DR. ELSIS LEWIS KIN 44 THE HEALTH AND WELFARE of the ROYAL BOROUGH of KINGSTON UPON THAMES 1970 Royal Borough of Kingston upon Thames ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 1970 John C. Birchall, M.B., Ch.B., D.P.H. HEALTH AND WELFARE DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: 01-399 Sill and 1 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1970 To the Mayor, Aldermen and Councillors Mr. Mayor,Ladies and Gentlemen, I present my report on the health of the citizens of the Royal Borough for 1970, and the services proyided, including the School Health Service. It is the sixth annual report in the life of the borough and is the last one to include a report on the welfare services, which under the Social Services Act 1970 are to be transferred to the new Social Services Department in 1971, together with certain of the health services. Statistics The Registrar General's estimate of the population of the borough as at mid-1970 of 142,690 shows a further reduction. The birth rate is minimally higher than last year, against a continuing national decline. Regrettably there was a 9 per cent increase in the illegitimate birth rate. The infant mortality rate reached the very low level of 10.7 compared with 13«2 in 1969 and a national average of 18. There were no recorded maternal deaths during the year. Cancer of the lung caused 96 deaths in the borough - almost double the number of people who died from accidents of all types including motor vehicle and self-inflicted injuries. The second report of the Royal College of Physicians was published, and this repeated that premature death and disabling diseases caused by cigarette smoking had reached epidemic proportions, and presents the most challenging of all opportunities for preventive medicine. The report indicated that the level of consumption of cigarettes by men has remained unchanged since 1961, but it is still rising in women. It appears that smoking in schools continues to increase among girls but not boys. 2 On the other hand, smoking by doctors has declined since 1951 and in 1965 only one-third smoked cigarettes compared with two-thirds in other men. I am sure this second report will cause many more people to renew previous efforts to give up smoking. Of 5,724 persons who attended the Mass Miniature Radiography Service in the borough during the year, 11 cases of cancer of the lung were discovered, but only 4 cases of tuberculosis. , Communicable Diseases The number of notifiable infectious diseases remained low. There was an increase in the notifications of infective jaundice 37 against 14 in 1969. This illness was only made notifiable in June 1968 and it is possible that not all cases are being notified. Measles also showed an increase in 1970, a "non-epidemic" year. 458 cases were notified compared with 283 cases in 1969, which should have been an "epidemic" year. I believe that an effort should now be made to immunise all children against measles once the triple antigen injections and poliomyelitis immunisations have been oompleted. Although a proportion (possibly up to about one-third) show a temperature or a mild measles illness it could lead to the abolition of measles in this country. Regrettably, in line with national trends, venereal diseases and associated conditions showed an increase of 62 per cent. The number of cases of gonorrhoea was almost double that of 1969 - Vaccination and Immunisation The percentage of children resident in the borough who received full protection against various infectious diseases continued at a high level, but constant effort is necessary to maintain this state. Immunisation against rubella (German measles) became available towards the end of the year and 478 girls in their 13th year received protection. 3 Health Centres and Clinics Building started on the extension of Manor Drive Clinic during the year and was planned to be in operation early in 1971. Efforts to obtain a site in the centre of New Maiden for a health centre to replace Roselands Clinic were unsuccessful. I regard this as a high priority new project for the borough. Another very urgent priority is the replacement of the old and substandard clinic premises at South Place, Surbiton. It is scheduled to be replaced on an adjacent site, but this and other Council projects are held up pending the holding of a public enquiry. Health Visiting and Domiciliary Nursing and Midwifery Services There has been an increasing involvement of the community nursing services with the general practitioners by way of attachment and liaison schemes which, where successful, must lead to a better service for the patient. With further information on the reorganisation of the health services expected there was increased interest and collaboration between the local authority and hospital nursing services, which culminated in a joint one-day conference in November to learn more of each other's work and role*. During the year arrangements were made for a ward at Kingston Hospital to be converted into a general practitioner obstetric ward. Women in labour will be admitted under the care of their own doctors, and attended by the domiciliary midwife. Mother and baby will be discharged home within 24-36 hours. This will have the effect of reducing even more the number of babies born at home (7 per cent in 1970) to negligible proportions» The scheme, which will give the safety of delivery in hospital consistent with minimal risk of cross infection, is expected to start in 1971. Day Nurseriesp Private Nurseries and Child Minders There was a continued expansion of the private sector services. One nursery and 78 daily minders were added to the registers, providing an increase of 156 places. Health Education This continued in the main on a similar pattern to previous years. 4 A successful dental health campaign was held in March involving 2,500 children aged five years. Two smoking advisory courses, each comprising six weekly meetings were held, with encouraging initial success reports, and follow-up is to be continued. When it is realised that not many people succeed in giving up smoking at one attempt, the results may underestimate the real value. Some of the non-successful candidates may yet succeed by their own efforts at a further attempt. However, the longer term follow-up must be awaited. Further courses are being arranged for 1971. Mental Health Services The staffing position as regards mental health social workers improved considerably during the year, and with two members of staff returning to the department after attending courses as a result of which they obtained their Certificate in Social Work, 50 per cent of the mental health social workers were professionally qualified at the end of the year, A house in Kingsdowne Road, Surbiton was purchased for use as a hostel for the mentally ill. The provision of this hostel accommodation will enable more such persons to live in the community who otherwise would have to remain in hospital. Plans were approved for a new Adult Training Centre and Workshop in Blagdon Road, New Maiden, and it was expected that building would be commenced early in 1971. Chiropody In 1970 there was a 10 per cent increase in treatments recorded in thi3 valuable service, mainly for the elderly. Home Help Service Recruitment of home helps continued to be a great problem, in spite of repeated advertising and publicity campaigns,, The service operated at about two-thirds of the establishment. A rather smaller number of hours were devoted to helping a rather larger number of sick and elderly persons. Welfare Section The position as regards accommodation for the elderly improved during the year as a result of the opening of the first purpose-built old 5 people's home - Amy Woodgate House, Kingston Hill, of 50 beds. Waratah, at Sanderstead, also reopened earlier in the year after being closed for extensive improvements. However, many more beds are still required. 38 beds have to be found for Kingston people resident in Kingsmead, Richmond. A number of the present homes are unsuitable or too smallp and will need to be replaced when other accommodation can be provided. The use of beds to provide short term care for old people in both the welfare homes and hospitals to give relief to relatives is an important service, and may delay or sometimes prevent the necessity for full time admission. Special attention has been given to the improvement of staff accommodation which helps to retain staff and aids recruitment. The output of the Meals-on-Wheels Service again increased. Unfortunately the present poor kitchen accommodation is unlikely to be replaced for another two years. The provisions of the Chronically Sick and Disabled Persons Act 1970 enable local authorities to give a great deal of additional help to handicapped persons, but it will obviously be some time before the Act can be fully implemented. The number of handicapped persons on the register increased by 136. Environmental Health Section The year was one of continuing vigilance in all sections of the work, with an increased involvement in the improvement of older houses, including improvement areas under the Housing Act 1969. School Health Service The population of maintained schools in the borough increased by 440 children during the year. Of the 5,857 children examined at periodic medical inspection, 680, or 11,8 per cent were found to be in need of treatment. This compares with 12.9 per cent for 1969. Of those examined only five children were found to be in an unsatisfactory physical condition. 6 Vaccination and Immunisation Towards the end of the year vaccination against rubella (German measles) became available, and was offered to all girls in their 13th year. There was an 86 per cent acceptance rate, and 478 girls received protection. This immunity is given to prevent infection during pregnancy, with its high risk of foetal abnormality. Speech Therapy Speech therapy for pre-school children continued to be a most important part of the work undertaken by the therapists. Progress was made with the formation of a special class for young children at accommodation in a school in Chessington. It was expected that the class would be ready to admit children after Easter 1971. Audiology The joint audiology service with the London Borough of Merton continued to expand„ The partially-hearing nursery unit has provided for a real need, and the help given to young hearing-handicapped children has been very much appreciated by parents. Bedelsford School Fhase I of the remodelling of the buildings was completed, providing places for 85 physically handicapped children. There were 66 children on the roll at the end of the year. StoPhilip's School Younger children continued to enter this school at the age for normal school entry. They gain much in confidence as a result of receiving education with their equals. If they attend an ordinary school they are likely to drop rapidly behind others in their age group, often becoming frustrated and discouraged, which not infrequently causes other problems. Proposed Reorganisation of the National Health Service The second Green Paper on the National Health Service in England and Wales was published early in 1970. In his foreword, the then Secretary of State for Social Services stated that most of those who had commented on the Green Paper of 1968 endorsed its central theme - the need to weld together the three parts of the Health Service at every level to form an integrated service. 7 The 1970 Green Paper contained details of the following three major decisions of the Government: (a) The National Health Service will not be administered by local government but by area health authorities directly responsible to the Secretary of State and closely associated with local authorities. (b) The administrative boundary, which must as a consequence be drawn between the National Health Service and the public health and personal social services, which will continue to be administered by local authorities. (c) The number and areas of the new health authorities must match those of the new local authorities - the unitary areas of the metropolitan districts outside London. The Secretary of State stated that apart from these three matters upon which firm decisions had been taken, the Government was not finally committed to the proposals made in the Green Paper. The White Paper containing the final proposal of the Government had not been published by the time of the General Election in June 1970. The new Government's proposals for the reorganisation of the National Health Service had not been made known by the end of the year. Acknowledgments I am pleased to acknowledge the help and co-operation received from family doctors, hospital staff, staff of other statutory authorities, voluntary organisations, my fellow Chief Officers and their staffs and head teachers. Once again I should like to pay tribute to my own staff for their good work, despite concern about impending changes. I also thank the Health and Welfare and Education Committees and their respective Chairmen, and the Council as a whole for the support received during the year. I am, Yours faithfully, JOHN C. BIRCHALL Medical Officer of Health and Principal School Medical Officer 8 ROYAL BOROUGH OP KINGSTON UPON THAMES HEALTH AND WELFARE COMMITTEE AS AT DECEMBER 1970 * * * * * * * * Councillor Harry Mayor: W„ Payne, Hon„FSLAET, ARAeS Chairman: Alderman A.C.Healey, M.Sc., Ph.D., F.R.I.C. Vice-Chairman: Councillor R.M.Church Aldermen: K.Bidmeadj, B.A. J.H.Cocks, 0oB.E. Councillors: Mrs. J. L„ Ah era, R.C.S.N. B.G.Baker S.W0B.Barter, M.B.E. F0 G.Belcham Mrs.D.T.Butler Mrs. W.J.Carter Mrs. V.A.Clare N.A.Ellis R.H.Gibbs &.R.Grant G„L.Haylock W„E„Messenger, M.Inst.T. Mrs.A„IoPamment F.J.Steptoe Mrs.R.M.Vernon Co-opted Members: R„HoBartley, M.R.C.S.,L.R„C.P. R,A„Baylis, L.D.S., R.C.S. JoSeBearcroft, 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.E.R.Fletcher Mra.C^EoHobkirk, J.P. A„AoHunt C.J.Rowland, M.B. , B.S., M.R.C.S., L.R.C.P. , D.R.C.O.G. F, Ac Speller Mrs.C.MoWaugh Local Medical Committee Local Dental Committee Consultant Psychiatrist«, Kingston and Long Grove Group Hospital Management Committee Midwife Teachers9 Training College Kingston upon Thames Association for the Blind Kingston upon Thames Association of Old People's Welfare Committees Kingston and Long Grove Group Hospital Management Committee Local Medical Committee Kingston upon Thames Association for the Handicapped South West London and Surrey Executive Council 9 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 Home Help Supervisor Chief Administrative Officer J.C.Birchall, M.B., Ch.B., D.P.H. A.H.Fairlamb, M.B., B.S., C.P.H., D.P.H. R.G. Isaac, M.R.C.S., L.R.C.P., D.P.H. A.W.C.Lobban, M.B., Ch.B., D.P.H. (Resigned 2.8.70) Mary J. O'Donovan, M.B., B.Ch., D.C.H., D.P.H. (appointed 16.11.70) D.M.Dodd, L.D.S., B.D.S. P.E.Kinton, M.R.S.H., M.A.P.H.I. F.J.Meacock, M.I.S.W. Beryl G.Anscombe, M„B., Ch.B., D.(Obst.)R.C.0„G., D.P.M. Mrs.K.L.Sewell, S.R.N., H.V.Certificate, Soc.Sc.Dip., T.T.D., N.N.E.B. 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 D.T.Rattray, C.S.W. Mrs.I.E.Roobottom H.A.Sears, D.M.A. CONTENTS VITAL STATISTICS AND GENERAL SERVICES 12 PERSONAL HEALTH SERVICES 29 MENTAL HEALTH SERVICES 54 WELFARE SERVICES 63 ENVIRONMENTAL HEALTH SERVICES 89 SCHOOL HEALTH SERVICE 134 * * * * * * VITAL STATISTICS AND GENERAL SERVICES 12 VITAL STATISTICS Area: 9,281 acres Population, estimate of Registrar General at mid-year 1970: 142,690 Rateable Value at 1st April 1970: £10,510,963 Produce of a Penny Rate at 1st April 1970: £42,000 Separately Rated Dwellings at 1st April 1970: 48,822 Live Births: Males Females Total Percentage Legitimate 932 902 1,834 93.0 Illegitimate 75 62 137 7.0 1,007 964 1,971 100.0 Crude Birth Rate per 1,000 estimated population 13.8 Adjusted Birth Rate for purposes of comparison using the comparability factor 1.01 13.9 (England and Wales) 16.0 Still Births: (11 males and 9 females) 20.0 Rate per 1,000 live and still births 10.0 (England and Wales) 13.0 Total Births 1,991 Deaths: Total (781 males and 813 females) 1,594 Crude death rate per 1,000 population 11.2 Adjusted death rate for purposes of comparison using the comparability factor 0.93 10.4 (England and Wales) 11.7 Maternal deaths nil Maternal Mortality rate (including abortion) per 1,000 total live and still births nil (England and Wales) 0.18 Infant Mortality: Infant deaths (infants under one year): Males Females Total Legitimate 14 7 21 Illegitimate - - Totals 14 7 21 (continued) 13 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 10.7 (England and Wales) 18.0 Mortality rate of legitimate infants per 1,000 legitimate live births 11.4 Mortality rate of illegitimate infants per 1,000 illegitimate live births Nil Mortality rate of male infants per 1,000 male live births 13.9 Mortality rate of female infants per 1,000 female live births 7.3 Neonatal deaths (under 4 weeks of age) (9 males and 5 females) 14 Neonatal mortality rate per 1,000 live births 7.1 (England and Wales) 12.3 Early neonatal deaths (under 1 week of age) (9 males and 3 females) 14 Early neonatal mortality rate per 1,000 live births 7.1 (England and Wales) 10.6 Perinatal mortality (still births plus deaths under 1 week) 34 Perinatal mortality rate per 1,000 total live and still births 17.1 (England and Wales) 23.0 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Anoxia (Congestive Cardiac Failure - - - - - Congenital Heart Disease) - 1 - 1 Cerebral Anoxia (Prematurity) 1 1 - 2 Cerebral Anoxia (Respiratory Distress Syndrome - Prematurity) 1 - - 1 Heart Failure (Congenital Heart Disease and Downs Syndrome) - 1 - 1 Neonatal Asphyxia (Failure to establish Respiration properly after birth) 1 - - 1 I Pneumonia (Prematurity) - 1 - 1 1 Prematurity 3 - - 3 Prematurity (Maternal Eclampsia) 1 - - 1 Pulmonary Atelectasis (Prematurity) (Ante-parturn Haemorrhage) 1 - - 1 Respiratory Distress Syndrome (Prematurity) 1 - - 1 Respiratory Failure (Prematurity) 1 - - 1 Totals 10 4 - 14 14 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 Fev$r M – – – – – – – – – – – – F – – – – – – – – – – – – Bacillary Dysentezy M – – – – – – – – – – – – and Amoebiasis F – – – – – – – – – – – – Enteritis and Other M – – – – – – – – – – – – Diarrhoeal Diseases F – – – – – – – – – – – – Tuberculosis of M – – – – – – – – – – – – Respiratory System F 1 - — — - — — — — — — 1 Late Effects of M 1 — — - — - — — 1 — — Respiratory T.B. F - - - — — — - — — — — Other Tuberculosis M 1 — – – – – – – – – 1 – F – — – – – – – – – – – – Plague M – — – – – – – – – – – – F — — — — — _ – – – – – _ Diphtheria M _ — – – – – – – – – – – F – – – – – – – – – – – – Whooping Cough M – – – – – – _ _ – – – F – – – – – – – – – – – – Streptococcal Sore M - - - - - - - — — — — — Throat & Scarlet Fever F — • — — — — — — — — — — Meningococcal Infection M - - – – – – – – – – – – F - - — - - — — — — — — — Acute Poliomyelitis M - — — — — — — — — — _ — F — — — — – — — — — — — Smallpox M – — – – – – – – – – – – F - - – – – – – – – – – – Measles M - - - — - — — — — — — _ F — — – – – – – – – – – – Typhus and other Rickettsioses 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 Malaria M — — — _ — — _ — _ F — _ _ _ — — • — — - Syphilis and its Sequelae M 1 - - - - - - - 1 - - - F 1 — — — — — — — — — — 1 Other Infeotive and Parasitic Diseases M 3 - - - - - - 1 - 1 1 - F 1 - - - - - 1 - - - - - Malignant Neoplasm, Buccal Cavity etc. M 3 - - - - - - - - 1 - 2 F 3 - - - - - - - - 1 - 2 Malignant Neoplasm, Oesophagus M 12 - — — — — — — — 3 4 5 F 4 - - - - - - - - - - 4 Malignant Neoplasm, Stomach M 20 - - - - - - 1 2 6 4 7 F 21 - - - - - - - 1 2 6 12 Malignant Neoplasm, Intestine M 30 - — — — — — — 4 6 7 13 F 36 - - - - - - — 1 9 8 18 Mali giant Neoplasm, Larynx M 3 - - - - - - - - 1 - 2 F - - - - - - - - - - - - Malignant Neoplasm, Lung, Bronohus M 77 - - - - - - 1 6 26 30 14 F 20 - — — — — — 1 1 9 5 4 Malignant Neoplasm, Breast M 2 - - - - - - - - - - 2 F 43 - - - - - 3 3 4 13 6 14 Malignant Neoplasm, Uterus F 10 — — — — — 1 1 — 3 4 1 Malignant Neoplasm, Prostate M 17 — — — _ — — — _ 1 8 8 Leukaemia M 5 - - — — - - - - 1 1 3 F 4 - - - - - - - 1 1 1 1 Other Malignant Neoplasms M 39 - - - - - 1 2 - 14 14 8 F 66 - - - - - - 2 5 14 18 27 TOTAL all forms of Cancer 415 - - - - - 5 11 25 111 116 147 (continued) 16 CAUSES OF DEATH BY A&E (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 Benign and Unspecified Neoplasms M — — — —_ . — — — — — — « F 2 - — — — — — — — — 1 1 Diabetes Mellitus M 4 — — - - - - - - 1 1 2 F 8 — — — — — — — — 1 1 6 Avitaminoses and other nutritional deficiencies M - - — — — — — — — — — — F — — — — — — — • — Other Endocrine, Nutritional and Metabolic Diseases M 1 - — — — — — — — 1 - - F 7 — — — — — — — — 2 3 2 Anaemias ■ 1 — — — — — — — — — - 1 F 3 - — — — — — — — - 2 1 Other Diseases of Blood and bloodforming Organs M - - - - - - - - - - - - F — — — — — — — — — — Mental Disorders M 2 — — — — — — — — — — 2 F 4 - - - - - - - - 2 - 2 Meningitis M 1 - — - - - - - - 1 - - F _ — — — — — — — — — - - Multiple Sclerosis M 1 - - - - - - - 1 - - - F 2 - — — — — — — — — 2 - Other Diseases of Nervous System etc, M 4 - - - - - 1 - 1 2 - - . F 6 - — — — — — — — 1 1 4 Active Rheumatio Fever M - - - - - - - - - - - - F - - — — — — — — — — — — Chronic Rheumatic Heart Disease M 7 - - - - - - - 1 1 3 2 F 16 - - - - = - - 2 2 3 9 Hypertensive Disease ? M 28 - — — — — — — — 9 8 11 F 26 - - - - - - - 1 2 5 18 Isehaemic Heart Disease M 221 - - - - - - 3 18 39 81 80 F 148 - - - - - - - 7 13 31 97 (continued) 17 CAUSES OP DEATH BY A&E (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 Forms of Heart Disease M 17 — _ _ _ — — _ 2 1 5 9 F 62 - — — — — • — — 2 7 53 Cerebrovascular Disease M 63 - - - - — - 1 4 12 16 30 F 108 - - - - - — 3 _ 5 22 78 Other Diseases of Circulatory System TOTAL Heart and M 29 - - — - — — 1 1 1 9 17 F 41 — — — — — — — — 2 5 34 Circulatory Diseases 766 - - - - - - 8 36 89 195 438 Influenza M 8 — — — — 1 — — 2 1 2 2 F 14 - — — — — — — — 1 6 7 Pneumonia M 49 - 3 1 1 - — - 1 3 11 29 F 59 - - - - - - 1 — 3 4 51 Bronchitis and Emphysema M 50 - - - - - — 1 1 7 17 24 F 18 - - - - - - - 3 2 2 11 Asthma M 1 - — — — — — — — — — 1 F 3 - — — — — — — 1 1 1 — Other Diseases of Respiratory System M 1 — 1 — — — — — — — — — F 8 - 1 1 - - - - — 1 - 5 Peptic Ulcer M 11 - — — — — — — — 2 3 6 F 2 — — — — — — — — — — 2 Appendicitis M — — _ _ _ _ — — — — — — F _ •> — — — — — — — — — — Intestinal Obstruction and Hernia M 3 — - • — — — _ • 1 2 F 1 - — — — — — — — — — 1 Cirrhosis of Liver U 1 — — — — — — — — 1 _ — F — — — _ — — — — _ — _ Other Diseases of Digestive System M 3 - — - — — — — — — 1 2 F 9 - — — — — — — 1 1 1 6 Nephritis and Nephrosis M 6 - - - - - 1 - 1 2 1 1 F 4 - - - - - — 1 - 1 - 2 Hyperplasia of Prostate M 6 — - — - - - - - - 2 4 (continued) 18 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 Diseases, M 3 – – – – – – – – – 2 1 Geni to-U rinary F 3 - – – – – – – – - 1 2 System Abortion F _ . – – – – – – – – – – Other Complications of Pregnancy, Child birth & Puerperium F – – – – – – – – – – – – Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F - - - - - - - - - - - - Diseases of Musculoskeletal System M 4 - - - - - - - - - 2 2 F 9 - - - - - 1 - 1 2 2 3 Congenital Anomalies M 9 2 1 2 — - - - - 3 - 1 F 3 - 1 – – – – – – – 1 1 Birth Injury, Difficult Labour etc M 3 3 – – – – – – – – – – F 2 2 - – – – – – – – – – Other Causes of Perinatal Mortality M 4 4 – – – – – – – – – – F 3 3 - – – – – – – – – – Symptoms and Illdefined Conditions M 1 - - - - 1 - - - - - - F 2 – – – – – – – – – – 2 Motor Vehicle Accidents M 9 - - 1 1 - 1 - 2 1 2 1 F 7 - - - - - - - 1 - 2 4 All Other Accidents M 6 - - - - 1 - - 1 2 1 1 F 10 - - - - 1 - 1 - 1 - 7 Suicide and Selfinflicted Injuries M 7 - - - - - - 1 2 1 2 1 F 13 - - - - - - 2 2 4 5 - All other External Causes M 3 - - - - - - - 2 - - 1 F - - - - - - - - - - - - TOTAL Accidents, Suicide & Violence – – – – 1 1 2 1 4 10 – 12 15 TOTAL ALL CAUSES M 781 9 5 4 2 3 4 12 53 152 240 297 F 813 5 2 1 - 1 6 15 32 101 156 494 19 ANALYSIS OF MARRIAGES 1970 1,242 marriages were registered in the borough during 1970. Of these 438 were Church of England marriages and 804 took place either in other churches or in register offices. INFECTIOUS DISEASES The infectious diseases required 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 table shows the numbers of cases notified during 1970 by age groups: Disease Under 5 5-14 15-44 45-64 65 and over Age unknown Total Scarlet Fever 11 24 6 — — — 41 Whooping Cough 17 8 — - - - 25 Measles 274 171 13 - - - 458 Dysentery 2 7 6 - - - 15 Infective Jaundice 1 17 14 5 — - 37 Tuberculosis, Respiratory — 1 12 9 7 _ 29 Tuberoulosis, other — 1 2 1 — — 4 Totals 305 229 53 15 7 - 609 20 Sonne Dysentery 15 cases occurred during the year; 5 of these and 1 carrier were of school age. Tuberculosis There were 29 cases of respiratory tuberculosis and 4 cases of non-respiratory tuberculosis. 