BOROUGH OF RICHMOND (SURREY) ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. by C. S. BREBNER, D.S.O., M.D., D.P.H, Medical Officer of Health and School Medical Officer, &c., Borough of Richmond. richmond : J. h. broad & co., printers, 8, king street. BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. by C. S. BREBNER, D.S.O., M.D., D.P.H., Medical Officer of Health and School Medical Officer, &c., Borough of Richmond. richmond : j. h. broad & co., printers, 8, king street. 2 Public Health Department, 38, Sheen Road, Richmond, Surrey. March, 1926.. To the Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gentlemen, 1 have the honour to submit my Annual Report on the health and sanitary condition of the Borough during the year ended December 31st, 1925. The Report is arranged on the lines suggested in Circular 648 from the Ministry of Health, and is intended to be a " special " or survey report as distinguished from the reports of the preceding five years, which were ' ordinary " reports. The General Death Rate is lower than that of 1924, and corrected for population is lower than that of England and Wales as a whole. The Birth Rate is slightly higher than that of 1924, but is still below that of England and Wales. The Infantile Mortality rate is slightly higher than the rate in 1924—in that- year it was the lowest ever recorded—but it remains well below those of England and Wales and London. 1 am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER. 3 Natural and Social Conditions of the Area. Area (in acres) 2,599 Population (census 1921) 36,639 „ (estimated 1925) 34,690 Number of inhabited houses (1921) 7,661 „ (1925) 7,994 Number of families or separate occupiers (1921) 8,891 Rateable Value £369,545 Sum represented by a penny rate £1,482 Physical features and general character of the area. The Borough of Richmond lies on the south bank of the Thames. Incorporated in 1890, its boundaries were in 1892 enlarged by the inclusion of the parishes of Kew, Petersham and a part of Mortlake. The height above ordnance datum varies, being 16 feet at the bottom of Water Lane, 31 feet opposite the General Post Office 152 feet at the Park Gates, and 180 feet inside Richmond Park. The subsoil is chiefly gravel and sand interspersed with patches of clay on the Hill. Social Conditions. The Borough is chiefly a residential district. There are one or two small factories in addition to the usual trades carried on in any town, while a certain number of the inhabitants are engaged in those industries and occupations connected with boating. Poor Law Relief. The following particulars give the amounts granted by the Guardians in Outdoor Relief to persons resident in the Borough :— 286 cases ... Total amount granted, €3845 3s. 11d. Charity. The following figures have been obtained from the Central Aid 4 Society and represent the cases that have been directly assisted by them Hospital Letters 35 Surgical Appliances 22 Convalescent Aid 15 Other forms of Relief 52 Total 124 The Philanthropic Society has also assisted the needy to the following extent:— Boots and Clothing £200 Relief in other forms £247 Convalescent Home, Hospital & Surgical Aid Letters purchased £31.10. They have also administered a fund of £350 collected by the Ex-Mayor, Mr. Councillor A. Howitt, J.P., for boots and clothing. Richmond Royal Hospital. The Secretary, Mr. Richard Allen, has kindly supplied the following information :— 837 In-Patients, 4214 Out-Patients, and 1864 Casualties were treated at the Hospital during 1925. Those received from the Borough of Richmond were:—304 In-Patients and 1059 OutPatients. Extracts from Vital Statistics of the Year. total. m. f. Births (Legitimate) 490 264 226 (Illegitimate) 40 21 19 Deaths 442 208 234 Birth Rate (R.G.) 15.2 Death Rate (R.G.) 12.7 Number of women dying in, or in consequence of, childbirth—from sepsis, nil; from other causes, nil. Deaths of infants under one year of age per 1,000 births : Legitimate, 42, Illegitimate, 100. Total, 47 5 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 2 Birth Rate per 1.000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1000 Births. All Causes. Measles. Scarlet Fever. I )iph- theri'a, Diarrhoea and Enteitis under two years Total Deaths under one year. England and Wales 18.3 12 2 0.13 0.03 0.07 8.4 75 London 18.8 12 2 0.17 0 03 0.09 10 8 79 Richmond 15 2 12.7 0.05 nil. 0.5 3.07 47 The following table shews the most important Statistics of the last five years :— 1921 1922 1923 1924 1925 No. of Births 581 565 554 516 530 Birth Rate 16.5 15.09 15.7 14.8 15.2 No. of Deaths 438 414 402 471 442 Death Rate 12.4 11.7 11.4 13.5 12.7 Infantile Mortality 58 54 57 42 47 Cases of Diphtheria 28 16. 30 56 25 ,, Scarlet Fever 83 47 32 23 112 ,, Pulmonary Tuberculosis 28 30 48 44 48 Deaths from Tuberculosis (all forms) 26 22 40 36 29 Population. The Registrar-General estimates the population to he 34,690 as compared with 34,670 in 1924. As stated in previous reports I am of opinion that this is a low estimate. In 1921 the population as ascertained by the Census was 35.639 and in 1923 the Registrar General estimated the population to be lower than in 1922, and again in 1924 to be lower than in 1923. This in spite of the fact that (1) there had been more births than deaths, and (2) there had been a large number of houses built and occupied in the years under review, 6 I merely mention this because a low estimate of population naturally makes the various rates, death, birth, etc, higher than they really are. Births. There were 530 births during the year (285 males and 245 females), which gives a birth rate of 15.2 per 1,000 of the population as compared with a rate of 18.3 in England and Wales and 18.8 in London. Deaths. The number of deaths of residents in the Borough registered during the year is stated by the Registrar-General to be 442 (208 males and 234 females). In the list of deaths supplied weekly by the local Registrar there were 106 deaths of persons usually residing outside the Borough. On the other hand, 64 persons who normally resided in the Borough died elsewhere, and are included in the total deaths. The number of deaths which occurred in Institutions in the Borough was 189 and the number of Inquests held was 62 though all of these were not concerned with Richmond residents. The death rate is therefore 12.7 per 1,000 of the population as compared with a death rate in England and Wales of 12.2 and 12.2 in London. Corrected for age and sex distribution of the population, the death rate is 10.7. The deaths occurred in persons of the following ages :— 25 under 1 year of age, 11 between 1 and 5 years of age. 7,, 5 ,,15 „ 7 „ 15 „ 25 „ 38 „ 25 „ 45 „ 111 „ 45 „ 65 „ 169 „ 65 „ 80 „ 70 over 80 years of age. 7 Causes of death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under I year 1. Bronchitis ... ... 