RICHI 12 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1943. RICHMOND : J. H. BROAD AND CO., LTD., PRINTERS, 8, KINO STREET. 1 Public Health Department, Parkshot, Richmond, (Surrey). August, 1944. 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, 1943. 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. Typhoid Fever. In June 1943 I received notification of a case of Enteric Fever. This was immediately removed to hospital and the usual enquiries made. Another case was notified in a few days, and from the enquiries made other suspicious cases were found. The Ministry of Health were at once informed, and I had the assistance of one of the Medical Officers from the Ministry. The medical practitioners in the neighbourhood were notified so that they would be on the lookout for suspicious cases, and several patients were seen, and bacteriological examinations made. Altogether twelve cases were notified, and all recovered after a stay in hospital. From the blood of two of the cases it was found that the germ of the disease belonged to what is known as Type L. 2. No cases due 2 to this type had been met with in the London area since 1940, and Type L. 2 strains had been isolated only on two occasions—viz. in 1939 from a child in Aberdeen, and in 1940 from a family in Oxfordshire. It would therefore appear that the outbreak was not imported from the Metropolitan area. The cause of the outbreak in this Borough was never definitely discovered, but it was thought that some of the cases at least were due to the eating of raw salads. Diphtheria. During the year under review only one case of Diphtheria was notified to me, and this case was that of a man serving in H.M. Forces who came on leave suffering from the disease. It may be said therefore that during the year there was a complete absence of Diphtheria in the Borough. In this Report will be found a statement as to the number of children immunised against Diphtheria during the year, and also the total number of children now immunised in the Borough. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER. Temporary Medical Officer of Health. 3 STATISTICS. Rateable Value £572,146 Sum represented by a Penny Rate £2,193 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Birth-rate per 1,000 of estimated resident population 17.3 Death-rate per 1,000 of estimated resident population 15.4 Death-rate from Puerperal Sepsis and other Puerperal causes 4.93 Deaths from Cancer (all ages) 73 Deaths from Measles Nil Deaths from Whooping Cough Nil Deaths from Diarrhoea (under 2 years) 4 Infantile Mortality. Death-rate of infants under 1 year of age (all infants per 1,000 live births) 46 Deaths of infants occurring (a) in the Borough 14 (b) outside the Borough 13 (c) in Institutions 20 4 BIRTH BATE, CIVILIAN DEATH RATE & ANALYSIS OF MORTALITY DURING THE YEAR 1943 (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 16.5 0.51 12.1 0.00 0.02 0 00 0.03 0.03 0.37 5.3 49* 126 County Boroughs and Great Towns, including London 18.6 0.63 14.2 0.00 - 0.02 000 0.03 0.04 0.36 7.9 58 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) 19.4 0.61 12.7 0.00 - 0.02 000 0.03 0.04 0.37 4.4 46 London Administrative County 15.8 0.45 15.0 0.00 - 0.02 000 0.03 0.02 0.27 10.4 58 RICHMOND 17.3 0.49 15.4 — - — — - 0.40 6.8 46 * Per 1,000 related births. Abortion Abortion Puerperal with Sepsis, without Sepsis. Infections. Other. The maternal mortality rates for England and Wales are as follows Per 1,000 Total Births 0.34 0.11 0.39 1.45 The maternal mortality rates for Richmond are as follows Per 1,000 Total Births 0.00 0.00 1.64 3.29 5 Attendances at Clinics. Ante-natal. Number attended. Total attendances. 413 1,378 Attendances. Windham Road Mothers 5,277 Children 5,327 Trefoil House, Petersham Mothers 1,209 Children 1,268 Doctor's Consultations 2,116 Toddlers 620 Health Visitors' Visits First visits Revisits. 489 3,179 Nursing Homes. The Surrey County Council have registered eight Nursing Homes. 