C.I. M AC44 13 (1) Richmon) Rich 3 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1934. RICHMOND: J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STREET. BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1934. richmond: j. h. broad and co., ltd., printers, 8, king street. 2 Public Health Staff. Medical Officer of Health and School Medical Officer— *Charles Stuart Brebner, D.S.O., M.D., D.P.H., F.R. San. Inst. Barrister-at-Law. Ante-Natal Clinic and Child Welfare Centre, Petersham and Ham— Margaret E. Cryer, M.D. (Glas.). Consultant for cases of Puerperal Fever and for Difficult Labours— J. W. Bell, M.D., L.R.C.P.. L.R.C.S., Diphtheria Immunisation Clinic— D. S. Murray, B.Sc., M.B., Ch. B. Chief Sanitary Inspector— *George Laws, P.R. San. Inst., F.S.I.A. Certified Inspector of Meat and other Foods. Inspector under Shop Honrs Acts. Assistant Sanitary Inspectors— Bernard Aisthorpe (Certificate Royal Sanitary Institute and Meat and Food Inspectors' Certificate). Victor Edward Baughan (Certificate Royal Sanitary Institute, Meat and Food Inspectors' Certificate and Smoke Inspectors' Certificate). Alec Henry Garton Johnson (Certificate Royal Sanitary Institute and Meat and Food Inspectors' Certificate). School Nurses and Health Visitors— Miss J. D. Law, R.R.C., S.R.N., C.M.B., Health Visitors' Certificate, Univ. Edin. Miss C. G. Hay, S.R.N., C.M.B., New Health Visitors' Certificate, R.S.I. Miss C. Burton, S. R.N., S.C.M., New Health Visitors' Certificate. Clerks— Miss D. K. Jemmett. Miss M. J. Bird. Miss O. W. Ponsford. 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* 3 Public Health Department, Parkshot, Richmond, Surrey. June, 1935. To The Mayor, Aldermen and Councillors of the Borough of Richmond (Surrey). Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary condition of the Borough during the year ended December 31st 1934. The Report is drawn up according to the directions contained in Circular 1417 issued by the Ministry of Health in October, 1934 and is what is known as an Ordinary Report. During the year considerable progress was made in the Slum Clearance Programme under the Housing Act of 1930. This will be dealt with at length in the Section headed " Housing." The Birth rate throughout England and Wales for 1934 is 14.8, while the rate in Richmond is only 10.4 per 1,000 of the population. The Death rate for the Borough is 11.3 per 1,000 of the population, while this year's rate for England and Wales is 11.8. The Infantile Mortality rate is 55 per 1,000 births, which compares favourably with the Infant Mortality rate of England and Wales, viz., 59 per 1,000 births. 1 take this opportunity to express my thanks to the Chief Sanitary Inspector and the Staff of the Department for their work during the year. I am, Ladies and Gentlemen Your obedient Servant, C. S. BREBNER. 4 Natural and Social Conditions of the Area. Area (in acres) 4,243 Population (census 1931) 37,791 „ (estimated 1934) 38,570 Number of inhabited houses (1934) 9,162 Rateable Value £541,226 Sum represented by a penny rate £2,150 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. On April 1st, 1933, the Borough was further enlarged by the inclusion of a large part of the Ham Urban District. 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, whilst a certain number of the inhabitants are engaged in those industries and occupations connected with boating. Poor Law Relief. The Clerk of the Public Assistance Committee informs me the approximate number of cases afforded Outdoor Relief in the Richmond district during the year was 544. 5 The Philanthropic Society has assisted the needy to the following extent:— £ s. d. To Monetary Grants, on petition, for surgical appliances, convalescent treatment, etc. 185 0 0 Boots and Clothing 70 0 0 Relief in other forms 250 0 0 Convalescent Home, Hospital and Surgical Aid Letters purchased 50 0 0 Richmond Royal Hospital. The Secretary-Superintendent, Captain G. M. F.den, has kindly supplied the following information:— 1,516 In-Patients and 5,610 Out-Patients were treated at the Hospital during 1934. Those received from the Borough of Richmond were 421 In-Patients and 1,278 Out-Patients. Extracts from Vital Statistics of the Year. total. m. f. Births (Legitimate) 374 188 186 „ (Illegitimate) 29 16 13 Stillbirths (Legitimate) 14 6 8 ,, (Illegitimate) 2 — 2 Deaths 508 218 290 Birth Rate (R.G.) 10.4 Death Rate (R.G.) 11.3 Death Rate of Infants under 1 year of age. Deaths of all children under 1 year per 1,000 Births 55 Deaths of Legitimate Infants per 1,000 Legitimate live Births 48 Deaths of Illegitimate Infants per 1,000 Illegitimate live Births 138 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 1 9 BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1934. (Provisional figures). (The mortality rates for England and Wales refer to the whole population but for London and the towns to civilians only). Rate per 1,000 total population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. Live Births. Still-births. All Causes. Typhoid and Paratyphoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza Violence. Diarrhoea and Enteritis (under two years). Total Deaths under one year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 118 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 132 Smaller Towns (Esti mated Resident Populations 25,000 to 50,000 at Census 1931) 15.0 0.67 11.3 0.00 0.00 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0 07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 RICHMOND 10.4 0.41 11.3 0.00 0.00 0.00 0.00 0.02 0.10 0.31 0.70 2.5 55 78.2 16.7 5.1 0.0 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows per 1,000 Live Births 2.03 2.57 4.60 „ „ Total Births 1.95 2.46 4.41 The maternal mortality rates for Richmond are as follows per 1,000 Live Births 2.48 0.00 2.48 „ „ Total Births 2.39 0.00 2.39 7 Population. At the Census of 1931 the population of the Borough was 37,791 while the Registrar General's estimate of the population at the middle of 1934 was 38,570. Births. There were 403 births during the year (204 males and 199 females). This gives a birth rate of 10.4 per 1,000 of the population as compared with a rate of 14.8 in England and Wales and 13.2 in London. There were 16 still births registered giving a rate of 0.41 per 1,000 of the population, as compared with 0.62 in England and Wales and 0.50 in London. Deaths. The number of deaths registered during the year was 508 (218 males and 290 females). In the list of deaths supplied weekly by the local Registrar there were 232 deaths of persons usually residing outside the Borough. These are not included in my statistics but are dealt with in the districts concerned. On the other hand 89 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 380, and the number of inquests held was 85, though all of these were not concerned with Richmond residents. The 508 deaths gives a crude death rate of 13.2 per 1,000 of the population. This crude death rate however cannot be used to compare the mortality with that of other districts as the populations of all areas are not similarly constituted as regards the proportions of their sex and age group components. 8 The Registrar General supplies a comparability factor and the crude death rate multiplied by this figure can then be compared with the crude death rate of the county as a whole or with the mortality of any other local areas. The corrected death rate obtained by the above is 11.3 as compared with 11.8 for England and Wales and 11.9 for London. The total number of deaths received weekly from the local Registrar does not always tally with the number received at the end of the year from the Registrar-General. This is due to the fact that the statistical year of the Registrar-General may not begin at the first day of the week. The number of deaths, therefore, in the following table, is as near to the Registrar-General's figure as I am able to make it. The deaths occurred in persons of the following ages:— 20 under 1 year of age. 7 between 1 and 5 years of age. 9 „ 5 „ 15 „ 9 „ 15 „ 25 37 ,, 25 ,, 45 ,, 158 „ 45 „ 65 180 „ 65 „ 80 93 over 80 years of age. It will be noticed that no fewer than 273 persons died over the age of 65, i.e., more than half the total deaths, while 93 were deaths of people over 80 years of age. 9 Causes of death under 1 Year of age. Cause of Death Under 1 week I—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 1 year 1. Other Tuberculous Diseases. ... ... ... ... ... ... ... ... ... ... 2. Bronchitis ... ... ... ... ... 1 ... ... 1 2 3. Pneumonia ... ... ... 2 2 ... ... 2 ... 4 4 Congenital Debilitv and Malformation including Premature Birth 6 ... ... ... 6 1 ... ... ... 7 5. Other defined diseases 4 ... 1 ... 5 1 2 1 ... 9 10 ... 1 2 13 3 2 3 i 22 Infantile Mortality. This rate is calculated on the number of deaths of children under one year of age per 1,000 births. During 1934 there were 22 deaths of children under one year of age and 403 births. This gives an Infantile Mortality rate of 55 per 1,000 births, as compared with 59 in England and Wales, and 67 in London. It will be seen from the table that out of the 22 deaths, ten occurred in the first week of life. The neonatal deaths, i.e„ deaths occurring in the first four weeks numbered 13 out of the total 22. This gives a neonatal mortality of 32 per 1,000 births. Six of these deaths were due to Congenital Debility and Premature Birth, but of the 22 deaths of children under one year of age three were children who were found in the River Thames. In one case the verdict at the Inquest was "Inattention at Birth" and in the other two cases "Murder by person or persons unknown." Ten of these 22 deaths occurred in hospital while inquests were held in eight cases. There were four deaths of illegitimate infants under one year of age out of 29 illegitimate births. This gives an Infantile Mortality rate of illegitimate children of 138 per 1,000 births. 10 Causes of Death. M. F. All Causes 218 290 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough 1 — 5. Diphtheria 2 2 6. Influenza 4 8 7. Encephalitis Lethargica 1 — 8. Cerebro-Spinal Fever — 1 9. Tuberculosis of respiratory system 10 11 10. Other tuberculosis diseases 2 1 11. Syphilis 1 — 12. General paralysis of the insane, tabes dorsalis 1 1 13. Cancer, malignant disease 30 58 14. Diabetes 2 1 15. Cerebral haemorrhage, etc. 10 16 16. Heart disease 44 61 17. Aneurysm — 2 18. Other circulatory diseases 18 24 19. Bronchitis 8 4 20. Pneumonia (all forms) 11 15 21. Other respiratory diseases 3 7 22. Peptic Ulcer 8 2 23. Diarrhoea, etc. (under 2 years) — 1 24. Appendicitis 4 1 25. Cirrhosis of Liver — 1 26. Other diseases of liver, etc. 1 2 27. Other digestive diseases 4 15 28. Acute and chronic nephritis 7 9 29 Puerperal sepsis — 1 30. Other puerperal causes — — 31. Congential debility, premature birth, malformations, etc. - 8 32. Senility 4 6 33. Suicide 8 1 34. Other violence 7 11 35. Other defined diseases 27 20 36. Causes ill-defined or unknown — - 11 General Provision of Health Services in the Area. (1) Public Health Officers of the Authority. A list showing the staff employed in the Public Health Department is on Page 2. (2) (a) Laboratory Facilities The Pathologist at the Royal Hospital, Richmond, undertakes the Bacteriological examinations required by the Council. During the year 475 examinations were made and a detailed list is shown on page 52. Samples of Certified Milk are taken on instructions from the Ministry of Health and are examined at the National Institute for Dairying Research, Reading. Chemical and Bacteriological examinations are also made frequently of samples of water taken from the various supplies in the Borough. Local and 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). 