RICH 6 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1937. richmond: j. h. broad and co., ltd., printers, 8, king street. BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH 1937. 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.) Consultants for cases of Puerperal Fever and for Difficult Labours— J. W." Bell, M.D., L.R.C.P., L.R.C.S. Arnold Walker, F.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 Institute, Sanitary Science Certificate and Meat and Food Inspectors' Certificate). Victor Edward Bauohan (Resigned October, 1937) (Certificate Royal Sanitary Institute, Sanitary Science Certificate, Meat and Food Inspectors' Certificate and Smoke Inspectors' Certificate). Frederick Binns Hartley (Appointed December, 1937) (Certificate Royal Sanitary Institute, Sanitary Science Certificate and Meat and Food Inspectors' Certificate). Ernest Sidney Power (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. (Resigned December, 1.937) New Health Visitors' Certificate, R.S.I. Miss V. Kusel, S.R.N. S.C.M. (Resigned June, 1937), New Health Visitors' Certificate. Miss E. D. Steuart, S.R.N., R.F.N., S.C.M. (Appointed July, 1937). Clerks— Miss D. K. Jbmmett. 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. July, 1938. 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, 1937. The Report is drawn up according to the directions contained in circular 1650 issued by the Ministry of Health in October, 1937 and is what is known as an Ordinary Report. The Birth Rate throughout England and Wales for 1937 is 14.9 while the rate in Richmond is only 10.2 per 1,000 of the population. The Death Rate for the Borough is 11.2 per 1,000 of the population, while this year's rate for England and Wales is 12.4. The Infantile Mortality Rate is 38 per 1,000 births, compared with 58 per 1,000 births in England and Wales. 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. 1 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 1937) 38,350 Number of inhabited houses (1937) 9,758 Rateable value £572,991 Sum represented by a Penny Rate £2,235 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 537. The Philanthropic Society has assisted the needy to the following extent:— £ s. d. To Monetary Grants, on petition, for surgical appliances, convalescent treatment, etc 95 0 0 Boots and Clothing 110 0 0 Relief in other forms 190 0 0 Convalescent Home, Hospital and Surgical Aid Letters purchased 50 0 0 Richmond Royal Hospital. The Secretary-Superintendent, Captain G. M. Eden, has kindly supplied the following information:— 1,632 In-Patients and 5,221 Out-Patients were treated at the Hospital during 1937. Those received from the Borough of Richmond were 481 In-Patients and 1,185 Out-Patients, 5 Extracts from Vital Statistics of the Year. total. m. f. Live Births (Legitimate) 365 202 163 „ ,, (Illegitimate) 24 13 11 Birth Rate per 1,000 of the estimated resident population .. 10.2 Stillbirths 13 4 9 Rate per 1,000 total (live and still births) 32.3 Deaths 501 235 266 Death Rate per 1,000 of the estimated resident population 11.2 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— deaths Rate per 1,000 total (live and still) births No. 29 Puerperal sepsis — 0.00 No. 30 Other puerperal causes 2 4.97 Total 2 4.97 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 38 Illegitimate infants per 1,000 illegitimate live births 42 Deaths from Cancer (all ages) 88 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under two years of age) 1 6 BIRTH RATE, DEATH RATE, AND ANALYSIS OP MORTALITY DURING THE YEAR 1937. (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. Diarrhœa and Enteritis (under two years). Total Deaths under one year. England and Wales 14 9 0 60 12.4 0.00 — 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 — 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 15.3 0.64 11.9 0.00 — 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London Administrative County 13.3 0 54 12.3 0.00 — 0.01 0 01 0.06 0.05 0.38 0.51 12.0 60 RICHMOND 10.2 0 34 11.2 0.00 — 0.00 0.00 0.00 0.00 0.47 0.81 0.03 38 Puerperal Sepsis. Others Total. The maternal mortality rates for England and Wales are as follows Per 1,000 Live Births 0.97 2.26 3.23 ,, ,, Total Births 0.94 2.17 3.11 The maternal mortality rates for Richmond are as follows per 1,000 Live Births 0.00 5.1 5.1 „ „ Total Births 0.00 4.97 4.97 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 1937 was 38,350. It is interesting to note that since the date of the Census the number of deaths each year has been greater than the number of births. Altogether in the seven years there have been 660 more deaths than births. There has been a considerable amount of building in Petersham and Ham (apart from the erection of Council Houses). This may have some effect on the figures as estimated. Births. There were 389 births during the year (215 males and 174 females). This gives a birth rate of 10-2 per 1,000 of the population as compared with a rate of 14.9 in England and Wales and 13.3 in London. There were 13 still births registered giving a rate of 0.34 per 1,000 of the population, as compared with 0.60 in England and Wales and 0.54 in London. Deaths. The number of deaths registered during the year was 501 (235 males and 266 females). In the list of deaths supplied weekly by the local Registrar there were 294 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 110 persons who normally resided in the Borough died elsewhere and are included in the total deaths. The number of deaths whicli occurred in Institutions in the Borough was 447, and the number of inquests held was 68, though all of these were not concerned with Richmond residents. 8 The 501 deaths give a crude death rate of 13.1 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. 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 country as a whole or with the mortality of any other local area. The corrected death rate obtained by the above is 11.2 as compared with 12.4 for England and Wales and 12.3 for London. The deaths occurred in persons of the following ages:— 15 under 1 year of age. 3 between 1 and 5 years of age. 4 „ 5 „ 15 „ 13 ,, 15 ,, 25 ,, 35 ,, 25 „ 45 „ 125 „ 45 „ 65 „ 197 „ 65 „ 80 „ 108 ,, over 80 ,, It will be noticed that no fewer than 305 persons died over the age of 65, i.e., more than half the total deaths, while 108 were deaths of people over 80 years of age. 9 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 6 ... ... ... 6 2 1 ... ... 9 3. Other defined diseases 1 ... ... ... 