RICH 051 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER of HEALTH FOR THE YEAR 1920, by C. W. HUTT, M.A., M.D., D.P.H., Medical Officer of Health and School Medical Officer, &c., Borough of Richmond. Consulting Physician, Mogden and Dockwell Isolation Hospitals, richmond: j. h. broad and co., printers, king street. 2 HEALTH COMMITTEE. Alderman Dr. G. J. Maguire (Chairman. Alderman Bernays. Councillor Mrs. Ethel Johnstone, „ Randall. „ Laws. „ Dr. Taylor. „ Mangbr. Councillor Bevan. ,, Maycock. „ Mrs. Ellen Edwards Morrison. „ A. D. Ellis. „ Sanderson. „ Gladwell. PUBLIC HEALTH DEPARTMENT. STAFF. Medical Officer of Health : C. W. Hutt, M.A., M.D., D.P.H. Chief Sanitary Inspector: Geo. Laws, M. R. San. I,, Ceraified Inspector of Meat and other Foods. Assistant Sanitary Inspector : F. H. Lennard, A. R. San. 1. Certified Inspector of Meat and other Foods. School Nurses and Health Visitors. Nurse Dinford. Nurse Fryar. Clerks : Miss E. D. Bond. Miss F. H. Bramwell. 3 STATISTICAL SUMMARY, 1920. Population, estimated to middle of year (as supplied by the Registrar General), for Birth and Death Rates 35 572 Population, Census 1911 33,233 Births 735 Annual Rate of Births per 1,000 population 20.7 Deaths 406 Annual Rate of Deaths per 1,000 population 11.4 Zymotic Death Rate 0.31 Excess of Registered Births over Deaths 329 Infantile Mortality per 1,000 Births 57 Area. The total area of the Borough is 2,599 acres Excluding tidal water and foreshore 2.491 acres Rateable Value £337,198 A Rate of 1d. in the £ yields £1,323 VITAL STATISTICS OF ENGLAND & WALES. Annual Rates per 1,000 living. Deaths under 1 year to 1,000 Births. Births. Deaths England and Wales 25.4 12.4 80 RICHMOND 20.7 114 57 4 Public Health Department, 38, Sheen Road, Richmond, Surrey. March, 1921. To the Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gbntlbmen, Herewith I beg to present a Report upon the Health and Sanitary Condition of the Borough for the year 1920, which has been prepared in compliance with the instructions of the Ministry of Health. 1 would like to pay a tribute to the work carried out on behalf of the Borough by my predecessor, Dr. J. H. Crocker. One of the features of the year has been the response to the requirements for an increase in the amount of Infant Welfare work, a work of national importance. The work for the prevention of tuberculosis has been amplified In consequence of a letter received from the President of the British Red Cross Society and the Order of St. John, Sir Arthur Stanley, arrangements were made so that ladies belonging to the local Voluntary Aid Detachment could take part in the Public Health work of the Borough. In connection with Mater nity and Child Welfare work arrangements have been made with the Richmond District Nursing Association whereby four ladies were given an insight into the district nursing so that their services will be available when required, especially during an epidemic. At the Infant Welfare Centre the services cf six ladies are being utilised one afternoon a week. At the School Clinic six ladies have assisted in the treatment of the children with the help of the school nurses. The experiment has been a marked success. Believe me, Ladies and Gentlemen, Yours obediently, C. W. HUTT, Medical Officer of Health. 5 NATURAL, SOCIAL AND SANITARY CONDITIONS OF THE DISTRICT. The Borough of Richmond lies upon the South Bank of the Thames. Incorporated by Royal Charter in 1890, its boundaries were in 1892 enlarged by the inclusion of the parishes of Kew, Petersham and a portion of Mortlake, the combined area amounting to 2,599 acres. The subsoil is chiefly gravel and sand, interspersed with patches of clay on the Hill. The Borough is chiefly a residential district, the few industries being Building, Dy???ng and Cleaning Works, Electric Lamp Works, Bottling business, and those industries and occupations connected with Boating. The Secretary, Mr. Richard Allen, has kindly supplied the following information:—The number of patients treated at the Royal Hospital during 1920 were: In-patients, 594 ; other patients, 5,741. The patients attending from the Borough of Richmond were: In-patients, 215; Out-patients, 582, Ophthalmic patients, 376; and Dental patients, 69. I am indebted to Mr. Percy Umney, the Clerk to the Guardians, for the following particulars:— No. of persons in receipt of Medical Relief only (31/12/20) 27 Average weekly number of persons relieved in the Sick Wards 74 No. of Tuberculous patients (since re-opening Institution on 10/5/20) 9 No. of Maternity patients (since re-opening Institution on 10/5/20) 15 6 Marriages. The marriages this year have been 456, as compared to 517 last year. For the three years before the war, 1911, 1912 and 1913, the average was 302. Births. Year. No. Total Birth Rate. Legitimate. Total. Birth Rate. Illegitimate. Total Birth Rate, M. No. F. No. M. No. F. No. 1911 550 16.4 276 244 520 15.6 16 14 30 0.8 1912 598 17.8 281 297 578 17.2 8 12 20 0.6 1913 617 18.3 294 277 571 17.0 21 25 46 1.3 1914 616 18.2 304 272 576 17.0 22 18 40 1.2 1915 580 17.2 292 261 553 16.4 16 11 27 0.8 1916 545 15.0 270 239 509 14.0 17 19 36 1.0 1917 452 12.1 224 192 416 11.2 24 12 36 0.9 1918 441 11.7 216 189 405 10.8 22 14 36 0.9 1919 479 13.4 224 220 444 12.4 20 15 35 1.0 1920 735 20.7 342 338 680 19.2 26 29 65 1.5 Deaths. There have been 406 deaths this year, as compared to 437 last year. The death rate is 11.4 this year (12.8 last year). Zymotic Death Rate. There have been 11 deaths from Zymotic Disease this year as compared to 10 last year. The Zymotic death rate is 0.31. 7 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water. The Borough Water Supply is obtained from the following sources:— (a) Deep wells about 300 feet deep which pass through the London clay 160 feet thick, the Woolwich and Reading beds 60 feet thick, the Thanet sands 23 feet thick and penetrate the chalk for about 30 feet. At the depth of about 300 feet from the surface some two miles of adits have been cut in various directions to collect the water from the various isolated fissures which are found in the chalk. The water collected from this source has been naturally softened by passing through the Thanet Sands, and the hardness is only about 5 (Clark's Scale), i.e., 5 grains per gallon or 7 parts per 100,000 of salts causing temporary or permanent hardness. (b) Petersham Well—Conduits from this well intercept and collect the water flowing through the gravel beds on top of the London clay. This water is treated when the occasion arises on open sand filter beds installed at Petersham; since 1919, chlorination has been carried out, and has by now generally proved adequate by itself for the purification of this water. Pure Chlorine Gas is used and is administered and measured by a " Wallace-Tiernan " plant. It is found with this water that a dose of Chlorine as small as 1 part in 4,000,000 to 1 part in 5,000 000, causes a degree of purification adequate for all ??? purposes and superior to that obtained by open sand filters. The hardness of this water is about 22° (Clark's Scale), but as before pumping into the mains it is mixed with the water obtained from the Deep Well the hardness is Considerably modified. 8 (c) Bulk Supply.