RICH 047 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER of HEALTH FOR THE YEAR 1906, by J. H. CROCKER, M.D., b.ch., d.p.h., m.r.c.s., etc,, Medical Officer of Healthy Borough of Richmond, Medical Officer to the Education Committee, Richmond, and Visiting Physician, Mogden Isolation Hospital. Richmond: J H. BROAD &Co., Printers, 8, King Street; and at Chiswick, Town Hall, Richmond, Surrey, February 1st, 1907. To the Chairman and Members of the Health Committee. Gentlemen, I beg to present a Report upon the Health and Sanitary Condition of the Borough for the year 1906, in compliance with the instructions of the Local Government Board. Believe me, Gentlemen, Yours obediently, J. H. CROCKER, Medical Officer of Health. 3 HEALTH COMMITTEE, 1906. His Worship the Mayor. NORTH WARD, Councillor Shrimpton. „ A. J. Ward. SOUTH WARD. Alderman Gascoyne. Councillor Alabaster „ DaviSi ,, Heasler. „ Wadd, m.b., (Chairman) EAST WARD. Councillor Cook. „ Pi errepont. ,, Trower. WEST WARD. Councillor Billett. „ McDocgall. KEW WARD. Alderman Beauchamp. Councillor Payne. Meetings every Second Friday at 6 o'clock p.m. JOINT HOSPITAL COMMITTEE, 1906. 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. CONTENTS. page Statistical Summary 8 SECTION I. Vital Statistics— Population 10 Marriages 12 Births 13 Deaths 13 Zymotic death rate 14 Mortality in Age Groups 15 Infantile Mortality 15 Tuberculosis 15 Respiratory Diseases 15 Deaths in Public Institutions 15 Inquests 15 Tables I., II., IV., and V. of the L.G.B. 16-19 SECTION II. Infectious Disease 21 Records of Infectious Disease 22 Notification of Infectious Disease 22 Table III. of the L.G.B 23 Notifications from 1896 to 1906 24 5 page Prevalence and Distribution of Infectious Disease 25 Small-Pox 25 Diphtheria 25 Erysipelas 25 Scarlet Fever 25 Enteric Fever 25 Measles 26 Whooping Cough 27 Chicken Pox 27 Mumps 27 Diarrhœa 27 Tuberculosis 27 Measures taken to Prevent the spread of Infectious Disease 28 Disinfection 31 Infectious Disease Hospitals 31 Annual Report of Mogden Hospital 32 Classified list of Admissions to Mogden Hospital 36 Extension of Mogden Hospital 37 Percentage of cases removed during 1906 44 Bacterioscopic examination in cases of Diphtheria and Enteric Fever 44 Annual Report of Medical Officer to the Education Committee 46 SECTION III. Sanitary Matters 51 Special Sanitary Matters 52 Water Supply 52 Condemned Wells 52 New Water Mains 53 Red Lion Street Area 53 Housing of the Working Classes Act 57 Houses unfit for Human Habitation 58 Customs and Inland Revenue Act, 1890 58 6 Sanitary Matters—Continued Page Physical Deterioration and Alcoholism 58 Water Closets without proper and sufficient flushing apparatus 60 Sanitary Conveniences 60 Open Space, North Sheen 60 Sewer Ventilation 60 Removal and Disposal of House Refuse 60 Mortuary 60 Sale of Food and Drugs Act 61 Public Baths 62 Ordinary Sanitary Work of the Health Department. Staff 63 Systematic Inspections 63 Abatement of Nuisances under the P.H. Acts 63 Private Slaughter Houses 64 Meat 64 Drainage Examinations 65 Dairies, Cowsheds and Milkshops 65 Canal Boats 65 Sanitary Inspector's Summary 65 Factory and Workshops Act, 1901 Bakehouses 68 Summary of Work done under the Act 68 SECTION IV. Annual Rainfall 70 Statistical Summary. 8 STATISTICAL SUMMARY. Borough of Richmond, 1906. Population, estimated to the middle of the year 34,358 Births. Males, 324; Females, 312 636 Annual Rate of Births per 1,000 of Population 18 5 Deaths 377 Annual Rath op Deaths per 1,000 of Population 110 Zymotic Death Rate 0.8 Excess of Registered Births over Deaths 259 Infantile Mortality per 1,000 Births 83 Area. The Total Area of the Borough is 2534 acres Density. The Mean Density of the Borough is equal to 13.5 persons per acre. 1906. Annual Birth-rates, Death-rates, and Rates from the Seven Chief Epidemic Diseases. Annual Kates per 1,000 Living. Infantile Mortality Annual Deathrate of Infants under 1 Year per 1,000 Births. Births. Deaths from all Causes. Deaths from Seven Chief Epidemic Diseases. England and Wales 270 15.4 1.73 133 Rural England & Wales 26.3 15.0 1.18 115 76 great towns 27.9 16.0 2.24 146 142 smaller towns (including Richmond) 26.5 14.4 1.70 138 RICHMOND 185 11.0 0.8 83 SECTION I. Vital Statistics. 10 SECTION I VITAL STATISTICS. Population. The population of the Borough at the middle of the year 1906 was estimated by the Registrar General as 34,358. The increase during the decade 1891-1901 was from 26,875 to 31,677, a total of 4,802. The method of estimating the population is to assume that the population has gone on increasing since 1901 at the same ratio as during the preceding decade. Obviously this is open to several errors. The estimated population of the Borough as given by the Registrar General, is probably somewhat in excess of what actually exists. The Borough Accountant has kindly supplied the following particulars, taken from the Rate Books:— Number of houses at census, 1901 (including 54 building) 6514 Erected since, to 30th June, 1906 561 7075 Empty houses, June, 1906 429 Number of inhabited houses, June, 1906 6646 At the last Census there was an average of 5.1 persons per house, and assuming the same average per house in 1906, the above shows a population of 33,894 or 464 less than that given by the Registrar General. 11 As, however, the above figures affect the results to a slight extent only, those given in this Report are based on the population as estimated by the Registrar General, viz., 34,358. The new houses erected during the year 1906 were chiefly in the North Ward. NEW HOUSES, 1906. NorthWard 127 South „ 6 East ,, 9 West „ 6 Kew ,, 12 Total 160 The number of new houses erected during the year 1906 was much above the average for preceding years. The Borough Surveyor has kindly furnished the following particulars of new houses erected since the year 1901:— New houses erected 1902 78 1903 115 1904 84 1905 153 1906 160 Total for 5 years 590 12 Estimated population of the various Wards Ward. Population. Census. 1901. 1906. Estimated at the Middle of the year Estimated at the middle of the year North 9073 9139 10,329 South 6038 6044 6185 East 9140 9176 9909 West 4727 4727 4775 Kew 2699 2714 3160 Total 31,677 31,800 34,358 Marriages. In the course of the year 273 marriages took place within the Borough as compared with 295 for 1905. By the Established Cnurch 171 At other places of Public Worship 20 At the Offices of the Registrar 82 Total 273 This gives a marriage rate of 15.9 per 1,000 inhabitants in the Borough during the year 1906 as compared with 17.4 for 1905 and 15.7 for the year 1904. 13 Births. The number of births registered during the year 1906 was 636 as compared with 668, the average for the preceding ten years. Of these 324 were males and 312 were females. The birth-rate for the year was 18.5 per 1,000 of the population. The average for the Borough during the preceding ten years was 21T. There were 25 illegitimate births during 1906, 12 of these occurring in the Union Workhouse, 7 in the North Ward, 4 in the East, and 2 in the West Ward. The birth rate varied in the different Wards, being 25.1 in the North, 8.9 in the South, 22 3 in the East, 11.5 in the West, and 14.2 in the Kew Ward. The birth rate for England and Wales during 1906 was 27 0, being lower than the rate in any year on record; for the 76 great towns on the Registrar General's list it was 27 9, and for the 142 smaller towns it was 26 5 per 1,000 of the population. Deaths. The total number of deaths registered in the Borough during 1906 was 409; of these 113 died in the Union Workhouse and Royal Hospital, 47 of whom belonged to outside districts. Three patients from Richmond died at Mogden Isolation Hospital, and 12 at Brookwood Asylum. Correcting for the above, results in a total of 377 deaths for the Borough, which gives an annual rate of 11 per 1,000 of the population living. The mean annual death rate of the Borough for the preceding ten years was 13.5. The death rate for England and Wales in 1906 was 15.4, the 76 great towns 16.0, and Rural England and Wales 15 0. 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 10 4, South Ward 14 3 or without the Workhouse deaths 7-9, East Ward 11-3, West Ward 7 5, and Kew Ward 10 1 per 1,000 of the population, 14 The death rate in 1906 for England and Wales was 0'2 per 1000 above the rate for 1905, which was lower than the rate in any other year on record. Births and Deaths during 1906 in the various Wards. Wards. Total Births. Birth Rate per 1000 living Total Deaths. Death Rate per 1000 living. North 260 25.1 108 10.4 South 55 8.9 89 7.9† East 221 22.3 112 11.3 West 55 11.5 36 7.5 Kew 45 14.2 32 10.1 Total for Borough 636 18.5 377 11.0 t After deducting 40 in the Union Workhouse. Chief Epidermic Diseases, Death Rate. I he number of deaths due to the "seven principal Zymotic Diseases" usually classified under this heading was 30. This gives a zymotic death rate of 0.8 per 1000 persons living, as compared with 1.3 for 1905. The zymotic death rate of England and Wales for 1906 was 1.73, that for the 76 great towns 2.24, and Rural England and Wales 118. Scarlet Fever.—2 deaths. Measles.—2 deaths, one at 5 years of age and one below 5. Diphtheria and Croup.