1 ... 1 ... ... 1 ... 2 2. Pneumonia ... ... ... ... ... ... 1 2 ... 3 3. Diarrhoea & Enteritis ... ... ... ... ... 1 1 ... ... 2 4. Congenital Debility and Malformation including Premature Birth 8 2 1 ... ... 11 2 ... ... 14 5. Other Causes 2 ... 1 ... 3 ... ... 1 ... 4 10 2 3 ... 15 2 ... 4 ... 25 8 (1) Tuberculosis of Respiratory System, or Consumption. Twenty-one deaths were due to this disease as compared with 27 in 1924. Although there are still numbers of these cases notified, I think that on the whole they are not so numerous as previously in spite of the fact that housing conditions are not satisfactory. The number or deaths in the last five years was as follows:— 1921 27 1922 22 1923 40 1924 27 1925 21 (2) Cancer. There were 62 deaths from this disease during the year as compared with 84 in 1924. The deaths from this disease have undoubtedly gone up in the last few years, partly owing to better diagnosis, etc. The Ministry of Health have issued circulars regarding this disease and efforts are being made not only to find the causation and better curative measures, but also to let the general public know what can be done if only the disease is discovered early. 1921 64 1922 58 1923 64 1924 84 1925 62 (3) Respiratory Diseases. The deaths from these diseases, viz., Bronchitis, Pneumonia and other respiratory diseases number 70 as compared with 74 in 1924. Causes of Death M. P. All Causes. 208 234 1. Enteric Fever — — 2. Smallpox — — 3. Measles 2 — 4. Scarlet Fever — — 5. Whooping Cough — — 6. Diphtheria 1 1 7. Influenza 8 6 8. Encephalitis Lethargica 1 3 9. Meningococcal Meningitis — — 10. Tuberculosis of Respiratory System 14 7 11. Other Tuberculous Diseases 3 5 12. Cancer, Malignant Disease 29 33 13. Rheumatic Fever — 1 14. Diabetes 1 5 15. Cerebral Hæmorrhage, &c. 11 20 16. Heart Disease 29 47 17. Arterio-sclerosis 9 7 18 Bronchitis 18 23 19. Pneumonia (all forms) 12 13 20. Other Respiratory Diseases — 4 21. Ulcer of Stomach or Duodenum 2 2 22. Diarrhoea, &c. (under 2 years) 1 1 23 Appendicitis and Typhlitis 1 2 24. Cirrhosis of Liver 2 1 25. Acute and Chronic Nephritis 7 3 26. Puerperal Sepsis — — 27. Other Accidents and Diseases of Pregnancy and Parturition — 28. Congenital Debility and Malformation, Premature Birth 11 4 29. Suicide 1 — 30. Other Deaths from Violence 15 6 31. Other defined Diseases 30 40 32. Causes ill defined or unknown — — Special Causes (included above)— Poliomyelitis — — Polioencephalitis — — Death of Infants ( Total 16 9 under 1 year ( Illegitimate 2 2 Total Births... 285 245 Legitimate 264 226 Illegitimate 21 19 Population 34,690 10 General Provision of Health Services in the Area. Hospitals. (1) Tuberculosis. Patients seen by the County Tuberculosis Officer and found to be suitable for Hospital treatment are sent to Hospitals and Sanatoria. (2) Maternity. No Maternity Hospital has been provided by the Local Authority, but the Guardians have set aside certain beds at the Infirmary, Grove Road, for Maternity cases. (3) Children. By arrangement with the Education Com— mittee and the Council through the Maternity and Child Welfare Committee, the Richmond Royal Hospital admits suitable cases of children attending the Welfare Centre or the ElementarySchools of the Borough. (4) Fever. Richmond sends its infectious cases to the Mogden Isolation Hospital which is managed by a Joint Hospital Board composed of Members of the Richmond and Heston and Isleworth Councils. This Hospital is not in the Borough, but in the Urban District of Isleworth. The Hospital accommodates 45 patients, mainly Scarlet Fever and Diphtheria cases, but provision can be made for the admission of Enteric cases also. A tabulated statement of the cases admitted during the year is attached. 11 MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED Richmond. Richmond Union. Heston and Isleworth. Isleworth Union. Hounslow Carrison Hospital Staff. TOTALS. Scarlet Fever. Diphtheria Enteric Fever. Other Diseases Total Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases, Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases Total. 1925 97 22 .. 6 125 .. 3 1 .. 4 69 41 .. 4 114 2 10 .. .. 12 .. 1 .. .. 1 .. .. .. 2 2 168 77 1 12 258 12 (5) Small-pox. The Small-pox Hospital is controlled by the Joint Hospital Board above mentioned, and is situated at Dockwell, in Middlesex, about one mile due west of Hounslow Barracks. (6) Other Hospitals. The Royal Hospital, Richmond, is a General Hospital, and provides for Medical, Surgical, Ophthalmic and Dental cases from Richmond and the neighbouring towns and districts in the Thames Valley. The Venereal Clinics organised by the Surrey County Council arc held at the Hospital, and there is also a special Maternity and Child Welfare Department to which infants and children up to 5 years of age may be sent from the Maternity and Child Welfare Centre. The Richmond Council makes a grant towards the expenses of this Department. Institutional Provision for Unmarried Mothers and Illegitimate Infants. There is no Home in the Borough for these cases, but by an arrangement with the County Council such mothers may be sent to a Home at Epsom where beds are available. Ambulance Facilities. (a) The Joint Hospital Committee possess a Motor Ambulance which is kept at Mogden Hospital and which is used for the removal of infectious cases to that Hospital. (b) In 1919 the British Red Cross Society through the Local Branch provided a Motor Ambulance for use by the Borough Council. This is used for accidents and non-infectious cases. Charges are made for its use according to the mileage, but the charges may be w holly or partly remitted. During the year 1925, the Ambulance was used 329 times, and the mileage covered was 2,184. 