??? 4413 (/) RICH 29 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1960 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1960 J. H. BROAD & Co. Ltd., Printers, 8, King Street, Richmond, Surrey. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: ERIC PEREIRA, M.B., B.S., D.P.H. Deputy Medical Officer of Health: C. J. RADWAY, B.M., B.Ch., D.P.H. Chief Public Health Inspector: EDWARD S. HERBERT, M.A.P.H.I. Senior Additional Public Health Inspector: HENRY DOUGLAS WILLIAMS, M.A.P.H.I. Additional Public Health Inspectors: CHARLES S. SMEATON, M.R.S.H. DAVID MEIRION HUGHES, M.R.S.H. (Left: 31.8.60). JOHN WILLIAM REAVLEY, M.A.P.H.I., A.R.S.H. (Commenced: 10.10.60). Technical Assistant: HARRY SMITH. (Commenced: 14.3.60). Chief Clerk: MRS. FLORENCE G. SMITH. Clerks: MRS. MARGARET M. SUMPTER. MISS PAMELA A. EVANS (Left: 19.2.60). MISS MARGARET M. DENNEHY. (Commenced: 22.2.60). Rodent Officer: THOMAS R. SMITH. Rodent Operator: RONALD EVANS. Disinfector and Driver: JAMES DAVIS. (Retired: 21.4.60). JOHN BENNETT. (Commenced: 22.2.60). 4 Public Health Department, Municipal Offices, Parkshot, Richmond. July, 1961. To the Mayor, Aldermen and Councillors of The Borough of Richmond (Surrey). Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1960 upon the Sanitary Circumstances, Sanitary Administration, and Vital Statistics of the Borough. The form of the Report is in accordance with the instructions of the Minister of Health, and special reference is made to certain subjects at the Minister's request. In March 1960, Dr. C. J. Radway commenced duty as Deputy Medical Officer of Health and Deputy Divisional Medical Officer. This appointment has been most helpful in providing official cover at all times, and in assisting in the co-ordination of the environmental and the personal health services. I am indebted to Mr. E. S. Herbert, Chief Public Health Inspector, for his report on the sanitary circumstances of the area, and to Mrs. F. G. Smith for dealing with the tables of Vital Statistics and preparing the report for the printers. Finally, I wish to express my thanks to the Chairman and Members of the Health Committee for their support throughout the year and to every member of the Staff of the Public Health Department for their loyalty, hard work, and Co-operation. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 5 BOROUGH OF RICHMOND (SURREY). PREFACE. SECTION A.—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Staff. At the end of August Mr. D. M. Hughes transferred to another Authority after serving this Council for more than three years. The vacancy was filled by the appointment of Mr. J. W. Reavley who commenced duty in October. Mr. Harry Smith was appointed Technical Assistant for duties under the Clean Air Act, 1956. He commenced duty in March. Miss Pamela Evans, clerk, left the department in February and was replaced by Miss M. M. Dennehy. Population. The Registrar General's estimate of the population in 1960 was 42,2 7 0 which is slightly lower than his estimate for the previous year. Births. During the year 635 births were recorded (314 males and 321 females) compared with 552 in 1959. There were 32 premature live births and of these, 29 survived. Two of the 3 infants who failed to survive weighed less than 4lbs. 6ozs. at birth and so would be extremely difficult to rear. Of the 6 infant deaths under the age of 1 year, 3 were due to prematurity, and 2 were due to congenital abnormalities. Deaths. The total number of deaths occurring amongst residents was 564 (281 males and 283 females) compared with 601 in 1959. The death rate, when corrected to allow for the high proportion of elderly residents is 9.6 per thousand population which compares favourably with other towns in the country. 6 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. These are mainly provided by the Surrey County Council, the South West Metropolitan Regional Hospital Board, and the Executive Council for the County. In order to make the report complete these are briefly described below. (a) Services Provided by the Surrey County Council. These are organized on a Divisional basis, the Northern Division comprising the Boroughs of Richmond and Barnes. The Medical Officer of Health for Richmond is also the Divisional Medical Officer and this arrangement assists 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 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. 7 (b) Services Provided by the Regional Hospital Board. Hospitals. The Royal Hospital and Kingston Hospital 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. Psychiatric Services. The Medical Staff of Banstead Hospital hold Out-patient Clinics on Tuesday and Friday afternoons at the Royal Hospital for patients living in Richmond and Barnes. 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.1 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. 8 Nursing Homes. The following private Nursing Home is registered by the Surrey County Council:— Tyneham House Nursing Home, 108, Church Road. (c) Services Provided by the Surrey Executive Council. Under Part IV of the National Health Service Act 1946, the Surrey Executive Council has the responsibility of providing General Medical and Dental Services, Pharmaceutical Services, and Supplementary Ophthalmic Services. More than Twenty doctors living within the Borough have undertaken to provide General Medical Services. Many of these have also undertaken to provide Maternity Medical Services. A list of doctors taking part is available at the Main Post Office, Public Library and Public Health Department. The offices of the Council are situated at 187, Ewell Road, Surbiton Care of the Aged and the Chronic Sick. The local scheme for the care of the aged and the chronic sick is largely unchanged. The general Health Visitors continue to supervise those who are frail or in need of assistance while the geriatric Health Visitor supervises those who are on the Waiting List for admission to hospital. Other than in times of epidemic the waiting period for admission to a hospital or a home is not unduly long, and a desperate case is invariably admitted without delay. In