iiio. Mr. HALLETT. BOROUGH OF RICHMOND (surrey). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1936. richmond : j. h. broad and co., ltd., printers, 8, king street. BOROUGH OF RICHMOND (surrey). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1936. 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. Anle-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 and Housing Officer— *George Laws, F.R. San. Inst., F.S.I.A. Certified Inspector of Meat and other Foods ; Inspector under Shops Acts. Assistant Sanitary Inspectors— Bernard Aisthorpe (Certificate Royal Sanitary Institut* and Meat and Food Inspectors' Certificate). Victor Edward Baughan (Certificate Royal Sanitary Institute, Sanitary Scienco Certificate, Meat and Food Inspectors' Certificate and Smoke Inspectors' Certificate). Alec Henry Garton Johnson (Resigned May, 1936). (Certificate Royal Sanitary Institute and Meat and Food Inspectors' Certificate). Ernest Sydney Power (Appointed June, 1936). (Certificate Royal Sanitary Institute, Sanitary Science Certificate, Meat and Food Inspectors' Certificate and Smoke 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 Visitor! Certificate, R.S.I. Miss C. Burton, S.R.N., S.C.M. (Resigned April, 1936). New Health Visitors' Certificate. Miss V. Kusel, S.R.N., S.C.M. (Appointed May, 1936). New Health Visitors' Certificate. Clerks— Miss D. K. Jemmett. Miss M. J. Bird. Miss 0. W. Ponsford. Miss H. E. Iles. 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. Junb, 1937 To the Mayor, Aldbrmen 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, 1936. The Report is drawn up according to the directions contained in circular 1561 issued by the Ministry of Health in October, 1936 and is what is known as an Ordinary Report. The Birth Rate throughout England and Wales for 1936 is 14.8 while the rate in Richmond is only 10.7 per 1,000 of the population. The Death rate for the Borough is 11.6 per 1,000 of the population, while this year's rate for England and Wales is 12.1. The Infantile Mortality Rate is 56 per 1,000 births, compared with 59 per 1,000 births in England and Wales. The rate is higher than usual and is discussed in more detail later in this Report. 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 1936) 38,260 Number of inhabited houses (1936) 9,567 Rateable Value £564,930 Sum represented by a penny rate £2,235 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 smali 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 592, 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 100 0 0 Boots and Clothing 120 0 0 Relief in other forms 150 0 0 Convalescent Home, Hospital and Surgical Aid Letters purchased 35 0 0 Richmond Royal Hospital. The Secretary-Superintendent, Captain G. M. Eden, has kindly supplied the following information :— 1,700 In-Patients and 4,843 Out-Patients were treated at the Hospital during 1936. Those received from the Borough of Richmond were 453 In-Patients and 949 Out-Patients. Extracts from Vital Statistics of the Year. TOTAL. M. F. Births (Legitimate) 373 175 198 ,, (Illegitimate) 37 18 19 Stillbirths (Legitimate) 13 7 6 ,, (Illegitimate) 2 1 1 Deaths 515 233 282 Birth Rate (R.G.) 10.7 Death Rate (R.G.) 11.6 Death Rate of Infants under 1 year of age. Deaths of all children under 1 year per 1,000 Births 56 Deaths of Legitimate Infants per 1,000 Legitimate live Births 35 Deaths of Illegitimate Infants per 1,000 Illegitimate live Births 270 Deaths from Cancer (all ages) 81 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 1936. (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 8 0.61 12.1 0.01 — 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 121 County Boroughs and Great Towns, including London 14.9 0.67 12.3 0.01 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 140 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Censusl931) 15.0 0.64 11.5 0.00 0 04 0.01 0.04 0.05 0.15 0.39 3.4 55 London Administrative County 13.6 0.53 12.5 0.01 — 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 RICHMOND 10.7 0.39 11.6 0.00 — 0.00 0.00 0.00 0.00 0.23 0.47 4.9 56 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows per 1,000 Live Births 1.40 2.41 3.81 ,, ,, Total Births 1.34 2 31 3 65 The maternal mortality rates for Richmond are as follows per 1,000 Live Births 0.00 0.00 0.00 ,, ,, Total Births 0.00 0.00 0.00 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 1936 was 38,260. Births. There were 410 births during the year (193 males and 217 females). This gives a birth rate of 10.7 per 1,000 of the population as compared with a rate of 14.8 in England and Wales and 13.6 in London. There were 15 still births registered giving a rate of 0.39 per 1,000 of the population, as compared with 0.61 in England and Wales and 0.53 in London. Deaths. The number of deaths registered during the year was 515 (233 males and 282 females). In the list of deaths supplied weekly by the local Registrar there were 273 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 112 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 376, and the number of inquests held was 69, though all of these were not concerned with Richmond residents. The 515 deaths give a crude death rate of 13.5 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 an areal 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*6 as compared with 121 for England and Wales and 12'5 for London. The deaths occurred in persons of the following ages :— 23 under 1 year of age. 5 between 1 and 5 years of age. 3 ,, 5 „ 15 ,, 7 „ 15 „ 25 ,, 40 „ 25 „ 45 „ 144 „ 45 „ 65 201 „ 65 „ 80 92 over 80 years of age. It will be noticed that no fewer than 293 persons died over the age of 65, i.e., more than half the total deaths, while 92 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 ... ... ... ... ... ... ... ... ... 2 2 Congenital Debility and Malformation including Premature Birth 8 1 1 ... 10 1 ... ... ... 11 3. Other defined diseases 4 1 ... ... 5 1 3 ... 1 10 12 2 1 ... 15 2 4 1 1 23 9 Infantile Mortality. There was a considerable rise in the number of deaths under one year of age. For several years this mortality rate has been low—in 1935 it was 39 per 1,000 births, compared with 57 in England and Wales. During 1936 there were 23 deaths under one year of age, giving an Infantile Mortality rate of 56 per 1,000 births, as compared with 59 in England and Wales and 66 in London. It will be noticed that of the 23 deaths, no less than 10 were of illegitimate children. The mortality rate of these children is always high and 10 deaths referred to give a mortality rate of 270 per 1,000 illegitimate births. Only eight of the 23 deaths are known definitely to have occurred in the Borough. Eleven deaths occurred in outside districts, while four of the deaths were of newly born children whose bodies were found in the Borough— two in the River, one in the Terrace Field and one in an Hotel Cloakroom. These children may not have any connection with the Borough—except that they were left here—but they help to increase the Infantile Mortality Rate. It will be seen from the table that out of 23 deaths, twelve occurred in the first week of life. The neonatal deaths, i.e., deaths occurring in the first four weeks numbered 15 out of the total 23. This gives a neonatal mortality of 37 per 1,000 births. Ten of these deaths were due to Congenital Debility and Premature Birth. Thirteen of these 23 deaths occurred in hospital while inquests were held in five cases. 10 Causes of Death. M. F. All Causes 233 282 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — — 6. Influenza 3 6 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever — 9. Tuberculosis of respiratory system 8 12 10. Other tuberculosis diseases 4 1 11. Syphilis ... — — 12. General paralysis of the insane, tabes dorsalis 2 — 13. Cancer, malignant disease 40 41 14. Diabetes ... 