RICH 15 AC (1413 (1) RICHMOND BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1946. DEVONPORT PRESS LTD., 8, DEVONPORT ROAD, W. 12 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1946. contents Page Introductory Letter 1-2 List of Staff 3-4 section a—statistics and social conditions Social Conditions 5 Births 5 Deaths 6 Comparative Statistics Table The Health of the Borough 8-9 section b—general provision of health services Laboratory Work 10 Ambulance Facilities 11-12 List of Treatment Centres & Clinics 13 Health Visitors 14-15 Premature Infants 16 Care of Illegitimate Children 17-18 Nursing Homes 18 Wartime Nurseries 19 Home and Domestic Help Service 19-20 section c—sanitary circumstances Water Supply 21-22 Sanitary Inspection 22-25 Sanitary Defects 25-28 Notices Served 28-29 Complaints Received 29-30 Food Inspection 30-31 Petroleum Acts 32 Disinfection and Disinfestation 32 Destruction of Insect Pests and the use of D.D.T. 32-33 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 38 section f—prevalence of, and control over, infectious and other diseases Notification of Infectious Disease 39 Precautions against Typhus and Smallpox 39 Admissions to South Middlesex Fever Hospital 40 Diphtheria Immunisation 40-41 Verminous Conditions—Scabies and Head-lice 41-42 Tuberculosis 42-45 index 46-47 1 Health Department, Pakkshot, Richmond. August, 1947 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 1946, upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. Although I have been your Medical Officer of Health since 1941 this is the first occasion on which I have had the privilege of presenting the report. Even so, I was only in your service during half of the year under review, and I would like to express my appreciation of Dr. C. S. Brebner and Dr. J. Dancy who deputized for me until my return in July 1946. At the request of the Ministry of Health, the material for this report has once again been curtailed by the omission of certain tables of statistics. As in previous years, these will be retained in the Public Health Department. The work of the Department has continued to increase both in scope and in volume. The Birth Rate at 19.8 per thousand is the highest recorded and there was not a single maternal death. No case of Diphtheria was notified and there was no death from an infectious disease other than influenza. Richmond is fortunate in having available all the facilities of the South Middlesex Fever Hospital. This hospital gives an excellent service which undoubtedly plays a large part in the high recovery rate. The Maternity and Child Welfare Scheme continues to function with success, and the number of residents making use of the facilities increases week by week. Additional ante-natal clinics and an extra infant welfare clinic were started as the numbers attending had become so great. 2 Arrangements were made for a new Health Centre to be built at Ham. This will be a great help to those living in that district. The "Home Helps" service gradually expanded and was able to give most valuable help in maternity cases and cases of illness and infirmity. Sanitary work was confronted with ever increasing difficulties owing to the shortage of labour and materials. Under these conditions little progress could be made and only urgent sanitary or housing defects were remedied. This naturally means that many houses are progressively deteriorating. In addition the building programme cannot keep pace with the requirements, and there are very numerous cases of over-crowding. In many houses there are two or more families. Though not legally overcrowded, this mode of life is not one which leads to health and happiness. Throughout the year Mr. B. Aisthorpe has been in office as your Chief Sanitary Inspector and I am indebted to him for the report on "Sanitary Circumstances" of the area. This gives some idea of the work done by the Sanitary Inspectors and indicates some of the problems encountered. In conclusion, I must thank every member of my Department for their loyal and efficient support, without which, this report could never have been prepared. My Chief Clerk, Miss V. Slack, who so ably helped to carry the Department through the difficult war years, unfortunately left in November to take up duties with Wimbledon Borough Council. However, Miss J. Black acted most efficiently in her place and all difficulties were overcome. I am also indebted to the Council and its Committees for their encouragement and help which are important factors in the smooth running and effectiveness of the work of my Department. I am, Ladies and Gentlemen, Your Obedient Servant, ERIC PEREIRA Medical Officer of Health. 3 LIST OF STAFF Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. (On War Service until July, 1946). Temporary Medical Officer of Health: JOHN DANCY, M.B., B.S., D.P.H. (until July, 1946). 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 Dept.: C. J. L. BLAIR, M.R.C.S., L.R.C.P. Dental Surgeon to Maternity and Child Welfare Department: GEORGE PACKHAM, M.R.C.S., L.R.C.P., L.D.S. (Part time). Chief Sanitary Inspector: BERNARD AISTIIORPE, M.R.San.I. Senior Additional Sanitary Inspector: THOMAS S. ELLIS, Cert. S.I.B., M.S.I.A. (from July, 1946). Additional Sanitary Inspectors: ERNEST s. POWER, Cert. S.I.B., M.S.I.A. CHARLES S. SMEATON, M.R.San. 1. Senior Health Visitor: MISS E. D. STEUART, S.R.N., R.F.N., S.C.M., H.V.'s Cert. 4 Health Visitors: 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. MISS M. J. GALLIGAN, S.R.N., R.F.N., S.C.M., H.V.'s Cert. MTSS S. M. GABBUTT, S.R.N., S.C.M., H.V.'s Cert. Social Welfare Worker: MISS H. OLIVER. Clinic Assistant: MRS. E. ELVIDGE. Dental Attendant: MISS J. AYLAND (Part time). Clerks: MISS V. SLACK (Chief Clerk until November, 1946). MISS J. BLACK (Acting Chief Clerk from November, 1946). MISS I. E. WORLAND. MRS. E. G. SMITH (from November, 1946). MRS. N. PHILLIPS MRS. M. WRIGHT (from February, 1946). MISS D. K. A. BONNOR. MISS J. HAWKINS (from July, 1946). Drain Tester and Disinfector: J. DAVIS. 