KIN 46 THE HEALTH of the ROYAL BOROUGH of KINGSTON UPON THAMES 1972 Royal Borough of Kingston upon Thames ANNUAL REPORTS of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 1972 John C. Birchall, M.B., Ch.B., D.P.H. HEALTH DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: 01-399 51ll 1 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT OP THE MEDICAL OFFICER OF HEALTH for the year 1972 To the Mayor, Aldermen and Councillors Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my eighth annual report on the health of the citizens of the Borough and the health services provided. The report is divided into four sections: vital statistics and general services, personal health, environmental health and school health. I comment below on certain statistics and special items. Statistics The Registrar General's estimate of the population of the borough at mid-1972 was 139,420, giving a fall of 1,130 for the year and a flail of 7,050 since the inception of the new borough in 1965. The birth rate is the lowest ever in the new borough, but the percentage of illegitimate births rose slightly, although still well below the national percentage. The infant mortality rate is again higher than that for the previous year but also remains well below the national average. There was no maternal death in the borough reported during the year. Deaths from cancer of all types rose from 394 to 418 and those from cancer of the lung increased from 104 to 115, a rise of 10.6 per cent. Ninety-five of the lung cancer deaths were in men and represent 42 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 63. Of 4,709 persons X-rayed by the Mass Miniature Radiography Service in the borough during the year, 4 persons were found to be suffering from tuberculosis and 12 from lung cancer. 2 Cancer of the lung is largely a preventable disease, having regard to its proven association with smoking. Smoking has been called a social habit but I would regard it as antisocial in view of the pollution of indoor atmosphere and its contribution to chronic bronchitis etc. Following the 1971 census, the Registrar General has made an interesting alteration to his birth and death rate comparability factors for 1972. These factors were previously: births 1.01 and deaths 0.93, which meant that the borough was considered to contain slightly fewer persons of child-bearing age than the national average and a greater number of elderly persons. The new factors are: births 0.96 and deaths 0.91 so the Registrar General now considers that the population of the borough contains more persons of child-bearing age than the average nationally and also a much greater proportion of elderly. Communicable Diseases The numbers of infectious diseases were less than half of those for the previous year, due mainly to a reduction in notifications of measles. There was a welcome decrease in both respiratory and nonrespiratory tuberculosis, but the need for constant vigilance and preventive measures remains as necessary as heretofore. Health Centres and Clinics The conversion of Gosbury Hill Clinic into a health centre was completedin March and although there were some problems in the early days, it is now running smoothly. Building started on the Hawks Road Clinic early in 1972. This will replace Grange Road Clinic, and is expected to open in June 1973. No progress was made in the replacement of South Place Clinic. The result of the public enquiry was favourable, but the need to await the result of this enquiry has further delayed this project. A site has not yet been found for a health centre to replace Roselands Clinic in the difficult area of New Maiden. 3 Health Visiting and Domiciliary Nursing and Midwifery Services Collaboration between the local hospital nursing staff and community nursing staff has increased and it is hoped will continue to increase, especially in view of the coming reorganisation of the National Health Service in a little over one year's time. Health Education This continued along similar lines to previous years. There was considerable activity as regards dental health education. March was dental health month and there were special poster and pamphlet displays at clinics. The 'Apples for Schools' scheme continued and a special campaign involving dental hygiene kits, films and talks, was directed at five year old children. 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. The numbers of sessions, patients and attendances were all higher than the corresponding numbers for the previous year. Venereal Diseases There has been a rapid increase in the numbers of persons treated over the past five years as is shown by the following totals: 1968 107 1969 192 1970 111 1971 319 1972 382 As the figures are sent in only by those centres where Borough residents have attended for treatment, they are not 100 per cent reliable but there can be little doubt that the numbers are increasing. Doubtless the main reason is increased promiscuity, but it is hoped that greater willingness to obtain treatment and better follow up of contacts have also contributed. Such treatment is always provided in circumstances of complete confidentiality. 4 Chiropody This service continued to expand, but at a much slower rate than previously, there being an increase of only 3.7 per cent in the number of persons treated as compared with 1971. This slower rate of expansion may have been affected by the resignation of chiropodists and the consequent difficulty in covering planned sessions. Environmental Health Despite very serious staff shortages throughout the year, 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 Preparations for this reorganisation are now under way. This Borough is to be linked with Richmond upon Thames to form an area health authority and a joint liaison committee consisting of officers of the two boroughs, the hospital services and the executive council and general practitioners, has been set up to collect and collate information and be in a position to advise the shadow authority to be set up after the necessary legislation has received the Royal Assent, probably during the summer of 1973. 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 5 ROYAL BOROUGH OF KINGSTON UPON THAMES HEALTH COMMITTEE AS AT DECEMBER 1972 Mayor: Councillor Claude E. Potts Leader of the Council: Councillor C. M. Cotton, F.R.I.C.S., F.R.V.A. Leader of the Opposition: Councillor N. Howard Chairman: Alderman A. C. Healey, M.Sc., Ph.D., F.R.I.C. Vice-Chairman: Alderman R. M. Church Aldermen: J. H. Cocks, O.B.E. J. Harrison Councillors: F. C. Ailes S. W. B. Barter, M.B.E. P. H. Danbury, B.A., LL.B., Dip. Crim. D. A. Denham, B.Sc.(Lond.), Ph.D. (Cantab.) J. P. Greenwood Mrs.Y.K.A.Jones, B.A.(Hons.) A. S. MacKinlay, D.M.A. P. H. T. Magee N. J. S. McLaughlan, B.S.L. H. W. Payne, Hon.FSLAET, ARAeS. R. B. Sherar F. J. Steptoe Mrs. J. M. F. Webb 6 Co-opted Members: A. A. Hunt D. L. Roberts, M.B., Ch.B. 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 7 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., D.D.P.H.,R.C.S. P. E. Kinton, M.R.S.H.,M.A.P.H.I. Beryl G. Anscombe, M.B.,Ch.B. D.(Obst.) 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 10 PERSONAL HEALTH SERVICES 27 ENVIRONMENTAL HEALTH SERVICES 51 SCHOOL HEALTH SERVICE 99 VITAL STATISTICS AND GENERAL SERVICES 10 VITAL STATISTICS Area: 9,281 acres Population, estimate of Registrar General at mid-year 1972: 139,420 Rateable Value at 1st April 1972: £10,755,943 Produce of a Penny Rate at 1st April 1972: £104,502 Separately Rated Dwellings at 1st April 1972: 49,709 Live Births: Males Females Total Percentage Legitimate 890 843 1,733 93.3 Illegitimate 6l 63 124 6.7 951 906 1,857 100.0 Crude Birth Rate per 1,000 estimated population 13.3 Adjusted Birth Rate for purposes of comparison using the comparability factor 0.96 12.8 (England and Wales) 14.8 Still Births: (7 males and 6 females) 13.0 Rate per 1,000 live and still births 7.0 (England and Wales) 12.0 Total Births 1,870 Deaths: Total (786 males and 870 females) 1,656 Crude death rate per 1,000 population 11.9 Adjusted death rate for purposes of comparison using the comparability factor 0.91 10.8 (England and Wales) 12.1 Maternal deaths nil Maternal Mortality rate (including abortion) per 1,000 total live and still births nil (England and Wales) 0.15 Infant Mortality: Infant deaths (infants under one year) Males Females Total Legitimate 17 7 24 Illegitimate 1 2 3 18 9 27 11 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 34.5 (England and Wales) 17.0 Mortality rate of legitimate infants per 1,000 legitimate live births 13.8 Mortality rate of illegitimate infants per 1,000 illegitimate live births 24.2 Mortality rate of male infants per 1,000 male live births 18.9 Mortality rate of female infants per 1,000 female live births 9.9 Neonatal deaths (under 4 weeks of age) (12 males and 8 females) 20 Neonatal mortality rate per 1,000 live births 10.8 (England and Wales 12.0 Early neonatal deaths (under 1 week of age) (10 males and 8 females) 18 Early neonatal mortality rate per 1,000 live births 9.7 (England and Wales) 10.0 Perinatal mortality (still births plus deaths under 1 week) 31 Perinatal mortality rate per 1,000 total live and still births 16.6 (England and Wales) 22.0 12 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Asphyxia (congenital abnormality) 1 - - 1 Asphyxia - intrapartum (retroplacental haemorrhage) — 1 — 1 Brain damage (hydrocephalus and myelocele) — 1 — 1 Bronchopneumonia (prematurity; jaundice) - 1 - 1 Bronchopneumonia (pneumothorax and subarachnoid haemorrhage (together); respiratory distress syndrome; pre-term by caesarian section; diabetic mother) - 1 - 1 Cardiac respiratory failure (failure to commence breathing; diaphragmatic hernia) 1 1 Cerebral damage (intrapartum anoxia; pneumonia) - 1 - 1 Congenital heart disease - anomaly (patent ductus triouspid incompetence) - 1 - 1 Dysmaturity and pneumothorax - 1 - 1 G-astro-intestinal haemorrhage (aspiration pneumonia) — — 1 1 M ening omyelo c e1e - - 1 1 Prematurity 1 2 - 3 Respiratory distress (prematurity) 4 - - 4 Respiratory distress (postmaturity) 1 - - 1 Respiratory distress and cardiac distress (prematurity) 1 - - 1 TOTAL 8 10 2 20 13 CAUSES OF DEATH BY AGE Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year A&E IN YEARS 1- 5- 15- 25- 35- K5- 55- 65- 75 and over Cholera M - - - - - - - - - - - - F - - - - - - - — - - - - Typhoid Fever M - — - - - - - - - - - - F - - - - - - - - - - - - Baoillary Dysentery and Amoebiasis M - - - - - - - - - - - - F - - - - - - - - - - - - Enteritis and Other Diarrhoeal Diseases M — - — - - - — — — — — — F - -_ — — — — — — — — — — Tuberculosis of Respiratory System M — ~ - — — — — — — — — — F 3 - - - - - - - 1 - 1 1 Late Effects of Respiratory T.B. M - - - - - - - - - - - - F - - - - - - - - - - - - Other Tuberculosis M - - - — — — — — — - - — F — — — — — _ _ — - - mm Plague M — - - - - - - - - - - - F — -- - — _ — — — — _ — — Diphtheria M - - — — - — — — — — - — F — ~ — — _ — — — — - — — Whooping Cough M - — — — — — — — — — — — F — - - — — — — - — — — — Streptococcal Sore Throat and Scarlet Fever M - - - - - - - - - - - - Meningococcal Infection M 1 - - - - - - - - - 1 - F — ~ - — — — — — — — — - Acute Poliomyelitis M — - — — mm - — — — — - — F — — — — — - — — — — mm — Smallpox M — — - — — — — — — — — - F - - — - _ — — — - - - Measles M — - - — — — — - - — - — F — — - — — — — — - — - — (continued) 14 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks A- Weeks and under 1 Year 1- A&E IN YEARS 5- 15- 25- 35- 45- 55- 65- 75 and over Typhus and other Riokettsioses M - - - - - - - - - _ - _ F - - - - - - - - - - - - Malaria M - - - -[ - - - - - - - - F — — - - - - - - - - - - Syphilis and its Sequelae M — — - - - - - - - - - - F 1 — - - - - - - - - - 1 Other Infective and Parasitic Diseases M 2 — — — — -- — 1 - — 1 — F 3 — — — — — — — - 1 — 2 Malignant Neoplasm Buccal Cavity, etc. M 4 - - — - — - - - 1 2 1 F 2 — — — — — - - - - 1 1 Malignant Neoplasm, Oesophagus M 4 - — — — — — — 1 2 1 — F 7 - - — — — — 2 1 - 1 3 Malignant Neoplasm, Stomach M 19 - - - - - - 1 1 3 6 8 F 16 - — — — — — - 1 1 5 9 Malignant Neoplasm, Intestine M 25 - — — - — - -— 3 6 6 10 F 26 - - - — — — 1 5 8 12 Malignant Neoplasm, Larynx M 3 - - - - - - - - 2 - 1 F — — - — — — — — _ — - - Malignant Neoplasm, Lung, Bronchus M 95 _ - - - _ _ 5 33 32 25 F 20 - — — — — — — 4 7 6 3 Malignant Neoplasm, Breast M 2 - - - - - - - - 1 - 1 F 50 - - - - - - 2 9 15 13 11 Malignant Neoplasm, Uterus F 10 - - - - - 1 2 2 3 2 Malignant Neoplasm, Prostate M 14 - - - - - - - 1 1 6 6 (continued) 15 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 ^eeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Leukaemia M 7 — — - - 1 - 1 1 2 2 _ F 6 - - - - - - 1 1 1 3 Other Malignant Neoplasms M 51 — - 1 mm 1 3 1 16 17 12 F 57 - - - 1 2 - - 4 15 17 18 TOTAL all forms of Cancer 418 - - 1 1 3 1 11 35 113 127 126 Benign and Unspecified Neoplasms M 1 - _ _ - - - - 1 - _ _ F 1 - - - - - - - — 1 _ - Diabetes Mellitus M 4 - - - - - - - - - 2 2 F 13 - - - - - - - - - 4 9 Avitaminoses and other nutritional deficiencies M 1 _ - - - - - - - - 1 - F 1 - - - - - - - - - - 1 Other Endocrine, Nutritional and M 2 - - - - - - - 1 - — 1 F 3 — — — — — — — — 2 _ 1 Metabolic Diseases Anaemias M 1 - - - - - - - - 1 - - F 3 — - — - — — - _ — - 3 Other Diseases of Blood and Blood- M - - - - - - - - - - - - F - - - - - - - - - - - - forming Organs Mental Disorders M _ - - - - - - - - - - _ F 4 - - - 1 1 —- - 1 - _ 1 Meningitis M - _ - - _ - - - - - _ - F 1 - - - - - - - - - 1 - Multiple Sclerosis M - - - - - - - - - - - - F 3 - - - - - - - 2 1 - - Other Diseases of Nervous System etc. M 3 - 1 _ _ 2 F 2 -- - - - - 1 - - - 1 - 16 CAUSES OF DEATH BY AGS (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year ACE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Active Rheumatic Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Chronic Rheumatic Heart Disease M 10 - - - - - - - 2 1 3 4 F 17 - - - - - - - - 4 3 10 Hypertensive Disease M 12 - - - - - - - - 2 5 5 F 11 - - - - - - - 1 1 4 5 Ischaemic Heart Disease M 207 - - - - - - 4 20 52 64 67 F 157 - - - - - - 1 3 10 40 103 Other Forms of Heart Disease M 22 - - - - - - - - 5 2 15 F 62 - — — - - - - - 2 5 55 Cerebrovascular Disease M 64 - - - - - - - 1 8 22 33 F 120 - - - - - - 1 4 7 20 88 Other Diseases of Circulatory System M 24 - - — — - - - - 8 8 8 F 38 - - - - - - - 1 3 5 29 TOTAL Heart and Circulatory Diseases 744 - - - - - - 6 32 103 181 422 Influenza M 2 - - - - - - - - - - 2 F 1 _ _ - - _ - _ — — — 1 Pneumonia M 80 2 4 1 — — — - - 2 16 55 F 118 — — — — — — — 1 2 13 102 Bronchitis and Emphysema M 53 - 1 — _ _ _ — _ 11 14 27 F 15 - - - — - - - 2 1 5 7 Asthma M 3 - - - - - - 1 - 1 1 — F 6 - - - - - - - 1 - 2 3 Other Diseases of Respiratory System M 4 - - - - - - - - - 3 1 F 4 - - - - - - - - - - 4 Peptic Ulcer M 4 - - - - - - 1 - 1 - 2 F 8 - - - - - - - - 1 1 6 (continued) 17 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Appendicitis M 2 _ - 1 - - - - - - 1 _ F - - - - - - - - - - - - Intestinal Obstruction and Hernia M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 Cirrhosis of Liver M 1 - - - - - - - - - - 1 F 3 - - - - - - - 2 1 - - Other Diseases of Digestive System M 5 1 - - - - - - - 1 - 3 F 8 - - - - - - - - - 3 5 Nephritis and Nephrosis M 6 - - - - - - - - 2 - 4 F 3 - - - - - - - - 2 1 - Hyperplasia of Prostate M 2 - - - - - - - - - - 2 Other Diseases G-enito-Urinary System M 2 - - - - - - - - - l 1 F 8 — — — — — — — 1 - 1 6 Abortion Other Complications F - - - - - - - - - - - - of Pregnancy, Childbirth & Puerperium F - - - - - - - - - - - - Diseases of Skin, Subcutaneous Tissue M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - Diseases of Musculoskeletal System M - - - - - - - - - - - - F 5 - - - - - - - - - 4 1 Congenital Anomalies M 6 1 1 - - - - - - 2 2 - F 9 3 - 1 - - 1 - - 1 1 2 Birth Injury, Difficult Labour, etc. M 4 4 - - - - - - - - - - F 2 2 - - - - - - - - - - Other Causes of Perinatal Mortality M 4 4 - - - - - - - - - - F 3 3 - - - - - - - - - - (continued) 18 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 and over Symptoms and Illdefined Conditions M 1 - - - - - - - - - - 1 F 3 - 1 - - - - - - - - 2 Motor Vehicle Accidents M 10 - - - - 3 1 1 3 1 l - F 15 - - - 1 3 - - 4 2 1 4 All Other Accidents M 11 - - 1 l 2 2 - 1 1 2 1 F 8 - - 1 - 1 1 - 1 1 1 2 Suicide and Selfinflicted Injuries M 4 - — — — — 1 — 3 - — - F 10 - - - - - 1 1 l 3 2 2 All Other External Causes M 3 - - - l - 1 1 - - - - F 2 — — — — 1 — — — — 1 TOTAL