BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of thb MEDICAL OFFICER OF HEALTH 1935. richmond: j. h. broad and co., ltd., printers, 8, king street. BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1935. 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 Immunization Clinic— D. S. Murray, B.Sc., M.B., Ch.B. Chief Sanitary Inspector— *Gborge Laws, F.R. San. Inst., F.S.I.A. Certified Inspector of Meat and other Foods. Inspector under Shop Hours 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). Housing Estates Inspector— Leslie Martindale. 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 J. M. Bird. Miss O. W. Ponsford. Miss H. E. Iles. Drain Tester and Disinfectcr-—- 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, 1936. 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, 1935. The Report is drawn up according to the directions contained in circular 1492 issued by the Ministry of Health in October, 1935 and is what is known as an Ordinary Report. During the year good progress was made with the Second Slum Clearance Programme and this will be more fully dealt with in the Section headed " Housing." During the year the work was commenced on the Report to be furnished to the Ministry of Health, re: Overcrowding. The Birth rate throughout England and Wales for 1935 is 14 7 while the rate in Richmond is only 9.4 per 1,000 of the population. The Death rate for the Borough is 11.4 per 1,000 of the population, while this year's rate for England and Wales is 11.7. The Infantile Mortality rate is 39 per 1,000 births, which compares favourably with the Infant Mortality rate of England and Wales, viz., 57 per 1,000 births. I 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 1935) 38,450 Number of inhabited houses (1935) 9,395 Rateable Value £556,060 Sum represented by a penny rate £2,165 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 sub-soil 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 475, 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. 120 0 0 Boots and Clothing 90 0 0 Relief in other forms 132 0 0 Convalescent Home, Hospital and Surgical Aid Letters purchased 30 0 0 Richmond Royal Hospital. The Secretary-Superintendent, Captain G. M. Eden, has kindly supplied the following information:— 1,671 In-Patients and 4,984 Out-Patients were treated at the Hospital during 1935. Those received from the Borough of Richmond were 440 In-Patients and 982 Out-Patients. Extracts from Vital Statistics of the Year. Total. M. F. Births (Legitimate) 337 179 158 „ (Illegitimate) 23 11 12 Stillbirths (Legitimate) 14 6 8 ,, (Illegitimate) 1 - 1 Deaths 510 224 286 Birth Rate (R.G.) 9.4 Death Rate (R.G.) 11.4 Death Rate of Infants under 1 year of age. Deaths of all children under 1 year per 1,000 Births 39 Deaths of Legitimate Infants per 1,000 Legitimate live Births 38 Deaths of Illegitimate Infants per 1,000 Illegitimate live Births 43 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) - Deaths from Diarrhoea (under 2 years of age) 2 6 BIRTH RATE, DEATH RATE, AND ANALYSIS OP MORTALITY DURING THE YEAR 1935. (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. 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. England and Wales 14.7 0.62 11.7 0.00 - 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 14.8 0.64 11.2 0.00 - 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London Administrative County 13.3 0.52 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 RICHMOND 9.4 0.39 11.4 0.00 0.00 0.00 0.00 0.00 0.10 0.13 0.78 5.5 39 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows per 1,000 Live Births ,, ,, Total Births per 1,000 Live Births ,, „ Total Births 1.68 2.42 4.10 1.61 2.32 3.93 The maternal mortality rates for Richmond are as follows 11.11 0.00 11.11 10.66 0.00 10.66 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 1935 was 38,450. Births. There were 360 births during the year (190 males and 170 females). This gives a birth rate of 9.4 per 1,000 of the population as compared with a rate of 14.7 in England and Wales and 13'3 in London. There were 15 still births registered giving a rate of 0.39 per 1,000 of the population, as compared with 0.62 in England and Wales and 0.52 in London. Deaths. The number of deaths registered during the year was 510 (224 males and 286 females). In the list of deaths supplied weekly by the local Registrar there were 229 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 88 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 391, and the number of inquests held was 73, though all of these were not concerned with Richmond residents. The 510 deaths give a crude death rate of 13.3 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 11.4 as compared with 11.7 for England and Wales and 11.4 for London. The deaths occurred in persons of the following ages:— 14 under 1 year of age. 6 between 1 and 5 years of age. 5 „ 5 „ 15 „ 13 „ 15 „ 25 „ 43 „ 25 ., 45 „ 140 „ 45 „ 65 „ 186 „ 65 „ 80 „ 103 over 80 years of age. It will be noticed that no fewer than 289 persons died over the age of 65, i.e., more than half the total deaths, while 103 were deaths of people over 80 years of age. Causes of death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... 1 ... 1 ... ... ... ... 1 2. Congenital Debility and Malformation including Premature Birth 4 1 1 1 7 ... ... ... ... 7 3. Other defined diseases 1 1 ... ... 2 2 ... 1 1 6 5 2 2 1 10 2 ... 1 1 14 9 Infantile Mortality. This rate is calculated on the number of deaths of children under one year of age per 1,000 births. During 1935 there were 14 deaths of children under one year of age and 360 births. This gives an Infantile Mortality rate of 39 per 1,000 births, as compared with 57 in England and Wales and 58 in London. It will be seen from the table that out of 14 deaths, five occurred in the first week of life. The neonatal deaths, i.e., deaths occurring in the first four weeks numbered 10 out of the total 14. This gives a neonatal mortality of 28 per 1,000 births. Seven of these deaths were due to Congenital Debility and Premature Birth. Ten of these 14 deaths occurred in hospital while inquests were held in two cases. There was one death of an illegitimate infant under one year of age out of 23 illegitimate births. This gives an Infantile Mortality rate of illegitimate children of 43 per 1,000 births. Causes of Death. M. F. All Causes 224 286 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria 2 2 6. Influenza 2 3 7. Encephalitis Lethargica — 1 8. Cerebro-Spinal Fever — — 9. Tuberculosis of respiratory system 10 8 10. Other tuberculosis diseases 1 4 11. Syphilis — — 12. General paralysis of the insane, tabes dorsalis 1 — 13. Cancer, malignant disease 44 57 10 Causes of Dbath. M. P. 14. Diabetes 5 2 15. Cerebral hæmorrhage, etc. 5 10 16. Heart disease 57 75 17. Aneurysm 2 — 18. Other circulatory diseases 13 20 19. Bronchitis 4 2 20. Pneumonia (all forms) 3 13 21. Other respiratory diseases 2 5 22. Peptic Ulcer 2 23. Diarrhoea, etc. (under 2 years) 1 1 24. Appendicitis 3 J 25. Cirrhosis of Liver 2 1 26. Other diseases of liver, etc. — 3 27. Other digestive diseases 2 9 28. Acute and chronic nephritis 8 7 29. Puerperal sepsis — 4 30. Other puerperal causes — — 31. Congenital debility, premature birth, ations, etc. 5 3 32. Senility 7 18 33. Suicide 5 5 34. Other violence 12 8 35. Other defined diseases 26 24 36. Causes ill-defined or unknown — — 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 349 examinations were made and a detailed list is shown on Page 54. 