AC 4413 (1) 2nd copy 2. Library Rich 30 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1961 borough of richmond (SURREY) ANNUAL REPORT OF THE medical officer of health 1961 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, M.A., 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. (Died: 5.9.61). JOHN WILLIAM REAVLEY, M.A.P.H.I., A.R.S.H. JOHN B. FACER. (Commenced: 1.12.61). Technical Assistant : HARRY SMITH. (Left: 20.5.61). WILLIAM J. HAUTING. (Commenced: 3.7.61). Chief Clerk : MRS. FLORENCE G. SMITH. Clerks: MRS. MARGARET M. SUMPTER. (Left: 25.8.61). MISS MARGARET M. DENNEHY. MISS EILEEN M. LANE. (Commenced: 29.8.61). Rodent Officer: THOMAS R. SMITH. Rodent Operator: RONALD EVANS. Disinfector and Driver: JOHN BENNETT. 4 Public Health Department, Municipal Offices, Parkshot, Richmond. August, 1962. 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 1961 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. Apart from Measles, the incidence of notifiable infectious disease has been very low during the year and the small number of admissions to infectious disease hospitals is quite remarkable. 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 compiling the tables of Vital Statistics and preparing the report for the printers. I wish to express my thanks to all members of the Council for their support throughout the year, and to record my gratitude to every member of the staff of the Public Health Department for their loyalty and co-operation. I am, 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. Mr. C. S. Smeaton, who had a serious illness in 1957 had another severe attack and died on the 5th September, 1961 after serving the Council as District Public Health Inspector for more than 20 years. The vacancy for an Inspector was filled by the appointment of Mr. J. B. Facer who commenced duty on the 1st December. Mr. Harry Smith, Technical Assistant for duties under the Clean Air Act, 1956, resigned his appointment in May and was replaced by Mr. W. J. Hauting in July. Mrs. M. M. Sumpter, Clerk, left in August and was replaced by Miss E. Lane. Population. The Registrar General's estimate of the population was 40,700. This may be compared with his estimate of 42,270 for the previous year and the Census 1961 figure of 41,002. Births. During the year 670 births were recorded (351 males and 319 females) compared with 635 in 1960. There were 37 premature live births and of these, 33 survived. Of the four infant deaths, 3 weighed less than 3 lbs. 4ozs. at birth and so would be extremely difficult to rear. Deaths. The total number of deaths occurring amongst residents was 626 (316 males, and 310 females) compared with 564 in 1960. The death rate when corrected to allow for the high proportion of elderly residents is 10.9 per thousand population which compares favourably with other towns in the country. 6 The Infant Mortality, Neo-natal Mortality, and Still birth rates, are all higher than in the previous year. However, it should be noted that the rates for 1960 were exceptionally low and the rates quoted in Table 4 compare satisfactorily with those for England and Wales. Similarly, the illegitimate death rate is raised, but this is of little significance in view of the small numbers concerned. There were 15 infant deaths which are set out in Table 4 in their age groups. Apart from the infant found dead, all save one in the first two columns were born in hospital and received every attention. One domiciliary birth was so premature that it could not be expected to survive. It is unfortunate that two older infants developed pneumonia and failed to respond to treatment. 7 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. 8 (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. 9 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. The Home Helps and District Nurses continue to play an important part in the care 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. Laundry Service. 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 incontinent patients and articles laundered are limited to sheets and draw sheets. This Service is provided twice weekly throughout the year. Soiled sheets are collected on Tuesdays and Fridays and at the same time 10 an appropriate number of laundered sheets is delivered to the house. A charge of sixpence per sheet is made which is covered by a supplementary allowance for those in receipt of National Assistance. The charge has not been known to cause hardship. The service continues to be of great benefit to those who use it, and similar arrangements are now being made in other parts of Surrey. Number of new patients 30 Admitted to hospital 10 Died 10 Service discontinued 3 Number of patients using Service at 31.12.61 7 Number of sheets laundered and issued 2,097 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. Under the National Assistance Act 1948 and the Amendment Act 1951 the Medical Officer of Health can apply to the Court or to a Magistrate for a compulsory Removal Order which has the effect of placing and detaining the patient in hospital or home. It was not necessary to use these powers during the year under review. 