RICH 103 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1944. richmond: j. h. broad and co., ltd., printers, 8, king street. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1944. I INDEX. Page. Adoption 14 Aged Persons 27 Ambulance Calls, Analysis of 11, 12 Ambulance Facilities 11 Ante-Natal Clinics 13 Ante-Natal Work 14 Bakehouses 19 Bed-Bugs 24 Billeting 28—31 Birth-Rate 6, 10 Births, Analysis of 6, 9 Births, Still 6, 9, 14 Cancer 6 Cerebro-Spinal Meningitis 34, 35 Chief Sanitary Inspector, Report of 18 Chiropody Clinic 13 Clinics, List of 13 Complaints, Sanitary 18, 22 Dampness 21 Death-Rate 6, 10 Deaths, Analysis of 6, 9 Deaths, Causes of under one year 8 Dental Clinics 13 Diarrhoea (under 2 years) 6, 8, 9 Diphtheria 6, 9, 10, 34, 35 Diphtheria Immunisation 13, 35 Diseases of Animals Acts 24 Disinfection of Premises 24 Drains 20 Dysentery 34 Encephalitis 34 Evacuation 28—31 Eye Clinic 13 Factories Act 19 Fish 19, 23 Food and Drugs 19, 22, 23, 33 Foodstuffs, Decontamination of 31 Head-Lice 37 Health of the Borough, Commentary upon 10 Health Services 10—17 Health Visitors 14 Home Help 14, 15 Homeless Persons 29, 30 Houses, "Half-Way" 30 Housing Accommodation 6, 10, 27, 28 Housing Defects (Sanitary) 18, 20, 21, 22 Housing Development 28 Housing Disrepair 22, 27 Housing Officer, Report of 18 Housing Shortage 27 Ice-Cream 19 Illegitimacy 6, 7 Illegitimate Children 16 Infant Life Protection 14 Infant Mortality 7, 9, 14, 16 Infant Mortality, Analysis of 7 II Page. Infant Mortality Rate 7, 10 Infantile Paralysis See Poliomyelitis Infectious Diseases, Notifiable 10, 19, 24, 34 Influenza Laboratory Work 10 Malaria 34, 35 Maternal Mortality, Analysis of 7, 9, 10, 34 Maternal Morbidity 34 Maternal-Mortality Rate 7, 9 Maternity and Child Welfare Clinics 13 Maternity Cases 6, 11, 13, 14, 16 Maternity Homes 17 Measles 6, 9, 34 Meat 19, 23 Milk 23 Milk and Dairies Orders 19 Milk (Special Designations) Order, 1936 34 Minor Ailments Clinic 13 Notices, Sanitary 19, 21, 22 Nuisances, Sanitary 18, 21 Nursing Homes 17 Ophthalmia Neonatorum 34 Overcrowding See Housing Accommodation Paratyphoid Fever 9 Petroleum Acts 24 Pneumonia 8, 34 Poliomyelitis 34, 35 Population 6 Premature Infants 8 Premature Infants, Care of 14, 15, 16 Puerperal Pyrexia 34 Rats and Mice Destruction Act, 1919 21, 25, 26 Rehousing 28—31 Restaurant Kitchens 19 Richmond Royal Hospital 10 Ringworm Treatment 13 Rodent Destruction See Rats and Mice Sanitary Conveniences 20 Sanitary Inspection 18—21 Scabies 13, 14, 36 Scarlet Fever 9, 34, 35 Sewers 20 Sewers, Baiting of 25 Shops Acts 19 Slum Clearance 27 Smallpox 9 Social Welfare Worker 16 South Middlesex and Richmond Fever Hospital 11 Statistics 6 Treatment Centres and Clinics 13 Tuberculosis 10, 13, 14, 24, 38, 39 Typhoid Fever 9 Unmarried Mothers, Hostels for 16 Venereal Diseases 10 Verminous Conditions 21, 24, 35 Wartime Nurseries 17 Water Closets 20 Water Supply 17, 18, 20 Whooping-Cough 6, 8, 9, 14, 34, 35 5 Public Health Department, Parkshot, Richmond, (Surrey). 31st October, 1945. 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 for the year 1944 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. For economy's sake the material for this Report has once more been curtailed by the omission of certain tables of statistics, which however remain filed in the Department so that their continuity from year to year may be preserved. On the other hand, at the request of the Ministry of Health, I have included special reference to the water supply of the Borough, as also to certain measures adopted in connection with the care of premature infants and illegitimate children, and to the steps taken in the Borough to combat uncleanliness and infestation. As the Council will be aware, during the greater part of the year under review Dr. C. S. Brebner was Temporary Medical Officer of Health. I desire to express to him, and to the staff of the Public Health Department, my acknowledgement for their support in general, and in particular for their co-operation in preparing this Report. I am, Ladies and Gentlemen, Your obedient Servant, JOHN DANCY, Temporary Medical Officer of Health. 6 SUMMARY OF STATISTICS. SOCIAL CONDITIONS Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1944) 32,560 Number of inhabited houses (estimated) 9,930 Rateable value £579,262 Sum represented by a Penny Rate £2,245 BIRTHS. Birth-Rate per 1,000 of estimated resident population 17.4 Total number of births (live and still) 584 Analysis:— M. F. Total. Live Births. Legitimate 254 251 505 Illegitimate 31 31 62 Still Births. Legitimate 5 10 15 Illegitimtate — 2 2 Still-Birth Rate per 1,000 total births 29 Environment of Births:— Proportion taking place in the Borough 65% Proportion taking place outside the Borough 35% Proportion taking place in Institutions 73% Proportion taking place in dwelling-houses 27% Proportion notified by midwives alone 90% Proportion notified by doctors or parents 10% DEATHS. Death-Rate per 1,000 of estimated resident population 15.8 Total number of deaths from all causes 513 Analysis:— M. F. Total. All Causes 227 286 513 Cancer 38 64 102 Diphtheria — — — Measles — . — — Whooping Cough — 1 1 Diarrhoea (under two years) 3 1 4 7 Maternal-Mortality Rate per 1,000 total births 1.76 Total number of maternal deaths 1 Analysis:— Deaths from puerperal and post-abortive sepsis — Deaths from other maternal causes 1 Environment of Maternal Deaths:— Number occurring in the Borough — Number occurring outside the Borough 1 Number occurring in Institutions 1 Number occurring in dwelling-houses — Infant Mortality. (Deaths under one year of age). Infant-Mortality Rate for all infants per 1,000 live births 42 Rate for legitimate infants per 1,000 legitimate live births 41 Rate for illegitimate infants per 1,000 illegitimate live births 48 Total number of infant deaths in the Borough 24 Analysis:— M. F. Total. Legitimate 13 8 21 Illegitimate 2 1 3 Environment of Infant Deaths:— Number occurring in the Borough 14 Number occurring outside the Borough 10 Number occurring in Institutions 16 Number occurring in dwelling-house 8 8 Causes of death under 1 year of age. Cause of Death Under I week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... ... ... ... ... 