I KIN 45 THE HEALTH of the ROYAL BOROUGH of KINGSTON UPON THAMES 1971 Royal Borough of Kingston upon Thames ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 1971 John C. Birchall, M.B., Ch.B., D.P.H. HEALTH DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: 01-399 Sill 1 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1971 To the Mayor, Aldermen and Councillors Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my seventh annual report on the health of the citizens of the Borough and the health services provided. This year the report is divided into four sections only: vital statistics and general services, personal health, environmental health and school health. The welfare services, mental health services and some other erstwhile health services were transferred to the new Social Services Committee in April. I comment below on certain statistics and special items. Statistics The Registrar General's estimate of the population of the borough at mid-1971 (a census year) was 140,550, giving a fall of 2,140 for the year and a fall of 5,920 since the inception of the new borough in 1965. The birth rate is the lowest ever in the new borough, as is the illegitimate birth rate. The infant mortality rate is back to approximately the 1969 figure after the abnormally low one for 1970, and remains well below the national average. There was no maternal death reported during the year. Although deaths from cancer of all types fell from 415 to 394, those from cancer of the lung increased from 97 to 104. 88 of the deaths were in men and represent 41 per cent of male deaths from cancer. Deaths from cancer of the lung are almost double those for deaths from all accidents and violence, which totalled 55. Of 5,724 persons X-rayed 2 by the Mass Miniature Radiography Service in the borough during the year, 3 persons were found to be suffering from tuberculosis and 13 from lung cancer. Communicable Diseases The number of infectious diseases remained low. 1971 was an epidemic year for measles and there were 758 cases. This compares with 1,899 in 1967 - the last epidemic year before measles vaccination was introduced. The illness could be eliminated with an increase in the numbers of children vaccinated. There was an increase in both respiratory and non-respiratory tuberculosis, and the need for constant vigilance and preventive measures remains as necessary as heretofore. Health Centre and Clinics The conversion of Manor Drive Clinic into a health centre was completed in April and apart from minor problems in the early days has run very smoothly since. The conversion of Gosbury Hill Clinic into a health centre for occupation by four doctors was commenced during the year and should be ready early in 1972. Building will start on the Hawks Road Clinic early in 1972, to replace Grange Road Clinic, and is expected to open in June 1973. No progress was made in the replacement of South Place Clinic, as the result of the public enquiry was still awaited at the end of the year. A site has not yet been found for a health centre to replace Roselands Clinic in the difficult area of New Maiden. Health Visiting and Domiciliary Nursing and Midwifery Services The attachment of health visitors and district nurses to general practices continued in 1971 until the point was reached in September where all the remaining staff not so attached had to be allocated to the remaining doctors or partnerships. Work on an area basis then ceased. The change was completed very smoothly and has proved to be successful. 3 Collaboration between the local hospital nursing staff and community nursing staff has increased and it is hoped will continue to increase. Care of Pre-school Children The Health Department continued to supervise the Council's day nurseries and be responsible for the Nurseries and Child Minders Regulation Act services, reporting to the Social Services Committee throughout the year. Health Education This continued along similar lines to previous years. A dental health campaign on the same basis as 1970 took place in March for five-year-olds. A health exhibition was held for four days during October in the Market Hall, Kingston, and two further smoking advisory courses were held during the year. Family Planning This was provided for the borough on an agency basis by the Family Planning Association. Premises were made available free of charge and full reimbursement was made for all women treated on medical or social grounds. Chiropody This service continued to expand, there being an increase of over 11 per cent in the number of persons treated, and over 9 per cent in the number of treatments given as compared with 1970. Environmental Health The Environmental Health Section under the leadership of the Chief Public Health Inspector continued their efforts to improve the environment, by careful watch on the handling of food, improvement of housing conditions and by continuing the extension of clean air zones. Reorganisation in the Health Services This subject was mentioned last year but the Consultative Document published during the year added little information to that 4 already known. Despite the unsettling conditions prevailing, I congratulate and thank all the staff for their efforts in maintaining and extending the services. I also acknowledge the help and co-operation of family doctors, particularly in making the attachment of nursing staff a success. I am indebted to the Town Clerk and fellow Chief Officers for help received during the year. Finally, I thank the Health Committee and Council for their continued interest and support. I am, Yours faithfully, JOHN C. BIRCHALL Medical Officer of Health and Principal School Medical Officer 5 ROYAL BOROUGH OP KINGSTON UPON THAMES HEALTH COMMITTEE AS AT DECEMBER 1971 Mayor: Alderman J.Harrison, M.I.Prod.E. Chairman: Alderman A.C.Healey, M.Sc., Ph.D., F.R.I.C. Vice-Chairman: Alderman R. M.Church Councillors: F.C.Ailes S.W.B.Barter, M.B. E. Mrs.D.T.Butler P.H.Danbury, B.A., LL.B., Dip.Crim. D.A.Denham, B.Sc.(Lond.), Ph.D.(Cantab). A.S.MacKinlay, D.M.A. P.H.T.Magee N.J.S.McLaughlan, B.S.L. W.E.Messenger, F.C.I.T. W. S.Mutimer, J.P. B.B.Myers H.W.Payne, Hon.FSLAET, ARAeS. R.B.Sherar F.J.Steptoe Mrs.J.M.F.Webb Co-opted Members: J.S.Bearcroft, M.D.,M.R.C.P.,D.P.M. C.J.Rowland, M.B.,B.S.,M.R.C.S., L.R.C.P.,D.R.C.O. G. M.J.Shaw,B.D.S.,L.D.S. ,R.C.S. Mrs.C.M.Waugh Kingston and Long Grove Group Hospital Management Committee South West London and Surrey Local Medical Committee South West London and Surrey Local Dental Committee South West London and Surrey Executive Council 6 SENIOR STAFF OF THE HEALTH DEPARTMENT Medical Officer of Health Deputy Medical Officer of Health Senior" Medical Officers Chief Dental Officer Chief Public Health Inspector Psychiatrist (Child Guidance) Health Education Officer Superintendent Health Visitor Superintendent Home Nursing Services and Non-medical Supervisor of Midwives 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. Mary J.O Donovan, M.B.,B.Ch.,D.C.H., D. P.H. D.M.Dodd, L.D.S.,B.D.S. P.E.Kinton, M.R.S.H.,M.A.P.H.I. Beryl G. Anscombe, M.B.,Ch.B., D.(0bst.)R.C.O.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 H.A.Sears, D.M.A. CONTENTS VITAL STATISTICS AND GENERAL SERVICES 9 PERSONAL HEALTH SERVICES 26 ENVIRONMENTAL HEALTH SERVICES 55 SCHOOL HEALTH SERVICE 101 VITAL STATISTICS AND GENERAL SERVICES 9 VITAL STATISTICS Area: 9,281 acres Population, estimate of Registrar General at mid-year 1971 : 140,550 Rateable Value at 1st April 1971: £10,655,109 Produce of a Penny Rate at 1st April 1971: £102,000 Separately Rated Dwellings at 1st April 1971: 49,249 Live Births: Males Females Total Percentage Legitimate 940 832 1,772 94.2 Illegitimate 54 55 109 5.8 994 887 1,881 100.0 Crude Birth Rate per 1,000 estimated population 13.4 Adjusted Birth Rate for purposes of comparison using the comparability factor 1.01 13.5 (England and Wales) 16.0 Still Births: (7 males and 8 females) 15.0 Rate per 1,000 live and still births 7.9 (England and Wales) 12.0 Total Births 1,896 Deaths : Total (756 males and 799 females) 1,555 Crude death rate per 1,000 population 11.1 Adjusted death rate for purposes of comparison using the comparability factor 0.93 10.3 (England and Wales) 11.6 Maternal deaths nil Maternal Mortality rate (including abortion) per 1,000 total live and still births nil (England and Wales) Not available at time of printing Infant Mortality: Infant deaths (infants under one year); Males Females Total Legitimate 17 6 23 Illegitimate — 2 2 17 8 25 (continued) 10 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 13.3 (England and Wales) 18.0 Mortality rate of legitimate infants per 1,000 legitimate live births 13.0 Mortality rate of illegitimate infants per 1,000 illegitimate live births 18.3 Mortality rate of male infants per 1,000 male live births 17.1 Mortality rate of female infants per 1,000 female live births 9.0 Neonatal deaths (under 4 weeks of age) (10 males and 3 females) 13 Neonatal mortality rate per 1,000 live births 8.0 (England and Wales) 12.0 Early neonatal deaths (under 1 week of age) (10 males and 4 females) 14 Early neonatal mortality rate per 1,000 live births 7.4 (England and Wales) 10.0 Perinatal mortality (still births plus deaths under 1 week) 29 Perinatal mortality rate per 1,000 total live and still births 15.3 (England and Wales) 22.0 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Anoxia (Multiple congenital abnormalities) 1 — 1 2 Cerebral Anoxia 1 — — 1 Postmaturity 1 — — 1 Prematurity 4 1 — 5 Prematurity (? Cerebral haemorrhage) 1 — — 1 Respiratory Distress Syndrome with prematurity — 1 — 1 Respiratory Distress (Renal agenesis, lung hyperplasia) — 1 — 1 Respiratory Failure (Prematurity) — 1 — 1 Tentorial Tear — 1 — 1 Tentorial Tear (Prematurity) — 1 — 1 TOTAL 8 6 1 15 11 CAUSES OF DEATH BY AGE Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Cholera M - - - - - - - - - - - - F - - - - - - - - - - - - Typhoid Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Bacillary Dysentery and Amoebiasis M - - - - - - - - - - - - F - - - - - - - - - - - - Enteritis and Other Diarrhoeal Diseases M 2 - 2 - - - - - - - - - F 3 - - 1 - - - - 1 - - 1 Tuberculosis of Respiratory System M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - Late Effects of Respiratory T.B. M 1 - - - - - - - - 1 - - F 1 - - - - - - - 1 - - - Other Tuberculosis M - - - - - - - - - - - - F - - - - - - - - - - - - Plague M - - - - - - - - - - - - F - - - - - - - - - - - - Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - Streptococcal Sore Throat and Scarlet Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Meningococcal Infection M - - - - - - - - - - - - F - - - - - - - - - - - - Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - Smallpox M - - - - - - - - - - - - F - - - - - - - - - - - - (continued) 12 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 Measles M - - - - - - - - - - - - F - - - - - - - - - - - - Typhus and other Rickettsioses M - - - - - - - - - - - - F - - - - - - - - - - - - Malaria M - - - - - - - - - - - - F - - - - - - - - - - - - Syphilis and its Sequelae M 1 - - - - - - - - 1 - - F 1 - - - - - - - - - 1 - Other Infective and Parasitic Diseases M 2 - - - - - - - - - 2 - F 1 - - - - - - - - - - 1 Malignant Neoplasm, Buccal Cavity etc. M 5 - - - - - - - 2 1 1 1 F 1 - - - - - - - - - - 1 Malignant Neoplasm, Oesophagus M 6 - - - - - - - - 2 2 2 F 6 - - - - - - - - 3 1 2 Malignant Neoplasm, Stomach M 17 - - - - - - - 2 8 4 3 F 15 - - - - - - - - 2 4 9 Malignant Neoplasm, Intestine M 25 - - - - - - - 2 9 8 6 F 30 - - - - - - - 3 8 8 11 Melignant Neoplasm, Larynx M 1 - - - - - - - - - 1 - F - - - - - - - - - - - - Malignant Neoplasm, Lung, Bronchus M 88 - - - - - - 1 9 24 40 14 F 16 - - - - - - - 3 7 4 2 Malignant Neoplasm, Breast M 1 - - - - - - - - - 1 - F 33 - - - - - 1 - 4 10 6 12 Malignant Neoplasm, Uterus F 13 - - - - - - 2 1 3 2 5 Malignant Neoplasm, Prostate M 19 - - - - - - - - 2 8 9 (continued) 13 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Leukaemia M 7 - - - - - - - - 1 - 3 F 5 - - - - - - 2 - 1 - 2 Other Malignant Neoplasms M 45 - - - 1 1 - 1 4 15 13 10 F 61 - - - - 1 2 4 6 14 12 22 TOTAL all forms of Cancer 394 - - 1 2 3 3 10 36 110 115 114 Benign and Unspecified Neoplasms M 1 - - - - - - - - - - 1 F 3 - - - - - - 1 1 - - 1 Diabetes Mellitus M 5 - - - - - - - - 2 2 1 . F 10 - - - - - - - - 2 1 7 Avitaminoses and other nutritional deficiencies M 1 - - - - - - - - - 1 - F - - - - - - - - - - - - Other Endocrine, Nutritional and Metabolic Diseases M 1 - - - - - - - - - 1 - F 3 - - - - - - - 1 1 - 1 Anaemias M - - - - - - - - - - - - F 4 - - - - 1 - - - - 1 2 Other Diseases of Blood and bloodforming Organs M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - Mental Disorders M 2 - - - - - - - 1 - 1 - F 3 - - - - - - - - - 1 2 Meningit is M - - - - - - - - - - - - F - - - - - - - - - - - - (continued) 14 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Multiple Sclerosis M 1 - - - - - - - - 1 - - F 1 - - - - - - - - - 1 - Other Diseases of Nervous System etc. M 2 - 1 - - - - - - - 1 - F 6 - - - - - - - - 1 2 3 Active Rheumatic Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Chronic Rheumatic Heart Disease M 18 - - - - - - 1 2 4 6 5 F 24 - - - - - - - - 5 6 13 Hypertensive Disease M 10 - - - - - - - 1 5 1 3 F 15 - - - - - - - 1 2 1 11 Ischaemic Heart Disease M 196 - - - - - - 4 20 46 64 62 F 158 - - - - - - - 2 23 34 99 Other Forms of Heart Disease M 18 - - - - - - - - 1 3 14 F 64 - - - - - - - - 3 3 58 Cerebrovascular Disease M 58 - - - - - - 1 3 5 22 27 F 119 - - - - - 1 - 6 9 23 80 Other Diseases of Circulatory System M 29 - - - - - - - 1 5 7 16 F 46 - - - - - - - - 2 9 35 TOTAL Heart and Circulatory Diseases 755 - - - - - 1 6 36 110 179 423 Influenza M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Pneumonia M 44 - 3 - - - - 1 1 3 4 32 F 65 - 2 1 - - - - - 1 6 55 Bronchitis and Emphysema M 49 - 1 - - - - - 1 9 18 20 F 11 - - - - - - - 1 3 4 3 Asthma M 3 - - - - 1 - - - 1 1 - F 3 - - - - - - - - 1 1 1 (continued) 15 CAUSES OP DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Other Diseases of Respiratory System M 4 - - 1 - - - - - 1 1 1 F 5 - 1 - - - - - - - 1 3 Peptic Ulcer M 11 - - - - - - - 2 2 3 4 F 9 - - - - - - - - 1 2 6 Appendicitis M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - Intestinal Obstruction and Hernia M 2 - - - - - - - - - 1 1 F 5 - - - - - - - - - 1 4 Cirrhosis of Liver M 2 - - - - - - - 1 - 1 - F 1 - - - - - - - 1 - - - Other Diseases of Digestive System M 8 - - - - - - - - 3 1 4 F 7 - - - - - - - - - 1 6 Nephritis and Nephrosis M 4 - - - - - - - - 1 1 2 F 2 - - - - - - - 1 - 1 - Pfyperplasia of Prostate M 3 - - - - - - - - - - 3 Other Diseases, Genito-Urinary System M 6 - - - - - - - - 1 - 5 F 6 - - - - - - - - - 1 5 Abortion F - - - - - - - - - - - - Other Complications of Pregnancy, Childbirth & Puerperium F - - - - - - - - - - - - Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - Diseases of Musculoskeletal System M 1 - - - - - - - - 1 - - F 3 - - - - - - - - - 2 1 Congenital Anomalies M 7 2 - 1 1 - 1 - 1 - 1 - F 5 1 - 1 - - - - 1 1 1 - (continued) 16 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks k Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Birth Injury, Difficult Labour etc. M 3 3 - - - - - - - - - - F 3 3 - - - - - - - - - - Other Causes of Perinatal Mortality M 5 5 - - - - - - - - - - F 1 1 - - - - - - - - - - Symptoms and Illdefined Conditions M - - - - - - - - - - - - F 4 - - - - - - - - - - 4 Motor Vehicle Accidents M 14 - - - 1 6 - - - 3 3 1 F 2 - - - 1 - - - - 1 - - All Other Accidents M 17 - - - - 1 - 3 4 2 3 4 F 14 - - - - - 1 - 2 1 1 9 Suicide and Selfinflicted Injuries M 8 - - - - - 1 1 1 2 2 1 F 6 - - - - - - 2 - 4 - - All other External Causes M 1 - - - - 1 - - - - - - F 2 - - - - - - 1 1 - - - TOTAL Accidents, Suicide and Violence 64 - - - 2 8 2 7 8 13 9 15 TOTAL ALL CAUSES M 756 10 7 3 4 11 2 13 58 163 229 256 F 799 5 3 3 1 2 5 12 37 109 145 477 17 ANALYSIS OF MARRIAGES 1971 1,265 marriages were registered in the borough during 1971. Of these, 439 were Church of England marriages and 826 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 Baciliary) 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 1971 by age groups: Disease Under 5 5-14 15-44 45-64 65 and over Age unknown Total Scarlet Fever 11 16 - - - - 27 Whooping Cough 10 6 1 - - - 17 Measles 421 327 9 1 - - 758 Dysentery 1 - 3 - - - 4 Infective Jaundice - 3 10 1 2 - 16 Tuberculosis, Respiratory - - 17 8 8 - 33 Tuberculosis, other - - 6 5 2 - 13 Acute Meningitis 1 - - - - - 1 Food Poisoning - - 4 - - - 4 Malaria - - 1 - - - 1 Typhoid Fever - - 1 - - - 1 TOTALS 444 352 52 15 12 - 875 18 Sonne Dysentery 4 cases occurred during the year; one of these was of school age. Typhoid Fever 1 case (a man of 23) contracted the illness abroad. Tuberculosis There were 33 cases of respiratory tuberculosis and 13 cases of non-respiratory tuberculosis. Three deaths occurred from respiratory tuberculosis. Comparative Table of Notified Infectious Diseases 1966-1971 Disease 1966 1967 1968 1969 1970 1971 Scarlet Fever 42 33 20 86 41 27 Measles 736 1899 293 283 458 758 Whooping Cough 16 34 20 10 25 17 Acute Infective Encephalitis: Post-infective - 1 - - - - Infective - - - - - - Typhoid and Paratyphoid Fevers 1 1 - 2 - 1 Infective Jaundice - - 5 14 37 16 Food Poisoning - 4 - 8 - 4 Dy s ent ery 146 72 27 104 15 4 Tuberculosis, Respiratory 27 46 35 31 29 33 Tuberculosis, Other 6 1 4 7 4 13 Leptospirosis - - - 1 - - Acute Meningitis - - - 2 - 1 Malaria - - - - - 1 Laboratory Service Bacteriological and viral specimens are dealt with by the Public Health Laboratory at Epsom and also by Kingston Hospital Laboratory. Sexually Transmitted 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: 19 Treatment Centre Totals all conditions Syphilis Gonorrhœa Other Conditions Primary and Secondary Other St.Thomas' Hospital S.E.1 120 2 - 19 99 Whitechapel Clinic London Hospital, E.1 5 - - 1 4 St.Bartholomew's Hospital, E.C.1 28 - - 2 26 Westminster Hospital S.W.1 27 1 - 2 24 Croydon General Hospital, London Road, Croydon 7 - - 1 6 TOTALS 187 3 - 25 159 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 farnale contacts. During the year no requests were received for contaot tracing, but several visits were made to four women to investigate failure to keep appointments at special clinics. A visit was also paid to one man but this proved abortive as he had given a false address. Health education activities concerning venereal diseases are reported on page 20. 