11 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 1961. Measles. The expected biennial epidemic of measles occurred and no less than 671 cases were notified. Eight were severe enough to require admission to hospital but all made complete recoveries. Otherwise the amount of notifiable infectious disease was quite remarkably low and only three other cases were admitted to hospital. There were only two very small outbreaks of food poisoning and only two children were notified suffering from a mild form of dysentery. Pulmonary tuberculosis showed an increase both in the notification of new cases and in deaths during 1961. The increase in the number of notifications is due to better facilities for diagnosis and case finding, and the recognition that the disease can be found in all age groups. Reference to Table 16 shows that one very young child was notified, and no less than 7 cases were over 65 years of age. Of the 6 deaths — 2 were of elderly men whose disease was diagnosed after death, two were men aged 75 who had been under observation and treatment for many years; one was a younger man who had suffered from severe chronic tuberculosis since 1940 and one was an elderly woman who died from broncho-pneumonia with arrested pulmonary tuberculosis. IMMUNIZATION. The Schemes for immunizing children against diphtheria, whooping rough, tetanus, and poliomyelitis continued as in previous years, and the response from parents was very good indeed. Reference to Section F will show how these schemes are progressing. Only about 60% of parents agree to their children being inoculated against tuberculosis and efforts are to be made to increase this in future. B.C.G. vaccination confers most useful protection during the susceptible years and could materially assist in eradicating the disease from this country. 12 Late in the year a case of smallpox was imported into the country and since then a great deal of vaccination against the disease has been carried out. About 45% of our babies are vaccinated which is higher than in many parts of the country, but in my opinion, is not high enough. The protection afforded by vaccination fades gradually and an individual will remain immune to the disease only if re-vaccinated at least every three years. On the other hand, successful re-vaccination produces immunity in 5 days whereas primary vaccination takes 10 days to do the same. In the presence of smallpox, re-vaccination offers a greater chance of preventing the disease and this is an important argument in favour of the vaccination of infants. Furthermore, there is an added risk when primary vaccination takes place in later life. The risk in infancy is extremely small and there are good reasons for continuing to recommend vaccination in early life (before age 5) and re'vaccination at school entry. 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. Mass Radiography Service. 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 conveniece 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. The Unit is also available for use by the general public. 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 plumb-solvent and every dwelling house in the Borough has a piped supply of water fit for human consumption. The determination of radioactivity in the well water supplies of the Borough was first carried out in 1959 when samples from each of the five wells proved to be satisfactory. The examination was repeated in 1960 and further samples have been taken in the past year, and in all cases the samples have continued to show entirely satisfactory results. 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 17 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 all during the year, have proved satisfactory. 14 3. Sewerage and Sewage Disposal. The Borough is sewered on a partially separate system, with the drainage from roads discharging directly into the river through surface water sewers. The soil sewers drain to the purification works of the Richmond Main Sewerage Board, which receives sewage from the Boroughs of Richmond and Barnes. The works are adequate for the area, and all sewage arrives there by gravity, the sewage from Ham being pumped through a rising main to join the main flow at Buccleuch Gardens. 