4 ... ... 4 2. Congenital Debility and Malformation including Premature Birth 9 1 1 ... 11 1 ... 1 ... 13 3. Convulsions ... ... ... ... ... ... ... ... ... ... 4. Enteritis ... ... ... ... ... ... 1 1 1 3 5. Whooping-cough ... ... ... ... ... ... ... ... 1 1 6. Other defined diseases 3 ... ... ... 3 ... ... ... ... 3 12 I 1 ... 14 1 5 2 2 24 9 BIRTH RATE, CIVILIAN DEATH RATE & ANALYSIS OF MORTALITY DURING THE YEAR 1944 (Provisional figures). (The Mortality rates for England and Wales refer to the whole population but those for London and the towns refer to civilians only). Note : A dash signifies that there were no deaths. 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 17-6† 0.50† 11 .6† o.oo 0.00 0.01 o.oo 0.03 0.02 0.12 4*8 46* 126 County Boroughs and Great Towns, including London 20.3 0'64 13.7 o.oo - 0.01 o.oo 0.03 0.03 0.10 7.3 52 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) ... 20.9 0'61 12.4 o.oo - 0.01 o.oo 0.02 0.03 011 4.4 44 London Administrative County 15.0 0.42 15.7 o.oo - 0.00 o.oo 0.04 001 008 10.1 61 RICHMOND 17.4 0.52 15.8 - - - - o.oo - 0.12 7.0 42 Per 1.000 related births. †Per 1,000 total population. Abortion with Sepsis. Abortion without Sepsis. Pucrperal Infections Other The maternal mortality rates for England and Wales are as follows Per 1,000 Total Births 031 0.09 0.28 1.25 The maternal mortality rates for Richmond are as follows ... Per 1,000 Total Births — — — 1.76 10 THE HEALTH OF THE BOROUGH. All the statistical data for the year 1944 serve to show that the health of Richmond has been well maintained. The standard of nutrition, both for adults and for children, has likewise remained surprisingly high; the people have fed less well, but apparently more wisely. The Birth'Rate has risen once again, even exceeding by a comfortable margin the Death-Rate under war conditions. There has been only one Maternal Death, whilst the Infant-Mortality Rate, which rose abruptly from 25 in the year 1939 to 42 in the year 1940, continues to show no further rise since that period. As to the prevalence of sickness, the Borough has withstood yet one more year of overcrowding and shelter-life without notable increase in epidemic illness. In addition, during the year under review, the specific infectious diseases have dealt kindly with our children; for example, our solitary case of Diphtheria was a mild one occurring in an immunised child upon return from evacuation. On the other hand, as elsewhere, the Venereal Diseases have pursued their alarming war-time spread, whilst the position in the case of Tuberculosis continues to give ground for anxiety. Reference to the latter will be found at the end of the Report. HEALTH SERVICES. LABORATORY WORK. The standing arrangements with Richmond Royal Hospital continued to operate satisfactorily during the year. The following table gives particulars of the specimens examined:— Disaasc Suipected. Nature of Specimen. Result. Total. Positive. Negative Diphtheria Swabs from Throat and Nose Nil 51 51 Tuberculosis Sputa 3 26 29 Other Diseases ... 6 11 17 Total 9 88 97 11 AMBULANCE FACILITIES. The South Middlesex and Richmond Joint Hospital Board have ambulances in which infectious cases are removed to hospital. The Richmond Council has two motor ambulances for use in accident and private cases. These are housed in an outbuilding erected at the rear of the Technical Institute and are manned continuously by whole-time Civil Defence personnel assisted by volunteers from the St. John Ambulance Brigade. The service provided is adequate for the needs of the Borough, and is in any case supplemented where necessary by the use of Civil Defence vehicles. Recriprocal ambulance facilitites have also been agreed by the Borough with the L.C.C. with the Boroughs of Barnes, Brentford and Chiswick, Surbiton and Twickenham, and with the Royal Borough of Kingston. The following table shows the steady increase in the work of the Richmond Ambulance Service:— 1935—841 calls. 1940—1,127 calls. 1936—862 calls. 1941—1,071 calls. 1937—913 calls. 1942—1,247 calls. 1938—943 calls. 1943—1,497 calls. 1939—1,046 calls. 1944—1,480 calls. Analysis of Calls obeyed during the year 1944. 1944 Accident cases. Removal cases. Maternity cases. Others* Total 1st qr. 77 245 62 8 392 2nd qr. 127 220 74 8 429 3rd qr. 95 167 46 2 310 4th qr. 90 196 50 13 349 TOTAL 389 828 232 31 1480 ■"Including false alarms and malicious calls. 