RICH 10 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1941. RICHMOND : J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET. 1 Public Health Department, Parkshot, Richmond, Surrey. August, 1942. To the Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health on the Health and Sanitary Condition of the Borough for the year ended 31st December, 1941. The Ministry of Health have requested that "on grounds of national security, care should be taken not to publish in the Annual Report complete tables of local populations, or quotations from the figures supplied by the Registrar-General which may enable any substantial series of local populations to be reconstructed." The Report is therefore considerably shortened, as several tables of statistics have been omitted. The figures are however tabulated, and will be kept in the Department for future reference. As the Council are aware, this Report deals with a period of 1941 during which I was your Medical Officer, and the period (after the 3rd of August) during which Dr. Pereira was Medical Officer of Health. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER, Temporary Medical Officer of Health. 2 Statistics. Rateable value £591,031 Sum represented by a Penny Rate £2,200 Extracts from vital statistics of the year. Birth rate per 1,000 of estimated resident population 12.3 Death rate per 1,000 of estimated resident population 16.4 Death rate from Puerperal Sepsis and other Puerperal causes 0.00 Death rate of infants under 1 year of age— All infants per 1,000 live births 40 Deaths from cancer (all ages) 75 Deaths from measles Nil Deaths from whooping-cough Nil Deaths from diarrhoea (under 2 years) 1 3 BIRTH RATE, CIVILIAN DEATH RATE & ANALYSIS OF MORTALITY DURING THE YEAR 1941. (Provisional figures). (The mortality rates for England and Wales refer to the whole population but for London and the towns to civilians only). Rate per 1,000 Civilian population. Annual Death Rate per 1,000 Civilian Population. Rate per 1,000 Live Births. Live Births. Still-births. All Causes. Typhoid and Paratyphoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales ... 14.2 0.51 12.9 0.00 — 0.03 0.00 0.06 0.07 0.19 6.1 59 126 County Boroughs and Great Towns, including London ... 14.7 0.5S 14.9 0.00 0.03 0.00 0.07 0.08 0.17 7.5 71 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) 16.4 0.60 13.0 0.00 0.03 0.01 0.06 0.06 0.20 4.6 56 London Administrative County 8.9 0.33 16.3 0.01 — 0.02 0.00 0.04 0.03 0.15 6.8 68 RICHMOND 12.3 0.53 16.4 0.00 — 0.00 0.00 0.00 0.03 0.31 0.03 40 Puerperal nfection Others. Total. The maternal mortality rates for England and Wales are as follows Per 1,000 Total Births 0.48 1.75 2.23 The maternal mortality rates for Richmond are as follows Per 1,000 Total Births 0.00 0.00 0.00 4 Treatment Centres and Clinics. Address. By whom provided. Minor Ailments Clinic Windham Road, Richmond. For Elementary School Children Education Committee. Dental Clinic Ditto Ditto. Ditto. Do. d Ditto M. and C.W Committee. Eye Clinic Ditto (1 session per fortnight). Education Committee. Ante-Natal Clinic Ditto (1 session per week plus one extra session on alternate weeks). M. and C.W. Con.mittee. Diphtheria Immunisation . Ditto Health Committee. Tonsils and Adenoids Richmond Royal Hospital. By arrange ment with Education Ringworm (X-rays) Dr. D. B. I. Hallett, 2, Old Palace Terrace, Richmond. When required. Committee. Education Committee Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. By arrangement with M. & C. W Tuberculosis Treatment.. 38, Sheen Rd., Richmond. Once weekly. Committee. County Council. 5 Attendances at Clinics. Ante-natal. Number attended. Total attendances. 291 862 Attendances. Windham Road Mothers 2,951 Children 2,676 Trefoil House Mothers 886 Petersham Children 990 Doctor's Consultations 1,870 Toddlers 300 Health Visitors' Visits First visits Re-visits. 278 2,019 Nursing Homes. The Surrey County Council have registered seven Nursing Homes. 44, Onslow Road, General Medical and Maternity 22, Cardigan Road, „ „ 25, West Park Road, „ „ 86, Mount Ararat Road, General Medical 19, Grena Road, „ „ 18, Mortlake Road, „ „ Beaconsfield, Kew Green, Maternity only. All these Homes have been visited during the year. SANITARY INSPECTION OF THE AREA. Report of Chief Sanitary Inspector. The figures given below indicate the nature of the work carried out. In addition, the billeting and rehousing of evacuees, homeless persons and welfare arrangements for the care of overseas war refugees, have been carried out by this Department. 