AC4413(1)RICHMOND RICH 17 LIBRARY BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1948. richmond: j. h. broad and co., ltd., printers, 8, king street. 1 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1948. CONTENTS. Page. Introductory Letter 1 List of Staff 4 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 6 Births 6 Deaths 6 Comparative Statistics Table 8 The Health of the Borough 9 SECTION B—GENERAL PROVISION OF HEALTH SERVICES. Laboratory Work 11 Ambulance Facilities 12 List of Treatment Centres & Clinics 14 Health Visitors 15 Premature Infants 17 Care of Illegitimate Children 18 Nursing Homes 20 Day Nurseries 20 Home and Domestic Help Service 22 SECTION C—SANITARY CIRCUMSTANCES. Water Supply 24 Sanitary Inspection 27 Sanitary Defects 30 Notices Served 32 Complaints Received 34 Food Inspection 35 Petroleum Acts 38 Disinfection and Disinfestation 38 Destruction of Insect Pests and the Use of D.D.T. 38 Diseases of Animals Acts 39 Rats and Mice Destruction Act 39 SECTION D—HOUSING. Housing 41 Council's Housing Programme 43 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Sale of Food and Drugs Acts 44 Milk (Special Designations) Order 1936 45 Ice Cream 45 SECTION F—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Disease 46 Precautions against Typhus and Smallpox 47 Admissions to South Middlesex Fever Hospital 48 Diphtheria Immunisation 48 Verminous Conditions—Scabies and Head-lice 50 Tuberculosis 51 INDEX 53 1 Health Department, Parkshot, Richmond. August, 1949. 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 1948 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. On the 5th July certain services which had long been under the control of the Council were transferred to the Surrey County Council under the National Health Service Act, 1946. These Services included the Ambulance Service, all schemes in connection with the Care of Mothers and Young Children and the Home Help Service. In 1945, under the Education Act, 1944. there was a similar transfer of the School Medical Service. These Services had been built up over a long period of years and were as highly developed as those in any part of the country. Richmond cannot gain anything by the transfer but I have no doubt that the centralized administration will lead to improvements in the more backward areas. All who were concerned with these Services regretted the neccessity for the transfer. Under the County Council's Scheme for Divisional Administration, Richmond and Barnes have become the Northern Division, and the majority of the local services are administered by a Divisional Sub-Committee composed of members of the two local Councils and the Surrey County Council. In this way local interest has been maintained. As Divisional Medical Officer, as well as your Medical Officer of Health, I am in a position to provide most of the figures relating to these Services for the whole of the year. With the concurrence 2 of the County Medical Officer and in order to make this report comparable with those of previous years, this report covers the whole year. Next year they will not be included at all. I beg to draw your attention to the section headed "The Health of the Borough" in which I attempt to bring out some of the more interesting facts in the Vital Statistics and to all paragraphs relating to the transferred Health Services. The control of the purity of the water supply has been discussed in some detail as this is a matter of such great importance to the health of the residents. Examination of the figures relating to the Diphtheria and Whooping Cough Immunization Schemes will show that steady progress has been made. The remarkable decline in the incidence of scabies and infestation with head lice is perhaps one of the most satisfactory features. 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 Council's Housing Programme. Mr. Aisthorpe has reported fully on the "Survey of Food Premises" which has been undertaken. The figures show progress up to the 31st December only. This is a matter which is actively occupying the attention of the Health Committee at present. A great deal has already been done and co-operation between the Health Department and the local tradesmen is excellent. Every effort is to be made to ensure that methods of preparation and sale of foods in the Borough are second to none in regard to structure and sanitation of premises, cleanliness and general hygeine. I think that the Report shows clearly that the health of the residents has been good during the year, that the Department has made every effort to eliminate any unsatisfactory circumstances and that progress in this respect will be made year by year. I would like to thank every member of the staff for their loyalty and hard work during the year. Without their enthusiastic cooperation the high standard required of these public services could never be maintained. Mr. B. Lamacraft was my Chief Clerk throughout the year but, as he has recently been transferred to the Surrey 3 County Council, Miss J. Black has been responsible for the preparation of this Report. To these two, and to all other clerks serving the department, I wish to express my gratitude. Finally I wish to express my appreciation of the support and kindness received from the Chairmen and members of all Committees with which I have been concerned. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 4 LIST OF STAFF. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. Medical Officer to Ante-Natal and Post-Natal Clinics: PHYLLIS M. REX, M.R.C.S., L.R.C.P. (Part-time). 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 Department: C. J. L. BLAIR, M.R.C.S., L.R.C.P. Dental Surgeon to Maternity and Child Welfare Department: ROBERT FULLERTON FERGUSON, H.H.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: CHARLES S. SMEATON, M.R.San.I. DUNCAN A. PATERSON, M.S.I.A., A.R.San.I. Senior Health Visitor: MISS E. D. STEUART, S.R.N., R.F.N., S.C.M., H.V.'s Cert. 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. (Resigned 29th March, 1948). 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. MISS J. L. KIRBY, S.R.N., H.V.'s Cert. (From 26/7/48). Social Welfare Worker: MISS H. OLIVER, Soc.Sc.D. (University of London). Dental Attendant: MISS J. AYLAND (Part-time). 5 Chief Clerk: B. LAMACRAFT. Clerks: MISS J. BLACK (Senior Clerk). MISS I. E. WORLAND. MRS. F. G. SMITH. MRS. M. WRIGHT. MISS H. BLACK. MISS J. WELCH. MISS E. BRUNT (from 12/7/48). Drain Tester and Disinfector: J. DAVIS. 6 SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1931) 37,791 Population (estimated 1948) 41,480 Number of inhabited houses (estimated) 10,710 Rateable value £600,363 Sum represented by a Penny Rate £2,466 BIRTHS. Birth-Rate per 1,000 of estimated resident population 16.7 Total number of births (live and still) 696 Analysis:— M. F. Total. Live Births: Legitimate 357 293 650 Illegitimate 18 20 38 Still Births: Legitimate 3 5 8 Illegitimate — — — Still-Birth Rate per 1,000 total births 11.5 Environment of Births:— Proportion Taking place in the Borough 46% Proportion taking place outside the Borough 54% Proportion taking place in Institutions 77% Proportion taking place in dwelling houses 23% Proportion notified by midwives alone 98% Proportion notified by doctors or parents 2% DEATHS. Death-Rate per 1,000 of estimated resident population 11.3 Total number of deaths from all causes 471 Analysis:— M. F. Total. All causes 226 245 471 Cancer 34 44 78 Diphtheria — — — Measles — — — Whooping Cough — 1 1 Diarrhoea (under two years) 1 — 1 7 Maternal Mortality Rate per 1,000 total births 0.00 Total number of maternal deaths 0 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 26.1 Rate for legitimate infants per 1,000 legitimate live births 27.7 Rate for illegitimate infants per 1,000 illegitimate live births 0.00 Total number of infant deaths in the Borough 18 Analysis:— M. F. Total. Legitimate 9 9 18 Illegitimate — — — Environment of Infant Deaths:— Number occurring in the Borough 6 Number occurring outside the Borough 12 Number occurring in Institutions 14 Number occurring in dwelling houses 4 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 2 ... 