1 ... ... 3 1 5 7 1 ... ... 8 2 1 3 1 15 Infantile Mortality. This rate is calculated on the number of deaths of children under one year of age to 1,000 live births. In the year under review 15 children under one year of age died giving a rate of 38 per 1,000 births. This is very satisfactory and compares favourably with the rate for England and Wales, which is 58 per 1,000, and that of London, which is 60 per 1,000. It will be noticed that of the 15 deaths, there was one of an illegitimate child. The mortality rate of these children is always high and the 1 death referred to gives a mortality rate of 42 per 1,000 illegitimate births. Ten of the 15 deaths are known definitely to have occurred in the Borough. Pour deaths occurred in outside districts, while one of the deaths was that of a newly born child whose body was found in Richmond Park. It will be seen from the table that out of 15 deaths, seven occurred in the first week of life. 10 The neonatal deaths, i.e. deaths occurring in the first four weeks numbered 8 out of the total of 15. This gives a neonatal mortality of 20 per 1,000 births. Six of these deaths were due to Congenital Debility and Premature Birth. Seven of these 15 deaths occurred in hospital or nursing homes while inquests were held in three cases. Causes of Death. M. F. All Causes 235 266 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — — 6. Influenza 6 12 7. Encephalitis Lethargica — — 8. Cerebro-Spinal Fever — — 9. Tuberculosis of respiratory system 11 11 10. Other tuberculosis diseases 3 2 11. Syphilis — — 12. General paralysis of the insane, tabes dorsalis 1 — 13. Cancer, malignant disease 45 43 14. Diabetes 3 3 15. Cerebral hœmorrhage, etc. 5 10 16. Heart disease 58 50 17. Aneurysm 1 1 18. Other circulatory diseases 16 19 19. Bronchitis 9 9 20. Pneumonia (all forms) 13 10 21. Other respiratory diseases 4 4 22. Peptic Ulcer 1 2 23. Diarrhoea, etc. (under 2 years) 1 — 24. Appendicitis 3 2 25. Cirrhosis of liver 3 1 26. Other diseases of liver, etc. 1 1 11  M. F. 27. Other digestive diseases 3 6 28. Acute and chronic nephritis 4 12 29. Puerperal sepsis — — 30. Other puerperal causes — 2 31. Congenital debiliity, premature birth, malformations, etc. 4 6 32. Senility 8 16 33. Suicide 2 — 34. Other violence 11 18 35. Other defined diseases 19 26 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 230 examinations were made and a detailed list is shown on Page 56. Chemical and Bacteriological examinations are also made frequently of samples of Drinking Water taken from the various supplies in the Borough. These are undertaken by the Counties Public Health Laboratories (Drs. Beale and Suckling). 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 12 Local Government Act 1894 Public Health Acts Amendment Act (part of) 1907 Richmond (Surrey) Corporation Act 1937 The following is a list of the Bye-laws and 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 12 (2) Housing Act, 1935. 12. Bye-laws as to Fish Frying, 1920. 13. Bye-laws as to Tents, Vans, Sheds, etc., 1920. 14. Bye-laws as to Houses Let in Lodgings. (b) Ambulance Facilities. The 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 913 times and the mileage covered was 3,939.6. (c) Nursing in the Home. The local Queen's District Nursing Association through its 13 three nurses perform 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 435 and the number of visits paid was 8,733. The Nurse employed by the Kew and Kew Gardens Association attended 232 cases and paid 6,838 visits. Infectious Disease. The District Nurses referred to above will also attend cases of minor infectious illness such as measles if the necessity arises. 14 Clinics and Treatment Centres. Address. By whom provided. Minor Ailments Clinic Windham Road, Richmond. For Elementary School Children Education Committee. Dental Clinic Ditto Ditto. Ditto. Do. do. Ditto M. and C.W Committee. Eye Clinic Ditto (1 session per fortnight). Education Committee. Ante-Natal Clinic Ditto (1 session per week). M. and C.W. Committee. Diphtheria Immunisation Ditto Health Committee. Tonsils and Adenoids Richmond Royal Hospital. By arrangement with Education Committee. Ringworm (X-rays) Dr. D. B. I. Hallett, 2, Old Palace Terrace, Richmond. When required. Education Committee. Maternity and Child Welfare Treatment Richmond Royal Hospital. Once weekly By arrangement with M. & C. W. Committee. Tuberculosis Treatment 38, Sheen Rd., Richmond. Once weekly. County Council The Minor Ailment Clinic is held every morning, and during the year .750 children have made 3,625 attendances. The Eye Clinic is held once a fortnight by Mr. Blair, who prescribes glasses for those children requiring them. The glasses are obtained from a Richmond optician at a contract price: 182 children were treated during the year. The School Dental Clinic is held 11 times a fortnight, and 1,384 children were treated during the year. In December, 1934, a Clinic for Schick testing and Diphtheria 15 Immunisation was begun and Dr. Murray, the Pathologist of the Royal Hospital, Richmond, was appointed to do the actual immunising. Hospitals. The South Middlesex and Richmond Joint Hospital Board has been established to provide hospital accommodation for Infectious Diseases occurring in Richmond, Heston and Isleworth and the enlarged Borough of Twickenham. The Hospital, formerly known as Mogden Hospital, has been greatly enlarged, brought up to date, and is now known as the South Middlesex Fever Hospital. 1. 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. 5. Other Hospitals. The Royal Hospital, Richmond, is a General Hospital and provides for Medical, Surgical, Ophthalmic and Dental cases from Richmond and the neigbouring towns and districts in the Thames Valley. The Grove Road Infirmary, formerly under the Guardians is now under the control of the Surrey County Council. 16 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Scarlet Fever 53 Diphtheria 19 Other Diseases 8 Total 80 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. 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 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. During the year the attendances at the Centres were:— Windham Road. Mothers 4,368 Average per session 26 Children 8,584 „ „ „ 51 The Medical Officer of Health held 1,728 consultations during the year at the Baby Clinics. Dr. Cryer held 462 consultations at the Toddlers' Clinics. 