RICH 046 Rich sid BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1905, by J. H. CROCKER, M.D., b.ch., d.p.h., m.r.c.s., &c., Medical Officer of Health, Borough of Richmond, Medical Officer to the Education Committer, Richmond, and Visiting Physician, Mogden Isolation Hospital. Richmond, Surrey: J. H. Broad & Co., Printers, 8, Kino Street, and Water Lane. 3 HEALTH COMMITTEE, 1905. His Worship the Mayor. NORTH WARD. Councillor Shrimpton. „ A. J. Ward. SOUTH WARD. Alderman Gascoyne. Councillor Alabaster. „ Davis. „ Hbaslbr. „ Wadd, m.b„ (Chairman). EAST WARD. Councillor Cook. „ Pierrepont. „ T rower. WEST WARD. Councillor Billett. „ McDougall. KEW WARD. Alderman Beauchamp. Councillor Payne. Meetings every Second Friday at 6 o'clock p.m. JOINT HOSPITAL COMMITTEE, 1905. Members from the Richmond Corporation. Councillor A. J. Ward (Vice-Chairman). Councillor Shrimpton. „ Davis. „ Wadd, m.b. „ Cook. „ Alabaster. Meetings once a month at 4.45 p.m. 5 Statistical Summary. 6 STATISTICAL SUMMARY. Borough of Richmond, 1905. Population. estimated to the middle of the year 33,837 Births. Males, 342; Females, 354 696 Annual Rate of Births per 1,000 of Population 20.5 Deaths 439 Annual Rate of Deaths per 1,000 of Population 12.9 Zymotic Death Rate 1.3 Excess of Registered Births over Deaths 257 Infantile Mortality per 1,000 Births 99 Area. The Total Area of the Borough is 2534 acres Density. The Mean Density of the Borough is equal to 13.3 persons per acre. 1 905. Annual Birth.rates, Death.rates, and Rates from the Seven Chief Epidemic Diseases. Annual Rates per 1,000 Living. Infantile Mortality Annual Death. rate of Infants under I Year per 1,000 Births. Births. Deaths from all Causes. Deaths from Seven Chief Epidemic Diseases. England and Wales 27.2 15.2 1.52 128 Rural England&Wales 26.3 14.9 1.09 113 76 great towns 28.2 15.7 1.88 140 141 smaller towns (including Richmond) 26.9 14.4 1.5 132 RICHMOND 20.5 12.9 1.3 99 7 SECTION I. Dital Statistics. 8 SECTION 1. 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 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 two last census, due allowance being made for the increase of population during that decade. The Registrar General in his quarterly reports has estimated the population of the Borough of Richmond for 1905 to be 33,837. 9 Divided into Wards the figures are as follows:— Ward. Population. Census. 1901. 1905. Estimated at the Middle of the year. Estimated at the middle of the year. North 9073 9139 9928 South 6038 6044 6160 East 9140 9176 9874 West 4727 4727 4775 Kew 2699 2714 3100 Total 31,677 31,800 33,837 Marriages. In the course of the year 295 marriages took place within the Borough, as compared with 262 for 1904. By the Established Church 159 At other places of Public Worship 33 At the offices of the Registrar 103 Total 295 This gives a marriage rate of 17.4 per 1.000 inhabitants in the Borough during the year 1905 as compared with 15.7 for 1904 and 19 for the year 1903. 10 Births. The number of births registered during the year 1905 was 696, as compared with 661, the average for the preceding ten years. Of these 342 were males and 354 were females. The birth rate for the year was 20.5 per 1,000 of the population. The average for the Borough during the preceding ten years was 21.2. There were 35 illegitimate births during 1905, 21 of these occurring in the Union Workhouse, 8 in the North Ward, 4 in the East, 1 in the West Ward, and 1 in the Kew Ward. The birth rate varied in the different Wards, being 26 4 in the North, 10.6 in the South, 24 2 in the East, 14 4 in the West, and 17 in the Kew Ward. The birth rate for England and Wales during 1905 was 27.2, being lower than the rate in any year on record; for the 76 great towns on the Registrar General's list it was 28 2, and for the 141 smaller towns it was 26.9 per 1,000 of the population. Deaths. The total number of deaths registered in the Borough during 1905 was 487; of these, 140 died in the Union Workhouse and Royal Hospital, 60 of whom belonged to outside districts. Four patients from Richmond died at Mogden Isolation Hospital, and 8 at Brookwood Asylum. Correcting for the above, results in a total of 439 deaths for the Borough, which gives an annual rate of 12.9 per 1,000 of the population living. The mean annual death rate of the Borough for the preceding ten years was 13 7. The death rate for England and Wales in 1905 was 15.2, the 76 great towns 15.7, and Rural England and Wales 14.9. 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, 51 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 13.2, South Ward 18, or without the Workhouse deaths 10.2, East Ward 11.8, West Ward 10, and Kew Ward 10 per 1,000 of the population. 11 The death rate in 1905 for England and Wales was l.0 per 1000 below the rate for 1904, and lower than the rate in any other year on record. Births and Deaths during 1905 in the various Wards, Wards. Total Births. Birth Rate per 1000 living Total Deaths. Death Rate per 1000 living. North 263 26.4 132 13.2 South 72 10.6 114 10.21 East 239 24.2 117 11.8 West 69 14.4 46 10.0 Kew 53 17.0 30 10.0 Total for Borough 696 20.5 439 12.9 †After deducting 51 in the Union Workhouse. Chief Epidemic Diseases, Death Rate. The number of deaths due to the " seven principal Zymotic Diseases"* usually classified under this heading was 47. This gives a zymotic death rate of 1.3 per 1000 persons living, as compared with 1.5 for 1904. The zymotic death rate of England and Wales for 1905 was 1.52, that for the 76 great towns 1.88, and Rural England and Wales 1.09. Scarlet Fever.—1 death. Measles. —4 deaths, all below 5 years of age. Diphtheria and Croup.—3 deaths below 5 years of age. Whooping Cough.—25 deaths, 24 below 5 years of age. Enteric Fever.—A deaths. Diarrhcea.—10 deaths, 6 of these being below 1 year of age. * Small pox, measles, scarlet fever, diphtheria, whooping cough, fever typhus, enteric, and continued), and diarrhoea. \ 12 Mortality in age Croups. As will be seen by the Table of Causes of Death, at the end of this Section, there were 150 deaths above 65 years of age, and 61 below one year of age. Infantile Mortality. The total number of deaths under one year was 61; this is at the rate of 99 per 1,000 births. The average for the preceding 10 years was 132. Tuberculosis. The total number of deaths attributed to this disease vas 36, being 8 percent. of the total deaths as compared with 15 percent. for 1904, and 11 percent. for 1903. This is a little over a rate of 1 per 1,000 of the population, as compared with 1.8 for 1904, 1.6 for 1903; and 1.3 for 1902. Respiratory Diseases. 