—3 deaths. Whooping Cough. —5 deaths, all below 5 years of age. Enteric Fever.— 1 death. Diarrhcea.—17 deaths, 14 of these being below 1 year of age. *Small pox. measles, scarlet fever, diphtheria, whooping cough, fever, (typhus, enteric, and continued), an i diarrhœa 15 Mortality in age Croups. As will be seen by the Table of Causes of Death, at the end of this Section, there were 127 deaths above 65 years of age, anil 53 below one year of age. Infantile Mortality. The total number of deaths under one year was 53; this is at the rate of 83 per 1,000 births. The average for the preceding 10 years was 128. Tuberculosis. The total number of deaths attributed to this disease was 45, being 11.9 per cent, of the total deaths as compared with 8 per cent, for 1905, and 15 per cent, for 1904. This is a rate of 1.3 per 1,000 of the population, as compared with 1 for 1905, 1.8 for 1904 and 1.6 for 1903. Respiratory Diseases, Respiratory 46 deaths were registered as due to diseases of the Diseases, chest other than phthisis. This gives a mortality of 1.3 per 1,000 of the population as against 1 9 for 1905, 1.6 for 1904 and 1.5 for 1903. Deaths in Public Institutions. Parishioners, Non-Parishioners. Total In the Richmond Hospital 26 25 51 „ Union Workhouse 40 22 62 „ Brookwood Asylum 12 — 12 ,, Mogdsn Hospital 3 — 3 Inquests. There were 52 inquests held in the Borough during the year. I. 11. III. Institutions within the District receiving sick & infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District Other Institutions, the deaths in which have been distributed among the several localities in the District. Union Workhouse Mogden Isolation Hospital, Middlesex. Royal Hospital. Dockwell Small-pox Hospital, Middlesex. Brookwood Asylum. The Union Workhouse is situated in the South Ward of Borough 16 VITAL STATISTICS OF WHOLE DISTRICT DURING 1906 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. N'ett 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 1896 29400 665 22'6 98 147 414 14.0 72 40 10 384 13 2 1897 29880 704 235 98 139 432 14.4 11 63 6 369 12 3 1S98 30360 663 21 8 113 170 493 1.2 107 56 5 443 14 5 1899 30840 691 224 107 154 541 17.5 110 48 8 501 162 1900 31320 617 197 84 144 518 16.5 117 53 10 475 15 ° 1901 31800 707 222 78 100 459 14.4 93 40 8 427 13 4 1902 32300 641 198 59 92 458 14.1 114 53 21 426 13 2 1903 32808 683 20'8 76 in 46o 14.0 106 45 13 428 13 0 T9°4 33320 621 18 6 83 133 443 13.3 104 53 10 400 120 1905 33837 696 205 61 99 487 14.4 140 60 12 439 12-9 Averages for years 1896-1905. 31586 668 211 86 128 470 14.8 107 51 10 429 135 1906 34358 636 18 5 53 83 409 11.2 113 47 15 377 no *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water) 2534. Total of population at all ages 31677 Number of inhabited houses 6184 Average number of persons per house 51 At Census of 1901. 17 VITAL STATISTICS OF SEPARATE LOCALITIES IN 1906 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 1 Jirths i egistered 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 legistered Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each j ear. Births registered. Deaths at all Ages. Deaths undsr 1 \ear Population estimated to middle of each year. Births registered Deaths at all Ages. Deaths under I 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 32,30c 641 426 59 9403 211 [19 19 6068 66 98 5 9320 232 J07 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 Average of Years to 1905 32564 66l 432 75 9562 238 118 28 6097 69 ico 6 9533 23s 114 25 4755 76 59 9 2866 47 40 6 1906 34358 636 177 53 10329 260 108 27 6185 55 89 1 9909 221 112 18 4775 55 36 2 3160 45 32 5 18 CAUSES OF, AND AGES AT, DEATH DURING YEAR 1906. Borough of Richmond (Surrey). Causes of Death. Deaths in ok 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 2 .. 1 1 .. .. .. 2 .. .. .. .. .. Scarlet Fever 2 .. .. 1 .. 1 .. 1 .. 1 .. .. .. Whooping-cough 5 1 4 .. .. .. .. 1 .. 1 .. 3 .. Diphtheria and membranous croup 3 .. .. 2 .. .. .. 2 .. 1 .. .. .. Enteric Fever 1 .. .. .. .. 1 .. 1 .. .. .. .. 1 Epidemic influenza 5 .. .. .. .. 3 .. 2 1 2 .. .. .. Diarrhoea.. 17 14 1 1 .. .. 1 8 1 7 .. 1 2 Enteritis .. .. .. 1 .. .. .. 1 .. .. .. .. 1 Puerperal Fever 1 .. .. .. .. 1 .. .. .. 1 .. .. .. Erysipelas 2 .. .. .. .. 1 1 .. .. 1 .. 1 .. Other septic diseases 4 .. .. .. .. 1 2 1 .. 1 .. 2 1 Phthisis (Pulmonary Tuberculosis) 34 .. .. 1 5 26 2 11 12 10 1 .. 11 Other tubercular diseases 11 .. .. 1 1 5 .. 4 1 3 1 2 7 Cancer, malignant disease 28 .. .. .. .. 16 12 2 8 9 7 2 3 Bronchitis 19 1 .. .. .. 7 11 1 4 11 3 .. 3 Pneumonia 26 .. .. 1 1 10 4 7 2 8 7 2 2 Other diseases of Respiratory Organs 1 .. .. .. .. .. 1 .. .. 1 .. .. 1 Alcoholism, Cirrhosis of liver 12 .. .. .. .. 11 1 3 3 1 3 2 1 Venereal Diseases 2 .. .. .. .. .. .. 1 .. 1 .. .. .. Premature birth 10 10 .. .. .. .. .. 4 .. 5 .. 1 .. Diseases and accidents of parturition 1 1 .. .. .. .. .. .. .. 1 .. .. .. Heart diseases 52 1 .. .. 2 22 26 18 15 10 4 5 17 Accidents 12 2 .. 2 2 2 4 4 3 4 .. 1 4 Suicides 5 .. .. .. 1 4 .. 2 .. 1 .. 2 4 All other causes 121 11 4 3 6 37 60 32 39 32 10 8 55 All causes 377 53 16 M 19 148 127 108 89 112 36 32 113 19 INFANTILE MORTALITY DURING THE YEAR 1906. 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 6 5 3 2 16 4 6 5 5 3 4 2 4 2 2 53 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Diarrhœal Diseases. Diarrhœa, all forms .. .. .. .. .. .. 1 3 1 .. .. .. 3 1 .. 1 10 Enteritis, Muco-enteritis Gastro-enteritis .. .. .. .. .. .. 2 1 .. .. .. 1 .. .. .. .. 4 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases. Premature Birth 4 2 1 1 8 2 .. .. .. .. .. .. .. .. .. .. 10 Congenital Defects .. 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 2 Injury at Birth .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus .. .. 1 .. 1 1 1 1 1 .. 1 .. .. .. .. .. 6 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. 1 4 Tuberculous Peritonitis Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. 1 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 Convulsions .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 2 Bronchitis .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Pneumonia .. 1 .. .. 1 1 .. .. .. 2 .. .. .. 1 .. .. 5 Suffocation, overlying .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Other Causes 2 .. .. .. 2 .. 1 .. .. .. 1 .. .. .. .. .. 4 6 5 3 2 16 4 6 5 5 3 4 2 4 2 .. 2 53 District (or sub-division) of Richmond, (Surrey). Population Births in the year legitimate 611 illegitimate, 25 Estimated to middle of 1906. 34,358. Deaths in the year f legitimate infants 45 [ illegitimate infants 8 Deaths from all Causes at all Ages 377 SECTION II. Infections Disease. 22 SECTION II RECORDS OF INFECTIOUS DISEASE AND PRECAUTIONARY MEASURES ADOPTED. Notification of Infectious Disease under the Notification Act of 1889. The total number of cases notified under the above Act for the year 1906 was 94. The number notified during the previous year was 96; for the year 1904 the number was 118 and for 1903 it was 195. Table of Monthly Notifications. Month. Totals Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Puerperal Fever. January 6 ... 1 4 1 ... February 7 ... ... 5 2 ... March 9 2 3 3 ... 1 April 12 5 1 6 ... ... May 9 ... 1 7 1 ... June 6 ... 1 5 ... ... July 12 1 ... 10 1 ... August 8 ... ... 5 1 ... September 4 1 ... 3 ... ... October 12 3 ... 7 2 ... November 5 3 ... 2 ... ... December 4 1 1 2 ... ... Total 94 16 10 59 8 l 23 Table III L.G.B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1906. 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. I to 5 5 to 5 15 t0 25 25 to 65 65 and upwards. Diphtheria 16 .. 3 9 3 1 .. 8 .. 5 .. 3 5 .. 1 .. 1 Erysipelas 10 1 .. .. 2 5 2 3 1 3 .. 3 .. .. 1 .. .. Scarlet fever 59 .. 18 30 5 6 .. 22 6 20 .. 6 18 4 17 5 4 Enteric fever 8 .. 1 1 2 4 .. 2 1 1 2 2 .. .. 1 1 1 Puerperal fever 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. Totals 94 1 22 40 12 17 2 35 8 3 7 14 23 4 20 6 Small-pox Hospital—Dockwell, Middlesex isolation Hospital—-Mogden, Middlesex Joint Hospital Committee The Workhouse is situated in the South Ward, 24 NOTIFICATIONS OF INFECTIOUS DISEASES FROM 1895 to 1906. Disease. 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 Annual Average 1896-1905 1906 Small-pox .. .. .. .. .. 2 11 1 .. .. 1.4 .. Scarlet fever 92 112 93 148 78 52 92 119 68 46 90 59 Diphtheria & membraneous croup 15 15 25 31 25 41 39 43 21 11 266 16 Enteric fever 6 15 8 10 21 12 17 13 7 13 12.2 8 Continued fever .. 6 8 6 4 4 .. 1 .. .. 2.9 .. Erysipelas 21 18 21 41 24 20 16 18 20 23 22.2 10 Puerperal fever .. .. .. .. 2 .. 2 .. 2 2 0.8 1 Typhus Fever •• •• .. •• .. .. .. .. .. 1 0.1 .. Totals 134 166 155 236 154 131 177 195 118 96 156.2 94 25 PREVALENCE AND DISTRIBUTION OF INFECTIOUS DISEASE. Small-pox. No cases of this disease were notified during the year. Diphtheria. During the year there were 16 cases of this disease notified as compared with 11 for the previous year. Three deaths occurred. Seven cases were removed to Mogden Hospital, being 43 7 pei- cent, of the notified cases. Erysipelas. Ten cases of this disease were notified during the year, as compared with 23 for the previous year. One death was registered as due to this disease. Scarlet Fever. Fifty-nine cases of this disease were notified during the year, as compared with 46 for the previous year. Ten of these cases occurred during the month of July. Two deaths occurred from this disease. Forty-eight cases were removed to Mogden Hospital, being 81 per cent, of the cases notified. Enteric Fever. Eight cases only of this disease were notified during the year, and in one instance the medical practitioner intimated later that the disease was not enteric fever. Thirteen cases were notified in 1905 and 7 in 1904. One death was reported as due to this disease. 