13 Clinics and Treatment Centres. Address. By whom provided. Minor Ailments Clinic .. 38, Sheen Rd , Richmond. For Elementary School Children Education Committee. Dental Clinic Ditto Ditto. (7 half-davs per fortnight). Ditto. Do. do. Ditto 1 hour weekly. M. and C.W Eye Clinic Ditto (1 session per fortnight). Committee, Education Committee. Tonsils and Adenoids RichmondRoyal Hospital. By arrangement with Education Ringworm (X-rays) Mr. G. G.. Blake. 10, Onslow Rd., Richmond. When required. Committee Education Committee. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. Bv arrange ment with M & C. W Committee. Tuberculosis Treatment.. Kingston-onThames. 3 times weekly. County Council Venerea! Clinics Richmond Royal Hospital. Twice weeklv. ' County Council. School Clinics. The school clinics include Minor Ailments Clinic, Eye Clinic, and Dental Clinic, while Tonsils and Adenoids are dealt with at the Richmond Royal Hospital, and Ringworm (by means of the X-Rays) by Mr. G. G. Blake. The Minor All.ment Clinic at 38, Sheen Road, is held every morning, and during the year 574 children have made 4,815 attendances. The Minor Clinic is held once a fortnight at 38, Sheen Road, by Dr. Blair, who prescribes glasses for those children requiring them. The glasses are obtained from a Richmond optician at a contract price ; 102 children were treated during the year, 14 The Dental Clinic is held seven times in a fortnight, and although it is the Clinic which attracts least, still 1,104 children were treated during the year. T uberculosis. The treatment for this disease is carried out by the County Authorities. The Tuberculosis Officer (Dr. Cameron Renwick) sees cases at the centre at Kingston, and the Richmond Council pays the fares of patients who proceed to Kingston if they are unable to do so themselves. Cases of doubtful Tuberculosis in the schools are sent to the County Tuberculosis Officer for an opinion, and generally there is close co-operation between the Medical Officer of Health and the Tuberculosis Officer. Venereal Disease. This also is carried out by the County. A centre for treatment has been established at the Richmond Royal Hospital. The County Medical Officer of Health has given me the following figures. During the year 1925 :— Number of persons dealt with for the first time. 178 Number of persons discharged after completion of treatment 16 Total attendances 5,995 Number of doses of Salvarsan substitutes given 577 Public Health Staff. Medical Officer of Health and School Medical Officer. *Charles Stuart Brebnbr, D.S.O., M.D., D.P.H., Barrister-at-Law. Chief Sanitary Inspector. *George Laws, M.R.San.Inst. Certified Inspector of Meat and other Foods, Inspector under Shop Hours Acts. 15 Assistant Sanitary Inspectors, William James Tiley (Certificate Royal Sanitary Institute). Wilfrid Charles Cockell (Certificate Royal Sanitary Institute and Meat Inspector's Certificate). School Nurses and Health Visitors. *Nurse L. K. Dunford, C.M.B. Nurse J. D. Law, C.M.B. Health Visitors Certificate, Univ. Edin. Clerks. Miss E. D. Bono. Miss E. M. Oakes. Drain Tester and Disinfector. J. Davis (part time). Veterinary Inspector. W. J". Hatton, M.R.C.V.S. (part time). Contribution is made to Salaries of Officers marked thus* Professional Nursing in the Home. A branch of the Queen Victoria's Jubilee Nurses' Association is established in Richmond, and two Nurses were employed during the year. A great deal of very useful work is done by these nurses. A grant of £75 is made by the Council to the Association, and the nurses attend cases of Measles, Ophthalmia and other diseases, especially of children. During the year nurses have attended 117 cases,'and 1,041 visits have been paid. These cases have been notified by the M.O.H. or private practitioners. There are also nurses specially employed in Kew and Petersham. 16 Midwives. No midwives are employed or subsidised by the Council. The total number of midwives practising in the district is 5. Chemical Work. Arrangements have been made whereby samples of the Borough water supply are regularly examined (monthly or more often if required). These water samples are examined by Drs. Thresh, Beale and Suckling, and their reports are invariably good shewing that the water supply is of excellent quality. 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 Acts 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. 17 10. Bye-laws tinder Good Rule and Government of the Borough. 11. Ditto as to Female Domestic Servants' Registries. 12. 3ye-laws with respect to occupation of basement sleeping rooms, Section 17 (7) H. & T.P. Act. 1909. 13. Bye-laws as to Fish Frying, 1920. 14. Bye-laws as to Tents, Vans, Sheds, &c., 1920. Sanitary Circumstances of the Area. Water. The Borough receives its water from two sources (1) From Wells situated in the area and '2) From the Metropolitan Water Board. The local wells are of two kinds (1) a deep well in the chalk and (2) two wells near the river. One of these latter has only recently been sunk, and has added 150,000 gallons of water per day to the supply. The water from the latter wells is chlorinated by an automatic process and on analysis (which is done very regularly) the results show a practically sterile water, and one which the analysts declare to be excellent as a public supply. Drainage and Sewerage. Practically all houses in the Borough are drained into the sewers. The construction of drains for new buildings is supervised by the Borough Surveyor and his staff, after plans for the erection of the new buildings have been approved by the Highways Committee and the Council. The reconstruction or repair of drains is supervised by the Public Health Department, and details of the house drainage work supervised by the Sanitary Inspector will be found below. 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 sewerage from the Borough of Richmond and from Barnes. 