? AC.43371 1. Mr Muslim B.415 2.. Mr Morley Parry A.421 3. Mr Perry. A.405 THE HEALTH AND WELFARE of the ROYAL BOROUGH of KINGSTON UPON THAMES 1968 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1968 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. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for 1968. Statistics Each year during the life of the new Borough the Registrar General's estimate of population has been slightly lower and at Mid 1968 it was reported as 144,480. The normal ten year census due in 1971 will confirm, or otherwise, this trend. The vital statistics of the Borough compared favourably with the national rates. The birth rate was marginally lower than the previous year and the illegitimate birth rate at 7.5 per cent of total births was also somewhat lower. The general death rate was below the national average, but in keeping with it, slightly above 1967. Over 71 per cent of deaths were in persons aged 65 years or over, and over 47 per cent were in persons aged 75 years or over. Diseases of the heart and arteries, and cancer, are still the principal causes of death. I am pleased to report that the new Borough remains free of maternal deaths. There was a further slight increase in the number of deaths from cancer of the lung, but a point of interest and possible significance was an increase of 50 per cent in female deaths from this cause. Communicable Diseases The position regarding communicable diseases was very satisfactory. Attention is drawn in the appropriate section, page 19 to the changes in the notifiable infectious diseases. Measles vaccination was commenced in May but it remains to be seen to what extent the number vaccinated will affect the next "epidemic" year. 2 Health Education A very successful health education exhibition entitled "Let's Live" was organised jointly by the Health and Welfare and Education Departments at Hollyfield Youth Centre. Health education continued in schools and generally throughout the work of the department, and in connection with talks to various organisations. Personal Health Services (National Health Service Act. 1946) Although there are as yet no health centres in Kingston, local doctors made approaches about the possible extension of two of our clinics to provide accommodation for general practitioners. It is hoped that a start on at least one will be made in the next financial year. Plans for three purpose-built health centres, two to replace present clinics, were also under consideration. At the end of the year 4 midwives, 4 district nurses, 1 nursing auxiliary and 6 health visitors were working in attachment to or in liaison with family doctors. There was again a sharp fall in the number of mothers confined at home. The number of children cared for in private homes and nurseries by child minders continued to increase, and further training courses in child development and child care were held in conjunction with the Education Department for persons wishing to register under the Nurseries and Child-Minders Regulation Act, 1948. Section 60 of the Health Services and Public Health Act, 1968, which came into effect on 1st November 1968, strengthened local authorities' powers as regards registration and supervision of day nurseries and child minders. It is now an offence for an unregistered person to look after, in her own home for reward for a period of two hours in the day, one or more children to whom she is not related. In Ministry of Health Circular 37/68 the Minister of Health gave guidance to local health authorities on day care of children generally and amongst other things dealt with standards of accommodation and general care and supervision of children. The aims of the new legislation are to ensure a uniform standard of premises and equipment and to provide better facilities for the care of the children and additional safeguards for their health and welfare. A considerable amount of extra work will be involved. 3 Mental Health The improvements and extensions to the Kingston Training Centre and Workshops for Subnormals has reduced the congestion and allowed some reorganisation of the work being carried out, and enabled children to be admitted to the centre from the age of three years. This policy of early training is invaluable as far as the subnormal child is concerned. The training centre has received favourable comment from numerous visitors including students placed there for practical training from diploma courses. It is anticipated that building will start on a new adult workshop in the next financial year. The day centre for the mentally ill functioned well throughout the year in its rather poor temporary premises. It has proved invaluable in the rehabilitation and support necessary for patients recovering from mental illness. The number of referrals to the mental health social workers continued at the previous year's high level. Prevention of Illness, Care and After Care There was an increase in the number of families being assisted to prevent their break-up or to prevent them becoming homeless. This is an instance of when additional facilities are available, in this case more staff, more need comes to light and at an earlier stage. We have a good staff of home helps, but despite the job satisfaction which comes from the large element of welfare work undertaken by the home helps with the aged and handicapped, there is always a shortage of staff. The main reason for this is probably the demand of local light industry in the Borough for female labour, generally offering higher rates of pay. The amount of chiropody undertaken continued to increase. Almost one third more persons were treated, and the number of treatments rose by 12 per cent. 4 Welfare Section The number of beds available for the elderly has not increased and in fact Waratah was closed from the end of September for improvements. The lack of beds has put a strain on the domiciliary services of all types which help old people who remain at home. Recruitment of staff for old people's homes is very difficult and the residential care of the confused elderly continues to be a big problem in the Borough. During the year twice the number of short-term admissions of old persons to hospitals were arranged, compared with the previous year, in order to give old people and their relatives a change. The meals-on-wheels kitchen increased its output by almost 8 per cent. Building was started in June on a new home to be called the Amy Woodgate House, which, it is hoped, will be ready for occupation by the end of 1969. Domiciliary visiting both to the aged and to the handicapped showed a considerable increase. Outwork classes for the handicapped were commenced in April and proved very popular; the arrival of a second ambulance proved timely in this connection. Environmental Health The report on the environmental health services indicates the enormous variety of the work, visiting and checking that goes on to protect the health of the inhabitants of the Borough. It is particularly pleasing to learn that by the end of the year all the premises known for registration under the Offices, Shops and Railway Premises Act, 1963 had been inspected and registered. The number of such premises was 1,647 at the end of the year. It will be noted that houseboats are quite a problem in the Borough as compared with the minor one of caravans. School Health Services The report again reflects the generally satisfactory state of health of the school population. Increasing emphasis is being put on the ascertainment of handicaps in school children. 5 During the year an additional audiometry test was introduced for children in their first year in secondary school. Towards the end of the year a new Keystone Vision Screener came into operation; this will be of particular value in schools where inspection facilities are poor. Selective medical examinations were carried out fully in the 8 year-old group in the three schools in which it was tried out last year, and were extended to the remaining schools with 8 year-old pupils on a trial basis. The selective examination will be applied in 1969 to all 8 year-olds. This method of examination is designed to give more time to children most likely to be in need. Measles vaccination was introduced in May and 1,259 children of school age were vaccinated. It will be seen from the report on the audiology service that it is hoped to start a partially hearing nursery unit in the coming year in conjunction with the London Borough of Merton. The unit will be attached to a normal primary school in Merton. This should prove to be a valuable step forward in the provision of help for these children. Grateful thanks are tendered to the following for their co-operation and assistance in what must always be a combined effort to give the residents of the Borough the best possible services: Family doctors and hospital staff. The staff of the Executive Council. Members of voluntary organisations and other volunteers. Chief Officers, Heads of Departments and their staffs. Head Teachers and their staffs. I should also like to thank the members of my own staff for their efforts during the year, particularly those in sections handicapped by staff shortages. 6 Finally I should like to thank the members of the Council and in particular of the Health and Welfare and Education Committees and their Chairmen and Vice Chairmen for their support throughout the year. JOHN C. BIRCHALL Medical Officer of Health and Principal School Medical Officer 7 ROYAL BOROUGH OF KINGSTON UPON THAMES HEALTH AND WELFARE COMMITTEE AS AT DECEMBER 1968 Mayor: Alderman K.Bidmead, B.A., J.P. Chairman: Councillor H.W.Payne, M.S.L.A.E.T.(Hon.), A.F.R.Ae.S. Vice-Chairman: Alderman A.C.Healey, M.Sc., Ph.D., F.R.I.C. Aldermen: J.H.Cocks, O.B.E. J.Harrison, C.Eng. Councillors: C.W.H.Adams, A.M.I.R.S.E. Mrs.J.L.Ahern, R.S.C.N. B.G.Baker F.G.Belcham Mrs.D.T.Butler R.M.Church R.H.Gibbs J. P. Greenwood 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.Beareroft, 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 C.J.Rowland, M.B., B.S., M.R.C.S., L.R.C.P., D.R.C.O.G. F.A.Speller Miss N.K.Watts G.L.Haylock W.E.Messenger, M.Inst.T. Mrs. A.I.Pamment F. J.Steptoe J.A.G.Stonehouse, M.A.(Oxon) Barrister-at-Law Mrs. R.M.Vernon Miss V.A.Whittaker 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 Kingston upon Thames Association for the Handicapped South West London and Surrey Executive Council 8 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. (Resigned 12.2.68.) A.H.Fairlamb, M.B.,B.S.,C.P.H.,D.P.H. (Appointed 29,7.68.) 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. (Resigned 15.11.68.) D.M.Dodd, L.D.S.,B.D.S. (Appointed 6.1.69) P.E.Kinton, M.R.S.H.,M.A.P.H.I. F.J.Meacock Beryl G.Anscombe, M.B.,Ch.B., D.(0bst.) R.C.O.G.,D.P.M. Mary L.Goodyear, M.B.,Ch.B. (Resigned 7.1.68.) Mrs.K.L.Sewell, S.R.N.,H.V.Certificate Soc.Sc.Dip.,T.T.D.,N.N.E.B. (Appointed 17.4.68.) Mrs.C.M.Owen, S.R.N.,H.V.Certificate Miss P.M.Stanley, S.R.N.,S.C.M., Queen's Nurse, H.V.Certificate E.V.Oram, A.A.P.S.w.,S.R.N.,R.M.D.N. Miss M.F.Birley, B.A.,A.I.M.S.W. Miss J.M.Hodgetts, C.S.W. Mrs.I.E.Roobottom H.A.Sears, D.M.A. 9 CONTENTS VITAL STATISTICS AND GENERAL SERVICES 12 PERSONAL HEALTH SERVICES 28 MENTAL HEALTH SERVICES 60 WELFARE SERVICES 69 ENVIRONMENTAL HEALTH SERVICES 99 SCHOOL HEALTH SERVICE 151 VITAL STATISTICS AND GENERAL SERVICES 12 VITAL STATISTICS Area: 9,281 acres. Population, estimate of Registrar General at mid-year 1968: 144,480 Rateable Value at 1st April 1968: £10,181,887 Produce of a Penny Rate at 1st April 1968: £40,800 Separately Rated Dwellings at 1st April 1968: 48,218 Live Births: Males Females Total Percentage Legitimate 999 952 1,951 92.5 Illegitimate 77 82 159 7.5 Totals 1,076 1,034 2,110 100.0 Crude Birth Rate per 1,000 estimated population 14.6 Adjusted Birth Rate for purposes of comparison using the comparability factor 1.01 14.7 (England and Wales) 16.9 Still Births; (15 males and 15 females) 30 Rate per 1,000 live and still births 14.0 (England and Wales) 14.0 Total Births 2,140 Deaths: Total (791 males and 898 females) 1,689 Crude death rate per 1,000 population 11.7 Adjusted death rate for purposes of comparison using the comparability factor 0.92 10.8 (England and Wales) 11.9 Maternal deaths Nil Maternal Mortality rate (including abortion) per 1,000 total live and still births Nil (England and Wales) 0.24 Infant Mortality: Infant deaths (infants under one year): Males Females Total Legitimate 14 13 27 Illegitimate 4 2 6 Totals . 18 15 33 (contd.) 13 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 16.0 (England and Wales) 18.0 Mortality rate of legitimate infants per 1,000 legitimate live births 13.8 Mortality rate of illegitimate infants per 1,000 illegitimate live births 37.7 Mortality rate of male infants per 1,000 male live births 16.7 Mortality rate of female infants per 1,000 female live births 14.4 Neonatal deaths (under 4 weeks of age) (10 males and 9 females) 19 Neonatal mortality rate per 1,000 live births 9.0 (England and Wales) 12.3 Early neonatal deaths (under 1 week of age) (10 males and 7 females) 17 Early neonatal mortality rate per 1,000 live births 8.1 (England and Wales) 10.5 Perinatal mortality (still births plus deaths under 1 week) 47 Perinatal mortality rate per 1,000 total live and still births 22.0 (England and Wales) 25.0 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Acute Influenza - 1 - 1 Cardiac Failure (Anomalous pulmonary venous drainage) - - 1 1 Congenital Heart Disease (Atrial Septal Defect) 1 - - 1 Hydrocephalus and Spina Bifida 1 - - 1 Intra-cranial Haemorrhage (Premature) - 1 - 1 Multiple Congenital Deformities 1 - - 1 Neonatal Asphyxia 2 - - 2 Prematurity 2 3 - 5 " (Hyaline Membrane Disease) - 1 - 1 " (Jaundice) - 1 - 1 " (Respiratory Distress Syndrome) - 3 - 3 Respiratory Failure - - 1 1 Totals 7 10 2 19 (continued) CAUSES OF 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 Cholera M - - - - - - - - - - - - F - - - - - - - - - - - - Typhoid Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Bacillary Dysenteiy and Araoebiasis M - - - - - - - - - - - - F - - - - - - - - - - - - Enteritis and other Diarrhoeal Diseases M 2 - 2 - - - - - - - - - F 1 - - - - - - - - - - 1 Tuberculosis of Respiratory System M 1 - - - - - - - - 1 - - F 1 - - - - - - - - 1 - - Other Tuberculosis, incl. late effects M 1 - 1 - - - - - - - - - F - - - - - - - - - - - - Plague M - - - -... - - - - - - - - F - - - - - - - - - - - - Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - Streptococcal Sore Throat & Scarlet Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Meningococcal Infection M - - - - - - - - - - - - F 1 - - 1 - - - - - - - - Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - Smallpox M - - - - - - - - - - - - F - - - - - - - - - - - - Measles M - - - - - - - - - - - - F - - - - - - - - - - - - Typhus and other Rickettsioses M - - - - - - - - - - - - F - - - - - - - - - - - - 14 CAUSES OP 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 Malaria M - - - - - - - - - - - - F - - - - - - - - - - - - Syphilis and its Sequelae M - - - - - - - - - - - - F 3 - - - - - - 1 - - 1 1 Other Infective and Parasitic Diseases M 1 - - - - - - - - 1 - - F 1 - - - - - - - - - 1 - Malignant Neoplasm Stomach M 10 - - - - - - - - 2 4 4 F 19 - - - - - - - 1 3 7 8 Malignant Neoplasm Lung, Bronchus M 80 - - - - - - 2 3 35 23 17 F 27 - - - - - - - 4 6 10 7 Malignant Neoplasm Breast M 1 - - - - - - - - - 1 - F 49 - - - - - - 5 8 8 17 11 Malignant Neoplasm Uterus F 7 - - - - - - - 1 2 3 1 Leukaemia M 5 - - - - - - 1 1 2 1 - F 4 - - - - 2 - - - - 1 1 Other Malignant Neoplasms, etc. M 78 - - - - 1 1 1 8 17 26 24 F 109 1 - 1 - - - 3 9 31 30 34 TOTAL all forms of Cancer 389 1 - 1 - 3 1 12 35 106 123 107 Benign and Unspecified Neoplasms M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - Diabetes Mellitus M 4 - - - - - - - - - 2 2 F 8 - - - - - - 2 - 2 - 4 Avitaminoses and other Nutritional deficiencies M - - - - - - - - - - - - F - - - - - - - - - - - - (continued.) 15 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 Other Endoorine, Nutritional and Metabolic Diseases M 2 - - - - - - - 1 - 1 - F 4 - - - - - - 1 - 1 - 2 Anaemias M 2 - - - - - - - - - 1 1 F 2 - - - - - 1 - - - 1 Other Diseases of Blood and Bloodforming Organs M - - - - - - - - - - - - F 1 - - - - - - - - - 1 Mental Disorders M 1 - - - - - - 1 - - - - F - - - - - - - - - - - - Meningitis M - - - - - - - - - - - - F - - - - - - - - - - - - Other Diseases of Nervous System etc. M 8 - - - - - - 1 1 - 3 3 F 5 - 1 - - - - - - 1 1 2 Active Rheumatic Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Chronic Rheumatic M 9 - - - - - - 1 1 3 1 3 Heart Disease F 12 - - - - - - - 1 3 4 4 Hypertensive Disease M 24 - - - - - - 1 1 5 6 11 F 24 - - - - - - - 1 1 4 18 Ischaemic Heart Disease M 225 - - - - - - 7 19 58 64 77 F 160 - - - - - - 1 2 14 47 96 Other Forms of Heart Disease M 29 - - - - - - - 1 5 3 20 F 53 - - - - - - - 1 - 2 50 Cerebrovascular Disease M 73 - - - - - - - 6 13 21 33 F 141 - - - - - - 2 6 12 24 97 Other Diseases of Circulatory System M 33 - - - - - - - 2 8 7 16 F 51 - - - - - - - 2 3 5 41 TOTAL Heart and Circulatory Diseases 834 - - - - - - 12 43 125 188 466 ( continued.) 16 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 Influenza M 6 1 - - - - - - - 1 1 3 F 14 - - - - - - - - - 3 11 Pneumonia M 39 - 3 - - 1 - - - 3 10 22 F 79 - 1 - - - - - 2 1 9 66 Bronchitis and Emphysema M 67 - - - - - - 1 - 10 28 28 F 27 - - - - - - - 1 2 9 15 Asthma M 2 - - - 1 - - - - 1 - - F 6 - - - - - - 1 1 2 - 2 Other Diseases of Respiratory System M 7 - - 2 - - - - 1 1 1 2 F 6 - - - - - - 1 - - 2 3 Peptic Ulcer M 2 - - - - - - - - - - 2 F 3 - - - - - - - - 1 - 2 Appendicitis M - - - - - - - - - - - - F - - - - - - - - - - - - Intestinal Obstruction and Hernia i M 1 - - - - - - - - - - 1 F 7 - - - - - - - - 1 1 5 Cirrhosis of Liver M 3 - - - - - - - - 3 - - F 2 - - - - - - - - 1 1 - Other Diseases of M 5 - - - - - - - 1 1 1 2 Digestive System F 14 - - - - - - - 1 1 3 9 Nephritis and Nephrosis M 2 - - - - - - - - 1 1 - F 2 - - - - - - - - 2 - - Hyperplasia, of Prostate M 7 - - - - - - - - 1 - 6 Other Diseases of Genito- Urinary System M 5 - - - - - - - - - 2 3 F 5 - - - - - - - - - 3 2 Abortion F - - - - - - - - - - - - Other Complications of Pregnancy, Childbirth and Puerperium F - - - - - - - - - - - - (continued) 17 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 Diseases of the Skin and Subcutaneous M - - - - - - - - - - - - Tissue F - - - - - - - - - - - - Diseases of M 1 - - - - - - - - 1 - - skeletal System F 4 - - - - - - - 2 1 1 - Congenital Anomalies M 9 2 2 - - - - - - 3 2 - F 9 2 3 3 - - - 1 - - - - Birth Injury, Difficult Labour etc. M 2 2 - - - - - - - - - - F 4 4 - - - - - - - - - - Other Causes of Perinatal Mortality M 4 4 - - - - - - - - - - F 2 2 - - - - - - - - - - Symptoms and Illdefined Conditions M 1 - - - - - - - - - - 1 F 6 - - - - - - - - - - 6 Motor Vehicle Accidents M 10 - - - 1 3 2 - 1 2 1 - F 8 - - - - 2 - - - 2 2 2 All Other Accidents M 15 - - - 1 3 2 - 1 3 - 5 F 14 - 1 - - 1 - 2 - 3 - 6 Suicide and Selfinflicted Injuries M 10 - - - - - 2 2 4 1 - 1 F 3 - - - - - - - - 2 - 1 All Other External Causes M 3 1 - - - - - - 1 1 - - F - - - - - - - - - - - - TOTAL Accidents, Suicide and Violence 63 1 1 - 2 9 6 4 7 14 4 15 TOTAL ALL CAUSES M 791 10 8 2 3 8 7 18 54 183 211 287 F 898 9 6 5 - 5 - 21 43 107 192 510 18 19 ANALYSIS OF MARRIAGES 1968 1,206 marriages were registered in the borough during 1968. Of these, 468 were Church of England marriages and 738 took place either in other Churches or in Register Offices. The following table shows an analysis by age groups of the 738 marriages conducted via the Register Offices within the borough during 1968. No such analysis of the 468 Church of England marriages is available. Age of Parties Marriages in Register Offices Marriages in Non-Conformist Churches Where Registrar Attends Marriages in Churches Where Minister Registers Own Ceremony M F M F M F Under 21 68 131 12 40 9 25 21 - 30 244 239 86 63 96 90 31 -40 85 56 5 2 17 4 41 - 50 43 29 2 - 1 4 Over 50 62 47 2 2 6 6 Totals 502 502 107 107 129 129 INFECTIOUS DISEASES Changes in the notification of infectious diseases were made during the year. Certain diseases were notifiable by medical practitioners to the medical officer of health under Section 144 of the Public Health Act, 1936 and Regulations made thereunder. On the 15th June 1968 Infective Jaundice was made notifiable under the Public Health (infective Jaundice) Regulations 1968. From the 1st October 1968 other changes were made in the notification of infectious diseases by the Health Services and Public Health Act, 1968 Section 47-49, and by the Public Health (infectious Diseases) Regulations 1968. 20 Consequently, the infectious diseases to be notified to the medical officer of health are now: Acute Encephalitis Acute Meningitis Acute Poliomyelitis Anthrax Cholera Diphtheria Dysentery (Amoebic or Bacillary) Food Poisoning (or Suspected Food Poisoning) Infective Jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia Neonatorum Paratyphoid Fever Plague Relapsing Fever Scarlet Fever Smallpox Tetanus Tuberculosis Typhoid Fever Typhus Whooping Cough Yellow Fever The following diseases are no longer notifiable: Acute Influenzal Pneumonia Acute Primary Pneumonia Acute Rheumatism Erysipelas Membranous Croup Puerperal Fyrexia Under the same Act the notification fee payable to medical practitioners was increased to 5s.Od from 1st October 1968. The following table shews the numbers of cases notified during 1968 by age groups:- Disease Under 5 5-14 15-44 45-64 65 and over Age unknown Total Scarlet Fever 8 12 - - - - 20 Whooping Cough 12 7 1 - - - 20 Measles 190 97 6 - - - 293 Dysentery 12 11 4 - - - 27 Acute Pneumonia - 1 1 - 1 - 3 Infective Jaundice - - 4 1 - - 5 Erysipelas - - - 1 - - 1 Puerperal Pyrexia - - 27 - - - 27 Tuberculosis, Respiratory 1 - 16 12 6 - 35 Tuberculosis, other - - 2 2 - - 4 Totals 223 128 61 16 7 - 435 21 Sonne Dysentery 27 cases occurred during the year, 20 of these and 8 carriers being in an outbreak involving a number of schools in the borough. The other 7 cases were isolated incidents. Food Poisoning It is pleasing to report that no case of food poisoning occurred during the year. However, there is a continuing need for constant vigilance in the hygienic handling and preparation of food. Tuberculosis There were 35 cases of pulmonary tuberculosis and 4 cases of tuberculosis of other organs (endometrium, kidneys, spine and kidney and glands of neck). There were 2 deaths from respiratory tuberculosis both over the age of fifty-five and 1 death under the age of one year from tuberculosis of other organs. Comparative Table of Notified Infectious Diseases 1962-1968 Disease 1962 1963 1964 1965 1966 1967 1968 Acute Pneumonia 17 27 13 17 52 9 3 Scarlet Fever 28 31 19 29 42 33 20 Measles 410 1482 235 1971 736 1899 293 Whooping Cough 21 42 49 20 16 34 20 Puerperal Pyrexia 38 37 18 41 43 58 27 Poliomyelitis - - - - - - Acute Infective Encephalitis: Post-Infective - - - - - 1 - Infective 1 - 1 - - - - Erysipelas 5 1 5 4 2 3 1 Diphtheria - - - - - - - Ophthalmia Neonatorum - - - - - - - Typhoid and Paratyphoid Fevers - 3 2 4 1 1 - Infective Jaundice - - - - - - 5 Food Poisoning 7 37 6 4 - 4 - Dysentery 94 96 10 54 146 72 27 Meningococcal Infection 2 2 - - - - - Tuberculosis, Respiratory 68 66 64 32 27 46 35 Tuberculosis, Other 5 9 9 2 6 1 4 22 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. 61 - - 9 52 Seamen's Hospital, Greenwich. 1 - - - 1 St. Helier Hospital, Carshalton. 