17 Trefoil House, Petersham, Mothers 730 Average per session 15 Children 1,132 „ „ „ 23 Dr. Cryer, the Medical Officer, held 708 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, 392 first visits were made and 2,105 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 1937 are:— Number attended, 108. Total attendances, 442. 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. Midwives Act. Under this Act the Local Supervising Authority for Midwives (in the case of this Borough, the Surrey County Council) has appointed salaried midwives in all parts of the County. It was decided that Richmond required two salaried midwives and arrangements were made with the District Nursing Association whereby one of their nurses should become a salaried midwife, while at the same time one of the midwives practising in the Borough was also appointed, to work under the directions of the District Nursing Association. 18 Maternal Mortality. The Maternal Mortality rate is calculated on the number of Births in the area. During 1937 there were no deaths from Puerperal Sepsis giving a mortality rate for this disease of 0.00 per 1,000 births, as compared with a rate of 0:94 per 1,000 births in England and Wales. There were two deaths in the Borough from other puerperal causes and the mortality rate for all deaths after confinement was 4.97 per 1,000 births, as compared with 3.23 in England and Wales. Dental Clinic. Arrangements have been made for Dental work in connection with the Maternity and Child Welfare Centre. Anæsthetics are given by the Medical Officer of Health and artificial dentures supplied at prices similar to those charged in connection with the National Health Insurance Scheme. The Council has 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 1937, 40 sessions have been held, including 23 for the administration of anaesthetics. One hundred and twenty-four patients were treated and made 402 attendances. The work was done as follows:— Extractions of permanent teeth 218 „ temporary ,, 242 Pilling of permanent teeth 25 ,, temporary teeth 16 Other operations chiefly in connection with provision of dentures 109 19 Dentures supplied 9 Number of anaesthetics given 146 (it) 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. Three trained nurses with certificates of the Central Midwives Board act as Health Visitors (half time). They also do the work of School Nurses (iv) Child Life Protection. Public Health Act, 1936. The above Health Visitors have been appointed Child Protection Visitors under Section 209 of the above Act. All persons taking children for gain have to be registered and their homes are visited by the Child Protection Visitors. Children up to nine years of age come under this Act, but the nurses of course pay more visits to children under School age. 267 visits were paid to Foster Children during 1937. 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. 20 The number of Homes in the Borough during the year was 8 of which 6 take Maternity Cases. Inspections have been made and no contraventions of the Bye-laws have been found. Sanitary Circumstances of Area. Water. Owing to recent events I prepared a report on the water supply of the Borough for presentation to the Health and Water Committees. Although this was written at the beginning of the present year, it is convenient to incorporate it in this Annual Report for 1937. Public Health Department, Parkshot, Richmond, Surrey. January 18th, 1938. To the Chairman and Members of the Health Committee. Ladies and Gentlemen, Recent events have focussed the attention of the Public on Water Supplies and 1 think that it is likely that, in the near future the Ministry of Health will issue some information and possibly instructions. It seems opportune, therefore, to set out a statement as to the supply in this Borough and the conditions under which it is maintained. With the exception of a comparatively small amount obtained from the Metropolitan Water Board, the supply in this Borough is obtained from one deep well in the chalk (at the Terrace Gardens) 21 and from six shallow wells (in gravel and sand) two at the Old Deer Park, two at Petersham and two at Ham. The water from the deep well, Old Deer Park and Petersham Wells is pumped to a low level reservoir at Petersham where it is mixed before distribution. If flooding occurs, as occasionally happens, the wells in the flooded area are shut down for a time. Samples are taken frequently for analysis, generally after the water has been treated (i.e. as it is supplied to the Public) but occasionally—for purposes of comparison—before treatment. Routine samples are taken monthly and other samples taken when it is considered necessary, for instance, after flooding. Bacteriological examinations are made more frequently than chemical analyses for it is the presence or absence of certain bacteria which indicates pollution. The Bacteriologists ascertain and report on, among other things, the absence or presence of certain excretal organisms in varying quantities of water. Almost invariably the reports on the Richmond Water before it has been treated are very good. No Bacillus Coli in 100 cubic centimetres and no other excretal organisms. Occasionally a sample has been taken which, before treatment, has been found to contain Bacillus Coli in 100 cubic centimetres, but none in 50 cubic centimetres or less. No other excretal bacteria have ever been found in any reports with which I have had to deal. Bacillus Coli is very wide spread. It is found in all rivers and in excreta of animals as well as in that of man. The presence of such bacteria might be due to accidental contamination of the vessel in which the water is placed at the time of collection. 22 Savage, an authority on the examination of water supplies, says:— "A working standard—that the finding of excretal Bacillus Coli in 10 c.c. or less points to undesirable pollution—is both justifiable and in accordance with actual experience. With Bacillus Coli present in smaller amounts—e.g. 1 c.c. or less—the water can be safely condemned as unsuitable for drinlsing purposes. If no B. coli are present in 50 c.c. the water may probably be safely passed as satisfactory as far as conditions actually present are concerned." In "The Examination of Water Supplies" by Drs. Thresh and Beale, it is stated:— "Where a public supply usually conforms to the high standard given, even if Bacillus Coli is found in 100 c.c. and is absent in 50 c.c., it may be considered as satisfactory; if found in a much smaller quantity—say in 10 c.c.