began on 15th September, and start a second course on 10th October which catered for a further 20 students. The attendance was good and a third course is to start in January 1968. The superintendent health visitor has acted as course tutor and the lecturers have been drawn from the health department and Gypsy Hill Training College. It is hoped that in the next academic year it will be possible to provide longer courses of twenty lectures in response to suggestions from this year's students. 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. During 1967 the Council accepted financial responsibility for 32 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. 30 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. From these and other 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. Information about children remaining on this register at the age of five years is transferred to the school health records. The total number of children on this register at 31st December 1967 was 3396. Of the 2139 children born alive in the borough during 1967, 932 were added to the "at risk" register, a percentage of 4-3.6. Many children are taken off the register when it is established that their physical and mental development is normal and they are no longer considered to be "at risk". Children are also removed at the time of entry to school. The number removed in 1967 was 587. 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 48 babies were notified at birth as congenitally malformed. Of these 3 were stillborn and 5 subsequently died, 4 of the deaths being a direct result of the abnormality notified; the fifth was due to prematurity, the malformation being a contributory cause. 40 babies had survived at the end of 1967. Details according to the Registrar-General's classification are as follows: 31 32 CONGENITAL MALFORMATIONS Total Malformations Reported Central Nervous System Eye Ear Alimentary System Heart and Great Vessels 60 7 1 9 4 (48 children) (6 children) (1 child) (7 children) (4 children) 3 Stillborn 2 Anencephalus 1 Deformity of Ear 2 Cleft Lip 3 Congenital Heart Disease 5 Died 2 Hydrocephalus 1 Hirschsprung's Disease n.o.s. * 40 Survived 1 Spina Bifida 1 Intestinal 1 Systolic Murmur 1 Hydrocephalus and Spina Bifida Atresia 2 Rectal Atresia 1 Oesophageal Atresia, Intestinal Atresia and Defects of Alimentary System n.o.s, * * n.o.s. = not otherwise specified 33 CONGENITAL MALFORMATIONS Respiratory System Urogenital System Limbs Other Skeletal Other Systems Other Malformations - 5 22 2 4 6 (5 children) (18 children) (2 children) (4 children) (6 children) 4 Hypospadias 10 Talipes 1 Craniostenosis 1 Birthmark on Arm 6 Mongolism 1 Defect of Genitalia 3 Congenital Dislocation of Hip 1 Craniotabes 1 Exompha]os 1 Syndactyly 1 Defects of 1 Defect Muscles n.o.s. * 1 Haemangioma 1 Talipes and Dislocation of Hip 1 Defect of Hand and Defect of Toe 1 Reduction Deformity, Polydactyly and Dislocation of Hip * n.o.s. = not otherwise specified Of the 48 children with abnormalities, 43 are shown in one column only, and 5 in two columns. 40 of these children were surviving at the end of the year. 34 THE WELFARE AND PREVENTION OF BREAK-UP OF FAMILIES As was agreed at the co-ordinating conference held in July 1966, quarterly reports on cases opened and closed were circulated via the Medioal Offioer of Health. This has ensured that the register has been kept up to date and that those workers involved in the prevention of family breaknip have been kept informed of the current position of the register. At the co-ordinating conference held in July 1967 it was agreed that this had been a satisfactory arrangement and that the procedure should be continued in the current year. The position during the year was: Number of families Number of children "At Risk" involved 1.1.67 125 458 31.12.67 144 539 The causes of failure or difficulty may be classified as follows: No. of families Marital 43 (29.9%) Material (Housing, Employment. 116 Financial) (80.5%) Disorders (Physical, Mental, 73 Psychological) (50.8%) Care of Home and Children 30 (20.8%) Desertion 15 (10.4%) Delinquency 22 (15.3%) Other reasons 22 (15.3%) The total percentage is more than 100 as most families are included under more than one heading. 35 Primary reasons for referral: No. of Couses families Marital 20 (13.9%) Material (Housing, Employment, 32 Financial) (22.2%) Disorders (Physical, Mental, 54 Psychological) (37.5%) Care of Home and Children 10 (6.9%) Desertion 6 (4.2%) Delinquency 7 (4.9%) Other reasons 15 (10.4%) There continues to be a slight increase in the number of case conferences held; this year there were 30. The reason for this is not only that more cases are being referred to the register but also because workers are seeing the usefulness of meeting together to discuss plans of action and to attempt to eliminate duplication and overlapping of services. The increase in the number of families is also something which need not be at all discouraging as in many instances the reason for referral appears to indicate that families are being referred at an early stage in their difficulties due to field workers' recognition of the more subtle symptoms of stress. There has also been a greater number of families referring themselves to the various social agencies as the general public are becoming increasingly aware of the help available. As early referral usually leads to a quicker return to the equilibrium with less intensity of visiting, referrals of this nature are, of course, desirable. During the school holidays the three school age children of an unsupported mother were financed for two weeks at a Church of England holiday home where they conducted themselves so well they were invited for a holiday at Christmas free of charge. 36 Prior to September 1967 the social welfare officers involved in family oasework had a general case load including physically handicapped and elderly people. Since that time however, a family casework team has been formed to deal specifically with the prevention of family break-up. The team consists of a senior social welfare officer, an assisting social welfare officer and a welfare assistant. It is anticipated that in concentrating on helping "problem" families and families with problems the team will be able to give a wider and more intensive casework service. As in previous years a considerable amount of help and co-operation has been received from both statutory and voluntary organisations. The casework team are most grateful for the help and encouragement they have been given. MIDWIFERY SERVICE Mothers confined at home were cared for by 9 full time midwives, 3 other full time staff who devoted part of their time to home nursing, and 4 part time maternity nurses. These staff were supervised by a non-medical supervisor and deputy, both of whom combined their posts with supervisory posts in the home nursing service. These domiciliary midwives attended the births of 462 babies born to Kingston residents, and cared for a further 359 mothers who were discharged from hospitals within ten days after confinement. They summoned medical aid in 103 cases. During the year 167 births to Kingston residents took place in institutions, so that the domiciliary midwives dealt with 21.7 per cent of all births occurring. Training The training of midwives includes a period of three months with local authority midwives who have been approved as teachers. There were 8 midwives who had been so approved in the borough's service and during the year 22 pupil midwives reoeived their three months training. The obstetric student nurses from Kingston Hospital each spend a morning with one of the approved midwife teachers as part of their obstetric course. Negotiations continued with the Central Midwives Board with a view to commencing Part II midwifery training in Kingston Hospital. The pupils would then 37 complete their training with the Borough Council's midwives. This scheme will commence in March 1968. Group Attachment to General Practitioners Two further liaison arrangements by midwives with groups of general practitioners were started during the year, making a total of three altogether. These arrangements are proving very satisfactory from the point of view of both patients and staff. HOME NURSING At the end of December 1967 the staff of the home nursing service consisted of the superintendent and her deputy, who also acted as non-medical supervisors of the midwifery service, 19 full time and 13 part time home nurses, 3 full time persons who shared their time between the home nursing and midwifery services, and 2 full time and 2 part time nursing auxiliaries. The services of the district nurses were made available at the request of general practitioners, evening calls being covered by a rota of nurses. Altogether 2184 persons were nursed during 1967, involving a total of 84,840 visits. Details are shown in the table overleaf. Nursing Auxiliaries Nursing auxiliaries, who were first appointed last year, have now become well integrated in the nursing structure and are proving to be very helpful, particularly in the care of the aged who do not require continual skilled nursing care. Instruction in procedures is given by the senior nursing staff. The Younger Chronic Sick being Nursed at Home The district nurses are spending a considerable proportion of their time giving skilled nursing to help these patients to remain in their own homes. The staff are trained to be aware of the stresses which so often occur in the families, particularly those who are coping with long term illness. A very close liaison must be maintained with the social welfare officer who is also visiting the patient so that the utmost support can be given to the relatives as well as nursing care to the patient, throughout their difficulties, and to maintain their independence within the community. 38 The number of patients in this area with these crippling diseases appears to be on the increase and more accommodation to help with holiday breaks would be greatly appreciated. These special nursing aids are provided, when required, to assist in nursing and for the comfort of the patient: Hydraulic hoists Ripple beds and cushions Pulleys and special beds Sheepskin pads Marie Curie Night Nursing Service This is provided for certain patients who need terminal care and are needing skilled night nursing. The payment for this service is made by special arrangement with the medical officer of health from the Marie Curie Memorial Foundation. Group Liaison with General Practitioners Following an approach by two groups of general practitioners working in Surbiton and Chessington respectively, and after some consultation and planning, home nurses were attached to the two practices. This makes a total of three such arrangements within the borough, the same three practices as have been referred to under "Midwifery" above. Laundry Service for the Incontinent This service is only provided for patients having treatment by the district nurse, and whose relatives have no facilities for coping with this problem. Six clean draw sheets are provided twice weekly and the soiled sheets are collected for laundering. The servioe is greatly appreciated by the relatives who are so often under stress and hard pressed in nursing very ill persons at home. Disposable incontinence pads and special geriatric protective garments are also issued to certain patients. District Nurse Training Four students were trained in 1967 and qualified for the National Certificate, also for the Queen's Roll. The theoretical course is now held at Ewell Technical College, in conjunction with Surrey County Council. Practical training is carried out within the borough . 39 HOME NURSING VISITS 1967 - BREAKDOWN BY AGE AND DISEASE Category of Disease Age 65+ Age 5-65 Age 0-5 Cases Visits Cases Visits Cases Visits 1. Heart Disease 125 5658 28 1195 - - 2. Circulatory Diseases 188 6676 38 2804 - - 3. Blood Diseases 129 4054 66 1039 - - 4. Diseases of Central Nervous System 44 3578 58 4729 1 50 5. Influenza 1 4 1 11 - - 6. Diabetes 47 6641 22 1328 - - 7. Burns and Scalds 12 266 7 300 - - 8. Accidents and Injuries 75 3256 20 333 - - 9. Rheumatic and Arthritic Conditions 126 7764 45 2472 - - 10. Varicose Ulcers 85 5612 18 497 - - 11. Abdominal Conditions 231 4183 199 1846 4 71 12. Gynaecological 31 585 17 399 - - 13. Genito-Urinary 33 667 21 332 19 153 14. Skin Conditions 42 1724 22 333 3 7 15. Orthopaedic 29 1540 23 751 - - 16. Breast Conditions 25 1090 22 846 - - 17. Ophthalmic Conditions 16 1173 3 45 - - 18. Miscarriages - - 12 140 - - 19. Tuberculosis 3 59 18 537 - - 20. Notifiable Infectious Diseases - 2 14 1 13 21. Ear, Nose and Throat Conditions 6 129 27 297 3 20 22. Midwifery Home Confinement - - - - - - 23. Midwifery Early Hospital Discharges - - 1 26 - - 24. Old Age and Debility 182 9227 1 25 - - 25. Physically Handicapped 1 32 2 252 2 62 26. Psychiatric Conditions 7 660 3 71 - - 27. Chest and Lung Conditions 145 5532 74 1686 5 38 28. Endocrine Disorders - - 1 19 - - CANCER (already shown above) 125 5111 76 3037 — - Total Persons 1429 63669 719 20775 36 396 Total Visits The total persons and the total visits are not the totals of the above columns as each person is shown in all the appropriate categories. 40 HEALTH VISITING The health visiting establishment at the end of 1967 provided for the employment of one superintendent health visitor, one group adviser, 26 health visitors, 2 student health visitors and the equivalent of 3 clinic nurses. The actual staff were: 1 superintendent health visitor, 1 group adviser, 21 full time health visitors, 5 part time health visitors, 1 geriatric health visitor, 2 student health visitors and 8 part time clinic nurses. One full time health visitor post was vacant. 3 of the health visitors were fieldwork instructors, one was employed entirely with the elderly, and one shared her time between health visiting and the preparation of materials for health education displays. The geriatric health visitor was attached to Kingston Hospital and her services were shared with the Borough of Richmond upon Thames and with Surrey County Council. Each health visitor continues to be responsible for the families and schools in a prescribed geographical area and has her base at the clinic nearest to her area. Her work has five main aspects: 1. The prevention of mental, physical and emotional ill health and its consequences. 2. Early detection of ill health and the surveillance of high risk groups. 3. Recognition and identification of need and mobilisation of appropriate resources where necessary. 4. Health teaching. 5. Provision of care; this includes support during periods of stress and advice and guidance in cases of illness, as well as in the care and management of children. The health visitor is not however, actively engaged in technical nursing procedures. Health visitors usually attend the following clinics: Ante-natal Infant Welfare Audiology Minor Ailment s Cervical Cytology Mothercraft Education in Childbirth Mothers Clubs Fathercraft Parentcraft Health Clinic for the Elderly Toddlers 41 The cytology, fathercraft, and health clinic for the elderly were commenced during 1967. Fathercraft A very successful course of five lectures was arranged by a health visitor in response to requests from fathers in the New Maiden area. Health Clinic for the Elderly Since January of this year one health visitor has been working entirely with the elderly and has visited 420 persons belonging to one group practice only. This health visitor was also responsible for the health clinic for the elderly. Two clinics were commenced in the borough where the elderly healthy are encouraged to attend for routine health checks. These are staffed by a senior medical officer, health visitor, district nurse and a group of voluntary workers. A comprehensive report on an examination is sent to the person's general practitioner. No treatment is carried out at the clinic, but vitamins and other food supplements are available at reduced prices. Opportunity is given for the discussion of problems, and light refreshments are provided. Cervical Cytology Facilities are now available at four clinics for mothers to attend for cervical smear tests and examination of the breasts. Of a total of 347 smears examined during the year, six were of cells suspected of malignancy and referred for further investigation; one was definitely malignant and referred for treatment. Mothers Clubs Clubs have been commenced in two more clinics and are now held in five clinics and one church hall. These were organised to assist the lonely and often depressed mother. Most mothers of first babies have worked until six weeks before their confinement, giving them little opportunity of getting to know their neighbours. Mothers are encouraged to organise their own meetings and supply refreshments. A health visitor is present to answer queries. A programme of activities is produced yearly which covers a wide range of topics in the field of health education and includes lectures, films, demonstrations, discussion groups and keep fit classes. A clinic nurse takes care of the children in a room apart. 42 Mothercraft Sessions in education for childbirth and mothercraft have been increased. A health visitor participates in a mothercraft series held at Kingston Hospital. Mothers who attended sessions at the clinic also had the opportunity to visit the maternity unit at Kingston Hospital and to see a film on the birth of a baby. Health visitors held 751 sessions on health education in schools, clinics and clubs. Three took part in weekly programmes at five senior schools. Short courses and isolated lectures were given in most of the borough's schools. Types of Cases Visited by Health Visitors during 1967 Number of cases Children born in 1967 2344 Children born in 1966 2612 Children born in 1962/65 7004 Persons aged 65 or over 1128 Mentally disordered persons 84 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 41 Tuberculous households Households visited on aocount of other 10 infectious diseases 1 Tuberculous households visited by tuberculosis visitor 247 Expectant mothers 1120 Geriatric patients visited by geriatric health visitor 342 School children for follow-up defects 521 Student Training Two student health visitors completed their training during the year, and both commenced duties as health visitors with the borough in September. Two more students were sponsored by the borough and commenced their training during the year. Arrangements were also made for two student health visitors from Surrey County Council to be attached to one of our fieldwork instructors for practical training. The superintendent health visitor took over the lectures given to student nurses at Kingston Hospital on the National Health Service, Prevention of 111 Health and Social Aspects of Disease. These students also had the 43 opportunity of spending one day observing the work of the health visitor. During the year 407 students from various fields attended sessions with health visitors. Liaison of Health Visitors with General Practitioners It is the Council's policy to extend the number of health visitors in liaison with general practitioners in group practices as quickly as possible. The health visitor chosen is the one who carries the heaviest caseload for the group practice. When a visit or information about a patient in another health visitor's geographical area is required, the health visitor attached to the group contacts her colleagues to obtain the information and reports back to the doctor. During the year four health visitors started regular weekly consultations or closer links with general practitioners in group practices, making a total of five such arrangements by the end of the year. Immigrant Health The medical officer of health is notified by airports and seaports of new arrivals in the country and the addresses 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. Of 112 immigrants whose arrivals were notified, 76 were visited during the year; the remainder were either untraceable or were known to have moved to other areas. VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation is reasonable in the borough. There was a fall in the number of primary vaccinations and immunisations recorded but this move resulted from a change in the procedure whereby local authorities are informed of the work undertaken by general practitioners, rather than an actual decline. It is encouraging to report an increase in reinforcing doses. 44 Smallpox (under 16 years) Age at time of Vaccination Total Vaccinated Numbers Revaccinated Complications Reported 0-3 months 16 - - 3-6 months 27 - - 6-9 months 16 - - 9-12 months 65 - - 1 year 1183 - - 2-4 years 243 22 - 5-15 years 83 167 - Totals 1633 189 - Diphtheria. Whooping Cough and/or Tetanus and/or Poliomyelitis (under 16 years) Complete Primary Course Boosters Diphtheria only - 63 Whooping Cough only - - Tetanus only 209 63 Combined Diphtheria and Whooping Cough - - Combined Diphtheria and Tetanus 202 3316 Combined Diphtheria, Whooping Cough and Tetanus 1821 1561 Poliomyelitis only * 2141 3015 Quadruple 10 2 *These figures include 26 primary courses of SALK (injection) vaccine and 1 booster injection of SALK, the rest being oral type SABIN vaccine. 45 Total children receiving immunisation against the four illnesses whether given separately or combined: Primary Course Booster Diphtheria 2034 4942 Whooping Cough 1831 1563 Tetanus 2242 4942 Poliomyelitis 2151 3017 Yellow Fever vaccination is controlled by the World Health Organisation and only certain centres are recognised for this and the issue of international certificates of vaccination. Grange Road Clinic, Kingston is the centre for this area. A fee of 10s.6d. is charged for the vaccination. During 1967, 999 persons were vaccinated against yellow fever. Smallpox vaccination of adults and injections for typhoid, paratyphoid and cholera are normally given by the family doctor when requested for travel abroad. The following table shows the percentage of children vaccinated and immunised in Kingston upon Thames, compared with the national average: Children born in 1966 Smallpox (children under 2) Whooping Cough Diphtheria Poliomyelitis (1) (2) (3) (4) England and Wales 74 75 71 39 Kingston upon Thames 81 83 82 58 The figures in columns (1) - (3) are calculated to show the percentage of children born in 1966 who have been vaccinated at any time. 46 Column 4 includes only children who were vaccinated during 1967 and were under two years old at the time,and is calculated as a percentage of children born during 1966. This is considered to give a reasonable estimate of the proportion of young children being vaccinated against smallpox. 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 The measures for the prevention, control and treatment of tuberculosis are directed by the chest physicians and staff of the Chest Clinic at Kingston Hospital. During 1967, 47 cases were notified in the borough and of these, 46 were pulmonary and one non-pulmonary. Eleven of the notifications were in respect of two families in which 9 children developed primary tuberculosis. The 46 pulmonary cases were in the undermentioned stages of the disease: A. or Tuberculosis - (sputum negative) 26 B.1 or Tuberculosis + (early cases, sputum positive) 3 B.2 or Tuberculosis + (intermediate cases, 3putum positive) 10 B.3 or Tuberculosis + (advanced cases, sputum positive) 5 Not known 2 The non-pulmonary case was tuberculous glands of neck. On 1st January 1967 there were 435 cases on the register and at the end of the year this figure had decreased to 407: 47  Pulmonary Non-Pulmonary Total Males 219 12 231 Females 152 24 176 Totals 371 36 4-07 The foregoing figures show an increase in the number of new cases of tuberculosis and serves as a reminder that this is no time for complacency. However, early detection and improved methods of treatment have resulted in another reduction in the number of sufferers from this disease at the end of the year. The following tables show the work undertaken by the Chest Clinic at Kingston Hospital during 1967 insofar as it affects patients resident in the borough: Number of chest clinic sessions held 344 Number of attendances: New Patients 695 Old Patients 3370 Total: 4065 Average attendances per session 11.8 Tuberculin Tests and B.C.G.Vaccinations Contacts School Children and Students Others Skin tested 226 12 48 Found positive 32 - 8 Found negative 129 6 9 Vaccinated 94 3 6 48 There were two deaths from pulmonary tuberculosis and one from non-pulmonary tuberculosis during the year. The following table shows comparative figures of notified cases and deaths for the years 1961-1967 inclusive: Year Cases Notified Deaths Respiratory Non-Respiratory Total Respiratory Non-Respiratory 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 1966 27 6 33 8 - 8 1967 46 1 47 2 1 3 No action was necessary during the year 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 1967, 67 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. 