5 SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1946) 39,290 Number of inhabited houses (estimated) 10,252 Rateable value £594,759 Sum represented by a Penny Rate £2,314 BIRTHS Birth-Rate per 1,000 of estimated resident population 19.8 Total number of births (live and still) 772 Analysis:— M. F. Total Live Births: Legitimate 353 346 699 Illegitimate 30 21 51 Still Births: Legitimate 10 9 19 Illegitimate 12 3 Still-Birth Rate per 1,000 total births 28 Environment of Births:— Proportion taking place in the Borough 57% Proportion taking place outside the Borough 43% Proportion taking place in Institutions 76% Proportion taking place in dwelling houses 24% Proportion notified by midwives alone 96% Proportion notified by doctors or parents 4% DEATHS Death-Rate per 1,000 of estimated resident population 12.7 Total number of deaths from all causes 500 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 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 ... 2 ... ... 2 2 ... ... ... 4 2. Congenital Debility and Malformation including Premature Birth 13 ... ... ... 13 1 ... ... ... 14 3. Convulsions ... ... ... ... ... 1 2 ... ... 3 4. Enteritis ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... 6. Other defined diseases ... ... ... ... ... ... 2 ... 1 3 7. Asphyxia (Accidental Death) ... ... ... ... ... 1 1 1 ... 3 13 2 ... ... 15 5 5 1 1 27 Analysis:— M. F. Total All Causes 230 270 500 Cancer 30 45 75 Diphtheria — — — Measles — — — Whooping Cough — — — Diarrhoea (under two years) — — — Maternal-Mortality Rate per 1,000 total births 0.00 Total number of maternal deaths Nil Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 37 Rate for legitimate infants per 1,000 legitimate live births 33 Kate for illegitimate infants per 1,000 illegitimate live births 98 Total number of infant deaths in the Borough 27 Analysis:— M. F. Total Legitimate 11 11 22 Illegitimate — 5 5 Environment of Infant Deaths:— Number occurring in the Borough 14 Number occurring outside the Borough 13 Number occurring in Institutions 17 Number occurring in dwelling houses 10 7 COMPARATIVE STATISTICS—1946 England and Wales 126 County Boroughs and Great Towns including London 148 smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Richmond Rates per 1,000 Civilian Population Births— Live 19.1 22.2 21.3 21.5 19.8 Still 0.53 0.67 0.59 0.54 0.57 Deaths— All Causes 11.5 12.7 11.7 12.7 12.7 Typhoid and Paratyphoid Fever 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.25 Smallpox 0.00 0.00 0.00 — — Measles 0.00 0.01 0.00 0.01 0.00 Rates per 1,000 Live Births Deaths under 1 year of age 43 46 37 41 37 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 0.00 Rates per 1,000 Civilian Population Notifications— Typhoid Fever 0.01 0.01 0.01 0.01 0.07 Paratyphoid Fever 0.02 0.02 0.01 0.01 0.00 Cerebro-Spinal Fever 0.05 0.05 0.04 0.06 0.00 Scarlet Fever 1.38 1.51 1.33 1.42 0.88 Whooping Cough 2.28 2.48 2.05 2.22 2.29 Diphtheria 0.28 0.32 0.31 0.24 0.00 Erysipelas 0.22 0.25 0.22 0.27 0.25 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 2.37 Pneumonia 0.89 1.02 0.74 0.75 0.38 Rates per 1,000 Total Births (Live and Still) Puerperal Fever 8.50 10.35 7.63 1.62 0.00 Puerperal Pyrexia 9.68 1.28 Maternal Mortality— Abortion with Sepsis 0.13 not available 0.00 Abortion without Sepsis 0.06 000 8 THE HEALTH OF THE BOROUGH Population At the Census of 1931 the population of the Borough was 37,791, while the Registrar General's estimate at the middle of 1946 was 39,290. It is interesting to note that until the year 1943 there were always more deaths than births in Richmond. Since 1943 there has been an excess of births over deaths each year until in 1946 when 750 live births were recorded compared with 500 deaths. Births There were 772 births during the year (394 males and 378 females). This gives a Birth-Rate of 19.8 per thousand of the population as compared with a rate of 19.1 in England and Wales. The number of illegitimate births has fallen from 64 in 1945 to 54 in 1946. This decline should continue as social conditions generally improve. It is surprising to find that as many as 76% of the confinements took place in hospitals and nursing homes and only 24% in dwelling houses. Deaths The total number of deaths occurring amongst residents was 500 (230 males and 270 females). This gives a Death-Rate of 12.7 per thousand of the population as compared with 11.5 for England and Wales. This is a crude Death-Rate which is not strictly comparable since the ages of populations in different districts vary. If corrected and made comparable it would be more favourable in Richmond. Despite the reduction in the number of illegitimate births the infant mortality rate is higher this year than it was in 1945, and the Still Birth-Rate shows a similar increase. This appears to be due to a rather higher proportion than usual of infants born suffering from congenital malformation or 9 debility. These increases are not of great significance since the number concerned is small. It is satisfactory to record that there were no maternal deaths and no death from any infectious disease other than influenza. Infectious Diseases In almost every case the incidence of infectious diseases in Richmond compares very favourably with other towns and the county as a whole. There were three cases of Typhoid Fever but these were almost certainly contracted outside the Borough and there was no spread of the infection. There was not a single case of diphtheria; due, no doubt, to the immunity of the population which has resulted from the successful Diphtheria Immunization Campaign which has been conducted since 1934. 10 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 4 168 172 Tuberculosis Sputa 3 37 40 Hæmolytic Streptoccus Swabs from Throat and Nose 4 2 6 Other Diseases 10 39 49 Total 21 246 267 In the case of the four swabs which produced a culture of C. Diphtherias, subsequent tests proved these organisms to be non-virulent and incapable of producing diphtheria. Milk and Water Routine samples of milk and water were examined at The London and Home Counties Public Health Laboratories, 66 Victoria Street, E.C.4. Ice Cream Following the outbreak of typhoid fever in Aberystwyth which resulted from the consumption of infected ice-cream, arrangements were made for routine sampling of ice-cream produced and sold in the Borough. For the examination of these samples advantage was taken of the facilities offered by the Ministry of Health Public Health Laboratories, Epsom. Though these bacteriological examinations can only be used as a guide by the Department, they have been of great value. There is no doubt that the standard of ice-cream production has been much improved by these means. 