RICH 43 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1902, by J. H. CROCKER, M. D., b.ch., d.p.h., m.r.c.s., &c., Medical Officer of Health, Borough of Richmond, and Visiting Physician, Mogden Isolation Hospital. Richmond, Surey. J. H. Broad and Co., Printers. 8, King Street. 3 Town Hall, Richmond, Surrey, February 13th, 1903. To the Chairman and Members of the Health Committee. Gentlemen, Herewith I beg to present a Report upon the Health and Sanitary Conditions of the Borough tor the year 1902, together with a resume of the work performed in the Health Department. The Report is drawn up in compliance with the requirements of the Local Government Board, and contains a summary of the work done under the Factory and Workshop Act, 1901, which, according to the Act, must be reported to the Council and a copy of such Report forwarded to the Secretary of State. Believe me, Gentlemen, Your obedient Servant, J. H. CROCKER. 4 HEALTH COMMITTEE, 1902. His Worship the Mayor. NORTH WARD. Councillor Skelton. „ A. J. Ward. SOUTH WARD. Alderman Gascoyne, j.p. ,, Marsh Ray. Councillor Alabaster. ,, Heasler. ,, Wadd, m.b. {Chairman). EAST WARD. Councillor Cook. „ Thompson, WEST WARD. Councillor Billett. „ McDougall, j.p. KEW WARD. Councillor Beauchamp. ,, Hulme. Meetings every second Friday at 6 o'clock p.m. (in future, 6.15 p.m.) JOINT HOSPITAL COMMITTEE, 1902. Members from the Richmond Corporation. Alderman Marsh Ray. Councillor Chancellor. Councillor Alabaster (Vice.Chairman). ,, Wadd, m.b. ., Brooking „ A. J. Ward. Meetings once a Month at 4.45 p.m. 5 CONTENTS. page. Statistical Summary 9 SECTION I. Vital Statistics— Population, 12 Marriages 13 Births 14 Deaths 14 Zymotic death rate 15 Mortality in Age Groups 16 Infantile Mortality 16 Tuberculosis 16 Respiratory Diseases 16 Deaths in Public Institutions 16 Inquests 17 Bodies recovered from River Thames ... ... 17 Tables 1., II. & IV. of the L.G.B. 18.20 SECTION II. Records of Infectious Diseases and Precautionary Measures Adopted 21 Records of Infectious Diseases 22 Notification of Infectious Diseases 22 Table III. of the L.G.B. 23 Notifications from 1891 to 1902 24 Notification by School Teachers 25 6 page. Prevalence and Distribution of Infectious Diseases 27 Small.Pox. 27.41 Diphtheria 41 Erysipelas 41 Scarlet Fever 41 Enteric Fever 42 Puerperal Fever 42 Measles 42.44 Whooping Cough 44 Chicken Pox 45 Mumps 45 Diarrhoea 45 Tuberculosis 45 Acute Pemphigus 45 Measures taken to prevent the spread of Infectious Diseases— 46 Disinfection 46 Infectious Diseases Hospitals 46 Percentage of cases removed 49 Bacterioscopic examination in cases of Diphtheria, Enteric Fever, and Tuberculosis 49 Vaccination 50 SECTION III. Ordinary Sanitary Work of the Health Department 52 Staff 52 Systematic Inspections 52 Abatement of Nuisances under the P.H. Acts 52 Private Slaughter Houses 52 Meat 52 Drainage Examinations 53 Dairies, Cowsheds and Milkshops 53 Canal Boats . 53 Sale of Food and Drugs Acts 54 Sanitary Inspector's Table 55.56 7 page. SECTION IV. Factory and Workshop Act, 1901 58 Duties of Local Authority 58 Sanitation in Workshops, &c.59 Home Work . 60.61 Summary of insanitary conditions 62 Underground bakehouses 62 SECTION V. Special Sanitary Matters— 64 Water Supply . 64 Street Improvement Committee 64 Housing of the Working Classes Act 64 Mortuary 64 Tuberculosis . 66.68 Baths. 69 SECTION VI. .Meteorological Report 71.78 8 Statistical Summary. 9 STATISTICAL SUMMARY Borough of Richmond, 1902. Population, estimated to the middle of the year 32,300 Births. Males, 325; Females, 316 641 Annual Rate of Births per 1,000 of population 19.8 Deaths. Males, 206; Females, 220 426 Annual Rate of Deaths per 1,000 of population 13 2 Zymotic Death Rate 1.3 Excess of Registered Births over Deaths. 215 Infantile Mortality. Per 1,000 births 92 Area. The Total Area of the Borough is 2,534 acres Density. The Mean Density of the Borough is equal to 127 persons per acre Rateable Value £290,440 12s. 6d. Amount produced by a Penny Rate for year 1901.2 £1,094 11s. 1d. 1902 Annual Birth.rates, Death.rates and Rates from the Seven Chief Epidemic Diseases Annual Rates per 1,000 Living. Infant Mortality. Annual Death. rate of Infants under 1 Year per 1,ooo Births. Births. Deaths from all Causes. Deaths from Seven Chief Epidemic Diseases. England and Wales 28.6 16 3 1.64 133 Rural England & Wales 27.4 15.3 1.14 119 76 great towns 30 0 17.4 2.12 145 103 smaller towns 27.3 15.3 153 135 London 28.5 17.2 2.21 139 B1CHM0ND 19 8 13.2 1 39 92 11 SECTION I. Vital Statistics. 12 SECTION I. VITAL STATISTICS Population The Following are particulars of the census of 1901, as applied to the Borough of Richmond, compared with those of 1891:— Year Population. Inhabited Houses. Borough 1901 31677 6184 Do. 1891 26875 4939 Increase ... 4802 1245 From this it will be seen that whilst in 1891 the average number of occupants per house was 5.4, in 1901 this had decreased to 5.1 per house. For statistical purposes it is necessary to estimate the population at the middle of each year; the usual mode of arriving at these figures is to assume that the annual increase is at the same rate as that which occurred between the last two census, due allowance being made for the increase of population during the decade. The Registrar General in his quarterly reports has estimated the population to be 32,300. 13 Divided into Wards the figures are as follows:— Ward. Population. 1901. 1902 Census. Estimated at the Middle of the year. Estimated at the Middle of the year. North 9073 9139 9403 South 6038 6044 6068 East 9140 9176 9320 West 4727 4727 4735 Kew 2699 2714 2774 Total 31,677 31,800 32,300 Marriages. In the course of the year 248 marriages took place within the Borough, as follows By the Established Church 165 At other places of Public Worship 18 At the offices of the Registrar 65 Total 248 This shows that 15.3 persons out of every 1,000 inhabitants entered the bonds of matrimony in the Borough during the year 1902. This is slightly over the mean annual rate for the previous ten years. 14 Births. The number of births registered during the year 1902 was 641 as compared with 646, the average for the preceding ten years. Of these 325 were males and 316 were females. The birth rate for the year was 19.8 per 1,000 of the population. The average for the Borough during the preceding ten years was 22.6. There were 17 illegitimate births during 1902, 10 of these occurring in the Union Workhouse, 1 in the North Ward, 4 in the East, and 2 in the West Ward. The birth rate varied in the different Wards, being 22.4 in the North, 10 8 in the South, 24'9 in the East, 17.1 in the West, and 18 4 in the Kew Ward. The birth rate for England and Wales during 1902 was :28'6, for the 76 great towns on the Registrar General's list it was 30, and for the 103 smaller towns it was 27.3 per 1,000 of the population. Deaths. The total number of deaths registered in the Borough during 1902 was 458; of these 114 died in the Union Workhouse and Royal Hospital, 53 of whom belonged to outside districts. Eight patients from Richmond died at Mogden Isolation Hospital and 13 at Brookwood Asylum. Correcting for the above, results in a total of 426 deaths for the Borough—(206 males and 220 females)—which gives an annual rate of 13.2 per 1,000 of the population living. There were 11 bodies recovered from the river Thames. None of these persons had resided in the Borough, but according to the instructions of the Local Government Board, in estimating the death rate only non.residents in public institutions are to be .excluded. The above.mentioned deaths have, therefore, been allocated to the Wards in which the bodies were taken from the river. Deducting these figures, the death rate for the year would be 12.3 per 1,000 of the population. The mean annual death rate of the Borough for the preceding ten years was 14T, whilst the mean for London for the same period 15 •was 19 0, The death rate for England and Wales in 1902 was 16 3, the 76 great towns 17 4, Rural England and Wales 15.3, and London 17.2. The death rate varied in the different Wards. Owing to the returns from the Registrar not giving the previous addresses of the persons dying in the Union Workhouse, 40 deaths at that institution are placed in the South Ward, but in all probability none, or very few, actually belong to that Ward. The death rate for the North Ward was 12.6, South Ward 16.1, or without the Workhouse deaths 9.5, East Ward 11.4, West Ward 12.7, and Kew Ward 15.1 per 1,000 of the population. Births and Deaths during 1902 in the various Wards. Wards. Total Births. Birth Rate per 1000 living. Total Deaths. Death Rate per 1000 living. North 211 22.4 119 12.6 South 66 10.8 98 9.5* East 232 24.9 107 11.4 West 81 17.1 60 12.7 Kew 51 18.4 42 15.1 Total for Borough 641 19.8 426 13.2 After deducting 40 in the Union Workhouse. The number of deaths due to the "seven principal Zymotic Diseases" † usually classified under this heading was 45. This gives a zymotic death rate of 1.39 per 1,000 persons living, being about the average for the Borough. The zymotic death rate of England and Chief Epidemic Diseases, Death Rate. † Small.pox, measles, scarlet fever, diphtheria, whooping cough, fever, typhus, enteric, and continued) and diarrhoea. 16 Wales for 1902 was 1.64, that for the 76 great towns 2.12 and Rural England and Wales 1.14. Small-pox.—1 death. Scarlet fever.—6 deaths. Measles.—17 deaths, all but one below five years of age. Diphtheria.—4 deaths, all below five years of age. Whooping couoh.—6 deaths, all below five years of age. Enteric fever.— No deaths. Diarrheal.—11 deaths, 10 of these being below one year of age. As will be seen by the Table of Causes of death,. Mortality in Age at the end of this Section, there were 149 deaths Croups. above 65 years of age, and 59 below one year of age. Of those above 65 years many were between 90 and 100. The total number of deaths under one year was Infantile Mortality. 59; this is at the rate of 92 per 1,000 births. The average for the preceding 10 years was 138. The total number of deaths attributed to this. Tuberculosis. disease was 42, being 10 per cent. of the total deaths and a little over a rate of 1.3 per 1,000 of the population, as compared with 1 for 1901. „ 67 deaths were registered as due to diseases of Respiratory Diseases. the chest other than phthisis. This gives a mortality of 2 per 1,000 of the population as against 2 5 for 1901. Deaths in Publio Institutions. Parishioners. Non-Parishioners. Total. In the Richmond Hospital 21 31 52 „ Union Workhouse 40 22 62 ,, Brookwood Asylum 13 — 13 ,, Mogden Hospital 8 — 8 17 Bodies recovered from the river Thames, within the Borough There were 11 bodies taken from the river. The deaths are recorded in the various wards specified below. None of these persons had resided in the Borough Ward in which recorded. Former residence. West Ward Clapham. Kew „ Manchester. South ,, Twickenham. Kew ,, Pimlico. Do. ,, oplar. Do. ,, ... ... ... Unknown. South „ ... ... ... Wandsworth. Do. ,, ... ... ... Pimlico. Kew ,, ... ... ... Twickenham. Do. „ ... ... ... Stroud Green. West ,, ... ... ... Unknown. Inquests. There were 42 inquests held in the Borough during the year, viz., Richmond 31, Petersham 3, and Kew 8. Coroner's Inquests held during the Year 1902, in the Kingston District of Surrey. Kingston 59 Ham 5 Old Maiden — Wimbledon 41 Merton 4 Richmond 31 Petersham 3 Kew 8 Mortlake 13 Barnes 17 Long Ditton 1 Thames Ditton 4 (105 Males and 81 Females) 186 VITAL STATISTICS OF WHOLE DISTRICT DURING 1902 AND PREVIOUS YEARS borough of richmond (surrey). Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 year of age At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.' Number Rate." 1 2 3 4 5 6 7 8 9 10 11 12 13 1892 23900 5i9 21.7 80 154 428 179 96 46 .. 382 160 1893 28200 632 22.5 81 128 451 160 98 38 .. 413 146 1894 28500 651 22 .8 78 119 411 140 90 49 .. 352 12 3 1895 28920 618 21.3 75 121 432 150 75 29 9 412 142 1 896 29400 655 22.6 98 147 414 140 72 40 10 384 132 1897 29880 704 23.5 98 139 432 14.4 "5 6.3 6 369 123 i998 30360 663 21.8 113 170 493 16.2 107 56 5 443 145 1893 30840 691 22.4 107 154 541 17.5 no 48 8 5°i 162 i900 31320 617 197 89 144 518 r6'5 117 53 10 475 150 190 i 31800 707 222 78 110 459 14.4 93 40 8 427 134 Averages for years 1902-1901. 29312 646 226 89 138 458 156 97 46 8 4T5 I4'1 1902 32300 6 ji 198 59 92 458 141 "4 53 21 426 13 2 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. 18 VITAL STATISTICS OF SEPARATE LOCALITIES IN 1902 AND PREVIOUS YEARS. Borough of Richmond (Surrey). Names of Localities. Borough. North Ward, South Ward. East Ward. West Ward. Kf.w Ward. Year. Population estimated to middle of each vear. births registered. Deaths at all Ages. Deaths under 1 rear. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each vear. Births registered. Deaths at all Ages. Deaths under 1 vear. Population csti- mated to middle of each year. Births registered. Deaths at all Ages. j Deaths under t vear. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths undsr 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. 1900 a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b c. d. 7 31.320 617 475 89 122 32 101 9 129 29 75 13 43 1901 31,800 707 427 73 9.139 226 211 110 28 6,044 76 90 6 9,176 266 107 28 4.727 70 7 2714 42 48 11 1902 32,300 641 426 59 9-103 119 19 6068 66 98 5 9320 232 107 22 4735 8l 60 8 2774 51 42 5 19 CAUSES OF, AND AGES AT, DEATH DURING YEAR 1902. Borough of Richmond (Surrey). Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Wards (at all Ages). Total Deathsin Public Institutions in the District. All ages. Under 1 year. 1 and 5 and under under 5- 15- 15 and under 25- 25 and 65 and under up65. wards North South East West Kew. Small-pox 1 .. 1 .. .. .. .. .. .. 1 .. .. .. Measles 17 2 14 1 .. .. .. 7 1 7 2 .. 2 Scarlet Fever 6 .. 2 4 .. .. .. 3 1 1 1 .. .. Whooping-cough 6 4 2 .. .. .. .. 4 .. 2 .. .. .. Diphtheria and membranous croup 4 .. 4 .. .. .. .. 2 1 .. 1 .. .. Epidemic influenza 7 1 1 .. .. 3 .. 3 .. 3 1 .. i Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 11 10 .. .. .. .. .. 5 .. 5 .. .. 2 Enteritis 1 .. .. .. .. 1 .. 1 .. .. .. .. .. Erysipelas 2 .. .. .. .. 2 .. .. 1 .. 1 .. i Other septic diseases 7 6 .. 1 .. .. .. 2 .. 4 1 .. .. Phthisis 26 1 .. 1 5 19 .. 9 5 5 4 3 9 Other tubercular diseases 16 .. .. 7 3 2 .. 7 .. 4 4 1 11 Cancer, malignant disease 24 .. .. .. .. 9 5 5 8 3 6 2 6 Bronchitis 23 5 .. .. .. 6 12 6 5 6 4 2 4 Pneumonia 43 8 .. 2 .. 9 16 15 9 10 5 4 7 Pleurisy 1 .. .. .. .. 1 .. .. .. .. 1 .. .. Alcoholism, Cirrhosis of liver 14 .. .. .. .. 13 .. 1 2 4 3 4 1 5 Venereal diseases 2 2 .. .. .. .. 1 .. 1 .. .. .. Premature birth 2 2 .. .. .. .. .. .. .. 2 .. .. .. Heart diseases 42 1 .. .. 2 14 25 12 14 12 1 3 12 Accidents.. 16 2 1 1 .. 9 3 2 3 4 2 5 5 Suicides 5 .. .. .. 1 4 .. .. 1 2 1 1 1 All other causes 150 15 9 3 2 46. 75 33 45 32 21 19 48 All causes 426 59 46 20 14 138 149 119 98 107 60 42 114 20 21 SECTION II . Records of Infections Diseases. and Precantionary Measures Adopted. 22 SECTION II. RECORDS OF INFECTIOUS DISEASES AND PRECAUTIONARY MEASURES ADOPTED Notification of Infectious Diseases under the Notification Act of 1S89. The total number of cases notified under the above Act for the year 1902 was 177. The number notified during the previous year was 131, and 154 for the year 1900. Table of Monthly Notifications. Month. Totals Small-pox. Diphtheria. Croup. Erysipelas. Scarlet Fever. Enteric Fever. Puerperal Fever. January 7 ... 1 1 ... 4 1 ... February 8 2 1 ... 2 1 2 ... March 23 3 4 ... 2 12 2 ... April 35 2 4 ... 2 26 1 ... May 13 ... 7 ... ... 4 1 1 June 21 3 6 ... 1 8 3 ... July 15 1 4 ... 1 6 3 ... August 10 ... 1 ... 4 5 ... ... September 11 ... 1 ... ... 9 1 ... October 11 ... 1 ... 1 7 2 ... November 14 ... 3 ... 1 9 1 ... December 9 ... 5 ... 2 1 ... 1 Total 177 11 38 1 16 92 17 2 Three of the above cases notified as enteric fever, were, upon removal to Mogden, found not to be suffering from the disease. One of the above cases of enteric fever was brought from Sunbury, and another from Twickenham; these were both treated in the Royal Hospital. Three of the cases notified in Richmond were also treated at the Royal Hospital. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1902 Notifiable Disease Cases Notified in whole district. Total Cases Notified in each Ward. No. of Cases removed to Hospital from each Ward. At all Ages. At Ages—Years. North. South. East. West. Kew. North. South. East. West. Kew. Under 1. 1 to 5. 5 to 15. 15 to 25- 25 to 65. 65 and upwards. Small-pox II .. 1 2 2 6 .. 1 2 3 4 1 1 2 2 4 1 Diphtheria 38 .. 11 16 4 7 .. 12 7 9 7 3 8 8 c 2 Membranous croup 1 •• 1 .. .. .. ..•• 1 •• .. .. .. 1 .. .. .. .. Erysipelas 16 •• .. 1 .. 13 2 5 3 1 4 3 .. •• •• .. .. Scarlet fever 92 1 26 47 13 5 .. 34 10 36 9 3 25 8 34 9 2 Enteric fever 17 •• .. 3 5 9 .. 5 2 9 1 .. 3 .. 5 .. .. Puerperal fever 2 .. • • •• •• 2 .. 1 •• 1 .. .. .. .. .. .. .. Totals 177 1 39 69 24 42 2 59 24 59 25 10 38 10 49 19 5 Small-pox Hospital—Dockwell, near Cranfortb, Middlesex Isolation Hospital—Mogden, near Isleworth, Middlesex Hospital 23 NOTIFICATIONS OF INFECTIOUS DISEASES FROM i8gi to 1902. Disease. 1891 1892 1893 1894 1893 1896 1897 1898 1899 1900 1901 1902 Small-pox 3 6 6 1 •• 2 11 Scarlet fever "3 66 126 246 202 92 112 93 148 78 52 92 Diphtheria and membraneous croup 11 18 15 22 7 15 15 25 31 25 41 39 Enteric fever 11 36 6 10 15 6 15 8 10 21 12 17 Continued fever 20 1 •• •• 6 8 6 4 4 Erysipelas 10 14 44 37 18 21 18 21 41 24 20 16 Puerperal fever 2 3 •• 2 2 Total 167 114 197 321 243 >34 166 155 236 154 >31 x77 24 Notification of The arrangements mentioned in last year's report Infectious have been continued throughout the year. Upon Diseases by School Teachers the receipt of a notification from the Schoolmaster regarding the absence of a Scholar, said to be, or suspected of, suffering from, measles, whooping-cough, chicken-pox or mumps, the assistant inspector at once proceeds to the house to make enquiries as to the nature of the illness. In the event of the illness being of an infectious nature and the patient not under medical treatment, instructions are given as to proper means of isolation and precautions to be adopted. Other scholars of the family are prohibited from attending school, and certificates in accordance with the Educational Code are forwarded to the Schoolmaster. Upon receipt of the Inspector's Report, the Medical Officer of Health also visits the houses and schools when considered necessary. The amount of time occupied in investigating these cases far exceeds that necessitated by notifications of diseases under the Notification Act, but undoubtedly benefit is being derived, as we find that as a result of our visits the parents are beginning to realise that these ailments are of a far more serious nature than they formerly considered them. The monetary benefit derived by the schools as a result of the Certificates of the Medical Officer of Health is considerable. Of the 221 houses visited on account of one of the abovementioned ailments, a medical practitioner was in attendance at 125. At the other houses, 96 in number, the Inspector, upon being informed by the parents that they did not think it necessary to call in a doctor, left a circular drawn up by the Medical Officer of Health and pointed out the necessity of isolation and the advisability of seeking medical aid. Possibly, owing to want of experience in notification or for want of realization of the seriousness of neglect, or by suppression of information by parents, in some instances there was a delay in notification, with a result that the disease had taken a firm hold amongst the scholars before rhe matter was brought to the notice of the Health department. ( ee page 44). 25 26 The following figures will illustrate the great amount of extra work which has resulted from undertaking these duties:— The total number of cases notified and found to be actually suffering from one of the above-mentioned diseases during 1902 was 291, in connection with these there were 289 other children kept from School on account of having been in contact with the sufferers. PARTICULARS OF CASES NOTIFIED. Measles. Whooping Cough. Chicken Pox. Mumps. Suffering from 245 32 10 4 Other children not ill but kept at home owing to sickness in the house 250 23 8 8 495 55 18 12 Number of houses in which the diseases occurred 221 „ „ notified but infectious disease not present 31 Total houses visited 252 Schools notifying. Number of Notifications (Houses). Holy Trinity Schools, Princes Road 42 Holy Trinity Schools, Lower Mortlake Road 34 National Parochial School 35 St. John's School 29 St. Luke's School 22 Russell British School 12 Wesleyan School 8 British School 6 St. Elizabeth's School 3 New Richmond School 2 193 27 Discovered by Sanitary Inspector, School Attendance Officer and other sources 28 221 Houses notified but no disease present 31 Total 252 PREVALENCE AND DISTRIBUTION OF INFECTIOUS DISEASES Owing to the proximity of the Borough to London the ma pox. past year has been an anxious one for the members of the Health Committee and sanitary officials, due to the continuance of the epidemic of small-pox in London, which began in August, 1901. Eleven cases of the disease were notified in the Borough during the year 1902, ten of which were removed to Dockwell Hospital. On six different occasions throughout the year, the disease was introduced into the Borough, but, fortunately, it was confined to the individual or members of the household in all but one instance ; in this case the patient died before the characteristic rash developed, and consequently before the nature of the illness was diagnosed. Many cases of chicken pox also occurred throughout the year. Most of these were seen by the Medical Officer of Health in consultation with the Medical Practitioners in attendance. Four such cases were removed to the special observation wards at Dockwell on account of insufficient accommodation for isolation at home or on account of a doubt as to the nature of the illness. It is very satisfactory to note that no deaths occurred amongst the patients suffering from small-pox or chicken pox who were removed to Dockwell Hospital. DOCKWELL SMALL-POX HOSPITAL—RICHMOND CASES, 1902. No. Names (Initials). Occupation. Age. Admission. Discharge. Days. Vaccination. Result. 1 I- S. Workhouse Casual 39 Feb. 19 April 7 48 Vaccinated in infancy Cured. 