20 GENERAL SERVICES HEALTH EDUCATION There was no great change in the range of activities in the Health Education Section during 1971. In the planned group activities there was a drop in the numbers of sessions in schools but an increase in work in clubs, voluntary associations and other adult groups. Recorded Sessions 1971 1970 Schools 198 259 Clinics 502 499 Clubs 109 91 Other groups 14-6 111 Total number in audiences during 1971 - 19,040 The ad hoc group talks and one-to-one discussions at clinics and in private houses are not recorded. The subjects covered included: Family care and relationships Child care Care of the elderly Hazards of modern living, including smoking, alcoholism, misuse of drugs and venereal diseases Prevention of accidents and first aid Care of the sick and handicapped Use of leisure and travel Community services Environmental health and food care The practice of team teaching was tried out in some instances and proved effective and popular. More than one person conducts a session so this method results in greater audience participation. The variety of audio-visual aids continues to increase, many aids having been made in the Health Education workshop. All materials and equipment required for teaching purposes are supplied to the venue and collected after use, resulting in an economy in the time of skilled staff, as well as on the equipment and materials. 21 Aids used totalled 1,301 individual items, as follows Posters and pamphlets 320 Models 291 Films 162 Film loops 35 Filmstrips and slides 63 Flannelgraphs 64 Chalk board, suede board etc. 177 Demonstrations, tape recorder, overhead projector etc. 209 Small displays were prepared for each health clinic and the Health Department headquarters each month. The topics were: 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; play material September Immunisation and disease prevention October Scalds - all ages November Winter health; care of aged; fireworks December Nutrition A great deal of assistance was given by the Health Education Section in the planning and arranging of the "Welcome to Citizenship" Exhibition held at the Guildhall in March. A health exhibition was held for four days during October at the Market Hall, Kingston. In spite of much publicity the response was disappointing. The dental health campaign in March was conducted on similar lines to that of 1970. Approximately 2,500 five year olds were shown films and demons trations. Two smoking advisory courses were held during the year: the first in February-March and the second in October-November. Thirty-nine registered for the first course and sixteen for the second. The success rate in both courses was a little under 50 per cent at the end of six meetings. As with previous courses, it is expected that the twelve month review will demonstrate further success. 22 Assistance was given in training students from various fields of nursing, medicine, and social work. The Health Education Officer acted as examiner to young people involved in the Duke of Edinburgh Award scheme. Cervical Cytology A limited campaign was conducted during 1971 in which posters for display and leaflets for distribution were sent to general practitioners and to local industrial and commercial concerns. As the numbers of women availing themselves of this facility increased during the year, it may be assumed that this campaign was successful. NATIONAL ASSISTANCE ACT 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT 1957 Action can be taken under these Acts for compulsory removal of persons to suitable premises in circumstances where they are: (a) suffering from grave chronic disease, or being aged, infirm or physically incapacitated, are living in insanitary conditions; (b) unable to look after themselves and are not receiving proper care and attention from other persons. Regrettably, three elderly persons had to be dealt with under the provision of these Acts: Mr.J.R.W. aged 85 had to be removed urgently to hospital on 12 January, and Mrs.A.S. aged 85 and Mrs.H.W. aged 84 had similarly to be removed on 28 June and 27 August respectively. It is emphasized that removal of a person to an institution for the reasons detailed above is only undertaken with great reluctance, Both Mr.J.R.W. and Mrs.H.W. subsequently died 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 23 registered during 1971 . At the end of the year there were three registered nursing homes in the borough and these provided a total of 68 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 1 January each year. One agency asked for its licence to be withdrawn in 1971, and the one remaining agency was granted a licence to continue for another year. 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 1,364 cremations. None was rejected and queries raised were answered satisfactorily before the services. MORTUARY SERVICES These have been arranged jointly with Kingston Hospital. ADULT MEDICAL EXAMINATIONS 255 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 476 were accepted on completion of a medical history form, without actual examination. 306 newly appointed teachers and candidates for admission to teacher training colleges were medically examined as required by the Department of Education and Science. 301 teachers were considered fit upon completion of a medical history form. 24 HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital Royal Bye Hospital. Upper Brighton Road Surbiton Kingston Hospital, Wolverton Avenue, Kingston upon Thames Services Available Ophthalmic, Refraction sessions Medical, Surgical, Fracture, Paediatric, Gynaecology, Bar, Nose and Throat, Maternity, Orthopaedic, Psychiatric, Adolescent, Orthodontic, Rheumatology, Diabetic, Dermatology, Ophthalmology, Pathology, Chest Diseases, Oral Surgery, Plastic Surgery Tolworth Hospital, Red Lion Road, Tolworth Infectious Diseases. Chest Diseases, Geriatric Surbiton General Hospital, Ewell Road, Surbiton Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Genito-urinary, Gynaecology, Pathology, Psychiatric PERSONAL HEALTH SERVICES 26 PERSONAL HEALTH SERVICES (NATIONAL HEALTH SERVICE ACT. 1946) HEALTH CENTRES AND CLINICS Section 21 of the National Health Service Act 1946 requires local health authorities to provide, equip and maintain health centres. The health centre at Manor Drive, Worcester Park opened on 24 April 1971, the old clinic premises having been extended by the addition of accommodation for four family doctors. A similar extension to form a health centre at Gosbury Hill, Hook, is under way and is expected to open in April 1972. Due to the extension of Bedelsford School, it is necessary to replace Grange Road Clinic, Kingston, which is in the same grounds. A suitable site was found at Hawks Road, Kingston, and building work is expected to commence in February 1972. It is hoped that this clinic will open in June 1973. A site has been earmarked in Alpha Road, Surbiton, for the building of a clinic to replace the very old and unsuitable premises at South Place. Due to the need to obtain compulsory purchase orders for certain of the properties, there has been some delay in commencing work on this site. 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 147 sessions at these clinics and at the Surbiton and Maiden District Nurses Homes, at which 100 women made 250 attendances. 4,009 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed. There were, in addition, 300 sessions held by general practitioners to whose practices borough midwives are attached. There were 2,859 attendances at these sessions. 27 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 36 26 263 Acre Road, Kingston 49 50 48 436 Roselands, New Maiden) Kingston Vale ) 52 47 23 434 Manor Drive, Worcester Park 27 9 4 38 South Place, Surbiton) Hamilton Avenue, ) Tolworth 49 60 19 521 Gosbury Hill, Hook ) St.Mary's Church Hall) Chessington ) 52 30 12 130 TOTALS 281 232 132 1822 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 Pairmead Day Nursery, as follows: 28 Surbiton W.R.V.S. 154 Ewell Road Mon. Tues. Thurs. Fri. 10.0 - 12 noon 2.0 - 4 p.m. New Maiden W. S.V. S. Blagdon Road Mon. Tues. Thurs. Fri. 10.0 - 12.30 p.m. 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 124 590 3887 Acre Road, Kingston 117 677 3353 Kingston Vale 19 84 202 Roselands, New Maiden 143 980 3695 Manor Drive, Worcester Park 124 996 4340 South Place, Surbiton 144 767 4961 Hamilton Avenue, Tolworth 88 605 3267 Gosbury Hill, Hook 147 595 3788 St.Mary's Church Hall, Chessington 53 287 1473 TOTALS 959 5581 28966 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: 29  Children Aged 0-4 inclusive Expectant and Nursing Mothers Inspected 562 81 Requiring Treatment 340 77 Offered Treatment 329 76 Treated 333 67 Visits for Treatment 886 199 Fillings 698 182 Teeth Filled 643 137 Teeth Extracted 99 17 General Anaesthetics 47 1 Patients X-rayed 3 18 Scalings and Gum Treatment 114 49 Teeth Otherwise Conserved 112 - Completed Courses of Treatment 381 65 Dentures Provides: Full - 12 Partial - - Treatment Sessions 231 Combined CHILDREN'S HOMES The Social Services Committee has seven homes in the borough. The premises are inspected quarterly by a medical officer of the Health 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. CONGENITAL MALFORMATIONS Since 1964 a scheme has been in existence to notify to the local health authorities information relating to babies born with congenital abnormalities. The person in attendance at the birth of a child is required by law to notify the birth and as this person is almost always a doctor or midwife they are asked to examine evrery baby and to record any congenital abnormality which it is possible to detect. 30 Every child found to have a congenital abnormality is followed up and in the case of local hospitals, detailed reports are submitted as a routine. For hospitals elsewhere the necessary information has been made available on request. These cases are kept under periodic review until a decision can be made that the child is either developing normally and no special help is required, or until special educational treatment etc., appears to be indicated, when arrangements are made for the appropriate section or department to accept responsibility for the future care and guidance of the case concerned. All cases of congenital abnormalities are reported to the Registrar General in order that a check may be maintained nationally of any change in the pattern of these very often distressing conditions. These reports are submitted in a form which makes it impossible for anyone to identify a particular case. It is pleasing to record the very highest co-operation of all concerned in this most important work. Seventy-four babies were notified at birth as congenitally malformed. Of these, four were stillborn and three subsequently died, one death being the direct result of the abnormalities notified. The other two babies died from other causes. 32 CONGENITAL MALFORMATIONS Total Malformations Reported Central Nervous System Eye Ear Alimentary System Heart and Great Vessels 89 (74 children) 2 (2 children) 4 (4 children) 13 (11 children) 4 (4 children) 1 Anencephalus 1 Accessory Auricle 3 Cleft Palate 4 Specified Malformations of Heart and Circulatory System 1 Hydrocephalus 3 Specified Malformations of Ear 4 Malformation of Tongue 1 1 Cleft Palate and Divided Tongue 1 Oesophageal Atresia and Anal Atresia 2 Specified Malformations of Alimentary System 33 CONGENITAL MALFORMATIONS Respiratory System Urogenital System Limbs Other Skeletal Other Systems Other Malformations 4 (4 children) 18 (15 children) 21 (21 children) 5 (5 children) 10 (10 children) 8 (8 children) 4 Specified Malformations of Respiratory System 6 Hypospadias 4 Polydactyly 5 Malform ations of Skull or Face Bones 1 Sternomastoid Tumour 3 Down's Syndrome (Mongolism) 4 Undescended Testicle 15 Talipes 1 Congenital Dislocation of Hip 1 Defect of Endocrine Glands 3 Pilonidal Sinus 1 Hypospadias and Undescended Testicle 2 Unspecified Malformations 1 Specified Malformation of Leg 4 Pigmented Naevus 1 Undescended Testicle and Malformation of External Genitalia 2 Specified Malformations of Skin 2 Other Malformations of Face and Neck 2 Malformation of External Genitalia 1 Renal Agenesis and Bladder Defect 34 MIDWIFERY SERVICE 1971 was a year of preparation for the coming unification of the local health authority and hospital and general practitioner services. Prolonged discussions took place throughout the year concerning the delayed opening of the domiciliary delivery unit in the Dorchester Ward at Kingston Hospital, but owing to difficulties resulting from the structural problems, it was not possible to begin the scheme until the end of the year. The final inauguration date for the scheme is 1 January 1972, and the balcony of the Florence Ward is to be used for the purpose. The agreed proposals are for patients to be booked by their own general practitioners and for records to be referred to the obstetrician who checks each booking. If suitable, the patients continue their antenatal care under the general practitioners and domiciliary midwives. They are admitted to the balcony of the Florence Ward when in labour and deliveries are conducted by the midwives, or student midwives, with general practitioners in attendance. Mothers and babies are discharged home by ambulance as soon as possible. Special consultations with the Greater London Council's ambulance staff took place to plan the special arrangements for this scheme. All Council midwives now work in close liaison with the general practitioners who undertake obstetrics. A part-time midwife also attends the ante-natal booking clinics at Kingston Hospital. This midwife advises on social conditions, especially for mothers being discharged after 48 hours. She attended 146 sessions at which patients made 8,268 attendances. The Non-Medical Supervisor of Midwives now attends the regular meetings of the Maternity Medical Committee at the Kingston Medical Centre. During the year the trend towards hospital confinements, as opposed to domiciliary confinements, continued and of the 1,907 births in the borough only 126, or 6.6 per cent, took place in the mothers' homes. Medical aid was summoned in 103 cases. Midwifery Training The Authority is approved by the Central Midwives Board as a training authority for students taking Part II of their training. During the year 18 such students were trained. They came from Kingston and 35 Central Middlesex Hospitals. It is becoming increasingly difficult to provide this training as there are fewer domiciliary confinements for the pupils to deliver but it is expected that the opening of the domiciliary ward in Kingston Hospital will improve the situation because it will provide an additional source of experience for the pupil midwives. Births Survey This survey was organised under the joint auspices of the National Birthday Trust and the Royal College of Obstetricians and Gynaecologists. Midwives, both from the Kingston Hospital and from the domiciliary field, co-operated in this survey following briefing by Mr.Geoffrey Chamberlain who addressed them at a local branch meeting of the Royal College of Midwives. The staff found the work of collecting data interesting and look forward to being advised of the results of the survey when these are available. HOME NURSING The work has increased during the year, due partly to the full implementation of group attachment of district nursing teams to the general practices. The final attachments were completed in September. Prior to this, all the doctors requesting to have nursing staff attached were visited by the Medical Officer of Health and the Nursing Superintendent. The work load of the practice was assessed and informal discussion took place on the volume and type of work within each practice. Some doctors were unaware of the procedures the nurses could undertake and guide lines on this were issued to each doctor. The remainder of the doctors who had not requested attachment and who, in the main, work in single practices, were notified and given full particulars of the nurse who would be visiting their patients and thus were given the opportunity of forming closer ties with each nurse who would call in, by prior arrangement, to see them at the surgeries. The work now undertaken by the staff is much more varied, and the trained staff are not regarded as being employed 3olely on "hygiene care of the patients" but are using the skills for which they have been trained to a greater advantage. Less skilled tasks are undertaken by the enrolled nurse and the auxiliary in the team. 2,814 patients were nursed at home during the year and 111,748 visits were paid to them. Another 1,393 were treated in general practitioners' surgeries. 