RICH 7 BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1938. RICHMOND: J. H. BROAD AND CO., LTD., PRINTBRS, 8, KING STRBET, BOROUGH OF RICHMOND (SURREY). ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1938. RICHMOND: J. H. BROAD AND CO., LTD., PRINTERS, 8, KING STRBET, 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.I. Barrister-at-Law. Ante-Natal Clinic and Child Welfare Centre, Petersham and Ham— Margaret E. Cryer, M.D. (Glas.) Consultants for cases of Puerperal Pyrexia 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.I., F.S.I.A. Certified Inspector of Meat and Other Foods; Inspector under Shops Acts. Assistant Sanitary Inspectors— Bernard Aisthorpe, M.R. San.I., M.S.I.A. (Certificate Royal Sanitary Institue. Sanitary Science Certificate and Meat and Food Inspectors' Certificate). Frederick Binns Hartley, M.R. San.I., M.S.I.A. (Certificate Royal Sanitary Institute, Sanitary Science Certificate, Meat and Food Inspectors' Certificate and Smoke Inspectors' Certificate). Ernest Sidney Power, M.R. San.I., M.S.I.A. (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 E. D. Steuart, S.R.N., R.F.N., S.C.M. New Health Visitors' Certificate. Miss A. Petersen, S.R.N., S.C.M. New Health Visitors' Certificate. Clerks— Miss D. K. Jemmett (Resigned July, 1938). Thos. L. Canton (Appointed August, 1938). Miss O. W. Ponsford. Miss M. J. Bird (Resigned April, 1938). Miss L. Higgin (Appointed June, 1938). Miss H. E. Iles. Drain Tester and Disinfector— J. Davis (part time). Veterinary Inspector— W. J. Hatton, M.R.C.V.S. (part time). (Resigned May, 1938). Contribution is made to Salaries of Officers marked thus * 3 Public Health Department, Parkshot, Richmond (Surrey). June, 1939. 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, 1938. The Report is drawn up according to the directions contained in circular 1728 issued by the Ministry of Health in October, 1938, and is what is known as an Ordinary Report. The Birth Rate throughout England and Wales for 1938 is 15.1 while the rate in Richmond is only 10.9 per 1,000 of the population. The Death Rate for the Borough is 10.7 per 1,000 of the population, while this year's rate for England and Wales is 11.6. The Infantile Mortality Rate is 55 per 1,000 births, compared with 53 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. I am, Ladies and Gentlemen, Your obedient Servant, C. S. BREBNER, Medical Officer of Health. 4 SECTION A. Statistics and Social Conditions of the Area. Area (in acres) 4,234 Population (census 1931) 37,791 Population (estimated 1938) 38,280 Number of inhabited houses (1938) 9,912 Rateable value £585,999 Sum represented by a Penny Rate £2,260 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 497. The Philanthropic Society has assisted the needy to the following extent:— £ s. d. To Monetary Grants, on petition, for surgical appliances, convalescent treatment, etc. 200 0 0 Boots and Clothing 120 0 0 Relief in other forms 220 0 0 Convalescent Home, Hospital and Surgical Aid Letters purchased 45 0 0 Richmond Royal Hospital. The Secretary-Superintendent, Captain G. M. Eden, has kindly supplied the following information:— 2,122 In-Patients and 6,040 Out-Patients were treated at the Hospital during 1938. Those received from the Borough of Richmond were 574 In-Patients and 1,242 Out-Patients. 5 Extracts from Vital Statistics of the Year. total. m. f. Live Births (Legitimate) 384 196 188 Live Births (Illegitimate) 32 24 8 Birth Rate per 1,000 of the estimated resident population 10.9 Stillbirths 12 8 4 Rate per 1,000 total (live and still births) 11.2 Deaths 483 239 244 Death Rate per 1,000 of the estimated resident population 10.7 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 4.67 Total 2 4.67 Death Rate of Infants under 1 year of age. All infants per 1,000 live births 55 Legitimate infants per 1,000 legitimate live births 47 Illegitimate infants per 1,000 illegitimate live births 156 Deaths from Cancer (all ages) 91 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under two years of age) 5 6 BIRTH RATE, DEATH RATE, AND ANALYSIS OP MORTALITY DURING THE YEAR 1938. (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. Stillbirths. All Causes. Typhoid and Paratyphoid Fevers Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales ... 15.1 0 60 11.6 0.00 — 0.04 0.01 0.03 0.07 0.11 5 5 53 126 County Boroughs and Great Towns, including London 15.0 0.65 11.7 0.00 — 0.05 0 01 0.03 0 07 0.10 7.8 57 148 Smaller Towns (Resident Population 25,000 to 50,000 at 1931 Census) 15.4 0.60 11.0 0.00 0 03 0.01 0.02 0.06 0.11 3.6 51 London Administrative County 13.4 0 48 11.4 0.00 — 0.06 0.01 0 03 0.05 0.06 13.1 57 RICHMOND 10.9 0 3! 10.7 0.00 — 0.00 0.00 0.00 0.00 0.13 12.0 55 The maternal mortality rates for England and Wales are as follows The maternal mortality rates for Richmond are as follows Puerperal Sepsis. Others. Total. (per 1,000 Live Births 0.89 2.19 3.08 ( ,, ,, Total Births 0.86 2.11 2 97 per 1,000 Live Births 0.00 4.8 4.8 ( ,, ,, Total Births 0 00 4.67 4.67 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 1938 was 38.280. Births. There were 416 births during the year (220 males and 196 females). This gives a birth rate of 10.9 per 1,000 of the population as compared with a rate of 15.1 in England and Wales and 13.4 in London. There were 12 still births registered giving a rate of 0.31 per 1,000 of the population, as compared with 0.60 in England and Wales and 0.48 in London. Deaths. The number of deaths registered during the year was 483 (239 males and 244 females). In the list of deaths supplied weekly by the local Registrar there were 261 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 87 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 401, and the number of inquests held was 62, though all of these were not concerned with Richmond residents. The 483 deaths give a crude death rate of 12.5 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. 