5 10 15. Cerebral hasmorrhage, etc. 10 9 16. Heart disease 60 78 17. Aneurysm 2 2 18. Other circulatory diseases 15 18 19. Bronchitis 4 1 20. Pneumonia (all forms) 18 12 21. Other respiratory diseases 1 5 22. Peptic Ulcer 2 3 23. Diarrhoea, etc. (under 2 years) 1 1 24. Appendicitis 2 5 25. Cirrhosis of liver — — 26. Other diseases of liver, etc. 1 3 27. Other digestive diseases 5 7 28. Acute and chronic nephritis 8 9 29. Puerperal sepsis — — 30. Other puerperal causes — — 31. Congenital debility, premature birth, malformations, etc. 7 6 32. Senility 7 19 33. Suicide 2 3 34. Other violence 7 6 35. Other defined diseases 18 25 36. Causes ill-defined or unknown I — 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 201 examinations were made and a detailed list is shown on Page 65. 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. 12 5. Bye-laws as to Slaughterhouses. 6. ,, ,, New Streets and Buildings. 7. „ ,, Pleasure Grounds. 8. „ „ Allotments. 9. „ ,, Locomotive Act, 1898. 10. Bye-laws under Go id 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 Pish Prying, 1920. 13. Bye-laws as to Tents, Vans, Sheds, etc., 1920. 14. Bye-laws as to Houses Let in Lodgings. (ft) 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 Fire Station, for use in accidents and private cases. During the year this ambulance was used 862 times and the mileage covered was 3,739-9. (c) Nursing iti 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 413, and the number of visits paid was 8,315. 13 The Nurse employed by the Kew and Kew Gardens Association attended 244 cases (Medical 178, Surgical 66), and paid 5,676 visits. Infectious Disbasb. 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 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). Ante-Natal Clinic Ditto (1 session per fortnight). Diphtheria Immunisation Ditto Twice weekly. Health Committee. Tonsils and Adenoids Richmond Royal Hospital. When required. By arrangement with Education Committee. Education Committee. Ringworm (X-rays) Mr.J.S.Harwood 8, Onslow Rd., Richmond. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly. By arrangement with M. & C. W. Committee. County Council. Tuberculosis Treatment.. 38, Sheen Rd., Richmond. Once weekly. 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. J. S. Harwood, 14 Thb Minor Ailment Clinic is held every morning, and during the year 589 children have made 3,497 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 : 152 children were treated during the year. The School Dbntal Clinic is held 10 times a fortnight, and 1,284 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 were necessary for a time. Hospitals. The South Middlesex and Richmond Joint Hospital Board was established to take infectious cases from Richmond, Twickenham, Heston and 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. The new Borough of Twickenham includes Hampton, Hampton Wick and Teddington and Mogden Hospital is at present being enlarged. When completed it will be able to deal with all the cases in the three Districts. 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. MOGDEN HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted. Scarlet Fever 42 Diphtheria 17 Other Diseases 12 Total 71 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 once weekly at Petersham for the inhabitants of Petersham and Ham, 16 A Toddlers' Clinic, i.e., a separate clinic for children between 18 months and five years, is held once a fortnight at Windham Road. By having separate sessiotis 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. During the year the attendances at the Centres were : — Windham Road. Mothers ... 5,070 Average per session ... 31 Children ... 5,853 „ ,, ,, ... 36 The Medical Officer of Health held 2,469 consultations during the year. Trefoil House, Petersham. Mothers ... 657 Average per session ... 25 Children ... 741 ,, „ „ ... 28 Dr. Cryer, the Medical Officer, held 607 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. Hazelby and Mrs. Sprague (who are co-opted members on the Maternity and Child Welfare Committee), Mrs. Klinkhart, Miss Reid and Mrs. Smith. At Petersham the ladies who do excellent work are Mrs. Field, Miss Hornby, Mrs. Hughes and Mrs. Coleman. The Health Visitors visit at the homes and during the year under review, 368 first visits were made and 1,839 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 1936 are :— Number attended, 99. Total attendances, 356, 17 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 1936 there were no deaths from Puerperal Sepsis giving a mortality rate for this disease of O.OO per 1,000 births, as compared with a rate of l.34 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 0.00 per 1,000 births, as compared with 3.65 in England and Wales. Dental Clinic. Arrangements have been made for Dental work in connection with the Maternity and Child Welfare Centre. For some time only one session per fortnight has been allotted to this work, but Miss E. Russell, L.D.S., who is also the School Dental Surgeon, found that the work was increasing and now it has been decided to have one session weekly for the dental treatment of expectant and nursing mothers and of children up to five years of age. Anaesthetics are given by the Medical Officer of Health and artifical 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 1936, 36 sessions have been held, including 18 for the administration of anaesthetics. Ninety-one patients were treated and made 256 attendances, 18 The work done was as follows :— Extractions of permanent teeth 170 „ temporary ,, 283 Filling of permanent teeth 22 ,, temporary teeth 11 Other operations chiefly in connection with provision of dentures 30 Dentures supplied 5 Number of anaesthetics given ... ... 130 (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 once a week. (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. 210 visits were paid to Foster Children by the Nurses in 1936. 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 10 of which six 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 that 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. 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 Swimming Baths and Pools. There are no privately owned swimming baths or pools in the Borough, the district at present being served by the Public Baths which are under the control of the Baths Superintendent, who has supplied the following particulars :— No of bathers during the year—Males: 52,845 Females : 33,888 A Constant Filtration Plant is installed which provides for a turn-over of the water every four hours. The water is thereby Filtered, Chlorinated and Aerated, and frequent Tests each day show a free Chlorine content of from .2 to .5. Samples sent for Bacteriological examination have always resulted in a very satisfactory report. 22 SANITARY INSPECTION OF THE AREA. Report of Chief Sanitary Inspector. In compliance with Article 27 of the Sanitary Officers (outside London) Regulations, 1935, 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 1936 in connection with the administration of the numerous Acts of Parliament and Bye-Laws in force within the district. The many and varied duties carried out by the Department under the various Acts, Orders and Regulations, have all received prompt attention throughout the year. Increased activity was demanded by the work arising out of the Overcrowding Survey and house to house inspections in accordance with the Housing Regulations. 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 living or 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 February, 1936. 12 premises were the subject of special reports to the Health Committee. 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. 