36 Psychiatric Care in the Community Two district nurses who are also psychiatric qualified were appointed to visit and nurse patients who need specialised psychiatric care. This involved giving support and also supervising the medication ordered by the consultant psychiatrist. These patients were usually referred back to their own doctors. The nurses attended the special sessions held in Kenley Ward at Kingston Hospital for group and case discussion. They are also involved with the care of psycho-geriatric patients in the community, who often require additional support from the district nurses who also have knowledge of the facilities available to help both patients and relatives. Geriatric At Risk Register With the consent of the general practitioner involved, several elderly patients, who have deteriorated either physically or mentally, have been entered on the "at risk" register after referral by home nurses and health visitors and surveillance has been kept by special visiting, including seven day a week coverage when the other services were not available. Where further deterioration has taken place, the senior medical officer makes a domiciliary visit and advises on action to be taken. The maintenance of the register and regular discussion with the workers involved has helped in preventing more patients being removed to hospital under compulsory removal orders under Section 47 of the National Assistance Act. Special consideration has been given to prevention of hypothermia in the elderly and emergency kits have been maintained for this purpose. Communications with Hospitals As a result of a combined study day for district nurses, health visitors and ward sisters, it was agreed that the service to the patient could usually be improved by better links in communications. A revised form was introduced for a trial period to the staff of two wards at the hospital for completion by the ward sisters when the patients are being discharged. This confidential report gives detailed information on each patient and an assessment of his ability on discharge, and this is proving to be very helpful to the district nurses and also to the patients' general 37 practitioners. It is hoped that after further consultation it will be used throughout Kingston Hospital. Surbiton Hospital It has been arranged that the district nursing sister will visit the wards to meet the ward sister to discuss discharge of patients who need the care of the district nurse. A planned discharge can then be arranged and the other services can also be organised. Tolworth Hospital The nursing staff visit the hospital and rehabilitation centre to see the Geriatrician if any special difficulties arise in the care of the geriatric patient. Extended Evening Nursing Service These services were expanded during the year and altogether 1554 visits were paid to patients. These visits were made by two fully qualified district nurses who work from 7.30 p.m. to approximately midnight. They visit any patient who requires specialised care or night sedation by injection. This service is used for all ill patients, not only for those with a cancer condition. With careful assessment and administration it has been possible to serve many cases, thereby avoiding the need to employ fully trained nurses to stay throughout the night. Night Nursing Service Fourteen patients were provided with the use of a trained nurse for a total of thirty-eight nights and another eight were given the use of a nursing auxiliary for a total of forty-five nights. The cost of the service has been reimbursed by the Marie Curie Memorial Foundation. It is hoped to extend the service by the employment of more auxiliary sitters following an educational project to be held in 1972. This project is sponsored by the Marie Curie Memorial Foundation who are using the facilities within the borough. 38 District Nurse Training This training has continued during the year at Chiswick Polytechnic. Two nurses took the course in September and were successful. This is lower than in previous years because the arrangements with Surrey County Council were cancelled early in the year when the tutor resigned. It is planned to send students to Surrey and also to Chiswick for postgraduate district nurse training, which is now recommended as a necessary requirement by the Department of Health and Social Security. Two senior nurses undertook the Practical Workers Instructors Course and several members of the staff attended special courses on topics of interest, e.g. care of the feet, stoma care, group attachment. This Authority continues to receive visits from students, both those in training and postgraduate nurses who wish to see the work of the nurse in the community. The Nursing Superintendent has lectured to nurses in training at Kingston and Surbiton Hospitals. Later in the year it was also agreed to hold an introductory day in community nursing for the student nurses at The Manor Hospital, Epsom. The General Nursing Council have now made regulations for this to be a compulsory subject in nurse training, both for the General Register and in the psychiatric and subnormal fields. HEALTH VISITING Health visiting establishment was increased from twenty-nine to thirty health visitors during 1971, which enabled them to give up their traditional geographical areas and become responsible for the families on the lists of general practitioners within the local authority boundary. A lunch time meeting to discuss attachment of local authority nursing staff to general practices was organised at the Medical Centre, Kingston Hospital, and was well attended by general practitioners, hospital and local authority medical and nursing staff. A general practitioner, a health visitor and a district nurse from different group practices were 39 invited to speak and it was evident that the consumer benefited from group attachment. Following this session many general practitioner partnerships invited the Medical Officer of Health, the Superintendent Health Visitor and Supervisor of Midwives and District Nurses to their surgeries to discuss the attachment of the local authority nursing staff to their practices. Case Finding It was agreed that the health visitors would attempt to identify and visit, as far as possible, people amongst the practice population who came into the following categories: 1. Elderly persons unknown to the doctors or not visited by them for some time. 2. Patients put on the waiting list for hospital admission. 3. Patients on discharge from hospital. 4. The mentally and physically handicapped. 5. Ante-natal patients. 6. Families with a child or children under five years of age. 7. Families in which there was recent bereavement. 8. Families in which the bread winner was unemployed or had a long illness. 9. Households where home accidents necessitating medical care had occurred. Full attachment was achieved in September 1971 and this has meant many changes in the work of the health visitors. Their work has become much more varied. Whereas their previous field of work had been in dealing mainly with the ante-natal period, children and the elderly, they are now visiting all age groups. The main disadvantages have been that the health visitors have less local knowledge and their travelling time has been increased, but total patient care has improved because of mutual understanding and improved communications between the general practitioner and the community nursing team. 40 Hospital Liaison Good communication has continued between the local hospitals and the community nursing teams. During the year all the health visitors had the opportunity of spending one day at Kingston Hospital. The morning was spent in the children's ward and the afternoon in the paediatric out-patients department. In exchange, the senior staff of the children's ward and out-patients department spent a day with the health visitor observing her work. This enabled the staff to be more aware of each other's role and because they now knew each other, communication regarding the care of the young child improved. A senior health visitor continues to spend one morning a week at Kingston Hospital. She exchanges information with the sisters of the maternity and children's wards as well as the senior medical social worker and welfare officer. She also visits the mothers in the maternity wards should they have any problems. This information is then passed on to the appropriate health visitor in the field. This liaison has been most valuable, and mothers, babies and children have benefited because of the health visitor's prompt home visits where there have been signs of stress. One health visitor participates in the mothercraft classes held at Kingston Hospital and expectant parents who attend the local authority health clinics are invited for an evening to Kingston Hospital to see films on the birth of a baby and have the opportunity to visit the maternity unit. A geriatric health visitor is attached to Tolworth and Barnes Hospitals and assists in assessing the admission of the elderly either as in-patients or to the day rehabilitation unit; she also visits these patients after their discharge to satisfy herself that they are able to manage in their home surroundings. The same health visitor liaises with the group attached health visitor and keeps her informed about admissions, progress and discharge of her patients. One tuberculosis health visitor is attached to the chest unit at Kingston Hospital. She supervises the progress of all patients in the borough who attend the chest clinic. Nursing Education The Superintendent Health Visitor has continued to lecture to the first, second and third year nurses at Kingston Hospital and all student nurses have had the opportunity of observing community nursing by spending one day with a health visitor and one day with a district nurse. The Superintendent Health Visitor and the Superintendent of District Nurses have had discussions with the tutors at Kingston Hospital 41 about the new syllabus for nurse training and for the introduction of the community health course. Student nurses choosing this course will be given eight weeks community nursing experience. Health Visitor Student Training Four health visitors who are qualified field work instructors were responsible for the practical training of seven student health visitors. These were all successful in their final examinations. Students from varying fields have spent 567 sessions with health visitors observing their work. Health Education The health visitors have provided health education for groups in clinics, schools and church halls, totalling 731 sessions. 42 VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation in the borough was above the national average for the three main categories of protection offered (i.e. whooping cough, diphtheria and poliomyelitis). During July a circular letter was received from the Chief Medical Officer at the Department of Health and Social Security, indicating that vaccination against smallpox need no longer be recommended as a routine procedure in early childhood, because the chances of the introduction of smallpox into Great Britain have substantially diminished and are likely to lessen. Also, although vaccination is a safe and reliable method of protection against smallpox for the vast majority of persons and the number of serious complications in childhood few, these complications are now out of proportion to the risk of smallpox in Great Britain. The circular advised however that all travellers to and from areas of the world where smallpox is endemic, or where eradication programmes are still in progress, should continue to be protected by revaccination. Also health service staff, likely to come into contact with smallpox patients, should continue to be offered vaccination and regular revaccination. In view of this circular vaccination against smallpox as a routine procedure in early childhood was discontinued. Immunisation against rubella (German measles) became available during the latter part of 1970 and at first, girls in their thirteenth year were offered this protection. Subsequently this age was reduced to the twelfth year of life so that girls are now offered this protection during their first year at secondary school. 1,387 received the injection during the year. Smallpox (under 16 years - 1 January to 28 July only) Age at time of vaccination Total Vaccinated numbers Revaccinated Complications Reported 0-3 months 11 – – 3-6 months 24 – – 6-9 months 8 – – 9-12 months 12 — _ 1 year 569 6 – 2-4 years 177 22 – 5-15 years 44 126 – TOTALS 845 154 – 43 Diphtheria, Whooping Cough and/or Tetanus and/or Poliomyelitis, Measles (under 16 years) and Rubella (aged 13 years) Complete Primary Course Boosters Diphtheria 1 8 Whooping Cough only - — Tetanus only 59 527 Combined Diphtheria and Whooping Cough - — Combined Diphtheria and Tetanus 160 1482 Combined Diphtheria, Whooping Cough and Tetanus 1489 310 Poliomyelitis only 1677 2537 Quadruple – - Measles 1214 - Rubella 1387 - Total children receiving immunisation against the five illnesses whether given separately or combined: Primary Course Booster Diphtheria 1650 1800 Whooping Cough 1489 310 Tetanus 1708 2319 Poliomyelitis 1677 2537 Measles 1214 — 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 1971, 1592 persons were vaccinated against yellow fever. 44 Smallpox vaccirxation of adults and injections for typhoid, paratyphoid and cholera are normally given by the family doctor when requested for travel abroad. The following table shows the percentage of children vaccinated and immunised in Kingston upon Thames, compared with the national average: Percentage of Children Born in 1969 Vaccinated by 31.12.71 Whooping Cough (1) Diphtheria (2) Poliomyelitis (3) England and Wales 78 80 80 Kingston upon Thames 83 87 88 The figures in columns (l) to (3) are calculated to show the percentage of children born in 1969 who have been vaccinated at any time. 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. 