6 Inspections under the Housing and Public Health Acts. Total inspections 8,513 Nuisances discovered on 373 of the premises 760 Defects abated by the end of the year 690 Outstanding defects at the end of the year 66 Action deferred until after the War 4 Visits paid to ascertain that the defects were being properly remedied 967 Inspections made under the Housing Acts 3 Sanitary defects remedied, and improvements made in accordance with the above 23 Shops Acts. Number of shops on register at the end of the year 698 Special visits made 5 Changes of occupancy 20 Factories Act 1937. Factories on the register at the end of the year. Mechanical 1ll Non-Mechanical 62 Inspections made 57 Written notices served 6 Defects found 14 Defects (a) remedied 14 Defects (b) in abeyance Nil Service of Notices. Informal Notices Served 180 Statutory or Formal Notices Served 66 Number of dwelling-houses which were rendered fit after service of Formal Notice under the Housing Act— (a) By Owners 1 (b) By Local Authority in default of owners Nil 7 Petroleum Acts 1928. Visits made during the year 133 Licences for which applications for renewal were made during the year: — (a) Petroleum 48 (b) Carbide of Calcium 2 New licences issued during the year 1 Number of persons licensed to keep Petroleum 45 Number of persons licensed to keep Carbide of Calcium 2 Slaughterhouses. There is one slaughterhouse in the district, but this is not now in use, as the slaughtering of animals has been centralised, and is carried out under the supervision of Government inspectors. The nearest slaughterhouse under this scheme is at Kingston. Visits made to meat shops or stores, and other premises where food is prepared, or exposed for sale 160 Eradication of Bed Bugs. Disinfestation methods were applied to the following properties: — Council Houses 10 Requisitioned Houses 1 Other Houses 25 Disinfection of Premises. Reason. Houses. Rooms. Bedding. disinfected. Infectious Fevers 48 53 79 Tuberculosis 4 4 16 Scabies 1 2 67 Other Diseases 16 24 55 Vermin 36 96 31 Public Shelters Disinfected (Comprising 968 compartments) 50 8 Complaints. Number received and dealt with during the year 560 (Signed) GEORGE LAWS, F.R. San.I., F.S.IA. Chief Sanitary Inspector, and Officer under the Housing Acts. 9 SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1941:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal formal Total Formal Informal Total Milk 31 1 32 3 ... 3 ... ... Butter ... 2 2 ... ... ... ... ... Lard ... 1 1 ... ... ... ... ... Flour 2 ... 2 1 ... 1 ... ... Coffee ... 1 1 ... ... ... ... ... Sausages 2 1 3 ... ... ... ... ... Confectionery and Jam 1 5 6 ... 1 1 ... ... Sausage Meat 2 ... 2 ... ... ... ... ... Chocolate Spread ... 1 1 ... ... ... ... Dried Eggs ... 2 2 ... ... ... ... ... Egg Mixture 1 1 2 ... 1 2 ... ... "Eggstead" ... 1 1 ... 1 1 ... ... Yorkshire Pudding Mixture 1 ... 1 ... ... ... ... ... Lactic Sugar ... 1 1 ... ... ... ... ... Egg Substitute ... 4 4 ... ... ... ... ... Custard Powder ... 3 3 ... ... ... ... ... "Lem Lem" 1 1 2 1 1 2 ... ... "Batter Mix" 1 1 2 1 1 2 ... ... Lemon Essence ... 1 1 ... ... ... ... ... Totals 42 27 69 7 5 12 ... ... 10 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases during the year. Disease Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Smallpox ... ... ... Scarlet Fever 33 19 ... Diphtheria 12 12 1 Paratyphoid Fever 1 1 ... Puerperal Pyrexia 5 5 ... Pneumonia 20 9 23 (all forms) Cerebro-Spinal Fever 12 11 3 Ophthalmia Neonatorum ... ... ... Erysipelas 3 2 ... Measles 126 2 ... Whooping Cough 130 ... ... Acute Anterior Poliomyelitis 1 1 ... Total 343 62 27 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Scarlet Fever 19 Diphtheria 12 Cerebro-Spinal Meningitis 4 Measles 2 Other Diseases 12 Total 49 DIPHTHERIA IMMUNISATION CLINIC. Total number of children seen during the year 1,067 Total number of attendances 1,943 Total number of children who received primary Schick test 139 11 Total number of children naturally immune 36 Percentage of children naturally immune 25.8% Number of certificates given 450 Number of children who required additional injections for complete immunity 14 Number re-tested after 2 years 14 Number of children who were still immune 12 Number of children who required further injections 2 Number re-tested after 4 years 18 Number of children who were still immune 15 Number of children who required further injections 1 Total number of certificates given after immunisation. (a) Pre-school children 183 (b) School children 267 As previously mentioned, Bacteriological Examinations for Infectious Disease are carried out by the Pathologist at the Royal Hospital, Richmond. During the year the number of specimens, etc., sent up for examination was as follows:— Disease Suspected. Nature of Specimen. Result. Total. Positive. Negative- Diphtheria Swabs from Throat and Nose 11 79 90 Tuberculosis Sputa 4 36 40 Typhoid ... — 1 1 Other Diseases ... 