75 deaths were registered as due to diseases of the chest other than phthisis. This gives a mortality of 1.9 per 1,000 of the population as against 1.6 for 1904, 1.5 for 1903 and 2 for 1902. Deaths in Public Institutions. Parishioners. Non.Parishioners. Total. In the Richmond Hospital 29 31 60 „ Union Workhouse 51 29 80 „ Brookwood Asylum 8 — 8 „ Mogden Hospital 4 — 4 Inquests There were 54 inquests held in the Borough during the year, viz., Richmond 45, Petersham 3 and Kew 6. Coroner's Inquests held during the Year 1905 in the Kingston District of Surrey. Kingston 44 Ham 1 New Maiden 9 Coombe 1 Old Maiden 1 13 Surbiton 13 Hook 1 Wimbledon 23 Merton 6 Richmond 45 Petersham 3 Kew 6 Mortlake 12 Barnes 21 Long Ditton 1 Claygate 3 Thames Ditton 9 Total (133 males and 66 females) 199 I. Institutions within the District receiving sick & infirm persons from outside the District. Union Workhouse. Royal Hospital. II. Institutions outside the District receiving sick and infirm persons from the District. Mogden Isolation Hospital, Middlesex. Dockwell Small-pox Hospital, Middlesex. Brookwood Asylum. III. Other Institutions, the deaths in which have been.distributed among the several localities in the District. 14 VITAL STATISTICS OF WHOLE DISTRICT DURING 1905 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 Number. Rate.* Number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 28920 618 21.3 75 121 432 15.0 75 29 9 412 14.2 1896 29400 665 22.6 98 147 414 14.0 72 40 10 384 13. 2 1897 29880 704 23.5 98 139 432 14. 4 115 63 6 369 12.3 1898 30360 663 21.8 113 170 493 l6.2 107 56 5 443 14.5 1899 30840 691 22.4 107 154 541 17.5 110 48 8 501 16.2 1900 31320 617 19.7 89 144 518 16.5 117 53 10 475 15.0 1901 31800 707 22.2 78 110 459 14.4 93 40 8 427 13.4 1902 32300 641 19.8 59 92 458 14.1 114 53 21 426 13.2 1903 32808 683 20.8 76 111 460 14.0 106 45 13 428 13.0 1904 33320 621 18.6 83 133 443 13.3 104 53 10 400 12.0 Averages for years 1895-1904. 31094 661 21.7 87 132 465 14. 9 101 48 10 426 13.7 1905 33837 696 20.5 61 99 487 14.4 140 60 12 439 12.9 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population, 15 VITAL STATISTICS OF SEPARATE LOCALITIES IN 1908 AND PREVIOUS YEARS. Borough of Richmond (Surrey). Names of Localities. Borough. North Ward. South Ward. East Ward. West Ward. Kew Ward. Year. Population estimated to middle of each year. Births registered . Deaths at all Ages. Deaths under 1 year Population estimated to middle of each year Births registered. Deaths at all Ages. Deaths under 1 year. 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 year. Population estimated to middle of each vear. 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. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b c. d. 1900 31,320 617 475 89 122 32 101 9 129 29 75 13 43 7 1901 31,800 707 427 78 9,139 226 110 28 6,044 76 90 6 9,176 266 107 28 4.727 97 70 7 2,714 42 48 11 1902 32,300 641 426 59 9403 211 119 19 6068 66 98 5 9,320 232 107 22 4735 81 60 8 2774 51 42 5 1903 32,808 683 428 76 9539 250 119 29 6078 68 111 8 9572 246 107 24 4765 70 54 8 2854 49 37 7 1904 33,320 621 400 86 9803 243 107 33 6134 64 89 4 9722 208 117 29 4775 66 49 11 2886 40 38 6 1905 33,837 696 439 61 9928 263 132 28 6160 72 114 5 9874 239 117 18 4775 69 46 9 3100 53 30 1 16 CAUSES OF, AND AGES AT, DEATH DURING YEAR 1905. 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 Deaths in Public Institutions in the District All ages Under 1 year. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards North South East West Kew. Measles 4 .. 4 .. .. .. .. .. .. 2 2 .. .. Whooping-cough 25 9 15 1 .. .. .. 8 3 9 5 .. 3 Diphtheria and membranous croup 3 .. 3 .. .. .. .. 2 .. 1 .. .. 1 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. 1 Enteric Fever 4 .. .. 1 1 2 .. 2 .. • • 1 1 2 Epidemic influenza 5 .. .. .. .. 1 .. 1 4 .. .. .. .. Diarrhoea.. 10 6 4 .. .. .. .. 4 2 3 1 .. 1 Enteritis 1 1 .. .. .. .. .. 1 .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. 1 .. .. .. .. .. Erysipelas 2 .. .. 1 .. .. .. .. .. 1 1 .. .. Other septic diseases 2 .. .. .. 1 1 .. 2 .. .. .. .. 2 Phthisis (Pulmonary Tuberculosis) 27 1 .. 2 2 21 1 5 6 12 1 3 12 Other tubercular diseases 9 2 2 3 .. 1 1 5 .. 1 2 1 6 Cancer, malignant disease 32 .. .. .. .. 14 18 8 11 8 3 2 12 Bronchitis 39 3 4 .. .. 11 21 8 9 17 3 2 5 Pneumonia 32 9 5 1 .. 10 6 11 6 9 2 4 8 Pleurisy 2 .. .. 1 .. 1 .. 1 1 .. .. .. 1 Other diseases of Respiratory Organs 3 .. .. .. .. 2 1 1 .. .. .. .. 1 Alcoholism, Cirrhosis of liver 12 .. .. .. .. 10 2 5 2 3 1 1 5 Premature birth 14 14 .. .. .. .. .. 4 1 7 2 .. 1 Diseases and accidents of parturition 1 1 1 Heart diseases 50 4 1 1 1 18 25 14 11 14 9 .. 7 Accidents 14 .. 1 2 2 6 3 7 3 1 2 1 14 Suicides 3 .. .. .. .. 3 .. 2 1 .. .. .. 5 All other causes 143 12 3 3 4 54 67 41 53 29 12 8 53 All causes 439 61 42 16 12 158 150 133 113 118 48 27 140 17 INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under one Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5 -6 Months. 6 7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months 11-12 Months Total Deaths under 1 Year.  All Causes. Certified 17 5 4 1 27 5 4 3 3 3 2 2 3 5 1 3 61 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 1 1 2 .. .. .. .. .. 1 2 8 Diarrhœal Diseases. Diarrhoea, all forms .. .. .. .. .. .. .. 1 • • .. .. 1 1 .. .. 3 Enteritis (not Tuberculous) .. 1 1 .. 2 1 .. 1 .. 1 .. .. .. .. .. .. 5 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 Wasting Diseases. Premature Birth 8 2 2 .. 12 1 .. .. .. .. .. .. .. .. .. .. 13 Congenital Defects 2 1 .. .. 3 .. .. .. .. .. .. .. .. .. .. .. 3 Injury at Birth 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Atrophy, Debility, , Marasmus 1 1 1 1 4 .. .. .. .. .. 1 .. .. .. .. .. 5 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 TuberculousPeritonitis Tabes M esenterica .. .. .. .. .. .. .... .. .. .. .. 1 .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Bronchitis .. .. .. .. .. .. 1 .. .. .. .. .. .. 2 .. .. 3 Pneumonia .. .. .. .. .. 3 1 .. 1 1 1 .. 1 1 .. .. 9 Other Causes 4 .. .. .. 4 .. .. 1 .. .. .. .. •• .. .. 4 17 5 4 1 27 5 | 4 3 3 3 2 2 3 5 1 3 61 District (or sub-division) of Richmond, (Surrey). legitimate 661 Population Births in the year 696. Estimated to middle of 1905. illegitimate, 35 33,837. Deaths from all Causes at all Ages 487 (correcting for residents & non-residents, 439). 