45 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 1971, 46 cases were notified in the borough and of these, 33 were pulmonary and 13 non-pulmonary, compared with the previous year's figures of 29 and 4 respactively. This increase in the number of both respiratory and nonrespiratory cases of tuberculosis during the year should be a warning against complacency. The possibility of pulmonary tuberculosis should be kept in mind in cases of chronic cough in elderly persons among the resident population, and in all ages in the immigrant population. A chest X-ray is readily available and will help prevent the spread of infection. It is regrettable that a chest X-ray is not required before entry to this country. At least one person arrived in this borough with the infection during the year. A tuberculin test and BCG vaccination is now being offered to students, including those from abroad, attending Kingston Colleges, who have missed it at school. The 33 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) 16 B.3 or Tuberculosis + (advanced cases, sputum positive) 3 The non-pulmonary cases were: Tuberculous epididymitis 2 Skeletal 1 46 Abdominal gland 1 Cervical glands 1 Left axillary gland 1 Tenosynovitis 1 Kidney 1 Uterus 1 Mediastinal glands 1 Neck gland 1 Urogenital tract 2 On 1 January 1971 there were 341 cases on the register and at the end of the year 350. Pulmonary Non-Pulmonary Total Males 166 17 183 Females 139 28 167 TOTALS 305 45 350 The following tables show the work undertaken by the Chest Clinic at Kingston Hospital during 1971, insofar as it affects patients resident in the borough: Number of chest clinic sessions held 422 Number of attendances: New patients 830 Old patients 3852 4682 Average attendances per session 11 47 Tuberculin Tests and BCG Vaccinations Contacts School children and students Others Skin tested 114 26 51 Found positive 21 14 22 Pound negative 101 23 24 Vaccinated 62 8 13 There were three deaths from pulmonary tuberculosis during the year. The following table shows comparative figures of notified cases and deaths for the years 1961-1971 inclusive: Year Cases Notified Deaths Respiratory Nonrespiratory 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 1971 33 13 46 3 — 3 No action was necessary during the year under the Public Health (Prevention of Tuberculosis) Regulations 1925, or Section 172 of the Public Health Act 1936. These regulations respectively relate to the restriction of tuberculosis sufferers from employment in the handling of milk and the compulsory removal to hospital in certain circumstances of persons suffering from tuberculosis. 48 The following table gives an analysis by age groups of the new cases and deaths from tuberculosis during the year: Category New Cases Deaths Male - Female Under 1 year 1-4 years 5-14 years 15-24 years 25- 34 years 35-44 years 45-54 years 55-64 years 65 and over TOTAL Under 1 year 1-4 years 5-14 years 15-24 years 25- 34 vears 35-44 years 45- 54 years 55-64 years 65 and over TOTAL Respiratory Tuberculosis M - - - 3 2 3 - 5 3 16 - - - - - - - 2 - 2 F - - - 1 4 4 2 1 5 17 - - - - - - 1 - - 1 T - - - 4 6 7 2 6 8 33 - - - - - - 1 2 - 3 NonRespira tory Tuberculosis M - - - 1 1 2 2 1 1 8 - - - - - - - - - - F - - - 1 1 - 1 1 1 5 - - - - - - - - - - T - - - 2 2 2 3 2 2 13 - - - - - - - - - - Mass Radiography The following is a summary of the work of the Mass Radiography Units in the borough: Total persons X-rayed 6798 Cases found to be suffering from tuberculosis 3 (all males) Cases found to be suffering from lung cancer 13 (all males) 49 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 1971, 40 patients 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. 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 796 doctor sessions were held which were attended by 1,357 new patients. Altogether there was a total of 11,885 clinic attendances. Details of Family Planning Clinics currently being held are as follows: Roselands, 163 Kingston Road, New Maiden Mondays, Tuesdays and Thursdays 6.30 to 7.30 p.m. Appointments: Phone 942 0734 South Place, Surbiton Mondays, Wednesdays and Thursdays Fridays 6.30 to 7.30 p.m. 9.30 to 10.30 a.m. Appointments: Phone 399 8898 204 Acre Road, Kingston Wednesdays and Alternate Thursdays 7 to 8 p.m. Appointments: Phone 546 5812 1 Gosbury Hill, Hook, Chessington Tuesdays and Thursdays 7 to 8.30 p.m. Appointments: Phone 397 5737 The Manor Drive, Worcester Park Wednesdays 10 a.m. to 12 noon 7 to 8 p.m. Fridays 10 a.m. to 12 noon Appointments: Phone 337 024-6 50 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 548 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 30 September 197*1, 26 chiropodists were approved. A patient can be treated at home by the chiropodist if certified unable to attend the surgery by the family doctor. The indirect scheme is operated by the local Old People's Welfare Committees on behalf of the Council. The following is a summary of the service provided: A. Persons treated during the year Local Authority Voluntary Organi satio ns Total Persons of pensionable age and over 3232 771 4003 Expectant mothers 2 - 2 Physically handicapped, under 65 43 - 43 Blind, under 65 3 - 3 TOTALS 3280 771 4051 51 B. Treatments given during the year Local Authority Voluntary Organisations Total In clinics - 3629 3629 In patients' homes 4655 137 4792 In old people's homes 956 - 956 In chiropodists' surgeries 10900 — 10900 TOTALS 16511 3766 20277 These figures show a 9.2 per cent increase in the number of treatments given over 1970. Home Dialysis Two homes were adapted for home dialysis during the year. One of the families in Council accommodation was rehoused for this purpose. This makes a total of three patients on home dialysis in the borough. ENVIRONMENTAL HEALTH SERVICES 55 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR P.E. KINTON, M.A.P.H.I.. M.R.S.H. In the year under review there was no reduction in the interest in the topic of Environmental Health,, If anything, public interest, news media, and governments, showed an even greater interest than in the previous year. There is every reason to believe that this interest will continue and the public participation by refusing to accept unnecessary packaging of goods and the concern about vehicle pollution, pollution of the sea, contamination of rivers, will feature prominently in the news. To call for drastic measures to prevent the gross pollution by other people and organisations is very commendable but it is necessary that every member of the community should make his contribution in the hundred and one small ways in which the health and amenities of the borough can be preserved. Acceptance of low hygiene standards in the handling of food, the discarding of unwanted cigarette cartons in the streets, the fouling of footpaths by dogs, the offensive bonfire, and the accumulation of refuse, all detract from the very environment which we are seeking to protect. Although the Greater London Council provides facilities for the reception of unwanted large items of household refuse at the loading bay at Athelstan Road, Kingston upon Thames, mattresses, armchairs, and similar discarded items can be seen littering the rivers and open spaces. As will be seen from the report, progress has been made in the introduction of general improvement areas in the borough. This exercise, which has resulted in the public participation and the formation of a committee of the residents of Mill Street Area, Kingston upon Thames, who worked closely with the officers of the Council, gives an indication of the success which can be achieved in this direction. It is also worthy of note that such schemes require the co-operation of a multitude of disciplines within the Council's own organisation and the assistance of colleagues in all departments is acknowledged. The department has for many years been concerned with the identification and treatment of houses infested with various insects. We were rather surprised to find an infestation of Aridius satelles - plaster beetles - in a house at Tolworth. These insects which originate from Australia were submitted to the Pest Laboratory of the Ministry of Agriculture, Fisheries and Food and were then sent to the British Museum entomologists who must have been delighted with this discovery for they only had two specimens in their collection at that time. It should be added that these insects themselves are quite harmless. 56 An investigation was carried out in co-operation with the Council's Public Analyst and the Government Analyst into the dangers of lead in imported pottery. Whilst on this occasion there was no cause for concern the presence of lead in the environment is a matter upon which vigilance is necessary. A report was received that workmen on a building site were suffering from nose bleeding when handling certain materials. This problem was investigated when it was ascertained that sodium dichromate, a constituent of the cementation material in use was the cause. Instructions were given regarding safety precautions and the matter was pursued with the Department of Employment. In July reports were received that employees at a pet shop who had been in contact with a parrot were ill. This immediately alerted the department to the possibility of psittacosis. It transpired that a parrot had died and the premises were disinfected. Fortunately all the contacts recovered but the infection was confirmed in the parrot. The invitations to speak and to give lectures on various topics to schools, hospitals, mothers' groups, civic societies and similar organisations have been numerous. Whilst these meetings are time consuming and often in the evenings, they are welcomed as being an opportunity to present the department's aims and objectives to interested and receptive audiences. The Health Service is to undergo a major change on the 1st April, 1974 - the date upon which local government in England and Wales, outside of London, is also being completely reorganised. All the indications are that the Environmental Health Service will constitute the Health Department of the future although the pattern of this development has yet to be determined. There is little doubt that the reorganisation of local government and the attractiveness of working outside of the London area will make it increasingly difficult for this authority to attract staff unless the problems of the high cost of housing can be solved and preferential salaries offered. 57 It is again my privilege to record appreciation for the co-operation of colleagues in the department who have been under considerable pressure from sheer volume of work. At the time of writing, this is partly due to shortage of staff which is more serious than it has been at any time in the past. The Chairman, Vice-Chairman and Members of the Health Committee have given every support and encouragement which is much appreciated and the co-operation of Dr. Birchall and the other Chief Officers, is gratefully acknowledged. P.E. KINTON. Chief Public Health Inspector. 58 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 0.15 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 33 occasions samples were taken from private houses, shops, schools, nurseries and 26 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 sterilisation is effected by breakpoint chlorination. Apart from regular pool-side tests of the chemical condition of the water, 71 samples were taken during the year for bacteriological examination of which 70 were reported satisfactory. The Surbiton Lagoon, situated in Raebum 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 two samples were taken for bacteriological examination both of which were satisfactory. (b) School Pools. One private school has a swimming pool fitted with filtration plant and sterilisation is effected by hand dosing with sodium hypochlorite. 59 Eight primary schools have swimming pools with treatment plants. In addition to numerous pool-side chemical tests, 28 samples of water were taken for bacteriological examination, of which 5 were reported as having a count higher than desirable due to inadequate chlorination. 3. RIVERS AND STREAMS The River Thames forms the western boundary of the b.orough and 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 borougho 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, smother 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 in particular from litter and waste arising from house boats occupied by the river-side dwellers and other river users has been a matter of concern to the department. 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. The Council has restricted the use of the river-side 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. A small quantity of the sewage in the district is discharged to the sewage disposal works of the Greater London Council at Worcester Park and to the Wandle Valley Works;, the remainder is dealt with at the Hogsmill Valley Sewage Treatment Works. This plant which is situated at Lower Marsh Lane, also deals with the sewage from the Borough of Epsom and Ewell. With the exception of a few houses, all dwellings are connected to the main sewerage system. 5. PUBLIC CLEANSING. The Borough Engineer and Surveyor is responsible for the collection and delivery of refuse to a central loading point whence it is hauled in large vehicles to tips operated by contractors employed by the Greater London Council, who are responsible for the disposal of refuse. The total amount of refuse passing over the weighbridge during the year ended 31st December, 1971 was 45,134 tons. 60 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 MP RAILWAY PREMISES ACT. 1965. During the year 399 registered premises received one or more general inspections, these included inspection of all the 77 newly registered premises. The total number of registered premises at the end of the year was 1,702. All premises known to the department have received a thorough general inspection. The total number of inspections carried out during the year was 2,099. 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. The need for regular inspection of the district is emphasized by the fact that of the 77 new registrations recorded during the year nearly all were found by inspection and very few as the result of applications for registration. 8. NOISE. One hundred and two complaints regarding alleged nuisance from noise were received during the year and fifty-four nuisances were confirmed. Fifteen arose from industry, eight from commercial undertakings, twelve from domestic sources and fifteen from building works. Forty-six of these nuisances were abated following informal action and four abatement notices were served. Eight complaints regarding the level of sound arising from loudspeakers were received and these were all remedied informally. The increasing use of mechanical equipment is causing a rise in noise levels in and around our homes, which must be resolutely tackled. Present legislation is inadequate to deal effectively with the situation and the report of the working group on the Noise Abatement Act, entitled "Neighbourhood Noise" points the way ahead. It recommends improvements 61 in the existing "nuisance" procedure, the imposition of Town Planning restrictions in appropriate cases, the introduction of noise control areas and a requirement that machinery manufacturers shall specify the sound power level of their products,, The report does not deal with the important aspects of traffic and aircraft noise but a great amount of work is "being done by various authorities which offers hope of improvements in the near future. We are already trying to reduce noise levels from proposed new factories by co-operation with the Borough Planning Officer in imposing conditions specifying maximum noise levels, but there are legal and technical difficulties which will need to be resolved before a satisfactory procedure can be established. The likely effect of traffic noise on houses near proposed new roads is also being studied in the hope that means can be devised for alleviating it. 9. CLEAN AIR. Clean Air Acts 1956/1968 - Smoke Control Areas. Particulars of Kingston upon Thames Nos. 18 and 19 Smoke Control Orders which were confirmed on 8th January 1971, 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 In October the Council made Smoke Control Orders Nos„ 20 and 21 and confirmation by the Minister of Housing and Local Government has been received. They come into operation on 1st October 1972. Details are as follows Area 20 21 Locality Amberwood Rise New Maiden Villiers Avenue Surbiton Acreage 228 184 Domestic premises 2166 1850 Commercial " 17 52 Industrial " 1 5 Other " 5 10 62 The Council's Smoke Control Area programme provides for a further six areas by 1978 in addition to the twenty-seven already covered by confirmed Smoke Control Orders. The position at the end of the year is summarised as follows:- Number of Areas Domestic premises Areas in operation 25 28,723 Orders confirmed and not yet operative (Areas 20 and 21) 2 4,016 Area being surveyed (Area 22) 1 2,530 Future areas 5 15,430 The suspension of nine Smoke Control Orders, mentioned in my last report, was terminated on 30th April, 1971° The expected shortage of solid smokeless fuel did not materialise as we were fortunate in having a very mild winter. The fuel trade advises that production has now increased to such an extent that all likely demands can be met. Air Pollution complaints. There were 167 complaints from the public about nuisance from smoke and grit; 129 of these concerned bonfires; 8 smoke from factory chimneys; 4 smoking domestic chimneys; 3 grit and smuts; 7 smoke from demolition sites and 16 fumes. Now that the Council's Smoke Control Area programme is well advanced and commercial heating equipment is designed to operate almost smokelessly, people are more conscious of the discomfort caused by garden bonfires. This is reflected in the increased number of complaints received. We distribute an advisory leaflet on the subject, but it is obvious that stronger measures are required. The National Society for Clean Air is looking into the possibility of promoting legislation to deal with the more objectionable bonfires. Three applications were submitted for approval of chimney heights under the Clean Air Acts 1956 and 1968. These were approved without modification. In a further three 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 eases. It is gratifying to be able to report an increased use of natural gas in large boiler furnaces, resulting in a reduction in sulphur dioxide emissions. 