5 10 15 Total 20 126 146 12 TUBERCULOSIS. It has not been necessary to take action under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. Respiratory Tuberculosis (Phthisis). Fifty-seven cases of this disease were notified during the year (35 males and 22 females). Of these 41 (28 males and 13 females) were removed to Hospital or Sanatorium. There were 36 cases notified in 1940. There were 18 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for 5 deaths while 10 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory 0 M F M F M F M F ... ... ... 1 ... ... ... 1 1 ... 1 1 ... ... ... 1 ... 5 ... 1 1 ... ... ... ... ... 15 7 10 1 1 1 ... ... ... 25 9 5 1 ... 3 2 1 ... 25 6 ... ... 3 2 2 ... ... 45 7 2 1 ... 4 1 1 ... 55 3 2 ... ... 2 ... 1 ... 65 and upwards 3 1 ... ... 1 ... ... ... Totals 35 22 5 5 13 5 4 1 BOROUGH OF RICHMOND (SURREY). Education Committee. ANNUAL REPORT OF THE School Medical Officer 1941. richmond : j. h. broad and co., ltd., printers, 8. king street. 2 Staff. School Medical Officer : C. S. Brebner, D.S.O., M.D., D.P.H., Barrister-at-Law. Retired July, 1941. Eric Pereira, M.B., B.S., D.P.H. Ophthalmic Surgeon (part time) : C. Longworth Blair, M.R.C.S., L.R.C.P. Dental Surgeon : Miss Evelyn Russell, L.D.S., R.C.S. (Eng.). (part time). School Nurses : Miss J. D. Law, R.R.C. (S.R.N., S.C.M.). Called for war service, September, 1939. (Health Visitors Cert.). Miss E. D. Steuart, (S.R.N., R.F.N., S.C.M.). (New Health Visitors Cert.). Miss N. H. Jones, (S.R.N., S.C.M.). Called for war service, May, 1941. (New Health Visitors Cert.). (Tuberculosis Certificate). Temporary Staff : Miss E. M. Mortimer, (S.R.N., S.C.M.). (New Health Visitors Cert.). Miss C. E. V. Clark, (S.R.N., S.C.M.). (New Health Visitors Cert.). Dental Assistant (part time): Miss M. D. Banks. Called for war service September, 1939. Dental Assistant (temporary staff): Miss J. Ayland. Clerks : Miss M. M. O'Connor (part time). Temporary Staff : Miss L. M. Johnson (part time). 3 BOROUGH OF RICHMOND (SURREY). Report on the Medical Inspection and Treatment of Elementary School Children for the year ended December, 31st, 1941. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Report on the work of the School Medical Department during the year 1941. The Report deals with the work carried on while I was in office up to the end of July and the continuation of the work under Dr. Pereira up to the end of the year. As you are aware Dr. Pereira has been called up to serve in the R.A.M.C. and it is on that account that I am temporarily acting as school medical officer. The Report is a brief one as requested by the Board of Education. A summary of the statistics is as follows:— Average number of children on the registers during 1941 2,619 Average attendance at Elementary Schools during 1941 2,308 Number of Routine Medical Inspections 1,049 Number of attendances at Minor Ailment Clinic 2,938 Number of children obtained glasses after examination by specialists 127 Number of children operated on for Tonsils and Adenoid conditions 22 Number of attendances at Dental Clinic 1,744 Number of children given general anaesthetics (Gas or Ethyl Chloride) 613 I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER 4 Medical Inspection. (Table I, page 10). Medical Inspections were carried out during the year as follows: — 1. Routine Inspections required by the Board of Education. (a) Entrants; (b) Intermediates; (c) Leavers. 2. Other Inspections: (a) Special children not in the above groups but who are examined usually at the request of the Head Teacher. (b) Children seen at the Clinic, sent by Parents, Head Teachers or the School Nurses. (c) Re-inspections of children previously found with a defect of some kind. There were 291 entrants examined at the Routine Inspections and 319 parents or guardians attended. 300 children of the intermediate age were inspected and 268 leavers, i.e., children aged 12 years. There were 190 other Routine Inspections made during the year, so that the total number of children examined was 1,049 as compared with 633 in 1940. It was not possible to complete all the Routine Medical Inspections which were due in 1941. Other inspections include children seen as "specials." These are generally children brought forward by the Head Teachers, or they may be seen by one of the School Nurses and deemed suitable cases for a special examination. 