4. Public Health Inspection. The wide range of public health duties to which attention is given is shown in Table 18. It proved possible during the year to increase the number of inspections of food premises while the survey of a new Smoke Control Area has again added considerably to the visits made by members of the department. The number of complaints received in 1961 (Table 20) shows a decrease of 12 due to fewer complaints received in respect of housing defects. Every effort is made to ensure that each complaint is investigated within twenty-four hours of its receipt. Table 19 indicates the number of informal and statutory notices served for the repair of premises and the abatement of nuisances; in two instances legal proceedings were taken against owners of dwelling-houses for failure to carry out repairs; in one case a Nuisance Order was granted, with five guineas costs, for the work to be done within two months, and in the other, the owner was fined £5, with one guinea costs, and ordered to carry out repairs in 21 days. 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 21. 15 6. Atmospheric Pollution. (a) Smoke Control Areas. The second Smoke Control Order, covering approximately 1,910 acres in Ham and Petersham (to the south of Sandy Lane) was confirmed by the Minister of Housing and Local Government on 30th June, 1961, and came into operation on 1st January, 1962. Included in this area are 902 private dwellings, 615 Council houses and 84 other premises. The third Smoke Control Order was made by the Council on 12th September, 1961 and awaits confirmation. This Order covers an area of 382 acres, extending from Sandy Lane to the Vineyard and includes 1,663 private dwellings, 214 Council houses and 112 other properties. The Order is expected to come into operation on 1st October, 1962. (b) Complaints of Smoke Emission. The number of complaints received has remained low and they have referred to bonfires in gardens and on building sites 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. Diseases of Animals Act, 1950. Outbreaks of foot and mouth disease were much lower in the country in 1961 when 103 outbreaks were confirmed (compared to 298 in the previous year). Richmond was not included in an infected area and no case of the disease occurred in the Borough. 8 Petroleum Spirit Storage. Forty-eight premises are licensed to store petrol and petroleum mixtures totalling 77,140 gallons. The licence conditions provide that storage tanks be tested in the 20th, 25 th and 30th year after installation and thereafter in every second year. Ten tanks were tested and found satisfactory, and at one garage a 750 gallon tank was examined and found be 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. There is, in the Borough, only one licensed site which accommodates three caravans. 16 SECTION D. —HOUSING. 1. Unfit Houses. Further progress was made during the year on areas of unfit properties, and fifty houses in Orchard Cottages, Orchard Road and Garden Road were demolished following the rehousing of the tenants. In May 1961, the Council considered a report on the unfitness of Nos. 4—10 (consecutively) Wellington Place, which was declared a Clearance Area to be compulsorily acquired by the Council. The confirmation of the Order by the Minister was awaited at the end of the year. During the year Closing Orders were made in respect of two individual dwelling houses (310 Kew Road and 2 Clarence Street) and in respect of one basement dwelling (43 Hill Rise); one other basement dwelling (6 Greville Road) was voluntarily closed by the Council. Repairs to one unfit basement enabled the Council to determine a Closing Order made in 1937 (31 Grosvenor Road). 2. Council Houses. Total number of houses erected post-war, 31st December, 1961 Temporary bungalows 179 Permanent Houses 485 Permanent Flats 468 953 1132 Since 1956 a total of 68 prefabricated bungalows have been demolished and one taken over for use as a dental clinic by the Surrey County Council 69 Total 1063 Housing Waiting List. Total number of families on Waiting List as at 31st Dec., 1961 508 Applications from Aged Persons as at 31st Dec., 1961 245 Total number of families rehoused in 1961 24 Miscellaneous allocations 6 30 17 Current Building Programme. The erection of 13 single storey Old Persons' Dwellings in terraces on land at the rear of Popham Gardens are under construction. Future Housing Programme. Ham Close Site — 192 Dwellings. The Minister of Housing and Local Government has now agreed that, in addition to the approval given for the invitation of tenders for 84 dwellings during 1962, the Council would be given authority for a further 50 or 60 dwellings to be commenced