12 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. „ „ Locomotive Act, 1898. 10. Bye-laws under Good Rule and Government of the Borough. 11. Bye-laws with respect to occupation of basement sleeping rooms, Section 18 (7) H. & T.P. Act, 1925. 12. Bye-laws as to Fish Frying, 1920. 13. Bye-laws as to Tents, Vans, Sheds, etc., 1920. 14. Bye-laws as to Houses Let in Lodgings. (b) Ambulance Facilities. The Joint Isolation Hospital Committee have two ambulances which remove infectious cases to the Hospital. The Richmond Council has a motor ambulance kept at the Fire Station, for use in accidents and private cases. During the year this ambulance was used 776 times and the mileage covered was 3,201. (c) Nursing in the Home. The local Queen's District Nursing Association through its two nurses performs excellent work in nursing patients in their own homes. The Kew and Kew Gardens District Nursing Association (with one nurse) performs a similar service in Kew and St. Luke's parishes. The Ham District Nursing Association also provides a nurse for the parish of Ham. The Richmond Council makes grants towards the Queen's District and the Kew Nursing Associations and in return cases of illness in children under five years of age receive nursing assistance 13 During the year the total number of patients attended by the District Nurses was 339 and the number of visits paid was 7,237. The Nurse employed by the Kew and Kew Gardens Association attended 175 cases (Medical 137, Surgical 35, Maternity 3) and paid 5,603 visits. Infectious Disease. The District Nurses referred to above will also attend cases of minor infectious illness such as Measles if the necessity arises. Clinics and Treatment Centres. Address. By whom provided. Minor Ailments Clinic Windham Road, Richmond. For Elementary School Children Education Committee. Dental Clinic Ditto Ditto. (10 halt-days per fortnight). Ditto. Do. do. Ditto 1 hour weekly. M.and C.W Eye Clinic Ditto (1 session per fortnight). Committee. Education Committee. Ante-Natal Clinic Ditto (1 session per fortnight). M. and C.W. Committee. Diphtheria Immunisation Ditto Twice weekly. Health Committee. Tonsils and Adenoids Richmond Royal Hospital. By arrangement with Education Committee. Ringworm (X-rays) Mr. G. G. Blake, 10, Onslow Rd., Richmond. When required. Education Committee. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. By arrangement with M. & C. W. Committee. Tuberculosis Treatment 38, Sheen Rd., Richmond. Twice weekly. Countv Council. 14 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, M.I.E E., F.Inst.P. The Minor Ailment Clinic is held every morning, and during the year 1,028 children have made 4,330 attendances. The Eye Clinic is held once a fortnight by Mr. Blair, who prescribes glasses for those children requiring them. The glasses are obtained from a Richmond optician at a contract price; 130 children were treated during the year. The School Dental Clinic is held 10 times a fortnight, and 1,407 children were treated during the year. In December, 1934 a Clinic for Schick testing and Diphtheria Immunisation was begun and Dr. Murray, the Pathologist of the Royal Hospital, Richmond, was appointed to do the actual immunising. Sessions were at first one per week, but the number applying for the treatment became so great that two sessions a week are at present working well. Hospitals. 1. Isolation Hospitals. As mentioned in last year's Report, many Conferences were held with a view to establishing a South West Middlesex & Richmond Joint Board. At the time of writing, this Board has now come into being and the Hospitals at Mogden (formerly belonging to the Joint Hospital Committee of Richmond, Heston and Isleworth), Twickenham and Hampton may be regarded as one hospital for the use of the inhabitants of these areas and of Hampton Wick, Sunbury and Teddington in addition. A scheme for the enlargement of Mogden Hospital is now being considered. 2. Smallpox. Arrangements have been made with the Surrey County Council whereby cases of Smallpox occurring in the Borough will be admitted to the Smallpox Hospital at Clandon. 15 3. Tuberculosis. Patients seen by the County Tuberculosis Officer and found to be suitable for Hospital treatment are sent to Hospitals and Sanatoria. The Surrey County Council have a Sanatorium at Milford, near Godalming, for the reception of Tubercular cases from all parts of the County. 4. Children. The Richmond Royal Hospital has a special Children's Department one day a week, Children can be sent from the Council's Maternity and Child Welfare Centres, and are treated as In or Out Patients according to condition. The Richmond Council make a grant towards this Department. 5. 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 Grove Road Infirmary, formerly under the Guardians is now under the control of the Surrey County Council. 16 MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED. Richmond. Richmond Union. Heston and Isleworth. Hounslow Carrison. Brentford Union. Teddington. Staines. 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 Scarlet Fever Diphtheria Enteric Fever Other Diseases Total. Scarlet Fever Diphtheria Enteric Fever Other Diseases Total. 1984 42 45 ... 1 88 2 ... ... ... 2 261 65 ... 27 353 1 ... ... ... 1 ... 1 1 ... 2 ... ... ... 2 2 ... 1 ... ... 1 ... ... ... ... ... 306 112 1 30 449 17 3. (i) Midwifery and Maternity Service. Maternity and Child Welfare Centres are held thrice weekly at the Health Centre, Windham Road, while a Centre is held at Petersham twice monthly, for the inhabitants of Ham and Petersham. During the year the attendances at the Centres were:— Windham Road. Mothers 5,481 Average per session 37 Children 7,133 48 The Medical Officer of Health held 2,562 consultations during the year. Trefoil House, Petersham. Mothers 491 Average per session 20 Children 687 „ „ „ 28 Dr. Cryer, the Medical Officer, held 501 consultations during the year. I have again to express my thanks to the voluntary workers at both Centres for their valuable assistance week by week. They include Mrs. Govett and Mrs. Sprague (who are co-opted members on the Maternity and Child Welfare Committee), Mrs. Brebner, Mrs. Klinkhart, Miss Reid, Mrs. Hammond and Mrs. Smith. We are sorry to lose the services of Mrs. Johnstone who has left the district. At Petersham the ladies who do excellent work are Mrs. Field, Mrs. Daniels, Mrs. Soimenow, Mrs. Hughes and Mrs. Coleman. The Health Visitors visit at the homes and during the year under review, 406 first visits were made and 2,697 revisits. 18 Ante-Natal Work. An Ante-Natal Clinic is held twice a month (2nd and 4th Wednesday afternoons) at which expectant mothers can attend and receive advice. The figures for the year 1934 are:— Number attended, 98. Total attendances, 331. Midwives and doctors have been advised of any abnormalities and the mothers also advised re diet, etc. Many have received Dental treatment as a result of attending the Ante-Natal Clinic. Maternal Mortality. The Maternal Mortality rate is calculated on the number of Births in the area. During 1934 there was one death (in Hospital) from Puerperal Sepsis giving a mortality rate for this disease of 2.39 per 1,000 births, as compared with a rate of 1.95 per 1,000 births in England and Wales. There was no other death in the Borough from other puerperal causes and the mortality rate for all deaths after confinement was 2.39 per 1,000 births, as compared with 4.41 in England and Wales. Dental Clinic. 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. Russell, L.D.S. (Eng.) the School Dental Surgeon, 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. During the year 1934, 39 sessions have been held, including 19 for the administration of anaesthetics. IS One hundred and twenty-seven patients were treated and made 245 attendances. The work done was as follows:— Extractions of permanent teeth ... ... 151 ,, ,, temporary ,, ... ... 362 Filling of permanent teeth ... ... 7 „ ,, temporary ,, ... ... 9 Other operations chiefly in connection with provision of dentures ... ... 2 Dentures supplied ... ... ... 6 Number of anaesthetics given ... ... 129 (ii) Institutional Provision for Mothers or Children. There is a Home (supported by voluntary effort) for unmarried mothers and illegitimate children. No arrangements are made for confinements to take place there. By arrangement with the Surrey County Council unmarried mothers and their children can be sent to a Home at Epsom if beds are available. (iii) Health Visitors. There are three Health Visitors employed as such half-time. The rest of their work is as School Nurses. With the enlargement of the Borough some re-arrangement of districts was required, and the Health Visitor who takes the southern portion of the Borough (including Ham and Petersham) attends the Welfare Centre at Petersham twice monthly. (iv) Infant Life Protection (under part 1 of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932). The Maternity and Child Welfare Work also includes the supervision of Foster Children, a work formerly in the hands of the Guardians. All persons taking children for gain require to be registered and their homes are visited by the Health Visitors. 20 The children come under this Act until they are nine years of age, and of course, the Nurses pay more frequent visits when the children are below school age. 247 visits were paid to Foster Children by the Nurses in 1934. Schools taking in Boarders under 9 years of age also come under this Act and are subject to inspection unless specially exempted. 4. Nursing Homes Registration Act, 1927. The Surrey County Council are the supervising Authority for Registration of these Homes. After registration is completed the delegation of all powers is given to the local Council and inspections are carried out by the Medical Officer of Health of the Borough from time to time. The County Medical Officer consults me with regard to premises when registration is asked for. The County Council have issued Bye-laws with regard to Nursing Homes. The number of Homes in the Borough during the year was 12 of which 7 take Maternity cases. Inspections have been made and no contraventions of the Bye-laws have been found. Sanitary Circumstances of 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) five wells near the river. The water from these latter wells is chlorinated by an automatic process. Even before chlorination analysis shows rhat the water is a good one, but after chlorination the analyst's report invariably shows a practically sterile water, and one excellent for the purpose of a public supply, 21 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 and Barnes Corporations, deals with the sewage from the Boroughs of Richmond and Barnes. 