3 2. Congenital Debility and Malformation including Premature Birth 9 ... ... ... 9 ... 1 ... ... 10 3. Enteritis ... ... ... ... ... ... ... ... ... ... 4. Other defined diseases ... ... 2 ... ... 2 1 1 ... ... 4 5. Asphyxia (Accidental Death) 1 ... ... ... 1 ... ... ... ... 1 6. Accidental Death ... ... ... ... ... ... ... ... ... ... 10 2 ... ... 12 1 3 2 ... 18 8 COMPARATIVE STATISTICS—1948. 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 Civilan Population. Births— Live Births 17.9 (a) 20.0 19.2 20.1 16.5 Still Births 0.42 (a) 0.52 0.43 0.39 0.2 Deaths— All Causes 10.8 (a) 11.6 10.7 11.6 11.3 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.01 0.02 Diphtheria 0.00 0.00 0.00 0.01 — Tuberculosis 0 51 0.59 0.46 0.63 0.48 Influenza 0.03 0.03 0.04 0.02 — Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 — Pneumonia 0.41 0.38 0.36 0.54 0.8 Notifications (corrected) Tpyhoid Fever 0.01 0.00 0.01 0.00 0.02 Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro spinal Fever 0.03 0.03 0.02 0.03 — Scarlet Fever 1.73 1.90 1.82 1.37 1.03 Whooping Cough 3.42 3.51 3.31 3.13 4.36 Diphtheria 0.08 0 10 0.09 0.10 — Eyriseplas 0.21 0.23 0.21 0.22 0.07 Smallpox — — — — — Measles 9 34 9.75 8.84 9.17 2.8 Pneumonia 0.73 0.84 0.60 0.57 0.14 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.19 Acute Polioencephalitis 0.00 0.00 0.00 0.00 0.02 Bates per 1,000 Live Births. Deaths— All causes under 1 year of age 34(b) 39 32 31 26.1 Enteritis and Diarrhcea under 2 years of age 3.3 4.5 2.1 2.4 1.4 Rates per 1,000 Total (Live and Still) Births. Notifications (corrected)— Puerperal Fever and Pyrexia 6.89 8.90 4.71 7.34(c - Maternal Mortality— Abortion with sepsis 0.11 Abortion without Bepsis 0.06 not available Puerperal Infections 0.13 Other maternal causes 0.73 (a) Rates per 1,000 total population. (b) per 1,000 related births. 9 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 1948 was 41,480. Since 1943 there has been an excess of births over deaths each year until 1948 when 696 births are recorded compared with 471 deaths. Births. There were 696 births during the year (378 males and 318 females) which is 156 less than in 1947 when the record total of 852 was recorded. This gives a birth-rate of 16.7 compared with 20.3 in 1947. The number of illegitimate births fell to 38 compared with 57 in the previous year. 77% of births took place in hospitals and nursing homes and only 23% in dwelling houses. Deaths. The total number of deaths occurring amongst residents was 471 compared with 574 in the previous year. This gives a crude death rate of 11.3 compared with 10.8 for the whole country and 11.6 for the County of London. The Infant Mortality Rate (deaths under one year of age) has fallen from 29.0 to 26.1 per thousand live births. Of the 38 illegitimate births recorded there was not a single death or still birth. Each of the 18 infant deaths was carefully investigated with a view to ascertaining what preventive measures could help to reduce the incidence in future. From the table it will be seen that 10 of the deaths were due to congenital debility or malformation. The prevention of death in such cases is most difficult. It is some satisfaction to note that no infants died from entiritis during the year. Fourteen of the deaths took place in Institutions and four in dwelling houses. 10 Infectious Diseases. From the table it will be seen that deaths from, and the incidence of notifiable infectious disease compares favourably with other towns and the country as a whole. Again I am pleased to report that there was not a single case of diphtheria. The last confirmed case occurred in 1945 and, prior to this, cases and a few deaths were recorded every year. There is no doubt that the immunisation scheme which was commenced in 1934 has saved the community a large amount of sickness and a number of deaths. The epidemic of infantile paralysis which was country wide in 1947, spread to Richmond rather late in that year. In 1948 eight further cases occurred. Early in the year an adult male was seriously affected by the disease and died after a few days in hospital. Apart from this I am glad to report that the other patients made good recoveries. Three girls aged 11 attending one of the local schools developed the disease within a few days of one another. This gave rise to considerable anxiety as it was felt that further cases might well occur. Every precaution was taken with the fullest co-operation of the school staff and there was no further spread of the infection. The three pupils all made complete recoveries. The remaining patients were as follows; girl aged 14; boy aged 18 months; woman aged 21; male aged 24. This illustrates clearly that the disease is by no means confined to the very young and that the name "infantile paralysis'" can be very misleading. Apart from the three school girls no connection was discovered between the cases. In no case was it probable that the infection had been contracted while swimming in the river or public swimming pools. Overcrowded housing conditions did not seem to play any part, and the cases were scattered throughout the Borough. All the patients were in excellent health before they contracted the disease. Prevention is therefore extremely difficult, and all that one can advise is that young people should avoid crowds and excessive fatigue when cases are occurring, and that the importance of general hygiene should be remembered at all times. 11 SECTION B—GENERAL PROVISION OF HEALTH SERVICES. LABORATORY WORK. The standing arrangements with Richmond Royal Hospital continued to operate satisfactorily during the year. The following table gives particulars of the specimens examined:— Disease Suspected. Nature of Specimen. Result. Total. Positive. Negative. Diphtheria Swabs from Throat and Nose Nil 58 58 Tuberculosis Sputa 6 36 42 Haemolytic Streptococcus Swabs from Throat and Nose 13 63 76 Other Diseases 16 50 66 Total 35 207 242 This arrangement is very convenient for the local general practitioners. In addition the following labaratory facilities are available to the Public Health Department:— Central Public Health Laboratory, Colindale Avenue, N.W.9. For advice, special immunising agents and special invest' igations. Ministry of Health, Public Health Laboratory. Epsom. For examination of samples of milk, ice cream and water and for advice and field investigations in cases of epedemics. 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. 12 AMBULANCE FACILITIES. The South Middlesex and Richmond Fever Hospital has ambulances for the conveyance of infectious diseases. At all times calls upon these vehicles have been answered promptly, and the conveyance of patients has been carried out with tact and efficiency on the part of the attendants. The Council's Ambulance Service was transferred to the Surrey County Council on the 5th July under the terms of the National Keatlth Service Act. Since that date the service has been administered centrally by the County Council and figures related to calls answered are not available for the second half of the year. The table of figures given does, however, show that the Ambulances were most actively engaged up to the time of the transfer. Just prior to the 5th July the new Austin Ambulance arrived and was put in commission. In addition the accommodation occupied by the Ambulance Personnel was improved and completely redecorated. These actions by the Council were much appreciated and the County Council was fortunate in taking over an efficient and well equipped Service. 