in May or June, 1963, and the remainder of the dwellings to complete the redevelopment commenced in January, 1964. SECTION E. — INSPECTION AND SUPERVISION OF FOOD. 1. Unsound Food Complaints. Twenty-four 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. Investigating complaints of unsound food is a task demanding an open mind and careful enquiry as the following case illustrated. A housewife brought to the office some currant buns which had been sliced, toasted and buttered in her home; she reported with some concern that a fragment of glass had been found in the substance of a piece of bun as it was being eaten. Before interviewing the baker who had made the buns, a visit was made to the complainant's home and her recollection was that there had been no accident involving any breakage of glass which might have caused a fragment to fly on to the buns or butter. Nevertheless when the butter dish was examined it was found to be chipped in one corner and the fragment found in the buttered bun exactly fitted the missing section. The housewife, in this case, had made a genuine mistake which could have resulted in more serious consequences for the baker. It is pleasing to report that no legal proceedings were authorised in respect of food complaints. 18 2. Food Sampling. The practice of selective rather than random food sampling has been continued through the year and 30 per cent of all samples were reported as irregular. The interest taken by the Public Analyst (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 investgation into irregular samples to be brought to a successful conclusion. Of the 37 irregular samples, 20 were imported products whose labels did not conform to the Labelling of Food Order, 1953, and one cannot help thinking that food sampling adminstration 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. 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 sixteen premises are registered for the sale and storage of ice-cream, and during the year 51 samples were submitted to the Public Health Laboratory for examination, of which 41 were satisfactory (Grades I and II) and 10 were unsatisfactory (Grades III and IV). Unsatisfactory samples received thorough investigation, and in 8 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 2 samples were taken from an ice-cream manufacturer whose plant was thoroughly examined and sterilised and from whom satisfactory samples were obtained afterwards. 4. Other Foods. Twenty-three other samples were examined bacterioligically, these samples included meat products, ice cream server waters, and 19 swabs from the surface of food tables. Two samples of ice-cream server water proved to be unsatisfactory and after suitable advice had been given the results showed a very satisfactory standard. 5. 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 but the one pasteurising plant licensed by the Council as the Food and Drugs Authority closed during the year under review. Details of sampling are included in Table 30. borough of richmond (SURREY) APPENDIX TO THE ANNUAL REPORT OF THE medical officer of health 1961 23 TABLE 1. STATISTICAL SUMMARY — 1961. SECTION A. — SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1961) 41,002 Population (Estimated 1961) 40,700 Number of inhabited houses (estimated) at 1.4.62 12,454 Rateable value at 1.4.62 £1,029,757 Sum represented by a Penny Rate, 1962/63 £4,158 BIRTHS. Birth Rate per 1,000 of estimated resident population 16.5 (Corrected) 15.5 Total number of births (live and still) 670 Analysis:— m F Total Live Births Legitimate 325 291 616 Illegitimate 22 23 45 Still Births Legitimate 4 4 8 Illegitimate - 1 1 Still Birth Rate per 1,000 total births 13.4 Environment of Births:— Proportion taking place in Institutions (482) 74.84 Proportion taking place in dwelling houses (162) 25.15 deaths. Total number of deaths from all causes 626 Death rate per thousand estimated resident population 15.4 (Corrected) 10.9 The principal causes of deaths:— Malignant Neoplasms 122 Heart disease 168 281 Vascular lesions of Nervous System 79 Other circulatory diseases 34 Pneumonia 34 77 Bronchitis 36 Other respiratory diseases 7 Malignant Neoplasms were responsible for 122 deaths or 19.5% of total deaths. 