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. Tne 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. 22 SANITARY INSPECTION OF THE AREA. Report of Chief Sanitary Inspector. In compliance with Article 19 of the Sanitary Officers Order, 1926, made by the Minister of Health, I have the honour to submit the following tabulated particulars upon the work carried out by the Sanitary Staff during the year 1934 in connection with the administration of the numerous Acts of Parliament and Bye-Laws in force within the district. Whilst the functions and duties of the Sanitary Staff are numerous as shown by the work set out in the following tabular statements, it can be said that all the demands made upon it closely affect and concern the well-being of the community in the application of those social reforms which make for the common good. The work accomplished during the year in the inspection and condemnation of the second batch of slums consisting of 121 houses and the consequent labours involved in the numerous functions and duties in the preparations made for the re-housing of the displaced tenants—453 in number—have entailed much extra work upon the whole staff. In addition to the work involved in slum clearance, good progress has been made in the inspection of many unsatisfactory premises found to be let out into tenements and which were the cause of many complaints arising from unsuitable sanitary conditions, etc., also the inspection of basement properties occupied as cellar dwellings and underground rooms used as sleeping rooms in contravention of the Statutes. The new byelaws and regulations governing the use of such premises and giving greater power to control such premises came into force in May, 1933. 12 premises were the subject of special reports to the Health Committee followed by closure. The work done is set out more fully in the section of this report dealing with Housing. 23 The continued shortage of housing accommodation emphasises the need for maintaining existing houses in an efficient state of repair. 1,064 houses were inspected for housing defects either under the Public Health or the Housing Acts. Details of the inspections made and improvements effected as a result of such surveys are set out in the following summary. Inspections. The total number of inspections made during the year was 5,760. On 425 of the premises visited nuisances to the number of 1,922 were discovered, and in dealing with the sanitary defects from which they arose 227 "intimation" or " preliminary " notices and 64 statutory notices were served. The number of letters written with regard to the abatement of nuisances, etc., was 191. At the end of the year 1,082 of the defects discovered had been abated, the work of remedying 666 was in hand, and the remaining 174 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 1,297 visits were paid to the respective premises. The number of inspections made under the Housing and Town Planning Act and particulars recorded was 202, and the number of sanitary defects remedied and improvements made under this heading was 927. The following list shows the number of routine inspections and visits made :— Inspections During 1934. Houses inspected and particulars recorded (H.T.P. Acts) 202 Houses visited (P.H. Acts) 862 Re-visits to houses and other premises 641 Miscellaneous visits 1,282 Visits to works in progress 656 ,, factories ... 20 ,, workshops, bakehouses, etc. 126 24 Visits to outworkers' premises 10 „ workplaces, tearooms, etc. 135 „ dairies, cowsheds and milkshops 72 „ ice cream vendors 6 „ food stores 135 „ slaughter house 98 „ fried fish shops 16 „ greengrocers' premises 66 „ stables 88 „ piggeries 16 „ public conveniences 83 „ petrol stores 199 „ employment agencies 16 „ school premises 55 „ re infectious diseases 88 Inspections after infectious diseases 89 Smoke observations 21 Special visits re Shops Acts 217 Visits re Destructive Insects and Pests Acts 30 Visits under Rats and Mice Destruction Act 182 Visits to Corporation dwellings 296 Samples of "Certified Milk" sent for Analysis 15 Interviews re abatement of nuisances, &c. 38 Total visits made 5,760 Rent Restriction Act. Number of certificates issued certifying premises not in a reasonable state of repair 6 Shop Hours Acts. Number of shops on register at end of year 980 „ new additions to register 1 „ changes of occupancy notified 1 Contraventions:— Half-holiday notices not exhibited 1 Serving of customers after closing hours (warned) — 25 SANITARY IMPROVEMENTS. Water Supply. Drinking-water cisterns repaired, cleansed or covered 10 Water fittings repaired or renewed 2 Taps provided direct from rising main 12 Water Closets. New pans fixed 61 Pans cleansed or repaired 8 Walls, roofs, &c., repaired 100 Flushing cisterns repaired and renewed 47 Water supply re-instated or provided 6 Foul woodwork around closets removed 2 W.C.'s lighted and ventilated 2 Brickwork repaired and re-pointed 4 Seats repaired and renewed 18 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 20 Drainage. System re-constructed 34 Repaired or cleansed 86 Manholes repaired or new provided 21 Ventilating pipes repaired or renewed 20 Drains intercepted from sewer 5 Want of Drainage 62 Sub-soil drainage renewed — Gullies renewed or provided 54 Gratings, dishing or curbing renewed 7 Fresh air inlets renewed 10 Dustbins. New provided 95 26 Yard Paving. Repaired 30 Newly paved 17 Sinks, &c. New provided 45 New waste pipes provided 23 Waste pipes repaired, trapped or ventilated 28 Insanitary wall surfaces around sinks cemented 1 Dampness. Roofs repaired 50 Gutters and downspouts repaired and renewed 74 Damp course fixed 23 External walls repaired and pointed 32 Pointing to reveals renewed 18 Floor cavities ventilated 2 Site of house concreted 1 Wall ventilators to floor cavities renewed 18 General Repairs. Walls and ceilings repaired 148 Floors repaired 33 Doors, windows, sills, &c., repaired 125 Window fastenings renewed 54 Windows made to open — Stoves repaired and renewed 71 Coppers repaired or renewed 26 Rooms cleansed and re-decorated 1ll Verminous rooms cleansed 61 Passages, staircases cleansed 13 Sash cords renewed 45 Larders repaired 1 Outbuildings repaired or renewed 2 Goal cupboards repaired 5 27 Obstructive buildings removed 2 Staircases repaired 3 Accumulations of refuse removed 24 Rooms ventilated 4 Defective and smoky flues remedied 9 Dirty floors and bedding cleansed 10 Basement sleeping rooms unfit for use, closed 8 Rat infested premises (remedied) 28 Nuisances from the keeping of fowls, &c., remedied - Overcrowding abated 3 Miscellaneous. Nuisances remedied 151 Stables. Manure accumulations removed 3 Manure receptacles provided or repaired 1 Stables repaired, cleansed, &c. 2 Yards repaved, cleansed, &c. 2 Urinals. Reconstructed, and flushing apparatus provided 2 Repaired, &c. 12 Flushing tanks repaired 7 Dairies. Accumulations removed 3 Premises repaired 4 Premises cleansed 2 Gullies cleansed 5 Other defects 12 Greengrocers' Premises. Accumulations removed 10 Nuisance from fowls or other animals 2 Yards repaved 4 Yards cleansed 6 Other defects 18 28 Testing of Drains and Sanitary Fittings. Applications of smoke test 67 „ water test (new work) 1ll „ chemical test 6 Drainage systems opened out for examination, on written complaint 6 Sewers relaid by Corporation on private property — Service of Notices. The following table shows the particulars of the notices served:— Informal Notices 227 Statutory or Formal Notices:— Sec. 94, Public Health Act, 1875 (To abate nuisances 6 Sec. 49, Public Health Act, 1875 (To remove filth) 5 Sec. 41, Public Health Act, 1875 (To redrain premises) 20 Sec. 17, Housing Act, 1930 (To repair houses) 4 Sec. 36, Public Health Act, 1875 (To provide dustbin) 28 Sec. 36, Public Health Act, 1875 (To provide sufficient water closet 1 291 Number of interviews with owners of Property, Builders, etc., re Sanitary Improvements 191 Defective Drainage. 19 drainage systems were completely reconstructed and 77 repaired under the supervision of this department. 6 drainage systems were opened out and examined under Section 41 of the Public Health Act, 1875. 29 Disinfection of Premises. Reason. Houses. Rooms. Number of Houses Bedding removed. Infectious Fevers 106 120 113 Tuberculosis 24 25 23 Other Diseases 27 26 26 Vermin, &c. 105 207 157 262 378 319 Costs recovered for the disinfection of rooms reported to be in a verminous condition amounted to £15 12s. 3d. Meat and Food Inspection. The operation of the Public Health (Meat) Regulations, which came into force in April, 1925, has necessitated considerably increased activity by the staff in the inspection and supervision of meat and food supplies throughout the district. Slaughterhouses. There is one "registered" slaughterhouse only and this is situated at Ham. 82 visits of inspection were made during the year. The number of animals inspected after slaughter was as follows:— 1 calf 29 beasts 193 sheep and Iambs 60 pigs The carcase and organs of one ox affected with Generalized Tuberculosis were voluntarily surrendered for destruction. Nineteen livers and lungs principally affected with "fluke" disease and cirrhosis were surrendered for destruction. 30 Four hundred and thirty visits have been made to the Meat Shops or Stores and other premises where food is prepared or exposed for sale. Inspection of Meat and other Foods. The following is a list of the articles of unsound food surrendered and condemned:— 1 ox carcase, 2 offal (1,036 lbs.) 1 pig's mesentery 8i ox livers (129 lbs.) 2 boxes fish fillets (28 lbs.) 2 pairs ox lungs (17 lbs.) 2 boxes whiting (133 lbs.) 1 ox head (22 lbs.) 2 rabbits 1 ox mesentery 2½ lbs. sirloin of beef 4 ox tails 40 grape-fruit 8 pairs sheep's lungs 5 apple dumplings ½ pig's lung 1 pear tart Bakehouses. The number of bakehouses on the register at the end of the year was 15, five of these being underground. Frequent inspection of the bakehouses have been made during the year. Dairies, Cowsheds and Milkshops. There are two cow-keepers and 28 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 all the milch cows in the Borough by the Veterinary Surgeon, Mr. J. H. Hatton, M.R.C.V.S who reports to the Executive Committee monthly. Inspections of all milch cows are also periodically made by the Veterinary Inspectors of the Surrey County Council. 