—then further investigation is necessary.'' The Analyses of the Richmond Water before treatment have never shown Bacillus Coli in 10 ex., nor even in 50 c.c. Treatment. Practically all waters, no matter from what source they are obtained, are liable to contamination and require some form of treatment. This may be (1) Storage, (2) Filtration, (3) Chlorination. Any two of these methods may be combined or all three methods used together. (1) Storage means the collecting of quantities of the water in large open reservoirs. The water is allowed to remain there for a considerable time permitting disease producing bacteria to die out. 23 (2) Filtration. The water is passed through beds of gravel and sand and this process removes impurities. Formerly filter beds were in use at Petersham, but as it was found that the water was not improved out was not in such good condition as before the filtration, it was decided to give up this method of treatment. (3) Chlorination. This method of treating the water is in use in connection with our water supply. It is used by many Water Authorities all over the country including the Metropolitan Water Board. It is not a new method, having been in use in some districts since 1910. During the War the system was introduced into the Army and water known to be seriously polluted was drunk by the troops after having been chlorinated by the addition of chlorinated lime (containing a percentage of free chlorine). In our Supply the Chlorine is introduced as a gas by means of special machines which work automatically. There are machines at one of the Petersham Wells, one of the Old Deer Park Wells and at both Ham Wells. The water from the first two of the above is mixed with the water from the other Petersham Well, the other Old Deer Park Well and the Deep Well. These machines are very reliable and can be set to give out a certain amount of Chlorine to any given quantity of water. They are examined at least twice every day and if one should fail to function, the other machine would be emitting enough chlorine to keep the water in a satisfactory condition. It is most unlikely that both machines would fail at the same time. In the event of a stoppage of a Chlorinating machine for some time, the pumping from that well is stopped. Only a small quantity of chlorine is required to be added to the water. At present, one part of chlorine is added to four 24 million parts of water. Even when only one part of chlorine was added to ten million parts of water, the reports from the analysts were very good, but it is thought better to use more than this quantity in order to ensure a safe supply at all times. Most of the analyses are made after the water has been chlorinated, i.e. as it is delivered to the public. The samples are taken either from the wells, mains or taps in a private house. I have never yet had a report on the chlorinated water which cast any doubt on the purity. The chemical analyses have been good and the Bacteriological examinations have always shown that there was no Bacillus Coli in 100 c.c. and no Bacillus Enteritidis in 100 c.c. This is a very high standard and the analyses can be considered very satisfactory. Workmen Employbd at the Works. No member of the staff employed at the Works has had Typhoid Fever. Workmen employed in the Wells are required to wear rubber boots, well washed before entering the wells. This is to prevent fouling of the well by the carrying in, for example, excreta on their ordinary boots. Other Precautions. Great care must always be taken when dealing with a public water supply and any activities likely to have an effect on the supply must be closely watched. Therefore, care has been taken at various times to control the sanitary arrangements of camps, etc. by insisting that special closets should be used and arrangements made to carry away from the ground slop water which might otherwise find its way into the soil. Owing to the special character of the Borough's water supply, such camps should not be encouraged. 25 Summary. (1) The water drawn from the Richmond Wells is of good quality even before it is treated. (2) After chlorination, which is used as a safeguard, analyses show that it is "a clear bright water of the highest degree of bacterial purity. It is a pure and wholesome water suitable for the purposes of a public supply" to use the words of the analysts. (3) Every precaution is taken by frequent inspection to ensure that the water supply will continue to be of the above good quality. I am, Ladies and Gentlemen, Your obedient Servant, C.S. BREBNER, Medical Officer of Health. 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. 26 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 in general throughout the Borough. 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: 72,860 Females: 41,338 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. 27 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 1937 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. Six Closing Orders in respect of unfit cottages were made and confirmed during the year. 695 houses were inspected for housing defects either under the Public Health or the Housing Acts. 16 "unfit" underground dwellings, which contravened the Housing Regulations, were specially reported during the year; 10 Closing Orders were made and 6 voluntary undertakings that the premises would be kept closed until made fit for human habitation were accepted. Details of the inspections made and improvements effected as a result of surveys are set out in the following summary. Inspections The total number of inspections made during the year was 7,507. On 720 of the premises visited nuisances to the number of 4,167 were discovered, and in dealing with the sanitary defects from which they arose 2421 "intimation" or "preliminary" notices and 48 statutory notices were served. The number of letters written with regard to the abatement of nuisances, etc., was 389. At the end of the year 2861 of the defects discovered had been abated, the work of remedying 1203 was in hand, and the 28 remaining 103 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 2,666 visits were paid to the respective premises. The number of inspections made under the Housing Acts and particulars recorded was 228, and the number of sanitary defects remedied and improvements made under this heading was 2928. The following list shows the number of routine inspections and visits made:— Inspections during 1937. Houses inspected (Housing Acts) 304 Premises visited (P.H. Acts) 