AC 4413(1) RICHMOND BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1947. DEVONPORT PRESS LTD., 8 DEVONPORT ROAD, W.12. BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1947. CONTENTS Page Introductory Letter List of Staff 3-4 SECTION A—STATISTICS AND SOCIAL CONDITIONS Social Conditions 5 Births 5 Deaths 6 Comparative Statistics Table 7 The Health of the Borough 8-9 SECTION B—GENERAL PROVISION OF HEALTH SERVICES Laboratory Work 10 Ambulance Facilities11-12 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 30 Food Inspection 32 Petroleum Acts 32 Disinfection and Disinfestation 33 Destruction of Insect Pests and the use of D.D.T 33 Diseases of Animals Acts 34 Rats and Mice Destruction Act 34-35 SECTION D—HOUSING Housing 36 Council's Housing Programme 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 Verminous Conditions—Scabies and Head-lice 42-44 Tuberculosis 42-44 INDEX 45-46 1 Health Department, Parkshot, Richmond. September, 1948 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 1947 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 been once again curtailed by the omission of certain tables of statistics. As in previous years these will be retained in the Public Health Department. Examination of the section on Vital Statistics shows that the health of the residents of Richmond has been good during the year under review. The Birth rate is the highest ever recorded and the low Infant Mortality Rate is most satisfactory. The new Health Centre at Ham was opened in July and has proved to be a great asset to your Maternity and Child Welfare Services. Not only are the residents of Ham given a better service but the Centre has also reduced congestion at the Health Centre, Windham Road. I am indebted to Mr. B. Aisthorpe, Chief Sanitary Inspector for the report on the Sanitary Circumstances of the area and to Mr. L. Martindale, Housing Manager, for the figures relating to the housing programme. Mr. Aisthorpe's report gives some idea of the scope of the work which was carried out by the Department even though for seven months of the year there was a vacancy for an Inspector caused by the retirement of Mr. E. S. Power. I must take this opportunity of expressing my gratitude to every member of the staff for their loyal and efficient support. Miss 2 J. Black acted most ably as Chief Clerk during the first quarter of the year when the vacancy was filled by the appointment of Mr. B. Lamacraft. 1 am grateful to the Council for agreeing to a staff establishment which has proved adequate, and for the support I have received from all Committees with which I have been concerned. I am, Mr. Mayor, 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. Medical Officers to Ante-Natal and Post-Natal Clinics: PHYLLIS M. REX, M.R.C.S., L.R.C.P. (Part time). EVELYN FISHER, B.A., M.D., D.P.H., (Part time). Medical Officers to Child Welfare Clinics and Day Nurseries: MARJORIE F. CARTLEDGE, M.R.C.S., L.R.C.P. (Part time). EVELYN FISHER, B.A., M.D., D.P.H., (Part time). Ophthalmic Surgeon to Maternity and Child Welfare Dept.: C. J. L. BLAIR, M.R.C.S., L.R.C.P. Denial Surgeon to Maternity and Child Welfare Department: ROBERT FULLERTON FERGUSON, H.D.D., L.D.S., R.F.P.S. Chief Sanitary Inspector: BERNARD AISTHORPE, M.R.San.I. Senior Additional Sanitary Inspector: THOMAS S. ELLIS, Cert. S.I.B., M.S.I.A. Additional Sanitary Inspectors: ERNEST S. POWER, Cert. S.I.B., M.S.I.A. (Resigned July, 1947.) CHARLES S. SMEATON, M.R.San.I. 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. GALEIGAN, S.R.N., R.F.N., S.C.M., H.V.'s Cert. MISS S. M. GABBUTT, S.R.N., S.C.M., H.V.'s Cert. MISS D. O. ASHCROFT, S.R.N., S.C.M., H.V.'s Cert. (From January, 1947). Social Welfare Worker: MISS H. OLIVER, Soc.Sc.D. (University of London). Clinic Assistant: MRS. E. ELVIDGE. (Resigned September, 1947.) Dental Attendant: MISS J. AYLAND (Part time). Chief Clerk: B. LAMACRAFT. (From 14th April, 1947.) Clerks: MISS J. BLACK (Senior Clerk—Acting Chief Clerk to 14th April, 1947). MTSS I. E. WORLAND. MRS. F. G. SMITH MRS. M. WRIGHT MISS J. HAWKINS (resigned 30th November, 1947). MISS H. BLACK (from 19th May, 1947). MISS J. WELCH (from 1st December, 1947). 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 1947) 41,100 Number of inhabited houses (estimated) 10,432 Rateable value £604,453 Sum represented by a Penny Rate £2,377 births Birth-Rate per 1,000 of estimated resident population 20.8 Total number of births (live and still) 852 Analysis:— M. F. Total Live Births: Legitimate Illegitimate 427 25 355 29 782 54 Still Births: Legitimate Illegitimate 7 2 6 1 13 3 Still-Birth Rate per 1,000 total births 18.7 Environment of Births:— Proportion taking place in the Borough 48% Proportion taking place outside the Borough 52% Proportion taking place in Institutions 78% Proportion taking place in dwelling houses 22% Proportion notified by midwives alone 96% Proportion notified by doctors or parents 4% deaths Death-Rate per 1,000 of estimated resident population 13.9 Total number of deaths from all causes 574 6 Analysis:— M. F. Total All Causes Cancer Diphtheria Measles Whooping Cough Diarrhoea (under two years) 276 38 – – 1 3 298 56 – – – – 574 94 – – 1 3 Maternal-Mortality Rate per 1,000 total births 2.3 Total number of maternal deaths 2 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 29.9 Rate for legitimate infants per 1,000 legitimate live births 29.4 Rate for illegitimate infants per 1,000 illegitimate live births 37 Total number of infant deaths in the Borough 25 Analysis:— M. F. Total Legitimate Illegitimate 12 1 11 1 23 2 Environment of Infant Deaths:— Number occurring in the Borough Number occurring outside the Borough Number occurring in Institutions Number occurring in dwelling houses 9 16 18 7 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 ... 