BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1953 CONTENTS. Page. List of Staff 2 Preface 3 SECTION A—STATISTICS AND SOCIAL CONDITIONS. Social Conditions 11 Births 11 Deaths 12 Maternal Mortality 12 Infant Mortality 12 Premature Infants 14 Illegitimate Infants 14 Comparative Statistics 15 SECTION B— GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Clinics and Treatment Centres 16 Health Visitors 16 District Nurses and Midwifery Services 16 Moral Welfare 16 Home and Domestic Help Services 16 Ambulance Facilities 16 Day Nursery 16 Hospitals 17 Laboratory Facilities 17 Mortuary 17 Nursing Homes 17 SECTION C— SANITARY CIRCUMSTANCES. Water Supply 18 Sanitary Inspection 20 Sanitary Defects 23 Notices Served 24 Complaints Received 25 Petroleum Acts 26 Disinfection and Disinfestation 26 Rodent Control 27 Smoke Abatement 27 Rag, Flock and Other Filling Materials Act, 1951 28 Pet Animals Act, 1951 28 Diseases of Animals Act, 1950 29 SECTION D— HOUSING. Housing 30 Council's Housing Programme 32 Closing Orders 33 Slum Clearance 3 3 SECTION E— INSPECTION AND SUPERVISION OF FOOD. Food Inspection 34 Food Premises 36 Byelaws 37 Richmond Clean Food Traders' Guild 38 Sale and Storage of Ice Cream 38 The Food and Drugs (Milk &? Dairies) Act, 1944 39 SECTION F- PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification of Infectious Diseases 41 Admission to Infectious Diseases Hospitals 41 Food Poisoning 41 Diphtheria Immunisation 41 whooping Cough Immunisation 42 Vaccination Against Smallpox 43 Verminous Conditions Scabies and Head Lice 44 Tuberculosis 45 1 Public Health Department, Parkshot, Richmond. August, 1954. 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 1953 upon the Sanitary Circumstances, Sanitary Administration and Vital Statistics of the Borough. The form of the report is similar to that for the year 1952 and is in accordance with Ministry of Health Circulars 42/51 and 1/54. I wish again to record my appreciation of the efficient and conscientious work carried out by my staff, the assistance and close Co-operation of my colleagues in other Departments, and the support throughout the year of the Chairman and Members of the Health Committee. I am, Ladies and Gentlemen, Your obedient servant, ERIC PEREIRA, Medical Officer of Health 2 LIST OF STAFF. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. Chief Sanitary Inspector: BERNARD AISTHORPE, M.R.San.I. Senior Additional Sanitary Inspector: EDWARD S. HERBERT, M.S.I.A. Additional Sanitary Inspectors: CHARLES S. SMEATON, M.R.San.I. KENNETH H. HALSTEAD, M.S.I.A. Clerks: MISS J. BLACK (Senior Clerk). MRS. F. G. SMITH. MISS M.' WILTSHIRE. Rodent Officer: THOMAS R. SMITH. Rodent Operator: RONALD EVANS. Drain Tester, Disinfector and Driver : JAMES DAVIS. 3 BOROUGH OF RICHMOND. Report of the Medical Officer of Health for the year 1953. PREFACE. Staff. Mr. E. S. Herbert was appointed Senior Additional Sanitary Inspector in place of Mr. G. C. Smith who had resigned in order to take up a more senior post with another Authority. Mr. Herbert commenced duty in January and so has been with this Department for most of the year under review. There were no other changes in staff. Population. The Registrar General's estimate of the population was 42,440 which is an increase of nearly 500 on the census population of 1951. The Surrey section of the Census Report for 1951 has been published and contains a great deal of information about the popula tion of Richmond. The total population was 41,944, comprising 18,878 males and 23,066 females. The percentage increase in the inter-censal years 1931-1951 was 6.8 which is very low compared with most other districts in the country and only slightly higher than the percentage increase during the years 1921-1931. The percentage distribution of population by age as compared w that cf the administrative county was as follows:— Richmond. Surrey. 0— 4 years 7.7 7.7 5—14 „ 10.9 13.1 15—44 „ 42.2 41.5 45—64 „ 25.3 25.9 65 ,, and over 13.9 11.8 In the total population there were 3,236 children under school age, 4,551 children of compulsory school age, and 1,082 persons over the age of 75 of whom 45 were over the age of 90. The rather high percentage of elderly persons does not favour a low death rate and the marital state does not particularly favour a high birth rate. Of the total population 41.1% were single, 49.2% were married, and 9.7% were widowed or divorced. 4 Births. During the year 585 births were recorded—(308 males and 277 females). This figure may be compared with 614 in 1952 and 851 in 1947. The number of illegitimate births was 34 which is a little higher than in 1952 but compares favourably with figures for previous years and is at the pre-war level. The proportion of births taking place in dwelling houses has risen slightly from 20% in 1952 to 24%in the year under review. This increase may be of no significance or it may mean that expectant mothers are beginning to appreciate once again that, where housing conditions are satisfactory, there is a good deal to be said in favour of home confinement. There were 26 premature births of which 24 survived. The two infants who failed to survive died within 24 hours of birth. One was born at home and one in hospital. Health Visitors are notified early of premature births and all possible assistance is given to the mothers. Deaths. The total number of deaths occurring amongst residents was 510 (260 males and 250 females). When considering this figure it must be remembered that all deaths occurring in Kings mead and other long-stay Institutions are assigned to this district. Because of this and the high proportion of elderly people resident in Richmond, the Registrar General supplies a factor, by which, the death rate is corrected and made comparable with the rest of the country. The corrected death rate is 9.6 per thousand population which compares very favourably with the rates for other towns and the country as a whole. Reference to the table of Comparative Statistics will show that the death rates for most diseases compare satisfactorily with other towns. The exceptions are influenza, poliomyelitis, and whooping cough. The rather high number of deaths due to influenza is related to the dense fogs which occurred late in 1952 and early in 1953. They were all dderly people and most of them were living in one or other of the Old Peoples Homes. 