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. 8 The corrected death rate obtained by the above is 10.7 as compared with 11.6 for England and Wales and 11.4 for London. The deaths occurred in persons of the following ages:— 23 under 1 year of age. 6 between 1 and 5 years of age. 5 „ 5 „ 15 „ 4 „ 15 „ 25 „ 44 „ 25 „ 45 „ 123 „ 45 „ 65 „ 193 „ 65 „ 80 „ 85 „ over 80 „ It will be noticed that no fewer than 278 persons died over the age of 65, i.e., more than half the total deaths, while 85 were deaths of people over 80 years of age. Causes of death under 1 year of age. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year 1. Pneumonia ... ... 1 ... 1 3 ... ... ... 4 2. Congenital Debility and Malformation including Premature Birth 8 2 ... ... 10 1 ... ... 1 12 3. Convulsions ... ... ... ... ... 1 1 ... ... 2 4. Enteritis ... ... ... ... ... 1 1 1 ... 3 5. Other defined diseases ... ... ... ... ... ... 1 1 ... 2 8 2 1 ... 11 6 3 2 1 23 Infantile Mortality. This rate is calculated on the number of deaths of children under one year of age to 1,000 live births. 9 In the year under review, 23 children under one year of age died, giving a rate of 55 per 1,000 births. The rate for England and Wales for 1938 is 53. Five of the 23 deaths were of illegitimate children, and these five deaths give a mortality rate of 156 per 1,000 illegitimate births. The mortality rate for 1938 is the largest for some time, but it must be remembered that one or two more deaths per annum make a considerable difference in the rate. Two sets of twins died within a few hours of birth, while altogether 8 of the deaths occurred during the first week of life. 13 of the deaths occurred in Institutions, and 2 in Nursing Homes, while one child was killed in a motor accident, and another found on the foreshore of the River Thames. The neonatal deaths, i.e., deaths occurring in the first four weeks numbered 11 out of the total of 23. This gives a neonatal mortality of 26 per 1,000 births. Twelve of these deaths were due to Congenital Debility and Premature Birth. M. F. All Causes 239 244 1. Typhoid and Paratyphoid Fevers — — 2. Measles — — 3. Scarlet Fever — — 4. Whooping Cough — — 5. Diphtheria — — 6. Influenza 5 — 7. Encephalitis Lethargica — 1 8. Cerebrospinal Fever 1 — 9. Tuberculosis of respiratory system 12 7 10. Other tuberculous diseases — 3 11. Syphilis 1 — 12. General paralysis of the insane, tabes dorsalis 2 1 13. Cancer, malignant disease 35 56 14. Diabetes 3 6 15. Cerebral hæmorrhage, etc. 11 15 10  M. F. 16. Heart disease 71 60 17. Aneurysm 1 1 18. Other circulatory diseases 20 25 19. Bronchitis 6 3 20. Pneumonia (all forms) 8 4 21. Other respiratory diseases 1 1 22. Peptic Ulcer 2 — 23. Diarrhoea, etc. (under 2 years) 4 1 24. Appendicitis 2 1 25. Cirrhosis of liver 1 1 26. Other diseases of liver, etc. 1 2 27. Other digestive diseases 6 8 28, Acute and chronic nephritis 4 8 29. Puerperal sepsis — — 30. Other puerperal causes — 2 31. Congenital debility, premature birth, malformations, etc. 9 3 32. Senility 2 7 3 3. Suicide 3 1 34. Other violence 11 13 35. Other defined diseases 17 14 36. Causes ill-defined or unknown — — SECTION B. General Provision of Health Services for the Area. (1) Public Health Officers of the Authority. A list showing the staff employed in the Public Health Department is on Page 2. (a) Laboratory Facilities. The Pathologist at the Royal Hospital, Richmond undertakes the Bacteriological examinations required by the Council. During the year 278 examinations were made and a detailed list is shown on Page 49. 11 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, Byelaws and Regulations. The following is a list of the Adoptive Acts in force in the district:— Infectious Disease Prevention Act (part of) 1890 Public Health Acts Amendment Act (part of) 1907 Private Street Works Act 1892 Public Libraries Act 1893 Local Government Act (part of) 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. Byelaws 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, 1936. 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. 12 (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 943 times and the mileage covered was 4,058.8. (c) Nursing in the Home. The local Queen's District Nursing Association through its three nurses performs excellent work in nursing patients in their own homes. The Kew and Kew Gardens District Nursing Association (with one nurse) performs a similar service in Kew and St. Luke's parishes. The Ham District Nursing Association also provides a nurse for the parish of Ham. The Richmond Council makes Grants towards the Queen's District and the Kew Nursing Associations and in return cases of illness in children under five years of age receive nursing assistance. During the year the total number of patients attended by the Richmond District Nurses was 484 and the number of visits paid was 10,328. The Nurse employed by the Kew and Kew Gardens Association attended 229 cases and paid 7,548 visits. Infectious Disease. The District Nurses referred to above will also attend cases of minor infectious illness such as measles if the necessity arises. 13 (d) Treatment Centres and Clinics. 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 701 children have made 2,805 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: 136 children were treated during the year. The School Dental Clinic is held 13 times a fortnight, and 1,235 children were treated during the year. In December, 1934, a Clinic for Schick testing and Diphtheria 14 Immunisation was begun and Dr. Murray, the Pathologist of the Royal Hospital, Richmond, was appointed to do the actual immunising. (e) 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 occuring in the Borough will be admitted to the Smallpox Hospital at Clandon. 2. 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. 