45 1 - 6 38 Totals 107 1 - 15 91 23 GENERAL SERVICES HEALTH EDUCATION Expansion in the field of health education continued throughout 1968. Mrs. K.L. Sewell was appointed health education officer on 17th April to replace Dr. Mary L. Goodyear who had resigned on 7th January. In addition to the health education officer and her assistant, many field workers carry out health education during the normal course of their work in the community. There is now a good supply of audio-visual material available. Throughout the year there has been a succession of poster displays at clinics and on public notice boards, and 1,314 talks and discussions were held at clinics, clubs, schools and various premises of voluntary organisations. The themes of these displays were changed each month as follow: January - Care of the Elderly February - Infectious Diseases March - Cancer April - Diet - Bias on Obesity May - Dental Health June - First Aid July - Holiday Safety and Litter August - Mental Health Service September - Immunisation October - Fireworks November - Toys December - Safety at Christmas The subjects of the talks and discussions were: Local Health and Welfare Services Home Safety Smoking and Health Preparation for Retirement The Use of Leisure Food Hygiene and the Control of Food Inspection Nutrition Hygiene in the Home Preparation for Foreign Travel Health in the Affluent Society First Aid and Home Nursing Preparation for Marriage Preparation for Parenthood The Care of our Children Health and its Protection Care of the Elderly Health in Adolescence Social Hazards Relative to Health 24 Six weekly lectures for the lay public, well publicised, were held in conjunction with the staff of Kingston and Long Grove Hospitals on evenings during April and May, at the Kingston Medical Centre. The subjects were: Heart Attacks What is Cancer Resuscitation Psychiatry and the Law Prepare for your Holiday How to use the Health Service by a Consultant Physician by a Consultant Pathologist by a Consultant Surgeon by a Consultant Psychiatrist by the Health Education Officer, Royal Borough of Kingston upon Thames by a General Practitioner A special poster campaign was held in October to publicise treatment facilities for venereal diseases. During the week commencing 11th November a very successful exhibition was staged at the Hollyfield Youth Centre, entitled "Let's Live". This was organised jointly by officers of the health and welfare and education departments and more than two thousand people attended. There were thirty-two stands, including some provided by various organisations such as the Metropolitan Police, London Fire Brigade, London Ambulance Service, Kingston Hospital and the Family Planning Association. 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 two cases during the year in which action was taken under the National Assistance (Amendment) Act 1951. In February an old lady of 95 was removed to hospital as a matter of urgency and in November a lady of 75 was similarly removed to hospital. This person was suffering from osteo-arthritis and had also become mentally confused. 25 ABORTION ACT, 1967 This Act, which came into force on 27th April 1968, legalises the termination of pregnancy by a registered medical practitioner if two such practitioners are of the opinion that the continuation of the pregnancy would involve risk to the life of the pregnant woman, or of injury to her physical or mental health or that of any existing children of her family, greater than if pregnancy were terminated, or if there is a substantial risk that if the child were born it would suffer from such physical or mental abnormality as to be seriously handicapped. Subsection 3 of Section 1 of the Act provides that, except in the case of urgent termination of pregnancy to save the life of or prevent gross permanent injury to the physical or mental health of the pregnant woman, termination of pregnancy must be carried out either in a National Health Service hospital or in a place approved for the purpose by the Minister or Secretary of State for Health. 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 1968 but two were given authority for an increase in the number of patients. At the end of the year there were three registered nursing homes in the borough and these provided a total of 70 beds for chronic sick and medical patients. None provided any maternity bed3, but one of the registered homes may receive up to three persons for treatment for the termination of pregnancy, in accordance with Section 1(3) of the Abortion Act, 1967. 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 two agencies were licensed to supply nurses to private cases at home, hospitals and nursing homes, and one agency's licence was withdrawn on request. CREMATIONS The medical officer of health, deputy medical officer of health and a senior medical officer are recognised by the Home Office and act as medical referees to the borough crematorium in Kingston. During the year there were 1,447 cremations. None was rejected and none was referred to the Coroner, although queries were raised on various points in several cases. 26 MORTUARY SERVICES These have been arranged jointly with Kingston Hospital. ADULT MEDICAL EXAMINATIONS 293 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 355 were accepted on completion of a medical history form, without actual examination. 155 newly appointed teachers and candidates for admission to teachers training colleges were medically examined as required by the Department of Education and Science. 259 teachers were considered fit upon completion of a medical history form, of whom two required medical examination, having regard to the details entered on the form. 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, Oral Surgery. Infectious Diseases, Chest Diseases, Geriatric. Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Genito-Urinary, Gynaecology, Pathology, Psychiatric. PERSONAL HEALTH SERVICES NATIONAL HEALTH SERVICE ACT, 1946. 28 PERSONAL HEALTH SERVICES (NATIONAL HEALTH SERVICE ACT, 1946) HEALTH CENTRES Section 21 of the National Health Service Act, 1946 requires local health authorities to provide, equip and maintain health centres. There are no health centres in the borough at present but groups of general practitioners have made approaches regarding the extension of two existing clinics to provide accommodation for them. Discussions are proceeding and it is hoped a start may be made in the next financial year. Owing to the expansion of Bedelsford School, Grange Road Clinic will have to be relocated to make room as it is situated in the same grounds. A site has been earmarked in Hawks Road and enquiries were still being pursued at the end of the year about possible family doctor interest, to build a health centre. Similar enquiries were also being made in respect of a replacement for South Place Clinic. A good deal of interest has been shown by family doctors in the possibility of a health centre in Blagdon Road, New Maiden. CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and Post-natal Clinics There are six Council owned clinics at which ante and postnatal sessions are held. These are attended by medical officers and health visitors, and most of them by midwives. The following table gives the details, but in addition midwives held -344 sessions at these clinics and at the Surbiton and Maiden District Nurses Homes, at which 432 women made 1,257 attendances. 3,763 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed. There were, in addition, 176 sessions held by general practitioners to whose practices borough midwives are attached. There were 2,015 attendances at these sessions. 29 Address of Clinic Number of sessions held during the year Number of women who attended Total Attendances Ante-Natal Post-Natal Grange Road, Kingston. 52 101 53 513 Acre Road, Kingston. 51 104 44 622 Roselands, New Maiden.) 51 90 42 595 Kingston Vale. ) - - - - Manor Drive, Worcester Park. 26 26 13 157 South Place, Surbiton. 50 90 49 652 Hamilton Avenue, Tolworth. - - - - Gosbury Hill, Hook. 51 53 38 404 St.Mary's Church Hall, Chessington. - - - - Totals 281 464 239 2943 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, Chessington. 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 on previous page, except South Place, Surbiton and Hamilton Avenue, Tolworth. 30 They are also sold at the Women1s 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. Kingston W.R.V.S. Mon. Tues. ) .10.45-4 p.m. 23a Fife Road Thurs. Frid. ) " 10.45-12.45 p.m. Wednesday 10.45 - 12.45 p.m. New Maiden W.R.V.S. Mon. Tues. ) 10. 0 - 12.30 p.m. Blagdon Road Thurs. Frid. ) 2. 0 - 4.3,0 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 attend- Grange Road, Kingston 124 913 6430 Acre Road, Kingston 128 1000 4162 Kingston Vale 23 99 373 Roselands, New Maiden 156 1296 5223 Manor Drive, Worcester Park 126 1068 4224 South Place, Surbiton 155 1315 5584 Hamilton Avenue, Tolworth 101 820 4819 Gosbury Hill, Hook 153 905 4861 St.Mary's Church Hall, Chessington 51 278 1546 Totals 1017 7694 37222 DENTAL SERVICE FOR EXPECTANT AND NURSIN& MOTHERS AND Y0UN& 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. 32 Mothers Dental Care and Treatment at Clinics Treatment Provided Grange Road Acre Road Roselands Manor Drive South Place Gosbuiy Hill TOTALS Treatment sessions 9 14 3 5 6 17 54 Examined 14 35 13 16 10 19 107 Treated 15 26 13 8 11 17 90 Completed courses of treatment 8 30 5 17 16 4 80 Scaling and gum treatment 22 27 9 13 10 8 89 Fillings 26 87 5 10 58 41 227 Silver nitrate treatment - - - - - - - Crowns - 1 - - 1 3 5 Inlays - - - - - 2 2 Extractions 15 12 1 - 4 1 33 General anaesthetics - - 1 - 1 - 2 Dentures provided Full - - 2 - - - 2 Partial 2 - 2 - - 4 Radiographs - 11 4 - - 5 20 33 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 26 43 19 21 22 29 160 Examined 242 269 85 92 36 99 823 Treated 49 144 81 40 45 96 455 Completed courses of treatment 48 135 93 62 28 41 407 Scaling and gum treatment 13 27 13 7 7 109 176 Fillings 145 413 103 108 50 139 958 Silver nitrate treatment - 51 56 147 17 18 289 Crowns - 1 - - 6 4 11 Inlays - - - - - - - Extractions 6 43 39 - 4 11 103 General anaesthetics - - 23 - 2 2 27 Dentures provided Full - - - - - - - Partial - - - - - - - Radiographs - 4 - 2 - 5 11 34 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. Many students in the field of education, social work, child care and health visiting as well as student nurses and senior school children, have visited the nurseries to observe child development and the day care of children. 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 31.12.68. Average daily attendance during the year Number on waiting list at 31.12.68. Under 2 Age 2-5 Under 2 Age 2-5 Fairmead, Tolworth. 42 10 36 7 30 35 Canbury Park, Kingston. 46. 11 38 8 31 43 Totals 88 21 74 15 61 78 35 Nurseries and Child-Minders Regulation Act 1948 The Health Services and Public Health Act 1968 was passed during the year and Section 60, which amends the Nurseries and ChildMinders Regulation Act 1948, came into operation on 1st November 1968. The purpose of this section was to strengthen local health authorities' powers and to increase maximum penalties for failure to register. Whereas previously it was necessary to register only if more than two children under 5 were received for reward for a substantial part of the day, it is now necessary to register even if only one child is received for an aggregate of two hours during the day. The maximum fine for failure to register or for breach of any requirements of the local authority is now £50 for the first offence, and for a second or subsequent offence a person is liable to three months' imprisonment or a fine of £100 or both. Section 60 also lays down improved standards of premises, equipment, and qualifications or experience of the persons caring for the children which should be met by persons applying for registration. Registrations increased during the year and at the end of the year there were 38 registered day nurseries providing 860 places, and 49 daily minders providing 293 places. All people registered are supervised and reported upon each month by a health visitor. Training courses for people responsible for the care of children are provided in collaboration with the education department, and these are very well attended. CHILDREN'S HOMES The Children's Committee has five homes in the borough and one 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. 36 HOMES FOR MOTHERS AND BABIES There are no homes for mothers and babies in the borough. During 1968 the Council accepted financial responsibility for 22 unmarried 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. RECUPERATIVE HOLIDAYS FOR MOTHERS AND Y0UNG CHILDREN Holidays were arranged for 10 mothers whose home conditions were poor. They were accompanied by a total of 15 young children. Of these only 4 families stayed for the full period. One family returned home for domestic reasons and 5 families returned home because conditions in the holiday home were reported to be unsatisfactory. The home concerned has since closed. 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 1968 was 3,437. Of the 2,110 children born alive in the borough during 1968, 842 were added to the "at risk" register, a percentage of 39.9. 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 1968 was 1,006. The register is used to indicate children in the 0-5 age group who are likely to require special educational facilities. This 37 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 65 babies were notified at birth as congenitally malformed. Of these, 4. were stillborn and 8 subsequently died, 6 of the deaths being a direct result of the abnormality notified; the malformation being a contributory cause of the other 2. 53 babies had survived at the end of 1968. Details according to the Registrar General's classification are overleaf. 38 CONGENITAL MALFORMATIONS Total Malformations Reported Central Nervous System Eye Ear Alimentary System Heart and Great Vessels 80 (65 children) 13 (9 children) 3 (3 children) 12 (12 children) 10 (9 children) 4 Stillborn 1 Anencephalus and Spina Bifida 1 Bupthalmos 2 Cleft Lip 4 Congenital Heart Disease n.o.s.* 8 Died 2 Hydrocephalus 2 Other Defects of Ear 2 Cleft Palate 1 Interatrial Septal Defect 53 Survived 3 Hydrocephalus and Spina Bifida 1 Intestinal Atresia 1 Interatrial Septal Defect and Persistent Ductus Arteriosus 2 Spina Bifida 7 Other Defects of Alimentary System 1 Persistent Ductus Arteriosus 1 Other Defect of Spinal Cord 1 Tetralogy of Fallot 1 Other Defect of Heart and Great Vessels * n.o.s. = not otherwise specified 39 CONGENITAL MALFORMATIONS Respiratory System Urogenital System Limbs Other Skeletal Other Systems Other Malformations Nil 11 (11 children) 22 (20 children) 1 (1 child) 7 (7 children) 1 (1 child) 9 Hypospadias 5 Dislocation of Hip 1 Defect of Skull and Face 1 Exomphalos 1 Mongolism 1 Indeterminate Sex 1 Reduction Deformity 2 Naevus of Face 1 Other Defect of Genitalia 2 Syndactyly of Toes 1 Naevus of Abdomen 1 Syndactyly of Toes and Dislocation of Hip 1 Vascular Defects of Skin 10 Talipes 1 Other Defects of Skin 1 Defects of Upper Arm and Hand 1 Webbed Toes 40 MIDWIFERY SERVICE Mothers confined at home were cared for by 8 full-time midwives, 2 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 316 babies born to Kingston residents, and cared for a further 441 mothers who were discharged from hospitals within ten days after confinement. They summoned medical aid in 49 cases. During the year 1,784 births to Kingston residents took place in institutions, so that the domiciliary midwives dealt with 15.0 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 10 midwives who had been so approved in the borough's service and during the year 24 pupil midwives received their three months* training. A new scheme for Part II midwifery training of student midwives in conjunction with Kingston Hospital was commenced in March. Because of the increased number of hospital beds in the locality and also the falling birth rate it has become more difficult for each student midwife to have ten domiciliary deliveries as stipulated by the Central Midwives Board. Arrangements are in process for a new scheme of training to be carried out. The student midwife will have six domiciliary cases with four deliveries in hospital which she must nurse at home. She will also have a programme of visits to attend various clinics and centres which are linked with the local authority services. Various lectures on this aspect of the work will be given to the student. This scheme must be approved by the Central Midwives Board. The non-medical supervisor of midwives or her deputy attends Kingston Hospital to talk to the students before they come to work on the district. It has also been arranged that the deputy supervisor or a senior midwife attend weekly at the ante-natal booking session at Kingston Hospital. All patients who are having a planned early discharge are seen by her and a closer integration is therefore being established within the midwifery service. 41 Group Attachment to General Practitioners This scheme is now well established in three practices and one new attachment appears to be working well. The patients and staff, both general practitioners and midwives, find this to be a better arrangement, and visits are not duplicated. Greater co-operation is maintained. Notification of Infectious Diseases Act Puerperal pyrexia is no longer notifiable under this Act. Midwives are still required to notify the local supervising authority under the rules of the Central Midwives Board. HOME NURSING At the end of December 1968, 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, 23 full-time and 11 part-time home nurses, 2 full-time persons who shared their time between the home nursing and midwifery services, and 2 full-time and 5 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 2,216 persons were nursed during 1968, involving a total of 93,136 visits. These numbers show increases of 32 and 8,296 respectively over the corresponding figures for 1967. More cases are being referred by general practitioners, especially those practices to which district nurses have been attached. Disposable Equipment Much of the equipment now being used by the staff is disposable, e.g. syringes, catheters, bags and towels. This is proving more efficient than the previous method of sterilisation by boiling. 42 Marie Curie Night Nursing Service This service has expanded during the year, particularly the last quarter - October to December, due to the increase in the number of terminal cases being nursed at home who require skilled night nursing or nursing auxiliaries. Payment for this is reimbursed by the Marie Curie Memorial Foundation. This is a voluntary organisation which has a special interest in the welfare of the cancer patient. 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 service 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 In 1968 five students were trained for the National Certificate in District Nursing. The examination for the Queen's Roll, which was organised by the Queen's Institute of District Nursing, has now ceased. All students take their practical experience in the Surbiton Nurses Home and their theoretical training at Ewell Technical College by arrangement with Surrey County Council. The superintendent of home nursing has been approved as an examiner by the panel of assessors at the Department of Health and Social Security. Four student nurses from Hammersmith Hospital (University of Surrey) Integrated Training Scheme have taken the first part of their practical training at Surbiton Nurses Home. They will return to complete their district nursing training at the end of their third year in Hammersmith Hospital. 43 HOME NURSING VISITS 1968 - 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 137 5608 21 734 - - 2 Circulatory Diseases 222 13249 56 2767 - - 3 Blood Diseases 189 4687 67 958 2 8 4 Diseases of Central Nervous System 51 3579 86 5209 - - 5 Influenza 6 396 - - - • 6 Diabetes 50 4947 18 1619 - - 7 Burns and Scalds 12 651 4 139 2 35 8 Accidents and Injuries 80 3385 29 1337 - - 9 Rheumatic and Arthritic Conditions 121 8406 58 2619 — — 10 Varicose Ulcers 117 7831 31 1282 - - 11 Abdominal Conditions 252 3790 255 2139 5 13 12 Gynaecological 48 1331 20 527 - - 13 Genito-Urinary 32 922 23 426 8 48 14 Skin Conditions 47 1656 24 420 - - 15 Orthopaedic 30 712 22 539 - - 16 Breast Conditions 32 1180 17 365 - - 17 Ophthalmic Conditions 18 996 12 350 1 6 18 Miscarriages - - 10 94 - 0 19 Tuberculosis - - 10 197 - - 20 Notifiable Infectious Diseases . — 2 13 . - 21 Ear, Nose and Throat Conditions 10 225 38 434 1 8 22 Midwifery Home Confinement - - - - - - 23 Midwifery Early Hospital Discharges - - 3 33 - - 24 Old Age and Dfebility 223 10307 4 327 - - 25 Physically Handicapped 4 471 4 88 - - 26 Psychiatric Conditions 19 1003 13 320 - - 27 Chest and Lung Conditions 184 5984 71 1762 5 51 28 Endocrine Disorders - - 1 50 - - CANCER (already shown above) 145 4273 99 3031 - Total: Persons Visits 1470 70597 721 22370 25 169 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. 44 HEALTH VISITING The health visiting establishment at the end of 1968 provided for the employment of one superintendent health visitor, one group adviser, 28 health visitors, 2 student health visitors and the equivalent of 3 clinic nurses. The actual staff were: 1 superintendent health visitor, 1 group adviser, 25 full-time health visitors, 6 part-time health visitors, 2 student health visitors and 7 part-time clinic nurses. Four of the health visitors are fieldwork instructors and are responsible for the practical training of student health visitors. Two health visitors work entirely with the elderly. One is attached to the geriatric unit of Kingston Hospital, her services being shared with the borough of Richmond upon Thames and with Surrey County Council. The second geriatric health visitor has been responsible for organising the health clinics for the elderly and for liaison with the general practitioners in the areas where these clinics have been commenced. One health visitor's time continues to be shared between health visiting and preparation of materials for health education displays. Five health visitors participate in regular health education series in schools. Six health visitors have regular liaison with general practitioners. Arrangements are made for the health visitor who carries the heaviest caseload belonging to the group practice to visit the surgery either once or twice weekly for exchange of information. This service has been provided to all general practitioners who have requested it. One health visitor is attached to the Chest Clinic at Kingston Hospital and also has a small caseload of elderly. Each health visitor continues to be responsible for the families, elderly, and schools in a prescribed geographical area and has her base at the clinic nearest to her area. The main increase in the work of the health visitors has been in the care of the elderly and the supervision of daily minders, playgroups and private day nurseries. 45 Mothercraft It has been possible during the year to start mothercraft sessions at one more clinic. This means that mothercraft teaching and education in childbirth is now available at five of our clinics. Evening Fathercraft sessions have also been available at these five clinics. Care of the Elderly Better liaison between general practitioners and health visitors, and also the necessity for health visitors to visit the elderly who are attending the health advisory clinics, have increased the health visitors assessment visits to the elderly. It was felt that many of the elderly being visited by the health visitors were often being excellently cared for by voluntary visitors from the Old People's Welfare Association or by local churches, but most were working in isolation and there was very little communication between the visitors. Many elderly were found to be visited by as many as five statutory or voluntary visitors, while other elderly were frequently missed altogether. To try and improve the channels of communication the superintendent health visitor arranged a course for both statutory and voluntary visitors of the borough. This was held at one of the clinics and consisted of eight two-hourly afternoon sessions. There were talks, discussions and films covering every aspect of the care of the elderly. As a result of this course names and addresses of people visited have been exchanged between workers and two of our clinics are now open once a month for statutory and voluntary visitors to meet and discuss cases. Once every three months a more formal meeting of all the workers has been held at four of our clinics to discuss continued liaison. At the last meeting of the year an invitation was also sent to the clergy of the area. There was an excellent response and there was a most fruitful and excellent discussion which will lead to the benefit of the elderly. 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 114 immigrants whose arrivals were notified, 71 were visited during the year; the remainder were either untraceable or were known to have moved to other areas. 