KIN 47 THE HEALTH of the ROYAL BOROUGH of KINGSTON UPON THAMES 1973 Royal Borough of Kingston upon Thames ANNUAL REPORTS of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR ENDED 1973 John C. Birchall, M.B., Ch.B., D.P.H. HEALTH DEPARTMENT, TOLWORTH TOWER, SURBITON, SURREY. TELEPHONE: 01-399 5111 1 ROYAL BOROUGH OF KINGSTON UPON THAMES ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the year 1973 To the Mayor, Aldermen and Councillors Mr.Mayor, Ladies and Gentlemen, I have the honour to present my ninth and the last annual report on the health of the citizens of the Royal Borough and on the local health authority services provided. The reorganisation of the National Health Service marks the close of the era of the Medical Officer of Health and in many ways is a rather sad and nostalgic occasion. Looking back into the history of public health the post of Medical Officer of Health was created in the days when there were large epidemics of infectious disease, the actual causes of which were not known, but nevertheless they had the effect of causing heavy mortality amongst the population. The situation in environmental health which existed in the nineteenth century led to the appointment of the first Medical Officer of Health, Dr.Duncan of Liverpool in 1847 and following this, Dr.Simon was appointed in London in 1848. On 1 April 1974 the post of Medical Officer of Health ceases to exist and the local health authority medical staff, nurses and health services which sire provided by the borough, other than the environmental health service, will be transferred to the newly created Area Health Authority, comprising the Royal Borough of Kingston upon Thames and the London Borough of Richmond upon Thames, together with an overlap area from Elmbridge (formerly Esher). The Kingston and Richmond Area Health Authority will also be responsible for the hospitals in the area and the Executive Council functions which include the general practitioner services, the dental, pharmaceutical and ophthalmic services in the area. The effect of the reorganisation will be that all medical services in the area, apart from occupational health services, will be amalgamated under one authority. In addition to the transfer of services to the new authority, staff will also be transferred and they will enter the new service which must change to meet the needs of the community and provide 2 what we all hope will be an improved Health Service. Whilst the public health service has made great strides in the improvement of the environment and the control of infectious disease, one subject which has proved to be most resistant is the failure to influence the public to any great extent about the ill effects associated with smoking on their health and also the point of view of prevention of dental caries by fluoridation of water supplies. This final report will be divided, as on former occasions, into four sections: vital statistics and general services, personal health, environmental health and school health. Statistical information on the relevant sections is to be found under those headings. I should like to thank my deputy Dr.Fairlamb, also Dr.Isaac, Dr.O'Donovan and Mr.Bellman, Chief Administrative Officer, for their very considerable support. To the staff of the department as a whole my thanks are due for another year of loyal service and my best wishes go with them. I cannot let this final report go by without mentioning Dr.Valerie Wills who transferred into the new Royal Borough in 1965 from Surrey and retired several years ago. Since then she has been extremely active and has continued to give excellent service in the child health and geriatric fields when needed. The Environmental Health services will remain with the borough and they will form a separate department of the Council. I should like to congratulate Mr.Kinton and Mr.Haines on their well deserved appointments as Chief and Deputy Chief Environmental Health Officers respectively and would wish them well for the future. I should like to pay tribute to all doctors practising in the area, whether in general practice or in hospital, and thank them for the help and co-operation which I have received during my period of office. I also thank the Town Clerk and fellow Chief Officers and their staff for the essential part they play in the provision of health services. May I also express my gratitude to the Chairman and Members of the Health and Control Committee for their support and encouragement. Finally I thank you, Mr.Mayor, Ladies and Gentlemen, for your support throughout my period of office, and particularly during 1973. I am, Yours faithfully, JOHN C. BIRCHALL Medical Officer of Health 3 ROYAL BOROUGH OF KINGSTON UPON THAMES HEALTH AND CONTROL COMMITTEE AS AT DECEMBER 1973 Mayor r Councillor John P. Greenwood Leader of the Council: Councillor C. M. Cotton, FRICS, FRVA Leader of the Opposition: Councillor P.F. Alexander Chairman: Alderman A. C. Healey, MSc, PhD, ERIC Vice-Chairman: Alderman R. M. Church Aldermen: J. H. Cocks, OBE J. Harrison Councillors: F. C. Ailes W. E. Crook P. H. Danbury, BA, LLB, Dip.Crim. D. A. Denham, BSc(Lond), PhD(Cantab) N. Howard M. E. Mace F. R. S. Montgomery Mrs. Jenny Philpott Mrs. J. M. F. Webb Co-opted Members: R. J. Fisher A. A. Hunt Mrs. C.M. Waugh L. P. J. Wright, MB, BS, MRCS, LRCP South West London and Surrey Local Dental Committee Kingston and Long Grove Group Hospital Management Committee South West London and Surrey Executive Council South West London and Surrey Local Medical Committee 4 SENIOR STAFF OF THE HEALTH DEPARTMENT Medical Officer of Health J. C. Birchall, MB, ChB, DPH Deputy Medical Officer of Health A. H. Fairlamb, MB, BS, CPH, DPH Senior Medical Officers R. &. Isaac, MRCS, LRCP, DPH Mary J. O'Donovan, MB, BCh, DCH, DPH Chief Dental Officer D. M. Dodd, LDS, BDS, DDPH, RCS Chief Public Health Inspector P. E. Kinton, MRSH, MAPHI Psychiatrist (Child Guidance) Beryl G-. Anscombe, MB, ChB, D(0bst)RC0G, DPM Health Education Officer Mrs. K. L. Sewell, SRN, HV Cert, Soc.Sc.Dip, TTD, NNEB Director of Nursing Services Miss B. L. Shippam, SRN, SCM, Queen's Nurse, HV Certificate Chief Administrative Officer H. A. Sears, DMA (resigned 3.3.73) A. M. Bellman (appointed 5.3.73) CONTENTS VITAL STATISTICS AND GENERAL SERVICES 8 PERSONAL HEALTH SERVICES 27 ENVIRONMENTAL HEALTH SERVICES 49 SCHOOL HEALTH SERVICE 109 VITAL STATISTICS AND GENERAL SERVICES 8 VITAL STATISTICS Area: 9,281 acres Population, estimate of Registrar General at mid-year 1973: 138,620 Rateable Value at 1 April 1973: £26,215,494 Produce of a Penny Rate at 1 April 1973: £258,000 Separately Rated Dwellings at 1 April 1973: 49,927 (Note: the figures for Rateable Value and Produce of a Penny Rate are much higher than in the previous year due to Revaluation having taken place) Live Births: Males Females Total Percentage Legit imate 858 734 1592 94.1 Illegitimate 51 49 100 5.9 909 783 1692 100.0 Crude Birth Rate per 1,000 estimated population 12.2 Adjusted Birth Rate for purposes of comparison using the comparability factor 0.96 11.7 (England and Wales) 13.7 Still Births: (8 males and 8 females) 16.0 Rate per 1,000 live and still births 9.0 (England and Wales) 12.0 Total Births 1708 Deaths: Total (747 males and 819 females) 1566 Crude death rate per 1,000 population 11,3 Adjusted death rate for purposes of comparison using the comparability factor 0.91 10.3 (England and Wales) 12.0 Maternal deaths nil Maternal Mortality rate (including abortion) per 1,000 total live and still births nil (England and Wales) not available Infant Mortality: Infant deaths (infants under one year) Males Females Total Legitimate 17 7 24 Illegitimate 1 - 1 18 7 25 9 VITAL STATISTICS (continued) Mortality rate of all infants per 1,000 live births 15.0 (England and Wales) 17.0 Mortality rate of legitimate infants per 1,000 legitimate live births 15.1 Mortality rate of illegitimate infants per 1,000 illegitimate live births 10.0 Mortality rate of male infants per 1,000 male live births 19.8 Mortality rate of female infants per 1,000 female live births 8.9 Neonatal deaths (under 4 weeks of age) (8 males and 5 females) 13 Neonatal mortality rate per 1,000 live births 7.7 (England and Wales) 11.0 Early neonatal deaths (under 1 week of age) (9 males and 3 females) 11 Early neonatal mortality rate per 1,000 live births 6.5 (England and Wales) 10.0 Perinatal mortality (still births plus deaths under 1 week) 27 Perinatal mortality rate per 1,000 total live and still births 15.6 (England and Wales) 21.0 10 NEONATAL DEATHS Cause of Death Age 0-24 hours Age 1-7 days Age 7-28 days Total Bronchopneumonia - - 1 1 Meningitis (Lumbar Meningomyelocoele) - - 1 1 Prematurity 1 2 - 3 Prematurity (Pulmonary Atelectasis) - 1 - 1 Respiratory Failure/Distress Syndrome (Prematurity) 2 4 - 6 Tracheo-oesophageal Fistula (Aspiration Pneumonia, Prematurity, Multiple Congenital Abnormalities) - 1 - 1 TOTAL 3 8 2 13 11 CAUSES OP DEATH BY AGE Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- 55- 65- Cholera M - - - - - - - - - - - - F - - - - - - - - - - - - Typhoid Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Baoillary Dysentery and Amoebiasis M - - - - - - - - - - - - F - - - - - - - - - - - - Enteritis and Other Diarrhoeal Diseases M - - - - - - - - - - - - F 1 - - - - - - - - - 1 Tuberculosis of Respiratory System M 2 - - - - - - - - - 1 1 F - - - - - - - - - - - - Late Effects of Respiratory T.B M - - - - - - - - - - - - F - - - - - - - - - - - - Other Tuberculosis M - - - - - - - - - - - - Plague F - - - - - - - - - - - - M - - - - - - - - - - - - Diphtheria F - - - - - - - - - - - - M - - - - - - - - - - - - Whooping Cough F - - - - - - - - - - - - M - - - - - - - - - - - - Streptococcal Sore F - - - - - - - - - - - - M - - - - - - - - - - - - Throat and Scarlet Fever F - - - - - - - - - - - - Meningococcal Infection M 1 - 1 - - - - - - - - - F - - - - - - - - - - - - Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - Smallpox M - - - - - - - - - - - - F - - - - - - - - - - - - Measles M - - - - - - - - - - - - F - - - - - - - - - - - - (continued) 12 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- 55- 65- Typhus and other M - - - - - - - - - - - - Rickettsioses F - - - - - - - - - - - - Malaria M - - - - - - - - - - - - F - - - - - - - - - - - - Syphilis and its Sequelae M - - - - - - - - - - - - F 2 - - - - - - - - - 1 1 Other Infective and Parasitic Diseases M 1 - - - - - - - - - - - F 3 - - - - - - - 1 - - 2 Malignant Neoplasm Buccal Cavity etc. M 2 - - - - - - - - 2 - - F 1 - - - - - - - - - 1 - Malignant Neoplasm Oesophagus M 3 - - - - - - - - 2 - 1 F 5 - - - - - - - - 1 3 1 Malignant Neoplasm Stomach M 16 - - - - - - 1 2 1 9 3 F 15 - - - - - - - - 3 8 4 Malignant Neoplasm Intestine M 24 - - - - - - - 1 2 11 10 F 22 - - - - - - - - 4 5 13 Malignant Neoplasm Larynx M 2 - - - - - - - 1 1 F — - - - - - - - - - - - Malignant Neoplasm Lung, Bronchus M 87 - - - - - - - 3 29 42 13 F 31 - - - - - - - 2 9 12 8 Malignant Neoplasm Breast M - - - - - - - - - - - - F 28 - - - - - - 2 6 5 7 8 Malignant Neoplasm Uterus F 14 - - - - - - - 2 7 2 3 Malignant Neoplasm Prostate M 12 - - - - - - - 1 - 5 6 (continued) 13 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- - 55- 65- Leukaemia M 4 - - - - - 1 - 2 1 - - F 4 - - - - - - - 1 - 3 Other Malignant M 45 - - - - 3 2 2 2 14 12 10 Neoplasms etc F 54 - - - - 1 - 1 3 12 14 23 TOTAL all forms 369 - - - - 4 3 6 24 93 132 107 of Cancer Benign and Unspecified Neoplasms M 3 - - - - - - - - 1 1 1 F 3 - - - - - - - 2 1 - - Diabetes Mellitus M 5 - - - - - - 1 - - 2 2 F 6 - - - - - - - 1 - 1 4 Avitaminoses and other nutritional M - - - - - - - - - - - - F - - - - - - - - - - - - Deficiencies Other Endocrine, - M 2 - - - - - - - - - 1 1 Nutritional and Metabolic Diseases F 2 - - - - - - - - - 1 1 Anaemias M - - - - - - - - - - - - F 2 - - - - - - - - - - 2 Other Diseases of Blood and Bloodforming Organs M - - - - - - - - - - - - F - - - - - - - - - - - - Mental Disorders M 1 - - - - 1 - - - - - - F 1 - - - - 1 - - - - - - Meningitis M - - - - - - - - - - - - F 1 - - - - - - - 1 - - - Multiple Sclerosis M 1 - - - - - - - - 1 - - F 2 - - - - - 1 - - - - 1 Other Diseases of Nervous System etc M 7 - - - - - 1 - - 2 2 2 F 4 - - - - - - - 1 - - 3 (continued) 14 CAUSES OP DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- 55- 65- Active Rheumatic Fever M - - - - - - - - - - - - F - - - - - - - - - - - - Chronic Rheumatic Heart Disease M 6 - - - - - - - 1 2 2 1 F 11 - - - - - - - - 1 4 6 Hypertensive Heart Disease M 3 - - - - - - - - 1 1 1 F 17 - - - - - - - - 1 2 14 Ischaemic Heart Disease M 184 - - - - - - 2 20 34 63 65 F 165 - - - - - - - 4 18 40 103 Other Forms of Heart Disease M 39 - - - - - 1 - 3 4 4 27 F 53 - - - - - - - 1 2 4 46 Cerebrovascular Disease M 74 - - - - - 1 1 2 12 24 34 F 132 - - - - - - - 2 10 17 103 Other Diseases of Circulatory System M 24 - - - - - - - 4 3 9 8 F 32 - - - - - - - - 1 10 21 TOTAL Heart and Circulatory Diseases 740 - - - - - 2 3 37 89 180 429 Influenza M 2 - - - - - - - - 2 - - F 1 - - - - - - - - - - 1 Pneumonia M 71 - 4 - - - - 1 1 2 15 48 F 125 1 1 - - 1 - 1 - 3 20 98 Bronchitis and Enphysema F 43 - - - - - - - 1 8 19 15 F 10 - - - - - - - - 2 2 6 Asthma M 2 - - - - - - - - 2 - - F 1 - - - - - - - - 1 - - Other Diseases of Respiratory System M 3 - - - 1 - - - - - 2 - F 3 - 1 - - - - - - 1 — 1 Peptic Ulcer M 7 - - - - - - 1 1 - 3 2 F 3 - - - - - - - 1 - 1 1 (continued) 15 CAUSES OF DEATH BY AGE (continued) Cause of Death Sex Total all Ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- 55- 65- Appendicitis M - - - - - - - - - - - - F - - - - - - - - - - - - Intestinal Obstruction and Hernia M 3 — - - - - - - - - 1 2 F 5 - - - - - - - - - 3 2 Cirrhosis of Liver M 3 - - - - - - - - 2 1 - F 4 - - - - - - - - 2 1 1 Other Diseases of Digestive System M 2 - - - - 1 - - - - - 1 F 13 - - - - - - - - 2 1 10 Nephritis and Nephrosis M 1 - - - - - - 1 - - - - Hyperplasia of Prostate F 1 - - - - - - - - - - 1 M 2 - - - - - - - - - - 2 Other Diseases, Genitourinary System M 3 - - - - - - - - - 1 2 F 4 - - - - - - - - 1 - 3 Abortion F - - - - - - - - - - - - Other Complications of Pregnancy, Childbirth and Puerperium F 1 - - - - - - 1 - - - - Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F - - - - - - - - - - - - Diseases of Musculoskeletal System M 2 - - - - - - - 1 - 1 - F 2 - - - - - - - - - 2 - Congenital Anomalies M 10 1 1 1 1 1 1 - 1 1 2 - F 5 1 - 1 - - - - - - 1 2 Birth Injury, Difficult Labour etc M 5 5 - - - - - - - - - - F 3 3 - - - - - - - - - - Other Causes of Perinatal Mortality M 3 3 - - - - - - - - - - F - — - - - - - - - - - - (continued) 16 CAUSES CF DEATH BY ACE (continued) Cause of Death Sex Total all Ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 75 and over 1- 5- 15- 25- 35- 45- - 55- 65- Symptoms and Illdefined Conditions M 3 - 2 - - - - - - - 1 - F 6 - - - - - - - - - - 6 Motor Vehicle Accidents M 11 - - - 1 3 1 1 1 1 - 3 F 6 - - - - - - - - 4 1 1 All Other Accidents M 10 - - 2 - - 1 - 2 1 2 2 F 5 - - - - - 1 - 1 1 1 1 Suicide and Selfinflicted Injuries M 8 - - - - 1 1 3 - - 2 1 F 9 - - - - 1 - 2 1 1 3 1 All Other External Causes M 5 - - - - - - 2 1 2 - - F 1 - - - - - - 1 - - - - TOTAL Accidents, Suicide and Violence 55 - - 2 1 5 4 9 6 10 9 9 TOTAL ALL CAUSES M 747 9 9 3 3 10 10 16 50 132 240 265 F 819 5 2 1 - 4 2 8 29 94 168 506 17 ANALYSIS OF MARRIAGES 1973 1,108 marriages were registered in the borough during 1973. Of these, 312 were Church of England marriages and 796 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 Measles Acute Meningitis Ophthalmia Neonatorum Acute Poliomyelitis Paratyphoid Fever Anthrax Plague Cholera Relapsing Fever Diphtheria Scarlet Fever Dysentery (Amoebic or Bacillary ) Smallpox Food Poisoning (or Suspected Tetanus Food Poisoning) Tuberculosis Infective Jaundice Typhoid Fever Leprosy Typhus Leptospirosis Whooping Cough Malaria Yellow Fever The following table shows the numbers of cases notified during 1973 by age groups: Disease Under 5 5-14 15-44 45-64 65 and over Total Scarlet Fever 7 17 2 - - 26 Measles 500 336 18 - - 854 Dysentery 5 2 7 - - 14 Infective Jaundice - 1 3 3 - 7 Tuberculosis, Respiratory 1 2 13 10 6 32 Tuberculosis, other - 1 5 2 1 9 Acute Meningitis 1 - - - - 1 Malaria - - 1 - - 1 Whooping Cough 7 6 - - - 13 TOTALS 521 365 49 15 7 957 18 Sonne Dysentery 14 cases occurred during the year; two of these were of school age. Tuberculosis There were 32 cases of respiratory tuberculosis and 9 cases of non-respiratory tuberculosis. Two deaths ocourred from respiratory tuberculosis. Comparative Table of Notified Infectious Diseases 1967-1973 Disease 1967 1968 1969 1970 1971 1972 1973 Scarlet Fever 33 20 86 41 27 21 26 Measles 1899 293 283 458 758 221 854 Whooping Cough 34 20 10 25 17 - 13 Acute Infective Eneephalitis: Post-infective 1 — - — - — Infective - — — — — - Typhoid and Paratyphoid Fevers 1 - 2 - 1 2 - Food Poisoning 4 - 8 - 4 - - Infective Jaundice - 5 14 37 16 20 7 Dysentery 72 27 104 15 4 23 14 Tuberculosis, Respiratory 46 35 31 29 33 25 32 Tuberculosis, other 1 4 7 4 13 6 9 Leptospirosis - - 1 - - 1 - Acute Meningitis - - 2 - 1 - 1 Malaria - " " " 1 " 1 19 Laboratory Service Bacteriological and viral specimens are dealt with by the Public Health Laboratory at Epsom and also by Kingston Hospital Laboratory. Sexually Transmitted Diseases The following figures were taken from returns submitted by the physicians in charge of the treatment centres shown, and they relate to new cases occurring among borough residents: Treatment Centre Totals all conditions Syphilis Gonorrhoea Other Conditions Primary and Secondary Other Croydon General Hospital 7 1 — 1 5 St.Thomas's Hospital, SE1 110 - - 10 100 St.Bartholomew's Hospital, EC1 9 - - 1 8 Westminster Hospital, SW1 31 - - 4 27 St.Helier Hospital Carshalton 229 1 — 18 210 Central Middlesex Hospital, Park Royal NW 10 3 — — — 3 Dreadnought Seamen's Hospital, Greenwich 1 — - - 1 Whitechapel Clinic, London Hospital, E1 9 - - 2 7 TOTALS 399 2 - 36 361 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. 20 Control of these diseases is attempted by trying to ensure that not only the infected persons receive treatment, but that their contacts, ie, 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. 