—This water is taken directly from the Metropolitan Water Board Mains to make up the deficiency in the yield from the Corporation's own sources of supply. (d) River water is pumped directly from the Thames and distributed by a system of mains entirely distinct from the domestic supply mains. It is used for flushing sewers, watering streets and gardens, and for some trade purposes. A constant supply is given to all parts of the Borough with the exception of the upper parts of the houses situated on the highest parts of Richmond Hill—here the cisterns are filled in the morning by increasing the pressure in the pumping main for about an hour. The average consumption of water per head per day for all purposes is about 36 gallons and is an increasing quantity in spite of a continuous system of waste detection. The increase appears to be due almost entirely to a growing carelessness in the use of water. The total consumption from the various sources for the twelve months ending March 31st, 1921, was: — Gallons. Deep Wells 66,348.000 Petersham Well 138,738,000 Metropolitan Water Board 201,216,000 Total Domestic Water 406,302,000 River Water 64,161,000 Total Consumption 470,463,000 Drainage and Sewerage. All house dr???s discharge into the sewers. The construction of drains for new buildings is upervised by the staff of the Borough Surveyor, after plans for the erection of new buildings have been approved by the Highways Committee, 9 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 oollecting 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 Pigeons Hotel under the towpath as far as and under Friars Lane across Richmond Green and by way of Parkshot and the Railway Station Yard 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 load 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 ago, 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 procipitation and bacterial filtering beds, the effluent passing into the Thames. The Engineer to the Main Sewerage Board is Mr. J. T. Fairley, M.I.C.E. Water closet accommodation is general throughout the Borough. 10 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 arrangement entered into between the Corporation and the Barnes Urban District Council whereby the Barnes Council have undertaken to burn the house and ordinary trade refuse produced within the Borough, at their Destructor at Mortlake, has been carried out since January 7th, 1921. Sanitary Inspection of District. Report of Sanitary Inspector. In compliance with Article XX (16) of the Local Government Board's General Order of 1910, I have the honour to submit the following repot upon the work carried out during the year 11 The following table shows the number of routine inspections made Inspections during 1920. Number of houses inspected and particulars recorded (H.T.P. Act, 1909) 130 ,. houses visited (P.H. Acts) 773 ,, revisits to houses and other premises 1932 „ miscellaneous visits 322 „ visits to works in progress 470 ,, visits to factories 35 ., visits to workshops, bakehouses, etc. 153 „ visits to outworkers premises 11 „ visits to workplaces, tea rooms, etc. 43 ,, visits to dairies, cowsheds and milkshops 45 „ visits to ice cream vendors 17 „ visits to food stores 243 ,, visits to slaughterhouses 24 „ visits to fried fish shops 31 „ visits to stables 57 „ visits to piggeries 6 ,, visits to urinals 40 „ visits under Destructive Insects Acts 42 „ visits under Canal Boat Acts 24 „ visits to school premises 15 ,, visits re infectious diseases 289 „ smoke observations 22 „ visits re Shops' Acts 145 ,, special visits re letting of Corporation new houses 41 ,, meetings attended 49 Total visits made 4958 12 NOTICES. The following table shews the particulars of the notices served:— Preliminary Notices 352 Statutory Notices under Sec. 94 Public Health Act, 1875, to abate nuisances 82 187 „ under Sec. 25, Public Health Acts Amendment Act, 1907, pave yards 22 ,, under Sec. 36, Public Health Act, 1875, to provide a sufficient dust receptacle 65 ,, to provide a sufficient water closet 9 „ under Sec. 41, Public Health Act, to alter and amend drains, W.C.'s, etc. 6 „ under Sec. 49, Public Health Act, 1875, to remove offensive accumulations 3 Total 539 The number of interviews or consultations with owners of property, builders, etc., re abatement of nuisances or the execution of sanitary improvements was 307. In one instance legal proceedings were commenced, the work, however, was done, and the owner paid the cost of the summons. In 34 other cases delay occurred, but the work was eventually carried out; three statutory notices had to be served. 13 House Drainage. The drainage systems and sanitary arrangements of 55 houses were entirely reconstructed, 65 drainage systems were repaired or cleansed and sundry repairs were effected at 55 premises. As the result of the application of the smoke test, 30 written applications were made to the Local Authority for permission to open out ground and examine the drains after twenty-four hours' notice in writing to the occupiers of the premises. The conditions found were duly reported to the Health Committee and notices were served requiring the reconstruction, alteration or amendment of the defective drains. In two instances the notices were not complied with. The Health Committee resolved that in accordance with the terms of the notice the work be carried out by the Local Authority through their contractor and the costs recovered from the respective owners. The work was duly executed on behalf of the Council at a cost of £47 6s. 2d. Particulars of the work involved in testing and examination of drains and sanitary fittings during the year is as follows:— Application of Smoke Test 151 ,, Water Test (new work) 90 „ Chemical Test — Drainage systems opened out for examination 30 Total 271 14 SANITARY IMPROVEMENTS. Water Supply. Drinking water cisterns repaired, cleansed, or covered 53 Water fittings, repaired or renewed 41 Taps provided direct from rising main 40 Water Closets. New pans fixed 50 Walls, roofs, etc., repaired 66 Lighting and ventilation improved 9 Flushing cisterns repaired and renewed 79 Soil Pipes. Repaired, renewed or ventilated 23 Drains. System reconstructed 55 Repaired or cleansed 65 Sundry drainage repairs 55 Manholes provided or repaired 35 Ventilating pipes repaired or renewed 32 Disused cesspool abolished 1 Dustbins. New provided 190 Yard Paving. Repaired 51 Newly pav«d 19 Sinks, etc New provided 58 New waste pipes provided 39 Waste pipes repaired, trapped or ventilated 60 15 Sanitary Improvements—continued. Dampness. Roofs repaired 124 Gutters and downspouts repaired or renewed 107 Damp courses fixed 36 External walls repaired 61 Floor cavities ventilated 37 Site of house concreted 4 General Repairs. Walls and ceilings repaired 256 Floors repaired 143 Windows repaired, etc. 279 Stoves, coppers, etc., repaired 85 Rooms cleansed and redecorated 351 Outbuildings repaired or renewed 15 Accumulations of refuse removed 21 Rooms ventilated 22 Miscellaneous 7 Stables. Manure accumulations removed 4 Manure receptacles provided 2 Urinals. New provided 1 Repaired, etc. 4 Water supply reinstated 9 Total 2582 16 Sanitary Condition of Theatres, Music Halls, &c. The attention of Local Authorities has been directed to. this subject by the Minister of Health during the past year by the receipt of a circular letter to the effect that the Minister of Health had recently received numerous serious complaints