Accidents, Suicide and Violence 63 - - 2 3 10 7 3 13 8 7 10 TOTAL ALL CAUSES M 786 12 6 4 2 6 6 14 47 166 222 301 F 870 8 1 2 3 8 4 9 48 92 174 521 19 ANALYSIS OF MARRIAGES 1972 1,249 marriages were registered in the borough during 1972. Of these, 385 were Church of England marriages and 864 took place either in other churches or in register offices. INFECTIOUS DISEASES The infectious diseases required to be notified to the Medical Officer of Health are now: Acute Encephalitis Acute Meningitis Acute Poliomyelitis Anthrax Cholera Diphtheria Dysentery (Amoebic or Bacillary) Food Poisoning (or Suspected Food Poisoning) Infective Jaundice Leprosy Leptospirosis Malaria Measles Ophthalmia Neonatorum Paratyphoid Fever Plague Relapsing Fever Scarlet Fever Smallpox Tetanus Tuberculosis Typhoid Fever Typhus Whooping Cough Yellow Fever The following table shows the numbers of cases notified during 1972 by age groups: Disease Under 5 5-14 15^+4 45-64 65 and over Total Scarlet Fever 11 8 2 — — 21 Measles 119 101 1 - - 221 Dysentery 7 10 6 - - 23 Infective Jaundice - 8 9 3 - 20 Tuberculosis, Respiratory - 3 8 9 5 25 Tuberculosis,other l - 4 1 - 6 Typhoid Fever - 1 1 - - 2 Leptospirosis - - 1 - - 1 TOTALS 138 131 32 13 5 319 20 Sonne Dysentery 23 cases occurred during the year; ten of these were of school age. Typhoid Fever 2 cases occurred during the year; one in a Tanzanian boy of 7 who had been living in the Borough since July 1971, and one in a 16 year old girl who had recently come from India. Tuberculosis There were 25 cases of respiratory tuberculosis and 6 cases of non-respiratory tuberculosis. Three deaths occurred from respiratory tuberculosis. Comparative Table of Notified Infectious Diseases 1966-1972 Disease 1966 1967 1968 1969 1970 1971 1972 Scarlet Fever 42 33 20 86 41 27 21 Measles 736 1899 293 283 458 758 221 Whooping Cough 16 34 20 10 25 17 - Acute Infective Encephalitis: Post Infective - 1 - - - — — Infective - - - - - - - Typhoid and Paratyphoid Fevers 1 1 - 2 - 1 2 Food Poisoning - 4 - 8 4 - Infective Jaundice - - 5 14 37 16 20 Dysentery 146 72 27 104 15 4 23 Tuberculosis, Re spiratory 27 46 35 31 29 33 25 Tuberculosis, Other 6 1 4 7 4 13 6 Leptospirosis - - - 1 - - 1 Acute Meningitis - - - 2 - 1 - Malaria - - - - - 1 - 21 Laboratory Servioe Bacteriological and viral speoimens 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; Treatment Centre Totals all conditions Syphilis Gonorrhoea Other Conditions Primary and Secondary Other St. Thomas's Hospital S.E.l. 88 2 _ 12 74 St. Bartholomew's Hospital E.C.I. 14 - - 1 13 Westminster Hospital S.W.I. 42 - - 8 34 St. Helier Hospital Carshalton 221 - - 18 203 Central Middlesex Hospital, Park Royal N.W.10. 2 - - 1 1 Dreadnought Seamen's Hospital, Greenwich 4 1 - 1 2 Whitechapel Clinic, London Hospital, E.1 11 - - - 11 TOTALS 382 3 - 41 338 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. 22 Control of these diseases is attempted by trying to ensure that not only the infected persons receive treatment, but that their contacts, i.e. the sources of their infection, are also traced and persuaded to undergo treatment. A senior medical officer is responsible for tracing male contacts and the health visitors for tracing female contacts. Health education activities concerning venereal diseases are reported on page 23. 23 GENERAL SERVICES HEALTH EDUCATION There was no great change in the range of activities in the Health Education Section during 1972. Planned group activities were increased but there was a drop in the numbers attending. Recorded Sessions 1971 1972 Schools 198 200 Clinics 502 503 Clubs 109 121 Other Groups 111 107 Total number in audiences during 1972 - 17,966 There is no record kept of the numerous one-to-one discussions which take place in clinic, school, club or home, nor of the small adhoc group discussions held in clinic, school and club. All aspects of health, environmental and physical, are covered in the programmes arranged throughout the year. The monthly health theme varies from year to year depending on presenting needs. In 1972 the topics were: January Smoking and Influenza February Venereal Diseases: Cervical Cytology March Oral Hygiene April Housing Improvement May Safety in Retirement June "Happy Families" - Mental Health Campaign July "Learn to Swim" August Family Planning September Immunisation October "Mind" Campaign November Fireworks: Winter Safety December Nutrition 24 Ten small exhibits on the relative theme were shown each month in establishments throughout the borough. Audio-visual aids used totalled 1,075. These included films, slides, posters, pamphlets, flannelgraphs and other pieces of demonstration material. Health education was carried out by all members of the community health team, i.e. medical officers, health visitors, home nurses and midwives, public health inspectors and others engaged in public health work. Much of the work carried out in schools was planned with the assistance of the school teachers. Smoking Advisory Courses Two smoking advisory courses were held during the year: the first in March - April and the second in November - December. Twenty-seven registered for the first course and eighteen for the second. The attendances dwindled to eight and five respectively for the last sessions. The success rate was just over 50 per cent on both courses. Some of those who discontinued attending before the end of the course had been able to give up smoking quite quickly but a very small minority on each count found it impossible to discontinue smoking or to reduce consumption. Several heavy smokers who could not give it up altogether reduced to five per day and have been able to keep to that number. Others switched to pipe smoking. NATIONAL ASSISTANCE ACT 1948. SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT 1951 Action can be taken under these Acts for compulsory removal of persons to suitable premises in circumstances where they are: (a) suffering from grave chronic disease, or being aged, infirm or physically incapacitated, are living in insanitary conditions. (b) unable to look after themselves and are not receiving proper oare and attention from other persons. It is emphasised that removal of a person to an institution for the reasons stated above is only undertaken with great reluctance. No one was removed under this Section during 1972. 25 REGISTRATION OP NURSING- HOMES The Borough Council is the registration authority for nursing homes under Part VI of the Public Health Act 1936. No homes were registered during 1972. 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 the licensing of nurses agencies under the Nurses Agencies Act 1957. These licences are renewed on 1 January each year. One 3uch agency was granted a licence to continue for a further year and two new agencies were granted licences during the 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 1,433 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 431 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 352 were 26 accepted on completion of a medical history form, without actual examination. 257 newly appointed teachers and candidates for admission to teacher training colleges were medically examined as required by the Department of Education and Science. 268 teachers were considered fit upon completion of a medical history form. HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital Royal Eye Hospital Upper Brighton Road Surbiton Kingston Hospital Wolverton Avenue Kingston upon Thames Tolworth Hospital Red Lion Road Tolworth Surbiton General Hospital Ewe11 Road Surbiton Services Available Ophthalmic, Refraction sessions Medical, Surgical, Fracture, Paediatric, Gynaecology, Ear, Nose and Throat, Maternity, Orthopaedic, Psychiatric, Adolescent, Orthodontic, Rheumatology, Diabetic, Dermatology, Ophthalmology, Pathology, Chest Diseases, Oral Surgery, Plastic Surgery Geriatric Rehabilitation and Day Hospital, Chest Diseases, Paediatrics Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Gynaecology, Pathology, Psychiatric PERSONAL HEALTH SERVICES 29 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 Gosbury Hill, Hook, Chessington opened on 1 March 1972, the old clinic premises having been extended by the addition of accommodation for four family doctors. Due to the extension of Bedelsford School, it is necessary to replace Grange Road Clinic,Kingston, which is in the same grounds, and a new clinic is being built at Hawks Road, Kingston. This is expected to 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. Although the result of a public enquiry has been favourable the need for this and to await the result has meant further delay to this project. CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and Post-natal Clinics There are six Council owned clinics at which ante and post-natal sessions are held. These are attended by medical officers and health visitors, and most of them by midwives. The following table gives the details, but in addition, midwives held 129 sessions at these clinics and at the Surbiton and Maiden District Nurses Homes, at whioh 78 women made 205 attendances. 4,663 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed. There were, in addition, 301 sessions held by general practitioners to whose practices borough midwives are attached. 225 mothers made 2,849 attendances at these sessions. 30 Address of Clinic Number of sessions held during the year Number of women who att ended Total attendances Ante-natal Post-natal Grange Road, Kingston 51 20 13 167 Acre Road, Kingston 47 24 23 236 Roselands, New Maiden 52 31 18 245 Manor Drive, Worcester Park 21 3 2 8 South Place, Surbiton 48 43 40 465 Gosbury Hill, Hook 42 18 7 100 TOTALS 261 139 103 1221 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. They are sold at the Women's Royal Voluntary Service Centres at Maiden and Surbiton, as follows: 31 Surbiton, W.R.V.S. 154 Ewell Road Mon. Tues. Thurs. Fri. 10.0 - 12 noon 2.0 - 4 p.m. New Maiden W.R.V.S. Blagdon Road Mon. Tues. Thurs. Fri. 10.0 - 12.30 p.m. 2.0 - 4.30 p.m. The following table shows the sessions held and attendances each of the various child welfare clinics: at Address of Clinic Number of sessions during year Number of children who attended Total attendances G-range Road, Kingston 125 655 4004 Acre Road, Kingston 120 605 3354 Kingston Vale 11 41 156 Roselands, New Maiden 150 685 3150 Manor Drive, Worcester Park 127 942 3920 South Place, Surbiton 151 593 4545 Hamilton Avenue, Tolworth 99 566 3104 Gosbury Hill, Hook 146 524 3843 St. Mary's Church Hall, Chessington 52 253 1468 TOTALS 931 4864 27,544 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: 32 Children Aged 0-4 inclusive Expectant and Nursing Mothers Inspected 387 54 Requiring Treatment 225 37 Offered Treatment 211 34 Treated 220 37 Visits for Treatment 610 98 Fillings 465 71 Teeth Filled 426 60 Teeth Extracted 78 9 General Anaesthetics 42 4 Patients X-rayed 4 12 Scalings and Gum Treatment 102 31 Teeth Otherwise Conserved 81 - Completed Course of Treatment 303 35 Dentures Provided: Full 1 - Partial - - Treatment Sessions 134 Combined CHILDREN'S HOMES The Social Services Committee has six homes in the borough. The premises are inspected periodically 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 every baby and to record any congenital abnormality which it is possible to detect. 33 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. Eighty-three babies were notified at birth as congenitally malformed. Of these, five were stillborn and eight subsequently died, six deaths being the direct result of the abnormalities notified. The remaining two babies died from other causes. 34 CONGENITAL MALFORMATIONS - 1972 Malformations Reported Central Nervous System Eye and Ear Alimentary System Heart and Circulatory System 117 14 8 11 11 (83 children) . (8 children) (6 children) (7 children) (11 children) 2 Anencephalus 1 Abnormally shaped and placed ears 1 Absent anus 1 Congenital heart disease 1 Arnold Chiari Syndrome 1 Colon block 1 Encephalocele 2 Accessory auricle 1 Diaphragmatic hernia 1 Heart lesion 5 Hydrocephalus 1 Bilateral squint 1 Duodenal atresia 8 Systolic murmur 3 Meningocele 2 Spina bifida 1 Corneal opacity 1 Imperforate anus 1 Ventricular septal defect 1 Dermolipoma 2 Oesophageal atresia 1 Ear tag 2 Tongue tie 1 Microphthalmus 2 Tracheooe sophageal fistula 35 ratory System Urinogenital System Limbs Other Parts of Musculoskeletal System Other Systems Other Malformations 2 25 20 7 14 5 (2 ohildren' (20 children) (19 children) (6 children) (13 children) (5 children) 1 Unexpended lungs 2 Absent kidney 1 Absent hand 1 Bony fragments near spine 1 Dermoid cyst 1 Anomaly adrenal and thymus glands 3 Congenital dislocation of hip 1 Ichthyosis 1 Lungs poorly insulated 1 Bicornate uterus 1 Extra fontanelle 8 Pigmented naevus 1 Hemi-vertebrae 1 Cystic hygroma 1 Cysts of ovary 1 Hip click 1 Osteogenesis imperfecta 1 Scar on lip and nose 1 Partially dislocated hip 2 Dimple sacral area 8 Hydrocele 1 Scoliosis 2 Sebaceous cyst 1 Hydronephrosis 2 Polydactyly 1 Umbilical Hernia 1 Thyroglossal sinus 1 Simian creases 6 Hypospadias 1 Short lower limbs 1 Wide head sutures 1 Polycystic kidney 1 Syndactyly 1 Renal agenesis 9 Talipes 2 Undescended testicle 1 Pour toes only left foot 2 Vaginal skin tag 36 MIDWIFERY SERVICE The national policy towards a 100 per cent hospital confinement rate is rapidly being accomplished in Kingston. There were only 48 domiciliary confinements. 543 patients were discharged home early after hospital delivery, including 40 patients who were admitted to the Domino Unit at Kingston Hospital where deliveries are undertaken by the patients general practitioners and domiciliary midwives. It has been disappointing that this unit has not been fully used but many patients were considered obstetrically unsuitable for this scheme. The co-operation of the general practitioners is necessary to make this scheme fully operational. District midwives attended 301 ante-natal clinic sessions in doctors' surgeries, including the health centre at Gosbury Hill. 245 mothers made 2,849 attendances at sessions. 129 sessions were held by the midwives, in nurses homes, including booking sessions. 146 sessions were attended at Kingston Hospital to see patients being discharged early. Epidural anaesthesia is now recognised as normal midwifery practice,and mothers in labour are given every facility to assist in a painless labour. The domiciliary midwives are being instructed by the staff at Kingston Hospital so they can become competent in this procedure and also in an effort to reduce the incidence of stillbirth and neonatal death. The domiciliary midwives have accepted their changed role and have also recognised the importance of new practices and improved ante-natal care and the contribution they can make in caring for the early discharge patients who often require considerable reassurance and support when they are discharged home from hospital shortly after delivery. The Council's midwives summoned medical aid in 76 cases, of which 9 were domiciliary and 67 early discharges from hospital. Total Visits by Midwives Post-natal 7,331 Home Assessments for early discharge 513 Ante-natal visits 652 Ante-natal visits in labour 178 37 HOME NURSING SERVICE During the year the number of visits has increased, due to greater participation in surgery sessions both at the general practitioners' surgeries, and in the health centres. 