21 GENERAL SERVICES HEALTH EDUCATION Health education activities during 1973 were very similar to those of the previous year. Despite staff shortage during the latter part of the year, planned group activities were increased as compared with the previous year although the numbers attending were lower. Recorded Sessions 1972 1973 Schools 200 266 Clinics 503 527 Clubs 121 87 Other groups 107 74 Total number in audiences 17,966 16,056 No records are kept of the small group discussions and individual teachings by health department staff, mainly health visitors. Subjects covered in health education programmes included all aspects of personal and environmental health and, as in previous years, there was a definite theme for each month. This theme was emphasised in display material in Council establishments and other suitable outside sites. Oral hygiene was stressed during March and April, when five year old schoolchildren were shown films and encouraged in dental care. Family planning and cervical cytology were other subjects to receive special attention and it was encouraging to notice an apparent increase in the numbers of persons using these services towards the end of the year. Assistance was given to the Kingston Association for Mental Health with their campaign during October. There was continued co-operation with other Council departments, especially with the Education Department. Close links with the schools and teachers centre were maintained and the increasing interest in health education by school staffs is reflected in the number of requests they made for help, especially in the use of audi-visual aids and literature. Two smoking advisory courses, each of six weeks duration, were 22 held during the year. Attendances were lower than in previous years but the success rates were higher: 70 per cent for the first course and 100 per cent for the second course, which was however attended by only six persons. NATIONAL ASSISTANCE ACT 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT 1951 Action can be taken under these Acts for compulsory removal of persons to suitable premises in circumstances where they are: (a) suffering from grave chronic disease, or being aged, infirm or physically incapacitated, are living in insanitary conditions. (b) unable to look after themselves and are not receiving proper care and attention from other persons. It is emphasised that removal of a person to "suitable premises" for the reasons stated above is only undertaken with great reluctance. Mr.A.B. aged 86 years An approach was made by this patient's doctor on 6 February 1973 asking for help in getting the patient into hospital. He was dirty and ill and suffering from hypothermia. He was living alone and his condition had become serious; he had refused to go into hospital voluntarily. He was admitted on the same day to Tolworth Hospital and died on 20 February 1973. Miss E.F aged 73 years This lady living in sheltered accommodation, was suffering from advanced cancer. She had been visited by members of the staff of the health department for many months and in spite of the support given, she was living in insanitary conditions. She refused to enter hospital of her own accord and was admitted to Kingston Hospital on 22 June 1973. She died on 13 July 1973. Compulsory removal was also considered in a number of other cases but fortunately this action did not have to be taken. REGISTRATION OF NURSING HOMES The Borough Council is the registration authority for nursing homes under Part VI of the Public Health Act 1936. No homes were 23 registered during 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 1968, 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. Three nurses agencies are currently licensed by this authority. CREMATIONS The medical officer of health, his deputy, 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 1,429 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 447 candidates for appointment to the Council's staff were examined as to their fitness for employment. An additional 547 were accepted on completion of a medical history form, without actual examination. 221 newly appointed teachers and candidates for admission to teacher training colleges were medically examined as required by the Department of Education and Science. 332 teachers were considered fit upon completion of a medical history form. 24 HOSPITAL SERVICES The borough is well served by hospital services and the following hospitals are situated within the borough boundaries: Hospital Services Available Royal Eye Hospital Upper Brighton Road Surbiton Ophthalmic, Refraction sessions Kingston Hospital Wolverton Avenue Kingston upon Thames Medical, Surgical, Fracture, Paediatric, Gynaecology, Ear, Nose and Throat, Maternity, Orthopaedic, Psychiatric, Adolescent, Orthodontic, Rheumatology, Diabetic, Dermatology, Ophthalmology, Pathology, Chest Diseases, Oral Surgery, Plastic Surgery Tolworth Hospital Red Lion Road Tolworth Geriatric Rehabilitation and Day Hospital, Chest Diseases, Paediatrics Surbiton General Hospital Ewell Road, Surbiton Medical, Surgical, Ear, Nose and Throat, Fracture, Orthopaedic, Gynaecology, Pathology, Psychiatric PERSONAL HEALTH SERVICES 27 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 new clinic at Hawks Road, Kingston, was opened in July and replaces Grange Road Clinic at Kingston. Unfortunately little progress has been made as regards the projected new clinic at Alpha Road, Surbiton, which is intended to replace the old clinic in South Place. The delay is mainly due to financial restrictions imposed by the Department of Health and Social Security. The fact that the project is for a clinic as distinct from a health centre has resulted in the project being given a comparatively low priority. CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and Post-natal Clinics There are six Council owned clinics at which ante and postnatal sessions are held. These are attended by medical officers and health visitors, and most of them by midwives. The following table gives the details, but in addition, midwives held 117 sessions at these clinics and at the Surbiton and Maiden District Nurses Homes, at which 88 women made 330 attendances. 4,869 attendances were made at ante-natal, mothercraft and relaxation classes held at the clinics listed. There were, in addition, 323 sessions held by general practitioners to whose practices borough midwives are attached. 354 mothers made 3,453 attendances at these sessions. 28 Address of Clinic Number of sessions held during the year Number of women who attended Total attendances Ante-natal Post-natal Hawks Road, Kingston 51 16 12 115 Acre Road, Kingston 50 18 8 114 Roselands, New Maiden 51 14 3 111 Manor Drive, Worcester Park 12* - - - South Place, Surbiton 50 39 15 241 Gosbury Hill, Hook 25 10 5 47 TOTALS 259 97 43 658 * These were combined ante-natal and cytology sessions at which no ante-natal patients attended. 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: 29 Surbiton, WRVS 154 Ewell Road Mon. Tues. ) Thurs. Fri. ) 10.00 - 12 noon 2.00 - 4 pm New Maiden WRVS Blagdon Road Mon. Tues. ) Thurs. Frid.) 10.00 - 12.30 pm 2.00 - 4.30 pm The following table shows the sessions held and atterdances at each of the various child welfare clinics: Address of Clinic Number of sessions during year Number of children who attended Total attendances Hawks Road, Kingston 128 472 3209 Acre Road, Kingston 99 707 3426 Kingston Vale 11 37 135 Roselands, New Maiden 155 621 2737 Manor Drive, Worcester Park 124 947 4637 South Place, Surbiton 154 541 4169 Hamilton Avenue, Tolworth 100 554 2852 Gosbury Hill, Hook 152 517 3626 St.Mary's Church Hall, Chessington 51 205 1412 TOTALS 974 4601 26,203 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: 30  Children Aged 0-4 inclusive Expectant and Nursing Mothers Inspected 401 43 Requiring Treatment 204 37 Offered Treatment 196 36 Treated 191 41 Visits for Treatment 509 98 Fillings 373 70 Teeth Filled 338 62 Teeth Extracted 53 16 General Anaesthetics 32 - Patients X-rayed 2 14 Scalings and Gum Treatment 96 33 Teeth otherwise conserved 78 - Completed course of treatment 232 27 Dentures Provided: full - partial - - Treatment Sessions 112 combined 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. 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 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. 31 It is pleasing to record the very highest co-operation of all concerned in this most important work. Forty-eight babies were notified at birth as congenitally malformed. Of these, six were stillborn and two subsequently died, the deaths being the direct result of the abnormality notified. 32 CONGENITAL MALFORMATIONS 1973 Total Malformations Reported Central Nervous System Eye and Ear Alimentary System Heart and Circulatory System 65 (48 children) 5 (5 children) 4 (3 children) 11 (7 children) 7 (5 children) 4 Anencephalus 1 Rudimentary ears 1 Oesophageal atresia 1 Hole in Heart 1 Meningomyelocele 1 Colomba of eyelid 1 Narrowed aorta 3 Hare lip 3 Systolic murmur 1 Dermato-lipomata cornea 3 Cleft palate 1 Interatrial septum 1 Hirschsprung's disease 1 Small pinna with pinhole external meatus 1 Dextrocardia 1 Tracheooesophageal fistula 1 Intestinal atresia 1 Imperforate anus 33 CONGENITAL MALFORMATIONS 1973 Respiratory System Urinogenital System Limbs Other Parts of Musculoskeletal System Other Systems Other Malformations 1 (1 child) 16 (16 children) 17 (14 children) 1 (1 child) 2 (2 children) 1 (1 child) 1 Lungs haemorrhagic tissue 7 Hypospadias 7 Talipes 1 Bilateral clicking hips 1 Pigmented naevus 1 Down1s syndrome 6 Hydrocele 1 Forearms short and distorted 1 Foetal lobulation of kidneys 1 Haemangioma 3 Absence of fingers and thumbs 1 Undescended testicles 1 Abnormal skinfold, penis 2 Congenital dislocation of hips 2 Syndactyly 1 Polydactyly 1 Outward turns foot 34 THE NURSING SERVICES MANAGEMENT STRUCTURE The new nursing management structure as recommended by the Mayston Committee was introduced during the year. This provided for the appointment of a director of nursing services as top manager, two area nursing officers as middle managers and four nursing officers as lower middle managers. The area nursing officers and nursing officers have functional responsibilities for specific groups of nursing and midwifery staff and health visiting staff. The structure corresponds in principle to the new nursing structure recently introduced into the hospital service as a result of the recommendations of the Salmon Committee. These arrangements will provide for a progressive career structure for those nurses who are interested in administrative and personnel duties. SOCIAL SERVICES LIAISON A nursing officer visits the authority's old people's homes to advise on problems of incontinence, diet, rehabilitation, and the lifting of patients. Nursing officers are members of a working party set up by the Social Services Department to decide action in cases of child abuse. A case register of neglected children and those at risk is kept in the Social Services Department and health visitors report regularly upon the children under observation, and attend case conferences. Membership support is given by nursing officers to the Community Voluntary Services and Old People's Welfare Committees. MIDWIFERY SERVICE There was a continuation of the trend towards hospital confinements and there were only 27 domiciliary confinements within the borough during the year. 516 patients were discharged home early after hospital delivery to be cared for by the domiciliary midwives, including 40 who had been admitted to the special unit at Kingston Hospital where deliveries are undertaken by the patients' general practitioners and district midwives. 35 District midwives attended 323 ante-natal clinic sessions in doctors' surgeries and 354 mothers made 3453 attendances at these sessions. 117 sessions were held by midwives in Nurses Homes, including booking sessions. District midwives attended 131 sessions at Kingston Hospital to see patients being discharged early. One part time district midwife attends the ante-natal clinics to advise patients on the care available in the community. Home conditions are assessed and reported to hospital by the district midwives. The following visits were paid by district midwives during the year: Post-natal 6652 Home assessments for discharge 497 Ante-natal visits 640 Ante-natal visits in labour 101 Training There was continued liaison between the hospital and the community service for the training of Part II pupil midwives. Opportunities for obstetric experience in the community is limited but the pupils are informed of the availability of the community services including the continuity of ante and post-natal care outside hospital. The Central Midwives Board has approved plans for integrated pupil training when the hospital staff establishment is adequate. HOME NURSIN& SERVICE This service has continued at about the same level as previously but it has not proved possible to recruit and maintain sufficient nursing auxiliaries mainly, it is felt, due to the poor remuneration. Furthermore it has been necessary to introduce some flexibility into the working times of nurses. This was partly due to the extension of hospital day care which in turn resulted in a necessary extension of night care in the domiciliary service. 36 Training Chiswick College of Further Education, Ewell College of Further Education and the University of Surrey have provided courses for district nurses training for both State registered and enrolled nurses employment in the borough. Two district nurses attended a practical work instructor's course at the North London Polytechnic. 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, hoists, electric suction apparatus, ripple beds and easi-nurse mattresses. Disposable aids for incontinent patients are also issued free. Much assistance with the provision of special equipment for special cases is received from the Surbiton and Kingston Nursing Association. HEALTH VISITING The health visiting service continued to operate in very much the same way as during the previous year with the health visitors responsible for visiting families on the lists of general practitioners to whom they were attached. In addition 413 sessions were devoted to health education and 293 of these were at schools. Training All three of the student health visitors sponsored by the authority were successful at the examination and have taken up appointments as health visitors. There continues to be close co-operation with Ewell College of Further Education, Chiswick College of Further Education and the University of Surrey with regard to health visitor and fieldwork instructor training. Geriatrics One health visitor is responsible for maintaining a link between the hospital and the patients in their own homes. She visits patients for the purpose of assessment at the request of either the geriatrician at the hospital or of the health visitor attached to the patient's family practitioner. A nursing officer is a member of the Geriatric Liaison Committee which reviews local services for the elderly. 37 Children Nursing officer liaison continues with the staff of children's wards in the hospital concerning the referral of special problems and health visitors are notified of child casualties. These notifications assist the health visitors to identify need for health teaching either for individual parents or groups. It also helps to identify "abused children" if any such children attend frequently as a result of minor injuries. Chest Clinic Health Visitor One health visitor is attached to the Chest Clinic at Kingston Hospital and is responsible for tracing contacts of tuberculosis and for the fallow up of Bacillus Calmette-Guerin vaccinations. 38 VACCINATION AND IMMUNISATION The acceptance rate by parents for vaccination and immunisation in the borough was up to the national average for protection against diphtheria and whooping cough. 270 girls in their twelfth year of life received injections against rubella 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 – 13 Whooping Cough only – – Tetanus only 28 792 Combined Diphtheria and Whooping Cough – – Combined Diphtheria and Tetanus 145 1256 Combined Diphtheria, Whooping Cough and Tetanus 1288 375 Poliomyelitis only 1419 2543 Quadruple – – Measles 884 – Rubella 270 — Total children receiving immunisation against the five illnesses whether given separately or combined: Primary Course Booster Diphtheria 1433 1644 Whooping Cough 1288 375 Tetanus 1461 2423 Poliomyelitis 1419 2543 Measles 884 ~~ 39 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. Up to 3 June 1973 Grange Road Clinic was the centre for this area but on that date it was closed in order to permit of the extensions to Bedelsford School. Prom 4 June the Manor Drive Health Centre has been the yellow fever vaccination centre for this area. A fee of £1.05 is charged for the vaccination. During 1973 1236 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 far travel abroad. The following table shows the percentage of children vaccinated and immunised in Kingston upon Thames, compared with the national average: Percentage of Children Born in 1971 Vaccinated by 31.12.73 Whooping Cough (1) Diphtheria (2) Poliomyelitis (3) England and Wales 79 81 80 Kingston upon Thames 74 79 80 The figures in columns (1) to (3) are calculated to show the percentage of children born in 1971 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. 