49 The table shown overleaf 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 2 4 3 5 4 20 - - - - - - 1 - 1 2 F 2 - 7 3 5 2 4 2 1 26 - - - - - - - - - - T 2 1 7 4 7 6 7 7 5 46 - - - - - - 1 - 1 2 NonRespir atory Tuberculosis M - - - - - - - - - - - - - - - - - - - - F - - - - - 1 - - - 1 - - - - - - - - 1 1 T - - - - - 1 - - - 1 - - - - - - - - 1 1 Occupational Therapy Nine chest patients received domiciliary occupational therapy from the occupational therapists based at 104 Westbury Road, New Maiden, and of these, eight were attending the chest clinic. One occupational therapist also attends Tolworth Hospital where patients are treated for various chest complaints. 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 9613 8548 13161 Cases found to be suffering from tuberculosis 11 3 14 Cases found to be suffering from lung cancer 9 3 12 50 Recuperative Holidays Patients are sent for recuperative holidays upon the recommendation of their general practitioners or hospital consultants, and during the year 44 recommendations were received, of which 35 came from general practitioners. 37 patients subsequently accepted the arrangements made for their recuperative holidays but one returned home before the expiry of the booked period. FAMILY PLANNING The Council made clinic premises available free of charge to the South West London branch of the Family Planning Association, and reimbursed payments on a per capita basis for cases advised and treated on medical/social grounds. During the year a total of 573 doctor sessions were held which were attended by 1087 new patients. 280 of these patients were fitted with the "cap", 416 were prescribed the "pill", 241 were fitted with an I.U.D., and 84 received advice only. Altogether there was a total of 7445 clinic attendances. Details of Family Planning Clinics currently being held are as follows: Roselands, 163 Kingston Road, New Maiden Alternate Mondays, Tuesdays and Thursdays 6.30 to 8.30 p.m. Appointments: Phone 942 0734 South Place, Surbiton Mondays, Wednesdays and Thursdays Fridays 6.30 to 7.30 p.m. 9.30 to 10.30 a.m. Appointments: Phone 399 8898 204 Acre Road, Kingston Wednesdays 7 to 8 p.m. Appointments: Phone 546 5812 1 Gosbury Hill, Hook, Chessington Tuesdays 6.30 to 7.30 p.m. Appointments: Phone 397 5737 The Manor Drive, Worcester Park Wednesdays 10 a.m. to 12 noon Appointments: Phone 337 0246 51 LOAN OF NURSING EQUIPMUNT 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 Council. The scheme is intended to facilitate simple short term nursing care in the patients' homes, and under the arrangements deposits are collected from patients by the British Red Cross Society and refunded to them when the equipment is returned. Altogether 732 loans of nursing equipment were made during the year and the following table gives the details: Article Number on Inventories Total Loans during 1967 Periods for which loans were made Under 3 mos. 3 - 6 months Over 6 mos. Air Beds 2 - - - - Air Bellows 3 - - - - Air Rings 24 55 43 7 5 Bed Rests 24 72 49 11 12 Perfection Bed Pans 24 101 78 13 10 Bed Tables/Trays 9 14 12 1 1 Invalid Chairs, Push Type 8 85 69 7 9 Invalid Chairs, selfpropelling 2 42 32 3 7 Commodes 18 135 97 21 17 Cradles 10 46 34 9 3 Crutches, pairs 5 26 22 3 1 Douche Cans 4 2 2 - - Feeding Cups 10 16 14 1 1 Inhalers 5 - - - - Mackintosh Sheets (draw) 8 4 4 - Mackintosh Sheets (long) 20 40 30 4 6 Pillow Cases, Jaconet - - - - - Steam Kettles - - - - - Male Urinals 11 36 30 3 3 Female Urinals 3 10 8 - 2 Walking Sticks - 27 11 4 12 Bed Blocks 1 1 - 1 - Sputum Cups - - - - - Kidney Bowls 1 1 1 - - Carrying Chairs 1 1 - - 1 Walking Aids - 17 13 1 3 Infra Red Lamps — 1 1 - - The Borough Council makes a grant to the British Red Cross Society in respect of the running of this service. The St. John Ambulance Association also has two centres in the borough from which small items of equipment are loaned on request. This body does not receive a Council grant. 52 CHIROPODY The chiropody service assists elderly persons, expectant mothers and the permanently handicapped. There are two schemes in operation. Under the direct scheme patients receive treatment from the "approved" chiropodist of their choice in his own surgery. As at 31st December 1967, 14 chiropodists were approved. A patient can be treated at home by the chiropodist if certified unable to attend the surgery by the family doctor. The indirect scheme is operated by the local Old People's Welfare Committees on behalf of the Council. The following is a summary of the service provided: A. Persons Treated during the year Local Authority Voluntary Organisations Total Persons of pensionable age and over 1901 727 2628 Expectant mothers 2 - 2 Physically handicapped, under 65 44 - 44 Blind, under 65 5 - 5 Totals 1952 727 2679 Note: Deletions during this time due to persons having died or leaving the district total 152 persons. B. Treatments Given during the year Local Authority Voluntary Organisations Total In clinics — 4003 4003 In patients' homes 2529 245 2774 In Old People's Homes 665 - 665 In Chiropodists' surgeries 7855 - 7855 Totals 11049 4248 15297 53 HOME HELP SERVICE The Home Help service is provided to meet the needs of people who for various reasons such as home confinement, sickness or old age, are either temporarily or permanently unable to carry out housework or need assistance towards such tasks as shopping, cleaning or washing. The service is provided on the recommendation of the family doctor and the amount of service is assessed on need by the home help supervisor, and on availability of home helps. A charge is made based on the cost of the service, but is reduced according to the recipient's means where necessary. The establishment of the equivalent of 60 full time home helps has never been reached, but at 31st December 1967 there were 93 home helps, equivalent to 42.3 full time staff. The home help service offers a rewarding job for anyone interested in helping those in need. It is not just dull repetitive work but involves meeting people and giving social help and encouragement as well as domestic assistance. The following are details of the households assisted during the year: Category Number Assisted Persons aged 65 or over at time of first visit 699 Chronic sick and tuberculous 39 Mentally disordered 2 Maternity cases 139 Others 31 Total 952 The total number of hours devoted to patients by the home help service was 75,751. MENTAL HEALTH SERVICES 57 MENTAL HEALTH SERVICES Administration The Medical Officer of Health is in charge of the administration and. he, the deputy and one senior medical officer are approved for the purpose of the Mental Health Act. Dr.J.S.Bearcroft, consultant psychiatrist from Long Grove Hospital serves as a co-opted member on the Health and Welfare Committee and acts as psychiatric adviser to the Local Health Authority, and assists in the appointment of mental health staff. Excellent relationships have continued also with the two hospitals that receive subnormal patients from the borough and I am grateful for the co-operation and help of Dr. J.M.Crawford, Physician Superintendent of Botleys Park Hospital, and Dr.B.H.Kirman, consultant psychiatrist of Queen Mary's Hospital for Children, Carshalton. Staff The establishment consists of a principal mental welfare officer, Mr.E.V.Oram, and seven other mental health social workers, of whom five were in office at the end of the year. One mental health social worker, seconded for one year's full time course leading to the National Certificate in Social Work, returned to the department in August, after successful completion of the course. The principal mental welfare officer has continued to supervise students from the Certificate in Social Work Course at Croydon Technical College, and a further student was placed for part time practical training in September. The volume of work undertaken by the mental health social workers has continued to expand, the total number of patients referred increasing from 528 in 1966 to 631 in 1967: but owing to staff changes and absences during part of the year on secondment and maternity leave, for six of the twelve months only four social workers in addition to the principal mental welfare officer were available for duty. This, together with the need for in-training of newly recruited social workers, placed the staff under very heavy pressure during 1967. 2,914 domiciliary visits were made during the year and in addition, mental health sooial workers undertake the psychiatric social work at outpatient clinics at Kingston Hospital, attend oase conferences at Long Grove Hospital, and work with groups of patients at the social centre. All mental health social workers are authorised to act as mental welfare officers under the Mental Health Act 1959. 58 MENTAL ILLNESS Referrals The total number of mentally ill patients referred for assistance in 1967 was 588 as against 496 in 1966. Most of the increase resulted from a rapid growth in the number of patients referred directly by family doctors. These referrals are mainly for oasework advice and consultation, and continued social work; referrals with a view to hospital admission now account for less than a quarter of the total. An increasing volume of work in outpatient clinics produced a rise in the number of patients referred from this source, but there was a fall in the number first referred at the time of discharge from hospital, reflecting the fact that an increasing number of short stay hospital patients are already known to the mental health social workers. The number of patients from other sources remained fairly stable; these consist mainly of referrals from other social service agencies, but inolude also a number of direct requests for help by patients and their families. Mentally 111 Persons Referred to the Local Health Authority Referred by 1966 1967 General Practitioners 100 183 Hospitals, on discharge from inpatient treatment 125 98 Hospitals after or during outpatient or day treatment 144 181 Other (e.g. health visitors, police, relatives, self-referred) 127 126 Totals 496 588 Admissions During 1967 responsibility for admission of psychiatric patients from the borough was shared between Brookwood Hospital, covering the Surbiton and Chessington areas, and Long Grove Hospital, covering the remainder of the borough. Mental health social workers act in liaison 59 with hospitals and family doctors, and in their function as mental welfare officers can request a domiciliary visit by a psychiatrist when appropriate. The active assistance of mental health social workers was sought in the admission of 112 patients during 1967, but for only 36 of these was it necessary to use compulsory procedures under the Mental Health Act 1959. This low incidence of compulsory admission, which has now been maintained for two years, has been made possible by early referral, continuity of care and close co-operation between doctors and social workers. Stable residence is a precondition of continuity of care, and we are fortunate in this area in having a very low proportion of transients and temporary residents. Of the 10 patients in this category who were admitted to hospital from the borough, but whose homes are elsewhere, 7 were so acutely ill by the time contact was made that compulsory admission was necessary. This proportion is twice as high as for residents. Year Total Admissions Admissions under Mental Health Act Informal Admissions Emergency With Psychiatric Consultation With Psychiatric Consultation 1965 116 47 35 34 1966 107 13 26 68 1967 112 16 20 76 Hostel Accommodation There is no hostel accommodation in the borough and this has been provided by arrangement with the Cheshire Foundation, Richmond Fellowship and Mental After Care Association. During the year financial responsibility was accepted for hostel accommodation of 8 patients as follows: Male Female Cheshire Foundation 1 1 Richmond Fellowship 2 - Mental After Care Association 1 3 60 Psychiatric Day Centre and Social Centre Premises During the year a short lease was obtained of a house at 3 Gloucester Road, Kingston upon Thames for use as a combined day centre and social centre. The premises are due for redevelopment early in 1969, by which time it is hoped to find more permanent accommodation. The present short life building, in addition to meeting immediate needs, is providing valuable experience of the kind of facilities needed for a long term centre. The building was in poor decorative condition, and redecoration was undertaken by voluntary working parties of club members and friends assisted by members of a voluntary action group attached to Toe H. I would like to thank these members and voluntary workers for the time and hard work they put in. These evening and weekend working parties were supervised by the social work staff in their own time and outside normal duties. Day Centre The day centre was opened on 30th October 1967 with a staff of two, a supervisor, who is a qualified occupational therapist, and an assistant supervisor. It is intended to accommodate about 20 persons on a full time basis each day. Facilities are available for differing activities including occupational and relation therapy as well as group activities and outings. Catering at present is provided by the patients themselves, with cooking facilities provided. Purchasing and preparing meals forms a valuable part of the group activities, and meals for patients receiving Ministry of Social Security supplementary benefit are subsidised. At the end of the year two patients were attending the centre full time on a daily basis, and work was in process to introduce others early in January. Social Centre There are two weekly discussion groups each led by a mental health social worker, which together cater for about sixteen patients, and there are plans for further groups as soon as the social work staffing position permits. A small room has been set aside for social worker interviews with persons attending the centre and for evening interviews for patients who may be working during the day. 61 Social Club The social club continued to meet in a room at the Roselands Clinic during the first half of 1967, and during the summer a number of outings were arranged. The club started to meet at the new centre in June, and since then it has expanded substantially and received a fresh impetus as a result of the acquisition of premises. There have been two main reasons for this rapid growth. Many who are housebound with young children can now come, bringing the children with them. The work to be done and opportunity for a self-help enterprise has brought in many patients who did not want to attend a purely supportive social club, but who can make a real contribution, and a number have shown great benefit from doing so. To encourage a full contribution by members, club management and activities are arranged by a committee consisting of members and day centre staff under the chairmanship of a mental health social worker. A number of special social occasions have been arranged, including a well attended Bring and Buy sale. There is a strong need for further evening activities for the benefit of members who are working, but whose social life outside working hours is often very restricted. It is intended to start regular evening meetings very shortly. MENTAL SUBNORMALITY At the end of 1967 there were about 435 mentally subnormal persons known to the department whose home addresses were within the boundaries of the borough. Of these 203 were reported as receiving hospital care, and 232 were living in the community. Of the latter number, 79 were attending the training centre. Visiting is carried out by mental health social workers in co-operation with health visitors. 43 subnormal children and adults were referred to the mental health services for the first time during the year. 19 of these were children, an increasing proportion of whom are becoming known to the department during the first two years of life, when help can be given to the parents in the early stages of adjustment and planning for the future. A further 10 were of adolescents and older teenagers, either referred for community care on leaving school or experiencing difficulties in their first years of adult life. Hospital Care The borough is within the catchment area of Botleys Park Hospital, to which application is made for admission of all adult 62 mentally subnormal patients needing hospital care. Children are referred either to Botleys Park Hospital or to Queen Mary's Hospital for Children, Carshalton, which also has provision for children with psyohiatric problems or multiple handicaps. Both hospitals admit patients for short periods to give relief to their families. Patients are also seen at outpatient clinics for advice regarding their educational and other needs, and this service is of particular value to the authority in determining the best educational provision for children of borderline intelligence, or rith multiple problems. Kingston Training Centre Kingston Training Centre is a purpose built combined centre, consisting of a special care unit for severely handicapped children, a junior training centre for children up to sixteen years of age, and an adult centre and workshop for trainees over the age of sixteen. During the year extensions were made to the special care unit and adult workshops which from January 1968 will provide an additional 23 places. These extensions are largely needed to relieve existing overcrowding. At the end of 1967, 105 trainees were in attendance. Pressure on adult places in particular will remain heavy until completion of the new adult workshop planned for erection at Blagdon Road, New Maiden. The shortage of places has also been relieved by the opening of a new junior centre in the London Borough of Richmond, to which 7 children living in that area have been transferred. This reduces the number of places allocated to trainees from Richmond from 25 to 18 who are mainly adults. In addition, during the year one trainee attended the centre from the London Borough of Merton, and one severely handioapped Kingston child attended a centre attaohed to a spastic unit. Special Care Unit Ten severely subnormal children requiring constant nursing care attended the unit during 1967. Nursing care was provided by a staff of two. From 18th January 1968 it will be possible to accommodate one additional member of staff and a daily attendance of 15. The unit is designed to meet the needs of severely handicapped children under the age of 16. It is hoped that in the future day hospital facilities will be provided by the Regional Hospital Board for patients over the age of 16. 63 Junior Training Centre The junior centre provides for the needs of children between five and sixteen years of age. During 1967 it has been possible for the first time to admit some four year olds, and it is hoped to extend this provision as far as facilities permit in 1968. For the younger children emphasis is placed on simple toilet training and social awareness, proceeding to identification of familiar symbols associated with social situations. Towards adolescence formal tuition and more advanced social training are begun. Adult Workshops The adult centre is equipped with workshops, domestic science and social training facilities. The extension to the workshops has made it possible for the adult and junior centres to function as completely separate units and one additional workshop supervisor to be engaged for 1968. The workshops are run as far as possible on industrial lines and special contracts for assembly work have been obtained from local light engineering firms. In total, contracts to the value of £1,000 were earned by the trainees over the year. Trainees also carry out domestic work such as catering and laundry at the centre, and receive social training which includes outings to shops. The Staff of the Centre At the end of 1967 the staff consisted of one supervisor, five assistant supervisors, three adult workshops supervisors and three guide/ assistants, who combined coach duties with domestic duties. During the year five students were seconded to the centre for six weeks practical training from the National Association for Mental Health Training School and Chiswick Polytechnic. A physiotherapist attends for two sessions each week and a speech therapist for four sessions each week. Hearing tests on children suspected of deafness were also carried out at the centre by an audiometrician. Physiotherapy Twelve children have received regular physiotherapy at the centre during the year. Treatment was given for severe disablement due to cerebral palsy, for serious and less serious postural defects, and for general re-education in walking. 64 Speech Therapy 158 sessions were held during the year with a total of 994 attendances. 6 children were admitted during the year, making a total of 35 children who were either under treatment or supervision. 3 of these children were on the training centre waiting list and were seen at holiday clinics, when parents were given advice as to how to help their children with speech and language development. One child left during the year. The centre has a small purpose built, sound-insulated speech therapy room for individual treatment, which is also just large enough for small groups of two or three children. The Amplivox Auditory Training Unit has proved invaluable in the treatment of these children as it helps to focus a distractable child's attention on speech. Social Activities Pirates Spring Holiday 33 children and adults from the centre had a most successful week's holiday in June, at the Pirates Spring holiday camp at Dymchurch. They included 29 trainees from the borough and 4 from Richmond, and were accompanied by five members of the staff. A Christmas show was performed by the trainees on 13th December and was attended by the Mayor accompanied by the Town Clerk and more than 200 parents and friends. Christmas parties were held for junior and adult pupils and over the year trainees have participated in a number of outings. Thirteen children from the centre, together with boys and girls from Rivermead and Tiffin Schools, took part in a nativity play with audience participation arranged by the Organisation for Bringing Art and Music to the Handicapped. During the year the centre received many visitors, including a number from overseas. Voluntary Help The centre was fortunate in receiving a number of gifts of equipment, toys and money. Thanks are tendered to all donors, including the Kingston Society of Mentally Handicapped Children. 65 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 home and not requiring hospital admission, as follows: Adults Male Female Guardianship Society - 2 St. Teresa's Convent, Dockenfield - 3 Children St. Francis School, Buntingford 1 - WELFARE SERVICES 69 REPORT ON THE WELFARE SERVICES F.J.Meacock. Chief Welfare Officer Introduction I have pleasure in presenting this report on welfare services for the year 1967. The basis of future developments is the 'Ten Year Plan for the Development of Welfare Services of the Borough; which was submitted to the Ministry of Health in November 1965 in accordance with circular 14/65. WELFARE OF THE ELDERLY The policy should be one of progressively extending supportive domiciliary services in order to ease pressure on residential accommodation by enabling many more elderly people to look after themselves in their own homes. There will be many who will become so frail or so handicapped that they will need at some stage to be looked after in the Council's homes, and the cost of running existing homes and providing new ones will continue to represent the major part of the annual budget. The best possible provision should be made for those needing care and attention in Council homes, including many elderly people who are in hospital following treatment because there are insufficient places in old people's homes. Elderly people in homes need to be encouraged to remain active and to maintain a lively interest in the activities about them. They need surroundings to make them feel secure and if possible, the affectionate interest of friends and relations. Homes for the Elderly Whilst it is the object to keep old people contented in their own homes as long as possible, accommodation is provided for persons who need care and attention that cannot otherwise be provided. Every effort is made to ensure that persons in such accommodation are happy and comfortable. The homes are attractively furnished and all personal services are met, including clothing, chiropody, hairdressing etc. Entertainments and outings are arranged, and there are no irksome rules or restrictions other than those necessary for the comfort and welfare of residents. Visitors are welcome at reasonable hours. Residents must contribute towards the cost of their maintenance in accordance with their means, as laid down within the provisions of the Ministry of Social Security Act 1966; they retain however, at least 18/a week for personal spending. 