11 Samples of Certified Milk are taken on instructions from the Ministry of Health and are examined at the Counties Public Health Laboratories. 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). 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 12. Bye-laws as to Fish Prying, 1920. 13. Bye-laws as to Tents, Vans, Sheds, etc., 1920. 14. Bye-laws as to Houses Let in Lodgings. (b) Ambulance Facilities. The South Middlesex and Richmond Joint Hospital Board have ambulances in which infectious cases are removed to Hospital. The Richmond Council has a motor ambulance kept at the Frre Station, for use in accidents and private cases. During the year this ambulance was used 833 times and the mileage covered was 3,110.9. (c) Nursing in the Home. The local Queen's District Nursing Association through its three 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. During the year the total number of patients attended by the Richmond District Nurses was 352 and the number of visits paid was 8,049. The Nurse employed by the Kew and Kew Gardens Association attended 215 cases (Medical 152, Surgical 59, Maternity 4) and paid 5,570 visits. Infectious Disease. The District Nurses referred to above will also attend cases of minor infectious illness such as measles if the necessity arises. 13 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 half-days per fortnight). Ditto. Do. do. Ditto 1 hour weekly. M. and C.W Committee. Education Committee. M. and C.W. Committee. Eye Clinic Ditto (1 session per fortnight). (1 session per fortnight). Ante-Natal Clinic Ditto Diphtheria Immunisation Ditto Twice weekly. Health Committee. Tonsils and Adenoids .. Richmond Royal Hospital. By arrangement with Education Ringworm (X-rays) Mr. G. G. Blake, 10, Onslow Rd., Richmond. When required. Committee. Education Committee. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. By arrangement with M. & C. W. Tuberculosis Treatment.. 38, Sheen Rd., Richmond. Once weekly. Committee. County Council. School Clinics. The School Clinics include Minor Ailments Clinic, Eye Clinic and Dental Clinic, while Tonsils and Adenoids are dealt with at the Richmond Royal Hospital, and Ringworm (by means of the X-rays) by Mr. G. G. Blake, M.I.E.E., F.Inst. P. The Minor Ailment Clinic is held every morning, and during the year 718 children have made 3,090 attendances. Thb 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; 195 children were treated during the year. 14 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 Immunization was begun and Dr. Murray, the Pathologist of the Royal Hospital, Richmond, was appointed to do the actual immunizing. 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. The South Middlesex and Richmond Joint Hospital Board was established to take infectious cases from Richmond, Twickenham, Heston & Isleworth, Hampton, Hampton Wick and Teddington. 1. The three Hospitals formerly belonging to these areas, viz.:— Mogden, Twickenham and Hampton, were taken over, but it has been decided to enlarge the Mogden Hospital at once and make further extensions when necessary. Hampton Hospital has been closed and Twickenham Hospital is used partly as a Convalescent Annexe for Mogden while its cubicle block is used for cases which require separate accommodation. 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. 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. 15 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. MOGDEN AND TWICKENHAM HOSPITALS. ADMISSIONS CLASSIFIED. Disease. Mogden Hospital. Twickenham Hospital (April to September, 1935). Scarlet Fever 59 4 Diphtheria 28 3 Other Diseases 9 — Total 96 7 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. The Council has also resolved to have a "Toddler's Clinic," i.e. a separate Clinic for children between 18 months and 5 years. These children are brought to the ordinary sessions of the Welfare Centre but there is not sufficient time to give them the attention they require because of the presence of the younger infants who require more supervision. By having separate sessions for the Toddlers it is hoped to keep in regular touch with many of these children until they reach school age when they are of course seen by me as School Medical Officer, 16 During the year the attendances at the Centres were:— Windham Road. Mothers 5,990 Average per session 40 Children 7,322 ,, ,, ,, 49 The Medical Officer of Health held 2,758 consultations during the year. Trefoil House, Petersham. Mothers 523 Average per session 21 Children 724 30 Dr. Cryer, the Medical Officer, held 541 consultations during the year. 1 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. Hazleby, Mrs. Klinkhart, Miss Reid and Mrs. Smith. 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, 339 first visits were made and 2,074 revisits. 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 1935 are: — Number attended, 79. Total attendances, 277. 