11 AMBULANCE FACILITIES The South Middlesex and Richmond Fever Hospital has ambulances for the conveyance of infectious diseases. The Richmond Council have two ambulances for accident and removal cases, together with an Austin Utility vehicle originally presented to the Council by Mrs. Reynolds Veitch. These three vehicles are located at the Technical Institute, Kew Road. Covered accommodation is available for two of the vehicles and the personnel are housed in a small part of the ground floor of the Institute. Twelve whole-time driver-attendants are employed to operate the service; this number includes a Station Officer and five women. The two ambulance vehicles are very old and for this reason are rather frequently undergoing repair. One new Austin ambulance has been ordered. Even so, a satisfactory service has been maintained although the number of calls continues to increase each year. Reciprocal mutual-aid arrangements exist with surrounding Boroughs and it will be seen from the table that calls were answered for other Authorities on 83 occasions. During the year the Council purchased a Minnitt Gas-Air Anaesthetic apparatus for the use of the District Midwives in the homes of their patients. The apparatus is kept at the Ambulance Station and, at the request of a midwife, it is delivered to the patient's home and collected when no longer required. All the District Midwives have been instructed in its use and it is of real benefit to mothers who are confined in their own homes. The following table shows the continued increase in the work of the Richmond Ambulance Service:— 12 1935 841 calls 1943 1,497 calls 1937 913 calls 1944 1,480 calls 1939 1,046 calls 1945 1,826 calls 1946 1,930 calls Analysis of calls obeyed during the year 1946 1946. Accident cases Removal cases Maternity cases Others Total 1st qr. 104 247 60 - 411 2nd qr. 124 261 75 — 460 3rd qr. 126 339 77 — 542 4th qr. 107 347 63 - 517 TOTAL 461 1,194 275 — 1,930 Division of Calls into time periods Number of calls received between 6 a.m. and 6 p.m. 1474 Number of calls received beween 6 p.m. and midnight 316 Number of calls received between midnight and 6 a.m. 140 Total calls for the year 1946 1930 Miscellaneous Figures Total distance (in miles) covered by the ambulance vehicles in 1946 11,972 Average mileage per call 6 1/5 Number of calls referred to other Authorities 66 Number of calls answered for other Authorities 83 Greatest number of calls answered in any one day 14 Average time lag in reaching scene of accident 4½ mins. Number of occasions upon which both ambulances were out at the same time 36 Number of complete days when one vehicle was out of commission for repairs 129 Number of accidents to ambulance vehicles 6 Number of instances of mechanical breakdown 16 Number of false alarms and malicious calls 36 13 TREATMENT CENTRES AND CLINICS—1946 Nature of Service Address in Richmond Particulars By whom provided or arranged Total number of:— Sessions held Pts. attending Attendances made Doctor's consultations Ante-Natal Clinic. Windham Road Eight sessions per month M. & C.W. C'tte 93 457 2,138 1,607 Ante-Natal Clinic. Windham Road (for Grove Rd.) Two sessions per month County Council 26 218 418 418 M. & C.W. Clinic. Windham Road For infants, twice weekly M. & C.W. C'tte 105 609 5,295 1,915 M. & C.W. Clinic. Windham Road For toddlers, twice monthly M. & C.W. C'tte 24 241 556 309 M. & C.W. Clinic. Trefoil House, Petersham Once weekly M. & C.W. C'tte 51 184 1,732 525 M. & C.W. Clinic. St. Winifred's Hall, Kew Once weekly (from 3.9.46) M. & C.W. C'tte 18 126 654 M. & C.W. Consultations. Royal Hospital, Richmond Once weekly M. & C.W. C'tte — 92 — M. & C.W. Eye Clinic. Windham Road By appointment M. & C.W. C'tte 21 32 M. & C.W. Dental Clinic. Windham Road Twice weekly M. & C.W. C'tte 77 232 827 Diphtheria Immunisation Clinic. Windham Road Once weekly M. & C.W. C'tte 50 928 1,560 Scabies Treatment. Windham Road Daily, as required Health C'tte 377 621 14 HEALTH VISITORS The Borough employed five 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 1946 the Health Visitors paid a total of 4,254 visits, as under:— First Visits Revisits Routine visits paid to:— Expectant mothers 444 121 Children under 1 year 474 1,016 Children between 1 and 5 years ... 1,962 Special visits in connection with:— Adoption cases 12 Diphtheria immunisation 2 Home Helps 68 Infant Deaths 1 Infant Life Protection ... 85 Infectious Diseases 13 Maternity Survey 21 Neonatal Deaths 2 Post Natal 3 Scabies cases 6 Special enquiries 2 Stillbirths 11 Tuberculosis 7 Whooping Cough 4 Totals 1,070 3,184 During the year authority was obtained to increase the establishment of Health Visitors for all purposes to six, and to appoint one of the six to the position of Senior Health Visitor. The latter appointment was made in September when Miss E. D. Steuart was promoted to the position, but it was not found possible to complete the establishment until the close of the year. 15 Clinic Activities During the year the ante-natal clinics steadily became more and more crowded and it was found essential to increase the number of sessions from 6 to 8 per month. Infant Welfare Clinics were becoming overcrowded and arrangements were made to hold a weekly session at St. Winifred's Church Hall. This session is very much appreciated by the residents of Kew and has done something to ease the strain at Windham Road. There is a case for at least one weekly session located in the neighbourhood of Richmond Hill. During the year efforts were made to find suitable accommodation, but these were unsuccessful. Such a clinic would again ease the strain at Windham Road which is most desirable, and would be a great advantage to parents living in the area indicated. A Creche was opened at the Health Centre on