3. 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. 4. 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. 15 SOUTH MIDDLESEX FEVER HOSPITAL. ADMISSIONS CLASSIFIED. Disease. No. of Patients Admitted from Richmond. Scarlet Fever 33 Diphtheria 21 Erysipelas 2 Measles 8 Chicken pox 1 Other Diseases 7 Total 72 MATERNITY AND CHILD WELFARE. (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 residents of Petersham and Ham. A Toddlers' Clmic, i.e., a separate clinic for children between 18 months and five years, is held 4 times a month at Windham Road. During the year the attendances at the Centres were:— Windham Road. Mothers 4,700 Average per session 32 Children 4,902 „ „ „ 33 The Medical Officer of Health held 1,531 consultations during the year at the Baby Clinics. Dr. Cryer held 729 consultations at the Toddlers' Clinics. Trefoil House, Petersham. Mothers 992 Average per session 51 Children 1,144 „ „ „ 24 Dr. Cryer, the Medical Officer, held 901 consultations during the year. 16 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, 423 first visits were made and 3,103 revisits. Ante-Natal Work. An Ante-Natal Clinic is held four times a month at which expectant mothers can attend and receive advice. The figures for the year 1938 are:— Number attended, 149. Total attendances, 677. 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 1938 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 0.89 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 4.67 per 1,000 births, as compared with 3.08 in England and Wales. The Council has made arrangements whereby a Medical Practitioner attending a maternity case can have the services of a Specialist if he finds it necessary. 17 The Council has also made arrangements with Queen Charlotte's Hospital (Isolation Block) into which Hospital cases of Puerperal Pyrexia occurring in the Borough can be received. Dental Clinic. Arrangements have been made for Dental work in connection with the Maternity and Child Welfare Centre. Anaesthetics are given by the Medical Officer of Health and artificial dentures supplied at prices similar to those charged in connection with the National Health Insurance Scheme. The Council has 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 1938, 43 sessions have been held, including 24 for the administration of anaesthetics. One hundred and seventy-five patients were treated and made 332 attendances. The work was done as follows:— Extractions of permanent teeth 175 „ temporary „ 282 Filling of permanent teeth 27 „ temporary teeth 10 Other operations chiefly in connection with provision of dentures 29 Dentures supplied 8 Number of anaesthetics given 124 (ii) 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. (iii) Child Life Protection. Public Health Act, 1936. The above Health Visitors have been appointed Child Protection Visitors under Section 209 of the above Act, 18 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. 292 visits were paid to Foster Children during 1938. Schools taking in Boarders under 9 years of age also come under this Act and are subject to inspection unless specially exempted. 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 numbers of Homes in the Borough during the year was 6, viz.:— General Medical and Maternity Cases 4 General Medical Cases 1 Maternity Cases only 1 Two persons in charge of nursing homes have been warned that they must strictly comply with the Bye-laws. SECTION C. Sanitary Circumstances of the Area. Water. The Borough receives its water from two sources (1) from Wells situated in the area and (2) from the Metropolitan Water Board. The local wells are of two kinds (1) a deep well in the chalk and (2) 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 19 practically sterile water, and one excellent for the purpose of a public supply. Drainage and Sewerage. 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 reconsruction 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. 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 Botough. Arrangements have recently been made to enlarge the Sewage Works, at the same time improving the plant. Treatment of Sewage. The present method of sewage disposal at the Works is that of precipitation, and through bacterial filter beds, the effluent passing into the Thames. 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 arc under the control of the Baths Superintendent, who has 20 supplied the following particulars:— No. of bathers during the year—Males: 69,702 Females: 40652. 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. 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 1938 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 strict attention throughout the year. 1,772 houses were inspected for housing defects either under the Public Health or the Housing Acts. 28 unfit underground dwellings, which contravened the Housing Regulations, were specially reported during the year; 7 Closing Orders were made and 7 voluntary undertakings that the premises would be kept closed until made fit for human habitation were accepted. 