70 The following residential establishments for the accommodation of elderly persons were being administered by the department throughout the year: Establishment No. of Residents 12/14 Langley Avenue, Surbiton 48 women 26 Langley Avenue, Surbiton 27 women Fircroft, 96 Ditton Road, Surbiton 26 men Fairlawn, Warren Road, Kingston Hill 31 women Coombe Oak, Warren Road, Kingston Hill 33 women Waratah, Sanderstead Road, Sanderstead 20 mixed Total 185 In addition, 38 beds at Kingsmead, Richmond, are allocated to the Borough Council, but it is anticipated that the Ministry will call for the closure of this establishment in the near future. Waiting List On 1st January 1967, 21 men and 69 women were awaiting admission to residential accommodation. Admissions The following admissions were made during the year: 1967 1966 Men Women Men Women (a) Homes administered by the borough 20 31 25 50 (b) Other local authority homes 3 10 6 12 (c) Voluntary homes 5 5 4 5 28 46 35 67 Of these admissions during the year, 7 men and 13 women were on the waiting list prior to 1st January 1967. It will be seen that a reasonable number of admissions have been effected, but not so many as during 1966. Other welfare authorities have assisted by accommodating some of the emergency admissions. The numbers on the waiting list have increased, there being 25 men and 77 women on the waiting list at 31st December 1967. 71 Short Stay Admissions As well as providing permanent residential care, 53 persons were admitted during the year under review for periods to enable relatives to take a holiday or to give them a break from the continued care of their elderly relatives, or to give the individual a necessary change of environment. Many enquiries were dealt with from other persons for assistance in making private arrangements for the care of their elderly relatives. The 53 admissions were all elderly persons and were as follows: Men Women Homes administered by the borough 5 8 Voluntary old people's homes 8 14 Voluntary homes for handicapped 4 14 17 36 New Accommodation At the end of the year plans were in an advanced stage for a new home for the elderly at Coombe Oak, Warren Road, Kingston Hill; this will be for 50 residents and it is anticipated that building will start early in 1968. Staff Considerable difficulties have continued to be experienced in the recruitment of suitable staff for the residential homes, but it is hoped that when the standard of staff accommodation is improved the situation will become brighter. Occupational Therapy at Welfare Homes for the Elderly Regular occupational therapy sessions are held at the Council's old people's homes and the residents find interest and relaxation in this work. Materials are purchased from the residents comforts fund and the finished articles are sold by the matrons at fetes or coffee mornings for the benefit of the fund. A number of articles were exhibited and sold at the exhibition and sale of handicrafts that was held at the British Legion Hall, Hollyfield Road, 72 Surbiton, on the 2nd November , The residents may, if they wish, purchase the articles they make at the cost of the materials involved,, Coombe Oak - Eire Damage On the 18th April 1967 a fire occurred at this home and severely damaged a large area of the main roof and the vicinity of the lift shaft, which was under construction. The heat of the fire caused extensive cracks which necessitated partial rebuilding of the home, and the electrical wiring and the telephone line on the first floor were considerably damaged. The residents and staff were transferred to other homes for about seven months whilst repairs and redecorations were carried out. Voluntary Services in the Residential Homes It is a pleasant duty to take this opportunity of recording appreciation to those individuals and members of voluntary organisations who did much to brighten the lives of residents by bringing some of the outside world to them by way of entertainments, gifts, and in other ways. Particular thanks are due to the members of the Women's Royal Voluntary Servioe, who provided a trolley shop in several of the homes, and the local Women's Institutes and Friends of Homes, who did so much to provide such entertainment and enjoyment for the elderly residents. Residential Accommodation in other Local Authorities Homes Some 78 elderly people from the borough are accommodated by other local authorities. Although many of these residents were already accommodated in these homes when the new borough came into being, these authorities have on several occasions also assisted with emergency vacancies when it has not been possible to provide accommodation locally, and thanks are expressed for their help. There were 54. residents at the 31st December 1967 in the Council's old people's homes who were the responsibility of other local authorities. All residents in homes outside the borough for whom this authority has accepted financial responsibility are visited by welfare officers from the authority in whose area the home is situated, and a report submitted to the Chief Welfare Officer. 73 Homes Administered by Voluntary Organisations There are many voluntary organisations throughout the country maintaining their own homes for those persons who satisfy their individual requirements for admission. It is thus often possible to place residents in homes according to a wide range of special provision for example, past profession, religion, social, occupational or educational background; accommodation thus provided makes a valuable contribution to the welfare of the old people. It is not practicable for the Council to provide separate accommodation for these different categories, but fortunately a great deal of work in providing suitable residential care is undertaken by voluntary organisations. There is no geographical restriction on which voluntary homes the Council may use, provided they are considered satisfactory and the residents' personal needs are met. Charges to the Council are agreed by negotiation and depend upon the financial position of the organisations concerned. Agreement of charges for maintenance is the responsibility of the welfare authority of the area where the home is situated. An arrangement between the Council and a voluntary home is advantageous to both, since the Council is helped in carrying out its duty to provide suitable residential accommodation and the home is assisted in continuing its activities by the payments made by the Council. Council residents in voluntary homes are visited periodic silly by an officer of the local authority where the home is situated, as this ensures a contact between the resident and the local authority and also provides an opportunity to deal with any problems which may arise. It also helps to maintain cordial relations which exist between the Council and the organisations managing the homes. 74 !**■ Persons resident in accommodation provided by voluntaryorganisations : Physical Category Age Sex 1.1.67 31.12.67 Not materially handicapped Aged M 24 13 Not Aged F 46 29 M — 1 F — 1 Blind Aged M _ F 4 5 Not Aged M _ - F 4 2 Epileptic Aged M 1 2 F - — Not Aged M 6 4 F - - Others physically handicapped Aged M 1 1 F 1 _ Not Aged M 1 5 F 3 9 Deaf Aged M - - F - - Not Aged M - - F - - Totals 91 72 75 It is continually a problem to find suitable vacancies in voluntary or other authorities' homes for those persons who are physically disabled, and this will, it seems, continue to be a problem as the welfare departments of the new London boroughs expand their services for the disabled and thereby create a greater demand. The Borough Council has in its Ten Year Plan a scheme for the erection of a purpose built home for physically handicapped persons. Three local voluntary organisations - the Maiden and Coombe Old People's Welfare Committee, the Surbiton Red Cross Society and the Surbiton Housing Society, also provide facilities for the admission of elderly persons, and thereby make a most valuable contribution. Registration and Inspection of Private Homes for the Elderly There were three registered voluntary old people's homes and twelve registered private old people's homes within the borough at the end of the year. One voluntary home and one private home closed during the early part of the year under review. There is also one voluntary home run by the British Red Cross Society under its own Charter. The registered homes have been regularly inspected and 34 visits were made during the year. Domiciliary Services Support for the Aged and Disabled There are those whose age, infirmity or other circumstances make it essential that they receive full care and attention in a home or in hospital, but the majority of those elderly or disabled people who need social help can, of course, manage in their own homes if such partial support as they need is available to them. Emphasis has been placed on those branches of the service which contribute in positive ways to prevent, or at least postpone, the need for admission to a home or hospital. It is felt that such measures should be seen as part of a wide community effort embracing all the services, such as home helps, district nurses, health visitors and other statutory and voluntary workers, as well as 76 families, friends and neighbours, who help to support and sustain those who would find it difficult or impossible to manage otherwise. Although preventive social services are costly, it is well to keep in mind the hidden savings in avoiding the much heavier costs of residential care, quite apart from the human gain in keeping people in their own homes with their families, friends and neighbours. Meals on Wheels Service Providing regular well balanced meals is an obvious essential requirement in a service which sets out to sustain elderly people in their own homes. The department has given particular attention to the meals on wheels service, which was started many years ago by pioneering voluntary organisations. Consideration is constantly being given to the improvement of the quality to give a greater variety of menu, and to the special requirements of individuals. Attention is given to the dietetic requirements of elderly people, whilst also continuing to cater for the traditionally popular dishes. Substantial progress has been made during the past year with the expansion of the meals on wheels service, which is seen as an essential daily service to the housebound and infirm, who have no regular or satisfactory means of obtaining a hot meal. During 1967 a total of 34,087 meals were delivered as compared with 19,105 in the last 9 months of 1966. The Kingston Women's Royal Voluntary Service continued to be responsible for the delivery of the meals in the Kingston district, whilst the British Red Cross carried out this function similarly for Surbiton, and the average monthly meals delivered were 1,500 and 1,225 respectively. The Maiden and Coombe Old People's Welfare Association, with the assistance of the Maiden W.R.V.S. continued to be responsible for the provision and delivery of meals in the Maiden and Coombe area of the borough, but were also supplied from the Council's meals on wheels kitchen with approximately 110 meals each month. During the year the British Red Cross Society experienced some difficulty in delivering the meals to elderly people because of the lack of voluntary drivers, but after an enquiry and an appropriate advertisement, the Society was able to undertake satisfactory deliveries in the Surbiton area. The following is a graph showing the monthly meals supplied from the meals on wheels kitchen during 1967. 77 78 Recreation and Meals The Borough Council makes an annual grant to voluntary organisations whose activities include the provision of meals and/or recreation for old people. The three Old People's Welfare Committees in Kingston, Surbiton and Maiden provide such services at their Old People's Clubs. WELFARE OF THE HANDICAPPED Section 29 of the National Assistance Act 1948 provides for local welfare authorities to promote the welfare of persons who are blind, deaf or dumb, and other persons who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed by the Minister. The Registers Registers of handicapped persons are kept in accordance with the requirements of the Minister of Health. There were 1,117 persons registered at 31st December 1967. The grouping of disabilities is in accordance with the Medical Research Council's code of diseases and disabilities as used by the Ministry of Labour. REGISTERS as at 31.12.67 Male Female Total Blind Persons 120 212 332 Partially Sighted 27 29 56 Deaf with Speech 12 11 23 Deaf without Speech 34 26 60 Hard of Hearing 10 18 28 Other Handicapped (General Classes) 272 346 618 475 642 1117 79 The Blind Register Registration is determined by examination by an Ophthalmologist of consultant status and appointments for examination are made through the department. Once a person is registered, every effort is made to overcome as far as possible the effects of the disability. A register is kept of those persons who wish to obtain the advantages of registration and come within the definition of blindness given in 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. The number of registered blind persons showed a net decrease of 10 over the previous year. The following tables show the age distribution of the blind population registered with the department on 31st December 1967. Age Period Blind Register as at 31.12.67, including transfers in and out New Cases Registered in the Borough during 1967 Male Female Total Male Female Total Under 1 - - - - - - 2 - _ - _ _ — 3 1 - 1 - - - 4 - - - - 1 1 5-10 2 1 3 - - - 11 - 15 1 - 1 — - - 16-20 - 2 2 - - - 21 - 29 1 3 4 - - - 30 - 39 5 2 7 - - - 40-49 11 7 18 - - - 50-59 20 5 25 1 1 2 60-64 10 10 20 - 3 3 65 - 69 9 28 37 4 5 9 70 - 79 32 65 97 5 15 20 80-84 8 39 47 3 11 14 85 - 89 12 26 38 1 4 5 90 and over 8 24 32 1 4 5 Unknown — — — — — — Totals 120 212 332 15 44 59 80 The position regarding the five children under 16 on the register as at 31st December 1967 is as follows: three are attending special schools for the blind and partially sighted, one is still in a hospital for mentally subnormal children and one is at home awaiting admission to a special school. 271 persons out of the total of 332 (82 per cent) on the blind register are over the age of 60. The age at onset of blincLiess was as follows: Age at onset of Blindness Age Period Male Female Total Under 1 15 10 25 1 — — — 2 — 2 2 3 - - - 4 - - - 5-10 - 1 1 11 - 15 1 3 4 16-20 4 1 5 21-29 12 2 14 30 - 39 12 5 17 40-49 8 12 20 50-59 11 13 24 60 - 64 7 17 24 65 - 69 10 23 33 70-79 21 62 83 80-84 9 37 46 85 - 89 4 11 15 90 and over 5 8 13 Unknown 1 5 6 Totals 120 212 332 81 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 40-9 50-59 60-64 65 and over Total employed Male — 4 7 10 5 2 28 Female 1 1 — 1 — 1 4 Totals 1 5 7 11 5 3 32 The people in this table are engaged in the following occupations: Masseurs and Physiotherapists 2 Machine Tool Operators 3 Lecturers, Teachers 1 Storekeepers and Assistants 1 Barristers, Solicitors, Boot and Shoe Repairers 1 related workers 1 Craftsmen/Process Workers 9 Telephone Operators 7 Labourers 1 Shop -Assistants/Salesmen 1 Miscellaneous Workers 4 Total = 32 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 included on the register at 31st December 1967, shows a reduction of six over the figure for 1966. Age Groups: 0-1 2-4 5-15 16-20 21 -49 50-64 65 & over Total Male - 2 _ 1 7 6 11 27 Female - - 2 - 3 2 22 29 Totals - 2 2 1 10 8 33 56 82 Home Workers Scheme The home workers scheme is organised by the Home Industries Department of the Royal National Institute for the Blind at Reigate, Surrey. Blind home workers are employed in a variety of occupations and supervision of these workers is carried out by visiting officers of the Home Industries Department. The Council is responsible for two home workers, one of whom does radio and electrical repairs, and the other is a piano tuner. Sheltered Workshops The Council is responsible for one employee in a sheltered workshop at Waterloo, under the auspices of the Royal School for the Blind. Residential Accommodation The number of registered blind and partially sighted persons in residential accommodation as at 31st December 19^7 was as follows: In homes for the blind - 9 women, - men ) Total 51 In other homes - 34 women, 8 men Every effort has been made to place blind persons in the homes of their choice, but it is hoped to integrate a percentage of blind persons into the Council's old people's homes when new purpose built homes are available. Social Rehabilitation The main centres for social rehabilitation are situated at Oldbury Grange, Bridgnorth, Manor House, Torquay, and America Lodge, Torquay. These centres are administered by the Royal National Institute for the Blind, and it may be found that after a short period of social rehabilitation a blind or partially sighted person is suitable for an industrial rehabilitation course. Oldbury Grange caters for social rehabilitation mainly for housewives and men in the upper age group, and a period of such rehabilitation is often a great help in enabling a newly blind person to settle down to normal domiciliary environment. One newly blind lady was sent for a period of social rehabilitation at Oldbury Grange during the year. 83 Holidays During September a block booking of 28 beds was made for two weeks at a hotel at Bognor Regis for a party of blind and partially sighted persons. Two physically handicapped persons were included in the party and a social welfare officer for the blind (home teacher) attended, with another home teacher joining for the second week. The home teachers were able to enlist a great deal of support from local blind clubs and other organisations who also lent a hand on many occasions for outings and other events, and contributed greatly to the success of the holiday. National Library for the Blind The National Library for the Blind provides a free service, apart from the appropriate charge made to the local authority, of Braille and Moon books to blind persons of all ages. There is a comprehensive range of fiction and non-fiction books available and if sufficient demand exists any particular book will be transcribed. The Braille and Moon books are sent to and from the Library by post and there is no postage charge. Talking Books The Nuffield Talking Book Library provides talking book machines on loan to registered blind persons over the age of 21 years, or to persons who have defective vision and can prove by an ophthalmologist's report that their eyesight is so poor that they cannot read. A comprehensive list of books on tape is available from the Library. The cost of renting a talking book machine is £3 per annum and the Borough Council has agreed to be responsible for the rental of up to 20 talking book machines in cases of need. Wireless for the Blind Fund Wireless sets, both battery and mains operated, are supplied on loan to registered blind persons who do not have a set of their own. The British Wireless Fund for the Blind provides the sets and the distribution is carried out by the social welfare officers for the blind. 84 Domiciliary Visiting Two social welfare officers for the blind (home teachers) concentrate on the care of the blind and partially sighted persons in the borough. They are generally responsible for making the initial contact with the newly blind, a task demanding understanding and knowledge in order to counter the shock both to the person and relatives. It is necessary at first for a firm relationship to be established by regular visits, in order to learn the needs of the person and the home and to deal adequately with problems as they arise. The social welfare officers teach Braille, Moon and handicrafts etc., and also arrange for the provision of talking books, wireless sets, books and periodicals. A weekly handicraft class is held in Surbiton. During the year assistance was given as follows: 1 newly blind person was sent on a social rehabilitation course 31 people were in attendance at the handicraft class 23 people made articles in their own homes as occupational therapy 6 people were taught Braille 6 people were taught Moon 20 people were given radio sets supplied by the British Wireless Fund for the Blind Kingston upon Thames Association for the Blind The blind and partially sighted persons in the borough have the support of a voluntary organisation - the Kingston upon Thames Association for the Blind, in addition to the services provided by the local authority, central government and national agencies. This Association supplements the statutory services and provides the extras which might not be otherwise available, and makes grants for a wide variety of purposes, including holidays, special equipment, books, magazines, clothing, bedding, fuel, fires and repairs to wireless sets. Welfare of the Deaf and Hard of Hearing (a) The Register The number of persons with total or substantial hearing loss registered with the department shows an increase of 29 over the previous year and the total number on the register at the present time is 111. This increase does not stem from an actual increase in the number of deaf and hard of hearing persons within the borough, but rather from the activities of the department in exercising their 85 responsibility for this service by the ascertainment, visiting and casework. A male social welfare officer for the deaf and hard of hearing, competent to converse and deal with this type of person, was appointed during July 1967 and this has undoubtedly had a bearing on the number of persons now registered. The total persons on the register are as shown in the table on page 70 and they can be mainly classified as under: Deaf with speech 23 Deaf without speech 60 Hard of hearing 28 (b) General Welfare The welfare of deaf persons places a heavy degree of responsibility upon the social welfare officer undertaking the duties, since he is frequently the only one who can be consulted on all or any matters in connection with this particular type of welfare work. The service for the deaf and hard of hearing has been given particular attention during the year and the results are reflected in the increased number of persons who are receiving the benefit of the local authority services. It is anticipated that during the next year the services and facilities for the deaf and hard of hearing will be further improved. Welfare of the Physically Handicapped - General Classes (a) The Register of Handicapped Persons - other than Blind. Partially Sighted and Deaf and Dumb The following tables give details of the above handicapped persons on the register as at 31st December 19&7. TABLE I Age Groups: S e X Children under 16 Persons 16-64 Persons 65 and over Totals Handicapped Parsons (General Classes) M 45 157 70 272 F 34 148 164 346 Totals 79 305 234 618 86 TABLE ii Register of Handicapped Persons - General Classes (By causes and age groups) a/e 0-15 16-29 30-49 50-64 65 and over Total Collective Total M F M F M F M F M F m F _ _ 2 _ 8 6 19 4 15 7 44 17 61 f 1 2 - 4 1 7 13 28 16 85 31 126 157 & 26 17 3 4 2 1 3 3 - 7 34 32 66 H/l 5 1 - 1 1 4 9 5 7 10 22 21 43 Q/T 3 1 3 1 13 5 13 7 8 8 40 22 62 v 9 10 10 11 18 30 32 22 23 38 92 111 203 u/w 1 3 - - - - 1 1 - 1 2 5 7 Z - - - - 3 2 3 2 1 8 7 12 19 Totals 45 34 18 21 46 55 93 72 70 164 272 346 618 Key: A/E Amputation V Organic nervous diseases - F Arthritis and rheumatism epilepsy, disseminated sclerosis, & Congenital malformations and poliomyelitis, sciatica etc. deformities U/W Neuroses, psychoses and other H/L Diseases of the digestive and nervous and mental disorders genito-urinary systems; of the not included in V. heart or circulatory system; Z Diseases and injuries not of the respiratory system specified above. (other than tuberculosis) and of the skin. Q/T Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine. 87 (b) Occupational Therapy - Handicapped The services continue to operate from the Occupational Therapy Centre at 104 Westbury Road, New Maiden and classes have been further extended during the year and they are now held as follows: Number of persons attending Tuesdays (all day) 16-18 Wednesday (morning) Art Class 6 Wednesday (afternoon) 12 Thursday (afternoon) 10 Friday (afternoon) 12 These numbers are the maximum that can be carried at the present time with only one ambulance, but an additional ambulance which should be delivered early next year will facilitate expansion of the classes. A hot meal from the meals on wheels kitchen is provided for those attending the all day class on Tuesdays. An additional occupational therapist was appointed during August and this has made it possible to extend the domiciliary services for the physically handicapped and introduce an extra class. The addition of further classes will thus also be more easily achieved. Many physically handicapped persons continue to produce articles of high quality, and regular orders from the trade continue to be received. One of the crafts being taught at one occupational therapy class is chair caning and this is developing quite well, with orders being received from firms of repute. (c) Aids and Adaptations An assistant technical instructor was appointed in the latter part of the year with a view to expanding and dealing more speedily with the demand for aids and adaptations. At the 31st December 1966 there was a backlog of 28 adaptations and aids still to be completed and during the present year 124 further applications were received, making a total of 152 to be dealt with. 130 of these were completed, leaving a backlog of 22 still to be done. The 130 completed aids 88 were as follows: Bathroom aids (special seats, rails etc.) 48 Ramps for invalid chairs 13 Structural alterations to premises 5 Others (walking aids, lifting poles etc.) 64 130 (d) 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 III of the National Assistance Act, 1948. (e) Outwork It was still not possible to reintroduce an outwork scheme during the year under review. (f) Sale of Articles Articles continue to be produced for certain retailers. Every effort is made to dispose of the produce of the centre by having a staff at various sales arranged by voluntary organisations, and also by staging our own exhibition and sale of work. (g) Voluntary Workshops The Kingston Spastic Centre provides a workshop at 13 Geneva Road, Kingston upon Thames for approximately 26 spastic young persons, of whom approximately 15 live in the borough. The centre makes a valuable contribution to the welfare of the handicapped in the borough and the borough Council makes a financial grant towards its work. (h) Car Badges for the Handicapped 49 car badges were issued to disabled drivers during 1967, as compared with 41 during 1966. 