one afternoon each week. Twenty children under the age of five are cared for from 2 until 6 p.m., thus allowing the mothers an afternoon of freedom. A tea meal is provided and a small charge is made. It is supervised by one Health Visitor and a number of voluntary workers. A "Sitters-In" Service was started and organised by a voluntary committee with Mrs. M. A. Toms of 4 Lawn Crescent, Kew Gardens, as chairman, and a panel of Sitters-In exists who will take care of the home and the children while the parents go out in the evening. ON 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 11 11 1 2 1 7 (b) In Nursing Homes 3 3 — — — 3 (c) In Hospitals 12 12 1 — 1 10 Richmond Children born outside the Borough: (a) In Nursing Homes 1 1 — — - 1 (b) In Hospitals 9 9 — — - 9 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 employment of a Social Welfare Officer by the Boroughs of Richmond and Barnes continues to justify itself by the volume and nature of the work performed. The following is a record of the work carried out in Richmond only:— Number of cases brought to the notice of the Department during the year. (a) Through Local Authority Records, Clinics and Health Visitors 52 (b) Through Almoners, Probation Officers, Clergy, etc., 18 70 Number of cases visited for the first time during the year 62 Number of home visits and re-visits to all known cases 432 Number of visits to employers, relatives, institutions, hostels and welfare societies in connection with cases 200 Total 694 Arising out of these visits, the following arrangements were concluded:— On Behalf of Mothers Ante- and post-natal home 4 cases Post-natal home 4 „ Short-stay shelter 12 „ Special homes for confinement 7 „ Residential employment found 12 „ Non-residential employment 4 „ Affiliation Order obtained through Court procedure 4 „ Affiliation Order arranged voluntarily 5 „ Mothers who were able, but refused to make application 2 „ 18 On Behalf of Children Children placed apart from their mothers :—- By adoption 4 „ In Church homes 2 „ With foster-mothers 3 „ In residential nursery 1 „ As recorded in the Section on Vital Statistics the number of illegitimate infants born to women residents in Richmond has fallen from 64 in 1945 to 54 in 1946. It is hoped that this decline will continue as social conditions improve. The problem, however, is likely to remain a large one since the management of each individual case is almost always most complicated and consequently very time consuming. Details of the type of work carried out were given in the Annual Report for 1945 and will not be repeated here. It should be noted, however, that the figures given cannot give a real value to the work performed. There is no doubt that the Social Welfare Worker relieves many of these unfortunate women from a great deal of suffering, and in many instances is able to improve very considerably the future prospects of their infants. 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. 19 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 (60 places). The total attendances made at each nursery during the years 1945 and 1946 were as follows:— 1945 1946 Parkshot Nursery 9,587 10,286 Grey Court Nursery 10,820 11,707 These two nurseries continue to perform a most useful service in the Borough. The attendances at both are greater than in the previous year, but still fall a good deal below the possible maximum. This is inevitable in view of the susceptibility of children under the age of five to infectious diseases and it is unlikely that much improvement can be made. There is always a waiting list of children requiring admission. A condition of admission is that the mothers must all be intending to undertake full time work and some preference is given to parents who are in serious financial or social difficulties. HOME HELP SERVICE The following are details of the work carried out by Home Helps during 1946:— During the year 10 Home Helps and 4 Casual Home Helps were appointed. Number of households attended:— (a) M. and C.W. cases 112 (b) Domestic cases 85 Number of hours engaged in work:— (a) M. and C.W. cases 4,463 (b) Domestic cases 1,604¾ 20 Altogether an average of 39.9 hours was spent on each M. and C.W. case, and an average of 18.9 hours per Domestic 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 619 12 10 Payments received or due 417 1 11 Net loss 202 10 11 In Richmond the Home Help Service is a combined one and provides help for Domiciliary Maternity cases and cases of illness and other emergencies in the home. During the early part of the year the two services were entirely separate and were administered from different offices. This was found to be unsatisfactory and wasteful of personnel and, accordingly the services were united and based on the Health Centre, Windham Road. In many ways a difficult service to organize, there is no doubt that the Department was able to assist a number of very deserving cases. It is gradually being expanded as it develops—any rapid expansion would be extravagant and unsatisfactory. An important difficulty has been to find suitable Home Helps who are reliable, enjoy the work, and are prepared to undertake the duties as a permanent occupation. 21 SECTION C— SANITARY CIRCUMSTANCES Water Supply Richmond has two separate sources of drinking water:— (a) From local wells. (b) From the Metropolitan Water Board. (a) There are seven wells and they produce the bulk of the water supply to the district. One of them, known as the Terrace Gardens Well, is 320 feet deep and reaches two miles of adits in the chalk. The remainder are shallow wells which draw their water from the ballast covering the London Clay. The water is not filtered but is chlorinated before being passed into the mains for supply to the public. Of the water so treated, forty samples were examined during the course of the year, all of which reached the highest standard of bacterial purity. Richmond water contains 27 parts per 100,000 of hardness and is not plumbo-solvent. (b) The supply from the Metropolitan Water Board is received in bulk through six connections off the 30-inch M.W.B. main. The source is the River Thames, abstracted at the Laleham and Walton intakes, and pumped into Oueen Mary Reservoir, Littleton, and Knight and Bessborough Reservoirs, Walton. After storage the water passes to the works at Hampton, where it is treated by primary and secondary sand filtration and finally is sterilized by the ammonia-chlorine process before being pumped into the supply. Samples are collected on five days a week at each stage of the purification process, and the tests include physical, chemical and bacteriological examination. Samples are taken at weekly intervals for full chemical and biological tests. The results of these tests indicated that a very high standard of chemical and bacteriological purity was maintained throughout the year. The water is not plumbo-solvent. 