2 deaths occurred from respiratory tuberculosis and 1 from non-pulmonary tuberculosis. Comparative Table of Notified Infectious Diseases 1965-1970 Disease 1965 1966 1967 1968 1969 1970 Acute Pneumonia 17 52 9 3 _ . Scarlet Fever 29 42 33 20 86 41 Measles 1971 736 1899 293 283 458 Whooping Cough 20 16 34 20 10 25 Puerperal Pyrexia 41 43 58 27 - - Poliomyelitis - - - - - - Acute Infective Encephalitis: Post-infective . . 1 . . . Infective - - - - - - Erysipelas 4 2 3 1 - - Diphtheria - - - - - - Ophthalmia Neonatorum - - - - - - Typhoid and Paratyphoid Fevers 4 1 1 - 2 - Infective Jaundice - - - 5 14 37 Food Poisoning 4 - 4 - 8 - Dysentery 54 146 72 27 104 15 Meningococcal Infection - - - - - - Tuberculosis, Respiratory 32 27 46 35 31 29 Tuberculosis, Other 2 6 1 4 7 4 Leptospirosis - - - - 1 - Acute Meningitis . . . . 2 . 21 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 ; t Gonorrhoea Other Conditions Primary and Secondary Other St. Thomas Hospital, S.E.1. 135 1 2 29 103 Central Middlesex Hospital, N.W.10 3 1 — 2 St. Helier Hospital, Carshalton 132 15 117 Whitechapel Clinic, London Hospital, E.1 3 — 2 1 St. Bartholomew's Hospital, E.C. 1 25 <— 3 22 Westminster Hospital, S.W. 1 13 - - 3 10 Totals 311 2 2 52 255 Patients may be dealt with by other hospitals or their own doctors and therefore the above table cannot represent a complete picture of the incidence of these conditions. Control of these diseases is attempted by trying to ensure that not only the infected persons receive treatment, but that their contacts, i.e, the sources of their infection, are also traced and persuaded to undergo treatment. A senior medical officer is responsible for tracing male contacts and the health visitors for tracing female contacts. During the year the hospitals requested these staff to trace 5 persons who had failed to keep appointments for treatment and after a great deal of effort, including several evening visits,new addresses were traced and further appointments offered. Health education activities concerning venereal diseases are reported on page 24. 22 GENERAL SERVICES HEALTH EDUCATION There has been a considerable increase in work load in the Health Education Section during 1970. This can be seen in the number of teaching sessions and in the equipment used. Although only planned group teaching sessions have been recorded, sight must not be lost of the greater volume of health teaching which takes place in the home, clinic, school or club on a one-to-one basis, or in a small ad hoc group. Talks recorded 1970 1969 Schools 259 228 Clinics 499 445 Clubs 91 72 Others - i. e. Adult groups in voluntary organisations, industry, further education, hospital and professional bodies 111 136 960 881 The subject matter covered included: Parentcraft Care of children of all ages Family health Personal relationships Nutrition and weight control Anti-smoking Home safety Use of leisure Community services Travelling abroad First aid and home nursing Prevention of infection Preparation for marriage Alcoholism, misuse of drugs Social hazards, i. e, venereal disease Care of the elderly and handicapped Environmental health and food hygiene In planning and carrying out health education, much use is made of the full range of audio-visual aids. The following figures show the number of occasions on which aids were used during 1970: Posters and pamphlets 329 Flannelgraphs 108 Models 214 Chalkboard and suedeboard 202 Films 247 Demonstrations 262 Film loops 35 Tape recorder 17 Film strips and slides 67 Overhead projector 13 23 Co-operation between the education and health departments continues to be good. Schools, further education establishments, the youth service and the teachers centre make good use of the health education section. In each month of the year a health education topic was used throughout the borough and displays on this topic were mounted at clinics, nurseries and in the health and welfare department. The topics were as follows: January Anti-smoking and 'flu February Fire Prevention and Anti-scalds March Dental Health April Safety in the First Three Years May Mental Health June Water Safety; Summer Hazards July Anti-noise; Anti-litter August Use of Leisure September Immunisation and Prevention of Disease October Scalds - All Ages November Winter Health - Care of Aged; Fireworks December Christmas Preparations; Play Material The health education working team met on five occasions when decisions were made on future work, the approval of new equipment, films etc., and an assessment of work done. There were two special activities during 1970: the dental health campaign during March was a result of the combined efforts of dental and health staff. Approximately 2,500 five-year-olds were seen and shown films and demonstrations; a dental kit was given to each child and a "Happy Smile" badge to those who carried out regular teeth cleaning. A smoking advisory clinic was set up and two courses of six weekly meetings were held during the year; 63 attended the first course and 48 the second course. The success rate is encouraging and follow-up will continue for eighteen months. Results of follow-up of the two smoking advisory clinics at three months and six months are as follows: 24 April Course End of Course At 3 months At 6 months 63 Enrolled Non-smoking 22 20 18 Much reduced consumption of cigarettes 15 12 13 Changed to pipe or cigar 4 4 3 No change 10 8 7 No reply 12 19 22 October Course 48 Enrolled Non-smoking 15 Much reduced consumption 12 Changed to pipe or cigar 2 No change 8 No reply 11 Assistance was given in training students of health visiting, midwifery, teaching and social work; also in postgraduate training at the Midwife Teachers' Training College and the London Boroughs Training Committee. Youth groups entering for the Duke of Edinburgh Award Scheme invited the health education section to act as examiners in specific studies. Venereal Diseases During 1970 all public conveniences under the Council's control were provided with plastic notices giving information on V.D. treatment facilities. The subject was discussed in schools, clubs and clinics on sixty or more occasions sometimes by special requests, and otherwise incidentally when dealing generally with infectious diseases, hazards to health, or problems associated with growing up. Posters and leaflets were frequently used. 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: 25 (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. Regrettably, two elderly ladies had to be dealt with under the provisions of these Acts: Mrs.A.H., aged 83, had to be removed urgently to hospital on 24th February and Mrs.M.T., aged 77, was also taken to hospital urgently on 16th December. It is emphasized that removal of a person to an institution for the reasons detailed above is only undertaken with great reluctance and it is fortunate that both Mrs. A.H. and Mrs.M.T. soon became reconciled to their stay in hospital. 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 1970. 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 beds, 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, which 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 Secretary of State for Health and Social Services. 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 1st January each year. During the year two agencies were licensed to supply nurses to private cases at home, hospitals and nursing homes. 26 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 1,464 cremations. None was rejected although queries were raised on various points in several cases. In one cage the medical referee was unable to obtain the required medical certificate and the matter was referred to H.M. Coroner who issued the necessary clearance certificate. MORTUARY SERVICES These have been arranged jointly with Kingston Hospital. ADULT MEDICAL EXAMINATIONS 210 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 415 were accepted on completion of a medical history form, without actual examination. 166 newly appointed teachers and candidates for admission to teachers training colleges were medically examined as required by the Department of Education and Science. 263 teachers were considered fit upon completion of a medical history form. HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital Services Available Royal Eye Hospital, Upper Brighton Road, Surbiton Ophthalmic, Refraction sessions Kingston Hospital, Wolverton Avenue, Kingston upon Thames Medical, Surgical, Fracture, Paediatric, Gynaecology, Ear, Nose and Throat, Maternity, Orthopaedic, Psychiatric, Adolescent, Orthodontic, Rheumatology, Diabetic, Dermatology, Ophthalmology, Pathology, Chest Diseases, Oral Surgery 27 Tolworth Hospital, Red Lion Road, Tolworth Infectious Diseases, Chest Diseases, Geriatric Surbiton General Hospital, Swell Road, Surbiton Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Genito-urinary, Gynaecology, Pathology, Psychiatric PERSONAL HEALTH SERVICES 30 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. Work has been in progress on the extension at the Manor Drive, Worcester Park, Clinic and the new accommodation will come into use early in 1971. Discussions are still in progress concerning details of the accommodation to be provided in the extension at the Hook Clinic at Gosbury Hill. Bedelsford School is being expanded and consequently Grange Road Clinic, which is situated in the same grounds, will need to be replaced. A suitable site has been earmarked in Hawks Road for the building of a clinic and it is hoped that work will commence in 1971. A site has been earmarked for a clinic to replace South Place Clinic j, and a site is being sought for a health centre in 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 106 sessions at these clinics and at the Surbiton and Maiden District Nurses Homes, at which 146 women made 309 attendances. 5,297 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed. There were, in addition, 235 sessions held by general practitioners to whose practices borough midwives are attached. There were 2,342 attendances at these sessions. 31 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 42 10 254 Acre Road, Kingston 50 43 24 383 Roselands, New Maiden 52 58 13 420 Kingston Vale - - - - Manor Drive, Worcester Park 30 12 7 71 South Place, Surbiton 50 61 13 455 Hamilton Avenue, Tolworth - - - - Gosbury Hill, Hook ) 52 26 16 187 St. Mary's Church Hall Chessington - - - Totals 286 242 83 1770 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 above, except South Place, Surbiton and Hamilton Avenue, Tolworth, They are sold at the Women's Royal Voluntary Service Centres at Kingston, Maiden, Surbiton, and Fairmead Day Nursery, as follows: 32 Surbiton W.R.V.S. Mon. Tues. 10.0 - 12 noon 154 Ewell Road Thurs. Fri. 2.0 - 4 p.m. Kingston W.R„V.S., Mon. Tues. 10.45 - 4 p.m. 23a Fife Road Thurs. Fri. Wednesday 10.45 - 12.45 p.m. New Maiden W.R.V.S Mon. Tues. 10.0 - 12.30 p.m. Blagdon Road Thurs. Fri. 2.0 - 4.30 p.m. Tolworth Fairmead Day Nursery, Ewell Road Monday 2.0 - 4 p.m. The following table shows the sessions held and attendances at each of the various child welfare clinics: Address of Clinic Number of sessions during year Number of children who attended Total attendances Grange Road, Kingston 126 698 4003 Acre Road, Kingston 124 1163 4718 Kingston Vale 36 66 357 Roselands, New Maiden 149 1417 4091 Manor Drive, Worcester Park 128 1002 4193 South Place, Surbiton 154 905 5091 Hamilton Avenue, Tolworth 155 788 4441 Gosbury Hill, Hook 149 1071 4197 St. Mary's Church Hall, Chessington 53 295 1357 Totals 1074 7405 32448 DENTAL SERVICE FOR EXPECTANT AND NURSING MOTHERS AND YOUNG CHILDREN The following table shows the numbers of mothers and young children provided with the various forms of dental care and treatment during the year: 33  Children Aged 0-4 inclusive Expectant and Nursing Mothers Inspected 482 85 Requiring Treatment 296 73 Offered Treatment 290 67 Treated 327 77 Visits for Treatment 809 170 Fillings 651 113 Teeth Filled 598 100 Teeth Extracted 117 19 General Anaesthetics 50 2 Patients X-rayed 7 13 Scalings and Gum Treatment 101 46 Teeth Otherwise Conserved 37 2 Completed Courses of Treatment 316 61 Dentures Provided: Full _ 6 Partial _ — Treatment Sessions 191 Combined 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. 34 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 31.12.70 Average daily attendance during the year Number on waiting list at 31.12.70 Under 2 Age 2 - 5 Under 2 Age 2-5 Fairmead, Tolworth 42 14 32 10 27 46 Canbury Park, Kingston 46 9 40 8 30 50 Totals 88 23 72 18 57 96 Nurseries and Child-Minders Regulation Act, 1948 The health visitors have continued to supervise all the private nurseries, playgroups and daily minders in the borough. Gourses on the day care of children were arranged under the auspices of the Education and Health and Welfare Departments. Fifty-six persons qualified for a certificate in the day care of children during 1970 and in September, sixty-three commenced a new course which is due to eni in March 1971. Statistics 125 applications were made during the year 116 were approved 9 were withdrawn prior to registration At the end of 1970 there were 51 registered premises providing 1,130 places, and 301 daily minders providing 674 places. 35 CHILDREN'S HOMES The Children's Committee has six homes in the borough. 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 departmental medical officers undertake the routine medical inspections when visiting, and on admission and discharge; they advise generally on the promotion of positive health of the children. HOMES FOR MOTHERS AND BABIES There are no homes for mothers and babies in the borough. During 1970 the Council accepted financial responsibility for twelve 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 YOUNG CHILDREN Holidays were arranged for one mother with medical and social problems. She was accompanied by her four young children. 36 CONGENITAL MALFORMATIONS Total Malformations Reported Central Nervous System Eye Ear Alimentary System Heart and Great Vessels 62 (58 children) 6 (5 children) 6 (6 children) 5 (4 children) 5 (3 children) 1 Spina bifida and Hydrocephalus 3 Accessory auricle 1 Cleft lip 5 Unspecified Malformations of heart and circulatory system 1 Spina bifida 1 Malformed auricle 1 Cleft lip and cleft palate 1 Anencephalus 1 Malformed pinna and absence of external auditory meatus 1 Achalasia of the cardia 2 Hydrocephalus 1 Pseudo pterigium 1 Malformation of tongue 37 CONGENITAL MALFORMATIONS Respiratory System Urogenital System Limbs Other Skeletal Other Systems Other Malformations 1 (1 child) 9 (9 children) 21 (20 children) Nil 2 (2 children) 7 (7 children) 1 Malformation of nose 6 Hydrocele 5 Talipes 2 Unspecified malformations of 6 Down's syndrome (mongolism) 2 Hypospadias 1 Talipes and hip click muscles, skin and fascia 1 Unspecified Malformation . 1 Undescended testicle 7 Congenital dislocation of hip 2 Polydactyly 4 Syndactyly 1 Absence of radii 38 MIDWIFERY SERVICE The trend towards hospital confinements is continuing and during 1970 only 7.2 per cent births took place in the mothers' homes. This is in keeping with the national trend and the recommendation in the Peel Report where closer integration between maternity hospitals and the local authority services is advocated. A scheme proposed for Kingston Hospital, whereby domiciliary midwives employed by the local authority will conduct delivery of patients in a general practitioner ward at the hospital, has been delayed as this accommodation is closed for structural alterations. The local authority is approved by the Central Midwives Board as a training authority far students taking Part II of their training. During the year twenty students were placed with the authority, and all were successful in their final examinations. Domiciliary midwives work in close liaison with the general practitioners and with the health visitors in the parentcraft and psychoprophylaxis sessions at the clinics All babies born are tested for phenylketonuria, using the Guthrie test. This test is either carried out in hospital or on the district, between the sixth and fourteenth day after delivery. Specimens are sent to the Central Laboratory, Queen Mary's Hospital, Carshalton, for screening. The table below denotes the births for Kingston: Kingston Hospital 1375 Other Hospitals 356 Nursing Homes 113 (including St.Teresa's Hospital) 1844 *Domiciliary 143 1987 *Included in this number, one case was dealt with by a private midwife and one by Kingston Hospital Flying Squad. 39 The number of visits made by midwives was as follows: Ante-natal at Home 1174 Ante-natal at Clinics 2452 Post-natal (including early discharges) 7184 Total Clinic Sessions: Ante-natal 186 GPs Ante-natal 235 Kingston Hospital 98 519 Medical aid was summoned in 34 instances - to 21 infants and 13 mothers. HOME NURSING The work in this section has continued to increase and the attachment of home nurses to general practices has resulted in a better service to patients. Closer contact is being made with nursing staff and medical social workers at Kingston Hospital to deal with the after care of patients who are discharged from the hospital. One of the highlights of the year was a combined study day for the nursing staffs of both hospital and local authority, when the whole aspect of the continuity of patient care in the community was discussed, and nursing equipment and aids available for nursing patients at home were demonstrated. If early discharge from hospital is to be achieved it will be necessary for supporting services for the patient to be provided. The table below indicates the position with regard to the attachment of nurses to general practices; Staff Fully Attached Liaised Home Nurses: S.R.N. 11 S.E.N. 2 Nursing Auxiliaries 2 Midwives District Nurse/Midwives 1 3 40 Late Night Visiting and Night Nursing Service The late night nursing service providing visits from 7.30 p.m. to 11.30 p.m. approximately was continued, and the two part-time nurses engaged on these duties paid 1,778 visits to 204 patients during the year. This extension of the normal district nursing service was a great help to many patients, but did not of course meet the needs of those cases requiring care and attention throughout the night. Almost all of these were terminal canser patients whose relatives were doing their best to look after them at home rather than that they should be admitted to hospital. The Marie Curie Memorial Foundation have for many years past paid for the services of night nurses to look after cancer patients, but they generally rely on the local health authority to obtain nurses and at times there have bean difficulties in finding suitably trained staff at short notice. Towards the end of 1970 a pilot scheme was started in the borough and a trained nurse and a nursing auxiliary employed by the Council to undertake night nursing duties far terminal cases or the aged who are very ill. The Marie Curie Memorial Foundation continued to reimburse the Council the coat of the service when the nurses attended cancer patients. Nursing Aids and Equipment An increased range of aids and equipment is now available for assisting the nurse in her work both for the handicapped and seriously ill, thereby helping the patients to remain in their own homes. Accidental Hypothermia District marses visit regularly many elderly "At Risk™ cases, and they are aware of the serious ri3ks of accidental hypothermia. Special emergency kits for use in such oases are provided. Care of In.eonta.nent Patients There is a laundry service far sheets which are supplied to incontinent patients. Disposable pads and accessories are also provided for such patients. 41 HEALTH VISITING There is an establishment of twenty-nine health visitors, six of whom have special responsibilities. One is based at the Chest Clinic at Kingston Hospital and is responsible for giving support and advice to patients with tuberculosis. She traces all contacts and refers them for screening. She liaises with other statutory and voluntary workers and attends B.C.