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, 17 Maternal Mortality. The Maternal Mortality rate is calculated on the number of Births in the area. During 1935 there were 4 deaths (in Hospital) from Puerperal Sepsis giving a mortality rate for this disease of 10.66 per 1,000 births, as compared with a rate of 1.61 per 1,000 births in England and Wales. The Maternal Mortality Rate is much higher for the year under review than previously. Four such deaths occurred during the year and all were due to Puerperal Septicaemia. All these confinements took place in Institutions. One patient was sent to the new Isolation Block of Queen Charlotte's Hospital. There was no other death in the Borough from other puerperal causes and the mortality rate for all deaths after confinement was 10.66 per 1,000 births, as compared with 3.93 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. Anaesthetics 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. The Council has now agreed to advance the money for Artificial Dentures in suitable cases so that patients need not wait for them until they have saved up the required amount. During the year 1935, 44 sessions have been held, including 20 for the administration of anaesthetics. One hundred and thirty-two patients were treated and made 299 attendances, 18 The work done was as follows:— Extractions of permanent teeth 218 „ „ temporary „ 400 Filling of permanent teeth 14 „ „ temporary „ 7 Other operations chiefly in connection with provision of dentures 18 Dentures supplied 5 Number of anaesthetics given 159 (ii) Institutional Provision for Mothers or Children. By arrangements 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. 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. 192 visits were paid to Foster Children by the Nurses in 1935. 19 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 Circnmstances 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 that the water is a good one, but after chlorination the analyst's report invariably shows a practically sterile water, and one excellant fpr the purpose of a public supply, 20 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. Arrangements have recently been made to enlarge the Sewage Works, at the same time improving the plant. Treatment of Sewage. The method of sewage disposal at the Works is that of precipitation, and through bacterial filter beds, the effluent passing into the Thames. Closet Accommodation. Water closet accommodation is general throughout the Borough. 21 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 1935 in connection with the administration of the numerous Acts of Parliament and ByeLaws 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. Good progress has been made in the Housing Section, and re-conditioning of premises. 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 have been dealt with. 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. 8 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. The continued shortage of housing accommodation emphasises the need for maintaining existing houses in an efficient state of repair. 22 1,350 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 8,055. On 592 of the premises visited nuisances to the number of 3,808 were discovered, and in dealing with the sanitary defects from which they arose 408 "intimation" or "preliminary" notices and 31 statutory notices were served. The number of letters written with regard to the abatement of nuisances, etc. was 214. At the end of the year 2,686 of the defects discovered had been abated, the work of remedying 968 was in hand, and the remaining 154 were oustanding. In order to ascertain that the sanitary defects were being properly remedied 2,325 visits were paid to the respective premises. The number of inspections made under the Housing and Town Planning Act and particulars recorded was 222, and the number of sanitary defects remedied and improvements made under this heading was 2,731. The following list shows the number of routine inspections and visits made:— Inspections During 1935. Houses inspected and particulars recorded ( H.T.P. Acts) 222 Houses visited (P.H. Acts) 1128 Re-visits to houses and other premises 1320 Miscellaneous visits 1391 Visits to works in progress 1015 „ factories 22 „ workshops, bakehouses, etc. 96 „ outworkers' premises 12 23 Visits to workplaces, tearooms, etc. 103 „ dairies, cowsheds and milkshops 71 „ ice cream vendors 18 „ food stores 154 „ slaughter house 98 „ fried fish shops 40 „ greengrocers' premises 40 „ stables 69 piggeries 2 „ public conveniences 94 „ petrol stores 247 „ employment agencies 11 „ school premises 15 „ re infectious diseases 86 Inspections after infectious diseases 96 Smoke observations 1 Special visits re Shops Acts. 1094 Visits re Destructive Insects and Pests Acts 5 Visits under Rats and Mice Destruction Act 212 Visits to Corporation Dwellings 296 Samples of "Certified Milk" sent for Analysis 14 Interviews re abatement of nuisances, &c. 83 Total visits made 8055 Rent Restriction Act. Number of certificates issued certifying premises not in a reasonable state of repair 3 The Shops Acts, 1912—1934. The Shops Acts were again the subject of alteration and revision by the Government when the Shops Act, 1934 was introduced on the 25th July, 1934, and came into operation on December 30th, 1935. 24 The Shops Act, 1934, has two objects. In the first place it contains provisions for regulating of hours of employment of young persons, that is, persons between the ages of 14 and 18 years, who are employed about the business of wholesale or retail shops or of warehouses occupied by retail traders or wholesale dealers, or employed in retail trading elsewhere than in shops, such as in street trading. The effect will be to bring within the Shops Acts large numbers of young persons who are "employed about the business" of shops and warehouses, but to whom the Shops Act, 1912, has not applied and whose employment has not hitherto been subject to statutory limitation. The provisions of the Act are however, limited to young persons employed in the distributive trades, so that the employment of young persons engaged in similar occupations will in some cases be subject to the Acts, while in others it will still remain unregulated. For example, the Act has no application to the employment of young persons in offices, unless such offices are connected with shops or warehouses. In the second place, the Act contains provisions for improving the conditions affecting the health and comfort of all persons of whatever age who are employed about the business of wholesale and retail shops and warehouses. These provisions deal with ventilation, temperature, sanitary fittings, lighting, washing facilities, and, where meals are taken in the shop, facilities for the taking of meals. A survey of the whole of the shops in the Borough was made during the early part of 1935 involving 1,094 inspection and reinspection visits as to the observance of the provisions of the Act. The total number of shops inspected and particulars recorded was 768, the number of empty shops being 15. The number of new additions to the Register was 73 and changes of occupancy were noted in 183 cases. Of the 768 shops inspected, 524 were found to employ assistants, the number employed being as follows:— 25 Adult Assistants—877 males and 1,136 females. Young Persons—208 males and 219 females. 