RICH 14 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1945. RICHMOND : J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1945. CONTENTS. Page. Introductory Letter 1 List of Staff 2—3 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 4 Births 4 Deaths 4—6 Birth-Rate, Death-Rate & Analysis of Mortality (Table) 7 The Health of the People 8—10 SECTION B—GENERAL PROVISION OF HEALTH SERVICES. Laboratory Work 11 Ambulance Facilities 11 Ambulance Calls, Analysis of 12—13 List of Treatment Centres & Clinics 14 Health Visitors 15 Premature Infants 16 Care of Illegitimate Children 17—19 Nursing Homes 19 Wartime Nurseries 19 Home Helps, Maternity 20 Home Helps, Domestic 20—21 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 21 Sanitary Inspection 22—24 Sanitary Defects 25—27 Notices Served 27—28 Complaints Received 28—29 Food Inspection 29—30 Petroleum Acts 31 Disinfection and Disinfestation 31 Destruction of Insect Pests and the Use of D.D.T. 31—34 Diseases of Animals Acts 34 Rats and Mice Destruction Act 34—35 SECTION D—HOUSING. Housing 36 Billeting and Evacuation 36—37 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Sale of Food and Drugs Acts 38 Milk (Special Designations) Order 1936 39 SECTION F—PREVALENCE OF, AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES. Notification of Infectious Disease 39 Assistance to Householders in Case of Epidemics 40 Precautions against Typhus and Smallpox 40—41 Admissions to South Middlesex Fever Hospital 41 Diphtheria Immunisation 41—44 Verminous Conditions—Scabies and Head-lice 44—45 Tuberculosis 45—47 INDEX 48—49 1 Public Health Department, Parkshot, Richmond, (Surrey). August, 1946. 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 1945 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough.. , At the request of the Ministry of Health, the material for this Report has once more been curtailed by the omission of certain tables of statistics. As in previous years, these will be retained in the Public Health Department for purposes of record. Full reference has however been made to the Care of Illegitimate Children, to the new insecticide D.D.T., and to certain changes which have been made in the routine of Diphtheria Immunisation and in the running of the Borough Ambulance Service. During the War years the work of the Department has gathered both in volume and in scope, and at present there would appear to be no indication that it will diminish during the post War period. I desire to express my thanks to all members of the Council for their appreciation and encouragement during a particularly full year of work, and once again to record my gratitude to all members of the staff of the Public Health Department for their ungrudging support during Dr. Pereira's absence. No account of the year's happenings would be complete without a reference to the retirement of the Chief Sanitary Inspector. Mr. Laws devoted 3 5 years of his life to the service of Richmond. In the Department he was respected by his colleagues and trusted by the public. Among his peers at the Royal Sanitary Institute he was repeatedly elected to positions of the highest possible dignity. Finally, for his services to the Nation, he was honoured by His Majesty the King. I am, Ladies and Gentlemen, Your obedient Servant, JOHN DANCY, Temporary Medical Officer of Health. 2 LIST OF STAFF. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. (On War Service). Temporary Medical Officer of Health: JOHN DANCY, M.B., B.S., D.P.H. Medical Officer to Ante-Natal and Post-Natal Clinics: PHYLLIS M. REX, M.R.C.S., L.R.C.P. Part-time). Medical Officer to Child Welfare Clinics and Day Nurseries: MARJORIE F. CARTLEDGE, M.R.C.S., L.R.C.P. (Part-time) Ophthalmic Surgeon to Maternity and Child Welfare Department: C. J. L. BLAIR, M.R.C.S., L.R.C.P. Dental Surgeon to Maternity and Child Welfare Department: MISS EVELYN RUSSELL, L.D.S., R.C.S.(Eng). (Part-time until March 1945). GEORGE PACKHAM, M.R.C.S., L.R.C.P., L.D.S. (Part-time from April 1945). Chief Sanitary Inspector: GEORGE LAWS, M.B.E., F.R.San.I., F.S.I.A. (Retired 7/7/45). Assistant Sanitary Inspectors: BERNARD AISTHORPE, M.R.San.I. (Acting Chief Sanitary Inspector from 8/7/45). ERNEST S. POWER, Cert. S.I.B., M.S.I.A. CHARLES S. SMEATON, M.R.San.I. Health Visitors: MISS E. D. STEUART, S.R.N., R.F.N., S.C.M., H.V.'s Cert. MRS. N. H. ELDER, S.R.N., S.C.M., H.V.'s Cert. (On War Service). MISS E. M. MORTIMER, S.R.N., S.C.M., H.V.'s Cert. MISS J. L. EDDYVEAN, S.R.N., H.V.'s Cert. (Temporary). MISS D. F. MARTIN, S.R.N., S.C.M., H.V.'s Cert. (Temporary until 25/7/45). MISS M. J. GALLIGAN, S.R.N., R.F.N., S.C.M., H.V.'s Cert, (Temporary from 10/9/45). 3 Social Welfare Worker: MISS H. OLIVER. Clinic Assistant: MRS. E. ELVIDGE. Clerks: MISS V. SLACK (Chief Clerk). MISS I. E. WORLAND. MRS. N. PHILLIPS. MISS S. MOORE. MISS D. K. A. BONNER (from 7/8/45). Drain Tester and Disinfector: J. DAVIS. 4 SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1944) 34,160 Number of inhabited houses (estimated) 9,988 Rateable value £584,039 Sum represented by a Penny Rate £2,275 BIRTHS. Birth-Rate per 1,000 of estimated resident population 16.7 Total number of births (live and still) 571 Analysis:— M. F. Total Live Births: Legitimate 259 239 498 Illegitimate 34 28 62 Still Births: Legitimate 4 5 9 Illegitimate 1 1 2 Still-Birth Rate per 1,000 total births 19 Environment of Births:— Proportion taking place in the Borough 63% Proportion taking place outside the Borough 37% Proportion taking place in Institutions 75% Proportion taking place in dwelling-houses 25% Proportion notified by midwives alone 95% Proportion notified by doctors or parents 5% DEATHS. Death-Rate per 1,000 of estimated resident population 13.9 Total number of deaths from all causes 478 Analysis:— M. F. Total All Causes 218 260 478 Cancer 37 47 84 Diphtheria — — — Measles 1 — 1 Whooping Cough — — — Diarrhoea (under two years) 2 — 2 5 Maternal-Mortality Rate per 1,000 total births 1.75 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 34 Rate for legitimate infants per 1,000 legitimate live births 30 Rate for illegitimate infants per 1,000 illegitimate live births 65 Total number of infant deaths in the Borough 19 Analysis:— M. F. Total Legitimate 6 9 15 Illegitimate 2 2 4 Environment of Infant Deaths:— Number occurring in the Borough 11 Number occurring outside the Borough 8 Number occurring in Institutions 12 Number occurring in dwelling-houses 6 Found in River Thames 1 6 Causes of death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks end under 3 months 3 months and 1 under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... ... ... ... l 3 2 ... 6 2. Congenital Debility and Malformation including Premature Birth 4 2 ... ... 6 ... ... ... ... 6 3. Convulsions ... ... ... ... ... ... ... ... ... ... 4. Enteritis 1 ... ... 1 2 ... ... ... ... 2 5. Whooping-cough ... ... ... ... ... ... ... ... ... ... 6. Other defined diseases 1 ... ... ... 1 3 1 ... ... 5 6 2 ... 1 ... 4 4 2 ... 19 7 BIRTH RATE, CIVILIAN DEATH RATE & ANALYSIS OF MORTALITY DURING THE YEAR 1945 (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. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 16.1† 0.46† 11.4† 0.00 0.00 0.02 0.00 0.02 0.02 0.08 5.6 46* 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 — 0.02 0.00 0.02 0.02 0.07 7.8 54 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) 19.2 0.53 12.3 0.00 — 0.02 0.00 0.00 0.02 0.07 4.5 43 London Administrative County 15.7 0.40 13.8 0.00 — 0.01 0.00 0.02 0.01 0.07 7.6 53 RICHMOND 16.7 0.32 13.9 — — 0.03 — — — — 3.5 34 *Per 1,000 related births. Abortion with Sepsis. Abortion without Sepsis. Puerperal Infection Other. †Per 1,000 total population. The maternal mortality rates for England and Wales are as follows Per 1,000 Total Births 0.25 0.08 0.24 1.22 The maternal mortality rates for Richmond are as follows Per 1,000 Total Births — — — 1.75 8 THE HEALTH OF THE PEOPLE. The definition of health. The word 'health' implies by derivation a state of haleness or wholeness as opposed to one of illness. Hence the popular fallacy, which continues to linger, that health is largely a matter of freedom from sickness. When Preventive Medicine entered the field of public health its primary objective became the abatement of disease insofar as it appeared preventable. The attack therefore opened upon infectious diseases, with special reference to those which were notifiable. Today, our conception of the problem is less static. Preventive Medicine has become Social Medicine, under which health can no longer be evaluated in terms of disease, nor can it be achieved by its elimination. The health we demand for the people is rather a reserve of fitness in face of all baneful biological influences, of which disease is only one, and, even so, only in part preventable. In any case, preventable disease can only be prevented by disentangling its roots, which include poverty, bad housing, malnutrition, and ignorance. Moreover, the new fitness must be physical, mental and spiritual: it must be total and maximal. To express this ideal, the term Positive Health has recently become current, conveying as it does the conception of good health progressing to even better health, with the goal for ever moving ahead of achievement. Accepted in this dynamic sense it follows that positive health aspires to become a matter rather for international comparison than for Local Government statistics. The available Statistics. The statistical evidence for the year 1945, in Richmond as throughout England and Wales, suggests that despite the War the physical health of the civil population has suffered remarkably little. Births have replaced deaths with an increasingly easy margin. The country as a whole has fed better, and certainly more fairly, than at any other period in English history. The specific infectious diseases, for reasons partly unknown to us, have remained quiescent, even failing to thrive under conditions of gross overcrowding: the only exception would appear to be Sonne Dysentery, but even here the rise is in part to be explained by better diagnosis. 9 Meanwhile, the infant-mortality rate, always accepted hitherto as the most sensitive and reliable index to the health of the people, has pursued a steady downward trend throughout the War and, singularly enough, this applies equally in cities that have been bombed. Doubtless the credit lies with certain off-setting factors, notably the favourable effect of differential rationing which has been universal, and the fact that more and more babies today are indirectly reaping the harvest of the great maternity and child welfare movement which was officially started in 1918. If so, this would account also for the parallel fall which has occurred in the rates for still-births, neo-natal deaths and prematurity, all of them tokens of the standard of motherhood. Of the remaining rates, that for illegitimacy still stands disquietingly high, whilst the malformation-rate alone clings to its pre-War level. This is hardly surprising since, with few exceptions, the cause of congenital malformation is genetic and its incidence is therefore mathematical. The fact however that malformations have not increased with the War should at last put a term to the ancient superstition that they are due to some horrifying experience on the part of the expectant mother. The limit of statistics. On the other hand, these routine figures only take into account a small fraction of the known diseases, and even so merely to the extent that they happen to be notifiable or to have caused death. Nowhere is expression given to the fact that each year we lose in industry in England and Wales an average of 40 million working weeks; or that one out of six of our school entrants is still arriving with some outspoken defect requiring immediate treatment. What is more, the mass of minor ailments which in the aggregate account for the major invalidity of the nation passes entirely unrecorded: yet the Wartime Social Survey has indicated that 60% of all civilians between the ages of 16 and 64 experience several times a year some ill-health which is appreciable although not necessarily demanding their absence from work. The fact is that these minor ailments fall largely within the sphere of the private practitioner, in whose personal files a wealth of statistical material has in the past been lost to the nation. 10 Psycho-physical illness. Much of this type of invalidity is both mental and physical, a feature of disease which is reserved for the human species alone. The present century has already seen a steady rise in psychophysical illnesses of all kinds. To these the War has now added both a rush of new cases and a variety of new types corresponding to ever changing stresses. Of those stresses one can only speak in general terms. The effects of bombing and of battle have proved less serious than had been forecast. It seems finally clear that, where the body escapes, the human mind can withstand a shock even of extreme violence so long as it is of brief duration and admits of some sort of direct or indirect action in reply. The true factors possessing the power to break down human resistance are long-continued anxiety to which no term can be fixed; or, again, long periods of unreasonably severe self-denial or privation. To this one should add that, where any particular stress has to be suffered in the home rather than in the field, the load becomes proportionately greater. Looking at our community in this light, it becomes evident that, although on the physical side the people have escaped the major disasters of famine and pestilence, on the mental and moral sides they have come through devastating experiences from which they cannot expect to escape unscathed. Apart from causing anxiety and privation, the War has broken down that first bulwark of national health which has always been the family unit. With it the education of the young has partly broken down, sowing the seeds of delinquency and unhappiness for many years to come. Among young adults, morals have loosened and standards of honesty have lapsed. Finally, in attempting to restore the family unit, we are confronted with a grievious shortage of houses. It seems a safe prophecy that, for so long as peace remains a mere breathing space between wars, psycho-physical illness can only increase. Presumably, however, with the advent of the new Health Centres, more and more of its problems will receive statistical recognition and some may then prove amenable to statutory attention at their source. 11 SECTION B—GENERAL PROVISION OF 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:— Disease Suspected. Nature of Specimen. Result. Total. Positive. Negative. . Diphtheria Swabs from Throat and Nose Nil 75 75 Tuberculosis Sputa 3 31 34 Haemolytic Streptococcus Swabs from Throat and Nose 19 51 70 Other Diseases ... 4 29 33 Total 26 186 212 AMBULANCE FACILITIES. The South Middlesex and Richmond Joint Hospital Board have ambulances for the conveyance of infectious cases. The Richmond Council have two ambulances for use in accident and private cases, together with an Austin utility vehicle originally presented to the Council during the War by Mrs. Reynolds Veitch. These three vehicles are based upon the yard at the rear of the Technical Institute, where shelter is afforded them by a temporary outbuilding. At the beginning of the year the Richmond Borough Ambulance Service was manned by Civil Defence personnel, assisted by volunteers from St. John Ambulance Brigade. With the disbandment of the Civil Defence Services in May 1945 this entire staff was transferred to the control of the Health Committee. Twelve whole-time driver attendants are now employed, of whom five are women. 