which the Ministry were satisfied in many instances were justified respecting the unsatisfactory sanitary conditions, more especially in the accommodation for the artistes and staff employed, which obtain in theatres and music hails in different parts of the country. He suggested sanitary inspection of these premises and added to at the Secretary of State was suggesting to the Licensing Authorities that where any such report is received by them, they should cause the licensee of the premises to be informed that unless the conditions are promptly remedied, the matter will be taken into consideration when the question of the renewal of the license com's before them. The Secretary of State is also suggesting that when considering an application for the grant or renewal of a licence in respect of any theatre, music hall, or other place of public entertainment, the Licensing Authority should require a certificate from the inspector of nuisances that the condition of the building is satisfactory in sanitary and other respects, and if they desire to grant or renew the licence they should attach such conditions to it as will ensure the building being maintained in a proper state. Acting upon the suggestions contained in this letter the General Put poses Committee of the Council asked to be furnished with a report upon the sanitary conditions. &c., of the Richmond Hippodrome prior to the renewal of the annual license in November A detailed inspection of the building was accordingly made with special reference to the following:— (a) Lavatory and sanitary accommodation. (b) Ventilation and condition of dressing rooms. (c) Ventilation of auditorium. (d) Precautions against fire. (e) General cleanliness of the premises. 17 The result of the inspection shewed that the building was in all respects maintained in a satisfactory condition. Licences for Music and Dancing and Cinemas are considered by the Music and Licensing Committee of the Surrey County Council, Bitting at the County Hall, Kingston, in October of each year. With regard to Stage Play Licences, the General Purposes Committee of the Town Council make recommendations to the Council at their meeting on the 9th November of each year as to the granting of these Licences. Canal Boats Acts, 1877-1884. In accordance with section 3 of the Canal Boats Acts 1884,1 beg to report as follows: During the year ending December 31st, 1920, 24 visits were made to the wharfs along the river side in order to asceitain whether any boats coming under the definition of Canal Boats were plying their trade within the Borough Boundaries. No Canal Boats were seen or inspected. A few vessels were found "moored" at the wharf, but on examination they proved to be registered as" Ships" under the Merchant Shipping Acts. The Canal Boat Traffic has for some years past been directed away from Richmond. Shops Acts. The number of shops on tbe register at the end of the year was 793. Systematic inspection of the district has been carried out from time to time and the provisions of the Shops Acts appeared to be generally well observed. 20 minor infringements of Section 1 (2) of the A???t were reported and remedied. This section requires that piinted notices in ,the ???rescribed form having reference to the week day on which assistants are not employed after 1.30 p.m. shall be exhib??>ed. One tradesman was summoned in December for serving customers after the p???scribed hour for closing. Several complaints 18 had been received and although an official warning had been given the offence was repeated. The defendant was fined 20s. Destructive Insects and Pests Acts. No infringements of the Orders under these Acts were reported during the year. Market Gardeners and Allotment Holders have been circularised in the past upon the necessity of reporting the existence of disease known as the American Gooseberry Mildew on their fruit bushes or " Wart Disease " in the potato crops. Non-notification of these diseases or pests renders the g??? liable to a penalty. In December at the request of the Board of Agriculture owners of plum trees were notified by letter that under the Silver Lea Ol der of 1919 growers must grub up and burn all dead plum trees and cart away and burn all dead wood from plum trees before 1st April of each year under a penalty for neglect. Similarly a circular letter was forwarded to all persons in the Borough registered for the sale of Seed Potatoes as to the declaration necessary under the Wart Disease of Potatoes (Imported Scottish Seed Potatoes Order of 1920), in respect of all consignments of potatoes from Scotland into this country. George Laws, Chief Sanitary Inspector. Camps. A large camp was held in the Old Deer Park at the end of July and the beginning of August. When the holding of further camps is contemplated, I would recommend that the sanction of the Corporation should only be given on the condition that the sanitary accommodation to be provided shall be provided before the rest of the camp is erected and that a penalty clause be inserted in the agreement between the responsible persons and the sanitary contractors embodying this condition. 19 Exhumation of Bodies. In accordance with a letter received from the Under Secretary of State, Home Office, Whitehall, exhumations were made of the bodies of nine Australian war workers in the part of Fulham Cemetery situated within the Borough of Richmond. Your Medical Officer and Chief Sanitary Inpector supervised the removals, which were carried out satisfactorily by the Cemetery Superintendent and the staff. Schools. A separate report is issued on School Hygiene by the Medical Officer of Health, who is also School Medical Officer. FOOD. Milk Supply.—There are three registered cowkeepers and 24 dairymen and purveyors of milk r egistered under the Dairies, Cow sheds and Milkshops Orders within the Borough. The number of dairy cows kept in cowsheds in the Borough at the end of 1920 was 42. The cowsheds, dairies and miikshops have beer kept under snpervision during the year and were generally found to be kept in a satisfactory condition. In a few instances verbal warnings were ssued to milk sellers as to the necessity of keeping the milk vessels properly covered to protect the milk from contamination by dust etc. The quantity of milk used in the district averages 14,620 allons each week. Of this quantity 820 gallons is produced within the Borough, the remaining 13,800 gallons is imported into the district by train. For work done under the Milk (Mothers and Children) Order, 1919, see page 32. 20 UNSOUND FOOD. The following is a list of the unsound food condemned during the year 1920:- Commodity. Condition. Result of action taken. 80 lbs. frozen beef Decomposition Surrendered 28 lbs. frozen ment Deep seated mould ” 31 lbs. 5 ozs. frozen lamb Deep sealed mould ” 16 lbs. mutton Decomposition ” 21 lbs. ox kidneys ” ” 5 boxes herrings (578 lbs. ” ” 1 box skate (42 lbs.) ” ” 1 box cod fish (168 lbs.) ” ” 8 boxes kippers ” ” 2 boxes English rabbits ” ” (88 lbs) Fly-blown ” 3 boxes frozen rabbits (146 lbs) Decomposition ” 30 lbs. canned beef ” ” 5 lbs. brawn ” ” 14 lbs. tripe ” ” 40½ lbs. bacon ” ” 51 tins condensed milk ” ” 1 case (400) Egyptian eggs ” ” 4 meat pies Mouldy Seized & owner ” warned 51 lbs. dates Maggotty Surrendered 16 lbs. apples Rotten ” The number of slaughter-houses in use in the district are as follows:— In 1914. In January, 1920. In December, 1920. Registered 4 4 4 Licensed Nil Nil Nil Total 4 4 4 21 Only one of these slaughter-houses has been in frequent use during the past year. Bakehouses. There are 23 registered bakehouses on the register. 