63 Smoke and Sulphur Dioxide measurements. Four continuously operating instruments for daily measurements of smoke and sulphur dioxide are sited at the rear of the old Municipal Offices, High Street, New Maiden, "Alfriston", Berrylands Road, Surbiton, Tiffin Girls School, Richmond Road, and the Guildhall, Kingston upon Thames. Three of these are automatic instruments constructed by a member of our own staff, which need reading only once a week. The results at the Tiffin Girls School site since 1958 compared with average temperatures are shown in FIG.l. It is pleasing to report that the measurements at this site are undertaken by the pupils of the school and the assistance of the head-mistress, staff and pupils is gratefully acknowledged. 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. It can be seen from FIG.2. that a steady fall over several years in the readings at the Canbury Gardens site was interrupted by a high deposit in 1970 and a slightly lower one in 1971. The reason for these disappoint ing fluctuations is not known. The Power Station is now operating on lower loads than previously, so grit emissions from the chimneys should be lower. 10. RODENT AND INSECT PEST CONTROL. It is pleasing to be able to report a further reduction in the number of premises found to be infested by rodents. The figure of .87% 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 pro duced on wasps which proved to be very successful. Both leaflets are available on request. Fifteen complaints were received concerning foxes. Three animals were caught where they had been concerned mainly in disturbance and the death of children's pets. Four foxes were found dead in different parts of the borough, having been killed by vehicles. 64 Several complaints were received concerning plaster beetles. In one instance where a house had been damaged by a burst pipe an infestation occurred of Aridius satelles, an Australian insect which so far as is known is the first instance of this species being found under these circumstances,, The British Museum of Natural History was pleased to have some specimens for its collection We were fortunate in being able to maintain a full staff in this section during the year. 65 H 0 U S I K G The volume of work in connection with housing continues unabated. During the year progress was made with the implementation of the clearance of Fairfield Place, including the Public Inquiry when the Compulsory Purchase Order was confirmed and detailed inspections were carried out in the Elm Crescent Area of Kingston upon Thames prior to a report being submitted to the Council. During the year no less than 334 houses were repaired as a result of informal action by the officers and 11 demolition or closing orders were made. Houses in multiple occupation have continued to receive limited attention only and in the course of the year 24 informal and 18 statutory notices were served requiring works, notably for additional facilities and in connection with means of escape from fire„ It is pleasing to note the continuing interest in grants for the conversion of the larger type of house into suitable self contained flats and some of the properties concerned are the large Victorian houses which had for a number of years previously been used in multiple occupation, often accompanied by poor living conditions for the occupants. Grants for these conversions are made up to half the cost of works as approved by the Council, subject to a maximum of £1,000 per dwelling produced by the conversion (£1,200 per dwelling in the case of a building of three or more storeys). Following upon the completion of appropriate works by the Council to its own houses, grant payments from the Exchequer were received in respect of 39 dwellings, and approval received from the Secretary of State for the Environment in two other cases. As in the past year the concentrated effort on the improvement of houses was continued and General Improvement Areas at Thorne Road, New Maiden and Mill Street, Kingston upon Thames, were the subject of public meetings presided over by the Mayor and attended by a very large number of residents from the localities. In each case there was lively discussion and constructive observations were made by the residents and there followed considerable press publicity. At Mill Street the residents elected their own Committee which closely collaborated with the officers of the Council to recommend the improvements to the satisfaction of all concerned. Other areas of the borough are being surveyed but the problems of staff and time required to do the detailed work present difficulties in departments where the staff are limited in number. 66 The progress with the improvement of individual houses has continued and the Council is co-operating with the Department of the Environment in mounting a massive publicity campaign for the London area in April and May of 1972. In June the Department of the Environment organised a meeting with builders and house owners in the South West of London at the Surbiton Assembly Rooms and the Chief Public Health Inspector contributed a paper at this conference which was very well attended. Contrary to expectations the amount of work in connection with the issue of Qualification Certificates continued, the number of applications on the register being 1,050. 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 and none resorted to or resided in the area. 67 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 1971 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 1975 and all are dealers' licences to sell pre-packed milk. Premises and type of licence Number Premises in which milk is sold 93 Pasteurised milk 80 Sterilised milk 36 Ultra Heat Treated milk 53 Untreated milk 11 Bacteriological Examination of Milk. During the year 29 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 22 * - 23 1 — - — Ultra Heat Treated - - - - - - 3 Sterilised - - - - 2 - - * Plus 2 samples which passed the modified test for milk from dispensers. The phosphatase test indicates that pasteurisation has been properly carried out; the methylene blue test is used to determine cleanliness and keeping quality and the turbidity test is a check on sterilisation. 68 Ice Cream. The number of registered premises in the borough at 31st December 1971 in which ice cream could be stored or from which it could be sold was 293» In addition to these dealers there are other premises which are not required to be registered such as restaurants, canteens and cinemas where ice cream is sold. 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. The table shows the results of examination of 47 samples submitted to the Public Health Laboratory at Epsom during 1971. GRADE Total I II III IV Ice Cream 33 2 4 8 47 Of the twelve samples Graded III and IV nine were taken from open cans and three from soft ice cream machines. The majority of samples taken were of unwrapped ice cream and unless care is taken to keep scoops in a hygienic condition and containers covered when not serving, the risk of bacteriological contamination is increased. Bacteriological Examination., Sixty-seven samples of various kinds of food-stuff were taken for bacteriological examination in the Epsom Public Health Laboratory to check on fitness for human consumption and possible association with cases of suspected food poisoning. Equipment and surfaces with which food cones into contact, including slicing machines, were swabbed to check on the standards of cleanliness,. Lead. Five imported glazed pottery drinking mugs were submitted for examination as to possible risk of liquids placed therein becoming contaminated with lead from the glazing used. In only one case was any lead absorption detected and this was so low that the mug was perfectly safe for use. 69 Chinese Pood Syndrome, Towards the end of the year two persons who had dined at a Chinese restaurant reported that within half an hour they were suffering with itching, swollen faces and piaffed up eyes with exudation. The soy sauce was analysed and was reported as containing a normal amount of monosodium glutamate. Any substance, if consumed in sufficient quantities or under certain circumstances, may produce effects on the body. Monosodium glutamate, which is a normal constituent of protein, if taken in excessive quantity, can produce the Chinese Food Syndrome. 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 eight wholesale meat depots in the borough, the main group being situated in The Bittoms, with two 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 277 containers of food, mainly 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. Date Stamping of Food. During the year the Food Standards Committee of the Ministry of Agriculture, Fisheries and Food invited comments on the subject of date stamping of food in connection with a review which they were undertaking. Whilst at first sight it would seem to be a simple procedure to mark foods with a clear date of manufacture or the date by which the food should be used or "the shelf life", there are many difficulties or such a practice would have been adopted long ago. These difficulties include the bulk packaging of food-stuffs at a time of surplus, the variety of factors influencing the keeping quality of foods, and the whole question of legal responsibility for the sale of food not of the quality expected by the purchaser. The Council decided that observations be submitted in respect of cases of sale of unsound food which had occurred in the borough and requested that the following points be considered:- 70 1. Open date stamping (i.e. date of receipt at the retail shop) of perishable pre-packed foods - bread, meat products (such as sausages and meat pies), and milk products (such as yoghurt) should be adopted as routine procedure by all retailers. 2. That the practice of either open or coded dating be continued by the manufacturers. 3. That all dating and coding should be in clear print on a contrasting colour in indelible ink. 4. The practice of sale or return should be an offence in the merchandising of these particular foods. Food Hygiene. There are 1,553 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 Inspectorate. There are no poultry processing premises within the borough. FOOD AND DRUGS SUBJECT OF COMPLAINT A total of 297 complaints about articles of food were received during the year, all were thoroughly investigated and appropriate action 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. Sliced Bacon - fly blown Fine £20 and £5 costs. Yoghurt - fermenting Fine £50 and £8 costs. Sausages - skinless - mould Fine £15 and £6 costs. Cottage Cheese - sour and mould Fine £40 and £5 costs. Sausages - skinless - mould Fine £10 and £3 costs. Blackcurrant Fool-fresh cream dessert-mould Fine £60 and £20 costs. Danish Fruit Bun - mould Fine £10 and £5 costs. Beef Steak and Kidney Pie - mould Fine £20 and £5 costs. Apple Tart - mould Fine £10 and £3 costs. Cooked Chicken - maggots Fine £20 and £5 costs. 71 ANIMAL ESTABLISHMENTS There are six animal hoarding establishments and thirteen pet animal shops licensed by the Council. There are three riding establishments in the borough licensed by the Council and the co-operation of Mr. G.W. Serth, Mr. M. Rand, and Mr.M.A.P. Simons, Veterinary Surgeons, in the administration of this legislation is gratefully acknowledged. TRADE DESCRIPTIONS ACT. 1968 283 inspections were carried out under the Act in respect of food to ensure that articles were appropriately labelled and warnings were given where necessary. FERTILISERS AND FEEDING STUFFS ACT. 1926 This Act requires vendors of fertilisers and feeding stuffs to apply a description to such materials when exposed for sale or when consigned or delivered so that the purchaser is aware of the more important constituents. Six samples were submitted to the Public Analyst during the year of which three were reported as being satisfactory. Two of the latter were not to the prejudice of the purchaser in that while constituents were outside the permitted variations they were in excess. The third sample was of a compound fertiliser which was deficient in potash in excess of the limits of variation allowed and a repeat sample could not be taken in the prescribed manner as no more was found exposed for sale. 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 11 names were removed and 7 added. The total number of names on the list at the end of the year was 100. 72 The ingredients should be shown in the correct descending order of proportion by weight. Milk, Channel Island Contained added water. The sample contained: Milk fat 4.43%; milk solids other than milk fat 8.59%; added water 1.5% and the freezing point(Hortvet)of the sample was -0.531°C. Thorough investigation and warning given. Follow-up samples were satisfactory. Danish Bacon Savouree Not of the quality expected. The sample was old stock and the meat was discoloured by contact with corroded areas of the can. This was old stock. The department was unsuccessful in obtaining the name and address of the importer and in finding any more exposed for sale. Chocolate - Strawberry filled Contained preservative not permitted for use in any of the ingredients of the sample. The sample contained: 640 p.p.m. of sorbic acid in the filling equal to 150 p.p.m. in the whole sample. The retailer ceased to trade. The matter was taken up with the importer who stated that the import of these chocolates had ceased following a consignment being stopped at the port of entry. Pappadoms Contained foreign matter. Three of the biscuits had coarse vegetable fibres attached to them. The matter was raised with the importer. FOOD AND DRUGS ACT. 1955. 514 samples of foods and drugs were submitted to the Public Analyst for examination. Of the 22 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. 73 Chocolate Fudge The fudge was coated with a chocolate substitute. A subsequent formal sample was reported to be genuine. Ice Cream Deficient in fat to the extent of 16$. The sample contained: Fat - 4.2$: Milk solids other than fat - 11c 2$o Legal proceedings instituted. Fine £12. Costs of £5. and Public Analyst11 s Fee £5.65 awarded. Vegetable Pat^ The minimum quantity of Vitamin B1 present in each ounce of the food was not declared, The sample contained: Vitamin B1 - not less than 1 mg. per ounce. Label amended following correspondence. Pineapple Flavoured Syrup (Two samples) Samples contained a dye not included in the permitted list of Colouring Matters in Food Regulations 1966. Following correspondence with the manufacturers, the matter was referred to the Local Authority in whose district production took place. Glycerine, Lemon and Honey Pastilles The active ingredients of the pastilles were not declared as required by the Pharmacy and Medicines Act 1944o Following correspondence the manufacturers agreed to omit the words "soothing and demulcent" from the label. Cheese - full fat soft* Contained mould in the folds of the wrapper. The attention of the importer was drawn to the condition. Beef Goulash Deficient in meat to the extent of 29$. and did not carry the description required by the Canned Meat Product Regulations 1967. The sample contained total meat - 58$. Raised with importer but correspondence not yet concluded. Pork Sausages Contained preservative which was not declared. The sample contained Sulphur Dioxide 310 parts per million by weight. The retailer had failed to keep a preservative notice displayed. 74 Fried Oyster Contained an ingredient which was not declared on the label. The sample contained: Added oil 36%. The importer arranged for the label to be amended. Barmene Spread Incorrectly labelled. The label declared the amount of vitamin B12 present in 1 ounce to be one thousand times greater than was actually present. The sample contained Vitamin B12 -12mcg. per ounce. The manufacturer agreed to amend the label. Fruit Cocktail in heavy syrup The article was not of the quality expected. Only l4% of grapes were present compared with the minimum of 6$ expected. The matter was raised with the importer who found the amounts were well outside tolerances allowed by their specification which required approximately 20% of grapes. The matter was taken up with the supplier. Cheese - soft full fat Misleading label. The sample consisted of a compound product containing full fat soft cheese and ground pepper grains but the illustration on the wrapper showed a complete coating of pepper grains. The matter was raised with the importer. Pork Sausages Contained preservative which was not declared. The sample contained: Sulphur Dioxide 240 parts per million. Retailer stated preservative notice had been mislaid. Notice now being displayed following a warning. Margarine Contained excess water. The sample contained: Water - 16.6% being 0.6% in excess. Followed up by formal sample which proved satisfactory. 