12 The service provided in this way is adequate for the needs of the Borough, and even so is supplemented in an emergency by standing arrangements for the exchange of reciprocal services with neighbouring authorities. In May 1945, failing any leader on the part of the Government as to the future running of civil ambulances in general, the Council revised the scale of local ambulance charges to residents, with the effect of bringing them into line with those levied by other authorities in the County. The use of the vehicles remained free to cases of accident or similar emergency, and this exemption was now extended to cover all maternity cases, public assistance cases, cases handled at the request of the Richmond Royal Hospital, and certain other classes, of case. Where however a charge was to be made, authority was given for its collection at the time. As reviewed in September 1945 the takings of the Richmond Borough Ambulance Service for the previous quarter suggested an annual revenue of £450. The following table shows the continued increase in the work of the Richmond Ambulance Service:— 1935 841 calls. 1943 1,497 calls. 1937 913 calls 1944 1,480 calls. 1939 1,046 calls. 1945 1,826 calls. Analysis of calls obeyed during the year 1945. 1945 Accident cases. Removal cases. Maternity cases. Others* Total 1st qr. 96 247 41 9 393 2nd qr. 168 292 62 7 529 3rd qr. 131 281 42 14 468 4th qr. 83 286 49 18 436 TOTAL 478 1106 194 48 1826 *Including false alarms and malicious calls. 13 Division of Calls into time-periods. Number of calls received between 6 a.m. and 6 p.m. 1379 Number of calls received between 6 p.m. and midnight 341 Number of calls received between midnight and 6 a.m. 106 Total calls for the year 1945 1826 Miscellaneous Figures. Total distance (in miles) covered by the ambulance vehicles in 1945 11044 Average mileage per call 6 Number of calls referred to other Authorities 34 Number of calls answered for other Authorities 59 Greatest number of calls answered in any one day 12 Average time-lag in reaching scene of accident 5-6 mins. Number of occasions upon which both ambulances were out at the same time 40 Number of complete days when one vehicle was out of commission for repairs 80 Number of accidents to ambulance vehicles 8 Number of instances of mechanical breakdown 9 14 TREATMENT CENTRES AND CLINICS—1945. 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 73 403 1341 1101 Ante-Natal Consultns. Grove Rd. Hosp. Two sessions per month County Council 160 247 247 M. & C.W. Clinic Windham Road For infants, twice weekly M. & C.W. C'ttee 102 487 4867 1790 M. & C.W. Clinic Windham Road For toddlers, twice monthly M. & C.W. C'ttee 22 227 496 330 M. & C.W. Clinic Trefoil Ho. P'm. Once weekly M. & C.W. C'ttee 51 91 632 305 M. & C.W. Consultns. Royal Hospital Once weekly Arranged by M. & C.W. C'ttee 82 M. & C.W. Eye Clinic Windham Road By appointment M. & C.W. C'ttee 16 16 M. & C.W. Dental Clinic Windham Road Once weekly M. & CW. C'ttee 51 117 377 Minor Ailments Clinic Windham Road For elem. school children Education C'ttee 306 498 3545 School Dental Clinic Windham Road For elem. school children Education C'ttee 200 758 1302 School Eye Clinic Windham Road For elem. school children Educatioh C'ttee 24 213 271 Ear, Nose and Throat Consultations Royal Hospital For elem. school children Arranged by Education C'ttee 45 Ringworm Treatment 2, Old Pal. Tce. By appt. with Dr. D. Hallett Education C'ttee 2 Chiropody Clinic Windham Road Mr. C. L. Sheppard, Registered Med. Aux. Education and M. & C.W. C'ttee 37 52 217 Chest Clinic S.C.C. Health Centre, Mortlake. Once weekly County Council 51 Diphtheria Immunisation Windham Road Once weekly Health C'ttee 47 460 988 Scabies Treatment Windham Road Daily, as required Health C'ttee 274 485 15 HEALTH VISITORS. The Borough employs four State-Registered Nurses, all possessing the New Health Visitors' Certificate, who act for one half of their time as Health Visitors and for the remainder as School Nurses. In addition to their indoor duties in connection with the various Clinics, during the year 1945 the Health Visitors paid a total of 3,445 visits, as under:— First Visits. Revisits. Routine visits paid to:— Expectant mothers 183 60 Children under one year 364 953 Children between 1 and 5 years — 1667 Special visits in connection with:— Adoption cases 34 — Diphtheria immunisation 25 — Home Help 54 — Infant Deaths 1 — Infant Life Protection — 80 Measles 1 — Miscarriages 4 — Neonatal deaths 1 — Scabies cases 8 — Special enquiries 3 — Stillbirths 4 — Tuberculosis 3 — Totals 685 2760 16 PREMATURE INFANTS. Number born Number nursed Number born alive but dying within Number surviving for over 28 days 24 hrs. 7 days 28 days Richmond Children born in the Borough: (a) At Home 4 4 — — — 4 (b) In Nursing Homes 3 3 — 1 — 2 (c) In Hospitals 10 10 — 1 — 9 Richmond Children born outside the Borough: (a) In Nursing Homes 5 5 1 — — 4 (b) In Hospitals 16 16 — — — 16 Children born in Richmond, mother normally residing elsewhere: (a) In Nursing Homes 1 1 — — — 1 (b) In Hospitals 1 1 1 — — — 17 CARE OF ILLEGITIMATE CHILDREN. The appointment of a Social Welfare Worker continues to justify itself both in the volume of work performed and in the widening scope of its development. As to the volume of work, although the Social Welfare Worker is only employed in Richmond for one half of her time, during the year she paid the following visits: — First visits 69 Re-visits 411 Miscellaneous visits 233 Total 713 Arising out of these visits, the following arrangements were concluded: — On Behalf of Mothers : — Accommodation provided in : — Ante and post-natal home 4 cases Post-natal home 4 „ Maternity home 12 „ Short-stay Shelter 4 „ Residential employment found 12 „ Affiliation Order obtained 4 „ Voluntary allotment secured 1 „ Returned to own home in Eire 3 „ On Behalf of Children : — Children placed apart from their mothers: — By adoption 3 In Church Homes 2 With foster-mothers 1 In residential nurseries 1 As to the scope of the work, cold statistics can give little idea of the multifarious and time-consuming activities involved. 18 The office of the Social Welfare Worker is based upon the Health Centre, where she holds the goodwill of the Health Visitors, whose co-operation is a first essential. From there she acts as liaison officer between the Richmond Welfare Authority and the many voluntary and religious organisations interested in rescue work. Among her other regular contacts are officials of the Public Assistance Department, Lady Almoners covering a wide range of hospitals, Probation Officers, and Clergy of many denominations. As friend to the expectant mother, she acts as chaperone during her interviews with the putative father and with legal advisers. She goes with her to reason with relatives; to find alternative accom modation; to secure suitable work. She attends with her to book her stay at some hostel or other institution, often many miles distant, and to arrange for her confinement. She travels with her upon her admission, makes repeated journeys to visit her during her stay, and finally goes and fetches her home together with the baby. In one instance it was necessary for a mother and her baby to be given personal conduct all the way to her parents' home in Eire. The cases handled by the Social Welfare Worker fall commonly into two classes. There is first the illegitimate child who has been conceived extramaritally. These cases have naturally multiplied during the War. Here, the ideal aimed at is a reconciliation with the husband, which has the effect of preserving intact the home for the child. Alternatively, in some cases the home may yet be reconstituted by divorce and remarriage. In others there remains only adoption. The second class of case is by far the more common. It is that of the unmarried girl whose partner will not or cannot marry her. The policy here is to hope for a reconciliation with the grandparents, who may then accept the child as their own; unfortunately they cannot always afford the expense. Since the line of least resistance, both for the unwed mother and for her scandalised parents, is to seek secrecy in hasty adoption, it speaks volumes for the success of the Social Welfare Worker in Richmond that, with 157 officially ascertained cases upon the illegitimacy register, in only seven instances during the year was it found necessary to place the child apart from its mother. 