12 Division of Calls into time-periods. Number of calls received between 6 a.m. and 6 p.m. 1,037 Number of calls received between 6 p.m. and midnight 328 Number of calls received between 12 midnight and 6 a.m 115 Total calls for the year 1944 1,480 Total distance (in miles) covered by the ambulance vehicles in 1944 8,181 Average mileage per call 5½ Number of calls referred to other Authorities 2 Number of calls answered for other authorities 69 Greatest number of calls answered in any one day 20 Average time-lag in reaching scene of-accident 5.89 mins. Number of occasions upon which both ambulances were out at the same time 28 Number of complete days when one vehicle was out of commission for repairs 6 Number of accidents to ambulance vehicles 8 Number of instances of mechanical breakdown 6 13 TREATMENT CENTRES AND CLINICS—1944. Nature of Service. Address in Richmond. Particulars. By whom provided or arranged. Total Annual Number of:— Sessions held. Pts. attending. Attendances made. Doctor's consultations. Ante'Natal Clinic Windham Road. Six sessions per month M. & C.W. C'ttee 75 371 1305 1109 Ante-Natal Consultns. Grove Rd. Hosp. Two sessions per month County Council 150 176 176 M. & C.W. Clinic Windham Road. For infants, twicc weekly M. & C.W. C'ttee 102 506 6556 1718 M. & C.W. Clinic Windham Road. For toddlers, twice monthly M. & C.W. C'ttee 23 191 645 292 M. & C.W. Clinic Trefoil Ho. P'm. Once weekly M. & C.W. C'ttee 51 323 1033 28 M. & C.W. Consultns. Royal Hospital Once weekly Arranged by M. & C.W. C'ttee 88 M. & C.W. Eye Clinic Windham Road. Two sessions per month M. & C.W. C'ttee 12 16 M. & C.W. Dental Clinic Windham Road. Once weekly M. & C.W. C'ttee 35 145 317 Minor Ailments Clinic Windham Road. For elem. school children Education C'ttee 306 479 2053 School Dental Clinic Windham Road. For elem. school children Education C'ttee 189 1087 1613 School Eye Clinic Windham Road. For elem. school children Education C'ttee 23 166 180 Ear, Nose and Throat Consultations Royal Hospital For elem. school children Arranged by Education C'ttee 7 Ringworm Treatment 2, Old Pal. Tee. By appt. with Dr. D. Hallett Education C'ttee 3 Chiropody Clinic Windham Road. Mr. C. L. Sheppard, Registered Med. Aux. Education and M. & C.W. C'ttee 37 178 Chest Clinic 38, Sheen Road Once weekly County Council 51 Diphtheria Immunisation Windham Road. Once weekly Health C'ttee 46 347 801 Scabies Treatment Windham Road. Daily, as required Health C'ttee 430 872 14 HEALTH VISITORS. The Borough employs four State-registered nurses, all of whom possess the New Health Visitors' Certificate, to act for one half of their time as Health Visitors and for the other half as School Nurses. In addition to their indoor duties in connection with the various Clinics, during the year 1944 the Health Visitors paid a total of 3,375 visits as under:— First Visits. Revisits Routine visits paid to:— Expectant Mothers 177 92 Children under one year 407 1,034 Children between 1 and 5 years — 1,468 Special visits in connection with:— Adoption cases 6 — Aged persons 2 — Diphtheria Immunisation 1 — Evacuation 6 — Home Help 16 14 Infant Deaths 6 — Infant Life Protection 5 1ll Scabies cases 14 - Stillbirths 11 - Tuberculosis 3 - Whooping-cough 2 - Totals 656 2,719 CARE OF PREMATURE INFANTS. In March of this year the Ministry of Health issued Circular 20/44 setting out certain measures which had recently been recommended by their Advisory Committee for the better care of Premature Infants. The Circular asks that all Welfare Authorities will adopt these 15 measures in so far as questions of staffing and accommodation will permit. The following are the main recommendations:— (1) Ascertainment: The provision of separate space upon the notification of birth cards so that information may be received when the weight at birth is 5½1bs. or less. For this purpose any child of that weight will be deemed to be premature. (2) Home Treatment: (a) Adequate and suitable equipment, including if necessary certain special devices used in feeding, clothing and protecting the infant, and in generating warmth. (b) The provision, where necessary, of a supply of expressed breast milk. (c) The provision of a consultant .paediatrician. (d) The employment upon the case of midwives and health visitors who have had special experience in the rearing of premature infants. (e) The provision of a Home Help. (3) Institutional Treatment: The establishment in certain institutions of "Premature-Infant Units" conforming to special standards of construction, heating and humidity, and staffed both by a resident paediatrician and by specialist nurses in adequate numbers. (4) Transport: Means of warmed transport such as an ambulance or car containing a heated basket or other carrier together with apparatus for the giving of oxygen. The position in Richmond upon the 31st December, 1944 was that action had been taken fully under heading (1) and in part also under headings (2) and (4). In the light of the information available for the year under review, the following table represents the situation with regard to Premature Infants in the Borough. 16 Premature Infants. Number born.* Number nursed. Number of children born alive but dying. Number surviving for over 28 days. Within 24 hrs. Within 7 days. Within 28 days. At Home 5 5 1 — — 4 In Nursing Homes 8 8 — 1 1 6 In Hospitals 25 25 2 2 - 21 * Includes Richmond children born outside the Borough. CARE OF ILLEGITIMATE CHILDREN. On the 8th August, 1944, a salaried Social Welfare Worker was appointed jointly by the Boroughs of Richmond and Barnes, with the duty of ascertaining, advising, and giving continued help to all cases of illegitimacy; and, in this connection, to act as liasion officer between the two Local Authorities and the various voluntary and religious organisations interested. During the remainder of the year the Welfare Worker traced 74 cases of illegitimacy registered since the beginning of the year 1943, and found that no fewer than 55 of these were still in need of help. By the 31st December some 26 fresh cases had been added and the whole work in Richmond alone was requiring an average of 60 visits per month, or 6 per duty-day, in addition to clerical work and interviews held at the Health Centre in Windham Road. The outstanding problem in connection with this work is the need for more residential accommodation where an employed mother may be received post-natally together with her baby. Foster-mothers are difficult to find in these days, and resident posts, when offered, usually prove to be merely menial. The so-called Short Stay Hostel is designed rather for shelter and midwifery than for after-care, whilst the Long Stay Hostel calls for the building or acquisition of expensive premises, leading in turn to a sharp rise in the running costs. In any case the 17 ideal hostel would be one which is able to preserve part at least of the domestic atmosphere of a family home. 