1935 841 calls. 1944 1,480 calls. 1937 913 calls. 1945 1,826 calls. 1939 1,046 calls. 1946 1,930 calls. 1943 1,497 calls. 1947 2,445 calls. Up to 5/7/48 1,271 calls. Analysis of calls obeyed up to 5/7/48. 1948 Accident cases Removal cases Maternity cases Others Total 1st Qr. 89 399 73 - 561 2nd Qr. 120 532 68 — 710 TOTAL 209 931 131 — 1271 13 Division of Calls into time periods. Number of calls received between 6 a.m. and 6 p.m. 1,057 Number of calls received between 6 p.m. and midnight 163 Number of calls received between midnight and 6 a.m. 51 Total calls up to 5/7/48 1,271 Miscellaneous Figures. Total distance (in miles) covered by the ambulance vehicles up to 5/7/48 6,720 Average mileage per call 51 Number of calls referred to other Authorities 65 Number of calls answered for other Authorities 24 Greatest number of calls answered in any one day 20 Average time lag in reaching scene of accident 3 mins. Number of occasions upon which both ambulances were out at the same time 4 Number of complete days when one vehicle was out of commission for repairs 16 Number of accidents to ambulance vehicles 2 Number of instances of mechanical breakdown 3 Number of false alarms and malicious calls 18 14 TREATMENT CENTRES AND CLINICS—1948. Nature of Service. Address in Richmond. Particulars. By whom provided or arranged. Total number of:— Sessions held Pts. attending for first time Attendances made Doctor's consultations Ante-Natal Clinic Windham Road Twice weekly M. & C.W. C'ttee 102 519 2156 1738 Ante-Natal Clinic Back Lane, Ham Two sessions per month M. & C.W. C'ttee 25 88 282 249 Ante-Natal Clinic Windham Road (for Grove Road) Alternate weeks County Council 28 230 288 288 M. & C.W. Clinic Windham Road For infants, twice weekly M. & C.W. C'ttee 105 539 5347 2077 M. & C.W. Clinic Windham Rond For toddlers, twice monthly M. & C.W. C'ttee 22 123 560 342 M. & C.W. Clinic Back Lane, Ham For infants and toddlers, twice weekly M. & C.W. C'ttee 101 324 2872 1123 M. & C.W. Clinic St. Winifride's Hall, Kevv For infauts and toddlers, once weekly M. & C.W. C'ttee 52 228 2290 758 M. & C.W. Consultns. Royal Hospital, Richmond Once weekly M. & C.W. C'ttee 41 M. & C.W. Eye Clinic Windham Road By appointment M. & C.W. C'ttee 24 29 M. & C.W. Dental Clinic Windham Road One or two sessions weekly M. & C.W. C'ttee 60 216 517 Diphtheria Immunisat'n Clinic Windham Road Back Lane, Ham Once weekly As required M & C.W. C'ttee 52 1187 1649 M. & C.W. C'ttee 17 293 454 15 HEALTH VISITORS. In addition to their indoor duties in connection with the various clinics, during the year 1948, the Health Visitors paid a total of 4,514 visits, as under:— First visits. Revisits. Routine visits paid to:— Expectant mothers 421 234 Children under 1 year 458 1,186 Children between 1 and 5 years 1,991 Special visits in connection with:— Adoption cases 75 Home Helps 15 Infant Deaths 15 Infant Life Protection 8 84 Nenonatal Deaths 2 Special enquiries 7 Stillbirths 9 Tuberculosis 2 Aged Persons 4 Blind Persons 1 Vaccination 1 Maternity Survey 1 Totals 1,018 3,496 Clinic Activities. Clinic sessions have continued as in 1947. The policy has been to ensure that, wherever possible, two Health Visitors attend each session. This has a most important bearing on the success and usefulness of a clinic. Only in this way is it possible for the Health Visitor to inspect the children and infants and to advise the mothers on their care. Our clinics are not places where the parents come simply to obtain their supplies of foods, vitamins, etc., at a more favourable price. An atmosphere of interest and enthusiasm is created by the Health Visitors and consequently the mothers attend regularly and feel that they are getting a really good service. 16 It must be remembered, however, that clinic sessions keep the Health Visitor from other important duties namely, home visiting. The number of home visits made is less than in the previous year for this reason. Under the National Health Service Act additional responsibilities have been placed upon the Health Visitors and stress is placed upon their important role in connection with Health Education. With a limited staff and these numerous responsibilities it is most important to strike a balance which provides the most efficient service. There remains a need for clinic facilities more conveniently placed for residents living on or near the Richmond Hill. This is being kept constantly in mind; but such facilities would almost certainly demand an increase in staff if existing services are to be maintained at their present high level of efficiency. PREMATURE INFANTS Number born Number nursed Number born alive but dying within Number surviving for over 28 days 24 hours 7 days 28 days Richmond Children born in the Borough: (a) At Home 11 6 2 1 8 (b) In Nursing Homes 1 1 — — — 1 (o) In Hospitals 6 11 I — 5 Richmond Children born outside the Borough: (a) In Nursing Homes 2 2 - - - 2 (b) In Hospitals 19 19 — — — 19 Children born in Richmond, mother normally residing elsewhere: (a) In Nursing Home3 1 1 - - - 1 (b) In Hospitals 4 4 — — — 4 17 18 CARE OF ILLEGITIMATE CHILDREN. The employment of a Social Welfare Officer to work in 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 31 (b) By Nursing Homes, Hospitals, Police, Clergy, etc. 21 (c) By mothers themselves 9 61 Number of cases visited for the first time during the year 55 Number of home visits and revisits to all known cases 493 Number of visits to employers, relatives, institutions, hostels, etc., in connection with cases 302 850 Number of mothers:— (a) admitted to:— ante natal or post natal homes long stay training homes short stay shelters 17 special homes for confinements 18 (b) for whom:— residential employment was found 15 non-residential employment was found 12 housing accommodation was found 1 arrangements were made for return to native land Number of mothers concerned who were, at the end of the year living:— 19  With Child Without Child Total as married 9 — 9 in own home with husbands (extra marital) - - - with parents or relatives 9 7 16 at homes of employers (residential employment) 10 9 19 in lodgings 2 8 10 in institutions or hostels 1 6 7 31 30 61 Affiliations:— Number obtained through court procedure 10 Number arranged voluntarily 15 Number of mothers who refused to make application 14 Number of children for whom arrangements were made:— for adoption 14 for admission to homes, institutions or residential nurseries 2 to be cared for by foster mothers 15 to remain with mothers, or relatives 30 Miss Oliver was first appointed as Welfare Worker by the Boroughs of Richmond and Barnes on the 8th August, 1944. Her duties were to ascertain, advise and give continual help to all cases °f illegitimacy. 1944 1945 1946 1947 1948 No. of illegitimate live births 62 62 51 54 38 No. of illegitimate deaths under 1 year 3 4 5 2 0 Illegitimate death rate 48 65 98 37 0 20 It is interesting to examine the figures in the above table. The number of illegitimate live births shews a definite tendency to decline. This is a natural trend following disturbed conditions due to the war. The Infant Mortality Rate for illegitimate infants shows a similar decline until 1948 when for the first time, there have been no illegitimate infant deaths at all. As the figures are small they cannot have much statistical significance but at least they support the feeling that everything possible is being done to ease the difficulties of these unfortunate girls, and to enable them to have their babies under the most suitable conditions. NURSING HOMES. The Surrey County Council have registered nine Nursing Homes 44, Onslow Road General Medical and Maternity. 