5 basements were made fit voluntarily by owners and in 9 cases action was deferred until 1939. Details of the inspections made and improvements effected as a result of surveys are set out in the following summary. Inspections. Routine house-to-house inspection s in accordance with the 21 Housing and Public Health Acts have been systematically carried out during the year. The total number of inspections made during the year was 9,702. On 992 of the premises visited nuisances to the number of 5,337 were discovered, and in dealing with the sanitary defects from which they arose 592 intimation or preliminary notices and 31 statutory notices were served. The number of letters written with regard to the abatement of nuisances etc., was 321. At the end of the year 2,409 of the defects discovered had been abated, the work of remedying 2,214 was in hand, and the remaining 754 were outstanding. In order to ascertain that the sanitary defects were being properly remedied 3579 visits were paid to the respective premises. The number of inspections made under the Housing Acts and particulars recorded was 468, and the number of sanitary defects remedied and improvements made under this heading was 3725. The following list shows the number of routine inspections and visits made:— Inspections during 1938. Houses inspected (Housing Acts) 507 Houses inspected (P.H. Acts) 1265 Re-visits to houses and other premises 1856 Miscellaneou3 visits 1606 Visits to works in progress 1723 „ factories 24 „ workshops, bakehouses, etc. 118 „ outworkers' premises 13 ,, restaurants, tearooms, etc. 111 „ dairies, cowsheds and milkshops 89 ,, ice cream vendors 74 „ food stores 85 „ slaughterhouse 83 „ fried fish shops 27 „ greengrocers' premises 41 ,, stables 73 22 Visits to piggeries 16 ,, public conveniences 117 „ petrol stores 200 „ employment agencies 38 „ school premises 20 „ re-infectious diseases 73 Inspections after infectious diseases 65 Smoke observations 4 Special visits re Shops Acts 472 Visits re Destructive Insects and Pests Acts 2 Visits under Rats and Mice Destruction Act 274 Visits to Corporation Dwellings 531 Interviews re abatement of nuisances, etc 196 Total visits made 9706 Rent Restriction Act. 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. Shops and Offices. The Public Health Department is responsible for the administration of Section 10 of the Shops Act 1934, which contains provisions as to sanitary and other arrangements for the health of the workers employed in, or about, shops and warehouses. Only one complaint was received during the year, this was with reference to the absence of heating and washing arrangements in a greengrocer's shop. Notice was served upon the occupier of the premises, who installed electrical heating and suitable washing facilities. In connection with Offices, no complaints were received by the Public Health Department during the year in relation to overcrowding, cleanliness, ventilation or closet accommodation 23 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 trader's 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. Shops Acts—Inspections. No. of Shops on Register at end of year 763 „ Special visits made 472 „ New Additions to Register 1 „ changes of occupancy 30 Contraventions:— Lack of satisfactory washing accommodation 1 Lack of satisfactory heating 1 Lack of satisfactory ventilation 1 Half Holiday Notices not exhibited 4 Early closing notices not exhibited 5 Records of Hours of Young Persons (Form F.) not exhibited 1 24 Abstract of Provisions of Shops Acts relating to Young Persons not exhibited (Form H.) 2 Provision of Seats for Female Assistants (Form K.) not exhibited 5 Serving of Customers after Closing Hours (warned) 2 Prosecutions (serving of Customers after Closing Hours, etc.) 9 Details of Prosecutions. Offence. Date Case Heard. Conviction Fine I. Sale of bottle of pickles and beans on 29.4.38 contrary to Shops (Hours of Closing) Act, 1928. 22.6.38 22.6.38 10/- 2. Sale of cigarettes on 23.8.38 contrary to Shops (Hours of of Closing) Act, 1928. 26.10.38 26.10.38 10/- 3. Employment of assistants after 1.30 p.m. on half holiday on 7.9.38 contrary to Section 1 of the Shops Act, 1912. 26.10.38 26.10.38 £1 4. Sale of cigarettes on 23.8.38 contrary to Shops (Hours of Closing) Act, 1928. 26.10.38 26.10.38 £1 5. Sale of bottle of pickles on 23.7.38 contrary to Shops (Hours of Closing) Act, 1928. 26.10.38 26.10.38 10/- 6. Sale of Ice Cream on 17.8.38 contrary to Shops (Hours of Closing) Act, 1928. 26.10.38 26.10.38 10/- 7. Sale of cigarettes on 8.10.38 contrary to Shops (Hours of Closing) Act, 1928. 30.11.38 30.11.38 10/- 8. Employment of assistant after 1.30 p.m. on half holiday on 31.8.38 contrary to Section 1 of the Shops Act, 1912. 30.11.38 30.11.38 30/- 9. Sale of cigarettes on 8.10.38 contrary to Shops (Hours of Closing) Act, 1928. 30.11.38 30.11.38 10/- 25 Exchange of toys and other articles for rags and old clothes. Section 154—Public Health Act, 1936 Legal proceedings authorised by the Council resulted in the conviction of a person who whilst engaged in collecting old clothes, delivered a goldfish in exchange for rags to a child under the age of fourteen years in contravention of the Public Health Act, 1936. The case was heard at the Richmond Petty Sessions Court on the 19th of October, 1938, and a fine of 10/- was imposed. The Council issued a notice in the local newspapers urging parents and other persons, in order to prevent the spread of vermin and contagious diseases, not to permit children to deliver rags, etc., to collectors of such articles in exchange for toys, goldfish and other articles. Camping Sites. There are no camping sites within the Borough. 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. Five complaints of nuisance by smoke were received during the year, all of which were abated without recourse to legal proceedings. Eradication of Bed Bugs. This problem which has assumed considerable importance has again 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 36 Other houses 31 26 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 eradiction 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 such as zaldecide, slatford and eradico. The methods found to be most successful have been the use of any of the above insecticides applied through powerful sprays, 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 one of the insecticides mentioned 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 zaldecide etc., 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. 27 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. 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 Week—November 7th to 12th, 1938. 