5 The single death due to poliomyelitis was the case of a child who contracted the disease in 1951 and who was so seriously affected that he could not live without the assistance of an iron lung. None of the cases which occurred in 1953 were fatal. The death from whooping cough is a reminder that this is a most serious disease which not only kills several hundred children each year but also does much harm to the health of many thousands. There is reason to hope the incidence and mortality rate will be gradually reduced by preventive inoculation. There were only 6 deaths of infants under 1 year of age. This is the smallest number ever recorded and the rate compares most favourably with other towns. No child under the age of 2 years died from enteritis. Unfortunately, I again have to report that there was one death due to pregnancy—the patient, who was mother of a large family and expecting another baby died suddenly, as a result of a condition complicating the pregnancy. NOTIFIABLE DISEASES. The table of Comparative Statistics shows that Richmond residents suffered an unduly high incidence of whooping cough, poliomyelitis, and food poisoning. Whooping Cough. I can offer no satisfactory reason for the high incidence of whooping cough but suggest that it may be related to the particularly low incidence of this disease in 1952. Poliomyelitis. Between the 10th May and the 26th June there occurred 7 cases of poliomyelitis, of which, no less than 5 were severely ill. The occurrence of these cases so early in the season and within such a short period was a matter of very grave concern and might well have been the beginning of a considerable outbreak. Six of the cases were children between and 10 years of age and one was an adult male. Three of the children attended private schools, and home conditions were good in all cases. In one case, the onset of the disease followed shortly after an operation for the removal of tonsils, and in another, it followed an 6 operation for appendicitis. One child received an inoculation 6 weeks before the onset of paralysis. Two of the children attended the same private school. The only mild case was the young brother of a girl who was severely affected. Although 5 of the cases were dangerously ill, all recovered and residual paralysis was much less than had been feared. Preventive measures included closure of a private school for three weeks exclusion and "house-and-garden" quarantine of close contacts. Parents were informed and advised when a case occurred in a school and all pupils were kept under observation. An attempt was made to discover abortive or mild cases amongst school absentees but this was unsuccessful. All cases occurred in the northern part of the borough. Food Poisoning. During the year there were three outbreaks of food poisoning and in addition, nine isolated cases occurred. One of the outbreaks involved a large number of school children and had a most dramatic onset. Outbreak No. 1. In the afternoon of Friday the 10th July between 3.30 and 4 p.m., a number of children were suddenly taken ill in school. Many became ill on the way home, some being picked up by Ambulance and taken to the Royal Hospital. 31 cases reported to hospital and, of these, 12 were admitted. The more severe cases showed shock and prostration with vomiting, abdominal pain, and diarrhoea. The majority made rapid recoveries and were discharged home next day. Immediate enquiries showed that all schools supplied with meals from Gainsborough Central Kitchen had been affected. The outbreak occurred at a difficult time but Dr. Hill (in my absence) and the Chief Sanitary Inspector were able to recall the kitchen staff and start immediate investigations. These continued throughout the week-end, and by Monday, it was possible to take action to prevent the occurrence of further cases. It soon became apparent that every patient had consumed artificial cream made on the same day from dried milk supplied under arrangement made by the Ministry of Food. 7 The Central Public Health Laboratory isolated a staphylococcus commonly associated with food poisoning from a sample of the original artificial cream ; from the remnants of the dried milk used in its preparation and from several unopened tins of the same brand of dried milk. All other investigations, including examination of kitchen staff, were negative and it was finally established that the cause was infected dried milk. On the day of the outbreak no less than 732 meals were prepared by the Central Kitchen and of those who consumed them, 355 are known to have had symptoms of poisoning. It is probable that many others had trivial symptoms which were not reported. It transpired later that similar outbreaks occurred at Epsom, Banstead, and in the London area, and the cause was found to be the same brand of dried milk. All remaining stocks of this milk held at schools throughout the county were withdrawn and no further cases occurred. Outbreak No. 2. In October there was a small outbreak involving 8 people who had symptoms very suggestive of the staphylococcus food poisoning described above. In this case it was found that the cook had an infected finger and that she partly cooked the meat on the day before consumption, re-heating it on the following day. Conclusive bacteriological proof was not obtained, but it is reasonable to assume that the meat or gravy was contaminated by the cook's finger on the day when it was pre-cooked. During the night the organisms were able to multiply and to produce toxims. These would not necessarily be destroyed by the warming up process on the following day and would cause symptoms of food poisoning. This habit of cooking food on the day before consumption is most dangerous and is commoner than is generally appreciated. Efficient storage in refrigerators minimizes this danger but the practice cannot be too strongly condemned. 8 Outbreak No. 3. There was a small outbreak involving a family of five of whom three suffered from food poisoning due to an organism known as Salmonella typhimurium. The origin of the infection was never discovered. All three patients were treated in hospital and made good recoveries. Apart from these outbreaks there were nine isolated cases. Six of these were due to an organism known as Salmonella typhimurium and three were due to unknown agencies. The source of infection was not. traced in any case. One of the patients infected with Salmonella typhimurium was elderly and in such poor general health that she was unable to overcome the infection and died after a few days. Though food poisoning in this country is generally without very serious results, there may be fatal results when those infected are very young, old, or in delicate health. Tuberculosis. Reference to Section F shows that 74 new cases of pulmonary tuberculosis were notified compared with 84 in 1952. This number is still high and is an indication of careful searching for cases by the medical profession and the increasing consciousness of the disease in the minds of the general public. No less than 28 cases were diagnosed in children of school age or under, whereas until quite recently, such cases were rarely notified. Earlier admission of cases to hospital or sanatorium is effective by removing the source. Good facilities for the examination of contacts by X-Rays and skin tests, lead to the discovery of early cases which readily respond to treatment. Mass Radiology continues to play an important part by revealing unsuspected cases and by making the public conscious of this ever present menace. These measures, together with modern methods of treatment and a proposed scheme to offer preventive vaccination to school children, should have the effect of greatly reducing the incidence of this disease and perhaps even eradicating it eventually from the community. 