RICH 050 Borough of Richmond (Surrey). Annual Report of the MEDICAL OFFICER OF HEALTH for the year 1913, By J. H. Crocker, m.d., b.ch., d.p.h., m.r.c.s., etc., Medical Officer of Health and School Medical Officer, Borough of Richmond. Consulting Physician, Hoyden and Dockwell Isolation Hospitals. Public Health Department, 38, Sheen Road, Richmond, Surrey, March, 1914. To the Mayor, Aldermen and Councillors of the Borough of Richmond, Surrey. Gentlemen, Herewith I beg to present a Report upon the Health and Sanitary Condition of the Borough for the year 1913, in compliance with the instructions of the Local Government Board. Believe me, Gentlemen, Yours obediently, J. H. Crocker, Medical Officer of Health. HEALTH COMMITTEE, 1913. His Worship the Mayor, Councillor Cook. NORTH WARD. Councillor Drummond, Councillor Dr. Maguire. Councillor Randall. WEST WARD. Councillor Dr. Boulter, Councillor Richards. EAST WARD. Councillor Carless, Councillor A. J. Martin, „ Cook, „ Morrison, ,, Dr. Hunt, „ Dr. Taylor. SOUTH WARD. Councillor Manger, Councillor Dr. Wadd (Chairman). NORTH SHEEN WARD. Councillor Filby. KEW WARD. Alderman Dr. Payne. Meetings every alternate Friday at 6 o'clock p.m. JOINT ISOLATION HOSPITAL COMMITTEE, 1913. Members from the Richmond Corporation. Councillor Cook, Councillor Richards, „ Frost, „ Towers, „ Dr. Hunt, „ Dr. Wadd. Meetings of General Committee and Visiting Committee once a month. 4 STATISTICAL SUMMARY. Borough of Richmond, 1913. Population, estimated to the middle of the year 33,592 Population, Census, 1911 33,223 Births 617 Annual Rate of Births per 1,000 of population 18.3 Deaths 458 Annual Rate of Deaths per 1,000 of population 12.6 Zymotic Death Rate 0.80 Excess of Registered Births over Deaths 159 Infantile Mortality—Per 1,000 births 82 Area—The Total Area of the Borough is 2599 acres Density—The Mean Density of the Population is equal to 13 persons per acre Rateable Value £325076 A Rate of Id. in the £ yields £1239 1913 VITAL STATISTICS IN ENCLAND AND WALES. Annual Rates per 1,000 Living. Dentils under One Year to 1,000 Births. Births. Deaths. Crude. Standardized England and Wales 23.9 13.7 13.4 109 96 great towns, including London 25.1 14.3 14.7 116 145 smaller towns 23.9 12.8 13.0 112 England & Wales less the above 241 towns 22.2 131 12.1 96 London 24.8 14.2 14.2 104 RICHMOND 18.3 14.7 12.6 82 5 Natural, Social, and Sanitary Conditions of the District. The Physical features and General Characteristics of the District were described in the Annual Report for 1911. Population. The Population of the Borough estimated by the Registrar General to the middle of the year 1913 was 33,592. Social Conditions. The Borough is chiefly a residential district; the few industries being Building, Dyeing and Cleaning Works, a Brewery, and those industries and occupations connected with boating. Out-door Belief by the Board of Guardians. The following particulars give the amounts granted by the Guardians in Out-door Relief to persons resident in the Borough:— Oct. 1st, 1911, to Oct. 1st, 1912, to Sept. 30th, 1912, Sept. 30th, 1913, For twelve months £1,570 Os. Od. £1.553 4s. 8d. Old Age Pensions. The number of Pensions granted to residents within the Borough during the year ending Nov. 9th, 1913, was 98, as against 102 for the previous year. Richmond Royal Hospital. The Secretary, Mr. Richard Allen, has kindly supplied the following information:— The number of Patients treated at the Royal Hospital during 1913 were—In-Patients, 704; Out-Patients, 7213. The total number of Attendances was 28,890. The patients attending from the Borough of Richmond were—In-Patients, 230; Out-Patients, 768; Ophthalmic Patients, 440, and Dental Patients, 326. Water Supply. The Borough water supply is obtained partly from the Metropolitan Water Board, partly from deep wells in the Borough, one in oolite and one in chalk, and partly from a well in gravel beds at Petersham. 6 All the water obtained from the Petersham Well is passed through sand filters at Petersham. The filter beds, which were completed in July, 1910, continue to act efficiently. The water is analysed at least once a week by your Medical Officer of Health. In certain portions of the Borough the supply is intermittent. Those houses situated on the line of the main from the pumping station to the reservoir cannot be otherwise under existing conditions, as the supply has to be shut off for short periods each day in order to get sufficient pressure to pump the water to the storage reservoirs situated on the Hill. One hundred and, sixty intimation notices were served upon owners or occupiers to remedy defective conditions in connection with water storage tanks, defective drinking water tanks, tanks so placed or constructed as likely to cause contamination of the water therein, defective covers of drinking water tanks, and dirty condition of drinking water tanks. Contamination of the water in storage tanks is frequently caused by the presence of dead birds, mice, dirt and other filth, and this is often aggravated by the cisterns being placed in inaccessible positions. Drainage and Sewerage. The Richmond Main Sewerage Board, formed in 1887, of which the constituent authorities are the Richmond Corporation and the Barnes Urban District Council, deals with the Sewage from the Borough of Richmond and the Urban District of Barnes. The Board's Sewage Works are situated alongside the river, near West Hall, in the Parish of Mortlake. The Sewage of the Borough is conveyed by numerous collecting sewers into a main outfall sewer belonging to the Richmond Main Sewerage Board. This outfall sewer runs from the corner of Petersham Meadow for a short distance under Petersham Road, thence from the Pigeon's Hotel under the towpath as far as, and under Friar's Lane, across Richmond Green, and by way of Parkshot and the Railway Station Yard 7 to Kew Road as far as the Selwyn Fountain, and thence under the Lower Mortlake Road as far as the Boundary of the Borough in Lower Richmond Road, it is thence continued along that Road and via Kew Lane to the Outfall Works at Mortlake. A second outfall sewer commences in Mortlake Road, Kew, and passes thereunder as far as the Borough Boundary at Gipsy Corner, and thence to the Outfall Works. The town was partially re-sewered in 1898. The separate system was introduced several years age, and surface water sewers are now laid along most of the streets within the Borough, the principal exceptions being portions of the Petersham Road and Sheen Road, near the Borough Boundary. Treatment of Sewage. The method of sewage disposal at the Outfall Works, is that of precipitation and bacterial filtering beds, the effluent being passed into the Thames. The Engineer to the Main. Sewerage Board is Mr. J. T. Fairley, M.I.C.E. Sewers, Roads, New Houses, &c. I am indebted to the Borough Surveyor, Mr. J. H. Brierley, A.M.I.C.E., for the following information:— " Beyond the reconstruction of certain combined drains and the clearing out of certain surface water sewers in the Kew District, there has been no alteration in the sewerage system of the Borough. Sewer flushing and cleansing has been carried out at regular intervals. The Port of London Authority have raised the level of the towpath between the Town Hall Gardens and the Steamboat Pier which is a very useful public improvement. The Highways Committee authorised the tarpainting of the surfaces of about six miles of carriageway within the Rnrnimh 8 Sandycombe Road and Lower Mortlake Road have been waterproofed, and the upper portion of Hill Street has been paved with wood. Thirty-six new buildings have been erected during the year, consisting of 20 houses, 14 shops with flats or houses, 1 workshop and 1 lock-up shop.'' Closet Accommodation. Water closet accommodation is general throughout the Borough. Scavenging. The removal of house refuse and the cleansing and scavenging of the streets are under the control and supervision of the Borough Surveyor. The Surveyor states that the scavenging of the streets has received the usual attention. Certain portions of the main road and principal thoroughfares are scavenged daily ; other portions three times a week, whilst the other main and residential streets are scavenged once or twice each week, according to their condition. The house refuse is collected once a week from every house and tenement in the Borough. The Council decided to give a second weekly collection during the summer months which was much appreciated. In the case of blocks of flats, business establishments, hotels, boarding houses, and similar large establishments, house refuse is collected therefrom twice a week throughout the year. Disposal of House Refuse. The house refuse as collected is carted to a loading platform at the Central Depot, Lower Mortlake Road, and there placed into railway wagons. No alteration has been made in the arrangements for the disposal of house refuse, which is let by contract and is removed daily from the private siding alongside the loading platform. 9 Sanitary Inspections of District. Article XX (16) of the Local Government Board's General Order of the 13th December, 1910, states that " The Inspector of Nuisances shall, as soon as practicable after the thirty-first day of December in each year, furnish the Medical Officer of Health with a tabular statement containing the following particulars:— (a) The number and nature of inspections made by him during the year. (b) The number of notices served during the year, distinguishing statutory notices from the informal notices. (c) The result of the service of such notices. In accordance with the General Order of the Local Government Board, the Inspector of Nuisances submits the following tables shewing the number and nature of Inspections made during the year ending December 31st, 1913, with particulars relating to the service of notices. The statement is again very satisfactory, and shews that a large amount of good and useful work has been accomplished during the year. (a) Number and Nature of Inspections, 1913. Total number of visits made 5985 No. of Houses inspected (Housing, &c., Act) 298 No. of Sanitary defects and nuisances dealt with 2870 No. of Houses,&c., inspected (ordinarily re complaints, &c.) 1552 Visits re Nuisances in course of abatement 2508 Visits re Infectious Disease 372 Visits re Tuberculosis 150 Visits to Factories 9 „ Workshops 237 „ Outworkers 20 „ Bakehouses 69 „ Dairies, Cowsheds and Milkshops 120 „ Ice Cream Makers Premises 16 „ Dining Rooms, &c. 108 Slaughterhouses 18 10 Visits to Shops re Food Supplies 171 „ Fried Fish Shops 0 „ Piggeries 18 „ Stables 203 „ Public Urinals 15 „ Riverside Wharfs re Canal Boats 50 No. of Smoke observations recorded 16 (n) Number of Notices Served. Statutory Notices. Section 91, P.H.A., 1875 47 93 „ 36, P.H.A., 1875 16 „ 41, P.H.A., 1875 4 „ 46, P.H.A., 1875 17 „ 49, P.H.A., 1875 2 „ 25, P.H.A. (A), 1907 7 Informal Notices. Preliminary intimations served... 435 Letters written 730 Written Application for examination of drains, Section 41, P.H.A., 1875 50 No. of Consultations with owners, builders, &c., rc sanitary defects and nuisances 482 (c) Result of Service of Notices. All notices served were complied with. Legal proceedings had to be taken on three occasions to enforce the abatement of nuisances. As the owners commenced the work immediately after the service of a summons, the Magistrates made an order for the Works to be completed within seven days. The summonses were afterwards withdrawn on payment of costs. Premises and Occupations which can be controlled by Bye-laws or Regulations. The following is a list of the Bye-laws or Regulations in force in the district:— 1. Bye-laws as to keeping water closet supplied with sufficient water for flushing. 11 2. Bye-laws with respect to nuisances (limiting the time for removal of offensive matter through the streets). 3. Regulations as to Glanders or Farcy. 4. Regulations as to Dairies, Cowsheds and Milkshops. 5. Bye-laws as to slaughterhouses. 6. Ditto as to New Streets and Buildings. 7. „ Pleasure Grounds. 8. „ Allotments. 9. „ Locomotives Act, 1898. 10. Ditto under Good Rule and Government of the Borough. 