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 7th to the 12th. 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—9,472. A second inspection was made when it was found that 7,383 or 77.9% of the baits laid down had been taken. 28 The baits consisted of Red Squill either in the form of Red Squill Biscuits 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 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. SANITARY IMPROVEMENTS. Water Supply. Drinking water cisterns repaired, cleansed or covered 24 Water fittings repaired or renewed 11 Taps provided direct from rising main 4 Water Closets. New pans fixed 36 Pans cleansed or repaired 18 Walls, roofs, etc., repaired 154 Flushing cisterns, repaired and renewed 50 Water supply re-instated or provided 1 Foul woodwork around closets removed 1 W.C.'s lighted and ventilated 10 Brickwork repaired and repointed 5 Seats repaired or renewed 32 Soil Pipes and Ventilating Pipes. Repaired, renewed or ventilated 50 Drainage. System re-constructed 44 Repaired or cleansed 97 29 Manholes repaired or new provided 48 Ventilating pipes repaired or renewed 50 Drains intercepted from sewer 10 Want of drainage 55 Sub-soil drainage renewed - Gullies renewed or provided 67 Gratings, dishing or curbing renewed - Fresh air inlets renewed 27 Dustbins. New provided 98 Yard Paving. Repaired 56 Newly paved 5 Sinks, etc. New provided 61 New waste pipes provided 101 Waste pipes repaired, trapped or ventilated 26 Insanitary wall surfaces around sinks cemented 4 Dampness. Roofs repaired 149 Gutters and downspouts repaired and renewed 126 Damp course fixed 108 External walls repaired and pointed 125 Pointing to reveals renewed 64 Floor cavities ventilated 17 Site of house concreted 31 Wall ventilators to floor cavities renewed 37 General Repairs. Walls and ceilings repaired 443 Floors repaired 143 Doors, windows, sills, etc., repaired 574 Door and window fastenings renewed 193 Windows made to open 6 30 Stoves repaired and renewed 179 Coppers repaired or renewed 28 Rooms cleansed and re-decorated 291 Verminous rooms cleansed 124 Passages and staircases cleansed 30 Sash cords renewed 182 Larders repaired 78 Outbuildings repaired or renewed 19 Coal cupboards repaired 40 Obstructive buildings removed 3 Staircases repaired 45 Accumulations of refuse removed 47 Rooms ventilated 100 Defective and smoky flues remedied 103 Dirty floors and bedding cleansed 48 Basement sleeping rooms unfit for use, closed 11 Rat infested premises (remedied) 65 Nuisances from the keeping of fowls, etc., remedied - Overcrowding. "Permitted" number not inserted in rent book 169 Name and address of M.O.H. and landlord not inserted in rent book 157 Overcrowding abated 1 Miscellaneous. Nuisances remedied 451 Stables. Manure accumulations removed 8 Manure receptacles provided or repaired 4 Stables repaired, cleansed, etc. 9 Yards repaved, cleansed, etc. 6 Urinals. Reconstructed and flushing apparatus provided - Repaired, etc. 7 Flushing tanks repaired 1 31 Dairies. Walls and ceilings cleansed 2 Greengrocers' Premises Floors, walls and ceilings cleansed 3 Floors, doors and windows repaired 2 Brickwork repaired 1 Other defects 8 Testing of Drains and Sanitary Fittings. Applications of smoke test 33 „ water test (new work) 110 „ chemical test 9 Drainage systems opened out for examination, on written complaint 2 Service of Notices. The following table shows the particulars of the notices served:— Informal Notices 592 Statutory or Formal Notices:— Sec. 93, Public Health Act, 1936 (To abate nuisances) 6 Sec. 9, Housing Act, 1936 (To repair houses) 9 Sec. 83, Public Health Act, 1936 (To cleanse verminous premises) 13 Sec. 45, Public Health Act, 1936 (To repair water closets) 3 623 Number of interviews with Owners of Property, Builders, etc., re Sanitary Improvements 196 Defective Drainage. 57 drainage systems were completely reconstructed and 44 32 repaired under the supervision of this department. 2 drainage systems were opened out and examined under Section 48. of the Public Health Act., 1936. They were found to be in a defective condition and to require alteration and amendment. Notices served upon the owners to reconstruct the defective systems were complied with. Disinfection of Premises. Reason. Houses. Rooms. Bedding Disinfected Infectious Fevers 62 64 94 Tuberculosis 19 29 20 Other Diseases 19 27 13 100 120 127 Vermin 67 135 132 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 throughout the district. Slaughterhouses. There is one registered slaughterhouse only and this is situated at Ham. 83 visits of inspection were made during the year. The number of animals inspected after slaughter was as follows:— 7 calves 26 beasts 125 sheep and lambs 60 pigs. 33 The following articles found affected with disease were surrendered for destruction:— 1 beast's liver (Tuberculosis) 2 beasts' livers (Distomatosis) 1 beast's liver (Fibrosis of Gland) 1 beast's lungs (Tuberculosis) 1 beast's kidney and skirt (Tuberculosis) 2 pigs' heads (Tuberculosis) 2 pigs' livers (Tuberculosis) 2 pigs' lungs (Tuberculosis) 2 pigs' mesenteris (Tuberculosis). Three hundred and eighty-two visits have been made to the Meat Shops or Stores and other premises where food is prepared or exposed for sale. The following article of unsound food was surrendered and condemned:— 7 lbs. Haddock. Bakehouses. The number of bakehouses on the register at the end of the year was 16, four of these being underground. Frequent inspections of the bakehouses have been made during the year. Dairies, Cowsheds and Milkshops. There are three cow-keepers and 35 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. From the 1st April, 1938, the veterinary functions under the Diseases of Animals Acts, 1894 to 1937 are discharged by Veterinary Inspectors appointed by the Minister of Agriculture and Fisheries. 