18 The Board's works are situated alongside the River Thames in the Parish of Mortlake. The sewage of the Borough is conveyed by numerous collecting sewers into a main outfall sewer. The town was partially re-sewered in 1898. The separate system was introduced many years ago and surface water sewers are now laid along most of the streets within the Borough. Treatment of Sewage. The method of sewage disposal at the Works is that of precipitation, and through bacterial filter beds, the effluent passing into the Thames. 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. Portable galvanised dustbins are in use in all parts of the Borough The house refuse is removed as a rule once weekly, but in the summer time arrangements have been made to collect the refuse twice weekly. All house refuse is conveyed to the destructor at Barnes and there destroyed by burning. Schools. All the elementary Schools are regularly inspected with regard to their sanitary condition. Many of the schools are old and not up to the modern standard. 19 Improvements have recently been made in the sanitary offices at two schools in the Borough, and further improvement is contemplated. The secondary schools are under the control of the County Council, but on the advice of this Department the sanitary accom modation of the County School for Boys was altered and brought up to date. SANITARY INSPECTION OF THE AREA. Report of Sanitary Inspector. In compliance with Article 19 (12) of the Sanitary Officers Order, 1922, made by the Minister of Health, 1 have the honour to submit the following tabulated particulars upon the work carried out by the Sanitary staff during the year 1925 in connection with the administration of the numerous Acts of Parliament and Byelaws in force within the district. Complaints. During the year 544 verbal or written complaints were recorded and investigated, and action taken where found necessary. The total number of inspections made during the year was 6,748. as compared with 5,452 in 1924. On 1,074 of the premises visited nuisances to the number of 4,635 were discovered, and in dealing with the sanitary defects from which they arose 532 " intimation " or " preliminary " notices and 118 statutory notices were served. The number of letters written with regard to the abatement of nuisances, &c., was 343. At the end of the year 3192 of the nuisances discovered had been abated, the work of remedying 1,228 was in hand, and the remaining 215 were outstanding. In order to ascertain that the sanitary defects were being properly remedied, 2.964 visits were paid to the respective premises. The number of inspections made under the Housing and Town Planning Act and particulars recorded was 502, and the number of 20 sanitary defects remedied and improvements made under this heading was 3,053. The following list shews the number of routine inspections and visits made :— Inspections during 1925. Inspections during 1925. Houses inspected and particulars recorded (H.T.P. Acts) 502 Houses visited (P.H. Acts) 1017 Re-visits to houses and other premises 1781 Miscellaneous visits 539 Visits to works in progress 644 ,, factories 25 ,, workshops, bakehouses, etc. 220 ,, outworkers'premises 25 ,, workplaces, tearooms, &c. 101 ,, dairies, cowsheds and milkshops 53 ,, ice cream vendors 30 ,, food stores 193 „ slaughterhouses 130 „ fried fish shops 43 „ stables 138 piggeries 10 ,, public urinals 138 ,, under Destructive Insects and Pests Acts 42 „ „ Canal Boats Acts 9 Canal boats inspected 0 Visits to school premises 30 ,, re infectious diseases 145 „ re Tuberculosis 47 Smoke observations 43 Special visits re Shops Acts 757 Visits under Rats and Mice Destruction Act 86 Total visits made 6748 21 Rent Restrictions Act. Number of certificates issued certifying premises not in a reasonable state of repair 10 Shop Hours Acts. Number of shops on register at end of year 984 „ new additions to register 15 „ changes of occupancy notified 10 Contraventions:— Half holiday notices not exhibited 8 Serving of customers after closing hours (warned) 1 SANITARY IMPROVEMENTS. Water Supply. Drinking water cisterns repaired, cleansed or covered 32 Water fittings repaired or renewed 16 Taps provided direct from rising main 66 Cistern in unsuitable positions abolished 48 Water Closets. New pans fixed 51 Pans cleansed or repaired 46 Walls, roofs, &c. repaired 248 Flushing tanks provided 19 Flushing cisterns repaired rnd renewed 75 Water supply re-instated or provided 1 Closet buildings re-constructed, &c. 0 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 16 Drainage. System re-constructed 36 Repaired or cleansed 28 22 Sundry drainage repairs 102 Manholes repaired or new provided 54 Ventilating pipes repaired or renewed 34 Drains intercepted from Sewer 8 R. water pipes disconnected from drains 12 Drains ventilated 7 Dustbins. New provided 226 Ashpits abolished 9 Dust shoots repaired, &c. 2 Yard Paving. Repaired 50 Newly paved 52 Sinks, &c. New provided 51 New waste pipes provided 55 Waste pipes repaired, trapped or ventilated 27 Dampness. Roofs repaired 179 Gutters and downspouts repaired or renewed 310, Damp courses fixed 38 External walls repaired or pointed 226 Floor cavities ventilated 40 Site of house concreted 3 General Repairs. Walls and ceilings repaired 457 Floors repaired 132 Windows, cills, &c., repaired 466 Windows made to open 22 Stoves repaired or renewed 118 Coppers repaired or renewed 52 23 Rooms cleansed and redecorated 503 Sash cords renewed 249 Outbuildings repaired or renewed 18 Obstructive buildings removed 10 Staircases repaired 28 Accumulations of refuse removed 68 Rooms ventilated 15 Defective and smoky flues remedied 41 Dirty floors and bedding cleansed 27 Basement sleeping rooms unfit for use, closed 2 Rat infested premises (remedied) 10 Miscellaneous. Nuisances remedied 115 Stables. Manure accumulations removed 8 Manure receptacles provided 1 Stables repaired, cleansed, etc. 14 Urinals. Reconstructed, and flushing apparatus provided 1 Repaired, etc. 26 Water supply reinstated 1 Fried Fish Shops. Rooms cleansed 4 Floors repaired 1 Bakehouses. Walls, ceilings and floors repaired 1 Floors cleansed 2 Walls and ceilings cleansed 5 Accumulations