11. Ditto as to Female Domestic Servants Registries. Common Lodging Houses. There are none in the District. Cellar Dwellings. There are an increasing number of premises within the Borough which come within the definition of cellar dwellings. The premises referred to are basement houses, many of which are let off to two or more families ; the basement usually being let off separately to one family. Frequent inspections of such premises are necessary, as in the majority of cases the structures do not comply with the requirements of the Public Health Act and the Housing Act relating to cellar dwellings. Rooms or premises of this description come within the meaning of Section 17 (7) of the Housing, &c., Act, 1909. As there are a considerable number of basement houses in the Borough, it would be advantageous if the Council were to frame regulations to deal with the basement sleeping rooms. Section 17 of the Housing, Town Planning, &c., Act, 1909, reads:—" A room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall for the purposes of this section be deemed to be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation, if the room either— 12 {a) is not on an average at least seven feet in height from floor to ceiling ; or (b) does not comply with such regulations as the local authority with the consent of the Local Government Board may prescribe for securing the proper ventilation and lighting of such rooms, and the protection thereof against dampness, effluvia, or exhalation: Provided that if the Local Authority, after being required to do so by the Local Government Board, fail to make such regulations, or such regulations as the Board approve, the Board may themselves make them, and the regulations so made shall have effect as if they had been made by the Local Authority with the consent of the Board : " Provided that a closing order in respect of a room to which this sub-section applies shall not prevent the room being used for purposes other than those of a sleeping place ; and that, if the occupier ot the room after notice of an order has been served upon him fails to comply with the order, an order to comply therewith may, on summary conviction, be made against him. Offensive Trades. There are no scheduled offensive trades within the -district. Under Section 51 of the Public Health Act Amendment Act, 1907, power is given to the Local Authority to declare fish-frying to be an offensive trade. At present there are only five fish-frying establishments within the Borough. Schools. A separate report on the Sanitary condition of the Schools and School Medical Inspection has been made to the Education Committee. Food, (a) Milk Supply. There are three cowsheds and 43 dairies and milkshops in the Borough. The number of cows kept in the Borough at the 13 end of the year was 55. Three purveyors of milk were registered during the year, and three were removed from the register, having given up the business. The cowsheds, dairies and milkshops have been systematically inspected by the Sanitary Inspectors during the year. In addition, monthly inspections arc made of all the milch cows in the Borough by the Veterinary Surgeon, Mr. Claude Ewin, M.R.C.V.S., w ho also examines all swine in the district. He reports to the Executive Committee monthly. The greater quantity of milk consumed in the district has to be imported, and is brought into the district by rail. No complaint has been received regarding the conditionor quality of the milk sold in the district during the past year. Annual Report of Veterinary Inspector for 1913. Mr. Claude A.A. Ewin, M.R.C.V.S.L., reports at follows:— "During the year 554 Inspections of milk cows were made. 71 Visits were made to owners of pigs, and 1633 animals inspected. Tuberculosis Order of 19/3. This Order, which came into force on 1st May, 1913, dealswith the compulsory notification, the application of the Tuberculin test with the consent of the owners, compulsory slaughter by the local authorities and proportionate compensation according to the condition of the carcase. In connection with this fact it is interesting to note that a large proportion of the milch cows in the Borough are tested with the Tuberculin test before being purchased by the dairymen. It is with pleasure I have to state that during the past year not a single scheduled disease has occurred in theBorough." 14 (b) Other Foods. During the year shops and premises in which meat, fish, poultry, fruit and other food stuffs are prepared, stored or exposed for sale have been frequently visited by the Sanitary Inspector, and the various articles examined. Food purveyors have been advised to consult the Medical Officer of Health or Sanitary Inspector at once if they have any articles of food of doubtful quality. During the year the following articles were condemned as unfit for human food, and voluntarily destroyed under the Inpector's supervision : — 1 sack of shell fish. 1 box of cod's roe. 20 lbs. of bream and hake. 112 lbs. of cod fish. 5 stones of plaice. 6 lbs. of salmon. 1 box (250) herrings. 1 trunk of haddock. 20 lbs. of potatoes. 12 lbs. of apples. During the month of August complaint was received that at a small sweet shop the occupier was selling to young children unsound apples, coated with toffee, and described as farthing toffee apples. Upon investigation it was found that the occupier of the shop had purchased a quantity of apples, the majority of which were unfit for food, but they were being coated with toffee and sold at a farthing each. All such articles found on the premises were condemned and destroyed and the occupier warned. 15 Slaughterhouses and Meat Inspection. There are five registered Slaughterhouses in use in the thorough. Frequent inspections of the premises have been made. All the premises are old, but they have been kept in a clean condition. There are very few animals slaughtered locally. The greater portion of the meat sold in the district -comes direct from the Abattoirs and wholesale markets in London. The Sanitary Inspector and the Assistant Sanitary Inspector both hold certificates qualifying them to act as Inspectors of Meat and other foods. Bakehouses. The number of Bakehouses on the register at the end of the year was 25, six of these being underground. All the bakehouses were frequently inspected during the year, and the usual standard of cleanliness was well maintained. In addition, systematic inspections have been made of the public dining rooms, restaurants, kitchens, fried fish shops and the food supplies found therein. The food supplies on the street hawkers' carts and barrows were also examined from time to time. Disposal of Carbage and Trade Refuse. There has been considerable improvement during the past year in the removal and disposal of garbage and trade refuse from shopkeepers premises. The warnings given during the previous year have had good effect, and the removal contractors have cleared the refuse regularly, twice, and, during the summer months, three times weekly, from the various fish, meat and greengrocers' premises in the Borough. At the majority of fish shops, the contractors provide the shopkeeper with sealed pails for the reception of the offal. 16 (c) Sale of Food and Drugs Acts. The duties in connection with these Acts have been carried" out in the Borough by the Inspector acting under the County Council. The County Medical Officer of Health has kindly furnished the following particulars:— Articles Analysed Adulterated or Deteriorated Prosecutions Convictions Milk 63 8 2 2 Cream 3 — — — Butter 23 — — — Cheese 1 — — — Lard 2 — — — Coffee 1 — — — Cocoa 2 — — — Spirits 12 1 — — Other articles 9 5 1 1 Totals 116 14 3 3 Housing. The administration of the Housing and Town Planning Act, 1909, has been diligently and efficiently carried out during the past year. The total number of houses examined in accordance with the provisions of the Housing Regulations, was 298, and the number of sanitary defects and nuisances reported under tthe heading was 1696. 17 Of the 298 houses inspected: — 30 were let at an annual rental of £16 or under 189 „ „ „ £16 to £26 40 „ „ £26 to £40 39 „ „ over £40 Sec. 14 of the Housing and Town Planning Act, 1909, reads : " In any contract made after the passing of this Act for letting for habitation a house or part of a house at a rent not exceeding— (a) in the case of a house situate in the administrative County of London, forty pounds; (b) in the case of a house situate in a borough or urban district with a population according to the last census for the time being of fifty thousand or upwards, twenty-six pounds: (c) in the case of a house situate elsewhere, sixteen pounds; there shall be an implied condition that the house is at the commencement of the holding in all respects reasonably fit for human habitation, but the condition aforesaid shall not be implied when a house or part of a house is let for a term of not less than three years upon the terms that it be put by the lessees into a condition reasonably fit for occupation, and the lease is not determinable at the option of either party before the expiration of that term." As the population of the Borough is under fifty thousand, Section 14 of the above-mentioned Act, can only apply to those houses let up to £16 per annum. So far as the Borough of Richmond is concerned, the rental fixed under this section is too low for the provisions of the Act to be of much benefit to the district, as the following particulars show : Total number of dwelling houses in Borough (Census 1911) 6,545. „ „ „ „ up to £16 rental, 525. „ „ „ above £16 and not I iic-i exceeding £26 rental/ 18 In districts like Richmond where the majority of houses occupied by the working classes are let at rentals above £16 per annum, the Section of the Act referred to requires amending so that the rental clause shall include houses the rent of which are at least £26 per annum. Of the total number of houses inspected during the year under the Housing Regulations, 219, or 73 per ccnt. were of houses let at rentals up to £26 per annum, these being houses chiefly occupied by the working classes. The Housing Regulations of the Local Government Board provide that enquiries shall be made in relation to the following matters, viz.:— (1) The arrangements for preventing the contamination of the water supply, (2) Closet accommodation, (3) Drainage, (4) The condition of the dwelling house in regard to light, the free circulation of air, dampness and cleanliness, (5) The paving, drainage and sanitary condition of any yard or outhouses belonging to or occupied with the dwelling house, (6) The arrangement for the deposit of refuse, and ashes, (7) The existence of any room which would in pursuance of sub-section (7) of section 17 of the Act of 1909 be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation. (8) Any defects or other matters which may tend to render the dwelling-house dangerous or injurious to the health of an inhabitant. The following statement is compiled in accordance with the instructions of the Local Government Board:— A. No. of dwelling houses inspected (Housing tions) 298 B. No. of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 19 C. No. of houses in Group (B) which were made fit for habitation without formal representations to Local Authority 5 D. No. of formal representations to Local Authority with a view to the issue of Closing Orders 1 E. Number of Closing Orders made 1 F. No. of houses represented unfit for habitation which were made fit without Closing Orders 5 G. No. of houses in which defects were remedied after the issue of Closing Orders 1 H. No. of houses voluntarily closed by owners 9 I. No. of houses voluntarily demolished by owners 0 Six houses were demolished during the year, viz:—Nos. J, 2, 3, 4, 5, 6, Hampton's Cottages, Closing Orders having been made during 1912. Particulars of Premises found to be Unfit for Human Habitation. Situation. Rental. Result of action taken. Campbell Cottage, 8, Albany Road £22 2 0 ClosingOrder madeand premises put in order. 41, The Quadrant £70 0 0 Voluntarily closed and put in order. 8 Clarence Street £16 18 0 „ „ „ 9 £15 12 0 „ „ „ 1, Grove Terrace £16 18 0 „ „ „ 8. £16 18 0 „ „ „ 77, Worple Way £13 0 0 Voluntarily closed, Owner arranging for demolition. 