40 PREVENTION OF ILLNESS, CARE AND AFTER CARE Tuberculosis The measures for the prevention, control and treatment of tuberculosis are directed by the chest physicians and staff of the Chest Clinic at Kingston Hospital. During 1973, 41 cases were notified in the borough and of these, 32 were pulmonary and 9 non-pulmonary, compared with the previous year's figures of 25 and 6 respectively. The 32 pulmonary cases were in the undermentioned stages of the disease: A or Tuberculosis - (sputum negative) 11 B.1 or Tuberculosis + (early cases, sputum positive) 4 B.2 or Tuberculosis + (intermediate cases, sputum positive) 10 B.3 or Tuberculosis + (advanced cases, sputum positive) 7 The non-pulmonary cases were: Glands of neck 2 Kidney 2 Intestinal mesenteric 1 Spine 1 Abdomen 1 Finger 1 Urogenital 1 On 1 January 1973 there were 331 cases on the register and at the end of the year 317. Pulmonary Non-Pulmonary Total Males 154 21 175 Females 114 28 142 TOTALS 268 49 317 41 The following tables show the work undertaken by the Chest Clinic at Kingston Hospital during 1973, in so far as it affects patients resident in the borough: Number of chest clinic sessions held 396 Number of attendances: New patients 962 Old patients 3604 4366 Average attendances per session 12 Tuberculin Tests and BCG Vaccinations Contacts School Children and Students Others Skin tested 124 51 85 Found positive 13 17 21 Found negative 61 23 29 Vaccinated 42 15 22 There were two deaths from pulmonary tuberculosis during the year. The following table shows comparative figures of notified cases and deaths for the years 1962-1973 inclusive: Year Cases Notified Deaths Respiratory Non-respiratory Total Respiratory Nonrespiratory Total 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 1973 32 9 41 2 – 2 42 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. New Cases Death 3 Category | 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 - 1 1 2 2 1 5 3 5 20 - - - - - - - - 2 2 Tuberculosis F - - 1 4 2 2 2 - 1 12 - - - - - - - - - - T - 1 2 6 4 3 7 3 6 32 - - - - - - - - 2 2 Non- Respiratory M - - 1 1 1 1 1 1 1 7 - - - - - - - - - Tuberculosis F - - - - - - - - - 2 - - - - - - - - - - T - - 1 1 3 1 1 1 1 9 - - - - - - - - - - 43 Kingston and District Care Committee Help is given to tuberculosis and other chest disease patients and their dependants by the Kingston and District Care Committee. During 1973, 32 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. Requests for help are tending to fall into two main categories: elderly chest sufferers needing assistance to keep their homes reasonably warm, and a smaller group which seeks help for family holidays. 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 883 doctor sessions were held which were attended by 1744 new patients. There was a total of 14,873 clinic attendances. Details of family planning clinics currently being held are as follows: Roselands Tuesdays 6.30 to 8.30 pm 163 Kingston Road, New Maiden 2nd & 4th Thursdays 9.30 to 11.30 am Appointments: Phone 942 0734 South Place Mondays, Wednesdays Surbiton and Thursdays 6.30 to 8.00 pm Fridays 9.30 to 10.30 am Appointments: Phone 399 8898 204 Acre Road Wednesdays and Kingston upon Thames Thursdays 7 to 8.30 pm Appointments: Phone 546 5812 1 Gosbury Hill Tuesdays and 2nd Hook, Chessington & 4th Thursdays 7 to 8.30 pm Appointments: Phone 397 5737 The Manor Drive Wednesdays 10 am to 11.30 am Worcester Park 7 to 8.30 pm Fridays 10 am to 11.30 am Appointments: Phone 337 0246 Hawks Road Thursdays 1.30 to 3.30 pm Kingston upon Thames Appointments: Phone 546 1115 44 CERVICAL CYTOLOGY 5298 cervical cytology reports were received in respect of Kingston residents during 1973. In January of that year a five year recall system was instituted and recall letters were sent to 834 borough residents with the following results: 196 appointments were made 475 recall letters remained unanswered 163 had had cytology tests during the past five years LOAN OF NURSING EQUIPMENT The Kingston and Surbiton divisions of the British Red Cross Society operate a scheme for the loan of nursing equipment on behalf of the borough council. The scheme is intended to facilitate simple short term nursing care in the patients' homes, and under the arrangement deposits are collected from patients by the British Red Cross Society and refunded to them when the equipment is returned. A total of 410 loans of nursing equipment were made during the year. The borough council made 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 1973, 23 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: 45 A. Persons treated during the year Persons of pensionable age and over Local Authority Voluntary Organisations Total 3603 627 4230 Expectant mothers 2 - 2 Physically handicapped, under 65 54 - 54 Blind, under 65 1 - 1 Mentally handicapped 2 - 2 TOTALS 3662 627 4289 B. Treatments given during the year Local Authority Voluntary Organisations Total In clinics 2388 2388 In Patients' homes 6401 956 6401 In old People's homes 956 - 956 In Chiropodists' surgeries 10,704 - 10,704 TOTALS 18,061 2388 20,449 HOME DIALYSIS Three applications were received for homes to be adapted for home dialysis during 1973. In two cases this was achieved by the provision of mobile units and the third patient left the area before any action to adapt his home could be taken. One patient who had been on home dialysis from the previous year died during August. At the end of the year there were nine patients on home dialysis in the borough. One of these died in January 1974. ENVIRONMENTAL HEALTH SERVICES 49 REPORT OF CHIEF PUBLIC HEALTH INSPECTOR P.E. KINTON. W.A.P.H. I.. M.R.S.H. It is with pleasure that I can report upon the greatly improved staffing situation due to the action taken by the Council to improve the structure of the section and the embargo placed upon the movement of staff out of London. The department has been fortunate to attract enthusiastic newly qualified and experienced staff and it is to be hoped that they will find job satisfaction with this authority and prove to be of service to the Council and to the ratepayers. The Council appointed Mr. R.E. Haines to be Deputy Chief Public Health Inspector in succession to Mr. G.C. Smith who resigned through ill health. During the year under review there has been a great upsurge of activity in the housing, noise abatement and food and drugs aspects of the department's work due to new and proposed legislation and scientific investigations undertaken. The report contains reference to action taken in connection with improvement grant procedures, planning and noise, traffic noise, pollution investigation and temperature control of food display cabinets. The Land Compensation Act 1973 and the Noise Insulation Regulations 1973 will greatly increase the local authority's ability to protect the residents and will place considerable responsibility on the department. During the latter part of the year the attention of the nation was dramatically drawn to the "energy crisis". The nation, local authorities and individuals will need to be increasingly aware of the need to conserve our resources, recycle materials and avoid waste for both our economic and environmental well being. The plagues of infectious disease, slums and malnutrition are no longer the main targets for Health Departments. Pollution prevention whether it be the air we breathe, the food we eat or the water we drink, are of immense importance and combined with the world's increasing population and consumption of raw materials pollution assumes a new importance. This report is being produced before the 1st April when the Health Department functions will be divided into the new Environmental Health Department and the reorganised National Health Service. 50 The staff of the Environmental Health Section are grateful to the Council for establishing an Environmental Health Department to be led by a Chief Officer. I regard it as an honour to have been appointed the Council's first Chief Environmental Health Officer. In establishing a separate department the Council has recognised the importance of our work and the increasingly vital role we have to play in the future to secure a healthy environment. It is appropriate to record our appreciation to the Medical Officer of Health on his retirement and to the Personal Health staff on their departure into the National Health Service. Mr. Mitchell and Mr. Elms, Administrative Officers in the section have each served this authority and its predecessors for over 40 years, and Miss Foister for 28 years and they will be retiring during April 1974. 110 years of loyal and faithful service from these three officers is quite outstanding and their service is grateefully acknowledged. The 1st April 1974 heralds the advent of a new era in Environmental Health. Whilst great progress has been made over the years much remains to be achieved. New problems will arise and by a progressive approach, modern techniques, enthusiastic and well informed staff it is anticipated that the new department will prove to be of great value to the authority and of service to the individuals in the community. The support and encouragement received from the Chairman and Vice-Chairman of the Health and Control Committee and all members of the Council is gratefully acknowledged and the co-operation of the Chief Officers and colleagues in the Health and all departments is much appreciated. P.E. KINTON. Chief Public Health Inspector. 51 ENVIRONMENTAL HEALTH 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 seven occasions samples were taken from private houses and shops and all were satisfactory. 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, 127 samples were taken during the year for bacteriological examination of which 113 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 20 samples were taken for bacteriological examination, one of which was unsatisfactory. (b) School Pools. One private school has a swimming pool fitted with filtration plant and sterilisation is effected by hand dosing with sodium hypochlorite. Nine primary schools have swimming pools with treatment plants. In addition to numerous poolside tests, 68 samples of water were taken for bacteriological examination, of which six were reported as having a count higher than desirable due to inadequate chlorination. 52 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. During the course of the year there would appear to have been a marginal improvement to the condition of the water-courses and streams. The public, in general, have become increasingly aware of the "environment" and "conservation" and readily complain concerning conditions. However, the problem of the dumping of rubbish in streams still exists despite greater publicity concerning the free tipping facilities provided in the borough. The pollution of the Thames from litter and waste arising from the houseboats remains a problem despite the Council restricting the use of the riverside moorings, in its ownership, to non-residential use. Whilst the quality of the water in the Thames has improved it is not fit for bathing. Reports are frequently received from the public, Thames Conservancy and Greater London Council about the pollution of water-courses by oil and other deleterious substances. These are investigated in co-operation with officers of the Borough Engineer and Surveyor's department, but such work is often difficult and time consuming. However, in some cases it has been possible to trace the source and prevent further pollution. It is sometimes found that premises in which oil is liable to be spilled are not equipped with proper oil interceptors and, where such interceptors are fitted, they are not always properly maintained. It is considered that a more effective way of overcoming the problem is the routine surveillance of those industrial and commercial undertakings which are at risk in this respect when managements can be advised as to the precautions necessary to prevent river pollution. Another likely source of oil pollution arises from the activities of private motorists who change their own engine oil. In view of the present high price of oil products, waste oil should not be thrown away, but proper facilities should be provided for collection at central points from which it could be economically transported to waste oil processing plants. 53 4. DRAINAGE AND SEWERAGE Other than a few houses in Chessington, all dwellings are connected to the main sewerage system. A small quantity of sewage is discharged to the sewage disposal works of the Greater London Council at Worcester Park and the Wandle Valley Works, otherwise all sewage is treated at the Hogsmill Valley Sewage Treatment Works which is sited at Lower Marsh Lane. During the course of the year, there was a considerable increase in the drainage works and repairs initiated by the department. Over 1,300 complaints were received concerning blocked and defective drainage systems. Problems often arise in the older area of the borough which were built prior to this century. Many cases involved lengthy investigations, especially with regard to responsibility for combined drainage systems. Where necessary, legal notices were served to ensure the repair of defects. Assistance was given to residents affected by the flooding incident of the 6th July when a freak storm caused substantial storm-water flooding to parts of Tolworth, Hook and Chessington. Public Health Inspectors visited many properties giving advice and assistance and an information sheet was distributed to all properties known to have been affected. 5. PUBLIC CLEANSING The Borough Engineer and Surveyor is responsible for the collection and delivery of refuse to a central loading point whence it is hauled in large vehicles to tips operated by contractors employed by the Greater London Council, who are responsible for the disposal of refuse. The total amount of domestic refuse passing over the weighbridge during the year ended 31st December, 1973 was 46,190 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. A number of complaints were received during the year concerning Sunday trading. In all instances, appropriate advice was given to shopkeepers and no legal proceedings were necessary. 7. OFFICES. SHOPS AND RAILWAY PREMISES ACT. 1963 Enforcement of the Act. The statistical information detailed at the end of this report shows that, as in previous years, the most common deficiencies brought to the attention of the occupiers of premises were generally of a 54 minor nature but toilet facilities again figured prominently as did the lack of adequate care of floors, passage-ways and staircases. Registration is neglected by most occupiers of premises. Of nearly two hundred registration forms received in 1973 less than a dozen were received on the occupier's initiative. Generally, occupiers of premises were aware of their responsibilities under this legislation and where contraventions were observed, in the main, little difficulty was experienced in enforcement. However, some were reluctant to meet their obligations under the Act and although in most of these cases the suggestion of legal proceedings had the desired effect, it was found necessary to institute legal proceedings in one instance, a florist, but as the shop closed before the date of the hearing the case was adjourned sine die. Review of the first ten years. The problem of providing adequate ventilation has not been helped by lower ceilings, providing less space for movement of air; the installation of false ceilings and partitions to change 'ancient' to 'modern' often obscuring windows, rooflights, etc. which formerly provided ventilation and natural lighting; the problem is compounded by the consequent lowering and intensifying of artificial lighting with its resultant heat gain; in shops the simple, quickly installed plate glass shop front and the improvement in artificial lighting standards have all contributed to the need for effective means of ventilation. Where these conditions prevail it is no longer a question of opening a door or windows (if there are any which open) but a need for an efficient means of mechanical ventilation to introduce or extract air in sufficient quantity to cope with these new considerations. Lighting generally has significantly improved over the period of the Act although natural lighting tends to have lost ground in shops and smaller offices though not so in the larger office blocks with large or open plan offices. The standard of artificial lighting is considerably better with the widespread use of modern fluorescent fittings which have extremely good lighting properties without undue glare. Employers have realised the benefits of good artificial lighting both from the safety angle in passageways, stairs, etc. and in its effect in the increase in accuracy and efficiency. 55 There would appear to have been little deterioration in maintaining the standard of available space even with the increase in cost of business premises. The minimum specified in the Act, in fact, is at about the level at which a well equipped office can sensibly cope. Strangely, the few problems of overcrowding which have occurred in recent years have been in the larger office buildings. This is attributable to the lower furniture/employee ratio possible in large open offices. The provision for the storage and disposal of refuse was not a major problem except in some of the larger shops in primary shopping areas and this was mainly confined to the problem of cardboard cartons, etc. Bailing presses were recommended in many cases but seldom implemented. However, as long as adequate gangways were maintained no further action was taken. Generally the workrooms of both offices and shops were maintained in a clean condition but there has been a constant struggle to maintain the same standards behind the scenes. Storerooms and toilet facilities have been particularly neglected especially in recent years mainly due to the lack of cleaners. Poor pay, coupled with unsocial hours, has largely contributed to this shortage. Nevertheless, an improvement has been achieved but the need for regular inspection is essential to maintain a satisfactory standard. Insistence on maintenance of gangways and the provision of adequate coverings to floors and staircases has contributed to a reduction in the number of accidents attributable to flooring defects. It has been obvious that many accidents have not been brought to the attention of the Authority even after ten years of the operation of the Act despite a wider awareness of this requirement. Virtually all notified accidents came from large organisations such as multiple retailers, and it is essential that both the employer and the employee are more fully acquainted with the need to inform the appropriate authority in order that investigations can be conducted. Although the majority of cases require no further action to be taken, in perhaps five per cent of accidents advice has been given which would considerably lessen the possibility of recurrence. Taken over the ten year period a large number of accidents must have been averted as a direct result of such recommendations. Conclusion This legislation has undoubtedly achieved a great deal in improving the conditions under which people work in offices, shops and. warehouses in this borough but still further progress would have been made were the employers more aware of their obligations. 