24 of these cases were examined during the year. Included in the Special Inspections in Table I, are the cases seen at the Inspection and Minor Ailment Clinic, so that there is a total of 770 special inspections. From the table on page 10 it will be seen that re-inspections totalled 1,226. While visiting Schools for Routine Inspections, re-inspections 5 are made of children who have previously been found with defects and also of children who have been placed "under observation." Parents are also asked to bring children to the Inspection Clinic and advice is given there. Age Croups Inspected. The Board of Education requires Local Authorities to make provision for the Medical Inspection of all children admitted to school during the year ending March 31st, and of all children between 12 and 13 years of age, together with children over 13 who have not been inspected after reaching the age of 12. An intermediate group, children between 8 and 9 years of age, must also be examined. The 291 entrants comprised 169 boys and 122 girls. „ 300 intermediates „ 169 „ 131 „ „ 268 leavers „ 129 „ 139 ,, The number inspected and re-inspected under the heading "Other Inspections" is 1,972 as compared with 1,515 in 1940. Findings at Medical Inspections. Uncleanliness. The degree of cleanliness of both head and body is noted at the Medical Inspections and 40 children were found at these inspections who had to be referred for treatment for verminous or "nitty" heads. The School Nurses pay periodical visits to the schools for the purpose of inspecting heads, particularly after a holiday period. During the year under review the average number of visits per school by the Nurses for these cleanliness inspections was 7. The total number of examinations during these inspections was 5,521 as compared with 5,020 in 1940. 247 individual children were found either to be verminous or to have so many nits in their hair that notices had to be sent to the parents. When children are found to be unclean they are excluded and a notice is sent to the Education Secretary. A warning is sent by him to the parent that if the child is not made clean within 7 days, a prosecution will follow. The children have to attend at the Clinic until they can be certified as being fit to attend school. 6 Minor Ailments and Diseases of the Skin. Table IV, page 13). During the year 390 minor ailments were referred for treatment as compared with 382 in 1941. Children suffering from these minor ailments were either seen at the Routine Inspections or were sent to the Clinic by parents or teachers. The ailments consist of skin diseases, such as Ringworm, Impetigo, Ear diseases and External Eye diseases. The method of dealing with these are referred to later. During 1941 there were 3 cases of Ringworm of the scalp and 6 cases of Body Ringworm seen at the Clinic. Thirty-four cases of Scabies were seen during the year as compared with 16 last year. During the year under review arrangements were made whereby cases of scabies in the Borough can be treated at the First Aid Post at the Health Centre. This arrangement is being continued. Visual Defects and External Eye Disease. 23 cases of external eye disease were referred for treatment during the year, all of these being treated at the Clinic. 74 children were referred for treatment for defective vision and squint. 172 children received treatment during the year, 6 of these being cases referred from inspection in 1940. 62 cases were discovered at the routine inspections, and the remaining 110 were sent to the Clinic by parents or teachers owing to evidence of eye strain. Js[ose and Throat Defects. (Table IV, continued page 14). At Medical Inspections 24 children were found to be suffering from Enlarged Tonsils, Adenoids or both defects. 35 hospital vouchers were actually given. 22 children received operative treatment at the Richmond Royal Hospital. 18 cases are awaiting operation. Dental Defects. (Table V, page 15). During 1941, children of all age groups, i.e., 4—16, were examined by the School Dentist. Miss E. Russell, L.D.S., the School Dental Surgeon, examined 2,329 children of all age groups and found 1,505 to require treatment. 7 Arrangements for Treatment. Arrangements have been made for the treatment of :— (a) Minor Ailments. (b) Enlarged tonsils and adenoids. (c) Defective Vision. (d) Dental Defects. (e) Ringworm. Minor Ailments. The treatment of these diseases is carried out each morning at the Health Centre. The School Medical Officer is present four mornings a week (including Saturdays) to see new cases and cases requiring supervision. The dressing of the various cases is carried out by one of the School Nurses. The number of children who attended the Clinic for actual treatment during the year was 299 (as compared with 232 in 1940), and the total number of defects treated was 390. Also 376 children attended for inspection only, i.e., dirty heads, sore throats, etc. The total number of attendances was 2,938 as compared with 2,325 in 1940. Tonsils and Adenoids. Arrangements have been made with the Richmond Royal Hospital authorities to undertake the operative treatment of these conditions. The Education Committee pay an agreed sum per operation. Some parents prefer to have treatment by their own doctor, or to go to a London Hospital. In every case the parents are advised to bring the child to the Clinic as soon as possible after the operation, so that they may be advised as to the necessary after-treatment by means of breathing exercises, etc. Thirty-five vouchers were given for the Royal Hospital for the treatment of these conditions. External Eye Diseases. 