9 Immunization. The diphtheria immunization scheme has continued as in former years. The response has been good and the figures given in Section F are realistic and as accurate as possible. Immunization against whooping cough has become very popular indeed and nearly every baby is now given a combined diphtheriawhooping cough vaccine. This not only reduces the total number of injections required to confer immunity but probably gives a greater degree of immunity to both diseases than when the prophylactics are given separately. The number of infants vaccinated against smallpox is remarkably high, when compared with other parts of the country. This must be a reflection of the energetic propaganda carried on by the Health Visitors and the sensible appreciation of modern preventive measures by most of the Richmond mothers. NATIONAL ASSISTANCE ACTS, 1948 and 1951. Removal to suitable premises of persons in need of care and attention. Once again no action was taken under the above Acts during the year 1953. There were numerous cases of old or infirm persons who required help but in every case some solution was found which made compulsory removal unnecessary. Although the powers conferred by the Acts may be essential in a few cases one cannot but help being reluctant to remove by compulsion any old or infirm person who is of sound mind. The difficulty of getting elderly patients into hospital beds for the chronic sick is just as great. The solution to the problem is not easy and I am afraid that there is little likelihood of an improvement in the immediate future. Improvement in the local geriatric services would be a step in the right direction but the immediate need is more beds. In really bad cases I continue to have the active co-operation of the Physician Superintendent of Kingston Hospital who controls beds for the chronic sick, and of the Divisional Welfare Officer who is 10 concerned with the admission of elderly persons to Part III accommodation. Housing. During the year 153 houses and 22 flats were added to the Council's estate bringing the total of properties owned up to 1,817. Unfortunately it will not be possible to maintain this rate of progress in subsequent years since there is very little more land available for building purposes. The question of Slum Clearance was examined during the year, and, after careful consideration I submitted to the Health Committee a list of 90 properties which I felt that I would be prepared to represent as unfit for human habitation and that the most satisfactory method of dealing with them would be by demolition. Although both the Health and Housing Committees were anxious to deal with this comparatively small amount of slum property their inability to rehouse those displaced presented a serious problem. Unfortunately, few of the sites enumerated would be of much use for rebuilding purposes. Finally, it was decided to make a start by representing 1-3, California Cottages, Kew Green and 1-3, Berridges Cottages, Richmond. Orders for the demolition of these properties were confirmed by the Ministry of Housing and Local Government and all families had been rehoused before the end of the year. Unfit property of this type should be dealt with even though there may be a considerable waiting list. These properties can only become more and more unhealthy by delaying the day of their demolition. It is hoped that there will be sufficient building within the next year or so to cover these needs. Sanitary Circumstances. The report of the Chief Sanitary Inspector is included in Sections C, D and E, and reference to these shows the large and varied amount of work carried out by the team of Inspectors and the Rodent Control Staff. All details regarding the sale of food have been grouped together and, at the request of the Ministry of Health, additional details have been included. 11 The Sanitary Inspector's duties arc very varied and include duties relating to housing, prevention of the spread of infectious diseases and supervision of the purity of water supplies. The staff establishment is just sufficient to cover all requirements provided there are no vacancies due to sickness or resignations. However, there is a tendancy for additional duties to be added each year and if this continues it may become necessary to reconsider this establishment at some future date. Although the number of cases of food poisoning reported during the year was unusually large, it is satisfactory to be able to report that not one of these cases was traced to a public restaurant or cafe. APPENDIX. SECTION A—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1952) 42,440 Number of inhabited houses (estimated) 11,528 Rateable value £639,407 Sum represented by a Penny Rate £2,523 BIRTHS. Birth Rate per 1,000 of estimated resident population . 13.8 (corrected) 12.8 Total number of births (live and still) 585 Analysis:— M F Total Live Births Legitimate 279 257 536 Illegitimate 21 13 34 Stillbirths Legitimate 8 7 15 Illegitimate — — — Still birth rate per 1,000 total births 25.6 12 Environment of births:— Proportion taking place in the Borough 24% Proportion taking place outside the Borough 76% Proportion taking place in Institutions 76% Proportion taking place in dwelling houses 24% Proportion notified by midwives alone 26% Proportion notified by doctors or parents 74% DEATHS. Death Rate per 1,000 estimated resident population 12.0 (corrected) 9.61 Total number of deaths from all cause 510 Analysis:— M F Total All causes 260 250 510 Cancer 40 35 75 Diphtheria — — — Measles — — — Whooping Cough 1 — 1 Diarrhoea (under two years) — — — Maternal Mortality Rate per 1,000 total births 1.7 Total number of maternal deaths 1 Infant Mortality (Deaths under one year of age). Infant Mortality Rate for all infants per 1,000 live births 10.5 Rate for legitimate infants per 1,000 legitimate live births 9.3 Rate for illegitimate infants per 1,000 illegitimate live births 29.4 Total number of infant deaths in the Borough 6 Analysis:— M F Total Legitimate 3 2 5 Illegitimate - 1 1 13 Environment of Infant Deaths:— Number occurring in the Borough 3 Number occurring outside the Borough 3 Number occurring in Institutions 3 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 months and under 9 months 9 months and under 12 months Total deaths under I year 1. Pneumonia ... ... ... ... ... ... ... 1 ... 1 2. Acute Suppurative Bronchitis ... ... ... ... ... ... 1 ... ... 1 3. Whooping Cough ... ... ... ... ... ... 1 ... ... 1 4. Enteritis ... ... ... ... ... ... ... ... ... ... 5. Congenital Debility and Malformation including Premature Births 3 ... ... ... 3 ... ... ... ... 3 6. Birth Injury ... ... ... ... ... ... ... ... ... ... 7. Asphyxia ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 ... 2 1 ... 6 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 7 7 1 - - 6 (b) In Nursing Homes — — - - - - (c) In Hospitals — — — — — - Richmond Children born outside the Borough: (a) In Nursing Homes — — — — — — (b) In Hospitals 19 19 1 — — 18 Children born In Richmond, mother normally residing elsewhere: (a) In Nursing Homes — - - - - - (b) In Hospitals - - - - - - 14 ILLEGITIMATE BIRTHS 1944 1945 1946 1947 1948 1949 19.10 1951 1952 1953 No. of illegitimate live births 62 62 51 54 38 40 . 43 43 25 34 No. of illegitimate deaths under 1 year 3 4 5 2 0 1 2 0 3 1 Illegitimate death rate 48 65 98 30 0 25 46 0 120 29 15 COMPARATIVE STATISTICS—1953 England and Wales 160 County Boroughs and Great Towns including London. 