23 861 houses were inspected for housing defects either under the Public Health or the Housing Acts. Details of the inspections made and improvements effected as r. result of such surveys are set out in the following summary. Inspections. The total number of inspections made during the year was 8,288. On 606 of the premises visited nuisances to the number of 3,534 were discovered, and in dealing with the sanitary defects from which they arose 379 "intimation " or " preliminary" notices and 25 statutory notices were served. The number of letters written with regard to the abatement of nuisances, etc. was 254. At the end of the year 2,896 of the defects discovered had been abated, the work of remedying 227 was in hand, and the remaining 411 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 2,196 visits were paid to the respective premises. The number of inspections made under the Housing Acts and particulars recorded was 561, and the number of sanitary defects remedied and improvements made under this heading was 2,624. The following list shows the number of routine inspections and visits made Inspections During 1936. Houses inspected and particulars recorded (Housing Acts) 590 Premises visited (P.H. Acts) 1116 Re-visits to houses and other premises 930 Miscellaneous visitssits to works in progress 1266 ,, factories 22 ,, workshops, bakehouses, etc. 11l „ outworkers' premises 1 24 Visits to workplaces, tearooms, etc. 157 „ dairies, cowsheds and milkshops 88 „ ice cream vendors 25 „ food stores 121 „ slaughter house 84 „ fried fish shops 32 „ greengrocers' premises 71 „ stables 68 „ piggeries 13 „ public conveniences 159 „ petrol stores 268 „ employment agencies 12 „ school premises 30 „ re infectious diseases 68 Inspections after infectious diseases 68 Smoke observations 3 Special visits re Shops Acts 271 Visits re Destructive Insects and Pests Acts 10 Visits under Rats and Mice Destruction Act 82 Visits to Corporation Dwellings 1064 Samples of "Certified Milk" sent for Analysis 8 Interviews re abatement of nuisances, etc, 138 Total visits made 8288 Rent Restriction Act. For the first time since the Rent Restriction Act became operative in 1915, no applications were received during the year for Certificates by occupiers of working class premises, to enable them to suspend the increase of rent on the grounds that the premises were not in a reasonable state of repair. The Shops Acts, 1912/1936. In the previous Annual Report I called attention to the fact that the Shops Acts had been the subject of alteration and revision by the Government and as a result, the Shops Act of 1934 came 25 into operation on the 30th December, 1935. Briefly, this Act regulates the hours of employment of persons under the age of 18 years who are employed about the business of wholesale or retail shops, or employed elsewhere in connection with wholesale or retail trade or business, and makes provision as to the arrangement in shops and warehouses for the health and comfort of workers. A full report on the administration of this new legislation was given in the previous Annual Report. The passing of the Shops Act, 1936, the Retail Meat Dealers Shops (Sunday Closing) Act, 1936, and the Shops (Sunday Trading Restriction) Act, 1936, has thrown further additional work on the Department during the year. There are now seven Acts and four sets of Regulations specifically relating to shops and employment in shops and the hope may be expressed that before long the various Acts and Regulations will be consolidated. The Shops Act, 1936—This Act provides for the application of the Acts of 1912/1934, to premises and places where the business of lending books or periodicals is carried on for the purposes of gain. This Act came into operation on the 1st January, 1937. The Retail Meat Dealers Shops (Sunday Closing) Act, 1936. This Act provides, with certain exceptions, for the compulsory closing of meat traders' shops and stalls on Sundays. The Act came into operation on the 1st January, 1937. The Shops (Sunday Trading Restriction) Act, 1936—This Act restricts the opening of shops and trading on Sunday. The Act came into operation on the 1st May, 1937 and is referred to as the Act of 1936. Shop Acts—Inspections. No. of Shops on Register at end of year 772 „ „ Special visits made 271 „ „ New Additions to Register 4 „ „ changes of occupancy 11 26 Contraventions— Half Holiday Notices not exhibited 6 Early Closing „ „ „ 10 Records of Hours of Young Persons (Form F.) not exhibited 6 Records of Overtime worked by Young Persons not exhibited (Form G.) 5 Abstract of Provisions of Shops Acts relating to Young Persons not exhibited (Form H.) 5 Provision of Seats for Female Assistants (Form K.) not exhibited 3 Serving of customers after Closing Hours (warned) 13 Prosecutions (serving of Customers after Closing Hours, etc.) 7 Details of Prosecutions. Offence. Date Case Heard. Conviction Fine. 1. Sale of bacon on 26.8.36 (Wednesday) contrary to Grocers & Provision Dealers Order, 1914. 29.10.36 29.10.36 20/and 2/6 costs 2. Sale of salmon, cheese and soup, on Wednesday, 26.8.36 contrary to Grocers and Provision Dealers Order, 1914 & Shops (Hours of Closing) Act, 1928. 29.10.36 29.10.36 20/- 3. Sale of Grocery on Wednesday, 23.9.36 contrary to Grocers & Provision Dealers Order, 1914 and Shops (Hours of Closing) Act, 1928. 3.12.36 3.12.36 5/- 4. do. 3.12.36 3.12.36 5/- 5. do. 3.12.36 3.12.36 5/- 6. do. 3.12.36 3.12.36 10/- 7. do. 3.12.36 3.12.36 5/- 27 Smoke Abatement. Richmond being a residential district, contains no large works or factories. There are a few small factories but these give little trouble of smoke nuisance. One complaint was made during the year; smoke observation was taken and the complaint rectified at once. Eradication of Bed Bugs. This problem, which has assumed one of considerable importance and magnitude since the crusade for better housing and the abolition of the slums commenced in real earnest in 1933, has received much attention during the year. The only rational attitude that a Sanitary Authority can adopt towards the problem of the bed bug is that of prevention, and it is on these lines that the department has carried out routine measures for cleansing and eradication purposes since 1911. The number of houses reported to be in a verminous condition and action taken during the year was as follows:— Council Houses 48 Other houses 131 This number is considerably above that dealt with in previous years on account of the re-housing of families during Slum Clearance operations. Disinfestation methods were applied in all properties where a report was made that vermin had been located. Methods employed for freeing infested houses from bugs. There is no universal remedy for the eradication of infestation because of the great adaptability of the bug to difficulties of environment and breeding, also because its breeding places are so often well protected and concealed. 28 When infestation unfortunately occurs certain methods can be applied which ultimately prove successful provided they are directed intelligently, and of the various methods, the most reliable is cleanliness, which will also prevent infestation. The co-operation of the householders with the officers of the Public Health Department in this matter is, therefore of paramount importance. At the present time all Local Authorities are attaching considerable importance to this problem and many methods for the destruction and prevention of the bed bug are being tried out. It is reported that the most effective treatment is by the application of HCN. fumigation (hydrocyanic gas). This method is howeverfraught with serious difficulties and danger to life. The Ministry of Health recommend that at least 24 hours should be allowed as the minimum time for the ventilation of the premises after HCN. fumigation. This means considerable extra cost in view of the fact that alternative accommodation for the tenants for 36 hours must be found and paid for, and also it is necessary to vacate the tenants of adjoining houses on either side of the infected premises for a period up to 24 hours, a precaution that is both inconvenient and expensive in the way of compensation. Another disadvantage in the case of HCN. gas is that its smell, although characteristic, is neither strong or irritating and it is difficult to judge whether it is present in a dangerous amount. The business of a pronounced warning introduces a special element of danger and necessitates the importance