4,859 patients were treated; this includes surgical dressings, ear syringes, administration of injections, venepuncture and certain diagnostic tests within the nurses' ability. The staff are finding this work interesting and rewarding, but they are still aware that the care of the patient in the home is of primary importance. Visiting in Residential Homes Certain sick residents in the Council's residential homes are visited regularly by the District Nurses. This is a service given when specialised nursing procedures are ordered by the general practitioner, and the staff of the home require support and advice from skilled nursing staff. Rehabilitation of the Elderly and Handicapped It is the objective of the community nurse to work closely with the occupational therapy staff of the Social Services Department. Throughout the year Miss Bennett, the organiser of Westbury Road Occupational Therapy Centre, has arranged a programme whereby nursing staff visited the Centre to meet the staff engaged in this sphere of domiciliary care. All facilities available were seen, and discussions on referrals were encouraged. This has resulted in very good working relationships and the patients have benefitted, particularly the severely handicapped who require a considerable variety of aids to make their lives tolerable, and ease the strain on their relatives. Joint consultations with the occupational therapy staff, and the nurses are often held at the patient's home so that all aspects of care can be explored, and the maximum help given. Several patients were referred for Attendance Allowances during the year. Late Night Visiting and Night Nursing Service The late night nursing service operating from 7.30 p.m. 11.30 p.m. continues. Part-time trained nurses are employed in this service which enables the patient to have nursing care in addition to the service provided by the day nurses. The nurses engaged on late night visiting paid 1119 visits to 115 patients during the year. This 38 is a service which has been greatly appreciated by both patients and their relatives. An increasing number of terminally ill patients are being nursed in the familiar surroundings of their own homes. Their families continue to be supported by the district nurses. The Health department acts as an agent for the Marie Curie Foundation which, in the case of patients suffering from cancerous diseases, pays for a night nursing service to help relieve stress suffered by relatives. Each patient is visited by a nursing officer and the needs assessed. The borough employs two trained night nurses. Geriatric At Risk Register The care of elderly patients is still one of the main priorities for the community nursing services. An 'At Risk' register is kept of those who live alone, who are deteriorating either physically or mentally, and are without regular support. Meetings are held for staff of the Health and Social Services departments, when each elderly person is assessed, and surveillance is continued throughout the year by field staff. These elderly residents are particularly vulnerable when gas or electricity strikes are threatened. Hypothermia kits have continued to be maintained in readiness for such emergencies. Psychiatric Care of the Patient in the Home Two district nurses, who are psychiatrically trained, have continued to visit selected patients. They are able to give supportive help, and also administer the drug maintenance (modicate) for certain patients having long-term treatment for schizophrenia. Several psychogeriatric patients are able to stay in their own homes instead of having to be admitted into institutional care. These nurses have also attended case studies in Kenley Ward, Kingston Hospital. Marie Curie Memorial Foundation - Pilot Educational Project This project was held at the Nurses' Home from April - June, 1972, in eight 2-hourly afternoon sessions. The cost of hospitality was met by the Surbiton District Nursing Association. 39 National interest has been shown in this educational project and enquiries for more information have been received from the following Authorities: Nottingham, Doncaster, Southeni, and from Newfoundland, Canada. Nursing Aids and Medical Equipment The borough provides certain equipment and aids for long term loan to patients. This equipment includes special beds and mattresses, Easi Nurse special beds, hydraulic hoists, ripple beds and cushions, medical sheepskins and slings, and portable pulleys and suckers. Disposable aids for incontinent patients are also issued free. HEALTH VISITING The health visiting establishment has remained at 30 during 1972. This has proved to be inadequate because of the change in the pattern of the work. The health visitors are all now responsible for visiting families on the lists of general practitioners within the local authority boundary. This has involved greater travelling as well as a ohange in the pattern of visiting. In previous years, the health visitor's main role was in the care of young children and the elderly, but during 1972 at the request of the general practitioners, they have visited and advised families in the following categories as well as coping with normal case loads: Visits 1 Elderly persons 920 2 Patients put on waiting list for hospital admission 68 3 Patients discharged from hospital 148 4 Ante-natal patients 1,145 (388 referred by G.P) 5 Families in which there was a recent bereavement 195 6 Families in which the breadwinner was unemployed 119 7 Households where home accidents necessitating medical care had occurred 85 8 Marital problems 178 9 Mental illness and depression 154 40 Visits 10 Menopausal adjustments 24 11 Drug problems 17 12 Alcohol 4 13 Dieting 6 14 Homelessness 14 15 Housing queries 83 16 Medical problems affecting schoolchildren 75 17 Termination of pregnancy 5 18 Occupational problems 3 19 Home dialysis 1 20 Supporting families when a member is in prison 6 21 Adoption 6 22 Families nursing terminal illness 9 23 Unmarried mothers with problems 25 24 Problems with A.I.D. 1 25 Immigrant family 1 26 V.D. 1 In-Service Training During the year an in-service course was organised for all the health visitors,on Developmental Paediatrics. This included lectures on: (a) Chromosome abnormalities (b) Screening procedures, including vision and hearing as well as speech development, and other developmental tests. (c) Metabolic disorders and factors affecting development. (d) Several films were shown on medical procedures for testing at different stages of development. Screening procedures are normally performed by the medical officer at clinic sessions. There was some concern that defects could be missed in the non-clinic attenders and this course enabled the health visitor to carry out certain screening procedures in the patients homes. Seminar Sessions at Child Guidance Clinic Dr.Anscombe, consultant psychiatrist, agreed to see a representative group of health visitors for "teach-ins" fortnightly 41 throughout the year. This enabled the health visitors to discuss certain aspects of their relationships with families which they had found difficult. It deepended their insight into various facets of their work. As these sessions were so successful, they are being repeated to a different group of health visitors in 1973. The health visitors were fortunate again this year to have been allowed to attend various courses and day seminars. The seminars were in relation to the health visitors' role, with the following groups: Schools Health Education in schools G-roup discussion methods for health visitors. Social Problems Drug Abuse and Alcohol Venereal Diseases Working with Families of Battered Babies Elderly The Ageing Process Psycho-geriatric Care Conference Family Welfare The Continuing Care of the Diabetic Children's Feet The Ageing Process Other seminars were related to the: Changing Role of the Health Visitor Working with the &.P.'s Preparation for the Integration of Nursing Services Health Education Health visitors have again increased their health education sessions. Mothercraft and psychoprophylaxis is now available at all the clinics. As well as an evening session for expectant parents, discussions on family planning have been included at these classes, and the health visitors were also requested to include advice on family planning when visiting the home. To assist them in this area of their work, a special course has been organised with the Family Planning Association in February 1973. During the year two of the health visitors commenced health advisory sessions in two of the senior schools. These have been very popular and advice has been given on a variety of personal and health problems. There are seven health visitors who give regular health education talks in schools, as well as several others who do so at the request of the school, or during various health campaigns. 42 Training The two health visitor students who were sponsored by the borough for training were successful in their final examinations and are now working full-time in the borough. Three more health visitor students were sponsored and commenced training in September, 1972. There are five field work instructors, and each is responsible for training two health visitor students. These students were from Surrey University, Chiswick Polytechnic and Ewell Technical College. All the students were successful in their final examinations. The staff of the Health Department have continued to assist with community training for the Kingston Hospital student nurses. Lectures are given at the hospital, and opportunities given to the nurses to observe the work of the health visitors and district nurses. Many students are from other fields such as midwifery, obstetric nurses, health visitors from other parts of the country, social workers, child care, tutors and students from Kingston Polytechnic. Liaison Regular meetings are now held throughout the borough between statutory and voluntary visitors to the elderly. These are organised in clinic premises and chaired by the Principal Nursing Officer. The purpose of the meetings is to enable workers in the field to share information, improve communications, and to detect the needs in the locality, thus helping each individually, and all collectively, to give a better service to the elderly. 43 VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation in the borough was above the national average for protection against diphtheria and poliomyelitis, but below that average for whooping cough. 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. 978 received the injection during the year. 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 50 668 Combined Diphtheria and Whooping Cough - - Combined Diphtheria and Tetanus 140 1,353 Combined Diphtheria, Whooping Cough and Tetanus 1,462 391 Poliomyelitis only 1,633 2,627 Quadruple - - Measles 1,070 - Rubella 978 - Total children receiving immunisation against the five illnesses whether given separately or combined: Primary Course Booster Diphtheria 1,603 1,752 Whooping Cough 1,462 391 Tetanus 1,652 2,412 Poliomyelitis 1,633 2,627 Measles 1,070 - 44 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 1972, 1,416 persons were vaccinated against yellow fever. Smallpox vaccination of adults and injections for typhoid, paratyphoid and cholera are normally given by the family doctor when requested for travel abroad. The following table show the percentage of children vaccinated and immunised in Kingston upon Thames, compared with the national average: Percentage of Children Born in 1970 Vaccinated by 31.12.72 Whooping Cough Diphtheria Poliomyelitis (1) (2) (3) England and Wales 79 81 80 Kingston upon Thames 76 82 81 The figures in columns (l) to (3) are calculated to show the percentage of children born in 1970 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 ILLN5SS. 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 1972, 31 cases were notified in the borough and of these, 25 were pulmonary and 6 non-pulmonary, compared with the previous year's figures of 33 and 13 respectively. The 25 pulmonary cases were in the undermentioned stages of the disease: A or Tuberculosis - (sputum negative) 5 B.1 or Tuberculosis + (early cases, sputum positive) 10 B.2 or Tuberculosis + (intermediate cases, sputum positive) 5 B.3 or Tuberculosis + (advanced cases, sputum positive) 5 The non-pulmonary cases were: Right hip 1 Left ankle 1 Fallopian tube 1 Kidney 2 Urogenital 1 On 1st January, 1972, there were 350 cases on the register and at the end of the year 331. Pulmonary Non-Pulmonary Total Males 159 19 178 Females 127 26 153 TOTALS 286 45 331 46 The following tables show the work undertaken by the Chest Clinic at Kingston Hospital during 1972, insofar as it affects patients resident in the borough: Number of chest clinic sessions held 407 Number of attendances: New Patients 898 Old Patients 3542 4,440 Average attendances per session 10 Tuberculin Tests and BCG Vaccinations Contacts School Children and Students Others Skin tested 136 41 61 Found positive 24 20 28 Found negative 92 18 18 Vaccinated 58 6 7 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 - 1972 inclusive: Year Cases Notified Deaths Respiratory Non-respiratory Total Respiratory Non-respiratory. Total 1961 59 8 67 10 1 11 1962 62 2 64 6 – 6 1963 54 8 62 13 1 14 1964 44 8 52 8 2 10 1965 32 2 34 2 1 3 1966 27 6 33 8 – 8 1967 46 1 47 2 1 3 1968 35 4 39 2 1 3 1969 31 7 38 6 4 10 1970 29 4 31 2 1 3 1971 33 13 46 3 – 3 1972 25 6 31 3 – 3 47 No action was necessary during the year under the Public Health (Prevention of Tuberculosis) Regulations 1925, or Section 172 of the Public Health Act 1936. These regulations respectively relate to the restriction of tuberculosis sufferers from employment in the handling of milk and the compulsory removal to hospital in certain circumstances of persons suffering from tuberculosis. The following table gives an analysis by age groups of the new cases and deaths from tuberculosis during the year. Category New Cases Deaths Male - Female Under 1 year 1-4 years 5 - 14 years 15-24 years 25 - 34 years 35 - 44 years 45-54 years 55-64 years 65 and over TOTAL Under 1 year 1-4 years 5-14 years 15-24 years 25 - 34 years 35 - 44 years 45 - 54 years 55-64 years 65 and over TOTAL Respiratory M – – 2 3 – 3 3 3 3 17 – – – – – – – – – – Tuberculosis F – – 1 1 1 – 1 2 2 8 – – – – – – 1 – 2 3 T – – 3 4 1 3 4 5 5 25 – – – – – – 1 – 2 3 NonRespira tory M 1 – – 1 1 l – – – 4 – – – – – – – – – – Tuberculosis F – – – – 1 – 1 – – 2 – – – – – – – – – – T 1 – – 1 2 1 1 – – 6 – – – – – – – – – – Mass Radiography The following is a summary of the work of the Mass Radiography Units in the borough: Total persons X-rayed 4,709 Cases found to be suffering from tuberculosis 4 (all males) Cases found to be suffering from lung cancer 12 (9 males and 3 females) 48 Kingston and District Care Committee Considerable help is given to tuberculosis and other chest disease patients and their dependants by the Kingston and District Care Committee. During 1972, 75 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. In addition, 16 patients were referred to Rotary Clubs for Christmas gifts. Two-thirds of the cases helped suffered from bronchitis and other chest complaints, and only onethird were tuberculosis patients. 