75 Guava Cheese Deficient in fruit to the extent of 37%. The sample contained: Guava fruit 25%. Taken up with importer correspondence not yet concluded. Bran Crispbread Misleading label. The crispbread contained 26.7 calories per slice but the label claimed that each slice contained only 10 calories. Following correspondence the importer agreed to amend the label. Raspberries Misleading label. The sample consisted of raspberries intended for making into jam, the label claiming that the contents of the container would make 6 lbs. of jam. The proportion of fruit in the container, however, would only produce a jam containing 27.5% fruit, compared with the required fruit content of 30% for raspberry jam in Food Standards (Preserves) Order. Taken up with manufacturer - correspondence not yet concluded. 76 FOOD AND DRUG SAMPLES Milk 22 Milk Products 45 Meat and Meat Products 68 Fish and Fish Products 20 Oils and Fats 12 Sugar and Preserves 37 Confectionery and Chocolate 27 Fruit and Fruit Products 46 Vegetables and Vegetable Products 13 Cereals and Cereals Products 8 Flour Confectionery 42 Beverages 14 Soft Drinks 21 Alcoholic Drinks 8 Condiments and Sauces 29 Soups 7 Spices and Flavourings 10 Food Additives and Supplements 3 Slimming and Diabetic Foods 6 Drugs 37 Baby Foods 12 Chicken and Chicken Products 3 Miscellaneous 24 514 77 FOODSTUFFS SURRENDERED AND CONDEMNED AS UNFIT Canned Goods lbs. Chicken 18 Fish 29 Fruit and Fruit Juice 1,915 Jams and Preserves 34 Meat and Meat Products 414 Milk 16 Vegetables 138 Soup 30 Others 104 Bacon 172 Biscuits 65 Cheese 40 Cherries 600 Chicken 824 Cordial 10 Fish 244 Meat 13,073 Rabbits 89 Sultanas 13 Turkey 13 Frozen Foods (Refrigeration failure) 6,976 Food and Drugs Act. 1955. Section 9. Unsound food found on a mobile hamburger van, which appeared to have been abandoned, was seized and taken before the Justices and condemned. 78 FOOD HYGIENE (MARKETS. STALLS AND DELIVERY VEHICLES) REGULATIONS. 1966. The following tabulated statement shows the nature of infringements to which attention was drawn:- Number of stalls selling food 59 Total Name and address not displayed 22 Washable overclothing not worn 19 Washing facilities 13 First aid equipment 18 Protection of food 12 General cleanliness 12 Covering of stalls 6 102 The proprietor of a Hot Dog and Hamburger van was prosecuted for contravention of the above Regulations. He was fined £25.00 and costs of £10.50 were awarded. 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 40 115 Butchers 70 218 Clubs 60 18 Confectioners 168 85 Fish shops (wet or fried) 35 46 Greengrocers 80 100 Grocers 142 279 Ice cream, manufacture 1 15 Institutions 292 80 Milks shops and deports 37 24 Mobile shops 93 63 Office, shop and works canteens - 57 Office, shop and works canteens 88 49 Open Markets 2 565 Public houses, hotels and licensed premises 138 115 Restaurants and cafes 151 344 School canteens 74 135 School canteens 10 189 Wholesale meat shops 72 70 1,553 2,567 79 FOOD HYGIENE The following tabulated statement shows the nature of the infringements to which attention was drawn Washing facilities for staff Absence of. defective, inadequate hand basins 17 Absence of hot and cold water Lack of towels, soap and nailbrushes 52 Defective Water heaters 9 Sanitary Conveniences Lack of "Wash Your Hands" Notices 27 Fittings, defective and dirty 27 Lighting inadequate 4 Walls and ceilings defective and dirty 11 Ventilation and/or ventilated lobby required 8 Others 10 Repairs to Food Rooms Floors defective 3 Walls and ceilings defective 4 General cleansigs 3 Inadequate lighting 1 Sinks and draining boards Lacking or defective 10 Protection of Food against contamination Smoking 9 Food not kept 18" off ground 3 Covers not Provided for food 1 Other 24 Uncleanliness Kitchens and equipment 35 Food Stores 10 Preparation rooms 13 Floors, walls and ceilings 63 Refrigerators 12 Ventilation 8 Dustbins-insufficient and defective 6 Uncovered, and collection of, refuse 2 First aid equipment 16 Clothing-storage and cleanliness 10 Accumulations 11 General defects 13 422 Notices served 127 Notices complied with 87 Legal proceedings were instituted against a company found to be using premises contravening the Regulations for boning out carcase meat. Fines of £975 were imposed in respect of thirteen summonses together with £25 costs. 80 COMPLAINTS The following is a brief list of causes for complaints received during 1971 which resulted in investigation by the department and in all cases where necessary, appropriate action was taken. Accumulations 105 Animals 36 Caravans, illegal Parking 4 Cellulose spraying 5 Dampness 81 Drainage/Sanitary arrangements 1,261 Dirty milk bottles 13 Dustbins 17 Flooding 73 Foods 160 Food Hygiene 29 Fouling of footpaths by dogs 15 General Housing defects 142 Insects 693 Noise 102 Offensives Odours 124 Offices, Shops and Railway Premises Act 4 Overcrowding 7 Pigeons 50 Public Conveniences 4 Rodents Rate 1,068 Mice 231 1,299 Rivers and streams - pollution 6 Shops Act 5 Smoke, including grit, smuts and fumes 167 Squirrels 66 Water 14 Others 74 4,556 81 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 108 Bacteriological Sample Visits 170 Betting, Gaming and Lotteries Act 29 Building Sites 70 Chiropody and Massage Establishments 33 Committee and Council Meetings 90 Consumer Protection Act (Fireguards) 31 Council House - Disinfestations 20 " " - Inspections 36 Court 35 Depot visits or inspections 108 Diseases of Animals Act and Waste Food Order 5 Disinfections 4 Disinfestations 13 Drainage visits 1,071 Employment Agencies 67 Food Complaints 297 Food and Drugs Samples 371 Food Hygiene Regulations - Bakehouses 44 -Bakers' shops 71 - Butchers 136 - Confectioners -Cooked meat shops 85 82 - Fish shops (wet or fried) 46 - Greengrocers 100 - Grocers 279 - Ice cream, manufacture 15 - " " Sale 80 - Institutions 24 - Milk shops and deports 63 - Mobile shops 57 - Office and Works canteens 49 - Public houses, hotels and licensed premises 115 - Restaurants and cafes 344 - School canteens 135 - Sports clubs 18 C/Fwd 4,313 82 B/Fwd 4,313 - Open Markets 565 - Wholesale meat shops 189 - Other food premises 70 Factories - non-power 36 " -power 210 Fertilisers and Feeding Stuffs 12 Hairdressers and Barbers 26 Health Education 92 Home Safety 15 Houses in Multiple Occupation 720 Housing Enquiries 84 Housing Act Inspections 693 " " Reinspections 298 " " Qualification Certificates 782 Improvement Grant Visits 2,239 Infectious Disease Visits 1,159 Insect Pests 102 Interviews with Owners, Builders, etc 1,551 Miscellaneous (including no reply) 2,724 Noise Abatement 425 Offices, Shops and Railway Premises 2,099 Old People and Problem Families 48 Overcrowding 4 Pet Animals Act 13 Pigeons 15 Piggeries 19 Pharmacy and Poisons Act 80 Public Conveniences 127 Public Health Act Inspections 1,253 " " " reinspections 1,115 Rag and Bone, Scrap Metal Dealers 16 Rag Flock Act 5 Refreshment Houses (Licences) 1 Refuse Tips 7 Rent Act 6 Riding Establishments 8 Rivers, Ditches and Ponds 79 Rodent Control 124 Shops Act 77 C/Fwd 21,401 83 B/Fwd 21,401 School Premises 114 Smoke Abatement 327 Smoke Control Areas 8,316 Smoke Control Areas - No access 1,488 Special Surveys 1,030 Tents, Vans, Sheds and Caravans 26 Trade Descriptions Act 412 Unsound Food 206 Vacant land 62 Visits outside district 245 Waste Food (Staining and Sterilisation) Order 4 Water Supply and Sampling (including Swimming Pools) 360 Work in Progress 731 Work Places and Outworkers 33 34,755 84 Informal Written and verbal 813 Statutory (a) Housing Acts (excluding those mentioned in (b) below) 49 (b) Housing Act, 1957 - Section 170 - requiring information as to ownership 125 (c) Public Health Acts (other than mentioned in (d) below) 73 (d) Public Health Act, 1936 - Section 277 - requiring information as to ownership 44 (e) Clean Air Act 42 NOTICES COMPLIED WITH Informal Written and verbal 693 Statutory (a) Housing Acts 11 (b) Public Health Acts 38 (c) Clean Air Act 19 85 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 Sections 1,2,3,4,6 are enforced by the 47 36 – – Factories not included above in which Section 7 is enforced by the 582 210 11 – Other premises excluding outworkers 113 70 3 – 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 Inadequate Ventilation 3 2 – 1 – Sanitary Conveniences: Unsuitable or defective 3 3 _ – – Not separate for sexes 3 1 – – – Other offences against the Act (not including offences relating to outwork) 5 8 – 1 – 14 14 – 2 – 86 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 Curtains and furniture hangings 2 Fuse makers 10 Wearing apparel - making etc. 13 Household linen - making etc. 1 Artificial flowers 2 Lampshades 5 33 87 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 2 15 Eating facilities 7 6 Temperature 29 16 Floors, passages and stairs 12 7 Ventilation 17 17 Fencing exposed parts of machinery 5 8 Lighting 5 20 Safety precautions 4 9 Sanitary Conveniences 29 24 First Aid 27 10 Washing facilities 16 29 Registration 18 12 Clothing Accommodation 7 50 Provision of Abstract 39 Other matters 9 Total 226 88 ACCIDENTS Workplace Reported Non Fatal Total No. Investigated Action Recommended Informal advice No action Offices 2 1 1 1 Retail shops 54 27 27 27 Wholesale shops Warehouses 4 2 2 2 Catering establishments open to public, canteens 4 3 3 1 TOTAIS: 64 33 33 31 ANALYSIS OF REPORTED ACCIDENTS Offices Retail shops Wholesale Warehouses Catering establishments open to public, canteens Transport – 3 – – Falls of persons 1 21 2 1 Stepping on or striking against object or person – 4 – – Handling goods – 15 1 2 Struck by falling object – 1 – 1 Use of hand tools – 5 – – Not otherwise specified – 6 1 – 89 PEST CONTROL - STATISTICAL SUMMARY 1. Number of properties in district 60,674 2. (a) Total number of properties (including nearby- premises) inspected following notification 2,142 (b) Number infested by (i) Rats 573 (ii) Mice 255 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification. 209 (b) Number infested by (i) Rats 118 (ii) Mice 24 4. Complaints received: Rats 1,068 Mice 231 Squirrels 66 Pigeons 50 Wasps/Bees 299 Other Insects 194 90 HOUSING The following is a tabulated statement of action taken under the Housing Acts. 1. Number of houses inspected 693 2. (a) Number of houses which, on inspection, were considered to be unfit for human habitation 6 (b) Parts of houses which, on inspection, were considered to be unfit for human habitation 5 3. Number of houses, the defects of which were remedied in consequence of informal action by the local authority or its officers 334 4. Number of representations made to the local authority with a view to:- (a) The serving of notices requiring the execution of works 36 (b) The making of demolition or closing orders (number of houses involved) 11 (c) Declaration of Clearance Areas (number of houses involved) - 5. Number of formal notices served requiring the execution of works 45 6. Number of houses which were rendered fit after the service of formal notices 23 7. Number of demolition or closing orders made 11 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 5 lO. Number of houses where demolition or closing order determined on the premises being made fit 6 91 RENT ACT. 1968 APPLICATIONS FOR CERTIFICATES OF DISREPAIR. One certificate was issued in respect of some of the defects. No other applications were received. 92 HOUSING ACT. 1969. IMPROVEMENT GRANTS - STANDARD Owner/Occupied Tenanted Applications received 18 44 " approved 19 45 Dwellings improved 29 13 £ Amounts paid in grants 5,261.86 Average per house 125.28 Amenities provided - (a) fixed bath or shower 21 (b) wash-hand basin 30 (c) hot water supply (to any fittings) 37 (d) water closet within dwelling 24 (e) sink 7 IMPROVEMENT GRANTS - DISCRETIONARY Single Dwellings Improved Owner/Occupied Tenanted Applications received 79 53 " approved 65 38 Dwellings improved or provided 36 31 £ Amount paid in grants 36,025.81 Average per house 537.70 Dwellings Provided by Conversion Owner/Occupied Tenanted Applications received 3 19 " approved (dwellings) 9 50 Dwellings provided 2 20 £ Amount paid in grants 12,305.59 Average per dwelling 559.35 93 SPECIAL GRANTS Owner/Occupied Tenanted Houses Households Houses Households Applications received – – 1 10 " approved – – 2 11 Grants paid 1 2 5 24 £ Amount paid in grants 753.89 Average per house 125.65 Average per household 28.99 94 HOUSING ACT 1969 - PART III CERTIFICATES OF QUALIFICATION IMPROVEMENT CASES No. of applications in register at 31.12.71 112 No. of applications for Qualification Certificates under Section 44(2) under consideration at 31.12.71. 27 No. of Certificates of Provisional Approval issued 81 No. of Qualification Certificates issued under Section 46(3) 19 STANDARD AMENITIES ALREADY PROVIDED No. of applications in register at 31.12.71 939 No. of applications for Qualification Certificates under Section 44(l) under consideration at 31.12.71. 219 No. of Qualification Certificates issued under Section 45(2) in respect of:- (i) dwellings with rateable value of £90 or more in Greater London 324 (ii) dwellings with rateable value less than £90 in Greater London 200 EXEMPTION FOR LOW INCOME TENANTS FROM SECTION 54 No. of applications in register at 31.12.71 3 No. of certificates issued under Section 55 3 95 WATER SUPPLY The following information has been kindly supplied by the Director of Water Examination, Metropolitan Water Board. All the water supplied to the borough is derived from the River Thames. Yearly Average Bacteriological Results Before Treatment Number of Samples 8.154 Agar plate count per ml. 20-24 hours at 37°C 53.9 Coliform count - Per cent, samples negative in 100 ml. 40.37 Count per 100 ml 12.2 Escherichia coli count - Per cent, samples negative in 100 ml 54.91 Count per 100 ml 5.1 After Treatment Number of Samples 3.901 Agar plate count per ml. 20-24 hours at 37°C 8.4 Coliform count - per cent samples negative in 100 ml 99.51 E. coli count - per cent samples negative in 100 ml 99.97 96 Results of the Chemical Examination of Water supplied to Borough, (in milligrammes per litre) Number of Samples 364 Ammoniacal Nitrogen 0.029 Albuminoid Nitrogen 0.084 Nitrate Nitrogen 6.1 Oxygen abs. from KMn04 4 hrs. at 27°C. 1.04 Hardness (total) CaC03 281 Hardness (non-carbonate) CaC03 90 Magnesium as Mg 5 Sodium as Na 23.5 Potassium as K 5.1 Chloride as CI 34 Phosphate as P04 2.3 Silicate as Si02 10 Sulphate as S04 64 Natural Fluoride as F 0.15 Surface-active material as Manoxol OT 0.02 Turbidity units 0.1 Colour (Burgess units) 13 pH value 7.8 Electrical Conductivity (microhmess) 580 97 98 SCHOOL HEALTH SERVICE 101 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1971 To the Chairman and Members of the Education Committee Ladies and Gentlemen, I am pleased to present the annual report on the School Health Service in the new Royal Borough for 1971. I have the following comments to make on certain items: School Health Service The population of maintained schools in the borough increased by 570 pupils during the year. Of the 4,892 children examined at periodic medical inspections 654 (15.4 per cent; were found to be in need of treatment. This compares with 680 (11.8 per cent) for 1970. Of those examined only five children were found to be in an unsatisfactory condition. Vaccination and Immunisation During the year immunisation against rubella (German measles) was offered to all girls between their 11th and 13th years. The acceptance rate was high and 1,387 girls received protection. This immunity is given to prevent infection during pregnancy, with the attendant 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. During the year a special class for speech defective children was opened in accommodation in a school in Chessington. The value of the intensive therapy which is given in the class has been proved and it has been possible for several children to return to ordinary schools. 