160 Smaller Towns (Resident populations 25,000— 50,000 at 1951 Census London Administrative County- Richmond Richmond Actual Kates per 1,000 Home Population. Nos. Births— Live Births 15.5 17.0 15.7 17.5 13.4 570 Still Births 0.35 0.13 0.34 0.38 0.35 15 22.4 (a) 24.8(a) 21.4(a) 21.0 (a) 25.6 (a) Deaths— All Causes 11.4 12.2 11.3 12.5 corrected 12.0 9.6 510 Typhoid and Paratyphoid 0.00 0.00 - - — 0 Whooping Cough 0.01 0.01 0.00 0.00 0.02 1 Diphtheria 0.00 0.00 0.00 — — 0 Tuberculosis 0 20 0 24 0.19 0.24 0.19 8 Influenza 0.16 0.15 0.17 0.15 0.45 19 Smallpox 0.00 0.00 0.00 — — 0 Acute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.01 0.01 0.02 1 Pneumonia 0.55 0.59 0 52 0.64 0.40 17 Notification (corrected) Typhoid Fever 0.00 0.00 0.00 0.01 - 0 Paratyphoid Fever 0 01 0.01 0.01 0.01 — 0 Meningicoccal Infection 0.03 0.04 0.03 0.03 — 0 Scarlet Fever 1.39 1.50 1.44 1.02 1.22 52 Whooping Cough 3.58 3.72 3.38 3.30 6.15 261 Diphtheria 0 01 001 0.01 0.00 — 0 Erysipelas 0.14 0.14 0.13 0.12 0.12 6 Smallpox 0.00 0.00 0.00 - — 0 Measles 12.36 11.27 12.32 8.09 7.77 330 Pneumonia 0.84 0.92 0.76 0.73 0.35 15 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0 07 0 06 0.06 0.07 0.14 6 Non Paralytic 0.04 0.03 0.04 0.03 0.02 1 Food Poisoning 0.24 0.25 0.24 0.38 2.42 103 Puerperal Pyrexia 18.23 (a) 24.33(a) 12.46(a) 28.61(a) — 0 Kates per 1,000 Live Births. Deaths— All causes under 1 year of age 26.8 30.8 24.3 24.S 10.5 6 Enteritis and Diarrhoea under 2 years of age 1.1 1.3 0.9 1.1 — 0 MATERNAL MORTALITY England and Wales Richmond Number of Deaths Rates per 1,000 Total (Live and Still) Births Number of Deaths Rates per 1,000 Total (Live and Still) Births Other complications of pregnancy, childbirth and puerperium 125 0.18 1 1.7 (a) Per 1,000 Total (Live and Still) Births 16 SECTION B— GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. These are mainly provided by the Surrey County Council and the South West Metropolitan Regional Hospital Board. In order to make the report complete these are briefly described below. (a) Services Provided by the Surrey County Council. These are organised on a Divisional basis, the Northern Division comprising the Borough of Richmond and Barnes. The Medical Officer of Health for Richmond is also the Divisional Medical Officer and this arrangement provides close co-ordination of the personal health services and environmental health. Administrative, Infant Welfare, and School Medical functions are carried out from the following Centres:— Divisional Health Offices and Welfare Centre, Kings Road, Richmond. Welfare Centre, Windham Road, Richmond. Welfare Centre, Back Lane, Ham. Health Visitors are employed and, according to the District in which they work they are based on one or other of the above centres. District Nurses and Midwives are provided and in Richmond their centre is the Nurses Home, 19, Larkfield Road. They work under the direct supervision of the general practitioners. Moral Welfare or the care of unmarried mothers and illegitimate children is undertaken by an officer based at the Divisional Health Office. A Home Help Service provides for domestic help in the home in cases of home confinement or illness. The service is under the management of the Home Help Supervisor who is based at the Divisional Health Office. An Ambulance Service is provided from the station in Kings Road, Richmond which operates under the control station in Maiden. The service is supported by the ambulance of the local division of the St. John Ambulance Brigade. A' Day Nursery for the care of children up to the age of five years is located in Parkshot, Richmond. 17 (b) Services Provided by the Regional Hospital Board. Hospitals. The Royal Hospital and Kingston Hospitals provide general treatment both for in-patients and out-patients. In addition, hospitals in London and Middlesex are frequently used by Richmond residents. Patients suffering from infectious diseases are admitted to the South Middlesex Hospital, Mogden Lane, except in the few instances when no beds are available. In these cases, patients are admitted to Tolworth Isolation Hospital or to a hospital in the London area. Laboratory Facilities. The laboratory of the Royal Hospital is available for the examination of specimens sent in by general practitioners. The Ministry of Health, Public Health Laboratory, Epsom, is available for the examination of samples of milk, ice-cream, and water and of any pathological specimens. In addition, the staff is always available to assist the Medical Officer of Health in field investigations in the case of epidemics or outbreaks of food poisoning. The Central Public Health Laboratory, Colindale, N.W.9, is available for advice, special immunising agents and special investigations. The Counties Public Health Laboratories, Victoria Street, S.W.I are used for the examination of water samples and for advice in the control of purity of the water supply. Mortuary. This is provided and maintained by Richmond Borough Council on a site close to the Petty Sessions Court. It is well equipped with two post-mortem examination tables. All such examinations required within the boroughs of Richmond and Barnes are carried out here and Barnes Borough Council make an annual payment for this service. Nursing Flomes. The following private Nursing Homes are registered by the Surrey County "Council:— The Misses E. Town and D. Smith, 9, Townshend Road. Tyneham House Nursing Home, 108, Church Road. Tuqvor House Nursing Home, 18, Mortlake Road, Kew. 18 SECTION C— SANITARY CIRCUMSTANCES. Water Supply. Richmond has two separate sources of drinking water:— (a) From local wells. (b) From the Metropolitan Water Board. The origin and method of treatment of these supplies have been fully reported in previous years and remain unchanged. Both supplies are treated by chlorination: and very close observation of the purity of the water is maintained by frequent examinations of the water samples. During the year the following samples were taken for examination:— (a) Richmond Water Supply. Untreated water 131 samples Treated water 402 samples For chemical analysis 24 samples Every sample of treated water passing into public supply was of the highest standard of bacterial purity. Chemical analysis of samples showed that the organic quality of the water maintained a high and satisfactory standard. (b) Metropolitan Water Board Supply. Samples examined bacteriologically 873 Samples examined chemically 234 The results of these examinations indicated that a very high standard of chemical and bacteriological purity was maintained throughout the year. In addition to these two supplies of drinking water there is a supply of raw river water which is delivered to Kew Gardens, allotments and to the gardens of a proportion of the residences in Richmond. The water is chlorinated as a precautionary measure but is not fit for drinking. 19 The following figures show the daily average consumption from the three sources:— 1952 1953 All Richmond Wells 796,533 galls. 771,049 galls. Metropolitan Water Board 837,997 galls. 946,937 galls. Raw River Water 258,397 galls. 