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 807 doctor sessions were held which were attended by 1,592 new patients. Altogether there was a total of 12,912 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 8.30 p.m. Appointments: Phone 942 0734 South Place, Surbiton Mondays, Wednesdays and Thursdays 6.30 to 8.00 p.m. Fridays 9.30 to 10.30 a.m. Appointments: Phone 399 8898 204 Acre Road, Kingston Wednesdays and 1st and 3rd Thursdays 7 to 8.30 p.m. Appointments: Phone 546 5812 1 Gosbury Hill, Hook, Chessington Tuesdays and 2nd and 4th Thursdays 7 to 8.30 p.m. Appointments: Phone 397 5737 The Manor Drive, Worcester Park Wednesdays 10 a.m. to 11.30 a.m. 7 to 8.30 p.m. Fridays Appointments: Phone 337 0246 10 a.m. to 11.30 a.m. 49 CERVICAL CYTOLOGY 5,482 cervical cytology reports were received in respect of Kingston residents during 1972. In January of that year a five year recall system was instituted and recall letters were sent to 321 borough residents, with the following results: 92 appointments were made 118 recall letters remained unanswered 94 had had cytology tests during the past five years 11 did not require appointments because they had had hysterectomies 6 letters were returned, marked "address not known" 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 tern nursing care in the patients' homes, and under the arrangement deposits are collected from patients by the British Bed Cross Society and refunded to them when the equipment is returned. Altogether, 629 loans of nursing equipment were made during the year. The borough oouncil 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 1972, 25 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: 50 A. Persons treated during the year Persons of pensionable age and over Local Authority Voluntary Organisations Total 3,450 686 4,136 Expectant mothers 3 – 3 Physically handicapped, under 65 58 – 58 Blind, under 65 3 – 3 TOTALS 3,514 686 4,200 B. Treatments given during the year In clinics Local Authority Voluntary Organisations Total – 3,195 3,195 In patients' homes 5,588 47 5,635 In old people's homes 905 – 905 In chiropodists' surgeries 10,733 – 10,733 TOTALS 17,226 3,242 20,468 These figures show a slight increase (191) in the number of treatments given over 1971. During the year four chiropodists in private practice who were on the "approved" list retired and two employed sessionally by voluntary organisations resigned. HOME DIALYSIS Three applications were received for homes to be adapted for home dialysis during 1972 and information was received that a fourth patient was making private arrangements for the necessary adaptation of her home. One person whose application had been received during November 1971 had her council home adapted at council expense and a mobile unit was provided for one of the three 1972 applicants. The privately arranged adaptation was also completed during 1972 and the two remaining patients began using their home dialysis units during January 1973, one having been provided with a mobile unit and the other having had his council house adapted. This made a total of 6 patients on home dialysis at the end of 1972 and 8 by the end of January 1973. ENVIRONMENTAL HEALTH SERVICES 53 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR P.E. KINTON. M.A.P.H.I.. M.R.S.H. The year under review has proved to be the most depressing since the formation of the authority as staff have been attracted away by higher salaries offered by other authorities and it has not been possible to recruit replacements due to the high cost of housing. As a consequence a very heavy burden has been thrust upon the remainder of the staff and it would be idle to pretend that the department had maintained the standard it attained in previous years. In spite of this the department has achieved a great deal. The smoke control programme has been pursued and work is now progressing in the Surbiton area, the department fully co-operated in the massive London House Improvement campaign and has dealt with the enormous number of enquiries which ensued and processed many more improvement grant applications than previously. In food hygiene the number of inspections carried out was 2337 compared with 2567 in the previous year. All this has been achieved by hard work, often long after normal office hours by the Public Health Inspectors and Technical Assistants. Much which ought to be done has been delayed but it is most encouraging to report that the staffing position has greatly improved since the establishment was altered,, During the latter part of the year Mr. G.C. Smith, Deputy Chief Public Health Inspector, was taken ill and by the time this report is published he will have retired prematurely. It is fitting to pay tribute to his work not only for this authority but with the former Royal Borough of Kingston upon Thames when he was Chief Public Health Inspector and to express the hope that he will recover and enjoy his retirement. As in the past years, concern for the environment has become even more popular with the general public and a study of the statistics will reveal the department's contribution to securing and maintaining safe and healthy conditions. Attention is drawn to the house condition survey and the mouse survey which were carried out during the year. Although such exercises are time consuming they do add to our knowledge and enable the work of the department to be measured. Objectives for the future. Continued progress with the smoke control programme. The introduction of grants to protect those members of the public who become affected by traffic noise and increased liaison with the Borough Planning Officer to prevent noise nuisance at the planning stage of noise producing industrial and commerical development and the possible formation of noise control areas. 54 The completion of the programme for the clearance of unfit houses, the elimination of those aspects of multiple occupation which make this form of housing substandard, the introduction of more general improvement areas and progress with those now being developed and action to secure the improvement and repair of the houses in the Borough. The raising of the standards of hygienic food handling in manufacturing, wholesale and retail establishments including date stamping of perishable foods and clear labelling of products. The maintenance and improvement of the service to the public in dealing with pest control and problems of an urgent public health nature by an extension of the radio control service and the introduction of work study techniques. The introduction of a liaison with the National Health Service after the 1st April, 1974 which will ensure satisfactory protection for the public in such matters as the investigation and control of infectious diseases. Investigate in the Borough the pollutants in the atmosphere from vehicles, aircraft and combustion processes in addition to the monitoring of dirt and sulphur dioxide. Pursue vigorously the policy of securing pollution free rivers and streams. In concluding this introduction of the report on the Environmental Health Section I record my appreciation to the conscientious staff and thank them for their loyalty at a time of stress, thank the Chief Officers and colleagues in other departments, especially those who co-operate so well in the group consisting of an accountant, architect, clerk, engineer, planner, education and housing officers who work with the department in establishing General Improvement Areas. The support of the Chairman, Vice-Chairman and Members of the Health Committee and Members of the Council is greatly appreciated. By the time the next Annual Report is published the Medical Officer of Health and the doctors, dentists, health visitors, nurses and many of the personal health service staff will have been absorbed into the National Health Service. On behalf of the Environmental Health Section, I thank them for their co-operation and hope that this can continue in the new arrangements after the 1st April, 1974. P.E. KINTON. Chief Public Health Inspector. 55 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 stand-pipes, 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 ten occasions samples were taken from private houses and shops and all were satisfactory. 2. SWIMMING BATHS (a) Public. The Corporation's indoor swimming baths are situated in Denmark Road, Kingston upon Thames, and comprise two pools, one of which is in use throughout the year, whilst the other is used for swimming during the summer months, and in the winter season is converted for use as a hall for concerts, dancing and other purposes. In addition there is an instructional pool. The baths are equipped with pressure filters and sterilisation is effected by breakpoint chlorination. Apart from regular poolside tests of the chemical condition of the water, 130 samples were taken during the year for bacteriological examination of which 122 were reported satisfactory. The Surbiton Lagoon, situated in Raeburn Avenue, Surbiton, is an open air pool 165 feet long, the water being treated by continuous pressure sand filtration and breakpoint chlorination. Apart from chemical tests 16 samples were taken for bacteriological examination, all 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. Eight primary schools have swimming pools with treatment plants. In addition to numerous poolside tests, 70 samples of water were taken for bacteriological examination, of which eight were reported as having a count higher than desirable due to inadequate chlorination. 56 3. RIVERS AND STREAMS The River Thames forms the western boundary of the borough 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 borough. In dry weather a considerable portion of the flow of this river comprises the effluent from the Hogsmill Valley Sewage Treatment Works. The Beverley Brook, another tributary of the Thames, forms part of the eastern boundary and receives the effluent of the Worcester Park Sewage Disposal Works. The pollution of the rivers 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 AMD SEWERAGE A small quantity of the sewage 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. The department is responsible for what can be termed the private sector of drainage and over 1,200 complaints were received. Many of these related to blocked drains and the department operates a service for which, in the case of private single drains, a charge is made. In many instances such complaints may necessitate lengthy investigations, particularly in those parts of the borough which were built over at the beginning of the century and where buchan traps are often found to exist. Where appropriates, notices are served to remedy defects, and at times legal difficulties arise particularly in the case of combined drainage systems which were constructed prior to 1936. 57 5. PUBLIC CLEANSING The Borough Engineer and Surveyor is responsible for the collection and delivery of refuse to a central loading point whence fit 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 1972 was 46,725 tons. 6. SHOPS ACT. 1950 The provisions relating to closing hours, half-holidays, hours of employment of young persons and Sunday trading are administered by the department. 7. OFFICES. SHOPS AND RAILWAY PREMISES ACT. 1963 During the year 442 registered premises received one or more general inspections including inspection of all the 118 newly registered premises., The total number of registered premises at the end of the year was 1778. All premises known to the department have received a thorough general inspection. The total number of inspections carried out during the year was 1711. 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. Generally speaking, occupiers of premises to which the Act applies are aware of their responsibilities under this legislation and where contraventions were observed, little difficulty is experienced in enforcement. However, one prosecution was taken during the year and fines totalling £200, plus £50 costs were imposed as follows:- Section 4 Cleanliness £45 " 7 Ventilation £20 " 8 Lighting £45 " 9 Sanitary Conveniences £45 " 10 Washing Facilities £45 58 Notification of Accidents Palls accounted for a large percentage of notified accidents, but very few were caused as a result of deficiencies under the Act. Most were attributable to carelessness. There would appear to be still many reportable accidents which are not notified as the majority of accident report forms come from the larger concerns and branches of multiple organisations. This problem is difficult to remedy for although the occupiers may know of the requirement, if the necessary notice is not given there is no way of the local authority knowing if an accident has occurred unless the injured person makes a complaint about a particular hazard, As very few accident investigations in this borough result in the need for further action, there may be no need to strengthen the law in this respect, but if there is a problem nationally then consideration should be given to the employee notifying the local authority. 8. NOISE One hundred and thirty-five complaints of alleged nuisance from noise were received during the year, compared with one hundred and two in 1971; sixty nuisances were confirmed. Eight of these arose from industry, sixteen from commercial undertakings, sixteen from domestic sources and sixteen from building works. Fifty-nine noise nuisances were abated following informal action and one abatement notice was served, Neighbourhood noise. There is at present insufficient legal power to deal with the rising noise levels in and around dwellings. The report of a working group of the Noise Advisory Council entitled "Neighbourhood Noise" recommends improvements in the existing nuisance abatement 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. It is understood that legislation is now being drafted to implement these recommendations. Planning and Noise In anticipation of recommendations from the Department of the Environment for imposing conditions in certain planning consents specifying maximum noise levels, this department already co-operates with the Planning Department and all planning applications relating to 59 industry are examined. Where appropriate the question of possible increases in noise levels is discussed with the developers. Several proposals to install emergency generating sets have been dealt with in this way and useful improvements in sound insulation have been obtained. Traffic Noise At the end of the year the Land Compensation Bill and Circular Roads No. 56/72 were published, outlining the Government's proposals for dealing with excessive noise from road traffic. An aspect of these proposals which is to be administered by this department concerns the assessment of grants for acoustic insulation for householders adversely affected by new road developments. Preliminary traffic noise predictions and recordings indicate that many houses in the borough will be affected by the scheme,, It is expected that where, adjacent to new roads, a noise level of 70 dBA is exceeded for one tenth of the time between 6 a.m. and 12 midnight, grants will be payable for the provision of double windows and ventilating units for the rooms affected. Grants may also be available for houses affected by an increase in noise resulting from road improvements opened for traffic after 17th October, 1969. 9. CLEAN AIR Clean Air Acts 1956/1968 - Smoke Control Areas Particulars of Kingston upon Thames Nos. 20 and 21 smoke control orders which were confirmed on 10th January 1972, 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 60 In October the Council made smoke control order No. 22 and confirmation by the Secretary of State for the Environment has been received. It comes into operation on 1st October 1973. Details are as follows:- Area 22 Locality King Charles Road Surbiton Acreage 353 Domestic Premises 3432 Commercial " 111 Industrial " 13 Other " 29 The Council's Smoke Control Area programme provides for a further five areas by 1977 in addition to the twenty-eight 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 27 32739 Order confirmed and not yet operative (Area 22) 1 3432 Area being surveyed (Area 23) 1 2500 Future areas 4 12930 Air Pollution Complaints There were 147 complaints from the public about nuisance from smoke and grit; 95 of these concerned bonfires; 7 smoke from factory chimneys; 9 smoking domestic chimneys; 6 grit and smuts; 20 smoke from demolition sites and 10 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 large number of complaints received. Advisory leaflets about bonfires are sent to all residents in smoke control areas. During the year over 700 leaflets were sent to other householders in response to special requests. 61 Four 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 cases. In at least two large factories fuel oil was replaced by natural gas for boiler firings, so reducing sulphur dioxide emissions. 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,, Hew 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. 1. 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. The increase in SO2 concentration is disappointing, but other towns experienced similar increases in 197l/2. Records show that the weather was distinctly colder than average for each month from April to September 1971 resulting in fires and central heating plants being operated out of season and probably contributing to the higher SO2 figures. 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 the deposits during 1972 were among the lowest recorded since 1958. 10. RODENT AND INSECT PEST CONTROL During the course of the year over 2,000 properties were inspected for rodent infestation, and there was a significant increase in the number of complaints of mice infestation. 461 complaints were also received regarding other pests and insects. The department has produced a number of advisory leaflets on rats and mice, squirrels, wasps and pigeons, all of which are available upon request. 