46 Hospital Liaison One of our health visitors continues to participate regularly at the mothercraft sessions held at Kingston Hospital. Our group adviser continues to spend Tuesday mornings at Kingston Hospital. She has discussions with the medical social workers, the maternity unit ward sisters,and visits the expectant mothers and the new mothers from the borough. The group adviser is the link between the hospital and the health visitor, and reports all the information received to the appropriate health visitor. This has proved to be a very valuable exchange of information and the health visitors are able to arrange to give extra support to the mother who is experiencing difficulties, and the hospital are able to receive first hand information on the patients' social background and home conditions. Mothers' Clubs Two more mothers' clubs have been started during the year and they are now available at all clinics and two church halls. The mothers are extremely grateful for this service and benefit considerably from being able to air and share their problems. The programme is varied and includes discussions, usually led by the health visitor, demonstrations, speakers, films and keep fit classes. The children are cared for in another room by a clinic nurse. Types of Cases Visited by Health Visitors during 1968 Number of Cases Children born in 1968 2,346 Children born in 1967 2,486 Children born in 1963/66 7,327 Persons aged 65 or over 1,280 Mentally disordered persons 96 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 25 Tuberculous households 13 Households visited on account of other infectious diseases 1 Tuberculous households visited by tuberculosis visitor 186 Expectant mothers 1,157 Geriatric patients visited by geriatric health visitor 357 School children for follow-up defects 901 Handicapped 51 Miscellaneous 634 47 VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation is reasonable in the borough. There was a further fall in the number of primary vaccinations and immunisations recorded but this was largely due to a fall in the number of births. The reduced number of booster immunisations against diphtheria and tetanus was due to the implementation of the Department of Health and Social Security's revised schedule whereby 8 year olds no longer receive these injections. Immunisation against measles began in May 1968. Smallpox (under 16 years) Age at time of Vaccination Total Numbers Complications Reported Vaccinated Revaccinated 0-3 months 19 — — 3-6 months 17 — — 6-9 months 22 — — 9-12 months 49 — — 1 year 1065 2 — 2 - 4 years 240 36 — 5 - 15 years 69 113 — Totals 1481 151 — Diphtheria, Whooping Cough and/or Tetanus and/or Poliomyelitis and (under 16 years) Measles Complete Primary Course Boosters Diphtheria only 5 90 Whooping Cough only — — Tetanus only 183 105 Combined Diphtheria and Whooping Cough — — Combined Diphtheria and Tetanus 208 2474 Combined Diphtheria, Whooping Cough and Tetanus 1713 1399 Poliomyelitis only * 1996 2358 Quadruple — — Measles 2131 — *These figures include 9 primary courses of SALK (injection) vaccine and 9 booster injections of SALK, the rest being oral type SABIN vaccine. 48 Total children receiving immunisation against the five illnesses whether given separately or combined: Primary Course Booster Diphtheria 1926 3963 Whooping Cough 1713 1399 Tetanus 2104 3978 Poliomyelitis 1996 2358 Measles 2131 — 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 1968, 1,089 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 1967 Smallpox (children under 2) (4) Whooping Cough (1) Diphtheria (2) Poliomyelitis (3) England and Wales 76 78 74 38 Kingston upon Thames 81 84 81 55 The figures in columns (1) - (3) are calculated to show the percentage of children born in 1967 who have been vaccinated at any time. Column 4 includes only children who were vaccinated during 1968 and were under two years old at the time, and is calculated as a percentage of children born during 1967. 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 Malden. 49 PREVENTION OF ILLNESS, CARE AND AFTER CARE The Welfare and Prevention of Break-up of Families The annual co-ordinating conference was held at the Guildhall in July. Because of the increasing number of families coming on to the register and the general pressure of work on all those involved, it was agreed that in future the reports on cases opened and closed should be circulated half-yearly in May and November instead of quarterly. In an attempt to bring some uniformity into the information to be integrated into the register, it was decided that forms should be issued. The question of the need for 'special' home helps to be employed for assisting with the training in housewifery was discussed and it was generally agreed that if such a service could be provided it would be of much help in a selective number of cases. The position during the year was: Date Number of families "At Risk" Number of children involved 1. 1.68. 144 539 31.12.68. 212 629 The causes of failure or difficulty may be classified as follows: Cause Number of families Marital 70 (33.0%) Material (Housing, Employment, Financial) 201 (94.8%) Disorders (Physical, Mental, Psychological) 137 (64.6%) Care of Home and Children 59 (27.8%) Desertion 27 (12.7%) Delinquency 33 (15.6%) Other Reasons 46 (21.7%) The total percentage is more than 100 as most families are included under more than one heading. 50 Primary reasons for referral: Cause Number of families Marital 34 (16.0%) Material (Housing, Employment, Financial) 42 (19.8%) Disorders (Physical, Mental, Psychological) 64 (30.2%) Care of Home and Children 19 (9.0%) Desertion 13 (6.1%) Delinquency 13 (6.1%) Other Reasons 27 (12.7%) The number of case conferences held during the year was 22. Family Casework Team During the first three months of the year the senior social worker was on sick leave, which left a heavy burden on the remaining two team members and their clerk. However, they managed to give an adequate service to the families with which the team were involved. In August another social welfare officer who had recently obtained an honours degree in social administration was appointed to the team. At the beginning of the academic year, a first year student from the Croydon College of Technology two year course for the Certificate in Social Work was accepted for practical training. This student will work with the team for two days a week until the end of June 1969. Of the 212 cases on the register, 116 are being helped by various voluntary and statutory agencies, other than the health and welfare department. This department's team have directly assisted 96 of the families and have also helped a number of other families who, although not at any such risk, needed some assistance from a social worker. The caseloads of the team are small compared with those of workers in other sections and departments. This is due to the intensity of work required with the families. Often, particularly in the early days of referral, a family may need to be visited two or three times a week and in some cases ideally should have daily visiting. 51 Because many of the problems involve difficulties with finance, the team spend a lot of time negotiating with the Gas and Electricity Boards, hire purchase firms and other creditors - co-operation from these agencies is remarkably good and greatly appreciated. In general it is felt that it is in the best long term interest of the families if arrangements can be made for them to clear their debts by making small regular payments, if necessary collected by the social worker, rather than receiving grants. It is felt that in this way they learn to accept at least to some degree responsibility for their own actions and to feel a sense of achievement and self respect. They are usually very willing to accept this form of solution and in the main are not the 'shiftless' individuals that the term 'problem family' conveys. There are times, however, due to either the pressure from outside, overwhelming difficulties or the need for recognition of the efforts already made by the family, that it is necessary to raise grants. The family casework team are grateful for the help they have received in this way from both local and national agencies. We are also grateful to the local officers of the Department of Health and Social Security for their co-operation in making grants for special need when relevant. At Christmas a box of toys was donated by Beverley Boys' School. With these and with money donated by the staff of the health and welfare department a small gift was provided for all the children whom it was felt would be unlikely to receive a present from any other source. The team very much appreciated the kindness both of their colleagues in other sections and the boys of the school and would like to take this opportunity to express their thanks. 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 1968, 39 cases were notified in the borough and of these, 35 were pulmonary and 4 non-pulmonary. 52 The 35 pulmonary cases were in the undermentioned stages of the disease: A. or Tuberculosis - (sputum negative) ... 20 B.1 or Tuberculosis + (early cases, sputum positive) ... 2 B.2 or Tuberculosis + (intermediate cases, sputum positive) ... 11 B.3 or Tuberculosis + (advanced cases, sputum positive) ... 2 The non-pulmonary cases were: 1 Tuberculous endometrium 1 Tuberculous kidney 1 Tuberculous spine and kidney 1 Tuberculous glands of neck On 1st January 1968 there were 407 cases on the register and at the end of the year this figure had decreased to 388. Pulmonary Non-Pulmonary Total Males 211 12 223 Females 141 24 165 Totals 352 36 388 53 The foregoing figures show a decrease in the number of new cases of tuberculosis and a 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 1968 insofar as it affects patients resident in the borough: Number of chest clinic sessions held 357 Number of attendances: New Patients 780 Old Patients 3,026 Total: 3,806 Average attendances per session 10.6 Tuberculin Tests and B.C.G. Vaccinations Contacts School Children and Students Others Skin tested 173 40 24 Found positive 28 9 8 Found negative 85 18 4 Vaccinated 69 9 2 54 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 ana deaths for the years 1961—1968 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 1968 35 4 39 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 1968, 41 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. 55 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 - - - 4 2 4 3 5 3 21 - - - - - - - 1 - 1 F - — 1 — 5 1 1 3 3 14 - - - - - - - 1 - 1 T - - 1 4 7 5 4 8 6 35 - - - - - - - 2 - 2 Non Respiratory Tuberculosis M - - - 1 - - - - - 1 1 - - - - - - - - 1 F - - - - - 1 2 - - 3 - - - - - - - - - - T - - - 1 - 1 2 - - 4 1 - - - - - - - - 1 Mass Radiography The following is a summary of the work of the Mass Radiography Units in the borough: Males Females Totals Total persons X-rayed 4,598 6,277 10,875 Cases found to be suffering from tuberculosis 5 4 9 Cases found to be suffering from lung cancer 15 3 18 56 Recuperative Holidays Patients are sent for recuperative holidays upon the recommendation of their general practitioners or hospital consultants, and during the year 38 recommendations were received, of which 30 came from general practitioners. 25 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, making the service free to such persons. During the year a total of 569 doctor sessions were held which were attended by 1,189 new patients. Altogether there was a total of 9,054 clinic attendances. Details of Family Planning Clinics currently being held are as follows: Roselands, Alternate Mondays, 6.30 to 8.30 p.m. 163 Kingston Road,New Maiden. Tuesdays and Thursdays Appointments: Phone 942 0734 South Place, Mondays, Wednesdays 6.30 to 7.30 p.m. Surbiton. and Thursdays Fridays 9.30 to 10.30 a.m. Appointments: Phone 399 8898 204 Acre Road, Wednesdays 7 to 8 p.m. Kingston. Appointments: Phone 546 5812 1 Gosbury Hill, Tuesdays and Thursdays 6.30 to 7.30 p.m. Hook, Chessington. Appointments: Phone 397 5737 The Manor Drive, Wednesdays 10 a.m. to 12 noon Worcester Park. Appointments: Phone 337 0246 57 LOAN OF NURSING EQUIPMENT The Kingston and Surbiton Divisions of the British Red Cross Society operate a scheme for the loan of nursing equipment on behalf of the Borough 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 742 loans of nursing equipment were made during the year and the following table gives the details: Article Number on Inventories Total Loans During 1968 Periods for which loans were made Under 3 mths 3-6 months Over 6 mths Air Beds 2 - - - - Air Bellows 2 — - - - Air Rings 28 58 42 12 4 Bed Rests 26 60 45 10 5 Perfection Bed Pans 24 105 84 15 6 Bed Tables/Trays 9 7 4 1 2 Invalid Chairs,Push Type 10 75 62 7 6 Invalid Chairs, Self-propelling 3 46 37 9 - Commodes 20 153 115 21 17 Cradles 12 69 55 11 3 Crutches, pairs 5 26 19 3 4 Douche Cans 4 - - — - Feeding Cups 10 9 8 - 1 Inhalers 5 - - - - Mackintosh Sheets (draw) 8 7 6 1 - Mackintosh Sheets (long) 20 28 23 4 1 Pillow Cases, Jaconet - - — — — Steam Kettles - — — — — Male Urinals 11 45 36 9 - Female Urinals 4 6 5 1 — Walking Sticks - 19 - - - Bed Blocks - 3 — — — Handling Aids - 2 — - - Carrying Chairs - 2 - - - Walking Aids — 22 - - - 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. 58 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 30th September 1968, 24 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 2425 687 3112 Expectant mothers - - - Physically handicapped, under 65 39 - 39 Blind, under 65 6 - 6 Totals 2470 687 3157 Note: Deletions during this time due to persons having died or leaving the district total 206 persons. B. Treatments given during the year Local Authority Voluntary Organisations Total In clinics - 3887 3887 In patients' homes 2896 221 3117 In old people's homes 717 — 717 In chiropodists' surgeries 9390 - 9390 Totals 13003 4108 17111 59 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, and at 31st December 1968 there were 73 home helps, equivalent to 39 full-time staff. Advertisements in the local press and postcards in shop windows etc. brought many enquiries, but most persons withdrew when the full implications of the work were explained. 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 recruitment difficulties have resulted in heavy pressure on existing staff which has in some instances proved inadequate to meet the demands on the service. The following are details of the households assisted during the year: Category Number Assisted Persons aged 65 or over at time of first visit 695 Chronic sick and tuberculous 51 Mentally disordered 3 Maternity cases 107 Others 73 Total 929 The total number of hours devoted to patients by the home help service was 70,823. 6o MENTAL HEALTH SERVICES Administration There have been no changes in the general administration of this section during the year. As in former years the medical officer of health is in charge. Dr.J.S.Bearcroft, consultant psychiatrist, Kingston and Long Grove Hospitals, is employed in a consultant capacity on a part-time basis as well as serving as a co-opted member of the Health and Welfare Committee. Close liaison exists between the department and staff of the two hospitals which receive subnormal patients who are resident in the borough. I am grateful for the help given by Dr.D.S.Sharpe, acting physician superintendent, Botley's Park Hospital, and Dr.B.H.Kirman, consultant psychiatrist, Queen Mary's Hospital for Children, Carshalton, for their help in the assessment and placement of urgent cases. Staff Training Mrs.B.A.Harris, assistant supervisor at the Junior Training Centre, has been seconded for further training on the course for teachers of the mentally handicapped, organised by Chiswick Polytechnic. Mr.J.Dooley, mental health social worker, was seconded for a two year course in social work which leads to the National Certificate in this field. The principal mental welfare officer continued to supervise practical work being carried out by students who have been seconded to this authority for practical placement from the social work courses being held at Croydon Technical College and Chiswick Polytechnic. MENTAL ILLNESS During the year 586 mentally ill patients were referred to the department for care and after care. The following table indicates the sources of referral: Mentally Ill Persons Referred to the Local Health Authority Referred by 1967 1968 General Practitioners 183 116 Hospitals, on discharge from in-patient treatment 98 77 Hospitals,after or during out-patient or day treatment 181 286 Other (e.g. health visitors, police, relatives, self-referred) 126 107 Totals 588 586 61 3768 domiciliary visits were made during the year, an increase of 854 on the previous year. In addition to domiciliary visiting mental health social workers attended out-patient clinics at Kingston Hospital on 207 occasions. They also attend case conferences at Long Grove Hospital. Hospital Admissions Kingston and Long Grove hospitals dealt with the majority of psychiatric patients from the borough. In November 1968 a modern psychiatric unit and day hospital were opened at Kingston Hospital which has increased the facilities available for dealing with the mentally ill. During 1968, 117 cases were admitted to hospital by mental welfare officers. In 44 instances the procedure was carried out under the Mental Health Act 1959. As in former years the incidence of compulsory admission is low. This has been made possible by early referral, continuity of care and close co-operation between doctors and mental health social workers. The following table indicates the method of admission to hospital: Year Total Admissions Admissions under Mental Health Act Informal Admissions Emergency With Psychiatric Consultation With Psychiatric Consultation 1967 112 16 20 76 1968 117 10 34 73 7 patients were admitted to hospitals by Court Order under provision of section 60 of the Mental Health Act 1959. 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 6 patients as follows: Male Female Cheshire Foundation 1 1 Richmond Fellowship 1 - Mental After Care Association - 3 62 Psychiatric Day Centre During most of the year this was situated at 3 Gloucester Road, Kingston, but as the premises were due for demolition early in 1969, further accommodation was sought and new premises in Blagdon Road, New Maiden, will be available by April 1969. During the year 70 patients attended the day centre for varied periods. The average length of attendance was 13 weeks, and during the period under review the numbers attending increased steadily, and in December, 16 were attending the unit daily. During the year, 21 patients returned to their previous occupations, 15 were returned to psychiatric care and 16 ceased to attend of their own accord. At the end of the year 18 were in attendance. Those who attend the centre are responsible for the catering arrangements, which work out at a cost of about 2s.0d per head per day. For those who are in receipt of social security benefit a subsidy of 1s.6d per head per day is granted by the authority. Discussion groups led by a mental health social worker were held twice weekly and facilities were made available for interviewing patients to discuss their personal problems. Social Club The social club continues to be popular and the meetings were transferred to Friday evenings, but in addition, Wednesday afternoons were made available for social functions. On the Wednesday afternoon sessions, those who attended were mainly patients who were already in attendance at the day centre. The patients' committee undertook the responsibility for arranging programmes and organising various activities such as the establishment of a secondhand clothing store for families in financial need, and contacting members who were ill in hospital or at home. Friday evening socials have continued to be popular, with an average attendance of 40 members plus their families. A sale of work was held in November and a total of £72 was raised. It is pleasing to report that the general public have taken an interest in the club over the year, and a donation of £25 was made by the Hook Townswomen's Guild. This donation enabled members to have many social outings. The Kingston Rotary Club have also taken an interest and invited members' children to a Christmas party. 63 MENTAL SUBNORMALITY At the end of 1968 there were 440 subnormal persons known to the mental health section. Of this total 207 were receiving hospital care and 233 were living in the community. Of those in the community 90 attended the training centre. Over the year 24 subnormal children and adults were referred for assessment and placement. Botleys Park Hospital is responsible for dealing with all adult mentally subnormal patients needing hospital care. So far as children are concerned they are referred either to Queen Mary's Hospital for Children, Carshalton, or to Botleys Park Hospital. The hospital at Carshalton also makes provision for children with psychiatric problems or multiple handicaps. Both hospitals admit patients for short term care in order to give families some relief from the constant burden of caring for the severely handicapped, and perhaps, physically disabled child. Kingston Training Centre This is a purpose-built centre which consists of a special care unit for severely retarded physically handicapped children, a junior training centre for children up to the age of 16 years, and an adult centre and workshop for those over 16. The extension to the special care unit has provided an increased number of places for this type of child. Extensions to the workshops were also completed in January, thus alleviating the overcrowding which existed, and allowing more space for industrial activities to be carried out. At the end of the year 105 children and adult trainees were attending this training centre. 17 trainees attend the Kingston Training Centre from the London Borough of Richmond, and during the year 1 trainee was admitted from the London Borough of Merton. Special Care Unit During the year 12 severely subnormal children, who also suffer from physical handicaps, and who presented special problems of care, attended this unit. Nursing care and attention is provided by a staff of three. The value of this type of care is that early training can be instituted and progress assessed from time to time. It also relieves the family of the severe burden which is placed upon them in the day to day care of the child. 10 children received physiotherapy at the centre during the year. Treatment was provided for severe disablement due to cerebral palsy and postural defects. Speech therapy is also available at the training centre. 64 Junior Training Centre This centre provides for the needs of children between the ages of 5 and 16. During the year under review some reorganisation took place so that smaller groups were formed, with the result that more individual attention could be given. An innovation was the establishment of a pre-school class of children whose ages range from 3½ to 5 years. Those children who showed special aptitudes were placed in a special group so that these could be developed. It is important in dealing with retarded children that as much individual tuition as possible can be provided as it is necessary for those who are so handicapped to be dealt with by a system of programme learning. During the year a health education programme for those attending the junior training centre and adult occupational centre was instituted. This consisted of film shows on various aspects of hygiene followed by questions and demonstrations. Adult Workshops The adult centre and workshops are equipped to deal with assembly work. Domestic science training is valuable and emphasis is placed on social training, a facet which is often lacking in the adult mentally retarded. So far as is possible the workshops are run on industrial lines and attempts are made to obtain contracts for assembly work from local firms. Social Activities Pirates Spring Holiday 30 children and adults from the centre had a most successful week's holiday in July at Pirates Spring holiday camp, Dymchurch. They included 22 trainees from the borough, 7 from Richmond and 1 from Merton, and were accompanied by 4 members of staff, a student, and a voluntary worker. A Christmas show was performed by the trainees on the 11th December and was attended by the Mayor accompanied by the Town Clerk, the Medical Officer of Health, officials from the Council and more than 200 parents and friends. Christmas parties were held for junior and adult pupils and in the evening of the adult party they were entertained by the Queen Mother's Pipe Major Leslie DeLaspe. Over the year trainees have participated in a number of outings, e.g. to the Ice Show at Wembley, London Airport, and Chessington Zoo. 65 During the year the centre entertained and received more than 100 visitors, including a number from overseas. Voluntary Help The centre was fortunate in receiving a number of gifts of money, equipment and toys. £100 was donated from St.Mary's Training College, Twickenham, and at Christmas time the same college presented a Christmas tree to the centre and also presents for the children. School children from Bonner Hill and Hollyfield Road have helped voluntarily and boys from the Latchmere House Detention Centre have shown an interest in the activities of the training centre. During the year the centre was adopted by the m/v AKAROA of the Shaw Savill & Albion Co.Ltd. Collections are made on this ship and from time to time donations of money are made to the centre by Captain Larrive. The donations have been put to good purpose by Mrs.Beilby, supervisor, who has been able to purchase additional equipment for use by the children. 