79, £13 0 0 „ „ „ 3, Hope Cottages £13 0 0 Voluntarily closed. 4. £13 13 0 „ „ „ 20 As required by the Memorandum of the Local Govern ment Board, the following are particulars of the general character of the defects and nuisances dealt with as a result of the inspection of houses under the Housing Regulations:— General character of defects and nuisances found to exist:— Defective drainage and sanitary fittings. Defective paving. Defective roofs, gutters and spouting. Defective receptacles for household refuse. Foul and defective drinking water tanks. Damp houses (want of damp course) or pointing of brickwork. Damp subsoil under house floors. Want of ventilation under floors. Dilapidated walls, floors and ceilings Windows not made to open. Want of increased window area. Defective window frames and sills. Inadequate ventilation of rooms (through ventilation provided). Temporary buildings interfering with free circulation of light and air. Removed. Dilapidated outbuildings. Dirty house premises. Overcrowding. The general classification, and the total number of sanitary defects and nuisances dealt with, are enumerated in the Sanitary Inspector's Report. Nos. 8 and 9, Perseverance Place. These houses were demolished as a result of Closing Orders made in 1912, and were re-constructed during the year in accordance with plans approved by the Highways Committee. Nos. 1-6, Hampton's Cottages, Mitchel's Row. These houses were demolished by the owners during the year, as a result of closing and demolition orders made in 1912. 21 Owing to the site being so small it is not possible to re-build the houses. Housing and Town Planning, &c., Act, 1909. The following particulars shew the number of houses inspected during the year, in accordance with the Housing Regulations:— Ward. No. of houses inspected under £16 rental. £16 to £26 rental. £26 to £40 rental. Over £40 rental. Totals. North 5 47 10 8 70 South 9 0 4 15 28 East 3 94 23 5 125 West 13 46 3 9 71 N. Sheen – 1 — 1 2 Kew — 1 — 1 2 Totals 30 189 40 32 298 (B) North Ward. Number of houses inspected (H.T.P. Act) 70 Number of sanitary defects and nuisances reported 502 Situation of Premises Inspected. The Avenue 2 Alexandra Road 8 Beaumont Avenue 1 Clarence Street 2 Elizabeth Cottages 1 Jocelyn Road 3 Kew Road 3 Kew Foot Road 6 Shaftesbury Road 5 King's Road 1 Lichfield Road 1 Lower Mortlake Road 4 Voluntarily closed and put in order (Rent £15 12s. 0d. —£16 18s. 0d.). Mitchel's Row 28 Pagoda Avenue 2 Raleigh Road 1 Selwyn Avenue 2 22 South Ward. Number of houses inspected (H.T.P. Act), 28 Number of sanitary defects and nuisances reported 197 Cambrian Road 1 Church Road 1 Ellerker Gardens 3 Lancaster Par 1 Marlborough Road 1 Montague Road 1 Onslow Avenue 1 Onslow Road (Flats) 2 Park Road 1 Petersham Road 5 Park Mews 9 Queen's Road 1 The Vineyard 1 East Ward. Number of houses inspected (H.T.P. Act) 125 Number of sanitary defects and nuisances reported 664 Situation of Premises Inspected. Albert Road 35 Albany Road 1 Albany Passage 5 Audley Road 5 Crown Terrace 3 Duncan Road 2 Grena Road 1 Houblon Road 4 King's Road 1 Princes Road 4 Victoria Villas 4 Worple Way 2 Sandymount 4 Closing Order made. Sheen Road 14 Sheen Park 1 Sheendale Road 2 Sydney Road 1 St. Mary's Grove 2 Townshend Road 1 Townshend Terrace 1 Re Inspections. Wilton Avenue 32 Re Inspection. Voluntarily closed. West Ward. Number of houses inspected (H.T.P. Act) 71 Number of sanitary defects and nuisances reported 310 Situation of Premises Inspected. Berridge's Cottages 3 Quadrant 1 Bridge Street 1 Sheen Road 1 George Street 3 Green (The) 2 Grosvenor Road 1 Mount Ararat Road 3 Petersham Road 4 Two Houses Closed Sheen Vale 9 re-inspections St. Helena Cottages 3 re-inspections Union Court 8 Water Lane 14 re-inspections Whitecross Row 18 re-inspections North Sheen Ward. Number of houses inspected (H.T.P. Act) 2 Number of sanitary defects and nuisances reported 16 Situation of Premises Inspected. Sandycombe Road 1 West Park Road 1 Kew Ward. Number of houses inspected (H.T.P. Act) 2 Number of sanitary defects and nuisances reported 9 Situation of Premises Inspected. Priory Road. 1 Cambridge Cottages. 1 23 24 Workmen's Dwellings. The Corporation have during the last few years elected 194 houses under the Housing of the Working Classes Acts, 1890. The situation and description of the houses are as follows:— Manor Grove. No. OF Houses. Rent. Description of Houses Nos.1-12, 14, 16-23, 81-119 60 8s. per week 4 bedrooms, parlour, living room & scullery Nos. 13-15 2 7s. 6d. „ Ditto Nos. 64-79, 124 125 18 7s. 6d. D 3 bedrooms, parlour, living room & scullery. Nos. 24-35, 48-63, 120-133 42 6s. 6d. „ 2 bedrooms, parlour, living room & scullery. Nos. 36, 37, 42. 43. 44. 45 6 5s. 6d. „ 1st floor Hats, living room 2 bedrooms & scullery. Nos. 38, 39, 40. 41, 46 47 6 4s. 6d. „ Ground flats, living room 1 bedroom 6c scullery. North Sheen. Nos. 23-32, North Road 40 7s. 9d. „ Living room, kitchen, scullery (with bath) 3 bedrooms. Nos. 51-70, Dancer Road Nos. 47-65, Darell Road Victoria Place 10 6s. 6d. ,, Ground floor flats. „ „ „ 10 5s. 6d. „ 1st floor flats, living room with lobby, 2 bedrooms and scullery. Erection of New Houses. The following table shews the number of houses, etc., erected during the year ending December 31st, 1913:— Ward Houses. Shops with Flats or houses. Work150 shops Lock-up Shops. North 10 11 — – South 7 — — — East — — — West — 3 1 1 North Sheen 3 — — — Kew – — — — Totals 20 14 1 1 25 Factory and Workshop Act, 1901. The Medical Officer of Health is required by Section 132 of this Act, to report, annually on the Administration of the Act in connection with Factories, Workshops, Workplaces, and Home-work in the Borough. The following table shows the work done in supervising the various registered Workshops and Workplaces in the district:— Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors). Premises. Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries) 9 — — Workshops (Including Workshop Laundries) 306 45 — Workplaces (Other than Outworkers) premises included in Part 3 of this Report) 108 12 Total 423 57 — Defects Found. Particulars. Number of Defects. Referred to H.M Inspector Prosecutions. Found. Remedied. Want of Cleanliness 15 15 1 – Want of Ventilation 7 7 1 – Overcrowding 2 2 1 – Want of Drainage of floors 4 4 — – Other Nuisances 73 73 — – Sanitary Accommodation: Insufficient 2 2 1 – Unsuitable or Defective 5 5 1 – Not separate for sexes 2 2 1 – Breach of Special Sanitary Requirements for Bakehouses 3 3 –– Other Offences – – – – - 113 113 6 — 26 Home Work. Lists received from Employers— Twice in the year 2 Number of Outworkers 6 Once in a year 3 Number of Outworkers 6 Nature of Work— Making, &c., of Wearing Apparel. Registered Workshops. The following are the principal classes of Workshops on the Register at the end of the year— Dressmaking and Millinery 29 Laundries 18 Tailoring 15 Boot Repairing 6 Builders and Contractors 6 Cycle making, &c. 3 Furniture Upholsterers 3 Furriers, &c. 2 Bakehouses 25 Other Trades 11 118 Dining Rooms, Workplaces, &c, 58 Total 176 Other Matters. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of Act 7 Other matters 5 Action taken in matters referred by H.M. Inspector asremediable under Public Health Act :— Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other matters — Underground Bakehouses in use at end of year 6 27 The inspection of the Workshops and Workplaces in theBorough revealed the fact that the premises generally were kept in a satisfactory condition, and the requirements of theAct were being duly observed. Sanitary Administration of the District. I. Sanitary Inspector's Work. Pull details of the work carried out by the Sanitary Inspector and Staff during the year will be found at the end of this report. The report of work done during the year is extremely satisfactory, and is evidence of the diligent and efficient manner in which the Sanitary Inspector continues to carry out the responsible duties entrusted to him. 2. Isolation Hospitals. The Small-pox Hospital is situated at Dockwell in Middlesex. The position is about midway between the Bath and Staines Roads, and about one mile due west of Hounslow Barracks. Mogden Isolation Hospital for other infectious diseases issituated about midway between Isle worth and Twickenham in the County of Middlesex. The management and control of these Hospitals are under a Joint Committee of members from the Richmond Town Council and the Urban District Council of Heston and Isleworth. The Medical Superintendent of the Hospitals is Dr. Bramwell Reid. The following tables shew— (1). The yearly summary since the opening of the- Hospital. (2). Number of admissions classified. 28 mogden isolation hospital. yearly summary since the opening of the hospital Year. admissions. deaths. cases mortality, per cent. avhrage stay in hospital. daily average on books. 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. 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 .. 4.02 66 42 48 62 37.7 1901 136 57 13 4 210 3 6 2 1 12 2.2 10.5 15.3 25.0 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 25.0 .. 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 11.1 7.5 54 33 25 44 20.8 1906 109 65 5 4 183 1 5 1 1 8 0.9 7.7 20.0 25.0 4.3 56 31 41 48 24.5 1907 120 59 3 3 185 4 5 .. .. 9 3.3 8.4 .. ... 4.3 59 38 85 56 2.5 1908 148 51 5 3 208 •• 6 .. .. 6 .. 11.7 .. .. 2.8 52 33 35 45 25.3 1909 193 68 2 1 264 3 2 .. .. 5 1.5 2.9 .. .. 1.8 53 35 .. 49 35.7 1910 148 64 1 .. 213 .. 3 1 .. 4 .. 3.1 100 .. 1.8 54 34 .. 49 32.3 1911 121 45 9 .. 175 6 5 1 .. 12 5.0 1.11 11.1 .. 6.8 54 40 41 50 20.1 1912 102 42 1 .. 145 1 5 .. 6 0.8 10.9 .. .. 4.13 42 30 48 39 15.6 1913 150 66 3 9 228 2 3 1 .. 6 1.3 4.5 33.3 .. 2.6 39 19 12 32 19. 4 Since opening of the Hospital 2242 914 86 42 3285 45 94 13 3 155 2.01 10.2 15.1 7.14 4.7 48 27 24 41 22.8 29 MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED. Richmond Richmond Union. Heston and Isleworth. Isleworth Union, Hounslow Carrisoiv 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 4 183 1907 44 7 2 1 54 .. .. .. .. .. 64 22 1 1 88 9 30 .. .. 39 3 .. .. .. 4 .. .. .. .. .. 20 59 3 3 185 1908 78 20 1 1 100 .. .. .. .. .. 63 30 4 1 98 7 1 .. .. 8 .. .. .. .. .. 1 .. .. 1 2 49 51 5 3 208 1909 98 46 1 1 146 .. .. .. .. .. 90 15 1 .. 106 .. 6 .. .. 10 1 1 .. .. 2 .. .. .. .. .. 193 68 2 1 264 1910 88 41 .. .. 129 1 .. .. .. 1 55 18 1 .. 74 3 4 .. .. 7 .. 1 .. .. 1 1 .. .. .. 2 148 64 1 .. 213 1911 60 30 1 .. 91 2 .. .. .. 2 61 15 8 .. 84 12 2 .. .. 14 .. .. .. .. .. 1 .. .. .. 1 121 45 9 .. 175 1912 41 20 .. .. 61 .. 1 .. .. 1 60 15 1 .. 76 1 1 .. .. 2 .. 4 .. .. 4 .. 1 .. .. 1 102 42 1 .. 45 1913 65 36 1 6 108 .. .. .. .. .. 77 25 1 .. 103 1 6 1 .. 8 6 .. .. .. 6 .. .. .. .. .. 149 67 3 9 228 Total 1014 346 32 25 |1517 10 1 .. 1 12 1092 474 52 2 1620 51 65 1 .. 7 78 24 .. 1 103 12 7 1 9 29 2342 915 86 42 3401 30 Local or General Adoptive Acts. The following is a list of the Adoptive Acts in force in the -district :— Infectious Disease Notification Act, 1889. Infectious Disease Prevention Act, 1890. Public Health Acts Amendment Act, 1890. Private Street Works Act, 1892. Public Libraries Act, 1893. Local Government Act, 1894. Public Health Acts Amendment Act (part of),1907. Chemical and Bacteriological Investigations. Chemical and Bacteriological Analyses of the water have been carried out in the Laboratory at Eton Lodge during the year, and a report as to the condition of the water was presented to the Water Committee once a month. Chemical analysis of the town's water is made weekly. I he following are the results of the Bacteriological Investigations of the specimens forwarded to the Lister Institute of Preventive Medicine, etc. :— Disease Suspected Nature of Specimen. Result. Total. Positive. Negative. Diphtheria. Swabs from Throat,&c. 25 78 103 Enteric Fever. Blood. – 3 3 Tuberculosis. Sputum. 