62 Several complaints were received of rat infestation in new properties. Upon investigation it was found that old drainage systems, prior to redevelopment, had been inadequately sealed off and provided a means of egress of rats into the locality. In several cases rats had gained access to premises through the lack of "mailing good" where service pipes entered the property. Notifications were also received of rat infestation from the many railway embankments which traverse the borough. Many of these embankments are extremely overgrown and would appear to act as reservoirs of infestation. Pigeons continue to be a source of annoyance, particularly in Kingston and Surbiton town centres where despite trapping controls and publicity by the departments, they are still attracted and encouraged by people leaving food. A number of complaints were received concerning clovermite infestation in new flats. Although harmless, the insects are extremely unpleasant and in all oases the cause of the problem was found to be the practice of landscaping with lawns laid to abut the elevation of properties. A number of cases of bed bugs were dealt with, most of which were in houses in multiple occupation. One case of tick infestation arose from an overgrown area of land which had previously been used as an allotment. Mice in London In order to ascertain the extent of mice infestation in London the Greater London Boroughs including this Council co-operated with the Ministry of Agriculture, Fisheries and Food in carrying out a survey. A questionnaire was produced by the Ministry and 50 industrial premises and 947 dwelling houses in the borough, which were selected on a random basis, were visited by members of staff. Although the Ministry has not, tc date, produced detailed statistics, it is hoped that the information obtained will be able to show not only the degree of infestation in London but also the type of properties where mice infestation is likely to exist. In this respect it is probable that the survey will re-affirm our belief that the greatest problem exists in food premises and in houses in multiple occupation. 63 HOUSING The volume of the department's housing work has continued at a high level throughout the year, but the accompanying staff shortage has necessitated greater emphasis on some aspects, notably house improvement, to the detriment of others, for example general house repair work and conditions in houses in multiple occupation. Unfit Houses and Houses in Disrepair During the year all the houses in the Fairfield Place (Clearance Areas) Compulsory Purchase Order Site were demolished,, The negotiated acquisition by the Council of 1, 2 and 3 Fullbrooks Cottages, Worcester Park (a Clearance Area declared in 1970) met legal difficulties, following which a decision to acquire compulsorily was taken. By the end of the year it became apparent that negotiations might profitably continue and they have since been satisfactorily concluded. Part of the 1973 Slum Clearance Programme was advanced and a report made to the Council on fifty houses in the Canbury Park Industrial Area. A Clearance Area was declared and the Council decided to acquire compulsorily the properties in the area together with some land adjacent to it. During the year 257 houses were repaired as a result of informal action and nine demolition or closing orders were made. One house previously closed was made fit and the order determined, whilst in the case of three houses closing orders made by the former Borough of Kingston upon Thames were revoked, demolition orders substituted and demolition effected by the Council in default of action by the owner. House Improvement The Council made a substantial local contribution to the Greater London House Improvement Publicity Campaign, sponsored by the Department of the Environment in the Spring of 1972. Publicity material provided by the Department of the Environment together with additional local information was displayed widely through the assistance of public utility undertakings, estate agents, building societies, builders, builders merchants etc. The Health Department staged and maintained sixteen publicity exhibitions in libraries, clinics, etc. throughout the period of one month during which there was massive television and press advertising regionally and locally. At the end of July a follow up feature was arranged in co-operation with South Eastern Gas Board when, following a typical improvement scheme, a Council owned house was put on show to the public and attracted 731 visitors during daily sessions over two weeks 64 when staff were present to deal with enquiries. The co-operation of the Housing Committee and other officers in making this house available for use is gratefully acknowledged. The build up of enquiries and applications during 1971 followed by the campaign resulted in the highest ever number of grant applications being handled, Following upon the completion of appropriate works by the Council to its own houses,, grant payments from the Exchequer were received in respect of three dwellings, and approval to grant received from the Secretary of State for the Environment for 34 flats on the Thorne Road Estate, Hew Maiden. Applications in respect of the remaining dwellings will follow. General Improvement Areas During the year no further public participation meetings have been held and no new General Improvement Areas declared, but the effort of officers of all departments involved has been directed to making progress with works in General Improvement Areas in Thorne Road, New Maiden, Mill Street, Kingston upon Thames, and in preparing for the declaration of the Portland Road area of Kingston, Certificates of Qualification A further 151 applications for qualification certificates were received and progress was made in dealing with all outstanding cases in the register. Housing Condition Survey Following a request from the Secretary of State for information and strategy of action to deal with unfit and substandard houses, the Council appointed two retired public health inspectors to carry out a sample survey of approximately 1,000 houses. The purpose of the survey was to establish a picture of the condition of the housing stock of the borough as a whole and to assess the number of houses likely to be unfit, lacking in amenities and other related matters. The survey was completed at the end of the year and a report submitted to the Housing and Health Committees in 1973. 65 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. During the course of the year a considerable influx of gypsies occurred resulting in the establishment of several encampments, two of which were close to residential areas and gave rise to many complaints in respect of the conditions of the land, rubbish accumulations, rat infestations, as well as noise nuisance from dogs, chickens and portable generators. A number of prosecutions were taken under the Surrey County Council Act for the parking of moveable dwellings within prohibited areas. The Council decided to provide a permanent caravan site under the Caravan Sites Act 1968 and 15 gypsy families were selected for places on the site. As an interim measure these gypsies have been permitted to park on a Council car park where sanitary, water and refuse facilities are provided. 66 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 1972 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 Decembers, 1975 and all are dealers' licences to sell pre-packed milk. Premises and type of licence Number Premises in which milk is sold 104 Pasteurised milk 90 Sterilised milk 37 Ultra Heat Treated milk 53 Untreated milk 10 Bacteriological Examination of Milk During the year 65 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 Vest Turbidity Test Colony Count Pass Fail Pass Fail Void Pass Fail Under 10 Pasteurised 49 – 45 – 4 – – – Ultra Heat Treated – – – – – – – 10 Sterilised – – – – – 6 – – 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. 67 Ice Cream The number of registered premises in the borough at 31st December 1972 in which ice cream could be stored or from which it could be sold was 302. 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. The table shows the results of examination of 33 samples submitted to the Public Health Laboratory at Epsom during 1972. Owing to the numerous factors governing the hygienic quality of ice cream, undue attention is not paid to the bacteriological results on any single sample. Those which are placed within Grades I and II are considered to be satisfactory and those within Grades III and IV not so. Adequate follow-up action is taken where samples fall within the latter grades. GRADE I II III IV Total Ice Cream 23 3 5 2 33 Of the seven samples graded III and IV four were taken from soft ice cream machines and two from open cans. 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 Fifty-two 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. Heat 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. 68 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 142 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. The Date Marking of Food The Food Standards Committee Report on the Date Marking of Food was published in July 1972. The Committee recognised the right of the consumer to be able to purchase food in as fresh a condition as is technically possible and to know he is doing so. It concluded that new legislation would be required to increase the protection of the consumer, to assist the retail trade and to aid in the enforcement of the law and recommended that a comprehensive system of open date marking of prepacked foods should be introduced. Regulations should come into effect in three years time to allow a period for full discussion of the detailed proposals and the necessary changes in practices and packaging machinery,, There would be a few exemptions, such as prepacked fresh fruit and vegetables., For the purposes of open date marking, foods would be divided into two main groups, short-life foods and long-life foods. Shortlife foods would be those which the manufacturer considered should be sold within three months, taking into account the time needed by the purchaser to keep them at home. These foods would be required to show a "sell by" date conspicuously on the label where it could be sees, readily by the purchaser and by the retailer. The marking would show the day, month and year in a prescribed form, e.g., "sell by 02 SEP 72". The date wold assist in stock rotation and give reassurance to the consumer about the freshness of foods on display. Foods subjected to special processes, e.g., vacuum packing, could be marked with an "open by" date as an alternative to the "sell by" date. For long-life foods the Committee recommends a date of manufacture or of prepacking which could be used for stock rotation and which would show the age of individual packages. This date, 69 representing the month and year, would be shown legibly anywhere on the label or container. The regulations would be made under the Food and Drugs Act and its general provisions would continue to apply fully to the condition of the food when sold. The fact that unsatisfactory food offered for sale was still within its assigned and marked life would be no protection from prosecution under the Act if it were clear that it had deteriorated extensively., The existence of a date might make it easier to distinguish between the retailer's responsibility for the storage conditions and the manufacturer's responsibility for the state of the product as delivered,, It would not be made an offence to sell food after a "sell by" date. Food Hygiene There are 1,576 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 203 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. Sausages - mouldy and unfit Cooked chicken - maggots Yoghurt - fermenting Doughnut containing metal Sliced loaf containing metal Fine £25 and £6 costs Fine £20 and £5 costs Fine £100 and £10 costs Fine £20 and £10 costs Fine £20 and £10 costs Bottle of Milk containing particles of glass Fine £30, £10 costs and £6 Public Analyst's fee Chocolate Easter Eggs - mouse droppings Bread Roll - wire Cornish pasty - fly Fried Chips - cigarette end Fine £15 and £5 costs Fine £20 and £10 costs Fine £100 and £10 costs Fine £50, Costs £6 and Witness' fees £4 Lollipop - wire Yoghurt - fermenting Fine £20 and £10 costs Fine £20 and £6 costs 70 Yoghurt - deteriorated Pine £20 and £5 costs Chocolate Eclairs - stale and cream rancid Fine £25 and £10 costs Ginger cake - mouldy Fine £20 and £6 costs Meat pie - drawing pin £25, £6 costs and £6.55 public Analyst's fee Steak and Kidney Pie - mouldy Fine £15 and £5 costs Bacon joint - maggots Fine £40 and £15 costs ANIMAL ESTABLISHMENTS There are six animal boarding establishments and twelve 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. and Mr. M.A.P. Simons, Veterinary Surgeons, in the administration of this legislation is acknowledged. TRADE DESCRIPTIONS ACT, 1968 278 inspections were carried out under the Act in respect of food to ensure that articles were appropriately labelled and warnings 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. Five samples were submitted to the Public Analyst during the year of which three were reported as being satisfactory. The two subject of adverse report were not to the prejudice of the purchaser in that while constituents were outside the permitted variations they were in excess. 71 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 14 names were removed and 12 added. The total number of names on the list at the end of the year was 98. HAIRDRESSERS The Byelaws in respect of Hairdressers and Barbers made under the Public Health Act, 1961, are administered by the department and there are 142 registered hairdressers in the borough. 72 FOOD AND DRUGS ACT. 1955. 435 samples of foods and drugs were submitted to the Public Analyst for examination. The sixteen samples which were the subject of adverse report are listed below together with the action taken. It will be noted that several were due to failure to comply with labelling requirements of the Labelling of Food Order, 1953 or the Labelling of Food Regulations, 1970. Frankfurter Sausages Contained 18 per cent. Matter taken up with excess sodium nitrate. importers. The sample contained Sodium Nitrate 590 ppm. Guava Jelly Deficient in fruit to Withdrawn from sale. the extent of 50 per Matter raised with cent. The sample con- importers whose tained: Guava Fruit analyst has drawn not more than 20 per attention to the def— cento inition "fruit tent" given in the Food Standards Preserves Order, 1953. A formal sample will be taken if this article is observed on sale. Creamy Chocolate Misleading description. Matter taken up with Biscuits The article contained the manufacturers no butterfat to justify and The Cake & Biscuit the description. Alliance Ltd. factory conclusion not yet reached. Cheese and Salmon Misleading label, The label was amended Spread The name of the arti- following correspon- cle did not correctly dence with the describe its compo- importers sition and was much more conspicuous than the appropriate designation. 73 Red Rose Gargle Incorrectly labelled. The label was amended The quantitative par- following corresponticulars of one of dence with the the active ingredients retailer. were not declared. The gargle was described as a combination of phenol,chlorate of potash, thymol and tannin, but the amount of tannin was not declared. Fresh Milk Con- Deficient in milk Following correspon- Centrate solids including milk dence with the manufac- fat to the extent of turers the article 9.1 per cent, and appears to have been incorrectly labelled. withdrawn from sale. The sample consisted of condensed milk, half cream, unsweetened and contained: Milk Fat - 6.96%. The container did not bear a label complying with the provisions of the Condensed Milk Regulations 1959. Fresh Cream The sample was not of The retailer was Doughnuts the substance expected. warned. The article did not contain cream. Sterilised Cream The sample was defi- The matter was taken cient in milk fat to up with the manufac- the extent of 1.7 per turers and a subse- cent. quent sample was reported genuine. Pork & Beef Deficient in meat to The attention of the Sausages the extent of 15%. manufacturers was The sample contained: drawn to the report. Lean Meat - 24.0%, Fat 24o0%. Total meat 48o0%. Excess fat l.0%. 74 Mussels Incorrectly labelled. The matter was taken The ingredients were up with the importers not listed in the who amended the order in which they label. were used. Drink Concentrate Incorrectly labelled. Taken up with manu- Orange Flavoured The list of ingred- facturers who stated ients included three the sample was from terms which were old stock. Current generic and not production correctly appropriate for the labelled. purposes of the Labelling of Food Order, 1953. Soured Cream The sample was def- Followed up by formal icient in milk fat. sample which was re- The sample contained ported genuine. milk fat - 17.3%. Fried Oyster Incorrectly labelled. The importers stated The ingredients were they had no remaining not declared. stocks but in the event of further imports would ensure the ingredients were listed on the label. Mincemeat Incorrectly labelled. The matter was raised The list of ingredients with the manufacturer included the term who stated the article nutter which is not an had been discontinued, appropriate designation for the purposes of the Labelling of Food Order, 1953. 