102 Audiology The joint audiology service with the London Borough of Merton continued to expand. The partially hearing nursery unit continues to provide for a very real need and plans are well advanced to open a similar unit for children of primary school age at accommodation at a school in Tolworth. It is expected that the new unit will open in September 1972. Dysart School By virtue of the Education (Handicapped Children) Act 1970, responsibility for Kingston Junior Training Centre was transferred from the Health Committee to the Education Committee on 1 April 1971. The Centre was renamed Dysart School and the 54 children in attendance will continue to receive the whole range of health services available to school children. St.Philip's School Younger children continue to be admitted to this school at the age for normal school entry. They gain in confidence as a result of receiving education with their equals. If they were to attend an ordinary school with much larger classes, they would be likely to drop rapidly behind others in the same age group, become frustrated and discouraged, which not infrequently causes many other problems. Bedelsford School The work of this school continues and there were 68 children attending at the end of the year. Over the years the nature of the handicapping condition for which a child is admitted has changed. This is due in part to immunisation against poliomyelitis which has significantly reduced the incidence of the illness, ans also to improved surgical techniques in overcoming congenital abnormalities. Health Service Reorganisation The uncertainty of the future administration of various sections of the work of the School Health Service caused much disquiet and doubt both in health and education circles during the year. No guidance however, materialised. 103 I should like to record my thanks to the Committee for their support and encouragement, and to the Chief Education Officer and his staff and Head Teachers for their co-operation at all times. I am, Yours faithfully, JOHN C. BIRCHALL Principal School Medical Officer 104 SCHOOL HEALTH SERVICE The population of the borough, estimated by the Registrar General, was 140,550 at mid-1971. In January 1972 the number of pupils on the registers of maintained schools was 20,630 made up as follows: Primary Schools 12,242 Secondary Schools 7,973 Nursery Schools 152 Special Schools 263 In addition it is estimated that 2,900 children attend independent schools registered under Part III of the Education Act 1944, and 560 attend the direct grant school which is served by the school health service. The number of maintained schools in the borough on 31 December 1971 was 59: 13 secondary, 41 primary, 2 nursery, 3 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 two other medical officers. The services of sessionally employed medical officers are also used to maintain the programme of fixed appointments at clinics and as reliefs for leave and sickness. The health visiting staff consisting of a Superintendent Health Visitor, a Deputy Superintendent and 30 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. 105 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 1971 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 4,892 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, 603 children were selected for examination out of a total of 1,690 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 4,892 pupils inspected, 4887 were deemed to be of satisfactory general condition. This is a personal assessment by the inspecting medical officer which takes into account general body countour 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 1967, two in 1966, one in 1960 and one in 1956. 106 Defects Found at Periodic Medical Inspection During 1971, 654 (13.4 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 1967 and later 201 2 12 14 1966 685 9 43 51 1965 249 3 17 20 1964 52 2 6 7 1963 462 23 45 62 1962 141 7 11 18 1961 52 3 5 6 1960 1056 98 56 148 1959 498 52 41 81 1958 64 8 6 10 1957 50 3 5 7 1956 and earlier 1382 181 65 230 TOTALS 4892 391 312 654 107 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 61 228 Eyes: (a) Vision 391 401 (b) Squint 33 56 (c) Other 8 20 Ears: (a) Hearing 15 104 (b) Otitis Media 15 45 (c) Other 3 8 Nose and Throat 27 256 Speech 45 50 Lymphatic Glands 10 97 Heart 1 43 Lungs 15 86 Development: (a) Hernia 2 11 (b) Other 11 40 Orthopaedic: (a) Posture 16 49 (b) Feet 39 97 (c) Other 17 44 Nervous System: (a) Epilepsy 13 17 (b) Other 2 39 Psychological: (a) Development 16 210 (b) Stability 8 117 Abdomen 11 47 Other 34 73 TOTAL: 2931 793 2138 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 707. 108 Special Inspections Special inspections of pupils who are not due for periodic inspection are carried out at any age at the request of parents, teachers, family doctors or school health service staff, either at school or a school clinic. Defects noted in the 605 pupils examined at these inspections are analysed below: Defect or Disease Requiring Treatment Observation Skin 52 11 Byes: (a) Vision 15 14 (b) Squint – – (c) Other 1 – Ears: (a) Hearing 92 102 (b) Otitis Media 2 6 (c) Other 1 1 Nose and Throat 5 5 Speech 20 9 Lymphatic Glands 1 1 Heart 1 1 Lungs 2 – Development: (a) Hernia – – (b) Other 2 4 Orthopaedic: (a) Posture 2 – (b) Feet 11 3 (c) Other 5 – Nervous System: (a) Epilepsy 1 1 (b) Other 3 2 Psychological: (a) Development 11 4 (b) Stability 9 14 Abdomen 2 1 Other 21 33 TOTAL: 471 259 212 109 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 – Scabies 2 Impetigo 5 Other 5 Vision and Squint 1463 Other Eye conditions 14 Ear, Nose and Throat 119 Speech 694 Heart 11 Lungs 59 Development 5 Orthopaedic 215 Nervous Diseases 65 Abdomen 72 Other 39 TOTAL: 2768 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 Ear, Nose and Throat 119 children received operative treatment by ear, nose and throat surgeons, including 45 cases of tonsils and adenoids. 110 Speech Therapy 1971 has been an eventful year for the speech therapy service. There were further changes of staff, with one full time therapist leaving in December, another in June, and a part time therapist who had lived and worked in the borough for several years, leaving in September to move to another district. During the course of the year the establishment has been increased by one full time and one part time therapist. The part time post was to allow for five sessions a week at the Kingston Adult Training Centre, thereby making it possible for trainees leaving Dysart School to attend the Adult Training Centre to continue their treatment if necessary, and to provide speech therapy for other adults who had never had the opportunity to receive treatment in the past. The therapists in these centres are concerned with both defective articulation and with the development and use of speech and language. The speech therapy unit at Buckland Infants School was opened in April, with the admission of five children needing frequent treatment to ensure good progress and to overcome the various educational difficulties which so often accompany speech defects. There is a full time teacher, and daily speech therapy. The teacher and the therapists work in close co-operation. Before the opening of this unit an advisers panel was formed, consisting of a senior medical officer, a consultant psychiatrist, an educational psychologist, a psychiatric social worker, a head teacher, a senior administrative assistant from the Education Department, and the senior speech therapist. This panel selects the children for admission and advises wherever necessary with their treatment. The social worker holds a parents meeting once a month and also consults with and advises the staff of the unit wherever there are social or emotional problems. By December there were ten children in the class, two of whom had improved sufficiently to return to their own schools. One was subsequently found to be unsuitable. The following tables show the work undertaken by speech therapists at the various centres, with 1970 figures for comparison: 111 Centre Present Weekly Number of Sessions Initial Caseload Children Treated Remaining for Next Year 1970 1971 1970 1971 1970 1971 1970 1971 Acre Road Clinic 2 2 26 50 44 66 37 39 Adult Training Centre – 5 – – – 19 – 19 Bedelsford School Buckland Speech 8 9 24 17 26 24 17 15 Therapy Unit – 10 – 5 – 10 – 7 Dysart School 5 5 47 52 57 61 50 58 Grange Road Clinic 2 2 22 22 34 43 22 32 Hook Clinic 3 4 46 57 79 99 57 65 Roselands Clinic 6 5 74 77 127 178 77 97 St.Philip's School 10 10 47 48 74 66 48 55 Surbiton Clinic 2 2 28 37 54 56 37 37 Tolworth Clinic Worcester Park 2 2 28 28 48 41 28 32 Clinic 3 2 38 38 57 50 38 42 TOTALS: 43 58 380 431 600 713 411 498 112 Analysis of Cases Treated Children Treated Discharged Remaining at end of period 1970 1971 1970 1971 1970 1971 Stammering 46 52 15 20 31 32 Cluttering 3 4 – 1 3 3 Dyslalia 294 340 100 129 194 211 Idioglossia 2 2 – 2 2 – Anarthria/Dysarthria 13 8 6 2 7 6 Aphasia/Dy sphasia 9 7 2 – 7 7 Aphonia/Dy sphonia 2 1 2 – – 1 Amentia/Dementia 57 80 7 3 50 77 Cleft Palate 6 5 1 2 5 3 Hyperrhinophonia 7 5 3 2 4 3 Hyporhinophonia – 4 – 2 – 2 Deafness 11 8 3 4 8 4 Retarded Speech Development 145 196 46 47 99 149 Unclassified 5 1 4 1 1 – TOTALS: 600 713 189 215 411 498 113 Ophthalmic Clinics During the year 1762 children were examined at the school eye clinics; 443 were prescribed glasses, which were dispensed by National Health Service opticians. Immediately after children obtain their spectacles they are re-examined at the eye clinics. Children requiring orthoptic treatment are referred to hospital. Vision testing of all school children is carried out at the time of their routine medical examinations, and also at thirteen years of age. Audioloigy The following are details of work undertaken in schools: Children sweep tested: Primary 3114 Secondary 1415 Special 47 4576 Children who failed test: Primary 247 Secondary 78 Special 2 327 Result of Investigations by School Medical Officers: No significant hearing loss on clinical examination 49 No significant hearing loss, but child appears mentally retarded 1 Hearing loss confirmed and attributed to: (i) Catarrhal condition (with or without inflammation of ear) 33 (ii) Old otitis media 8 (iii) Injury 2 (iv) Other causes 24 (v) Undetermined causes 4 Investigations incomplete at end of year 1 Investigations not possible - left district or otherwise unavailable for examination 4 Recommendations by School Medical Officers in the first instance: (i) No action required 13 (ii) For observation only 72 (iii) Refer to audiology clinic 21 (iv) Refer to general practitioner 14 (v) Refer to ear, nose and throat consultant 8 114 There were 25 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 63. Audiology Clinic Of the 473 attendances during the year, 195 were made by 146 children under the age of five, and 278 were made by 135 children aged five and over. Details of children and attendances are as follows: AGS GROUP Totals Under 2 2-4 5-7 8-11 11 + New cases referred from all sources 38 108 72 42 20 280 Cases carried over from 1970 – – 1 – – 1 Found to have normal hearing 35 97 30 17 1 184 Deaf in one or both ears – – 1 – 4 5 Found to have remediable hearing loss 2 10 40 23 10 85 Impaired hearing requiring auditory training and/or hearing aid 1 1 2 2 1 7 Not fully assessed at end of 1970 – – 1 – – 1 Attendances 55 140 140 88 50 473 Physiothera py 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 218 Children treated 113 Attendances 2631 New cases admitted 54 Cases discharged 44 115 The 68 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, 13 of the children examined were referred for treatment and 17 others were noted for observation at a later date. Cleanline ss The work of health visitors and school nurses in connection with uncleanliness and verminous conditions in schools is summarised below: School children examined 9396 Number found infested (head lice/nits) 69 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 21 Enteric Fever – Measles 314 German Measles 66 Chicken Pox 223 Mumps 35 Jaundice 1 Dysentery – Influenza – Other 19 679 116 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 at present 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 co-operation of head teachers in making arrangements for medical officers to visit the schools is very much appreciated. Diphtheria Primary Immunisation Number who completed a primary course 53 Reinforcing Number who received reinforcing injections 1675 1728 Poliomyelitis Primary Course Number who completed a primary course 153 Reinforcing Number who received a reinforcing dose 2525 2678 Tetanus Primary Course Number who completed a primary course 698 Reinforcing Number who received a reinforcing injesction 2198 2896 Primary Courses completed from previous year 589 Measles Number who received immunisation 239 Smallpox (up to July 1971 only) Primary Vaccination Number who received primary vaccination 44 Reinforcing Number who received revaccination (Vaccination against Smallpox was discontinued as a routine procedure during July 1971, see page 42 ) 126 170 117 Rubella (German measles) Number who received immunisation Vaccination against Tuberculosis 1387 During 1971 one case of pulmonary tuberculosis in a school child was notified by the Chest physician. Epidemiological investigations were undertaken and no other cases in either members of the school staff or class contacts were elicited. Arrangements were made for tests to be repeated during 1972. 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. 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 2210 1893 145 94 1634 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. 118 Child Guidance The work of the clinic continues to progress, with increasing emphasis on treatment of the whole family, rather than the individual child. Treatment facilities remain limited in that psychotherapists are in short supply and there are neither sufficient day places for the education of disturbed children nor a residential unit for those requiring a period of skilled care away from their homes. During the past year a senior registrar in child psychiatry has been trained and the training of social work students has continued. The clinic continues to maintain close links with other agencies, e.g. the Social Services Department, speech therapists, the Education Department and the Paediatric Department of Kingston Hospital. The following table shows the work done during the year: Caseload brought forward from 1970 356 Waiting list at December 1970 20 376 160 new cases were referred during 1971 by the following: Health Visitors 5 Court 12 School Health Service 42 Private practitioners 60 Other Clinics 2 Direct non-medical 19 Education Department 12 School Psychological Service 5 Social Services Department 2 Speech Therapists 1 New cases initially seen by psychiatrist during the year 136 New caseload initial distribution: Psychiatrist 53 Psychiatric Social Worker 76 Psychologist 7 Total of caseload during the year 536 119 All cases - closures during the year: Consultation and advice only 7 Non-co- operati ve 26 Other arrangements made 9 Improved 65 Failed to attend 4 Transferred to other agencies 3 Left school 27 Moved from district 10 Lost contact 6 157 Caseload on treatment at end of year 363 On waiting list for diagnostic interview 16 120 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 1971 Recommended for placement - parent s refused Receiving home tuition On waiting list for special school Day Special Schools or Units Boarding Special Schools or Ho st els Kingston Other Other Boys Girls B G B G B G B G B G Blind — — — — 1 — — — 1 — — — Partially Sighted — — 3 2 1 — — — — — 1 — Deaf — — 3 3 1 1 — — — — — — Partially Hearing — — 6 4 1 — — — — — 4 3 Educationally Subnormal 106 91 1 2 5 2 — 1 — — 3 2 Epileptic — — 1 — — 1 — — — — — — Maladjusted 6 5 3 1 18 7 1 — 7 1 4 — Physically Handicapped 10 8 2 5 2 — — 2 1 — — Delicate 2 — — — 4 3 — — — — 1 — Speech Defect 7 2 — — — — — — — — — — TOTALS 131 106 17 14 36 16 1 1 10 2 13 5 121 Bedelsford School, Grange Road. Kingston Thanks are expressed to Miss G.H.Campbell, Headmistress, for the following report: The school caters for physically handicapped children from 2½ to 17 years and there are 68 children on roll at present, all of whom are multiple-handicapped. During the year there has been an increase in the number of spina bifida cases. This condition now represents approximately 40 per cent of the school roll. Handicaps present are as follows: 27 Spina bifida and hydrocephalus 14 Cerebral palsy 9 Muscular dystrophy 4 Cardiac conditions 3 Cerebellar ataxia 2 Hemiplegia with epilepsy 2 Hydrocephalus 1 Epileptic 6 various undiagnosed conditions 68 Of the spina bifida cases, 25 are doubly incontinent. The children are all under 11 years of age and present a growing nursing and supervision responsibility. Eight children are additionally handicapped with epilepsy. Two children are partially hearing, and 14 children are currently receiving treatment for speech defects. Pinal work on Stage 2 of the rebuilding programme was completed in the autumn and the last two classes have moved into their new accommodation. The start of the third and last stage is dependent upon the resiting of Grange Road Clinic, which at present occupies one section of the old building. This area will then be remodelled to provide new treatment rooms for physiotherapy and speech therapy, and a hydrotherapy pool. Currently, treatment is carried out in temporary accommodation comprising two small rooms and one classroom. The appointment of an additional nursery nurse has enabled the admission of five more children to the nursery group. Nursery 122 education, of importance to all children, is proving of particular value for the handicapped pre-school child. The classes in the main school have been reorganised during the year to reduce the age range in each teaching group. The aim of the school is to provide as normal a school programme as possible, bearing in mind the time that must be given to physiotherapy and other forms of remedial treatment. 