of filth removed 4 Butchers' Shops. Tap provided from rising main 1 Refuse receptacles provided 1 Accumulations of filth removed 1 24 Floors cleansed 2 W.C. pan cleansed 0 New pans provided 1 W.C. (walls, etc., repaired) 4 Flushing tanks repaired or renewed 1 Testing of Drains and Sanitary Fittings. Application of smoke test 13 „ water test (new work) 74 „ chemical test 0 Drainage systems opened out for examination on written complaint 10 Sewers relaid by Corporation on private property 0 Service of Notices. The following table shows the particulars of the notices served:- Informal notices 532 Statutory or formal notices under Sec. 94, Public Health Act, 1875, to abate nuisances 47 Statutory or formal notices under Sec. 36, Public Health Act, 1875, to provide a sufficient dust receptacle 32 Statutory or formal notices under Sec. 41, Public Health Act, to alter and amend drains, W.C.'s, etc. 38 Statutory or formal notice under Sec. 25, Public Health Act, Amendment Act, 1907, to pave and drain yard 1 Total 650 Number of interviews with owners of property, builders, etc., re sanitary improvements 360 25 Legal Proceedings. Legal proceedings were taken in respect of the following cases No. Nature of Offence. Result 1 Failing to comply with notices to remedy insanitary conditions. Order made for notices to be complied with within 14 days and to pay Court Costs. 2 To recover the sum of £24 6s. 8d. in respect of drainage works executed by the Corporation in default of owner complying with notices to alter and amend drains under P.H. Acts. Ordered to pay the sum demanded, plus 5 per cent, and £1 1s. 0d. Court Costs. Disinfection of Premises. Reason. Houses. Rooms. Number of Houses Bedding removed. Infectious Fevers 133 146 128 Tuberculosis 34 36 31 Other Diseases 75 105 20 242 287 179 Meat and Food- Inspection. Three hundred and sixty-six visits have been made to Slaughterhouses, Butchers' Shops, and other premises where food is prepared or exposed for sale. The following is a list of the unsound food surrendered and condemned:— Pork (Tuberculous) 1 head 63 lbs. Pork (Putrefaction) 13 lbs. Six Lungs (parasitical) 72 lbs. Wet Fish 168 lbs. Dried and Smoked Fish 86 lbs. 26 Shell Fish (Whelks) 1 bag Biscuits (Cheese) 20 pkts. Slaughterhouses. Number remaining in district ("registered") 2 Number of inspections made 130 Bakehouses. The number of bakehouses on the register at the end of the year was 21, six of these being under ground. Frequent inspections of the bakehouses have been made during the year. Dailies, Cowsheds and Milkshops. There are 3 cowkeepers and 33 dairymen and purveyors of milk registered under the Dairies, Cowsheds and Milkshops Orders within the Borough. The dairies, cowsheds and milkshops have been kept under supervision during the year and were generally found to be kept in a satisfactory condition. Monthly inspections are made of ill the milch cows in the Borough by the Veterinary Surgeon, Mr. W.J. Hatton, M.R.C.V.S., who reports to the Executive Committee monthly. Factory and Workshops Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 187. The businesses carried on at the respective premises are as follows Bakehouses 21 Dressmakers and Milliners 22 Tailors 11 Bootmakers 7 Laundries 10 27 Builders Workshops ... ... 8 Restaurant Kitchens ... ... 81 Motor Engineers ... ... 3 Shoeing Forges ... ... 2 Wig Making ... ... 2 Coach Building ... ... 2 Furriers ... ... 2 Other trades ... ... 16 187 These premises have been visited, and as a result of action taken by the department, the following defective conditions have been remedied:- Want of Cleanliness 13 Walls and floors repaired 0 Dampness (remedied) 4 Sanitary Accommodation Insufficient 0 Not separate for sexes 0 Unsuitable or defective 6 Accumulations removed 4 Other nuisances and defects remedied 10 Sash cords renewed 5 42 Stable Premises. There are 39 premises on the register, and these have all been systematically inspected during the year, strict attention being given to the provision of efficient receptacles for the storage of manure, and the prompt and frequent removal of all manure from the premises in order to minimise the risk of nuisance from "flies." 28 Rats and Mice Destruction Act. The provisions of this Act have been enforced during the year, and in 15 instances '"preliminary" intimations have been served upon the owners and occupiers of premises to eradicate rodents." and render the premises rat proof. Signed, GEORGE LAWS, Chief Sanitary Inspector. Housing Statistics for the Year 1925. Number of new houses erected during the year (a) Total 123 (111 Houses, 12 Flats). (b) With State assistance under the Housing Acts:- (1) By the Local Authority 10 (2) By other bodies or persons 113 (12 Flats) 1. Unfit dwelling-houses. Inspection- (l) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1519 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1926 502 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 978 2. 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 848 3. Action under Statutory Powers— A. Proceedings under Section 3 of the Housing Act, 1925. (l) Number of dwelling houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling houses which were rendered fit after service of formal notices:- (a) By owners 0 (b) By Local Authority in default of owners 0 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B. Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 118 (2) Number of dwelling houses in which defects were remedied after service of formal notices:- (a) By owners 98 (b) By Local Authority in default of owners 20 29 30 C Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders 0 (2) Number of dwelling houses in respect of which Closing Orders were made 0 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 0 (4) Number of dwelling houses in respect of which Demolition Orders were made 3 (5) Number of dwelling houses demolished in pursuance of Demolition Orders 0 HOUSING. General Housing Conditions. It is gratifying to be able to record that the question of maintaining good housing conditions throughout the district continues to receive the very earnest consideration of the Council, and the fact is generally recognised that good housing makes for sound health. Year by year the housing conditions in the Borough shew steady signs of improvement, both from the point of view of the erection of new houses, and the supervision, repair and maintenance of existing dwellings. During the year 1919 the Ministry of Health called for a survey of housing needs for the district. Subsequently the programme for building 114 houses to meet immediate needs was accepted, This programme has not only been carried into effect, but the number of new houses and fiats was increased from 114 to 168. Subsequently a further 10 houses were erected on the Darell Road site. Thus, the total number of new houses and flats erected by the Council during the past live years is 178. 