quieter times, Dr. Finn is able to admit elderly chronic sick patients to hospital for periods of two or three weeks in order to give exhausted relatives a short rest. At the same time the patient is carefully assessed and is given any form of treatment thought to be beneficial. The Home Helps and District Nurses continue to play an important part in the case of elderly patients in their homes and the voluntary services do most valuable work by such services as "Meals on Wheels, Old Peoples' Clubs, etc. A laundry service for incontinent patients is provided which considerably reduces the burden on relatives and makes it possible for them to nurse at home a patient who would otherwise have to be admitted to hospital. The service is confined exclusively to 9 nent patients and articles laundered are limited to sheets and draw sheets. During 1960, 39 new patients availed themselves of the service. Of these, 10 have since died, 11 have been removed to hospital, and 14 discontinued the service. At the end of the year 4 cases only were continuing the service. During the year, 2,183 sheets were washed. NATIONAL ASSISTANCE ACT, 1948—SECTION 47. In many cases old people create their own difficulties by refusing to leave their homes when they can only be properly cared for in hospital or other suitable accommodation. A satisfactory solution is generally arrived at without resort to compulsion but in one case the Council took action under the above Act. This was the case of an elderly woman who had lived for many years in one room in a large house. She was suffering from arthritis and cerebral arteriosclerosis and had become bedridden. She suffered from delusions at night-time and became very noisy, disturbing other members of the household. On more than one occasion she was found lying on the floor unable to return to her bed. She had the daily assistance of a Home Help and a District Nurse but it was clear that she could not be properly cared for in her own home. She refused to consider admission to hospital and accordingly application was made to a Magistrate for a Removal Order. This was granted and the patient was removed to Kingston Hospital where she settled reasonably well, but refused to relinquish the tenancy of her room as she continued to hope that she would be able to return home. In due course application was made for an extension of the Order for a further period of three months. This was granted and thereafter the patient remained voluntarily in hospital. 10 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (Civilians only). NOTIFIABLE DISEASES. The table in Section F sets out the number of cases of infectious diseases notified during 1960. Measles. Following the epidemic of the previous year only 18 cases of measles were notified in 1960. These were only of moderate severity and none required admission to hospital. Whooping Cough. Only 33 cases were notified and, of these, there were no cases severe enough to require admission to hospital. Poliomyelitis. There was not a single case of poliomyelitis in the district during the year. The incidence throughout the country was low. Vaccination of a high proportion of children against the disease may have played an important part in this satisfactory state of affairs. Food Poisoning. Three cases only were notified. One was a child aged six infected with Salmonella typhimurium, one a woman infected with Salmonella Newport, and the third a man infected with Salmonella Newport. There was no connection between any of the cases and no spread of infection to close contacts. Suspected food was not available for examination and it was not possible to trace the source of infection in any case. Scarlet Fever. Eighteen cases were notified compared with 49 during the previous year. The cases were generally mild but in 5 instances admission to hospital was thought advisable. Post Infective Encephalitis. This was the case of a young woman who developed symptoms of encephalitis three days after she was vaccinated against Smallpox. 11 Investigations confirmed the diagnosis. Fortunately, the patient's condition improved rapidly and she made a complete recovery. IMMUNIZATION. Schemes for giving protective inoculations against various diseases are administered from the Divisional Health Office, and are carried out at the Surrey County Council Clinics. Diphtheria and Whooping Cough. The majority of infants are inoculated against these diseases. Efforts are made to complete the course of injections before the end of the first year, but the policy of using single antigens during the warmer months makes this very difficult. The last recorded case of diphtheria was in 1944 and the incidence and severity of Whooping Cough have been considerably reduced in recent years. Tetanus. Protection against tetanus is being requested by an increasing number of parents. It is given combined with other antigens in the winter quarters and singly or combined with diphtheria formol Toxoid in summertime. Smallpox. 70.2% of babies were vaccinated during the year. This is still not high enough, but is a better figure than in many parts of the country. Poliomyelitis. In order to encourage those eligible to be vaccinated against poliomyelitis a "Polio Week" was held during the period 16th to 21st May. Every available form of publicity was used including the local press, the B.B.C., local cinemas, posters, and Civil Defence loud-speaker van. Afternoon and evening vaccination centres were set up in places rod at times thought to be convenient to the public. The local Civil Defence organization was of great assistance by providing a Mobile Unit, a loud-speaker van, and many euthusiastic volunteers, who did much to persuade members of the public to accept vaccination. 