56 Some strong suggestions were made in the recent Report on Health and Safety at Work that the enforcement of any new legislation would become the responsibility of a government department and whilst the centralisation of the enforcing authority might lead to greater uniformity of enforcement, much local knowledge would be lost. The Local Authority should retain its responsibilities for enforcing such legislation in order to maintain its good relations with local commerce and to avoid multiplicity of inspection by different officers for various purposes. The improvements under existing legislation have been achieved as much by good relations between the Authority and the employers as by quoting legal requirements. 8. NOISE 191 complaints of alleged nuisance from noise were received during the year compared with 135 in 1972. 73 nuisances were confirmed, 17 of those arose from industry, 20 from commercial undertakings, 7 domestic sources and 23 building and engineering works. 71 nuisances were abated following informal action. Neighbourhood Noise Circular 10/73, issued by the Department of the Environment at the beginning of the year, recommended that when town planning applications in respect of commercial and industrial developments are approved, conditions should be imposed to control noise levels in suitable cases. Such applications are consequently being carefully investigated and recommendations made to the Borough Planning Officer about suitable conditions to be applied. These may include limiting noise emitted by machinery, requiring special acoustic insulation of buildings and specifying maximum noise levels at the boundary of the site. In some cases limitation of hours of work may be recommended. Legislation is contemplated which will enable local authorities to declare noise control areas within which noise sources will be monitored. A register open to public inspection, will be kept of the noise level of each source in the area. Noise emission limits may be imposed upon factories and these may be reduced from time to time, managements being given a specified time in which to achieve the required reduction. It is also proposed that further powers will be given to Local Authorities to abate noise nuisances more speedily than at present. 57 Traffic Noise Under Section 20 of the Land Compensation Act 1973, HighwayAuthorities are required to make grants for noise insulation in respect of dwellings adjacent to new roads if the noise level has increased and exceeds a specified figure which, at present, is 68 dBA on the L 10 (the level exceeded for one-tenth of the time between 6 a.m. and midnight). They are also given discretionary power to make grants in respect of dwellings adjacent to roads which have been widened or otherwise improved. It is probable that a number of houses within the borough will be eligible for insulation grants and the department carried out many traffic noise recordings during the year as part of a preliminary survey with the object of identifying the dwellings likely to be affected. It is also proposed to use the information so obtained for the purpose of applying conditions aimed at limiting noise levels within proposed new dwellings which are the subject of town planning applications. This procedure is recommended in Circular 10/73, mentioned in the previous section, Neighbourhood Noise. Aircraft Noise When the wind is easterly (about a third of the time) some aircraft fly on a route from Heathrow Airport over Kingston Vale, causing some degree of annoyance to residents during busy periods. Another route known as the Mole Valley route passes to the west of the borough, but aircraft on the edge of this route sometimes overfly parts of Surbiton and Chessington. Representations were made to the Surrey County Council and the Noise Advisory Council objecting to a proposal to modify the Mole Valley route in a way which would have resulted in many more planes passing over westerly parts of the borough. The department carries out monitoring of aircraft noise when complaints are received and keeps in touch with the Civil Aviation Division of the Department of Trade and Industry and members of the Authority are members of the Local Authorities Aircraft Noise Council. It is understood that a scheme is being prepared which will impose penalties on operators who do not equip their existing aircraft with noise reducing modifications. Most new planes are much quieter than their predecessors and this is an indication of the concern and action being taken by the aircraft industry. 9. CLEAN AIR Clean Air Acts 1956/1968 - Smoke Control Areas Particulars of the Kingston upon Thames No.22 Smoke Control Order which was confirmed on 15th January 1973 are as follows:- 58 Locality King Charles Road Surbiton Acreage 353 Domestic premises 3432 Commercial premises 111 Industrial premises 13 Other premises 29 In October the Council made Smoke Control Order No.23 and confirmation by the Secretary of State for the Environment has been received. It comes into operation on 1st October 1974. Details are as follows Locality Ditton Road Surbiton Acreage 345 Domestic premises 2860 Commercial premises 90 Industrial premises 7 Other premises 12 The Council's Smoke Control Area programme provides for a further four areas by 1977 in addition to the twenty-nine 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 28 36,171 Order confirmed and not yet operative (Area 23) 1 2,860 Area being surveyed (Area 24) 1 2,863 Future areas 3 10,067 59 Air pollution complaints There were 232 complaints from the public about nuisance from smoke and grit; 123 of these concerned bonfires; 9 smoke from factory chimneys; 5 smoking domestic chimneys; 12 grit and smuts; 26 smoke from demolition sites and 45 fumes. This compares with a total of 147 complaints received in the previous year. 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 850 leaflets were sent to other householders in response to special requests. An advisory leaflet about the composting of garden refuse is also supplied in suitable cases. Two applications were submitted for approval of chimney heights under the Clean Air Acts, 1956 and 1968. These were approved without modification. In a further seven cases heating engineers consulted the department about chimney designs for boilers to which Section 6 of the 1968 Act was not applicable and advice was given. The majority of new boiler installations are fired by natural gas which does not pollute the air. Smoke and Sulphur Dioxide measurements Pour continuously operating instruments for daily measurements of smoke and sulphur dioxide are sited at the rear of the old Municipal Offices, High Street, New Maiden; "Alfriston", Berrylands Road, Surbiton; Tiffin Girls' School, Richmond Road and the Guildhall, Kingston upon Thames. Three of these are automatic instruments constructed by a member of our own staff, which need reading only once a week. The results at the Tiffin Girls' School site since 1962 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. A special unit, constructed by a member of the health department staff has been installed at the school to enable measurements to be continued automatically during holidays. Fig.1 shows that there was a marked reduction in S02 concentrations and a resumption in the downward trend of smoke concentrations, in spite of lower average winter temperatures. This improvement in air quality may be attributed to the satisfactory 60 progress being made with the Council's Smoke Control Area programme and the increasing use of gas and electricity for space heating. Vehicle and Aircraft Pollution Imperial College, London, are conducting an investigation into the effect upon air quality of emissions from aircraft using Heathrow Airport and comparing emissions from other oil-burning equipment such as road vehicles and industrial boilers. They have developed advanced techniques to enable specific hydrocarbons to be characterised and linked to their source. The Council have made a contribution to the cost of the investigation, part of which will be conducted within the borough. 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. The deposit at Tiffin Girls' School was the lowest since 1958, but that at Canbury Gardens tends to fluctuate. This is probably due to the occasional deposit of stack solids from the Power Station which is very local in its effect. (See Fig.2). RODENT AND INSECT PEST CONTROL Unfortunately, the failure to retain a full compliment of staff necessitated a considerable reduction in the level of service undertaken and curtailed much pest control work. Over 1,100 complaints were received and some 2,000 properties inspected concerning rodent infestation. Mice infestation occurred in several of the Council's flats where, because of the mode of construction with resultant complexity of duct work, easy access is afforded to different storeys and flats. 524 complaints were received concerning other pests and insects. Although there appeared to be a decline in the number of wasps, compared to previous years, 200 calls were received relating to wasps nests. After advice from the department, most householders were able to eradicate their nests. The department continued to receive many complaints concerning grey squirrels and foxes. In both cases, these animals may be attracted by the good intention of people leaving food on the garden lawn, for the birds. Squirrels can gain access to roof spaces and can cause considerable damage to properties and are best controlled by trapping. 61 The fox has, to a large extent, changed its mode of existence and habit and may live in large numbers close to an urban environment and, in such areas, has become more of a scavenger than a predator. Both the squirrel and fox present a quandary to the department. Some residents are loath to have these animals exterminated from their surroundings whilst their neighbours may be actively complaining. This presents a problem difficult to reconcile. Pigeons continue to be a source of annoyance. These birds can harbour infective organisms and, by roosting on many buildings and churches, defile much of the stonework and surrounding area. It is essential that the practice of residents feeding the birds be actively discouraged. Where necessary, disinfection and disinfestation treatment is carried out and the department also operates a service for the collection and disposal of contaminated dressings, bedding and clothing. It was necessary during the year to take legal action under Section 84 of the Public Health Act 1936 to secure the removal and destruction of materials that were found to be in a filthy condition in a dwelling. 62 HOUSING The department's housing work has continued throughout the year, but the staff shortage has, for a large part of the year, 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. Progress was however possible in these spheres towards the end of the year as the staffing situation improved. Unfit Houses and Houses in Disrepair Slow progress was made with the Elm Crescent Compulsory Purchase Order following the Council's decision to declare a clearance area. The Department of the Environment has set the date for a Public Local Enquiry to be the 2nd April, 1974. The last of the substandard properties in St. Johns Road area were demolished during the year ending an era of dealing with a group of houses partly by formal action and partly by informal action in association with the Borough Planning Officer. During the year 152 houses were repaired as a result of informal action and four Demolition or Closing Orders were made. Two houses previously closed were made fit and the Orders determined. House Improvement House improvement continued at a high level throughout the year. A graph included in this report shows three positive aspects of this activity, applications for grants received, approved and paid, and indicates the growth of this work following the Housing Act 1969, the impact of the 1972 London Publicity Campaign and the time which elapses between receipt of application and payment upon completion of works. It does not of course give any true indication of the amount of effort expended in advisory and supervisory activity with the hundreds of applicants and their builders. During 1972 and 1973 Improvement Grants received considerable adverse criticism and publicity because of speculative activity in inner London and some other parts of the country. Whilst it was considered that such activity in Kingston was never more than minute, following the publication of a Government circular, Council policy was changed at the end of August to deny approval of a Discretionary Grant in the following circumstances:- 63 1. Where the grant is for the improvement of a second home. 2. Where the applicant purchases the property for the purpose of improvement (including conversion to flats) and sale. 3. Where the rehabilitation of a particular property would not, in the Council's opinion, help towards meeting the housing needs of the Borough. The implementation of these changes did not produce any problems with known intending applicants or a marked drop in interest from new intending applicants. Financial information about improvement grants is given in the accompanying table showing the relationship between total costs of works, amount of grant approved, and the balance of costs to applicants. It should be borne in mind that the Council receives an Exchequer subsidy payment for 20 years of three quarters of the annual loan charges referable to the amount of grant paid, and additional rate fund income resulting from enhanced Rateable Values of improved properties. Following completion of a pilot scheme of improvements to three houses on the Tolworth Estate, carried out by the Council in co-operation with the Gas, Electricity and Solid Fuel supply undertakings, the houses were put on. show to the public and attracted 501 visitors during daily sessions over two weeks when staff were present to deal with enquiries. Special arrangements were made by the Chief Housing Officer and Borough Architect to obtain from tenants on the estate their comments and observations in relation to the proposed improvement of the remainder of the estate. The co-operation of the Housing Committee and of the above officers in making these houses available is gratefully acknowledged,as is the help received from the fuel supply undertakings and in their sharing the publicity costs as a joint venture with the Council. Numerous enquiries from the general public about improvement grants resulted from the project. Now that a programme for improvement of Council owned properties has commenced the number of houses dealt with, to which Exchequer contributions are related is given in an accompanying table. General Improvement Areas The satisfying progress made in the Thorne Road General Improvement Area, is evident to any visitor to the area. The improvement of the Council owned flats and the environmental improvements are proceeding and most are likely to be completed by the Spring of 1974. Some of the houses in the private sector on the periphery are also being improved. 64 In the Mill Street General Improvement Area, house improvements have continued at a steady rate and environmental works should commence in February 1974. Delay in implementation has been due to the time taken to negotiate acquisition of small parcels of land required for works, some of which had not been completed by the end of the year. Whilst no new General Improvement Areas have been declared a very successful public participation meeting was held in respect of the proposed Portland Road General Improvement; Area, following which the residents of the area, bounded by Springfield Road, Grove Lane Villiers Road and the Hogsmill River, formed the Spring Grove Residents Association. The Association undertook a detailed study of the matters raised at the public meeting with residents in the area and submitted an excellent report for study by the officers in their further consideration of environmental proposals for the area. Coincident with the decision to consider this areaas a General Improvement Area the Housing Committee decided to revise their proposals for the Portland Road Housing Site, retaining only a small section for redevelopment by a sheltered housing scheme, and turning to rehabilitation for properties in Council ownership in the major area of the site, work upon which will commence in February 1974. 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. The Council has agreed to the continuing use of King George's Field Car Park, Tolworth as a temporary caravan site by fifteen gypsy families. Although sanitary, water and refuse facilities are provided and electricity is being connected, the site adjoins residential properties and, naturally, complaints are received from time to time. The integration of the gypsies within the community is going to be an interesting exercise and it is hoped that the Council's intention to establish a permanent gypsy site at Hook Rise North will be implemented quickly. Legal proceedings were taken in Kingston Magistrates Court under the Surrey County Council Act 1931, against two gypsy families who had encamped on land adjacent to Fairoak Lane, Maiden Rushett. The Magistrates found the case proved and fines of £5 and £8 were imposed upon the defendants. 65 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 1973 under the provisions of the Milk (Special Designations) Regulations, 1963 and 1965. These regulations prescribe that the licence shall cover the period expiring on the 31st December, 1975 and all are dealers' licences to sell pre-packed milk. Premises and type of licence Number Premises in which milk is sold 113 Pasteurised milk 96 Sterilised milk 36 Ultra Heat Treated milk 57 Untreated milk 10 Bacteriological Examination of Milk. During the year 42 samples of milk were sent to the Public Health Laboratory at Epsom and the following is a tabulated statement of the results:- Phosphatase Test Methylene Blue Test Turbidity Test Colony Count Pass Fail Pass Fail Void Pass Fail Under 10 Pasteurised 35 — 33 2 — — — _ Ultra Heat Treated — — — — — — — 4 Sterilised — — — — — 3 — — 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. 66 MILK & DAIRISS (GENERAL) REGULATIONS. 1959 Legal proceedings were instituted against two companies in respect of failing to ensure that a milk bottle used by them was in a state of thorough cleanliness immediately before use. In one case the defendant was fined £15.00 and costs of £5 were awarded, and in the other case the defendant was fined £15 and costs of £5 awarded, together with Public Analyst's fee. Ice Cream The number of registered premises in the Borough at 31st December, 1973 in which ice cream could be stored or from which it could be sold was 289. 