89 (i) Greater London Rally A party of 31 handicapped persons and helpers attended a rally at London School, East Ham on the 19th August 1967 and had a very enjoyable afternoon. Entertainment and a tea was provided. Five of the wheelchair cases included in this party were conveyed by the department's ambulance. (j) Domiciliary Visiting of the Handicapped In order to assist handicapped persons to overcome the effects of their disabilities, the social welfare officers visit the disabled on the register as regularly as possible, and every effort is made to integrate them into the community. They give advice and guidance on personal problems and in connection with any services which may be of benefit whether they be provided by voluntary or statutory agencies. In pursuance of this policy the social welfare officers made some 4,908 visits during the year. Many of these were of an introductory nature as a first step in ascertaining needs. (k) Domiciliary Visiting - General The cases in each category being dealt with at 31st December 1967 and the average monthly visits were as follows: No. on Register Average Monthly Visits Average Monthly New Referrals Elderly 276 226 22 Blind and Partially Sighted * 388 186 6 Deaf and Hard of Hearing 111 53 5 Physically Handicapped 618 170 9 Homeless Families 13 6 1 Other Miscellaneous Clients 16 19 3 * This figure includes 26 persons who are included on the departmental register and are the financial responsibility of this authority, although they are resident in different parts of the country. The visiting services have almost doubled for all groups of people during the year under review. 90 (l) Social and Recreational Clubs for the Handicapped The remainder of the services which are provided for physicallyhandicapped 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, for handicapped persons, and receive grants from this authority. Their efforts in this field are much appreciated. 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 afternoons Mrs. J. Eraser Day, Willowend, Manor Close, East Horsley Kingston Endeavour Club, Bedelsford School, Grange Road, Kingston upon Thames 2nd and 4th Thursday each month - evenings Mrs. A. Carter, 23D Church Street, Twickenham Multiple Sclerosis Society, Catholic Church Hall, Ewell Road, Surbiton 3rd Tuesday each month afternoon Mrs. M. J. Sellars, 2 Bramley Mansions, Berrylands Road, Surbiton Davis - Darby and Joan Club, Deaf and Dumb, Methodist Church Hall, Ewell Road, Surbiton Fortnightly Thursday afternoons Mr. G. Gibbs, 27 Rodney Close, New Maiden Surbiton Deaf Club, Club Room, Meals on Wheels Kitchen, Ewell Road, Surbit on Weekly Thursday Evenings Mr. M. J. Brooker, 140 Banstead Road, Ewell 91  Miss L. Kilpatrick, 38 Thorkhill Road, Thames Ditton Spartan Swimming Club, Kingston Baths, Denmark Road, Kingston upon Thames Weekly Thursday evenings Surbiton Afternoon Club for the Blind, Club Room, Meals on Wheels Kitchen, Ewell Road, Surbiton Alternate Tuesday afternoons Mrs. D.Yorke, 219 Swell Road, Surbiton Surbiton and District Evening Blind Club, Club Room, , Meals on Wheels Kitchen, Ewell Road, Surbiton Alternate Wednesday evenings Miss M. Boughton, 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 Thames OTHER WELFARE SERVICES (a) 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 of managing and administering his property and affairs. The appointment of a receiver is at the discretion of the Court and it may happen that although the Council take action to secure a receivership, the Chief Welfare Officer is not appointed as receiver. The Chief Welfare Officer is acting as receiver in two cases and there are two other cases being considered by the Court of Protection. 92 (b) Burial and Cremation The Borough Council has a duty under Section 30 of the National Assistance Act 1948 to arrange the burial or cremation of 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 made or are being made. The department has made arrangements for four burials during 1967. (c) Safeguarding Property The Borough Council has a duty under Section 48 of the National Assistance Act 1948 for the protection of property of persons who are unable to care for their personal effects whilst undergoing a period of hospitalisation or are admitted to a residential home, and where there are no relatives or friends prepared to assume this responsibility. There have been a number of calls on this service. ENVIRONMENTAL HEALTH SERVICES 95 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR P.E.KENTON. M.R.S.H.. M.A.P.H.I. Nineteen sixty-seven was a year of progress particularly in the field of inspection of offices, shops and houses in multiple occupation. This was largely due to reasonable stability amongst staff. The Public Health Inspectorate was for a time almost at full strength after Mr. C.P.Rampling and Mr. T.Hutchins were appointed but Mr. B. Cova left the staff towards the end of the year. Mr. T.H.Yorke, Technical Assistant Offices and Shops, was transferred to the Housing Department but his successor, Mr F.W.King, was not appointed for three months. The routine work of the Department was interrupted by housing surveys carried out in co-operation with both the Greater London Council and the Ministry of Housing and Local Government and the results of this work are already proving to be of value to the Department. In addition all members of the staff were involved in an organisation and method and a job evaluation survey. As in previous years, it is pleasing to report progress in the field of health education where there has been increased activity particularly in giving talks and demonstrations to school children, student nurses and mothers' groups. Members of the Health and Welfare Committee visited the Express Dairy Bottling Establishment and the Metropolitan Water Board and after one of their meetings a film and exhibition on Clean Air was provided. Close liaison has been maintained with scientific organisations including the National Physical Laboratory, the Scientific Department of the Greater London Council, the Infestation Laboratory of the Ministry of Agriculture and similar organisations. 96 At the time of writing I have to record with great regret the death of Mr. D.D.Moir, Public Analyst to the Authority and previously Public Analyst to the constituent Authorities for many years, Mr. Moir was a prominent member of his profession and he will be greatly missed by the Local Authorities whom he served. The outbreak of Foot and Mouth Disease has served to illustrate the need for constant vigilance in the matter of animal health as well as human well being. The relationship between human and animal disease and the constant need for hygienic practices in food handling establishments where cross infection can occur is emphasized. Much of the time of the Health Inspectors is devoted to the investigation of infections contracted by holiday makers to the Continent and North Africa and tourists should be advised to be meticulously careful in the consumption of raw or unwashed foodstuffs and against the purchasing of ice cream and similar products from street vendors. Readers will observe that comment is made in the report about the progress being made in the Cambridge Road and Alpha Road development areas where many houses have been cleared and the consequent removal of three ice cream manufacturers who have traded in Kingston for many years. The co-operation of the Medical Officer of Health and the officers of all departments is gratefully acknowledged and the support and interest of the Chairman and members of the Health and Welfare Committee has provided encouragement throughout the year. P.E.KINTON Chief Public Health Inspector. 97 ENVIRONMENTAL HEALTH 1. WATER SUPPLY. The whole area is served by the Metropolitan Water Board through a piped main supply. Regular chemical and bacteriological examinations are carried out by their Water Examination Department but in addition to this on thirteen occasions samples were taken during the course of the year from private houses, a children's home and schools (special, technical and primary) from kitchens and cloakrooms and all samples were satisfactory,, A chemical analysis made on water from a children's home was satisfactory, the water is not plumbo-solvent and no lead or other contaminating metals were found. The water is also good in appearance and organic content. The Minister of Health in a circular in November reminded Local Authorities that the upper limit of lead in water is 0.1 mg/l. but that where lead piping is used the amount may be higher, but not more than 0.3 mg/l. after 16 hours. The World Health Organisation now gives a revised figure of 0.05 mg/l. as the upper limit in drinking water supply and as far as is known no supply in this country from a statutory undertaking exceeds this amount. 2. SWIMMING BATHS. (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 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 free chlorine. 98 During the course of the year bacteriological samples were taken from these baths on 23 occasions. In addition to this, numerous visits were made when the chemical content of the pools was checked by means of a Lovibond comparator. The overall standard has been satisfactory with only two lapses during the year. The learners' pool has been maintained at breakpoint chlorination with the exception of a period when the baths were closed in April and shortly after in early May. There was only one occasion when bacterial contamination was excessive in this pool due to heavy use, inadequate chlorination and pollution by the bathers. The water supply to the slipper bath is constantly flowing from the mains, and the washing and toilet facilities attached to this bath are satisfactory. Heavy pollution occurred at the outlet in No. 1 Pool in late May/early June due, it was thought, to insufficient circulation. These corners were hand dosed with additional sodium hypochlorite and despite the bath being closed for one day in the middle of this period it was nearly four weeks before conditions were entirely satisfactory. During this time chemical readings gave satisfactory results, the water was maintaining a good colour and there were no complaints from bathers of smarting eyes. Provision was made in the financial estimates for the installation of breakpoint chlorination equipment for Nos. 1 and 2 Pools. 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 feet. There is also a paddling pool for small children. 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 Engineer and Surveyor and the plant is adjusted as necessary. In addition Samples were taken on five occasions by the Health and Welfare Department for bacteriological examination all of which proved to be satisfactory. (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 and changes of water as necessary. Samples were taken on three occasions during the summer when this open air pool was in use. These were satisfactory with the exception of the final occasion at the end of term when the dosing had not been fully carried out at the time of inspection but this was immediately rectified. 99 There are also seven swimming baths with treatment plants at primary schools, an additional three having been constructed this year. Bacteriological samples were taken on 41 occasions and these have in the main been satisfactory with the exception of one bath where a defect in the chlorinator gave rise in early summer to bacterial contamination. A small coliform count has been recorded at the majority of other baths on occasion and all these instances could be attributed to insufficient chlorination. All school baths were kept under constant observation, advice was given where necessary and the overall standard maintained was 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 Brook, another tributary of the Thames, forms part of the eastern boundary and receives the effluent of the Worcester Park Sewage Disposal Works. 4. DRAINAGE AND SEWERAGE. 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 Greater London Council Wandle Valley Works, the sewage of the district is treated at the Hogsmill Valley Sewage Treatment Works. This modern plant also deals with the sewage from the Borough of Epsom & Ewell. There are a few houses which use cesspools, but the remaining houses in the Borough are connected to the main sewage system. 5. PUBLIC CLEANSING. The Borough Engineer and Surveyor is responsible for the collection and delivery of refuse to a central loading point whence it is hauled in large vehicles to tips operated by contractors employed by the Greater London Council, who are now responsible for the disposal of refuse. The total amount of refuse passing over the weighbridge during the year ended 31st December, 1967 was 43,700 tons. 100 INSPECTION OF 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 the Pest Control Officers. Animal Boarding Establishments 10 Atmospheric Pollution Gauges 283 Bacteriological Sample visits 205 Betting, Gaming and Lotteries Act 85 Biological Sample visits 53 Building Sites 71 Chiropody and Massage Establishments 40 Committee and Council Meetings 42 Consumer Protection Act (Fireguards) 23 Council House - Disinfestations 6 " " Inspections 86 Court 60 Depot visits or inspections 157 Diseases of Animals Act and Waste Food Order 23 Disinfections 12 Disinfestations 14 Drainage visits 1,756 Employment Agencies 53 Food Complaints 236 Food and Drug Samples 317 Food Hygiene Regulations - Bakehouses 52 - Bakers' Shops 107 - Butchers 196 - Confectioners 113 - Cooked meat shops 75 - Fish shops (wet or fried) 90 - Greengrocers 159 - Grocers 377 - Ice cream, manufacture 90 - Ice cream, sale 186 - Institutions 9 - Milk shops and depots 56 - Mobile shops 107 - Office and Works canteens 50 - Public Houses, Hotels and licensed premises 139 - Restaurants and cafes 337 - Sausage manufacturers 41 - School canteens 122 - Sports clubs 20 - Open Market 420 C/Fwd. 6,278 101 B/Fwd. 6,278 - Wholesale Meat Shops 65 - Other Pood Premises 112 Factories - Non-Power 22 " - Power 362 Fertilisers and Feeding Stuffs 17 Health Education 63 Home Safety 4 Houses in Multiple Occupation 283 Housing Enquiries 24 Housing Act Inspections 125 Housing Act Reinspections 310 Improvement G-rant Visits 1,098 Infectious Disease Visits 2,442 Insect Pests 127 Interviews with owners, builders„ etc. 859 Merchandise Marks Act 45 Miscellaneous (including no reply) 5,328 Noise Abatement 350 Nursing Homes 1 Offices, Shops and Railway Premises 1,834 Old People and Problem Families 32 Outworkers 21 Overcrowding 9 Pet Animals Act 47 Pigeons 5 Piggeries 25 Pharmacy and Poisons Act 92 Public Conveniences 107 Public Health Act inspections 904 Public Health Act reinspections 1,197 Rag and Bone, Scrap Metal Dealers 29 Rag Flock 5 Redevelopment Areas 65 Refreshment Houses (Licences) 23 Refuse Tips 15 Rent Act 14 Riding Establishments 32 Rivers, Ditches and Ponds 41 Rodent Control 163 Shops Acts 497 School Premises 190 Smoke Abatement 566 Smoke Control Areas (inspections and revisits) 12,777 C/Fwd. 36,605 102 B/Fwd. 36,605 Special Surveys 283 Tents, Vans, Sheds and Caravans 152 Unsound Food 219 Vacant Land 186 Visits outside district 388 Waste Food (Staining and Sterilisation) Order 6 Water Supply and Sampling (including Swimming Pools) 474 Work in progress 321 Work Places 38 Working Party 6 38,678 NOTICES SERVED. Informal. Written and Verbal 1013 Statutory. (a) Housing Acts 11 (b) Public Health Acts 93 (c) Clean Air Act 22 NOTICES COMPLIED WITH. Informal. Written and Verbal 792 Statutory. (a) Housing Acts 14 (b) Public Health Acts 58 (c) Clean Air Act 20 7. FACTORIES ACT. 1961. The following are the particulars required to be furnished to the Ministry of Labour concerning matters dealt with by the Corporation under Parts I and VIII of the Factories Act. 103 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 50 22 2 - Factories not included above in which Sec.7 is enforced by the Corporation 629 362 55 - Other premises excluding outworkers 220 71 1 - 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 1 1 - - - Sanitary Conveniences Insufficient 1 - - 1 - Unsuitable or defective 4 — - — - Other offences against the Act (not including offences relating to outwork) 48 19 13 3 - 104 PART VIII OF THE ACT Outwork. The following table gives details of work which is carried out in private dwelling houses. The conditions obtaining have been found to be satisfactory. Nature of Work No. of Outworkers Curtains and furniture hangings 2 Wearing apparel making etc. 31 Lampshades 8 Brass and Brass Articles 9 Artificial Flowers 3 53 8. SHOPS ACT. 1950. The welfare provisions of this Act were repealed and are covered by the requirements of the Offices, Shops and Railway Premises Act. The remaining provisions relating to closing hours, half-holidays, hours of employment of young persons and Sunday trading are administered by the Department and 497 visits were made. Exemption Orders have been made under Section 1 whereby it is not an obligation to close a shop on one half-day in each week. These Orders relate to the central shopping area of Kingston and the whole of the former Boroughs of Maiden and Coombe and Surbiton. By this means it is possible for sixday trading to be operated in respect of many trades and businesses. 9. 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. 105 Class of Premises Number of Premises registered during the year Total Number of registered premises at end of year Offices 88 616 Retail shops 85 912 Wholesale shops, warehouses 5 52 Catering establishments open to the public, canteens 9 141 Fuel storage depots - 1 187 1,722 Class of Workplace Number of Persons employed Offices 7,483 Retail Shops; 6,781 Wholesale departments, warehouses 463 Catering establishments open to the public 1,127 Canteens 94 Fuel Storage Depots 11 15,959 During the year under review satisfactory progress was made and in spite of changes in staff the number of initial inspections was increased. By the end of the year out of a total of 1,722 premises 1,174 had received a general inspection and in view of our experience already in 1968 it is confidently expected that all registered premises will have been inspected by the end of the year. As referred to in previous reports, premises, after receiving a general inspection and any necessary follow-up action, would be expected to comply in all respects with the provisions of the Act. It is essential both in the interest of the occupier, the employees and the Department that the inspection 106 should be thorough and cover all aspects of the Act. This, of course, is time consuming; the practice, however, is appreciated by the management and is the means whereby good relations are maintained. Although there were fewer registered premises at the end of the year, the number of new registrations was higher than in the previous year. This is probably due to the increased activities of the staff and perhaps to the gradual awakening of interest on the part of employers. Operation of the General Provisions of the Act. Reference to the following table of contraventions reveal3 that they vary little from year to year and the proportions of the various contraventions are remarkably similar. Section Number of Contraventions found Section Number of Contraventions found 4 Cleanliness 76 13 Sitting facilities 6 5 Overcrowding 19 14 Seats (sedentary - 6 Temperature 197 15 Workers Eating facilities 7 7 Ventilation 137 16 Floors, passages and stairs 129 8 Lighting 75 17 Fencing exposed parts machinery 23 9 Sanitary conveniences 221 18 Protection of young persons from dangerous machinery 10 Washing facilities 219 19 Training of young persons working at dangerous machinery 11 Supply of drinking water 18 23 Prohibition of heavy work — 12 Clothing accommodation 22 24 First Aid Other Matters 156 177 Total 1,482 107 The figures indicate the relative causes for action and the following comments may be of interest. Cleanliness. These related mainly to stock rooms, stairways, passages and stores and as one would expect, not to the part of the shop to which the customers have access. Ventilation. It was most noticeable when inspections were made during hot weather that where in the smaller premises satisfactory natural ventilation was provided, this was much more effective than that provided by mechanical means. There are many occasions when it is essential to provide electric fans but it is regretted that so often the natural forces which are available for the purpose are entirely ignored. This is particularly apparent where means of through ventilation have been ignored or there has been failure to take advantage of air movement which can be provided by staircases. Lighting. No difficulty has been experienced in implementing the standards recommended by the Illuminating Engineering Society. Sanitary Accommodation. It is interesting to note that in only 13 instances was the accommodation found to be insufficient. Washing Facilities. 106 of these notices related to the absence of a satisfactory hot water supply to existing wash basins. Floors. Passages and Stairs. The contribution to safety in attention to these matters cannot be over-emphasized. Fiftynine notices were served in respect of defective floors, floor coverings and stairs and 37 in respect of hand-rails. First Aid. These notices were concerned entirely with the insufficiency or absence of first aid boxes. Other Matters. There were 88 contraventions concerning the absence of the Abstract and 52 relating to failure to register. In addition there were 35 notices drawing attention to general safety precautions. Accidents. Seventy-two accidents were reported during the year compared with 90 during 1966. Of the total figure 25 related to falls and 17 to the handling of goods. As in previous years, very few accidents were notified other than from the premises of the large multiple retailers. 108 Prosecutions. There were no prosecutions during the year under review. 