of stringent precautions. It is obvious that the use of any method where tenants are required to vacate premises for a lengthy period causes serious inconvenience. The same position arises when wooden fittings have to be removed, walls stripped and methods involving second and sometimes third applications have to be carried out. 29 "Cimex" blocks have been used for the generation of gas, and these have been used in conjunction with the use of various insecticides applied through powerful sprays. The methods we have found to be most successful have been the use of an insecticide through a powerful spray, the woodwork— such as the picture mouldings, skirtings, window linings and door frames and architraves having been loosened or removed before treatment is applied. The wall paper is afterwards stripped and a second application of insecticide or "Cimex" is carried out in bad cases. Occupiers are requested by notices to take down the iron bedsteads and frames which are treated by means of spraying with suitable insecticide, and pictures and other articles of furniture in the room are thoroughly cleansed and sprayed. Afterwards the whole premises have to be cleansed and purified under notice and supervison of departmental officers. No operations can be deemed to be a success without the full co-operation of the householder and the results of experience prove that where cleanliness has been established and maintained, the bed bug can be completely eliminated- Methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council Houses. Before any re-housing to Council Dwellings is put into effect, the house and the contents are thoroughly inspected and if found to be dirty or verminous, precautionary measures as previously stated are put into effect, particularly in the case of purification of bedding and furniture. The removal and destruction of dirty badly infested bedding is insisted upon. 30 No matter what methods have been applied before or during removal of tenants, special supervision by the Sanitary Staff must be given during the Slum Clearance and Re-housing Schemes and transfer of tenants to Council Houses to correct all unfavourable domestic habits which are likely to cause deterioration of the new house. It should be emphasised that tenants must be taught that disinfestation cannot be substituted for good housekeeping. Papering of walls must be discouraged because bugs can so readily shelter behind the paper and observations in infested houses have shown that a concentrated dose of sulphur dioxide may not reach the bugs and eggs in pockets behind wall paper. It is essential that continued efforts should be made to advise methods of bug-proofing new houses. Wooden picture rails should be abolished and the skirting boards replaced by a skirting of cement and woodwork should be reduced to a minimum. All work for the disinfestation of verminous premises is carried out by the trained officers of the Department. National Rat W«ek—November 2nd to 7th, 1936. In conformity with the request of the Ministry of Agriculture and Fisheries, the Local Authority co-operated in the measures for the extermination of rats in the Borough during National Rat Week which was held from November 2nd to the 7th. Prior to the commencing of Rat Week, the attention of all householders was called to the provisions of the Rats and Mice (Destruction Act) by the publication of posters throughout the Borough setting out the provisions of the Act and the duties of householder's to keep their premises free from rats and mice. Special workmen were employed during Rat Week in baiting the sewers and rubbish dumps throughout the Borough. The work done was as follows:— No. of special rat baits laid down—8,515. 31 A second inspection was made when it was found that 8,361 or 98% of the baits laid down had been taken. The baits consisted of Red Squill either in the form of Red Squill Biscuit or bread soaked with the poison. Many of the sewers and manholes throughout the Borough revealed the presence of rats and certain defective conditions were reported for attention and repair. No complaints of nuisance caused by rats were received from householders during Rat Week. The Public Heath Department does not confine its attention to the extermination of rats during one week in the year, repressive measures being put into operation for the destruction of rats and mice throughout the whole of the year. Nuisance from Rubbish Dumps. Complaints were received during the year of serious nuisance from two rubbish dumps both situated in the Ham area. The dumps consisted of disused gravel pits, one at the rear of the Equestrian Club, Ham, and the other The Ham River Grit Co. Both these dumps, consisting of large stretches of water of several acres in extent, are being filled in by builders' rubbish principally from Kingston and Richmond. The Surrey County Council Act contains a special clause that persons creating any rubbish dump in the district of another Local Authority shall first of all obtain the consent of the County Council and of the Authority of the district in which it is proposed to create the dump, before the rubbish can be deposited. As a result of the complaints, which were found to be justified, the attention of the Surrey County Council was called to the matter and subsequently notice was served upon the firms having 32 control of the dumps requesting them to apply for sanction. This was followed by special conditions being laid down which were subsequently agreed upon by the Surrey County Council and the Health Department and these have been strictly enforced during the year. SANITARY IMPROVEMENTS. Water Supply. Drinking water cisterns repaired, cleansed or covered 40 Water fittings repaired or renewed 5 Taps provided direct from rising main 1 Water Closets. New pans fixed 61 Pans cleansed or repaired 21 Walls, roofs, &c., repaired 99 Flushing cisterns, repaired and renewed 52 Water supply re-instated or provided 5 Foul woodwork around closets removed 1 W.C.'s lighted and ventilated 11 Brickwork repaired and re-pointed 18 Seats repaired and renewed 33 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 36 Drainage. System re-constructed 23 Repaired or cleansed 113 Manholes repaired or new provided 32 Ventilating pipes repaired or renewed 36 Drains intercepted from sewer 6 Want of Drainage 76 33 Sub-soil drainage renewed — Gullies renewed or provided 51 Gratings, dishing or curbing renewed 10 Fresh air inlets renewed 12 Dustbins. New provided 68 Yard Paving. Repaired 57 Newly paved 8 Sinks, &c. New provided 27 New waste pipes provided 61 Waste pipes repaired, trapped or ventilated 10 Insanitary wall surfaces around sinks cemented 3 Dampness. Roofs repaired 66 Gutters and downspouts repaired and renewed 103 Damp course fixed 87 External walls repaired and pointed 48 Pointing to reveals renewed 39 Floor cavities ventilated 14 Site of house concreted 15 Wall ventilators to floor cavities renewed 34 General Repairs. Walls and ceilings repaired 449 Floors repaired 122 Doors, windows, sills, &c., repaired 400 Window fastenings renewed 106 Windows made to open 5 Stoves repaired and renewed 127 Coppers repaired or renewed 42 34 Rooms cleansed and re-decorated 161 Verminous rooms cleansed 155 Passages, staircases cleansed 20 Sash cords renewed 127 Larders repaired . 