26 PARTICULARS OF ENTERIC FEVER CASES, 1906. Initials. Age. Notification. Water Supply to House. Possible Origin of Disease and Remarks. E. M. 3 years Jan 10 Southwark and Vauxhall Ate some winkles previous to illness. H. S. 42 „ Jan 20 Richmond Recently come to the district. Staying at an Hotel. L. S. 43 „ Feb 19 Southwark and Vauxhall Drains at house found in bad condition. G.W.W. 5 „ July 3 Richmond Last solid food before illness, some fish. Cases of gastritis from persons who had partaken of fish from the same shop at the same time. W. H M. 54 „ May 23 Southwark and Vauxhall Away all day at business in London previous to illness. J. S. 50 „ Aug 18 Richmond Origin unknown. F W.B. 19 „ Oct 16 Richmond After notification Doctor concluded it was not Enteric fever. P. W. 16 „ Oct 26 Southwark and Vauxhall Origin unknown. Measles. Thirty cases of this disease were notified by the school teachers, and five from other sources, as compared with 81 for the previous year, and 225 for 1904. Altogether there were 67 children kept from school on account of this disease. 27 Two deaths were registered as due to the disease. Whooping Cough. Five cases of this disease were notified by the school teachers as compared with 36 for the previous year. Seven children were kept from school on account of this disease. There were five deaths registered as due to this disease ; all of these occurred below five years of age. Chicken Pox. Two cases of this disease were notified by school teachers and one by the Libr arian. Enquiries as to vaccination and isolation were made in every instance. Two children were kept from school on account of this ailment. Mumps. Two cases of this affection were notified. Diarrhœa. Seventeen deaths were registered as due to diarrhœa, chiefly during the hot weather. Fourteen of the deaths were below one year of age. The number of deaths from this complaint in 1905 was ten. Tuberculosis. During the year there were 34 deaths registered in the Borough as due to Phthisis, and 11 to other tubercular diseases, a total of 45 deaths due to tuberculosis. The number of deaths registered as due to this disease in 1905 was 36, and in 1904 the number was 61. Of the total number of deaths in the Borough for 1906 this disease claimed 12 per cent., as compared with 7 per cent., for 1905 and 15 per cent., for 1904. Of the 45 deaths, 31 occured between the ages of 25 and 65 years. During the year there have been 14 cases of tuberculosis 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 28 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 DISEASE. Upon the receipt of a Notification of an Infectious Case, as soon as possible, the Medical Officer of Health or Sanitary Inspector visits the house and makes enquiries as to the possible source of the disease. If considered advisable by the Medical Officer of Health and if the friends consent, the case is removed to the Isolation Hospital at Mogden, the ambulance being ordered by telephone. Small-pox cases are removed to Dockwell. 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 and during the illness periodic visits are made by the Sanitary Inspector to see that the instructions are being carried out. An addressed post card is left at the house for the medical practitioner to sign and forward at the termination of the illness, when he considers the house is ready for disinfection. When a medical practitioner at the time of notifying a case gives satisfactory reasons to the Medical Officer cf Health as to the advisibility of removal of the patient to the Isolation Hospital this is acted upon immediately, previous to making the usual investigations. Particulars of the patient and other occupants of the house, milk supply, &c. are entered on special printed forms and filed at the Health Office. The following is a specimen of the particulars 29 enquired into concerning a case of Diphtheria. The questions are slightly modified for the particulars of other diseases.— BOROUGH OF RICHMOND (SURREY). DIPHTHERIA. Ward. Name of Patient Age Address Medical Attendant First called in Notified at o'clock on the 190 Condition of Premises. House. -New Old ( years) Good Repair Clean Dry Living Rooms Bedrooms Cellars. Yard In good order Water Closet Ventilated and lighted Adjoining external wall Soil pipe Outside house Inside Accessible Ventilated by pipe Privy Ashpit Good sole use Cleared Sinkstone Lavatory Bath Waste pipes trapped Disconnected Drains Water Sppply Nuisances near the House Piggeries Stables Cowsheds Ditches Stagnant Water Manure, &c Other Nuisances. Milk Supply Butcher Grocer Baker Business carried on in the house 30 Patient Isolated in Bedroom In Living Room No Isolation Separate Attendant Other duties of Attendant Previous health of Patient—Good Fair Bad Previous illnesses of Patient How long resident in house Recent visits to other Houses Suspected source of infection Previous Cases of Diphtheria in the same house in vicinity Nature of other recent cases of illness in the House Special Points to be noted Date of Inspection Age M. F. Occupation. Place of Work, or School. *Diphtheria History. Date of Onset. Last at Work or School. *A.—Have had Diphtheria B.—Have not had Diphtheria. C.—Now ill. 31 Precautions Adopted:— Patient removed to Hospital at o'clock 190 Schoolmaster written on the the of 190 County School written on the of 190 Milk Seller written on the of 190 Librarian, Free Library written on the of 190 Bedding requiring removal Date and rooms disinfected Date of Stripping walls Date of Removal of Bedding Date of Recovery Termination of Case Date of Death Date Inspector 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, under certain circumstances, free of cost from the Health Department. 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 Isleworth and have been fully described in previous reports. 32 MOGDEN ISOLATION HOSPITAL. Report of the Resident Medical Officer at the Mogden Isolation Hospital for the year ending the 31st day of December, 1906. RETURN of the number of Patients in the Hospital on the last day of the preceding year. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. (Specify). Remarks. Borough of Richmond 8 - — 1 9 Richmond Union — — — - — Heston and Isleworth Urban District 27 11 l - 39 Isleworth Union 6 3 - - 9 Hounslow Garrison — 1 — — 1 Hospital Staff — — - - — Totals 41 15 l 1 58 ADMITTED during the Year. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. (Specify). Remarks. Borough of Richmond 50 7 2 3 62 Richmond Union — — — — — Heston and Isleworth Urban District 55 49 3 - 107 Isleworth Union — 5 — — 5 Hounslow Garrison 4 3 - — 7 Hospital Staff — — — 1 1 Twickenham — 1 — — 1 Totals 139 65 5 4 183 33 DISCHARGED during the Year. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. (Specify). Remarks. Borough of Richmond 52 6 2 3 63 Richmond Union — — — — — Heston and Isleworth Urban District 72 49 3 - 124 Isleworth Union 6 7 — — 13 Hounslow Garrison 4 4 — — 8 Hospital Staff — — — 1 1 Twickenham — 1 — — 1 Totals 134 67 5 4 210 DIED during the Year. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. (Specify). Remarks. Borough of Richmond l l — 1 Erysipelas 3 Richmond Union — — - — — Heston and Isleworth Urban District - 3 1 - 4 Isleworth Union — 1 — — 1 Hounslow Garrison — — - - — Hospital Staff — — - - — Totals l 5 1 1 8 REMAINING in Hospital on the last Day of the Year. Scarlet Fever. Diphtheria: Enteric Fever. Other Diseases. (Specify). Remarks. Borough of Richmond 5 — - — 5 Richmond Union — - — — — Heston and Isleworth Urban District 10 8 - - 18 Isleworth Union — — — — — Hounslow Garrison — — - — — Hospital Staff — — — — — Totals 15 8 — — 23 34 GENERAL REMARKS. Total Admissions. The total admissions during 1906 were 183, which is the lowest we have had, with the exception of 1904, when the numbers were 154. Scarlet Fever. One hundred and nine cases of this disease were admitted which is again the lowest with the exception of 1904, when there were only 97. One death occurred giving a case mortality of 0.9 percent. Diphtheria. Sixty-five cases of diphtheria were admitted, of which only 7 came from the Borough of Richmond. There were five deaths, giving a case mortality of 7.7 per cent., being the lowest on record since the opening of the Hospital, with the exception of that for the year 1904, when the case mortality for this disease was at the unusually low figure of 4.2 per cent. It is satisfactory to be able to report that the number of Diphtheria cases, admitted in a hopeless condition, appears to be decreasing every year, and, with this decrease, there is a corresponding decrease in the case mortality in the Hospital records. Enteric Fever. There were five cases of this disease admitted with one death. Erysipelas. There was one case of this disease and one death in a woman of 70. Staff. No member of the Staff was warded with Infectious disease. The only member warded was Clark, the porter, who was laid up for five days with an abscess in the leg. Since the opening of the Hospital, in 1898, ten of the staff have contracted Scarlet Fever and four diphtheria. Four of the Scarlet Fever and three of the Diphtheria cases occurring during the last six years. The cases of members of the Staff contracting an infectious disease have, without exception, occurred when the wards were crowded. MOGDEN ISOLATION HOSPITAL. YEARLY SUMMARY SINCE THE OPENING OF THE HOSPITAL. Year. ADMISSIONS DEATHS. CASE MORTALITY PER CENTUM AVERAGE DURATION IN HOSPITAL OF PATIENTS DISCHARGED AVE RAGE DAILY NUMBER ON THE BOOKS Scarlet Fever. Diphthera. 