10. NOISE. Fifty-five complaints of alleged nuisance from noise were received during the year of which 17 were confirmed. The noises included panel beating, boilerhouses, machinery, vehicles and "beat groups". The investigation of these complaints necessitated prolonged visits, sometimes during the night, in order to assess the degree of nuisance caused to the complainants. In one case a petition was received alleging nuisance from noise arising from panel beating at a vehicle repair garage. Twenty-three local residents signed the petition and, upon interview, it was found that thirteen of the complainants were concerned about radio and television interference and the obstruction of the road by garage vehicles. The remaining signatories were concerned with alleged noise nuisance arising from panel beating and an interview with the proprietor brought about some improvement. A noisy machine in a factory gave rise to complaints of noise nuisance to residents in the area and extensive works were carried out to improve the sound insulation of the factory building. When the works were completed the main complainant expressed his complete satisfaction that the noise had been abated. Sheet metal work in a long established factory caused alleged nuisance to residents in a nearby block of flats, the main complaints being about evening and weekend work. It was found that the factory had regular export orders which involved long working hours. There are plans to extend the factory premises and it is proposed to move the offending machinery to the new part of the factory which will be well away from the flats. In the meantime the factory staff are under instructions to keep all unnecessary noise to a minimum and no further complaints have been received to date. Investigations are continuing into alleged nuisance from the loading of lorries at a contractor's yard, from amplified musical instruments of a "beat group" and from a factory boilerhouse which appears to emit low frequency noise which affects residents in some of the nearby houses. 109 The number of complaints of alleged nuisance from noise decreased from 81 last year and whenever possible, sources of potential nuisance have been dealt with before any nuisance has occurred. This policy has kept down the volume of general noise and an example of this is the good oo-operation now received from contractors in the use of mufflers on pneumatic drills. 11. CLEAN AIR. Clean Air Act. 1956 - Smoke Control Areas. The Kingston upon Thames Nos. 9 and 10 Orders became operative on the 1st October, 1967. They cover approximately 458 acres in the George Road, Coombe and the Queens Road districts of Kingston. Particulars of these areas are as followss- Area 9 10 Locality George Road, Coombe Queens Road, Kingston Acreage 351 107 Domestic Premises 602 1478 Commercial Premises 8 63 Industrial Premises - 5 Other Premises 4 3 In May the Council made Smoke Control Orders Nos. 11 and 12, These were confirmed by the Minister of Housing and Local Government in July. Smoke Control Order No. 13 was made in July and confirmed in October and these areas come into operation on 1st October, 1968. Particulars of these areas are as follows Area 11 12 13 Locality Acre Road, Kingston High Drive, Maiden Dickerage, Maiden Acreage 143 203 197 Domestic Premises 1533 1184 455 Commercial " 105 8 63 Industrial " 10 - 7 Other " 8 3 7 110 During the year survey work was started on Area 14 in the Kings Road, Kingston locality and Area 15 in the Elm Road, New Maiden locality with a view to the making of Orders which should become operative on the 1st October, 1969. Fireplace conversions in 14 areas comprising 2,128 acres and 12,227 dwelling houses in the Borough have now been completed. The Council's Smoke Control Area programme provides for a further 14 areas by 1978 in addition to the nineteen already covered by confirmed Smoke Control Orders. The present position can be summarised as follows:- Number of Areas Dwelling Houses Areas completed 14 12,227 Areas nearing completion (Areas 9 and 10) 2 2,080 Adaptations in progress (Areas 11, 12 and 13) 3 3,172 Areas being surveyed (Areas 14 and 15) 2 3,092 Future Areas 12 24,306 Noter The numbering of areas was not consecutive prior to the formation of the new Royal Borough,, Air Pollution Complaints. There were 110 complaints from the public about nuisance from smoke and grit. Sixty-two of these concerned bonfires, 21 smoke from factory chimneys, 18 smoking domestic chimneys and 9 grit and smuts. There has been an increase in recent years in the number of bonfire complaints which is indicative of the growing concern of the public about the problem. The Department distributes leaflets to residents in smoke control areas giving advice on how to reduce smoke from bonfires and avoid complaints. Advice and assistance are also given verbally and by letter when specific complaints are under investigation. The complaints about smoke, grit and smuts from factory chimneys were the result of defects in plant or operation and the majority were quickly rectified. A nuisance from fumes in the vicinity of a large plant was traced to a defective flue which was affected by severe corrosion necessitating extensive repairs. Repeated heavy smoke emissions from a large incinerator of good design were found to be due to lack of care in operation of the equipment. It is difficult to recruit intelligent personnel for such a menial task. 111 The Ministry of Housing and Local Government published in August 1967 a Memorandum entitled "Grit and Dust", dealing with the measurement of emissions and recommending maximum levels of emission. All solid fuel and oil-fired furnaces in the Borough comply with the standards suggested. Chimney Heights. Five plans were submitted for determination of chimney heights under Section 10 of the Clean Air Act, 1956. In nine further cases advice was given where new chimneys, exempted from the provisions of Section 10, were being erected. A revised Memorandum on chimney heights has been issued by the Ministry of Housing and Local Government, this extends the range of application of the original Memorandum to include small installations having a sulphur dioxide emission of 3 lbs. per hour and upwards allowing for a minimum chimney height of 25 feet instead of 40 feet as formerly. Until practical means are generally available for the removal of sulphur from fuel or sulphur oxides from flue gases, some control over the heights of new chimneys is essential in order to keep within reasonable limits the concentration of sulphur dioxide at ground level. Larger supplies of low sulphur fuel oils are now becoming available, but a much greater effort is needed in this direction. It is unfortunate that shops, offices and blocks of flats are exempted from the provisions of Section 10 which deals with the height of new chimneys, but legislation is at present before Parliament to widen the scope of this Section and improve administrative procedure. 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, Alpha Road Public Health depot and at a site in Maiden Road, New Maiden. These operate continuously, and at the first three sites readings are taken five times a week. A more sophisticated sampling instrument known as the 8-port sampler has been constructed by a member of the staff and is now in use at the Maiden Road site. This provides daily readings, but only needs visiting once 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. It is felt that readings have been taken over a long enough period to enable some attempt to be made at interpreting them. A major difficulty is that weather conditions have a far greater influence on the results than any other factor. For example, 112 113 114 115 116 during a period of calm weather the sulphur dioxide concentrations may be ten times the readings taken in windy conditions. This makes it difficult to determine over short periods what improvements are being achieved. By taking annual averages the effect of calm or turbulent air conditions may be expected in most years to balance themselves out, but the figures so produced tend to rise or fall according to the severity or mildness of the winters. This effect is what one would expect, considering the greater amount of fuel burned during cold weather, and it is confirmed by comparing graphs of pollution averages for the Guildhall site and "degree days" (Figure l) "Degree days"are an estimate of the number of degrees below 60 P. maintained for 24 hours aggregated over a period (in this case annually). It will be seen that rises and falls in "degree days" are nearly always accompanied by similar movements in pollution but there is also a strong overall tendency for the pollution figures to fall so that although the "degree day" graph shows that the winter of 1966-67 was of about the same severity as 1953-59, the sulphur dioxide concentrations were over 30% lower and smoke concentrations about 66% lower. The graph (Figure l) shows that the very cold weather experienced in the winter of 1962-63 caused a marked rise in pollution, but from the graph for domestic coal consumption it is seen that there was no increase in the amount of coal used in that year although the prevailing tendency for this figure to fall was temporarily arrested. Since coal burnt in domestic grates is the main source of smoke pollution, the rise in 1962-63 wa3 probably due to the prevalence of calm and often foggy conditions associated with very cold weather such as was experienced in that winter, allowing pollution to accumulate near ground level. Figure 2 shows the monthly variations in smoke and sulphur dioxide concentrations at Alpha Road, Surbiton and Figure 3 compares the annual averages of smoke and sulphur dioxide concentrations at all four sites. Deposit Gauges. Two deposit gauges for the monthly measurement of grit and dust fall are located at Canbury Gardens and Tiffin Girls' School, Kingston upon Thames. Figure 4 shows the average annual deposit at the two sites for the years 1952 to 1967. 12. COMPLAINTS. The following is a brief list of causes for complaints received during 1967 which resulted in investigation by the Department and in all cases where necessary, appropriate action was taken. 117 Accumulations 68 Animals 9 Caravans - illegal parking 9 Dampness 122 Drainage/Sanitary Arrangements 953 Dustbins 17 Flooding 23 Foods 144 Food Hygiene 17 G-eneral Housing Defects 129 Insects 451 Noise 55 Offensive Odours 101 Overcrowding 10 Pigeons 42 Rodents Rats 1,131 1,258 Mice 127 Shops Acts 2 Smoke 110 Squirrels 39 Water 14 Yards and Paving 4 Others 67 3,644 13. RODENT AND INSECT PEST CONTROL. Fewer complaints of rodents were received during the year which may be an indication that the intensive work previously carried out is having some effect and that work done on surveys anticipated complaints which would otherwise have been made. The rate of turnover of manual staff during the period under review was far too high and it is still difficult to recruit and retain workmen of a sufficiently high calibre for the variety of work which is required of staff on pest control and other manual work in the Department. There is no doubt that there would be fewer complaints of rats if the occupiers of business and residential properties kept their yards and gardens reasonably tidy, for frequently shelter is provided for rats by accumulations of rubbish and unwanted furniture. It is to be hoped that passing of the Civic Amenities Act, 1967 will have some effect in reducing the amount of dumping of such materials. 118 More complaints were received of nuisance caused by pigeons. These arise from the encouragement of flocks to assemble at points where they are regularly fed and in some instances control has been made extremely difficult because of the lack of co-operation by some members of the public. A number of birds were trapped during the year. 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 were discontinued their numbers in towns could soon be reduced to an acceptable figure. When complaints of nuisance from squirrels are received, advice is given on trapping or proofing. The extensive damage which can be caused by these creatures is not realised until the buildings have been invaded. Here again, residents are not easily convinced that they should not feed them if they do not wish to attract them to the vicinity of dwellings. With regard to the treatment of sewers, some 400 manholes were baited but it was not possible to complete the programme during the year due to the shortage of staff. An information leaflet was prepared and forwarded to the 301 residents who complained about wasps and bees and letters and comments received indicate that this service was much appreciated. If an infestation is to be treated it should be done after dusk when the wasps are back in the nest. Experience has proved that if the average person is properly advised he can easily deal with a wasp nest without risk. In those cases where the occupiers were unable through infirmity or similar handicap to remedy the nuisance, members of the staff of the Department gave practical assistance. Close liaison was maintained with the staff of the Laboratory at the Ministry of Agriculture, Fisheries and Food at Tolworth where advice on problems of treatment for various insects was readily obtainable. In return we were pleased tc assist in providing facilities for the training of field officers on overseas work and also a representative of the United Nations. Facilities were also provided to assist in the production of a film on rodent control in sewers which is being prepared by the Ministry. The accompanying tabulated statement is an indication of the work carried out during the year. 119 Rodent Control - Statistical Statement 1967. Local Authority Property Dwelling Houses Business & Factory Premises Totals Number of complaints received by the Department 33 1,074 151 1,258 Number of properties inspected by the Department 55 2,413 426 2,894 Properties Infested Rats Mice 29 11 1,014 73 188 129 1,231 213 40 1,087 317 1,444 120 HOUSING. The following is a tabulated statement of action taken under the Housing Act, 1957:- 1. Number of houses inspected and recorded 125 2. Number of houses which, on inspection, were considered to be unfit for human habitation - (a) Parts of houses which, on inspection were considered to be unfit for human habitation 3 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers- 147 4. Number of representations made to the Local Authority with a view to- (a) The serving of notices requiring the execution of works 85 (b) The making of demolition or closing orders (number of houses involved) 2 5. Number of formal notices served requiring the execution of works 27 6. Number of houses which were rendered fit after the service of formal notices 22 7. Number of demolition or closing orders made 2 8. Number of houses in respect of which an undertaking was accepted under sub-section 4 of Section 16 of the Housing Act, 1957 1 9. Number of houses demolished 13 10. Number of houses where demolition or closing order determined on the premises being made fit 1 121 RENT ACT. 1957. Applications for Certificates of Disrepair, Applications 1 Decisions not to issue certificates - Decisions to issue certificates (a) in respect of some but not all defects 1 (b) in respect of all defects - Undertakings given by landlords under paragraph 5 First Schedule 1 Undertakings refused by Local Authority - Certificates issued - Applications for Cancellation of Certificates. By Landlord 1 Objections by tenants to cancellation - Decisions by Local Authority to cancel in spite of Tenant's objection - Certificates cancelled 1 Houses in Multiple Occupation - Housing Act. 1961. There are no common lodging houses in the Borough. During the year 283 visits have been made to houses in multiple occupation when the standard code of requirements which was adopted by the Council has been implemented resulting in 44 notices being sent to owners. Most of the notices sent entailed the provision of additional fire precautions. The Greater London Council issued a Code of Practice for means of escape in case of fire at houses in multiple occupation. This is being administered by members of the Department in collaboration, where necessary, with the Fire Brigade. "Means of Escape" does not necessarily mean the erection of an expensive iron staircase at the rear or side of buildings,, In the majority of the cases with which members of the Department deal it entails using the staircase in the house as the means of escape and fireproofing all doors leading on to the staircase and making these doors self-closing. Doors must be made to close in this way because, if a fire occurs in a room, the door will close after the occupants leave the room confining the fire in the room and thus allowing time for the occupants of the rest of the house to leave safely. 122 Improvement Grants. The Housing Acts, 1958 - 1964 provide for Local Authorities to make grants for the conversion or improvement of dwellings. Two types of grant are 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:- £ 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 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 £350 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 leasehold interest of which not less than 15 years remain unexpired. 123 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 standard grant amenities. In the case of discretionary grants, the Council must be satisfied 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 many enquiries were received and advice given, mostly culminating in applications being made. The following table summarises the applications dealt with and the interest of owners of tenanted properties referred to last year has been maintained although only small compared with that of owner occupiers. Improvement Grants - Standard. Owner/Occupiers Tenanted Applications received 35 7 " approved 35 5 Dwellings improved 30 8 Amount paid in grants £ s. d. 4,016. 18. 3. Average per house 105. 14. 2. Amenities provided- (a) fixed bath or shower 25 (b) wash hand basin 28 (c) hot water supply (to any fittings) 29 (d) water closet within dwelling 32 (e) food store 27 124 Improvement Grants- Discretionary, Owner /Occupiers Tenanted Applications received 24 12 " approved 22 7 Number of dwellings improved 22 20 Amount paid in grants £ s. d. 12,961. 4. 6. Average per house 308. 12. 0. The 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 dwellings, many of them recently acquired by the applicants, have been improved in various ways with grants averaging £212, 5.0. per house. Of this sum £53. 1.3. 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 wellbeing and good health within the community. In addition to the improvement work undertaken by private owners referred to above, the Council's schemes prepared by the Borough Engineer and Surveyor for modernising 24 flats in Athelstan House, Athelstan Road, Kingston upon Thames, and 12 flats in Dryland House, Fairfield North, Kingston upon Thames, have been approved by the Minister of Housing and Local Government for Exchequer contribution. "Our Older Homes- A call for action" (The Pennington Report), This is the title to a Report of the sub-committee appointed by the Central Housing Advisory Committee in 1965, "to consider the practicability of specifying objective criteria for the purposes of slum clearance, rectification of disrepair and other housing powers relating to minimum tolerable standards of housing accommodation; and to make recommendations. The Report is refreshingly clear in its detail and conclusions, largely because the Committee has reviewed as a whole the various standards used by Local Authorities to determine fitness, of houses. The Report contains recommendations for a new standard for a satisfactory dwelling which amplifies the present twelve point standard of eligibility for a discretionary improvement grant and lesser standards specifying five and three point scales for houses in poorer condition. 125 Turning to how the standards might be applied the Committee concluded that in general, all dwellings which are expected to remain in use for at least 25 years should be brought up to the full standard for a satisfactory dwelling. If they are to remain in use for at least 15 years the five point scale would be appropriate and those which are expected to remain in use for 7 to 15 years should be improved to the three point scale. The minimum standard by whioh houses are judged to be unfit and if so whether they should be demolished or repaired was also considered and the recommendation is a revised minimum standard of fitness. There are also recommendations regarding simplification of procedure in dealing with improvement grants. Legislation whioh might implement the recommendations is awaited. Housing Surveys. Ministry of Housing and Local Government. Following a recommendation contained in the Report of the Central Housing Advisory Committee (The Dennington Report) the Minister of Housing and Local Government carried out a survey on a random sample basis of some 6,000 dwellings spread over 250 Local Authority areas. This Borough was included in the sample and the Department assisted by making available an officer to accompany the inspector (a public health inspector seconded to the Ministry for the purpose) to introduce him and generally speed the completion of the survey. The Greater London Council. Chiefly for the purpose of its development plan, the Greater London Council initiated through the London Boroughs a Condition of Dwellings and Households Survey which was carried out during the year. Part I of the survey, that of dwellings to establish the useful future life of the various parts of the stock of dwellings and whether they are capable of improvement or conversion at reasonable cost, was completed by the end of July. Approximately 2,110 dwellings were surveyed by staff of the Borough Planning Officer and an assessment of useful life in doubtful cases and the improvement or conversion of properties and at what cost was referred to the Public Health Inspectors who dealt with 228 dwellings in this connection. The results of the survey are now being studied. 126 Part II of the survey was of households and directed to provide information on "hidden" households and the present relation of rent, rates, occupation and accessibility to workplace,, This was carried out by the Greater London Council through a Market Research Organisation. No unfit houses additional to those already known were found but the survey did reveal the ages of the Borough's housing stock and its general condition,, Those of a generally poor character are shown in the table below. Constructed Pre 1875 1876-1919 1920-1939 Post 1939 Total number of dwellings 2015 12575 23775 9500 Condition Poor structure with poor internal and external maintenance 25 100 - - Poor structure with poor and fair internal and external maintenance 34 25 - - Poor structure with good and fair internal and external maintenance - 50 - - Availability of Baths and Water Closets. Total number of dwellings No bath (including 137 with bath elsewhere than bathroom) Outside Water Closet 47,865 2,876 2,837 127 From other tabulations analysing the possibility of improvement, the following figures have been extracted. Dwellings requiring internal water closet only 650 " " bath only 588 " " bath and internal water closet 1512 2750 From the above it is assumed that there are some 2900 dwellings lacking in one or more of the standard amenities, 2750 of which are probably capable of improvement, The Present Situation,, Improvement grants have been given throughout the Borough since their introduction in 1949 and the mandatory Standard Grant Scheme introduced in 1959. One thousand and twenty-five dwellings have been improved and grants paid. The Future. It is estimated that nearly all of the 2750 dwellings referred to earlier as lacking in amenities are capable of improvement at least to the 5 point standard and that because of rising costs the majority of such work is likely to be carried out with grant assistance. Publicity, Each house improved and each grant made must bring a limited amount of publicity and in 1966 the Council and the Ministry of Housing and Local Government staged a week of publicity including the use of the Ministry's Mobile Exhibition, This form of encouragement will continue. Arrangements have been made to publicise improvement grants in correspondence to residents in smoke control areas now being surveyed. The card is designed to show the amenities present and lacking in a house, whether the occupier is a tenant or owner and whether the occupier is interested in discussing the improvement of the dwelling with the aid of a grant. Those tenants and owners who express an interest will be visited and encouraged to improve their homes. 