7 Outbuildings repaired or renewed 9 Coal cupboards repaired 13 Obstructive buildings removed 9 Staircases repaired 18 Accumulations of rdfuse removed 27 Rooms ventilated 32 Defective and smoky flues remedied 49 Dirty floors and bedding cleansed 76 Basement sleeping rooms unfit for use, closed 12 Rat infested premises (remedied) 26 Nuisances from the keeping of fowls, &c., remedied 1 Overcrowding abated 1 Miscellaneous. Nuisances remedied 275 Stables. Manure accumulations removed 6 Manure receptacles provided or repaired 2 Stables repaired, cleansed, &c. 1 Yards repaved, cleansed, &c. 1 Urinals. Reconstructed and flushing apparatus provided 3 Repaired, &c. 13 Flushing tanks repaired 3 Dairies. Nuisance from smoke 1 35 Greengrocers' Premises. Accumulations removed 1 Yards repaved 1 Other defects 3 Testing of Drains and Sanitary Fittings. Applications of smoke test 40 „ water test (new work) 86 „ chemical test — Drainage systems opened out for examination, on written complaint 3 Service of Notices. The following table shows the particulars of the notices served:— Informal Notices 379 Statutory or Formal Notices:— Sec. 94, Public Health Act, 1875 (To abate nuisances) 9 Sec. 41, Public Health Act, 1875 (To redrain premises) 1 Sec. 17, Housing Act, 1930 (To repair houses) 4 Sec. 36, Public Health Act, 1875 (To provide dustbin) 10 Sec. 46, Public Health Act, 1925 (To cleanse Verminous premises) 1 404 Number of interviews with Owners of Property, Builders, etc., re Sanitary Improvements 324 Defective Drainage. 14 drainage systems were completely reconstructed and 42 repaired under the supervision of this department. 36 Three drainage systems were opened out and examined under Section 41 of the Public Health Act, 1875. As a result of action taken under Section 41 of the Public Health Act, 1875, the drainage systems of the under-mentioned premises were opened out and examined and found to be in a defective condition and to require alteration and amendment. Notices were served upon the owners to reconstruct the defective drainage systems and were not complied with. Estimates were, therefore, obtained from local builders for carrying out the works in default. The work was done under the supervision of the department, and the costs recovered from the owners after being apportioned as required by the provisions of the Public Health Act. Single Private Drain and Branch Drains. Do. 42/46, Jocelyn Road, l/10, Ashley Road and 39/43, Evelyn Road. 1/7, Houblon Road, Total cost of work— £158-15-0. Total cost of work— £63-3-0. Disinfection of Premises. Reason. Houses. Rooms. Bedding removed. Infectious Fevers 64 66 68 Tuberculosis 22 24 28 Other Diseases 16 18 12 102 108 108 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, 37 Slaughterhouses. There is one "registered" slaughterhouse only and this is situated at Ham. 84 visits of inspection were made during the year. The number of animals inspected after slaughter was as follows:— 5 calves 29 beasts 178 sheep and lambs 58 pigs 1 beast's mesentery affected with Tuberculosis was voluntarily surrendered for destruction. Five hundred and fifty-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:— 9 stone of plaice. 21 lbs. smoked fish fillets. 2 boxes of Pears (342). 1 beast's mesentery. 1 tin of ham (11 lb. 6 ozs.) 4½ lbs. ham (in cut). Bakehouses. The number of bakehouses on the register at the end of the year was 15, four of these being underground. Frequent inspection of the bakehouses have been made during the year. 38 Dairies, Cowsheds and Milkshops. There are three cow-keepers and 24 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. Factory and Workshops Acts, 1901 and 1907. The total number of Factories, Workshops and Workplaces on the register is 170. The businesses carried on at the respective premises are as follows:— Bakehouses 15 Dressmakers and Milliners 18 Tailors 9 Bootmakers 3 Laundries 4 Builders' workshops 4 Restaurant kitchens 96 Motor engineers 2 Shoeing forges 2 Wig making 2 Coach building 1 Furriers 2 Other trades 12 170 39 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 9 Walls, floors, gutters and roofs repaired 12 Sanitary accommodation Insufficient — Not separate for sexes — Unsuitable or defective 18 Foul sanitary conveniences 7 Accumulations removed 1 Other nuisances and defects remedied 20 Defective dustbins 16 83 Stable Premises. There are 33 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. Thirty-seven complaints were received, and in twenty-six instances "preliminary" intimations have been served upon the owners and occupiers of premises to eradiate "rodents" and render the premises rat proof. School Sanitation. A routine sanitary survey of all the twelve elementary 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 now in the Borough containing the latrine or trough type of closets, all the others having been altered and 40 brought up-to-date. The attention of the Manager of the Ham Schools has been called to the need for modernising the sanitary fittings of the school and the matter is now under the special notice of the Health Committee and the Education Authority. PETROLEUM ACTS, 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 268 Number of applications for licences during the year 69 Number of new licences granted and issued during the year 9 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 (53). Storage capacity 81,920 gallons. Stores for 2-gallon metal cans either in brick or metal bins (15). Storage capacity 1,610 gallons. Stores for Butyl Acetate in 10-gallon drums (1). Storage capacity 100 gallons. Amount of fees collected in respect of the licences issued during the year:—£42 10s. 0d. 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 manufactured, used or sold. 41 Housing Statistics for the Year, 1936. Number of new houses erected during the year:— (a) Total (including numbers given separately) under (b) houses, 174 flats, 121 (1) By the Local Authority house 92 (2) By other Local Authorities Nil (3) By other bodies and persons houses, 82 flats, 121 (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 houses 4 (c) For other purposes Nil (d) For the purposes of Housing Act, 1930 houses 88 (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) 861 (b) Number of Inspections made for the purpose 890 (2) (a) Number of dwelling-houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulation, 1925 561 (b) Number of Inspections made for the purpose 590 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 42 (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 860 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 826 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 rendered fit after service of formal notice:— (a) By owners 2 (b) By Local Authority in default of owners 2 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 21 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 21 (b) By Local Authority in default of owners — 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 43 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.— Proceedings under Section 20 of the Housing Act, 1930:— (l) Number of separate tenements of underground rooms in respect of which Closing Orders were made 5 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 2 4. Housing Act, 1935—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 121 (ii) Number of families dwelling therein 121 (iii) Number of persons dwelling therein 770 (b) Number of new cases of crowding reported during the year Nil. (c) (i) Number of cases of overcrowding relieved during the year Nil. (ii) Number of persons concerned in such cases Nil. (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil. 44 (e) Any other particulars with respect See to overcrowding conditions upon special which the Medical Officer of Housing Health may consider it desirable Section to report Report. Number of cases of overcrowding in houses owned by Corporation which have been relieved during year Nil. Number of cases of overcrowding which have been relieved in the course of Slum Clearance operations Nil. 