7 of which are below ground. These have been regularly visited and, with one exception, were found to be in a satisfactory condition. This bakehouse requires alteration and amendment. Notice has been given to bring it up to the requisite standard, and plans have been approved by the Health Committee for the re-construction of same. Slaughterhouses. There are lour registered slaughterhouses in the Borough. Frequent inspections of the premises have been made. There are very few animals slaughtered locally, as the greater portion of the meat sold in the district comes direct from the Wholesale Markets in London. Sale of Food and Drugs Acts (1875 to 1907). The duties in connection with these Acts have been carried out in the Borough by the Inspector acting under the County Council. The County Inspector, Mr. R. A. Houghton, has kindly furnished the following particulars fur 1920. 22 Article. Number Purchased. Number Genuine. Adulterated. Proceedings taken. Convictions. Fines and Costs. £ s. d. Milk 73 71 2 2 2 6 5 0 Butter 4 3 1 — — — Lemon Squash 3 2 1 1 1 30 10 0 Raisin Wine 1 1 — — — Port (flavour) Wine 1 — 1 1 — — Cornflour 1 1 — — — — Salad Oil 2 2 — — — — Baking Powder 1 1 — — — — Ham Rissole 1 1 — — — — Totals 87 82 5 4 3 36 15 0 In addition 4 informal samples of butter were analysed, one of which was found to be adulterated or deteriorated ; four other informal samples were also analysed. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASE. Small Pox. On April 25th a letter was received from the Medical Officer of Health, Twickenham, stating that a patient suffering from Small Pox had been about in Richmond and had been in contact with several people, For her information was obtained and in the end three contacts were vaccinated; the vaccinations all "took," The 23 matter was reported to the Health Committee, who went into the desirability of putting the case for vaccination against Small Pox prominently before the public. On Dr. Maguire's suggestion it was arranged that a leaflet on the matter should be drawn up by the Medical Officer of Health and sent out to the parents in the case of every birth registered in the area. This has been carried out since July 22nd. Diphtheria. The attack rate per 1,000 of the population has been 1.48. 43 cases were removed to hospital, making 81 per cent. of the total number, 53. A certain number of the patients notified were suffering from bacteriological diphtheria, i.e., a mild form, capable, however, of spreading the disease of a deadly character. On account of the extreme prevalence of diphtheria and scarlet fever in London and the surrounding districts bacteriological examination of the noses and throats of patients suspected to be suffering from Diphtheria and also all contacts was of extreme importance during the latter half of the year. A number of cases that otherwise would not have been detected were found, also 12 positive contacts. The practice generally carried out was to swab school children and children below school age able to walk. When thought advisable swabs of the nose as well as the throat were taken In positive cases swabs were taken about fortnightly until the child was no longer found to harbour diphtheria bacilli. When a child has harboured diphtheria bacilli in its nose and throat for more than about six weeks I have referred the parents to the Inoculation Department of St. Mary's Hospital, who have made a vaccine from the germs present in the child's throat to in???culate him. Three children were treated in this way. The details are as follows:— Child No. 1. Given 4 inoculations; treatment commenced 8-12-20 treatment ended 5-1-21 Child No. 2. Given 9 inoculations; treatment commenced 26-1-21 treatment ended 31-3-21 24 Child No. 3. Given 7 inoculations; treatment commenced 2-2-21 first negative swab 30-3-21 Diphtheria antitoxin is obtainable from a local chemist for prophylactic purposes at the expense of the Council. Scarlet Fever. Scarlet fever was also unduly prevalent in London and neighbourhood during last autumn. There were 41 cases notified during the year, the attack rate per 1,000 of the population being 1.15. Twenty-eight cases were removed to hospital, making 68 per cent. of the total number. Enteric Fever. One case of enteric fever has been notified this year. Encephalitis Lethargica was made notifiable from January 1st, 1919. Notifications were received during the year relating to two patients: there was obviously no connection between the sources of origin of the two cases. Both patients unfortunately died. There were three cases of malaria notified, one case of dysentery, three cases of primary pneumonia, and four cases of influenzal pneumonia. Seven cases of erysipelas were also notfied during the year. In view of the fact that sanitary defects are more common in the houses of patients suffering from this disease arrangements have been made for the special sanitary inspection of such houses, also for the disinfection of any bedding required. Tuberculosis. The Tuberculosis Regulations issued in 1912 by the Local Government Board require that on notification of a case of tuberculosis, visits are to be paid to the home by an officer acting under the instructions of the Medical Officer of Health to investigate the source of infection, the spread of infection, and to remove conditions favourable to infection. A new form of enquiry caul has been got out; suitable notified patients are visited at least 25 terly, more frequent visits being made in certain cases. Experience shows that the homes of tuberculous patients are often visited in connection with infant visiting and the supply of free or assisted milk. As each nurse deals with the cases in her own district overlapping and too frequent visitation is avoided. Advice has been given especially as regards the disposal of sputum and any change in the sleeping accommodation required to prevent relative overcrowding in bedrooms occupied by the patient and the spread of infection. Statistics relating to the prevalence, etc., in the area of the disease since 1912 is given below:— Year. No. of Notifications. Attack Rate per 1,000 of population. No. of Deaths. Death Rate per 1,000 of population. 1912 66 1.9 35 1.0 1913 73 2.1 18 0.5 1914 86 2.5 36 1.0 1915 78 2.0 39 1.1 1916 62 1.7 30 0.9 1917 61 1.6 46 1.4 1918 57 1.5 40 1.2 1919 43 1.2 34 1.0 1920 40 1.1 32 0.9 26 Disinfection of Premises. Reason. Houses. Rooms. No. of Houses Bedding removed. Infectious Fevers 106 122 91 Tuberculosis 24 45 16 Other Diseases 29 33 19 Verminous Premises 5 4 1 Totals 164 204 127 Venereal Disease. I have to thank the Surrey County Medical Officer of Health for the following particulars relating to the work of the Richmond Venereal Diseases Centre during 1920:— No. of persons dealt with for first time 96 No. of persons discharged after completion of treatment 7 Total attendances 1063 No. of doses of salvarsan substitutes given 346 The Clinic is available for patients residing in Middlesex, and in fact anywhere. MATERNITY AND CHILD WELFARE. Midwives Acts, 1902-1918. 