25, West Park Road General Medical and Maternity. 86, Mount Ararat Road General Medical. 22, Cardigan Road General Medical. 19, Grena Road General Medical. 18, Mortlake Road General Medical. 108, Church Road General Medical. Beaconsfield, Kew Green Maternity only. 21, King's Road Maternity only. AH these Homes have been visited during the year. 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 1947 and 1948 were as follows:— 1947 1948 Parkshot Nursery 11,443 11,563 Grey Court Nursery 10,878 2,358 (up to 31/3/48). 21 Once again the attendances made at Parkshot Day Nursery attained a record height. This is a sure indication of the low incidence of infectious diseases amongst the children. There were, in fact, no important outbreaks and fortunately no case of poliomyelitis occurred. It was with considerable regret that arrangements were finally completed and Grey Court Day Nursery was handed over to the Education Authority on the 31st March. This Nursery was first opened in 1943 in response to a demand by the local residents. It was most efficiently managed by the Matron, Mrs. Marshall, who had the knack of gathering and retaining a happy and efficient staff. The children themselves gained much. Spending their days in the atmosphere of a pleasant country house with spacious grounds they rapidly put on weight and gained confidence. When they reached the age of five and were transferred to school the teachers invariably noticed how much easier Grey Court children were to handle than those who came straight from home. A few "problem" children were admitted to the Nursery and in every instance progressive improvement was made and school life was commenced at age five without difficulty. It was unfortunate that there were not sufficient local children in the particular age groups to keep the nursery full. Every day twenty or more childern were transported from Richmond. This was very expensive and there was the constant fear that the vehicle filled with these very young children might be involved in a road accident. I am pleased to say that the use of the premises has not been lost to the local inhabitants. Grey Court is now a successful Nursery School and it is only children under two years of age who cannot gain admission. The Maternity and Child Welfare Committee expressed their sorrow at having to terminate Mrs. Marshall's appointment but the Council will be pleased to learn that she has since been appointed to a Day Nursery situated in the Borough of Barnes, 22 HOME HELP SERVICE. In Richmond the Home Help Service is a combined one and provides help for Domiliciliary 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 12 to 14 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 1948:— No of households attended:— (a) M. and C.W. cases 58. (b) Domestic cases 86. Number of hours engaged in work:— (a) M. and C.W. cases 5,062. (b) Domestic cases 10,660. Altogether an average of 87.3 hours were spent on each M. and C.W. case, and an average of 123.9 hours per Domestic case. This is the service that gets more praise and more abuse than any other. If great efforts to recruit Home Helps were made the number employed could be considerably increased. All demands could be met and the Public Health Department would be managing a Domestic Agency. Applicants for help would be satisfied but the ratepayers would undoubtedly object to the very heavy expenditure. These facts are kept constantly in mind and an endeavour is made to maintain a staff which will be able to help in all cases of real need and who can be usefully employed when there is less pressure upon their services. Expectant mothers who are to be confined at home are promised full time home help in advance. It often happens that the baby is born much earlier or much later than was expected. Occasionally a number of babies expected at reasonable intervals, are all born on or near the same day. Such occurrences are liable to dislocate the service. In order to help the mother with the new born child, Home 23 Helps must be transferred without warning from patients who feel that they cannot manage without. Such occurrences could not be avoided without very excessive expenditure. However, in spite of difficulties a great deal of most helpful work has been carried out during the year and this service through' out the country must be easing the very difficult situation as regards hospital beds. I feel that the present policy is the right one, namely to provide as efficient and useful a service as possible, having regard to reason' able economy; and to provide a Home Help at a household where help is required owing to the presence of:—-"any person who is ill, lying-in or an expectant mother, mentally defective, aged, child not over compulsory school age within the meaning the Education Act, 1944." 24 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) Richmond Borough Council owns seven wells. One of them, known as the Terrace Gardens well is 320 feet deep and reaches two miles of adits in the chalk. From this is obtained a pure and wholesome water which is softer in character than the supply obtained from the remainder. These 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 supply to the public. Early in the year it became apparent that the supplies from the two Ham wells were not maintaining a sufficiently high standard of purity and it was decided that the whole question of the local water supply should be investigated in detail. Resulting from these investigations and advice taken from experts, the two Ham Wells were put out of commission and certain other alterations were made which resulted in increased control over the chjorination process. The local supply now comes from the deep well, from two shallow wells in the Old Deer Park and from two shallow wells in Petersham. Water from all these wells is pumped to the low level reservoir at Petersham where it is chlorinated. Water takes four to five hours to pass through the reservoir and is then pumped to the high level reservoir in Richmond Park where it remains for 24 hours before passing into public supply. The amount of free chlorine contained in the water issuing from the low level reservoir is estimated every two hours by day and night. The amount of free chlorine in the water passing from the Richmond Park reservoir to public supply is estimated daily. In addition to these precautions samples of both the unchlorin' ated well waters and the chlorinated water passing into public supply are taken at regular intervals for bacteriological, physical and chemical examination. 25 During the year no less than 310 such samples were taken and examined. Of these, 129 were samples of chlorinated water passing into public supply; everyone of these was free from coliform organisms and of a very high standard of purity. Chemical examinations of the water from individual wells now in use, showed that the organic quality remained entirely satisfactory throughout the year. Bacteriological examinations of the untreated water showed that, under normal conditions, the wells produce a water of remark' able purity. Only at times of serious flooding by the river Thames is a temporary deterioration sometimes observed in one or more of the wells. Under the present arrangements this can readily be dealt with by shutting down the wells concerned for a few days. There have been complaints that the water tastes of chlorine. Every effort is made to reduce this to a mininium but this nuisance cannot be eliminated unless new and very expensive apparatus is installed. Fortunately the proportion of residents who are unduly sensitive to the taste is not large and I am able to say, with confidence, that the small quantity of chlorine is quite harmless and that the water supply is wholesome in every respect. Richmond water contains 30 parts per 100.000 of hardness and is not plumbo'solvent. (b) The supply of the Metropolitan Water Board is received in bulk through six connections off the 30 inch M.W.B. main. The source of the water is the River Thames abstracted at Wraysbury, Laleham and Walton intakes and stored in the Thames Valley reservoirs. After storage the water is treated at the filtration works at Hampton and Surbiton. All the water is chlorinated before it leaves the works and adequate contact to ensure complete action has been provided at Hampton by the building of a contact tank which first came into operation in July, 1948. Since the 19th October the filtered water has been treated by the method of controlled super'chlorination in place of the ammonia-chlorine process. Free chlorine is a much more powerful disinfectant than chloramine and there is, in addition, a considerable saving in the cost of chemicals. 