24 Diseases of the Heart and Circulation caused 281 deaths or 44.9% of total deaths. Diseases of the Respiratory System caused 77 deaths or 12.3% of total deaths. TABLE 2. — ANALYSIS OF DEATHS RELATING TO RICHMOND FOR THE YEAR 1961. Causes of Deaths. Male. Female. Total. Tuberculosis, respiratory 5 1 6 Tuberculosis, other - - - Syphilitic Disease 2 1 3 Meningococcal Infections - 1 1 Measles - 1 1 Malignant neoplasm, stomach 8 2 10 Malignant neoplasm, lung bronchus 22 3 25 Malignant neoplasm, breast - 10 10 Malignant neoplasm, uterus - 6 6 Other malignant and lymphatic neoplasms 33 38 71 Leukaemia, Aleukaemia 1 3 4 Diabetas 1 4 5 Vascular lesions of nervous system 33 46 79 Coronary disease, angina 65 32 97 Hypertension with heart disease 5 5 10 Other heart disease 20 41 61 Other circulatory diseases 14 20 34 Influenza 3 2 5 Pneumonia 20 14 34 Bronchitis 26 10 36 Other diseases of respiratory system 4 3 7 Ulcer of stomach and duodenum 5 5 10 Gastritis, enteritis and diarrhoea 2 4 6 Nephritis and nephrosis - 3 3 Hyperplasia of prostate 5 - 5 Congenital malformations 3 1 4 Other defined and ill defined diseases 30 35 65 Motor vehicle accidents 2 4 6 All other accidents 2 8 10 Suicide 5 7 12 316 310 626 TABLE 3. MATERNAL MORTALITY — 1961. 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 220 0.27 Due to abortion 54 0.07 Total maternal mortality 274 0.33 25 Richmond. Maternal causes, excluding abortion Nil Due to abortion Nil Total maternal mortality Nil TABLE 4. INFANT MORTALITY. (Deaths under one year of Age). Infant Mortality Rate for all infants per 1,000 live births 22.7 Rate for legitimate infants per 1,000 legitimate live births 21.1 Rate for illegitimate infants per 1,000 illegitimate live births 44.4 Total number of infant deaths in the Borough 15 Analysis:— M F Total Legitimate 11 2 13 Illegitimate 2 - 2 Environment of Infant Deaths:— Number occurring in the Borough 3 Number occurring outside the Borough 12 Number occurring in Institutions 12 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. Pneumonia - - - 2 - 2 2.Birth Accident 2 - - - - 2 3. Prematurity 4 - - - - 4 4.Congenital Abnormality 2 1 - - 1 4 5. Meconium Ileus. - 2 - - - 2 6. Found Dead 1 - - - - 1 9 3 - 2 1 15 Neo-natal Mortality Rate: (Deaths under 4 weeks per 1,000 total live births) 16.6 Early Neo-natal Mortality Rate: (Deaths under 1 week per 1,000 total live births) 12.1 Perinatal Mortality Rate: (Stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 25.4 26 TABLE 5. ILLEGITIMATE BIRTHS. 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 No. of illegitimate births 25 34 33 31 40 30 40 36 46 45 No. of illegitimate deaths under 1 year 3 1 2 0 3 1 0 1 1 2 Illegitimate death rate 120 29 60 0 75 33 0 27 21 44 TABLE 6. COMPARATIVE STATISTICS — 1961. 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 17.4 18.7 12.0 21.4 15.5 Richmond 15.5 (Corrected) 13.4 10.9 (Corrected) 22.7 16.6 27 TABLE 7. PREMATURE LIVE BIRTHS — 1961. 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 3 3 — — — — — — 1 — — Over 31b. 4oz to 41b. 6oz. 4 — — 4 1 — — 1 2 — — Over 41b. 6oz. to 41b. 15oz. 9 — — 9 — — — — 1 — — Over 41b. 15oz. to 51b. 8oz. 13 — — 13 7 1 — 6 — 1 — TOTALS 29 3 — 26 8 1 — 7 4 1 — Note: No cases in following categories:—(1) Born at home and transferred to Hospital on 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. Pueperal Pyrexia 4 — — Erysipelas 4 2 — Scarlet Fever 7 1 — Pneumonia 4 — — Measles 671 8 — Whooping Cough 6 — — Food Poisoning 4 — — Opthalmia-Neonatorum 2 — — Dysentery 2 — — 704 11 Nil TABLE 9. FOOD POISONING. Total number of outbreaks 2 Number of cases notified 4 Number of deaths Nil TABLE 10. DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1961:— (a) Pre-School children (under 5 years) 526 (b) Between 5 and 15 years 61 587 Grand Total of Children in the Borough who have received immunising treatment by the end of the year:— (a) Under 5 years 1903 (b) Between 5 and 15 years 5125 Number of children given re-inforcing doses during 1961 440 29 TABLE 11. POLIOMYELITIS VACCINATION. Northern Division — Richmond and Barnes. Number of Persons vaccinated during year 1961. 1st injection. 2nd injection. 3rd injection. 4th injection. A. Children born in years 1943-1961 1837 1460 — — B. Young Persons born in years 1933-1942 388 340 — — C. Persons born before 1933 who have not passed their 40th birthday 970 869 — — D. Others 154 134 — — E. Total A to D 3349 2803 5692 4279 Number of record cards submitted by General Practitioners during the year (a) Recording 1st and 2nd injections 1247 (b) Recording 3rd injection 1265 (c) Recording 4th injection 472 Total number of Poliomyelitis Injections given during 1961 20,354 TABLE 12. VACCINATION AGAINST SMALLPOX 1961. 1- Analysis of Vaccinations at Welfare Centres and Private Doctors' Surgeries: Children. Primary Vaccination 369 Re-vaccination 29 Total 398 In addition 7 vaccinated, 42 Re-vaccinated — over 15 years of age. 2. Figures showing the percentage of children under 1 Year vaccinated during 1961: No. Vaccinated. Estimated mid-year Population under 1 year. % Vaccinated. 