75 Mincemeat The sample was defic- The matter was taken ient in soluble solids up with the manufacto the extent of 1.5 turer. per cent. The sample contained: Soluble Solids (by refractometer) 64 per cent. Mango Juice The sample was not of The matter was raised the nature of mango with the importer who juice. The sample con- agreed to amend the tained: Mango juice - label to "Mango not more than 30% and Nectar". should be called mango crush or nectar. 76 POOD AND DRUG SAMPLES Milk 10 Milk Products 37 Meat and Meat Products 39 Fish and Fish Products 13 Oils and Fats 8 Sugar and Preserves 20 Confectionery and Chocolate 20 Fruit and Fruit Products 56 Vegetables and Vegetable Products 11 Cereals and Cereal Products 13 Flour Confectionery 12 Beverages 16 Soft Drinks 22 Alcoholic Drinks 25 Condiments and Sauces 18 Soups 6 Spices and Flavourings 2 Foods Additives and Sypplements 7 Baby Foods 5 Drugs 13 Miscellaneous 32 435 77 • FOODSTUFFS SURRENDERED AND CONDEMNED AS UNFIT Canned Goods lbs. Fish 69 Fruit and Fruit Juice 1,606 Jams and Preserves 33 Meat and Meat Products 113 Milk 20 Vegetables 121 Soup 83 Other 71 Bacon 15 Chocolate 38 Fish 1,892 Meat 6,503 Milk shake Syrup 528 Poultry 1,285 Rabbits 74 Miscellaneous Foods (Refrigeration Failure and Fire Damaged 16,084 78 FOOD HYGIENE (MARKETS. STALLS MP DELIVERY VEHICLES) REGULATIONS. 1966 The following tabulated statement shows the nature of infringements to which attention was drawn:- Number of stalls selling food 56 Total Name and address not displayed 18 Washable over clothing not worn 8 Washing facilities 3 First aid equipment 3 Protection of food 4 General cleanliness 2 38 FOOD HYGIENE (GENERAL) REGULATIONS. 1970 The following is a tabulated statement of inspections made of the various types of food premises:- No, of Premises Visits Bakers and Bakers shop 41 175 Butchers 55 116 Clubs 66 19 Confectioners 158 46 Fish shops (wet or fried 33 64 Greengrocers 77 61 Grocers 144 301 Ice Cream, manufacture 1 5 “ “ sale 302 56 Institutions 36 11 Milk shops and depots 95 20 Mobile shop 24 Office , shop and works canteens 88 54 Open Markers 2 226 Public houses, hotels and licensed premises. 148 129 Restaurants and cafes 158 615 School canteens 81 110 Wholesale meat shops 10 124 Other food premises 81 112 1,576 2,268 79 FOOD HYGIENE The following tabulated statement shows the nature of the infringements to which attention was drawns:- Total number of food premises 1576 Washing facilities for staff Absence of defective, inadequate hand basins) Absence of hot and cold water) 68 Lack of towels, soap and nailbrushes 47 Defective water heaters 8 Sanitary Conveniences Lack of “Wash Your Hands" Notices 44 Fittings, defective and dirty 19 Lighting inadequate 10 Walls and ceilings defective and dirty 30 Ventilation and/or ventilated lobby required 8 Others 5 Repairs to Food Rooms Floors defective 10 Walls and ceilings defective 13 Others 3 Sinks and draining boards Lacking Or defective 5 Protection of Food against contamination Smoking 7 Food not kept 18“ off ground 6 Covers not provided for food 14 Other 6 Uncleanliness Kitchens and equipment 65 Food Stores 34 Preparation room 21 Floors, walls and ceilings 101 Refrigerators 18 Ventilation 5 Dustbins-insufficient and defective 8 Uncovered, and collection of, refuse 6 First aid equipment 34 Clothing storage and cleanliness 7 Accumulations 19 General defects 28 649 Notices served 139 Notices complied with 150 80 COMPLAINTS The following is a brief list of causes for complaints received during 1972 which, resulted in investigation by the department and in all cases where necessary, appropriate action was taken. Accumulations 1 u Animals 47, Caravans, illegal parking 23 Cellulose spraying 2 Dampness 108 Drainage/Sanitary arrangements 1,221 Dirty milk bottles 6 DuStbins 21 Flooding 14 Foods 203 Food Hygiene 35 Fouling of footpaths by dogs 12 General Housing defects 142 Insects 318 Noise 135 offensive Odours 115 Offices, shops and Railway Premises Act 5 Overcrowding 14 Pigeons 65 Public Conveniences 8 Rodents Rats 1,064 1,413 Mice 349 Rivers and streams -pollution 5 Smoke, including grit, smuts and fumes 147 Squirrels 78 Water 12 Others 95 4,358 81 VISITS AND INSPECTIONS The following is a tabulated list of visits and inspections made by the Public Health Inspectors and Technical Officers. Visits made by the Pest Control Officer and Rodent Operative/General Assistants not included. Animal Boarding Establishments 7 Atmospheric Pollution Gauges 31 Bacteriological Sample Visits 224 Betting, Gaming and Lotteries Act 12 Building sites 1 Chiropody and Massage Establishments 5 Committee and Council Meetings 248 Consumer Protection Act (Fireguards) 26 Council House - Disinfestations 1 " " - Inspections 10 Court 54 Depot visits or inspections 85 Diseases of Animals Act and Waste Food Order 5 Disinfestations 3 Drainage Visits 429 Employment Agencies 30 Food and Complaints 306 Food and Drugs Samples 339 Food Hygiene Regulations - Bakehouses 77 -Bakers' shops 98 -Butchers 126 -Confectioners 46 -Cooked meat shops 81 -Fish shops(wet or fried) 64 Greengrocers 61 -Grocers 301 -Ice cream,manufacture 5 -" ", sale 56 -Institutions 11 -Milk shops and depots 20 -Mobile shops 24 - Public houses, hotels and 54 licensed premises 129 -Restaurants and cafes 615 -School canteens 110 -Sport clubs 19 C/Fwd 3,713 82 B/Fwd 3,713 -Open Markets 226 - Wholesale meat shops 124 - Other food premises 90 Factories-non-power 29 " -power 78 Fertilisers and Feeding Stuffs 8 Hairdressers and Barbers 8 Health Education 43 Homes Safety 1 Houses in Multiple Occupation 386 Housing Enquiries 38 Housing Act Inspections 343 " " Reinspections 152 " " Qualification Certificates 911 Improvement 2,676 Infectious Disease Visits 751 Insect pests 53 Interviews with Owners, Builders,ets. 1,264 Miscellaneous(including no reply) 1,775 Noise Abatement 347 Offices, Shops and Railway Premises 1,711 Old People and Problem Families 2 Overcrowding 5 Pet Animals Act 16 Pigeons 2 Piggeries 5 Pharmacy and Poisons Act 59 Public Conveniences 45 Public Health Act inspections 946 " " " reinspections 432 Rag Flock Act 5 Refreshment houses(Licences) 10 Rent Act 3 Riding Establishments 1 Rivers, Ditches and Ponds 45 Rodent Control 96 Shop Act 11 C/Fwd 16,410 83 B/Fvd 16,410 School Premises 50 Smoke Abatement 384 Smoke Control Areas 7,855 Smoke Control Areas- No access 1,553 Special Surveys 403 Tents,Vans, Sheds and Caravans 324 Trade Descriptions Act 278 Unsound Food 136 Vacant land 16 Visits outside district 203 Waste Pood (staining and Sterilisation) Order 1 Water Supply and Sampling (including Swimming Pools) 455 Work in progress 301 28,369 84 NOTICES SERVED Informal Written and verbal 642 Statutory (a) Housing Acts (excluding those mentioned in (b)below) 23 (b) Housing Act, 1957 - Section 170-requiring information as to ownership 116 (c) Public Health Acts (other than mentioned in (d)below) 30 (d) Public Health Act, 1936 - Section 277- requiring information as to ownership 30 (e) Clean Air Act 12 NOTICES COMPLIED WITH Informal Written and verbal 659 Statutory (a) Housing Acts 7 (b) Public Health Acts 25 (c) Clean Air Act 16 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 Corporation 47 29 - - Factories not included above in which Section 7 is enforced by the Corporation 592 78 5 - Other premises excluding outworkers. 83 1 - - 2. CASES IN WHICH DEFECTS WERE FOUND No. of cases in which defects found Found Remedied Referred No. of Prosecutions To H.M. Inspector By H.M. Inspector Sanitary Conveniences: Unsuitable or defective 2 2 - 1 - Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) 5 7 1 1 - 7 9 1 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 3 Fuse makers 13 Wearing apparel - making etc. 22 Artificial flowers 4 Lampshades 9 51 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. Class of Premises Premises newly registered during the year Total No.of regis tered premises No.of registered premises receiving general inspection during yr. No. of persons employed Offices 57 683 113 10,156 Retail Shops 47 868 180 7, 111 Wholesale & Warehouses 4 61 14 1,083 Catering Establishments 10 156 135 1,333 Fuel Storage Depots - 2 - 18 Totals 118 1,770 442 19,701 Section Number of Contraventions found Section Number of Contraventions found 4 Cleanliness 4 14 Seating 3 5 Overcrowding 1 15 Eating facilities 2 6 Temperature 60 16 Floors, Passages and Stairs 33 7 Ventilation 20 17 Fencing Machinery 2 8 Lighting 13 20 Safety Precautions 11 9 Sanitary Conveniences 36 24 First Aid 48 10 Washing Facilities 38 49 Registration 28 12 Clothing Accommodation 21 50 Provision of Abstract 65 Other matters 6 Total 391 88 ACCIDENTS Workplace Reported NonFatal Total No. Investigated Action Recommended Informal Advice No action Offices 4 3 3 1 Retail shops 73 47 47 26 Wholesale shops Warehouses 4 2 2 2 Catering Establishments open to public, canteens - - - - Totals 81 52 52 29 ANALYSIS OF REPORTED ACCIDENTS Offices Retail Shops Wholesale Warehouses Catering establishments open to public, canteens Machinery - - - - Transport - 3 1 - Falls of persons 2 31 1 - Stepping on or striking against object or person - 6 - - Handling goods 1 15 — _ Struck by falling object - 6 1 - Use of hand tools - 5 - - Not otherwise specified 1 8 - - 89 PEST CONTROL - STATISTICAL SUMMARY 1. Number of properties in district 62,077 2. (a) Total number of properties (including nearby 1,399 (b) Number infested by (i) Rats 535 (ii) Mice 349 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 75 6 (b) Number infested by (i) Rats 94 (ii) Mice - 4. Complaints received: Rats 1,064 Mice 349 Squirrels 78 Pigeons 65 Insects 318 90 HOUSING The following is a tabulated statement of action taken under the Housing Acts. 1. Number of houses inspected 343 2. (a) Number of houses which, on inspection, were considered to be unfit for human habitation 7 (b) Parts of houses which, on inspection, were considered to be unfit for human habitation 2 3. Number of houses, the defects of which were remedied in consequence of informal action by the local authority or its officers 257 4. Number of representations made to the local authority with a view to:- (a) The serving of notices requiring the execution of works 10 (b) The making of demolition or closing orders (number of houses involved 9 (c) Declaration of Clearance Areas (number of houses involved 50 5. Number of formal notices served requiring the execution\ of works 2 6. Number of houses which wore rendered fit after the service of formal notices 7 7. Number of demolition or closing ordres made 9 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 65 10. Number of houses where demolition or closing orders determined on the premises being made fit 1 11. Closing Orders revoked and Demolition Orders made 3 91 HOUSING ACT. 1969. IMPROVEMENT GRANTS - STANDARD Owner/Occupied Tenanted Total Applications received 13 13 26 " approved 9 5 14 Dwellings improved 16 £ 23 39 Amounts paid in grants £3,392.00 Average per house 86.97 Amenities provided - (a) fixed bath or shower 14 (b) wash-hand basin 20 (c) hot water supply (to any fittings). 37 (d) water closet within dwelling 14 (e) sink 3 IMPROVEMENT GRANTS - DISCRETIONARY Single Dwellings Improved Owner/Occupied Tenanted Total Applications received 96 53 149 " approved 90 41 131 Dwellings improved or provided 55 r- 31 86 Amount paid in grants £47,448.00 Average per house 551.72 Dwellings Provided by Conversion Owner/Occupied Tenanted Total Applications received 6 65 71 " approved (dwellings) 10 43 53 Dwellings provided 6 f 17 23 Amount paid in grants £15,505.00 Average per dwelling 674.13 92 SPECIAL GRANTS Owner/Occupied Tenanted Houses Households Houses Households Applications received 1 5 2 13 " approved 1 5 2 13 Grants paid 1 5 1 3 Amount paid in grants £ 210.00 Average per house 105.00 Average per household 26.25 RENT ACT. 1968 APPLICATIONS FOR CERTIFICATES OF DISREPAIR. ETC. One Certificate of Disrepair was cancelled upon application from the landlord following rectification of defects. No other applications were received. 93 HOUSING FINANCE ACT. 1972 - PART III CERTIFICATES OF QUALIFICATION IMPROVEMENT CASES Applications received 34 granted 24 refused 3 STANDARD AMENITIES ALREADY PROVIDED Applications received 117 granted 145 refused143 EXEMPTION FOR LOW INCOME TENANTS FROM SECTION 54 - HOUSING ACT 1969. Number of certificates issued under Section 55 1 (NOTE:- These sections of the Housing Act 1969 were repealed by the Housing Finance Act 1972). 94 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 8,087 Agar plate count per ml. 20-24 hours at 37°C 42.3 Coliform count - Per cent. samples negative in 100 ml 41.94 Count per 100 ml 10.2 Escherichia coli count - Per cent. samples negative in 100 ml 56.76 Count per 100 ml 4.0 After Treatment Number of Samples 3,891 Agar plate count per ml. 20-24 hours at 37°C 10.0 Coliform count - per cent samples negative in 100 ml 99.85 E.coli count - per cent samples negative in 100 ml 99.97 95 Results of the Chemical Examination of Water supplied to the Borough Number of samples 364 Ammoniacal Nitrogen 0.031 Albuminoid Nitrogen 0.069 Nitrate Nitrogen 6.9 Oxygen abs. from KMnO4 4 hrs. at 27°C 1.06 Hardness (total) CaCO3 274 Hardness (non-carbonate) CaO3 82 Magnesium as Mg 5.0 Sodium as Na 24.5 Potassium as K 5.5 Chloride as Cl 35 Phosphate as PO4 2.8 Silicate as SiO2 10 Sulphate as SO4 58 Natural Fluoride as F 0.15 Surface-active material as Manoxol OT 0.02 Turbidity units 0.1 Colour (Burgess units) 13 pH value 7.9 Electrical Conductivity (microhomes) 570 96 97 SCHOOL HEALTH SERVICE 101 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT of the PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1972 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 1972. I have the following comments to make on certain items: School Health Service The population of maintained schools in the borough increased by 1,077 pupils during the year. Of the 4.992 children examined at periodic medical inspections 704 (14.1 per cent) were found to be in need of treatment. This compares with 654 (13.4 per cent) for 1971. Of those examined only three 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 during their 12th year of life, and 978 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. The new special class for speech defective children in a school in Chessington has now been in operation for one year and the children have responded well to the daily therapy and this has improved their educational progress. 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. Meanwhile, this unit is functioning at Surbiton Hill Nursery School. 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 1st April, 1971. The Centre was renamed Dysart School and the children in attendance have continued to receive the whole range of health services available to school children. Since this transfer, the school has begun to adjust to the new educational system. Children are now admitted at 2 years of age and there is an additional nursery class at the school. 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 76 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, and also to improved surgical techniques in overcoming congenital abnormalities. Nowadays, 40 per cent of the children suffer from spina bifida. Rebuilding will enter its final phase in 1973 and will provide much needed additional accommodation. Health Service Reorganisation Preparations for reorganisation are nowwell under way and this borough is to be linked with Richmond upon Thames to form an area health authority. The school health service will be transferred to this new body, which will need to make arrangements to ensure the continued co-operation between its medical officers, school nurses and the staff at the schools. 