228,411 galls. The drinking water supplies in the district are not plymbosolvent. Water fit for human consumption is made available by piped supply to every dwelling house in the Borough. 20 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 1953. Houses visited and particulars recorded (Housing Act) 12 Houses visited (Public Health Acts) 1074 Revisits to houses and other premises 1815 Visits paid in connection with:— Overcrowding 216 Vermin 94 Disinfection 503 Enquiries into Infectious Diseases 259 Corporation Dwellings 81 Routine inspections in connection with:— Factories (mechanical) 302 Factories (non-mechanical) 32 Outworkers 41 Bakehouses 61 Butchers' Shops 70 Dairies and Milk Shops 41 Fishmongers and Poulterers 18 Fried Fish Shops 10 Ice-cream premises 178 Greengrocers' and Fruiterers 51 Other food stores 93 Public Houses 28 Restaurants and Tea Shops 205 Milk Sampling (Pasteurised) 121 Unsound Food 188 Drainage 837 Interviews 708 Massage Establishments 3 Pet Animals Act 6 Petroleum Acts 153 21 Piggeries 1 Rag and Bone Dealers 1 Rag Flock Act 2 Rats and Mice (Visits to Properties) 3916 Rats and Mice (Visits re sewer treatments) 1357 Schools—Elementary and Secondary 9 Shop Acts 16 Smoke Nuisances—Inspections and Observations 23 Tents, Vans and Sheds 3 Water Supply 291 Miscellaneous Visits 1439 14,258 Drain* and Sewerage Systems Tested. Hydraulic tests 39 Smoke tests 21 Chemical tests 34 Examinations 22 116 Factories Act, 1937. At the end of the year there were 168 factories on the register (150 mechanical and 18 non-mechanical) carrying on the following trades:— Mechanical. NonMechanical. Artificial wreaths, etc 2 1 Bakeries 10 2 Boat Repairs 1 1 Boilermakers 2 — Boot-making and Repairing 9 — Building 1 3 Butchers 3 — Clothing 3 1 Cycle Repairs 1 1 Dressmaking 9 3 22 Electrical Instruments, etc. 10 — Engineering 18 — Furniture and Upholstery 8 3 Gas Storage 1 — Glue-making 1 — Jewellery Repairs 1 1 Joiners 6 — Laundering and Cleaning 4 — Milk Pasteurising 2 — Motor Vehicle repairing 24 — Photography (Printing & Developing) 1 — Printing 6 — Saw Mills 2 — Tailoring 1 2 Undertaking 1 — Wallpaper manufacture 2 — Wheelwright and Coach Building 7 — Miscellaneous Trades 14 — 150 18 334 visits of inspection were made to the premises outlined above and the following defective conditions were remedied:— Want of cleanliness to Factory walls, etc. — Inadequate ventilation of Factories — Ineffective drainage of Factory floors — Insufficient Sanitary accommodation 16 Unsuitable or defective conditions in Sanitary accommodation 96 Other matters requiring attention 20 132 Shops Acts, 1950. Shops on the Register 793 Visits made 16 The above figure docs not include the number of visits paid to food shops which, when visited, are covered for all provisions of the Various Acts. 23 SANITARY DEFECTS REPORTED. Animal nuisances 4 Basement areas inadequate 7 Ceilings broken or otherwise defective 99 Chimney stacks defective 11 Coppers broken or otherwise defective 3 Damp-proof courses required or defective 13 Doors defective 57 Drainage systems obstructed 60 Drainage systems leaking or defective 94 Firegrates and flues defective 64 Floors broken or otherwise defective 83 Floor drainage inadequate 1 Food preparation equipment unsatisfactory 3 Food rooms requiring reconstruction 3 Food storage unsatisfactory 13 Gutters leaking or defective 71 Lighting inadequate 40 Paving inadequate or defective 21 R.W.Ps. ventilating drainage systems 2 R.W.Ps. broken or otherwise defective 23 Refuse accumulations 27 Refuse receptacles defective 60 Roofs leaking or defective 10 Rooms requiring cleansing 59 Sanitary accommodation insufficient 19 Sanitary accommodation not separate for sexes 9 Sinks insanitary or defective 35 Sites requiring concreting 7 Soilpipes leaking or defective 27 Staircases defective 14 Ventilation of rooms inadequate 53 Verminous premises 12 Walls: plaster defective 79 Walls: brickwork defective 93 Washing facilities in food premises inadequate 12 Wastepipes leaking or defective 31 Water fittings defective 31 24 Water supply cut off 12 Water supply inadequate 2 W.C.'s leaking or defective 184 Windows defective 178 Miscellaneous defects 96 2,132 At the end of the year, 1421 of the defects discovered had been abated, the work of remedying 269 was in hand, and the balance of 442 were still outstanding. In order to see that the defects were being properly remedied 1815 visits were paid to the various premises. NOTICES SERVED TO REMEDY DEFECTS AND ABATE NUISANCES. Informal Action. Preliminary intimations 347 Verbal intimations 186 Interviews 708, Statutory Action. [ ]Act and Section. Notices Authorised. Notices Served Public Health Act, 1936. Section 24 (Drainage) 10 5 Section 39 (Drainage) 25 13 Section 45 (Defective Closets) 6 4 Section 75 (Dustbins) 8 7 Section 92/93 (Nuisances) 77 34 Housing Act, 1936. Section 9 (Insanitary Dwelling) 3 2 In the main the work called for by Statutory notices was carried out by the owners but in two cases it became necessary for the Local 25 Authority to carry out work in default under Section 9 of the Housing Act, 1936, at a cost of £193/18/3 and £192/15/0 respectively. In one case, under Section 75, Public Health Act, 1936, the Local Authority provided three dustbins at a dwelling house and recovered the cost from the owner. PROSECUTIONS. It became necessary to take proceedings against an occupier of premises who failed to comply with an abatement notice served under sections 92/93, Public Health Act, 1936. At the Petty Sessions Court, on the 1st October, 1953, a Nuisance Order was made requiring the occupier to carry out works to abate the nuisance within 28 days, and a fine of £5 was imposed with two guineas cost. An appeal by an owner against a Statutory Notice served under Section 75, Public Health Act, 1936, to provide a dustbin at a dwelling house, was heard at the Petty Sessions Court on the 12th November, 1953. The magistrate disallowed the appeal. COMPLAINTS. The number of complaints received from the 1st January to 31st December, 1953 was 886 which is an increase of 289 over the same period in 1952. The complaints received have been classified as follows : — Defective firegrate's 8 Defective sinks 7 Defective drainage 99 Defective water fittings 44 Defective windows 10 Defective walls and ceilings 18 Defective chimneys 6 Defective W.C.'s 39 Defective roofs and gutters 34 Dampness 57 Defective stairs and steps 8 Accumulation of rubbish 18 Defective dustbins 17 16 Unsound food 30 Nuisance from rats and mice 271 Nuisance from animals 13 Nuisance from smoke 25 Nuisance from vermin, ants, etc..47 General Defects 122 Overcrowding 4 Noise Nuisance 9 886 Prompt investigation was made and suitable action was taken to remedy the complaints. PETROLEUM (CONSOLIDATION) ACT 1928 AND REGULATIONS MADE THEREUNDER. Fifty premises within the Borough are licensed to store a total of 66,275 gallons of Petrol, Petroleum Mixtures and Cellulose solutions. They have received regular inspection to ensure that the various regulations have been observed. In all a total of 153 visits were made to the various installations. One new licence was approved and the total licence fees amounted to £33 17s. 6d. Only minor infringements of the Regulations were found. DISINFECTION OF PREMISES. Reason. Houses. Rooms. Bedding, etc. Infectious Fevers 45 48 319 Tuberculosis 19 24 105 Vermin 32 100 28 Other Diseases 31 20 205 Costs recovered throughout the year : £28 17s. 5d. Solutions of D.D.T. in Kerosene are used for dealing with infest ations by bedbugs and are usually applied in spray form to the wall:, ceilings and woodwork of the infested rooms. It is becoming a rare 27 occurence to give more than one course of treatment to eradicate bedbugs. D.D.T. powders prove very effective in dealing with ants and cockroaches and much practical help and advice has been extended to householders who have found their premises infested with these pests. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The rodent section of the staff have done much useful work during the year in eradicating rats and mice from premises and foul sewers. A total of 3,916 visits were made to Dwellings and Business premises throughout the year. 271 complaints of infestation by rats or mice were received from occupiers of premises, and inspection and investigation revealed rat infestation at 176 premises and mice infestation at 100 premises. By the end of the year infestations had been cleared at 263 of these premises. Treatment of the foul sewers was carried out on two occasions a total of 1,357 visits being made for this purpose in connection with inspection, baiting, poisoning and checking results. In all 450 manholes were dealt with and of this number 149 were found to be infested and were baited and poisoned. The takes of poison baits in the infested manholes were good and the results obtained at both sewer treatments were very satisfactory. SMOKE ABATEMENT. Richmond, being residential in character, has few large works or Factories, but an increasing number of complaints has been received alleging nuisance from smoke emission. Twenty-five complaints were received during the year, and 12 observations for excess smoke were made. Interviews with managers and advice to stokers, in those cases where the complaints were justified resulted in improved conditions. At the end of the year, the investigations of two complaints involving boilerhouse chimneys was still continuing. 28 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. This Act came into force on the 1st November, 1951 and briefly its provisions call for the registration of all premises in which Rag Flock or other filling materials, as defined in Section 33 of the Act (i.e.: Kapok; Woollenfelt; Cotton flock, etc.) are used, in the manufacture of bedding, toys, babycarriagcs and other articles of upholstery. The Act also calls for the licensing of premises where Rag Flock is (a) Manufactured; (b) Stored for distribution to registered premises but no premises coming within this definition are situated within the Borough. Only 1 Factory in the Borough has been registered, regular supervision of the premises has been maintained during the yeai. No infringements of the provisions of the Act were observed. PET ANIMALS ACT 1951. This Act came into force on the 1st April, 1952 and is designed to secure for Pet Animals kept in shops, for sale to the Public, suitable accommodation as regards size, temperature, lighting, ventilation and cleanliness; adequate supplies of food and drinking water; prevention of sale at too early an age; precautions to prevent the spread of infectious diseases amongst the animals and precautions to be taken in case of fire or other emergency. No person may now keep a pet shop unless he obtains a licence from the Local Authority, and it is an offence to sell animals as pets in any part of a street or public place, except at a stall or barrow in a market, or to sell pets to children under 12 years of age. In the Act, "animal" is defined as including any description of vertebrate and as such includes goldfish and cage birds, which are the principal sales in the shops licensed in the Borough. Four premises hold licences from the Richmond Borough Council to carry on this business. 29 Regular inspection of the premises is carried out, and a cbse liaison maintained wth the Local representative of the Royal Society for the Prevention of Cruelty to Animals. Licences are renewable annually and an inspection is made before renewals are brought before the. Council. DISEASES OI; ANIMALS ACT 1950. The number of outbreaks of Foot and Mouth Disease reported throughout England and Wales was considerably reduced in 1953 compared with the previous year. Richmond was not directly involved in any of these outbreaks but came under Infected Area Restrictions on one occasion during 1953. These restrictions controlled the movement of animals except for special purposes and in connection with this control the following licences were issued or countersigned. * One occupational licence issued to allow movement of animals from farm buildings to grazing grounds and 4 licences countersigned to allow movement of calves or pigs to slaughterhouses for immediate slaughter. 30 SECTION D—HOUSING. Housing Statistics for the Year 1953. 1. Number of dwellings owned by the Local Authority:— Number of Houses ... 1468 Number of Flats ... 349 1817 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) 1086 (b) Number of inspections made for the purpose 2901 (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 12 (b) Number of re-inspections made under the Regulations 80 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 368 (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 cases outstanding from the previous year) 322 31 (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 2 (ii) Number of dwelling houses which were rendered fit after service of formal notices : — (a) By owners Nil. (b) By Local Authority in default of owners 2 B. Proceedings under the Public Health Acts : — (i) Number of dwelling houses in respect of which notices were served, requiring defects to be remedied 43 (ii) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 22 (b) By Local Authority in default of owners Nil. C. Proceedings under sections 11 and 13 of the Housing 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 2 32 3. Overcrowding. Overcrowding is still considerable throughout the Borough. The points scheme of House allocation usually covers the worst of these cases and their overcrowded conditions are relieved as and when houses are available. 