31 Further, estimates have also been accepted by the Council for the erection of 4 more houses on a spare plot of land in Dudley Road, adjoining the existing Housing Scheme, and the work of erection is to commence almost immediately. The total number of houses and flats owned and controlled by the Council up to December 31st, 1925, is 373. This is no mean achievement and shows that the Council is fully alive to its responsibilities. The building of houses by private enterprise also shews steady improvement. The number of houses and flats erected under this agency during the past five years is :— 1921 1922 1923 1924 1925 3 16 25 76 113 Total 233 Though much has been done locally to cope with the housing shortage, there is evidence that more remains to be done before the shortage in the district has been overcome. Unfortunately, the majority of houses built by private enterprise during the last five years are beyond the means of the average working man. Overcrowding. Application for Workmen's Dwellings. In December last, on the instructions of the Health Committee, the Town Clerk made a census of the applicants on the waiting list for Corporation dwellings, which list then totalled 1130. It is interesting to note that of this number no less than 379 of the applicants lived outside the district. As a result of the Town Clerk's canvas, the list of applicants was reduced to 483. A house to house inquiry has also been made of certain streets in each Ward throughout the Borough to ascertain to what extent overcrowding was prevalent. The number of houses or premises at which inquiries were instituted was 2266, and a detailed report is now in course of preparation for presentation to the Health Committee. 32 it is evident from the foregoing that more houses for the working classes are still urgently required. The Health Committee are at the present time considering a scheme for building approximately 70 more houses on the Manor Road allotments, when such land becomes available for building purposes. The question of obtaining land for building has become a very difficult one, by reason of the small amount of land available in the Borough. The high price charged for such land makes the building of small workmen's houses practically prohibitive, except at an economic loss. Fitness of Houses. The duties imposed upon the local authority by the Housing Acts, and the Inspection of District Regulations, viz., to supervise the inspection of all existing dwellings to see that such premises are maintained at all times reasonably fit for human habitation, are being thoroughly and consistently carried out. The details of the work executed under this heading will be found set out in the tabulated report of the Chief Sanitary Inspector, wherein it will be observed that a large amount of valuable work has been accomplished by the Sanitary Staff. The able and vigorous discharge of this section of the department's work cannot fail to have the result of making for good standards of health and sanitation throughout the Borough. All the sanitary improvements made during the year have been effected by utilising the powers contained under the Public Health Acts, and it is pleasing to be able to record that owners of property or their agents have, generally speaking, shewn a readiness or willingness to fulfil their obligations, when their attention has been called to the necessity for remedying sanitary defects or executing sanitary improvements. A great deal of work has been done by the service of "preliminary" or informal notices only, and in those instances when large and costly improvement works are asked for, the Chief Sanitary Inspector endeavours to arrange for a personal interview 33 of the works under notice, with the owner or agent on the spot. This method often enables the department to get the work done with the minimum amount of friction. A reasonable time is given for the execution of all repairs and alterations, and when an extension of time is required the sanction of the Health Committee is first obtained. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Most of the milk supplied in the district is brought in from country districts. There are, however, three dairy farmers who keep their own cows in the Borough. The Veterinary Inspector appointed by the Corporation inspects all cattle regularly and reports to the Executive Committee monthly. All Dairies and Cowsheds are frequently inspected. In 1923 the Milk (Special Designations) Order came into force by which milk is graded into four special classes:- (a) Certified Milk. (b) Grade A Tuberculin tested. (c) Grade A. (d) Pasteurised. Producers of Certified Milk receive their licences direct from the Ministry of Health. County Councils and County Borough Councils are authorised to grant licences to producers to sell Milk as Grade A, and District Councils are authorised to grant licences to any person other than a producer to sell milk as Certified, Grade A and Pasteurised. The Ministry of Health have granted a licence to one firm in the Borough for the production of Certified Milk. The Ministry have also asked the Richmond Council to arrange for samples of certified milk sold in the Borough to be taken at different times throughout the year. This has been done and usually the results 34 of these analyses have been very good. On two occasions the results were not good and the sale of the