1 beg to thank the County Medical Officer for the following information:—The number of notifications received from midwives living in Richmond having sent for medical help during 1918, 1919 and 1920 were 13, 8 and 32 respectively. 27 Child Welfare. The voluntary Centre of the Richmond Infants Health Association,* of which Mrs, Gates is the Honorary Superintendent, has been held, as for some years past, in St. Paul's Hall, Raleigh Road, each Thursday afternoon from 2.30 to 4 o'clock. Three hundred and eleven mothers and 383 infants have attended the Welcome during the year; the total number of attendances of the mothers being 4,137. The average attendance of mothers weekly has been 90; that of the children 100. The attendance at the Centre has been maintained, and in fact of late has increased; for the first time recently the attendance of mothers has been over 100. A movement among the mothers themselves should be recorded as it may grow to be of importance. Several of the old members whose children have reached school age have agreed to maintain their connection with the Welcome by "adopting" a baby whose mother cannot herself bring it, and the Committee have decided that any member so adopting a child is to count as its mother and to be eligible for all prizes or advantages that would fall to the lot of the real mother. The activities of the Centre include:— Weighing of Infants. One hundred and forty individual babies were weighed ; the total number of weighings was 880. Weekly Lectures. Forty lectures, &c., were given, of which 26 related directly to health topics. * For much of the information relating to the Centre I am indebted to Mrs. Gates. 28 Sale of Glaxo to children under 12 months, Ambrosia and Virol to children over 1 year. Sale of Clothes.— Insurance for Doctor at Confinement.— Organized Play with Toddlers. —War Savings Association.—Loan of Books. In connection with the sale of clothes especial efforts have been made to persuade mothers to provide their babies with knitted woollen belts (as soon as the umbilicus has healed) instead of binders, also to provide knitted woollen vests. Directions for making these articles have been cyclostyled in the Health Office and distributed at the Welcome and elsewhere; both the voluntary workers and the Health Visitors have endeavoured to make or get made as many of these garments as possible to be sold at the cost of the wool and postage. Dr. J. E. Adam conducted the weekly consultations up till April 15th; since then the Medical Officer of Health has attended weekly to hold the Infant Consultations. He is assisted by the two Health Visitors, who also make themselves generally useful at the Welcome where their advice is much appreciated by the mothers. The Health Visitors also take part in the giving of more formal instruction to the mothers in the form of lectures, &c. A special feature has been the careful supervision of ailing babies not sufficiently ill to be sent to the Maternity and Child Welfare Department of the Richmond Royal Hospital. During the year 24 babies have been seen more or less weekly, either at the Welcome or in the home; this is a necessity in these cases if the baby is to be kept under the regular supervision required to do any real good. The arrangement whereby sick babies whose parents are not able to afford a private doctor, but on the presentation of a card from the Medical Officer of Health are enabled to receive attention at the local hospital, has worked well and proved of real service. Leaflets have been drawn up by the Medical Officer of Health 29 on; Breast feeding; Bottle feeding; Feeding of children 9 months to 7 years; How to prevent Summer Diarrhœa; Measles; Whooping cough; these have been distributed in suitable cases at the Welcome and elsewhere. The local practising midwives and nurses of the Richmond District Nursing Association have been so good as to help in the distribution of these leaflets. During the year 166 first visits and 2,213 re-visits were paid by Voluntary Health Visitors. Since July 1st the two Health Visitors have taken part in the infant visiting. The Health Visitors each take half of the town, roughly north and south, and devote half of their time to the work. They are now (1921) working in co-operation with 5 Voluntary Health visitors. By the Health staff 268 first visits have been paid; 472 re-visits and 33 visits to babies seen at the Welfare. A scheme for the co-ordination of the work and cards have been drawn up by the Medical Officer of Health for the use of the Health Visitors and Voluntary Visitors. Puerperal Fever. The following cases were notified during the years 1913-1919:— 1913, 1; 1914, 2; 1915, 1; 1917, 1; 1918, 2; 1919, 2. In 1920 there has been 1 case of puerperal fever—this proved fatal; the patient was admitted to a Nursing Home. The services of the Health Department were asked for in connection with a woman suffering from a severe illness connected with the puerperal state. Ophthalmia Neonatorum. The number of cases notified during the years 1916-1919 were — 1916, nil; 1917, 3; 1918, 6; 1919, 1; 30 The following table gives the necessary information relating to cases in 1920:— No. Sex. Date Notified. Disease. Result. Slight Mod. Severe Cured Permanent Injury. Slight Severe. 1 P. 23-4-20 ... both eyes ... ... Slight ... 2 M. 15-5-20 Both ... ... Cured ... ... 3 F. [Foundli'g admitted to Poor Law Infirmary] 3-7-20 ... ... ... Died ... ... 4 M. 20-9-20 — ... both eyes ... ... R.eye bli'd some sight in L. eye 5 F. 29-10-20 Both ... ... Cured ... ... 6 M. 9-11-20 Both ... ... Cured ... ... 7 F. 20-12-20 Both ... ... Cured ... ... 8 M. 21-12-20 Both Very sl ... ... Cured ... ... There were two other cases in which a midwife had to call in medical help on account of " eyes " during 1920. Measles and Whooping Cough. Arrangements have been made for the notification of measles by the head teachers and others, especially the School Attendance Officer. Forms for notification have been got out and distributed to all head teachers of elementary schools and by the courtesy of the head teachers of the County Secondary Schools within the Borough we are informed also of cases of this disease occurring among the school children in attendance at these schools. 31 The Health Visitors have paid visits in 41 cases , leaflets have been got out by the Medical Officer of Health and distributed to each patient and arrangements made whereby if the patients require nursing the services of the nurses of the Richmond District Nursing Association will be available. Similar arrangements have been made with regard to whooping cough as described for measles. Unfortunately the intimation of the presence of this disease by parents and others is not so good as it should be. Epidemic Diarrhoea. Leaflets were got out and left at the houses in the poorer quarters where a birth had taken place during the twelve months before July, 1921. These houses were visited frequently, especially during August, in order to prevent the onset of the disease. Mrs. Gates afforded much help at the Centre in the prevention of Summer diarrhœa by explaining the leaflet to the mothers and seeing that it was appropriately distributed. Still-births. Investigations as to the cause of still-births are made by the nurses in all cases. 