2 G. B. Draper's Assistant in London 17 „ 26 24 58 Not vaccinated „ 3 C. U. Waitress at home (a restaurant) 19 March 9 M 37 Vaccinated 10 days before „ 4 L. B. Scholar 7 9 5 1 Admission, after Contact with No. 2. „ 5 G. B. Do 13 „ 10 5 2 7 „ 6 W. H. Workhouse Casual 28 April 12 May 10 28 Vaccinated infancy, 3 marks „ 7 R. P. J .. Draughtsman in London 30 „ 22 9 18 Vaccinated infancy, 4 marks „ 8 E. H. Housewife (working class) 27 June 24 July 16 23 Vaccinated infancy „ 9 J. C. Do. do. 58 25 Aug. 12 49 „ „ „ „ 10 S. N. No occupation 55 July 7 9 34 „ „ „ „ There were, in addition, four cases for observation. The attacks proved to be chicken pox, 29 Case 1 was that of a "casual" who had been three days in the Workhouse before the disease developed. He was at once removed to Dockwell Hospital and precautionary measures taken in connection with those who had been in contact. Case 2 was that of a young lady employed in London, who, not feeling well, came to her home, and the case being somewhat obscure the nature of the illness was not diagnosed for some days. She had never been vaccinated. Cases 3, 4 & 5, were the sisters and brother of No. 2 who had been in contact with her during her illness. They had never been vaccinated, but upon discovery of the nature of the illness, this operation was performed five days after the sister began to be ill. Their attacks were mild and, as will be seen by the table, they were liberated from hospital much sooner than their sister. Case No. 6 was that of a "casual" at the Workhouse who developed the disease three days after arrival at the Workhouse. Case No. 7 was that of a gentleman engaged in business in London where he probably contracted the disease. Case No. 8 was that of a neighbour of case No. 11 who assisted in nursing the patient. Case No. 9 was a neighbour who laid out the body of No. 11 after death. Case No. 10 was a visitor who came from Canterbury where she had contracted the disease, arriving in the Borough before it had developed. Case No. 11 was that of a child who died before the nature of the illness was apparent. The age of the child was 3 years 11 months, and he had never been successfully vaccinated. He fell ill on June 5th, and died on the 9th. The medical practitioner who had been in attendance described the symptoms of the case to the Medical Officer of Health, who, upon investigation came to the conclusion that the case had been one of virulent small-pox. Precautionary measures were taken and advice given as to vaccination but, unfortunately, the two neighbours, who had been in contact, did not follow this advice. 30 During the illness the occupants of the house -a small one. two rooms downstairs and two upstairs—had been in contact with the patient but did not contract the disease, whereas, as before mentioned, a neighbour who had assisted in nursing the patient and another who laid the body out after death contracted the disease. The following is the vaccination history in connection with this case. > Father— vaccinated in infancy, revaccinated when in the navy. Remained well. Mother—vaccinated in infancy, had mild small-pox when 13 years of age; no "pitting" or other evidence. Remained well. Twins, aged 6 years. Both successfully vaccinated in infancy, well marked cicatrices on the arms. Remained well. Patient, aged 3 years 11 months, never successfully vaccinated, died of virulent small-pox. Other people who had been in contact with patient. E.H., aged 27, vaccinated in infancy—never re-vaccinated; began to be ill with small-pox 11 days after the death of the child. Had the disease mildly. Recovered. J.C., aged 55, vaccinated in infancy—never revaccinated ; began to be ill 12 days after laying out the body. Rather severe attack but no pitting. Recovered. The parents of the child referred to could give no explanation of the origin of this case, as they assured me neither they nor the child had been out of Richmond for many weeks, and that the child, beyond going to school, in the same street, had not been out of their charge. Upon further investigation it was found the child had resumed school duties for 10 days before his fatal attack, having been at home for some weeks previously. Case B. reported on page 33, resided higher up in the same street; the children of this household and the child in question attended the same school, and, it is reported, played together, but otherwise the families were strangers to each other. 31 Case B., came to Richmond in March, whereas this child was taken ill in June. It is possible that the children (brothers of case B.) though protected themselves by vaccination, may have conveyed the disease in their clothing which was possibly withheld from disinfection at the time, but of this there is no evidence. It is admitted, however, that the elder brother (suspected case) being fond of his brothers had often taken them on his knee when he first came home. Measures adopted for preventing the spread of Small pox. These may be summarised as follows:— 1. Notification. 2. Isolation. 3. Disinfection. 4. Vaccination and revaccination. 5. Medical inspection of "Contacts." 6. Inter-communication by letter or telephone with other Sanitary districts. It is the duty of the medical practitioner and houseNotification. holder to notify forthwith, upon becoming aware of the nature of the illness, any case of small-pox. In every instance this was done by the medical practitioner. In the two cases which occurred at the Workhouse, the Master communicated with the Medical Officer of Health immediately there was any suspicion of the nature of the illness. Although chicken pox is not included in the list of notifiable diseases in the Borough, it may be included with the consent of the Local Government Board. As many Authorities adopted this measure, the question came before the Health Committee, who acting on the advice of the Medical Officer of Health, decided not to include chicken pox under the Notification Act. There are many reasons to explain why this decision was arrived at, one important one being that in making his investigations regarding any case notified, the Medical Officer must not see the patient unless requested to do so by the Medical Practitioner, and then only as an act of courtesy. If this disease is made notifiable, the enquiries of the Medical Officer without 32 ination of the patient, might lead to a condition of false security, or the questions put to the friends as to the possible nature of the illness might lead to a feeling of uneasiness on their part, with consequent distrust in the Medical Practitioner, which would naturally lead to resentment. It has been argued that because small-pox has been mistaken for chicken pox, therefore the latter should be made notifiable. Undoubtedly these diseases, being in some instances similar, may be mistaken, but every practitioner is alive to the fact, and other diseases such as Eczema, Scabies, &c., have been mistaken for small-pox, but I do not think anyone would suggest that these should be included under the Notification Act. Further, this argument would make it appear advisable to make even influenza notifiable, as the history of the two following cases will show. Investigated. Case A.—(No. 2 on Table, page 28). A young lady, aged by the Medical 16, feeling ill, came to her parents' home in Richmond, Officer of February 21st. Called in doctor February 22nd. Health. Patient was feverish and complained of headache, backache and aching of limbs. Diagnosis, influenza. February 23rd, symptoms easier. A few small spots came out on forehead and face like a sweat rash. February 24th, temperature normal. February 25th, temperature normal. February 26th, temperature normal. As doctor realised spots were increasing and suspecting small-pox, requested Medical Officer to see patient. Diagnosis, discrete small-pox. Patient removed and all occupants vaccinated. March 8th. Two sisters of above who had been in contact with patient between February 21st and 26th were found feverish. March 9th. The above two and a brother, who had not been confined to bed nor complained of feeling ill, found with rash coming out on face, chest and arms. Diagnosis, small-pox. None of the above had been vaccinated in infancy. Dirty clothing from this house had been sent to a laundry on February 24th. All occupants of laundry vaccinated on 33 26th, and none developed small-pox. Sixteen members of a club met on February 25th, at the house from whence the above patients were removed. All were communicated with on the 27th and advised to be vaccinated. All remained well. Case B.—A man, aged 22, lodging at Clapham Junction, was taken ill on February 12th, sent for doctor who diagnosed influenza. Was in bed until March 1st, when he came to Richmond. Patient says he noticed some spots on his forehead during the second week of illness one day when he got up and looked in the glass, does not know how long they had been out, but there were several, each about the size of a pill. They faded in the course of the next day or two, but some spots he had on his head wenton tosores. Information was received at the Health Office from the Medical Officer of Health for Battersea to the effect that a fellow lodger, who occupied the same bed as above at the commencement of the illness, was removed to hospital on February 27th, suffering from small-pox. Upon examination of convalescent patient on March 7th, there was no evidence of small-pox, but, from the history, there is every probability that he had been suffering from modified small-pox (he had been vaccinated in infancy), The members of the household of Case B had all been vaccinated in infancy and were re-vaccinated on March 7th. They all showed evidence of the effect of the re-vaccination with the exception of the suspected person, who did not re-act at all. Rooms, bedding, clothing, &c., disinfected. Mother aged 45, suspected person aged 22, children aged 14, 11, 10, 6 and 5. All remained well. As the legal responsibility for notification rests with the Medical Practitioner, the Medical Officer of Health did not consider it advisable to interfere with this, but suggested that means should be afforded to any Medical Practitioner desirous of obtaining a second opinion, in the event of his having any case in which he 34 had any doubt as to the nature of the illness. Having had experience in dealing with small-pox cases the Medical Officer of Health offered his services for such a purpose. The Health Committee acted on this suggestion. The Medical Officer of Health for the Heston and Isleworth Urban District being of the same opinion advised his Authority accordingly, and as a result a copy of the following letter was sent to every Medical Practitioner in the respective districts. the BOROUGH OF RICHMOND (SURREY) and the HESTON & ISLEWORTH URBAN DISTRICT JOINT HOSPITALS. PRIVATE. 