17 45 62 Total 42 126 168 31 Prevalence of, and Control over, Acute Infectious Diseases. The total number of cases of acute infectious disease notified during the year was 170, which is equal to an attack rate of 5.0 per 1000 of the population, as compared with an attack rate of 2.9 per 1000 for the year 1912, 3.1 per 10C0 for the year 1911, 5.0 per 1000 for the year 1910, and 6.0 per 1000 for the year 1909. Percentage of Infectious Cases Removed to Hospital. Of the 170 cases of Infectious Disease notified, 101 were removed to Hospital, which is at the rate of 59 per cent., as compared with 67 per cent. for 1912, and 71 per cent. for 1911. Small-Pox. No case of small-pox occurred in the Borough during the past year. The last case notified was in the year 1903. Diphtheria. Fifty-three cases of this disease were notified, as compared with 34 for the previous year. The attack rate was 1.5 per thousand of the population. Thirty-four patients were removed to Mogden Hospital, being 64 per cent. of the notified cases. One death occurred from this disease. Forty-one of the cases occurred in patients below 15 years of age. Thirty-two of the cases were notified in the North Ward. At the beginning of October a mild case of Diphtheria was notified in Alexandra Road. Upon investigation it was found there had been some cases of mild sore throat in the same street previously. At different periods throughout the month other cases of diphtheria arose in the same street, occurring in houses on one side of the street only. There was a history in each case of personal contact with a previous case. St. Luke's School was visited and the throats of every scholar examined, swabs being taken from those throats which showed 32 the slightest deviation from normal. In no case was there clinical evidence of diphtheria. The bacteriological examination of the swabs gave a positive result in four instances. The four scholars from whom these swabs were taken were at once isolated. Between October 29th and November 7th, there were seven other notifications of children attending the same school. The throats of all the children in one classroom were examined, and four swabs taken, but all gave a negative result. So far as could be discovered all the cases arose from personal contact, and not from any insanitary conditions at the school or dwellings. The first case discovered at the School (October, 1913), had been absent for a week, but had not been under medical treatment. The School Medical Officer took a swab and sent the boy home again. The bacteriological result was positive. Although apparently well the boy remained a " carrier" for some time. As swabs taken from time to time gave a positive result, the boy was removed to Mogden Hospital, where he remained until there was no longer any evidence of infection (February 23rd, 1914). Scarlet Fever. Ninety cases of this disease were notified, as compared with 53 for the previous year. The attack rate was 2.6 per thousand of the population. Sixty-seven cases were removed to Mogden Hospital, being 74 per cent. of the cases notified. All the cases were of a mild nature and no deaths occurred from this disease. Seventy-five of the cases occurred in patients below 15years of age. Fifty-six of the cases were notified from the North and East Wards. The following particulars concerning some of the cases are of interest:— On September 22nd, Q.S., aged 5 (case No. 83), was brought to the Health Department by the mother. The child was in the " peeling" stage of the disease. The mother stated the child had suffered from a " cold " two weeks earlier, and. 33 had attended school up to the time she was found to be peeling. Five children attending the same school subsequently contracted scarlet fever. Another child, living in the same street, was notified three days before. He had associated with this patient. On September 5th, Mrs. B. called at the Health Department for some " disinfectant," as one of her children had been notified to be suffering from scarlet fever earlier in the day. She had refused to have the child removed to the Hospital, as she doubted whether her child really had the disease, her reason being that the rash found on the child was similar to one she (herself) had about a month earlier. This woman was noticed to be slightly peeling, and was advised to go home and consult her doctor. This case was afterwards notified, as well as a third case in the same household. A child in the same road, whose father worked alongside this woman's husband, was also notified to be suffering from scarlet fever. R.H., aged 23 (case No. 69), servant, was notified on 11/9/13. Another servant (case No. 73), who worked in the same house, was notified a few days later, and also a brother of the latter (case No. 86). Following upon this, a child, aged 4 (case No. 79), who had' been in contact with the servant, contracted scarlet fever. On October 3rd, D.B., aged 6 (case No. 92), was discovered by the mother to be " peeling." A slight rash had been observed on the child about a month earlier, which the mother thought was " nettlerash." The child remained at home from school for one day only previous to the " peeling " being discovered. Two other cases of scarlet fever were notified among scholars attending the same school. On October 15th, A.W. (case No. 104), was notified to be suffering from scarlet fever, Upon investigation it was found that the patient was in the " peeling " stage. This girl was employed as a domestic servant, and had followed her ordinary duties up to the time of notification, and in addition she had moved freely about the town. 34 M.D., aged 10 (case No. 109), was discovered in the acute stage of the illness when brought to the Health Department from school. A brother of this patient, who was attending the Infants' Department of the same school, was discovered " peeling." He had been ill a week previously. Later, V.B., aged 6, of another elementary school and who resided in Twickenham, was found in school on October 20th in the " peeling " stage. This case was probably the source of infection of two other children who were in the same class at school. One of the latter resided in Mortlake. Enteric Fever. One notification of this disease was received, but was afterwards cancelled. Erysipelas. Twenty-five cases of this disease were notified during the year as compared with seven for the previous year. The attack rate was 0.70 per thousand of the population. Puerperal Fever. One case of this disease was notified during the year. The patient recovered. Attack rates of Infectious Disease compared with those of the aggregate of Boroughs and Urban Sanitary Districts in Surrey. Richmond. Aggregate of Boroughs and Urban Districts (Surrey). Diphtheria 1.5 1.37 Scarlet Fever 2.6 2.37 Enteric Fever 0.0 0.12 Puerperal Fever ... 0.03 0.06 Erysipelas 0.70 0.49 Acute Poliomyelitis. One case of acute poliomyelitis, or infantile paralysis, was notified during the year. The patient was a boy, aged 3 years. Soon after his recovery the patient left the district. 35 Table shewing Notifications of Infectious Diseases from 1903 to 1913. Disease. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Annual Average 1903-1912 1913 Small-pox 1 .. .. .. .. .. .. .. .. .. 0.1 .. Scarlet fever 119 68 46 59 51 90 136 105 78 53 80.5 90 Diphtheria & membranous croup 43 21 11 16 22 41 65 60 39 34 35.2 53 Enteric fever 13 7 13 8 4 5 4 1 2 3 6.0 .. Continued fever 1 .. .. .. .. .. .. .. .. .. 0.1 .. Erysipelas 18 20 23 10 16 11 16 11 12 7 14.4 25 Puerperal fever .. 2 2 1 .. .. .. .. .. .. 0.5 1 Typhus Fever .. .. 1 .. .. .. .. .. .. .. 0.1 .. Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. 1 Totals 195 118 96 94 93 147 221 177 131 97 136.9 170 36 Measles, Whooping-Cough, Chicken-Pox and Mumps. These diseases occurring among school children are notified' by the Head Teachers. A Special Report upon Measles was presented to the Council through the Health Committee, in December. Arrangements have been made by the District Nursing Association to allocate a nurse to attend cases of Measles in the event of another outbreak. Measures taken to prevent the spread of Infectious Disease. The routine duties as to visitation, removal to hospital, disinfection of dwellings and articles of clothing, and other procedure in connection with any case of infectious disease brought to the notice of the Health Department, were well carried out by the staff during the year. The measures adopted to prevent the spread of disease were fully described in my Annual Report for 1906. Prevalence of, and Control over Tuberculosis. Previous Orders of the Local Government Board, as tothe Notification of Pulmonary Tuberculosis were:— 1. The Public Health (Tuberculosis) Regulations 1908, which enforced notification of Pulmonary Tuberculosis under Poor Law Officials. 2. The Tuberculosis in Hospitals Regulations (22nd March 1911), relating to patients attending Voluntary Hospitals. 3. The Public Health (Tuberculosis) Regulations 1912, making compulsory the notification of all cases of Pulmonary Tuberculosis. On the 20th December, 1912, the Local Government Board issued further Regulations, viz:—The Public Health (Tuberculosis) Regulations 1912, which came into operation onFebruary 1st, 1913, and consolidated and amended all previous Regulations. 37 The circular letter of the Board dated 20th December, 1912, states:— " The new Regulations apply to non-pulmonary as well as to pulmonary tuberculosis. More than half the deaths from non-pulmonary tuberculosis are of children under five years of age, and it is probable that a much higher percentage of the total number of persons suffering from non-pulmonary tuberculosis are children of this age. It is hoped that notifications of these cases will facilitate the investigation of sources of infection and assist in securing improvements in the conditions under which the children live." 38 Notifications of Tuberculosis received during: the Year 1913. 73 Notifications of Tuberculosis were received during the year, viz.: 61 Notifications of Pulmonary tuberculosis (39 males and 22 females), and 12 Notifications of Non-Pulmonary tuberculosis (4 males and 8 females). 150 Visits were made to the homes of Tubercular patients during the year. The following table shows the age periods, etc., of the cases notified : Disease. Cases Notified. Total Cases notified in each Ward. At Ages—Years. Total 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and up'rds North. South. East. West. North Sheen. Kew. Total. Pulmonary Tuberculosis … 7 14 30 10 … 61 14 5 23 11 8 … 61 Non-Pulm'y. Tuberculosis 2 5 2 1 1 1 12 5 1 3 2 … 1 12 Totals 2 12 16 31 11 1 73 19 6 26 13 8 1 73 As will be observed from the foregoing table: 16-4 per cent. of the cases notified occurred in persons between 5 and 15 years. 21-9 per cent. of the cases notified occurred in persons between 15 and 25 years, 42 4 per cent. of the cases notified occurred in persons between 25 and 45 years. 18 out of the 73 cases notified, died, and 9 had left the district at the end of the year. 39 During investigation of the cases of Pulmonary Tuberculosis, thefamily history was obtained in 50 instances, and it was ascertained that tuberculosis had occurred in near relatives in 30 instances. A similar history was ascertained in 3 out of the 12 NonPulmonary cases. The Non-Pulmonary cases received treatment as follows: St. Nicholas Home, Pyrford 1 Richmond Royal Hospital 3 London Hospitals 3 Putney Hospital 1 Occupations of persons suffering from Pulmonary Tuberculosis. indoor workers. outdoor workers. Home Workers 14 Labourers 8 Scholars 7 Painters 4 Clerks 5 Gardeners 0 Boot Repairers 3 Newsboy (father tubercular) 1 Shop Attendants 2 Compositor 1 Mechanic 1 Grocer 1 Carman 1 Fishmonger 1 Horsekeeper 1 Waiter 1 Packer 1 Dressmaker 1 Golf Ball Maker 1 No Occupation 5 Of the 61 cases of Pulmonary Tuberculosis — 32 were insured persons, 14 were non-insured, and 15 were dependents. Of the 12 Non-Pulmonary cases— 1 was an insured person, 2 were non-insured, and 9 were dependents. Institutional Treatment. Thirty-one Pulmonary cases and one Non-Pulmonary case received some form of Institutional treatment. 