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. Total. 1898 42 20 7 1 70 1 2 1 .. 4 2.4 10 14.3 .. 5.7 47 28 44 41 13.6 1899 182 42 5 .. 229 4 7 .. .. 11 2.2 16.7 .. .. 4.8 66 40 48 62 37.6 1900 176 56 6 .. 238 2 6 2 .. 10 1.1 10.7 33.3 .. 4.2 66 42 48 62 37.7 1901 136 57 13 4 210 3 6 2 1 12 2.2 10.5 15.3 .25 5.7 67 38 35 52 29.5 1902 183 85 9 2 279 8 16 1 .. 25 4.3 18.8 11.1 .. 8.9 60 32 27 51 36.8 1903 218 48 8 2 276 6 7 2 .. 15 2.7 14.5 25 .. 5.4 59 36 31 55 44.1 1904 97 47 6 4 154 3 2 .. .. 5 3.1 4.2 .. .. 3.2 59 35 39 52 18.8 1905 117 99 3 9 228 1 14 1 1 17 0.8 14.1 33.3 1l.1 7.5 54 33 25 44 20.8 1906 109 65 5 4 183 1 5 1 1 8 0.9 7.7 20 .25 4.3 56 31 41 48 24.5 Totals 1260 519 62 26 1867 29 65 10 3 107 2.1 12.5 16.1 11.6 5.7 60 32 36 53 30.3 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. 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 1906 50 7 2 3 62 .. .. .. .. .. 55 49 3 .. 107 .. 5 .. .. 5 4 3 .. .. 7 .. 1 .. .. 1 109 65 5 4 l83 Total 540 146 26 16 728 7 .. .. 1 8 622 334 35 .. 991 14 15 .. .. 29 68 18 .. .. 86 9 6 1 8 24 1260 519 62 26 1867 *A Patient from Twickenham. 37 Modgen Hospital Extension. Unfortunately the two Authorities concerned in this Hospital cannot agree as to the proportion of expenses to be borne by each Authority for the extension of the buildings and future administration of the extension. At the February meeting of the Richmond Town Council the following report was presented by the Special Committee appointed for the consideration of this matter. The Committee have had before them a letter dated the 13th June, 1905, from the Local Government Board enclosing copy of a letter which the Board had received from the Heston and Isleworth Urban District Council relative to the proposed extension of the Modgen Joint Isolation Hospital, together with a copy of the Board's reply, which reply is as follows:— Local Government Board, Whitehall, S.W. 13th, June, 1905. Sir,—I am directed by the Local Government Board to advert to your letter of the 26th ultimo, enclosing copy of correspondence which have passed between the Urban District Council of Heston and Isleworth and the Town Council of Richmond relative to the proposed extension of the Modgen Joint Isolation Hospital. As regards the question at issue between the two Councils as to the apportionment of the expenses, I am to suggest that that the Councils should consider whether the difficulties could not be removed by the adoption of the arrangement set out in Section 17 of the Isolation Hospitals Act, 1893, according to which the expenses would be divided into "Structural," "Establishment," and "Patients" expenses. The structural expenses, i.e. the cost of the proposed extension, might be divided equally between the two Districts, as the Urban District Council conditionally propose, the establishment 38 expenses might be borne, as in the existing Agreement, in proportion to the assessable value of the two districts, and the patients expenses would be borne, as provided in section 19 of the Act, by the districts from which the patients are respectively sent to the Hospital. I am, Sir, Your obedient servant, (signed) Noel T. Kershaw, Assistant Secretary. The Clerk to the Heston and Isleworth Urban District Council. The Committee have also had before them a letter, dated the 20th September last, from the Clerk to the Heston and Isleworth Urban District Council, adverting to previous correspondence in the matter of the proposed extension of the Hospital and stating that the following Resolution had been passed by the District Council:— "That a copy of the letter of the Local Government Board, dated 13th June last, be forwarded to the Richmond Town Council, and that the Town Council he informed that this Council is prepared to adopt the suggestion contained therein." A copy of the letter from the Board was enclosed and the Town Council were asked to consider the matter. The matter of the proposed Extension having been referred by the Town Council to this Special Committee, the suggestions of the Local Government Board and the above Resolution have been considered. The Committee RECOMMEND the Council to agree to the principle suggested by the Local Government Board and to approve and send the following letter to the Heston and Isleworth Urban District Council:— 39 Town Hall, Richmond (Surrey), February, 1906. Mogden Isolation Hospital. Dear Sir,— Referring to your letter of 20th September last, with Copy of a Resolution passed by your Council with respect to the suggestions of the Local Government Board, contained in their letter of the 13th June last, the matter has now been fully considered by the Town Council, and 1 am directed to say that they are prepared to accept the principle suggested by the Board and to make an Agreement with your District Council based upon the following terms, viz.:— (1) The "Structural Expenses" (as defined by Section 17 of the Isolation Hospitals Act, 1893) of the proposed extension to be equally divided between the two Districts. (2) The 'Establishment Expenses" (as defined by the Act) of the whole Hospital to be borne in proportion to the Assessable Value of the two Districts. (3) The "Patients Expenses" (as defined by the Act) to the whole Hospital to be borne as provided by Section 19 of the Act by the respective Districts from which the Patients are sent to the Hospital. It must be understood that the above terms are to be taken as a whole and are not severable. I am to ask the favour of a reply to this letter as early a possible. Yours faithfully, H. J. Baker, Esq., Clerk, Heston and Isleworth Urban Town Clerk. District Council. The Council passed a Resolution to the effect that the recommendation of the Committee be adhered to. 40 At the May meeting of the Town Council the Special Committee reported as follows:— The Committee have had before them the following letter received from the Clerk to the Heston and Isleworth Urban District Council, which letter was referred by the Town Council to this Committee for consideration and report:— (copy.) Heston and Isleworth Urban District Council, Clerk's Officb, Town Hall, Hounslow, 26th March, 1906. Dear Sir, Mogden Isolation Hospital. I am directed by the Council to advert to your letter of the 14th ulto., and to state that after giving the matter full and careful consideration the Council are unable to accept the terms contained therein. The Council feel that in meeting the Richmond Town Council as they have with regard to "Structural Expenses," and in agreeing to "Patient's Expenses," when the number of scarlet fever patients exceeds 42 being borne by the District from which such patients in excess of 42 are sent, they have done everything which can be reasonably expected of them in endeavouring to arrive at a settlement of this matter, but as a final attempt to bring the very protracted negotiations to an end, they have directed me to inform you that they are prepared to enter into an agreement based upon the following terms:- 1. The "Structural Expenses" (as defined by Section 17 of the Isolation Hospitals Act, 1893) of the proposed extension to be equally divided between the two districts. 41 2. The "Establishment Expenses" (as defined by the Act) of the whole hospital to be borne in proportion to the assessable value of the two districts. 3. The "Patients' Expenses" (as defined by the Act) of all patients other than scarlet fever patients, to be borne in proportion to the assessable value of the two districts. 4. When the number of scarlet fever patients in the hospital does not exceed 30, the "Patients' Expenses" (as defined by the Act) of such patients to be borne in proportion to the assessable value of the two districts. 5. When the number of scarlet fever patients in the hospital exceeds 30, the "Patients' Expenses" (as defined by the Act) of 30 of such patients to be borne in proportion to the assessable value of the two districts, and the "Patients' Expenses" (as defined by the Act) of the remainder to be borne by the district from which the patients last admitted in excess of 30 are sent. It must be understood that the above terms are to be taken as a whole and are not severable. I shall be glad of your reply in due course. Yours faithfully, F. B. Senior, Esq., (Signed) H. J. Baker, Town Clerk, Clerk of the Council. Richmond, Surrey. The matter has been carefully considered, and the Committee direct the attention of the Town Council to the letter of the 13th June, 1904, addressed by the Local Government Board to the Heston and Isleworth Urban District Council (vide page 45 of the Minutes of the Town Council) and to the suggestions made by the Board for the settlement of the question at issue between the two Councils. 