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: Adult s 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 It is indeed a pleasure to present this report upon the functional operation of the welfare services for the year 1968 which describes the degree of progress, achieved with some difficulty, against a background of increased national economic stringency of "squeeze and freeze" and which laid in-roads into the Council's plans for the expansion of the welfare services, but this in itself is an exciting challenge to all engaged to find, ways and means of overcoming difficulties and I would pay tribute to every member of the staff who has played his or her part in seeking to improve quality and quantity of the service. WELFARE OF THE ELDERLY The same policy has continued to be pursued in an endeavour to extend supportive domiciliary services to relieve pressure on residential accommodation, but this has indeed been difficult in the year under review. Wherever possible, every effort has been made to assist elderly people to continue living their lives in their own homes for as long as possible and to encourage them to be active and to maintain an interest in day to day affairs. The provision of adequate residential accommodation to meet the needs of the ever increasing number of elderly people is clearly a large undertaking and applications for admission into the Council's homes have continued to increase. Homes for the Elderly Every effort is made as far as possible to ensure that old people have as many of the domiciliary services as possible in order to keep them contented in their own homes, but when they are eventually provided with accommodation in an old persons' home every effort is again made to ensure that they are happy and comfortable by making the home as attractive as possible and to provide as many personal services as can be permitted within the circumstances and environment of each establishment. The elderly people have facilities for hair dressing, chiropody, and many entertainments and outings are arranged, and as much personal effort as possible is put in by the staff of the homes to see to the welfare and comfort of the residents. Visitors are welcome at reasonable hours. Residents in the welfare homes contribute towards the cost of their maintenance in accordance with their means and, by instructions laid down by the Ministry, they must have at least 18s.0d a week for their personal spending. 70 The following residential establishments for accommodation of elderly people were being administered throughout the year with the exception of Waratah, Sanderstead, which was closed on 29th September in order that provision could be made for structural alterations. Establishment Number 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, the Borough Council has an allocation of 38 beds at Kingsmead, Richmond, but the Ministry has called for the closure of this establishment during 1972/73. Waiting List On the 1st January 1968, 25 men and 77 women were awaiting admission to residential accommodation. Admissions The following admissions were made during the year: 1968 1967 Men Women Men Women (a) Homes administered by the borough 7 48 20 31 (b) Other local authority homes 2 8 3 10 (c) Voluntary homes 5 7 5 5 14 63 28 46 Of these admissions during the year 1 man and 9 women were on the waiting list prior to the 1st January 1968. The number of persons on the waiting list has again increased and, at the 31st December 1968, there were 26 men and 86 women awaiting admission to homes. 71 Length of Time on the Waiting List - as at 31.12.68. Time Males Females Total Under 6 months 8 32 40 7-12 months 4 11 15 13 - 18 months 5 11 16 19 - 24 months 4 11 15 25 - 30 months 1 7 8 Over 30 months 4 14 18 Totals 26 86 112 72 Short Stay Accommodation The need is recognised to provide short stay accommodation for elderly and infirm persons who do not require permanent accommodation, but need to be cared for for short periods, whether because of domestic difficulties in the household in which they normally reside, or to allow the relations who are looking after them to have a holiday which would not otherwise be possible. The demands for this facility are increasing and in addition to the permanent admissions, 107 elderly persons were admitted for short stay holiday periods to establishments as under: Men Women Homes Administered by the Borough 1.2 30 Voluntary Old People's Homes 2 16 Voluntary Homes for the Handicapped 12 35 26 81 New Accommodation I am very happy to be able to report that the building of the new home for the elderly in the grounds of Coombe Oak, Warren Road, Kingston Hill, was commenced during June and the contractor made good progress by the end of the year and I have every hope that, if the progress continues, this home for 50 residents may open some time in September/October 1969. Waratah. Sanderstead This small home for 20 elderly residents which had been of great use, particularly for emergency cases and holiday periods, was closed temporarily in September to allow extensive internal structural alterations to be carried out. The residents who remained at the time of the closure were accommodated, in the main, in homes run by voluntary organisations. Staff The recruitment of suitable staff for the residential homes has been a considerable problem during the year and there does not seem to be a ready solution for this problem. It was with great regret that the local authority lost the valued service of the superintendent of Fircroft in Ditton Road, Surbiton, Mr.L.J.Tribe who died on the 19th October 1968, having served some eleven years as superintendent of this home for elderly men. 73 Occupational Therapy at Welfare Homes for the Elderly In the early part of the year the regular occupational therapy sessions were continued at the Council's old people's homes, but, owing to the resignation of one occupational therapist and the lengthy illness of another, it was not possible to continue regular sessions, but these were held intermittently. Those residents who wished to participate in this therapy found relaxation and interest and a number of the articles made were sold by the matrons at the various coffee mornings and the profits distributed to the amenity funds of the respective homes. Hobbies and Handicraft Exhibition The Kingston upon Thames Association of Old People's Welfare Committees held a Hobbies and Handicraft Exhibition at the Guildhall in June for entries from the elderly people in the borough, and I am pleased to be able to report that 6 elderly people in the borough's old people's homes who entered exhibits won awards. Voluntary Services in the Residential Homes Many voluntary organisations and associations gave considerable help in entertaining elderly residents by way of gifts, parties and musical entertainment, and I am pleased to record again my appreciation to all concerned. Residential Accommodation in Other Local Authorities' Homes At the 31st December 1968, there were 72 elderly people from the borough accommodated in homes run by other local authorities and 44 residents in the Council's old people's homes who were the responsibility of other local authorities. Residents in homes outside the borough for whom this authority has accepted financial responsibility are visited by officers of the authority where the home is situated, and a report submitted. Arrangements are made for reports to be submitted to other authorities, when requested. Homes Administered by Voluntary Organisations A number of voluntary organisations provide residential accommodation for old people and the disabled, and these homes are an important and valuable addition to the Council's own establishments, catering as many do for professional., religious, occupational and educational backgrounds as well as for special disabilities. 74 The homes are required to be satisfactory in every way and the Council usually has a standard agreement with the bodies which run them. Charges to the Council are agreed by negotiation and depend on the financial position of the organisations concerned. The advantage to both the Council and a voluntary home is mutual since the Council is able to carry out its duty for the provision of suitable accommodation and the home is assisted in conducting its activities by the financial contributions received from the Council. Reports received of visits to the residents by officers of the local authority where the home is situated helped to maintain a cordial relationship between the residents, the Council, and the Management Committee of the homes. Persons resident in accommodation provided by voluntary organisations: Physical Category Age Sex 1.1.68 31.12.68 Not Materially Handicapped Aged M 13 23 F 29 23 Not Aged M 1 - F 1 1 Blind Aged M - - F 5 4 Not Aged M - - F 2 1 Epileptic Aged M 2 2 F - - Not Aged M 4 3 F - - Others Physically Handicapped Aged M 1 1 F - - Not Aged M 5 6 F 9 10 Deaf Aged M - - F - - Not Aged M - - F - - Totals 72 74 75 It has become increasingly difficult to find vacancies in voluntary and other authorities' homes for both young and elderly persons who are physically disabled and the problem becomes more acute as time passes and the ideal solution would be to erect a purpose-built home for physically handicapped within the administrative area of the borough and, whilst such a proposal has been made in the Council's ten year plan, the continued financial restrictions do not make this a possibility for a very long time. The local voluntary organisations have helped in some small measure in providing facilities for admission of elderly persons, but here too vacancies have been hard to secure. 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 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. Registration and Inspection of Private Homes for the Elderly The three registered voluntary old people's homes and the voluntary home run by the British Red Cross under its own Charter continued to operate during the year. There were thirteen registered private old people's homes within the borough at the end of the year. One new home included in this figure was registered during the year under review. All homes have been regularly inspected, many of them in conjunction with the fire prevention officer, and 36 visits were made during the year. Temporary Accommodation The National Assistance Act, 1.948, Section 21(l)(b) placed on local authorities the duty of providing temporary accommodation for persons in urgent need, being need arising in circumstances which could not reasonably have been foreseen, or in such circumstances as the authority may in any particular case determine: 76 (a) the statutory obligation to provide accommodation in cases of persons rendered homeless through fire or flood; (b) the responsibility to care for families rendered homeless in other circumstances e.g. eviction or domestic breakdown. From the 1st April 1965, the responsibility for temporary accommodation was delegated to the Housing Department, but this function was taken over by the Health and Welfare Department as from the 1st April 1968, Many homeless families have social problems in addition to that of housing, and a high proportion of the families dealt with became homeless because of their failure to pay the rent of their previous accommodation and, despite the preventive work undertaken, the department experienced many difficulties. The accommodation for homeless families taken over by the department was four single room units and four double room units, but during the period to the 31st December 1968, there were times when the double roomed unit contained some seven families in different combinations of accommodation. It has been the policy of the department to take the enlightened and humane view of not separating the husbands from their wives, nor children from their parents. The emergency accommodation of the homeless is one part of a complex and deeply troubled problem affecting the welfare of families against the general background of a housing shortage and extensive social welfare fieldwork in the closest collaboration with other departments is necessary. This has been particularly hard work because of the shortage of social welfare officers. Applications Dealt With -1st April 1968 to 31st December 1968: Received 95 Accepted for admission 26 Families Leaving Temporary Accommodation; Rehoused by Housing Department 12 Private arrangement 2 Families Remaining in Temporary Accommodation 12 Number of Persons Resident in Homeless Family Accommodation at 31st December 1968: Men 8 Women 12 Children 18 77 Meals- on- Wheels Service Progress has been made during the year with this service, notwithstanding the considerable difficulties that had to be surmounted, such as the lack of a meals-on-wheels organiser for many months and the lack of volunteers in the Surbiton area for delivery of the meals. A small van was provided for the assistance of the volunteers in the Surbiton area and on some days a driver was supplied as well. The meals which are prepared and cooked in the Council's kitchen are delivered in the Kingston area five days of the week by the Kingston Women's Royal Voluntary Service, whilst the British Red Cross carried out this function for Surbiton, each voluntary organisation delivering an average monthly of 1,590 and 1,34-2 meals respectively. The Maiden and Coombe Old People's Welfare Association, with the assistance of the Maiden "omen's Royal Voluntary Service, has again been responsible for the provision and delivery of meals in the Maiden and Coombe area from their own day centre kitchen, but were also supplied from the Council's kitchen with approximately 128 meals each month. A new meals-on-wheels organiser was appointed towards the end of the year and this lady, who is experienced and qualified, has improved the quality and variety of the menu and there is a different meal every day for each period of four weeks. Dietetic requirements are given special consideration. The regular supply of good meals to elderly people can have the overall effect of reducing the need for other domiciliary services, such as home helps where a helper sometimes only attends at the home of an elderly person in order to cook a meal. At Christmas 1968, 207 full Christmas dinners, consisting of turkey, sausage, savoury stuffing, roast potatoes and brussels sprouts, and Christmas pudding were delivered. During 1968, a total of 36,722 meals were delivered, compared with 34,087 during 1967. 78 MEALS-ON-WHEELS 1968 Monthly Meals Supplied Maximum monthly delivery in 1967 - 3072 TOTAL FOR YEAR 36722 Maximum monthly delivery in 1968 - 3526 79 Recreation and Meals Grants are made annually to voluntary organisations whose activities include the provision of meals and/or recreation for old people. The three Old People's Welfare Committees in the borough provide day centres combined with their old people's clubs. It is hoped in the not too distant future that the borough may be able to provide its own day centre for the elderly for some 40 persons where they may have social and occupational entertainment as well as being provided with a mid-day lunch. 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 1,231 persons registered at 51st December 1968. This is an increase of 114 over 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 31.12.68 Male Female Total Blind Persons 123 219 342 Partially Sighted 24 28 52 Deaf with Speech 6 10 16 Deaf without Speech 25 24 49 Hard of Hearing 13 24 37 Other Handicapped (General Classes) 330 405 735 521 710 1231 80 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 an increase of 10 over the previous year. The following tables show the age distribution of the blind population registered with the department on 31st December 1968. Age Period Blind Register as at 31.12.68, including transfers in and out New Cases Registered in the Borough during 1968 Male Female Total Male Female Total Under 1 1 — — - - - - 2 — - - - - - 3 - - - - - - 4 - - - - - - 5-10 2 1 3 - - - 11-15 1 - 1 - - - 16-20 - 2 2 - - - 21-29 2 1 3 - - - 30-39 5 4 9 - - - 40-49 10 5 15 - - - 50-59 21 6 27 3 1 4 60-64 10 9 19 - 2 2 65-69 12 28 40 4 4 8 70-79 29 68 97 3 12 15 80-84 13 45 58 4 7 11 85-89 12 26 38 - 5 5 90 and over 6 24 30 1 4 5 Unknown — — — - — - Totals 123 219 342 15 35 50 81 The position regarding the four children under 16 on the register as at 31st December 1968, is as follows: three are attending special schools for the blind and partially sighted, and one is still in a hospital for mentally subnormal children. 282 persons out of the total of 342 (82 per cent) on the blind register are over the age of 60. The age at onset of blindness was as follows: Age Period Age at onset of Blindness Male Female Total Under 1 14 9 23 1 - 2 2 2 - 2 2 3 1 - 1 4 - - - 5-10 1 3 4 11-15 1 3 4 16-20 4 1 5 21-29 12 2 14 30-39 11 5 16 40-49 7 10 17 50-59 14 16 30 60-64 8 20 28 65-69 13 23 36 70-79 19 69 88 80-84 12 37 49 85-89 3 10 13 90 and over 3 6 9 Unknown — 1 1 Totals 123 219 342 82 Employment of Registered Blind Persons The following tables indicate the pattern of full-time employment of persons on the register: Persons in Pull Employment under Ordinary Conditions Age Groups: 16-20 21-39 40-49 50-59 60-64 65 and over Total employed Male - 7 6 11 2 4 30 Female 1 1 - 2 - 2 6 Totals 1 8 6 13 2 6 36 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 - Barristers, Solicitors, Related Workers 3 Boot and Shoe Repairers 1 Craftsmen/Process Workers 7 Telephone Operators 7 Labourers 1 Shop Assistants/Salesmen 1 Miscellaneous Workers 3 Clerical Workers 2 Shop Managers 2 Street Vendors 1 Farm Workers 1 Domestics 1 Total = 36 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". During the year, six partially sighted persons died, three moved out of the area and nine were transferred to the blind person's register. Four transferred into the borough from outside and there were ten new cases. The following summary of cases on the register at 31st December 1968 therefore, shows a reduction of four cases as compared with 1967. Age Groups: 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Male - 1 1 1 6 6 9 24 Female - - 2 - 4 1 21 28 Totals - 1 3 1 10 7 30 52 83 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 1968 was as follows: In homes for the blind 7 women, - men Total 51 In other homes 35 women, 9 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 purposebuilt homes are available. Social Rehabilitation The main centres for social rehabilitation are situated at Old bury 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. Old bury 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 man and one newly blind lady were sent for a period of social rehabilitation at Old bury Grange, Bridgnorth, and one newly blind lady was sent for a period of industrial rehabilitation at America Lodge, Torquay, during the year. 84 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. As many patients pay privately for these machines, the total number of them in use within the borough is not known, but the number paid for by the authority in use at the end of the year was 9. 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. 42 blind persons received wireless sets during the year. 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. 85 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 an industrial rehabilitation course 2 newly blind persons were sent on social rehabilitation courses 35 people were in attendance at the handicraft class 26 people made articles in their own homes as occupational therapy 7 people were taught Braille 14 people were taught Moon Kingston upon Thames Association for the Blind This Association for the Blind, which is a registered charity, has continued to support the Borough Council with its work for the blind and partially sighted persons within the borough and has provided many extras which might not otherwise be available, such as special equipment, repairs to wireless sets, books, magazines, bedding, fuel, fires, grocery parcels, cigarettes, toiletries etc. Walfare 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 a decrease of 9 under the previous year and the total number on the register at the present time is 102. This decrease is occasioned by an exceptionally high number of deaths of persons on this register. The male social welfare officer for the deaf and hard of hearing was seconded to a two year course for the Certificate of Social Work during September 1968. 86 The total persons on the register are as shown in the table on page 77 and they can be mainly classified as under: Deaf with speech 16 Deaf without speech 49 Hard of hearing 37 (b) General Welfare The service for the deaf and hard of hearing continued to be given particular attention by the male social welfare officer prior to going on the course, and since then the general welfare has been maintained by the other social welfare officers in the department. 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 1968: TABLE I Age Groups: S e X Children under 16 Persons 16-64 Persons 65 and over Totals Handicapped Person (General Classes) M 64 181 85 330 F 50 161 194 405 Totals 114 342 279 735 87 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 X F - - ,2 - 10 6 18 5 15 10 45 21 66 F 2 1 - 4 1 6 10 31 21 103 34 145 179 G 45 36 4 5 2 1 3 1 1 6 55 49 104 H/L 3 1 1 - 2 3 9 7 12 13 27 24 51 Q/T 2 1 4 4 14 3 18 7 6 8 44 23 67 V 9 8 14 14 24 32 39 29 30 41 116 124 240 U/W - - - - - 1 1 - - 1 1 2 3 Z 3 3 - - 1 1 4 1 - 12 8 17 25 Totals 64 50 25 27 54 53 102 81 85 194 330 405 735 Key: A/E Amputation Q/T Injuries of the head, face, F Arthritis and rheumatism neck thorax, abdomen, G Congenital malformations pelvis or trunk. and deformities Injuries or diseases (other H/L Diseases of the digestive than tuberculosis) of the and genito - urinary systems; upper and lower limbs and of the heart or circulatory of the spine, system; of the respiratory V Organic nervous diseases - system (other than epilepsy, disseminated tuberculosis) and of the skin. sclerosis, poliomyelitis, sciatica etc. U/W Neuroses, psychoses and other nervous and mental disorders not included in V. Z Diseases and injuries not specified above. 88 (b) Occupational Therapy - Handicapped The services continue to operate from the Occupational Therapy Centre at 104 Westbury Road, New Maiden, and the classes that were held until the end of April when a senior occupational therapist resigned for personal reasons, were as follows: Number of persons attending Tuesday (all day) 16-18 Wednesday (morning) Art Class 6 Wednesday (afternoon) 12 Thursday (afternoon) 10 Friday (afternoon) 12 After this date, there was a variation in the classes and the Thursday afternoon craft class had to be discontinued, but an outwork class was substituted. Another occupational therapist resigned for personal reasons at the end of October which meant a further curtailment of the craft classes, but in their places were substituted outwork classes. The small number of handicapped persons who attended for craft classes continued to produce articles that were saleable through the trade and orders have continued to be received. A wide range of crafts continued to be taught at this centre, (c) Aids and Adaptations The senior technical instructor was off sick for some considerable time and the assistant technical instructor carried on with the work of dealing with the aids and adaptations, and during the year a total of 120 aids and adaptations were completed and this total included the backlog of 22 which was outstanding at the 31st December 1967. The completed aids were as follows; Bathroom aids (special seats, rails etc.) 65 Ramps for invalid chairs 11 Structural alterations to premises 7 Others (walking aids, lifting poles etc.) 37 120 89 (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 The technical instructor, who was ill, was on his return to employment, given the job of organising outwork for handicapped persons, and a scheme was put into operation during April, and at the same time a second ambulance was delivered and used extensively for this purpose. The outwork carried out by the handicapped in this connection has consisted of packing bricks and toys for toy manufacturers and putting small fittings into electrical apparatus for manufacturers. The classes now being held are as follows: Number of persons attending Monday (all day) 12-18 Tuesday (all day) 12-18 Thursday (all day) 12-18 Friday (all day) 12-18 Outwork has proved very popular with handicapped persons who have preferred to attend these classes in preference to craft classes because they have been able to earn a few shillings weekly for their work. Social Security benefits are not affected unless the money earned exceeds £2.0s.11d per week. (f) Articles for Sale Articles continued to be produced for certain retailers and every effort is made to dispose of the other produce of the centre at sales arranged by voluntary organisations. In this connection, the Occupational Therapy Centre had a stall at the spring fair in May and the Christmas fair in November, run by the Maiden and Coombe Community Association at the Graham Spicer Institute. (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. 