31 Factory and Workshops Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 159. The businesses carried on at the respective premises are as follows:— Bakehouses 15 Dressmakers and Milliners 20 Tailors 6 Bootmakers 5 Laundries 4 Builders' workshops 4 Restaurant kitchens 83 Motor engineers 2 Shoeing forges 2 Wig making 2 Coach building 1 Furriers 2 Other trades 13 159 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 20 Walls, floors, gutters and roofs repaired 6 Sanitary accommodation Insufficient — Not separate for sexes — Unsuitable or defective 6 Foul sanitary conveniences 4 Accumulations removed 2 Other nuisances and defects remedied 8 Defective dustbins 4 50 32 Stable Premises. There are 36 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. Rats and Mice Destruction Act. The provisions of this Act have been enforced during the year. Forty-two complaints were received, and in fourteen instances "preliminary" intimations have been served upon the owners and occupiers of premises to eradicate "rodents" and render the premises rat proof. School Sanitation. A sanitary survey of all the school sanitary fittings was made during the year. The closets at the under-mentioned schools, which consisted of the latrine, or trough type, were deemed to be unsatisfactory and to require alteration and amendment. The Managers of the said schools were all interviewed and recommended to abolish the existing latrine water closets and to provide up-to-date pedestal water closets with separate flushing apparatus, and to re-construct the drains in connection therewith. At two Schools, viz., St. Luke's and Princes Road, new spray drinking water fountains were also provided. Holy Trinity School. Boys' and Girls' Departments. Princes Road School. „ „ „ „ St. Elizabeth's School. „ „ „ „ St. Luke's School. „ „ „ „ King's School, Kew. Boys' Department. This work was carried out and completed during the summer holiday recess, 33 PETROLEUM ACTS, 1871-1926. All premises under licence have been systematically inspected to see that the special conditions embodied in the respective licences were being complied with. Total number of visits made during the year 199 Number of applications for licences during the year 62 Number of new licences granted and issued during the year 4 Number of persons on the register licensed to keep Petroleum 49 The licences cover two different methods of storage, namely:— Bulk storage in underground tanks with pumps (42) Storage capacity, 63,750 gallons. Stores for 2-gallon metal cans either in brick or metal bins (20) Storage capacity, 2,318 gallons. Amount of fees collected in respect of the licences issued during the year:—£39 0s. 0d. The quantity of carbide of calcium which may be kept in licensed stores is 2,452 pounds. Rag Flock Acts, 1911-1928. There are no premises in the Borough on which rag flock is manufactured, used or sold. Housing Statistics for the Year, 1934. Number of New Houses erected during the year:— (a) Total (including numbers given separately) under (b) houses, 33 flats, 77 (1) By the Local Authority 86 (2) By other Local Authorities Nil (3) By other bodies and persons houses, 33 flats, 77 34 (b) With State Assistance under the Housing Acts:— (1) By the Local Authority:— (a) For the purpose of Part 2 of the Act of 1925 Nil (b) For the purpose of Part 3 of the Act of 1925 23 (c) For other purposes Nil (d) For purposes of Housing Act, 1930 63 (2) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,064 (b) Number of Inspections made for the purpose 1,064 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulation, 1925 202 (b) Number of Inspections made for the purpose 202 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 121 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 506 35 2. Remedy of Defects during the year without service of formal Notices: — Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 506 3. Action under Statutory Powers during the year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling-houses which were dered fit after service of formal notice:— (a) By owners 4 (b) By Local Authority in default of owners Nil B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 55 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 55 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which demolition orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 36 D.— Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit Nil Complaints. Pour hundred and twenty-six complaints were received with reference to the following matters, viz.:— Defective drains and sanitary fittings 43 Defective water storage tanks and fittings 2 Absence of, or defective dustbins 108 Insanitary condition of houses 11 Insanitary condition of passage-ways, etc. 3 Nuisance from dampness 22 Nuisance from general defects, etc. 44 Nuisance from keeping of animals 2 Nuisance from rats and mice 42 Smoke nuisances 11 Nuisances from overcrowding 5 Verminous premises 42 Accumulation of refuse or manure 15 Miscellaneous 76 Prompt investigations of complaints were made and suitable action taken where it was found necessary. (Signed) George Laws, F.R.SAN.I., F.S.I.A., Chief Sanitary Inspector, and Officer under the Housing Acts, 37 HOUSING. It is gratifying to be able to report that during the year considerable progress has again been made through the administration of the chief provisions of the Housing Act, 1930. The first programme which aimed at the demolition of 104 unfit dwellings, has been practically completed during the year, and by the time this report is ready for issue, all the new houses and flats to rehouse the families displaced, will have been completed and the unfit houses demolished. The transference of the families from the old slum conditions to the new Council dwellings provided under the Act has been carried out with care and deliberation, and it is not too much to say that general appreciation and gratitude has been shown by the tenants, many of whom, for the first time have a real opportunity to make good, and to appreciate their responsibilities as tenants. The new Council Dwellings—houses and flats—with their splendid up-to-date appearance, lay-out, and modern planning— embracing all those hygienic principles and conditions which have been desired by the housing reformers—offer to many who have lived under overcrowded and insanitary conditions for many years, through their inability to find improved housing conditions, an entirely new outlook on life—and under very exceptional terms regarding the rent charged for such accommodation. This has been made possible only by the subsidies provided by the State and Local Authority, but it is a practical and much needed effort to provide good new housing accommodation for the working classes at rents they can afford to pay. Under such improved environmental conditions which the new dwellings provide, it is not too much to say that the benefits which must result by the provision of such good housing accommodation will prove inestimable. It promotes a feeling of freedom to tenants which many of them have not hitherto enjoyed, and this results in happiness and 38 contentment both for the breadwinner and particularly for the mother of the young family, which must lead to a better and healthier mode of living. To the young and growing children—the citizens of the future —these improved environmental housing conditions provide the foundation for better health and physique, and gives a moral uplift which every child has a right to expect and enjoy as their heritage. "Good housing" is an investment to which all classes of the community can make their contribution. Prior to the transference of the families from the old houses to the new, in all those instances where verminous conditions had been discovered or reported at the time the slum clearance survey was made, cleansing and disinfestation of the contents of the dwelling was carried into effect. In many instances so anxious were the tenants to make a clean and fresh beginning, that not only were the beds and bedding but much of the general furniture, entirely abandoned and destroyed with the assistance of the Local Authority. Doubtful articles were cleansed, disinfested and purified to eliminate possible contamination and infestation of the new dwelling. In all these cases, the families were requested to co-operate with the Health Department by at once reporting any recurrence of the trouble so that the necessary advice and treatment could be given. Frequent "following-up" visits are made to these premises by the sanitary staff and it is gratifying to be able to report that greatly improved conditions are resulting from these efforts. Particulars of the houses and flats now erected to replace those demolished are as follows:— 39 TYPES. Al. A2. A3. A4. Braddon Rd., 6 Flats @ 5/l Richmond. per week. — — 10 Houses @ 9/9 per week. Cleves Road, — 6 Houses @ 20 Houses @ — Ham. 5/ll per wk. 7/3 per week. Mead Road, Ham. — — 27 Houses @ — 7/3 per week. 1 House @ ll/ll per wk. Back Lane, Ham. — 4 Houses @ 5/ll per wk. — — Lovell Road. Ham. — — 12 Houses @ 7/3 per week. — Total (80 Houses and 6 Flats). 6 10 60 10 In addition to the foregoing, 16 flats which are being erected in Botten's Place, are nearing completion and will be occupied by the middle of the year. The various types of accommodation offered at the rentals set out in the above table are as follows:— Type. Living Rooms. Scullery Bedrooms. Bathroom(Batch & W.C.) Larder. Coal Store. Al. (Flats) 1 1 1 1 1 1 A2. (Houses) 1 1 2 1 1 1 A3. (do.) 1 1 3 1 1 1 A4. (do.) 1 1 4 1 1 1 This completes the first slum clearance programme. 40 SECOND SLUM CLEARANCE PROGRAMME. Whilst the work of carrying into effect the first slum clearance programme was in progress, Local Authorities were requested by the Ministry of Health again to review the "Housing Needs" of their Areas and to extend their Slum Clearance Programmes by bringing forward proposals for dealing with those properties scheduled in the second scheme at an earlier date. As a result, the second programme, which contained a list of 83 premises, was reviewed and extended by the addition of 38 dwellings—making a total of 121-containing 453 occupants. The detailed surveys of premises were made and special reports, together with the necessary representations as to unfitness, were submitted to the Health Committee in September last. All these properties were visited and inspected by the Health Committee before the "formal resolutions" were submitted to the Council for confirmation. The Health Committee considered that the most satisfactory way of dealing with the properties in the eleven Areas was to demolish them and the Council decided to declare the areas as Clearance Areas. The following is a list of the properties with the number of occupants in each block:— 41 LIST OF PROPERTIES AND NUMBER OF OCCUPANTS. Premises. SUMMARY. No. of houses. Occupants. Lodgers Total No. of persons (including Lodgers). Over 10 Under 10 1/10, York Cottages, Ham 10 25 5 (5) 30 41/45, Petersham Road 3 7 1 (2) 8 5/8. Hope Place. Ham 4 10 3 (2) 13 14/20, Water Lane 4 23 1 (5) 24 1/9, Sheen Vale 9 36 6 (2) 42 6/18, Whitecross Row 13 45 4 (1) 49 7/13, Clarence Street 4 13 5 18 8/9, Clarence Cottages 2 4 3 — 7 1/3, York Cottages, Richmond 3 9 — — 9 11/15, Princes Street 5 19 5 (2) 24 74/80, Kew Green 4 16 1 (4) 17 7/9, James Cottages, Kew 3 7 1 - 8 1/2, Clayton Cottages 2 6 4 — 10 1/2, Cobden Cottages 1/41, Crofton Terrace 2 8 — — 8 41 122 22 (28) 144 2/10, West Sheen Vale 9 30 4 (1) 34 1/3, St. Helena Cottages 3 8 — - 8 121 388 65 (52) 453 Of the 121 houses affected, "appeals" were lodged with the Ministry of Health by the owners in respect of:— 41, 43, & 45, Petersham Road. l/9 (inclusive), Sheen Vale. 6/18, Whitecross Row. l/3 (inclusive), St. Helena Cottages. l/30 (inclusive), Crofton Terrace. 