244 shops employed no assistants. The various forms required to be exhibited by occupiers of shops were found not exhibited in the following cases:— Notices relating to Assistants' Half Holiday 304 Exemption from Early Closing Notice 29 Record of hours of employment of Young Persons (Form F) 129 Record of Overtime worked by Young Persons (Form G) 94 Abstract of Provisions of Shops Acts relating to Young Persons (Form H) 136 Provision of Seats for Female Assistants (Form K) 219 In 8 cases the hours of Young Persons were being exceeded and in one case the provision for the want of seats for female assistants. The attention of occupiers was drawn to the lack of the above requirements and infringements and these were later rectified by the occupiers in question. The provision of the Act with reference to ventilation, temperature, lighting, heating, want of proper sanitary fittings, washing faciliies and facilities for taking of meals were found to be contravened as follows:— 8 shops were found to be insufficiently ventilated. 3 shops were insufficiently heated. 20 shops were without adequate water closet accommodation. 34 shops had no separate water closet accommodation for males and females. 52 water closets were in a defective condition. 11 shops were without reasonable washing accommodation. 13 shops washing accommodation was defective and unsatisfactory. 4 shops—facilities for taking of meals were unsatisfactory. 26 The attention of the owners or occupiers was drawn to the above contraventions and requests made for them to be remedied in accordance with the requirements of the Act. The 768 shops comprise a total of 87 different classes of trade which have been properly classified for future record. SANITARY IMPROVEMENTS. Water Supply. Drinking-water cisterns repaired, cleansed or covered 23 Water fittings repaired or renewed 4 Taps provided direct from rising main 10 Water Closets. New pans fixed 36 Pans cleansed or repaired 24 Walls, roofs, &c., repaired 161 Flushing cisterns repaired and renewed 50 Water supply re-instated or provided 4 Foul woodwork around closets removed W.C.'s lighted and ventilated 10 Brickwork repaired and re-pointed 17 Seats repaired and renewed 40 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 31 Drainage. System re-constructed 38 Repaired or cleansed 113 Manholes repaired or new provided 49 Ventilating pipes repaired or renewed 31 Drains intercepted from sewer 14 Want of Drainage 71 Sub-soil drainage renewed - 27 Gullies renewed or provided 52 Gratings, dishing or curbing renewed 6 Fresh air inlets renewed 9 Dustbins. New provided 60 Yard Paving. Repaired 86 Newly paved 18 Sinks, &c. New provided 37 New waste pipes provided 46 Waste pipes repaired, trapped or ventilated 39 Insanitary wall surfaces around sinks cemented 10 Dampness. Roofs repaired 89 Gutters and downspouts repaired and renewed 110 Damp course fixed 81 External walls repaired and pointed 56 Pointing to reveals renewed 76 Floor cavities ventilated 8 Site of house concreted 8 Wall ventilators to floor cavities renewed 51 General Repairs. Walls and ceilings repaired 447 Floors repaired 101 Doors, windows, sills, &c., repaired 397 Window fasenings renewed 123 Windows made to open 2 Stoves repaired and renewed 174 Coppers repaired or renewed 64 28 Rooms cleansed and re-decorated 210 Verminous rooms cleansed 114 Passages, staircases cleansed 39 Sash cords renewed 126 Larders repaired 13 Outbuildings repaired or renewed 5 Coal cupboards repaired 23 Obstructive buildings removed 17 Staircases repaired 30 Accumulations of refuse removed 24 Rooms ventilated 46 Defective and smoky flues remedied 36 Dirty floors and bedding cleansed 40 Basement sleeping rooms unfit for use, closed 6 Rat infested premises (remedied) 46 Nuisances from the keeping of fowls, &c., remedied - Overcrowding abated 2 Miscellaneous. Nuisances remedied 244 Stables. Manure accumulations removed 2 Manure receptacles provided or repaired — Stables repaired, cleansed, &c. 1 Yards, repaved, cleansed, &c. 2 Urinals. Reconstructed, and flushing apparatus provided Repaired, &c. 7 Flushing tanks repaired 1 Dairies. Accumulations removed — Premises repaired — 29 Premises cleansed — Gullies cleansed Other defects 3 Greengrocers' Premises. Accumulations removed Nuisance from fowls or other animals — Yards repaved Yards cleansed — Other defects 4 Testing of Drains and Sanitary Fittings. Applications of smoke test 73 „ water test (new work) 68 „ chemical test Drainage systems opened out for examination, on written complaint 26 Sewers relaid by Corporation on private property Service of Notices. The following table shows the particulars of the notices served:— Informal Notices 408 Statutory or Formal Notices:— Sec. 94, Public Health Act, 1875 (To abate nuisances 2 Sec.49,Public Health Act, 1875 (To remove filth) 1 Sec. 41, Public Health Act, 1875 (To redrain premises) 18 Sec. 17, Housing Act, 1930 (To repair houses) 3 Sec. 36, Public Health Act, 1875 (To provide dustbin) 5 30 Sec. 46, Public Health Act, 1875 (To cleanse Verminous premises) 2 439 Number of interviews with owners of Property, Builders; etc., re Sanitary Improvements ... 215 Defective Drainage. 38 drainage systems were completely reconstructed and 71 repaired under the supervision of this department. 26 drainage systems were opened out and examined under Section 41 of the Public Health Act, 1875. Disinfection of Premises. Reason. Houses Rooms. Bedding removed. Infectious Fevers 106 113 106 Tuberculosis 25 32 32 Other Diseases 24 19 24 Vermin, &c. 116 190 135 271 354 297 Costs recovered for the disinfestation of rooms reported to be in a verminous condition amounted to £19-4-5. 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, 31 98 visits of inspection were made during the year. The number of animals inspected after slaughter was as follows:— 4 calves 29 beasts 217 sheep and lambs 78 pigs 1 pig's mesentery, 2 pigs' heads and 1 pig's liver and lungs affected with Tuberculosis were voluntarily surrendered for destruction. Three hundred and ninety-six 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:— 2 pigs' heads. 1 pig's mesentery 10 boxes kippers (140 lbs.) 15 stones fresh herrings (210 lbs.) 36 stones fish roes (504 lbs.) 46 stones of cod (644 lbs.) 48 chickens (224 lbs.) 28 grouse Bakehouses. The number of bakehouses on the register at the end of the year was 13, three of these being underground. Frequent inspection of the bakehouses have been made during the year. Dairies, Cowsheds and Milkshops. There are three cow-keepers and 28 dairymen and purveyors of milk registered under the Dairies, Cowsheds and Milkshops Orders within the Borough. 