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. WAR-TIME NURSERIES. With the approval of the Ministry of Health two Day Nurseries are maintained in the Borough:— Address. No. of places. Total attendances during 1944. Parkshot Day Nursery, Richmond. 52 9799 Grey Court Day Nursery, Ham Street, Ham. 52 5854 WATER SUPPLY. Richmond is fortunate in possessing two separate sources of drinking-water, viz: from certain local wells and from the Metropolitan Water Board. The wells are seven in number, one of them being sunk 320 feet deep to reach 2 miles of adits in the chalk, whilst the supply from the Metropolitan Water Board is received through six connections off the 30-inch diameter M.W.B. Main. Thus it may be said that the reserve of water available can never fall below 100%. 18 As to physical properties, the Richmond well-water contains 27 parts per 100,000 of hardness, whilst the M.W.B. water contains 22. During the year 1944, three samples were taken from the raw water, and found on analysis to be bacteriologically satisfactory. Chemical investigation, however, was regarded as unnecessary since the tests for the previous ten years had given uniformly good results. Despite these excellent qualities in the raw water, the whole of the drinking-water for the Borough is chlorinated before going into supply, a small residuum of chlorine being allowed to remain in solution as an extra precaution. Of the water so treated, no fewer than 37 samples were taken during the course of the year, and these reached the highest standard of bacterial purity, being virtually sterile in every instance. The Richmond drinking-water is thus of unexceptionable quality, and most suitable for the purpose of a public supply. It is moreover available by piped delivery to every building in the Borough. SANITARY INSPECTION OF THE AREA. REPORT OF THE CHIEF SANITARY INSPECTOR AND HOUSING OFFICER. In accordance with the Sanitary Officers (Outside London) Regulations 1935, I beg to submit particulars of the work arising out of the Sanitary Inspection of the district during the year 1944. Inspection of the District. Inspections (all purposes) 8,678 Complaints investigated 836 Sanitary defects and nuisances reported 978 Premises at which defects or nuisances were reported 450 Defects, etc. abated by the end of the year 708 Defects outstanding at the end of 1943, abated in 1944 107 Houses inspected under Public Health Acts 1,159 Houses inspected under Housing Acts 763 Visits to works in progress 1,327 Premises re-inspected 1,384 Council dwellings inspected 473 19 Factories Act, 1937 Mechanical Factories in the Borough 131 Non-mechanical Factories in the Borough 71 Inspections made 24 Written notices served 6 Defects found 13 Defects (a) remedied 11 (b) in abeyance 2 Bakehouses in the Borough 16 Restaurant Kitchens in the Borough 115 Outworkers 5 Shops Act, 1934. Shops on the Register 720 Visits made 69 Changes of occupancy 10 Infectious Diseases. Visits made 39 Inspections 29 Milk and Dairies. Cowsheds in the Borough 3 Dairies 51 Visits made 17 Samples taken for bacteriological examination 31 (all found to be satisfactory) Foodstuffs. Ice-cream premises on the Register 68 Fishmongers' shops 15 Fried-fish shops 5 Meat. Private slaughterhouses in the Borough 1 Butchers' shops and Food Stores 32 Other Inspections Made. Stables 32 20 Piggeries 5 Greengrocery and Fruit Stores 18 Public Urinals and Sanitary Conveniences 83 Kennels and Boarding-houses for animals 4 Schools (sanitation) 15 Infestation by Rats and Mice. Complaints received 172 Inspections made 645 Drains and Sewerage systems tested. Hydraulic tests 3 Smoke tests 29 Examinations 6 Miscellaneous Visits made. 1327 RETURN AS TO THE NUMBER AND NATURE OF SANITARY DEFECTS. Drainage. Defective drains 20 Choked drains 24 Defective fittings 8 Defective soil-pipes 12 Water Supply. Defective service-pipes and cisterns 10 Storage-tanks in a foul condition 2 Water Closets. Defective or insanitary 34 Defective flushing cisterns 34 Defective buildings 13 Closets without water supply 14 Insufficient accommodation 1 Defective urinals 2 21 Sinks. Defective or insanitary 6 Defective or insanitary waste pipes 46 Sinks not provided 2 Dampness. Wall-dampness 20 House-sub-soil dampness 5 Defective roofs and guttering 92 General Defects. Nuisances from fowls or other animals 13 Rubbish accumulations and insanitary yards 26 Defective internal walls and ceilings 123 Rooms requiring cleansing 42 Window frames and fastenings defective 54 Defective sashcords 42 Rooms inadequately lighted and ventilated 8 Defective firegrates and ranges 39 Defective chimney stacks, pots and flues 8 Defective and dangerous staircases 18 Rooms in a verminous condition 78 Bedding in a verminous condition 69 Premises infested with rats and mice 35 Stable premises dirty or insanitary 4 Miscellaneous defects 151 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal. Preliminary intimations 340 Interviews 197 22 Statutory. Housing Act 1936—Section 9 (To repair insanitary dwellings) 74 Notices complied with by owners 51 Works carried out in default by Local Authority Nil Public Health Act 1936:— Section 39 (To execute works of drainage) 31 Section 40 (To repair soil and vent-pipes) 1 Section 45 (To repair defective closets) 16 Section 75 (To provide covered dustbins) 13 Section 79 (To remove noxious matters) 1 Section 83 (To cleanse dirty premises) 1 Section 92/3 (To abate nuisances) 30 Rats and Mice Destruction Act 1919—Section 5 (to destroy rats and make premises rat-proof) 2 169 Complaints. 