26 Treatment is controlled by hourly testing of the final water at the works and by an instrument continuously recording the amount of residual chlorine in the water after a specified period of contact. Samples of the water are collected at all stages of purification at least five times each week and analysed at the labaratories of the Metropolitan Water Board. Chemical examination was carried out on 754 samples and 1581 samples were examined bacteriologically. The results of these examinations indicated that a very high standard of chemical and bacteriological purity was maintained throughout the year. All new and repaired mains are disinfected with chlorine before being restored to supply and samples of water from them are tested to establish that its quality is up to that normally supplied. None of the samples was plumbo-solvent. 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 sewers. The following figures show the daily average consumption from the three sources:— Daily Average 1947/48 Consumption. 1948/49 All Richmond Wells 976,651 galls. 655,765 galls. Metropolitan Water Board 532,688 galls. 878,400 galls. Raw River Water 229,271 galls. 191,602 galls. The reduction in the quantity of water obtained locally is, no doubt, mainly due to the closing down of the two wells at Ham. Two cottages connected with Teddington Lock obtain their water from a private well. Apart from this, water fit for human consumption is made available by piped supply to every dwelling house in the Borough. 27 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 1948. Houses visited and particulars recorded (Housing Act) 20 Houses visited (Public Health Acts) 1743 Revisits to houses and other premises 1642 Visits paid in connection with:— Overcrowding 39 Vermin 204 Disinfestation 7 Enquiries into Infectious Diseases 113 Corporation Dwellings 15 Routine inspections in connection with:— Factories (mechanical) 17 Factories (non-mechanical) 14 Work-places 5 Bakehouses 19 Butchers' Shops 72 Fishmongers'and Poulterers 16 Other registered food stores 6 Cowsheds 2 Dairies and Milk Shops 51 Ice-cream premises 255 Restaurants and Tea Shops 251 Fried Fish Shops 7 Stables 6 Piggeries 1 Public Sanitary Conveniences 7 Shop Acts 184 Theatres and Cinemas 3 Greengrocers' and Fruiterers 2 Tents, Vans, and Sheds 6 Rats and Mice 584 Smoke Observations 31 Schools—Elementary and Secondary 14 28 Water Supply 279 Drainage 437 Employment Agencies 2 Massage Establishments 16 Milk Sampling (Pasteurised) 62 Food Sampling 41 Unsound Food 178 Petroleum Acts 111 Rent Restrictions Acts 2 Interviews 680 Miscellaneous Visits 1634 8778 Drains and Sewerage Systems Tested. Hydraulic test 94 Smoke tests 76 Chemical tests 9 Examinations 31 Factories Act, 1937. At the end of the year there were 182 factories on the register (123 mechanical and 59 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreathes, etc 1 — Bakeries 11 2 Boot Repairs 3 1 Boot-making 8 4 Box-making 1 1 Building 5 8 Carpentry 1 2 Carpet-repairing — 1 Clothing 4 — Dressmaking 3 8 Electrical Instruments 7 — Engineering 8 — 29 Furniture and Upholstery 4 4 Furriers — 2 Gas Storage 1 — Glue-making 1 — Jewellery Repairs 1 1 Laundering and Cleaning 4 1 Millinery — 2 Milk Pasteurising 1 — Motor Vehicle repairing 19 2 Printing 10 — Sausage-making 6 — Saw Mills 2 — Surgical Instruments 2 — Tailoring 1 12 Undertaking 1 — Welding 2 — Wheelwright and Coach Building 3 — Wig-making - 1 Wireless Repairs 1 1 Miscellaneous Trades 12 6 123 59 Thirty-one 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 4 Want of cleanliness 11 Unsuitable sanitary conveniences 7 Other nuisances and defects remedied 33 55 Shop Acts, 1934. Shops on the Register 781 Visits made 184 30 SANITARY DEFECTS REPORTED. Water Supply: Defective or foul storage tanks 16 Defective fittings (notified to Water Engineer) 4 W.C.'s and Urinals: Defective pans 81 Foul pans 12 Defective woodwork around pans 12 Defective seats 7 Absence of water supply 12 Defective flushing apparatus 16 Defective flush-pipe connections 24 Defective walls, floors or roofs 20 Defective doors and windows 28 Want of light and ventilation 6 Insufficient closet accommodation 11 Defective walls and channels of urinals 9 Insanitary urinals cleansed 9 Defective brickwork (repaired or re-built) 11 Soil-Pipes: Defective or insufficient soil-pipes and vent shafts 19 Want of, or defective ventilation shafts 4 Rainwater pipe acting as ventilation shafts 3 Defective Fresh air inlets 11 Drains: Defective drains 38 Defective sewers 18 Want of additional house drains Choked or foul drains or gullies 20 Defective or insufficient gullies 5 Defective grating, dishing or curbing 5 Absence of, or defective, interceptor 7 Defective manholes 12 Defective manhole covers and frames 11 Sub-soil drains required Defective drainage of Stables 1 31 Dustbins: Defective receptacles 44 Paving: Defective paving of yards, forecourts, etc. 12 Sinks: Defective or insanitary sink 34 Want of sink 8 Insanitary wall-surface around sink 10 WastcPipes: Insanitary W.P.'s or shafts 55 Defective waste-pipes 8 Untrapped or unventilated waste-pipes 7 Waste-pipes directly connected to drain Dampness: Defective roofs 166 Defective gutters or spouting 96 Want of damp-proof course 2 Defective external brickwork 31 Defective pointing of door and window reveals 16 Damp and insanitary site under floor 1 Floor cavity unventilated 2 Defective wall or floor ventilators 3 General Defects: Verminous rooms 28 Verminous bedding 7 Dirty floors, woodwork, etc. 26 Accumulations of offensive matter 31 Nuisances from fowls, or other animals 5 Defective plastering (No. of rooms) 400 Dirty walls and ceilings (No. of rooms) 255 Dirty walls and ceilings of staircases and passages 31 Defective floors 84 Defective doors and windows 53 32 Defective doors and window fastenings 39 Defective furnace or brickwork of copper 3 Permitted No. not in rent book 2 Defective sashcords 74 Defective window sills 47 Windows not made to open 15 Inadequate lighting and ventilation 13 Defective firegrates and kitchen ranges 58 Defective chimney pots, etc. 16 Smoke nuisances 10 Defective coppers 1 Defective coal cupboards 3 Defective staircases 4 Premises infested with rats and mice 125 Contraventions of Byelaws 11 Temporary Outbuildings obstructing light and air 2 Miscellaneous defects 370 2,647 NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 353 Interviews 680 Statutory Action. Act and Section Notices Authorised Notices Served Public Health Act, 1936. Section 39 (Drainage) 11 10 Section 44 (Provision of Closets) 2 — Section 45 (Defective Closets) 4 4 Section 75 (Dustbins) 1 — Section 92/3 (Nuisances) 59 52 Housing Act, 1936. Section 9 (Insanitary Dwellings) 25 18 33 In the main the work called for on Statutory Notices was carried out by owners. In five cases, the owners failed to carry out their obligations and it became neccessary for the Local Authority to do the work in default. Address of Premises Act and Section Cost of Repairs 55, Mount Ararat Road Housing Act, 1936. Section 9. £83 0 0 22, Clarence Road, Kew. Housing Act, 1936. Section 9. 