18 SECTION II. Infections Diseases. 19 SECTION II. RECORDS OF INFECTIOUS DISEASES AND PRECAUTIONARY MEASURES ADOPTED. Notification of Infectious Diseases under the Notification Act of 1889. The total number of cases notified under the above Act for the year 1905 was 96. The number notified during the previous year was 118; for the year 1903 the number was 195 and for 1902 it was 177. Table of Monthly Notifications. Month. Totals Typhus Fever. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Puerperal Fever January 6 ... ... ... 3 3 ... ... February 6 1 1 ... 1 3 ... ... March 9 ... 1 ... 4 4 ... ... April 3 ... 1 ... ... 2 ... ... May 7 ... 1 ... 1 3 2 ... June 9 ... ... ... 1 6 ... ... July 6 ... ... ... 2 4 ... ... August 5 ... 1 ... 2 2 ... ... September 9 ... 1 ... 2 3 3 ... October 17 ... 1 ... 3 10 3 ... November 7 ... 2 ... ... 3 2 ... December 12 ... 2 ... 4 3 3 ... Total 96 1 11 ... 23 46 13 2 Two of the above cases of enteric fever and the case of typhus fever were brought from Twickenham; these were treated in the Royal Hospital. 20 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1905. Notifiable Disease Cases Notified in whole district. Total Cases Notified in each Ward. No. of Cases removed to Hospital from each Ward. At Ages—Years North. South East. West. Kew. North South. East. West Kew. At all Ages. Under 1. 1 to 5 5 to 15 15 to 25. 25 to 65 65 and upwards. Diphtheria 11 . . 5 3 3 .. .. 6 1 2 2 .. 4 .. 2 2 .. Erysipelas 23 1 .. 2 4 14 2 8 2 6 2 5 1 .. .. .. •• Scarlet fever 46 .. 14 20 6 6 •• 21 4 11 7 3 20 3 10 4 2 Typhus Fever 1 .. •• •• .. 1 •• 1 •• •• •• .. .. .. .. .. .. Enteric fever 13 .. 2 1 3 7 .. 5 1 3 2 2 2 .. 2 1 •• Puerperal fever 2 .. .. .. 2 .. .. 1 1 .. .. .. .. .. .. .. .. Totals 96 1 21 26 18 28 2 42 9 22 13 10 27 3 14 7 2 Small-pox Hospital—Dock well, Middlesex. Isolation Hospital- Mogden, Middlesex Joint Hospital Committee. Two of the above cases of Enteric Fever and the case of Typhus Fever were treated in the Royal Hospital, Richmond The Workhouse is situated in the South Ward, 21 NOTIFICATIONS OF INFECTIOUS DISEASES FROM 1895 TO 1905 Disease 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 Annual Average 1895-1904 1905 Small-pox 1 .. .. .. .. .. 2 11 1 .. 15 .. Scarlet fever 202 92 112 93 148 78 52 92 119 68 105.6 46 Diphtheria & membraneous croup 7 15 15 25 31 25 41 39 43 21 26.2 11 Enteric fever 15 6 15 8 10 21 12 17 13 7 12.1 13 Continued fever .. .. 6 8 6 4 4 .. 1 .. 29 .. Erysipelas 18 21 18 21 41 24 20 16 18 20 21.4 23 Puerperal fever .. .. .. .. .. 2 .. 2 .. 2 0.4 2 Typhus Fever .. .. .. .. .. .. .. .. .. .. 1 Totals 243 134 166 155 236 154 131 177 195 118 170 96 22 PREVALENCE AND DISTRIBUTION OF INFECTIOUS DISEASES. Small-pox. No cases of this disease were notified during the year. Diphtheria. During the year there were 11 cases of this disease notified as compared with 21 for the previous year. Three deaths occurred. Seven cases were removed to Mogden Hospital, being 63 per cent, of the notified cases. One case was brought to the Royal Hospital from Feltham. The arrangement for storing anti-diphtheritic serum at the Royal Hospital continues to be very satisfactory. Erysipelas. Twenty-three cases of this disease were notified during the year, as compared with 20 for the previous year. One death was registered as due to this disease. Scarlet Fever. Forty-six cases of this disease were notified during the year, as compared with 68 for the previous year. Ten of these cases occurred during the month of October. One death occurred from this disease. Thirty-nine cases were removed to Mogden Hospital, being 57 per cent, of the cases notified. Enteric Fever. Thirteen cases only of this disease were notified during the year, and two of those were brought to the Royal Hospital from outside districts. Seven cases were notified in 1904 and 13 in 1903, 4 deaths of residents and 1 non-resident were reported as due to this disease. Measles. Eighty-one cases of this disease were notified by the school teachers, as compared with 225 for the previous year, and 16 for 1903. Altogether there were 107 children kept from school on account of this disease, in addition to those kept away by closing of schools. The first serious outbreak occurred in connection with the infant department of the British Schools, when we found, upon investigation, 33 different infected homes containing 50 children. The 33 cases all began to be ill between the 26th and 28th of March. 23 Twenty-three other cases were notified from this school between the above date and April 28th. Four deaths were registered as due to the disease. Whooping Cough. Thirty-six cases of this disease were notified by the school teachers as compared with 133 for the previous year. Altogether 90 children were kept from school on account of this disease. There were 25 deaths registered as due to this disease; 24 of these occurred below five years of age, and one was registered as five years of age. Chicken Pox. Twelve cases of this disease were notified by school teachers during the months from March to May. Enquiries as to vaccination and isolation were made in every instance. Thirty-three children were kept from school on account of this ailment. Mumps. Twenty-one cases of this affection were notified. Diarrhœa. Ten deaths were registered as due to diarrhoea, chiefly during the hot weather. Six of the deaths were below one year of age. The number of deaths from this complaint in 1904 was 23. Tuberculosis. During the year there were 27 deaths registered in the Borough as due to Phthisis, and 19 to other tubercular diseases, a total of 36 deaths due to tuberculosis. The number of deaths registered as due to this disease in 1904 was 44, and in 1903 the number was 54. Of the total number of deaths in the Borough for 1905 this disease claimed 7 per cent, as compared with 15 per cent, for 1904, and 11 per cent, for 1903. Of the 35 deaths, 22 occurred between the ages of 25 and 65 years. 