34 Diseases of Animals Acts—Tuberculosis Order, 1938. Two cases of Tuberculosis in dairy cattle were reported by the Veterinary Officers of the Ministry of Agriculture and Fisheries on the 22nd June and the 28th September last. The animals were destroyed and the usual Notices for the cleansing and disinfecting of the cowsheds, etc., were carried out in accordance with the regulations pertaining thereto. Diseases of Animals Acts—Swine Fever Order, 1938. In consequence of information received from the Ministry of Agriculture and Fisheries on the 29th October and the 28th November last, it was found necessary to place two piggeries in the Ham area under "Movement Restriction" notice owing to suspected Swine Fever. After the Ministry of Agriculture and Fisheries Officers had made exhaustive enquiries, followed by post mortem examinations, the disease was not confirmed, and the Orders were cancelled after a period of 28 days. Factories Act, 1937. The above Act which repeals the Factory and Workshop Act, 1901, came into operation on the 1st July, 1938. The new Act consolidates the Act of 1901 and the various supplementary Acts passed between that date and 1929, and brings into one Statute the requirements that have hitherto been scattered in a number of different Acts. The Act of 1937 gives Local Authorities many new increased powers and duties but they share with H.M. Factory Inspectorate the enforcement of certain other requirements. The new Factories Act abolishes the distinction between a factory and a workshop. The expression "workshop" disappears and only one term "factory" is employed. For certain purposes a distinction is drawn in the Act between factories where mechanical power is used and factories where mechanical power is not used. The particular provisions of the Act which it is the duty of the Local Authority to enforce are with respect to cleanliness; overcrowding; temperature; ventilation; drainage of wet floors and sanitary accommodation in factories without mechanical power, 35 sanitary accommodation only in factories with mechanical power, and the certification of means of escape in case of fire at all factories. It is the statutory duty of the Council to keep a register of factories situated within their District with respect to which the Council is responsible for the enforcement of any provision by Part I of the Act. When the Factory Act came into operation, H.M. Inspector of Factories for the District (Miss Coombs) took an early opportunity of conferring with me on the new provisions and later supplied a list of all factories on the official register. I should like to acknowledge the assistance rendered by the Factory Inspector in putting into operation the provisions of the new Act. At the close of the year there were 188 factories on the register — (Mechanical 109 and Non-Mechanical 79). 253 inspections were made and 21 written Notices were served. It was not found necessary to institute legal proceedings in any case. The businesses carried on at the respective premises are as follows:— Factories (Mechanical). Accumulator Repairs 2 Boilers 1 Letter-press Printing 7 Engineering 3 Motor Engineering 21 Glue 1 Bakehouses 15 Sausages 2 Minced Meat, etc. 1 Upholstery 2 Jewellery 1 Bootmaking 9 Bottling 1 Wireless Repairs 2 Wheelwright 2 Carpet Cleaning 1 36 Wallpaper painting 1 Vulcanizers 1 Laundries Boats 1 Knitted Goods 1 Coffin making 1 Electricity 3 Electric signs and Sheet metal 1 Gramophone Records 1 Building 3 Gas Storage 1 Blacksmith 1 Saw Mills Dressmaking 1 Cabinet Making 1 Fire Appliances 1 Artificial Wreaths I Artificial Poppies 1 Milk Pasteurising 1 Clothes Pressing 1 Packing Iodine Seaweed 1 Joinery Electricity Repairs (Cookers) 1 Speedometers 1 Plating and Paint Spraying 1 Scrap Metal 1 Cellulose Spraying 1 Scientific Instruments 1 Wharf 1 Total 109 Factories (Non-Mechanical). Bakehouses 1 Dressmakers and Milliners 19 Tailors 11 Bootmakers 4 37 Laundries 2 Motor Engineers 7 Shoeing Forges 1 Wig Making 2 Furniture and Upholstery 3 Furriers 3 Fancy Needlework and Knitted Goods 2 Confectionery 1 Printing 1 Ironmongery and Joinery 3 Building 7 Clothes Pressing 2 Photography 1 Umbrella Repairs 1 Wireless Recording 2 Jewellery 1 Golf Club Repairs 1 Picture Frames 1 Boats 1 Blinds and Curtains 1 Wheelwright 1 Total 79 I - INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH Premises. Number of: Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 24 9 - Factories without mechanical power 118 3 — Other premises under the Act (including works of building and engineering construction, but not including outworkers' premises) 111 9 — Total 253 21 - 38 II.—DEFECTS FOUND. Particulars. Number of Defects: Number of Defects in respect of which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness (S.1) 49 49 — — Overcrowding (S.2.) — — — — Unreasonable Temperature (S.3.) — — — — Inadequate Ventilation (S.4.) — — — — Ineffective Drainage of Floors (S.6.) — — — — Sanitary Conveniences (S.7.): Insufficient — — — — Unsuitable or defective 19 19 — — Not separate for sexes — — — — Other offences 23 23 — — Total 91 91 — — Stable Premises. There are 35 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-two complaints were received, and in twenty-three instances preliminary intimations have been served upon the owners and occupiers of premises to eradicate rodents and render the premises rat proof. 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. 39 Total number of visits made during the year 200 Number of applications for licences during the year 62 Number of new licences granted and issued during the year 6 Number of persons on the register licensed to keep Petroleum 55 The licences cover two different methods of storage, namely:— Bulk storage in underground tanks with pumps (52). Storage capacity 84,920 gallons. Stores for 2 gallon metal cans either in brick or metal bins (14). Storage capacity 1,700 gallons. Amount of fees collected in respect of the licences issued during the year:—£43 17s. Od. 