10 10 0 26, Mount Ararat Road. Housing Act, 1936. Section 9. 52 1 0 42, Manor Road. Housing Act, 1936. Section 9. 21 7 6 14/14a, Darell Road. Public Health Act, 1936. Section 45. 9 12 6 PROSECUTIONS. It was found necessary to take legal procedings in one case of a contravention of Section 92 of the Public Health Act, 1936. The case was heard at the Petty Sessions Court, Paradise Road, as follows:— Date Case heard Result of hearing Amount of Fine Failure to comply with a notice served under the provisions of Section 92/93 of the Public Health Act, 1936 to carry out repairs to a dwelling. 9.2.48. Conviction. £2/2/0 plus costs. 34 COMPLAINTS. The number of complaints received by the Department from the 1st January to 31st December, 1948, was 846. The complaints received have ben classified as follows:— Defective sinks 15 Defective drains 54 Leaking pipes 7 Defective windows 2 Defective walls and ceilings 55 Defective storage tanks 15 Defective floor boards 7 Insanitary living conditions 15 Offensive manholes 8 Lack of water supply 5 Defective W.C.'s 50 Defective roofs and gutters 49 Dampness 51 Dry rot 15 Defective stoves 22 Defective stairs and steps 4 Accumulations of rubbish 16 Defective dustbins 19 Unsound Food 15 Nuisance from rats and mice 218 Nuisance from pigeons 3 Nuisance from smoke 7 Nuisance from vermin, ants, etc. 54 General defects 140 846 35 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 30 5 Decomposed Baked Beans 16 12½ Tins blown or pierced Bovril 4 Contaminated by glass Biscuits 12 Mouldy Cereals 1 34 7 Unsound or insect infested Cake 31 4 Mouldy Cheese 43 6 Decomposed Condiments 3 7½ Mouldy Dried Egg 5 Out of Condition Fats 47 8 Sour Fish (Tinned) 4 12 4 Tins blown or pierced Fish (Wet) 15 64 4 Decomposed Fish Cakes 1 22 8 Mouldy Flour 111 0 Insect infested Fruit 5 111 0 Tins blown or pierced Jam, etc. 22 2 Mouldy Meat(Tinned) 17 100 10½ Tins blown or pierced Meat 1 15 9 Decomposed Milk (Tinned) 5 8 12 Tins blown or pierced Orange Juice 3 12 ,, ,, ,, ,, Paste (Fish and Meat) 25 13¼ ,, ,, ,, ,, Pickles 110 9 Fermented Poultry 5 55 13 Decomposed Puddings 26 11 Mouldy Babbits 2 104 6 Decomposed Ryvita 7 Mouldy SauceB 37 13 Fermented and Unfit Sausages 83 6 Out of Condition Soft Drinks 1 12 ,, ,, ,, Soup 50 7½ Tins blown or pierced Spaghetti 10 0 ,, ,, ,, ,, Sugar 38 0 Moisture spoiled Sweets 42 12 ,, ,, Vegetables 5 55 5 Tins blown or pierced Vinegar 11 6 Fermented and Unfit 104 Cream Trifles Sour 9 Hares Decomposed 36 Survey of Food Premises. In the early part of the year a survey was commenced of all food premises within the Borough and by the end of December surveys had been completed and reports submitted to the Health Committee and Council in respect of:— 114 Restaurants, Cafes and Dining Rooms. 78 Ice Cream premises. 23 Butchers' premises. 18 Dairies and milkshops. 7 Fish Frying premises. 10 Wet Fishmongers' premises. In conducting the survey particular attention was paid to the following points:— Provision of sanitary accommodation for both staff and general public. General layout and positioning of kitchens, etc. Condition of the structural part of the premises. Cleanliness in respect of Food preparing rooms, utensils, and methods of handling by staffs. Provision of hot water supply and washing facilities. Methods employed in the washing of crockery, etc. General standard of compliance with the Food and Drugs Act. It was felt that to report properly on these premises it was neccessary for a standard of clarification to be adopted and this was eventually fixed to three Catergories. Category A. Premises which complied in all respects with the Food and Drugs Act standards. Category B. Premises falling short of the Food and Drugs Act but requiring only minor repairs, etc., to bring them up to standard. Category C. Premises far below the standard and requiring major work or alteration to bring them up to the requirements, 37 Restaurants, Cafes and Dining Rooms. Of the 114 premises inspected 22 were in Class "A," 40 in Class "B" and 52 in Class "C." 25 of the kitchens were situated in the basements of the premises. Proprietors of classes B and C were approached by the Department and in most cases a ready response was made to suggestions for improvement and by the end of the year. steady progress was being made towards improved conditions. Ice Cream Premises. Of the 78 premises inspected 68 were in Class "A" and 10 in Class "B." The general standard of the premises was good and minor repairs or alterations only were needed to improve the standard of the Class B premises. Five of the Manufacturers' premises are not the ideal, but the premises are well run and give consistently good sample results. Butchers. Of the 33 premises 23 were in Class "A" and 10 in Class "B." The general standard of premises was good and minor repairs only are necessary. Dairies and Milkshops. Of the 21 premises 18 were in Class "A" and 3 in Class "B." Minor repairs only are needed to bring the "B" standard to Class "A." Fish Fryers. All 7 premises were in Class "A" the general standard being good. Wet Fish Mongers. Of the 13 premises 10 were in Class "A" and 3 in Class "B" and again minor repairs only were necessary to the Class "B" premises, 38 A Food Sub-Committee has been formed and meetings have been held to discuss ways and means of securing the active cooperation of the Food traders and to instruct Food handlers in hygienic methods of handling foodstuffs. PETROLEUM ACTS 1928. Visits made 111 Licences for which applications for renewal were made during the year:— (a) Petroleum Spirit 50 Licences transferred during the year 1 New licences issued during the year 4 Premises under Government control and not subject to licence by the Local Authority 1 DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding. Pig Food Bins. Infectious Fevers 25 29 171 Tuberculosis 17 22 77 Vermin 49 110 34 Other Diseases 42 42 249 Pig Food Bins 247 The total costs recovered from the disinfection and disinfesttation of rooms during the year amount to £52 2s. 6d. DESTRUCTION OF INSECT PESTS IN THE HOME. Bugs: During the year 49 houses, involving 110 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 a marked effect in eradicating these pests from properties. The product "Gammaxane" has been added to the Department's list of lethal powders and is also giving excellent results, 39 Flies: In August 247 pig food 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 were satisfactory. DISEASES OF ANIMAL ACTS. On the 20th July, 1948, a suspected case of Swine Fever was reported from premises situated in the Borough and the usual form "A" declaring an infected place was served upon the occupier on the same day. It was later found this was not a case of Swine Fever and the Form A was withdrawn. Rats and Mice (Destruction) Act 1919. 218 complaints were received from occupiers of dwellings or business premises of suspected rat infestation of premises. 