??? 4413(1) RICH 33 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1964 BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1964 Printed by J. H. Broad & Co. Ltd., 8, King Street, Richmond, Surrey. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health : ERIC PEREIRA, M.B., B.S., D.P.H. Deputy Medical Officer of Health : ELZA H. TODD, M.B., Ch.B., 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 : JOHN WILLIAM REAVLEY, M.A.P.H.I., A.R.S.H. ROGER WALTER SHEPPARD, M.A.P.H.I., A.R.S.H. Technical Assistant: WILLIAM J. HAUTING. Chief Clerk : MRS. FLORENCE G. SMITH. Clerks : MISS EILEEN M. LANE. MISS MARGARET M. DENNEHY. Rodent Officer : THOMAS R. SMITH. Rodent Operator: RONALD EVANS. Disinfector and Driver : ALBERT CLEGG. 3 Public Health Department, Municipal Offices, Parkshot, Richmond. To the Mayor, Aldermen and Councillors of The Borough of Richmond upon Thames. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1964, upon the Sanitary Circumstances, Sanitary Administration, and Vital Statistics of the Borough of Richmond (Surrey). 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. I am, Ladies and Gentlemen, Your obedient Servant, ERIC PEREIRA, Medical Officer of Health. 4 BOROUGH OF RICHMOND (SURREY). PREFACE. SECTION A. —SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Population. The Registrar Generals estimate of the population was 41,290. This may be compared with his estimate of 40,630 for the previous year and the Census 1961 figure of 41,002. Births. During the year 692 live births were recorded (359 males and 333 females) compared with 656 in 1963. There were 42 premature live births and of these 38 survived. Deaths. The total number of deaths occurring amongst residents was 572 (277 males and 295 females) compared with 660 in 1963. The death rate when corrected to allow for the high proportion of elderly residents is 10.20 per thousand population which compares favourably with other towns in the country. The Infant Mortality, Neo-natal Mortality and Still Birth rates compare favourably with rates for England and Wales. There were 13 infant deaths, and of these 5 died of pneumonia, 4 of prematurity, 3 from complications at birth, and one was found dead. 5 SECTION B. —GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. These are mainly provided by the Surrey County Council, the South West Metropolitan Region 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 at 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. (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 m London and Middlesex are frequently used by Richmond residents. 6 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.I are used for the examination of water samples and for advice in the control of purity of the water supply. Mortuary. This is provided and maintained by Richmond Borough Council on a site close to the Petty Sessions Court. It is well equipped with two post-mortem examination tables. All such examinations required within the boroughs of Richmond and Barnes are carried out here and Barnes Borough Council make an annual payment for this service. Nursing 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. 7 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 is not unduly long, and a desparate 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. Chiropody. The Surrey County Council has established a most effective chiropody service throughout the Boroughs of Richmond and Barnes. Under this Scheme any person who is of pensionable age or substantially and permanently physically handicapped can obtain treatment at a Chiropodist's Surgery for a payment of three shillings or free in case of need. Surgeries are fairly conveniently situated and there are facilities for domicilliary visits. At the present time over 800 elderly persons are obtaining treatment under this scheme, in addition to those who are attending special sessions provided by voluntary bodies. The Scheme is quite costly, but by helping to keep elderly people mobile and in good health, it will undoubtedly tend to reduce the need for institutional accommodation. 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 properly be 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. 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 8 sheets are collected on Tuesdays and Fridays and at the same time 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. During the year ending 31st December, 1964, 1,917 sheets were issued and laundered. 