90 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 38 car badges were issued to disabled drivers during 1968 as compared with 49 during 1967. These car badges are renewable every three years or when the driver changes his or her car. (i) Greater London Rally A party of 34 handicapped persons and helpers attended a rally at London School, East Ham, on the 13th July 1968 and enjoyed the entertainment and tea provided. 6 of the wheelchair cases included in this party were conveyed to the rally by the department's ambulances. (j) Holidays for the Handicapped During May 1968 a party of 19 handicapped persons and 3 members of the staff had a week's holiday at the Riviera Lido Holiday Club at Bognor Regis which was very much appreciated and enjoyed by the persons who were able to attend. (k) Domiciliary Visiting of the Handicapped The social welfare officers visited the disabled persons on the register as regularly as possible in order to assist them to overcome the effects of their disabilities and to endeavour to integrate them into the community. Advice and guidance on personal problems and in connection with any services which may be of benefit, whether they are provided by voluntary or statutory agencies, is given. The social welfare officers made some visits during the year. Many of these were of an introductory nature as the first step in ascertaining needs. (l) Domiciliary Visiting - General The cases in each category being dealt with at the 31st December 1968, and the average monthly visits were as follows: No. of Cases Average Monthly Visits Average Monthly New Referrals Elderly 975 374 32 Blind and Partially Sighted * 394 237 5 Deaf and Hard of Hearing 102 22 (5 in the year) Physically Handicapped 735 174 8 Temporary Accommodation 12 48 8 Other Miscellaneous Clients 14 18 1 * 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 considerably increased during the year under review, particularly in connection with the elderly and the physically handicapped. 91 Possum Installation In the early part of the year it was possible to supply and install a Possum Unit (patient operated selector mechanism) for the use of a severely disabled young man who has suffered from neurofibromatosis since he was seven years of age. The apparatus enables paralysed and other disabled persons to operate a range of electrical equipment by mouth or other small physical movements. The Possum Unit is supplied free by the Ministry of Health, but the cost of installation and additional apparatus falls to be met by the Council under its scheme for the welfare of the physically handicapped as provided for by the provisions of the National Assistance Act, 1948. This young man can now, by means of mouth suction, operate a loudspeaking telephone, intercom to the front door with a control to open that door switch on an electric fire, the wireless and the television. Kingston upon Thames Association for the Handicapped In September 1967 an inaugural meeting was held at the Guildhall under the Chairmanship of The Worshipful the Mayor to consider the formation of a voluntary association for the handicapped in the borough. It was agreed that such an association should be formed and a steering committee set up. It is pleasing to be actively concerned with this association and to have had the privilege of acting as its secretary until an appointment was made. Social and Recreational Clubs for the Handicapped The remainder of the services which are provided for physically handicapped persons can be described as recreational. These involve grants to clubs and provision of holidays. There are in the borough a number of organisations which run social clubs, as listed overleaf for handicapped persons, and which receive grants from this authority. Their efforts in this field are much appreciated. 92 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, Surrey. Kingston Endeavour Club, Bedelsford School, Grange Road, Kingston upon Thames. 2nd and 4th Thursday each month - evenings Mrs. A.Carter, 23D Church Street, Twickenham, Middlesex. Multiple Sclerosis Society (North Surrey Branch) Catholic Church Hall, Ewell Road, Surbiton. 3rd Tuesday each month evenings Mr. P.R. Knight, 2 Havers Avenue, Hersham, Surrey. Multiple Sclerosis Society (Kingston Branch) Bedelsford School, Grange Road, Kingston upon Thames. 1st Tuesday each month evenings Mr. J. Lumb, 27 Beaufort Road, Kingston upon Thames, Surrey. 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, Surrey. 93 Clubs for the Handicapped Club Meetings Honorary Secretary Surbiton Deaf Club, Club Room, Meals- on -Wheels Kitchen, Swell Road, Surbiton. Weekly- Thursday evenings Mr. M.J. Brooker 140 Banstead Road, Ewell, Surrey. Spartan Swimming Club, Coronation Baths, Denmark Road, Kingston upon Thames. Weekly Thursday evenings Miss L.Kilpatrick, 38 Thorkhill Road, Thames Ditton, Surrey. Surbiton Afternoon Club for the Blind, Methodist Church Hall, Ewell Road, Surbiton. Alternate Tuesday afternoons Mrs. D.Yorke, 219 Ewell Road, Surbiton, Surrey. 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, Surrey. Kingston arid 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, Surrey. 94 OTHER WELFARE SERVICES (a) Receivership The Chief Welfare Officer was appointed by the Borough Council 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 or her property and affairs. The appointment of a receivership is at the discretion of the Court and it may happen that, although action has been taken to secure a receivership, it does not necessarily mean that the Chief Welfare Officer is eventually appointed as it may be that a relative or the official solicitor is appointed instead. At the commencement of the year under review, the Chief Welfare Officer acted as receiver in two cases but one lady died and at the end of the year there was one active case; another case is pending and is under the consideration of the Court of Protection. (b) Burial and Cremation The National Assistance Act, 1948, Section 30. places upon the Borough Council a duty to arrange for the burial or cremation of a body of any person who has died or who has been found dead in the borough, and in any case where it appears that no suitable arrangements for the disposal of the body can or have been made. During the year arrangements were made for four burials. There were no cremations. (c) Safeguarding Property The Borough Council also has a duty under Section 48 of the National Assistance Act, 1948, to protect the property of persons who are unable to care for their personal effects whilst undergoing a period in hospital or who are admitted to a residential home, and where there are no relatives or friends prepared to assume this responsibility. During the year action was taken in twelve cases. 95 Kingston upon Thames Council of Social Service On the 7th December 1967, a public meeting was called by the Mayor at the Guildhall, Kingston, to consider the setting up of a Council for Social Service for the borough and, if agreed that such a Council be set up, to request the Borough Council to make a grant towards the administrative expenses. The Chief Welfare Officer was very pleased to act as the honorary secretary for the many meetings that followed, culminating in a Council for Social Service being formed and a paid secretary eventually being appointed. He took up his duties on the 1st November 1968, part-time, and will commence full-time duties early in the new year. ENVIRONMENTAL HEALTH SERVICES 99 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR P. E. KINTON. M.R.S.H., M.A.P.H.I. Staff Shortage. The staffing situation deteriorated badly towards the end of the year with the departure of Messrs,, Gravett and Rampling to local authorities outside the London area and it has not been possible to secure their replacement with suitably experienced and qualified Health Inspectors., It is pleasing to report that Mr„ A. West, a student in the department, qualified during the year and he was appointed as a Public Health Inspector,, It has also been difficult to attract and retain general assistants to carry out the numerous tasks connected with pest control and the wide variety of similar responsibilities. New Legislation. During the year legislation concerning the registration of Hairdressers and Barbers and Night Cafes was introduced in Greater London (General Powers) Acts 1967 and 1968, The Trade Descriptions Act, 1968 emphasises the department's responsibilities for consumer protection with regard to foods and the Clean Air Act, 1968 amended the law concerning chimney heights and details concerning Smoke control. Noise - The current problem. Noise continues to be prominent as a nuisance to residents of the Borough,, On investigation some notable successes have been achieved in abatement whilst other incidents have proved to be difficult to solve. Aircraft noise, particularly from aircraft taking off from London Airport in an easterly direction, caused some concern and resulted in meetings with the Member of Parliament and representatives of the Board of Trade. Whilst much of the Borough does not lie in the flight path, the situation concerning landing, take-off and stacking noise will continue to receive attention. 100 Severe Flooding. Flooding in parts of Kingston, Surbiton and Maiden was serious following heavy rainfall in September and staff were fully engaged in helping and advising those affected and in addition it was possible to assist Esher Urban District Council whose flooding problems were much worse than our own. It is in the interest of both public health and the maintenance of property that preventive measures be adopted without delay. The River Dwellers. In recent years there has been much publicity concerning the plight of the caravan dwellers but little has been said about those who live in potentially more hazardous accommodation - the small boat. During the year a survey of the river boat population was carried out and where necessary action taken to secure improved conditions. This is an aspect of Kingston riverside which could deteriorate if any of those concerned fail to appreciate the needs of river users. In general terms, small boats are eminently suitable for recreation and pleasure but are unsuitable for bringing up a family, with inadequate facilities, narrow gang planks and the ever present water. Port Health Work. An additional responsibility wa3 passed to the Public Health Inspectors with the Imported Food Regulations which now permit containers of food to pass direct from the port of entry to Kingston for inspection and unloading. The effect is to give this authority responsibilities similar to those of a sea or air port. Houses into Homes. Housing continues to hit the headlines of the press and programmes on television such as "Cathy Come Home" stimulated further public concern for the problem. The white paper Old Houses into New Homes is a statement of government policy of changing emphasis from the elimination of slums - a task which has largely been completed, to the conservation of those houses which are basically sound and improving their environment and facilities. Since 1949 when improvement grants were introduced hundreds of houses have been provided with baths, hot water supplies and indoor water closets. The Bill which has now been published envisages a broader approach which takes into 101 consideration the increasing problem of car parking, narrow roads, play areas, tree planting, and could well empower the elimination of through traffic in some residential roads to prevent road accidents and reduce noise. Whilst these proposals may at first appear to be imaginative they will conserve sound small dwellings with their own gardens, be infinitely less costly than allowing houses to degenerate into slums with subsequent very heavy expenditure on clearance and rebuilding. The support and interest of the Chairman and members of the Health and Welfare Committee and of the Mayor, Aldermen and Councillors is greatly appreciated„ The ready co-operation of the staff of all departments, including the Medical Officer of Health and the Health and Welfare Department and in particular those of the Environmental Health Section is gratefully acknowledged. P. E. KINTON Chief Public Health Inspector, 102 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 37 occasions samples were taken from private houses, schools, playgrounds, a caravan site, hospital and clinic, and all samples were satisfactory. 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 3½ hours during bathing periods. Nos. 1 and 2 Pools started the year with marginal chlorination, but in the spring equipment was installed to achieve breakpoint chlorination. There were initial troubles due to plant failure and insufficient sterilization during peak bathing loads, but since August results from bacteriological samples have been generally satisfactory. In the first instance bacterial contamination was identified at the outlets of the baths, but only on one occasion in mid-July were coliform organisms isolated. Advice was offered and sampling carried out daily for fourteen days, during which time the contamination had been Overcome. In August and October complaints were received concerning "eyesmarting" of bathers, probably due to chemical imbalance, again at times of peak load. No. 3 Pool - Learners - has been satisfactory throughout, except for one occasion in late January when heavy bacterial contamination was shown on bacteriological samples - due to low chlorine dosage and a heavy bathing load. Prom chemical readings taken it appears that breakpoint chlorination has not been constantly maintained but nevertheless, except for the above mentioned occasion, all bacteriological samples from this pool have been satisfactory. 103 Samples were taken from these Baths on 40 occasions and numerous other visits were made to check the chemical content of the water. 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 four occasions by the Health and Welfare Department for bacteriological examination all of which proved to be satisfactory. (b) School Pools, One private school has a small swimming pool which is used only by scholars and staff. Sterilisation is by hand dosing with chlorine and changes of water as necessary. Samples were taken during the summer when this open air pool was in use. These were satisfactory with the exception of one occasion when the dosing had not been fully carried out at the time of inspection but this was immediately rectified. There are seven swimming pools with treatment plants at primary schools. In addition to numerous pool-side tests, bacteriological examinations were carried out on 62 occasions, Chlorinators at three of these school plants were out of action for part of the swimming season which meant resorting to hand dosing of chlorine. This method is more difficult to control and called for much more time being spent on supervision. An increased number of samples were reported as containing coliform counts higher than desirable due to this situation, the cause being insufficient chlorination. All school baths were kept under observation, advice was given where necessary and the overall standard maintained was satisfactory. 104 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. Whilst there has been a marked improvement in the cleanliness of the water of the Thames litter continues to be an eyesore and a nuisance. 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. With the exception of a few houses, all dwellings are connected to the main sewage system. 5. FLOODING. During the weekend of the 14th to l7th September, 1968 very heavy rainfall occurred over south eastern England and because of the water-logged condition of the ground and the inability of the sewers to carry the flood waters, some flooding occurred in the Borough. The Hogsmill River overflowed at Villiers Road, Kingston and further flooding occurred at Clayton Road, Chessington, and to a lesser extent in other parts of the Borough. The cost and great inconvenience to those affected emphasize the need for rapid implementation of the relief sewers proposed for Clayton Road, Chessington and Brockenhurst Avenue, Worcester Park. The neighbouring authority of Esher Urban District Council was very seriously flooded and it is pleasing to report that the Council permitted the staff to give assistance to that authority. 6. 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 responsible for the disposal of refuse. The total amount of refuse passing over the weighbridge during the year ended 31st December, 1968 was 49,870 tons. 105 7. INSPECTION OP THE AREA. The following is a tabulated list of visits and inspections made by the Public Health Inspectors and Technical Officers other than visits made by the Pest Control Officers. Animal Boarding Establishments 22 Atmospheric Pollution Gauges 353 Bacteriological Sample Visits 166 Betting, Gaming and Lotteries Act 93 Biological Sample visits 2 Building Sites 62 Chiropody and Massage Establishments 21 Committee and Council Meetings 84 Consumer Protection Act (Fireguards) 20 Council House - Disinfestations 17 " " -Inspections 222 Court 18 Depot visits or inspections 153 Diseases of Animals Act and Waste Food Order 31 Disinfections 6 Disinfestations 19 Drainage visits 1,380 Employment Agencies 40 Flooding 240 Food Complaints 233 Food and Drug Samples 199 Pood Hygiene Regulations - Bakehouses 47 -Bakers' Shops 85 - Butchers 219 - Confectioners 121 -Cooked meat shops 56 - Fish Shops (wet or fried) 124 - Greengrocers 166 - Grocers 357 - Ice Cream, manufacture 15 - Ice Cream, sale 148 - Institutions 36 - Milk shops and depots 34 - Mobile Shops 149 - Office and Works canteens 31 - Public Houses, Hotels and Licensed Premises 199 - Restaurants and cafes 408 - Sausage Manufacturers 29 - School Canteens 151 - Sports Clubs 22 C/fwd. 5,778 106 B/Pwd. 5,778 - Open Market 424 - Wholesale Meat Shops 111 - Other Pood Premises 82 Factories - Non-Power 38 " - Power 232 Fertilisers and Feeding Stuffs 12 Hairdressers and Barbers 55 Health Education 103 Houses in Multiple Occupation 473 Housing Enquiries 23 Housing Act Inspections 276 Housing Act Reinspections 280 Improvement Grant Visits 1,041 Infectious Disease Visits 1,084 Insect Pests 120 Interviews with owners, builders, etc. 1,142 Merchandise Marks Act and Trade Descriptions Act 251 Miscellaneous (including no reply) 1,794 Noise Abatement 380 Nursing Homes 16 Offices, Shops and Railway Premises 2,872 Old People and Problem Families 90 Outworkers 8 Overcrowding 6 Pet Animals Act 29 Pigeons 10 Piggeries 15 Pharmacy and Poisons Act 109 Public Conveniences 70 Public Health Act inspections 1,153 Public Health Act reinspections 1,421 Rag and Bone, Scrap Metal Dealers 46 Rag Flock 4 Redevelopment Areas 37 Refreshment Houses (Licences) 14 Refuse Tips 19 Rent Act 51 Riding Establishments 17 River Boats 13 Rivers, Ditches and Ponds 34 Rodent Control 210 Shops Act 130 School Premises 150 Smoke Abatement 426 C/Fwd. 20,649 107 B/Fwd. 20,649 Smoke Control Areas (inspections and revisits) 11,358 - do - (no access) 2,921 Special Surveys 133 Tents, Vans, Sheds and Caravans 112 Unsound Food 268 Vacant Land 106 Visits outside district 382 Waste Food (Staining and Sterilisation) Order 5 Water Supply and Sampling (including Swimming Pools) 641 Work in progress 393 Work places 42 37,010 NOTICES SERVED. Informal. Written and Verbal 1,056 Statutory. (a) Housing Acts 34 (b) Public Health Acts 60 (c) Clean Air Act 17 NOTICES COMPLIED WITH. Informal. Written and Verbal 856 Statutory. (a) Housing Acts 27 (b) Public Health Acts 70 (c) Clean Air Act 18 8. 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. 108 PART I OF THE ACT. 1. INSPECTIONS. No. on Register Number of Inspections Written Notices Prosecutions Factories in which Sec. 1,2,3,4,6 are enforced by the Corporation 50 38 2 - Factories not included above in which Sec. 7 is enforced by the Corporation 663 232 8 - Other premises excluding outworkers 205 62 2 - 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 Sanitary Conveniences Insufficient - 1 - - - Unsuitable or defective - 2 - - 1 Not separate for sexes 2 1 - 2 - Other offences against the Act (not including offences relating to outwork) 11 24 2 9 - 109 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 1 Wearing apparel making, etc. 28 Lampshades 1 Brass and Brass Articles 10 Artificial Flowers 5 45 9, SHOPS ACT„ 1950. The provisions relating to closing hours, half-holidays, hours of employment of young persons and Sunday trading necessitated 130 visits,, Exemption Orders have been made under Section 1 whereby it is not an obligation to close a shop on one half-day in each week0 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 six-day trading to be operated in respect of many trades and businesses, 10. OFFICES. SHOPS AND RAILWAY PREMISES ACT, 1965■ 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, 110 Class of Premises Number of Premises registered during the year Total Number of registered premises at end of year Offices 117 582 Retail shops 103 884 Wholesale shops, warehouses 4 43 Catering establishments open to the public, canteens 20 138 Fuel storage depots - - 244 1.647 Class of Workplace Number of Persons employed Offices 7,895 Retail Shops 6,714 Wholesale departments, warehouses 698 Catering establishments open to the public 1,106 Canteens 208 Fuel storage depots 2 16,623 All premises inspected. During the year 574 registered premises received one or more general inspections. These included inspection of all registered premises outstanding from the previous year and 244 newly registered premises. The total number of registered premises at the end of the year was 1,647. All premises known to the department have now received a thorough general inspection. 111 There is close co-operation with the Borough Planning Officer which enables the department to see all plans submitted in respect of new construction or alteration to premises to which the provisions of the Act apply. It is thus possible to approach the persons responsible at an early stage in the development and ensure that, when completed, the premises will comply with the requirements of the Act. This service not only simplifies administration but is appreciated by the managements concerned. There has been little difficulty in enforcement. It has been observed that occupiers of premises are becoming more aware of their obligations and co-operation given by employers and managements has continued to be excellent. Inspections, whilst being thorough and covering all aspects of the Act, have been carried out in an atmosphere of understanding and goodwill. Operation of the General Provisions of the Act. The undermentioned tabulated statement indicates the number of contraventions dealt with during the year. Section Number of Contraventions found 4 Cleanliness 74 5 Overcrowding 6 6 Temperature 193 7 Ventilation 62 8 Lighting 33 9 Sanitary Conveniences 186 10 Washing facilities 150 11 Supply of drinking water 2 12 Clothing accommodation 16 13 Sitting facilities 1 14 Seats (sedentary workers) - 15 Eating facilities 5 16 Floors, passages and stairs 109 C/Pwd, 839 112 Section Number of Contraventions found B/Pwd. 839 17 Fencing exposed parts machinery 16 18 Protection of young persons from dangerous machinery - 19 Training of young persons working at dangerous machinery - 23 Prohibition of heavy work - 24 First Aid 178 49 Registration 121 50 Provision of Abstract 219 Other matters 11 Total 1,384 The figures indicate the relative causes for action and the following comments may be of interest. Cleanliness, Attention was drawn to the occurrence of dampness in walls and floors and the redecoration of areas to which the public does not have access such as stock rooms, stores, passageways, water closets and lobbies. Overcrowding. Only six cases were recorded during the year. This low figure may be due to our earlier general inspections when the attention of occupiers was drawn to the need for compliance before 1st August, 1967. Temperature. In most offices and shops the temperature was maintained at a higher figure than that required by the Act, but in a few smaller establishments, possibly for reasons of economy, the heating arrangements were inadequate. Lighting. Standards of lighting recommended by the Illuminating Engineering Society were accepted and no difficulty was experienced in implementing the recommendations. Sanitary Accommodation. The enforcement of the Sanitary Conveniences Regulations proceeded satisfactorily. 