&. vaccination sessions. Another health visitor, based at the Geriatric Unit at Tolworth Hospital, works in co-operation with the consultant geriatrician,, She visits the elderly in their homes in order to assess their suitability for admission to the day centre or the hospital. She keeps in touch with the relatives while the patient is in hospital and often supervises the care of the patient after discharge. Pour of the health visitors are field work instructors and as such are responsible for the practical training of student health visitors. Five student health visitors were trained in the borough during the year. Group Attachment During 1970 eight more health visitors were attached to group practices. This is a formal arrangement in which a health visitor is responsible for the patients on the lists of specified general practitioners within the local authority boundary instead of having a traditional geographical district. One health visitor maintains, a liaison with a group practice, which means that she is responsible for' a traditional geographical district but at the same time has a formal arrangement with specified general practitioners. If the patiants referred by the general practitioner are not within her own district she passes on the reference to the appropriate health visitor. Altogether nine health visitors are now attached to group practices and two health visitors are liaising with group practices. Appointments have been made to meet four more group practices early in January to discuss farther attachments. The health visitors who have been attached to group practices feel this has led to a closer liaison between themselves and the family doctors and this in turn has led to tetter care for the patient. The 42 health visitors have certainly been made more aware of the needs of the general practitioners' patients and conversely the general practitioners have been made more aware of the health visitors' preventive work in the community. Attachment to group practice has meant that the health visitor has been used as an adviser on health to the family, although their largest case load is with the young and the elderly. The attached health visitors have been better able to assist parents to cope with their ill toddlers as they have been available to give advice at the correct time. They are more aware of the problems occurring in adolescence and have been able to advise families on the ways to deal with the problems. They have had mare contact with the bereaved and have been able to give more support to the families of the dying. Some of the health visitors have been able to hold group discussions on a variety of health subjects in the doctors' waiting rooms, and two of them have commenced Well Baby Clinics in their doctors' surgeries, thus making a total of three in the borough. Junior Training Centre for Mentally Handicapped In March 1970 one health visitor was attached to the Junior Training Centre. She has been present, with the senior medical officer, at all the medical inspections and has liaised with the parents and the staffs of the Training Centre and the Mental Health Section. The health visitor has visited the homes and the parents have been glad of the opportunity to discuss their handicapped children with her. Many have been concerned about their children's behaviour problems and particularly those whose children suffer from enuresis. Help has also been provided with arrangements for holiday homes for the children and information given regarding the local Society for the Mentally Handicapped and the various other facilities in the borough. The same health visitor now participates in the health education programme, showing films, giving talks and demonstrations to the children at the Training Centre. Cytology Clinic The health visitors have encouraged mothers at risk to have cervical smears taken, either by appointment with their own doctors or at a local authority clinic. Instruction on self-examination of the breasts 43 is also given at Well Women Clinics. Mary health visitors have addressed various Ladies' Clubs on the importance of the cervical smear as a screening test for the early detection of malignant disease. The number of smears examined in 1970 was 1,075 as compared with 930 in the previous year. 166 were sent for treatment or placed under observation. New Venture in Community Care A one-day conference on community care was held at Kingston Hospital in November 1970. It was arranged jointly by the Matron of Kingston Hospital, the Superintendent of Midwifery and Home Nursing Services and the Superintendent Health Visitor, and was attended by thirty senior hospital nursing staff and thirty senior local health authority staff. The morning programme covered the work of the health visiting, midwifery and nursing services and opportunity was given for group discussion between the hospital and local authority staff. In the afternoon a panel of speakers from the hospital addressed the conference and this was followed by a session of "Any Questions" and visits to the wards. As a result of this conference the local authority and hospital staff have been made more aware of each other's role, and liaison has been improved. Co-ordinating the Needs of the Elderly Meetings have been held at two-monthly intervals in the Surbiton, Chessington, New Maiden and Worcester Park Clinics to co-ordinate the services available to the elderly. These meetings have been well attended by both the statutory and voluntary visitors. The statutory visitors have included social workers, mental health social workers, health visitors, district nurses, the Home Help Supervisor, and the voluntary visitors have included representatives from the Old People's Welfare Association, the Churches and the Council of Social Service. It has been possible at these meetings to discuss the needs of the elderly, to avoid duplication of visiting and, where necessary, to arrange daily visiting. Amongst other beneficial results of these meetings were the formation of a Luncheon Club and the arrangement of outings for the handicapped and transport for the elderly. 44 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 to persuade them to register with a general practitioner and to have a chest X-ray if this has not been done on entry. Of 131 immigrants whose arrivals were notified, 79 were visited during the year; the remainder were either untraceable or were known to have moved to other areas. VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation is reasonable in the borough. There was an increase in the number of primary vaccinations and immunisations recorded during 1970. Immunisation against rubella (German measles) became available during the latter part of the year and girls in their thirteenth year were offered this protection. 478 received the injection before the end of the year. Smallpox (under 16 years) Age at time of vaccination Total Vaccinated numbers Revaccinated Complications Reported 0-3 months 13 — — 3-6 months 25 — — 6-9 months 20 _ — 9-12 months 23 — — 1 year 859 5 — 2-4 years 239 42 — 5-15 years 71 321 — Totals 1250 368 — 45 Diphtheria. Whooping Cough and/or Tetanus and/or Poliomyelitis. Measles (under 16 years) and Rubella (aged 13 years) Complete Primary Course Boosters Diphtheria 1 17 Whooping Cough only — — Tetanus only 100 491 Combined Diphtheria and Whooping Cough — — Combined Diphtheria and Tetanus 126 1606 Combined Diphtheria, Whooping Cough and Tetanus 1582 732 Poliomyelitis only * 1851 3027 Quadruple — — Measles 1681 — Rubella 478 — *These figures include 13 primary courses of SALK (injection) vaccine and 2 booster injections of SALK, the rest being oral type SABIN vaccine. Total children receiving immunisation against the five illnesses whether given separately or combined: Primary Course Booster Diphtheria 1709 2355 Whooping Cough 1532 732 Tetanus 1808 2829 Poliomyelitis 1851 3027 Measles 1681 — 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 £1.05 is charged for the vaccination. During 1970, 1653 persons were vaccinated against yellow fever. 46 Smallpox vaccination of adults and injections for typhoid, paratyphoid and cholera are normally given by the family doctor when requested far travel abroad. The following table shows the percentage of children vaccinated and immunised in Kingston upon Thames, compared with the national average: Percentage of Children Born in 1968 Vaccinated by 31.12.70 Smallpox (Children under 2) (4) Whooping Cough (1) Diphtheria (2) Poliomyelitis (3) England and Wales 79 81 79 35 Kingston upon Thames 79 84 82 48 The figures in columns (1) to (3) are calculated to show the percentage of children born in 1968 who have been vaccinated at any time. Column(4) includes only children who were vaccinated during 1970 and were under two years old at the time, and is calculated as a percentage of children born during 1969. This is considered to give a reasonable estimate of the proportion of young children being vaccinated against smallpox. AMBULANCE SERVICE The borough council is not an ambulance authority, this service being the responsibility of the Greater London Council. The service in the borough is co-ordinated from the main area control centre in New Maiden. 47 PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis The measures for the prevention, control and treatment of tuberculosis are directed by the chest physicians and staff of the Chest Clinic at Kingston Hospital. During 1970, 33 cases were notified in the borough and of these, 29 were pulmonary and 4 non-pulmonary. The 29 pulmonary cases were in the undermentioned stages of the disease: A. or Tuberculosis - (sputum negative) 11 B.1 or Tuberculosis + (early cases, sputum positive) 3 B.2 or Tuberculosis + (intermediate cases, sputum positive) 12 B.3 or Tuberculosis + (advanced cases, sputum positive) 3 The non-pulmonary cases were: 4 Tuberculous glands of neck On 1st January 1970 there were 363 cases on the register and at the end of the year this figure had decreased to 339. Pulmonary Non-Pulmonary Total Males 173 14 187 Females 130 22 152 Totals 303 36 339 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. 48 The following tables show the work undertaken by the Chest Clinic at Kingston Hospital during 1970 insofar as it affects patients resident in the borough: Number of chest clinic sessions held 405 Number of attendances: New patients 941 Old patients 4068 5009 Average attendances per session 12 Tuberculin Tests and BCG Vaccinations Contacts School children and students Others Skin tested 235 20 47 Found positive 41 15 32 Found negative 160 7 16 Vaccinated 59 8 3 There were two deaths from pulmonary tuberculosis and one from non-pulmonary tuberculosis during the year. The following table shows comparative figures of notified cases and deaths for the year 1961-1970 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 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 1969 31 7 38 6 4 10 1970 29 4 31 2 1 3 49 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. The following table gives an analysis by age groups of the new cases and deaths from tuberculosis during the year: ory • New Cases Deaths Male - Female Under 1 year 1-4 years 5-14 years 15-24 years 25 - 34 years 35-44 years 45-54 years 55 - 64 years 65 and over TOTAL Under 1 year 1-4 years 5 - 14 years 15 - 24 years 25-34 years 35-44 years 45 - 54 years 55 - 64 years 65 and over TOTAL Respiratory Tuberculosis M - - 1 3 3 - 4 3 5 19 - - - - - - - 1 - 1 F - - - 1 1 4 1 1 2 10 - - - - - - - - 1 1 T - - 1 4 4 4 5 4 7 29 - - - - - - - 1 1 2 Non- Respiratory Tubercu losis M - - 1 - 1 - - - - 2 - - - - - - - - 1 1 F - - - - 1 - 1 - - 2 - - - - - - - - - - T - - 1 - 2 _ 1 - - 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 5724 Cases found to be suffering from tuberculosis 3 1 4 Cases found to be suffering from lung cancer 9 2 11 50 Kingston and District Care Committee Considerable help is given to tuberculous and other chest disease patients and their dependants by the Kingston and District Care Committee. During 1970, 52 families in the borough were helped by way of grants for extra nourishment, fuel, holidays, fares, pocket money etc. This service is greatly appreciated by all who have benefited therefrom. 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 32 came from general practitioners. 23 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 716 doctor sessions were held which were attended by 1290 new patients. Altogether there was a total of 12,083 clinic attendances. Details of Family Planning Clinics currently being held are as follows; Roselands, 163 Kingston Road, New Maiden Appointments: Phone 942 0734 Mondays;, Tuesdays and Thursdays 6.30 to 8.30 p.m. South Place, Surbiton Appointments: Phone 399 8898 Mondays Wednesdays and Thursdays Fridays 6.30 to 7.30 p.m. 9.30 to 10.30 a.m. 204 Acre Road, Kingston Appointments: Phone 546 5812 Wednesdays 7 to 8 p.m. 51 Gosbury Hill, Hook, Chessington Appointments: Phone 397 5737 Tuesdays and Thursdays 7 to 8.30 p.m. The Manor Drive, Worcester Park Appointments: Phone 337 0246 Wednesdays Fridays 10 a.m. to 12 noon 10 to 11.30 a.m. LOAN OF NURSING EQUIPMENT The Kingston and Surbiton Divisions of the British Red Cross Society operate a scheme for the loan of nursing equipment on behalf of the Borough Council. The scheme is intended to facilitate simple short term nursing care in the patients homes, and under the arrangement deposits are collected from patients by the British Red Cross Society and refunded to them when the equipment is returned. Altogether 576 loans of nursing equipment were made during the year. The Borough Council makes a grant to the British Red Cross for 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. 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 1970, 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: 52 A. Persons treated during the year Local Authority Voluntary Organisations Total Persons of pensionable age and over 2924 664 3588 Expectant mothers - - - Physically handicapped, under 65 47 - 47 Blind, under 65 4 — 4 Totals 2975 664 3639 NOTE: Deletions during this time due to persons having died or leaving the district total 147. B. Treatments given during the year Local Authority Voluntary Organisations Total In clinics - 3628 3628 In patients' homes 3933 188 4121 In old People's Homes 680 - 680 In chiropodists' surgeries 10134 - 10134 Totals 14747 3816 18563 These figures show a 5.2 per cent increase in the number of persons treated over 1969. 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. 53 The service is provided on the recommendation of the family doctor and the amount of service is assessed on need and availability of home helps by the Home Help Supervisor. 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 1970 there were 74 home helps, equivalent to 36 full time staff. During the year 97 applicants were interviewed; 39 of these were not considered suitable or found other employment. There is a potential reservoir of married women who are interested in doing this type of work but cannot make arrangements for their school children to be cared for during the school holidays. These recruitment difficulties have resulted in heavy pressure on existing staff which has in some instances proved inadequate to meet the demands on the service. Despite these difficulties a total of 65,207 hours of service were devoted to the care of the sick and elderly in the borough. The following are details of the households assisted during the year: Category Number Assisted Persons aged 65 or over at time of visit 814 Chronic sick and tuberculous 60 Mentally disordered 4 Maternity cases 79 Others 81 Total: 1038 54 MENTAL HEALTH SERVICES Under the Mental Health Act 1959 and the Health Services and Public Health Act 1968, local authorities are empowered to provide community care for persons who are suffering from mental disorder, a generic term which includes mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind. The Mental Health Act 19'59 gives wide powers for authorities to deal with the care and aftercare of such persons and indicates that authorities should provide the following; 1. Appointment of officers to act as mental welfare officers. 2. Centres or other facilities for training or occupation for the mentally ill and mentally subnormal. 3. Equipment of residential accommodation for the mentally handicapped and mentally ill. The local authority also has responsibility in relation to persons placed under guardianship, in accordance with the Mental Health Act. Mental Welfare Officers It is pleasing to report that during 1970 the staffing position in the mental health section improved,, Two members returned to duty after having successfully completed the Certificate in Social Work course. The position now is that 50 per cent of the mental health social workers are professionally qualifiedo As the section became fully staffed it was possible to have greater liaison with general practitioners and consultant psychiatrists, with the result that more cases were referred for care and after-care. Special emphasis was placed on offering a supportive casework and preventive service. 778 referrals were made,, which is 60 per cent more than the previous year. Arising out of this, 3754 visits were made to mentally ill persons and their families, compared with 2464 in 1969. Mental health social workers attended out-patient clinics and hospitals on 209 occasions. At these sessions the mental health 55 social workers obtained social histories from the patients and their families and discussed their social implications with both patients and doctors. In addition to the above, officers of the section attended discharge conferences at Kingston and Long Grove Hospitals, with a view to establishing liaison with the hospital staff and discussing what effective after-care could be provided for the patients concerned. The section was involved in 135 admissions to Kingston and Long Grove Hospitals, 42 of these being informal admissions. During the year the Local Authority Social Services Act 1970 received Royal Assent,, This Act provides for the transfer of the services now provided by the mental health section of the health department under Section 12 of the Health Services and Public Health Act 1968 to be transferred to the Social Services Department. The only exception will be the responsibility for the education of mentally handicapped children, which is dealt with in Circular 15/70 issued by the Department of Education and Science on 22nd September 1970. This circular outlines the arrangements to be made for the proposed transfer of this service to the local education authority from 1st April 1971. Day Centre for the Mentally 111 (Pine Lodge Day Centre, Blagdon Road, New Maiden) This centre continues to function as part of the community care services available for the mentally ill in the borough. The prime objective of the unit is to provide a sheltered environment for patients who have received treatment in hospital for mental disorder but have not recovered sufficiently to return to full employment or household duties. It also provides support for patients who, though not ill enough to be admitted to hospital,, are likely to break down as a result of the stresses of modern society. At the end of 1969 there were 21 patients on the register. The daily average attendance during 1970 was 16. During the year there were 46 admissions. 16 were referred from psychiatric hospitals and 30 from general practitioners and mental health social workers. By the end of the year 39 patients had left the centre for the following reasons; 15 to employment, 4 to return to household duties, 7 readmitted to psychiatric hospitals, 12 ceased attendance 56 at their own request (this group were visited in their homes by mental health social workers on leaving the centre), 1 was admitted to an industrial rehabilitation unit. 10 patients discharged during the year had to be readmitted later owing to re-exacerbation of illness. It is pleasing to report that 15 patients were discharged to open employment - the average attendance of this group at the centre was of ten weeks duration. The provision of work creates a therapeutic setting for many patients and helps in their rehabilitation. One of the new activities which proved useful in this sphere was the introduction of a printing machine, which was purchased by the patients as a result of their own efforts. It is unfortunate that the supply of outwork for printing has been irregular but efforts are being made to secure a regular supply of work. A certain amount of industrial work has been obtained from local industries. Discussion groups are held at the centre and the mental health social workers maintain contact with the patients who attend there. Several successful open days were held during the year when the public were invited to see the work done at the centre. As in previous years the Disablement Resettlement Officers of the Department of Employment and Productivity have given valuable advice regarding the placement of patients attending the unit. Kingston Training Centre for the Mentally Handicapped This unit has now been in operation for six years. It provides accommodation for children who require special care, training facilities for children between the ages of 5 and 16 and also training for adults, together with workshop facilities. A special care unit provides 12 places for children who are severely mentally subnormal and also physically handicapped. This group receive physiotherapy twice weekly, which is helpful in assisting them to overcome physical disabilities. The programme in the special care unit is formed on basic training and "self-help" activities such as eating, toilet training and dressing. When progress is satisfactory the children are transferred to the nursery class where more formal activities are introduced. Transfer to other classes cannot be decided on chronological age alone; other factors such as limitations imposed by intelligence level, sensory defects, emotional attitudes and social conditions have to be taken into account before a change is made. Each case is discussed by members of the staff before a transfer is made. 57 In recent years it has been the practice to admit children to this unit as soon as they are three years old. This allows care and training to be provided from an early age, which is beneficial to the child and also to the parents, as it relieves the mother of the heavy burden of caring for an untrained subnormal child at home a task which can take up the greater part of her working day. Junior Training Centre This centre has 45 pupils on the register. The classes are small - one teacher to about ten children, thus allowing more attention to be given to individual children during periods of formal instruction. Much emphasis is placed on practical instruction or learning through doing. This is accomplished by children being taken out regularly in small groups to observe, in natural setting, situations they have been shown in the classroom. By constant repetition memory is developed, learning takes place and what is learned in one situation is retained and often transferred to another. Many children have emotional difficulties and have acquired bad habits in early childhood. These difficulties need to be overcome before any real progress can occur in a learning situation. The top class of the junior training centre deals with pupils whose ages range from 12 to 16. During this age period, the programme provided in the centre is devoted to learning in a community situation, which is important to help the adolescent take his place in the community when school days are over. With this end in view, visits were made to police stations, fire stations, a telephone exchange, libraries, banks, post offices etc. A selected party of children was taken by members of the staff to the Young Vic Theatre in London on a Saturday morning, and they were invited to take part in an event on the stage. This was an enlightening experience for both children and the staff who accompanied them. During the year we were fortunate in obtaining the use of the gymnasium at Latchmere House Detention Centre for one morning a week. Unfortunately, as Latchmere House is now a remand home and there has been a change of policy, this is no longer available for use by children attending the centre. Some of the boys from Latchmere House visited the training centre regularly and helped with the pupils. This appeared to be an enjoyable experience for both the children who attend the training centre as well as the boys from the detention centre. 