9 SECTION F. — PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES. The table in Section F sets out the number of cases of infectious diseases notified during 1964. It will be seen that the incidence of such cases was very moderate, and that there is little that calls for comment. Measles. 1963 was a 'measles' year (473 cases) and 62 cases in 1964 is more than would have been expected. Trials of a new measles vaccine were held in various parts of the country in the Autumn, and it is to be hoped that this will prove to be an effective preventive measure. Food Poisoning. Three cases only were notified. One was caused by Salmonella typhimurium, a second by Salmonella newport, and in the third case the causal organism was not identified. The cases were quite unconnected and there was no spread of the disease. Two un-notified cases were at first reported by the Public Health Laboratory as being infected with Salmonella paratyphi B. They were two pre-school children who played together daily while the mother of one worked in a food shop. Appropriate action was taken, including the exclusion of the mother from her occupation as a food handler. Two weeks later the laboratory reported that the organism was not salmonella paratyphi B. but was Salmonella abony, an organism often associated with tortoises. It was then found that the children played frequently with a tortoise, which, on being sent to the laboratory, was found to be infected with the same organism. In order to prevent any further spread of this infection, the tortoise was found a new home where there were no children! Encephalitis. A child aged 18 months was vaccinated against smallpox and five days later became extremely ill with post-vaccinal encephalitis. Fortunately recovery occurred after a few days and, when examined six weeks later, he appeared to have made a complete recovery. This is a most unpleasant complication of vaccination, which fortunately occurs very rarely. Prevention of Typhoid Fever. The serious outbreak of typhoid fever in Aberdeen put an extra burden on the staff of the Health Department. The Public Health Inspectors were very active in calling in suspect 10 batches of canned meat stocked locally and in taking the opportunity of stepping up the standard of hygiene in all food premises. 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. During 1964 a total of 389 boys and girls were inoculated with B.C.G. Mass Radiography Service. The Regional Hospital Board sets 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. The Unit is also available for use by the general public. 11 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 served partly from local wells and partly from the Metropolitan Water Board, and the origin, purity and treatment of these supplies has been fully reported in the past. Water from the five local wells is pumped to the low level reservoir at Petersham Pumping Station, and thence to the high level reservoir in Richmond Park; from here it is distributed by gravity to a proportion of the residents and, in particular, to those living in and around Richmond Hill. Formerly the water was treated only by chlorination, but during 1962 apparatus was installed to enable treatment by "superchloriantion and dechlorination" to be carried out. The advantage of this process is that a dose of chlorine large enough to deal with any possible contamination can be added to the water at its entry to the Petersham Reservoir and, after a suitable contact period excess chlorine is destroyed by the addition of an appropriate amount of sulphur dioxide. This procedure gives an even greater measure of safety, and in addition, by preventing fluctuations in the level of residual chlorine reduces to a minimum the chances of the water tasting unpleasant. 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 has been repeated annually at times of flooding and further samples were taken in the past year which 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 12 100 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. 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 civil engineering works of reconstructing the primary digestion tanks, together with extensive ancillary works, including a new boilerhouse, had been completed by the end of 1964, and the purification plant should ensure that a high standard effluent is discharged into the River Thames without causing a nuisance to residents in the neighbourhood. 