particular milk was stopped. The Borough Council has granted licences to sell Certified Milk to three firms in the Borough, and a licence to sell Grade A milk to one firm. No licences have been issued for the sale of Pasteurised Milk although the larger firms supplying milk do pasteurise most of the milk coming from the country. Certified milk on examination must not contain any Bacillus Coli in one-tenth of a cubic centimetre and not more than 30,000 bacteria per cubic centimetre. Seven samples were examined during 1925, and in none was the Bacillus Coli found. The number of bacteria per c.c. varied from 750 in one sample to 11,400 in another, so that it will be seen that all were below the number allowed. (b) Meat. Meat has always been very thoroughly inspected in this Borough, so that very little change was necessary when the Public Health (Meat) Regulations, 1924 came into force on the 1st of April, 1925. By these Regulations notice of killing must be sent to the Medical Officer of Health. All animals killed have been inspected. No meat has had to be seized as unsound, but in another part of this report will be found a note of the quantities surrendered voluntarily by the retailers. Any meat surrendered or condemned is destroyed. If a large quantity such as a whole carcase is to be dealt with arrangements are made for it to be sent to a firm who boil it down. Smaller quantities are burnt at the destructor. The administration of the other part of the Meat Regulations is not so easy. Nothing definite is laid down as to the requirements necessary to comply with the regulations, so that the regulations may be applied in different ways in various districts, 35 Opposition has been aroused in certain places to the provision of windows in butcher's shops. In the same districts there are butchers whose shops are provided with windows, and they do not appear to have less business or to have more trouble in keeping their meat than those traders who do not possess windows. The practice of bringing meat outside the shop either hanging on the sides of doors and windows, or on a slab without covering of any sort should certainly not be allowed. Slaughterhouses In 1920. In Jan. 1925. In Dec. 1925. Registered 4 2 2 Licensed - - - Total 4 2 2 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 Medical Officer of Health has kindly furnished the following particulars for 1925. SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during year ending December 31st, 1925:- Articles Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 5.1 51 1 Cream 7 7 „ Preserved 2 2 Butter 2 2 Cheese 3 3 1 1 Coffee 1 1 Cocoa 1 1 Sugar 1 J Spirits 3 6 1 1 1 1 Drugs 2 2 Other Articles 1 1 Totals 66 11 77 2 1 3 1 1 36 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Notifiable Diseases during the Year. Disease Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Diphtheria 25 22 2 Scarlet Fever 112 97 ... Enteric Fever 1 1 ... Paratyphoid B. ... ... ... Pneumonia (Primary) 3 ... ... Influenzal Pneumonia ... ... ... Erysipelas 9 3 ... Chicken Pox 28 ... ... Acute Poliomyelitis ... ... ... Encephalitis Lethargica 3 1 3 Ophthalmia Neonatorum 2 2 ... Tuberculosis: (a) Pulmonary (M.) 30 24 14 (F.) 18 14 7 Total 48 38 21 (b) Non-Pulmonary (M.) 6 2 4 (F) 3 2 4 Total 9 4 8 Diphtheria. Twenty-five cases of this disease were notified during the year. The case rate of this disease per 1,000 living was 0.7, compared with 1.23 for England and Wales. During the past five years the notifications of this disease were as follows:- 1921 28 1922 16 1923 30 1924 56 1925 25 The deaths from this disease numbered two, a death rate of 0.05 as compared with 0.07 in England and Wales and 0.09 in London. One of the two deaths occurred in a child who died outside the district. He may have contracted the disease outside. Twenty-two cases occurring in the Borough were treated at the Isolation Hospital. 37 It cannot be too often brought to the notice of the public that Diphtheria is a serious disease, and also that if seen and treated at once it is possible to avoid a fatal ending. Parents should never neglect a sore throat and should seek medical advice at once, Many cases are seen where there are enlarged glands under the jaw (due to Diphtheria), the parents not seeking advice till late in the disase as they imagined the children had contracted Mumps. Unfortunately may cases of Diphtheria do not cause the throat to be sore, and in young children especially no complaint is made. I repeat that it is better to seek medical advice early, as a delay of twenty-four or even twelve hours may mean the difference between life and death. The Council has arranged that Diphtheria Antitoxin is kept at one or two chemists in the Borough, and the local practitioners can obtain it day or night for use in suspected cases. During the year the cost of Antitoxin so supplied was £17 4s. 9d. Bacteriological examinations are carried out by the Lister Institute by an arrangement with the Council. 38 During the year the number of Specimens, &c. sent up for examination was as follows:- Disease Suspected. Nature and Specimen. Result. Total. Positive. Negative Diphtheria Swabs from Throat and Nose 40 217 257 Tuberculosis Sputum 16 63 79 Enteric Fever Blood .. 3 3 Syphilis Blood .. 1 1 56 284 340 Scarlet Fever. During 1925, 112 cases of this disease were notified and 97 were treated in hospital. The rate per 1,000 living was 3.2 as compared with a case rate of 2.36 in England and Wales. There were no deaths. This is a disease which appears to occur in regular cycles. For some years there may be few cases notified and this is followed by a year in which there is an epidemic. During the last five years the numbers were 1921 83 1922 47 1923 32 1924 23 1925 112 If we go back over the last fifty years we find that every few years there is a recrudescence of the disease. 39  Total Casks Notified. Total Heaths. Under I year 1-2 2—3 3—4 4 -5 5-10 10-15 15-20 20-35 35-45 45—65 65 and over. Under 1 year 1—2 2—3 3-4 4-5 5 -10 10-15 15—20 20—35 35-45 45—65 55 and over. Diphtheria ... ... 5 ... ... 14 3 ... 2 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... 