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: The number of children on roll in 1971 has remained at approximately 140-142, and the number awaiting admission has been brought down to a minimum. Termly newsletters, visits from parents, and open evenings held throughout the year have all helped to maintain good contact with parents. The school also endeavours to keep in contact with all its school leavers. Through the weekly Youth Club meetings and Youth Club letters quite a large number keep in touch either by weekly, monthly termly or yearly visits. Parties are run for them twice yearly, and often they visit with wife or husband and children. The majority appear to be fully employed. Those who left the school in 1971 have all found employment. All children in the school, unless excused on medical grounds, receive swimming instruction. The swimming successes have been high, and in December 1971 the children won six bronze, six silver, and two gold A.S.A. awards. In the Kingston Schools Art Exhibition in January 1971 the school was well represented with entries of twelve paintings, some abstract panels, and thirty pieces of pottery and woodwork. In April one of the boys won the "Apples for Schools" painting competition. As well as a personal prize, he won for his whole class a trip to the orchards in Kent, with lunch provided. 123 The school continues to send a group of the best readers to the local library, and encourages them to continue this interest on leaving school. In May, for the sixth year running, a party of children and teachers went for a week's school holiday. For the second year in succesion. the school has come second in the Surrey Special School League chess match, and one boy won a medal for being runner-up champion. Ascertainment of Handicapped Pupils Children ascertained in 1971 as requiring special educational placement: Category Number Blind 1 Partially sighted nil Deaf nil Partially hearing 12 Educationally subnormal 26 Epileptic nil Maladjusted 20 Physically handicapped 1 Delicate 7 Speech defect 4 TOTAL: 71 Health Education Details of activities which took place in schools and youth centres are reported on page 20. The total number of health education sessions in schools in which the Health Department personnel have been involved shows a slight decrease on previous years (see section on Health Education, page 20.) This does not necessarily indicate less health teaching; it appears that the health education content of the schools syllabus dealt with by the teaching staff is increasing. Members of the teaching staff make enquiries concerning the availability and suitability of audio-visual materials and seek advice on specific subjects. 124 Health Department personnel are becoming more involved in team teaching than hitherto. Individual health education is carried out in schools by the school health staff on occasions such as medical examinations, dental inspections and visits to schools in an advisory capacity. Parents and children seek help in this way. School Milk and Meals Service There is close collaboration between the Environmental Health Section and the School Heals 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 1971 Returns Children in attendance 19,054 Taking milk 5,330 Percentage taking milk 27.97 Taking meals 12,614 Percentage taking meals 66.20 Cost of meal to pupil 12p Actual cost of meal 20p Percentage taking meal at: Full cost 91.4 Free 8.6 Average number of days meals were supplied in year 183 Average daily number of meals supplied 13,049 Number of meals supplied: Other establishments 11,799 2,388,018 Maintained schools 2,376,219 Deaths of School Children During the year notifications were received in respect of the deaths of five children of school age resident in the borough. The causes of death were as follows: 125 1 Cerebral haemorrhage and acute lymphocytic leukaemia 1 Cancer and Wilm's tumour 1 Multiple injuries (accident) 1 Fracture and dislocation of cervical spine (accident) 1 Cardiac arrest, cerebral circulatory insufficiency and cerebral oedema following correction of congenital hypertension Medical Examination of Adults 306 newly appointed teachers and candidates for admission to teacher training colleges were medically examined, as required by the Department of Education and Science. 301 teachers were appointed to Kingston schools after submitting medical history forms. 126 SCHOOL DENTAL SERVICE Donald M. Dodd, L.D.S. . B.D.S., Chief Dental Officer Staff The loss of two part-time dental officers during the first six months was quickly offset by the appointment of a part-time replacement, which enabled establishment levels to be brought almost to full strength again. The staffing position of dental surgery assistants remained stable throughout the year. Dental Inspections (see tables) 18,650 children were inspected either routinely at schools or at clinics and 2,679 (14 per cent) reinspected. In view of the temporary loss of dental staff at one point, these figures indicate a reasonably satisfactory coverage of the area. Dental Treatment (see tables) 7,218 (37 per cent) of children examined at their first inspection of the year required treatment and of these, 3,832 (53 per cent) were treated by the school dental service. It is encouraging to note that the emphasis of this treatment was once more directed mainly towards conservation. This is shown by the fact that 8.8 permanent teeth were filled for every one that required extraction. The orthodontic clinic continued to provide excellent facilities both for the school dental service and, in many cases, for the general dental service. No patient had to be referred to an outside consultant from this clinic during the whole year. Dental Health Education Dental health education is an important and integral part of any comprehensive dental service. In order to produce tomorrow's dentally fit generation of young adults, we must stress upon today's school children the importanoe of sound, healthy teeth. When one considers that over a million working days are lost each year through tooth troubles, 127 this point begins to assume a position of some importance. Consequently a vigorous programme of dental health education was pursued throughout the year and with the unhesitating co-operation of the Education Department, health visitors, teachers and dental staff all played invaluable roles in the process. A dental hygiene kit campaign similar to that of the previous year was carried out and involved more than two thousand infant school, nursery school and playgroup children. March was dental health month and during the four weeks all clinics exhibited displays in connection with the attainment and maintenance of healthy gums and teeth. The "Apples for Schools" scheme was expanded in an effort to reduce the amount of sweets and biscuits sold in school tuckshops. Although the expansion was slow, it has nevertheless been obvious. In the late spring one of the large toothpaste manufacturers offered to supply, free of charge, with free transport and distribution, toothpaste samples to all primary school children in the borough. The offer was taken up and as a result, eleven and a half thousand toothpaste samples were handed out. Throughout the year, health visitors have continued to give talks and demonstrations on the importance of dental health to expectant and nursing mothers and also to school children of all age groups. This continuous process of providing information, guidance and help forms one of the most valuable aspects of health education. Fluoridation Fluoridation of community water supplies remains the safest and most effective way of producing a dramatic reduction in the amount of tooth decay. This reduction can reach 50 - 60 per cent of those just starting school and beneficial effects are continued into middle age. Reduction in human discomfort and in the amount of time lost from school and work as a result of dental disease would more than justify the implementation of this process by the borough. Unfortunately the Metropolitan Water Board is not prepared to undertake fluoridation unless there is one hundred per cent agreement with all the boroughs supplied through its system. Although at the moment about three quarters of the London Boroughs are in favour of the idea, opposition from the remaining quarter is merely delaying for its children the provision of an immensely beneficial and safe public health measure. 128 General Dental Inspection and Treatment First inspections of the year: At school 16,345 18,650 At clinic 2,305 Reinspections at school and clinic 2,679 Found to require treatment from first inspections 7,218 Offered treatment from first inspections 5,738 Treated 3,832 Attendances for treatment 11,948 Sessions for inspection 158 Sessions for treatment 1,958 Sessions devoted to dental health education 96 Number of fillings in permanent teeth 5,611 Number of fillings in temporary teeth 4,728 Number of permanent teeth filled 4,681 Number of temporary teeth filled 4,230 Number of permanent teeth extracted 530 Number of temporary teeth extracted 1,255 General anaesthetics 520 Pupils X-rayed 655 Prophylaxis 1,072 Teeth otherwise conserved 735 Teeth root-filled 53 Inlays — Crowns 20 Orthodontic Cases Commenced during the year 200 Brought forward from 1970 483 Completed during year 165 Discontinued during year 35 Referred to hospital consultant — Removable appliances fitted 272 Fixed appliances fitted 218 Under treatment at end of year 483 129 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 Child Guidance South Place Surbiton Minor Ailments Speech Dental General Medical Roselands 163 Kingston Road New Maiden Minor Ailments Speech Dental General Medical Physiotherapy Mecklenberg House 50 Kingston Road New Maiden Child Guidance The Manor Drive Worcester Park Minor Ailments Speech Dental Eye General Medical Physiotherapy Audiology St.George's Hall Hamilton Avenue Tolworth Speech With the exception of Minor Ailments, attendance is by appointment. 130 INDEX Page Accidental Hypothermia 36 Accidents 88 Acknowledgments 4, 103 Adult Medical Examinations 23, 125 After Care 45-51 Air Pollution 61-63 Ambulance Service 44 Animals 71 Ante-natal Clinics 26-27 Area 9 Ascertainment of Handicapped Pupils 123 Attachment of Nurses to General Practices 35, 38, 39 Audiology 102, 113-114 Bacillus Calmette-Guerin (B.C.G.) Vaccination 47, 117 Bacteriological Examinations 67, 68, 95, 96, Bedelsford School 102, 121 Birds 63 Birth Rate 1,9 Births 9 British Red Cross Society 50 Cancer 1-2 Caravans 66 Caravan Sites and Control of Development Act 1960 66 Care Committee 49 Care of Mothers 26, 27 Care of Young Children 27, 28 Causes of Death 11-16 Central Midwives Board 34 Certificates of Vaccination 43, 44 Cervical Smears 22 Chest Clinic 40, 46 Chief Dental Officer 126-128 Chief Public Health Inspector 55-57 Child Guidance 118-119 Child Welfare 27-28 Children's Homes 29 Chimneys 62 Chiropody 3, 50-51 Cholera 44 131 Page Clean Air 61-63 Clean Air Act 61, 84 Cleanliness 115 Cleansing 59 Clinics 2, 26-28, 113, 114, 126, 129 Communicable Diseases 2 Complaints 62, 63, 64, 70, 72, 73, 74, 75, 80 Congenital Malformations 29-30, 32-33 Contagious Diseases 115 Cremations 23 Cytology 22 Deaths 9, 124-125 Dental Inspection 28-29, 126-128 Dental Service 28-29, 126-128 Dental Treatment 28-29, 126-128 Department of Education and Science 105, 125 Diphtheria 43, 44, 115 Disrepair - Certificates 91 District Nursing 35-38 Domiciliary Nursing 2, 3 Drainage 59 Drugs 70, 72, 76, 77 Dust 63 Dwellings, Separately Rated 9 Dysart School 102 Education Act 1944 104 Education (Handicapped Children) Act 1970 102 Elderly Persons 39, 50-51 Environmental Health 3, 55-98 Epileptic Children 115 Evening Nursing Service 37 Factories Act 1961 85-86 Family Planning 49 Family Planning Association 49 Feeding Stuffs 71 Fertilisers 71 Fertilisers and Feeding Stuffs Act 1926 71 132 Page Food 67-79 Food and Drugs Act 1955 72-79 Food Hygiene 70, 79 Food Hygiene (General) Regulations 1960 78 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 78 Food Premises 67-68 Fluoridation of Water 127 General Services 20-24 Geriatric Unit 40 German Measles 42, 101, 117 Greater London Council 44 Grit 63 Group Attachment 2, 34, 35, 38, 39 Handicapped Pupils 102, 120-123 Head Lice 115 Health Centres 2, 26 Health Education 3, 20-22, 123-124 Health Visiting 2, 38-41 Health Committee 5 Hearing Aids 114 Hearing Loss 114 Home Dialysis 51 Home Nursing 35-38 Hospitals 24, 36, 40 Hostel for Handicapped Ripils 120 Housing 65-66, 90-92 Housing Act 1969 90-92 Housing Acts 90, 93-94 Hypothermia 36 Ice Cream 68 Immunisation 2, 42-44, 101, 116, 117 Impetigo 109 Imported Food 69 Improvement Areas 65-66 Improvement Grants 92-94 Infant Mortality 9-10 Infectious Diseases 2, 17-19, 115 Insects 55, 63-64, 82, 89 Inspections 81-83, 85 International Certificates of Vaccination 43, 44 133 Page Kingston and District Care Committee 49 Labelling or Fooa 72-75 Laboratory Service 18 Late Night Nursing 37 Lead 68 Legal Proceedings 72, 74 Lice 115 Licensing or Nurses Agencies 23 Loan of Nursing Equipment 50 Mantoux Tests 117 Marie Curie Memorial Foundation 37 Marriages 17 Mass Miniature Radiograpny 2, 48 Maternal Deaths 1, 9 Meais 124 Measles 2, 43, 115, 116 Meat 69, 77 Medical Aid 34 Medical Examination or Adults 23, 125 Medical Inspection 105-115 Metropolitan Water Board 95, 127 Mice 80, 89 Midwifery Service 2, 34-35 Milk 67, 72, 124 Mortality Rates 9-10 Mortuary Services 23 Movable Dwellings 66 Multiple Occupation 65 National Assistance Act 1y4o 22 National Health Service Act 26 Neonatal Dea-cns 10 Night Nursing Service 37 Noise 60, 80 Notices 84 Nurseries and Child-Minders Regulations Act 1948 3 Nurses Agencies 23 Nurse Training 40, 41 Nursing Equipment 50 Nursing Homes 22 134 Page Offices, Shops and Railway Premises Act 1963 60, 87 Ophthalmic Clinics 113 Orthodontic Treatment 126 Orthoptic Treatment 113 Outwork 86 Paratyphoid Fever 17, 44 Penny Rate Product 9 Periodic Medical Inspection 105-115 Personal Health Services 26-51 Pest Control 63-64, 89 Pharmacy and Poisons Act 1933 71 Physiotherapy 114-115 Pigeons 50, 82, 89 Poisons List 71 Poliomyelitis 42-46, 116 Pollution 55, 62-63, 97-98 Population 9 Post-natal Clinics 26-27 Pre-School Children 3 Prevention of Illness 45-51 Psychiatric Care 36 Public Analyst 72 Public Cleansing 59 Public Health Laboratory 67, 68 Public Health (Prevention of Tuberculosis) Act 1936 47 Rateable Value 9 Rats 80, 89 Registrar General 1 Registration of Nursing Homes 22-23 Rent Act 1968 91 Reorganisation of National Health Service 3-4, 102 Riding Establishments Act 1970 71 Ringworm 109 Rivers 59 Rodents 63, 80, 89 Rubella 42, 101, 117 St. John Ambulance Association 50 St.Philip's School 102, 122-123 Sale of Welfare Foods 27, 28 Samples 72-75 135 Page Scabies 109 School Dental Service 126-128 School Health Service 101-129 School Meals 124 School Milk 124 School Population 104 Sewage Disposal 59 Sewerage 59 Sexually Transmitted Diseases 18, 19, 20 Shops Act 1950 60 Skin Testing 47, 117 Smallpox 42-44, 115-116 Smoke 63, 97~98 Smoke Control Areas 61-63 Smoke Control Orders 61-63 Smoking 20, 21 Sonne Dysentery 18 Special Inspection 108 Special Schools 102, 120 Speech Therapy 110-111 Squirrels 63, 80, 89 Staff 6, 104 Staff Medical Examinations 23, 125 Staff of Health Department 6 Statistics 1 Stillbirths 9 Streams 59 Sulphur Dioxide 63, 97 Sweep Testing 113 Swimming Baths 58-59 Tetanus 43,116 Trade Descriptions Act 1968 71 Treatment of Diseases and Defects 109 Tuberculin Tests 47, 117 Tuberculosis 17, 18, 45-49, 117 Typhoid Fever 18, 44 Unfit Foodstuffs 72-75, 77 Vaccination 2, 42-44, 101, 116-117 Venereal Diseases 18, 19, 20 136 Page Verminous Conditions 115 Vision Testing 113 Vital Statistics 9 Wasps 63, 89 Water Supply 58, 95-96, 127 Welfare Poods 27-28 Whooping Cough 43, 44, 116 Yellow Fever 43