4. Public Health Inspections. The wide range of public health inspections is shown in Table 18 and routine visits to food premises and for food sampling were maintained throughout the year. Table 19 shows that many improvements are effected by informal action and without the need to resort to statutory procedures. Nearly all formal notices served under the Public Health and Housing Acts arose because of delay in carrying out works of repair. The number of complaints (Table 20) increased by 121 on the figure for the previous year. Every effort is made to ensure that each complaint is investigated within twenty-four hours of its receipt. No legal proceedings were instituted by the Council to enforce property repairs. 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 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. 6. Atmospheric Pollution. The fifth Smoke Control Order came into operation on 1st October, 1964, and the Council made the No. 6 Smoke Control Order during the year which comes into operation on 1st October, 1965. 13 The progress made in the Clean Air programme is summarised below:— Area. Dwelling. Other Premises. No. 1 Order 85 acres 338 3 No. 2 Order 1,910 acres 1,517 83 No. 3 Order 382 acres 1,877 112 No. 4 Order 122 acres 1,068 485 No. 5 Order 126 acres 2,280 24 No. 6 Order 108 acres 2,007 125 The work of approving proposed works of firegrate adaptations and of examining grant applications has proceeded smoothly and the Clean Air Officer has endeavoured to give householders full information and advice on every enquiry made to the department. The Council have given sympathetic consideration to many cases of financial hardship and, where need has been shown, a 100% grant has been made instead of the normal 70% grant. 7. Diseases of Animals Act, 1950. Richmond was included in an Infested Area following an outbreak of Swine Fever in Surrey between the 26th August, 1964 and the 22nd October, 1964, but no case of the disease occurred in the Borough. Routine visits were continued to the Ham piggery during the year to ensure that all waste foods for animal feeding are sterilised by heat treatment. 8. Petroleum Spirit Storage. Forty-eight premises are licensed to store petrol and petroleum mixtures and total storage amounted to 92,480 gallons. The conditions of licence require storage tanks to be tested in the 20th, 25th and 30th year after installation and thereafter in every second year, and 22 tanks were tested and all were found to be satisfactory. One petrol filling station reported the loss of petroleum spirit from a leaking tank which has now been taken out of use. 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. 10. Shops Act, 1950. A number of enquiries are dealt with each year about general closing hours and Sunday trading and the advice given is usually acted upon with confidence. The co-operation of shopkeepers in dealing with the complexities of the Act has not been lacking, and no legal proceedings were taken during the year for contravention of this Act. 14 SECTION D. —HOUSING. 1. Unfit Houses. Nos. 1-5 (consecutive) The Bench, Ham, were represented as an unfit area during the year and the Clearance Order was confirmed by the Minister in October, 1964. Nos. 1-7 (consecutive) Paradise Cottages were also represented as a Clearance Area and in this instance the Council decided to make a compulsory purchase order. Five dwellings were reported as being unfit for human habitation and not capable of repair at reasonable expense, namely:— Basement, 31, Kew Green. Basement, 316, Kew Road. Basement, 41, Hill Rise. Basement, 29, Church Road. 7, Albert Road. During the year Closing Orders were made in respect of 3a, Vine Cottages, Petersham Road and Basement, 316, Kew Road; an undertaking was accepted to carry out repairs at Basement, 31, Kew Green, and an undertaking in respect of Basement, 25, Queen's Road, was given that the premises would not be used for human habitation. A Closing Order in respect of Basement, 91, Church Road, and an undertaking to effect repairs at 7 and 7a, Kew Foot Road were cancelled after the premises had been made fit for human habitation. 2. Houses in Multiple Occupation. Further progress was made during the year by co-operation with owners of houses in multiple occupation, whereby improvements were made in the standard of amenities provided in such houses. 