1056 Re-visits to houses and other premises 1088 Miscellaneous visits 1076 Visits to works in progress 1578 „factories 16 „ workshops, bakehouses, etc. 147 „ outworkers' premises 15 „ workshops, tearooms, etc. 106 „ dairies, cowsheds and milkshops 70 „ icecream vendors 27 „ food stores 131 „ slaughterhouse 72 „ fried fish shops 17 „ greengrocers' premises 41 „ stables 51 „ piggeries 1 „ public conveniences 88 „ petrol stores 209 „ employment agencies 23 „ school premises 58 „re infectious diseases 65 Inspections after infectious diseases 70 Smoke observations 5 Special visits re Shop Acts 292 29 Visits re Destructive Insects and Pests Acts — Visits under Rats and Mice Destruction Act 197 Visits to Corporation Dwellings 563 Interviews re abatement of nuisances, etc. 141 Total visits made 7507 Rent Restriction Act. Two 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, a certificate in each case was granted. The Shops Acts, 1912/1936. In the previous Annual Report I called attention to the fact that the Shops Acts have been the subject of alteration and revision by the Government and as a result, the Shops Act of 1934 came 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 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, and 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. 30 Shop Acts—Inspections. No. of Shops on Register at end of year 777 „ Special visits made 292 „ New Additions to Register 5 „ changes of occupancy 8 Contraventions:— Lack of satisfactory washing accommodation 1 Lack of satisfactory heating 1 Half Holiday Notices not exhibited 4 Early Closing „ „ 1 Records of Hours of Young Persons (Form F.) not exhibited 5 Records of Overtime worked by Young Persons not exhibited (Form G.) 4 Abstract of Provisions of Shop Acts relating to Young Persons not exhibited (Form H.) 2 Provision of Seats for Female Assistants (Form K.) not exhibited 2 Serving of Customers after Closing Hours (warned) 14 Prosecutions (serving of Customers after Closing Hours, etc.) 7 31 Details of Prosecutions. Offence. Date Case Heard. Conviction Fine 1. Sale of newspaper and cigarettes on 1.6.37, contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.27 10/- 2. Sale of cigarettes on 1.6.37, contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.37 10/- 3. Sale of cigarettes on 1.6.37 contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.37 10/. 4. Sale of bacon, cheese and tea on 5.7.37, contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.37 £2 5. Sale of salmon, tea and cheese on 7.7.37, contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.37 10/- 6. Sale of bottle of pickles and salmon on 7.7.37, contrary to Shops (Hours of Closing) Act. 1928. 21.7.37 21.7.37 £3 7. Sale of apples on 7.7.37, contrary to Shops (Hours of Closing) Act, 1928. 21.7.37 21.7.37 10/- Smoke Abatement. Richmond being a residential district, contains no large works or factories. There are a few small factories hut these give little trouble of smoke nuisance. Five complaints of nuisance by smoke were received during the year. All of which were abated without recourse to legal proceedings. 32 Eradication of Bed Bugs. This problem, which has assumed one of considerable importance, 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 continued to carry 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 26 Other houses 45 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. 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. "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 33 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 has to be cleansed and purified under notice and supervision of departmental officers. No operation 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 ond 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. 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. 34 National Rat Week November 1st to 6th, 1937. 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 1st to the 6th. Prior to the commencement 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 householders 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—10,274. A second inspection was made when it was found that 8,072 or 78.6% 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. Five complaints of nuisance caused by rats were received from householders during Rat Week. The Public Health 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. 35 SANITARY IMPROVEMENTS. Water Supply. Drinking water cisterns repaired, cleansed or covered 20 Water fittings repaired or renewed 1 Taps provided direct from rising main 13 Water Closets. New pans fixed 38 Pans cleansed or repaired 21 Walls, roofs, etc., repaired 136 Flushing cisterns, repaired and renewed 34 Water supply re-instated or provided 1 Foul woodwork round closets removed 1 W.C.'s lighted and ventilated 3 Brickwork repaired and re-pointed 47 Seats repaired and renewed 30 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 37 Drainage. System re-constructed 49 Repaired or cleansed 103 Manholes repaired or new provided 47 Ventilating pipes repaired or renewed 37 Drains intercepted from sewer 14 Want of drainage 59 Sub-soil drainage renewed — Gullies renewed or provided 42 Gratings, dishing or curbing renewed 14 Fresh air inlets renewed 13 Dustbins. New provided 139 36 Yard Paving. Repaired 66 Newly paved 7 Sinks, etc. New provided 21 New waste pipes provided 63 Waste pipes repaired, trapped or ventilated 9 Insanitary wall surfaces around sinks cemented 5 Dampness. Roofs repaired 101 Gutters and downspouts repaired and renewed 111 Damp course fixed 53 External walls repaired and pointed 83 Pointing to reveals renewed 37 Floor cavities ventilated 7 Site of house concreted 61 Wall ventilators to floor cavities renewed 53 General Repairs. Walls and ceilings repaired 375 Floors repaired 145 Doors, windows, sills, etc., repaired 494 Door and window fastenings renewed 110 Windows made to open 2 Stoves repaired and renewed 156 Coppers repaired or renewed 38 Rooms cleansed and re-decorated 216 Verminous rooms cleansed 104 Passages and staircases cleansed 57 Sash cords renewed 123 Larders repaired 7 Outbuildings repaired or renewed 20 Coal cupboards repaired 52 37 Obstructive buildings removed 1 Staircases repaired 27 Accumulations of refuse removed 42 Rooms ventilated 48 Defective and smoky flues remedied 113 Dirty floors and bedding cleansed 51 Basement sleeping rooms unfit for use, closed 11 Rat infested premises (remedied) 45 Nuisances from the keeping of