1 ... ... 1 ... ... 1 ... 2 2. Congenital Debility and Malformation including Premature Birth 10 1 1 1 13 1 ... 1 ... 15 Enteritis ... ... ... ... ... 3 ... 1 ... 4 4. Other defined diseases ... ... ... ... ... ... 1 ... ... 1 5. Asphyxia (Accidental Death) ... ... ... ... ... 1 ... ... ... 1 6. Accidental Death ... ... ... ... ... ... 2 ... ... 2 10 2 1 1 14 5 3 3 ... 25 7 COMPARATIVE STATISTICS—1947 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 20.5§ 23.3 22.2 22.7 20.3 Still 0.50S 0.62 0.54 0.49 0.5 Deaths— Ail Causes 12.0§ 13.0 11.9 12.8 13.9 Typhoid and Paratyphoid Fever 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 – Whooping Cough 0.02 0.03 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 — Influenza 0.09 0.09 0.08 0.08 0.15 Smallpox 0.00 0.00 0.00 — — Measles 0.01 0.02 0.02 0.01 Rates per 1,000 Live Births Deaths under 1 year of age 41† 47 36 37 29.9 Deaths from Diarrhœa and Enteritis under 2 years of age 5.8 8.0 3.7 4.8 3.5 Rates per 1,000 Civilian Population Notifications— Typhoid Fever 0.01 0.01 000 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebro-Spinal Fever 0.05 0.06 0.05 0.05 0.01 Scarlet Fever 1.37 1.54 1.37 1.31 0.58 Whooping Cough 2.22 2.41 2.02 2.89 2.31 Diphtheria 0.13 0.15 0.14 0.14 0.00 Erysipelas 0.19 0.21 0.18 0.22 0.19 Smallpox 0.00 0.00 0.01 0.00 0.00 Measles 9.41 9.13 9.58 5.29 10.19 Pneumonia 0.79 0.89 0.68 0.64 0.12 Rates per 1,000 Total Births (Live and Still) Puerperal Fever 7.16 8.99 6.27 1.21 0.00 Puerperal Pyrexia 6.94+t 7.0 Maternal Mortality— Abortion with Sepsis 0.10 not available Abortion without Sepsis 0.06 1.17 Puerperal Infections 0.16 Other maternal causes 0.85 1.17 Signifies that there were no deaths. 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 1947 was 41,100. 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 1947 when 852 births were recorded compared with 574 deaths. Births There were 852 births during the year (461 males and 391 females) which is 80 more than were recorded in 1946. This gives a birth-rate of 20.3 compared with 19.8 in 1946. The number of illegitimate births was 57 compared with 54 in the previous year. 78% of confinements took place in hospitals and nursing homes and only 22% in dwelling houses. Deaths The total number of deaths occurring amongst residents was 574 (276 males and 298 females). This gives a death rate of 13.9 per thousand of the population compared with 12.0 for England and Wales. These are crude Death Rates which are not strictly comparable since the ages of populations in different areas vary. If corrected and made comparable it would be more favourable in Richmond. The Infant Mortality Rate (Deaths under one year of age) has fallen from 37 to 29 per thousand live births. Each of the 25 Infant Deaths was carefully investigated with a view to ascertaining what action could be taken to reduce the number of such cases in the future. 9 From the table it will he seen that the majority of deaths under 4 weeks of age fell into the sub-heading "Congenital Debility and Malformation." The prevention of death in such cases is most difficult. Sixteen of the deaths took place in hospital, two in Nursing Homes and seven in dwelling houses. Two of the latter were 6 months old twins who died as a result of burns received when their home was destroyed by fire. Unfortunately there were two maternal deaths during the year. One of these patients suffered from heart disease. She attended the Antenatal clinic frequently and was under close supervision by specialists. She was admitted to hospital but died from heart failure after the confinement. The second patient died from the effects of self-induced abortion. Infectious Diseases In almost every case the incidence of infectious diseases in Richmond compares very favourably with other towns and the country as a whole. There was not a single case of diphtheria. The country-wide epidemic of poliomyelitis spread to Richmond rather later than to other areas. There was a total of 10 confirmed cases (6 males and 4 females). The first case occurred early in September. Eight of the cases were admitted to the South Middlesex and Richmond Isolation Hospital and two remained at home under private doctors. Five of the patients made rapid recoveries soon after the initial acute phase had subsided. Two cases were transferred to Orthopaedic Hospitals and made good recoveries after some weeks. The remainder were left with some degree of muscular weakness but were able to be treated at home, where they made complete recoveries under medical supervision. 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 Nil 108 108 Tuberculosis Sputa 4 23 27 Hemolytic Streptococcus Swabs from Throat and Nose 11 27 38 Other Diseases ... 