3. Council Houses. Number of dwellings owned by the Local Authority as at 31st December, 1964:— Number of houses 1,337 Number of flats 745 Total 2,082 Total number of houses erected post-war, 31st December, 1964. Temporary bungalows 179 Permanent Houses 498 Permanent Flats 568 1,066 1,245 Since 1956, 137 prefabricated bungalows have been demolished and 2 taken over for other uses 139 Total 1,106 15 Housing Waiting List. Total number of families on Waiting List as at 31st Dec., 1964 378 Applications from Aged Persons as at 31st Dec., 1964 315 Total number of families rehoused in 1964 68 Miscellaneous allocations 20 — 88 Current Building Programme. Ham Close Estate — Erection of 192 Dwellings. During the year 100 of these flats were occupied and it is anticipated that the remaining flats will be completed by June, 1965. One of the latter is being adapted for occupation by a tenant disabled by multiple sclerosis. Future Housing Programme. Plans have been passed and a tender accepted for the erection of 35 flats on the Hardwicke Road site at Ham comprising 4 threebedroomed flats, 8 two-bedroomed flats, 14 two-bedroomed maisonettes, 7 bed-sittingroom type flats and 2 one-bedroomed flats which are specially designed for occupation by disabled persons. In 1964 the Council rented and adapted a house (86, Queen's Road) for use as emergency accommodation. The accommodation comprises 6 rooms with bathroom and kitchen facilities which can be used either singly or in combination to rehouse evicted families, and during the year three such families were accommodated. 16 SECTION E. — INSPECTION AND SUPERVISION OF FOOD. 1. Food Complaints. Forty one complaints alleging unfitness in food sold or exposed for sale were received during the year. The investigations which followed showed that about one-third of complaints referred to mould growths or souring due to the failure of the food trader to turn over stock in a proper manner. There is growing evidence of the advantage to the retailer if a system of visual-aid coding is adopted for deliveries of prepacked perishable goods; the retailer can then easily determine the date of delivery and is in no doubt as to the day when the "shelf-life" of the article has expired, so that such foods can be withdrawn from sale and destroyed. 2. Food Premises. There has been an improving standard of hygiene in food shops in the Borough over a number of years, and in many premises now the proprietor is choosing to reconstruct and re-equip food rooms rather than patch and repair them as was the practice in the immediate post-war years. Table 29 shows the broad headings under which food premises were improved in the past year. In general, excellent co-operation has been maintained with proprietors of food businesses, and in only two cases were legal proceedings necessary where premises failed to conform to the standards laid down in the Food Hygiene (General) Regulations, 1960. In one case fines totalling £235 with 70 guineas costs were imposed against a baker; in the second case, a restaurant proprietor and his manager were fined a total of £264 with 80 guineas costs and the magistrates made an order disqualifying the defendants from carrying on the business for three months. 3. Food Sampling. One hundred and twenty-two samples were procured during the year of which 6 were shown to be irregular. The Public Analyst (D D. Moir, Esq., M.Sc., F.R.I.C.) has at all times given most Helpful advice and his continued interest has contributed in great measure to the usefulness of this branch of public health work. As in past years most of the irregular samples failed to satisfy the Labelling of Food Order either in the description of the product or in the list of ingredients, but in all cases it proved possible to reach agreement with the manufacturers or importers to remedy the irregularity revealed by sampling. 4. Ice-Cream. There are three ice-cream manufacturers in the Borough; one makes ice-cream by heat-treating the product for 10 minutes at a temperature not less than 160°F; the other two receive heat-treated ice-cream in 17 sealed containers from suppliers outside the Borough and complete the manufacturing process by freezing the product on their premises. One hundred and sixteen premises are registered for the sale and storage of ice-cream, and during the year 83 samples were submitted to the Public Health Laboratory for examination, of which 75 were satisfactory (Grades I and II) and 8 were unsatisfactory (Grades III and IV). Unsatisfactory samples received thorough investigation, and in both 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. 