4. Council Houses. Total number of houses erected . post-war to 31st December, 1953 Temporary bungalows 179 Permanent houses 485 Permanent flats 187 672 Total number included in above, erected in 1953 Permanent houses 153 Permanent flats 22 Total number of requisitioned premises up to December 31st., 1953 107 (providing 220 family units) Total number of families rehoused in 1953 225 Total number of families still on Waiting List at December 31st, 1953 1371 At the present time 8 one-roomed flats for aged persons on two separate sites are nearing completion. Nine one-roomed flatlets in Eton Street are now occupied. As to the future, it is proposed to erect 24 flats on the factory site, Townshend Terrace and Grena Road. Moveable Dwellings. An owner of land within the Borough, holds a licence, renewable annually, permitting him to stand two caravans on the land. Satisfactory provision is made for the disposal 'of household refuse, use of sanitary conveniences and main water supply. Three inspections of this site were made during the year. 33 Withdrawal of Closing Orders or Undertakings. Undertakings were given by owners, in 1937 and 1938, respect' ively, not to let the basement rooms of Nos. 80, Mount Ararat Road and 87, Church Road, until they were rendered fit for human habitation. The works necessary to render the basements fit for habitation was carried out during the year and the undertakings have been cancelled. Housing Act, 1936. Section 25. (Power to declare an Area to be a Clearance Area). Richmond (Surrey) (California Cottages) Clearance Order, 1953. Richmond (Surrey) (Berridges Cottages) „ „ 1953. California and Berridges Cottages each consisted of three terrace type two-storey cottages which had reached the stage of being completely unfit for human habitation. Official representation to this effect was made to the Health Committee by the Mcdical Officer of Health on the 3rd of June. The Richmond Borough Council declared both areas to be Clearance Areas on the 16th of June, 1953, and confirmation of the orders was received from the Ministry of Housing and Local Government on the 30th September, 1953. By the 30th November, 1953, all six families had been rehoused and it is anticipated that complete demolition of the properties will be effected early in 1954. Rent & Mortgage (Interest Restrictions) Acts, 1920-1939. No applications for a certificate under the provisions of the above Act were received during the year. 34 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. 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. Articles Tons Cwts. Qrs. lbs. Cheese — — — 29 Fish (Wet and Pried) — 3 — — Flour and Flour Confectionery — 2 2 10 Fruit (Dried) — — — 2 Meat and Meat Products — 2 2 — Sugar — — — 21 Tea 1 4 Tinned Goods (all classes) 2 6 — 1 2 11 3 11 Whenever possible condemned food is salvaged to be used for animal feeding, but in all other cases, the food is destroyed by burning at the Refuse destructor. It was not found necessary to institute any legal proceedings against any person for the sale of food unfit for human consumption. Thirty complaints, alleging that food had been sold in a condition unfit for human consumption, were received during the year and received full investigation and as a result, reports were made to the Health Committee in ten cases and warning letters were sent to the offenders. 35 Food SC Drugs Act, 19.3S (Sale of Food & Drugs—Sampling detr.il>). The following table gives details of the number and kind :: sample taken in the Borough of Richmond by the Surrey Cour.r. Council during the year ending 31st December, 1953. Articles. Analysed Adulterated or Irregular Formal Informal Total Forma! Informal Total. Milk 28 12 40 Coffee — 1 1 Cream, double 1 1 1 Cream, sterilised — 1 1 Dripping — 2 2 Fish Cakes — 1 1 Flour — 1 1 Grape Juice — 1 1 Honey — 1 1 Ice Cream 1 — 1 Jelly — 2 2 Marzipan — 1 1 Meat Paste — 1 1 Meat Pie — 1 1 Meat Pudding — 1 1 Soft Drink — 1 1 Tomato Ketchup — 1 1 Whisky 5 — 5 Wine — 1 1 Totals 35 30 65 — — — 36 Classification of Food Premises. The number of food premises within the Borough is shown in the following table and has been classified, according to the principal business carried on: — Bakehouses 13 Butchers 34 Confectioners (flour) 15 Confectioners (sugar) 41 Dairies (registered) 10 Fishmongers 18 Greengrocers 38 Grocers 76 Ice Cream Manufacturing premises 3 Licensed premises 67 Restaurants, Cafes, etc. 100 415 Premises registered under the provisions of Section 62 of the Richmond (Surrey) Corporation Act, 1937 are as follows:-— Premises registered for the manufacture of preserved food 28 Premises registered for the manufacture, storage, and sale of Ice Cream 100 The number of premises which are registered as Dairies under the Milk and Dairies Regulations of 1949 is 10. Inspection of Food Premises. The inspection of food premises has been steadily maintained throughout the year, a total of 755 visits being made. Of this number visits were made as follows to registered premises : — Butchers 70 Dairies 41 Ice Cream Premises 178 37 As the result of such inspections the following improvements have been carried out: — Food rooms repaired, cleansed or redecorated 142 premises .Additional Sanitary accommodation provided 3 „ Existing Sanitary accommodation improved. 29 ,, Constant hot water supply installed 2 „ Staff washing facilities improved 11 „ New sinks provided 7 ,, Ventilation and lighting of food rooms improved 5 „ Drainage improved, repaired or altered 11 „ Floor drainage provided 1 „ Food rooms reconstructed 3 „ Food storage improved 13 ,, Food preparation equipment renewedal attention by Sanitary Inspectors when visiting and inspecting food premises and it is pleasing to note that proprietors and staff of food establishments are in general observing the requirements. Attention has been drawn to infringements and advice, together with suggestions for improvement, has been given in many cases in an endeavour to help management and staff to reach a higher hygienic standard. On the whole, the byelaws were well received and Co-operation by food traders has been good. 38 Richmond Clean Food Traders' Guild. By the end of 1953 membership of the Guild had increased by two to a total of fifty-seven which represents a percentage of 15.04 of the total number of food traders within the Borough and, while. such a low figure is discouraging, it compares favourably with membership of similar Guilds operating in adjoining Boroughs. There are many non-members of the Guild whose premises are in good condition and would qualify for immediate membership, but it is still very difficult to get them to make application. The premises of members have, along with other food traders, received regular inspection throughout the year and have been kept, apart from minor items of disrepair, etc., well up to the standards required by the Guild and the various Acts and Regulations. In the main the badge of membership has been prominently displayed to public view. There has again been very little business for the Advisory Committee to discuss but the prospect of changes in food legislation during 1954 may mean changes in Guild Policy. Ice Cream. Premises manufacturing, storing or selling Ice Cream have been regularly supervised, a total of 178 visits being made. Three premises are registered for the manufacture of ice cream, but in no case is the additional heat-treatment method approved by the Ice Cream (Heat Treatment) Regulations, 1952, in use. A total of 128 samples were submitted to the Bacteriologist for examination and of this number 114 were within Grades I and II and considered to be satisfactory but 14 which came within Grades III and IV were considered to be unsatisfactory. In the case of the unsatisfactory samples careful inspection was made of the premises, equipment and methods of storage or manufacture and help and advice given as to the best means of effecting improvement. The policy with sampling is to take the greater number of samples from premises which have produced unsatisfactory samples in the past and to sample only occasionally those dealers who invariably produce good results. 