4 45 49 Total 19 203 222 This arrangement is very convenient for the local general practitioners. In addition the following aboratory facilities are available to the Public Health Department— Central Public Health Laboratory, Colindale Avenue, N.W.9 For advice, special immunising agents and special investigations. Ministry of Health, Public Health Laboratory, Epsom For examination of samples of milk, ice cream and water and for advice and field investigations in case of epidemics. The Counties Public Health Laboratories, 66 Victoria Street, S.W.1 For examination of water samples and advice on the control of a water supply. 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. Ten whole time driver-attendants are employed to operate the service; this number includes a Station Officer and three 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 58 occasions. 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 1947 2,445 calls Analysis of calls obeyed during the year 1947 1947 Accident cases Removal cases Maternity cases Others Total 1st qr. 111 377 91 – 579 2nd qr. 135 407 81 – 623 3rd qr. 185 428 67 — 680 4th qr. 124 371 68 – 563 TOTAL 555 1,583 307 — 2,445 Division of Calls into time periods Number of calls received between 6 a.m. and 6 p.m. 1,931 Number of calls received beween 6 p.m. and midnight 358 Number of calls received between midnight and 6 a.m. 156 Total calls for the year 1947 2,445 Miscellaneous Figures Total distance (in miles) covered by the ambulance vehicles in 1947 13,164 Average mileage per call 51/3 Number of calls referred to other Authorities 113 Number of calls answered for other Authorities 58 Greatest number of calls answered in any one day 17 Average time lag in reaching scene of accident 4½ mins. Number of occasions upon which both ambulances were out at the same time 22 Number of complete days when one vehicle was out of commission for repairs 250 Number of accidents to ambulance vehicles Number of instances of mechanical breakdown 4 Number of false alarms and malicious calls 47 13 TREATMENT CENTRES AND CLINICS—1947 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 Twice weekly M. & C.W. C'tte 102 511 2,098 1,631 Ante-Natal Clinic. Back Lane, Ham (opening date Sept. 1947) Two sessions per month M. & C.W. C'tte 8 18 87 74 Ante-Natal Clinic. Windham Road (for Grove Rd.) Alternate weeks County Council 27 214 373 373 M. & C.W. Clinic. Windham Road For infants, twice weekly M. & C.W. C'tte 100 580 5,659 2,087 M. & C.W. Clinic. Windham Road For toddlers, twice monthly M. & C.W. C'tte 23 190 466 297 M. & C.W. Clinic. Back Lane, Ham (transferred from Trefoil House in July, 1947 For infants and toddlers, twice weekly M. & C.W. C'tte 75 237 2,341 975 M. & C.W. Clinic. St. Winifride's Hall, Kew For infants and toddlers, once weekly M. & C.W. C'tte 51 207 2,150 677 M. & C.W. Consultations. Royal Hospital, Richmond Once weekly M. & C.W. C'tte 25 M. & C.W. Eye Clinic. Windham Road By appointment M. & C.W. C'tte 13 20 M. & C.W. Dental Clinic. Windham Road Two sessions per week M. & C.W. C'ttee 91 261 793 Diphtheria Windham Road, Once weekly M. & C.W. C'ttee 47 1,675 2,227 tion Clinic. Back Lane, Ham As required M. & C.W. C'tte 5 132 204 Scabies Treatment. Windham Road Daily, as required Health C'tte 66 87 14 HEALTH VISITORS In addition to their indoor duties in connection with the various clinics, during the year 1947 the Health Visitors paid a total of 5.303 visits, as under:— First Visits Revisits Routine visits paid to:- Expectant mothers 442 273 Children under 1 year 649 1,397 Children between 1 and 5 years ... 2,309 Special visits in connection with:— Adoption Cases 39 Home Helps 58 Infant Deaths 7 Infant Life Protection ... 83 Neonatal Deaths 1 Scabies 1 Special enquiries 11 Stillbirths 11 Tuberculosis 1 Whooping Cough 1 Chicken Pox 1 Post-natal 1 Aged Persons 15 Home conditions 3 Totals 1,241 4,062 15 The weekly Infant Welfare Session held at St. Winifred's Hall, Kew was very popular and served a useful purpose in shortening the journey for numerous mothers. The premises are by no means satisfactory but alternative accommodation is not available. The Creche which was opened for one afternoon each week at the Health Centre, Windham Road, was not well attended and was discontinued in September. The "Sitters-In" Service has continued under a voluntary Committee with Mrs. M. A. Toms, of 4 Lawn Crescent, Kew Gardens, as Chairman. There is an adequate panel of Sitters-In but their services are not fully used. 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 14 12 1 — — 13 (b) In Nursing Homes 5 5 – — — 5 (c) In Hospitals 7 9 – — — 7 Richmond Children born outside the Borough: (a) In Nursing Homes 9 7 1 1 1 6 (b) In Hospitals 19 . 