24 During the year there have been 21 cases notified voluntarily by medical practitioners. The houses of these patients, as well as of those certified as suffering from this disease in the monthly returns received from the Clerk to the Guardians, have been visited and advice given to the inmates as to precautionary measures that should be adopted. In several instances rooms have been disinfected which have been previously occupied by patients suffering from this disease, and in every instance where a death has been registered as due to this disease, the rooms and articles liable to retain infection have been disinfected, the bedding and such like articles having been sent to Mogden for this purpose. MEASURES TAKEN TO PREVENT THE SPREAD OF INFECTIOUS DISEASES. The ordinary routine followed when a case of infectious disease is notified has been explained in a previous report. When a case of infectious disease is notified, as soon as possible the Medical Officer or Sanitary Inspector calls at the house and investigates the possibility, or otherwise, of the case being isolated at home. If the Medical Officer of Health considers it is to the interest of the community that the patient should be removed to the Isolation Hospital, advice to this effect is accordingly given. If the patient remains at home, printed particulars as to isolation, disinfection, &c., together with a short epitome of the law bearing on the subject, are left at the house. During the period of illness periodic visits are made by the Sanitary Inspector to see that the instructions are being complied with. An addressed postcard is also left for the medical attendant to sign and forward at the termination of the illness, when he considers the house is ready for disinfection. Full particulars of the patient and other occupants of the house, number of rooms, condition of premises, milk supply and other matters bearing on the possible origin of the disease are entered on special printed forms and filed in the Health Office. 25 Special certificates are forwarded to the school teachers, if any occupants of the house attend school, the milk-seller, and to the librarian at the Public Library. Any books which may be in the house, borrowed from the Library, are taken to Mogden to be disinfected by Formaldehyde gas, or destroyed. Where a medical practitioner at the time of notifying a case gives satisfactory reasons to the Medical Officer of Health why a case should be removed to the Isolation Hospital, this is always acted upon previous to malting the usual investigations. 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 walls, ceilings and floors of the rooms are sprayed with solution of Formalin. Under certain circumstances books are disinfected in a special apparatus at Mogden. Disinfectant fluid and powder are supplied to householders free of cost from the Health Department. Infectious These Hospitals are under a Joint Committee of Diseases representatives of the Borough of Richmond and the tyospitals. Urban District Council of Heston and Isleworth, and have been fully described in previous reports. The two authorities have not yet come to any agreement as to enlargement of Mogden Hospital. The Heston and Isleworth District Council have laid the correspondence before the Local Government Board, and the suggestions of the latter authority should lead to an early settlement of the matter. 26 MOGDEN ISOLATION HOSPITAL. Dr. Power, the Resident Medical Officer, reports as follows:— Return as to Patients for the Year ending the 31st day of December, 1905. ADMITTED. Scarlet Fever. Diphtheria Enteric . Fever. Other Diseases Totals* From the Borough of Richmond 41 7 2 4 54 „ Richmond Union — — — 1 1 „ Heston and Isleworth Urban District 68 82 1 - 151 „ Hounslow Barracks (Garrison) 1 3 - - 4 „ Brentford Union (Isleworth) 6 7 — — 13 „ Mogden Hospital Staff 1 — — 4 5 Totals 117 99 3 9 228 DISCHARGED. Scarlet Fever. Diphtheria Enteric ,. Fever. Other Diseases . Totals* From the Borough of Richmond 41 5 1 3 50 „ Richmond Union — — - 1 1 „ Heston and Isleworth Urban District 48 63 - - 111 „ Hounslow Barracks (Garrison) 1 2 - - 3 „ Brentford Union (Isleworth) - 6 - - 6 „ Mogden Hospital Staff 1 — — 4 5 TOTALS 91 76 1 8 176 DIED. Scarlet Fever. Diphtheria Enteric . Fever. Other Diseases. Totals,. From the Borough of Richmond — 2 l l 4 „ Heston and Isleworth Urban District l 12 — — 13 Totals l 14 l l 17 The following is a Statement showing the number of admissions for each year since the opening of the Hospital. 27 Year. Scarlet Fever. Diphtheria, Enteric Fever. Other Diseases. Totals. 1898 42 20 7 l 70 1899 182 42 5 0 229 1900 176 56 6 0 238 1901 136 57 13 4 210 1902 183 85 9 2 279 1903 218 48 8 2 276 1904 97 47 6 4 154 1905 117 99 3 9 228 Totals 1151 454 57 22 1684 Total Admissions. The admissions during 1905 amounted to 228; being 74 more than in 1904, and slightly below the average of former years. Diphtheria. 99 cases of this disease were admitted. Not only was the proportion of Diphtheria cases unusually high (99 out of a total of 228), but the total number of cases w'as in excess of the average (which is 57) and of the previous highest total (85) in 1902. There were 14 deaths; giving a case mortality of 141 per cent., which is slightly above our average mortality in this disease. This was no doubt due to the large number of very severe cases admitted during the late epidemic. Of the total number of cases 70 were admitted during the last four months of the year. Scarlet Fever. 117 cases were admitted, compared with 97 during the previous year and an average of 165 for all years. This total promised at one time to be much less, but there was a sharp epidemic during the last quarter, which added 50 cases. One death occurred; giving a case mortality of -8 per cent, for the year, the lowest we have ever had. Staff. One member of the staff was warded with Scarlet Fever during the year. In spite of the Dipptheria wards being crowded for several months, it is satisfactory to be able to report that none of the staff contracted the disease, as so frequently happens under these conditions, four members of the staff were warded for various other complaints. 28 MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED. Richmond. Richmond Union. Heston and Isleworth. Isleworth Union. Hounslow Carrison. Hospital Staff. TOTALS. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total Scarlet fever. Diphtheria. | Enteric Fever. Other Diseases. Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total. Scarlet Fever Diphtheria. Enteric Fever. Other Diseases. Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Total. Scarlet Fever. j Diphtheria. Enteric Fever. Other Diseases. Total. 1898 25 9 1 1 36 .. .. .. .. .. 16 11 5 .. 32 .. .. .. .. .. 1 .. .. .. 1 .. .. 1 .. 1 42 20 7 1 70 1899 101 10 3 .. 114 .. .. .. .. .. 72 32 2 .. 106 .. .. .. .. .. 4 .. .. .. 