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. SECTION D. Housing Statistics for the Year, 1938. Number of new houses erected during the year:— (a) Total (including numbers given houses, Nil separately) under (b) flats, Nil (1) By the Local Authority Nil (2) By other Local Authorities Nil (3) By other bodies and persons houses, 70 flats, 40 (b) With State Assistance under the Housing Acts:— (1) By the Local Authority:— (a) For the purposes of Parts 2 and 3 of the Housing Act, 1936 Nil 40 (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) 1120 (b) Number of Inspections made for the purpose 1772 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 468 (b) Number of Inspections made for the purpose 507 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 1,112 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 1,094 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 8 (2) Number of dwelling-houses which were rendered fit after service of formal notice:— (a) By owners 8 (b) By Local Authority in default of owners Nil, 41 B.— Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 18 (b) By Local Authority in default of owners Nil. 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 Nil. (2) Number of dwelling-houses demolished in suance of Demolition Orders Nil. D.— Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 13 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 4 4. Housing Act, 1936 (Part IV.)—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 126 (ii) Number of families dwelling therein 129 (iii) Number of persons dwelling therein 862 (b) Number of new cases of overcrowding reported during the year 6 42 (c) (i) Number of cases of overcrowding lieved during the year 3 (ii) Number of persons concerned in such cases 27 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the Local Authority have take steps for the abatement of overcrowding Nil. Number of cases of overcrowding in houses owned by Corporation which have been relieved during year 1 Number of cases of overcrowding which have been relieved in the course of Slum Clearance operations Nil. The scheme for the erection of 104 new dwellings to re-house overcrowded families is almost completed and it is anticipated that re-housing will be finished during 1939. Under Section 62 of the Housing Act, 1936, 50 certificates with information regarding 246 houses were supplied to owners by the Public Health Department. Complaints. Five hundred and eight complaints were received with reference to the following matters, viz:— Defective drains and sanitary fittings 55 Defective water storage tanks and fittings 18 Absence of, or defective dustbins 63 Insanitary condition of houses ... 12 Insanitary condition of passageways, etc. 2 Nuisance from dampness 48 Nuisance from general defects, etc. 70 Nuisance from keeping of animals I Nuisance from rats and mice 52 Smoke Nuisances 5 Nuisances from overcrowding 1 Verminous premises 38 43 Accumulation of refuse or manure Offensive odours from sewers Cesspool Burning of refuse Insanitary stable Permitted Number not in rent book Unsound food Seating accommodation for female staff Hours of employment of staff Selling after hours Miscellaneous 17 1 1 7 1 19 1 1 4 1 90 (Signed) George Laws, f.r.san.i., f.s.i.a. Chief Sanitary Inspector, and Officer under the Housing Acts. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Agriculture Act, 1937: Transfer of Veterinary Services. The services of the Veterinary Inspector appointed by the Corporation were determined on the 31st May, 1938, in consequence of the transfer to the Ministry of Agriculture and Fisheries of the veterinary services of Local Authorities under the above Act. Notwitstanding this transfer Local Authorities still retained powers and duties (of a non-veterinary character) under the Diseases of Animals Acts, 1894 to 1937, and the Council therefore decided that the Chief Sanitary Inspector be appointed as Inspector (other than veterinary) of the Council as from the 31st May, 1938, for the execution and enforcement of the Diseases of Animals Acts and the Orders of the Ministry of Agriculture and Fisheries made thereunder. 44 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. 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 9 premises) and Pasteurised Milk to six firms (comprising 18 premises). They have also granted a Pasteurising Licence to one firm. Meat and Other Foods. There is only one slaughterhouse in the Borough and this is under constant supervision. During the year the slaughterhouse was visited on 83 occasions and 218 carcases inspected. The following articles were surrendered:— 4 Beasts' livers. 1 Beast's lungs. 1 Beast's kidney and skirt. 2 Pigs' livers. 2 Pigs' heads. 2 Pigs' lungs. 2 Pigs' mesenteries. 45 Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs, Number killed (if known) 26 ... 7 125 60 Number inspected 26 ... 7 125 60 All Diseases except Tuberculosis. Whole carcases condemned ... ... ... ... ... Carcases of which some part or organ was condemned 3 ... ... ... ... Percentage of the number in spected affected with disease other than tuberculosis 115% ... ... ... Tuberculosis only. Whole carcases condemned ... ... ... ... ... Carcases of which some part or organ was condemned . 3 ... ... ... 8 Percentage of the number inspected affected with tuberculosis 11.5% ... ... ... 13-3% Food and Drugs (Adulteration) Act, 1928. 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 1938. 46 SURREY COUNTY COUNCIL. SALE OF FOOD AND DRUGS ACTS. Particulars of samples taken in the Borough of Richmond during the year ended December 31st, 1938:— Articles. Analysed Adulterated or Deteriorated Prosecutions Convictions. Formal Informal Total Formal Informal Total Milk 41 ... 41 ... ... ... ... ... Cream 2 ... 2 ... ... ... ... ... Cheese ... 1 1 ... 