17 still-births have been notified during the year. Ante-natal Hygiene. Prom time to time the Medical Officer of Health is consulted at the Centre, chiefly through the agency of the Secretary of the Infants' Health Association by expectant mothers. As a result of a communication from the Council of the Unmarried Mother and her Child a Sub-Committee of the Maternity and Child Welfare Committee was formed to consider what provision, if any, should be made for the unmarried mother and her child. Three meetings have been held; the matter is now being considered by a body of social workers in the town and subsequently doubtless further meetings of the Sub-Committee will be held. It would seem possible to come to some arrangement whereby unmarried mothers and their children could be boarded 32 but under the aegis of a Committee, formed either independently of or in connection with the Richmond Diocesan Rescue and Preventive Association. Supply of Milk. Adequate arrangements for the assisted or free supply of milk have been made. The Maternity and Child Welfare Committee received 83 applications for assisted or free supplies of milk during the year. 74 applicants were granted permits to obtain milk either free or at half price, and 9 were found unsuitable for assistance. The Committee have for some time worked on the following scale:— Free Milk where total income, less rent, is £2 a week or less, or if over £2 does not exceed 10s. per head per week. Half-price milk where total income, less rent, is over £2 and between 10s, and 15s. per head per week. Recently they have as regards the quantities of milk given considered in each case the recommendations of the circular sent out by the Central Government in connection with the Milk (Mothers and Children) Order, 1918. The sum of £201 has been expended during the calindar year. The Work of Voluntary Societies. During the year 1920, 13 women were afforded relief by the Richmond Lying-in Charity, of which Mrs. Terry is the Hon. Secretary. Eleven of these were attended by a midwife and 2 by a doctor. Dwellers east of Sandycombe Road are not eligible for benefit from the Richmond Lying-in Charity, and the following are not entitled to the charity:— (a) A woman expecting her first child. (b) A woman who has not lived one year in Richmond, (c) A woman whose husband is a servant in place. (d) A woman whose husband is in receipt of wages that may be considered to disqualify his wife from seeking help from this Charity. 33 The patient contributes 7s. 6d. if a midwife attends, 12s. 6d. if a doctor attends; for this the patient has attendance for 10 days, half a sack of coals, and the loan of linen, which is kept by the storekeeper of the Charity and is overlooked after each loan and where necessary re-washed; in doubtful cases it is sent away for disinfection. At times worn articles are given to persons in very poor circumstances. The work of the Infants' Health Association has already been mentioned. Co-ordination of Maternity and Child Welfare Work with the School' Medical Service. The Maternity and Child Welfare Committee is fully co-ordinated with the work of the School Medical Service; each Health Visitor gives half her time to School Medical work. The Medical Officer for the Maternity and Child Welfare Committee is also the School Medical Officer. The clerical work in the Health Office has been so arranged that the clerk who does the school medical work also does the Maternity and Child Welfare work. Women confined away from their own homes are accepted at the Richmond Poor Law Infirmary, Queen Charlotte's Hospital, and the Clapham Maternity Home. The Maternity and Child Welfare Committee have not hitherto made official arrangements with any Institution. During the past year the Committee have considered the possibility of establishing two or three beds for maternity cases at the Richmond Royal Hospital or in a private nursing home or some other institution. A letter was sent by the Committee to the authorities at the Richmond Royal Hospital asking if arrangements could be made to provide two or three maternity beds at the hospital; the matter was very thoroughly gone into by the Hospital authorities, but it was decided that the accommodation existing at the hospital does not allow of their entering into the desired arrangements with the Corporation. The Committee have always been prepared to send away suitable children to Convales???ent and other Institutions; this work has 34 hitherto been undertaken by the Richmond Royal Hospital and the Central Aid Society, but in the event of suitable cases being presented to the Committee doubtless the matter would receive sympathetic consideration. Particulars of the deaths of infants under 1 year of age in 1920 are as follows:—Premature birth, 8; Diarrhœa and Enteritis, 3; Pneumonia, 6; Bronchitis, 1; Whooping Cough, 3; Congenital defects, 13; Violence, 1; Tuberculosis, 1; Influenza, 1; other causes, 5; total, 42, The Infantile Mortality rate was 57 as opposed to 73 last year. SANITARY ADMINISTRATION. Factories and Workshops Act, 1901. The following table shows the work done in supervising the various registered workshops and workplaces in the district:— 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 35 3 Workshops (Including Woikshop Laundries) 153 14 Workplaces (Other than Outworkers' premises included in Part 3 of this part of the Report) 43 4 Total 231 21 Nil 35 2.—Defects found in Factories, Workshops & Workplaces. Particulars. Number of Defects: Number of Prosecutions. Found. Remedied Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of cleanliness 8 8 Want of ventilation 1 1 Overcrowding 1 1 Want of drainage of floors Other nuisances 27 27 Sanitary accommodation insufficient 1 1 unsuitable or defective 8 8 not separate for sexes Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 7 7 Other offences (Excluding offerees relating to outwork which are included in Part 3 of this Report) 2 2 2 Total 55 55 2 Nil NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Lists Received from Employers. Notices served on occupiers as to keeping or sending lis's. Prosecutions. Instances. Notices Served. Prosecutions. Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. 1. 2. 3. 4. 5 6 7. 8. 9. 10. 11. 12 13. Wearing Apparel— Making, &c. 13 14 3 3 Cleaning and Washing Household linen Lace, lace curtains & nets Curtains and furniture hangings 1 1 Fur pulling 1 2 Total 1 2 14 15 3 3 36 3.—Home Work. 37 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. 1. 2. Bakehouses 23 Blouse making 2 Boot repairing 6 Builders 7 Dressmaking 16 Laundries 15 Millinery 9 Motor repairs 2 Tailors 13 Wheelwrights 2 Wigmaking 2 Miscellaneous 13 Workplaces 70 Total number of Workshops on Register 180 5.—Other Matters. Class. Number. 1. 2. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133, 1901) 5 Action taken in matters referred by H.M. Inspector as remediable under the PublicHealth Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector 6 Reports (of action taken) sent to H.M. Inspector 6 Other Underground Bakehouses (s. 101) in use at the end of the year 6 38 Causes of Death in Richmond M.B. 1920. supplied by the Registrar-General. Causes of Death. Males. Females Total. ??? All Causes 188 218 406 1 Enteric fever ... ... ... 2 Small-pox ... ... ... 3 Measles ... ... ... 4 Scarlet fever ... ... ... 