250 556 44.9 30 TABLE 13. IMMUNIZATION AGAINST TETANUS. During the year 547 children were given courses of inoculations against Tetanus at the parent's request. In addition 99 children were given a reinforcing dose to maintain their immunity. TETANUS IMMUNIZATION. AGE at date of final injection 0—4 years 5—14 years Total Number of children who have completed a primary course of three injections whether single or combined during the year ended 31st December, 1961 500 47 547 Number of children who received a reinforcing dose 13 86 99 TABLE 14. WHOOPING COUGH IMMUNIZATION. Number of children who have completed a primary course of 3 injections during the year ended 31st December, 1961 531 TUBERCULOSIS. Vaccination Against Tuberculosis. During 1961 a total of 612 boys and girls were inoculated with B.C.G. in the Northern Division (Richmond and Barnes). NOTIFICATIONS : Respiratory Tuberculosis. Thirty-three cases of respiratory tuberculosis were notified during the year, viz:— 22 males and 11 females. The corresponding figure for 1961was 25. Non-Respiratory Tuberculosis. One new case of non-respiratory tuberculosis was notified during the year and there were no deaths from this cause. Three such cases were notified during 1960. 31 TABLE 15. 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 98 5 Females 52 10 150 15 Corresponding figures for 1961 159 18 TABLE 16. ANALYSIS OF CASES AND DEATHS FOR 1961. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M b' M K M F M F 0— 4 1 - - - - - - - 5—14 - - - - - - - - 15—24 4 3 - - - - - - 25—44 5 2 - - - - - - 45—64 6 5 - 1 1 1 - - 65 and upwards 6 1 - 4 4 - - - Totals 22 11 - 5 5 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 MASS RADIOGRAPHY SERVICE. General Practitioners' Service. Men Women Total Number of patients referred 356 374 730 Cases of Pulmonary Tuberculosis 2 2 4 Cases of Lung Cancer 6 4 10 Public Mass Radiography Service 710 624 1334 Cases of Pulmonary Tuberculosis 2 0 2 Cases of Lung Cancer Nil Nil Nil Employees of Richmond Borough Council referred by Medical Officer of Health — 35. 33 SECTION C—SANITARY CIRCUMSTANCES. TABLE 17. WATER SUPPLY. (a) The following figures show the daily average consumption of water in the district:— 1960 1961 All Richmond Wells 819,022 galls. 798,616 galls. Metropolitan Water Board 957,482 galls. 1,098,414 galls. Raw River Water 246,578 galls. 275,797 galls. (b) During the year the following samples were taken for examination:— (i) Richmond Water Supply: Untreated water 268 samples. Treated water 176 „ For chemical analysis 22 „ (ii) Metropolitan Water Board Supply: Bacteriological examination 1,835 „ Chemical examination 156 „ (iii) Raw River Water 50 „ (c) Swimming Water samples 24 „ TABLE 18. PUBLIC HEALTH INSPECTIONS. Houses inspected 310 Revisits to houses and other premises 732 Houses visited for Certificates of Disrepair ... 6 Visits paid in connection with:— Permitted number for dwellings 4 Vermin 64 Enquiries into Infectious Diseases and Disinfection 110 Routine inspections in connection with:— Factories (mechanical) 51 Factories (non-mechanical) 9 Outworkers 4 Bakehouses 25 Butchers' Shops 92 Confectioners (Flour) 28 Confectioners (Sugar) 52 Dairies and Milk Shops 8 Fishmongers and Poulterers 31 Fried Fish Shops 5 34 Greengrocers and Fruiterers 100 Grocers 178 Ice-cream premises 70 Public Houses 84 Restaurants and Tea Shops 232 Food and Drugs Act Sampling 123 Milk Sampling (Designated Milk) 77 Ice-cream Sampling 51 Unsound Food 99 Caravans 2 Clean Air Act — Inspection and Observations 1665 Diseases of Animals Act — Drainage 534 Interviews 837 Heating Appliances (Fireguard) Act 10 Merchandise Marks Act 24 Noise Abatement 10 Pet Animals Act, 1951 6 Petroleum Act, 1928 118 Piggeries 16 Rag Flock Act 2 Rats and Mice (Visits to Properties) 4502 Rats and Mice (Visits re sewer treatments) 593 Schools — Elementary and Secondary 6 Shops Act, 1950 87 Theatres and Cinemas 4 Water Supply 297 Miscellaneous Visits 1473 12,731 TABLE 19. SERVICE OF NOTICES. (1) Informal action by letter or verbal intimation 392 (2) Statutory action by notice: (a) under the Public Health Act, 1936— (i) Section 39 (drainage) 5 (ii) Sections 92/93 (nuisances) 12 (b) under the Clean Air Act, 1956— Section 12 (firegrate adaptations) 48 35 TABLE 20. COMPLAINTS. The complaints received have been classified as follows: — Disrepair of premises:— Dampness 24 Drainage 108 General defects 129 Nuisance from refuse 18 Nuisance from smoke or fumes 57 Nuisance from Insects, animals, etc. 50 Rodent infestations 236 Unsound food 24 Miscellaneous nuisances 22 668 TABLE 21. DISINFECTION AND DISINFESTATION. A summary of the treatment of premises, bedding, clothing and other articles is given below:— Houses. Rooms. Bedding, etc. Infectious Fevers 1 1 3 Tuberculosis 4 