584 visits to investigate the above complaints were made and infestations were eventually isolated and dealt with at 125 premises. The Richmond Borough Council at their meeting on the 8th June, 1948, approved a scheme put forward by the Health Committee for the free treatment of rat or mouse infested dwelling houses in the Borough. Since this scheme commenced in June, 1948, there have been 143 complaints from residents and to the 31st December, 1948, 108 houses had been freed from rats or mice. Special Rat Surveys. The Health Committee after receiving reports of suspected heavy infestation in two sections of the Borough, agreed to a house to house survey being carried out in a section of Kew (comprising streets around Kew Green and along the riverside) and an area in Petersham (bounded by Petersham Road, Ham Common, The Avenue and Sandy Lane). The results of these Surveys were as follows:— 40 Kew Area. 592 premises were inspected and infestations located at 17 (13 dwellings—1 Factory, 2 Builders' yards and a Railway Embank' ment). No infestation was of a major character and treatment to free the premises was carried out immediately. Petersham Area. 297 premises were inspected and infestations located at 27 (26 dwellings and 1 piggery). The dwellings were minor infestations only but the piggery was major in character. Treatment was commenced on the 27 premises almost immediately following the survey and the rats cleared in a reasonably short period. Sewer Baiting. October, 1948. 140 manholes in various sections of the Borough were subjected to a two day prebaiting and third day poisoning (Zinc Phosphide) treatment and of this number 94 gave a positive result. November, 1948. A test with unpoisoned bait (sausage rusk) was carried out on 1 in 10 of the foul sewer manholes in the Borough the object of this test being to obtain information as to the needs for treatment of the sewers in 1949. The results show that it will be necessary to treat some 328 manholes on two occasions namely March and October, 1949. Smoke Abatement. Richmond being a residential district contains no very large works or factories. The smaller factories give little trouble by smoke nuisance. Seven 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. 31 observations for excess smoke were made on various chimneys from business premises throughout the area. 41 SECTION D—HOUSING. Housing Statistics for the Year 1948. 1. Number of dwellings owned by the Local Authority:— Number of houses 1123 Number of flats 240 Total 1363 2. Unfit Houses. (I) Inspection of Dwelling Houses during the Year:— (i) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1763 (b) Number of inspections made for the purpose 3405 (ii) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 20 (b) Number of re-inspections made under the Regulations 98 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (iv) Number of dwelling houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 637 (II) Remedy of Defects during the Year without service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers (including 72 cases outstanding from the previous year) 600 42 (III). Action under Statutory Powers during the Year:— A. Proceedings under sections 9, 10, and 16 of the Housing Act, 1936:— (i) Number of dwelling houses in respect of which notices were served requiring repairs 18 (ii) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 9 (b) By Local Authority in default of owners 4 B. Proceedings under the Public Health Acts:— (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 66 (ii) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 46 (b) By Local Authority in default of owners 1 C. Proceedings under sections 11 and 13 of the ing Act, 1936:— (i) Number of dwelling houses in respect of which Demolition Orders were made Nil. (ii) Number of dwelling houses demolished in suance of Demolition Orders Nil. D. Proceedings under section 12 of the Housing Act. 1936:— (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (ii) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 43 3. Overcrowding. Overcrowding is still very considerable throughout the Borough. Progress is made by the Housing Department but it is unable to keep pace with the heavy demands. 4. Council Houses. Total number of houses erected post-war to 31st December, 1948 Temporary Bungalows 179 Permanent Houses 140 Permanent Flats 78 Total number included in above, erected in 1948 Permanent Houses 90 Permanent Flats 78 Total number of premises requisitioned up to 31st December, 1948 125 (including 239 family units) Total number of families rehoused in 1948 197 Total number of families still on Waiting List at 31st December, 1948 1526 Future Programme. At the present time there are 68 permanent houses and flats under construction and the Council have acquired or are in the process of acquiring land which will permit the erection of a further 368 dwellings approximately. Present development and future schemes are all sited in the Ham area. 44 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 31st December, 1948. Articles. Analysed Adulterated or Irregular Prosecutions Convictions Formal Informal Total Formal Informal Total FOOD : Milk 28 9 37 2 2 Chocolate Spread 1 1 Flour Mixture 1 1 Ice Cream 1 1 Meat Cooked and Prepared 2 2 Meat Paste 3 3 Minced Beef Sandwich 1 1 Olive Oil 3 3 Salad Cream and Dressing 3 3 Salt 1 1 1 1 Sausages 2 3 5 Sausage Meat 1 1 1 1 Soft Drinks 4 4 Wheat Embryo 1 1 DRUGS: Bicarbonate of Soda 1 1 Cold and Cough Mixture 1 1 Cough Linctus and Syrup 2 2 Liquid Paraffin 1 1 Yeast Tablets 1 1 Totals 31 39 70 2 2 4 45 Milk (Special Designations) Order 1936. No. of samples of milk taken for analysis during the year 43 No. of samples found to be satisfactory 41 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 FOOD POISONING OUTBREAKS. During the year no cases of food poisoning were notified by the local practitioners and no outbreak of disease required investigation as suspected food poisoning. ICE CREAM. Ice Cream premises were kept under regular supervision during the year, 255 visits being paid to manufacturers and retailers in the Borough. 95 samples of Ice Cream were submitted to the Bacteriologist for examination and of this number 72 samples fell within Grades I and II and were considered satisfactory, and 23 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 given. All manufacturers and retailers were found to be very co-operative in their efforts to improve conditions. 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 pasteurised, cooled and stored and to provide for the protection of Ice Cream at all times during manufacture, distribution and storage. Regular inspections are made to see that the provisions of these regulations are being complied with. 46 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 43 35 Puerperal Pyrexia ... ... ... Pneumonia 6 2 35 Erysipelas 3 2 ... Measles 116 3 ... Whooping Cough 181 6 ... Malaria 1 1 ... Poliomyelitis 8 8 ... Cerebro Spinal Meningitis ... ... ... Dysentery 1 1 ... Typhoid 1 1 ... Total 360 59 36 From the table it will be seen that there was no very serious incidence of infectious disease during the year. The number of cases of Whooping Cough was excessive, but measles had fallen sharply to its non-epidemic level. The cases of scarlet fever were all mild and no complications were observed. One case of typhoid fever occurred. The patient was in hospital for nearly three months and was seriously ill. She finally made a good recovery. Enquiries failed to discover the source of infection and no other cases were reported. The case of dysentery was first of all thought to be paratyphoid fever and that infection had possibly originated in Scotland. However, a diagnosis of dysentery was finally confirmed bacteriologically, and it seemed probable that the infection was contracted in a London restaurant. The single case of malaria was contracted in Nigeria. The eight cases of poliomyelitis which occurred have been discussd under The Health of the Borough. 47 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 1948. Month. Nature of Contact Typhus. Smallpox. January — — February — 1 March — 3 April — — May — — June — — July — — August — — September — — October — — November — — December — — Total 4 Contacts of these diseases are visited daily during the incubation period by the Sanitary Inspectors. In cases of difficulty where a medical examination seems advisable, the Medical Officer of Health visits. Contacts who leave the district during the incubation period are notified to the Medical Officer of Health of the area to which they are proceeding. 