37/38, Crofton Terrace. The owners of Nos. l/30, Crofton Terrace subsequently withdrew their "appeal." On January 15th, Mr. J. Bentley, P.A.S.I., Inspector of the Ministry of Health, attended at the Town Hall to hear the objections of the owners of the properties concerned. Some of the owners engaged Counsel, and called expert witnesses on their behalf. The case for the Corporation was stated by the Town Clerk. 42 After a full two days' enquiry, all the properties were inspected by the Ministry of Health Inspector, accompanied by one representative of each owner, and the Chief Sanitary Inspector. It is gratifying to be able to report, that the Ministry of Health agreed that all the houses in the various slum clearance schemes "represented" were unfit for human habitation and must be demolished. Individual Unfit House. No. 50, Kew Green, known as Harwarden Cottage, was upon inspection found to be unfit for human habitation and not capable at reasonable expense of being made fit. A representative of the owners attended the meeting of the Health Committee when the report on the condition of the dwelling was considered. It was agreed to accept an Order for demolition, and such "Order" was subsequently made by the Council, in accordance with Section 19 of the Housing Act, 1930. Prevention of New Slums. The duties of a Local Authority under the Housing Acts, deal not only with the removal of the present slums, but gives powers for the prevention of future slums. Experience has shown that new slums were rapidly being created by the evils arising out of subletting, or the occupation of one house by several families, without the alterations or adaptations of such building for the purpose. Unfortunately the greatest evils were being perpetuated by the use of basements or underground rooms let as separate tenements, or used for sleeping purposes, and the occupation of top floors, or attic rooms in large houses with sloping ceilings, let separately as a tenement. Such premises being damp, dark, defective and not possessing the proper sanitary services for the use of tenants occupying them. Section 19 of the Housing Act, 1930, enables a Local Authority to close "part of a dwelling" let as a separate tenement if found unfit for habitation, until it has been made habitable. Similar 43 powers are also given for the closure of underground rooms or "rooms used habitually as sleeping places, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining, or nearest to the room, or more than three feet below the surface of any ground within nine feet of the room", unless the Regulations made under Section 18 (l) of the 1925 Act, and Section 20 of the l930 Act, are fully complied with. In addition, the byelaws relating to Houses let in Lodgings made under Section 6 of the principal Housing Act, have been rigidly enforced during the year. These byelaws deal with the following matters:— For fixing the number of persons who may occupy a house or part of a house which is let in lodgings, or occupied by members of more than one family. For the registration and inspection of such houses. For enforcing drainage and promoting cleanliness and ventilation of such houses. For requiring provisions adequate for the use of and readily accessible to each family of:— 1. Closet accommodation; 2. Water supply and washing accommodation; 3. Accommodation for the storage, preparation and cooking of food; and, where necessary, for securing separate accommodation as aforesaid for every part of such house which is occupied as a separate dwelling. For the keeping in repair and adequate lighting of any common staircase in such houses. For securing the prevention of and safety from fire. For the cleansing and redecoration of the premises at stated times. For the provision of handrails, where necessary, for all Staircases of such houses, 44 For securing the adequate lighting of every room in such houses. Much useful and effective work has been done during the year in the operation of the Housing Statutes with the Regulations and Byelaws pertaining thereto. The following is a list of the premises dealt with:— 2, Park Hill. Basement Tenement. Closing Order made. 21, Park Road. „ „ „ „ „ 19, Church Road. „ „ „ „ „ 92, Queen's Road. „ „ „ „ „ 28, Richmond Hill. „ „ „ „ „ 48, Queen's Road. „ „ „ „ „ 9, Church Road. „ „ „ „ „ 1, Warrington Road. „ „ „ „ „ 2, Warrington Road. (Underground Sleeping Room). Written undertaking given to make premises habitable within specified time. 4, Warrington Road. Basement Tenement. „ 6, Warrington Road. „ „ „ 91, Church Road. (Underground Sleeping Room). Closing Order made. Housing Inspections. Power of Local Authority to require repair of insanitary houses. Systematic house to house inspections have been carried out during the year in accordance with the Housing Act, and all dwellings occupied by the working classes, or of a type suitable for occupation by the working classes, found in any respect unfit for human habitation, have been the subject of notice to repair or recondition same, when reported upon as being found capable of repair at reasonable expense, 1,064 dwelling houses were inspected for housing defects (under the Public Health or Housing Acts), and 202 of such dwellings were examined and particulars recorded under the Housing Regulations. 45 PARTICULARS OF DWELLINGS ERECTED BY THE COUNCIL. Situation of Dwellings. Description. No. of houses. Weekly rent inclusive of rates. Manor Grove (built 1895-6). Housing Act, 1890. Part 3. (No Subsidy). Type A. Parlour, living room, scullery and four bedrooms 62 25 @ 11/7 27 @ 11/3 10 @ 10/10 Type D. Parlour, living room, scullery and three bedrooms 18 12 @ 10/11 6 @ 10/6 ,) 16 @ 9/8 Type B. Parlour, living room, scullery and two bedrooms 42 16 @ 9/8 16 @ 9/4 10 @ 8/11 Addition to rent if bathroom is provided— Types A. and D., 2/4. Type B. 3/-. Flats:—First Floor: — Type C. Living room, scullery and two bedrooms 6 7/5 Flats:—Ground Floor:— Type C. Living room, scullery and one bedroom 6 6/2 House and Shop Premises (No. 80):— Shop, living room and scullery, parlour and three bedrooms 21/7 per week. Tenant pays rates. North Sheen (built 1907-8). Housing Acts, 1890-1923. (No Subsidy). Living room, kitchenette (with bath) and three bedrooms 40 ll/8 46 Situation of Dwellings Description. No. of houses. Weekly tent inclusive of rates. Victoria Place (built 1908-9). Housing Act, 1906. (No Subsidy). Flats—First Floor:— Type— Living room (with lobby), scullery and two bedrooms 10 8/7 Flats—Ground Floor:— Type— Living room (with lobby), scullery and two bedrooms 10 9/7 King's Farm Estate (built 1927-9), Housing Act, 1924 (with Special Conditions Subsidy). Type A. Parlour, living room, scullery and three bedrooms (with bathroom) 35 16/7 Type B. Living room, scullery and three bedrooms (with bathroom) 54 13/10 North Sheen (built 1924-5). Housing Acts, 1890-1923. (No Subsidy). Type B3. Parlour, living room, scullery and three bedrooms (with bathroom) 7 20/1 Type E. Living room, kitchenette and three bedrooms (with bathroom) 3 16/5 Selwyn Estate (built 1922). Housing Act, 1919 (with Treasury and Council Subsidy). Type B4. Parlour, living room, scullery and four bedrooms (with bathroom) 20 22/11 Type B3. Parlour, living room, scullery and three bedrooms (with bathroom) 62 20/1 Type B3. *Ditto 4 20/1 47 Situation of Dwelling Description. No. of houses. Weekly rent inclusive of rates. Type A, Living room, scullery and three bedrooms (with bathroom) 10 16/10 Flats—First Floor:— Living room, scullery and two bedrooms (with bathroom) 38 13/1 Flats—Ground Floor:— Living room, scullery and two bedrooms (with bathroom) 38 13/1 *These four houses are £6 Subsidy Houses (Housing Act, 1923) built 1926. The remainder on the Selwyn Estate are Addison Scheme. Braddon, Road, Richmond. Type Al. Living room, scullery, and one 6 5/1 bedroom (with bathroom). flats Type A4. Living room, sculley and four bedrooms (with bathroom) 10 9/9 Clbves Road, Ham. Type A2. Living room, scullery and two bedrooms (with bathroom) 6 5/11 Type A3. Living room, scullery and three bedrooms (with bathroom) 20 7/3 Mead Road, Ham. Type A3. Living room, scullery and three bedrooms (with bathroom) 27 7/3 Type A3. Living room, scullery and three bedrooms (with bathroom) 1 11 /11 Back Lane, Ham. Type A2. Living room, scullery and two bedrooms (with bathroom) 4 5/11 Lovell Road, Ham. Type AS. Living room, scullery and three bedrooms (with bathroom) 12 7/3 48 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, four 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 Designation) 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 licenses 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. Other firms purchase this grade of milk and retail it under licence. The Ministry of Health have asked the Richmond Council to take samples of the Certified Milk sold in the Borough and have these analysed. Last year 24 such samples were taken and on analysis 20 were found to be up to the required standard. The Analysts employed (The National Institute of Research in Dairying, Reading) report direct to the Ministry on every analysis, 49 The Borough Council have granted licences to sell Certified Milk to 5 firms in the Borough (comprising 11 premises), Grade A Tuberculin Tested Milk to 4 firms (comprising 5 premises), Pasteurised Milk to 6 firms (comprising 17 premises), and Grade A Pasteurised Milk to one firm. They have also granted a Pasteurising Licence to one firm. (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 first of April, 1925. By these Regulations notice of killing must be sent to the Medical Officer of Health. Up to April, 1933 there had been no slanghterhouse in the Borough for some time, but with the amalgamation of Ham there is now one slaughterhouse to come under supervision. Any meat surrendered or condemmed 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 to boil it down. Smaller quantities are burnt at the destructor. During the year the slaughterhouse was visited on 82 occasions and 283 carcases inspected. The following articles were surrendered:— 8½ Ox livers. 9 Sheep's lungs. ½ Pig's liver. Carcase of 1 bullock and organs. 1 Ox head. 2 Pairs of Ox lungs. 2 Ox mesenteries. 1 Pig's mesentery. Sale of Food and Drugs Acts (1875 to 1907). (C) 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 1934, 50 SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1934:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 53 ... 53 1 ... 1 ... ... Cream 2 ... 2 ... ... ... ... ... Meat 3 ... 3 ... ... ... ... ... Tea ... 1 1 ... ... ... ... ... Cocoa ... 1 1 ... ... ... ... ... Sausages 5 ... 5 ... ... ... ... ... Gin ... 3 3 ... ... ...... ... ... Whiskv 1 ... 1 ... ... ... ... ... Other Articles 9 10 19 3 1 4 1 1 Totals 73 15 88 4 1 5 1 1 51 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Notifiable Diseases during the year. Disease. Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Poliomyelitis 1 1 ... Amoebic Dysentery 2 2 ... Cerebro-spinal Meningitis 2 2 1 Diphtheria 55 55 ... Scarlet Fever 52 47 ... Puerperal Fever 2 2 1 Puerperal Pyrexia 5 5 ... Pneumonia (Primary) 33 22 6 Influenzal Pneumonia 1 1 1 Erysipelas 19 13 1 Chicken Pox 52 1 ... Ophthalmia Neonatorum 3 3 ... Tuberculosis : [a) Respiratory (M). 