19 Especial praise is likewise due this year to the Richmond and District Girls' Aid Society for their valuable help, as also to the Public Assistance Committee of the Surrey County Council and to their officials for ready co-operation, given promptly and with added flexibility. 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. WARTIME NURSERIES. With the approval of the Ministry of Health the following Day Nurseries are maintained in the Borough: — (a) Parkshot Day Nursery, Richmond (52 places). (b) Grey Court Day Nursery, Ham (52 places). The total attendances made at each nursery during the years 1944 and 1945 were as follows: — 1944 1945 Parkshot Nursery 9,799 9,587 Grey Court Nursery 5,854 10,820 From these figures it will be seen that during 1945 the attendances at Grey Court Day Nursery were almost double those made during the previous year. This is explained by the fact that throughout the year the Council operated a daily car service whereby Richmond children were conveyed to and fro between the Town Hall and the Day Nursery, thus ensuring maximal attendance. 20 In this way, practically one half of the attendances at Grey Court during 1945 were made by Richmond children. PROVISION OF MATERNITY HOME HELPS. Throughout the year one whole-time and one part-time Home Help were employed by the Department, and in addition three casual workers were employed, each for a period of two weeks. Altogether, assistance was given in 97 cases for an average of 23.5 hours per case. After allowing for charges waived in necessitous cases, sick absences on the part of the Home Helps, and the intermittent character of their occupation, the balance sheet at the end of the year was as under: — £ s. d. Wages paid 231 19 3 Payments received or due 139 8 2 Excess of expenditure over income 92 11 1 PROVISION OF DOMESTIC HELP. In December 1944, the Minister of Health issued a Circular expressing concern as to the position of certain sick or infirm persons who might be unable to afford the current charges for private domestic work. To meet this situation, the Circular gave powers to Local Authorities to institute and, where necessary, to subsidise a scheme of domestic help. Reasonable expenses would in either case be reimbursed by the Ministry. The following types of case were specified as being eligible for assistance under the scheme : — (a) Where a housewife falls sick or is obliged to undergo an emergency operation. (b) Where a wife is suddenly called away to visit her husband in hospital, and arrangements must therefore be made for the separate care of the children. 21 (c) Cases of infirmity or sudden illness in the elderly. (d) Simultaneous illness of several members of the same family. (e) Other temporary domestic predicaments of a similarly deserving and urgent nature. By the 15th of January, 1945, the Public Health Department had appointed their first Domestic Help, and all local medical practitioners, nurses and others interested had been notified of the commencement of the scheme. During the first six months of the year, 22 households were provided with varying amounts of domestic assistance. In June the Scheme was temporarily discontinued owing to lack of demand, but it was revived again at the end of November. During the last month of the year the services of a Domestic help were made available to six households. SECTION C—SANITARY CIRCUMSTANCES. WATER SUPPLY. Richmond has two separate sources of drinking water: — (a) from certain local wells, (b) 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. As to purity, 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, 32 samples were taken during the course of the year, all of which reached the highest standard of bacterial purity. During the year, one sample was also taken from the raw water itself and found upon analysis to be bacteriologically satisfactory. As to physical properties, Richmond well water contains 27 parts per 1,000,000 of hardness, whilst the M.W.B. water contains 22. So mixed, the water supply is made available by piped delivery to every building in the Borough. 22 SANITARY INSPECTION. For the following particulars I am indebted to the Chief Sanitary Inspector, who submitted his Report in accordance with the Sanitary Officers (Outside London) Regulations 1935. Inspections during 1945. Houses visited and particulars recorded (Housing Act) 339 Houses visited (Public Health Acts) 1,729 Re-visits in connection with above (a) Housing Act 30 (b) Public Health Acts 1,472 Visits paid in connection with: — Overcrowding 13 Reinspections 6 Vermin 32 Reinspections 23 Disinfestation 44 Infectious Disease 66 Corporation dwellings 245 Routine inspections in connection with : — Factories (mechanical) 18 Factories (non-mechanical) 4 Outplaces 2 Bakehouses 9 Butchers' shops 33 Fishmongers and Poulterers 13 Other registered food stores 8 Cowsheds 6 Dairies and Milk Shops 15 Ice-cream premises 50 Restaurants and Tea Shops 45 Fried Fish Shops 11 Stables 47 Piggeries 8 Public Sanitary Conveniences 9 Shops Acts 2 Theatres and Cinemas 2 23 Rats and Mice 836 Smoke Observations 2 Schools—Elementary and Secondary 4 Water Supply 45 Drainage 14 Destructive Insects and Pests Act 2 Employment Agencies 4 Massage Establishments 3 Chiropodists' Establishments 4 Milk Sampling (Pasteurised) 35 Food and Drugs Sampling 7 Unsound Food 181 Petroleum Acts 134 Rent Restrictions Acts 5 Visits in connection with billeting 497 Interviews 405 Miscellaneous Visits 2029 8488 Drains and Sewerage Systems Tested. Hydraulic tests 7 Smoke tests 16 Chemical tests 5 Examinations 5 Factories Act, 1937. At the end of the year there were 200 factories on the Register (128 mechanical and 72 non-mechanical), carrying on the following trades: — 14 Mechanical Non- mechanical Aircraft parts 2 — Artificial wreaths, etc. 3 — Bakeries 11 2 Boiler-making 1 — Boot-making 10 6 Building 3 9 Butchery 2 — Carpentry, etc. — 1 Carpet-repairing — 1 Clothing 7 — Dressmaking — 10 Electrical Instruments 8 — Engineering 10 — Furniture and Upholstery 3 5 Furriers — 2 Laundering and Cleaning 6 2 Motor Engineering 5 — Motor-Vehicle Repairing 14 4 Printing 6 — Research Laboratories 2 — Sausage-making 2 — Sawmills 2 — Tailoring — 15 Toy-making 4 — Undertaking 1 — Welding 3 — Wireless Repairs 2 — Miscellaneous Trades 21 15 128 72 Inspections made during the year ... 21 Written notices served ... 3 Defects found ... 16 Defects remedied ... 16 Shops Acts, 1934. Shops on the Register ... 720 Visits made ... 