40 (a) Either by the County Insurance Committee, (b) Private sources, (c) Local Hospital or Guardians. The particulars of the Institutional treatment are as follows:— Pulmonary Cases—Frimley Sanatorium 2. Royal Sanatorium, Bournemouth 1. Dartmoor Sanatorium 1. Crooksbury Sanatorium 3. Ventnor Sanatorium 1. St. Michael's Home, Asbridge, 1. Private Sanatorium 1. Fulham Hospital (out patient), 1. Brompton Hospital (out-patient), 1. Victoria Park Hospital (out-patient) 1 Richmond Royal Hospital (out-patients) 4. Richmond Union Infirmary 11. Two cases were removed to Brookwood Asylum, and one case to Croydon Mental Hospital. Action taken upon Receipt of Notification. (a) Visits made on Receipt of Primary Notification. Upon receipt of a notification of Tuberculosis, the home of the patient is visited by the Medical Officer of Health, or Health Visitor, and the history of the case is recorded in a scheduled form and filed for future reference. All patients are visited by the direction of the Medical Officer of Health, unless the certifying practitioner indicates that an official visit is not desirable. In such instances the Medical Practitioner in attendance is requested to supply the necessary information. Advice is given to the occupants of the house as to the measures which should be taken to prevent the spread of infection, and a leaflet on pr ecautions to be observed, as well as particulars relating to the disease, illustrated in a graphic manner, is left with the patient. An inspection of the dwelling house is made by the Sanitary Inspector, and defective and insanitary conditions found to exist are dealt with as early as possible. 41 The total number of visits made by the Health Visitor 011 receipt of primary notifications was 63. (b) Subsequent Visits. Subsequent visits are made to the homes by the Health Visitor to see that the instructions given on the primary visit are being duly observed. 87 such visits were made during the year. (c) Nature of any arrangements for the detection of unrecognised cases of Tuberculosis associated with notified cases of the disease. Arrangements have been made whereby Medical Practitioners may forward suspected samples of sputum for bacteriological examination to the Royal Lister Institute of Preventive Medicine. The outfits for the collection and transmission of such sputum are kept at the Health Department. The expenses of such examinations are defrayed by the Health Committee. The sub-dispensary proposed to be established in the Borough by the Surrey County Council is not yet in existence. (d) IV|easures of Cleansing and Disinfection. Disinfection is carried out when the patient is removed to an institution or vacates the premises. Occupiers are also advised to have the bedding, clothing, and other articles likely to retain infection removed and disinfected. Where necessary, owners of houses occupied by tubercular patients are requested to strip and cleanse the walls and ceilings, &c., of infected rooms. The work arising out of disinfection of premises has grown considerably, since compulsory notification of all cases of Tuberculosis came into force. During the past year 299 rooms at 208 houses were disinfected from various causes, and bedding was removed in 139 instances. Of these, 61 were in connection with tubercular cases. 42 "Disinfectant" fluid is also supplied to occupiers of premises when a case of Tuberculosis or other infectious disease is notified. The following are particulars concerning the deaths from Tuberculosis occurring in the Borough during the year 1913:— Table A. Age Incidence. Pulmonary Tuberculosis. Tubercular Meningitis Other Tubercular Diseases. Total. Male. Female Male. Female. Male. Female. Under 1 year ... ... ... ... 1 ... 1 1 year and under 2 years ... ... ... ... 1 ... 1 2 years „ 5 „ ... ... 1 ... ... ... 2 5 „ „ 15 „ ... ... 1 ... 1 ... 2 15 „ „ 20 „ 3 ... ... ... 1 ... 4 20 „ „ 25 „ 1 l ... ... ... ... 3 25 ,, „ 30 „ 3 ... ... ... ... • • • 3 30 „ „ 35 „ 2 3 ... ... 1 ... 6 35 ,, ,, 40 ,, 1 2 ... ... ... ... 3 40 „ 45 „ 4 1 ... ... ... ... 5 45 „ „ 50 „ 2 ... ... ... ... ... 2 50 „ „ 55 „ 2 ... ... ... ... ... 2 55 „ „ 60 „ ... ... ... ... 1 • • • 1 60 „ „ 65 „ 1 ... ... ... ... ... 1 65 „ and upwards ... 1 ... ... ... l 2 Total 19 8 2 l 6 2 38 Table. B. Ward. Pulmonary Tuberculosis. Tubercular Meningitis. Other Tubercular Diseases. Total. Male. Female. Male. Female. Mule. Fmale. North 3 2 1 ... 2 ... 8 South 7 ... ... ... 1 ... *8 East 7 3 ... ... 1 2 13 West 1 1 ... l 1 ... 4 North Sheen 1 2 ... ... 1 ... 4 Kew ... ... l ... ... ... 1 Total 19 8 2 l 6 2 38 *Of the 8 deaths allocated to the South Ward, six occurred in the Workhouse Infirmary. 43 Deaths from Pulmonary Tuberculosis, 1913. The following list shows the occupations, sex and ages of those persons belonging to the Borough, whose deaths were due to Pulmonary Tuberculosis during the year 1913. Employment. Male. Female. Ages. Clerk 2 ... 61, 28 Home Worker ... 5 30, 39, 42, 39, 31 Scholar 1 ... 7 Paper Boy 1 ... 15 Boatman 1 ... 41 Grocer's Assistant 1 ... 19 Stockbroker 1 ... 28 Shoemaker 2 ... 32, 33 Painter 2 ... 23, 40 Potman 1 ... 42 Labourer 3 ... 54, 30, 43 No occupation ... 3 26,21,65 Printer 1 ... 18 Messenger 1 ... 46 Gardener 1 ... 51 Plate Grinder 1 ... 18 Totals 19 8 Average age at death, 34 years. The average annual number of Deaths from Tuberculosis in the Borough of Richmond for the five years ending 31st December, 1908, was 45; for the five years ending December 31st, 1913, (he annual average was 35 2. 44 Means for Preventing: Mortality in Childbirth and Infancy. Midwives Act. The administration of this Act is carried out by the Surrey County Council, and your Medical Officer has no information on the subject. Infantile Mortality. By the term "Infantile Mortality" is meant the proportion of infants who die before reaching the age of twelve months to the total number born during the year. The total number of deaths under one year of age was 51, giving a rate of 82 per thousand registered births. This shows an increase over the preceding year of 12, when the deaths under one year totalled 42, giving a rate of 70 per thousand. The infantile mortality rate throughout England and Wales was 109 per thousand. Of the 51 deaths of infants under one year, 10 infants failed to survive the first week of life. The following table shows the periods in which 51 deaths took place :— Under one month 15 One month and under three months 11 Three months „ six „ 12 Six „ „ nine „ 9 Nine „ „ twelve ,, 4 Total 51 An important report was issued in July, 1913, by the Medical Officer of the Local Government Board, relative to Infantile Mortality. The report sets out similar facts as to 241 Urban areas whose populations vary between 20,000 and three quarters of a million, and whose aggregate population comprises nearly three-fifths of the total population of the country. For the first time, the Sanitary Authorities and Medical Officers of Health of the 241 Urban areas comprised within the scope of this report are able to ascertain the exact relative 45 position of the areas for whose public health welfare they are responsible, not only in respect of total mortality at ages 0-1 and 1-5 years, but also in respect of mortality in different parts of infancy, and from the chief causes of death. The report shews the mean rates for the four years 19071910 in the 241 largest Urban areas of England and Wales. These rates varied from 189.0 per 1,000 in Stalybridge, to 67 in Hornsey, Richmond appearing in the lowest 25 towns with an infantile mortality of 80. Among the 111 smaller towns, having a population of between 20,000 and 50,000, Richmond occupied the eleventh place. On further analysis, the position of Richmond among the smaller towns was classified as being 12th lowest in death rate for 0-1 month 5th lowest „ ,, 6-12 months 5th lowest „ the group of 5 6th lowest „ „ 1-5 years bracketed. Notification of Births Act. The Health Committee are considering the question as to the adoption of the Notification of Births Act. The Richmond Infants' Health Society was formed in 1908, on the suggestion of the Medical Officer of Health. It consists of an Hon. Secretary and nine Visitors, all educated and experienced ladies who reside in the Borough. Each worker has a district, and visits are made to the homes, chiefly upon intimation from the doctors and midwives. The midwives are given stamped and printed cards, on which they write the name and address of the patient, and the same is posted to the Hon. Secretary, who forwards it to the Visitor for the particular district. The Visitor makes a call within a few days, and afterwards visits regularly for the first year or eighteen months. Advice is given to the mother upon all matters concerning the healthy rearing of infants. During the year 1913 the homes of 222 infants were visited, as compared with 218 during the previous year. 46 Of the 222 infants, 121 were males and 101 females. One hundred and sixty eight infants were stated to have been breast fed. Eight deaths were notified, all of whom had been entirely breast fed. Vital Statistics of the District. Population Estimated in 1913. The Vital Statistics are based upon an estimate of the population at the middle of the year. The Registrar-General estimated the population of the Borough at 33,592, an increase of 166 over the population for 1912. ferriages. In the course of the year marriages took place within the Borough as follows:— By the Established Church 146 At other places of public worship 28 At the offices of the Registrar 127 301 Births. The number of births registered during the year was 616. Correction must be made for the transferable births from particulars supplied by the Registrar-General. There were ten inward transfers and nine outward transfers, leaving the corrected number of births for the year at 617, as compared with 598 for the previous year. Of the 617 births, there were 315 males, and 302 females. There were 46 illegitimate births. The birth rate was 18.3 per thousand, as compared with 17.8 for the year 1912. The rate for England and Wales for the year 1913 was 23'9 per thousand. Deaths. The total number of deaths registered in the district during 1913 was 495. Of these, 85 were those of non-residents, viz., persons who had a fixed residence or whose usual resi- 47 dence was outside the Borough, but who died in Richmond. In accordance with the instructions of the Registrar-General, this number is deducted from the registered deaths, and transferred to the respective districts. On the other hand, 48 persons whose homes were in Richmond died outside the district, and these have been added to the registered deaths, making the total number of deaths belonging to the district 458. This gives a death rate of 13 6 but the Registrar-General has supplied a "factor" to correct the age and sex distribution in the Borough. This "factor" is .9296. The corrected death rate for the Borough for the year 1913 was therefore 12.6. The death rate for England and Wales for the year 1913 was 13'4 per thousand of the population. Forty-two per cent, of the deaths which occurred in the Borough during the year 1913 were of persons over 65 years of age. One hundred and fifty of the deaths in the Borough occurred in persons over 70 years of age, viz.:— 81 between 70 and 80 years of age. 62 „ 80 „ 90 7 „ 90 „ 100 Particulars of Transferable Deaths. Of the 85 deaths of non-residents registered in the district 76 took place in public institutions, viz., 42 in the Workhouse Infirmary and 34 in the Royal Hospital, The remainder took place in various parts of the Borough, viz., 4 in the river Thames, and 5 in other parts of the Borough. Deaths of Residents Registered outside the District. The deaths occurring outside the district of persons belonging to the Borough were 48. 48 Table showing particulars of deaths of Residents registered outside the district. Where death occurred. Male Female Total Battersea, River Thames - 1 1 Chiswick, Nursing Home — 1 1 „ River Thames 1 — 1 Chailey, St. George's Retreat, Ditchling — 1 1 Chelsea, Nursing Home 1 — 1 Croydon, Private House — 2 2 Egham, Sanatorium, Virginia Water 1 — 1 Finchley, Nursing Home — 1 1 Greenwich, Seamen's Hospital 1 — 1 Godstone, Mental Hospital — 1 1 Hammersmith Infirmary 1 — 1 „ West London Hospital 1 3 4 Hackney, German Hospital 1 — 1 Harrogate, Hotel - — 1 Heston and Isleworth, Mogden Hospital 1 — 1 Holborn, French Hospital 1 — 1 „ {National „ 1 — 1 Isle of Thanet, Private House 2 — 2 Lambeth, „ „ — 1 1 Margate, 1 — 1 Paddington, Nursing Home 1 — 1 Reigate, Netherne Asylum 2 — 2 Slough, Private House — 1 1 Southwark, Eveline Hospital — 1 1 Staines, Private House - 1 1 Stepney, London Hospital 1 - 1 St. Marylebone, Middlesex Hospital 1 2 3 St. Pancras, University College Hospital 1 — 1 Wandsworth, Putney Railway Station 1 — 1 „ Private House 2 - 2 ,, (Royal Hospital — 1 1 Westminster (Nursing Home 1 1 2 „ 1n Street 1 — 1 Woking, Brookwood Asylum 2 3 5 Total 27 21 48 49 Zygotic Death Rate. Chief Epidemic Diseases.