32 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. Factory and Workshops Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 141. The businesses carried on at the respective premises are as follows:- Bakehouses 13 Dressmakers and Milliners 19 Tailors 6 Bootmakers 4 Laundries 4 Builders' workshops 4 Restaurant kitchens 68 Motor engineers 2 Shoeing forges 2 Wig making 2 Coach building 1 Furriers 2 Other trades 14 141 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 10 33 Walls, floors, gutters and roofs repaired 3 Sanitary accommodation Insufficient — Not separate for sexes — Unsuitable or defective 3 Foul sanitary conveniences 1 Accumulations removed — Other nuisances and defects remedied 9 Defective dustbins 2 28 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. Sixty complaints were received, and in ten 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 routine sanitary survey of all the twelve elementarv schools, one special school and two secondary schools with regard to the condition of the school sanitary fittings was made during the year. There is only one school in the Borough containing the latrine or trough type 0f closet, all the others having been altered during the previous year. The attention of the Managers of this school has been drawn to the need for conversion and the installation of up-to-date school sanitary fittings and I anticipate this will be put in hand at an early date. All the other school premises are in a satisfactory condition, 34 PETROLEUM ACTS, 1871-1928. 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 247 Number of applications for licences during the year 66 Number of new licences granted and issued during the year 5 Number of persons on the register licensed to keep Petroleum 51 The licences cover two different methods of storage, namely:— Bulk storage in underground tanks with pumps (47) Storage capacity, 70,850 gallons. Stores for 2-gallon metal cans either in brick or metal bins (19) Storage capacity 1,588 gallons. Amount of fees collected in respect of the licences issued during the year:—£41-18-0. The quantity of carbide of calcium which may be kept in licensed stores is 2,676 pounds. Rag Flock Acts, 1911-1928. There are no premises in the Borough on which rag flock is manufacturered, used or sold. Housing Statistics for the Year, 1935. Number of New Houses erected during the year:— (a) Total (including numbers given separately) under (b) houses, 121 flats, 250 (1) By the Local Authority 16 flats (2) By other Local Authorities 66 (3) By other bodies and persons houses, 39 flats, 234 35 (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 Nil (c) For other purposes Nil (d) For purposes of Housing Act, 1930 16 (2) By other bodies or persons Nil 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 1,350 (b) Number of Inspections made for the purpose 1,350 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulation, 1925 222 (b) Number of Inspections made for the purpose 222 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 379 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 379 36 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 3 (2) Number of dwelling-houses which were dered fit after service of formal notice:— (a) By owners 3 (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 28 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 24 (b) By Local Authority in default of owners 4 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 Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 D.—Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made 8 (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 1 37 Housing Inspections. Further details of the inspections made and the work accomplished under this heading during the year are fully set out in the special report under the Housing Section in this report. Complaints. Four hundred and fifty-nine complaints were received with reference to the following matters, viz.:— Defective drains and sanitary fittings 58 Defective water storage tanks and fittings 11 Absence of, or defective dustbins 63 Insanitary condition of houses 7 Insanitary condition of passage ways, etc. 3 Nuisance from dampness 36 Nuisance from general defects, etc. 33 Nuisance from keeping of animals 4 Nuisance from rats and mice 60 Smoke nuisances 5 Nuisances from overcrowding 7 Verminous premises 65 Accumulation of refuse or manure 26 Miscellaneous 81 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. 38 HOUSING. The year 1935 was one of more than ordinary significance in the progress of Housing. Not only did it mark the half-way stage of the most resolute campaign for the abolition of slums ever initiated, but it also put upon the Statute Book one of the most important housing measures that has ever been introduced, namely—a measure to abate by direct action for the first time, the evil of overcrowding. The 1935 Housing Act deals principally with overcrowding, re-development and re-conditioning of working class dwellings. As an administrative measure the Act is revolutionary as compared with previous legislation, since under certain conditions it makes overcrowding an offence punishable by fine in the case of both the occupier and landlord, and provides effective machinery for the enforcement of this provision of the Local Authorities. The Act requires the Council to cause an inspection of the Borough to be made within a fixed period in order to ascertain what dwelling houses are overcrowded according to the "defined standard" and to submit a report to the Minister of Health showing the result of the inspection and the number of new houses required to abate overcrowding, and to prepare and submit to the Minister proposals for providing such new houses unless they would otherwise be provided. The overcrowding standard is decidedly not an ideal standard of housing, but the minimum only, which, in the view of Parliament, is tolerable, while at the same time capable of immediate or early enforcement. 