12 In addition valuable assistance was received from members of the B.R.C.S., the St. John Ambulance Brigade, the District Nurses and Health Visitors, and the staff of the local Health Department During the week no less than 2,907 persons were inoculated at the special Centres. Subsequently, arrangements were made to give second and third doses and the response was generally very satisfactory. Tuberculosis. As in previous years all children aged 13 years were offered B.C.G. vaccination. The object is to provide artificial immunity to the disease during the adolescent period when children are susceptible and can be seriously affected. Mobile X-Ray. The Regional Hospital Board set up a Mobile X-Ray Unit at the Bus Station behind the Odeon Cinema on every Thursday from 5.30 to 6.30 p.m. The Unit is primarily for the convenience of the local general practitioners who can refer their patients without any prior appointment, and who receive a written report within two or three days of the examination. The service is much appreciated by the doctors, and is also a convenience to the patients who are saved both travelling and waiting time. Prospective employees of the Council who are unable to provide proof of recent chest X-Ray are referred, and the reports are of considerable assistance in enabling a decision to be made as to whether or not they are suitable for inclusion in the Superannuation or Sick Pay Schemes. During the year 30 employees attended for chest X-Ray. 13 THE REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR, Mr. E. S. HERBERT, IS CONTAINED IN THE FOLLOWING SECTIONS C, D and E. SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. 1. Water Supply. The drinking water supply in Richmond is made up, in part from local wells and, in part, from the Metropolitan Water Board. The origin and method of treatment of these supplies have been fully reported in the past and remain unchanged. Frequent sampling ensures that the purity of the water supply is maintained, and throughout the year the sample results have shown a high standard of bacteriological and chemical fitness. The drinking water supplies in the district are not plumbo-solvent and every dwelling house in the Borough has a piped supply of water fit for human consumption. A river water supply is piped to Kew Gardens, allotments and to many domestic gardens; the water is chlorinated as a precautionary measure but it is not fit for drinking. Table 16 gives information on the consumption of water in the Borough and on the samples taken. 2. Swimming Pools. There is only one public swimming pool in the Borough which is the public baths establishment owned by the Council. The pool is 100 feet by 32 feet with a capacity of 96,000 gallons, the water supply being from local wells and the Metropolitan Water Board. The water is filtered by Candy pressure filters, giving a turnover of approximately six hours, and sterilization is achieved by chlorine gas treatment. Daily recordings are made of available and residual chlorine in the water, the pH value, and the shallow and deep-end temperatures. In addition, bacteriological samples of the water are taken each month, and with one exception during the year, have proved satisfactory. 3. Sewerage and Sewage Disposal. Arrangements for sewage disposal have remained unaltered, use being made of the Richmond Main Sewage Works situated in the Borough of Barnes which are adequate for the area. 14 4. Public Health Inspection. The wide range of public health duties to which attention is given is shown in Table 17. The increase in the number of inspections made in the year (2,337) is due entirely to the expanding programme of creating Smoke Control Areas in the Borough. The number of complaints received in 1960 (Table 19) shows a decrease of 36 due to fewer notifications of infestations by rats and mice. Every effort is made to ensure that each complaint is investigated within twenty-four hours of its receipt. Table 18 indicates the number of informal and statutory notices served for the repair of premises and the abatement of nuisances, and in no instance was it necessary to institute legal proceedings. 5. Disinfection and Disinfestation. There has been no increase in the treatment of premises after cases of infectious disease or of bed-bug infestation. The spraying of School Kitchens operating under the School Meals Service has continued and involves one treatment in the year by D.D.T. solution. The fumigation of clothing before being sent abroad is carried out to assist members of the public to satisfy Post Office regulations, and a small charge is made for the treatment. A summary of the work done is contained in Table 20. 6. Atmospheric Pollution. (a) Smoke Control Areas. The first Smoke Control Area, covering the south-west corner of Ham, operated from the 1st October 1960, and it is evident that full co-operation has been given by the owners and occupiers of dwellings in that area. The second Order was made by the Council in October and awaits confirmation by the Minister of Housing and Local Government. It covers an area in Ham and Petersham to the south of Sandy Lane, approximately 1,910 acres in extent and includes 902 private dwellings, 615 Council houses and 84 other premises. The work on the survey of these premises was made possible by the appointment of a Technical Assistant who commenced duty in March. Two members of the staff attended courses held by the Coal Utilization Council on the use of smokeless fuel appliances, and during the year talks were given to three voluntary organizations in the Borough on the subject of Clean Air. 15 (b) Complaints of Smoke Emission. The number of complaints received was greatly reduced compared with the previous year, and many complaints referred to bonfires in gardens and allotments rather than to industrial chimneys. The few complaints made of smoke emission from factory chimneys were properly investigated and the advice given generally resulted in the desired improvement. No legal proceedings were taken in the year for any contravention of the Clean Air Act. 7. Disease of Animals Act, 1950. Outbreaks of foot and mouth disease were very high in the country in 1960 when 298 outbreaks were confirmed (compared to 45 in the previous year). Richmond was included in an infected area in April, but no case of the disease occurred in the Borough. 