5. Other Foods. Twenty-two other samples were examined bacteriologically; these samples included meat products, ice cream server waters, frozen egg, mousse, artificial cream and orange-drink. Eight samples of ice-cream server water proved to be unsatisfactory and after suitable advice had been given the results showed a very satisfactory standard. 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 licensing, inspection and control. There is one dairy farm within the Borough under the control of the Ministry. Details of sampling are included in Table 30. 18 BOROUGH OF RICHMOND (SURREY) APPENDIX TO THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1964 TABLE 1. STATISTICAL SUMMARY — 1964. SECTION A. —SUMMARY OF STATISTICS AND SOCIAL CONDITIONS. Area in acres 4,234 Population (Census 1961) 41,002 Population (Estimated 1964) 41,290 Number of inhabited houses (estimated) at 1.4.64 12,413 Rateable value at 1.4.64 £2,625,012 Sum represented by a Penny Rate, 1964/65 £10,490 BIRTHS. Birth Rate per 1,000 of estimated resident population.. 17.0 (Corrected) 16.6 Total number of births (live and still) 699 Analysis:— M F Total Live Births Legitimate 321 297 618 Illegitimate 38 36 74 Still Births Legitimate 2 5 7 Illegitimate 2 - 2 Still Birth Rate per 1,000 total births 12.8 Environment of Births:— Proportion taking place in Institutions (526) 76.12 Proportion taking place in dwelling houses (165) 23.88 DEATHS. Total number of deaths from all causes 572 Death rate per thousand estimated resident population 13.9 (Corrected) 10.2 The principal causes of deaths:— Malignant Neoplasms 121 Heart disease 188 270 Vascular lesions of Nervous System 57 Other circulatory diseases 25 Pneumonia 37 62 Bronchitis 21 Other respiratory diseases 4 Malignant Neoplasms were responsible for 121 deaths or 21.2% of total deaths. Diseases of the Heart and Circulation caused 270 deaths or 47.2% of total deaths. Diseases of the Respiratory System caused 62 deaths or 10 8% of total deaths. 20 TABLE 2. —ANALYSIS OF DEATHS RELATING TO RICHMOND FOR THE YEAR 1964. Causes of Death. Male. Female. Total. Tuberculosis, Respiratory 1 - 1 Tuberculosis, Other - 1 1 Syphilitic Disease - 1 1 Other Infective and Parasitic Diseases 3 1 4 Malignant Neoplasm, Stomach 8 6 14 Malignant Neoplasm, Lung, Bronchus 27 5 32 Malignant Neoplasm, Breast - 16 16 Malignant Neoplasm, Uterus - 4 4 Other Malignant and Lymphatic Neoplasms 22 33 55 Leukaemia, Aleukaemia 1 - 1 Diabetes 2 4 6 Vascular Lesions of Nervous System 21 36 57 Coronary Disease, Angina 63 53 116 Hypertension with Heart Disease 5 5 10 Other Heart Disease 21 41 62 Other Circulatory Disease 12 13 25 Influenza - 2 2 Pneumonia 19 18 37 Bronchitis 16 5 21 Other Diseases of Respiratory System 3 1 4 Ulcer of Stomach and Duodenum 3 1 4 Gastritis, Enteritis, and Diarrhoea 3 2 5 Nephritis and Nephrosis 1 1 2 Hyperplasia of Prostate 3 - 3 Congenital Malformations 3 1 4 Other Defined and Ill-defined Diseases 24 32 56 Motor Vehicle Accidents 4 6 10 All Other Accidents 7 2 9 Suicide 5 5 10 277 295 572 TABLE 3. —MATERNAL MORTALITY, 1964. 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 176 0.20 Due to abortion 50 0.06 Total maternal mortality 226 0.25 Richmond. Maternal causes, excluding abortion Nil Due to abortion Nil Total maternal mortality Nil 21 TABLE 4. —INFANT MORTALITY. (Deaths under one year of Age). Infant Mortality Rate for all infants per 1,000 live births 18.8 Rate for legitimate infants per 1,000 legitimate live births 17.8 Rate for illegitimate infants per 1,000 illegitimate live births 27.02 Total number of infant deaths in the Borough 13 Analysis:— M F Total Legitimate 7 4 11 Illegitimate 1 1 2 Environment of Infant Deaths:— Number occurring in the Borough 3 N umber occurring outside the Borough 10 Number occurring in Institutions 10 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 4 - - - - 4 2. Pneumonia 2 - - — 3 5 3. Birth Accident 3 - - - — 3 4. Found Dead 1 - - - — 1 10 - - - 3 13 Neo-natal Mortality Rate: (Deaths under 4 weeks per 1,000 total live births) 14.5 Early Neo-natal Mortality Rate: (Deaths under 1 week per 1,000 total live births) 14.5 Perinatal Mortality Rate: (Stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 27.1 22 23 TABLE 5. — ILLEGITIMATE BIRTHS. 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 No. of illegitimate births 31 40 30 40 36 46 45 54 65 76 No. of illegitimate deaths under 1 year 0 3 1 0 1 1 2 0 1 2 Illegitimate death rate 0 75 33 0 27 21 44 0 15 27 TABLE 6. — COMPARATIVE STATISTICS, 1964. 