21 2 2 — 15 Children born in Richmond, mother normally residing elsewhere: (a) In Nursing Homes 4 — – — – 4 (b) In Hospitals 2 — – — – 2 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 44 (b) Through Almoners, Probation Officers, Clergy, personal applications, etc. 16 60 Number of cases visited for the first time during the year 54 Number of home visits and re-visits to all known cases 453 Number of visits to employers, relatives, institutions, hostels and welfare societies in connection with cases 299 Total 806. Arising out of these visits, the following arrangements were concluded:— On Behalf of Mothers Ante- and post-natal home 5 cases Post-natal home 3 „ Short-stay shelter 15 „ Special homes for confinement 8 ,, Residential employment found 14 „ Non-residential employment found 10 ,, Affiliation Order obtained through Court procedure 3 „ Affiliation Order arranged voluntarily 6 „ 18 On Behalf of Children Children placed apart from their mothers:— By adoption 10 cases In Church homes 2 „ With foster-mothers 2 „ As recorded in the section on Vital Statistics the number of illegitimate infants born to women resident in Richmond was 57 compared with 54 in 1946. When the increased population and birth rate are taken into account it is seen that the situation is much as it was in 1946. Miss Oliver has had an active year and has been able to carry out a great deal of most helpful work. Richmond Borough Council helped numerous girls during the year by paying the cost of their maintenance in residential homes and hostels. NURSING HOMES The Surrey County Council have registered eight Nursing Hemes. 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 DAY 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 1946 and 1947 were as follows: 1946 1947 Parkshot Nursery 10,286 11.443 Grey Court Nursery 11,707 10,878 The high attendance at Parkshot Day Nursery is most satisfactory and is a reflection on the low incidence of infectious disease amongst the children. Whooping Cough was largely responsible for reducing attendances at Grey Court and, in addition, at the end of the year, vacancies were not filled as the Nursery was shortly to be taken over as a Nursery School. HOME HELP SERVICE 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. The service is organised from the Public Health Department and detailed administration is in the hands of the Senior Clerk. A staff of nine or ten Home Helps was maintained throughout the year, with the result that it was possible to give a more complete and satisfactory service to those who required it. The following are details of the work carried out by Home Helps during 1947:— 20 Number of households attended:— (a) M. and C.W. cases 93 (b) Domestic cases 69 Number of hours engaged in work:— (a) M. and C.W. cases 5,645 (b) Domestic cases 8,468 Altogether an average of 60.7 hours were spent on each M. and C.W. case, and an average of 125.3 hours per Domestic case. After allowing for charges waived in necessitous cases, sick absences on the part of the Home Helps, holidays and time lost due to travelling, the balance sheet at the end of the year was as under:— £ s. d. Wages paid 1367 1 6 Payments received or due 702 9 6 Net cost 664 12 0 Approximate cost to ratepayers 200 0 0 The Home Help Service is now firmly established in Richmond and is a success. So many very deserving cases have been helped that it is difficult to understand how these patients fared when no such facilities existed. It is now easier to obtain suitable and reliable Home Helps and it is intended to increase the staff gradually as the need arises. 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 in 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, sixty-two 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 Queen 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. Chemical examination was carried out on 252 samples and 1080 samples were examined bacteriologically. 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 allotments, Kew Gardens and 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 976,651 galls. Metropolitan Water Board 532,688 galls. Raw River Water 229,271 galls. 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 1947 Houses visited and particulars recorded ("Housing Act) 7 Houses visited (Public Health Acts) 2108 Revisits to houses and other premises 2360 Visits paid in connection with:— Overcrowding 30 Vermin 81 Disinfection 3 Enquiries into Infectious Diseases 64 Corporation Dwellings 32 23 Routine inspections in connection with:— Factories (mechanical) 33 Factories (non-mechanical) 42 Work-places 2 Bakehouses 27 Butchers' shops 28 Fishmongers and Poulterers 16 Other registered food stores 3 Cowsheds 1 Dairies and Milk Shops 32 Ice-cream premises 160 Restaurants and Tea Shops 68 Fried Fish Shops 2 Stables 10 Piggeries 6 Public Sanitary Conveniences 12 Shops Acts 115 Theatres and Cinemas 4 Greengrocers and Fruiterers 2 Tents, Vans, and Sheds 2 Rats and Mice 455 Smoke Observations 9 Schools—Elementary and Secondary 46 „ —Private 1 Water Supply 30 Drainage 195 Employment Agencies 1 Massage Establishments 1 Milk Sampling (Pasteurised) 23 Food and Drugs Sampling 5 Unsound Food 137 Petroleum Acts 126 Rent Restrictions Acts 57 Interviews 593 Miscellaneous Visits 794 7,723 24 Drains and Sewerage Systems Tested Hydraulic tests 62 Smoke tests 52 Chemical tests 6 Examinations 10 Factories Act, 1937 At the end of the year there were 191 factories on the register (117 mechanical and 74 non-mechanical), carrying on the following trades: Mechanical Nonmechanical Artificial wreaths, etc. 1 – Bakeries 12 2 Boat Repairs 3 1 Boot-making 8 4 Box-making 1 1 Building 5 9 Carpentry 1 4 Carpet-repairing – 1 Clothing 4 – Dressmaking 3 8 Electrical Instruments 7 – Engineering 8 – Furniture & Upholstery 4 6 Furriers – 3 Gas Storage 1 – Glue-making 1 – Jewellery Repairs 1 1 Laundering & Cleaning 4 1 Millinery – 2 Milk Pasteurising 1 – Motor Vehicle repairing 17 3 Printing 5 1 Sausage-making 6 – Saw Mills 2 – Surgical Instruments 2 – Tailoring 1 15 Undertaking 1 –. 