8. Petroleum Spirit Storage. Fifty-three premises are licensed to store petrol and petroleum mixtures totalling 85,470 gallons. The licence conditions provide that storage tanks be tested in the 20th, 25th and 30th year after installation and thereafter in every second year. Seven tanks were tested and found satisfactory, and at one garage a 500 gallon tank was examined and found to be leaking; the use of this tank was discontinued forthwith. 9. Caravan Sites. The Caravan Sites and Control of Development Act, 1960 came into operation during the year. The Act gives local authorities effective powers for controlling sites so that they may be properly equipped and conducted and permitted only in acceptable places. A licence was granted during the year for a temporary site for one caravan in Ham. SECTION D.—HOUSING. 1. Unfit Houses. Satisfactory progress was made during the year on areas of unfit properties. Twenty-two houses in Grove Terrace and Motes Cottages were demolished, and after a public enquiry in March, the Minister confirmed Clearance Orders covering Orchard Cottages, Orchard Road and 1—15 Garden Road (35 houses in all). The rehousing of 16 families from these areas was completed by the end of the year, and altogether 56 families were found alternative accommodation. The No. 2 Garden Road Area (16 houses) was represented to the Gouncil in March and the Order was confirmed by the Minister in December. Representations were made to the Council on one individual unfit house, and one dwelling was demolished after a Demolition Order had been made. Repairs to unfit basement accommodation enabled the Council to determine two Closing Orders and to cancel undertakings in respect of four other basement dwellings. 2. Council Houses. Total number of houses erected post-war, 31st December, 1960 Temporary bungalows 179 Permanent Houses 485 Permanent Flats 468 953 1132 Since 1956 a total of 62 prefabricated bungalows have been demolished and one taken over for use as a dental clinic by the Surrey County Council 63 Total 1069 Total number, included in above, erected in 1960 Permanent houses Nil Permanent flats 106 Housing Waiting List. Total number of families on Waiting List at 31st Dec., 1960 446 Applications from Aged Persons at 31st Dec., 1960 179 Total number of families rehoused in 1960 44 Miscellaneous allocations 6 50 Total number of aged persons rehoused in 1960 37 Building Schemes. By June 1960, 64 1-bedroomed flats on the Lower Mortlake Road site (Finucane Court) were occupied. 17 A further 42 bed-sitting room flats on the North Road site (McDougall Court) were occupied by August 1960 and, for the first time, 32 older persons from the Waiting List were re-housed on this new Estate. Future Housing Programme. Planning approval has been obtained for the erection of 192 dwellings on the Ham Close site comprising 48 bed-sitting room type flats, 60 one-bedroomed flats, 72 two-bedroomed flats and 12 threebedroomed flats in three, four and five storey blocks. Tenders are to be invited for the erection of 13 one-bedroomed bungalows on the land at the rear of Popham Gardens. SECTION E.—INSPECTION AND SUPERVISION OF FOOD. 1. Unsound Food Complaints. Thirty-one complaints alleging that food had been sold to the dissatisfaction of the customer were received during the year. The investigations which followed showed that, in the majority of complaints, there had been a failure to turn over stocks of the food and that deterioration, usually by mould or souring, had resulted. A few cases revealed carelessness in food preparation, giving rise to complaints of string (from flour sacks) or pieces of old dough in bread. One unusual complaint showed the presence in a tin of fish of what to the naked eye appeared to be pieces of glass, but closer examination showed the "glass" to be crystals of magnesium ammonium phosphate. The formation of these crystals, which are harmless, is thought to be associated with the presence of chemicals in the fish substance. Legal proceedings were taken on two complaints. In the first, a fine of £50 with ten guineas costs was imposed on a bakery firm for selling a loaf containing a cigarette end, and in the second, a fine of £2 with three guineas costs was imposed on a retailer for selling a mouldy steak and kidney pie. 2. Food Sampling. The practice of selective rather than random food sampling has heen continued through the year and 20 per cent of all samples were reported as irregular. The interest taken by the Public Analyst 18 (D. D. Moir, Esq., M.Sc., F.R.I.C.) has been most encouraging and the willing help and advice which he has freely given at all times has enabled the investigation into irregular samples to be brought to a successful conclusion. Of the 24 irregular samples, 15 were imported products whose labels did not conform to the Labelling of Food Order, 1953, and one cannot help thinking that food sampling administration would be more efficient if imported foods were properly checked before being distributed throughout the country. In all cases, however, arrangements with the manufacturers or importers were approved to remedy the irregularity revealed by the sampling. 3. Codes of Practice. In order to encourage those who are engaged in the various food trades to achieve the highest standards in food premises, equipment and food handling techniques, the Ministers of Health and of Agriculture, Fisheries and Food from time to time issue codes of practice. In the year under review, two codes were printed for the Retail Fish Trade and for the Transport of Fish, and in the interests of improved food distribution to the public, the Council agreed that a copy of the code for the Retail Fish Trade should be sent free of charge to each fish retailer in the Borough. 