4 5 .. .. .. 5 182 42 5 .. 229 1900 55 19 3 .. 77 1 .. .. .. 1 119 37 3 .. 159 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 176 56 6 .. 238 1901 44 27 7 2 80 .. .. .. .. .. 71 26 6 .. 103 .. .. .. .. .. 21 3 .. .. 24 .. 1 .. 2 3 136 57 13 4 210 1902 78 25 3 2 108 .. .. .. .. .. 76 51 6 .. 133 3 2 .. .. 5 26 5 .. .. 31 .. 2 .. .. 2 183 85 9 2 279 1903 100 27 5 2 134 6 .. .. .. 6 97 20 3 .. 120 4 .. .. .. 4 10 .. .. .. 10 1 1 .. .. 2 218 48 8 2 276 1904 46 15 .. 2 63 .. .. .. .. .. 48 26 6 .. 80 1 1 .. .. 2 1 4 .. .. 5 1 1 .. 2 4 97 47 6 4 154 1905 41 7 2 4 54 .. .. .. 1 1 68 82 1 .. 151 6 7 .. .. 13 1 3 .. .. 4 1 .. .. 4 5 117 99 3 9 228 Total 490 139 24 13 666 7 .. .. 1 8 567 285 32 .. 884 14 10 .. .. 24 64 15 .. .. 79 9 5 1 8 23 1151 454 57 22 1684 29 Percentage of Infection's Cases removed to Hospital. Of the 70 cases of Diphtheria, Scarlet Fever, and Enteric Fever which were notified in the Borough, there were 52 removed to Hospital, which is at the rate of 74.2 per cent., as compared with 64.5 per cent, for the previous year. 1905. Per cent. 1904. Per cent. 1903 Per cent. 1902. Per cent. 1901. Per cent. Small-pox — — 100 90 100 Diphtheria and Croup 72.8 66 64 63 66.6 Scarlet Fever 84.7 67.6 84.8 84.7 84.6 Enteric Fever 38.6 28 30 47 75 Bacterioscopic Examination of Material from Suspected Cases of Diphtheria and Enteric Fever. The arrangement made between the Health Committee and the Lister 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 Lister Institute, has been found of great service. There were 9 such samples forwarded from patients suspected to be suffering from Diphtheria, 1 of which showed the presence of Diphtheria Bacilli, and 8 samples of blood from suspected cases of Enteric Fever. 4 giving the Widal reaction. PUBLIC ELEMENTARY SCHOOLS. The following is a copy of a Report presented to the Education Committee :— Gentlemen,- I beg to report on the duties carried out by me as your Medical Officer in connection with the Elementary Schools during the year 1905. Seventy-five visits were made to the various departments of the Elementary Schools in the Borough, several of the visits being at the request of the Teachers. Twenty-five visits and examinations of children at their homes were made, at the request of the School Attendance Officer or Teachers, owing to the children being absent from School, said to be ill and not under medical treatment. 30 Six medical examinations were made and certificates granted in special cases; 1 for the Holme Court Truant School at Isleworth, 1 (3 times) for Deaf and Dumb School and 2 for Truant Schools. One School was closed for three weeks owing to an outbreak of measles, and the Infant Department of one School was closed for a fortnight on account of whooping cough. The Sanitary conditions of the various Schools have been satisfactory with the exception of overcrowding at times at one of the Schools. Exclusion from School.— Throughout the year 61 children were excluded from School on different occasions, for varying periods, after inspection at the Schools. This was necessary owing to the condition of the scholar in each instance being such as to render him a possible source of danger to other children. Of these, there were 19 suspected measles, 14 suspected whooping cough, 2 impetigo contagiosa, 15 ringworm, 2 scabies (itch). 16 on account of dirty heads, and 3 on account of dirty bodies (verminous). In each instance, with the exception of the suspected cases of measles and whooping cough, a copy of the following certificate, duly filled in was sent to the parents of the affected children :— RICHMOND (SURREY) EDUCATION COMMITTEE. Town Hall, Richmond, Surrey. 190 School Class To the Parents or Guardians of I beg to inform you the above-mentioned Child is suffering from and he should not attend School until free from infection or contagion. 31 You should obtain Medical advice at once. In the event of your position being such that you cannot afford to consult a private doctor, it is recommended that you should take the Child to the Out-patient Department of the Royal Hospital. If properly attended to the ailment should soon be cured, consequently, any prolonged abstention of the Child from School will render you liable to prosecution. Signed Medical Officer to the Education Committee. Many other children were examined and allowed to remain at School as their condition was not considered dangerous to others. Amongst those were: 4 cases enlarged glands in the neck, 21 defects in eyes, 1 weak heart, 6 eczema capitis. 1 herpes, 1 mentally deficient, and 9 ringworm (cured). The parents were recommended to seek medical advice where considered necessary. Mumps.— A sharp outbreak of this affection occurred in connection with three of the Schools. In each instance when brought to my notice, I found upon examination that several children were attacked and others were recovering, the nature of the illness not having been recognised. Under the circumstances I did not consider it advisable to recommend closing of the Schools. In the majority of cases the nature of the illness was mild and of short duration. Measles.— Upon visiting the Petersham British School on February 22nd, I was informed that 9 children in 7 houses were away from School suspected to be suffering from measles. I visited two houses and found the children were ill with measles. The schoolmaster's own child unfortunately contracted the disease. The School was closed from February 23rd to March 20th. There is little doubt but that the disease was introduced into the School by a scholar from Twickenham. This scholar had previously resided in Petersham. 32 Whooping Cough.— Upon visiting the Infant Department of King's School on May 3rd, I found 14 children with coughs, Suspicions of whooping cough. This department was closed for a fortnight. Visits to Scholars at their Homes.— Absent scholars said to be ill and not under treatment were reported to the Medical Officer by the School Attendance Officer or Teachers on various occasions, and upon visiting the homes and inspecting the children the following conditions were found: Abscess 1 Suspected Scarlet Fever 1 Measles 2 Whooping Cough 3 Ringworm 7 Rheumatism 1 Impetigo Contagiosa 5 Pediculi 2 No Illness 3 Total 25 In addition to the foregoing duties which were carried out personally by your Medical Officer, the following were carried out by the Health Department in connection with the various diseases not included under the Infectious Disease (Notification) Act, affecting scholars of the Elementary Schools. The suspected cases were notified by the School Teachers or School Attendance Officer, and upon receipt of such notification the Sanitary Inspector called at the house and gave advice as to isolation and left a copy of a circular drawn up by the Medical Officer relating to the illness. 