58 The adoption of the training centre by the motor vessel AKAROA of the Shaw Savill and Albion Co. Ltd., continues to flourish. Donations collected by passengers amounted to two sums of £40 each; this money was used to purchase two budgerigars, a cage, a Moulton bicycle and a high chair for use in the special care unit. Two visits were made to AKAROA whilst she was berthed at King George V dock. During the month of December the children performed their annual show, entitled "The Brightest Star" and entertainment in the form of a Christmas party for juniors and a social evening for adults was arranged. These functions were all successful and well attended by parents and friends. In June a small party of children accompanied by the staff were taken to Pirates Spring for a week"s holiday. The cost of this was borne by the parents but the local authority were responsible for the cost of transport„ The Ham Football Club deserve thanks for their generous donation which enabled the adults and juniors to attend the Ice Show at Wembley. Adult Training Centre The Adult Training Centre and Workshops continue to provide a programme of training to enable those who attend to develop to their full potential, and as a result of this training to lead an independent life in the community, so far as their limited intellectual capacity will allow. It is important that the training should allow the trainees to develop skills which will be useful for them in open employment as well as providing stimulating activities for those who are only able to work under the sheltered environment of a workshop It is also necessary to provide instruction for leisure pursuits and this can be accomplished if it is linked with an active programme of social training. Owing to the lack of accommodation and staffing difficulties, it has not been possible to expand and introduce new activities into the workshops but a fairly regular supply of contract work has been provided by four local firms in the area. Thanks are due to these firms for the interest shown in providing work for the men and women who attend this centre. All the money which is earned is paid out in the form of wages to trainees. Payment for work acts as an incentive for the trainees to make progress and achieve further independence. 59 At December 1970 there were 61 on the register. During the year there were two new adult trainees, plus two entrants from the junior centre, and two left to attend the Richmond Training Centre. With the passing of the Local Authority Social Services Act, this service will be transferred to the newly created Social Services Department on 1st April 1971. Residential and Hostel Accommodation This borough at present has no hostels for the mentally ill or the mentally handicapped, although "Woodbury", Kingsdowne Road, Surbiton, is to be purchased early in 1971 from Surrey County Council and will be used as a hostel for 15 adult mentally handicapped persons. At the present time, the Authority accepts financial responsibility for those persons requiring hostel accommodation, and listed below are the numbers of persons that the borough accepted financial responsibility for in 1970: Mentally 111 - Hostel Accommodation Males Females Cheshire Foundation - 1 Mental After Care Association — 3 National Society for Epileptics - 1 5 Residential Care for Mentally Handicapped Guardianship Society, Brighton - 2 Holmbush Home 2 - St. Bernadette's School — 1 St. Teresa"s Convent - 3 Privately boarded out - 1 2 7 WELFARE SERVICES 63 REPORT ON THE WELFARE SERVICES F.J.Meacock, M.I.S.W., Chief Welfare Officer Introduction It is with some pride and pleasure, but not without regret, that I present this report upon the welfare services of the borough for the year 1970. This will be my last report as Chief Welfare Officer, a Director of Social Services having now been appointed to take over and combine the future development of welfare, children's and mental welfare services, and the office of Chief Welfare Officer will cease to exist. The work has been a challenge in difficult circumstances and I would like to say a sincere "thank you" to all members of the staff who have played their part towards the furtherance and improvement of the welfare services. WELFARE OF THE ELDERLY The demand for services for the elderly has continued to increase during the year under review and because of the lack of places in old people's homes the supportive domiciliary services have been considerably under pressure to provide the help for the elderly who were continuing to live in their own homes. So whilst there has been some improvement in the number of Part III beds available, the application from the ever increasing number of elderly people becoming known to the department has outnumbered the additional facilities provided. Homes for the Elderly The following residential establishments for accommodation of elderly people were administered by the department throughout the year: Establishments 12/14 Langley Avenue, Surbiton 26 Langley Avenue, Surbiton Number of Residents 48 women 27 women 64 Fircroft, 96 Ditton Road, Surbiton Fair lawn, Warren Read, Kingston Hill Coombe Oak, Warren Road, Kingston Hill Waratah, Sanderstead Road, Sanderstead (reopened January 1970) 26 men 31 women 33 women 20 mixed In addition, 38 beds at Kingsmead, Richmond are allocated to the borough council but this establishment is scheduled for closing during 1972/73. For part of the year the new home, Amy Woodgate House, has been available to the department and the first few residents were admitted during June 1970. This home provides for 50 beds for both men and women. Waiting List On 1st January 1970 there were 34 men and 97 women, a total of 131 persons on the waiting list and at 31st December 1970 the number of persons on the waiting list was 14 men and 71 women, a total of 85, which indicates a considerable reduction brought about by the opening of the new Amy Woodgate House at Kingston Hill. Length of time on the Waiting List as at 31.12.70 Time Males Females Total Under 6 months - - - 7-12 months 11 47 58 13-18 months 2 5 7 19-24 months 1 4 5 25 - 30 months - 6 6 Over 30 months - 9 9 Totals 14 71 85 65 Age Groups of Persons on Waiting List Age Group Hales Females Total Under 65 - - - 65 - 69 - 6 6 70 - 79 4 22 26 80 - 89 9 36 45 90 plus 1 7 8 Totals 14 71 85 Admissions The following admissions were made during the year: 1970 1969 Men Women Men Women Homes administered by the borough Other local authority homes Voluntary homes 25 64 4 28 1 2 1 11 7 11 13 16 33 77 18 55 Of these admissions during the year 19 men and 46 women were on the waiting list prior to 1st January 1970. Short Stay Accommodation As well as providing permanent residential care, 53 persons were admitted during the year under review for periods to enable relatives to take a holiday or to give them a break from the continued care of their elderly relatives, or to provide the individual with a necessary change of environment. The demands for this service have been fairly substantial and the numbers of persons who were so admitted are indicated as follows: 1970 1969 Men Women Men Women Homes administered by the borough Voluntary Old People's homes Voluntary homes for the handicapped 9 24 4 15 6 5 5 14 7 24 7 11 22 53 16 40 66 New Accommodation - Any Woodgate House This new home for 50 elderly persons in the grounds of Coombe Oak, Warren Road, Kingston Hill was handed over to the department on 20th March 1970 and then the exercise of equipping and furnishing the home had to be carried out. The first residents were admitted on 1st June 1970, and from then to the end of the year more elderly persons were admitted as the staffing position permitted,, On 14th August 1970 The Worshipful the Mayor of the Royal Borough of Kingston upon Thames, Councillor Harry W Payne, former Chairman of the Health and Welfare Committee, performed the opening ceremony in the presence of the son of the late Mrs.Amy Woodgate, whose name was given to this establishment in recognition of the services to elderly people that had been rendered to the borough over a considerable number of years by this eminent lady, as well as many other prominent citizens, Aldermen, Councillors and officials of the Borough Council, Waratah, Sander stead Road Sanderstead This small home for 20 residents which was closed throughout 1969 for internal structural alterations, was reopened for residents during March 1970 and very soon received its full complement of elderly men and women. Staff Considerable difficulties continued to be experienced throughout the year in the recruitment of suitable staff for the residential homes and every endeavour is being made to improve the standard of staff accommodation in order to attract suitable applicants. Occupational Therapy at Welfare Home s for the Elderly As far as possible every effort has been made to continue the occupational therapy tuition at the Council's old people's homes, where requests have been made from the residents, but this again has proved difficult because of the lack of occupational therapy staff. Large Print Books The Borough's Library Department continued to provide a regular supply of large print books for the use of the residents in the welfare homes. 67 Voluntary Services in Residential Homes I should like to take this opportunity of recording my appreciation to those individuals and members of voluntary organisations and associations who have done so much to brighten the lives of residents by entertainments, gifts, and in many ways attempting to bring some of the outside world to the residents of the homes. Charges for Accommodation During the early part of the year the standard charge for accommodation provided in the borough's old people's homes was reviewed and increased from £13.3.1 to £13.7.10, with effect from 11th January 1970, to those few residents who pay the full cost, and back-dated to 1st April 1969 to those local authorities who are responsible for maintenance of elderly people in the borough's homes. Nearly all the residents in the old people's homes pay the minimum assessment of £4 weekly as laid down in the provisions issued by the Department of Health and Social Security, and receive the balance of £1 of their retirement pensions for pocket money. Later in the year the standard charge for accommodation was again revised and increased to £16.13.4 weekly from 1st April 1970 for other local authorities and from 11th October 1970 for those residents who were still able to pay the full cost. Residential Accommodation in other Local Authorities' Homes At 31st December 1970 there were 41 elderly people from the borough accommodated in homes run by other local authorities, and 11 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 to me. Similarly, I arrange for reports to be submitted where requests are made Homes Administered by Voluntary Organisations There were 71 persons resident in homes administered by voluntary organisations as at 31st December 1970 who are the responsibility of this borough. 68 Persons resident in accommodation provided by Voluntary Organisations Physical Category Age Sex 31.12.1969 .1970 Not materially handicapped Aged M 24 12 F 45 24 Not M 3 - Aged F - 2 Blind Aged M - 3 F 5 10 Not M 1 - Aged F 1 1 Epileptic Aged M 1 1 F - - Not M 2 2 Aged F - 2 Others physically handicapped Aged M 3 2 F 2 _ Not M 5 5 Aged F 13 7 Deaf Aged M - — F - - Not M - - Aged F - Totals 105 71 The number of persons indicated in this table are maintained in homes in all parts of the country. Some are receiving specialised care because of special needs and others have been admitted because they have desired to remain in an area in order to be near to their immediate relatives. It is a problem to find suitable vacancies in voluntary or other authorities' homes, particularly for physically handicapped people, who are a special problem, but it is hoped in the not too distant future to provide a purpose built home, specially designed, to cater for all types of physically handicapped persons, within the borough. 69 Registration and Inspection of Private Homes for the Elderly There were three registered voluntary old people's homes and twelve registered private old people's homes within the borough at the end of the year. Two private homes closed during the year. The registered homes were regularly inspected and 32 visits were made during the year. Meals-on-Wheels This service continued to expand throughout the year as more and more referrals were received from hospitals, district nurses, health visitors, doctors, statutory and voluntary organisations, and it is now felt that the existing kitchen is working to its maximum capacity. The department has maintained its close link with the voluntary organisations, and to assist them with the delivery of the meals so that the five day week service could be maintained, a part-time van driver was employed during May 1970 to drive the Council's van and so relieve the pressure on the local voluntary organisation delivering meals in the Surbiton area. An indication of how this service has grown can be seen from the following comparative figures. It is hoped that the new meals-on-wheels kitchen planned for the Alpha Road area will be operational in the not too distant future. At Christmas 1970, 285 free Christmas dinners consisting of the traditional turkey, savoury stuffing, sausages, roast potatoes, brussels sprouts and Christmas pudding were delivered to the elderly people in the borough. Meals delivered monthly 1st January to 31st December 1970 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Total 4883 4034 3904 3960 5106 4075 5104 4036 3863 5329 4292 4137 52723 70 1st January to 31st December 1969 Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Total 4100 3262 3254 2852 3012 3181 4020 3244 3086 4252 3598 3188 41050 1st January to 31st December 1968 3113 2964 2932 2741 3192 2639 3252 3337 2823 3526 3417 2786 36722 Recreation and Meals The Council continued to make an annual grant to the Royal Borough's Old People's Liaison Committee (Kingston upon Thames) to help provide services for the elderly in their clubs and day centres and to include the provision of meals at these day centres. During March 1970 the Surbiton Old People's Welfare Committee extended their meals facilities for elderly people by opening a luncheon club in the Chessington area and the meals for this club are supplied from the Council's meals-on-wheels kitchen. WELFARE OF THE HANDICAPPED The National Assistance Act 1948, Section 29 provides for local welfare authorities to promote the welfare of persons who are blind, deaf and dumb and other persons who are substantially and permanently handicapped by illness injury or congenital deformity and such other disabilities as may be prescribed by the Department of Health and Social Security. During the year a new Act - the Chronically Sick and Disabled Persons Act 1970 - became law, but up to the time of the preparation of this report local authorities were still awaiting definite instructions from the Department of Health and Social Security on its implications, which are bound to be extensive and which will involve local authorities in considerable additional expenditure. 71 The Registers A register of handicapped persons is kept in accordance with the requirements of the Department of Health and Social Security. There were 1420 persons registered at 31st December 1970. The grouping of disabilities is in accordance with the Medical Research Council's code of diseases and disabilities, as used by the Department of Employment and Productivity. Registers as at 31st December 1970 Male Female Total Blind Persons 114 206 320 Partially Sighted 32 41 73 Deaf with Speech 7 9 16 Deaf without Speech 26 26 52 Hard of Hearing 12 23 35 Other Handicapped (General Classes) 377 547 924 Totals 568 852 1420 The Blind Register Registration is determined by examination by an ophthalmologist of consultant status and appointments for examination are made through the department. Once a person is registered every effort is made to overcome as far as possible the effects of the disability. A register is kept of those persons who wish to obtain the advantages of registration and come within the definition of blindness given in Appendix III to the Ministry of Health Circular 4/55, namely "so blind as to be unable to perform any work for which eyesight is essential." This disability refers to any work and not the particular occupation of the person being examined, and does not take account of any other physical or mental defect. The number of registered blind persons showed a decrease of 19 over the previous year. The following tables show the age distribution of the blind population registered with the department on 31st December 1970. 72 Age Period Blind Register as at 31.12.70 including transfers in and out New Cases Registered in the Borough during 1970 Male Female Total Male Female Total Under 1 - - - - - - 1 2 - - - - - - 3 - - - - - - 4 - - - - - - 5-10 - 1 1 - - - 11 - 15 3 - 3 - - - 16 - 20 - 1 1 — - - 21 - 29 2 1 3 - - - 30 - 39 4 4 8 - - - 40 - 49 8 6 14 - - - 50 - 59 23 5 28 1 1 2 60 - 64 11 4 15 1 2 3 65 - 69 9 18 27 1 2 3 70 - 79 23 55 78 1 2 3 80 - 84 9 48 57 2 6 8 85 - 89 15 36 51 3 5 8 90 and over 7 27 34 - 1 1 Unknown - - - - — - Totals 114 206 320 9 19 28 The position regarding the four children under 16 on the register as at 31st December 1970 is as follows: Three are attending special schools for the blind and partially sighted, and the remaining child is in a hospital for mentally subnormal children. 262 persons out of the total of 320 (82 per cent) on the blind register are over the age of 60. Employment of Registered Blind Persons The following table indicates the pattern of full-time employment of persons on the register: 73 Persons in full employment under ordinary conditions Age Groups 16-20 21-39 40-49 50-59 60-64 65 and over Total employed Male - 6 4 12 2 3 27 Female - 1 - 2 - 1 4 Totals - 7 4 14 2 4 31 The people in this table are engaged in the following occupations: Masseurs and Physiotherapists 2 Machine Tool Operators 3 Lecturers, Teachers 1 Boot and Shoe Repairers 1 Barristers, Solicitors and related workers 2 Craftsmen/Process Workers 8 Labourers 1 Telephone Operators 5 Miscellaneous Workers 3 Shop Assistants/Salesmen 2 Farm Workers 1 Other professional workers 1 Fitters and Assemblers 1 Total: 31 Partially Sighted Register Partially sighted persons are defined as "substantially and permanently handicapped by congenitally defective vision, or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character." The following is a summary by age of those persons included in the register at 31st December 1970 and shows an increase of 13 over the figure for 1969. 74 Age Group Male Female Total 0-4 - - ... 5-10 2 - 2 11 - 15 2 2 4 16 - 20 1 - 1 21 - 29 1 - 1 50 - 59 2 1 3 40-49 2 2 4 50 - 59 5 2 7 60 - 64 2 1 3 65 - 69 2 2 4 70 - 74 4 4 8 75 - 79 5 4 9 80 - 84 2 11 13 85 - 89 1 7 8 90 + 1 5 6 Totals 32 41 73 Social Rehabilitation The main centres for social rehabilitation are situated at Oldbury Grange, Bridgnorth; Manor House, Torquay:and America Lodge, Torquay. These centres are administered by the Royal National Institute for the Blind, and it may be found that after a short period of social rehabilitation a blind or partially sighted person is suitable for an industrial rehabilitation course. Oldbury Grange caters for social rehabilitation mainly for housewives and men in the upper age group, and a period of such rehabilitation is often a great help in enabling a newly blind person to settle down to normal domiciliary environment. 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. 75 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 is responsible for the rental of talking book machines in a number of cases where there is need. Wireless for the Blind Fund Wireless sets, mainly of the modern transistor type, are supplied on loan to registered blind persons who do not have a set of their own. The British Wireless for the Blind Fund provides the sets and the distribution is carried out by the social welfare officers for the blind. In certain needy cases new batteries are provided free of charge by the Kingston upon Thames Association for the Blind, Domiciliary Visiting Two full time 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 the relatives. It is necessary at first for a firm relationship to be established by regular visits, in order to learn the needs of the person and the home and to deal adequately with problems as they arise„ The social welfare officers teach Braille, Moon, and handicrafts, 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: 76 1 newly blind person was sent on a rehabilitation course 33 people were in attendance at the handicraft class 51 people made articles in their own homes as occupational therapy 5 people were taught Braille 4 people were taught Moon 30 people were given radio sets supplied by the British Wireless for the Blind Fund Social Activities - Holidays During September 1970 arrangements were made for a party of 34 blind and partially sighted persons and their guides with two members of the staff to spend a week's holiday at Maddiesons, Littlestone Holiday Centre, New Romney, Kent. All had an enjoyable time and considerable help was received from local organisations. Handicraft Classes Handicraft classes for the blind and partially sighted persons are held at Surbiton, and throughout the year the classes have been well attended. This has been achieved mainly because transport is provided by the two sitting ambulances used for the transportation of the handicapped. Apart from the therapeutic value, the classes provide an incentive for blind persons to move outside their home environment. Home Workers Scheme The Home Workers Scheme is organised by the Home Industries Department of the Royal National Institute far the Blind at Reigate, Surrey. Blind home workers are employed in a variety of occupations and supervision of their work is carried out by visiting officers of the Home Industries Department. The Council is now responsible for three home workers. During the year structural alterations and the installation of certain equipment were carried out at the home of a blind lady so that she could produce knitted articles on a special type of knitting machine. This arrangement was carried out in liaison with the Department of Employment and Productivity and the Royal National Institute for the Blind. Of the other two home workers, one is employed as a piano tuner and the other does radio and electrical repairs. 77 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. Mobility - Long Cane Technique In recent years there has been introduced into this country a longflr white cane for the assistance of the blind. This followed successful trials in the United States, and gives greater independence in walking for some blind people than has previously been possible with the shorter white cane. An intensive course of instruction is essential to ensure a safe and satisfactory outcome, and blind people are not all capable of benefiting from the course and the new technique, but it is considered that eight to ten registered blind persons in the borough each year could learn and use the new system. Qualified instructors, of whom there are very few available as yet, are necessary as tutors and each can deal with up to nine blind candidates. Consequently meetings have been held with officers of the London Boroughs of Merton and Sutton and it has been agreed in principle that a joint appointment of an officer be shared between the three boroughs and it is hoped that a tripartite arrangement can operate from 1st April 1971. Kingston upon Thames Association for the Blind This Association, 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 have been available through normal welfare channels, such as parcels of groceries, toiletries, bedding, fuel, fires, repairs to wireless sets, door bell installations, telephones, carpet cleaning etc. Welfare of the Deaf and Hard of Hearing The Register The number of persons with total or substantial hearing loss registered with the department shows a decrease of one from the previous year and the total number on the register at the present time is 103. 