4. Ice-Cream. There is only one ice-cream manufacturer in the Borough; the process involves the heat-treatment of the product to a temperature of not less than 160°F for 10 minutes, and not the high-temperatureshort-time method (175°F for 15 seconds), which is also permitted by the Ice-Cream (Heat Treatment) Regulations. One hundred and thirteen premises are registered for the sale and storage of ice-cream, and during the year 66 samples were submitted to the Public Health Laboratory for examination, of which 51 were satisfactory (Grades I and II) and 15 were unsatisfactory (Grades III and IV). Unsatisfactory samples received thorough investigation, and in 5 instances there was evidence that the low grading was due to a failure to keep sterile the water in which the server was kept. The proprietors, in each case, were advised on the use of sterilising agents and subsequent samples proved satisfactory. The remaining 10 samples were taken from one restaurant and the low grading was 19 thought to be due to a fault in manufacture; this ice-cream was not made in Richmond, but the manufacturers and the local authority concerned carried out a close examination of the ice-cream plant and at the end of the season samples from the restaurant were satisfactory. 5. Other Foods. Fifty-six other samples were examined bacteriologically; these samples included meat products, cream cakes, artificial cream and ice-cream server waters. Seven samples of ice-cream server water proved to be unsatisfactory and also one other sample of sliced boiled ham. Suitable advice was given in each case and, in general, the results showed a very satisfactory standard of food handling. 6. Milk—Licensing and Sampling. Under the provisions of the Food and Drugs Act, 1955, and Regulations made thereunder, Dairy Farms have become the direct responsibility of the Ministry of Agriculture and Fisheries: the premises on which milk is pasteurised or sterilised are licensed 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 is one dairy farm within the Borough under the control of the Ministry and there is one pasteurising plant licensed by the Council as the Food and Drugs Authority. Details of sampling are included in Table 29. borough of richmond (SURREY) APPENDIX TO THE ANNUAL REPORT OF THE medical officer of health 1960 23 TABLE 1. STATISTICAL SUMMARY—1960. SECTION A.—SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1951) 41,944 Population (Estimated 1960) 42,270 Number of inhabited houses (estimated) at 1.4.61 12,361 Rateable value at 1.4.61 £1,015,322 Sum represented by a Penny Rate, 1961/62 £4,089 BIRTHS. Birth Rate per 1,000 of estimated resident population 15.0 (Corrected) 13.9 Total number of births (live and still) 635 Analysis:— M F Total Live Births Legitimate 296 289 585 Illegitimate 16 30 46 Still Births Legitimate 1 2 3 Illegitimate 1 — 1 Still Birth Rate per 1,000 total births 6.3 Environment of Births:— Proportion taking place in Institutions (544) 75.5 Proportion taking place in dwelling houses (177) 24.5 DEATHS. Total number of deaths from all causes 564 Death rate per thousand estimated resident population 13.3 (Corrected) 9.6 The principal causes of deaths:— Malignant Neoplasms 121 Heart disease 152 258 Vascular lesions of Nervous System 74 Other circulatory diseases 32 Pneumonia 24 61 Bronchitis 32 Other respiratory diseases 5 Malignant Neoplasms were responsible for 121 deaths or 21.4% of total deaths. 24 Diseases of the Heart and Circulation caused 258 deaths or 45.7% of total deaths. Diseases of the Respiratory System caused 61 deaths or 10.8% of total deaths. TABLE 2.—ANALYSIS OF DEATHS RELATING TO RICHMOND FOR THE YEAR 1960. Causes of Deaths. Male. Female. Total. Tuberculosis, respiratory 2 1 3 Tuberculosis, other – – – Syphilitic Disease 3 — 3 Other Infective and parasitic diseases 1 2 3 Malignant neoplasm, stomach 5 7 12 Malignant neoplasm, lung bronchus 27 10 37 Malignant neoplasm, breast 1 13 14 Malignant neoplasm, uterus – 4 4 Other malignant and lymphatic neoplasms 28 26 54 Leukaemia, Aleukaemia 3 2 5 Diabetas 1 2 3 Vascular lesions of nervous system 31 43 74 Coronary disease, angina 62 43 105 Hypertension with heart disease 2 4 6 Other heart disease 17 24 41 Other circulatory diseases 16 16 32 Influenza – 1 1 Pneumonia 12 12 24 Bronchitis 26 6 32 Other diseases of respiratory system 4 1 5 Ulcer of stomach and duodenum 3 5 8 Gastritis, enteritis and diarrhoea 1 1 2 Nephritis and nephrosis – 1 1 Hyperplasia of prostate 1 – 1 Congenital malformations – 1 1 Other defined and ill defined diseases 26 43 69 Motor vehicle accidents 4 2 6 All other accidents 5 8 13 Suicide 5 5 281 283 564 TABLE 3. MATERNAL MORTALITY — 1960. The provisional numbers of deaths and death rates per 1,000 total live and still births are:— England and Wales. Number Rate Maternal causes, excluding abortion 248 0.31 Due to abortion 63 0.08 Total maternal mortality 311 0.39 25 Richmond. Maternal causes, excluding abortion Nil Nil Due to abortion Nil Nil Total maternal mortality Nil Nil TABLE 4. INFANT MORTALITY. (Deaths under one year of Age). Infant Mortality Rate for all infants per 1,000 live births 9.5 Rate for legitimate infants per 1,000 legitimate live births 8.5 Rate for illegitimate infants per 1,000 illegitimate live births 21.7 Total number of infant deaths in the Borough 6 Analysis:— M F Total Legitimate 1 4 5 Illegitimate 1 – 1 Environment of Infant Deaths:— Number occurring in the Borough 1 Number occurring outside the Borough 5 Number occurring in Institutions 5 Causes of Death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2-3 weeks 3—4 weeks over 4 weeks Total 1. Prematurity 3 ... ... ... ... 3 2. Congenital Abnormality ... ... ... ... 1 1 3. Acute Pneumonitis ... ... ... ... 1 1 4. Erythroblastosis 1 ... ... ... ... 1 4 ... ... ... 2 6 Neo-natal Mortality Rate: (Deaths under 4 weeks per 1,000 total live births) 7.9 Early Neo-natal Mortality Rate: (Deaths under 1 week per 1,000 total live births) 7.9 Perinatal Mortality Rate: (Stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 14.2 26 TABLE 5. ILLEGITIMATE BIRTHS. 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 No. of illegitimate births 43 25 34 33 31 40 30 40 36 46 No. of illegitimate deaths under 1 year 0 3 1 2 0 3 1 0 1 1 Illegitimate death rate 0 120 29 60 0 75 33 0 27 21 TABLE 6. COMPARATIVE STATISTICS — 1960. Rate per 1,000 Population LIVE BIRTHS Rate per 1,000 (Total Live & Still) STILLBIRTHS Rate per 1,000 Population DEATHS (All Ages) Rate per 1,000 Related Live Births DEATHS (Under One Year) Neonatal Mortality (Under 4 weeks, (Live Births). England & Wales 17.1 19.8 11.5 21.9 15.6 Richmond 13.9 (Corrected) 6.3 | 9.6 (Corrected) 9.5 7.9 27 TABLE 7. PREMATURE LIVE BIRTHS — 1960. PREMATURE STILLBIRTHS. Born in Hospital Born and Nursed at Home Born In Hospital Born at Home born in Nursing Home Weight Total Died within 24 hours of birth Died 2nd-28th day Survived 28 days Total Died within 24 hours of birth Died 2nd-28th day Survived 28 days 31b. 4oz. or less 2 1 — 1 — — — — 2 — — Over 31b. 4oz to 4lb. 6oz. 7 1 — 6 2 — — 2 — — — Over 41b. 6oz. to 41b. 15oz. 7 — — 7 — — — — — — — Over 41b. 15oz. to 51b. 8oz. 10 1 — 9 4 — — 4 — — — TOTALS ... 