2 3 9 53 34 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... 3 1 2 12 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Primary) ... ... ... ... ... ... ... ... 1 1 1 ... 3 1 1 ... ... ... 1 ... 1 1 11 8 Influenzal Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipe'as ... ... ... ... ... ... ... ... ... 1 6 2 ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid B. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... 1 ... 1 1 Tuberculosis:— (a) Pulmonary ... ... ... ... ... ... 1 ... 26 8 13 ... ... ... ... ... ... ... ... 1 5 6 7 2 (b) Non Pulmonary ... ... 2 ... ... 1 1 1 3 1 ... ... ... ... 3 1 ... ... ... ... ... 2 1 1 40 Pulmonary Tuberculosis (Phthisis). Forty-eight cases of this disease were notified during the year (30 males and 18 females). Of these 38 (24 males and 14 females) were removed to Hospital or Sanatorium. There were 21 deaths from this disease during the year. Non-pulmonary tuberculosis was responsible for 8 deaths, while 9 cases were notified during the year. Tuberculosis. Age-Periods. New Cases. Deaths. Pulmonary NonPulmonarv Pulmonary NonPulmonary M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 1 3 5 ... ... 1 ... ... ... ... ... 10 ... 1 1 ... ... ... ... ... 15 ... ... ... 1 1 ... ... ... 20 4 2 1 ... ... 1 ... ... 25 11 9 1 1 2 2 ... ... 35 4 4 1 ... 5 1 2 ... 45 8 2 ... ... 3 1 ... 1 55 3 ... ... ... 2 1 ... 65 and upwards ... ... ... ... 1 1 1 ... Totals 30 18 6 3 14 7 4 4 41 Maternity and Child Welfare. The Richmond Infants Health Association has existed since 1908 with Mrs. Gates as Honorary Superintendent, and a large band of enthusiastic voluntary workers. In 1919 the Town Council began to make a grant af £65 per annum, and a Committee composed of members of the Council, together with three co-opted lady members, deals with all matters relating to Maternity and Child Welfare. For many years the voluntary workers not only attended at the weekly meetings of the Centre, but also visited the mothers and children in their homes, now all home visiting is carried out by two Health Visitors (trained nurses) employed by the Council. The Centre was, up to recently, held once a week, on Thursday afternoons, from 2.30—4 p.m. The members seeking medical advice became so numerous that it was decided to have a Centre on Monday afternoons also. The Medical Officer of Health and the Health Visitors therefore attend on both of these days, and the children are seen mainly for the purpose of giving advice re feeding, etc. No treatment is carried out, as children requiring more than the very simplest treatment are referred to the Royal Hospital, Richmond. A special children's department has been set up there, and the Council makes a grant of £30 per annum. At the Centre also, the babies are weighed and mothers can purchase Dried Milk, Virol, etc. The voluntary workers under the direction of Mrs. Gates, carry on what may be called the social side of the Centre on Thursday afternoons. Lectures and music are supplied, and conferences arranged for the mothers, so that every week of the year there is something of an educative nature about the Centre. The Health Visitors attend at the Centre and assist generally in weighing the babies, giving advice to the mothers, and giving occasional courses of lectures. 42 These Nurses also visit at the homes, and during the year under review, 402 first visits were made, and 1,102 re-visits. The total attendances at the Centre during the year were:— Mothers 4,121. Average per week 82.4. Children 5,515. 110.3. A Child Welfare Centre for the district of Kew is run on voluntary lines, and there is practically no Co-ordination with the Maternity and Child Welfare Committee of the Corporation. It is held weekly during the winter months only. At the other end of the Borough, the village of Petersham has had up to lately, no special centre, and of course it is too far from the centre at Raleigh Road to expect the mothers to attend there. The County Authorities in starting Maternity and Child Welfare work in the neighbouring district of Ham, had to hold their Centre in a Hall in Petersham. An arrangement, therefore, has been made with the County that mothers and babies belonging to Petersham may attend at the Centre held once a fortnight and receive advice from the Medical Officer (one of the County Medical Staff). The District Nurse at Petersham (Nurse Henrys), who acts unofficially as a Health Visitor for the Borough, attends at the Centre in order to be in touch with the Mothers and the Doctor. This arrangement works very well as, of course, in the Village, the District Nurse is known to all. Dried milk is supplied by the County to necessitous Mothers free or at reduced rates, and any expense on milk so supplied to Petersham (i.e. Richmond) Mothers would be refunded by the Richmond Council to the County Council. During the year, arrangements have been made for Dental work in connection with the Maternity and Child Welfare Centre. A Dental Clinic is held once a week, and Miss E. Walker, L.D.S. (Eng.), one of the School Dental Surgeons attends for the treatment of nursing and expectant Mothers and of children under 5 years of age. Anæsthetics are given by the Medical Officer of Health, and artificial dentures supplied at prices similar to those charged in connection with the National Health Insurance Scheme. 43 This Clinic was opened in February, 1925, and during the year 38 sessions have been held including six for the administration of anæsthetics. Thirty-eight patients were treated and made 137 attendances. The work done was as follows:- Extractions of permanent teeth 116 „ „ temporary „ 48 Filling of permanent Teeth 27 ,, „ temporary „ 26 Other operations chiefly in connection with provision of Dentures 20 Dentures supplied 2 „ in course of preparation 4 Ophthalmia Neonatorum. This is an inflammation of the eyes in newborn children (up to three weeks old), and is a very serious disease if not immediately treated. Total blindness may be caused by neglect. Two cases were notified during the year. Ophthalmia Cases Vision Unimpaired Vision Impaired Total Blind ness Deaths Notified Treated At Home In. Hospital Neonatorum 2 - 2 2 - - -