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 and Principals for their co-operation at all times. I am, Yours faithfully, JOHN C. BIHCHALL Principal School Medical Officer 104 SCHOOL HEALTH SERVICE The population of the borough, estimated by the Registrar General, was 139,4-20 at mid-1972. In January, 1973, the number of pupils on the registers of maintained schools was 21,707, made up as follows: Primary Schools 12,207 Secondary Schools 9,031 Nursery Schools 194 Special Schools 275 In addition, it is estimated that 3,000 children attend independent schools registered under Part III of the Education Act 1944, and 556 attend the direct grant school which is served by the school health service. The number of maintained schools in the borough on 31st December, 1972 was 6l: 13 secondary, 43 primary, 2 nursery, 3 special. One direot 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 three other medical officers. The services of sessionally employed medical officers are also used to maintain the programme of fixed appointments at clinics and as reliefs for leave and sickness. The health visiting staff consisting of a Superintendent Health Visitor, a 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 statiatical requirements of the Department of Education and Science. During 1972, periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 4,992 children being examined. The arrangements for periodic medical inspection are summarised below: On or immediately before entry to infant and nursery school On entry to the junior school (selective examination) On entry to the secondary school During the year in which age fifteen is reached (selective examination) At the 8-year-old level, 758 children were selected for examination out of a total of 1,000 children in this age group and during the year in which age fiften is reached, 395 out of a total of 1,008 were selected. 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 4,992 pupils inspected, 4,989 were deemed to be of satisfactory general condition. This is a personal assessment by the inspecting medical officer which takes into account general body contour and covering, general muscle tone, facial complexion, appearance of mucous membranes and eyes, posture, alertness and poise. In modern times it is more common to find pupils who are over-nourished rather than underweight. Obesity has many disadvantages in school life as well as carrying increased risk to normal health in later years. In most cases obesity is preventable or can be cured, and merits more serious consideration by parents and teachers than is usually given. The three children whose general condition was deemed unsatisfactory consisted of one born in 1967, one in 1964 and one in 1959. 106 Defects Found at Periodic Medical Inspection During 1972, 704 (14.1 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 1968 and later 229 7 32 35 1967 1,059 17 61 88 1966 666 10 27 41 1965 100 3 18 18 1964 550 13 54 70 1963 208 4 25 28 1962 61 7 11 12 1961 994 97 98 178 I960 551 59 47 101 1959 75 14 13 24 1958 44 6 8 13 1957 and earlier 455 64 43 96 TOTALS 4,992 301 437 704 107 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 78 147 Eyes (a) Vision 267 341 (b) Squint 39 94 (c) Other 12 36 Ears: (a) Hearing 21 142 (b) Otitis Media 13 104 (c) Other 1 11 Nose and Throat 21 346 Speech 47 91 Lymphatic Glands 22 92 Heart 2 47 Lungs 15 92 Development: (a) Hernia - 11 (b) Other 2 49 Orthopaedic: (a) Posture 37 62 (b) Feet 64 125 (c) Other 18 32 Nervous System: (a) Epilepsy 8 14 (b) Other 23 44 Psychological: (a) Development 50 180 (b) Stability 21 118 Abdomen 8 49 Other 38 36 TOTAL: 3,070 807 2,263 Children with defects noted at periodic or special medical inspections are re-inspected at appropriate intervals by the school medical officers. The number of such re-inspections carried out was 403. 108 Special inspections of pupils who are not due for periodic inspection are carried out at any age at the request of the parents, teachers, family doctors or school health service staff, either at school or a school clinic. Defects noted in the pupils examined at these inspections are analysed below: Defect or Disease Requiring Treatment Observation Skin 6 23 Eyes: (a) Vision 10 10 (b) Squint - 1 (c) Other - 1 Ears: (a) Hearing 80 119 (b) Otitis Media 16 7 (c) Other 2 - Nose and Throat 3 9 Speech 17 8 Lymphatic Glands - 1 Heart - - Lungs 12 3 Development: fa) Hernia - - (b) Other - 2 Orthopaedic: (a) Posture 1 - (b) Feet 2 14 (c) Other 1 6 Nervous System: (a) Epilepsy - 2 (b) Other - 2 Psychological: (a) Development 4 7 (b) Stability 4 15 Abdomen 3 2 Other 5 16 TOTAL: 414 166 248 109 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 2 Scabies 2 Impetigo 8 Other 28 Vision and Squint 2005 Other Eye Conditions 14 Ear, Nose and Throat 89 Speech 765 Heart 10 Lungs 56 Development 12 Orthopaedic 216 Nervous Diseases 60 Abdomen 36 Other 135 TOTAL 3437 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 89 children received operative treatment by ear, nose and throat surgeons, including 18 cases of tonsils and adenoids. 110 Speech Therapy There have been no farther developments in the speech therapy service during 1972. One full time therapist resigned in February and her replacement took up her appointment in September. It was unfortunately necessary to discontinue the speech therapy programme at the Mult Training Centre during this time but this has now been resumed, the therapist working as a member of the team concerned with the overall provision for trainees at the Centre. Medical officers and health visitors have co-operated in the work of identifying children who develop speech late, and early referral to speech therapists for diagnosis, therapy and parent guidance is of very great value. From these young children are selected the severely speech handicapped children who are referred to the advisory panel consisting of a senior medical officer, consultant psychiatrist, educational psychologist, psychiatric social worker, head teacher and senior education assistant, to consider admission to the Speech Therapy Unit at Buckland Infants School. This unit has now been in operation for over a year and the children have responded well to daily therapy and are also reported to be making educational progress. Therapy is provided for groups of pre-school age children in those clinics which have room available and parents are finding this a useful service and it allays some of their own anxiety. With an increase in the numbers of school children referred for therapy,waiting lists began to build up at some clinics and wherever possible those have been reduced by grouping children for therapy. An application has been made for an increase in the establishment of speech therapists to allow therapy to be provided at the newly opened partially hearing unit and to allow for an increased provision of sessions at St.Philip's School where there are 14 children requiring intensive therapy and 36 children with minor speech defects. It would also be possible to provide farther therapy at Bedelsford School which has an increased number of young children with very delayed speech and language development, and at Dysart School where frequent therapy is advisable to ensure that progress is maintained. 111 Centre Present Weekly Number of Sessions Children Treated Remaining for Next Year 1971 1972 1971 1972 1971 1972 Acre Road Clinic 2 2 66 63 39 47 Adult Training Centre 5 5 19 - 19 - Bedelsford School 9 9 24 16 15 15 Buckland School - 1 - 18 - 10 Buckland Speech Therapy Unit 10 10 10 34 7 9 Dysart School 5 5 61 72 58 61 Grange Road Clinic 2 1 43 38 32 34 Hook Clinic 4 3 99 93 65 43 Roselands Clinic 5 3 178 132 97 67 St. Philip's School 10 10 66 73 55 36 Surbiton Clinic 2 2 56 55 37 36 Tolworth Clinic 2 2 41 54 32 31 Worcester Park Clinic 2 2 50 64 42 42 King Athelstan School - 1 - 23 - 22 Robin Hood School - 1 - 12 - 5 The Mount School - 2 - 38 - 50 TOTALS 58 61 713 765 498 484 112 Analysis of Cases Treated Children Treated Discharged Remaining at end of period 1971 1972 1971 1972 1971 1972 Stammering 52 45 20 17 32 28 Cluttering 4 3 1 2 3 1 Dyslalia 340 350 129 152 211 198 Idioglossia 2 - 2 - - - Anarthria/Dysarthria 8 8 2 2 6 6 Aphasia/Dysphasia 7 7 - - 7 7 Aphonia/Dysphonia 1 2 - 1 1 l Amentia/Dementia 80 72 3 11 77 61 Cleft Palate 5 8 2 3 3 5 Hyperrhinophonia 5 3 2 3 3 - Hyporhinophonia 4 2 2 2 2 - Deafness 8 8 4 2 4 6 Retarded Speech and Language Development 196 255 47 84 149 171 Unclassified 1 2 1 2 - - TOTALS 713 765 215 281 498 484 113 Ophthalmic Clinics During the year 1,648 children were examined at the school eye clinics; 373 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. Audiology The following are details of work undertaken in schools: Children sweep tested: Primary 3,170 Secondary 744 Special 132 4,046 Children who failed test: Primary 200 Secondary 51 Special 1 252 Result of Investigations by School Medical Officers: No significant hearing loss on clinical examination 84 No significant nearing loss, but child appears mentally retarded - Hearing loss confirmed and attributed to: (i) Catarrhal condition (with or without inflammation of ear) 65 (ii) Old otitis media 8 (iii) Injury 3 (iv) Other causes 28 (v) Undetermined causes 8 Investigations Incomplete at End of Year 7 Investigations Not Possible - left district or otherwise unavailable for examination 4 Recommendations by School Medical Officers in the first instanoe: 114 (i) No action required 12 (ii) For observation only 131 (iii) Refer to audiology clinic 36 (iv) Refer to general practitioner 13 (v) Refer to ear, nose and throat consultant 11 There were 40 recommendations made during the year for children to sit in favourable positions in the classroom. The total number of pupils attending school at the end of the year known to have been provided with hearing aids was 67. Audiology Clinic Of the 507 attendances during the year, 242 were made by 173 children under the age of five, and 262 were made by 104 children aged five and over. Details of children and attendances are as follows: AGE GROUP Totals Under 2 2-4 5-7 8-11 11+ New cases referred from all sources 37 136 49 30 25 277 Cases carried over from 1971 - - - - - - Found to have normal hearing 34 119 23 11 7 194 Deaf in one or both ears 1 - - 1 1 3 Found to have remediable hearing loss 1 15 25 17 15 73 Impaired hearing requiring auditory training and/or hearing aid - - - 1 2 3 Not fully assessed at end of 1971 1 2 1 - - 4 Attendances 58 187 117 83 62 507 115 Physiotherapy Physiotherapy sessions are held weekly at four clinics, and the physiotherapist also attends St. Philip's Special School. The results obtained are very beneficial and details of the actual work undertaken are as follows: Sessions held 213 Children treated 117 Attendances 2,653 New cases admitted 47 Cases discharged 63 There were 74 children attending Bedelsford Special School at the end of 1972 and all receive physiotherapy from the physiotherapists attached to the school. Epileptic Children As a result of periodic medical inspections, 8 of the children examined were referred for treatment and 14 others were noted for observation at a later date. Cleanliness The work of health visitors and school nurses in connection with uncleanliness and verminous conditions in schools is summarised below: School children examined 17,039 Number found infested lice/nits) 152 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 16 Enteric Fever - Measles 37 116 German Measles 194 Chicken Pox 385 Mumps 400 Jaundice 5 Dysentery 1 Influenza - Other 18 1,056 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. 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 teaohers in making arrangements for medical officers to visit the schools is very much appreciated. Diphtheria Primary Immunisation Number who completed a primary course 35 Reinforcing Number who received reinforcing injections 1609 1644 Poliomyelitis Primary Course Number who completed a primary course 69 Reinforcing Number who received a reinforcing dose 2509 2578 Tetanus Primary Course Number who completed a primary course 83 Reinforcing Number who received a reinforcing injection 2263 2346 Number of Primary Courses completed from previous year 179 Measles Number who received immunisation 162 117 Rubella (German Measles) Number who received immunisation 978 Vaccination Against Tuberculosis 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 Heaf Positive Vaccinated 1,929 1,749 166 245 1,435 118 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 home. The advent of the Social Services Department, which now provides the social workers for this clinic, and the provision of a consultation service for this department by the consultant psychiatrist from this clinic, have gone some way to furthering the community approach to child and family psychiatry. The general practitioners, members of the school health service, health visitors and probation officers continue to use the diagnostic, treatment and consultation services, and the links with the paediatric and other psychiatric services at Kingston Hospital provide a valuable basis for the interchange of differing skills. During the past year the teaching and training activities of this clinic have included a training programme for a senior registrar in child and family psychiatry, under the Married Women Doctors' Training Scheme, two social work students and in-service group seminars for health visitors and probation officers. The following table shows the work done during the year: Caseload brought forward from 1971 376 Waiting list at December 1971 16 392 160 new cases were referred during 1972 by the following: Health Visitors 4 School Health Service 35 Private practitioners 57 Other clinics 1 Direct non-medical 15 Education Department 3 School psychological service 7 Social Services Department 7 Speech therapists 1 Hospitals 7 Assessment Centre 1 New cases initially seen by psychiatrist during the year 132 119 New caseload initial distribution: Psychiatrist 69 Psychiatric Social Worker 58 Psychologist 5 Total of caseload during the year 530 All cases - closures during the year: Non co-operative 11 Other arrangements made 9 Improved 55 Failed to attend 3 Transferred to other agencies 7 Left school 24 Moved from district 3 Lost contact 28 140 Caseload on treatment at end of year 372 On waiting list for diagnostic interview 13 120 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 1972 Recommended, for placement - parents refused Receiving home tuition On waiting list for special school Day Special Schools or Units Boarding Special Schools or Hostels Kingston Other Other Boys Girls B G B G B G B G B G Blind — — 1 — 1 — — — — — — — Partially Sighted — — 3 3 1 — — — — — — — Deaf — — 4 3 1 1 — — — — — — Partially Hearing 4 1 6 7 1 1 — — — — — — Educationally Subnormal 100 86 2 3 5 3 — — — — 5 5 Epileptic — — 1 — 1 l — — — — — — Maladjusted 5 5 2 l 27 5 1 — 5 3 — — Physically Handicapped 11 9 — 2 5 2 _ _ 1 2 4 _ Delicate — — 1 1 l 1 — — — — 1 — Speech Defect 5 3 — — — — — — — — — — TOTALS 125 104 20 20 43 14 1 — 6 5 10 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 - 18 years and there are currently 76 children on roll, an increase on the last few years. Handicaps present are: Spina Bifida and Hydrocephalus Cerebral Palsy Muscular Dystrophy Cardiac Cerebellar Ataxia Hydrocephalus Hemiplegia and Epilepsy Arthrogryphosis Still's Disease Achondroplasia & Hydrocephalus Myositis Ossificans Hirschsprung's Disease Congenital absence abdominal wall TOTAL 30 34 13 3 3 2 2 2 1 1 1 1 1 76 The high incidence of Spina Bifida cases has maintained at the same level as last year - approximately 40 per cent of the school roll. Of the 30 cases, 29 are doubly incontinent and the nursing and personal care of these children requires a high level of welfare provision. Fifteen children are receiving speech therapy, 2 children are partially hearing and are visited weekly by a peripatetic teacher of the deaf. Seven children are additionally handicapped with epilepsy. Work on the final phase of the rebuilding programme should start in the autumn, 1973 and will provide the school with much needed accommodation for speech therapy, physiotherapy and hydrotherapy. The completion of this project will then release additional class space, enabling a further increase in the size of the school. An additional class was opened in September, 1972, making improved provision for the younger children who form the greater proportion of the school roll. During the year a new school library has been set up. A close link has also been established with the Kingston Polytechnic whose students visit weekly to take part in youth club activities with the senior ohildren. 122 The school's continuing aim is to provide as full and normal a school life as possible, together with a planned programme of such physiotherapy, speech therapy and other remedial help as is required by the children. 