26 3 — 23 6 — — 6 2 — — Note : No cases in following categories:— (1) Born at home and transferred to Hospital or or before 28th day. (2) Born in Nursing Home and nursed entirely there. (3) Born in Nursing Home and transferred to hospital on or before 28th day. 28 SECTION F.—PREVALENCE OF, AND CONTROL OVER. INFECTIOUS AND OTHER DISEASES. (Civilians only). TABLE 8. NOTIFIABLE INFECTIOUS DISEASES. Diseases. Total Cases Notified. Cases admitted to Hospital. Total Deaths. Erysipelas 1 1 – Encephalitis— Post Infective 1 1 – Scarlet Fever 18 5 – Pneumonia 6 — – Measles 18 — – Whooping Cough 33 – – Food Poisoning 3 2 – Opthalmia-Neonatorum 1 – – 81 9 Nil TABLE 9. FOOD POISONING. Total number of outbreaks Nil Number of cases notified 2 Number of deaths Nil TABLE 10. DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1960:— (a) Pre-School children (under 5 years) 441 (b) Between 5 and 15 years 24 465 Grand Total of Children in the Borough who have received immunising treatment by the end of the year:— (a) Under 5 years 1804 (b) Between 5 and 15 years 5148 Number of children given re-inforcing doses during 1960 828 29 TABLE 11. STATE OF IMMUNITY. The following table shows the percentages of children immunized in various age groups for the past three years. Age Group. 1958 1959 1960 Under 1 year 80.4 78.1 75.8 1—4 73.1 78.1 78.5 5 — 15 96.6 96.6 97.6 The state of immunity of all children is indicated by the "Immunity Index" which is the number of children immunized (primary or booster) during the last five years expressed as a percentage of the total estimated mid-year child population. The following table shows the trend during the last three years 1958 1959 1960 Immunity Index for children 0—15 77.1 78.9 79.8 TABLE 12. VACCINATION AGAINST SMALLPOX 1960. 1. Analysis of Vaccinations at Welfare Centres and Private Doctors' Surgeries: Children. Primary Vaccination 445 Re-vaccination 23 Total 468 2. Figures showing the percentage of children under 1 Year vaccinated during 1960: No. Vaccinated. Estimated mid-year Population under 1 year. % Vaccinated. 363 517 70.2 TABLE 13. IMMUNIZATION AGAINST TETANUS. During the year 309 children were given courses of inoculations against Tetanus at the parent's request. 30 TUBERCULOSIS. Vaccination Against Tuberculosis. Each year children who have reached their 13th year are offered vaccination against tuberculosis with B.C.G. (Bacille CalmetteGuerin). The inoculation is preceded by a Mantoux skin test which indicates whether or not the child has already been infected with tuberculosis. Those who have already been infected are not given the inoculation but they are investigated by X-Rays and by enquiries regarding home contacts. The object of the scheme is to provide resistance to tuberculosis during the adolescent period when children are most susceptible to the infection. During 1960 a total of 823 boys and girls were inoculated with B.C.G. in the Northern Division (Richmond and Barnes). NOTIFICATIONS: Respiratory Tuberculosis. Twenty-five cases of respiratory tuberculosis were notified during the year, viz:— 15 males and 10 females. The corresponding figure for 1959 was 29. Non-Respiratory Tuberculosis. Three new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Four such cases were notified during 1959. TABLE 14. 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 107 9 Females 52 9 159 18 Corresponding figures for 1959 182 20 31 TABLE 15. ANALYSIS OF CASES AND DEATHS FOR 1960. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0— 4 – – – – – – – – 5—14 1 – – – – – – – 16—24 1 2 – 1 – – – – 25—44 6 7 – 2 – – – – 45—64 5 1 – — 2 1 – – 65 and upwards 2 – – – – – – – Totals 15 10 — 3 2 1 — — 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. 32 SECTION C—SANITARY CIRCUMSTANCES. TABLE 16. WATER SUPPLY. (a) The following figures show the daily average consumption of water in the district:— 1959 1960 All Richmond Wells 759,071 galls. 819,022 galls. Metropolitan Water Board 992,151 galls. 957,482 galls. Raw River Water 369.742 galls. 246.578 galls. (b) During the year the following samples were taken for examination:— (i) Richmond Water Supply: Untreated water 148 samples. Treated water 326 „ For chemical analysis 25 „ (ii) Metropolitan Water Board Supply: Bacteriological examination 1,101 „ Chemical examination 52 „ (iii) Raw River Water 52 „ (c) Swimming Water samples 28 „ TABLE 17. PUBLIC HEALTH INSPECTIONS. Houses inspected (Public Health Acts) 439 Revisits to houses and other premises 1124 Houses visited for Certificates of Disrepair 35 Visits paid in connection with:— Permitted number for dwellings 75 Vermin 106 Enquiries into Infectious Diseases and Disinfection 76 Routine inspections in connection with:— Factories (mechanical) 32 Factories (non-mechanical) 3 Outworkers 1 Bakehouses 7 Butchers' Shops 42 Confectioners (Flour) 1 Confectioners (Sugar) 14 Dairies and Milk Shops 15 n Fishmongers and Poulterers 7 Fried Fish Shops 3 33 Greengrocers and Fruiterers 41 Grocers 59 Ice-cream premises 44 Public Houses 59 Restaurants and Tea Shops 156 Food and Drugs Act Sampling 170 Milk Sampling (Designated Milk) 64 Ice-cream Sampling 38 Unsound Food 120 Caravans 2 Clean Air Act—Inspection and Observations 2267 Diseases of Animals Act 1 Drainage 480 Interviews 936 Heating Appliances (Fireguard) Act 16 Merchandise Marks Act 8 Noise Abatement 19 Pet Animals Act, 1951 16 Petroleum Act, 1928 135 Piggeries 1 Rag Flock Act 1 Rats and Mice (Visits to Properties) 4084 Rats and Mice (Visits re sewer treatments) 484 Schools—Elementary and Secondary 23 Shops Act, 1950 143 Water Supply 378 Miscellaneous Visits 