33 The following is a summary of the result of the investigations of the various cases notified:- Measles. Whooping Cough. Chicken Pox. Mumps. Total. Suffering from— 81 36 12 21 150 Other children in the infected house kept from School 107 54 21 29 211 188 90 33 50 361 Number of houses in which diseases occurred 105 „ „ „ notified but no disease present 39 „ „ „ „ outside the Borough 12 Total 156 Houses Schools. Notified. Holy Trinity, Lower Mortlake Road 7 Ditto Princes Road 14 St. Mary's 3 St. John's 2 St. Luke's 2 British (The Vineyard) 33 King's 7 Russell (Petersham) 14 Discovered by Sanitary Inspector and other sources 23 105 Houses notified but no disease presen 39 „ „ outside the Borough 12 Total 156 34 NOTIFICATION FORM. BOROUGH OF RICHMOND (SURREY). INFECTIOUS DISEASES. NOTIFICATION FORM FOR SCHOOLS. Measles, Whooping Cough, Chicken Pox, Mumps. If a child is suffering from any of the above diseases, or if, though not himself affected some other occupant of the same house is, this Form should be at once filled up and forwarded to the Medical Officer of Health. Date when reNames of Addresses of ported to Supposed , •Scholars. Scholars. attendance at Medical officer nature of Illness Remarks. Sch°o1 ot Health. Name of School Department Teacher's Signature Date 35 CIRCULAR Re MEASLES. BOROUGH OF RICHMOND. Measles. Town Hall, Richmond. Measles is again prevalent in this 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. The disease begins like a cold in the head; this lasts four days before the rash comes out, and the case is "catching" during all this period, as well as 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 measles is contracted the better is the prospect 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. J. H. CROCKER, M.D. Medical Officer of Health. CIRCULAR Re WHOOPINC COUCH BOROUGH OF RICHMOND. Whooping Cough. This disease is a serious one, especially if occuring in children under five years of age. The most common complication is bronchitis, but the severe coughing and straining during the illness rnay tear the lung tissue and thus set up inflammation. 36 Whooping cough is very infectious, but susceptibility to the disease is lessened as the child grows older. In this district there are many more deaths from whooping cough than from scarlet fever. Nearly all the deaths occur below the age of 5 years. It follows, therefore, that the older the child it when he contracts whooping cough the better chance he has of recovery. During the past thirteen years, in the Borough of Richmond, which includes Richmond, Kew, North Sheen and Petersham, there were 101 deaths due to whooping cough, whilst during the same period the number of deaths from scarlet fever was 23. The incubation period of whooping cough is about a fortnight, that is, after becoming infected the child is apparently quite well, as far as this disease is concerned, for that length of time. The onset begins with :i short cough, like that of an ordinary cold, but, as a rule, there is no "whoop" until a fortnight after the commencement of this bronchitic cough; the child, however, may give the disease to others during this period. The infectious stage lasts at least six weeks from the commencement of the cough. The child is liable to impart infection to others after this period has elapsed unless the cough has disappeared. The patient should be isolated during the whole period of the ailment. lie should not be exposed to cold winds or draughts, but plenty of fresh air in the room will be beneficial. The infection is given off by the breath of the patient and is also contained in what is coughed up; therefore, a handkerchief should not be used for wiping the mouth after coughing; soft paper is preferable. The paper snould be burnt immediately after using. 37 Any material contaminated by the patient should be boiled in water for at least ten minutes. Plates, cups, spoons, or any other articles used by the patient should be thoroughly cleansed after using and should be kept entirely for the patient's use. Any person not suffering from whooping cough may carry the disease from a sufferer to others, particularly if the patient has coughed on such person's clothing. It is advisable to wear a cotton garment over the ordinary clothing whilst with the patient. This cotton garment should be removed, the face and hands washed and hair brushed before associating with the other inmates of the house. If an infected child is taken into the street or any public place, the party in charge of the child is liable to prosecution. Any child known to have been exposed to the danger of whooping cough, who, after ten days or a fortnight, begins to cough —even if there is no whoop— should be kept away from others. On no account should a child be sent to day or Sunday school under such circumstances. Upon termination of the illness the house and any articles liable to retain infection will be disinfected free of charge if word is sent to the Health Department, Town Hall. The Medical Officer of Health will be obliged if persons will send information to him when they have any case of infectious disease in the house. J. H. CROCKER, M.D. Medical Officer of Health. Town Hall, Richmond, Surrey. 38 CIRCULAR LETTERS TO HEAD TEACHERS. Public Health Department, Town Hall, Richmond (Surrey). 190 Dear Sir, 1 beg to inform you that living at is suffering from 1 understand that the following inmates of the same house attend your school:— Please do not permit to attend again until medically certified to be free from infection. This, of course, applies equally to Sunday School attendance if in your power to prevent it. Yours truly, J. H. CROCKER, m.d., d.p.h., Medical Officer of Health. The Head Master. School. 39 Public Health Department, Town Hall, Richmond (Surrey). 