—By the Zymotic death rate is meant the number of deaths per thousand of the population due to the seven chief epidemic diseases, viz.: — Notifiable (1) Small-pox (2) Scarlet Fever (3) Diphtheria (4) Fevers—Typhus, Enteric, Continued. (5) Measles Non-Notifiable (6) Whooping Cough (7) Diarrhoea. The number of deaths due to the seven principal "Zymotic diseases" was 29, as compared with 9 for the previous year. This gives a Zymotic death rate of 0.80 per thousand, as compared with 0 20 for 1912, 1.25 for 1911, and 0.24 for 1910. Scarlet Fever. No deaths. Diphtheria. One death, between five and under fifteen years. Enteric Fever. No deaths. Measles. This disease was very prevalent during the early part of the year. Eighteen deaths were recorded :— 3 were under 1 year of age; 9, 1 and under 2 years ; 4, 2 and under 5 years ; 2, 5 and under 15 years. During the past 10 years, there have been six times as many deaths from measles as from scarlet fever in the Borough of Richmond, Whooping Cough. One death was due to this disease, as compared with 3 for the year 1912. Diarrhcea. Nine deaths were notified, as compared with three for the year 1912. Seven deaths were under one year of age. 50 Table showing deaths for the past ten years due to the seven chief Epidemic diseases:— No. of Deaths. Total 10 Yrs. Cause of Death. 1904 . 1905 1906 1907 1908 1909 0161 1911 1912 1913 Small-pox ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 1 1 2 ... ... 2 1 2 1 ... 10 Diphtheria, including Membranous Croup 3 3 3 2 2 ... 3 4 1 1 22 Fever— Enteric ... 4 1 ... ... 1 ... 1 1 ... 8 Measles 13 4 2 4 2 8 1 8 ... 18 60 Whooping Cough 11 25 5 6 5 1 1 10 3 1 68 Diarrhoea 23 10 17 7 11 9 3 18 3 9 110 51 47 30 19 20 21 9 43 9 29 278 Influenza. Seven deaths occurred from this disease, as compared with 18 deaths for the previous year. Cancer, During the year 48 deaths were registered due to the different forms of malignant disease. Of these 23 were males and 25 females. The death rate was 1.4 per thousand of the population. The age incidence was as follows:— Between 25 and 45 years 4 „ 45 „ 65 years 25 65years and upwards 19 51 Respiratory Diseases. Seventy-four deaths were registered as due to diseases of the chest other than phthisis. This gives a mortality of 2.2 per 1,000, as compared with 2.0 for 1912, 1.8 for 1911, 1.8 for 1910, and 2.1 for 1909. Tuberculosis. Thirty-eight deaths were due to this disease, giving a rate of 1.1 per 1,000 of the population, as compared with l.0 per 1,000 for 1912, and 1.1 for 1911. Mortality in Age Croups. The following table shows the deaths in groups according to age periods— Deaths in Groups. 1913. 1912. Under 1 year of age 51 42 Between 1 year and under 2 years 18 6 „ 2 years ,, 5 years 12 8 „ 5 years „ 15 years 12 13 ,, 15 years „ 25 years 15 24 „ 25 years ,, 45 years 54 43 ,, 45 years „ 65 years 104 101 65 years and upwards 192 193 Total 1 458 430 Inquests. The number of inquests held in the Borough of Richmond during 1913 was 60, as compared with 45 for 1912, and 53 for the year 1911. Mortuary, During the year 59 bodies were received at the Mortuary, 31 males, 21 females and 7 infants. Post mortem examinations were made upon 34 bodies. 52 Sanitary Work of the Health Department, Staff. Sanitary Inspector Assistant Sanitary Inspector „ „ Clerk George Laws, C. R. S.I. W. Stanley Parsons (Resigned July, 1913). F. H. Lennard, A. R. S.I. (Appointed July, 1913). Miss E. Bond. Inspection of District. Systematic inspection of the district has been continued during the year, in compliance with the provisions of the Public Health Acts and the general orders of the Local Government Board, relating to Housing, etc. From the items enumerated in the summary at the end of this report, it will be evident that a considerable amount of structural improvements and alterations have been effected. The total number of inspections made during the year was 5,985, and the number of sanitary defects and nuisances reported for abatement was 2,870. Four hundred and thirty-five informal, and 93 statutory notices were served, and the number of interviews with owners of property, builders and contractors, etc., was 482. Legal proceedings to enforce the abatement of nuisances had to be resorted to on three occasions. Complaints. The number of complaints received was 233, as compared with 232 for the previous year. Each complaint is duly recorded in a special register, and investigated as early as possible, prompt measures being taken to effect the abatement of nuisances reported. 53 The following summary gives details of the complaints received and dealt with during the year:— Alleged defective and chcUed drains 65 Accumulations of refuse or manure 17 Non-removal of house refuse 16 Alleged over-crowding 15 Insanitary condition of house 13 Defective receptacles for household refuse 11 Nuisance from dampness 11 Nuisance from animals 8 Defective and uncovered drinking water cisterns 8 Insanitary water closets and urinals 11 Defective roofs, gutters and spouting 10 Smells from public sewer 6 Nuisance from stables 7 Nuisance from chimneys 5 Insanitary condition of passage 3 Burning of refuse 3 Flooding of basements 2 Unsound food 2 Dirty food store 1 Nuisance from rats 1 Other complaints 18 233 House Drainage. The amount of work carried out during the past year under this heading was considerably in excess of that executed in previous years. The drainage systems of 95 houses were either entirely reconstructed, or repaired, according to the nature of the defects discovered. Seventy houses were entirely re-drained and the sanitary fittings brought up-to-date; at twenty-five houses the drains and sanitary fittings were repaired. In sixty instances written application was made to the Local Authority under the Public Health Acts, 1875 to 1907, for the examination of drains and water closets. The necessary 54 authority having been obtained, written notice was served on the occupier of each house, notifying them of the intention of the Local Authority to examine the drains. In each instance defective conditions were found and the usual notices were served to alter and amend the drains and fittings. All such notices served during the year were complied with. New drains are required to be constructed of salt glazed stoneware or heavy cast iron pipes laid on a suitable bed of concrete, the concrete being extended to at least half-way up the sides of the pipes. Where a drain passes under a building, the pipes used are usually of heavy cast iron properly coated, and laid in concrete to a thickness of six inches, suitable manholes for access and cleansing purposes being provided. The drains are disconnected from the public sewer by means of an intercepting trap fixed in a man-hole. The internal brickwork of the man-holes are rendered with cement, and made watertight, iron air-tight frames and covers being provided at the ground level. The ventilation of the drainage system is effected by means of a fresh air inlet fitted with a mica flap valve, connected with the intercepting chamber, and a 4in. galvanized or heavy cast iron pipe with molten lead caulked joints is erected at the summit of the drains. On completion of each re-drainage scheme, a survey and final test of the drains and fittings are made by the Inspector, and a block plan is prepared and filed for future reference. Such plans, together with other tabulated particulars, form a complete and valuable record of all alterations and re-drainage carried out in the district. Of the houses re-drained during the year, 54 were on the combined drainage system, viz.: conduits receiving the drainage of more than one house. In five instances, such conduits serving 17 houses were found to be in one ownership, and as the "law'' defines such conduits to be sewers, the Local Authority were put to the expense of re-laying them. Attention has been drawn in previous Annual Reports to the advisability of the Corporation obtaining a private Act, to 55 amend this anomaly. Many Authorities have obtained such powers whereby these combined drains are repairable by the owner of the property. Drains. Forty-eight choked drains were unstopped and cleansed, and five intercepting traps were each provided with a sealed cap, twenty-one manholes were cleansed and repaired, and twenty-nine manholes were provided with new air tight covers, in lieu of defective ones, nine drainage systems not previously ventilated were provided with suitable ventilating shafts, and forty-four defective drain ventilators were repaired or renewed. Gully Traps. Ninety-seven defective brick, stoneware or iron gully traps were ordered to be removed and substituted by properly glazed stoneware self-cleansing fittings. In 14 instances additional gullies were provided, and at 26 houses the gully traps having been found in a filthy concondition were cleansed after notice had been given to the occupier to cleanse same. Urinals. Four urinals were found to be in a foul and defective condition, and notices to cleanse and repair same were complied with. In two instances the flushing arrangements were found to be defective and inadequate. These defects were remedied under notice from the department. Soil and Ventilating Pipes. Twenty-one defective soil pipes wer eremoved and replaced by strong cast iron pipes having molten lead caulked joints. Six defective soil pipe ventilating shafts were repaired or renewed and on three occasions rain water pipes were found connected with soil pipes, these were disconnected and made to discharge over or into properly trapped gullies and the soil pipes properly ventilated. Water Closets. Seventy-five foul and defective closet pans were removed and substituted by suitable pedestal wash down closets. 56 Forty-four defective waste water preventers were removed and new ones provided. Nine closets not previously supplied with water had the water supply properly laid 011. Twenty-five water closet flush pipes which were found connected directly to the drinking water tank by means of a spindle valve were disconnected, and suitable waste water preventer or flush-box provided. One additional water closet was provided where the existing accommodation was found to be insufficient. Twenty dilapidated closet buildings were repaired and put in order, and in nineteen instances the lighting and ventilation of such buildings were improved. Sinks. Fifty-five foul and defective absorbent stone sinks were abolished and new glazed stoneware trough sinks substituted. Twelve houses were found to be without a suitable sink, but suitable sinks were provided by the owners upon written request from the Health Department. Thirty-two defective waste pipes were properly trapped and ventilated. In connection with this class of nuisance the following statement appears in a special report recently issued by a departmental committee of the Local Government Board on house drainage:— "There seems to be 110 doubt that untrapped "waste pipes of sinks and lavatories discharging into "the open air, even those which are of short length, "may be the cause of serious nuisance inside the "dwelling, and that such pipes, 011 this account, need to "be provided with efficient traps close to the fittings to "which they belong." Testing of Drains and Sanitary Fittings. The number of tests applied to drains and sanitary fittings during the year was 344. Smoke tests applied to old drains, etc., 214. Water tests applied to new drains, 123. 