8 25 Vermin 27 60 180 Other Diseases 4 5 452 Costs recovered throughout the year: £39 l1s. 8d. TABLE 22. FACTORY INSPECTIONS. Inspections. Premises. Number on Register. Inspections. Written Notices. Prosecutions. Factories (non'power) 15 9 Nil Nil Factories (power) 145 51 10 Nil Building Sites and Institutions 14 14 Nil Nil 36 2. Defects. Particulars. Found. Remedied. Referred by H.M. Inspector. Want of Cleanliness 2 2 Nil Sanitary Conveniences. (a) Unsuitable 8 8 2 (b) Not separate for sexes 4 4 1 3. Outworkers. Nature of Work Number of Outworkers. Number of Unwholesome Premises. Wearing apparel (making) 20 Nil. Brass and brass articles 5 Nil. Lampshades 3 Nil. Legal Proceedings — no prosecutions were taken in 1961. TABLE 23. RODENT CONTROL. The rodent control staff have continued to do much useful work in eradicating rats and mice from premises. Number of complaints received 236 Number of infestations found 224 Number of infestations cleared 210 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 53 Nil. Manholes above found infested 3 Nil. Manholes poison-baited 46 62 Manholes infested 24 24 Number of visits 283 310 37 SECTION D — HOUSING. TABLE 24. Housing Statistics for 1961. 1. Number of dwellings owned by the Local Authority:— Number of houses 1395 Number of Flats 641 Total 2036 2. Unfit Houses. (a) Dwelling houses inspected 310 (b) Total number of visits made 1048 (c) Clearance Areas represented to Council 1 (d) Dwellings included in (c) above 7 (e) Compulsory Purchase Orders made by Council 1 (f) Dwellings demolished after Clearance Orders made 50 (g) Dwellings represented for Demolition or Closing Orders 4 (h) Undertakings received that dwellings be not used for human habitation 1 (i) Closing Orders made (a) in respect of whole of building 2 (b) in respect of part of building 1 (j) Dwellings demolished in pursuance of Demolition Order Nil. (k) Undertakings received to repair part of a building Nil. (l) Closing Orders determined on part of a building being made fit 1 (m) Undertakings cancelled on part of a building being made fit 2 (n) Dwellings in respect of which formal notices were served requiring defects to be remedied 13 (o) Dwellings in which defects were remedied after service of formal notices 8 (p) Dwellings in respect of which informal notices were served requiring defects to be. remedied 187 (q) Dwellings in which defects were remedied after service of informal notices 161 38 TABLE 25. 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. 1958 1959 1960 1961 Number of applications ... 37 15 8 Nil Number of decisions not to issue certificates 4 1 Nil Nil Number of decisions to issue certificates:— (a) in respect of some but not all defects 29 7 7 Nil (b) in respect of all defects 6 7 1 Nil Number of undertakings given by landlords 24 9 2 Nil Number of undertakings refused by Local Authority 1 Nil Nil Nil Number of certificates issued 12 5 5 1 PART 2. — Applications for Cancellation of Certificates. 1958 1959 1960 1961 Applications by landlords to local Authority for cancellation of certificates 8 3 2 1 Objections by tenants to cancellation of certificates 2 1 Nil 1 Decisions by Local Authority to cancel in spite of tenants' objection 1 1 Nil Nil Certificates cancelled by Local Authority 7 3 2 Nil 39 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. TABLE 26. INSPECTION OF FOOD. The following foodstuffs, found to be unfit for human consumption, were voluntarily surrendered and destroyed. Fresh Foods (all classes) 8 cwts. 2 qrs. 8 lbs. Tinned Meats, vegetables 9 „ 3 „ 17 „ Tinned Fruits 4 „ 1 „ 5 „ 1 ton. 2 cwts. 3 qrs. 2 lbs. TABLE 27. 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 Bread — 5 5 — 4 4 Bread and Butter — 9 9 — 2 2 Cereals and Cakes — 7 7 — 1 1 Cheese — 5 5 — 1 1 Coffee — 5 5 — — — Cream — 2 2 — — — Fish and Fish Products — 2 2 — 1 1 Flour — 1 1 — — — Fruit. Juice — 11 11 — 9 9 Fruit (Tinned) — 2 2 — 2 2 Fruit Puddings — 3 3 — — — Ice Cream — 2 2 — — — Jams and Marmalade — 1 1 — — — Jelly — 3 3 — — — Margarine — 1 1 — 1 1 Meat and Meat Products — 8 8 — 1 1 Milk — 19 19 — 2 2 Mustard — 1 1 — 1 1 Pickles and Sauces — 13 13 — 5 5 Sweets — 10 10 — 2 2 Svrup — 2 2 — 1 1 Vegetables — 7 7 — 3 3 Vegetable Juice — 2 2 — 1 1 Vegetable Oil — 2 2 — — — Totals — 123 123 — 37 37 40 The irregular samples are referred to below:— (a) in this group are those samples reported to be irregular because the label did not specify the ingredients of the product as required by the Labelling of Food Order, 1953; in every case correspondence with the retailer and the manufacturer or importer resulted in an undertaking being given that the labelling of unsold stocks and of future consignments would be correctly