27 19 11 (F.) 24 15 11 Total 51 34 22 (b) Non-Respiratory (M.) 4 2 2 (F)... 4 2 1 Total 8 4 3 Diphtheria. Daring the year 55 cases of Diphtheria were notified as compared with 64 in 1933. The rate per 1,000 living was 1.42 as compared with a case rate of 1.70 in England and Wales. There were unfortunately four deaths from the disease during the year. It cannot be too well known that patients with this disease, if treated properly within the first twenty-four hours will almost certainly recover. Every hour of delay beyond this means increased danger to the life of the patient. Antitoxin for the treatment of the disease is kept by various chemists in the Borough and is immediately available for any medical practitioner. The cost of serum so supplied during the year was £6 19s. 6d. 52 Last year I included in my Annual Report, a special report which 1 had submitted to the Health Committee, on the Schick test and Immunisation against Diphtheria. During the year the Committee recommended that an Immunising Clinic be set up and in December last this was opened on one day a week. As a beginning notices were sent to parents of children attending one particular school. These notices gave particulars of the Schick test and of immunisation and invited the parents to have their children protected. A tear off slip was attached to the notice so that replies could be sent to the Health Centre. As soon as the children coming from this school were completed, notices were sent to another school and this arrangement is being continued. The number who replied asking that their children should be immunised was so large that it was necessary to have the clinic open two days a week. Even then it must be understood that it is not possible to complete the immunisation of large numbers in a short time. For instance if a batch of say 40 children arrive one week, they are Schick tested and have to return for the next three weeks in succession to receive the inoculations. After these three inoculations a period of three months elapses when the children fire again Schick tested. If immune a certificate to that effect is issued. The whole arrangement is working very well and at the time of writing 39 have been immunised. During the year the number of specimens, etc., sent up for examination was as follows :— Disease Suspected. Nature of Specimen. Result. Total. Positive. Negative. Diphtheria Swabs from Throat and Nose 35 341 376 Tuberculosis Sputum 17 78 95 Enteric Fever Blood 1 3 4 53 416 475 S3 Scarlet Fever. During 1934, 52 cases of this disease were notified and 47 were treated in hospital. The rate per 1,000 living was 1-35 as compared with a case rate of 3-76 in England and Wales. In 1933 there were 138 cases. There were no deaths from this disease. Puerperal Fever and Puerperal Pyrexia. During 1934 five cases of Puerperal Pyrexia and two cases of Puerperal Fever were notified. There was one death from Puerperal Sepsis. The Council has made arrangements whereby a medical practitioner in attendance on one of these cases can have a consultation with an Obstetric Specialist if he desires. 54  Total Cases Notified. Total Deaths. Under 1 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 65 and over. Amoebic Dysentery ... ... ... ... ... ... ... ...... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Diphtheria ... 1 2 1 ... 35 11 2 1 1 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... Scarlet Fever ... 1 1 4 7 18 8 4 7 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... 2 1 3 5 29 11 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Primary). 1 5 3 1 ... 1 2 1 6 3 9 1 1 ... ... ... ... ... ... ... 1 1 3 ... Influenzal Pneumonia ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 3 4 10 ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Tuberculosis:— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (a) Respiratory ... 1 ... ... ... 1 3 4 19 7 12 4 ... ... ... ... ... ... ... 3 4 1 10 4 (b) Non-Respiratory ... ... 1 ... ... 2 ... ... 3 2 ... ... ... 1 ... ... ... 1 ... ... 1 ... ... 55 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken under this Act. Public Health Act, 1925. Section 62. No action was taken under these Regulations. Respiratorv Tuberculosis (Phthisis). Fifty-one cases of this disease were notified during the year (27 males and 24 females). Of these 34 (19 males and 15 females) were removed to Hospital or Sanatorium. There were 51 cases notified in 1933. There were 22 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for 3 deaths while 8 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory NonRespiratory. Respiratory. NonRespiratory. M F M F M F M F 0 ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... 1 ... 5 2 2 2 ... ... ... 1 ... 15 5 5 ... ... ... 3 ... 1 25 4 10 1 2 2 2 ... ... 35 4 2 1 1 ... 1 ... ... 45 6 2 ... ... 4 1 ... ... 55 4 ... ... ... 3 2 ... ... 65 and upwards 1 3 ... ... 2 2 ... ... Totals 27 24 4 4 11 11 2 I 56 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. Three cases were notified during the year. Ophthalmia Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital Neonatorum 3 — 3 3 - — — BOROUGH OF RICHMOND (SURREY). Education Committee. ANNUAL REPORT OF THE School Medical Officer. 1934. richmond : J. H. Broad & Co., Ltd., 8, King Street. BOROUGH OF RICHMOND (SURREY). Report on the Medical Inspection and Treatment of Elementary School Children for the year ended December 31st, 1934. To the Chairman and Members of the Education Committee. Mr. Chairman, Ladies and Gentlbmen, I have the honour to present my Report on the work done by the School Medical Staff during the year 1934. This is my fourteenth Annual Report as your School Medical Officer. Owing to my absence from duty recently the report has had to be somewhat curtailed, but a study of the statistical tables will show that a great deal of work was done during the year under review. The average number of children on the School registers for the year was 3,267. A summary of the year's work in all the schools is appended. 1,027 children medically inspected. 4,330 attendances at the Minor Ailment Clinic. 100 children suffering from Defective Vision obtained glasses after examination by an Eye Specialist, either at Clinic or privately. 63 children underwent operations for Throat and Nose disease, 4 1,930 attendances were made at the Dental Clinic. 547 children were given general anaesthetics {i.e., Gas or Ethyl Chloride). I wish to express my thanks to the staff of the Department for their loyal work during the year, and to the Teachers for their co-operation. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNEK. 5 Staff. School Medical Officer : C. S. Brebner, D.S.O., M.D., D.P.H., Barrister-at-Law. Ophthalmic Surgeon (part time): C. Lonoworth Blair, M.R.C.S., L. R.C.P. Dental Surgeon : Miss Evelyn Russell, L.D.S., R.C.S. (Eng.). {half-time). School Nurses: Mrs. L. K. Dunforc, S.C.M. (Died October). Miss C. G. Hay (S.R.N., S.C.M.) (New Health Visitors' Cjrt.) Miss J. D. Law, R.R.C. (S.R.N., S.C.M.) (Health Visitors' Cert.) Miss C. Burton (S.R.N., S.C.M.) (New Health Visitors' Cart.) (Appointed November). Dental Assistant (part time): Miss M. D. Banks. Clerks: Miss M. J. Bird (part time). Miss O. W. Ponsford (part time). The death of Mrs. Dunford, one of the School Nurses, during the year deprived the Committee of the services of an Officer who had been 18 years in their service, and who had done excellent work. 6 Co-ordination with other Health Services. The three School Nurses act also as Health Visitors in the Maternity and Child Welfare work The School Medical Officer is also Medical Officer of Health and Medical Officer to the Maternity and Child Welfare Centre. There is thus close cooperation between these departments, and this is particularly useful in connection with the occurrence of Infectious Diseases in the Schools and in the Borough generally. School Hygiene. There are thirteen schools in the Borough, four being Council Schools (one Special School), the remainder being Church of England 7, Roman Catholic 1, and Undenominational 1. Many of the School Buildings are old, but some have been altered and brought to a fairly satisfactory condition. The sanitary conveniences in four schools mentioned in last year's report have now been modernised. Medical Inspection (Table 1, page 18). Medical Inspections were carried out during the year as follows :— 1. Routine Inspections required by the Board of Education. (a) Entrants; (b) Intermediates; (c) Leavers. 2. Other Inspections: (a) Special children not in the above groups but who are examined, usually at the request of the Head Teacher. (b) Children seen at the Clinic, sent by Parents, Head Teachers or the School Nurses. (c) Re-inspections of children previously found with a defect of some kind. 7 There were 310 entrants examined at the Routine Inspections and 222 parents or guardians attended. 331 children of the intermediate age were inspected and 302 leavers, i.e., children aged 12 years. There were 84 other Routine Inspections made during the year, so that the total number of children examined was 1,027. Other inspections include children seen as "Specials." These are generally children brought forward by the Head Teachers, or they may be seen by one of the School Nurses and deemed suitable cases for a special examination. 43 of these cases were examined during the year. Included in the Special Inspections in Table 1. are the cases seen at the Inspection and Minor Ailment Clinic, so that there is a total of 879 special inspections. Prom the table on page 18 it will be seen that re-inspections totalled 1,342. While visiting schools for Routine Inspections, re-inspections are made of children who have previously been found with defects and also of children who have been placed "under observation." The routine inspections and special examinations take up a considerable time, and it is not possible to re-examine as often as one would wish. "Following up" at home by the School Nurses is thoroughly carried out and the figures in the tables at the end of this report show that a very small percentage of the defects go untreated. Parents are also asked to bring children to the Inspection Clinic and advice is given there. Age Groups Inspected. The Board of Education requires Local Authorities to make provision for the Medical Inspection of all children admitted to school during the year ending March 31st, and of all children between 12 and 13 years of age, together with children over 13 who have not been inspected after reaching the age of 12. An intermediate group, children between 8 and 9 years of age, must also be examined, 8 The 310 entrants comprised 162 boys and 148 girls. „ 331 intermediates „ 168 ,, „ 163 ,, ,, 302 leavers „ 152 ,, ,, 150 ,, The number inspected and re-inspected under the heading " Other Inspections" is 2,221 as compared with 2,042 last year. Findings at Medical Inspections. (a) Malnutrition. I have again to report that I have no evidence of malnutrition owing to lack of food. No children have been reported to me as being so badly nourished that they are not able to receive the benefit of education. The Board of Education have now omitted the term "Malnutrition" from the list of defects in Section A, Table II., and now require the nutrition of the children examined to be classified in four categories, viz.:—(a) Excellent; (b) Normal; (c) Slightly Subnormal ; (d) Bad. This classification is to be made on Clinical grounds and not solely on the height and weight of the child. (b) Uncleanliness. The degree of cleanliness of both head and body is noted at the inspections. 