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 seventy-six complaints were received with reference to the following matters, viz.:— Defective drains and sanitary fittings 63 Defective water storage tanks and fittings 5 Absence of, or defective dustbins 89 Insanitary condition of houses 6 Insanitary condition of passageways, etc. 1 Nuisance from dampness 44 Nuisance from general defects, etc. 73 Nuisance from keeping of animals 11 Nuisance from rats and mice 37 Smoke nuisances 11 Nuisances from overcrowding — Verminous premises 47 Accumulation of refuse or manure 19 Miscellaneous 70 45 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. HOUSING The year 1936 was marked by a great advance in the crusade for Slum Clearance and better housing conditions. The Second Slum Clearance Scheme involving the demolition of 121 houses and the re-housing of 453 persons was completed and the families re-housed on the new Housing Estate at Ham. The work of transferring all the tenants from their condemned dwellings to the new Housing Estate was carried out most successfully. The houses provided at Ham consisted of—8 A.2 type, 74 A.3 and 10 A.4, making a total of 92 houses. Many of the tenants after settling down in their new surroundings expressed great satisfaction at the change in their new mode of living under such improved surroundings. The erection of 28 flats consisting of 12 A.2 and 16 A.3 type was commenced under the 1925 Act, on the Crofton Terrace "Clearance" Area. Some of these flats are expected to be ready for occupation about July and all should be occupied before the end of the present year. Housing Act, 1935 Overcrowding Survey. The Overcrowding Survey required by Section 1 of the Housing Act, 1935, was commenced on the 19th December, 1935, find completed on the 14th March, 1936. A detailed report on the 46 Survey was submitted to the Health Committee on the 20th March, 1936. The Survey was carried out strictly in accordance with the provisions of the Ministry of Health's Memorandum B. in which a dwelling house is defined as any premises used as a separate dwelling by persons of the working classes, or of a type suitable for such use. It therefore includes any part of a building which is used, or is capable of being used, by persons of the working classes. The part of a house occupied by a sub-tenant is, therefore a separate dwelling for the purposes of the Overcrowding Provisions. In Richmond many houses in the better residential parts of the Borough, formerly occupied by one family, have during recent years been sub-let or occupied by working class families as tenements, or as basement dwellings, and some difficulty was experienced in order to ascertain which premises or parts of such premises were occupied by members of the working classes. Two separate surveys were made—first a preliminary house to house survey of all working class houses as required by Form A. If as a result of this survey, the house was deemed to be overcrowded according to the standard, then a second survey was made, as required by form B. which necessitated the measuring of all rooms normally used as living rooms or bedrooms. The total number of dwellings visited deemed to be occupied by persons of the working classes was 5,033, containing 5,973 separate families, representing a population of 20,037, which is slightly more than half the total population of the whole of the Borough. (Population at last Census was given as 39,276). The average number of persons per dwelling is 3.98 „ „ „ families „ „ „ 1.19 „ „ „ „ persons per family „ 3.35 47 The number of cases of overcrowding reported according to the standard fixed by the Minister is 110, or 1.84 per cent. distributed in the following wards:— North Sheen Ward 24 East „ 17 King's „ 15 Park „ 15 Selwyn „ 12 St. Luke's „ 11 Sudbrook „ 6 Central „ 5 Town „ 3 Kew „ 2 Total 110 The total number of persons affected is 711 and Local Authorities providing housing accommodation for overcrowded persons, who are to be displaced, will be bound by the provisions of Section 37 of the 1930 Act as regards the number of persons who may be deemed to be properly accommodated in any replacement houses belonging to themselves. In addition to the 110 cases of overcrowding, there are 12 families which will become overcrowded before December, 1936, and a further 11 families which will become overcrowded during 1937/1938. All of these will have to be revisited when the appropriate review dates arrive. In considering the application of the Standard in relation to particular families it is to be noted "that apart from the number of persons who may occupy a house, there is an over-riding condition that the accommodation available for a particular family must be such that no two persons both of 10 years of age or over of opposite sexes, except persons living together as husband and wife, must sleep in the same room" (Section 2(1) (a)). The Survey revealed 48 cases of moral overcrowding viz, where persons of both sexes over 10 years of age were found to be sharing the same bedroom. 48 If this is to be remedied, the living rooms such as parlour or kitchen must be used for sleeping purposes to separate the sexes, and occupiers appear to loathe to adopt this course, but an improvement could be affected in each instance by the families "spreading out" or utilising all the rooms in the dwelling. The overcrowding standard which includes the living room or kitchen as air space in the dwelling is generally deemed to be an unsatisfactory one in as much as so many of these kitchens, owing to congestion of furniture and domestic arrangements, do not lend themselves to the use of this common day apartment as a sleeping place, and on hygienic grounds it would be an unsatisfactory arrangement. Many families in the Borough are on the border line of overcrowding, and will not utilise the kitchen or living room as a bedroom. For purposes of comparison and general interest, we have estimated that of the 523 families surveyed on Form B, if kitchens were excluded from the standard, the number of cases of overcrowding to be reported would be 264—or 154 in excess o) the present figure. It is interesting to note that of the 110 cases of overcrowding:— 1 family consisted of 13 persons. 1 „ „ 11 5 families „ 10 „ 12 „ „ 9 „ 19 „ „ 8 „ 19 „ „ 7 „ 20 „ „ 6 „ 12 „ „ 5 „ 10 „ „ 4 „ 8 „ „ 3 „ 3 „ „ 2 „ Total 110 families. 49 Of the 110 cases of overcrowding, 23 occurred in Corporation Dwellings, and 2 more will come up for review, before the end of 1936. These occurred as follows :— 1 family 4 rooms 11 persons 2 families 4 „ 10 „ 7 „ 4 „ 9 „ 5 „ 4 „ 8 „ 4 „ 4 „ 7 „ 2 „ 4 „ 6 „ 1 family 3 „ 4 „ 1 „ 1 „ 2 „ Five cases of overcrowding were reported in flats (private ownership) in Petersham Road property and six cases will come up for review during 1936/37. It is also interesting to note that of the 5,973 families visited :— 335 families were living in 1 room, and 19 were overcrowded. 485 „ ,, „ 2 rooms 24 „ 1,164 „ „ „ 3 ,, 27 „ 1,484 „ „ „4 „ 38 „ 2,112 „ „ „ 5 ,, 2 „ 393 „ „ „ 6 ,, and over. 5,973 families 110 overcrowded. The following Table gives further details of the overcrowding cases in wards and shows the location of those houses belonging to the Corporation found to be overcrowded. Careful records of all dwellings and families visited have been filed for future reference, 50 TABLE SHOWING DETAILS OF OVERCROWDING IN WARDS. WARD. No. of families overcrowded. No. of persons i n families. Average No. of persons per family. No. of rooms occupied by overcrowded families. Average No. of persons per room. Kew 2 11 5.50 4 2.75 St. Luke's 11 (4) 76 (37) 6.90 28 (14) 2.72 North Sheen 24 (8) 166 (58) 6.91 81 (31) 2.05 Selwyn 12 80 6.66 32 2.50 Town 3 11 3.66 6 1.83 Central 5 30 6.00 13 2.30 East 17 (9) 131 (80) 7.70 56 (36) 2.34 Park 15 85 5.66 37 2.30 King's 15 85 5.66 39 2.18 Sudbrook 6 (2) 36 (17) 6.00 16 (8) 2.25 110 (23) 711 (192) 6.46 312 (89) 2.28 Note.— Figures in brackets denote Corporation Houses found to be overcrowded. 