1 1 ... ... Lard 1 1 2 ... ... ... ... ... Sugar 4 ... 4 3 ... 3 ... ... Jam ... 1 1 ... ... ... ... ... Other Articles 7 2 9 1 ... 1 ... ... Totals 55 5 60 4 1 5 ... ... SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases during the year. Disease. Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Smallpox ... ... ... Scarlet Fever 42 33 ... Diphtheria 23 21 ... Enteric Fever 1 ... ... Puerperal Pyrexia 12 9 ... Pneumonia 20 8 12 (all forms) Cerebrc-Spinal Fever 1 1 1 Ophthalmia Neonatorum 2 1 ... Erysipelas 6 2 ... Undulant Fever 1 ... ... Total 108 75 13 47 Diphtheria. During the year 23 cases of Diphtheria were notified as compared with 19 in 1937. The rate per 1,000 living was 0.60 as compared with a case rate of 1.58 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 £3 5s. 6d. DIPHTHERIA IMMUNISATION CLINIC. The Diphtheria Immunisation Clinic is still held weekly but the numbers of the 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 1938 has been generally satisfactory, although the number of new cases seen has been smaller than in 1937. One important change that has been made is that children under school age are now immunised without previous test. This cuts down the number of attendances and follows upon the figures given 48 last year which show that only 10 per cent, of the whole child population were naturally immune. In this year's table, given below, the naturally immune children are all of school age, hence the increase in the percentage. Taking this factor into consideration, it can be claimed that the number of children in the schools of Richmond, who are naturally or artificially immune, is now sufficiently high to guarantee freedom from a serious epidemic provided the rate of re-testing the older children and the immunisation of younger children of Richmond is maintained. During the year three cases of Diphtheria have occurred in children who had attended the Clinic, one of these became ill before the course of injections had been completed. Another occurred a year after a certificate had been given and was a very mild case; the other occurred two years after the certificate was issued, in a boy who had proved particularly difficult to immunise and had had eight injections in all. This case was also comparatively mild. Total number of children seen during the year 504 Total number of attendances 1687 Total number of children who received primary Schick test 204 Total number of children naturally immune 55 Percentage of children naturally immune 27% Number of certificates given 220 Number of children who required additional injections for complete immunity 7 Number of children due for re-test, after 2 years 370 Number re-tested after 2 years 281 Number of children who were still immune 278 Number of children who required further injections 3 Total number of certificates issued at the Clinic since 1934 1,902 D. S. Murray, B.Sc., M B., Ch.B. 49 The following Diphtheria Prophylactics are used for immunisation purposes:— TA.F. (Toxoid-Antitoxin Floccules) TA.M. (Toxoid-Antitoxin-Mixture) A.P.T. (Alum Precipitated Toxoid). Number of children immunised during the year. Total number of certificates given after immunisation. (a) Preschool children 65 (b) School children 220 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 14 188 202 Tuberculosis Sputa 8 61 69 Typhoid ... - 2 2 Other Diseases ... — 5 5 Total 22 256 278 Scarlet Fever. During 1938, 42 cases of this disease were notified and 32 were treated in hospital. The rate per 1,000 living was 1.09 as compared with a case rate of 2.41 in England and Wales. In 1937 there were 59 cases. There were no deaths from this disease. 50 Puerperal Pyrexia. During 1938 twelve cases of Puerperal Pyrexia were notified. There were no deaths from Puerperal Sepsis. Undulant Fever. One case of this disease was brought to the notice of the Department during the year, the patient being a man aged 43 years. An investigation revealed that the patient had contracted the disease whilst out of the Borough, and the matter was referred to the Medical Officer of Health of the Local Authority concerned. AGE DISTRIBUTION OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING 1938. Total Cases Notified. Total Deaths. Under 1 year 12 2-3 3-4 4—5 5-10 10-15 15 20 20—35 35—45 45—65 65 and over. Under 1 year i 1-2 2—3 3—4 4-5 5-10 10-15 15—20 20-35 35 45 45—65 65 and over. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... 4 3 16 6 3 7 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... 1 1 ... ... 14 4 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... 10 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 2 2 ... ... ... 4 ... 2 4 ... 2 2 ... ... ... ... ... ... ... ... 1 3 3 ... Cerebro-Spinal Fever ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Undulant Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 4 4 1 4 3 34 10 6 24 10 6 2 ... 1 ... ... ... ... ... ... 1 3 3 5 51 52 TUBERCULOSIS. It has not been necessary to take action under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 172 of the Public Health Act, 1936. Respiratory Tuberculosis (Phthisis). Forty-five cases of this disease were notified during the year (24 males and 21 females). Of these 41 (24 males and 17 females) were removed to Hospital or Sanatorium. There were 40 cases notified in 1937. There were 19 deaths from this disease during the year. Non-Respiratory Tuberculosis was responsible for three deaths while 11 cases were notified during the year. Tuberculosis. Age Periods. New Cases. Deaths. Respiratory NonRespiratory. Respiratory. NoRespiratory M F M F M F M F 0 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 5 ... ... 1 1 ... ... ... ... 15 3 5 3 2 ... 2 ... ... 25 6 7 1 1 3 1 ... 1 35 9 4 1 ... 3 1 ... ... 45 4 3 ... ... 4 4 ... ... 55 2 ... ... ... 1 ... ... ... 65 and upwards ... 2 ... ... ... ... ... ... Totals 24 21 6 5 11 8 ... 3