16 children were referred for treatment owing to verminous or "nitty" heads. During the year the average number of visits per school by the Nurses for Cleanliness Inspections was 6. The total number of examinations during these inspections was 8,281, as compared with 8,284 in 1933. 311 individual children were found either to be verminous or to have so many nits in their hair that notices had to be sent to the parents. (c) Minor Ailments and Diseases of the Skin. (Table IV., page). During the year 636 minor ailments were referred for treatment as compared with 604 in 1933, 9 Children suffering from these minor ailments were either seen at the Routine Inspections or were sent to the Clinic by parents or teachers. The diseases consist mainly of skin diseases, such as Ringworm, Impetigo, Ear diseases and External Eye diseases. The methods of dealing with these are referred to later. During 1934 there were no cases of Ringworm of the scalp in attendance at the Clinic, as compared with 2 in 1933 and 1 in each of the four preceding years. One case of Body Ringworm was seen and treated at the Clinic. 18 cases of Scabies were seen during the year as compared with 6 last year. (d) Visual Defects and External Eye Disease. 24 cases of external eye disease were referred for treatment during the year, 22 of these being treated at the Clinic and 2 elsewhere. 123 children were referred for treatment for defective vision and squint. 130 children received treatment during the year, 17 of these being cases referred from inspection in 1933. 37 cases were discovered at the routine inspections, and the remaining 86 were sent to the Clinic by parents or teachers owing to evidence of eye strain. All children who cannot read 6/12 line of Snellen's test type are referred for treatment, and also any who complain of difficulty in reading at short distance. 16 cases of Squint were seen during the year and found to require treatment. Usually these cases are seen for the first time when children are admitted to school. The correction and cure of the trouble is then more difficult and it should be known that a squint should be treated as early as possible. (e) Nose and Throat Defects. (Table IV., page 24). 57 children were found to be suffering from enlarged Tonsils, Adenoids, or both defects. 63 received operative treatment, 55 Hospital Vouchers were actually given, Of the 57 children 10 referred for treatment, 53 were operated on (50 at Richmond Royal Hospital and 3 privately). Two cases are awaiting operations, making the percentage of cases treated or under treatment during the year 96-5. No case is recommended for operation unless it is obvious that the condition is causing general physical disability, or a special defect, such as deafness. Actually 63 children were operated on during the year (59 at Richmond Royal Hospital and 4 privately) 8 of these being cases referred from 1933. All cases sent to Richmond Royal Hospital are seen by the Nose and Throat Specialist before operation is finally decided upon. (/) Ear Disease and Defective Hearing. 15 cases were referred for treatment. Most of these were cases of discharging ears and they were treated at the Clinic. Six cases were sent to the Royal Hospital. (g) Dental Defects. (Table IV., page 25). During the Routine Medical Inspection the teeth are examined, but not as thoroughly as. they are examined by the Dental Surgeon, i.e., with probe and mirror. Only the obvious carious teeth are therefore seen and noted by the School Medical Officer. During 1934, children of all age groups, i.e., 5—15, were examined by the School Dentist. Miss E. Russell, L.D.S., the School Dental Surgeon, examined 2,465 children of all age groups and found 1,318 to require treatment. This is 53'4B per cent., a lower percentage than in the previous jear. This may seem to be a large proportion, but it must be remembered that the treatment in many cases is very small in amount and is conservative, that is, the preservation of the permanent teeth. (h) Orthopcedic and Postural Defects. The former may be caused by (l) Infantile Paralysis; (2) Rickets; (3) Tuberculosis; (4) Brain or Nerve Lesions ; (5) Congenital Defects, 11 The Postural Defects occur in otherwise healthy children who develop the condition by faulty positions while standing or sitting. They are corrected by remedial exercises. Nine cases are under observation at the present time. Orthopaedic defects under observation at present include:— Infantile Paralysis 6 Tuberculosis 2 Congenital Defects 9 There is no special Orthopaedic treatment scheme, but cases are referred to Hospitals dealing specially with these defects. When parents are able to pay moderate fees for advice, the cases have been sent to the Red Cross Curative Post at Kingston, where Orthopsedic Specialists can be seen and treatment obtained. (i) Heart Disease and Rheumatism. Ten cases of Heart Disease are under observation, one a congenital case and the others the result of illness. Seven cases of Rheumatism were seen at the Clinic, and were referred elsewhere for treatment. All 5 of these cases are under observation, and the remaining two are now well. (j) Tuberculosis. The one case of suspected pulmonary tuberculosis and one case of suspected non-pulmonary tuberculosis were seen at the Clinic and referred to the County Tuberculosis Officer. Following Up. After each Routine Inspection at the Schools a list of defective children and the defects found is made out and copies are given to the School Nurse and the Head Teacher concerned. The list also states the treatment necessary for each defective and in many cases the teachers can assist in getting treatment carried out. Further notice is sent to the parents of those found untreated, and if necessary the School Nurses call at the homes, or the parents are asked to attend at the Clinic and talk over the matter with the School Medical Officer. 12 54 visits were paid to the homes by Miss Banks re Dental treatment. The number of attendances at the Clinic in 1934 was 4,330 as compared with 4,201 in 1933. Arrangements for Treatment. Arrangements have been made for the treatment of:— (a) Minor Ailments. (b) Enlarged tonsils and adenoids. (c) Defective Vision. (d) Dental Defects. (e) Ringworm. (a) Minor Ailments. The treatment of these diseases is carried out each morning at the Health Centre. The School Medical Officer is present four mornings a week (including Saturdays) to see new cases and cases requiring supervision. The dressing of the various cases is carried out by one of the School Nurses. The number of individual children who attended the Clinic for actual treatment during the year was 548, and the total number of defects treated was 586. Also 480 children attended for inspection only, i.e., dirty heads, sore throats, &c. The total number of attendances was 4,330. (b) Tonsils and Adenoids. Arrangements have been made with the Richmond Royal Hospital authorities to undertake the operative treatment of these conditions. The Education Committee pay an agreed sum per operation. Some parents prefer to have treatment by their own doctor, or to go to a London Hospital. In every case the parents are advised to bring the child to the Clinic as soon as possible after the operation, so that they may be advised as to the necessary after-treatment by means of breathing exercises etc. 13 During the year 57 children were referred for treatment after inspections. 55 Vouchers were given for the Hospital. Actually, 63 operations were performed (59 at the Richmond Royal Hospital and 4 elsewhere). Eight of these were cases referred from 1933, and there are 2 children awaiting operation, so that the percentage of children actually treated or under treatment as a result of examinations during the year was 96.5. (c) Tuberculosis. Any child suspected of being tubercular is referred to the County Tuberculosis Officer (Dr. A. Cameron Renwick) who deals with the treatment of all Tubercular cases in this area of the County. The Tuberculosis Dispensary for the Richmond and Barnes area is now situated at 38, Sheen Road, and the County Tuberculosis Officer attends there once a week. (d) Skin Diseases. Most of these are classed under Minor ailments, and include Impetigo and Scabies, both of which are treated at the Clinic. The Education Committee has arranged to pay for the treatment of ringworm of the scalp by means of the X-rays in suitable cases. This is done by Mr. G. G. Blake, under the supervision of the School Medical Officer. There were no cases requiring X-ray treatment during 1934. Ringworm of the body is treated at the Clinic. (e) External Eye Diseases. 24 cases were seen during the year. (F) Defective Vision. These cases are treated at a special Eye Clinic which is held at the Health Centre, once a fortnight. Mr. Blair attends on these occasions, and prescribes glasses when necessary. The Committee pay a fee per case seen and Mr. Blair sees all cases twice and sometimes three times. During the year under review, 123 cases were referred for treatment. In all, 130 cases were treated (17 of these being cases 14 referred from the previous year), and in 100 cases glasses were prescribed. Actually 100 children obtained glasses. Arrangements have been made whereby the glasses can be purchased by the parents from a local optician at a contract rate. The Education Committee pays the whole or part of the cost of glasses in necessitous cases. (g) Ear Cases. Most of these cases are treated at the Minor Ailment Clinic. In some special cases the parents have been advised to have a specialist's opinion and have been referred to the Royal Hospital, Richmond. (h) Dental Treatment. During the year 2,465 children were inspected by the Dental Surgeon, and 1,318 were referred for treatment. In addition 418 were referred for treatment from the inspections of the School Medical Officer, or were sent up to the Clinic by Head Teachers, making a total of 1,736 as compared with 1,849 in 1933. 1,407 were actually treated at the Clinic, some of these being cases referred from 1933. 1,417 children were re-treated as a result of periodical examination. These figures and those given in Table IV., Group 4, are a very good record for the year's work. Miss Russell does the whole of the Dental work and attends five half-days a week. 13« half-days were devoted to inspection of the teeth at the Schools and 192? half-days were given up to treatment. It it now possible to inspect all age groups of children attending school every year and provide treatment when necessary. On reference to the table above-mentioned, it will be seen that during the year 1,182 permanent teeth were filled and 100 temporary teeth. 