128 The Housing Act 1964 places a duty upon the Local Authority to cause an inspection of their district to be made from time to time with a view to ascertaining whether there is any area in the district which ought to be made an improvement area. The concept of improvement areas does not only mean putting facilities into houses which lack them but the environment of the area is taken into account and can be improved where possible. Some areas have been considered for such development and rejected for various reasons but other areas are now being considered. The extent to which the recommendations of the Dennington Report are accepted by the Government and the manner of their implementation, particularly in the matter of simplifying the procedures are awaited with interest. The financial restrictions resulting from the national and international economic situation make it even more necessary than in the past to secure the improvement of our older sound houses. Moveable Dwedllings, The following sites remained licensed under the Caravan Sites and Control of Pevelopment 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, 3, For three caravans on land at Chalky Lane, Chessington to be used as Circus winter quarters. There are nine effective Orders under the Surrey County Council Act in force in the Borough prohibiting the parking of moveable dwellings. As in previous years, some trouble was caused by itinerant caravan-dwellers who, in contravention of this law, placed their vehicles on open land in the Borough and were reluctant to move on. These families are either passing to or from race meetings at Epsom Downs or enter the district for the purpose of tar Macadaming garden paths and drives. In neither case do they intend to stay permanently in the area and the Borough has been free from the nuisance experienced in other parts of the country from this type of land occupation. 129 Gypsies and Other Travellers. During the year the plight of these travellers was given a great deal of publicity on television and in the Press and the results of surveys were considered by various committees in the London area and consideration was given to the need for making provision within the boundaries of this Council for a caravan site. As a result of the action taken by the constituent authorities the problem in this Borough has been confined to those passing through and no encampments have been established. The problems associated with itinerants are very largely due to the trade in which they engage, namely dealing and car breaking. As a riverside Authority it is necessary to bear in mind the problems associated with water travellers and in particular the problems of families living in boats which were not designed for such use and this particular problem is one which has been kept under observation. 130 FOOD AND FOOD PREMISES, Milk Supply. The following table shows the number of premises from which milk is sold and the types of licences in force during 1967 under the provisions of the Milk (Special Designations) Regulations, 1963 and 1965. These Regulations prescribe that the licences shall cover the period expiring on the 31st December, 1970 and all are dealers. licences to sell pre-packed milk. Premises and Type of Licence Number Premises in which milk is sold 105 Pasteurised milk 99 Sterilised milk 36 Ultra Heat Treated milk 31 Untreated milk 22 Bacteriological Examination of Milk. During the year 101 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 J Pass Fail Void Pass Fail Pasteurised 70 - 71* 1 7 - - Sterilised - - - - - 9 - Untreated - - 4 4 4 - - Ultra Heat Treated 1 sample - Satisfactory *Including 9 samples which passed the modified Methylene Blue Test for dispensers. 131 Two of the untreated milks failing the methylene blue test were farm bottled at one farm and the other two were cartoned on the producer's premises and sold from vending machines. These failures were reported to the County Dairy Husbandry Adviser of the Ministry of Agriculture, Fisheries and Food who is responsible for supervising milk production. The eleven samples shown as void were due to the atmospheric shade temperature during the period of storage exceeding 70°F. so that the methylene blue test was not applied,, The phosphatase test indicates that pasteurisation has been properly carried out; the methylene blue test is used to determine cleanliness and keeping quality and the turbidity test is a check on sterilisation. Ice Cream. The number of registered premises in the Borough at 31st December, 1967 in which ice cream may be stored or from which it may be sold is 289. This figure includes one producer. In addition to these dealers and producer there are other premises which are not required to be registered such as restaurants, canteens and cinemas where ice cream is sold. With the progress made in clearing the houses and factories for housing redevelopment in the Cambridge Road area three ice cream factories which had been established in the Borough for many years have been closed. The following table shows the results of examination of 116 samples submitted to the Public Health Laboratory at Epsom during 1967. Owing to the numerous factors governing the hygienic quality of ice cream, undue attention is not paid to the bacteriological results on any single sample. Those which are placed within Grades I and II are considered to be satisfactory and those within Grades HI and IV not so. Adequate follow-up action is taken where samples fall within the latter grades. One of the Grade IV samples was of soft ice cream, one was loose ice cream and one was from an open container. The majority of the samples taken were of unwrapped ice cream which being exposed is far more liable to contamination. Unless great care is taken to keep scoops in a hygienic condition and containers covered when not serving loose ice cream, the risk of bacteriological contamination is increased. 132  GRADE I II III IV Total Ice Cream 65 22 26 3 116 Meat and Other Foods. There are no slaughterhouses in the Borough and the retail shops receive their meat from Smithfield and from the local wholesale depots. Some home killed meat comes from the modern abattoir at Guildford. There are nine wholesale meat depots in the Borough, the main group being situated in The Bittoms, with three in Wood Street and one in Cambridge Road. The meat handled includes fresh meat from within the British Isles and imported meat from Europe, South America and Australasia. In addition to carcase meat a great quantity of offal is received, packed in either cartons or tins. During the year a number of consignments of rabbits were received from various places, including Poland, Australia and China. The meat arrives from producers in this country through Smithfield, other wholesale markets, or in sealed containers from Northern Ireland. All the depots handle the above products, but one firm in The Bittoms deals exclusively with poultry and game. Some imported meat is stored in the Ice Storage Depot at The Bittoms. The depots consist of a main selling area, chiller and freezer compartments, with office accommodation at the rear and on the first floor of the premises,, Sanitary accommodation and staff rooms are provided and all the premises are conducted and maintained in a satisfactory manner in accordance with the Food Hygiene Regulations. During the year numerous visits were made to these depots following requests for the inspection of meat. The following table gives details of meat found to be unfit for human consumption and voluntarily surrendered from these premises. 133  Reason for Condemnation Weight lbs. BOVINE Forequarter Necrosis, general decomposition bruising, deep seated abscess, calloused 391 Hindquarter Abscess, hydronephrosis. decomposition,, bruising, tumour, fibrinous deposits, calloused, bacterial slime, bone taint . muscular fibrosis 1,348 Kidneys Decomposition and mould 199 Liver Fatty degeneration, general decomposition 87 Ox Cheeks Decomposition 964 Ox Tails Mould, decomposition 181 Trimmings Decomposition, soiled condition 129 A carcase of beef was surrendered,, being contaminated with mould and general bacterial spoilage having been retained in a cold store for three weeks due to cysticereus bovis infection 456 OVINE Lamb - leg Arthritis 3 Livers General and bacterial decomposition, fatty degeneration . tyrosin crystals 519 Kidneys Decomposition 5 Offal Decomposition 103 C/Fwd. 4.385 134  Reason for Condemnation Weight lbs Breasts and Trimmings E/Fwd. Bacterial and general decomposition 4,385 704 Carcase General decomposition, mould, "fly blown"', calloused: including 21 carcases of New Zealand lambs found to be heavily contaminated with "black spot" mould which were inspected shortly after the dock strike. 735 PORCINE. Kidneys Decomposition and putrefaction 96 Offal Decomposition 274 Leg Bruised and abscessed 48 Whole carcase Multiple abscesses, septicaemia 87 MISCELLANEOUS Rabbits (Australian) General decomposition 82 Cockerels (English) Emaciation 39 Chickens (English) General decomposition 190 Corned Beef (Argentine) Tins damaged and blown 21 Corned Beef (Paraguay) - do - 8 Total meat condemned-Approx 3 tons. 135 Amount of meat passing through the depots in the course of a year- approximately 18,352 tons. Amount of meat condemned as a percentage of the whole- 0.016%. Foodstuffs Condemned as unfit. The following unfit foodstuffs were voluntarily surrendered and destroyed:- Canned Goods. lbs. Cream 9 Fish 105 Fruit and fruit juice 1,858 Jam 87 Meat and meat production 930 Milk 26 Milk production 31 Poultry 51 Soup 69 Vegetable 326 Other 30 Fish 68 Flour 22 Frozen 637 Fruit (fresh) 2,456 " (dried) 685 Meat 7,328 Potatoes 224 Poultry 419 Rabbits 112 Salt 5 Sugar 6 Other 50 Prosecution. The Council instituted legal proceedings against a supermarket for exposing for sale roast beef which was unfit for human consumption and had been seized and taken before a Justice of the Peace. A fine of £25 was imposed and 10 guineas costs awarded. 136 Pood Hygiene,, There are 1,409 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 bacteriologically satisfactory. The value of chemical sterilising agents in cleansing procedures is being constantly stressed. The public are becoming more conscious of the need for cleanliness in the handling of food and this gives encouragement to those traders whose standards are high. The following tabulated statement shows the nature of the infringements to which attention was drawn. Washing facilities for Staff, Absence of 9 defective;, inadequate hand basins 27 " " hot water 31 " " cold water 10 Lack of towels, soap and nailbrushes 21 Defective water heaters 7 Sanitary Conveniences. Lack of "Wash your Hands" Notices 17 Fittings defective and dirty 6 Lighting inadequate 6 Walls and ceilings defective and dirty 10 Ventilation and/or ventilated lobby required 12 Water closet entered direct from preparing room 2 Designation 3 Repairs to Food Rooms Floors defective 2 Walls and ceilings defective 6 General cleansing 8 168 137  B/Pwd. 168 Sinks and Draining Boards,, Lacking or defective 9 Protection of Pood against Contamination. Smoking 13 Pood not kept 18" off ground 3 Covers not provided for food 3 Others 7 Equipment,, Unclean and/or defective 2 Uncleanliness Kitchens and equipment 26 Pood Stores 8 Preparation rooms 13 Refrigerators 7 Floors, walls and ceilings 37 Mice 1 Ventilation 11 Electric Light Fittings 8 Dining rooms 3 Dustbins. Insufficient and without lids 16 Miscellaneous 20 First Aid Equipment 19 Clothing- Storage and Cleanliness 11 Accumulations 5 390 Notices served l60 Notices complied with 133 138 Pood Hygiene (General) Regulations. 1960. The following is a tabulated statement of inspections made of the various types of food premises No. of Premises Visits Bakehouses and Bakers' Shops 34 159 Butchers 60 237 Confectioners 151 115 Pish Shops (wet or fried) 26 90 Greengrocers 71 159 Grocers 141 452 Ice cream, manufacture 4 90 " sale 289 186 Institutions 34 9 Milk shops and depots Mobile shops 105 56 107 Office, show and works canteens 102? 50 Public houses, hotels and licensed premises 134 139 Restaurants and cafes 68 337 School canteens 72 122 Clubs 59 20 Open Markets 2 420 Wholesale meat shops 9 65 Other food premises 48 112 1,409 2,923 Prosecutions, Legal proceedings were instituted in respect of a number of contraventions of the Pood Hygiene (General) Regulations 1960 at two restaurants in the Borough,, The defendants in each case pleaded guilty and fines totalling £160 in one case and £490 with £20 costs in the other were imposed. Eighteen summonses were issued in respect of the latter case. 139 Food Hygiene (Markets. Stalls and Delivery Vehicles) Regulations. 1966. These Regulations which came into operation on 1st January, 1967 extended the food hygiene requirements in respect of food handling at markets, stalls and delivery vehicles. The main markets are those held daily in Market Place and Apple Market with an average of 46 stalls of which approximately 38 sell foodstuffs,, Fruit and vegetables are the main products sold but foul stalls sell fresh fish, one sells eggs and another farm produce. The markets are regularly inspected during the week to ensure that a satisfactory standard of Food Hygiene is being maintained, particular regard being paid to the handling and placing of foodstuffs and to the personal hygiene of the stall holders. At present there are some toilet facilities in the Market House for the use of traders, as well as the shop employees in the Market House. The Council has approved a scheme for the modernisation of the Market to incorporate suitable and sufficient sanitary accommodation for males and females, together with washing facilities, rooms with locker accommodation for outer clothing, provision for first aid and staff quarters for Council employees working at the market under the direction of the Market Superintendent. It is also envisaged that the fish stalls will be improved in design and each provided with adequate facilities for washing and cleansing the fish, as well as personal ablutions. It is anticipated that this work will be put in hand in the near future, and discussions are planned with the Market Traders' Representatives with regard to their obligations under these Regulations particularly the provision and wearing of suitable protective clothing and the manner in which food is stored, handled and displayed. The Fairfield Market held on Monday mornings includes a number of food stalls, selling only fruit and vegetables as open food- all other foodstuffs, for example, cakes and biscuits being wrapped. Two wash hand basins with hot and cold water, soap. towel and nail brush have been made available for the sole use of food handlers at stalls on this market. The wash basins are in a room adjacent to the gentlemen's public convenience and every endeavour is made to ensure that food stalls are positioned close to these facilities. It is proposed that ladies' sanitary accommodation in the form of water closets in a mobile trailer will be provided. 140 The number of 'barrow boys' operating within the Borough is small, but the number of food vehicles considerable and progress is being made towards securing compliance with the Regulations. The following tabulated statement shows the nature of infringements to which attention was drawn. Name and address not displayed] 18 Washable over clothing not worn 15 Water supply 3 Washing facilities 23 Lighting 4 First aid equipment 16 Separation and disposal of waste 11 Ventilation 1 Protection of food 12 General cleanliness 16 Smoking 3 122 Bacteriological Examination, Thirty-eight samples of various kinds of food were taken for bacteriological examination in the Public Health Laboratory. as a routine measure to check on fitness for human consumption. Thirty-seven swabs from surfaces with which food comes into contact including slicing machines and cutlery, were taken during the year to ensure that satisfactory standards of cleansing were being maintained. POOD AND DRUGS' ACT, 1955. The following tabulated statement gives details of 430 samples of foodstuffs submitted to the Cbuncil's Public Analyst to ascertain whether they complied with the Pood and Drugs Act, 1955, Labelling of Pood Order, 1953 and other relevant legislation. Of these 45 were formal samples and the remainder were samples obtained by informal procedures. 141 Commodity No. of Samples Accent Monosodium Glutamate 1 Almonds, ground 3 Amy lobarbitone 1 Anchovies in pure olive oil 2 Angel Delight 1 Antusin (Cough Mixture) 1 Apple and Blackberry Pilling 1 Apple Juice 1 Apricot and Pineapple Dessert 1 Baby Pood (Swiss)! 1 Bamboo Shoots 1 Banana and Rose Hip Dessert 1 B-Compleat Tablets 1 Bean Sprouts 1 Beef, Minced 4 Benzyl Penicillin 1 Biscuits 3 Bitter Lemon Squash 1 Blackcurrant drink 3 Blackcurrant juice syrup 1 Blackcurrant Pie Pilling 1 Blackberries 1 Blackberries in heavy syrup 2 Bread 4 Bread sauce mix 1 Bronchial Balsam 1 Burgundy 1 Butter 14 Cake and cake mix 2 Celery salt 1 Cheese 30 Cheese Blended with Beer 1 Cottage Cheese 1 Cheese Food 1 Cheese Spread 3 Cheeselets 1 Cherry Pie Pilling 1 Chestnut Puree 1 Chicken in Chicken Jelly 1 Chicken, curried in Mushrooms 1 C/FWd„ 99 142 Commodity No. of Samples B/Fwd, 99 Chicken Livers 1 Chicken Supreme 1 Chilli Beef with Beans 1 Chilli Powder 1 Chlorpropamide 1 Chocolate 3 Chocolate, Diabetic 1 Chocolate drink 1 Chocolate mould 1 Cochineal, Extract of 1 Cochineal Substitute 1 Cockles Confectionery 3 Coffee 18 Cooking Oil 1 Cornflour 1 Cough Mixture and Linctus 7 Crab and Crab Meat 3 Crystallised Rose Petals 1 Curried Beef and Mushrooms 1 Curried Mutton 1 Curry Paste 1 Curry Powder 1 Custard Powder 1 Carp, stuffed 1 Do-do Tablets (for bronchial coughs) 1 Eels, jellied 1 Ehzygest (Vitamins and Enzymes) 1 Essences, Flavourings and Colourings 6 Faggots 2 Flour 12 Food drink 1 Fruit and Nut Cereal 1 Fruit Salad in heavy syrup 1 Gelatine 2 Ginger drink 1 Goldenberries in syrup 2 Granadilla (Canned Fruit) 1 Grapefruit Juice 1 C/Fwd 187 143 Commodity No. of Samples B/Pwd. 187 Haggis 1 Ham and Chicken Roll 1 Ham and Tongue Spread 1 Hamburgers 2 Herbs, mixed 1 Honey and Horehound 1 Honey Comb 1 Horseradish 2 Ice Cream 3 Ice Cream Mix 1 Ice Cream Powder 1 Jam and Marmalade 4 Jelly 8 Jelly, Diabetic 1 Kidneys in Gravy 1 Lambs Tongues 2 Lembena (health drink) 1 Lemon Barley Drink 1 Lemon Cheese and Curd 12 Lemon Drink 5 Lemonade Shandy 1 lentils 1 Limeade 1 Lobster Bisque 1 Log Cabin Syrup 1 Loganberries in heavy syrup 1 Lumpfish Roe 1 Lychees in Syrup 2 Macaroon Paste 1 Maple Syrup 1 Margarine 15 Marzipan 3 Meat Pudding 1 Melon in Syrup 1 Milk 15 Milk (hot) 2 Milk, instant low fat 1 Minnims non-fattening sweetening cubes 1 Molasses 2 C/Fwd. 289 144 Commodity No. of Samples B/Fwd. 289 Mushroom Cubes 1 Mushrooms, creamed 1 Mustard Mustard Piccalilli 1 New Formula V.M. (vitamins and minerals) 1 Nocki in Tomato Sauce (noodles) 1 Octopus, broiled 1 Onion Salt 1 Orange Drink 1 Orange and Rose Hip Syrup 1 Oranges 1 Oyster (Smoked) 1 Panaleve Elixir (tonic) 1 Paprika 1 Parsley, dried 1 Paste- meat and fish 3 Peaches in heavy syrup 2 Pease Pudding 2 Pickles and Sauces 14 Pilchards 1 Plums 1 Pork Roll, stuffed 1 Porridge, tinned: 1 Prawns 1 Pudding 5 Ravioli with Tomato Sauce 1 Readi-Rice 1 Roe 3 Salad Cream 1 Salmon 1 Salmon Spread 1 Salmon Spread with butter 1 Sardines 2 Sausages 9 Savoury Minced Steak l Scampi Bisque 1 Sea Food Dressing 1 Shandy 1 Sherry 6 Sherry French Dressing 1 C/Fwd. 367 145 Commodity No. of Samples B/FWd„ 367 Sild in Tomato Sauce 1 Soup 14 Spaghetti Bolognese l Spice, mixed 1 Steak and Kidney Pudding 1 Stockpot, beef flavoured 1 Sultanas l Sunervin (herbal tranquilliser) l Sunny Spread 1 Tapioca Tea 22 Toallini Paesani l Toasty Grills l Tomatoes 2 Tuna light meat l Vanillin sugar l Vecon Tonic Food 1 Vegetable Oil 1 Vinegar 2 Vitamin Capsules l Welsh Rarebit l Wine 4 Yoghurt 1 430 Of the 23 samples which were the subject of adverse comment by the Public Analyst the majority were due to failure to comply with labelling requirements. The provisions of the Labelling of Pood Order, 1953 are designed to give information to the customer and to this end require that most prepacked foods containing more than one ingredient list the common or usual name. The ingredients should be shown in the correct descending order of proportion by weight. The Labelling of Pood Regulations, 1967 will supersede the Labelling of Food Order, 1953 on the 4th January, 1971, but from the 1st January, 1968 came into operation in so far as they apply to any food (other than a soft drink) containing calcium cyclamate, sodium cyclamate or cyclamic acid. 146 Details of action taken in respect of samples which were the subject of adverse comment:- Austrian Smoked Cheese. This article should have been described as "Pull fat soft cheese"- the Cheese Regulations 1965, It contained 22.7% milk fat and 46% water,, Following advice, the article was correctly described. Curd Cheese, This should have been described as "Medium soft cheese"the Cheese Regulations 1965, It contained 15.1% milk fat and 67,7% water. It was correctly described by a notice on the counter. Farmhouse Brie Cheese. The article should have been described as "Full fat soft cheese"- the Cheese Regulations 1965, It contained 20.2% milk fat and 58,5% water. It was correctly described by a notice on the counter. Port Salut Cheese. This should have been described as "Full fat soft cheese"the Cheese Regulations, 1965. It contained 26.8% milk fat and 47.4% water. It was correctly described by a notice on the counter. Dutch Processed Cheese. This should have been described as "Medium fat processed cheese"- the Cheese Regulations, 1965. It contained 25.5$ milk fat, 45.1% water and the milk fat in the dry matter was 46,5%. It was correctly described by a notice on the counter. Beef Sausages. This sample consisted of preserved beef sausages containing 260 parts per million of sulphur dioxide which is an added preservative and its presence in beef sausages without declaration is contrary to the requirements of the Preservatives in Food Regulations, 1962, The matter was taken up with the manufacturer and the retailer and since then a preservative notice has been displayed in the shop. 147 Pork Sausages.(2 samples) Consisted of preserved pork sausages containing 290 parts per million of sulphur dioxide contrary to the requirements of the Preservative in Pood Regulations, 1962. The retailer was warned and a preservative notice has since been displayed. Fish Soup. The addition of milk was required to make the fish soup but this was not specified on the label on the front of the container. Also the correct description of the article was Pish Soup Mix, not Pish Soup. The matter was raised with the importers who agreed to amend the description on the label to "Deep Sea Pish Soup Mix". Milk (Hot). Sight per cent. deficient in fat. Contained only 2.75 per cent. instead of a minimum of 3%. Adverse report due to milk in heated container on counter not being adequately agitated to mix effectively before serving. A warning was given in this case. Broiled Octopus. Ingredients incorrectly specified on the label as Octopus, Soy Sauce, Sugar, Monosodium Glutamate. The article contained salt and hydrolised protein and both these substances could be constituents of the soy sauce and they should be individually specified. Correspondence with importers was left in abeyance pending the publishing of new Labelling Regulations and has not yet been concluded. Cockles. Salt was not specified on the label as an ingredient. The packers stated that salt was not added as an ingredient and are carrying out an investigation among their cockle suppliers. Fillets of Anchovies in Pure Olive Oil. Salt was not specified on the label as an ingredient. The matter was raised with the importers who arranged for the packers to amend the labels so as to include "salt added". 148 Beef Flavoured Stockpot. This sample contained 13% of wheat starch which was not specified on the label as an ingredient. Also the description of the article could be misleading since no meat or beef extract was present. This was taken up with the manufacturers who agreed to include wheat starch in the list of ingredients forthwith and they were considering amending the description on redesigning the label. Cape Goldenberries in Syrup. The ingredients were specified on the label as gooseberries in syrup but the fruit content was not gooseberries as commonly known in this country but the cape gooseberry which is the fruit of a different species. The importers raised the matter with the packers who stated that the label must have been out of date as the present labels included "Goldenberries" in the list of ingredients. Milk and Honey Biscuits. This was a case of misdescription. The filling contained no cream but the article was described on the label as "Sweet Jam and Cream Pilled Sandwich Biscuits". The manufacturers are now using a new wrapper omitting the description which was the subject of adverse comment. Lemon Jelly and Orange Jelly. The illustrations on the cartons were considered to be misleading. The articles contained no lemon or orange juice but the cartons in which they were sold bore illustrations of the fruits and sections from which tears of juice were about to fall. The matter was taken up with the manufacturers who agreed to omit illustrations of fruit on redesigned cartons. Sweet and Sour Sauce. One of the ingredients of this article was specified as "other seasonings". This is a generic term and not a specific description and is not considered to be an appropriate designation for the purpose of the Labelling of Food Order, 1953. The matter was raised with the importers who instructed the suppliers to amend the labels to comply with the Labelling of Food Order, 1953. 