183 25 SANITARY DEFECTS REPORTED. Water Supply : Defective storage-tanks 5 Foul storage-tanks 5 Defective fittings (notified to Water Engineer) 12 W.C.s and Urinals : Defective pans 42 Foul pans 21 Defective woodwork around pans 1 Defective seats 8 Absence of water-supply 23 Defective flushing-apparatus 78 Defective flush-pipe connections 34 Defective walls, floors or roofs 22 Defective doors and windows 11 Want of light and ventilation 1 Insufficient closet accommodation 1 Closets not separate for sexes 4 Defective walls and channels of urinals 2 Insanitary urinals cleansed 5 Soil-pipes : Defective or insufficient soil-pipes and vent-shafts 19 Want of,, or defective ventilation-shafts 2 Rain-water pipe acting as ventilation-shaft 7 Defective Fresh-air inlets 5 Drains : Defective drains 31 Defective sewers 15 Want of additional house-drains 7 Choked or foul drains or gullies 45 Defective or insufficient gullies 6 Defective grating, dishing or curbing 7 Absence of, or defective, interceptor 16 Defective manholes 7 Defective manhole covers and frames 7 Want of additional manholes 4 26 Dustbins : Defective receptacles 120 Defective or insanitary dust-chutes 3 Paving : Defective paving of yards, forecourts, etc. 5 Sinks : Defective or insanitary sink 6 Want of sink 2 Insanitary wall-surface around sink 1 Waste-pipes : Defective waste-pipes 63 Untrapped or unventilated waste-pipes 3 Waste-pipes directly connected to drain 1 Dampness : Defective roofs 157 Defective gutters or spouting 99 Want of damp-proof course 4 Defective external brickwork 13 Defective pointing of door and window reveals 16 Damp and insanitary site under floor 1 Floor-cavity unventilated 1 Defective wall or floor ventilators 8 General Defects : Verminous rooms 37 Verminous bedding 19 Dirty floors, woodwork, etc. 7 Accumulations of offensive matter 43 Nuisances from fowls or other animals 4 Defective plastering (no. of rooms) 231 Dirty walls and ceilings (no. of rooms) 32 Dirty walls and ceilings of staircases and passages 4 Defective floors 68 Defective doors and windows 70 Defective door and window fastenings 10 27 Defective sashcords 113 Defective window sills 18 Windows not made to open 3 Inadequate lighting and ventilation 3 Defective firegrates and kitchen ranges 91 Defective chimney pots, etc. 7 Smoke nuisances 4 Defective coppers 2 Defective larders 3 Defective coal cupboards 2 Defective staircases 31 Unfit basement rooms 1 Dilapidated outbuildings 4 Premises infested "with rats and mice 51 Contraventions of Byelaws 6 Accumulations of manure 5 Dirty yards 2 Defective stable buildings 1 Miscellaneous defects 140 1,968 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 532 Interviews 290 Statutory Action. Act and Section Notices Authorised Notices Served Public Health Act 1936. Section 24 (Drainage) 17 17 Section 39 (Drainage) 35 27 Section 40 (Soil and Vent Pipes) 1 1 Section 45 (Defective Closets) 19 15 Section 75 (Dustbins) 58 55 Section 79 (Noxious Matters) 2 2 Section 83 (Dirty Premises) 2 2 Section 92/3 (Nuisances) 29 25 28 Housing Act 1936. Section 9 (Insanitary Dwellings) 131 127 Rats and Mice Destruction Act 1919. Section 5 4 4 Factories Act 1937. Section 7 2 Although in the main the work called for on Statutory Notices was carried out by owners, in three cases the owners failed to carry out their obligations and it became necessary for the Local Authority to do the work in default. Details of these cases are as follows:—- , Premises Act and Section Cost of work carried out in default 11a Dancer Road Housing Act, Section 9 £16 4s. Od. 242 Sandycombe Road ditto £21 3s. Od. 2/4 Rosemont Road ditto £ 7 15s. 6d. COMPLAINTS. The average number of complaints received by the Department annually before the War was 500 : the figure from the 1st January to the 31st December 1945 was 1,045. This greatly increased number serves to indicate the extreme difficulty being encountered today in getting building repairs carried out. The underlying reasons are on the one hand shortage of labour and of materials, and, on the other, the limit of expenditure permitted except where the property is one covered by a building licence. The complaints received during the year have been classified and are set out below: — Defective sinks 18 Defective drains 96 Leaking pipes 36 Offensive manholes 5 Offensive sewers 9 Lack of water 28 29 Defective W.C.s 95 Defective roofs and gutters 71 Dampness 53 Dry rot 14 Defective ceilings 26 Defective chimneys 5 Defective fences 2 Defective stoves 14 Defective sashcords 10 Defective steps and stairs 8 Defective boilers 1 Accumulations of manure 1 Accumulations of rubbish 21 Defective dustbins 88 Unsound food 124 Nuisance from rats 170 Nuisance from noises 4 Nuisance from smoke 10 Nuisance from vermin, ants, etc. 57 General defects 83 1,049 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. 30 Commodity. Amount condemned Reason for condemnation. Bacon and Ham. 16 tins Blown or pierced. ditto 128¾ lbs. Decomposed. Beans 207 tins Blown or pierced. Biscuits 3 Samples Mouldy. Cheese 25½ lbs. Decomposed. Chickens, ducks, etc. 92 (339 lbs.) Decomposed. Dried egg 1 pkt. Out of condition. Fish 538 tins Blown or pierced. ditto 182¾ stones Decomposed. ditto 1 sack Decomposed. ditto 6 jars Out of condition. Fish cakes 1212 Decomposed. Fruit 6 tins Blown or pierced. ditto 202 lbs. Decomposed. Jam, Marmalade, etc. 90 jars & tins Blown or pierced. Lemonade crystals 18 bots. Out of condition. Lemon curd 1 jar Out of condition. Meat 306 tins Blown or pierced. ditto 449J lbs. Decomposed. Meat and Vegetables 17 tins Blown or pierced. Milk 752 tins Blown or pierced. Milk (dried) 58 tins Blown or pierced. Oranges 14½ cases Mouldy. Paste (fish, meat, etc.) 144 jars Out of condition. Peas 32 tins Blown or pierced. Pickles 34 bottles Mouldy. Pork pies 27 lbs. Decomposed. Potatoes 24 cwts. Frost-bitten. Prunes 7 lbs. Mouldy and decomposing. Rabbits 1948 lbs. Decomposed. Ryvita 1 pkt. Mouldy. Sauces, salad cream, etc. 4 bots. Out of condition. Sausages 59½ lbs. Out of condition. Soup 40 tins Blown or pierced. ditto 66 cubes Unsound. ditto 323 pkts. Unsound. Sponge, cake and pudding mixtures 274 pkts. Damaged by water. Sugar 1 pkt. Liquid contamination. Sultanas 89¾ lbs. Infested with insects. Syrup 1 tin Blown or pierced. Vegetables 29 tins Blown or pierced. 31 PETROLEUM ACTS, 1928. Visits made 134 Licences for which applications for renewal were made during the year : — (a) Petroleum Spirit 42 (b) Carbide of Calcium 2 Licences transferred during the year 1 New licences issued during the year 4 Premises under Government control and not subject to licence by the Local Authority 3 DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding. Infectious Fevers 21 30 184 Tuberculosis 10 11 82 Other Diseases 6 6 88 Vermin 51 120 75 Total 88 167 429 Six ponds were sprayed with an insecticide for the eradication of mosquitoes. The total costs recovered from the disinfection and disinfestation of rooms during the year amounted to £23 9s. 9d. DESTRUCTION OF INSECT PESTS IN THE HOME. With the release of D.D.T. for civilian use, the year 1945 has seen a revolution in our methods of vermin-destruction. Known to chemists for over half a century, this substance was re-discovered as an insecticide in 1940, in which capacity it made its sensational debut in Switzerland by saving the entire potato crop from the Colorado beetle. 32 Accordingly, when in 1942 the Japanese advance robbed us of our main sources of former natural insecticides, pyrethrum and derris, D.D.T. was brought into large-scale production in America and in England. Thereafter it joined with our new quinine-substitute, mepacrine, in becoming a major weapon of war in Burma. Together these two enabled our troops to fight through that terrible country and to fight on even during the monsoon. What mepacrine did to protect the soldier from the mosquito, D.D.T. did to bring down the insects in flight and to kill their larvae in the swamps. In 1943 D.D.T. performed a second miracle, in Naples. Faced with a sharp outbreak of typhus, the military authorities promptly brought this wonder-chemical to bear upon the body-lice of the local population, as many as 72,000 of them being treated in one day. In this way, for the first time in history, a winter epidemic of typhus was stamped out at its source. A similar epidemic at the close of the 191418 war had spread throughout the Balkan countries costing over 3,000,000 lives in Russia alone. When in 1944 the news of these dramatic successes was first released, sensational claims for D.D.T. were made in press-reports, some even foreshadowing a world freed at last from all insect-pests. As a precaution, now that D.D.T. is made available for civil purposes, the public will do well to discount some of the romance and avoid exploitation by buying D.D.T. only from responsible firms, who standardise their products, and at the same time by learning something of its limitations. Crude D.D.T. is a white powder which is insoluble in water but soluble in certain oily liquids. It is never applied