113 Ventilation. Every effort is made to ensure that the best method of ventilation suited to the premises is employed either by natural or mechanical means. Recommendations by the department were accepted and where shop fronts were constructed or renewed, emphasis was laid on the provision of ventilation louvres or fans. As stated above, it is important to approach the shop fitters at an early stage where proposals are made for new shop fronts, to ensure the provision of adequate ventilation. In ladies. hairdressing establishments, heat and steam emission from hair driers, rinsing processes, hair washes and heaters cause the atmosphere to be heavy and oppressive. Condensation on the windows and walls is a sign of lack of extract facilities, Discussions with the management have invariably produced the necessary equipment to improve ventilation,, Washing Facilities. There is a reluctance in the smaller shops to provide running hot water, but it has been possible to convince the owners of the need to comply with the requirements of the Regulations. Eating Facilities, Most of the large offices and shops have arranged a rest room or separate accommodation where the staff may eat food and be away from the public and their work place in periods of relaxation,, Floors, passages and stairs. Particular attention was paid to defective floors and floor coverings, worn step nosings and stair treads, inadequate lighting and lack of handrails,, Attention was also given to the unguarded openings in floors leading to cellars and suitable action was taken in each case to provide adequate fencing to such openings. First Aid. Offices and shops with staff of 150 in number have separate rooms for the care of sick employees during the hours of work. Unfortunately employees do not appear to wish to qualify in first aid and accordingly the large establishments possess the necessary facilities but they have difficulty on occasions in recruiting suitably qualified first aiders. The notices served were in the main concerned with the absence or insufficiency of first aid equipment. Abstract of the Act, 219 notices were served. The reason invariably given was the difficulty experienced by employers in obtaining the document. The department despatched particulars with each notice advising where the Abstract could be purchased. 114 Non-registration of Premises, Most of the 121 notices concerned new premises or premises which had been vacated and re-occupied. general defects. In 11 cases attention was drawn to general safety precautions. Accidents. 77 accidents were reported compared with 72 for the previous year. These were as follows:- Falls 30 Handling of goods 24 Hand tools 13 Others 10 77 Prosecutions. There were no prosecutions during the year under review. 11. NOISE. Sixty-eight complaints of alleged nuisance from noise were received during the year of which 35 were confirmed. Twelve concerned industry, thirteen commercial undertakings and ten domestic sources. The investigation of these complaints necessitated prolonged visits, sometimes during the night, in order to assess the degree of nuisance caused to the complainants. Three members of the staff attended courses of instruction at Kingston College of Technology on noise. 12. CLEAN AIR. Clean Air Act. 1956 - Smoke Control Areas. Particulars of Kingston upon Thames Nos. 11 and 12 Smoke Control Orders which became operative on 1st October, 1968 are as follows:- Area 11 12 Locality Acre Road, Kingston. High Drive, Maiden Acreage 143 203 Domestic premises 1,533 1,184 Commercial " 105 8 Industrial " 10 - Other " 8 3 115 In October the Council made Smoke Control Orders Nos, 14 and 15 and they were confirmed by the Minister of Housing and Local Government in December, These Orders, together with Order No, 13 made in July 1967 come into operation on 1st October, 1969 and details are as follows:- Area 15 14 15 Locality Dickerage, Maiden Kings Road, Kingston Elm Road, Maiden Acreage 197 148 180 Domestic premises 455 1,233 1,932 Commercial " 63 51 68 Industrial " 7 1 5 Other " 7 7 5 The Council's Smoke Control Area programme provides for a further twelve areas by 1978 in addition to the twenty-one already covered by confirmed Smoke Control Orders. The position at the end of the year can be summarised as follows Number of Areas Dwelling Houses Areas in operation 18 17,024 Adaptations in progress (Areas 13,14 and 15) 3 3,620 Areas being surveyed (Areas 16 and 17) 2 2,997 Future Areas (The numbering of areas was not consecutive prior to the formation of the new Royal Borough) 10 21,209 Air Pollution Complaints. There were 120 complaints from the public about nuisance from smoke and grit; 74 of these concerned bonfires, 20 smoke from factory chimneys; 15 smoking domestic chimneys and 11 grit and smuts. There has been an increase in recent years in the number of complaints about bonfires which is indicative of the growing concern of the public. 116 The department publicises advice on how to reduce smoke from bonfires and avoid complaints. The complaints about smoke, grit and smuts from factory chimneys arose from defects in plant or faulty operation and the majority were quickly rectified. Chimney Heights. Pour plans were submitted for determination of chimney heights under Section 10 of the Clean Air Act, 1956. In three further cases advice was given where new chimneys, exempted from the provisions of Section 10, were being erected. Smoke and Sulphur Dioxide. 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 Maiden Road, New Maiden. The apparatus operates continuously and at the first three sites readings are taken five times a week. An 8-port sampling apparatus is in use at the Maiden Road site which provides daily readings, but needs visiting only once a week. The results are submitted monthly to the Ministry of Technology's Warren Spring Laboratory for inclusion in the national survey of atmospheric pollution. In co-operation with the Ministry of Technology, two further instruments are to be installed;, one on the twenty-first floor of Tolworth Tower, the other in a day nursery nearby. It is proposed to make observations for a year at these sites in order to compare pollution at ground level with that at a height of 212 feet. Annual averages of smoke and sulphur dioxide at the Guildhall site since 1958 are shown in Fig. 1. The graph marked 'degree days' indicates average monthly weather conditions, the peaks show cold years and the troughs warm years. 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. Grit and Duat. 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 deposits at the two sites for the years 1953 to 1968. 117 118 119 120 121 CLEAN AIR ACT, 1968. Since the coming into force of the Clean Air Act, 1956, which provided principally for the introduction of smoke control areas, the regulation of smoke and grit from industrial chimneys and the control of industrial chimney heights, there has been a great improvement in the purity of our atmosphere. Ground level smoke concentrations in the Borough have been reduced by 60 per cent. and ground level sulphur dioxide concentrations by 16 per cent., since 1958 when measurements commenced. In some respects, however, the provisions of the 1956 Act have been found inadequate and the Clean Air Act, 1968 is intended to remedy these defects. The most important provisions affecting this Borough ares:- 1. The emission of dark smoke due to the burning of trade refuse will be controlled. 2. The Act widens the control of chimney heights to include large heating installations for flats, offices and shops and gives the Council power to require existing chimneys to be raised when certain alterations to furnaces are carried out. 3. Fuel merchants, subject to certain exceptions, may be prosecuted for selling raw coal for delivery to a building in a smoke control area. 13. COMPLAINTS. The following is a brief list of causes for complaints received during 1968 which resulted in investigation by the department and in all cases appropriate action was taken. Accumulations 67 Animals 10 Birds (Pigeons) 61 Caravans - illegal parking 5 Car Spraying 3 Dampness 181 Dangerous Buildings 4 Drainage/Sanitary Arrangements 1,034 Dustbins 21 Flooding 57 Foods 149 Food Hygiene 16 General Housing Defects 198 C/Fwd. 1,745 122 B/Fwd. 1,745 Insects 311 Merchandise Marks Act 1 Noise 68 Offensive Odours 141 Overcrowding 3 Rodents Rats 19033 Mice 142 1,175 Shops Acts 5 Offices, Shops and Railway Premises Act 3 Smoke 120 Squirrels 53 Water 13 Yards and Paving 3 Others 65 3,767 14. RODENT AND INSECT PEST CONTROL. Again 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 may have anticipated complaints which would otherwise have been made. 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. There was an increase in the number of complaints received in respect of squirrels and advice was given on trapping and 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. 123 An information leaflet prepared in the department was forwarded to residents who complained about wasps and bees and 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. The accompanying tabulated statement is an indication of the work carried out during the year. PEST CONTROL - STATISTICAL STATEMENT 1968. 1. Number of properties in district 58,373 2. (a) Total number of properties (including nearby premises) inspected following notification 2,797 (b) Number infested by (i) Rats 1,063 (ii) Mice 182 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 148 (b) Number infested by (i) Rats 75 (ii) Mice 56 4. Complaints received; Squirrels 53 Pigeons 6l Wasps/Bees 131 Other insects 180 124 HOUSING. The following is a tabulated statement of action taken under the Housing Act, 1957:- 1. Number of houses inspected 276 2. (a) Number of houses which, on inspection, were considered to be unfit for human habitation 1 (b) Parts of houses which, on inspection were considered to be unfit for human habitation 1 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 181 4. Number of representations made to the Local Authority with a view to:- (a) The serving of notices requiring the execution of works 45 (b) The making of demolition or closing orders (number of houses involved) 2 5. Number of formal notices served requiring the execution of works 24 6. Number of houses which were rendered fit after the service of formal notices 27 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 - 9. Number of houses demolished 2 10. Number of houses where demolition or closing order determined on the premises being made fit 1 125 RENT ACT. 1957. Applications for Certificates of Disrepair Applications 4 Decisions not to issue certificates - Decisions to issue certificates (a) in respect of some but not all defects 4 (b) in respect of all defects - Undertakings given by landlords under paragraph 5 First Schedule 1 Undertakings refused by Local Authority - Certificates issued 3 No applications were received for cancellation of Certificates. Houses in Multiple Occupation - Housing Act. 1961. There are no common lodging houses in the Borough. During the year 473 visits have been made to houses in multiple occupation in connection with the standard code of requirements adopted by the Council. It has been necessary to serve 85 informal and two Statutory Notices upon owners requiring works to comply with the Code. In addition to specifying additional facilities a number of notices required works to provide an adequate means of escape from fire in accordance with a Code of Practice issued by the Greater London Council. The importance of protecting residents of houses let in this manner against the risk of fire cannot be too strongly emphasized. The cost of works embracing repairs, additional facilities and means of escape is considerable and despite a shortage of local building labour for this type of work, progress is being made. 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 makes both standard and discretionary grants to applicants as appropriate. 126 Improvement Grants - Standard. Owner/Occupiers Tenanted Applications received 44 4 " approved 39 3 Dwellings improved 32 6 £ s. d. Amount paid in grants 5,130. 18. 0. Average per house 135. 0. 0. Amenities provided- (a) fixed bath or shower 29 (b) wash hand basin 31 (c) hot water supply (to any fittings) 35 (d) water closet within dwelling 30 (e) food store 27 Improvement Grants - Discretionary. Owner/Occupiers Tenanted Applications received 29 17 " approved 26 20 Dwellings improved or provided 19 15 £ s. d. Amount paid in grants 9,588. 9. 10. Average per house 282. 0. 0. Publicity. Arrangements are being made to improve a house in Surbiton which is owned by the Council and will be open to the general public as a demonstration house for two weeks. It is hoped that the exhibition will provide publicity for the new Housing Act and stimulate owners to apply for grants. 127 Moveable Dwellings. Licences under the Caravan Sites and Control of Development Act, i960 have been issued for The Riverhill Estate where 36 caravans are permitted, one caravan in the orchard of a private house and 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. Little trouble was caused by itinerant caravandwellers placing their vehicles on open land in the Borough. Gypsies and Other Travellers. The Caravan Sites Act, 1968 introduces provisions concerning the powers of local authorities to provide sites for gypsies and for the prohibition of unauthorised camping in designated areas. This particular part of the Act has not been implemented to avoid a fresh statutory burden being imposed on local authorities at this stage. River Dwellers. During the year a survey of all boats moored between Town End Wharf and Railway Wharf was conducted. Of 60 craft moored 35 were being used for full time occupation and 14 were tenanted. Ten of the boats were occupied by families with children and their health appeared to be good. In one case where there were more than two children present and the conditions were unsatisfactory the family was rehoused and the owner undertook not to let to families. 128 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 1968 under the provisions of the Milk (Special Designations) Regulations, 19&3 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 102 Sterilised milk 38 Ultra Heat Treated milk 34 Untreated milk 22 Bacteriological Examination of Milk. During the year 42 samples of milk were sent to the Public Health Laboratory at Epsom and the following is a tabulated statement of the results:- Phosphatase Test Methylene Blue Test Turbidity Test Pass Fail Pass Fail Void Pass Fail Pasteurised 34 - *34 3 3 — - Sterilised - - - - - 2 - *Including 11 samples which passed the modified Methylene Blue Test for dispensers. The three 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. 129 Ice Cream. The number of registered premises in the Borough at 31st December, 1968 in which ice cream may be stored or from which it may be sold is 262. 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. The following table shows the results of examination of 63 samples submitted to the Public Health Laboratory at Epsom during 1968. Owing to 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 G-rades III and IV not so. Adequate follow-up action is taken where samples fall within the latter grades. The G-rade IV sample 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. GRADE I II III IV Total Ice Cream 52 6 4 1 63 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. 130 During the year numerous visits were made to these depots and the undermentioned quantities of meat found to be unfit for human consumption were voluntarily surrendered:- Fresh meat and offal 13,945 lbs. Canned meat and offal 975 lbs. Imported Food. On August 1st the Imported Pood Regulations, 1968 became operative and this will mean that containers of imported food may be directed to inland depots without being inspected by Port Health Inspectors and/or Customs Officers at the port of entry. This places the responsibility on Inspectors of the district to examine the contents of these containers and check the validity etc. of the accompanying Official Certificates. To date only two containers have arrived in this Borough, both being containers of boneless beef from Prance and Yugoslavia satisfactory in both instances. It is thought unlikely that many of these containers will be sent to the Wholesale Meat Depots in this district because (a) they are not large enough to cope with the volume of produce that these containers hold, and (b) the access to the Depots is rather restricted via the narrow Kent Road. Foodstuffs Condemned as unfit. The following unfit foodstuffs from various sources were voluntarily surrendered and destroyed:- Canned Goods. lbs. Cream 12 Pish 84 Fruit and Fruit Juice 1,811 Jam and preserves 253 Meat and meat products 824 Milk 29 Milk Pudding 168 Poultry 5 Soup 94 Vegetables 192 Others 69 Chickens 281 Pish 93 Fruit 262 Meat 104 Rabbits 36 Others 5 Frozen Foods (refrigeration failure) .19,491 131 Food Hygiene. There are 1,424 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 following tabulated statement shows the nature of the infringements to which attention was drawn:- Washing facilities for Staff. Absence of, defective, inadequate hand basins 33 Absence of hot or cold water 35 Lack of towels, soap and nailbrushes 22 Defective water heaters 8 Sanitary Conveniences. Lack of "Wash your Hands" Notices- 25 Fittings defective and dirty 3 Lighting inadequate 8 Walls and ceilings defective and dirty 10 Ventilation and/or ventilated lobby required 3 Additional water closet accommodation 1 Others 2 Repairs to Food Rooms. Floors defective 1 Walls and ceilings defective 3 General Cleansing 8 Sinks and Draining Boards Lacking or defective 5 Protection of Food against Contamination Smoking 5 Food not kept 18"' off ground 1 Covers not provided for food 2 Others 13 C/Fwd. 188 132 B/Fwd. 188 Uncleanliness. Kitchens and equipment 32 Food Stores 9 Preparation rooms 10 Floors, walls and ceilings 34 Dining rooms 2 Refrigerators 5 Ventilation 8 Artificial lighting improved 7 Dustbins - insufficient and defective 8 Uncovered, and collection of, refuse 3 Miscellaneous 9 First Aid Equipment 9 Clothing - storage and cleanliness 3 Accumulations 5 332 Notices served 119 Notices complied with 89 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 four stalls sell fresh fish, one sells eggs and another farm produce. Regular inspections of the markets are made to ensure that hygienic practices are maintained. It is regretted that the scheme to modernize the Ancient Market .food stalls, although approved, had not been executed during the year. 133 The number of 'barrow boys' operating within the Borough is small, but the number of food vehicles is considerable„ The following tabulated statement shows the nature of infringements to which attention was drawn. Name and address not displayed 24 Washable overclothing not worn 18 Water supply 2 Washing facilities 28 Lighting 7 First aid equipment 15 Separation and disposal of waste 8 Ventilation 1 Protection of food 18 General cleanliness 9 Smoking 4 134 Food Hygiene (&eneral) 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 37 132 Butchers 63 248 Confectioners 149 121 Fish Shops (wet or fried) 27 124 Greengrocers 74 166 Grocers 150 413 Ice cream, manufacture 1 15 " sale 247 148 Institutions 39 36 Milk shops and depots 105 34 Mobile shops 149 Office, shop and works canteens 98 31 Public houses, hotels and licensed premises 137 199 Restaurants and cafes 99 408 School canteens 71 151 Clubs 63 22 Open Markets 2 424 Wholesale meat shops 9 111 Other food premises 53 82 1,424 3,014 134 Bacteriological Examination. Thirty-five 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. Six articles 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. FOOD AND DRUGS ACT . 1955. The following tabulated statement gives details of 414 samples of foodstuffs submitted to the Council's Public Analyst to ascertain whether they complied with the Pood and Drugs Act, 1955, Labelling of Pood Order, 1953 and other relevant legislation. Of these 27 were formal samples and the remainder were samples obtained by informal procedures. Commodity No. of Samples Acerola Cherry Syrup 1 Ale 1 Almond Oil B.P. 1 Anchovies, fillets 1 Angel Delight Dessert 1 Apple and Blackberry Pie Pilling 1 Apricot Pie Filling 1 Aspirin 1 Baby Food - bone and vegetable broth 6 Baked beans 3 Baked egg farfols 1 Bio salt 1 Bitter beer 2 Biscuits 9 Blackcurrant drinks and syrups 8 Black pudding 1 Blood pressure pills 1 Bread 10 Bun round 1 Butter cakes and puddings 3 C/Fwd. 54 135 Commodity No. of Samples B/Fwd. 54 Camphorated Oil B.P. 1 Cascara Tablets B.P. 1 Castor Oil 1 Celery Salt 1 Cheese 5 Cheese - French Farmhouse Brie 1 Cheese Spread & Cheese Food 11 Chemical food 1 Chestnut purée 1 Chewing gum 1 Chicken products 5 Chilblain ointment 1 Chocolate 8 Chocolate Meringue Pie 1 Chocolate milk drink 1 Cod liver oil B.P. 1 Cockles 1 Coffee and coffee essence 6 Compound block 1 Compound yeast extract 1 Confectionery - sugar 5 Cough mixtures and syrups 6 Crab, dressed 2 Cream cakes 3 Creamer, non-dairy 1 Crispbread 2 Crumble mixture 1 Crystallized petals 1 Custard and custard powder 3 Dakatone 2 Dates, stoned 1 Devilled ham paste 1 Dressing, fish 1 Drinking chocolate 1 Eel, pickled 1 Essences, flavourings and colourings 4 Eucalyptus oil B.P. 1 Figs in syrup 1 Fruit juices 4 Fruit salad, evaporated 4 Fruits for salad 1 C/Fwd. 150 136 Commodity No. of Samples B/Fwd. 150 Gervais Butter 1 Ginger beer shandy 1 Ginger punch 1 Glace cherries 1 Glycerine B.P. 1 Golden raising powder 1 Grapefruit squash 1 Gravy powder and improver 5 Ground almond 1 Halibut liver oil capsules B.P. 1 Hamburgers 2 Hazelnut spread 1 Herbal nerve sedative 1 Herbs - dried 3 Herring fillets 1 Honey - kola 1 Ice cream 3 Ice cream powder 1 Irish stew 2 Jam and marmalade 5 Jelly 5 Lambs tongues 1 Lemon curd 1 Lemon drinks 5 Lemon and lime flavoured syrup 1 Liquid fruit pectin 1 Low fat spread 2 Macaroni animal shapes 1 Magnesia, cream of 1 Mag, sulphate paste 1 Margarine 12 Marzipan 4 Mayonnaise 2 Meatless stew 1 Meat pudding 1 Medicated cigarettes 1 Mel.Boracis Borax and Honey B.P.C. 1 Menthol and Eucalyptus Tablets 1 Milk 20 Milk: shake syrup 2 Milk top 2 C/Fwd. 250 137 Commodity No. of Samples B/Fwd. 250 Minced Beef with Gravy 1 Mint Jelly 1 Miracle Whip 1 Molasses 1 Multivitamin tablets and capsules 2 Mustard 1 9 Vitamin health drugs 1 Nut spread 1 Olive oil 1 Onions, dried 2 Orange and Kahao Creme 1 Orange, lemon and lime drinks 15 Paprika, pork stuffed with cream and tomato sauce 1 Paraffin, liquid 1 Parrish's Pood B.P.C. 1 Passion fruit squash 1 Pastry vegetable 1 Pastry cases 1 Pâté 5 Pease pudding 3 Pineapple in syrup 1 Pepsi-Cola 1 Polony 1 Pork, chopped 1 Pork pies 5 Potatoes, instant, mashed and canned 8 Prawns 1 Pumpernickel, sliced 1 Rhubarb in syrup 1 Rice Creamola 1 Rice pudding 1 Rose hip syrup 2 Rum flavoured cola 1 Rumba cup 1 Salmon 1 Salami 1 Sardines 2 Sauces, spices and pickles 13 Sausages 3 C/Fwd. 338 138 Commodity No. of Samples B/Fwd. 338 Savoury cheese mini-gateau 1 Savoury rice 1 Shrimp chow mein 1 Soup 11 Sparkling cola 1 Steak and kidney pie and pudding 4 Stewed apples 1 Stewed steak 2 Strawberry flavoured syrup 1 Strawberry fruit filling 2 Sugar - coffee 1 Sugarless sweeteners 3 Suet 1 Sustain vitamin A. capsules 1 Sweedish red cabbage 1 Sweet'n' Easy 1 T.A.B. 1 Tea 2 Tinted dragees. 1 Toast savouries 1 Toasty grill, liver and bacon 1 Toasty grills 1 Tomato paste and puree 6 Tomatoes 2 Top of Milk 1 Treacle 1 Turkey spread 1 Turkish delight 1 Vecon 1 Vegetable juices 1 Vegetable oils 2 Vinegar 5 Vitacup 1 Walnuts, pickled 1 Wheat germ 1 Whelks 1 Whisk-It 1 Whisky 3 Wine 4 Yeast, baking 1 Yeast tablets 1 Yoghurt 1 Total 414 139 Of the 33 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. Minced Beef and Onion with Gravy. This article had a meat content of 37.8 per cent. Deficiency of 25 per cent. The meat content for an article described as Minced Beef and Onion with Gravy should be at least 50 per cent. The matter was taken up with manufacturers who stated that it was their intention to reformulate the product and the label before May 1969. In view of limited time before new regulations come into force the matter was not pursued. Creamed Potatoes. The article was incorrectly labelled, should have read "Creamed Potato Mix". This was taken up with manufacturers who did not agree that "mix" was usual name of this food but that it was dehydrated. In view of imminence of new regulations it was decided to leave this matter in abeyance. Coffee Sugar. Contained non permitted colouring matter not included in the permitted list of colours in the Colouring Matter in Food Regulations 1966. The manufacturers were of the opinion that the sample was old stock. Chewing Sum, Ingredients incorrectly specified on label. The manufacturers decided to omit the list of ingredients on the label so that there would be no contravention of the Labelling of Pood Order, 1953. Low Calorie Blackcurrant Health Drink (2 samples). This was a case of misdescription. The label described the article as "Triple Vitamin C enriched". There is no basic standard for the enrichment of an article of this nature and the claim was considered liable to mislead as to the quality of the drink. Following correspondence the manufacturers agreed to amend the label by omitting the word "Triple" and inserting "Rich" in its place. 