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 25 samples submitted to the Public Health Laboratory at Epsom during 1973. Owing to the numerous factors governing the hygienic quality of ice cream, undue attention is not paid to the bacteriological results on any single sample. Those which are placed within Grades I and II are considered to be satisfactory and those within Grades III and IV not so. Adequate follow-up action is taken where samples fall within the latter grades. GRADE Total I II III IV Ice Cream 11 — 5 9 25 Of the 14 samples graded III and IV nine were taken from soft ice cream machines and five 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 Twenty-one 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. 67 Meat Depots and Imported Food There are no slaughterhouses in the Borough and the retail shops receive their meat from Smithfield and from the local wholesale depots. Some home killed meat comes from the modern abattoir at Guildford. There are eight wholesale meat depots in the Borough, the main group being situated in The Bittoms, with two in Wood Street and one in Cambridge Road. The meat handled includes fresh meat from within the British Isles and imported meat from Europe. During the year numerous visits were paid to the depots and 141 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 were from the continent. Food Hygiene There are 1,556 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. Hygiene in Public Houses and Licensed Premises The Association of Public Health Inspectors published Practice Notes in respect of Hygiene in Public Houses and Licensed Premises in the latter part of the year with the aim of improving standards. A start was made on distributing these Notes to the occupiers of all licensed premises and they have been favourably accepted by the trade. Survey of Retail Refrigerated Display Cabinets This Authority took part in a sample survey of retail refrigerated (chill) display cabinets and storage facilities carried out in 80 local authority areas during December. This survey was specifically requested by the Ministry of Agriculture, Fisheries and Food on behalf of the Steering Group on Food Freshness, which was set up in February of this year following publication of the Food Standards Committee's Report on the Date Marking of Food. 68 The Steering Group's terms of reference are "to review and report periodically to Ministers on the progress of measures which are designed to ensure that prepacked food is sold and consumed in the best possible condition, including developments in open date marking, trade distribution and stock control procedures, temperature control, packaging and informative labelling. To advise Ministers on action which might be taken to assist further progress". To help it in its work, the Steering Group set up several Sub-Groups including one on temperature control, to deal with particular aspects of food freshness. The Sub-Group on Temperature Control (which includes a Chief Public Health Inspector among its members) considered the question of the temperature control of food at all stages of manufacture, distribution and retail sale. The Sub-Group recognised that there was a need for information as to the typical temperature control conditions existing in retail shops. Whilst much information was available about retail frozen food cabinets, there appeared to be little published information available about retail refrigerated (chill) cabinets and cold storage facilities which are designed to hold foods such as dairy produce, meat and megt produces, etc. at temperatures on average of between about 26 F. and 50ºF. (-3.3ºC. to 10ºC.). The Sub-Group were of the view, therefore, that some form of survey was necessary to establish fairly accurately not only the numbers of shops using refrigeration equipment but al3 0 just how effectively such equipment was being used. The Sub-Group were convinced that the only way for such a survey to be effectively carried out was through Local Authorities and their knowledge of local retail conditions. Visits were made to 24 shops of specified types chosen at random within the Borough where the presence or absence of refrigerated facilities were noted and several temperature readings taken. The results of the survey are at present being interpreted by the Sub-Group. There are no poultry processing premises within the Borough. 69 FOOD AND DRUGS SUBJECT OF COMPLAINT A total of 196 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. Cornish pasty - mouldy Cornish pasties - mouldy Brazil nuts - grossly deteriorated Loaf containing nail Salted Peanuts - containing Glass Ham Sandwich - decomposing Fine £25.00 and £5.00 costs Fine £20.00 and £5.00 costs Fine £10.00 and £10.00 costs and £6.55 Public Analyst fee Fine £20.00 and £12.00 costs Fine £25.00 and £10.00 costs and £7.10 Public Analyst fee Fine £15.00 and £5.00 costs LABELLING OF FOOD ORDER. 1955 - SECTION 3 Following the observation of unlabelled tins of soup exposed for sale, three summonses were issued and at the hearing fines totalling £50.00 and costs of £10.00 were imposed. LABELLING OF FOOD REGULATIONS. 1970 Legal proceedings were instituted against two Companies for contraventions of the Regulations; one for describing their product as "Choice Luncheon Pork" instead of the appropriate designation "Luncheon Meat" and the other for selling an unlabelled can of soup. Both Companies were fined £30 with costs of £10. 70 ANIMAL ESTABLISHMENTS. There are six animal boarding establishments and twelve pet animal shops licensed by the Council. There are four 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. 176 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 STPFFS ACT. 1926. This Act requires vendors of fertilisers and feeding stuffs to apply a description to such materials when exposed for sale or when consigned or delivered so that the purchaser is aware of the more important constituents. Six samples were submitted to the Public Analyst during the year all of which were reported as being satisfactory. 71 PHARMACY AMD 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 dye and acids for domestic or industrial use. During the year under review five names were removed and three added. The total number of names on the list at the end of the year was 96. HAIRDRESSERS. The Byelaws in respect of Hairdressers and Barbers made under the Public Health Act 1961 are administered by the department and there are 131 registered hairdressers in the borough. 72 FOOD AND DRUGS ACT. 1955 493 samples of food and drugs were submitted to the Public Analyst for examination. The 76 samples which were the subject of adverse report are listed below together with the action taken. It will be noted that the majority of these were due to failure to comply with labelling requirements of the Labelling of Food Regulations, 1970. Complan Incorrectly labelled. The appropriate designation was incorrect in stating that milk was the basis of the article, since skimmed milk was used. Matter raised with manufacturers.Change of description to be implemented at reprint of carton. Ham Deficient in meat to the extent of 14 per cent. The sample contained total meat 77 per cent. Followed up by formal sample. Hot Dog Sausages Deficient in meat to the extent of 27 per cent. The sample contained in the drained weight total meat 51 per cent. No action taken following discussion with Public Analyst as label did not describe sis Frankfurters. Hot Dog Sausages Deficient in meat to the extent of 27 per cent. The sample contained in the drained weight total meat 58 per cent. No action taken as label did not describ e as Frankfurters. Luncheon Pork Misleading label. The sample consisted of luncheon meat but the description used is not an appropriate designation specified by the Labelling of Food Regulations and is calculated to mislead as to the nature of the article. Legal proceedings instituted. Fined £30 with £10 costs. 73 Pork Sausages Deficient in meat to the extent of 4.6 per cent. The sample contained meat 62 per cent. Recipe stated to be used by manufacturer included sufficient meat and therefore poor report probably due to inadequate mixing (no bowl chopper).Warning given. Cod Roe Incorrectly labelled. The ingredients of the article were not declared. Retailer unable to trace supplier, suspected of having been transferred from another shop and therefore unsuccessful in tracing importer. Glace Cherries Incorrectly labelled. The ingredients enythrosine and sulphur dioxide were not declared. Advised retailer no stocks remain. Honey 'n Orange Spread Misleading label. The ingredients were not headed by the word 'Ingredients' and a statement on the label quoting protein and carbohydrate contents was ambiguous and calculated to mislead as to the nature of the article. Manufacturing firm closed down. Retailer withdrew stocks from sale. Jam (3 samples) Incorrectly labelled. The ingredients of the sample were not declared. Taken up with importers and manufacturers who agreed to amend labels. Cake Covering Incorrectly labelled. The list of ingredients was not headed by the word 'Ingredients'. Manufacturers amended labels. 74 Chocolate Pudge Dessert Topping Incorrectly labelled. The print size used for the ingredients was too small and the list was not headed by the word 'Ingredients'. Part of the list had been blocked out including some ingredients still present. Taken up with importer. Labels to be amended. Apricots & Peaches Incorrectly labelled. The presence of preservative waa not declared. Matter taken up with retailer - labels to be amended. Gooseberries in Syrup Incorrectly labelled. The ingredients of the article were not declared. Manufacturers stated sample was old stock and current labels comply with Regulations. Peas Incorrectly labelled. The sample did not bear an appropriate designation. Manufacturer amended the label. Mixaroon Incorrectly labelled. The need to add split almonds and pastry to complete the food was not declared on the label. Following correspondence, the manufacturer agreed to amend the label. Lift (Beverage) Incorrectly labelled. The list of ingredients was not simultaneously visible with the appropriate designation or enclosed in a surrounding line. The manufacturers stated the sample was obviously old stock. The current label complied with the Labelling of Food Regulations 1970. Hot Pepper Sauce Incorrectly labelled. The size of the print used in the list of ingredients was 1.3 m.m. compared with the required size of 1.5 m.m. The importers arranged for the size of the lettering on the label to be increased. 75 Moutarde de Dijon Incorrectly labelled. The presence of sulphur dioxide as an ingredient was not declared. The importers agreed to amend the label. Haldi (Spice) Incorrectly labelled. The sample consisted of turmeric powder for which haldi is not an appropriate designation. The importers agreed to amend the label. Mazzarella Cheese Incorrectly labelled. The description specified by the Cheese Regulations did not appear on the label. The article consisted of full fat soft cheese. The importer stated that owing to an error of the shipper a consignment packed for the U.S.A. was landed in this country. A consignment for this country was rejected in the U.S.A. Beef Sausages Contained permitted colouring matter which was not declared. The sausage contained: Red 2G. The retailers stated they were awaiting delivery of labels from the printers. Canned Ham Deficient in meat to the extent of 22 per cent. The sample contained total meat 70$. Legal proceedings instituted. Pined £50, costs £25 and £6.55 Analyst's fee awarded. Luncheon Pork Misleading label. The sample consisted of meat with cereal but did not bear the appropriate designation specified by the Labelling of Food Regulations; the description used does not indicate the true nature of the article and is calculated to mislead as to the nature of the article. Legal proceedings instituted. Pine £10., £12 costs and £655 Analyst's fee awarded. 76 Ox Tongue Incorrectly labelled. The sample consisted of ox tongue with jelly but did not bear the appropriate designation specified by the Labelling of Pood Regulations. Correspondence with the packers not yet concluded. Pork Sausages Deficient in meat and contained permitted colouring matter which was not declared. The sample contained: Meat 62 per cent, and was coloured with Red G2. The matter was taken up with the manufacturer/retailer. The meat deficiency was apparently due to poor mixing. A notice is now being displayed regarding colouring. Pigs Head Meat Incorrectly labelled. The sample consisted of pressed meat but did not bear the appropriate designation specified by the labelling of Pood Regulations. The list of ingredients was not headed by the word "Ingredients". The importers advised that all stocks had been cleared and no further imports of this product were expected. Hearts of Palm Incorrectly labelled. The article did not bear an appropriate designation or a list of ingredients. The matter was raised with the importers who have requested their suppliers to amend the label. Lemon Curd Incorrectly labelled. The ingredients were not declared. The manufacturers agreed and new labels were adopted. Creamy Chocolate Biscuits Incorrectly labelled. The description of the article did not indicate the true nature of the food which was a chocolate sandwich biscuit made with a filling which contained no milk fat. Legal proceedings instituted. Case dismissed. 77 Coffee Break Incorrectly labelled. The article was described as an extract of coffee with milk and cream but it was made with concentrated separated milk. The manufacturer agreed to amend the label. Liver and Bacon Paste Incorrectly labelled. The ingredients of the article were not declared. The manufacturer agreed to include a list of ingredients on the label. Mango Chutney Incorrectly labelled. The size of print used in the list of ingredients, 1 mm. was smaller than the size required for a container 17 centimetres greatest dimension. The importers arranged for the label to be amended. Mushroom Ketchup Incorrectly labelled. The list of ingredients was not headed by the word "Ingredients". The manufacturers produced two labels which were stated to have been used for the last ten years which complied with the Labelling of Pood Regulations, 1970. The sample was presumably very old stock. Soya Sauce (3 samples) The samples were unfit for human consumption. The samples contained Lead 6.8ppm.,2.15ppm., and 2.3ppm. respectively. The importer arranged for all stocks to be withdrawn for return to Hong Kong. Garam Masala (Ground Spices) The sample was unfit for human consumption. The spice contained Lead 47ppm. This was taken up with the importer and the remainder of the stock bearing the same code was surrendered. Two samples taken by another Local Authority bearing a different code were reported to be satisfactory. 78 Sleepwell Tablets Misleading label. Neither of the active ingredients paracetamol or salicylamide have sleep inducing properties. The matter was taken up with the manufacturer. Gherkin cheese spread Incorrectly labelled. The description did not contain the appropriate designation required by the Cheese Regulations 1970. The Supermarket stickon label obliterated the words "Cheese Spread". The matter was rectified. Beefburgers (4 samples) The samples contained artificial colouring matter and preservative which was not declared on a ticket placed on the food. Since investigation with the retailers the appropriate tickets have been displayed. Ham (Canned) Incorrectly labelled. Part of the appropriate designation was printed in letters which did not contrast with the background and were not more prominent than the name and address and list of ingredients. They were not so prominent in height, visual emphasis and position as to be conspicuous by comparison with the net weight and registered trade mark. Correspondence not yet concluded with the manufacturer. Minced Meat Not of the quality expected. The sample contained more than the expected maximum of 30% fat. It contained Pat 35.2%. A warning was given to the retailer. 79 Beefburgers Incorrectly labelled. The presence of preservative was not declared. The appropriate ticket is now being displayed after drawing the infringement to the retailer's attention. Beefburgers Incorrectly labelled. The ingredients were not declared. The retailer was unable to give the name of the supplier. No stock remains. Beef Sausages Incorrectly labelled. The presence of preservative and colouring matter was not declared. Since investigation with the retailer, the appropriate ticket has been displayed. Beef Sizzles Incorrectly labelled. The list of ingredients included a term which was generic and was not an appropriate designation. The presence of preservative was not declared in the form required by the Labelling of Pood Regulations. The description of the food did not indicate its true nature and was not an appropriate designation. The manufacturer has agreed to the labels being redesigned. Corned Beef Deficient in meat to the extent of 11 per cent. The sample contained: Lean (defatted) corned beef - 66%; Fat - 185: Total corned beef 84%: Excess water 15%: Salt, spices,etc. 1%. On investigation with the importer it was ascertained that this product is no longer imported and no stocks remain. Ox Tongue Deficient in meat to the extent of 13 per cent. The sample contained: Meat 78%. Correspondence with the manufacturer is not concluded. 80 Ham Deficient in meat to the extent of 20 per cent. The article consisted of ham in natural juice with gelatine added and contained 64% meat. A reasonable minimum meat content would be 80 per cent. This was investigated with the manufacturer and further sample taken. Pork Luncheon Meat Incorrectly labelled. The ingredients of the article were not declared. Raised with the importer. No stock remaining and no further imports to be made. Pork Sausage Meat Incorrectly labelled. The presence of preservative was not declared. The matter was raised with the retailer and the appropriate ticket is now displayed. Pork Sausagespreserved. (3 samples) Incorrectly labelled. The presence of colouring matter was not declared. The matter was raised with the retailer and the appropriate ticket is now displayed. Shrimps in Brine Incorrectly labelled. The list of ingredients was headed by the word 'Contents1. The label is being amended by the importer. Butterscotch Topping. Incorrectly labelled. The list of ingredients was headed by the word 'Contents' instead of 'Ingredients' and declared the presence of hydrolised starch in liquid form as 'corn syrup'. The label is being amended by the importer. 