22 There is also a supply of raw river-water delivered to a proportion of the residences in Richmond. After sedimentation it is pumped to a special reservoir and is delivered from there by gravity. This water is not fit for drinking; it is used for gardens and for periodic flushing of the sewers. The following figures show the daily average consumption from the three sources:- Source Daily Average Consumption All Richmond Wells 1,143,821 gals. Metropolitan Water Board 475,786 gals. Raw River Water 131,928 gals. At all times there is an unlimited reserve available from the Metropolitan Water Board. Water fit for human consumption is made available by piped supply to every dwelling-house in the Borough. No privately owned wells are in use. 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 1946 Houses visited "and particulars recorded (Housing Act) 1ll Houses visited (Public Health Acts) 2,357 Revisits in connection with above (a) Housing Act 152 (b) Public Health Acts 2,280 Visits paid in connection with:— Overcrowding 42 Reinspections 1 Vermin 117 Reinspections 99 Disinfestation 34 Enquiries into Infectious Diseases 62 Miscellaneous Visits „ 51 Corporation Dwellings 189 23 Routine inspections in connection with:— Factories (mechanical) 5 Factories (non-mechanical) 17 Outplaces 6 Bakehouses 9 Butchers' shops 34 Fishmongers and Poulterers 19 Other registered food stores 4 Cowsheds 3 Dairies and Milk Shops 19 Ice-cream premises 83 Restaurants and Tea Shops 51 Fried Fish Shops 5 Stables 14 Piggeries 6 Public Sanitary Conveniences 24 Shops Acts 150 Theatres and Cinemas 1 Greengrocers and Fruiterers 7 Tents, Vans, and Sheds 8 Houses let in lodgings 2 Rats and Mice 560 Smoke Observations 16 Schools—Elementary and Secondary 2 ,, —Private 1 Water Supply 13 Drainage 157 Employment Agencies 2 Massage Establishments 1 Milk Sampling (Pasteurised) 33 Food and Drugs Sampling 26 Unsound Food 128 Petroleum Acts 112 Rent Restrictions Acts 20 Visits in connection with Billeting 23 Interviews 653 Miscellaneous Visits 1,028 8,737 24 Drains and Sewerage Systems Tested Hydraulic tests 2 Smoke tests 58 Chemical tests 6 Examinations 58 Factories Act, 1937 At the end of the year there were 173 factories on the Register (108 mechanical and 65 non-mechanical), carrying on the following trades:— Mechanical Nonmechanical Artificial wreaths, etc. 2 — Bakeries 12 2 Boat Repairs 1 1 Boot-making 11 5 Box-making 1 — Building 4 10 Butchery 2 — Carpentry — — Carpet-repairing — 1 Clothing 2 - Dressmaking 3 6 Electrical Instruments 8 — Engineering 10 — Fire Appliances 1 — Furniture & Upholstery — 5 Furriers — 2 Gas Storage 1 — Glue-making 1 — Jewellery Repairs 1 — Laundering & Cleaning 4 2 Motor Engineering — — Millinery — 3 Milk Pasteurising 1 — Motor Vehicle repairing 13 4 Printing 6 — Research Laboratories — — Sausage-making 2 — 25 Saw Mills 2 — Surgical Instruments 2 — Tailoring — 13 Undertaking 1 — Upholstery 2 2 Welding 1 — Wheelwright & Coach building 3 1 Wig-making — 1 Wireless Repairs 1 1 Miscellaneous Trades 10 6 108 65 Inspections made during the year 22 Written notices served 19 Defects found 45 Defects remedied 35 Shops Acts, 1934 Shops on the Register 720 Visits made 148 Employment of Young People 2 SANITARY DEFECTS REPORTED Water Supply: Defective storage-tanks 4 Foul storage-tanks 1 Defective fittings (notified to Water Engineer) 14 W.C.s and Urinals: Unsuitable or defective urinals 1 Defective pans 74 Foul pans 11 Defective woodwork around pans 4 Defective seats 12 26 Absence of water-supply 13 Defective flushing apparatus 72 Defective flush-pipe connections 22 Defective walls, floors or roofs 39 Defective doors and windows 7 Want of light and ventilation 4 Insufficient closet accommodation 8 Closets not separate for sexes — Defective walls and channels of urinals 1 Insanitary urinals cleansed 1 Defective brickwork (repaired or re-built) 1 Soil-pipes: Defective or insufficient soil-pipes and vent- shafts 37 Want of, or defective ventilation-shafts 2 Rain-water pipe acting as ventilation shafts 6 Defective Fresh-air inlets 16 Drains: Defective drains 33 Defective sewers 16 Want of additional house-drains 9 Choked or foul drains or gullies 39 Defective or insufficient gullies 18 Defective grating, dishing or curbing 6 Absence of, or defective, interceptor 6 Defective manholes 12 Defective manhole covers and frames 11 Want of additional manholes 6 Sub-soil drains required 2 Defective drainage of Stables 2 Dustbins: Defective receptacles 99 Defective or insanitary dust-chutes 3 Defective or uncovered offal bins 1 Paving: Defective paving of yards, forecourts, etc. 6 27 Sinks: Defective or insanitary sink 22 Want of sink 8 Insanitary wall-surface around sink 1 Waste-pipes: Insanitary W.P.'s or shafts 4 Defective waste-pipes 52 Untrapped or unventilated waste-pipes 7 Waste-pipes directly connected to drain 1 Dampness: Defective roofs 222 Defective gutters or spouting 142 Want of damp-proof course 6 Defective external brickwork 26 Defective pointing of door and window reveals 19 Damp and insanitary site under floor 3 Floor cavity unventilated Defective wall or floor ventilators 8 General Defects: Verminous rooms 45 Verminous bedding 12 Dirty floors, woodwork, etc. 14 Accumulations of offensive matter 43 Nuisances from fowls, or other animals 3 Defective plastering (No. of rooms) 438 Dirty walls and ceilings (No. of rooms) 110 Dirty walls and ceilings of staircases and passages 22 