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 18.4 16.4 11.3 20.0 13.8 Richmond 16.6 (Corrected) 12.8 10.2 (Corrected) 18.8 14.5 24 TABLE 7. WEIGHT AT BIRTH PREMATURE LIVE BIRTHS — 1964 BORN IN HOSPITAL. BORN AT HOME OR IN A NURSING HOME. PREMATURE STILLBIRTHS Nursed entirely at Home or in a Nursing Home. Transferred to Hospital on or before 28th day. TOTAL BIRTHS DIED TOTAL BIRTHS DIED TOTAL BIRTHS DIED BORN Within 24 Hours of Birth In 1 and under 7 days. In 7 and under 28 days. Within 24 Hours of Birth In 1 and under 7 days. In 7 and under 28 days. Within 24 Hours of Birth In 1 and under 7 days. In 7 and under 28 days. In Hospital. At Home or in a Nursing Home. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) 1. 21b. 3oz. or less — — — — — — — — — — — — — — 2. Over 21b. 3oz. up to and including 3lb. 4oz 3 2 — — — — — — — — — — 1 — 3. Over 31b. 4oz. up to and including 4lb. 6oz 8 7 — — — — — — — — — — 1 — 4. Over 41b. 6oz. up to and including 4lb. 15oz. 9 — — — 1 — — — — — — — _ _ 5. Over 4lb. 15oz. up to and including 51b. 8oz 16 — — — 5 — — — — — — — — — 6. TOTAL 36 1 4 — — 6 — — — — — — — 2 — 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. Puerperal Pyrexia 1 _ — Erysipelas 2 2 — Scarlet Fever 20 2 — Pneumonia 4 _ — Measles 62 — — Whooping Cough 32 1 — Food Poisoning 3 — — Opthalmia Neonatorum 1 — — Encephalitis 1 — — 126 5 — TABLE 9.— FOOD POISONING. Total number of outbreaks Nil Number of cases notified 3 Number of deaths Nil TABLE 10. — DIPHTHERIA IMMUNISATION. Number of children immunised for the first time during the year 1964: — (a) Preschool children (under 5 years) 512 (b) Between 5 and 15 years 28 540 Number of children given re-inforcing doses during 1964 1,011 Total number of children immunised during last five years : — (a) Under 5 years 2,722 (b) Between 5 and 15 years 3,325 25 TABLE 11. —VACCINATION AGAINST SMALLPOX, 1964. 1. Analysis of Vaccinations of Children at Welfare Centres and Private Doctor's Surgeries: Children. Primary Vaccination 275 Re-vaccination 9 Total 284 TABLE 12. — IMMUNIZATION AGAINST TETANUS. During the year 878 children were given courses of inoculations against Tetanus at the parents' request. In addition 611 children were given a re-inforcing 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, 1964 514 364 878 Number of children who received a reinforcing dose 335 276 611 TABLE 13. —WHOOPING COUGH IMMUNIZATION. Number of children who have completed a primary course of 3 injections during the year ended 31st December, 1964 471 26 TABLE 14. — POLIOMYELITIS VACCINATION. Northern Division — Richmond and Barnes. PRIMARY COURSE. Age Group — Born in Number of Persons who completed a Primary Course of Treatment in 1964. 1964 137 1963 696 1962 188 1961 62 1943-60 235 1933-42 57 Others 66 Total 1,441 In addition 1,232 reinforcing doses were given during the year. TUBERCULOSIS. Vaccination Against Tuberculosis. During 1964 a total of 389 boys and girls were inoculated with B.C.G. in the Northern Division (Richmond and Barnes). NOTIFICATIONS : Respiratory Tuberculosis. Twenty-three cases of respiratory tuberculosis were notified during the year, viz:— 14 males and 9 females. The corresponding figure for 1963 was 28. Non-Respiratory Tuberculosis. Two new cases of non-respiratory tuberculosis were notified during the year and there were no deaths from this cause. Two cases were notified in 1963. 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 103 2 Females 47 10 150 12 Corresponding figures for 1963 148 13 27 TABLE 16. — ANALYSIS OF CASES AND DEATHS FOR 1964. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0— 4 1 1 — — — — — — 5—14 — — — — — — — — 15—24 3 2 — — — — — — 25—44 5 3 — 1 1 — — — 45—64 4 3 — 1 — — — 1 65 and upwards 1 — — — — — — — Totals 14 9 — 2 1 — — 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. MASS RADIOGRAPHY SERVICE. General Practitioners' Service. Men. Women. Total. Number of patients referred 426 419 845 Cases of Pulmonary Tuberculosis 4 2 6 Cases of Lung Cancer 5 — 5 Public Mass Radiography Service 1704 2145 3849 Cases of Pulmonary Tuberculosis 6 1 7 Cases of Lung Cancer — — — Employees of Richmond Borough Council referred by Medical Officer of Health — 37. 28 SECTION C. —SANITARY CIRCUMSTANCES. TABLE 17.— WATER SUPPLY. (a) The following figures show the daily average consumption of water in the district: — 1963 1964 All Richmond Wells 737,074 galls. 753,636 galls. Metropolitan Water Board 1,093,505 galls. 1,078,611 galls. Raw River Water 261,276 galls. 