81 Lychees in Syrup Incorrectly labelled.The ingredients were not declared as required by the Labelling of Pood Regulations 1970. The matter was raised with the supplier and the label is to be amended. Pork Sausages Contained artificial colouring but its presence was not declared. (The Labelling of Pood Regulations 1970.) Taken up with the retailer and appropriate ticket since displayed. Murabba Harar (Vegetable Product) Incorrectly labelled. The list of ingredients was not in the form required by the Labelling of Food Regulations 1970 and the description was not an appropriate designation. This was raised with the supplier and the label is to be amended. Mayonnaise Incorrectly labelled. The ingredients were not declared as required by the Labelling of Food Regulations 1970. On investigation the retailer was unable to supply the name of the importer or supplier. The remaining 12 jars in stock were withdrawn from sale. Ground Jeera Incorrectly labelled. The description did not constitute an appropriate designation for the purposas of the Labelling of Food Regulations 1970. The importer has agreed to amend the label. Processed Cheese Incorrectly labelled. The description of the article did not include the appropriate description or declaration specified for the chease by the Cheese Regulations 1970. The list of ingredients was not declared. This infringement was raised with the importer and the label was redesigned. 82 Glace Cherries Incorrectly labelled. The ingredients were not declared. Matter raised with the importers and amended labels are being printed. Jam Incorrectly labelled. The ingredients were not declared. Following representation to the manufacturer new labels were printed. Dried Apricots Incorrectly labelled. The presence of preservative was not declared. By agreement with the importer new labels are being printed. Fruit Salad Incorrectly labelled. The ingredients were not declared. By agreement with the importer new labels aire being printed. Peaches, dried Incorrectly labelled. The presence of preservative was not declared. By agreement with the importer new labels are being printed. Sultanas Incorrectly labelled. The presence of preservative was not declared. By agreement with the importer new labels are being printed. Salad Dressing Incorrectly labelled. The ingredients were not declared in the form of a list. The matter was raised with the importer. The labels are being re-designed and there will be no further imports during the interim period. Blackcurrant Cough Syrup with Vitamin C. The sample was deficient by 28 per cent of the amount of vitamin C declared on the label. This article is no longer manufactured and stock at the retailers has been taken off sale. 83 FOOD AND DRUG SAMPLES Milk 6 Milk Products 49 Meat and Meat Products 132 Fish and Fish Products 24 Sugar and Preserves 38 Confectionery and Chocolate 15 Fruit and Fruit Products 43 Vegetables and Vegetable Products 17 Cereals and Cereal Products 10 Flour Confectionery 25 Beverage 7 Soft Drinks 18 Alcoholic Drinks 17 Condiments and Sauces 31 Spices and Flavourings 12 Food Additives and Supplements 6 Slimming and Diabetic Foods 7 Drugs 24 Chicken and Chicken Products 3 Miscellaneous 9 493 84 FOODSTUFFS SURRENDERED OR CONDEMNED AS UNFIT Canned Goods lbs. Fish 41 Fruit and Fruit Juice 9,569 Jams and Preserves 14 Meat and Meat Products 85 Milk 31 Vegetables 21 Soup 3 Others 6 Bacon 245 Butter 28 Cheese 43 Fish 274 Fruit 1,269 Meat 14,096 Poultry 10 Rabbits 44 Miscellaneous Foods (Refrigeration Failures, Fire Damaged and Flooding) 15,335 -do- 307 gallons. -do- 433 bottles. -do- 89 packets. The loss of food caused by refrigeration failure has not diminished significantly from last year and appears to be due to lack of proper maintenance to cabinets. 85 FOOD HYGIENE (MARKETS. STALLS AND DELIVERY VEHICLES) REGULATIONS. 1966 The following tabulated statement shows the nature of infringements to which attention was drawn Number of stalls selling food 59 Total Name and address not displayed 14 Washable overclothing not worm 5 Washing facilities 3 First aid equipment 2 Protection of food 4 28 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 Bankers and Bakers Shops 38 88 Butchers 58 92 Clubs 67 23 Confectioners 152 118 Fish shops(wet or fried) 32 64 Greengrocers 74 85 Grocers 131 268 Ice cream, manufacture 1 2 " " sale 288 39 Institutions 44 27 Milk shops and depots 102 11 Mobile shops 12 25 Office, shop and works canteens 86 44 Open Markets 2 93 Public houses, hotels and licensed premises 137 208 Restaurants and cafes 151 341 School Canteens 83 45 Wholesale meat shops 8 136 Other food premises 90 279 1,556 1,988 86 FOOD HYGIENE The following tabulated statement shows the nature of the infringements to which attention was drawn:- Total number of food premises 1556 Washing facilities for staff Absence of defective, inadequate hand basins) 131 Absence of hot and cold water ) Lack of towels, soap and nailbrushes 62 Defective water heaters 5 Sanitary Conveniences Lack of "Wash your Hands" Notices 31 Fittings, defective and dirty 16 Lighting inadequate 11 Walls and ceilings defective and dirty 44 Ventilation and/or ventilated lobby required 7 Others 14 Repairs to Pood Rooms Floors defective 26 Walls and ceilings defective 59 Others 8 Sinks and draining boards Lacking or defective 44 Protection of Food against contamination Smoking 4 Food not kept 18" off ground 10 Covers not provided for food 7 Others 16 Uncleanliness Kitchens and equipment 102 Food stores 83 Preparation rooms 17 Floors, walls and ceilings 146 Refrigerators 21 Ventilation 9 Dustbins - insufficient and defective 8 Uncovered, and collection of, refuse 4 First aid equipment 34 Clothing - storage and cleanliness 10 Accumulations 17 General defects 12 Rats/Mice infestation 10 Total 968 Notices served 207 Notices complied with 136 87 FOOD HYGIENE (GENERAL) REGULATIONS. 1970. Legal proceedings under the Regulations were instituted in three cases, details of which are as follows (i) Regulation 25 Walls dirty " 25 Ceiling dirty The defendant was fined £15 and ordered to pay £4 costs. (ii) Regulation 7 Counter defective " 7 Hot Cabinet dirty " 21 No hot water to sink " 25 Floor dirty " 25 Walls dirty " 25 Ceiling dirty Fines totalling £180 with £20 costs were imposed. (iii) Regulation 18 (2) No hot water to wash-hand basin. " 11 Washable overclothing not worn. The defendant was fined £50 and ordered to pay £5 costs and 54p. witness expenses. 88 COMPLAINTS The following is a brief list of causes for complaints received during 1973 which resulted in investigation by the department and in all cases where necessary, appropriate action was taken. Accumulations 148 Animals 35 Caravans, illegal parking 11 Cellulose spraying 6 Dampness 85 Drainage/Sanitary arrangements 1,322 Dirty milk bottles 14 Dustbins 17 Flooding 70 Foods 196 Food Hygiene 27 Fouling of footpaths by dogs 10 General Housing defects 189 Insects 373 Noise 191 Offensive Odours 143 Offices, Shops and Railway Premises Act 5 Overcrowding 11 Pigeons 61 Public Conveniences 8 Rodents Rats 853 Mice 297 1,150 Rivers and streams - pollution 10 Smoke, including grit, smuts and fumes 232 Squirrels 75 Water 10 Others 75 4,474 89 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 are not included. Animal Boarding Establishments 5 Atmospheric Pollution Gauges 24 Bacteriological Sample Visits 281 Betting, Gaming and Lotteries Act 6 Building sites 39 Chiropody and Massage Establishments 10 Committee and Council Meetings 129 Council House - Disinfestations 1 " " - Inspections 30 Court 37 Depot visits or inspections 130 Diseases of Animals Act and Waste Food Order 15 Disinfestations/Disinfections 18 Drainage visits 918 Employment Agencies 61 Flooding 189 Food Complaints 235 Food and Drugs Samples 368 Food Hygiene Regulations - Bakehouses 30 - Bakers' shops 58 - Butchers 92 - Confectioners 118 - Cooked meat shops 33 - Fish shops (wet or fried) 64 -Greengrocers 85 - Grocers 268 - Ice cream, manufacture 2 - " " sale 39 - Institutions 27 - Milk shops and depots 11 - Mobile shops 25 - Office and Works canteens 44 - Public houses, hotels and licensed premises 208 - Restaurants and cafes 341 - School canteens 45 - Sports clubs 23 C/Fwd 4,009 90 B/Fwd 4,009 - Open Markets 93 - Wholesale meat shops 136 - Other food premises 246 Factories - non-power 24 - power 87 Fertilisers and Feeding Stuffs 4 Gipsy site inspections 15 Hairdressers and Barbers 177 Health Education 39 Home Safety 3 Houses in Multiple Occupation 1,100 Housing Enquiries 26 Housing Act Inspections 235 " " Reinspections 130 " " Qualification Certificates 65 Improvement grant visits 2,110 Infectious Disease visits 321 Insect Pests 27 Interviews with owners, builders, etc 1,069 Miscellaneous (including no reply) 1,742 Noise Abatement 443 Noise - Traffic 181 Offices, Shops and Railway Premises 1,541 Office meetings 202 Overcrowding 9 Pet Animals Act 6 Pigeons 31 Piggeries 5 Pharmacy and Poisons Act 58 Public Conveniences 25 Public Health Act inspections 1,115 " " " reinspections 1,843 Rag Flock Act 1 Refuse Tips 9 Riding Establishments 5 Rivers, ditches and ponds 109 Rodent Control 110 Shops Act 18 C/Fwd 17,369 91 B/Pwd 17,369 School Premises 19 Smoke Abatement 509 Smoke Control Areas 7,818 Smoke Control Areas - No access 1,486 Special Surveys 524 Tents. Vans. Sheds and Caravans 124 Trade Descriptions Act 176 Unsound Food 220 Vacant Land 41 Visits outside district 216 Waste Pood (Staining and Sterilisation) Order 1 Water Supply and Sampling (including Swimming Pools) 369 Work in progress 166 Workplaces 1 29,039 92 NOTICES SERVED Informal Written and verbal 762 Statutory (a) Housing Acts (excluding those mentioned in (b) below) 33 (b) Housing Act, 1957 - Section 170 - requiring information as to ownership 68 (c) Public Health Acts (other than mentioned in (d) below) 99 (d) Public Health Act, 1936 - Section 277 - requiring information as to ownership 105 (e) Clean Air Act 17 NOTICES COMPLIED WITH Informal Written and verbal 620 Statutory (a) Housing Acts - (b) Public Health Acts 29 (c) Clean Air Act 16 93 FACTORIES ACT. 1961 The following are the particulars required to be furnished to the Department of Employment 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 45 24 - - Factories not included above in which Section 7 is enforced by the Corporation 572 87 9 - Other premises excluding outworkers 63 39 -- - 2. CASES IN WHICH DEFECTS WERE FOUND No. of cases in which delects found Found Remedied Referred No. of Prosecutions To H.M. Inspector By H.M. Inspector Sanitary Conveniences: Unsuitable or defective 9 - - - - Not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - - - - 9 - - - - 94 FACTORIES ACT. 1961 PART VIII OF THE ACT OUTWORK The following table gives details of work which is carried out in private dwelling houses. The conditions obtaining have been found to be satisfactory. Nature of Work No. of Outworkers Curtains and furniture hangings 2 Fuse makers 1 Wearing apparel - making etc. 24 Artificial flowers 3 Lampshades 7 37 95 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 yr. Total No. of registered premises No, of registered premises receiving general inspection during yr. No. of Persons employed Offices 70 721 154 10,897 Retail shops 72 891 338 7,052 Wholesale & Warehouses 17 63 39 1,094 Catering Establishments 7 151 167 1,373 Fuel Storage Depots - 2 - 18 Totals 166 1,828 698 20,434 Section Number of contraventions found Section Number of contraventions found 4 Cleanliness 20 13 Seating 4 5 Overcrowding 3 15 Eating facilities 1 6 Temperature 63 16 Floors,Passages & Stairs 37 7 Ventilation 30 17 Fencing Machinery 10 8 Lighting 21 20 Safety Precautions 16 9 Sanitary Conveniences 49 24 First Aid 78 10 Washing facilities 65 49 Registration 36 12 Clothing accommodation 16 50 Provision of Abstract 87 Other Matters 18 Total 554 96 ACCIDENTS Workplace Reported NonFatal Total No. Investigated Action Recommended Informal Advice No action Offices 3 3 3 - Retail shops 53 19 19 34 Wholesale shops Warehouses 5 2 2 3 Catering Establishments open to public, canteens 5 2 2 3 Totals 66 26 26 40 ANALYSIS OF REPORTED ACCIDENTS Offices Retail Shops Wholesale Warehouses Catering establishments open to public,canteens Machinery - 1 - - Transport - 2 - - Falls of persons 2 18 1 2 Stepping on or striking against object or person - 2 - - Handling goods - 15 1 2 Struck by falling object - 9 2 1 Use of hand tools - 2 - - Not otherwise specified 1 4 1 - 97 PEST CONTROL - STATISTICAL SUMMARY 1. Number of properties in district 62,860 2. (a) Total number of properties (including nearby- premises) inspected following notification 2,129 (b) Number infested by (i) Rats 451 (ii) Mice 304 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 1,005 (b) Number infested by (i) Rats 110 (ii) Mice 31 4. Complaints received: Rats 853 Mice 297 Squirrels 75 Pigeons 61 Insects 373 98 HOUSING The following is a tabulated statement of action taken under the Housing Acts. 1. Number of houses inspected 235 2. (a) Number of houses which, on inspection, were considered to be unfit for human habitation 2 (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 152 4. Number of representations made to the local authority with a view to:- (a) The serving of notices requiring the execution of works 5 (b) The making of demolition or closing orders (number of houses involved) 4 (c) Declaration of clearance areas (number of houses involved) - 5. Nramber of formal notices served requiring the execution of works 5 6. Number of houses which were rendered fit after the service of formal notices - 7. Number of demolition or closing orders made 4 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 4 10. Number of houses where demolition or closing orders determined on the premises being made fit 2 11. Closing Orders revoked and Demolition Orders made - HOUSING ACT 1969 IMPROVEMENT GRANTS - DISCRETIONARY SINGLE DWELLING IMPROVEMENTS Total Owner/ Occupied Tenanted Total Cost Of Works Proposed Total Amount Of Grants Approved Total Balance Of Costs To Owners Total Amount Of Grants Paid Applications received 129 - — Applications approved 125 93 32 £337,556 (av £2700) £100,457 (av £804) £237,099 (av £1897) — Dwellings improved 101 83 18 - — — £74,777 (av £740) DWELLINGS PROVIDED BY CONVERSION Applications received 60 - - Applications approved 64 17 47 £216,479 (av £3382) £71,940 (av £1124) £144,539 (av £2258) - Dwellings provided 47 4 43 - - — £46,280 (av £985) 99 IMPROVEMENT GRANTS - STANDARD Total Owner/Occupied Tenanted Applications received 17 - - Applications approved 21 10 11 Dwellings improved 14 10 4 Amounts paid in grants £2476.03 Average per house £ 176.86 Amenities provided:- (a) fixed bath or shower 10 (b) wash-hand basin 12 (c) hot water supply (to any fittings 14 (d) water closet within dwellings 9 (e) sink 2 SPECIAL GRANTS NIL 100 HOUSING FINANCE ACT. 1972 - PART III CERTIFICATES OF QUALIFICATION IMPROVEMENT CASES Applications received 7 granted 12 refused STANDARD AMENITIES ALREADY PROVIDED Applications received 23 granted 17 refused 12 101 DISCRETIONARY AND STANDARD GRANTS 102 COUNCIL OWNED PROPERTIES EXCHEQUER CONTRIBUTIONS FOR IMPROVEMENT Standard Contributions (Dwellings) Improvement Contributions (Dwellings) Applications 20yr. Annual Contribution Commenced Applications 20yr. Annual Contribution Commenced Made Approved Made Approved 1965 NIL 1966 NIL 1967 36 36 1968 36 1969 1 1 1970 1 1 1 1971 39 39 (38 less 4 since sold) 34 2 2 1 1972 75 69 3 1973 89 95 109 Total 20 yr.subsidy being received 71 £443 per annum 113 £5541 per annum 103 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 8,064 Agar plate count per ml. 20-24 hours at 37°C 43.4 Coliform count - Per cent, samples negative in 100 ml 30.78 Count per 100 ml 15.7 Escherichia coli count - Per cent. samples negative in 100 ml 53.58 Count per 100 ml 4.1 After Treatment Number of Samples 3,858 Agar plate count per ml. 20-24 hours at 37°C 9.9 Coliform count - per cent samples negative in 100 ml. 99.92 E.coli count - per cent samples negative in 100 ml 100.0 104 Results of the Chemical Examination of Water supplied to the Borough Number of samples 357 Ammoniacal Nitrogen 0.039 Albuminoid Nitrogen 0.080 Nitrate Nitrogen 7.4 Oxygen abs. from KMn04 4hrs. at 27°C 1.00 Hardness (total) CaC03 276 Hardness (non carbonate) CaC03 74 Magnesium as Mg 5.7 Sodium as Na 27.5 Potassium as K 6.1 Chloride as Cl 41 Phosphate as P04 3.0 Silicate as S02 9 Sulphate els S04 62 Natural Fluoride as F 0.15 Surface-active material as Manoxol OT 0.02 Turbidity units 0.1 Colour (Burgess units) 8 pH value 7.8 Electrical Conductivity (micromhos) 580 105 SCHOOL HEALTH SERVICE 109 SCHOOL HEALTH SERVICE The population of the borough, estimated by the Registrar General, was 138,620 at mid-1973. In January 1974 the number of pupils on the registers of maintained schools was 21,209, made up as follows: Primary Schools 12,074 Secondary Schools 8,626 Nursery Schools 214 Special Schools 293 In addition, it is estimated that 3,000 children attend independent schools registered under Part III of the Education Act 1944, and 557 attend the direct grant school which is served by the school health service. The number of maintained schools in the borough on 31 December 1973 was 60: 12 secondary, 43 primary, 2 nursery, and 3 special. One direct grant school was included in the school health service under the terms of Section 78 of the Education Act 1944. Staff The Medical Officer of Health and his deputy are also Principal and Deputy Principal School Medical Officers and were assisted by two senior and 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. Periodic Medical Inspection The figures given in this and all other sections of the report relate to schools as classified by the Education Act 1944 and are, broadly speaking, in accordance with the statistical requirements of the Department of Education and Science. 