190 Dear Sir, Re You may re-admit Children from this address on or after provided that no other case of Infectious Disease arises in the house in the meantime. Yours faithfully, J. H. CROCKER, m.d., d.p.h., Medical Officer of Health. The Head Master. School. Believe me, Gentlemen, Your obedient Servant, J. H. CROCKER, m.d., d.p.h., &c. 40 SECTION III. Sanitary matters 41 SECTION III. SPECIAL SANITARY MATTERS. Petersham Meadow. Several large hollows in the meadow have been filled in, and the open water course which previously crossed the meadow has been filled in and the water conducted away by jointed pipes. Deep Well. The water from this well continues in an excellent condition. Analyses. Chemical analyses of the various supplies have been made by the Medical Officer of Health and bacteriological examination by Professor Klein at different periods throughout the year. Red Lion Street Area. During the year 1905 a distinct advance was made in connection with this area. A scheme was prepared under the Public Health Act and an enquiry was held by an Inspector of the Local Government Board. There was opposition to the Scheme and only a small portion of it was approved. Acting upon the advice of the Local Government Board a scheme has been prepared under the Housing of the Working Classes Act and there is every prospect of the area being improved in the immediate future under this Act. Housing of the Working Classes. The houses in Manor Grove, built by the Corporation under Part III. of the Act, continue to be in a satisfactory condition and are all occupied. Usually there is a long waiting list. Three additional Workmen's Dwellings on the vacant land, the property of the Corporation, in Manor Grove, were completed during the year 1905. Mortuary. During the year there have been 54 bodies received at the Mortuary, 36 males and 22 females. Post mortem examinations were made upon 45 bodies, and 54 inquests were held. Treatment of Sewage and Disposal of House and Trade Refuse. These matters are dealt with in a similar manner as explained in the annual report for 1901. 42 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 Inspector, reports as follows:— I beg to forward herewith a list of the Articles purchased under the provisions of the above Act during the year 1905. 57 samples were taken, of which 50 were genuine, 7 slightly adulterated or deteriorated, and in which the percentages were not such as would justify legal proceedings. Articles Purchased. Number of Samples Genuine Slightly adulterated or deteriorated. Cases in which proceedings were taken. Convictions obtained Total Fines. Milk 23 21 2 Butter 13 8 5 Spirits 5 5 Ice Cream 6 6 Cheese 6 6 Jam 3 3 Sausages 1 1 Totals 57 50 7 43 PUBLIC BATHS-SUPERINTENDENT'S RETURN OF BATHERS from 1st January to 31st December, 1905. FROM 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 31st March 3009 105 1510 575 4519 680 487 1st April to 7th July 13118 2657 6406 537 2280 268 3184 1272 19524 3194 5464 1540 16 8th July to 13th October 12975 3515 6872 450 2241 271 2858 1192 19847 3965 5099 1463 91 14th October to 31st December 345 90 50 3 2429 114 1164 499 395 93 3593 613 703 Totals 26438 6262 13328 990 9959 758 8716 3538 39766 7252 18675 4296 1297 For corresponding period of last year (1904 ) 25977 4641 12790 756 10439 667 9816 3607 38767 5397 20255 4274 986 Corresponding period of 1904. Corresponding period of 1903. Total Number of Males (including Dressing Box Tickets) 58,531 60,008 56,421 Total Number of Females 11,548 9,671 9,112 Total Bathers 70,079 69,679 65,533 Average Temperature 56 44 ORDINARY SANITARY WORK OF THE HEALTH DEPARTMENT. Staff. Chief Inspector: G. T. Norman, Cert. San. Inst. Assistant Inspector: W. S. Parsons. Systematic Inspection. During the year there were 1,673 inspections of nuisances in course of abatement 1,162 houses inspected, 434 visits to cases of infectious diseases, besides systematic inspections of slaughter houses, cowsheds, bakehouses, &c. Abatement of Nuisances under the Public Health Acts. A summary of nuisances investigated by the Sanitary Inspectors during the year 1905 is given at the end of this Section, and it is satisfactory to report that at the end of the year, out of a total of 2,163 defects reported only 22 remained not done, all of which were reported during the end of December. Only 3 defects had to be reported to the Health Committee for their sanction to serve statutory notices on the owners, and these were abated during the time allowed by the notices. The work of supervising the reconstruction of the drains and other sanitary arrangements where they are found defective is done by the Sanitary Inspector. During the year the drainage at 70 houses has been entirely reconstructed, i.e., a fresh connection made to the sewer, new drains, either of tested earthenware or iron pipes, laid with efficient intercepting trap and the necessary chambers. All these drains stood the water test after they were covered. Full particulars of this work are kept in the Inspector's office for reference. At 123 houses it was found that although a defect was discovered in the drains the reconstruction of a branch either to the water closet or sink pipes would put the drainage in a satisfactory condition. One hundred and fifty water closets have been reconstructed. In all these cases, the existing foul and defective water closet has been abolished and a wash-down or other suitable type of convenience fixed with efficient flushing apparatus, soil pipe and 45 ventilating shaft of full bore. Careful supervision is exercised by the Inspector over this work. In all cases a lift-up seat is recommended, thus doing away with the objectionable "riser" (front boarding.) In the case of cottage property the floor is made of concrete with a good fall from the back to the front of the structure so that it can be readily cleansed. Where the pan or trap of a water closet was found broken it has been put under the heading of water closets defective. This occurred in 30 instances. In most of the cases of the flushing apparatus being defective, the existing cistern was abolished and a suitable one fixed. One hundred and fifty-six houses were found to have defective dust bins; proper and suitable bins were provided in each case. The walls and ceilings of 579 rooms were found to be in a dirty condition, and these were cleansed and limewashed. Under the headings, "Walls and ceilings to be cleansed after infectious disease," and "Floors and furniture of infected rooms to be cleansed after infectious disease or in a dirty condition," 83 rooms were cleansed and 83 floors and furniture cleaned. Included under the latter heading are a number of floors of houses which were found in a dirty