23 cases were seen during the year. Defective Vision. These cases are treated at a special Eye Clinic which is held at the Health Centre, once a fortnight. Mr. Blair attends on these occasions, and prescribes glasses when necessary. The Committee pay a fee per case seen and Mr. Blair sees all cases twice and sometimes three times. 8 During the year under review, 166 cases were referred for treatment. In all, 172 cases were treated (6 of these being cases referred from the previous year), and in 127 cases glasses were prescribed. Actually 127 children obtained glasses. Arrangements have been made whereby the glasses can be purchased by the parents from a local optician at a contract rate. The Education Committee pays the whole or part of the cost of glasses in necessitous cases. Dental Treatment. During the year 2,329 children were inspected by the Dental Surgeon, and 1,505 were referred for treat ment. In addition 250 were referred for treatment from the inspections of the School Medical Officer, or were sent up to the Clinic by Head Teachers, making a total of 2,579 as compared with 1,999 in 1940. It will be noted that 1,505 children were found to require treatment and 1,296 were actually treated during the year. A branch of the dental work not mentioned in the Table on page 15 is Treatment for Regulation. The number of cases treated only for Regulation during the year was 106 and 110 were treated partly for Regulation. In the years 1935-41 inclusive 564 children have had dental treatment for Regulation only. When it is found necessary to extract several teeth, a general anaesthetic is given, either Nitrous Oxide Gas or Ethyl Chloride. A special Dental Clinic is held once a week for this purpose, and the School Medical Officer administers the anaesthetics. During 1941 anaesthetics were administered to 613 children, as compared with 678 in 1940. Immunisation of School Children against Diphtheria. Total number of children seen during the year 578 Total number of attendances 1,272 Total number of children who received primary Schick test 132 Total number of children naturally immune 32 Percentage of children naturally immune 24% 9 Number of certificates given 267 Number of children who required additional injections for complete immunity 8 Number of children re-tested after 2 years 12 Number of children who were still immune 10 Number of children who required further injections 2 Total number of certificates issued at the Clinic since 1934 2,390 Number of children re-tested after 4 years 18 Number of children who were still immune 15 Number of children who required further injections 1 Miscellaneous. Employment of Children. Bye-laws under the Employment of Children Act, 1903, have been adopted by the Education Committee, and children attending school who wish to obtain employment (part-time) must be examined as to their fitness by the School Medical Officer. Before the examination the Head Teachers concerned are asked to give their views as to the prejudicial eifect of the proposed employment on the children's education. During the year 3 girls and 84 boys have been examined in connection with medical certification as to their fitness for employment. 83 certificates were granted. Of the 83 children granted certificates, 51 were employed in the delivery of newspaprs and 32 as errand boys. 12 Table 111.—continued. B. Delicate Children. This Section is confined to children (except those included in other groups whose general health renders it desirable that they should be specially selectec for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — Nil C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 1 — — 1 Children Suffering from Multiple Defects. Combination of Defect. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. Epileptic and feeble-minded Crippled and feeble-minded — — — — Nil Nil 13 Table IV.—Return of Defects Treated during the year ended 31st December, 1941. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin- Ringworm—Scalp — 3 — 3 (1) X-Ray Treatment— If none, indicate by dash (2) Other — — — Ringworm—Body 6 — 6 Scabies 34 — 34 Impetigo 8 — 8 Other Skin Disease 12 — 12 Minor Eve Defects— (external and other) 23 — 23 Minor Ear Defects 22 — 22 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, &c.) 282 — 282 Total 390 — 390 Group 2—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments). No. of Defects dealt with. Under the Authority's Scheme. Otherwise. Total. Errors of Refraction (including Squint) 172 Nil 172 Other defect or disease of the eyes (excluding those recorded in Group 1) — — — Total 172 Nil 172 Under the Authority's Scheme. Otherwise. Total. No. of Children for whom spectacles were— (a) Prescribed 127 Nil 127 (b) Obtained 127 Nil 127