110 During 1973 periodic medical inspection of all schools in the borough was carried out in the appropriate age groups, 4825 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 815 children were selected for examination out of a total of 1773 children in this age group and during the year in which age fifteen is reached, 437 out of a total of 1297 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 4,825 pupils inspected, 4,824 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 child whose general condition was deemed unsatisfactory was born in "[96"] . 111 Defects Found at Periodic Medical Inspection During 1973, 709 (14.7 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 group 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 1969 and later 262 8 44 51 1968 1014 22 11 125 1967 600 13 71 79 1966 66 - 5 5 1965 608 45 60 95 1964 207 23 22 36 1963 45 2 2 3 1962 929 75 54 126 1961 560 43 40 78 1960 75 6 5 11 1959 22 4 - 4 1958 and earlier 437 69 33 96 TOTALS 4825 310 347 709 112 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 54 140 Byes: (a) Vision 310 450 (b) Squint 69 64 (c) Other 18 50 Ears: (a) Hearing 26 159 (b) Otitis Media 6 67 (c) Other 3 6 Nose and Throat 26 281 Speech 56 60 Lymphatic Glands 34 61 Heart 1 37 Lungs 7 111 Development: (a) Hernia 2 5 (b) Other 4 48 Orthopaedic: fa) Posture 12 41 (b) Feet 74 130 (c) Other 14 50 Nervous System: (a) Epilepsy 16 9 (b) Other 5 31 Psychological: (a) Development 4 155 (b) Stability 10 138 Abdomen 10 29 Other 32 51 TOTAL: 2966 793 2173 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 276. 113 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 3 1 Eyes: (a) Vision 11 6 (b) Squint - 1 (c) Other 1 - Ears: (a) Hearing 6 4 60 (b) Otitis Media 1 4 (c) Other - 1 Nose and Throat - 1 Speech 13 5 Lymphatic Glands - - Heart - 1 Lungs 2 1 Development: (a) Hernia - - (b) Other 1 - Orthopaedic: (a) Posture - 1 (b) Feet 7 9 (c) Other 4 - Nervous System: fa) Epilepsy - - (b) Other - - Psychological: (a) Development 2 16 (b) Stability 5 9 Abdomen 3 - Other 13 8 TOTAL: 254 130 124 510 examinations were also carried out regarding the fitness of children not over compulsory school age to be employed. 114 Treatment of Diseases and Defects The number of defects known to be treated by all sources during the year is shown in the following table: Defects or Diseases Number Skin: Ringworm, head or body -- Scabies 3 Impetigo 17 Oth er 54 Vision and Squint 1301 Other Eye Conditions 13 Ear, Nose and Throat 36 Speech 812 Heart 4 Lungs 60 Development 4 Orthopaedic 203 Nervous Diseases 33 Abdomen 31 Other 245 TOTAL 2816 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 24 children received operative treatment by ear, nose and throat surgeons, including 14 cases of tonsils and adenoids. 115 Speech Therapy There have been seme changes of staff in 1973. One full time therapist left in February after two years at Roselands Clinic, the Mount School and St.Fhilip's School. A part-time therapist who had worked at Acre Road Clinic for two sessions a week, left the same month. The full-time therapist at Buckland Speech and Language Unit, who had been working there since its opening in April 1971 returned to her home in Australia in October. We were unable to recruit any new staff until September, but by the end of November we were fully staffed once again, and were able to fill the extra post due to an increase in the establishment. In January we held our first intensive course for stammerers at Manor Drive Clinic, Worcester Park. It took place daily from 10 am to 3.30 pm for a week during the Christmas holidays, and was attended by four girls and five boys between the ages of twelve and seventeen. Letters from the Medical Officer of Health had been sent to all the secondary schools in the borough beforehand to see if they had any pupils who might benefit from such a course, who were not already attending the speech clinics. The response from the schools was very helpful and we did receive names of several children who were not already known to us. We were then able to contact their parents with application forms and information about the course. The children's attendance was excellent and they were very enthusiastic about this new method of treatment. They were taught a new technique of speaking on the first day; they then had to practise it intensively every day in reading, conversation and spontaneous speech on a given or a chosen topic. Their speech was timed and analysed for an increased number of syllables every day and a graph was made of the results. In addition they were subjected to increasingly stressful situations, such as telephoning, or being interviewed by a stranger, until on the last day they were able to carry out a speech therapy survey among the general public. Not only did the children find the assignments enjoyable, but they did help them to gain confidence in every kind of talking situation. We have found the results encouraging. A further course was held for a fortnight in the summer holidays, when we had eight children, three of whom came for the first time; we are hoping to arrange further courses in the summer holidays in the future. 116 With our increase of establishment, we have been able to start one session a week at the Partially Hearing Unit at Knollmead School, at the request of the Chi.ef Education Officer. We have also increased our sessions at the Mount School and at Bedelsford. There is a large number of children at the Mount School needing speech therapy, and with the opening of a nursery there, the need is even greater. We are getting some very young children at Bedelsford School who need frequent therapy, and it was necessary to return to the ten sessions a week. We have also increased the sessions at Dysart School from five to six, and it is to be hoped that in the future we can increase to ten sessions. We have been asked by the Social Services Department to increase our sessions at the Adult Training Centre from five to ten, but so far this has not been possible. Intensive therapy is needed at both Dysart School and the Adult Training Centre if results are to be achieved. With the opening of the new Hawks Road Clinic we have stopped our session at King Athelstan School, which is close to the clinic. We have also transferred the Robin Hood School session to Roselands Clinic for the time being, as there are so few speech defective children in the school at present. The sessions at Acre Road Clinic and Hawks Road Clinic have been increased from two to three, as there were long waiting lists in both clinics. The work in the clinics continues to flourish. We are endeavouring to keep the waiting lists down as much as possible by arranging group therapy for the children who can benefit from it. The new room at Hawks Road Clinic is a big improvement on the one used for speech therapy at Grange Road Clinic. It is much bigger, is suitable for group treatment and has its own toilet and washing facilities. In addition it has good storage space for the varied equipment one needs when treating young children. We are getting more pre-school children with retarded language development referred to us and there is a greater need for representational toys that a suitable for the younger age group, eg dolls, cots, tea-sets, dolls house, toys etc. Treatment is done through play with these young children. The children at the Buckland Speech and Language Unit are making good progress. We are delighted with the results obtained by daily therapy for these severely speech handicapped children. The work in the special schools continues as before. There is still the problem of accommodation at St.Philip's School, as we share a room with the doctor, who is a frequent visitor. There is very little alternative space as every room in the school is in use most of the time. 117 There are many children requiring therapy at St Fhilip's and we could do with more sessions if there was adequate accommodation. It is to be hoped that the new school, planned for the future, will have provision for both the doctor and the speech therapists, as well as the other visiting specialists. Each full-time therapist, with the exception of the therapist at Buckland Speech and Language Unit, now has one session a week for administration, home and school visiting, assessments, advisory clinics, and for the many other things we have to do which require extra time. A schools visiting programme to cover all the schools in the borough is planned for 1974. We are grateful to the doctors, health visitors, teachers, and the staffs of the Audiology Clinic and the Child Guidance Clinic, who do so much to help us. 118 Centre Present Weekly Number of Sessions Children Treated Remaining for Next Year Acre Road Clinic 3 65 35 Adult Training Centre 5 79 47 Bedelsford School 10 19 18 Buckland School 1 18 13 Buckland Speech Therapy Unit 10 13 9 Dysart School 6 72 64 Grange Road/Hawks Road Clinics 3 58 41 Hook Clinic 3 70 51 King Athelstan School - 26 - Manor Drive Clinic 2 60 35 Partially Hearing Unit 1 9 9 Robin Hood School - 9 - Roselands Clinic 4 103 60 South Place Clinic 2 63 41 St. Philip's School 10 65 55 The Mount School 4 39 16 Tolworth Clinic 1 44 27 Administration Home & School Visiting 6 TOTAIS 71 812 521 119 Analysis of Cases Treated Defective Speech due to Children Treated Discharged Remaining at end of period 1972 1973 1972 1973 1972 1973 Stammering 45 51 17 24 23 27 Cluttering 3 2 2 - 1 2 Dyslalia 350 301 152 129 198 172 Idioglossia - - - - - - Anarthria/Dysarthria 8 10 2 1 6 9 Aphasia/Dysphasia 7 7 - 1 7 6 Aphonia/Dysphasia 2 3 1 - 1 3 Amentia/Dementia 72 72 11 8 61 64 Cleft Palate 8 9 3 4 5 5 Hyperrhinophonia 3 2 3 - - 2 Hyporhinophonia 2 - 2 - - - Deafness 8 17 2 2 6 15 Retarded Speech and Language Development 255 338 84 122 171 216 Unclassified 2 " 2 " TOTALS 765 812 281 291 484 521 120 Ophthalmic Clinics During the year 1314 children were examined at the school eye clinics; 354 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. All eye clinics have been very busy during the year as more new referred cases were sent to the clinics. An increased number of children were referred to hospital for orthoptic treatment. With regard to elderly people, the number of blind registrations were fewer than in the previous year. Audiology The following are details of work undertaken in schools: Children sweep tested: Primary 1603 Children who failed test: Primary 142 Result of Investigations by School Medical Officers: No significant hearing loss on clinical examination 73 No significant hearing loss, but child appears mentally retarded 1 Hearing loss confirmed and attributed to: (i) Catarrhal condition (with or without inflammation of ear) 38 (ii) Old otitis media 7 (iii) Injury (iv) Other causes 15 (v) Undetermined causes 13 Investigations incomplete at end of year 3 Investigations not possible - left district or otherwise unavailable for examination 2 121 Recommendations by School Medical Officers in the first instance: (i) No action required 13 (ii) For observation only 30 (iii) Refer to audiology clinic 15 (iv) Refer to general practitioner 18 (v) Refer to ear, nose and throat consultant 17 There were 25 recommendations made during the year for children to sit in favourable positions in the classroom. The total number of pupils attending school at the end of the year known to have been provided with hearing aids was 82. Audiology Clinic Of the 397 attendances during the year, 183 were made by 143 children under the age of five and 214 were made by 109 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 28 115 64 31 14 252 Cases carried over from 1972 - - 2 - - 2 Found to have normal hearing 26 104 31 16 7 184 Deaf in one or both ears - - - - - - Found to have remediable hearing loss - 10 32 15 4 61 Impaired hearing requiring auditory training and/or hearing aid 1 1 1 - 3 6 Not fully assessed at end of 1973 1 _ 1 _ - 2 Attendances 39 144 85 89 40 397 122 In September a second partially hearing unit was opened at Hollyfield Secondary School. Here using radio microphone equipment the hearing impaired children are able to integrate and partake in a normal school timetable. Specialist help from a teacher of the deaf is available on a tutorial basis. As in previous years audiology courses were held for health visitors and medical officers. 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 226 Children treated 114 Attendances 2269 New cases admitted 51 Cases discharged 39 There were 79 children attending Bedelsford Special School at the end of 1973 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 14,924 Number found infested (head lice/nits) 107 Present standards of cleanliness and freedom from infestation have enabled discretion concerning the frequency of hygiene inspections to be used. 123 Infectious and Contagious Diseases The number of children prevented from attending school because they were suffering from or in contact with infectious or contagious diseases, including any who were excluded on suspicion, is shown in the following table: Smallpox - Diphtheria - Scarlet Fever 21 Enteric Fever - Measles 436 German Measles 606 Chicken Pox 293 Mumps 270 Jaundice - Dysentery 1 Influenza - Other 53 TOTAL 1680 Immunisation and Vaccination It is now usual for children to be fully immunised against diphtheria, whooping cough, tetanus, mealses and poliomyelitis by the time they enter school at five years of age. Any necessary reinforcing injections are made available to children at school. The percentage of children immunised can be regarded generally as satisfactory and the co-operation of head teachers is very much appreciated. Diphtheria: Number who completed primary course 42 Number who received reinforcing injections 1506 1548 Poliomyelitis: Number who completed a primary course 44 Number who received a reinforcing dose 2427 2471 Tetanus: Number who completed a primary course 70 Number who received a reinforcing injection 2283 2353 Number of primary courses completed from previous year 226 124 Measles: Number who received immunisation 122 Rubella (German Measles): Number who received immunisation 270 Vaccination against Tuberculosis The scheme for the routine BCG (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 summarises the work undertaken: Routine BCG Programme BCG Offered 1726 Consented 2544 Absent 407 Heaf Positive 146 Vaccinated 991 Child Guidance Case load brought forward from 1972 372 Waiting list brought forward 13 New cases referred during the year by: General practitioners 70 School Health Service 39 Social Services Department 5 Hospitals 6 Direct non-medical 18 Education Department 5 Health visitors 3 School Psychological Service 4 Court 1 Other Child Guidance Clinic 3 154 539 New cases seen initially by psychiatrist during the year: 137 Initial distribution: Psychiatrist 72 Psychologist 5 P.S.W. 60 125 Cases closed during 1973 154 Reasons: Unco-operative 7 Failed to attend 12 Transferred 34 Improved 43 Moved from district 10 No further contact 29 Left school 18 Other arrangements 1 Cases withdrawn from diagnostic waiting list during 1973 3 Waiting list for diagnostic interview 8 Case load to be carried forward to 1974 374 539 126 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 1973 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 2 1 — — — 1 — — - - Partially Sighted 3 1 - - - 1 - - - - Deaf 1 4 - - 4 1 - - - - Partially Hearing 13 7 1 1 2 1 - - - - Educationally Subnormal 110 91 5 4 10 4 — 2 3 Epileptic 1 - - - - 1 - - 1 - Maladjusted 14 7 1 - 35 3 - - 6 3 Physically Handicapped 13 12 34 21 3 4 — 1 1 Delicate 1 1 - - 2 1 - - - - Speech Defect 8 1 TOTALS 166 125 41 26 56 17 - - 9 10 10 7 127 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 3-17+ years and there are currently 79 children on roll. 24 children are from the Royal Borough of Kingston and the school also accepts children from the London Boroughs of Sutton, Merton and Richmond and from the County of Surrey. Handicaps present are as follows: Spina bifida and hydrocephalus 28 Cerebral palsy 14 Muscular dystrophy 12 Cardiac 5 Cerebellar ataxia 3 Hemiplegia and epilepsy 2 Hydrocephalus 2 Arthrogryphosis 2 Epilepsy 1 Post-poliomyelitis 1 Still's disease 1 Achondroplasia and hydrocephalus 1 Hydrocephalus and epilepsy 1 Hirschsprung's disease 1 Congenital absence of abdominal wall 1 Osteogenesis imperfecta 1 Incontinenta pigmenti and epilepsy 1 Partial excision of brain tumour 1 Degenerative condition of cerebellum and retinal area 1 TOTAL 11 22 children are receiving speech therapy, 2 children are partially hearing and require the help of a peripatetic teacher of the deaf, 10 children are additionally handicapped with epilepsy, and a noticeable number of children have intelligence quotients within the educationally subnormal range. During the year one child has been officially registered as partially sighted and another registered as blind. From these details of additional handicaps it will be readily seen that the majority of children on roll are very severely handicapped and present many educational, social and medical problems. Due to current difficulties in the building trade there has been some delay over the final phase of the rebuilding programme. It is now hoped that work will start in the spring. 128 Two events of particular interest have taken place during the year. Ten of the junior children went on a school journey to the New Forest for five days. This was a most successful venture and the accommodation at Beaverbrook Lodge proved very suitable for physically handicapped children. It is hoped to make further use of this new centre for other classes. Twenty-five children took part for the first time in a physically handicapped schools sports day. Four schools competed in a wide range of events and the children did very well, winning a good number of certificates. Plans are in hand for the school to enter for this interschool event again in 1974. Throughout the year the school aims to provide a full and normal educational programme for the children, together with individual physiotherapy, speech therapy and other remedial help as required. St. Philip's School for Educationally Subnormal Children, Fleetwood House, Leatherhead Road, Chessington Thanks are expressed to Mr J.A.Ainley, Headmaster for the following report: The number on roll rose in January 1974 to its highest ever total of 146. This was due to the number of older boys and girls staying on after the statutory leaving age and to relieve the urgency of some children on the waiting list (which still however numbers eight). Staffing improvements have been recommended and approved, and I hope the first phase of these will still go through this year. A new building is planned for completion in 1976, to take 140 pupils. It is hoped that the old buildings on the site will be retained in the continued service of special education (including 'remedial' and 'slow learner' work) as a centre, after the move to new buildings, so that the school may continue to play its part in the expansion of this work in Kingston. An experienced member of staff, Mrs. Sunderland, was last year appointed as teacher/adviser in the borough. It is felt that there will be need for future provision in two directions, not at present allowed for in the new buildings planned: (i) Adequate accommodation for the 'support' services - medical inspections, hygiene, hearing and vision testing, IQ testing and case work, physiotherapy and particularly speech therapy. (Note: 27 speech defective children on January count). 