Defective floors 98 Defective doors and windows 132 Defective doors and window fastenings 9 Overcrowding 15 Defective furnace or brickwork of copper 3 Name and Address of Owner or M.O.H. not in Rent Book 2 28 Want of manure receptacle 1 Defective manure receptacle 1 Defective sashcords 96 Defective window sills 46 Windows not made to open 3 Inadequate lighting and ventilation 14 Defective firegrates and kitchen ranges 90 Defective chimney-pots, etc. 20 Smoke nuisances 4 Defective coppers 3 Defective larders 4 Defective coal cupboards — Defective staircases 11 Unfit basement rooms 12 Dilapidated outbuildings 2 Premises infested with rats and mice 52 Contraventions of Byelaws 8 Accumulations of manure 2 Dirty yards 1 Miscellaneous defects 167 2,623 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES Informal Action Preliminary intimations 590 Interviews 653 Statutory Action Act and Section Notices Authorised Notices Served Public Health Act 1936 Section 24 (Drainage) 7 7 Section 39 (Drainage) 33 26 Section 45 (Defective Closets) 16 12 Section 75 (Dustbins) 46 43 29 Public Health Act 1936 Section 83 (Dirty Premises) 1 0 Section 92/3 (Nuisances) 35 29 Housing Act 1936 Section 9 (Insanitary Dwellings) 103 86 Factories Act 1937 Section 1 1 1 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 1, la, 2, 2a, Evelyn Housing Act 1936, Sec. 9 £118 0s. 0d. Mansions 1/2 York Villas do £119 10s. 0d. 242, Sandycombe Road do £28 5s. 6d. COMPLAINTS The average number of complaints received by the Department annually before the War was 500: the figure from the 1st January to 31st December 1946 was 1,153. This greatly increased number served 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 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 22 Defective drains 76 Leaking pipes 32 30 Offensive manholes 7 Offensive sewers 3 Lack of water 26 Defective W.C.s 99 Defective roofs and gutters 79 Dampness 61 Dry rot 22 Defective ceiling 28 Defective chimneys 9 Defective fences 6 Defective stoves 19 Defective sashcords 14 Defective stairs and steps 12 Defective boilers 2 Accumulations of manure 5 Accumulations of rubbish 23 Defective dustbins 92 Unsound food 154 Nuisance from rats 161 Nuisance from noises 5 Nuisance from smoke 9 Nuisance from vermin, ants, etc. 62 General defects 111 Overcrowding 14 1,153 FOOD INSPECTION The following foodstuffs, found to be unfit for human consumption, were surrendered by the owners and either salvaged for animal food or destroyed:— 31 Commodity Amount Condemned Reason for Condemnation Cwt. lbs. ozs. Tins Bacon 61. 0 Decomposed. Baked Beans 102. 0 102 Blown or pierced. Beans 49. 13 45 do. Beetox 8 1 Blown. Bread 2. 80. 12 Insect infested. Biscuits 37. 0 Mouldy. Cereals 110. 4 Unsound. Cheese 30. 0 Decomposed. Chickens, etc. 70. 0 do. Cream Buns 61. 8 Mouldy. Dried Egg 2. 5 4 Out of condition. Dried Fruit 5. 24. 8 Insect infested. Fish 1. 63. l1¾ 262 Blown or pierced. do. 19. 51. 0 Decomposed. Flour 27. 0 9 Mouldy. Fruit and Vegs. 3. 38. 0 Decomposed. Fruit 1. 42. 3½ 85 Blown or pierced. Jam, etc. 55. 2½ 45 do. Lard 28. 0 Out of condition. Meat 1. 0. 4½ 88 Blown or pierced. do. 49. 0 Out of condition. Malted Food 15. 0 19 do. Meat and Veg. 28. 0 28 Blown or pierced. Milk 8. 77. 5½ 1,102 do. Oranges 6. 28. 0 Mouldy. Paste 16. 15½ 15 Out of condition. Pickles 5. 11 5 Mouldy. Pork Brawn 6. 0 Decomposed. Rabbits 1. 4. 0 do. Sausages 7. 19. 0 Out of condition. Soup 31. 11½ 36 Blown or pierced. Shortcake 10¼ Contaminated by oil. Soya Cream 6. 8 365 (pkts.) Unsound. Tea 12 Contaminated. Tripe 3. 36. 0 Decomposed. Treacle Pudding 14½ 1 Blown. Vegetables 2. 45. 10½ 238 Blown or pierced. 32 PETROLEUM ACTS 1928 Visits made 112 Licences for which applications for renewal were made during the year:— (a) Petroleum Spirit 53 (b) Carbide of Calcium 2 Licences transferred during the year 2 New licences issued during the year 9 Premises under Government control and not subject to licence by the Local Authority 2 DISINFECTION OF PREMISES Reason Houses Rooms Bedding Infectious Fevers 34 36 242 Tuberculosis 11 22 69 Other Diseases 18 17 147 Vermin 48 112 49 111 187 507 The total costs recovered from the disinfection and disinfestation of rooms during the year amount to £17 6s. 3d. DESTRUCTION OF INSECT PESTS IN THE HOME. As the insecticide D.D.T. was fully described in the last Report, it is desirable briefly to record some of the experiences of the department in its use during 1946. Bugs: There were not a great number of instances of bug infestation in the borough. The cases which did occur were all dealt with by spraying the walls, furniture and bedsteads in the infested premises with a 5% solution of D.D.T. in kerosene. Results obtained were satisfactory but certain factors have to be watched. Initially there is normally a large kill and conditions are greatly improved. However, the spray cannot reach all dormant insects and cannot destroy the 33 eggs. The great advantage of D.D.T. is that its lethal action persists and any dormant bugs which later become active or bugs which have hatched out from their eggs, will be fatally poisoned when they cross the sprayed surface. The lethal effect of D.D.T. will last for about two months and during this time, under favourable conditions, every bug will be destroyed. During the week or two following the spraying, occupiers may see a few bugs and may feel that the method has failed. They must be re-assured on this point. In all cases of severe infestation it is advisable to repeat the treatment at an interval which varies according to the season. The reason for this is that some of the eggs may not hatch out for many months; well after the D.D.T. has lost its lethal effects. Fleas and Lice: These insects are usually eradicated easily by ordinary cleanliness. However, in bad cases, the D.D.T. spray has played a most useful part. Cockroaches: These insects can be a most objectionable pest in homes and Hats of all types. The D.D.T. spray is useless against them but encouraging results have been obtained by the use of 5% D.D.T. powder. This is spread liberally at places over which the insects are likely to pass. Once some of the powder has become adherent to the hairs of the legs, poisoning will commence. It is usually possible to eradicate the pest within a week—fewer and fewer insects being seen each day. Flies: D.D.T. solutions are very lethal to flies but cannot play avery big part in their control in civil life. The spraying of fly-proofed cookhouses and food stores was valuable in military camps and could be used by the public, in particular by establishments which handle food. It is almost useless spraying a room with unprotected windows as flies will enter, contaminate food, and die some hours later when the damage has been done. Their proper control must remain the correct disposal of garbage and the elimination of their breeding nlaces. 