39 It consists of two parts, the first provides that there must be sufficient sleeping accommodation in a house to provide separation of sexes. The second is a standard of capacity and fixes the maximum number of persons that may be permitted to sleep in that house at one time. In the case of a house, part of which is sub-let, the rooms occupied by the sub-tenant will constitute a separate house. Children between the ages of one and ten years count as one person, and a child under one year of age does not count at all. No two persons both of ten years of age or over of opposite sexes, except living together as husband and wife, must sleep in the same room. Only rooms normally used in the locality as living and sleeping rooms are to be counted as rooms. Full details of the provisions of this Act were circulated by posters throughout the district and the dissemination of leaflets setting forth the details of the overcrowding standard and the obligations upon both landlord and tenant. The Minister of Health fixed April 1st, 1936 as the date by which the inspection of the district must be made and in order to comply with the Ministry's requirements six special enumerators were engaged to carry out the survey on the lines laid down by the Minister. It was estimated that the number of dwellings to be visited would be over 5,000 and the number of separate families to be recorded would be about 6,000. The other principal alterations in the Housing Act, 1935 so far as they affect the Local Authority, dealing with the redevelopment and re-conditioning of buildings, considerably strengthen the existing provisions and should make for further progress. 40 The year under review has seen the completion of the building programme and the occupancy of the new dwellings by tenants de-housed under the first slum clearance scheme and the second slum clearance involving the demolition of 121 houses and the re-housing of 453 persons, has been considerably further advanced. The Ministry of Health approved the Council's scheme for the erection, at Ham of 8 A.2, 74 A.3 and 10 A.4 type houses making a total of 92 houses. In addition, 28 flats are to be erected under the 1925 Act on the Crofton Terrace Area. Good progress has been made with the building of the new houses on the Ham estates and 34 families have been transferred from the condemned slum areas to the new dwellings. It is expected that the whole of the families will be re-housed before the end of 1936. Individual Unfit Premises. During the year official representations were made of the premises la, Duke Street and Nos. 6 and 8, Paved Court, which were parts of buildings let as separate tenements and occupied by persons of the working classes. The said premises were unfit for human habitation and were not capable at reasonable expense of being rendered so fit. The owners were given an opportunity of presenting their case before the Committee and in each instance gave an undertaking that the premises would not be used for human habitation until the Authority, on being satisfied that they had been rendered fit for such purposes, cancelled such undertaking. Closure of Underground Sleeping Rooms. As a result of action taken by the Council under Section 18 (1) of the Housing Act, 1925, which resulted in the closure of 41 underground rooms used habitually as sleeping places, during the year 1934, the following premises were made fit for occupation during the year and the "undertaking " cancelled:— 1, Warrington Road. 2, „ „ 4, „ „ 6, „ „ 7, Onslow Road. Closure of Unfit Underground Rooms. The continued occupancy due to subletting of basements or underground rooms to families for living or sleeping purposes constitutes another slum housing problem, and detailed inspection continues to reveal the most unhealthy housing conditions due to dampness, darkness and lack of adequate sanitary provisions. The most urgent requirement is the closing of these unhealthy underground dwellings which contravene the Housing Regulations. The Health Committee have put into operation the powers recently granted by applying Closing Orders to the unfit premises which have been discovered and the following premises were reported as unfit during the year. The basements which were let separately as dwellings to members of the working classes and which were found to be unfit for human habitation, were the subject of special reports to the Health Committee during the year and resulted in the application of Closing Orders or "undertakings " being given by the owners to close such premises until made fit. 19, Friars Stile Road. 34, Friars Stile Road. 31, Church Road. 104, Queen's Road. 15, Marlborough Road. 7, Onslow Road. 45, Church Road. 15, Montague Road. 42 Individual Unfit Houses—Section 19, Housing Act, 1930. The following individual unfit houses were demolished as a result of action taken by the Authority during the year:— 17/21, Worple Way. 18 and 18a, Parkshot. 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. 1,350 dwelling houses were inspected for housing defects (under the Public Health or Housing Acts), and 222 of such dwellings were examined and particulars recorded under the Housing Regulations. PARTICULARS OF WORKING CLASS DWELLINCS OWNED BY THE COUNCIL. Situation of Dwellings. Description. No. of Houses Weekly rent inclusive of rates. Manor Grove (built 1895-96). Housing Act, 1890. Part 3 (No Subsidy). Type A. Parlour, living room, scullery and four bedrooms 62 8 @ 12/7 2 @ 15/- 1 @ 16/3 25 @ 12/2 8 @ 11/9 2 @ 13/11 (bathroom) 1 @ 14/7 13 @ 12/4 2 @14/4 (bathroom) 43 Situation of Dwellings. Description. No. of Houses Weekly rent inclusive of rates. Type D. Parlour, living room, scullery and three bedrooms 18 6 @ 11/- 9 @ 11/4 2 @ 12/9 1 @ 14/3 (bathroom) Type B. Parlour, living room, scullery and two bedrooms 42 2 @ 12/11 16 @ 9/7 9 @ 9/2 13 @ 9/11 2 @ 10/11 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 3 @ 8/7 3 @ 7/11 Flats: Ground Floor:— Type C. Living room, scullery and one bedroom 6 4 @ 6/8 2@7/7 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 26 @ 11/6 4 @ 12/3 9 @ 11/3 1 @ 12/- Built 1924-25 Housing Acts, 1890-1923. (No Subsidy). Type B. Parlour, living room, scullery and three bedrooms (with bathroom) 7 7 @ 20/7 44 Situation of Dwellings. Description. No. of Houses Weekly rent inclusive of rates. Type E. Living room, kitchenette, three bedrooms (with bathroom) 3 3 @ 16/3 Victoria Place (built 1908-9). Housing Act, 1906 (No Subsidy). Flats: First Floor:— Type Living room (with Lobby) Scullery and two bedrooms 10 8 @ 8/1 12 @ 10/1 Flats: Ground Floor:— Type Living room (with Lobby) Scullery and two bedrooms 10 6 @ 9/9 4 @ 10/10 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 @ 17/1 Type B. Living room, scullery, and three bedrooms (with bathroom) 54 @ 14/3 Selwyn Estate (built 1922). Housing Act, 1919 (with Treasury and Council Subsidy). Type B.4 