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: There were 140 children on the roll in September 1972 and ten more on the waiting list. It is interesting to compare this situation with six years ago, when there were 115 children on the roll, but only 80 from Kingston, compared with 130 of the present total. This represents a 60 per cent increase in the Kingston children. The increase might be interpreted as due to any, or all of the variables: Improved diagnosis Change in attitudes (of teachers, parents, doctors) The work and achievements of the school Although the intelligence range for entry is nomally 50-75, the present actual range is 43-95, with probably more children over 70 than under, and a number being admitted with IQs of around 80. The pattern of admission ages is also interesting. In September 1972 of all the children on the roll, 36 per cent were admitted before the age of 7, and 77 per cent before the age of 9. Unfortunately a few children still come at 13+ or 14+ years when previous educational efforts have failed, and when the chances of making progress in amy direction are muoh reduced. Three boys left before the age of 16 years in order to start work, and one girl of 13 transferred to secondary school. No doubt this number will increase as secondary schools become better able to deal with children who have learning difficulties. Fourty-four children were considered by the Senior Medical Officer and the Head to be multiply-handicapped, the largest handicap being speech. As observed by the Medical Officer of Health in a memorandum to the Chief Education Officer on 31 October 1972, speech therapy could make a much bigger contribution if there was additional accommodation. 123 Dysart School for Severely Subnormal Children, Dukes Avenue. Kingston upon Thames Thanks are expressed to Mrs. K. M. Beilby, Headmistress, for the following report: During 1972 Dysart School began to re-adjust to the educational system and children are now admitted from the age of two years. With the transfer of the Adult Training Centre to new premises in 1972, more space became available and it was possible to rearrange classes. There are now two nursery classes and this has made it possible to stream the younger children with more emphasis placed on the wide range of abilities encountered in the admission classes. A Special Care Unit is also provided for the most severely handicapped children. The upper age limit is eighteen years and it has become possible to divide the third year classes into two, 12-15 year olds, and a transition class for those aged over 15 years. The classes are accommodated in two rooms previously used as workshops. A qualified teacher has been appointed for the transition class and the second nursery class has a supply teacher until a member of staff returns from secondment. Now that more space is available and there are school assistants in each class it has been possible to introduce further subjects. One teacher is responsible for physical education throughout the school, one for music and one for art. There is also a woodwork teacher who teaches the older boys, and ballet lessons are provided for older girls. Ascertainment of Handicapped Pupils Children ascertained in 1972 as requiring special educational placement: Category Number Blind nil Partially sighted nil Deaf nil Partially hearing 8 Educationally subnormal 35 Epileptio nil Maladjusted 11 Physically handicapped 4 Delicate 2 Speech defect 5 TOTAL 65 124 Health Education Details of activities which took place in schools ;;nd youth centres are reported on pages 23 and 24. 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 23). 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. 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 'ealth Section and the School Meals Service in order to ensure continued high standards of hygiene. Equipment is continually improved and the quality of the meals is good. The provision of milk and meals in school is very valuable, particularly to those children whose mothers are in employment, and the following figures are of interest: Based on September 1972 Returns Children in attendance 18,985 Taking milk 5,208 Percentage taking milk 27.43 Taking meals 13,035 Percentage taking meals 68.66 Cost of meal to pupil 12p Actual cost of meal 22p Percentage taking meal at: Full charge 92.04 Free 7.96 Average number of days meals were supplied in year 192 Average daily number of meals supplied 14,121 125 Number of meals supplied: Other establishments Maintained schools 7,242 2,704,083 2,711,325 Deaths of School Children During the year notifications were received in respect of the deaths of six children of school age resident in the borough. The causes of death were as follows: 1 Neuroblastoma 1 Fractured skull and lacerated brain (accident) 1 Open verdict - hanging 1 Multiple injuries (accident) 1 Lacerated brain and cerebral contusion (accident) 1 Bronchopneumonia and severe mental handicap Medical Examination of Adults 257 newly appointed teachers and candidates for admission to teacher training colleges were medically examined, as required by the Department of Education and Science. 268 teachers were appointed to Kingston schools after submitting medical history forms. 126 SCHOOL DENTAL SERVICE Donald M. Dodd, L.D.S., B.D.S., D.D.P.H..R.C.S., Chief Dental Officer Staffing The establishment of dental officers remained at almost full strength throughout the year. A vacancy caused by the resignation of one part-time officer at the end of December was filled immediately by a new appointment. Clinics All the clinics were inspected frequently in order to ensure that the highest standards of cleanliness and hygiene were being maintained. Dental Inspection (see tables) Every school in the borough was visited at least once during the twelve months. On these occasions, 18,646 children received their first dental inspection of the year and 112 subjects were inspected during each session. This, in effect, covered 93 per cent of the school population, which compared more than favourably with the national average of 58 per cent. An additional 2,321 also underwent their first inspection at a clinic. Of the total inspected, 14.2 per cent were re-inspected, an indication that opportunities for regular treatment were being offered to the children more than once per year. Dental Treatment (see tables) As a result of the above first inspections, 7,180 children (34.4%) were found to require treatment. Some of these did not require immediate attention and others were patients of private practitioners, with the result that 6,109 were offered treatment. Of the former number, 3,519 (49%) were treated by the school dental service. Caries is the major dental health problem experienced by children in this country. It is therefore encouraging to note that 9.2 permanent teeth had been preserved by means of fillings, for every one that was beyond repair and had to be extracted. Likewise, in the deciduous dentition, three teeth were able to be saved, for every one that was lost through caries. After having allowed for absentees through sickness and failed appointments, 6.1 patients visited the surgery during each treatment session, which was approximately the same attendance figure as that exhibited by the country as a whole. 127 The orthodontic clinic at Acre Road maintained its high standard in the production and fitting of appliances and 13.8 per cent of all sessions were devoted to this specialised branch of dentistry. Appreciation by the General Dental Services of the work was indicated by an increasing number of patients referred by practitioners for advice and treatment. Further liaison with hospital consultant services in the orthodontic field was facilitated by Kingston Hospital's invitation to share their orthodontic laboratory and consulting rooms for very complicated cases. Arrangements along these lines were completed, with no costs involved to the borough and the scheme is now in operation on one session per week. Dental Health Education 4.8 per cent of all sessions were devoted to dental health education, which meant that considerable time and effort was expended on this very important subject; a positive approach to any health problem being infinitely preferable to a negative one. Maroh was dental health month and new poster and pamphlet displays v/ere set up for a period of four weeks at each clinic. The 'Apples for Schools' scheme was continued and helped to remind the children of the importance of clean teeth and healthy gums. During the Spring a dental health campaign involving dental hygiene kits, films and talks was held and was again directed towards the five year olds. About two thousand children were involved. This is becoming an annual event and it is hoped that repetition of the dental health message to children during their early impressionable years, will ultimately induce a correct attitude towards oral hygiene. Fluoridation No action was taken by the Metropolitan Water Board to fluoridate water supplies because one quarter of its constituent authorities remained opposed to the idea. The result was that threequarters of the children in Greater London, where the authorities had agreed to fluoridation, continued to be denied the safe and highly beneficial effects which result from such a desirable health measure. The matter was again raised at the November Health Committee meeting and a strong body of opinion urged that further action be taken in 1973. 128 GENERAL D2NTAL INSPECTIONS AND TREATMENT 1972 First inspections of the year: At School 18646 20877 At Clinic 2231 Re-inspection at school and clinic 2969 Found to require treatment from first inspection 7180 Offered treatment from first inspections 6109 Treated 3519 Attendances for treatment 11521 Sessions devoted to inspection 167 Sessions devoted to treatment 1913 Sessions devoted to dental health education 105 Number of fillings in permanent teeth 5411 Number of fillings in temporary teeth 4336 Number of permanent teeth filled 4557 Number of temporary teeth filled 3918 Number of permanent teeth extracted 496 Number of temporary teeth extracted 1323 General anaesthetics 618 Pupils X-rayed 626 Prophylaxis 1057 Teeth otherwise conserved 834 Teeth root-filled 43 Inlays 1 Crowns 6 Orthodontic Cases Commenced during the year 196 Brought forward from 1971 372 Completed during the year 92 Discontinued during the year 37 Referred to hospital consultant 1 Removable appliances fitted 265 Fixed appliances fitted 126 Under treatment or observation at end of year 503 129 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 Eye General Medical Roselands 163 Kingston Road New Maiden Minor Ailments Speech Dent al Eye 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 Accidents Acknowledgments Adult Medical Examinations After Care Air Pollution Ambulance Service Animal 8 Ante-natal Clinics Area Ascertainment of Handicapped Pupils Attachment of Nurses to General Practices Audiology Bacillus Calmette-Guerin (BCG) Vaccination Bacteriological Examinations Bedelsford School Birth Rate Births British Red Cross Society Cancer Caravans Caravan Sites and Control of Development Act 1960 Care Committee Care of Mothers Care of Young Children Causes of Death Certificates of Vaccination Cervical Smears Chest Clinic Chief Dental Officer Chief Public Health Inspector Child Guidance Child Welfare Children's Homes Chimneys Chiropody Cholera Clean Air Clean Air Act 38 58, 88 4, 103 25-26, 125 45-50 59-61 44 70 29-30 10 123 37, 39 102, 113-114 46, 117 66, 67, 94 102, 121 1, 10 10 49 1-2 65 65 48 29, 30 30, 31 13-18 44 49 45, 46 126-128 53-54 118 -119 30-31 32 60, 61 4, 49-50 19 59-61 59, 84 131 Page Cleanliness Cleansing Clinics Communicable Diseases Complaints Congenital Malformations Contagious Diseases Cremations Cytology- Date Marking of Pood Deaths Dental Inspection Dental Service Dental Treatment Department of Biucation and Science Diphtheria Disrepair - Certificates District Nursing Domiciliary Nursing Drainage Drugs Dust Dwellings, Separately Rated Dysart School Ear. Nose and Throat Treatment Education Act 1944 Education (Handicapped Children) Act 1970 Elderly Persons Environmental Health Epileptic Children Evening Nursing Service Factories Act 1961 Family Planning Family Planning Association Feeding Stuffs Fertilisers 115 57 2, 29-31, 113, 114, 126, 129 2 61, 62, 69, 70, 80 32-33, 34-35 115-116 25 49 68-69 10, 13-18, 125 31-32, 126-128 31-32, 126-128 31-32, 126-128 105, 125 43, 44, 115 92 3, 37-39 3, 37-39 56 69, 70, 72-76 61 10 102, 123 109 104 102 39, 49, 50 4, 53-97 115 37 85-86 3, 48 3, 48 70 70 132 Page fertilisers and Feeding Stuffs Act 1926 Pood Food and Drugs Food Hygiene Food Hygiene (General) Regulations 1960 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 Food Premises Fluoridation of Water General Services Geriatric 'At Risk' Register German Measles Greater London Council Grit Group Attachment Hairdressers Handicapped Pupils Head Lice Heaf Tests Health Centres Health Education Health Visiting Health Committee Hearing Aids Hearing Loss Home Dialysis Home Nursing Hospitals Hostel for Handicapped Pupils Housing Housing Act 1969 Housing Acts Hypothermia Ice Cream Illegitimate Births Immunisation Impetigo Imported Food 70 66-79 69-70, 72-79 69, 79 78 78 66-70 127 23-26 38 43, 101, 117 44 61 37, 39 71 102, 120-123 115 117 2, 29 3, 23-24, 41, 124 3, 39-41 5-6 113-114 113-114 50 37-39 26, 33, 36 120 63-65, 90-92 91-92 90, 91-93 38 67 1, 10 43-44, 101, 116, 117 109 67 133 Page Improvement Areas Improvement Grants Infant Mortality Infectious Diseases Insects Inspections International Certificates of Vaccination Kidney Machines Kingston and District Care Committee Labelling of Food Laboratory Service Late Night Nursing Lice Licensing of Nurses Agencies Loan of Nursing Equipment Marie Curie Memorial Foundation Marriages Mass Miniature Radiography Maternal Deaths Meals Measles Meat Medical Aid Medical Examination of Adults Medical Inspection Metropolitan Water Board Mice Midwifery Service Milk Mortality Rates Mortuary Services Movable Dwellings Multiple Occupation National Assistance Act 1948 - Section 47 National Health Service Act Neonatal Deaths 6 3-64 91-93 10, 11 2, 19-20, 115-116 61-62, 80, 89 81-83, 85 44 50 48 72-74 21 37-38 115 25 49 38-39 19 1, 47 1, 10 124-125 2, 43, 115, 116 67-68, 76, 77 36 25-26, 125 104-109 94, 127 62, 80, 89 36 66, 73, 76, 124-125 10-11 25 65 54 24 29 12 134 Page Night Nursing Service Noise Notices Nurses Agencies Nurse Training Nursing Equipment Nursing Homes Offices, Shops and Railway Premises Act 1963 Ophthalmic Clinics Orthodontic Treatment Orthoptic Treatment Outwork Paratyphoid Fever Penny Rate Product Periodic Medical Inspection Personal Health Services Pest Control Pharmacy and Poisons Act 1933 Riysioth erapy Pigeons Poisons List Poliomyelitis Pollution Population Post-natal Clinics Prevention of Illness Psychiatric Care Public Analyst Public Cleansing Public Health Laboratory Public Health (Prevention of Tuberculosis) Act 1936 Rateable Value Rats Registrar General Registration of Nursing Homes Rehabilitation of Elderly and Handicapped Rent Act 1968 37-38 58-59, 80 84 25 38-39, 40, 41, 42 39, 49 25 57-58, 87 113 127 113 86 19, 44 10 104-109 29-50 61-62, 89 71 115 62, 82, 89 71 43-44, 116 1, 54, 60-61 10 29-30 45-50 38 72 57 66, 67 47 10 62, 80, 89 1 25 37 92 135 Page Reorganisation of National Health Service Riding Establishments Ringworm Rivers Rodents Rubella St.John Ambulance Association St.Philip's School Sale of Welfare Foods Samples Scabies School Clinics School Dental Service School Health Service School Meals School Milk School Population Sewage Disposal Sewerage Sexually Transmitted Diseases Shops Act 1950 Skin Testing Smallpox Smoke Smoke Control Areas Smoke Control Orders Smoking Sonne Dysentery Special Inspection Special Schools Speech Therapy Squirrels Staff Staff Medical Examinations Staff of Health Department Statistics Stillbirths Streams Sulphur Dioxide Sweep Testing Swimming Baths 4, 102 70 109 56 62, 80, 89 43, 116 49 102, 122 30-31 72-76 109 129 126-128 101-129 124-125 124-125 104 56 56 3, 21-22, 23 57 46, 117 44, 115 59-61, 84, 96-97 59-61, 84 59-61, 84 2, 23-24 20 108 102, 120-123 101,110-112 61, 80, 89 7, 104 25-26, 125 7 1, 10-18 10 56 61, 96 113 55 136 Page Tetanus Trade Descriptions Act 1968 Treatment of Diseases and Defects Tuberculin Tests Tuberculosis Typhoid Fever Unfit Foodstuffs Vaccination Venereal Diseases Verminous Conditions Veterinary Surgeons Vision Testing Vital Statistics Wasps Water Supply Welfare Foods Whooping Cough Yellow Fever 43, 116 70 109 46, 117 19, 20, 45-48, 117 19, 44 69-70, 77 43-44, 101, 116-117 3, 21-22, 23 115 70 113 10-11 61 55, 94-95, 127 30-31 43, 44, 116 44