2808 14,533 TABLE 18. SERVICE OF NOTICES. (1) Informal action by letter or verbal intimation 145 (2) Statutory action by notice: (a) under the Public Health Act, 1936— (i) Section 24 (public sewers) 2 (ii) Section 39 (drainage) 3 (iii) Sections 92/93 (nuisances) 11 (b) under the Clean Air Act, 1956— Section 12 (firegrate adaptations) 14 34 TABLE 19. COMPLAINTS. The complaints received have been classified as follows:— Disrepair of premises:— Dampness 24 Drainage 84 General defects 170 Nuisance from refuse 22 Nuisance from smoke or fumes 21 Nuisance from Insects, animals, etc. 56 Rodent infestations 208 Unsound food 49 Miscellaneous nuisances 46 680 TABLE 20. DISINFECTION AND DISINFESTATION. A summary of the treatment of premises, bedding, clothing and other articles is given below:— Houses. Rooms. Bedding, etc. Infectious Fevers 3 3 9 Tuberculosis 2 6 6 Vermin 33 83 166 Other Diseases 3 4 460 Costs recovered throughout the year: £42 4s. 3d. TABLE 21. FACTORY INSPECTIONS. 1. Inspections. Premises. Number on Register. Inspections. Written Notices. Prosecutions. Factories (non-power) 18 3 4 Nil Factories (power) 146 25 3 Nil Building Sites and Institutions 13 7 Nil Nil 35 2. Defects. Particulars. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 7 7 2 Sanitary Conveniences. (a) Unsuitable 3 3 2 (b) Not separate for sexes 1 1 1 3. Outworkers. Nature of Work. Number of Outworkers. Number of Unwholesome Premises. Wearing apparel (making) 27 Nil. Brass and brass articles 9 Nil. Lampshades 2 Nil. Legal Proccedings — no prosecutions were taken in 1960. TABLE 22. RODENT CONTROL. The rodent control staff have continued to do much useful work in eradicating rats and mice from premises. Number of complaints received 208 Number of infestations found 199 Number of infestations cleared 187 The treatment of foul sewers was carried out in May and November using the anti-coagulent, Warfarin, and baiting was concentrated in specific areas known to be persistently infested with rats. May. November. Manholes test-baited 46 Nil. Manholes above found infested 2 Nil. Manholes poison-baited 37 61 Manholes infested 23 29 Number of visits 240 244 36 SECTION D—HOUSING. TABLE 23. Housing Statistics for 1960. 1. Number of dwellings owned by the Local Authority:— Number of houses 1401 Number of Flats 641 Total 2042 The 2042 units of accommodation comprise:— Existing. Bed-sitting room flats 63 One-bedroom flats 164 Two-bedroom flats/houses 385 Three-bedroom flats/houses 1139 Four-bedroom flats/houses 163 Five-bedroom houses 12 Prefabricated bungalows 116 2042 2. Unfit Houses. (a) Dwelling houses inspected 439 (b) Total number of visits made 1598 (c) Clearance Areas represented to Council 1 (d) Dwellings included in (c) above 16 (e) Clearance Orders made by Council 1 (f) Dwellings demolished after Clearance Orders made 22 (g) Dwellings represented for Demolition or Closing Orders 1 (h) Undertakings received that dwellings be not used for human habitation 1 (i) Dwellings made fit after undertakings received to carry out repairs 1 (j) Dwellings demolished in pursuance of Demolition Order 1 (k) Undertakings received to repair part of a building (1) Closing Orders determined on part of a building being made fit 2 (m) Undertakings cancelled on part of a building being made fit 4 37 (n) Dwellings in respect of which formal notices were served requiring defects to be remedied 11 (o) Dwellings in which defects were remedied after service of formal notices 16 (p) Dwellings in respect of which informal notices were served requiring defects to be remedied 145 (q) Dwellings in which defects were remedied after service of informal notices 157 TABLE 24. RENT ACT, 1957. The Rent Act, 1957, came into operation on the 6th July, 1957, and repealed the Housing Repairs and Rent Act, 1954. The 1957 Act permits the rents of controlled houses to be in creased within specified limits, and lays down a procedure to enable the tenant and landlord to reach agreement on works of repair which should be carried out to the property. Should agreement not be possible, the tenant may apply to the local authority for a Certificate of Disrepair which, if granted, stops the rent increase. The landlord has the opportunity, however, of giving an undertaking to carry out the repairs within 6 months, and if such an undertaking is accepted by the local authority, the rent increase continues to be payable. The following tables show the action taken since the Act came into force:— PART 1.—Applications for Certificates of Disrepair. 1957 1958 1959 1960 Number of applications 59 37 15 8 Number of decisions not to issue certificates Nil 4 1 Nil Number of decisions to issue certificates:— (a) in respect of some but not all defects 37 29 7 7 (b) in respect of all defects 20 6 7 1 Number of undertakings given by landlords 47 24 9 2 Number of undertakings refused by Local Authority Nil 1 Nil Nil Number of certificates issued 10 12 5 5 38 PART 2.—Applications for Cancellation of Certificates. Applications by landlords to local Authority for cancellation of certificates 4 8 3 2 Objections by tenants to cancellation of certificates 1 2 1 Nil Decisions by Local Authority to cancel in spite of tenants' objection 1 1 1 Nil Certificates cancelled by Local Authority 4 7 3 2 39 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. TABLE 25. INSPECTION OF FOOD. The following foodstuffs, found to be unfit for human consumption, were voluntarily surrendered and destroyed. Fresh Foods (all classes) 15 cwts. 2 qrs. 5 lbs. Tinned Meats, vegetables 7 „ 1 ,, 16 „ Tinned Fruits 4 „ 2 „ 11 ,, 1 ton. 7 cwts. 2 qrs. 4 lbs. TABLE 26. FOOD SAMPLING. The following table shows the results of examinations made of samples procured during the year. Articles. Number Analysed Number Irregular Formal Informal Total Formal Informal Total Baking Powder – 2 2 – – – Beans — 1 1 — — – Beverages – 5 6 — – – Cereals — 5 5 – 2 2 Cheese and Cheese Spread 1 4 5 – 1 1 Cordials — 10 10 — 4 4 Cough Mixtures 1 4 5 — — — Cream — 3 3 – – – Fats – 4 4 – 1 1 Flour – 2 2 – 2 2 Friars Balsam 1 – 1 — – – Fish and Fish Products – 1 1 – – – Fruit 1 6 7 – 1 1 Gelatine — 1 1 — — — Jams