42 The Heston and Isleworth Urban District Council now adopt the suggestions of the Local Government Board with regard to the payment of "Structural" and "Establishment" expenses. With regard to "Patients'" Expenses, the Board suggested that they should be borne, as provided by Section 19 of the Isolation Hospitals Act, 1893, by the districts from which the patients are respectively sent to the hospial. The Urban District Council do not agree to this, but propose the variation set out in paragraphs 3, 4, and 5 of their letter. It is estimated that the approximate increased cost to the Borough represented by the terms proposed by the Urban District Council, as compared with the suggestions of the Local Government Board, will be £180 per annum. Having regard to the suggestions of the Local Government Board, which, it should be remembered, were made at the request of the Heston and Isleworth Council, and have been adopted by the Town Council, and to all the circumstances, the Committee are of opinion that the resolution passed by the Town Council on the 13th February, last (vide page 46 of the Minutes,) should be adhered to, and they RECOMMEND the Council to resolve accordingly, and that the Heston and Isleworth Council be so informed. It was Resolved that the Resolution passed by this Council on the 13th February last be adhered to, and that the Heston and Isleworth Urban District Council be informed accordingly. 43 At the July meeting of the Council the following letter was read Heston and Isleworth Urban District Council. Clerk's Office, Council House, Hounslow, June 22nd, 1906. Dear Sir, Mogden Isolation Hospital. proposed extensions. I am directed by the Council to advert to your letter of the 9th May last, and to state that the Council at their meeting held on the 19th instant, passed the following Resolution:— "That the Richmond Town Council be informed that "this Council cannot accept the proposals contained in "their letter of the 14th February last, and that all offers "made by this Council in the matter of the proposed "extension of Modgen Isolation Hospital are now "withdrawn." I am, at the same time, to point out that the Council cannot agree with the statement contained in your letter, that the Richmond Town Council have adopted the suggestions of the Local Government Board, in as much as their suggestions related only to the proposed extensions. Yours faithfully, H. J. Baker, Clerk. F. B. Senior, Esq., Town Clerk, Richmond. Whereupon it was Resolved that in regard to the proposed extensions of the Modgen Isolation Hospital, any further consideration of the subject be postponed sine die. 44 Percentage of Infectious Cases removed to Hospital. Of the 83 cases of Diphtheria, Scarlet Fever, and Enteric Fever, which were notified in the Borough, there were 58 removed to the Hospital, which is at the rate of 70 per cent., as compared with 74.2 per cent. for the previous year and 64.5 per cent., in 1904. 1906. 1905. 1904. 1903. 1902. 1901. Per Per Per Per Per Per cent. cent. cent. cent cent cent. Small-pox — — — 100 90 100 Diphtheria and Croup 43.7 72.8 66 64 63 66.6 Scarlet Fever 81 84.7 67.6 84.8 84.7 84.6 Enteric Fever 37.5 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. 45 The following are particulars of the specimens forwarded for bacteriological investigations. DATE OF REPORT. DISEASE SUSPECTED. RESULT. NOTIFICATION BY DOCTOR. January 24th Enteric Fever Positive Notified as suffering from the Disease March 22nd Diphtheria „ Ditto April 4th „ Negative „ 7th „ „ May 5th „ „ July 4th Enteric Fever „ 13th „ Slightly Positive October 3rd Diphtheria Negative November 2nd „ „ „ 3rd „ „ December 1st „ „ Notified as suffering from the Disease „ 21st „ Positive Ditto The case under date December 1st, although notified, in the ultimate opinion of the medical practitioner, was not Diphtheria. 46 MEDICAL OFFICER'S ANNUAL REPORT TO THE EDUCATION COMMITTEE. Town Hall, Richmond, Surrey, 7th January, 1907. To the Chairman and Members of the Richmond Education Committee. Ladies and Gentlemen, I have the honour to present to you a Report of the duties performed by me during the year 1906, as your Medical Officer. Elementary Schools. Periodic visits, and also special visits at the request of the Teachers, have been made to the 11 Elementary Schools (25 Departments) and children inspected and advice given. Speaking generally, the health of the Scholars throughout the year has been good. In most of the Schools the children look well cared for and there is a distinct improvement in cleanliness of the bodies and clothing of the children. The following is a list of some of the cases dealt with by your Medical Officer in connection with Scholars at the Elementary Schools. No. of Nature of Measures taken Scholars. Ailment. and Result. 17. Suspected Ringworm. Twelve excluded from School, and written suggestions sent to parents as to procuring medical advice. After treatment, re-admitted to School when considered free by Medical Officer. 2. Scabies. Excluded from School, written advice to parents as to nature of affection and advised to procure medical treatment. Re-admitted after treatment. 2. Suspected Measles. Excluded from School for a fortnight. 3. Suspected Whooping Cough. Children excluded from School. Parents visited and cautioned. Kept under observation. After ten days undoubted signs of the 47 disease. Children excluded from School until free from infection. No other cases arose. 1. Febricula. Excluded from School for a week. 2. Weak heart. Advised school drill to be modified. 3. General debility. Par ents advised through teachers that children wanted careful feeding, 2. Poriigo. Written advice to parents that the heads required attention and advising procuring medical advice. 4. Otorrhœa. Written advice to parents that medical ment should be procured. 1. Phlyctenular Ulcer. Advised parents to take the child to the Ophthalmic Department of Royal Hospital. 1. Ophthalmia. Ditto. 22. Defective sight. Parents advised to consult Ophthalmic surgeon. 1. Eczema. Written advice to parents to obtain medical treatment. 1. Chronic Chorea. Teacher advised to be lenient in tional requirements. 5. Vermin in hair. Children excluded for a time, parents written to calling attention to the condition and advising immediate attention. Attended to in every instance and children re-admitted when clean. 2. Vermin on body. Children excluded and parents written to, calling attention to the dirty condition of clothing. Corrected in one instance, but in the other the child was sent to school again in the same filthy condition, with a note to the Teacher stating that if the child were sent home again they should remove her to another School. Called at the house with the Sanitary Inspector and found it dirty, gave instructions that the 48 rooms should be cleaned and the walls limewashed. This was done. Informed the parents that if the child were not properly attended to should report the matter to the Society for Prevention of Cruelty to Children. The child has since been sent to School in a clean condition. 1 Dirty Clothes—Foul odour. Child excluded from school, and parents informed that unless he was kept in a cleaner condition information would be sent to the S.P.C.C. Child returned to School in a clean condition. 1. Incontinence. Parents written to advising consulting a medical man. The advice was followed and the child put under treatment. As three cases of scarlet fever were notified, occurring in children attending the same School, all the scholars in that department were inspected at the School. No case was discovered there and fortunately no other cases occurred afterwards in connection with that School. The exclusion of scholars suffering from notifiable diseases and the measures adopted in connection with those cases, will be reported in the Annual Report of the Medical Officer of Health. Darell Road School. These excellent buildings were opened in September. Towards the end of the year several cases of measles occurred amongst the younger scholars. Referring to the buildings, I notice there is no provision for ventilation in the ceiling or roof of the main hall. This is not necessary at present, but if the hall becomes crowded and occupied for a prolonged period, it would be advisable to provide ventilation, such as perforated openings in the ceiling communicating with Boyle's ventilators on the roof. Another matter of detail is that the doors of all the Class-rooms open inwards only. 49 Absence of Epidemics. A noteworthy point is that there has been no epidemic of disease during the year, such as has occurred in previous years when it has spread from School to School throughout the Borough. It is early yet to attribute this to the exclusion of scholars below 5 years of age ; but, nevertheless, it is the first year that we have been free since I