78 The male social welfare officer for the deaf and hard of hearing who was seconded to a two year course for the Certificate of Social Work during September 1968, returned to the department in September 1970, but left this Authority shortly afterwards. The total persons on the register are as shown in the tables on page 85 and they can be mainly classified as under: Deaf with speech 16 Deaf without speech 52 Hard of hearing 35 103 Welfare of the Physically Handicapped - General Classes 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 1970: S e X Children under 16 Persons 16-64 Persons 65 and over Total Handicapped Persons (General Classes) M 56 203 118 377 F 46 206 295 547 Totals 102 409 413 924 79 Register of Handicapped Persons - General Classes (By Causes and Age Groups) 0-15 16-29 30-49 50-64 65 and over Total Collective Total M F M F M F M F M F M F A/E - - 2 - 9 6 19 4 19 12 49 22 71 F 1 1 1 2 2 9 14 42 34 181 52 235 287 G 40 34 6 8 2 1 3 3 2 5 53 51 104 H/L 3 2 1 - 2 2 11 8 18 17 35 29 64 q/T 1 - 5 4 14 8 22 6 8 12 50 30 80 V 9 7 17 19 23 43 43 35 33 54 125 158 283 U/W 1 2 1 - 1 2 3 5 z 2 2 2 1 - 1 3 2 4 13 11 19 30 Totals 56 46 34 34 52 71 117 101 118 295 377 547 924 Key: A/E Amputation F Arthritis and rheumatism G Congenital malformations and deformities H/L Diseases of the digestive and genito-urinary systems; of the heart or circulatory system; of the respiratory system (other than tuberculosis) and of the skin Q/r Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine. V Organic nervous diseases epilepsy, disseminated 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 80 Occupational Therapy for the Handicapped The services continued to operate from the Occupational Therapy Centre at Pine Lodge, Blagdon Road, New Maiden, to a limited extent because of the lack of occupational therapy staff. Outwork classes continued at 104 Westbury Road, New Maiden. Occupational Therapy Classes Number of persons attending Wednesday (morning) Art Class 6-8 Wednesday (afternoon) 10 - 12 Friday (afternoon) 10 - 12 A wide range of crafts are taught at this centre. Aids and Adaptations The senior technical instructor and the assistant technical instructor continued with the aids and adaptations, and during the year a total of 171 additional aids and adaptations were completed. The total completed aids were as follows: Bathroom aids (special seats, rails etc.) 56 Ramps for invalid chairs 2 Structural alterations to premises 3 Others (walking aids, lifting poles etc.) 110 171 Outwork The outwork organiser has continued to obtain various kinds of outwork from firms and factories in the area or close to the borough boundary, and the work carried out by the handicapped in this connection consisted of packing soap and perfume and trimming rubber bushes for car bodies. The classes held were as follows: 81 No. of persons attending Mondays (all day) 12 - 18 Tuesdays (all day) 12 - 18 Thursdays (all day) 12 - 18 Fridays (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. Home Work for the Housebound Physically Handicapped The outwork organiser obtains suitable work from local factories and takes it to certain handicapped people who are capable of undertaking the work in their own homes, but are unable to attend the Work Centre. The officer demonstrates the best way to perform the task, ensures that the completed work is up to standard, and returns it to the manufacturer. The total number of persons participating in this scheme was between 20 and 25. Voluntary Workshops The Kingston Spastics Centre provides a workshop at 13 Geneva Road, Kingston for some 40 spastic young persons, of whom approximately 15 live in the borough. The centre makes a valuable contribution to the welfare of the handicapped in the borough and the borough council makes a financial grant of £90 per capita towards its work per annum. Car Badges far Severely Disabled Drivers A further service designed for the benefit of disabled drivers is the provision of distinguishing car badges for display on motorised vehicles supplied by the Department of Health and Social Security, or on cars which have been specially adapted to suit individual needs„ To date there are 117 persons in receipt of badges and 25 new badges were allocated during 1970. The badge itself carries no legal weight but its purpose is intended to enable the 82 handicapped person of impaired mobility to be easily recognisable by the police and other road users in an endeavour to make driving and parking a somewhat less hazardous occupation and in this borough allows disabled drivers to park at meters without time limit. There is in existence the Disabled Drivers Association for owners of petrol or motor driven vehicles, which is an independent association formed by disabled persons for the benefit of disabled people and this association has a branch in North London. Its activities are very wide ranging, including a cultural society, social evenings, theatre outings, group rallies and car rallies, a holiday home in Norfolk and holidays arranged abroad. Advice is also given on the daily problems which disabled drivers may encounter. The popularity of this association is shown by the steadily increasing membership. Structural Adaptations to Property The homes of two handicapped persons were adapted to help them overcome the effects of their disabilities, as follows: (a) a physically handicapped man suffering from increasing muscular weakness, particularly of the legs, and unable to use the upstairs toilet, was assisted with a grant of £87.25, half the cost of structural adaptations to provide ground floor toilet facilities. (b) a physically handicapped lady suffering from disseminated sclerosis and consequently unable to use the upstairs toilet, was assisted with a grant of £118, half the cost of structural adaptations to provide ground floor toilet facilities. Group Holidays A party of eleven physically handicapped persons together with two helpers enjoyed a holiday at the Riviera Lido Holiday Club, Nyetimber, near Bognor Regis from 15th to 22nd May 1970. 83 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, for handicapped persons, some of which also receive grants from this authority. Their efforts in this field are much appreciated. Clubs for the Handicapped Club Meetings Hon.Secretary Kingston and Surbiton Guild of the Crippled, Presbyterian Church Hall, Grove Crescent, Kingston upon Thames Fortnightly Tuesday afternoons Mrs.J.Fraser Day, Willowend, Manor Close, East Horsley Kingston Endeavour Club, King Athelstan School, Villiers Road, Kingston upon Thames 2nd and 4th Thursday each month, evenings Mrs.C.Carter, 23D Church Street, Twickenham Multiple Sclerosis Society, North Surrey Branch, Catholic Church Hall, Ewe 11 Road, Surbiton 3rd Tuesday each month, evenings Mr.P.R. Knight, 2 Havers Avenue, Hersham Multiple Sclerosis Society, Kingston Branch, Red Cross Hall, King Charles Crescent, Surbiton 1st Tuesday each month, evenings Mr.J.Lumb, 27 Beaufort Road, Kingston upon Thames Davis- Darby and Joan Club, Deaf and Dumb, Methodist Church Hall, Ewell Ro%d, Surbiton Fortnightly Wednesday afternoons (2nd and 4th) Mr.R.Saunders, 28 Court Way, Twickenham 84 Surbiton Deaf Club, Club Room, Meals on Wheels Kitchen, Ewell Road, Surbiton Weekly Thursday evenings Mr.M.D.Buckley, Santa Maria, Redstone Hollow, Redhill, RH1 4BZ Spartan Swimming Club, Kingston Baths, Denmark Road, Kingston upon Thames Weekly Thursday evenings Miss L.Kilpatrick, 38 Thorkhill Road, Thames Ditton Surbiton Afternoon Club for the Blind, Methodist Church Hall, Ewell Road, Surbiton Alternate Tuesday afternoons Mrso DoYorke, 219 Ewell Road, Surbiton Surbiton and District Evening Blind Club, Club Room, Meals on Wheels Kitchen, Ewell Road, Surbiton Alternate Wednesday evenings Miss M.Boughtons 30 Winter down Road, West End, Esher Kingston and Distract Social Club for the Blind, Congregation Hall, Union Street, Kingston upon Thames Alternate Wednesday afternoons Mrs.E.Jutson, 38 Chesham Road, Kingston upon Thames Maiden and Coombe Social Club for the Blind, Christ Church Hall, New Maiden Alternate Wednesday afternoons MrSoM.Smith, 13 Sandal Road, New Maiden Maiden and District Evening Club for the Blind, Christ Church Hall, New Maiden Alternate Wednesday evenings Mrs.M.Read, 52 Beechcroft Avenue, New Maiden 85 Social Work in the Community - Domiciliary Visiting The social welfare officers under the direction of the deputy chief welfare officer, have carried out their work under intense pressure during the year, and the increased number of persons placed in residential homes and the amount of assistance provided for a larger number of handicapped people does not in itself illustrate the demanding nature of the work. Again I must stress that the success of the work of the social welfare officers cannot be measured in statistics - advice, sympathetic guidance and help at the right time can prevent the need for an elderly person to be placed in a home. Effective social work support depends upon the co-operation of different agencies. The demand from hospital medical social workers for help for patients discharged home has again been great and has required the cooperative efforts of all the domiciliary services, such as home helps, district nurses, health visitors, as well as other statutory and voluntary workers. The social welfare officers made some 9125 visits during the year, many of which were of an introductory nature as the first step in ascertaining needs. The cases in each category being dealt with at 31st December 1970 were as follows: No. of cases Elderly 1174 Blind and partially sighted 393 Deaf and hard of hearing 103 Physically handicapped 924 Other miscellaneous clients 24 OTHER WELFARE SERVICES 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 86 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. The Chief Welfare Officer was acting as Receiver in three active cases at the end of the year. Burial and Cremation During the year arrangements were made for six burials in accordance with the provisions of Section 50 of the National Assistance Act 1948, which places upon the borough council a duty to arrange the burial or cremation of a body of any person who has died or 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. Temporary Protection of Property The call on this service, which provides for the temporary protection of property of persons admitted to hospital or other institutions, has been comparatively light and in twelve cases has it been necessary for the department to physically store or safeguard property. ENVIRONMENTAL HEALTH SERVICES 89 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR P,E, KINTON. M.R.S.H.. M.A.P.H.I. 1970 was a notable year for the very great publicity given to Public Health, Never before have the topics of the environment, pollution and conservation been so much in the news. European Conservation year awakened the interest of the general public to the advantages of caring for all that is worthy of preservation and on both sides of the Atlantic concern was expressed in the most dramatic terms that pollution of our environment ~ the atmosphere and the seas could produce a threat to the very existence of mankinds This welcome publicity serves to illustrate the work we have been doing in the department for years but the value of all the publicity will only be of value to the community if these matters are not forgotten. Everyone can make a contribution to improving the environment by eliminating unnecessary noise, refraining from dropping litter, by avoiding nuisance from garden bonfires, maintaining property, preventing dogs from fouling footpaths. As a department, we will continue to pursue every opportunity to protect the health of the community and improve the environment. The year was marked by continued pressure of work particularly brought about by the Housing Act 1969 with preparatory work for General Improvement Areas and the requirements concerning the issue of Qualification Certificates, The granting of these certificates is proving to be a time consuming meticulous process which will result in many rents being raised but it should also provide landlords with the financial means for maintaining their property. There was much concern from a public health point of view at the time of the autumn strike of the refuse collectors but it was fortunate that this occurred at a time when weather conditions were favourable. The solid fuel supply situation gave further cause for some anxiety and it was with reluctance that the Council decided to suspend 40% of its smoke control orders for the winter. The department was involved in detailed investigations into an outbreak of infective hepatitis and the usual spate of holidaymakers returning from abroad with food poisoning but fortunately none brought cholera although this disease did spread from the East and it was necessary to visit some travellers who had been in contact. 90 We were concerned when imperforated plastic sacks were being left on doorsteps for the reception of jumble. These bags can easily suffocate a child if he gets inside and it would be appreciated if any similar practices are reported to the department immediately. This can be as hazardous as leaving old refrigerators or cars where they can be misused by children. Pood hygiene tends to have been eclipsed by the publicity given to pollution generally. As the report indicates there is a continuing need for constant vigilance on the part of the public health inspectorate but the housewife can play her part by refusing to shop where the standards are not high and by drawing the attention of managements to the unsatisfactory handling of food. The department has published a series of information sheets to assist ratepayers in dealing with some of the current problems. Pigeons and squirrels in particular are the subjects of complaint. As with rats and mice much can be done by making sure no food is left out and this will discourage them from residential areas. It is not the policy of this authority to kill all living creatures but in the interest of preventing disease it is essential to keep wild animals in towns down to reasonable numbers. The future of the Health Service has been the subject of two "Green Papers" and the present Government has expressed its intention to absorb the local authority personal health services into a comprehensive health service., If implemented this would make environmental health the major health responsibility of the Council - a situation which appertained in the constituent Boroughs before amalgamation in 1965. As the reorganisation of local government outside London is to be effective from the 1st April 1974 and the reorganisation of the Health Service is planned to coincide,, a period of uncertainty similar to the years preceding 1965 can be anticipated., I wish to pay tribute to the work of the Deputy Chief Public Health Inspector and Senior Public Health Inspectors and particularly to Mr. F.H.A. Burton in connection with his work on improvement grants and housing generally., There haa been a great increase in the volume of the department's work and their contribution together with that of all colleagues in the department is appreciated by me. My thanks are due to the Chairman, Vice-Chairman and members of the Health and Welfare Committee for their support and encouragement and to Dr. Birehall and to the staff of the Health and all other departments for their ready co-operation., Special thanks are extended to colleagues in other departments who have co-operated in the planning of General Improvement Areas. P.E. KINTON. Chief Public Health Inspector., 91 ENVIRONMENTAL HEALTH. 1. WATER SUPPLY. The whole area is served by the Metropolitan Water Board through a piped main supply. The service is satisfactory in quantity and quality, no houses in the district are supplied permanently from standpipes, there is no added fluoride, the natural content is 0.20 milligrammes per litre, the water is not plumbo solvent. Regular chemical and bacteriological examinations are carried out by their Water examination Department but in addition to this on 29 occasions samples were taken from private houses, shops, schools, nurseries and 23 samples were satisfactory. Repeat samples were taken when reports were not entirely satisfactory. Uncovered storage tanks in roof spaces can result in contamination of water and this is particularly likely should birds have access. 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 and sterilization is effected by breakpoint chlorination. Apart from regular pool-side tests of the chemical condition of the water, 106 samples were taken during the year for bacteriological examination of which 105 were reported satisfactory. The Surbiton Lagoon, situated in Raeburn Avenue, Surbiton, is an open air pool 165 feet long, the water being treated by continuous pressure sand filtration and breakpoint chlorination. Apart from chemical tests 21 samples were taken for bacteriological examination all of which were satisfactory. 92 (b) School Pools. One private school has a small swimming pool without filtration plant, the water being changed as necessary, sterilization being carried out by hand dosing by hypochlorite. Seven primary schools have swimming pools with treatment plants. In addition to numerous pool-side chemical tests, 78 samples of water were taken for bacteriological examination, of which one was reported as having a count higher than desirable due to inadequate chlorination. 3. RIVERS AND STREAKS. The River Thames forms the western boundary of the Borough said is under the control of the Thames Conservancy. 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. The pollution of the rivers has been a matter of concern to the department and in particular from litter and waste arising from house boats occupied by river-side dwellers. Members of the general public can do much to reduce the nuisance from litter and the practice of dumping large pieces of unwanted furniture, mattresses, prams and similar items can produce hazards in streams which would otherwise be attractive amenities and the Council has restricted the use of riverside moorings in its ownership to non-residential use and this should make a useful contribution to the cleanliness of the river. Whilst the quality of the water in the Thames is improving it is not fit for bathing. 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 sewerage system. 93 5. PUBLIC CLEANSING. The Borough Engineer and Surveyor is responsible for the collection and delivery of refuse to a central loading point whence it is hauled in large vehicles to tips operated by contractors employed by the Greater London Council, who are responsible for the disposal of refuse. The total amount of refuse passing over the weighbridge during the year ended 31st December, 1970 was 43,762 tons, 6. SHOPS ACT. 1950, The provisions relating to closing hours, half-holidays, hours of employment of young persons and Sunday trading are administered by the department. 7. OFFICES. SHOPS AND RAILWAY PREMISES ACT. 1963,, During the year 167 registered premises received one or more general inspections, these included inspection of all the 140 newly registered premises, The total number of registered premises at the end of the year was l,744. All premises known to the department have received a thorough general inspection,. The total number of inspections carried out during the year was 2,206. 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. Under the provisions of the Offices,, Shops & Railway Premises Act, 1963 and the Post Offices Act, 1969, many post offices. telephone exchanges and telecommunication centres and the Post Office Purchasing and Supply Department are no longer regarded as Crown premises. On receipt of the respective registration forms OSR 1 from the Factory Inspectorate,, all these premises received a thorough general inspection. The implementation of the Offices, Shops & Railway Premises (Hoists & Lifts) Regulations, 1968 was referred to in the previous annual report. The importance of the application of these regulations to office and other premises was amply demonstrated during the year; in one instance the report on a lift used in a three storied block of offices stated that the suspension ropes were splintered throughout the full length. 9k The inspection of licensed premises revealed that a high proportior of the hoists were in need of urgent repair, particularly the immediate replacement of suspension ropes and the fitting of gates to openings. 8. NOISE. One hundred and one complaints regarding alleged nuisance from noise from premises were received during the year and thirty-four nuisances were confirmed, Eleven arose from industry, twenty from commercial undertakings, and three domestic sources. Thirty of these nuisances were abated following informal action and one abatement notice was served. Four complaints regarding the level of sound arising from loudspeakers were received and these were all remedied informally. Effecting the reduction of noise from industrial premises can be most time consuming. Observation of sound pressure levels in the vicinity, identification of the item of equipment producing the noise giving rise to complaint, advice to management, the taking of remedial measures followed by further observations and possibly further action can result in many weeks elapsing before a noise nuisance is abated. Among any substantial group of complainants there is usually at least one person who is hypersensitive to noise and is difficult, if not impossible, to satisfy no matter what reduction in noise level is achieved. 9. CLEAN AIR. Clean Air Acts 1956/1968 - Smoke Control Areas. Particulars of Kingston upon Thames Nos. 16 and 17 Smoke Control Orders which were confirmed on 2nd March, 1970 are as follows:- Area 16 17 Locality Tudor Drive Kingston Windsor Avenue New Maiden. Acreage 328 116 Domestic premises 2711 1191 Commercial " 36 12 Industrial " 2 1 Other " 9 6 95 In October the Council made Smoke Control Orders Nos. 18 and 19 and confirmation by the Minister of Housing and Local Government has been received. They come into operation on 1st October, 1971. Details are as follows:- Area 18 19 Locality Kingston Road New Maiden Maple Road Surbiton Acreage 225 169 Domestic premises 1983 2194 Commercial " 136 211 Industrial " 12 7 Other „ 11 10 The Council's Smoke Control Area programme provides for a further eight areas by 1978 in addition to the twenty-five 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 21 20,644 Orders confirmed and not yet operative (Areas 16,17,18 and 19) 4 8,079 Areas being surveyed (Areas 20 and 2l) 2 2,762 Future Areas 6 17,960 Because of an expected nation-wide shortage of premium solid smokeless fuel, the operative date of Smoke Control Orders 16 and 17 was deferred from the 1st October 1970 to 1st May 1971. Later in 1970 it was found necessary, for the same reason, to suspend until 31st March 1971 nine Smoke Control Orders covering about 40 per c ent of premises under smoke control. Since most householders now use gas or electricity for heating, it is not expected that these measures will have any noticeable effect on air pollution. 