51 Section 1 of the Act provides that unless a Local Authority are satisfied that the necessary accommodation, shown by their report, to be required for the abatement of overcrowding will be otherwise provided, the Local Authority must prepare and submit to the Minister proposals for providing such accommodation. The Council subsequently prepared a scheme for the re-housing of 104 overcrowded families. This was subsequently approved by the Minister. . The types of houses being erected are as follows: — A.3 18 A.3 L 18 B.4 L 30 A.4 36 B.5 2 Total 104 Since the completion of the survey and the preparation of the re-housing scheme, a number of families have vacated the overcrowded dwellings and found improved accommodation. The new houses are to be built on the Ham Estate and building works should be in operation before the autumn of 1937. Closure, of Unfit Underground Rooms- Further progress has been made during the year with regard to the practice of sub-letting basements or underground rooms to families for living or sleeping purposes, which constitutes another slum housing problem. Detailed inspections of these rooms or parts of dwellings reveal the most unhealthy conditions due to dampness, darkness and lack of adequate sanitary provisions. Under Section 20 of the Housing Act, 1930, action has been taken to close as a separate tenement, those underground rooms which by virtue of sub-section (1) of Section 18 of the principal Act, has been deemed to be unfit for human habitation. The following premises were reported during the year :— 3, Pyrland Road. 47, Sheen Road. 15, Onslow Road. 4, Park Hill, 52 " Redholme," The Hermitage. 17, Friars Stile Road. 35, Evelyn Road. 31, The Vineyard. 3, Marlborough Road. 9, Montague Road. 33, The Vineyard. la, Park Hill. Closing Orders were made in respect of five of these premises, undertakings being given by the owners that the premises would not be re-let until made fit for habitation. In the remaining six properties, undertakings were given that the premises would be voluntarily closed and not re-occupied until made fit to the satisfaction of the Local Authority. Reoontiitioning of dilapidated property. As a result of house to house inspections followed by intimations to the owners, the following premises were thoroughly reconditioned during the year :— Nos. 3, 5 and 7, Albany Road at a cost of (approx.) £180, and Nos. 11/21, Watcombe Cottages at a cost of £600. 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. 861 dwelling houses were inspected for housing defects (under the Public Health or Housing Acts, anD 53 561 of such dwellings were examined and particulars recorded under the Housing Regulations. PARTICULARS OF WORKING CLASS DWELLINGS OWNED BY THE COUNCIL. Note. A. indicates a non-parlour type dwelling. B. indicates a parlour type dwelling. The numbers 1, 2, 3, 4, indicate the number of bedrooms. Situation of Dwellings. Type. No. of Dwellings. Weekly rent inclusive of rates. Manor Grove (built 1895-96). Housing Act, 1890. Part 3 (No Subsidy). B. 4. 62 10 @ 12/7 1 @ 14/10 1 @ 12/10 10 @ 12/4 2 @ 15/1 4 @ 12/5 1 @ 16/6 21 @ 12/2 (1 with bathroom) 3 @ 13/11 4 @ 11/9 1 @ 14/2 (with bathroom) 2 @ 14/4 (with bathroom) 2 @ 12/- B. 2. 42 1 @ 9/10 3 @ 11/2 3 @ 12/11 (with bathroom) 15 @ 9/7 7 3@ 9/2 10 @ 9/11 2 @ 9/5 1 @ 10/2 54 Situation of Dwellings. Type No. of Dwellings. Weekly rent inclusive of rates. Manor Grove (built 1895-96). Housing Act, 1890. Part 3 (No Subsidy) — contd. B. 3. 18 1 @ 13/8 (with bathroom) 5 @ 11/- 6 @ 11/4 2 @ 13/- 3 @ 11/7 1 @ 11/3 A. 2 flats. 6 3 @ 8/10 3 @ 7/11 A. 1 flats. 6 3 @ 6/11 1 @ 6/8 2 @ 7/7 House and shop premises (No. 80). Shop, livingroom, parlour, scullery and 3 bedrooms. 1 @ 21/7 (tenant pays rates) North Sheen (built 1907-08). Housing Acts, 1890-1923. (No Subsidy). A. 3. 40 - 31 @ 11/7 1 @ 11/6 4 @ 12/7 3 @ 11/10 1 @ 12/4 Built 1924-25. Housing Acts, 1890-1923. (No Subsidy). B. 3. 7 7 @ 20/8 A. 3. 3 3 @ 16/4 Victoria Place (built 1908-09). Housing Acts, 1890-1923. (No Subsidy). A. 2. flats. 10 4 @ 10/11 4 @ 9/10 2 @ 10/1 10 2 @ 10/3 A. 2. flats. 7 @ 9/- 1 @ 9/3 55 Situation of Dwellings. Type. No. of Dwellings. Weekly rent inclusive of rates. King's Farm Estate (built B. 3. 35 35 @ 17/1 1927-29). Housing Act, 1924. (Special Conditions Subsidy). A. 3. 54 152 (a>, 14/7 t 2 @ 14/10 Selwyn Estate (built 1922). Housing Act, 1919. B. 4. 20 20 @ 23/9 B. 3. 62 62 @ 19/1 1 (Treasury & Council Subsidy). *B. 3. 4 4 @ 20/8 A. 3. 10 10 @ 17/6 A. 2. flats 38 38 @ 13/8 A. 2. flats 38 38 @ 13/6 * (These four houses are £6 Subsidy houses, Housing Act, 1923, built 1926. The remainder on the Selwyn Estate are Addison Scheme). Braddon Road, Richmond. A. 1. flats 6 6 @ 5/6 A. 4. 10 10 @ 10/6 Ham Estate— Cleves Road (built 1934). Housing Act, 1930. A. 2. 6 6 @ 6/5 A. 3. 20 20 @ 7/11 Mead Road (built 1930-31) Housing Act, 1924. A. 3. 50 27 @ 7/11 22 @ 11/8 1 @ 12/7 Back Lane (built 1934) Housing Act, 1930. A. 2. 4 4 @ 6/5 Built 1936. Housing Act, 1930 A. 2. 2 2 @ 7/5 A. 3. 2 1 @ 8/11 1 @ 12/10 Craig Road (built 1921-22). B. 3. Housing Act, 1930. 12 8 @ 17/2 2 @ 18/1 2 @ 17/- Lock Road (built 1921-22). B. 3. Housing Act, 1919. 6 1 @ 17/8 4 @ 17/2 1 @ 17/- Lovell Road (built 1934) Housing Act 1930. A. 3. 12 12 @ 7/11 Built 1936. Housing Act 1930. A. 3. 2 2 @ 8/11 56 Ham Estate—contd. Situation of Dwellings. Type. No. of Dwellings. Weekly rent inclusive of rates. Ashburnham Road (built 1936). Housing Act 1930. A. 2. 3 2 @ 7/5 1 @3 10/6 A. 3. 9 8 @ 8/11 1 @ 12/10 A. 4. 8 8 @ 11/- Mowbray Road (built 1936) Housing Act 1930. A. 2. 3 3 @ 7/5 A. 4. 1 1 @ 15/5 A. 3. 32 31 @ 8/11 1 @ 12/10 Sheridan Road (built 1936) Housing Act 1930. A. 4. 1 1 @11/- A. 3. 29 8 @ 12/10 121 @ 8/11 Marksbury Estate (built 1930-31). Chertsey Arterial Road Scheme A. 2. 32 - 1 @ 9/7 2 @ 12/7 1 @ 9/5 1 @ 12/8 10 @ 14/2 5 @ 10/7 1 @ 6/4 1 @ 7/7 1 @ 20/- 1 @ 5/1 1 @ 12/1 1 @ 10/11 1 @ 11/- 1 @ 9/5 1 @ 7/1 1 @ 14/1 1 @ 12/10 1 @ 4/7 57 Situation of Dwellings Type No. of Dwellings Weekly rent inclusive of rates. Marksbury Estate (built 1930-31). Chertsey Arterial Road Scheme—contd. A. 3. 50 13 @ 16/9 1 @ 11/2 4 @ 8/8 2 @ 13/8 5 @ 13/2 5 @ 10/8 2 @ 7/8 2 @ 6/5 3 @ 9/3 1 @ 6/8 2 @ 10/1 2 @ 12/8 1 @ 15/2 1 @ 10/- 1 @ 16/2 1 @ 11/8 1 @ 14/11 1 @ 9/5 1 @ 5/8 1 @ 4/8 B. 3. 26 2 @ 16/3 8 @ 18/8 1 @ 6/8 1 @ 7/2 1 @ 16/8 1 @ 10/8 1 @ 6/5 2 @ 12/8 1 @ 14/10 1 @ 11/8 1 @ 13/2 2 @ 14/5 1 @ 9/8 1 @ 8/8 1 @ 11/3 1 @ 10/3 58 Situation of Dwellings Type No. of Dwellings Weekly rent inclusive of rates. Marksbury Estate (built 1930-31). Cherlsey Arterial Road Scheme—conld. B. 4. 16 2 @ 12/9 1 @ 10/9 1 @ 18/9 1 @ 7/9 1 @ 6/6 1 @ 13/7 5 @ 20/7 1 @ 15/- 1 @ 15/9 1 @ 10/7 1 @ 16/9 I he variation in rental of the above is accounted for by the fact that persons who were displaced under the Chertsey Arterial Road Scheme were re-housed at the rental being paid for the demolished dwelling. Houses becoming vacant will be re-let at the following standard rentals : — A. 2. 14/2 A. 3 16/9 B. 3. 18/7 B. 4. 20/6 West Sheen Vale (built 1935) Housing Act 1930. A. 3. flats. 4 3@ 9/- 1@ 8/11 A. 2. flats. 12 l@ 7/4 1 @ 7/1 59 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. During the year, the Milk (Special Designations) Order, 1936 came into force. This takes the place of the Order of 1923 which designated four types of Milk (a) Certified, (b) Grade A. Tuberculin Tested, (c) Grade A., (d) Pasteurised. Under the new Order the designated milks are (a) Tuberculin Tested ; (b) Accredited ; (c) Pasteurised. Tuberculin tbsted milk is taken from specially tested herds, kept separate from other cattle and is sold in sealed bottles or containers. If bottled at the place of production the word Certified may be used after the description Tuberculin Tested Milk. This milk may be pasteurised and where it is so retailed the word Pasteurised must be added to the description on the label. The milk on bacteriological analysis shall satisfy a certain methylene blue reduction test and shall contain no coliform bacillus in one-hundredth of a millilitre. If pasteurised, the milk shall be found to contain not more than 30,000 bacteria per millilitre. Accredited Milk is milk from a registered herd, every cow of which is submitted to a Veterinary Surgeon's examination once in three months. Every sample of such milk shall satisfy a 60 certain methylene blue reduction test and shall be found to contain no coliform bacillus in one-hundredth of a millilitre. Pasteurised Milk is milk which has been retained at a temperature of not less than 145° Fahrenheit and not more than 150° Fahrenheit for at least 30 minutes, and be immediately cooled to a temperature of not more than 55° Fahrenheit. On a sample being taken after pasteurisation, the milk shall be found to contain not more than 100,000 bacteria per millilitre. Licences, other than supplementary licences, authorising the use of the special designations "Tuberculin Tested" and "Accredited "by producers are granted by County and County Borough Councils. All other licences under the Order may be granted by Councils of County Boroughs, Boroughs, Urban Districts and Rural Districts. The Borough Council have granted licences to sell Tuberculin Tested Milk to four firms in the Borough (comprising 10 premises) and Pasteurised Milk to six firms (comprising 19 premises). 