amended: Sample 752 : Liquid Mustard. „ 758: Mango Chutney. „ 768: Peeled Shrimps. „ 770: Pickled Cucumbers. „ 773: Tomato Puree. „ 822: Bottled Olives. „ 823: Sliced Gherkins. „ 828: Bean Sprouts. „ 842: Golden Corn. „ 845: Pineapple. „ 848: Asparagus Tips. „ 849: Chow-Chows. (b) the second group includes samples for which the label made some claim as to vitamin or mineral content but without giving the quantitative statement which is required by the Labelling of Food Order, 1953; in all these cases, too, undertakings were given that the labelling of unsold stock and future consignments would conform to the requirements of the 1953 Order: Sample 749 : Apple Juice. „ 754: Grapefruit Juice. „ 757: Apple Juice. ,, 759: Orange Juice. „ 776: Date Syrup. „ 778: Grapefruit Juice. „ 780: Rice Crispies. „ 782: Soda Bread mix. „ 783: Wholemeal Soda Bread mix. „ 787: Carrot Juice. „ 827: Orange Juice. „ 831: Grapefruit Juice. 41 (c) a further group of samples proved to be irregular because the description of the product was misleading or because the product was not of the standard prescribed by statute; in these cases undertakings were given that the correct description would be used in future or that the statutory standard would be complied with: Sample 766: Passion Fruit Juice: the ingredients required this product to be described correctly as Passion Fruit Drink. Sample 772: Cream Cheese: the sample did not conform to the standard for cream cheese and the description should not have included the word 'cream'. Sample 803: Hot Milk: contained 12% added water because the milk was heated by steam injection and contained bottle rinsings. Sample 805: Hot Milk: contained 28% added water because the article was made by mixing the 'top' or cream from a bottle of milk with hot water. Sample 806: Bread and Butter: proved to be bread and margarine. Sample 818: Bread and Butter: proved to be bread and margarine. Sample 856: Edible Father Christmas: both sample contained a prohibited colouring Sample 857: Edible Christmas Heart: matter. Sample 748: Apple Juice: the sample was irregular in that the vitamin content was not shown in the terms required by the Labelling of Food Order, 1953, and in that the contents were deficient in the vitamin claimed; the unsold stocks were relabelled so as to comply with the Order and so as to show the true vitamin content. (d) A small group of samples were reported as irregular, but no action was taken by the Council because of the absence of a statutory standard to which the manufacturer's attention could be drawn: Sample 764: Margarine: claimed to be suitable for persons suffering from thrombosis, atheroma, etc. Sample 771: Casserole Steak: made of a mixture of 3 parts mutton and 1 part beef : Sample 777: Slym Bread: the food was not in itself slimming and the description might have been misleading: Sample 785: American Enriched Loaf: the nature and quality of the enriching substance was not specified. 42 TABLE 28. CLASSIFICATION OF FOOD PREMISES. No. of Premises. No. of Visits. Bakehouses 8 25 Butchers (including 27 premises registered for manufacture of preserved food) 31 92 Confectioners (flour) 16 28 Confectioners (sugar) 42 52 Dairies (registered under Milk and Dairies Regulations) 4 8 Fishmongers 13 36 Greengrocers 37 100 Grocers (including 3 premises registered for manufacture of preserved food) 65 178 Ice-cream premises (manufacture) 1 70 Ice-cream premises (sale and storage) 116 Licensed premises 81 84 Restaurants, cafes, etc. 79 232 493 905 TABLE 29. IMPROVEMENTS IN FOOD PREMISES. As the result of inspections made the following improvements were carried out:— 1. Food rooms reconstructed 12 premises 2. Food rooms repaired, cleansed or redecorated 99 ,, 3. Food storage improved 18 ,, 4. Food preparation equipment improved 74 ,, 5. Ventilation and lighting improved 17 ,, 6. Staff washing facilities improved 31 ,, 7. Staff clothing accommodation provided 13 ,, 8. First aid boxes provided 5 ,, 9. Constant hot water supply installed 15 ,, 10. New sinks provided 8 ,, 11. Existing sanitary accommodation improved 20 ,, 12. Drainage improved, repaired or altered 14 ,, 13. Refuse accumulations removed 18 ,, 14. Refuse receptacles provided 6 ,, 15. Other improvements or repairs carried out 260 ,, 43 TABLE 30. MILK LICENSING. The following licences have been granted by the Council authorising dealers to store and sell Designated milks:— Pasteurised Milk 23 Tuberculin Tested Milk 19 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 35 samples Number found unsatisfactory Nil Tuberculin Tested (Pasteurised) Milk 28 ,, Number found unsatisfactory Nil Sterilised Milk 10 ,, 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. 1