10th February, 1902. Dear Sir, You are probably aware that any case of small-pox which may be notified in the above Districts will be removed to the Hospital at Dockwell, near Hounslow. One isolation block at the hospital has been set aside, under a separate nursing staff, for observation purposes. In the event of your having any doubtful case of chicken pox, or other case suspicious of small-pox, we can arrange for its removal to this observation block, if you desire. Realising the anxiety which sometimes occurs in arriving at a correct diagnosis in the early stages of chicken pox and other cutaneous eruptions, we wish to intimate to you that we will willingly visit any doubtful case you may have in our respective districts at any time, and, although possibly we may not be able to throw any further light on the case, we shall be glad to share the responsibility with you in deciding as to whether it should be sent to the hospital or not. 35 If you desire to see any of your patients under observation at the hospital, Dr. Steegmann will be pleased to meet you at any time, if you will make an appointment. We are, dear Sir, Yours faithfully, J. H. Crocker, Medical Officer of Health, Town Hall, Richmond. Visiting Physician, Mogden Isolation Hospital. E. J. Steegmann, Medical Officer of Health, Heston & Isleworth Urban District Council, Town Hall, Hounslow. Medical Officer in Charge of Dochwell Hospital Dr As a result of this the Medical Officer of Health was requested by the practitioners to see every doubtful case of chicken pox and other cutaneous diseases which occurred in the Borough. In some instances, where the nature of the disease was doubtful, the medical officer telegraphed for the County Medical Officer, Dr. Seaton, who readily came and gave his valuable opinion. In every instance the case was removed to the Isolation Dockwell Small-pox Hospital as soon as possible after Notification, with the exception of the chifd which died before the disease had fully developed. Arrangements were made by the Joint Hospital Committee for a driver to be always on duty, with a result that the Ambulance could be obtained at any hour, day or night. The Hospitals and Town Hall being in telephonic communication, enabled the necessary instructions to be given without delay. Upon admission of chicken pox patients to the special wards or in the event of any case of a doubtful nature being admitted, vaccination was at once performed by Dr. Steegmann. That no 36 case of chicken pox contracted small-pox and that no deaths occurred amongst the patients sent in from the Borough of Richmond, are evidence of the care and skill exercised by Dr. Steegmann and his staff at the Hospital. As soon as the patient was removed, the rooms in Disinfection. which he had been during the illness were sprayed with a solution of perchloride of mercury and afterwards fumigated with sulphurous acid gas. The following day the paper was stripped from the walls and burnt. All articles of bedding clothing, &c., that were likely to spread infection were removed to Dockwell for disinfection or destruction. Disinfection of the rooms was carried out most carefully by Assistant Inspector Norman and Junior Assistant Parsons who performed these duties as soon as the patient was removed, necessitating their working, on many occasions late on into the night. The Sanitary Inspectors also assisted in the removal of the patients, and special waterproof cloaks were provided for their use on these occasions. Vaccination In every instance the occupants of the household and from whence a case was removed were advised as to He-Vaccina- the importance of vaccination and revaccination. tiorj- Similar advice was given to any person known to have been in the infected house, and on some occasions a house to house visitation was undertaken,by the Medical Officer of Health, in the street where a case had occurred. Intimation was given to the vaccination officer of every case, and he also made visits and informed the public vaccinator of those people desirous of being vaccinated or revaccinated. The Medical Officer, Sanitary staff, medical men in attendance on the cases, ambulance drivers, man in charge, and nurses at Dockwell Hospital had all been recently revaccinated, with a result that none contracted the disease, though exposed to the infection on many occasions, and in some instances, for lengthy periods. A copy of the following circular was forwarded to the occupier of every laundry in the Borough. 37 Town Hall, Richmond, Surrey, March 3rd, 1902. FACTORY AND WORKSHOP ACT,1901. LAUNDRIES. Dear Sir or Madam, It has recently transpired that clothing from a person infected with small-pox has been sent to a laundry in the Borough, before the friends were aware that the case was one of small-pox. Such a danger may arise in connection with your laundry at any time, and your employees may thus be exposed to infection. If small-pox occurs in connection with your laundry you are liable to a heavy penalty if you fail to immediately notify the same to the Medical Officer of Health. The Town Council acting on the advice of the Medical Officer of Health may make an order forbidding the occupier of any laundry, or any contractor employed by him, to give out washing (or any work incidental to washing) to be done in a house in which an inmate is suffering from a notifiable infectious disease. This order may be made though the person so suffering has been removed from the house. Such order shall be made, either for a specified time, or subject to the condition that the house shall be disinfected to the satisfaction of the Medical Officer of Health, or that other reasonable precautions shall be adopted. For contravention of the above the penalty is £10. The Medical Officer considers that vaccination is a reasonable precaution. You are therefore strongly urged to see that all your employees have been successfully vaccinated and revaccinated if such vaccination took place some years ago. If you do not call in your own medical practitioner, vaccination and revaccination will be performed by the public Vaccinator (Dr. Yates, The Green, Richmond) free of cost, and he will call at the house, if so desired. Believe me, dear Sir or Madam, Yours truly, Medical Officer of Health. 38 Medical In arresting the spread of small-pox there is no doubt inspection that, next to vaccination, re-vaccination and disin- of Contacts fection, the medical inspection of persons who have been in contact with a case of small-pox, is the most important. As a rule the disease takes from 10 to 12 days in incubation, during which period the person is apparently well; at the end of this period he becomes feverish, and 14 days from infection begins with a pimply rash, this appearing first on the forehead. The initial feverish condition may be of short duration, and upon the appearance of the rash the patient may feel quite well for a time and thus go about in an infected condition, unaware of the serious mischief he may be committing. Daily inspections were made of all the members of the household from whence a case was removed, as well as that of people who may have visited the house during the illness, and not until 16 days had elapsed were they considered safe. This entailed much extra work on the medical officer, but the importance of such procedure is shown in the history of cases 3, 4, 5, 8, and 9, who, as a result of such inspection, were all discovered immediately they began to be ill, and thus were removed to the Hospital before they could spread the disease. As small-pox is not infectious during the incubation period it was not considered necessary to keep the " contacts " from their occupation, but they were warned at the end of a week that if they felt ill in from 10 to 14 days from exposure to infection they should remain at home and at once send word to the Medical Officer, if this occurred after his daily visit. In one instance upon development of the disease in three "contacts" (3, 4 and 5) the premises were closed, for a few days, by desire of the occupier, whilst the house was thoroughly disinfected and cleansed throughout. The husband of case 9, being employed by the Corporation as a road sweeper in a residential part of the Borough, was granted a fortnight's holiday. Where the people reside in the Borough the duties of medical inspection can be carried out with good results, but in the case of 39 Casuals at the Workhouse, who as a rule have no idea where they will be in 10 or 14 days, such a procedure is, under ordinary conditions, obviously impossible. The Medical Officer of Health had an interview with the Committee, Medical Officer and Master of the Workhouse, and recommended voluntary detention of "contacts" for 17 days. This recommendation was adopted. Fortunately no other cases developed, after the primary ones, due chiefly to the precautions undertaken by the Master, Medical Officer, and Nurses of the Workhouse. The Board of Guardians and officials of the Workhouse are to be congratulated on the measures they took in endeavouring to arrest the spread of the disease, thus benefitting, not only the Borough, but the country generally. A letter of the Local Government Board dated February 22nd 1902, officially draws attention to the advisability of medical observation of "contacts" for at least a fortnight after exposure to infection, and further states that when, under special circumstances, "contacts" are kept at their homes, or in a special place provided for them, a reasonable expenditure out of the Rates will be sanctioned by the Board. Communication At the commencement of the epidemic in London a with otf)er daily inter-communication concerning small-pox was Sanitary arranged amongst the Metropolitan Medical Officers Districts. of Health, and when any one of these Medical Officers was aware that a "contact" had moved to a district outside of London, such information was forwarded to the Medical Officer of Health for that district. Similar procedure was followed by the majority of Provincial Medical Officers of Health with satisfactory results. But for such information Case B would probably not have been heard of. It is evident from the foregoing report that efficient vaccination in infancy and re-vaccination at 10 or 12 years of age are necessary to prevent the disease. If the community at large will not undergo these precautions, then further legislation is necessary 40 for the compulsory detention of "contacts" for a period of 17 days This does not necessarily mean removal from their homes nor detention from occupation in the majority of cases, but powers should be given to a Local Authority to take such precautions when considered advisable. Particularly is this necessary in the case of the tramp class. That Parliament has recognised the advisability of some such measures is evident by clauses in Private Bills which have been granted in recent years to some of the towns in the North of England. In the Eccles Private Bill—one of the last granted— the following clause was inserted, and received the sanction of Parliament: — Extract from Private Bill referred to. "Clause 129. If the Corporation deem it necessary to remove from any house or part thereof, all or any of the residents not being themselves sick on account of the existence or recent existence therein of infectious disease or for the purpose of disinfecting such house or part thereof they may make application to a Justice and the Justice if satisfied of the necessity of such removal may grant a warrant authorising any officer of the Corporation to remove such residents to such place of reception as shall be named therein and imposing such conditions as to time and otherwise as to him may seem fit provided always that no such warrant shall be necessary when the removal is carried out with the consent of any such resident or his parent or guardian. The Corporation shall and they are hereby empowered to provide free of charge temporary shelter with any necessary attendance for such persons while prevented from returning to such house or part thereof. The Corporation may for the purposes of this section:— Themselves build any place of reception. Contract for the use of any place of reception. 