96 Air Pollution complaints. There were 127 complaints from the public about nuisance from smoke and grit; 81 of these concerned bonfires; 5 smoke from factorychimneys; 9 smoking domestic chimneys; 13 grit and smuts; 8 smoke from demolition sites and 11 fumes. Sometimes complaints about air pollution are made without justification. A hospital chimney was alleged to be responsible for a deposit of white powder discovered in the roof space of a house about a mile away On investigation it was found that the powder was flocculent and dissolved rapidly in water. Inspection of the roof revealed that efflorescence was taking place on the underside of the clay roof tiles and the dried powder so formed was being deposited on the roof timbers below. Chimney heights. Six applications were submitted for approval of chimney heights under the Clean Air Acts 1956 and 1968. These were approved without modification. In a further six cases heating engineers consulted the department about chimney designs for boilers to which Section 6 of the 1968 Act was not applicable. Suitable advice was given in these cases. It is gratifying to be able to report the increased use of distillate oil and natural gas in large boiler furnaces, resulting in a reduction in sulphur dioxide emissions. Smoke and Sulphur dioxide measurements. Six continuously operating instruments for daily measurements of smoke and sulphur dioxide are sited in various parts of the Borough. Two of these are for a Department of Trade and Industry short-term investigation of pollution at high and low levels and will cease to be used early in 1971. The remainder are being gradually replaced by automatic instruments which need reading only once a week. These are being constructed by a member of our own staff. The results at the Guildhall site since 1958 compared with average temperatures are shown in Figure 1. Grit and Dust. Two deposit gauges for the monthly measurement of grit and dust are located at Canbury Gardens and Tiffin Girls' School, Kingston upon Thames. Although there are fluctuations in the readings from year to year, the long-term pattern shows a slight but steady decrease in grit fall over the Borough. The increase in 1970 for the Canbury Gardens site (see Figure 2) was probably the result of a heavy fall of scale in 97 the vicinity of Kingston Power Station, lasting about four hours, which occurred in August. The boilers had been completely shut down for two weeks and when they were started up in the morning of the occurrence, condensation in the cold flues, coupled possibly with thermal movement of the metal, must have caused the formation and detachment of scale. The precise mechanism by which the scale was formed and emitted is still under investigation, but there has been no recurrence. On matters concerning the Power Station, the department maintains a close liaison with H.H. Alkali Inspector and also with the Power Station authorities, who make every effort to keep air pollution to a minimum. It is opportune to emphasize that the combustion of coal in large industrial boilers under properly controlled conditions, such as are maintained at the Power Station, does not result in the emission of substances injurious to health. This cannot be said of the 'burning of raw coal in the domestic grate, which causes the emission at low level of tar laden smoke. According to present medical opinion the inhaling of air polluted with domestic smoke can cause chronic bronchitis. 10. RODENT AMD INSECT PEST CONTROL, It is possible to be able to report a further reduction in the number of premises found to be infested by rodents. The figure of 1.7% of the premises in the Borough where rats were found compares with a national average for urban areas of 2.0%. This was the figure for the Borough during the first year of amalgamation. In spite of the nuisance and damage caused by pigeons it has not been possible adequately to persuade people not to feed the birds to excess and it is disappointing to note the presence of large flocks of birds both in Kingston and Surbiton despite the efforts of the department to control them and this is of serious concern both to us and a proportion of the general public. Squirrels are also a nuisance in certain parts of the Borough and the department prepared an advisory leaflet on the subject similar to that produced on wasps which proved to be very successful. Both leaflets are available on request. We were fortunate in being able to maintain a full staff in this section during the year. 98 HOUSING, Further progress has been made in housing work during the year, especially with regard to works at houses in multiple occupation and in dealing with unfit dwellings. It is pleasing to record appreciation to the Housing Committee and the Chief Housing Officer for their ready co-operation in rehousing occupants of individual unfit dwellings. This has been of great assistance in dealing with both newly identified unfit dwellings and those in St. John's Road and Avenue Road, New Maiden, brought into the current 4 year (1970 - 1973) slum clearance programme. Three clearance areas in the current programme were declared, two (25 houses) in Fairfield Place, Kingston, and one (3 houses) in Church Road;, Worcester Park. The Council decided to acquire all these houses and certain adjacent properties; those in Church Road, Worcester Park, by agreement, and those in Fairfield Place were made the subject of a Compulsory Purchase Order, objections to which will be heard at a Public Inquiry due to be held in February 1971. During the year 973 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 45 informal and 13 statutory notices upon owners requiring works to comply with the code. Direction Orders restricting the number of persons and households permitted to occupy 2 houses in multiple occupation were made. There are no common lodging houses in the Borough. A major effort has continued to be in the repair and improvement of dwellings. During the year the Department of the Environment sponsored general publicity about improvement grants on television and in the national press which brought an increase in the number of grant enquiries and applications. Twelve hundred and ninety seven houses in the Borough have been improved since grant aid was introduced in 1949 and many others improved without grant assistance yet i± is estimated that in the Borough there are 2,200 homes suitable for improvement still lacking the basic amenities of:- 99 A fixed bath or shower in a bathroom. A hot and cold water supply at a fixed bath or shower. A wash-hand basin. A hot and cold water supply at a wash-hand basin. A sink. A hot and cold water supply at a sink. A water closet in and accessible from within the dwelling. The Council is prepared to make generous grants in the form of Standard or Discretionary Improvement Grants for those owners wishing to improve or modernise their homes. The scheme of improving older houses relates essentially to providing those standard amenities which are absent. An improvement grant may also be paid towards the cost of providing (by means of an approved method) a damp-proof course; for improving inadequate natural lighting or ventilation and for providing adequate facilities for heating where it does not exist, and in certain cases the Council may allow grant towards approved repairs and replacements. Improvement grants may also be given towards the cost of dividing a large house into self-contained flats, where the Council considers that the house is not suitable for use by a single family, and greater interest has been shown in this aspect of house improvement during the year. The normal maximum grant in respect of each dwelling improved (or provided by conversion) is one-half of the approved expense up to a maximum of either £1,000 in the case of a Discretionary Improvement Grant or £200 in the case of a Standard Grant. Despite the real increase in the amount of grant available, finance is still a limiting factor. The Council offers all the assistance possible in the particular circumstances of a case, and has widened its assistance to include maturity loans under the new Act, which will be of particular benefit to elderly people who would otherwise find it difficult or even impossible to repair or improve their homes, and one such loan was made during the year. The new Act also enables the Council to declare General Improvement Areas into which special effort and resources can be directed to improve houses and where possible also the environment. This responsibility has been placed with the Health and Welfare Committee and a working party of officers has been established to make recommendations. 100 Considerable progress has been made with the study of potential areas, the first of which to progress was the Thorne Road General Improvement Area, comprising largely a Council owned estate. A public meeting is to be held in February 1971 in connection with proposals for the area and detailed studies of other areas are continuing. Dwellings subject to rent controlled tenancies which meet a qualifying standard, that is dwellings which possess all the basic amenities and are in good repair, or dwellings which are improved to that standard, can be converted to regulated tenancies and the owner is entitled to increase the rent as assessed by the Rent Officer. During the year applications were received from owners for Qualification Certificates. This necessitated detailed inspection of the houses concerned and placed a heavy burden on the limited resources of the department. It is pleasing to record the ready co-operation of landlords in carrying out works of repair on an informal basis prior to the issue of a certificate. The effects of this process are that a large amount of repair work has been carried out to the stock of houses in a sector which for economic reasons has tended to be neglected and that being in receipt of higher rents, owners will be able to maintain their property in better condition in the future. Moveable Dwellings. Licences under the Caravan Sites and Control of Development Act, 1960 are in force for 36 caravans which are stationed on the Riverhill Estate. There are 9 effective orders "under the Surrey County Council Act in force in the Borough prohibiting the parking of moveable dwellings. No problems arose during the year in connection with the illegal stationing of caravans by itinerants but considerable national publicity was given to the eviction of an animal dealer from private land. 101 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 1970 under the provisions of the Milk (Special Designations) Regulations, 1963 and 1965. These Regulations prescribe that the licence 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 111 Pasteurised Milk 107 Sterilised Milk 39 Ultra Heat Treated Milk 41 Untreated Milk 22 Bacteriological Examination of Milk. During the year 43 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 Colony Count Pass Fail Pass Fail Pass Fail Under 10 Pasteurised 33 _ 32 1 - - - Ultra Heat Treated - - - - - - 2 Sterilised - - - - 8 - Ice Cream. The number of registered premises in the Borough at 31st December 1970 in which ice cream may be stored or from which it may be sold is 312. 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. 102 The table shows the results of examination of 40 samples submitted to the Public Health Laboratory at Epsom during 1970. Owing to the numerous factors governing the hygienic quality of ice cream, undue attention is not paid to the bacteriological results on any single sample. Those which are placed within Grades I and II are considered to be satisfactory and those within Grades III and IV not so. Adequate follow-up action is taken where samples fall within the latter grades. GRADE Total I II III IV Ice Cream 27 7 3 3 40 Two of the Grade IV samples were taken from open cans and the other from a soft ice cream machine. Bacteriological Examination. Twenty samples of various kinds of food were taken for bacteriological examination in the Public Health Laboratory to check on fitness for human consumption and possible association with cases of food poisoning. Three samples of pet foods were examined and no food poisoning organisms found. Articles with which food comes into contacts, including slicing machines, were swabbed to check on the standards of cleanliness. Meat Depots and Imported Food. 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 ten 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. During the year numerous visits were paid to the depots and 278 containers of food, almost entirely meat, were received in Kingston from various ports without having been inspected by Port Health Inspectors. The majority came from Ireland but some from the continent. 103 Food Hygiene. There are 1,517 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. There are no poultry processing premises within the Borough. FOOD AM) DRUGS SUBJECT OF COMPLAINT. A total of 175 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 legal proceedings. Fresh Cream Mandarin Dessert - Mould Bread Pudding - Wire Opening receptacles containing Milk and transferring milk from one to another Black Rye Loaf - Metal Chicken and Veal Pie - Paper Zinc and Castor Oil Cream - Glass Bottle of Milk - Flies Chicken. Ham and Mushroom Pie Mould Sausages containing a nail Meat Pie containing label and metal tag Fine £20. and £10. costs. Fine £10. and £ 4. costs. Absolute discharge. £4. towards costs. Fine £40., £10. costs and Witness1 expenses £3.0.4. Fine £30. and £10. costs. Public Analyst's fee £9.15.0. Fine £10. and £5. costs. Fine £20. and £5.5.0. costs. Fine £5. and £2. costs. Fine £20. and £10. costs. Public Analyst's fee £4.14.0. Fine £20. and £10.costs. 104 ANIMAL ESTABLISHMENTS The Riding Establishments Act 1970, which amends the Riding Establishments Act 1964, received the Royal Assent on the 29th Hay and authorises the local authority to grant a three month provisional licence to keep a riding establishment if the Council does not feel justified in granting a full licence. This legislation was introduced largely as a result of the deficiencies in the earlier Act which were revealed in the proceedings taken by this Council in the local Magistrates' Court in 1967. There are three riding establishments in the Borough licensed by the Council. There are six animal boarding establishments and thirteen pet animal shops licensed by the Council. The co-operation of Mr, M. Rand and Mr. M.A.P. Simons, Veterinary Surgeons, in the administration of this legislation is gratefully acknowledged. TRADE DESCRIPTIONS ACT. 1968. This Act replaced the Merchandise Marks Acts 1887 to 1953. 342 inspections were carried out under the Act to ensure that articles were appropriately labelled and warnings were given where necessary. FERTILISERS AM) FEEDING STUFFS ACT. 1926. This Act requires vendors of fertilisers and feeding 3tuf"fs to apply a description to such materials when exposed for sale or when consigned or delivered so that the purchaser is aware of the more important constituents. Thirteen samples were submitted to the Public Analyst during the year of which ten were reported as being satisfactory. 105 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 12 names were removed and 8 added. The total of names on the list at the end of the year was 104. 106 COMPLAINTS The following is a brief list of causes for complaints received during 1970 which resulted in investigation by the department and in all cases where necessary, appropriate action was taken. Accumulations 105 Animals 5 Dampness 114 Drainage/Sanitary Arrangements 1136 Dustbins 22 Flooding 31 Foods 175 Food Hygiene 45 General Housing Defects 194 Insects 581 Noise 101 Offensive Odours 122 Overcrowding 6 Pigeons 38 Rodents Rats 1048 1252 Mice 204 Shops Acts 2 Smoke 127 Squirrels 84 Water 7 Yards and Paving 2 Offices, Shops and Railway Premises Act 4 Others 84 4237 107 VISITS AND INSPECTIONS 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 12 Atmospheric Pollution Gauges 194 Bacteriological Sample Visits 96 Betting, Gaming and Lotteries Act 81 Bioligical Sample Visits 19 Building Sites 94 Chiropody and Massage Establishments 45 Committee and Council Meetings 105 Consumer Protection Act (Fireguards) 26 Council House-Disinfestations 10 " " - Inspections 184 Court 49 Depot visits or inspections 181 Diseases of Animals Act and Waste Food Order 8 Disinfections 12 Disinfestations 46 Drainage Visits 1,149 Employment Agencies 49 Food complaints 250 Food and Drugs Samples 326 Food Hygiene Regulations-Bakehouses 53 - Bakers' Shops 137 - Butchers 172 Confectioners 142 - Cooked meat shops 116 Fish shops (wet or fried) 61 Greengrocers 132 Grocers 445 Ice Cream, Manufacture 7 - " " sale 222 Institutions 23 - Milk shops and depots 98 - Mobile shops 63 - Office and Works canteens 51 - Public houses, hotels and licensed Premises 127 Restaurants and cafes 322 Sausage manufacturers 20 School canteens 104 - Sports Clubs 17 C/Fwd 5,248 108 B/Fwd 5,248 - Open Markets 456 - Wholesale meat shops 106 - Other food premises 35 Factories - Non-Power 14 " - Power 221 Fertilisers and Feeding Stuffs 19 Hairdressers and Barbers 145 Health Education 72 Home Safety 3 Houses in Multiple Occupation 973 Housing Enquiries 49 Housing Act Inspections 630 ,, ,, Reinspetions 539 ,, ,, Qualification Certificates 867 Improvement Grant Visits 1,951 Infectious Disease Visits 1,482 Insect Pests 145 Interviews with Owners, Builders, etc 1,309 Licensing Act (Unlicensed Premises) 4 Merchandise Marks Act 67 Miscellaneous (including no reply) 2,557 Night Cafes 7 Noise Abatement 512 Nursing Homes 1 Offices, Shops and Railway Premises 2,206 Old People and Problem Families 168 Overcrowding 10 Pet Animals Act 35 Pigeons 29 Piggeries 6 Pharmacy and Poisons Act 108 Public Conveniences 73 Public Health Act inspections 1,712 ,, ,, ,, reinspections 1,254 Rag Flock Act 8 Refreshment Houses (Licences) 7 Refuse Tips 33 Rent Act 54 Riding Establishments 72 Rivers, Ditches and Ponds 51 C/Fwd 23.238 109 B/Fwd 23,238 Rodent Control 131 Shops Act 119 School Premises 210 Smoke Abatement 420 Smoke Control Areas 8,425 Smoke Control Areas-No access 1,325 Special Surveys 505 Tents, Vans, Sheds and Caravans 61 Trade Descriptions Act 342 Unsound food 261 Vacant land 146 Visits outside district 344 Waste Food (Staining and Sterilisation) Order 3 Water Supply and Sampling (including Swimming Pools) 418 Work in progress 425 Work Places and Outworkers 61 36,434 110 FOOD AND DRUGS ACT. 1955, 436 samples were submitted to the Public Analyst for examination Of the 28 samples which were the subject of adverse comment by the Public Analyst several were due to failure to comply with labelling requirements. The provisions of the Labelling of Food Order, 1953 and the Labelling of Food Regulations, 1970 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. Cheese Spread Deficient in milk fat to the extent of 6 per cent. The sample contained milk fat 18.8 per cent. The manufacturers were unable to explain as their tests showed fat consistently in excess of 20%. Subsequent sample satisfactory. Braised Kidneys Deficient in meat to the extent of 4 per cent. The sample contained lean meat 70 per cent., fat 2 per cent., total 72 per cent. The matter was taken up with the manufacturers who, it appeared, were not allowing sufficient margin for filling errors. A further sample is to be taken. Pork Sausages Deficient in meat to the extent of 13.8 per cent, and contained foreign matter in the form of a piece of string. The sample contained lean meat 28 per cent., fat 28 per cent.,, total meat 56 per cent excess fat 6 per cent. Manufacturers stated fat in the can was "boil out" from sausages and that the recipe for product meets statutory requirements. A further sample was taken and proved to be satisfactory . Flour Plain The sample contained no added chalk. The manufacturers stated they were about to alter their creta preparata feeder which should assist in even mixing. 111 Frankfurter Sausage hot dog type Deficient in meat to the extent of 12.5 per cent. The sample consisted of frankfurters in brine and contained lean meat 48.0 per cent., fat 13.2 per cent., total meat 61.2 per cent. The importer stated that this was an old label and the product was now described as Hot Dog Sausages. Frankfurter Sausages in brine Deficient in meat to the extent of 3.4 per cent. The sample contained: Lean (defatted meat) 45.5% Fat 22.1% 67.6% Skimmed milk powder 1.4% Added water 31.0% 100.0% Taken up with the importers who raised it with the manufacturers. There was a difference of opinion as to the method of determining the meat content of sausages packed in brine. Chocolate Crunch The sample was not of the nature of chocolate. It was coated with a chocolate substitute containing a high proportion of vegetable fat, other than cocoa butter. Legal proceedings Fine £10. Costs £10. Flour (plain) Deficient in chalk to the extent of 79 per cent. The sample contained chalk - 50 mg. per 100 g. In view of Regulation 25 of the Bread and Flour Regulations, the matter was referred to the Local Authority in whose area the Flour Hill was situated whose subsequent samples proved satisfactory. Concentrated Orange Squash Contained a nonpermitted artificial sweetener. The sample contained: Cyclamic acid 3700 grains per 10 gallons. This was presumed to be old stock as no more was found on sale. 112 Pure Wine Vinegar Not of the quality expected. The sample contained dead bacterial cells and other vegetable matter in suspension. The bottlers withdrew stocks, the condition of which was suspected to be due to failure of filters. Inner Fresh Incorrectly labelled. One of the active ingredients listed on the label was not in the current B.P.C. and did not include the date on which it last appeared in the B.P.C. Hanufacturers arranged for the label to be amended. Zinc and Castor Oil Cream The sample contained 16 per cent in excess of the maximum amount of zinc oxide laid down in the BP., and also contained two minute fragments of glass. The sample contained Zinc Oxide . 9.3% Glass . 0.002% Taken up with the manufacturers and stocks were withdrawn from sale. Cornish Pasty Deficient in meat to the extent of 38 per cent. The sample contained Heat - 9 per cent. Warning given. Pasty Deficient in meat to the extent of 44 per cent. The sample contained Heat - 7% The retailer/manufacturer was warned and he agreed to amend the recipe. Guava Cheese Deficient in soluble solids content and incorrectly described. The sample contained Soluble Solids 64.8% and neither eggs nor fat which should be present in a fruit cheese. Taken up with the importer who stated that he would not be having further consignments and would raise the matter with the supplier. 