140 Mint Jelly. This sample contained non permitted colouring matter. The matter was raised with the manufacturers who stated that the sample must have been old stock as the particular colouring concerned had not been used since the Colouring Matter in Food Regulations 1966 came into force. Sugarless Sweetener. The label did not bear the correct declaration required by the Artificial Sweeteners in Pood Regulations 1967. The manufacturers stated that this was old stock as they were now using amended labels to conform to these Regulations. French Farmhouse Brie Cheese. This article was incorrectly labelled. It had the composition of a full fat soft cheese but did not bear the declaration required by the Cheese Regulations 1965. On revisiting the retailer it was found that correct notices were available but an obsolete notice had been affixed at the time of sale. Chicken Chow Mein. Defioient in meat content. The sample contained total meat 12.395 whereas in the opinion of the Public Analyst, a canned meat product in which the name of a variety of meat is mentioned first in the title and which bears an illustration showing that variety of meat as a major ingredient should have a meat content of not less than 35$. The manufacturers agreed to amend the label to "Chow Mein with Chicken". Fried Hamburgers with Gravy. This sample was deficient in meat content, containing only 39.9% total meat content. It was the opinion of the Public Analyst that such a product should contain not less than 50$ meat. The manufacturers undertook to ensure that all future products would have a 50% meat content. Fruits for Salad. The sample was deficient in apricots, pineapple and cherries as judged by the Code of Practice No. 4 of the Local Authorities Advisory Committee on Food Standards but the product was canned abroad and was not subject to this Code of Practice. 141 Tea. The sample was incorrectly labelled. The container did not bear the name of the packer or labeller and the address at which the business was carried on as required by the Labelling of Food Order 1953. The packer was under a misapprehension and has since marked the packets with his own name and address. Low Calorie Orange Drink, This sample was incorrectly labelled. The word "drink" on the label was not preceded by the name of the citrus fruit as required by the Soft Drinks Regulations 1964, The letters and words Orange Drink were not uniform in size as required by the Soft Drinks Regulations, 1964 and the manufacturers agreed to amend the label. Lemonade Shandy, This sample was deficient in proof spirit content. It contained 1.4% proof spirit and in the opinion of the Public Analyst a shandy should contain not less than 1.5% proof spirit. The matter was raised with the manufacturers who stated that they agreed and aimed for 1.7% proof spirit, Mel, Boracis Borax and Honey B.P.C, The sample was incorrectly labelled. Borax and honey was not included in the current edition of the British Pharmaceutical Codex and the label should indicate the date of the edition in which the medicine is described. The Public Analyst thought that a warning ought to be included in the label that special care is necessary in treating infants, because of the toxic nature of boric acid allied to its slow rate of excretion. The manufacturer stated that since publication of B.P.C. 1963 labelling had been in terms similar to those suggested by the Public Analyst. Borax and honey had not been produced since 1966, Custard. The sample was found to be not of the quality expected. It had separated into a solid mass and a clear liquid. The manufacturer reported that the formulation broke down in a batch and this had since been corrected. 142 Savoury Cheese Mini-Gateau. This article was incorrectly named. It contained added butter and therefore became a cheese spread or cheese food. Correspondence with the importers is continuing. Jellied Pickled Eel. The ingredients were not specified on the label as required by the Labelling of Food Order 1953 and the importers have arranged for the label to be amended to include a list of ingredients. Shrimp Chow Mein, The article contained 9% of shrimp. In the opinion of the Public Analyst the title for such an article should not have the name of a variety of fish as the first word in the title and the label has been amended. Low Fat Spread (2 Samples). The article contained times the maximum amount of water permitted by the Food Standards (Butter and Margarine) Regulations 1955. A general claim for the presence of vitamins was made in the form of the inclusion of Vitamins A and D in the list of ingredients, but the minimum quantities of Vitamin A and Vitamin D were not declared on the label as required by the Labelling of Food Order 1953® Following correspondence, the labels were amended to include the quantities of Vitamins A and D. Glacé Cherries. Some of the ingredients were not correctly declared. Two were listed as 'glucose' and 'S02' but the appropriate designations for these are glucose syrup and sulphur dioxide. The supplier agreed to amend the list of ingredients on the container. 143 Strawberry Fruit Filling. The title and illustration were misleading. The sample contained 23% of strawberries, but the title and illustrations of a dish of fresh strawberries were calculated to give the impression that the article consisted essentially of fruit. In the opinion of the Public Analyst the article should be described as Strawberry Pie Filling. The manufacturers reported that this product was formulated to contain a much higher proportion of strawberries and a subsequent sample was found to be satisfactory. Rum Flavoured Cola. The title was misleading. The minute proportion of rum present, 0.6% did not appear to justify the name. The manufacturers agreed to change the name of this product to Rum Flavour Cola and the declaration of proof spirit to "not more than 0.5 degrees proof". Dried Herbs. The ingredients were not specified on the label as required by the Labelling of Food Order 1953. The packers amended the label to include a list of ingredients in descending order by weight. Orange and Kahao Creme. The ingredients were not specified on the label as required by the Labelling of Food Order 1953.and the importers have agreed to amend the label. Non-dairy Creamer. The label on this product was misleading. It bore the statement "for creaming coffee" but the sample contained no butter fat. The matter was raised with the importers and the label amended. 144 Irish Stew. The sample contained 7.5% cooked peas which were not declared in the list of ingredients. The packers regretted that the peas were not listed in the ingredients and stated that the Company had ceased manufacture of this product some months before the sample was procured. Butter Sponge Bar. The sponge contained no butter fat and was subsequently sampled by the formal procedure. Cascara Tablets B.P. The tablets were dispensed,in terms of Imperial Weight and not Metric Weight. Following correspondence the tablets withdrawn from sale. Turtle Soup. The list of ingredients included the term "other amino acids". This is a generic and not a specific term. The manufacturers stated that the sample was old stock and that current labels conform. Tinted Drawees. The sample contained Blue VRS which is a colouring matter not included in the list of permitted colouring matters in the Colouring Matter in Food Regulations, 1966. The manufacturer stated that this was old stock as Blue VRS had been replaced by G-reen S for some time. Arrangements were made to check stocks and replace as necessary and cartons were to be coded to assist in effective stock rotation. 145 FOODS SUBJECT OF COMPLAINT. A total of 98 complaints about articles of food were received during the year, all were thoroughly investigated and appropriate action was taken. Mould and foreign bodies continue to be the main reasons for complaint. The following complaints were considered sufficiently serious to necessitate taking proceedings. Two bottles of Milk containing Foreign Matter. Foreign matter in two bottles of milk delivered by the roundsman at the same time. A fine of £20 was imposed with 5 guineas costs. Metal in Loaf. A fine of £40 and 10 guineas costs, was imposed. Mouldy Cornish Pasty. A fine of £20 with 10 guineas costs was imposed. Strawberries - mouldy and unfit for human consumption. The strawberries were sold in a very poor condition, many were moist, mouldy and decomposing. A fine of £5 with 3 guineas costs was imposed. Mouldy Pork Pie. A fine of £5. with £16. 5. 0. costs was imposed. JOINT SURVEY OF PESTICIDE RESIDUES IN FOODSTUFFS. The Interim Report of the results obtained in the first year of the National Pesticide Residues Survey in which this Food and Drugs Authority participated, shows that traces of pesticide residues were found in a significant number of samples of the foods examined. The amounts found were generally small and corresponded with the known use of pesticides on crops. Whilst it is clearly desirable that amounts of pesticide residues should be kept as low as practicable, there would appear to be no short-term hazard associated with the amounts found and no samples showed gross contamination. It is stressed that the Report is an interim one and conclusions necessarily tentative. 146 Eighteen samples of food were taken during the year in connection with this survey. TRADE DESCRIPTIONS ACT. 1968. This Act, which replaced the Merchandise Marks Acts 1887 to 1953, came into force during the year. During routine visits to food shops, inspections were carried out under the 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. Twelve samples of fertiliser were purchased during the year and all were found to be satisfactory. Very little animal feeding stuff is sold within the Borough. PHARMACY AND POISONS ACT. 1933. 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 and acids for domestic or industrial use . During the year under review 16 names were removed and five added. The total of names on the list at the end of the year was 126. 147 SAFETY. During the year one complaint was received concerning the possible toxic effects from a joke box containing "electric sneezing snuff". The snuff was pushed into a child's face which produced painful symptoms. In co-operation with the Home Office the manufacturers undertook to include a warning on the package. Whilst most members of the general public are aware of the dangers arising from inadequate airing of dry cleaned fabrics and clothing at self-service dry cleaners, it is necessary to keep this particular hazard before the operators and the users of the apparatus. ANIMAL ESTABLISHMENTS. There are three riding establishments in the Borough which are licensed under the provisions of the Riding Establishments Act, 1964 and the Department, in collaboration with the Veterinary Surgeon appointed by the Corporation carry out the necessary administrative work. There are six animal boarding establishments and thirteen pet animal shops licensed by the Council. SCHOOL HEALTH SERVICES ROYAL BOROUGH OF KINGSTON UPON THAMES EDUCATION (SCHOOLS AND FURTHER EDUCATION) SUB-COMMITTEE AS AT DECEMBER 1968 Chairman: Councillor P.R.Wise, F.C.A. Vice-Chairman: Councillor K.C.Gooding Aldermen: Miss D.L.Tapping J.H.Cocks, O.B.E. W.J.Marshall Councillors: Mrs.E.A.Bidmead J.P.C.Kimber, B.Sc.,(Econ)F.C.I.I. R.M.Church Mrs.R.M.Vernon J.G.Glasspool, B.Sc., B.A.(Oxon.) W.J.Webb, B.A. C.R.Goss, A.A.I.B. R.P.T.Wickes D.Ives, M.A.(Oxon.) Co-opted Members: Mrs.M.Hall R.Humphrey E.Morgan F.Seal W.F.Richardson O.F.Thompson 151 SCHOOL HEALTH SERVICE Readers are referred to the comments on the school health service on pages 4 and 5. The population of the borough, estimated by the Registrar General, was 144,480 at mid-1968. In January 1969 the number of pupils on the registers of maintained schools was 19,178 made up as follows; Primary Schools 10,986 Secondary Schools 7,912 Nursery Schools 76 Special Schools 204 In addition it is estimated that 2,877 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 services. The number of maintained schools in the borough on 31st December 1968 was 55: 14 secondary, 38 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-three health visitors, carry out the functions of school nurses, demoting 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 and sixteen year old pupils. 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 1968 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 6,417 children being examined. 152 At the three schools where examination of eight year olds was carried out on a purely selective basis, 127 children were selected for examination. The arrangements for periodic medical inspection are summarised below: On entry to infant and nursery schools On entry to the junior school On entry to the secondary school During the year in which age fifteen is reached In addition to these complete medical examinations, the hearing of every child is tested at the age of six and eleven years (approximately) by a pure tone audiometer. 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 the summer term the scheme of selective medical examinations of eight year olds was extended to all junior and primary schools with the proviso that, during the first year the scheme was in operation at any school, all children be examined regardless of whether or not any defects were noted from the information available- Judging from the results of the examinations carried out, the system of selective examinations proved to be very successful and in view of the findings it has been approved that in the future this system of medical examination be adopted for all eight year old pupils. General Conditions as Recorded at Periodic Inspection Of the 6,417 pupils inspected, 6,414 were deemed to be of satisfactory general condition. This is a personal assessment by the inspecting medical officer which takes into account general body contour and covering, general muscle tone, facial complexion, appearance of mucous membranes and eyes, posture, alertness and poise. In modern times it is more common to find pupils who are over nourished rather than underweight. Obesity has many disadvantages in school life as well as carrying increased risk to normal health in later years. In most cases obesity is preventable or can be cured, and merits more serious consideration by parents and teachers than is usually given. The 3 children whose general condition was deemed unsatisfactory consisted of 1 born in 1961, 1 in 1957 and 1 in 1953. 153 Defects found at Periodic Medical Inspections During 1968, 807 (12.6 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 1964 and later 251 8 29 36 1963 1299 33 96 114 1962 172 6 7 12 1961 104 3 4 7 1960 1029 41 74 109 1959 234 13 12 25 1958 69 4 8 10 1957 1079 109 58 153 1956 503 60 38 85 1955 68 9 - 9 1954 45 3 1 4 1953 and earlier 1564 205 81 243 Totals 6417 494 408 807 154 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 72 127 Eyes: (a) Vision 494 381 (b) Squint 71 17 (c) Other 8 13 Ears: (a) Hearing 8 100 (b) Otitis Media 16 96 (c) Other 12 6 Nose and Throat 27 236 Speech 39 49 Lymphatic Glands 5 96 Heart 2 58 Lungs 7 127 Development: (a) Hernia 3 7 (b) Other 6 106 Orthopaedic: (a) Posture 46 104 (b) Feet 68 80 (c) Other 27 82 Nervous System: (a) Epilepsy 10 20 (b) Other 5 32 Psychological: (a) Development 8 95 (b) Stability 12 153 Abdomen 10 24 Other 28 63 Total: 3056 984 2072 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 1,498. 155 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 283 pupils examined at these inspections are analysed below: Defect or Disease Requiring Treatment Observation Skin 65 40 Eyes: (a) Vision 9 9 (b) Squint 1 - (c) Other - - Ears: (a) Hearing 12 50 (b) Otitis Media 2 2 (c) Other 2 2 Nose and Throat - 13 Speech 4 4 Lymphatic Glands 1 4 Heart - 1 Lungs 3 4 Development: (a) Hernia - - (b) Other 2 3 Orthopaedic: (a) Posture 2 2 (b) Feet 19 12 (c) Other 3 3 Nervous System: (a) Epilepsy - - (b) Other - -• Psychological: (a) Development 6 7 (b) Stability 3 10 Abdomen 3 1 Other 6 30 Toted defects: 340 143 197 156 Treatment of 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 - Head or Body 2 Scabies 1 Impetigo 4 Other 8 Vision and Squint 1,301 Other Eye Conditions 42 Ear, Nose and Throat 488 Speech 493 Lymphatic Glands 2 Heart 9 Lungs 52 Development 17 Orthopaedic 299 Nervous Diseases 70 Abdomen 69 Other 149 Total 3,006 Combined general medical and immunisation sessions attended by a school medical officer 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: Operative Treatment Tonsils and Adenoids * 488 Diseases of the Ear Received other forms of treatment 60 *This number includes children treated in hospitals within the borough and may include a few children from adjoining areas. 157 Speech Therapy The work of the speech therapy service has continued satisfactorily during 1968 in spite of some staff changes. There was a continued growth in the service during the year, a total of 492 children receiving treatment as compared with 435 during 1967. Pre-school groups have been started wherever the demand and clinic facilities allow. These groups are very valuable in the stimulation of speech and language development through play methods and it has been found that the young children respond well to informal treatment at this age, particularly as there is no established habit factor. Details of the work undertaken at the centres are shown below, with the 1967 figures for comparison. Centre Present Number of Sessions Initial Caseload Children Treated Remaining for Next Year 1968 1967 1968 1967 1968 1967 1968 1967 Acre Road 1 2 25 24 41 47 18 25 Bedelsford School 9 6 27 22 35 31 25 27 Grange Road 3 2 23 13 50 26 32 23 Hook 3 3 40 31 56 53 34 40 Roselands 5 5 57 51 101 98 58 57 St.Philip's School 7 2 38 38 68 47 47 38 Surbiton 2 2 12 27 32 36 20 12 Tolworth 2 2 14 19 38 32 27 14 Worcester Park 5 4 47 48 71 65 49 47 Totals 37 28 283 273 492 435 310 283 158 Analysis of Cases Treated Children Treated during Discharged Remaining at end of period covered 1968 1967 1968 1967 1968 1967 Stammering 56 73 23 26 33 47 Cluttering - - - - - - Dyslalia 271 249 114 96 157 153 Idioglossia - - - - - - Anarthria/Dysarthria 21 19 4 4 17 15 Aphasia/Dysphasia 14 11 2 1 12 10 Aphonia/Dysphonia 3 4 2 1 1 3 Cleft Palate 4 5 1 1 3 4 Hyperrhinophonia 12 9 2 2 10 7 Hyporhinophonia 1 1 - - 1 1 Defective Speech due to Deafness 8 5 2 2 6 3 Retarded Speech and Language Defect 100 52 31 18 69 34 Unclassified 2 7 1 1 1 6 Totals 492 435 182 152 310 283 Ophthalmic Clinics During the year 1,304 children were examined at the school eye clinics; 441 were prescribed glasses, which were dispensed by National Health Service opticians,, Immediately after children obtain their spectacles they are re-examined at the eye clinics. Children requiring orthoptic treatment are referred to hospital. Vision testing of all school children is carried out at the time of their routine medical examinations, and also at thirteen and sixteen years of age. The increase in the numbers referred is attributed to the introduction of the Keystone Vision Screener in September. Audiology The joint audiology service with the London Borough of Merton has shown a further expansion. Not only has the number of attendances increased but since the appointment of a second peripatetic teacher of the deaf, pre-school children with hearing impairments are now visited twice weekly. With the appointment of a second audiometrician a second sweep testing has been introduced into the secondary schools and already results show that this is a much needed service. 159 A wide variety of training courses .has been held in both boroughs for professional and lay workers. During 1969 a partially hearing nursery unit attached to a normal primary school is to be established in Merton. This will be staffed by a qualified and experienced teacher of the deaf assisted by a nursery helper, and will serve both as a diagnostic and teaching unit. Children attending special schools and units outside the borough attend special clinics, in order that their educational placements can be reviewed. School leavers were also seen at special clinics in conjunction with the social welfare officer for the deaf, so as to establish close co-operation between the school and post-school services for these handicapped children in adult life. The service is staffed by a medical officer specially trained in this work who is assisted by two audiometricians and two teachers of the deaf. All pupils have a routine hearing test between the ages of six and seven and again on entry into the secondary school. Details of the work undertaken in schools: Children sweep tested - Primary 1,491 Secondary 2,046 - 3,537 Children who failed test - Primary 88 Secondary 57 - 145 Result of investigations by school medical officers: No significant hearing loss on clinical examination 46 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) 34 (ii) Old Otitis Media 10 (iii) Injury (iv) Other causes 26 (v) Undetermined causes 14 Investigations incomplete at end of year 10 Investigations not possible - left district or otherwise unavailable for examination 3 160 Recommendations by school medical officers in the first instance: (i) No action required 41 (ii) For observation only 60 (iii) Refer to audiology clinic 16 (iv) Refer to general practitioner 5 (v) Refer to ear, nose and throat consultant 10 There were 54 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 56. Audiology Clinic Of the 264 attendances during the year, 125 were made by 96 children under the age of five, and 159 were made by 98 children aged five and over. Details of children and attendances are as follows: A&E GR0UP Totals Under 2 2-4 5-7 8-11 11+ New cases referred from all sources 24 60 44 30 21 179 Cases carried over from 1967 7 5 2 1 - 15 Found to have normal hearing 27 54 30 22 9 142 Deaf in one or both ears - - 4 6 8 18 Found to have remediable hearing loss - 8 11 3 2 24 Impaired hearing requiring auditory training and/or hearing aid 1 4 - - 1 6 Not fully assessed at end of 1968 - - 1 - 1 2 Attendances 44 81 59 46 34 264 161 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 184 Children treated 165 Attendances 2,071 New cases admitted 79 Cases discharged 81 The 88 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, 10 of the children examined were referred for treatment and 20 others were noted for observation at a later date. Enuresis This is a distressing condition, often difficult to overcome, and parents frequently seek advice from the school medical officers. 27 children were found to require treatment for this condition and a further 24 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. 23 children were loaned this apparatus during 1968, and of these, 7 were cured, 3 benefited, 6 are still using the alarm and 7 failed to benefit from the 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 64 Examined 13,191 Cases with nits 58 Cases with lice 5 Cases with verminous bodies Nil 162 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 15 Enteric Fever - Measles 108 Whooping Cough 15 German Measles 1 ,121 Chicken Pox 698 Mumps 49 Jaundice - Dysentery 1 Influenza - Other 37 Total 2,044 Immunisation and Vaccination It is now usual for children to be fully immunised 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,, Immunisation against measles was introduced in May and by the end of the year 1,259 children of school age had been immunised. Any necessary reinforcing injections are made available to children while they are at 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 school is very much appreciated. 