41 And expenses incurred by the Corporation under this section shall be paid out of the district fund and general district rate. Provided that for the purposes of building any such place of reception the Corporation may borrow money under and subject to the provisions of this Act." local Covernment Board Inspector On February 18th, Dr. Reece of the Local Government Board attended at the Town Hall and conferred with the Mayor, the Chairman of the Health Committee and the officers of the Corporation with reference to the precautions to be taken against the outbreak and spread of small-pox. The steps already taken in the matter were explained to the Inspector. Diphtheria. During the year there were 38 cases notified as compared with 39 for the previous year. The notifications were spread over the year, the monthly numbers being highest in May and June. There was no epidemic in connection with any of the Schools. Twenty-four of the cases were removed to Mogden Hospital, every case upon admission being treated with antitoxin. Only two deaths occurred at the Hospital and two at home, being a case mortality of 10 per cent. Erysipelas. Sixteen cases were notified as compared with 20 for the previous year. Scarlet Fever. Ninety-two cases of this disease were notified throughout the year. There was a threatened epidemic during March and April in the North and East Wards, but prompt measures were taken as to removal to hospital, with satisfactory results. Of the 12 cases notified during March 11 were removed to hospital, and of the 26 cases notified in April 25 were removed. The cases which occurred in the East Ward during April were chiefly amongst the scholars of one school, the patients being all about the same age. Several of the cases arose during the Easter holidays, when the schools were closed, and were traceable to a 42 case which was under treatment at home. As the cases continued to occur after the schools were re-opened, the Medical Officer of Health inspected all the children at the school but found no evidence of the disease. Two days after the Medical Officer's visit, a child who had been attending school, showed signs of peeling ; this patient was removed to Mogden, and from that time no other cases occurred amongst the scholars of that school. There were 6 deaths due to this disease. Enteric Fever. There were 17 cases of this disease notified, as compared with 12 for the previous year. Eight cases were removed to Hospital. No deaths occurred. Puerperal Fever. . It was ascertained from the medical men in attendance on these cases that advice had been given to the nurses as to measures to be taken to prevent the spread of the disease. Both patients recovered. Measles. There were 245 cases notified by the teachers, and, in addition, many cases occurred after the schools were closed during the epidemic. Advice was given as to isolation and the possible dangers of the disease pointed out to the parents. A copy of the following circular was also left with the parents. Town Hall, Richmond. Measles is again prevalent in the District. There are more deaths every year from Measles than from Scarlet Fever. This is due to the neglect of parents, in many cases, because of the mistaken idea that the disease is not dangerous. Take the same care and precautions as you do with Scarlet Fever, and you may save your children. Measles is a Fever. 43 The disease begins like a cold in the head ; this lasts four days before the rash conies out, and the case is " catching " during all this period, as well as for some fortnight or more after the disappearance of the rash. Isolate the Patient. Keep off Measles as long as you can, as 90 per cent, of the deaths occur below 5 years of age. The older the child is when it has measles the better chance it has of living through it. Bronchitis, Pneumonia, and Inflammation of the Kidneys, even in very mild cases, follow on the disease if the patient is not kept in bed. Medical Officer of Health. During the first quarter of the year, 14 cases of measles, in 10 houses, occurred amongst scholars attending the Russell British School, Petersham. Each case was promptly notified by the head master. Upon visiting the houses, most of the cases were found to be under medical treatment, and proper precautions were being taken. Only two more cases were notified during the year in connection with this school. From March to August sporadic cases occurred in connection with nearly every school in the Borough, but towards the end of September and early part of October many cases were notified from the Holy Trinity Schools, Lower Mortlake Road. Several cases were notified in connection with St. John's Schools during the middle of October, and by the last week in that month the disease had reached some of the scholars of Holy Trinity Schools, Princes Road, followed by an outbreak amongst the scholars of the Parochial Schools during November. It is quite possible that the epidemic would have spread in spite of all our efforts ; it is, however, unfortunate that information concerning the absence of children suffering from this disease in September in connection with the first school affected, viz. : Holy 44 Trinity, Lower Mortlake Road, was not brought to our notice sooner. The first notification was received September 25th, and upon investigation the mother informed us the disease had begun and the child was kept from school ten days before. Several of the other cases notified about the same date had been ill for many days. It is essential for the efficient working of this arrangement that the teachers should let us know of the individual first cases and not wait until they can send in a batch of names. The notification of cases in connection with St. John's Schools was prompt and complete. Delay marked the notifications from Holy Trinity Schools, Princes Road. The onset of the first case (and last attendance at school) was October 17th. This was notified on the 24th, the second case six days after last at school, third case promptly notified, fourth case 12 days after onset, fifth case 10 days after onset, sixth case 10 days after onset, &c. When the epidemic had established itself the notifications were more prompt. In connection with the National Schools the first notification was received November 5th, but the date of onset and last attendance at school was October 23rd, and two other cases notified November 6th, were last at school and taken ill 21 days before. It is possible in some instances that the information was' withheld from the teachers. There were 17 deaths during the year directly due to Measles. Owing to the epidemic of Measles the infant department of the National Schools was closed for 17 days in November, by order of the Sanitary Authority. Whooping Cough. Of the 32 cases notified, 25 occurred amongst scholars of St. Luke's Schools, Sandycombe Road. The first case notified was December of the previous year (recorded in last annual report) and notifications were received from this school up to February 11th. 45 Advice as to the period and mode of isolation was given tothe parents and the possible dangers of neglecting the disease were impressed upon them. Six deaths from this disease occurred. Chicken Pox. Several cases of this disease were investigated, some being seen in consultation with medical practitioners. Enquiries were made in every instance as to vaccination, and if the child had not been vaccinated the parents were advised to have it done immediately. Mumps. Thp 4 cases visited were not isolated nor were they under medical treatment. Advice was given as to isolation. Diarrhœa. There were only 10 deaths from Diarrhoea during the year amongst young children, as compared with 23 for the previous year. This disease is most prevalent during a hot and dry summer. Tuberculosis. There were 26 deaths from phthisis and 16 from other tubercular diseases, as compared with 30 and 7 for the previous year. Upon receipt of the returns from the Clerk to the Guardians, if any cases of phthisis are notified, enquiries are made as to the precautions taken and a leaflet is left, as described in last year's Annual Report. After death of a patient from this disease the room or rooms are disinfected by the Sanitary Authority, free of cost. Acute Pemphigus. In October, Dr. Maguire, of Kew, called the attention of the Medical Officer of Health to a number of cases of a septic nature, probably acute pemphigus, which he had been called in to see. The disease affected young infants, and Dr. Maguire had ascertained they had all been washed or attended by an assistant midwife, who was immediately stopped from following her duties, and as a result no more cases occurred. Altogether there were 17 cases with 8 deaths. 46 MEASURES TAKEN TO PREVENT THE SPREAD OF INFECTIOUS DISEASES. When a case of infectious disease is notified, as soon as possible, the Medical Officer or Sanitary Inspector calls at the house and, if considered advisable, the patient is recommended to be removed to one of the Isolation Hospitals. If the patient remains at home, printed particulars as to isolation, disinfection. &c., together with a short epitome of the law applicable to infectious cases are left at the house. An addressed postcard is also left for the medical attendant to sign and forward when he considers the patient free from infection. If no medical practitioner is in charge, advice as to isolation, &c., is given, and a circular on the special disease from which the patient is suffering, left at the house. Full particulars of the patient and other occupants of the house with particulars of the sanitary arrangements, milk supply, school or place of work, and other details are recorded on special forms which are filed in the Health Office. If necessary the drains of the dwelling are examined by the smoke test preparatory to serving an order to open them up. Special certificates are forwarded to the School Teachers, if any occupants attend school, and also to the Milk seller and Librarian of the Public Library. Any books which may be present from the Library are at once taken to Mogden to be disinfected by Formaldehyde or destroyed. Disinfection. Upon the removal or termination of an infectious case the bedding and clothing are removed to Mogden to be disinfected by steam. If the case is one of Small-pox the articles are removed to Dockwell for disinfection. The rooms are sprayed with corrosive sublimate solution or Formaline. Under certain circumstances books are disinfected in a special apparatus at Mogden. Sanitas fluid and powder are supplied to householders free of cost. Infectious Diseases Hospitals. These Hospitals are under a Joint Committee of representatives of the Borough of Richmond and the Urban District Council of Heston and Islsworth. 47 The Small-pox Hospital is situated at Dockwell, nr. Cranford, Middlesex, and the Hospital for Diphtheria, Scarlet fever, and Enteric Fever is situated at Mogden, nr. Twickenham. The Small-pox Hospital formerly consisted of an Administrative block, three separate Isolation blocks, with accommodation for 12 patients, Disinfection station, Ambulance shed and Mortuary. It is well isolated. During the past year a new block has been erected, making provision for another 12 patients. A discharging room has also been fitted up. The Mogden Isolation Hospital was opened in 1898, and has been described in a previous report. MOGDEN ISOLATION HOSPITAL. Return as to Patients for the \car ending the 31st day of December, 1902. ADMITTED — Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases From the Borough of Richmond 78 25 3 2 „ Heston & Isleworth Urban District 76 51 6 0 „ Hounslow Barracks (Garrison) 26 6 0 0 „ Brentford Union (Isleworth) 3 2 0 0 183 84 9 2 TOTALS— From the Borough of Richmond 108 „ Heston & Isleworth Urban District 133 „ Hounslow Barracks (Garrison) 32 „ Brentford Union (Isleworth) 5 278 48 DISCHARGED— Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases From the Borough of Richmond 67 22 2 2 „ Heston & Isleworth Urban District 65 31 3 0 „ Hounslow Barracks (Garrison) 19 5 0 0 Brentford Union (Isleworth) 4 4 0 0 155 62 5 2 TOTALS— From the Borough of Richmond 93 „ Heston & Isleworth Urban District 99 „ Hounslow Barracks (Garrison) 24 „ Brentford Union (Isleworth) 8 224 DIED— Scarlet Fever. Diphtheria. Enteric Fever. From the Borough of Richmond 6 1 I „ Heston & Isleworth Urban District 1 14 0 „ Hounslow Barracks (Garrison) 1 0 0 „ Brentford Union (Isleworth) 0 1 0 8 16 1 TOTALS— From the Borough of Richmond 8 „ Heston & Isleworth Urban District 15 „ Hounslow Barracks (Garrison) 1 „ Brentford Union (Isleworth) 1 25 The daily average of Patients on the books was 35.4 as compared with 29.5 during the year ending the 31st day of December, 1901. The total admissions for the year were 278, being 40 in excess of the highest previous number. 