in neat strength, but after dilution in the form of a liquid, a powder or a gas. As a liquid, D.D.T. may be made up into an emulsion with water, but it is more widely useful when dissolved in kerosene or paraffin. Since the solvent may affect household paint, D.D.T. has recently been compounded with an oil-bound water paint or whitewash in which state it is actually claimed to retain its activity for a longer period than when sprayed upon a painted surface. These experiments are still continuing. When sold as a powder the usual formula is 5.10% D.D.T. mixed with kaolin, which is china clay. 33 Finally, D.D.T. can be made up in 'bomb' form with a gas such as freon, being then liberated in a mist which remains suspended in the air for some minutes, eventually blowing away without settling. This method is therefore employed only against flying types of insects. The lethal power of D.D.T. is exceptionally high, but the time taken varies with different insects. Thus mosquitoes and flies quickly succumb, but bugs and cockroaches require several hours before dying. In using D.D.T. the first principle to accept is that it is in no sense a fumigant, since it gives off no vapour. It can therefore form no substitute for the older insect-repellants. The action of D.D.T. is purely that of a contact-poison, reaching the insect's brain by absorption through its body or its feet. For this reason it is useless to apply D.D.T. powder to clothing in the hope of preventing moth. Mothlarvae are able to browse contentedly upon one face of a lapel while D.D.T. powder lies idly upon the other. The only way to protect clothing with D.D.T. would be to spray or impregnate the whole of the fabric with a liquid solution in such a way as to leave a residual coat of D.D.T. crystals upon every surface. Similarly, in dealing with bugs, the method is to use a spray of D.D.T. in kerosene, paying attention not only to the bedstead but also to the walls surrounding the bed, together with the adjacent edges of the floor and ceiling. Afterwards, any bug desiring to return to its feed can only do so by crossing a sprayed surface. This introduces the second principle, that D.D.T. is a stable substance possessing valuable clinging properties. Consequently any surface sprayed with D.D.T. will remain lethal to bugs for weeks or months. The chemical will thus not only achieve a large initial kill, but will remain to mop up succeeding generations as they hatch out. This residual activity places D.D.T. far in advance of anything we have possessed in the past. Indeed, experiments suggest that by the use of D.D.T. distemper we may be able literally to make bug-proof a room or an entire house for long periods. Unfortunately, in dealing with flies in the home, the clinging property of D.D.T., although useful, avails us less. Flies breed out of doors, and no amount of D.D.T. can hope to take the place of proper disposal of garbage. Unless this rule be followed, flies may die in the sprayed room, but others will Still come in to take their places. In any case, food which has been 34 removed or carefully covered before spraying must afterwards remain covered, since most flies will live long enough to reach it, even after settling upon a sprayed surface. The use of D.D.T. 'bombs' would of course intercept this movement at once, but would be unsafe in the presence of food and should hardly be needed in its absence. The best way to hasten the effect of D.D.T. upon flies is to add to the spray-mixture a 'knock-down' agent such as 0.05% pyrethrin. The third principle in handling D.D.T. is to realise that, although poisoning by D.D.T. is exceptionally rare in man, certain precautions are necessary in its use. Gloves and overalls should be worn by the operator in spraying, and the hands should be completely washed after work or before eating. Where a fine spray is used indoors, a gauze mask is advisable. In addition, care must be taken not to contaminate foodstuffs with D.D.T. since, although little harmful to man externally, it will cause gastric symptoms if swallowed. In the Richmond Public Health Department full advantage was taken of D.D.T. from the earliest moment of its release. A number of local experiments were made, and it was seen at once that the chief service of this new chemical is likely to lie in the eradication of bed bugs by thorough spraying. The spray-mixture favoured at present contains both D.D.T. and a small fraction of a 'knock-down' agent. DISEASES OF ANIMALS ACTS. In Richmond Park, four hundred and forty-five sheep were dipped, and the necessary certificate was furnished to the owner of the animals. In controlling the movement of cattle to or from infected areas, two movement licences were issued, and six countersigned. RATS AND MICE (DESTRUCTION) ACT 1919 AND MINISTRY OF FOOD INFESTATION ORDER 1943. During the year 170 complaints were received from occupiers as to the presence of rats on their premises, and the work of tracing and isolating the breeding-places of the rats entailed 836 visits. 35 In all cases of infestation the occupiers were given notice to eradicate rats from their premises, and in only 4 cases was it found necessary to have recourse to statutory proceedings under the Act. Sewer Treatments—1945. The following is a brief account of the operations carried out during the year in the baiting of sewers for rodent extermination: — 21.3.45 to 9.4.45. 200 manholes were prebaited for 4 days and poisoned on the 5 th day. Examination on the 6th day and calculation of poison taken, according to the formulae of the Ministry of Food, gave an estimated kill of 1,450 rats. 20.11.45 to 3.12.45. 212 manholes were prebaited for 4 days and poisoned on the 5th day. Examination on the 6th day and calculation of poison taken, according to the formulae of the Ministry of Food, gave an estimated kill of 800 rats. The unpoisoned prebait used was sausage-rusk, the same material, mixed with zinc phosphide, being used as the poison bait. The sewers covered by these operations were within an area bounded by Riverside, Nightingale Lane, Queen's Road, Sheen Court Flats, Southern Railway to St. George's Road, Stanmore Gardens, St. Paul's Road, Pagoda Avenue, Kew Road from Pagoda Avenue to Old Deer Park Gardens, Evelyn Terrace, Kew Foot Road and the Chertsey Road. The results obtained may be considered satisfactory. 36 SECTION D— HOUSING. The normal work of making routine house-to-house surveys in accordance with the directions laid down in the Housing Regulations has been much curtailed as a result of the War. Even so, the extreme shortage of labour and of materials has brought almost to a standstill the service of notices for reconditioning and the closure or demolition of houses found to be unfit. Under these circumstances all classes of property in the Borough have naturally fallen into a state of progressive disrepair. In spite of these difficulties, 339 houses were inspected under the powers of the Housing Act, 1936, and all urgent sanitary or housing defects were abated. There is still considerable delay in the carrying out of work called for by notices, but it is hoped that, with the release of more men to the building trades, and an improvement in the supply of building material, work of this character may soon proceed at an increased rate. The number of cases of overcrowding in the Borough is still on the increase, and there are many cases of houses occupied by two or three families (e.g. parents accommodating married sons or daughters and their families), which, while they do not constitute legal overcrowding, are very near to the sanitary limits and must lead to exceedingly uncomfortable conditions—as when several families use the same kitchen facilities and share the same living-room. It is under these conditions that the urgent need has arisen for more and more houses, whether prefabricated or permanent, so as to meet the ever-increasing demands of the public now that