836 complaints were received and investigated during the year. Complaints of insanitary conditions and disrepair have been more numerous owing to circumstances arising out of the War—the shortage of man-power and lack of materials, etc. Works of a most urgent character have only been dealt with after what has often been a considerable lapse of time. Food Inspection. The following foodstuffs, found to be unfit for human food, were surrendered by the owners and either salvaged for animal feeding or destroyed. 23 Commodity. Amount condemned Reason for condemnation. Bacon & Ham 136 lbs. Decomposed. Beans 130 tins Blown or damaged. Barley-sugar bars 144 bars Contaminated by disinfectant. Bread 97 lbs. Contaminated by paint. Cheese 33½ lbs. Decomposed. Chocolate, sweets, etc. 83 lbs. Damaged by blast (glass). Cereals 176 pkts. Damaged by glass & fire. Custard Powder 7 tins Damaged by glass & fire. Dried Eggs 8 pkts. Damaged by glass & fire. Fish 497 tins Blown or damaged. 1015 lbs. Decomposed. Fruit Cake, etc. 131 ¾ lbs. Mouldy. Fruit 38 lbs. Decomposed. Flour 28 lbs. Damaged by glass. Geese & Chickens 2 Decomposed. Jam, Marmalade & Honey 58 jars Damaged by enemy action (glass). Margarine, Butter & Lard 70 lbs. Damaged by enemy action (glass). Meat 185 tins Blown or damaged. 561 lbs. Decomposed. Meat pies 65 Decomposed. Milk 810 tins Blown or damaged. Peas (dried) 46 lbs. Damaged by enemy action (glass & water). Sauce, salad cream, etc. 224 lbs. Damaged by enemy action (glass & water). Soft drinks 32 bots. Damaged by enemy action (glass & water). Spaghetti 16 lbs. Damaged by enemy action (glass & water). Sugar 18 lbs. Contaminated by disinfectant. Sultanas 178 lbs. Contaminated by paint. Soup 130 tins Blown or damaged. Rabbits 130 lbs. Decomposed. Vegetables 64 tins Blown or damaged. Christmas puddings & tart mixtures 70¼ lbs. Damaged by mice. 24 Petroleum Acts, 1928. Visits made 102 Licences for which applications for renewal were made during the year:— (a) Petroleum Spirit 42 (b) Carbide of Calcium 2 New licences issued during the year Nil Premises under Government control and not subject to licence by the Local Authority 4 Disinfection of Premises. Reason. Houses. Rooms. Bedding. Infectious Fevers 30 33 206 Tuberculosis 12 13 91 Other Diseases 3 4 15 Vermin 45 78 69 Air-raid Shelters — 1 8 Total 90 129 389 Eradication of Bed-bugs. Council Houses disinfested 4 Other houses disinfested 41 Where bed-bugs are found all wooden fixtures are dismantled. The furniture and other belongings are treated by spraying with 'Zaldecide' insecticide, and the bedding by steam disinfection or, with the consent of the tenant, destroyed. A second treatment is given when found necessary, and the premises are kept under observation. Prior to rehousing in Council dwellings from other premises, the home conditions of all selected applicants are inspected, and disinfestation-work or destruction of bedding is carried out where necessary. Diseases of Animals Acts. Two hundred and twenty-four sheep were dipped in Richmond Park, and the necessary certificate was furnished to the owner of the animals. 25 Rodent Destruction. The following summary shows the work done during the year in carrying out the provisions of the Rats and Mice Destruction Act 1919. Complaints received 172 Visits and inspections made 645 Informal notices served 35 Formal notices authorised 2 Private premises under special Contract to the Rodent Officers of the Surrey County Council at the end of the year 56 Since 1920 Richmond Borough Council has launched a Publicity Campaign almost annually, and has carried out as a routine measure the inspection of premises notified as being rat-infested. This has included the giving of directions as to the proper treatment for ratdestruction and for rat-proofing of buildings. The main sewerage system of the district has been treated annually by the laying down of poison bait for the destruction of rats, and this method—one of the first to be tried out—was found to produce good results. In 1943 the Ministry of Food (Rat Infestation Branch) imposed by compulsory Order, upon all local authorities, the duty of treating the sewers for rat destruction, and they have laid down directions that the treatment shall be carried out twice a year. Under the existing legal Statutes occupiers of land and premises found to be infested with rats and mice are responsible for the destruction of the rodents. Local Authorities are responsible for similarly treating any infested public sewers. The following is a brief account of the operations carried out during the year in the baiting of sewers for rodent extermination. Sewer Treatments—1944. 10-1-44 to 18-1-44. 88 manholes (prebaited on 2 days and poisoned on 3rd day). Total amount of prebait used (sausage rusk) ... 44 lbs. Total amount of poison bait laid (zinc phosphide and rusk) 14 lbs. 26 Total amount of poison bait taken 13 lbs. Proportion of bait taken 93 % Streets covered: Kew Green area: Clarence Road: Elizabeth Cottages: Lawn Crescent: Alexandra Road: Sandycombe Road: Raleigh Road: St. George's Road: Trinity Road: Lower Mortlake Road: Avalon Terrace: Pagoda Avenue: Selwyn Avenue: Kew Foot Road: Old Palace Lane: Riverside area: Petersham Road: Vineyard: Lancaster Park: Ellerker Gardens: Sheen Road: Sheen Park : Worple Way and Princes Road areas. 13-3-44 to 17-3-44. 