was appointed Medical Officer of Health for the Borough six years ago, and it is the first year that children below 5 years of age have been excluded from the Schools. The usual premonitory symptoms of any prevalent infectious disease have been explained to the Teachers of the Schools in the neighbourhood of such infectious disease. County School. The County School has been visited at different periods, and on one occasion, at the request of the Head Teacher, I called and examined a recent case of ringworm which necessitated exclusion of the scholar from School. A few days afterwards I inspected 30 scholars in the Class to which the excluded scholar belonged, and discovered an unsuspected case of chronic ringworm. This scholar was also excluded. Both cases underwent medical treatment and one being eventually cured the boy resumed school duties. No other cases arose amongst the scholars attending this School. High School for Girls. On different occasions throughout the year visits were made to this School, or at the homes of 13 scholars who were attending the School preparatory to undertaking the duties of pupil teachers. These were thoroughly examined as to the condition of the lungs, heart, eyes, hearing, and teeth, as well as their general physique. In certain instances, owing to slight eye defects and bad teeth, they were advised to consult specialists, which they promised to do. Certificates of the result of the medical examinations were forwarded to your Clerk. School Attendance Sub-Committee. In three instances, at the request of the School Attendance Sub-Committee, I visited, examined, and reported as to the condition of the children referred 50 to. On several occasions, at the request of the School Attendance Officer, or Head Teachers, 1 visited and reported on children who were absent from School, said to he ill, but not under medical treatment. In only one instance was the statement incorrect, and the child was sent to School again immediately after my visit. One child mentally defective was examined and certificate given. One child was certified for a Truant School. Testing of the Sights of Scholars. In consequence of a Special Report to the Elementary Education Sub-Committee regarding the testing of the sight of Scholars, it was suggested by that Committee that a preliminary test should be carried out by the Teachers. Test Cards were obtained and I called at each School and explained to the Head Teachers the manner of using the Test Cards. The examinations are being carried out and the results will be reported to you when completed. Ventilation, &c. Advice as to ventilation, lighting and heating has been given to Teachers on different occasions. Without exception I have met with every assistance from the Teachers, otherwise my duties would have been considerably increased. I beg to remain, Ladies and Gentlemen, Yours obediently, J. H. CROCKER, M.D. SECTION III. Sanitary Matters 52 SECTION III. SPECIAL SANITARY MATTERS. Water Supply to the Borough. The "added areas" of Kew, North Sheen and Petersham are supplied entirely by water from what was formerly the Southwark and Vauxhall Water Company (now the Metropolitan Water Board). Richmond is supplied with water from the deep well (chalk stratum), Petersham well and Southwark & Vauxhall Water. Roughly speaking, equal proportions of these waters are pumped to a Reservoir in Richmond Park and supplied to the town by gravitation. The Fountain Spring, Petersham. As the water of this spring has locally a great reputation for purity, and as many people drink it, the Medical Officer of Health has analysed samples on two occasions, during dry weather and after heavy rain. Both samples showed no signs of contamination and as far as Chemical Analysis can show it is a good water for drinking and domestic purposes. Constant Supply. Houses adjacent to the water main extending from the Waterworks to Richmond Park, as well as those in the Petersham and North Sheen districts have a constant water supply, whereas those in Kew and a part of Richmond have not. As there are so many advantages in having a constant water supply it is desirable that these advantages should be extended to the whole of the Borough as soon as it can be arranged. The matter is under the consideration of the Water Committee. Condemned Wells. In four houses where the only source of water supply was by pumps connected with shallow wells the Medical Officer of Health, upon analysis, found the water unfit for drinking purposes in each instance. Notices were served 53 upon 3 owners, and as a result the pumps were removed and water from the mains laid on. As regards the fourth house there was no water main near, this is now remedied. Notice of the unsatisfactory conditions of the water has been sent to the owners of the property and they are dealing with the matter. The occupiers of the house were warned not to drink the water immediately the Medical Officer discovered the pollution. In addition to the above, at a house where a pump was connected with a surface well but the water was not used for drinking purposes, it was recommended that the pump should be removed. This recommendation was carried out. New Water Mains. During the year a 6 inch water main with the necessary hydrants was extended along the Lower Richmond Road for 270 yards to a point opposite the western boundary of the Fulham Cemetery. A 3 inch domestic water main for the purpose of supplying water to 22 houses known as Benn's Cottages was also laid. Previously the only source of water for these houses was by means of four tanks in gardens adjacent to the Cottages. Red Lion Street Area. The Council having applied to the Local Government Board for the issue of an Order to confirm a Scheme made by the Council under the Housing of the Working Classes Acts, 1890 to 1903, for improving the Red Lion Street Area, an enquiry was held on the 28th of February by Major C. E. Norton, R E., an Inspector of the Board, for the purpose of ascertaining the correctness of the Official Representation made to the Council by the Medical Officer of Health as to the area being an unhealthy area and also for investigating the sufficiency of the Scheme provided for the improvement of the area, and any local objections which might be made to the Scheme. A letter was received, dated 30th May, from the Local Government Board, enclosing drafts of an Order which the Board had caused to be prepared for confirming the Improvement Scheme 54 made by the Town Council under Part I of the Housing of the Working Classes Act, 1890. By this Order provision will have to be made for housing 300 persons in suitable dwellings either within or without the area, and subject to the approval of the Local Government Board. A communication was received from the Local Government Board, dated 19th July, enclosing copies of the Order and calling attention to the provisions of the Housing of the Working Classes Act, 1903, as regards service upon owners, &c., and the publication of the draft Confirming Order. The Council at their meeting in August confirmed the action of the Street Improvement Committee in instructing the Town Clerk to take all necessary steps in the matter. The draft Order was published in the "London Gazette" on 31st July. At the October meeting of the Council the Street Improvement Committee reported as follows :— The Committee, in anticipation of the Order of the Local Government Board confirming the Scheme for the Improvement of the Red Lion Street Area, made under the Housing of the Working Classes Acts, becoming operative at an early date, have had under consideration the question of providing housing accommodation for the persons who will be displaced by the carrying out of that Scheme. The Council will remember that the draft Order provides that such accommodation shall be provided for 300 persons of the working class, either upon the lands within the area comprised in the Scheme, or upon some other site or sites to be approved by the Local Government Board, Various sites, both within and outside the area, have been considered, and the Committee are of opinion that the most suitable 55 site for the erection of Workmen's Dwellings is to be found on the estate of the Popham Trustees, between Darell Road and North Road. They have been in negotiation for the purchase of a site, and the Trustees are now prepared to sell two acres for the erection of dwellings at the price of £2000 per acre, the Trustees at their own cost to put the sewers in the roads, to make up the same as Builder's Roads, and to kerb the footpaths. A plan showing the two acres referred to will be exhibited in the Council Chamber. The Committee recommend the Council to agree, subject to the approval of the Local Government Board, to purchase the two acres referred to at the price of £2,000 per acre, on the conditions above-mentioned. In the event of the above recommendation being adopted, the Committee further recommend the Council to authorise the sealing of a Provisional Agreement for purchase of the land, and to instruct the Town Clerk to apply to the Local Government Board for their approval of the site. The purchase of properties within the Red Lion Street area from the Trustees of the Toby Estate has now been completed, in accordance with the instructions of the Council at the last meeting. There remains, however, the question of completing the purchase of one cottage, No. 14, Artichoke Alley, agreed to be purchased for the sum of £160, and the Committee have included the purchase money and costs of completion in the lists of Accounts recommended for payment, and they RECOMMEND the Council to complete the purchase forthwith. The above Recommendations were adopted by the Council. 