44, Onslow Road, General Medical and Maternity 25, West Park Road, ,, ,, 86, Mount Ararat Road, General Medical 22, Cardigan Road ,, ,, 19, Grena Road, ,, ,, 18, Mortlake Road, ,, ,, 108, Church 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. Owing to the restricted size of the Annual Report, it is not possible to give a detailed report of the Department's activities during the year, but some indication of the nature of the work carried out is given below:— 6 Inspections under the Housing and Public Health Acts. Total inspections 10,559 Nuisances discovered on 716 of the premises 1,396 Defects abated by the end of the year 1,261 Defects in course of being remedied at end of year 61 Outstanding defects at the end of the year 63 Action deferred 11 Visits paid to ascertain that the defects were being properly remedied 1,565 Defects outstanding at the end of 1942, which have now been abated 40 Shops Acts. Number of shops on register at the end of the year ... 720 Special visits made 40 Changes of occupancy 41 Factories Act 1937. Factories on the register at the end of the year. Mechanical 127 Non-Mechanical 67 Inspections made 82 Written notices served 2 Verbal notice given 2 Defects found 16 Defects (a) remedied 16 (b) in abeyance Nil Service of Notices. Informal Notices Served 349 Statutory or Formal Notices Served 180 7 Petroleum Acts 1928. Visits made during the year 164 Licences for which applications for renewal were made during the year:— (a) Petroleum 45 (b) Carbide of Calcium 2 New licences issued during the year 1 Number of persons licensed to keep Petroleum 43 Number of persons licensed to keep Carbide of Calcium 2 Premises under Government control and not subject to licence by the Local Authority 4 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 208 Eradication of Bed Bugs. Disinfestation methods were applied to the following properties:— Council Houses 2 Other Houses 65 Disinfection of Premises. Reason. Houses. Rooms. Bedding. disinfected. Infectious Fevers 37 38 291 Tuberculosis 3 3 19 Scabies Nil Nil 18 Other Diseases 6 11 52 Vermin 77 141 58 Complaints. Number received and dealt with during the year 906 8 Diseases of Animals Acts. Five hundred and fifty sheep were dipped in Richmond Park during the summer, and the necessary certificates were furnished to the owners of the animals. Rats and Mice Destruction Act, 1919. As a result of a Conference of various local authorities, called early in the year by the Ministry of Food, a survey of rat infestations in the Borough was undertaken. Of the three types of infestation to be considered (reservoir type—major primary—minor secondary), it was found that only the minor secondary type appeared to affect this Borough. On the 1st of October a Rodent Publicity Campaign was launched under the directions of the Ministry of Food. This campaign urged the public to report rat infestation, and it covered (a) advertisements in the local Press: (b) posters: (c) cinema slides, and (d) coupons incorporated in advertisements, to be sent to this Department via the local wardens' posts. As a result of this drive, 113 complaints of rat infestation were received, and were found in all cases to be due to the minor secondary type—i.e. stray rats settling in old buildings, on vacant land, etc. The Rat Officers of the Surrey County Council were employed at the request and under the supervision of this Department, and carried out extermination and ratproofing for the various owners or occupiers of the buildings and land concerned. 1 he following is a summary of the work done during the year in connection with the destruction of rats and mice:— Total complaints received 178 Visits of inspection paid 827 Informal notices served 36 Formal notices authorised 3 Premises under contract to the Surrey County Council at the end of the year:— Annual contract 23 Monthly contract 5 9 Pigeons (Richmond (Surrey) Corporation Act). During the year, 72 pigeons have been caught and disposed of in accordance with Section 85 of this Act Unsound Food. A very large quantity of tinned and other food has been con' demned as unfit for human consumption. Food and Drugs Act, 1938. During the year a survey was made of all known premises in the Borough where food intended for sale was prepared or stored. At 11 premises the attention of responsible persons was called to unsatisfactory conditions. Public Health Act, 1936—Section 269. One licence was issued during the year permitting the use of a caravan on vacant ground in the Borough, subject to certain conditions as to sanitation and general cleanliness being complied with, the licence to expire at the end of twelve months. Rehousing. This branch of the work has again received special attention during the year. 43 houses were requisitioned and adapted for 77 families who had been rendered homeless by enemy action. In addition to these, good progress has been made with regard to the requisitioning of houses to rehouse persons inadequately housed. 