25 Welding 2 – Wheelwright & Coach building 3 – Wig-making – 1 Wireless Repairs 1 1 Miscellaneous Trades 12 10 117 74 Seventy-five visits were made to the above premises during the year and as a result of action taken by the department, the following defective conditions have been remedied:— Ineffective drainage of floors 3 Want of cleanliness 8 Unsuitable sanitary conveniences Other nuisances and defects remedied 7 10 28 Shops Acts, 1934 Shops on the Register781 Visits made 115 SANITARY DEFECTS REPORTED Water Supply: Defective or foul storage tanks 26 Defective fittings (notified to Water Engineer) 12 W.C.s and Urinals: Defective pans 66 Foul pans 9 Defective woodwork around pans 11 Defective seats 5 Absence of water-supply 15 26 Defective flushing apparatus 21 Defective flush-pipe connections 15 Defective walls, floors or roofs 15 Defective doors and windows 6 Want of light and ventilation 7 Insufficient closet accommodation 8 Defective walls and channels of urinals 2 Insanitary urinals cleansed 11 Defective brickwork (repaired or re-built) 7 Soil-pipes: Defective or insufficient soil-pipes and vent- shafts 9 Want of, or defective ventilation-shafts 9 Rain-water pipe acting as ventilation shafts 19 Defective Fresh-air inlets 16 Drains: Defective drains 13 Defective sewers 24 Want of additional house-drains 2 Choked or foul drains or gullies 26 Defective or insufficient gullies 10 Defective grating, dishing or curbing 5 Absence of, or defective, interceptor Defective manholes 5 Defective manhole covers and frames 1 Sub-soil drains required 1 Defective drainage of Stables 2 Dustbins: Defective receptacles 75 Paving: Defective paving of yards, forecourts, etc 1 27 Sinks: Defective or insanitary sink 22 Want of sink 5 Insanitary wall-surface around sink 6 Waste-pipes: Insanitary W.P.'s or shafts 6 Defective waste-pipes 37 Untrapped or unventilated waste-pipes 5 Waste-pipes directly connected to drain 2 Dampness: Defective roofs 185 Defective gutters or spouting 114 Want of damp-proof course 2 Defective external brickwork 28 Defective pointing of door and window reveals 15 Damp and insanitary site under floor 3 Floor cavity unventilated 1 Defective wall or floor ventilators 3 General Defects: Verminous rooms 126 Verminous bedding 226 Dirty floors, woodwork, etc. 10 Accumulations of offensive matter 20 Nuisances from fowls, or other animals 2 Defective plastering (No. of rooms) 344 Dirty walls and ceilings (No. of rooms) 174 Dirty walls and ceilings of staircases and passages 24 Defective floors 67 Defective doors and windows 56 Defective doors and window fastenings 35 Overcrowding 5 Defective furnace or brickwork of copper 5 Permitted No. not in Rent Book 2 28 Defective sash cords 65 Defective window sills 38 Windows not made to open 10 Inadequate lighting and ventilation Defective firegrates and kitchen ranges 51 Defective chimney-pots, etc. 19 Smoke nuisances 8 Defective coppers 2 Defective coal cupboards 2 Defective staircases 2 Premises infested with rats and mice 84 Contraventions of Bye laws Temporary Outbuildings obstructing light & air 1 Miscellaneous defects 261 2,538 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES Informal Action Preliminary intimations 519 Interviews 593 Statutory Action Act and Section Notices Authorised Notices Served Public Health Act 1936 Section 24 (Drainage) 3 3 Section 39 (Drainage) 32 32 Section 44 (Provision of Closets) 2 1 Section 45 (Defective Closets) 14 14 Section 75 (Dustbins) 28 28 Section 92/3 (Nuisances) 111 107 Housing Act 1936 Section 9 (Insanitary Dwellings) 32 29 29 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. Premises Act and Section Cost of Work Carried out in default 19/21 Church Road Housing Act, 1936 Section 9. £32 12s. 0d. 31 Evelyn Road Public Health Act, 1936 Section 45. £4 0s. 0d. 6/11a Dancer Road Public Health Act, 1936 Sections 39 and 45. £3 0s. 0d. PROSECUTIONS It was found necessary to take legal proceedings in two cases of contraventions of Acts or Regulations. Both cases were heard at the Petty Sessions Court, Paradise Road and the details are as follows:— Offence Date Case heard Result of hearing Amount of Fine 1. Sale of 11 pineapples which were unfit for human consumption in contravention of Sections 9 & 10 of the Food & Drugs Act, 1938. 10.3.47 Conviction £10 Fine £1 1s. 0d. Costs 2. Storage of 290 gals, of rubber solution (Petroleum Mixture) in contravention of the Petroleum (Consolidation) Act, 1928, i.e., stored on premises without licence and not in an approved Pet- 20.11.47 Conviction £10 Fine £21 0s. 0d. Costs 30 COMPLAINTS The number of complaints received by the Department from the 1st January to 31st December, 1947 was 1.087. The complaints received during the year have been classified and are set out below:— Defective sinks 5 Defective drains 66 Leaking pipes 45 Defective windows 10 Defective walls 15 Defective storage tanks 13 Defective skylights 1 Defective floorboards 4 Unsatisfactory living conditions 16 Offensive manholes 10 Offensive sewers 6 Lack of water 23 Defective W.C.s 105 Defective roofs and gutters 46 Dampness 89 Dry rot 19 Defective ceiling 48 Defective chimneys 9 Defective fences 7 Defective stoves 16 Defective sash cords 3 Defective stairs and steps 3 Accumulations of rubbish 18 Defective dustbins 46 Unsound food 68 Nuisance from rats 169 Nuisance from pigeons 4 Nuisance from smoke 5 Nuisance from vermin, ants, etc. 77 General defects 124 Overcrowding 17 1,087 31 ICE CREAM Ice Cream premises were kept under regular supervision during the year, 160 visits being paid to manufacturers and retailers in the Borough. 