and Marmalade 1 8 9 – 1 1 Jellies – 2 2 — — – Meat and Meat Products — 15 15 — 1 1 Milk Powder — 1 1 — — – Molasses Tablets – 1 1 – 1 1 Rice Pudding – 2 2 – – – Sauces and Spices – 15 15 – 3 3 Sweets — 12 12 — 2 2 Vegetables – 10 10 – 5 5 Yeast – 1 1 — — — Totals 5 115 120 — 24 24 40 The irregular food samples were:— Sample 640: Skinless Boned Chicken: Label did not declare the ingredients of the article; the importers gave an undertaking that all future shipments would be labelled so as to comply with the Labelling of Food Order, 1953. Sample 644: Cress: Reported to be rape and not cress; growers and retailers agreed that the product should be described as "Growing Salad". Sample 645: Home-made Marmalade: Deficient in soluble solids; stocks withdrawn and manufacture discontinued. Sample 649: Bilberries: Label did not declare the ingredients; the importers arranged for a new pack design, incorporating the correct labelling, to be introduced. Sample 652: Cranberry Sauce: Label did not declare the ingredients; the importers undertook to amend the labelling so as to comply with the Labelling of Food Order, 1953. Sample 655: Egg Noodles: Label did not declare the ingredients and the importers arranged for the labelling to be correctly amended. Sample 659: Cornflakes: Label did not give quantative details in respect of vitamins claimed; the manufacturers produced a new pack, correctly labelled. Sample 665: Cream Cheese: Reported to be a cheese spread and manufacturers arranged for the product to be redesignated. Sample 669: Dry-Fry: Label did not declare ingredients; revised label approved and brought into use by manufacturers. Sample 684: Beetroot Soup: Vitamin content not correctly expressed; importers undertook that future consignments would be labelled to comply with the Labelling of Food Order, 1953. Samples 698 and 699: Liqueur Chocolates: Reported to be misdescribed as the products failed to give the characteristic flavour of cognac and whiskey; importers stated that these articles were no longer distributed in this country. Sample 700: Carrot Juice: Label did not specify qualitative details of vitamin claimed; importers arranged for labelling amendment to eliminate any claim as to vitamin content. 41 Sample 701: Molasses Tablets: Label did not give qualitative details of vitamins claimed; manufacturers undertook to amend label to comply with Labelling of Food Order, 1953. Sample 702: Apple Juice: Label did not specify quantative details for vitamin C; manufacturers amended the label correctly. Sample 703: Celery Juice: Label did not give quantative details for vitamin C; importers undertook not to accept any future consignment which contravened the Labelling of Food Order, 1953. Sample 705: Celery Juice: Reported to contain an excessive quantity of tin; importers instructed producers to ensure that fully lacquered tins are used, failing which they undertook to cease importing the product. Sample 710: Wholewheat Meal: Reported to show moth infestation and to be deficient in carbon dioxide; all stocks withdrawn and special arrangements made by retailer to ensure frequent stock turnover. Sample 712: French Mustard: Label did not specify the ingredients; importers undertook to amend labelling to comply with the Labelling of Food Order, 1953. Sample 730: Millstone Flour: Pamphlet made vitamin claim without giving quantative details; manufacturers withdrew and correctly reprinted the pamphlet. Sample 735: Prawn Balichow: Label did not specify ingredients; importers arranged for label to be correctly amended. Samples 737 and 738: Grapefruit Juice and Orange Juice: Label did not give quantative details of vitamins claimed; importers undertook to ensure that future consignments complied with the Labelling of Food Order, 1953. Sample 743: Apple Juice: Sample found to be deficient in quantity of vitamin claimed and quantative details were not correctly expressed; stocks withdrawn and importers undertook to ensure that future consignments did not contravene the Labelling of Food Order, 1953. 42 TABLE 27. CLASSIFICATION OF FOOD PREMISES. No. of Premises. No. of Visits. Bakehouses 8 7 Butchers (including 28 premises registered for manufacture of preserved food) 32 42 Confectioners (flour) 16 1 Confectioners (sugar) 42 14 Dairies (registered under Milk and Dairies Regulations) 4 15 Fishmongers 13 10 Greengrocers 37 41 Grocers (including 4 premises registered for manufacture of preserved food) 67 59 Ice-cream premises (manufacture) 1 44 Ice-cream premises (sale and storage) 113 Licensed premises 81 59 Restaurants, cafes, etc. 81 156 495 448 TABLE 28. IMPROVEMENTS IN FOOD PREMISES. As the result of inspections made the following improvements were carried out:— 1. Food rooms reconstructed 9 premises 2. Food rooms repaired, cleansed or redecorated 31 ,, 3. Food storage improved 8 ,, 4. Food preparation equipment improved 69 ,, 5. Ventilation and lighting improved 5 ,, 6. Staff washing facilities improved 17 „ 7. Staff clothing accommodation provided 7 „ 8. First aid boxes provided 4 ,, 9. Constant hot water supply installed 5 „ 10. New sinks provided 4 ,, 11. Existing sanitary accommodation improved 9 ,, 12. Drainage improved, repaired or altered 8 ,, 13. Refuse accumulations removed 8 ,, 14. Refuse receptacles provided 1 ,, 15. Other improvements or repairs carried out 164 ,, 43 TABLE 29. MILK LICENSING. The following licences have been granted by the Council authorising dealers to store and sell Designated milks:— Pasteurised Milk 22 Tuberculin Tested Milk 20 Sterilised Milk 21 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. Under the regulations the Local Authority continued to take samples from dealers and during the year under review the following were taken:— Pasteurised Milk 23 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 27 „ Number found unsatisfactory Nil Sterilised Milk 4 „ Number found unsatisfactory Nil Raw Milk examined biologically for the presence of Tubercle bacilli 4 „ Number found unsatisfactory Nil The District Medical Officer of Health retains the power to take appropriate action to prevent the spread of disease by infected milk.