129 (ii) There is no special provision in the borough for under-fives, who are E.S.N., suspected E.S.N, or need a period of assessment for appropriate placement because of predictable learning difficulties, although recent proposals in nursery education have been aimed at improving the lot of deprived and handicapped children. Provision is made at the borough's other special schools for more severely subnormal and physically handicapped children, where one must assume the handicap is more obvious. It might be thought that the problems of many E.S.N. children are equally clear to the professional eye. It is felt that the essential requirements for the assessment and early treatment of learning difficulties: qualification, experience and insight are already available at St Philip's. Buckland Speech Therapy Unit Thanks are expressed to Mrs Humble, Headmistress of Buckland Infants School, for the following report: The unit, opened in April 1971, is administered by the Education Department of the Royal Borough of Kingston upon Thames in close co-operation with the Health Department and is part of the establishment of Buckland Infants School, Chessington. A maximum of ten children with severe speech handicaps from within the borough can be catered for at any one time. Ages range from 3+ to 7+. There has been an increasing and welcome tendency for children to be referred for admission under statutory school age, increasing the prospects of effective treatment. Children are transported daily by minimus accompanied by an escort provided by the authority. Children may be referred to the Principal School Medical Officer for possible admission to the unit from various sources, such as speech clinic, hospital or school. Detailed reports concerning each child are carefully considered by a team of advisers which meets monthly, before a decision is made as to whether a child would be likely to benefit from admission to the unit. This team includes a school medical officer, a consultant psychiatrist, a psychiatric social worker, an educational psychologist, the senior speech therapist, the headmistress of Buckland 'School, the assistant education officer and an administrative assistant from the Education Department. All children pay a preliminary visit to the class with their parents before admission. 130 Regular opportunities are given for parents to meet the head teacher, class teacher and speech therapist. The psychiatric social worker acts in a supporting role to parents and her group meetings for mothers held fortnightly at the school are well attended. Accommodation comprises a classroom well equipped for the educational needs of this wide age range and a soundproofed treatment room where intensive speech therapy is given. Many facilities, such as dining area, hall and playground, are shared with other classes in the school. A qualified teacher is in charge of the class, working closely with a full-time speech therapist attached to the unit. There is full liaison with other members of the teaching and ancillary staff of the school. The children take a full part in the life of the school and share assemblies, physical education, television and radio programmes with other classes. The younger children are closely linked with the two nursery classes. As children progress in the unit they spend an increasing part of the school week in other classes with children of their own age group to help to prepare them for transfer to a class in their local school. Before transfer takes place, on the recommendation of the class teacher and speech therapist, endorsed by the advisory panel, the child's future head teacher and class teacher are invited to visit the unit and a preliminary visit is made by the child, parents and speech therapist to the receiving school. Reinspections of past pupils are arranged by the speech therapist to ensure that progress is maintained. Since the establishment of the unit eleven children have made such progress that they have ceased to need special educational provision and have been able to continue their education in a normal school situation, a goal towards which all concerned with the unit are always looking. School Milk and Meals Service There is close collaboration between the Environmental Health Section and the School Meals Service in order to ensure continued high standards of hygiene. Equipment is continually improved and the quality of the meals is good. The provision of milk and meals in school is very valuable, particularly to those children whose mothers are in employment, and the following figures are of interest: 131 Children in attendance 19,218 Taking milk 5,402 Percentage taking milk 28.1 Taking meals 12,808 Percentage taking meals 66.65 Cost of meal to pupil 12p Percentage taking meal at: Full charge 92.14 Free 7.86 Average number of days meals were supplied in year 199 Average daily number of meals supplied 13,886 Number of meals supplied: Other establishments 4,673 Maintained schools 2,758,654 2,763,327 Deaths of School Children During the year notifications were received in respect of the deaths of five children of school age resident in the borough. The causes of death were as follows: 1 Fibrosarcoma 1 Congenital heart disease 1 Prolonged cerebral anoxia 1 Cerebral and subdural haemorrhage (accident) 1 Carcinomatosis Medical Examination of Adults 241 newly appointed teachers and candidates for admission to teacher training colleges were medically examined, as required by the Department of Education and Science. 332 teachers were appointed to Kingston schools after submitting medical history forms. 132 SCHOOL DENTAL SERVICE Donald M. Dodd, LPS, BPS, DDFH, RCS, Chief Dental Officer Staffing The establishment of dental officers remained at almost full strength throughout the year. One part-time dental officer resigned in August, but by October this vacancy had been filled. Clinics Regular visits were made to each clinic in order to ensure that high standards of cleanliness were being maintained in all dental suites. Hawks Road Clinic was opened for patients at the end of July and it is hoped that by the appointment of a dental auxiliary early in 1974 good use will be made of the second dental surgery. Dental Inspections (see tables) Close liaison with head teachers and teachers facilitated the dental inspection of all schools at least once during the year. On these occasions 18,162 children were seen which meant that 88% of the school population received its first dental inspection of the year at school. This compared extremely favourably with a national average of less than 60%. 2526 children also received their first inspection of the year at a clinic and 3522 were reinspected. The latter figure indicated that 17% of pupils were being offered more than one course of treatment per year if this was found to be necessary. Dental Treatment (see tables) 6954 children, at their first inspection, were recorded as requiring treatment. Some needed fairly early attention, whilst others were not necessarily regarded so urgently; in addition a certain number were already under the care of their own private dentists. As a result, 6176 children out of the above total were offered treatment and 3460 or 49.8% accepted treatment within the school dental service. An encouraging trend towards preservation of teeth continued to be evident, with a ratio of nine permanent teeth filled to every one extracted and this was also noticed in respect of deciduous teeth where the ratio was three to one. The orthodontic clinic at Acre Road continued to provide comprehensive 133 treatment including removable, fixed and extra-oral appliances. Arrangements, started in 1972 for the dental officer concerned to work one session a week with the consultant orthodontist at Kingston Hospital, proved most successful and will be continued. Dental Health Education Treatment of existing disease is one of the priorities in any dental health programme. Hardly less important is the necessity to create in the minds of the population, particularly in younger age groups, an idea of the importance of healthy teeth and gums. In support of this concept, for the fourth consecutive year, a large scale dental health campaign was carried out. It was again directed towards two thousand intake children at infant, nursery and special schools and involved films, talks, demonstrations and the distribution of dental hygiene kits and Happy Smile Club badges. Various schools continued to participate in the Apples for Schools scheme in an effort to cut down the sales of chocolate, biscuits and sweets. March was chosen as dental health month and table, posters, and pamphlet displays were set up in each clinic. It was hoped thereby to stimulate further interest particularly on the part of nursing and expectant mothers as to the importance of sound dental health. 5.6% of all sessions were devoted to this preventive aspect of dentistry and although this may not seem a large proportion of the total working time, it is nevertheless looked upon as a vital part of any comprehensive dental scheme. Caries Survey In the early spring an extensive survey was carried out on the state of teeth in five year old children in the borough. It was found that overall, slightly less teeth had been affected by decay than was expected from average national figures. Reasons for this were difficult to discern, but it seemed that when compared with certain other parts of the country both parental and child attitudes generally favoured aboveaverage attention to dental health matters. A fairly good supply of dentists, coupled with regular dental health education programmes, possibly helped also to produce a relatively encouraging picture. Fluoridation of Water Supplies No further moves were made by the Metropolitan Water Board to fluoridate community water supplies, primarily because a small proportion of boroughs served by the system remained opposed to the idea. 134 The process, which has been accepted by all our responsible professional bodies as the safest, cheapest and most efficient method of reducing dramatically the amount of dental decay, is thereby being withheld from children in this area. As the beneficial effects of fluoridation are known to be carried on into middle age, our next generation of adults is consequently going to be affected through lack of implementation of the measure. 135 DENTAL INSPECTIONS AND TREATMENT 1973 First inspections of the year: at school 18,162 at clinic 2,526 20,688 Reinspections at school and clinic 3,522 Found to require treatment from first inspections 6,954 Offered treatment from first inspections 6,176 Treated 3,460 Attendances for treatment 11,187 Sessions devoted to inspections 176 Sessions devoted to dental health education 134 Sessions devoted to treatment 1,997 Number of fillings in permanent teeth 6,287 Number of fillings in temporary teeth 4,211 Number of permanent teeth filled 5,445 Number of temporary teeth filled 3,848 Number of permanent teeth extracted 594 Number of temporary teeth extracted 1,191 General anaesthetics 664 Pupils X-rayed 690 Prophylaxis 1,172 Teeth otherwise conserved 857 Teeth root filled 41 Inlay s 4 Crowns 4 Orthodontic cases: Commenced during the year 162 Brought forward from 1972 503 Completed during the year 243 Discontinued during the year 36 Referred to hospital consultant - Removable appliances fitted 138 Fixed appliances fitted 194 Under treatment or observation at end of year 437 136 SCHOOL CLINICS Address Clinic Hawks 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, Dental, Eye General Medical Physiotherapy Mecklenberg House 50 Kingston Road New Maiden Child Guidance The Manor Drive Worcester Park Minor Ailments Speech, Dental, Bye General Medical Physiotherapy Audiology St. George's Hall Hamilton Avenue Tolworth Speech With the exception of Minor Ailments, attendance is by appointment. 137 INDEX Page Abused children 37 Accidents 96 Acknowledgments 2 Adult Medical Examinations 23, 131 After care 40-43 Air Pollution 59, 60 Aircraft Noise 57 Ambulance Service 39 Animals 70 Ante-natal Clinics 27, 28 Area 8 Area Health Authority 1 Audiology 120-122 Bacillus Calmette-Guerin (BCG) Vaccination 37, 41, 124 Bacteriological Examinations 65, 66, 103 Bedelsford Sohool 127, 128 Birth Rate 8 Births 8 British Red Cross Society 44 Buckland Speech Therapy Unit 129,130 Cancer Deaths 13 Caravans 64 Caravan Sites and Control of Development Act 1960 64 Care Committee 43 Care of Mothers 27-30 Care of Young Children 28 Causes of Death 11-16 Certificates of Vaccination 39 Cervical Smears 21, 44 Chest Clinic 37 Chief Dental Officer's Report 132-134 Chief Public Health Inspector's Report 49-50 Child Guidance 124-125 Child Welfare 28, 29 Chimneys 59 Chiropody 44, 45 Clean Air 57-60 Clean Air Act 56-58 Cleanliness 122 Cleansing 53 Clinics 27, 28, 120, 121 132, 136 138 Complaints 69, 88, 97 Congenital Malformations 30, 31, 32, 33 Contagious Diseases 123 Cremations 23 Cytology 21, 44 Deaths 8, 11-16, 41, 42, 131 Dental Inspection 29, 30, 132, 135 Dental Service 29, 30, 132-135 Dental Survey 133 Dental Treatment 29,30, 132-135 Department of Education and Science 109-114, 131 Diphtheria 38, 39, 123 Disinfection and Disinfestation 61 Display Cabinets Survey 67, 68 District Nursing 35-36 Domiciliary Nursing 35-36 Drainage 53 Drugs 69, 72-83 Dust 60 Dwellings, Separately rated 8 Dysart School 116 Ear, Nose and Throat Treatment 114 Education Act 1944 109 Elderly Persons 36, 44, 45 Environmental Health 1, 2, 49-106 Epileptic Children 122 Evening Nursing Service 35 Executive Council 1 Factories Act 1961 93, 94 Family Planning 21, 43 Family Planning Association 43 Feeding Stuffs 70 Fertilisers 70 Fertilisers and Feeding Stuffs Act 1926 70 Flooding 53 Food 65-87 Food and Drugs 72-83 Food Hygiene 67 Food Hygiene (General) Regulations 1970 85-87 Food Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 85 139 Food Premises 65-68 Fluoridation of Water 2, 51, 133, 134 Poxes 60, 61 General Services 21 -24 Geriatric Liaison 36 German Measles 38, 123-124 Greater London Council 39 Grit 60 Hairdressers 71 Handicapped Pupils 126-130 Head Lice 122 Heaf Tests 124 Health Centres 27 Health Education 21, 133 Health Visiting 36, 37 Health and Control Committee 3 Hearing Aids 121 Hearing Loss 120 Home Dialysis 45 Home Nursing 35, 36 Hospitals 1, 24 Hostel for Handicapped Pupils 126 Housing 62-64, 98-102 Housing Act 1969 62, 99 Housing Acts 98-102 Ice Cream 66 Illegitimate Births 8, 9 Immunisation 38, 39, 123, 124 Impetigo 114 Imported Pood 67 Improvement Areas 63, 64 Improvement Grants 62, 63, 99-102 Infant Mortality 8-9 Infectious Diseases 1, 17-18, 123 Insects 60, 88, 97 Inspections 89-91, 93, 98 International Certificates of Vaccination 39 Kidney Machines 45 Kingston and District Care Committee 43 Kingston Association for Mental Health 21 Kingston & Richmond Area Health Authority 1 140 Labelling of Food 69, 72-82 Laboratory Service 19 Late Night Nursing 35 Lice 122 Licensing of Nurses Agencies 23 Loan of Nursing Equipment 44 Marriages 17 Maternal Deaths 8 Meals 130, 131 Measles 38, 124 Meat 67, 83, 84 Medical Examination of Adults 23, 131 Medical Inspection 109 - 113 Metropolitan Water Board 51, 103 Mice 60, 88, 97 Midwifery Service 34, 35 Milk 65, 66, 130, 131 Mortality Rates 8-9 Mortuary Services 23 Movable Dwellings 64 National Assistance Act 1948 - Section 47 22 National Health Service Act 1946 27 National Health Service (Reorganisation) Act 1973 1, 2 Neonatal Deaths 10 Night Nursing Service 35 Noise 56, 57 Notices 92, 98 Nurses Agencies 23 Nurse Training 35, 36 Nursing Equipment 36 Nursing Homes 22 Nursing Services 34-37 Offices, Shops & Railway Premises Act 1963 53-56, 95, 96 Ophthalmic Clinics 120 Oral Hygiene 21 Orthodontic Treatment 135 Orthoptic Treatment 120 Outwork 94 Paratyphoid Fever 17, 39 Penny Rate Product 8 Periodic Medical Inspection 109-112 Personal Health Services 27-45 Pest Control 97 Pharmacy and Poisons Act 1933 71 141 Physiotherapy 122 Pigeons 61, 88, 97 Poisons List 71 Poliomyelitis 38, 39, 123 Pollution 49, 59, 60 Population 8 Post-natal Clinics 27, 28 Prevention of Illness 40-43 Public Analyst 66, 70 Public Cleansing 53 Public Health Laboratory 19, 65, 66 Public Health (Prevention of Tuberculosis) Act 1936 42 Rateable Value 8 Rats 60, 88, 97 Registrar General 8 Registration of Nursing Homes 22 Reorganisation of National Health. Service 1, 2 Riding Establishments 70 Ringworm 114 Rivers and Streams 52 Rodents 60, 61, 88, 90 Rubella 38, 124 St John Ambulance Association 44 St Philip's School 128,129 Sale of Welfare Poods 28, 29 Samples 72-83, 103, 104 Scabies 114 School Clinics 136 School Dental Service 132-135 School Health Service 109-131 School Meals 130, 131 School Milk 130, 131 School Population 106 Sewage Disposal 53 Sewerage 53 Sexually Transmitted Diseases 19-20 Shops Act 1950 53 Skin Testing 124 Smallpox 39 Smoke 59, 105, 106 142 Smoke Control Orders 57, 58 Smoking 21, 22 Sonne Dysentery 18 Social Services Liaison 34 Special Inspections 113 Special Schools 126-130 Speech Therapy 115-119 Squirrels 60, 61, 88,97 Staff of Health Department 1, 2, 4, 49,50 Staff Medical Examinations 23, 131 Statistics 8-9 Stillbirths 8 Sulphur Dioxide 59, 105, 106 Swimming Baths 51 Tetanus 38, 123 Trade Descriptions Act 1968 70 Traffic Noise 57 Treatment of Diseases and Defects 114 Tuberculin Tests 41, 124 Tuberculosis 18, 37, 40-43 Typhoid Fever 17, 39 Unfit Foodstuffs 69, 84 Vaccination 38, 39, 123,124 Venereal Diseases 19-20 Verminous Conditions 122 Veterinary Surgeons 70 Vision Testing 120 Vital Statistics 8-9 Wasps 60 Water Supply 51, 103, 104 Welfare Foods 28, 29 Whooping Cough 38, 39 Yellow Fever 39