34 DISEASES OF ANIMALS ACTS During the year two outbreaks of Foot and Mouth Disease brought Richmond within the boundaries of " infected areas " and in consequence imposed restrictions upon the movement of cattle. The outbreaks were as follows :— 29. 6. 46. Bailey Battle Bridge, Kings Cross 9. 12. 46. Rickmansworth During the periods of restriction of movement, 2 occupational and 1 movement licences were issued to stock holders to enable them to move cattle for essential purposes. RATS AND MICE (DESTRUCTION) ACT 1919 AND MINISTRY OF FOOD INFESTATION ORDER 1943 During the year 161 complaints were received from occupiers as to the presence of rats on their premises and the work of tracing and isolating the breeding places entailed 560 visits. Sewer Treatments—1946 The following is a brief account of the operations carried out during the year in baiting the foul sewers for rodent extermination. 18.3.46 to 29.3.46 200 manholes were pre-baited for 3 days and poisoned on the 4th day. Examination after poisoning gave an estimated kill (based on Ministry of Food Formulae) of 952 rats. The area covered in these operations was all streets within the boundary of Kew Road, Kew Green, Ennerdale Road. Sandycombe Road, and Mortlake Road. In May 1946 it was decided to approach the Ministry of Food and ask for grant payment towards the cost of sewer treatments. 35 The Ministry finally agreed to pay a 30% grant towards the cost of new expenditure and also work already done on sewer treatment, providing the whole of the sewer system was given an immediate overall treatment consisting of 2 days pre-baiting and third day poisoning, the records of such treatment to be sent weekly to the Ministry of Food. This treatment was accordingly carried out between the 8.7.46 and the 1.9.46. 737 foul sewer manholes were baited, 201 manholes showing pre-bait takes and 105 manhole poison takes, the results being very satisfactory and meeting with the approval of the Ministry of Food. 36 SECTION D—HOUSING The nomal 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. 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, 111 houses were inspected under the powers of the Housing Act, 1936, and all urgent sanitary or housing defects were abated. In addition, one Closing Order, in respect of part of a building unfit for human habitation, has been made and enforced. There is still considerable delay in the carrying out of work called for by notices. 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 over-crowding, 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. BILLETING AND EVACUATION At the end of 1946 there were 8 elderly people remaining in billets in the area. Those were people who were rendered homeless by enemy action and who have not yet been provided with alternative accommodation by the Authorities in whose area they originally lived. It is expected that the billeting arrangements will cease early in 1947, 37 The present work in connection with these billetees is negligible and is carried out in the Department without the need of special staff. I would like, at this juncture, to put on record appreciation of the work done by the staff of the Public Health Department at all stages of billeting, both during the war and afterwards. The Sanitary Inspectors and Clerical Staff at all times gave of their best to make a difficult task run smoothly. 38 SECTION E—INSPECTION AND SUPERVISION OF FOOD SALE OF FOOD AND DRUGS Particulars of samples taken in the Borough of Richmond by Surrey County Council during the year ended December 31st, 1946. Articles Analysed Adulterated or Deteriorated Prosecutions Convictions Formal Informal Total Formal Informal Total Milk 26 26 3 3 Coffee 3 3 Sausages 2 2 1 1 1 1 Sausage Meat 2 2 1 1 1 1 Spirits 2 2 "Multivite" 1 1 Meat Paste 3 3 Vinegar 2 2 1 1 Cod Liver Oil 1 1 Completevite Vitamins 1 1 1 1 " Egg Savouree" 1 1 Malted Food 1 1 1 1 Soup 1 4 5 2 2 Grd. Cinnamon 1 1 Ground Ginger 1 1 Grd. Nutmeg 1 1 Sauce 1 1 "Milkimalt" 1 2 3 1 2 3 "Vecon" 1 1 Totals 32 26 58 6 7 13 2 2 Milk (Special Designations) Order 1936 No. of samples of milk taken for analysis during the year 30 No of samples found to be satisfactory 28 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 Pasteurised licences 1 Supplementary Licences granted 2 39 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 33 30 - Puerperal Pyrexia 1 1 — Pneumonia 15 — 27 Erysipelas 10 3 — Measles 93 4 — Whooping Cough 90 7 — Malaria 4 3 — Dysentery 4 3 — Ophthalmia Neonatorum 2 - - Typhoid 3 3 - Total 255 54 27 PRECAUTIONS AGAINST TYPHUS AND SMALLPOX 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 1946. Month Nature of Typhus Contact Smallpox January — 5 February 5 5 March 1 11 April 3 12 May 3 14 June 4 1 July 1 3 August 1 1 September 1 — 40 October — — November — — December — — Total 19 52 SOUTH MIDDLESEX FEVER HOSPITAL ADMISSIONS CLASSIFIED Disease No. of Patients Admitted from Richmond Malaria 3 Scarlet Fever 30 Diphtheria — Measles 4 Whooping Cough 7 Pneumonia — Other Diseases 8 Total 52 DIPHTHERIA IMMUNISATION CLINIC Total number of attendances 1,560 Number of Children immunised for the first time during the year 1946:— (a) Pre-school children (under 5 years) 507 (b) Between 5 and 15 years 107 Total 614 Grand Total of Children in the Borough who had received immunising treatment by the end of the year:— (a) Under 5 years 1,608 (b) Between 5 and 15 years 3,192 41 Number of Children given boosting doses during 1946:— (a) Under 