39 The standard of ice cream production and sale is generally high and in all cases the Ice Cream (Heat Treatment) Regulations, 1947/52 have been complied with in every respect. Food and Drugs (Milk and Dairies) Act, 1944. This Act, together with various regulations made under it, came into operation on the 1st October, 1949. The general effect was that all Dairy Farms became the direct responsibility of the Ministry of Agriculture and Fisheries : premises on which milk is pasteurised or sterilised are licenced by the Food and Drugs Authority and in all other cases, Dairies or Dealers in Designated milk come under the complete control of the Local Authority in respect of licencing, inspection and control. There are two dairy farms under the control of the Ministry and two pasteurising premises are under direct licence by the Food and Drugs Authority, i.e., Surrey County Council. The following licences have been granted by the Richmond Borough Council authorising dealers to store and sell Designated milks: — Pasteurised Milk .terilised Milk 22 Supplementary licences were also granted, authorising dealers to retail milk in the Borough from premises situated outside, as follows: — Pasteurised Milk 8 Tuberculin Tested Milk 8 Sterilised Milk 8 All premises are inspected before licences are granted, and principal licences are verified with the appropriate local authorities before licences are issued. No licences were refused 40 Under the regulations the Loeal Authority may continue to take samples from any dealer and during the year under review the following were taken: — Pasteurised Milk 119 samples Number found to be satisfactory. 117 „ Samples of raw milk examined biologically for the presence of Tubucle bacilli 6 „ Number found to be satisfactory 6 „ The District Medical Officer of Health retains the power to take appropriate action to prevent the spread of disease by infected milk. 41 SECTION F- PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). Diseases. Total Cases Notified. Cases Admitted to Hospitals. Total Deaths. Scarlet Fever 52 10 — Pueperal Pyrexia — — — Pneumonia 15 8 17 Erysipelas 5 1 — Measles 330 7 — Whooping Cough 261 7 1 Poliomyelitis Paralytic 6 0 1 Poliomyelitis Non Paralytic 1 1 — Dysentery 38 — — Ophthalmia Neonatorum 2 — — Food Poisoning 103 26 1 Malaria 1 1 — Total 814 67 20 FOOD POISONING. Total number of outbreaks 3 Number of cases notified 103 Number of deaths 1 DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1953 : — (a) Pre-school children (under 5 years) 441 (b) Between 5 and 15 years 19 Total 460 Grand Total of Children in the Borough who have received immunising treatment by the end of the year : - (a) Under 5 years 1923 (b) Between 5 and 15 years 4649 Number of Children given re-inforcing doses during 1953 544 42 The following table show; the percentages of children immunised as recorded in the Annual Reports since 1946: — 19-16 1947 194S 1949 1950 1951 1952 1953 Under 5 years 69.9 59 69. S 69.8 69 67.6 69.9 65.1 5 to 15 years 86.2 88 95.3 94 91.4 95 2 91.5 95.8 In addition the policy of giving single reinforcing doses at appropriate intervals during a child's school life has been continued. The materials used are, for children under 10, Alum Precipitated Toxoid and for children over 10 Toxoid Anti-Toxin Floccules. T.A.F. is used for all reinforcing doses and is given subcutaneously. WHOOPING COUGH IMMUNISATION. A combined prophylactic giving protection against Diphtheria and Whooping Cough is used, or in cases where Diphtheria Immunisation has already been completed, protection against Whooping Cough is given separately. Attendances at Clinics during 1953. Diphtheria and Whooping Cough Combined Whooping Cough only Windham Road, Richmond 522 212 Back Lane, Ham ... 205 74 Sheen Road, Richmond (since 6.5.53) 315 66 Private Doctors. In addition 122 children were immunised with the combined prophylactic by private doctors and 30 against whooping cough alone. 43 VACCINATION AGAINST SMALLPOX. 1. Welfare Centres. Number of persons vaccinated at Welfare Centres in the Borough during 1953 was as follows:-— No. Vaccinated Children Adults Windham Road, Richmond 193 12 Back Lane, Ham 63 1 Sheen Road, Richmond (since 6.5.53) 95 3 Totals 351 16 Grand total 367 3. Analysis of vaccinations at Welfare Centres and Private Doctors Surgeries. Children. Adults. Primary Vaccination 504 42 Re-vaccination 17 138 Totals 521 180 Grand Total 701 4. Figures showing the percentage of children under 1 year vaccinated during 1953. No. Vaccinated Live Births 1952 % Vaccinated 468 579 80.8 2. Private Doctors. Number of Richmond residents who \vcre vaccinated by private doctors was as follows: — Children Adults 170 164 Grand Total 334 44 VERMINOUS CONDITIONS. YEAR 1941 1942 1943 1944 1945 1946 1947 194S 1949 1950 1951 1952 1953 Scabies . 34 12S 241 431 274 377 66 12 11 7 2 Nil. 4 Head Lice — 204 205 181 188 308 239 78 141 129 98 40 54 Figures in the above table are children attending schools in the Borough found to be verminous at routine inspections in school by Health Visitors. Scabies is no longer a problem in the district. The 54 cases of louse infestation are school children who are well known to the School Nurses. They are given materials for cleansing and parents are given full instructions. Bad cases are cleansed at the school clinics by the Health Visitors. TUBERCULOSIS. The position in Richmond for the year 1953 may be summarised as follows: — NOTIFICATIONS: Respiratory Tuberculosis. Seventy-four cases of respiratory tuberculosis were notified viz 45 males and 29 females. The corresponding figure for 1952 was 84. Non-Respiratory Tuberculosis. Eight new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Four such cases have been notified during 1952. 45 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 175 17 Females 125 17 300 34 Corresponding figures for 1952 336 44 The considerable reduction in the number of names on the register was effected by careful scrutiny of each case and by making a personal call on each patient in respect of whom no recent information was available. tion was available. In this way, it was discovered that a number of patients were cured, had left the district, or that their circumstances had so changed that their names should no longer be included. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 ... 1 ... ... ... ... ... ... 1 1 2 ... 1 ... ... ... ... 5 2 1 ... 2 ... ... ... ... 15 8 13 ... ... ... ... ... ... 25 15 6 ... ... ... 1 ... ... 35 5 3 ... 1 1 1 ... ... 45 8 1 ... 1 1 2 ... ... 55 2 1 ... ... ... ... ... ... 65 and upwards 4 1 ... ... 2 ... ... ... Totals 45 29 3 5 4 4 ... ... 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. 46 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 1953 it was not found necessary to take action under either of the above enactments. AFTER CARE. The Barnes and Richmond Tuberculosis Care Committee continued their important part in the Surrey County Council Scheme for the "care and after care" of tuberculous patients. The aim of the Committee is to supplement official help for the patient and his family, according to his individual needs, and so lessen the anxieties which hinder recovery.