hostilities have ceased and demobilisation of the armed forces has begun. BILLETING AND EVACUATION. When hostilities ceased the Public Health Department could not immediately be released from its obligations in connection with evacuated persons. Already, in February 1945, the London County Council had circularised Evacuation Authorities asking them to prepare plans for the organised return to their own homes of all evacuees, whether 37 toothers in charge of children or unaccompanied school children. As a result, the Department was busily engaged from February until May in the preparation of a detailed scheme for this movement, based upon the number of persons known to have been evacuated during 1944. The summons to bring this scheme into action was received on the 2nd May, but in point of fact the first train-load of returning evacuees did not arrive until the beginning of June. What with this interval and with the fact that in the meantime the long-range rockets had ceased their activity, it was found in practice that many families had already returned to their homes privately. The following, however, availed themselves of the official arrangements and it is pleasing to record that they were all returned home without a single mishap:— Mothers with children 115 Unaccompained school-children 110 The Department desires to express thanks to the school-teachers, members of the W.V.S. and all other persons who so readily volunteered to act as stewards, escorts, etc.; as also to those ladies who thoughtfully invited escorts for a much needed night's rest before embarking upon their return journey. 38 SECTION E—INSPECTION AND SUPERVISION OF FOOD. 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, 1945. Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 50 2 52 10 - 10 1 1* Flour — 1 1 Coffee - 3 3 - 1 1 Sausages 2 - 2 Confectionery and Jam 1 - 1 Sausage-Meat 4 — 4 Wine 9 5 14 4 2 6 Spirits — 3 3 Orange Squash 1 — 1 Vinegar 1 — 1 Cough Cure — 2 2 Lung Syrup — 1 1 Bloater Paste — 1 1 Ham and Beef Paste - 1 1 Curry Powder — 2 2 — 1 1 Drinking Chocolate - 1 1 Meat Extract — 1 1 "Savouree" — 1 1 "Egg Savouree" — 1 1 — 1 1 Sausage Seasoning - 1 1 Sausage Preservative - 1 1 Pure Meat Extract — 1 1 Totals 68 28 96 14 5 19 1 1 * Seven formal samples were taken on behalf of the S.C.C. by the Bucks. County Council, of which 3 proved to have been adulterated, 39 Milk (Special Designations) Order 1936. No. of samples of milk taken for analysis during the year 33 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 Supplementary Licences granted 1 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). Disease. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Scarlet Fever 16 14 ... Diphtheria 1 1 ... Puerperal Pyrexia 3 3 ... Pneumonia 14 3 15 (all forms) Erysipelas 2 ... ... Measles 353 5 ... Whooping Cough 75 2 1 Malaria 1 1 1 Dysentery 10 4 ... Total 475 33 18 40 *ASSISTANCE TO HOUSEHOLDERS IN CASE OF EPIDEMICS. In November 1945 the Ministry of Health issued Circular 196 calling upon Local Authorities to renew their precautions against a possible winter epidemic. The revised plans included the provision of extra medical, nursing and domestic assistance, together with the cooking and delivery of meals. In compliance with this Circular a meeting was arranged with representatives of the former W.V.S. (Housewives' Service) and afterwards with officers of the various voluntary organisations operating locally. In this way, the central framework of an Emergency Epidemic Service was established, links being secured with certain subsidiary organisations set up in different parts of the Borough and known as Good-Neighbours' Schemes. Notice was then circulated to hospitals, doctors, nurses and all other appropriate persons, announcing that the Epidemic Service was ready to go into action if the Minister should declare a state of emergency. Although in fact no such emergency arose during the winter, it was felt that a most useful foundation had been laid for any similar scheme in the future. PRECAUTIONS AGAINST TYPHUS AND SMALLPOX. With the close of hostilities in May, there developed a greater flow of passengers returning from the Continent by air and sea transport. In view of the presence in Europe of both smallpox and typhus, this led to a sudden increase in the number of contacts requiring supervision after their arrival. The following figures serve to show the extent of this work in Richmond. The Council will already be aware that no case of either of these diseases occurred in the Borough during 1945. 41 Month. Nature of Contact Typhus. Smallpox. January — — February — — March — 2 April — 2 May 3 — June 6 — July 9 — August 16 — September 4 — October 2 2 November 4 — December 2 1 Total 46 7 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Malaria 1 Scarlet Fever 14 Diphtheria 1 Measles 5 Whooping Cough 2 Pneumonia 1 Other Diseases 13 Total 37 DIPHTHERIA IMMUNISATION. The Diphtheria Germ. Diphtheria is due to a germ which survives with difficulty apart from the human body. Thus the disease spreads normally through the agency either of cases or of "carriers." In rarer instances it has been spread by milk. 42 Numerous types of the diphtheria germ are known to exist, but, whilst all types are similar in microscopic appearance, only a few are virulent to man. Even so, several grades of virulence are recognisable. The danger from the germ in any particular case cannot however be determined at the bedside, but by animal experiment requiring the passage of many days. Luckily the prevailing type of diphtheria germ in this country has in the past been of low or medium virulence. The Risk of Infection. At certain seasons the virulence of the diphtheria germ becomes self-exalted. When this occurs the carrier-rate rises, leading in a few days to a crop of cases among susceptibles. Conditions are then ripe for an epidemic to occur. Normally some 5% of healthy children attending school are carriers of diphtheria. Children in the same class as a carrier naturally acquire the germ by contact. If unprotected by inoculation they may suffer the illness: if previously immunised they are likely merely to become carriers also. In this way, the routine immunisation of school children. whilst reducing the number of actual cases, tends indirectly to inflate the number of carriers. Hence the paramount need for a maximal effort in securing the immunisation of each school child. The Position in Richmond. In the Spring of 1945 an analysis was made of the state of immunity of all Richmond school children, and a Report was issued to the Council. It was shown that the proportion of school children of the Borough who had been subjected to inoculation against diphtheria stood as high as 78%. This compared favourably with the corresponding figures for most local authorities in Surrey, and extremely well with the figure of 56% for England and Wales. The Changing Outlook. In the light of modern experience, our conception of diphtheria as a disease has recently undergone a certain change. It has become clear that inoculation, as practised with such resounding success in past years, cannot fully protect a community against the diphtheria germ when it appears in its most virulent form. 43 Thus, on the continent of Europe, malignant diphtheria has been able recently to reappear, and has in fact spread unchecked from Germany to Scandinavia and the Netherlands, where it now provides the worst epidemic for 50 years. In England and Wales there have been several smaller but similarly virulent outbreaks, and in each the fatalities have included a number of 'immunised' children, some of whom were also Schick' negative. Although the toll so exacted may still appear small when compared with that of former years, it is disquieting to note that each week there continue to occur in England and Wales some 500 cases of diphtheria with about 30 deaths. With a view to consolidating the machinery for Diphtheria Immunisation throughout the country, in November 1945 the Minister of Health transferred the responsibility for this work from the local Health Authorities to the Welfare Authorities. Newer Technique. In keeping with the new general outlook, the technique of immunisation in this country is likewise becoming modified. The modern view is that immunisation, to be really effective, should no longer be confined to infants but should follow up each child throughout its school life; and that, at each review, the action taken should be directed less to the measurement of susceptibility than to the securing of all possible protection to the child. Accordingly the routine usually recommended today is that every child shall be immunised at or before the age of one year, afterwards receiving a reinforcing or 'boosting' dose at the age of four and again at the age of eight. The Schick Test thus becomes reserved for older children, subject always to their having received in full the three earlier treatments. It is a matter for record that these modifications of technique were first introduced into the routine in Richmond during the autumn of 1944. 