49 Percentage of Infectious cases removed to Hospital Of the 159 cases of Small-pox, Diphtheria, Croup, Scarlet Fever, and Enteric Fever which were notified in the Borough, there were 121 removed to Hospital, which is at the rate of 76 per cent., being the same as for 1901. 1902. 1901. 1900. Small-pox 90 percent. 100 per cent. Diphtheria & Croup 63 „ 66 6 „ 72per cent. Scarlet Fever 84.7 „ 84.6 „ 74 „ Enteric Fever 47 „ 75 „ 36 „ Particulars of cases removed to Dockwell Hospital and precautionary measures adopted in cases of Small-Pox have been given in a previous part of this Report as well as the measures adopted in connection with Schools and those followed in connection with Tuberculosis and Acute Pemphigus. Bacterioscopic Examination of Material from Suspected cases of Diphtheria and Enteric Fever. The arrangement made between the Health Committee and the Jenner Institute of Preventive Medicine whereby any medical practitioner in the Borough can obtain at the Town Hall a suitable apparatus for collecting and forwarding material from suspected cases, to the Jenner Institute, has been found of great service. There were 22 such samples forwarded from patients suspected to be suffering from Diphtheria, 8 of which showed the presence of Diphtheria Bacilli, and 3 samples of blood from suspected cases of Enteric Fever, one giving the Widal reaction. In the majority of the cases, from the after course of the illnesses, the medical practitioners considered those specimens which gave a negative result were from patients who were not suffering from the disease first suspected. Bacterioscopic Examination of Sputum. Six specimens of Sputum have been examined throughout the year, and tubercle bacilli were found in five instances. 50 Vaccination. Fortunately the Borough of Richmond is the best vaccinated district in the County of Surrey. Great credit is due to the Board of Guardians, who upon the appearance of Small-pox in London, promptly exercised all means within their power to enforce vaccination and re-vaccination. 51 SECTION III. Ordinary Sanitary Work of the Health Department. 52 SECTION III. ORDINARY SANITARY WORK OF THE HEALTH DEPARTMENT. Staff. Chief Inspector: W. Parsons, Cert. San. Inst. Assistant Inspector: G. T. Norman, Cert. San. Inst. Clerk and Disinfector: W. S. Parsons. Systematic Inspection. During the year there were 3,192 inspections of nuisances in course of abatement, 1,022 houses inspected, 786 visits to cases of infectious diseases, besides systematic inspections of slaughterhouses, milkshops, cowsheds, bakehouses, &c. A summary is given at the end of this Section. Abatement of Nuisances under the Public Health Acts. Details of work under this heading are given at the end of this Section. Most of these abatements were of a permanent nature. Private Slaughter Houses. There are 8 slaughter houses in the Borough. They have been regularly inspected and found satisfactory. Meat. Inspections of meat offered for the sale of food have been made by the Veterinary Surgeon and Sanitary Inspector, and a half-bushel of red currants were destroyed by order of a Magistrate, but no proceedings taken. Thirteen sheep's hearts were seized on December 29th, and the owner summoned before the Magistrates during January, 1903. 53 Drainage Examinations. The water test is applied to all new drains, and to all drains relaid. The smoke test has been applied to the drains at 71 houses, and in 20 instances demonstrated that the drains were defective. Dairies. Cowsheds, and Milkshops. There are 7 cowsheds and 22 dairies in theBorough all of which have been regularly inspected. The following defects were discovered and remedied, viz.: Walls and ceilings of 4 cowsheds dirty, and yard at 1 dairy badly paved. Canal Boats. During the year 3 boats were inspected, against 1 in 1901. Two children, aged respectively 9 and 7< years, were found on one of the boats, the parents of whom admitted: that they had never been to school. The Local Authority who registered the boat was informed. On June 5th His Majesty's Inspector under the Canal Boats Acts made his annual visit for the purpose of reporting to the Local Government Board as to how the Acts were enforced, and expressed himself satisfied with the way the duties were performed. 54 Sale of Food and Drugs Act. The enforcement of this Act in the Borough has been carried out by the Inspector, acting under the County Council. Mr. R. A. Houghton, the County The enforcement of this Act in the Borough has been carried out by the Inspector, acting under the County Council. Mr. R. A. Houghton, the County nspector, reports as follows :— Articles Purchased. Number of samples. Genuine Slightly adulterated or deteriorated. Cases in which proceedings were taken. Convictions obtained Total Fines. Milk 46 36 8 2 2 £13 14s. 6d. Butter 16 16 Cheese 1 1 Coffee 1 Lard 1 1 Jam 1 Margarine 1 1 Spirits 5 Sweets 1 1 Lucca Oil 1 1 Pepper 1 1 Vinegar 1 — 1 1 £2 16s. 6d. Cordials 4 Pickles 1 1 Camphorated Oil 1 1 Ketchup 1 1 Totals 83 72 8 3 3 £16 11s. 0d. In 1901 a sample of " milk," sold in glasses at Kew Green, was found to consist of " Condensed Separated Milk " mixed with water from the Thames, the vendor of which disappeared soon afterwards, and a warrant was obtained for his arrest. This was executed in June last, upon the return of the defendant to the Borough, and a conviction obtained ; the defendant being fined £12 7s. 6d. including costs, or in default, imprisonment with hard labour for two calendar months. The quality of the milk sold in 1902 has been found good, but I regret to report that the use of " preservatives" has largely increased. 55 SUMMARY OF THE SANITARY INSPECTOR'S REPORT FOR THE YEAR 1902. 1901. 1902. Number of Visits made 5120 5656 „ Complaints received and attended to 173 245 „ Statutory Notices served 76 118 „ Preliminary Notices served 334 432 SUMMARY OF INSPECTIONS MADE. Inspection of Nuisances in course of abatement 3630 3192 Houses Inspected 530 1022 Visits to Cases of Infectious Disease 657 786 Inspections of Slaughterhouses 22 17 „ Milkshops 90 13 „ Cowsheds 20 22 „ Bakehouses 95 101 „ Workshops 65 97 „ Piggeries 11 46 „ Miscellaneous ... 360 Totals 5120 5656 56 SUMMARY OF NUISANCES INVESTIGATED DURING THE YEAR 1902. No. done. No. not done. Total. To Clear or Amend Drains 71 2 73 To Re-lay Drains 64 3 67 To Remove Defective Traps and properly Trap Drains 34 6 40 To cause Waste Pipes to discharge on the Surface and Repair same 17 2 19 To Repair or Disconnect Rain-water Pipes 45 0 45 To Repair or Ventilate Soil Pipes 14 3 17 To Clear, Cleanse, or Repair Closets or Flushing Apparatus 43 3 46 To Re-construct Closet and Provide New Closets 121 2 123 To Provide a proper Water Supply and Apparatus to Closets 18 9 27 To Provide External Ventilation to Closets 7 1 8 To Cleanse, Provide, or Cover Drinking Water Cisterns 44 5 49 To Pave or Repair the Paving of Yards, &c. 30 1 31 To Repair Roof of House 8 1 9 To Repair Dustbins or to Provide Sanitary Dustbins 33 5 38 To Remove Animals causing a Nuisance 4 2 6 To Remove Foul Accumulations 37 2 39 Miscellaneous Nuisances 24 0 24 To Disinfect, Cleanse, and Whitewash Rooms 232 2 234 To Provide a proper Supply of Water 16 1 17 To Abate Overcrowding 2 1 3 To Pave and Drain Stables 3 2 5 Totals 867 53 920 57 SECTION IV. Factory & Workshop Act, 1901. 58 SECTION IV. FACTORY AND WORKSHOP ACT, 1901 Duties of Local Authority. Means of Escape in case of Fire It is the duty of the Council to see that proper provision for means of escape from fire is made in connection with Factories and Workshops where more than 40 people are occupied, and to grant a certificate to that effect in recently built structures. The Local Authority may make bye-laws on this matter. Whilst the factory or workshop is occupied, the doors shall not be locked or fastened in such a manner that they cannot be easily and immediately opened from the inside. Any factory or workshop built after January, 1896, and occupied by more than ten persons shall have the doors constructed to open outwards or to have sliding doors. The Borough Surveyor undertakes the carrying out of the above portion of the Act. Workshops, Workplaces, & Home-work. The work devolving upon the Health Department in connection with Factories, is to see that proper sanitary conveniences are provided. As regards workshops and work-places, they are brought under the Public Health Acts, the controlling authority being the Borough Councils acting by their officers, the Medical Officer of Health, and the Inspector of Nuisances, who have for this purpose the powers ot factory inspectors. 59 In addition to the special sections in the Factory and Work shop Act, the following sections under the Public Health Acts are applicable to Workshops. It is the duty of the Sanitary Authority to cause systematic inspection of workshops to be made (P.H.A., 1875, Sec. 92). The Sanitary Authority may cause proper privy accommodation to be provided for workshops or manufacturies, or for both sexes (P.H.A.A., Sec. 22). It is the duty of the Sanitary Authority to secure proper ventilation, and to prevent overcrowding of workshops (P.H.A., 1875, Sec. 91). The Sanitary Authority has power to secure a proper supply of water in all workshops (P.H.A., 1875, Sec. 62 & Sec. 4). The duties of the Local Authority in connection with workshops, &c., are to be directed to the following points:— 1. Cleanliness. 2. Air Space. 3. Ventilation. 4. Sanitary Accommodation. 5. Home Work. 6. Keeping of Register. 7. Certain Information to be sent to Factory Inspector from to time. 8. Annual Report to be forwarded to Secretary of* State. As regards Bakehouses there are special duties, particularly concerning Underground Bakehouses. Cleanliness. Where on the certificate of the Medical Officer of Health or Inspector of Nuisances it appears to any District Council that the limewashing, cleansing or purifying of any such workshop or of any part thereof, is necessary, for the health of the persons employed therein, the Council shall give notice to that effect to the owner or occupier. 60 In 20 such instances, throughout the year, dirty conditions of the walls, &c., were discovered, but they were cleansed and limewashed without formal notice. Air Space. 