149 Curry Pasta. This sample contained salt which was not specified on the label as required by the Labelling of Food Order, 1953. The matter was raised with the distributors and arrangements have been made for the label to be amended. Lemon Pickle. This sample also contained salt which was not specified on the label. This was raised with the manufacturers who agreed to amend their label. Creamed Mushrooms, This was considered a misleading description. The sample consisted of sizeable pieces of mushroom in a white sauce that was devoid of cream. The word "creamed" could apply to a finely comminuted mushroom product that had been subjected to the culinary process of creaming, or to mushrooms in a sauce in which cream is a major ingredient. The matter has been raised with the manufacturers but has not yet been finalised. Shandy. The sample contained 1.3 per cent, proof spirit, whereas in the opinion of the Public Analyst, shandy should contain not less than 1.5 per cent. On drawing the manufacturers' attention to the deficiency they stated that they subscribed to 1.5 per cent. minimum and expressed their regret. Pesticides in Food Surrey. With other Food and Drug Authorities the Council has continued to participate in a scheme to ascertain the extent of contamination of foodstuffs by toxic chemicals. A collated report will be published but is not yet available. 150 FOODS SUBJECT OF COMPLAINT. A total of 144 complaints about articles of food were received during the year, all were thoroughly investigated and appropriate action taken. Moulds and foreign bodies are the main reasons for complaint, the variety of the latter are endless and included during this year were flies, nails, wire mesh, wood, cement, glass, slug, brass bolt and cloth. Enquiries following the report of a lire earthworm being sucked up a straw from a bottle of milk failed to ascertain how it gained access. In two instances sabotage by food firms' employees was suspected, one in respect of cakes in which matches had been packed and the other a number of bottles of milk containing extraneous material. Failure by retailers to maintain effective stock rotation continues to result in foodstuffs being sold out of condition on occasion. This is particularly important with perishable foods such as sausages, pies and wrapped bakery goods which are subject to mould growth. Attention of retailers is being constantly drawn to the need for coding such wrapped commodities so that the length of time they have been in stock is known. The following complaints were considered sufficiently serious to necessitate taking proceedings. Loaf containing wire. Legal proceedings were instituted and a fine of £25 with £10.4.0. costs imposed. Mouldy Loaf. Legal proceedings were instituted against the retailer in respect of this sale. The case was found to be proved but it was held that the defendants had a defence under Sections 113 and 115 of the Food and Drugs Act, 1955. The suppliers, who had been joined in the action by the retailers, pleaded guilty and were fined £30 and ordered to pay 16 guineas costs to the retailers. An application for costs against the Council was refused. Metal in Bread. Three firms were prosecuted in respect of offences relating to the sale of bread containing metal. In each case the defendants pleaded guilty. (a) Fined £15 with £6.6.0. costs. (b) Fined £25 with £10.10.0. costs. (c) Fined £20 with £10.10.0. costs. 151 Mouldy Beef Steak Pudding with Kidney. Proceedings were instituted against the retailer and a fine of £25 with 5 guineas costs was imposed. Mouldy Steak and Kidney Pie. A pie sold approximately three hours after delivery to the retailer was found to be mouldy. The manufacturers, who supplied the retailer direct, were prosecuted and a fine of £25 with 10 guineas costs was imposed. 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. FERTILISERS AND FEEDING STUFFS ACT. 1926. This Act requires vendors of fertilisers and feeding stuffs to apply a description to such materials when exposed for sale or when consigned or delivered. This description can take different forms but results in the purchaser being made aware of the more important constituents in the fertilisers or feeding stuffs and is commonly a statutory statement. Samples are submitted to the Agricultural Analyst to ensure that particulars given are within the limit of variation laid down. Eleven samples of fertiliser and one of feeding stuff were purchased during the year and were satisfactory except for one. This was a sample of bonemeal which contained an excess of nitrogen which was not to the prejudice of the purchaser. PHARMACY AND POISONS ACT. 1935. The Act requires that persons who are vendors of poisons scheduled in Part II of the Poisons List must apply to the Local Authority for their names and those of their deputies to be entered on the Poisons List. The substances to which the Act relates are usually disinfectants, herbicides, certain types of hair dyes said acids for domestic or industrial use. During the year under review 13 names were removed and seven added. The total of names on the list at the end of the year was 137. 152 SAFETY. During the year publicity was given to toys (mainly imported from abroad) which were contaminated with harmful substances. Co-operation with the traders concerned and the Home Office resulted in the withdrawal of crayons and toy tools. Teddy bears which were examined were found to contain harmless material. All premises in the Borough engaged in dry cleaning were visited and managements advised on safety precautions to be observed. Customers to self-service establishments are advised to thoroughly air cleaned articles before taking them into the confined space of a car or before using them. RIDING ESTABLISHMENTS. The Riding Establishments Act, 1964 was enacted for the purpose of regulating the manner in which such establishments are conducted and in particular the care and welfare of the animals. There are five riding stables in the Borough which are licensed under the provisions of the Act and the Department, in collaboration with the Veterinary Surgeon appointed by the Corporation, carry out the necessary administrative work. Following considerable difficulty during 1966, in connection with a Riding Establishment, proceedings for non-compliance with the conditions of licence were heard by the Magistrates Court in January, 1967. The premises were in existing use when the Riding Establishments Act 1964 came into force and a licence with conditions was issued. In order to give the occupier maximum opportunity in the precise manner of complying with the conditions, those relative to the accommodation and drainage were to be to the satisfaction of the licensing authority". The hearing took place on two days and following a great deal of legal argument the defence satisfied the magistrates that the conditions specified were ultra vires, being void for uncertainty and therefore unenforceable. It was claimed that the conditions must inter alia set out on the face of licence what the applicant must achieve otherwise he does not know what is to be done and cannot judge the reasonableness or otherwise of the requirement in order to accept it or to exercise his right of appeal. The magistrates made no order covering costs. The remaining four establishments were conducted in a satisfactory manner. SCHOOL HEALTH SERVICES ROYAL BOROUGH OF KINGSTON UPON THAMES EDUCATION (SCHOOLS) SUB-COMMITTEE AS AT DECEMBER 1967 Alderman W. J. Marshall Vice-Chairman: Councillor P. R. Wise, F.C.A. Alderman: J. H. Cocks, O.B.E. Councillors: Chairman Mrs. E. A. Bidmead R. M. Church K. C. Gooding N. Howard D. Ives, M.A.(0xon.) C. E. Potts, A.C.I.S D. Scott A. I. A. Spevack R. P. Wickes Co-opted Members: Mrs. M. Hall The Rev, A. W. Holder The Rt. Rev. Mgr. H. Hunt R. Humphrey F. Seal Miss B. M. Weedon 155 SCHOOL HEALTH SERVICE I would refer readers to my comments on the School Health service in my opening letter on page 4. The population of the borough, estimated by the Registrar General, was 145,240 at mid-1967. In January 1968 the number of pupils on the registers of maintained schools was 18,367 made up as follows: Primary Schools 10,289 Secondary Schools 7,797 Nursery Schools 78 Special Schools 203 In addition it is estimated that 2,876 children attend independent schools registered under Part III of the Education Act 1944, and approximately 750 attend direct grant and independent schools which are served by the school health service. The number of maintained schools in the borough on 31st December 1967 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 and were assisted by two senior and three 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, a group adviser, and twenty-one health visitors carry out the functions of school nurses, devoting about 20 per cent 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. 156 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 1967 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 6,926 children being examined. The arrangements for periodic medical inspection sire 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 and sixteen plus 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. During 1967 a trial scheme of selective medical examinations of eight year olds was carried out in three junior schools with the idea of extending the system to all schools should it prove successful. Questionnaires were sent to parents by the heads, and information was also sought from the teaching staff on pupils taking part in the scheme. Only three parents failed to return questionnaires and the co-operation of parents and schools was excellent. The forms were examined on their return together with the child's medical record card (Form 10M) by the school medical officer; following scrutiny the forms were divided into two groups according to whether or not the children would have been selected for examination from the information available. On this occasion all the children were examined and the details are as follows: 157 Number of pupils taking part in the scheme 229 A. Number of children who would have been examined on a selective basis 133 (58%) B. Number of children who would not have been examined on a selective basis 96 Number of children in A. who did not have defects 10 Number of children in B. whose defects would have been missed 1 Judging from the results the trial scheme proved to be successful and shewed selective medical examinations disclosed higher proportion of children with emotional problems; in fact 7.4 per cent of the children who took part in the trial scheme had emotional problems as compared with 3.7 per cent of the total eight year olds examined in the previous year. In view of the findings from the survey carried out at the three schools, it is proposed that the system of selective medical examinations be gdopted for all eight year old children, with the proviso that during the first year the scheme is in operation at any school, all children be examined regardless of whether or not any defects were indicated on the parents' or teachers' questionnaire. At the three schools which took part in the survey examinations will be carried out on an entirely selective basis. General Conditions as Recorded at Periodic Inspection Of the 6,926 pupils inspected, 6,911 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 cam be cured, and merits more serious consideration by parents and teachers than is usually given. The 15 children whose general condition was deemed unsatisfactory consisted of 1 born in 1963, 3 in 1962, 2 in 1960, 3 in 1959, 1 in 1958, 4 in 1955 and 1 in 1952. 158 Defects found at Periodic Medical Inspections During 1967, 922 (13.3 per cent) 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 pupils 1963 and later 384 1 30 31 1962 1453 40 108 142 1961 229 14 23 33 1960 111 4 14 18 1959 1200 37 116 138 1958 375 17 28 42 1957 110 3 10 13 1956 1074 89 92 177 1955 568 47 44 86 1954 91 21 10 25 1953 49 6 8 12 1952 and earlier 1282 177 57 205 Totals 6926 456 540 922 159 Defects noted at periodic medical inspections (whether or not they were already under treatment or observation) are analysed below: Defect or Disease Requiring Treatment Observation Skin 71 138 Eyes: (a) Vision 456 363 (b) Squint 61 33 (c) Other 8 19 Ears: (a) Hearing 25 60 (b) Otitis Media 9 77 (c) Other 9 8 Nose and throat 31 296 Speech 66 59 Lymphatic Glands 17 96 Heart 1 76 Lungs 22 139 Development: (a) Hernia 5 12 (b) Other 5 122 Orthopaedic: (a) Posture 51 110 (b) Feet 114 156 (c) Other 28 86 Nervous System: fa) Epilepsy 25 18 (b) Other 9 43 Psychological: (a) Development 7 128 (b) Stability 10 161 Abdomen 4 32 Other 47 103 Total: 3416 1081 2335 Children with defects noted at periodic or special medical inspections are reinspected at appropriate intervals by the school medical officers. The number of such reinspections carried out was 1,097. 160 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 845 pupils examined at these inspections are analysed below: Defect or Disease Requiring Treatment Observation Skin 2 14 Eyes: (a) Vision 3 18 (b) Squint 2 4 (c) Other 2 3 Ears: (a) Hearing 12 54 (b) Otitis Media 1 6 (c) Other 2 3 Nose and throat 7 36 Speech 11 11 Lymphatic Glands 1 20 Heart - 6 Lungs 3 10 Development: (a) Hernia - 1 (b) Other 1 5 Orthopaedic: (a) Posture 3 7 (b) Feet 8 38 (c) Other 2 7 Nervous System: fa) Epilepsy - 2 (b) Other - 7 Psychological: ( a) Development 7 18 (b) Stability 7 15 Abdomen - 2 Other 6 9 Total defects: 376 80 296 161 Treatment or Diseases and Defects The number of defects known to be treated by all sources during the year is shown in the following table: Defect or Disease Number Skin: Ringworm - (a) Head - (b) Body - Scabies 4 Impetigo 3 Other 16 Vision and Squint 1281 Other Eye Conditions 32 Ear, Nose and Throat 525 Speech 435 Lymphatic Glands 1 Heart 25 Lungs 32 Development 21 Orthopaedic 297 Nervous Diseases 45 Abdomen 46 Other 88 Total 2851 Combined general medical and immunisation sessions attended by a school medical offioer with a school nurse in attendance are 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: 162 Operative Treatment Tonsils and Adenoids * 452 Diseases of the Ear 1 Received other forms of treatment 72 This number includes children treated in hospitals within the borough and may include a few children from adjoining areas. Speech Therapy In December 1967 the speech therapy staff comprised one full time and five part time therapists working a total of 22 sessions a week. The senior speech therapist resigned in August and a replacement was not appointed until December. This meant that sessions had to be rearranged and the shortage was particularly felt at St.Philip's Special School and the Worcester Park Clinic. However, in spite of this there was a continued growth in the service during the year, a total of 435 children receiving treatment as compared with 398 during 1966. The provision of additional equipment has once again helped in coping with the increased caseload and the clinics at Grange Road, Kingston and South Place, Surbiton were provided with tape recorders. In addition to clinical work the therapists had several meetings during the year to discuss treatment methods and problems arising within the service. These meetings provided a valuable opportunity to meet colleagues and co-ordinate the work in the borough. Details of the work undertaken at the centres are shown below, with the 1966 figures for comparison. Centre Present Number of Sessions Initial Caseload Children Treated Remaining for Next Year 1967 1966 1967 1966 1967 1966 1967 1966 Acre Road 2 2 24 25 47 47 25 24 Bedelsford School 6 8 22 19 31 26 27 22 Grange Road 2 2 13 9 26 17 23 13 Hook 3 2 31 30 53 39 40 31 Roselands 5 5 51 61 98 110 57 51 St.Philip's School 2 5 38 27 47 44 38 38 Surbiton 2 2 27 15 36 36 12 27 Tolworth 2 2 19 20 32 27 14 19 Worcester Park 4 2 48 34 65 52 47 48 Totals 28 30 273 240 435 398 283 273 163 Analysis of Cases Treated Children Treated during Discharged Remaining at end of period covered 1967 1966 1967 1966 1967 1966 Stammering 73 66 26 19 47 47 Cluttering - 1 - 1 - - Dyslalia 249 228 96 79 153 149 Idioglossia - 3 - 3 - - Anarthria/Dysarthria 19 17 4 1 15 16 Aphasia/Dysphasia 11 10 1 1 10 9 Aphonia/Dysphonia 4 3 1 1 3 2 Cleft Palate 5 8 1 4 4 4 Hyperrhinophonia 9 7 2 1 7 6 Hyporhinophonia 1 - - - 1 - Defective speech due to: Amentia/Dementia - 4 - 2 - 2 Deafness 5 3 2 - 3 3 Retarded Speech 52 40 18 11 34 29 Unclassified 7 8 1 2 6 6 Totals 435 398 152 125 283 273 Analysis of Children Discharged 1967 1966 By Therapist 118 89 Because of non-co-operation of parents 6 8 Because of transfer to another district 12 11 Because of transfer to special schools 9 7 For other reasons 7 10 Totals 152 125 Ophthalmic Clinics During the year 1277 children were examined at the school eye clinics; 477 were prescribed glasses, which were dispensed by National 164 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. Audiology The audiology service run jointly with the London Borough of Merton continued to expand. Not only the number of attendances at the audiology clinic increased but following a survey of approximately 800 secondary pupils in 1966 when 32 children were found to require further investigation, it was agreed to extend the sweep testing of children to the secondary schools, and it is hoped to start this service in 1968. The service is staffed by a medical officer specially trained in this work who is assisted by an audiometrician and a teacher of the deaf. All pupils have a routine hearing test between the ages of six and seven and each primary school is now visited annually by the audiometrician. In addition to cases seen at the audiology clinic, home visits were made to pre-school children with hearing impairment and the peripatetic teacher of the deaf made periodic visits to schools which children with impaired hearing attended. Details of the work undertaken in schools: Children sweep tested - 1710 Children who failed test - 127 Result of investigations by school medical officers: No significant hearing loss on clinical examination 42 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) 29 (ii) Old otitis media 15 (iii) Injury - (iv) Other oauses 12 (v) Undetermined causes 15 Investigations incomplete at end of year 9 Investigations not possible - left district or otherwise unavailable for examination 3 165 Recommendations by school medical officers in the first instance: (i) No action required 5 (ii) For observation only 72 (iii) Refer to audiology clinic 19 (iv) Refer to general practitioner 5 (v) Refer to ear, nose and throat consultant 14 There were 40 recommendations made during the year for children to sit in favourable positions in the classroom. The total number of pupils attending school at the end of the year known to have been provided with hearing aids was 28. Audiology Clinic Of the 234 attendances during the year, 126 were made by 99 children under the age of five, and 108 were made by 74 children aged five and over. Details of children and attendances are as follows: Age Group Totals Under 2 2-4 5-7 8 -11 11 + New cases referred from all sources 30 49 27 20 14 140 Cases carried over from 1966 13 7 1 11 1 33 Found to have normal hearing 34 46 16 13 8 117 Deaf in one or both ears - - 1 3 2 6 Found to have remediable hearing loss - 4 9 8 2 23 Impaired hearing requiring auditory training and/or hearing aid - 1 1 1 3 6 Not fully assessed at end of 1967 7 5 2 1 15 Attendances 56 70 42 41 25 234 166 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 226 Children treated 183 Attendances 3343 New cases admitted 96 Cases discharged 97 The 77 children attending Bedelsford Special School were also provided with physiotherapy by the physiotherapists attached to the school. Epileptic Children As a result of periodic medical inspections, 25 of the children examined were referred for treatment and 18 others were noted for observation at a later date. The 2 children examined as "specials" for this illness 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. 21 children were found to require treatment for this condition and a further 27 were noted for observation at a later date. Some children are referred to the child guidance clinic and others are given the use of an electric alarm apparatus for varying periods. 13 children were loaned this apparatus during 1967, and of these. 2 were cured, 1 benefitted, 1 child left the district, 7 are still using the alarm, and in two cases parents purchased private apparatus. 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 68 Examined 12908 Cases with nits 63 Cases with lice 3 Cases with verminous bodies nil 167 Present standards of cleanliness and freedom from infestation have enabled discretion concerning the frequency of hygiene inspections to be used. 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 17 Enteric Fever - Measles 551 Whooping Cough 34 German Measles 90 Chicken Pox 211 Mumps 604 Jaundice - Dysentery 9 Influenza - Other 96 Total 1612 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 reinforcing 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. 168 Diphtheria Primary Immunisation Number who completed a primary course 140 Reinforcing Number who received reinforcing injections 3514 Total 3654 Poliomyelitis Primary Course Number who completed a primary course 198 Reinforcing Number who received a reinforcing dose 2680 Total 2878 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 348 Reinforcing Number who received a reinforcing injection 3512 Total 3860 Smallpox Number who received primary vaccination 83 Reinforcing Number who received revaocination 167 Total 250 169 The number of organised school parties taking children abroad is steadily increasing. The most notable trip during 1967 was a Mediterranean cruise, calling at Venice, Piraeus, Malta and Gibraltar, on the s.s, Nevasa, on which 250 children from six schools were accompanied by members of staff. In order to protect the children against various diseases prevalent in the countries visited, the school health service ensured that they had all received smallpox vaccination and other inoculations deemed necessary, before departure. Vaccination against Tuberculosis During the year seven school children involving two families were notified by the chest clinic as positive cases. The scheme for the routine B.C.G.(Bacillus Calmette-Guerin) vaccination of school children between their thirteenth and fourteenth birthdays continued during the year under review. Pulmonary tuberculosis is steadily being brought under control by early diagnosis and rapid and efficient treatment. The following table summarises the work undertaken: Routine B.C.&.Programme B.C.G. Offered Consented Absent Mantoux Positive Vaccinated No. Percentage of those tested No. Percentage of those offered 1625 1568 (96.5%) 274 90 7% 1204 74% Child G-uidance During 1967 two major events have facilitated the treatment of psychiatric illness in the families with children in this community. New clinic premises at Mecklenberg House occupied on 27th November providing adequate working accommodation has enabled each staff member to use his or her available time more freely in the interest of the patient. 