Parlour, living room scullery and four bedrooms (with bathroom) 20 @ 23/7 Type B. 3. Parlour, living room, scullery and three bedrooms (with bathroom) 62 @ 20/4 Type B.3. X—Ditto 4 @ 20/7 Type A. Living room, scullery, and three bedrooms (with bathroom) 10 @ 17/5 Flats: First Floor:- Living room, scullery and two bedrooms (with bathroom) 38 @ 13/7 45 Situation of Dwellings. Description. No. of Houses. Weekly rent inclusive of rates. Flats Ground Floor:— Living room, scullery and two bedrooms (with bathroom) 38 @ 13/5 X—These four houses are £6 Subsidy Houses (Housing Act, 1923) built 1926. The remainder on the Selwyn Estate are Addison Scheme. Braddon Road, Richmond. (1934). Type A.1 Living room, scullery and one bedroom (with bathroom) 6 Flats @ 5/2 Type A.4. Living room, scullery and four bedrooms (with bathroom) 10 Flats @ 10/2 Cleves Road, Ham. (1934). Type A.2 Living room, scullery and two bedrooms (with bathroom) 6 @ 6/1 Type A.3 Living room, scullery and three bedrooms (with bathroom) 20 @ 7/6 Mead Road, Ham. (22 built 1920-1 by Ham U.D.C.). (28 built 1934 by R.B.C.). Type A. 3. Living room, scullery and three bedrooms (with bathroom) 27 @ 7/6 Type A. 3. Living room, scullery and three bedrooms (with bathroom) 23 1 @ 12/3 21 @ 11/4 1 @ 11/6 Back Lane, Ham. (1934). Type A.2 Living room, scullery and two bedrooms (with bathroom) 12 @ 7/6 Craig Road Ham (1934). (Erected by Ham U.D.C. 1921-22). Type B. 3. Sitting room, living room, scullery and three bedrooms (with bathroom) 13 8 @ 17/- 3 @ 17/11 2 @ 16/10 Lock Road Ham. (Erected by Ham U.D.C. 1921/22). Type B. 3. Sitting room, living room, scullery and three bedrooms (with bathroom) 6 1 @ 17/6 4 @ 17/- 1 @ 16/10 46 Situation of Dwellings. Description. No. of Houses. Weekly rent inclusive of rates. Lovell Road, Ham. (Erected by Ham U.D.C. 1921/22). Type B.3. Living room, scullery and three bedrooms (with bathroom) 12 @ 7/6 Marksbury Estate (Built (Taken over from Surrey County Council). 1930-31). < 1 @ 23/- 1 @ 20/- 1 @ 15/4 9 @ 14/2 1 @ 14/1 1 @ 12/10 1 @ 12/7 2 @ 12/4 Type A.2. Living room, scullery and two bedrooms (with bathroom) 32 1 @ 11/10 1 @ 10/9 4 @ 10/4 1 @ 9/4 2 @ 9/2 2 @ 7/4 1 @ 6/10 1 @ 6/1 1 @ 5/10 1 @ 4/10 12 @ 16/9 1 @ 16/2 1 @ 15/2 1 @ 14/8 2 @ 13/5 5 @ 12/11 2 @ 12/5 1 @ 11/5 1 @ 10/11 Type A.3. Living room, scullery and three bedrooms (with bathroom) 50 6 @ 10/5 2 @ 9/10 1 @ 9/9 1 @ 9/2 4 @ 9/- 3 @ 8/5 2 @ 7/5 1 @ 6/5 2 @ 6/2 1 @ 5/5 1 @ 4/5 47 Situation of Dwellings. Description. No. of Huses. Weekly rent inclusive of rates. 8 @ 18/7 1 @ 16/5 2 @ 16/- 1 @ 14/7 2 @ 14/2 Type B.3. Parlour, living room, scullery and three bedrooms (with bathroom) 26 1 @ 12/11 2 @ 12/5 1 @ 11/5 1 @ 10/5 2@ 10/- 1 @ 9/5 1 @ 8/5 1 @ 6/11 1 @ 6/5 1 @ 6/2 Type B.4. Parlour, living room, scullery and four bedrooms (with bathroom) 16 5 @ 20/6 1 @ 18/6 2 @ 16/6 1 @ 15/6 1 @ 14/9 1 @ 13/4 2 @ 12/6 1 @ 10/6 1 @ 7/6 1 @ 6/3 The variation in rental of the above is accounted for by their being a portion of the Chertsey Arterial Road Scheme. Persons displaced were re-housed at the same rent as was being paid for the demolished dwellings. Houses becoming vacant would be re-let at the following standard rentals:— Type B.4. 20/6. Type B.3. 18/7. Type A.3. 16/9. Type A.2. 14/2. West Sheen Vale. (1935). Type A.3. Flats. Living room, scullery, three bedrooms (with bathroom) 4 @ 8/8 Type A.2. Flats. Living room, scullery, two bedrooms (with bathroom) 12 @ 7/- 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, three dairy farmers who keep their own cows in the Borough. The Veterinary Inspector appointed by the Corporation inspects all cattle regularly and reports to the Health Committee monthly. All Dairies and Cowsheds are frequently inspected. In 1923 the Milk (Special Designations) Order came into force by which milk is graded into four special classes. (a) Certified Milk. (b) Grade A Tuberculin tested. (c) Grade A. (d) Pasteurised. Producers of Certified Milk receive their 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 20 such samples were taken and on analysis 19 were found to be up to the required standard. The Analysts employed (The Counties Public Health Laboratories) report direct to the Ministry on every analysis. 49 The Borough Council have granted licences to sell Certified Milk to 4 firms in the Borough (comprising 10 premises), Grade A Tuberculin Tested Milk to 3 firms (comprising 4 premises), Pasteurised Milk to 6 firms (comprising 19 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 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 slaughterhouse 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 condemned is destroyed. If a large quantity, such as a whole carcase is to be dealt with, arrangements are made for it to be sent to a firm to boil it down. Smaller quantities are burnt at the destructor. During the year the slaughterhouse was visited on 92 occasions and 328 carcases inspected. The following articles were surrendered. 1 Pig's mesentery. 2 Pigs' heads. 1 Pig's liver and lungs. 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 1935. 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, 1935:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 30 ... 30 ... ... ... ... ... Cream 2 ... 2 ... ... ... ... Meat 4 ... 4 ... ... ... ... ... Butter 1 ... 1 1 ... 1 ... ... Cheese 2 ... 2 ... ... ... ... ... Sausages 3 ... 3 ... ... ... ... ... Other Articles 3 ... 3 ... ... ... ... ... ... ... ... ... ... Totals 45 ... 45 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. Diphtheria 31 31 4 Scarlet Fever 69 64 ... Puerperal Fever 10 9 4 Puerperal Pyrexia 9 6 ... Pneumonia (Primary) 21 12 4 Influenzal Pneumonia 1 1 1 Erysipelas 21 12 1 Ophthalmia Neonatorum 3 3 ... Tuberculosis: (a) Respiratory (M). 