57 Coloured water tests, 7. The application of the smoke test revealed defective conditions in 70 instances. Drainage systems were opened out and examined on 60 occasions. On many occasions it was found that repairs and alterations had been surreptitiously made to drains and sanitary fittings which were not in accordance with modern methods. In order to adequately safeguard public health, a Local Authority should have power to render it a penal offence for alterations or amendments to be made to drains and sanitary fittings without notice having been given to the Local Authority of their intention to execute such repairs. Many Local Authorities have such powers in operation and they have proved to be of considerable benefit. Water Fittings. One of the most important points in connection with the inspection of a dwelling is that pertaining to the water supply. During the past year 196 defective conditions were reported and dealt with, viz.:— Defective drinking water tanks, 27. Defective covers to tanks, 74. Storage tanks in a dirty condition, 53. Water tanks in unsuitable and inaccessible positions, 17. Water tanks connected directly with closets, 25. Dampness. One hundred and sixty-three nuisances due to damp house walls were reported during the year and a considerable amount of work was involved to secure a satisfactory remedy of such nuisances. The nuisance in the majority of cases resulted from the absence of a damp proof course in the walls. One hundred and two notices were served to remedy the nuisance by inserting a suitable damp proof course in the walls, under the level of the lowest timbers. A vertical damp course was also provided where the ground adjoining the walls was above the floor level. The nature of the damp course provided consisted 58 either of vitrified glazed stoneware bricks, bituminous asphalte or two courses of slates set in cement. In many instances it was necessary to take up the floors and remove several inches in depth of subsoil in order to obtain a sufficient cavity under the floor joists. The site was afterwards concreted and a sufficient number of air gratings provided in the front and back walls of the house. On two occasions the subsoil was so wet as to render the provision of subsoil drains necessary. The cause of dampness in sixty-one instances was due to the perished and defective condition of the brickwork. The walls were either properly re-pointed with cement mortar or the whole surface of the brickwork floated with cement. In eighty-one instances the floors and joists were repaired, and adequate ventilation of the floor cavity provided in 77 instances. Defective eaves, gutters and spouting contributed to the cause of dampness in 73 instances. Defective Paving. A defective or unpaved yard surface often has an important effect upon the general sanitary condition of the house premises. The percolation of a large amount of rain water into the soil is frequently a cause of dampness in the house walls. Another serious nuisance is the fact that during wet weather the surface of such yard allows of the accumulation of stagnant pools of water about the house and premises. The paving and drainage of yards in connection with and exclusively belonging to a dwelling house is enforceable in the Borough under Section 25 of the Public Health Acts Amendment Act, 1907. The Local Authority may require the owner of any yard which is not so formed, flagged, asphalted or paved as to allow of the effectual drainage of the sub-soil or surface water, to execute all such works as are necessary for the purpose, within 21 days. In default of the notice not being complied with, the Local Authority may do the work and recover the expenses. 59 During the year, notices were served for the paving of 50 unpaved yard surfaces, and to repair the existing defective paving in 98 instances. Lighting and Ventilation. On 63 occasions the ventilation of bedrooms was found to be unsatisfactory, owing to the want of means of through ventilation, due to the absence of a fireplace. In each instance notice was served to provide means of through ventilation by the provision of a suitable ventilating grating in the outer wall of the room. On 10 occasions the lighting of the room was found to be inadequate, and was improved by increasing the window area. Forty-five notices were served, requiring the windows to be made to open top and bottom; and 10 notices were served requiring removal of temporary wooden buildings, which were found erected against the house wall and shutting out the light and air from the house premises. Dust Receptacles. Section 36 of the Public Health Act, 1875, empowers the Local Authority to require that every house shall be provided with sufficient ashpit accommodation. During the year 25 ashpits were found to be in a defective condition, these were abolished and suitable portable galvanised iron receptacles provided. 269 defective dustbins were also found to be unsuitable or defective, and these were substituted by new and efficient galvanised iron receptacles. The cause of nuisance in many cases was contributed to by the householders depositing liquid filth in the receptacles. Dirty House Premises. Two hundred and sixty-seven rooms, at 95 houses were found to be in a dirty condition, these were ordered to be cleansed by stripping the wall paper, and distempering the walls and ceilings. 60 Fifty Notices were served upon occupiers to remove accumulations of filth, cleanse dirty and verminous beds and bedding, cleanse house floors and yard surfaces, etc. Overcrowding. Fewer cases of overcrowding were reported during the year, 13 houses were found to be so overcrowded as to constitute a nuisance, dangerous to the health of the inmates, as compared with 22 cases for 1912 and 35 for 1911. Notice to abate the nuisance was served in each instance and complied with. Notification of Dirty and Verminous Persons by the School Medical Officer. As a result of the Medical Inspection of school children 15 notifications of children found to be in a dirty and verminous condition were received from the School Medical Officer. The homes of the children were visited and in 6 instances the premises and bedding were found to be in a dirty and verminous condition. Instructions were given to the occupiers as to the thorough cleansing of the bedding and house premises, and subsequent inspections were made to see that the instructions had been complied with. Infectious Disease and Disinfection. All cases of infectious disease are visited immediately upon receipt of the notification. Upon the termination of the case, or when the patient is removed to hospital, the room and contents are disinfected by means of formalin. Similarly all cases of tuberculosis are visited by the Health Visitor, and revisits are made, at frequent intervals. Disinfection of the room and contents is offered and generally accepted. Arrangements are carried out for the removal and disinfection of all infected articles and bedding. The work entailed in visiting the homes of patients and the subsequent disinfection of the premises has considerably increased as shown by the particulars in the following table:— 61 Cause. Visits made. Rooms disinfected. No. of Houses. Bedding &c. removed. 1913. 1912. 1913. 1912. 1913. 1912. 1913. 1912. Zymotic 372 159 200 100 139 74 108 98 disease Tuber- 150 76 61 60 48 40 14 20 culosis Other 36 10 25 14 18 7 14 4 diseases Vermin 16 26 13 61 3 18 3 1 Totals 574 271 299 235 208 139 139 123 Stable Premises. Two hundred and three visits were made to stable premises during the year, as compared with 71 visits for the previous year. Nineteen notices were served for the cleansing and limewashing of stables, &c., 13 notices, to remove offensive accumulations of manure, 5 notices to provide suitable manure receptacles, and 6 notices to repair dilapidated stable buildings and amend the defective paving and drainage. All notices were complied with. As a rule, manure is removed from the stables in the Borough once a week, and in some instances twice a week. The frequent removal of stable manure and offensive accumulations of filth is an important factor in preventing the spread of disease, as flies have their breeding places in all kinds of accumulations of filth and breed in such refuse with great rapidity. Factory and Workshops Act, 1901. The number of workshops and work places on the register at the end of the year was 176, an increase of three over the previous year. The provisions of the Act, which the Local Authority has to administer relate chiefly to the following matters:— (1) (a) Cleanliness. (b) Air space. 62 (c) Ventilation. (d) Drainage. (e) Provision of Sanitary Conveniences for both sexes. (2) The provision of means of escape in case of fire in Factories and Workshops in which more than 40 persons are employed. (3) Sanitary regulations for Bakehouses. (4) Homework. Further details of the work carried out by your Inspectors, are described in the special report of the Medical Officer of Health to the Secretary of State, and is Contained in the first part of this report. Outworkers' Premises. Five lists from employers were received during the year. The addresses of the workers in the Borough were visited and the premises inspected. All were found in a satisfactory condition. The names and addresses of persons living outside the district but employed by Contractors in the Borough were forwarded to the Medical Officers of Health of the respective districts. Trade Premises. Included under this heading are the:— (a) Dairies, Cowsheds and Milkshops. (b) Slaughterhouses. (c) Fried Fish Shops. (d) Shops—re food supplies. All the premises recorded in the registers have been periodically inspected during the year, and any matters found requiring attention were promptly dealt with. Further particulars of the inspections made, together with a list of the defects and nuisances dealt with are enumerated in the summary at the end of this report. 63 Public Dining Rooms and Tea Rooms. The number of premises on the register at the end of the year was 64. These were all systematically inspected, and 16 sanitary defects and nuisances dealt with. Additional urinal accommodation was provided in two instances, and the closet accommodation improved in three instances. Strict attention was given to the general cleanliness, also the lighting and ventilation of the kitchen premises. The food supplies were also inspected and found to be satisfactory. Manufacture of Ice Cream. There are six known pr emises in the Borough occupied by Italians, where Ice Cream is manufactured for sale in the streets. The premises have been inspected during the year, and were found to be kept in a clean condition. At present there are no regulations in force in the district for controlling the manufacture of this commodity. Destructive Insects and Pests Acts, 1877-1907. American Cooseberry Mildew Order, 1912. During the year three outbreaks of "mildew" were discovered, the bushes affected being situated in the Allotments at Petersham and a market garden in the Kew district. The Board of Agriculture and Fisheries were informed, and the Sanitary Inspector, accompanied by the Board's Inspector, visited the Allotments, and gave written instructions for the affected bushes to be properly pruned and tipped and the affected parts burned. The notices were complied with. The Wart Disease of Potatoes Order, 1912. One notice was received from the Board of Agriculture and Fisheries during the year that wart disease had been discovered on the Petersham Allotments. The Sanitary Inspector was appointed in September as Inspector under the above Orders, and gave instructions for the Regulations of the Board to be complied with. 64 General. The records of the work of the Department are kept on the card index system, and are filed away for future reference. All clerical matters have been promptly and efficiently attended to and kept up to date. The following are the tabulated particulars shewing the nature of inspections and details of the sanitary defects and nuisances dealt with during the year ending December 31st, 1913 :— Summary of Sanitary Inspector's Report for the Year, 1913. Tabulated particulars of the number and nature of inspections, and the sanitary defects and nuisances dealt with during the year ending December 31st, 1913. Houses. No. of houses inspected and particulars recorded, H.T.P. Act 298 No. of houses re-visited, H.T.P. Act 82 No. of houses found unfit for human habitation 