293,490 galls. (b) During the year the following samples were taken for examination: — (i) Richmond Water Supply : Untreated water 288 samples. Treated water 186 ,, For chemical analysis 23 „ (ii) Raw River Water 54 „ (c) Swimming Water samples 28 „ TABLE 18. —PUBLIC HEALTH INSPECTIONS. Houses inspected 182 Revisits to houses and other premises 1,119 Houses visited for Certificates of Disrepair 6 Visits paid in connection with: — Permitted number for dwellings 89 Vermin 23 Enquiries into Infectious Diseases and Disinfection 222 Routine inspections in connection with : — Factories (mechanical) 93 Factories (non-mechanical) 12 Outworkers 2 Bakehouses 9 Butchers' Shops 79 Confectioners (Flour) 22 Confectioners (Sugar) 61 Dairies and Milk Shops 21 Fishmongers and Poulterers 14 Fried Fish Shops 16 Greengrocers and Fruiterers 58 Grocers 159 Ice-cream premises 60 Public Houses 75 Restaurants and Tea Shops 292 Food and Drugs Act Sampling 6 Milk Sampling (Designated Milk) 82 Ice-cream Sampling 82 Unsound Food 45 Caravans 8 Clean Air Act — Inspection and Observations 425 29 Diseases of Animals Act 4 Drainage 992 Interviews 475 Heating Appliances (Fireguard) Act 5 Merchandise Marks Act 2 Noise Abatement 23 Offices, Shops and Railway Premises Act, 1963 957 Pet Animals Act, 1951 14 Petroleum Act, 1928 68 Piggeries 1 Rats and Mice (Visits to Properties) 3,074 Rats and Mice (Visits re sewer treatments) 472 Schools — Elementary and Secondary 12 Shops Act, 1950 91 Water Supply 312 Miscellaneous Visits 1,987 11,751 TABLE 19. — SERVICE OF NOTICES. (1) Informal action by letter or verbal intimation 570 (2) Statutory action by notice : (a) under the Public Health Act, 1936— (i) Section 39 (drainage) 2 (ii) Sections 92/93 (nuisances) 13 (b) under the Housing Act, 1961 — (i) Section 15 (essential amenities) 2 (ii) Section 19 (overcrowding) 1 (c) under the Clean Air Act, 1956— Section 12 (firegrate adaptations) 88 TABLE 20. — COMPLAINTS. The complaints received have been classified as follows : — Disrepair of premises : — Dampness 45 Drainage 173 General defects 88 Nuisance from refuse 26 Nuisance from smoke or fumes 65 Nuisance from insects, animals, etc. 25 Rodent infestations 259 Unsound food 43 Miscellaneous nuisances 18 Noise nuisance 6 Pigeons 12 Water Supply 10 770 30 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 — 3 16 Tuberculosis — — — Vermin 5 25 8 Other Diseases — 219 Costs recovered throughout the year: £11 3s. Id. TABLE 22. —FACTORY INSPECTIONS. 1. Inspections. Premises. N[umber on Register. Inspections. Written Notices. Prosecutions Factories (non-power) 12 12 Nil Nil Factories (power) 148 93 14 Nil Building Sites and Institutions 2 2 Nil Nil 2. Defects. Particulars. Found. Remedied. Referred by H.M. Inspector. Want of Cleanliness 3 3 Nil Sanitary Conveniences. (a) Unsuitable 5 5 Nil (b) Insufficient Nil Nil Nil Miscellaneous 22 22 Nil 3. Outworkers. Nature of Work. Number of Outworkers. Number of Unwholesome Premises. Wearing apparel (making) 27 Nil Brass and brass articles 4 Nil Lampshades 1 Nil Artificial flowers 10 Nil Brushes 2 Nil Jewellery 1 Nil Legal Proceedings — no prosecutions were taken in 1964. 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 259 Number of infestations found 238 Number of infestations cleared 226 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. 31  May. November. Manholes test-baited 66 Nil Manholes above found infested 6 Nil Manholes Warfarin-baited 45 40 Manholes infested 15 13 Number of visits 312 160 SECTION D. —HOUSING. TABLE 24. — Housing Statistics for 1964. 1. Number of dwellings owned by the Local Authority:— Number of houses 1,337 Number of Flats 745 Total 2,082 2. Unfit Houses. (a) Dwelling houses inspected 182 (b) Total number of visits made 1,396 (c) Clearance Areas represented to Council 2 (d) Dwellings included in (c) above 12 (e) Compulsory Purchase Orders made by Council 1 (f) Dwellings demolished after Clearance Orders made Nil (g) Dwellings represented for Demolition or Closing Orders 5 (h) Undertakings received that dwellings be not used for human habitation 1 (i) Closing Orders made (a) in respect of whole of building. 1 (b) in respect of part of building 1 (j) Dwellings demolished in pursuance of Demolition Order Nil (k) Undertakings received to repair dwellings 1 (1) Closing Orders determined on a building being made fit 1 (m) Undertakings cancelled on dwellings being made fit 1 (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 ... 