103 samples of Ice Cream were submitted to the Bacteriologist for examination and of this number 54 samples fell within Grades I and II and were considered satisfactory, and 49 fell within Grades III and IV and were unsatisfactory. In all cases of unsatisfactory samples careful checks were made of the premises concerned and help and advice were given. All manufacturers and retailers were found to be very co-operative in their efforts to improve conditions, and in most cases the result was satisfactory. The Ice Cream (Heat Treatment) Regulations, 1947 came into force on the 1st May, 1947, its main objects being to fix the temperatures at which Ice Cream should be pasteurized, cooled and stored and to provide for the protection of Ice Cream at all times during manufacture, distribution and storage. Retailers and Manufacturers have been visited and the provisions of the Regulations have been fully explained. 32 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:— Commodity Amount Condemned Reason for Condemnation Cwt. lbs. ozs. Bacon 20. 0 Decomposed. Baked Beans 77. 7 Tins blown or pierced. Baking Powder 12 Moisture spoiled. Butter 2. 0 Rancid. Biscuits 37. 0 Mouldy. Cereals 2. 52. 8 Unsound, weevil infested. Cheese 1. 31. 6 Decomposed. Chocolate Trifles 11. 4 Mouldy. Chickens, etc. 8. 34. 4 Decomposed. Cocoa 1. 0 Mouldy. Dried Egg 2. 15 Out of Condition. Fish (Tins) 3. 7. 13½ Tins blown or pierced. do. (Wet) 23. 108. 0 Decomposed. Flour 35. 0 Mouldy. Fruit 5. 57. 5 Decomposed. Jam, etc. 3. 91. 11 Tins blown or pierced. Meat (Tinned) 2. 80. 5½ Tins blown or pierced. Meat 2. 48. 14 Decomposed. Margarine 1. 0 Rancid. Macaroni 11. 8 Weevil infested. Milk 20. 16. 8 Tins blown or pierced. Paste (Fish & Meat) 1. 0½ Decomposed. Peanuts 100. 0 Weevil infested. Pickles 31. 1½ Fermented. Pheasants 3. 14½ Decomposed. Puddings 35. 8 Mouldy. Rabbits 55. 5 Decomposed. Sausages 71. 6 Out of Condition. Soup 77. 9 Tins blown or pierced. Spaghetti 6. 8 Unsound. Sugar 1. 8 Moisture spoiled. Tea 1. 4 Moisture spoiled. Vegetables 7. 2. 24 Tins blown or pierced. 33 PETROLEUM ACTS 1928 Visits made 126 Licences for which applications for renewal were made during the year:— (a) Petroleum Spirit 51 (b) Carbide of Calcium 2 Licences transferred during the year 1 New licences issued during the year 5 Premises under Government control and not subject to licence by the Local Authority 2 Licences refused by Local Authority 2 DISINFECTION OF PREMISES Reason Houses Rooms Bedding Infectious Fevers 38 41 383 Tuberculosis 20 30 144 Vermin 19 23 150 Other Diseases 75 126 226 The total costs recovered from the disinfection and disinfestation of rooms during the year amount to £41 7s. 9d. DESTRUCTION OF INSECT PESTS IN THE HOME. Bugs: During the year 75 houses, involving 126 rooms, were treated by the Department for the destruction of bed bugs. The treatment consisted of spraying the walls, furniture and bedsteads with a 5% solution of D.D.T. in kerosene. Respraying, particularly after redecoration of the rooms is effective in preventing a recurrence. Cockroaches: 5% and 10% D.D.T. Powder has had a marked effect in eradicating these pests from properties and in addition the product "Gammaxane" has been added to the Department's list of lethal powders and is giving even better results than D.D.T. Flies: In August all pig bins, together with the ground and wall surfaces in their immediate vicinity were sprayed with 5% D.D.T. in kerosene. It was hoped that flies attracted by the pig food would be destroyed in this way. The results appear to be very satisfactory and it is now proposed to make this a regular feature of the summer programme until such time as the necessity for the pig bin ceases. 34 DISEASES OF ANIMALS ACTS Foot & Mouth Disease During the year four outbreaks of Foot & 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:— 17.2.47 Ashford (Middlesex) 19.2.47 Maidenhead 25.2.47 Romford 15.3.47 Ewell During the periods of restriction of movement, 1 Occupational and 4 Movement licences were issued or countersigned to enable stockholders to move stock for essential purposes (i.e., immediate slaughter or breeding purposes). Fowl Pest Changes took place in the Fowl Pest legislation during the year and a new order known as the Fowl Pest (Amendment) Order, 1947 was issued on the 15th April, 1947. In effect this order does not now require poultry keepers to send the carcases of suspected poultry to the Ministry of Agriculture at Weybridge but provides for immediate notification to the police who in turn notify the Divisional Inspector of the Ministry of Agriculture. The Veterinary Inspectors of the Ministry of Agriculture deal with the outbreak, including the declaration of infected premises and subsequent disinfection. Two cases were notified by the Divisional Inspector as occurring in the Richmond District on the 28th October, 1947, and 18th November, 1947. RATS AND MICE (DESTRUCTION) ACT 1919 AND MINISTRY OF FOOD INFESTATION ORDER 1943 During the year 169 complaints were received from occupiers of dwelling houses or business premises of suspected rat infestation of their premises. To investigate these complaints 455 visits were made to various properties. 