10 No. of houses inspected or visited (ordinarily) 1552 No. of visits to works in progress 2508 Roofs repaired 54 Plaster on walls and ceilings repaired 90 Dilapidated and dangerous ceilings renewed 3 Dilapidated and dangerous walls re-built 9 Floors repaired or renewed 81 Ventilation provided under floors 77 Windows made to open top and bottom 45 Want of means of through ventilation to bedrooms (air shaft provided) 63 Window frames made weather-proof 13 Window area inadequate (window enlarged) 10 Fireplaces causing smoke nuisance; remedied 10 Dilapidated staircases repaired or renewed 3 Damp walls (damp course provided) 102 Damp walls (brickwork re-pointed) 61 65 Houses cleansed, whitewashed, etc. 95 Floors and yards cleansed by occupiers 15 Dirty and verminous bedding cleansed 4 Overcrowding (remedied) 13 Refuse accumulations removed 29 Temporary buildings, shutting out light and air to house premises, removed 10 Nuisances caused by the keeping of fowls and animals (remedied) 9 Dilapidated outbuildings remedied 7 Cellars cleansed and whitewashed 2 Rooms cleansed after disinfection of premises 299 Miscellaneous defects remedied 15 Drains. Number of applications of smoke test 214 „ „ water test 123 „ „ colour test 7 Drainage systems bared for examination 60 Drainage systems re-constructed 70 Drainage systems repaired 25 Branch drains re-laid 231 Unstopped and cleansed 48 Intercepting trap provided with sealed cap 4 Manholes cleansed and repaired 21 Manhole cover repaired 29 Drains ventilated 9 Fresh air inlet repaired 27 Extract ventilating shaft renewed or repaired 18 Cully Traps. Defective gullies renewed 97 Want of gullies 14 Filthy traps cleansed 26 Soil and Vent Pipes. New soil pipes provided 21 Ventilating shaft renewed or repaired 1 Rain water pipes disconnected from soil pipes 3 Soil pipes ventilate 5 66 Water Closets. New pan and trap provided 75 Various defects remedied 6 Filthy pans cleansed 17 Dilapidated closet buildings repaired 20 Light and ventilation provided to closet buildings 19 Waste water preventer repaired or renewed 44 Closets provided with flushing apparatus 9 Spindle valve abolished, flush pipe disconnected from drinking water tank, and waste water preventer provided 25 Additional closet accommodation provided 1 Eaves Cutlers and Rain Water Pipes. Eaves gutters, and rain water pipes renewed 73 Rain water pipes disconnected from drains 36 Paving. Yards paved, 50; paving repaired, 98 148 Ashpits and Dustbins. Ashpit abolished and dustbin provided 25 New dustbins provided 269 Water Supply. Water fittings causing waste of water 11 Drinking water tanks renewed 17 New covers to storage tanks provided 74 Dirty storage tanks cleansed 53 Storage tanks made accessible for cleansing 17 Sinks, Foul sinks substituted by new ones 55 Want of sink and trapped lead waste pipe 12 Waste Pipes. Trapped, repaired, and ventilated 32 Disconnected from drains 6 Brick kerbing amended 12 67 Urinals, Number inspected 15 Cleansed and repaired 4 Flushing apparatus provided 2 Stables. Number inspected 203 Paving and drainage repaired 4 Cleansed and limewashed 16 Manure accumulations removed 13 Filthy stable yards cleansed 3 Manure receptacles provided or repaired 5 Dilapidated stable buildings repaired 2 Factories. Number inspected 9 Workshops. Number inspected 237 Cleansed and limewashed 6 Overcrowding, cases remedied 2 Abstract provided 3 Additional light and ventilation provided 3 Various other nuisances remedied 32 Insufficiency of closet accommodation remedied 0 Closets not separate for sexes remedied 4 W.C.'s unsuitable or defective 4 Outworkers' Premises. Number inspected 20 Bakehouses. Number inspected 69 Cleansed and limewashed 9 Various other nuisances remedied 34 Dining Rooms and Restaurants. Number inspected 108 Premises cleansed 2 Nuisances and defects remedied 16 Additional sanitary accommodation provided 2 68 Fried Fish Shops. Number inspected 9 Premises cleansed 2 Nuisances and defects remedied 5 Slaughterhouses. Number inspected 18 Premises cleansed 6 Dairies, Cowsheds and Millshops. Number inspected 120 Persons newly registered for sale of milk 3 Premises cleansed 3 Covers provided to milk receptacles 0 Various nuisances remedied 3 Ice Cream Premises. Number inspected 16 Premises cleansed 4 Nuisances remedied 3 Shops re Food Supplies. Number inspected 171 Food stores cleansed 5 Piggeries. Number inspected 18 Premises limewashed 6 Paving and drainage repaired 4 Prevention of Infectious Diseases. Number of visits of inquiry made 372 Number of rooms disinfected 299 Number of books sent for disinfection 41 Smoke Nuisances. Number of observations made 16 Emissions of black smoke (time limit exceeded) 2 Canal Boats. Number inspected 0 Visits to Wharfs 50 69 Complaints. Received and attended to 233 Consultations. With owners, builders, and others re abatement of nuisances 482 Legal Proceedings. Summonses issued 3 Clerical Work. Informal Notices served 435 Statutory Notices 93 Letters written 739 Letters received 825 70 Legal Proceedings. No. Nature of Offence. Date of Proceedings. Result of Proceedings. 1 Failing to abate nuisances arising from defective paving, defective drinking water tank, foul and defective w.c., defective floors and walls, damp walls, and defective roof. March 17th, 1913 Defendant ordered to pay costs, and order made to complete the work in 14 days. 2 Failing to abate nuisances arising from defective roof and defective paving. April 21st, 1913 Case withdrawn on payment of costs. Notice complied with before date summons returnable. 3 Failing to abate nuisances arising from defective paving. October 20th, 1913 Ditto. Customs and lnland Revenue Act, 1890, Section 26. Revenue Act, 1903, Section II. Five applications for Certificates as to Inhabited House Duty were received under this Act during the year and four were granted. (Signed) J. H. CROCKER, M.D., &c„ Medical Ofticer of Health. Public Health Department, 38, Sheen Road, Richmond, Surrey. March 31st, 1914. 71 Table I OF L.G.B. VITAL STATISTICS OF WHOLE DISTRICT DURING 1913 AND PREVIOUS YEARS, borough of richmond (surrey). Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Under 1 year of age At all Ages. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate. Number. Rate per 1,000 Nett Births Number Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 32794 612 612 18.6 462 14.0 50 14 65 106 426 12.9 1909 32949 610 610 18.5 446 13.5 62 22 48 77 406 12.3 1910 33104 609 609 18.3 356 10.7 46 15 37 60 325 9.8 1911 33390 55o 550 16.4 463 13.8 77 36 64 116 422 12.6 1912 33426 603 598 17.8 471 14.0 80 39 42 70 430 12.8 1913 33592 616 617 18.3 495 14.7 85 48 51 82 458 13.6 Area of District in acres (land and inland water) 2599. Total population at all ages 33,223 Number of Inhabited Houses 6,545 Average number of Persons per House 5 07 At Census of 1911. 72 Table II. of L.G.B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. Borough of Richmond, (Surrey). Notifiable Disease Number of Cases Notified. Total Cases Notified in each Locality. (e.g. Parish or Ward) of the District. Total Cases removed to Hospital. At all Ages. At Ages—Years North. South. East. West. North Sheen. Kew. Total. 1 to 5. 5 to 15 15 to 25 25 to 45. 45 to 65. 65 and upwards Diphtheria (including Membranous Croup) 53 4 37 6 5 .. 1 32 2 9 3 6 1 53 34 Erysipelas 25 .. 4 3 9 6 3 11 3 5 2 2 2 25 .. Scarlet fever 90 10 65 9 6 .. .. 23 5 33 14 11 4 90 67 Enteric fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. Poliomyelitis l 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. Pulmonary Tuberculosis 61 .. 7 14 30 10 .. 14 5 23 11 8 .. 61 .. Tuberculosis 12 2 5 2 1 1 1 5 1 3 2 .. 1 12 .. Totals 243 17 118 34 52 17 5 86 16 74 32 27 8 243 101 Small-pox Hospital—Dockwell, Middlesex, Isolation Hospital- -Mogden, Middlesex Joint Hospital Committee. The Workhouse is situated in the South Ward. 73 TABLE III. of L.G.B. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1913. Borough of Richmond (Surrey). Causes of Death (All Certified). Nett Deaths at the subjoined ages of "Residents” whether occurring within or without the district. Total Deaths whether of “Residents” or ''non-Resident' in Insti tutions in the District. All ages. Under 1 year 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25 25 and under 45. 45 and under 65. 65 anc upwards Enteric Fever .. .. .. .. .. .. .. .. .. .. Measles 18 3 9 4 2 .. .. .. .. .. Whooping-Cough 1 .. 1 .. .. .. .. .. .. .. Diphtheria and Croup 1 .. .. .. 1 .. .. .. .. .. Influenza 7 .. .. .. .. .. 1 2 .. .. Erysipelas 2 .. .. .. .. .. .. 1 1 .. Phthisis (Pulmonary Tuberculosis) 27 .. .. .. .. 5 16 5 1 9 Tuberculous Meningitis 3 .. .. .. .. .. .. .. .. 2 Other tuberculous diseases 8 1 1 .. 1 2 1 1 1 1 Cancer, malignant disease 48 .. .. .. .. .. 4 25 19 22 Meningitis 2 2 .. .. .. .. .. .. .. .. Organic Heart Disease 55 .. .. .. .. 2 7 19 27 16 Bronchitis 29 1 .. .. .. .. .. 2 26 6 Pneumonia (all forms) 41 7 .. .. .. .. 9 4 8 8 Other diseases of Respiratory Organs 4 .. .. .. 1 .. .. 1 2 2 Diarrhoea and Enteritis 9 7 .. .. .. .. .. .. 1 1 Appendicitis and Typhlitis 3 .. .. .. .. .. .. 1 .. 3 Cirrhosis of liver i .. .. .. .. .. .. .. 1 1 Alcoholism 5 .. .. .. .. .. 1 3 1 3 Nephritis and Bright's Disease 13 .. .. .. .. .. 1 3 9 6 Other accidents and diseases of Pregnancy and Parturition 1 .. .. .. .. 1 .. .. .. 1 Congenital Debility and Malformation including Premature Birth 18 18 .. .. .. .. .. .. .. 8 Violent Deaths, excluding Suicide 13 1 .. .. .. .. 2 5 3 4 Suicides 8 .. .. .. .. .. 2 5 1 5 Other Defined Diseases 136 10 .. .. .. 3 10 26 84 61 Diseases ill-defined or unknown 5 1 .. .. .. .. .. 1 3 1 Totals 458 51 18 12 12 15 54 104 192 160 74 Table IV of L.G.B. BOROUGH OF RICHMOND (SURREY). INFANTILE MORTALITY DURINC THE YEAR 1913. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week 1 1-2 Weeks. 2-3 Week. 3-4 Weeks. Total under 4 weeks. 4 weeks & under 3 Months. 3-6 Months. 6-9 Months. 1 9-12 Months. Total Deaths under 1 Year All Causes. Certified 11 2 2 1 16 10 12 9 4 51 Measles .. .. .. .. .. .. 1 1 3 Abdominal Tuberculosis .. .. .. .. .. .. 1 .. .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. 2 .. 2 Convulsions .. .. .. .. .. 1 .. .. .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. 1 .. .. 1 Pneumonia (all forms) .. .. 1 1 2 2 6 Diarrhoea .. .. .. .. .. .. 1 .. .. 1 Enteritis .. .. .. .. .. 3 2 1 .. 6 Gastritis .. .. .. .. .. 1 .. .. .. 1 Syphilis .. 1 .. .. 1 .. .. .. .. 1 Rickets .. .. .. .. .. .. 1 .. .. 1 Suffocation, overlying .. .. .. .. .. .. 2 .. .. 2 Injury at birth 2 .. .. .. 2 .. .. .. .. 2 Atelectasis .. .. .. 1 1 .. .. 1 .. 2 Congenital Malformations .. .. .. .. .. .. .. 1 .. 2 Premature Birth 8 .. .. .. 8 2 1 .. .. 11 Atrophy, Debility and Marasmus .. 1 1 .. 2 1 1 1 .. 5 Other Causes 1 .. .. .. 1 .. .. .. .. 2 11 2 2 1 |16 10 12 9 4 51 Nett Births in the year legitimate 579 illegitimate, 38 Nett Deaths in the year legitimate infants 45 illegitimate infants 6 75 RICHMOND PUBLIC BATHS—SUPERINTENDENT'S RETURN OF BATHERS from 1st January to 31st December, 1913 PERIOD SWIMMING BATHS. WARM BATHS. TOTALS. Football Exchange. Dressing Boxes. 1st Class. 2nd Class. 1st Class. 2nd Class. Swimming. Warm. Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies Gents. Ladies January 1st to March 31st 181 11 134 2637 153 1495 806 315 11 4132 959 494 379 April 1st to June 27th 10497 4598 14861 4462 1554 245 2614 1407 25358 9060 4168 1652 - — June 28th to October 3rd 12082 5044 13761 3975 2260 271 3096 1645 25843 9019 5356 1916 39 29 October 4th to December 31st 1167 37i 1332 327 2161 152 1510 839 2499 698 3671 991 771 434 Totals 23927 10024 30888 8764 8612 821 8715 4697 54015 18788 17327 5518 1304 842 Corresponding period of last year (1912) 26033 9217 226l8 5804 7943 861 8285 4140 48651 15021 1623 500I 1336 854 Corresponding Corresponding Corresponding Corresponding Corresponding period of 1912. period of 1911. period of 1910. period of 1909. period of 1908. Total Number of Males (including Dressing Box Tickets) 734,88 67,071 67,828 61,047 56,465 64,278 Total Number of Females 24,306 20,022 20,134 18,145 15,944 15,842 Total Bathers 97,794 87,093 87,962 79.192 72,409 80,120 Average Shade Temperature at Noon 60° 601/3° 623/5° 58¾° 58° 59°