condition. Considerable trouble has been caused by occupiers of stables delaying to get the manure pits emptied. Farmers do not appear to trouble to go out of their way to do this, and consequently the Sanitary Inspector has had to serve 50 notices to have such accumulations removed. Private Slaughter Houses. Meat. There are eight slaughter houses in the Borough They have been regularly inspected. Inspections of Meat have been made by the Veterinary Surgeon and Sanitary Inspector. Special attention is given to this work, and all premises where the food of man is exposed for sale are visited from time to time. The Sanitary Inspector devotes several hours per week to this work, and it is 46 gratifying to know that he has not found it necessary to make any seizures during the year. On several occasions tradesmen have sought advice of the Medical Officer or Sanitary Inspector as to the suitability of articles of food about which there was a doubt, and where it was considered that the articles were unfit for food they were at once detroyed. 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 41 houses, and in 21 instances demonstrated that the drains were defective. Dairies, Cowsheds, and Milk Shops. There are seven cowsheds and 22 dairies in the Borough, all of which have been regularly inspected. The following defects were discovered and remedied: Two floors of milk shops found defective, and in two instances the flushing apparatus to w.c.'s in connection with milk shops were found defective. In connection with cowsheds the walls and ceiling were found in a dirty condition in one instance, and an objectionable accumulation of manure was found in another instance. Regulations under Section 13 of the Dairies, Cowsheds, and Milkshops Order were adopted April 7th, 1903, after being submitted to the Local Government Board. Canal Boats. During the year 4 boats were inspected; these complied with the Acts in every respect. SUMMARY OF THE SANITARY INSPECTOR'S REPORT FOR THE YEAR 1905. Number of Visits made 3900 „ Complaints received and attended to 132 „ Statutory Notices served 3 „ Preliminary and Verbal Notices served 786 47 SUMMARY OF INSPECTIONS MADE. Inspection of Nuisances in course of abatement 1673 Houses Inspected 1162 Visits to Cases of Infectious Disease 434 Inspections of Slaughter Houses 6 „ Milk Shops 22 „ Cowsheds 6 „ Bakehouses 54 „ Workshops 24 „ Piggeries 6 „ Miscellaneous, Services of Notices, Interviewing Owners of Property, Builders, &c. 513 3900 48 SUMMARY OF NUISANCES INVESTIGATED BY THE SANITARY INSPECTOR DURING THE YEAR 1905. Number done. Number not done. Total. Drains to be reconstructed 70 0 70 Drains amended 123 0 123 Drains cleared 60 0 60 Water Closets to be reconstructed 150 0 150 Water Closets defective 30 0 30 Water Closets, flushing apparatus defective 58 0 58 Water Closets, want of light & ventilation 61 0 61 Water Closets, soil pipes defective 32 0 32 Premises without proper and suitably covered dust bins 156 4 160 Sink Waste Pipes in a defective condition 82 0 82 Premises without a proper and sufficient supply of water for drinking and domestic purposes 0 0 0 Drinking Water Cisterns in a defective condition 28 1 29 Drinking Water Cisterns without a proper cover 94 1 95 Drinking Water Cisterns in a dirty condition 24 0 24 Eave Gutters and Rain Water Pipes defective 165 0 165 Roofs defective 17 1 18 Yards without proper Paving and Drainage 157 2 159 Animals kept so as to be a nuisance 20 0 20 Houses so overcrowded as to be dangerous or injurious to the health of the inmates 2 0 2 Workrooms without proper light and ventilation 0 0 0 Walls and Ceilings in a dirty condition 579 11 590 Walls and Ceilings to be cleansed after Infectious Disease 83 0 83 Floors and Furniture of infected rooms to be cleansed after Infectious Disease 83 0 83 Foul accumulation to be removed 50 1 51 Miscellaneous 17 1 18 Totals 2141 22 2163 49 FACTORY AND WORKSHOP ACT, 1901. Bakehouses. These have been periodically visited by the Medical Officer, and generally found in a satisfactory condition. The following is a summary of the work done during the year under this Act:— Factories, Workshops, Laundries, Workplaces and Homework. 1—INSPECTIONS. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions Factories (including Factory Laundries) 7 l — Workshops (including Workshop Laundries) 79 16 — Workplaces 4 — — Homeworkers' Premises 8 — — Total 98 17 — 2—DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H. M. Inspector. Number of Prosecutions. Nuisances under the Public Health Acts:— Want of cleanliness 12 12 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 6 6 — — Other nuisances 20 20 — — Sanitary accommodations— Insufficient — — — — Unsuitable or defective 5 5 — — Not separate for sexes — — — — 44 44 — — 50 3— OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 3 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5). (Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspectors 9 Underground Bakehouses (S. 101):— In use during 1904 — Certificate granted in 1905 — In use at the end of 1905 3 Homework:— Number of Lists. Workers. Lists of Outworkers (S. 107):— Lists received 6 9 Addresses of Workers forwarded to other Authorities 0 received from other Authorities 4 Wearing Apparel. Other. Homework in unwholesome or infected premises:— Notices prohibiting homework in unwholesome premises (S. 108) — — Cases of infectious disease notified in home- workers' premises — — Orders prohibiting homework in infected premises (S. 110) — — Workshops on the Register (S. 131) at the end of 1905— Workshop Bakehouses 28 Dressmakers and Milliners 46 Laundries 28 Other Trades 49 Total number of workshops on Register 151 51 RAINFALL, 1905. MONTH. Number of days on which rain fell in Richmond. Total fall in inchcs. 1904 1905 Richmond 1905 London Mean for 1866-1900. January 22 6 .95 2.01 February 18 13 .72 1.69 March 17 22 3.03 1.49 April 11 18 1.58 1.65 May 18 8 .69 1.69 June 7 16 4.82 1.93 July 9 5 .86 2.27 August 9 16 2.74 2.30 September 11 16 1.65 2.21 October 12 11 1.23 2.70 November 8 17 3.15 2.29 December 13 8 .65 2.15 Total 155 156 22.07 24.38 The rainfall for the year in Richmond was 22.07 inches as compared with 20.79 inches for 1904, 36.13 inches for 1903, 21.2 inches for 1902, and 17.54 inches for 1901. March, June, August, and November were the wettest months. (Signed) J. H. CROCKER, M.D., &c., Medical Officer of Health. Town Hall, Richmond, Surrey. April, 1906.