35 Infestations were eventually isolated and dealt with at 84 premises. Destruction of Rats in Sewers, 1947 Operations were continued in 1947 in investigating and treating all sewers for the destruction of rats. Baiting of sewers for this purpose took place as follows:— 3.3.47 to 23.3.47 430 manholes throughout the whole area of the Borough were prebaited with sausage rusk for two days and poison bait consisting of Zinc phosphide mixed with sausage rusk was applied on the 3rd day. Out of 430 manholes so treated 89 only gave a positive result. 15.12.47 to 22.12.47 166 manholes throughout the whole borough were treated as in March, and of this number 79 manholes only gave a positive result. The results obtained on both these poisoning campaigns were considered to be very satisfactory- Treatment is repeated at regular intervals otherwise the sewers would soon be heavily infested. Major Rat Infestation One major rat infestation on private property was dealt with in April, 1947. The infestation occurred in open land and treatment consisted of prebaiting and poisoning on similar lines to the system used in sewers. The first treatment was the baiting of 400 rat holes and at 350 points poison bait was taken. A second treatment of the same number of points showed a reduction in takes to 10, and final treatment and test baiting produced a clear result. Smoke Abatement Richmond being a residential district contains no very large works or factories. The smaller factories give little trouble by smoke nuisance. Five complaints of a minor character were received during the year and all were overcome by inspection of the boiler plant, advice to stokers and interviews with managers. 36 SECTION D—HOUSING The normal routine house to house inspection of workingclass dwellings is still very much curtailed, principally by reason of the shortage of building materials and post-war difficulties. The effect of this is seen in the steady deterioration of the dwellings in the Borough. Overcrowding throughout the Borough is heavy. In 1947 five new cases of overcrowding, according to the standard of the Housing Act, 1936, were added to the Department's list. Two cases were abated by rehousing the families in new houses provided by the Borough at Ham. A basement flat was found to be in such a state of disrepair as to be unfit for human habitation. The owner gave an undertaking not to relet the flat for habitation and the family were re-housed at Ham. A garden hut also unfit for human habitation was found to be in occupation for living purposes. The owner gave an undertaking not to relet the hut again for living purposes and the tenants of the hut found other accommodation- Moveable Dwellings A licence is held by an owner of land in the Borough permitting him to allow two caravans to stand on his land. This licence is renewable each year. Satisfactory provision is made for refuse' disposal, sanitary conveniences and water supply and frequent inspections of the site are made each year. Housing Programme Total number of houses erected post-war to 31st Dec., 1947 Temporary) 179 (Permanent) 50 Total number, included in above erected in 1947 Temporary) 54 (Permanent) 50 37 Total number of premises requisitioned up to 31st Dec., 1947 125 (providing 246 family units) Total number families rehoused in 1947 154 Total number families still on waiting list at 31st Dec., 1947 1,990 Between January and August, 1948, a further 124 families have been rehoused in permanent Council Houses and flats* and requisitioned property. * (The flats referred to are 78 in number, are situate at Beaufort Court, Ham, and are all served with central heating and constant domestic hot water). Total waiting list at present date is 2,088. Future Programme Contracts are in hand for a further 126 dwellings, of which 84 should be completed during 1948. Beyond this, further projects encompass a total of 442 dwellings. Present development and future schemes are all sited in the Ham area. 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, 1947. Articles Analysed Adulterated or Irregular Prosecutions Convictions Formal In formal Total Formal In- formal Total Milk 34 10 44 2 2 Cocoa 1 1 2 Coffee 1 1 Cooking Fat 1 1 Dried Milk 1 1 1 1 Drugs 8 8 Fish Paste 1 1 Home Brewed Ale 1 1 Lemonade Powder 1 1 Malt Extract 1 1 Malted Milk 1 1 Salad Oil 1 1 Salami 1 1 Soup 1 1 Soya Milk Cocoa 1 1 2 1 1 2 Spirits 1 1 2 Vinegar 1 1 - Totals 39 31 70 3 2 5 Milk (Special Designations) Order 1936 No. of samples of milk taken for analysis during the year 46 No of samples found to be satisfactory 43 Applications granted for the renewal of licences to sell Special Designated Milk:— Pasteurised Milk 18 Tuberculin Tested Milk 14 Applications granted for the renewal of Pasteurised licences 1 Supplementary Licences granted 4 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 24 22 – Puerperal Pyrexia 6 6 – Pneumonia 5 1 15 Erysipelas 8 4 – Measles 419 15 – Whooping Cough 95 4 1 Malaria 1 1 – Poliomyelitis 10 8 – Cerebro-spinal Meningitis 2 1 1 Total 570 62 17 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 1947. Month Nature of Contact Typhus Smallpox January – – February – 1 March – – April – 2 May – 5 June – 2 July – 4 August – – September – — 40 October – – November – – December – – Total – 14 SOUTH MIDDLESEX FEVER HOSPITAL ADMISSIONS CLASSIFIED Disease No. of Patients Admitted from Richmond Poliomyelitis 8 Malaria 1 Scarlet Fever 22 Diphtheria – Measles 15 Whooping Cough 4 Pneumonia – Other Diseases 34 Total 84 DIPHTHERIA IMMUNISATION CLINIC Total number of attendances 2,431 Number of Children immunised for the first time during the year 1947:— (a) Pre-school children (under 5 years) 636 (b) Between 5 and 15 years 47 Total 683 Grand Total of Children in the Borough who had received immunising treatment by the end of the year:— (a) Under 5 years 1,829 (b) Between 5 and 15 years 3,528 41 Number of Children given boosting doses during 1947:— (a) Under 5 years 135 (b) Between 5 and 15 years 1,023 At the 31st December the percentages of children who had been immunised were as follows:— 0—5 years 59% 5—15 years 88% If it is remembered that during the year eight hundred infants were added to the population and that, therefore, there must always be a number who are not yet old enough for immunisation, it will be seen that the figures are very satisfactory. The policy of giving single small reinforcing doses at appropriate intervals during a child's life has been pursued. Over three times as many such doses were given in 1947 as in 1946. The materials used are, for children under 10 years, Alum Precipitated Toxoid, and, for children over 10, Toxoid AntiFoxin Floccules. The number of reactions resulting from the use of these materials has been very small. Immunization Against Whooping Cough For some time now immunization against Whooping Cough has been available to Richmond residents. As the efficacy of the vaccine still remains in doubt, no effort has been made to encourage parents to have their children protected . In spite of this there has been a growing demand and during the year 93 children received full courses of the injections. The material used is Alum Precipitated Vaccine (Glaxo Laboratories Ltd.), and the course consists of two injections of 0.5 c.c. followed by a final injection of 1.0 c.c. 42 VERMINOUS CONDITIONS SCABIES During the year 1947, 66 new cases of scabies were treated at the Health Centre. This figure includes school children, and compares very favourably with .337 new cases treated in 1946. HEAD LICE The following figures serve to indicate the position for the year under review:— Children Total number of inspections of children made in the schools by the .School Nurses 6,730 Number of individual children found to be unclean at above 239 Proportion of children found unclean at all inspections 3.4% Number successfully cleansed by parent or guardian without requiring exclusion for more than 24 hours 213 Number excluded for longer than 24 hours 26 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 The position in Richmond for the year 1947 may be summarised as follows;— 43 NOTIFICATIONS: Respiratory Tuberculosis Sixty-six cases of respiratory tuberculosis were notified, viz., 38 males and 28 females. The corresponding figure for 1946 was 58. Non-Respiratory Tuberculosis Five new cases of non-respiratory tuberculosis were notified during the year and there were 2 deaths from this cause. Eleven such cases had been notified during 1946. 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 NonPulmonary Males 190 24 Females 133 27 Total 323 51 Corresponding figures for 1946 were 293 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 1947 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 ... ... ... ... ... ... 5 1 ... 2 ... ... ... ... ... 15 8 11 1 ... ... 3 ... ... 25 9 9 ... ... 1 3 ... ... 35 9 2 ... 2 1 1 ... 1 45 4 3 ... ... 4 1 ... ... 55 5 2 ... ... 7 ... ... 1 65 and upwards 1 ... ... ... 1 ... ... ... Totals 38 28 3 2 14 8 ... 2 AFTER CARE The voluntary After Care Committee has continued actively on behalf of the tuberculosis patients of Richmond and Barnes. The financial position of the Committee was much more satisfactory than formerly as a result of a successful Sale of Seals Campaign held in the autumn of 1946. 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. 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 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 33 D.D.T 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 33 Disinfestation 22, 32, 33 Drains 24, 26 Erysipelas 39 Eye Clinics 13 Factories Act 23, 24, 25, 29 Food & Drugs Act 23, 38 Food, Unsound 32 Head-Lice 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 4 Infant Mortality 6, 7 8, 14 Infectious Diseases, Notifiable 22, 39 Inhabited Houses 5 Laboratory Work 10 46 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 38, 43 Milk (Special Designations) Order, 1936 38 Notices, Sanitary 28 Nuisances See "Sanitary" Nursing Homes 18 Overcrowding 22, 36 Paratyphoid Fever 7 Petroleum Acts 23, 33 Pneumonia 6, 39, 40 Population 3 Premature Infants 6, 16 Puerperal Pyrexia 39 Rateable Value 5 Rats and Mice Destruction 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 35 Sewers, Baiting of 35 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, 42, 46 Typhoid Fever 10 Typhus Fever 39, 40 Verminous Conditions 22, 27, 41, 42 Wartime Nurseries 19 Water Closets & Urinals 25, 26, 29 Water Supply 21, 23, 25 Whooping-Cough 5, 6, 7, 39. 40