250 cubic feet, and 400 cubic feet if overtime, per person are required as the minimum amount of air ;space. Overcrowding was found in 3 instances and remedied. Ventilation. In 5 instances, other than bakehouses, insufficient ventilation was found. All were improved after verbal notice. The Secretary of State may, by Special Order, prescribe a standard of sufficient ventilation for any class of factories or workshops. It is to be hoped that this will be done in connection with underground bakehouses, even after they are certified by the Local Authorities. Sanitary Accommodation In one instance there was a w.c. in a bakehouse and one workshop was without accommodation. Nine water closets were found in a foul condition, in 5 instances drains were defective, in 7 instances gully traps were found in a foul condition, and in 5 instances floors were found dirty or defective. All the above mentioned defects were remedied. Horrie Work. A copy of the following letter was sent to 71 employers of labour during October and November, and 6 replies were received. Only two employed outworkers, one employing 3 and the other 1. One outworker resided outside the Borough and the Local Authority was informed. Information was received from Chiswick and Kensington as to home workers residing in this Borough. Dear Sir or Madam, I am directed by the Health Committee to call your attention to Section 107 of the Factory and Workshop Act of 1901, which refers to Outworkers. By the Act of 1891 power was given to the Secretary of State to require the occupier of any factory or workshop, and any contractor employed by such an 61 occupier to keep a list showing the names and addresses of all persons employed by them (either as workmen or as contractors) outside the factory or workshop, and the places where they are employed. This requirement under the Act of 1901, which came into force in January last, now applies to any place from which work is given out. A copy of such list must be sent to the Town Council twice a year, on or before February 1st and August 1st, but a copy need only be sent to the Factory Inspector when he requires it. A Special Order has been made by the Secretary of State requiring these lists to be kept by occupiers and contractors in the following trades :— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel, and any work incidental thereto. The making, ornamenting, mending, and finishing of lace, and of lace curtains and nets. Cabinet and furniture making and upholstery work. The making of electro plate. The making of files. Fur pulling. If you employ any Outworkers you are requested to furnish such list forthwith, as by any contravention of the Section referred to you render yourself liable to a fine of forty shillings and in the event of a second offence to a fine of £5. Medical Officer of Health. Register A register in accordance with the Act is kept. In addition particulars are kept as to the measurements, air space, number of occupants, sanitary conveniences, &c., of the workshops. During the past year this work has been systematically done, particular attention being first directed to bakehouses. It is anticipated that by the end of 1903 such particulars will be obtained and recorded in connection with all the workshops, workplaces, bakehouses, &c., in the Borough. 62 The following is a summary of the work done during the year under this Act:— "Visits of inspection, Bakehouses, 81 ; Workshops, 97 ; Total, 178 Number on Register, ,, 31; ,, 64; „ 95. Insanitary conditions discovered and remedied:— Bakehouse Walls and ceilings dirty 12 „ Drains defective 2 ,, Gully traps foul 7 „ Floors dirty or defective 5 „ Water closets foul 5 „ Water closet inside 1 „ Miscellaneous 4 Workshops & Laundries Overcrowded 3 „ „ Insufficiently ventilated 5 ,, „ Walls and ceilings dirty 8 „ „ Drains defective 3 ,, „ Water closets foul 4 ,, „ Miscellaneous 11 Total 70 Underground Bakehouses In December a Report on the subject of underground bakehouses was presented to the Health Committee. Full particulars of the present condition of those structures within the Borough were given, together with suggestions on the requirements necessary before granting a certificate. (This Report was adopted by the Health Committee in February 1903.) 63 SECTION V. Special Sanitary Matters. 64 SECTION V. SPECIAL, SANITARY MATTERS Water Supply. The supply for the Borough is from three sources Deep Well, Petersham Well, and Southwark and Vauxhall Water Company. Street Improvement Committee. The work in connection with the widening of George Street has made satisfactory progress during the year, many of the old houses in the street have been demolished, and new structures are in course of erection. Housing of the Working Classes Act. In February the Medical Officer of Health made a representation, under Part II. of the 1890 Act, to the Health Committee that three dwelling houses Nos. 117, 119 & 121, Kew Road, were unfit for human habitation. The Committee (confirmed by the Council) authorised that all necessary proceedings against the owners or occupiers should be taken for closing the dwellings. As a result the houses were closed without legal proceedings. The houses built by the Corporation under Part III. of the 1890 Act, continue to be in a satisfactory condition, and all are occupied. Mortuary. The total number of bodies taken to the Mortuary during the year was 45 ; inquests being held on 41 of these. Post-mortem examinations were made upon 39, viz., 23 males and 16 females. 65 Proposed New Mortuary and Post-mortem Room. On February 26th, Mr. Arnold Royle, C.B., an Inspector of the Local Government Board, held an inquiry at the Town Hall, as to the application of the Corporation for sanction to a loan of £2,050 for the purchase of Eton Lodge as a site for a mortuary and post-mortem room. This loan was granted. In May, a sub-committee, consisting of the chairman (Councillor Wadd), and Councillors Billett and Heasler, together with the Medical Officer of Health and the Borough Surveyor visited the mortuaries of the City of London and Battersea. The officials above mentioned alsovisited other mortuaries, which have been erected in recent years, preparatory to designing plans for the Eton Lodge site. In September, plans and estimate were presented to the Committee, who approved of them and recommended them to the Council for adoption. These were adopted at the meeting of the Council in October, and an application was made to the Local Government Board for a loan of £1,600, which, after due public enquiry, was granted in December. Small-pox Hospital Accommodation for the County of Surrey. The Medical Officer of Health attended the County Conference on the above matter, held at Kingston in February. A communication was received from the Sanitary Committee of the Surrey County Council in July, enclosing a draft scheme for the provision of Small-pox Hospital accommodation for the County, which that Committee had framed in pursuance of the request of the Conference. Under this scheme the cost of the purchase of land and structural expenses would be paid for out of the County Fund, but the scheme also provides that Richmond shall be recouped to the extent of its contribution, as the Corporation have already, in conjunction with the Heston and Isleworth District Council, established a Small-pox Hospital. The Health Committee, therefore, took no action in the matter of the proposed scheme. Sewerage of the Borough. Treatment of Sewage and Disposal of House and Trade Refuse. These were fully described in last year's Annual Report. The sewer in George Street was being relaid at the latter part of the year. 66 Tuberculosis. One of the important events of the year 1902 was the completion of the new Workhouse Infirmary. The chief matter of importance in connection with the buildings, from a public health point of view, are the arrangements for the open-air treatment of consumption. Everything in connection with the new buildings has been most admirably arranged, and great credit is due to the architect, Mr. Partridge. It has been stated that not much good will result to the individuals treated for consumption at this institution on account of the disease being far advanced before a person becomes so pauperised as to necessitate his going into the institution. Probably there will be few absolute cures in such cases, but to have healthy surroundings with good nursing and suitable food will certainly tend to improve the patient, and if a complete cure is not arrived at, he will at least have his latter days in comparative comfort. What is of more importance, from a public health point of view, is the removal of such cases from the various parts of the Borough, where they act as foci of infection, to an institution so arranged that precautions will be taken to prevent the patients being a source of danger to themselves as well as others. At the International Conference on Tuberculosis, held in Berlin on October 25th, 1902, Professor Koch (the discoverer of the germ of consumption) gave an address on "The Transference of Bovine Tuberculosis to Man." Whatever differences of opinion there may be on this point, there can be none on the practical suggestions of Professor Koch, so far as they go, given at the end of his address, viz:— " In this connexion I can only repeat what I said in my London address: The fight with tuberculosis must not be fought on wrong lines if it is to have a real result. It must aim at shutting off the chief, indeed we may say almost the only, source of infection. This is those consumptives who in consequence of the unfavourable conditions under which 67 they live, or because they obstinately set aside the simplest rules for the prevention of infection, are a danger to their companions. In some way or other we must look after these sick people, either by procuring for them more favourable conditions, for example, as regards dwelling places, or by so sheltering them in suitable institutions that they cease to be a danger to their neighbours. "After the experiences we have had of other infectious diseases, we must come to the conclusion that in no other way can anything be attained, and therefore I should like urgently to advise that for the future this task should be kept to the fore in the battle against tuberculosis until it has been accomplished." Evidently the new departure undertaken by the Richmond Board of Guardians is one which is bound to be followed in other districts. When it is remembered that tubercular disease slays 61,000 persons every year in England and Wales—an awful total of ten per cent. of all the deaths—(Richmond 1902 of the 426 deaths, 42 were due to tuberculosis), while under ordinary conditions all other infectious diseases, including small-pox, account for but a third of the toll exacted by tuberculosis in its various forms, the duty of public bodies charged with the protection of the public health becomes obvious. Further arrangements however, are required, as it is of very great importance that the individual, before he becomes a pauper, should be able to obtain the advantages of the open air treatment immediately the nature of his disease is diagnosed. As soon as the patient is well enough he should be instructed in gardening or farming—in connection with an Institution—and thus avoid having to return to the occupation and surroundings which he has already proved are a source of danger. Once having recovered, by following an outdoor life, either in this country or in one of our colonies, and by exercising reasonable care, in the majority of cases the cure would be permanent. 