5 years 70 (b) Between 5 and 15 years 300 At the 31st December the percentages of children who had been immunised were as follows:— 0—5 years 69.9% 5—15 years 86.2% If it is remembered that each year some seven hundred infants are added to the population, and that therefore there is always a number of infants who are not yet old enough for immunisation, it will be seen that the figures are very satisfactory. Recently the importance of small re-inforcing or boosting doses has been emphasised, and an endeavour is being made to give each child three such doses at appropriate intervals during school life. The materials used are, for children under 10 years, Alum Precipted Toxoid (Burroughs Welcome & Co.) and for children over 10, Toxoid Anti-Toxin Floccules. The number of reactions resulting from the use of these materials has been very small. Not a single case of Diphtheria was notified during the year and it seems certain that the credit for this must go to the successful Diphtheria immunization campaign which has been continuously conducted since 1934. verminous conditions SCABIES During the year 1946, 377 new cases of scabies were treated at the Health Centre. This figure included 81 school children. head lice The following figures serve to indicate the position for the year under review:— 42 Children Total number of inspections of children made in the schools by the School Nurses 8,385 Number of individual children found to be unclean at above 308 Number of ditto found to be unclean at School Medical Inspections 22 Proportion of children found unclean at all inspections 3.94% Number successfully cleansed by parent or guardian without requiring exclusion for more than 24 hours 288 Number excluded for longer than 24 hours 20 Number of cases in which legal proceedings were taken (a) Under the Education Act, 1944 Nil (b) Under the School Attendance Byelaws Nil Adults Five Adults were referred to the Health Centre for treatment during the year. TUBERCULOSIS The position in Richmond for the year 1946 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis Fifty-eight cases of respiratory tuberculosis were notified, viz., 32 males and 26 females. The corresponding figure for 1945 was 62. Non-Respiratory Tuberculosis Eleven new cases of non-respiratory tuberculosis were notified during the year, and there were 3 deaths from this cause. Eleven such cases had been notified during 1945. 43 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:— Non- Pulmonary Pulmonary Males 172 23 Females 121 27 Total 293 50 Corresponding figures for 1945 were 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 1946 it was not found necessary to take action under either of the above enactments. 44 TUBERCULOSIS Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 1 ... ... ... ... ... ... ... 1 1 2 1 1 ... ... ... ... 5 ... 2 1 2 ... ... ... ... 15 8 6 1 1 ... ... ... ... 25 8 9 ... 1 1 ... 1 ... 35 4 2 ... 1 1 ... ... .. 45 4 2 ... 1 1 ... ... 1 55 3 3 ... ... 2 1 ... ... 65 and upwards 3 ... ... 1 2 ... ... 1 Totals 32 26 3 8 7 1 1 2 45 AFTER CARE A voluntary After Care Committee acts jointly for the tuberculous patients of both Richmond and Barnes. During the year this Committee had only very little money at its disposal, but in spite of this, most welcome help was given to twenty-seven Richmond residents. In April the Surrey County Council took over the responsibility of payment for milk. In this way a number of patients also benefited by receiving a free milk supply. Towards the end of the year, the Sale of Seals Campaign was very actively carried out with most satisfactory results. This has greatly improved the financial position of the Committee and the number of patients benefiting in 1947 will be greatly increased. The aim of the Committee is to supplement where necessary the Surrey County Council's Treatment Allowances Scheme, to enable patients to carry out the recommended treatment with a minimum of financial worry. Cases are treated confidentially and are given individual consideration. 46 INDEX Page Adoption 14-18 Ambulance Calls, Analysis of 12 Ambulance Facilities 11, 12 Ante-Natal Clinics 13 Area of Borough 5 Bakehouses 23, 24 Biilleting 23, 36, 37 Birth-Rate 5, 7, 8 Births, Analysis of 5 Cancer, deaths from 6 Chief Sanitary Inspector, Report of 22 Chiropody Clinic 13 Clinics, List of 13 D.D.T 32, 33 Death-Rate 6, 7, 8 Deaths, Analysis of 6, 7, 8 Deaths, Maternal 6, 7, 8 Deaths, Neo-Natal . 8, 14 Dental Clinics 13 Diarrhoea & Enteritis (under 2 years) 6, 7 Diphtheria 6, 7, 9, 10, 40, 41 Diphtheria Immunisation 13, 14, 40, 41 Diseases of Animals Acts 34 Disinfection 32 Disinfestation 22, 32, 33 Drains 24, 26 Dysentery 39 Erysipelas 39 Evacuation 36, 37 Eye Clinics 13 Factories Act 23, 24, 25, 29 Food & Drugs Act 23, 38 Food, Unsound 23, 30, 31 Head-Lice 41, 42 Health of the People 8 Health Services 10-20 Health Visitors 14 Home Help Service 19, 20 Housing 36 Illegitimacy 5, 6, 8, 17, 18 Infant Life Protection 14 Infant Mortality 6, 7 8, 14 Infectious Diseases, Notifiable 22, 39 Inhabited Houses 5 Laboratory Work 10 47 Page Malaria 39 Malformation, Congenital 6, 8 Maternal-Mortality 6, 7 Maternity & Child Welfare Clinics 13 Maternity Homes 16, 18 Measles 6, 7, 39, 40 Milk 2, 3, 38, 43 Milk (Special Designations) Order, 1936 38 Notices, Sanitary 27, 28 Nuisances See " Sanitary Nursing Homes Overcrowding 22, 36 Paratyphoid Fever Petroleum Acts 23, 32 Pneumonia 6, 39, 40) Population 5 Premature Infants 6, 16 Puerperal Pyrexia 39 Rateable Value Rats and Mice Destruction Act, 1919 23, 28, 30, 34, 35 Richmond Royal Hospital 10, 13 Sanitary Inspection & Complaints 22, 23, 25-28 Scabies 13, 14, 41 Scarlet Fever 7, 39, 40 Sewers 34 Sewers, Baiting of 34 Shops Acts 23, 25 Smallpox 7, 39,40 Social Welfare Worker 17, 18 South Middlesex Fever Hospital 40 Staff, List of 3, 4 Statistics 5 Stillbirths 5, 7, 8, 14 Streptococcal Infections 10 Treatment Centres & Clinics 13 Tuberculosis 10, 13, 14, 32, 42-46 Typhoid Feve 10 Typhus Fever 39, 40 Verminous Conditions 22, 27, 32, 41, 42 Wartime Nurseries 19 Water Closets & Urinals 25, 26, 29 Water Supply 21, 23, 25 Whooping-Cough 5, 6, 7, 39, 40 •• , , as ' : .