163 Diphtheria Primary Immunisation Number who completed a primary course 143 Reinforcing Number who received reinforcing injections 2,649 Total 2,792 Poliomyelitis Primary Course Number who completed a primary course 210 Reinforcing Number who received a reinforcing dose 1,995 Total 2,205 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 320 Reinforcing Number who received a reinforcing injection 2,665 Total 2,985 Measles Number who received immunisation 1,259 Smallpox Number who received primary vaccination 69 Reinforcing Number who received revaccination 113 Total 182 164 Vaccination against Tuberculosis During the year three school children involving three 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.G.Programme B.C.G. Offered Consented Absent Mantoux Positive Vaccinated No. Percentage of those tested No. Percentage of those offered 1538 1467 (95.4%) 220 76 6% 1171 76% Child Guidance The number of referrals to the Child Guidance Clinic has remained constant. The clinic has continued to be selective in deciding which children would benefit from a specialised service and this has reduced the number of social problems previously referred to the clinic which could not properly be helped by a psychiatric service. The waiting list remains within manageable proportions and the clinic continued to have liaison with other agencies, such as the probation service, child care service, and the health and welfare services. It is hoped that health visitors will be able to participate in consultative seminars of the type used by the probation service. Increased psychotherapy sessions have enabled more children to receive intensive treatment at the clinic. Since the inception in November 1967 of the day unit for emotionally disturbed children at Mecklenberg House, 11 children between the ages of six and fourteen years have been admitted. The unit has provided an opportunity for closer observation and assessment of the overall functioning of these children, so that their future placement can be more accurately determined. One child was in fact able to return to normal school, whilst others have returned on a part-time basis. 165 There is a high degree of co-operation between the work of the teacher at the unit and the child's normal school. The following table shows the work done during the year: Caseload brought forward from 1967 297 Waiting list at December 1967 7 304 137 new cases were referred during 1968 by the following: Court 6 School Health service 28 Hospitals 12 Private practitioners 40 Child Guidance clinics 2 Direct non-medical 48 Specialists 1 137 Reasons: Nervous disorders 30 Behaviour problems 74 Habit disorders 11 Psychosomatic disorders 1 Educational problems 14 For special examination 6 Advice only 1 Total of new cases 137 137 Total caseload during year 441 New cases initially seen by psychiatrist during the year 136 New caseload initial distribution: Psychiatrist 51 Psychiatric Social Worker 67 Psychologist 15 Psychotherapist 3 136 166 All cases - closures during year: Treatment completed 1 Advice only 7 Non co-operative 13 Other arrangements made 20 Improved 17 Failed to attend 17 Transferred to other clinics 5 80 Caseload on treatment at end of year 350 On waiting list for diagnostic interview at end of year 11 441 HANDICAPPED PUPILS Special Schools and Hostels The following table shows the placement of Kingston children in special schools, units and hostels: Category Number attending at end of 1968 Recommended for placement-parents refused consent Receiving home tuition On waiting list for special school Day Special Schools or Units Boarding Special Schools or Hostels Kingston Other Other Boys Girls B G B G B G B G B G Blind - - - - 1 - - - - - - - Partially Sighted - - 2 2 - - - - - - - - Deaf — — 3 1 2 2 - - - - - - Partially Hearing - - 1 1 1 - - - - — 1 1 Educationally Subnormal 59 29 - - 7 3 - 1 - - - 1 Epileptic - - 1 - - 4 - - - - - - Maladjusted 6 — 1 — 18 5 — — 4 — 7 - Physically Handicapped 12 7 1 - 3 5 - - 2 2 2 4 Delicate - - 3 - - - - - - - 1 - Speech Defect - - - - - - - - - - - - Totals 77 36 12 4 32 19 - 1 6 2 11 6 167 Bedelsford School, Grange Road,, Kingston This school for physically handicapped children now receives into the nursery class children from the age of three, which is not only of great benefit to the children but a tremendous help to their parents. Children are provided with transport to and from school and are accompanied by escorts. All pupils receive a mid-day meal at school and special arrangements are made for children in need of diets. It has always been the endeavour to emphasise normality as far as education is concerned and whenever possible children are encouraged to be independent and transferred to normal schools. As the classes are small, it is possible to provide education on individual lines and instruction is also given in crafts and domestic science. Children at the school are examined regularly by a senior medical officer and all the children are receiving social training and daily physiotherapy. Pupils with speech defects are treated by the senior speech therapist at an early age. In the early summer of 1968, a large number of children undertook a journey to Austria accompanied by teachers and physiotherapists. The children stayed in a specially adapted hostel for physically handicapped children in the Vienna Woods. During their stay in Austria the children were received by the Lord Mayor of Vienna and each child was given a beautifully illustrated booklet showing all the historic sights. This trip proved a great success, both educationally and socially. St.Philip's School for Educationally Subnormal Children Fleetwood House, Leatherhead Road, Chessington Thanks are expressed to Mr.J.A,Ainley, Headmaster, for the following report: This school has accommodation for 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. 168 During 1968 it was the school's aim to achieve better contacts and relationships with the community. To improve relationships with parents monthly open evenings were inaugurated. Termly news letters and annual reports were prepared for distribution and many invitations were given to parents to come to the school. The school was visited by teachers from other schools, students, lecturers and social workers, and teachers at the school made visits to other establishments. In addition members of staff were involved in one or more of 14 different courses and conferences held during the year. The school's success in swimming continued and the children won 3 gold, 5 silver, and 10 bronze A.S.A. medals. A group of the best readers in the school visited the local library weekly in the hope that their interest in reading would be continued at home and maintained after leaving school. The employment position continues to present few problems and all our leavers since January 1968 have been found employment. A total of 13 children left the school during 1968 and were assisted in finding employment by the Youth Employment Service. Types of employment in which success has been achieved: Nursery Assistant Clerk Labourer Parks Assistant Laundry Assistant Factory Hand Canteen Assistant Sales Assistant Baker'e Assistant 169 Ascertainment of Handicapped Pupils Children ascertained in 1968 as requiring special educational placement Category Number Blind Nil Partially Sighted Nil Deaf 1 Partially Hearing 2 Educationally Subnormal 25 Epileptic 1 Maladjusted 15 Physically Handicapped 9 Delicate 4 Speech Defect Nil Total 57 Health Education Details of activities which took place in schools and youth centres are reported on pages 23 and 24. Youth Employment Service - Year Ended 30th September 1968 Number 1967 1968 Boys and girls living in the borough known to have left school 1 ,010 1,024 New entrants into National Insurance: School leavers 674 688 First advisory interviews 1,129 1,240 Interviewed who continued full time education at school or college 556 621 Applications for employment* 1,255 1,235 First applications included in above figure 633 578 Vacancies notified* 1,960 2,137 Kingston boys and girls placed in local employment 772 734 Kingston boys and girls placed in other districts 62 92 Local residents included in above figures who were placed in first situations 369 401 Total of vacancies filled in Kingston area 897 887 * Including register brought forward on 1st October. Thanks are expressed to Mr.F.S. Robinson, Principal Youth Employment Officer, for his assistance in compiling the sections of this report dealing with school leavers. 170 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. The number of examinations for these purposes and the results of the examinations are shown in the following table: Examinations for employment certificates 281 Children examined for entertainment licences 8 Found 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 ls.6d 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: Based on September 1968 Returns Children in attendance 17,434 Taking milk 9,733 Percentage taking milk 55,83% Taking meals 13,968 Percentage taking meals 80,12% Cost of meal to pupil 1s. 6d Actual cost of meal 2s.10½d Percentage taking meal at: Pull cost 91.33% Free 8.67% Average number of days meals were supplied in year 181 Average daily number of meals supplied 14,417 Number of meals supplied: Non-maintained schools and other establishments 39,606 Maintained schools 2,728,655 2,768,261 171 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. 33 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 4 children of school age. The causes of death were as follows: 1 Pneumonia 1 Secondary deposits Sarcoma of Maxilla 1 Electrocution (on railway line) 1 Accidental death (road accident) Medical Examination of Adults 155 newly appointed teachers and candidates for admission to teachers training colleges were medically examined as required by the Department of Education and Science. Of 259 teachers appointed to Kingston schools, submitting medical history forms, 257 were considered fit from scrutiny of the forms,and the remaining 2 following medical examination having regard to details in the forms. 172 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. Mecklenberg House, 50 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. 173 SCHOOL DENTAL SERVICE Chief Dental Officer - Miss Ann Hobley, L.D.S., R.C.S.(Eng.) (Resigned 15.11.68.) (D.M.Dodd L.D.S., B.D.S. appointed 6.1.69.) STAFF From the beginning of the year until the end of the summer term, the borough maintained the full establishment of dental officers with no changes. In the autumn a part time locum dental officer replaced the two part time staff who left during the summer months at Gosbury Hill Clinic. Miss Hobley resigned her appointment as chief dental officer in mid-November, immediately prior to her marriage; and Mr.Fuller, the senior dental officer, and Mrs.Herd, both resigned at the 31st December, Mr.Fuller having been appointed to the post of area dental officer in Buckinghamshire. Mr.Donald Dodd, deputy chief dental officer of Cheshire, has been appointed to succeed Miss Hobley and will take up his duties in the new year. No provision has yet been made for a hygienist to be employed in the borough, and the part time auxiliary was not replaced when Mrs. Hibbert left in the autumn. The staff of dental surgery assistants has remained basically unchanged during the year, and the dental officers are always especially grateful for the willing assistance of relief staff during holidays and times of sickness. The dental officers continued to have their regular staff meetings,a considerable amount of time, especially earlier in the year, being given to the problems of health education. Some meetings were attended by the surgery assistants who helped in the campaign. Special discussions were held at certain meetings, following business matters; these included one on school inspections and another on orthodontics. During the late spring a very favourable report was received from the Ministry of Education and Science, following the inspection by one of their dental officers, Mr.J.Rodgers, the previous autumn. The chief dental officer attended the Annual Conference of the British Dental Association at Brighton, and the senior dental officer attended a course on Children's Dentistry at the Eastman Dental Hospital in the spring. Once again, the professional staff are indebted to both the Consultant Oral Surgeon, Mr.R.A.Peebles, and the Consultant Orthodontist, Mr.H.Orton, at Kingston Hospital, for their assistance and co-operation, and along with this, the staff would like to record their thanks to all their medical and dental colleagues in the borough. 174 CLINICS Plans to rebuild various clinics are under discussion. Meanwhile, the present clinics are, on the whole, adequately equipped, but in each year's budget some provision must be made for replacement of old equipment and an aspirator is an essential item of new equipment to be purchased. Thanks are again due to Mr.Hicks and his staff in the Surrey County Council laboratory, which facilities are available to Kingston. SCHOOL INSPECTIONS Because of the importance of school inspections, the dental officers were urged to plan inspections for their schools to spread them over the year, and some were able to do this. However, due to one dental officer's long sick leave, and understaffing later in the year, as well as considerable time being spent on the dental health campaign, several schools were not inspected during the year. The special schools were the responsibility of the chief dental officer, who undertook inspection at St.Philip's and Bedelsford Schools, and the Kingston Training Centre. TREATMENT Routine treatment continues to be the major part of the dental officer's work, but also where necessary, emergency treatment is given. Most important of all, there is a recall system to maintain dental health for those previously made dentally fit. ORTHODONTIC SERVICE This remains in the capable hands of the same two prthodontists, and an excellent service is maintained. DENTAL HEALTH EDUCATION The importance of dental health education is being increasingly realised by the profession, and it is considered by many to be one of the main responsibilities of the school dental service. Having embarked on a fuller programme of dental health education during last year, this was further expanded. In mid-1967 early plans were laid for the main campaign in May 1968. Meanwhile, a return visit of Pierre the Clown to the borough was financed by the health and welfare department, in order that he might visit the other half of the schools not included in his initial campaign in June 1967. This return visit took place in March, and he was as waraily received by the heads and staffs of the schools as well, of course, by the pupils, as he had been previously. 175 The main campaign held in the middle two weeks of May was organised in conjunction with the Oral Hygiene Service, to whom the borough is greatly indebted. Mention must be especially made of the work of Miss Doreen Land, their dental health education lecturer, who not only undertook the major part of the organisation with the chief dental officer, but also gave her services for the first week, lecturing in the borough. In January Mr„Colin Davis, director of the Oral Hygiene Service, lectured on dental health education to the heads and discussed briefly the forthcoming campaign. During the spring the dental staff were busy preparing their lectures and visual aids, because the main part of the campaign comprised visits by the dental teams to all the primary schools in the borough to give talks and show dental films to groups of children. Apart from these talks in the schools, there were various other aspects of this project, which will be briefly mentioned here. A poster, specifically designed for Kingston, was printed and distributed widely to publicise the campaign. A window display at Bentalls was arranged for the week prior to the campaign. A letter was sent from the chief dental officer to the parents of all primary school children in the borough, this being distributed through the schools. A letter was also sent to all medical and dental practitioners, and another to all pharmacists, concerning the campaign, and dental health literature was made available to them. Another letter was sent to all leaders of youth and womens' organisations in the borough. Miss Land gave a lecture to the student nurses at Kingston Hospital one afternoon, on the importance of dental health education, after which she and Miss Hobley visited the children's ward to distribute toothpaste and dental health jigsaws to the patients. Finally, one of the main activities of the campaign was the open meeting held at the Assembly Rooms, Surbiton, on 15th May. There was a panel of speakers under the chairmanship of Mr.Gordon Williams, immediate past Chairman of the Kingston and District Section of the British Dental Association. Mr.Williams' special interest in and concern about dental health education, and his encouragement with all the plans for the campaign, was of the greatest possible help to the chief dental officer, and to Miss Land and the dental staff. The speakers were Mr.Rivers, head of one of the borough's primary schools, Mrs.iSden, a nutrition expert, Miss Land on dental health education, and Miss Hobley, the chief dental officer. A dental health film was shown, after which each member of the panel spoke briefly on his/her subject, and then invited questions from the audience. 176 The results and success of such a campaign are almost impossible to assess, but it is only to be hoped that in the next few years, with further follow-up projects taking place, there will gradually be a reduction of dental disease in the children of the borough. In November the dental staff took part in the health exhibition held for a week at the Hollyfield Centre, and organised by the health and welfare department. 177 The following is a summary of the work undertaken: General Dental Inspection and Treatment Numbers Inspections: At school 13,206 At clinic 15,805 Re-inspections at school and clinic 1,883 Pound to require treatment 6,740 Treated 4,628 Attendances for treatment 11,783 Sessions for inspection 125 Sessions for treatment 2,250 Sessions devoted to dental health education 91 Fillings: Permanent teeth 5,743 Temporary teeth 3,693 9,436 Filled: Permanent teeth 4,991 Temporary teeth 3,310 8,301 Extractions: Permanent teeth 384 Temporary teeth 1,031 1,415 General anaesthetics 286 Other operations: X-rays 516 Prophylaxis 2,206 Teeth otherwise conserved 1,278 Root teeth filled 29 Crowns and Inlays 27 4,056 Orthodontic Cases Commenced during the year 185 Brought forward from previous year under treatment or observation 486 671 Completed during the year 157 Discontinued during the year 72 Referred to hospital consultant 4 Removable appliances fitted 220 Fixed appliances fitted 74 Total attendances 2,061 Under treatment or observation at end of year 438 178 INDEX Page Abortion Act 1967 25 Accommodation for Elderly 69-75 Admissions to Hospital 61 Aids and Adaptations for Handicapped 88 Air Pollution 114-121 Aircraft Noise 99 Ambulance Service 48 Animal Boarding Establishments 147 Ante-natal Clinics 28 Atmospheric Pollution 114-121 At Risk Register 36 Audiology 158-160 Audiometry 158-160 Bacteriological Examinations 22,102,128,134 Baths 102-103 B.C.G. Vaccination 53,164 Births 12 Birth Rate 12 Blind, Welfare of 80-85 British Red Cross Society 57 Bronchitis 17 Burial or Cremation of Deceased Persons 94 Cancer Education 23 Cancer Statistics 15,43 Caravans 127 Car Badges for the Handicapped 90 Certificates, Disrepair 125 Certificates, International Vaccination 48 Chest Clinic 51,53 Chicken Pox 162 Child Guidance Clinic 164-166 Child Minders 35 Child Welfare Clinics 29 Children's Homes 35 Chiropody 58 Clean Air Act 114-121 Cleanliness 112,161—162 179 Page Clinics 28,29,30,48,56,61, 158,160,164-166,172 Closing Orders 124 Clubs 62,91-93 Community Care 62 Complaints 121,122,145 Compulsory Removal 24 Congenital Malformations 37-39 Co-ordinating Conferences 49 Cremations 25,94 Crematorium 25 Day Nurseries 34,35 Deaf 79,85,86,158-160 Deaths 14-18 Death Rates 12,13 Demolition Orders 124 Dental Services 30-33,173-177 Dental Health Education 174-176 Diphtheria 20,21 Disinfection 105 Disinfestation 105 District Nurses 41-43 Domiciliary Services 40-46,61,75-79,83-86 Drainage and Sewerage 104 Dysentery 20,21 Education Act 151 Education (Schools & Further Education Sub- Committee) 150 Educationally Subnormal Children 166-169 Elderly Persons 43,45,69-75 Employment of Children 170 Employment of Handicapped 89 Encephalitis 20,21 Enuresis 161 Environmental Health Services 99-147 Epileptic Children 161 Factories Act 1961 107-109 Family Planning Association 56 180 Page Families with Problems 49-51 Family Welfare 49-51 Fathercraft 45 Fertilisers and Feeding Stuffs 146 Flooding 100,104 Food and Drugs Act 134-144 Food Hygiene Regulations 128-134 Food Poisoning 20,21 Food Premises 128-134 General Practitioners - Attachment 41,44 Gypsies 127 Handicapped Children 166-169 Handicapped Services 79-93 Health and Welfare Committee 7 Health and Welfare Staff 8 Health Centres 28 Health Education 23,24,169 Health Services and Public Health Act 1968 35 Health Visiting 44-46 Heart Disease 16 H.M.Inspector of Factories 107,108 Holidays - Children 171 Handicapped 90 Recuperative 36,56 Home Help Service 49,59 Home Nursing 41-43 Home Nursing Equipment Loans 57 Homes for Elderly 69-75,83 Homes for Handicapped 83 Home Workers Scheme 83 Hospitals 26 Hospital Confinements 40 Hospital Liaison 46 Hostels 61 House Improvements 100,125,126 Houses - Multiple Occupation 125 Houses Unfit 124 Housing Acts 124 181 Page Ice Cream 129 Illegitimate Births 12 Immigrants 45 Immunisation and Vaccination 4-7,4-8,162-164 Imported Food 130 Improvement Grants 125,126 Incontinence Laundry Service 42 Infant Mortality 12,13 Infant Welfare Clinics 29,30 Infectious Diseases 19-21,162 Infective Jaundice 19-21 Influenza 162 Insect Pest Control 122,123 Inspections 105-108,110,111,151-155, 174,177 International Certificates of Vaccination 48 Introductory Letter 1-6 Laboratory Service 22 Legitimate Births 12 Library for the Blind 84 Licences 128 Live Births 12 Loan of Nursing Equipment 57 Lung Cancer 15,55 Marie Curie Night Nursing Service 42 Marriages 19 Mass Radiography 55 Maternal Mortality 12 Meals on Wheels 77-79 Measles 20,21,162,163 Meat Inspection 129-133 Medical Aid 40 Medical Examination of Adults 26,171 Medical Treatment 156 Meningococcal Infection 21 Mental Health Services 60-65 Mental Illness 60-62 Mental Subnormality 63-65 Merchandise Marks Act 146 182 Page Midwifery Service 40,41 Milk 128 Mortuary 26 Mothercraft Training 45 Mothers Clubs 46 Movable Dwellings 127 Multiple Occupation - Houses 125 Mumps 162 National Assistance Act 24,79,94 Neonatal Mortality 13 Noise 99,114 Notices 107,124 Nurseries and Child Minders Regulation Act 1948 35 Nurses Agencies 25 Nursing Equipment - Loans 57 Nursing Homes 25 Occupational Therapy 73,88 Offices, Shops and Railway Premises Act 109-114 Old People's Homes 69-75 Ophthalmia Neonatorum 20,21 Ophthalmic Clinics 158 Orthodontic Service 174,177 Outwork 89 Partially Sighted 82 Patient Operated Selector Mechanism (POSSUM) 91 Perinatal Mortality 13 Personal Health Services 28-59 Pest Control 122,123 Pet Animals Act 106 Pharmacy and Poisons Act 106,146 Physically Handicapped, Children 166-169 Physically Handicapped, Schools 166-169 Physically Handicapped, Services 79-93 Physiotherapy 63,161 Pigeons 121,122 Pneumonia 20,21 Poliomyelitis 20,21 Population 12 183 Page Post-natal Clinics 28 Problem Families 49-51 Protection of Property 94 Psychiatric Services 62 Public Cleansing 104 Public Health Acts 106 Public Health Laboratory Service 22,128,129,134 Puerperal Pyrexia 20,21,41 Rateable Value 12 Receivership 94 Recuperative Holidays 36,56 Refuse Collection and Disposal 104 Registration - Homes for the Elderly 75 Relaxation Classes 28 Residential Homes 69-75 Residential Hostels 61,65 Riding Establishments Act 147 Ringworm 156 Rivers and Streams 100,104 Rodent Control 122,123 Safety 147 St.John Ambulance Association 57 Samples - Bacteriological, Chemical 103,128,129,134-146 Scabies 156 Scarlet Fever 20,21,162 School Children 151-177 School Dental Service 173-177 School Health Service 151-177 School Meals 170 School Milk 170 Sewerage and Drainage 104 Sheltered Workshops 83 Shops Act 109 Short Stay Accommodation - Aged 72 Smallpox 162 Smoke Control 114-121 Social Clubs 62,91-93 Sonne Dysentery 20,21,162 Special Care Unit 63 Speech Therapy 63,157,158 Staff 8 Stillbirths 12,13 Suicide 18 Swimming Baths 102-103 184 Page Temporary Accommodation 75,76 Trade Descriptions Act 1968 146 Training Centre 63,64 Tuberculosis 20,21,51-55,164 Typhoid Fever 20,21 Unfit Houses 124-125 Unmarried Expectant Mothers, Care of 36 Unsound Food 130,145 Vaccination 47,48,53,162-164 Venereal Diseases 15,22,24 Verminous Conditions 122,123,161 Vision Testing 155,156,158 Vital Statistics 12-18 Voluntary Homes 73-75 Voluntary Organisations 61,65,73,77-79,85 Voluntary Workshops 89,90 Water 102 Welfare - Clinics 28,29 Foods 29,30 Physically Handicapped 79-93 Services 69-95 Whooping Cough 20,21 Wireless for the Blind 84 Women's Royal Voluntary Service 30 Workshops 64,83,89,90 X-rays, Mass 55 Yellow Fever Vaccination 48 Youth Employment 169