170 The opening in September of the Mecklenberg Day Unit adjoining the clinic premises has met a need in the community for the treatment and education of emotionally disturbed children who cannot sustain ordinary sohool, but who can be contained in their homes during the period of their illness. At present, three children attend the unit on a full time basis and two on a part time basis. It is anticipated that the unit will be able to accommodate six to eight children at a time when it is fully functioning. Increasing co-operation from general practitioners in referring patients is reflected in this year's figures and we continue to have a good liaison with the Paediatric Department of Kingston Hospital. The clinic continues to provide teaching and training facilities for students of ancillary disciplines. Three social work students from the Younghusband Course and three students on the Course for the Diploma in the Education of Maladjusted Children have successfully completed their training in this clinic, to date. A psychotherapist was appointed for five sessions during 1967 and this has gone some way towards meeting the increasing demand for treatment . The following table shows the work done during the year: Caseload brought forward from 1966 174 Waiting list at December 1966 24 198 151 new oases were referred during 1967 by the following: Court 11 School Health service 51 Hospitals 4 Private practitioners 42 Child Guidance clinics 2 Direct non-medical 41 151 Reasons: Nervous disorders 24 Behaviour problems 86 Habit disorders 14 171 Psychosomatic disorders 4 Organic disorders 2 Psychotic illness Educational problems 9 For special examination Total of new cases 51 151 Total caseload during year 349 New cases initially seen by psychiatrist during the year 22 New caseload initial distribution: Psychiatrist 39 Psychiatric Social Worker 58 Psychologist 25 Psychotherapist - 122 All cases - closures during year: Treatment completed 8 Advice only 2 Non co-operative 8 Other arrangements made 11 Improved 2 Failed to attend 11 Transferred to other clinics3 45 Caseload on treatment at end of year 297 On waiting list for diagnostic interview at end of year 7 349 HANDICAPPED PUPILS Special Schools and Hostels The following table shows the placement of Kingston children in special schools: 172 Category Number attending at end of 1967 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 - - - - - - - Partially Sighted - - 2 3 - - - - - - - - Deaf - - 3 2 3 3 - - - - - - Partially Hearing - - 2 - - - - - - - - - Educationally Subnormal 53 31 - - 4 2 1 - 1 - 1 - Epileptic - - - - - 2 - - - - - - Maladjusted 3 1 - - 18 5 - - 3 - 2 - Physically Handicapped 15 8 2 3 3 2 - - 3 1 - - Delicate 1 - - - 4 - - - - - - - Speech Defect - - - - - - - - - - - - Totals 72 40 9 8 33 14 1 - 7 1 3 - Bedelsford School, Grange Road. Kingston I am grateful to Mr.E.C.Cooke, Headmaster, for the following report: There are 77 children on roll and all are severely physically handicapped except for two boys with asthma. It is of interest that there are only two cases of anterior poliomyelitis and both children are paralysed as a result of the 1955 epidemic. None have been admitted since so it seems that this will not be a problem in the future, due to the anti-polio immunisation. 173 There are 8 children with spina bifida, 6 under five having been admitted to the nursery class within the year. There are 32 children with cerebral palsy, most of whom have multiple handicaps. As well as the obvious physical disability they have speech, emotional and psychological difficulties, also epilepsy. 9 boys and 1 girl suffering from muscular dystrophy attend the school. 3 children have congenital cardiac conditions which it is hoped will respond to surgery and enable them to go to normal school. The whole approach to education and treatment is to emphasise normality and where possible, it is the policy to encourage children to go on to a normal school. Pupils, who because of their physical disability cannot attend any other school, where suitable, will be prepared for the Certificate of Secondary Education, and during the year 4 children were integrated into ordinary schools. In addition to the basic subjects pupils are given instruction in the various crafts and domestic science. It must be remembered that children so severely disabled, by necessity spend a great deal of time having specialised treatment, including physiotherapy, speech therapy, and visits to hospitals for various tests. During the forthcoming year a large rebuilding programme will be carried out to facilitate the work and accommodate a larger number of children. St.Philip's School for Educationally Subnormal Children Fleetwood House. Leatherhead Road. Chessington I am grateful to Mr.J.A.Ainley, Headmaster, for the following report: This school has on roll between 100 and 130 children aged five to seventeen. The staff comprises 8 class teachers and a nursery assistant who helps with the youngest age group. Speech therapy and physiotherapy is provided in the school on a sessional basis, for those children who need help. It is a school with every advantage; pleasant buildings and grounds, a teacher-pupil ratio of 1:16. It provides a secure family atmosphere where children who have learning difficulties can spend the whole of their school lives, unharassed by a sense of failure or by the various pressures sometimes experienced in the main stream of education. The timetable is flexible, based on practical and creative activities and 174 also on individual interests and abilities. It is hoped that children who leave the school have balanced personalities and are able to enjoy a fall normal life within their limitations. This aim is certainly achieved, except for a few exceptional cases, to judge from the contacts which old pupils make with the school through the Youth Club or when they visit. A total of 14 children left the school during 1967 and were assisted in finding employment by the Youth Employment Service. Types of employment in which success has been achieved: Dye Worker Factory Hand Canteen Assistant Sales Assistant Gardener Stock Room Assistant Parks Assistant Ascertainment of Handicapped Pupils Children ascertained in 1967 as requiring special educational placement Category Number Blind nil Partially Sighted 2 Deaf 2 Partially Hearing nil Educationally Subnormal 18 Epileptic 1 Maladjusted 9 Physically Handicapped 1 Delicate nil Speech Defect nil Total 33 175 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 teachers at the unit and the child's normal school. Health Education Details of activities which took place in schools and youth centres are reported on pages 19 and 20. Youth Employment Service - Year ended 30th September 1967 Number 1966 1967 Boys and girls living in the borough known to have left school 1286 1010 New entrants into National Insurance: School leavers 848 674 First advisory interviews 1412 1129 Interviewed who continued full time education at school or college 499 556 Applications for employment* 1136 1255 First applications included in above figure 694 633 Vacancies notified * 2042 1960 Kingston boys and girls placed in local employment 725 772 Kingston boys and girls placed in other districts 101 62 Local residents included in above figures who were placed in first situations 429 369 Total of vacancies filled in Kingston area 901 897 * Including register brought forward on 1st October. 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. 176 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. Based on September 1967 Returns Children in attendance 17095 Taking milk 14317 Percentage taking milk 83.74% Taking meals 13569 Percentage taking meals 79.33% Cost of meal to pupil 1s.0d. Actual cost of meal 2s.9d. Percentage taking meals at: Full cost 95.81% Free 4.19% The number of examinations for these purposes and the results of the examinations are shown in the following table: Examinations for employment certificates 250 Children examined for entertainment licences 6 Pound to be unfit nil 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: 177 Average number of days meals were supplied in year 200 Average daily number of meals supplied 13857 Number of meals supplied: Non-maintained schools and other establishments 44796 Maintained schools 2726787 2771583 Recuperative Holiday Scheme This is a useful scheme which enables children attending maintained schools to have a recuperative holiday on medical and medico-social grounds. Cases are very carefully selected and the holiday is normally for two weeks. There is no doubt that these arrangements are of great benefit to the children and families concerned. Assistance with fares can be given where necessary. 23 children enjoyed recuperative holidays under this scheme during the year. Deaths of School Children During the year notifications were received in respect of deaths of four children of school age. The causes of death were as follows: 1 Pulmonary embolism 1 Bronchial asthma 1 Uraemia 1 Accidental death Medical Examination of Adults 173 newly appointed teachers and candidates for admission to teachers training colleges were medically examined as required by the Department of Education and Science. Of 260 teachers appointed to Kingston schools, submitting medical history forms, 251 were considered fit from scrutiny of the forms and the remaining 9 following medical examination having regard to details in the forms. 178 School Clinics Address Grange Road, Kingston upon Thames 204 Acre Road, Kingston upon Thames 1 Gosbury Hill, Hook South Place, Surbiton Roselands, 163 Kingston Road, New Maiden The Manor Drive, Worcester Park St.George's Hall, Hamilton Avenue, Tolworth Clinic Minor Ailments Speech Dental General Medical Minor Ailments Speech Dental Eye General Medical Physiotherapy Audiology Minor Ailments Speech Dental General Medical Physiotherapy Minor Ailments Speech Dental Eye General Medical Minor Ailments Speech Dental Eye General Medical Physiotherapy Child Guidance Minor Ailments Speech Dental Eye General Medical Physiotherapy Audiology Speech With the exception of Minor Ailments, attendance is by appointment, 179 SCHOOL DENTAL SERVICE Chief Dental Officer: Miss Ann Hobley. L.D.S..R.C.S.(Eng.) STAFF Miss Ann Hobley was appointed Chief Dental Officer and took up this post early in May. In August, Mr, Patrick T.Fuller was promoted to the post of Senior Dental Officer. An auxiliary, whose appointment is combined with the London Borough of Merton, spends two days a week in one clinic, working under the supervision of the dental officers in attendance. It is hoped at some future date to employ a dental hygienist in a part time capacity to assist especially in the field of dental health education. Four full time and several sessional and part time dental surgery assistants are in attendance at the clinics. Crises arise with sickness and at holiday times, when difficulty is experienced in obtaining relief surgery assistants. As previously mentioned one of the chief reasons for difficulty experienced in obtaining dental surgery assistants of high calibre is the poor rate of remuneration. A trained efficient dental surgery assistant whose duties combine nurse, receptionist and clerk, is essential to every dental surgeon in order that he or she may undertake the work for which they are qualified; without this, their work is hampered in every aspect. The first dental officers staff meeting was held in June, and these have now become a regular event in the department's programme. This has enable the dental officers to meet each other to discuss with their colleagues matters of mutual professional interest, thus, by becoming part of a team, reducing the isolation sometimes felt in clinic work, especially amongst the young recently qualified members of staff. The borough is extremely fortunate in having a very young staff, and it is hoped that this will be maintained. At the December meeting, Miss Doreen Land, dental health education lecturer from the Oral Hygiene Service, addressed the staff on general planning and preparation for dental health projects, and in particular about the one proposed for this borough in 1968. She also showed some of the excellent dental health films available and spoke on the subject of visual aids. 180 The Chief Dental Officer attended two courses during the year; one held at Bristol was a refresher course on dental treatment of the handicapped patient, the other, held in London, was a course on administration for senior members of the local authority dental service. Dental officers hope to attend more courses and conferences in future in order to keep abreast with current trends and to improve the image of the school service. The professional staff would like to record their thanks especially to Mr.R.A.Pfeebles, consultant oral surgeon, and to Mr.H.Orton, consultant orthodontist, both at Kingston Hospital, for the most courteous attention given to all patients referred for consultation; thanks are due also to medical practitioners for their co-operation in providing case histories where necessary and in prescription of drugs, especially antibiotics. The assistance of local medical and dental colleagues is of the utmost importance and the staff appreciate this in the borough of Kingston. CLINICS There are six clinics within the borough, two of which are twin surgery clinics. At Acre road, one of the newest clinics, one surgery is used for the orthodontic department, this being extremely convenient for the orthodontic staff as the Surrey County Council Dental Laboratory is situated in these premises, and Kingston shares these facilities. The laboratory staff under the supervision of Mr,Hicks are at all times most co-operative. All the clinics are now equipped with high speed apparatus, and there is sufficient X-ray and general anaesthetic apparatus in the clinics. SCHOOL INSPECTIONS In spite of a concerted effort in the last few months of the year, it was not possible to inspect all the schools in the borough. However, this is to be a priority in the ensuing year, since a large demand for dental treatment, whether through the school service or the National Health Service, comes as a direct result of school inspections. The Chief Dental Officer undertook special responsibility for handicapped persons. Pupils at Bedelsford School were inspected and treated where necessary at Grange Road Clinic. Children at St.Philip's School and those attending the Kingston Training Centre were also inspected, and children requesting treatment were generally referred to the clinic nearest to their homes, both for convenience and to spread the caseload rather than overtax one 181 dental officer with all these persons, for whom treatment can be tiring and time consuming, in spite of the satisfaction on completion. TREATMENT Most clinics now run an efficient recall system, sending appointments for a dental check up to their patients when necessary, usually at 4-monthly intervals. This routine treatment for their regular patients constitutes the largest part of the dental officer's work. When, as a result of school inspections, treatment is requested by new patients, appointments are arranged at the earliest possible date, and emergency treatment is given within a day. It will be seen from the figures that more teeth have been filled compared with previous years, whilst the figure for extractions continues to decrease, with fewer general anaesthetics being given. This is a satisfactory state, and should progress in this way each year. Appointments missed by patients without adequate reason are a cause of irritation to the dental officers who could be using the time on other children. DENTAL HEALTH EDUCATION During the year more time has been spent by dental officers in the most important field of dental health education. At the end of June Mr.Pierre Picton, a freelance professional clown under the title of "Pierre the Clown" spent a week in the borough. Sponsored by the Fruit Producers' Council in conjunction with the General Dental Council, he visited 21 of the primary schools and at his special request also visited Bedelsford School and St.Philip's School for handicapped pupils, and the Kingston Training Centre, talking in all to over 5,500 children, distributing apples, badges and dental health literature to each one. Dressed in his clown's outfit, he spoke for about 20 minutes to the pupils at each school, his talk being based on the four Rules for Good Teeth. His Worship the Mayor, Councillor R.Pearse Oliver, gave his support to the campaign and attended a session at one of the schools. Pierre's visits to the schools made a tremendous impact on the children and letters received from heads after the campaign bore out this fact. 182 As a result of this successful venture a return visit of Pierre the Clown to the borough has been arranged for March next year, to visit all the schools missed this year. Towards the end of the year plans were being made for a follow-up oampaign to all primary schools and talks will be given to children in small groups by the regular dental staff, and films shown. In November the dental staff participated in a general health exhibition staged at the Chessington Youth Club. This was open to youth club members on the two evenings and to senior pupils from the local secondary schools on the same two afternoons. Some equipment for this was loaned by the staff of the Children's and Periodontal Departments of the Royal Dental Hospital, to whom the borough is indebted for their co-operation. Talks have been given and films shown by some of the dental officers in the schools in their area. In addition, a great deal of chairside time is spent with patients who attend the clinics in the borough, and with their parents, in teaching the correct method of tooth brushing, discussion of suitable non-cariogenic diets, and in stressing the importance of regular dental visits. In children not dentally inspected until entrance to school at the age of five years, decay is often rampant, necessitating extractions with all the consequent problems. One of the distressing facts that dental officers experience in their visits to schools is the large number which still have tuck shops. These tuck shops sell almost exclusively cariogenic foods, mainly biscuits, sweets and lollies. While this state of affairs continues the dental condition of our children will never improve, and dental surgeons in general will be spending their time providing treatment for what is largely a preventable disease. ORTHODONTIC SERVICE The orthodontic service is at present staffed by two orthodontic surgeons, one of whom attends for two sessions and the other, who holds a full time appointment combined with Surrey County Council, the London Borough of Merton and this borough, attends for five sessions. The demand for orthodontic treatment by patients and dental surgeons is increasing and at the end of the year there was a waiting list for consultations and treatment. For the majority of cases a removable appliance is used to align the teeth correctly. However, more fixed appliance work is being carried out for certain carefully selected cases, necessitating increased chairside time for these patients, but usually at the conclusion of treatment, the aesthetic result is very much finer than could be achieved with a removable appliance. 183 The following is a summary of the work undertaken: General Dental Inspection and Treatment Numbers Inspections: At school 15072 At clinic 1835 16907 Re-inspections at school and clinic 2539 Found to require treatment 7028 Treated 3617 Attendances for treatment 11857 Sessions for inspection 135 Sessions for treatment 2074 Sessions devoted to dental health education 36 Fillings: Permanent teeth 5614 Temporary teeth 3816 9430 Filled: Permanent teeth 4320 Temporary teeth 3355 8175 Extractions: Permanent teeth 389 Temporary teeth 1023 1412 General anaesthetics 254 Other operations: X-rays 477 9532 Prophylaxis 1517 Teeth otherwise conserved 875 Root teeth filled 28 Crowns and Inlays 20 Other treatment 6615 Orthodontic Cases Commenced during the year 141 Brought forward from previous year under treatment or observation 555 696 Completed during the year 146 Discontinued during the year 51 Referred to hospital consultant 13 Removable appliances fitted 245 Fixed appliances fitted 30 Total attendances 2450 Under treatment or observation at end of year 486 184 INDEX Page Accommodation for Elderly 69-75 Admissions to Hospital 58, 59 Mr Pollution 109-116 Ambulance Service 46 Animal Boarding Establishments 100 Ante-natal Clinics 24 Atmospheric Pollution 109-116 At Risk Register 30 Audiology 164-165 Audiometry 164-165 Bacteriological Examinations 18,130,131,140 Baths 97-99 B.C.G-. Vaccination 47,169 Births 10 Birth Rate 10 Blind, Welfare of 79-84 Bronchitis 13 Burial or Cremation of Deceased Persons 92 Cancer Education 19 Cancer Statistics 12,13,39 Caravans 128 Car Badges for the Handicapped 88 Certificates, Disrepair 121 Certificates, International Vaccination 45 Cervical Cytology 41 Chest Clinic 46-47 Chicken Pox 167 Child Guidance Clinic 169-171 Child Minders 29 Child Welfare Clinics 25 Children's Homes 29 Chiropody 52 Clean Air Act 109-116 Cleanliness 103,166-167 Clinics 24,25,26,27,46,47,50, 57,163,164,165,169-171, 178 185 Page Closing Orders 120 Clubs 61,90-91 Community Care 60-61 Complaints 116,150 Congenital Malformations 30-33 Co-ordinating Conferences 34 Cremations 21,92 Crematorium 21 Day Nurseries 28,29 Deaf 78,84,85,164-165 Deaths 12-14 Death Rates 10-11 Demolition Orders 120 Dennington Report 128 Dental Services 25-27,179-183 Dental Health Education 181-182 Diphtheria 17 Disinfection 100 Disinfestation 100 District Nurses 37-39 Domiciliary Services 36-43,59,75-78,84,89 Drainage and Sewerage 99 Dysentery 16,17 Education Act 156 Educationally Subnormal Children 172-175 Elderly Persons 39,40-41,69-76 Employment of Children 176 Employment of Handicapped 81-82 Encephalitis 16,17 Enteric Fever 16,17 Enuresis 166 Environmental Health Services 95-152 Factories Act 1961 102-104 Family Planning Association 50 Families with Problems 34-36 Fatheroraft 41 186 Page Fertilisers and Feeding Stuffs 151 Food and Drugs Act 140-151 Food Hygiene Regulations 136-140 Food Poisoning 16,17 Food Premises 130-140 General Practitioners - Attachment 37,38,43 Gypsies 129 Handicapped Children 171-175 Handicapped Services 78-91 Health and Welfare Committee 6 Health and Welfare Staff 7 Health Education 19-20,175 Health Visiting 40-43 Heart Disease 13 H.M. Inspector of Factories 103 Holidays - Children 177 Handicapped 83 Recuperative 50 Home Help Service 53 Home Nursing 37-39 Home Nursing Equipment (loans) 51 Homes for Elderly 69-74,82 Homes for Handicapped 82 Home Workers Scheme 82 Hospitals 22 Hospital Confinements 36 Hostels 59,65 House Improvements 122-125 Houses - Multiple Occupation 121 Houses Unfit 120 Housing Acts 120 Housing Surveys 125-127 Ice Cream 131-132 Illegitimate Births 10 Immigrants 43 Immunisation and Vaccination 43-46,167-169 187 Page Improvement Grants 122-125 Incontinence Laundry Service 38 Infant Mortality 10-11 Infant Welfare Clinics 25 Infectious Diseases 16-18,167 Influenza 16-18,167 Insect Pest Control 117-119 Inspections 100-102,156-160, 180-181,183 International Certificates of Vaccination 45 Introductory Letter 1-5 Legitimate Births 10 Licences 130 Live Births 10 Lung Cancer 12 Marriages 15 Mass Radiography 49 Maternal Mortality 10 Meals on Wheels 76-78 Measles 16,17,167 Meat Inspection 132-135 Medical Aid 36 Medical Examination of Adults 21,177 Medical Treatment 29,161-162 Meningococcal Infection 17 Mental Health Act 57,59 Mental Illness 58-61 Mental Subnormality 61-65 Merchandise Marks Act 151 Midwifery Service 36-37 Milk 130-131 Ministry of Social Security Act 69 Mortuary 21 Mothercraft Training 42 Mothers Clubs 41 Moveable Dwellings 128 Multiple Occupation - Houses 120 Mumps 167 188 Page National Assistance Act 20,78,92 Neonatal Mortality 11 Noise 108-109 Notices 102,120 Nursing Agencies 21 Nursing Equipment - Loans 51 Nursing Homes 20,21 Occupational Therapy 49,71-72,87 Offices, Shops and Railway Premises Act 104-108 Old People's Homes 69-74 Ophthalmia Neonatorum 17 Ophthalmic Clinics 163-164 Outwork 88 Partially Sighted 81 Perinatal Mortality 11 Personal Health Services 24-53 Pest Control 117-119 Pet Animals Act 101 Pharmacy and Poisons Act 151 Physically Handicapped, Children 171-175 Physically Handicapped, Schools 171-175 Physically Handicapped, Services 78-91 Physiotherapy 63,166 Pigeons 118 Pneumonia 16,17 Poliomyelitis 17 Population 10 Post natal Clinics 24 Problem Families 34-36 Protection of Property 92 Psychiatric Services 58-59 Public Cleansing 99 Public Health Acts 101 Public Health Laboratory Service 18,130,131,140 Puerperal Pyrexia 16,17 189 Page Rateable Value 10 Receivership 91 Recuperative Holidays 50 Refuse Collection and Disposal 99 Registration - Homes for the Elderly 75 Relaxation Classes 24 Residential Homes 69-74 Residential Hostels 59,65 Riding Establishments Act 152 Ringworm 161 Rivers and Streams 99 Rodent Control 117-119 Safety 152 Samples -Bacteriological, Chemical 97,98,99,130, 131,140-151 Scabies 161 Scarlet Fever 16,17,167 School Children 155-183 School Dental Service 179-183 School Health Service 155-183 Sewerage and Drainage 99 Shops Act 104 Small Pox 167 Smoke Control 109-116 Social Clubs 61,90-91 Sonne Dysentery 16,17,167 Special Care Unit 62 Speech Therapy 64,162-163 Staff 7 Stillbirths 10,11 Suicide 14 Swimming Baths 97-99 Training Centre 62-64 Tuberculosis 16,17,46-49,169 Typhoid Fever 16,17 190 Page Unfit Houses 120 Unmarried Expectant Mothers, Care of 29 Unsound Food 135,150 Vaccination 43-46,47,167-169 Venereal Diseases 12,18 Verminous Conditions 117-119,166 Vision Testing 158-160,163-164 Vital Statistics 10-14 Voluntary Homes 73-75 Voluntary Organisations 64,72,76,78,84 Voluntary Workshops 88 Water 97 Welfare - Clinics 24-25 Foods 25 Physically Handicapped 78-91 Services 69-92 Whooping Cough 16,17,167 Workshops 63,82,88 X-rays, Mass 49 Yellow Fever Vaccination 45 Youth Employment 175