113 Sarson Ka Saag The ingredients of the article were not declared. The matter was raised with the importer who undertook to contact his suppliers regarding the ingredients being declared. Tinda The ingredients of the article were not declared. - do - Chocolate Wafers Incorrectly named. The article consisted of a wafer biscuit filled with a chocolate substitute. Description being suitably amended. Sherbet 2 samples. Incorrectly described. The article consisted of lemonade powder. The retailer was warned to label correctly. Raspberry flavoured Vinegar Incorrectly described. The sample consisted of sweetened flavoured vinegar. Old stock; retailer withdrew remaining bottles from sale. Cheese Deficient in milk fat to the extent of 4.9%. The sample consisted of Emmenthal cheese and contained Water - 39.05% Milk fat in the dry matter 42.8%. Raised with the importer who contacted the manufacturers. Latter stated that the sample must have been an exception as regular fat content controls are taken. Follow-up sample to be taken. Cottage Cheese The container did not bear the description "low fat soft cheese" as required by the Cheese Regulations 1970. The sample contained Fat - 5.0 per cent. Water - 76.5 per cent. Following correspondence, the manufacturers arranged to change the wording on the container. 114 Marmalade Misleading label. The size of print used to claim the presence of Cointreau was unduly prominent considering the proportion of liqueur present. The sample contained Alcohol 0.23 per cent. proof spirit. Matter raised with manuturers - correspondence not yet concluded. Chocolate Top Sandwich Misleading title. The article contained no cocoa butter. The sample contained: Total vegetable fat - 0.4 per cent. Agreed with manufacturers that 'Chocolate flavour top sandwich' would be acceptable but the retailer gave instructions to sales staff not to label any cakes. Cherry Cough Linctus Incorrectly described. The sample contained no extract of wild cherry baric. Discussed with the manufacturers who have amended the design of the pack but objection is taken to the wording on this package. Correspondence not yet concluded. Dressed Crab 2 samples. Misleading description. The sample consisted of a soft paste of highlycomminuted crab meat, with starch filler, salt, spice and colour not usually described as "Dressed Crab". Taken up with the importers and canners who pointed out that 'Dressed Crab" was recognised under the Fish and Meat Spreadable Products Regulations 1968. Since these products are clearly pastes and yet the manufacturers are not prepared to label them as such, one can only conclude that they feel that by giving a more accurate description of the product this would affect its saleability. Dressed crab is a culinary description given to crab prepared for the table and whilst part of the separated crab meat is often mixed with mayonnaise and seasoned it is not minced or highly comminuted. In my opinion the Regulations are being used as an excuse to degrade a well recognised article and one can only hope that they will be amended so as to require the inclusion of the word "paste" in the description of dressed crab. 115 FOOD AND DRUG SAMPLES Milk 11 Milk Products 42 Meat and Meat Products 66 Fish and Fish Products 13 Oils and Fats 10 Sugar and Preserves 37 Confectionery and Chocolate 35 Fruit and Fruit Products 28 Vegetables and Vegetable Products 11 Cereals and Cereal Products 30 Flour Confectionery 17 Beverages 11 Soft Drinks 32 Alcoholic Drinks 18 Condiments and Sauces 24 Soups 3 Spices and Flavourings 5 Food Additives and Supplements 6 Slimming and Diabetic Foods 6 Drugs 12 Miscellaneous 19 436 FOODSTUFFS CONDEMNED AS UNFIT Canned Goods lbs. Cream 4 Fish 79 Fruit 2, 287 Jams and Preserves 49 Meat and Meat Products 409 Milk 47 Milk Pudding 14 Soup 52 Vegetables 548 Others 90 Bacon 95 Biscuits 1,070 Fish 152 Meat 9.897 Poultry 70 Rabbits 90 Vegetables 12 Walnuts 540 Frozen Foods (Refrigeration failure) 5,992 342 (Number) 116 FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS. 1966. The following tabulated statement shows the nature of infrigements to which attention was drawn:- Number of stalls selling food 61 Total Name and address not displayed. 4 Washable overclothing not worn. 5 Washing facilities 7 First aid equipment 5 Protection of food 2 General cleanliness 3 26 Four Street Traders were prosecuted for contravention of the above Regulations and penalties were as follows:- Fine £7. with £3. costs. Fine £3. Fine £2. with £1. costs. Fine £4. FOOD HYGIENE (GENERAL) REGULATIONS. 1960. The following is a tabulated statement of inspections made of the various types of food premises:- No.of Premises Visits Bakers and Bakers shops 43 190 Butchers 72 172 Confectioners 167 142 Fish shop (wet or fried) 34 61 Greengrocers 83 132 Grocers 144 445 Ice cream, manufacture 1 7 ,, ,, sale 312 222 Institutions 37 23 Milk shops and depots 111 98 Mobile shops 63 Office, shop and works canteens 90 51 Public houses, hotels and licensed premises 137 127 Restaurants and cafes 136 322 School Canteens 56 104 Clubs 60 17 Open Markets 2 456 Wholesale meat shops 10 106 Other food premises 72 35 1.567 2.773 117 FOOD HYGIENE The following tabulated statement shows the nature of the infringements to which attention was drawn:- Total number of food premises 1.567 Washing facilities for staff Absence of, defective, inadequate hand basins 19 Absence of hot and cold water 37 Lack of towels, soap and nailbrushes 21 Defective water heaters 6 Sanitary Conveniences Lack of "Wash Your Hands" Notices 6 Fittings defective and dirty 9 Lighting inadequate 3 Walls and ceilings defective and dirty 5 Ventilation and/or ventilated lobby required 3 Others 6 Repairs to Food Rooms Floors defective 2 Walls and ceilings defective 2 General cleansing 4 Sinks and Draining Boards Lacking or defective 10 Protection of Food against Contamination 4 Food not kept 18" off ground l Covers not provided for food 2 7 Uncleanliness Kitchens and equipment- 17 Food Stores 3 Preparation rooms 2 Floors, walls and ceilings 44 Refrigerators 4 Ventilation 3 Dustbins — insufficient and defective 2 Uncovered, and collection of, refuse 1 First Aid Equipment 4 Clothing - storage and cleanliness 3 Accumulations 3 233 Notices served 69 Notices complied with 106 118 NOTICES SERVED Informal Written and verbal 850 Statutory (a) Housing Acts (excluding those mentioned in (b) below) 108 (b) Housing Act, 1957 - Section 170 - requiring information as to ownership 161 (c) Public Health Acts (other than mentioned in (d) below) 50 (d) Public Health Act, 1936 - Section 277 - requiring information as to ownership 40 (e) Clean Air Act 7 NOTICES COMPLIED WITH Informal Written and verbal 751 Statutory (a) Housing Acts 4 (b) Public Health Acts 19 (c) Clean Air Act 22 119 FACTORIES ACT. 1961 The following are the particulars required to be furnished to the Department of Employment and Productivity concerning matters dealt with by the Corporation under Parts I and VIII of the Factories Act. PART I OF THE ACT 1. INSPECTIONS No. on Register Number of Inspections Written Notices Prosecutions Factories in which Section 1,2,3,4,6 are enforced by the Corporation 49 14 - - Factories not included above in which Section 7 is enforced by the Corporation 639 221 13 - Other premises excluding outworkers 144 94 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 1 - - - Unsuitable or defective 10 9 1 - - Other offences against the Act (not including offences relating to outwork) 3 3 1 - - 120 FACTORIES ACT. 1961. 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 Tapestry 1 Curtains and furniture hangings 1 Fuse makers 8 Wearing apparel - making etc. 11 Household linen - making etc. 1 Artificial flowers 2 Lampshades 9 33 121 OFFICES. SHOPS AND RAILWAY PREMISES ACT. 1963. The figures enumerated in the following tables are those submitted in accordance with the provisions of Section 60 of the Act and included in the Annual Report to the Department of Employment and Productivity. Section Number of Contraventions found Section Number of Contraventions found 4 Cleanliness 25 13 Sitting facilities 1 5 Overcrowding 5 15 Eating facilities 3 6 Temperature 61 16 Floors, passages and stairs 44 7 Ventilation 40 17 Fencing exposed parts of machinery 7 8 Lighting 4 20 Safety Precautions 7 9 Sanitary Conveniences 37 24 First Aid 67 10 Washing facilities 61 29 Registration 40 12 Clothing Accommodation 5 50 Provision of Abstract 68 Other matters 4 Total 479 122 ACCIDENTS Workplace Reported Non Fatal Total No. Investigated Action Recommended j Informal advice No action Offices 4 3 3 1 Retail shops 48 30 30 18 Wholesale shops Warehouses 5 4 4 1 Catering establishments open to public, canteens 5 4 4 1 TOTAIS: 62 41 41 21 ANALYSIS OF REPORTED ACCIDENTS Offices Retail shops Wholesale warehouses Catering establishments open to public, canteens Falls of persons 3 16 4 1 Stepping on or striking against object dr person - 4 - - Handling goods - 15 - 1 Struck by falling object - 2 1 — Use of hand tools - 8 - - Not otherwise specified 1 3 — — Fires and Explosions - - - 3 123 PEST CONTROL - STATISTICAL STATEMENT 1. Number of properties in district 59,660 2. (a) Total number of properties (including nearby premises) inspected following notification 1,726 (b) Number infested by ( i) Rats 535 (ii) Mice 204 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 1,082 (b) Number infested by ( i) Rats 297 (ii) Mice 24 4. Complaints received: Rats 1,048 Mice 204 Squirrels 84 Pigeons 38 Wasps/Bees 413 Other insects 168 124 HOUSING The following is a tabulated statement of action taken under the Housing Acts, 1. Number of houses inspected 630 2. (a) Number of houses which, on inspection, were considered to be unfit for human habitation 38 (b) Parts of houses which, on inspection, were considered to be unfit for human habitation 8 3. Number of houses, the defects of which were remedied in consequence of informal action by the Local Authority or its officers 341 4. Number of representations made to the Local Authority with a view to:- (a) The serving of notices requiring the execution of works 77 (b) The making of demolition or closing orders (number of houses involved) 18 (c)Declaration of Clearance Areas (number of houses involved) 28 5. Number of formal notices served requiring the execution of works 56 6. Number of houses which were rendered fit after the service of formal notices 16 7. Number of demolition or closing orders made 18 8. Number of houses in respect of which an undertaking was accepted under Sub-section 4 of Section 16 of Housing Act, 1957. - 9. Number of houses demolished 17 10. Number of houses where demolition or closing order determined on the premises being made fit 1 125 RENT ACT. 1968 Applications for Certificates of Disrepair Applications 2 Decisions not to issue certificates - Decisions to issue certificates (a) in respect of some but not all defects 1 (b) in respect of all defects 1 Undertakings given by landlords under paragraph 5 First Schedule 1 Undertakings refused by Local Authority - Certificates issued 2 Applications for Cancellation of Certificates By landlord 1 Objections by tenants to cancellation - Decisions by Local Authority to cancel in spite of tenant's objection - Certificates cancelled 1 126 HOUSING ACT, 1969 IMPROVEMENT GRANTS - STANDARD Owner/Occupiers Tenanted Applications received 44 30 " approved 36 17 Dwellings improved 49 6 £ s. d. Amount paid in grants 9, 283.14. 6. Average per house 168.15. 2. Amenities provided - a j fixed bath or shower 37 b wash-hand basin 40 c hot water supply (to any fittings) 50 d water closet within dwelling 44 sink 12 IMPROVEMENT GRANTS - DISCRETIONARY Owner/Occupiers Tenanted Applications received 59 61 " approved 52 51 Dwellings improved or provided 39 14 £ s. d. Amount paid in grants 20,865. 13. 1. Average per house 393. 13. 10. SPECIAL GRANTS Owner/Occupiers Tenanted Houses Households Houses Households Applications received 6 25 3 26 " approved 4 15 2 19 Grants paid - - 3 22 £ s. d. Amount paid in grants 175. 12. 6. Average per house 58. 10. 10. Average per household 7. 19. 8. 127 HOUSING ACT 1969 - PART III CERTIFICATES OF QUALIFICATION IMPROVEMENT CASES No. of applications in register at 31.12.70 40 No. of applications for Qualification Certificates under Section 44(2) voider consideration at 31.12.70 17 No. of Certificates of Provisional Approval issued 22 No. of Qualification Certificates issued under Section 46(3) 7 STANDARD AMENITIES ALREADY PROVIDED No. of applications in register at 31.12.70 656 No. of applications for Qualification Certificates under Section 44(l) under consideration at 31.12.70 253 No. of Qualification Certificates issued under Section 45(2) in respect of:- (i) dwellings with rateable value of £90 or more in Greater London 170 (ii) dwellings with rateable value of £60 to less than £90 in Greater London 117 (iii) dwellings with rateable value of less than £60 in Greater London 1 EXEMPTION FOR LOW INCOME TENANTS FROM SECTION 54 No. of applications in register at 31.12.70 1 No. of certificates issued under Section 55 1 128 WATER SUPPLY, The following information has been kindly supplied by the Director of Water Examinations, Metropolitan Water Board, Yearly Average Bacteriological Results Before Treatment. Number of Samples 8,259 Agar plate count per ml. 20-24 hours at 37°C 31.9 Coliform Count - Per cent, samples negative in 100 ml 37.91 Count per 100 ml 17.3 Escherichia coli count - Per cent, samples negative in 100 ml 53.58 Count per 100 ml 4.7 After Treatment. Number of Samples 3,710 Agar plate count per ml. 20-24 hours at 37°C 8.0 Coliform count - per cent samples negative in 100 ml. 99.92 E. Coli count - per cent. samples negative in 100 ml. 99.97 129 Results of the Chemical Examination of Water supplied to Borough. (in milligrammes per litre) Number of Samples 363 Ammoniacal Nitrogen 0.026 Albuminoid Nitrogen 0.083 Nitrate Nitrogen 4.8 Oxygen abs. from KHn04 4 hrs. at 27 C. 1.02 Hardness (total) CaC03 274 Hardness (non-carbonate) CaC03 79 Magnesium as Mg 5 Sodium as Na 27.7 Potassium as K 5.6 Chloride as CI 40 Phosphate as P04 2.7 Silicate as Si02 9 Sulphate as S04 70 Natural Fluoride as F 0.20 Surface-active material as Manoxol OT 0.03 Turbidity units 0.1 Colour (Burgess units) 11 pH value 7.9 Electrical Conductivity (micromhos) 570 130 131 SCHOOL HEALTH SERVICE 134 ROYAL BOROUGH OP KINGSTON UPON THAMES EDUCATION (SCHOOLS AND FURTHER EDUCATION) SUB-COMMITTEE AS AT DECEMBER 1970 Chairman: Councillor Mrs. E. Bidmead Vice-Chairman: Councillor K. C. Gooding Aldermen: J. H. Cocks, O.B.E. J. Harrison A. C. Healey, M.Sc., Ph.D., P.R.I.C. W. J. Marshall Councillors: Mrs. J. L. Ahern, R.S.C.N. P. R. S. Montgomery R. M. Church Mrs. A. D. Parry, B„Ao(0xon) D. Ives, M.A.(Oxon) W. J. Webb, B.A. J. P. C. Kimber, B.Sc.(Econ.), P.C.I.I. P. R. Wise Co-opted Members: Mrs. M. Hall E„ Morgan Rt. Rev. Mgr. H. Hunt W. P. Richardson E. Lawler F. Seal 135 SCHOOL HEALTH SERVICE Readers are referred to the comments on the school health service on pages 5 and 6. The population of the borough, estimated by the Registrar General, was 142.690 at mid-1970. In January 1971 the number of pupils on the registers of maintained schools was 20,060 made up as follows: Primary Schools 11,835 Secondary Schools 7,940 Nursery Schools 78 Special Schools 207 In addition it is estimated that 2,900 children attend independent schools registered under Part III of the Education Act 194^, and 560 attend the direct grant school which is served by the school health service. The number of maintained schools in the borough on 31st December 1970 was 57: 13 secondary, 40 primary, 1 nursery, 2 special. One direct grant school was 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 Officers and were assisted by two senior and one other medical officer., 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 Deputy Superintendent and 28 health visitors carry out the functions of school nurses, devoting about 20 per cent of their time to duties in connection with the school health service. Sessionally employed state registered nurses work with medical officers at medical inspections in secondary schools, immunisation sessions and general medical clinics, and are responsible for vision testing of thirteen and sixteen-year-old pupils. 136 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 1970 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 5857 children being examined. The arrangements for periodic medical inspection are summarised below: On entry to infant and nursery schools On entry to the junior school (selective examinations) On entry to the secondary school During the year in which age fifteen is reached At the 8-year-old level, 583 children were selected for examination out of a total of 1585 children in this age group. 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. General Conditions as Recorded at Periodic Inspection Of the 5857 pupils inspected, 5852 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 five children whose general condition was deemed unsatisfactory consisted of one born in 1965, one in 1964 and three in 1962. 137 Defects Found at Periodic Medical Inspection During 1970, 680 (11.8 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 1966 and later 525 4 44 48 1965 1250 18 83 93 1964 201 1 14 15 1963 80 1 5 5 1962 442 15 54 68 1961 141 11 13 22 1960 70 6 3 8 1959 977 52 48 89 1958 572 35 43 76 1957 58 1 2 3 1956 52 3 3 6 1955 and earlier 1489 164 94 247 Totals 5857 311 406 680 138 Defects noted at periodic medical inspection (whether or not they were already under treatment or observation) are analysed below: Defect or Disease Requiring Treatment Observation Skin 75 85 Eyes: (a) Vision 311 306 (b) Squint 42 36 (c) Other 2 11 Ears: (a) Hearing 12 100 (b) Otitis Media 15 87 (c) Other 7 2 Nose and Throat 41 219 Speech 44 60 Lymphatic Glands 16 81 Heart 1 65 Lungs 16 129 Development: (a) Hernia - 13 (b) Other 7 66 Orthopaedic: (a) Posture 19 65 (b) Feet 56 102 (c) Other 29 53 Nervous System: (a) Epilepsy 19 22 (b) Other 6 24 Psychological: (a) Development 4 92 (b) Stability 12 180 Abdomen 9 21 Other 45 49 Total: 2656 788 1868 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 1210. 139 Special Inspection: 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 in the 461 pupils examined at these inspections are analysed below: Requiring Defect or Disease Treatment Observation Skin 3 41 Eyes: (a) Vision 16 3 (b) Squint - - (c) Other - - Ears: (a) Hearing 52 52 (b) Otitis Media 1 - (c) Other - - Nose and Throat 7 4 Speech 3 11 Lymphatic Glands 4 - Heart 1 - Lungs 4 3 Development: (a) Hernia - - (b) Other 3 3 Orthopaedic: (a) Posture 4 2 (b) Feet 13 31 (c) Other - 2 Nervous System: (a) Epilepsy - - (b) Other - - Psychological: (a) Development - - (b) Stability 9 10 Abdomen - - Other 18 42 Total: 342 138 204 140 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: Defects or Diseases Number Skin: Ringworm, head or body 8 Scabies 9 Impetigo 8 Other 4 Vision and Squint 1461 Other Bye conditions 11 Ear, Nose and Throat 110 Speech 543 Heart 20 Lungs 50 Development 2 Orthopaedic 211 Nervous Diseases 59 Abdomen 92 Other 70 Total: 2658 Combined general medical and immunisation sessions attended by a school medical officer with a school nurse, 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 Bar, Nose and Throat 110 children received operative treatment by ear, nose and throat surgeons, including one case of tonsils and adenoids. Speech Therapy The work of the speech therapy service continued satisfactorily during 1970 in spite of further staff changes. 141 The number of cases treated has increased slightly and although a larger number of children were discharged, a higher number of children remained under treatment at the end of the year. The pre-school groups continued to provide help for young children who suffer from various epeech defects, and student speech therapists from the London Training Schools worked with these groups under the guidance of qualified therapists. In addition to sessions held in the clinics, certain schools are visited which are either at an appreciable distance, or an awkward journey from the nearest clinic. so that children are able to benefit by regular treatment. The number of children attending Bedelsford School who required speech therapy continued to decrease due to the changing pattern of physical disability from which the children suffer. At St. Philip's School, Chessington, the number of educationally retarded children who required treatment for speech defects continued to increase. During the latter part of the year children with severe speech defects were under consideration for possible admission to the proposed unit for speech handicapped children, which is expected to commence functioning during 1971. Details of the work undertaken at the centres are shown overleaf, with the 1969 figures for comparison. 142 Centre Present Number of Sessions Initial Caseload Children Treated Remaining for Next Year 1969 1970 1969 1970 1969 1970 1969 1970 Acre Road 2 2 18 26 37 44 26 37 Bedelsford School 8 8 25 24 34 26 24 17 Grange Road 2 2 32 22 39 34 22 22 Hook 3 3 34 46 58 79 46 57 Ros elands 6 6 38 74 109 127 74 77 St. Philip's School 10 10 47 47 61 74 47 48 Surbiton 2 2 20 28 41 54 28 37 Tolworth 2 2 27 28 36 48 28 28 Worcester Fark 3 3 49 38 66 57 38 38 Totals 38 38 310 335 481 543 333 341 Analysis of Cases Treated Children Treated during Discharged Remaining at end of period covered 1969 1970 1969 1970 1969 1970 Stammering 46 46 17 15 29 31 Cluttering 1 3 - - 1 3 Dyslalia 269 294 89 100 180 194 Idioglossia 2 2 - - 2 2 Anar thria/Dysarthria 18 13 7 6 11 7 Aphasia/Dysphasia 11 9 2 2 9 7 Aphonia/Dysphonia 1 2 - 2 1 - Cleft Palate 4 6 - 1 4 5 Hyp errhinophonia 10 7 3 3 7 4 Hyporhinophonia 1 - 1 - - - Defective Speech due to Deafness 10 11 1 3 9 8 Retarded Speech and Language Defect 104 145 28 46 76 99 Unclassified 4 5 - 4 4 1 Totals 481 543 148 182 338 361 143 Ophthalmic Clinics During the year 1472 children were examined at the school eye clinics; 456 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. Audiology The following are details of work undertaken in the schools: Children sweep tested: Primary 2031 3319 Secondary 1288 Children who failed test: Primary 191 245 Secondary 54 Result of Investigations by School Medical Officers: No significant hearing loss on clinical examination 60 No significant hearing loss, but child appears mentally retarded 3 Hearing less confirmed and attributed to: (i) Catarrhal condition (with or without inflammation of ear)45 (ii) Old otitis media 10 (iii) Injury - (iv) Other causes 19 (v) Undetermined causes 8 Investigations Incomplete at end of year 17 Investigations not possible - left district or otherwise unavailable for examination 9 Recommendations by School Medical Officers in the first instances: (i) No action required 20 (ii) For observation only 50 (iii) Refer to audiology clinic 22 (iv) Refer to general practitioner 20 (v) Refer to ear, nose and throat consultant 7 144 There were 35 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 46. Audiology Clinic Of the 500 attendances during the year, 219 were made by 135 children under the age of five, and 281 were made by 133 children aged five and over. Details or cnildren and attendances are as follows: AGE GROUP Totals . Under 2 2-4 5-7 8-11 11 + New cases referred from all sources 27 107 66 41 25 266 Cases carried over from 1969 1 _ 1 _ _ 2 Found to have normal hearing 25 89 24 15 1 154 Deaf in one or both ears 1 1 2 4 4 12 Found to have remediable hearing loss _ 15 40 25 14 94 Impaired hearing requiring auditory training and/or hearing aid 2 3 1 _ 1 7 Not fully assessed at end of 1970 _ _ 1 _ _ 1 Attendances 48 171 122 100 59 500 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: Sessions held 217 Children treated 151 Attendances 2320 New cases admitted 68 Cases discharged 71 145 The 75 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, 19 of the children examined were referred far treatment and 22 others were noted for observation at a later date. Cleanliness The work of health visitors and school nurses in connection with uncleanliness and verminous conditions in schools is summarised below: School children examined 13,600 Number found infested (head lice/nits) 94 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: Smallpox - Diphtheria - Scarlet Fever 46 Enteric Fever 1 Measles 200 German Measles 150 Chicken Pox 186 Mumps 566 Jaundice 21 Dysentery 3 Influenza - Other 39 Total 1,243 146 Immunisation and Vaccination It is now usual for children to be fully immunised against diphtheria, whooping cough, tetanus, measles and poliomyelitis by the time they enter school at five years of age. In addition the majority are vaccinated against smallpox. 