68 In October last, an interesting paper was read at the local meeting of the British Medical Association by Dr. Johnson, of this Borough, entitled " Notes on Phthisis in Richmond—some Inferences." After calling attention to the fact that tubercular disease of the chest was the cause of many deaths in Richmond, he gave the results of his investigations as to the origin of the disease in the cases which had come under his notice. He attributes the chief cause to the inhalation of infected dust, particularly so of that in old houses where a consumptive had previously resided. Since writing the above 1 have received the following particulars concerning a " Subscription Open-air Sanatorium." Patients in the earlier stages of consumption are received at inclusive fees, ranging from two guineas to 32s. per week. Patients applying on their own behalf will pay two guineas weekly. A reduction to 35s. will be made in cases in which the fees are paid for necessitous patients by Doctors, Clergymen, and Charitable Societies. Patients sent by Municipalities or Hospitals will be received at the inclusive rate of 32s. each per week, provided that not less than four are sent for not less than four months. (Arrangements have been made, and in some cases carried out, to receive Municipal and Hospital patients on these terms.) A Medical Certificate as to the condition of each patient is required, as advanced cases cannot be received. Patients who are considered to be sufficiently well must make their own beds and keep their own rooms tidy ; and assist in attending of poultry, pheasant-rearing, gardening, and such farming operations as may be prescribed, at the discretion of the Resident Physician. It is believed that this arrangement will prove of great value to many patients whose former occupation was of an unhealthy character, as it will assist in fitting them for an openair life after leaving the Sanatorium. 69 PUBLIC BATHS —SUPERINTENDENT'S RETURN OF BATHERS from January 1st to December. st, 1902. WEEK ENDING SWIMMING BATHS. WARM BATHS. TOTALS. Dressing Boxes. 1st Class. 2nd Class 1st Class. 2nd Class. Swimming. Warm. Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies 1st January to 28th March 2749 172 1362 518 4111 690 370 29th March to 13th Juue 4467 421 2824 109 1752 221 2284 912 7291 530 4036 1133 20 14th June to 19th September 11343 2679 6317 621 2352 273 3465 i5'3 17660 33oo 5817 1786 20 20th September to 31st December 1345 280 555 365 3478 154 1964 636 1900 445 5442 790 453 Bathers since last Meeting 17155 3380 9696 895 10331 820 9075 3579 26851 4275 19406 4399 843 For corresponding period of last year 21667 4355 14532 1575 10061 812 10148 3975 36199 5930 20209 4787 771 Total Number of Males (including Dressing Box Tickets) 47,100 57.179 10,079 Total Nhmber of Females 8,674 10,717 2,043 Total Bathers 55,774 67,896 12,122 71 SECTION VI. Meteorological Report. 72 SECTION VI. METEOROLOGICAL REPORT. From Particulars furnished by Mr. Hunt, Head Keeper, Terrace Gardens. JANUARY. Barometer. The mean pressure for the month was 30 inches being the same as the mean for the 30 years previously which was 30 inches. With slight variations the barometer kept above 30 inches during the month until the 25th. Owing to an anti-cyclone it rose to the unusual height of 30.7 inches on the 15th Thermometers. The maximum thermometer fell from 52 degrees at the beginning of the month to 37 degrees at the end of the month. The mean for the month was 45.6 degrees and the mean for the month for the 30 years previously was 43.8 degrees. The minimum thermometer followed somewhat the variations of the maximum, the mean for the month being 36.2 degrees as compared with 33.6 degrees the mean for the preceding 30 years. The lowest temperature registered was 21 degrees on the 15th. Rainfall. Rain or snow fell on 8 days during the month as compared with 16, the mean for the month for the preceding 35 years. The rainfall was 0.52 inches being below the mean for twenty years, which was 2.01 inches. Wind. The wind was westerly veering from S. to N.W. for the first ten days, then N.E. for the rest of the month. 73 FEBRUARY. Barometer. The mean pressure for the month was 29.98 inches being practically the same as the mean for the month for the preceding 30 years, viz., 29.99. It fell from 30.5 on the 1st to 29.2 on the 6th, rising gradually to 30.2 on the 16th, and then falling to 29.2 at the end of the month. Thermometers. The mean maximum temperature was 40.0 the mean for the preceding 30 years being 45.8. It was 33 degrees on the 3rd of the month and gradually rose to 54 degrees on the 28th. The mean minimum temperature was 30.8 degrees as compared with 34.7 degrees, the mean for the month during the preceding 30 years. The lowest record was on the 16th, when it registered 17 degrees. Rainfall. Rain fell on 9 days and snow 1 day during the month, the total rainfall being 0.94 inches as compared with 1.69 the mean for the preceding 35 years. Wind. During most of the month the wind was from the E. or N.E., until the last 2 days, when it became S.W. MARCH. Barometer. The mean pressure for the month was 30 inches as compared with 29.9 the mean for the preceding 30 years. Rising from 29.3 on the 1st to over 30 on the 16th, gradually falling to slightly below 29 on the 25th and then rising rapidly to 29.8 on the 26th. Thermometers. The mean maximum temperature was 54 degrees as compared with 50.1 degrees the mean for the preceding 30 years. With variations the registrations kept between 50 and 60 degrees throughout the month. The mean minimum temperature was 37.4 degrees as compared with 35.3 the mean for the preceding 30 years. The lowest point was reached on the 7th when 27 degrees was registered. 74 Rainfall. Rain fell on 10 days during the month, the total fall being 1.52 inches as compared with 1.49 the mean for the preceding 35 years. Wind. Chiefly S.W. throughout the month. APRIL. Barometer. The mean pressure for the month was 29.85 inches as compared with 29.9 the mean for the preceding 30 years. Thermometers. The mean maximum temperature was 57 degrees as compared with 56.6 the mean for the preceding 30 years. The temperature fell to 45 degrees on the 9th, rising to 64 degrees on the 14th, and again falling at the end of the month to 52 degrees. The mean minimum temperature was 38.9 degrees, as compared with 39.9 degrees the mean for the preceding 30 years. The lowest was 30 degrees on the 7th. Rainfall. Rain fell 10 days in the month, the total being 0.60 inches as compared with 1.65 the mean for the preceding 35 years. Wind. Chiefly from the W. and S.W. until the 7th, when veered to the N.E. for 6 days, then changing to S.W. again until the end of the month. MAY. Barometer. The mean barometric pressure for the month was 29.83 inches as compared with 29.98 the mean for 30 years. There was a fall of half.an.inch on the 3rd and again on the 18th, then a gradual rise to 30.5 on the 25th, and then falling to 29.5. Thermometers. The mean maximum temperature was 58 degrees as compared with 62.6 degrees the mean for the preceding 30 years. There was a sharp rise at the beginning of the last week in the month. 75 The mean minimum temperature was 40 degrees as compared with 44.5 the mean for the previous 30 years. Rainfall. Rain fell on 22 days. Total amount 2.37 inches the mean for 35 years being 1.69. Wind. N.W., with variations to N.E. during the second week, when it changed to S.W. JUNE. Barometer. The mean barometric pressure for the month was 29.79 inches, being slightly below the mean for the preceding 30 years. Thermometers. The mean maximum temperature was 70 degrees as compared with 69.5 degrees the mean for the preceding 30 years. The mean minimum temperature was 50 degrees as compared with 50.9 degrees the mean of the preceding 30 years. The lowest temperature registered was 40 degrees on the 10th. Rainfall. Rain fell on 17 days, the total being 3.67 inches. The mean for the preceding 35 years was 1.93. Wind Chiefly from the W., veering from S.W. to W.S.W., and changing to E. at the end of the month. JULY. Barometer. The mean temperature was 29.9 being the same as that for the preceding 30 years. Thermometers. The mean maximum temperature was 70 degrees being below the mean of the preceding 30 years which was 72.7 degrees. The mean minimum temperature was 53 degrees, the mean for the preceding 30 years being 54.2 degrees. Rainfall. Rain fell on 10 different days to a total of 1.01 inches, being below the mean for the past 35 years which was 2.27. Wind Chiefly from the West. 76 AUGUST. Barometer. The mean pressure was 29.7 inches, that for the past 30 years being 29.96. Thermometers The mean maximum temperature was 63 degrees, the mean for the preceding 30 years being 71.9 degrees. The mean minimum temperature was 53 degrees, being the same as the mean for the preceding 30 years. Rainfall. Rain fell on 21 days to the extent of 3.44 inches. The mean for the preceding 35 years being 2.30. Wind Chiefly from the W. SEPTEMBER. Barometer. The mean pressure was 29.9 inches, being the same as the mean for the preceding 30 years. Thermometers. The mean maximum temperature was, 65 degrees, being slightly below the mean for the preceding 30 years. The mean minimum temperature was 49 degrees as compared with 49.7 degrees, the mean for the preceding 30 years The lowest point reached was 39 degrees on the 19th and 27th. Rainfall. On 8 days rain fell, total 2.5 inches. The mean for the preceding 35 years was 2.21. Wind. S.S.W. at the beginning of the month and keeping to tbe W. chiefly during the remainder of the month. OCTOBER. Barometer The mean pressure was 29'8 inches, being the same as the mean for the preceding 30 years. Thermometers, The mean maximum temperature was 55 degrees, as compared with 56.8 degrees, the mean for the preceding 30 years. The mean minimum temperature was 44 degrees, as compared with 42.9 degrees, that for the preceding 30 years. 77 Rainfall On 19 days rain fell, total 1.6 inches. The mean for the preceding 35 years was 2.7. Wind, Variations of N.E. for the first ten days, then changing to W. with variations from the 10th. NOVEMBER. Barometer. The mean pressure was 29.79 inches as compared with 299, the mean for the preceding 30 years. Thermometers. The mean maximum temperature was 49 degrees as compared with 49 8 degrees, the mean for the preceding 30 years The variations were sudden and great at the middle of the month. The mean minimum temperature was 40 degrees as compared with 38.5 degrees, the mean for the preceding 30 years. fiainfall, Rain fell on 13 days and to the total amount of 1.72 inches. The mean for the preceding 35 years was 2.29. Wind. Chiefly from the E. DECEMBER. Barometer. The mean pressure was 29.9 inches, being the same as the mean for the preceding 30 years, which was 29.95. Thermometers. The mean maximum temperature was 44 degrees as compared with 44.7 degrees the mean for the preceding 30 years. The mean minimum temperature was 37 degrees, as compared with 34.4 degrees the mean for the preceding 30 years. Rainfall. Rain fell on 13 days to the total of 1.31 inches. The mean for the preceding 35 years was 2.15. Wiqd. First ten days from the E., and from the W. during the remainder of the month. 78 RAINFALL 1902. MONTH. Number of days on which Rain fell in Richmond. Total fall in inches. Richmond 1902 London Mean for 1866-1900. 1901 1902 January 11 8 .52 2.01 February 6 10 .94 1.69 March 15 10 1.52 1.49 April 14 10 .60 1.65 May 6 22 2.37 1.69 June 11 17 3.67 1.93 July 7 10 1.01 2.27 August 10 21 3.44 2.30 September 6 8 2.50 2.21 October 14 19 1.60 2.70 November 4 13 1.72 2.29 December 15 13 1.31 2.15 119 161 21.20 24 38 The rainfall for the year in Richmond was 21.2 inches, as compared with 17.54 inches for 1901, and 21.16 inches for 1900. There were 47 more days on which rain fell during 1902 than during the year 1901. May, June, August and October Were the wettest months, whilst January and April were the driest.