56 At the December meeting of the Council the Street Improvement Committee reported as follows:— The Committee have approved draft Provisional Agreement for the purchase of two acres of land in North Sheen on the estate of the Popham Trustees, and they recommend the Council to apply to the Local Government Board for sanction to borrow the sum of £4000, the amount of the purchase money, such sum to be repayable within the maximum period allowed by the Housing of the Working Classes Act, 1903. The Local Government Board have issued an Order confirming the Scheme made by the Council under Part I of the Housing of the Working Classes Act, 1890, for the Improvement of the Red Lion Street Area, and the Committee propose to take into consideration forthwith the steps required to carry the Order into effect. The Council may remember that on the 27th May, 1902, the Local Government Board issued their formal sanction to the borrowing under the Public Health Act, 1875, of the sum of £6000, in order to enable the Council to complete the purchase of premises in Red Lion Street from the Trustees of the Toby Estate, but that as the Council were not at that time prepared with a Scheme for dealing with the Red Lion Street Area, they stipulated that such loan should be repaid within ten years, at the same time intimating that when a Scheme had been submitted to the Board, they would be prepared to entertain an application for sanction to the reborrowing, for an extended term of years, of so much of the loan as might then be properly outstanding. The amount of such loan so outstanding is £4,800, and the Committee RECOMMEND the Council to make application to the Local Government Board for sanction to the re-borrowing of the sum of £4,800 for the maximum period allowed under the Public Health Act, 1875, that is to say, within 60 years from the actual date of the original borrowing. With reference to the above-mentioned Confirming Order, the 57 Scheme submitted to the Board was accompanied by an estimate of the cost of acquiring the properties comprised within the area, such estimate amounting, with incidental expenses and cost of sewers and roads, to the sum of £43,528. This sum, however, included the above-mentioned sum of £6,000 borrowed under the Board's sanction of the 27th May, 1902. In order to put the payments for other properties already purchased upon a proper basis, and to provide funds for the purchase of the remaining properties, the Committee RECOMMEND the Council to make application to the Local Government Board for sanction to borrow the sum of £37,528, such sum to be repayable within the maximum period allowed under the Housing of the Working Classes Act, 1903, that is to say, 80 years. The Recommendations were adopted by the Council. HOUSING OF THE WORKING CLASSES ACT, 1890- Part 111. The 135 houses built by the Corporation have been kept in a satisfactory condition and are all occupied. There are now 369 children living with their parents in these houses. Twelve of the Dwellings are flats let at rents of 4s. 6d. and 5s 6d. per week, and are only suitable for small families. Twelve children are resident in these flats. Excluding these, there is an average number of three children in each house. It should be remembered that owing to the popularity of the Dwellings, removals are not frequent, and many of the children who were quite young when their parents became tenants of the houses, have now grown up, married and removed elsewhere. Applicants with a large number of children are not accepted as tenants for the flats, on account of the limited accommodation, but with this exception, no preference has ever been given to applicants on account of their having few children. 58 In 1906 there were nineteen births and eight deaths in the Workmen's Dwellings. The estimated population of the 135 houses is 650, and upon this basis the birth rate per 1,000 for the year was 29, and the death rate was 12.3, as compared with a birth rate of 18.5 and a death rate of 11 for the whole of the Borough during the same period. House Unfit for Human Habtation. Upon a Report from the Medical Officer of Health that an unoccupied house in Perseverance Place was unfit for human habitation the owner gave a written guarantee that the house should not be occupied until put in a condition satisfactory to the Local Authority, consequently no further proceedings were taken. Customs & Inland Revenue Act, 1890, Section 26. Revenue Act, 1903, Sec. II. Four houses were inspected and certificates given under the above Acts. Placard re Physical Deterioration and Alcoholism. The following is a copy of a poster which was put up in various parts of the Borough by Ol der of the Council. CORPORATION OF RICHMOND (SURREY). PHYSICAL DETERIORATION AND ALCOHOLISM. THE REPORT OF THE COMMITTEE on Physical Deterioration, presented to Parliament by command of His Majesty, states thatThe abuse of alcoholic stimulants is a most potent and deadly agent of physical deterioration. Alcoholic persons are specially liable to Tuberculosis and all inflamatory disorders. Evidence was placed before the Committee shewing that in Abstinence is sought the source of muscular vigour and dexterity. The lunacy figures shew a large and increasing number of admissions of both Sexes which are due to drink, 59 THE FOLLOWING FACTS, recognised by the Medical Profession and placarded all over France by order of the Government, are published in order to carry out the recommendation of the Committee, to bring home to the community the fatal effects of alcohol on physical efficiency— (1) Alcoholism is a chronic poisoning, resulting from the habitual use of alcohol (whether as spirits, wine, or beer), which may never go so far as drunkenness. (2) It is incorrect to think that those doing hard work sarily require stimulants. (3) Alcohol is really a narcotic, dulling the nerves like laudanum or opium, but it is more dangerous than either, in that often its first effect is to weaken a man's self-control while his passions are excited; hence the number of crimes which occur under its influence. (4) Spirits rapidly produce alcoholism, but milder alcoholic drinks, as beer, and even cider, drunk repeatedly every day, produce after a time alcoholic poisoning with equal certainty. (5) The habit of drinking leads to the ruin of families, the neglect of social duties, and to misery, theft and crime. It leads also to the Hospital, for alcohol produces the most various and the most fatal diseases, including Paralysis, Insanity, diseases of the Stomach and Liver, and Dropsy. It also paves the way to Consumption, and frequenters of public houses furnish a large proportion of the victims of this disease. It complicates and aggravates all acute diseases; Typhoid Fever, Pneumonia, and Erysipelas are rapidly fatal in the subject of alcoholism. (6) In short, alcoholism is an enemy to personal health, to family happiness, and to national prosperity. By order of the Town Council, William Sandover, Mayor. J. H. Crccker, Medical Officer of Health. Town Hall, Richmond (.Surrey). December, 1905. 60 Water Closets without proper and sufficient Flushing Apparatus. As there was an uncertainty of the legal powers as to dealing with certain conveniences in the Borough which were without any flushing apparatus, the Health Committee in previous years did not insist on such apparatus in old buildings. During the past year, attention being again called to the matter, the Town Clerk reported that such powers were contained, in his opinion, in Section 36 of the Public Health Act, 1875. Action was taken in connection with 133 houses and a suitable flushing apparatus was fitted in each instance. In most of the houses the defect was due to water not being laid on, consequently the procedure taken led to this being remedied. In nearly every instance the drains were found defective, and as a result these were relaid or rearranged on modern lines. It is proposed to lay a surface water sewer along the front of Benn's Cottages and to pave the passage, at an estimated cost of £205. Sanitary Conveniences. The Sanitary Convenience for Women erected at Kew Bridge was completed early in the year. The new Sanitary Conveniences for Men at Kew Bridge and River Walk were put in use at the latter part of the previous year. Open Space, North Sheen. The purchase of four acres of land, belonging to the Popham Estate, for the purpose of a Recreation Ground for the North Sheen district was sanctioned by the Council at the meeting in October. Sewer Ventilation As a result of a report from the Medical Officer of Health arrangements are being made for further ventilation of the sewers by means of ventilating shafts in different parts of the Borough. Removal and Dis posal of House Refuse, &c. Mortuary. The method employed has been described in previous Annual Reports as has also the method of disposal of sewage. During the year 52 bodies were received at the Mortuary, 27 males and 25 females. Post-mortem examinations were made upon 38 bodies and 52 inquests were held. 61 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 reports as follows:— 1 have pleasure in forwarding herewith my Annual Report as to the Articles purchased under the provision of the above Acts during the year 1906 in your District. 