5 Whooping cough 2 2 4 6 Diphtheria and Croup 4 ... 4 7 Influenza 1 8 9 8 Erysipelas ... 2 2 9 Pulmonary tuberculosis 13 12 25 10 Tuberculous meningitis ... 2 2 11 Other tuberculous diseases ... 5 5 12 Cancer, malignant disease 30 36 66 13 Rheumatic fever ... 1 1 14 Meningitis ... 2 2 15 Organic heart disease 14 33 47 16 Bronchitis 11 15 26 17 Pneumonia (all forms) 11 9 20 18 Other respiratory diseases 1 1 2 19 Diarrhoea, &c. (under 2 years) 2 1 3 20 Appendicitis and typhilitis 4 1 5 21 Cirrhosis of liver 1 2 3 21a Alcoholism 1 ... 1 22 Nephritis and Bright's disease ... 6 9 23 Puerperal fever ... 1 1 24 Parturition, apart from puerperal fever ... 3 3 25 Congenital Debility, &c. 9 9 18 26 Violence, apart from suicide 12 3 15 27 Suicide 6 1 7 28 Other defined diseases 62 61 123 29 Causes ill-defined or unknown 1 2 3 Special Causes (included above) ... ... ... Cerebro-spinal Fever ... ... ... Poliomyelitis ... ... ... Encephalitis Lethargica ... 1 1 Deaths of infants under 1 year of age 21 21 42 Illegitimate 2 7 9 Total Births 368 367 735 Legitimate 342 338 680 Illegitimate 26 29 55 Population (for births and deaths) 35572 39 Isolation Hospitals. The Small Pox Hospital is situated at Dockwell, in Middlesex. The position is about midway between the Bath and Staines Road, and about one mile due west of Hounslow Barracks. Mogden Isolation Hospital for other infectious diseases is situated about midway between Isleworth 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. J. E. Adam. The following tables show:— 1. The Yearly Summary. 2. Number of Admissions classified. MOGDEN ISOLATION HOSPITAL Year. ADMISSIONS. DEATHS. CASES MORTALITY, PER CENT. AVERAGE STAY IN HOSPITAL. DAILY AVERAGE ON BOOKS. Scarlet Fever. Diphtheria. j Enteric Fever. j 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. 1920 191 126 1 13 331 1 7 0 0 8 0 53 5. 0 0 2 4 32 20 46 9 26 26-5 MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED. Richmond. Richmond Union. Heston and Isleworth. Isleworth Union. Hounslow Carrison. Hospital Staff. TOTALS. Scarlet Fever. Diphtheria Enteric Fever. Other Disease! 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. 1920 33 37 2 2 74 1 .. .. .. 1 153 77 .. 4 234 2 17 1 4 24 2 1 .. .. 3 .. .. 2 2 191 132 3 12 338 40 41 Local or General Adoptive Acts, Bye-Laws and Regulations. 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 Notification of Births Act 1914 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. 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. „ Dairies, Cowsheds and Milkshops. 5. Bye-laws as to Slaughterhouses. 6. „ 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. 12. Bye-laws with respect to occupation of basement sleeping rooms, Section 17 (7) H. & T.P. Act, 1909. 42 During the year the Health Committee have had under coilsideration the acquirement of powers under Bye-laws to control Fish Frying and the Sanitary conditions of Tents, Vans, Sheds and similar structures. Anthrax in the human subject has, on the application of the application of tne Council to the Ministry of Health, been added to the list of Compulsorily notifiable diseases. Bacteriological Examinations. Since 1912 specimens have been forwarded to the Lister Institute of Preventive Medecine tor bacteriological examination. The numbers that have been forwarded from 1912-1920 are as follows:— 136, 168, 162, 212, 133, 88, 66, 184 and 445. The increase in 1920 has been largely due to the examination of swabs from cases and contacts necessitated by the unusual prevalence of diphtheria (and scarlet fever) in London and neighbourhood, The following are the results of the examinations made during 1920:— Year. Disease Suspected. Nature and Specimen. Result. Total. Positive Negative 1920 Diphtheria Swabs from Throat & Nose 53 310 363 Tuberculosis Sputum 16 54 70 Cerebro-Spinal Fever Swabs from Naso-pharynx — 1 1 Syphilis Blood 5 3 8 Enteric Fever Blood 1 2 3 75 370 445 43 Mortuary. During the year 1920 45 bodies were received at the Mortuary, viz., 38 adults and 7 infants. Post-mortem examinations were made upon 37 bodies; 45 inquests were held. Annual Report of the Veterinary Inspector. Mr. W. J. Hatton, M.R.C.V.S., reports as follows:— The usual monthly veterinary inspections of all cattle, sheep and pigs in the Borough of Richmond have been made during 1920 and reported upon at the Executive Committee of the Borough. There are about 50 milch cows and about 170 pigs housed in the Borough. During 1920 this district has been free from any notifiable disease with the exception of a c: se of parasitic mange in a horse in May last. HOUSING. General Housing Conditions in the District. In the special report forwarded to the Housing Commissioner on October 31st, 1919, the number of dwelling houses of all classes in the district was stated to be 7,000, and of this number 3,163 were deemed to be occupied by the Working Classes. The measure taken to meet any shortage has been the putting in hand of a scheme for the erection of 112 houses under the direction of the Borough Surveyor, Mr. J. H. Brierley. This work is being carried out on the Selwyn Estate in co-operation with H.M. Office of Works, 44 The esential details relating to the Corporation Housing Scheme are as follows:— No. of Dwellings to be provided. Type. Accommodation. Initial weekly rents (including rates). 8 A Living room and 3 bedrooms ° 19s. 3d. 62 B3 Living room, parlour and 3 bedrooms 23s. 3d. 20 B4 Living room, parlour and 4 bedrooms 26s. 6d. 24 Flats Living room and 2 bedrooms 15s. 0d. The number of houses in connection with the Corporation housing scheme ready for occupation at about the end of June, 1921, it is anticipated will be 32—Type A, living room, scullery and 3 bedrooms, 8 ; Type B 3, parlour, living room, scullery and 3 bedrooms 24. At the end of 1921 the Borough Surveyor estimates that a further 26 houses will be completed. The number of working-class houses erected during 1920 by private builders was 10, and the number erected with the consent of the Local Authority under Section 25 of the Housing, Town Planning, &c. Act, 1919, was 3. The average annual increase in population for the last ten years is roughly 200 ; there is no reason to think that this rate of increase will be altered. As regards overcrowding the number of tenements with more than two occupants per room was given last year as 106 occupied by 1124 persons; the number of houses intended for one family only which were occupied without having been especially adapted by two or more families was given as 425. This information was obtained from the Food Control rationing cards. 