44 DIPHTHERIA IMMUNISATION CLINIC. Total number of attendances 869 Number of Children immunised during the year 1945. (a) Preschool children (under 5 years) 391 (b) School children (5—15 years) 25 Total 416 In addition 84 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 1,459 (b) Between 5 and 15 years 3,022 VERMINOUS CONDITIONS. SCABIES. As was to be expected, the close of the War has been followed by a sharp reduction in the incidence of Scabies among the civil population, most fresh cases today being traceable to the restoration of demobilised members of the Armed Forces to their families. Thus, during the year 1945, 274 new cases of scabies were treated at the Health Centre as against 431 in the year 1944. This figure included 141 school children. HEAD-LICE. On the other hand, no parallel fall has occurred in the incidence of head'infestation, which continues, in peace as in war, to bear relation rather to the proportion of school children derived from socalled problem-families. The steps taken by the Public Health Department to combat this class of infestation have been redoubled during the year in an effort to establish a fresh code of cleanliness among such families, a number of whom have recently returned from evacuation. The following figures serve to indicate the position for the year under review:— 45 Children. Total number of inspections of children made in the schools by the School Nurses 4,471 Number of individual children found to be unclean at above 188 Number of ditto found to be unclean at School Medical Inspections Nil Proportion of children found unclean at all inspections 4.2% Number successfully cleansed by parent or guardian with out requiring exclusion for more than 24 hours 122 Number excluded for longer than 24 hours 12 Number of cases in which legal proceedings were taken (a) Under the Education Act, 1944 Nil (b) Under the School Attendance Byelaws Nil Adults. No adults were referred to the Health Centre for treatment during the year. TUBERCULOSIS. During the final quarter of the year 1945 the Public Health Department complied a comprehensive Report upon the many-sided problems of tuberculosis in Richmond, throughout England and Wales and on the Continent. This Report was submitted to the Counicl in the early spring of 1946. The position in Richmond for the year 1945 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Sixty-two cases of respiratory tuberculosis were notified, viz. 41 males and 21 females. The corresponding figure for 1944 was 57. Non-Respiratory Tuberculosis. Eleven new cases of non-respiratory tuberculosis were notified during the year, and there were 3 deaths from this cause. Eight such cases had been notified during 1944. 46 TUBERCULOSIS REGISTER. After all additions and deletions had been taken into account, the number of cases of tuberculosis remaining upon the Register at the close of the year was as under:— Pulmonary. Non-Pulmonary. Males 159 22 Females 110 28 Total 269 50 PREVENTION OF TUBERCULOSIS. Under the Public Health (Prevention of Tuberculosis) Regulations 1925, powers are given to prohibit any person suffering from respiratory tuberculosis from entering upon employment involving the handling of milk. Under the Public Health Act 1936 (Section 172) powers are given to cause the removal and detention of any tubercular patient where proper precautions are not being taken and the circumstances are such as could constitute a danger to others. During the year 1945 it was not found necessary to take action under either of the above enactments. 47 TUBERCULOSIS. Age Periods. New Cases. Deaths. Respiratory NonRe«piratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 5 2 ... 1 2 ... ... ... ... 15 12 8 ... 2 ... ... ... ... 25 9 8 ... 2 3 1 ... 1 35 6 2 1 1 1 ... ... ... 45 5 3 ... ... 1 ... 1 ... 55 5 ... 1 ... 1 1 ... ... 65 and upwards 2 ... ... ... 1 1 ... ... Totals 41 21 4 7 7 3 2 1 48 INDEX. Page. Abortions and Miscarriages 7, 15 Adoption 15, 17 Ambulance Calls, Analysis of 12, 13 Ambulance Facilities 11 Ante-Natal Clinics 14 Area of Borough 4 Bakehouses 22 Billeting 23, 36 Birth-Rate 4, 7 Births, Analysis of 4 Cancer 4 Chief Sanitary Inspector, Report of 22 Chiropody Clinic 14 Clinics, List of 14 D.D.T. 31, 32, 33, 34 Death-Rate 4, 7 Deaths, Analysis of 4, 5, 7 Deaths, Maternal 5 Deaths, Neo-Natal 9, 15 Dental Clinics 14 Diarrhoea & Enteritis (under 2 years) 4, 6, 7 Diphtheria 4, 7, 11, 39, 41, 42, 43 Diphtheria Immunisation 14, 15, 41, 42, 43, 44 Diseases of Animals Acts 34 Disinfection 31 Disinfestation 22, 31, 32, 33, 34 Drains 23, 25 Dysentery 8, 39 Epidemics, Emergency Service for 40 Erysipelas 39 Evacuation 36, 37 Eye Clinics 14 Factories Act 22, 23, 24, 28 Food and Drugs Act 23, 38 Food, Unsound 23, 29, 30 Head-Lice 44, 45 Health, Definition of 8 Health of the People 8 Health Services 11-21 Health Visitors 15 Home Help 15 Home Help, Domestic 20, 21 Home Help, Maternity 20 Housing Accommodation 36 Housing Development 36 Housing Disrepair 36 Housing Shortage 36 Illegitimacy-Death-Rate 5 Illegitimacy-Rate 9 Illegitimate Children 17, 18 Infant Life Protection 15 Infant Mortality 5, 7, 15 Infant Mortality, Analysis of 5, 6 Infant Mortality Rate 5, 7, 9 Infectious Diseases, Notifiable 22, 39 Infestation Order, Ministry of Food 34 Influenza 7 Inhabited Houses 4 49 Page. Laboratory Work 11 Malaria 39, 41 Malformation, Congenital 6, 9 Maternal Morbidity 7 Maternal Mortality, Analysis of 5, 7 Maternal-Mortality Rate 5, 7 Maternity and Child Welfare Clinics 14 Maternity Homes 16, 17, 19 Measles 4, 7, 15, 39, 41 Milk 23, 38, 46 Milk (Special Designations) Order, 1936 39 Minor Ailments 9 Minor Ailments Clinics 14 Mosquitoes, Destruction of 31, 32 Notices, Sanitary 27, 28 Nuisances See 'Sanitary' Nursing Homes 19 Overcrowding 22, 36* Paratyphoid Fever 7 Petroleum Acts 23, 31 Pneumonia 6, 39, 41 Population 4 Premature Infants 6, 16 Prematurity-Rate 9 Puerperal Pyrexia 39 Psycho-Physical Illness 10 Rateable Value 4 Rats and Mice Destruction Act, 1919 23, 27, 28, 29, 34, 35 Richmond 6? District Girls' Aid Society 19 Richmond Royal Hospital 11, 14 Ringworm Treatment 14 Sanitary Complaints 28, 29 Sanitary Defects 25, 26, 27, 36 Sanitary Inspection 22 Sanitary Nuisances 27 Scabies 14, 15, 44 Scarlet Fever 7, 39, 41 School Nurses 15 Sewers 35 Sewers, Baiting of 35 Shops Acts 22, 24 Smallpox 7, 40, 41 Social Welfare Worker 17, 18 South Middlesex Fever Hospital 41 Staff, List of 2, 3 Statistics 4 Stillbirth-Rate 4, 7, 9 Stillbirths 4, 7, 9, 15 Streptococcal Infections 11 Treatment Centres and Clinics 14 Tuberculosis 11, 14, 15, 31, 45, 46, 47 Typhoid Fever 7 Typhus Fever 32, 40, 41 Verminous Conditions 22, 26, 31, 44 Wartime Nurseries 19 Wartime Social Survey 9 Water Closets and Urinals 25, 29 Water Supply 21, 23, 25 Whooping-Cough 4, 6, 7, 39, 41 • ■