77 Samples were taken of which 66 were genuine, 5 slightly adulterated or deteriorated, and in 6 cases proceedings have been taken, 4 Convictions have been obtained and Fines and Costs to the amount of £13 11s. 7d. inflicted, 1 case was dismissed and 1 case has not yet been decided. A detailed list of the various articles is herewith appended. Articles Purchased. Number of Samples Genuine Slightly adulterated or deteriorated. Cases in which proceedings were taken. Convictions obtained Total Fines. Milk 39 31 2 6 4 £ s d. Butter 13 11 2 13 11 7 Cheese 6 6 Spirits 9 9 Olive Oil 2 2 Jam 1 1 Vinegar 2 2 Cocoa 1 1 Baking Powder 1 1 Shrimps 1 1 Beer 2 2 Totals 77 66 5 6 4 £13 11 7 62 PUBLIC BATHS—SUPERINTENDENT'S RETURN OF BATHERS from Ist January to 31st December, 1906. FROM SWIMMING BATHS. WARM BATHS. TOTALS. Dressing Boxes. Ist Class. 2nd Class. Ist Class. 2nd Class. Swimming. Warm. Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Ist January to 30th March 3248 139 1318 549 4566 688 656 31st March to 8th June 6161 1272 3566 216 1474 176 2302 804 9727 1488 3776 980 — 8th June to 14th September 18845 5363 1159 1519 2086 254 3499 1418 30804 6882 5585 1672 — 15th September to 31st December 2427 761 1237 306 3483 154 1719 747 3664 1067 5202 901 656 Totals 27433 7396 16762 2041 10291 723 8838 3518 44195 9437 19129 4241 1312 For corresponding period of last year (1905. ) 26438 6262 13328 990 9959 758 8716 3538 39766 7252 18675 4296 1297 Total Number of Males (including Dressing Box Tickets) Corresponding period of 1905. Corresponding period of 1904 Corresponding period of 1903. Corresponding period of 1902. 64.636 58.531 60,008 56,421 47,100 Total Number of Females 13.678 11,548 9,671 9,112 8,674 Total Bathers 78.314 70,079 69,679 65.533 55.774 Average Temperature 58 56 03 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 2,539 inspections of nuisances in course of abatement, 961 houses inspected, 245 visits to cases of infectious diseases, besides syste maticinspections 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 1906 is given at the end of this Section, and it is satisfactory to report, that out of a total of 1,503 defects reported, all were remedied before the end of the year. Seventy-five 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 110 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 113 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 and this accordingly was done. One hundred and ninety-seven 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 ventilating shaft of full bore. Careful supervision is exercised by 64 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 27 instances. In most of the cases of the flushing apparatus being defective, the existing cistern was abolished and a suitable one fixed. Seventy-six houses were found to have defective dust b ns proper and suitable dust bins were provided in each instance. The walls and ceilings of 183 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," 80 rooms were cleansed and 80 floors and furniture cleaned. Included under the latter heading are a number of floors of houses which were found in a dirty condition. There is still considerable trouble caused by occupiers of stables delaying to get the manure pits emptied. The Sanitary Inspector has had to serve 35 notices to have such accumulations removed. Private Slaughter Houses. There are seven slaughterhouses in the Borough, all of which have been regularly inspected. The following defects were discovered and remedied ; one floor of pen defective, one accumulation of manure, and walls and ceiling dirty in one instance. Meat. 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. 65 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 destroyed. 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 78 houses, and in 22 instances demonstrated that the drains were defective. Dairies, Cowsheds and Milk Shops. There are six cowsheds and 24 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, one water closet defective and the walls and ceilings dirty in three instances. In connection with cowsheds no cause of complaint was found. 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 there were no boats inspected. SUMMARY OF THE SANITARY INSPECTORS REPORT FOR THE YEAR 1906. Number of Visits made 4114 „ Complaints received and attended to 45 ,, Statutory Notices served 75 „ Preliminary and Verbal Notices served 570 66 SUMMARY OF INSPECTIONS MADE. Inspection of Nuisances in course of abatement 2539 Houses Inspected 961 Visits to Cases of Infectious Disease 245 Inspections of Slaughter Houses 2 „ Milk Shops 30 „ Cowsheds 2 ,, Bakehouses 57 ,, Workshops 25 „ Piggeries 6 ,, Miscellaneous, Services of Notices, Interviewing Owners of Property, Builders, &c. 247 4114 67 SUMMARY OF NUISANCES INVESTIGATED BY THE SANITARY INSPECTOR DURINC THE YEAR 1906. Number done. Number not done. Total. Drains to be reconstructed 110 0 110 Drains amended 113 0 113 Drains cleared 50 0 50 Water Closets to be reconstructed 197 0 197 Water Closets defective 27 0 27 Water Closets, flushing apparatus defective 32 0 32 Water Closets, want of light & ventilation 43 0 43 Water Closets, soil pipes defective 6 0 6 Premises without proper and suitably covered dust bins 76 0 76 Sink Waste pipes in a defective condition 40 0 40 Premises without a proper and sufficient supply of water for drinking and domestic purposes 45 0 45 Drinking Water Cisterns in a defective condition 37 0 37 Drinking Water Cisterns without a proper cover ... 23 0 23 Drinking Water Cisterns in a dirty condition 2 0 2 Eave Gutters and Rain Water Pipes defective 43 0 43 Roofs defective ... 54 0 54 Yards without proper Paving and Drainage 124 0 124 Animals kept so as to be a nuisance 9 0 9 Houses so overcrowded as to be dangerous or injurious to the health of the inmates 1 0 1 Workrooms without proper light and ventilation 0 0 0 Walls and Ceilings in a dirty condition 183 0 183 Walls and Ceilings to be cleansed after Infectious Disease 80 0 80 Floors and Furniture of infected rooms to be cleansed after Infectious Disease 80 0 80 Foul accumulation to be removed 35 0 35 New Sink and Waste Pipe provided 36 0 36 Structure of Water Closet reconstructed 32 0 32 Want of Manure Pit 4 0 4 Miscellaneous 21 0 21 Totals 1503 0 1503 68 FACTORY AND WORKSHOP ACT, 1901, Bakehouses. These have been periodically visited by the Medical Officer and Sanitary Inspector, 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 — — Workshops (including Workshop Laundries) 82 26 - Workplaces 4 — — Homeworkers' Premises 8 — — Total 101 26 — 2—DEFECTS FOUND. Particulars. Number of Dfefects. Found. \ Remedied. Referred to H.M. Inspector. Number of Prosecutions. Nuisances tinder the Public Health Acts :— Want of cleanliness 26 26 - — Want of ventilation — — - — Overcrowding — — — — Want of drainage of floors — — - — Other nuisances 3 3 — — Sanitary accommodations— Insufficient — — - — Unsuitable or defective — — — — Not separate for sexes 3 3 - — 32 32 — — 69 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) 2 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 7 Reports (of action taken sent to H.M. Inspector. 5 Underground Bakehouses (S. 101):— In use during 1905 — Certificate granted in 1906 — In use at the end of 1906 3 Homework :— Number of Lists. Workers. Lists of Outworkers (S. 107): — Lists received l l Addresses of Workers forwarded to other Authorities 0 received from other Authorities l Wearing Apparel. Other. Homework in unwholesome or infected premises:— Notices prohibiting homework in unwholesome premises (S. 108) - - Cases of infectious disease notified in homeworkers' premises - - Orders prohibiting homework in infected premises (S. 110) Workshops on the Register (S. 131) at the end of 1905— Workshop Bakehouses 29 Dressmakers and Milliners 50 Laundries 28 Other Trades 51 Total number of workshops on Register 158 70 RAINFALL, 1906. MONTH. Number of days on which rain fell in Richmond. Total fall in inches. Richmond 1906 London Mean for 1866-1900 1905 1906 January 6 18 3.0 2.01 February 13 17 1.47 1.69 March 22 15 1.03 1.49 April 18 6 .51 1.65 May 8 15 1.25 1.69 June 16 7 2.64 1.93 July 5 7 .93 2.27 August 16 7 .52 2.30 September 16 10 1.57 2.21 October 11 15 3.26 2.70 November 17 15 3.83 2.29 December 8 18 1.75 2.15 Total 156 150 21.76 24.38 The rainfall for the year in Richmond was 21.76 inches as compared with 22.07 inches for 1905, 20.79 inches for 1904, 3613 inches for 1903, and 21.2 inches for 1902. January, June, October, and November were the wettest months. (Signed) J. H. CROCKER, M.D., &c. Medical Officer of Health. Town Hall, Richmond, Surrey, February 1st, 1907,