45 This overcrowding is due to the common cause operative throughout the country, namely, the difficulties in the erection of houses entailed by the war. At the request of the Committee a report was submitted on the selection of tenants for the Corporation houses from the point of view of public health. The Committee were advised that other things being equal persons residing in overcrowded homes and tuberculous patients requiring better housing accommodation should have prior consideration. A number of cases of overcrowding were reported during the year, but owing co the insuperable difficulty of finding alternative accommodation no action could be taken in the matter. The general standard of housing in the district is satisfactory. When the survey of housing needs was made in 1919 there were no considerable areas of seriously defective houses The general character of the defects found to exist in unfit houses is shewn in the following table:— 46 HOUSING, &c., ACT INSPECTIONS. Defects in Unfit Houses. Water Supply. Sinks, &c. Defective Water storage tanks 12 Defective sinks 36 Defective waste pipes 25 Dirty storage tanks 8 Waste pipes trapped, &c. 36 Cistern in unsuitable position 2 Dampness. Draw off taps provided 37 Defeciive roofs 55 Defective water fittings 12 Defective gutters, &c. 59 Water Closets. Want of damp course 23 Damp subsoil 2 Defective W.C. pans 16 Floor space unventilated 33 Dirty W.C. pans 4 Defective pointing of Defects in W.C. building 45 brickwork 49 Lighting and ventilation inadequate 10 General Repairs. Defective flushing apparatus 15 Dilapidated outbuildings 9 Defective walls and ceilings 254 Drainage. Defective window sills 116 Defective soil pipes and ventilation shafts 9 Windows not made to open 13 Defective and choked drains 7 Defective sash cords 77 Want of additional window space 3 Defective drains relaid 39 Defective drainage fittings 28 Dirty wall and ceilings 209 Defective manholes 19 Want of improved ventilation to living room 11 Defective drain ventilators 11 Defective staircase 11 Dustbins. Defective and smoky chimneys 50 Defective receptacles for refuse 47 Miscellaneous 8 Total 1,447 Paving. Defective paving 28 Want of paving 19 These defects found in house property of all rentals were the result of the difficulty of finding labour to carry out repairs during and after war time, 47 In accordance with the instructions contained in the Manual of Housing issued by the Ministry of Health, notices have been served where necessary under the Public Health Acts. In reference to a block of 16 cottages the owners stated their inability to carry out the work required owing to poverty; the Health Committee resolved to put in force Section 28 of the H.T.P. Act, 1919, but the notices were not served until the early part of 1921. As regards difficulties in remedying unfitness, in a few instances the owners requested a longer period within which to carry out the work, owing to financial difficulties. I am to report that the Ministry has recently (1921) given its sanction to the putting in force of bye-laws in connection with tents, vans, sheds, &c. Rent Restriction Act, 1920. Section 2 (2) of the Increase of Rent and Mortgage Interes (Restriction) Act, 1920, provides that "at any time or times not being less than three months after the date of any increase of rent permitted under this Act the tenant or Sanitary Authority may apply to the County Court for an order suspending such increase on the grounds that the house is not in all respects reasonably fit for human habitation or is otherwise not in a reasonable state of repair. The Court on being satisfied, by the production of a certificate from the Sanitary Authority, that any such ground as aforesaid is established, and on being further satisfied that the condition of the house is not due to the tenant's neglect or default or breach of express agreement, shall order that the increase be suspended until the Court is satisfied, on the report of the Sanitary Authority or otherwise, that the necessary repairs (other than the repairs, if any, for which the tenant is liable) have been executed, and on making of such Order the increase shall cease having effect until the Court is so satisfied." 48 Six applications for certificates were received from occupiers of premises, and in each instance a certificate was granted that the house was not in a reasonable state of repair In one instance the occupier had paid the increase of rent for more than three months and applied to the County Court fc r an order suspending such increase. After hearing the evidence the Court made an Order suspending such increase until the house was put into a reasonable state of repair. Unfit Houses. The number of inhabited houses reported on in 1919 as not being and cannot be made fit for human habitation was 12. The number of persons inhabiting these houses was 57. No action yet has been taken with regard to these houses, the period granted within which to deal with these houses expires in October, 1922. The same applied to the four houses subject in 1919 to Closing Orders. The 109 houses reported in 1919 as being seriously defective but which can be made habitable are being gradually dealt with. I desire to express my sincere thanks to Mr. George Laws and other members of the staff for their earnest work for the Health Department during the year. I am, Ladies and Gentlemen, Your obedient servant, C. W. HUTT. 49 Appendices. Housing Conditions. STATISTICS FOR YEAR ENDED 31st DECEMBER, 1920. 1.—General. 1. Estimated population 35,572 2. General Death Rate 11.4 3. Death-rate from tuberculosis 0.9 4. Infantile mortality .. 57 5. Number uf dwelling-houses of all classes 7,013 6. Number of working class dwelling-houses 3,176 7. Number of new working ctass houses erected 13 2.—Unfit Dwelling-houses. I.—-Inspection. 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 773 2. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 130 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 4. Number of dwelling-houses (exclusive of those ferred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 449 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 319 50 III.—Actions under Statutory Powers. A. - Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1909. 1. Number of dwelling-houses in respect of which notices were served requiring repairs Nil 2. Number of dwelling-houses which were rendered fit- (a) by owners Nil (b) by Local Authority in default of owners Nil 3. Number of dwelling-houses in respect of whieh Closing Orders became operative in pursuance of declaration by owners of intention to close Ni| B.—Proceedings under Public Health Acts. 1. Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 146 2. Number of dwelling-houses in which defects were remedied— (a) by owners 128 (b) by Local Authority in default of owner 2 C.— Proceedings under Sections 17 and 18 of the Housing and Town Planning, etc., Act, 1909. 1. Number of representations made with a view to the making of Closing Orders Nil 2. Number of dwelling-houses in respect of which Closing Orders were made Nil 3. Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil 4. Number of dwelling-houses in respect of which Demolition Orders were made Nil 5. Number dwelling-houses demolished in pursuance of Demolition Orders Nil 51 3. —Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I. or (b) Part II. of the Act of 1890— 1. Name of area Nil 2. Acreage Nil 3. Number of working-class houses in area Nil 4. Number of working-class persons to be displaced Nil 4. — Number of houses not complying with the building byelaws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 3 5.—The Staff engaged on housing work The Chief Sanitary Inspector has been designated as the officer acting under the direction and supervision of the Medical Officer of Health to prepare the necessary lists of dwelling-houses, the early inspection of which, in the opinion of the Medical Officer of Health, is desirable. This work is carried out with the assistance of the Assistant Sanitary Inspector and the clerical staff.