41 manholes (prebaited on 2 days and poisoned on 3rd day). Total amount of prebait used (sausage rusk) 42 lbs. Total amount of poison bait laid (zinc phosphide and rusk) 14 lbs. Total amount of poison bait taken 12 lbs. Proportion of bait taken 89.07% Streets covered: Albert Road and side streets: Houblon Road: Grena Road: Richmond Hill: Cardigan Road: Onslow Road: Marlborough Road: Petersham: Ham Street: Lock Road: Orchard Road area: North Road: Burlington Avenue: Defoe Avenue and Bush wood Road. The results obtained can be considered as satisfactory, and these operations should be extended in future to all the worst portions of the infested main-sewerage systems. Rats cause considerable loss of food. They carry disease, and do other damage such as injuring building structures and equipment— as when they gnaw through electric insulation and lead water pipes. Money spent on their extermination (under skilled supervision) is well expended. The conservation of health and food supplies, and the prevention of damage to habitable premises and public buildings are of primary importance. 27 HOUSING PROBLEMS. The normal routine work of making house-to-house surveys in accordance with the directions laid down in the Housing Regulations, the service of notices for reconditioning and the closure or demolition of unfit buildings, has of necessity been held up owing to the exigencies of War. As a result, a considerable amount of disrepair of property has accumulated owing to lack of man-power and building materials. In spite of these difficulties 763 houses were visited under the powers of the Housing Acts during the year, and urgent sanitary or housing defects were reported for treatment. Much delay has taken place in the execution of necessary work because of War-time conditions. The destruction of houses by enemy action, restrictions on the amount that can be spent on their repair, and problems arising out of evacuation and the consequent re-distribution of population, have thrown a severe strain on all types of dwelling accommodation throughout the area: there has been a great increase in subletting, and in overcrowding. Acute housing shortage has resulted in the deferring of the slumclearance programme and of the provision of more houses for aged persons, both of which, up to the outbreak of hostilities, were making headway. In addition, the curtailment of housing repairs and maintenance generally has been fraught with serious results and a further lowering of hygienic standards. The past achievement of the Council in the provision of housing accommodation has resulted in 966 houses and flats having been erected between the years 1895 and 1939 at a cost of £503,166 19s. Od. At the request of the Health and Housing Committee and the Post-War Reconstruction Committee I prepared a 'Survey of Housing Needs' and submitted a report dated August, 1944 which was later considered by both Committees of the Council. Accompanying the Report were plans showing the areas meriting consideration for 'clearance' or 're-development.' Though only incorporated 54 years ago, Richmond contains many 28 areas of old properties—80 to 100 years old—the relic of an age which had a low hygienic standard. Some of these properties have already reached the end of their effective life, and others will fall into that category in a few years' time, thus indicating the need for a short' term and a long-term policy of rehousing development. Plans have already been prepared for building both temporary and permanent houses, as soon as possible after the cessation of hostilities, and when the supply of building materials and man-power render this possible. At the end of 1944 the demand for housing accommodation from applicants having local residential qualifications was 1,064—comprising 3,375 persons. This included 163 young families comprising 432 persons who had married during the War and continued to reside with their parents or friends—all Council House tenants—resulting in overcrowding and family discord owing to lack of space and of adequate domestic facilities. In addition to this, there is evidence of 34 cases of overcrowding, but this does not represent the full extent of overcrowding in Council Houses although in the year 1936 the Council complied with the requirements of the Overcrowding Act by building 110 new houses to rehouse all known cases of overcrowding previously reported. As is now well known, Richmond is almost a built-up area and the amount of land available for building at the present time is not sufficient to meet present-day housing needs. WARTIME REHOUSING, BILLETING and EVACUATION. Some details of the many and varied duties carried out consequent upon enemy action, dealing with the problems of evacuation, rehousing, billeting and general care of the homeless, are set out in the following tabular statement, 29 Persons billeted during the War period, to the end of 1944. Homeless Persons. (a) From the London Area: Mothers 183 Children 366 Other adults 883 Unaccompanied children 3 1,435 (b) From Richmond: Mothers 66 Children 133 Other adults 452 651 (c) From other Areas: Mothers 21 Children 30 Other adults 87 Unaccompanied children 6 144 Evacuation of the Priority Classes. (a) From the London Area: Mothers 9 Children 16 Other adults 9 Unaccompanied children 24 58 (b) From other Areas: Adults 2 2 Coastal Evacuation. Mothers 22 Children 41 Other adults 69 Unaccompanied children 2 134 E.M.S. Billeting. Doctors 4 Nurses 31 35 Total 2,459 30 In addition to the foregoing, 762 persons rendered homeless by enemy action were permanently rehoused and provided with furniture, bedding and other household equipment under the scheme laid down by the Ministry of Health. Before the official scheme came into operation Richmond had initiated its own scheme for providing furniture, etc. to families rendered homeless. The first steps were taken towards the