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 1st 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. 61 During the year the slaughterhouse was visited on 84 occasions and 270 carcases inspected. The following articles were surrendered. 1 Beast's mesentery. Sale of Food and Drugs Aots (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 1936. SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st. 1936:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 44 ... 44 ... ... ... ... ... Cream 2 1 3 2 1 3 1 1 Meat 5 ... 5 ... ... ... ... ... Confectionery and Jam 1 3 4 1 ... 1 ... ... Cheese ... 4 4 ... ... ... ... ... Sausages 3 ... 3 ... ... ... ... ... Sausage Meat 1 ... 1 ... ... ... ... ... Other Articles 1 4 5 1 ... 1 1 1 Totals 57 12 69 4 1 5 2 2 62 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Notifiable Diseases during the year. Disease Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Paratyphoid Fever 1 I ... Meningococcal Meningitis 1 1 ... Diphtheria 17 17 ... Scarlet Fever 49 44 ... Puerperal Pyrexia 5 5 ... Pneumonia (Primary) 27 17 6 Influenzal Pneumonia 1 1 ... Erysipelas 15 11 ... Tuberculosis : ... (a) Respiratory (M). 20 12 8 (F.) 28 19 12 Total 48 31 20 (6) Non-Respiratory (M.)... 7 6 4 (F ) ... 4 4 1 Total ... 11 10 5 Diphtheria. During the year 17 cases of Diphtheria were notified as compared with 31 in 1935. The rate per 1,000 living was 0.41 as compared with a case rate of 1.39 in England and Wales. There were no deaths from the disease during the year. 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 £2 6s. 6d. 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, 63 Schick Test and Diphtheria Immunisation. As mentioned in last year's report, the Clinic for the above was instituted at the end of 1934. At first it was found necessary to have two sessions weekly, but at present, owihg to the smaller numbers attending, only one session weekly is held. All parents of school children were circularised and a good number responded. Now the circulars are sent to all parents whose children are entering school for the first time. In addition, notices are given to mothers attending the Welfare Centres in order that the children from one year to five years of age may have the benefit of immunisation if the parents so desire. The details of the year's work at this Clinic are shown in the following report by Dr. D. S. Murray :— DIPHTHERIA IMMUNISATION CLINIC. The attendance at the Diphtheria Immunisation Clinic for the year 1936 has been generally satisfactory, as the figures given in the table show. There has, however, been a falling off in the number of new cases and we have not yet quite reached the ideal position, which, as stated in the last report, requires at least 60% of the children in the district to be immune. The number of attendances at the clinic is relatively fewer than last year. This is due to the fact that children under five years are now being immunised without the first Schick test. Our experience in Richmond showed that among children of pre-school age there were practically none naturally immune, and having ascertained this fact it was possible to dispense with the Schick test. A further diminution in the number of attendances required has also been made possible by using a two injection instead of the three injection method, for the younger children. This has proved satisfactory both in the production of immunity and in freedom from reactions so long as it is confined to those under school age. 64 During the year special efforts have been made to complete the immunisation of all children whose names were on the register. Despite these efforts, since the clinic began in 1934, 123 children have failed to complete the course in addition to a number who have left the district and some who have failed to attend at all after filling up the application form. Of the 123 children who have failed to complete the course, nearly all have had the full course of injections and lack only the final Schick test, so that the larger proportion of them may be taken as being immune. There have been no cases of diphtheria during the year in children to whom certificates have been given. Since the end of the year we have begun to retest those children who were immunised two years ago. This is very important for the maintenance of immunity of the community, and the response of those notified to attend for this test has proved fairly satisfactory. Once again it is gratifying to note the large number of children who have attended the clinic, although no alarmist propaganda has been carried out in the district. Total number of children seen during the year 861 Total number of attendances during the year 3,110 Total number of children Schick tested 317 Total number of children naturally immune 50 Percentage of tested children found to be immune 15.8% Total number of certificates given 697 Number of children who failed to complete course (1934-1936) 123 Number of children who required additional injections for complete immunity 12 D. S. MURRAY, B.Sc., M.B., Ch.B, 65 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 12 115 127 Tuberculosis Sputum 8 66 74 20 181 201 Scarlet Fever. During 1936, 49 cases of this disease were notified and 44 were treated in hospital. The rate per 1,000 living was 1.28 as compared with a case rate of 2.53 in England and Wales. In 1935 there were 69 cases. There were no deaths from this disease. Puerperal Fever and Puerperal Pyrexia. During 1936 five cases of Puerperal Pyrexia and no cases of Puerperal Fever were notified. There were no 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. 66 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. Paratyyhoid Fever ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... 1 ... ... ... •• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria — ... 2 2 1 7 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever !2 1 2 31 4 3 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Primary) 1 1 2 2 ... ... 3 2 10 6 ... ... ... ... ... ... ... ... ... ... ... 5 1 Influenzal Pneumonia ... ... ... .. ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... 3 1 9 2 ... ... ... ... ... ... ... ... ... ... • • • • • • Puerperal Pyrexia ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis :— (a) Respiratory ... 1 ... ... ... 2 1 3 22 11 8 ... ... ... ... ... ... ... ... 2 6 5 7 ... (6) Non Respiratory ... 1 ... 1 ... 1 1 2 3 ... 2 ... ... 1 ... ... ... ... ... 2 ... ... 2 ... 67 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 (PhthSis). Forty-eight cases of this disease were notified during the year (21 males and 27 females). Of these 31 (12 males and 19 females) were removed to Hospital or Sanitorium. There were 43 cases notified in 1935. There were 20 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for fve deaths while 11 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespratory. M F M F M F M F 0 • • • • • • • • • • • • • • • • • • • • • • • • 1 • • • 1 2 • • • • • • • • • 1 • • • 5 1 2 1 1 • • • • • • • • • • • • 15 2 7 1 1 1 2 1 • • • 25 6 10 1 2 1 4 • • • 1 85 6 5 • • • • • • 3 2 • • • • • • 45 4 1 1 • • • 2 3 1 • • • 55 2 1 1 • • • 1 1 1 • • • 65 and upwards • • • • • • • • • • • • • • • • • • • • • • • • Totals ... 21 27 7 4 8 12 4 1 68 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. No cases were notified during the year.