15 429 permanent teeth had to be extracted. This is because parents do not realise that a child's first permanent molars come in at six years of age. It is quite common to find these molars decayed so much that nothing but extraction is possible. These teeth were considered to be first teeth and were neglected with the above result. When it is found necessary to extract several teeth, a general anaesthetic is given, either Nitrous Oxide Gas or Ethyl Chloride. A special Dental Clinic is held once a fortnight for this purpose, and the School Medical Officer administers the anaesthetics. During 1934 I administered anaesthetics to 547 children, as compared with 431 in 1933. During the year the following amounts were received as fees at the Clinic :— £ s. d. Dental Fees 67 9 0 Tonsil and Adenoid Fees 3 3 6 £70 12 6 In addition to the above fees paid by parents grants to the Education Committee to the value of £8 10s. Od. were made in respect of operations for enlarged tonsils and adenoids in cases where the parents were contributors to the Hospital Saturday Fund or Hospital Savings Association, so that the total amount received as fees was £79 2s. 6d. Infectious Diseases. During the year the number of Diphtheria cases in the Borough was greater than usual. The increase was not exceptional to this District, and the cases were of a similar kind to those occurring in neighbouring Boroughs. 16 Diphtheria is a disease chiefly affecting young children, and the Council have now instituted a Clinic for the immunisation of children against the disease. This Clinic only began operating in December last, but already a large number of parents have accepted the invitation to have their children safeguarded. It was not found necessary to close any of the schools for infectious disease during 1934. Open-Ait Schools. There is no open-air school in the Borough. At all Medical Inspections, however, a note is made of those children who would benefit by attendance at an open-air school. Co-operation of School Attendance Officer and Voluntary Bodies. The only Voluntary Body now co-operating with the School Medical Service is the Richmond Philanthropic Society whose Secretary is Mr. R. Smith, the School Attendance Officer. During the year under review the Philanthropic Society has supplied 210 pairs of boots. 350 children were provided with clothing other than boots. 17 children were sent to Convalescent Homes and 34 children were given extra nourishment while ill. Mentally Defective Children. The School for Mental Defectives has accommodation for 30 children. The Mistress (Miss Rowling) has special qualifications for the work and takes a very deep interest in the children at the School. The children have their mid-day meal at school, and most of them assist in the purchase of the food and in its preparation. The Committee have made an agreement with the County Council whereby children from Barnes and Mortlake can attend 17 so long as there is accommodation for them. At present 4 children attend from Barnes and Mortlake, and 16 from Richmond. Miscellaneous. Employment of Children. Bye-laws under the Employment of Children Act, 1903, have been adopted by the Education Committee, and children attending school who wish to obtain employment (part-time) must be examined as to their fitness by the School Medical Officer. Before the examination the Head Teachers concerned are asked to give their views as to the prejudicial effect of the proposed employment on the children's education. During the year 32 boys have been examined in connection with the medical certification as to their fitness for employment. 30 certificates were granted. Of the 30 children granted certificates, 29 were employed in the delivery of newspapers and 1 in the delivery of greengrocery. Medical Examination of Teachers and Caretakers. The Education Committee require that Teachers appointed to schools in the Borough should pass a Medical Examination. During the year, I examined 3 such teachers and certified them as fit to carry out their duties. 18 Table I.—Return of Medical Inspections. A.—Routine Mbdical Inspections. Number of Code Group Inspections— Entrants 310 Intermediates 331 Leavers 302 Total 943 Number of other Routine Inspections 84 B.— Other Inspections. Number of Special Inspections 879 Number of Re-Inspections 1,342 Total 2,221 Table II.—A. Return of Defects found by Medical Inspection in the year ended 31st December, 1934. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation but not requ'ring Treatment. Requiring Treatment. Requiring to oe kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition — — — Skin Ringworm — Scalp - - Body - - 1 - Scabies 2 - 16 - Impetigo 1 - 33 - Other Diseases (NonTuberculous) 2 — 4 — Eye Blepharitis - - 1 - Conjunctivitis — — 9 Keratitis — — Corneal Opacities — — Defective Vision (excluding Squint) 34 23 73 - Squint 3 — 13 - Other Conditions — — 14 19 Table 11.—continued. Defect or Disease. Routine Inspections. Special Inspection!. No. of Defects. No of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Ear Defective Hearing — — — — Otitis Media 2 2 4 — Other Ear Diseases — — 9 — Nose & Throat 'Chronic Tonsillitis only 3 62 2 Adenoids only — 2 1 — Chronic Tonsillitis and Adenoids 4 6 47 2 ^Other Conditions 1 9 7 — Enlarged Cervical Glands (NonTuberculous) — — 4 — Defective Speech — 3 — 1 Heart & Circulation Heart Disease:— Organic — — — — Functional — 7 — — Anaemia — 2 — — Lungs Bronchitis — — 1 — Other Non Tuberculous Diseases 1 1 — — Tuberculosis ' ["Pulmonary:— Definite — — — — Suspected — — — 1 Non-Pulmonary: — Glands — — — 1 Bones and Joints — — — — Skin - — — — Other Forms — — — — Nervous System Epilepsy - - Chorea 1 — 3 — Other Conditions 1 — 2 — Deformities Rickets - - - Spinal Curvature 2 — 1 — Other Forms 1 4 1 — Other Defects and Diseases 6 2 517 5 20 Table II.—continued. B. Number of Individual Children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspec'ed. (2) Found to require Treatment. (3) Prescribed Groups: Entrants 310 15 4.84 Second Age Group 331 17 5.14 Third Age Group 302 26 8.61 Total (Prescribed Groups 943 58 6.15 Other Routine Inspections 84 5 5.95 Table III.— Return of all Exceptional Children in the Area. CHILDREN SUFFERING FROM MULTIPLE DEFECTS. Blindness (NOT Partial Blindness). Deafness (NOT Partial Deafness). Mental Defect. Epilepsy. Active Tuberculosis. Crippling (as defined in the penultimate category of the Table). Heart Disease. Number of children suffering from any combination of the above defects 2 BLIND CHILDREN. At Certified Schools for the Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. - — — — — 21 Tablb III.—continued. PARTIALLY BLIND CHILDREN. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — DEAF CHILDREN. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — PARTIALLY DEAF CHILDREN. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — — — — — MENTALLY DEFECTIVE CHILDREN. Feeble-Minded Children. Mentally Defective children are children who, not being imbecile and not being merely dull and backward, are incapable by reason of mental defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit trom instruction in Special Schools for mentally defective children. This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and excludes all children who have been notified to the Local Authority under the Mental Deficiency Act. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 14 — — — 14 22 Table III.—continued. EPILEPTIC CHILDREN. Children Suffering from Severe Epilepsy. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 — — — 1 I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra thoracic glands). At Certified Special Schools. At Public Elementary Schools At other Institutions. At no School or Institution. Total. — — — — — II.--Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above). At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total — 1 2 1 4 B. Delicate Children. This Section is confined to children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 - — — 6 23 Tablb III.—continued. C. Crippled Children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 1 9 1 - 11 D. Children with Heart Disease. This Section is confined to children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. A t no School or Institution. Total. — 1 — — 1 Table IV.—Return of Defects Treated during the year ended 31st December, 1934. TREATMENT TABLE. Group I Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the 1 Authority's 1 Scheme. Otherwise. Total. Skin- Ringworm—Scalp— (1) X-Ray Treatment— If none, indicate by dash (2) Other — — - Ringworm—Body 1 — 1 Scabies. 15 3 18 Impetigo 33 — 33 Other Skin Disease 2 3 5 Minor Eye Defects— (external and other) 22 3 25 Minor Ear Delects 9 6 15 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, &c.) 504 35 539 Total 586 50 636 24 Table IV.—Group 2. Defective Vision and Squint. Defect or Disease. (1) Number of Defects dealt with. Under the Authority's Scheme. (2) Submitted to Refraction by Private Practitioner or at Hospital. (3) Otherwise. (4) Total. (5) Errors of Refraction (including squint) 128 2 - 130 Other Defect or Disease of the Eyes — — — — Total 128 2 — 130 Total number of children for whom spectacles were prescribed [a) Under the Authority's Scheme 99 (b) Otherwise . 1 Total number of children who obtained or received spectacles. (а) Under the Authority's Scheme 99 (б) Otherwise. 1 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids, (iv) Other defects of the nose and throat. Table IV.—Group 3. Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. (4) Total number treated. (5) Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from Authority's Scheme. (2) Total. (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1 1 56 — — - 5 — 1 1 61 - - 63 25 Table IV.—Group 4. Orthopaedic and Postubal Defects. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic, (iii) Number of children treated. — — — 1 — 4 5 Table IV.—Group 5. Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged 5 years 144 Total 2,465 Routine Age Groups ,, 6 „ 245 ,, 7 „ 276 ,, 8 ,, 275 ,, 9 „ 282 ,, 10 „ 281 ,, 11 „ 269 ,, 2 ,, 210 „ 13 ,, 212 „ 14 „ 231 ,,15 „ 39 ,,16 „ 1 Speoials 626 Grand Total 3,091 (b) Found to require treatment 1,318 (c) ' Actually treated 1,407 (d) Re-treated during the year as the result of periodical examination 1,417 (2) Half-days devoted to (Inspection 13½ Total 206 (Treatment 192½ (3) Attendances made by children for treatment 1,930 (4) Fillings Permanent Teeth 1,182 Total 1,282 Temporary 100 (5) Extractions Permanent Teeth 429 Total 3,302 Temporary ,, 2,873 (6) Administration of general anaesthetics for extractions 547 (7) Other Operations Permanent Teeth 100 Total 110 Temporary „ 10 26 Table IV.— Group 6. Uncleanliness and Verminous Conditions. Average number of visits per school made daring the year by the School Nurses . . 6 Total number of examinations of children in the Schools by School Nurses 8,281 Number of individual children found unclean 311 Number of children cleansed under arrangements made by the Local Education Authority Nil Number of cases in which legal proceeding* were taken , (a) Under the Education Aot, 1921. 3 (6) CJnder School Attendance Byelaws 4