end of 1939 by the setting up of a furniture store at Parkshot adjoining the Public Health Department. In response to a public appeal by the Mayor, many gifts of furniture and household equipment were received, and when the first influx of refugees from Belgium and Czecho-Slovakia arrived it was possible to furnish completely 13 requisitioned houses which were in readiness for the occupation of the refugees on their arrival. The number of Foreign War Refugees thus housed was 120. Half-way Houses. In addition 10 houses were later requisitioned and completely furnished, and adapted for the accommodation of 149 persons immediately after the loss of their homes until more permanent accommodation could be provided. These were described as HalfWay Houses. As the housing shortage increased, Local Authorities were given powers to requisition and adapt premises for providing housing accommodation at rents which tenants could afford to pay. Good use was made of these powers and up to the end of 1944, 120 such premises had been requisitioned for families who were without a home. Greater London Evacuation Scheme for Priority Classes. Evacuation from Richmond. Between the 8th July and the 23rd September, 1944, awing to the effects of enemy action by flying-bombs and rockets, Richmond was included in the Greater London Evacuation Scheme and arrangements had to be made for organised parties of mothers and children, school children and aged persons to be evacuated from Richmond. These were sent out in daily parties by trains to the various Reception Areas chosen by the London County Council. 31 In addition to these parties considerable numbers of travelvouchers were issued to mothers with children, aged persons, invalids and expectant mothers who had made arrangements privately with relatives in safe areas. The following table gives the numbers of persons evacuated under the Scheme and the supervision of your Officers. Evacuation 8-7-44 to 23-9-44. Official Private Mothers 251 737 Children under school age 315 696 *Children of school age 240 851 Expectant Mothers 24 Aged persons 184 Infirm persons 43 Blind persons 5 Totals 806 2,540 * Excluding children (unaccompanied) who were officially evacuated and dealt with by the Education Department. The whole of the billeting, temporary rehousing and evacuation arrangements were carried out successfully by the staff of the Public Health Department together with a number of voluntary helpers, many of whom acted as escorts to the places of reception, and to whom special thanks are due. These multifarious duties have necessitated a considerable amount of clerical work and keeping of official records, and I would express my thanks to Miss V. Slack, Chief Clerk of the Public Health Department, for the hard work she has loyally and efficiently performed throughout the War period. Scheme for Decontamination of Foodstuffs Contaminated by PoisonGas. In accordance with the direction of the Ministry of Food a Scheme was prepared for dealing with foods contaminated by poison-gas. The Pavilion in the Old Deer Park was requisitioned 32 and adapted as a gas-decontamination centre. Seventeen volunteers from the various food-trades in the Borough, together with five permanent members of the Sanitary and Housing Departments, constituted the personnel, under the supervision and direction of your Chief Sanitary Inspector. All were trained in anti-gas precautions and given the extra training necessary for handling gas-contaminated foodstuffs. The training was ably conducted by Mr. B. Aisthorpe (Acting Deputy) and Mr. E. S. Power. Complete preparations were made, and approved by the Ministry of Food, for the working of the Service if called upon. CONCLUSION. This is the last Report which I have the honour to present for your consideration, and by the time it is in print I shall—with great regret—have ceased to hold office owing to compulsory retirement under the Superannuation Act. I have completed fifty years in the Local Government Service— all in Public Health and Sanitary Administration or environmental hygiene. The last thirty-five years have been spent in Richmond as your Chief Sanitary Inspector and Housing Officer. I wish to record my thanks to the Council, especially to the Health and Housing Committees, for their unfailing interest and support, and also to the Officers of the Council and the Staff of the Health and Housing Departments for their invaluable assistance and co-operation. GEORGE LAWS, M.B.E., F.R.San. I., F.S.I.A. Chief Sanitary Inspector and Housing Officer. 33 SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond by Surrey County Council during the year ended December 31st, 1944, Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 22 1 23 3 — 3 1 1 Cocoa — 2 2 Sausages 4 — 4 Sausagemeat 1 — 1 Wine 3 3 6 — 3 3 Spirits 5 — 5 Cake Flour Powder — 1 1 Pudding Mixture — 1 1 Custard Flavour — 1 1 Almond Cake Flour — 1 1 Pancake Mixture — 1 1 Bun Flour — 1 1 Pork and Duck Stuffing — 1 1 Glycerine — 3 3 Zinc Ointment — 2 2 Totals 35 18 53 3 3 6 1 1 34 MILK (SPECIAL DESIGNATIONS) ORDER 1936. No. of samples of milk taken for analysis during the year 31 No. of samples found to be satisfactory 31 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. Scarlet Fever 24 17 ... Diphtheria 1 1 ... Puerperal Pyrexia 2 1 ... Pneumonia 10 1 15 (all forms) Ophthalmia Neonatorum 4 4 ... Erysipelas 7 1 ... Measles 23 ... ... Whooping Cough 73 4 1 Cerebro-Spinal Meningitis 3 3 ... Acute Anterior Poliomyelitis 1 1 ... Polio-Encephalitis 1 1 1 Malaria 1 1 1 Dysentery 1 ... ... Total 151 35 18 35 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Malaria 1 Scarlet Fever 17 Diphtheria 1 Cerebro-Spinal Meningitis 2 Acute Anterior Poliomyelitis 