13 (p) Dwellings in respect of which informal notices were served requiring defects to be remedied 273 (q) Dwellings in which defects were remedied after service of informal notices 312 32 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 increased 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. 1957-1963 1964 Number of applications 123 3 Number of decisions not to issue certificates 5 1 Number of decisions to issue certificates:— (a) in respect of some but not all defects 84 2 (b) in respect of all defects 34 Nil Number of undertakings given by landlords 86 2 Number of undertakings refused by Local Authority 1 Nil Number of certificates issued 33 Nil PART 2. — Applications for Cancellation of Certificates. Applications by landlords to Local Authority for cancellation of certificates 17 Nil Objections by tenants to cancellation of certificates 6 Nil Decisions by Local Authority to cancel in spite of tenants' objection 4 Nil Certificates cancelled by Local Authority 15 Nil 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. cwts. qrs. lbs. ozs. Fresh Foods (all classes) 7 0 23 10 Tinned Meats, vegetables 10 0 18 10 Tinned Fruits 6 0 13 2 Animal Foods — 1 12 8 23 3 11 14 33 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 Cereal 2 2 — — — Bread and Rolls 1 4 5 1 1 2 Butter — 1 1 — — — Creams and Cream Products — 13 13 — 1 1 Cheese — 3 3 — 1 1 Drinks 1 12 13 — _ — Flour and Flour Mixtures _ 3 3 — _ — Fruit and Vegetables — 3 3 — — — Meat and Meat Products — 41 41 — 1 1 Medicinal Preparations — 12 12 — — Milk and Milk Products — 9 9 — 1 1 Pickles and Sauces _ 1 1 — — — Sweets ... — 14 14 — — — Totals 2 120 122 1 5 6 The irregular samples were : — (1) English Sterilised Cream: contained 21.7 per cent milk fat instead of the statutory minimum content of 23 per cent. Investigation showed that the manufacturers exercise efficient sampling control and that all batches of cream conformed to statutory requirements; the sample in question seems to have been only an isolated occurrence. (2) Buttered Rolls : two samples related to the use of margarine instead of butter; the proprietor of the business gave an undertaking not to use margarine on the premises in future and the Council decided, in this instance, not to take legal proceedings. (3) Beef Sausages : the sample contained a preservative permitted by law but no notice of the presence of the preservative was given at the time of sale : the butcher arranged for a suitable notice to be displayed and no further action was taken. (4) Welsh Rarebit : the sample contained excessive rusk and the manufacutrers decided to discontinue making the product. (5) S.M.A. Skimmed Milk : the irregularity arose because the sample was purchased in liquid form and the statutory standard referred only to the powdered product; amending regulations are being made to include the liquid product. 34 TABLE 28. — CLASSIFICATION OF FOOD PREMISES. No. of Premises. No. of Visits. Bakehouses 6 9 Butchers (including 23 premises registered for manufacture of preserved food) 28 79 Confectioners (flour) 14 22 Confectioners (sugar) 49 61 Dairies (registered under Milk and Dairies Regulations) 3 21 Fishmongers 13 30 Greengrocers 33 58 Grocers (including 4 premises registered for manufacture of preserved food) 59 159 Ice-Cream premises (manufacture) 3 60 Ice-Cream premises (sale and storage) 115 Licensed premises 83 75 Restaurants, cafes, etc. 82 292 488 866 TABLE 29. — IMPROVEMENTS IN FOOD PREMISES. As the result of inspections made the following improvements were carried out :— 1. Food rooms reconstructed 34 premises 2. Food rooms repaired, cleansed or redecorated 281 3. Food storage improved 14 4. Food preparation equipment improved 80 5. Ventilation and lighting improved 27 6. Staff washing facilities improved 51 7. Staff clothing accommodation provided 11 8. First aid boxes provided 10 9. Constant hot water supply installed 37 10. New sinks provided 12 11. Existing sanitary accommodation improved 20 12. Drainage improved, repaired or altered 32 13. Refuse accumulations removed 13 14. Refuse receptacles provided 10 15. Other improvements or repairs carried out 240 35 TABLE 30. —MILK LICENSING. The following licences have been granted by the Council authorising dealers to store and sell Designated milks : — Pasteurised Milk 30 Tuberculin Tested Milk 14 Sterilised Milk 20 Untreated 5 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 51 samples Number found unsatisfactory 2 „ Tuberculin Tested (Pasteurised) Milk 21 „ Number found unsatisfactory Nil Sterilised Milk 14 „ 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. 36 JR2/68