48 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Poliomyelitis 8 Malaria 1 Scarlet Fever 33 Diphtheria — Measles 3 Whooping Cough 6 Pneumonia 2 Other Diseases 18 Total 71 Richmond residents are fortunate in having the facilities of the well staffed and well equipped South Middlesex Fever Hospital. This convenient arrangement has been in operation for many years and it is hoped that it will continue under the new hospital administration. At all times during the year patients were promptly admitted and efficiently treated. Detailed reports on their condition have readily been made available by the Medical Superintendent. Without exception, every patient discharged from the hospital has praised enthusiastically the treatment received. DIPHTHERIA IMMUNISATION CLINIC. Total number of attendances 2003 Number of Children immunised for the first time during the year 1948:— (a) Pre-school children (under 5 years) 724 (b) Between 5 and 15 years Total 944 49 Grand Total of Children in the Borough who had received immunising treatment by the end of the year:— (a) Under 5 years 2164 (b) Between 5 and 15 years 3825 Number of Children given boosting doses during 1948:— Under 5 years 1 (b) Between 5 and 15 years 772 At the 31st December the percentages of children who had been immunised were as follows:— 0—5 years 69.8% 5—15 years 95.3% From these figures it will be seen that the Diphtheria Immunisation Scheme has been actively conducted during the year. The number of children immunised for the first time was 944 compared with 683 in 1947. In addition the policy of giving single re-inforcing doses at appropriate intervals during a child's school life has been continued. The materials used are, for children under 10, Alum Precepitated Toxoid and for children over 10 Toxoid Anti-Toxin Floccules. Immunisation Against Whooping Cough. There has been a growing demand for the immunisation of young children against whooping cough. During the year 248 children received full courses of the injections compared with 93 in 1947. The material used is Alum Precepitated Vaccine (Glaxo Laboratories, Ltd.), and the full course consists of three injections at monthly intervals. Reactions have been few, and though no significant statistics are available, my impression is that the injections are effective. Immunised children who did contract the disease are very mildly affected. In order to reduce the total number of injections a combined Diphtheria-Whooping Cough Prophylactic will be brought into use in the near future. 50 VERMINOUS CONDITIONS. SCABIES. During the year 1948, 12 new cases of scabies were treated at the Health Centre. This figure includes school children, and compares very favourably with 66 new cases treated in 1947 and 337 new cases 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 7671 Number of individual children found to be unclean at above 78 Proportion of children found unclean at all inspections 1.02% Number successfully cleansed by parent or guardian without requiring exclusion for more than 24 hours 68 Number excluded for longer than 24 hours 10 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. There has been a really remarkable decline in the incidence of scabies and infestation by head lice. The number of individual children found to be unclean was 78 compared with 239 in 1947. This reduction in incidence has become apparent in spite of the fact that nearly 1,000 more inspections were carried out by the School Nurses. A high proportion of the 78 children who were found to be unclean are old offenders. The marked improvement must be due to improved social conditions; to energetic action by the School Medical Service, and to the efficiency of the materials now being used to treat infestation, 51 TUBERCULOSIS. The position in Richmond for the year 1948 may be summarised as follows:— NOTIFICATIONS: Respiratory Tuberculosis. Fifty-three cases of respiratory tuberculosis were notified, viz., 31 male and 22 females. The corresponding figure for 1947 was 66. Non-Respiratory Tuberculosis. Seven new cases of non-respiratory tuberculosis were notified during the year and there were three deaths from this cause. Five such cases had been notified during 1947. 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 181 23 Females 118 30 Total 299 53 Corresponding figures for 1947 were 323 51 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 1948 it was not found necessary to take action under either of the above enactments. 52 TUBERCULOSIS. Age Periods New Cases. Deaths. Respiratory NonRespiratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... 5 ... 1 ... ... ... ... ... ... 15 4 3 1 1 ... 1 ... ... 25 9 8 1 1 ... 2 ... ... 35 8 5 ... 1 3 3 1 ... 45 7 4 ... ... 2 1 ... ... 55 ... 1 ... ... 2 ... 1 ... 65 and upwards 2 ... ... 1 3 ... ... 1 Totals 31 22 2 5 10 7 2 1 AFTER CARE. The Barnes and Richmond Tuberculosis Care Committee continued to play a most important part in the Surrey County Council Scheme for the "care and after-care" of tuberculosis patients. This voluntary Committee spent over £500 in this work during the year although financial help from the County Council amounted to only £25. The Committee have been strengthened during the year by the addition of representatives of various official bodies concerned with helping the tuberculous. The aim of the Committee is to supplement where necessary the Surrey County Council Treatment Allowances Scheme to enable patients to carry out the recommended treatment with a minimum of financial worry. Forty-eight families have been given help in Richmond, in cash or kind, during the year. In addition many families have been referred to other agencies for help; and recommendations for free milk, paid for by the Surrey County Council, pass through the Care Committee. 53 INDEX. Page Adoption 15, 18 Ambulance Calls, Analysis of 13 Ambulance Facilities 12 Ante-Natal Clinics 14 Area of Borough 6 Birth-Rate 6 Births, Analysis of 6, 9 Cancer, Deaths from 6 Chief Sanitary Inspector, Report of 27 Clinics, List of 14 Day Nurseries 20 D.D.T. 38 Death- Rate 6 Deaths, Analysis of 6, 9 Deaths, Maternal 7 Deaths, Neo -Natal 7 Dental Clinics 14 Diarrhoea & Enteritis (under 2 years) 6, 7 Diphtheria 8, 14 Diphtheria Immunisation 14, 48 Diseases of Animal Acts 39 Disinfection 38 Disinfestation 38 Drains 28 Dysentry 46 Erysipelas 46 Eye Clinics 14 Factories Act 28 Food and Drugs Act 44 Food, Survey 36 Food, Unsound 35 Head-Lice 50 Health of the Borough 9 Health Services 11—23 Health Visitors 15 Home Help Service 22 Housing 41 Illegitimacy 18 Ice Cream 45 Infant Life Protection 15 Infant Mortality 6 54 Page Infectious Diseases, Notifiable 10, 46 Inhabited Houses 6 Laboratory Work 11 Malaria 48 Malformation, Congenital 7 Maternal-Mortality 7 Maternity and Child Welfare Clinics 14 Maternity Homes 20 Measles 6, 8, 46, 48 Milk 35 Milk (Special Designations) Order, 1936v45 Notices, Sanitary 32 Nursing Homes 20 Petroleum Acts 38 Pneumonia 7, 46 Population 6 Poliomyelitis 10 Premature Infants 17 Prosecutions 33 Puerperal Pyrexia 8, 46 Rateable Value 6 Rats and Mice Destruction Act, 1919 39 Sanitary Inspection and Complaints 24, 27, 34 Scabies 50 Scarlet Fever 46 Sewers 28 Sewers, Baiting of 40 Shops Acts Smallpox 8 Social Welfare Worker 18 South Middlesex Fever Hospital 48 Staff, List of 4, 8 Statistics 6, 8 Stillbirths 6 Streptococcal Infections 11 Treatment Centres and Clinics 14 Tuberculosis 51 Typhoid Fever 46 Typhus Fever 47 Verminous Conditions 50 Water Supply 24 Whooping- Cough 49