fowls, etc., remedied 3 Miscellaneous. Nuisances remedied 426 Stables. Manure accumulations removed 6 Manure receptacles provided or repaired 1 Stables repaired, cleansed, etc. 6 Yards repaved, cleansed, etc. 2 Urinals. Reconstructed and flushing apparatus provided 2 Repaired, etc. 9 Flushing tanks repaired — Dairies. Defective F.A.I. 1 Miscellaneous 1 Greengrocers' Premises. Accumulations removed 6 Yards repaved Other defects 6 Rat infested 1 38 Testing of Drains and Sanitary Fittings. Applications of smoke test 95 „ water test (new work) 69 „ chemical test 2 Drainage systems opened out for examination, on written complaint 14 Service of Notices. The following table shows the particulars of the notices served:— Informal Notices 421 Statutory or Formal Notices:— Sec. 94, Public Health Act, 1875 (To abate nuisances) 6 Sec. 41, Public Health Act, 1875 (To redrain premises) 8 Sec. 9, Housing Act, 1936 (To repair houses) 16 Sec. 36, Public Health Act, 1875 (To provide dustbin) 15 Sec. 46, Public Health Act, 1925 (To cleanse Verminous premises) 2 Sec. 287, Public Health Act, 1936 (To enter premises) 1 469 Number of interviews with Owners of Property, Builders, etc., re Sanitary Improvements 276 Defective Drainage. 29 drainage systems were completely reconstructed and 49 repaired under the supervision of this department. 19 drainage systems were opened out and examined under Section 41 of the Public Health Act, 1875. 39 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. Total cost of work. £ s. d. Single private drain and Nos. 27 & 29, Princes 71 13 9 branch drains. Road. Do. Nos. 48, 50 & 52, Sheen 16 0 9 Park. Do. 2/24, Cambrian Road. 14 8 11 (choked drainage system). Disinfection of Premises. Reason. Houses. Rooms. Bedding disinfected. Infectious Fevers 66 71 98 Tuberculosis 28 34 37 Other Diseases 15 27 8 109 132 143 Vermin 71 194 88 Meat and Food Inspection. The operation of the Public Health (Meat) Regulations, which came into force in April, 1925, necessitates continuous activity by the staff in the inspection and supervision of meat and food supplies throughtout the district. 40 Slaughterhouses. There is one "registered" slaughterhouse only and this is situated at Ham. 72 visits of inspection were made during the year. The number of animals inspected after slaughter was as follows:— 6 calves 33 beasts 143 sheep and lambs 79 pigs The following articles found affected with disease were surrendered for destruction:— 1 pig's head (Tuberculosis) 2 beasts' heads and tongues (Tuberculosis) 1 set of ox lungs (Tuberculosis) 1 pig's liver (Cirrhosis) Four hundred and forty-two 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: — 6 stones of whiting 36 chickens 1 set of ox lungs 2 heifers' heads and tongues 1 pig's liver 1 pig's head Bakehouses. The number of bakehouses on the register at the end of the year was 15, four of these being underground. 41 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. 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 168. The businesses carried on at the respective premises are as follows:— Bakehouses 15 Dressmakers and Milliners 14 Tailors 11 Bootmakers 3 Laundries 3 Builders' workshops 4 Restaurant kitchens 97 Motor engineers 2 Shoeing forges 1 Wig making 2 42 Furniture and upholstery 5 Furriers 2 Other trades 9 168 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 30 Walls, floors, gutters and roofs repaired 7 Insufficient Not separate for sexes Sanitary accommodation Unsuitable or defective 9 Foul sanitary conveniences 8 Accumulations removed 8 Other nuisances and defects remedied 20 Defective dustbins 1 83 Stable Premises. There are 30 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. Fifty-one complaints were received, and in forty-five instances "preliminary" intimations have been served upon the owners and occupiers of premises to eradicate "rodents" and render the premises rat proof, 43 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 209 Number of applications for licences during the year 60 Number of new licences granted and issued during the year 5 Number of persons on the register licensed to keep Petroleum 57 The licences cover two different methods of storage, namely: — Bulk storage in underground tanks with pumps (52). Storage capacity 82,300 gallons. Stores for 2-gallonmetal cans either in brick or metal bins (12). Storage capacity 1,730 gallons. Stores for Butyl Acetate in 10-gallon drums (l) Storage capacity 100 gallons. Amount of fees collected in respect of the licences issued during the year:—£44 13s. 6d. The quantity of carbide of calcium which may be kept in licensed stores is 2,676 pounds. In December 1936, the Health Committee refused to renew the licence for the storage of 60 gallons of Petroleum spitit at the rear of No. 58, Kew Road. The applicant appealed to the Home Office against the refusal of the Council to renew the licence and an enquiry was held by an inspector from the Home Office at the Town Hall on the 19th of February, 1937. The Home Office upheld the Council and the licence was cancelled. 44 Rag Flock Acts, 1911-1928. There are no premises in the Borough on which rag flock is manufactured, used or sold. Housing Statistics for the Year, 1957. Number of new houses erected during the year:— (a) Total (including numbers given separately) under (b) houses, Nil flats, Nil (1) By the Local Authority 30 flats (2) By other Local Authorities Nil (3) By other bodies and persons houses, 76 flats, l42 (b) With State Assistance under the Housing Acts:— (1) By the Local Authority:— (a) For the purposes of Parts 2 & 3 of the Housing Act, 1936 30 flats (2) By other bodies or persons Nil 1. Inspection of Dwellinghouses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 695 (b) Number of Inspections made for the purpose 1360 (2) (a) Number of dwelling-houses (included under sub-head (l) above) which were inspected and recorded under the Housing Consolidated Regulation, 1925 228 (b) Number of Inspections made for the purpose 304 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 45 (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 689 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 641 3. Action under Statutory Powers during the year:— A. - Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 16 (2) Number of dwelling-houses which were rendered fit after service of formal notice:— (a) By owners 13 (b) By Local Authority in default of owners 3 B.— Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 32 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 27 (b) By Local Authority in default of owners 5 46 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made 4 (2) Number of dwelling-houses demolished in suance of Demolition Orders Nil D.—Proceeding under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 15 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 1 4. Housing Act, 1936 (Part IV.)—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 120 (ii) Number of families dwelling therein 122 (iii) Number of persons dwelling therein 815 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding lieved during the year 5 (ii) Number of persons concerned in such cases 30 (d) Particulars of any cases in which ing houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 47 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. Statutory Proceedings to Repair Unfit "Working Class" Dwellings. The owners having failed to comply with Statutory Notices to render fit for human habitation the undermentioned dwellinghouses occupied by members of the working classes, the Local Authority, after obtaining estimates, executed the necessary work and applied for the recovery of the costs in the manner provided by the Housing Statute:— 10, Clarence Road Cost of repairs £43 9 0 19, Alexandra Road „ „ £25 16 0 74, „ „ „ „ £28 17 0 Housing Act, 1936, Section 62. This Section, which requires Owners of Working Class Dwellings to have the "Permitted Number" of persons who may occupy the dwelling inscribed in the rent book, was found to have been con- travened in 30 instances and notices to rectify the omissions were complied with. 48 Complaints. Five hundred complaints were received with reference to the following matters, viz:— Defective drains and sanitary fittings 49 Defective water storage tanks and fittings 9 Absence of, or defective dustbins 156 Insanitary condition of houses 7 Insanitary condition of passageways, etc. 2 Nuisance from dampness 31 Nuisance from general defects, etc. 61 Nuisance from keeping of animals 4 Nuisance from rats and mice 51 Smoke Nuisances 9 Nuisances from overcrowding 3 Verminous premises 35 Accumulation of refuse or manure 13 Miscellaneous 70 Prompt investigations of complaints were made and suitable action taken where it was found necessary. Legal Proceedings to enforce compliance with a notice to abate a nuisance which occurred at an occupied dwelling house, resulted in the owner being fined 3/6 and an "Order" made for the abatement of the nuisance within one month. (Signed) George Laws, F.R.SAN.I., F.S.I.A., Chief Sanitary Inspector, and Officer under the Housing Acts. 49 HOUSING. Routine house-to-house inspections in accordance with the Housing and Public Health Acts have been systematically carried out during the year. The total number of dwelling houses inspected for all purposes was 695, of which 228 were recorded under the Housing Consolidated Regulations, 1925. Six dwelling houses were found to be in such a state as to be so dangerous or injurious to health as to be unfit for human habitation. These were represented to the Council as unfit for human habitation and incapable of being rendered so fit at reasonable expense. These were:— 1, 2 and 3, Oak Cottages, Ham. 7, Church Walk. Zion Cottage, Compass Hill. Toll Gate House, Upper Ham Road. Demolition Orders were subsequently made in respect of four of these premises, and undertakings were given as to the remaining two premises. In addition, part of a building let as a separate tenement, found to be unfit for human habitation and incapable of being rendered so fit at reasonable expense, was the subject of a Closing Order—(52, Church Road). During the year a report was presented dealing with the works necessary to recondition Nos. l/28, Mitchell's Row and l/27, Rosedale Road. The Local Authority acting on the reports submitted to them subsequently had several interviews with the trustees representing this Estate and subsequently plans were submitted showing the works necessary to recondition, together with structural alterations and additions to the building showing the provision of new sculleries and outbuildings, together with the sanitary services, the enlargement of the yards and open spaces at the rear and 50 the re-drainage of the premises. These plans received the approval of the Health Committee and the owners are now endeavouring to make arrangements for this work to be put into effect. The estimated cost of the work is approximately £5,000. Six new cases of overcrowding discovered during the year occurred in five houses. Two of these, which occurred in one house at 6, Jocelyn Road, were relieved by transferring the tenants to vacant Council Dwellings. Under Section 62 of the Housing Act, 1936, 40 certificates with information with regard to 294 houses were supplied to owners by the Health Department. 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 has regularly inspected all cattle in the District and has reported to the Health Committee each month. In future this duty will be undertaken by County Council Veterinary Inspectors. All Dairies and Cowsheds are frequently inspected. 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. There is only one slaughter house in the Borough and this is under constant supervision, 51 During the year the slaughterhouse was visited on 72 occasions and 261 carcases inspected. The following articles were surrended:— 1 Pig's head. 1 Pig's liver. 1 Beast's head and tongue. 1 Ox lung. 1 Heifer's head and tongue. Carcases Inspected and Condemned. Cattle, excluding Cows. Cows Calves. Sheep and Lambs. Pigs, Number killed (if known) 33 ... 6 143 79 Number inspected 33 ... 6 143 79 All Diseases except Tuberculosis. Whole carcases condemned ... ... ... ... ... Carcases of which some part or organ was condemned ... ... ... ... 1 Percentage of the number inspected affected with disease other than tuberculosis ... ... ... ... 1.3% Tuberculosis only. Whole carcases condemned ... ... ... ... ... Carcases of which some part or organ was condemned 3 ... ... ... 1 Percentage of the number inspected affected with tuberculosis 9.09% ... ... ... 1.3% 52 Sale of Food and Drug's Acts (1875 to 1807). (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 1937. SURREY COUNTY COUNCIL. SALE OP POOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1937:— Articles Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 54 1 55 2 ... 2 ... ... Butter ... 1 1 ... ... ... ... ... Meat 4 ... 4 ... ... ... ... ... Confectionery 2 ... 