10 houses were requisitioned and adapted for the rehousing of 20 families. 59 houses were requisitioned and the work of adaptation for the rehousing of 13 families is practically complete. 10 13 further houses have been requisitioned and are awaiting adaptation for the rehousing of 24 families. This work has, however, been postponed owing to the manpower shortage, priority being given to the repair of war damaged houses. In addition to the above, 10 houses are under requisition and have been repaired and completely furnished for the housing of 169 persons, rendered homeless by enemy action, this being temporary accommodation until their own houses have been rendered habitable. Billeting of Evacuees, and the care of Foreign War Refugees. The routine work in connection with the evacuees billeted in the Borough, and with the Foreign War Refugees here, has continued. GEORGE LAWS, M.B.E., F.R. San. I., F.S.I.A., Chief Sanitary Inspector and Officer under the Housing Acts. 11 SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1943. Articles Analysed Adulterated or I deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 27 - 27 Coffee — 3 3 — 1 1 Cocoa 2 — 2 1 — 1 Sausages — 5 5 Spirits 1 1 2 Blackcurrant flavour wine - 1 1 Dried Milk — 2 2 1 1 Lemon-flavour Junket - 1 1 "Glenmar" Pudding - 1 1 Blackcurrant Flavouring Essence - 1 1 Fish Roll — 1 1 Malt Cocoa Spread — 1 1 Dessert Powder — 1 1 Meat Extract — 1 1 "Marstead" — 1 1 Sponge Mixture — 1 1 Chocolate Flavour Biscuit Mixture - 1 1 Mustard 1 1 Malt Vinegar 1 1 Extract of Beef — 1 1 Real Egg S.R. Flour - 1 1 Chocolate Pudding Mixture — 1 1 Totals 32 26 58 1 2 3 Nil Nil 12 MILK (SPECIAL DESIGNATIONS) ORDER 1936. No. of samples of milk taken for analysis during the year 26 No. of samples found to be satisfactory 26 Applications granted for the renewal of licences to sell Special Designated Milk:— Pasteurised Milk 17 Tuberculin Tested Milk 9 Applications granted for the renewal of Pasteurisers' licences. 1 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases during the year. (Civilians only). Disease. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Typhoid Fever .. 12 12 Paratyphoid Fever 2 o Scarlet Fever 33 20 Diphtheria Puerperal Pyrexia 3 2 Pneumonia 18 1 27 (all forms) Ophthalmia Neonatorum... 3 1 Erysipelas 5 3 Measles 209 8 Whooping Cough 76 1 Total ... 361 50 27 13 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Typhoid Fever 12 Paratyphoid Fever 1 Scarlet Fever 20 Diphtheria ... Cerebro-Spinal Meningitis ... Measles 7 Whooping Cough 1 Erysipelas 2 Other Diseases 17 Total 60 DIPHTHERIA IMMUNISATION CLINIC. Total number of attendances 1,826 Number of children immunised. (a) Preschool children (under 5 yrs) 559 (b) School children (5—15 yrs) 429 Total 988 In addition 107 children were found to have been immunised in other districts. Total number of children immunised in the Borough. (a) Under 5 years 1,338 (b) Between 5 and 15 years 2,949 SCABIES. During the year, 241 cases of Scabies were seen, either at the Clinic, or sent by medical practotioners. 14 Arrangements have been made for Scabies cases to be treated at the First Aid Post adjacent to the Clinic, and the personnel of this post have carried out the treatment in a very satisfactory way. The material used for treatment was a Benzyl-Benzoate Emulsion. Of the 241 cases seen, 122 were school children. BACTERIOLOGICAL EXAMINATIONS. 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 1 66 67 Tuberculosis Sputa 4 30 34 Other Diseases ... 7 26 33 Total 12 122 134 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 (36 males and 21 females). Of these 22 (16 males and 6 females) were removed to Hospital or Sanatorium. There were 56 cases notified in 1942. 15 There were 14 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for 2 deaths while 14 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory Nonrespiratory. Respiratory. NonRespiratory M F M F M f M F 0 ... ... ... ... ... ... ... ... 1 ... 1 2 1 ... 1 1 ... 5 1 4 2 ... ... 1 ... ... 15 5 3 2 1 1 ... ... ... 25 12 6 1 2 ... ... 1 ... 35 7 3 ... 1 2 2 ... ... 45 9 ... 1 ... 3 ... ... ... 55 1 3 ... ... 1 2 ... ... 65 and upwards ... 1 1 ... 1 ... 1 ... ... Totals 36 21 8 6 7 7 2 Nil I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER, Temporary Medical Officer of Health..