21 13 9 (F.) 22 16 8 Total 43 29 17 (6) Non-Respiratory (M.) 5 4 2 (F) 6 3 1 Total 11 7 3 Diphtheria. During the year 31 cases of Diphtheria were notified as compared with 55 in 1934. The rate per 1,000 living was 0.81 as compared with a case rate of 1'60 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 £4 4s. 6d. 52 This small amount is explained by the fact that patients are usually sent into Hospital immediately on being seen. In this way they receive Antitoxin, as soon as - if not sooner - than they would do if the doctor had to give it at the home. Schick Test and Diphtheria Immunization. As mentioned in last year's report, the Clinic for the above was instituted at the end of 1934. Two sessions weekly have been held throughout the year with a constant attendance. The method of working up to the present time has been to send a leaflet describing the test, etc. to the parents of school children. Each school has been taken in turn and all the schools, except the Secondary Schools, have now been dealt with. The numbers of parents who returned the forms accepting the treatment varied in different schools. The percentage of acceptances ranged from 63 per cent, in one school down to 18 percent, in another. There was a very poor response from one School and at this particular school the natural immunity of the children was very low. Practically no child tested was found to be immune. Recently a case of Diphtheria occurred in one of the scholars and a reminder was sent to all those parents who had not replied to the first letter. In two or three days over 100 replies were received asking for immunization and this has now been carried out. The next group of children to be considered is the group from 1 year to 5 years of age and these will be reached through the Maternity and Child Welfare Centres and by the Health Visitors during home visits. The details of the year's work at this Clinic are shown in the following report by Dr. D. S. Murray:— 53 DIPHTHERIA IMMUNIZATION CLINIC. The Diphtheria Immunization Clinic, which began in December, 1934, has been very well received, and the number of applications became so great that it was necessary to have a clinic two days in the week. As will be seen from the figures, 1,100 children were Schick tested during the year, but only 15.5 per cent, of these were found to be immune. It is estimated that unless at least 60 per cent of the children in a district are immune there is no real safety from severe Diphtheria. If the figures the second year of the clinic are maintained as is expected, then this position will be reached in Richmond by the end of 1936. Meanwhile, it is satisfactory to report that 711 certificates of immunity were issued during the year. The number of children who required a second course of injections to complete the immunity was very small indeed, and it is also noted that the number of reactions of any severity was practically negligible. The attendance at the clinic has been particularly good, although 42 forms were filled up for children who failed to attend. In addition, 16 children failed to complete the course for various reasons, and a number of these left the district. Similarly, 63 failed to attend for the posterior Schick test Certificates were therefore not issued to these children, but on the basis of the other figures at least 60 of them are probably immune. There have been no cases of Diphtheria during the year in the children to whom certificates have been given. One child was found to have Diphtheria during the course, but only a mild attack, and was immune when tested six months later. Another child developed Diphtheria after the course of injections was completed but before time for retesting. The attack was mild and it is certain that immunity had not been gained by the date of infection. This was confirmed by testing another member of the family, who had also had the injections, and who was found to be still slightly susceptible, but was sufficiently protected not to get the disease. 54 A third and older member of the family, it is interesting to note, had been found to be naturally immune and did not contract the disease. Of the children immunized during 1935, over 200 have since received certificates, but these will, of course, be included in next year's figures. In conclusion, it is very gratifying to note the high percentage of children who have been sent to the clinic without much propaganda requiring to be done, and without any attempt to frighten parents into taking advantage of this service. Diphtheria Immunization Clinic. Total number of children seen during year 1109 Total number of attendances during the year 5630 Total number of children Schick tested 1106 Total number of children naturally immune 172 Percentage of tested children found to be immune 15.5% Total number of certificates given 711 Total number of tests outstanding at end of year 319 Number of children who failed to attend for re-Schick 63 Number of children who failed to complete course 16 Number of children who required additional injections for complete immunity 9 Reactions noted in 711 children obtaining certificates 14 D. S. MURRAY, B.Sc., M.B., Ch.B. 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 23 260 283 Tuberculosis Sputum 6 60 66 29 320 349 55 Scarlet Fever. During 1935, 69 cases of this disease were notified and 64 were treated in hospital. The rate per 1,000 living was 1.79 as compared with a case rate of 2.96 in England and Wales. In 1934 there were 52 cases. There were no deaths from this disease. Puerperal Fever and Puerperal Pyrexia. During 1935 nine cases of Puerperal Pyrexia and ten cases of Puerperal Fever were notified. There were 4 deaths 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 so desires. 56 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. Diphtheria ... 1 2 1 ... 16 8 ... 2 1 ... ... ... ... ... 1 ... 2 1 ... .. ... ... ... Scarlet Fever ... ... 2 2 5 30 18 2 8 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Primary) 1 1 ... ... 2 6 ... 1 ... 5 1 4 1 ... ... ... ... ... ... ... ... ... ... 3 Influenzal Pneumonia ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas 1 ... ... ... ... ... ... 1 6 7 4 2 1 ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... 1 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... 3 5 2 ... ... ... ... ... ... ... ... ... ... 2 2 ... ... Tuberculosis:— (a) Respiratory ... ... ... ... ... 1 ... 5 26 5 4 2 ... 1 ... ... ... ... ... ... 6 6 3 1 (b) Non Respiratory ... ... 1 ... 1 ... ... 2 4 1 2 ... ... ... 1 ... ... ... ... 1 1 ... ... ... 57 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. Respiratory Tuberculosis (Phthisis). Forty-three cases of this disease were notified during the year (21 males and 22 females). Of these 39 (13 males and 16 females) were removed to Hospital or Santorium. There were 51 cases notified in 1934. There were 17 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for 3 deaths while 11 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 1 ... 5 ... 1 ... ... ... ... ... ... 15 4 8 2 1 ... 2 ... 1 25 10 9 1 2 2 2 1 ... 35 3 2 ... ... 5 1 ... ... 45 2 1 ... 2 2 1 ... ... 55 1 ... 1 ... ... ... ... ... 65 and upwards 1 1 ... ... ... 1 ... ... Totals 21 22 5 6 9 8 2 1 58 Ophthalmia Neonatorum This is an inflammation of the eyes in new-born 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 — — —