2 ... ... ... ... ... Cheese ... 1 1 ... ... ... ... ... Sausages 4 ... 4 ... ... ... ... ... Wine ... 1 1 ... ... ... ... ... Other Articles 8 6 14 2 1 3 1 1 Totals 72 10 82 4 1 5 1 1 53 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Notifiable Diseases during the year Disease. Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Malaria 2 ... ... Dysentery 1 ... ... Cerebrospinal Meningitis 1 1 ... Diphtheria 19 19 ... Scarlet Fever 59 57 ... Puerperal Pyrexia 5 5 ... Pneumonia (Primary) 26 12 5 Influenzal Pneumonia 3 ... ... Erysipelas 11 10 1 Tuberculosis: («) Respiratory (M). 27 19 11 (F.) 13 8 11 Total 40 27 22 (b) Non-Respiratory (M.) 8 5 3 (F ) 6 4 1 Total 14 9 4 Diphtheria. During the year 19 cases of Diphtheria were notified as compared with 17 in 1936. The rate per 1,000 living was 0.49 as compared with a case rate of 1.49 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 4s. 0d. 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 home. Schick Test and Diphtheria Immunisation. As mentioned in last year's report, the Clinic for the above was instituted at the end of 1934. 54 At first it was found necessary to have two sessions weekly, but at present, owing 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. Parents whose children were immunised two years ago have been asked to have them Schick tested again in order to see if they are still immune. The response has been good and the result very satisfactory, only one or two cases requiring a second immunisation. DIPHTHERIA IMMUNISATION CLINIC. The Diphtheria Immunisation Clinic is still held weekly but the numbers of School children now attending have naturally dropped. Comparatively few cases of Diphtheria have occurred during the year under review but whenever one has been notified the opportunity has been taken to circularise the parents of the children in the neighbourhood pointing out that a case has arisen and offering immunisation. In this way many children, whose parents ignored the matter previously, have been protected. Parents whose children were immunised two years ago have been asked to have them Schick tested again in order to see that they are still immune. The result has been most satisfactory, only one or two cases requiring a second immunisation. The following report is furnished me by Dr. D. S. Murray, who carries out the Schick testing and immunisation:— The attendance at the Diphtheria Immunisation Clinic for the year 1937 has been generally satisfactory, although the number of new cases seen has been smaller than in 1936. The most important 55 feature of the table is the results of the Schick tests carried out in children immunised two years ago. The proportion of those due for re-test who have attended is fairly high, and the number who remain immune after this period is very good indeed. Attention should be drawn to the small percentage of children who have been found to be naturally immune, as this indicates that the level of immunity in those children who have not been seen at the Clinic is so low that, for practical purposes, all children in the Borough who have not been artificially immunised can be regarded as susceptible. Further efforts are being made to bring the importance of immunisation to the notice of the parents of these children. There have been no cases of Diphtheria during the year in children to whom certificates have been given. One case occurred in a girl who had just completed the third injection, and another in a boy who was due for re-test. Neither case was seriously ill. Total number of children seen during the year 657 Total number of attendances during the year 1,643 Total number of children who received primary Schick test 161 Total number of children naturally immune 17 Percentage of children naturally immune 10.6 Total number of certificates given 155 Number of children who required additional injections for complete immunity 7 Number of children due for re-test after 2 years 528 Number retested after 2 years 395 Number of children who were still immune 386 Number of children who required further injections 9 Total number of certificates issued at the Clinic since 1934 1,626 D, S. MURRAY, B.Sc., M.B., Ch. B, 56 As previously mentioned, Bacteriological Examinations for Infectious Disease are carried out by the Pathologist at the Royal Hospital, Richmond. 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 17 129 146 Tuberculosis Sputum 11 73 84 28 202 230 Scarlet Fever. During 1937, 59 cases of this disease were notified and 57 were treated in hospital. The rate per 1,000 living was 1.54 as compared with a case rate of 2.33 in England and Wales. In 1936 there were 49 cases. There were no deaths from this disease. Puerperal Fever and Puerperal Pyrexia. During 1937 five cases of Puerperal Pyrexia and no cases of Puerperal Fever were notified. There were no deaths from Puerperal Sepsis. 57 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. 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. Malaria ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... 2 ... 1 14 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 1 2 3 3 33 5 3 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia (Primary) ... 2 ... l 1 4 1 ... 2 2 9 4 ... ... ... ... ... ... ... ... ... ... 3 1 Influenzal Pneumonia ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... 2 ... ... 5 4 ... ... ... ... ... ... ... ... ... ... ... 1 Puerperal Pyrexia ... ... ... ... ... ... ... 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis:— (a) Respiratory ... 1 ... ... ... ... ... 3 16 10 9 1 ... ... ... ... ... ... ... ... 9 5 6 2 (b) Non Respiratory ... 1 ... ... 1 1 3 2 4 ... 1 1 ... ... ... ... ... ... ... 1 1 ... 1 1 58 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 cases of this disease were notified during the year (27 males and 13 females). Of these 27 (19 males and 8 females) were removed to Hospital or Sanatorium. There were 48 cases notified in 1936. There were 22 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for four deaths while 14 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory Nonrespiratory. Respiratory NonRespiratory. M F M. F M F M F 0 ... ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... 5 ... ... 2 2 ... ... ... ... 15 7 2 3 1 ... 2 2 ... 25 8 3 1 1 4 3 ... ... 35 6 3 ... ... 2 3 ... ... 45 4 4 ... ... 2 3 ... ... 55 1 ... 1 ... 1 ... 1 ... 65 and upwards ... 1 ... 1 2 ... ... 1 Totals 27 13 8 6 11 11 3 1 59 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.