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 cooperation of head teachers in making arrangements for medical officers to visit the schools is very much appreciated. During the latter part of the year vaccination against rubella (German measles) became available and was offered initially to girls born in 1957. It is intended to reduce the age at which this protection is available so that all girls have the opportunity of full protection during their twelfth year of life. Diphtheria Primary Immunisation Number who completed a primary course 55 Reinforcing Number who received reinforcing injections 1896 1951 Poliomyelitis Primary Course Number who completed a primary course 180 Reinforcing Number who received a reinforcing dose 2764 2944 Tetanus Primary Course Number who completed a primary course 152 Reinforcing Number who received a reinforcing injection 2368 2520 147 Measles Number who received immunisation 492 Smallpox Primary Vaccination Number who received primary vaccination 71 Reinforcing Number who received revaccination 321 392 Rubella (German measles) Number who received immunisation 478 Vaccination against Tuberculosis Daring the year one school child was notified by the Chest Clinic as a positive case of tuberculosis of the neck glards. 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 1297 1111 33 70 1008 Children found to be Mantoux positive were referred to the Chest Clinic for chest X-ray, but none of these was found to have active disease. 148 Child guidance The number of new cases referred to the clinic in 1970 was slightly higher than in the previous year, and of the varied sources of referral, the general practitioners formed the largest single source, indicating their increasing awareness and involvement with the psychiatric service provided for children and parents. The day unit for children with emotional problems has functioned well under the supervision of two newly appointed staff who have coped admirably with a difficult task and have co-operated well with the clinic staff. Staff resignations and staff shortages have increased the work load of the remaining members of the clinic team, but the remaining staff continue to give a high standard of service. The consultant paediatrician at Kingston Hospital provides his very necessary expertise most willingly and helpfully. The Children's Department, the Probation Service and other community agencies continue to have a close working relationship with the clinic and a special speech therapy treatment unit, due to open in 1971, will involve the psychiatric team in the overall treatment programme. Because of the geographical difficulty of interviewing patients from the Chessington and Hook areas, arrangements are being made to use accommodation in the Hook Clinic for interviewing new patients. The following table shows the work done during the year: Caseload brought forward from 1969 326 Waiting list at December 1969 10 336 146 new cases were referred during 1970 by the following: Health Visitors 1 Court 6 School Health Service 40 Hospitals 5 Private practitioners 43 Child Guidance Clinics 1 149 Direct non-medical 34 Education Department 6 School Psychological Service 3 Children's Department 3 Speech Therapists 2 Family Welfare Section 2 Reasons: Nervous disorders 16 Behaviour problems 94 Habit disorders 16 Psychosomatic disorders 3 Educational problems 9 For special examination 7 Advice only 1 Total of new cases 146 New cases initially seen by psychiatrist during the year 125 New caseload initial distribution: Psychiatrist 40 Psychiatric Social Worker 80 Psychologist 5 Total of caseload during the year 482 All cases - closures during the year: Treatment completed 8 Advice only 7 Non-co-operative 14 Other arrangements made 15 Improved 30 Failed to attend 5 Transferred to other agencies 3 Left school 16 Moved from district 7 Deceased _1_ 106 Caseload on treatment at end of year 356 On waiting list for diagnostic interview 20 150 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 1970 Recommended for placement - parents refused 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 — — — — 1 — — Partially Sighted — — 2 2 1 — — — — — 1 — Deaf — — 3 2 1 1 — — — — — — Partially Hearing — — 5 4 1 1 — — — — 1 — Educationally Subnormal 70 49 2 1 6 2 — — — — 1 3 Epileptic — — 1 _ — 2 — — 1 — — — Maladjusted 3 2 3 — 20 3 — — 3 3 2 3 Physically Handicapped 9 9 — 2 4 1 — _ 4 3 — — Delicate — — — — 4 1 — — — — — — Speech Defect — — — — — — — — — — — — Totals 82 60 16 11 38 11 — — 8 7 5 6 151 Bedelsford School, Grange Road, Kingston Thanks are expressed to Mr. E. C. Cooke, Headmaster, for the following report: The work on the remodelling of the building is now completed. The capacity is for 85 children, ranging in age from 2½ to 16 plus. There are however only 66 on roll at the moment. The decrease in number seems to be accounted for by the fewer cases of cerebral palsy and no more poliomyelitis cases. The increase in the number of spina bifida and hydrocephalus cases does not at the moment appear to be evident. The layout of the new nursery unit is exceptionally good. There is a teacher and a nursery nurse assistant for ten children. Provision has already been made by the Authority for an additional helper. This will enable the number to be increased to fifteen. The school now has a very up to date language laboratory which will be useful for remedial reading, etc. The handicaps at present are as follows: Cerebral Palsy 23 Spina Bifida and Hydrocephalus 18 Muscular Dystrophy 12 Congenital Heart Disease 4 Various 9 Total: 66 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: A recent survey (December 1970) of ten-year-olds showed the following characteristics, which may be taken as fairly typical of the school: 152 There were 18 ten-year-olds: 11 boys, 7 girls, placed in three different classes according to social maturity and related factors. 16 were from within the borough. I.Q. range 52 - 80: mean 70. Reading age range: <5 - 10.3; mean<6.4. Average age of admission: 7½ years. 3 children are poor attenders: 166 228 272 384 384 384 6 children receive free school meals. 3.7 children per family (4 families of 6 children) 3 broken families (one parent gone) and 6 more under stress (total ½) Strong association: practically same children who receive free meals come from families under stress, and live in same area (Norbiton). 11 assumed 'normally' backward, i.e. one end of a normal distribution. Others: 1 psychotic (?), 1 maladjusted, and remaining 5 - some form of neurological impairment assumed. 8 children had working mothers. 11 children said they had never been to London. Ascertainment of Handicapped Pupils Children ascertained in 1970 as requiring special educational placement Category Number Blind Nil Partially sighted 1 Deaf 1 Partially hearing 2 Educationally subnormal 15 Epileptic nil Maladjusted 13 Physically handicapped 5 Delicate 1 Speech defect nil Total: 38 153 Health. Education Details of activities which took place in schools and youth centres are reported on page 23. Youth Employment Service - Year ended 30th September 1970 1969 1970 Boys and girls who left schools in the borough 1662 1628 New entrants into National Insurance: school leavers 646 667 First advisory interviews 1131 1477 Applications for employment* 1197 1157 First applications included in above figure 630 588 Vacancies notified* 2089 2024 Kingston boys and girls placed in local employment 674 688 Kingston boys and girls placed in other districts 100 94 Local residents included in above figures who were placed in first situations 383 353 Total of vacancies filled in Kingston area 832 826 * 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. 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 256 Children examined for entertainment licences 14 Pound to be unfit nil 154 School Milk and Meals Service 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 1970 Returns Children in attendance 19,066 Taking milk 10,719 Percentage taking milk 56.22 Taking meals 14,307 Percentage taking meals 75.04 Cost of meal to pupil 1s.9d. Actual cost of meal 3s.6d. Percentage taking meal at: Full cost 94.6 Free 5.4 Average number of days meals were supplied in year 200 Average daily number of meals supplied 14,612 Number of meals supplied: Non-maintained schools and other Establishments 23,915 Maintained schools 2,898,507 2,922,422 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. Four children enjoyed recuperative holidays under this scheme during the year. 155 Deaths of School Children During the year notifications were received in respect of the deaths of two children of school age resident in the borough. The causes of death were as follows: 1 Fractured skull and lacerated brain (Motor vehicle accident) 1 Broncho-pneumonia and cerebral palsy Medical Examination of Adults 166 newly appointed teachers and candidates for admission to teachers training colleges were medically examined, as required by the Department of Education and Science. 263 teachers were appointed to Kingston schools after submitting medical history forms; all were fit. 156 SCHOOL DENTAL SERVICE Donald M. Dodd, L.D.S., B.D. S., Chief Dental Officer Staff The staff position remained at almost full strength throughout the year. Clinics and Equipment Regular inspections of clinics and items of equipment were carried out and arrangements made for a phased replacement of certain old dental units to begin during 1971/72. Dental Inspections (see tables) "19,491 pupils were inspected at either schools or clinics and 2,799 reinspected. The large number of inspections achieved was due almost entirely to the improved staff situation, compared with that of the previous twelve months. Dental Treatment (see tables) 7,581 children (39 per cent) were found to require treatment at their first inspection of the year and of these, 3,535 (47 per cent) were treated by the school dental service. Satisfactory trends continued to be observed in the basic pattern of treatment provided. Thus, 8.4 permanent teeth were filled to every one extracted, indicating that great emphasis is laid on preservation, as opposed to extraction of teeth. 430 orthodontic appliances were fitted at Acre Road Clinic, many of which were often of an extremely complex nature, involving the latest techniques. Orthodontic cases continued to be referred to this clinic from general practitioners in the area, reflecting a high local regard for the services provided in this specialised sphere of dentistry. Fluoridation There was no change in the Metropolitan Water Board's decision relating to fluoridation of water supplies, which requires 157 100 per cent agreement of the authorities supplied. The Council however had reversed its previous decision and is at present opposed to fluoridation. This highly beneficial and completely safe step, which would eventually produce a dramatic reduction in the amount of tooth decay, has already received official backing from Ministers of Health, Shadow Ministers of Health, the British Dental Association, British Medical Association, International Dental Federation, Central Health Services Council and World Health Organisation. Dental Health Education The importance of good dental health can never be too strongly emphasised and the earlier in life that children are encouraged to think along these lines, the better. In March a dental health campaign was held, aimed at more than two thousand five-year-old pupils in infant schools and an additional number in nursery classes, nursery schools and a class of E.S.N. children. The campaign involved talks, films and simple demonstrations, together with a distribution of toothbrushes, fluoride toothpaste samples and coloured beakers. This was followed a few weeks later by the handing out of Happy Smile Club badges and more short talks. March was also dental health month throughout the borough, when displays, posters and pamphlets were exhibited at each clinic. A high degree of co-operation was always forthcoming from the Education Department, Health Education Section and health visitors, the latter always being most willing to give talks, demonstrations and films in schools. At one clinic a post-Christmas party was held for young mothers and pre-school children. This included instruction on mouth cleanliness and the distribution of foods which are less harmful to teeth than sweets. A pilot scheme was started in November involving the sale of applet at school tuck shops. This again was intended to reduce the intake of sweets and biscuits and it is hoped that the scope of this project will be expanded in 1971. The following is a summary of the work undertaken in the School Dental Service in 1969. 158 General Dental Inspection and Treatment First inspections of the year: At school 17,178 At clinic 2,313 19,491 Reinspections at school and clinic 2,799 Pound to require treatment from first inspections 7,581 Offered treatment from first inspections 6,180 Treated 3,535 Attendances for treatment 11,381 Sessions for inspection 156 Sessions for treatment 1,976 Sessions devoted to dental health education 67 Number of fillings in permanent teeth 5,355 Number of fillings in temporary teeth 4,320 Number of permanent teeth filled 4,578 Number of temporary teeth filled 3,951 Number of permanent teeth extracted 499 Number of temporary teeth extracted 1,259 General anaesthetics 577 Pupils X-rayed 577 Prophylaxi s 1,087 Teeth otherwise conserved 790 Teeth root-filled 49 Inlays 2 Crowns 46 Orthodontic Cases Commenced during the year 153 Brought forward from 1969 259 Completed during year 113 Discontinued during year 20 Referred to hospital consultant Removable appliances fitted 245 Fixed appliances fitted 185 Under treatment at end of year 483 159 SCHOOL CLINICS Address Clinic Grange Road, Kingston upon Thames Minor Ailments Speech Dental General Medical 204 Acre Road, Kingston upon Thames Minor Ailments Speech Dental Eye General Medical Physiotherapy Audiology 1 Gosbury Hill, Hook Minor Ailments Speech Dental Eye General Medical Physiotherapy South Place, Surbiton Minor Ailments Speech Dental Eye General Medical Roselands, 163 Kingston Road, New Maiden Minor Ailments Speech Dental Eye General Medical Physiotherapy Mecklenberg House, 50 Kingston Road, New Maiden Child Guidance The Manor Drive, Worcester Park Minor Ailments Speech Dental Bye General Medical Physiotherapy Audiology St.George's Hall, Hamilton Avenue, Tolworth Speech With the exception of Minor Ailments, attendance is by appointment. 160 INDEX Page Accidental Hypothermia 40 Accidents 122 Acknowledgments 7 Adaptations 80,82 Adult Medical Examinations 26,155 Adult Training Centre 58,59 After Care 47-52 Aids for the Handicapped 80 Air Pollution 96 Ambulance Service 46 Animals 104 Ante-natal Clinics 30 Area 12 Ascertainment of Handicapped Pupils 152 Attachment of Nurses to General Practices 39,41,42 Audiology 6,143,144 Bacillus Calmette-Guerin (B.C.G.)Vaccination 48,147 Bacteriological Examinations 101,102,128 Birds 97 Birth Rate 1,12 Births 12 Blind Persons 68,71-77 British Red Cross Society 51 Burial 86 Cancer 1 Car Badges 81,82 Caravans 100 Caravan Sites and Control of Development Act 1960 100 Care Committee 50 Care of Mothers 30,31 Care of Young Children 30,31 Causes of Death 14-18 Central Midwives Board 38 Centres for Social Rehabilitation 74 Certificates in Social Work 4,54 Certificates of Vaccination 45,46 Cervical Smears 42,43 Charges for Accommodation 67 Chest Clinic 41,48 Chief Dental Officer 156 161 Page Chief Public Health Inspector 89 Chief Welfare Officer 63 Child Guidance 148,149 Child Minders 3,34 Child Welfare 31,32 Children and Young Persons Act 153 Children' s Homes 35 Children's Department 148 Chimneys 96 Chiropody 4,51,52 Cholera 46 Chronically Sick and Disabled Persons Act 1970 70 Clean Air 94-97 Clean Air Act 118 Cleanliness 145 Cleansing 93 Clinics 3,30,31,32,156,159 Clubs for the Handicapped 83,84 Communicable Diseases 2 Community Care 43 Complaints 96,103,106,123 Congenital Malformations 36,37 Contagious Diseases 145 Coroner 26 Cremations 26,86 Cytology 42,43 Day Centre for Mentally 111 55,56 Day Nurseries 3,33,34 Deaf Persons 68,71,77,78 Deaths 12,155 Dental Inspection 156,158 Dental Service 32,33 Dental Treatment 156,158 Department of Education and Science 136,155 Department of Health and Social Security 67,70 Diphtheria 45,46,146 Director of Social Services 63 Disabled Drivers 81,82 Disablement Resettlement Officers 56 Disrepair - Certificates 125 District Nursing 39,40 Domiciliary Nursing 3 Domiciliary Visiting 75,85 Drainage 92 162 Page Drugs 103,110,112 Dust 96,97 Dwellings, Separately Rated 12 Education Act 1944 134 Education (Schools and Further Education) Sub-Committee 134 Elderly Persons 43,51,63-67 Employment of Blind Persons 73 Employment of School Children 153 Environmental Health 5,89-131 Epileptic Children 145 Epileptic Persons 68 Factories Act 1961 119,120 Family Planning 50,51 Family Planning Association 50 Feeding Stuffs 104 Fertilisers 104 Fertilisers and Feeding Stuffs Act 1926 104 Food 101,102,103,110-117 Food and Drugs Act 1955 110-115 Food Hygiene 90,103,116,117 Food Hygiene (General) Regulations 1960 116 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 116 Food Premises 101 Fluoridation of Water 156,157 General Services 22-27 Geriatric Unit 41 German Measles 2,6,44,45,146,147 Greater London Council 46 Grit 96,97 Group Attachment 39,41,42 Guthrie Test 38 Handicapped - Classes 76 Handicapped Persons 68,70-85 Handicapped Pupils 150-152 Hard of Hearing 77 Head Lice 145 Health Centres 3,30 Health Education 3,22-24,153,157,158 163 Page Health Visiting 3,41-44 Health and Welfare Committee 8 Hearing Aids 144 Hearing Loss 143 Holidays 82,154 Holidays for the Blind and Partially Sighted 76 Home Help Service 4,52,53 Home Nursing 39,40 Home Work 81 Home Workers 76 Homes for Mothers and Babies 35 Homes for the Elderly 63-67 Hospital Services 26,27 Hostel Accommodation 59 Hostel for Handicapped Pupils 150 Housebound Physically Handicapped 81 Housing 98-100 Housing Act 1969 5,89 Housing Acts 118,124,126,127 Hypothermia 40 Ice Cream 101,102 Immigrant Health 44 Immunisation 2,6,44-46,146,147 Impetigo 140 Imported Pood 102 Improvement Areas 89,90,100 Improvement Grants 98,99,126 Incontinent Patients 40 Infant Mortality 12 Infectious Diseases 2,19,20,145 Insects 97 Inspections 107-109,119 International Certificates of Vaccination 45,46 Junior Training Centre for Mentally Handicapped 42,57,58 Kingston and District Care Committee 50 Labelling of Food 110-115 Laboratory Service 21 Large Print Books 66 164 Page Late Night Nursing 40 Legal Proceedings 103 Library for the Blind 74 Lice 145 Licensing of Nurses Agencies 25 Loan of Nursing Equipment 51 Local Authority Social Services Act 1970 55,59 Long Cans Technique 77 Mantoux Tests 147 Marie Curie Memorial Foundation 40 Marriages 19 Mass Miniature Radiography 2,49 Maternal Deaths 1,12 Meals 154 Meals-on-Wheels 69,70 Measles 2,45,146,147 Meat 102 Medical Aid 39 Medical Examination of Adults 26,155 Medical Inspection 136-139 Mental Health Act 1959 54 Mental Health Services 4,54-59 Mentally Handicapped 42,56-59 Mentally 111 55,56,59 Mental Welfare Officers 54,55 Metropolitan Water Board 156 Mice 106,123 Midwifery Service 3,38,39 Milk 101,154 Mobility 77 Mortality Rates 12,13 Mortuary Services 26 Movable Dwellings 100 Multiple Occupation 98 National Assistance Act 1948 24,25,70,86 National Health Service Act 30 National Library for the Blind 74 Neonatal Deaths 13 Night Nursing Service 40 Noise 94 Notices 118 165 Page Nurseries and Child-Minders Regulations Act 1948 34 Nurses Agencies 25 Nursing Aids 40 Nursing Equipment 51 Nursing Homes 25 Occupational Therapy 66,80 Offices, Shops and Railway Premises Act 1963 93,94,121,122 Old People's Homes 5 Ophthalmic Clinics 143 Orthodontic Treatment 158 Orthoptic Treatment 143 Outwork 80,81,120 Paratyphoid Fever 46 Partially Sighted Persons 71,73,74,76 Peel Report 38 Penny Rate Product 12 Periodic Medical Inspection 136-138 Personal Health Services 30-53 Pest Control 97,123 Pharmacy and Poisons Act 1933 105 Phenylketonuria 38 Physically Handicapped Persons 68,78 Physiotherapy 144,145 Pigeons 97,106,123 Poisons List 105 Poliomyelitis 45,46,146 Pollution 90,96,97,130,131 Population 12 Post-natal Clinics 30 Prevention of Illness 47-52 Private Homes for the Elderly 69 Private Nurseries 3,34 Probation Service 148 Protection of Property 86 Public Analyst 104,110 Public Cleansing 93 Public Health Laboratory 21,101,102 Public Health (Prevention of Tuberculosis) Act 1936 49 Rateable Value Rats 12 97,106,123 166 Page Receivership 85,86 Recreation 70,83 Recuperative Holidays 35,50,154 Registers of Handicapped Persons 71,72,77-79 Registrar General 1 Registration of Nursing Homes 25 Rehabilitation 74,76 Rent Act 1968 125 Reorganisation of National Health Service 6 Residential Accommodation 59 Riding Establishments Act 1970 104 Ringworm 140 Rivers 92 Rodents 97 Rubella 2,6,44,45,146,147 St.John Ambulance Association 51 St. Philip's School 151,152 Sale of Welfare Foods 31,32 Samples 110-115 Scabies 140 School Dental Service 156-158 School Health Service 5,135-155 School Meals 154 School Milk 154 School Population 135 Secretary of State for Social Services 6 Sewage Disposal 92 Sewerage 92 Sheltered Workshops 77 Shops Act 1950 93 Short Stay Accommodation 65 Skin Testing 48,147 Smallpox 44,46,146,147 Smoke 130 Smoke Control Areas 94,95 Smoke Control Orders 95 Smoking 2,4 Social Clubs for the Handicapped 83,84 Social Rehabilitation 74 Social Workers for the Handicapped 85 Sonne Dysentery 20 Speech Therapy 6,140-142 167 Page Special Inspection 139 Special Schools 150 Squirrels 97,106,123 Staff 135 Staff Medical Examinations 26 Staff of Health and Welfare Department 9 Statistics 1,34 Stillbirths 12 Streams 92 Structural Adaptations 80,82 Sulphur Di oxide 96,130 Sweep Testing 143 Swimming Baths 91,92 Talking Books 75 Tetanus 45,146 Trade Descriptions Act 1968 104 Training Centre for Mentally Handicapped 56,57 Treatment of Diseases and Defects 140 Tuberculin Tests 48 Tuberculosis 20,47-50,147 Typhoid Fever 46 Unfit Dwellings 98 Unfit Foodstuffs 115 Unmarried Mothers 35 Vaccination 2,6,44,45,46,48,146,147 Venereal Diseases 21,24 Verminous Conditions 145 Vision Testing 143 Visiting the Blind 75 Vital Statistics 12 Voluntary Organisations 67-70,81 Voluntary Services 67 Voluntary Workshops 81 Wasps 97,123 Water Supply 91,128,129,156 Welfare Foods 31,32 Welfare of the Elderly 63 168 Page Welfare Section 4 Welfare Services 63-86 Well Women Clinics 43 Whooping Cough 45,46,146 Wireless for the Blind 75,76 Yellow Fever 45 Youth Employment Officer 153 Youth Employment Service 153