1 Whooping Cough 4 Erysipelas 1 Other Diseases 14 Total 41 DIPHTHERIA IMMUNISATION CLINIC. Total number of attendances 801 Number of Children immunised during the year 1944. (a) Preschool children (under 5 years) 311 (b) School children (5—15 years) 36 Total 347 In addition 5 children were found to have been immunised in other districts. Grand Total of children in the Borough who had received immunising treatment by the end of the year. (a) Under 5 years 1,486 (b) Between 5 and 15 years 2,802 VERMINOUS CONDITIONS. Throughout the War there has been a progressive increase in contagious skin diseases, including infestation of every kind. Non-industrial areas such as Richmond have naturally suffered less in comparison. On the other hand we have borne our fair share 36 of air-raid conditions; whole sections of our people have had to resort for weeks at a time to nightly shelter life with all its hygienic imperfections, not least of which has been the war-time habit of sleeping without fully changing the underclothing. As a result there has been in the Borough a general increase in all verminous conditions, whilst Scabies, which before the War had largely disappeared from civil life, has grown steadily to become a major problem. These points are brought out in the following paragraphs. SCABIES. During the year 1944, 431 cases were treated at the Health Centre, as against 290 in the year 1943. Of these, approximately two-thirds were adults of either sex, school children being in the minority. Further, the disease has now broken all precedent by attacking every social class without distinction. As in previous years, the remedy employed has been Benzyl Benzoate Emulsion, and the work of treating all scabies cases has been undertaken by the personnel of the Windham Road First Aid Post, to whose willingness and patience much credit is due. One of the difficulties encountered in stamping out this scourge has been that of persuading the whole of the members of any affected household to submit to treatment irrespective of whether they be showing signs of active infestation at the time or not. On the other hand, granted this co-operation, experience shows that one single application of the remedy will be followed by cure in no fewer than 95% of cases, 37 HEAD-LICE. During the year under review the position has been as follows: Children. Total number of inspections -of children made in the schools by the School Nurses 4,803 Number of individual children found to be unclean at above 181 Number of ditto found to be unclean at School Medical Inspections 5 Proportion of children found unclean at all inspections 3.76% Number successfully cleansed by parent or guardian without requiring exclusion for more than 24 hours 178 Number excluded for longer than 24 hours 8 Number of cases in which legal proceedings were taken (a) Under the Education Act 1921 2 (b) Under the School Attendance Byelaws Nil Adults. Number of adults with head-lice referred from factories Number of adults applying for treatment independently 5 It will thus be seen that, unlike Scabies, infestation of the head remains a problem largely of school-children, among whom it has been well described as the most stubborn remaining obstruction to the securing of a really national system of education. Further, an analysis of case-names reveals that head-infestation tends always to repeat itself in certain families, of which in Richmond there appear to be some fifty. In course of time the children of these families have been listed by the School Nurses, whose duty it has become urgently to review their state of cleanliness whenever school re-opens, and in some cases after each weekend. Special visits are also paid to the home in these cases so as to give encouragement and help to the mother; it has been found that more can be achieved in this way than by older methods. 38 Thus it becomes evident that we have in our midst problem' families who, from one cause or another, have sunk into a state of sanitary indifference out of which we may hope to raise them in this generation only by better housing, and in the next by better education. TUBERCULOSIS. Throughout the year 1944 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. Fiftyseven cases of Respiratory Tuberculosis were notified, viz. 33 males and 24 females. The corresponding figure for 1943 was likewise 57. Thus the notification-rate for Richmond has shown no further rise since the marked increase which occurred in 1941. The Death-Rate from Respiratory Tuberculosis is satisfactory, the figure for 1944 being the second lowest recorded in the last 10 years. The number of cases of Tuberculosis in the Borough remaining upon the Register at the close of the year was as follows:— Pulmonary. Non-Pulmonary. Males 144 22 Females 106 28 Total 250 50 Unfortunately the admission-rate remains low, 31 out of the 57 new cases notified being afforded institutional benefit. Moreover, in cases where institutional treatment has been recommended, the average lapse of time before the admission of the patient has been two months. Non-Respiratory Tuberculosis. Eight new cases of Non-Respiratory Tuberculosis were notified during the year, but there were no deaths from this disease. Fourteen cases were notified during 1943. 39 TUBERCULOSIS. Age Periods. New Cases. Deaths. Respiratory NonRespiratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 5 1 ... ... 1 ... ... ... ... 15 7 8 ... 2 1 1 ... ... 25 8 6 ... ... 1 1 ... ... 35 4 5 ... 4 2 1 ... ... 45 6 1 ... ... 1 ... ... ... 55 5 ... ... ... 2 ... ... ... 65 and upwards 2 4 ... ... 2 1 ... ... Totals 33 24 1 7 9 4 Nil Nil I am, Ladies and Gentlemen, Your obedient Servant, JOHN DANCY, Temporary Medical Officer of Health,